1
|
Barry R, Green E, Robson K, Nott M. Factors critical for the successful delivery of telehealth to rural populations: a descriptive qualitative study. BMC Health Serv Res 2024; 24:908. [PMID: 39113042 PMCID: PMC11308699 DOI: 10.1186/s12913-024-11233-3] [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: 03/19/2024] [Accepted: 06/23/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The use of telehealth has proliferated to the point of being a common and accepted method of healthcare service delivery. Due to the rapidity of telehealth implementation, the evidence underpinning this approach to healthcare delivery is lagging, particularly when considering the uniqueness of some service users, such as those in rural areas. This research aimed to address the current gap in knowledge related to the factors critical for the successful delivery of telehealth to rural populations. METHODS This research used a qualitative descriptive design to explore telehealth service provision in rural areas from the perspective of clinicians and describe factors critical to the effective delivery of telehealth in rural contexts. Semi-structured interviews were conducted with clinicians from allied health and nursing backgrounds working in child and family nursing, allied health services, and mental health services. A manifest content analysis was undertaken using the Framework approach. RESULTS Sixteen health professionals from nursing, clinical psychology, and social work were interviewed. Participants mostly identified as female (88%) and ranged in age from 26 to 65 years with a mean age of 47 years. Three overarching themes were identified: (1) Navigating the role of telehealth to support rural healthcare; (2) Preparing clinicians to engage in telehealth service delivery; and (3) Appreciating the complexities of telehealth implementation across services and environments. CONCLUSIONS This research suggests that successful delivery of telehealth to rural populations requires consideration of the context in which telehealth services are being delivered, particularly in rural and remote communities where there are challenges with resourcing and training to support health professionals. Rural populations, like all communities, need choice in healthcare service delivery and models to increase accessibility. Preparation and specific, intentional training for health professionals on how to transition to and maintain telehealth services is a critical factor for delivery of telehealth to rural populations. Future research should further investigate the training and supports required for telehealth service provision, including who, when and what training will equip health professionals with the appropriate skill set to deliver rural telehealth services.
Collapse
Affiliation(s)
- Rebecca Barry
- Three Rivers Department of Rural Health, Charles Sturt University, Locked Bag 588, Tooma Way, Wagga Wagga, NSW, 2678, Australia.
| | - Elyce Green
- Three Rivers Department of Rural Health, Charles Sturt University, Locked Bag 588, Tooma Way, Wagga Wagga, NSW, 2678, Australia
| | - Kristy Robson
- Three Rivers Department of Rural Health, Charles Sturt University, Locked Bag 588, Tooma Way, Wagga Wagga, NSW, 2678, Australia
| | - Melissa Nott
- Three Rivers Department of Rural Health, Charles Sturt University, Locked Bag 588, Tooma Way, Wagga Wagga, NSW, 2678, Australia
| |
Collapse
|
2
|
Mosadeghrad AM, Afshari M, Isfahani P, Ezzati F, Abbasi M, Farahani SA, Zahmatkesh M, Eslambolchi L. Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review. BMC Health Serv Res 2024; 24:841. [PMID: 39054502 PMCID: PMC11270795 DOI: 10.1186/s12913-024-11278-4] [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: 01/14/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Primary Health Care (PHC) systems are pivotal in delivering essential health services during crises, as demonstrated during the COVID-19 pandemic. With varied global strategies to reinforce PHC systems, this scoping review consolidates these efforts, identifying and categorizing key resilience-building strategies. METHODS Adopting Arksey and O'Malley's scoping review framework, this study synthesized literature across five databases and Google Scholar, encompassing studies up to December 31st, 2022. We focused on English and Persian studies that addressed interventions to strengthen PHC amidst COVID-19. Data were analyzed through thematic framework analysis employing MAXQDA 10 software. RESULTS Our review encapsulated 167 studies from 48 countries, revealing 194 interventions to strengthen PHC resilience, categorized into governance and leadership, financing, workforce, infrastructures, information systems, and service delivery. Notable strategies included telemedicine, workforce training, psychological support, and enhanced health information systems. The diversity of the interventions reflects a robust global response, emphasizing the adaptability of strategies across different health systems. CONCLUSIONS The study underscored the need for well-resourced, managed, and adaptable PHC systems, capable of maintaining continuity in health services during emergencies. The identified interventions suggested a roadmap for integrating resilience into PHC, essential for global health security. This collective knowledge offered a strategic framework to enhance PHC systems' readiness for future health challenges, contributing to the overall sustainability and effectiveness of global health systems.
Collapse
Affiliation(s)
- Ali Mohammad Mosadeghrad
- Health policy and management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Afshari
- Health policy, School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran
| | - Parvaneh Isfahani
- Health management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Farahnaz Ezzati
- Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Abbasi
- Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Akhavan Farahani
- Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Zahmatkesh
- Health Management, School of Business and Management, Royal Holloway University of London, London, UK
| | - Leila Eslambolchi
- Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
3
|
Taylor C, Mitchell C, Kaneko H, Foley B, Shaw J. Review of the Australian nurse teacher professional practice standards: An e-Delphi study. Nurse Educ Pract 2024; 79:104045. [PMID: 38991261 DOI: 10.1016/j.nepr.2024.104045] [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: 03/15/2024] [Revised: 04/30/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
AIM The aim of the study was to review the 2010 Australian nurse teacher professional practice standards ('the Standards') to see if they were still relevant to current nursing educator practice in any practice setting, such as academia or clinical settings. BACKGROUND It has been over 10 years since 'the Standards have been reviewed. Nurse education practice has met many challenges in the past decade, so it is timely to evaluate whether the Standards are still relevant to nursing educators today. DESIGN A modified Delphi technique was used for this study. METHODS Delphi surveys were used to obtain consensus on the relevance of the Standards' statements to any nursing educator. Links to two electronic surveys were sent to an expert panel of nursing educator leaders. Also, two online focus groups of nursing educators from any practice setting or level of experience were held. Results from the first survey and focus groups led to word changes and additional statements, which were included in the second Delphi survey. RESULTS Forty participants responded to the first survey and 38 to the second. Fifteen nursing educators attended the focus groups. There was ≥85 % agreement on all statements in the first survey. with similar high agreement responses in the second survey. Changes in the Standards included language used around culture, inclusion of 'sustainability of the program' and 'demonstrates knowledge and expertise in teaching and educational practice'. CONCLUSIONS The Australian nurse teacher professional practice standards remain highly relevant to nursing educators across all practice settings. In response to feedback from nursing educators some changes to language and additional standard statements were included in the revised standards.
