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1.
Arch Osteoporos ; 16(1): 21, 2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33527160

RESUMO

We determined the extent of and reasons for non-adherence to oral bisphosphonates among veterans and conducted a pilot text message reminder application aimed at the most commonly cited reason for non-adherence. The intervention was found to be acceptable and feasible. PURPOSE: To evaluate the extent of and reasons for non-adherence to oral bisphosphonates among veterans and to assess the acceptability and feasibility of a pilot text message reminder application. METHODS: We surveyed 105 veterans initiating oral bisphosphonates for osteoporosis/osteopenia within the prior 18 months utilizing a validated self-report measure adapted for osteoporosis. Additionally, we conducted a pilot text message reminder to determine feasibility in 12 veterans who were initiating or were currently non-adherent to oral bisphosphonates. RESULTS: Of the 43 (40.9% response rate) completed surveys, the most common reasons for non-adherence were "I forgot" (37.5%), "I had other medications to take" (20.5%), "my bones are not weak" (18.4%), "I felt well" (18.4%), and "I worried about taking them for the rest of my life" (17.9%). Median MPR for the 49 (46.7%) non-adherent (MPR < 0.80) veterans was 0.35 (IQR 0.21-0.64). Of veterans offered a weekly automated text message reminder, 12 (50%) accepted. Nine of these 12 veterans reported that the text message reminders did "very well" at reminding them to take their medication and would recommend the application to other patients/family/friends. The median 6-month MPR for the reminder group was 0.96 (IQR 0.54-1.00). CONCLUSION: Half the veterans in our sample were taking insufficient doses of oral bisphosphonates to attain the full benefit of fracture risk reduction. Reasons for poor adherence included forgetfulness, polypharmacy, and misconceptions about osteoporosis. A pilot text message reminder intervention targeted to one of the most commonly cited reasons was found to be acceptable and feasible among veterans.


Assuntos
Osteoporose , Envio de Mensagens de Texto , Veteranos , Estudos de Viabilidade , Humanos , Adesão à Medicação , Osteoporose/tratamento farmacológico , Projetos Piloto , Sistemas de Alerta
2.
Proc Natl Acad Sci U S A ; 118(4)2021 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-33468656

RESUMO

The ability to cast a mail ballot can safeguard the franchise. However, because there are often additional procedural protections to ensure that a ballot cast in person counts, voting by mail can also jeopardize people's ability to cast a recorded vote. An experiment carried out during the COVID-19 pandemic illustrates both forces. Philadelphia officials randomly sent 46,960 Philadelphia registrants postcards encouraging them to apply to vote by mail in the lead-up to the June 2020 primary election. While the intervention increased the likelihood a registrant cast a mail ballot by 0.4 percentage points (P = 0.017)-or 3%-many of these additional mail ballots counted only because a last-minute policy intervention allowed most mail ballots postmarked by Election Day to count.


Assuntos
/epidemiologia , Política , Sistemas de Alerta , /psicologia , Humanos , Pandemias , Pennsylvania/epidemiologia , Serviços Postais , /isolamento & purificação
3.
BMC Infect Dis ; 21(1): 50, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430792

RESUMO

BACKGROUND: Hand hygiene (HH) is the cornerstone of infection control, and the promotion of HH is the focus of the world. The study aims to compare the role of two different types of electronic hand hygiene monitoring systems (EHHMSs) in promoting HH of healthcare workers (HCWs) in the intensive care unit (ICU). METHODS: In a 16-bed ICU of a general tertiary hospital in Shenzhen, the research was divided into three stages with interrupted time series (ITS) design. In the first stage, the direct observation method was used to monitor and feed back the HH compliance rate of HCWs monthly. In the second stage, the type1 EHHMS was applied to monitor and feed back the individual number of HH events monthly. In the third stage, the type2 EHHMS with a function of instant reminder and feedback was employed, and the personal HH compliance rates were fed back monthly. Meanwhile, direct observation continued in the last two stages. RESULTS: In the second stage, The HH compliance rate increased. However, there was no significant difference in the trajectory of the rate compared with the first stage. In the first month of the third stage, the HH compliance rate increased by 12.324% immediately and then ascended by 1.242% over time. The number of HH events per bed day and HH products' consumption per bed day were consistent with the change of HH compliance rate observed. CONCLUSION: Monitoring and feedback can improve the HH of HCWs. The EHHMS, with the function of real-time reminders and feedback, has a more noticeable effect on promoting HH.


