A patient-centered mobile intervention to promote self-management and improve patient outcomes in chronic heart failure: The ManageHF4Life trial (Preprint)

2020 ◽  
Author(s):  
Michael P. Dorsch ◽  
Karen B. Farris ◽  
Brigid E. Rowell ◽  
Scott L. Hummel ◽  
Todd M. Koelling
Keyword(s):  
Heart Failure ◽  
Mobile Application ◽  
Controlled Trial ◽  
Intervention Group ◽  
Self Care ◽  
Self Management ◽  
Control Group ◽  
Patient Centered ◽  
Self Monitoring ◽  
Heart Failure Questionnaire

BACKGROUND Successful management of heart failure (HF) involves guideline based medical therapy as well as self-care behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. OBJECTIVE Evaluate the effectiveness of a mobile application intervention that enhances self-monitoring on health-related quality of life, self-management, and reduces HF readmissions. METHODS A single-center randomized controlled trial was performed. Patients greater than 45 years of age and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group used a mobile application (App). The intervention prompted daily self-monitoring and promoted self-management. The control group (No App) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire and recurrent HF admissions. RESULTS Eighty-three patients were enrolled and completed all baseline assessments. Baseline characteristics were similar between groups with the exception of HF etiology. The App group had a reduced MLHFQ at 6 weeks (37.5 ± 3.5 vs. 48.2 ± 3.7, P=0.039) but not at 12 weeks (44.2 ± 4 vs. 45.9 ± 4, P=0.778) compared to No App. There was no effect of the App on the SCHFI at 6 or 12 weeks. The time to first HF admission was not statistically different between the App versus No App groups (HR 0.89, 95% CI 0.39-2.02, P=0.781) over 12 weeks. CONCLUSIONS The mobile application intervention improved MLHFQ at 6 weeks, but did not sustain its effects at 12 weeks. No effect was seen on HF self-care. Further research is needed to enhance engagement in the application for a longer period of time and to determine if the application can reduce HF admissions in a larger study. CLINICALTRIAL NCT03149510

Effectiveness of Asthma Self-Care Program Through Mobile Line Application (SALA) on Lung Function among Asthma Patients in Angthong Hospital: A Randomized Control Trial

2021 ◽  
Vol 104 (2) ◽  
pp. 264-270
Keyword(s):  
Lung Function ◽  
Usual Care ◽  
Controlled Trial ◽  
Demographic Data ◽  
Intervention Group ◽  
Self Care ◽  
Care Program ◽  
Self Management ◽  
Control Group ◽  
Asthma Patients

Background: Asthma is a disease that causes a lot of suffering. It becomes a hurdle in everyday life. Asthma self-care program through mobile Line application (SALA) might be a good choice to help resolving this problem. Objective: To evaluate effectiveness of SALA program among asthma patients. Materials and Methods: The present study was a randomized controlled trial. The study sample consisted of 62 participants aged between 20 to 60 years with mild to moderate asthma. The study sample were randomly assigned to intervention plus usual care (intervention group, n=31) or usual care (control group, n=31) by computer generated. SALA program was sent to participants once a week for two months through their mobile phone, drug reminder appointment date for four months. The study period was six months. Clinical record form and Questionnaire were adapted to collect the demographic data and lung function via spirometer as FEV₁, FVC, FEV₁/FVC, PEFR, ACS, knowledge, attitude, and self-management. Mini Asthma Quality of Life (QOL) questionnaire was used to collect the data. Intention to treat (ITT), Repeated ANOVA, and General Linear model were statistical technique used to analyze the data. Results: Data from 60 asthma patients were available for analyses. The baseline characteristics of both groups were not significantly different. There were statistically significant mean differences in between the groups at three and six months. The mean difference in the following variables were FEV₁ 13.83 (5.01 to 22.65) FVC, 13.36 (2.62 to 24.09) FEV₁/FVC, 11.65 (4.8 to 18.49), PEFR 9.85 (0.03 to 19.67), ACS 2.45 (0.62 to 4.27), knowledge 2.64 (0.81 to 4.46), and self-management 4.26 (2.00 to 6.52). Conclusion: SALA improved knowledge, self-management, asthma status, and lung function among asthma patients. Keywords: Asthma, Self-care program, Mobile line application

An improvement in self-care behaviour in heart failure patients lead to better management of hypertension

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D.S Sahlin ◽  
S Gerward
Keyword(s):  
Heart Failure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Controlled Trial ◽  
Intervention Group ◽  
Self Care ◽  
Control Group ◽  
Chi Square ◽  
Home Based ◽  
Number Of Patients

