scholarly journals A Smart Home System for Information Sharing, Health Assessments, and Medication Self-Management for Older People: Protocol for a Mixed-Methods Study (Preprint)

2018 ◽  
Author(s):  
Margaretha Norell Pejner ◽  
Wagner Ourique de Morais ◽  
Jens Lundström ◽  
Hélène Laurell ◽  
Ingela Skärsäter

BACKGROUND Older adults often want to stay in a familiar place, such as their home, as they get older. This so-called aging in place, which may involve support from relatives or care professionals, can promote older people’s independence and well-being. The combination of aging and disease, however, can lead to complex medication regimes and difficulties for care providers in correctly assessing the older person's health. In addition, the organization of health care is fragmented, which makes it difficult for health professionals to encourage older people to participate in their own care. It is also a challenge to perform adequate health assessments and to engage in appropriate communication between health care professionals. OBJECTIVE The purpose of this paper is to describe the design for an integrated home-based system that can acquire and compile health-related evidence for guidance and information-sharing among care providers and care receivers in order to support and promote medication self-management among older people. METHODS The authors used a participatory design approach for this mixed-methods project, which was divided into four phases. Phase I, Conceptualization, consists of the conceptualization of a system to support medication self-management, objective health assessments, and communication between health care professionals. Phase II, Development of a System, consists of building and bringing together the conceptualized systems from Phase I. Phase III, Pilot Study, and Phase IV, Full-Scale Intervention, are described briefly. RESULTS Participants in Phase I were people who were involved in some way in the care of older adults and included older adults themselves, relatives of older adults, care professionals, and industrial partners. With input from Phase I participants, we identified two relevant concepts for promoting medication self-management, both of which related to systems that participants believed could provide guidance for the older adults themselves, relatives of older adults, and care professionals. The systems will also encourage information-sharing between care providers and care receivers. The first is the concept of the Intelligent Age-Friendly Home (IAFH), defined as an integrated residential system that evolves to sense, reason, and act in response to individuals’ needs, preferences, and behaviors as these change over time. The second concept is the Medication safety, Objective assessments of health-related behaviors, and Personalized medication reminders (MedOP) system, a system that would be supported by the IAFH, and which consists of three related components: one that assesses health behaviors, another that communicates health data, and a third that promotes medication self-management. CONCLUSIONS The participants in this project were older adults, relatives of older adults, care professionals, and our industrial partners. With input from the participants, we identified two main concepts that could comprise a system for health assessment, communication, and medication self-management: the IAFH and the MedOP system. These concepts will be tested in this study to determine whether they can facilitate and promote medication self-management among older people. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12447

2020 ◽  
Author(s):  
Inga Hunter ◽  
Phoebe Elers ◽  
Caroline Lockhart ◽  
Hans Guesgen ◽  
Amardeep Singh ◽  
...  

BACKGROUND Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. OBJECTIVE The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. METHODS Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. RESULTS The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. CONCLUSIONS The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.


10.2196/24157 ◽  
2020 ◽  
Vol 8 (12) ◽  
pp. e24157
Author(s):  
Inga Hunter ◽  
Phoebe Elers ◽  
Caroline Lockhart ◽  
Hans Guesgen ◽  
Amardeep Singh ◽  
...  

Background Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. Objective The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. Methods Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. Results The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. Conclusions The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.


Author(s):  
Samuel O Bolarinde ◽  

Background of the study: Smartphones medically related applications are quickly becoming one of the main tools for accessing clinical information among health care professionals. Aim of Study: This study assessed the perception of patients on usage of smartphones by health care professionals during clinic hours. Methodology: The study recruited 185 patients. Data on demographic characteristics and perception of patients on the use of smartphones for medical information were obtained using a self-administered questionnaire. Data were summarized using a descriptive statistics and inferential statistics of Chi square. Alpha level was set at 0.005 Results: 76 Males, 109 Females participated in this study. 67.6% (125) own a smartphones. 34.6% (64) have seen health care professionals using smartphones during clinic hours, 28.1% (18) had their health care providers explain to them reasons for using smartphone. 34.1% (63) agreed it was unprofessional for health care provider to use smartphone during clinic, 33.5% (62) disagreed, 32.4% (60) were undecided. No association observed between respondents’ age (χ2= 12.00, p= 0.606), educational qualification (χ2= 8.501, p= 0.075) and responses to the statement that use of smartphones by health care professional was unprofessional. Conclusion: Although one third of the respondents agreed that usage of smartphones by healthcare professionals in the clinic while attending to patients was unprofessional however, usage of smartphone for health related information by health care professionals during clinic hours should be with caution to avoid losing the confidence repose in them by their patients.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S296-S296
Author(s):  
Chrysanne Karnick ◽  
Ruth Manna ◽  
Natalie Gangai ◽  
Rosario Costas Muniz ◽  
Beatriz Korc-Grodzicki

