scholarly journals Strategies for the follow-up of patients with chronic diseases and polypharmacy: development and implementation of a new health care approach based on mobile technology (DIPP-mHeart Study). (Preprint)

2018 ◽  
Author(s):  
Mar Gomis-Pastor ◽  
Esther Rodriguez-Murphy ◽  
Anna Feliu ◽  
Gerardo Ontiveros ◽  
Francesc Garcia-Cuy�s ◽  
...  
Keyword(s):  
Health System ◽  
New Technologies ◽  
Solid Organ ◽  
Design Development ◽  
Chronic Patient ◽  
High Complexity ◽  
Chronic Patients ◽  
Health Authorities ◽  
Improve Health

BACKGROUND Multimorbidity is related to a high increase in costs for the health system and a poorer quality of life for patients. It is the professional’s responsibility to establish new care models oriented to improve health outcomes in high complexity patients. We have developed a comprehensive care program for these patients based on carrying out sustainable highly effective interventions for the health system through technology. The use of new technologies to improve health results is an unstoppable trend. The implementation in practice of new forms of healthcare based on telemedicine leads to a need for professionals to specialize in an often unfamiliar area. OBJECTIVE The main aim of the study is to design and Develop, Integrate and implement an mHealth tool to support monitoring of the chronic Patient with Polypharmacy (DIPP-mHeart Study). The secondary aim of our study is to make the development of these new technologies easier for other research groups through describing the limitations encountered by our team during the development of the project and the corresponding solutions implemented to overcome those limitations. METHODS The study was carried out in four stages: design, development, integration and implementation, followed by ensuring the quality, security and legal requirements of the mHeart® prototype. The design and development of the tool was based on a review of the bibliography and several surveys done to the main stakeholders (patients, health professionals, Health Authorities and experts in mHealth). All these findings allow us to focus mHeart functionalities on the user’s expectations and the polymedicated patient’s real needs as well as to discover realistic solutions to overcoming the main limitations of implementing the new tool within the health environment. The tool was adapted to the solid organ transplant population, a perfect example of the chronic patient of high complexity. RESULTS 133 chronic patients, 26 stakeholders, as well as health authorities, patients’ associations and scientific societies were interviewed. Based on the information gathered, the design of the new tool was focused on improving the management of polytherapy and the flow of communication between professionals, patients and care levels. After carrying out diverse tests, the final mHeart® platform prototype was obtained (website and mobile application). Its functionalities allow for the sustainable intervention of a multidisciplinary team in real time and in a patient’s habitual context, thus empowering the patient through clinician feedback. The main limitations encountered were the integration of the tool with our health system’s information technology system, ensuring quality and safety, as well as considering other legal aspects which the clinical team were not familiar with. CONCLUSIONS The DIPP-mHeart project resulted in a new holistic eHealth tool that will be extremely useful for the follow-up of chronic patients with polypharmacy. Not only was this platform to be designed and developed, but its safety and quality, its implementation in our environment, and its continued use in the long term were also to be ensured. Sharing the key aspects involved in overcoming the major difficulties encountered could be highly interesting for the scientific community and widely applicable in our setting.

scholarly journals The Chronic Patient in the Community A Two-Year Follow Up of 338 Chronic Patients

1968 ◽  
Vol 13 (3) ◽  
pp. 231-236 ◽  
Author(s):  
M. Herjanic ◽  
A. Stewart ◽  
R. C. Hales
Keyword(s):  
Social Worker ◽  
Living Arrangements ◽  
Community Care ◽  
Psychiatric Patients ◽  
Chronic Patient ◽  
Chronic Patients ◽  
Chronic Psychiatric Patients

Three hundred and thirty-eight chronic psychiatric patients were followed up for two years after their discharge. Information was available on all but four patients. During the twenty-four month follow-up period, 11% had died and 25% required readmission. The source of support and living arrangements for the whole group were discussed, and the opinions about the outcome by the informant, psychiatrist, and social worker, were compared, The opinions correlated remarkably well. Characteristics of community care deemed important by the investigators were discussed briefly.

scholarly journals “Impresiones en azul”. La cianotipia como agente catalizador de la mejora psicosocial y fomento de la comunicación de las personas con demencia temprana

