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3.
Int J Chron Obstruct Pulmon Dis ; 14: 1681-1690, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31440044

RESUMO

Background: In the Netherlands, almost 600,000 people had chronic obstructive pulmonary disease (COPD) in 2017. This decreases quality of life for many and each year, COPD leads to approximately 6,800 deaths and about one billion health care expenditures. It is expected that eHealth may improve access to care and reduce costs. However, there is no conclusive scientific evidence available of the added value of eHealth in COPD care. We conducted a scoping review into the use of eHealth in Dutch COPD care. The aim of the research was to provide an overview of all eHealth applications used in Dutch COPD care and to assess these applications on a number of relevant criteria. Methods: In order to make an overview of all eHealth applications aimed at COPD patients in the Netherlands, literature was searched in the electronic databases PubMed and Google Scholar. In addition, Dutch health care websites were searched for applications that have been evaluated for effectiveness and reliability. The identified eHealth applications were assessed according to five relevant quality criteria, eg, whether research has been conducted on the effectiveness. Results: Thirteen health care programs and patient platforms in COPD care have been found that use eHealth. In addition, 13 self-care and informative websites and 15 mobile apps were found that are available to citizens and patients. Five of 13 care programs and patient platforms were found to be effective in improving quality of life or reducing hospital admissions in small pilot studies. The effectiveness of these and the other eHealth applications should be established in larger studies in the future. Discussion: More research into the effectiveness of eHealth applications for COPD patients is needed. We recommend to develop a nationwide open source platform where well-evaluated eHealth applications can be showcased for patients and health care providers to improve COPD care.


Assuntos
Informação de Saúde ao Consumidor/métodos , Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Software/normas , Telemedicina , Acesso aos Serviços de Saúde/normas , Humanos , Países Baixos/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Doença Pulmonar Obstrutiva Crônica/terapia , Melhoria de Qualidade , Telemedicina/métodos , Telemedicina/normas
4.
Bone Joint J ; 101-B(8): 951-959, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362551

RESUMO

AIMS: This study aimed to develop a virtual clinic for the purpose of reducing face-to-face orthopaedic consultations. PATIENTS AND METHODS: Anonymized experts (hip and knee arthroplasty patients, surgeons, physiotherapists, radiologists, and arthroplasty practitioners) gave feedback via a Delphi Consensus Technique. This consisted of an iterative sequence of online surveys, during which virtual documents, made up of a patient-reported questionnaire, standardized radiology report, and decision-guiding algorithm, were modified until consensus was achieved. We tested the patient-reported questionnaire on seven patients in orthopaedic clinics using a 'think-aloud' process to capture difficulties with its completion. RESULTS: A patient-reported 13-item questionnaire was developed covering pain, mobility, and activity. The radiology report included up to ten items (e.g. progressive periprosthetic bone loss) depending on the type of arthroplasty. The algorithm concludes in one of three outcomes: review at surgeon's discretion (three to 12 months); see at next available clinic; or long-term follow-up/discharge. CONCLUSION: The virtual clinic approach with attendant documents achieved consensus by orthopaedic experts, radiologists, and patients. The robust development and testing of this standardized virtual clinic provided a sound platform for organizations in the United Kingdom to adopt a virtual clinic approach for follow-up of hip and knee arthroplasty patients. Cite this article: Bone Joint J 2019;101-B:951-959.


Assuntos
Assistência ao Convalescente/normas , Artroplastia de Quadril , Artroplastia do Joelho , Tomada de Decisão Clínica/métodos , Procedimentos Clínicos/normas , Telemedicina/normas , Assistência ao Convalescente/métodos , Algoritmos , Técnica Delfos , Humanos , Medidas de Resultados Relatados pelo Paciente , Radiografia , Telemedicina/métodos , Reino Unido
6.
Rev Bras Enferm ; 72(4): 933-939, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432949

RESUMO

OBJECTIVE: Describe the nurse's role in the Telemedicine Program in Cardiology implanted in Pernambuco, Brazil. METHODS: Qualitative study, with a target audience of nurses, performed between July and December 2016 at the Emergency Care Units. Data were collected through an online instrument, consisting of open and closed questions, performed with 19 professionals. The data were analyzed through the discourse of the collective subject by QuantiQualisoftware. RESULTS: The sample consisted of 19 nurses, mostly female (80%), with a mean age of 30 years old. Two central ideas were constructed: nurses' knowledge about the Telemedicine Program in Cardiology; and actions developed by nurses. Also, a flow of the program's assistance was built. FINAL CONSIDERATIONS: The nurse in Telecardiology performs functions of assistance and continuing education of monitoring and training for patients.


