Mobile Apps for Increasing Treatment Adherence: Systematic Review

Background: It is estimated that 20% to 50% of patients do not take their medication correctly, and this leads to increased morbidity and inefficacy of therapeutic approaches. Fostering treatment adherence is a priority objective for all health systems. The growth of mobile apps to facilitate therapeutic adherence has significantly increased in recent years. However, the effectiveness of the apps for this purpose has not been evaluated. Objective: This study aimed to analyze whether mobile apps are perceived as useful for managing medication at home and if they actually contribute to increasing treatment adherence in patients. Methods: We carried out a systematic review of research published using Scopus, Cochrane Library, ProQuest, and MEDLINE databases and analyzed the information about their contribution to increasing therapeutic adherence and the perceived usefulness of mobile apps. This review examined studies published between 2000 and 2017. Results: Overall, 11 studies fulfilled the inclusion criteria. The sample sizes of these studies varied between 16 and 99 participants. In addition, 7 studies confirmed that the mobile app increased treatment adherence. In 5 of them, the before and after adherence measures suggested significant statistical improvements, when comparing self-reported adherence and missed dose with a percentage increase ranging between 7% and 40%. The users found mobile apps easy to use and useful for managing their medication. The patients were mostly satisfied with their use, with an average score of 8.1 out of 10. Conclusions: The use of mobile apps helps increase treatment adherence, and they are an appropriate method for managing medication at hom

Mobile Apps for Helping Informal Caregivers: A Systematic Review

Background: The physical and psychological consequences suffered by informal caregivers have been extensively studied. MHealth solutions appear to be an opportunity to help overcome the caregiver burden. The objective of this study was to evaluate available mobile applications for informal caregivers of people who are ill and to determine whether these mobile applications were developed considering the needs of caregiver users. (2) Methods: A systematic review was carried out using the MEDLINE, ProQuest, and Scopus databases. The information about mobile applications for informal caregivers was analyzed. This review examined studies published between January 2011 and July 2020 in English. The data extracted from each paper included the development of the mobile application, if that application was assessed considering the caregivers’ needs, functions of the mobile application, measures for evaluating caregivers’ needs, measures for evaluating the effectiveness of the mobile application, and the main results obtained. (3) Results: Eleven studies fulfilled the inclusion criteria. The most common functions of the apps were summaries with information about the person they care for, educational information, resources and services for caregivers, Citation: Sala-González, M.; Pérez-Jover, V.; Guilabert, M.; Mira, J.J. Mobile Apps for Helping Informal Caregivers: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 1702. https://doi.org/10.3390/ ijerph18041702 Academic Editor: Paul B. Tchounwou Received: 31 December 2020 Accepted: 8 February 2021 Published: 10 February 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). solutions to common problems during care, and questionnaires to assess caregivers’ well-being. Most of these studies assessed caregivers’ needs before designing mobile applications to adapt them to the needs of their users. (4) Conclusions: Mobile applications for caregivers appear to provide solutions for them. Moreover, the effectiveness of these apps will depend largely on whether their characteristics match users’ needs. Current studies have shown the poor quality of evidence

