scholarly journals Experiences of Complex Patients With Telemonitoring in a Nurse-Led Model of Care: Multimethod Feasibility Study (Preprint)

2020 ◽  
Author(s):  
Kayleigh Gordon ◽  
Katie N Dainty ◽  
Carolyn Steele Gray ◽  
Jane DeLacy ◽  
Amika Shah ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Patient Adherence ◽  
Care Delivery ◽  
Qualitative Interviews ◽  
Perceived Usefulness ◽  
Adherence Rate ◽  
Model Of Care ◽  
Care Needs ◽  
Complex Patients ◽  
At Home

BACKGROUND Telemonitoring (TM) interventions have been designed to support care delivery and engage patients in their care at home, but little research exists on TM of complex chronic conditions (CCCs). Given the growing prevalence of complex patients, an evaluation of multi-condition TM is needed to expand TM interventions and tailor opportunities to manage complex chronic care needs. OBJECTIVE This study aims to evaluate the feasibility and patients’ perceived usefulness of a multi-condition TM platform in a nurse-led model of care. METHODS A pragmatic, multimethod feasibility study was conducted with patients with heart failure (HF), hypertension (HTN), and/or diabetes. Patients were asked to take physiological readings at home via a smartphone-based TM app for 6 months. The recommended frequency of taking readings was dependent on the condition, and adherence data were obtained through the TM system database. Patient questionnaires were administered, and patient interviews were conducted at the end of the study. An inductive analysis was performed, and codes were then mapped to the normalization process theory and Implementation Outcomes constructs by Proctor. RESULTS In total, 26 participants were recruited, 17 of whom used the TM app for 6 months. Qualitative interviews were conducted with 14 patients, and 8 patients were interviewed with their informal caregiver present. Patient adherence was high, with patients with HF taking readings on average 76.6% (141/184) of the days they were asked to use the system and patients with diabetes taking readings on average 72% (19/26) of the days. The HTN adherence rate was 55% (29/52) of the days they were asked to use the system. The qualitative findings of the patient experience can be grouped into 4 main themes and 13 subthemes. The main themes were (1) making sense of the purpose of TM, (2) engaging and investing in TM, (3) implementing and adopting TM, and (4) perceived usefulness and the perceived benefits of TM in CCCs. CONCLUSIONS Multi-condition TM in nurse-led care was found to be feasible and was perceived as useful. Patients accepted and adopted the technology by demonstrating a moderate to high level of adherence across conditions. These results demonstrate how TM can address the needs of patients with CCCs through virtual TM assessments in a nurse-led care model by supporting patient self-care and keeping patients connected to their clinical team.

scholarly journals Experiences of Complex Patients With Telemonitoring in a Nurse-Led Model of Care: Multimethod Feasibility Study

JMIR Nursing ◽  
10.2196/22118 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e22118
Author(s):  
Kayleigh Gordon ◽  
Katie N Dainty ◽  
Carolyn Steele Gray ◽  
Jane DeLacy ◽  
Amika Shah ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Patient Adherence ◽  
Care Delivery ◽  
Qualitative Interviews ◽  
Perceived Usefulness ◽  
Adherence Rate ◽  
Model Of Care ◽  
Care Needs ◽  
Complex Patients ◽  
At Home