Assuntos
Avaliação de Desempenho Profissional/métodos , Enfermeiras e Enfermeiros/psicologia , Telemedicina/normas , Adulto , Brasil , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Pesquisa Qualitativa , Telemedicina/métodos
7.
JMIR Mhealth Uhealth ; 7(7): e13817, 2019 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-31293246

RESUMO

BACKGROUND: Mobile phones and tablets are being increasingly integrated into the daily lives of many people worldwide. Mobile health (mHealth) apps have promising possibilities for optimizing health systems, improving care and health, and reducing health disparities. However, health care apps often seem to be underused after being downloaded. OBJECTIVE: The aim of this paper is to reach a better understanding of people's perceptions, beliefs, and experience of mHealth apps as well as to determine how highly they appreciate these tools. METHODS: A systematic review was carried out on qualitative studies published in English, on patients' perception of mHealth apps between January 2013 and June 2018. Data extracted from these articles were synthesized using a meta-ethnographic approach and an interpretative method. RESULTS: A total of 356 articles were selected for screening, and 43 of them met the inclusion criteria. Most of the articles included populations inhabiting developed countries and were published during the last 2 years, and most of the apps on which they focused were designed to help patients with chronic diseases. In this review, we present the strengths and weaknesses of using mHealth apps from the patients' point of view. The strengths can be categorized into two main aspects: engaging patients in their own health care and increasing patient empowerment. The weaknesses pointed out by the participants focus on four main topics: trustworthiness, appropriateness, personalization, and accessibility of these tools. CONCLUSIONS: Although many of the patients included in the studies reviewed considered mHealth apps as a useful complementary tool, some major problems arise in their optimal use, including the need for more closely tailored designs, the cost of these apps, the validity of the information delivered, and security and privacy issues. Many of these issues could be resolved with more support from health providers. In addition, it would be worth developing standards to ensure that these apps provide patients accurate evidence-based information.


Assuntos
Antropologia Cultural/métodos , Aplicativos Móveis/normas , Pacientes/psicologia , Percepção , Pesquisa Qualitativa , Antropologia Cultural/estatística & dados numéricos , Humanos , Aplicativos Móveis/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Pacientes/estatística & dados numéricos , Telemedicina/instrumentação , Telemedicina/métodos , Telemedicina/normas
8.
JMIR Mhealth Uhealth ; 7(7): e12900, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31271150

