Perceived organizational affiliation and its effects on patient trust: Role modeling with embodied conversational agents

ObjectiveVerbal and non-verbal behaviors, which are known as “relational contextualization cues”, relay information about relationships and how they are structured. We developed a computer-simulated provider conducting an informed consent process for clinical research to investigate the effects of a provider’s alignment of interests with a patient, the research team, or a neutral party on patient trust in the provider.MethodsParticipants (N = 43) interacted with a simulated provider for a research informed consent process in a three-arm, counterbalanced, within-subjects experiment. Participants reported their trust in the simulated provider after each treatment.ResultsParticipants successfully recognized the alignment manipulation, and perceived the patient-aligned provider as more trustworthy than the other providers. Participants were also more satisfied with the patient-aligned provider, liked this provider more, expressed more desire to continue working with this provider, and stated that they were significantly more likely to sign the consent form after interacting with this provider compared to the other two.ConclusionRelational contextualization that aligns with the patient increases trust, satisfaction, and willingness to enroll in the context of research informed consent.Practice implicationsHealth providers should align themselves with patients’ interests.     

Physicians' communication of the common-sense self-regulation model results in greater reported adherence than physicians' use of interpersonal skills

Objectives. Interventions that address patients’ illness and treatment representations have improved patient adherence and outcomes when administered by psychologists and/or health educators and focused on a single chronic illness. The current study assesses the potential feasibility/effectiveness of an intervention based on the common‐sense self‐regulation model (CS‐SRM) when administered by providers in a primary care setting. Design. We designed a prospective, correlational study in order to optimize patients’ and providers’ time and to gain initial evidence of the CS‐SRM‐approach's feasibility/effectiveness. Methods. Patients (n= 243) were recruited from a primary care waiting room and reported on objective behaviours of their providers (providers’ CS‐SRM‐related behaviours and interpersonal skills) and other theoretically related measures directly after the medical encounter and reported on adherence, presenting problem resolution, and emergency care usage 1 month later. Results. The more providers gave their patients an adaptive understanding of their presenting problem/treatment (the greater the number of CS‐SRM‐related behaviours they engaged in), the more adherent were patients in the month following the encounter and the better was their problem resolution 1 month later. The CS‐SRM‐related behaviours were more predictive of these outcomes and emergency care usage than were the providers’ interpersonal skills. Conclusions. In the time‐limited encounter, interventions may have to prioritize theoretical approaches for attaining patient adherence. The current study, although correlational, indicates that addressing the patients’ illness/treatment representations is more important than the providers’ interpersonal skills for attaining patient adherence and provides preliminary evidence that a CSM‐based intervention in the primary care setting may be both feasible and effective.     

Specifying the effects of physician's communication on patients’ outcomes: A randomised controlled trial

ObjectiveTo experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain.MethodsUsing a 2 × 2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants’ outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed.ResultsPositive affect-oriented communication reduced anxiety (p < 0.001), negative mood (p = 0.001), and increased satisfaction (p < 0.001) compared to negative affect-oriented communication. Positive expectations increased feelings of self-efficacy (p < 0.001) and outcome expectancies (p < 0.001), compared to uncertain expectations, but did not reduce anxiety. The combination of positive affect-oriented communication and a positive expectation reduced anxiety (p = 0.02), increased outcome expectancies (p = 0.01) and satisfaction (p = 0.001).ConclusionBeing empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients’ outcomes for the best.Practice implicationsContinued medical training is needed to harness placebo-effects of medical communication into practice.     