Collapse
Affiliation(s)
- Christine Taylor
- School of Nursing and Midwifery, Western Sydney University, NSW, Australia; NSW Centre for Evidence-Based Health Care: A Joanna Briggs Institute Affiliated Centre, Rydalmere, NSW, Australia.
| | - Creina Mitchell
- School of Nursing and Midwifery, Griffith University, QLD, Australia
| | - Hellen Kaneko
- Queensland Digital Academy, Queensland Health, QLD, Australia
| | - Belinda Foley
- The Tweed Hospital, Northern NSW Local Health District, NSW, Australia
| | - Julie Shaw
- Department of Nursing and Allied Health, Swinburne University of Technology, VIC, Australia
| |
Collapse
|
4
|
White SJ, Nguyen AD, Roger P, Tse T, Cartmill JA, Hatem S, Willcock SM. Tailoring communication practices to support effective delivery of telehealth in general practice. BMC PRIMARY CARE 2024; 25:232. [PMID: 38937674 PMCID: PMC11210157 DOI: 10.1186/s12875-024-02441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/22/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The unprecedented increase in telehealth use due to COVID-19 has changed general practitioners' (GP) and patients' engagement in healthcare. There is limited specific advice for effective communication when using telehealth. Examining telehealth use in practice in conjunction with perspectives on telehealth as they relate to communication allows opportunities to produce evidence-based guidance for optimal use of telehealth, while also offering practitioners the opportunity to reflect on elements of their communicative practice common to both styles of consultation. The objective of this research was to develop evidence-based resources to support effective, person-centred communication when GPs and patients use telehealth. This included examination of interactional practices of recorded telehealth consultations, exploration of GP and patient perspectives relating to telehealth, and identifying priorities for guidance informed by these analyses as well as participant co-design. METHODS This study involved recording telehealth consultations (n = 42), conducting patient surveys (n = 153), and interviewing patients (n = 9) and GPs (n = 15). These were examined using interaction analytic methods, quantitative analysis, and thematic analyses, to create a robust, integrated picture of telehealth practice and perspectives. The process of research translation involved a co-design approach, engaging with providers, patients, and policy makers to facilitate development of evidence-based principles that focus on supporting effective communication when using telehealth. RESULTS Three key themes relating to communication in telehealth were identified across the different analyses. These were relationship building, conversational flow, and safety netting. The draft best practice principles drawn from these themes were modified based on co-design feedback into five Best Practice Principles for Communication between GPs and Patients using Telehealth. CONCLUSIONS Effective communication is supported through relationship building and attention to conversational flow in telehealth consultations, which in turn allows for safety netting to occur. In telehealth, GPs and patients recognise that not being co-present changes the consultation and use both intuitive and strategic interactional adjustments to support their exchange. The mixed-method examination of experiences through both a detailed analysis of telehealth consultations in practice and comparative exploration of GP and patient perspectives enabled the identification of principles that can support effective communication when using telehealth. Co-design helped ensure these principles are ready for implementation into practice.
Collapse
Affiliation(s)
- Sarah J White
- Centre for Social Impact, UNSW Sydney, 704, Level 7, Science Engineering Building (E8), Kensington, NSW, 2052, Australia.
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Amy D Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- St Vincent's Clinical Campus, UNSW Sydney, Darlinghurst, NSW, Australia
| | - Peter Roger
- Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Tim Tse
- Department of Primary Care, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - John A Cartmill
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sarah Hatem
- Department of Primary Care, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Simon M Willcock
- Department of Primary Care, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| |
Collapse
|
5
|
De Guzman KR, Smith AC, Snoswell CL. General practitioner preferences for telehealth consultations in Australia: a pilot survey and discrete choice experiment. Prim Health Care Res Dev 2024; 25:e28. [PMID: 38721700 DOI: 10.1017/s1463423624000136] [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] [Indexed: 05/16/2024] Open
Abstract
AIM To identify and quantify general practitioner (GP) preferences related to service attributes of clinical consultations, including telehealth consultations, in Australia. BACKGROUND GPs have been increasingly using telehealth to deliver patient care since the onset of the 2019 coronavirus disease (COVID-19) pandemic. GP preferences for telehealth service models will play an important role in the uptake and sustainability of telehealth services post-pandemic. METHODS An online survey was used to ask GPs general telehealth questions and have them complete a discrete choice experiment (DCE). The DCE elicited GP preferences for various service attributes of telehealth (telephone and videoconference) consultations. The DCE investigated five service attributes, including consultation mode, consultation purpose, consultation length, quality of care and rapport, and patient co-payment. Participants were presented with eight choice sets, each containing three options to choose from. Descriptive statistics was used, and mixed logit models were used to estimate and analyse the DCE data. FINDINGS A total of 60 GPs fully completed the survey. Previous telehealth experiences impacted direct preferences towards telehealth consultations across clinical presentations, although in-person modes were generally favoured (in approximately 70% of all scenarios). The DCE results lacked statistical significance which demonstrated undiscernible differences between GP preferences for some service attributes. However, it was found that GPs prefer to provide a consultation with good quality care and rapport (P < 002). GPs would also prefer to provide care to their patients rather than decline a consultation due to consultation mode, length or purpose (P < 0.0001). Based on the findings, GPs value the ability to provide high-quality care and develop rapport during a clinical consultation. This highlights the importance of recognising value-based care for future policy reforms, to ensure continued adoption and sustainability of GP telehealth services in Australia.
