Reminder System Research Articles

The Development of a Smart Reminder System to Promote Adherence to Technology-Based Intervention and Assessment

The overarching aim of the National Institute on Aging funded Adherence Promotion with Person-centered Technology (APPT) Project is to promote adherence to technology-based solutions designed to enhance the early detection and treatment of cognitive decline. The goal is to build and evaluate adaptive, tailored, and integrated technology-based adherence support systems for mobile software platforms that assess and train cognitive skill. The symposium describes the various steps of the development process of the APPT smart adherence support system. N. Charness will present an overview of the APPT project, its aims, and the clinical trials designed to assess the effectiveness of the APPT smart reminder system compared to typical reminder systems. S. Chakraborty will present detailed analyses of past cognitive intervention data to inform understanding of who is likely at risk for poor adherence and how adherence lapses might be predicted in advance to provide just-in-time adherence support. D. Carr will present an exploration of motivating factors for participants to engage in research, and these motivations will be tapped to help develop motivational messages for the APPT adherence support system to be used in the two planned clinical trials. M. Dieciuc will provide additional insights into motivations for engaging in home-based cognitive assessment and training derived from a focus group study. Finally, S. Zhang will describe the results of an initial pilot study examining the effectiveness of motivational reminder messages that match vs. mismatch participants’ own motivations. All results inform the design of the APPT system to maximize adherence.

The Effect of Reminder Message Tailoring on Cognitive Intervention Adherence

Abstract To examine the potential impact of tailored messaging on adherence and attitudes toward text message reminders, a pilot study conducted in advance of the APPT randomized controlled trial systematically manipulated the match between text message content and participants’ self-reported motivations to participate in a cognitive intervention study. Older adults (n=40) were asked to engage in cognitive training, in the form of gamified neuropsychological tests, 30 minutes a day for 10 consecutive days, and adherence was tracked remotely over time. Critically, each day text message reminders alternated between messages consistent or inconsistent with participants’ previously reported motivations for entering the study. This talk presents results, derived from multilevel modeling, that explore the effectiveness of this simple and cost-effective message tailoring approach for facilitating adherence and engendering positive attitudes toward the reminder system, and implications for programs requiring long-term adherence.

The Development of a Smart Reminder System to Promote Adherence to Technology-Based Intervention and Assessment

The COVID-19 pandemic has impacted all of our lives, but the population most at risk are older adults. Canadians over the age of 60 account for 36% of all COVID-19 cases but 95% of the deaths, and over two-thirds of ICU admissions. Older adults with chronic health conditions are especially at risk. Prior to COVID-19, family caregivers (FCGs) for older adults were managing their caregiving duties at the limits of their emotional, physical and financial capacity. As such, FCGs need special consideration during these times of uncertainty to support them in their role and enable the continuation of care for their older adult family members. This symposium will report on independently conducted studies from across Canada that have examined how the pandemic and associated public health measures have influenced resource utilization by FCGs and the older adults for whom they provide care. McAiney et al’s study examines the deleterious effect of reduced services on community dwelling FCGs and the wellbeing of their family member with dementia. Parmar & Anderson examined the effect of pandemic restrictions on FCGs of frail older adults and found they were experiencing increased distress and decreased wellbeing. Flemons et al report on the experiences of FCGs managing caregiving without critical services and the effect of restrictive visiting policies and the well-being of the caregiving dyad (FCGs and family member with dementia). Finally, McGhan et al will share how FCGs evaluated the efficacy of public health measures and the public health messaging about the pandemic.

