scholarly journals Becoming more of an insider: A grounded theory study on patients’ experience of a person-centred e-health intervention

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241801
Author(s):  
Emmelie Barenfeld ◽  
Lilas Ali ◽  
Sara Wallström ◽  
Andreas Fors ◽  
Inger Ekman
Keyword(s):  
Primary Care ◽  
Grounded Theory ◽  
Intervention Group ◽  
Health Intervention ◽  
Self Management ◽  
Chronic Obstructive ◽  
Telephone Support ◽  
Digital Platform ◽  
Side Door ◽  
Core Category

Objective The aim was to explore the experiences of a person-centred e-health intervention, in patients diagnosed with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF). Design Grounded theory was applied to gather and analyse data. Setting The study is part of a research project evaluating the effects of person-centred care (PCC) using a digital platform and structured telephone support for people with COPD or CHF recruited from nine primary care units in Sweden. Participants Twelve patients from the intervention group were purposefully selected in accordance with the initial sampling criteria. Intervention The intervention was delivered through a digital platform and telephone support system for 6 months. The intervention relied on person-centred ethics operationalised through three core PCC components: patient narratives, partnership and shared documentation. Results A core category was formulated: Being welcomed through the side door when lacking the front door keys. The core category reflects how a PCC intervention delivered remotely provides access to mutual and informal meetings at times when professional contacts were desired to support patient self-management goals. According to patients’ wishes, family and friends were seldom invited as care partners in the e-health context. Conclusions A PCC intervention delivered remotely as a complement to standard care in a primary care setting for patients diagnosed with COPD or CHF is a viable approach to increase patients’ access and involvement in preventive care. The e-health intervention seemed to facilitate PCC, strengthen patients’ position in the health service system and support their self-management.

scholarly journals Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial

10.2196/26794 ◽  
2021 ◽  
Vol 23 (12) ◽  
pp. e26794
Author(s):  
Lilas Ali ◽  
Sara Wallström ◽  
Andreas Fors ◽  
Emmelie Barenfeld ◽  
Eva Fredholm ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care Professionals ◽  
Self Efficacy ◽  
Chronic Obstructive ◽  
Telephone Support ◽  
Obstructive Pulmonary Disease ◽  
Digital Platform ◽  
Centered Care ◽  
Composite Scores ◽  
General Self Efficacy

Background Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce. Objective The aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF. Methods A multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5%) or PCC combined with usual care (110/222, 49.5%). The intervention’s main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention. Results No significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (P=.047), although it was not maintained until the end of the 6-month follow-up (P=.24). This effect was driven by a change in general self-efficacy from baseline. Conclusions PCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF. Trial Registration ClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817

scholarly journals Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial (Preprint)

2021 ◽  
Author(s):  
Lilas Ali ◽  
Sara Wallström ◽  
Andreas Fors ◽  
Emmelie Barenfeld ◽  
Eva Fredholm ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care Professionals ◽  
Self Efficacy ◽  
Chronic Obstructive ◽  
Telephone Support ◽  
Obstructive Pulmonary Disease ◽  
Digital Platform ◽  
Centered Care ◽  
Composite Scores ◽  
General Self Efficacy

BACKGROUND Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce. OBJECTIVE The aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF. METHODS A multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5%) or PCC combined with usual care (110/222, 49.5%). The intervention’s main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention. RESULTS No significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (<i>P</i>=.047), although it was not maintained until the end of the 6-month follow-up (<i>P</i>=.24). This effect was driven by a change in general self-efficacy from baseline. CONCLUSIONS PCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF. CLINICALTRIAL ClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817

The Effectiveness of a Healthcare Application and Human Coaching Program in Primary Care Clinics: A Non-randomized Controlled Trial (Preprint)

2021 ◽  
Author(s):  
HyoRim Ju ◽  
EunKyo Kang ◽  
YoungIn Kim ◽  
HyunYoung Ko ◽  
Belong Cho
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Sleep Quality ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Primary Care Clinics ◽  
Healthcare Application

