Chronic Disease Management Research Articles

Determinants of Health Care Utilization among the Elderly in India: An Evidence-Based Review

Abstract Health services for the elderly include preventive, curative, rehabilitative, and palliative care, addressing age-related needs such as screenings, chronic disease management, and mobility support. With India’s elderly population expected to exceed 300 million by 2050, understanding healthcare access barriers is crucial for effective policy. This paper reviews empirical evidence from national surveys (LASI, NSSO) and studies (2008–2024) to examine how income, gender, education, residence, and policy coverage influence healthcare utilization. Findings show lower utilization among women, rural residents, and the poor due to cost, low awareness, infrastructure gaps, and systemic neglect. Recommendations include strengthening geriatric care at the primary level, expanding insurance to cover outpatient services, improving elderly health literacy, and adopting gender- and region-sensitive policies. Keywords Healthcare Utilization, Elderly Care, Socio-Economic Determinants, Gender Disparities and Health Policy

Development of planning of the integrated care for older people in China: a theory of change approach

BackgroundIntegrated Care for Older People (ICOPE), developed by the World Health Organization (WHO) with a global perspective, faces varying degrees of barriers to implementation, particularly in middle-and low-income countries. Therefore, as with other new public service interventions, we draw on established integrated care interventions to design a Theory of Change (ToC) model for ICOPE, and to propose methods and pathways for adapting community-based integrated care models for older people (OP) to specific contexts, thereby updating and enhancing the implementation of ICOPE.MethodsAn initial ToC for the ICOPE was drafted based on the WHO guidelines and published literature, and synthesizing the results of semi-structured interviews, group discussions. A total of 36 healthcare stakeholder experts in geriatric nursing, geriatric care and chronic disease management, rehabilitation and quality of life, and psychiatric-mental health were recruited to participate in a 5-stage ToC group workshop conducted consecutively. Each workshop has 2–3 facilitators, and lasts from 60 to 120 min. In multiple workshops, the experts discussed the causal pathway, the interventions needed to activate it, the underlying principles and assumptions, evaluated and refined them, and finally reached consensus.ResultsThe ToC design has improved the ICOPE program, identifying the resources, long-term outcomes, and impacts required for the implementation of ICOPE in a specific setting, and clarifying the specific components of the integrated care interventions, such as materials, procedures, and intervention providers. The localized, OP-centred model of integrated home care developed in our study may contribute to healthy ageing through four potential long-term outcomes: (1) reduction of unnecessary hospitalizations and increased utilization of referral services, (2) enhancement of self-care capacity to prevent, reverse, or delay the decline of intrinsic capacity in OP, (3) improvement of the quality of life of OP living at home, and (4) reduction of caregiving burdens and improvement in the level of caregiving.ConclusionThe ToC is effective in identifying key characteristics of resources, interventions, impact, and outcomes of integrated care for OP. Our ICOPE program has been strengthened by ToC, which forms an integrated care model for assessment, planning, implementation, and evaluation, adapted to a specific setting, and provides guidance for other areas in similar settings.

Reliability and usability of a portable spirometer compared to a laboratory spirometer

BackgroundAccess to spirometry remains limited due to the expense and inconvenience of stationary laboratory spirometers, which may compromise the diagnosis and management of chronic respiratory diseases (CRDs), such as chronic obstructive pulmonary disease (COPD) and asthma. Portable spirometers offer potential advantages over laboratory spirometers in terms of affordability, user-friendliness, and portability. The objective of this study is to evaluate the reliability and usability of a portable spirometer (Medcaptain VC-30 Pro) compared to a conventional laboratory spirometer (Jaeger MasterScreen PFT).MethodsIn this multi-center, randomized, open-label crossover study, 132 subjects from two hospitals were recruited to perform pulmonary function tests using both the portable spirometer and the laboratory spirometer. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow (PEF), forced expiratory flow between 25 and 75% of FVC (FEF25-75%), vital capacity (VC), maximal voluntary ventilation (MVV), and forced expiratory volume in six seconds (FEV6) were compared for correlation and agreement between two spirometers. The concordance of their spirometric abnormality diagnoses and severity classifications was assessed. An additional 30 healthy volunteers were recruited to perform a pulmonary function test by themselves after a session guided by specialists to evaluate the usability of the portable spirometer.ResultsA total of 126 recruited participants achieved acceptable pulmonary function test results. The intraclass correlation coefficients (ICCs) for primary outcomes FEV1 and FVC were 0.994 and 0.993, respectively (both p < 0.001). ICCs for other outcomes ranged from 0.968 to 0.995 (all p < 0.001). The Bland–Altman analysis showed that FEV1 and FVC met preset acceptable criteria, with 96.0% of values falling within the 95% limits of agreement (LoA). Cohen’s kappa statistics for the diagnosis of spirometric abnormality and classification of severity were 0.872 and 0.878, respectively. In the usability test, 28 out of 30 volunteers obtained a Grade A result.ConclusionsThe portable spirometer exhibited a strong correlation and agreement with a high-quality laboratory spirometer, as well as concordance in spirometric abnormality diagnosis and severity classification. Non-specialist can obtain acceptable results using this portable spirometer.

