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Feng Z, Li H, Chen X, Zhang T, Chen Y, Shao S, Du J. Patient Participation in Medication Safety for Noncommunicable Diseases: A Qualitative Study of General Practitioners, Pharmacists, and Outpatients' Perspectives in Beijing. Patient Prefer Adherence 2024; 18:1907-1918. [PMID: 39296427 PMCID: PMC11409925 DOI: 10.2147/ppa.s474921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 09/10/2024] [Indexed: 09/21/2024] Open
Abstract
Purpose Our study aimed to explore the current status of patient participation in medication safety from the perspectives of general practitioners (GPs), pharmacists, and outpatients in Beijing, China. Patients and Methods A qualitative study using semi-structured in-depth individual interviews with GPs, pharmacists, and outpatients. Subjects were identified by purposive sampling until code saturation. Semi-structured qualitative interviews were conducted with GPs, pharmacists, and patients from community health service centers in three urban districts of Beijing, China. The interviews were transcribed verbatim and the text was analysed using thematic analysis techniques including familiarising with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. Results A total of eight GPs, seven pharmacists, and 18 outpatients were interviewed. Data analysis led to the generation of five key themes: (1) mutual trust between patient and GP, (2) communication with healthcare professionals, (3) acquisition of knowledge about medication safety, (4) implementation of medication self-management at home, and (5) different attitudes toward participation in medication decisions. Patients participated in medication safety in multiple ways. However, insufficient knowledge about medication safety, lack of awareness of the patient's role in ensuring medication safety, shortage of consultation lengths, and being misled by some information were problems with patient participation in medication safety. Conclusion This exploratory study contributes to our initial understanding of patient participation in medication safety. There were still many issues and barriers in the process of patient participation. Appropriate policies and measures, such as providing various forms of patient education, ensuring sufficient physician-patient communication, giving full play to the role of pharmacists, and making judicious use of digital health tools should be taken to improve medication safety by fully utilising the role of patients.
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Affiliation(s)
- Zhengwen Feng
- School of General Practice and Continuing Education, Capital Medical University, Beijing, People's Republic of China
| | - Hui Li
- School of General Practice and Continuing Education, Capital Medical University, Beijing, People's Republic of China
| | - Xiaolei Chen
- School of General Practice and Continuing Education, Capital Medical University, Beijing, People's Republic of China
| | - Tiancheng Zhang
- Department of General Practice, Dahongmen Community Health Service Center, Beijing, Fengtai District, People's Republic of China
| | - Yanxiang Chen
- Department of general practice, Changying Community Health Service Center, Beijing, Chaoyang District, People's Republic of China
| | - Shuang Shao
- School of General Practice and Continuing Education, Capital Medical University, Beijing, People's Republic of China
| | - Juan Du
- School of General Practice and Continuing Education, Capital Medical University, Beijing, People's Republic of China
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Vöcking M, Karrenbrock A, Beckmann A, Vondeberg C, Obert L, Hemming B, Minartz P, Bleck C, Cürlis D, Kuske S. Emotional and Psychological Safety in Healthcare Digitalization: A Design Ethnographic Study. Int J Public Health 2024; 69:1607575. [PMID: 39310719 PMCID: PMC11414544 DOI: 10.3389/ijph.2024.1607575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/19/2024] [Indexed: 09/25/2024] Open
Abstract
Objectives Emotional and psychological safety is important during the use of digital technologies in healthcare. We aimed to gain comprehensive insight into needs, influencing factors and outcomes in the context of perceived safety and digital technologies in healthcare. Methods We employed a participatory, design ethnographic research approach with 16 participants in 10 use cases. The methods included in an iterative process were, think-aloud, guideline-based interviews, process mapping, storyboard creation, and photo documentation. A qualitative, primarily inductive data analysis and synthesis was performed. Results Perceived safety is influenced by various factors and unmet needs. Increased perceived safety can positively support the use of digital technologies, whereas low perceived safety can limit or even hinder its use. Conclusion The needs of the different target groups should be considered throughout the entire process of digital technology development and healthcare provision to support their implementation. These findings support further research by providing specific aspects of emotional and psychological safety regarding target groups, settings, and ages and those with different levels of affinity for digital technologies.
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Affiliation(s)
- Mara Vöcking
- Fliedner Fachhochschule Düsseldorf, Düsseldorf, Germany
| | | | | | | | - Laura Obert
- Fliedner Fachhochschule Düsseldorf, Düsseldorf, Germany
| | | | - Peter Minartz
- Fliedner Fachhochschule Düsseldorf, Düsseldorf, Germany
| | - Christian Bleck
- Department of Social and Cultural Sciences, Hochschule Düsseldorf, University of Applied Sciences Düsseldorf, Düsseldorf, Germany
| | - Diana Cürlis
- Department Münster School of Design, FH Münster, University of Applied Sciences, Münster, Germany
| | - Silke Kuske
- Fliedner Fachhochschule Düsseldorf, Düsseldorf, Germany
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A Rodrigues D, I Plácido A, Mateos-Campos R, Figueiras A, Herdeiro MT, Roque F. Usability of APIMedOlder: A Web Application to Manage Potentially Inappropriate Medication in Older Adults. ACTA MEDICA PORT 2024; 37:609-616. [PMID: 39226560 DOI: 10.20344/amp.21537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/05/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Considering the increase in the proportion of the older population worldwide, the demand for health system resources also arises. These tools optimize clinical decision-making, thus avoiding iatrogenesis and thus contributing to a better quality of life for the older population. In response, we created an online web application, the APIMedOlder, that provides access to healthcare professionals to allow healthcare professionals to access potentially inappropriate medication identification criteria through a useful tool with a simplified profile, allowing its applicability in clinical practice. This study aims to assess the usability of the APIMedOlder online web application by healthcare professionals. METHODS A questionnaire, based on the System Usability Scale, was distributed among 15 healthcare professionals (five pharmacists, four physicians, three pharmacy technicians, and three nurses), to fully explore the website. RESULTS Overall, healthcare professionals' evaluation of the usability of the APIMedOlder online web application was rated as "Best imaginable" (mean score of 87.17 points), with individual scores ranging from 75 to 100 points. Internal consistency of α = 0.881 (CI 95%: 0.766 - 0.953) was achieved. Specific questionnaire items contributing to this high score included ease of use, learning efficiency, and integration of functions. CONCLUSION The overall evaluation of the developed tool was positive, with this online application being recognized as being easy to use and having well-integrated functions.
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Affiliation(s)
- Daniela A Rodrigues
- Biotechnology Research, Innovation and Design for Health Products (BRIDGES) - Research Laboratory on Epidemiology and Population Health. Instituto Politécnico da Guarda. Guarda; Health Sciences Research Centre (CICS). Universidade da Beira Interior. Covilhã; Universidad de Salamanca. Salamanca. Spain
| | - Ana I Plácido
- Biotechnology Research, Innovation and Design for Health Products (BRIDGES) - Research Laboratory on Epidemiology and Population Health. Instituto Politécnico da Guarda. Guarda. Portugal
| | - Ramona Mateos-Campos
- Area of Preventive Medicine and Public Health. Department of Biomedical and Diagnostic Sciences. Universidad de Salamanca. Salamanca. Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health. Universidade de Santiago de Compostela. Santiago de Compostela. Spain; Health Research Institute of Santiago de Compostela (IDIS). Santiago de Compostela. Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP). Madrid. Spain
| | - Maria Teresa Herdeiro
- Department of Medical Sciences. Institute of Biomedicine (iBiMED). Universidade de Aveiro. Aveiro. Portugal
| | - Fátima Roque
- Biotechnology Research, Innovation and Design for Health Products (BRIDGES) - Research Laboratory on Epidemiology and Population Health. Instituto Politécnico da Guarda. Guarda; Health Sciences Research Centre (CICS). Universidade da Beira Interior. Covilhã. Portugal
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Glenton C, Paulsen E, Agarwal S, Gopinathan U, Johansen M, Kyaddondo D, Munabi-Babigumira S, Nabukenya J, Nakityo I, Namaganda R, Namitala J, Neumark T, Nsangi A, Pakenham-Walsh NM, Rashidian A, Royston G, Sewankambo N, Tamrat T, Lewin S. Healthcare workers' informal uses of mobile phones and other mobile devices to support their work: a qualitative evidence synthesis. Cochrane Database Syst Rev 2024; 8:CD015705. [PMID: 39189465 PMCID: PMC11348462 DOI: 10.1002/14651858.cd015705.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
BACKGROUND Healthcare workers sometimes develop their own informal solutions to deliver services. One such solution is to use their personal mobile phones or other mobile devices in ways that are unregulated by their workplace. This can help them carry out their work when their workplace lacks functional formal communication and information systems, but it can also lead to new challenges. OBJECTIVES To explore the views, experiences, and practices of healthcare workers, managers and other professionals working in healthcare services regarding their informal, innovative uses of mobile devices to support their work. SEARCH METHODS We searched MEDLINE, Embase, CINAHL and Scopus on 11 August 2022 for studies published since 2008 in any language. We carried out citation searches and contacted study authors to clarify published information and seek unpublished data. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with a qualitative component. We included studies that explored healthcare workers' views, experiences, and practices regarding mobile phones and other mobile devices, and that included data about healthcare workers' informal use of these devices for work purposes. DATA COLLECTION AND ANALYSIS We extracted data using an extraction form designed for this synthesis, assessed methodological limitations using predefined criteria, and used a thematic synthesis approach to synthesise the data. We used the 'street-level bureaucrat' concept to apply a conceptual lens to our findings and prepare a line of argument that links these findings. We used the GRADE-CERQual approach to assess our confidence in the review findings and the line-of-argument statements. We collaborated with relevant stakeholders when defining the review scope, interpreting the findings, and developing implications for practice. MAIN RESULTS We included 30 studies in the review, published between 2013 and 2022. The studies were from high-, middle- and low-income countries and covered a range of healthcare settings and healthcare worker cadres. Most described mobile phone use as opposed to other mobile devices, such as tablets. We have moderate to high confidence in the statements in the following line of argument. The healthcare workers in this review, like other 'street-level bureaucrats', face a gap between what is expected of them and the resources available to them. To plug this gap, healthcare workers develop their own strategies, including using their own mobile phones, data and airtime. They also use other personal resources, including their personal time when taking and making calls outside working hours, and their personal networks when contacting others for help and advice. In some settings, healthcare workers' personal phone use, although unregulated, has become a normal part of many work processes. Some healthcare workers therefore experience pressure or expectations from colleagues and managers to use their personal phones. Some also feel driven to use their phones at work and at home because of feelings of obligation towards their patients and colleagues. At best, healthcare workers' use of their personal phones, time and networks helps humanise healthcare. It allows healthcare workers to be more flexible, efficient and responsive to the needs of the patient. It can give patients access to individual healthcare workers rather than generic systems and can help patients keep their sensitive information out of the formal system. It also allows healthcare workers to communicate with each other in more personalised, socially appropriate ways than formal systems allow. All of this can strengthen healthcare workers' relationships with community members and colleagues. However, these informal approaches can also replicate existing social hierarchies and deepen existing inequities among healthcare workers. Personal phone use costs healthcare workers money. This is a particular problem for lower-level healthcare workers and healthcare workers in low-income settings as they are likely to be paid less and may have less access to work phones or compensation. Out-of-hours use may also be more of a burden for lower-level healthcare workers, as they may find it harder to ignore calls when they are at home. Healthcare workers with poor access to electricity and the internet are less able to use informal mobile phone solutions, while healthcare workers who lack skills and training in how to appraise unendorsed online information are likely to struggle to identify trustworthy information. Informal digital channels can help healthcare workers expand their networks. But healthcare workers who rely on personal networks to seek help and advice are at a disadvantage if these networks are weak. Healthcare workers' use of their personal resources can also lead to problems for patients and can benefit some patients more than others. For instance, when healthcare workers store and share patient information on their personal phones, the confidentiality of this information may be broken. In addition, healthcare workers may decide to use their personal resources on some types of patients, but not others. Healthcare workers sometimes describe using their personal phones and their personal time and networks to help patients and clients whom they assess as being particularly in need. These decisions are likely to reflect their own values and ideas, for instance about social equity and patient 'worthiness'. But these may not necessarily reflect the goals, ideals and regulations of the formal healthcare system. Finally, informal mobile phone use plugs gaps in the system but can also weaken the system. The storing and sharing of information on personal phones and through informal channels can represent a 'shadow IT' (information technology) system where information about patient flow, logistics, etc., is not recorded in the formal system. Healthcare workers may also be more distracted at work, for instance, by calls from colleagues and family members or by social media use. Such challenges may be particularly difficult for weak healthcare systems. AUTHORS' CONCLUSIONS By finding their own informal solutions to workplace challenges, healthcare workers can be more efficient and more responsive to the needs of patients, colleagues and themselves. But these solutions also have several drawbacks. Efforts to strengthen formal health systems should consider how to retain the benefits of informal solutions and reduce their negative effects.
