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Osman S, Churruca K, Ellis LA, Luo D, Braithwaite J. The Unintended Consequences of Telehealth in Australia: Critical Interpretive Synthesis. J Med Internet Res 2024; 26:e57848. [PMID: 39190446 PMCID: PMC11387926 DOI: 10.2196/57848] [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: 02/27/2024] [Revised: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Despite more than 2 decades of telehealth use in Australia and the rapid uptake during the COVID-19 pandemic, little is known about its unintended consequences beyond its planned and intended outcomes. OBJECTIVE The aim of this review was to synthesize evidence on the unintended consequences of telehealth use in Australia to clarify its impact beyond its planned and intended outcomes. METHODS We conducted a search of 4 electronic databases: Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, and Scopus. A critical interpretive synthesis approach was adopted for its flexibility and interpretive nature. We extracted data about study characteristics and the types and models of telehealth services. The extracted unintended consequences were coded and mapped into the domains and dimensions of the Australian Health Performance Framework. RESULTS Of the 4241 records identified by the search, 94 (2.22%) studies were eligible for data extraction and analysis. Of these 94 studies, 23 (24%) reported largely positive unintended consequences of telehealth associated with health status, while 6 (6%) noted a potential negative impact of telehealth on socioeconomic status. The findings of 4 (4%) of the 94 studies highlighted societal and financial consequences of telehealth beyond the health system. Almost all studies (93/94, 99%) reported unintended consequences under the 5 dimensions of the Australian Health Performance Framework. CONCLUSIONS Our synthesis offers a framework for understanding the unintended consequences of the use of telehealth as an alternative to in-person care in Australia. While we have documented many unintended benefits of telehealth use, our findings also shed light on many challenges of delivering care via telehealth across different domains and dimensions. These findings hold significant practice and policy-making implications for ensuring safe and high-quality care delivery via telehealth.
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Affiliation(s)
- Sagda Osman
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Dan Luo
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
- The Daffodil Centre, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
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O'Brien KH, Pei Y, Kemp AM, Gartell R, Wallace T. Pilot testing the SUCCESS peer mentoring program for students with concussion: the role of personas in mobile technology development. Disabil Rehabil Assist Technol 2024; 19:1964-1979. [PMID: 37522162 DOI: 10.1080/17483107.2023.2239293] [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: 11/30/2022] [Revised: 05/12/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE College students with concussion experience academic, cognitive and psychosocial challenges, yet frequently lack supports necessary for successful reintegration into school. Success in College after Concussion with Effective Student Supports (SUCCESS) is a virtual peer mentoring program designed to provide education, support and connection through a mobile application. The purpose of this study was to describe use of personas as components of mobile app development and conduct preliminary testing of SUCCESS using personas. METHODS Personas were developed from case studies and portrayed by college students trained as fictitious mentees. Mentors were blinded to use of personas. Eleven mentors completed measures pre and post a 4-week mentoring cycle. Mentors and personas interacted in the app via chat, video calls and sharing of educational materials. Measures included the Post-Concussion Symptom Scale (PCSS); PROMIS Self-Efficacy; Depression, Anxiety and Stress Scale (DASS); and a series of focus groups. RESULTS Mentors suggested improvements to resolve instability of video calls, expand educational materials to address psychosocial functioning, and add structure to the mentoring relationship. Some preferences around communication, like groups chats and emoji keyboards, were not able to be addressed. As expected, PCSS scores were stable. DASS score (p = .04), especially depression (p = .03), decreased. PROMIS scores showed a trend towards growth (p = .057), although were not statistically significant. CONCLUSIONS Use of personas allowed technical challenges and program refinements to be addressed before including students with subacute concussion in testing. Although continued development will address enhancement of communication modalities preferred by students, future efficacy testing of SUCCESS is warranted.
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Affiliation(s)
- Katy H O'Brien
- Communication Sciences and Special Education, University of Georgia, Athens, GA, USA
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN, USA
| | - Yalian Pei
- Communication Sciences and Special Education, University of Georgia, Athens, GA, USA
| | - Amy M Kemp
- Communication Sciences and Special Education, University of Georgia, Athens, GA, USA
| | - Rebecca Gartell
- Shepherd Center, Crawford Research Institute, Complex Concussion Clinic, SHARE Military Initiative, Atlanta, GA, USA
| | - Tracey Wallace
- Shepherd Center, Crawford Research Institute, Complex Concussion Clinic, SHARE Military Initiative, Atlanta, GA, USA
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Berardi C, Antonini M, Jordan Z, Wechtler H, Paolucci F, Hinwood M. Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework. BMC Health Serv Res 2024; 24:243. [PMID: 38408938 PMCID: PMC10898174 DOI: 10.1186/s12913-023-10536-1] [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: 02/04/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Despite the potential for improved population mental health and wellbeing, the integration of mental health digital interventions has been difficult to achieve. In this qualitative systematic review, we aimed to identify barriers and facilitators to the implementation of digital technologies in mental healthcare systems, and map these to an implementation framework to inform policy development. METHODS We searched Medline, Embase, Scopus, PsycInfo, Web of Science, and Google Scholar for primary research articles published between January 2010 and 2022. Studies were considered eligible if they reported barriers and/or facilitators to the integration of any digital mental healthcare technologies. Data were extracted using EPPI-Reviewer Web and analysed thematically via inductive and deductive cycles. RESULTS Of 12,525 references identified initially, 81 studies were included in the final analysis. Barriers and facilitators were grouped within an implementation (evidence-practice gap) framework across six domains, organised by four levels of mental healthcare systems. Broadly, implementation was hindered by the perception of digital technologies as impersonal tools that add additional burden of care onto both providers and patients, and change relational power asymmetries; an absence of resources; and regulatory complexities that impede access to universal coverage. Facilitators included person-cantered approaches that consider patients' intersectional features e.g., gender, class, disability, illness severity; evidence-based training for providers; collaboration among colleagues; appropriate investment in human and financial resources; and policy reforms that tackle universal access to digital health. CONCLUSION It is important to consider the complex and interrelated nature of barriers across different domains and levels of the mental health system. To facilitate the equitable, sustainable, and long-term digital transition of mental health systems, policymakers should consider a systemic approach to collaboration between public and private sectors to inform evidence-based planning and strengthen mental health systems. PROTOCOL REGISTRATION The protocol is registered on PROSPERO, CRD42021276838.