Background Telemonitoring (TM) interventions have been designed to support care delivery and engage patients in their care at home, but little research exists on TM of complex chronic conditions (CCCs). Given the growing prevalence of complex patients, an evaluation of multi-condition TM is needed to expand TM interventions and tailor opportunities to manage complex chronic care needs. Objective This study aims to evaluate the feasibility and patients’ perceived usefulness of a multi-condition TM platform in a nurse-led model of care. Methods A pragmatic, multimethod feasibility study was conducted with patients with heart failure (HF), hypertension (HTN), and/or diabetes. Patients were asked to take physiological readings at home via a smartphone-based TM app for 6 months. The recommended frequency of taking readings was dependent on the condition, and adherence data were obtained through the TM system database. Patient questionnaires were administered, and patient interviews were conducted at the end of the study. An inductive analysis was performed, and codes were then mapped to the normalization process theory and Implementation Outcomes constructs by Proctor. Results In total, 26 participants were recruited, 17 of whom used the TM app for 6 months. Qualitative interviews were conducted with 14 patients, and 8 patients were interviewed with their informal caregiver present. Patient adherence was high, with patients with HF taking readings on average 76.6% (141/184) of the days they were asked to use the system and patients with diabetes taking readings on average 72% (19/26) of the days. The HTN adherence rate was 55% (29/52) of the days they were asked to use the system. The qualitative findings of the patient experience can be grouped into 4 main themes and 13 subthemes. The main themes were (1) making sense of the purpose of TM, (2) engaging and investing in TM, (3) implementing and adopting TM, and (4) perceived usefulness and the perceived benefits of TM in CCCs. Conclusions Multi-condition TM in nurse-led care was found to be feasible and was perceived as useful. Patients accepted and adopted the technology by demonstrating a moderate to high level of adherence across conditions. These results demonstrate how TM can address the needs of patients with CCCs through virtual TM assessments in a nurse-led care model by supporting patient self-care and keeping patients connected to their clinical team.

scholarly journals Use of a Digital Medication Management System for Effective Assessment and Enhancement of Patient Adherence to Therapy (ReX): Feasibility Study (Preprint)

2018 ◽  
Author(s):  
Ronit Shtrichman ◽  
Stefan Conrad ◽  
Kai Schimo ◽  
Ran Shachar ◽  
Ehud Machluf ◽  
...  
Keyword(s):  
Real Time ◽  
Feasibility Study ◽  
Dose Regimen ◽  
Human Factor ◽  
Patient Adherence ◽  
Medication Management ◽  
Standard Of Care ◽  
Adherence Rate ◽  
Control Test ◽  
Adherence Data

BACKGROUND Medication nonadherence is a major problem in health care, imposing poor clinical outcomes and a heavy financial burden on all stakeholders. Current methods of medication adherence assessment are severely limited: they are applied only periodically, do not relate to actual pill intake, and suffer from patient bias due to errors, misunderstanding, or intentional nonadherence. ReX is an innovative medication management system designed to address poor patient adherence and enhance patient engagement with their therapy. ReX controls and tracks pills from the point of packaging right through to the patient’s mouth. ReX generates robust, real-time adherence data. The system enables patients to report outcomes, complete surveys, and receive messages and instructions. ReX includes a reusable drug dispensing unit, disposable cassette containing pills, and a cloud-based data portal. OBJECTIVE We aimed to evaluate ReX feasibility by human factor studies including evaluation of ReX safety; ReX acceptance and usability; and ReX efficacy of providing pills according to a preprogrammed dose regimen, managing reminders and adherence data, and enhancing the adherence rate compared with the standard of care. METHODS The ReX system was evaluated in 2 human factor, nonclinical feasibility studies. Human subjects used ReX for the administration of pill-shaped Tic Tac sweets. The initial study evaluated ReX use and pill intake administration; second was a self-controlled, 4-day home-use study. All subjects took pills at home, according to a preprogrammed dose regimen, for 4 days each via the device (ReX test) or from standard packaging (control test). The adherence rate (percent of pills taken) was measured by the study subject’s report, remaining pills count, and ReX records (in the ReX test). ReX safety and usability were evaluated by a questionnaire filled out by the subject. RESULTS The initial feasibility study evaluated usability and acceptance of the ReX novel approach to pill dispensing. All subjects successfully managed 2 pill intakes. The ReX device was rated as easy to use by 81% (48/59) of subjects. The 4-day home-use study evaluated the safety, efficacy, and usability of the ReX system. No adverse event occurred; no pill overdose or pill malformation was reported. The overall adherence rate in the ReX test was 97.6% compared with 76.3% in the control test (P<.001). Real-time, personalized reminders provided in the event of a delay in pill intake contributed to 18.0% of doses taken during the ReX test. The ReX system was found easy to use by 87% (35/40) of subjects; 90% (36/40) felt comfortable using it for their medication. CONCLUSIONS ReX’s novel “tracking to the mouth” technology was found usable and accepted by subjects. The assessment of adherence rates was reliable; adherence of subjects to the dose regimen was significantly enhanced when using ReX compared with the standard of care.

