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1.
BMC Public Health ; 19(1): 1421, 2019 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666039

RESUMEN

BACKGROUND: Inability to track children's vaccination history coupled with parents' lack of awareness of vaccination due dates compounds the problem of low immunization coverage and timeliness in developing countries. Traditional Reminder/Recall (RR) interventions such as paper-based immunization cards or mHealth based platforms do not yield optimal results in resource-constrained settings. There is thus a need for a low-cost intervention that can simultaneously stimulate demand and track immunization history to help reduce drop-outs and improve immunization coverage and timeliness. The objective of this study is to evaluate the impact of low-cost vaccine reminder and tracker bracelets for improving routine childhood immunization coverage and timeliness in Pakistani children under 2 years of age. METHODS: The study is an individually randomized, three-arm parallel Randomized Controlled Trial with two intervention groups and one control group. Infants in the two intervention groups will be given two different types of silicone bracelets at the time of recruitment, while infants in the control group will not receive any intervention. The two types of bracelets consist of symbols and/or numbers to denote the EPI vaccination schedule and each time the child will come for vaccination, the study staff will perforate a hole in the appropriate symbol to denote vaccine administration. Therefore, by looking at the bracelet, caregivers will be able to see how many vaccines have been received. Our primary outcome measure is the increase in coverage and timeliness of Pentavalent-3/PCV-3/Polio-3 and Measles-1 vaccine in the intervention versus control groups. A total of 1446 participants will be recruited from 4 Expanded Program on Immunization (EPI) centers in Landhi Town, Karachi. Each enrolled child will be followed up till the Measles-1 vaccine is administered, or till eleven months have elapsed since enrolment. DISCUSSION: Participant recruitment commenced on July 19, 2017, and was completed on October 10, 2017. Proposed duration of the study is 18 months and expected end date is December 1, 2018. This study constitutes one of the first attempts to rigorously evaluate an innovative, low-cost vaccine reminder bracelet. TRIAL REGISTRATION: ClinicalTrials.gov NCT03310762 . Retrospectively Registered on October 16, 2017.


Asunto(s)
Programas de Inmunización/métodos , Esquemas de Inmunización , Padres , Sistemas Recordatorios , Cobertura de Vacunación , Vacunación , Vacunas/administración & dosificación , Cuidadores , Preescolar , Análisis Costo-Beneficio , Países en Desarrollo , Femenino , Humanos , Lactante , Masculino , Sarampión/prevención & control , Pakistán , Poliomielitis/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Sistemas Recordatorios/instrumentación , Proyectos de Investigación , Estudios Retrospectivos , Población Urbana
2.
Patient Educ Couns ; 102(12): 2208-2213, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31235394

RESUMEN

OBJECTIVE: Patients want to discuss spirituality more with their doctors but feel disempowered. Question prompt lists (QPLs) assist conversations. This study assessed the impact of a QPL on spirituality discussions in Palliative Care (PC). METHODS: This was a sub-study of a trial in which PC patients were randomised to either receive a QPL prior to a consultation or not, to see whether its provision influenced advanced cancer patients'/caregivers' questions and discussion of topics relevant to end-of-life care during consultations with a PC physician. Consultations were recorded and transcribed. Transcriptions were analysed to examine the frequency and content of spirituality discussions. We conducted logistic regression to investigate the impact of the QPL and other predictors. RESULTS: 174 patients participated. Spirituality was discussed in half the consultations. Patients receiving a QPL discussed spirituality 1.38 times more than controls. This finding did not reach statistical significance. First PC consultation and being asked about their concerns by the doctor were significant predictors of a spiritual discussion. CONCLUSION: Patients are more likely to discuss spirituality in their first PC consultation, and when their doctor asks them about their concerns. PRACTICE IMPLICATIONS: Doctors caring for patients at the end of life should routinely raise spiritual issues.


Asunto(s)
Comunicación , Neoplasias/psicología , Neoplasias/terapia , Cuidados Paliativos/métodos , Participación del Paciente , Relaciones Médico-Paciente , Espiritualidad , Cuidado Terminal/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Derivación y Consulta , Sistemas Recordatorios/instrumentación , Enfermo Terminal
3.
JMIR Mhealth Uhealth ; 7(4): e11720, 2019 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-30964436

