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An Audio Personal Health Library of Clinic Visit Recordings for Patients and Their Caregivers (HealthPAL): User-Centered Design Approach

Barr P, Haslett W, Dannenberg M, Oh L, Elwyn G, Hassanpour S, Bonasia K, Finora J, Schoonmaker J, Onsando W, Ryan J, Bruce M, Das A, Arend R, Piper S, Ganoe C. An Audio Personal Health Library of Clinic Visit Recordings for Patients and Their Caregivers (HealthPAL): User-Centered Design Approach. J Med Internet Res 2021;23(10):e25512 DOI: 10.2196/25512

This paper describes the user-centered development of HealthPAL, an audio personal health library for patients to collect and organize clinic audio recordings. Forty participants representative of older patients and caregivers were recruited from community settings. Participants gave feedback during 5 rounds of usability sessions. In the first three sessions, researchers used paper prototypes and focused on features to refine the user interface. In rounds 4 and 5, participants moved to low-fidelity and high-fidelity software versions of HealthPAL. Participants listened to a primary care visit recording before completing a series of typical user tasks (e.g., find where the provider describes a possible surgery). In the final session, patients’ actual primary care clinic visits were recorded. Perceived usability was collected at each session with the System Usability Scale and whether tasks were completed independently, with the assistance of a facilitator, or not completed. Results found usability increased over the rounds and in the final round where participants reported a score of 78.2 on average (range 20-100). By the final round, participants were able to complete most tasks (at least 88%) without any assistance. Participants also reported very positive perceptions of having a curated audio recording of a clinic visit. Concerns reported were related to privacy and computer literacy required to access recordings. Overall, HealthPAL was rigorously co-designed with patients and their caregivers; next steps include further field testing of the first patient-centered app to access recordings of clinic visits. Sharing visit audio recordings with patients is an emerging strategy for the goal of improving transparency and communication in healthcare.


Research Team Receives $7 Million Funding Award to Study Most Effective Way of Sharing Clinic Visit Information with Older Adults

Article Excerpt: A Dartmouth-led research group, including investigators from Vanderbilt University Medical Center (VUMC), University of Texas Medical Branch (UTMB) at Galveston, and Harvard Medical School, has received a five-year, $7 million funding award from the Patient-Centered Outcomes Research Institute (PCORI). Their project will assess the effectiveness of visit information provided to older adult patients and caregivers—as an audio recording compared to reviewing the physician note of the visit using the patient electronic health portal—on quality of life… “Providing written summaries of office visits through online patient portals is a widely adopted approach to close this information gap,” explains Principal Investigator Paul Barr, PhD, an associate professor of The Dartmouth Institute for Health Policy & Clinical Practice, and Center for Technology & Behavioral Health at the Geisel School of Medicine… “But it hasn’t been clear if this is the best way to share information,” he says. “Visit audio recordings have emerged as another evidence-based strategy to share information. This has resulted in a decisional dilemma for patients and healthcare leaders who ask the question, ‘What is the most effective approach to communicate healthcare visit information to older adults living in the community?’”

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Article Source: Dartmouth Geisel School of Medicine News. Also posted on News-Medical.Net.


Effect of digital psychoeducation and peer support on the mental health of family carers supporting individuals with psychosis in England (COPe-support): a randomised clinical trial

Sin J, Henderson C, Elkes J, Cornelius V, Woodham LA, Batchelor R, Chen T, Corredor AM, Coughlan D, Dhital R, Evans S, Haider B, Heathcote J, Mansfield S, O’Brien A, Qassim M, Sserunkuma J, Travis CH, Williams E & Gillard S. (2022). Effect of digital psychoeducation and peer support on the mental health of family carers supporting individuals with psychosis in England (COPe-support): a randomised clinical trial. The Lancet (British Edition), 4(5), e320–e329.