scholarly journals Succeeding with prolonged usage of consumer-based activity trackers in clinical studies: A mixed methods approach

2020 ◽  
Author(s):  
André Henriksen ◽  
Anne-Sofie Sand ◽  
Trygve Deraas ◽  
Sameline Grimsgaard ◽  
Gunnar Hartvigsen ◽  
...  
Keyword(s):  
Heart Rate ◽  
Energy Expenditure ◽  
Feasibility Study ◽  
Success Factors ◽  
Communicable Disease ◽  
Qualitative Interviews ◽  
Perceived Usefulness ◽  
Clinical Trial Registry ◽  
Wear Time ◽  
One Year

Abstract Background: Lack of physical activity (PA) is a risk factor for death and non-communicable disease. Despite this, more than one fourth of adults worldwide do not follow PA guidelines. As part of a feasibility study to test a complex intervention for increasing PA, we included a consumer-based activity tracker (AT) as a tool to measure PA outcomes and to track heart rate during exercise sessions. The aim of the present study was to identify factors that increase wear time when using a consumer-based AT for monitoring of participants in clinical research. Methods: Sixteen participants aged 55-74 years, with obesity, sedentary lifestyle, and elevated cardiovascular risk were recruited to a 12-month feasibility study. Participants wore a Polar M430 AT to collect continuous PA data during a six-month intervention followed by six months of follow-up. We performed quantitative wear time analysis, tested the validity of the AT, and completed two rounds of qualitative interviews to investigate how individual wear-time was linked to participant responses. Results: From one year of tracking, mean number of valid wear days were 292 (SD=86), i.e. 80%. The Polar M430 provides acceptable measurements for total energy expenditure. Motivations for increased wear time were that participants were asked to wear it and the ability to track PA progress. Perceived usefulness included time keeping, heart rate- and sleep tracking, becoming more conscious about day-to-day activity, and improved understanding of which activity types were more effective for energy expenditure. Sources of AT annoyance were measurement inaccuracies and limited instruction for use. Suggestions for improvement were that the AT was big, unattractive, and complicated to use.Conclusions: Adherence to wearing a consumer-based AT was high. Results indicate that it is feasible to use a consumer-based AT to measure PA over a longer period. Potential success factors for increased wear time includes adequate instruction for AT use, allowing participants to choose different AT designs, and using trackers with accurate measurements. To identify accurate trackers, AT validation studies in the target cohort may be needed. Trial registration: U.S. National Library of Medicine, Clinical Trial registry: NCT03807323; Registered 16 September 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03807323

scholarly journals Importance of Patient Education for At-home Yoga Practice in Women With Hormonal Therapy-induced Pain During Adjuvant Breast Cancer Treatment: A Feasibility Study

2021 ◽  
Vol 20 ◽  
pp. 153473542110637
Author(s):  
Kerstin Faravel ◽  
Marie-Eve Huteau ◽  
Marta Jarlier ◽  
Hélène de Forges ◽  
Laetitia Meignant ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Education ◽  
Hormonal Therapy ◽  
Patient Adherence ◽  
Adherence Rate ◽  
Yoga Practice ◽  
Therapy Discontinuation ◽  
Adjuvant Breast Cancer ◽  
Articular Pain ◽  
At Home

Background Osteo-articular pain (OAP) is experienced by approximately 50% of women under hormonal therapy (HT) for breast cancer (BC), which increases the risk for therapy discontinuation. This study was aimed to assess benefits of yoga practice combined with patient education (PE) for at-home practice by evaluating feasibility among BC patients under HT and measuring OAP, flexibility and satisfaction. Methods Feasibility was evaluated by patient adherence as accomplishment of at least 4 out of 6 supervised yoga-PE sessions along with 70% or more at-home yoga sessions. Intervention (12 weeks) included two 6-weeks periods: P1 comprising one 90-minutes supervised yoga-PE session/week and 15-minutes daily at-home yoga and P2, daily autonomous at-home yoga sessions. Evaluations (at inclusion and by the end of each period) consisted in assessment of OAP on Visual Analog Scale (VAS), forward flexibility (cm) and patient satisfaction on Likert (0-10 points) scale. Results Between September 2018 and May 2019 we included 24 patients of median 53 years (range 36-72). Feasibility was validated by 83% successful adherence rate. Pain was significantly reduced from median VAS of 6 [range 4-10] to 4 [range 0-7] at the end of both P1 and P2 ( p < 0.01), albeit with no difference between P1 and P2. Forward flexibility improved by a median gain of 8 cm (end of P2) and median satisfaction score of 10/10 [range 8-10]. Conclusion Combined physiotherapy-yoga-PE intervention is a feasible strategy to increase at-home yoga practice with potential benefit on pain, flexibility, and satisfaction, thus prompting further evaluations in larger randomized multicenter trials. ClinicalTrials.gov NCT04001751