RESUMO

BACKGROUND: Antiretroviral (ART) adherence among people living with HIV (PLWH) continues to be a challenge despite advances in HIV prevention and treatment. Mobile health (mHealth) interventions are increasingly deployed as tools for ART adherence. However, little is known about the uptake and attitudes toward commercially available, biprogrammatic mobile apps (ie, designed for both smartphone and short message service [SMS] messaging) among demographically diverse PLWH. OBJECTIVES: The Florida mHealth Adherence Project for PLWH (FL-mAPP) is an innovative pilot study that aimed to determine the acceptability of a commercially available, biprogrammatic mHealth intervention platform to ensure medication adherence and gauge the current attitudes of PLWH toward current and future mHealth apps. METHODS: A predeveloped, commercially available, biprogrammatic mHealth platform (Care4Today Mobile Health Manager, Johnson & Johnson, New Brunswick, NJ) was deployed, with self-reported ART adherence recorded in the app and paper survey at both short term (30-day) or long-term (90-day) follow-ups. Consented participants completed baseline surveys on sociodemographics and attitudes, beliefs, and willingness toward the use of mHealth interventions for HIV care using a 5-point Likert scale. Chi-square tests and multivariate logistic regression analyses identified correlations with successful uptake of the mHealth platform. RESULTS: Among 132 PLWH, 66% (n=87) initially agreed to use the mHealth platform, of which 54% (n=47) successfully connected to the platform. Of the 87 agreeing to use the mHealth platform, we found an approximate 2:1 ratio of persons agreeing to try the smartphone app (n=59) versus the SMS text messages (n=28). Factors correlating with mHealth uptake were above high school level education (adjusted odds ratio 2.65; P=.05), confidence that a clinical staff member would assist with mHealth app use (adjusted odds ratio 2.92, P=.048), belief that PLWH would use such an mHealth app (adjusted odds ratio 2.89; P=.02), and ownership of a smartphone in contrast to a "flip-phone" model (adjusted odds ratio 2.80; P=.05). Of the sample, 70.2% (n=92) reported daily interest in receiving medication adherence reminders via an app (80.4% users versus 64.7% nonusers), although not significantly different among the user groups (P=.06). In addition, 34.8% (n=16) of mHealth users reported a theoretical "daily" interest and 68.2% (n=58) of non-mHealth users reported no interest in using an mHealth app for potentially tracking alcohol or drug intake (P=.002). CONCLUSIONS: This commercially available, biprogrammatic mHealth platform showed feasibility and efficacy for enhanced ART and medication adherence within public health clinics and successfully included older age groups. Successful use of the platform among demographically diverse PLWH is important for HIV implementation science and promising for uptake on a larger scale.


Assuntos
Infecções por HIV/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Adesão à Medicação/psicologia , Aplicativos Móveis/normas , Inquéritos e Questionários/normas , Adulto , Idoso , Antirretrovirais/administração & dosagem , Antirretrovirais/uso terapêutico , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Florida , Infecções por HIV/psicologia , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Projetos Piloto , Inquéritos e Questionários/estatística & dados numéricos , Telemedicina/métodos , Telemedicina/normas , Telemedicina/estatística & dados numéricos
9.
Int J Technol Assess Health Care ; 35(4): 351-360, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307566

RESUMO

OBJECTIVES: The aim of this study is to determine whether the approach used in Australia to regulate mobile medical applications (MMA) is consistent with international standards and is suitable to address the unique challenges of these technologies. METHODS: The policies of members of the International Medical Device Regulator's Forum (IMDRF) were analyzed, to determine whether these regulatory bodies address IMDRF recommendations for the clinical evaluation of software as a medical device (SaMD). Case-studies of varying types of regulated MMAs in Australia and the United States were also reviewed to determine how well the guidance in the IMDRF's SaMD: Clinical Evaluation (2017) document was operationalized. RESULTS: All included jurisdictions evaluated the effectiveness of MMAs and addressed the majority of the key sub-categories recommended in the IMDRF guidance document. However, safety principles concerning information security (cybersecurity) and potential dangers of misinformation (risk-classification) were generally not addressed in either the case-studies or in the policy documents of international regulatory bodies. Australia's approach was consistent with MMA regulation conducted internationally. None of the approaches used by global regulatory bodies adequately addressed the risk of misinformation from apps and the potential for adverse clinical consequences. CONCLUSIONS: The risks posed by MMAs are mainly through the information they provide and how this is used in clinical decision-making. Policy in Australia and elsewhere should be adjusted to follow the IMDRF risk-classification criteria to address potential harms from misinformation. Australian regulatory information should also be updated so the harm posed by cybersecurity and connectivity can be comprehensively evaluated.