An Interdisciplinary Collaboration to Improve Hypertension Medication Adherence for Older Adults

Hypertension is highly prevalent in older adults (74.5% in ≥60 years) with dire consequences, and adherence to hypertension medications is low (approximately 50%). With increased smartphone use among older adults (81% for 60-69 years, 62% for ≥70 years), technology innovations can improve medication adherence. This symposium highlights the efforts of an innovative interdisciplinary team of experts (clinical, cognitive aging, human factors, health technology) to develop and implement the Medication Education, Decision Support, Reminding, and Monitoring (MEDSReM) system to improve hypertension medication adherence for older adults. MEDSReM is a theory-based, integrated mobile application (app) and companion web portal that educates, supports missed dose decisions, reminds, monitors adherence, and incorporates blood pressure feedback. In this symposium, we describe the interdisciplinary development efforts. Insel et al. will present the theory-based intervention, technology translation, and advancement of the MEDSReM system. Lee et al. will describe the interdisciplinary team and describe the work by the decision support subteam that created the medication formulary and generated an algorithm to guide missed-dose decisions based on pharmacology of aging. Rogers et al. will discuss the education subteam’s development of educational information about hypertension, medications, and adherence for the MEDSReM system. Mitzner et al. will illustrate the instructional support sub-team’s efforts to ensure older adults can interact with both the smartphone app and online portal. Lastly, Hale et al. will describe the user testing subteam’s usability processes including the integration of blood pressure self-monitoring. These efforts will provide insights for other interdisciplinary teams developing technology interventions for older adults.

Machine Learning Approaches to Understanding and Predicting Patterns of Adherence

In cognitive training of older adults, adherence is a major challenge, but appropriate just-in-time adaptive interventions can improve adherence. To understand adherence patterns and predictors of adherence lapses, we aggregated data from two previous trials (N > 230) involving home-based cognitive interventions. This dataset, detailing 40,000 intervention interactions, contains information about intervention engagement and measures of objective and subjective cognitive performance, demographics, technology proficiency, and attitudes. Exploratory analyses were conducted to understand patterns and predictors of faltering adherence, using classification models, together with feature selection to remove redundant variables. Adherence behaviors in a week were predictive of quitting the following week. Game parameters such as the time of play were weak indicators of future playing patterns, whereas game success was a strong predictor of adherence. These and other useful observations will be incorporated in the design and development of the smart reminder system to be deployed in the APPT project.

Factors That Motivate Older Adults to Participate in Research: Typologies and Implications

A key challenge for scholars who study aging is identifying a pool of research volunteers willing to participate. Toolkits and strategies acknowledge the differences in recruitment needed for older adults relative to younger adults, but there is little information about variations among older adult research volunteers. Based on a community sample of older adults age 60+, this study evaluates differences across seven specific motivators across three broad categories: values/altruism, personal growth/improvement, and immediate gratification. We then identify and evaluate four typologies of older adult volunteers based on the combinations of motivations the older adults in our sample identify as important to participation in research studies. Based on these analyses, we describe how our results might inform recruitment and retention practices in aging studies. Further, we will discuss how these results will help shape our technology-based reminder system with a greater understanding of motivations.

Descriptive analysis of routine childhood immunisation timeliness in the Western Cape, South Africa

Adherence to recommended age-specific immunisation schedules is critical in ensuring vaccine effectiveness against vaccine preventable diseases (VPDs). There is limited data on immunisation timeliness in sub-Saharan Africa. Therefore, this study assessed the timeliness of age-specific routine childhood immunisation within the Western Cape Province of South Africa. Participant records (N = 709) from a prospective health-facility based study conducted in Cape Town, SA in 2012–2016 were analysed. The outcome measure was receiving age-specific immunisations ≥4 weeks of that recommended for age as per the South African Expanded Programme on Immunisation (EPI-SA) schedule. Proportions, medians, inter-quartile ranges (IQR) and regression were used to obtain the prevalence, time-at-risk, and risk factors for delayed immunisation. A total of 652 /709 (91.9%) participants were eligible. Immunisation coverage declined with age from 94.9% (95% CI 92.9–96.4) at birth to 72.0% (95% CI 65.7–77.6) at 18 months. The highest delay in the uptake of vaccine doses was observed among the 3 rd dose of the DTP vaccine [163 (34.6% (95% CI 30.3–39.1)], while the lowest was seen among BCG [40 (6.5% (95% CI 4.7–8.8)]. The longest median time-at-risk of VPDs was among the 2 nd dose of the measles vaccine [12.9 (IQR 6.7–38.6) weeks] and the lowest was OPV birth dose [IQR 6.3 (5.3–9.1) weeks]. Low and upper-middle socio-economic quartiles were associated with delayed uptake of vaccine doses. Delayed vaccination increases the time of susceptibility to VPDs during infancy and childhood. There is a need to develop strategies aimed at mitigating factors associated with delay in uptake of routine childhood vaccines in the Western Cape. Mitigation strategies should provide vaccine education and mobile reminder systems. Education about timely vaccine uptake will aid in the provision of informed council from healthcare providers to caregivers. Multiple reminder systems could cater for low network coverage areas and caregivers with busy schedules.

