Jan LISKA

- Background: Cardiometabolic conditions including acute coronary syndrome (ACS) and type 2 diabetes (T2D) require comprehensive care and patient engagement in self-care behaviors, and the drivers of those behaviors at the individual and health system level are still poorly understood.
- Objective: We aim to gain insights into self-care behaviors of individuals with cardiometabolic conditions.
- Methods: A convenience sample of 98 adult patients with ACS and T2D was recruited in the… Voir plus

- Background: Cardiometabolic conditions including acute coronary syndrome (ACS) and type 2 diabetes (T2D) require comprehensive care and patient engagement in self-care behaviors, and the drivers of those behaviors at the individual and health system level are still poorly understood.
- Objective: We aim to gain insights into self-care behaviors of individuals with cardiometabolic conditions.
- Methods: A convenience sample of 98 adult patients with ACS and T2D was recruited in the United States, Germany, and Taiwan to participate in a mixed methods study using ethnographic methods. All participants completed 7-day web-based diaries tracking their level of engagement, and 48 completed 90-minute web-based semistructured interviews between February 4, 2021, and March 27, 2021, focusing on themes including moments of engagement. Qualitative analysis identified factors influencing self-care practices and a Patient Mind States Model prototype.
- Results: Patient reports indicate that many patients feel social pressure to adhere to treatment. Patients’ experience can be understood within 5 categories defined in terms of their degree of engagement and adherence (“ignoring,” “struggling,” “juggling,” “controlling,” and “reframing”).
- Conclusions: For people living with ACS and T2D, the self-care journey is defined by patterns of patient experiences, which can identify areas that tailored digital health care interventions may play a meaningful role. Voir moins

Background:
Seasonal influenza affects 5% to 15% of Americans annually, resulting in preventable deaths and substantial economic impact. Influenza infection is particularly dangerous for people with cardiovascular disease, who therefore represent a priority group for vaccination campaigns.

Objective:
We aimed to assess the effects of digital intervention messaging on self-reported rates of seasonal influenza vaccination.

Methods:
This was a randomized, controlled… Voir plus

Background:
Seasonal influenza affects 5% to 15% of Americans annually, resulting in preventable deaths and substantial economic impact. Influenza infection is particularly dangerous for people with cardiovascular disease, who therefore represent a priority group for vaccination campaigns.

Objective:
We aimed to assess the effects of digital intervention messaging on self-reported rates of seasonal influenza vaccination.

Methods:
This was a randomized, controlled, single-blind, and decentralized trial conducted at individual locations throughout the United States over the 2020-2021 influenza season. Adults with self-reported cardiovascular disease who were members of the Achievement mobile platform were randomized to receive or not receive a series of 6 patient-centered digital intervention messages promoting influenza vaccination.

Results:
Of the 49,138 randomized participants, responses on the primary end point were available for 11,237 (22.87%; 5575 in the intervention group and 5662 in the control group) participants. The vaccination rate was significantly higher in the intervention group (3418/5575, 61.31%) than the control group (3355/5662, 59.25%; relative risk 1.03, 95% CI 1.004-1.066; P=.03). Participants who were older, more educated, and White or Asian were more likely to report being vaccinated. The intervention was effective among White participants (P=.004) but not among people of color (P=.42). The vaccination rate was 13 percentage points higher among participants who completed all 6 intervention messages versus none, and at least 2 completed messages appeared to be needed for effectiveness. Participants who reported a diagnosis of COVID-19 were more likely to be vaccinated for influenza regardless of treatment assignment.

Conclusions:
This personalized, evidence-based digital intervention was effective in increasing vaccination rates in this population of high-risk people with cardiovascular disease Voir moins

This review aimed to assess brief digital behavior change solutions (i.e., solutions that require limited engagement or contact) for T2D, including use of behavior change techniques (BCTs) and their impact on self-care and glycemic control.
A review was conducted by searching Embase and gray literature using a predefined search strategy to identify randomized controlled trials (RCT) published between January 1, 2015, and March 21, 2021. BCTs were coded using an internationally established… Voir plus

