International Journal of Environmental Research and Public Health

Editorial

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6 pages, 432 KiB

Open AccessEditorial

Special Issue on E-Health Services

by Rolf Wynn, Elia Gabarron, Jan-Are K. Johnsen and Vicente Traver

Int. J. Environ. Res. Public Health 2020, 17(8), 2885; https://doi.org/10.3390/ijerph17082885 - 22 Apr 2020

Cited by 28 | Viewed by 4244

Abstract

The importance of e-health to citizens, patients, health providers, governments, and other stakeholders is rapidly increasing. E-health services have a range of advantages. For instance, e-health may improve access to services, reduce costs, and improve self-management. E-health may allow previously underserved populations to [...] Read more.

The importance of e-health to citizens, patients, health providers, governments, and other stakeholders is rapidly increasing. E-health services have a range of advantages. For instance, e-health may improve access to services, reduce costs, and improve self-management. E-health may allow previously underserved populations to gain access to services. Services utilizing apps, social media, or online video are rapidly gaining ground in most countries. In this special issue, we present a range of up-to-date studies from around the world, providing important insights into central topics relating to e-health services. Full article

(This article belongs to the Special Issue E-Health Services)

Research

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17 pages, 2581 KiB

Open AccessArticle

Adaptation of TECCU App Based on Patients´ Perceptions for the Telemonitoring of Inflammatory Bowel Disease: A Qualitative Study Using Focus Groups

by Javier Del Hoyo, Pilar Nos, Raquel Faubel, Guillermo Bastida, Diana Muñoz, Elena Valero-Pérez, Alejandro Garrido-Marín, Pablo Bella, Beatriz Peña, Claudia Savini and Mariam Aguas

Int. J. Environ. Res. Public Health 2020, 17(6), 1871; https://doi.org/10.3390/ijerph17061871 - 13 Mar 2020

Cited by 5 | Viewed by 3538

Abstract

Background: Despite the continuous adaptation of eHealth systems for patients with inflammatory bowel disease (IBD), a significant disconnection persists between users and developers. Since non-adherence remains high, it is necessary to better understand the patients’ perspective on telemonitoring for IBD. Accordingly, this study [...] Read more.

Background: Despite the continuous adaptation of eHealth systems for patients with inflammatory bowel disease (IBD), a significant disconnection persists between users and developers. Since non-adherence remains high, it is necessary to better understand the patients’ perspective on telemonitoring for IBD. Accordingly, this study aimed to adapt the TECCU telemonitoring app to the preferences and needs of IBD patients. Methods: A qualitative study was carried out using successive focus groups of IBD patients. Meetings were audio-recorded and a thematic analysis was employed until data saturation was achieved. The first group included patients who had used the TECCU App in a pilot clinical trial, and subsequent meetings included patients with Crohn’s disease and ulcerative colitis recruited from the Spanish Confederation of patient associations. The information collected at each meeting guided consecutive changes to the platform. Results: Data saturation was reached after three focus groups involving a total of 18 patients. Three main themes emerged: (1) platform usability, (2) the communication process, and (3) platform content. All participants indicated that TECCU is easy to use, permitting continuous and personalized feedback. According to patients´ perspectives, the platform was adapted to foster a flexible follow-up and shared decision-making using open and safe communication networks. Many participants appreciated the educational elements and, consequently, the app was connected to reliable and continuously updated webpages. Conclusions: IBD patients valued the usability and personalized monitoring offered by the TECCU App. Improvements in the messaging system and continuously updated educational content were introduced to address patients´ needs and favor their engagement. Full article

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14 pages, 2861 KiB

Open AccessArticle

Analysis of Network Structure and Doctor Behaviors in E-Health Communities from a Social-Capital Perspective

by Zhigang Li and Xu Xu

Int. J. Environ. Res. Public Health 2020, 17(4), 1136; https://doi.org/10.3390/ijerph17041136 - 11 Feb 2020

Cited by 17 | Viewed by 3427

Abstract

In tandem with internet development and widespread social media use, e-health communities have begun to emerge in recent years. These communities allow doctors to access forums anywhere, anytime, seek or exchange medical information online, find literature, and so on. This is convenient and [...] Read more.