Abstract Background A common heart failure (HF) aetiology is hypertension (HTN), second only to ischemic heart disease and with a prevalence in the HF community of between 62% and 84%, depending on sex and ejection-fraction. Undertreated HTN leads to worse prognosis and resistant HTN is defined as blood pressure (BP) exceeding 140/90 mmHg, in spite of pharmacological treatment. Since one constituent of self-care behaviour is treatment adherence, we wished to study whether patients exposed to a digital intervention shown to improve self-care behaviour, would also display improved BP control. Methods SMART-HF was a randomized controlled trial, recruiting patients from seven centres in Region Skåne in southern Sweden, where patients in the intervention group (IG) were equipped with a digital home-based tool, designed to enhance self-care behaviour for HF-patients and the control group (CG) were subject to standard care. BP data was registered at baseline and after eight months of intervention and self-care behaviour was measured using the European Heart Failure Self-care Behaviour Scale (EHFScB). We used a Chi-square test to analyse whether there was an inter-group difference of prevalence of resistant HTN or a mean arterial pressure (MAP) outside the recommended range of 60 mmHg < MAP <100 mmHg. Results Out of the 118 patients included in the original analysis, 92 (78%) had complete BP measurements. At baseline there was no difference in self-care behaviour between the groups, with CG: 25 [17.5; 32] and IG: 24.5 [18; 30], p=0.61, and 28% of the CG patients and 24% of the IG population displayed resistant HTN, p=0.73. After eight months of intervention the IG had 21% (or 4.5 points) better self-care behaviour compared to the CG, p=0.014, and the fraction of patients with resistant HTN was 30% for the CG and 11% for the IG, p=0.027. There was also a significant effect on the fraction of patients having a MAP >100 mmHg, with 22% in the CG versus 16% in the IG having MAP >100 mmHg at baseline (p=0.39) and 19% in the CG versus 0% in the IG at follow-up (p=0.002). Conclusions There was a significant improvement in self-care behaviour and also a significant reduction in the number of patients with resistant hypertension and elevated mean arterial pressure after eight months of intervention. Funding Acknowledgement Type of funding source: None

scholarly journals Proof-of-concept trial results of the HeartMan mobile personal health system for self-management in congestive heart failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Els Clays ◽  
Paolo Emilio Puddu ◽  
Mitja Luštrek ◽  
Giovanni Pioggia ◽  
Jan Derboven ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health System ◽  
Exercise Capacity ◽  
Illness Perception ◽  
Intervention Group ◽  
Self Care ◽  
Self Management ◽  
Personal Health ◽  
Control Group ◽  
Proof Of Concept

AbstractThis study tested the effectiveness of HeartMan—a mobile personal health system offering decisional support for management of congestive heart failure (CHF)—on health-related quality of life (HRQoL), self-management, exercise capacity, illness perception, mental and sexual health. A randomized controlled proof-of-concept trial (1:2 ratio of control:intervention) was set up with ambulatory CHF patients in stable condition in Belgium and Italy. Data were collected by means of a 6-min walking test and a number of standardized questionnaire instruments. A total of 56 (34 intervention and 22 control group) participants completed the study (77% male; mean age 63 years, sd 10.5). All depression and anxiety dimensions decreased in the intervention group (p < 0.001), while the need for sexual counselling decreased in the control group (p < 0.05). Although the group differences were not significant, self-care increased (p < 0.05), and sexual problems decreased (p < 0.05) in the intervention group only. No significant intervention effects were observed for HRQoL, self-care confidence, illness perception and exercise capacity. Overall, results of this proof-of-concept trial suggest that the HeartMan personal health system significantly improved mental and sexual health and self-care behaviour in CHF patients. These observations were in contrast to the lack of intervention effects on HRQoL, illness perception and exercise capacity.

scholarly journals Effect of an orientation group for patients with chronic heart failure: randomized controlled trial

2018 ◽  
Vol 25 (0) ◽  
Author(s):  
Cristina Silva Arruda ◽  
Juliana de Melo Vellozo Pereira ◽  
Lyvia da Silva Figueiredo ◽  
Bruna dos Santos Scofano ◽  
Paula Vanessa Peclat Flores ◽  
...  
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trial ◽  
Chronic Heart Failure ◽  
Controlled Trial ◽  
Intervention Group ◽  
Self Care ◽  
Control Group ◽  
Adherence To Treatment ◽  
Randomized Controlled ◽  
Orientation Group