Effectiveness of a standardized back school program for patients with chronic low back pain after implementation in routine rehabilitation care

ObjectiveTo evaluate the effectiveness of a standardized, patient-oriented, biopsychosocial back school after implementation in inpatient orthopedic rehabilitation.MethodsA multi-center, quasi-experimental controlled study of patients with low back pain (n = 535) was conducted. Patients in the control group received the traditional back school before implementation of the new program (usual care); patients in the intervention group received the new standardized back school after implementation into routine care. Patients’ illness knowledge and conduct of back exercises (primary outcomes) and secondary self-management outcomes and treatment satisfaction were obtained at admission, discharge, and 6 and 12 months after rehabilitation.ResultsWe found a significant small between-group intervention effect on patients‘ illness knowledge in medium- to long term (6 months: η² = 0.015; 12 months: η² = 0.013). There were trends for effects on conduct of back exercises among men (6 and 12 months: η² = 0.008 both). Furthermore, significant small effects were observed for treatment satisfaction at discharge and physical activity after 6 months.ConclusionsThe standardized back school seems to be more effective in certain outcomes than a usual care program despite heterogeneous program implementation.Practice implicationsFurther dissemination within orthopedic rehabilitation may be encouraged to foster self-management outcomes.     

Patient–provider communication and reproductive health among HIV-positive women in Rio de Janeiro,Brazil

ObjectiveTo qualitatively assess the influence of patient–provider communication on contraceptive choice among HIV-positive women in the context of universal antiretroviral therapy (ART) access.MethodsFocus group discussions (FGD; n = 3), in-depth (IDI; n = 15) and freelist interviews (FLI; n = 36) were conducted with HIV-positive women aged 18–40 years recruited from public health units in Rio de Janeiro/Brazil.ResultsOf 70 participants, 49 used ART and the median time since HIV diagnosis was 6 years (range: 1–18). The majority of participants (71.4%) reported some degree of dissatisfaction with their health providers (usually lack of open dialogue) and a few reported experiences of stigma/prejudice during appointments. Intra, interpersonal and social factors modulated behaviors and reproductive health decisions, and those issues were rarely addressed by providers during HIV clinical care.ConclusionDespite dramatic increases in survival and life quality after universal ART implementation in Brazil, reproductive health issues are neglected by multiple cadres of HIV health providers. Communication on reproductive health issues remains fragmented and potentially contradictory, compromising care in these settings.Practice implicationsAdequate provider training to address reproductive health-related issues in a comprehensive, culturally sensitive manner and improved integration of HIV and reproductive health care are urgently needed in this setting.     

Providing prenatal care to pregnant women with overweight or obesity: Differences in provider communication and ratings of the patient-provider relationship by patient body weight

ObjectiveTo examine the association of women’s body weight with provider communication during prenatal care.MethodsWe coded audio recordings of prenatal visits between 22 providers and 117 of their patients using the Roter Interaction Analysis System. Multivariate, multilevel Poisson models were used to examine the relationship between patient pre-pregnancy body mass index and provider communication.ResultsCompared to women with normal weight, providers asked fewer lifestyle questions (IRR 0.66, 95% CI 0.44–0.99, p = 0.04) and gave less lifestyle information (IRR 0.51, 95% CI 0.32–0.82, p = 0.01) to women with overweight and obesity, respectively. Providers used fewer approval (IRR 0.68, 95% CI 0.51–0.91, p = 0.01) and concern statements (IRR 0.68, 95% CI 0.53–0.86, p = 0.002) when caring for women with overweight and fewer self-disclosure statements caring for women with obesity (IRR 0.40, 95% CI 0.19–0.84 p = 0.02).ConclusionLess lifestyle and rapport building communication for women with obesity may weaken patient-provider relationship during routine prenatal care.Practice implicationsInterventions to increase use of patient-centered communication – especially for women with overweight and obesity – may improve prenatal care quality.     

Perspectives on wellness self-monitoring tools for older adults

PurposeOur purpose was to understand different stakeholder perceptions about the use of self-monitoring tools, specifically in the area of older adults’ personal wellness. In conjunction with the advent of personal health records, tracking personal health using self-monitoring technologies shows promising patient support opportunities. While clinicians’ tools for monitoring of older adults have been explored, we know little about how older adults may self-monitor their wellness and health and how their health care providers would perceive such use.MethodsWe conducted three focus groups with health care providers (n = 10) and four focus groups with community-dwelling older adults (n = 31).ResultsOlder adult participants’ found the concept of self-monitoring unfamiliar and this influenced a narrowed interest in the use of wellness self-monitoring tools. On the other hand, health care provider participants showed open attitudes toward wellness monitoring tools for older adults and brainstormed about various stakeholders’ use cases. The two participant groups showed diverging perceptions in terms of: perceived uses, stakeholder interests, information ownership and control, and sharing of wellness monitoring tools.ConclusionsOur paper provides implications and solutions for how older adults’ wellness self-monitoring tools can enhance patient-health care provider interaction, patient education, and improvement in overall wellness.     