RESUMEN

BACKGROUND: Ensuring treatment adherence is important for the internal validity of clinical trials. In intervention studies where touch points decrease over time, there is even more of an adherence challenge. Trials with multiple cohorts offer an opportunity to innovate on ways to increase treatment adherence without compromising the integrity of the study design, and previous cohorts can serve as historical controls. Electronically delivered nudges offer low-cost opportunities to increase treatment adherence. OBJECTIVE: This study aimed to evaluate the effectiveness of electronic messages (e-messages) on treatment adherence to the last cohort of a parent weight loss intervention during the second half of a year-long trial, when intervention checkpoint frequency decreases. Treatment adherence is measured by intervention class attendance and adherence to the intervention diet. METHODS: All participants in the last cohort (cohort 5, n=128) of a large randomized weight loss study were offered an e-message intervention to improve participant adherence during the last 6 months of a 1-year weight loss program. Overall, 3 to 4 electronic weekly messages asked participants about intervention diet adherence. A propensity score model was estimated using 97 participants who opted to receive e-messages and 31 who declined in cohort 5 and used to pair match cohort 5 e-message participants to a historical control group from cohorts 1 to 4. Moreover, 88 participants had complete data, yielding 176 participants in the final analyses. After matching, intervention and matched control groups were compared on (1) proportion of class attendance between the 6 and 12 month study endpoints, (2) diet adherence, as measured by total carbohydrate grams for low-carbohydrate (LC) and total fat grams for low-fat (LF) diets at 12 months, and (3) weight change from 6 to 12 months. The dose-response relationship between the proportion of text messages responded to and the 3 outcomes was also investigated. RESULTS: Compared with matched controls, receiving e-messages had no effect on (1) treatment adherence; class attendance after 6 months +4.6% (95% CI -4.43 to 13.68, P=.31), (2) adherence; LC -2.5 g carbohydrate, 95% CI -29.9 to 24.8, P=.85; LF +6.2 g fat, 95% CI -4.1 to 17.0, P=.26); or on (3) the secondary outcome of weight change in the last 6 months; +0.3 kg (95% CI -1.0 to 1.5, P=.68). There was a positive significant response correlation between the percentage of messages to which participants responded and class attendance (r=.45, P<.001). CONCLUSIONS: Although this e-message intervention did not improve treatment adherence, future studies can learn from this pilot and may incorporate more variety in the prompts and more interaction to promote more effective user engagement. Uniquely, this study demonstrated the potential for innovating within a multicohort trial using propensity score-matched historical control subjects. TRIAL REGISTRATION: ClinicalTrials.gov NCT01826591; https://clinicaltrials.gov/ct2/show/NCT01826591. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1016/j.cct.2016.12.021.


Asunto(s)
Envío de Mensajes de Texto/normas , Cumplimiento y Adherencia al Tratamiento/psicología , Adulto , Estudios de Cohortes , Femenino , Grupos Focales/métodos , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Sistemas Recordatorios/instrumentación , Sistemas Recordatorios/normas , Sistemas Recordatorios/estadística & datos numéricos , Encuestas y Cuestionarios , Envío de Mensajes de Texto/instrumentación , Envío de Mensajes de Texto/estadística & datos numéricos , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos
4.
BMC Geriatr ; 19(1): 116, 2019 04 23.
Artículo en Inglés | MEDLINE | ID: mdl-31014276

RESUMEN

BACKGROUND: New technologies such as mobile/smartphones have the potential to help senior people perform everyday activities. However, senior people may find it difficult using mobile/smartphones, especially the digital calendar and short text message features. Therefore, senior people might need user-friendly, flexible, and interactive digital calendars that provide them with active reminders about their everyday activities. This study focuses on community dwelling seniors' experiences learning and using RemindMe, an interactive digital calendar with active reminders, as part of customizing an intervention appropriate for senior people with cognitive impairments. METHODS: Four focus groups were conducted with 20 community dwelling seniors (11 men and 9 women) who all had used RemindMe for six weeks. The focus groups were tape recorded, transcribed verbatim, and analysed using content analysis. RESULTS: For participants in this study, using a calendar was an essential part of their everyday lives, but only a few had experiences using a digital calendar. Although the participants described RemindMe as easy to use, they had a difficult time incorporating RemindMe into their daily routines. In part, these difficulties were the result of the participants needing to change their mobile/smartphone routines. Some participants felt that using an interactive digital calendar was a sign of modernity allowing them to take part in the society at large, but others felt that their inability to use the technology was due to their age, dependence, and loss of function. Participants found that receiving active reminders through short text messages followed by actively acknowledging the reminder helped them perform more everyday life activities. This feature gave them a higher sense of independence and control. CONCLUSIONS: Community dwelling seniors found that RemindMe was easy to learn and to use, although they also found it challenging to integrate into their everyday lives. For senior people to make the effort to develop new routines for mobile/smartphone use, a prerequisite for using a digital calendar, they need to be motivated and believe that the technology will make their lives better.


Asunto(s)
Calendarios como Asunto , Teléfono Celular , Grupos Focales/métodos , Motivación , Sistemas Recordatorios , Entrenamiento Simulado/métodos , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/psicología , Disfunción Cognitiva/terapia , Femenino , Humanos , Masculino , Sistemas Recordatorios/instrumentación , Suecia/epidemiología , Envío de Mensajes de Texto
5.
JMIR Mhealth Uhealth ; 7(2): e11114, 2019 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-30720439