This review aimed to assess brief digital behavior change solutions (i.e., solutions that require limited engagement or contact) for T2D, including use of behavior change techniques (BCTs) and their impact on self-care and glycemic control.
A review was conducted by searching Embase and gray literature using a predefined search strategy to identify randomized controlled trials (RCT) published between January 1, 2015, and March 21, 2021. BCTs were coded using an internationally established BCT taxonomy v1 (BCTTv1).
Out of 1426 articles identified, 10 RCTs were included in qualitative synthesis. Of these, six reported significant improvements in primary outcome(s), including improved patient engagement, glycemic control, self-efficacy, and physical activity. Interventions as short as 12 min were found to be effective, and users’ ability to control their preferences was noted as conducive to engagement. Almost three quarters of BCTs targeted by interventions were under the hierarchical clusters of “Feedback and monitoring,” “Goals and planning,” and “Shaping knowledge.” Interventions that targeted fewer BCTs were at least as effective as interventions that were more comprehensive in their goals.
Digital behavior change solutions can successfully improve T2D self-care support and outcomes in a variety of populations including patients with low incomes, limited educational attainment, or living in rural areas. Easy-to-use interventions tailored to patient needs may be as effective as lengthy, complex, and more generalized interventions.
Brief digital solutions can improve clinical and behavioral outcomes while reducing patient burden, fitting more easily in patients’ lives and potentially improving usability. As T2D patients increasingly expect access to self-care assistance between face-to-face encounters, digital support tools will play a greater role in effective diabetes management programs. Voir moins

Aim: This survey for cardiometabolic patients diagnosed with T2 diabetes and/or an ACS aims at providing deep human-centric insights into the behavioral dimension of their patient experience, while mapping future-focused opportunities to increase adherence for chronic and acute patients, facilitate healthy behaviors, and improve patient outcomes.

Methods: We employed virtual observational ethnography—a social-scientific methodology of qualitative research—to detect sociocultural patterns… Voir plus

Aim: This survey for cardiometabolic patients diagnosed with T2 diabetes and/or an ACS aims at providing deep human-centric insights into the behavioral dimension of their patient experience, while mapping future-focused opportunities to increase adherence for chronic and acute patients, facilitate healthy behaviors, and improve patient outcomes.

Methods: We employed virtual observational ethnography—a social-scientific methodology of qualitative research—to detect sociocultural patterns and differences among a sample of patients from US, Germany and Taiwan, composed by 50% compliant and 50% non-compliant patients. 98 Online auto-ethnographic diaries and 48 semi-structured web-based interviews patients and caregivers were conducted to understand self-care adherence drivers from medical, psychological and cultural perspectives.

Results: Cardiometabolic patients see their journeys as non-linear, influenced by cognitive and/or emotional aspects of their health and life continuous changes. Adherence to care interventions appears as result of an ongoing process. Self-care initiation and -maturity in cardiometabolic patients evolve with their mind state. Tailored support considering patients' current mind state may result in optimal initiation, adherence and self-care expertise.

Discussion: Providers need to assess patients’ mind state prior to care initiation for optimal patient engagement. Sustained virtual care solutions that help patients step up gradually from struggling or juggling to controlling mind state and embrace fully patient-relevant social determinants of health, are likely to increase patient self-care expertise.

Conclusion: This survey opens novel perspectives for disease management design, implementation and patient adherence monitoring. Voir moins

There is an urgent need for improvements in maternal and newborn health despite the efforts of numerous stakeholders and the adoption of specific targets as in the Sustainable Development Goals. In 2018, using an evidence-based and design-thinking approach involving communities, three stakeholders (a foundation, an NGO, and a startup) decided to combine their expertise to better understand and potentially revisit the drivers for improving maternal and newborn health. The AIM – Accelerated… Voir plus

There is an urgent need for improvements in maternal and newborn health despite the efforts of numerous stakeholders and the adoption of specific targets as in the Sustainable Development Goals. In 2018, using an evidence-based and design-thinking approach involving communities, three stakeholders (a foundation, an NGO, and a startup) decided to combine their expertise to better understand and potentially revisit the drivers for improving maternal and newborn health. The AIM – Accelerated Impact Model - has been designed as a systemic, needs-led innovation framework for improving maternal and newborn health in low and middle-income countries. The AIM is currently being tested to assess its real-world impact in the Saint-Louis region of Senegal. This integrated approach is associated with community empowerment and accompanied by “glocal” experts and organizations. It represents the backbone of the AIM method. The first step of the AIM application was the pre-pilot phase, as the population itself identified the health and medical-social barriers contributing to maternal and newborn mortality together with the corresponding corrective measures. The second step integrated co-created projects into a three-pillar program centered on awareness of community engagement. To test the sustainability of the model, the third step of the AIM approach resulted in the creation of a local pilot team to accelerate the implementation of new co-created projects and optimize existing initiatives supported by local and global sponsors. Over the course of one month, the newly formed “Rawal ak Diam” platform transformed the COVID-19 epidemic into an opportunity to mobilize the community and connect with the authorities. The community program focus here is on the two first deadlines (the decision to request help and access care) in maternal health while remaining aligned with the Sustainable Development Goal of reducing maternal and neonatal mortality in low- and middle-income countries. Voir moins