Evaluation of an interactive web-based nursing course with streaming videos for medication administration skills

PurposeNursing students should exhibit competence in nursing skills in order to provide safe and quality patient care. This study describes the design and students’ response to an interactive web-based course using streaming video technology tailored to students’ needs and the course objectives of the fundamentals of nursing skills clinical course.MethodA mixed-methodology design was used to describe the experience of 102 first-year undergraduate nursing students at a school of nursing in Jordan who were enrolled in the course. A virtual course with streaming videos was designed to demonstrate medication administration fundamental skills. The videos recorded the ideal lab demonstration of the skills, and real-world practice performed by registered nurses for patients in a hospital setting. After course completion, students completed a 30-item satisfaction questionnaire, 8 self-efficacy scales, and a 4-item scale solicited their preferences of using the virtual course as a substitute or a replacement of the lab demonstration. Students’ grades in the skill examination of the procedures were measured. Relationships between the main variables and predictors of satisfaction and self-efficacy were examined.ResultsStudents were satisfied with the virtual course (3.9 ± 0.56, out of a 5-point scale) with a high-perceived overall self-efficacy (4.38 ± 0.42, out of a 5-point scale). Data showed a significant correlation between student satisfaction, self-efficacy and achievement in the virtual course (r = 0.45–0.49, p < 0.01). The majority of students accessed the course from home and some faced technical difficulties. Significant predictors of satisfaction were ease of access the course and gender (B = 0.35, 0.25, CI = 0.12–0.57, 0.02–0.48 respectively). The mean achievement score of students in the virtual class (7.5 ± 0.34) was significantly higher than that of a previous comparable cohort who was taught in the traditional method (6.0 ± 0.23) (p < 0.05). Nearly 40% of the students believed that the virtual course is a sufficient replacement of the lab demonstration.ConclusionsThe use of multimedia within an interactive online learning environment is a valuable teaching strategy that yields a high level of nursing student satisfaction, self-efficacy, and achievement. The creation and delivery of a virtual learning environment with streaming videos for clinical courses is a complex process that should be carefully designed to positively influence the learning experience. However, the learning benefits gained from such pedagogical approach are worth faculty, institution and students’ efforts.     

Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial

ObjectivesTo assess advanced communication skills among second-year medical students exposed either to a computer simulation (MPathic-VR) featuring virtual humans, or to a multimedia computer-based learning module, and to understand each group’s experiences and learning preferences.MethodsA single-blinded, mixed methods, randomized, multisite trial compared MPathic-VR (N = 210) to computer-based learning (N = 211). Primary outcomes: communication scores during repeat interactions with MPathic-VR’s intercultural and interprofessional communication scenarios and scores on a subsequent advanced communication skills objective structured clinical examination (OSCE). Multivariate analysis of variance was used to compare outcomes. Secondary outcomes: student attitude surveys and qualitative assessments of their experiences with MPathic-VR or computer-based learning.ResultsMPathic-VR-trained students improved their intercultural and interprofessional communication performance between their first and second interactions with each scenario. They also achieved significantly higher composite scores on the OSCE than computer-based learning-trained students. Attitudes and experiences were more positive among students trained with MPathic-VR, who valued its providing immediate feedback, teaching nonverbal communication skills, and preparing them for emotion-charged patient encounters.ConclusionsMPathic-VR was effective in training advanced communication skills and in enabling knowledge transfer into a more realistic clinical situation.Practice implicationsMPathic-VR’s virtual human simulation offers an effective and engaging means of advanced communication training.     