2018 ◽  
pp. 27
Author(s):  
María del Carmen Moreno Sáez
Keyword(s):  
Qualitative Research ◽  
Alzheimer Disease ◽  
New Technologies ◽  
The Elderly ◽  
Personal Relationships ◽  
Design Development ◽  
Social Wellbeing ◽  
Early Dementia ◽  
Nuevas Tecnologías

“Impresiones en azul” se corresponde con el nombre genérico de varios talleres dentro de un programa de educación artística para personas con demencia temprana, realizados en el Centro de Referencia Estatal de Atención a Personas con Enfermedad de Alzheimer y otras Demencias, de Salamanca, dependiente del IMSERSO. El objetivo de este programa era evaluar si la implementación de actividades artísticas podía ser una estrategia eficaz para promover el bienestar y las capacidades psicosociales, cognitivas y de comunicación de las personas con demencia temprana y, en consecuencia, una manera de mejorar los sistemas de cuidado de los mayores con principios de demencia. Estos talleres consistieron en el desarrollo de una sencilla técnica fotográfica, combinada con nuevas tecnologías. La investigación psicosocial cualitativa fue la metodología utilizada, prevista en tres fases: diseño de las actividades, desarrollo y seguimiento de los mismos y análisis de las producciones artísticas de los asistentes. Las conclusiones a las que se han llegado se pueden resumir en las siguientes: la demencia no ha supuesto problema alguno para el desarrollo de los talleres, el interés demostrado por los pacientes ha sido significativo, obteniendo resultados positivos en relación con su bienestar psicosocial, se ha experimentado un incremento de la comunicación entre los asistentes, tanto en sus relaciones interpersonales, como en su proyección al exterior y, por último, merece la pena destacar los modelos que pueden ser desarrollados en el cuidado de las personas con demencia temprana.“Impressions in blue” is the generic name given to several workshops belonging to an Art Education program targeted to people with early dementia, carried out in the State Centre for the Attention to People with Alzheimer Disease and other Dementias, in Salamanca, dependent on the IMSERSO. The aim of this program was assessing if the implementation of artistic activities could be an efficient strategy for promoting wellbeing and psychosocial, cognitive and communication capacities in people with early dementias and, therefore, improve the caring systems for the elderly with early dementias. These workshops consisted on the development of a simple photographic technique, combined with new technologies. The psychosocial qualitative research was the chosen methodology and was organised in three phases: activities design, development, follow-up and analysis of the artistic productions done by the participants. The conclusions drawn can be outlined as follows: Dementia didn’t cause any problem while developing the workshops; the interest shown by the participants was remarkable, obtaining positive reactions in regard to their psycho-social wellbeing; it was observed an increase in communication amongst the participants, not only in their personal relationships but also in their contact with the outside; lastly, it is worth highlighting the models that can be developed in the early dementia care.

scholarly journals Design, development and deployment of a hand/wrist exoskeleton for home-based rehabilitation after stroke - SCRIPT project

Robotica ◽  
2014 ◽  
Vol 32 (8) ◽  
pp. 1331-1346 ◽  
Author(s):  
F. Amirabdollahian ◽  
S. Ates ◽  
A. Basteris ◽  
A. Cesario ◽  
J. Buurke ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professional ◽  
New Technologies ◽  
Supporting Evidence ◽  
Design Development ◽  
Interactive Games ◽  
Home Based ◽  
System Usability Scale ◽  
System Usability

