scholarly journals Patient Adherence to a Mobile Phone–Based Heart Failure Telemonitoring Program: A Longitudinal Mixed-Methods Study (Preprint)

2018 ◽  
Author(s):  
Patrick Ware ◽  
Mala Dorai ◽  
Heather J Ross ◽  
Joseph A Cafazzo ◽  
Audrey Laporte ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mixed Methods ◽  
Mobile Phone ◽  
Disease Severity ◽  
Patient Adherence ◽  
Age Groups ◽  
Ease Of Use ◽  
Peace Of Mind ◽  
Program Enrollment ◽  
Over Time

BACKGROUND Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients consistently adhere to taking prescribed home readings. OBJECTIVE The objectives of this study were to (1) quantify the degree to which patients adhered to taking prescribed home readings in the context of a mobile phone–based TM program and (2) explain longitudinal adherence rates based on the duration of program enrollment, patient characteristics, and patient perceptions of the TM program. METHODS A mixed-methods explanatory sequential design was used to meet the 2 research objectives, and all explanatory methods were guided by the unified theory of acceptance and use of technology 2 (UTAUT2). Overall adherence rates were calculated as the proportion of days patients took weight, blood pressure, heart rate, and symptom readings over the total number of days they were enrolled in the program up to 1 year. Monthly adherence rates were also calculated as the proportion of days patients took the same 4 readings over each 30-day period following program enrollment. Next, simple and multivariate regressions were performed to determine the influence of time, age, sex, and disease severity on adherence rates. Additional explanatory methods included questionnaires at 6 and 12 months probing patients on the perceived benefits and ease of use of the TM program, an analysis of reasons for patients leaving the program, and semistructured interviews conducted with a purposeful sampling of patients (n=24) with a range of adherence rates and demographics. RESULTS Overall average adherence was 73.6% (SD 25.0) with average adherence rates declining over time at a rate of 1.4% per month (P<.001). The multivariate regressions found no significant effect of sex and disease severity on adherence rates. When grouping patients’ ages by decade, age was a significant predictor (P=.04) whereby older patients had higher adherence rates over time. Adherence rates were further explained by patients’ perceptions with regard to the themes of (1) performance expectancy (improvements in HF management and peace of mind), (2) effort expectancy (ease of use and technical issues), (3) facilitating conditions (availability of technical support and automated adherence calls), (4) social influence (support from family, friends, and trusted clinicians), and (5) habit (degree to which taking readings became automatic). CONCLUSIONS The decline in adherence rates over time is consistent with findings from other studies. However, this study also found adherence to be the highest and most consistent over time in older age groups and progressively lower over time for younger age groups. These findings can inform the design and implementation of TM interventions that maximize patient adherence, which will enable a more accurate evaluation of impact and optimization of resources.

scholarly journals Patient Adherence to a Mobile Phone–Based Heart Failure Telemonitoring Program: A Longitudinal Mixed-Methods Study (Preprint)

10.2196/13259 ◽  
2018 ◽  
Author(s):  
Patrick Ware ◽  
Mala Dorai ◽  
Heather J Ross ◽  
Joseph A Cafazzo ◽  
Audrey Laporte ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mixed Methods ◽  
Mobile Phone ◽  
Patient Adherence ◽  
Mixed Methods Study

scholarly journals Teleconsultation Using Mobile Phones for Diagnosis and Acute Care of Burn Injuries Among Emergency Physicians: Mixed-Methods Study (Preprint)

2018 ◽  
Author(s):  
Anders Klingberg ◽  
Lee Alan Wallis ◽  
Marie Hasselberg ◽  
Po-Yin Yen ◽  
Sara Caroline Fritzell
Keyword(s):  
Mixed Methods ◽  
Mobile Phone ◽  
Acute Care ◽  
Clinical Findings ◽  
Ease Of Use ◽  
Burn Injuries ◽  
Referral Process ◽  
Think Aloud ◽  
Burn Care ◽  
Medical Referrals