Student-Centered Group-Based Learning System

This study developed a student-centered group-based learning system. The system requirements were gathered from relevant literature on pedagogy and WebRTC. The study identified social loafing as a major drawback of most student-centered learning groups. The system was designed using block, architectural pattern, flow-chart, use-case, sequence, class and architectural-context diagrams and the system’s application logic was implemented using ASP.NET C#; HTML, JAVASCRIPT and BOOTSTRAP for the front-end and SQL for the database, HangFire and SignalR for the reminder and texting system. SendGrid API for reminders and OpenVidu Media server for video and audio-calling. The system has been tested and proven to be effective in providing different forms of communication and structure to group-learning that reduces social loafing, and can be recommended for tertiary institutions who want to promote a better student-student relationship for improved learning.

Barriers and Facilitators to Implementation of a Preschool Outcome Measure: An Interview Study with Speech-Language Pathologists

IntroductionThe Preschool Speech and Language Program in Ontario, Canada implemented the Focus on the Outcomes of Communication Under Six (FOCUS), an outcome measure, in 2012. This study aimed to investigate commonly experienced facilitators of and barriers to implementing the FOCUS in clinical practice from the perspectives of speech-language pathologists (SLPs). MethodsThirty-seven SLPs participated in semi-structured interviews to share their experiences adopting the FOCUS in clinical practice. A deductive content analysis of interview transcripts was conducted using the Theoretical Domains Framework (TDF), followed by an inductive analysis to identify sub-themes within each domain. ResultsSLPs frequently encountered barriers within three TDF domains: Environmental Context and Resources (e.g., difficulties integrating the FOCUS into assessment sessions and intervention schedules), Beliefs about Consequences (e.g., beliefs that data collected using the FOCUS lack relevance to clinical practice), and Social Influences (e.g., administration of the FOCUS harmed rapport with families). Commonly reported facilitators were found in the Behavioural Regulation (e.g., reminder system) and Environmental Context and Resources (e.g., availability of administrative personnel and technology support) domains. ConclusionsSLPs identified barriers and facilitators to implementing an evidence-based outcome measure into practice. Insights drawn from SLPs’ perspectives will support the design of new methods to improve the implementation of functional outcome measurement tools within programs.

Machine Learning and Medication Adherence: Scoping Review.

