scholarly journals Beyond the Therapist’s Office: Merging Measurement-Based Care and Digital Medicine in the Real World

2021 ◽  
pp. 176-182
Author(s):  
Emil Chiauzzi ◽  
Paul Wicks
Keyword(s):  
Real World ◽  
Patient Engagement ◽  
Outcome Data ◽  
Care Process ◽  
Digital Measurement ◽  
Office Visits ◽  
Feedback Systems ◽  
Digital Medicine ◽  
Measurement Based Care ◽  
Engagement Process

This viewpoint focuses on the ways in which digital medicine and measurement-based care can be utilized in tandem to promote better assessment, patient engagement, and an improved quality of psychiatric care. To date, there has been an underutilization of digital measurement in psychiatry, and there is little discussion of the feedback and patient engagement process in digital medicine. Measurement-based care is a recognized evidence-based strategy that engages patients in an understanding of their outcome data. When implemented as designed, providers review the scores and trends in outcome immediately and then provide feedback to their patients. However, the process is typically confined to office visits, which does not provide a complete picture of a patient’s progress and functioning. The process is labor intensive, even with digital feedback systems, but the integration of passive metrics obtained through wearables and apps can supplement office-based observations. This enhanced measurement-based care process can provide a picture of real-world patient functioning through passive metrics (activity, sleep, etc.). This can potentially engage patients more in their health data and involve a critically needed therapeutic alliance component in digital medicine.

Real-world treatment patterns in relapsed/refractory multiple myeloma: Clinical and economic outcomes in patients treated with pomalidomide or daratumumab

2021 ◽  
pp. 107815522199553
Author(s):  
Joshua Richter ◽  
Vamshi Ruthwik Anupindi ◽  
Jason Yeaw ◽  
Suneel Kudaravalli ◽  
Stojan Zavisic ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Real World ◽  
Treatment Options ◽  
Proteasome Inhibitors ◽  
Economic Outcomes ◽  
Office Visits ◽  
Refractory Multiple Myeloma ◽  
Kaplan Meier ◽  
Real World Evidence ◽  
New Treatment

Introduction Real-world evidence on later line treatment of relapsed/refractory multiple myeloma (RRMM) is sparse. We evaluated clinical outcomes among RRMM patients in the 1-year following treatment with pomalidomide or daratumumab and compared economic outcomes between RRMM patients and non-MM patients. Patient and Methods Adult patients with ≥1 claim of pomalidomide or daratumumab were identified between January 2012 and February 2018 using IQVIA PharMetrics® Plus US claims database. Patients were required to have a diagnosis or treatment for MM and a claim of any immunomodulatory drugs and proteasome inhibitors before the index date. Mean time to new therapy, overall survival (OS) using Kaplan-Meier curve and adverse events (AEs) were reported over the 1-year post-index period. RRMM patients were also matched to a non-MM comparator cohort and economic outcomes were compared between the two cohorts. Results 289 RRMM patients were matched to 1,445 patients without MM. Most prevalent hematological AE was anemia (72.0%) and non-hematological AE was infections (75.4%). Mean (SD) time to a new treatment was 4.7 (5.3) months and median OS was 14.6 months. RRMM patients had significantly higher hospitalizations and physician office visits (Both P < .0001) compared to non-MM patients. Adjusting for baseline characteristics, patients with RRMM had 4.9 times (95% CI 3.8-6.4, P < .0001) the total healthcare costs compared with patients without MM. The major driver of total costs among RRMM patients was pharmacy costs (67.3%). Conclusion RRMM patients showed a high frequency of AEs, low OS, and a substantial economic burden suggesting need for effective treatment options.