Researchers evaluated the effectiveness of a web-based multicomponent intervention (COPe-support) for improving the mental health and caregiving outcomes of caregivers of individuals with serious mental illness. A randomized two-arm trial was conducted to compare the COPe-support intervention to a passive control condition (an online information resource). Participants were adult relatives and close friends who provided at least weekly support in any format for persons with psychosis. Four hundred and seven participants were recruited from 30 mental health provider organizations across England. The COPe-support intervention included features addressing psychoeducation about psychosis and treatment, caregiving issues, wellbeing promotion, expert and peer support forums, and relevant external resources. Participants in the treatment group downloaded the free app and had access for 40 weeks. Participants were recommended to use the app for at least 30 minutes weekly. Participants completed self-reported assessments of psychological wellbeing, quality of life, caregiving experience and support at baseline, 10 weeks, 20 weeks, and 40 weeks. The results found no difference in mental wellbeing between the COPe-support group and the control group at 20 weeks follow-up. Participants who reported higher use of COPe-support reported a greater effect in improved mental well-being, but this difference was not statistically significant. The results were similar at the 40 weeks follow-up as well. Overall, the COPe-support for caregivers supporting an individual with psychosis was not superior to an information resource at 20 weeks. Considering the projected increase in the caregiver population and demand for support, a digital intervention targeting psychological support for caregivers such as COPe-support is valuable. Research to demonstrate the efficacy of digital interventions to support caregivers of individuals with serious mental illness is needed.


Geisel Researchers Receive $4 Million Grant to Improve Office Visit Interactions Between People Living with Dementia, Care Partners, and Clinicians

Article Excerpt: A team of researchers at Dartmouth’s Geisel School of Medicine and New York University (NYU) Grossman School of Medicine has received a $4 million grant from the National Institute on Aging to improve “triadic” interactions between patients living with dementia, their care partners, and their clinicians. An estimated 6.5 million Americans aged 65 or older currently live with Alzheimer’s disease or Alzheimer’s disease-related dementia, and that number is projected to rise to nearly 13 million by 2050, placing an even greater burden on patients, caregivers, and the healthcare system. People living with dementia and their care partners (typically family members or friends) rely on primary care clinic visits for information about their disease, its management, and community referrals. While research has shown that quality interpersonal communication is associated with improved health outcomes, the degree to which effective communication is achieved during triadic visits is unknown, and few interventions have been developed to support it.

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Article Source: Dartmouth Geisel School of Medicine News


Are caregivers ready for digital? Caregiver preferences for health technology tools to monitor medication adherence among patients with serious mental illness

Forma F, Chiu K, Shafrin J, Boskovic DH, & Veeranki SP. (2022). Are caregivers ready for digital? Caregiver preferences for health technology tools to monitor medication adherence among patients with serious mental illness. Digital health, 8, 20552076221084472.

This study explored the preferences and willingness-to-pay for digital tools that monitor medication adherence among caregivers of persons with serious mental illness (SMI). Among digital tools, four options were identified: (1) smart pill bottles that records the frequency the bottle is opened or closed; (2) smart pill dispenser that sorts and organizes pills for use; (3) mobile apps; and (4) pills embedded with an ingestible event market (IEM) sensor that signals to a mobile app upon medication ingestion. Researchers administered a web-based survey to 184 caregivers of adult SMI patients recruited through phone, conferences, social media, and referrals. Fifty-seven participants cared for bipolar depression, 61 for major depressive disorder, and 66 for schizophrenia. The survey instrument consists of a discrete choice experiment module that assesses the caregivers’ preferences for adherence monitoring tools. Specifically, the survey includes items to assess source of medication adherence information, medication adherence information accessibility, patients’ report of wellbeing, and caregivers’ monthly out-of-pocket cost for the health technology tool. Results demonstrated that caregivers highly preferred a medical adherence tool using a pill embedded with an IEM sensor and tracking patients’ well-being compared to a non-digital pill organizer. Caregivers were willing to pay on average $255 more per month for this tool than a pill organizer. Findings suggest that caregivers value digital tools that monitor adherence and track their loved ones’ health.