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Affiliation(s)
- Chiara Berardi
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia.
| | - Marcello Antonini
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Department of Health Policy, London School of Economics and Political Science, London, WC2A 2AE, UK
| | - Zephanie Jordan
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Heidi Wechtler
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Francesco Paolucci
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Madeleine Hinwood
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Woon LSC, Maguire PA, Reay RE, Looi JCL. Telepsychiatry in Australia: A Scoping Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241237116. [PMID: 38462906 DOI: 10.1177/00469580241237116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Telepsychiatry formed part of the Australian mental health response to COVID-19, but relevant reviews pre- and post-pandemic are sparse. This scoping review aimed to map the literature on telepsychiatry in Australia and identify key research priorities. We searched databases (Medline, PubMed, PsycINFO, Scopus, Web of Science, EBSCO Psychology & Behavioral Sciences Collection, Proquest databases, and Cochrane Central Register of Controlled Trials) and reference lists from January 1990 to December 2022. Keywords included telepsychiatry, videoconferencing, telephone consultation, psychiatry, mental health, and Australia. Two reviewers independently screened titles, abstracts, and full texts. We identified 96 publications, one-third of which appeared since 2020. Extracted data included article types, service types, usage levels, outcome measures, perceptions, and research gaps. Most publications were quantitative studies (n = 43) and narrative reports of services (n = 17). Seventy-six papers reported mostly publicly established services. Videoconferencing alone was the most common mode of telepsychiatry. There was increased use over time, with the emergence of metropolitan telepsychiatry during the pandemic. Few papers used validated outcome measures (n = 5) or conducted economic evaluations (n = 4). Content analysis of the papers identified perceptions of patient (and caregiver) benefits, clinical care, service sustainability, and technology capability/capacity. Benefits such as convenience and cost-saving, clinical care issues, and implementation challenges were mentioned. Research gaps in patient perspectives, outcomes, clinical practice, health economics, usage patterns, and technological issues were identified. There is consistent interest in, and growth of, telepsychiatry in Australia. The identified perception themes might serve as a framework for future research on user perspectives and service integration. Other research areas include usage trends, outcome measures, and economic evaluation.
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Affiliation(s)
- Luke Sy-Cherng Woon
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
- Department of Psychiatry, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT, Australia
| | - Rebecca E Reay
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
| | - Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT, Australia
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Kavanagh BE, Corney KB, Beks H, Williams LJ, Quirk SE, Versace VL. A scoping review of the barriers and facilitators to accessing and utilising mental health services across regional, rural, and remote Australia. BMC Health Serv Res 2023; 23:1060. [PMID: 37794469 PMCID: PMC10552307 DOI: 10.1186/s12913-023-10034-4] [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: 05/15/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Inadequate healthcare access and utilisation are implicated in the mental health burden experienced by those living in regional, rural, and remote Australia. Facilitators that better enable access and utilisation are also reported in the literature. To date, a synthesis on both the barriers and facilitators to accessing and utilising mental health services within the rural Australian context has not been undertaken. This scoping review aims to (1) synthesise the barriers and facilitators to accessing and utilising mental health services in regional, rural, and remote Australia, as identified using the Modified Monash Model; and (2) better understand the relationship between barriers and facilitators and their geographical context. METHODS A systematic search of Medline Complete, EMBASE, PsycINFO, Scopus, and CINAHL was undertaken to identify peer-reviewed literature. Grey literature was collated from relevant websites. Study characteristics, including barriers and facilitators, and location were extracted. A descriptive synthesis of results was conducted. RESULTS Fifty-three articles were included in this scoping review. Prominent barriers to access and utilisation included: limited resources; system complexity and navigation; attitudinal and social matters; technological limitations; distance to services; insufficient culturally-sensitive practice; and lack of awareness. Facilitators included person-centred and collaborative care; technological facilitation; environment and ease of access; community supports; mental health literacy and culturally-sensitive practice. The variability of the included studies precluded the geographical analysis from being completed. CONCLUSION Both healthcare providers and service users considered a number of barriers and facilitators to mental health service access and utilisation in the regional, rural, and remote Australian context. Barriers and facilitators should be considered when re-designing services, particularly in light of the findings and recommendations from the Royal Commission into Victoria's Mental Health System, which may be relevant to other areas of Australia. Additional research generated from rural Australia is needed to better understand the geographical context in which specific barriers and facilitators occur.
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Affiliation(s)
- Bianca E Kavanagh
- Deakin Rural Health, School of Medicine, Deakin University, Princes Highway, Warrnambool, VIC, 3280, Australia.
| | - Kayla B Corney
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
| | - Hannah Beks
- Deakin Rural Health, School of Medicine, Deakin University, Princes Highway, Warrnambool, VIC, 3280, Australia
| | - Lana J Williams
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
| | - Shae E Quirk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Deakin University, Princes Highway, Warrnambool, VIC, 3280, Australia
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Isaacs A, Mitchell EKL, Sutton K, Naughton M, Hine R, Bullock S, Azar D, Maybery D. Clinicians' and Users' Views and Experiences of a Tele-Mental Health Service Implemented Alongside the Public Mental Health System during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105870. [PMID: 37239597 DOI: 10.3390/ijerph20105870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
A tele-mental health model called Head to Health was implemented in the state of Victoria, Australia to address the crisis caused by the COVID-19 pandemic. It was a free centralized intake service that adopted a targeted approach with several novel elements, such as stepped care and telehealth. This study examines the views and experiences of clinicians and service users of the tele-mental health service in the Gippsland region of Victoria during the COVID-19 pandemic. Data from clinicians were obtained via an online 10-item open-ended survey instrument and from service users through semi-structured interviews. Data were obtained from 66 participants, including 47 clinician surveys and 19 service user interviews. Six categories emerged from the data. They were: 'Conditions where use of tele-mental health is appropriate', 'Conditions where tele-mental health may not be useful', 'Advantages of tele-mental health', 'Challenges in using tele-mental health', 'Client outcomes with tele-mental health', and 'Recommendations for future use'. This is one of a few studies where clinicians' and service users' views and experiences have been explored together to provide a nuanced understanding of perspectives on the efficacy of tele-mental health when it was implemented alongside public mental health services.