ABSTRACT Objective: To evaluate the effect of the orientation group on therapeutic adherence and self-care among patients with chronic heart failure. Method: Randomized controlled trial with 27 patients with chronic heart failure. The intervention group received nursing consultations and participated in group meetings with the multi-professional team. The control group only received nursing consultations in a period of four months. Questionnaires validated for use in Brazil were applied in the beginning and in the end of the study to assess self-care outcomes and adherence to treatment. Categorical variables were expressed through frequency and percentage distributions and the continuous variables through mean and standard deviation. The comparison between the initial and final scores of the intervention and control groups was done through the Student’s t-test. Results: The mean adherence in the intervention group was 13.9 ± 3.6 before the study and 4.8 ± 2.3 after the study. In the control group it was 14.2 ± 3.4 before the study and 14.7 ± 3.5 after the study. The self-care confidence score was lower after the intervention (p=0.01). Conclusion: The orientation group does not improve adherence to treatment and self-care management and maintenance and it may reduce confidence in self-care. Registry REBEC RBR-7r9f2m.

scholarly journals Family Support-Based Intervention Using A Mobile Application By Pharmacists For Older Adults With Diabetes: A Randomised Controlled Trial

2021 ◽  
Author(s):  
Potjana Poonprapai ◽  
Sanguan Lerkiatbundit ◽  
Woranuch - Saengcharoen
Keyword(s):  
Family Support ◽  
Mobile Application ◽  
Controlled Trial ◽  
Intervention Group ◽  
The Elderly ◽  
Self Management ◽  
Control Group ◽  
Diabetes Knowledge ◽  
Randomised Controlled ◽  
Family Behaviour

Abstract Background Family support is crucial in the care of elderly patients with diabetes. Pharmacists have proven to play an important role in assisting patients to achieve goals of drug therapy. However, more information is needed to evaluate the potential benefits of family-based intervention through a mobile application by pharmacists in the elderly diabetes patients.Objective To evaluate the influences of family support-based intervention using a mobile application on glycaemic control and diabetes control-related outcomes in the older adults with diabetes. Setting A hospital in the south of Thailand.Method A randomised controlled trial was conducted with 9 months of follow-up. Family members in the intervention group (n = 78) received diabetes educational courses and encouragement via a mobile application from pharmacists to help their elderly relatives with diabetes in self-management tasks. The control group received usual care (n = 79). Main outcome measure Glycosylated haemoglobin (HbA1c).Results As compared to baseline, significant improvements were observed in the intervention patients for HbA1c, blood pressure, family behaviour in diabetes care, diabetes knowledge, self-management practices and medication adherence (P < 0.001). The intervention group showed greater decline in HbA1c levels relative to the control group (-0.97% vs. -0.12%; P = 0.001). Significant differences between groups for changes in blood pressure levels including scores of family behaviour, diabetes knowledge, self-management and medication adherence were found (P < 0.001), with the intervention group showing greater improvement. Conclusion Family support intervention via a mobile application by pharmacists is beneficial to diabetes care for the elderly. Trial registration number: TCTR20200615001 (date 13 June 2020, retrospectively registered).

Self-care educational intervention to reduce hospitalisations in heart failure: A randomised controlled trial

2017 ◽  
Vol 17 (2) ◽  
pp. 178-185 ◽  
Author(s):  
M Boyde ◽  
R Peters ◽  
N New ◽  
R Hwang ◽  
T Ha ◽  
...  
Keyword(s):  
Heart Failure ◽  
Randomised Controlled Trial ◽  
Educational Intervention ◽  
Hospital Readmission ◽  
Controlled Trial ◽  
Intervention Group ◽  
Self Care ◽  
Control Group ◽  
Patients With Heart Failure ◽  
Randomised Controlled

Background: A variety of educational interventions have been implemented to assist patients with heart failure to maintain their own health, develop self-care behaviours and decrease readmissions. Aims: The purpose of this study was to determine the effectiveness of a multimedia educational intervention for patients with heart failure in reducing unplanned hospital readmissions. Methods: The study, a randomised controlled trial in a large tertiary referral hospital in Australia, recruited 200 patients. Patients diagnosed with heart failure were randomly allocated 1:1 to usual education or a multimedia educational intervention. The multimedia approach began with an individual needs assessment to develop an educational plan. The educational intervention included viewing a DVD, and verbal discussion supported by a written manual with a teach-back evaluation strategy. The primary outcome was all-cause unplanned hospital readmission at 28 days, three months and 12 months post-recruitment. The secondary outcomes were changes in knowledge and self-care behaviours at three months and 12 months post-recruitment. Results: At 12 months, data on 171 participants were analysed. There were 24 participants who had an unplanned hospital readmission in the intervention group compared to 44 participants in the control group ( p=0.005). The self-care educational intervention reduced the risk of readmission at 12 months by 30% (relative risk: 0.703; 95% confidence interval: 0.548–0.903). Conclusion: A targeted multimedia educational intervention can be effective in reducing all-cause unplanned readmissions for people with heart failure.