Does capitation payment influence healthcare service behavior in county medical community? Evidence from patients with diabetes in rural China

ObjectiveAmid efforts to develop primary healthcare, China has been working to establish an integrated care system through the county medical community model, incorporating capitation payment to improve chronic disease management. This study investigates the impact of capitation payment reform on diabetes-related healthcare service behaviors across different levels of healthcare facilities within the county medical community.MethodsWe conducted interrupted time series analysis to evaluate the changes in healthcare service behavior before and after the implementation of the capitation model. Using F County, as the sample area, we collected outpatient reimbursement records of type 2 diabetes mellitus (T2DM) patients from six townships that initiated reform in April 2015. The dataset, covering January 2014 to December 2019, includes 49,326 records from primary healthcare facilities and 1,628 from county hospitals, with information on medical costs, service items, and other details.ResultsFollowing the implementation of capitation, both the average medical costs per visit and proportion of examination and testing costs showed a deceleration in growth in primary healthcare facilities (-0.615, p < 0.05; -1.554, p < 0.01). The proportion of medication costs, the proportion of insulin or combination therapy and the average number of medications exhibited a significant downward trend prior to the reform, while all reversed to upward trends after reform. In county hospitals, the proportion of medication costs increased by 19.115% immediately post-reform, and both the level and slope of average number of medications significantly rose (2.041, p < 0.01; 0.244, p < 0.01). Although the proportion of examination and testing costs increased before the reform, both the instantaneous level and the trend declined afterward (-19.684, p < 0.05; -1.833, p < 0.05).ConclusionsIn the sample area, the average medical costs for T2DM outpatients were effectively controlled after the capitation reform. Township health centers showed improved standardization in prescribing practices, while county hospitals focused more on comprehensive examinations and testing services. Medication prescription intensity increased across all facilities, contributing to enhanced chronic disease management.

At-home validation of a non-contact, radar-based breathing monitor for long-term care of patients with respiratory diseases: A proof-of-concept study.

Long-term monitoring of respiratory rate (RR) is an important component in the management of chronic respiratory diseases (CRDs). Specifically, predicting acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is of significant scientific and clinical interest. This study aimed to evaluate the long-term validity of a novel contactless sleep monitor (CSM) in the home environment of CRD patients receiving ventilatory support. Additionally, we assessed patient acceptance, device usability, and RR fluctuations associated with AECOPD to establish a robust foundation for future research.In this prospective proof-of-concept study, nineteen patients requiring non-invasive ventilation (NIV) were provided with the CSM in their home environment for six months and seven patients requiring invasive mechanical ventilation (IMV) for one month. The primary indication for NIV therapy was chronic obstructive pulmonary disease (COPD).The CSM was validated under real-life conditions by comparing its nocturnal RR values with software data from both types of ventilators. Acceptability and usability of the sensor were assessed using a questionnaire. Additionally, COPD exacerbations occurring during the study period were analyzed for potential RR fluctuations preceding these events.Mean absolute error (MAE) of median RR between the NIV device and the CSM, based on 2326 nights, was 0.78 (SD: 1.96) breaths per minute (brpm). MAE between the IMV device and the CSM was 0.12 brpm (SD: 0.52) for 215 nights. The non-contact device was accepted by the patients and proved to be easy in use. In some of the overall only 13 cases of AECOPD, RR time courses showed variations of increased nocturnal respiratory activity a few days before the occurrence of such events.The present CSM is suitable for valid long-term monitoring of nocturnal RR in patients' home environment and is well accepted by the patients. The exploratory findings related to AECOPD events may serve as a starting point for larger studies aimed at developing robust prediction rules.