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Affiliation(s)
- Anton Isaacs
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | | | - Keith Sutton
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Michael Naughton
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Rochelle Hine
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Shane Bullock
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Denise Azar
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
- Gippsland Primary Health Network, Traralgon, VIC 3844, Australia
| | - Darryl Maybery
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
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Negev M, Magal T, Kaphzan H. Attitudes of psychiatrists toward telepsychiatry: A policy Delphi study. Digit Health 2023; 9:20552076231177132. [PMID: 37312951 PMCID: PMC10259121 DOI: 10.1177/20552076231177132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/04/2023] [Indexed: 06/15/2023] Open
Abstract
Objectives To delineate areas of consensus and disagreements among practicing psychiatrists from various levels of clinical experience, hierarchy and organizations, and to test their ability to converge toward agreement, which will enable better integration of telepsychiatry into mental health services. Methods To study attitudes of Israeli public health psychiatrists, we utilized a policy Delphi method, during the early stages of the COVID pandemic. In-depth interviews were conducted and analyzed, and a questionnaire was generated. The questionnaire was disseminated amongst 49 psychiatrists, in two succeeding rounds, and areas of consensus and controversies were identified. Results Psychiatrists showed an overall consensus regarding issues of economic and temporal advantages of telepsychiatry. However, the quality of diagnosis and treatment and the prospect of expanding the usage of telepsychiatry to normal circumstances-beyond situations of pandemic or emergency were disputed. Nonetheless, efficiency and willingness scales slightly improved during the 2nd round of the Delphi process. Prior experience with telepsychiatry had a strong impact on the attitude of psychiatrists, and those who were familiar with this practice were more favorable toward its usage in their clinic. Conclusions We have delineated experience as a major impact on the attitudes toward telepsychiatry and the willingness for its assimilation in clinical practice as a legitimate and trustworthy method. We have also observed that the organizational affiliation significantly affected psychiatrists' attitude, when those working at local clinics were more positive toward telepsychiatry compared with employees of governmental institutions. This might be related to experience and differences in organizational environment. Taken together, we recommend to include hands-on training of telepsychiatry in medical education curriculum during residency, as well as refresher exercises for attending practitioners.
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Affiliation(s)
- Maya Negev
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tamir Magal
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Hanoch Kaphzan
- Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
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Tabaeeian RA, Hajrahimi B, Khoshfetrat A. A systematic review of telemedicine systems use barriers: primary health care providers' perspective. JOURNAL OF SCIENCE AND TECHNOLOGY POLICY MANAGEMENT 2022. [DOI: 10.1108/jstpm-07-2021-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose
The purpose of this review paper was identifying barriers to the use of telemedicine systems in primary health-care individual level among professionals.
Design/methodology/approach
This study used Scopus and PubMed databases for scientific records identification. A systematic review of the literature structured by PRISMA guidelines was conducted on 37 included papers published between 2009 and 2019. A qualitative approach was used to synthesize insights into using telemedicine by primary care professionals.
Findings
Three barriers were identified and classified: system quality, data quality and service quality barriers. System complexity in terms of usability, system unreliability, security and privacy concerns, lack of integration and inflexibility of systems-in-use are related to system quality. Data quality barriers are data inaccuracy, data timeliness issues, data conciseness concerns and lack of data uniqueness. Finally, service reliability concerns, lack of technical support and lack of user training have been categorized as service quality barriers.
Originality/value
This review identified and mapped emerging themes of barriers to the use of telemedicine systems. This paper also through a new conceptualization of telemedicine use from perspectives of the primary care professionals contributes to informatics literature and system usage practices.
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Jonasdottir SK, Thordardottir I, Jonsdottir T. Health professionals? Perspective towards challenges and opportunities of telehealth service provision: A scoping review. Int J Med Inform 2022; 167:104862. [PMID: 36179598 DOI: 10.1016/j.ijmedinf.2022.104862] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/08/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Telehealth, or healthcare offered through the internet, computers, and other devices for communication, is rapidly increasing with changing times and technological advancement. For quality and security of such services, it is crucial that professionals are competent in offering such service. Still, lack of professionals' training has been identified as one of the barriers to implementation of telehealth. Thus, to improve such training, it is crucial to identify professionals' knowledge, experience, and perspectives towards challenges and opportunities of using telehealth. OBJECTIVE The review's objective was to answer the research question: what is known in the literature about challenges and opportunities of telehealth service provision from the perspective of health professionals? METHODS Arksey and O'Malley's five-stage approach for scoping studies was used for the review. Studies were collected across four databases: Scopus, PubMed, ProQuest and EBSCOhost. The data from the 22 included studies were reported by using frequency counts and categorization of health professionals' experiences. RESULTS The findings of the review led to three categories: (1) study demographics, (2) challenges for telehealth, and (3) opportunities for telehealth. The most frequently reported challenges were issues related to communications, inadequate technology, or support, and need for training and knowledge to use the technology. The most frequent categories of opportunities related to improved access to services, benefits related to sharing of information sharing and experience and training of using technology. DISCUSSION Further research is needed to explore health professionals' experience of training, and to understand the type of support, resources, and training content they need to enhance their competency in telehealth provision.