Randomized trial of an uncertainty self-management telephone intervention for patients awaiting liver transplant

ObjectiveWe tested an uncertainty self-management telephone intervention (SMI) with patients awaiting liver transplant and their caregivers.MethodsParticipants were recruited from four transplant centers and completed questionnaires at baseline, 10, and 12 weeks from baseline (generally two and four weeks after intervention delivery, respectively). Dyads were randomized to either SMI (n = 56) or liver disease education (LDE; n = 59), both of which involved six weekly telephone sessions. SMI participants were taught coping skills and uncertainty management strategies while LDE participants learned about liver function and how to stay healthy. Outcomes included illness uncertainty, uncertainty management, depression, anxiety, self-efficacy, and quality of life. General linear models were used to test for group differences.ResultsNo differences were found between the SMI and LDE groups for study outcomes.ConclusionThis trial offers insight regarding design for future interventions that may allow greater flexibility in length of delivery beyond our study’s 12-week timeframe.Practice implicationsOur study was designed for the time constraints of today’s clinical practice setting. This trial is a beginning point to address the unmet needs of these patients and their caregivers as they wait for transplants that could save their lives.     

End-of-life parental communication priorities among bereaved fathers due to cancer

ObjectivesTo elicit widowed fathers’ perspectives on which domains of parenting-related communication they consider most important for dying parents to discuss at the end of life (EOL).MethodsTwo hundred seventy nine fathers widowed by cancer completed a survey about their own depression and bereavement symptoms, their wife’s illness, and EOL parental communication priorities. Chi square and Fisher’s exact tests and logistic regression were used to evaluate relationships between maternal EOL characteristics and fathers’ responses to parenting-related EOL communication priorities.ResultsFathers identified raising children in a manner that reflected maternal wishes, whether/how to talk with children about their mother’s death, and how the mother wanted to be remembered as the most important EOL communication domains. Fathers who reported that their dying wives were worried about the children were more likely to prioritize raising children in ways that reflect her wishes (p = 0.01). Other EOL characteristics were not associated with communication domains.ConclusionsCommunicating with children and maintaining emotional connection with the deceased parent are important priorities for bereaved fathers who lost a spouse to cancer.Practice implicationsHealth care providers working with seriously ill parents may improve family outcomes by supporting communication at the EOL between co-parents.     

Clinical trainees’ responses to parents who question evidence-based recommendations

ObjectiveWe examined clinicians’ attitudes, beliefs, and behavioral intentions about discussing evidence and eliciting values when patients question recommendations.MethodsWe randomized trainees to read one of three scenarios about a parent of a one-year-old: 1) overuse (parent requests antibiotics for presumed viral infection); 2) equipoise (tubes for recurrent ear infections); 3) underuse (parent hesitates about vaccination). Participants then answered survey questions. Outcomes included time spent clarifying values (primary), attitudes and beliefs about the parent (secondary).Results132 medical students and pediatric residents enrolled; 119 (90%) completed the study. There were no differences in time participants would spend clarifying values (antibiotics 26 ± 12%; equipoise 28 ± 11%; vaccine-hesitancy 22 ± 11%; p = 0.058). Participants in the vaccine-hesitancy group (vs. other groups) would spend less time answering questions (p = 0.006). Participants in the antibiotics (vs. equipoise) group perceived the parent as difficult (p = 0.0002). Those in the vaccine-hesitancy group (vs. other groups) perceived the parent as difficult, saw less value in the conversation, and had lower respect for the parent’s views (all ps < 0.0001). Most (76%) wanted additional training navigating these discussions.ConclusionClinicians’ attitudes may impact conversations when patients question evidence-based recommendations.Practice implicationsClinicians should consider ways to discuss evidence and clarify patients’ values to optimize health without damaging patient-clinician relationships.     