Collapse
Affiliation(s)
- Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| |
Collapse
|
6
|
Azar R, Chan R, Sarkisian M, Burns RD, Marcin JP, Gotthardt C, De Guzman KR, Rosenthal JL, Haynes SC. Adapting telehealth to address health equity: Perspectives of primary care providers across the United States. J Telemed Telecare 2024:1357633X241238780. [PMID: 38515372 DOI: 10.1177/1357633x241238780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Telehealth has the potential to increase access to care for medically underserved patients. This qualitative study aimed to identify telecare practices used during the COVID-19 pandemic to meet the needs of patients experiencing homelessness, patients with disabilities, and patients with language preference other than English (LOE). METHODS We conducted a secondary qualitative data analysis of 47 clinician interviews at Federally Qualified Health Centers (FQHCs) around the country. Using thematic analysis, transcripts were coded by line-by-line by five qualitative researchers. A multidisciplinary team of telehealth experts, researchers and primary care clinicians reviewed memos and excerpts to generate major themes. RESULTS We identified six main areas demonstrating how community providers developed strategies or practices to improve access to care for vulnerable patients: reaching patients experiencing homelessness, serving deaf and hard of hearing patients, improving access for patients with disabilities, serving patients with LOE, improving access for mental and behavioral health services, and educating patients about telehealth. During the pandemic, FQHCs developed innovative solutions to provide access to care for the unhoused, including using telehealth in shelters, vans, and distributing devices like mobile phones and tablets. Telehealth reduced transportation burdens for patients with disabilities and reduced no-show rates for mental health services by adapting group therapy via telehealth features (like break-out rooms) and increasing provider capacity. CONCLUSION Our study identified strategies adopted by FQHCs to serve underserved populations during the COVID-19 pandemic. Our findings highlight the need for enduring strategies to improve health equity through telehealth..
Collapse
Affiliation(s)
- Rachel Azar
- UC Davis School of Medicine, Sacramento, CA, USA
| | - Rachel Chan
- UC Davis School of Medicine, Sacramento, CA, USA
| | | | | | - James P Marcin
- UC Davis School of Medicine, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Health, Sacramento, CA, USA
- Center for Health and Technology, UC Davis Health, Sacramento, CA, USA
| | | | - Keshia R De Guzman
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Jennifer L Rosenthal
- UC Davis School of Medicine, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Health, Sacramento, CA, USA
- Center for Health and Technology, UC Davis Health, Sacramento, CA, USA
| | - Sarah C Haynes
- UC Davis School of Medicine, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Health, Sacramento, CA, USA
- Center for Health and Technology, UC Davis Health, Sacramento, CA, USA
| |
Collapse
|
7
|
Traynor NM, Hughes M, Wood A, Onslow G, Edwards K, Clements J, Kohlhoff J. Supporting families with complex early parenting needs through a virtual residential parenting service: An investigation of outcomes, facilitators and barriers. J Clin Nurs 2024; 33:1122-1133. [PMID: 37962242 DOI: 10.1111/jocn.16927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
AIM To investigate clients' perspectives about outcomes of a telehealth residential unit (RU) program for families experiencing complex early parenting issues, and to explore facilitators and barriers to positive client outcomes. DESIGN Qualitative study using semi-structured interviews. METHODS Semi-structured interviews were conducted with mothers (n = 18) admitted to a telehealth RU program. Interview transcripts were analysed using thematic analysis. RESULTS Mothers reported short-term improvements in their child's presenting issues (e.g. feeding to sleep, night-time waking, co-sleeping), increased confidence and increased partner involvement. According to participants, program outcomes were facilitated by a positive parent-clinician relationship, the accessibility of clinicians and being able to take part in the program from their own home. Barriers included difficulties with technical equipment and connecting with the clinician overnight, and challenges with implementing strategies in the longer term. CONCLUSION This nurse-led telehealth program was viewed positively by parents and the study identified a number of areas for improvement. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Telehealth early parenting programs provide an important way for parents to receive support with early child sleep, settling and feeding issues. Clinicians working in this area should focus on the development of positive parent-nurse relationships, enhancing communication and availability for parents during overnight periods and supporting parents to develop early parenting skills that will be applicable across the early childhood period. IMPACT The study is the first to address client experiences of a telehealth RU program. Facilitators and barriers identified will inform service improvements to the program going forward, and similar telehealth programs for families; to ensure benefits and service outcomes are maximised for parents for such a crucial service. REPORTING METHOD The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative research were followed.
Collapse
Affiliation(s)
- Nicole M Traynor
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | | | - Angela Wood
- Karitane, Kensington, New South Wales, Australia
| | | | | | | | - Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Karitane, Kensington, New South Wales, Australia
| |
Collapse
|
8
|
Babaei N, Zamanzadeh V, Valizadeh L, Lotfi M, Kousha A, Samad-Soltani T, Avazeh M. Virtual care in the health care system: A concept analysis. Scand J Caring Sci 2024; 38:35-46. [PMID: 38009448 DOI: 10.1111/scs.13227] [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: 08/05/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Health care providers need a better understanding of virtual care to recognise and use it for service delivery. AIM To provide a more comprehensive definition of the concept of virtual care. METHOD This study was conducted based on Walker and Avant's concept analysis method. A comprehensive review of the published texts in English from 2012 to 2022 was performed using the PubMed, Web of Science, Scopus, ProQuest, Science Direct, Ovid, CINAHL and Google Scholar databases. RESULTS The main aspects and attributes of virtual care, including the use of any information and communication technology in various formats such as platforms, telephone calls, messages, email consultation, remote monitoring, secure and two-way digital communication between health care providers and patients, the possibility of providing remote care synchronously or asynchronously, more interaction between patients and caregivers, the possibility of transferring information between patients and health care providers and within the teams themselves, symptom management, sending diagnostic results in the form of video visits, and providing follow-up care, are attributes that distinguish virtual care from telehealth, telemedicine and other methods of providing remote healthcare services. CONCLUSION Considering the positive and negative consequences of implementing virtual care, the findings of this study developed a basis for an operational definition of the concept so that providers can understand the meaning of virtual care and consider it when providing virtual care to patients. The findings of this study can be used in many international and national contexts in the health care system and in future studies on interventions to increase the use of virtual care.
