FRI0629-HPR USE AND USABILITY OF THE DR. BART APP AND ITS RELATION WITH CLINICAL OUTCOMES IN PEOPLE WITH KNEE AND/OR HIP OSTEOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 919.1-919
Author(s):  
T. Pelle ◽  
J. Van der Palen ◽  
F. Van den Hoogen ◽  
K. Bevers ◽  
C. Van den Ende
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Central Element ◽  
Hip Osteoarthritis ◽  
Theoretical Framework ◽  
Self Management ◽  
Care Utilization ◽  
Considerable Proportion

Background:Self-management is of paramount importance in non-surgical treatment of knee and/or hip osteoarthritis(OA). Modern technologies offer the possibility to support self-management 24/7. We developed an e-self-management application (dr. Bart app) for people with knee and/or hip OA.Objectives:To document the use of the dr. Bart app and its relation with health care utilization and clinical outcomes in people with knee and/or hip OA.Methods:For this study we used back end data of the first 26 weeks from the intervention group (N=214) of a RCT (total included 427) examining the effectiveness of the dr. Bart app. Participants were included based on self-reported knee and/or hip OA. In figure 1 the theoretical framework of the dr. Bart app is presented. A central element of the dr. Bart app is that the app proposes a selection of 72 preformulated goals for health behaviours based on the ‘tiny habits method’1(e.g. today I rise 12 times from my chair to train my leg muscles). The proposals are tailored to user characteristics and related to four themes that are core elements in the non-surgical management of OA. After a user completes one or more of the selected goals, a new selection is proposed by dr. Bart. A user can work on 3 goals simultaneously. Goals can be completed more than once by the same user. To assess the association between intensity of use of the app and health care utilization and clinical outcomes, we calculated Spearman rank correlation coefficients.Figure 1.Theoretical framework of the dr. Bart app.Results:171 / 214 participants (80 %) logged in at least once whilst 151 (71%) chose at least one goal and 114 (53 %) completed at least one goal during the 26 weeks. Of those who chose at least one goal, 56 participants (37 %) continued to log in up to 26 weeks, 12 (8 %) continued to select new goals from the offered goals and 37 (25 %) continued to complete goals (Figure 2). Preformulated goals regarding the themes activity (e.g. performing an exercise from the exercises library of the app) and nutrition (e.g. eat 2 pieces of fruit today) were found to be most popular by users. We found no correlations between intensity of use and health care utilization and clinical outcomes.Figure 2.Percentage of active users (N=151) over time.Conclusion:A considerable proportion of persons with knee and/or hip OA persistently used the app up to 26 weeks. Patients appear to have preferences for goals related to activity and nutrition, rather than for goals related to vitality and education. We found no relation between intensity of use of the dr. Bart app and health care utilization and clinical outcomes.References:[1] Fogg GJ: A behavior model for persuasive design. In: Proceedings of the 4thinternational Conference on Persuasive Technology: 2009: ACM; 2009: 40.Disclosure of Interests:None declared

scholarly journals Use and usability of the dr. Bart app and its relation with health care utilisation and clinical outcomes in people with knee and/or hip osteoarthritis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tim Pelle ◽  
Job van der Palen ◽  
Frank de Graaf ◽  
Frank H. J. van den Hoogen ◽  
Karen Bevers ◽  
...  
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Central Element ◽  
Hip Osteoarthritis ◽  
Health Care Utilisation ◽  
Self Management ◽  
Care Utilisation ◽  
System Usability Scale