BACKGROUND As the global burden of chronic conditions increases, effective management for these are a concern. There is an increasing need for chronic condition management using mobile self-management healthcare applications. OBJECTIVE This study evaluated the effectiveness of a mobile self-management healthcare application combined with human coaching for primary care services in patients with chronic conditions. METHODS A total of 110 patients with hypertension, diabetes, dyslipidemia, and/or metabolic syndrome who visited one of 17 participating primary care clinics from September 2020 to November 2020 were included in this study. Data regarding changes in body weight, sleep conditions, quality of life, depression, anxiety, stress, body mass index, waist circumference, blood sugar levels, blood pressure, and blood lipids levels were recorded. The intervention group (N=65) used a mobile self-management healthcare application with human coaching for 12 weeks, and the control group (N=45) underwent conventional, self-managed health care. RESULTS Patients in the intervention group reported significantly more weight loss than those in the control group (P=.002). The weight loss was markedly greater after using application for nine weeks than using it for four weeks or five to eight weeks (P=.002). Patients in the intervention group reported better sleep quality (P=.04) and duration (P=.004) than those in the control group. CONCLUSIONS The combination of a mobile self-management healthcare application and human coaching in primary care clinics results in better management of chronic conditions. The observed weight loss was greater and sleep quality improved than conventional primary care for patients with at least one chronic condition.

scholarly journals Supporting self-management of low back pain with an internet intervention in primary care: a protocol for a randomised controlled trial of clinical and cost-effectiveness (SupportBack 2)

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e040543
Author(s):  
Adam W A Geraghty ◽  
Lisa Roberts ◽  
Jonathan Hill ◽  
Nadine E Foster ◽  
Lucy Yardley ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Internet Intervention ◽  
Self Management ◽  
Low Back ◽  
Telephone Support ◽  
Randomised Controlled

IntroductionSelf-management and remaining physically active are first-line recommendations for the care of patients with low back pain (LBP). With a lifetime prevalence of up to 85%, novel approaches to support behavioural self-management are needed. Internet interventions may provide accessible support for self-management of LBP in primary care. The aim of this randomised controlled trial is to determine the clinical and cost-effectiveness of the ‘SupportBack’ internet intervention, with or without physiotherapist telephone support in reducing LBP-related disability in primary care patients.Methods and analysisA three-parallel arm, multicentre randomised controlled trial will compare three arms: (1) usual primary care for LBP; (2) usual primary care for LBP and an internet intervention; (3) usual primary care for LBP and an internet intervention with additional physiotherapist telephone support. Patients with current LBP and no indicators of serious spinal pathology are identified and invited via general practice list searches and mailouts or opportunistic recruitment following LBP consultations. Participants undergo a secondary screen for possible serious spinal pathology and are then asked to complete baseline measures online after which they are randomised to an intervention arm. Follow-ups occur at 6 weeks, 3, 6 and 12 months. The primary outcome is physical function (using the Roland and Morris Disability Questionnaire) over 12 months (repeated measures design). Secondary outcomes include pain intensity, troublesome days in pain over the last month, pain self-efficacy, catastrophising, kinesophobia, health-related quality of life and cost-related measures for a full health economic analysis. A full mixed-methods process evaluation will be conducted.Ethics and disseminationThis trial has been approved by a National Health Service Research Ethics Committee (REC Ref: 18/SC/0388). Results will be disseminated through peer-reviewed journals, conferences, communication with practices and patient groups. Patient representatives will support the implementation of our full dissemination strategy.Trial registration numberISRCTN14736486.

scholarly journals Effects of PACK guide training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians: a pragmatic cluster randomised controlled trial in Florianópolis, Brazil

2019 ◽  
Vol 4 (6) ◽  
pp. e001921
Author(s):  
Max Oscar Bachmann ◽  
Eric D Bateman ◽  
Rafael Stelmach ◽  
Alvaro A Cruz ◽  
Matheus Pacheco de Andrade ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Pulmonary Disease ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Link Type ◽  
To Receive

