Background: Interventions that teach people with bipolar disorder (BD) to recognize and respond to early warning signs (EWS) of relapse are recommended but implementation in clinical practice is poor. Objectives: The objective of this study was to test the feasibility and acceptability of a randomized controlled trial (RCT) to evaluate a Web-based enhanced relapse prevention intervention (ERPonline) and to report preliminary evidence of effectiveness. Methods: A single-blind, parallel, primarily online RCT (n=96) over 48 weeks comparing ERPonline plus usual treatment with “waitlist (WL) control” plus usual treatment for people with BD recruited through National Health Services (NHSs), voluntary organizations, and media. Randomization was independent, minimized on number of previous episodes (<8, 8-20, 21+). Primary outcomes were recruitment and retention rates, levels of intervention use, adverse events, and participant feedback. Process and clinical outcomes were assessed by telephone and Web and compared using linear models with intention-to-treat analysis. Results: A total of 280 people registered interest online, from which 96 met inclusion criteria, consented, and were randomized (49 to WL, 47 to ERPonline) over 17 months, with 80% retention in telephone and online follow-up at all time points, except at week 48 (76%). Acceptability was high for both ERPonline and trial methods. ERPonline cost approximately £19,340 to create, and £2176 per year to host and maintain the site. Qualitative data highlighted the importance of the relationship that the users have with Web-based interventions. Differences between the group means suggested that access to ERPonline was associated with: a more positive model of BD at 24 weeks (10.70, 95% CI 0.90 to 20.5) and 48 weeks (13.1, 95% CI 2.44 to 23.93); increased monitoring of EWS of depression at 48 weeks (−1.39, 95% CI −2.61 to −0.163) and of hypomania at 24 weeks (−1.72, 95% CI −2.98 to −0.47) and 48 weeks (−1.61, 95% CI −2.92 to −0.30), compared with WL. There was no evidence of impact of ERPonline on clinical outcomes or medication adherence, but relapse rates across both arms were low (15%) and the sample remained high functioning throughout. One person died by suicide before randomization and 5 people in ERPonline and 6 in WL reported ideas of suicide or self-harm. None were deemed study related by an independent Trial Steering Committee (TSC). Conclusions: ERPonline offers a cheap accessible option for people seeking ongoing support following successful treatment. However, given high functioning and low relapse rates in this study, testing clinical effectiveness for this population would require very large sample sizes. Building in human support to use ERPonline should be considered. Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN): 56908625; http://www.isrctn.com/ISRCTN56908625 (Archived by WebCite at http://www.webcitation.org/6of1ON2S0) Journal of Medical Internet Research
2013.02.21 Open Heart Surgery
Image by HotlantaVoyeur
This is minutes before I was rolled down to the operating room.
Let me start by stating that predictions are not my thing. I did not accurately predict many Oscar winners this year and I usually finish close to the bottom in any office hockey/baseball pool in which I participate. I do feel confident, however, in predicting an exciting year for our health informatics community. Why, given my track record, am I feeling so bold? Consider the following:
We have a Federal Health Minister who ‘gets it’. Dr. Philpott, a physician who has been using an EMR for years, has been consistent in her message that digital health is transforming the health system and that there is tremendous potential to do more. She understands the power of technology and the challenges of implementing the changes that will enable more widespread use of it and she is encouraging us, as a community, to continue our efforts to accelerate the pace of change.
We have federal funding being allocated to healthcare. By the time you read this blog, Minister Morneau will have tabled Budget 2017 in the House of Commons. This year’s federal budget is expected to be good news for the health sector after what many would describe as lean years. In addition to dollars allocated to health in the budget, Ottawa and the provinces/territories (except Manitoba) have reached bilateral funding agreements that will result in billions of dollars being transferred from the federal coffers.
We have an increasing number of Canadians who are empowered to be more proactive members of their care teams. This is significant. According to Canada Health Infoway public opinion research, Canadians are increasingly aware of the benefits of digital health and want access to these services and solutions – and they are getting them. The availability of digital health services for Canadians, for example, has more than doubled between 2014 and 2016.
We have a health informatics community that is dedicated to transforming the health system. Canada’s health informatics community is thriving. There is a renewed energy and a feeling that we are at a tipping point, poised to transform the health system at an unprecedented pace. We understand the potential, we understand the challenges, and we are committed to working together as governments, industry, organizations, and patients, to make a difference.
So, my prediction: eHealth 2017 will be the best conference experience you will have this year. The enthusiasm, the progress, the discussion and celebration will leave you excited, energized and smarter! Looking forward to seeing you at #eHealth2017!