RESUMEN

BACKGROUND: Fecal occult blood tests (FOBTs) are recommended by the US Preventive Services Task Force as a screening method for colorectal cancer (CRC), but they are only effective if positive results are followed by colonoscopy. Surprisingly, a large proportion of patients with a positive result do not follow this recommendation. OBJECTIVE: The objective of this study was to examine the effectiveness of text messaging (short message service, SMS) in increasing adherence to colonoscopy follow-up after a positive FOBT result. METHODS: This randomized controlled trial was conducted with patients who had positive CRC screening results. Randomization was stratified by residential district and socioeconomic status (SES). Subjects in the control group (n=238) received routine care that included an alert to the physician regarding the positive FOBT result. The intervention group (n=232) received routine care and 3 text messaging SMS reminders to visit their primary care physician. Adherence to colonoscopy was measured 120 days from the positive result. All patient information, including test results and colonoscopy completion, were obtained from their electronic medical records. Physicians of study patients completed an attitude survey regarding FOBT as a screening test for CRC. Intervention and control group variables (dependent and independent) were compared using chi-square test. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs for performing colonoscopy within 120 days for the intervention group compared with the control group while adjusting for potential confounders including age, gender, SES, district, ethnicity, and physicians' attitude. RESULTS: Overall, 163 of the 232 patients in the intervention group and 112 of the 238 patients in the control group underwent colonoscopy within 120 days of the positive FOBT results (70.3% vs 47.1%; OR 2.17, 95% CI 1.49-3.17; P<.001); this association remained significant after adjusting for potential confounders (P=.001). CONCLUSIONS: A text message (SMS) reminder is an effective, simple, and inexpensive method for improving adherence among patients with positive colorectal screening results. This type of intervention could also be evaluated for other types of screening tests. TRIAL REGISTRATION: ClinicalTrials.gov NCT03642652; https://clinicaltrials.gov/ct2/show/NCT03642652 (Archived by WebCite at http://www.webcitation.org/74TlICijl).


Asunto(s)
Cuidados Posteriores/métodos , Sangre Oculta , Sistemas Recordatorios/instrumentación , Envío de Mensajes de Texto/normas , Cuidados Posteriores/normas , Anciano , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/prevención & control , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Aplicaciones Móviles/normas , Aplicaciones Móviles/tendencias , Sistemas Recordatorios/normas , Envío de Mensajes de Texto/instrumentación , Cumplimiento y Adherencia al Tratamiento/psicología , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos
6.
Hum Vaccin Immunother ; 15(1): 102-106, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30192711

RESUMEN

Annual influenza vaccination is considered the best protection against influenza infection. We analyzed the influenza vaccine coverage (IVC) in cystic fibrosis (CF) patients and evaluated the factors associated with the IVC, including the effect of text-message/SMS reminders. We performed a cross-sectional study in the Community of Madrid (Spain) in 2015. The target population was people with CF older than 6 months of age at the beginning of the flu vaccination campaign. The IVC was calculated according to the study variables. A total of 445 CF patients were analyzed. In 2015, IVC reached 67.9% and was higher in children and women. The main factor associated with flu vaccination was having been vaccinated in the previous campaign (aOR 14.36; IC95%: 8.48-24.32). The probability of being vaccinated after receiving the SMS was more than twice than for those who did not receive it, although no statistical significance was reached. In conclusion the IVC of patients with CF is high, but it still has room for improvement. SMS reminders sent to CF patients might improve influenza vaccine uptake.


Asunto(s)
Fibrosis Quística/complicaciones , Programas de Inmunización , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Sistemas Recordatorios/instrumentación , Envío de Mensajes de Texto , Cobertura de Vacunación , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Fibrosis Quística/virología , Registros Electrónicos de Salud , Femenino , Humanos , Lactante , Masculino
7.
AIDS Educ Prev ; 30(5): 357-368, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30332308

RESUMEN

We examined adherence, medication-taking practices, and preferences to inform development of a wrist-worn adherence system. Two convenience samples of persons taking antiretroviral therapy and HIV pre-exposure prophylaxis completed a survey. Additional online questions asked about willingness to use a wrist-worn device and reminder and feedback preferences. Among 225 participants, 13% reported adherence < 90%; this was associated with younger age and clinic sample. Compared to pill bottle-using participants, mediset users less commonly reported adherence < 90% (aOR = 0.16, p = .02), and blister pack users (aOR = 6.3, p = .02) and pill roll users (aOR = 3.3, p = .04) more commonly reported adherence < 90%. Sixty-two percent of the online participants reporting adherence (< 100%) had some interest in receiving adherence reminders, including 42% with interest in receiving reminders by smartwatch notifications. Although confounders are likely, formative work identified potential users and interest in using a wrist-worn adherence system. Future work will determine its acceptability and efficacy.


Asunto(s)
Infecciones por VIH/prevención & control , Cumplimiento de la Medicación/psicología , Profilaxis Pre-Exposición/métodos , Sistemas Recordatorios/instrumentación , Adulto , Instituciones de Atención Ambulatoria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Muñeca
8.
Am J Clin Dermatol ; 19(5): 779-785, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30062632