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Affiliation(s)
- Claire Glenton
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Elizabeth Paulsen
- Department of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Smisha Agarwal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Global Digital Health Innovation, Johns Hopkins University, Baltimore, USA
| | - Unni Gopinathan
- Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
| | - Marit Johansen
- Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
| | - David Kyaddondo
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Susan Munabi-Babigumira
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Josephine Nabukenya
- Department of Information Systems, School of Computing and Informatics Technology, Makerere University, Kampala, Uganda
| | - Immaculate Nakityo
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rehema Namaganda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Josephine Namitala
- College of Education and External Studies, Department of Adult and Community Education, Makerere University, Kampala, Uganda
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tom Neumark
- Centre for Development and the Environment, University of Oslo, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Allen Nsangi
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Arash Rashidian
- Department of Science, Information and Dissemination, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | - Nelson Sewankambo
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Tigest Tamrat
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Simon Lewin
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Centre for Epidemic Interventions Research (CEIR), Norwegian Institute of Public Health, Oslo, Norway
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Rodríguez-Ortega M, Ortega-Latorre Y, Montano-Navarro E, Casado-Collado AJ, Nguepy FR, Damou F. Telemedicine as a counselling tool for nurses in Central Africa. J Adv Nurs 2024. [PMID: 39154349 DOI: 10.1111/jan.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 07/12/2024] [Accepted: 08/08/2024] [Indexed: 08/20/2024]
Abstract
AIM Compare the use and trend of a telemedicine tool for clinical advice among nurses and other Cameroonian healthcare providers and explore its feasibility and accessibility. DESIGN A comparative observational descriptive study. METHODS The sample includes all telemedicine users who request advice from volunteer medical specialists in Spain on clinical cases through the telemedicine tool "diagnosis assistance" (DA). It consisted of a total of 296 Cameroonian health professionals (59% women), of whom 77 were nurses. The variables in which the trend was explored (2013-2022) were DAs entered by nurses versus other healthcare professionals, compared by primary specialty, comments and documents attached. Feasibility and accessibility were explored through an anonymous survey. RESULTS There were 2527 DAs between 2013 and 2022, of which nurses introduced 68%. There is an increasing trend in the nurse/other healthcare providers ratio, with significant differences in the chi-square of the linear trend between 2015 and 2022 (χ2 = 395.05; df = 7; p < .001). The probability that a DA was requested by nurses (PR >1) was observed in all years except for 2014, 2018 and 2019. The most tele-counselling requested by nurses was in the specialties of internal medicine, obstetrics and gynaecology, and dermatology. The exchange of comments and attachments was mainly conducted among nurses (74.9% and 50.4%, respectively). The users surveyed considered the tool valuable for diagnosis, applicable, with limitations due to cost, Internet quality or lack of time and effective at reducing hospital referrals. CONCLUSIONS Telemedicine for clinical advice has been used mostly and with increasing tendency by nurses, mainly in internal medicine, gynaecology and dermatology, being a useful and feasible resource that can contribute to improving clinical decision-making by African nurses. IMPACT The study addressed the problem of the shortage of health professionals in Central Africa and the search for alternatives that facilitate decision-making in this context. Tele-counselling tools through digital platforms that put Spanish specialists in contact with health professionals in Central Africa are mostly used by nurses working in rural health centres with a growing trend in their use. The research allows us to determine that tele-counselling tools constitute a well-accepted resource, which has a positive impact in environments with a shortage of human health resources, favouring the safety of both the nursing professional, through support in decision-making, and the populations to whom they provide care, who benefit from a multidisciplinary approach to their processes. REPORTING METHOD The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- María Rodríguez-Ortega
- San Juan de Dios Foundation, Madrid, Spain
- Health Sciences, Department of San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, Madrid, Spain
| | - Yolanda Ortega-Latorre
- San Juan de Dios Foundation, Madrid, Spain
- Health Sciences, Department of San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, Madrid, Spain
| | | | | | | | - Fleur Damou
- Centre de Santé Mère Nazaria Ignacia de Oyack, Oyack, Douala, Cameroon
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Maugeri A, Barchitta M, Basile G, Agodi A. Public and Research Interest in Telemedicine From 2017 to 2022: Infodemiology Study of Google Trends Data and Bibliometric Analysis of Scientific Literature. J Med Internet Res 2024; 26:e50088. [PMID: 38753427 PMCID: PMC11140276 DOI: 10.2196/50088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/01/2023] [Accepted: 01/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Telemedicine offers a multitude of potential advantages, such as enhanced health care accessibility, cost reduction, and improved patient outcomes. The significance of telemedicine has been underscored by the COVID-19 pandemic, as it plays a crucial role in maintaining uninterrupted care while minimizing the risk of viral exposure. However, the adoption and implementation of telemedicine have been relatively sluggish in certain areas. Assessing the level of interest in telemedicine can provide valuable insights into areas that require enhancement. OBJECTIVE The aim of this study is to provide a comprehensive analysis of the level of public and research interest in telemedicine from 2017 to 2022 and also consider any potential impact of the COVID-19 pandemic. METHODS Google Trends data were retrieved using the search topics "telemedicine" or "e-health" to assess public interest, geographic distribution, and trends through a joinpoint regression analysis. Bibliographic data from Scopus were used to chart publications referencing the terms "telemedicine" or "eHealth" (in the title, abstract, and keywords) in terms of scientific production, key countries, and prominent keywords, as well as collaboration and co-occurrence networks. RESULTS Worldwide, telemedicine generated higher mean public interest (relative search volume=26.3%) compared to eHealth (relative search volume=17.6%). Interest in telemedicine remained stable until January 2020, experienced a sudden surge (monthly percent change=95.7%) peaking in April 2020, followed by a decline (monthly percent change=-22.7%) until August 2020, and then returned to stability. A similar trend was noted in the public interest regarding eHealth. Chile, Australia, Canada, and the United States had the greatest public interest in telemedicine. In these countries, moderate to strong correlations were evident between Google Trends and COVID-19 data (ie, new cases, new deaths, and hospitalized patients). Examining 19,539 original medical articles in the Scopus database unveiled a substantial rise in telemedicine-related publications, showing a total increase of 201.5% from 2017 to 2022 and an average annual growth rate of 24.7%. The most significant surge occurred between 2019 and 2020. Notably, the majority of the publications originated from a single country, with 20.8% involving international coauthorships. As the most productive country, the United States led a cluster that included Canada and Australia as well. European, Asian, and Latin American countries made up the remaining 3 clusters. The co-occurrence network categorized prevalent keywords into 2 clusters, the first cluster primarily focused on applying eHealth, mobile health (mHealth), or digital health to noncommunicable or chronic diseases; the second cluster was centered around the application of telemedicine and telehealth within the context of the COVID-19 pandemic. CONCLUSIONS Our analysis of search and bibliographic data over time and across regions allows us to gauge the interest in this topic, offer evidence regarding potential applications, and pinpoint areas for additional research and awareness-raising initiatives.
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Affiliation(s)
- Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Guido Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
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Bittner B, Munoz FJ, Odonoghue J, Ordonez JM, Schmidt J, Schmitt K, Stassen K. Disease-Agnostic Electronic Adherence Aid for Subcutaneous at-Home and Self-Administration Devices-The Lowest Common Denominator Based on a Cross-Indication Survey. ACS Pharmacol Transl Sci 2024; 7:1310-1319. [PMID: 38751643 PMCID: PMC11091979 DOI: 10.1021/acsptsci.3c00377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 05/18/2024]
Abstract
The value of connected devices and health apps with features such as adherence trackers, dosing reminders, and remote communication tools for users and healthcare providers has been assessed to support home-based subcutaneous administration. A comprehensive survey was conducted with 605 participants, including users and caregivers, from eight countries. Medical conditions encompassed ankylosing spondylitis, asthma, cerebral palsy, cluster headaches, Crohn's disease, hemophilia, lupus, migraine, multiple sclerosis, Parkinson's disease, plaque psoriasis, psoriatic arthritis, rheumatoid arthritis, spasticity, spondyloarthritis, and ulcerative colitis. Utilizing a maximum difference scaling methodology, the survey gauged participant preferences regarding specific attributes and features of connected drug delivery devices. Irrespective of demographic factors like age, gender, nationality, or the specific medical condition, the device's ability to verify a successful injection stood out as universally valued. The second and third most valued attributes pertained to temperature-related indicators or warnings. These features do not necessitate the use of a connected device and can be integrated into existing autoinjector platforms. The survey findings support the development of a universal adherence tool for at-home subcutaneous dosing, independent of a specific medical condition. This tool may be gradually improved with disease-specific features. Once established as a platform, manufacturers can launch any subcutaneous medication and later integrate real-world evidence for enhanced educational, treatment, and diagnostic capabilities. This approach is crucial for advancing connected adherence tools in decentralized healthcare, aligning with user and healthcare system needs while translating scientific innovation into practical solutions.
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Affiliation(s)
- Beate Bittner
- Global
Product Strategy, Product Optimization, F. Hoffmann-La Roche Ltd., Basel 4070, Switzerland
| | - Francisco Javier Munoz
- Global
Product Strategy, Product Optimization, F. Hoffmann-La Roche Ltd., Basel 4070, Switzerland
| | | | - Jose Manuel Ordonez
- Product
Development Clinical Operations, F. Hoffmann-La
Roche Ltd., Madrid 28042, Spain
| | - Johannes Schmidt
- Global
Product Strategy, Product Optimization, F. Hoffmann-La Roche Ltd., Basel 4070, Switzerland
| | | | - Katja Stassen
- Product
Development Medical Affairs, F. Hoffmann-La
Roche Ltd., Basel 4070, Switzerland
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Olowoyo KS, Esan DT, Adeyanju BT, Olawade DB, Oyinloye BE, Olowoyo P. Telemedicine as a tool to prevent multi-drug resistant tuberculosis in poor resource settings: Lessons from Nigeria. J Clin Tuberc Other Mycobact Dis 2024; 35:100423. [PMID: 38435000 PMCID: PMC10907208 DOI: 10.1016/j.jctube.2024.100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Background This mini review aims to provide an overview of the role of telemedicine in preventing multi-drug resistant tuberculosis (MDR-TB) in Nigeria. The specific objectives include examining the potential benefits of telemedicine, identifying the challenges associated with its implementation, and highlighting the importance of addressing infrastructure limitations and data privacy concerns. Methods This minireview is based on a comprehensive analysis of existing literature, including scholarly articles, and reports,. A systematic search was conducted using electronic databases, such as PubMed and Google Scholar, to identify relevant publications related to telemedicine and MDR-TB prevention in Nigeria. The selected articles were assessed for their relevance, and key findings were synthesized to provide an overview of the role of telemedicine in addressing the challenges of MDR-TB in Nigeria. Results The review demonstrates that telemedicine has the potential to significantly contribute to MDR-TB prevention efforts in Nigeria. The benefits of telemedicine include improved access to specialized care, enhanced patient adherence to treatment, and potential cost savings. However, challenges such as infrastructure limitations and data privacy concerns need to be addressed for successful implementation. Integrating telemedicine into the healthcare system has the potential to strengthen MDR-TB prevention, particularly in underserved areas, including within Nigeria. Specifically, the integration of telemedicine into the healthcare system can enhance access to specialized care, improve patient adherence, and potentially reduce costs associated with MDR-TB management. Conclusions Addressing infrastructure challenges, ensuring data privacy and security, and fostering trust among healthcare providers and patients are critical for successful implementation of telemedicine. Further research and policy frameworks are needed to guide the effective implementation and scale-up of telemedicine in MDR-TB prevention efforts in Nigeria.
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Affiliation(s)
- Kikelomo S. Olowoyo
- Department of Nursing Science, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
- Department of Internal Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Deborah T. Esan
- Faculty of Nursing Sciences, College of Health Sciences, Bowen University, Iwo, Nigeria
| | - Benedict T. Adeyanju
- Department of Obstetrics and Gynecology, Afe Babalola University/ABUAD Multi-System Hospital, Ado-Ekiti, Nigeria
| | - David B. Olawade
- Department of Allied and Public Health, School of Health, Sport and Bioscience, University of East London, London, United Kingdom
| | - Babatunji E. Oyinloye
- Department of Biochemistry, College of Sciences, Afe Babalola University, Ado-Ekiti, Nigeria and Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, South Africa
| | - Paul Olowoyo
- Department of Internal Medicine, Federal Teaching Hospital Ido-Ekiti, Nigeria/Afe Babalola University, Ado-Ekiti, Nigeria
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9
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Ilola T, Malmisalo M, Laukka E, Lehtiniemi H, Pölkki T, Kääriäinen M, He HG, Kanste O. The effectiveness of digital solutions in improving nurses' and healthcare professionals' mental well-being: a systematic review and meta-analysis. J Res Nurs 2024; 29:97-109. [PMID: 39070568 PMCID: PMC11271664 DOI: 10.1177/17449871241226914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Background Widespread challenges to mental well-being among nurses and healthcare professionals threaten the productivity and quality of healthcare. Digital solutions may prove to effectively support nurses' and healthcare professionals' mental well-being. Aim To synthesise evidence regarding the effectiveness of digital solutions in improving nurses' and healthcare professionals' mental well-being. Methods This systematic review followed the JBI guidance for systematic reviews of effectiveness. The PubMed, CINAHL, Scopus, Pro-Quest and APA PsycArticles databases were reviewed for randomised controlled trials and quasi-experimental studies published at any point prior to the 26th of October 2021. Meta-analysis and narrative synthesis were performed. Results Fourteen studies were included. Personal mental well-being solutions significantly improved nurses' and healthcare professionals' mental well-being. The effectiveness of work-related digital solutions could not be demonstrated. The meta-analysis revealed little to no effect on professionals' work engagement. Conclusions Personal digital solutions may have the potential to improve the mental well-being of nurses and healthcare professionals. With the support of nurse managers' facilitation, nurses have a key role to promote their own mental well-being by utilising digital mental health solutions. Nevertheless, further adequately powered, well-designed research is required.