Treatment of headache disorders with acupuncture: a 6-year retrospective study

2021 ◽  
pp. 096452842098757
Author(s):  
Javier Mata ◽  
Pilar Sanchís ◽  
Pedro Valentí ◽  
Beatriz Hernández ◽  
Jose Luis Aguilar
Keyword(s):  
Real World ◽  
Tertiary Care ◽  
Group Versus ◽  
Clinical Effectiveness ◽  
Outcome Data ◽  
Pain Clinic ◽  
Number Needed To Treat ◽  
Headache Disorders ◽  
Electronic Health Record Data ◽  
Clinical Benefits

Objective: Existing systematic reviews and meta-analyses indicate that acupuncture has similar clinical effectiveness in the prevention of headache disorders (HDs) as drug therapy, but with fewer side effects. As such, examining acupuncture’s use in a pragmatic, real-world setting would be valuable. The purpose of this study was to compare the effects of acupuncture and prophylactic drug treatment (PDT) on headache frequency in patients with HDs, under real-world clinical conditions. Methods: Retrospective cohort study of patients with HDs referred to a pain clinic, using electronic health record data. Patients continued with tertiary care (treatment of acute headache attacks and lifestyle, meditation, exercise and dietary instructions) with PDT, or received 12 sessions of acupuncture over 3 months, instead of PDT under conditions of tertiary care. The primary outcome data were the number of days with headache per month, and groups were compared at baseline and at the end of the third month of treatment. Results: Data were analysed for 482 patients with HDs. The number of headache days per month decreased by 3.7 (standard deviation (SD) = 2.9) days in the acupuncture group versus 2.9 (SD = 2.3) in the PDT group (p = 0.007). The proportion of responders was 39.5% versus 16.3% (p < 0.001). The number needed to treat was 4 (95% confidence interval = 3–7). Conclusion: Our study has shown that patients with HDs in tertiary care who opted for treatment with acupuncture appeared to receive similar clinical benefits to those that chose PDT, suggesting these treatments may be similarly effective of the prevention of headache in a real-world clinical setting.

Armed forces: Intrasexual selection for upper limb length in Homo sapiens

2021 ◽  
Author(s):  
Neil Robert Caton ◽  
David M. G. Lewis
Keyword(s):  
Sexual Dimorphism ◽  
Upper Limb ◽  
Real World ◽  
Lower Limb ◽  
Homo Sapiens ◽  
Armed Forces ◽  
Outcome Data ◽  
Resource Provisioning ◽  
Limb Length ◽  
Intrasexual Selection

Numerous taxa have evolved physiological appendage-based weaponry to increase damage output in violent fights, but no research has empirically shown that Homo sapiens upper appendages have uniquely evolved to increase resource-provisioning potential in real-world combat. In Study 1, we used actual fight outcome data (N = 715 fighters) to examine multiple competing hypotheses—the striker, defender, grappler, and knockout hypotheses—for the evolution of Homo sapiens upper limb length, controlling for approximately a dozen confounding variables (e.g., biacromial width, lower limb length, age, weight, height). There was exclusive support for the knockout hypothesis: upper limb length increases fighting success through knockout power. There was also evidence for a real-world association between biacromial width and knockout power. Because sexual dimorphism often emerges from selection on morphological structures that improve male’s fighting success, we consequently expected sexual dimorphism in upper limb length. Studies 2a-2d provided powerful evidence for this new universal sexual dimorphism in upper limb length. Even after controlling for weight, height, and lower limb length, males exhibited longer upper limbs than females across the globe: from mixed-martial-artists (Study 2a) and Croatian adolescents (but not pre-pubertal children; Study 2b) to older Singaporean adults (Study 2c) and over 6,000 United States Army personnel (Study 2d) born across seven major world regions (Africa, Europe, Asia, Oceania, and North, Central, and South America). Combined, our results provide comprehensive support for the argument that intrasexual selection has uniquely shaped Homo sapiens upper limb length to enhance fighting performance in real-world combat.

