A Clinician and Electronic Health Record Wearable Device Intervention to Increase Physical Activity in Patients With Obesity: Formative Qualitative Study.

BACKGROUND: The number of individuals using digital health devices has grown in recent years. A higher rate of use in patients suggests that primary care providers (PCPs) may be able to leverage these tools to effectively guide and monitor physical activity (PA) for their patients. Despite evidence that remote patient monitoring (RPM) may enhance obesity interventions, few primary care practices have implemented programs that use commercial digital health tools to promote health or reduce complications of the disease. OBJECTIVE: This formative study aimed to assess the perceptions, needs, and challenges of implementation of an electronic health record (EHR)-integrated RPM program using wearable devices to promote patient PA at a large urban primary care practice to prepare for future intervention. METHODS: Our team identified existing workflows to upload wearable data to the EHR (Epic Systems), which included direct Fitbit (Google) integration that allowed for patient PA data to be uploaded to the EHR. We identified pictorial job aids describing the clinical workflow to PCPs. We then performed semistructured interviews with PCPs (n=10) and patients with obesity (n=8) at a large urban primary care clinic regarding their preferences and barriers to the program. We presented previously developed pictorial aids with instructions for (1) providers to complete an order set, set step-count goals, and receive feedback and (2) patients to set up their wearable devices and connect them to their patient portal account. We used rapid qualitative analysis during and after the interviews to code and develop key themes for both patients and providers that addressed our research objective. RESULTS: In total, 3 themes were identified from provider interviews: (1) providers' knowledge of PA prescription is focused on general guidelines with limited knowledge on how to tailor guidance to patients, (2) providers were open to receiving PA data but were worried about being overburdened by additional patient data, and (3) providers were concerned about patients being able to equitably access and participate in digital health interventions. In addition, 3 themes were also identified from patient interviews: (1) patients received limited or nonspecific guidance regarding PA from providers and other resources, (2) patients want to share exercise metrics with the health care team and receive tailored PA guidance at regular intervals, and (3) patients need written resources to support setting up an RPM program with access to live assistance on an as-needed basis. CONCLUSIONS: Implementation of an EHR-based RPM program and associated workflow is acceptable to PCPs and patients but will require attention to provider concerns of added burdensome patient data and patient concerns of receiving tailored PA guidance. Our ongoing work will pilot the RPM program and evaluate feasibility and acceptability within a primary care setting.

The Interactions Between Diabetes Mellitus and Myelodysplastic Syndromes: Current State of Evidence and Future Directions.

Diabetes mellitus (DM) and cancer are disorders of global importance. Multiple epidemiologic studies show that diabetic patients have an increased risk of developing cancer of different types. Myelodysplastic syndromes (MDS) are among the most common hematologic malignancies and include a heterogeneous group of hematopoietic neoplasms characterized by dysplastic changes, low blood counts, and an increased risk of progression to acute myeloid leukemia. Potential epigenetic and metabolic interferences between DM and MDS have been reported but are poorly understood. DM and MDS share some predisposing risk factors such as obesity. Patients with MDS and DM can experience worsening of diabetic control due to multiple factors that exacerbate hyperglycemia and insulin resistance such as stress, infections, adjunct drugs (e.g. steroids to control nausea), and others. In addition, accurate assessment of glucose control in diabetic patients who have MDS can be complicated. Alternatively, DM when associated with end-organ damage can complicate management of MDS, increase risks of complications, and limit the applicability of intensive therapeutic interventions. Here we review the current knowledge of the interactions between DM and MDS at the pathogenetic, clinical and epidemiologic levels, discuss how this knowledge could be used therapeutically to improve the outcome of patients affected by both conditions, and delineate important unmet needs that should be addressed in future research.