Abstract Background Self-management is of paramount importance in the non-surgical treatment of knee/hip osteoarthritis (OA). Modern technologies offer the possibility of 24/7 self-management support. We developed an e-self-management application (dr. Bart app) for people with knee/hip OA. The aim of this study was to document the use and usability of the dr. Bart app and its relation with health care utilisation and clinical outcomes in people with knee/hip OA. Methods For this study we used backend data for the first 26 weeks of use by the intervention group (N = 214) of an RCT examining the effectiveness of the dr. Bart app. A central element of the dr. Bart app is that it proposes a selection of 72 preformulated goals for health behaviours based on the ‘tiny habits method’ (e.g. after lunch I rise 12 times from my chair to train my leg muscles). The usability of the app was measured using the System Usability Scale questionnaire (SUS), on a scale of 0–100. To assess the association between the intensity of use of the app and health care utilisation (i.e., consultations in primary or secondary health care) and clinical outcomes (i.e., self-management behaviour, physical activity, health-related quality of life, illness perceptions, symptoms, pain, activities of daily living) we calculated Spearman rank correlation coefficients. Results Of the 214 participants, 171 (80%) logged in at least once with 151 (71%) choosing at least one goal and 114 (53%) completing at least one goal during the 26 weeks. Of those who chose at least one goal, 56 participants (37%) continued to log in for up to 26 weeks, 12 (8%) continued to select new goals from the offered goals and 37 (25%) continued to complete goals. Preformulated goals in the themes of physical activity (e.g., performing an exercise from the exercises library in the app) and nutrition (e.g., ‘eat two pieces of fruit today’) were found to be most popular with users. The mean usability scores (standard deviation) at the three and six month follow-ups were 65.9 (16.9) and 64.5 (17.5), respectively. The vast majority of associations between the intensity of use of the dr. Bart app and target outcomes were weak at ρ < (−) 0.25. Conclusions More than one-third of people with knee/hip OA who started using the app, continued to use it up to 26 weeks, though usability could be improved. Patients appear to have preferences for goals related to physical activity and nutrition, rather than for goals related to vitality and education. We found weak/no associations between the intensity of use of the dr. Bart app and health care utilisation and clinical outcomes. Trial registration (21 September 2017): Dutch Trial Register (Trial Number NTR6693/NL6505)

scholarly journals A Smart Mobile Health Tool Versus a Paper Action Plan to Support Self-Management of Chronic Obstructive Pulmonary Disease Exacerbations: Randomized Controlled Trial

10.2196/14408 ◽  
2019 ◽  
Vol 7 (10) ◽  
pp. e14408 ◽  
Author(s):  
Lonneke Boer ◽  
Erik Bischoff ◽  
Maarten van der Heijden ◽  
Peter Lucas ◽  
Reinier Akkermans ◽  
...  
Keyword(s):  
Health Care ◽  
Health Status ◽  
Health Care Utilization ◽  
Self Efficacy ◽  
Respiratory Symptoms ◽  
Action Plan ◽  
Intervention Group ◽  
Self Management ◽  
Care Utilization ◽  
Management Behavior

Background Many patients with chronic obstructive pulmonary disease (COPD) suffer from exacerbations, a worsening of their respiratory symptoms that warrants medical treatment. Exacerbations are often poorly recognized or managed by patients, leading to increased disease burden and health care costs. Objective This study aimed to examine the effects of a smart mobile health (mHealth) tool that supports COPD patients in the self-management of exacerbations by providing predictions of early exacerbation onset and timely treatment advice without the interference of health care professionals. Methods In a multicenter, 2-arm randomized controlled trial with 12-months follow-up, patients with COPD used the smart mHealth tool (intervention group) or a paper action plan (control group) when they experienced worsening of respiratory symptoms. For our primary outcome exacerbation-free time, expressed as weeks without exacerbation, we used an automated telephone questionnaire system to measure weekly respiratory symptoms and treatment actions. Secondary outcomes were health status, self-efficacy, self-management behavior, health care utilization, and usability. For our analyses, we used negative binomial regression, multilevel logistic regression, and generalized estimating equation regression models. Results Of the 87 patients with COPD recruited from primary and secondary care centers, 43 were randomized to the intervention group. We found no statistically significant differences between the intervention group and the control group in exacerbation-free weeks (mean 30.6, SD 13.3 vs mean 28.0, SD 14.8 weeks, respectively; rate ratio 1.21; 95% CI 0.77-1.91) or in health status, self-efficacy, self-management behavior, and health care utilization. Patients using the mHealth tool valued it as a more supportive tool than patients using the paper action plan. Patients considered the usability of the mHealth tool as good. Conclusions This study did not show beneficial effects of a smart mHealth tool on exacerbation-free time, health status, self-efficacy, self-management behavior, and health care utilization in patients with COPD compared with the use of a paper action plan. Participants were positive about the supportive function and the usability of the mHealth tool. mHealth may be a valuable alternative for COPD patients who prefer a digital tool instead of a paper action plan. Trial Registration ClinicalTrials.gov NCT02553096; https://clinicaltrials.gov/ct2/show/NCT02553096.