In tandem with internet development and widespread social media use, e-health communities have begun to emerge in recent years. These communities allow doctors to access forums anywhere, anytime, seek or exchange medical information online, find literature, and so on. This is convenient and can solve some problems for doctors while also promoting doctor communication. This study collected and collated 102 doctors in the “Lilac Forum” and used social network tools to quantify the overall network density, centrality, core–periphery structure, and structural hole indicators of doctors’ information exchange from a social-capital perspective. The results showed that the frequency of interaction between doctors differed because of differences in the identities and participation of doctors in the e-health community. The density of the doctors’ information dissemination network (0.228) and network cohesion (0.610) were relatively high. Thus, the doctors were more closely connected, and information was easily spread. At the same time, doctors with higher professional titles had obvious location characteristics, familiarity and trust, and high levels of reciprocity. They could obtain redundant information in the network and were more likely to influence the behavior of other doctors. This study’s findings provide support for improving information exchange among doctors in e-health communities and improving the service levels of the platforms. Full article

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11 pages, 3860 KiB

Open AccessArticle

Cancer Prevention Using Machine Learning, Nudge Theory and Social Impact Bond

by Daitaro Misawa, Jun Fukuyoshi and Shintaro Sengoku

Int. J. Environ. Res. Public Health 2020, 17(3), 790; https://doi.org/10.3390/ijerph17030790 - 28 Jan 2020

Cited by 22 | Viewed by 7642

Abstract

There have been prior attempts to utilize machine learning to address issues in the medical field, particularly in diagnoses using medical images and developing therapeutic regimens. However, few cases have demonstrated the usefulness of machine learning for enhancing health consciousness of patients or [...] Read more.

There have been prior attempts to utilize machine learning to address issues in the medical field, particularly in diagnoses using medical images and developing therapeutic regimens. However, few cases have demonstrated the usefulness of machine learning for enhancing health consciousness of patients or the public in general, which is necessary to cause behavioral changes. This paper describes a novel case wherein the uptake rate for colorectal cancer examinations has significantly increased due to the application of machine learning and nudge theory. The paper also discusses the effectiveness of social impact bonds (SIBs) as a scheme for realizing these applications. During a healthcare SIB project conducted in the city of Hachioji, Tokyo, machine learning, based on historical data obtained from designated periodical health examinations, digitalized medical insurance receipts, and medical examination records for colorectal cancer, was used to deduce segments for whom the examination was recommended. The result revealed that out of the 12,162 people for whom the examination was recommended, 3264 (26.8%) received it, which exceeded the upper expectation limit of the initial plan (19.0%). We conclude that this was a successful case that stimulated discussion on potential further applications of this approach to wider regions and more diseases. Full article

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13 pages, 451 KiB

Open AccessArticle

Exploring the Impact of the Rational Antibiotic Use System on Hospital Performance: The Direct Effect and the Spillover Effect

by Shanshan Guo, Wenchao Du, Shuqing Chen, Xitong Guo and Xiaofeng Ju

Int. J. Environ. Res. Public Health 2019, 16(18), 3463; https://doi.org/10.3390/ijerph16183463 - 18 Sep 2019

Cited by 2 | Viewed by 2870

Abstract

Irrational antibiotic usage not only causes an increase in antibiotic-borne diseases, but also inflicts pain on patients, as a result of inappropriate treatment. In order to resolve the hazards caused by irrational antibiotic usage, a kind of e-health service, the Rational Antibiotic Use [...] Read more.

