Home-Based Outpatient Telepsychiatry to Improve Adherence With Treatment Appointments: A Pilot Study.
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ABSTRACT:
SUBMITTER: Shulman M
PROVIDER: S-EPMC5848466 | biostudies-literature | 2017 Jul
REPOSITORIES: biostudies-literature
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Home-Based Outpatient Telepsychiatry to Improve Adherence With Treatment Appointments: A Pilot Study.
Shulman Matisyahu M John Majnu M Kane John M JM
Psychiatric services (Washington, D.C.) 20170301 7
<h4>Objective</h4>This study examined whether patients who had been nonadherent with outpatient appointments and who were randomly assigned to receive treatment through a telepsychiatry intervention (home-based video teleconferencing) would show improvement in adherence to appointments, compared with a treatment-as-usual group.<h4>Methods</h4>Participants (N=22) were randomly assigned to home-based video teleconferencing or to outpatient treatment as usual during a six-month study. The primary o ...[more]
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Project description:BACKGROUND:Home care service in Norway is struggling to meet the increasing demand for health care under restricted budget constraints, although one-fourth of municipal budgets are dedicated to health services. The integration of Web-based technology in at-home care is expected to enhance communication and patient involvement, increase efficiency and reduce cost. DigiHelse is a Web-based platform designed to reinforce home care service in Norway and is currently undergoing a development process to meet the predefined needs of the country's municipalities. Some of the main features of the platform are digital messages between residents and the home care service, highlighting information on planned and completed visits, the opportunity to cancel visits, and notifications for completed visits. OBJECTIVE:This study aimed to test the usability and economic feasibility of adopting DigiHelse in four districts in Oslo by applying registry and behavioral data collected throughout a one-year pilot study. Early health technology assessment was used to estimate the potential future value of DigiHelse, including the predictive value of behavior data. METHODS:Outcome measures identified by stakeholder insights and scenario drafting in the project's concept phase were used to assess potential socioeconomic benefits. Aggregated data were collected to assess changes in health consumption at baseline, and then 15 and 52 weeks after DigiHelse was implemented. The present value calculation was updated with data from four intervention groups and one control group. A quasi-experimental difference-in-difference design was applied to estimate the causal effect. Descriptive behavioral data from the digital platform was applied to assess the usability of the platform. RESULTS:Over the total study period (52 weeks), rates increased for all outcome estimates: the number of visits (rate ratio=1.04; P=.10), unnecessary trips (rate ratio=1.37; P=.26), and phone calls (rate ratio=1.24; P=.08). A significant gap was found between the estimated value of DigiHelse in the concept phase and after the one-year pilot. In the present pilot assessment, costs are expected to exceed potential savings by €67 million (US $75 million) over ten years, as compared to the corresponding concept estimates of a potential gain of €172.6 million (US $193.6 million). Interestingly, behavioral data from the digital platform revealed that only 3.55% (121/3405) of recipients actively used the platform after one year. CONCLUSIONS:Behavioral data provides a valuable source for assessing usability. In this pilot study, the low adoption rate may, at least in part, explain the inability of DigiHelse to perform as expected. This study points to an early assessment of behavioral data as an opportunity to identify inefficiencies and direct digital development. For DigiHelse, insight into why the recipients in Oslo have not made greater use of the Web-based platform seems to be the next step in ensuring the right improvement measures for the home care service.
