Reaching Ambulatory Older Adults with Educational Tools: Comparative Efficacy and Cost of Varied Outreach Modalities in Primary Care.

BACKGROUND: Providing patients with access to health information that can be obtained outside of an office visit is an important part of education, yet little is known about the effectiveness of outreach modalities to connect older adults to online educational tools. The objective was to identify the effectiveness and cost of outreach modalities providing online information about advance care planning (ACP) for older adults. METHODS: Six different outreach modalities were utilized to connect patients to online educational tools (ACP video decision aids). Participants were 13,582 patients aged 65 and older of 185 primary care providers with appointments over a 30-month period within a large health system in the greater New York City area. Main outcome measures were number of online video views and costs per outreach for each modality. KEY RESULTS: There were 1150 video views for 21,407 remote outreach events. Text messages, sent to the largest volume of patients (8869), had the highest outcome rate (9.6%) and were the most economical ($0.09). Characterization of phone calls demonstrated 21.7% engagement in the topic of ACP but resulted in minimal video views (<1%) and incurred the highest cost per outreach ($2.88). In-office handouts had negligible results (<1%). CONCLUSIONS: Text was the most cost-effective modality to connect older adults to an online educational tool in this pragmatic trial, though overall efficacy of all modalities was low.

Both the cutaneous sensation and phosphene perception are modulated in a frequency-specific manner during transcranial alternating current stimulation.

PURPOSE: Transcranial alternating current stimulation (tACS) is a non-invasive stimulation technique for shaping neuroplastic processes and possibly entraining ongoing neural oscillations in humans. Despite the growing number of studies using tACS, we know little about the procedural sensations caused by stimulation. In order to fill this gap, we explored the cutaneous sensation and phosphene perception during tACS. METHODS: Twenty healthy participants took part in a randomized, single-blinded, sham-controlled study, where volunteers received short duration stimulation at 1.0 mA intensity between 2 to 250 Hz using the standard left motor cortex-contralateral supraorbital montage. We recorded the perception onset latency and the strength of the sensations assessed by visual rating scale as dependent variables. RESULTS: We found that tACS evoked both cutaneous sensation and phosphene perception in a frequency-dependent manner. Our results show that the most perceptible procedural sensations were induced in the beta and gamma frequency range, especially at 20 Hz, whereas minimal procedural sensations were indicated in the ripple range (140 and 250 Hz). CONCLUSIONS: We believe that our results provide a relevant insight into the procedural sensations caused by oscillatory currents, and will offer a basis for developing more sophisticated stimulation protocols and study designs for future investigations.