Irrational antibiotic usage not only causes an increase in antibiotic-borne diseases, but also inflicts pain on patients, as a result of inappropriate treatment. In order to resolve the hazards caused by irrational antibiotic usage, a kind of e-health service, the Rational Antibiotic Use System (RAUS), has been incorporated into the hospital information system. The RAUS provides doctors and patients with the functions of antibiotic usage monitoring, antibiotic information consultation and antibiotic prescription support. Though existing literature has already proved the usefulness of the RAUS on monitoring doctors’ behavior, the effects on hospital performance from an organizational perspective has rarely been measured by empirical data. Therefore, our study has explored the effects of the RAUS on the performance of a large Chinese hospital, which has implemented the RAUS since March 2014. Through empirical research, we quantified the effects of the implementation of the RAUS on a hospital’s performance from both the direct effects on the “drug income” and the spillover effect on the “treatment income”. The results indicate a significant positive spillover effect on the treatment incomes of a hospital in its inpatient activities (seen as significant in the long term) and in its outpatient activities (seen as significant in both the short and long terms). In addition, this research provides certain theoretical and practical implications for the dilemma of e-health services application in irrational antibiotic usage. Full article

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16 pages, 4484 KiB

Open AccessCommunication

Striving for Confidence and Satisfaction in Everyday Life with Chronic Obstructive Pulmonary Disease: Rationale and Content of the Tele-Rehabilitation Programme >C☺PD-Life>>

by Charlotte Simonÿ, Claus Riber, Uffe Bodtger and Regner Birkelund

Int. J. Environ. Res. Public Health 2019, 16(18), 3320; https://doi.org/10.3390/ijerph16183320 - 9 Sep 2019

Cited by 17 | Viewed by 3753

Abstract

Background: More feasible rehabilitation programmes for patients with chronic obstructive pulmonary disease (COPD) are warranted. Even so, still in its infancy, telerehabilitation to COPD patients reveals promising results, wherefore it is anticipated to contribute significant value to the current challenges of rehabilitation to [...] Read more.

Background: More feasible rehabilitation programmes for patients with chronic obstructive pulmonary disease (COPD) are warranted. Even so, still in its infancy, telerehabilitation to COPD patients reveals promising results, wherefore it is anticipated to contribute significant value to the current challenges of rehabilitation to these patients. To expand useful knowledge in the field, more sophisticated telerehabilitation interventions must be developed and appraised, but first and foremost, thoroughly described. Aims and methods: The aim of this article is to give a detailed description of the rationale and content of the >C☺PD-Life>> programme, within the bounds of the checklist of Template for Intervention Description and Replication (TIDieR). Approach: >C☺PD-Life>> is a telerehabilitation programme for COPD patients delivered as a study intervention by an interprofessional team of clinicians collaborating from both the hospital and the municipal healthcare system. Making use of two-way audio and visual communication software, 15 patients participated in the intervention via a tablet computer from their private setting. The programme was a six-month-long empowerment-based rehabilitation that aimed to support COPD patients in leading a satisfactory and confident life with appropriate physical activity and high disease management. Conclusions: A long-term interprofessional cross-sectoral telerehabilitation programme has been justified and described. The intervention was tested in 2017–2018 and the qualitative appraisal, along with an analysis of case-based measurements of development in physical capacity, COPD Assesment Test, and health management, is currently under production. Full article

(This article belongs to the Special Issue E-Health Services)

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13 pages, 673 KiB

Open AccessArticle

Telemonitoring and Quality of Life in Patients after 12 Months Following a Pacemaker Implant: the Nordland Study, a Randomised Trial

by Remedios López-Liria, Antonio López-Villegas, Terje Enebakk, Hilde Thunhaug, Knut Tore Lappegård and Daniel Catalán-Matamoros

Int. J. Environ. Res. Public Health 2019, 16(11), 2001; https://doi.org/10.3390/ijerph16112001 - 5 Jun 2019

Cited by 9 | Viewed by 3778

Abstract

The purpose of this study was to analyse the health-related quality of life (HRQoL) of patients followed up using a remote device-monitoring system (TM) compared to patients followed up through standard outpatient visits (HM), 12 months after the implantation of a pacemaker. This [...] Read more.

