The effectiveness of mI SMART:A nurse practitioner led technology intervention for multiple chronic conditions in primary care

Aims:Used as integrated tools,technology may improve access and outcomes of care.A new intervention that integrates multiple technologies called mI SMART has been developed,implemented,and evaluated by Nurse Practitioners.The aim of this paper is to present the initial effectiveness of a webbased,structure of sensors and mobile devices designed to overcome the known health determinant of access to care for rural,chronically ill patients by using technology.Methods:The study was conducted at a community primary-care clinic that provides free healthcare to impoverished adults.Adults with at least one chronic condition,a minimum of 3rd grade reading level,and without dementia/psychosis were recruited.Participants were given a Nexus7 tablet and Bluetooth self-monitoring devices.The intervention lasted for 12 weeks.Blood glucose,blood pressure,and weight were collected using the provided Bluetooth devices and means were evaluated with paired-samples ttests before and after the intervention.Results:Thirty participants were majority female,white,married,high-school educated or less,earning less than$20,000 per annum,and had multiple chronic conditions.Pre-intervention glucose,systolic blood pressure,diastolic blood pressure,weight and Body Mass Index were all reduced after the 12-week intervention.Conclusions:The mI SMART intervention is efficacious for use in improvised adults living in rural areas with multiple chronic conditions.As previously reported,the intervention was also shown to be feasible and acceptable to patients.The next step is a larger randomized controlled trial.

Effectiveness of LISTEN on loneliness,neuroimmunological stress response,psychosocial functioning,quality of life,and physical health measures of chronic illness

Objectives:Loneliness is a biopsychosocial determinant of health and contributes to physical and psychological chronic illnesses,functional decline,and mortality in older adults.This paper presents the results of the first randomized trial of LISTEN,which is a new cognitive behavioral intervention for loneliness,on loneliness,neuroimmunological stress response,psychosocial functioning,quality of life,and measures of physical health.Methods:The effectiveness of LISTEN was evaluated in a sample population comprising 27 lonely,chronically ill,older adults living in Appalachia.Participants were randomized into LISTEN or educational attention control groups.Outcome measures included salivary cortisol and DHEA,interleukin-6,interleukin-2,depressive symptoms,loneliness,perceived social support,functional ability,quality of life,fasting glucose,blood pressure,and body mass index.Results:At 12 weeks after the last intervention session,participants of the LISTEN group reported reduced loneliness(p=0.03),enhanced overall social support(p=0.05),and decreased systolic blood pressure(p=0.02).The attention control group reported decreased functional ability(p=0.10)and reduced quality of life(p=0.13).Conclusions:LISTEN can effectively diminish loneliness and decrease the systolic blood pressure in community-dwelling,chronically ill,older adults.Results indicate that this population,if left with untreated loneliness,may experience functional impairment over a period as short as 4 months.Further studies on LISTEN are needed with larger samples,in varied populations,and over longer periods of time to assess the long-term effects of diminishing loneliness in multiple chronic conditions.