The Role of Digital Technology and New Strategies in Engagement and Adherence Among Patients With Cardiometabolic Disease

Abstract This article explores challenges and barriers to managing cardiometabolic conditions, highlighting strategies and technologies for improving patient adherence. Approaches such as simplifying prescriptions, patient empowerment, health education, setting short-term goals, understanding social context, self-monitoring, and gamification have been effective in promoting adherence. The use of health apps for chronic diseases has also been increasing, facilitating medication adherence and self-monitoring. Integrating these approaches into clinical practice can lead to consistent outcomes and reduce care-associated costs.

Surgery remember@: an innovation to reduce surgical cancellations / Surgery remember@: uma inovação para reduzir os cancelamentos cirúrgicos

ABSTRACT The use of mobile phones has dramatically increased all over the world. Such revolution in the communication amongst individuals has a great impact in patient care, supporting their self-management and promoting shared responsibility with health services. Given that improved communication facilitates compliance with scheduled procedures and reduces surgical cancellations, the current work aims to develop a communication tool named Surgery Remember@ to mitigate surgical suspensions due to patient absenteeism. The present article is a study of technological production divided into four chapters: literature review; analysis of the hospital administrative profile; software development; and process mapping for software implementation. Taking into account that in the last three years the problem of absenteeism was the main cause of institutional surgical cancellations; the development of Surgery Remember@ endeavours to reduce surgery cancellations, improving efficiency and reducing costs. It is known that sending messages three days before the surgical procedure makes it possible to replace patients in the event of cancellations, optimizing the human and material resources in the operating room. The confirmation of the pre-aesthetic consultation is also positive, for it allows the verification of perioperative assistance improvement. Hence, besides being viable and easy to implement, the software developed allows the addition of other features based on user requirements, proving to be an asset to reduce surgery cancellations.

RESUMO O uso de telefones celulares aumentou dramaticamente em todo o mundo. Essa revolução na comunicação entre os indivíduos tem impacto no cuidado ao paciente, apoiando sua autogestão e promovendo a responsabilidade compartilhada com os serviços de saúde. Tendo em vista que a melhoria da comunicação facilita o cumprimento dos procedimentos programados e reduz os cancelamentos cirúrgicos, o presente trabalho tem como objetivo desenvolver uma ferramenta de comunicação denominada Surgery Remember@ para mitigar as suspensões cirúrgicas por absenteísmo do paciente. O presente artigo é um estudo da produção tecnológica dividido em quatro capítulos: revisão de literatura; análise do perfil administrativo do hospital; desenvolvimento de software; e mapeamento de processos para implementação de software. Tendo em conta que nos últimos três anos o problema do absenteísmo foi a principal causa de cancelamentos cirúrgicos institucionais o desenvolvimento do Surgery Remember@ se apresenta como esforço para reduzir os cancelamentos de cirurgias, melhorando a eficiência e reduzindo custos. Sabe-se que o envio de mensagens três dias antes do procedimento cirúrgico possibilita a reposição de pacientes em caso de cancelamentos, otimizando os recursos humanos e materiais da sala cirúrgica. A confirmação da consulta pré-anestésica também é positiva, pois permite verificar a melhora da assistência perioperatória. Assim, além de viável e de fácil implementação, o software desenvolvido permite agregar outros recursos de acordo com a necessidade do usuário, mostrando-se uma ferramenta para redução de cancelamentos cirúrgicos.

