Adoption of Digital Technologies in Health Care During the COVID-19 Pandemic: Systematic Review of Early Scientific Literature

Technologies, Physician's Caring Competency, and Patient Centered Care:A Systematic Review

This study aimed to conduct a systematic review to clarify patient understanding, understanding of caring concepts, understanding of technology, competency to express compassion, appropriate involvement in caring, and ethical and moral attitudes and responses toward patients. This systematic review was conducted through an electronic search across PubMed, Google Scholar, MEDLINE, and Science Direct. Authors independently appraised the methodological quality of the studies using the Mixed Method Appraisal Tool. A narrative synthesis approach was used to present these findings. Nine studies met the inclusion criteria and quality appraisal guidelines. Through thematic analysis, four major themes were identified:Technology and caring competency, Technology and patient-centered care, Empathetic skills, and Caring competency. This review has shown that patients choose physicians considering their emotions and communicate well with them, empowering them to take responsibility of their own or their loved ones' healthcare. In the age of technological advancement and availability of vast sources of information, it is expected of physicians to adapt to these character priorities while maintaining their sense of humanness, not only focusing on healing modalities, but also to guide, educate, and appropriately empower their patients toward achieving their healthcare goals. J. Med. Invest. 70 : 307-316, August, 2023.

Effects of the COVID-19 pandemic on self-reported 12-month pneumococcal vaccination series completion rates in Canada

Routine childhood vaccination improves health and prevents morbidity and mortality from vaccine-preventable diseases. There are indications that the COVID-19 pandemic has negatively impacted immunization rates globally, but systematic studies on this are still lacking in Canada. This study aims to add knowledge on the pandemic's effect on children's immunization rates with pneumococcal vaccine using self-reported immunization data from CANImmunize. An interrupted time series analysis was conducted on aggregated monthly enrollment of children on the platform (2016-2021) and their pneumococcal immunization series completion rates (2016-2020). Predicted trends before and after the onset of the COVID19-related restriction (March 1, 2020) were compared by means of an Autoregressive Integrated Moving Average (ARIMA). The highest monthly enrollment was 3,474 new infant records observed in January 2020, and the lowest was 100 records in December 2021. The highest Self-reported pneumococcal immunization series completion rate was 78.89%, observed in February 2017, and the lowest was 6.94% in December 2021. Enrollment decreased by 1177.52 records (95% CI: -1865.47, -489.57), with a continued decrease of 80.84 records each month. Completion rates had an immediate increase of 14.57% (95% CI 4.64, 24.51), followed by a decrease of 3.54% each month. The onset of the COVID-19 related restrictions impacted the enrollment of children in the CANImmunize digital immunization platform and an overall decrease in self-reported pneumococcal immunization series completion rates. Our findings support efforts to increase catch-up immunization campaigns so that children who could not get scheduled immunization during the pandemic are not missed.

Telemedicine in Thai-otorhinolaryngology patients in COVID-19 situation; primary surveys

Introduction

COVID-19 pandemic has put a strain on various aspects of hospital management due to high rates of infection and increased preventive measures around the world. Physicians and patients alike are susceptible to the ongoing virus causing concern leading to loss or postpone of follow up. Thailand has just start integration of digital solutions such as telemedicine which expected similar level of medical care and efficiency while reducing risk of exposure during the COVID-19 pandemic.

Objective

Evaluation the willingness to accept telemedicine in otorhinolaryngology patients during the peak COVID-19 outbreaks in our institution.

Methods

Collected data from all patients who had a schedule follow up for otorhinolaryngology department between the months of June to August, 2021 at out-patient Center.

Results

Total of 299 otorhinolaryngology patients included, 213 patients (71.2%) denied a virtual medical visit whereas 86 patients (28.8%) accepted. The obstructive sleep apnea (OSA) was the only group to have more acceptance of telemedicine, 79.5% than denying 20.5% with statistical significance (p < 0.01). Age difference between the accepting and declining group also showed statistical significance, 48.5 years and 56 years respectively (p < 0.01). Main Reasons for their decision, 48% of patients accepted due to experiencing clinical improvement and stability. The main reason for not accepting telemedicine was 80% of patients preferred a special otorhinolaryngologic examination on follow up.

Conclusions

This primary surveys among Thai otorhinolaryngology patients about telemedicine. The greater number of patients not interested in telemedicine due to requirement of otorhinolaryngologic examination. Which OSA follow-up patients have more attention in telemedicine.

Evaluation of pharmacist-led telemedicine medication management for hypertension established patients during COVID-19 pandemic: A pilot study

Aim

To evaluate the impact of a telemedicine medication management service in patients with hypertension.

Methods

Participants were allocated to either a telemedicine service (N = 173) or usual care (UC) (N = 179). The primary outcome was blood pressure (BP) reduction from baseline to the 6-month follow-up visit, the proportion of the target BP achievement, overall adherence to prescribed medication as well as a composite of non-fatal stroke, non-fatal myocardial infarction and cardiovascular death.

Results

At 6 months, BP was controlled in 89.6% (n = 155) of intervention patients and 78.8% (n = 141) of UC patients (OR = 1.14, 95% CI = 1.04-1.25, P = 0.006), giving a mean difference of -6.0 (-13.0 to -2.5 mmHg) and -2.0 mmHg (-4.0 to -0.1 mmHg) in SBP and DBP, respectively. 17.9% (n = 31) of the patients in the intervention group were non-adherent with medications, compared with 29.1% (n = 52) in the UC group (P = 0.014). The composite clinical endpoints were reached by 2.9% in the intervention group and 4.5% in the control group with no significant differences (OR = 1.566, 95% CI = 0.528-4.646).

Conclusion

Telemedicine medication management for hypertension management had led to better BP control and medication adherence improvement than UC during COVID-19 epidemic, resulting in a reduction of overall adverse cardiovascular events occurrence.

A Narrative Review of Innovative Responses During the COVID-19 Pandemic in 2020

Objectives: The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges to healthcare systems worldwide. While existing studies on innovation have typically focused on technology, health providers still only have a vague understanding of the features of emergency responses during resource exhaustion in the early stage of a pandemic. Thus, a better understanding of innovative responses by healthcare systems during a crisis is urgently needed. Methods: Using content analysis, this narrative review examined articles on innovative responses during the COVID-19 pandemic that were published in 2020. Results: A total of 613 statements about innovative responses were identified from 296 articles and were grouped under the following thematic categories: medical care (n = 273), workforce education (n = 144), COVID-19 surveillance (n = 84), medical equipment (n = 59), prediction and management (n = 34), and governance (n = 19). From the four types of innovative responses extracted, technological innovation was identified as the major type of innovation during the COVID-19 pandemic, followed by process innovations, frugal innovation, and repurposing. Conclusion: Our review provides insights into the features, types, and evolution of innovative responses during the COVID-19 pandemic. This review can help health providers and society show better and quicker responses in resource-constrained conditions in future pandemics.

An IT Platform Supporting Rectal Cancer Tumor Board Activities: Implementation Process and Impact Analysis

Colorectal cancer (RC) is the third most common cancer, with an increasing incidence in recent years. Digital health solutions supporting multidisciplinary tumor boards (MTBs) could improve positive outcomes for RC patients. This paper describes the implementation process of a digital solution within the RC-MTB and its impact analysis in the context of the Fondazione Policlinico 'A. Gemelli' in Italy. Adopting a two-phase methodological approach, the first phase qualitatively describes each phase of the implementation of the IT platform, while the second phase quantitatively describes the analysis of the impact of the IT platform. Descriptive and inferential analyses were performed for all variables, with a p-value < 0.05 being considered statistically significant. The implementation of the platform allowed more healthcare professionals to attend meetings and resulted in a decrease in patients sent to the RC-MTB for re-staging and further diagnostic investigations and an increase in patients sent to the RC-MTB for treatment strategies. The results could be attributed to the facilitated access to the platform remotely for specialists, partly compensating for the restrictions imposed by the COVID-19 pandemic, as well as to the integration of the platform into the hospital's IT system. Furthermore, the early involvement of healthcare professionals in the process of customizing the platform to the specific needs of the RC-MTB may have facilitated its use and contributed to the encouraging quantitative results.