This is the first scoping review to focus broadly on the topics of machine learning and medication adherence. This review aims to categorize, summarize, and analyze literature focused on using machine learning for actions related to medication adherence. PubMed, Scopus, ACM Digital Library, IEEE, and Web of Science were searched to find works that meet the inclusion criteria. After full-text review, 43 works were included in the final analysis. Information of interest was systematically charted before inclusion in the final draft. Studies were placed into natural categories for additional analysis dependent upon the combination of actions related to medication adherence. The protocol for this scoping review was created using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Publications focused on predicting medication adherence have uncovered 20 strong predictors that were significant in two or more studies. A total of 13 studies that predicted medication adherence used either self-reported questionnaires or pharmacy claims data to determine medication adherence status. In addition, 13 studies that predicted medication adherence did so using either logistic regression, artificial neural networks, random forest, or support vector machines. Of the 15 studies that predicted medication adherence, 6 reported predictor accuracy, the lowest of which was 77.6%. Of 13 monitoring systems, 12 determined medication administration using medication container sensors or sensors in consumer electronics, like smartwatches or smartphones. A total of 11 monitoring systems used logistic regression, artificial neural networks, support vector machines, or random forest algorithms to determine medication administration. The 4 systems that monitored inhaler administration reported a classification accuracy of 93.75% or higher. The 2 systems that monitored medication status in patients with Parkinson disease reported a classification accuracy of 78% or higher. A total of 3 studies monitored medication administration using only smartwatch sensors and reported a classification accuracy of 78.6% or higher. Two systems that provided context-aware medication reminders helped patients to achieve an adherence level of 92% or higher. Two conversational artificial intelligence reminder systems significantly improved adherence rates when compared against traditional reminder systems. Creation of systems that accurately predict medication adherence across multiple data sets may be possible due to predictors remaining strong across multiple studies. Higher quality measures of adherence should be adopted when possible so that prediction algorithms are based on accurate information. Currently, medication adherence can be predicted with a good level of accuracy, potentially allowing for the development of interventions aimed at preventing nonadherence. Monitoring systems that track inhaler use currently classify inhaler-related actions with an excellent level of accuracy, allowing for tracking of adherence and potentially proper inhaler technique. Systems that monitor medication states in patients with Parkinson disease can currently achieve a good level of classification accuracy and have the potential to inform medication therapy changes in the future. Medication administration monitoring systems that only use motion sensors in smartwatches can currently achieve a good level of classification accuracy but only when differentiating between a small number of possible activities. Context-aware reminder systems can help patients achieve high levels of medication adherence but are also intrusive, which may not be acceptable to users. Conversational artificial intelligence reminder systems can significantly improve adherence.

95 DOCUMENTATION OF URINARY CATHETER INDICATION AND INSERTION PROCEDURE FOR MEDICAL INPATIENTS AT A UNIVERSITY TEACHING HOSPITAL

Abstract Background Approximately 25% of inpatients have urinary catheters at some point during their hospital stay; over half are deemed inappropriate. This is significant as catheter-associated urinary tract infections (CAUTI) increase morbidity, mortality and length of hospitalisation. Lack of medical documentation and clinician awareness of catheters have been identified as risk factors for inappropriate catheterisation. The aim of this audit was to assess inpatient urinary catheter use among medical inpatients to determine if the indication and insertion procedure were clearly documented. Methods The audit was conducted over one day and included all medical inpatients aged 18 years and above. Emergency Department and High Dependency patients were excluded. Data was collected using standardised data collection sheets and involved a review of medical/nursing notes. Data was benchmarked against Health Service Executive guidelines. Results 27 of 132 medical inpatients (20%) had a urinary catheter in situ on the day of audit. 37% (n = 10) had long-term urinary catheters in situ prior to admission and are not considered further. Of the remaining 63% (n = 17), 9 were female (53%), 8 were male (47%), and the average age was 75 years. Indication was documented in nursing notes for 76% and in medical notes for 53%. Indications included monitoring urinary output (29%), urinary retention (24%), sepsis (18%), comfort (6%) and haematuria (6%). Catheter insertion procedure was documented in nursing notes for 59% and in medical notes for 12%. Conclusion One fifth of medical inpatients had urinary catheters on the day of audit. 63% of these patients did not have a catheter prior to admission. Overall medical documentation of catheter indication and insertion procedure is poor. Better documentation would likely improve clinician awareness of their patient’s catheters and prompt earlier review of appropriateness. Education sessions, insertion proforma stickers and catheter review reminder systems are suggested to improve documentation.

