Attitudes towards digital health tools for outpatient cirrhosis management in patients with decompensated cirrhosis

Bloom, Patricia P.; Marx, Madeline; Wang, Thomas J.; Green, Bradley; Ha, John; Bay, Camden; Chung, Raymond T.; Richter, James M.

doi:10.1136/bmjinnov-2019-000369

Cited by 12 publications

(11 citation statements)

References 23 publications

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Section: Resultsmentioning

confidence: 99%

“…In an interview study of 50 patients admitted for a complication of cirrhosis, 79% were interested in using a digital health management tool that could provide information about cirrhosis and 75% were interested in more education on a low-salt diet. (18) Few cirrhosis education programs were described in our literature review (Table 2), and the ones that exist demonstrated improvement on a small scale. Volk et al (13) administered a knowledge assessment questionnaire to 115 patients before and after an educational intervention (concise educational booklet), with scores increasing from 53% to 67% before and after intervention, respectively.…”

Section: Literature Reviewmentioning

confidence: 98%

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How Do Patients With Cirrhosis and Their Caregivers Learn About and Manage Their Health? A Review and Qualitative Study

Saleh¹,

Bloom

Grzyb

et al. 2021

Hepatology Communications

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The complexity of cirrhosis requires patients and their caregivers to be well educated to improve outcomes. Data are lacking regarding how to best educate patients and their caregivers in the setting of cirrhosis. Our aim is to understand (both through existing literature and by asking patients and their caregivers) how patients learn about their disease, barriers in their education and disease management, and self‐management strategies. We performed a structured search of published articles in PubMed (1973 to 2020) using keywords “cirrhosis” plus “barriers”, “education”, “self‐management”, or “self‐care”. Additionally, we conducted a focus group of a representative sample of patients and their caregivers to understand how knowledge about cirrhosis is found and incorporated into self‐management. Of 504 returned manuscripts, 11 pertained to barriers in cirrhosis, interventions, or educational management. Barriers are well documented and include disease complexity, medication challenges, comorbid conditions, and lack of effective education. However, data regarding addressing these barriers, especially effective educational interventions, are scarce. Current strategies include booklets and videos, patient empowerment, and in‐person lectures. Without widespread use of these interventions, patients are left with suboptimal knowledge about their disease, a sentiment unanimously echoed by our focus group. Despite linkage to subspecialty care and consistent follow‐up, patients remain uncertain about their disease origin, prognosis, and therapies to manage symptoms. It is clear that more data are needed to assess effective strategies to address unmet educational needs. Existing strategies need to be blended and improved, their effectiveness evaluated, and the results distributed widely.

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Section: Resultsmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 98%

How Do Patients With Cirrhosis and Their Caregivers Learn About and Manage Their Health? A Review and Qualitative Study

Saleh¹,

Bloom

Grzyb

et al. 2021

Hepatology Communications

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“…Nevertheless, the intervention includes valuable educational material and offers the potential to continue communication with the treating teams after discharge for most of the clinical issues that underlie readmission, such as hepatic encephalopathy, gastrointestinal bleeding, ascites, and medication management [3,9]. This approach was tested by Bloom et al [11] in a cross-sectional survey where theoretical acceptance of an app that would require similar communications as currently being tested with Patient Buddy was considered to be acceptable to most patients. This finding is in contrast to the results of this study, likely because unlike the theoretical constructs in the prior study, the dyads had to agree to be randomized for a 30-day trial in real life in our study.…”

Section: Discussionmentioning

confidence: 99%

Perspectives of Inpatients With Cirrhosis and Caregivers on Using Health Information Technology: Cross-sectional Multicenter Study