| S-EPMC6997925 | biostudies-literature
Project description:Pre-exposure prophylaxis (PrEP) provides a strong preventative benefit to individuals at risk for HIV. While PrEP adherence is highly correlated with its efficacy, adherence rates are variable both across and within persons.The objective of this study was to develop and pilot-test a smartphone-based intervention, known as mSMART, that targets PrEP adherence. mSMART provides contingency management in the form of monetary incentives for daily PrEP adherence based on a real-time adherence assessment using a camera-based medication event-monitoring tool as well as medication reminders, PrEP education, individualized behavioral strategies to address PrEP adherence barriers, and medication adherence feedback.This was a 4-week open-label, phase I trial in a community sample of young men who have sex with men already on PrEP (N=10).Although adherence composite scores corresponding to PrEP biomarkers indicated that 90% (9/10) of the sample already had an acceptable baseline adherence in the protective range, by the end of the 4-week period, the scores improved for 30% (3/10) of the sample-adherence did not worsen for any participants. Participants reported mean PrEP adherence rates of 91% via daily entries in mSMART. At the end of the 4-week period, participants indicated acceptable ratings of satisfaction, usability, and willingness to recommend mSMART to others. There were no technical difficulties associated with smartphone compatibility, user misunderstandings about mSMART features that interfered with daily use, or study attrition.This study is the first to apply contingency management to PrEP adherence. Findings indicated that mSMART is feasible and acceptable. Such an adherence intervention administered via a user-friendly smartphone app can allow for widespread dissemination. Future efficacy trials are needed.ClinicalTrials.gov NCT02895893; https://clinicaltrials.gov/ct2/show/NCT02895893 (Accessed by Webcite at http://www.webcitation.org/72JskjDJq).
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Project description:Study designThe pilot study was completed in 5 phases (Control and 4 phases of IMT) incorporating assessments at Baseline 1 (BL1), BL2, Follow-up 1 (F1), F2, F3, and F4.ObjectiveTo assess the adherence and impact of a daily high-intensity (80% of max) inspiratory muscle training (IMT) home program with once weekly supervision for people with spinal cord injury (SCI).SettingAssessments: research institution or zoom. IMT: participant's home.MethodsParticipants completed daily IMT in IMT Phase 1 and 2, once weekly in IMT Phase 3, self-selected frequency in IMT Phase 4. All phases had one weekly supervised session except IMT Phase 4. Primary outcomes included adherence and a difficulty score [DS (0- not difficult to 10- the most difficult)]. Secondary outcomes included respiratory function and seated balance.ResultsData from 10 people with chronic SCI (>1 year) (Cervical level of injury: 6, AIS: A-B, injury duration: 10.9 years 95% CI [3.9, 18.1]) were used in the analysis. Participants completed 69% of their training days in IMT Phase 1 and 65% overall reporting an average DS of 7.4 ± 1.4. Only one participant completed training during IMT Phase 4. One participant's training load was reduced due to suspected overtraining. Maximal inspiratory pressure (MIP), sustained MIP (SMIP), and total power (TP), improved significantly (p < 0.05) from BL2 to F1.ConclusionOur data suggest that people with SCI can perform high-intensity IMT at home to improve inspiratory performance. It is strongly recommended that participants be intermittently monitored for adherence and safety.Clinicaltrialsgov Registration number: NCT04210063.
| S-EPMC9617741 | biostudies-literature
Project description:OBJECTIVES:Patient navigation improves colorectal cancer screening among underserved populations, but limited resources preclude widespread adoption in minority-serving institutions. We evaluated whether a patient's self-selected social contact person can effectively facilitate outpatient screening colonoscopy. METHODS:From September 2014 to March 2017 in an urban tertiary center, 399 black participants scheduled for outpatient screening colonoscopy self-selected a social contact person to be a facilitator and provided the person's phone number. Of these, 201 participants (50.4%) were randomly assigned to the intervention arm for their social contact persons to be engaged by phone. The study was explained to the social contact person with details about colonoscopy screening and bowel preparation process. The social contacts were asked to assist the participants, provide support, and encourage compliance with the procedures. The social contact person was not contacted in the usual care arm, n = 198 (49.6%). We evaluated attendance to the scheduled outpatient colonoscopy and adequacy of bowel preparation. Analysis was performed by intention to treat. RESULTS:The social contact person was reached and agreed to be involved for 130 of the 201 participants (64.7%). No differences were found in the proportion of participants who underwent screening colonoscopy (77.3% vs 77.2%; relative risk = 1.01; 95% confidence interval: 0.91-1.12), but there was a modest increase in the proportion with adequate bowel preparation with social contact involvement (89.1% vs 80.9%; relative risk = 1.10; 95% confidence interval: 1.00-1.21). DISCUSSION:Engaging a patient's social network to serve in the role of a patient navigator did not improve compliance to outpatient screening colonoscopy but modestly improved the adequacy of bowel preparation.
