Dunsmuir Dustin, Wu Helen, Sun Terri, West Nicholas C, Lauder Gillian R, Görges Matthias, Ansermino J Mark
Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.
Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada.
JMIR Perioper Med. 2019 Jul 4;2(2):e12305. doi: 10.2196/12305.
Emphasis on outpatient pediatric surgical procedures places the burden of responsibility for postoperative pain management on parents or guardians. Panda is a mobile phone app that provides scheduled medication alerts and allows parents to track their child's pain and medication administration. We have previously tested and optimized the usability and feasibility of Panda within the hospital setting.
The purpose of this study was to evaluate and optimize the usability and feasibility of Panda for use at home based on alert response adherence (response to any medication notification within 1 hour) and parents' satisfaction.
Parents or guardians of children aged 3 to 18 years undergoing day surgery were recruited to use Panda at home for 1 to 7 days to manage their scheduled medications and to assess their child's pain. After the surgical procedure, a research assistant guided parents through app setup before independent use at home. We aimed to recruit 10 child-caregiver pairs in each of three rounds of evaluation. Each user's adherence with the recommended medication alerts was analyzed through audit-trail data generated during the use of the app. We used the Computer System Usability Questionnaire and a poststudy phone interview to evaluate the app's ease of use and identify major barriers to adoption. Suggestions provided during the interviews were used to improve the app between each round.
Twenty-nine child-caregiver pairs participated in three rounds, using the app for 1 to 5 days. Alert response adherence (response to any medication notification within 1 hour) improved as the study progressed: participants responded to a median 30% (interquartile range [IQR] 22%-33%) of alerts within 1 hour in round 1, and subsequently to median 60% (IQR 44%-64%) in round 2 and median 64% (IQR 56%-72%) in round 3 (P=.005). Similarly, response times decreased from median 131 (IQR 77-158) minutes in round 1 to median 31 (IQR 18-61) minutes in round 2 and median 10 (IQR 2-14) minutes in round 3 (P=.002). Analysis of interview feedback from the first two rounds revealed usability issues, such as complaints of too many pages and trouble hearing app alerts, which were addressed to streamline app function, as well as improve visual appearance and audible alerts.
It is feasible for parents or guardians to use Panda at home to manage their child's medication schedule and track their pain. Simple modifications to the app's alert sounds and user interface improved response times.
对儿科门诊手术的重视将术后疼痛管理的责任负担加在了家长或监护人身上。Panda是一款手机应用程序，可提供定时用药提醒，并允许家长追踪孩子的疼痛情况及用药情况。我们之前已在医院环境中测试并优化了Panda的可用性和可行性。
本研究的目的是基于提醒响应依从性（在1小时内对任何用药通知做出响应）和家长满意度，评估并优化Panda在家中使用的可用性和可行性。
招募3至18岁日间手术患儿的家长或监护人在家中使用Panda 1至7天，以管理其定时用药并评估孩子的疼痛情况。手术结束后，一名研究助理在家长在家中独立使用前指导他们完成应用程序的设置。我们的目标是在三轮评估中，每轮招募10对儿童-照顾者组合。通过应用程序使用期间生成的审计跟踪数据，分析每个用户对推荐用药提醒的依从性。我们使用计算机系统可用性问卷和研究后的电话访谈来评估应用程序的易用性，并确定采用的主要障碍。访谈期间提供的建议用于在每轮之间改进应用程序。
29对儿童-照顾者组合参与了三轮评估，使用该应用程序1至5天。随着研究的进行，提醒响应依从性（在1小时内对任何用药通知做出响应）有所提高：在第一轮中，参与者在1小时内对中位数30%（四分位间距[IQR]22%-33%）的提醒做出了响应，在第二轮中为中位数响应率60%（IQR 44%-64%），在第三轮中为中位数64%（IQR 56%-72%）（P=0.005）。同样，响应时间从第一轮的中位数131（IQR 77-158）分钟降至第二轮的中位数31（IQR 18-61）分钟，第三轮为中位数10（IQR 2-14）分钟（P=0.002）。对前两轮访谈反馈的分析揭示了可用性问题，例如抱怨页面过多以及难以听到应用程序提醒，针对这些问题对应用程序功能进行了简化，同时改善了视觉外观和声音提醒。
家长或监护人在家中使用Panda来管理孩子的用药时间表并追踪其疼痛情况是可行的。对应用程序提醒声音和用户界面进行简单修改可缩短响应时间。