The use of an electronic medication organizer device with alarm to improve medication adherence of older adults with hypertension / Uso de um dispositivo eletrônico organizador de medicamentos com alarme para melhorar a adesão medicamentosa de idosos com hipertensão

ABSTRACT Objective: To examine whether the use of a monthly electronic medication organizer device equipped with an alarm clock, called Electronic System for Personal and Controlled Use of Medications (Supermed), improves medication adherence of older adults with hypertension. Methods: This is a quali-quantitative, prospective, before-and-after study performed with 32 older adult patients with diagnosis of hypertension, who were recruited at a Primary Care Unit in Brazil. Results: The main outcome measures were improvement of medication adherence and blood pressure control after intervention with Supermed. Regarding medication adherence, 81.2% of patients were "less adherent" in the pre-intervention period, and 96.9% were "more adherent" in the post-intervention period. This means that 78.1% of patients changed from "less adherent" to "more adherent" after the intervention with Supermed (p<0.001). The mean systolic and diastolic blood pressure differences between intervention day and post-intervention were 18.5mmHg (p<0.0001) and 4.3mmHg (p<0.007), respectively, and the differences between mean systolic and diastolic blood pressure between pre-intervention and post-intervention were 21.6mmHg (p<0.001) and 4.7mmHg (p<0.001) respectively. Conclusion: The use of Supermed significantly improved self-reported medication adherence and blood pressure control in a hypertensive older adult population.

RESUMO Objetivo: Avaliar se o uso de um dispositivo organizador de medicamentos eletrônico, mensal, equipado com um despertador, chamado Sistema Eletrônico para Uso Personalizado e Controlado de Medicamentos (Supermed), melhora a adesão à medicação de idosos com hipertensão. Métodos: Trata-se de um estudo qualiquantitativo, prospectivo, antes e depois, realizado com 32 pacientes idosos, com diagnóstico de hipertensão, recrutados em uma Unidade Básica de Saúde do Brasil. Resultados: Os principais desfechos foram a melhor adesão à medicação e o controle da pressão arterial após a intervenção com Supermed. Quanto à adesão medicamentosa, 81,2% dos pacientes eram "menos aderentes" no período pré-intervenção, e 96,9% eram "mais aderentes" no período pós-intervenção. Isso significa que 78,1% dos pacientes mudaram de "menos aderentes" para "mais aderentes" após a intervenção com Supermed (p<0,001). As diferenças da pressão arterial sistólica e diastólica média entre o dia da intervenção e pós-intervenção foram 18,5mmHg (p<0,0001) e 4,3mmHg (p<0,007), respectivamente, e as diferenças entre as médias da pressões arteriais sistólica e diastólica entre os períodos pré-intervenção e pós-intervenção foram de 21,6mmHg (p<0,001) e 4,7mmHg (p<0,001), respectivamente. Conclusão: O uso de Supermed melhorou de forma significativa a adesão medicamentosa e o controle da pressão arterial em uma população idosa hipertensa.

Recordatorio a través de múltiples cartas para vacunación contra influenza / Multiple mail reminders to increase adherence to influenza vaccination

INTRODUCCIÓN: Distintas intervenciones han sido propuestas para reforzar el uso de la vacuna contra la influenza. El uso de recordatorios, ya sea a través de cartas, llamadas telefónicas, panfletos o aplicaciones tecnológicas, entre otras, ha destacado dentro de aquellas orientadas a incrementar la adherencia al tratamiento. Sin embargo, su efectividad no está clara. En este resumen, que forma parte de una serie de evaluaciones de recordatorios, se abordará el envío de múltiples recordatorios enviados por correo. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta-análisis y prepara-mos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyeron 35 estudios primarios, de los cuales cuatro corresponden a ensayos aleatorizados que analizan el uso de múltiples recordatorios enviados por correo. Concluimos que más de un recordatorio enviado por correo probablemente aumenta la adherencia a vacunación contra influenza en pacientes mayores de 60 años, mien-tras que podría resultar en poca o nula diferencia en menores de 6 años, pero la certeza de la evidencia es baja.

