The Effectiveness of a Healthcare Application and Human Coaching Program in Primary Care Clinics: A Non-randomized Controlled Trial (Preprint)

2021 ◽  
Author(s):  
HyoRim Ju ◽  
EunKyo Kang ◽  
YoungIn Kim ◽  
HyunYoung Ko ◽  
Belong Cho
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Sleep Quality ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Primary Care Clinics ◽  
Healthcare Application

BACKGROUND As the global burden of chronic conditions increases, effective management for these are a concern. There is an increasing need for chronic condition management using mobile self-management healthcare applications. OBJECTIVE This study evaluated the effectiveness of a mobile self-management healthcare application combined with human coaching for primary care services in patients with chronic conditions. METHODS A total of 110 patients with hypertension, diabetes, dyslipidemia, and/or metabolic syndrome who visited one of 17 participating primary care clinics from September 2020 to November 2020 were included in this study. Data regarding changes in body weight, sleep conditions, quality of life, depression, anxiety, stress, body mass index, waist circumference, blood sugar levels, blood pressure, and blood lipids levels were recorded. The intervention group (N=65) used a mobile self-management healthcare application with human coaching for 12 weeks, and the control group (N=45) underwent conventional, self-managed health care. RESULTS Patients in the intervention group reported significantly more weight loss than those in the control group (P=.002). The weight loss was markedly greater after using application for nine weeks than using it for four weeks or five to eight weeks (P=.002). Patients in the intervention group reported better sleep quality (P=.04) and duration (P=.004) than those in the control group. CONCLUSIONS The combination of a mobile self-management healthcare application and human coaching in primary care clinics results in better management of chronic conditions. The observed weight loss was greater and sleep quality improved than conventional primary care for patients with at least one chronic condition.

scholarly journals Impact of Pharmacist-Led Diabetes Management in Primary Care Clinics

2018 ◽  
Vol 9 (2) ◽  
pp. 17
Author(s):  
Benjamin Pontefract ◽  
Benjamin S. King ◽  
Cynthia A. King ◽  
David M Gothard
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Usual Care ◽  
Diabetes Management ◽  
Intervention Group ◽  
Control Group ◽  
Original Research ◽  
Diabetic Patients ◽  
Primary Care Clinics ◽  
The Impact

Purpose: Current literature supports that pharmacists effectively lower hemoglobin A1c (HbA1c) in diabetic patients. Little data exists on pharmacists’ effects on comorbidity management, patient satisfaction, or financial viability of these positions. This study looked to assess the impact of pharmacists on diabetes management compared to usual care. Methods: This multi-site, two-part study includes a retrospective chart review of patients referred to the pharmacist versus usual care within a large academic health system. The pharmacists collaborated under a consult agreement with primary care physicians. The second part of the study assessed patient satisfaction through an abbreviated CG-CAHPS survey. Results:A total of 206 patients with diabetes for an average of 12 years were included. The average patient age was 62 years with 60% of patients identifying as female and 81% as African-American. Patients were enrolled in a 2:1 fashion with 138 patients in the intervention group. Average baseline HbA1c was 10.1% in the intervention group and 9.3% in the control group (p= 0.0125). At 6 months, the mean change in HbA1c was -2.17% and 0.48% for the intervention and control groups respectively (p Conclusion: Pharmacists are effective at lowering HbA1c in primary care clinics, and patients were highly satisfied with these services. While direct revenue from this service did not meet cost, the pharmacist did positively affect outcomes that contribute to reimbursement. Treatment of Human Subjects: IRB review/approval required and obtained   Type: Original Research

scholarly journals Implementation of the WHO Approved “Tailoring Antimicrobial Resistance Programs (TAP)” Reduces Patients’ Request for Antibiotics

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 507 ◽  
Author(s):  
Nasser M. Kaplan ◽  
Yousef S. Khader ◽  
Mahmoud A. Alfaqih ◽  
Rami Saadeh ◽  
Lora Al Sawalha
Keyword(s):  
Primary Care ◽  
Antimicrobial Resistance ◽  
Intervention Group ◽  
Standard Of Care ◽  
Health Concern ◽  
Control Group ◽  
Upper Respiratory Tract ◽  
Primary Care Clinics ◽  
Randomized Design ◽  
Tract Infections

