scholarly journals Understanding Gaps between Daily-Living and Clinical Settings in Chronic Disease Management (Preprint)

2020 ◽  
Author(s):  
Mustafa Ozkaynak ◽  
Rupa Valdez ◽  
Katia Hannah ◽  
Gina Woodhouse ◽  
Patrick Klem
Keyword(s):  
Health System ◽  
Daily Living ◽  
Information Technologies ◽  
Patient Adherence ◽  
Physical Workload ◽  
Collaborative Management ◽  
Clinical Settings ◽  
Health Information Technologies ◽  
Home Based ◽  
Health Related

BACKGROUND Management of chronic conditions entails numerous activities in both clinical and daily-living settings. Of course, activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily-living environments. OBJECTIVE The purpose of this study was to characterize gaps (from the patient’s perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an exemplar. We conceptualized gaps as latent phenomena (i.e., a break in continuity). METHODS Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain-based health system were recruited. Data was collected by primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data was analyzed qualitatively based on a theory-driven approach and framework method of analysis. RESULTS The causes of gaps included clinician recommendations not fitting into patient’s daily routines, recommendations not fitting into patients’ living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised patient adherence. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies. CONCLUSIONS Understanding gaps, their consequences, and mitigating strategies, can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health system and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily-living settings (i.e., limited number and types of routines that are tracked).

scholarly journals Understanding Gaps Between Daily Living and Clinical Settings in Chronic Disease Management: Qualitative Study

10.2196/17590 ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. e17590
Author(s):  
Mustafa Ozkaynak ◽  
Rupa Valdez ◽  
Katia Hannah ◽  
Gina Woodhouse ◽  
Patrick Klem
Keyword(s):  
Daily Living ◽  
Information Technologies ◽  
Mitigation Strategies ◽  
Physical Workload ◽  
Collaborative Management ◽  
Clinical Settings ◽  
Health Information Technologies ◽  
Home Based ◽  
Clinician Education ◽  
Health Related

Background Management of chronic conditions entails numerous activities in both clinical and daily living settings. Activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily living environments. Objective The aim of this study is to characterize gaps (from the patient’s perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an example. The causes, consequences, and mitigation strategies (reported by patients) were identified to understand these gaps. We conceptualized gaps as latent phenomena (ie, a break in continuity). Methods Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain health care system were recruited. Data were collected through primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data were analyzed qualitatively using a theory-driven approach and framework method of analysis. Results The causes of gaps included clinician recommendations not fitting into patients’ daily routines, recommendations not fitting into patients’ living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised adherence to the therapy plan. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies. Conclusions Understanding gaps, their consequences, and mitigating strategies can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health systems and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily living settings due to the limited number and types of routines that are tracked.

scholarly journals An Instrumented Glove-Controlled Portable Hand-Exoskeleton for Bilateral Hand Rehabilitation

Biosensors ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 495
Author(s):  
Shih-Hung Yang ◽  
Chia-Lin Koh ◽  
Chun-Hang Hsu ◽  
Po-Chuan Chen ◽  
Jia-Wei Chen ◽  
...  
Keyword(s):  
Daily Living ◽  
Hand Function ◽  
Hand Movement ◽  
Clinical Settings ◽  
Hand Rehabilitation ◽  
Rehabilitation Programs ◽  
Home Based ◽  
Instrumented Glove ◽  
Flexible Mechanism ◽  
Hand Exoskeleton

Effective bilateral hand training is desired in rehabilitation programs to restore hand function for people with unilateral hemiplegia, so that they can perform daily activities independently. However, owing to limited human resources, the hand function training available in current clinical settings is significantly less than the adequate amount needed to drive optimal neural reorganization. In this study, we designed a lightweight and portable hand exoskeleton with a hand-sensing glove for bilateral hand training and home-based rehabilitation. The hand-sensing glove measures the hand movement of the less-affected hand using a flex sensor. Thereafter, the affected hand is driven by the hand exoskeleton using the measured hand movements. Compared with the existing hand exoskeletons, our hand exoskeleton improves the flexible mechanism for the back of the hand for better wearing experience and the thumb mechanism to make the pinch gesture possible. We designed a virtual reality game to increase the willingness of repeated movement practice for rehabilitation. Our system not only facilitates bilateral hand training but also assists in activities of daily living. This system could be beneficial for patients with hemiplegia for starting correct and sufficient hand function training in the early stages to optimize their recovery.

