scholarly journals Complementarity of Digital Health and Peer Support: “This Is What’s Coming”

2021 ◽  
Vol 2 ◽  
Author(s):  
Patrick Y. Tang ◽  
Janet Duni ◽  
Malinda M. Peeples ◽  
Sarah D. Kowitt ◽  
Nivedita L. Bhushan ◽  
...  
Keyword(s):  
Peer Support ◽  
Diabetes Management ◽  
Digital Health ◽  
Scale Up ◽  
Value Added ◽  
Self Management ◽  
Free Form ◽  
Primary Group ◽  
Management Support ◽  
Health Coaches

PurposeThis study examined integration of peer support and a Food and Drug Administration-cleared, diabetes management app (DMA) in diabetes self-management support as a scalable model for those with type 2 diabetes mellitus (T2DM).MethodsTwo lay health Coaches delivered telephone-based self-management support to adults (N = 43) with T2DM recruited through a primary group practice. Those eligible were offered no-cost access to DMA for the entire 6-month study. Coaches introduced DMA and contacted individuals by phone and text with frequency dependent on participant needs/preferences. DMA supported monitoring of blood glucose, carbohydrate intake, and medication use, as well as messaging personalized to participants’ medication regimens. Clinical data were extracted from DMA, electronic medical records, and Coaches’ records. Structured interviews of 12 participants, 2 Coaches, and 5 project staff were analyzed using deductive pre-identified codes (regarding adoptability, patterns of use, value added, complementarity, and sustainability) utilizing standard procedures for qualitative analysis.ResultsOf the 43 participants, 38 (88.4%) enrolled in DMA. In general, participants used both DMA and lay health coaches, averaging 144.14 DMA entries (structured, e.g., medications, and free form, e.g., “ate at a restaurant” and “stressed”) and 5.86 coach contacts over the 6-month intervention. Correlation between DMA entries and coach contacts (r = .613, p < 0.001) was consistent with complementarity as were participants’ and coaches’ observations that (a) DMA facilitated recognition of patterns and provided reminders and suggestions to achieve self-management plans, whereas (b) coaching provided motivation and addressed challenges that emerged. Mean hemoglobin A1c (A1c) declined from 9.93% to 8.86% (p < 0.001), with no pattern of coaching or DMA use significantly related to reductions. Staff identified resources to coordinate coach/DMA interventions as a major sustainability challenge.ConclusionsDMA and peer support for diabetes management are compatible and complementary. Additional practice integration research is needed for adoption and scale-up.

scholarly journals Digital Diabetes Management: A Literature Review of Smart Insulin Pens

2021 ◽  
pp. 193229682098386 ◽  
Author(s):  
Lutz Heinemann ◽  
Oliver Schnell ◽  
Bernhard Gehr ◽  
Nanette C. Schloot ◽  
Sven W. Görgens ◽  
...  
Keyword(s):  
Patient Preference ◽  
Diabetes Management ◽  
Electronic Device ◽  
Digital Health ◽  
Memory Function ◽  
Near Field ◽  
Self Management ◽  
Published Data ◽  
Technical Accuracy ◽  
Insulin Pens

Digital health management is increasingly pivotal in the care of patients with diabetes. The aim of this review was to evaluate the clinical benefits of using smart insulin pens with connectivity for diabetes management. The search was performed using PubMed and PubMed Central on May 15, 2019, to identify publications investigating the use of insulin pens. Studies evaluating insulin pens with connectivity via Bluetooth/Near Field Communication, with an associated electronic device enabling connectivity, or with a memory function were included in the review. Nine studies were identified in the search. Overall, these studies lacked data on smart insulin pens with a connectivity function, with eight of the available studies investigating only pens with a memory function. The studies focused primarily on assessing patient preference, usability, and technical accuracy. The number of studies assessing clinical outcomes was small ( n = 3). However, the majority of studies ( n = 8) reported that patients preferred smart insulin pens because they increased confidence with regard to diabetes self-management. These results suggest a lack of published data regarding smart insulin pens with connectivity for the management of diabetes. However, the available published data on usability and patient preference suggest that the use of smart insulin pens holds promise for improving and simplifying diabetes self-management.

scholarly journals Digital Person-Centered Self-Management Support for People With Type 2 Diabetes: Qualitative Study Exploring Design Challenges