The misuse of antibiotics is a worldwide public health concern. Behavioral Intervention programs that aim to reduce patients’ own request for antibiotics during their visit to primary care clinics is an attractive strategy to combat this problem. We tested the effectiveness of a behavioral modification method known as the Tailoring Antimicrobial resistance Programs (TAP) in reducing the request for antibiotics by patients visiting primary care clinics for mild upper respiratory tract infections (URTIs). A stratified cluster randomized design with two groups pre-post, comparing intervention with the control, was conducted in six health centers. TAP was implemented for eight weeks. Request for antibiotics was assessed before (period 1) and after introducing TAP (period 2). The percentage of patients or their escorts who requested antibiotics in period 1 was 59.7% in the control group and 60.2% in the intervention group. The percentage of patients who requested antibiotics did not significantly change between period 1 and 2 in the control group, who continued to receive the standard of care. The above percentage significantly decreased in the intervention group from 60.2% to 38.5% (p < 0.05). We conclude that behavioral change programs including TAP are a viable alternative strategy to address antibiotic misuse in Jordan.

scholarly journals Questionnaire Survey-Based Quantitative Assessment of the Impact of Transitional Care on Self-Management of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Wenjie Xu ◽  
Hui Hu ◽  
Yanjun Mao
Keyword(s):  
Sleep Quality ◽  
Questionnaire Survey ◽  
Transitional Care ◽  
Intervention Group ◽  
Life Quality ◽  
Self Management ◽  
Anxiety And Depression ◽  
Control Group ◽  
Chronic Obstructive ◽  
The Impact

Background and Objective. Chronic obstructive pulmonary disease (COPD) features high morbidity. Different nursing interventions can relieve patient’s burden. This investigation quantitatively assessed the impact of transitional care (TC) on self-management of patients with acute exacerbation of COPD based on a questionnaire survey. Methods. Clinical information of 78 COPD patients treated with TC (intervention group) or routine care (control group) in Shanghai Pulmonary Hospital during March 2019 and August 2020 was gathered. Patients were followed up for 3 months after discharge. The intervention group ( n = 39 ) was subjected to a TC plan for 3 months to help patients and their family caregivers for self-management of COPD. TC was provided by specially trained nurses, and patients were supported by standardized tools. Nursing measures in the control group ( n = 79 ) included transitional support for 30 d after hospital discharge. In this way, patients were guaranteed to follow discharge plans and transit to outpatient nursing. Patient’s anxiety and depression symptoms, sleep quality, survival quality, mobility, and life quality at admission and after 3 months of discharge were assessed by Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Quality of Life Scale Abbreviated Version, Activity of Daily Life Scale, St. George’s Respiratory Questionnaire, and COPD Assessment Test. Results. Except for anxiety and depression, patient’s sleep quality, survival quality, mobility, and life quality in two groups were significantly improved. Moreover, average change of total CAT score during 3 months of intervention was -5.44, while that in the control group was -1.74 ( p = 0.011 ). Improvement of survival quality of patients in the intervention group ( p = 0.001 ) was markedly greater than that in the control group ( p = 0.016 ). Conclusion. Altogether, TC based on quantification by questionnaire survey is beneficial to COPD patient’s life quality and self-management.

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

Randomized Trial for Weight Loss Using a Digital Therapeutic Application

2021 ◽  
pp. 193229682110008
Author(s):  
Tryggvi Thorgeirsson ◽  
Johanna E. Torfadottir ◽  
Erlendur Egilsson ◽  
Saemundur Oddsson ◽  
Thrudur Gunnarsdottir ◽  
...  
Keyword(s):  
Weight Loss ◽  
Mobile Application ◽  
Intervention Group ◽  
Lifestyle Change ◽  
Noncommunicable Diseases ◽  
Control Group ◽  
Intention To Treat ◽  
Protocol Group ◽  
Lifestyle Program ◽  
Program Intervention

Background: Smartphones present a near-ubiquitous channel through which structured lifestyle change can reduce risk or progression of the most common noncommunicable diseases. We explored whether a digital structured lifestyle program enhances weight loss. Methods: We randomized overweight and obese participants attending a four-month lifestyle change program to either standard weekly coaching sessions (controls), or standard treatment supplemented with a digital therapeutic mobile application (intervention). Changes in body mass index after four months were the main outcome measure. Odds ratios of achieving 5% weight loss were estimated with unconditional logistic regression. Results: Of 234 eligible persons, 146 (62%) agreed to participate, were block-randomized, showed up for the baseline measures, and constituted the intention-to-treat (ITT) sample ( n = 95 intervention group, n = 51 control group). In the intervention group, 70 (74%) downloaded the mobile application and completed the program (intervention per-protocol). Significant weight loss and BMI reduction were observed for both the intention-to-treat intervention group ( P < 0.05, P = 0.01) and the per-protocol intervention group ( P < 0.0001, P < 0.0001). For the intervention per-protocol group, the odds ratio of achieving 5% weight loss, compared to not treated per-protocol, was 3.3 (95% CI 1.3-8.2), adjusting for age and weight at baseline.Attendance to weekly coaching sessions decreased by 18% during the program in the control group while it increased by 3% amongst the per-protocol group ( P = 0.004). Conclusions: These preliminary findings support the benefit of a digital therapeutic to enhance weight reduction and attendance in a structured lifestyle change program. Larger trials of longer duration are needed to confirm these findings.

