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Payal Agarwal



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    OS02 - Venues of Virtual Care (ID 2)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 1
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      OS02.04 - Practical Apps: Evidence-Based Physician Reviewed mhealth Care Apps for Patients (ID 99)

      Payal Agarwal, Institute for Health System Solutions and Virtual Care (WIHV), Women’s College Hospital; Toronto/CA

      • Abstract

      Purpose/Objectives:
      There has been great excitement and growth in the mobile health field; however, due to a lack of oversight, it is likely that many of these apps are of poor quality posing potential risks to patients. Previous attempts, including efforts at the National Health Service, had significant limitations or were not sufficiently rigorous to inform health system decision makers. The objective of the Practical Apps project is to leverage a comprehensive framework to develop set of credible reviews that identify high quality, patient-facing health apps that have the potential to impact chronic disease outcomes across the health system.


      Methodology/Approach:
      The first phase of this project involved the development of a methodology to review mobile health apps for chronic disease management. The research team reviewed relevant academic literature and regulatory guidelines. No current evaluation criteria were comprehensively addressed all factors relevant to real-world clinical use. Therefore, a new framework was created incorporating previously identified quality criteria from multiple resources, listed and grouped into six common themes. A group of primary care physicians were trained in using the resulting framework to review 4-5 apps related to a single common chronic condition. Reviews were posted on the site practicalapps.ca with the ability for clinicians to subscribe to receive alerts of new reviews.


      Finding/Results:
      The resulting framework integrates quality heuristics related to both clinical and regulatory needs to support the rapid evaluation of app quality, thus enabling further decisions around clinical use and scale (see Table 1). Table 1: Mobile Health App Quality Framework Dimension Details Features overall purpose, user engagement, clinical integration, data integration Clinical Effectiveness creator credibility, evidence-based information, empirical evidence, clinically comprehensive Usability learnability, memorability, efficiency, satisfaction, visual appeal, clarity Privacy/Security privacy policy, secure data storage, data sharing, permission management, password use Safety/Reliability technical performance, technical support, ongoing updates, error handling, company profile Accessibility cost, available languages, health literacy level, compatible devices, accommodates disabilities Overall 1/5=no clinical use, 3/5=potential for clinical use with limitations, 5/5= appropriate for widespread clinical use and scale The framework was utilized to review 70 apps relating to 17 different health topics. Of the apps that were evaluated, the average overall rating was 3/5 with 39% receiving a rating of 3.5 or higher. However, there was significant variation on key indicators and between topics, especially with regards to clinical effectiveness and privacy/security. Overall, the apps rated well for accessibility and usability but poorly for privacy/security and clinical effectiveness. Over one year, over 3000 people, mostly clinicians, have registered for an online subscription to the site.


      Conclusion/Implications/Recommendations:
      The Practical Apps project and framework provides an effective tool to rapidly identify and inform use and scale of high quality mobile health apps for chronic disease management. The Practical Apps website has received significant amount of unique visitors and subscribers who read the reviews. Currently, our research team is working on a scoping review to inform a more comprehensive updated version of this framework. The results of the Practical Apps can support both clinicians and health systems decisions makers in identifying and supporting high quality apps for patient use.


      140 Character Summary:
      Practical Apps is a project aimed to assess the quality of patient-facing mobile health applications for chronic disease management.

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    OS22 - eServices: Better Than Paper! (ID 35)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 1
    • Coordinates: 5/28/2019, 01:15 PM - 02:15 PM, Area 4
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      OS22.01 - Screening While You Wait: Facilitating Primary Care Based Exercise Counselling (ID 384)

      Payal Agarwal, Institute for Health System Solutions and Virtual Care (WIHV), Women’s College Hospital; Toronto/CA

      • Abstract

      Purpose/Objectives:
      Lack of physical activity (PA) is the fourth leading risk factor for global deaths annually. Yet, only 18% of Canadians meet PA guidelines despite known impact on mortality and well-being. Guidelines recommend that primary care providers use evidence-based screening and counselling to encourage PA during routine visits, but this is rarely implemented. Reported barriers include lack of time to appropriately discuss PA levels, lack of knowledge and training in PA counselling, and a lack of success in changing patient behaviour. This pilot trial aims to reduce these barriers by (1) examining the feasibility of integrating a technology-based physical activity counselling tool in routine clinical care, and (2) evaluating preliminary effectiveness of the intervention.


      Methodology/Approach:
      An intervention was developed through a user-centered design process. The resulting design automatically summarized results and creates 1) a customized exercise prescription in the EMR, and 2) a personalized, printable toolkit with online and local resources to increase physical activity. A pragmatic, step wedge trial was conducted at an urban academic family health team. The intervention was sequentially administered in a randomized order, with one of four cluster switching to the intervention per 6-week step, until all clusters were exposed. Eligible patients received a secure baseline e-survey prior to their appointment to assess PA levels (using Metabolic Equivalent of Task minutes (MET-minutes) per week). The difference in MET-minutes per week between intervention and control groups was assessed at four months follow-up; secondary outcomes include changes in intention and self-efficacy for PA. Process measures included patient satisfaction with PA advice, receiving the toolkit and prescription, and estimated minutes spent on PA counselling.


      Finding/Results:
      Of the 530 total patients, 82.5% provided baseline and follow-up data. MET-minutes per week in the intervention group was 10% greater than controls (count ratio, 1.10, 95% CI 0.86-1.41, p=0.44). After adjusting for baseline covariates, the effect of the intervention remained non-significant (count ratio, 1.18, 95% CI 0.90-1.53). 61.8% of patients exposed to the intervention completed a process evaluation; of these patients, 49.4% reported receiving at least a prescription, 48.9% reported spending 2-5 minutes discussing PA with their provider, and 86.8% reported being satisfied with their PA discussion. table 1-swyw.png


      Conclusion/Implications/Recommendations:
      The introduction of the e-health tool for PA was feasible to implement in a large primary care practice and in this pilot trial resulted in a non-statistically significant increase in PA. Process evaluations indicated a need for better training and modifications to ensure fidelity of implementation. Future studies require a significantly larger number of clusters to achieve significant power.


      140 Character Summary:
      This trial establishes the feasibility of an e-health tool to assess PA levels, motivators, and barriers prior to a clinic-visit for delivery of tailored resources.