Experience Counts: Unveiling Patients' Willingness to Pay for Remote Monitoring and Patient Self-Measurement.

OBJECTIVES: This study aimed to (1) estimate patients' willingness to pay (WTP) for remote monitoring (RM) and patient self-measurement (PSM) for pregnant women at risk of gestational hypertensive disorders, (2) assess the impact of experience with these technologies on WTP, and (3) determine their impact on health-related quality of life (HRQoL). METHODS: Data collection was part of a multicentric randomized controlled trial, Pregnancy Remote Monitoring II, with 2 interventions: RM and PSM. A contingent valuation survey, combining a payment card and open-ended question, was completed twice by 199 participants. Two-part models analyze the impact of experience on WTP, regression models estimated using ordinary least squares the impact of RM and PSM on HRQoL. RESULTS: The mean WTP amount was approximately €120 for RM and €80 for PSM. Compared with having no experience, WTP RM was €63 higher after a long-term exposure to RM (P = .01) and WTP PSM was €26 lower after a short-term exposure to RM (P = .07). No significant impact of RM or PSM on HRQoL was found. CONCLUSIONS: This study contributes to the discussion on the impact of experience on WTP. Those who had a long-term experience with RM, were willing to pay more for RM than those without experience. This confirms our hypothesis that involving patients without experience with the valued treatment, possibly underestimates WTP. A long-term experience has, however, no impact on the WTP for technologies for which the potential benefits are apparent without experiencing them, such as PSM.

Effectiveness of Telerehabilitation Interventions for Self-management of Tinnitus: Systematic Review.

BACKGROUND: Tinnitus is a highly prevalent symptom affecting 10%-20% of the adult population. Most patients with tinnitus have chronic tinnitus, which can directly or indirectly disrupt their daily life and negatively affect the health-related quality of life. Therefore, patients with tinnitus are frequently in need of costly and time-consuming treatments. As an answer, telerehabilitation interventions are on a rise to promote self-management in patients with tinnitus and reduce their dependency on in-person care. OBJECTIVE: This systematic review aimed to provide an overview of the research concerning the effectiveness of telerehabilitation interventions for self-management of tinnitus. METHODS: This systematic review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were eligible for inclusion if study participants were adult patients with complaints of primary subjective tinnitus and the study intervention comprised any possible telerehabilitation form for the self-management of tinnitus complaints. A search for eligible studies was conducted on PubMed, ScienceDirect, Scopus, Web of Science, and Cochrane Library. The Cochrane Risk of Bias 2 tool was used to the assess risk of bias. RESULTS: In total, 29 articles were found eligible, and of these, 5 (17%) studied multiple telerehabilitation forms. Internet-based cognitive behavioral treatment with guidance by a psychologist or audiologist was examined in 17 studies (n=1767), internet-based cognitive behavioral treatment without guidance was examined in 4 studies (n=940), self-help manuals were examined in 1 study (n=72), technological self-help devices were examined in 2 studies (n=82), smartphone apps were examined in 8 studies (n=284), and other internet-based interventions were examined in 2 studies (n=130). These rehabilitation categories were proven to be effective in decreasing tinnitus severity and relieving tinnitus distress as measured by tinnitus questionnaires such as Tinnitus Functional Index, Tinnitus Handicap Inventory, or Tinnitus Reactions Questionnaire. However, dropout rates were often high (range 4%-71.4%). All studies reported between some concerns and high concerns of risk of bias, resulting in low to moderate certainty levels. CONCLUSIONS: Overall, there is low to moderate quality evidence that telerehabilitation interventions effectively reduce tinnitus severity and distress. These interventions form a possible tool to improve the self-management capacities of the patient and the accessibility of tinnitus care as a replacement or an addition to in-person care. Nevertheless, barriers such as lack of time, engagement, motivation, and openness of the patient causing high dropout should be considered. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42021285450; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285450.

