INTRODUCTION: As the South African province of KwaZulu-Natal addresses a growing multidrug-resistant tuberculosis (MDR-TB) epidemic by shifting care and treatment from trained specialty centers to community hospitals, delivering and monitoring MDR-TB therapy has presented new challenges. In particular, tracking and reporting adverse clinical events have been difficult for mobile healthcare workers (HCWs), trained health professionals who travel daily to patient homes to administer and monitor therapy. We designed and piloted a mobile phone application (Mobilize) for mobile HCWs that electronically standardized the recording and tracking of MDR-TB patients on low-cost, functional phones.
OBJECTIVE: We assess the acceptability and feasibility of using Mobilize to record and submit adverse events forms weekly during the intensive phase of MDR-TB therapy and evaluate mobile HCW perceptions throughout the pilot period.
METHODS: All five mobile HCWs at one site were trained and provided with phones. Utilizing a mixed-methods evaluation, mobile HCWs' usage patterns were tracked electronically for seven months and analyzed. Qualitative focus groups and questionnaires were designed to understand the impact of mobile phone technology on the work environment.
RESULTS: Mobile HCWs submitted nine of 33 (27%) expected adverse events forms, conflicting with qualitative results in which mobile HCWs stated that Mobilize improved adverse events communication, helped their daily workflow, and could be successfully expanded to other health interventions. When presented with the conflict between their expressed views and actual practice, mobile HCWs cited forgetfulness and believed patients should take more responsibility for their own care.
DISCUSSION: This pilot experience demonstrated poor uptake by HCWs despite positive responses to using mHealth. Though our results should be interpreted cautiously because of the small number of mobile HCWs and MDR-TB patients in this study, we recommend carefully exploring the motivations of HCWs and technologic enhancements prior to scaling new mHealth initiatives in resource poor settings.
Mobile technologies for health (mHealth) represents a growing array of tools being applied in diverse health care settings. mHealth interventions for improving HIV/AIDS care is a promising strategy, but its evidence base is limited. We conducted a formative research evaluation to inform the development of novel mHealth HIV/AIDS care interventions to be used by community health workers (CHWs) in Kampala, Uganda. A mixed methods formative research approach was utilized. Qualitative methods included 20 in-depth interviews (IDIs) and six focus groups with CHWs, clinic staff, and patients. Thematic analysis was performed and selected quotations used to illustrate themes. Quantitative methods consisted of a survey administered to CHWs and clinic staff, using categorical and Likert scale questions regarding current mobile phone and internet access and perceptions on the potential use of smartphones by CHWs. Qualitative results included themes on significant current care challenges, multiple perceived mHealth benefits, and general intervention acceptability. Key mHealth features desired included tools to verify CHWs' task completions, clinical decision support tools, and simple access to voice calling. Inhibiting factors identified included concerns about CHWs' job security and unrealistic expectations of mHealth capabilities. Quantitative results from 27 staff participants found that 26 (96%) did not have internet access at home, yet only 2 (7.4%) did not own a mobile phone. Likert scale survey responses (1-5, 1 = Strongly Disagree, 5 = Strongly Agree) indicated general agreement that smartphones would improve efficiency (Mean = 4.35) and patient care (4.31) but might be harmful to patient confidentiality (3.88) and training was needed (4.63). Qualitative and quantitative results were generally consistent, and, overall, there was enthusiasm for mHealth technology. However, a number of potential inhibiting factors were also discovered. Findings from this study may help guide future design and implementation of mHealth interventions in this setting, optimizing their chances for success.
BACKGROUND: Previous trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs.
OBJECTIVES: The objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring.
METHODS: Semi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based telemonitoring system for 6 months. The telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient's mobile phone based on their physiological values. Alerts were also sent to a cardiologist's mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach.
RESULTS: The telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients' heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from telemonitoring. Some clinical concerns included ongoing costs of the telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system.
CONCLUSIONS: The success of a telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing telemonitoring solutions.