Collapse
Affiliation(s)
- Nasib Babaei
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Vahid Zamanzadeh
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Valizadeh
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Lotfi
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Kousha
- Department of Health Education and Health Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taha Samad-Soltani
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Marziyeh Avazeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
9
|
Gabay G, Ornoy H, Gere A, Moskowitz H. Personalizing Communication of Clinicians with Chronically Ill Elders in Digital Encounters-A Patient-Centered View. Healthcare (Basel) 2024; 12:434. [PMID: 38391809 PMCID: PMC10888115 DOI: 10.3390/healthcare12040434] [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: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Chronically ill elderly patients are concerned about losing the personal connection with clinicians in digital encounters and clinicians are concerned about missing nonverbal cues that are important for the diagnosis, thus jeopardizing quality of care. AIMS This study validated the expectations and preferences of chronically ill elderly patients regarding specific communication messages for communication with clinicians in telemedicine. METHODS The sample comprised 600 elderly chronically ill patients who use telehealth. We used a conjoint-based experimental design to test numerous messages. The outcome variable is elder patient expectations from communication with clinicians in telemedicine. The independent variables were known categories of patient-clinician communication. Respondents rated each of the 24 vignettes of messages. RESULTS Mathematical clustering yielded three mindsets, with statistically significant differences among them. Members of mindset 1 were most concerned with non-verbal communication, members of mindset 2 prefer communication that enhances the internal locus of control, and members of mindset 3 have an external locus of control and strongly oppose any dialogue about their expectations from communication. CONCLUSIONS The use of the predictive algorithm that we developed enables clinicians to identify the belonging of each chronically ill elderly patient in the clinic to a sample mindset, and to accordingly personalize the communication in the digital encounters while structuring the encounter with greater specificity, therefore enhancing patient-centered care.
Collapse
Affiliation(s)
- Gillie Gabay
- Faculty of Social Sciences, Achva Academic College, Arugot 7980400, Israel
| | - Hana Ornoy
- Faculty of Business, Ono Academic College, Kiryat Ono 5545173, Israel
| | - Attila Gere
- Institute of Food Science and Technology, Hungarian University of Agriculture and Life Sciences, 1118 Budapest, Hungary
| | | |
Collapse
|
10
|
Matta-Machado ATGD, Pinto RDS, Peixoto RTRDC, Perillo RD, Borde EMS, Freitas MACD, Macieira C, Senna MIB, Godoy SCB, Aguiar RATD, Santos DF, Dramos LMM, Oliveira VBD, Santos ADFD. Use of Telehealth Resources in Primary Care and Its Association with Facing the COVID-19 Pandemic in Minas Gerais, Brazil. Telemed J E Health 2023; 29:1878-1889. [PMID: 37751188 DOI: 10.1089/tmj.2022.0441] [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] [Indexed: 09/27/2023] Open
Abstract
Introduction: Use of telehealth (TH) resources increased dramatically during the COVID-19 pandemic. This study set out to examine associations between the level of integration of TH resources and the level of Primary Health Care (PHC) structuring to deal with the COVID-19 pandemic in the State of Minas Gerais, Brazil. Methods: This work was a cross-sectional study conducted through the application of a semistructured questionnaire to a sample of 260 PHC Teams working in the state of Minas Gerais, Brazil, from September to December 2020. This study was approved by the Research Ethics Committee and logged under report number 44.294.637. Results: Two variables were created - Level of the PHC structuring to deal with the COVID-19 pandemic and Level of TH structuring. Variables were grouped into five categories (poor to excellent). Associations between variables were examined using the Tukey's test for multiple comparisons and the Spearman correlation coefficient. Variables associated with socioeconomic dimensions (human development index and Gini index) and health care were also analyzed. Levels of TH structuring in PHC ranged from poor (43%) to regular (40%) in most cases. Most PHC teams had regular (56%) or good (37%) levels of PHC structuring to deal with the pandemic. The greater the availability and use of TH resources at a given unit, the better the structure to face COVID-19 (0.45 - p < 0.001). Conclusion: PHC was structured to tackle the pandemic. However, there is a lot to be done before TH resources are effectively incorporated into PHC. Whenever incorporated, TH resources contributed to a more robust response to the COVID-19 pandemic.