Real-world comparison of abiraterone (A) versus enzalutamide (E) for first-line therapy of metastatic castration-resistant prostate cancer (mCRPC).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 133-133
Author(s):  
Juan Rodrigo Briones Carvajal ◽  
Mahdi Farzad Naimi ◽  
Liying Zhang ◽  
Urban Emmenegger
Keyword(s):  
Overall Survival ◽  
Median Time ◽  
Real World ◽  
Systemic Therapy ◽  
Nonparametric Test ◽  
Outcome Data ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Castration Resistant Prostate Cancer ◽  
First Line

133 Background: Second generation androgen receptor signaling inhibitors such as A and E are commonly used first-line treatment options for mCRPC. While differences in the side effect profile of these agents are well documented, there are no predictive markers of response to A versus E, and there is a paucity of comparative outcome data. Methods: We conducted a retrospective exploratory analysis of 100 mCRPC patients (pts) treated at Odette Cancer Centre (Toronto, ON, Canada) between August 2012 and June 2020 with either A (n = 50) or E (n = 50). Pts undergoing first-line mCRPC therapy were randomly selected from a list of 327 A and 254 E patients. Following extraction of disease and pt characteristics, as well as outcome data, we applied the Wilcoxon rank-sum nonparametric test or the Fisher exact test for continuous or categorical variables, respectively, for between group comparisons. For time to event analyses, we created Kaplan-Meier (KM) curves with log-rank testing. Two-sided p-values < 0.05 were considered significant. Results: The A and E cohorts were comparable regarding diagnostic PSA, Gleason score categories, and treatments prior to presentation with mCRPC. The median time to CRPC in the A cohort was 23.3 (95%CI 15.6-29.9) months, compared to 24.1 (19.4-37.4) months in the E cohort (p = 0.942). At initiation of A or E therapy both the median (Q1,Q3) age (77(70,82) vs 76(69,81) years) and median Charlson Comorbidity Index (10(9,11) vs 10(9,11)) were similar (p = 0.469 and p = 0.736, respectively). The rate of diabetes was significantly lower in the A group (8% vs 38%; p < 0.001), but there were no significant differences in cardiovascular comorbidities. Pts starting A therapy had a higher rate of bone metastasis (92% vs 68%; p = 0.005); otherwise, the metastatic pattern did not differ. The median PSA at start of A was 46.75 (13.77,176.80), compared to 27.07 (8.64,136.20) in the E group (p = 0.218). Baseline ALP, hemoglobin and albumin were all comparable. Median follow-up was 13.7 (8.3,26.3) and 19.5 (9.8,34.0) months in the A and E groups (p = 0.091). 38% of A pts and 44% of E pts went on to further lines of systemic therapy upon progression (p = 0.685). The median time to next line of systemic therapy was 11.3 (95%CI 8.3-15.9) months for the A cohort and 12.7 (9.7-16.6) for the E cohort (p = 0.844). The actuarial median overall survival from KM estimations was 35.7 (20.4-52.5) months for the A group, and 34.0 (25.7-38.0) months for the E group. Conclusions: In men undergoing first-line A or E therapy for mCRPC, time to next line of systemic therapy and overall survival did not differ significantly, while baseline pt and disease characteristics were largely similar. A substantial number of pts do not receive ≥2 lines of therapy for mCRPC under real-world circumstances.

The Value of Measuring Patient Engagement in Healthcare

2016 ◽  
pp. 192-214 ◽  
Author(s):  
Guendalina Graffigna ◽  
Serena Barello
Keyword(s):  
Patient Engagement ◽  
Psychological Adaptation ◽  
Active Role ◽  
Care Quality ◽  
Healthcare Management ◽  
Assessment Tools ◽  
Care Process ◽  
Level Of Involvement ◽  
Patient Health ◽  
Wide Debate

The concept of patient engagement offers a unique opportunity to inform our understanding of patients' ability to be active in managing their care. However, unless promoting the active role of patients is today identified as a priority to promote care quality, a wide debate still exists on how to translate this principle into practice and how to assess initiatives aimed at increasing the level of patient participation in their care. Measuring patient engagement along the care course might ensure that the medical care truly serves patients' needs, priorities, and preferences. Unless the measurement of patient engagement is today a big issue for policy makers and healthcare practitioners, only few scientifically validated assessment tools currently exist to identify patients' level of involvement in their healthcare. In this chapter authors review the main validated tools currently available in the scientific community devoted to assess the patients' ability and availability to be actively engaged in their care, with a particular focus on the recently developed Patient Health Engagement Scale, specifically designed to assess the emotional and psychological adaptation of patients along their care process and their level of engagement in the healthcare management.