Increased appropriateness of customized alert acknowledgement reasons for overridden medication alerts in a computerized provider order entry system

ObjectiveComputerized provider order entry systems commonly contain alerting mechanisms for patient allergies, incorrect doses, or drug–drug interactions when ordering medications. Providers have the option to override (bypass) these alerts and continue with the order unchanged. This study examines the effect of customizing medication alert override options on the appropriateness of override selection related to patient allergies, drug dosing, and drug–drug interactions when ordering medications in an electronic medical record.Materials and methodsIn this prospective, randomized crossover study, providers were randomized into cohorts that required a reason for overriding a medication alert from a customized or non-customized list of override reasons and/or by free-text entry. The primary outcome was to compare override responses that appropriately correlate with the alert type between the customized and non-customized configurations. The appropriateness of a subset of free-text responses that represented an affirmative and active acknowledgement of the alert without further explanation was classified as “indeterminate.” Results were analyzed in three different ways by classifying indeterminate answers as either appropriate, inappropriate, or excluded entirely. Secondary outcomes included the appropriateness of override reasons when comparing cohorts and individual providers, reason selection based on order within the override list, and the determination of the frequency of free-text use, nonsensical responses, and multiple selection responses.ResultsTwenty-two clinicians were randomized into 2 cohorts and a total of 1829 alerts with a required response were generated during the study period. The customized configuration had a higher rate of appropriateness when compared to the non-customized configuration regardless of how indeterminate responses were classified (p < 0.001). When comparing cohorts, appropriateness was significantly higher in the customized configuration regardless of the classification of indeterminate responses (p < 0.001) with one exception: when indeterminate responses were considered inappropriate for the cohort of providers that were first exposed to the non-customized list (p = 0.103). Free-text use was higher in the customized configuration overall (p < 0.001), and there was no difference in nonsensical response between configurations (p = 0.39).ConclusionThere is a benefit realized by using a customized list for medication override reasons. Poor application design or configuration can negatively affect provider behavior when responding to important medication alerts.     

Disappointing evaluation of a shared decision-making intervention for residents and orthopaedic surgeons

ObjectiveTo evaluate a shared decision-making (SDM) intervention in orthopaedic hip and knee osteoarthritis care.MethodsUsing a pre- post intervention design study, we tested an intervention, that included a decision aid for patients (ptDA) and a SDM training course for residents in training and orthopaedic surgeons. The theory of planned behaviour was used for intervention development. Primary outcomes included patient reported decisional conflict, SDM, and satisfaction. Secondary outcomes were physicians’ attitude and knowledge, and uptake of the ptDA.Results317 patients were included. The intervention improved physicians’ knowledge about SDM but had no effect on the primary outcomes. 19 eligible patients used the ptDA (17%). SDM was higher for middle educated patients compared to lower educated (mean difference 9.91, p = 0.004), patients who saw surgeons instead of residents (mean difference 5.46, p = 0.044) and when surgery was chosen and desired by patients compared to situations where surgery was desired but not chosen (mean difference 15.39, p = 0.036).ConclusionOur multifaceted intervention did not improve SDM and ptDA uptake was low.Practice ImplicationsIn orthopaedic hip and knee osteoarthritic care other ways should be explored to successful implement SDM. Since residents received lower SDM scores, special focus should go to this group.     

The effect of multimedia-based education on students’ anger management skill

IntroductionAnger leads to behaviors that cause a lot of damage. Life skills training can be effective in controlling anger because anger is due to a lack of skills and unpredictability of the situation. The present study aimed to determine the effect of multimedia-based education on students’ anger management skill.Material and methodsThe quasi-experimental study was performed on 88 students of Anesthesiology, Nursing, Midwifery and Operating Room of North Khorasan Nursing and Midwifery School. The educational content was screened through the monitor in front of the main hall of the Nursing & Midwifery School during the students’ attendance for one week. Students’ anger control skills were assessed by tests paired T-test, independent T-test and one-way ANOVA. Data were analyzed using spss16 software.ResultsThe mean age of the students was 20 ± 2.3. Regarding the effect of multimedia-based education on students’ anger control skills, the mean of anger control score was 24.61 ± 2.83 (Min = 11 and Max = 33) before the intervention, and 28.64 ± 2.40 after the intervention. There was a significant difference in mean scores before and after the intervention (P = .000).ConclusionMultimedia-based education has been effective in controlling students’ anger. Given the effect of multimedia-based education on anger control skills, this approach can be used to teach other essential topics to students, including life skills, especially in health science students.     