scholarly journals Exploring an Innovative Care Model and Telemonitoring for the Management of Patients With Complex Chronic Needs: Qualitative Description Study

JMIR Nursing ◽  
10.2196/15691 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e15691 ◽  
Author(s):  
Kayleigh Gordon ◽  
Carolyn Steele Gray ◽  
Katie N Dainty ◽  
Jane DeLacy ◽  
Patrick Ware ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Conditions ◽  
Chronic Care ◽  
Care Delivery ◽  
Models Of Care ◽  
Integrated Model ◽  
Qualitative Description ◽  
Model Of Care ◽  
Care Needs ◽  
Delivery Models

Background The growing number of patients with complex chronic conditions presents an urgent challenge across the Canadian health care system. Current care delivery models are overburdened, struggling to monitor and stabilize the complex needs of this growing patient population. Objective This qualitative study aimed to explore the needs and perspectives of patients and members of the care team to inform the development of an innovative integrated model of care and the needs of telemonitoring (TM) for patients with complex chronic conditions. Furthermore, we explored how these needs could be successfully embedded to support this novel model of complex chronic care. Methods A qualitative description design was utilized to conduct and analyze 29 semistructured interviews with patients (n=16) and care team members (CTM) (n=13) involved in developing the model of care in an ambulatory care facility in Southern Ontario. Participants were identified through purposive sampling. Two researchers performed an iterative thematic analysis using NVivo 12 (QSR International; Melbourne, Australia) to gain insights from examining multiple perspectives of different participants on complex chronic care needs. Results The analysis revealed 3 themes and 13 subthemes, including the following: (1) adequate health care delivery remains challenging for patients with complex care needs, (2) insights into how to structure an integrated care model, and (3) opportunities for TM in an integrated model of care. Participants not only identified continued challenges in accessing and navigating care in a fragmented and disconnected delivery system but also identified the need for more self-management support. Patients and CTM described the structure of an integrated model of care, including the need for a clear referral and triage processes and composing a tight-knit circle of collaborating interdisciplinary providers led by a nurse practitioner (NP). Finally, opportunities for TM in an integrated model of care were identified, including increasing access and communication, the ability to monitor specific signs and symptoms, and building a clinical workflow around TM-enabled care. Conclusions Despite entrenched health care service delivery models, a new model of care is acutely needed to care for patients with complex chronic needs (CCN). NPs are in a unique position to lead TM-enabled integrated models of care. TM can facilitate frequent and necessary monitoring of patients with CCN with more than one condition in integrated models of care.

scholarly journals Succeeding with prolonged usage of consumer-based activity trackers in clinical studies: A mixed methods approach

2020 ◽  
Author(s):  
André Henriksen ◽  
Anne-Sofie Sand ◽  
Trygve Deraas ◽  
Sameline Grimsgaard ◽  
Gunnar Hartvigsen ◽  
...  
Keyword(s):  
Heart Rate ◽  
Feasibility Study ◽  
Success Factors ◽  
Communicable Disease ◽  
Qualitative Interviews ◽  
Perceived Usefulness ◽  
Clinical Trial Registry ◽  
Wear Time ◽  
One Year ◽  
Study Participants