The influence of patient self-efficacy on value co-creation behavior and outcomes in chronic disease management: a cross-sectional study

BackgroundIn the medical field, value co-creation involves patients’ active involvement. By collaborating with service providers, patients can contribute to the creation of more targeted and effective value. Patients’ self-efficacy and behavior are crucial in this process, as their active participation and support can enhance their service experience. This study investigated the impact of chronic disease patients’ self-efficacy and value co-creation behaviors on the outcomes of value co-creation.MethodsRelevant data were acquired through a questionnaire survey using statistical methods, such as the t-test, analysis of variance, and stratified linear regression. This approach was used to examine the current conditions and factors influencing value co-creation outcomes among community-dwelling patients with chronic diseases. Additionally, a structural equation model was employed to systematically investigate and validate the impact pathways and mechanisms related to the influence of self-efficacy and value co-creation behaviors on value co-creation outcomes. We also explored the moderating effect of digital health technology application capabilities on the relationship between self-efficacy and value co-creation behaviors.ResultsSelf-efficacy, information search, interactive collaboration, feedback provision, and shared decision-making exert significant positive influences on the value co-creation outcomes among individuals with chronic diseases. The path analysis of the structural equation model indicates that self-efficacy and value co-creation behaviors may directly impact value co-creation outcomes. Concurrently, value co-creation behaviors partially mediate the association between self-efficacy and value co-creation outcomes. Furthermore, the digital health technology application capability exhibits a negative moderating effect in the pathway from self-efficacy to value co-creation behaviors.ConclusionsThe implementation of health education and social support measures by healthcare institutions and communities may augment patient self-efficacy, facilitate doctor-patient interactions, and promote shared decision-making. These initiatives could enhance the value of chronic disease services and optimize patient experiences. Additionally, healthcare institution managers are encouraged to focus on optimizing internet hospital platforms, organizing digital health training for patients, and bolstering patients’ proficiency in digital health technology applications. This strategy aims to instill a sense of health responsibility among patients with chronic diseases by fostering positive behaviors in interactive collaboration, information search, feedback provision, and other dimensions.

Use of Medicare-subsidised treatment services among people prescribed opioids for chronic non-cancer pain

Objectives Australians receive healthcare services subsidised by the Medicare national health insurance scheme, including through the Chronic Disease Management Initiative supporting primary care management of chronic conditions. The use of such subsidised services by people with chronic non-cancer pain (CNCP) is unknown. This study examined Medicare-subsidised service use, including Chronic Disease Management items, allied health service use, and specialist attendances, among Australians prescribed opioids for CNCP. Methods Medicare Benefits Schedule claims data for the period 1 January 2012–31 December 2018 were linked to a longitudinal cohort of 1206 adults prescribed opioids for CNCP. Service use was compared with the general population to examine whether individuals with CNCP make greater use of such services and factors associated with service use (including demographics, socioeconomic status, pain scores and opioid treatment characteristics, and physical and mental health scores) were examined. Results Use of primary, allied health, and specialist services among adults with CNCP was high when compared with the general population. Over 3 years, 928 participants (76.9%) received Chronic Disease Management items, mostly care plans (n = 825, 68.4%). Private health insurance and living in a major city were associated with increased odds and rates of any specialist and pain medicine specialist attendances (private insurance and specialist attendances: adjusted odds ratio 4.29, 99.5% confidence interval 2.32–7.91; major city and pain specialist attendances: adjusted incident rate ratio 1.70, 99.5% confidence interval 1.12–2.56). Conclusions Australians prescribed opioids for CNCP have a high use of subsidised primary, allied health, and specialist services. However, sociodemographic disparities were apparent, and there remains a need to improve specialist service accessibility for Australians who are uninsured and living in regional/remote areas. There is also a need to evaluate whether care delivered through current Medicare initiatives is meeting the needs of Australians with CNCP.

Association between primary care physician-nephrologist collaboration and clinical outcomes in patients with stage 5 chronic kidney disease: a JOINT-KD cohort study.