INTRODUCTION: Different interventions have been proposed to reinforce the use of the influenza vaccine. The use of reminders, whether through letters, phone calls, pamphlets or technological applications, among others, has stood out among those aimed at increasing ad-herence to treatment. However, its effectiveness is not clear. In this summary, which is part of a series of reminder evaluations, we assess the use of multiple mail reminders. METHODS: We conducted a search in Epistemonikos, the largest database of systematic health reviews, which is maintained by screening multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted the data from the identified reviews, analyzed the data from the primary studies, performed a meta-analysis and prepared a summary table of the results using the GRADE method. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including 35 primary studies, of which four analyze the use of more than one letter as a reminder. We conclude that the use of multiple mail reminders probably increase adherence to influenza vaccination in patients over 60; while it may make little or no difference in children under 6 years, but the certainty of the evidence is low.

Recordatorio enviado por correo postal para aumentar adherencia a vacunación contra influenza / Reminder sent by mail to increase adherence to influenza vaccination

INTRODUCCIÓN Distintas intervenciones han sido propuestas para reforzar el uso de la vacuna contra la influenza. El uso de recordatorios, ya sea a través de cartas, llamadas telefónicas, panfletos o aplicaciones tecnológicas, entre otras, ha destacado dentro de aquellas orientadas a incrementar la adherencia al tratamiento. Sin embargo, su efectividad no está clara. En este resumen, el primero de una serie de evaluación de recordatorios, se abordará el uso de un recordatorio enviado por correo. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta-análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos ocho revisiones sistemáticas que en conjunto incluyeron 35 estudios primarios, de los cuales, 32 corresponden a ensayos aleatorizados. Concluimos que un recordatorio enviado por correo probablemente aumenta la adherencia a vacunación contra influenza en todos los grupos etarios (población adulta, mayores de 60 años y menores de 18 años).

INTRODUCTION Different interventions have been proposed to improve influenza vaccine coverage. The use of reminders, through letters, phone calls, pamphlets or technological applications, among others, has stood out among the different alternatives to increase adherence to vaccination. However, its effectiveness is not clear. In this summary, the first of a series of evaluation of reminders will address the use of a reminder sent by mail. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the identified reviews, analyzed the data from the primary studies, performed a meta-analysis and prepared a summary table of the results using the GRADE method. RESULTS AND CONCLUSIONS We identified eight systematic reviews that included 35 primary studies, of which 32 correspond to randomized trials. We concluded that a reminder sent by mail, probably increase adherence to influenza vaccination in all age groups (adult population, over 60 an under 18)

Effectiveness of text messages, calls and e-mail on adherence to medical appointments. Review of systematic reviews and meta-analysis / Eficacia de los mensajes de texto, llamadas y e-mail en la adherencia a citas médicas. Revisión de revisiones sistemáticas y metaanálisis

Abstract Background: Mobile phones and all other forms of modern communication such as the Internet and instant messaging applications have become tools to improve attendance rates for medical appointments. Objectives: To evaluate the effectiveness of reminders to improve adherence to medical appointments. Methods: An overview of studies comparing the effectiveness and attendance rates for medical appointments between patients that did and did not receive reminders. Also, a meta-analysis was conducted to estimate the overall effect of keeping appointments depending on the age of the patients. Results: Seven reviews were identified which show that Short Message Service (SMS) improves adherence to medicai appointments. However, the meta-analysis showed a relative risk of 1,09 (CI 95%: 1,03 -1,11) for people with ages between 24 - 40 and 1,09 (CI 95% 1,05 - 1,14) for people with ages between 50 - 63, with regard to appointment assistance via SMS. Conclusions: The use of SMS reminders has a positive impact on medical appointment attendance. However, while reviewing the impact by age groups no differences were found.