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Harding S, Eyllon M, Twigden A, Hogan A, Barry D, Mirsky J, Barnes B, Nordberg S. Power on: The rapid transition of a large interdisciplinary behavioral health department to telemental health during the COVID-19 pandemic. JOURNAL OF INTERPROFESSIONAL EDUCATION & PRACTICE 2022; 27:100506. [PMID: 35229056 PMCID: PMC8866964 DOI: 10.1016/j.xjep.2022.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/11/2022] [Accepted: 02/22/2022] [Indexed: 11/10/2022]
Abstract
Background The COVID-19 pandemic necessitated a rapid transition to telemental health (TMH) for behavioral health services in the behavioral health department of a large integrated primary care organization. Although the COVID-19 pandemic was the initial trigger for rapid organizational change, systems were developed with a focus on longer term scalability and sustainability. Methods This paper discusses the process of organizational change within our healthcare delivery system using the Strengths, Opportunities, Aspirations, and Results (SOAR) framework. Within this framework a structured mixed methods survey of 38 clinicians representing 5 different disciplines was conducted. Internal and survey data were analyzed to evaluate and guide the iterative change process. Results The majority of BH clinicians reported that they were as or more effective with TMH. The transition to TMH in our organization resulted in increased access to care, with a 10.3% increase in BH visit completions. The transition to TMH may benefit clinician work-life balance, but requires resources to support clinical, technological, and communication/teamwork changes. Implications/conclusions TMH is a feasible treatment modality for integrated care settings. It is cost-effective and well-accepted by clinicians. The SOAR framework can be used to guide rapid organizational change and ongoing QI processes.
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11
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Vogel LK, Yeo V. “It’s Not a Cookie-Cutter Scenario Anymore”: the COVID-19 Pandemic and Transitioning to Virtual Work. JOURNAL OF POLICY PRACTICE AND RESEARCH 2022. [PMCID: PMC8886194 DOI: 10.1007/s42972-022-00050-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic forced human services agencies, including child support agencies, to find ways to continue providing services. Many agencies considered changes to where and how staff work, in addition to new modalities for service provision. This paper explores how five Wisconsin child support agencies approached staff work arrangements and service delivery during the pandemic; challenges and opportunities encountered; changes agencies expect to persist; and implications for policy and practice. Data were gathered through semi-structured interviews with child support directors and staff in five Wisconsin counties between January and February, 2021. Data were analyzed thematically. Despite limited information and little prior experience working virtually, county agencies rapidly adapted staff work arrangements and service delivery methods to facilitate service continuity. Strategies used by agencies varied across counties, given local directives, resources, and constraints, and as the pandemic evolved. Despite variation, counties contended with a similar array of decision points, including changes to physical spaces, office closures, and staff work locations. Agencies also implemented creative strategies to connect with customers and keep services accessible. Findings suggest that innovative combinations of traditional and newer methods can help agencies maximize reach. Further, the infrastructure and experiences counties gained by working in new ways offer increased flexibility and improved capacity for service continuity in the future. Policymakers could support these efforts by providing guidance related to confidentiality and data security; supporting and facilitating crisis contingency planning; coordinating information exchanges; procuring technology and resources; and advocating for infrastructure, particularly broadband internet.
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Affiliation(s)
- Lisa Klein Vogel
- Institute for Research on Poverty, University of Wisconsin-Madison, 1180 Observatory Drive, WI 53706 Madison, USA
| | - Vee Yeo
- Institute for Research on Poverty, University of Wisconsin-Madison, 1180 Observatory Drive, WI 53706 Madison, USA
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12
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Wilczewski H, Paige SR, Ong T, Soni H, Barrera JF, Welch BM, Bunnell BE. Provider Perspectives on Telemental Health Usage After COVID-19: A Retrospective Analysis (Preprint). JMIR Form Res 2022; 6:e39634. [PMID: 36322787 PMCID: PMC9662289 DOI: 10.2196/39634] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
Abstract
Background Mental health care pivoted to telemedicine during the COVID-19 pandemic, and there is uncertainty around the sustainability of this rapid shift. Objective This study examined how intentions to continue using telemedicine after the COVID-19 pandemic are influenced by provider perceptions of usefulness, ease of use, and professional social influence, facilitating organizational conditions. Methods We conducted a web-based, cross-sectional survey of 369 telemental health providers between February and March 2021. A hierarchical linear regression analysis was conducted to predict intentions to continue using telemedicine after the COVID-19 pandemic. Results Most providers began using telemedicine in March 2020 or later (257/369, 69.6%) and attended to ≥50% of their clients via telemedicine (299/369, 81.0%). Intention to continue using telemedicine after the COVID-19 pandemic was predicted by the telemedicine caseload (β=.10; P=.005), perceived usefulness in general (β=.10; P=.008), ease of use (β=.08; P=.04), social influence (β=.68; P<.001), and facilitating conditions (β=.08; P=.047). Conclusions Exploration of the predictors of telemedicine usage beyond the COVID-19 pandemic aids in surveillance of telemedicine usage, integration with future clinic workflows, and the shaping of public policy. It is important to consider telemedicine services as not only a response to a crisis but also an effective and useful solution for everyday life. Our results suggest widespread, sustainable telemedicine adoption.
