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1.
Medicine (Baltimore) ; 98(52): e18353, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876709

RESUMO

BACKGROUND: To determine the effectiveness of text message reminders (TMR) on medication adherence (MA) and to investigate the effects of TMR on clinical outcomes. METHODS: The PubMed, Cochrane library, EMbase, and China Biology Medicine databases were searched for randomized-controlled trials with TMR as the intervention for patients with coronary heart disease. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was conducted using Stata 15.0 software. RESULTS: In total, 1678 patients in 6 trials were included. Compared with the control group, the MA was 2.85 times greater among the intervention group (RR [relative risk] 2.85; 95% confidence interval [CI] 1.07-7.58). TMR reduced systolic blood pressure (BP) (weighted mean difference) = -6.51; 95% CI -9.79 to -3.23), cholesterol (standard mean difference = -0.26; 95% CI -0.4 to -0.12) and increased the number of patients with BP <140/90 mm Hg (RR 1.39; 95% CI 1.26-1.54). CONCLUSION: TMR significantly promoted MA and reduced systolic BP, cholesterol level, and body mass index, but had no effect on mortality, diastolic BP, or lipoproteins. However, substantial heterogeneity existed in our analyses.


Assuntos
Doença das Coronárias/tratamento farmacológico , Adesão à Medicação , Sistemas de Alerta , Mensagem de Texto , Humanos
2.
BMC Public Health ; 19(1): 1421, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666039

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. 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.


Assuntos
Programas de Imunização/métodos , Esquemas de Imunização , Pais , Sistemas de Alerta , Cobertura Vacinal , Vacinação , Vacinas/administração & dosagem , Cuidadores , Pré-Escolar , Análise Custo-Benefício , Países em Desenvolvimento , Feminino , Humanos , Lactente , Masculino , Sarampo/prevenção & controle , Paquistão , Poliomielite/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistemas de Alerta/instrumentação , Projetos de Pesquisa , Estudos Retrospectivos , População Urbana
3.
Cochrane Database Syst Rev ; 8: CD012379, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31425608

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is associated with high morbidity and death, which increases as CKD progresses to end-stage kidney disease (ESKD). There has been increasing interest in developing innovative, effective and cost-efficient methods to engage with patient populations and improve health behaviours and outcomes. Worldwide there has been a tremendous increase in the use of technologies, with increasing interest in using eHealth interventions to improve patient access to relevant health information, enhance the quality of healthcare and encourage the adoption of healthy behaviours. OBJECTIVES: This review aims to evaluate the benefits and harms of using eHealth interventions to change health behaviours in people with CKD. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 14 January 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs using an eHealth intervention to promote behaviour change in people with CKD were included. There were no restrictions on outcomes, language or publication type. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial eligibility, extracted data and assessed the risk of bias. The certainty of the evidence was assessed using GRADE. MAIN RESULTS: We included 43 studies with 6617 participants that evaluated the impact of an eHealth intervention in people with CKD. Included studies were heterogeneous in terms of eHealth modalities employed, type of intervention, CKD population studied and outcomes assessed. The majority of studies (39 studies) were conducted in an adult population, with 16 studies (37%) conducted in those on dialysis, 11 studies (26%) in the pre-dialysis population, 15 studies (35%) in transplant recipients and 1 studies (2%) in transplant candidates We identified six different eHealth modalities including: Telehealth; mobile or tablet application; text or email messages; electronic monitors; internet/websites; and video or DVD. Three studies used a combination of eHealth interventions. Interventions were categorised into six types: educational; reminder systems; self-monitoring; behavioural counselling; clinical decision-aid; and mixed intervention types. We identified 98 outcomes, which were categorised into nine domains: blood pressure (9 studies); biochemical parameters (6 studies); clinical end-points (16 studies); dietary intake (3 studies); quality of life (9 studies); medication adherence (10 studies); behaviour (7 studies); physical activity (1 study); and cost-effectiveness (7 studies).Only three outcomes could be meta-analysed as there was substantial heterogeneity with respect to study population and eHealth modalities utilised. There was found to be a reduction in interdialytic weight gain of 0.13kg (4 studies, 335 participants: MD -0.13, 95% CI -0.28 to 0.01; I2 = 0%) and a reduction in dietary sodium intake of 197 mg/day (2 studies, 181 participants: MD -197, 95% CI -540.7 to 146.8; I2 = 0%). Both dietary sodium and fluid management outcomes were graded as being of low evidence due to high or unclear risk of bias and indirectness (interdialytic weight gain) and high or unclear risk of bias and imprecision (dietary sodium intake). Three studies reported death (2799 participants, 146 events), with 45 deaths/1000 cases compared to standard care of 61 deaths/1000 cases (RR 0.74, CI 0.53 to 1.03; P = 0.08). We are uncertain whether using eHealth interventions, in addition to usual care, impact on the number of deaths as the certainty of this evidence was graded as low due to high or unclear risk of bias, indirectness and imprecision. AUTHORS' CONCLUSIONS: eHealth interventions may improve the management of dietary sodium intake and fluid management. However, overall these data suggest that current evidence for the use of eHealth interventions in the CKD population is of low quality, with uncertain effects due to methodological limitations and heterogeneity of eHealth modalities and intervention types. Our review has highlighted the need for robust, high quality research that reports a core (minimum) data set to enable meaningful evaluation of the literature.


