The Atrial Fibrillation Health Literacy Information Technology System: Pilot Assessment.
The Atrial Fibrillation Health Literacy Information Technology System: Pilot Assessment.
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DOI：
10.2196/cardio.8543
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发表时间：
2017-07
期刊：
影响因子：
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通讯作者：
Bickmore TW
中科院分区：
文献类型：
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作者：
Magnani JW;Schlusser CL;Kimani E;Rollman BL;Paasche-Orlow MK;Bickmore TW
心房颤动（AF）是一种非常普遍的心律状况，具有显著的相关发病率，需要长期治疗。移动医疗（mHealth）技术有潜力加强房颤护理的多个方面，包括教育、症状监测以及鼓励和跟踪药物依从性。我们之前已经实施和测试了相关药物，以改善慢性疾病的预后，并试图开发一种基于智能手机的相关药物，以改善心房颤动以患者为中心的预后。本研究的目的是试点一种基于智能手机的相关药物，为一项随机临床试验——心房颤动健康素养信息技术试验（AF- litt）做准备。我们根据之前的方法开发了智能手机使用的关系代理。我们将关系代理编程为计算机动画代理，以模拟面对面的对话，并作为房颤特定的健康咨询师或教练。关系代理的对话内容，通过文献回顾，侧重于以患者为中心的领域和对房颤患者的定性访谈，包括房颤教育、常见症状、依从性挑战和患者激活。我们确定，健康状况或计算机知识有限的个人也可以访问这些内容。关系代理内容与智能手机AliveCor Kardia心率和节律监测器的使用相协调。参与者（N=31）作为便利队列从门诊临床站点招募，并指示使用相关药物和卡地亚30天。我们收集了人口学、社会和临床特征，并对与健康相关的生活质量（HRQoL）进行了基线和30天评估，并采用心房颤动对生活质量的影响（AFEQT）测量；Morisky 8项药物依从性量表（MMAS-8）自我报告药物依从性；以及患者激活测量（PAM）的患者激活。参与者（平均年龄68岁[SD 11]； 39%[12/31]女性）平均使用关系剂17.8 （SD 10.0）天。平均独立登录次数为19.6次（SD 10.7）， 30天内中位数为20次。使用Kardia的平均次数为26.5 (SD 5.9)，使用Kardia的参与者在房颤中持续14.3天（SD 11.0）。AFEQT评分从基线时的64.5 （SD 22.9）显著提高到30天时的76.3 (SD 19.4) （P< 0.01）。我们观察到自我报告的药物依从性有边际但有统计学意义的改善（基线：7.3 [SD 0.9]， 30天：7.7 [SD 0.5]； P= 0.01）。对可接受性的评估表明，大多数参与者认为关系代理有用、信息丰富且值得信赖。我们进行了一项为期30天的基于智能手机的干预试验，该干预将关系代理与AF的专用内容结合起来，同时进行心律和节律监测。试点参与者在HRQoL和自我报告的药物依从性方面有良好的改善，对干预也有积极的反应。这些数据将指导一个更大的、增强的随机试验，实施智能手机关系代理和Kardia监测系统。
Atrial fibrillation (AF) is a highly prevalent heart rhythm condition that has significant associated morbidity and requires chronic treatment. Mobile health (mHealth) technologies have the potential to enhance multiple aspects of AF care, including education, monitoring of symptoms, and encouraging and tracking medication adherence. We have previously implemented and tested relational agents to improve outcomes in chronic disease and sought to develop a smartphone-based relational agent for improving patient-centered outcomes in AF. The objective of this study was to pilot a smartphone-based relational agent as preparation for a randomized clinical trial, the Atrial Fibrillation Health Literacy Information Technology Trial (AF-LITT). We developed the relational agent for use by a smartphone consistent with our prior approaches. We programmed the relational agent as a computer-animated agent to simulate a face-to-face conversation and to serve as a health counselor or coach specific to AF. Relational agent’s dialogue content, informed by a review of literature, focused on patient-centered domains and qualitative interviews with patients with AF, encompassed AF education, common symptoms, adherence challenges, and patient activation. We established that the content was accessible to individuals with limited health or computer literacy. Relational agent content coordinated with use of the smartphone AliveCor Kardia heart rate and rhythm monitor. Participants (N=31) were recruited as a convenience cohort from ambulatory clinical sites and instructed to use the relational agent and Kardia for 30 days. We collected demographic, social, and clinical characteristics and conducted baseline and 30-day assessments of health-related quality of life (HRQoL) with the Atrial Fibrillation Effect on Quality of life (AFEQT) measure; self-reported medication adherence with the Morisky 8-item Medication Adherence Scale (MMAS-8); and patient activation with the Patient Activation Measure (PAM). Participants (mean age 68 [SD 11]; 39% [12/31] women) used the relational agent for an average 17.8 (SD 10.0) days. The mean number of independent log-ins was 19.6 (SD 10.7), with a median of 20 times over 30 days. The mean number of Kardia uses was 26.5 (SD 5.9), and participants using Kardia were in AF for 14.3 (SD 11.0) days. AFEQT scores improved significantly from 64.5 (SD 22.9) at baseline to 76.3 (SD 19.4) units at 30 days (P<.01). We observed marginal but statistically significant improvement in self-reported medication adherence (baseline: 7.3 [SD 0.9], 30 days: 7.7 [SD 0.5]; P=.01). Assessments of acceptability identified that most of the participants found the relational agent useful, informative, and trustworthy. We piloted a 30-day smartphone-based intervention that combined a relational agent with dedicated content for AF alongside Kardia heart rate and rhythm monitoring. Pilot participants had favorable improvements in HRQoL and self-reported medication adherence, as well as positive responses to the intervention. These data will guide a larger, enhanced randomized trial implementing the smartphone relational agent and the Kardia monitor system.