Assuntos
Aplicativos Móveis , Avaliação da Tecnologia Biomédica/organização & administração , Telemedicina/organização & administração , Austrália , Segurança Computacional , Humanos , Avaliação da Tecnologia Biomédica/normas , Telemedicina/normas
10.
JMIR Mhealth Uhealth ; 7(7): e11527, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31290400

RESUMO

BACKGROUND: Despite the fact there are many wearable and mobile medical devices that enable patients to better self-manage their diabetes, not many patients are aware of all the options they have. In addition, there are those who are not fully satisfied with the devices they use, and those who often do not use them effectively. OBJECTIVE: The study aimed to propose possible changes to the combination of devices used by 6 specific patients for diabetes self-management. We assessed the suitability of selected technical devices for diabetes control. METHODS: Data of 6 patients (3 men and 3 women) with type 1 diabetes mellitus, who had been using the Diani telemedicine system for at least 3 months, were analyzed. The suitability of selected technical devices for diabetes control was ascertained using the data obtained via the Diani telemedicine system, as well as the patients' subjective feelings and statements, their everyday life habits, and self-management of diabetes. Informed consent was signed and obtained from each of the patients included. RESULTS: Each of the presented case studies describes how a given patient handled the system and its specific components based on his or her lifestyle, level of education, habits related to diabetes management, personality type, and other factors. At the conclusion of each case study, the best composition of devices for patients with similar personal descriptions was suggested. CONCLUSIONS: We believe this study can provide relevant guidance on how to help particular patients choose the technology that is best suited for their needs, based on the specific patient information we are able to obtain from them. Furthermore, clinicians or educators should be aware of available technologies a given patient can choose from. In addition, there is a substantial need for proper patient education in order for them to effectively use devices for diabetes self-management.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Gerenciamento Clínico , Telemedicina/normas , Adulto , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 1/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Autogestão/métodos , Telemedicina/métodos , Telemedicina/estatística & dados numéricos
11.
J Med Syst ; 43(9): 293, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31338682

RESUMO

eHealth has become popular worldwide, and it is transforming health care. However, studies examining  the use of eHealth applications in the Chinese population are scarce. The study reports on the characteristics of eHealth applications in Hong Kong information and communication technology (ICT) users, their attitudes towards eHealth, and their reasons for not using eHealth applications. A cross-sectional random-digit dialing survey targeting adults using ICT was conducted in Hong Kong to elicit information on respondents' use of and attitudes towards eHealth. A total of 495 ICT users completed the survey, of whom 353 (71.3%) were eHealth users. A smartphone was the most frequent way of performing eHealth activities (71.7%). The most prevalent eHealth activity was reading about health/illness (86.4%), with 93.5% indicating that eHealth applications improved their understanding of health care issues. People with less education were less likely to use eHealth applications. Non-eHealth users indicated that the main reasons for not using eHealth applications were lack of interest in health information (49.3%) and lack of confidence in the reliability of online information (45.1%). Quality monitoring of health information available on ICTs and tailoring the design and readability are recommended to meet the needs of those seeking health resources and to promote eHealth. Evidence from the study demonstrates the potential of eHealth to improve the dissemination of health information in Hong Kong, and it provides a basis for improving eHealth integration.


Assuntos
Atitude , Smartphone , Telemedicina/métodos , Adolescente , Adulto , Informação de Saúde ao Consumidor , Estudos Transversais , Feminino , Hong Kong , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores Socioeconômicos , Telemedicina/normas , Adulto Jovem
12.
IEEE J Biomed Health Inform ; 23(4): 1749-1759, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31283471

RESUMO

Electronic health systems, such as telecare medical information system (TMIS), allow patients to exchange their health information with a medical center/doctor for diagnosis in real time, and across borders. Given the sensitive nature of health information/medical data, ensuring the security of such systems is crucial. In this paper, we revisit Das et al.'s authentication protocol, which is designed to ensure patient anonymity and untraceability. Then, we demonstrate that the security claims are invalid, by showing how both security features (i.e., patient anonymity and untraceability) can be compromised. We also demonstrate that the protocol suffers from smartcard launch attacks. To mitigate such design flaws, we propose a new lightweight authentication protocol using the cryptographic hash function for TMIS. We then analyze the security of the proposed protocol using AVISPA and Scyther, two widely used formal specification tools. The performance analysis demonstrates that our protocol is more efficient than other competing protocols.