Negative Pressure Wound Therapy After Abdominal Body Contouring: A Comparative Matched Analysis of Outcomes and Cost

2021 ◽  
pp. 229255032110196
Author(s):  
Martin P. Morris ◽  
Adrienne N. Christopher ◽  
Viren Patel ◽  
Ginikanwa Onyekaba ◽  
Robyn B. Broach ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Body Contouring ◽  
Emergency Department Visits ◽  
Smoking History ◽  
Care Utilization ◽  
Wound Therapy

Background: Studies that have previously validated the use of incisional negative pressure wound therapy (iNPWT) after body contouring procedures (BCP) have provided limited data regarding associated health care utilization and cost. We matched 2 cohorts of patients after BCP with and without iNPWT and compared utilization of health care resources and post-operative clinical outcomes. Methods: Adult patients who underwent abdominoplasty and/or panniculectomy between 2015 and 2020 by a single surgeon were identified. Patients were propensity score matched by body mass index (BMI), gender, smoking history, diabetes mellitus, hypertension, and incision type. Primary outcomes included time to final drain removal, outpatient visits, homecare visits, emergency department visits, and cost. Secondary outcomes included surgical site occurrences (SSO), surgical site infections, reoperations, and revisions. Results: One hundred sixty-six patients were eligible, and 40 were matched (20 with iNPWT and 20 without iNPWT) with a median age of 47 years and BMI of 32 kg/m2. There were no differences in demographics or intraoperative details (all P > .05). No significant differences were found between the cohorts in terms of health care utilization measures or clinical outcomes (all P > .05). Direct cost was significantly greater in the iNPWT cohort ( P = .0498). Inpatient length of stay and procedure time were independently associated with increased cost on multivariate analysis (all P < .0001). Conclusion: Consensus guidelines recommend the use of iNPWT in high-risk patients, including abdominal BCP. Our results show that iNPWT is associated with equivalent health care utilization and clinical outcomes, with increased cost. Additional randomized controlled trials are needed to further elucidate the cost utility of this technique in this patient population.

scholarly journals Approaches to Evaluations of Virtual Care in Primary Care

2022 ◽  
Vol 2 (1) ◽  
pp. es0358
Author(s):  
Daphne Hui ◽  
Bert Dolcine ◽  
Hannah Loshak
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Care Utilization ◽  
Cost Analyses ◽  
Virtual Care ◽  
Primary Care Health ◽  
Guidance Documents ◽  
Care Health