scholarly journals Mobile Health to Improve Adherence and Patient Experience in Heart Transplantation Recipients: The mHeart Trial

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 463
Author(s):  
Mar Gomis-Pastor ◽  
Sonia Mirabet Perez ◽  
Eulalia Roig Minguell ◽  
Vicenç Brossa Loidi ◽  
Laura Lopez Lopez ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Patient Experience ◽  
Mobile Application ◽  
Standard Care ◽  
Controlled Trial ◽  
Intervention Group ◽  
Group Versus ◽  
Control Group ◽  
P Value ◽  
Adherence Score

Non-adherence after heart transplantation (HTx) is a significant problem. The main objective of this study was to evaluate if a mHealth strategy is more effective than standard care in improving adherence and patients’ experience in heart transplant recipients. Methods: This was a single-center, randomized controlled trial (RCT) in adult recipients >1.5 years post-HTx. Participants were randomized to standard care (control group) or to the mHeart Strategy (intervention group). For patients randomized to the mHeart strategy, multifaceted theory-based interventions were provided during the study period to optimize therapy management using the mHeart mobile application. Patient experience regarding their medication regimens were evaluated in a face-to-face interview. Medication adherence was assessed by performing self-reported questionnaires. A composite adherence score that included the SMAQ questionnaire, the coefficient of variation of drug levels and missing visits was also reported. Results: A total of 134 HTx recipients were randomized (intervention N = 71; control N = 63). Mean follow-up was 1.6 (SD 0.6) years. Improvement in adherence from baseline was significantly higher in the intervention group versus the control group according to the SMAQ questionnaire (85% vs. 46%, OR = 6.7 (2.9; 15.8), p-value < 0.001) and the composite score (51% vs. 23%, OR = 0.3 (0.1; 0.6), p-value = 0.001). Patients’ experiences with their drug therapy including knowledge of their medication timing intakes (p-value = 0.019) and the drug indications or uses that they remembered (p-value = 0.003) significantly improved in the intervention versus the control group. Conclusions: In our study, the mHealth-based strategy significantly improved adherence and patient beliefs regarding their medication regimens among the HTx population. The mHeart mobile application was used as a feasible tool for providing long-term, tailor-made interventions to HTx recipients to improve the goals assessed.

scholarly journals The Effects of Telemonitoring on Patient Compliance With Self-Management Recommendations and Outcomes of the Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure: Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Hang Ding ◽  
Rajiv Jayasena ◽  
Sheau Huey Chen ◽  
Andrew Maiorana ◽  
Alison Dowling ◽  
...  
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trial ◽  
Chronic Heart Failure ◽  
Patient Compliance ◽  
Controlled Trial ◽  
Care Program ◽  
Self Management ◽  
Control Group ◽  
Randomized Controlled ◽  
Management Recommendations

BACKGROUND Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but the objective assessment of patient compliance with self-management recommendations has seldom been studied. OBJECTIVE This study aimed to evaluate patient compliance with self-management recommendations of an innovative telemonitoring enhanced care program for CHF (ITEC-CHF). METHODS We conducted a multicenter randomized controlled trial with a 6-month follow-up. The ITEC-CHF program comprised the provision of Bluetooth-enabled scales linked to a call center and nurse care services to assist participants with weight monitoring compliance. Compliance was defined a priori as weighing at least 4 days per week, analyzed objectively from weight recordings on the scales. The intention-to-treat principle was used to perform the analysis. RESULTS A total of 184 participants (141/184, 76.6% male), with a mean age of 70.1 (SD 12.3) years, were randomized to receive either ITEC-CHF (n=91) or usual care (control; n=93), of which 67 ITEC-CHF and 81 control participants completed the intervention. For the compliance criterion of weighing at least 4 days per week, the proportion of compliant participants in the ITEC-CHF group was not significantly higher than that in the control group (ITEC-CHF: 67/91, 74% vs control: 56/91, 60%; <i>P</i>=.06). However, the proportion of ITEC-CHF participants achieving the stricter compliance standard of at least 6 days a week was significantly higher than that in the control group (ITEC-CHF: 41/91, 45% vs control: 23/93, 25%; <i>P</i>=.005). CONCLUSIONS ITEC-CHF improved participant compliance with weight monitoring, although the withdrawal rate was high. Telemonitoring is a promising method for supporting both patients and clinicians in the management of CHF. However, further refinements are required to optimize this model of care. CLINICALTRIAL Australian New Zealand Clinical Trial Registry ACTRN12614000916640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366691

