S114. THE EFFICACY OF “URGENT CONSULTATION REQUEST”; PRELIMINARY ANALYSIS OF A REAL-WORLD APP (REMIDCARE) FOR EARLY PSYCHOSIS

Abstract Background Patients are clamming for more personalized and closer clinical attention (Bonet et al. 2018). To this end, we developed RemindCare app. The app conducts daily and weekly assessments and this information is used to prevent relapses, to improve the therapeutic alliance and it is automatically included at the electronic clinical record of the hospital. Moreover, patients can contact clinicians by an “Urgent Consultation Request” (UCR), which is answered by a phone call in a period of 24-48h. This app was introduced in clinical practice in October 2018. Since then, 81 patients met criteria for inclusion and 57/81 (71%) started using the app. The aim of this study is to analyze the efficacy of this UCR to determine if this function can improve the real-world treatment of patients with early psychosis. Methods RemindCare app, is offered as an extra-service to the usual psychiatric care of patients in an Early Psychosis Program (EPP) at the Clinic Hospital of Valencia, Spain (Bonet et al. 2019). No remuneration is offered to any patient or clinician to use the app. Data of 57 patients diagnosed with a psychotic disorder was analyzed: the 26.3% (15/57) used the UCR (UCR group) and the 73.7% (42/57) did not (Non-UCR group). Mean age of the sample was 31.5 (SD=9.3), 56.1% were male, 87.7% caucasian and 82.5% were single. Mean years of illness was 3.5 (SD=2.8), CGI mean 4.1 (SD=0.9), GAF mean 60.5 (SD=12.3) and PANSS mean 56.6 (SD=12.2). Results Mean of months using the app was 8.4 (SD=4.5), 38.6% (22/57) of patients used the app for more than a year (12–13 months) and mean of engagement was 84.3 (SD=18.9). No significant differences were found between UCR and Non-UCR group in terms of demographic and clinical characteristics. However, there was a difference between groups in terms of engagement to the app (χ2= 6.3, p=0.04). The 93.3% of the UCR group had a percentage of engagement to the app between 81–100% compared to the 66.7% in the Non-UCR group and the number of visits to the Urgent Care Units (UCU) was also higher in the UCR group (χ2= 4.4, p=0.03). Additionally, only the 13.3% (2/15) of patients used the UCR for a psychotic symptom′s aggravation, the 33.3% (3/15) used it to inform of anxiety symptoms and another 33.3% (3/15) to change the clinical appointment. Moreover, the 66.7% (4/6) of patients who attended to UCU had previously made an UCR and they went to the UCU before that period of 24-48h of clinical response ended. Finally, there were no differences in terms of hospital admissions (χ2= 1.1, p=0.3) and psychotic relapses (χ2= 0.08, p=0.8) between groups. However, patients who stopped using the app had more relapses than patients who continued using it (χ2= 15.3, p<0.000). Discussion To our knowledge, this is the first e-Health intervention systematically introduced in clinical practice. Rates of acceptance and engagement are high (71%; 84.3%) and nearly 40% of the sample is using the app for more than a year. Mean of engagement with the app, was extremely high among patients who used the UCR (93.3%; engagement between 81–100%) and although this UCR service was the most required in our previous survey (Bonet et al. 2018), these preliminary results suggest ¡ that the use of this alarm is not related to psychotic relapse detection. However, patients who use RemindCare app had less relapses than the ones who discontinue its use, which highlights the efficacy of the app. This, along with the high engagement and the positive feedback received, suggests that an improvement in real-world treatment of patients with early psychosis may be found in upcoming analysis.

Download Full-text

ReMindCare App for Early Psychosis: Pragmatic Real World Intervention and Usability Study

JMIR mhealth and uhealth ◽

10.2196/22997 ◽

2020 ◽

Vol 8 (11) ◽

pp. e22997

Author(s):

Lucia Bonet ◽

John Torous ◽

David Arce ◽

Ignacio Blanquer ◽

Julio Sanjuan

Keyword(s):

