手機可幫助糖尿病患的血壓獲得控制


  【24drs.com】在一篇為期一年的研究中,以手機為基礎的遙控病患監測系統,可幫助高血壓控制不佳之第2型糖尿病患的血壓獲得控制;不過,只有居家檢測血壓,沒有藉由這個搖控系統向醫師通報的研究對象,其血壓在研究期間內並無顯著改變。
  
  加拿大安大略多倫多大學健康網絡eHealth Innovation資深主任Joseph Cafazzo博士表示,單單在家量血壓對病患沒有效益,必須要有遙控監測輔助。
  
  他解釋,我們相信,病患變得更有自我警覺,也認為他們的照護者更有義務知道這些數據,而照護者必須針對這些數據採取因應行動。
  
  Cafazzo博士在美國遠距醫學協會(ATA)第16屆國際年會的簡報中發表研究結果。
  
  新墨西哥大學Telehealth中心醫療主任、ATA理事長Dale C. Alverson醫師表示,行動式健康機制(mobile health/或簡稱mHealth)是遠距醫療科技中的熱門議題,亦即針對如糖尿病和慢性鬱血性心衰竭等慢性病患,應用一種以手機為基礎的系統進行遙控監測。
  
  他指出,這種技術越來越無所不在,在他們的計畫中,讓照護者和病患得以實際應用這種夢想中的科技,除了移動性之外,也在病患和照護者之間建立一種連結。
  
  Cafazzo博士等人發展並測試一種mHealth介入方式,透過一個以手機為基礎的系統自動掌握血壓讀數,提供行動簡訊給病患,並提供重症警訊給醫師;他們的研究包括了110名患有第2型糖尿病、且高血壓控制不佳的男性和女性,研究對象的平均年紀是62歲,平均體重是90.2公斤(198.4磅)。
  
  在這將近一年的期間,半數研究對象居家檢測血壓且有標準的居家血壓監測系統(控制組);另外半數則是使用一種藍芽血壓監測系統,透過以行動電話為基礎的遙控病患監測系統將讀數傳給他們的家庭醫師(介入組),如果這些病患有3天沒有測量,也會獲得系統自動提醒。
  
  開始時,病患的平均日間血壓是142.7/77.1 mm Hg,Cafazzo博士報告指出,一年後,介入組的收縮壓降低9.1 mm Hg (P< .0001)、舒張壓降低4.6 mm Hg(P< .0001),相對的,控制組實際上並無變化。
  
  根據研究者指出,遙控監測組的病患有50%的血壓獲得良好控制(定義為130/80 mm Hg),控制組則只有29%(P < .05)。
  
  Cafazzo博士表示,家庭醫師的照護對這些病患的改善其實無關,這實際上是一種自我照護工具,促進更好的自我照護,因為病患更有自我警覺,也更瞭解自己的責任。
  
  Cafazzo博士在簡報中分享了另一篇類似的結果,在最近完成的一篇研究中,以行動電話為基礎的系統顯著改善了一組慢性心衰竭病患的血壓控制。
  
  他解釋,對於心衰竭病患,我們有一種決策支持系統分析這些資料,且只有在推算認為這些病患在家中病況惡化時才發送相關資料給醫師;他指出,這是首度使用行動電話為基礎的系統監測多元參數。
  
  Cafazzo博士也發表了稱為「Bant」的iPhone應用程式的初次臨床試驗結果,這個程式完整整合血糖計,對象是12-16歲的第1型糖尿病患。
  
  他表示,這個年齡層是相當有難度的一個族群,從完全依賴家長的照顧變成自己獨立照顧,不幸的是,他們的糖化血色素往往也開始上升。我們知道,這群青少年會尊崇iPhone,但是他們的注意力也很短暫。
  
  為了誘導這些青年,研究者整合一個社交網絡應用程式。Cafazzo博士報告指出,這本質上就像是一個微網誌聊天室,孩子們可在此交換經驗;孩子們一般會用它來聊音樂、iPhone,除了糖尿病外的任何事。
  
  因此,藉由運用一個兌點系統,獎勵定期檢測並回報血糖值的iTunes使用者,Cafazzo博士表示,這個獎勵機制顯然效果不錯。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6515&x_classno=0&x_chkdelpoint=Y
  

Cell Phones Help Keep Blood Pressure, Diabetes in Check

By Megan Brooks
Medscape Medical News

May 6, 2011 (Tampa, Florida) — In a year-long study, a mobile-phone-based remote patient monitoring system helped patients with type 2 diabetes and uncontrolled hypertension get their blood pressure (BP) under control.