BACKGROUND The referral process in acute care remains challenging in many areas including burn care. Mobile phone apps designed explicitly for medical referrals and consultations could streamline the referral process by using structured templates and integrating features specific to different specialties. However, as these apps are competing with commercial chat services, usability becomes a crucial factor for successful uptake. OBJECTIVE The aim of this study was to assess the usability of a mobile phone app for remote consultations and referrals of burn injuries. METHODS A total of 24 emergency doctors and 4 burns consultants were recruited for the study. A mixed-methods approach was used including a usability questionnaire and a think-aloud interview. Think-aloud sessions were video-recorded, and content analysis was undertaken with predefined codes relating to the following 3 themes: ease of use, usefulness of content, and technology-induced errors. RESULTS The users perceived the app to be easy to use and useful, but some problems were identified. Issues relating to usability were associated with navigation, such as scrolling and zooming. Users also had problems in understanding the meaning of some icons and terminologies. Sometimes, some users felt limited by predefined options, and they wanted to be able to freely express their clinical findings. CONCLUSIONS We found that users faced problems mainly with navigation when the app did not work in the same way as the other apps that were frequently used. Our study also resonates with previous findings that when using standardized templates, the systems should also allow the user to express their clinical findings in their own words.

P6340Mortality and prognostic factors in dilated cardiomyopathy versus ischaemic heart disease in patients with heart failure with reduced ejection fraction - a Swedish population-based study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Silverdal ◽  
E Bollano ◽  
H Sjoland ◽  
A Pivodic ◽  
U Dahlstrom ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Ischaemic Heart Disease ◽  
Age Groups ◽  
Reduced Ejection Fraction ◽  
Probability Of Survival ◽  
Patients With Heart Failure ◽  
Over Time

Abstract Background In heart failure with left ventricular ejection fraction reduction <40% (HFrEF) the increased mortality in patients with underlying ischaemic heart disease (IHD) compared to multi-aetiological non-ischaemic HFrEF is established. The prognostic difference over time in comparison with dilated cardiomyopathy (DCM) is less clear. Purpose To evaluate the difference in mortality between IHD and DCM in HFrEF, overall, in specific subgroups and over time. Methods By applying multivariable Cox regression analyses on Swedish Heart Failure Registry data from the years 2000 to 2012 (including 51,060 patients), the incidence of mortality in 8,982 patients with non-valvular clinical IHD-HFrEF was compared to 2,220 patients with DCM-HFrEF overall and for subgrouping variables of age category, sex and EF group (<30% and 30–39%), adjusted for additional 23 baseline variables. Results The overall mortality was higher in IHD-HFrEF with the crude mortality of 42.1% and the event rate 15.4 (95% confidence interval [CI]: 14.9 - 15.9) per 100 person years compared with 19.4% and 5.5 (95% CI: 5.0–6.1) in DCM-HFrEF. The probability of survival in IHD-HFrEF was lower than in DCM-HFrEF (Figure). After multivariable adjustment the risk for mortality in IHD-HFrEF remained increased with a hazard ratio (HR) of 1.34 (95% CI: 1.18–1.50). The adjusted HR was higher in all groups of age <80 years and in both sexes, with a significantly higher risk in women than in men (HR 1.85 vs 1.22, p for interaction = 0.002). Overall, HR was increased regardless of EF group but analyses by both age group and EF group revealed significantly increased mortality in EF <30% only for age groups <80 years. No significant temporal trend was seen between IHD-HFrEF and DCM-HFrEF. Probability of survival Conclusions In patients with heart failure and reduced ejection fraction, ischaemic heart disease compared to dilated cardiomyopathy was associated with increased mortality in all age groups below 80 years of age, throughout the 13-year study period. Acknowledgement/Funding The Swedish Heart-Lung Foundation. The regional ALF agreement between Västra Götalandsregionen and University of Gothenburg (ALFGBG-72196, prof.Fu)

Abstract P058: Risk Of Heart Failure In Type 2 Diabetes Has Decreased Over Time - A Danish Nationwide Cohort Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Brian Schwartz ◽  
Vasan S Ramachandran ◽  
Christian Torp-Pedersen ◽  
Morten Schou ◽  
Asya Lyass ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
General Population ◽  
Cumulative Incidence ◽  
Age Groups ◽  
Cumulative Risk ◽  
Lifetime Risk ◽  
Risk Of Death ◽  
Over Time

