Integrating mHealth alcohol harm reduction into primary care: Protocol for an implementation trial (Preprint)

Mapping Intimacies ◽

10.2196/preprints.31109 ◽

2021 ◽

Author(s):

Andrew R Quanbeck

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Health Care ◽

Health Care Professionals ◽

Cost Effective ◽

Human Interaction ◽

Drinking Patterns ◽

Mhealth Intervention ◽

Implementation Costs

BACKGROUND Primary healthcare systems are uniquely positioned to provide access to strategies for reducing alcohol misuse and high-risk drinking, strategies which include mHealth apps. The extent of human interaction needed to achieve effective and cost-effective use of mHealth apps in primary care remains largely unexamined. This study seeks to understand how varying levels of human interaction affect the ways in which an mHealth intervention for the prevention and treatment of alcohol use disorders works or does not work, for whom, and under what circumstances. OBJECTIVE The primary aim is to detect the effectiveness of an mHealth intervention by assessing differences in self-reported risky drinking patterns and quality of life between participants in three study groups (self-monitored, peer-supported, and clinically integrated). Each group reflects differences in the level of human touch provided to support use of the intervention. The cost-effectiveness of each approach will be assessed . METHODS This Hybrid 1 study is an unblinded patient-level randomized clinical trial testing the effects of using an evidence-based mHealth system on participants’ drinking patterns and quality of life. There are two groups of participants for this study: individuals receiving the intervention and health care professionals practicing in the broader primary care environment. The intervention is a smartphone app encouraging users to reduce their alcohol consumption within the context of integrative medicine using techniques to build healthy habits. Primary outcomes for quantitative analysis will be participant data on their risky drinking days and quality of life, as well as app usage from weekly and quarterly surveys. Cost measures include intervention and implementation costs. Cost per participant will be determined for each study arm with intervention and implementation costs separated within each group. There will also be a qualitative assessment of health care professionals’ engagement with the app as well as their thoughts on participant experience with the app. RESULTS This protocol was approved on November 18, 2019 by the Health Sciences Minimal Risk Institutional Review Board with subsequent annual reviews. Recruitment began on March 06, 2020 but was suspended on March 13, 2020 due to COVID-19 restrictions. Limited recruitment resumed on July 6, 2020. Trial status as of June 9, 2021: 257 participants are enrolled in the study toward a planned enrollment of 546 participants. CONCLUSIONS New knowledge gained from this study could have wide and lasting benefits related to the integration of mHealth systems for alcohol use disorders in primary healthcare systems. Results of the study will guide policy makers and providers to cost-effective ways to incorporate technology in health care. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT04011644

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Patient Suffering in Chronic Digestive Diseases: Will Primary Care-Specialist Collaboration With Effective Interactive Communication and Integrative Medicine in the Plan of Care Improve Quality of Life?

Journal of Patient Experience ◽

10.1177/2374373520967798 ◽

2020 ◽

Vol 7 (6) ◽

pp. 989-993

Author(s):

Andrew Thomas ◽

Annie Thomas

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Health Care ◽

Health Care Providers ◽

The United States ◽

Care Providers ◽

Physician Visits ◽

Digestive Diseases ◽

Care Specialist

Acute and chronic digestive diseases are causing increased burden to patients and are increasing the United States health care spending. The purpose of this case report was to present how nonconfirmatory and conflicting diagnoses led to increased burden and suffering for a patient thus affecting quality of life. There were many physician visits and multiple tests performed on the patient. However, the primary care physician and specialists could not reach a confirmatory diagnosis. The treatment plans did not offer relief of symptoms, and the patient continues to experience digestive symptoms, enduring this burden for over 2 years. The central theme of this paper is to inform health care providers the importance of utilizing evidence-based primary care specialist collaboration models for better digestive disease outcomes. Consistent with patient’s experience, the authors propose to pilot/adopt the integrative health care approaches that are proven effective for treating digestive diseases.