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Affiliation(s)
- Tiina Ilola
- Nurse Manager, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Mikael Malmisalo
- MSc Student, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Elina Laukka
- Post-doctoral Researcher, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Heli Lehtiniemi
- Statistician, Infrastructure for Population Studies, University of Oulu, Oulu, Finland
| | - Tarja Pölkki
- Professor, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Maria Kääriäinen
- Professor, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Hong-Gu He
- Professor, Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Outi Kanste
- Professor, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
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Martín-Palomo MT, González-Calo I, Lucchetti G, Badanta B. Experiences of health and social professionals using care technologies with older adults during the COVID-19 pandemic: A qualitative study. Public Health Nurs 2024; 41:101-111. [PMID: 37897095 DOI: 10.1111/phn.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/23/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To investigate the perceptions and experiences of health and social care professionals concerning the use of technology for the care of older adults during the COVID-19 pandemic. DESIGN AND MEASURES A phenomenological qualitative, exploratory, and descriptive design using semi-structured interviews. SAMPLE Twenty Spanish health and social care workers in six Spanish cities between February and July 2021, during the COVID-19 pandemic. RESULTS During the COVID-19 pandemic care workers have become more familiar with technology devices, but they also recognize certain barriers for the implementation of technology, mainly in nursing homes and homecare, related to concerns of lack of humanization and difficulties in accessing and using these devices. CONCLUSION Politicians and social and healthcare managers should be aware of the benefits of techno-care, reducing the difficulties in implementing it and making more funding and further training available to care providers.
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Affiliation(s)
- María Teresa Martín-Palomo
- Institut of Sociology and Center for Migration Studies and Intercultural Relations (CEMyRI), Almería University, Andalucia, Spain
| | - Inés González-Calo
- Department of Social Sciences, University of Almería, Research Group under the Andalusian Research: "Social Inequality and Domination in Andalusia", (SEJ 339), Andalucia, Spain
| | - Giancarlo Lucchetti
- Department of Medicine, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Bárbara Badanta
- Department of Nursing; Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, Research Group under the Andalusian Research CTS 1050 "Complex Care, Chronic and Health Outcomes", and Center for Migration Studies and Intercultural Relations (CEMyRI), Seville, Spain
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11
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Gil Conde M, Peyroteo M, Maria A, Maia MR, Gregório J, Paulo MS, Alves M, Papoila AL, Lapão LV, Heleno B. Protocol for a cluster randomised trial of a goal-oriented care approach for multimorbidity patients supported by a digital platform. BMJ Open 2023; 13:e070044. [PMID: 37977860 PMCID: PMC10660818 DOI: 10.1136/bmjopen-2022-070044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Health information systems represent an opportunity to improve the care provided to people with multimorbidity. There is a pressing need to assess their impact on clinical outcomes to validate this intervention. Our study will determine whether using a digital platform (Multimorbidity Management Health Information System, METHIS) to manage multimorbidity improves health-related quality of life (HR-QoL). METHODS AND ANALYSIS A superiority, cluster randomised trial will be conducted at primary healthcare practices (1:1 allocation ratio). All public practices in the Lisbon and Tagus Valley (LVT) Region, Portugal, not involved in a previous pilot trial, will be eligible. At the participant level, eligible patients will be people with complex multimorbidity, aged 50 years or older, with access to an internet connection and a communication technology device. Participants who cannot sign/read/write and who do not have access to an email account will not be included in the study. The intervention combines a training programme and a customised information system (METHIS). Both are designed to help clinicians adopt a goal-oriented care model approach and to encourage patients and carers to play a more active role in autonomous healthcare. The primary outcome is HR-QoL, measured at 12 months with the physical component scale of the 12-item Short Form questionnaire (SF-12). Secondary outcomes will also be measured at 12 months and include mental health (mental component Scale SF-12, Hospital Anxiety and Depression Scale). We will also assess serious adverse events during the trial, including hospitalisation and emergency services. Finally, at 18 months, we will ask the general practitioners for any potentially missed diagnoses. ETHICS AND DISSEMINATION The Research and Ethics Committee (LVT Region) approved the trial protocol. Clinicians and patients will sign an informed consent. A data management officer will handle all data, and the publication of several scientific papers and presentations at relevant conferences/workshops is envisaged. TRIAL REGISTRATION NUMBER NCT05593835.
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Affiliation(s)
- Margarida Gil Conde
- USF Jardins da Encarnação, ACeS Lisboa Central/ Research and Ethics Committee, ARSLVT, Lisboa, Portugal
- University Clinic of Family Medicine, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal
| | - Mariana Peyroteo
- UNIDEMI, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
- Laboratório Associado de Sistemas Inteligentes, LASI, 4800-058 Guimarães, Portugal
| | - Ana Maria
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Mélanie Raimundo Maia
- UNIDEMI, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
- Laboratório Associado de Sistemas Inteligentes, LASI, 4800-058 Guimarães, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - João Gregório
- CBIOS, Universidade Lusófona de Humanidades e Tecnologias Escola de Ciências e Tecnologias da Saúde, Lisboa, Portugal
| | - Marilia Silva Paulo
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Marta Alves
- CEAUL, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Ana Luísa Papoila
- CEAUL, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Luís Velez Lapão
- UNIDEMI, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
- Laboratório Associado de Sistemas Inteligentes, LASI, 4800-058 Guimarães, Portugal
- WHO Collaborating Center on Health Workforce Policy and Planning, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Bruno Heleno
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
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12
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Zhou J, Dang W, Luo Z, Fan X, Shi H, Deng N, Xiong G. Telenursing needs and influencing factors in patients with type 2 diabetes mellitus: A cross-sectional study. J Clin Nurs 2023; 32:7298-7309. [PMID: 37337624 DOI: 10.1111/jocn.16805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to determine the relationship between the demand for telenursing and the chronic illness resources available to patients with type 2 diabetes mellitus (T2DM), as well as the factors that affect this requirement. DESIGN Cross-sectional. METHODS This study included 586 participants with T2DM. A telenursing needs questionnaire developed by the research team was used to assess the telenursing needs of patients with T2DM, and the Chinese version of the Chronic Illness Resources Survey was used to assess the participants' community chronic disease resources. A one-way ANOVA and multiple regression analysis were used to determine the factors influencing the demand for telenursing and to estimate the relationship between chronic illness resources and the need for telenursing. The STROBE checklist was followed. RESULTS The patients' telenursing needs, ranked from high to low, are as follows: individualized skills and safety; basic disease care; psychological and spiritual needs; respect and social support; and high-level health management. The chronic disease resource score was 3.47 ± .02, which suggested that patients with T2DM have relatively rich disease resources. Multiple regression analyses showed that resources for chronic diseases, the course of diabetes and complications, family income and other chronic diseases accounted for 79.6% of the variance in T2DM patients' telenursing needs. CONCLUSIONS The telenursing needs of patients with T2DM are prominent, and primarily focus on basic nursing needs for the disease. To some extent, chronic disease resources affect the telenursing needs of patients with T2DM. RELEVANCE TO CLINICAL PRACTICE It is crucial to pay attention to research on telenursing for T2DM patients from the patients' perspective. Enhancing resources for chronic diseases may help meet the telenursing needs of T2DM patients. PATIENT OR PUBLIC CONTRIBUTION Parents and diabetes management specialists participated in designing the telenursing needs questionnaire.
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Affiliation(s)
- Jian Zhou
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Wantai Dang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Zongting Luo
- Department of Nursing, The Third People's Hospital of Chengdu & The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Xinxin Fan
- School of nursing, Chengdu Medical College, Chengdu, China
| | - Hui Shi
- Department of Nursing, Chengdu Seventh People's Hospital, Chengdu, China
| | - Na Deng
- Department of Nursing, Chengdu Seventh People's Hospital, Chengdu, China
| | - Guizhi Xiong
- Department of Nursing, Bazhong Central Hospital, Bazhong, China
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13
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Lear R, Ellis S, Ollivierre-Harris T, Long S, Mayer EK. Video Recording Patients for Direct Care Purposes: Systematic Review and Narrative Synthesis of International Empirical Studies and UK Professional Guidance. J Med Internet Res 2023; 25:e46478. [PMID: 37585249 PMCID: PMC10468707 DOI: 10.2196/46478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Video recordings of patients may offer advantages to supplement patient assessment and clinical decision-making. However, little is known about the practice of video recording patients for direct care purposes. OBJECTIVE We aimed to synthesize empirical studies published internationally to explore the extent to which video recording patients is acceptable and effective in supporting direct care and, for the United Kingdom, to summarize the relevant guidance of professional and regulatory bodies. METHODS Five electronic databases (MEDLINE, Embase, APA PsycINFO, CENTRAL, and HMIC) were searched from 2012 to 2022. Eligible studies evaluated an intervention involving video recording of adult patients (≥18 years) to support diagnosis, care, or treatment. All study designs and countries of publication were included. Websites of UK professional and regulatory bodies were searched to identify relevant guidance. The acceptability of video recording patients was evaluated using study recruitment and retention rates and a framework synthesis of patients' and clinical staff's perspectives based on the Theoretical Framework of Acceptability by Sekhon. Clinically relevant measures of impact were extracted and tabulated according to the study design. The framework approach was used to synthesize the reported ethico-legal considerations, and recommendations of professional and regulatory bodies were extracted and tabulated. RESULTS Of the 14,221 abstracts screened, 27 studies met the inclusion criteria. Overall, 13 guidance documents were retrieved, of which 7 were retained for review. The views of patients and clinical staff (16 studies) were predominantly positive, although concerns were expressed about privacy, technical considerations, and integrating video recording into clinical workflows; some patients were anxious about their physical appearance. The mean recruitment rate was 68.2% (SD 22.5%; range 34.2%-100%; 12 studies), and the mean retention rate was 73.3% (SD 28.6%; range 16.7%-100%; 17 studies). Regarding effectiveness (10 studies), patients and clinical staff considered video recordings to be valuable in supporting assessment, care, and treatment; in promoting patient engagement; and in enhancing communication and recall of information. Observational studies (n=5) favored video recording, but randomized controlled trials (n=5) did not demonstrate that video recording was superior to the controls. UK guidelines are consistent in their recommendations around consent, privacy, and storage of recordings but lack detailed guidance on how to operationalize these recommendations in clinical practice. CONCLUSIONS Video recording patients for direct care purposes appears to be acceptable, despite concerns about privacy, technical considerations, and how to incorporate recording into clinical workflows. Methodological quality prevents firm conclusions from being drawn; therefore, pragmatic trials (particularly in older adult care and the movement disorders field) should evaluate the impact of video recording on diagnosis, treatment monitoring, patient-clinician communication, and patient safety. Professional and regulatory documents should signpost to practical guidance on the implementation of video recording in routine practice. TRIAL REGISTRATION PROSPERO CRD42022331825: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=331825.
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Affiliation(s)
- Rachael Lear
- Imperial Clinical Analytics, Research & Evaluation (iCARE), London, United Kingdom
- National Institute for Health and Care Research North West London Patient Safety Research Collaborative, Institute of Global Health Innovation, Imperial College London - St Mary's Hospital Campus, London, United Kingdom
| | - Sophia Ellis
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Hillingdon NHS Foundation Trust, London, United Kingdom
| | | | - Susannah Long
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Erik K Mayer
- Imperial Clinical Analytics, Research & Evaluation (iCARE), Digital Collaboration Space, London, United Kingdom
- National Institute for Health and Care Research North West London Patient Safety Research Collaborative, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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McCue M, Khatib R, Kabir C, Blair C, Fehnert B, King J, Spalding A, Zaki L, Chrones L, Roy A, Kemp DE. User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study. JMIR Hum Factors 2023; 10:e42768. [PMID: 37494099 PMCID: PMC10413250 DOI: 10.2196/42768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a leading cause of disability worldwide. Management of chronic conditions such as MDD can be improved by enhanced patient engagement, measurement-based care (MBC), and shared decision-making (SDM). A user-centered design approach can improve the understanding of the patient journey and care team workflows and thus aid the development of digital health care innovations optimized for the needs of patients living with MDD and their primary care teams. OBJECTIVE This study aims to use qualitative research methods for the user-centered design of a digitally enabled MDD care platform, PathwayPlatform, intended to enhance patient engagement, MBC, and SDM. METHODS Insights were gathered through 2 stages of qualitative interviews by a study team with expertise in qualitative research and user-centered design methods. Thematic analysis was used to generate an overarching understanding of a set of shared experiences, thoughts, or behaviors across a broad qualitative data set, including transcripts of interviews, to allow both inductive and deductive insights to emerge. Thematic analysis of interviews was supported by Dedoose (SocioCultural Research Consultants, LLC), a qualitative data analysis software tool that enables systematized coding. Findings and insights were presented based on code frequency, salience, and relevance to the research project. RESULTS In stage 1, interviews were conducted with 20 patients living with MDD and 15 health care providers from September 2018 to January 2019 to understand the experiences with and perceptions about the initial functionality of the Pathway app while also exploring the perceptions about potential additional features and functionality. Feedback about care team workflows and treatment approaches was collected in stage-2 interviews with 36 health care providers at 8 primary care sites. Inductive and deductive thematic analyses revealed several themes related to app functionality, patient-provider engagement, workflow integration, and patient education. Both patients and their care teams perceived the remote tracking of patient-reported outcomes via digital tools to be clinically useful and reliable and to promote MBC and SDM. However, there was emphasis on the need to enhance the flow of real-time data shared with the care team, improve trend visualizations, and integrate the data within the existing clinical workflow and educational programs for patients and their care teams. User feedback was incorporated into the iterative development of the Pathway app. CONCLUSIONS Ongoing communication with patients living with MDD and their care teams provided an opportunity for user-centric developmental iterations of the Pathway Platform. Key insights led to further development of the patient-facing and care team-facing visit preparation features, collaborative goal-setting and goal-tracking features, patient-reported outcome summaries, and trend visualizations. The result is an enhanced digital platform with the potential to improve treatment outcomes and provide patients living with MDD additional support throughout their treatment journey.