A Survey of Research Participants’ Privacy-Related Experiences and Willingness to Share Real-World Data with Researchers

Background: Real-world data (RWD) privacy is an increasingly complex topic within the scope of personalized medicine, as it implicates several sources of data. Objective: To assess how privacy-related experiences, when adjusted for age and education level, may shape adult research participants’ willingness to share various sources of real-world data with researchers. Methods: An electronic survey was conducted in April 2021 among adults (≥18 years of age) registered in ResearchMatch, a national health research registry. Descriptive analyses were conducted to assess survey participant demographics. Logistic regression was conducted to assess the association between participants’ five distinct privacy-related experiences and their willingness to share each of the 19 data sources with researchers, adjusting for education level and age range. Results: A total of 598 ResearchMatch adults were contacted and 402 completed the survey. Most respondents were over the age of 51 years (49% total) and held a master’s or bachelor’s degree (63% total). Over half of participants (54%) had their account accessed by someone without their permission. Almost half of participants (49%) reported the privacy of their personal information being violated. Analyses showed that, when adjusted for age range and education level, participants whose reputations were negatively affected as a result of information posted online were more likely to share electronic medical record data (OR = 2.074, 95% CI: 0.986–4.364) and genetic data (OR = 2.302, 95% CI: 0.894–5.93) versus those without this experience. Among participants who had an unpleasant experience as a result of giving out information online, those with some college/associates/trade school compared to those with a doctoral or other terminal degree were significantly more willing to share genetic data (OR = 1.064, 95% CI: 0.396–2.857). Across all privacy-related experiences, participants aged 18 to 30 were significantly more likely than those over 60 years to share music streaming data, ridesharing history data, and voting history data. Additionally, across all privacy-related experiences, those with a high school education were significantly more likely than those with a doctorate or other terminal degree to share credit card statement data. Conclusions: This study offers the first insights into how privacy-related experiences, adjusted for age range and education level, may shape ResearchMatch participants’ willingness to share several sources of real-world data sources with precision medicine researchers. Future work should further explore these insights.

Outcomes of a Community Engagement and Information Gathering Program to Support Telephone-Based COVID-19 Contact Tracing: Descriptive Analysis

BACKGROUND

Contact tracing is an important public health tool for curbing the spread of infectious diseases. Effective and efficient contact tracing involves the rapid identification of individuals with infection and their exposed contacts and ensuring their isolation or quarantine, respectively. Manual contact tracing via telephone call and digital proximity app technology have been key strategies in mitigating the spread of COVID-19. However, many people are not reached for COVID-19 contact tracing due to missing telephone numbers or nonresponse to telephone calls. The New York City COVID-19 Trace program augmented the efforts of telephone-based contact tracers with information gatherers (IGs) to search and obtain telephone numbers or residential addresses, and community engagement specialists (CESs) made home visits to individuals that were not contacted via telephone calls.

OBJECTIVE

The aim of this study was to assess the contribution of information gathering and home visits to the yields of COVID-19 contact tracing in New York City.

METHODS

IGs looked for phone numbers or addresses when records were missing phone numbers to locate case-patients or contacts. CESs made home visits to case-patients and contacts with no phone numbers or those who were not reached by telephone-based tracers. Contact tracing management software was used to triage and queue assignments for the telephone-based tracers, IGs, and CESs. We measured the outcomes of contact tracing-related tasks performed by the IGs and CESs from July 2020 to June 2021.

RESULTS

Of 659,484 cases and 861,566 contact records in the Trace system, 28% (185,485) of cases and 35% (303,550) of contacts were referred to IGs. IGs obtained new phone numbers for 33% (61,804) of case-patients and 11% (31,951) of contacts; 50% (31,019) of the case-patients and 46% (14,604) of the contacts with new phone numbers completed interviews; 25% (167,815) of case-patients and 8% (72,437) of contacts were referred to CESs. CESs attempted 80% (132,781) of case and 69% (49,846) of contact investigations, of which 47% (62,733) and 50% (25,015) respectively, completed interviews. An additional 12,192 contacts were identified following IG investigations and 13,507 following CES interventions.

CONCLUSIONS

Gathering new or missing locating information and making home visits increased the number of case-patients and contacts interviewed for contact tracing and resulted in additional contacts. When possible, contact tracing programs should add information gathering and home visiting strategies to increase COVID-19 contact tracing coverage and yields as well as promote equity in the delivery of this public health intervention.

Evolving strategies in whirlwind mode: The changing face of anatomy education during Covid-19 pandemic

The Covid-19 pandemic stipulated adoption of unfamiliar strategies for delivering anatomy education in online mode. The factors which determine education strategies are variable across geographical regions. It was perceived that an overview of education strategies around the globe would be useful for anatomists. Hence this narrative review was undertaken to collate observations from different geographical regions pertaining to education strategies adopted during the pandemic. Data relevant to the topic of study were extracted from 12 articles that were selected from an initial pool of 317 articles based on search criteria set for the review. Subtle differences in core education strategies implied that baseline response from anatomists was similar across regions. It was evident that online digital tools were key elements of education strategies adopted by educators for delivering online anatomy classes across the globe. Interestingly, a considerable gap in terms of number and variety of online tools used for anatomy education (those requiring commercial purchase) was noted between economically developed and developing regions. This may have an impact on learning outcome for students and may even lead to variations in anatomical knowledge by regions. It was observed that offline human dissection sessions were incorporated into online practical classes in one region as positive cases showed a declining trend. This positive development is worth emulating elsewhere based on cautious assessment of prevailing situation. From a broad perspective timely introduction of education strategies ensured delivery of anatomy education during the pandemic and gave an evolved outlook to the fabric of anatomy education.

Validity of Chatbot Use for Mental Health Assessment: Experimental Study

BACKGROUND

Mental disorders in adolescence and young adulthood are major public health concerns. Digital tools such as text-based conversational agents (ie, chatbots) are a promising technology for facilitating mental health assessment. However, the human-like interaction style of chatbots may induce potential biases, such as socially desirable responding (SDR), and may require further effort to complete assessments.

OBJECTIVE

This study aimed to investigate the convergent and discriminant validity of chatbots for mental health assessments, the effect of assessment mode on SDR, and the effort required by participants for assessments using chatbots compared with established modes.

METHODS

In a counterbalanced within-subject design, we assessed 2 different constructs-psychological distress (Kessler Psychological Distress Scale and Brief Symptom Inventory-18) and problematic alcohol use (Alcohol Use Disorders Identification Test-3)-in 3 modes (chatbot, paper-and-pencil, and web-based), and examined convergent and discriminant validity. In addition, we investigated the effect of mode on SDR, controlling for perceived sensitivity of items and individuals' tendency to respond in a socially desirable way, and we also assessed the perceived social presence of modes. Including a between-subject condition, we further investigated whether SDR is increased in chatbot assessments when applied in a self-report setting versus when human interaction may be expected. Finally, the effort (ie, complexity, difficulty, burden, and time) required to complete the assessments was investigated.

RESULTS

A total of 146 young adults (mean age 24, SD 6.42 years; n=67, 45.9% female) were recruited from a research panel for laboratory experiments. The results revealed high positive correlations (all P<.001) of measures of the same construct across different modes, indicating the convergent validity of chatbot assessments. Furthermore, there were no correlations between the distinct constructs, indicating discriminant validity. Moreover, there were no differences in SDR between modes and whether human interaction was expected, although the perceived social presence of the chatbot mode was higher than that of the established modes (P<.001). Finally, greater effort (all P<.05) and more time were needed to complete chatbot assessments than for completing the established modes (P<.001).

CONCLUSIONS

Our findings suggest that chatbots may yield valid results. Furthermore, an understanding of chatbot design trade-offs in terms of potential strengths (ie, increased social presence) and limitations (ie, increased effort) when assessing mental health were established.

Perceptions on Extending the Use of Technology after the COVID-19 Pandemic Resolves: A Qualitative Study with Older Adults

The COVID-19 pandemic of the last two years has affected the lives of many individuals, especially the most vulnerable and at-risk population groups, e.g., older adults. While social distancing and isolation are shown to be effective at decreasing the transmission of the virus, these actions have also increased loneliness and social isolation. To combat social distancing from family and friends, older adults have turned to technology for help. In the health sector, these individuals also had a variety of options that strengthened eHealth care services. This study analyzed the technologies used during the COVID-19 pandemic by a group of older people, as well as explored their expectations of use after the pandemic period. Qualitative and ethnographic interviews were conducted with 10 Portuguese older adults, and data were collected over a period of seven months between 2020 and 2021. The research demonstrated that the use of current and new technologies in the post-pandemic future is likely to be related to overcoming: (i) insecurity regarding privacy issues; (ii) difficulties in using technologies due to the level of use of digital technology; and (iii) the human distancing and impersonal consequences of using these technologies.