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Factors related to perceived continuity of care in hospitalized cardiac patients

European Heart Journal ◽

10.1093/ehjci/ehaa946.3408 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Safstrom ◽

T.J Jaarsma ◽

L.N Nordgren ◽

M.L Liljeroos ◽

A.S Stomberg

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Health Care ◽

Continuity Of Care ◽

Perceived Control ◽

Care Utilization ◽

Funding Source ◽

Patient Reported

Abstract Background Since healthcare systems are increasingly complex and often fragmented, continuity of care after hospitalization is a priority to increase patient safety and satisfaction. Aim Describe factors related to continuity of care in patients hospitalized due to cardiac conditions. Methods This cross-sectional multicenter study enrolled patients 6 weeks after hospitalization due to cardiac conditions. A total of 993 patients were included (mean age 72.2 (SD 10.4), males 66%) with AMI (35%), AF (25%), angina (21%) and HF (17.3%). Patients completed the Patient Continuity of Care Questionnaire, a questionnaire based on the definition that continuity of care is “the extent to which a series of health care services is experienced as connected and coherent and is consistent with a patient's health needs and personal circumstances”. The total score of the questionnaire ranges from 6 to 30, higher score indicating higher continuity and a score <24 indicating insufficient continuity. Cronbach's alpha on the total PCCQ was 0.94. Correlations between PCCQ and quality of life, depression, anxiety, perceived control and health care utilization were estimated using spearman rang correlation. Results Insufficient continuity of care ranged between 47% to 59% in the different diagnosis groups, which the highest continuity in the AMI group and lowest in patients with atrial fibrillation. In patients hospitalized due to AMI (n=355, mean age 71 (± 11), 70% men), continuity of care was related to higher perceived control, higher quality of life, a good financial situation, being a man, no symptoms of anxiety or depression (ᚹ range 0.17–0.26 p≤0.002). A low score on the PCCQ were associated with follow-up visit to a nurse in primary care after hospitalization (ᚹ −0.12 p=0.033). In patients hospitalized due to angina (n=210, mean age 73 (± 9), 74% men), continuity of care was related to higher perceived control, higher quality of life and no depressive symptoms (ᚹ range between 0.20 and 0.26 p=0.005). In patients with AF, (n=255, mean age 71 (± 10.), 58% men), continuity of care was related to having had contact by telephone with a nurse-led AF clinic, higher perceived control, higher quality of life and not being depressed (ᚹ range between 0.14–0.25 p=0.03). In patients with HF, (n=173, mean age 77 (±8) 59% men), continuity was related to male ender, younger age, follow-up in a nurse-led HF clinic and not being anxious (ᚹ range between 0.16 and 0.22 p=0.004–0.047). Low total score on PCCQ correlated to having had telephone contact with nurse in primary care (ᚹ −0.24 p=0.002). Conclusion Almost half of all patient reported insufficient continuity of care. Perceived control, quality of life, and symptoms of depression were related to higher continuity of care in all diagnose groups except heart failure. Further, there was a correlation between continuity and follow-up visits or contact by telephone with nurse-led clinics in all diagnose groups except angina. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Medical Research Council of Southeast Sweden, Centre for Clinical Research Sörmland

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Depression, Fatigue, and QoL in Colorectal Cancer Patients During and After Treatment

Western Journal of Nursing Research ◽

10.1177/0193945916630256 ◽

2016 ◽

Vol 38 (7) ◽

pp. 893-908 ◽

Cited By ~ 8

Author(s):

Hong-Yi Tung ◽

Tung-Bo Chao ◽

Yu-Hua Lin ◽

Shu-Fen Wu ◽

Hui-Yen Lee ◽

...

Keyword(s):

Quality Of Life ◽

Colorectal Cancer ◽

Health Care ◽

Cancer Patients ◽

Health Care Professionals ◽

Nursing Intervention ◽

Prevalence Of Depression ◽

Study Population ◽

Colorectal Cancer Patients

In this study, we sought to explore the prevalence of depression and fatigue in colorectal cancer patients during and after treatment to examine how these variables affect quality of life (QoL). In total, 170 patients with colorectal cancer participated in this study. The study population was divided into two groups: one receiving treatment and another that had finished treatment. The results showed that depression and fatigue measurements were higher in patients receiving treatment. Depression was a strong and significant predictor of QoL in both groups, whereas fatigue was not, with the exception of the symptom score. These findings underscore the importance of early detection and management of depression and fatigue during the treatment and survival stages of patients with colorectal cancer. Our findings indicate that health care professionals should provide appropriate nursing intervention to decrease depression and fatigue and enhance patient QoL.

