mHEALTH FOR SELF-MANAGEMENT OF BEHAVIORAL AND CLINICAL COMORBIDITY: IMPROVING PATIENT ENGAGEMENT AND COORDINATED CARE

Improved care in pulmonary arterial hypertension has led to increased longevity for patients, with a paralleled evolution in the nature of their needs. There is more focus on the impact of the disease on their day-to-day activities and quality of life, and a holistic approach is coming to the front of pulmonary arterial hypertension management, which places the patient at the centre of their own healthcare. Patients are thus becoming more proactive, involved and engaged in their self-care, and this engagement is an important factor if patient outcomes are to improve. In addition, involvement of the patient may improve their ability to cope with pulmonary arterial hypertension, as well as help them to become effective in the self-management of their disease. Successful patient engagement can be achieved through effective education and the delivery and communication of timely, high-quality information. A multidisciplinary approach involving healthcare professionals, carers, patient associations and expert patient programmes can also encourage patients to engage. Strategies that promote patient engagement can help to achieve the best possible care and support for the patient and also benefit healthcare providers.

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How to use remote patient monitoring successfully in cardiac and pulmonary patients: a realist review

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.139 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

E Thomas ◽

M Taylor ◽

A Smith ◽

L Caffery

Keyword(s):

Acute Care ◽

Patient Monitoring ◽

Realist Review ◽

Work Outcomes ◽

Self Management ◽

Remote Patient Monitoring ◽

Coordinated Care ◽

Eligibility Criteria ◽

Funding Sources ◽

Remote Patient

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Queensland Health Background Remote patient monitoring (RPM) is an underutilised telehealth intervention that can enhance self-management of cardiovascular and pulmonary disease and reduce acute care use. However, studies of effectiveness of RPM interventions vary widely. This study aimed to explain the variation in outcomes related to RPM interventions within cardiac and pulmonary populations. Specifically, we aimed to answer why some RPM interventions are more successful than others in reducing demand on acute care services. Methods In brief, search terms for remote monitoring and acute care utilisation were used across three electronic databases: PubMed, EMBASE and CINAHL. The search, conducted in October 2020, included articles published in the last five years (2015-2020). Articles were included if they used RPM to monitor an individual’s biometrics (e.g. heart rate, blood pressure) from a distance while they are not in hospital. Realist review methodology was used to enable exploration of how, why and for whom interventions do and do not work. Outcomes were evaluated to determine contextual factors and potential mechanisms that led to variation in cardiac and pulmonary intervention outcomes. Results After screening, 91 articles met the eligibility criteria and were included. We found that across a broad range of RPM interventions 31 factors emerged that are likely to impact the effectiveness of cardiac and pulmonary RPM innovations. These were synthesised into six theories of intervention success: 1) targeting populations at high risk; 2) accurately detecting a decline in health; 3) providing responsive and timely care; 4) personalising care; 5) enhancing self-management and, 6) ensuring collaborative and coordinated care. Conclusion While RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and with the key variables identified within this review incorporated, it is more likely that they will be effective at reducing acute hospital events.

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A Novel User Utility Score for Diabetes Management Using Tailored Mobile Coaching: Secondary Analysis of a Randomized Controlled Trial

JMIR mhealth and uhealth ◽

10.2196/17573 ◽

2021 ◽

Vol 9 (2) ◽

pp. e17573

Author(s):

Min-Kyung Lee ◽

Da Young Lee ◽

Hong-Yup Ahn ◽

Cheol-Young Park

Keyword(s):