JMIR Diabetes ◽  
10.2196/10702 ◽  
2019 ◽  
Vol 4 (3) ◽  
pp. e10702
Author(s):  
Robyn Schimmer ◽  
Carljohan Orre ◽  
Ulrika Öberg ◽  
Karin Danielsson ◽  
Åsa Hörnsten
Keyword(s):  
Type 2 Diabetes ◽  
Digital Health ◽  
Work Practice ◽  
Current Work ◽  
Self Management ◽  
Substantial Part ◽  
Management Support ◽  
Design Decisions ◽  
Ehealth Service

Background Self-management is a substantial part of treatment for patients with type 2 diabetes (T2D). Modern digital technology, being small, available, and ubiquitous, might work well in supporting self-management. This study follows the process of developing a pilot implementation of an electronic health (eHealth) service for T2D self-management support in primary health care. The use of digital health, or eHealth, solutions for supporting self-management for patients with T2D is increasing. There are good examples of successful implementations that can serve as guides in the development of new solutions. However, when adding person-centered principles as a requirement, the examples are scarce. Objective The objective of this study was to explore challenges that could impact the design of a person-centered eHealth service for T2D self-management support. The study included data collection from multiple sources, that is, interviews, observations, focus groups, and a Mentimeter (interactive presentation with polling) survey among stakeholders, representing various perspectives of T2D. Methods A user-centered design approach was used to exploratively collect data from different sources. Data were collected from a workshop, interviews, and observations. The different data sources enabled a triangulation of data. Results Results show that user needs related to an eHealth service for person-centered T2D self-management support are multifaceted and situated in a complex context. The two main user groups, patients and diabetes specialist nurses, express needs that both diverge and converge, which indicates that critical design decisions have to be made. There is also a discrepancy between the needs expressed by the potential users and the current work practice, suggesting more attention toward changing the organization of work to fully support a new eHealth service. Conclusions A total of three overarching challenges—flexible access, reducing administrative tasks, and patient empowerment—each having a significant impact on design, are discussed. These challenges need to be considered and resolved through careful design decisions. Special attention has to be given to the patient user group that could greatly impact current work practice and power structures at the primary care unit. A need for further studies investigating patient needs in everyday life is identified to better support the implementation of technology that does not give specific attention to organizational perspectives but instead approach design with the patient perspective in focus.

scholarly journals Willingness to Use Electronic Medical Record (EMR) System in Healthcare Facilities of Bahir Dar City, Northwest Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Birhanu Berihun ◽  
Desta Debalkie Atnafu ◽  
Getachew Sitotaw
Keyword(s):  
Logistic Regression ◽  
Health Professionals ◽  
Digital Health ◽  
Scale Up ◽  
Multivariable Logistic Regression Analysis ◽  
Bahir Dar ◽  
Management Support ◽  
Cross Sectional ◽  
Major Barrier ◽  
Willingness To Use

Background. Globally, electronic information and communication technology has been applied and much expanded in the healthcare industry. However, in developing counties including Ethiopia, EMR system adoption and utilization for medical practice are still inconsistent, and healthcare institutions which started utilization currently have also failed to sustain. A desirable readiness of healthcare experts is mandatory to expand digital health service delivery. Thus, this study is aimed at estimating the proportion of the willingness of professionals in Bahir Dar city to use EMR and at identifying factors associated with this proportion. Methods. An institution-based cross-sectional study was conducted from September 1 to October 30, 2019, among 634 health professionals. Respondents were selected using a simple random sampling method. Data were entered into EpiData version 3.1 and exported to SPSS version 23 for further analysis. Descriptive statistics were computed to describe study variables and presented using tables. Willingness to use the EMR system was computed. Bivariable and multivariable binary logistic regression models were fitted to identify the associated factors. The odds ratio with 95% confidence interval was used to measure the strength of association. Results. A total of 616 health professionals participated in the study with a response rate of 97%. The proportion of willingness to use the EMR system was 85.9%. Among health professionals who were not willing to use EMR, lack of access to EMR training (73.4%) was a major barrier to the willingness to use EMR. A multivariable logistic regression analysis showed that those health professionals who had good computer skill (AOR=2.5; 95% CI: 1.3-4.6), good knowledge on EMR (AOR=2.1; 95% CI: 1-4.4), gotten EMR training (AOR=3.8; 95% CI: 1.7-8.1), EMR guideline access (AOR=2.8; 95% CI: 1.4-5.6), and management support (AOR=2.6; 95% CI: 1.4-4.8) were more likely willing to use the EMR system. Conclusions. Majority of the professionals were willing to use the EMR system. EMR program should involve computer illiterate, less knowledgeable, those unable to access EMR guidelines, and managerially unsupported professionals. Enhancing health professionals’ attitude and contextualizing EMR training in the healthcare curricula are highly recommended to scale up EMR use.