Primary care physician-nephrologist collaboration plays an important role in the management of chronic kidney disease (CKD). However, the benefits of such collaboration in patients with stage 5 CKD remain unclear. We conducted a retrospective cohort study of adult outpatients with stage 5 CKD across nine nephrology centers in Japan. The exposure of interest was primary care physician-nephrologist collaboration. We examined the association between primary care physician-nephrologist collaboration and clinical outcomes in adult outpatients with stage 5 CKD: dialysis initiation and cause-specific hospitalizations using the Fine-Gray models, which treat death and preemptive kidney transplantation and death and kidney replacement therapy as competing risk events, respectively. Of the 570 patients included in the analysis, 91 (16.0%) received primary care physician-nephrologist collaboration, whereas the remaining patients were treated by nephrologists alone. During a median follow-up of 1.4years, 399 (70.0%) patients started dialysis, 11 (1.9%) received preemptive kidney transplantation, and 53 (9.3%) died. There were no significant between-group differences in dialysis initiation and CKD- and cardiovascular-related hospitalizations (adjusted subdistribution hazard ratio [SHR] [95% confidence interval], 0.89 [0.64-1.23], 1.22 [0.78-1.90], and 0.95 [0.46-1.98], respectively). However, primary care physician-nephrologist collaboration was associated with a lower risk of infection-related hospitalization (adjusted SHR [95% confidence interval], 0.36 [0.15-0.87]). Our findings suggest that primary care physician-nephrologist collaboration in the management of stage 5 CKD is not associated with delayed dialysis initiation but is associated with a lower risk of infection-related hospitalization, indicating the potential benefits of primary care physician-nephrologist collaboration in stage 5 CKD.

Optimizing the dynamic treatment regime of outpatient rehabilitation in patients with knee osteoarthritis using reinforcement learning

BackgroundKnee osteoarthritis (KOA) is a prevalent chronic disease worldwide, and traditional treatment methods lack personalized adjustment for individual patient differences and cannot meet the needs of personalized treatment.MethodsIn this study, a dedicated knee osteoarthritis bank (KOADB) was constructed by collecting extensive clinical data from patients. Random forest was used to select the features that had the greatest impact on treatment decisions from 122 questionnaire items. The questionnaire design was optimized to reduce the burden on patients and ensure the validity of data collection. Then, based on the key features screened out, a dynamic treatment recommendation system was constructed by using deep reinforcement learning algorithms, including Deep Deterministic Policy Gradien(DDPG), Deep Q-Network(DQN) and Batch-Constrained Q-learning(BCQ). A large number of simulation experiments have verified the effectiveness of these algorithms in optimizing the treatment strategy of KOA. Finally, the applicability and accuracy of the model were evaluated by comparing the treatment behaviors with actual patients.ResultsIn the application of deep reinforcement learning algorithms to treatment optimization, the BCQ algorithm achieves the highest success rate (79.1%), outperforming both DQN (68.1%) and DDPG (76.2%). These algorithms significantly outperform the treatment strategies that patients actually receive, demonstrating their advantages in dealing with dynamic and complex decisions.ConclusionsIn this study, a deep learning-based KOA treatment optimization model was developed, which was able to adjust the treatment plan in real time and respond to changes in patient status. By integrating feature selection and reinforcement learning techniques, this study proposes an innovative method for treatment optimization, which offers new possibilities for chronic disease management and demonstrates certain feasibility in the development of personalized medicine and precision treatment strategies.

Prediction of Type-II Diabetic through Blockchain Technology

Objectives: Blockchain technology is a recent development for extracting relevant information from the vast amount of data stored over cloud servers. The main objective of the present work is to use blockchain technology to predict diabetic patients at an early stage, and the proposed method improves data security and integrity. Methods: The proposed methodology consists of five key stages i.e. data collection, preprocessing, block formation, block evaluation, and finally valuable results are extracted. The source of data is related to diabetic patients which is taken from the Kaggle repository and categorized by age group. A blockchain model is developed and Python programming language is used to secure storage of the data, real-time analysis, and enhanced data security. Additionally, the study also finds association values between age groups and diabetic conditions which provide more meaningful information about affected people from diabetes. Findings: In this present work, statistical technique is used to evaluate the results and observe that the prevalence of diabetes increases with age, especially between the age group from 50 to 60. The study shows that blockchain may enhance chronic disease management by providing safe data storage and real-time analysis. The study combines blockchain technology with statistical correlation analysis, making it more suited for prediction rather than monitoring. Additionally, the storage size and retrieval time of the data are also computed in this study. Novelty: The primary contribution of the present work is that age-based block segmentation offers an innovative method for organizing and analysing patient data, especially for type-II diabetic, which have not been highlighted in other studies available in the literature. Keywords: Blockchain Technology, Medical Database, Diabetic Patients, Early Prediction, Data Security