Assuntos
Insuficiência Renal Crônica/mortalidade , Telemedicina , Progressão da Doença , Humanos , Adesão à Medicação , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistemas de Alerta
4.
BMC Public Health ; 19(1): 1162, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438908

RESUMO

BACKGROUND: The NHS Health Check (NHS HC) is a cardiovascular risk assessment to prevent cardiovascular disease. Public Health England (PHE) wants to increase uptake. METHODS: We explored the impact of behaviourally informed invitation letters and pre-notification and reminder SMS on uptake of NHS HCs. Patients at 28 General Practices in the London Borough of Southwark who were eligible to receive an NHS HC between 1st November 2013 and 31st December 2014 were included. A double-blind randomised controlled trial with a mixed 2 (pre-notification SMS - yes or no) × 4 (letter - national template control, open-ended, time-limited, social norm) × 2 (reminder SMS - yes or no) factorial design was used. The open-ended letter used simplification, behavioural instruction and a personalised planning prompt for patients to record the date and time of their NHS HC. The time-limited letter was similar but stated the NHS HC was due in a named forthcoming month. The social norms letter was similar to the open-ended letter but included a descriptive social norms message and testimonials from local residents and no planning prompt. The outcome measure was attendance at an NHS HC. RESULTS: Data for 12, 244 invites were analysed. Uptake increased in almost all letter and SMS combinations compared to the control letter without SMS (Uptake 18%), with increases of up to 12 percentage points for the time-limited letter with pre-notification and reminder (Uptake 30%; Adjusted Odds Ratio AOR 1.86; 95% CI 1.45-2.83; p < 0.00); 10 percentage points for the open-ended letter with reminder (Uptake 27%; AOR 1.68; 95% CI 1.31-2.17; p < 0.00) and a 9 percentage point increase using the time-limited letter with reminder (Uptake 27%; AOR 1.61; 95% CI 1.25-2.10; p < 0.00). The reminder SMS increased uptake for all intervention letters. The pre-notification did not add to this effect. CONCLUSIONS: This large randomised controlled trial adds support to the evidence that small, low cost behaviourally informed changes to letter-based invitations can increase uptake of NHS HCs. It also provides novel evidence on the effect of SMS reminders and pre-notification on NHS HC attendance. TRIAL REGISTRATION: Retrospectively Registered (24/01/2014) ISRCTN36027094 .