Assuntos
Equipamentos e Provisões Elétricas , Higiene das Mãos/métodos , Pessoal de Saúde , Promoção da Saúde/métodos , Controle de Infecções/métodos , Unidades de Terapia Intensiva , Adulto , China , Infecção Hospitalar/prevenção & controle , Retroalimentação , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Análise de Séries Temporais Interrompida , Masculino , Sistemas de Alerta , Centros de Atenção Terciária
4.
MMWR Morb Mortal Wkly Rep ; 69(44): 1622-1624, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33151919

RESUMO

Preventive care or follow-up care have the potential to improve health outcomes, reduce disease in the population, and decrease health care costs in the long-term (1). Approximately one half of persons in the United States receive general recommended preventive services (2,3). Missed physician appointments can hinder the receipt of needed health care (4). With electronic health record (EHR) systems able to improve interaction and communication between patients and providers (5), electronic reminders are used to decrease missed care. These reminders can improve various types of preventive and follow-up care, such as immunizations (6) and cancer screening (7); however, computerized capability must exist to make use of these reminders. To examine this capability among U.S. office-based physicians, data from the National Electronic Health Records Survey (NEHRS) for 2017, the most recent data available, were analyzed. An estimated 64.7% of office-based physicians had computerized capability to identify patients who were due for preventive or follow-up care, with 72.9% of primary care physicians and 71.4% of physicians with an EHR system having this capability compared with surgeons (54.8%), nonprimary care physicians (58.5%), and physicians without an EHR system (23.4%). Having an EHR system is associated with the ability to send electronic reminders to increase receipt of preventive or follow-up care, which has been shown to improve patient health outcomes (8).


Assuntos
Assistência ao Convalescente , Registros Eletrônicos de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Consultórios Médicos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Serviços Preventivos de Saúde , Sistemas de Alerta/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
5.
PLoS One ; 15(11): e0240526, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33141833

RESUMO

In-person (face-to-face) data collection methods offer many advantages but can also be time-consuming and expensive, particularly in areas of difficult access. We take advantage of the increasing mobile phone penetration rate in rural areas to evaluate the feasibility of using cell phones to monitor the provision of key health and nutrition interventions linked to the first 1,000 days of life, a critical period of growth and development. We examine response rates to calendarized text messages (SMS) and phone calls sent to 1,542 households over a period of four months. These households have children under two years old and pregnant women and are located across randomly selected communities in Quiche, Guatemala. We find that the overall (valid) response rate to phone calls is over 5 times higher than to text messages (75.8% versus 14.4%). We also test whether simple SMS reminders improve the timely reception of health services but do not find any effects in this regard. Language, education, and age appear to be major barriers to respond to text messages as opposed to phone calls, and the rate of response is not correlated with a household's geographic location (accessibility). Moreover, response veracity is high, with an 84-91% match between household responses and administrative records. The costs per monitored intervention are around 1.12 US dollars using text messages and 85 cents making phone calls, with the costs per effective answer showing a starker contrast, at 7.76 and 1.12 US dollars, respectively. Our findings indicate that mobile phone calls can be an effective, low-cost tool to collect reliable information remotely and in real time. In the current context, where in-person contact with households is not possible due to the COVID-19 crisis, phone calls can be a valuable instrument for collecting information, monitoring development interventions, or implementing brief surveys.


Assuntos
Telefone Celular/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Monitorização Fisiológica/estatística & dados numéricos , Estado Nutricional/fisiologia , Pandemias , Pneumonia Viral/epidemiologia , População Rural/estatística & dados numéricos , Adulto , Telefone Celular/economia , Pré-Escolar , Feminino , Guatemala/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Monitorização Fisiológica/economia , Gravidez , Sistemas de Alerta/economia , Sistemas de Alerta/estatística & dados numéricos , Inquéritos e Questionários , Telemedicina/economia , Telemedicina/estatística & dados numéricos , Envio de Mensagens de Texto/economia , Envio de Mensagens de Texto/estatística & dados numéricos
6.
Geriatr Gerontol Int ; 20(11): 1079-1084, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32896089

RESUMO

AIM: Adherence to medication is important in older patients with non-communicable diseases, and there is a need to investigate various interventions to enhance adherence in our Indian setting. This pilot randomized controlled trial aimed at testing the effectiveness of systematic education and behavioral intervention in enhancing medication adherence among older adults. METHODS: It was a single center, open label, parallel arm, randomized controlled trial carried out among older (age >60 years) inpatients of general medicine wards diagnosed with select non-communicable diseases, such as diabetes, hypertension, dyslipidemia and coronary artery disease. Participants were randomized either to receive the usual standard of care or the intervention that comprises of systematic education, patient diary to mark daily medicine intake and periodic telephone reminders. Barriers to medication adherence were identified and interventions were tailored according to the identified barriers over a 6-month follow-up period. The primary end-points were change in the reported pill count (RPC) within groups and between groups at the third and sixth month. RESULTS: The RPC in control and intervention arms at the thrid month were 78.20% and 91.88% (P = 0.007), whereas at 6 months they were 68.64% and 83.08% (P = 0.003), respectively. Similarly, change in RPC in intervention arm between baseline and the third month (mean difference 24.08%, P = 0.001), and between baseline and the sixth month (mean difference 15.280%, P = 0.006) were statistically significant. However, the RPC between the third and sixth month showed a significant decline (mean difference 8.8%, P = 0.016). CONCLUSION: In this pilot study, we prove that behavioral interventions have improved medication adherence among older adults, and it is feasible to carry out such studies among older adults in India. Geriatr Gerontol Int 2020; 20: 1079-1084.