A literature search informed this Environmental Scan and identified 11 evaluations of virtual care in primary care health settings and 7 publications alluding to methods, standards, and guidelines (referred to as evaluation guidance documents in this report) being used in various countries to evaluate virtual care in primary care health settings. The majority of included literature was from Australia, the US, and the UK, with 2 evaluation guidance documents published by the Heart and Stroke Foundation of Canada. Evaluation guidance documents recommended using measurements that assess the effectiveness and quality of clinical care including safety outcomes, time and travel, financial and operational impact, participation, health care utilization, technology experience including feasibility, user satisfaction, and barriers and facilitators or measures of health equity. Evaluation guidance documents specified that the following key decisions and considerations should be integrated into the planning of a virtual care evaluation: refining the scope of virtual care services; selecting an appropriate meaningful comparator; and identifying opportune timing and duration for the evaluation to ensure the evaluation is reflective of real-world practice, allows for adequate measurement of outcomes, and is comprehensive, timely, feasible, non-complex, and non–resource-intensive. Evaluation guidance documents highlighted that evaluations should be systematic, performed regularly, and reflect the stage of virtual care implementation to encompass the specific considerations associated with each stage. Additionally, evaluations should assess individual virtual care sessions and the virtual care program as a whole. Regarding economic components of virtual care evaluations, the evaluation guidance documents noted that costs or savings are not limited to monetary or financial measures but can also be represented with time. Cost analyses such as cost-benefit and cost-utility estimates should be performed with a specific emphasis on selecting an appropriate perspective (e.g., patient or provider), as that influences the benefits, effects, and how the outcome is interpreted. Two identified evaluations assessed economic outcomes through cost analyses in the perspective of the patient and provider. Evidence suggests that, in some circumstances, virtual care may be more cost-effective and reduces the cost per episode and patient expenses (e.g., travel and parking costs) compared to in-person care. However, virtual care may increase the number of individuals treated, which would increase overall health care spending. Four identified evaluations assessed health care utilization. The evidence suggests that virtual care reduces the duration of appointments and may be more time-efficient compared to in-person care. However, it is unclear if virtual care reduces the use of medical resources and the need for follow-up appointments, hospital admissions, and emergency department visits compared to in-person care. Five identified evaluations assessed participation outcomes. Evidence was variable, with some evidence reporting that virtual care reduced attendance (e.g., reduced attendance rates) and other evidence noting improved attendance (e.g., increased completion rate and decreased cancellations and no-show rates) compared to in-person care. Three identified evaluations assessed clinical outcomes in various health contexts. Some evidence suggested that virtual care improves clinical outcomes (e.g., in primary care with integrated mental health services, symptom severity decreased) or has a similar effect on clinical outcomes compared to in-person care (e.g., use of virtual care in depression elicited similar results with in-person care). Three identified evaluations assessed the appropriateness of prescribing. Some studies suggested that virtual care improves appropriateness by increasing guideline-based or guideline-concordant antibiotic management, or elicits no difference with in-person care.

scholarly journals Pharmacist Clinical Interventions and Discharge Counseling in Medical Rehabilitation Wards in a Local Hospital: A Prospective Trial

Geriatrics ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 53 ◽  
Author(s):  
Rosanna Nga Suet Ip ◽  
Justin Wade Tenney ◽  
Angus Chun Kwok Chu ◽  
Pauline Lai Ming Chu ◽  
Grace Wai Man Young
Keyword(s):  
Health Care ◽  
Medication Adherence ◽  
Health Care Utilization ◽  
Usual Care Group ◽  
Medication Reconciliation ◽  
Intervention Group ◽  
Medical Rehabilitation ◽  
Care Group ◽  
Care Utilization ◽  
Utilization Rate

Patients undergoing rehabilitation experience numerous changes in medication regimens during care transitions, exposing these patients to an increased risk of drug-related problems (DRPs). A prospective, non-randomized, quasi-experimental study was conducted in medical rehabilitation wards to evaluate the impact of pharmacist-delivered interventions and counseling on 30-day unplanned health care utilization and medication adherence for selected rehabilitation patients. A pharmacist provided medication reconciliation and counseling before discharge. Phone follow-up was completed 30 days after discharge to assess for unplanned health care utilization rate and medication adherence. A total of 85 patients (n = 43 in prospective intervention group and n = 42 in historical usual care group) were included. Among the intervention group, 23 DRPs were identified in 14 (32.6%) patients, resulting in 51 interventions. The intervention group had a significantly lower unplanned health care utilization rate than the usual care group (25.6% vs. 47.6%, p = 0.035). The risk of unplanned health care utilization was reduced by over 60% (Odds ratio (OR) = 0.378; 95% CI = 0.15–0.94). Patients reporting medium to high medication adherence increased from 23.6% to 88.4% 30 days after counseling (p < 0.05). Pharmacist medication reconciliation and discharge counseling reduced unplanned health care utilization 30 days after discharge and improved medication adherence.

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