Assuntos
Doenças Cardiovasculares/prevenção & controle , Promoção da Saúde/métodos , Sistemas de Alerta , Medicina Estatal/estatística & dados numéricos , Mensagem de Texto , Adulto , Método Duplo-Cego , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Fatores de Tempo
5.
J Pak Med Assoc ; 69(7): 964-967, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31308563

RESUMO

OBJECTIVE: To measure the effect of mobile phone Short Message Service reminder on the followup rate among patients visiting outpatient clinics. METHODS: The quasi-experimental study was conducted from September to November 2016 in three outpatient clinics of Saima General Hospital, Karachi. The intervention used was consultation follow upreminderuing Short Message Service. SPSS 1 9 was used for data analysis . RESULTS: Of the 606 subjects, 291(48%) visited the clinics in the pre intervention phase, and 315(52%) in the post-intervention phase. Of the former, 200(70%) patients adhered to the follow-up, while post-intervention adherence went up to 256(81%) (p<0.05). CONCLUSIONS: Using Short Message Service for reminders increased the follow-up rate.


Assuntos
Assistência ao Convalescente , Assistência Ambulatorial , Agendamento de Consultas , Cooperação do Paciente , Sistemas de Alerta , Mensagem de Texto , Doença Crônica , Humanos , Paquistão , Modalidades de Fisioterapia , Cuidado Pré-Natal
7.
BMC Med Inform Decis Mak ; 19(1): 122, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269946

RESUMO

BACKGROUND: According to WHO stroke is a growing societal challenge and the third leading cause of global disease-burden estimated using disability-adjusted life years. Rehabilitation after stroke is an area of mutual interest for health care in many countries. Within the health care sector there is a growing emphasis on ICT services to provide clients with easier access to information, self-evaluation, and self-management. ICT-supported care programs possible to use in clients' home environments are also recommended when there are long distances to the health care specialists. The aim of this study was to evaluate the technical usability of a SMS-based reminder system as well as user opinions when using such a system to assist clients to remember to perform daily rehabilitation activities, to rate their performance and to allow Occupational therapists (OT's) to track and follow-up clients' results over time. METHODS: Fifteen persons with stroke were invited to participate in the study and volunteered to receive daily SMS-based reminders regarding three activities to perform on a daily basis as well as answer daily SMS-based questions about their success rate during eight weeks. Clients, a number of family members, as well as OTs were interviewed to evaluate their opinions of using the reminder system. RESULTS: All clients were positive to the reminder system and felt that it helped them to regain their abilities. Their OTs agreed that the reminder and follow-up system was of benefit in the rehabilitation process. However, some technical and other issues were limiting the use of the system for some clients. The issues were mostly linked to the fact that the SMS system was based on a Swedish phone number, so that all messages needed to be sent internationally. CONCLUSION: In conclusion, it seems that this type of SMS-based reminder systems could be of good use in the rehabilitation process after stroke, even in low income counties where few clients have access to Internet or smart phones, and where access to healthcare services is limited. However, since the results are based on clients', OTs' and family members' expressed beliefs, we suggest that future research objectively investigate the intervention's beneficial effects on the clients' physical and cognitive health.


Assuntos
Sistemas de Alerta , Reabilitação do Acidente Vascular Cerebral , Mensagem de Texto , Atividades Cotidianas , Telefone Celular , Família , Humanos
8.
J Community Health Nurs ; 36(3): 105-114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291770

RESUMO

Older adults manage multiple medications for chronic disease and those living in rural areas are impacted by health care disparities due to health provider shortages and fewer pharmacies. The use of downloadable medication reminder apps on smartphones may serve as a strategy for medication self-management of chronic diseases. In this feasibility study, thirteen rural older adult participants downloaded Medisafe® and used the app to manage their daily medications. The community-dwelling aging adults in this pilot perceived the Medisafe® as not difficult to use, useful for medication tracking and providing reminders for the self-management of multiple medications.