Health literacy and Perceived health

La Alfabetización en Salud (AES) hace referencia al grado en el que las personas pueden obtener, procesar y entender información básica de salud y servicios que son necesarios para tomar decisiones adecuadas sobre su salud. Estudios previoshanrelacionadola AES con el nivel de salud. El objetivo de este estudio fue analizar si existían diferencias en AES en función dela salud percibida.Para ello, se llevóa cabo un estudio descriptivo en una muestra de 331 sujetos mayores de 55 años. Para medir el nivelde AES, se les administró el cuestionario European Health Literacy Survey (HLS-EU-q16)y para evaluarel nivel de salud percibido,el cuestionario de Salud General de Goldberg (GHQ-28).El 56% de la población adulta obtuvo niveles de alfabetización en salud suficientes. No se han encontrado diferencias estadísticamente significativas entreel nivel de AES y la salud percibida(p=0.442). A modo de conclusión, los altos niveles de AES encontrados y la inexistencia de relación entre AES y la salud percibida contrastan con otros los resultados de otros estudiossimilares. Como limitación del estudio, no se pueden generalizar los resultados ya que la muestra de este estudio son personas mayores de 55 años con un nivel sociocultural medio. Para futuros estudios sería recomendable la utilización de otras pruebas objetivas que midan tanto el nivel de AES como el nivel de salud de los pacientes y el empleo de una muestra con distintos niveles socioculturalesHealth literacy refers to the degree to which people can obtain, process and understand basic health information and services needed to make appropriate health decisions. Previous studies have linked health literacy to health outcomes. The aim of this study wasto analyze whether there weredifferences in health literacy on the basis of perceived health. To do this, a descriptive study was performed in a sample of 331 subjects over the age of 55. To measure the level of health literacy, theEuropean Health Literacy Survey (HLS-EU-q16)questionnaire was administered to them and the level of health perceivedwas evaluated by theGoldberg General Health Questionnaire (GHQ-28).56% of the adult population obtained sufficient levels of health literacy. No staticallysignificant differences were foundedbetween health literacy and health perceived. In conclusion, the high levels of health literacy founded and the absence of relation between health literacy and perceived health contrast with other similar studies. As a limitation of the study, theresults cannot be used because the sample of this study are people over the age of 55 witha mediumsocio-cultural level. For further studies it is recommendable the use of objectives test which evaluate the level of health literacy and health outcomesand the use of a sample with different sociocultural level

Experience of good practice in an occupational accident mutual insurance society, based on the voice of patients and professionals

Atenció centrada en el pacient; Satisfacció del pacient; Mútues asseguradoresPatient-centered care; Patient satisfaction; Mutual insurance societiesAtención centrada en el paciente; Satisfacción del paciente; Mutuas aseguradorasIn Spain, the protection of workers’ health is organized through what are known as occupational accident mutual insurance societies. While health protection is a fundamental issue within a mutual society, dimensions, such as patient quality and safety, are measured in the same way as in the conventional healthcare sector. However, in mutual societies, it is traditionally acknowledged that experiences of medical evaluation systems of healthcare provision and quality improvement are less frequent. The following is an example of how a Quality Plan has been structured within an organization with these characteristics, and instruments and measures have been developed to capture information in decision making from the perspective of patients and professionals. The Quality Plan represents the ongoing commitment of this organization to achieve patient-centered care. These changes revolve around these measures and, therefore, it is defined as a good practice

Medical information is not enough for patient’s participation in clinical decisions

This research was designed to analyze whether patients rate positively doctors’ attitudes and information provided favours the patient’s participation and involvement in clinical decisions. For this, we carry out a cross-sectional analysis of data on 1070 patients discharged from 7 hospitals in Spain. A total of 82% referred to be satisfied with the information, of which 3% did not have the feeling that their hospital doctor had listened carefully, 27% did not have their doubts clarified, and 76% were not informed of therapeutic alternatives. When the doctor showed a receptive attitude there was actually an increase in the number of patients that still had doubts about their diagnosis and treatment (OR= 1.9, p= 0.04). Older patients were less frequently involved in clinical decisions (2= 8.05, p=0.04) and often remained with doubts (2=9.05, p=0.03). The conclusion is that a substantial proportion of patients seem to assume a passive role in the interaction with the doctor. There are conditions that may restrict the patient’s autonomy which do not ever affect the patient’s rating of the information provided by the doctor

A systematic review on pediatric medication errors by parents or caregivers at home

Introduction: Medication errors (MEs) are frequent and, in some cases, can lead to hospitalization, disability, increased healthcare costs or, even, death. Most of pediatric medications are administered by parents or caregivers at home. It is necessary to explore the MEs at home to improve pediatric patient safety. Areas covered: This study aimed to review the current literature on the frequency of pediatric MEs by parents or caregivers at home, their associated factors, and pediatric ME reporting systems. Citable original articles of any type of study design or reviews published from 2013 to 2021 were searched in Medline, Scopus, Embase, and ScienceDirect databases. Expert opinion: The available data about the frequency of pediatric MEs at home varied from 30% to 80%. Current research suggests the risk of making a ME in pediatric patients at home may depend on the characteristics of the caregiver and may increase if a prescription contains ≥3 drugs. Findings conclude that providing dosing tools more closely matched to prescribed dose volumes, recommending the use of syringes as a measurement tool, and educational intervention for caregivers could be useful to reduce MEs. Concerning the reporting systems for pediatric MEs in the outpatient setting, no information was found