People with diabetes (PWD) have an increased risk of developing influenza-related complications, including pneumonia, abnormal glycemic events, and hospitalization. Annual influenza vaccination is recommended for PWD, but vaccination rates are suboptimal. The study aimed to increase influenza vaccination rate in people with self-reported diabetes. This study was a prospective, 1:1 randomized controlled trial of a 6-month Digital Diabetes Intervention in U.S. adults with diabetes. The… Voir plus

People with diabetes (PWD) have an increased risk of developing influenza-related complications, including pneumonia, abnormal glycemic events, and hospitalization. Annual influenza vaccination is recommended for PWD, but vaccination rates are suboptimal. The study aimed to increase influenza vaccination rate in people with self-reported diabetes. This study was a prospective, 1:1 randomized controlled trial of a 6-month Digital Diabetes Intervention in U.S. adults with diabetes. The intervention group received monthly messages through an online health platform. The control group received no intervention. Difference in self-reported vaccination rates was tested using multivariable logistic regression controlling for demographics and comorbidities. The study was registered at clinicaltrials.gov: NCT03870997. A total of 10,429 participants reported influenza vaccination status (5158 intervention, mean age (±SD) = 46.8 (11.1), 78.5% female; 5271 control, Mean age (±SD) = 46.7 (11.2), 79.4% female). After a 6-month intervention, 64.2% of the intervention arm reported influenza vaccination, vers us 61.1% in the control arm (diff = 3.1, RR = 1.05, 95% CI [1.02, 1.08], p = 0.0013, number needed to treat = 33 to obtain 1 additional vaccination). Completion of one or more intervention messages was associated with up to an 8% increase in vaccination rate (OR 1.27, 95% CI [1.17, 1.38], p < 0.0001). The intervention improved influenza vaccination rates in PWD, suggesting that leveraging new technology to deliver knowledge and information can improve influenza vaccination rates in high-risk populations to reduce public health burden of influenza. Rapid cycle innovation could maximize the effects of these digital interventions in the future with other populations and vaccines. Voir moins

Background: We describe the impact of influenza on medical outcomes and daily activities among people with and without type 2 diabetes mellitus (T2DM).
Results: A total of 54 656 T2DM and 113 016 non-DM controls were used for the study. People with T2DM had more influenza claims, vaccinations, and influenza antivirals per 100 people (1.96% vs 1.37%, 34.3% vs 24.3%, and 27.1 vs 22 respectively, P < .001). A total of 1086 persons with T2DM and 1567 controls had an influenza claim (47.4%… Voir plus

Background: We describe the impact of influenza on medical outcomes and daily activities among people with and without type 2 diabetes mellitus (T2DM).
Results: A total of 54 656 T2DM and 113 016 non-DM controls were used for the study. People with T2DM had more influenza claims, vaccinations, and influenza antivirals per 100 people (1.96% vs 1.37%, 34.3% vs 24.3%, and 27.1 vs 22 respectively, P < .001). A total of 1086 persons with T2DM and 1567 controls had an influenza claim (47.4% male, median age 54, 6.4% vs 7.8% trackers, respectively). Glycemic events, pneumonia, and ischemic heart disease increased over baseline during the peri-influenza period for T2DM (1.74-, 7.4-, and 1.6-fold increase respectively, P < .01). In a device wearing subcohort, we observed 10 000 fewer steps surrounding the influenza event, with the lowest (5500 steps) two days postinfluenza. Average heart rate increased significantly (+5.5 beats per minute) one day prior to influenza. Conclusion: Influenza increases rates of pneumonia, heart disease, and abnormal glucose levels among people with T2DM, and negatively impacts daily activities compared to controls. Voir moins

Medication nonadherence is a serious public health concern. Although there are promising interventions that improve medication adherence, most interventions are developed and tested in tightly controlled research environments that are dissimilar from the real-world settings where the majority of patients receive health care. Implementation science methods have the potential to facilitate and accelerate the translation shift from the trial world to the real world. We demonstrate their potential… Voir plus