Characterization of technologies in digital health applied in vision care

Digital health technology is increasingly becoming part of the evolution of health services, not only for the innovation of equipment but also in support of health processes. Eye health is one of the areas that most explores this field, being a reference in different segments of digital health and the use of applied technological resources. Thus, the purpose of this review was to analyse and characterize the development of research in digital health applied to vision sciences in the last decade. An exploratory-quantitative review of the research based on studies indexed in the SCOPUS database in the last 10 years, which related aspects of digital health technologies with their use within the vision sciences, was conducted. The research results were filtered, including journal articles and excluding those not directly related to vision. The final sample was categorized and classified according to the technology used, the relationship with eye/visual health and its practical applications. A total of 1069 reports were identified (32.09% published since 2021). "Artificial Intelligence" (77.74%) was the most frequent technological tool cited, and posterior segment (68.10%) most eye structure studied, being diabetic retinopathy (27.88%) the main studied disease. The vast majority have potential for clinical use (93.73%), especially those aimed at supporting decision-making. Technologies in digital health in the vision sciences have had a huge growth in recent years, with emphasis on artificial intelligence applied to the posterior segment, but with a low development of studies aimed at using this technology in primary visual care.

Descriptive Analysis of Mobile Apps for Management of COVID-19 in Spain and Development of an Innovate App in that field

To address the current pandemic, multiple studies have focused on the development of new mHealth apps to help in curbing the number of infections, these applications aim to accelerate the identification and self-isolation of people exposed to SARS-CoV-2, the coronavirus known to cause COVID-19, by being in close contact with infected individuals. The main objectives of this paper are: (1) Analyze the current status of COVID-19 apps available on the main virtual stores: Google Play Store and App Store for Spain, and (2) Propose a novel mobile application that allows interaction and doctor-patient follow-up without the need for real-time consultations (face-to-face or telephone). In this research, a search for eHealth and telemedicine apps related to Covid-19 was performed in the main online stores: Google Play Store and App Store, until May 2021. Keywords were entered into the search engines of the online stores and relevant apps were selected for study using a PRISMA methodology. For the design and implementation of the proposed app named COVINFO, the main weaknesses of the apps studied were taken into account in order to propose a novel and useful app for healthcare systems. The search yielded a total of 50 apps, of which 24 were relevant to this study, of which 23 are free and 54% are available for Android and iOS operating systems (OS). The proposed app has been developed for mobile devices with Android OS being compatible with Android 4.4 and higher. This app enables doctor-patient interaction and constant monitoring of the patient's progress without the need for calls, chats or face-to-face consultation in real time. This work addresses design and development of an application for the transmission of the user's symptoms to his regular doctor, based on the fact that only 16.6% of existing applications have this functionality. The COVINFO app offers a novel service: asynchronous doctor-patient communication, as well as constant monitoring of the patient's condition and evolution. This app makes it possible to better manage the time of healthcare personnel and avoid overcrowding in hospitals, with the aim of preventing the collapse of healthcare systems and the spread of the coronavirus.

Midwives' and women's views on digital midwifery care in Germany: Results from an online survey

BACKGROUND

Digital midwifery services were enabled for the first time in Germany from March 2020 to ensure outpatient midwifery care in times of COVID-19.

METHODS

In February and March 2021, a cross-sectional study with an online survey of midwives and mothers was conducted to find out to what extent digital services were offered by the midwives and used by the women, and to obtain information about the level of satisfaction and potential of digital midwifery care in pregnancy and post partum.

RESULTS

1821 mothers of 18,784 women, who had given birth between May and November 2020 and were asked to participate in the survey, provided feedback (response rate: 9,7%). 1551 midwives responded to the call to participate in the survey and completed the questionnaire. Around one third of the responding mothers had used digital midwifery services in pregnancy and/or the postpartum period and rated these services positively by over 80%. Half of the responding midwives offered digital services and wished to continue this care option. However, not all services were considered equally suitable for digital implementation. From the respondents' point of view, classes and counselling are very well suited whereas postpartum care often requires the midwife's presence. Mothers and midwives alike saw the advantages in COVID-19 infection control and in saving time and travel. The main challenges were seen in handling IT equipment and providing high quality care despite the lack of physical examination and direct assessment of clinical findings. The mothers wished for more interactivity and networking with each other.

CONCLUSION

The COVID-19 pandemic has become a catalyst for digitalisation in midwifery care in Germany. The digital services were, mostly, well accepted and seen to usefully complement the in-person care of midwives. IT-support, guidelines and quality standards could help to optimise the digital services.

Development and Usability Assessment of a Mobile App (Demensia KITA) to Support Dementia Caregivers in Malaysia: A Study Protocol

The impact of dementia on caregivers is complex and multi-dimensional. In low- and middle-income settings, caregivers are often left without adequate support, despite their multiple needs. These include health information, caregiving skills, social and emotional support, and access to local resources-all of which can be partially fulfilled by technology. In recent years, mobile apps have emerged and proven useful for caregivers. We found a few existing apps suitable for Malaysian users in terms of affordability and cultural and linguistic compatibility. Our study aims to design a mobile app that suits dementia caregivers in Malaysia and consists of three phases. Phase I is content development that employs Focus Group Discussion (FGD) and Nominal Group Technique (NGT) involving field experts. Phase II comprises a mobile app (Demensia KITA) designed in collaboration with a software developer specializing in mobile health apps. Phase III entails testing the usability of the app using the Malay version of the mHealth App Usability Questionnaire (M-MAUQ). This study protocol elaborates on the rigorous steps of designing a mobile app and testing its usability, along with anticipated challenges. Our protocol will provide insight for future researchers, healthcare providers, and policymakers and pave the way for better use of digital technology in the field of aging and caregiving.

Enabling image optimisation and artificial intelligence technologies for better Internet of Things framework to predict COVID

Sensor technology advancements have provided a viable solution to fight COVID and to develop healthcare systems based on Internet of Things (IoTs). In this study, image processing and Artificial Intelligence (AI) are used to improve the IoT framework. Computed Tomography (CT) image‐based forecasting of COVID disease is among the important activities in medicine for measuring the severity of variability in the human body. In COVID CT images, the optimal gamma correction value was optimised using the Whale Optimisation Algorithm (WOA). During the search for the optimal solution, WOA was found to be a highly efficient algorithm, which has the characteristics of high precision and fast convergence. Whale Optimisation Algorithm is used to find best gamma correction value to present detailed information about a lung CT image, Also, in this study, analysis of important AI techniques has been done, such as Support Vector Machine (SVM) and Deep‐Learning (Deep‐Learning (DL)) for COVID disease forecasting in terms of amount of data training and computational power. Many experiments have been implemented to investigate the optimisation: SVM and DL with WOA and without WOA are compared by using confusion matrix parameters. From the results, we find that the DL model outperforms the SVM with WOA and without WOA.

The Impact of Digital Health Transformation Driven by COVID-19 on Nursing Practice: Systematic Literature Review

Background

The COVID-19 pandemic has accelerated the uptake of digital health innovations due to the availability of various technologies and the urgent health care need for treatment and prevention. Although numerous studies have investigated digital health adoption and the associated challenges and strategies during the pandemic, there is a lack of evidence on the impact on the nursing workforce.

Objective

This study aims to identify the impact of digital health transformation driven by COVID-19 on nurses.

Methods

The online software Covidence was used to follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Relevant scientific health and computing databases were searched for papers published from January 2020 to November 2021. Using the 8D sociotechnical approach for digital health in health care systems, the papers were analyzed to identify gaps in applying digital health in nursing practice.

Results

In total, 21 papers were selected for content analysis. The analysis identified a paucity of research that quantifies the impact of the digital health transformation on nurses during the pandemic. Most of the initiatives were teleconsultation, followed by tele–intensive care unit (tele-ICU), and only 1 (5%) study explored electronic medical record (EMR) systems. Among the sociotechnical elements, the human-related factor was the most explored and the system measurement was the least studied item.

Conclusions

The review identified a significant gap in research on how implementing digital health solutions has impacted nurses during the COVID-19 pandemic. This gap needs to be addressed by further research to provide strategies for empowering the nursing workforce to be actively involved in digital health design, development, implementation, use, and evaluation.

A qualitative study of hospital and community providers’ experiences with digitalization to facilitate hospital-to-home transitions during the COVID-19 pandemic

Background

The COVID-19 pandemic has triggered substantial changes to the healthcare context, including the rapid adoption of digital health to facilitate hospital-to-home transitions. This study aimed to: i) explore the experiences of hospital and community providers with delivering transitional care during the COVID-19 pandemic; ii) understand how rapid digitalization in healthcare has helped or hindered hospital-to-home transitions during the COVID-19 pandemic; and, iii) explore expectations of which elements of technology use may be sustained post-pandemic.