Preferencias de rol en la toma de decisiones clínicas: Diferencias de género

Marco teórico: determinar a partir de las declaraciones de los/as pacientes si existen diferencias de género en la información proporcionada por el profesional para facilitar la participación del paciente en las decisiones clínicas. Método: Estudio observacional, descriptivo, transversal. Encuesta telefónica a 700 pacientes atendidos en hospitales y centros de salud del Sistema Nacional de Salud. Se preguntó a los pacientes sobre la información proporcionada por el médico y la actitud mantenida por el mismo durante la consulta. Resultados: Respondieron 687 pacientes (68,7%), 54,6% atendidos en hospitales y 45,4% en atención primaria. Encontramos diferencias en la mayor frecuencia con que los pacientes varones son informados, en atención primaria, de alternativas terapéuticas; y en la proporción de hombres dados de alta hospitalaria que afirmaron que pensaban que lo mejor era dejar la decisión en manos de su médico. Dichas diferencias sólo se mantienen en el grupo de pacientes menores de 30 años. Conclusiones: Los pacientes varones de atención primaria se consideran mejor informados sobre alternativas terapéuticas que las pacientes mujeres

Contributing factors for acute stress in healthcare workers caring for COVID-19 patients in Argentina, Chile, Colombia, and Ecuador

This study analyzed the frequency and intensity of acute stress among health professionals caring for COVID-19 patients in four Latin American Spanish-speaking countries during the outbreak. A cross-sectional study involved a non-probability sample of healthcare professionals in four Latin American countries. Participants from each country were invited using a platform and mobile application designed for this study. Hospital and primary care workers from different services caring for COVID-19 patients were included. The EASE Scale (SARS-CoV-2 Emotional Overload Scale, in Spanish named Escala Auto-aplicada de Sobrecarga Emocional) was a previously validated measure of acute stress. EASE scores were described overall by age, sex, work area, and experience of being ill with COVID-19. Using the Mann–Whitney U test, the EASE scores were compared according to the most critical moments of the pandemic. Univariate and multivariate analysis was performed to investigate associations between these factors and the outcome ‘acute stress’. Finally, the Kruskal–Wallis was used to compare EASE scores and the experience of being ill. A total of 1372 professionals responded to all the items in the EASE scale: 375 (27.3%) Argentines, 365 (26.6%) Colombians, 345 (25.1%) Chileans, 209 (15.2%) Ecuadorians, and 78 (5.7%) from other countries. 27% of providers suffered middle-higher acute stress due to the outbreak. Worse results were observed in moments of peak incidence of cases (14.3 ± 5.3 vs. 6.9 ± 1.7, p < 0.05). Higher scores were found in professionals in COVID-19 critical care (13 ± 1.2) than those in non-COVID-19 areas (10.7 ± 1.9) (p = 0.03). Distress was higher among professionals who were COVID-19 patients (11.7 ± 1) or had doubts about their potential infection (12 ± 1.2) compared to those not infected (9.5 ± 0.7) (p = 0.001). Around one-third of the professionals experienced acute stress, increasing in intensity as the incidence of COVID-19 increased and as they became infected or in doubt whether they were infected. EASE scale could be a valuable asset for monitoring acute stress levels among health professionals in Latin America.Fil: Martin Delgado, Jimmy. Universidad Catolica de Santiago de Guayaquil; EcuadorFil: Poblete, Rodrigo. Universidad de Santiago de Chile; ChileFil: Serpa, Piedad. Universidad Industrial Santander; ColombiaFil: Mula, Aurora. Hospital Universitario de Sant Joan D´alacant; EspañaFil: Carrillo, Irene. Universidad de Miguel Hernández; EspañaFil: Fernández, Cesar. Universidad de Miguel Hernández; EspañaFil: Vicente Ripoll, María Asunción. Universidad de Miguel Hernández; EspañaFil: Loudet, Cecilia. General José de San Martín de la Plata General Hospital; ArgentinaFil: Jorro, Facundo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Garcia Elorrio, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Guilabert, Mercedes. Universidad de Miguel Hernández; EspañaFil: Mira, José Joaquín. Universidad de Miguel Hernández; Españ

Healthcare experience and their relationship with demographic, disease and healthcare-related variables: a cross-sectional survey of patients with chronic diseases using the IEXPAC scale.

