Mobile Phone Technology for Children with Type 1 and Type 2 Diabetes: A Parent Survey
Pena V, Watson AJ, Kvedar JC, Grant RW. Mobile phone technology for children with type 1 and type 2 diabetes: a parent survey. J Diabetes Sci Technol. 2009 Nov 1;3(6):1481-9. PubMed PMID: 20144404.Read More...
The novel application of information technology has the potential to improve care for children with diabetes. We surveyed parents of children with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) to (1) identify their concerns related to their children's diabetes and (2) assess the relationship between these concerns and parental attitudes toward a glucometer integrated into a mobile phone that could provide parents and health care providers with a child's real-time glucose readings via text message and a secure Web site.
We conducted a cross-sectional Web-based survey of parents with children ages 10-19 years (125 with T1DM and 77 with T2DM). Parental concerns were grouped by (1) access to their child's provider, (2) parenting challenges, and (3) knowledge about managing their child's diabetes.
Parental concerns focused mostly on access to their child's health care provider. Over half of respondents expressed interest in subscribing to a mobile-phone-based service. In multivariate logistic regression models, the odds of being willing to use the service increased if parents had concerns about provider access, a child with T2DM, a college education, or currently subscribed to text messaging. Enthusiasm decreased with increasing annual service cost.
Study participants-particularly parents with provider access concerns or a child with T2DM-were receptive to adopting novel health technology to help manage their children's diabetes. Adoption of such tools is most likely driven by the unmet needs of parents.
Text-Message Reminders to Improve Sunscreen Use: A Randomized, Controlled Trial Using Electronic Monitoring
Armstrong AW, Watson AJ, Makredes M, Frangos JE, Kimball AB, Kvedar JC. Text-message reminders to improve sunscreen use: a randomized, controlled trial using electronic monitoring. Arch Dermatol. 2009 Nov;145(11):1230-6. doi: 10.1001/archdermatol.2009.269. PubMed PMID: 19917951.Read More...
To evaluate the effectiveness of cellular telephone text messaging as a reminder tool for improving adherence to sunscreen application.
We conducted a randomized, controlled trial of the effect of an electronic text-message reminder system on adherence to sunscreen application. Adherence to daily sunscreen use was evaluated using a novel electronic monitoring device.
Participants were recruited from the general community.
Seventy participants constituted a volunteer sample from the general community. The inclusion criteria required participants to be 18 years or older, to own a cellular telephone with text-message features, and to know how to retrieve text messages. Intervention Half of the participants received daily text-message reminders via cellular telephone for 6 weeks, and the other half did not receive reminders. The text-message reminders consisted of 2 components: a "hook" text detailing daily local weather information and a "prompt" text reminding users to apply sunscreen. Main Outcome Measure The primary end point of the study was adherence to sunscreen application measured by the number of days participants applied sunscreen during the 6-week study period.
All 70 participants completed the 6-week study. There were no statistically significant differences in baseline characteristics between the 2 study groups. At the end of the study period, the 35 participants who did not receive reminders had a mean daily adherence rate of 30.0% (95% confidence interval, 23.1%-36.9%). In comparison, the 35 participants who received daily text-message reminders had a mean daily adherence rate of 56.1% (95% confidence interval, 48.1%-64.1%) (P < .001). Among the participants in the reminder group, 24 (69%) reported that they would keep using the text-message reminders after the study, and 31 (89%) reported that they would recommend the text-message reminder system to others. Subgroup analysis did not reveal any significant demographic factors that predicted adherence.
Despite awareness of the benefits of sunscreen, adherence is low, even in this population, for whom adherence was knowingly monitored. Short-term data demonstrate that using existing cellular telephone text-message technology offers an innovative, low-cost, and effective method of improving adherence to sunscreen application. The use of ubiquitous communications technology, such as text messaging, may have implications for large-scale public health initiatives. Trial Registration clinicaltrials.gov Identifier: NCT00535769.
Up From Crisis: Overhauling Healthcare Information, Payment, and Delivery in Extraordinary Times
Kvedar JC, Hwang J, Moorhead T, Orlov LM, Ubel PA. Up from crisis: overhauling healthcare information, payment, and delivery in extraordinary times. Dialogue with featured speakers from the 6th annual connected health symposium. Telemed J E Health. 2009 Sep;15(7):634-41. doi: 10.1089/tmj.2009.9948. PubMed PMID: 19747071.Read More...
Digital Imaging in Dermatology: Attitudes, Behaviors, and Innovations
Idriss SZ, Armstrong AW, Kvedar JC, Lio PA. Digital imaging in dermatology: attitudes, behaviors, and innovations. Skin Res Technol. 2009 Aug;15(3):376-7. doi: 10.1111/j.1600-0846.2008.00340.x. PubMed PMID: 19624436.Read More...