The purpose of this study was to analyse the health-related quality of life (HRQoL) of patients followed up using a remote device-monitoring system (TM) compared to patients followed up through standard outpatient visits (HM), 12 months after the implantation of a pacemaker. This was a trial design that used the EuroQol-5D Questionnaire and the Minnesota Living with Heart Failure Questionnaire (MLHF). The HRQoL of a cohort of 50 consecutive patients randomly allocated to one of the two follow-up modalities was measured at baseline and then during follow-up, 12 months after the pacemaker implantation. Eventually, 23 patients were followed-up through standard outpatient visits, while 23 used a remote monitoring system. Results: The baseline clinical characteristics and health-related quality of life of the patients from both groups were observed to be statistically similar. Twelve months after the pacemaker implantation, both groups showed statistically significant improvements in the baseline parameters based on the MLHF. The patients followed up through hospital visits showed a greater increase in MLHF-HRQoL after 12 months, although the increase was not significantly greater than that of the TM group. Furthermore, the frequencies of emergency visits and re-hospitalisations did not differ between the groups. Full article

(This article belongs to the Special Issue E-Health Services)

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33 pages, 2350 KiB

Open AccessArticle

Developing a Sustainable Long-Term Ageing Health Care System Using the DANP-mV Model: Empirical Case of Taiwan

by Pei-Jian Lin, Yih-Chearng Shiue, Gwo-Hshiung Tzeng and Shan-Lin Huang

Int. J. Environ. Res. Public Health 2019, 16(8), 1349; https://doi.org/10.3390/ijerph16081349 - 15 Apr 2019

Cited by 21 | Viewed by 4224

Abstract

Most of the baby boomers born after the Second World War (WWII) have passed the age of 65, meaning they have gradually lost their social functions and positions, and are facing the need for care. In Taiwan, the lack of a long-term care [...] Read more.

Most of the baby boomers born after the Second World War (WWII) have passed the age of 65, meaning they have gradually lost their social functions and positions, and are facing the need for care. In Taiwan, the lack of a long-term care mechanism is having a certain degree of impact on society as a whole, and thus, it is important to have a mechanism to take care of the elderly. In order to make this system sustainable, sufficient funds and continuous improvement are important factors. In the past, in order to avoid the illegal transfer of benefits, the social welfare mechanism avoided the use of for-profit organizations. However, as the economic environment declines, the role of for-profit organizations should be considered. This study defines the long-term ageing health care system using five major dimensions and 20 criteria. The DANP-mV model was used to analyze Taiwan’s current system and identify problems, and then to develop a continuous improvement strategy from the perspective of the source of the problem in order to improve long-term ageing health care. Full article

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22 pages, 1057 KiB

Open AccessArticle

Acceptance of Online Medical Websites: An Empirical Study in China

by Yuan Tang, Yu-Tao Yang and Yun-Fei Shao

Int. J. Environ. Res. Public Health 2019, 16(6), 943; https://doi.org/10.3390/ijerph16060943 - 15 Mar 2019

Cited by 18 | Viewed by 5401

Abstract

As a new type of public health service product, online medical websites (OMWs) are becoming quite popular. OMWs can address patients’ basic medical problems remotely and give health guidance online. Compared to traditional hospitals, OMWs are more convenient and inexpensive, they can usually [...] Read more.

As a new type of public health service product, online medical websites (OMWs) are becoming quite popular. OMWs can address patients’ basic medical problems remotely and give health guidance online. Compared to traditional hospitals, OMWs are more convenient and inexpensive, they can usually provide a better service for patients with poor medical conditions (especially in rural areas), and they also contribute to the rational distribution of medical resources. Therefore, key factors that affect patients’ acceptance of OMWs must be identified to contribute to public health. By integrating perceived risk (PR) and the technology acceptance model (TAM), we proposed a modified TAM and clarified how PR and other factors affect patients’ behavioral intention (BI) towards OMWs. A sample of 245 research participants in China took part in this study and the structural equation model (SEM) was used to test our hypotheses. The results revealed that perceived usefulness (PU) is a positive predictor of BI but has no significant effect on attitude (ATT), while perceived ease of use (PEOU) can affect BI through PU and attitude (ATT). Moreover, trust (TRU) was identified as a mediator of PR and PU/PEOU. Also, the doctor–patient relationship (DPR) was shown to moderate PR and TRU. In order to increase patients’ BI, OMW providers need further innovations to improve patients’ TRU and reduce their PR. Full article