SUMMARYChanges in world-wide population trends have provided new demands for new technologies in areas such as care and rehabilitation. Recent developments in the the field of robotics for neurorehabilitation have shown a range of evidence regarding usefulness of these technologies as a tool to augment traditional physiotherapy. Part of the appeal for these technologies is the possibility to place a rehabilitative tool in one's home, providing a chance for more frequent and accessible technologies for empowering individuals to be in charge of their therapy.Objective:this manuscript introduces the Supervised Care and Rehabilitation Involving Personal Tele-robotics (SCRIPT) project. The main goal is to demonstrate design and development steps involved in a complex intervention, while examining feasibility of using an instrumented orthotic device for home-based rehabilitation after stroke.Methods:the project uses a user-centred design methodology to develop a hand/wrist rehabilitation device for home-based therapy after stroke. The patient benefits from a dedicated user interface that allows them to receive feedback on exercise as well as communicating with the health-care professional. The health-care professional is able to use a dedicated interface to send/receive communications and remote-manage patient's exercise routine using provided performance benchmarks. Patients were involved in a feasibility study (n=23) and were instructed to use the device and its interactive games for 180 min per week, around 30 min per day, for a period of 6 weeks, with a 2-months follow up. At the time of this study, only 12 of these patients have finished their 6 weeks trial plus 2 months follow up evaluation.Results:with the “use feasibility” as objective, our results indicate 2 patients dropping out due to technical difficulty or lack of personal interests to continue. Our frequency of use results indicate that on average, patients used the SCRIPT1 device around 14 min of self-administered therapy a day. The group average for the system usability scale was around 69% supporting system usability.Conclusions:based on the preliminary results, it is evident that stroke patients were able to use the system in their homes. An average of 14 min a day engagement mediated via three interactive games is promising, given the chronic stage of stroke. During the 2nd year of the project, 6 additional games with more functional relevance in their interaction have been designed to allow for a more variant context for interaction with the system, thus hoping to positively influence the exercise duration. The system usability was tested and provided supporting evidence for this parameter. Additional improvements to the system are planned based on formative feedback throughout the project and during the evaluations. These include a new orthosis that allows a more active control of the amount of assistance and resistance provided, thus aiming to provide a more challenging interaction.

Effects and utility of an online forward triage tool during the SARS-CoV-2 pandemic: patient perspectives (Preprint)

2020 ◽  
Author(s):  
Janet Michel
Keyword(s):  
Decision Making ◽  
Health System ◽  
Information Source ◽  
Patient Perspectives ◽  
User Friendliness ◽  
Fear And Anxiety ◽  
Mail Address ◽  
Second Wave ◽  
E Mail

BACKGROUND Background: Online forward triage tools (OFTT) or symptom checkers are being widely used during this COVID-19 pandemic. The effects and utility of such tools however, have not been widely assessed. OBJECTIVE Objective: To assess the effects (quantitatively) and the utility (qualitatively) of a COVID-19 OFTT in a pandemic context, exploring patient perspectives as well as eliciting recommendations for tool improvement. METHODS Methods: We employed a mixed-method sequential explanatory study design. Quantitative data of all users of the OFTT between March 2nd, 2020 and May 12th, 2020 were collected. A follow-up survey of people who consented to participation was conducted. Secondly, qualitative data was collected through key informant interviews (n=19) to explain the quantitative findings, as well as explore tool utility, user experience and elicit recommendations. RESULTS Results: An estimate of the effects, (quantitatively) and the utility (qualitatively) of a COVID-19 OFTT in a pandemic context, and recommendations for tool improvement. In the study period, 6,272 users consulted our OFTT; 560 participants consented to a follow-up survey and provided a valid e-mail address. 176 (31.4%) participants returned a complete follow-up questionnaire. 85.2% followed the recommendations given. 41.5% reported that their fear was allayed after using tool and 41.1% would have contacted the GP or visited a hospital had the tool not existed. Qualitatively, seven overarching themes emerged namely i) accessibility of tool, ii) user-friendliness of tool, iii) utility of tool as an information source, iv) utility of tool in allaying fear and anxiety, v) utility of tool in decision making (test or not to test), vi) utility of tool in reducing the potential for onward transmissions (preventing cross infection) and vii) utility of tool in reducing health system burden. CONCLUSIONS Conclusion: Our findings demonstrated that a COVID-19 OFTT does not only reduce the health system burden, but can also serve as an information source, reduce anxiety and fear, reduce cross infections and facilitate decision making (to test or not to test). Further studies are needed to assess the transferability of these COVID-19 OFTT findings to other contexts as the second wave sweeps across Europe.

scholarly journals Present and Future of Parkinson’s Disease in Spain: PARKINSON-2030 Delphi Project

