Browsing by Author "Aikens, James E"
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- ItemDiabetes self-management support using mHealth and enhanced informal caregiving.(2014-02-25) Aikens, James E; Zivin, Kara; Trivedi, Ranak; Piette, John DOBJECTIVE To characterize diabetes patient engagement and clinician notifications for an mHealth interactive voice response IVR service DESIGN Observational study METHODS For three to six months VA patients with diabetes received weekly IVR calls assessing health status and self care along with tailored education Patients could enroll with an informal caregiver who received suggestions on self management support Notifications were issued to clinicians when patients reported significant problems RESULTS Patients n 303 participated for a total of 5684 patient weeks during which 84 of calls were completed The odds of call completion decreased over time AOR 0 96 p Under 0 001 and were lower among unmarried patients AOR 0 67 p 0 038 and those who had difficulties with health literacy AOR 0 67 p 0 039 diabetes related distress AOR 0 30 p 0 018 or medication nonadherence AOR 0 57 p 0 002 Twenty one clinician notifications were triggered per 100 patient weeks The odds of notification were higher during the early weeks of the program AOR 0 95 p Under 0 001 and among patients who were older AOR 1 03 p 0 004 or more physically impaired AOR 0 97 p Under 0 001 CONCLUSIONS By providing information that is reliable valid and actionable IVR based mHealth services may increase access to between visit monitoring and diabetes self management support The system detects abnormal glycemia and blood pressure levels that might otherwise go unreported although thresholds for clinician notifications might require adjustment to avoid overloading clinicians Patient engagement might be enhanced by addressing health literacy and psychological distress
- ItemImprovements in illness self-management and psychological distress associated with telemonitoring support for adults with diabetes.(2015-03-11) Aikens, James E; Rosland, Ann-Marie; Piette, John DOBJECTIVE The objective of this observational open label trial was to characterize changes in diabetes self management and psychological distress associated with a mobile health mHealth interactive voice response IVR self management support program METHODS For 3 6 months 301 patients with diabetes received weekly IVR calls assessing health status and self care and providing tailored pre recorded self management support messages Patients could participate together with an informal caregiver who received suggestions on self management support and patients clinicians were notified automatically when patients reported significant problems RESULTS Patients completed 84 of weekly calls providing 5682 patient weeks of data Thirty nine percent participated with an informal caregiver Outcome analyses adjusted for study design factors and sociodemographics indicated significant pre post improvement in medication adherence physical functioning depressive symptoms and diabetes related distress all p values Under0 001 Analyses of self management problems indicated that as the intervention proceeded there were significant improvements in patients IVR reported frequency of weekly medication adherence SMBG performance checking feet and frequency of abnormal self monitored blood glucose readings all p values Under0 001 CONCLUSIONS We conclude that the combined program of automated telemonitoring clinician notification and informal caregiver involvement was associated with consistent improvements in medication adherence diabetes self management behaviors physical functioning and psychological distress A randomized controlled trial is needed to verify these encouraging findings
- ItemMobile health monitoring to characterize depression symptom trajectories in primary care.(2015-02-24) Pfeiffer, Paul N; Bohnert, Kipling M; Zivin, Kara; Yosef, Matheos; Valenstein, Marcia; Aikens, James E; Piette, John DBACKGROUND Classification of depression severity can guide treatment decisions This study examined whether using repeated mobile health assessments to determine symptom trajectories is a potentially useful method for classifying depression severity METHODS 344 primary care patients with depression were identified and recruited as part of a program of mobile health symptom monitoring and self management support Depression symptoms were measured weekly via interactive voice response IVR calls using the Patient Health Questionnaire PHQ 9 Trajectory analysis of weekly IVR PHQ 9 scores from baseline through week 6 was used to subgroup patients according to similar trajectories Multivariable linear regression was used to determine whether the trajectories predicted 12 week PHQ 9 scores after adjusting for baseline and 6 week PHQ 9 scores RESULTS The optimal trajectory analysis model included 5 non intersecting trajectories The subgroups of patients assigned to each trajectory had mean baseline PHQ 9s of 19 7 14 5 9 5 5 0 and 2 0 and respective mean decreases in PHQ 9s over six weeks of 3 2 0 3 6 2 3 and 1 9 In regression analyses each trajectory significantly predicted 12 week PHQ 9 scores using the modal trajectory as a reference after adjusting for both baseline and 6 week PHQ 9 scores LIMITATIONS Treatment history was unknown findings may not be generalizable to new episodes of treatment CONCLUSIONS Depression symptom trajectories based on mobile health assessments are predictive of future depression outcomes even after accounting for typical assessments at baseline and a single follow up time point Approaches to classify patients disease status that involve multiple repeated assessments may provide more accurate and useful information for depression management compared to lower frequency monitoring
- ItemOut-of-home informal support important for medication adherence, diabetes distress, hemoglobin A1c among adults with type 2 diabetes.(0000-00-00) Mayberry, Lindsay S; Piette, John D; Lee, Aaron A; Aikens, James EAdults with type 2 diabetes mellitus T2DM often receive self management support from adult children siblings or close friends residing outside of their home However the role of out of home support in patients self management and well being is unclear Patients N 313 with HbA1c 7 5 were recruited from community primary care clinics for a mobile health intervention trial and identified an out of home informal support person herein called a CarePartner 38 also had an in home supporter We tested cross sectional adjusted associations between CarePartner relationship characteristics and patients self management diabetes distress and HbA1c and whether having an in home supporter modified these associations Greater CarePartner closeness was associated with a greater odds of perfect medication adherence AOR 1 19 p 029 more fruit vegetable intake 0 14 p 018 and lower diabetes distress 0 14 p 012 More frequent CarePartner contact was associated with better HbA1c among patients with an in home supporter but with worse HbA1c among patients without an in home supporter interaction 0 45 p 005 Emotional closeness with a CarePartner may be important for supporting T2DM self management and reducing diabetes distress CarePartners may appropriately engage more frequently when patients with no in home supporter have poorly controlled diabetes
- ItemRethinking the frequency of between-visit monitoring for patients with diabetes.(2014-05-14) Piette, John D; Aikens, James E; Rosland, Ann M; Sussman, Jeremy BBACKGROUND Health systems increasingly look to mobile health tools to monitor patients cost effectively between visits The frequency of assessment services such as interactive voice response IVR calls is typically arbitrary and no approaches have been proposed to tailor assessment schedules based on evidence regarding which measures actually provide new information about patients status METHODS We analyzed longitudinal data from over 5000 weekly IVR monitoring calls to 298 diabetes patients using logistic models to determine the predictability of IVR reported physiological results perceived health indicators and self care behaviors We also determined the implications for assessment burden and problem detection of omitting assessment items that had no more than a 5 predicted probability of a problem report RESULTS Assuming weekly IVR assessments episodes of hyperglycemia were difficult to predict area under the curve AUC 69 7 95 confidence interval CI 50 2 89 2 based on patients prior assessment responses Hypoglycemic symptoms and fair poor perceived health were more predictable and self care behaviors such as problems with medication adherence AUC 92 1 95 CI 89 6 94 6 and foot care AUC 98 4 95 CI 97 0 99 8 were highly predictable Even if patients were only asked about foot inspection behavior when they had 5 chance of a problem report 94 of foot inspection assessments could be omitted while still identifying 91 of reported problems CONCLUSIONS Mobile health monitoring systems could be made more efficient by taking patients reporting history into account Avoiding redundant information requests could make services more patient centered and might increase engagement Time saved by decreasing redundancy could be better spent educating patients or assessing other clinical problems