The impact of expert- and peer feedback on communication skills of undergraduate dental students – a single-blinded,randomized, controlled clinical trial

ObjectiveTo evaluate the effect of peer- and expert feedback on communication skills of undergraduate dental students.MethodsAll students of the first clinical treatment course (n = 46) were randomly assigned into two groups. For three times a medical-dental interview/consultation of each student with a real patient was videotaped. After every consultation the videos were assessed either by a person experienced in communication (expert group) or by a fellow student (peer group), giving the students feedback regarding their chairside performed communication skills. Before and after the feedback-interventions all students conducted an interview with simulated patients, which was rated using a validated global rating and analyzed statistically.ResultsGlobal ratings mean scores after feedback-intervention were significantly improved (p < 0.05). Thereby, no significant differences in the overall assessment could be observed between expert and peer feedback (p > 0.05).ConclusionDuring this study students improved their communication skills in dentist-patient interactions. The communication experience of the feedback provider seems not to have any impact on the communication skills in undergraduate dental students.Practice implicationsThe clinical courses in dentistry offer the opportunity to implement peer-feedback interventions in real treatment situation as part of communication training to longitudinally improve communication skills.     

Patient satisfaction after primary total and unicompartmental knee arthroplasty: An age-dependent analysis

BackgroundPatient-related outcomes have become the focus of increased attention when assessing knee arthroplasty.MethodsWe retrieved questionnaires from 485 (584 knees) patients at a minimum of 3 years after undergoing primary knee arthroplasty. We excluded bilateral knee arthroplasty, leaving 141 UKA and 245 TKA who rated their satisfaction and expectation regarding pain, range of motion (ROM), daily living function (DLF), return to recreational activity (RRA) and ability to kneel (ATK) on a scale of 0 (worst) to 10 (best). We further collected data on pain level and the modified Cincinnati rating scale. Range of motion was documented pre- and postoperatively at a minimum of six months. The cohort was subdivided into three age groups and compared with each other (Group 1: < 55, n = 113; Group 2: 55–64, n = 117; Group 3: 65 +, n = 155).ResultsAverage satisfaction with pain, ROM and ATK for patients under 55 was higher for UKA than for TKA. Patients > 65 with TKA were on average more satisfied than patients with UKA in these three items. However, patients under 55 with UKA were up to 2.9 times more likely to have their expectations met when compared to patients receiving TKA. Patients with UKA under 55 rated their joint as good/excellent in 96.0% versus patients in the same age group with TKA in 81.0%.ConclusionsWe found that overall, younger patients who were treated with UKA demonstrated higher satisfaction scores in most subsets when compared with the patients of the same age group who received TKA.     

Designing,delivering and evaluating a distance learning nursing course responsive to students needs

Background and purposeThe majority of available studies in distance learning in nursing and health lack the sufficient details of course design and delivery processes which greatly affect the learning outcomes. Also, little is available about the fairness of this method of education to students with limited access to course resources. We describe the design and delivery processes and experience, in terms of satisfaction and achievement, of undergraduate nursing students in a distance course. The difference in achievement between the distance students and a comparable cohort of hybrid students is also examined. We also demonstrate the possibility of providing accessible education to students with limited technological resources.MethodsParticipants included all undergraduate nursing students who were enrolled in a distance and a hybrid section of a communication skills course offered at a School of Nursing in Jordan. The distance course was created using Blackboard and Tegrity learning management systems. The design and delivery processes of the distance course incorporated three pedagogical principles that enhance: (a) course access and navigation; (b) communication and interaction; and (c) active and collaborative learning experiences. After course completion, distance students completed a 27-item satisfaction questionnaire. Achievement in the course and correlates of satisfaction were measured.ResultsThe final sample included 25 students in the distance section and 35 in the hybrid section (N = 60). The mean score of overall satisfaction in the distance section was 4.14 (0.32) out of a 5-point scale, indicating a high satisfaction. Results revealed significant associations between total satisfaction score and achievement in the distance course, grade expected in the course, and frequency of accessing the course materials (p < .05). All distance students, including students with limited technological resources available at home, managed to successfully complete the course. Major concerns reported by distance students were related to lack of time management skills and negative attitudes toward group assignments. The mean final course grade of the distance section (80 ± 8.2) was significantly higher than the hybrid section (72.2 ± 9.5), (t = 3.5, p < .05).ConclusionsThe use of effective instructional strategies resulted in delivering successful distance learning, even for students with limited resources. Institutions have to make strategic decisions on how to optimize the use of technology to fit their individualized learning environments. Instructors need to become familiar with the characteristics of students cohort served by the course and design the course accordingly. In addition, students should be guided on how to manage their time in distance learning environments and work effectively in group assignments.     