RESUMEN

OBJECTIVE: The aim of this study was to evaluate the use of a mobile application (app) in patients already using total body photography (TBP) to increase skin self-examination (SSE) rates and pilot the effectiveness of examination reminders and accountability partners. DESIGN: Randomized controlled trial with computer generated randomization table to allocate interventions. SETTING: University of Pennsylvania pigmented lesion clinic. PARTICIPANTS: 69 patients aged 18 years or older with an iPhone/iPad, who were already in possession of TBP photographs. INTERVENTION: A mobile app loaded with digital TBP photos for all participants, and either (1) the mobile app only, (2) skin examination reminders, (3) an accountability partner, or (4) reminders and an accountability partner. MAIN OUTCOME MEASURE: Change in SSE rates as assessed by enrollment and end-of-study surveys 6 months later. RESULTS: Eighty one patients completed informed consent, however 12 patients did not complete trial enrollment procedures due to device incompatibility, leaving 69 patients who were randomized and analyzed [mean age 54.3 years, standard deviation 13.9). SSE rates increased significantly from 58% at baseline to 83% at 6 months (odds ratio 2.64, 95% confidence interval 1.20-4.09), with no difference among the intervention groups. The group with examination reminders alone had the highest (94%) overall satisfaction, and the group with accountability partners alone accounted for the lowest (71%). CONCLUSION: A mobile app alone, or with reminders and/or accountability partners, was found to be an effective tool that can help to increase SSE rates. Skin examination reminders may help provide a better overall experience for a subset of patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02520622.


Asunto(s)
Detección Precoz del Cáncer/instrumentación , Melanoma/prevención & control , Fotograbar/instrumentación , Autoexamen/instrumentación , Neoplasias Cutáneas/prevención & control , Adulto , Detección Precoz del Cáncer/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Melanoma/diagnóstico por imagen , Persona de Mediana Edad , Aplicaciones Móviles , Proyectos Piloto , Sistemas Recordatorios/instrumentación , Autoexamen/métodos , Neoplasias Cutáneas/diagnóstico por imagen , Teléfono Inteligente , Resultado del Tratamiento , Adulto Joven
9.
HIV Med ; 19(9): 585-596, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29963766

RESUMEN

OBJECTIVES: The aim of the study was to determine whether behaviourally informed short message service (SMS) primer and reminder messages could increase the return rate of HIV self-sampling kits ordered online. METHODS: The study was a 2 × 2 factorial design randomized control trial. A total of 9585 individuals who ordered a self-sampling kit from www.freetesting.hiv different SMS combinations: 1) standard reminders sent days 3 and 7 after dispatch (control); 2) primer sent 1 day after dispatch plus standard reminders; 3) behavioural insights (BI) reminders (no primer); or 4) primer plus BI reminders. The analysis was restricted to individuals who received all messages (n = 8999). We used logistic regression to investigate independent effects of the primer and BI reminders and their interaction. We explored the impact of sociodemographic characteristics on kit return as a secondary analysis. RESULTS: Those who received the primer and BI reminders had a return rate 4% higher than that of those who received the standard messages. We found strong evidence of a positive effect of the BI reminders (odds ratio 1.13; 95% confidence interval 1.04-1.23; P = 0.003) but no evidence for an effect of the primer, or for an interaction between the two interventions. Odds of kit return increased with age, with those aged ≥ 65 years being almost 2.5 times more likely to return the kit than those aged 25-34 years. Men who have sex with men were 1.5-4.5 times more likely to return the kit compared with other sexual behaviour and gender identity groups. Non-African black clients were 25% less likely to return the kit compared with other ethnicities. CONCLUSIONS: Adding BI to reminder messages was successful in improving return rates at no additional cost.


Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/etnología , Sistemas Recordatorios/instrumentación , Adolescente , Adulto , Factores de Edad , Anciano , Conducta , Inglaterra/etnología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Juego de Reactivos para Diagnóstico , Minorías Sexuales y de Género , Envío de Mensajes de Texto , Adulto Joven
10.
Aust J Gen Pract ; 47(6): 383-388, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29966185

RESUMEN

BACKGROUND AND OBJECTIVES: Preventive care in general practice is fundamental to managing the Australian diabetes epidemic. Recommended preventive care is nonetheless underperformed. The aim of this pilot study was to demonstrate proof of concept that pre-consultation patient-directed reminders could improve preventive care in general practice. METHOD: Over two weeks, four general practices used a special software tool to generate reminder sheets listing recommended checks for a subset of patients with type 2 diabetes mellitus (T2DM). The sheets were given to patients before their consultations. The number of checks performed was compared for patients who did and did not receive reminders. General practitioners (GPs) were interviewed about the reminders and chronic disease management. RESULTS: Patients who received reminders had more recommended checks performed than those who did not receive reminders. GPs found the reminders useful but suggested that broader system changes are required. DISCUSSION: Pre-consultation patient-directed reminders could potentially be an effective tool to increase preventive care for patients with T2DM in general practice.


Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Sistemas Recordatorios/instrumentación , Diabetes Mellitus Tipo 2/psicología , Medicina General/instrumentación , Medicina General/métodos , Humanos , Medicina Preventiva/métodos , Sistemas Recordatorios/tendencias
11.
Am J Ophthalmol ; 194: 54-62, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30053472