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Affiliation(s)
| | | | - Triton Ong
- Doxy.me Research, Doxy.me Inc, Rochester, NY, United States
| | - Hiral Soni
- Doxy.me Research, Doxy.me Inc, Rochester, NY, United States
| | - Janelle F Barrera
- Doxy.me Research, Doxy.me Inc, Rochester, NY, United States
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
| | - Brandon M Welch
- Doxy.me Research, Doxy.me Inc, Rochester, NY, United States
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, United States
| | - Brian E Bunnell
- Doxy.me Research, Doxy.me Inc, Rochester, NY, United States
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
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13
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Kaphzan H, Sarfati Noiman M, Negev M. The Attitudes and Perceptions of Israeli Psychiatrists Toward Telepsychiatry and Their Behavioral Intention to Use Telepsychiatry. Front Psychiatry 2022; 13:829965. [PMID: 35386519 PMCID: PMC8977602 DOI: 10.3389/fpsyt.2022.829965] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although telemedicine care has grown in recent years, telepsychiatry is growing at a slower pace than expected, because service providers often hamper the assimilation and expansion of telepsychiatry due their attitudes and perceptions. The unified theory of acceptance and use of technology (UTAUT) is a model that was developed to assess the factors influencing the assimilation of a new technology. We used the UTAUT model to examine the associations between the attitudes and perceptions of psychiatrists in Israel toward telepsychiatry and their intention to use it. Methods An online, close-ended questionnaire based on a modified UTAUT model was distributed among psychiatrists in Israel. Seventy-six questionnaires were completed and statistically analyzed. Results The behavioral intention of Israeli psychiatrists to use telepsychiatry was relatively low, despite their perceptions of themselves as capable of high performance with low effort. Nonetheless, they were interested in using telepsychiatry voluntarily. Experience in telepsychiatry, and to a lesser extent, facilitating conditions, were found to be positively correlated with the intention to use telepsychiatry. Psychiatrists have a positive attitude toward treating patients by telepsychiatry and perceive its risk as moderate. Discussion Despite high performance expectancy, low effort expectancy, low perceived risk, largely positive attitudes, high voluntariness, and the expectancy for facilitating conditions, the intention to use telepsychiatry was rather low. This result is explained by the low level of experience, which plays a pivotal role. We recommend promoting the facilitating conditions that affect the continued use of telepsychiatry when initiating its implementation, and conclude that it is critical to create a sense of success during the initial stages of experience.
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Affiliation(s)
- Hanoch Kaphzan
- Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | | | - Maya Negev
- Division of Health Systems Policy and Administration, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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14
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Amos AJ, Middleton J, Gardiner FW. Remote mental health clients prefer face-to-face consultations to telehealth during and after the COVID-19 pandemic. Australas Psychiatry 2022; 30:18-22. [PMID: 34570635 PMCID: PMC8894617 DOI: 10.1177/10398562211043509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To guide the efficient and effective provision of mental health services to clients in Central West and Far North Queensland, we surveyed preferences for face-to-face or in-person contact. METHODS A clinician-designed survey of contact preferences was offered to 248 clients of mental health services in Far North and Central West Queensland in mid-2020. With the onset of COVID-19, the survey was modified to measure the impact of the pandemic. RESULTS Just over half of the services' clients participated in the survey (50.4%), of whom more were female (63.2%). Of the participants, 46.3% in Far North and 8.6% in Central West Queensland identified as Indigenous. Strong resistance to telehealth before the pandemic across groups (76%) was moderated during COVID-19 (42.4%), an effect that appeared likely to continue past the pandemic for Central West clients (34.5%). Far North clients indicated their telehealth reluctance would return after the pandemic (77.6%). CONCLUSIONS Our results suggest that remote Australians strongly prefer in-person mental health care to telehealth. Although the COVID-19 pandemic increased acceptance of telehealth across regions while social distancing continued, there was evidence that Indigenous Australians were more likely to prefer in-person contact after the pandemic.
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Affiliation(s)
- Andrew James Amos
- Director of Training, Psychiatry for North Queensland, Townsville, QLD
| | - Jocelyn Middleton
- Manager, Mental Health and Wellbeing teams, Royal Flying Doctor Service, Cairns, QLD
| | - Fergus W. Gardiner
- Director, Public Health and Research, Royal Flying Doctor Service, Federation, Canberra, ACT
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15
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Drabarek D, Hammond R, Mitchell M, Colton H, Dean J, Stirling K, Wainwright L, Davies S, Haarsma S, Puckett C, McCann D, Blaydon D, Zandberg D, Harris J, Martiniuk A. Establishing therapeutic and supportive relationships throughout delivery of a school-based group parenting program via telehealth: Exploring causal pathways. Digit Health 2022; 8:20552076221129733. [DOI: 10.1177/20552076221129733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Access to specialised early intervention mental health services for children, including group counselling for parents/carers, is still a challenge in non-metropolitan areas of Australia. Aim To gain understanding of the acceptability of a school-based targeted parenting group program delivered via telehealth by exploring the experiences of parents/carers, clinicians and school staff, and asking what works, how, why and in what circumstances. Methods Caregivers, clinicians and school staff involved in the delivery of a mental health program via telehealth into primary schools in two rural Local Health Districts (LHDs) in southern New South Wales (NSW) were invited to participate in interviews and/or focus group discussions. Thematic analysis of the data was conducted with reference to realist theory. Findings We conducted semi-structured interviews with 12 caregivers, five semi-structured interviews and two focus group discussions with school staff from six participating schools, and three focus groups with seven clinicians who delivered the intervention. We found that the intervention and micro contexts interacted to influence acceptability by initiating or enhancing cohesion among caregivers, establishing channels of communication between caregivers and teachers, and connection between caregivers and clinicians despite geographic distance. Several adaptations were made to strengthen the therapeutic alliance between caregivers and clinicians. Conclusion Relationships crucial to the success of delivering psychological group counselling were established. Regional community contexts can facilitate acceptability of parenting group counselling delivered into schools via telehealth. Implementation of the program was flexible enough to allow clinicians to adjust their approach and materials to better suit the telehealth modality.