Assuntos
Segurança Computacional , Registros Eletrônicos de Saúde , Troca de Informação em Saúde/normas , Telemedicina/normas , Identificação Biométrica , Confidencialidade , Humanos
13.
Matern Child Health J ; 23(9): 1196-1205, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31228142

RESUMO

BACKGROUND: Rural populations face unique health disparities that prevent women from accessing reproductive health care services. Telehealth initiatives offer a health care delivery tool to increase access to contraception. OBJECTIVE: To understand women's contraceptive needs and perceptions of accessing contraception through telehealth services. METHODS: Researchers conducted 52 in-depth interviews with women ages 18-44 years living in five rural counties in South Carolina from May to July 2015. Researchers employed constant comparative data analysis using HyperRESEARCH 3.7.2. RESULTS: Most participants identified as Black (62%) or White (28%). Findings suggest successful telehealth interventions should accommodate women's complex and nuanced community views, including benefits and barriers of telehealth, to improve access to contraceptive methods in rural locations. In addition, telehealth initiatives should frame contraception as contributing to women's overall health and well-being. CONCLUSIONS FOR PRACTICE: Telehealth initiatives may address barriers to contraceptive access in rural locations. Findings from this study offer theoretical and practical opportunities to guide telehealth interventions that support and empower women's access to contraceptive methods in rural areas.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Acesso aos Serviços de Saúde/normas , Serviços de Saúde Rural/normas , Telemedicina/normas , Adolescente , Adulto , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Pesquisa Qualitativa , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , South Carolina , Telemedicina/métodos , Telemedicina/estatística & dados numéricos
14.
JMIR Mhealth Uhealth ; 7(6): e12645, 2019 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-31228180

RESUMO

BACKGROUND: Lung cancer patients experience various symptoms during treatment. Although pulmonary rehabilitation is an effective way to improve these symptoms, a medical environment of limited availability makes it difficult to provide seamless and adequate rehabilitation for lung cancer patients. OBJECTIVE: This study aimed to investigate the effects of a personalized pulmonary rehabilitation program using real-time mobile patient health data for patients with non-small cell lung cancer. METHODS: We conducted a prospective clinical trial in 64 patients with non-small cell lung cancer aged between 20 and 80 years at a large tertiary hospital in Seoul, South Korea. A 12-week personalized pulmonary rehabilitation program, called efil breath, was administered to determine the effectiveness of the newly developed rehabilitation app. Participants were randomly allocated to the fixed exercise or fixed-interactive exercise group (which received the personalized program). We measured changes in 6-minute walk distance (6MWD) and dyspnea (modified Medical Research Council [mMRC] score) at 6 weeks; and quality of life and service satisfaction at 12 weeks. We used the paired t test to analyze the variables. RESULTS: Patients used the newly developed mobile health pulmonary rehabilitation app and a real-time patient monitoring website. In all participants, significant changes were observed in 6MWD at 12 weeks from a mean of 433.43m (SD 65.60) to 471.25m (SD 75.69; P=.001), and mMRC from a mean score of 0.94 (0.66) to 0.61 (SD 0.82; P=.02). The intervention significantly improved their quality of life (EuroQol-visual analog scale [EQ-VAS]) compared with baseline (mean score 76.05, SD 12.37 vs 82.09, SD 13.67, respectively; P=.002). CONCLUSIONS: A personalized mobile health-based pulmonary rehabilitation app for recording and monitoring real-time health data of patients with non-small cell lung cancer can supplement traditional health care center-based rehabilitation programs. This technology can encourage improvement of physical activity, dyspnea, and quality of life.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/reabilitação , Reabilitação/instrumentação , Adulto , Idoso , Exercício/psicologia , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reabilitação/métodos , Autogestão/métodos , Autogestão/psicologia , Autogestão/estatística & dados numéricos , Seul , Telemedicina/instrumentação , Telemedicina/normas , Telemedicina/estatística & dados numéricos
15.
Diabetes Metab Syndr ; 13(3): 2106-2110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235144