RESUMEN

PURPOSE: To determine whether short message service (SMS) reminders improve adherence to scheduled ocular examinations among patients with diabetes in rural China. DESIGN: Randomized controlled trial. METHODS: This study enrolled consecutive patients with diabetes scheduled for eye examinations at 5 hospitals in low-income areas of Guangdong, China from March 1, 2015 to May 31, 2016. Participants were randomized (1:1) to receive automated SMS reminders containing information about diabetic retinopathy (DR) 1 week and 3 days prior to scheduled eye appointments (Intervention) or to appointments without reminders (Control). Regression models following intention-to-treat principles were used to estimate the association between the main outcome (attendance within ± 1 week of scheduled visit) and membership in the Intervention group, with and without adjustment for other potential predictors of follow-up. Secondary outcomes included change in DR knowledge score (1, worst; 5, best) and endline satisfaction with care (3, worst; 15, best). RESULTS: Among 233 patients, 119 (51.1%) were randomized to Intervention (age 59.7 ± 11.3 years, 52.1% men) and 114 (48.9%) to Control (58.7 ± 9.50 years, 49.1% men). All participants provided data for the main study outcome. Attendance at scheduled appointments for the Intervention group (51/119, [42.9%]) was significantly higher than for Controls (16/114, [14.0%], between-group difference 28.8% [95% confidence interval (CI) 17.9%, 39.8%], P < .001). Factors associated with attendance in multiple regression models included Intervention group membership (Relative Risk [RR] 3.04, 95% CI, 1.73-5.33, P < .001) and baseline DR knowledge (RR 1.47, 95% CI 1.21-1.78, P < .001). Improvement in Satisfaction (mean difference 1.08, 95% CI 0.70-1.46, P < .001) and DR knowledge (mean difference 1.30, 95% CI 0.96-1.63, P < .001) were significantly higher for the Intervention group. Total cost of the intervention was US$5.40/person. CONCLUSION: Low-cost SMS informational reminders significantly improved adherence to, knowledge about, and satisfaction with care. Additional interventions are needed to further improve adherence.


Asunto(s)
Teléfono Celular/instrumentación , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/terapia , Cooperación del Paciente/estadística & datos numéricos , Sistemas Recordatorios , Población Rural , Envío de Mensajes de Texto/instrumentación , Anciano , Citas y Horarios , Grupo de Ascendencia Continental Asiática/etnología , Teléfono Celular/economía , China/epidemiología , Retinopatía Diabética/etnología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistemas Recordatorios/instrumentación , Envío de Mensajes de Texto/economía
12.
Trials ; 19(1): 398, 2018 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-30045757

RESUMEN

BACKGROUND: Treatment for drug-sensitive tuberculosis (TB) is taken for at least 6 months and problems with adherence are common. Therefore, there is substantial interest in the possible use of eHealth interventions to support patients to take their treatment. Electronic medication monitors have been shown to improve adherence to TB medication, but the impact on clinical outcomes is unknown. We aim to evaluate the impact of a medication monitor-based treatment strategy for drug-sensitive TB patients on a composite poor outcome measured over 18 months from start of TB treatment. METHODS/DESIGN: We will conduct an open, pragmatic, cluster randomised superiority trial, with 24 counties/districts in three provinces in China, randomised 1:1 to implement the intervention or standard of care. Adults (aged ≥ 18 years) with a new episode of GeneXpert-positive and rifampicin-sensitive pulmonary TB, who plan to be in the study area for the next 18 months, and will receive daily fixed-dose combination tablets for 6 months of treatment are eligible. The intervention is centred around a medication monitor that holds a 1-month supply of medication and has three key functions: as an audio and visual reminder for patients to take their daily medication; reminds patients of upcoming monthly visit; and records date and time whenever the box is opened. At the monthly follow-up visit, the doctor downloads these data to generate a graphical display of the last month's adherence record for discussion with the patient and potentially to switch the patient to more intensive management. The primary outcome is a composite poor outcome measured over 18 months from start of TB treatment, defined as either of poor outcome at the end of treatment (death, treatment failure, or loss to follow-up) or subsequent recurrence (culture positive for TB at 12 or 18 months or re-starting TB treatment in the follow-up period). An economic evaluation will also be conducted as part of this study. DISCUSSION: This trial will assess whether a medication monitor-based treatment strategy can improve clinical outcomes for TB patients. Several trials of other eHealth interventions for TB treatment are ongoing and are summarised in this paper. This trial will provide an important part of the emerging evidence base for the potential of eHealth to improve TB treatment outcomes. TRIAL REGISTRATION: This trial was registered with Current Controlled Trials (identifier: ISRCTN35812455 ). Registered on May 19, 2016.


Asunto(s)
Antituberculosos/administración & dosificación , Cumplimiento de la Medicación , Sistemas Recordatorios/instrumentación , Telemedicina/instrumentación , Tuberculosis Pulmonar/tratamiento farmacológico , Administración Oral , Antituberculosos/efectos adversos , China , Esquema de Medicación , Combinación de Medicamentos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Estudios Multicéntricos como Asunto , Ensayos Clínicos Pragmáticos como Asunto , Comprimidos , Factores de Tiempo , Resultado del Tratamiento , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/microbiología , Tuberculosis Pulmonar/psicología
13.
BMJ Open ; 8(5): e020469, 2018 05 09.
Artículo en Inglés | MEDLINE | ID: mdl-29743326

