Background: Integrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care. Objective: The aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients. Methods: As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER). Results: A total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57% less unplanned visits (P=.004) and 50% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program. Conclusions: The implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs, and was cost-effective. These findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement integrated care.

Background: Osteoarthritis is a disabling condition that is often associated with other comorbidities. Total hip or knee arthroplasty is an effective surgical treatment for osteoarthritis when indicated, but comorbidities can impair their results by increasing complications and social and economic costs. Integrated care (IC) models supported by eHealth can increase efficiency through defragmentation of care and promote patient-centeredness. Objective: This study aims to assess the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)–enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty. Methods: As part of the Horizon 2020 Personalized Connected Care for Complex Chronic Patients (CONNECARE) project, a prospective, pragmatic, two-arm, parallel implementation trial was conducted in the rural region of Lleida, Catalonia, Spain. For 3 months, complex chronic patients undergoing total hip or knee arthroplasty and their caregivers received the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care (UC). We assessed changes in health status (12-item short-form survey [SF-12]), unplanned visits and admissions during a 6-month follow-up, and the incremental cost-effectiveness ratio. Results: A total of 29 patients were recruited for the mHealth-enabled IC arm, and 30 patients were recruited for the UC arm. Both groups were statistically comparable for baseline characteristics, such as age; sex; type of arthroplasty; and Charlson index, American Society of Anesthesiologists classification, Barthel index, Hospital Anxiety and Depression scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Pfeiffer mental status questionnaire scores. Patients in both groups had significant increases in the SF-12 physical domain and total SF-12 score, but differences in differences between the groups were not statistically significant. IC patients had 50% fewer unplanned visits (P=.006). Only 1 hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different cost scenarios, and the incremental cost-effectiveness ratio demonstrated cost-effectiveness. Conclusions: Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aimed at empowering patients and facilitating transitions from specialized hospital care to primary care. Such models can reduce unplanned contacts with the health system and reduce overall health costs, proving to be cost-effective. Overall, our findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement IC for patients undergoing elective surgery.

Purpose Body image encompasses body-related self-perceptions and personal attitudes. Dissatisfaction with body image during the early stages of adolescence is negatively related to self-esteem and other health problems. A few publications focused on positive body image and directly related to the experiences and interactions of adolescents themselves. To explore positive body image in adolescents and describe the familial and educational factors that contribute to its development.Methods A qualitative study was conducted. Purposive sampling was used, and 9 adolescents, 6 families, and 8 teachers participated in semi-structured interviews, which were then theme analyzed. Results Self-care, body acceptance, confronting messages that attack body image, and the influence of social media have been identified as emerging themes in adolescents’ positive body image experiences. Therefore, the pubertal period, family values, fostering, and educational actions as well as media literacy were identified as factors promoting self-esteem and positive body image in the family and educational environment. Conclusions Their parents also expressed aspects such as those that contribute to the development of healthy self-esteem, confidence, and positive body image. Alternatively, the teachers indicated educational activities to work on self-image and self-esteem when faced with situations of concern in the classroom.

Disorders of communication, social relationships, and psychomotricity are often characterized by cognitive impairment, which hinders daily activities and increases the risk of falls. This study aimed to evaluate the efficacy of an animal-assisted therapy (AAT) program in an institutionalized geriatric population with cognitive impairment. The variables evaluated included level of communication and changes in gait and/or balance. We performed a two-arm, parallel controlled, open-label, nonrandomized cluster clinical trial in two nursing home centers from an urban area. Patients in the two centers received 12 weekly sessions of physiotherapy, but the experimental group included AAT with a therapy dog. The study included a total of 46 patients (23 Control Group [CG], 23 Experimental Group [EG]) with a median age of 85.0 years. Of these, 32.6% had mild–moderate cognitive decline (Global Deterioration Scale of Reisberg [GDS] 2–4) and 67.4% severe cognitive decline (GDS 5–6). After the intervention, patients in the CG and EG showed a statistically significant improvement in all the response variables. When comparing both groups, no statistically significant differences were found in any of the Tinetti scale results (measuring gait and balance). However, the communication of patients in the EG, measured on the Holden scale, showed a statistically significant greater improvement postintervention than that of patients in the CG. AAT can be useful as a complementary, effective treatment for patients with different degrees of cognitive decline.