With the growth of mobile health in recent years, learning through the use of mobile devices (mobile learning [mLearning]) has gained recognition as a potential method for increasing healthcare providers' access to medical information and resources in resource-limited settings. In partnership with the University of Botswana School of Medicine (SOM), we have been exploring the role of smartphone-based mLearning with resident (physicians in specialty training) education. The SOM, which admitted its first class of medical students and residents in 2009, is committed to providing high-level on-site educational resources for resident physicians, even when practicing in remote locations. Seven residents were trained to use an Android-based myTouch 3G smartphone equipped with data-enabled subscriber identity module (SIM) cards and built-in camera. Phones contained locally loaded point-of-care and drug information applications, a telemedicine application that allows for the submission of cases to local mentors, and e-mail/Web access. Surveys were administered at 4 weeks and 8 weeks following distribution of phones. We found that smartphones loaded with point-of-care tools are effectively utilized by resident physicians in resource-limited settings, both for accessing point-of-care medical information at the bedside and engaging in self-directed learning at home.
BACKGROUND: Communication between clinicians is hampered by the frequent difficulty in reaching the most responsible physician for a patient as well as the use of outdated methods such as numeric paging. The aim of this study was to evaluate the use of smartphones to improve communication on internal medicine wards.
METHOD: At the Toronto General Hospital, residents were provided with smartphones. To simplify reaching the most responsible resident for a patient, a smartphone designated as "Team BlackBerry" was also carried by each senior resident and then passed to the resident covering the team at night and on weekends. Nurses were able to send email messages or call smartphones directly.
RESULTS: There were on average of 9.1 incoming calls, 6.6 outgoing calls, 14.3 received emails, and 2.8 sent emails per day to each Team BlackBerry. Team BlackBerrys received up to 35 calls and 57 emails per day. Residents strongly preferred the smartphones over conventional paging with perceived improvements in all items measured and felt that it improved efficiency and communication. Although nurses perceived a reduction in the time required to contact a physician (27.6 vs. 11 minutes P < 0.001), their overall satisfaction with physician's response time for urgent issues did not improve significantly.
DISCUSSION: When smartphones were used for clinical communication, residents perceived an improvement in communication with them. Residents strongly preferred emails as opposed to telephone calls as the prime method of communication. Further objective evaluation is necessary to determine if this intervention improves efficiency and more importantly, quality of care.
This paper describes the results of a Web survey on the use of personal digital assistants (PDAs) by physicians across Canada involved with the delivery of palliative medicine in different settings. Seventy-two physicians responded to the survey from April to July 2005. The survey revealed 58.3% of respondents currently use PDAs on a daily basis, mostly to organize their practice and to look up medical references. Some use their PDAs to store patient information and to access a central electronic patient record (EPR). In terms of potential PDA use in palliative medicine, six thematic areas are suggested: medical references, EPR, staying connected, personal productivity, clinical research, and issues/concerns. For implications, healthcare organizations should consider mobile technology as part of their information systems strategy. The feasibility of a portable EPR for palliative medicine should be explored, and an information-based approach can help advance palliative medicine research in Canada.
As the South African province of KwaZulu-Natal addresses a growing multidrug-resistant tuberculosis (MDR-TB) epidemic by shifting care and treatment from trained specialty centers to community hospitals, delivering and monitoring MDR-TB therapy has presented new challenges. In particular, tracking and reporting adverse clinical events have been difficult for mobile healthcare workers (HCWs), trained health professionals who travel daily to patient homes to administer and monitor therapy. We designed and piloted a mobile phone application (Mobilize) for mobile HCWs that electronically standardized the recording and tracking of MDR-TB patients on low-cost, functional phones.
OBJECTIVE:
We assess the acceptability and feasibility of using Mobilize to record and submit adverse events forms weekly during the intensive phase of MDR-TB therapy and evaluate mobile HCW perceptions throughout the pilot period.
METHODS:
All five mobile HCWs at one site were trained and provided with phones. Utilizing a mixed-methods evaluation, mobile HCWs' usage patterns were tracked electronically for seven months and analyzed. Qualitative focus groups and questionnaires were designed to understand the impact of mobile phone technology on the work environment.
RESULTS:
Mobile HCWs submitted nine of 33 (27%) expected adverse events forms, conflicting with qualitative results in which mobile HCWs stated that Mobilize improved adverse events communication, helped their daily workflow, and could be successfully expanded to other health interventions. When presented with the conflict between their expressed views and actual practice, mobile HCWs cited forgetfulness and believed patients should take more responsibility for their own care.
DISCUSSION:
This pilot experience demonstrated poor uptake by HCWs despite positive responses to using mHealth. Though our results should be interpreted cautiously because of the small number of mobile HCWs and MDR-TB patients in this study, we recommend carefully exploring the motivations of HCWs and technologic enhancements prior to scaling new mHealth initiatives in resource poor settings.