Assuntos
Terapia Comportamental/métodos , Adesão à Medicação/psicologia , Doenças não Transmissíveis/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/tratamento farmacológico , Diabetes Mellitus/tratamento farmacológico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Índia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Sistemas de Alerta , Projetos de Pesquisa , Telefone
7.
Transplantation ; 104(8): e224-e235, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732828

RESUMO

BACKGROUND: Lack of support for self-management may contribute to adverse health outcomes. eHealth has the potential to support self-management, but evidence in solid organ transplantation remains unclear. This review aims to evaluate the benefits and harms of eHealth interventions to support self-management in solid organ transplant recipients. METHODS: We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase databases for randomized trials of eHealth interventions in solid organ transplant recipients. We calculated the risk ratios or standardized mean difference of outcomes, and summary estimates were determined using random-effects models. The Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development, and Evaluations were used to assess trial quality. RESULTS: Twenty-one trials from 6 countries involving 2114 participants were included. Compared with standard care, eHealth interventions improved medication adherence (risk ratio, 1.34; CI, 1.12-2.56; I = 75%) and self-monitoring behavior (risk ratio, 2.58; CI, 1.56-4.27; I = 0%) up to 12 mo posttransplant. The treatment effects were largely consistent across different subgroups except for intervention functionality and mode of delivery. The effects on other outcomes were uncertain. Nine trials reported harms. The overall risk of bias was considered high or unclear, and the quality of evidence was low to very low for all outcomes. CONCLUSIONS: eHealth interventions may improve medication adherence and self-monitoring behavior in the short term, but high-quality intervention studies are needed to determine whether eHealth will improve long-term patient-relevant outcomes.


Assuntos
Rejeição de Enxerto/prevenção & controle , Transplante de Órgãos/efeitos adversos , Autogestão/métodos , Telemedicina/métodos , Transplantados , Rejeição de Enxerto/imunologia , Humanos , Imunossupressores/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistemas de Alerta , Resultado do Tratamento
8.
Am Heart J ; 228: 17-26, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32745732

RESUMO

BACKGROUND: Secondary preventive therapies play a key role in the prevention of adverse events after coronary artery bypass grafting (CABG). However, adherence to secondary preventive drugs after CABG is often poor. With the increasing penetration of smartphones, health-related smartphone applications might provide an opportunity to improve medication adherence. We aimed to evaluate the effectiveness and feasibility of using a smartphone-based application to improve medication adherence in patients after CABG. METHODS: The Measurement and Improvement Studies of Surgical coronary revascularizatION: medication adherence (MISSION-2) study is a multicenter randomized controlled trial that planned to enroll over 1000 patients who underwent isolated CABG at one of four large teaching hospitals in China; all enrolled participants had access to a smartphone and were able to operate at least three smartphone applications. The investigators randomly assigned the participants to one of two groups: (1) the intervention group with an advanced smartphone application for 6 months which was designed specifically for this trial and did not exist before. Participants could receive medication reminders and cardiac health education by the smartphone application or (2) the control group with usual care. The primary outcome was CABG secondary preventive medication adherence as measured by the translated Chinese version of the 8-item Morisky Medication Adherence Scale (MMAS-8) at 6 months after randomization. The secondary outcomes were mortality, major adverse cardiovascular and cerebrovascular events (MACCE), cardiovascular rehospitalization, self-reported secondary preventive medication use after 6 months of follow-up, blood pressure (BP), body mass index (BMI), and self-reported smoking status. All analyses were conducted using the intention-to-treat principle. RESULTS: A total of 1000 patients (mean age, 57.28 [SD, 9.09] years; 85.5% male) with coronary heart disease after CABG were enrolled between September 2015 and September 2016 and were randomly assigned to the intervention (n = 501) or control group (n = 499). At 6 months, the proportion of low-adherence participants, categorized by MMAS-8 scores, was 11.8% in the intervention group and 11.7% in the control group (RR = 1.005, 95% CI 0.682 to 1.480, P = 1.000). Similar results were found in sensitivity analyses that considered participants who withdrew from the study, or were lost to follow-up as nonadherent. There were no significant differences in the secondary clinical outcome measures, and there were no significant differences in the primary outcome across the subgroups tested. In the intervention group, the proportion of participants who used and operated the application during the first month after CABG was 88.1%; however, the use rate decreased sharply from 42.5% in the second month to 9.2% by the end of the study (6 months). CONCLUSIONS: A smartphone-based application supporting secondary prevention among patients after CABG did not lead to a greater adherence to secondary preventive medications. The limited room for improvement in medication adherence and the low participants' engagement with the smartphone applications might account for these non-significant outcomes.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Ponte de Artéria Coronária/efeitos adversos , Doença das Coronárias , Educação em Saúde/métodos , Adesão à Medicação/estatística & dados numéricos , Complicações Pós-Operatórias , Smartphone , Software , Ponte de Artéria Coronária/métodos , Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/psicologia , Doença das Coronárias/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Sistemas de Alerta/instrumentação , Prevenção Secundária/métodos
9.
BMC Public Health ; 20(1): 1086, 2020 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-32652969