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Affiliation(s)
- Maggie McCue
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Rasha Khatib
- Advocate Aurora Research Institute, Advocate Health Care, Downers Grove, IL, United States
| | - Christopher Kabir
- Advocate Aurora Research Institute, Advocate Health Care, Downers Grove, IL, United States
| | - Chris Blair
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Ben Fehnert
- Cognition Kit, Cambridge, United Kingdom
- Ctrl Group / Fora Health, London, United Kingdom
| | - James King
- Ctrl Group / Fora Health, London, United Kingdom
| | | | - Lara Zaki
- Ctrl Group / Fora Health, London, United Kingdom
| | - Lambros Chrones
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Anit Roy
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - David E Kemp
- Advocate Aurora Health, Downers Grove, IL, United States
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15
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Listorti E, Ferrara L, Adinolfi A, Gerardi MC, Ughi N, Tozzi VD, Epis OM. Joining telehealth in rheumatology: a survey on the role played by personalized experience from patients' perspective. BMC Health Serv Res 2023; 23:682. [PMID: 37349713 DOI: 10.1186/s12913-023-09575-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The beginning of the Covid-19 pandemic has forced many hospital departments worldwide to implement telehealth strategies for the first time. Telehealth represents the opportunity to increase value for all stakeholders, including patients and healthcare staff, but its success constitutes a challenge for all of them and particularly patients play a crucial role for their needed adherence. This study focuses on the experience of the Rheumatology Unit of Niguarda Hospital in Milan (Italy), where telehealth projects have been implemented for more than a decade with structured design and organized processes. The case study is paradigmatic because patients have experimented personalized mixes of telehealth channels, including e-mails and phone calls, Patient Reported Outcomes questionnaires, and home delivery of drugs. Given all these peculiarities, we decided to deepen patients' perspective through three main aspects related to the adoption of telehealth: (i) the benefits perceived, (ii) the willingness to enrol in future projects, (iii) the preference on the service-mix between remote contacts and in-person visits. Most importantly, we investigated differences in the three areas among all patients based on the mix of telehealth channels experienced. METHODS We conducted a survey from November 2021 to January 2022, enrolling consecutively patients attending the Rheumatology Unit of Niguarda Hospital in Milan (Italy). Our survey comprised an introductory set of questions related to personal, social, clinical and ICT skills information, followed by the central part on telehealth. All the answers were analysed with descriptive statistics and regression models. RESULTS A complete response was given by 400 patients: 283 (71%) were female, 237 (59%) were 40-64 years old, 213 (53%) of them declared to work, and the disease most represented was Rheumatoid Arthritis (144 patients, 36%). Descriptive statistics and regression results revealed that (i) non-users imagined wide-ranging benefits compared to users; (ii) other things being equal, having had a more intense experience of telehealth increased the odds of accepting to participate to future projects by 3.1 times (95% C.I. 1.04-9.25), compared to non-users; (iii) the more telehealth was experienced, the higher the willingness to substitute in-person with online contacts. CONCLUSIONS Our study contributes to enlighten the crucial role played by the telehealth experience in determining patients' preferences.
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Affiliation(s)
| | - Lucia Ferrara
- CERGAS SDA Bocconi, Bocconi University, Milan, Italy
| | - Antonella Adinolfi
- Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Nicola Ughi
- Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Oscar M Epis
- Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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16
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Gayesa RT, Ngai FW, Xie YJ. The effects of mHealth interventions on improving institutional delivery and uptake of postnatal care services in low-and lower-middle-income countries: a systematic review and meta-analysis. BMC Health Serv Res 2023; 23:611. [PMID: 37296420 DOI: 10.1186/s12913-023-09581-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Maternal mortality due to pregnancy, childbirth and postpartum is a global challenge. Particularly, in low-and lower-income countries, the outcomes of these complications are quite substantial. In recent years, studies exploring the effect of mobile health on the improvement of maternal health are increasing. However, the effect of this intervention on the improvement of institutional delivery and postnatal care utilization was not well analyzed systematically, particularly in low and lower-middle-income countries. OBJECTIVE The main aim of this review was to assess the effect of mobile heath (mHealth) interventions on improving institutional delivery, postnatal care service uptake, knowledge of obstetric danger signs, and exclusive breastfeeding among women of low and lower-middle-income countries. METHODS Common electronic databases like PubMed, EMBASE, the Web of Science, Medline, CINAHL, Cochrane library, Google scholar, and gray literature search engines like Google were used to search relevant articles. Articles that used interventional study designs and were conducted in low and lower-middle-income countries were included. Sixteen articles were included in the final systematic review and meta-analysis. Cochrane's risk of bias tool was used to assess the quality of included articles. RESULTS The overall outcome of the systematic review and meta-analysis showed that MHealth intervention has a positive significant effect in improving the institutional delivery (OR = 2.21 (95%CI: 1.69-2.89), postnatal care utilization (OR = 4.13 (95%CI: 1.90-8.97), and exclusive breastfeeding (OR = 2.25, (95%CI: 1.46-3.46). The intervention has also shown a positive effect in increasing the knowledge of obstetric danger signs. The subgroup analysis based on the intervention characteristics showed that there was no significant difference between the intervention and control groups based on the intervention characteristics for institutional delivery (P = 0.18) and postnatal care utilizations (P = 0.73). CONCLUSIONS The study has found out that mHealth intervention has a significant effect on improving facility delivery, postnatal care utilization, rate of exclusive breastfeeding, and knowledge of danger signs. There were also findings that reported contrary to the overall outcome which necessitates conducting further studies to enhance the generalizability of the effect of mHealth interventions on these outcomes.
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Affiliation(s)
- Reta Tsegaye Gayesa
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong S.A.R, China.
- Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Fei Wan Ngai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong S.A.R, China
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong S.A.R, China
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17
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Riera-Tur L, Antúnez-Estudillo E, Montesinos-González JM, Martín-Mateos AJ, Lechuga-Sancho AM. Test-retest of the Subjective Visual Vertical Test performed using a mobile application with the smartphone anchored to a turntable. Eur Arch Otorhinolaryngol 2023; 280:613-621. [PMID: 35838781 DOI: 10.1007/s00405-022-07512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/14/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The alterations of the Subjective visual vertical test are related to vestibular pathology. Our previously validated method to distinguish between healthy and pathological individuals measures the deviation from the Subjective visual vertical using a mobile application installed on a smartphone fixed to a turntable anchored to the wall. The aim of this study was evaluating the intra-observer reliability of our method in individuals with or without vestibular pathology. METHODS Participants were recruited consecutively. In each individual two measurements with an interval of 2 h were made. Both tests were performed by the same examiner. A total of 91 patients were included in this study, of which 25 were healthy and 66 diseased. Intra-observer reliability was evaluated using the intraclass correlation coefficient (ICC). To assess the clinical accuracy of the measurement, we calculated the standard error of the measurement (SEM) and the minimum detectable change (MDC) with a 95% confidence interval. RESULTS Intra-observer reliability was excellent with an ICC 0.95 (0.92-0.97) in the whole sample, in healthy patients 0.91 (0.80-0.96) and in pathological patients 0.92 (0.87-0.95). The SEM was calculated to be 0.59 for the whole sample (0.26 in the "healthy" group, and 0.67 in the pathological group). Likewise, the sample's MDC was 1.16, being 0.52 and 1.36 for the healthy and the pathological group, respectively. CONCLUSIONS Considering the results, our method presents an excellent intraobserver reliability. Furthermore, changes in deviation greater than 0.52 in healthy individuals and 1.36 in pathological individuals can be considered a real change in deviation.
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Affiliation(s)
- Laura Riera-Tur
- Department of Otolaryngology, Puerta del Mar University Hospital, Av. Ana de Viya 21, 11009, Cádiz, Spain. .,Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain. .,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain.
| | - Encarnación Antúnez-Estudillo
- Department of Otolaryngology, Puerta del Mar University Hospital, Av. Ana de Viya 21, 11009, Cádiz, Spain.,Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
| | - Juan M Montesinos-González
- Department of Otolaryngology, Puerta del Mar University Hospital, Av. Ana de Viya 21, 11009, Cádiz, Spain.,Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
| | - Antonio J Martín-Mateos
- Department of Otolaryngology, Puerta del Mar University Hospital, Av. Ana de Viya 21, 11009, Cádiz, Spain.,Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
| | - Alfonso M Lechuga-Sancho
- Department of Otolaryngology, Puerta del Mar University Hospital, Av. Ana de Viya 21, 11009, Cádiz, Spain.,Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
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18
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Bruce CR, Kamencik-Wright A, Zuniga-Georgy N, Vinh TM, Shah H, Shallcross J, Giammattei C, O’Rourke C, Smith M, Bruchhaus L, Bowens Y, Goode K, Arabie LA, Sauceda K, Pacha M, Martinez S, Chisum J, Benjamin Saldaña R, Nicholas Desai S, Awar M, Vernon TR. Design and Integration of a Texting Tool to Keep Patients' Family Members Updated During Hospitalization: Clinicians' Perspectives. J Patient Exp 2023; 10:23743735231160423. [PMID: 36968007 PMCID: PMC10037726 DOI: 10.1177/23743735231160423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
An important gap in the literature is how clinicians feel about patient-centered technologies and how clinicians experience patient-centered technologies in their workflows. Our goal was to identify clinician users' perspectives on facilitators (pros) and barriers (cons) to using 1 digital texting innovation to promote family centered care during patients' hospitalizations. This qualitative study was conducted at a tertiary care center in Houston, consisting of 7 hospitals (1 academic hospital and 6 community hospitals), involving analyzation of 3 focus groups of 18 physicians, 5 advanced practice providers, and 10 nurse directors and managers, as well as a content analysis of 156 real-time alerts signaling family dissatisfaction on the nursing unit/floor. Thematic analysis methods were used. We selected these participants by attending their regularly scheduled service-line meetings. Clinician feedback from focus groups resulted in 3 themes as facilitators: (a) texting platforms must be integrated within the electronic medical record; (b) texting reduces outgoing phone calls; (c) texting reduces incoming family phone calls. Clinician feedback resulted in 3 themes as barriers: (a) best practice alerts can be disruptive; (b) real-time alerts can create hopelessness; and (c) scale-up is challenging. The analyzation of facilitators (pros) and barriers (cons) pertains only to the clinician's feedback. We also analyzed real-time alerts signaling family dissatisfaction (defined as "service recovery escalation" throughout this manuscript). The most common selection for the source of family dissatisfaction, as reflected through the real-time alerts was, "I haven't heard from physicians enough," appearing in 52 out of 156 alerts (33%). The second most common selection for the source of dissatisfaction was "perceived inconsistent or incomplete information provided by team members," which was selected in 48 cases (31%). Our findings indicate that clinicians value inpatient texting, not only for its ability to quickly relay updates to multiple family members with 1 click, but also because, when used intentionally and meaningfully, texting decreases family phone calls.