Background: Integrated care (IC) can promote health and social care efficiency through prioritization of preventive patient-centered models and defragmentation of care and collaboration across health tiers, and mobile health (mHealth) can be the cornerstone allowing for the adoption of IC. Objective: This study aims to assess the acceptability, usability, and satisfaction of an mHealth-enabled IC model for complex chronic patients in both patients and health professionals. Methods: As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, 2-arm, parallel, hybrid effectiveness-implementation trial was conducted from July 2018 to August 2019 in a rural region of Catalonia, Spain. Home-dwelling patients 55 years and older with chronic conditions and a history of hospitalizations for chronic obstructive pulmonary disease or heart failure (use case [UC] 1), or a scheduled major elective hip or knee arthroplasty (UC2) were recruited. During the 3 months, patients experienced an mHealth-enabled IC model, including a self-management app for patients, a set of integrated sensors, and a web-based platform connecting professionals from different settings or usual care. The Person-Centered Coordinated Care Experience Questionnaire (P3CEQ) and the Nijmegen Continuity Questionnaire (NCQ) assessed person-centeredness and continuity of care. Acceptability was assessed for IC arm patients and staff with the Net Promoter Score (NPS) and the System Usability Scale (SUS). Results: The analyses included 77 IC patients, 58 controls who completed the follow-up, and 30 health care professionals. The mean age was 78 (SD 9) years in both study arms. Perception of patient-centeredness was similarly high in both arms (usual care: mean P3CEQ score 16.1, SD 3.3; IC: mean P3CEQ score 16.3, SD 2.4). IC patients reported better continuity of care than controls (usual care: mean NCQ score 3.7, SD 0.9; IC: mean NCQ score 4.0, SD 1; P=.04). The scores for patient acceptability (UC1: NPS +67%; UC2: NPS +45%) and usability (UC1: mean SUS score 79, SD 14; UC2: mean SUS score 68, SD 24) were outstanding. Professionals’ acceptability was low (UC1: NPS −25%; UC2: NPS −35%), whereas usability was average (UC1: mean SUS score 63, SD 20; UC2: mean SUS score 62, SD 19). The actual use of technology was high; 77% (58/75) of patients reported physical activity for at least 60 days, and the ratio of times reported over times prescribed for other sensors ranged from 37% for oxygen saturation to 67% for weight. Conclusions: The mHealth-enabled IC model showed outstanding results from the patients’ perspective in 2 different UCs but lacked maturity and integration with legacy systems to be fully accepted by professionals. This paper provides useful lessons learned through the development and assessment process and may be of use to organizations willing to develop or implement mHealth-enabled IC for older adults.

Background: The COVID-19 pandemic rapidly strained healthcare systems worldwide. The reference standard for diagnosis is a positive reverse transcription polymerase chain reaction (RT-PCR) test, but results are not immediate and sensibility is variable. Aim: To evaluate the diagnostic accuracy of lung ultrasound compared to chest X-ray for COVID-19 pneumonia. Design and Setting: A retrospective analysis of symptomatic patients admitted into one primary care centre in Spain between March and September 2020. Method: Patients’ chest X-rays and lung ultrasounds were categorized as normal or pathologic. RT-PCR confirmed COVID-19 infection. Pathologic lung ultrasound images were further categorized as showing either local or diffuse interstitial disease. McNemar and Fisher tests were used to compare diagnostic accuracy. Results: Most of the 212 patients presented fever at admission, either as a standalone symptom (37.74% of patients) or together with others (72.17% of patients). The positive predictive value of the lung ultrasound was 90% for the diffuse interstitial pattern and 46.92% for local pattern. The lung ultrasound had a significantly higher sensitivity (82.75%) (p < 0.001), but lower specificity (71%) than the chest X-ray (54.02% and 86%, respectively) (p = 0.008) for identifying interstitial lung disease. Moreover, sensitivity of the lung ultrasound for severe interstitial disease was 100%, and was significantly higher than the chest X-ray (58.33%) (p = 0.002). Conclusion: The lung ultrasound is more accurate than the chest X-ray for identifying patients with COVID-19 pneumonia and it is especially useful for those presenting diffuse interstitial disease.