RESUMO

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. We evaluated the impact of two types of silicone immunization reminder bracelets for children in improving immunization coverage and timeliness of Pentavalent-3 and the Measles-1 vaccines. METHODS: Children < 3 months were enrolled in either of the 2 intervention groups (Alma Sana Bracelet Group and Star Bracelet Group) or the Control group. Children in the intervention groups were provided the two different bracelets at the time of recruitment. Each time the child visited the immunization center, a hole was perforated in the silicone bracelet to denote vaccine administration. Each child was followed up till administration of Measles-1 vaccine or till 12 months of age (if they did not come to the center for vaccination). Data was analyzed using the intention-to-treat population between groups. The unadjusted and adjusted Risk Ratios (RR) and 95% confidence interval (CI) for Pentavalent-3 and Measles-1 coverage at 12 months of age were estimated through bivariate and multivariate analysis. Time-to-Pentavalent-3 and Measles-1 immunization curves were calculated using the Kaplan-Meier method. RESULTS: A total of 1,445 children were enrolled in the study between July 19, 2017 and October 10, 2017. Baseline characteristics among the three groups were similar. Up-to-date coverage for the Pentavalent-3 /Measles-1 vaccine at 12 months of age was 84.6%/72.0%, 85.4%/70.5% and 83.0%/68.5% in Alma Sana Bracelet group, Star Bracelet group and Control group respectively but the differences were not statistically significant. In the multivariate analysis, neither the Alma Sana bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06), (adjusted RR: 1.05; 95% CI: 0.97-1.13) nor the Star bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06) (adjusted RR: 1.03; 95% CI: 0.95-1.11) was significantly associated with Pentavalent-3 vaccination or Measles-1 vaccination. CONCLUSION: Although we did not observe any significant impact of the bracelets on improved immunization coverage and timeliness, our findings add to the existing literature on innovative, low cost reminders for health and make several suggestions for enhancing practical implementation of these tools. TRIAL REGISTRATION: ClinicalTrials.gov NCT03310762 . Retrospectively Registered on October 16, 2017.


Assuntos
Promoção da Saúde/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , Vacina contra Sarampo/administração & dosagem , Cooperação do Paciente/estatística & dados numéricos , Sistemas de Alerta/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Imunização , Lactente , Masculino , Sarampo/prevenção & controle , Paquistão , Projetos de Pesquisa , Vacinação/estatística & dados numéricos , Cobertura Vacinal
10.
BMJ ; 369: m1731, 2020 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522811

RESUMO

OBJECTIVE: To test a scalable health system intervention to improve long term adherence to secondary prevention treatments among patients who have had a recent myocardial infarction. DESIGN: Three arm, pragmatic randomised controlled trial with blinded outcome assessment. SETTING: Nine cardiac centres in Ontario, Canada. PARTICIPANTS: 2632 patients with obstructive coronary artery disease after a myocardial infarction, identified from a centralised cardiac registry. INTERVENTIONS: Participants were randomised 1:1:1 to receive usual care, five mail-outs developed through a user centred design process, or mail-outs plus phone calls. The phone calls were delivered first by an interactive automated system to screen for non-adherence to treatment. Trained lay health workers followed up as necessary. Interventions were coordinated centrally but delivered from each patient's hospital site. MAIN OUTCOME MEASURES: Co-primary outcomes were completion of cardiac rehabilitation and adherence to recommended medication. Data were collected by blinded assessors through patient report and from administrative health databases at 12 months. RESULTS: 2632 patients (mean age 66, 71% male) were randomised: 878 to the full intervention (mail plus phone calls), 878 to mail only, and 876 to usual care. Of the respondents, 174 (27%) of 643 in the usual care group, 200 (32%) of 628 in the mail only group, and 196 (37%) of 531 allocated to the full intervention completed cardiac rehabilitation (adjusted odds ratio 1.55, 95% confidence interval 1.18 to 2.03). In the mail plus phone group, 11.7%, 6.0%, 14.4%, 32.9%, and 35.0% reported adherence to 0, 1, 2, 3, and 4 drug classes after one year, respectively, in comparison with 12.5%, 6.8%, 13.6%, 30.2%, and 36.8% in the mail only group, and 12.2%, 8.4%, 13.1%, 30.3%, and 36.1% in the usual care group, respectively (mail only v usual care, odds ratio 0.98, 95% confidence interval 0.81 to 1.19; full intervention v usual care, 0.99, 0.82 to 1.20). CONCLUSIONS: Scalable interventions delivered by mail plus phone can increase completion of cardiac rehabilitation after myocardial infarction but not adherence to medication. More intensive interventions should be tested to improve adherence to medication and to evaluate the association between attendance at cardiac rehabilitation and adherence to medication. TRIAL REGISTRATION: ClinicalTrials.gov NCT02382731, registered 9 March 2015 before any patient enrolment.