Cost-effectiveness of a smartphone Application for Tinnitus Treatment (the CATT trial): a study protocol of a randomised controlled trial.

BACKGROUND: Tinnitus is a highly prevalent symptom, affecting 10-15% of the adult population. Tinnitus influenced by alterations in somatosensory afference from the neck or jaw is referred to as somatic tinnitus (ST). ST is known to respond positively to physiotherapy treatment; however, it is challenging to motivate patients to systematically perform home exercises correctly, and the necessary tinnitus counselling is often lacking. The aim of this study is twofold, namely to investigate both the effectiveness and cost-effectiveness of a blended physiotherapy program for ST, including a smartphone application designed to increase exercise therapy compliance and provide tinnitus counselling. METHODS: This study is designed as a single-blind two-arm 1:1 randomised controlled trial (RCT). Adult patients diagnosed with ST, without psychiatric comorbidities and with experience in using a smartphone, will be recruited at the Ear Nose Throat (ENT) department of the Antwerp University Hospital (UZA). Patients will be randomised into two groups. The experimental group will receive the blended physiotherapy program comprising six in-clinic physiotherapy sessions over a period of 12 weeks (1x/2 weeks) and an exercise and counselling program provided by the smartphone application. The control group will receive the standard care program comprising twelve weekly in-clinic physiotherapy sessions. Each physiotherapy session has a duration of 30 min. The primary outcome measure is the change in Tinnitus Functional Index (TFI) score. Additionally, a cost-effectiveness analysis will be performed from a societal perspective considering both direct and indirect costs. There will be follow-up assessments at one and 3 months after the final treatment session. DISCUSSION: Our study is the first to combine both tinnitus counselling and neck/jaw treatment provided by a digital application in a blended physiotherapy program. This, in order to empower ST patients to improve and better manage their own health and, possibly, reduce economic costs by alleviating the tinnitus burden that ST patients experience. The strengths of the planned RCT are the high-quality methodological design, the large sample size and the expertise of the involved multidisciplinary research team. TRIAL REGISTRATION: Clinicaltrials.gov NCT05245318 . Registered on 26 January 2022.

Examining the acceptance of an integrated Electronic Health Records system: Insights from a repeated cross-sectional design.

BACKGROUND AND PURPOSE: Hospital staff's acceptance of an integrated Electronic Health Records system (EHR) is a critical success factor to exploit the benefits EHRs can offer. This study employs a repeated cross-sectional design to differentiate between the enablers and barriers of EHR acceptance prior to EHR implementation and those that arise over time by testing a theoretical model specifically tailored to the EHR context. METHODS: A repeated cross-sectional design, consisting of one measurement of staff's acceptance before and two after EHR implementation, was employed in a Belgian hospital. To test the theoretical model, partial least squares structural equation modelling (PLS-SEM) was used. Furthermore, partial least squares multigroup analyses (PLS-MGA) and permutation tests were applied to examine whether the relations in the model vary significantly over time. RESULTS: The formulated model explains up to 80 % of the variance in hospital staff's attitude towards the EHR. The extent to which the EHR leads to administrative simplification outperforms the core technology acceptance variables. Furthermore, support was found for the significant role of implementation factors (i.e. communication quality and training) and prior IT experiences in explaining EHR acceptance. Finally, the results show significant evolutions in path coefficients over time. An important trade-off between effort expectancy and performance expectancy was revealed, meaning effort expectancy is the most important determinant of hospital staff's attitude towards the EHR, but once the EHR has been implemented performance expectancy becomes more important. CONCLUSIONS: The results of testing the hypothesized model reveal the importance of taking into account hospital staff's perception of the extent to which the EHR generates administrative simplification, a combination of implementation factors, and attitude towards technology in general when assessing the acceptance of an EHR. Moreover, the results highlight the importance of conducting repeated cross-sectional or longitudinal technology acceptance research as relations between core variables vary significantly over time, which implies hospital management and healthcare technology providers should adjust their policy throughout the various implementation stages.