Designing Disease-Specific mHealth Apps for Clinical Value

mHealth apps for patient use are promising but continue to face a plateau in usage. Current apps work for a limited segment of the patient population, i.e., those who enjoy tracking for intrinsic rewards. There are many opportunities to support patient care in between health care provider visits that are not currently being met for many diseases and patient types (personas). This is an area of great potential growth for mHealth apps and could contribute greatly to patient health and wellness. In this chapter, we propose a framework for how to think about the between-visit needs of patients that would motivate continued use of mhealth apps. We view the app design process from the following perspectives: 1) disease-specific needs, 2) non-disease specific needs, 3) behavioral theoretical aspects of app usage and 4) app-intrinsic usage motivators. Myasthenia gravis serves as the use case for illustrating these perspectives and how to use them in designing a disease-specific mHealth app.

Technologized Talk

In this study, the authors examine patient use of and feelings about wearable technologies for health attainment and management. Based on an online survey of 81 patients using wearable technologies to track and manage health, as well as interviews with three patients utilizing wearables for health management, the authors examine how wearable technologies are being used by patients to attain health, manage health, and/or prevent health issues, and what value users find in these wearable technologies. The authors also examine how such use is impacting communication between medical professionals and patients. Specifically, the authors explore how the inclusion of wearable technologies has changed the “rhetorical relationship” between patients and medical professionals. The study concludes with a discussion of the future of wearable devices in patient-medical practitioner relationships and clinical settings.

Swabs by emergency responders (SWABBER): Enhancing care beyond the cancer center during the COVID-19 pandemic.

97 Background: The COVID-19 pandemic caused sudden changes in healthcare delivery, and new policies were rapidly implemented to ensure safety for patients and staff. However, COVID-19 testing requirements presented a barrier for many patients. Outdoor testing in New York City became less feasible during colder months, and oncology patients have additional concerns, such as limited mobility and immunosuppression. To address these barriers, we created an in-home COVID-19 testing program through a partnership between Community Paramedicine and Oncology: SWABBER (SWABS by Emergency Responders). We evaluated patient use of and satisfaction with SWABBER. Methods: SWABBER began in September 2020 as an interdisciplinary initiative to offer in-home, asymptomatic COVID-19 PCR testing for patients on active treatment in an effort to provide more coordinated care and improve patient experience. Tests were performed prior to the first day of each treatment cycle at no cost to patients. Randomly selected patients completed a brief survey about their experiences with the program, with questions on a seven-point Likert scale. Sociodemographic data was collected from the EMR, and we used a chi-square test to identify differences in patient use of SWABBER by race. Results: From September 8, 2020–April 1, 2021, we saw 7,204 patients for infusion, of whom 993 (14%) participated in SWABBER. The cohort of all patients receiving treatment was 45% White, 19% Black, 6% Asian, 29% Other, and 1% Unknown race. The SWABBER cohort was 36% White, 21% Black, 12% Asian, 29% Other, and 1% Unknown race. There was a significant difference in patient race between these two groups (P < 0.00001), with more Black and Asian patients in SWABBER compared to all patients receiving treatment. A total of 406 (41%) SWABBER patients completed the patient experience survey. The mean scores for overall experience and likelihood of recommending the program were 6.9, with standard deviations of 0.56 and 0.44, respectively. Conclusions: SWABBER enabled us to deliver care directly to patients’ homes, mitigating COVID-19 exposure while promoting accessible care and providing an increased benefit for minority patients. Through SWABBER, we achieved near-perfect patient experience ratings, reduced the burden of testing, created a safer environment for patients and staff, and kept cancer care on track. Future work will evaluate ways to maintain elevated patient experience and continue striving for inclusive care beyond the pandemic.[Table: see text]