Assuntos
Reabilitação Cardíaca/estatística & dados numéricos , Doença da Artéria Coronariana/terapia , Adesão à Medicação/estatística & dados numéricos , Infarto do Miocárdio/prevenção & controle , Prevenção Secundária/estatística & dados numéricos , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/reabilitação , Ontário , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Educação de Pacientes como Assunto , Inibidores da Agregação de Plaquetas/uso terapêutico , Serviços Postais , Qualidade de Vida , Sistemas de Alerta , Prevenção Secundária/métodos , Telefone , Fatores de Tempo , Resultado do Tratamento
11.
West Afr J Med ; 37(3): 201-208, 2020.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-32476111

RESUMO

Diabetes Mellitus (DM) is one of the leading chronic diseases in low- and middle-income countries globally including Nigeria The morbidities and mortalities associated with diabetes especially in Nigeria, have remained unacceptably high compared to many other nations. It has become one of the leading causes of stroke, blindness, heart attack and end-stage kidney disease. Most deaths occur in those below 60 years of age, the productive segments of the population. Health situation in Nigeria is characterised by double burden of illness, grossly inadequate health spending, and inadequate healthcare personnel especially in the rural areas. Shortage of diabetes care specialist is one of the major barriers to diabetes care in Nigeria. Mobile phone has emerged as one of the potent strategies that can impact positively on diabetes care if properly harnessed. The ubiquitous access and the multitasking nature of mobile phones are great opportunities to improve diabetes prevention, patient care, encourage self-management, support healthy behavioural changes and an ideal way of providing patient-centred care at the frequency and intensity that patient desires. In addition, there is a potential for mobile phones to provide an effective way of giving support to patients in rural and remote areas where health care provider contact may be less accessible. Use of short message services (SMS) phone calls, video calls and the use of social media networking applications are some of the ways a mobile phone can be used in diabetes management.


Assuntos
Uso do Telefone Celular/estatística & dados numéricos , Telefone Celular , Diabetes Mellitus/terapia , Envio de Mensagens de Texto , Humanos , Pessoa de Meia-Idade , Nigéria , Sistemas de Alerta , Autocuidado
12.
Stud Health Technol Inform ; 270: 1251-1252, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570604

RESUMO

This project followed waterfall model to develop a context tailored and user-friendly reminder system to support home based TB treatment. Piloting was conducted on expert and patient levels. We developed a flexible and user-friendly web-based system that allows medication and refiling reminder. Participants agreed on its usefulness despite infrastructure and personal related challenges.


Assuntos
Sistemas de Alerta , Etiópia , Adesão à Medicação
13.
PLoS One ; 15(6): e0234817, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574181

RESUMO

Failure to attend hospital appointments has a detrimental impact on care quality. Documented efforts to address this challenge have only modestly decreased no-show rates. Behavioral economics theory has suggested that more effective messages may lead to increased responsiveness. In complex, real-world settings, it has proven difficult to predict the optimal message composition. In this study, we aimed to systematically compare the effects of several pre-appointment message formats on no-show rates. We randomly assigned members from Clalit Health Services (CHS), the largest payer-provider healthcare organization in Israel, who had scheduled outpatient clinic appointments in 14 CHS hospitals, to one of nine groups. Each individual received a pre-appointment SMS text reminder five days before the appointment, which differed by group. No-show and advanced cancellation rates were compared between the eight alternative messages, with the previously used generic message serving as the control. There were 161,587 CHS members who received pre-appointment reminder messages who were included in this study. Five message frames significantly differed from the control group. Members who received a reminder designed to evoke emotional guilt had a no-show rates of 14.2%, compared with 21.1% in the control group (odds ratio [OR]: 0.69, 95% confidence interval [CI]: 0.67, 0.76), and an advanced cancellation rate of 26.3% compared with 17.2% in the control group (OR: 1.2, 95% CI: 1.19, 1.21). Four additional reminder formats demonstrated significantly improved impact on no-show rates, compared to the control, though not as effective as the best performing message format. Carefully selecting the narrative of pre-appointment SMS reminders can lead to a marked decrease in no-show rates. The process of a/b testing, selecting, and adopting optimal messages is a practical example of implementing the learning healthcare system paradigm, which could prevent up to one-third of the 352,000 annually unattended appointments in Israel.