Introduction: Although type 2 diabetes (T2DM) is one of the strongest risk factors for heart failure (HF), there is limited data on contemporary lifetime risk estimates in this segment. Incident HF appears to be decreasing in the general population, but little is known how the risk has changed over time in patients with T2DM. The increasing prevalence and rapidly evolving management of T2DM has furthered interest in the epidemiological relationship between HF and T2DM. We therefore sought to investigate the lifetime risk of HF in people with T2DM and how the long term risk of HF has changed over time in patients with T2DM. Hypothesis: We assessed the hypothesis that there would be a statistically significant reduction in the ten- year risk of HF among patients with T2DM over time in all age groups except the youngest (<50 years old), mimicking trends in the general population and that men would have a higher cumulative risk than women. Methods: We employed the Danish nationwide databases which included information on all Danish citizens’ hospitalizations, outpatient visits, and medication use since 1978 (diagnoses) and 1995 (medications). Using this data, we calculated the cumulative incidence of HF among patients with T2DM who were free from HF at age 30, 40, 50, 60, and 70 years, respectively. We censored people at time of emigration or at Dec 31, 2017 and we used Aalen-Johnsen estimators to adjust for the competing risk of death. Results: A total of 473,685 patients (47% women) had a diagnosis of T2DM between Jan 1, 1995 and Dec 31, 2017. Of those who were free from HF before T2DM onset, 21,030 were diagnosed before the age of 30; 33,786 before age 40; 55,537 before 50 years of age; 85,108 before age 60; and 98,631 before age 70. During follow-up, 48,026 (10%) were diagnosed with HF and 133,561 were censored for death. The cumulative life-time risk of developing HF among people with diabetes at age 50 was 24% (95% CI 21-27%) in females and 27% (25-29%) in men, p for difference <0.0001. Among patients aged 50 years, the 10-year risk of HF decreased from 12.2% (1995-2005) to 9.6% (2005- 2015), p<0.0001. Similar 10-year risks decreased for those free from HF at age 60 year (from 19.0% in 1995-2005 to 13.3% in 2005-2015, p<0.0001) and 70 years old (from 22.2% to 17.1% between 1995-2005 and 2005-2015, p<0.0001). Conclusion: The lifetime risk of HF among patients with T2DM exceeds 1 in 4 for both men and women. There was, however, a decrease in ten-year cumulative incidence of HF over time among patients with T2DM in all age groups.

scholarly journals Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study (Preprint)

2018 ◽  
Author(s):  
Leanne L Lefler ◽  
Sarah J Rhoads ◽  
Melodee Harris ◽  
Ashley E Funderburg ◽  
Sandra A Lubin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Mixed Methods ◽  
Mobile Health ◽  
Call Center ◽  
Standard Care ◽  
Ease Of Use ◽  
Self Management ◽  
Limited Information ◽  
Post Intervention

BACKGROUND Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. OBJECTIVE This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. METHODS We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. RESULTS We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. CONCLUSIONS mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF.

scholarly journals Patients’ perceptions on the usability of the SurePal™ self-injection device for Omnitrope®: a questionnaire-based observational study conducted in paediatric patients in France

2017 ◽  
Vol 8 (9) ◽  
pp. 129-137 ◽  
Author(s):  
Régis Coutant ◽  
Clémentine Dupuis ◽  
Patricia Pigeon ◽  
Phillipe Rebaud
Keyword(s):  
Patient Adherence ◽  
Memory Function ◽  
Recombinant Human Growth Hormone ◽  
Age Groups ◽  
Ease Of Use ◽  
Injection System ◽  
Cross Sectional Survey ◽  
Growth Disturbances ◽  
Paediatric Patients ◽  
Pretreated Patients