Abstract Background: Lack of physical activity (PA) is a risk factor for death and non-communicable disease. Despite this, more than one fourth of adults worldwide do not follow PA guidelines. As part of a feasibility study to test a complex intervention for increasing PA, we included a consumer-based activity tracker (AT) as a tool to measure PA outcomes and to track heart rate during exercise sessions. The aim of the present study was to identify factors that increase wear time when using a consumer-based AT for participant monitoring in clinical research. Methods: Sixteen participants aged 55-74 years, with obesity, sedentary lifestyle, and elevated cardiovascular risk, were recruited to a 12-month feasibility study. Participants wore a Polar M430 AT to collect continuous PA data during a six-month intervention followed by six months of follow-up. We performed quantitative wear time analysis, tested the validity of the AT, and completed two rounds of qualitative interviews to investigate how individual wear-time was linked to participant responses. Results: From one year of tracking, mean number of valid wear days were 292 (SD=86), i.e. 80%. The Polar M430 provides acceptable measurements for total energy expenditure. Motivations for increased wear time were that participants were asked to wear it, and the ability to track PA progress. Perceived usefulness included time keeping, heart rate- and sleep tracking, becoming more conscious about day-to-day activity, and improved understanding of activity types effectiveness. Sources of AT annoyance were measurement inaccuracies and limited instruction for use. Suggestions for improvement were that the AT was big, unattractive, and too complicated to use.Conclusions: Adherence to wearing a consumer-based AT was high. Results indicate that it is feasible to use a consumer-based AT to measure PA over a longer period. Potential success factors for increased wear time includes adequate instruction for AT use, allowing participant to choose between different AT designs, and using trackers with accurate measurements. To identify accurate trackers, AT validation studies in the target cohort may be needed. Trial registration: U.S. National Library of Medicine, Clinical Trial registry: NCT03807323; Registered 16 September 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03807323

scholarly journals Exploring an Innovative Care Model and Telemonitoring for the Management of Patients With Complex Chronic Needs: Qualitative Description Study (Preprint)

2019 ◽  
Author(s):  
Kayleigh Gordon ◽  
Carolyn Steele Gray ◽  
Katie N Dainty ◽  
Jane DeLacy ◽  
Patrick Ware ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Conditions ◽  
Chronic Care ◽  
Care Delivery ◽  
Models Of Care ◽  
Integrated Model ◽  
Qualitative Description ◽  
Model Of Care ◽  
Care Needs ◽  
Delivery Models

BACKGROUND The growing number of patients with complex chronic conditions presents an urgent challenge across the Canadian health care system. Current care delivery models are overburdened, struggling to monitor and stabilize the complex needs of this growing patient population. OBJECTIVE This qualitative study aimed to explore the needs and perspectives of patients and members of the care team to inform the development of an innovative integrated model of care and the needs of telemonitoring (TM) for patients with complex chronic conditions. Furthermore, we explored how these needs could be successfully embedded to support this novel model of complex chronic care. METHODS A qualitative description design was utilized to conduct and analyze 29 semistructured interviews with patients (n=16) and care team members (CTM) (n=13) involved in developing the model of care in an ambulatory care facility in Southern Ontario. Participants were identified through purposive sampling. Two researchers performed an iterative thematic analysis using NVivo 12 (QSR International; Melbourne, Australia) to gain insights from examining multiple perspectives of different participants on complex chronic care needs. RESULTS The analysis revealed 3 themes and 13 subthemes, including the following: (1) adequate health care delivery remains challenging for patients with complex care needs, (2) insights into how to structure an integrated care model, and (3) opportunities for TM in an integrated model of care. Participants not only identified continued challenges in accessing and navigating care in a fragmented and disconnected delivery system but also identified the need for more self-management support. Patients and CTM described the structure of an integrated model of care, including the need for a clear referral and triage processes and composing a tight-knit circle of collaborating interdisciplinary providers led by a nurse practitioner (NP). Finally, opportunities for TM in an integrated model of care were identified, including increasing access and communication, the ability to monitor specific signs and symptoms, and building a clinical workflow around TM-enabled care. CONCLUSIONS Despite entrenched health care service delivery models, a new model of care is acutely needed to care for patients with complex chronic needs (CCN). NPs are in a unique position to lead TM-enabled integrated models of care. TM can facilitate frequent and necessary monitoring of patients with CCN with more than one condition in integrated models of care.