IntroductionThe Practical Approach to Care Kit (PACK) guide was localised for Brazil, where primary care doctors and nurses were trained to use it.MethodsTwenty-four municipal clinics in Florianópolis were randomly allocated to receive outreach training and the guide, and 24 were allocated to receive only the guide. 6666 adult patients with asthma or chronic obstructive pulmonary disease (COPD) were enrolled, and trial outcomes were measured over 12 months, using electronic medical records. The primary outcomes were composite scores of treatment changes and spirometry, and new asthma and COPD diagnosis rates.ResultsAsthma scores in 2437 intervention group participants were higher (74.8%, 20.4% and 4.8% with scores of 0, 1 and 2, respectively) than in 2633 control group participants (80.0%, 16.8% and 3.2%) (OR for higher score 1.32, 95% CI 1.08 to 1.61, p=0.006). Adjusted for asthma scores recorded in each clinic before training started, the OR was 1.24 (95% CI 1.03 to 1.50, p=0.022). COPD scores in 1371 intervention group participants (77.7%, 17.9% and 4.3% with scores of 0, 1 and 2) did not differ from those in 1181 control group participants (80.5%, 15.8% and 3.7%) (OR 1.21, 95% CI 0.94 to 1.55, p=0.142). Rates of new asthma and COPD diagnoses, and hospital admission, and indicators of investigation, diagnosis and treatment of comorbid cardiovascular disease, diabetes and depression, and tobacco cessation did not differ between trial arms.ConclusionPACK training increased guideline-based treatment and spirometry for asthma but did not affect COPD or comorbid conditions, or diagnosis rates.Trial registrationNCT02786030 (https://clinicaltrials.gov/).

scholarly journals A nurse led intermediate care package in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease

Thorax ◽  
2007 ◽  
Vol 63 (3) ◽  
pp. 194-200 ◽  
Author(s):  
M Sridhar ◽  
R Taylor ◽  
S Dawson ◽  
N J Roberts ◽  
M R Partridge
Keyword(s):  
Action Plan ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Chronic Obstructive ◽  
Intermediate Care ◽  
Obstructive Pulmonary Disease ◽  
Hospital Readmission Rate ◽  
Care Package ◽  
Oral Steroids

Objectives:To determine the effects of a nurse led intermediate care programme in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Design:Randomised controlled trial.Setting:Community and hospital care in west London.Participants:122 patients with COPD.Intervention:A care package incorporating initial pulmonary rehabilitation and self-management education, provision of a written, personalised COPD action plan, monthly telephone calls and 3 monthly home visits by a specialist nurse for a period of 2 years.Main outcome measure:Hospital readmission rate.Secondary outcomes:Unscheduled primary care consultations and quality of life.Results:There were no differences in hospital admission rates or in exacerbation rates between the two groups. Self-management of exacerbations was significantly different and the intervention group were more likely to be treated with oral steroids alone or oral steroids and antibiotics, and the initiators of treatment for exacerbations were statistically more likely to be the patients themselves. 12 patients in the control group died during the 2 year period, eight as a result of COPD, compared with six patients in the intervention group, of whom one died from COPD. This is a significant difference. When the numbers were adjusted to reflect the numbers still alive at 2 years, in the intervention group patients reported a total of 171 unscheduled contacts with their general practitioner (GP) and in the control group, 280 contacts. The number needed to treat was 0.558—ie, for every one COPD patient receiving the intervention and self-management advice, there were 1.79 fewer unscheduled contacts with the GP.Conclusions:An intermediate care package incorporating pulmonary rehabilitation, self-management education and the receipt of a written COPD action plan, together with regular nurse contact, is associated with a reduced need for unscheduled primary care consultations and a reduction in deaths due to COPD but did not affect the hospital readmission rate.