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Affiliation(s)
- Dorothy Drabarek
- Royal Far West, Sydney, Australia
- University of Sydney, Sydney, Australia
| | | | | | | | - John Dean
- Murrumbidgee Local Health District, NSW Health, Australia
| | | | | | | | | | - Cherie Puckett
- Southern NSW Local Health District, NSW Health, Australia
| | | | | | | | | | - Alexandra Martiniuk
- University of Sydney, Sydney, Australia
- George Institute, Office of the Chief Scientist, Sydney, Australia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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16
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Binci D, Palozzi G, Scafarto F. Toward digital transformation in healthcare: a framework for remote monitoring adoption. TQM JOURNAL 2021. [DOI: 10.1108/tqm-04-2021-0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PurposeDigital transformation (DT) is a priority for the healthcare sector. In many countries, it is still considered in the early stages with an underestimation of its benefits and potentiality. Especially in Italy, little is known about the impact of digitalization – particularly of the Internet of Things (IoT) – on the healthcare sector, for example, in terms of clinician's jobs and patient's experience. Drawing from such premises, the paper aims to focus on an overlooked healthcare area related to the chronic heart diseases field and its relationship with DT. The authors aim at exploring and framing the main variables of remote Monitoring (RM) adoption as a specific archetype of healthcare digitalization, both on patients and medical staff level, by shedding some lights on its overall implementation.Design/methodology/approachThe authors empirically inquiry the RM adoption within the context of the Cardiology Department of the Casilino General Hospital of Rome. To answer our research question, the authors reconstruct the salient information by using induction-type reasoning, direct observation and interviewees with 12 key informants, as well as secondary sources analysis related to the hospital (internal documentation, presentations and technical reports).FindingsAccording to a socio-technical framework, the authors build a model composed of five main variables related to medical staff and patients. The authors classify such variables into an input-process-output (I-P-O) model. RM adoption driver represents the input; cultural digital divide, structure flexibility and reaction to change serve the process and finally, RM outcome stands for the output. All these factors, interacting together, contribute to understanding the RM adoption process for chronic disease management.Research limitations/implicationsThe authors' research presents two main limitations. The first one is related to using a qualitative method, which is less reliable in terms of replication and the interpretive role of researchers. The second limitation, connected to the first one, is related to the study's scale level, which focuses on a mono-centric consistent level of analysis.Practical implicationsThe paper offers a clear understanding of the RM attributes and a comprehensive view for improving the overall quality management of chronic diseases by suggesting that clinicians carefully evaluate both hard and soft variables when undertaking RM adoption decisions.Social implicationsRM technologies could impact on society both in ordinary situations, by preventing patient mobility issues and transport costs, and in extraordinary times (such as a pandemic), where telemedicine contributes to supporting hospitals in swapping in-person visits with remote controls, in order to minimize the risk of coronavirus disease (COVID-19) contagion or the spread of the virus.Originality/valueThe study enriches the knowledge and understanding of RM adoption within the healthcare sector. From a theoretical perspective, the authors contribute to the healthcare DT adoption debate by focusing on the main variables contributing to the DT process by considering both medical staff and patient's role. From a managerial perspective, the authors highlight the main issues for RM of chronic disease management to enable the transition toward its adoption. Such issues range from the need for awareness of the medical staff about RM advantages to the need for adapting the organizational structure and the training and education process of the patients.
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17
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Magal T, Negev M, Kaphzan H. Attitudinal Barriers Hindering Adoption of Telepsychiatry among Mental Healthcare Professionals: Israel as a Case-Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12540. [PMID: 34886266 PMCID: PMC8656860 DOI: 10.3390/ijerph182312540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/07/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022]
Abstract
Despite proven advantages for the use of telemedicine in psychiatry, mental healthcare professionals have shown deep-seated mistrust and suspicion of telepsychiatry, which hinders its widespread application. The current study examines the attitudes of Israeli mental health professionals towards telepsychiatry and seeks to uncover the effects of experience and organizational affiliation on its adoption. The methodology included qualitative and thematic analysis of 27 in-depth interviews with Israeli mental health professionals, focusing on three major themes-clinical quality, economic efficiency, and the effects on the work-life balance of healthcare professionals. The attitudes of mental health professionals were found to be widely divergent and sharply dichotomized regarding different aspects of telepsychiatry and its suitability for mental healthcare services. However, there was a general consensus that telemedicine may not fulfil its promise of being a panacea to the problems of modern public medicine. In addition, attitudes were related to hierarchical position, organizational affiliation, and personal experience with telepsychiatry. Specifically, organizational affiliation influenced experience with and support for the assimilation of telepsychiatry. The study also revealed the role of organizational leadership and culture in promoting or inhibiting the proliferation and adoption of innovative technologies and services in modern medicine.
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Affiliation(s)
- Tamir Magal
- School of Public Health, University of Haifa, Haifa 3498838, Israel;
| | - Maya Negev
- School of Public Health, University of Haifa, Haifa 3498838, Israel;
| | - Hanoch Kaphzan
- Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa 3498838, Israel;
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18
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Parks J, Hunter A, Taylor A, Addis B, Setterfield M, Dean K, Nott S. Design, development and implementation of the virtual, coordination, access, referral and escalation service in western New South Wales. Aust J Rural Health 2021; 29:794-800. [PMID: 34586702 DOI: 10.1111/ajr.12800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022] Open
Abstract
PROBLEM People in rural and remote New South Wales experience avoidable admissions, limited access to skilled clinicians and commonly travel >400 km to access specialist services within the district and >700 km for tertiary services outside. DESIGN Iterative use of New South Wales Health redesign methodology in the period 2015-2020. SETTING Western New South Wales Local Health District is geographically the largest Health District within New South Wales and includes disadvantaged communities. Virtual Coordination Access Referral Escalation is an audio-visually enabled transport, patient flow and clinical advice unit established in 2006 to support patients and clinicians at 35 small, rural and remote hospitals. KEY MEASURES FOR IMPROVEMENT Right care, right place and right time by the right team the first time. Care delivery close to home and 'on country'. Safe and cost-effective transport. Performance measures to support quality, safety and clinical outcomes. Improving the human experience. STRATEGIES FOR CHANGE Cycles of strategic planning, innovation, productive partnerships, change management and human systems development. EFFECTS OF CHANGE Virtual Coordination Access Referral Escalation critical care telehealth more effectively supports rural and remote health care across large distances. LESSONS LEARNT Improvements include expanded/redefined management and nursing roles, integration of dedicated critical care emergency medicine specialists within the service, delegated authority to accept transfers, upgraded technology, 24-hour service provision and a central 'Virtual Support' proactive outreach model.