Assuntos
Hospitais/estatística & dados numéricos , Sistemas de Alerta , Envio de Mensagens de Texto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Garantia da Qualidade dos Cuidados de Saúde
14.
PLoS One ; 15(5): e0233220, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32428021

RESUMO

BACKGROUND: Excessive exposure to ultraviolet radiation increases the risk of skin cancer and other conditions. SMS text reminders may be a useful tool to improve sun protection habits due to its massive reach, low cost, and accessibility. OBJECTIVE: To perform a systematic review of randomized controlled trials (RCTs) that evaluated the effects of SMS text reminders in promoting sun protection habits. METHODS: We performed a systematic search in PubMed, Central Cochrane Library, and Scopus; following the PRISMA recommendations to perform systematic reviews. We included RCTs published up to December 2018, which evaluated the benefits and harms of SMS text reminders to improve sun protection habits. Random-effects meta-analyses were performed whenever possible. The certainty of the evidence was assessed for RCTs estimates using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol was registered in PROSPERO (CRD42018091661). RESULTS: Five RCTs were included in this review. When pooled, the studies found no effect of SMS text reminders in "sunburn anytime during follow-up" (two studies, risk ratio: 0.93; 95% confidence interval: 0.83-1.05). Contradictory results were obtained for sunscreen use (three RCTs) and sun protection habits (two RCTs), however, they could not be meta-analyzed because outcomes were measured differently across studies. The certainty of the evidence was very low for these three outcomes according to GRADE methodology. CONCLUSIONS: RCTs that assessed effects of SMS text reminders did not find a significant benefit on objective outcomes, such as having a sunburn, sunscreen use and composite score of sun protection habits. Since certainty of the evidence was very low, future high-quality studies are needed to reach a conclusion regarding the balance of desirable and undesirable outcomes. PROTOCOL REGISTRATION NUMBER: PROSPERO (CRD42018091661).


Assuntos
Sistemas de Alerta/tendências , Queimadura Solar/prevenção & controle , Envio de Mensagens de Texto/tendências , Telefone Celular/tendências , Hábitos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Cutâneas/prevenção & controle , Protetores Solares/farmacologia , Raios Ultravioleta/efeitos adversos
15.
J Pediatr ; 221: 123-131.e4, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32446470

RESUMO

OBJECTIVE: To evaluate the effect of different modalities of centralized reminder/recall (autodialer, text, mailed reminders) on increasing childhood influenza vaccination. STUDY DESIGN: Two simultaneous randomized clinical trials conducted from October 2017 to April 1, 2018, in New York State and Colorado. There were 61 931 children in New York (136 practices) and 23 845 children in Colorado (42 practices) who were randomized to different centralized reminder/recall modalities-4 arms in New York (autodialer, text, mailed, and no reminder control) and 3 arms in Colorado (autodialer, mailed, and no reminder control). The message content was similar across modalities. Up to 3 reminders were sent for intervention arms. The main outcome measure was receipt of ≥1 influenza vaccine. RESULTS: In New York, compared with the control arm (26.6%), postintervention influenza vaccination rates in the autodialer arm (28.0%) were 1.4 percentage points higher (adjusted risk ratio, 1.06; 95% CI, 1.02-1.10), but the rates for text (27.6%) and mail (26.8%) arms were not different from controls. In Colorado, compared with the control arm (29.9%), postintervention influenza vaccination rates for the autodialer (32.9%) and mail (31.5%) arms were 3.0 percentage points (adjusted risk ratio, 1.08; 95% CI, 1.03-1.12) and 1.6 percentage points (adjusted risk ratio, 1.06; 95% CI, 1.02-1.10) higher, respectively. Compared with the control arm, the incremental cost per additional vaccine delivered was $20 (New York) and $16 (Colorado) for autodialer messages. CONCLUSIONS: Centralized reminder/recall for childhood influenza vaccine was most effective via autodialer, less effective via mail, and not effective via text messages. The impact of each modality was modest. Compared with no reminders, the incremental cost per additional vaccine delivered was also modest for autodialer messages. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03294473 and NCT03246100.