Undertaking general practice quality improvement to improve cancer screening - a thematic analysis of provider experiences

BackgroundCancer is a major cause of illness and death, and its incidence and mortality can be reduced through effective screening. In order to improve below target screening rates in one region of Australia, the local Primary Health Network supported local general practices to implement a range of quality improvement initiatives.MethodsWe used a qualitative approach and interviewed 18 general practice staff and five Primary Health Network staff and contractors to understand their experiences with these quality improvement initiatives.ResultsIn a thematic analysis, we identified four key themes related to program set-up and implementation; patient and community education and promotion; engaging patients and communities in screening; and general practice enhancement. Program roles were clear and understood, and the program received strong oversight and support. Practice staff felt supported and motivated. Information Technology was a challenge for many practices often requiring tailored assistance. Education provided by practices facilitated patient empowerment but practice staff noted difficulties engaging patients in screening. Practices were enhanced though strong leadership and teamwork and practice learning activities.ConclusionsThe tailored evidence-based quality improvement initiatives were considered effective in supporting general practices to increase their cancer screening. Key facilitators reported by participants included use of Plan-Do-Study-Act cycles, enhanced data entry and audit capacity, effective recall and reminder systems and maintaining staff motivation.

Abstract 11272: Barriers and Enablers of Rheumatic Heart Disease Care in a Resource Limited Setting

Introduction: Rheumatic heart disease (RHD) has nearly been eradicated in wealthy nations but remains a significant public health concern in low-resource countries like Uganda. Many people living with RHD is these settings have not been diagnosed and many who are diagnosed have late-stage disease requiring surgery, an expensive intervention. Objectives: To explore the barriers and enablers to RHD care in a resource limited setting. Methods: This was a qualitative study. We held in-depth interviews among 36 RHD patients randomly selected from a computer-generated list of patients enrolled in the RHD registries in the Northern, Central, and South-western regions. The selected participants were interviewed by trained qualitative research staff. All interviews were tape recorded and transcribed verbatim. Data were analyzed by thematic content analysis and useful codes were generated by both inductive and deductive approaches. Generated codes were collapsed into themes. Coding was done by 3 independent researchers who compared their results and agreed on one codebook which was updated iteratively. Results: Barriers to care included financial constraints, high cost of medicines, poor access to RHD diagnostics, misdiagnosis, poor access to drugs, high cost of cardiac medicines and high costs of travel to health facilities. Enablers of RHD care included the desire to live, availability of drugs, diagnostics and healthcare workers at RHD clinics, good attitude, counseling and education by health workers, subsidised costs of services at RHD clinics, reminder systems and access to RHD services at nearer facilities. Conclusion: Enhancing enablers and mitigating barriers may improve access to RHD care in resource limited settings and significantly reduce the burden of disease.

Establishing a service improvement network to increase access to care and improve treatment outcomes in community mental health: a series of retrospective cohort studies

BackgroundNational reports using aggregate data have demonstrated that referrals to improving access to psychological therapies (IAPT) services increase year-on-year, but some groups struggle to access the services and outcomes are variable. To identify moderators of access and outcomes, individual patient data are required to control for confounding factors and mitigate ecological biases, and a collaborative effort is needed to carry through findings to local policy and practice. We created a network of services for these purposes. MethodsAs part of the network, a dataset was formed using routinely collected anonymised data from all individual patients referred to eight IAPT services across the north, central, and east London areas, UK (total population n=483 683; mean age 37·83 years [SD 14·40]; female n=311 790 [66·25%], male n=158 860 [33·75%]; Black and minority ethnic n=137 373 [35·40%], White n=250 740 [64·60%]). Cohort studies were done using pre-treatment clinical, sociodemographic, treatment-related, and care pathway data, to investigate the effects of service-level changes to care, and identify groups for whom there are inequalities in access or poorer treatment outcomes. Primary analyses involved regression modelling and propensity score matching. NHS ethical approval was not required for this study (confirmed by the Health Research Authority July 2020, reference number 81/81). The data were provided by the IAPT services for evaluation as part of a wider service improvement project conducted in accordance with the procedures of the host institution and the NHS Trusts which operate the IAPT services (project reference 00519-IAPT). FindingsAfter adjustment for all available confounders, increases in the number of treatment sessions received per patient (odds ratio 1·09, 95% CI 1·08–1·10), reductions in non-attended sessions (0·85, 0·84–0·86), and matching treatments to diagnoses (based on National Institute for Health and Care Excellence guidelines) were associated with better odds of symptomatic remission (0·91, 0·88–0·95). Furthermore, people aged 65 years and older had better outcomes than younger patients (1·33, 1·24–1·43), but were under-represented, and people younger than 25 years not in employment, education, or training (NEETS) had worse outcomes (0·68, 0·63–0·74). Social gradients were observed: people living in the least deprived areas had considerably better outcomes than those in more deprived areas, despite similar levels of access to care and referrals (1·28, 1·07–1·53). Consequently, the services improved the system of appointment reminders to reduce non-attendance, offered training and consultations to staff on matching treatment to diagnoses, and have set up initiatives to encourage more referrals of older adults and improve access and outcomes for NEETS. InterpretationThese studies demonstrate the value in appropriate data sharing aimed specifically at service improvement. Collaboration between services can better inform potential area-level modification to treatment pathways to improve access and care for adults with depression and anxiety. FundingWellcome Trust (grant number 201292/Z/16/Z).