Background: Virtual focus groups—such as online chat and video groups—are increasingly promoted as qualitative research tools. Theoretically, virtual groups offer several advantages, including lower cost, faster recruitment, greater geographic diversity, enrollment of hard-to-reach populations, and reduced participant burden. However, no study has compared virtual and in-person focus groups on these metrics. Objective: To rigorously compare virtual and in-person focus groups on cost, recruitment, and participant logistics. We examined 3 focus group modes and instituted experimental controls to ensure a fair comparison. Methods: We conducted 6 1-hour focus groups in August 2014 using in-person (n=2), live chat (n=2), and video (n=2) modes with individuals who had type 2 diabetes (n=48 enrolled, n=39 completed). In planning groups, we solicited bids from 6 virtual platform vendors and 4 recruitment firms. We then selected 1 platform or facility per mode and a single recruitment firm across all modes. To minimize bias, the recruitment firm employed different recruiters by mode who were blinded to recruitment efforts for other modes. We tracked enrollment during a 2-week period. A single moderator conducted all groups using the same guide, which addressed the use of technology to communicate with health care providers. We conducted the groups at the same times of day on Monday to Wednesday during a single week. At the end of each group, participants completed a short survey. Results: Virtual focus groups offered minimal cost savings compared with in-person groups (US $ 2000 per chat group vs US $ 2576 per in-person group vs US $ 2,750 per video group). Although virtual groups did not incur travel costs, they often had higher management fees and miscellaneous expenses (eg, participant webcams). Recruitment timing did not differ by mode, but show rates were higher for in-person groups (94% [15/16] in-person vs 81% [13/16] video vs 69% [11/16] chat). Virtual group participants were more geographically diverse (but with significant clustering around major metropolitan areas) and more likely to be non-white, less educated, and less healthy. Internet usage was higher among virtual group participants, yet virtual groups still reached light Internet users. In terms of burden, chat groups were easiest to join and required the least preparation (chat = 13 minutes, video = 40 minutes, in-person = 78 minutes). Virtual group participants joined using laptop or desktop computers, and most virtual participants (82% [9/11] chat vs 62% [8/13] video) reported having no other people in their immediate vicinity. Conclusions: Virtual focus groups offer potential advantages for participant diversity and reaching less healthy populations. However, virtual groups do not appear to cost less or recruit participants faster than in-person groups. Further research on virtual group data quality and group dynamics is needed to fully understand their advantages and limitations.
Journal of Medical Internet Research
Zorgaanbieders kloppen met een nieuwe Agenda voor de Zorg aan bij de overheid. Die moet ICT-standaarden in de zorg afdwingen en een digitale snelweg realiseren. Volgens Jan moeten die aanbieders misschien eerst eens bij zichzelf te rade gaan.
Background: Studies of criteria-based assessment tools have demonstrated the feasibility of objectively evaluating eHealth interventions independent of empirical testing. However, current tools have not included some quality constructs associated with intervention outcome, such as persuasive design, behavior change, or therapeutic alliance. In addition, the generalizability of such tools has not been explicitly examined. Objective: The aim is to introduce the development and further analysis of the Enlight suite of measures, developed to incorporate the aforementioned concepts and address generalizability aspects. Methods: As a first step, a comprehensive systematic review was performed to identify relevant quality rating criteria in line with the PRISMA statement. These criteria were then categorized to create Enlight. The second step involved testing Enlight on 42 mobile apps and 42 Web-based programs (delivery mediums) targeting modifiable behaviors related to medical illness or mental health (clinical aims). Results: A total of 476 criteria from 99 identified sources were used to build Enlight. The rating measures were divided into two sections: quality assessments and checklists. Quality assessments included usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. The checklists included credibility, privacy explanation, basic security, and evidence-based program ranking. The quality constructs exhibited excellent interrater reliability (intraclass correlations=.77-.98, median .91) and internal consistency (Cronbach alphas=.83-.90, median .88), with similar results when separated into delivery mediums or clinical aims. Conditional probability analysis revealed that 100% of the programs that received a score of fair or above (≥3.0) in therapeutic persuasiveness or therapeutic alliance received the same range of scores in user engagement and content—a pattern that did not appear in the opposite direction. Preliminary concurrent validity analysis pointed to positive correlations of combined quality scores with selected variables. The combined score that did not include therapeutic persuasiveness and therapeutic alliance descriptively underperformed the other combined scores. Conclusions: This paper provides empirical evidence supporting the importance of persuasive design and therapeutic alliance within the context of a program’s evaluation. Reliability metrics and preliminary concurrent validity analysis indicate the potential of Enlight in examining eHealth programs regardless of delivery mediums and clinical aims.
Journal of Medical Internet Research
Image by antiuser
My creature in Spore for the iPhone
Iedereen kan eigen gezondheid in de gaten houden; maar is de arts daarbij gebaat?
De moderne patiënt stelt zijn eigen diagnose
Slimme pleisters, onderbroeken, armbanden en contactlenzen: de snel groeiende hoeveelheid ‘wearables’ stelt iedereen in staat zelf zijn gezondheid in de gaten te houden. Zijn artsen daarbij gebaat of leidt het alleen maar tot nodeloos doktersbezoek?
Nictiz-expert Johan Krijgsman is door de Volkskrant gevraagd naar zijn opinie over zelfmetingen. Lees het volledige artikel uit de wetenschapsbijlage van de Volkskrant.
eHealth en mHealth nieuws uit Nederland en het buitenland: alles over gezondheidsapps, wearables, persoonlijk gezondheidsdossier, fitness en wellness.
Het bericht Newsroom: Nederlandse diabetes patiënten gebruiken implanteerbare sensor verscheen eerst op SmartHealth.
De patiënt heeft toegang tot zijn gegevens binnen de zorginstellingen, of krijgt dit binnenkort.
Met de stimuleringsgelden van VWS (zoals VIPP), en MedMij dat op stoom komt, hebben organisaties hun informatie op orde te hebben; vindbaar, toegankelijk, interoperabel en herbruikbaar.
Tijdens het congres Architectuur in de zorg informeren een palet aan sprekers je over deze actuele ontwikkelingen, bijbehorende standaarden en uitdagingen, en delen hun visie en ervaringen met je.
Het programma vindt je op de congreswebsite.
Dit jaar vindt het congres plaats op 22 juni 2017 in het prachtige Spoorwegmuseum te Utrecht.
Ook deelnemen aan Architectuur in de Zorg? Inschrijven kan hier.
Informatie- en netwerkplatform
Het congres is inmiddels uitgegroeid tot het informatie- en netwerkplatform van professionals die in deze sector werkzaam zijn. GS1 Nederland, HL7 Nederland, IHE Nederland, NAF en Nictiz zijn de drijvende kracht achter dit congres.