Pilot study of a smartphone application designed to socially motivate cardiovascular disease patients to improve medication adherence.

BACKGROUND: Social support received by patients from family and community has been identified as a key factor for success in improving medication adherence in those patients. This pilot study aimed to investigate the usability and feasibility of PillPal, a smartphone application that uses video-chatting as a social motivation medium to encourage medication adherence in cardiovascular disease (CVD) patients. We additionally gathered feedback on the Physician Calendar, an accompanying web platform that allows clinicians to view patient adherence data generated from the app. METHODS: Thirty patients were recruited from the Johns Hopkins Hospital (JHH) Lipid Clinic (n=14) and Inpatient Cardiology Service (n=16) to pilot test the app. Data were obtained through in-person interviews in which patients tested out the app and answered standardized questions regarding the app's feasibility as a means to enhance social support, as well as its usability measured in terms of ease of use and patient comfort level with the video-chat technology. Cardiologists (n=10) from JHH were interviewed to gain feedback on the Physician Calendar. RESULTS: We recorded 43.4% participants who stated that PillPal would increase their motivation to take their medications; 96.7% stated the app was easy to use; and 70% stated they were comfortable with video-chatting while taking their medications. Patient factors such as current adherence level, disease severity, and personality were more predictive of positive app reviews than the perceived level of social support. Clinicians generally approved of the Physician Calendar, as they would be able to quickly screen for non-adherence and begin conversations with patients to address the root cause of their non-adherence. CONCLUSIONS: Based on pilot testing and interviews, using a smartphone app for video-chatting as a social support medium to improve patient medication adherence is feasible and has potential to increase medication adherence depending on certain patient characteristics. The Physician Calendar was deemed a useful tool by clinicians to quickly identify and understand reasons for medication non-adherence.

Outcomes of Partnered Individuals Undergoing Bariatric Surgery Together: A Single Institution Case Series.

There exists marked variation in weight loss among the 200,000 annual bariatric patients, and many of these patients struggle with weight regain. Several studies have suggested that positive social support may significantly impact bariatric surgery outcomes, leading to more excess weight loss and maintenance of this weight loss through appropriate lifestyle changes. We sought to understand this by assessing clinical and behavioral outcomes among married couples whereby both spouses underwent bariatric surgery at our institution. In our case series, we found evidence that married couples meet or exceed postoperative weight loss milestones at 12, 18, and 24 months and did not show signs of weight regain as a group at 18 or 24 months. Among partners who underwent the same clinical pathway at our single institution, women tended to lose more weight than men at 12 months. Additionally, while there was significant variation in postoperative follow-up among patients, we found that partners within couples typically exhibited the same behavior with respect to postoperative visits when they had their surgeries within a year of each other. This case series suggests that partnered patients undergoing bariatric surgery can meet or exceed weight loss outcomes and may practice similar follow-up adherence.

Emergency department utilization and predictors of mortality for inpatient inguinal hernia repairs.

BACKGROUND: Although inguinal hernias are common surgical diagnoses, minimally symptomatic patients are often not scheduled for repairs and are asked to seek medical attention if they develop symptoms. We investigated factors associated with emergency department (ED) utilization for inguinal hernia repairs and determined whether ED utilization affected mortality for this otherwise electively treated condition. METHODS: We performed a retrospective analysis of the 2009-2013 Nationwide Inpatient Sample to identify patients who presented through the ED and were then admitted for unilateral inguinal hernia repairs. Multivariable logistic regressions that adjusted for several patient and hospital characteristics determined predictors of both ED admission and postoperative mortality. RESULTS: There were 116,357 inpatient hospitalizations. The majority (57%) resulted from ED admissions, of which most (85%) had a diagnosis of obstruction or gangrene. Notable predictors of ED admission from the multivariable analysis included obstruction (odds ratio, 9.77 [95% confidence interval: 9.05-10.55]), gangrene (18.24 [13.00-25.59]), Black race (1.47 [1.29-1.69]), Hispanic ethnicity (1.35 [1.18-1.54]), self-pay (2.29 [1.97-2.66]) and Medicaid insurance (1.76 [1.50-2.06]). While overall mortality decreased from 2.03% in 2009 to 1.36% in 2013, admission through the ED was independently associated with higher mortality compared with elective repair (1.67 [1.21-2.29]), even after adjusting for the diagnosis of obstruction and gangrene. Other predictors of mortality included patient age and comorbidities. CONCLUSIONS: In our study, Black, Hispanic, and self-pay patients were more likely to present through the ED. After adjusting for obstruction or gangrene, simply presenting through the ED was independently associated with a 67% higher postoperative mortality rate compared with that of an elective operation. Our findings suggest both a difference in ED utilization and subsequent difference in mortality by patient race and ethnicity and insurance for this common surgical condition.