Resumen Antecedentes: El teléfono móvil y cualquier forma de comunicación moderna como la Internet y las aplicaciones de mensajería instantánea se han convertido en herramientas para mejorar la tasa de asistencia a citas médicas. Objetivos: Evaluar la eficacia de los recordatorios para mejorar la adherencia a citas médicas. Métodos: Análisis de revisiones sistemáticas de estudios que comparan la efectividad y las tasas de asistencia a las citas entre los pacientes que reciben o no reciben recordatorios. Además, se realizó un metaanálisis para calcular el efecto global de la asistencia a citas en función de la edad de los pacientes. Resultados: Se identificaron siete revisiones que muestran que los mensajes de texto corto mejoraron la adherencia a las citas médicas. En el metaanálisis, agrupado por edad, se encontró un Odds Ratio de 1,09 (IC 95 %: 1,03 -1,11) en personas entre 24 - 40 años y de 1,09 (IC 95 %: 1,05 - 1,14) para las personas 50 a 63 años, respecto a la asistencia a citas mediante mensajes de texto corto. Conclusiones: El uso de los recordatorios vía mensajes de texto corto presenta un impacto positivo frente a la asistencia de las citas médicas. Sin embargo, al revisar el impacto por grupos de edad no encontramos diferencias.

O padrão etário na dinâmica temporal da dengue no Brasil

Dengue é uma doença viral provocada por quatro sorotipos de arbovírus e transmitida aos seres humanos por mosquitos do gênero Aedes. A dispersão geográfica dos vetores e dos vírus levou a uma reemergência global deste agravo, com destaque para as epidemias e o aparecimento de formas graves nosúltimos anos. Se, por um lado, as recentes publicações revelam baixo impacto nas estratégias de controle vetorial para dengue, por outro lado, houve grande expectativa com o lançamento de vacinas para a prevenção da doença. Em vários países onde a ocorrência de dengue é relevante, a distribuição dos casos por faixa etária não é homogênea, levantando dúvidas sobre quais os fatores interferem na dinâmica da incidência de dengue segundo a idade. Objetivo: Caracterizar o padrão de incidência de dengue e dengue grave ao longo do tempo segundo a faixa etária no período de 2007 a 2012 nas capitais estaduais brasileira.Métodos: Foi realizada a seleção das capitais com maior taxa de incidência entre as séries de dengue edengue grave por faixa etária em cada região do país para prosseguimento da pesquisa, totalizando a análise estatística de 4 capitais, referentes a suas respectivas regiões: Rio Branco (Região Norte), Aracaju(Região Nordeste), Cuiabá (Região Centro-Oeste) e Vitória (Região Sudeste). Seguiu-se a regressão das curvas de incidência de dengue e dengue grave, segundo faixa etária ao longo do tempo, utilizando Modelos Lineares Generalizados com distribuição de probabilidade de Poisson. Resultados e Discussão:Em função da análise exploratória das séries, foram construídos dois modelos de Poisson que incluíram como variáveis dependentes um termo autorregressivo, o grupo etário (<15 e ≥15 anos) e o tempo; no segundo modelo de Poisson, incluiu-se ainda um termo de interação entre o grupo etário e o tempo...

Dengue is a viral disease caused by 4 serotypes of arbovirus and transmitted to humans byAedes mosquitoes. The geographical dispersion of these vectors and viruses has led to a globalresurgence of this disease, with the occurrence of epidemics and the appearance of severe forms in thelast years. Prior studies have shown that vector control can have only limited impact on dengueincidence. We currently have 2 vaccines available to prevent dengue and there is great expectationwith the application of these vaccines on a large scale. In several countries where the incidence ofdengue is relevant, the distribution of cases by age group is not homogeneous, raising questions aboutwhich factors influence the dynamics of dengue incidence according to age. Objective: To characterizethe pattern of the incidence of dengue and severe dengue over time according to age group from 2007to 2012 in the Brazilian state capitals. Methods: Brazilian capitals with highest incidence rate ofdengue and severe dengue by age group in each region of the country were selected for furtherresearch, totaling the statistical analysis of 4 capitals, referring to their respective regions: Rio Branco(North Region), Aracaju (Northeast), Cuiabá (Midwest Region) and Vitória (Southeast). The incidencerate of dengue and severe dengue, according to age over time, were modeled using Generalized LinearModels with Poisson probability distribution. Results and Discussion: Descriptive statistics guided thecreation of two models that included an autoregressive term, age group and time as explanatoryvariables. The second model included also an interaction term of age group and time. In cases ofdengue in Rio Branco, Aracaju and Vitoria, the age group ≥15 years had a incidence rate that wassignificantly higher than that observed among those who were <15 years...