Collapse
Affiliation(s)
| | - Rafaela da Silveira Pinto
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Rosângela Durso Perillo
- Faculdade de Medicina, Telehealth Nucleus, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Elis Mina Seraya Borde
- Department of Social and Preventive Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - César Macieira
- Universidade Federal de Minas Gerais, Faculdade de Medicina - Belo Horizonte (MG), Brazil
| | - Maria Inês Barreiros Senna
- Department of Dental Clinic, Pathology and Surgery, Faculdade de Odontologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Delba Fonseca Santos
- Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | | | - Veneza Berenice de Oliveira
- Department of Social and Preventive Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Alaneir de Fátima Dos Santos
- Department of Social and Preventive Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Faculdade de Medicina, Telehealth Nucleus, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
11
|
Smart S, Imms D, Brewer M. Virtual nourishment: Paediatric feeding disorder management with telepractice amidst COVID-19: An allied health perspective. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-11. [PMID: 37933463 DOI: 10.1080/17549507.2023.2264550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE The rapid adoption of telepractice services by health professionals was necessary to maintain service continuity for children with paediatric feeding disorders during the COVID-19 pandemic, during periods where in-person therapy was restricted. The aim of this study was to explore clinical perspectives and reflections on the use of telepractice for managing paediatric feeding disorders during the pandemic. METHOD A post-positivist qualitative approach using thematic analysis was adopted. This study seeks to understand participants' experiences and thoughts from allied health professionals from speech-language pathology, occupational therapy, and dietetics working with paediatric feeding in Western Australia. All participants delivered at least 10 telepractice sessions to children from birth to 12 years with a paediatric feeding disorder. Braun and Clarke's six-step thematic analysis process was used to analyse the data inductively. RESULT Eleven allied health professionals representing eight clinical settings in Western Australia, including speech-language pathology, occupational therapy, and dietetics, working with paediatric feeding were recruited. The results revealed four themes: families becoming the catalyst of change, clinician comfort over confidence, insights into authentic mealtimes, and the paradox of choice. CONCLUSION This study highlighted the need to build clinicians' confidence and competence, and the provision of service guidelines and training. Although many clinicians had positive experiences with telepractice, most returned to in-person delivery once COVID-19 restrictions were lifted, emphasising the importance of comfort in service delivery selection. We recognise that the findings of this study are constrained by the fact that it was conducted in a single geographical region and utilised a small qualitative sample. While telepractice was successful in managing paediatric feeding disorders, further development and implementation of telepractice guidelines are needed for telepractice to be a viable service delivery option for families and children with feeding disorders.
Collapse
|
12
|
Dos Santos ADF, Pacheco-López A, Hidalgo ACC, Urteaga BIC, Marcillo DCA, López E, de Abreu MP, Robles OI, Arévalo RHR, Cano SED, Mejía SEG, Rondon SBRC, Montoya YAH, Rivadeneira RGC. Telehealth Actions to Address COVID-19 in Latin American Countries. Telemed J E Health 2023; 29:1650-1658. [PMID: 36944148 DOI: 10.1089/tmj.2022.0432] [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] [Indexed: 03/23/2023] Open
Abstract
Introduction: This study set out to examine the use of telehealth resources to tackle the coronavirus disease 2019 (COVID-19) pandemic in Latin America within the scope of national telehealth projects (NTPs). Methods: A qualitative study developed using ethnomethodology for appropriate understanding of how telehealth actions were carried out in practice during the COVID-19 pandemic within the scope of NTPs, in the following countries: Argentina, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Peru, and Uruguay. The study was carried out from October to 2020 to March 2021. The number of participations in the discussion groups, formed by coordinating teams of NTPs, totaled 90. Results were described in the worksheet completed according to the script. Each country reviewed its respective data, three times on average, in an effort to clarify actions developed. Results: Three groups of countries were identified: (1) Countries with a telehealth background that used these resources to tackle COVID-19 and thereby refined telehealth activities. Countries with greater experience in NTP design, such as Mexico, Colombia, Peru, and Argentina, were able to use a wide range of telehealth activities to tackle the pandemic, with offers of teleconsultation, teleguidance, telemonitoring to patients, and training of health professionals; (2) Countries with some telehealth activities to address COVID-19. Uruguay, Ecuador, El Salvador, and Costa Rica; and (3) Countries with no evidence of telehealth resource use during the pandemic. Honduras and Guatemala. Discussion: Most NTPs in Latin America have improved their telehealth activities, contributing to address the COVID-19 pandemic in Latin America.
Collapse
Affiliation(s)
- Alaneir de Fátima Dos Santos
- Federal University of Minas Gerais, Faculty of Medicine of Medicine, Preventive and Social Medicina, Belo Horizonte, Brazil
| | - Adrian Pacheco-López
- Telehealth Directorate, National Center of Technological Excellence in Health of the Federal Secretary of Health of Mexico, Mexico City, Mexico
| | | | | | | | - Emiliano López
- National Director of Human Talent and Knowledge, Ministry of Health of the Argentina
| | - Monica Pena de Abreu
- Center for Health Technology of the Faculty of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Antonacci G, Benevento E, Bonavitacola S, Cannavacciuolo L, Foglia E, Fusi G, Garagiola E, Ponsiglione C, Stefanini A. Healthcare professional and manager perceptions on drivers, benefits, and challenges of telemedicine: results from a cross-sectional survey in the Italian NHS. BMC Health Serv Res 2023; 23:1115. [PMID: 37853448 PMCID: PMC10585875 DOI: 10.1186/s12913-023-10100-x] [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: 11/29/2022] [Accepted: 10/01/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service. METHODS An online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis. RESULTS Key factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations' semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can't completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers. CONCLUSIONS Respondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process.
Collapse
Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK.
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK.