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Affiliation(s)
- James Parks
- Western NSW Local Health District, Dubbo, NSW, Australia
| | - Amanda Hunter
- Western NSW Local Health District, Dubbo, NSW, Australia
| | - Anne Taylor
- Western NSW Local Health District, Dubbo, NSW, Australia
| | - Bridget Addis
- The University of Sydney, Sydney Medical Program, Edward Ford Building University of Sydney, Camperdown, NSW, Australia
| | - Madeline Setterfield
- The University of Sydney, Sydney Medical Program, Edward Ford Building University of Sydney, Camperdown, NSW, Australia
| | - Kimberley Dean
- The University of Sydney, Sydney Medical Program, Edward Ford Building University of Sydney, Camperdown, NSW, Australia
| | - Shannon Nott
- Western NSW Local Health District, Dubbo, NSW, Australia
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19
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Borghouts J, Eikey E, Mark G, De Leon C, Schueller SM, Schneider M, Stadnick N, Zheng K, Mukamel D, Sorkin DH. Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review. J Med Internet Res 2021; 23:e24387. [PMID: 33759801 PMCID: PMC8074985 DOI: 10.2196/24387] [Citation(s) in RCA: 265] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/24/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
Background Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions. Objective This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. Methods A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. Results A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health. Conclusions Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.
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Affiliation(s)
| | - Elizabeth Eikey
- University of California San Diego, San Diego, CA, United States
| | - Gloria Mark
- University of California Irvine, Irvine, CA, United States
| | | | | | | | - Nicole Stadnick
- University of California San Diego, San Diego, CA, United States
| | - Kai Zheng
- University of California Irvine, Irvine, CA, United States
| | - Dana Mukamel
- University of California Irvine, Irvine, CA, United States
| | - Dara H Sorkin
- University of California Irvine, Irvine, CA, United States
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20
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Ganapathy A, Clough BA, Casey LM. Organizational and Policy Barriers to the Use of Digital Mental Health by Mental Health Professionals. Telemed J E Health 2021; 27:1332-1343. [PMID: 33646057 DOI: 10.1089/tmj.2020.0455] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Digital mental health (DMH) provides effective methods of overcoming issues of time constraints, accessibility, and availability of mental health care. They can provide a valuable means to deliver mental health care in the present pandemic. However, adoption of these methods has been slow. Mental health professional (MHP) concerns at the organizational and policy level that influence this slow adoption need to be examined. Materials and Methods: A narrative review was conducted to identify the barriers. Searches using the databases Scopus, Embase, and PubMed were conducted to identify research focused on barriers reported by MHPs to use DMH. Results: The search resulted in 356 unique citations, and 21 papers met the inclusion and exclusion criteria. Forward and backward sampling resulted in identifying an additional 19 relevant papers. Discussion: Unmet needs for information, training, and infrastructure, challenges to the workflow and excessive workloads, and ambiguous policies serve as barriers to DMH use. This article recommends strategies for researchers, organizations, DMH designers, and governmental institutions to ensure efficient utilization of DMH. Conclusion: Concerted efforts at individual, organizational, and governmental levels are essential to ensure efficient utilization of DMH.
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Affiliation(s)
- Aarthi Ganapathy
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| | - Bonnie A Clough
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| | - Leanne M Casey
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
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21
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Nittari G, Khuman R, Baldoni S, Pallotta G, Battineni G, Sirignano A, Amenta F, Ricci G. Telemedicine Practice: Review of the Current Ethical and Legal Challenges. Telemed J E Health 2020; 26:1427-1437. [PMID: 32049608 PMCID: PMC7757597 DOI: 10.1089/tmj.2019.0158] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/07/2019] [Accepted: 01/21/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Telemedicine involves medical practice and information and communications technology. It has been proven to be very effective for remote health care, especially in areas with poor provision of health facilities. However, implementation of these technologies is often hampered by various issues. Among these, ethical and legal concerns are some of the more complex and diverse ones. In this study, an analysis of scientific literature was carried out to identify the ethical and legal challenges of telemedicine. Materials and Methods: English literature, published between 2010 and 2019, was searched on PubMed, Scopus, and Web of Science by using keywords, including "Telemedicine," "Ethics," "Malpractice," "Telemedicine and Ethics," "Telemedicine and Informed consent," and "telemedicine and malpractice." Different types of articles were analyzed, including research articles, review articles, and qualitative studies. The abstracts were evaluated according to the selection criteria, using the Newcastle-Ottawa Scale criteria, and the final analysis led to the inclusion of 22 articles. Discussion: From the aforementioned sample, we analyzed elements that may be indicative of the efficacy of telemedicine in an adequate time frame. Ethical aspects such as informed consent, protection data, confidentiality, physician's malpractice, and liability and telemedicine regulations were considered. Conclusions: Our objective was to highlight the current status and identify what still needs to be implemented in telemedicine with respect to ethical and legal standards. Gaps emerged between current legislation, legislators, service providers, different medical services, and most importantly patient interaction with his/her data and the use of that data.