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Affiliation(s)
- Courtenay R Bruce
- System Patient Experience, Houston Methodist
Hospital System, Houston, TX, USA
- Courtenay R Bruce, JD, MA, System Patient
Experience, Houston Methodist System, Institute of Academic Medicine, Texas
A&M Health Science Center, College of Medicine, 6565 Fannin Street, Mail
Code B164 A/B, Houston, TX 77030, USA.
| | | | | | - Thomas M Vinh
- Information Technology Division, Houston Methodist
Hospital System, Houston, TX, USA
| | - Hema Shah
- Information Technology Division, Houston Methodist
Hospital System, Houston, TX, USA
| | | | | | | | - Mariana Smith
- Service Quality and Guest Relations;
Houston
Methodist Sugar Land Hospital, Sugar Land,
TX, USA
| | - Lindsey Bruchhaus
- Service Quality and Guest Relations;
Houston
Methodist Sugar Land Hospital, Sugar Land,
TX, USA
| | - Yashica Bowens
- Service Quality and Guest Relations;
Houston
Methodist Hospital, Houston, TX, USA
| | - Kimberley Goode
- Service Quality and Guest Relations;
Houston
Methodist Hospital, Houston, TX, USA
| | - Lee Ann Arabie
- Service Quality and Guest Relations,
Houston
Methodist Clear Lake Hospital, Nassau Bay,
TX, USA
| | - Katherine Sauceda
- Service Quality and Guest Relations;
Houston
Methodist Sugar Land Hospital, Sugar Land,
TX, USA
| | - Majeedah Pacha
- Service Quality and Guest Relations;
Houston
Methodist Sugar Land Hospital, Sugar Land,
TX, USA
| | - Sandra Martinez
- Service Quality and Guest Relations,
Houston
Methodist Willowbrook Hospital, Houston,
TX, USA
| | - James Chisum
- Service Quality and Guest Relations,
Houston
Methodist Baytown Hospital, Baytown, TX,
USA
| | - R Benjamin Saldaña
- Department of Emergency Medicine, Houston Methodist
Hospital, Houston, TX, USA
| | - S Nicholas Desai
- Department of Surgery, Houston Methodist
Sugar Land Hospital, Sugar Land, TX, USA
| | - Melina Awar
- Department of Medicine, Houston Methodist
Hospital, Houston, TX, USA
| | - Thomas R Vernon
- System Patient Experience, Houston Methodist
Hospital System, Houston, TX, USA
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19
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Saeidnia HR, Kozak M, Ausloos M, Herteliu C, Mohammadzadeh Z, Ghorbi A, Karajizadeh M, Hassanzadeh M. Development of a Mobile App for Self-Care Against COVID-19 Using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) Model: Methodological Study. JMIR Form Res 2022; 6:e39718. [PMID: 36054441 PMCID: PMC9472509 DOI: 10.2196/39718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/13/2022] [Accepted: 08/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background
Mobile apps have been shown to play an important role in the management, care, and prevention of infectious diseases. Thus, skills for self-care—one of the most effective ways to prevent illness—can be improved through mobile health apps.
Objective
This study aimed to design, develop, and evaluate an educational mobile-based self-care app in order to help the self-prevention of COVID-19 in underdeveloped countries. We intended the app to be easy to use, quick, and inexpensive.
Methods
In 2020 and 2021, we conducted a methodological study. Using the ADDIE (analysis, design, development, implementation, and evaluation) educational model, we developed a self-care management mobile app. According to the ADDIE model, an effective training and performance support tool is built through the 5 phases that comprise its name. There were 27 participants who conducted 2 evaluations of the mobile app’s usability and impact using the mobile health app usability and self-care inventory scales. The study design included pre- and posttesting.
Results
An Android app called MyShield was developed. The results of pre- and posttests showed that on a scale from 0 to 5, MyShield scored a performance average of 4.17 in the physical health dimension and an average of 3.88 in the mental well-being dimension, thereby showing positive effects on self-care skills. MyShield scored highly on the “interface and satisfaction,” “ease of use,” and “usefulness” components.
Conclusions
MyShield facilitates learning self-care skills at home, even during quarantine, increasing acquisition of information. Given its low development cost and the ADDIE educational design on which it is based, the app can be helpful in underdeveloped countries. Thus, low-income countries—often lacking other tools—can use the app as an effective tool for fighting COVID-19, if it becomes a standard mobile app recommended by the government.
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Affiliation(s)
- Hamid Reza Saeidnia
- Department of Knowledge and Information Science, Tarbiat Modares University, Tehran, Iran
| | - Marcin Kozak
- Department of Media, Journalism and Social Communication, University of Information Technology and Management in Rzeszow, Rzeszow, Poland
| | - Marcel Ausloos
- School of Business, University of Leicester, Brookfield, Leicester, United Kingdom
| | - Claudiu Herteliu
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
| | - Zahra Mohammadzadeh
- Department of Health Information Management and Technology, School of Allied Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali Ghorbi
- Department of Knowledge and Information Science, University of Tehran, Tehran, Iran
| | - Mehrdad Karajizadeh
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Mohammad Hassanzadeh
- Department of Knowledge and Information Science, Tarbiat Modares University, Tehran, Iran
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20
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Escobar MF, Echavarria MP, Vasquez H, Nasner D, Ramos I, Hincapié MA, Pabon S, Kusanovic JP, Martínez-Ruíz DM, Carvajal JA. Experience of a telehealth and education program with maternal and perinatal outcomes in a low-resource region in Colombia. BMC Pregnancy Childbirth 2022; 22:604. [PMID: 35906534 PMCID: PMC9336139 DOI: 10.1186/s12884-022-04935-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Maternal morbidity and mortality rates associated with perinatal care remain a significant public health concern. Rural populations from low and middle-income countries have multiple barriers to access that contribute to a lack of adherence to prenatal care, and high rates of maternal mortality and morbidity. An intervention model based on telehealth and education was implemented between a tertiary high complex care hospital and a second-level hospital from a limited source region. OBJECTIVES We sought to identify an association in maternal and perinatal care quality indicators after implementing a model based on telehealth and education for patients with obstetric emergencies between two hospitals in a southwestern region of Colombia. METHODS We conducted an ecological study between 2017 and 2019 to compare before and after obstetric emergency care through telemedicine from a secondary care center (Hospital Francisco de Paula Santander-HFPS) to the referral center (Fundación Valle del Lili-FVL). The intervention included verification visits to determine the installed capacity of care, a concerted improvement plan, and on-site educational training modules in obstetric and perinatal care. RESULTS There were 102 and 148 patients treated before and after telemedicine implementation respectively. Clinical indicators after model implementation showed a reduction in perinatal mortality of 29%. In addition, a reduction in the need for transfusion of blood products due to postpartum hemorrhage was observed as well as the rate of eclampsia. CONCLUSIONS Implementing a model based on telehealth and education between secondary and tertiary care centers allowed the strengthening of the security of care in obstetric emergencies and had a positive effect on perinatal mortality.
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Affiliation(s)
- María Fernanda Escobar
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia.
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia.
- Department of Telemedicine, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia.
| | - María Paula Echavarria
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Hilda Vasquez
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Department of Telemedicine, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
| | - Daniela Nasner
- Department of Telemedicine, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
| | - Isabella Ramos
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - María Antonia Hincapié
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Stephanie Pabon
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
| | - Juan Pedro Kusanovic
- Department of Obstetrics and Gynecology, Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Hospital Sótero del Río, Santiago, Chile
- Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Javier Andrés Carvajal
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
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21
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Tian XF, Wu RZ. Determining Factors Affecting the Users' Participation of Online Health Communities: An Integrated Framework of Social Capital and Social Support. Front Psychol 2022; 13:823523. [PMID: 35774944 PMCID: PMC9239732 DOI: 10.3389/fpsyg.2022.823523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
As the national awareness of health keeps deepening, online health communities (OHCs) have achieved rapid development. Users' participation is critically important to the sustainable development of OHCs. Nevertheless, users usually lack the motive for participation. Based on the social capital theory, this research examines factors influencing users' participation in OHCs. The purpose of this research is to find out decisive factors that influence users' participation in OHCs, enrich the understanding of users' participation in OHCs, and help OHCs address the issue of sustainable development. The research model was empirically tested using 1277 responses from an online survey conducted in China. Data was analyzed using the structural equation modeling (SEM). We found informational support and emotional support to have significant direct effects over the structural capital, relational capital and cognitive capital of OHCs. Meanwhile, it is observed that relational capital and cognitive capital degree have a significant influence on knowledge acquisition and knowledge contribution of OHCs. For researchers this study provides a basis for further refinement of individual models of users' participation. For practitioners, understanding the social capital is crucial to users' knowledge acquisition and knowledge contribution that achieve high participation in OHCs.
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Affiliation(s)
- Xiu-Fu Tian
- College of Business, Jiaxing University, Jiaxing, China
| | - Run-Ze Wu
- College of Economics, Jiaxing University, Jiaxing, China
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22
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Wu W, Hu L, Chen Y, Cao F, Ding S, Wu T, Xu J. Effectiveness of an online application of the health action process approach (HAPA) theory on oral hygiene intervention in young adults with fixed orthodontic appliances: a randomized controlled trial. BMC Oral Health 2022; 22:192. [PMID: 35590291 PMCID: PMC9118762 DOI: 10.1186/s12903-022-02219-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background This randomized controlled trial aimed to evaluate the effectiveness of an online application based on HAPA theory on oral hygiene promotion in young adults with fixed orthodontic appliances. Methods A WeChat mini-program (called “Clean Teeth”) based on HAPA theory was designed beforehand to improve oral-health behaviors and oral hygiene, and 44 participants aged 17–29 with fixed orthodontic appliances were recruited. Participants of the experimental group (n = 22) received the “Clean Teeth” mini-program, in addition to care as usual, and the control group (n = 22) only received routine oral health education. Data were collected during three orthodontic check-ups: baseline (T0), 6 weeks of follow-up (T1), and 12 weeks of follow-up (T2). All participants completed questionnaires assessing oral health behaviors and the psychosocial factors of the HAPA model and accepted the clinical examinations involving the dental plaque index and the gingival bleeding index. Results After a 12-week intervention, the plaque index and gingival bleeding index in the experimental group were significantly lower than that in the control group. The psycho-social parameters of social effects, expected outcomes, and action control were improved significantly after treatment, among which social effects increased significantly only in the experimental group but not in the control group. Conclusions The HAPA theory-based mini-program had positive effects on oral-health behavior promotion and oral hygiene among young adults with fixed orthodontic appliances. Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry, with the number CTR2200056731, dated 12/02/2022. http://www.chictr.org.cn/index.aspx. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02219-w.
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Affiliation(s)
- Weizi Wu
- Department of Stomatology, Anhui Medical University, Hefei, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Anhui Medical University Hefei, 69 Meishan Road, Hefei, Anhui Province, China
| | - Lulu Hu
- Department of Stomatology, Anhui Medical University, Hefei, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Anhui Medical University Hefei, 69 Meishan Road, Hefei, Anhui Province, China
| | - Yihan Chen
- Department of Stomatology, Anhui Medical University, Hefei, China
| | - Feiran Cao
- Department of Stomatology, Anhui Medical University, Hefei, China
| | - Sixie Ding
- Department of Stomatology, Anhui Medical University, Hefei, China
| | - Tingting Wu
- Department of Stomatology, Anhui Medical University, Hefei, China. .,Department of Orthodontics, Affiliated Hospital of Stomatology, Anhui Medical University Hefei, 69 Meishan Road, Hefei, Anhui Province, China.
| | - Jianguang Xu
- Department of Stomatology, Anhui Medical University, Hefei, China. .,Department of Orthodontics, Affiliated Hospital of Stomatology, Anhui Medical University Hefei, 69 Meishan Road, Hefei, Anhui Province, China.
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23
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Gavine A, Marshall J, Buchanan P, Cameron J, Leger A, Ross S, Murad A, McFadden A. Remote provision of breastfeeding support and education: Systematic review and meta-analysis. MATERNAL & CHILD NUTRITION 2022; 18:e13296. [PMID: 34964542 PMCID: PMC8932718 DOI: 10.1111/mcn.13296] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/23/2022]
Abstract
The Covid-19 pandemic has led to a substantial increase in remotely provided maternity care services, including breastfeeding support. It is, therefore, important to understand whether breastfeeding support provided remotely is an effective method of support. To determine if breastfeeding support provided remotely is an effective method of support. A systematic review and meta-analysis were conducted. Twenty-nine studies were included in the review and 26 contributed data to the meta-analysis. Remotely provided breastfeeding support significantly reduced the risk of women stopping exclusive breastfeeding at 3 months by 25% (risk ratio [RR]: 0.75, 95% confidence interval [CI]: 0.63, 0.90). There was no significant difference in the number of women stopping any breastfeeding at 4-8 weeks (RR: 1.10, 95% CI: 0.74, 1.64), 3 months (RR: 0.89, 95% CI: 0.71, 1.11), or 6 months (RR: 0.91, 95% CI: 0.81, 1.03) or the number of women stopping exclusive breastfeeding at 4-8 weeks (RR: 0.86, 95% CI: 0.70, 1.07) or 6 months (RR: 0.93, 95% CI: 0.85, 1.0). There was substantial heterogeneity of interventions in terms of mode of delivery, intensity, and providers. This demonstrates that remote interventions can be effective for improving exclusive breastfeeding at 3 months but the certainty of the evidence is low. Improvements in exclusive breastfeeding at 4-8 weeks and 6 months were only found when studies at high risk of bias were excluded. They are also less likely to be effective for improving any breastfeeding. Remote provision of breastfeeding support and education could be provided when it is not possible to provide face-to-face care.