scholarly journals Succeeding with prolonged usage of consumer-based activity trackers in clinical studies: A mixed methods approach

2020 ◽  
Author(s):  
André Henriksen ◽  
Anne-Sofie Sand ◽  
Trygve Deraas ◽  
Sameline Grimsgaard ◽  
Gunnar Hartvigsen ◽  
...  
Keyword(s):  
Heart Rate ◽  
Energy Expenditure ◽  
Feasibility Study ◽  
Success Factors ◽  
Communicable Disease ◽  
Qualitative Interviews ◽  
Perceived Usefulness ◽  
Clinical Trial Registry ◽  
Wear Time ◽  
One Year

Abstract Background: Lack of physical activity (PA) is a risk factor for death and non-communicable disease. Despite this, more than one fourth of adults worldwide do not follow PA guidelines. As part of a feasibility study to test a complex intervention for increasing PA, we included a consumer-based activity tracker (AT) as a tool to measure PA outcomes and to track heart rate during exercise sessions. The aim of the present study was to identify factors that increase wear time when using a consumer-based AT for monitoring of participants in clinical research. Methods: Sixteen participants aged 55-74 years, with obesity, sedentary lifestyle, and elevated cardiovascular risk were recruited to a 12-month feasibility study. Participants wore a Polar M430 AT to collect continuous PA data during a six-month intervention followed by six months of follow-up. We performed quantitative wear time analysis, tested the validity of the AT, and completed two rounds of qualitative interviews to investigate how individual wear-time was linked to participant responses. Results: From one year of tracking, mean number of valid wear days were 292 (SD=86), i.e. 80%. The Polar M430 provides acceptable measurements for total energy expenditure. Motivations for increased wear time were that participants were asked to wear it and the ability to track PA progress. Perceived usefulness included time keeping, heart rate- and sleep tracking, becoming more conscious about day-to-day activity, and improved understanding of which activity types were more effective for energy expenditure. Sources of AT annoyance were measurement inaccuracies and limited instruction for use. Suggestions for improvement were that the AT was big, unattractive, and complicated to use.Conclusions: Adherence to wearing a consumer-based AT was high. Results indicate that it is feasible to use a consumer-based AT to measure PA over a longer period. Potential success factors for increased wear time includes adequate instruction for AT use, allowing participants to choose different AT designs, and using trackers with accurate measurements. To identify accurate trackers, AT validation studies in the target cohort may be needed. Trial registration: U.S. National Library of Medicine, Clinical Trial registry: NCT03807323; Registered 16 September 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03807323

COVID 19 and Special Care Dentistry: A Narrative Review

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1473-1476
Author(s):  
Ashwika Datey ◽  
Soumya Singhai ◽  
Gargi Nimbulkar ◽  
Kumar Gaurav Chhabra ◽  
Amit Reche
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Services ◽  
Care Delivery ◽  
Special Care ◽  
World Health ◽  
Healthcare Sector ◽  
Health Care Needs ◽  
Oral Diseases ◽  
Care Needs

The COVID 19 outbreak has been declared a pandemic by the world health organisation. The healthcare sector was overburdened and overstretched with the number of patient increasing and requiring health services. The worst-hit population always are the people with special needs, whether it is children, pregnant females or the geriatric population. The need for the emergency kind of health services was so inflated that the other special population which required them equally as those patients with the COVID 19 suffered a lot. Dentistry was not an exception, and even that is also one of the important components of the health care delivery system and people requiring oral health care needs were also more. Those undergoing dental treatments would not have completed the treatment, and this would have resulted in various complications. In this situation, some dental emergency guidelines have been released by Centres for Disease Control (CDC) for the urgent dental care those requiring special care dentistry during the COVID 19 pandemic. Children with special care needs were considered more vulnerable to oral diseases; hence priority should have been given to them for dental treatments moreover in the future also more aggressive preventive measures should be taken in order to maintain oral hygiene and prevent many oral diseases. Guardians/caregivers should be made aware and motivated to maintain the oral health of children with special health care needs. This review mainly focuses on the prevention and management of oral diseases in children's with special care needs.

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