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Perception of Iranian Patients with Cancer, Their Relatives, and Health Care Professionals Towards Length of Life and Quality of Life: A Local Survey

Shiraz E-Medical Journal ◽

10.5812/semj.103598 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Negin Nourbakhsh ◽

Bahareh Tahani ◽

Azadeh Moghaddas

Keyword(s):

Quality Of Life ◽

Health Care ◽

Survival Time ◽

Health Care Professionals ◽

Treatment Modalities ◽

Cancer Center ◽

Treatment Choices ◽

Patients With Cancer ◽

Length Of Life

Background: Recently, therapeutic decision-making in oncology is changed to a big challenge for both patients and involved oncologists due to an increase in available treatment modalities with a variety of benefits or adverse effects. Objectives: The current study aimed at comparing the perception of treatment priorities regarding lengthening of survival time or maintenance of the quality of life (QoL) among patients with cancer by health care professionals (HCPs). Methods: The current cross-sectional study was conducted on patients with cancer, their relatives, and healthcare professionals in the referral cancer center of Omid affiliated to Isfahan University of Medical Sciences. To identify treatment choices, priority, and related variables influencing their opinions, all participants were interviewed using a standard and valid questionnaire in Persian. The collected data were analyzed using the SPSS software version 20, and the P-value less than 0.05 was considered statistically significant. Results: A total of 299 participants, including 100 patients, 109 relatives, and 90 HCPs (74.2% nurses, 20.2% physicians, 5.6% others) participated in the study. The priority of treatment between survival time (66.1% for relatives vs. 47.9% for patients and 21.3% for HCP) and QoL (33.9% vs.52.1% and 78.7%) was significantly different between the three groups (P < 0.001). Most of the HCPs, patients, and their relatives believed that the physician is the only person who should accept the responsibility of treatment choices and process (98.9% vs. 100% and 98%, respectively; P = 0.002). Conclusions: Among the Iranian population, both the length of life and QoL were valuable; however, it was observed that patients with cancer and HCPs preferred mostly to expand the QoL, while the length of life was more valuable for relatives. Also, all patients, their relatives, and HCPs preferred to choose the physicians as the decision-makers. The results of the study can be helpful in choosing treatment regimens and designing clinical trials.

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Quality of sleep and health-related quality of life among health care professionals treating patients with coronavirus disease-19

International Journal of Social Psychiatry ◽

10.1177/0020764020942800 ◽

2020 ◽

pp. 002076402094280 ◽

Cited By ~ 4

Author(s):

Jelena Stojanov ◽

Marina Malobabic ◽

Goran Stanojevic ◽

Milos Stevic ◽

Vuk Milosevic ◽

...

Keyword(s):