Assuntos
Adesão à Medicação , Aplicativos Móveis , Sistemas de Alerta , População Rural , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Smartphone
9.
Br J Community Nurs ; 24(7): 310-314, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31265343

RESUMO

Despite the introduction of Oxygen Alert Cards, guidelines and audits, oxygen therapy remains overused in NHS practice, and this may lead to iatrogenic mortality. This pilot study aimed to examine the use of Oxygen Alert Wristbands (OxyBand) designed to alert health professionals who are delivering oxygen to patients to ensure that the oxygen is administered and titrated safely to the appropriate target saturations. Patients at risk of hypercapnic acidosis were asked to wear OxyBands while presenting to paramedics and health professionals in hospitals. Inappropriate prescription of oxygen reduced significantly after the OxyBands were used. A questionnaire-based assessment showed that the clinicians involved had a good understanding of the risks of uncontrolled oxygen. Forty-two patients found the wrist band comfortable to wear, and only two did not. OxyBands may have the potential to improve patient safety over Oxygen Alert Cards.


Assuntos
Acidose Respiratória/epidemiologia , Hipercapnia/epidemiologia , Prescrição Inadequada/prevenção & controle , Oxigenoterapia/normas , Melhoria de Qualidade , Sistemas de Alerta , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/métodos , Planejamento de Assistência ao Paciente , Projetos Piloto
10.
Int J Health Policy Manag ; 8(6): 353-364, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31256567

RESUMO

BACKGROUND: In Africa, health systems are poorly accessible, inequitable, and unresponsive. People rarely have either the confidence or the opportunity to express their opinions. In Burkina Faso, there is a political will to improve governance and responsiveness to create a more relevant and equitable health system. Given their development in Africa, information and communication technologies (ICTs) offer opportunities in this area. METHODS: This article presents the results of an evaluation of a toll-free call service coupled with an interactive voice server (TF-IVS) tested in Ouagadougou, Burkina Faso, to assess its relevance for improving health systems governance. The approach consisted of a 2-phased action research project to test 2 technologies: recorded messages and touch keypad. Using a concurrent mixed approach, we assessed the technological, social, and instrumental relevance of the service. RESULTS: The call service is available everywhere, 24 hours per day, seven days per week. The equipment and its physical location were not adequately protected against technological hazards. Of the 278 days of operation, 49 were non-functional. In 8 months, there were 13 877 calls, which demonstrated the popularity of ICTs and the ease of access to telephone networks and mobile technologies. The TF-IVS was free, anonymous, and multilingual, which fostered the expression of public opinion. However, cultural context (religion, ethnic culture) and fear of reprisals may have had a negative influence. In the end, questions remained regarding people's capacity to use this innovative service. In the first trial, 49% of callers recorded their message and in the second, 48%. Touch key technology appeared more relevant for automated and real-time data collection and analysis, but there was no comprehensive strategy for translating the information collected into a response from healthcare actors or the government. CONCLUSION: This study showed the relevance and feasibility of implementing a TF-IVS to strengthen health system responsiveness in one of the world's poorest countries. Public opinion expressed through data collected in real-time is helpful for improving system responsiveness to meet care needs and enhance equity. However, the strategy for developing this tool must take into account the implementation context and the activities needed to influence the mechanisms of social responsibility (eg, information provision, citizen action, and state response).


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Sistemas de Alerta/estatística & dados numéricos , Telefone/estatística & dados numéricos , Burkina Faso , Humanos , Atenção Primária à Saúde/organização & administração , Voz
11.
BMC Health Serv Res ; 19(1): 474, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291959

