A digital self-care intervention for Ugandan patients with heart failure and their clinicians: User-centred design and usability study

Background: The prevalence of heart failure (HF) is increasing in Uganda. Ugandan patients with HF report receiving limited information about their illness, disease management, or empowerment to engage in self-care behaviors. Interventions targeted at improving HF self-care have been shown to improve patient quality of life and to reduce hospitalizations in high-income countries. However, such interventions remain underutilized in resource-limited settings like Uganda. Objective: To develop a digital health intervention that enables improved self-care amongst HF patients in Uganda. Methods: We implemented a user-centred design process to develop a self-care intervention entitled Medly Uganda. The ideation phase comprised a systematic scoping review and preliminary data collection amongst HF patients and clinicians in Uganda. An iterative design process was then used to advance an initial prototype into a fully-functional digital health intervention. The evaluation phase involved usability testing of the developed intervention amongst Ugandan patients with HF and their clinicians. Results: Medly Uganda is a digital health intervention that is fully integrated within a government-operated mobile health platform. The system allows patients to report daily HF symptoms, receive tailored treatment advice, and connect with a clinician when showing signs of decompensation. Medly Uganda harnesses Unstructured Supplementary Service Data technology that is already widely used in Uganda for mobile phone-based financial transactions. Usability testing showed the system to be accepted by patients, caregivers, and clinicians. Conclusions: Medly Uganda is a fully-functional and well-accepted digital health intervention that enables Ugandan HF patients to better care for themselves. Moving forward, we expect the system to help decongest cardiac clinics and improve self-care efficacy amongst HF patients in Uganda.

Strategic Responses During Frugal Innovation at the Base of the Pyramid: the Case of Philips Community Life Centres

When multinational enterprises (MNEs) seek to serve the needs of base of the pyramid (BOP) environments, they are often confronted with several environmental factors, among them, severe resource constraints and institutional complexities. MNEs adopt two overarching strategic orientations to navigate these factors: the strategy to adapt to the new context, or the strategy to shape the context. This paper investigates how and when these strategic orientations are deployed in an MNE. It further explores the intra-organisational tensions and dilemmas that arise when these strategic orientations are implemented. This paper analyzes a case of frugal innovation in a primary care intervention developed and deployed in Kenya by Philips N. V., a Dutch multinational technology company. Several propositions are generated based on the case findings. The paper contributes to the frugal innovation literature which lacks rigorous, in-depth analytical case studies on organisational processes associated with new product development. It also offers managers a useful toolkit that could inform how they could strategically navigate the pressures of BOP environments.

Narrative Review: Implementation of Pharmaceutical Care in Hypertension in Indonesia

Background: In the past, patient care was not a pharmacy orientation. Several developed countries have applied pharmaceutical care in the treatment of hypertension for years. However, it is still there. In Indonesia, the government issued guidelines for the care of hypertension medications for the first time in 2006. The stages are that pharmacists carry out assessments, prepare pharmaceutical service plans, then implement and monitoring. This study aims to examine the application of pharmaceutical care in hypertension in various articles published in Indonesia. Methods: This research is non-experimental research with a narrative review design. Articles were selected using the keywords pharmaceutical care, pharmacy care, pharmaceutical care and hypertension. Articles in national journals. The number of articles reviewed was 13 articles from 2014 to 2019. Results: The application of pharmaceutical care in hypertension in Indonesia has been carried out by pharmacists, especially in hospitals. The implementation stages are more focused on implementation and monitoring. Only 15% carried out the plan, and almost no carried out the assessment. Conclusion: The application of pharmacy in hypertension has not fully complied with the guidelines. Pharmacists have not assessed when they will start pharmaceutical care. Intervention is carried out with various models, such as leaflets, short messages sent and counselling. Results were monitored on the patient's knowledge, compliance and blood pressure. The result is an improvement, although some are not.

Primary Care Disease Management for Venous Leg Ulceration – Study Protocol for the Ulcus Cruris Care [UCC] Randomized Controlled Trial (DRKS00026126)

Background Venous leg ulcers (VLU) have a prevalence of 1–2% in developed countries and affected patients are severely and long-term impaired in daily activities, work and social participation. Evidence-based outpatient treatment based on compression therapy is frequently not implemented. The “Ulcus Cruris Care” project was established to develop a disease management concept to improve outpatient treatment for patients with VLU in German primary care. For this purpose, a multifaceted intervention was conceived consisting of an online training for general practitioners and medical assistants, standardized treatment recommendations, e-learning and print-based information for patients, and a software support for case-management. Main aims of the Ulcus Cruris Care intervention are to promote standardized treatment according to current scientific knowledge, to facilitate case management for VLU patients exerted by medical assistants and to support patient education and participation in the treatment process. The UCC trial was designed to evaluate the effectiveness of the Ulcus Cruris Care intervention. Methods The UCC trial is a prospective cluster-randomized controlled multicenter trial. Fifty GP practices are intended to be recruited and randomized 1:1 to intervention or control arm. Patients with venous leg ulcers will be recruited by participating GP practices, to include a total of 63 patients in each arm. The primary outcome is time to ulcer healing. Secondary outcomes comprise number and sizes of ulcers, recurrence, pain intensity according to the Visual Analogue Scale, health-related quality of life according to EQ-5D-5L, depressiveness according to Patient Health Questionnaire (PHQ-9), patient satisfaction according to the Patient Assessment of Chronic Illness Care (PACIC-5A) query and adherence to VLU treatment. The outcome analysis of the UCC trial is accompanied by a health economic analysis and a process evaluation. Discussion The UCC trial will evaluate whether the Ulcus Cruris Care intervention may lead to faster wound healing, higher health-related quality of life and lower use of medical resources. If the intervention turns out to have a positive impact on assessed outcomes, comprehensive implementation in primary care may be considered. Trial registration The trial protocol (version 1 as of July 19th, 2021) has been registered in the German Clinical Trials Register on August 30th, 2021 (DRKS000261265).

Cognitive Changes in Older Adults Following a Stepped Care Intervention for Late-life Depression

Older adults with depression may manifest cognitive decline and treating depression may maintain or improve cognition. However, cognitive outcomes could be overlooked in non-pharmacological interventions for depression. This analysis investigated cognitive changes in a stepped-care intervention (Clinical Trial ID: NCT03593889) and the potential association with individual depressive symptom change. The community-dwelling older adults at risk of or with depressive symptoms without significant cognitive impairment (n=802) were assigned to intervention group (n=644) and control group (n=138). Depressive symptoms and cognitive functions were measured using Patient Health Questionnaire-9 and Cognitive Montreal Assessment-5 minutes protocol, respectively. Paired-t-Test showed significant improvements in overall cognition and attention in both intervention and control groups, but the improvements of language fluency (Intervention: MD=-0.51 p<0.01; control: MD=0.14, p=0.500) and orientation (Intervention: MD=-0.22 p<0.05; control: MD=-0.11, p=0.229) only displayed in intervention group. As control group had better cognition at baseline, linear mixed-effects model analysis was used to compare between-group difference. Intervention group had no significant cognitive improvement after adjusting the covariates but a potential improvement in language fluency (Coef. =0.442, SE=0.247, p=0.074). A linear regression analysis in intervention group indicated that reduction of concentration problem (β=0.106, p<0.05) and retardedness (β=0.117, p<0.01) under the symptomatology of depression were associated with the improvement of language fluency. In this group of older persons without significant cognitive impairment, there is no clear evidence of global cognitive benefits in a stepped care depression intervention, although there may be improvements in certain cognitive domains, which may be related to improvements in cognitive aspects of depression.