Assuntos
Programas de Imunização/organização & administração , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Sistemas de Alerta , Adolescente , Criança , Pré-Escolar , Colorado , Humanos , Lactente , New York , Envio de Mensagens de Texto
16.
Pan Afr Med J ; 35(Suppl 1): 6, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32373257

RESUMO

Introduction: Cross Rivers State, in southern Nigeria, conducted measles Supplemental Immunization Activities (SIAs) in 2 phases from 2 -15 March, 2018. The SIAs coordination was led by the State technical coordination committee. A total of 90 supervisors from the national and subnational levels, including consultants were deployed to support the SIAs. The instant messaging service - WhatsApp was utilized to help in the communication and coordination among the State and field teams. Methods: We reviewed the chat logs from the WhatsApp group exchanges made between 28 February 2018 and 31 March 2018. Thematic content analysis was done. Results: A total of 653 WhatsApp messages were posted among the 55 group members during the study period, including text messages and media content. Eleven percent of the posts related to monitoring processes and data sharing, while posts related to vaccine logistics and waste management made up about 6% of the total. Overall coordination and deployment was covered in 6% of the posts. Forty percent of the media content showed vaccination service delivery and SIAs launching events or monitoring meetings in various areas. The coordination team used WhatsApp to send reminders to the field staff about data sharing, vaccine and waste management, as well as feedback on coverage and completeness of data sharing. The WhatsApp group discussions did not include most of the logistical and hesitancy challenges documented in the State SIAs technical report. Conclusion: We recommend focusing group discussions on instant messaging platforms so that they can be used for problem solving and sharing best practices, integrating it with other supervisory processes and tools, as well as providing feedback based on processed data from the field.


Assuntos
Programas de Imunização/organização & administração , Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Aplicativos Móveis , Envio de Mensagens de Texto , Cobertura Vacinal/organização & administração , Criança , Pré-Escolar , Comunicação , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Humanos , Programas de Imunização/métodos , Programas de Imunização/estatística & dados numéricos , Esquemas de Imunização , Ciência da Implementação , Aplicativos Móveis/estatística & dados numéricos , Nigéria/epidemiologia , Sistemas de Alerta/estatística & dados numéricos , Inquéritos e Questionários , Envio de Mensagens de Texto/estatística & dados numéricos , Vacinação , Cobertura Vacinal/métodos , Cobertura Vacinal/estatística & dados numéricos
17.
Pan Afr Med J ; 35(Suppl 1): 12, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32373263

RESUMO

Introduction: The Expanded Programme on Immunization has, since its inception, struggled to achieve high completion rates for child immunizations. The introduction of 2YL (second year of life) immunizations presents the programme with fresh challenges to assuring high completion rates. Methods: Using the same procedures as those employed in the 2017 article on SMS reminders, of which this is an update, I searched the NLM database for all recent articles from developing countries on SMS reminders for reduction of vaccination dropout rates. I summarized these and earlier articles in tabular form. Results: The freshly reviewed articles are confirmatory of earlier studies which show an improvement in vaccination completion rates when SMS reminders are sent to mothers and other caregivers. Conclusion: All of the studies reviewed were based on pilot projects. It is time, and past time, to go to scale with SMS reminders, perhaps stand alone, or as part of a larger system of electronic immunization registers. There may be potential for use of WhatsApp in dropout reduction, thus far documented only in other public health applications.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Programas de Imunização/métodos , Programas de Imunização/organização & administração , Sistemas de Alerta , Envio de Mensagens de Texto , Cobertura Vacinal/estatística & dados numéricos , África ao Sul do Saara/epidemiologia , Telefone Celular , Criança , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/provisão & distribução , Humanos , Vacinação em Massa/métodos , Vacinação em Massa/organização & administração , Vacinação em Massa/estatística & dados numéricos , Sarampo/epidemiologia , Sarampo/prevenção & controle , Participação do Paciente/métodos , Participação do Paciente/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Vacinação/estatística & dados numéricos
18.
BMC Health Serv Res ; 20(1): 363, 2020 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-32336283

RESUMO

BACKGROUND: Missed healthcare appointments (no-shows) are costly and operationally inefficient for health systems. No-show rates are particularly high for vulnerable populations, even though these populations often require additional care. Few studies on no-show behavior or potential interventions exist specifically for Federally Qualified Health Centers (FQHCs), which care for over 24 million disadvantaged individuals in the United States. The purpose of this study is to identify predictors of no-show behavior and to analyze the effects of a reminder intervention in urban FQHCs in order to design effective policy solutions to a protracted issue in healthcare. METHODS: This is a retrospective observational study using electronic medical record data from 11 facilities belonging to a New York City-based FQHC network between June 2017 to April 2018. This data includes 53,149 visits for 41,495 unique patients. Seven hierarchical generalized linear models and generalized additive models were used to predict no-shows, and multiple regression models evaluated the effectiveness of a reminder. All analyses were conducted in R. RESULTS: The strongest predictor of no-show rates in FQHCs is whether or not patients are assigned to empaneled providers (z = - 91.45, p < 10- 10), followed by lead time for appointments (z = 23.87, p < 10- 10). These effects were fairly stable across facilities. The reminder had minimal effects on no-show rates overall (No show rate before: 41.6%, after: 42.1%). For individuals with appointments before and after the reminder, there was a small decrease in no-shows of 2%. CONCLUSIONS: The limited effects of the reminder intervention suggest the need for more personalized behavioral interventions to reduce no-shows. We recommend that these begin with increasing the use of empaneled providers for preventive care appointments and reducing the lag time between setting the appointment and the actual date of the appointment, at least for individuals with a high rate of no-show. By complementing these with low-intensity, low-cost behavioral interventions, we would expect greater impacts for improved access to care, contributing to the well-being of vulnerable populations.