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Affiliation(s)
- Anna Gavine
- School of Health SciencesUniversity of DundeeDundeeScotlandUK
| | - Joyce Marshall
- Department of Nursing and MidwiferyUniversity of HuddersfieldHuddersfieldUK
| | | | - Joan Cameron
- School of Health SciencesUniversity of DundeeDundeeScotlandUK
| | | | - Sam Ross
- School of Medicine, Dentistry and NursingUniversity of Glasgow and NHS Greater Glasgow and ClydeGlasgowScotlandUK
| | - Amal Murad
- Maternity and Childhood Nursing Department, College of NursingTaibah UniversityMedinaSaudi Arabia
| | - Alison McFadden
- School of Health SciencesUniversity of DundeeDundeeScotlandUK
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24
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Jose R, Subramanian S, Augustine P, Rengaswamy S, Nujum ZT, Gopal BK, Saroji V, Samadasi R, John S, Narendran M, Lal A, Pillai R. Design and Process of Implementation Mobile Application Based Modular Training on Early Detection of Cancers (M-OncoEd) for Primary Care Physicians in India. Asian Pac J Cancer Prev 2022; 23:937-946. [PMID: 35345366 PMCID: PMC9360960 DOI: 10.31557/apjcp.2022.23.3.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Early detection of curable cancers is a cost-effective way to address the cancer care burden of low- and middle-income countries and active engagement of primary care physicians using mobile technology can have a significant impact on cancer outcomes in a short time. AIMS To describe the process of mHealth study; Oncology Education and Training for Providers using Mobile Phones which developed a mobile application (M-OncoEd) to educate physicians on approaches to early detection of curable cancers. It also aims to describe how the insight gained through qualitative research by the researchers was used in the design and implementation of the project. METHODOLOGY Qualitative research methods were used in all the phases of the study. Phenomenology was used in the formative phase with three expert meetings, two Focus Group Discussion (FGD) and five In-depth Interviews (IDI), and during the implementation stage with two FGDs, three IDI, and five informal discussions. OBSERVATIONS The majority of curable cancers are detected at a late stage and poorly managed in India, and active engagement of primary care physicians can have a significant impact on cancer outcomes. There is a lack of knowledge and skills for early detection of cancers among consultants and physicians and this can be attributed to the training gap. M-OncoEd was a need-based well designed engaging learning platform to educate primary care physicians on Breast, Cervical, and Oral Cancer early detection. It was found to be very useful by the beneficiaries and made them more confident for early detection of cancers from the community. CONCLUSIONS This research study could design a need-based, cost-effective mobile-based learning tool for primary care physicians using the expertise and experience of the experts in cancer care using qualitative methods.
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Affiliation(s)
- Regi Jose
- Snehita Women’s Health Foundation, Trivandrum, Kerala, India.
- Department of Community Medicine Sree Gokulam Medical College &RF, Kerala, India.
| | | | - Paul Augustine
- Department of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala, India.
| | - Sankaranarayanan Rengaswamy
- Former Special Advisor on Cancer Control and Head of the Section of Early Detection & Prevention (EDP) and Former Head of the Screening Group (SCR), International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France.
| | - Zinia T Nujum
- Department of Community Medicine, Government Medical College, Paripally, Kollam, Kerala, India.
| | - Bipin K Gopal
- Directorate of Health Services, Government of Kerala, India.
| | - Veena Saroji
- Directorate of Health Services, Government of Kerala, India.
| | - Resmi Samadasi
- Department of Community Medicine Sree Gokulam Medical College &RF, Kerala, India.
| | - Susanna John
- Department of Community Medicine Sree Gokulam Medical College &RF, Kerala, India.
| | - Meghana Narendran
- Department of Community Medicine Sree Gokulam Medical College &RF, Kerala, India.
| | - Anoop Lal
- Director, Zovoz Technologies, India.
| | - Rajmohanan Pillai
- School of Public Health, Kerala University of Health Sciences, India.
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25
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The New Role of Telehealth in Contemporary Medicine. Curr Cardiol Rep 2022; 24:271-275. [PMID: 35218502 PMCID: PMC8881748 DOI: 10.1007/s11886-022-01640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/25/2022]
Abstract
Purpose of Review Understand the current uses for telehealth as well as future directions as it relates to the COVID-19 pandemic and cardiovascular medicine. Recent Findings Telehealth interventions in various forms have proven to be efficacious in the management of obesity, hypertension, glycemic control in diabetes, hyperlipidemia, medication adherence, and ICU length of stay and mortality. The use and study of such interventions have been greatly expanded during the pandemic partly due to the expanded coverage by payers. However, heterogenous interventions and a relative lack of cost analyses are barriers to more widespread adoption. Summary Telehealth has proven efficacy for modifying risk factors for cardiovascular disease. To date, this has not been shown to translate to a reduction in hard cardiovascular endpoints such as mortality. With ongoing research and expanded funding, the role of telehealth is likely to evolve as the COVID pandemic continues.
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26
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Sánchez-Guarnido AJ, Gonzalez-Vilchez M, de Haro R, Fernández-Guillen M, Graell-Gabriel M, Lucena-Jurado V. Nursing and Telemental Health during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:healthcare10020273. [PMID: 35206886 PMCID: PMC8871975 DOI: 10.3390/healthcare10020273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 12/02/2022] Open
Abstract
Measures taken to reduce the rate of contagion during the first months of the COVID-19 pandemic in Spain led to the interruption of nursing interventions for many patients with serious mental illness (SMI), while others stayed in touch with their nurses telematically. However, published research into the impact of mental telehealth and the outcome of the changes that took place in the pandemic is very limited. Aim: The aim of this study was to analyze the changes in nursing interventions received by severe mental illness (SMI) patients and to test whether telemental health (TH) has been effective in reducing relapses during the COVID-19 pandemic. Materials and methods: Information was gathered retrospectively from about 270 patients under treatment at 15 mental health day hospitals (MHDHs) in Spain during the year 2020. Results: Face-to-face nursing interventions were found to have decreased and TH interventions were found to have increased in the first few months of the pandemic. In the following months, TH interventions—especially those conducted by video call—helped reduce the number of relapses. Conclusions: TH helps provide news forms of effective telematic nursing interventions that reduce the number of relapses and admissions in patients with serious mental health disorders.
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Affiliation(s)
| | | | - Rosario de Haro
- Hospital Santa Ana, 18600 Motril, Spain; (A.J.S.-G.); (M.G.-V.); (R.d.H.); (M.F.-G.)
| | | | | | - Valentina Lucena-Jurado
- Facultad de Ciencias de la Educación, Universidad de Córdoba, 14071 Córdoba, Spain
- Correspondence:
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Escobar MF, Echavarria MP, Gallego JC, Riascos N, Vasquez H, Nasner D, Pabon S, Castro ZA, Cardona DA, Castro AM, Ramos I, Hincapie MA, Kusanovic JP, Martínez-Ruíz DM, Carvajal JA. Effect of a model based on education and teleassistance for the management of obstetric emergencies in 10 rural populations from Colombia. Digit Health 2022; 8:20552076221129077. [PMID: 36204705 PMCID: PMC9530555 DOI: 10.1177/20552076221129077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Pregnant women and health providers in rural areas of low-income and middle-income countries face multiple problems concerning high-quality obstetric care. This study was performed to identify changes in maternal and perinatal indicators after implementing a model based on education and telecare between a high-complexity hospital in 10 low-complexity hospitals in a southwestern region of Colombia. Methods A quasiexperimental study with a historic control group and without a pretest was conducted between 2017 and 2019 to make comparisons before and after obstetric emergency care through the use of teleassistance from 10 primary care centers to the referral center (Fundación Valle del Lili, FVL). Results A total of 470 patients were treated before teleassistance implementation and 154 patients were treated after teleassistance implementation. After program implementation, the maternal clinical indicators showed a 65% reduction in the number of obstetric patients who were referred with obstetric emergencies. The severity of maternal disease that was measured at the time of admission to level IV through the Modified Early Obstetric Warning System score was observed to decrease. Conclusion The implementation of a model based on education and teleassistance between low-complexity hospitals and tertiary care centers generated changes in indicators that reflect greater access to rural areas, lower morbidity at the time of admission, and a decrease in the total number of emergency events.
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Affiliation(s)
- María Fernanda Escobar
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia
- Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia
| | - María Paula Echavarria
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Juan Carlos Gallego
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Natalia Riascos
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Hilda Vasquez
- Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia
| | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali,
Colombia
| | - Stephanie Pabon
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia
| | - Zindy Alexandra Castro
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia
| | - Didier Augusto Cardona
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia
| | - Ana Milena Castro
- Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia
| | - Isabella Ramos
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - María Antonia Hincapie
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Juan Pedro Kusanovic
- Department of Obstetrics and Gynecology, Center for Research and
Innovation in Maternal-Fetal Medicine (CIMAF), Hospital Sótero del Río, Santiago,
Chile
- Division of Obstetrics and Gynecology, School of Medicine,
Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Javier Andrés Carvajal
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia
- Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia
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Morrison K, Hughes T, Doi L. Understanding the use of telehealth in the context of the Family Nurse Partnership and other early years home visiting programmes: A rapid review. Digit Health 2022; 8:20552076221123711. [PMID: 36406154 PMCID: PMC9666867 DOI: 10.1177/20552076221123711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/15/2022] [Indexed: 08/31/2023] Open
Abstract
OVERVIEW This rapid review sought to understand the use of telehealth in early parenthood programmes sharing similarities with the Family Nurse Partnership. METHODS A rapid review protocol was developed in accordance with Cochrane Rapid Reviews Methods Guidance. Medline, Cochrane Library, and CINAHL databases were searched. Inclusion criteria were developed using population, intervention, comparator, outcome, study design, and timeframe components. Two reviewers searched, screened, and extracted data. AMSTAR was used for critical appraisal. Results were synthesised narratively. RESULTS Searches yielded 18 studies out of 881 for inclusion. Findings were identified across seven domains: acceptability and accessibility; therapeutic relationships; flexibility offered by telehealth; participation and engagement; confidentiality and privacy; equipment and technical considerations; and training and support. CONCLUSION Telehealth provides unique opportunities to improve access to early years health services for young mothers. However, considerable accessibility barriers remain in the form of connectivity issues, access to appropriate technology, and the acceptability of remote healthcare delivery. This review presents a timely overview of the opportunities and challenges associated with the use of telehealth in early parenthood and family-based programmes.
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Affiliation(s)
- Kathleen Morrison
- Scottish Collaboration for Public Health Research and Policy,
School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Thomas Hughes
- Scottish Collaboration for Public Health Research and Policy,
School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Lawrence Doi
- Scottish Collaboration for Public Health Research and Policy,
School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Marwaha S, Dusendang JR, Alexeeff SE, Crowley E, Haiman M, Pham N, Tuerk MJ, Wudka D, Hartmann M, Herrinton LJ. Comanagement of Rashes by Primary Care Providers and Dermatologists: A Retrospective Study. Perm J 2021; 25. [PMID: 35348083 DOI: 10.7812/tpp/20.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a high demand for managing skin disease, and dermatologists are in short supply. OBJECTIVES To better understand how rashes and other specific skin conditions are co-managed by primary care providers (PCPs) and dermatologists, we estimated the frequency with which PCPs sought consultation with or referral to dermatology and the proportion of patients who had a follow-up dermatology office visit in the following 90 days. DESIGN AND SETTING The retrospective longitudinal study included 106,459 patients with a skin condition diagnosed by 3,830 PCPs, from January 2017 to March 2017. METHODS Comprehensive electronic medical record data with generalized linear mixed modeling accounted for patient factors including diagnosis and clustering by medical center and PCP. RESULTS PCPs escalated 9% of patients to dermatology through consultation or referral, while 5% required a follow-up dermatology office visit within 90 days. Patients with bullous, hair, or pigment conditions or psoriasis were most likely to be escalated. Clustering of escalation and follow-up visits was minimal in relation to medical center (intraclass correlation, 0.04 for both outcomes) or PCP (escalation, intraclass correlation, 0.16; follow-up visits, 0.09). DISCUSSION Improving primary care education in skin disease and, for certain skin conditions, standardizing approaches to workup, treatment, and escalation may further streamline care and reduce pressure on the dermatologist workforce. CONCLUSION PCPs managed 91% of rashes without consultation or referral to dermatology, and the frequency of patients scheduled for dermatology office visits after primary care was similar from one PCP to another.
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Affiliation(s)
| | | | | | | | | | - Ngoc Pham
- Dermatology, Kaiser Permanente, Santa Clara, CA
| | | | - Danny Wudka
- The Permanente Medical Group, Quality and Operations Support, Kaiser Permanente, Oakland, CA
| | - Michael Hartmann
- The Permanente Medical Group, Quality and Operations Support, Kaiser Permanente, Oakland, CA
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Desimone ME, Sherwood J, Soltman SC, Moran A. Telemedicine in cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100270. [PMID: 34765457 PMCID: PMC8571077 DOI: 10.1016/j.jcte.2021.100270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 02/08/2023] Open
Abstract
Cystic Fibrosis (CF) requires lifetime multidisciplinary care to manage both pulmonary and extra pulmonary manifestations. The median age of survival for people with CF is rising and the number of adults with CF is expected to increase dramatically over the coming years. People with CF have better outcomes when managed in specialty centers, however access can be limited. Telemedicine and technology-based care solutions may help to overcome barriers to availability and improve access. This review outlines the use of telehealth for CF management. Telehealth has been utilized for CF across a broad variety of indications, even prior to the COVID-19 pandemic, and in general has been well accepted by patients and providers. There are a paucity of data, however, related to health outcomes, and the healthcare utilization specific to CF and its related comorbidities. Future studies are needed to address the questions of health outcomes, cost, burdens of telehealth and barriers to implementation.