Medication nonadherence is a serious public health concern. Although there are promising interventions that improve medication adherence, most interventions are developed and tested in tightly controlled research environments that are dissimilar from the real-world settings where the majority of patients receive health care. Implementation science methods have the potential to facilitate and accelerate the translation shift from the trial world to the real world. We demonstrate their potential by reviewing published, high-quality medication adherence studies that could potentially be translated into clinical practice yet lack essential implementation science building blocks. We further illustrate this point by describing an adherence study that demonstrates how implementation science creates a junction between research and real-world settings. This article is a call to action for researchers, clinicians, policy makers, pharmaceutical companies, and others involved in the delivery of care to adopt the implementation science paradigm in the scale-up of adherence (research) programs. Voir moins

This is the first population scale study to use medical claims linked with activity tracking data to quantify the behavioral and clinical effects of influenza in type 2 diabetes. These data highlight the impact of influenza on glycemic control and the daily lives of the Diabetic population, and reinforce the need for annual influenza vaccine, as recommended by the WHO and other global public health bodies.

Our analysis indicates that targeted interventions focussing on country-specific drivers of flu vaccination adherence among subpopulations of people with diabetes could lead to an increase in vaccination rates of up to 5%. By identifying country-specific behavioral drivers of flu vaccination and most receptive subgroups, we can design more tailored interventions to increase uptake.

Lipid-lowering medications have been shown to be efficacious, but adherence is suboptimal. This is a narrative, perspective review of recently published literature in the field of medication adherence research for lipid-lowering medications. We provide an overview of the impact of suboptimal adherence and use a World Health Organization framework (patient, condition, therapy, socioeconomic, and health system-related systems) to discuss factors that influence hyperlipidemia treatment adherence… Voir plus

Lipid-lowering medications have been shown to be efficacious, but adherence is suboptimal. This is a narrative, perspective review of recently published literature in the field of medication adherence research for lipid-lowering medications. We provide an overview of the impact of suboptimal adherence and use a World Health Organization framework (patient, condition, therapy, socioeconomic, and health system-related systems) to discuss factors that influence hyperlipidemia treatment adherence. Further, the review involves an evaluation of intervention strategies to increase hyperlipidemia treatment adherence with a special focus on mHealth interventions, patient reminders on packaging labels, nurse- and pharmacist-led interventions, and health teams. It also highlights opportunities for pharmaceutical companies to support and scale such behavioral interventions. Medication adherence remains a challenge for the long-term management of chronic conditions, especially those involving asymptomatic disease such as hyperlipidemia. To engage patients and enhance motivation over time, hyperlipidemia interventions must be targeted to individual patients’ needs, with sequencing and frequency of contact tailored to the various stages of behavioral change. Voir moins

While patients with multiple chronic conditions account for the bulk of health care spending in many countries, medical research and care remain organized around singular diseases and specialties. This siloed approach places the burden of managing multiple conditions on patients, who often have difficulty navigating the health care system and following treatment recommendations. This helps explain why patients with multiple chronic conditions have more unplanned admissions to the hospital… Voir plus

While patients with multiple chronic conditions account for the bulk of health care spending in many countries, medical research and care remain organized around singular diseases and specialties. This siloed approach places the burden of managing multiple conditions on patients, who often have difficulty navigating the health care system and following treatment recommendations. This helps explain why patients with multiple chronic conditions have more unplanned admissions to the hospital, worse health outcomes, and poorer quality of life.
Longer life expectancies, aging populations, and the increasing incidence of chronic conditions will vastly increase the number of patients living with multiple conditions, placing strains not only on patients but on governments and businesses paying for their care.
Pharmaceutical companies can play a pivotal role in addressing these issues by developing products, programs, and services geared to the unique physical, social, and emotional challenges patients with multiple chronic conditions face. Companies also can have a significant impact by promoting collaboration and communication among health system stakeholders, expanding the knowledge base about patients’ experiences with multiple chronic conditions, and developing therapies and tools to help patients adhere to treatments and improve their quality of life. Voir moins

Structuring our lives between periods of “anticipation” and periods of “action” has become a thing of the past. Timing for appropriate and specific engagement with brands and services has shifted from brands deciding the “when” and the “what” to consumers choosing and deciding how they want to interact. Nowadays, brands must integrate
themselves into individuals’ patterns – rather than creating these patterns themselves.

In times when the rights to freedom are becoming more nuanced, desire and health remain two apparently incompatible quests. Could the future hold opportunities to transform this dichotomy
into an alliance of unexpected, valuable, and meaningful synergies?