Revisiting Provider Role in Patient Use of Online Medical Records

Objectives Provider encouragement for patient use of online medical record (OMR) systems is poorly understood. The study examines temporal trends and predictors of provider encouragement and the effects of encouragement on OMR use. Methods Health Information National Trends Survey administered in 2017 and 2020 were used. Subjects were 18 to 75 years old with access to the Internet or smart devices. From 2017 and 2020, 2,558 and 3,058 subjects were included, respectively. Results In 2020, 52.8% reported receiving provider encouragement within the last year for OMR use compared with 41.3% in 2017 (p < 0.001). For respondents with chronic diseases (such as diabetes, hypertension, heart, or lung diseases [CVMD]), encouragement increased from 45.5 to 57.2% (p < 0.001). Sociodemographic determinants and clinical attributes (e.g., provider office visits, cancer history, or CVMDs) significantly (p < 0.05) predicted encouragement. Among CVMD subjects, gender and visit frequency were significant predictors. OMR use within a year grew recently (73.3% in 2020 vs. 60.6% in 2017, p = 0.002) among CVMD subjects reporting encouragement. Provider encouragement was associated (p < 0.05) with secure communication and viewing results using OMRs controlling for other predictors in the overall cohort and among CVMD subjects. Conclusion Many respondents reported not receiving provider encouragement for OMR use. These subjects represent millions of U.S. adults, including those participating during the pandemic, with CVMDs or cancer history. Encouragement rates grew over time and was associated with demographic or disease attributes and with OMR use. Future research should assess the optimality of encouragement. Resources enabling provider encouragement should continue and help prevent disparity in health technology use.

Security/Privacy Perceptions in Patient Use of Online Medical Records

Data breaches expose individuals to economic, mental, and social trauma. Electronic health information of individuals not only includes reports of medical diagnosis, medication histories but also comprises personally identifiable information (PII) (e.g, birth date). We examined the association of vulnerability perception - defined as privacy or security breach concerns and provider encouragement with the use of online medical records (OMR) and moderating effects of provider encouragement and age in the relationship between vulnerability and usage. Data came from a national population-based survey, the Health Information National Trends Survey (HINTS). This study included 1770 adult individuals many of who are chronic disease patients or cancer survivors. The majority of these subjects did report use of OMR. We found security/privacy related vulnerability and provider encouragement significantly predict patients' use of OMR. Healthcare providers and developers should work with patients to mitigate concerns and enable patients to derive benefits from using online medical records.

Multicenter Analysis of Genomically Targeted Single Patient Use Requests for Pediatric Neoplasms

PURPOSE The US Food and Drug Administration–expanded access program (EAP) uses a single patient use (SPU) mechanism to provide patient access to investigational agents in situations where no satisfactory or comparable therapy is available. Genomic profiling of de novo and relapsed or refractory childhood cancer has led to increased identification of new drug targets in the last decade. The aim of this study is to examine the SPU experience for genomically targeted therapies in patients with pediatric cancer. PATIENTS AND METHODS All genomically targeted therapeutic SPUs obtained over a 5-year period were evaluated at four large pediatric cancer programs. Data were collected on the type of neoplasm, agents requested, corresponding molecularly informed targets, and clinical outcomes. RESULTS A total of 45 SPUs in 44 patients were identified. Requests were predominantly made for CNS and solid tumors (84.4%) compared with hematologic malignancies (15.6%). Lack of an available clinical trial was the main reason for SPU initiation (64.4%). The median time from US Food and Drug Administration submission to approval was 3 days (range, 0-12 days) and from Institutional Review Board submission to approval was 5 days (range, 0-50 days). Objective tumor response was seen in 39.5% (15 of 38) of all evaluable SPUs. Disease progression was the primary reason for discontinuation of drug (66.7%) followed by toxicity (13.3%). CONCLUSION SPU requests remain an important mechanism for pediatric access to genomically targeted agents given the limited availability of targeted clinical trials for children with high-risk neoplasms. Furthermore, this subset of SPUs resulted in a substantial number of objective tumor responses. The development of a multi-institutional data registry of SPUs may enable systematic review of toxicity and clinical outcomes and provide evidence-based access to new drugs in rare pediatric cancers.