A tactical framework for EMR adoption

2019 ◽  
Vol 32 (3) ◽  
pp. 148-152
Author(s):  
James Lambley ◽  
Craig Kuziemsky
Keyword(s):  
Information Technologies ◽  
Implementation Strategies ◽  
Improve Patient Care ◽  
Theoretical Models ◽  
Clinical Settings ◽  
Human Diversity ◽  
Health Information Technologies ◽  
Emr Adoption ◽  
Legacy Information Systems ◽  
Improve Patient

Hospitals and other health settings across Canada are transitioning from paper or legacy information systems to Electronic Medical Records (EMR) systems to improve patient care and service delivery. The literature speaks to benefits of EMR systems, but also challenges, such as adverse patient events and provider workflow interruptions. Theoretical models have been proposed to help understand the complex interaction between health information technologies and the healthcare environment, but a shortcoming is the transition from conceptual models to actual clinical settings. The health ecosystem is filled with human diversity and organizational culture considerations that cannot be separated from technical implementation strategies. This paper analyzes literature on EMR implementation and adoption to develop a tactical framework for EMR adoption. The framework consists of six categories, each with a set of seed questions to consider when leading technology adoption projects.

Telemedicine in Cancer Care

2018 ◽  
pp. 540-545 ◽  
Author(s):  
S. Joseph Sirintrapun ◽  
Ana Maria Lopez
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Cancer Care ◽  
Symptom Management ◽  
Lifestyle Modification ◽  
Clinical Settings ◽  
Home Based ◽  
Home Based Care ◽  
Care Costs ◽  
Improve Access

Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. Telemedicine has been tested in multiple clinical settings, demonstrating at least equivalency to in-person care and high levels of patient and health professional satisfaction. Teleoncology has been demonstrated to improve access to care and decrease health care costs. Teleconsultations may take place in a synchronous, asynchronous, or blended format. Examples of successful teleoncology applications include cancer telegenetics, bundling of cancer-related teleapplications, remote chemotherapy supervision, symptom management, survivorship care, palliative care, and approaches to increase access to cancer clinical trials. Telepathology is critical to cancer care and may be accomplished synchronously and asynchronously for both cytology and tissue diagnoses. Mobile applications support symptom management, lifestyle modification, and medication adherence as a tool for home-based care. Telemedicine can support the oncologist with access to interactive tele-education. Teleoncology practice should maintain in-person professional standards, including documentation integrated into the patient’s electronic health record. Telemedicine training is essential to facilitate rapport, maximize engagement, and conduct an accurate virtual exam. With the appropriate attachments, the only limitation to the virtual exam is palpation. The national telehealth resource centers can provide interested clinicians with the latest information on telemedicine reimbursement, parity, and practice. To experience the gains of teleoncology, appropriate training, education, as well as paying close attention to gaps, such as those inherent in the digital divide, are essential.

scholarly journals Brain Health: Attitudes towards Technology Adoption in Older Adults

Healthcare ◽  
2020 ◽  
Vol 9 (1) ◽  
pp. 23
Author(s):  
Nadir G. Abdelrahman ◽  
Raza Haque ◽  
Molly E. Polverento ◽  
Andrea Wendling ◽  
Courtney M. Goetz ◽  
...  
Keyword(s):  
Older Adults ◽  
Technology Adoption ◽  
Physical Health ◽  
Social Engagement ◽  
Information Technologies ◽  
New Technology ◽  
Handheld Devices ◽  
Brain Health ◽  
Use Of Technology ◽  
Health Related