RESUMO

BACKGROUND: Mobile applications have the potential to provide needed support for older adults with diabetes. The field of medical application is currently one of the most dynamic in application development and medicine. OBJECTIVE: This study was designed to develop and validate a questionnaire to assess knowledge, attitude and practice of uncontrolled diabetic patients towards mobile based health applications. METHODS: A Cross Sectional study was designed and enrolled 78 adult uncontrolled diabetic (≥18 years old DM type 2)patients and clinically validated questionnaire was examined for internal consistency, reproducibility, convergent and discriminant validity using Cronbach's alpha, intra class correlation and CITC scores respectively. RESULTS: Cronbach's alpha coefficient was 0.97 for Assessment of Knowledge, 0.93 for Assessment of Attitude, and 0.90 for Assessment of Practice in uncontrolled diabetic population. CONCLUSION: The final version of questionnaire was found to be statistically internally consistent, reproducible and reliable and could be used to assess the awareness and attitude of patients towards self-management of diabetes mellitus.


Assuntos
Diabetes Mellitus/prevenção & controle , Autoavaliação Diagnóstica , Aplicativos Móveis/estatística & dados numéricos , Qualidade de Vida , Inquéritos e Questionários/normas , Telemedicina/normas , Adolescente , Adulto , Idoso , Biomarcadores/análise , Estudos Transversais , Diabetes Mellitus/psicologia , Feminino , Seguimentos , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Prognóstico , Psicometria , Autoeficácia , Adulto Jovem
16.
JMIR Mhealth Uhealth ; 7(6): e13987, 2019 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-31237239

RESUMO

BACKGROUND: With the rise of mobile technology, an increasing number of people use mobile-based social media to access health information. Many scholars have explored the nature of health information on social media; however, the impact of such information on people was understudied. OBJECTIVE: This study aimed to examine the nature and impact of health information on mobile-based social media. Specifically, we investigated how the levels of threat and efficacy of breast cancer prevention information affect individuals' engagement with the information, such as readings and likes. METHODS: Breast cancer prevention articles posted on a Chinese mobile-based social media platform (ie, WeChat Subscription Account [WeChat SA]) from January 1 to December 31, 2017, were extracted using the Python Web Crawler. We used content analysis and analysis of covariance to analyze our data. RESULTS: The results revealed that the vast majority of titles and main bodies of the articles involved one of the extended parallel process model components: threat or efficacy. CONCLUSIONS: Breast cancer prevention information on WeChat SA was well designed. Both threat and efficacy significantly affected the number of readings, whereas only efficacy had a significant effect on the number of likes. Moreover, breast cancer prevention information that contained both high levels of threat and efficacy gained the largest number of readings and likes.


Assuntos
Neoplasias da Mama/diagnóstico , Programas de Rastreamento/métodos , Mídias Sociais/instrumentação , Telemedicina/normas , Adulto , Neoplasias da Mama/psicologia , China , Feminino , Humanos , Mídias Sociais/normas , Mídias Sociais/estatística & dados numéricos , Telemedicina/estatística & dados numéricos
17.
JMIR Mhealth Uhealth ; 7(6): e13301, 2019 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-31237841