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11 pages, 314 KiB

Open AccessArticle

Health Information Engagement Factors in Malaysia: A Content Analysis of Facebook Use by the Ministry of Health in 2016 and 2017

by Afiq Izzudin A. Rahim, Mohd Ismail Ibrahim, Faizul Nizam A. Salim and Mohd Ariff Ikram Ariffin

Int. J. Environ. Res. Public Health 2019, 16(4), 591; https://doi.org/10.3390/ijerph16040591 - 18 Feb 2019

Cited by 39 | Viewed by 7504

Abstract

Health organizations have widely adopted social media for health promotion, public health communication conveyance, and organizational promotion activities. However, little published data exists on the factors that facilitate health information diffusion in South East Asia, especially Malaysia compared with Western countries. This study [...] Read more.

Health organizations have widely adopted social media for health promotion, public health communication conveyance, and organizational promotion activities. However, little published data exists on the factors that facilitate health information diffusion in South East Asia, especially Malaysia compared with Western countries. This study aimed to investigate factors associated with good engagement rates among internet users on the Facebook (FB) page of Ministry of Health Malaysia. In this observational study, 2123 FB posts were randomly selected. Data dated from 1 November 2016 to 31 October 2017 was gathered from the Facebook Insight. The logistic regression model was applied to identify factors associated with good engagement rates. This study found that a FB post with a good engagement rate was significantly associated with a health education post (Adjusted Odd Ratio (AOR): 3.80, 95% Confidence Interval CI: 3.02–4.78, p < 0.001), a risk communication post (AOR: 1.77, 95% CI: 1.39–2.26, p < 0.001), a post in the afternoon (AOR: 1.76, 95% CI: 1.34–2.31, p < 0.001) or in the evening (AOR: 1.48, 95% CI: 1.20–1.82, p < 0.001), and a video format (AOR: 3.74, 95% CI: 1.44–9.71, p = 0.007). Therefore, we present the first comprehensive analysis of health information engagement among internet users in Malaysia. The growing trends of online health information-seeking behaviors and demand for the availability of validated health information require effective strategies by public health organizations to disseminate health information and achieve better audience engagement on social media. Full article

(This article belongs to the Special Issue E-Health Services)

18 pages, 3055 KiB

Open AccessArticle

Smartphone Sensors for Monitoring Cancer-Related Quality of Life: App Design, EORTC QLQ-C30 Mapping and Feasibility Study in Healthy Subjects

by Sabina Asensio-Cuesta, Ángel Sánchez-García, J. Alberto Conejero, Carlos Saez, Alejandro Rivero-Rodriguez and Juan M. García-Gómez

Int. J. Environ. Res. Public Health 2019, 16(3), 461; https://doi.org/10.3390/ijerph16030461 - 5 Feb 2019

Cited by 10 | Viewed by 4234

Abstract

Quality of life (QoL) indicators are now being adopted as clinical outcomes in clinical trials on cancer treatments. Technology-free daily monitoring of patients is complicated, time-consuming and expensive due to the need for vast amounts of resources and personnel. The alternative method of [...] Read more.

Quality of life (QoL) indicators are now being adopted as clinical outcomes in clinical trials on cancer treatments. Technology-free daily monitoring of patients is complicated, time-consuming and expensive due to the need for vast amounts of resources and personnel. The alternative method of using the patients’ own phones could reduce the burden of continuous monitoring of cancer patients in clinical trials. This paper proposes monitoring the patients’ QoL by gathering data from their own phones. We considered that the continuous multiparametric acquisition of movement, location, phone calls, conversations and data use could be employed to simultaneously monitor their physical, psychological, social and environmental aspects. An open access phone app was developed (Human Dynamics Reporting Service (HDRS)) to implement this approach. We here propose a novel mapping between the standardized QoL items for these patients, the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and define HDRS monitoring indicators. A pilot study with university volunteers verified the plausibility of detecting human activity indicators directly related to QoL. Full article