Factors Influencing the Intention of MSM to Use the PrEP Intelligent Reminder System.

PurposeLow adherence to medication is an important reason why pre-exposure prophylaxis (PrEP) is not effective at reducing the rate of new human immunodeficiency virus (HIV) infections among men who have sex with men (MSM). The intelligent reminder system (IRS) has been designed to improve user compliance, but the intention of MSM to use the IRS remains unclear. This study establishes a theoretical model to analyze the factors influencing their intention to use the IRS.Patients and MethodsNon-probability sampling was used to recruit MSM volunteers in Chongqing and Sichuan, China, and the data were collected from MSM who had used the IRS. A model based on the unified theory of acceptance and use of technology (UTAUT) was established for the data through a structural equation model, and the perceived privacy risk was considered to explore the subjects’ behavior intention.ResultsA total of 111 volunteers who had used the IRS filled out a questionnaire. Social influence had the greatest impact on behavior intention (β = 0.360, P < 0.001), followed by performance expectancy (β = 0.331, P < 0.001), and perceived privacy risk had a negative impact on behavior intention (β = −0.151, P = 0.040). In addition, social influence had an indirect effect on behavior intention (β = 0.182, P = 0.003) and performance expectancy played a mediating role in this indirect effect.ConclusionDevelopments in the IRS are required to improve its usefulness and adequately explain its role when recommending it to MSM. It is also important to improve the system’s ability to protect user privacy. Clinical evidence for the effectiveness of the IRS is conducive to its widespread use.

Self-Management Applications For Improving The Productivity Of Adolescence At Risk Of HIV/AIDS

HIV/AIDS is a global health problem due to difficulty in spread detection. HIV spread is not visible directly, the symptoms will arise in 10-15 years. Adolescence is the period that is predicted as the highest exposure time in HIV. Self-management based on the mobile-phone app could be used to optimize the adolescents’ protection ability in HIV/AIDS. This activity aims to improve adolescent soft skills on using cheap and effective mobile-phone apps to optimize adolescent productivity. Implementation methods are using online learning through video conference, focusing on the use of Self management applications: Smarter time on their activities and overview of HIV/AIDS. The results that they can understand the use of smarter time in time management and daily activity targets. Smarter time can be used as a reminder system. One of the recommended features is the focus mode that allows adolescents to manage the used apps in their mobile phones while being focused on activities without interruption of any other application activities especially social media. Increasing adolescent productivity also can increase positive behavior in leisure time and reduce the risk factors of HIV/AIDS.