Methods

Using a pragmatic qualitative descriptive approach, remote interviews with healthcare providers involved in hospital-to-home transitions in Ontario, Canada, were conducted. Interviews were analyzed using a team-based rapid qualitative analysis approach to generate timely results. Visual summary maps displaying key concepts/ideas were created for each interview and revised based on input from multiple team members. Maps that displayed similar concepts were then combined to create a final map, forming the themes and subthemes.

Results

Sixteen healthcare providers participated, of which 11 worked in a hospital, and five worked in a community setting. COVID-19 was reported to have profoundly impacted healthcare providers, patients, and their caregivers and influenced the communication processes. There were several noted opportunities for technology to support transitions.

Interpretation

Several challenges with technology use were highlighted, which could impact post-pandemic sustainability. However, the perceived opportunities for technology in supporting transitions indicate the need to investigate the optimal role of technology in the transition workflow.

The Interplay of Work, Digital Health Usage, and the Perceived Effects of Digitalization on Physicians' Work: Network Analysis Approach

Background

In health care, the benefits of digitalization need to outweigh the risks, but there is limited knowledge about the factors affecting this balance in the work environment of physicians. To achieve the benefits of digitalization, a more comprehensive understanding of this complex phenomenon related to the digitalization of physicians’ work is needed.

Objective

The aim of this study was to examine physicians’ perceptions of the effects of health care digitalization on their work and to analyze how these perceptions are associated with multiple factors related to work and digital health usage.

Methods

A representative sample of 4630 (response rate 24.46%) Finnish physicians (2960/4617, 64.11% women) was used. Statements measuring the perceived effects of digitalization on work included the patients’ active role, preventive work, interprofessional cooperation, decision support, access to patient information, and faster consultations. Network analysis of the perceived effects of digitalization and factors related to work and digital health usage was conducted using mixed graphical modeling. Adjusted and standardized regression coefficients are denoted by b. Centrality statistics were examined to evaluate the relative influence of each variable in terms of node strength.

Results

Nearly half of physicians considered that digitalization has promoted an active role for patients in their own care (2104/4537, 46.37%) and easier access to patient information (1986/4551, 43.64%), but only 1 in 10 (445/4529, 9.82%) felt that the impact has been positive on consultation times with patients. Almost half of the respondents estimated that digitalization has neither increased nor decreased the possibilities for preventive work (2036/4506, 45.18%) and supportiveness of clinical decision support systems (1941/4458, 43.54%). When all variables were integrated into the network, the most influential variables were purpose of using health information systems, employment sector, and specialization status. However, the grade given to the electronic health record (EHR) system that was primarily used had the strongest direct links to faster consultations (b=0.32) and facilitated access to patient information (b=0.28). At least 6 months of use of the main EHR was associated with facilitated access to patient information (b=0.18).

Conclusions

The results highlight the complex interdependence of multiple factors associated with the perceived effects of digitalization on physicians’ work. It seems that a high-quality EHR system is critical for promoting smooth clinical practice. In addition, work-related factors may influence other factors that affect digital health success. These factors should be considered when developing and implementing new digital health technologies or services for physicians’ work. The adoption of digital health is not just a technological project but a project that changes existing work practices.

A qualitative research study of primary care physicians' views of telehealth in delivering postnatal care to women

BACKGROUND

The postpartum period is a critical time for women to optimise their physical and mental health. Primary care physicians (PCP) often manage postpartum women in the community setting after uneventful births. However, women encounter difficulties accessing care before and after their conventional 6-week physical review. Telehealth-based interventional studies have demonstrated their successful applications in several areas of postpartum care but is not widely adopted. The study aimed to explore the PCPs' views on their acceptability and perceived barriers of telehealth in delivering postpartum care to women in primary care.

METHODS

Twenty-nine PCPs participated in eleven in-depth interviews and four focus group discussions for this qualitative study conducted in Singapore. The purposively sampled PCPs had varied demographic background and medical training. Two investigators independently coded the audited transcripts. Thematic content analysis was performed using the codes to identify issues in the pertaining to the perceived usefulness, ease of use and attitudes towards telehealth in postpartum care as described in the "Telehealth Acceptance Model" framework.

RESULTS

Most PCPs perceived usefulness and ease of use of video consultation in delivering postpartum care. They recognised telehealth service to complement and support the current face-to-face postpartum care amidst the pandemic. However, training, leadership support, organizational infrastructure, healthcare financial policy and personal demographic profile influence their acceptance of a new care model for postnatal mothers.

CONCLUSION

Addressing the barriers and strengthening the facilitators will enhance PCPs' acceptance and utilisation of the proposed hybrid (telehealth and in-person) postnatal care model for mothers.

Continuing chronic care services during a pandemic: results of a mixed-method study

BACKGROUND

Patients with chronic diseases have seen unprecedented changes to healthcare practices since the emergence of COVID-19. Traditional 'on-site' clinics have had to innovate to continue services. Whether these changes are acceptable to patients and are effective for care continuation are largely unreported.

METHODS

We evaluated the effectiveness of care provision at a re-structured chronic care clinic and elicited the patient experiences of care and self-management. We conducted a convergent, parallel, mixed-methods study. Adult patients attending a chronic care clinic were included. We extracted data from 4,849 clinic visits before and during the COVID-19 pandemic, including operational metrics and attendee profile. We also conducted fifteen interviews with patients from the same clinic using a semi-structured interview guide.

RESULTS

Re-structuring the chronic clinic, including the introduction of teleconsultations, home-delivery of prescriptions and use of community-based phlebotomy services, served to maintain continuity of care while adhering to COVID-19 containment measures. Qualitatively, five themes emerged. Patients were able to adjust to healthcare practice changes and adapt their own lifestyles, although poor self-management practices were adopted. While most were apprehensive about attending the clinic, they valued ongoing care access and were reassured by the on-site containment measures.

CONCLUSIONS

Continuation of routine services is desired by patients and can be achieved through the adoption of containment measures, by greater collaboration with community partners, and the use of technology. Patients adapted to service changes, but poor self-management was evident. To prevent chronic disease relapse, services must strive to innovate rather than suspend services during pandemics.

Remote Versus In-person Outpatient Clinic Visits and Antibiotic Use Among Children During the COVID-19 Pandemic

BACKGROUND

The proportion of remote clinic visits was expected to increase among children during the COVID-19 pandemic which might result in antibiotic overuse.

METHODS

In southern Israel, 2 ethnic groups, Jewish and Bedouin, live side-by-side. Computerized data on visits for children <18 years were examined from clinics with ≥50 insured children, active both pre-COVID-19 and during the COVID-19 pandemic. Visits were divided into in-person and remote. Monthly infectious diagnoses and dispensed antibiotic prescription rates were calculated by age (<5, 5-17 years) and ethnic groups. Mean monthly rates of 2 parallel seasons (pre-COVID-19 and COVID-19 periods) were compared.

RESULTS

Overall 2,120,253 outpatient clinic visits were recorded. Remote clinic visit rates (per 1000 children) increased from 97.04 and 33.86 in the pre-COVID-19 to 179.75 and 50.05 in the COVID-19 period in Jewish and Bedouin children, respectively ( P < 0.01) along with a reduction of in-person visit rates in both populations. Comparing pre-COVID-19 and COVID-19 periods, the rates of overall infectious diagnoses in remote visits increased. Nevertheless, dispensed antibiotic prescription rates in remote visits (per 1000 visits) remained unchanged (9.84 vs. 8.67, P = 0.70, in the Jewish population and 14.32 vs. 14.17, P = 1.00, in the Bedouin population in the pre-COVID-19 and COVID-19 periods, respectively) with a similar distribution of antibiotic categories.

CONCLUSIONS

COVID-19 pandemic resulted in an expansion of remote visits of children <18 years with an increase in infectious diagnoses. However, remote dispensed antibiotic prescription rates remained unchanged. These dynamics were more accentuated in Jewish children, characterized by higher socio-economic conditions, compared to Bedouin children.

Effect of COVID-19 on hepatitis B and C virus countermeasures: Hepatologist responses from nationwide survey in Japan

AIM

Achieving hepatitis B virus (HBV) and hepatitis C virus (HCV) elimination requires continuous and sustained high volumes of diagnosis and treatment, which have been affected by the ongoing COVID-19 pandemic. This study assessed the effects of COVID-19 on hepatitis-related services in Japan and compared Japan's situation with a global survey.