scholarly journals 83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C Yang ◽  
Z Hui ◽  
S Zhu ◽  
X Wang ◽  
G Tang ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Older People ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Medication Knowledge ◽  
Management Intervention ◽  
Patient Reported

Abstract Introduction Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity. Method This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations. Results Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P &lt; 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up. Conclusions The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

scholarly journals Availability of a Flavored Beverage and Impact on Children’s Hydration Status, Sleep, and Mood

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1757
Author(s):  
Michael R. Szymanski ◽  
Gabrielle E. W. Giersch ◽  
Margaret C. Morrissey ◽  
Courteney L. Benjamin ◽  
Yasuki Sekiguchi ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Quality Index ◽  
Pittsburgh Sleep Quality Index ◽  
Intervention Group ◽  
Urine Osmolality ◽  
Urine Specific Gravity ◽  
Hydration Status ◽  
Control Group ◽  
Profile Of Mood States ◽  
Urine Color

Euhydration remains a challenge in children due to lack of access and unpalatability of water and to other reasons. The purpose of this study was to determine if the availability/access to a beverage (Creative Roots®) influences hydration in children and, therefore, sleep quality and mood. Using a crossover investigation, 46 participants were randomly assigned to a control group (CON) or an intervention group and received Creative Roots® (INT) for two-week periods. We recorded daily first morning and afternoon urine color (Ucol), thirst perception, and bodyweight of the two groups. Participants reported to the lab once per week and provided first morning urine samples to assess Ucol, urine specific gravity (USG), and urine osmolality (Uosmo). Participants also completed the questionnaires Profile of Mood States-Adolescents (POMS-a) and Pittsburgh Sleep Quality Index (PSQI). Dependent t-tests were used to assess the effects of the intervention on hydration, mood, and sleep quality. Uosmo was greater and Ucol was darker in the control group (mean ± SD) [Uosmo: INT = 828 ± 177 mOsm·kg−1, CON = 879 ± 184 mOsm·kg−1, (p = 0.037], [Ucol:INT = 5 ± 1, CON = 5 ± 1, p = 0.024]. USG, POMS-a, and PSQI were not significant between the groups. At-home daily afternoon Ucol was darker in the control group [INT = 3 ± 1, CON = 3 ± 1, p = 0.022]. Access to Creative Roots® provides a small, potentially meaningful hydration benefit in children. However, children still demonstrated consistent mild dehydration based on Uosmo, despite consuming the beverage.

scholarly journals A brief sleep focused psychoeducation program for sleep-related outcomes in new mothers: a randomized controlled trial

SLEEP ◽  
2020 ◽  
Vol 43 (11) ◽  
Author(s):  
Liora Kempler ◽  
Louise A Sharpe ◽  
Nathaniel S Marshall ◽  
Delwyn J Bartlett
Keyword(s):  
Sleep Quality ◽  
Daytime Sleepiness ◽  
Linear Mixed Model ◽  
Intervention Group ◽  
Control Group ◽  
Poor Sleep ◽  
Maternal Sleep ◽  
Pregnancy And Postpartum ◽  
Secondary Outcomes ◽  
Insomnia Symptoms

Abstract Study Objectives Poor sleep is commonly problematic during pregnancy and postpartum and is associated with depression. This trial investigated the efficacy of prenatal brief, group sleep psychoeducation in improving postpartum maternal sleep, and depression. Methods A total of 215 healthy expectant first-time mothers were cluster randomized (1:1) to receive either a 2 × 1.5 h psychoeducation intervention and a set of booklets, or a set of booklets only. Participants completed questionnaires during pregnancy (pre-intervention), and 6 weeks and 4 months postpartum. A post hoc subset of questionnaires was collected at 10 months postpartum. The primary hypothesis was the intervention group would have improved postpartum sleep quality, and reduced levels of insomnia symptoms, fatigue, and daytime sleepiness compared to the control group. Secondary outcomes included depression, anxiety, and stress. Results Linear mixed model analyses failed to confirm a group by time interaction on primary or secondary outcomes across all time points. There was no effect of the intervention on outcomes at 6 weeks, or 10 months postpartum. A significant time by group interaction was found at 4 months, favoring the intervention for sleep quality (p = 0.03) and insomnia symptoms (p = 0.03), but not fatigue or daytime sleepiness. Conclusions Prenatal sleep psychoeducation did not produce a sustained effect on maternal sleep throughout the postpartum period. There was little evidence of benefits on depressive symptoms. Clinical Trial Registration ACTRN12611000859987