RESUMO

BACKGROUND: Most evidence-based practices (EBPs) do not find their way into clinical use, including evidence-based mobile health (mHealth) technologies. The literature offers implementers little practical guidance for successfully integrating mHealth into health care systems. OBJECTIVE: The goal of this research was to describe a novel decision-framing model that gives implementers a method of eliciting the considerations of different stakeholder groups when they decide whether to implement an EBP. METHODS: The decision-framing model can be generally applied to EBPs, but was applied in this case to an mHealth system (Seva) for patients with addiction. The model builds from key insights in behavioral economics and game theory. The model systematically identifies, using an inductive process, the perceived gains and losses of different stakeholder groups when they consider adopting a new intervention. The model was constructed retrospectively in a parent implementation research trial that introduced Seva to 268 patients in 3 US primary care clinics. Individual and group interviews were conducted to elicit stakeholder considerations from 6 clinic managers, 17 clinicians, and 6 patients who were involved in implementing Seva. Considerations were used to construct decision frames that trade off the perceived value of adopting Seva versus maintaining the status quo from each stakeholder group's perspective. The face validity of the decision-framing model was assessed by soliciting feedback from the stakeholders whose input was used to build it. RESULTS: Primary considerations related to implementing Seva were identified for each stakeholder group. Clinic managers perceived the greatest potential gain to be better care for patients and the greatest potential loss to be cost (ie, staff time, sustainability, and opportunity cost to implement Seva). All clinical staff considered time their foremost consideration-primarily in negative terms (eg, cognitive burden associated with learning a new system) but potentially in positive terms (eg, if Seva could automate functions done manually). Patients considered safety (anonymity, privacy, and coming from a trusted source) to be paramount. Though payers were not interviewed directly, clinic managers judged cost to be most important to payers-whether Seva could reduce total care costs or had reimbursement mechanisms available. This model will be tested prospectively in a forthcoming mHealth implementation trial for its ability to predict mHealth adoption. Overall, the results suggest that implementers proactively address the cost and burden of implementation and seek to promote long-term sustainability. CONCLUSIONS: This paper presents a model implementers may use to elicit stakeholders' considerations when deciding to adopt a new technology, considerations that may then be used to adapt the intervention and tailor implementation, potentially increasing the likelihood of implementation success. TRIAL REGISTRATION: ClinicalTrials.gov NCT01963234; https://clinicaltrials.gov/ct2/show/NCT01963234 (Archived by WebCite at http://www.webcitation.org/78qXQJvVI).


Assuntos
Medicina do Vício/métodos , Medicina do Vício/normas , Medicina do Vício/estatística & dados numéricos , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/normas , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Feminino , Promoção da Saúde/métodos , Promoção da Saúde/normas , Promoção da Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Telemedicina/métodos , Telemedicina/normas , Telemedicina/estatística & dados numéricos
18.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31209162

RESUMO

Communication of health data has evolved rapidly with the widespread adoption of electronic health records (EHRs) and communication technology. What used to be sent to patients via paper mail, fax, or e-mail may now be accessed by patients via their EHRs, and patients may also communicate securely with their medical team via certified technology. Although EHR technologies have great potential, their most effective applications and uses for communication between pediatric and adolescent patients, guardians, and medical teams has not been realized. There are wide variations in available technologies, guiding policies, and practices; some physicians and patients are successful in using certified tools but others are forced to limit their patients' access to e-health data and associated communication altogether. In general, pediatric and adolescent patients are less likely than adult patients to have electronic access and the ability to exchange health data. There are several reasons for these limitations, including inconsistent standards and recommendations regarding the recommended age for independent access, lack of routine EHR support for the ability to filter or proxy such access, and conflicting laws about patients' and physicians' rights to access EHRs and ability to communicate electronically. Effective, safe electronic exchange of health data requires active collaboration between physicians, patients, policy makers, and health information technology vendors. This policy statement addresses current best practices for these stakeholders and delineates the continued gaps and how to address them.


Assuntos
Registros Eletrônicos de Saúde/normas , Portais do Paciente/normas , Pediatria/normas , Relações Profissional-Família , Relações Profissional-Paciente , Acesso à Informação , Adolescente , Fatores Etários , Criança , Confidencialidade/normas , Registros Eletrônicos de Saúde/legislação & jurisprudência , Política de Saúde , Humanos , Consentimento Informado por Menores , Consentimento dos Pais , Portais do Paciente/legislação & jurisprudência , Pediatria/legislação & jurisprudência , Pediatria/métodos , Telemedicina/legislação & jurisprudência , Telemedicina/métodos , Telemedicina/normas , Estados Unidos
19.
JMIR Mhealth Uhealth ; 7(6): e12920, 2019 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-31199329