RESUMEN

INTRODUCTION: Despite advances in infection prevention and control, catheter-associated urinary tract infections (CAUTIs) are common and remain problematic. Prolonged urinary catheterisation is the main risk factor for development of CAUTIs; hence, interventions that target early catheter removal warrant investigation. The study's objectives are to examine the efficacy of an electronic reminder system, the CATH TAG, in reducing urinary catheter use (device utilisation ratio) and to determine the effect of the CATH TAG on nurses' ability to deliver patient care. METHODS AND ANALYSIS: This study uses a mixed methods approach in which both quantitative and qualitative data will be collected. A stepped wedge randomised controlled design in which wards provide before and after observations will be undertaken in one large Australian hospital over 24 weeks. The intervention is the use of the CATH TAG. Eligible hospital wards will receive the intervention and act as their own control, with analysis undertaken of the change within each ward using data collected in control and intervention periods. An online survey will be administered to nurses on study completion, and a focus group for nurses will be conducted 2 months after study completion. The primary outcomes are the urinary catheter device utilisation ratio and perceptions of nurses about ease of use of the CATH TAG. Secondary outcomes include a reduced number of cases of catheter-associated asymptomatic bacteriuria, a reduced number of urinary catheters inserted per 100 patient admissions, perceptions of nurses regarding effectiveness of the CATH TAG, changes in ownership/interest by patients in catheter management, as well as possible barriers to successful implementation of the CATH TAG. ETHICS AND DISSEMINATION: Approval has been obtained from the Human Research Ethics Committees of Avondale College of Higher Education (2017:15) and Queensland Health (HREC17QTHS19). Results will be disseminated via peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: ACTRN12617001191381 (Pre-results).


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/prevención & control , Remoción de Dispositivos , Sistemas Recordatorios/instrumentación , Cateterismo Urinario/efectos adversos , Infecciones Urinarias/prevención & control , Australia , Protocolos Clínicos , Estudios de Evaluación como Asunto , Humanos , Catéteres Urinarios/efectos adversos
14.
Br J Dermatol ; 179(5): 1062-1071, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-29654699

RESUMEN

BACKGROUND: Adherence to topical psoriasis treatments is low, which leads to unsatisfactory treatment results. Smartphone applications (apps) for patient support exist but their potential to improve adherence has not been systematically evaluated. OBJECTIVES: To evaluate whether a study-specific app improves adherence and reduces psoriasis symptoms compared with standard treatment. METHODS: We conducted a randomized controlled trial (RCT, clinicaltrials.gov registration: NCT02858713). Patients received once-daily medication [calcipotriol/betamethasone dipropionate (Cal/BD) cutaneous foam] and were randomized to no app (n = 66) or app intervention (n = 68) groups. In total, 122 patients (91%) completed the 22-week follow-up. The primary outcome was adherence, which was defined as medication applied ≥ 80% of days during the treatment period and assessed by a chip integrated into the medication dispenser. Secondary outcomes were psoriasis severity measured by the Lattice System Physician's Global Assessment (LS-PGA) and quality of life, measured using the Dermatology Life Quality Index (DLQI) at all visits. RESULTS: Intention-to-treat analyses using regression was performed. More patients in the intervention group were adherent to Cal/BD cutaneous foam than those in the nonintervention group at week 4 (65% vs. 38%, P = 0·004). The intervention group showed a greater LS-PGA reduction than the nonintervention group at week 4 (mean 1·86 vs. 1·46, P = 0·047). A similar effect was seen at weeks 8 and 26, although it did not reach statistical significance. CONCLUSIONS: This RCT demonstrates that the app improved short-term adherence to Cal/BD cutaneous foam treatment and psoriasis severity.


Asunto(s)
Betametasona/análogos & derivados , Calcitriol/análogos & derivados , Fármacos Dermatológicos/administración & dosificación , Cumplimiento de la Medicación/estadística & datos numéricos , Aplicaciones Móviles , Psoriasis/tratamiento farmacológico , Administración Cutánea , Adulto , Aerosoles , Anciano , Betametasona/administración & dosificación , Calcitriol/administración & dosificación , Combinación de Medicamentos , Femenino , Humanos , Análisis de Intención de Tratar , Masculino , Persona de Mediana Edad , Psoriasis/diagnóstico , Sistemas Recordatorios/instrumentación , Índice de Severidad de la Enfermedad , Teléfono Inteligente , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
15.
Cephalalgia ; 38(14): 2035-2044, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29635937

RESUMEN

BACKGROUND: Effective management of migraine requires adherence to treatment recommendations; however, adolescents with migraine take their daily medications only 75% of the time. Low-cost adherence-focused interventions using technology may improve adherence, but have not been investigated. METHODS: Thirty-five adolescents and young adults (13-21 years) with migraine participated in an AB-design pilot study to assess the use of a mobile phone adherence-promotion application ("app") and progressive reminder system. Adherence was calculated using electronic monitoring during the baseline period and medication adherence intervention. RESULTS: Relative to baseline, adherence significantly improved during the first month of the intervention. Specifically, improvements existed for older participants with lower baseline adherence. Self-reported app-based adherence rates were significantly lower than electronically monitored adherence rates. Participants rated the intervention as acceptable and easy to use. CONCLUSIONS: "Apps" have the potential to improve medication adherence and are a promising intervention for adolescents and young adults with low adherence. Involving parents in the intervention is also helpful. Providers should assess barriers to adherence and use of technology-based interventions, encourage parents to incorporate behavioral incentives, and provide referrals for more intensive interventions to improve long-term outcomes. Further, tracking adherence in an app may result in an underestimation of adherence. Future full-scale studies should be conducted to examine adherence promotion app interventions.