Automation and Medication Adherence: A Societal Solution to Chronic Disease Management

Automation and Medication Adherence: A Societal Solution to Chronic Disease Management

Upskilling and Reskilling Non-Communicable Disease Cadres for Increasing Chronic Disease Management

Purpose: Non-communicable diseases (NCDs) are often chronic diseases, with the incidence rate increasing every year. All elements are involved in the prevention and management of NCDs. Likewise, NCDs posbindu cadres are the spearhead in the community. This community service aims to improve the knowledge and skills of NCDs posbindu cadres in efforts to prevent, early detect, manage and report NCDs. Method: The method used in community service uses a knowledge transfer approach, science and technology diffusion, asset-based community development and participatory action programs. All cadres of NCDs and Puskesmas were involved in this activity. The program implementation procedure is preceded by socialization, implementation, monitoring and evaluation. Practical Application: The implementation of upskilling and reskilling cadre activities is carried out in 2 stages. There are improving cognitive knowledge with structured education, then the next stage is skill improvement with early detection demonstrations using medical devices. Conclusion: This Upskilling and rekskilling activity for posbindu cadres can improve the knowledge and skills of NCDs posbindu cadres.

Clinical Advantages of Traditional Chinese Medicine in the Context of 'Healthy China'

Traditional Chinese Medicine (TCM) culture is a treasure of the Chinese nation. It provides modern medicine with invaluable wisdom through its clinical principles of holistic view, syndrome differentiation and treatment, Yin-Yang and Five Elements, and "preventing disease before its onset", as well as its philosophical tenets of human-centeredness and moderate harmony. TCM holds significant advantages in prevention, treatment, and rehabilitation. First, compared to the aggressive methods of Western medicine and the drug resistance of Western pharmaceuticals, TCM exhibits minimal side effects. TCM therapies, such as manual techniques applied to acupoints and meridians, enhance immunity through safe, gentle approaches with few adverse effects. Herbal medicines, derived from natural sources and rationally processed, also demonstrate low toxicity. Second, in contrast to Western medicine'shigh recurrence rates and poor long-term efficacy, TCM regulates the body's holistic state to achieve sustainable therapeutic outcomes. Herbal medicines act gradually, making them particularly effective for chronic diseases with notable long-term benefits. In recent years, the Chinese government has prioritized TCM development, issuing policies to support its innovation, inheritance, and grassroots system construction. Chronic disease management and the establishment of community-level TCM networks are emphasized as key future goals. Concurrently, China promotes TCM's global recognition through international collaborations and cultural exchanges, aiming to enhance its clinical and cultural influence worldwide 38. Finally, TCM embodies profound cultural significance. Its theoretical foundations, rooted in classical texts like Huangdi Neijing, the philosophy of Yin-Yang balance, and humanistic values, form a brilliant facet of China's traditional culture. TCM's strengths in clinical practice, policy frameworks, and cultural depth contribute uniquely to individual health and national governance under initiatives like "Healthy China.

Probiotic Studies Advancements about the Therapy of Type 2 Diabetes Mellitus

Type 2 diabetes Mellitus (T2DM), as the highest incidence of diabetes mellitus, has brought great troubles to many patients, seriously affecting their physical and mental health. Due to the characteristics of long-term management, existing treatment schemes are complicated to operate and difficult to maintain. New therapeutic means using probiotics to improve intestinal flora may become the key to break through this difficulty. This article briefly describes the symptoms of T2DM and the relationship between intestinal flora and probiotics, summarizes the evidence-based evidence on probiotics in the treatment of T2DM in recent years, and summarizes the related mechanisms and potential functions of probiotics in the therapy on T2DM. The agenda of this scrutiny is to supply a theoretical foundation to support the management of other chronic diseases, encourage the development of more efficient methods for the therapy of type 2 diabetes, and fully utilize the abilities of probiotics in this area.

AI-driven personalized nutrition: RAG-based digital health solution for obesity and type 2 diabetes.