Quality Of Life ◽

Health Care ◽

Mental Status ◽

Health Care Professionals ◽

Short Form ◽

Health Related Quality ◽

Quality Of Sleep ◽

Related Quality ◽

Health Related

Background: Health care professionals exposed to coronavirus disease 2019 (COVID-19) are facing high levels of stress. Aim: The aim was to evaluate the quality of sleep (QoS) and health-related quality of life (HRQoL), among health care professionals treating patients with COVID-19, as well as quantifying the magnitude of symptoms of depression and levels of anxiety. Methods: We included 201 health care professionals in a cross-sectional, web-based study by applying 7-item Generalized Anxiety Disorder (GAD-7) Scale, Zung Self-rating Depression Scale, 36-item Health Survey of the Medical Outcomes Study Short Form (SF36), Pittsburgh Sleep Quality Index (PSQI) and additional survey constructed for the purpose of the study. Results: Health care workers who treated COVID-19 patients were more afraid of becoming infected or of transmitting the infection to a family member with a significantly low self-assessment of their mental status. Poor QoS and HRQoL correlated with high health anxiety and severe depressive symptoms and several demographic characteristics. Multiple linear regression analysis showed that higher scores on GAD-7 (beta = .71, p < .01) and lower scores on mental health (MH) subscale on SF36 questionnaire (beta = –.69; p < .01) were independent predictors of the higher PSQI score (adjusted R2 = .61, p < .01 for overall model). Higher scores on GAD-7 (beta = .68, p < .01) and worse self-perceived mental status (beta = .25; p < .05) were independent predictors of the lower SF36 scores (adjusted R2 = .73, p < .01 for overall model). Conclusion: The major MH burden of health care professionals treating infected patients during the COVID-19 pandemic indicates that they need psychological support.

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Flash Glucose Monitoring: A Review of the Literature with a Special Focus on Type 1 Diabetes

Nutrients ◽

10.3390/nu10080992 ◽

2018 ◽

Vol 10 (8) ◽

pp. 992 ◽

Cited By ~ 17

Author(s):

Giulia Mancini ◽

Maria Berioli ◽

Elisa Santi ◽

Francesco Rogari ◽

Giada Toni ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Health Care ◽

Glycemic Control ◽

Health Care Professionals ◽

Glucose Monitoring ◽

Special Focus ◽

Flash Glucose Monitoring

In people with type 1 diabetes mellitus (T1DM), obtaining good glycemic control is essential to reduce the risk of acute and chronic complications. Frequent glucose monitoring allows the adjustment of insulin therapy to improve metabolic control with near-normal blood glucose concentrations. The recent development of innovative technological devices for the management of T1DM provides new opportunities for patients and health care professionals to improve glycemic control and quality of life. Currently, in addition to traditional self-monitoring of blood glucose (SMBG) through a glucometer, there are new strategies to measure glucose levels, including the detection of interstitial glucose through Continuous Glucose Monitoring (iCGM) or Flash Glucose Monitoring (FGM). In this review, we analyze current evidence on the efficacy and safety of FGM, with a special focus on T1DM. FGM is an effective tool with great potential for the management of T1DM both in the pediatric and adult population that can help patients to improve metabolic control and quality of life. Although FGM might not be included in the development of an artificial pancreas and some models of iCGM are more accurate than FGM and preferable in some specific situations, FGM represents a cheaper and valid alternative for selected patients. In fact, FGM provides significantly more data than the intermittent results obtained by SMBG, which may not capture intervals of extreme variability or nocturnal events. With the help of a log related to insulin doses, meal intake, physical activity and stress factors, people can achieve the full benefits of FGM and work together with health care professionals to act upon the information provided by the sensor. The graphs and trends available with FGM better allow an understanding of how different factors (e.g., physical activity, diet) impact glycemic control, consequently motivating patients to take charge of their health.

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Interprofessional Team-Based Care

10.1093/med/9780190466268.003.0029 ◽

2018 ◽

Author(s):

Beverly Lunsford ◽

Terry A. Mikovich

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Health Care ◽

Health Care Professionals ◽

Interprofessional Collaboration ◽

Functional Decline ◽

Care Program ◽

Coordination Of Care ◽

Palliative Care Teams

As older adults live longer, they experience a concomitant increase in chronic illness, which may be associated with a more frequent need for health care and intermittent or progressive functional decline. There is an increased need for regular health care monitoring as well as treatment and coordination of care among multiple providers and across settings to prevent, delay, or minimize decline in health and quality of life. Interprofessional collaboration is critical for safe coordination of care, reduction of duplication in services, and cost containment. Health care professionals who serve older adults are developing new models of collaboration to provide more integrated and person-centered approaches to maintaining the quality of life for older adults, especially those with multiple chronic illnesses. These models include health-oriented teams, home and community-based services, Acute Care for Elders (ACE), home-based primary care, Program of All-Inclusive Care for the Elderly (PACE), comprehensive geriatric assessment, and palliative care teams.

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