2021 ◽  
Vol 11 (8) ◽  
pp. 1027
Author(s):  
Diego Santos García ◽  
Marta Blázquez-Estrada ◽  
Matilde Calopa ◽  
Francisco Escamilla-Sevilla ◽  
Eric Freire ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
New Technologies ◽  
Management Strategies ◽  
Multidisciplinary Teams ◽  
Modified Delphi ◽  
Advanced Stages ◽  
Diagnostic Capacity ◽  
Socio Economic Impact

Parkinson’s disease (PD) is a chronic progressive and irreversible disease and the second most common neurodegenerative disease worldwide. In Spain, it affects around 120.000–150.000 individuals, and its prevalence is estimated to increase in the future. PD has a great impact on patients’ and caregivers’ lives and also entails a substantial socioeconomic burden. The aim of the present study was to examine the current situation and the 10-year PD forecast for Spain in order to optimize and design future management strategies. This study was performed using the modified Delphi method to try to obtain a consensus among a panel of movement disorders experts. According to the panel, future PD management will improve diagnostic capacity and follow-up, it will include multidisciplinary teams, and innovative treatments will be developed. The expansion of new technologies and studies on biomarkers will have an impact on future PD management, leading to more accurate diagnoses, prognoses, and individualized therapies. However, the socio-economic impact of the disease will continue to be significant by 2030, especially for patients in advanced stages. This study highlighted the unmet needs in diagnosis and treatment and how crucial it is to establish recommendations for future diagnostic and therapeutic management of PD.

scholarly journals Diagnostics and monitoring tools for noncommunicable diseases: a missing component in the global response

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Antonio Bernabé-Ortiz ◽  
Jessica H. Zafra-Tanaka ◽  
Miguel Moscoso-Porras ◽  
Rangarajan Sampath ◽  
Beatrice Vetter ◽  
...  
Keyword(s):  
Health System ◽  
New Technologies ◽  
Action Plan ◽  
Building Blocks ◽  
Communicable Diseases ◽  
Noncommunicable Disease ◽  
World Health ◽  
Noncommunicable Diseases ◽  
Diagnostic Tools ◽  
Monitoring Tools

AbstractA key component of any health system is the capacity to accurately diagnose individuals. One of the six building blocks of a health system as defined by the World Health Organization (WHO) includes diagnostic tools. The WHO’s Noncommunicable Disease Global Action Plan includes addressing the lack of diagnostics for noncommunicable diseases, through multi-stakeholder collaborations to develop new technologies that are affordable, safe, effective and quality controlled, and improving laboratory and diagnostic capacity and human resources. Many challenges exist beyond price and availability for the current tools included in the Package of Essential Noncommunicable Disease Interventions (PEN) for cardiovascular disease, diabetes and chronic respiratory diseases. These include temperature stability, adaptability to various settings (e.g. at high altitude), need for training in order to perform and interpret the test, the need for maintenance and calibration, and for Blood Glucose Meters non-compatible meters and test strips. To date the issues surrounding access to diagnostic and monitoring tools for noncommunicable diseases have not been addressed in much detail. The aim of this Commentary is to present the current landscape and challenges with regards to guidance from the WHO on diagnostic tools using the WHO REASSURED criteria, which define a set of key characteristics for diagnostic tests and tools. These criteria have been used for communicable diseases, but so far have not been used for noncommunicable diseases. Diagnostic tools have played an important role in addressing many communicable diseases, such as HIV, TB and neglected tropical diseases. Clearly more attention with regards to diagnostics for noncommunicable diseases as a key component of the health system is needed.

scholarly journals Factors Associated with Patients’ Connection to Referred Social Needs Resources at a Federally Qualified Health Center

2021 ◽  
Vol 12 ◽  
pp. 215013272110243
Author(s):  
Tyler Lian ◽  
Kate Kutzer ◽  
Diwas Gautam ◽  
Howard Eisenson ◽  
Jane C. Crowder ◽  
...  
Keyword(s):  
Health Center ◽  
Social Services ◽  
Social Needs ◽  
Phone Call ◽  
Community Based ◽  
Factors Associated ◽  
Federally Qualified Health Center ◽  
Or Applications ◽  
Improve Health