RESUMO

BACKGROUND: Despite the high burden of pneumococcal disease, pneumococcal vaccine coverage continues to fall short of Healthy People 2020 goals. A quasi-experimental design was used to investigate the impact of pneumococcal-specific best-practice alerts (BPAs) with and without workflow redesign compared to health maintenance notifications only, on pneumococcal vaccination rates in at-risk and high-risk adults, and on series completion in immunocompetent adults aged 65+ years. METHODS: This retrospective study used electronic health record and administrative data to identify pneumococcal vaccinations using cross sectional and historical cohorts of adults age 19+ years from 2013 to 2017 who attended clinics associated with the University of Utah Health. Difference-in-differences (DD) analyses was used to assess the impact of interventions across three observation periods (Baseline, Interim, and Follow Up). Adherence to the 2-dose vaccination schedule in older adults was measured through a longitudinal analysis. RESULTS: In DD analyses, implementing both workflow redesign and the BPA raised the vaccination rate by 8 percentage points (pp) (P < 0.001) and implementing the BPA only raised the rate by 7 pp. (P < 0.001) among at-risk adults age 19-64 years, relative to implementing health maintenance notifications (i.e., usual care) only in comparison clinics. In high-risk adults age 19-64 years, the BPA with or without workflow redesign did not significantly affect vaccination rates from baseline to follow up relative to health maintenance notifications. Per DD analyses, the effect of the BPA was mixed in immunocompetent and immunocompromised adults age 65+ years. However, immunocompetent older adults attending a clinic that implemented the BPA plus health maintenance notifications and workflow redesign (all 3 interventions) had 1.94 times higher odds (Odds ratio (OR) 1.94; P = 0.0003, 95% CI 1.24, 3.01) to receive the second pneumococcal dose than patients attending a usual practice clinic (i.e., no intervention). CONCLUSIONS: A pneumococcal BPA tool that reflects current guidelines implemented with and without workflow redesign improved vaccination rates for at-risk adults age 19-64 years and increased the likelihood of adults aged 65+ to complete the recommended 2-dose series. However, in other adult patient groups, the BPA was not consistently associated with improvements in pneumococcal vaccination rates.


Assuntos
Vacinas Pneumocócicas/administração & dosagem , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde , Sistemas de Alerta , Vacinação/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Registros Eletrônicos de Saúde , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Esquemas de Imunização , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/prevenção & controle , Estudos Retrospectivos , Medição de Risco , Adulto Jovem
12.
BMJ Health Care Inform ; 26(1)2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31201202

RESUMO

OBJECTIVE: To evaluate the effectiveness of the upgraded eCARE monitoring system on asthma control in discharged emergency department (ED) patients. METHODS: A multicentre randomised controlled study (randomised controlled trial) was done for patients with a primary diagnosis of asthma seen at the EDs in Singapore between 1 March 2013 and 28 February 2015. Those who met the inclusion criteria were randomised into a control group (routine care, n=212) and intervention group (eCARE, n=212). Patients in the intervention group received short message service (SMS) messages according to a structured workflow, while patients in the control group did not receive SMS support. RESULTS: For patients with poorly controlled asthma at recruitment, the results at 5 weeks showed no statistical difference in the proportion of patients who attained well-controlled asthma between the eCARE and routine care groups. At 3 months, the routine care group had a higher proportion of patients with well-controlled asthma but this was not statistically significant after adjustment for baseline differences using logistic regression. Approximately 95% of patients under the eCARE programme were satisfied with the SMS service. DISCUSSION: Patients in the eCARE programme did not have better asthma control than those receiving routine care. Conversely, patients in the eCARE programme appeared to have poorer asthma control, though a larger sample size will be required to confirm this finding.


Assuntos
Asma/terapia , Adesão à Medicação/estatística & dados numéricos , Sistemas de Alerta , Telemedicina , Mensagem de Texto , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Alta do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto , Singapura
13.
N Z Med J ; 132(1496): 31-38, 2019 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-31170131