scholarly journals Effect of pragmatic versus explanatory interventions on medication adherence in people with cardiometabolic conditions: a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036575
Author(s):  
Claire Fitzpatrick ◽  
Clare Gillies ◽  
Samuel Seidu ◽  
Debasish Kar ◽  
Ekaterini Ioannidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medication Adherence ◽  
Real World ◽  
Meta Analysis ◽  
Random Effect ◽  
Routine Care ◽  
Outcome Data ◽  
Eligibility Criteria ◽  
Novel Approach ◽  
Explanatory Trials

ObjectiveTo synthesise findings from randomised controlled trials (RCTs) of interventions aimed at increasing medication adherence in individuals with type 2 diabetes (T2DM) and/or cardiovascular disease (CVD). And, in a novel approach, to compare the intervention effect of studies which were categorised as being more pragmatic or more explanatory using the Pragmatic-Explanatory Continuum Indicator Summary-2 (PRECIS-2) tool, to identify whether study design affects outcomes. As explanatory trials are typically held under controlled conditions, findings from such trials may not be relatable to real-world clinical practice. In comparison, pragmatic trials are designed to replicate real-world conditions and therefore findings are more likely to represent those found if the intervention were to be implemented in routine care.DesignSystematic review and meta-analysis.Data sourcesOvid Medline, Ovid Embase, Web of Science and CINAHL from 1 January 2013 to 31 December 2018.Eligibility criteria for selecting studiesRCTs lasting ≥3 months (90 days), involving ≥200 patients in the analysis, with either established CVD and/or T2DM and which measured medication adherence. From 4403 citations, 103 proceeded to full text review. Studies published in any language other than English and conference abstracts were excluded.Main outcome measureChange in medication adherence.ResultsOf 4403 records identified, 34 studies were considered eligible, of which 28, including 30 861 participants, contained comparable outcome data for inclusion in the meta-analysis. Overall interventions were associated with an increase in medication adherence (OR 1.57 (95% CI: 1.33 to 1.84), p<0.001; standardised mean difference 0.24 (95% CI: −0.10 to 0.59) p=0.101). The effectiveness of interventions did not differ significantly between studies considered pragmatic versus explanatory (p=0.598), but did differ by intervention type, with studies that included a multifaceted rather than a single-faceted intervention having a more significant effect (p=0.010). The analysis used random effect models and used the revised Cochrane Risk of Bias Tool to assess study quality.ConclusionsIn this meta-analysis, interventions were associated with a significant increase in medication adherence. Overall multifaceted interventions which included an element of education alongside regular patient contact or follow-up showed the most promise. Effectiveness of interventions between pragmatic and explanatory trials was comparable, suggesting that findings can be transferred from idealised to real-word conditions.PROSPERO registration numberCRD42017059460.

scholarly journals The electronic health record as a patient engagement tool: mirroring clinicians’ screen to create a shared mental model

JAMIA Open ◽  
2018 ◽  
Vol 1 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Onur Asan ◽  
Jeanne Tyszka ◽  
Bradley Crotty
Keyword(s):  
Patient Engagement ◽  
General Medicine ◽  
Clinic Visit ◽  
Care Process ◽  
Health Records ◽  
Exam Room ◽  
Quantitative Results ◽  
General Medicine Clinic ◽  
Electronic Health ◽  
Screen Sharing