Real World ◽

Hospital Admissions ◽

Early Psychosis ◽

Urgent Care ◽

First Episode ◽

Smartphone App ◽

Usability Study ◽

Treatment As Usual ◽

The Mean ◽

Ehealth Intervention

Background eHealth interventions are widely used in clinical trials and increasingly in care settings as well; however, their efficacy in real-world contexts remains unknown. ReMindCare is a smartphone app that has been systematically implemented in a first episode of psychosis program (FEPP) for patients with early psychosis since 2018. Objective The objective of this study was to assess the efficacy of ReMindCare after 19 months of use in the clinic and varying use by individual patients. Methods The integration of the ReMindCare app into the FEPP started in October 2018. Patients with early psychosis self-selected to the app (ReMindCare group) or treatment as usual (TAU group). The outcome variables considered were adherence to the intervention and number of relapses, hospital admissions, and visits to urgent care units. Data from 90 patients with early psychosis were analyzed: 59 in the ReMindCare group and 31 in the TAU group. The mean age of the sample was 32.8 (SD 9.4) years, 73% (66/90) were males, 91% (83/90) were White, and 81% (74/90) were single. Results Significant differences between the ReMindCare and TAU groups were found in the number of relapses, hospitalizations, and visits to urgent care units, with each showing benefits for the app. Only 20% (12/59) of patients from the ReMindCare group had a relapse, while 58% (18/31) of the TAU patients had one or more relapses (χ2=13.7, P=.001). Moreover, ReMindCare patients had fewer visits to urgent care units (χ2=7.4, P=.006) and fewer hospitalizations than TAU patients (χ2=4.6, P=.03). The mean of days using the app was 352.2 (SD 191.2; min/max: 18-594), and the mean of engagement was 84.5 (SD 16.04). Conclusions To our knowledge, this is the first eHealth intervention that has preliminarily proven its benefits in the real-world treatment of patients with early psychosis. International Registered Report Identifier (IRRID) RR2-10.1111/eip.12960

Download Full-text

ReMindCare App for Early Psychosis: Pragmatic Real World Intervention and Usability Study (Preprint)

10.2196/preprints.22997 ◽

2020 ◽

Author(s):

Lucia Bonet ◽

John Torous ◽

David Arce ◽

Ignacio Blanquer ◽

Julio Sanjuan

Keyword(s):

Real World ◽

Hospital Admissions ◽

Early Psychosis ◽

Urgent Care ◽

First Episode ◽

Smartphone App ◽

Usability Study ◽

Treatment As Usual ◽

The Mean ◽

Ehealth Intervention

BACKGROUND eHealth interventions are widely used in clinical trials and increasingly in care settings as well; however, their efficacy in real-world contexts remains unknown. ReMindCare is a smartphone app that has been systematically implemented in a first episode of psychosis program (FEPP) for patients with early psychosis since 2018. OBJECTIVE The objective of this study was to assess the efficacy of ReMindCare after 19 months of use in the clinic and varying use by individual patients. METHODS The integration of the ReMindCare app into the FEPP started in October 2018. Patients with early psychosis self-selected to the app (ReMindCare group) or treatment as usual (TAU group). The outcome variables considered were adherence to the intervention and number of relapses, hospital admissions, and visits to urgent care units. Data from 90 patients with early psychosis were analyzed: 59 in the ReMindCare group and 31 in the TAU group. The mean age of the sample was 32.8 (SD 9.4) years, 73% (66/90) were males, 91% (83/90) were White, and 81% (74/90) were single. RESULTS Significant differences between the ReMindCare and TAU groups were found in the number of relapses, hospitalizations, and visits to urgent care units, with each showing benefits for the app. Only 20% (12/59) of patients from the ReMindCare group had a relapse, while 58% (18/31) of the TAU patients had one or more relapses (χ2=13.7, P=.001). Moreover, ReMindCare patients had fewer visits to urgent care units (χ2=7.4, P=.006) and fewer hospitalizations than TAU patients (χ2=4.6, P=.03). The mean of days using the app was 352.2 (SD 191.2; min/max: 18-594), and the mean of engagement was 84.5 (SD 16.04). CONCLUSIONS To our knowledge, this is the first eHealth intervention that has preliminarily proven its benefits in the real-world treatment of patients with early psychosis. INTERNATIONAL REGISTERED REPORT RR2-10.1111/eip.12960

Download Full-text

Real-world use and accuracy of stress echocardiography: preliminary insights from the EVAREST study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0017 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

W Woodward ◽

A McCourt ◽

C Dockerill ◽

L Ayres ◽

D Augustine ◽

...