Asunto(s)
Cumplimiento de la Medicación , Trastornos Migrañosos/prevención & control , Aplicaciones Móviles , Sistemas Recordatorios/instrumentación , Adolescente , Teléfono Celular , Femenino , Humanos , Masculino , Proyectos Piloto , Adulto Joven
16.
Patient Educ Couns ; 101(9): 1594-1600, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29703493

RESUMEN

OBJECTIVE: To document the effect of a cancer specific question prompt list (QPL) on patients question asking and shared decision-making (SDM), and to evaluate the combined effect of the QPL and consultation audio recording (CAR) on patient outcomes. METHOD: This exploratory study compared two groups of patients receiving either a QPL or combined QPL/CAR, to a control group. Measurements included number/types of questions asked, and physician SDM behavior (OPTION score). Questionnaire data included anxiety/depression and quality of life (QoL). RESULTS: A total of 93 patients participated (31 Control, 30 QPL and 32 Combined). Patients in the intervention groups asked more questions concerning prognosis (p < .0001), the disease (p = .006) and quality of treatment (p < .001) than patients in the control group, but no impact was found on the OPTION score. An increase in mean consultation length was observed in the intervention groups compared to the control group (44 vs. 36 min; p = .028). Patients rated both interventions positively. CONCLUSION: Provision of the QPL facilitates patients to ask a broader range of questions, but does not increase physician SDM behavior. PRACTICAL IMPLEMENTATION: The combination of QPL and CAR seems feasible and should be tested in an implementation study following the disease trajectory.


Asunto(s)
Comunicación , Toma de Decisiones , Neoplasias/psicología , Neoplasias/terapia , Participación del Paciente , Relaciones Médico-Paciente , Derivación y Consulta , Sistemas Recordatorios , Adulto , Anciano , Instituciones de Atención Ambulatoria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Sistemas Recordatorios/instrumentación , Grabación en Cinta
17.
Am J Infect Control ; 46(6): 610-616, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29502883

RESUMEN

BACKGROUND: We hypothesized that the addition of a novel verbal electronic audio reminder to an educational patient hand hygiene bundle would increase performance of self-managed patient hand hygiene. METHODS: We conducted a 2-group comparative effectiveness study randomly assigning participants to patient hand hygiene bundle 1 (n = 41), which included a video, a handout, and a personalized verbal electronic audio reminder (EAR) that prompted hand cleansing at 3 meal times, or patient hand hygiene bundle 2 (n = 34), which included the identical video and handout, but not the EAR. The primary outcome was alcohol-based hand sanitizer use based on weighing bottles of hand sanitizer. RESULTS: Participants that received the EAR averaged significantly more use of hand sanitizer product over the 3 days of the study (mean ± SD, 29.97 ± 17.13 g) than participants with no EAR (mean ± SD, 10.88 ± 9.27 g; t73 = 5.822; P ≤ .001). CONCLUSIONS: The addition of a novel verbal EAR to a patient hand hygiene bundle resulted in a significant increase in patient hand hygiene performance. Our results suggest that simple audio technology can be used to improve patient self-management of hand hygiene. Future research is needed to determine if the technology can be used to promote other healthy behaviors, reduce infections, and improve patient-centered care without increasing the workload of health care workers.


Asunto(s)
Electrónica Médica/instrumentación , Desinfección de las Manos/métodos , Sistemas Recordatorios/instrumentación , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autoadministración/estadística & datos numéricos
18.
BMJ Open ; 8(2): e018974, 2018 02 24.
Artículo en Inglés | MEDLINE | ID: mdl-29478016

RESUMEN

OBJECTIVE: A number of promising automated behaviour change interventions have been developed using advanced phone technology. This paper reviewed the effectiveness of interactive voice response (IVR)-based interventions designed to promote changes in specific health behaviours. METHODS: A systematic literature review of papers published between January 1990 and September 2017 in MEDLINE, CINAHL, Embase, PsycINFO, SCOPUS and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. From the total of 2546 papers identified, 15 randomised control trials (RCTs) met the eligibility criteria and were included in a random effects meta-analysis. Meta-regression analysis was used to explore whether behaviour change techniques (BCTs) that were used in the interventions were associated with intervention effectiveness. RESULTS: Meta-analysis of 15 RCTs showed that IVR-based interventions had small but significant effects on promoting medication adherence (OR=1.527, 95% CI 1.207 to 1.932, k=9, p=0.000) and physical activity (Hedges' g=0.254, 95% CI 0.068 to 0.439, k=3, p=0.007). No effects were found for alcohol (Hedges' g=-0.077, 95% CI -0.162 to 0.007, k=4, p=0.073) or diet (Hedges' g=0.130, 95% CI -0.088 to 0.347, k=2, p=0.242). In the medication adherence studies, multivariable meta-regression including six BCTs explained 100% of the observed variance in effect size, but only the BCT 'information about health consequences' was significantly associated with effect size (ß=0.690, SE=0.199, 95% CI 0.29 to 1.08, p=0.000). CONCLUSION: IVR-based interventions appear promising in changing specific health behaviours, such as medication adherence and physical activity. However, more studies are needed to elucidate further the combination of active components of IVR interventions that make them effective and test their feasibility and effectiveness using robust designs and objective outcome measures.