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Affiliation(s)
- Marisa E. Desimone
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Upstate Medical University 750 East Adams Street, Syracuse, NY 13210, USA
| | - Jordan Sherwood
- Division of Pediatric Endocrinology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sarah C. Soltman
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, 3270 SW Pavilion Loop, Portland, OR 97239, USA
| | - Antoinette Moran
- Division of Pediatric Endocrinology, University of Minnesota, 2512 S 7th Street, Minneapolis, MN 55454, USA
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van Hattem NE, Silven AV, Bonten TN, Chavannes NH. COVID-19's impact on the future of digital health technology in primary care. Fam Pract 2021; 38:845-847. [PMID: 34268563 PMCID: PMC8344716 DOI: 10.1093/fampra/cmab081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Nicoline E van Hattem
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anna V Silven
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Tobias N Bonten
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
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TV Interaction as a Non-Invasive Sensor for Monitoring Elderly Well-Being at Home. SENSORS 2021; 21:s21206897. [PMID: 34696111 PMCID: PMC8537784 DOI: 10.3390/s21206897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
The number of technical solutions to remotely monitoring elderly citizens and detecting hazard situations has been increasing in the last few years. These solutions have dual purposes: to provide a feeling of safety to the elderly and to inform their relatives about potential risky situations, such as falls, forgotten medication, and other unexpected deviations from daily routine. Most of these solutions are based on IoT (Internet of Things) and dedicated sensors that need to be installed at the elderly’s houses, hampering mass adoption. This justifies the search for non-invasive technical alternatives with smooth integration that relying only on existent devices, without the need for any additional installations. Therefore, this paper presents the SecurHome TV ecosystem, a technical solution based on the elderly’s interactions with their TV sets—one of the most used devices in their daily lives—acting as a non-invasive sensor enabling one to detect potential hazardous situations through an elaborated warning algorithm. Thus, this paper describes in detail the SecurHome TV ecosystem, with special emphasis on the warning algorithm, and reports on its validation process. We conclude that notwithstanding some constraints while setting the user’s pattern, either upon the cold start of the application or after an innocuous change in the user’s TV routine, the algorithm detects most hazardous situations contributing to monitor elderly well-being at home.
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Understanding How to Improve the Use of Clinical Coordination Mechanisms between Primary and Secondary Care Doctors: Clues from Catalonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063224. [PMID: 33804691 PMCID: PMC8003988 DOI: 10.3390/ijerph18063224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 01/27/2023]
Abstract
Clinical coordination between primary (PC) and secondary care (SC) is a challenge for health systems, and clinical coordination mechanisms (CCM) play an important role in the interface between care levels. It is therefore essential to understand the elements that may hinder their use. This study aims to analyze the level of use of CCM, the difficulties and factors associated with their use, and suggestions for improving clinical coordination. A cross-sectional online survey-based study using the questionnaire COORDENA-CAT was conducted with 3308 PC and SC doctors in the Catalan national health system. Descriptive bivariate analysis and logistic regression models were used. Shared Electronic Medical Records were the most frequently used CCM, especially by PC doctors, and the one that presented most difficulties in use, mostly related to technical problems. Some factors positively associated with frequent use of various CCM were: working full-time in integrated areas, or with local hospitals. Interactional and organizational factors contributed to a greater extent among SC doctors. Suggestions for improving clinical coordination were similar between care levels and related mainly to the improvement of CCM. In an era where management tools are shifting towards technology-based CCM, this study can help to design strategies to improve their effectiveness.
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Galle A, Semaan A, Huysmans E, Audet C, Asefa A, Delvaux T, Afolabi BB, El Ayadi AM, Benova L. A double-edged sword-telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers. BMJ Glob Health 2021; 6:e004575. [PMID: 33632772 PMCID: PMC7908054 DOI: 10.1136/bmjgh-2020-004575] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has led to a rapid implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences with providing telemedicine for maternal and newborn healthcare during the pandemic among healthcare professionals globally. METHODS The second round of a global online survey of maternal and newborn health professionals was conducted, disseminated in 11 languages. Data were collected between 5 July and 10 September 2020. The questionnaire included questions regarding background, preparedness and response to COVID-19, and experiences with providing telemedicine. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregated by country income level. RESULTS Responses from 1060 maternal and newborn health professionals were analysed. Telemedicine was used by 58% of health professionals and two-fifths of them reported not receiving guidelines on the provision of telemedicine. Key telemedicine practices included online birth preparedness classes, antenatal and postnatal care by video/phone, a COVID-19 helpline and online psychosocial counselling. Challenges reported lack of infrastructure and technological literacy, limited monitoring, financial and language barriers, lack of non-verbal feedback and bonding, and distrust from patients. Telemedicine was considered as an important alternative to in-person consultations. However, health providers emphasised the lower quality of care and risk of increasing the already existing inequalities in access to healthcare. CONCLUSIONS Telemedicine has been applied globally to address disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. More research regarding the effectiveness, efficacy and quality of telemedicine for maternal healthcare in different contexts is needed before considering long-term adaptations in provision of care away from face-to-face interactions. Clear guidelines for care provision and approaches to minimising socioeconomic and technological inequalities in access to care are urgently needed.
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Affiliation(s)
- Anna Galle
- ICRH, Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Elise Huysmans
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Constance Audet
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Therese Delvaux
- Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Alison Marie El Ayadi
- Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Bock NW, Wouters H, Lammers AJ, Blanker MH. Online Consultations Between General Practitioners and Psychiatrists in the Netherlands: A Qualitative Study. Front Psychiatry 2021; 12:775738. [PMID: 34803781 PMCID: PMC8600358 DOI: 10.3389/fpsyt.2021.775738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To examine the nature and scope of questions about psychiatric patient cases submitted by general practitioners (GPs) to an established online consultation platform and to determine if they could have been answered by consulting existing clinical guidelines. Methods: All anonymized psychiatric cases submitted by GPs to the online electronic Prisma platform between September 2018 and November 2019 were examined in a mixed-methods study. Descriptive statistics and qualitative thematic analysis were used, followed by axial coding to arrive at overarching themes to characterize cases. Results: Of the 136 included cases, 44.1% concerned female patients and about half concerned patients aged 31-60 years. Common psychiatric disorders were depression, attention deficit hyperactivity disorder, sleeping problems, sexual disorders, and eating disorders. The first response was usually given within 2 h (interquartile range, 0-14.3 h), with 86% answered within 24 h and 95% within 48 h. Qualitative analysis revealed four themes, namely "type of question," "cases in relation to current clinical guidelines," "case complexity" and "the doctor being pressured." Type of question comprised diagnostic, therapeutic, and referral questions. Notably, for 44.1% of questions no current clinical guidelines was present and 46.3% of cases were deemed complex in nature. GPs were willing to share their experiences of coping with being pressured by patients. Conclusion: The findings of this study support the potential for an online electronic consultation platform to facilitate feasible and useful interprofessional consultation between GPs and psychiatrists for a broad range mental illnesses and questions of varying complexity.
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Affiliation(s)
- Nynke W Bock
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, Netherlands
| | - Hans Wouters
- General Practitioners Research Institute, Groningen, Netherlands
| | - Anne J Lammers
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, Netherlands
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, Netherlands
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Serrano-Ripoll MJ, Meneses-Echavez JF, Ricci-Cabello I, Fraile-Navarro D, Fiol-deRoque MA, Pastor-Moreno G, Castro A, Ruiz-Pérez I, Zamanillo Campos R, Gonçalves-Bradley DC. Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis. J Affect Disord 2020; 277:347-357. [PMID: 32861835 PMCID: PMC7443314 DOI: 10.1016/j.jad.2020.08.034] [Citation(s) in RCA: 286] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed at examining the impact of providing healthcare during health emergencies caused by viral epidemic outbreaks on healthcare workers' (HCWs) mental health; to identify factors associated with worse impact, and; to assess the available evidence base regarding interventions to reduce such impact. METHOD Rapid systematic review. We searched MEDLINE, Embase, and PsycINFO (inception to August 2020). We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems, and used GRADE to ascertain the certainty of evidence. RESULTS We included 117 studies. The pooled prevalence was higher for acute stress disorder (40% (95%CI 39 to 41%)), followed by anxiety (30%, (30 to 31%)), burnout (28% (26 to 31%)), depression (24% (24 to 25%)), and post-traumatic stress disorder (13% (13 to 14%)). We identified factors associated with the likelihood of developing those problems, including sociodemographic (younger age and female gender), social (lack of social support, stigmatization), and occupational (working in a high-risk environment, specific occupational roles, and lower levels of specialised training and job experience) factors. Four studies reported interventions for frontline HCW: two educational interventions increased confidence in pandemic self-efficacy and in interpersonal problems solving (very low certainty), whereas one multifaceted intervention improved anxiety, depression, and sleep quality (very low certainty). LIMITATIONS We only searched three databases, and the initial screening was undertaken by a single reviewer. CONCLUSION Given the very limited evidence regarding the impact of interventions to tackle mental health problems in HCWs, the risk factors identified represent important targets for future interventions.
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Affiliation(s)
- Maria J Serrano-Ripoll
- Health Research Institute of the Balearic Islands (IdISBa). Carretera de Valldemossa, 79 Hospital Universitario Son Espases. Edificio S. 07120 Palma, Illes Balears, Spain; Balearic Islands Health Services, Primary Care Research Unit of Mallorca, Palma, Illes Balears, Spain; University of Balearic Islands (UIB), Department of Psychology, Carretera de Valldemossa, km 7.5. 07122, Palma, Illes Balears, Spain
| | - Jose F Meneses-Echavez
- Division for Health Services, Norwegian Institute of Public Health. Oslo, Norway; Facultad de Cultura Física, Deporte y Recreación. Universidad Santo Tomás. Bogotá, Colombia
| | - Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa). Carretera de Valldemossa, 79 Hospital Universitario Son Espases. Edificio S. 07120 Palma, Illes Balears, Spain; Balearic Islands Health Services, Primary Care Research Unit of Mallorca, Palma, Illes Balears, Spain; Centro de Investigación Biomédica en Red (CIBERESP). Avda. Monforte de Lemos, 3-5. Pabellón 11. 28029 Madrid, Spain.