[Abstract] BACKGROUND: Patient experience is acknowledged as a principal aspect of quality healthcare delivery, and it has implications with regard to outcomes. OBJECTIVES: Our objective was to evaluate the healthcare experience of patients with chronic diseases to identify patient-perceived healthcare gaps and to assess the influence of demographic and healthcare-related variables on patient experiences. METHODS: A cross-sectional survey was delivered to adult patients with chronic diseases: diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, inflammatory bowel disease (IBD) or rheumatic diseases. Patient experiences were assessed with the Instrument for Evaluation of the Experience of Chronic Patients (IEXPAC) questionnaire, with possible scores ranging from 0 (worst) to 10 (best experience). RESULTS: Of the 2474 patients handed the survey, 1618 returned it (response rate 65.4%). Patients identified gaps in healthcare related mainly to access to reliable information and services, interaction with other patients and continuity of healthcare after hospital discharge. The mean ± standard deviation (SD) IEXPAC score was 6.0 ± 1.9 and was higher for patients with HIV (6.6 ± 1.7) than for those with rheumatic disease (5.5 ± 2.0), IBD (5.9 ± 2.0) or DM (5.9 ± 1.9) (p < 0.001). In multivariate models, better overall IEXPAC experience was associated with follow-up by the same physician, follow-up by a nurse, receiving healthcare support from others and treatment with subcutaneous or intravenous drugs. The multivariate model that confirmed patients with HIV or DM had better experience than did those with rheumatic diseases. CONCLUSIONS: Through IEXPAC, patients identified aspects for healthcare quality improvements and circumstances associated with better experience, which may permit greater redirection of healthcare toward patient-centered goals while facilitating improvements in social care and long-term healthcare quality

A Spanish-language patient safety questionnaire to measure medical and nursing students' attitudes and knowledge.

[EN] OBJECTIVE: To design and validate a questionnaire for assessing attitudes and knowledge about patient safety using a sample of medical and nursing students undergoing clinical training in Spain and four countries in Latin America. METHODS: In this cross-sectional study, a literature review was carried out and total of 786 medical and nursing students were surveyed at eight universities from five countries (Chile, Colombia, El Salvador, Guatemala, and Spain) to develop and refine a Spanish-language questionnaire on knowledge and attitudes about patient safety. The scope of the questionnaire was based on five dimensions (factors) presented in studies related to patient safety culture found in PubMed and Scopus. Based on the five factors, 25 reactive items were developed. Composite reliability indexes and Cronbach's alpha statistics were estimated for each factor, and confirmatory factor analysis was conducted to assess validity. After a pilot test, the questionnaire was refined using confirmatory models, maximum-likelihood estimation, and the variance-covariance matrix (as input). Multiple linear regression models were used to confirm external validity, considering variables related to patient safety culture as dependent variables and the five factors as independent variables. RESULTS: The final instrument was a structured five-point Likert self-administered survey (the "Latino Student Patient Safety Questionnaire") consisting of 21 items grouped into five factors. Compound reliability indexes (Cronbach's alpha statistic) calculated for the five factors were about 0.7 or higher. The results of the multiple linear regression analyses indicated good model fit (goodness-of-fit index: 0.9). Item-total correlations were higher than 0.3 in all cases. The convergent-discriminant validity was adequate. CONCLUSIONS: The questionnaire designed and validated in this study assesses nursing and medical students' attitudes and knowledge about patient safety. This instrument could be used to indirectly evaluate whether or not students in health disciplines are acquiring and thus likely to put into practice the professional skills currently considered most appropriate for patient safety