| | - Elisabetta Benevento
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Pisa, Italy
| | | | | | - Emanuela Foglia
- Healthcare Datascience LAB, LIUC- Carlo Cattaneo University, Castellanza, VA, Italy
| | - Giulia Fusi
- LIUC- Cattaneo University, Castellanza, VA, Italy
| | - Elisabetta Garagiola
- Healthcare Datascience LAB, LIUC- Carlo Cattaneo University, Castellanza, VA, Italy
| | - Cristina Ponsiglione
- Department of Industrial Engineering, University of Naples Federico II, Naples, Italy
| | - Alessandro Stefanini
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Pisa, Italy
- School of Economics and Business, Kaunas University of Technology, Kaunas, Lithuania
| |
Collapse
|
14
|
Ward K, Vagholkar S, Lane J, Raghuraman S, Lau AYS. Are chronic condition management visits translatable to telehealth? Analysis of in-person consultations in primary care. Int J Med Inform 2023; 178:105197. [PMID: 37619394 DOI: 10.1016/j.ijmedinf.2023.105197] [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: 05/26/2023] [Revised: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Telehealth was rapidly adopted in primary care during COVID-19. However, there is a lack of research assessing how translatable in-person consultations are to telehealth. OBJECTIVE To examine insights from in-person GP-Patient consultations for patients with chronic conditions, including 1/frequency, duration, conditions of physical examinations, and when they occur during consultations, 2/types of physical artefacts used, 3/clinical tasks performed, and 4/translatability of clinical tasks to telehealth. METHODS Eligible consultations were extracted from a dataset archive named HaRI, which contains 281 in-person GP consultations in de-identified transcript and video format. 38 consultations were included for analysis meeting eligibility criteria in this study. A multi-method approach (using content analysis, visualisation, video and time analysis) was applied to eligible consultations, extracting clinical tasks that involve physical interactions. Finally, an evidence-based scoring system was used on each clinical task, determining the likelihood of whether each task could be translated into telehealth. RESULTS Nine chronic conditions were observed across 38 GP-Patient consultations, predominately diabetes (39 %, 15/38). Out of these 38 consultations, 76 % (29/38) featured physical examinations, where 68 % (26/38) were initiated by GPs (e.g., auscultation), and 26 % (10/38) were initiated by patients (e.g., self-palpation). The average percentage of time spent on physical examination(s) during consultations is low (13.6 %, SD = 9.4 %). A total of 24 clinical tasks were observed across these 38 consultations. Out of these 24 tasks, 92 % (22/24) were supported by physical artefacts. The average score of a task being translatable to Telehealth is 7/10 (where Score 1 = Not amenable to being replicated over telehealth at this stage, scoring 10 = Easily translatable over telehealth with almost no additional equipment being required). CONCLUSION All tasks observed across chronic condition management visits were deemed translatable/potentially translatable to telehealth. However, physical interactions between GPs and patients are still essential. Future research in telehealth should focus on examining ways to support physical examination, reduce uncertainty, promote safety netting, and facilitate patients' safety at home with effective technology and support.
Collapse
Affiliation(s)
- Kanesha Ward
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Sanjyot Vagholkar
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jared Lane
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sunayana Raghuraman
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
15
|
Godinho MA, Ashraf MM, Narasimhan P, Liaw ST. Understanding the convergence of social enterprise, digital health, and citizen engagement for co-producing integrated Person-Centred health services: A critical review and theoretical framework. Int J Med Inform 2023; 178:105174. [PMID: 37573637 DOI: 10.1016/j.ijmedinf.2023.105174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION To achieve Universal Health Coverage and the United Nations' (UN) Sustainable Development Goals (SDGs) agenda for 2030, the World Health Organisation (WHO) recommended the use of social enterprise, digital technology, and citizen engagement in the delivery of Integrated People-Centred Health Services (IPCHS) as part of its strategic vision for 21st century primary care. METHODS We conducted a hermeneutic review of frameworks, models and theories on social enterprise, digital health, citizen engagement and IPCHS. This involved multiple iterative cycles of (i) searching and acquisition, followed by (ii) critical analysis and interpretation of literature to assemble arguments and evidence for conceptual relationships until information saturation was reached. This process identified a set of constructs which we synthesised into a testable framework. RESULTS Several interdisciplinary frameworks, models and theories explain how social enterprises could use digital technology, and citizen engagement to enable the technical and social integration required to facilitate people-centred primary care. Innovative approaches can be used to maintain financial sustainability while delivering IPCHS at lower cost to vulnerable and marginalised populations in both developed and developing countries. CONCLUSION This framework provides a theoretical grounding to guide empirical inquiry into how social enterprises use digital technology to engage citizens in co-producing IPCHS.
Collapse
Affiliation(s)
- Myron Anthony Godinho
- WHO Collaborating Centre for eHealth, School of Population Health, UNSW Sydney, Australia; Yunus Social Business Health Hub, School of Population Health, UNSW Sydney, Australia
| | - Md Mahfuz Ashraf
- Entrepreneurship and Innovation, Crown Institute of Higher Education, Sydney, Australia
| | - Padmanesan Narasimhan
- WHO Collaborating Centre for eHealth, School of Population Health, UNSW Sydney, Australia; Yunus Social Business Health Hub, School of Population Health, UNSW Sydney, Australia
| | - Siaw-Teng Liaw
- WHO Collaborating Centre for eHealth, School of Population Health, UNSW Sydney, Australia; Yunus Social Business Health Hub, School of Population Health, UNSW Sydney, Australia.
| |
Collapse
|
16
|
Hattingh HL, Edmunds C, Buksh S, Cronin S, Gillespie BM. COVID-19 Patients' Medication Management during Transition of Care from Hospital to Virtual Care: A Cross-Sectional Survey and Audit. PHARMACY 2023; 11:157. [PMID: 37888502 PMCID: PMC10610024 DOI: 10.3390/pharmacy11050157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Virtual models of care were implemented to ease hospital bed pressure during COVID-19. We evaluated the medication management of COVID-19 patients transferred to virtual models of care. METHOD A retrospective audit of COVID-19 patients transferred from inpatient units to virtual care during January 2022 and surveys from patients transferred during December 2021-February 2022 was carried out. RESULTS One hundred patients were randomly selected: mean age 59 years (SD: 19.8), mean number of medicines at admission 4.3 (SD: 4.03), mean length of virtual ward stay 4.4 days (SD: 2.1). Pharmacists reviewed 43% (43/100) of patients' medications during their hospital stay and provided 29% (29/100) with discharge medicine lists at transfer. Ninety-two (92%) patients were prescribed at least one new high-risk medicine whilst in hospital, but this was not a factor considered to receive a pharmacist medication review. Forty patients (40%) were discharged on newly commenced high-risk medicines, and this was also not a factor in receiving a pharmacist discharge medication list. In total, 25% of patient surveys (96/378) were returned: 70% (66/96) reported adequate medicine information at transfer and 55% (52/96) during the virtual model period. CONCLUSION Patient survey data show overall positive experiences of medication management and support. Audit data highlight gaps in medication management during the transfer to a virtual model, highlighting the need for patient prioritisation.