Sustainable medicines use in clinical practice - a clinical pharmacological view on ecopharmacostewardship

Climate change continues to pose a dangerous threat to human health. However, not only is health impacted by this crisis, healthcare itself adds to the problem, through significant contributions to green house gas emissions. In the UK, the National Health Service (NHS) is responsible for an estimated 4% of the overall national carbon footprint. Medicines account for a quarter of this and whilst they are vital in in health now, through sustainable use they can also positively influence the environmental health of the future. In this review, we explore how clinical pharmacologists and other health care professionals can practice sustainable medicines use or eco-pharmaco-stewardship. We will discuss current and near future environmental practices within the NHS, which we suspect will resonate with other health systems. We will suggest approaches for championing eco-pharmaco-stewardship in drug manufacturing, clinical practices and patient use, to achieve a more a sustainable healthcare system.

A review of features and characteristics of smart medication adherence products

Background: Smart medication adherence products (smart MAPs) capture and transmit real-time medication intake by using various means of connectivity, allowing for remote monitoring. Numerous such products with different features are available to address medication nonadherence. A comparison of the features of these products is needed for clinical decision-making. Therefore, the objective of this review was to compare smart MAPs available for in-home use. Methods: We searched grey and published literature and videos to identify smart MAPs. To be considered smart, products required 2 features: connectivity (the ability for collected data to exist outside the physical device) and automaticity (the ability for data to be analyzed or processed automatically). Products were excluded if product descriptions were not available in English, not for in-home use and unable to dispense medications. Results: Of the 51 products identified, 38 commercially available and 13 prototypes met the definition. Of these, 75% ( n = 38) contained alarms, 24% ( n = 12) were unit-dose, 63% ( n = 32) were multidose, 43% ( n = 22) had locking features, 41% ( n = 21) were portable and 88% ( n = 45) sent notifications to patients. The cost of marketed products, excluding subscriptions, ranged from $10 to $1500 USD. Some products required a monthly ( n = 16) or yearly ( n = 1) subscription ranging from $10 to $100 USD. Discussion: There is a growing market of smart MAPs for in-home patient use with variable features. Clinicians can use these features to identify and recommend products according to the specific needs of their patients to address medication adherence. Can Pharm J (Ott) 2021;154:xx-xx.

Accuracy of online symptom checkers and the potential impact on service utilisation

Objectives The aims of our study are firstly to investigate the diagnostic and triage performance of symptom checkers, secondly to assess their potential impact on healthcare utilisation and thirdly to investigate for variation in performance between systems. Setting Publicly available symptom checkers for patient use. Participants Publicly available symptom-checkers were identified. A standardised set of 50 clinical vignettes were developed and systematically run through each system by a non-clinical researcher. Primary and secondary outcome measures System accuracy was assessed by measuring the percentage of times the correct diagnosis was a) listed first, b) within the top five diagnoses listed and c) listed at all. The safety of the disposition advice was assessed by comparing it with national guidelines for each vignette. Results Twelve tools were identified and included. Mean diagnostic accuracy of the systems was poor, with the correct diagnosis being present in the top five diagnoses on 51.0% (Range 22.2 to 84.0%). Safety of disposition advice decreased with condition urgency (being 71.8% for emergency cases vs 87.3% for non-urgent cases). 51.0% of systems suggested additional resource utilisation above that recommended by national guidelines (range 18.0% to 61.2%). Both diagnostic accuracy and appropriate resource recommendation varied substantially between systems. Conclusions There is wide variation in performance between available symptom checkers and overall performance is significantly below what would be accepted in any other medical field, though some do achieve a good level of accuracy and safety of disposition. External validation and regulation are urgently required to ensure these public facing tools are safe.