Abstract 226: Integration of Traditional and Alternate Chronic Care Models within a Primary Care Setting for Diabetes Management and Cardiovascular Disease Prevention

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Mohan Thanikachalam ◽  
G Shanmugasundar ◽  
Muthuswamy Ravikiran ◽  
Vijaykumar Harivanzan ◽  
Sripriya Ravi
Keyword(s):  
Primary Care ◽  
Blood Sugar ◽  
Care Setting ◽  
Primary Care Practice ◽  
Diabetes Management ◽  
Self Management ◽  
Care Practice ◽  
Control Group ◽  
Management Support ◽  
Care Models

Background: Several chronic care models (CCMs) for diabetes management and cardiovascular disease prevention have been implemented, but outcomes have been marginal. Traditionally, CCMs have been offered within the trusted primary care practice environment, but self-management support is episodic, cost ineffective and difficult to scale. Alternate CCMs that offer self-management support mostly through telephone coaching or virtual (web/mobile platforms) interventions, enable easy access, scalability and cost effectiveness, yet are impaired by the limits of isolated self-management support when provided outside the context of the trusted, therapeutic relationship of a primary care practice. We hypothesize that an integrated model taking advantage of positive aspects of traditional and alternate CCMs will lead to positive behavioral change (empowerment), sustained patient participation and better outcomes. Methods: To test this hypothesis, we implemented the Empowerment and Participatory Care Model (EPCM) in a study center in Chennai, India by integrating face-to-face support with customized telephone, Internet and mobile phone enabled interventions within a primary care setting. Patients who participated in the traditional CCM formed the control group. Results: In the participents in traditional CCM (n=422), there was an average reduction of 0.57% in HbA1c, 16 mg/dl in fasting blood sugar, 30 mg/dl in post prandial blood sugar and 16 mg/dl of LDL at the end of year-one. In comparison, among the patients (66% men; mean age 52 yrs) who participated in the EPCM and had completed one-year in the program (n=112) there was average reduction of 1.6% in HbA1c, 57 mg/dl in fasting blood sugar, 80 mg/dl in post prandial blood sugar and 18 mg/dl of LDL (p<0.01). Figure 1 shows the difference in percent reduction of the various biochemical parameters between the EPCM and the control group. The total cost of care (other than medication) per patient per year in the EPCM, after taking into consideration purchasing power parity between USA and India, was 900 USD. Conclusion: The persons with diabetes who participated in the EPCM had better quality of metabolic control, but long-term follow up is required to assess overall reduction in the risk of cardiovascular complications and cost effectiveness.

scholarly journals Digital Person-Centered Self-Management Support for People With Type 2 Diabetes: Qualitative Study Exploring Design Challenges (Preprint)

2018 ◽  
Author(s):  
Robyn Schimmer ◽  
Carljohan Orre ◽  
Ulrika Öberg ◽  
Karin Danielsson ◽  
Åsa Hörnsten
Keyword(s):  
Type 2 Diabetes ◽  
Digital Health ◽  
Work Practice ◽  
Current Work ◽  
Self Management ◽  
Substantial Part ◽  
Management Support ◽  
Design Decisions ◽  
Ehealth Service