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Review

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22 pages, 771 KiB

Open AccessReview

How to Value Digital Health Interventions? A Systematic Literature Review

by Katarzyna Kolasa and Grzegorz Kozinski

Int. J. Environ. Res. Public Health 2020, 17(6), 2119; https://doi.org/10.3390/ijerph17062119 - 23 Mar 2020

Cited by 57 | Viewed by 8951

Abstract

In Europe, there were almost twice as many patents granted for medical technology (13,795) compared to pharmaceuticals (7441) in 2018. It is important to ask how to integrate such an amount of innovations into routine clinical practice and how to measure the value [...] Read more.

In Europe, there were almost twice as many patents granted for medical technology (13,795) compared to pharmaceuticals (7441) in 2018. It is important to ask how to integrate such an amount of innovations into routine clinical practice and how to measure the value it brings to the healthcare system. Given the novelty of digital health interventions (DHI), one can even question whether the quality-adjusted life years (QALY) approach developed for pharmaceuticals can be used or whether we need to develop a new DHI’s value assessment framework. We conducted a systematic literature review of published DHIs’ assessment guidelines. Each publication was analyzed with a 12-items checklist based on a EUnetHTA core model enriched with additional criteria such as usability, interoperability, and data security. In total, 11 value assessment guidelines were identified. The review revealed that safety, clinical effectiveness, usability, economic aspects, and interoperability were most often discussed (seven out of 11). More than half of the guidelines addressed organizational impact, data security, choice of comparator, and technical considerations (six out of 11). The unmet medical needs (three out of 11), along with the ethical (two out of 11) and legal aspects (one out of 11), were given the least attention. No author provided an analytical framework for the calculation of clinical and economic outcomes. We elicited five recommendations for the choice of DHI’s value criteria and a methodological suggestion for the pricing and reimbursement framework. Our conclusions lead to the need for a new DHI’s value assessment framework instead of a QALY approach. Full article

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12 pages, 1038 KiB

Open AccessReview

Methodological Quality of Manuscripts Reporting on the Usability of Mobile Applications for Pain Assessment and Management: A Systematic Review

by Ana F. Almeida, Nelson P. Rocha and Anabela G. Silva

Int. J. Environ. Res. Public Health 2020, 17(3), 785; https://doi.org/10.3390/ijerph17030785 - 27 Jan 2020

Cited by 12 | Viewed by 3313

Abstract

Background: There has been increasing use of mobile mHealth applications, including pain assessment and pain self-management apps. The usability of mHealth applications has vital importance as it affects the quality of apps. Thus, usability assessment with methodological rigor is essential to minimize errors [...] Read more.

Background: There has been increasing use of mobile mHealth applications, including pain assessment and pain self-management apps. The usability of mHealth applications has vital importance as it affects the quality of apps. Thus, usability assessment with methodological rigor is essential to minimize errors and undesirable consequences, as well as to increase user acceptance. Objective: this study aimed to synthesize and evaluate existing studies on the assessment of the usability of pain-related apps using a newly developed scale. Methods: an electronic search was conducted in several databases, combining relevant keywords. Then titles and abstracts were screened against inclusion and exclusion criteria. The eligible studies were retrieved and independently screened for inclusion by two authors. Disagreements were resolved by discussion until consensus was reached. Results: a total of 31 articles were eligible for inclusion. Quality assessment revealed that most manuscripts did not assess usability using valid instruments or triangulation of methods of usability assessment. Most manuscripts also failed to assess the three domains of usability (effectiveness, efficiency and satisfaction). Conclusions: future studies should consider existing guidelines on usability assessment design, development and assessment of pain-related apps. Full article

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12 pages, 1011 KiB

Open AccessReview

Sociodemographic Factors Influencing the Use of eHealth in People with Chronic Diseases

by Fabienne Reiners, Janienke Sturm, Lisette J.W. Bouw and Eveline J.M. Wouters

Int. J. Environ. Res. Public Health 2019, 16(4), 645; https://doi.org/10.3390/ijerph16040645 - 21 Feb 2019

Cited by 149 | Viewed by 15197

Abstract

Alongside the growing number of older persons, the prevalence of chronic diseases is increasing, leading to higher pressure on health care services. eHealth is considered a solution for better and more efficient health care. However, not every patient is able to use eHealth, [...] Read more.