Effective management of obesity and type 2 diabetes is a major global public health challenge that requires evidence-based, scalable personalized nutrition solutions. Here, we present an artificial intelligence (AI) driven dietary recommendation system that generates personalized smoothie recipes while prioritizing health outcomes and environmental sustainability. A key feature of the system is the "virtual nutritionist", an iterative validation framework that dynamically refines recipes to meet predefined nutritional and sustainability criteria. The system integrates dietary guidelines from the National Institute for Public Health and the Environment (RIVM), EUFIC, USDA FoodData Central, and the American Diabetes Association with retrieval-augmented generation (RAG) to deliver evidence-based recommendations. By aligning with the United Nations Sustainable Development Goals (SDGs), the system promotes plant-based, seasonal, and locally sourced ingredients to reduce environmental impact. We leverage explainable AI (XAI) to enhance user engagement through clear explanations of ingredient benefits and interactive features, improving comprehension across varying health literacy levels. Using zero-shot and few-shot learning techniques, the system adapts to user inputs while maintaining privacy through local deployment of the LLaMA3 model. In evaluating 1,000 recipes, the system achieved 80.1% adherence to health guidelines meeting targets for calories, fiber, and fats and 92% compliance with sustainability criteria, emphasizing seasonal and locally sourced ingredients. A prototype web application enables real-time, personalized recommendations, bridging the gap between AI-driven insights and clinical dietary management. This research underscores the potential of AI-driven precision nutrition to revolutionize chronic disease management by improving dietary adherence, enhancing health literacy, and offering a scalable, adaptable solution for clinical workflows, telehealth platforms, and public health initiatives, with the potential to significantly alleviate the global healthcare burden.

The impact of COVID-19 pandemic on hospitalization rate, clinical impairment and mortality of cirrhotic patients.

The COVID-19 pandemic caused widespread disruption to global healthcare systems, necessitating the reallocation of resources to address the immediate demands. This reorganization had significant repercussions on the management of chronic diseases, including cirrhosis. We sought to provide a comprehensive picture of the COVID-19 impact on monthly hospitalization rates of cirrhotic patients at Local Health Board 1 hospitals in the Abruzzo Region, Italy. Using the International Classification of Diseases, Ninth Revision, we identified cases of alcohol-related, nonalcohol-related, biliary, and decompensated cirrhosis. We analyzed 957 Hospital Discharge Records from January 1 to December 31, 2019 (pre-pandemic), and from January 1 to December 31, 2022 (post-pandemic). We evaluated patients' clinical impairment, length of stay, and mortality before and after the pandemic. We identified 494 hospitalizations for nonalcohol-related cirrhosis and 310 for alcohol-related cirrhosis. As key findings, hospitalizations for nonalcohol-related cirrhosis decreased (69% vs. 48%; p < .0001), while hospitalizations for alcohol-related cirrhosis increased (31% vs. 52%; p < .0001), in the post-pandemic period. Additionally, there was a significant rise in decompensated patients with alcohol-related cirrhosis post-COVID (77% vs. 65%; p = .0216). Mortality risk increased for both nonalcohol- (11% vs. 18.5%; p = .0176) and alcohol-related cirrhosis (7.7% vs. 18%; p = .0059) in the post-pandemic era. The increase in hospitalizations for alcohol-related cirrhosis is alarming and likely to have a prolonged impact on the natural history of liver diseases. There is an urgent need to reduce alcohol consumption at the population level. Continued awareness and personalized follow-up are essential for guaranteeing the standard of care during health emergencies.

Electronic Implementation of Patient-Reported Outcome Measures in Primary Health Care: Mixed Methods Systematic Review.

Managing chronic diseases remains a critical challenge in primary health care (PHC) across the Organization for Economic Co-operation and Development countries. Electronic patient-reported outcome measures (ePROMs) are emerging as valuable tools for enhancing patient engagement, facilitating clinical decision-making, and improving health outcomes. However, their implementation in PHC remains limited, with significant variability in effectiveness and adoption. This systematic review aimed to assess the implementation and effectiveness of ePROMs in chronic disease management within PHC settings and to identify key barriers and facilitators influencing their integration. A mixed methods systematic review was conducted following the Cochrane Methods and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies that implemented ePROMs among adults for chronic disease management in PHC. The extracted data included patient health outcomes, provider workflow implications, implementation factors, and cost considerations. The reach, effectiveness, adoption, implementation, and maintenance framework was used. Our search yielded 12,525 references, from which 22 (0.18%) studies were included after screening and exclusions. These studies, primarily conducted in the United States (n=9, 41%) and Canada (n=8, 36%), covered various chronic diseases and used diverse ePROM tools, predominantly mobile apps (n=9, 41%). While some studies (n=10, 45%) reported improvements in patient health outcomes and self-management, others (n=12, 55%) indicated no significant change. Key barriers included digital literacy gaps, integration challenges within clinical workflows, and increased provider workload. Facilitators included strong patient-provider relationships, personalized interventions, and technical support for users. While some studies (n=10, 45%) demonstrated improved patient engagement and self-management, long-term cost-effectiveness and sustainability remain uncertain. Success in implementing ePROMs in PHC appears to hinge on addressing digital literacy, ensuring personalization and meaningful patient-provider interactions, carefully integrating technology into clinical workflows, and conducting thorough research on their long-term impacts and cost-effectiveness. Future efforts should focus on these areas to fully realize the benefits of digital health technologies for patients, providers, and health care systems. PROSPERO CRD42022333513; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022333513. RR2-10.2196/48155.