Study patients who merely checked their BP at home, without reporting it to their physician through the remote system, had no marked change in BP during the study.

"The act of just giving a patient a [BP] home monitor had no effect," said Joseph Cafazzo, PhD, PEng, senior director of eHealth Innovation at the University Health Network, in Toronto, Ontario, Canada. "It had to have the telemonitoring component."

"We believe that patients become far more self-aware and more accountable to their care provider knowing that the data are going back to their care provider and that the care provider will be acting on it," he explained.

Dr. Cafazzo presented the study findings at a press briefing here at the American Telemedicine Association (ATA) 16th Annual International Meeting.

Mobile Health a "Hot Topic"

Dale C. Alverson, MD, ATA president and medical director of the Center for Telehealth at the University of New Mexico Health Sciences Center in Albuquerque, said "mobile health, or mHealth, is the hot topic in telemedicine technology. These are applications for remote monitoring of patients with chronic disease, such as diabetes and chronic congestive heart failure, through a mobile phone-based system."

This technology is "becoming ubiquitous," he added, "and in our program, we are seeing the providers and the patients adopting this technology in ways we may never have dreamed of. It adds that mobility and that sense of connection between patient and provider."

Dr. Cafazzo and colleagues developed and tested an mHealth intervention to automate capture of BP readings through a mobile-phone-based system that provides "actionable messages to patients and critical alerts to physicians," they explain in a meeting abstract.

Their study involved 110 men and women with type 2 diabetes and uncontrolled systolic hypertension. Study subjects had a mean age of 62 years and a mean weight of 90.2 kg (198.4 lbs).

Over the course of 1 year, half of the subjects monitored their BP at home with a standard home BP monitoring system (the control group). The other half used a Bluetooth-enabled BP monitor that transmitted readings through a mobile-phone-based remote patient monitoring system to their family physician (the intervention group). These patients were also given automated reminders after 3 days of not taking their measurements.

At baseline, patients' mean daytime BP was 142.7/77.1 mm Hg. After 1 year, Dr. Cafazzo reported, the intervention group had a 9.1 mm Hg dip in systolic BP (P < .0001) and a 4.6 mm Hg dip in diastolic BP (P < .0001). In contrast, there was virtually no change in the control group.

According to the investigators, "50% of patients in the telemonitoring group had their BP under good control (130/80 mm Hg)," compared with only 29% in the control group (P < .05).

"The family doctors caring for these patients really had nothing to do with the improvements. This was really a self-care tool and the patients were performing better self-care because they were more self-aware, more accountable," Dr. Cafazzo said.

During the briefing, Dr. Cafazzo shared similarly promising findings from a recently completed study in which a mobile-phone-based system significantly improved uncontrolled BP in a group of chronic heart failure patients.

For the heart failure patient, he explained, "we have a decision support engine that looks at the data and only sends relevant data to the clinician when the algorithm determines that the patient is deteriorating at home."

This is a "first of its kind," he added, in terms of using a mobile-phone-based system to monitor multiple parameters.

Next Target: Adolescents With Diabetes

Dr. Cafazzo also presented preliminary findings from the first clinical trial of an iPhone application called "Bant," which has a fully integrated glucometer and targets adolescents 12 to 16 years of age with type 1 diabetes.

"This is a very difficult population," he said. "They are transitioning from being totally dependent on their parent's care to asserting their independence, and unfortunately their [glycated hemoglobin] often starts to increase. We knew this population would be amenable to the iPhone, but that their attention span would be very short."

To entice these young people, the researchers incorporated a social networking application. "There is essentially a microblogging chat room where these kids can exchange their experiences; so far, kids are using it and usually they talk about music, the iPhone, anything but their diabetes," Dr. Cafazzo reported.

There is also a redeemable point system that rewards participants with iTunes for taking and reporting their blood sugar levels regularly. "The rewards mechanism appears to be working very well," Dr. Cafazzo said.

The study currently has 28 adolescents enrolled. Dr. Cafazzo said he hopes to report full results at the next ATA meeting.

The study authors and Dr. Alverson have disclosed no relevant financial relationships.

American Telemedicine Association (ATA) 16th Annual International Meeting: Abstract 243. Presented May 3, 2011.

    
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