METHODS

We conducted an online cross-sectional questionnaire survey of hepatologists from the Japan Society of Hepatology from August to October 2021 by using the same questionnaire from which a survey was conducted globally to address the effects of COVID-19 on hepatitis-related services. Hepatologists responded based on own impressions of their affiliated institutions.

RESULTS

In total, 196 hepatologists participated from 35 prefectures including 49.5% in managerial positions. Approximately 40% survey participants reported a 1%-25% decline in HBV and HCV screening and confirmatory testing. In addition, 53.6% and 45.4% reported no decline in HBV and HCV treatment initiation, respectively. Comparing any level of decrease with the global survey, there was less of a decline observed in Japan for screening (HBV: 51% vs. 56.3%, HCV: 51% vs. 70.9%) and treatment initiation (HBV: 32.7% vs. 52.4%, HCV: 41.8% vs. 66%). However, patient anxiety/fear (67.4%) and loss of staff due to COVID-19 (49.0%) were reported as challenges for resuming services to pre-COVID-19 levels.

CONCLUSION

Although in Japan all-inclusive decline in HBV- and HCV-related services were lower than in other countries, a greater decline was observed in HBV and HCV screening and diagnosis than in treatment initiation. Prolonged anxiety/fear among patients, and loss of staff and facilities from the COVID-19 response activities must be addressed to achieve elimination of hepatitis by 2030.

Key Stakeholder Barriers and Facilitators to Implementing Remote Monitoring Technologies: Protocol for a Mixed Methods Analysis

Background

The implementation of novel digital solutions within the National Health Service has historically been challenging. Since the start of the COVID-19 pandemic, there has been a greater push for digitization and for operating remote monitoring solutions. However, the implementation and widespread adoption of this type of innovation have been poorly studied.

Objective

We aim to investigate key stakeholder barriers and facilitators to implementing remote monitoring solutions to identify factors that could affect successful adoption.

Methods

A mixed methods approach will be implemented. Semistructured interviews will be conducted with high-level stakeholders from industry and academia and health care providers who have played an instrumental role in, and have prior experience with, implementing digital solutions, alongside the use of an adapted version of the Technology Acceptance Model questionnaire.

Results

Enrollment is currently underway, having started in February 2022. It is anticipated to end in July 2022, with data analysis scheduled to commence in August 2022.

Conclusions

The results of our study may highlight key barriers and facilitators to implementing digital remote monitoring solutions, thereby allowing for improved widespread adoption within the National Health Service in the future.

Trial Registration

ClinicalTrials.gov NCT05321004; https://clinicaltrials.gov/ct2/show/NCT05321004

Modeling adoption, security and privacy of COVID-19 apps: findings and recommendations from an empirical study using UTAUT

Background

The global health crisis caused by COVID-19 has drastically changed human society in a relatively short time. However, this crisis has offered insights into the different roles that such a worldwide virus plays in the lives of people and how those have been affected, as well as eventually proposing new solutions. From the beginning of the pandemic, technology solutions have featured prominently in virus control and in the frame of reference for international travel, especially contact tracing and passenger locator applications.

Objective

The objective of this paper is to study specific areas of technology acceptance and adoption following a unified theory of acceptance and use of technology (UTAUT) research model.

Methods

We presented a research model based on UTAUT constructs to study the determinants for adoption of COVID-19–related apps using a questionnaire. We tested the model via confirmatory factor analysis (CFA) and structural equation modeling (SEM) using travelers’ data from an insular tourist region.

Results

Our model explained 90.3% of the intention to use (N=9555) and showed an increased understanding of the vital role of safety, security, privacy, and trust in the usage intention of safety apps. Results also showed how the impact of COVID-19 is not a strong predictor of adoption, while age, education level, and social capital are essential moderators of behavioral intention.

Conclusions

In terms of scientific impact, the results described here provide important insights and contributions not only for researchers but also for policy and decision makers by explaining the reasons behind the adoption and usage of apps designed for COVID-19.

Assessing the Implementation of Digital Innovations in Response to the COVID-19 Pandemic to Address Key Public Health Functions: Scoping Review of Academic and Nonacademic Literature

Background

Digital technologies have been central to efforts to respond to the COVID-19 pandemic. In this context, a range of literature has reported on developments regarding the implementation of new digital technologies for COVID-19–related surveillance, prevention, and control.

Objective

In this study, scoping reviews of academic and nonacademic literature were undertaken to obtain an overview of the evidence regarding digital innovations implemented to address key public health functions in the context of the COVID-19 pandemic. This study aimed to expand on the work of existing reviews by drawing on additional data sources (including nonacademic sources) by considering literature published over a longer time frame and analyzing data in terms of the number of unique digital innovations.

Methods

We conducted a scoping review of the academic literature published between January 1, 2020, and September 15, 2020, supplemented by a further scoping review of selected nonacademic literature published between January 1, 2020, and October 13, 2020. Both reviews followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach.

Results

A total of 226 academic articles and 406 nonacademic articles were included. The included articles provided evidence of 561 (academic literature) and 497 (nonacademic literature) unique digital innovations. The most common implementation settings for digital innovations were the United States, China, India, and the United Kingdom. Technologies most commonly used by digital innovations were those belonging to the high-level technology group of integrated and ubiquitous fixed and mobile networks. The key public health functions most commonly addressed by digital innovations were communication and collaboration and surveillance and monitoring.

Conclusions

Digital innovations implemented in response to the COVID-19 pandemic have been wide ranging in terms of their implementation settings, the digital technologies used, and the public health functions addressed. However, evidence gathered through this study also points to a range of barriers that have affected the successful implementation of digital technologies for public health functions. It is also evident that many digital innovations implemented in response to the COVID-19 pandemic are yet to be formally evaluated or assessed.

Artificial Intelligence Adoption and Digital Innovation: How Does Digital Resilience Act as a Mediator and Training Protocols as a Moderator?

This study aims to discover how technology firms accomplish digital innovation through AI adoption. The current research also investigated digital resilience’s role as a mediator and training protocol’s role as a moderator between AI adoption and digital innovation links. The data collection and analysis were conducted using a quantitative method. To examine the research hypotheses, we chose technology firms that face problems regarding the enhancement of digital innovation. The findings confirmed that the digital innovation of technology firms is forecasted through AI adoption. The results proved that digital resilience plays a mediating role between AI adoption and digital innovation links. Technology firms play a key role in the advancement of digital technology. This research study adds to the existing knowledge by offering a digital innovation model with the combined influence of AI adoption, digital resilience, and training protocol. This study will be helpful for top management by showing when, why, and how AI adoption helps firms in their achievement of digital innovation. Moreover, digital resilience’s role is also important in the current digitalized world; thus, we used digital resilience as mediator in this research.

Outcomes of Vital Sign Monitoring of an Acute Surgical Cohort With Wearable Sensors and Digital Alerting Systems: A Pragmatically Designed Cohort Study and Propensity-Matched Analysis

Background: The implementation and efficacy of wearable sensors and alerting systems in acute secondary care have been poorly described.

Objectives: to pragmatically test one such system and its influence on clinical outcomes in an acute surgical cohort.

Methods: In this pragmatically designed, pre-post implementation trial, participants admitted to the acute surgical unit at our institution were recruited. In the pre-implementation phase (September 2017 to May 2019), the SensiumVitals™ monitoring system, which continuously measures temperature, heart, and respiratory rates, was used for monitoring alongside usual care (intermittent monitoring in accordance with the National Early Warning Score 2 [NEWS 2] protocol) without alerts being generated. In the post-implementation phase (May 2019 to March 2020), alerts were generated when pre-established thresholds for vital parameters were breached, requiring acknowledgement from healthcare staff on provided mobile devices. Hospital length of stay, intensive care use, and 28-days mortality were measured. Balanced cohorts were created with 1:1 ‘optimal’ propensity score logistic regression models.

Results: The 1:1 matching method matched the post-implementation group (n = 141) with the same number of subjects from the pre-implementation group (n = 141). The median age of the entire cohort was 52 (range: 18–95) years and the median duration of wearing the sensor was 1.3 (interquartile range: 0.7–2.0) days. The median alert acknowledgement time was 111 (range: 1–2,146) minutes. There were no significant differences in critical care admission (planned or unplanned), hospital length of stay, or mortality.

Conclusion: This study offered insight into the implementation of digital health technologies within our institution. Further work is required for optimisation of digital workflows, particularly given their more favourable acceptability in the post pandemic era. Clinical trials registration information: ClinicalTrials.gov Identifier: NCT04638738.

Diagnosing Tuberculosis: What Do New Technologies Allow Us to (Not) Do?