Acharya¹,

Sehrawat²,

McGuire³

et al. 2021

J Med Internet Res

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Background Health information technology (IT) interventions to decrease readmissions for cirrhosis may be limited by patient-associated factors. Objective The aim of this study was to determine perspectives regarding adoption versus refusal of health IT interventions among patient-caregiver dyads. Methods Inpatients with cirrhosis and their caregivers were approached to participate in a randomized health IT intervention trial requiring daily contact with research teams via the Patient Buddy app. This app focuses on ascites, medications, and hepatic encephalopathy over 30 days. Regression analyses for characteristics associated with acceptance were performed. For those who declined, a semistructured interview was performed with themes focused on caregivers, protocol, transport/logistics, technology demands, and privacy. Results A total of 349 patient-caregiver dyads were approached (191 from Virginia Commonwealth University, 56 from Richmond Veterans Affairs Medical Center, and 102 from Mayo Clinic), 87 of which (25%) agreed to participate. On regression, dyads agreeing included a male patient (odds ratio [OR] 2.08, P=.01), gastrointestinal bleeding (OR 2.3, P=.006), or hepatic encephalopathy admission (OR 2.0, P=.01), whereas opioid use (OR 0.46, P=.03) and alcohol-related etiology (OR 0.54, P=.02) were associated with refusal. Race, study site, and other admission reasons did not contribute to refusing participation. Among the 262 dyads who declined randomization, caregiver reluctance (43%), perceived burden (31%), technology-related issues (14%), transportation/logistics (10%), and others (4%), but not privacy, were highlighted as major concerns. Conclusions Patients with cirrhosis admitted with hepatic encephalopathy and gastrointestinal bleeding without opioid use or alcohol-related etiologies were more likely to participate in a health IT intervention focused on preventing readmissions. Caregiver and study burden but not privacy were major reasons to decline participation. Reducing perceived patient-caregiver burden and improving communication may improve participation. Trial Registration ClinicalTrials.gov NCT03564626; https://www.clinicaltrials.gov/ct2/show/NCT03564626

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“…Technology represents a promising tool to facilitate the management of ascites by increasing the quality and quantity of patient-provider communication about weight data. In a recent interview study of patients with an early readmission for decompensated cirrhosis, the majority stated that they would use a smartphone to manage their condition, particularly if it was able to transmit weight data to their provider [ 13 ]. Retrospective and survey studies suggest that programs with enhanced outpatient care can improve outcomes for patients with ascites [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

A Smartphone App to Manage Cirrhotic Ascites Among Outpatients: Feasibility Study

Bloom¹,

Wang²,

Marx³

et al. 2020

JMIR Med Inform

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Background Ascites is a common, painful, and serious complication of cirrhosis. Body weight is a reliable proxy for ascites volume; therefore, daily weight monitoring is recommended to optimize ascites management. Objective This study aims to evaluate the feasibility of a smartphone app in facilitating outpatient ascites management. Methods In this feasibility study, patients with cirrhotic ascites requiring active management were identified in both inpatient and outpatient settings. Patients were provided with a Bluetooth-connected scale, which transmitted weight data to a smartphone app and then via the internet to an electronic medical record (EMR). Weights were monitored every weekday. In the event of a weight change of ≥5 lbs in 1 week, patients were called and administered a short symptom questionnaire, and providers received an email alert. The primary outcomes of this study were the percentage of enrolled days during which weight data were successfully transmitted to an EMR and the percentage of weight alerts that prompted responses by the provider. Results In this study, 25 patients were enrolled: 12 (48%) were male, and the mean age was 58 (SD 13; range 35-81) years. A total of 18 (72%) inpatients were enrolled. Weight data were successfully transmitted to an EMR during 71.2% (697/979) of the study enrollment days, with technology issues reported on 16.5% (162/979) of the days. Of a total of 79 weight change alerts fired, 41 (52%) were triggered by weight loss and 38 (48%) were by weight gain. Providers responded in some fashion to 66 (84%) of the weight alerts and intervened in response to 45 (57%) of the alerts, for example, by contacting the patient, scheduling clinic or paracentesis appointments, modifying the diuretic dose, or requesting a laboratory workup. Providers responded equally to weight increase and decrease alerts (P=.87). The staff called patients a mean of 3.7 (SD 3.5) times per patient, and the number of phone calls correlated with technology issues (r=0.60; P=.002). A total of 60% (15/25) of the patients chose to extend their participation beyond 30 days. A total of 17 patient readmissions occurred during the study period, with only 4 (24%) related to ascites. Conclusions We demonstrated the feasibility of a smartphone app to facilitate the management of ascites and reported excellent rates of patient and provider engagement. This innovation could enable early therapeutic intervention, thereby decreasing the burden of morbidity and mortality among patients with cirrhosis.

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Attitudes towards digital health tools for outpatient cirrhosis management in patients with decompensated cirrhosis

Cited by 12 publications

References 23 publications

How Do Patients With Cirrhosis and Their Caregivers Learn About and Manage Their Health? A Review and Qualitative Study

How Do Patients With Cirrhosis and Their Caregivers Learn About and Manage Their Health? A Review and Qualitative Study

Perspectives of Inpatients With Cirrhosis and Caregivers on Using Health Information Technology: Cross-sectional Multicenter Study

A Smartphone App to Manage Cirrhotic Ascites Among Outpatients: Feasibility Study

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