scholarly journals Factors Affecting the Implementation of Electronic Antiretroviral Therapy Adherence Monitoring and Associated Interventions for Routine HIV Care in Uganda: Qualitative Study

10.2196/18038 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e18038
Author(s):  
Jessica E Haberer ◽  
Lindsey Garrison ◽  
John Bosco Tumuhairwe ◽  
Robert Baijuka ◽  
Edna Tindimwebwa ◽  
...  
Keyword(s):  
Health Care ◽  
Antiretroviral Therapy ◽  
Clinical Outcomes ◽  
Care Delivery ◽  
Low Cost ◽  
Clinical Care ◽  
Hiv Care ◽  
Health Care Administrators ◽  
Adherence Monitoring ◽  
Data Informed

Background High, sustained adherence to HIV antiretroviral therapy (ART) is critical for achieving viral suppression, which in turn leads to important individual health benefits and reduced secondary viral transmission. Electronic adherence monitors record a date-and-time stamp with each opening as a proxy for pill-taking behavior. These monitors can be combined with interventions (eg, data-informed adherence counseling, SMS-based adherence support, and/or alarms) and have been shown to improve adherence in multiple settings. Their use, however, has largely been limited to the research context. Objective The goal of the research was to use the Consolidated Framework for Implementation Research (CFIR) to understand factors relevant for implementing a low-cost electronic adherence monitor and associated interventions for routine HIV clinical care in Uganda. Methods We conducted in-depth qualitative interviews with health care administrators, clinicians, and ART clients about likes and dislikes of the features and functions of electronic adherence monitors and associated interventions, their potential to influence HIV care, suggestions on how to measure their value, and recommendations for their use in routine care. We used an inductive, content analysis approach to understand participant perspectives, identifying aspects of CFIR most relevant to technology implementation in this setting. Results We interviewed 34 health care administrators/clinicians and 15 ART clients. Participants largely saw the monitors and associated interventions as favorable and beneficial for supporting adherence and improving clinical outcomes through efficient, differentiated care. Relevant outside factors included structural determinants of health, international norms around supporting adherence, and limited funding that necessitates careful assessment of costs and benefits. Within the clinic, the adherence data were felt likely to improve the quality of counseling and thereby morale, as well as increase the efficiency of care delivery. Existing infrastructure and care expenditures and the need for proper training were other noted considerations. At the individual level, the desire for good health and a welcomed pressure to adhere favored uptake of the monitors, although some participants were concerned with clients not using the monitors as planned and the influence of poverty, stigma, and need for privacy. Finally, participants felt that decisions around the implementation process would have to come from the Ministry of Health and other funders and would be influenced by sustainability of the technology and the target population for its use. Coordination across the health care system would be important for implementation. Conclusions Low-cost electronic adherence monitoring combined with data-informed counseling, SMS-based support, and/or alarms have potential for use in routine HIV care in Uganda. Key metrics of successful implementation will include their impact on efficiency of care delivery and clinical outcomes with careful attention paid to factors such as stigma and cost. Further theory-driven implementation science efforts will be needed to move promising technology from research into clinical care. Trial Registration ClinicalTrials.gov NCT03825952; https://clinicaltrials.gov/ct2/show/NCT03825952

scholarly journals Factors Affecting the Implementation of Electronic Antiretroviral Therapy Adherence Monitoring and Associated Interventions for Routine HIV Care in Uganda: Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Jessica E Haberer ◽  
Lindsey Garrison ◽  
John Bosco Tumuhairwe ◽  
Robert Baijuka ◽  
Edna Tindimwebwa ◽  
...  
Keyword(s):  
Health Care ◽  
Antiretroviral Therapy ◽  
Clinical Outcomes ◽  
Care Delivery ◽  
Low Cost ◽  
Clinical Care ◽  
Hiv Care ◽  
Health Care Administrators ◽  
Adherence Monitoring ◽  
Data Informed