Evaluating the effects of a mindfulness mobile application on student pharmacists’ stress, burnout, and mindfulness

2021 ◽  
Author(s):  
Angela Chu ◽  
Tyler M Rose ◽  
Danielle A Gundrum ◽  
Tressa E McMorris ◽  
Eytan A Klausner ◽  
...  
Keyword(s):  
Mobile Application ◽  
Controlled Trial ◽  
Intervention Group ◽  
Secondary Outcome ◽  
Control Group ◽  
Intervention Period ◽  
Entire Study ◽  
Positive Effects ◽  
Waitlist Control Group

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Pharmacists report high levels of burnout. Mindfulness approaches have been demonstrated to have positive results in the general population and in other healthcare professions. However, limited studies have been performed evaluating mindfulness approaches in student pharmacists. The aim of this study was to evaluate the effectiveness of daily use of a mindfulness mobile application in improving student pharmacists’ perceived stress, burnout, and mindfulness. Methods This study was a randomized, longitudinal, waitlist-controlled trial. The intervention group was asked to meditate using the mindfulness application Headspace daily for at least 6 weeks. The waitlist control group was asked to abstain from using the application for the entire study. Stress, burnout, and mindfulness were assessed using validated survey instruments at baseline, 6 weeks, and 10 weeks. A secondary outcome was to assess the persistence of application use after the intervention period. Results Fifty-six participants completed the study. The intervention group reported significantly lower scores on stress and burnout at 6 weeks compared to the control group. The intervention group also reported significantly higher scores on mindfulness. The differences in stress, burnout, and mindfulness persisted at follow-up. The mean percentage of students in the intervention group who used the application each day was 90% over the intervention period and 62% over the follow-up period. Conclusion A mindfulness mobile application significantly improved student pharmacists’ stress, burnout, and mindfulness with daily use. Most participants continued to use the application for 4 weeks after the end of the intervention. Positive effects on stress and mindfulness persisted even with decreased use.

Abstract P76: Effect of Patient Activation on Self-Management Behaviors in Heart Failure

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Martha Shively ◽  
Nancy Gardetto ◽  
Mary Kodiath ◽  
Ann Kelly ◽  
Tom Smith
Keyword(s):  
Heart Failure ◽  
Usual Care ◽  
Repeated Measures ◽  
Intervention Group ◽  
Patient Activation ◽  
Self Care ◽  
Self Report ◽  
Self Management ◽  
Significant Group ◽  
Repeated Measures Design

Background Disease management and chronic care models have evidenced success with heart failure (HF) patients but have not fully explored patients' engagement/activation in self- care. Objective Determine efficacy of a patient activation intervention (Heart PACT Program) compared to usual care on activation and self-care management in HF. Methods This study was a 4-year, randomized, 2-group, repeated-measures design (baseline, 3 months, and 6 months). Following consent, 84 patients were stratified by activation level and randomly assigned to usual care (n = 41), or usual care plus the activation intervention (n = 43). The primary outcome variables were patient activation using the Patient Activation Measure (PAM) (Hibbard et al., 2005), and self-care using the Self-Care for Heart Failure Index (SCHFI) (Riegel et al., 2004) and the Medical Outcomes Study (MOS) Specific Adherence Scale. The intervention consisted of individual meetings and phone call follow-up over 6 months based on the patient's level of activation: stage 1 or 2 (low activation), stage 3 (medium), or stage 4 (high) as assessed by the patient's self-report PAM score and brief interview. The leaders collaborated with patients to improve activation and self-management of HF: adhering to medications; monitoring weight, blood pressure, and symptoms; and implementing health behavior goals. Findings Participants were primarily male (99%), Caucasian (77%), and classified as NYHA III (52%). The mean age was 66 years (SD 11). The majority (71%) of participants reported 3 or more comorbid conditions. The intervention group compared to the usual care group showed a significant increase in activation/PAM scores from baseline to 6 months (significant group by time interaction linear contrast, F=16.90, p=.02). Although the baseline MOS mean was lower in the intervention group, results revealed a significant group by time effect (F=9.16, p = .001) with the intervention group improving more over time. There were no significant group by time interactions for the SCHFI. Conclusion Patient activation can be improved through targeted intervention. The patient activation model has the potential to change approaches to tailored patient education for self-management in heart failure.

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