Randomized Controlled Trial ◽

Glycemic Control ◽

Mobile Health ◽

Patient Engagement ◽

Utility Score ◽

Diabetes Management ◽

Controlled Trial ◽

Self Management ◽

Glucose Testing ◽

Randomized Controlled

Background Mobile health applications have been developed to support diabetes self-management, but their effectiveness could depend on patient engagement. Therefore, patient engagement must be examined through multifactorial tailored behavioral interventions from an individual perspective. Objective This study aims to evaluate the usefulness of a novel user utility score (UUS) as a tool to measure patient engagement by using a mobile health application for diabetes management. Methods We conducted a subanalysis of results from a 12-month randomized controlled trial of a tailored mobile coaching (TMC) system among insurance policyholders with type 2 diabetes. UUS was calculated as the sum of the scores for 4 major core components (range 0-8): frequency of self-monitoring blood glucose testing, dietary and exercise records, and message reading rate. We explored the association between UUS for the first 3 months and glycemic control over 12 months. In addition, we investigated the relationship of UUS with blood pressure, lipid profile, and self-report scales assessing diabetes self-management. Results We divided 72 participants into 2 groups based on UUS for the first 3 months: UUS:0-4 (n=38) and UUS:5-8 (n=34). There was a significant between-group difference in glycated hemoglobin test (HbA1c) levels for the 12-months study period (P=.011). The HbA1c decrement at 12 months in the UUS:5-8 group was greater than that of the UUS:0-4 group [–0.92 (SD 1.24%) vs –0.33 (SD 0.80%); P=.049]. After adjusting for confounding factors, UUS was significantly associated with changes in HbA1c at 3, 6, and 12 months; the regression coefficients were –0.113 (SD 0.040; P=.006), –0.143 (SD 0.045; P=.002), and –0.136 (SD 0.052; P=.011), respectively. Change differences in other health outcomes between the 2 groups were not observed throughout a 12-month follow-up. Conclusions UUS as a measure of patient engagement was associated with changes in HbA1c over the study period of the TMC system and could be used to predict improved glycemic control in diabetes self-management through mobile health interventions. Trial Registration ClinicalTrial.gov NCT03033407; https://clinicaltrials.gov/ct2/show/NCT03033407

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Predictors of Online Patient Portal Use among a Diverse Sample of Emerging Adults: A Cross-Sectional Survey (Preprint)

10.2196/preprints.33356 ◽

2021 ◽

Author(s):

Julie A. Wright ◽

Julie E Volkman ◽

Suzanne G Leveille ◽

Daniel J. Amante

Keyword(s):

Health Literacy ◽

Emerging Adults ◽

Patient Engagement ◽

Self Management ◽

Healthcare Team ◽

Patient Portal ◽

Patient Portals ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Convenience Sample

BACKGROUND Self-management of health is becoming increasingly more influenced by Health IT as online patient portals become more common. Patient portals allow patients direct access to their health information and opportunities to engage with their healthcare team. Data suggest that e-Health literacy is an important skill for using portals. Emerging adults (EA; ages 18-29), while generally healthy, are regular users of the healthcare system. A good understanding about their use of online patient portals and how their e-Health literacy skills impact their use is lacking. OBJECTIVE To describe patient portal use and explore the predictors of portal use among a diverse sample of EAs. METHODS A convenience sample, cross-sectional survey study was conducted at two universities. Demographics, healthcare visits, e-Health literacy, patient engagement and use of patient portal features (administrative and clinical) were asked. Logistic regression models were used to examine factors associated with portal use. RESULTS Of the 340 EAs (76% female, 65% white, 47% low income), 54% reported having patient portal access. Of those reporting access, 77% used at least 1 portal feature and 23% reported using none. Significant predictors were patient engagement (OR 1.08, 95% CI 1.04-1.13, p=.001;) and total encounters (OR 1.23, 95% CI 1.05-1.44, p=.009;) but not e-Health literacy. Hispanic and Asian EAs were more likely to be frequent users of clinical portal features than white EAs (Hispanic, OR 2.97, 95%CI 1.03-8.52 p=.043; and Asian, OR 4.28, 95%CI 1.08-16.89, p=.038). CONCLUSIONS Surprisingly, e-Health literacy did not predict use of patient portals in this diverse sample of EAs. Moreover, there may be ethnic differences that are important for healthcare systems to consider. Interventions to promote patient portal use, an essential self-management skill, should include strategies to increase patient engagement with patient portals in EA populations. CLINICALTRIAL N/A

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