BACKGROUND High, sustained adherence to HIV antiretroviral therapy (ART) is critical for achieving viral suppression, which in turn leads to important individual health benefits and reduced secondary viral transmission. Electronic adherence monitors record a date-and-time stamp with each opening as a proxy for pill-taking behavior. These monitors can be combined with interventions (eg, data-informed adherence counseling, SMS-based adherence support, and/or alarms) and have been shown to improve adherence in multiple settings. Their use, however, has largely been limited to the research context. OBJECTIVE The goal of the research was to use the Consolidated Framework for Implementation Research (CFIR) to understand factors relevant for implementing a low-cost electronic adherence monitor and associated interventions for routine HIV clinical care in Uganda. METHODS We conducted in-depth qualitative interviews with health care administrators, clinicians, and ART clients about likes and dislikes of the features and functions of electronic adherence monitors and associated interventions, their potential to influence HIV care, suggestions on how to measure their value, and recommendations for their use in routine care. We used an inductive, content analysis approach to understand participant perspectives, identifying aspects of CFIR most relevant to technology implementation in this setting. RESULTS We interviewed 34 health care administrators/clinicians and 15 ART clients. Participants largely saw the monitors and associated interventions as favorable and beneficial for supporting adherence and improving clinical outcomes through efficient, differentiated care. Relevant outside factors included structural determinants of health, international norms around supporting adherence, and limited funding that necessitates careful assessment of costs and benefits. Within the clinic, the adherence data were felt likely to improve the quality of counseling and thereby morale, as well as increase the efficiency of care delivery. Existing infrastructure and care expenditures and the need for proper training were other noted considerations. At the individual level, the desire for good health and a welcomed pressure to adhere favored uptake of the monitors, although some participants were concerned with clients not using the monitors as planned and the influence of poverty, stigma, and need for privacy. Finally, participants felt that decisions around the implementation process would have to come from the Ministry of Health and other funders and would be influenced by sustainability of the technology and the target population for its use. Coordination across the health care system would be important for implementation. CONCLUSIONS Low-cost electronic adherence monitoring combined with data-informed counseling, SMS-based support, and/or alarms have potential for use in routine HIV care in Uganda. Key metrics of successful implementation will include their impact on efficiency of care delivery and clinical outcomes with careful attention paid to factors such as stigma and cost. Further theory-driven implementation science efforts will be needed to move promising technology from research into clinical care. CLINICALTRIAL ClinicalTrials.gov NCT03825952; https://clinicaltrials.gov/ct2/show/NCT03825952

Consumer Wearables for Patient Monitoring in Otolaryngology: A State of the Art Review

2021 ◽  
pp. 019459982110616
Author(s):  
Shaan N. Somani ◽  
Katherine M. Yu ◽  
Alexander G. Chiu ◽  
Kevin J. Sykes ◽  
Jennifer A. Villwock
Keyword(s):  
Health Care ◽  
Clinical Outcomes ◽  
Behavioral Interventions ◽  
Early Recognition ◽  
Clinical Care ◽  
The United States ◽  
Major Surgery ◽  
Inpatient Setting ◽  
Biometric Data ◽  
Pubmed Search

Objective Consumer wearables, such as the Apple Watch or Fitbit devices, have become increasingly commonplace over the past decade. The application of these devices to health care remains an area of significant yet ill-defined promise. This review aims to identify the potential role of consumer wearables for the monitoring of otolaryngology patients. Data Sources PubMed. Review Methods A PubMed search was conducted to identify the use of consumer wearables for the assessment of clinical outcomes relevant to otolaryngology. Articles were included if they described the use of wearables that were designed for continuous wear and were available for consumer purchase in the United States. Articles meeting inclusion criteria were synthesized into a final narrative review. Conclusions In the perioperative setting, consumer wearables could facilitate prehabilitation before major surgery and prediction of clinical outcomes. The use of consumer wearables in the inpatient setting could allow for early recognition of parameters suggestive of poor or declining health. The real-time feedback provided by these devices in the remote setting could be incorporated into behavioral interventions to promote patients’ engagement with healthy behaviors. Various concerns surrounding the privacy, ownership, and validity of wearable-derived data must be addressed before their widespread adoption in health care. Implications for Practice Understanding how to leverage the wealth of biometric data collected by consumer wearables to improve health outcomes will become a high-impact area of research and clinical care. Well-designed comparative studies that elucidate the value and clinical applicability of these data are needed.

scholarly journals “Part of Getting to Where We Are is Because We Have Been Open to Change”Integrating Community Health Workers on Care Teams at Ten Ryan White HIV/AIDS Program Recipient Sites

2021 ◽  
Author(s):  
Linda Sprague Martinez ◽  
Melissa Davoust ◽  
Serena Rajabiun ◽  
Allyson Baughman ◽  
Sara Bachman ◽  
...  
Keyword(s):  
Health Care ◽  
Health Workers ◽  
Care Delivery ◽  
Implementation Strategies ◽  
Hiv Care ◽  
Organizational Policies ◽  
Ryan White ◽  
Aids Program ◽  
Group Interviews ◽  
Hiv Aids

Abstract Background: Community Health Workers (CHWs) have long been integrated in the delivery of HIV care, in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes.There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities. Methods: Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n=20). Findings: Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and TA strategies. Conclusions: Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for health care organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW implementation. The integration of the CHW role may present an occasion for health care delivery organizations to reassess policies that may unintentionally marginalize communities and both limit career opportunities and patient engagement.