Abstract Older adults can reduce fall risk in their homes and the community. Health care professionals (HCP) have a role in preventing falls. An interprofessional team of HCPs at a comprehensive cancer center created and delivered educational workshops to increase knowledge about falls prevention. Educational workshops were provided in community centers, libraries, places of worship and at local hospitals to medically underserved, diverse community members, caregivers and HCP. An Occupational (OT) and Physical Therapist (PT) taught three workshops together and the OT taught nine workshops. Workshops included fall prevention, home modifications, safe patient handling (SPH), and the role of OT/ PT in geriatric oncology care. Practical and culturally competent steps were emphasized, with translation of written materials and live interpretation provided as appropriate. Knowledge increase was assessed, and post-session qualitative data was collected. The mean age of community members was 68 years, of nurses was 42, and of caregivers 63. A majority of participants were female. 220 older adults completed surveys, 40 caregivers, and 11 registered nurses. The Falls Prevention workshops with unmatched (n=79) and matched data (n=140) showed significant improvements in knowledge [t(135)=-3.33, p<0.001; t(139)=-4.03, p<.001; respectively). Caregivers who participated in the SPH workshop improved their learning for the unmatched (n=12) and matched data (n=28) after participating in the workshops [t(22)=-3.50, p=.002; t(27)=-3.95, p<.001] respectively. For nurses, the change in scores from pre (M=.56) to post scores (M=.73) were significant (t=-2.76, df=10, p=.02). Caregivers and HCPs benefit from continued education to promote safer, holistic care for family members and patients.


10.2196/12447 ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. e12447 ◽  
Author(s):  
Margaretha Norell Pejner ◽  
Wagner Ourique de Morais ◽  
Jens Lundström ◽  
Hélène Laurell ◽  
Ingela Skärsäter

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S316-S317
Author(s):  
Hyunkyoung Oh ◽  
Yura Lee ◽  
Wonchan Choi ◽  
Zhi Zheng

Abstract This abstract introduces an ongoing research project that aimed to develop a patient-centered self-management program using health information and technologies for older adults with hypertension and diabetes. The purpose of the project in the first phase was to better understand challenges in self-management faced by older adults with both conditions. A semi-structured and face-to-face interview was conducted to explore the challenges in self-management of the target population living in Milwaukee areas, Wisconsin. Audio recordings were transcribed in verbatim; transcripts were analyzed; and themes were identified. A total of six individuals participated in this study by January 2019. Their age ranged from 56 to 75. Four of them were female; five of them were African Americans; and one was Caucasian. All participants reported more than two additional conditions that were arthritis, cardiovascular diseases, pain, kidney diseases, respiratory diseases, and depression. Most participants were self-managing their conditions mainly by taking prescribed medications. Several themes were emerged as challenges to self-management: monitoring blood pressure and glucose, engagement in physical activity, and healthy eating. Among these, participants reported healthy eating as the most difficult self-managing activity. Majority of participants expressed the need for physical activity support due to pain and/or vision problems known as one of diabetic complications. Understanding challenges and needs of a specific population is the first step for health care providers to support self-management of the patients appropriately. The results of this preliminary study will help health care providers develop effective self-management programs for older adults with both conditions.


10.2196/18073 ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. e18073 ◽  
Author(s):  
Tejal Patel ◽  
Jessica Ivo ◽  
Sadaf Faisal ◽  
Aidan McDougall ◽  
Jillian Carducci ◽  
...  

Background A decreased capacity to self-manage medications results in nonadherence, medication errors, and drug-related problems in older adults. Previous research identified 80 electronic medication adherence products available to assist patients with self-management of medications. Unfortunately, the usability and workload of these products are unknown. Objective This study aimed to examine the usability and workload of a sample of electronic medication adherence products. Methods In a prospective, mixed methods study, a sample of older adults, health care professionals, and caregivers tested the usability and workload of 21 electronic medication adherence products. Each participant tested 5 products, one at a time, after which they completed the system usability scale (SUS) and NASA-task load index (NASA-TLX), instruments that measure the usability and workload involved in using a product. Higher SUS scores indicate more user-friendliness, whereas lower NASA-TLX raw scores indicate less workload when using a product. Results Electronic medication adherence products required a mean of 12.7 steps (range 5-20) for the appropriate use and took, on average, 15.19 min to complete the setup tasks (range 1-56). Participants were able to complete all steps without assistance 55.3% of the time (103 out of the 186 tests were completed by 39 participants; range 0%-100%). The mean SUS and NASA-TLX raw scores were 52.8 (SD 28.7; range 0-100) and 50.0 (SD 25.7; range 4.2-99.2), respectively, revealing significant variability among the electronic medication adherence products. The most user-friendly products were found to be TimerCap travel size (mean 78.67, SD 15.57; P=.03) and eNNOVEA Weekly Planner with Advanced Auto Reminder (mean 78.13, SD 14.13; P=.049) as compared with MedReady 1700 automated medication dispenser (mean 28.63, SD 21.24). Similarly, MedReady (72.92, SD 18.69) was found to be significantly more work intensive when compared with TimerCap (29.35, SD 20.35; P=.03), e-pill MedGlider home medication management system (28.43, SD 20.80; P=.02), and eNNOVEA (28.65, SD 14.97; P=.03). The e-pill MedTime Station automatic pill dispenser with tipper (71.77, SD 21.98) had significantly more workload than TimerCap (P=.04), MedGlider (P=.03), and eNNOVEA (P=.04). Conclusions This study demonstrated that variability exists in the usability and workload of different electronic medication adherence products among older adults, caregivers, and clinicians. With few studies having investigated the usability and workload of electronic medication adherence products, no benchmarks exist to compare the usability and workload of these products. However, our study highlights the need to assess the usability and workload of different products marketed to assist with medication taking and provides guidance to clinicians regarding electronic medication adherence product recommendations for their patients. Future development of electronic medication adherence products should ensure that the target populations of patients are able to use these products adequately to improve medication management.