Development and Evaluation of a Smartphone Application for Managing Gestational Diabetes Mellitus / 대한의료정보학회지

OBJECTIVES: The purpose of this study was to develop and evaluate an application (app) that provides tailored recommendations based on lifestyle and clinical data entered by the user. METHODS: Knowledge and functions required for the gestational diabetes mellitus (GDM) management app were extracted from clinical practice guidelines and evaluated through an online survey. Common and tailored recommendations were developed and evaluated with a content validity index. Algorithms to link tailored recommendations with a patient's data were developed and evaluated by experts. An Android-based app was developed and evaluated by comparing the process of data entry and recommendation retrieval and the usability of the app. After the app was revised, the user acceptance of the app was evaluated. RESULTS: Six domains of knowledge and 14 functions were extracted. Seven common and 49 tailored recommendations were developed. Nine lifestyle and clinical data elements were modeled. Eight algorithms with 18 decision nodes presenting tailored recommendations based on patient's data and 12 user interface screens were developed. All recommendations obtained from the use of app concurred with recommendations derived by algorithms. The average usability score was 69.5 out of 100. The user acceptance score with behavioral intention to use was 5.5, intrinsic motivation 4.3, the perceived ease of use score was 4.6, and the perceived usefulness score was 5.0 out of 7, respectively. CONCLUSIONS: The GDM management knowledge and tailored recommendations obtained in this study could be of help in managing GDM.

Warning systems in a computerized nursing process for Intensive Care Units / Sistemas de alerta em um processo de enfermagem informatizado para Unidades de Terapia Intensiva / Sistemas de alerta en el proceso de enfermeria informatizado en Unidades de Terapia Intensiva

A hybrid study combining technological production and methodological research aiming to establish associations between the data and information that are part of a Computerized Nursing Process according to the ICNP® Version 1.0, indicators of patient safety and quality of care. Based on the guidelines of the Agency for Healthcare Research and Quality and the American Association of Critical Care Nurses for the expansion of warning systems, five warning systems were developed: potential for iatrogenic pneumothorax, potential for care-related infections, potential for suture dehiscence in patients after abdominal or pelvic surgery, potential for loss of vascular access, and potential for endotracheal extubation. The warning systems are a continuous computerized resource of essential situations that promote patient safety and enable the construction of a way to stimulate clinical reasoning and support clinical decision making of nurses in intensive care.

Estudio híbrido de producción de tecnología y de investigación metodológica. El objetivo fue establecer las asociaciones entre: los datos y la información que integra el Proceso de Enfermería Informatizado a partir de la CIPE® versión 1.0, los indicadores de Seguridad del Paciente y los Indicadores de la Calidad de la Atención, a partir de la orientación de la Agency for Healthcare Research and Quality y de la American Association of Critical-Care Nurses para la expansión de los sistemas de alerta. Se desarrollaron cinco sistemas de alerta para los siguientes problemas potenciales: neumotórax iatrogénico, infecciones secundarias a la atención de salud, dehiscencia de herida quirúrgica abdominal o pélvica en pacientes en el postoperatorio, pérdida del acceso vascular y extubación endotraqueal. Los sistemas de alerta son un recurso informatizado continuo de situaciones esenciales que promueven la seguridad del paciente y que permiten además de construir un modo de estimular el raciocinio clínico, apoyar la toma de decisiones clínicas de enfermería en terapia intensiva.