National Telemedicine Initiatives: Essential to Healthcare Reform
Bashshur RL, Shannon GW, Krupinski EA, Grigsby J, Kvedar JC, Weinstein RS, Sanders JH, Rheuban KS, Nesbitt TS, Alverson DC, Merrell RC, Linkous JD, Ferguson AS, Waters RJ, Stachura ME, Ellis DG, Antoniotti NM, Johnston B, Doarn CR, Yellowlees P, Normandin S, Tracy J. National telemedicine initiatives: essential to healthcare reform. Telemed J E Health. 2009 Jul-Aug;15(6):600-10. doi: 10.1089/tmj.2009.9960. PubMed PMID: 19534591.Read More...
Remote Assessment of Acne: The Use of Acne Grading Tools to Evaluate Digital Skin Images
Bergman H, Tsai KY, Seo SJ, Kvedar JC, Watson AJ. Remote assessment of acne: the use of acne grading tools to evaluate digital skin images. Telemed J E Health. 2009 Jun;15(5):426-30. doi: 10.1089/tmj.2008.0128. PubMed PMID: 19548822.Read More...
Digital imaging of dermatology patients is a novel approach to remote data collection. A number of assessment tools have been developed to grade acne severity and to track clinical progress over time. Although these tools have been validated when used in a face-to-face setting, their efficacy and reliability when used to assess digital images have not been examined. The main purpose of this study was to determine whether specific assessment tools designed to grade acne during face-to-face visits can be applied to the evaluation of digital images. The secondary purpose was to ascertain whether images obtained by subjects are of adequate quality to allow such assessments to be made. Three hundred (300) digital images of patients with mild to moderate facial inflammatory acne from an ongoing randomized-controlled study were included in this analysis. These images were obtained from 20 patients and consisted of sets of 3 images taken over time. Of these images, 120 images were captured by subjects themselves and 180 were taken by study staff. Subjects were asked to retake their photographs if the initial images were deemed of poor quality by study staff. Images were evaluated by two dermatologists-in-training using validated acne assessment measures: Total Inflammatory Lesion Count, Leeds technique, and the Investigator's Global Assessment. Reliability of raters was evaluated using correlation coefficients and kappa statistics. Of the different acne assessment measures tested, the inter-rater reliability was highest for the total inflammatory lesion count (r = 0.871), but low for the Leeds technique (kappa = 0.381) and global assessment (kappa = 0.3119). Raters were able to evaluate over 89% of all images using each type of acne assessment measure despite the fact that images obtained by study staff were of higher quality than those obtained by patients (p < 0.001). Several existing clinical assessment measures can be used to evaluate digital images obtained from subjects with inflammatory acne lesions. The level of inter-rater agreement is highly variable across assessment measures, and we found the Total Inflammatory Lesion Count to be the most reliable. This measure could be used to allow a dermatologist to remotely track a patient's progress over time.
Connected Health as a Lever for Healthcare Reform
Kvedar JC, Herzlinger R, Holt M, Sanders JH. Connected health as a lever for healthcare reform: dialogue with featured speakers from the 5th Annual Connected Health Symposium. Telemed J E Health. 2009 May;15(4):312-9. doi: 10.1089/tmj.2009.9972. PubMed PMID: 19441948.Read More...
Feasibility and Effectiveness of Telepsychiatry Services for Chinese Immigrants in a Nursing Home
Yeung A, Johnson DP, Trinh NH, Weng WC, Kvedar J, Fava M. Feasibility and effectiveness of telepsychiatry services for chinese immigrants in a nursing home. Telemed J E Health. 2009 May;15(4):336-41. doi: 10.1089/tmj.2008.0138. PubMed PMID: 19441951.Read More...
This study investigates the feasibility and effectiveness of providing telepsychiatry services to Chinese immigrants in a nursing home. The psychiatrist interviewed patients face-to-face for the initial consultation, and encouraged them to participate in this study to receive telepsychiatry-based follow-up visits. The feasibility and outcomes of telepsychiatry visits and satisfaction of the subjects, their families, and the nursing home staff were assessed. Nine monolingual Chinese immigrants, 8 women and 1 man, ranging from 54 to 88 years of age, were enrolled. The main reasons for psychiatric consultation were mood and behavioral problems. Eight of the 9 (88.9%) subjects participated in videoconference follow-up visits, and 1 subject (11.1%) declined. Among the 8 subjects, 6 were referred for psychiatric intervention, 1 for differential diagnosis, and 1 for suicide assessment. At the end of the study, all 6 subjects referred for intervention had greatly improved; the subjects, their families, and the nursing staff were highly satisfied with the telepsychiatry service. It is feasible to provide psychiatry consultations to ethnic immigrants in a nursing home despite the fact that many of them are unfamiliar with the technology and suffer from dementia and psychotic symptoms. Telepsychiatry provides an efficient way for ethnic elders in nursing homes to connect with mental health professionals with the appropriate language and cultural background, regardless of location. Telepsychiatry may decrease the disparities in treatment of mental illnesses among ethnic immigrants in nursing homes.