Background: A questionnaire-based survey was conducted to evaluate attitudes towards a reusable self-injection system, SurePal™, among paediatric patients with growth disturbances who were prescribed treatment with somatropin (Omnitrope®) as part of routine clinical practice. Methods: This cross-sectional survey was incorporated into the multinational, multi-centre, noninterventional PAtients TReated with Omnitrope® (PATRO) Children study. Questions were mainly focused on five areas: the attractiveness of SurePal™; training received; use of the device; opinion of the low-drug wastage system; experience compared with previous devices used (among pretreated patients). Results: Final results from participants in France are reported. Completed questionnaires were returned by 409 participants. Most patients (55%) were male and 89% were recombinant human growth hormone (rhGH)-treatment naïve. Around 57% of children completed the questionnaire by themselves, while 43% had help from a family member/other person. The mean (standard deviation) age of all participants was 11.3 (3.6) years, and most patients were aged 10–12 years ( n = 126) or 13–15 years ( n = 117). Overall, 86% of patients reported that preparing SurePal™ for injection was easy/very easy. Similarly, 83% reported that performing injections with SurePal™ was easy/very easy. The attractiveness of SurePal™ was rated as good/excellent by the majority (85%) of patients; this proportion was similarly high (> 80%) across all age groups. The dose-memory function was rated as helpful/very helpful by 54% of patients. Of the 174 patients who reported using the low drug-waste feature, 90% found it to be helpful/very helpful. Among the 24 pretreated patients, 17 reported that SurePal™ was better/much better than their previous device. Conclusions: This questionnaire-based survey conducted in a large cohort of paediatric patients with growth disturbances from France confirms the ease of use of SurePal™ to support daily administration of Omnitrope® across all age groups. The demonstrated acceptability of the device may help to improve patient adherence to long-term daily treatment with rhGH.

Profile Variables as a Basis for Segmenting Markets: A Guesthouse Perspective

2018 ◽  
Vol 10 (3(J)) ◽  
pp. 60-73
Author(s):  
Felix Amoah ◽  
Laetitia Radder ◽  
Marlé Van Eyk
Keyword(s):  
Customer Satisfaction ◽  
Market Segmentation ◽  
Age Groups ◽  
Education Level ◽  
Peace Of Mind ◽  
Gender Education

Marketers frequently use profile variables to differentiate between groups of customers. The question arises as to whether these variables can also be used by guesthouses in segmenting their market. Segmentation helps marketers better meet customers’ needs and leads to increased customer satisfaction. This study determines whether significant differences exist in visitors’ perceptions of experience realms, given their age, gender, education level, and prior visits to the guesthouse, and whether these variables can be used in segmenting the market. The analysis of data provided by 541 guests who stayed at 51 guesthouses in Ghana shows that visitors from different age groups differ significantly with respect to the experience realms, except for Escape. Prior visits to the guesthouse resulted in significant differences in perceptions of Entertainment, Escape, Atmospherics, Peace of mind, and Efficiency, while education resulted in different perceptions of the Entertainment realm . The results can assist guesthouse managers in Ghana in allocating resources to segments that would yield maximum returns in Ghana.

scholarly journals An analysis of users’ preferences on learning management systems: a case on German versus Spanish students

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Hasan Tinmaz ◽  
Jin Hwa Lee
Keyword(s):  
Information And Communication Technologies ◽  
Age Groups ◽  
Learning Management Systems ◽  
Content Management ◽  
Ease Of Use ◽  
Management Systems ◽  
Smart Learning ◽  
School Year ◽  
Design For All ◽  
Learning Management

Abstract The recent advancements in information and communication technologies have altered instructional contexts and re-shaped them into smart learning environments. One of the most common practices of these environments are learning management systems (LMS) where the learners and instructors utilize a software platform to fulfill, support and manage instructional activities around predefined objectives. Successful implementations of LMS have brought a variety on its usage from different cultures, genders, age groups or schooling levels. Hence, this study focuses on understanding the role of culture on LMS design, in along with the effects of gender, age and school year variables. The study participants were German (n = 83) and Spanish (n = 83) university students attending a fully online course offered by a South Korean university. At the end of the course, the students were asked to fulfill a survey on effective LMS design by pointing which features of LMS were more important for them. The survey included twenty questions on four major design factors; content management (six items), ease of use (five items), communication within LMS (four item) and screen design (five items). The dataset was analyzed by non-parametric statistical techniques around four variables on four dimensions (and their related survey questions). The most important result was insufficiency of one unique LMS design for all students which demonstrates the necessity of student demographics tailored smart systems. Additionally, age and gender variables were not making significant differences on LMS design as much as culture and school year variables. The study also revealed that while German students would appreciate goal-oriented individual learning, Spanish students would value process-oriented group learning with active communication. Furthermore, many features of LMS were highly valued by the freshman students more than other levels. The paper discusses these variables with possible explanations from the literature and depicts implementations for future design practices.