Introduction: In an effort to improve health outcomes and promote health equity, healthcare systems have increasingly begun to screen patients for unmet social needs and refer them to relevant social services and community-based organizations. This study aimed to identify factors associated with the successful connection (ie, services started) to social needs resources, as well as factors associated with an attempt to connect as a secondary, intermediate outcome. Methods: This retrospective cohort study included patients who had been screened, referred, and subsequently reached for follow-up navigation from March 2019 to December 2020, as part of a social needs intervention at a federally qualified health center (FQHC). Measures included demographic and social needs covariates collected during screening, as well as resource-related covariates that characterized the referred resources, including service domain (area of need addressed), service site (integration relative to the FQHC), and access modality (means of accessing services). Results: Of the 501 patients in the analytic sample, 32.7% had started services with 1 or more of their referred resources within 4 weeks of the initial referral, and 63.3% had at least attempted to contact 1 referred resource, whether or not they were able to start services. Receiving a referral to resources that patients could access via phone call or drop-in visit, as opposed to resources that required additional appointments or applications prior to accessing services, was associated with increased odds (aOR 1.95, 95% CI 1.05, 3.61) of connection success, after adjusting for age, sex, race, ethnicity, education, number of social needs, and resource-related characteristics. This study did not find statistically significant associations between connection attempt and any variable included in adjusted analyses. Conclusion: These findings suggest that referral pathways may influence the success of patients’ connection to social needs resources, highlighting opportunities for more accessible solutions to addressing patients’ unmet social needs.

scholarly journals Improvement of the heart failure patient process for the prevention of new events through tele-education and continuous tele-optimization of the treatment by nursing staff

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Perez Serrano ◽  
CNP Carlos Nicolas Perez Garcia ◽  
DEV Daniel Enriquez Vazquez ◽  
MFE Marcos Ferrandez Escarabajal ◽  
JDD Jesus Diz Diaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Randomized Study ◽  
Primary Objective ◽  
Control Group ◽  
Close Monitoring ◽  
Chronic Patients ◽  
Face To Face ◽  
Funding Sources

Abstract Funding Acknowledgements Type of funding sources: None. Introduction patients with heart failure (HF) are especially vulnerable to SAR-CoV-2 infection especially due to their worse prognosis for this disease. Purpose to demonstrate that patients with HF will present similar health outcomes if their education and pharmacological treatment is optimised remotely by a nurse rather than through conventional care. Methods  A single-centre, observational, prospective, non-randomized study was carried out in which two groups were compared. The experimental group had most of their care provided virtually by a nurse who could optimise their medication according to the clinical guides whilst the control group received conventional face-to-face care. During a follow-up period of 6 months, patients included in the study have an initial face-to-face consultation with a cardiologist and an evaluation of the patient where the treatment objectives are established. The rest of the follow-ups were done through videoconsultation with the nurse every 15 days for 6 months where the neurohormonal treatment was optimized and an educational program was carried out with different cardiovascular educational topics. Results   Thirty-seven patients have been included. Sex: 30 men (81.0%) and 7 women (19.0%) Mean age: 67.9 years (12.8). Range 42-87 years. Etiology: 61.2% ischemic and 38.8% non-ischemic mean LVEF at inclusion = 30.2%. A total of 17 patients have completed the study: a 13% average improvement of FEVI, a reduction of NT-proBNP of and improvement in functional heart failure class. The primary objective was to compare the proportion of neurohormonal drugs prescribed, as well as the mean of the maximum doses reached in each after 6 months of follow-up, as well as mean ejection fraction, NYHA class and mean NT-proBNP (Table 1) Conclusions Telemedicine offers us valuable tools that allow us to take care of chronic patients, reducing exposure to the virus as much as possible. Efficient use of virtual tools and human resources makes close monitoring possible. Specialized nursing is a key element in the education, pharmacological optimization and monitoring of these patients. Parámetros analíticos Valores iniciales Valores finales NT-proBNP ( pg/mL) 3469,7 (± 4057,3) 1446,4 (± 1305,2) Creatinina (mg/dL) 1,10 (± 0,24) 1,12 (± 0,39) TFG (mL/min/1,73m2 ) 65,4 (± 21,2) 62,7 (± 23, 6) Potasio (meq /L) 4,5 (± 0,5) 4,6 (± 0,4) Fevi 29,4 % (± 7,2) FEVI 42,7 % (± 9,6)

Sign in / Sign up

Export Citation Format

Share Document