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Project description:We examined patient interest in a telehealth model in which the patient supplies the hardware and Internet connectivity to meet with a healthcare provider from his or her home via video call (video appointment). We hoped to understand prospectively the desirability, feasibility, and viability from the patient perspective.A phone survey was conducted of a random sample of patients who had been seen in the outpatient setting at a single institution. The sample was stratified by proximity to the local institution with oversampling for patients living outside a 120-mile radius.Out of 500 total patients, 301 patients responded, and 263 met the inclusion criteria. Of those 263 respondents, 38% indicated "very likely" to accept an invitation to see their provider via video, 28.1% "somewhat likely," and 33.8% "not at all likely." Of respondents, 75% have broadband, although only 36% reported having a Web camera. The primary factors affecting willingness to participate in a video appointment include comfort in setting up a video call, age, and distance participants would have traveled for an in-clinic appointment.Patient survey data indicate that most patients are likely to be accepting of telehealth care to the home using video call and that most have the required technology. Nevertheless, there are still significant hurdles to effectively implement this adaptation of telehealth care as part of mainstream practice.
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Project description:Chinese American patients with Major Depressive Disorder (MDD) tend to underutilize mental health services and are more likely to seek help in primary care settings than from mental health specialists. Our team has reported that Culturally Sensitive Collaborative Treatment (CSCT) is effective in improving recognition and treatment engagement of depressed Chinese Americans in primary care. The current study builds on this prior research by incorporating telemedicine technology into the CSCT model.We propose a randomized controlled trial to evaluate the acceptability and effectiveness of a telepsychiatry-based culturally sensitive collaborative treatment (T-CSCT) intervention targeted toward Chinese Americans. Patients meeting the study's eligibility criteria will receive either treatment as usual or the intervention under investigation. The six-month intervention involves: 1) an initial psychiatric interview using a culturally sensitive protocol via videoconference; 2) eight scheduled phone visits with a care manager assigned to the patient, who will monitor the patient's progress, as well as medication side effects and dosage if applicable; and 3) collaboration between the patient's PCP, psychiatrist, and care manager. Outcome measures include depressive symptom severity as well as patient and PCP satisfaction with the telepsychiatry-based care management service.The study investigates the T-CSCT model, which we believe will increase the feasibility and practicality of the CSCT model by adopting telemedicine technology. We anticipate that this model will expand access to culturally competent psychiatrists fluent in patients' native languages to improve treatment of depressed minority patients in primary care settings.NCT00854542.
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Project description:BackgroundStreet-connected individuals (SCI) in Kenya experience barriers to accessing HIV care. This pilot study provides proof-of-concept for Enabling Adherence to Treatment (EAT), a combination intervention providing modified directly observed therapy (mDOT), daily meals, and peer navigation services to SCI living with HIV or requiring therapy for other conditions (e.g. tuberculosis). The goal of the EAT intervention was to improve engagement in HIV care and viral suppression among SCI living with HIV in an urban setting in Kenya.MethodsThis pilot study used a single group, pre/post-test design, and enrolled a convenience sample of self-identified SCI of any age. Participants were able to access free hot meals, peer navigation services, and mDOT 6 days per week. We carried out descriptive statistics to characterize participants' engagement in EAT and HIV treatment outcomes. We used McNemar's chi-square test to calculate unadjusted differences in HIV outcomes pre- and post-intervention among participants enrolled in HIV care prior to EAT. We compared unadjusted time to initiation of antiretroviral therapy (ART) and first episode of viral load (VL) suppression among participants enrolled in HIV care prior to EAT vs. concurrently with EAT using the Wilcoxon rank sum test. Statistical significance was defined as p < 0.05. We calculated total, fixed, and variable costs of the intervention.ResultsBetween July 2018 and February 2020, EAT enrolled 87 participants: 46 (53%) female and 75 (86%) living with HIV. At baseline, 60 out of 75 participants living with HIV (80%) had previously enrolled in HIV care. Out of 60, 56 (93%) had initiated ART, 44 (73%) were active in care, and 25 (42%) were virally suppressed (VL < 1000 copies/mL) at their last VL measure in the 19 months before EAT. After 19 months of follow-up, all 75 participants living with HIV had enrolled in HIV care and initiated ART, 65 (87%) were active in care, and 44 (59%) were virally suppressed at their last VL measure. Among the participants who were enrolled in HIV care before EAT, there was a significant increase in the proportion who were active in HIV care and virally suppressed at their last VL measure during EAT enrollment compared to before EAT enrollment. Participants who enrolled in HIV care concurrently with EAT had a significantly shorter time to initiation of ART and first episode of viral suppression compared to participants who enrolled in HIV care prior to EAT. The total cost of the intervention over 19 months was USD $57,448.64. Fixed costs were USD $3623.04 and variable costs were USD $63.75/month/participant.ConclusionsThis pilot study provided proof of concept that EAT, a combination intervention providing mDOT, food, and peer navigation services, was feasible to implement and may support engagement in HIV care and achievement of viral suppression among SCI living with HIV in an urban setting in Kenya. Future work should focus on controlled trials of EAT, assessments of feasibility in other contexts, and cost-effectiveness studies.