Collapse
Affiliation(s)
- H. Laetitia Hattingh
- Allied Health Research, Gold Coast Health, Gold Coast, QLD 4215, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
- School of Pharmacy, the University of Queensland, Brisbane, QLD 4102, Australia
| | - Catherine Edmunds
- Medical Services, Clinical Governance and Research, Gold Coast Health, Gold Coast, QLD 4215, Australia;
| | - Saberina Buksh
- Pharmacy Department, Gold Coast Health, Gold Coast, QLD 4215, Australia; (S.B.); (S.C.)
| | - Sean Cronin
- Pharmacy Department, Gold Coast Health, Gold Coast, QLD 4215, Australia; (S.B.); (S.C.)
| | - Brigid M. Gillespie
- NHMRC Wiser Wounds CRE, MHIQ, Griffith University, Gold Coast, QLD 4222, Australia;
- Nursing and Midwifery Education and Research Unit, Gold Coast Health, Gold Coast, QLD 4215, Australia
| |
Collapse
|
17
|
Karampatakis GD, Wood HE, Griffiths CJ, Lea NC, Ashcroft RE, Day B, Walker N, Coulson NS, De Simoni A. Ethical and Information Governance Considerations for Promoting Digital Social Interventions in Primary Care. J Med Internet Res 2023; 25:e44886. [PMID: 37756051 PMCID: PMC10568391 DOI: 10.2196/44886] [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: 12/07/2022] [Revised: 04/28/2023] [Accepted: 07/31/2023] [Indexed: 09/28/2023] Open
Abstract
Promoting online peer support beyond the informal sector to statutory health services requires ethical considerations and evidence-based knowledge about its impact on patients, health care professionals, and the wider health care system. Evidence on the effectiveness of digital interventions in primary care is sparse, and definitive guidance is lacking on the ethical concerns arising from the use of social media as a means for health-related interventions and research. Existing literature examining ethical issues with digital interventions in health care mainly focuses on apps, electronic health records, wearables, and telephone or video consultations, without necessarily covering digital social interventions, and does not always account for primary care settings specifically. Here we address the ethical and information governance aspects of undertaking research on the promotion of online peer support to patients by primary care clinicians, related to medical and public health ethics.
Collapse
Affiliation(s)
- Georgios Dimitrios Karampatakis
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Helen E Wood
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Chris J Griffiths
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Nathan C Lea
- Department of Medical Informatics & Statistics, The European Institute for Innovation through Health Data, Ghent University Hospital, Ghent, Belgium
| | | | - Bill Day
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Neil Walker
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Neil S Coulson
- Medical School, Nottingham City Hospital, Nottingham, United Kingdom
| | - Anna De Simoni
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
18
|
Thomas E, Lee CMY, Norman R, Wells L, Shaw T, Nesbitt J, Frean I, Baxby L, Bennett S, Robinson S. Patient Use, Experience, and Satisfaction With Telehealth in an Australian Population (Reimagining Health Care): Web-Based Survey Study. J Med Internet Res 2023; 25:e45016. [PMID: 37590037 PMCID: PMC10472164 DOI: 10.2196/45016] [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: 12/13/2022] [Revised: 03/27/2023] [Accepted: 04/28/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic triggered a rapid scale-up of telehealth services in Australia as a means to provide continued care through periods of physical restrictions. The factors that influence engagement in telehealth remain unclear. OBJECTIVE The purpose of this study is to understand the experience of Australian people who engaged in a telehealth consultation during the pandemic period (2020-2021) and the demographic factors that influence engagement. METHODS A web-based survey was distributed to Australians aged over 18 years that included 4 questions on frequency and type of clinical consultation, including with a general practitioner (GP), specialist, allied health, or nurse; 1 question on the experience of telehealth; and 2 questions on the quality of and satisfaction with telehealth. Statistical analysis included proportion of responses (of positive responses where a Likert scale was used) and regression analyses to determine the effect of demographic variables. RESULTS Of the 1820 participants who completed the survey, 88.3% (1607/1820) had engaged in a health care consultation of some type in the previous 12 months, and 69.3% (1114/1607) of those had used telehealth. The most common type of consultation was with a GP (959/1114, 86.1%). Older people were more likely to have had a health care consultation but less likely to have had a telehealth consultation. There was no difference in use of telehealth between metropolitan and nonmetropolitan regions; however, people with a bachelor's degree or above were more likely to have used telehealth and to report a positive experience. A total of 87% (977/1114) of participants agreed or strongly agreed that they had received the information they required from their consultation, 71% (797/1114) agreed or strongly agreed that the outcome of their consultation was the same as it would have been face-to-face, 84% (931/1114) agreed or strongly agreed that the doctor or health care provider made them feel comfortable, 83% (924/1114) agreed or strongly agreed that the doctor or health care provider was equally as knowledgeable as providers they have seen in person; 57% (629/1114) of respondents reported that they would not have been able to access their health consultation if it were not for telehealth; 69% (765/1114) of respondents reported that they were satisfied with their telehealth consultation, and 60% (671/1114) reported that they would choose to continue to use telehealth in the future. CONCLUSIONS There was a relatively high level of engagement with telehealth over the 12 months leading up to the study period, and the majority of participants reported a positive experience and satisfaction with their telehealth consultation. While there was no indication that remoteness influenced telehealth usage, there remains work to be done to improve access to older people and those with less than a bachelor's degree.