| | - David Fraile-Navarro
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Maria A Fiol-deRoque
- Health Research Institute of the Balearic Islands (IdISBa). Carretera de Valldemossa, 79 Hospital Universitario Son Espases. Edificio S. 07120 Palma, Illes Balears, Spain; Balearic Islands Health Services, Primary Care Research Unit of Mallorca, Palma, Illes Balears, Spain
| | - Guadalupe Pastor-Moreno
- Centro de Investigación Biomédica en Red (CIBERESP). Avda. Monforte de Lemos, 3-5. Pabellón 11. 28029 Madrid, Spain; Escuela Andaluza de Salud Pública. Campus Universitario de Cartuja. Cuesta del Observatorio, 4. 18080. Granada, Spain; Instituto de Investigación Biosanitaria (Ibs. Granada). Avda. de Madrid, 15. 18012. Granada, Spain
| | - Adoración Castro
- Health Research Institute of the Balearic Islands (IdISBa). Carretera de Valldemossa, 79 Hospital Universitario Son Espases. Edificio S. 07120 Palma, Illes Balears, Spain; Research Institute of Health Sciences (IUNICS), University of Balearic Islands. Carretera de Valldemossa, km 7.5. Edificio Científico-Técnico. 07122 Palma, Illes Balears, Spain
| | - Isabel Ruiz-Pérez
- University of Balearic Islands (UIB), Department of Psychology, Carretera de Valldemossa, km 7.5. 07122, Palma, Illes Balears, Spain; Centro de Investigación Biomédica en Red (CIBERESP). Avda. Monforte de Lemos, 3-5. Pabellón 11. 28029 Madrid, Spain; Escuela Andaluza de Salud Pública. Campus Universitario de Cartuja. Cuesta del Observatorio, 4. 18080. Granada, Spain; Instituto de Investigación Biosanitaria (Ibs. Granada). Avda. de Madrid, 15. 18012. Granada, Spain
| | - Rocío Zamanillo Campos
- Health Research Institute of the Balearic Islands (IdISBa). Carretera de Valldemossa, 79 Hospital Universitario Son Espases. Edificio S. 07120 Palma, Illes Balears, Spain; Balearic Islands Health Services, Primary Care Research Unit of Mallorca, Palma, Illes Balears, Spain; Valencian International University (VIU), Department of Health, 46002, Valencia, Comunitat Valenciana, Spain
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Gonçalves-Bradley DC, J Maria AR, Ricci-Cabello I, Villanueva G, Fønhus MS, Glenton C, Lewin S, Henschke N, Buckley BS, Mehl GL, Tamrat T, Shepperd S. Mobile technologies to support healthcare provider to healthcare provider communication and management of care. Cochrane Database Syst Rev 2020; 8:CD012927. [PMID: 32813281 PMCID: PMC7437392 DOI: 10.1002/14651858.cd012927.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The widespread use of mobile technologies can potentially expand the use of telemedicine approaches to facilitate communication between healthcare providers, this might increase access to specialist advice and improve patient health outcomes. OBJECTIVES To assess the effects of mobile technologies versus usual care for supporting communication and consultations between healthcare providers on healthcare providers' performance, acceptability and satisfaction, healthcare use, patient health outcomes, acceptability and satisfaction, costs, and technical difficulties. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and three other databases from 1 January 2000 to 22 July 2019. We searched clinical trials registries, checked references of relevant systematic reviews and included studies, and contacted topic experts. SELECTION CRITERIA Randomised trials comparing mobile technologies to support healthcare provider to healthcare provider communication and consultations compared with usual care. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 19 trials (5766 participants when reported), most were conducted in high-income countries. The most frequently used mobile technology was a mobile phone, often accompanied by training if it was used to transfer digital images. Trials recruited participants with different conditions, and interventions varied in delivery, components, and frequency of contact. We judged most trials to have high risk of performance bias, and approximately half had a high risk of detection, attrition, and reporting biases. Two studies reported data on technical problems, reporting few difficulties. Mobile technologies used by primary care providers to consult with hospital specialists We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: - probably make little or no difference to primary care providers following guidelines for people with chronic kidney disease (CKD; 1 trial, 47 general practices, 3004 participants); - probably reduce the time between presentation and management of individuals with skin conditions, people with symptoms requiring an ultrasound, or being referred for an appointment with a specialist after attending primary care (4 trials, 656 participants); - may reduce referrals and clinic visits among people with some skin conditions, and increase the likelihood of receiving retinopathy screening among people with diabetes, or an ultrasound in those referred with symptoms (9 trials, 4810 participants when reported); - probably make little or no difference to patient-reported quality of life and health-related quality of life (2 trials, 622 participants) or to clinician-assessed clinical recovery (2 trials, 769 participants) among individuals with skin conditions; - may make little or no difference to healthcare provider (2 trials, 378 participants) or participant acceptability and satisfaction (4 trials, 972 participants) when primary care providers consult with dermatologists; - may make little or no difference for total or expected costs per participant for adults with some skin conditions or CKD (6 trials, 5423 participants). Mobile technologies used by emergency physicians to consult with hospital specialists about people attending the emergency department We assessed the certainty of evidence for this group of trials as moderate. Mobile technologies: - probably slightly reduce the consultation time between emergency physicians and hospital specialists (median difference -12 minutes, 95% CI -19 to -7; 1 trial, 345 participants); - probably reduce participants' length of stay in the emergency department by a few minutes (median difference -30 minutes, 95% CI -37 to -25; 1 trial, 345 participants). We did not identify trials that reported on providers' adherence, participants' health status and well-being, healthcare provider and participant acceptability and satisfaction, or costs. Mobile technologies used by community health workers or home-care workers to consult with clinic staff We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: - probably make little or no difference in the number of outpatient clinic and community nurse consultations for participants with diabetes or older individuals treated with home enteral nutrition (2 trials, 370 participants) or hospitalisation of older individuals treated with home enteral nutrition (1 trial, 188 participants); - may lead to little or no difference in mortality among people living with HIV (RR 0.82, 95% CI 0.55 to 1.22) or diabetes (RR 0.94, 95% CI 0.28 to 3.12) (2 trials, 1152 participants); - may make little or no difference to participants' disease activity or health-related quality of life in participants with rheumatoid arthritis (1 trial, 85 participants); - probably make little or no difference for participant acceptability and satisfaction for participants with diabetes and participants with rheumatoid arthritis (2 trials, 178 participants). We did not identify any trials that reported on providers' adherence, time between presentation and management, healthcare provider acceptability and satisfaction, or costs. AUTHORS' CONCLUSIONS Our confidence in the effect estimates is limited. Interventions including a mobile technology component to support healthcare provider to healthcare provider communication and management of care may reduce the time between presentation and management of the health condition when primary care providers or emergency physicians use them to consult with specialists, and may increase the likelihood of receiving a clinical examination among participants with diabetes and those who required an ultrasound. They may decrease the number of people attending primary care who are referred to secondary or tertiary care in some conditions, such as some skin conditions and CKD. There was little evidence of effects on participants' health status and well-being, satisfaction, or costs.
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Affiliation(s)
| | - Ana Rita J Maria
- Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | | | | | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Brian S Buckley
- Department of Surgery, University of the Philippines, Manila, Philippines
| | - Garrett L Mehl
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Tigest Tamrat
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Odendaal WA, Anstey Watkins J, Leon N, Goudge J, Griffiths F, Tomlinson M, Daniels K. Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 3:CD011942. [PMID: 32216074 PMCID: PMC7098082 DOI: 10.1002/14651858.cd011942.pub2] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mobile health (mHealth), refers to healthcare practices supported by mobile devices, such as mobile phones and tablets. Within primary care, health workers often use mobile devices to register clients, track their health, and make decisions about care, as well as to communicate with clients and other health workers. An understanding of how health workers relate to, and experience mHealth, can help in its implementation. OBJECTIVES To synthesise qualitative research evidence on health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services, and to develop hypotheses about why some technologies are more effective than others. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, Science Citation Index and Social Sciences Citation Index in January 2018. We searched Global Health in December 2015. We screened the reference lists of included studies and key references and searched seven sources for grey literature (16 February to 5 March 2018). We re-ran the search strategies in February 2020. We screened these records and any studies that we identified as potentially relevant are awaiting classification. SELECTION CRITERIA We included studies that used qualitative data collection and analysis methods. We included studies of mHealth programmes that were part of primary healthcare services. These services could be implemented in public or private primary healthcare facilities, community and workplace, or the homes of clients. We included all categories of health workers, as well as those persons who supported the delivery and management of the mHealth programmes. We excluded participants identified as technical staff who developed and maintained the mHealth technology, without otherwise being involved in the programme delivery. We included studies conducted in any country. DATA COLLECTION AND ANALYSIS We assessed abstracts, titles and full-text papers according to the inclusion criteria. We found 53 studies that met the inclusion criteria and sampled 43 of these for our analysis. For the 43 sampled studies, we extracted information, such as country, health worker category, and the mHealth technology. We used a thematic analysis process. We used GRADE-CERQual to assess our confidence in the findings. MAIN RESULTS Most of the 43 included sample studies were from low- or middle-income countries. In many of the studies, the mobile devices had decision support software loaded onto them, which showed the steps the health workers had to follow when they provided health care. Other uses included in-person and/or text message communication, and recording clients' health information. Almost half of the studies looked at health workers' use of mobile devices for mother, child, and newborn health. We have moderate or high confidence in the following findings. mHealth changed how health workers worked with each other: health workers appreciated being more connected to colleagues, and thought that this improved co-ordination and quality of care. However, some described problems when senior colleagues did not respond or responded in anger. Some preferred face-to-face connection with colleagues. Some believed that mHealth improved their reporting, while others compared it to "big brother watching". mHealth changed how health workers delivered care: health workers appreciated how mHealth let them take on new tasks, work flexibly, and reach clients in difficult-to-reach areas. They appreciated mHealth when it improved feedback, speed and workflow, but not when it was slow or time consuming. Some health workers found decision support software useful; others thought it threatened their clinical skills. Most health workers saw mHealth as better than paper, but some preferred paper. Some health workers saw mHealth as creating more work. mHealth led to new forms of engagement and relationships with clients and communities: health workers felt that communicating with clients by mobile phone improved care and their relationships with clients, but felt that some clients needed face-to-face contact. Health workers were aware of the importance of protecting confidential client information when using mobile devices. Some health workers did not mind being contacted by clients outside working hours, while others wanted boundaries. Health workers described how some community members trusted health workers that used mHealth while others were sceptical. Health workers pointed to problems when clients needed to own their own phones. Health workers' use and perceptions of mHealth could be influenced by factors tied to costs, the health worker, the technology, the health system and society, poor network access, and poor access to electricity: some health workers did not mind covering extra costs. Others complained that phone credit was not delivered on time. Health workers who were accustomed to using mobile phones were sometimes more positive towards mHealth. Others with less experience, were sometimes embarrassed about making mistakes in front of clients or worried about job security. Health workers wanted training, technical support, user-friendly devices, and systems that were integrated into existing electronic health systems. The main challenges health workers experienced were poor network connections, access to electricity, and the cost of recharging phones. Other problems included damaged phones. Factors outside the health system also influenced how health workers experienced mHealth, including language, gender, and poverty issues. Health workers felt that their commitment to clients helped them cope with these challenges. AUTHORS' CONCLUSIONS Our findings propose a nuanced view about mHealth programmes. The complexities of healthcare delivery and human interactions defy simplistic conclusions on how health workers will perceive and experience their use of mHealth. Perceptions reflect the interplay between the technology, contexts, and human attributes. Detailed descriptions of the programme, implementation processes and contexts, alongside effectiveness studies, will help to unravel this interplay to formulate hypotheses regarding the effectiveness of mHealth.
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Affiliation(s)
- Willem A Odendaal
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Stellenbosch UniversityDepartment of PsychiatryCape TownSouth Africa
| | | | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Brown UniversitySchool of Public HealthProvidenceRhode IslandUSA
| | - Jane Goudge
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Frances Griffiths
- University of WarwickWarwick Medical SchoolCoventryUK
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Mark Tomlinson
- Stellenbosch UniversityInstitute for Life Course Health Research, Department of Global HealthCape TownSouth Africa
- Queens UniversitySchool of Nursing and MidwiferyBelfastUK
| | - Karen Daniels
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- University of Cape TownHealth Policy and Systems Division, School of Public Health and Family MedicineCape TownWestern CapeSouth Africa7925
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Ames HMR, Glenton C, Lewin S, Tamrat T, Akama E, Leon N. Clients' perceptions and experiences of targeted digital communication accessible via mobile devices for reproductive, maternal, newborn, child, and adolescent health: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 10:CD013447. [PMID: 31608981 PMCID: PMC6791116 DOI: 10.1002/14651858.cd013447] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Governments and health systems are increasingly using mobile devices to communicate with patients and the public. Targeted digital client communication is when the health system transmits information to particular individuals or groups of people, based on their health or demographic status. Common types of targeted client communication are text messages that remind people to go to appointments or take their medicines. Other types include phone calls, interactive voice response, or multimedia messages that offer healthcare information, advice, monitoring, and support. OBJECTIVES To explore clients' perceptions and experiences of targeted digital communication via mobile devices on topics related to reproductive, maternal, newborn, child, or adolescent health (RMNCAH). SEARCH METHODS We searched MEDLINE (OvidSP), MEDLINE In-Process & Other Non-Indexed Citations (OvidSP), Embase (Ovid), World Health Organization Global Health Library, and POPLINE databases for eligible studies from inception to 3-6 July 2017 dependant on the database (See appendix 2). SELECTION CRITERIA We included studies that used qualitative methods for data collection and analysis; that explored clinets' perceptions and experiences of targeted digital communication via mobile device in the areas of RMNCAH; and were from any setting globally. DATA COLLECTION AND ANALYSIS We used maximum variation purposive sampling for data synthesis, employing a three-step sampling frame. We conducted a framework thematic analysis using the Supporting the Use of Research Evidence (SURE) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether potential implementation barriers identified in our synthesis had been addressed in the trials included in the related Cochrane Reviews of effectiveness. MAIN RESULTS We included 35 studies, from a wide range of countries on six continents. Nineteen studies were conducted in low- and middle-income settings and sixteen in high-income settings. Some of the studies explored the views of people who had experienced the interventions, whereas others were hypothetical in nature, asking what people felt they would like from a digital health intervention. The studies covered a range of digital targeted client communication, for example medication or appointment reminders, prenatal health information, support for smoking cessation while pregnant, or general sexual health information.Our synthesis showed that clients' experiences of these types of programmes were mixed. Some felt that these programmes provided them with feelings of support and connectedness, as they felt that someone was taking the time to send them messages (moderate confidence in the evidence). They also described sharing the messages with their friends and family (moderate confidence).However, clients also pointed to problems when using these programmes. Some clients had poor access to cell networks and to the internet (high confidence). Others had no phone, had lost or broken their phone, could not afford airtime, or had changed their phone number (moderate confidence). Some clients, particularly women and teenagers, had their access to phones controlled by others (moderate confidence). The cost of messages could also be a problem, and many thought that messages should be free of charge (high confidence). Language issues as well as skills in reading, writing, and using mobile phones could also be a problem (moderate confidence).Clients dealing with stigmatised or personal health conditions such as HIV, family planning, or abortion care were also concerned about privacy and confidentiality (high confidence). Some clients suggested strategies to deal with these issues, such as using neutral language and tailoring the content, timing, and frequency of messages (high confidence).Clients wanted messages at a time and frequency that was convenient for them (moderate confidence). They had preferences for different delivery channels (e.g. short message service (SMS) or interactive voice response) (moderate confidence). They also had preferences about message content, including new knowledge, reminders, solutions, and suggestions about health issues (moderate confidence). Clients' views about who sent the digital health communication could influence their views of the programme (moderate confidence).For an overview of the findings and our confidence in the evidence, please see the 'Summary of qualitative findings' tables.Our matrix shows that many of the trials assessing these types of programmes did not try to address the problems we identified, although this may have been a reporting issue. AUTHORS' CONCLUSIONS Our synthesis identified several factors that can influence the successful implementation of targeted client communication programmes using mobile devices. These include barriers to use that have equity implications. Programme planners should take these factors into account when designing and implementing programmes. Future trial authors also need to actively address these factors and to report their efforts in their trial publications.
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Affiliation(s)
- Heather MR Ames
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
| | - Claire Glenton
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
| | - Simon Lewin
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070Cape TownSouth Africa7505
| | - Tigest Tamrat
- World Health OrganizationDepartment of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerlandCH‐1211
| | - Eliud Akama
- University of WashingtonSeattleWashingtonUSA
| | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070Cape TownSouth Africa7505
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