RESUMO

AIMS: Outpatient endoscopy non-attendance leads to diagnostic delay and increasing wait times. We aimed to analyse endoscopy non-attendance rates and factors associated with it at the Canterbury and Auckland District Health Boards during a five-year period. METHODS: Consecutive appointments between April 2012 and March 2017 were assessed. The following procedures were included: gastroscopy, colonoscopy and endoscopic retrograde cholangiopancreatography. Predictors of non-attendance were assessed using univariate and multivariate binary logistic regression. RESULTS: A total of 58,434 appointments were offered (Canterbury-33,697, Auckland-24,737), of which 2,694 (4.6%) were not attended. Maori (OR 3.0, 95%CI 2.63-3.42) and Pacific Peoples (OR 3.1, 95%CI 2.7-3.55) were significantly more likely to miss appointments compared with Europeans. Patients from socioeconomically most deprived areas (NZDep10) had higher rates of non-attendance (OR 2.13, 95%CI 1.72-2.63) compared with NZDep1. Males (OR 1.43, 95%CI 1.32-1.56) and the Auckland District Health Board patients (OR 2.28, 95%CI 2.08-2.50) had higher non-attendance rates. CONCLUSION: Overall, 4.6% patients did not attend endoscopy appointments. Maori, Pacific Peoples and patients from socioeconomically deprived areas had higher non-attendance rates. Targeted interventions for at-risk groups would potentially lessen health inequalities and optimise utilisation of endoscopy resources.


Assuntos
Agendamento de Consultas , Diagnóstico Tardio/estatística & dados numéricos , Endoscopia do Sistema Digestório/métodos , Cooperação do Paciente/estatística & dados numéricos , Adulto , Assistência Ambulatorial/organização & administração , Análise de Variância , Endoscopia do Sistema Digestório/estatística & dados numéricos , Grupos Étnicos , Feminino , Hospitais Públicos , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nova Zelândia , Pacientes Ambulatoriais/estatística & dados numéricos , Sistemas de Alerta , Estudos Retrospectivos , Medição de Risco , Fatores Socioeconômicos
15.
BMC Med Inform Decis Mak ; 19(1): 109, 2019 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-31230591

RESUMO

BACKGROUND: Poor adherence compromises medication treatment effectiveness which results in suboptimal illness control. This can lead to increased use of healthcare services, reduction in patients' quality of life and increased healthcare costs. Reminding patients of their medication intake increases their adherence. Therefore, this study aimed to assess the willingness of epileptic patients to receive cell-phone based medication reminders and its associated factors in Northwest Ethiopia. METHODS: Institution based cross sectional study was conducted in the study period scheduled from March 1 to April 30, 2018 to interview 422 study participants at University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia. Systematic random sampling was used to select 422 epileptic patients. A structured interviewer administered questionnaire was used to collect data and analyzed by using SPSS version 21. Binary and multivariate logistic regression analysis was performed to identify the determinant factors for willingness to receive cell-phone based medication reminders. P < 0.05 at 95% confidence interval was considered statistically significant. RESULTS: A total of 394 (93% response rate) respondents were interviewed. The majority of respondents 262 (66.5%) owned a cellphone. Among the participants 271 (68.8%) were willing to receive reminder messages. In the multivariate regression analysis; living in urban areas (AOR = 5.63, 95% CI; 3.18-9.96), experience of forgetting things (AOR = 2.63, 95% CI; 1.44-4.80), forgetting to take Long-term Antiepileptic Drugs (AEDs) (AOR = 2.17, 95% CI; 1.06-4.43) and average monthly income ≥2000 birr (AOR = 2.43, 95% CI; 1.03-5.75) were significantly associated with willingness to receive cell-phone medication reminders. Pertaining to marital status; being married (AOR = 5.75, 95% CI; 1.11-29.70) or divorced (AOR = 5.15, 95% CI; 1.29-20.49) participants were also more willing to receive cell-phone medication reminders as compared to singles. CONCLUSION: Most respondents have a cellphone and were willing to use it as a medication reminder. Marital status, place of residence, average monthly income, experience of forgetting things since they started AED, forget to take AED are the most notable factors that are associated with the willingness of patients to receive cell phone drug reminder messages.