New tuberculosis (TB) diagnostics are at a crossroads: their development, evaluation, and implementation is severely damaged by resource diversion due to COVID-19. Yet several technologies, especially those with potential for non-invasive non-sputum-based testing, hold promise for efficiently triaging and rapidly confirming TB near point-of-care. Such tests are, however, progressing through the pipeline slowly and will take years to reach patients and health workers. Compellingly, such tests will create new opportunities for difficult-to-diagnose populations, including primary care attendees (all-comers in high burden settings irrespective of reason for presentation) and community members (with early stage disease or risk factors like HIV), many of whom cannot easily produce sputum. Critically, all upcoming technologies have limitations that implementers and health workers need to be cognizant of to ensure optimal deployment without undermining confidence in a technology that still offers improvements over the status quo. In this state-of-the-art review, we critically appraise such technologies for active pulmonary TB diagnosis. We highlight strengths, limitations, outstanding research questions, and how current and future tests could be used in the presence of these limitations and uncertainties. Among triage tests, CRP (for which commercial near point-of-care devices exist) and computer-aided detection software with digital chest X-ray hold promise, together with late-stage blood-based assays that detect host and/or microbial biomarkers; however, aside from a handful of prototypes, the latter category has a shortage of promising late-stage alternatives. Furthermore, positive results from new triage tests may have utility in people without TB; however, their utility for informing diagnostic pathways for other diseases is under-researched (most sick people tested for TB do not have TB). For confirmatory tests, few true point-of-care options will be available soon; however, combining novel approaches like tongue swabs with established tests like Ultra have short-term promise but first require optimizations to specimen collection and processing procedures. Concerningly, no technologies yet have compelling evidence of meeting the World Health Organization optimal target product profile performance criteria, especially for important operational criteria crucial for field deployment. This is alarming as the target product profile criteria are themselves almost a decade old and require urgent revision, especially to cater for technologies made prominent by the COVID-19 diagnostic response (e.g., at-home testing and connectivity solutions). Throughout the review, we underscore the importance of how target populations and settings affect test performance and how the criteria by which these tests should be judged vary by use case, including in active case finding. Lastly, we advocate for health workers and researchers to themselves be vocal proponents of the uptake of both new tests and those - already available tests that remain suboptimally utilized.

The Impact of the COVID-19 Pandemic on Research and Volunteering Activities among Medical Students: A Cross-Sectional Study among Romanian and International Students from One Medical Faculty from Romania

Introduction: This study focuses on the influence of the COVID-19 pandemic on medical students in their last year of study at the Faculty of Medicine of the University of Medicine and Pharmacy in Cluj-Napoca, Romania. It analyzes the impact of social distance limits on the conduct of research activities required for the development of the graduation thesis, as well as assesses sixth-year students’ attitudes and behaviors toward volunteer activities during the COVID-19 pandemic. Methods: A cross-sectional survey was conducted in June–July 2021 among sixth-year students. It used an anonymous online questionnaire and was sent to all students from the Faculty of Medicine studying in the Romanian, English, or French sections (n = 606). The response rate was 38.28%, resulting in a final sample of 232 students from both Romanian and international sections. Results: The findings demonstrate that two-thirds of the students in the survey agreed that the COVID-19 pandemic had a substantial impact on their research. Some of the students had to choose another subject for their graduation thesis, while about a quarter of the students gave up collecting personal data, 25% of respondents stated that it was difficult to contact research participants, one-third of them linked the difficulty of doing activities at the hospital to the present outbreak, and almost 30% of the students had difficulty communicating with the coordinator. The disturbance of the research activity seems to be higher among international students in comparison with the Romanian students, while there are limited gender differences. One out of five medical students has been involved in volunteer activities during the pandemic. Most have opted to volunteer at hospitals (especially international students) and contribute to health education activities (especially women). Conclusions: This is the first study from Romania and one of the few from Europe that presents data regarding the influence of the COVID-19 pandemic on research and volunteering activities among medical students.

Human-Centered Design Approaches in Digital Mental Health Interventions: Exploratory Mapping Review

BACKGROUND

Digital mental health interventions have a great potential to alleviate mental illness and increase access to care. However, these technologies face significant challenges, especially in terms of user engagement and adoption. It has been suggested that this issue stems from a lack of user perspective in the development process; accordingly, several human-centered design approaches have been developed over the years to consider this important aspect. Yet, few human-centered design approaches to digital solutions exist in the field of mental health, and rarely are end users involved in their development.

OBJECTIVE

The main objective of this literature review is to understand how human-centered design is considered in e-mental health intervention research.

METHODS

An exploratory mapping review was conducted of mental health journals with the explicit scope of covering e-mental health technology. The human-centered design approaches reported and the core elements of design activity (ie, object, context, design process, and actors involved) were examined among the eligible studies.

RESULTS

A total of 30 studies met the inclusion criteria, of which 22 mentioned using human-centered design approaches or specific design methods in the development of an e-mental health solution. Reported approaches were classified as participatory design (11/27, 41%), codesign (6/27, 22%), user-centered design (5/27, 19%), or a specific design method (5/27, 19%). Just over half (15/27, 56%) of the approaches mentioned were supported by references. End users were involved in each study to some extent but not necessarily in designing. About 27% (8/30) of all the included studies explicitly mentioned the presence of designers on their team.

CONCLUSIONS

Our results show that some attempts have indeed been made to integrate human-centered design approaches into digital mental health technology development. However, these attempts rely very little on designers and design research. Researchers from other domains and technology developers would be wise to learn the underpinnings of human-centered design methods before selecting one over another. Inviting designers for assistance when implementing a particular approach would also be beneficial. To further motivate interest in and use of human-centered design principles in the world of e-mental health, we make nine suggestions for better reporting of human-centered design approaches in future research.

COVID-19 Mobile Health Apps: An Overview of Mobile Applications in Indonesia

Background

Mobile health applications (mHealth apps) have been widely used for various purposes for mitigating the COVID-19 pandemic, such as self-assessment, contact tracing, disseminating information, minimizing exposure, and reducing face-to-face health consultation. The objective of this study is to systematically review COVID-19 related mHealth apps and highlight gaps to inform the development of future mHealth initiatives in Indonesia.

Methods

A systematic search strategy using a PRISMA flowchart was used to identify mHealth apps available in Google Play and Apple Play stores. We searched mHealth apps using certain specific terms related to COVID-19 outbreaks. The inclusion criteria were apps-based smartphone users related to COVID-19 using local language, free of cost, available in the Google Play and Apple Play Stores, and supported by the Indonesian government. We excluded games, apps on infectious diseases unrelated to COVID-19 specifically, and apps with non-Bahasa Indonesia (Indonesian language). The selected mHealth apps were assessed based on two measures: (1) the WHO guidelines on digital health intervention and (2) the four dimensions of the mHealth technology fit framework. In addition, user feedback from experienced and non-experienced users was conducted to evaluate four dimensions of the apps.

Results

A total of 339 mHealth apps were generated from the initial search, remaining seven selected apps that met inclusion criteria. The results highlighted that mHealth apps reviewed had still not been widely used by the general public. The applications were purposed to disseminate information, conduct a self-risk assessment, provide an online community forum, and telemedicine or teleconsultation regarding COVID-19. Data services, including data storage, aggregation, and data exchange, are available in most apps. The rarest function found was contact tracing and assisting health management and health workers, such as the availability of testing facilities, reporting test results, and prescribing medication. The main issues reported were the lack of data security and data privacy protection, integration and infrastructures, usability, and usefulness.

Conclusion

Our study highlighted the necessity to improve mHealth apps' functions related to assisting health workers and the function of digital contact tracing. An effort to increase public awareness regarding the use of mHealth is also necessary to streamline the function of this innovation. Policymakers must consider usefulness, usability, integration, and infrastructure issues to improve their mHealth function.

Innovations during the Covid-19 pandemic to maintain delivery of care for vocal cord dysfunction (VCD) in a multidisciplinary team (MDT) clinic

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Empowering Patients Through Virtual Care Delivery: Qualitative Study With Micropractice Clinic Patients and Health Care Providers

BACKGROUND

Prior to the wider adoption of digital health technologies during the COVID-19 pandemic, applications of virtual care were largely limited to specialist visits and remote care using telehealth (phone or video) applications. Data sharing approaches using tethered patient portals were mostly built around hospitals and larger care systems. These portals offer opportunities for improved communication, but despite a belief that care has improved, they have so far shown few outcome improvements beyond medication adherence. Less is known about use of virtual care and related tools in the outpatient context and particularly in rural community contexts.