Abstract Objective Electronic health records (EHRs) in physician offices can both enhance and detract from the patient experience. Best practices have emerged focusing on screen sharing. We sought to determine if adding a second monitor, mirroring the EHR for patients, would be welcome and useful for patients and clinicians. Materials and Methods This mixed-method study was conducted in a general medicine clinic from March to June 2016. Clinicians and patients met in a specially equipped exam room with a patient-facing monitor. Visits were video-recorded to assess time spent viewing the EHR and followed by interviews, which were transcribed and analyzed using established qualitative methods. Results Eight clinicians and 24 patients participated. Main themes included the second screen serving as a catalyst for patient engagement, augmenting the clinic visit in a meaningful way, improving transparency of the care process and documentation, and providing a substantially different experience for patients than a shared single screen. Concerns and suggestions for improvement were also reported. Quantitative results showed high patient engagement times with the EHR (25% of the visit length) compared to reports in previous studies. The median satisfaction score was 5 out of 5 for patients and 3.3 out of 5 for clinicians. Discussion and Conclusion Providing patient access to the EHRs with this design was linked with several benefits including improved patient engagement, education, transparency, comprehension, and trust. Future studies should explore how best to display information in such screens for patients and identify impact on care, safety, and quality.

Clinical trials, real-world evidence, and digital medicine

2021 ◽  
pp. 191-215
Author(s):  
Jim Weatherall ◽  
Faisal M. Khan ◽  
Mishal Patel ◽  
Richard Dearden ◽  
Khader Shameer ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Real World ◽  
Digital Medicine ◽  
Real World Evidence

scholarly journals P600 Vedolizumab dose optimisation: Findings from a Belgian registry

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S501-S502
Author(s):  
E Louis ◽  
V Muls ◽  
P Bossuyt ◽  
A Colard ◽  
A Nakad ◽  
...  
Keyword(s):  
Clinical Response ◽  
Median Duration ◽  
Real World ◽  
Clinical Remission ◽  
Outcome Data ◽  
Real World Data ◽  
Secondary Loss ◽  
Loss Of Response ◽  
Starting Point ◽  
Dose Optimisation

Abstract Background Vedolizumab (VDZ) dose optimisation (DO), by interval shortening from 8-weekly (Q8W) to 4-weekly (Q4W) dosing, is used for patients with secondary loss of response. This report presents outcome data on patients receiving DO in real-world clinical practice in Belgium. Methods The Belgian VDZ Registry (ENcePP EUPAS6469) enrolled 202 VDZ-treated ulcerative colitis (UC) or Crohn’s disease (CD) adult patients (26% with no prior use of anti-TNF therapy) from 19 centres. The median length of VDZ therapy prior to enrolment was 11 months. Patients were followed-up every 6 months with the assessment of IBD features, use of biologics, and disease activity. Clinical remission was defined as Harvey–Bradshaw Index (HBI) &lt;5 or partial Mayo Score (pMS) &lt;2, and clinical response as a 2+ point improvement in pMS or a 3+ improvement in HBI. Results During a median follow-up of 19 months from enrolment, 57 (28%) patients (41 CD and 16 UC) received VDZ Q4W due to secondary loss of response. Q4W was mostly used in patients with CD or with prior anti-TNF therapy failure. The median starting point for Q4W dosing was 16 months after the start of VDZ (interquartile range (IQR) 8–27 months) and median duration of Q4W dosing was 4 months (IQR 2–8 months). After changing to Q4W dosing 44% achieved clinical remission, 3% clinical response, and 53% showed no improvement (Table 1). Among the 17 patients with clinical remission/response on Q4W dosing, 53% de-escalated back to Q8W, and continued with Q8W for a median duration of 12 months, 23.5% remained on Q4W with clinical remission, and 23.5% eventually stopped VDZ due to loss of response. A limitation of this study is that it did not systematically collect data on DO prior to recruitment, hence the proportion of patients receiving DO may be higher than reported here. Conclusion These real-world data show DO plays an important role in management of UC and CD. In this study, 28% of patients received DO following the secondary loss of response to Q8W therapy. Forty-seven per cent of patients receiving Q4W subsequently returned to clinical remission or had a clinical response, and half of these patients successfully returned to Q8W VDZ therapy. Controlled studies are warranted, ideally blinded, using more objective endpoint to reveal the true success rate of dose-optimisation.

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