BACKGROUND Self-management is a substantial part of treatment for patients with type 2 diabetes (T2D). Modern digital technology, being small, available, and ubiquitous, might work well in supporting self-management. This study follows the process of developing a pilot implementation of an electronic health (eHealth) service for T2D self-management support in primary health care. The use of digital health, or eHealth, solutions for supporting self-management for patients with T2D is increasing. There are good examples of successful implementations that can serve as guides in the development of new solutions. However, when adding person-centered principles as a requirement, the examples are scarce. OBJECTIVE The objective of this study was to explore challenges that could impact the design of a person-centered eHealth service for T2D self-management support. The study included data collection from multiple sources, that is, interviews, observations, focus groups, and a Mentimeter (interactive presentation with polling) survey among stakeholders, representing various perspectives of T2D. METHODS A user-centered design approach was used to exploratively collect data from different sources. Data were collected from a workshop, interviews, and observations. The different data sources enabled a triangulation of data. RESULTS Results show that user needs related to an eHealth service for person-centered T2D self-management support are multifaceted and situated in a complex context. The two main user groups, patients and diabetes specialist nurses, express needs that both diverge and converge, which indicates that critical design decisions have to be made. There is also a discrepancy between the needs expressed by the potential users and the current work practice, suggesting more attention toward changing the organization of work to fully support a new eHealth service. CONCLUSIONS A total of three overarching challenges—flexible access, reducing administrative tasks, and patient empowerment—each having a significant impact on design, are discussed. These challenges need to be considered and resolved through careful design decisions. Special attention has to be given to the patient user group that could greatly impact current work practice and power structures at the primary care unit. A need for further studies investigating patient needs in everyday life is identified to better support the implementation of technology that does not give specific attention to organizational perspectives but instead approach design with the patient perspective in focus.

scholarly journals Peer support in Shanghai’s Commitment to diabetes and chronic disease self-management: program development, program expansion, and policy

2020 ◽  
Vol 10 (1) ◽  
pp. 13-24
Author(s):  
Yuexing Liu ◽  
Xiaoyu Wu ◽  
Chun Cai ◽  
Patrick Y Tang ◽  
Muchieh Maggy Coufal ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Peer Support ◽  
Diabetes Management ◽  
Development Program ◽  
Self Management ◽  
Diabetes Distress ◽  
Health Staff ◽  
Community Resources ◽  
Development Phase ◽  
Expansion Phase

Abstract Identifying organizational settings for sustainable, scalable implementation of peer support (PS) is a challenge. Development, initial evaluation, and community expansion of PS for populations with diabetes staged in the context of the Shanghai Integration Model integrating primary and specialty care for diabetes. Development Phase with 9 Community Health Centers (CHCs) leading to Community Expansion Phase with additional 12 communities. Development Phase peer leaders (PLs) co-led meetings on diabetes management, led neighborhood activities, and followed up with individuals and families. Among 1,284 participants, changes in HbA1c, other clinical markers, and diabetes distress were significant (ps from 0.001 to 0.041), pronounced among those with elevated levels, for example, HbA1c reduction from 9.09% to 8.50% among those ≥8% at baseline (p &lt; 0.001). Ratings of Implementation were associated with reduced HbA1c and diabetes distress and increased neighborhood support. In particular, linking with community resources and utilization of neighborhood Residential Committees were associated with improved HbA1c, indicating the value of PS programs including community resources. Thus, the Community Expansion Phase includes district- and community-level health staff, Community Self Management Groups, and Residential Committees along with CHCs in 12 communities, all of which have implemented activities during the first 6 months. PS programs are feasible and appear to add value among populations with diabetes in community settings such as Shanghai. Recognition by the Shanghai government has included PS as a key strategy for achieving self-management of chronic disease in its 2030 health goals.

scholarly journals Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care: Qualitative Study on Using eHealth Services for Self-Management Support (Preprint)

2017 ◽  
Author(s):  
Ulrika Öberg ◽  
Ulf Isaksson ◽  
Lena Jutterström ◽  
Carl Johan Orre ◽  
Åsa Hörnsten
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Digital Health ◽  
Self Management ◽  
Management Support ◽  
Primary Health ◽  
Ehealth Services

BACKGROUND Digital health services are increasing rapidly worldwide. Strategies to involve patients in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance, and there is a need to optimize the delivery of care such as self-management support. Digitalized solutions have the potential to modify and personalize the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. It is a challenge to integrate core values of person-centered care into digitalized health care services. OBJECTIVE The objective of this study was to describe perceptions of using electronic health (eHealth) services and related technologies for self-management support among people with T2D treated in Swedish primary health care. METHODS This is a qualitative study based on interviews analyzed using qualitative content analysis conducted among people diagnosed with T2D. RESULTS Findings suggest that the participants had mixed feelings regarding the use of digital health services for self-management support. They experienced potentials such as increased involvement, empowerment, and security, as well as concerns such as ambivalence and uncertainty. CONCLUSIONS Digital health services for self-management are easily accessible and have the potential to reach a wide population. However, targeted training to increase digital skills is required, and personalized devices must be adapted and become more person-centered to improve patients’ involvement in their own care.

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