| S-EPMC10691070 | biostudies-literature
Project description:BackgroundOutpatient services in the UK, and in particular outpatient neurology services, are under considerable pressure with an ever-increasing gap between capacity and demand. To improve services, we first need to understand the current situation. This study aims to explore the patterns of appointment type seen in outpatient neurology, in order to identify potential opportunities for change.MethodsWe use State Sequence Analysis (SSA) on routinely collected data from a single neurology outpatient clinic. SSA is an exploratory methodology which allows patterns within sequences of appointments to be discovered. We analyse sequences of appointments for the 18 months following a new appointment. Using SSA we create groups of similar appointment sequence patterns, and then analyse these clusters to determine if there are particular sequences common to different diagnostic categories.ResultsOf 1315 patients 887 patients had only one appointment. Among the 428 patients who had more than one appointment a 6 monthly cycle of appointments was apparent. SSA revealed that there were 11 distinct clusters of appointment sequence patterns. Further analysis showed that there are 3 diagnosis categories which have significant influence over which cluster a patient falls into: seizure/epilepsy, movement disorders, and headache.ConclusionsNeurology outpatient appointment sequences show great diversity, but there are some patterns which are common to specific diagnostic categories. Information about these common patterns could be used to inform the structure of future outpatient appointments.
| S-EPMC10626691 | biostudies-literature
Project description:BackgroundRegular visit to psychiatric clinic is essential for successful treatment of any psychiatric condition including attention-deficit/hyperactivity disorder (AD/HD). However, cancellation of outpatient appointments in patients with AD/HD, which represents a significant medical loss, has not been systematically investigated to our knowledge.MethodsA systematic chart review was conducted for patients visiting the Shimada Ryoiku medical Center for Challenged Children in Japan at the age of ≤15 years from January to December 2013. The primary outcome measure was the cancellation rate, defined as the number of missed visits divided by the number of scheduled visits. The cancellation rates during 24 months after the first visit were compared between outpatients with AD/HD and other psychiatric disorders, including pervasive developmental disorders (PDD), and developmental coordination disorders and/or communication disorders (DCD-CD). A generalized linear model with binomial distribution was used to examine factors associated with cancellation rates exclusively in the AD/HD group.ResultsWe included 589 patients (mean ± SD age, 5.6 ± 3.4 years; 432 males) in the analysis. The cancellation rate in patients with AD/HD was 12.3% (95% confidence interval [CI]: 10.0-15.1), which was significantly higher than in those with PDD (5.6%, 95% CI: 3.8-8.3) and DCD-CD (5.3%, 95% CI: 3.6-7.8). Prescriptions of osmotic-release oral system-methylphenidate (OROS-MPH) and antipsychotics were associated with fewer cancellations in AD/HD patients (odds ratios: 0.61, 95% CI: 0.39-0.95 and 0.49, 95% CI: 0.25-0.95, respectively), although these significances did not find in the subgroup analysis including only patients with ≥ 6 years old.ConclusionsPatients with AD/HD were more likely to miss appointments compared to those with other psychiatric disorders. The impact of AD/HD medications as well as potential psychiatric symptoms of their parents or caregivers on appointment cancellations needs to be evaluated in more detail in future investigations.
| S-EPMC8604341 | biostudies-literature