Effectiveness of a Primary Care Program to Increase Physical Activity in People With Dementia and Their Family Caregivers (AFISDEMYF Study).

2021 ◽  
Author(s):  
Elena DE DIOS-RODRIGUEZ ◽  
María C PATINO-ALONSO ◽  
Susana GONZÁLEZ-SÁNCHEZ ◽  
Joana RIPOLL ◽  
Olaya TAMAYO-MORALES ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Primary Care ◽  
Systolic Blood Pressure ◽  
Family Caregivers ◽  
Intervention Group ◽  
Care Program ◽  
Control Group ◽  
People With Dementia ◽  
The Family

Abstract Aim: To evaluate the effectiveness of an intervention in primary health care designed to increase physical activity in people with dementia and their family caregivers.Methods: A cluster-randomized multicentre clinical trial was carried out.Participants: 140 people with dementia (median age 82 years;63.6% women) and 176 caregivers (median age 62 years ;72.7% women). Seventy patients and 80 caregivers were assigned to the Control Group (CG) and 70 patients and 96 caregivers to the Intervention Group (IG). The physical activity was measured with the pedometer and with the IPAQ-SF questionnaire. The intervention consisted of applying in primary care the program promoting physical activity (PEPAF) for 3 months. The changes observed at 6 months were analyzed. Results:In people with dementia, in the pedometer assessment a decrease was observed in both groups, but it was larger in the CG both in the total number step/day lower in the IG than in the CG and in the aerobic steps / day (52.89 vs -615.93). The activity reported with the IPAQ-SF decreased more in IG, both in the MET/min/week (-258.470 vs -148.23) and in the MVPA min/week. In caregivers the pedometer assessment showed that total steps/day increased more in the IG, as did aerobic steps/day (356.91 vs -12.95). The IPAQ-SF a smaller increase in global activity was declared in the IG than in the CG (545.25 MET/min/week vs 609.55), but the increase in vigorous activity was greater. No differences were found in changes in the functional status and the cognitive performances of people with dementia nor in the mental health in the caregivers, but systolic blood pressure, the Family APGAR and overload in the IG did improve.Conclusions: The results suggest that the intervention carried out may be effective on physical activity in both patients and caregivers. It can also improve systolic blood pressure, the Family APGAR and overload in caregivers. This is the first study to implement a primary care intervention aimed at simultaneously increasing physical activity in people with dementia and their relatives. These results reinforce the importance of using objective measures in clinical trials in people with dementia.Trial registration number: NCT 02044887.

scholarly journals Moderate Exercise Plus Sleep Education Improves Self-Reported Sleep Quality, Daytime Mood, and Vitality in Adults with Chronic Sleep Complaints: A Waiting List-Controlled Trial

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Carmen Gebhart ◽  
Daniel Erlacher ◽  
Michael Schredl
Keyword(s):  
Physical Exercise ◽  
Sleep Quality ◽  
Controlled Trial ◽  
Sleep Onset ◽  
Intervention Group ◽  
Waiting List ◽  
Control Group ◽  
Sleep Education ◽  
Sleep Complaints ◽  
Chronic Sleep

Research indicates that physical exercise can contribute to better sleep quality. This study investigates the six-week influence of a combined intervention on self-rated sleep quality, daytime mood, and quality of life. A nonclinical sample of 114 adults with chronic initiating and the maintaining of sleep complaints participated in the study. The intervention group of 70 adults underwent moderate physical exercise, conducted weekly, plus sleep education sessions. Improvements among participants assigned to the intervention group relative to the waiting-list control group (n=44) were noted for subjective sleep quality, daytime mood, depressive symptoms and vitality. Derived from PSQI subscores, the intervention group reported increased sleep duration, shortened sleep latency, fewer awakenings after sleep onset, and overall better sleep efficiency compared to controls. The attained scores were well sustained and enhanced over a time that lasted through to the follow-up 18 weeks later. These findings have implications in treatment programs concerning healthy lifestyle approaches for adults with chronic sleep complaints.

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