2009 ◽  
Vol 19 (2) ◽  
pp. 87-101 ◽  
Author(s):  
Danielle Harari

SummaryFaecal incontinence in older people is a distressing and socially isolating symptom and increases the risk of morbidity, mortality and dependency. Many older individuals with faecal incontinence will not volunteer the problem to their general practitioner or nurse and, regrettably, health care providers do not routinely enquire about the symptom. Even when older people are noted by health care professionals to have faecal incontinence, the condition is often managed passively, especially in the long-term care setting where it is most prevalent. The importance of identifying treatable causes of faecal incontinence in older people, rather than just managing passively, is strongly emphasized in national and international guidance, but audit shows that adherence to such guidance is generally poor. This article describes epidemiology, causes, assessment, diagnosis and treatment of faecal incontinence in older people.


Author(s):  
Digo Chakraverty ◽  
Annika Baumeister ◽  
Angela Aldin ◽  
Tina Jakob ◽  
Ümran Sema Seven ◽  
...  

Health literacy can be described as a complex process shaped by individual resources and preferences and by the nature and quality of health-related information people encounter. The main objective of this study was to explore the views of health care professionals on how gender as a personal determinant of health literacy affected their interactions with migrant patients. The interrelated challenges, needs and applied solutions were analyzed from a health literacy perspective. Five focus group discussions with health care professionals working with migrants (n = 31) were conducted in Cologne, Germany, audio recorded, transcribed and analyzed by qualitative content analysis. Gender-specific aspects, such as the gender of health care providers as a factor, were portrayed above all in relation to patients from Turkey and Arab countries regarding access to and understanding of health-related information. These statements exclusively represent the possibly biased or assumptions-based perspectives of health care professionals on their migrant patients and were made against the background of a systemic lack of time and the challenge of overcoming language barriers. Especially in this context, reducing time pressure and improving communication in the treatment setting may be to the benefit of all actors within healthcare.


2019 ◽  
Vol 34 (s1) ◽  
pp. s17-s17
Author(s):  
Peter Patel ◽  
James Kingsland ◽  
Virginia Murray ◽  
James O’Brien ◽  
Annapurna Sen ◽  
...  

Introduction:Both India and Nepal are prone to a wide range of natural and man-made disasters. Almost 85% of India’s area is vulnerable to one or more hazards, and more than 80% of the total population of Nepal is at risk of natural hazards. In terms of the number of people affected in reported disastrous events, India is in the top 10 and Nepal is in the top 20 globally. Over the last two decades, India and Nepal have taken steps to establish their respective National Disaster Management organizations, which provide essential disaster responses. However, key gaps still remain in trained clinical capacity for managing impacts from various disasters. Our review of the region has shown that large parts of the population suffer injuries, diseases, disabilities, psychosocial, and other health-related problems from disasters.Aim:Develop disaster medicine clinical capacity to reduce morbidities and mortalities from disasters.Methods:Independent published data and work undertaken by the lead author in various disasters in India and Nepal since 1993 formed the basis of establishing the Faculty of Disaster Medicine for South Asia. The Faculty of Disaster Medicine - India and Nepal (FDMIN) was launched from Pune in March 2015. This initiative is supported by the National Association of Primary Care (UK), Public Health England, Faculty of Pre-hospital Care of Royal College of Surgeons - Edinburgh and CRIMEDIM (Novara) - Italy.Discussion:FDMIN has international expert advisors and has outlined 16 modules training curriculum for health care professionals. FDMIN currently has partnerships for teaching disaster medicine program with 3 medical universities and 12 major health care providers. Six pilot training programmes have been conducted in Pune, Delhi, Chennai, and Kochin. Work is underway to submit an application to the Indian regulatory bodies for approval to establish a post-graduate diploma and Master’s for Disaster Medicine.


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