(1) Background: There is increasing scholarly support for the notion that properly implemented and used, technology can be of substantial benefit for older adults. Use of technology has been associated with improved self-rating of health and fewer chronic conditions. Use of technology such as handheld devices by older adults has the potential to improve engagement and promote cognitive and physical health. However, although, literature suggests some willingness by older adults to use technology, simultaneously there are reports of a more cautious attitude to its adoption. Our objective was to determine the opinions towards information technologies, with special reference to brain health, in healthy older adults either fully retired or still working in some capacity including older adult workers and retired adults living in an independent elderly living community. We were especially interested in further our understanding of factors that may play a role in technology adoption and its relevance to addressing health related issues in this population; (2) Methods: Two focus groups were conducted in an inner-city community. Participants were older adults with an interest in their general health and prevention of cognitive decline. They were asked to discuss their perceptions of and preferences for the use of technology. Transcripts were coded for thematic analysis; (3) Results: Seven common themes emerged from the focus group interviews: physical health, cognitive health, social engagement, organizing information, desire to learn new technology, advancing technology, and privacy/security; and (4) Conclusions: This study suggests that in order to promote the use of technology in older adults, one needs to consider wider contextual issues, not only device design per se, but the older adult’s rationale for using technology and their socio-ecological context.

Health of the offspring of immigrants: the BaBi birth cohort study

2019 ◽  
Vol 27 (4) ◽  
pp. 298-300
Author(s):  
Céline Miani ◽  
Oliver Razum ◽  
Jacob Spallek
Keyword(s):  
Early Childhood ◽  
Cohort Study ◽  
Cultural Diversity ◽  
Health System ◽  
Epidemiological Data ◽  
Migration Background ◽  
Heterogeneous Population ◽  
Birth Cohort Study ◽  
German Health ◽  
Health Related

Abstract Children with a migration background are more at risk of health-related problems than those without a migration background. The German health system still does not adequately meet the challenges of on increasingly heterogeneous population, not least due to a lack of adequate epidemiological data and models. The BaBi study contributes to gaining new insights in the development of health inequalities due to cultural diversity in Germany, with a focus on pregnancy and early childhood.

Comparison of rates of adherence to oral chemotherapy medications filled through an internal health-system specialty pharmacy vs external specialty pharmacies

2020 ◽  
Vol 77 (14) ◽  
pp. 1118-1127
Author(s):  
Colleen C McCabe ◽  
Meagan S Barbee ◽  
Marley L Watson ◽  
Alyssa Billmeyer ◽  
Collin E Lee ◽  
...  
Keyword(s):  
Health System ◽  
Multiple Regression ◽  
Patient Adherence ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medication Possession Ratio ◽  
Primary Objective ◽  
Wilcoxon Test ◽  
Tumor Type ◽  
Specialty Pharmacy

Abstract Purpose The primary objective of the study described here was to compare rates of patient adherence to anticancer medications filled at an internal health system specialty pharmacy (HSSP) vs external specialty pharmacies. The primary outcome was the medication possession ratio (MPR), and the secondary outcomes included proportion of days covered (PDC), and time to treatment (TTT). Methods A retrospective chart review was conducted to compare the MPR, PDC, and TTT for patients who received oral anticancer therapy using prescriptions claim data. A t test or Wilcoxon test was used to explore the effect of demographic and other factors on adherence and TTT. A multiple regression model with backward elimination was used to analyze significant factors to identify covariates significantly associated with the outcomes. Results Of the 300 patients screened for study inclusion, 204 patients whose records had complete MPR and PDC data and 164 whose records had TTT data were included in the analysis. There were significant between-group differences in mean MPR and mean PDC with patient use of the HSSP vs external pharmacies (1.00 vs 0.75 [P < 0.001] and 0.95 vs 0.7 [P < 0.001], respectively). Pharmacy type (P = 0.024) and tumor type (P = 0.048) were significantly associated with TTT. Conclusion The multiple regression analysis indicated that oncology patients who filled their anticancer medication precriptions at an internal HSSP at an academic medical center had significantly higher adherence, as measured by MPR and PDC, and quicker TTT than those who filled their prescriptions at an external specialty pharmacy.

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