Sensible use of observational clinical data

2011 ◽  
Vol 22 (1) ◽  
pp. 7-13 ◽  
Author(s):  
J Marc Overhage ◽  
Lauren M Overhage
Keyword(s):  
Health Care ◽  
Clinical Trials ◽  
Medical Research ◽  
Observational Data ◽  
Clinical Data ◽  
Low Cost ◽  
Clinical Care ◽  
Data Sets ◽  
Large Size ◽  
Health Care Operations

Observational data sets offer many potential advantages for medical research including their low cost, large size and generalisability. Because they are collected for clinical care and health care operations purposes, observational data sets have some limitations that must be considered in order to perform useful analyses. Sensible use of observational data sets can yield valuable insights, particularly when clinical trials are impractical.

Palliative and Spiritual Care of Persons with HIV and AIDS

2010 ◽  
Author(s):  
Mary Ann Cohen ◽  
Joseph Z. Lux
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Cultural Sensitivity ◽  
Care Delivery ◽  
Clinical Care ◽  
Symptom Control ◽  
Hiv And Aids ◽  
Hiv Care ◽  
Hospice Movement ◽  
Health Organization

Palliative care of persons with HIV and AIDS has changed over the course of the first three decades of the pandemic. The most radical shifts occurred in the second decade with the introduction of combination antiretroviral therapy and other advances in HIV care. In the United States and throughout the world, progress in prevention of HIV transmission has not kept pace with progress in treatment, thus the population of persons living with AIDS continues to grow. Furthermore, economic, psychiatric, social, and political barriers leave many persons without access to adequate HIV care. As a result, persons who lack access to care may need palliative care for late-stage AIDS while persons with access to AIDS treatments are more likely to need palliative care for multimorbid medical illnesses such as cardiovascular disease, cancer, pulmonary disease, and renal disease. Palliative care of persons with HIV and AIDS cannot be confined to the end of life. We present palliative care on a continuum as part of an effort to alleviate suffering and attend to pain, emotional distress, and existential anxiety during the course of the illness. We will provide guidelines for psychiatric and palliative care and pain management to help persons with AIDS cope better with their illnesses and live their lives to the fullest extent, and minimize pain and suffering for them and their loved ones. This chapter reviews basic concepts and definitions of palliative and spiritual care, as well as the distinct challenges facing clinicians involved in HIV palliative care. Finally, issues such as bereavement, cultural sensitivity, communication, and psychiatric contributions to common physical symptom control are reviewed. The terms palliative care and palliative medicine are often used interchangeably. Modern palliative care has evolved from the hospice movement into a more expansive network of clinical care delivery systems with components of home care and hospital-based services (Butler et al., 1996; Stjernsward and Papallona, 1998). Palliative care must meet the needs of the “whole person,” including the physical, psychological, social, and spiritual aspects of suffering (World Health Organization, 1990).

Human Factors–Based Mobile Application Design for Global Health

2018 ◽  
Vol 25 (6) ◽  
pp. 557-562 ◽  
Author(s):  
Tyson Schwab ◽  
John Langell
Keyword(s):  
Health Care ◽  
Global Health ◽  
Human Factors ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Mobile Apps ◽  
Low Cost ◽  
User Centered Design ◽  
App Development ◽  
Global Health Care

Background. The rapid adoption of smartphones and software applications (apps) has become prevalent worldwide, making these technologies nearly universally available. Low-cost mobile health (M-health) platforms are being rapidly adopted in both developed and emerging markets and have transformed the health care delivery landscape. Human factors optimization is critical to the safe and sustainable adoption of M-health solutions. The overall goal of engaging human factors requirements in the software app design process is to decrease patient safety risks while increasing usability and productivity for the end user. Methods. An extensive review of the literature was conducted using PubMed and Google search engines to identify best approaches to M-health software design based on human factors and user-centered design to optimize the usability, safety, and efficacy of M-health apps. Extracted data were used to create a health care app development algorithm. Results. A best practice algorithm for the design of mobile apps for global health care, based on the extracted data, was developed. The approach is based on an iterative 4-stage process that incorporates human factors and user-centered design processes. This process helps optimize the development of safe and effective mobile apps for use in global health care delivery and disease prevention. Conclusion. Mobile technologies designed for developing regions offer a potential solution to provide effective, low-cost health care. Applying human factors design principles to global health care app development helps ensure the delivery of safe and effective technologies tailored to the end-users requirements.