RESUMO

BACKGROUND: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the overall adoption levels of mHealth tools by health professionals remain relatively low. OBJECTIVE: This study aimed (1) to investigate attitudes of health care providers and mHealth experts toward mHealth tools in the health context in general, and this study aimed (2) to test the acceptability and feasibility of a specific mHealth tool for patients with an eating disorder (ED), called TCApp, among patients and ED specialists. METHODS: To this purpose, we conducted an explorative qualitative study with 4 in-depth group discussions with several groups of stakeholders: our first focus group was conducted with 11 experts on mHealth from the Catalan Association of Health Entities; the second focus group included 10 health care professionals from the Spanish College of Doctors of Barcelona; the third focus group involved 9 patients with an ED who had used the TCApp over a 12-week period, and the fourth and last focus group involved 8 ED specialists who had monitored such ED patients on the Web. RESULTS: The focus groups showed that health care providers and mHealth experts reported barriers for mHealth adoption more often than facilitators, indicating that mHealth techniques are difficult to obtain and use. Most barriers were attributed to external factors relating to the human or organizational environment (ie, lack of time because of workload, lack of direct interest on a legislative or political level) rather than being attributed to internal factors relating to individual obstacles. The results of the mHealth intervention study indicate that the TCApp was considered as easy to use and useful, although patients and the ED specialists monitoring them on the Web reported different adoption problems, such as the inability to personalize the app, a lack of motivational and interactive components, or difficulties in adhering to the study protocol. CONCLUSIONS: In general, this paper indicates that both health professionals and patients foresee difficulties that need to be addressed before comprehensive adoption and usage of mHealth techniques can be effectively implemented. Such findings are in line with previous studies, suggesting that although they acknowledge their possible benefits and cost-effectiveness, health care providers are quite resistant and conservative about integrating mHealth technologies in their daily practice.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Aplicativos Móveis/normas , Adolescente , Adulto , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Grupos Focais/métodos , Humanos , Masculino , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/estatística & dados numéricos , Aplicativos Móveis/estatística & dados numéricos , Pesquisa Qualitativa , Espanha , Telemedicina/métodos , Telemedicina/normas , Telemedicina/estatística & dados numéricos
20.
JMIR Mhealth Uhealth ; 7(6): e13950, 2019 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-31199330

RESUMO

BACKGROUND: Using a mobile health (mHealth) intervention, consisting of a smartphone and compatible medical device, has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes while mitigating health care costs. OBJECTIVE: The aim of this study was to explore the potential facilitators and barriers among health care providers (HCPs) regarding the use of mHealth interventions for COPD management. METHODS: This was a qualitative study. Semistructured individual interviews were conducted with HCPs, including nurses, pharmacists, and physicians who work directly with patients with COPD. A flexible prompts guide was used to facilitate discussions. Interview topics included the following: demographics, mHealth usage, perceptions toward challenges of mHealth adoption, factors facilitating mHealth adoption, and preferences regarding features of the mHealth intervention for COPD management. Interviews were conversational in nature, and items were not asked verbatim or in the order presented. The interviews were transcribed verbatim and compared against the digital recordings to ensure the accuracy of the content. After creating a codebook for analysis, 2 researchers independently coded the remaining interview data using pattern coding. They discussed commonalities and differences in coding until a consensus was reached. RESULTS: A total of 30 nurses, physicians, and pharmacists participated. The main facilitators to mHealth adoption are possible health benefits for patients, ease of use, educating patients and their HCPs, credibility, and reducing cost to the health care system. Alternatively, the barriers to adoption are technical issues, privacy and confidentiality issues, lack of awareness, potential limited uptake from the elderly, potential limited connection between patients and HCPs, and finances. CONCLUSIONS: It is important to understand the perceptions of HCPs regarding the adoption of innovative mHealth interventions for COPD management. This study identifies some potential facilitators and barriers that may inform the successful development and implementation of mHealth interventions for COPD management.


Assuntos
Gerenciamento Clínico , Pessoal de Saúde/psicologia , Percepção , Doença Pulmonar Obstrutiva Crônica/terapia , Adulto , Feminino , Grupos Focais/métodos , Pessoal de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Terra Nova e Labrador , Doença Pulmonar Obstrutiva Crônica/psicologia , Pesquisa Qualitativa , Telemedicina/métodos , Telemedicina/normas , Telemedicina/estatística & dados numéricos
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