scholarly journals Temporal trends in outcome and patient characteristics in dilated cardiomyopathy, data from the Swedish Heart Failure Registry 2003–2015

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Helen Sjöland ◽  
Jonas Silverdal ◽  
Entela Bollano ◽  
Aldina Pivodic ◽  
Ulf Dahlström ◽  
...  
Keyword(s):  
Heart Failure ◽  
Dilated Cardiomyopathy ◽  
Temporal Trends ◽  
Physical Symptoms ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Continuous Change ◽  
Ventricular Ejection Fraction ◽  
Increased Risk ◽  
Over Time

Abstract Background Temporal trends in clinical composition and outcome in dilated cardiomyopathy (DCM) are largely unknown, despite considerable advances in heart failure management. We set out to study clinical characteristics and prognosis over time in DCM in Sweden during 2003–2015. Methods DCM patients (n = 7873) from the Swedish Heart Failure Registry were divided into three calendar periods of inclusion, 2003–2007 (Period 1, n = 2029), 2008–2011 (Period 2, n = 3363), 2012–2015 (Period 3, n = 2481). The primary outcome was the composite of all-cause death, transplantation and hospitalization during 1 year after inclusion into the registry. Results Over the three calendar periods patients were older (p = 0.022), the proportion of females increased (mean 22.5%, 26.4%, 27.6%, p = 0.0001), left ventricular ejection fraction was higher (p = 0.0014), and symptoms by New York Heart Association less severe (p < 0.0001). Device (implantable cardioverter defibrillator and/or cardiac resynchronization) therapy increased by 30% over time (mean 11.6%, 12.3%, 15.1%, p < 0.0001). The event rates for mortality, and hospitalization were consistently decreasing over calendar periods (p < 0.0001 for all), whereas transplantation rate was stable. More advanced physical symptoms correlated with an increased risk of a composite outcome over time (p = 0.0043). Conclusions From 2003 until 2015, we observed declining mortality and hospitalizations in DCM, paralleled by a continuous change in both demographic profile and therapy in the DCM population in Sweden, towards a less affected phenotype.

scholarly journals Dementia Caregiver Satisfaction and Utilization of a Telehealth App: Results From the FamTechCare Trial

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 149-149
Author(s):  
Kristine Williams ◽  
Clarissa Shaw ◽  
Yelena Perkhounkova ◽  
Maria Hein ◽  
Carissa Coleman
Keyword(s):  
Mixed Methods ◽  
Support Groups ◽  
Expert Panel ◽  
Video Recording ◽  
Ease Of Use ◽  
Attention Control ◽  
Caregiver Satisfaction ◽  
Dementia Caregiver ◽  
Severity Of Dementia ◽  
Person With Dementia

Abstract Technology can enhance support for families caring for persons with dementia but must be acceptable to be adopted. In the FamTechCare trial, caregivers used an app to videorecord care encounters that were reviewed by an expert panel who provided tailored feedback. The intervention reduced caregiver depression and improved caregiver competence. This mixed methods study reports caregiver satisfaction and utilization of the intervention and evaluation of the intervention by the expert panel. A convergent parallel mixed methods design was used to evaluate the satisfaction, usability, and feasibility of the intervention. Caregiver-person with dementia dyads were randomized to the FamTechCare video support or telephone attention control support groups. Caregivers completed a satisfaction survey at the completion of the 3-month trial. The number and duration of videos submitted and calls received by caregivers were used to evaluate utilization. Relationships between participant characteristics and satisfaction and utilization were evaluated. Feasibility and future directions for the intervention were assessed through interviews with the expert panel. The majority of caregivers in both groups reported benefits from participation. More FamTechCare caregivers found the interventionist support to be helpful (p=.001) and effective (p=.020) compared to attention control caregivers. FamTechCare caregivers of persons with more severe dementia were more likely to report that video recording intruded on their privacy (p=.050). Age, gender, education, dyad relationship, rural status, and type and severity of dementia were not associated with ratings of acceptability, ease of use, or intervention utilization. The expert panel rated FamTechCare as useful and identified adaptations to enhance feasibility.

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