OBJECTIVE

This study aims to reflect on the opportunities and barriers for sustainable virtual care through an example of a digitally enabled rural micropractice, which has provided 10%-15% virtual care since 2016 and 70% virtual care since March 2020.

METHODS

Three focus groups, 1 with providers (physician and medical office manager) and 2 with a total of 8 patients from a rural micropractice in British Columbia, were conducted in November 2020 and December 2020. Virtual care delivery was explored through the topics of communication approach, mixing virtual and in-person care, the practice team's journey in developing these approaches, and provider and patient satisfaction with the care model. Interviews were transcribed, checked for accuracy against recordings, and thematically analyzed.

RESULTS

Both patients and providers reported ease of communication and high satisfaction. Either could initiate communication, and patients found the ability to share health information asynchronously through the portal allowed time to reflect and prepare their thoughts. Patients were highly engaged and reported feeling empowered and true partners in their health care, although they noted limited care coordination with specialists. The mix of virtual and in-person visits was highly regarded by patients and providers, and patients reported feeling safe and cared for 24/7, although both expressed concern about work spilling into the provider's home life. The physician worried about missed diagnoses with virtual care. With respect to establishing the micropractice, solutions took about 5 years to optimize, with providers noting a learning curve requiring technical support for both themselves and their patients and a willingness to respond to patient feedback to identify the best solutions. Despite a mature virtual practice, patients reported deferred care due to COVID-19.

CONCLUSIONS

The micropractice's hybrid care model encouraged patients to be true partners in their care and resulted in high patient engagement and satisfaction; yet, success may rely on the patient population being willing to engage and being comfortable with technology. Barriers lie in gaps in care coordination and provider fear that signs or symptoms more evident with an in-person exam could be missed. Even in this setting, deferral of care in light of COVID-19 was present, and opportunities to address care gaps should be sought.

The Rapid Development of Virtual Care Tools in Response to COVID-19: Case Studies in Three Australian Health Services

BACKGROUND

News of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people while maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefits; however, such rapid-cycle development also created risks.

OBJECTIVE

The aim of this study was to understand the sociotechnical aspects of the rapid-cycle development of seven different COVID-19 virtual care tools, and to identify enablers, barriers, and risks at three health services in Victoria, Australia.

METHODS

A qualitative, embedded, multiple case study design was adopted. Researchers from three health services collaborated with university researchers who were independent from those health services to gather and analyze structured interview data from key people involved in either clinical or technical aspects of designing and deploying seven different virtual care tools.

RESULTS

The overall objectives of each health service reflected the international requirements for managing large numbers of patients safely but remotely and for protecting staff. However, the governance, digital maturity, and specific use cases at each institution shaped the methodology and specific outcomes required. Dependence on key individuals and their domain knowledge within an existing governance framework generally enabled rapid deployment, but sometimes posed barriers. Existing relationships with technical service developers enabled strong solutions, which in some cases were highly scalable. Conventional project methodologies such as steering committees, scope, budget control, tight functional specification, consumer engagement and codesign, universal accessibility, and postimplementation evaluation were ignored almost universally in this environment.

CONCLUSIONS

These three health services took a variety of approaches to the rapid-cycle development of virtual care tools to meet their urgent needs for triaging and remote monitoring during the first year of the COVID-19 pandemic. Their experiences provided insights into many social and technical barriers and enablers to the development of virtual care tools. If these are addressed proactively, they will improve clinical governance and technical management of future virtual care. Some changes can be made within individual health services, while others entail health system policy reforms. Enhancing the environment for virtual care tool design and implementation now will yield returns not only during future health emergencies but also in many more routine care settings.

Digital health literacy to share COVID-19 related information and associated factors among healthcare providers worked at COVID-19 treatment centers in Amhara region, Ethiopia: A cross-sectional survey

Background

Coronavirus (CoV) is a novel respiratory virus that can cause severe acute respiratory syndrome (SARS). It affects millions of people in the world and thousands of people in Ethiopia. In responding to this, digital health technologies help to reduce COVID-19 outbreaks by sharing accurate and timely COVID-19 related information. Additionally, digital solutions are used for remote consulting during the pandemic, in creating COVID-19 related awareness, for distribution of the vaccine, and so on. Therefore, this study aimed to assess digital health literacy to share COVID-19 related information and associated factors among healthcare providers who worked at COVID-19 treatment centers in the Amhara region, Northwest Ethiopia.

Method

An institutional-based cross-sectional survey was conducted from April 4 to May 4, 2021. The study included 476 healthcare providers who worked at COVID-19 treatment centers in the Amhara region. A pretested, structured self-administered questionnaire was used to collect data. EpiData 4.6 and SPSS version 26 were used for data entry and analysis respectively. Bi-variable and Multivariable logistic regression analysis was used to identify factors associated with the dependent variable. A P-value of less than 0.05 was used to declare statistical significance.

Result

A total of 456 respondents were participated in the study, with 95.8% response rate. Digital health literacy to share COVID-19 related information found to be 50.4% (95% CI: 46–55). Educational status [AOR = 4.37, 95% CI(2.08–9.17)], training [AOR = 3.00, 95% CI (1.80–5.00)], attitude [AOR = 1.99, 95% CI(1.18–3.36)], perceived usefulness [AOR = 2.01, 95% CI(1.22–3.32)], perceived ease of use [AOR = 2.00, 95% CI(1.25–3.21)] and smartphone access [AOR = 5.21, 95% CI(2.34–9.62)] were significantly associated with digital health literacy to sharing of COVID-19 related information at P-value less than 0.05.

Conclusion

This finding indicated that approximately half of the respondents had digital health literacy to share COVID-19 related information which was inadequate. Improving respondents’ educational status, computer training, smartphone access, perceived usefulness, perceived ease of use, and attitude was necessary to measure digital health literacy to sharing of COVID-19 related information.

Internal dynamics within primary care teams in two Spanish regions during the COVID-19 pandemic: a qualitative study

BACKGROUND

Pandemics and epidemics have represented public health emergencies with severe consequences at a global level. Primary care teams have played a crucial role in disease surveillance and monitoring during the COVID-19 pandemic through early detection, contact tracing, and isolation of positive cases. The objective of this study was to explore the impact of the COVID-19 pandemic on primary care teams regarding their internal dynamics and their professional performance.

METHODS

Qualitative study carried out between July and December 2020 in two large central and southern Spanish regions (Castilla la Mancha and Madrid). Semi-structured interviews and focus groups were conducted with primary care workers. Data was analysed using thematic content analysis. Participants were accessed using purposive sampling.

RESULTS

A total of 53 primary care workers participated in the study, of which 38 were individually interviewed, and 15 participated in three focus groups.The analysis of their experiences revealed two main themes regarding the impact of the COVID-19 pandemic on primary care teams: 1) The need to reorganise traditional roles: Primary care settings closed their doors to the public and their workers restructured their roles to ensure the delivery of essential services; 2) The need to implement a new primary care delivery model: Each primary care team had to self-organise, making sure their reference population was cared for and developing resource optimisation strategies.

CONCLUSIONS

Primary care teams have quickly adapted their roles and internal dynamics to respond to the demands generated by COVID-19. In the new delivery model, some positive aspects could be highlighted - such as increased communication between professionals and the use of telemedicine for some cases. However, it is important to address the negative impact that the COVID-19 crisis has had on of the main functions of primary care. These measures are necessary to promote well-being in primary care teams, and to provide quality care that addresses the complex and individual needs of each person and reduces inequalities in healthcare delivery.

[Teletherapy after cochlear implantation during the COVID-19 pandemic]

BACKGROUND

Due to the COVID-19 pandemic, digitalization in healthcare grew rapidly. Auditory training after cochlear implantation usually takes place face-to-face but social distancing interferes with this therapeutic approach.

MATERIALS AND METHODS

In follow-up treatment, 42 adult cochlear implant (CI) users aged 53.8 (±15.6) years received video therapy 1 x/week for 5 weeks on a certified platform. After each therapy session, the technical process and therapeutic content were assessed. At the end of the study, usability and the relationship between therapist and patient were evaluated by patients and therapists using the System Usability Scale (SUS), a final questionnaire and by the Skala Therapeutische Allianz - Revised (STA-R). Furthermore, a cost-benefit analysis was done.

RESULTS

Usability for both users was high (87.97 versus 93.0). Despite the lack of personal contact, therapeutic alliance was highly appreciated by patients and therapists (87.8% versus 84.8%). The main advantages for the patients were reductions in time and costs. In contrast, the rehabilitation center faced higher costs initially due to the longer time therapists needed to prepare the lessons. Technical problems had to be solved in > 75% of the first sessions but did not bother training thereafter. In total, 47.6% of the patients believe that teletherapy can completely fulfill their therapeutic needs.