Alongside the growing number of older persons, the prevalence of chronic diseases is increasing, leading to higher pressure on health care services. eHealth is considered a solution for better and more efficient health care. However, not every patient is able to use eHealth, for several reasons. This study aims to provide an overview of: (1) sociodemographic factors that influence the use of eHealth; and (2) suggest directions for interventions that will improve the use of eHealth in patients with chronic disease. A structured literature review of PubMed, ScienceDirect, Association for Computing Machinery Digital Library (ACMDL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was conducted using four sets of keywords: “chronic disease”, “eHealth”, “factors”, and “suggested interventions”. Qualitative, quantitative, and mixed-method studies were included. Four researchers each assessed quality and extracted data. Twenty-two out of 1639 articles were included. Higher age and lower income, lower education, living alone, and living in rural areas were found to be associated with lower eHealth use. Ethnicity revealed mixed outcomes. Suggested solutions were personalized support, social support, use of different types of Internet devices to deliver eHealth, and involvement of patients in the development of eHealth interventions. It is concluded that eHealth is least used by persons who need it most. Tailored delivery of eHealth is recommended. Full article

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Other

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11 pages, 1552 KiB

Open AccessProtocol

Rethinking Models of Outpatient Specialist Care in Type 2 Diabetes Using eHealth: Study Protocol for a Pilot Randomised Controlled Trial

by Anish Menon, Farhad Fatehi, Dominique Bird, Darsy Darssan, Mohan Karunanithi, Anthony Russell and Leonard Gray

Int. J. Environ. Res. Public Health 2019, 16(6), 959; https://doi.org/10.3390/ijerph16060959 - 18 Mar 2019

Cited by 8 | Viewed by 5893

Abstract

Conventional outpatient services are unlikely to meet burgeoning demand for diabetes services given increasing prevalence of diabetes, and resultant impact on the healthcare workforce and healthcare costs. Disruptive technologies (such as smartphone and wireless sensors) create an opportunity to redesign outpatient services. In [...] Read more.

Conventional outpatient services are unlikely to meet burgeoning demand for diabetes services given increasing prevalence of diabetes, and resultant impact on the healthcare workforce and healthcare costs. Disruptive technologies (such as smartphone and wireless sensors) create an opportunity to redesign outpatient services. In collaboration, the Department of Diabetes and Endocrinology at Brisbane Princess Alexandra Hospital, the University of Queensland Centre for Health Services Research and the Australian e-Health Research Centre developed a mobile diabetes management system (MDMS) to support the management of complex outpatient type 2 diabetes mellitus (T2DM) adults. The system comprises of a mobile App, an automated text-messaging feedback and a clinician portal. Blood glucose levels (BGL) data are automatically transferred by Bluetooth-enabled glucose meter to the clinician portal via the mobile App. The primary aim of the study described here is to examine improvement in glycaemic control of a new model of care employing MDMS for patients with complex T2DM attending a tertiary level outpatient service. A two-group, 12-month, pilot pragmatic randomised control trial will recruit 44 T2DM patients. The control group will receive routine care. The intervention group will be supported by the MDMS enabling the participants to potentially better self-manage their diabetes, and the endocrinologists to remotely monitor BGL and to interact with patients through a variety of eHealth modalities. Intervention participants will be encouraged to complete relevant pathology tests, and report on current diabetes management through an online questionnaire. Using this information, the endocrinologist may choose to reschedule the appointment or substitute it with a telephone or video-consultation. This pilot study will guide the conduct of a large-scale study regarding the capacity for a new model of care. This model utilises multimodal eHealth strategies via the MDMS to primarily improve glycaemic control with secondary aims to improve patient experience, reduce reliance on physical clinics, and decrease service delivery cost. Full article

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