Assuntos
Agendamento de Consultas , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Sistemas de Alerta , Registros Eletrônicos de Saúde , Feminino , Instalações de Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Humanos , Modelos Lineares , Masculino , Cidade de Nova Iorque , Estudos Retrospectivos , Populações Vulneráveis
19.
Artigo em Inglês | MEDLINE | ID: mdl-32224975

RESUMO

The aim of this study is to increase evidence-based interventions by investigating the feasibility of an intervention using an interactive digital calendar with mobile phone reminders (RemindMe) as support in everyday life. Qualitative and quantitative data were collected from participating patients (n = 8) and occupational therapists (n = 7) from three rehabilitation clinics in Sweden. The intervention consisted of delivering the interactive digital calendar RemindMe, receiving an individualized introduction, a written manual, and individual weekly conversations for two months with follow-up assessments after two and four months. Feasibility areas of acceptability, demand, implementation, practicality, and integration were examined. Patients expressed their interest and intention to use RemindMe and reported a need for reminders and individualized support. By using reminders in activities in everyday life their autonomy was supported. The study also demonstrated the importance of confirming reminders and the possible role of habit-forming. Occupational therapists perceived the intervention to be useful at the rehabilitation clinics and the weekly support conversations enabled successful implementation. This study confirmed the importance of basing and tailoring the intervention to patients' needs and thus being person-centered.


Assuntos
Atividades Cotidianas , Telefone Celular , Disfunção Cognitiva , Sistemas de Alerta , Disfunção Cognitiva/terapia , Estudos de Viabilidade , Humanos , Suécia
20.
J Int AIDS Soc ; 23(4): e25478, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32294318

RESUMO

INTRODUCTION: Frequent HIV testing of at-risk individuals is crucial to detect and treat infections early and prevent transmissions. We assessed the effect of reminders on HIV retesting uptake. METHODS: The study was conducted within a programme involving four facilities providing free-of-charge HIV, syphilis and hepatitis B and C testing and counselling in northern Thailand. Individuals found HIV negative and identified at risk by counsellors were invited to participate in a three-arm, open-label, randomized, controlled trial comparing: (a) "No Appointment & No Reminder" (control arm); (b) "No Appointment but Reminder": short message service (SMS) sent 24 weeks after the enrolment visit to remind booking an appointment, and sent again one week later if no appointment was booked; and (c) "Appointment & Reminder": appointment scheduled during the enrolment visit and SMS sent one week before appointment to ask for confirmation; if no response: single call made within one business day. The primary endpoint was a HIV retest within seven months after the enrolment visit. The cost of each reminder strategy was calculated as the sum of the following costs in United States dollars (USD): time spent by participants, counsellors and hotline staff; phone calls made; and SMS sent. The target sample size was 217 participants per arm (651 overall). RESULTS: Between April and November 2017, 651 participants were randomized. The proportion presenting for HIV retesting within seven months was 11.2% (24/215) in the control arm, versus 19.3% (42/218) in "No Appointment but Reminder" (p = 0.023) and 36.7% (80/218) in "Appointment & Reminder" (p < 0.001). Differences in proportions compared to the control arm were respectively +8.1% (95% CI: +1.4% to +14.8%) and +25.5% (+17.9% to +33.2%). The incremental cost-effectiveness ratios of "No Appointment but Reminder" and "Appointment & Reminder" compared to the control arm were respectively USD 0.05 and USD 0.14 per participant for each 5% increase in HIV retesting uptake within seven months. CONCLUSIONS: Scheduling an appointment and sending a reminder one week before was a simple, easy-to-implement and affordable intervention that significantly increased HIV retesting uptake in these at-risk individuals. The personal phone call to clients probably contributed, and also improved service efficiency.


Assuntos
Agendamento de Consultas , Infecções por HIV/tratamento farmacológico , Sistemas de Alerta , Adulto , Análise Custo-Benefício , Feminino , Humanos , Masculino , Sistemas de Alerta/economia , Envio de Mensagens de Texto/economia , Tailândia
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