Keyword(s):

Clinical Practice ◽

Real World ◽

Stress Echocardiography ◽

Significant Coronary Artery Disease ◽

Phone Call ◽

Funding Source ◽

Private Company ◽

Coronary Syndrome ◽

Stress Echo ◽

Cardiac Outcome

Abstract Background Stress echocardiography is a widely used, non-invasive imaging modality used to identify prognostically significant coronary artery disease. High levels of accuracy have been reported, however this is highly dependent on operator training and image quality. There are currently limited data available on the accuracy of stress echo in every day clinical practice. Purpose The EVAREST study links stress echo clinics in 30 NHS Hospital Trusts in England and therefore provides data to evaluate the performance and diagnostic accuracy of stress echo in “real-world” clinical practice. Methods Analysis was performed on the first 7415 patients recruited prospectively between 2015 and January 2020. Participants are included if they have undergone stress echo to investigate for ischaemic heart disease. Data is collected on medical history and stress echo performance. Participants are followed up for 12 months through health records and patient phone call, with all outcomes undergoing expert adjudication. A positive cardiac outcome is defined as initiation of anti-anginal medications, ≥70% stenosis on coronary angiography, revascularisation, confirmed acute coronary syndrome or cardiac-related death. Results Mean age of patients undergoing stress echo is 65±12.3 years and 56% are male. Average BMI is 28.9±5.6 kg/m2. 71.4% undergo dobutamine stress (DSE) and 28.4% exercise with <1% having a pacemaker-mediated stress. Contrast was used in 71.4% of studies. Stress echos were interpreted at time of clinic visit as positive for inducible ischaemia in 18.2% of patients. One-year outcome data is currently available for 1892 participants. Sensitivity and specificity for clinician prediction of a positive cardiac outcome was 88.7% and 94.4%, respectively. Positive and negative predictive value of stress echo was 76.4% and 97.6%, respectively. Conclusion EVAREST provides unprecedented, large-scale information on the “real world” use and accuracy of stress echo across different healthcare settings in the UK, demonstrating performance consistent with best practice. Ongoing data collection will be used to evaluate sources of heterogeneity in the predictive accuracy of stress echo and identify optimal approaches to further improve performance. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Ultromics Ltd., Lantheus Ltd.

Download Full-text

Assessing the outcome of community-based psychiatric care: building a feedback loop from ‘real world’ health services research into clinical practice

Acta Psychiatrica Scandinavica ◽

10.1111/j.1600-0447.2007.01089.x ◽

2007 ◽

Vol 116 (s437) ◽

pp. 6-15 ◽

Cited By ~ 21

Author(s):

A. Lasalvia ◽

M. Ruggeri

Keyword(s):

Clinical Practice ◽

Health Services Research ◽

Health Services ◽

Real World ◽

Feedback Loop ◽

Psychiatric Care ◽

World Health ◽

Services Research ◽

Community Based

Download Full-text

Outpatient management of patients presenting with venous thromboembolism: Retrospective cohort study at 11 community hospitals

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-020-02328-9 ◽

2020 ◽

Author(s):

Rasha Khatib ◽

Kara Nitti ◽

Marc McDowell ◽

Rick Szymialis ◽

Chris Blair ◽

...

Keyword(s):

Clinical Practice ◽

Venous Thromboembolism ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Real World ◽

Emergency Departments ◽

Hospital Admissions ◽

Hospital Management ◽

Low Risk ◽

Outpatient Management

Abstract A gap exists between clinical practice guidelines and real-world practice. We aim to investigate hospital admissions among patients presenting to emergency departments of 11 hospitals with venous thromboembolism (VTE). Eligible patients’ first emergency department VTE visit were retrospectively collected between 2013 and 2018 from electronic medical records (EMR). Patients were categorized at low risk of VTE complications if they were diagnosed with deep vein thrombosis (DVT) of the leg or if they were diagnosed with pulmonary embolism (PE) and had a PE score index < 85. Multivariable logistic regression models were constructed to measure the adjusted odds ratios (OR) and 95% confidence intervals (CI) of hospital admissions before and after clinical practice guidelines were updated to recommend outpatient management of DVT and PE with low risk of complications. A total of 13,677 patients were included in the analysis, of which 55% were diagnosed with DVT. Mean age was 65 ± 17 years, 54% were females, and 62% were Caucasian. Overall, 9281 patients were categorized at low risk VTE complications, of whom 77% were admitted for in-hospital management. The rate of in-hospital management declined from 81% in 2013 to 73% in 2018. Patients visiting emergency departments between 2016 and 2018 (post-guidelines) were equally likely to be admitted compared to patients visiting the emergency departments between 2013 and 2015 (pre-guidelines; OR = 0.99; 95% CI: 0.88, 1.11). Results from this real-world study indicate that most low-risk VTE patients are admitted for in-hospital management, despite recommendations in clinical practice guidelines.

Download Full-text