CONCLUSION

Video therapy has been judged as a useful tool by all users and the majority wants to continue. However, it remains questionable whether the therapist-patient relationship can be sufficiently maintained over a longer period and whether online therapy is as effective as face-to-face therapy.

Internet of things in the management of chronic diseases during the COVID-19 pandemic: A systematic review

Introduction

The use of new technologies such as the Internet of Things (IoT) in the management of chronic diseases, especially in the COVID pandemics, could be a life-saving appliance for public health practice. The purpose of the current study is to identify the applications and capability of IoT and digital health in the management of the COVID-19 pandemic.

Methods

This systematic review was conducted by searching the online databases of PubMed, Scopus, and Web of Science using selected keywords to retrieve the relevant literature published until December 25th, 2021. The most relevant original English studies were included after initial screening based on the inclusion criteria.

Results

Overall, 18 studies were included. Most of the studies reported benefits and positive responses in the form of patients' and healthcare providers' satisfaction and trust in the online systems. Many services were provided to the patients, including but not limited to training the patients on their conditions; monitoring vital signs and required actions when vital signs were altered; ensuring treatment adherence; monitoring and consulting the patients regarding diet, physical activity, and lifestyle.

Conclusion

IoT is a new technology, which can help us improve health care services during the COVID-19 pandemic. It has a network of various sensors, obtaining data from patients. We have found several applications for this technology. Future studies can be conducted for the capability of other technologies in the management of chronic diseases.

Biodiagnostics in an era of global pandemics-From biosensing materials to data management

The novel corona virus SARS-CoV-2 (COVID-19) has exposed the world to challenges never before seen in fast diagnostics, monitoring, and prevention of the outbreak. As a result, different approaches for fast diagnostic and screening are made and yet to find the ideal way. The current mini-review provides and examines evidence-based innovative and rapid chemical sensing and related biodiagnostic solutions to deal with infectious disease and related pandemic emergencies, which could offer the best possible care for the general population and improve the approachability of the pandemic information, insights, and surrounding contexts. The review discusses how integration of sensing devices with big data analysis, artificial Intelligence or machine learning, and clinical decision support system, could improve the accuracy of the recorded patterns of the disease conditions within an ocean of information. At the end, the mini-review provides a prospective on the requirements to improve our coping of the pandemic-related biodiagnostics as well as future opportunities.

Comparison of clinicians' perceptions of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) before and during the COVID-19 pandemic

INTRODUCTION

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process encourages collaboration between clinicians, patients, and relatives on emergency care wishes and resuscitation decisions. The impact of the COVID-19 pandemic on clinicians' views of the ReSPECT process was unknown. We examined whether there were changes in clinicians' knowledge, skills, and attitudes regarding ReSPECT during the pandemic.

METHODS

We conducted a cross-sectional survey of clinicians at one acute hospital in the UK. We developed a questionnaire with a defined 5-point Likert scale and asked clinicians to recall their pre-pandemic views on ReSPECT and report their current views at the time of survey distribution (May 2020, end of the first COVID-19 wave in the UK). We compared their self-reported views before and during the pandemic.

RESULTS

We analysed 171 questionnaire responses. Clinicians reported ReSPECT telephone discussions with relatives were more challenging (pre-pandemic median 4, IQR 3-4; during pandemic median 4, IQR 4-5; p < 0.001) and negative emotions whilst conducting these discussions with relatives increased during the pandemic (pre-pandemic median 3, IQR 2-3.5; during pandemic median 3, IQR 2-4; p < 0.001). Clinicians also reported an increase in the importance of reaching a shared understanding of decisions with patients and relatives (pre-pandemic median 4, IQR 4-5; during pandemic median 5, IQR 4-5; p < 0.001).

CONCLUSIONS

There were differences in clinicians' knowledge, skills, and attitudes scores before and during the pandemic. Our findings highlighted that clinicians could benefit from training in remote ReSPECT conversations with relatives.

Video-Observed Therapy Versus Directly Observed Therapy in Patients With Tuberculosis

INTRODUCTION

This systematic review and meta-analysis synthesized evidence in the effects of video-observed therapy versus that of directly observed therapy on medication adherence, treatment completion, and tuberculosis resolution among patients with tuberculosis.

METHODS

Potential studies were identified from MEDLINE, Embase, CINAHLdirect, and Cochrane from inception to February 1, 2021. Inclusion criteria included (1) tuberculosis-infected population, (2) video-observed therapy as an intervention, (3) directly observed therapy as the comparison group, and (4) patient's medication adherence or clinical outcomes. Data were collected in 2021. Random-effects meta-analyses were conducted using Mantel-Haenszel methods with RR for dichotomous outcomes (medication adherence, treatment completion, and bacteriological resolution) and generic inverse variance methods with a weighted mean difference for continuous outcomes (proportion of doses observed).

RESULTS

A total of 9 studies were included in the systematic review and meta-analysis. Compared with patients receiving directly observed therapy, patients with video-observed therapy were associated with improved medication adherence (RR=2.79, 95% CI=2.26, 3.45, I²=25%), the proportion of doses observed (weighted mean difference=0.22, 95% CI=0.06, 0.39, I²=96%), and bacteriological resolution (RR=1.06, 95% CI=1.01, 1.11, I²=0%) but with similar treatment completion (RR=1.33, 95% CI=0.73, 2.43, I²=98%).

DISCUSSION

Implementation of video-observed therapy improved medication adherence and bacteriological resolution compared with that of directly observed therapy in tuberculosis-infected patients.

Assistive Multimodal Robotic System (AMRSys): Security and Privacy Issues, Challenges, and Possible Solutions

Assistive robotic systems could be a suitable solution to support a variety of health and care services, help independent living, and even simulate affection, to reduce loneliness. However, adoption is limited by several issues, as well as user concerns about ethics, data security, and privacy. Other than the common threats related to internet connectivity, personal robotic systems have advanced interaction possibilities, such as audio, video, touch, and gestures, which could be exploited to gain access to private data that are stored in the robot. Therefore, novel, safer methods of interaction should be designed to safeguard users’ privacy. To solicit further research on secure and private multimodal interaction, this article presents a thorough study of the state-of-the-art literature on data security and user privacy in interactive social robotic systems for health and care. In our study, we focus on social robotics to assist older people, which is a global challenge that is receiving a great deal of attention from the robotics and social care communities. This application will have a significant positive impact on the economy and society, but poses various security and privacy issues. This article analyses the key vulnerable areas where data leakage could occur during a multimodal interaction with a personal assistive robotic system. Thus, blockchain with a resource-aware framework, along with a continuous multifactor authentication mechanism, are envisaged as a potential solution for making such systems secure by design; therefore, increasing trust, acceptability, and adoption. Among the key cybersecurity research challenges, it is crucial to create an intelligent mechanism that autonomously determines the right trade-off between continuous user prompts and system usability, according to data types and personal preferences.

Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review protocol

INTRODUCTION

There is a surplus of information and communication technology (ICT)-based interventions for suicide prevention. However, it is unclear which of these ICT-based interventions for suicide prevention have been implemented in clinical settings. Furthermore, evidence shows that implementation strategies have often been mismatched to existing barriers. In response, the authors recognise the critical need for prospectively assessing the barriers and facilitators and then strategically developing implementation strategies. This review is part of a multiphase project to develop and test tailored implementation strategies for mobile app-based suicide prevention in clinical settings. The overall objective of this scoping review is to identify and characterise ICT-based interventions for all levels of suicide prevention in clinical settings. Additionally, this review will identify and characterise the barriers and facilitators to implementing these ICT-based interventions as well as reported measures and outcomes. The findings will directly inform the subsequent phase to maximise implementation and inform future efforts for implementing other types of ICT-based interventions related to suicide prevention in clinical settings.

METHODS AND ANALYSIS

This review will adhere to the methods described by the Joanna Briggs Institute for conducting scoping reviews. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review checklist. The following databases will be searched: Medline, PsycInfo, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science and Library, Information Science & Technology Abstracts (LISTA). Two reviewers will independently screen the articles and extract data using a standardised data collection tool. Then, authors will characterise extracted data using frameworks, typology and taxonomies to address the proposed review questions.

ETHICS AND DISSEMINATION

Ethics approval is not required for this scoping review. Authors will share the results in a peer-reviewed, open access publication and conference presentations. Furthermore, the findings will be shared with relevant health organisations through lay language summaries and informal presentations.