CORRELATES ASSOCIATED WITH ADHERENCE AMONG FEMALE SEX WORKERS ON HIV PRE- EXPOSURE PROPHYLAXIS IN NAIROBI CITY COUNTY, KENYA

Purpose: The main aim of the study was to assess correlates associated adherence among Female Sex Workers on PrEP in the study. This was done through determining level of knowledge on PrEP, level of adherence, correlates affecting adherence and analysis of strategies to enhancing PrEP adherence.&#x0D; Materials and Methods: A cross sectional analytical study with mixed method using both qualitative and quantitative data collection method was carried out between March and May 2021. Three hundred and forty-five Female Sex Workers (FSWs) were enrolled in the study. Data was collected using structured questionnaire from study participants after having their consent. Three focus group discussions (FGD) were conducted for those FSWs who will not be involved in the quantitative arm of study. Key Informant Interview was conducted with service providers using Key informant interview (KII) guide. Data collected was entered into Excel spread sheet in password protect computer. Data analysis was carried out in, Univariate analysis, bivariate analysis and multivariate analysis. Statistical Package of Social Science (SPSS) version 20.0 was used for analysis. Data was presented using graphs and Tables.&#x0D; Results: The study found that 72% did not know the name of PrEP, 39% reported to have missed PrEP with 33% having missed appointment for PrEP refill. Qualitative data showed that PrEP engagement meetings should be conducted monthly to enhance PrEP adherence. The respondents who had reminders on when to take medication was as well associated with adherence (p=0.014) compared with those not using reminders. The study also found out that employment status was associated with adherence to PrEP medication (P=0.050) with FSW who were salaried being 2.5 times more likely to adhere to PrEP medication compared to those who were not salaried.&#x0D; Unique contribution to theory, practice and policy: The Ministry of Health should ensure that targeted PrEP counselling is done during the initiation for the eligible clients. The information and telecommunication department to work on SMS reminder system in order to remind FSWs using PrEP about appointment dates for the pill pick up thus enhance adherence to FSWs using PrEP. The procurement department should work together with pharmacy department to ensure that there is enough stock for PrEP at every clinic. This will help to ensure that adherence is achieved for the FSWs on PrEP.

Long-term improvement of psoriasis patients\u2019 adherence to topical drugs: testing a patient-supporting intervention delivered by healthcare professionals

BackgroundPsoriasis affects 2–4% of the Western adult population and is a socio-economic burden for patients and society. Topical drugs are recommended as first-line treatment for mild-to-moderate psoriasis, but low adherence is a barrier to treatment success. Psoriasis patients require support, in order to improve their long-term use of topical drugs. The project aims to test whether a patient-supporting intervention delivered by dermatology nurses can reduce the severity of psoriasis, improve the use of topical drugs, and is cost-effective compared to standard procedure.MethodsThe intervention consists of improved support delivered to patients by three experienced dermatology nurses, who will support patients on a regular basis by consultations with a focus on providing reminder systems, accountability, reinforcement, and building trust in the treatment. Each patient will be supported by the same dermatology nurse throughout the entire study period. The effect will be compared with standard procedure.The intervention will be tested in a randomized controlled trial during a 48-week period. A group of patients with moderate-to-severe psoriasis (psoriasis affecting ≥ 4% of the total body surface area) and 18–85 years of age who are prescribed topical treatment will be randomized to a non-intervention (n ≈ 57) or intervention group (n ≈ 57). Participants in both arms will be prescribed topical preparations containing corticosteroid and/or calcipotriol.The primary outcome will be a change in the severity of psoriasis, measured as reduction in the Lattice-System Physician’s Global Assessment. Secondary outcomes will include changes in health-related quality of life (measured by disease specific and generic questionnaires), primary adherence (i.e., proportion of filled prescriptions), and secondary adherence by objective measure (rate of topical drug consumption (obtained by weighing medication packages) compared to estimated recommended consumption). A health economic evaluation is planned to run alongside the trial. Participants’ total health costs will be estimated on the basis of health costs reported to the national health registries and costs spent on the intervention, after which a cost-utility and cost-effectiveness analysis will be carried out.DiscussionIf the intervention can reduce the severity of psoriasis in a significant manner and is economically favorable compared to standard treatment, there is potential for implementing the intervention in dermatology clinics.Trial registrationClinicaltrials.govNCT04220554. Registered on January 7, 2020. Study results, either positive, negative, or inconclusive, will be published on www.clinicaltrials.gov.Trial registration no. with the Danish Regional Committee on Health Research Ethics, registration no. 72613.