The Effects of a Practice Guideline on Endoscopic Sinus Surgery at an Academic Center

1997 ◽  
Vol 11 (2) ◽  
pp. 161-166 ◽  
Author(s):  
Michael G. Stewart ◽  
Edward J. Hillman ◽  
Donald T. Donovan ◽  
Sarper H. Tanli
Keyword(s):  
Health Care ◽  
Clinical Outcomes ◽  
Endoscopic Sinus Surgery ◽  
Care Delivery ◽  
Hospital Costs ◽  
Sinus Surgery ◽  
Care Process ◽  
Short Term ◽  
Academic Center ◽  
Median Hospital

Practice guidelines (PG) (or clinical pathways) are increasingly important tools for standardizing health care delivery, improving efficiency, monitoring quality, and controlling costs. Health services researchers divide the delivery of health care into three stages: structure, process, and outcome. PGs are a technique to standardize the process of health care delivery, which may result in improved clinical outcomes or may maintain clinical outcomes while increasing process efficiency and decreasing costs. We describe the development and implementation of a PG for endoscopic sinus surgery at an academic center, and report preliminary results on the effects of the PG on the health care process. The PG was developed using a multidisciplinary combination of consensus-building and evidence-based techniques. Initially, participation in the PG was voluntary and at the attending physician's discretion. One year after implementation of the PG, 41 patients had been enrolled by members of the medical school's full-time faculty. Process and short-term outcome variables on those patients were compared to a random sample of 50 patients treated by the same physicians, but not using the PG. There was no evidence of selection bias into the PG based on demographics, severity of sinusitis, or the presence of comorbid factors. There were no differences in time spent in the operating room, postanesthesia care unit, or day surgery observation unit, between patients using the PG and not using the PG. However, patients not using the PG had a significantly higher rate of unplanned admission. Patients using the PG had significantly lower median hospital costs and charges than did patients not using the PG. In addition, median hospital costs and charges decreased steadily for all patients (not just those using the PG), simultaneous with the development and implementation of the PG. There were no differences in short-term clinical outcomes between PG and non-PG patients. In summary, the development and implementation of a PG for endoscopic sinus surgery resulted in lower hospital costs and charges while maintaining acceptable short-term clinical outcomes. PGs have important implications for improving the efficiency of the health care process.

scholarly journals Nephrologists’ Attitudes Regarding Psychosocial Care in Hemodialysis Units

2021 ◽  
Vol 8 ◽  
pp. 205435812110374
Author(s):  
Aidan Lehecka ◽  
David Mendelssohn ◽  
Gavril Hercz
Keyword(s):  
Health Care ◽  
Kidney Failure ◽  
Response Rate ◽  
Care Delivery ◽  
Clinical Care ◽  
Psychosocial Care ◽  
Survey Questionnaire ◽  
Canadian Society ◽  
Psychosocial Needs ◽  
Survey Responses

Background: There is a high prevalence of psychosocial issues affecting patients with kidney failure. Objective: We sought to examine Canadian nephrologists’ attitudes and opinions regarding the importance of renal patient psychosocial care, nephrologists’ roles, and experience with psychosocial care in addition to what barriers, if any, prevent these physicians from providing psychosocial care to their patients. Design: A self-administered, survey questionnaire. Setting: Online. Sample: Canadian Society of Nephrology members who predominantly work in clinical care with adult, in-center hemodialysis patients. Measurements: Measurements of the survey include demographics, training, and nephrologists’ opinions regarding their role in administering psychosocial care, potential administrative and patient time constraints, accessibility of other health care workers for this activity, and factors that influence or impede physicians’ ability to address their patients’ psychosocial needs. Methods: A self-administered survey was sent to almost 500 members of the Canadian Society of Nephrology between November 2018 and December 2018. The survey questionnaire was designed to gather opinions and attitudes on psychosocial care delivery as well as potential influencing factors on nephrologists’ ability to provide this care. A univariate statistical analysis was used to analyze survey responses. Results: A total of 30 nephrologists responded to the survey, generating a 6% response rate. Respondents varied across provinces, with the majority being staff nephrologists (80%). While over 94% of respondents either agreed or strongly agreed that focus on psychosocial care improves patient outcomes, only 43% felt that staff nephrologists were suited to provide this care to patients; 97% of respondents believed social workers to be the most suited to provide this. Lack of additional supporting health care members, the need for additional training, too many administrative duties, and empathy fatigue were some of the predominant barriers respondents felt prevented them from addressing the psychosocial care of their patients. Limitations: A low response rate for the survey was obtained, roughly 6%, limiting our ability to draw definitive conclusions. Survey answers by respondents may be different from those by nonrespondents. Answers may be subject to social desirability and/or selection bias. Conclusion: Nephrologists believe that the current psychosocial care of patients in hemodialysis units is inadequate. However, further research is necessary to elucidate the barriers nephrologists face in providing psychosocial care and the changes required to most effectively implement optimal psychosocial care for patients with kidney failure in hemodialysis units.

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