Assuntos
Telefone Celular , Epilepsia/terapia , Adesão à Medicação , Aceitação pelo Paciente de Cuidados de Saúde , Sistemas de Alerta , Adolescente , Adulto , Telefone Celular/estatística & dados numéricos , Estudos Transversais , Epilepsia/tratamento farmacológico , Etiópia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto Jovem
16.
Nat Rev Neurol ; 15(6): 353-359, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31073242

RESUMO

Dementia is a leading cause of disability, and the prevalence of dementia is steadily increasing. Although people with dementia are living longer lives in the community, without adequate support for their declining physical and psychological needs, the majority of these individuals end up in nursing homes. With no cure in sight, and in the context of population ageing, we must consider how to care for these individuals in the future. Technologies that augment existing care can maintain a person comfortably in their community, maximize individual autonomy and promote social participation. However, to date, such technologies have rarely been used in dementia care. This Perspectives article highlights the need for affordable and appropriate technologies to assist future dementia care, outlines some of the technologies currently available and describes the many challenges to integration of such technologies. Finally, guidelines are suggested for the development and implementation of new technologies in dementia care.


Assuntos
Demência/terapia , Equipamentos de Autoajuda/tendências , Humanos , Vida Independente , Sistemas de Alerta/tendências , Robótica/tendências , Telemedicina/tendências
17.
Trials ; 20(1): 273, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31097023

RESUMO

BACKGROUND: Treatment non-adherence is a serious challenge to effective tuberculosis (TB) control in Tibet. In this study we will pilot and evaluate the effectiveness of using new electronic monitors (e-monitors) and a smartphone app to improve treatment adherence among new pulmonary TB patients in Tibet. METHODS: We will use a multicentre, parallel-group, individually randomised controlled, superiority trial with blinded outcome evaluation and unblinded treatment. We will randomise new pulmonary TB outpatients (aged ≥ 15 years old and free from communication impairment) from Shigatse, Tibet to either the intervention or control arm in a 1:1 ratio at the time of their diagnosis. All patients will be treated according to the World Health Organisation standard 6-month TB treatment regimen and the China National TB programme guidelines. Intervention arm patients will be given their medication via e-monitors that have automatic voice reminders, and record medication adherence data and share it with health staff via Cloud connection. Intervention patients will also be encouraged to receive smartphone-based video-observed treatment if their adherence is problematic. Control arm patients will receive their medication in e-monitors that will collect medication adherence history, but will have their reminder function deactivated and are not linked to the app. The primary outcome is the rate of poor adherence, measured monthly during treatment as a binary indicator where poor adherence means missing ≥ 20% of doses in a month. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and an analysis of the long-term effects of the intervention on TB control. DISCUSSION: Our study is one of the first trials to evaluate the use of e-monitors and smartphone apps for customised treatment support in low- and middle-income countries (LMICs). All intervention activities are designed to be embedded into routine TB care with strong local ownership. Through the trial we intend to understand the feasibility of our intervention, its effectiveness, its cost-effectiveness and its long-term impacts to inform future scale-up in remote areas of China and other LMICs. TRIAL REGISTRATION: Current Controlled Trials, ID: ISRCTN52132803 . Registered on 9 November 2018.


Assuntos
Antituberculosos/uso terapêutico , Adesão à Medicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistemas de Alerta , Tuberculose/tratamento farmacológico , Interpretação Estatística de Dados , Humanos , Tamanho da Amostra , Mensagem de Texto , Tibet
18.
Clin Interv Aging ; 14: 753-762, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31118596