Smartphone-Based mHealth and Internet of Things for Diabetes Control and Self-Management.

In patients with chronic diseases condition, mobile health monitoring facility proves to play a significant role in providing significant assistance toward personal management. This research examined the use of smartphones by diabetes patients and their intentions to apply them for self-care and monitoring as well as management. This cross-sectional survey-based study was conducted in Jul-Aug 2021 with 200 diabetic patients (especially type 2) who were visiting specialized clinics and hospitals of Gujrat state, India. A validated questionnaire survey was designed to collect data, which included questions about demographics, information pertaining to other, use of cellphones, the Internet, and the intention to implement smartphones for diabetes monitoring, self-care, and self-management. A highest number of studied participants have mobile phone (97.5%) and smartphones (87%) and access the Internet on daily basis (83.5%). Younger participants were more inclined to use smartphone apps and have also shown more interest for continuous use in the future (p < 0.01). The majority of participants used apps for nutritional planning (85.5%), to monitor glucose control (76.5%), and for scheduling of diabetes appointments on the calendar (90.5%). Recommendations to use mobile app by doctors or healthcare profession were reported by 20.5% of the participants and attitude and future intention to use mobile apps were reported by the majority of participants. The majority of type 2 diabetes patients choose to use their cellphones and the internet or mobile phone reminder system for medication as well as to plan their diets, monitor their blood sugar levels, and communicate with their doctors. The findings of this research can be used to develop strategies and implement mHealth-based therapies to assist patients with type 2 diabetes to efficiently manage their health and might contribute to reducing patients' out-of-pocket expenditure as well as reducing disability-adjusted life years (DAILY) attributed by DM.

Reminder system for health screening in early childhood \u2013 an analysis regarding different social circumstances

BackgroundChildren with a low socio-economic position (SEP) participate in prevention and health examinations less often. In order to increase participation, reminder systems have been implemented in Germany since 2009. The aim of the study is to investigate whether this implementation is associated with an increased participation in health examination in early childhood for children in disadvantaged social circumstances.MethodsWe used data from the school enrolment examination from 2002 to 2017 from the city of Duesseldorf (n = 64,883 children). With a trend analysis we observed health examination over time and we compared rates of children after implementation of the reminder system (2010 or later) to those who were not exposed to the programme (earlier than 2010). Health examination was measured by participation in the last examination before school entry (“U9”) documented by paediatricians. Social circumstances included neighbourhood deprivation (very high to very low), migration background (foreign first language vs. German) and family status (one-parent vs. two-parent families). Poisson regression estimated adjusted Prevalence Ratios (PR) with a 95% confidence interval (CI) of U9 participation by reminder system exposure, both for the total population and within groups of social circumstances. Based on that, we calculated adjusted participation rates (predictive margins) by reminder system exposure for the different social circumstances.ResultsParticipation rates increased slightly, but gradually over time. The probability of U9 participation for children exposed to the reminder system is 1.04-fold (1.03–1.04 CI) compared to children who were not exposed to it. The association of the reminder system and U9 participation differs according to social circumstances. Adjusted prevalences increased the most in the group of children from very deprived neighbourhoods, ranging from 84.3 to 91.4% (PR = 1.07; 1.03–1.10 CI); in all language groups; more in children from one-parent families ranging from 82.4 to 88.9% (PR = 1.07; 1.05–1.09 CI).ConclusionOur results suggest that reminder systems have a moderate impact on the participation in health examinations in early childhood in the general population. In vulnerable groups, however, they could make a difference. Reminder systems should be combined with further activities of tailored prevention.