Specific technological communication skills and functional health literacy have no influence on self-reported benefits from enrollment in the TeleCare North trial

PurposeThe Danish TeleCare North trial has developed a telehealth system, Telekit, which is used for self-management by patients diagnosed with chronic obstructive pulmonary disease (COPD). Self-management is the engagement in one’s own illness and health by monitoring and managing one’s symptoms and signs of illness. The study examines the association between COPD patients’ use of Telekit and their functional health literacy and the association between their use of Telekit and their specific technological communication skills.MethodsA consecutive sample of participants (n = 60) from the TeleCare North trial were recruited. Face-to-face interviews were conducted with each participant to collect demographic data. Functional health literacy was measured with the Danish TOFHLA test. Participants completed a non-standardised questionnaire about their health status, their use of the Telekit system, and their specific technological communication skills. Binary logistic regressions were performed to examine how functional health literacy and specific technological communication skills influenced the use of Telekit by giving users an enhanced sense of freedom, security, control, and a greater awareness of COPD symptoms.ResultsParticipants (27 women, 33 men) had a mean age of 70 (SD: 8.37) years. Functional health literacy levels were classified as inadequate in 14 (23%) participants, as marginal in 12 (20%), and as adequate in 34 (57%). Participants self-reported a feeling of increased security (72%), greater freedom (27%), more control (62%), and greater awareness of symptoms (50%) when using Telekit. The use of Telekit was not significantly associated with levels of functional health literacy or with the number of specific technological communication skills (p > 0.05) based on the binary logistic regressions.ConclusionThe enhanced sense of security, freedom, control, and the greater awareness of COPD symptoms achieved by using Telekit were unassociated both with the patients’ score of functional health literacy and with their specific technological communication skills. On the basis of our results it seems that the specific technological communication skills and functional health literacy are not a prerequisite for the use of the Telekit system.     

SMS reminders improve adherence to oral medication in type 2 diabetes patients who are real time electronically monitored

BackgroundPoor adherence to oral antidiabetics has a negative influence on glycaemic control in type 2 diabetes patients. Real Time Medication Monitoring (RTMM) combines real time monitoring of patients’ medication use with SMS reminders sent only if patients forget their medication, aiming to improve adherence. This study aimed to investigate the effect of these SMS reminders on adherence to oral antidiabetics in patients using RTMM and investigate patients’ experiences with RTMM.MethodsData were collected in a RCT involving 104 type 2 diabetes patients with suboptimal adherence to oral antidiabetics. Fifty-six patients were randomised to receive SMS reminders if they forgot their medication, 48 patients received no reminders. Primary outcome measure was adherence to oral antidiabetics registered with RTMM, measured as: (1) days without dosing; (2) missed doses; (3) doses taken within predefined standardized time windows. Patients’ experiences were assessed with written questionnaires.ResultsOver the six-month study period, patients receiving SMS reminders took significantly more doses within predefined time windows than patients receiving no reminders: 50% vs. 39% within a 1-h window (p = 0.003) up to 81% vs. 70% within a 4-h window (p = 0.007). Reminded patients tended to miss doses less frequently than patients not reminded (15% vs. 19%, p = 0.065). Days without dosing were not significantly different between the groups. The majority of patients reported positive experiences with RTMM and SMS reminders.ConclusionRTMM with SMS reminders improves adherence of type 2 diabetes patients, especially the precision with which patients follow their prescribed regimen, and is well accepted by patients.Trial registrationNetherlands Trial Register NTR1882.