Asunto(s)
Terapia Conductista/métodos , Promoción de la Salud/métodos , Software de Reconocimiento del Habla , Teléfono/instrumentación , Terapia Conductista/instrumentación , Ejercicio Físico , Conductas Relacionadas con la Salud , Humanos , Cumplimiento de la Medicación , Ensayos Clínicos Controlados Aleatorios como Asunto , Sistemas Recordatorios/instrumentación , Interfaz Usuario-Computador
19.
J Gen Intern Med ; 33(5): 659-667, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29383550

RESUMEN

BACKGROUND: Patient reminders for influenza vaccination, delivered via electronic health record (EHR) patient portal messages and interactive voice response (IVR) calls, offer an innovative approach to improving patient care. OBJECTIVE: To test the effectiveness of portal and IVR outreach in improving rates of influenza vaccination. DESIGN: Randomized controlled trial of EHR portal messages and IVR calls promoting influenza vaccination. PARTICIPANTS: Adults with no documented influenza vaccination 2 months after the start of influenza season (2014-2015). INTERVENTION: Using a factorial design, we assigned 20,000 patients who were active portal users to one of four study arms: (a) receipt of a portal message promoting influenza vaccines, (b) receipt of IVR call with similar content, (c) both a and b, or (d) neither (usual care). We randomized 10,000 non-portal users to receipt of IVR call or usual care. In all intervention arms, information on pneumococcal vaccination was included if the targeted patient was overdue for pneumococcal vaccine. MAIN MEASURES: EHR-documented influenza vaccination during the 2014-2015 influenza season, measured April 2015. KEY RESULTS: Among portal users, 14.0% (702) of those receiving both portal messages and calls, 13.4% (669) of message recipients, 12.8% (642) of call recipients, and 11.6% (582) of those with usual care received vaccines. On multivariable analysis of portal users, those receiving portal messages alone (OR 1.20, 95% CI 1.06-1.35) or IVR calls alone (OR 1.15 95% CI 1.02-1.30) were more likely than usual care recipients to be vaccinated. Those receiving both messages and calls were also more likely than the usual care group to be vaccinated (ad hoc analysis, using a Bonferroni correction: OR 1.29, 97.5% CI 1.13, 1.48). Among non-portal users, 8.5% of call recipients and 8.6% of usual care recipients received influenza vaccines (p = NS). Pneumococcal vaccination rates showed no significant improvement. CONCLUSIONS: Our outreach achieved a small but significant improvement in influenza vaccination rates. Registration: ClinicalTrials.gov Identifier NCT02266277 ( https://clinicaltrials.gov/ct2/show/NCT02266277 ).


Asunto(s)
Vacunas contra la Influenza/administración & dosificación , Portales del Paciente/estadística & datos numéricos , Sistemas Recordatorios/instrumentación , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Gripe Humana/prevención & control , Masculino , Persona de Mediana Edad , Teléfono/estadística & datos numéricos , Envío de Mensajes de Texto/estadística & datos numéricos , Adulto Joven
20.
Hum Vaccin Immunother ; 14(7): 1647-1653, 2018 07 03.
Artículo en Inglés | MEDLINE | ID: mdl-29451833

RESUMEN

In an influenza pandemic, two vaccine doses administered 21 days apart may be needed for individuals of all ages to achieve seroprotection. Achieving dose-series completion can be challenging even for routinely recommended vaccines. To prepare for a two-dose influenza pandemic vaccine campaign and promote dose-series completion and correct dosing intervals, CDC and its partners developed a text message-based vaccine reminder system to remind persons who receive a first dose of pandemic influenza vaccine to receive the second dose. Taking advantage of the high prevalence of cell phones in the United States, the system sent second-dose text message reminders and hyperlinks to educational information. The system was pilot tested from November 2015 to April 2016 among graduate public health students enrolled at four United States universities. Universities were selected based on convenience, and each university used a different recruitment method. Among 59 volunteers who pilot tested the system and completed a survey, 57 (92%) felt the system would be helpful during a pandemic. Forty (68%) respondents felt the information included in the messages was informative. Volunteers recommended including actionable ways to stay healthy during a pandemic, though specific suggestions varied. With further development, text reminder systems could be used to promote adherence to a two-dose regimen in a future pandemic, although audience-specific messaging and other complementary systems will likely be needed. Public and private partners can adapt and implement this tool in conjunction with their routine patient information systems to improve dose-series completion and ensure optimal protection during an influenza pandemic.


Asunto(s)
Gripe Humana/prevención & control , Pandemias/prevención & control , Sistemas Recordatorios/instrumentación , Envío de Mensajes de Texto , Vacunación/estadística & datos numéricos , Teléfono Celular , Humanos , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/uso terapéutico , Proyectos Piloto , Salud Pública , Encuestas y Cuestionarios , Estados Unidos
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