Diabetes Connected Health: A Pilot Study of a Patient- and Provider-Shared Glucose Monitoring Web Application
Watson AJ, Kvedar JC, Rahman B, Pelletier AC, Salber G, Grant RW. Diabetes connected health: a pilot study of a patient- and provider-shared glucose monitoring web application. J Diabetes Sci Technol. 2009 Mar 1;3(2):345-52. PubMed PMID: 20144366.Read More...
Real-time sharing of blood glucose results with providers could improve communication and lead to more timely medication titration. New technology platforms are available to support the delivery of innovative models of care delivery.
In the Diabetes Connected Health (DCH) pilot study, patients with diabetes received access to an online application that stored and graphed glucose readings uploaded from a standard glucometer. Both patients and providers had access to this Web site, where data could be viewed, analyzed, and discussed. To examine the impact of the DCH program, we assessed adoption of the program, patient and provider satisfaction, frequency of use, and changes in glucose levels over a period of 3 months.
The mean age of the 7 pilot participants was 51 (range 35-65). Participants sent in an average of 50 readings in Month 1 and 38 readings in Month 3 and made, on average, 6 comments in Months 1 and 12 comments in Month 3. The mean blood glucose range decreased in Month 3 versus Month 1 (141.1 and 146.5, respectively). Self-reported HbA1c fell from 6.8% at the start of the study to 5.8% at the end. Five/seven participants described the site as excellent or good. Qualitative data analysis highlighted key benefits of the program as well as areas for improvement.
This pilot study of a shared glucose monitoring Web application was well received by patients. Programs like this may lead to improvements in the quality of clinical care delivered to people with type 2 diabetes.
The Role of Online Support Communities: Benefits of Expanded Social Networks to Patients with Psoriasis
Idriss SZ, Kvedar JC, Watson AJ. The role of online support communities: benefits of expanded social networks to patients with psoriasis. Arch Dermatol. 2009 Jan;145(1):46-51. doi: 10.1001/archdermatol.2008.529. PubMed PMID: 19153342.Read More...
To determine the demographics, usage patterns, attitudes, and experiences of online support site users.
Online survey. Patients A total of 260 subjects recruited from 5 online psoriasis support groups.
MAIN OUTCOME MEASURES:
An exploratory analysis was performed to determine demographic and disease characteristics of online support site users. Perceived benefits were also documented.
The mean (SD) age of respondents was 40.1 (11.5) years (range, 18-75 years), most (75.7%) were white, female (60.4%), and college educated (84.3%). Key factors associated with use of online support sites included availability of resources (95.3%), convenience (94.0%), access to good advice (91.0%), and the lack of embarrassment when dealing with personal issues (90.8%). The most common activities were posting messages (65.0%) and searching for information (63.1%). Nearly half of all respondents perceived improvements in their quality of life (49.5%) and psoriasis severity (41.0%) since joining the site. Intensity of participation in online support activities was associated with improved quality of life (P = .002), but not with improvements in psoriasis severity.
Our data demonstrate that psoriasis virtual communities offer users both a valuable educational resource and a source of psychological and social support. Such benefits could be further enhanced by physician engagement within these communities.
Innovations in Connected Health
Singh K, Kvedar JC. Innovations in connected health. Stud Health Technol Inform. 2009;149:111-29. PubMed PMID: 19745476.Read More...
Technological advancements in recent decades have made the concept of Connected Health feasible. These innovations include hardware innovations (such as wearable medical technology), and software (such as electronic personal health record systems e.g., Google Health and Microsoft HealthVault). Technology innovations must be accompanied by process innovations to truly add value. In health care that includes clinical process innovations and business process innovations. This chapter outlines how the healthcare system is being affected by innovations in connected health. It provides examples that illustrate the various categories of innovation and their impact. Now more than ever, health care reform is required in the U.S. The systems outlined in this chapter will allow care that is of high quality, while extending providers across more patients (i.e. increasing access) at a lower overall cost (improved efficiency).