Latinos understanding the need for adherence in diabetes (LUNA-D): a randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes

2021 ◽  
Author(s):  
Gregory A Talavera ◽  
Sheila F Castañeda ◽  
Paulina M Mendoza ◽  
Maria Lopez-Gurrola ◽  
Scott Roesch ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Intervention Group ◽  
Self Management ◽  
Culturally Appropriate ◽  
Significant Group ◽  
Randomized Controlled ◽  
Federally Qualified Health Center

Abstract We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23–80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = −0.32, p &lt; .01, 95% CI −0.49, −0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = −0.35, p = &lt;.01) versus Usual Care (ΔHbA1c = −0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p &lt; .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.

scholarly journals Effectiveness of chronic obstructive pulmonary disease self-management interventions in primary care settings: a systematic review

2019 ◽  
Vol 25 (3) ◽  
pp. 195 ◽  
Author(s):  
Hassan Hosseinzadeh ◽  
Mahmmoud Shnaigat
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Self Efficacy ◽  
Randomised Controlled Trials ◽  
Self Management ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Primary Care Settings ◽  
Randomised Controlled

Chronic obstructive pulmonary disease (COPD) is one of the more disabling diseases and the third cause of mortality worldwide. Self-management is considered an effective strategy for controlling and managing COPD. This review aims to summarise the available evidence on the effectiveness of COPD self-management in primary care settings. Social Sciences, Citation Index, MEDLINE, CINAHL, Academic Search Complete and Scopus were searched for randomised controlled trials of COPD self-management in general practice between 2001 and 2018. Ten randomised controlled trials of COPD self-management trials conducted in primary care settings were included in this review. The identified trials have recruited stable patients; a majority having mild to moderate COPD. The trials implemented different types of interventions and measured improvements in knowledge, skills and behaviours of self-management, mental health, self-efficacy and endpoint outcomes such as hospitalisation and quality of life. The findings showed that COPD self-management trials had positive effects on COPD knowledge and improved self-management behaviours such as adherence to medication, physical activities and smoking cessation in some cases; however, the effect of trials on hospitalisation rate, quality of life and healthcare utilisation were not conclusive. There was also not enough evidence to suggest that the trials were efficient in improving self-efficacy, a major driver of self-management behaviours. Primary care COPD self-management trials are efficient in improving surrogate outcomes such as knowledge of and adherence to self-management behaviours; however, such improvements are less likely to be sustainable in the absence of self-efficacy. Future studies should also focus on improving endpoint self-management outcomes like hospitalisation rate and quality of life to benefit both patient and healthcare system.

scholarly journals Person-centred care by a combined digital platform and structured telephone support for people with chronic obstructive pulmonary disease and/or chronic heart failure: study protocol for the PROTECT randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036356
Author(s):  
Lilas Ali ◽  
Sara Wallström ◽  
Emmelie Barenfeld ◽  
Andreas Fors ◽  
Eva Fredholm ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Ethical Review ◽  
Chronic Obstructive ◽  
Telephone Support ◽  
Chronic Obstructive Pulmonary Disorder ◽  
Digital Platform ◽  
Randomised Controlled

BackgroundA core feature of chronic obstructive pulmonary disorder (COPD) and chronic heart failure (CHF) is that symptoms may change rapidly because of illness progression. Thus, these chronic conditions are associated with high rehospitalisation rates. Person-centred care (PCC) has been shown to have several benefits for patients with COPD or CHF (or both disorders) but it has not yet been investigated through e-health services.AimThe project aims to evaluate the effects of PCC by a combined digital platform and structured telephone support for people with COPD and/or CHF.Methods and analysisA randomised controlled trial with open, parallel groups which employs a participatory design process will be used. This project will also include process and health economic evaluation of the intervention.Ethics and disseminationEthical approval has been secured from the Regional Ethical Review Board in Gothenburg, Sweden (Dnr 063-17 and T063-18). Results will be presented at conferences and to healthcare professionals, participants and patient organisations. Findings will also be submitted for publication in peer-reviewed journals.Trial registration numberNCT03183817

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