Estudo híbrido que combinou produção tecnológica e pesquisa metodológica com o objetivo de estabelecer associações entre os dados e as informações que integram um Processo de Enfermagem Informatizado baseado na CIPE® versão 1.0, indicadores de segurança do paciente e indicadores de qualidade do cuidado. Fundamentados nas orientações da Agency for Healthcare Research and Quality e da American Association of Critical Care Nurses para a ampliação dos sistemas de alerta, foram desenvolvidos cinco sistemas de alerta: potencial para pneumotórax iatrogênico, potencial para infecções secundárias ao cuidado prestado, potencial para deiscência de sutura no pós-operatório de pacientes de cirurgia abdominal ou pélvica, potencial para perda de acesso vascular e potencial para extubação endotraqueal. Os sistema de alerta são um recurso informatizado contínuo de situações essenciais que promove a segurança do paciente e permite construir um modo de estimular o raciocínio clínico e apoiar a tomada de decisão clínica do enfermeiro em Terapia Intensiva.

Comparison of the Quality of Bowel Preparation for Double Contrast Barium Enema According to Remind Calls: A Double-Blind Clinical Trial / 가정의학회지

BACKGROUND: Adequate bowel preparation is essential for accurate double-contrast barium enema (DCBE) examination. Several protocols have been performed including controlled diet, split dosage of cathartic, fasting dinner 1 day before the exam. The aim of this study was to compare the effect of remind calls on the quality of bowel preparation. METHODS: We conducted a clinical trial for 248 subjects who did DCBE at the health promotion center of a single hospital. One hundred and seven patients received instructions and remind calls one day before starting bowel preparation, and the others received only instructions. Two specialized radiologists rated the quality of bowel preparation on a scale of excellent/good/fair/poor. In addition, we collected data for age, sex, education, income, and the reason for the exam with a detailed questionnaire. RESULTS: The basal characteristics of subjects between 'remind call' and 'no remind call' groups were similar except age (57.0 +/- 9.8 years, 54.4 +/- 8.1 years, respectively P = 0.021). The proportion of 'excellent' was higher in the 'remind call' group (35.5%) than in the 'no remind call' group (23.4%) with statistical significance (P = 0.037). The adjusted odds ratio was 2.015 for 'remind calls' (P = 0.017), and 0.958 for age (P = 0.011). CONCLUSION: Remind calls and age were associated with the quality of bowel preparation. Remind calls increased the proportion of 'excellent' quality of bowel preparation, which can help accurate assessment.

Is the Use of Physician Reminder Sticker on Medical Records Effective for Improving the Rate of Recommending Influenza Vaccination?

BACKGROUND: For people who have high risk diseases or who are aged 65 years or more, routine influenza vaccination is required. However, in Korea, influenza vaccination rate of such people is low. We performed a study to assess the effectiveness of physician reminder in improving the rate of recommending influenza vaccination. METHODS: Among the patients who registered to tertiary care hospital family clinic center, 305 patients with diabetes mellitus or aged 65 years or more were randomly assigned into physician reminder group and control group. After excluding the patients who were vaccinated before the medical consultation or who did not attend the clinic, remaining 253 patients were included as final study subjects. For the physician reminder group, a sticker showing that influenza vaccination was needed was placed on each medical record. Demographic and clinical characteristics, recommendation of vaccination by physician, and the receipt of vaccination were checked through self-administered questionnaires, review of medical chart and order communication system, and telephone interview. RESULTS: The rates of recommending vaccination in the physician reminder group and the control group were 36% and 29.7%, respectively. The difference between the two groups was not significant. Vaccination rate in patients for whom influenza vaccination was recommended by their physician was 87.0%, whereas those for whom vaccination was not recommended was only 41.2%. CONCLUSION: Physician reminder for influenza vaccination was not effective in this study. However, the physician's recommendation was effective in improving the influenza vaccination rate. Effective strategies will be needed to encourage physicians to recommend influenza vaccination.