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Affiliation(s)
- Giulio Nittari
- Telemedicine and Telepharmacy Center, School of Health Science Products, University of Camerino, Camerino, Italy
| | - Ravjyot Khuman
- Telemedicine and Telepharmacy Center, School of Health Science Products, University of Camerino, Camerino, Italy
| | - Simone Baldoni
- Telemedicine and Telepharmacy Center, School of Health Science Products, University of Camerino, Camerino, Italy
| | - Graziano Pallotta
- Telemedicine and Telepharmacy Center, School of Health Science Products, University of Camerino, Camerino, Italy
| | - Gopi Battineni
- Telemedicine and Telepharmacy Center, School of Health Science Products, University of Camerino, Camerino, Italy
| | - Ascanio Sirignano
- Department of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Francesco Amenta
- Telemedicine and Telepharmacy Center, School of Health Science Products, University of Camerino, Camerino, Italy
| | - Giovanna Ricci
- Department of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
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22
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Connolly SL, Miller CJ, Lindsay JA, Bauer MS. A systematic review of providers' attitudes toward telemental health via videoconferencing. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020; 27:10.1111/cpsp.12311. [PMID: 35966216 PMCID: PMC9367168 DOI: 10.1111/cpsp.12311] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 11/12/2019] [Indexed: 11/29/2022]
Abstract
Telemental health conducted via videoconferencing (TMH-V) has the potential to improve access to care, and providers' attitudes toward this innovation play a crucial role in its uptake. This systematic review examined providers' attitudes toward TMH-V through the lens of the unified theory of acceptance and use of technology (UTAUT). Findings suggest that providers have positive overall attitudes toward TMH-V despite describing multiple drawbacks. Therefore, the relative advantages of TMH-V, such as its ability to increase access to care, may outweigh its disadvantages, including technological problems, increased hassle, and perceptions of impersonality. Providers' attitudes may also be related to their degree of prior TMH-V experience, and acceptance may increase with use. Limitations and implications of findings for implementation efforts are discussed.
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Affiliation(s)
- Samantha L. Connolly
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Christopher J. Miller
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jan A. Lindsay
- HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Mark S. Bauer
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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23
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Cottrell MA, Hill AJ, O'Leary SP, Raymer ME, Russell TG. Clinicians' Perspectives of a Novel Home-Based Multidisciplinary Telehealth Service for Patients with Chronic Spinal Pain. Int J Telerehabil 2018; 10:81-88. [PMID: 30588279 PMCID: PMC6296799 DOI: 10.5195/ijt.2018.6249] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chronic spinal pain conditions can often be successfully managed by a non-surgical, multidisciplinary approach, however many individuals are unable to access such specialised services within their local community. A possible solution may be the delivery of care via telerehabilitation. This study aimed to evaluate clinicians' perspectives on providing clinical care via telerehabilitation during the early implementation of a novel spinal telerehabilitation service. Eight clinicians' were recruited, completing surveys at four separate time points. Confidence in providing treatment via telerehabilitation significantly improved with time (χ2(3)=16.22, p=0.001). Clinicians became significantly more accepting of telerehabilitation being a time- (χ2(3)=11.237, p=0.011), and cost-effective (χ2(3)=9.466, p=0.024) platform in which they could deliver care. Overall satisfaction was high, with technology becoming easier to use (p=0.026) and ability to establish rapport significantly improved with experience (p=0.043). Understanding clinicians' perspectives throughout the early implementation phase of a new telerehabilitation service is a critical component in determining long-term sustainability.
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Affiliation(s)
- Michelle A Cottrell
- SCHOOL OF HEALTH AND REHABILITATION SCIENCE, UNIVERSITY OF QUEENSLAND, QUEENSLAND, AUSTRALIA.,CENTRE FOR RESEARCH EXCELLENCE IN TELEHEALTH, UNIVERSITY OF QUEENSLAND, QUEENSLAND, AUSTRALIA.,PHYSIOTHERAPY DEPARTMENT, ROYAL BRISBANE & WOMEN'S HOSPITAL, QUEENSLAND, AUSTRALIA
| | - Anne J Hill
- SCHOOL OF HEALTH AND REHABILITATION SCIENCE, UNIVERSITY OF QUEENSLAND, QUEENSLAND, AUSTRALIA.,CENTRE FOR RESEARCH EXCELLENCE IN TELEHEALTH, UNIVERSITY OF QUEENSLAND, QUEENSLAND, AUSTRALIA
| | - Shaun P O'Leary
- SCHOOL OF HEALTH AND REHABILITATION SCIENCE, UNIVERSITY OF QUEENSLAND, QUEENSLAND, AUSTRALIA.,PHYSIOTHERAPY DEPARTMENT, ROYAL BRISBANE & WOMEN'S HOSPITAL, QUEENSLAND, AUSTRALIA.,STATE-WIDE NEUROSURGICAL AND ORTHOPAEDIC PHYSIOTHERAPY SCREENING CLINIC & MULTIDISCIPLINARY SERVICE, METRO NORTH HOSPITAL & HEALTH SERVICE, QUEENSLAND, AUSTRALIA
| | - Maree E Raymer
- STATE-WIDE NEUROSURGICAL AND ORTHOPAEDIC PHYSIOTHERAPY SCREENING CLINIC & MULTIDISCIPLINARY SERVICE, METRO NORTH HOSPITAL & HEALTH SERVICE, QUEENSLAND, AUSTRALIA
| | - Trevor G Russell
- SCHOOL OF HEALTH AND REHABILITATION SCIENCE, UNIVERSITY OF QUEENSLAND, QUEENSLAND, AUSTRALIA.,CENTRE FOR RESEARCH EXCELLENCE IN TELEHEALTH, UNIVERSITY OF QUEENSLAND, QUEENSLAND, AUSTRALIA
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24
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Fairchild R, Ferng Kuo SF, Laws S, O’Brien A, Rahmouni H. Perceptions of Rural Emergency Department Providers regarding Telehealth-Based Care: Perceived Competency, Satisfaction with Care and Tele-ED Patient Disposition. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojn.2017.77054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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