RESUMO

Background: Electronic medical record (EMR) alerts may inform point of care decisions, including the decision to prescribe potentially inappropriate medications (PIM) identified in the Beers criteria. EMR alerts may not be considered relevant or informative in the clinician context, leading to a phenomenon colloquially known as "alert fatigue." Objective: To assess the frequency of clinical interaction with EMR alerts and associated deprescribing behaviors in ambulatory settings. Methods: This is a retrospective observational study in two ambulatory clinics (the Kaye Edmonton Clinic Senior's Clinic and the Lynnwood Family Practice Clinic) in Edmonton over an observational period of 30 months. Statistical analysis was done using descriptive statistics, chi-square and regression analysis. Results: The reminder performance for interactions with the alert was 17.2% across the two clinics. The Number Needed to Remind (NNR) or mean number of alerts shown on clinician screens prior to a single interaction of any kind with the alert was 5.8. When actions were defined as a deprescribing (ie discontinuation) event that was related to the alert and that particular interaction in the EMR, the reminder performance was 1.2%, for an NNR of 82.8. Conclusion: The configuration of alerts in the EMR was not associated with a clinically detectable increase in the uptake of the Beers criteria for high hazard medications.


Assuntos
Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Lista de Medicamentos Potencialmente Inapropriados/normas , Idoso , Idoso de 80 Anos ou mais , Sistemas de Apoio a Decisões Clínicas/organização & administração , Desprescrições , Registros Eletrônicos de Saúde/organização & administração , Feminino , Humanos , Masculino , Análise de Regressão , Sistemas de Alerta/normas , Estudos Retrospectivos
19.
Cutis ; 103(4S): S13-S15, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31116806

RESUMO

Nonadherence to topical therapies for psoriasis is common. Reasons include miscommunication or inadequate communication between patients and clinicians, a mismatch between physician and patient treatment priorities, the complexity of treatment regimens, and a lack of information conveyed to the patient about realistic expectations from therapy. Interventions to facilitate communication and education are available to support clinicians and patients.


Assuntos
Comunicação , Adesão à Medicação , Educação de Pacientes como Assunto , Relações Médico-Paciente , Psoríase/tratamento farmacológico , Administração Cutânea , Técnicas de Apoio para a Decisão , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Aplicativos Móveis , Navegação de Pacientes , Preferência do Paciente , Satisfação do Paciente , Sistemas de Alerta
20.
Glob Health Action ; 12(1): 1609297, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31124401

RESUMO

Background: Failure to attend maternal health services is an intractable challenge for the health-care system in low- and middle-income countries. The use of technology for reminding patients about their appointments has been demonstrated to be an effective (future) tool toward increased health care services utilization in developing countries, such as Ethiopia. Objective: We aimed to investigate the effect of enhanced reminders on postnatal care attendance versus usual care (notification of an appointment at discharge). Methods: The study was a cluster randomized controlled trial: out of eligible 86 health centers, 16 health centers in Addis Ababa (AA) were randomized to either the intervention (8) or the control (8) groups; with a total of 350 mothers equally randomized into each arm. Mothers in the intervention group received the SMS (short message service) or a voice call reminder at 48 and 24 hours before the due postnatal appointment, whereas the control group received only the usual notification of appointments provided by health professionals at discharge from the ward following delivery. We recruited participants on wards after delivery at discharge and followed them up to 6 weeks. This study's primary outcome was postnatal visit compliance. Our assessment consisted of a two-level bivariate and a multivariate ordinal logistic regression analysis. Results: The majority (97.7%) of the participants completed the study; 173(98.9%) of women in the intervention group and 169 (96.5%) of women in the control group. There was a statistically significant difference in postnatal care (PNC) compliance among women who were in the intervention versus the control group (p-value = 0.005). Higher odds of postnatal compliance was observed among the intervention group (AOR:2.98, 95% CI 1.51-5.8). Conclusions: Mobile phone reminders were effective in terms of enhancing adherence to PNC appointments. This indicates integration of mobile phone reminders in postnatal care could improve postnatal appointment compliance.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Agendamento de Consultas , Telefone Celular/estatística & dados numéricos , Serviços de Saúde Materna/organização & administração , Cooperação do Paciente/estatística & dados numéricos , Cuidado Pós-Natal/organização & administração , Sistemas de Alerta/estatística & dados numéricos , Mensagem de Texto/estatística & dados numéricos , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Etiópia , Feminino , Humanos , Serviços de Saúde Materna/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Adulto Jovem
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