Exploring the Association Between the Healthy Eating Food Index-2019 (HEFI-2019), the Canadian Healthy Eating Index 2007 (C-HEI 2007) and Health Among First Nation Adults Across Canada.

Assessing diet quality is crucial in public health research, as it reveals relationships between dietary patterns and health. The Healthy Eating Food Index-2019 (HEFI-2019) and the Canadian Healthy Eating Index 2007 (C-HEI 2007) are robust tools used to evaluate adherence to dietary guidelines. While the C-HEI 2007 has been widely applied in nutritional epidemiology, research exploring associations between the HEFI-2019, which reflects the updated 2019 Canadian dietary guidelines, and health remains limited. Given the distinct dietary habits and health profiles of First Nations, evaluating these indices in this population is essential. This study investigates associations between HEFI-2019 and C-HEI 2007 scores and health variables, including obesity, type 2 diabetes (T2D), and self-perceived health among First Nations adults. Data were drawn from the First Nations Food, Nutrition, and Environment Study, which included interviews and 24-hour dietary recalls from 5455 adults across 92 communities. Higher HEFI-2019 scores were significantly associated with increased odds of T2D but not with obesity or self-perceived health. C-HEI 2007 scores were also associated with T2D, with stronger associations in the highest tertile. However, C-HEI 2007 scores were not significantly associated with obesity or self-perceived health. The study highlights the significant relationships between HEFI-2019 and C-HEI 2007 scores and T2D among First Nations adults, underscoring the role of diet quality in chronic disease management. The positive associations with T2D may reflect dietary improvements following diagnosis, wherein individuals adopt healthier eating habits. However, given the cross-sectional design, causal relationships cannot be established, and the observed associations should be interpreted with caution. These findings underscore the need for culturally relevant dietary interventions to improve health in Indigenous populations.

Wearable E-Textiles for Monitoring Vital Signs in Healthcare Applications: A Review and Future Perspectives

Wearable electronic textiles (E-textiles) represent a groundbreaking integration of fabric technology and electronic systems, enabling continuous, non-invasive monitoring of vital signs. These innovations offer significant advancements in healthcare applications, especially for real-time patient monitoring, chronic disease management, and remote healthcare services.

ASSESSING THE IMPACT OF PHARMACOGENOMICS ON DRUG PRESCRIBING PATTERNS IN CHRONIC DISEASE MANAGEMENT

Background: Pharmacogenomics has emerged as a useful tool in tailoring drug therapies, particularly in managing chronic diseases, where safety and efficacy over the long term are critical. Objective: This study aimed to establish pharmacogenomics' effect on drug prescribing practices among medical practitioners managing chronic illnesses. Methodology: A cross-sectional survey was performed through a questionnaire structured in the physicians', pharmacists', and healthcare practitioners' practicing clinics of Pakistan. Data were examined through SPSS version 26.0 utilizing descriptive and inferential statistical analysis. Results: The results indicated that while 76.2% of the participants knew about pharmacogenomics, 45.5% of them reported using it in prescribing. A clear majority recognized that it could restrict adverse drug effects (69.4%) and enhance therapeutic efficacy (72.8%), but asserted that they encountered barriers of training and infrastructure that limited its use. Conclusion: This study concludes that although pharmacogenomics is more familiar with its benefits in chronic disease management, its use in routine practice remains limited, which emphasizes the role of guideline-based implementation strategies, clinician education, and policy efforts.