ABSTRACT
BACKGROUND: Alcohol dependence is common, yet highly undertreated. Smartphone applications (apps) have potential to enhance treatment accessibility and effectiveness, however evidence is limited, especially studies focussing on user experiences. The aim was to describe patient perceptions on the usability and acceptability of self-monitoring apps provided as treatment complement for alcohol dependence. METHODS: Individual semi-structured interviews were conducted through video or phone calls with 21 participants, recruited from a randomized controlled trial at a dependency clinic in Stockholm. The participants had used two specific apps for self-monitoring consumption ("Glasklart" and "iBAC") during 12 wk prior to the interviews. Data was analyzed using Qualitative Content Analysis. RESULTS: Two domains were identified: 1) Smartphone applications as facilitators to treatment, and 2) Barriers to smartphone application use. Using apps within the treatment context was believed to increase the accuracy of the reported consumption. Participants became more aware of their alcohol problem and described the apps as reinforcers that could increase both the motivation to change and the focus on the problem and commitment to treatment. The apps were further described as helpful to control alcohol consumption. However, app usage was constrained by technical problems, unfit app-specific features and procedures, and alcohol-related shame and stigma. DISCUSSION AND CONCLUSIONS: Self-monitoring alcohol apps have several beneficial features that can help assess, track, and control alcohol consumption, and improve communication with clinicians. The results indicate they can be useful complements to treatment for patients with alcohol dependence, but their use can be limited by different, foremost technical, issues.
Smartphone applications for self-monitoring of alcohol consumption may help provide accurate data, increase consumption awareness, focus, motivation, and perceived control;Smartphone applications for self-monitoring of alcohol consumption are considered helpful complements to alcohol treatment;The use of smartphone applications for self-monitoring of alcohol consumption can be constrained by technical problems, and unfit app-specific features and procedures.
Subject(s)
Alcoholism , Mobile Applications , Humans , Alcoholism/therapy , Smartphone , CommunicationABSTRACT
BACKGROUND: By 2050, the percentage of the population older than 80 years will double, and some data suggest that elderly patients receive less advanced treatment. Information of outcome in elderly (≥ 65 year), representing roughly half the intensive care unit (ICU) admissions, in Sweden is scarce. METHODS: Retrospective cohort study. We included all critically ill patients aged 65 or older (n = 605), admitted to the ICU during the years 2010-2011. Patients were categorized into two age groups: 65-79 (64%) and above 80 (36%). Demographic and epidemiology data were registered, as well as primary diagnosis, Simplified Acute Physiology Score III (SAPS III) mortality (ICU and hospital), withhold/withdraw life-sustaining treatment, the ICU workload, length of stay (ICU and hospital) and discharge location. RESULTS: Hospital mortality was significantly higher in patients above 80 years compared with patients 65-79 years of age (33.7% vs. 22.8%). These patients received less treatment and obtained more limitations in care (withhold/withdraw life-sustaining treatments). Patients above 80 years received less invasive ventilatory support (28.3% vs. 37.8%) and shorter length of invasive ventilatory support (1.1 ± 3.9 vs. 2.9 ± 7.4) compared with patients aged 65-79. In multivariate analysis, patients ≥ 80 years received less mechanical ventilation and more limitations in care even after adjustment for SAPS III and comorbidity. CONCLUSIONS: Patients above 80 years received less treatment and obtained more limitations in life-sustaining treatments compared with patients aged 65-79, even after adjustment for severity of illness and comorbidity.
