ict4selfcare - Interactive mobile phone

Day surgery implies a short period of postoperative surveillance before discharge from the surgery unit. Patients and families have to manage the recovery mainly by themselves at home. Over the years there has been a shift in day surgery and older persons with multiple diagnoses are also included. The organization of day surgery, allowing the patient to recover in familiar surroundings, is considered beneficial for older people. However, many day surgical patients feel burdened by the responsibility to manage their own care following discharge. The postoperative period at home is a weak link in an otherwise efficient flow of day surgical care.

Aim: To develop and evaluate the feasibility and cost-effectiveness of an interactive mobile phone self-report system aimed at supporting older persons recovery at home after day surgery.

Method: In order to develop a truly valid system, the iterative process recommended by the US Food and Drug Administration (FDA) regarding the development of a PRO instrument in clinical trials will be followed. Items included in the self-report system will be based on interviews with day surgery patients and a cognitive debriefing will be achieved through focus group interviews with experienced day surgical physicians and nurses and individual day surgery patients.

A communication system for mobile phones Circadian Questions (CQ) for the patient’s own mobile phone available for multiple platforms developed by 21st Century Mobile AB (http://www.cqmobil.se) will be used. The data will be returned and stored in a database, with security levels comparable to those used within Internet banking systems. The answers are only visible for patients and family carers through a personal login to the database (Hallberg et al. 2014).

In the pilot study older patients from one data collection site will be included. As part of the intervention patients in the intervention group respond to short questions in the mobile phone on postoperative day 1-14, 21 and 28. Patients in the control group follow their usual care on day 1-27. For evaluation purpose identical self-reported data will be collected in both groups on day 28.

Study populations: A convenient sample of 6-10 experienced (≥ 3 years) day surgery physicians and nurses in two focus groups. Twenty patients (≥ 60 years, Swedish-speaking with no cognitive disorders and scheduled for a day surgical procedure) will be used for cognitive debriefing. The evaluation phases initially consist of a pilot of the system (10 patients), followed by a multicentre RCT with 300 consecutively included patients divided into the intervention and the control group from three-day surgical units.

Impact: To facilitate interactive communication between patients and the health care, use of different ICT solutions may result in increased safety and satisfaction among patients when discharged. The mobile phone system is expected to increase patients’ feeling of health care professionals closeness and enable identification and prevention of complications and thereby increase patients’ and families’ sense of security during the postoperative period as well as reduce the consumption of health care.

What is new: The older person’s use of his or her own mobile phone results in a method uncomplicated to implement in clinical practice. The system has very high security and the data traffic is cheap.