Collapse
Affiliation(s)
- Elizabeth Thomas
- School of Population Health, Curtin University, Bentley, Australia
- Medical School, The University of Western Australia, Perth, Australia
| | | | - Richard Norman
- School of Population Health, Curtin University, Bentley, Australia
| | - Leanne Wells
- Consumers Health Forum of Australia, Canberra, Australia
| | - Tim Shaw
- Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Julia Nesbitt
- Consumers Health Forum of Australia, Canberra, Australia
| | - Isobel Frean
- Digital Health Cooperative Research Centre, Sydney, Australia
| | | | | | - Suzanne Robinson
- School of Population Health, Curtin University, Bentley, Australia
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, Australia
| |
Collapse
|
19
|
Maul LV, Jahn AS, Pamplona GSP, Streit M, Gantenbein L, Müller S, Nielsen ML, Greis C, Navarini AA, Maul JT. Acceptance of Telemedicine Compared to In-Person Consultation From the Providers' and Users' Perspectives: Multicenter, Cross-Sectional Study in Dermatology. JMIR DERMATOLOGY 2023; 6:e45384. [PMID: 37582265 PMCID: PMC10457706 DOI: 10.2196/45384] [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: 01/03/2023] [Revised: 04/15/2023] [Accepted: 06/09/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Teledermatology is currently finding its place in modern health care worldwide as a rapidly evolving field. OBJECTIVE The aim of this study was to investigate the acceptance of teledermatology compared to in-person consultation from the perspective of patients and professionals. METHODS This multicenter, cross-sectional pilot study was performed at secondary and tertiary referral centers of dermatology in Switzerland from August 2019 to January 2020. A customized questionnaire addressing demographics and educational data, experience with telemedicine, and presumed willingness to replace in-patient consultations with teledermatology was completed by dermatological patients, dermatologists, and health care workers in dermatology. RESULTS Among a total of 664 participants, the ones with previous telemedicine experience (171/664, 25.8%) indicated a high level of overall experience with it (patients: 73/106, 68.9%, dermatologists: 6/8, 75.0%, and health care workers: 27/34, 79.4%). Patients, dermatologists, and health care workers were most likely willing to replace in-person consultations with teledermatology for minor health issues (353/512, 68.9%; 37/45, 82.2%; and 89/107, 83.2%, respectively). We observed a higher preference for telemedicine among individuals who have already used telemedicine (patients: P<.001, dermatologists: P=.03, and health care workers, P=.005), as well as among patients with higher educational levels (P=.003). CONCLUSIONS This study indicates that the preference for teledermatology has a high potential to increase over time since previous experience with telemedicine and a higher level of education were associated with a higher willingness to replace in-patient consultations with telemedicine. We assume that minor skin problems are the most promising issue in teledermatology. Our findings emphasize the need for dermatologists to be actively involved in the transition to teledermatology. TRIAL REGISTRATION ClinicalTrials.gov NCT04495036; https://classic.clinicaltrials.gov/ct2/show/NCT04495036.
Collapse
Affiliation(s)
- Lara Valeska Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Anna Sophie Jahn
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Gustavo S P Pamplona
- Jules-Gonin Eye Hospital/Fondation Asile des Aveugles, Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
- Rehabilitation Engineering Laboratory (RELab), Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Markus Streit
- Department of Dermatology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lorena Gantenbein
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Simon Müller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Mia-Louise Nielsen
- Department of Dermatology, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | - Christian Greis
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
20
|
Li C, Jin Y, Homapour E. A scientometric review of hotspots and emerging trends in sustainable business model. Heliyon 2023; 9:e18446. [PMID: 37560644 PMCID: PMC10407053 DOI: 10.1016/j.heliyon.2023.e18446] [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] [Received: 09/29/2022] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
A sustainable business model (SBM) has become an inevitable trend for the traditional business model to follow the development of the times. Based on scientometrics, we explored and visually analyzed SBM's hotspots and emerging trends using the references co-citation networks, landmark references, burst references, keywords co-occurring networks, timeline map, and burst keywords indicators. Our findings consist of four aspects: hotspots and emerging trends, hotspots evolution history, landmark references, and burst references evolution history. First, the core hotspots are "sustainable innovation" and "open innovation". Second, the main hotspots have evolved from "sustainable innovation," "strategy," "performance," and "supply chain" from 1998 to 2012 into "resource-based view," "product-service system," "China," "life cycle assessment," and "conceptual framework" in 2013-2017. And "circular economy," "renewable energy," "value creation," "decarbonization" have appeared since 2019, which are emerging trends of SBM. Third, we have found ten landmark references in total. Articles written by Bocken & Short, Boons & Ludeke-Freund, and Zott & Amit are the three most landmark references that significantly impact the whole field. Last, the top 10 cited references have burst since 2011 and lasted until 2022. The article written by Teece became a long-term cited hotspot from 2011 to 2018. Moreover, the article written by Geissdoerfer & Vladimirova, which burst in 2020-2022, was the most cutting-edge. This research aims to enrich the existing research theories related to SBM and help governments and enterprises capture hotspots and emerging trends of SBM so that they can better understand and study SBM.
Collapse
Affiliation(s)
- Chuyao Li
- School of Business Administration, University of Science and Technology Liaoning, Anshan, 114051, China
| | - Yuran Jin
- School of Business Administration, University of Science and Technology Liaoning, Anshan, 114051, China
| | - Elmina Homapour
- Nottingham Business School, Nottingham Trent University, Nottingham, NG1 4FQ, UK
| |
Collapse
|
21
|
Ashley C, Williams A, Dennis S, McInnes S, Zwar NA, Morgan M, Halcomb E. Telehealth's future in Australian primary health care: a qualitative study exploring lessons learnt from the COVID-19 pandemic. BJGP Open 2023:BJGPO.2022.0117. [PMID: 36750374 DOI: 10.3399/bjgpo.2022.0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/21/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, telehealth emerged as a means of safely providing primary healthcare (PHC) consultations. In Australia, changes to telehealth funding led to the reconsideration of the role of telehealth in the ongoing provision of PHC services. AIM To investigate GPs', registered nurses' (RNs), nurse practitioners' (NPs), and allied health (AH) clinicians perceptions of the sustainability of telehealth in PHC post-pandemic. DESIGN & SETTING Semi-structured interviews were undertaken with 33 purposively selected clinicians, including GPs (n = 13), RNs (n = 5), NPs (n = 9), and AH clinicians (n = 6) working in PHC settings across Australia. Participants were drawn from responders to a national survey of PHC providers (n = 217). METHOD The thematic analysis approach reported by Braun and Clarke was used to analyse the interview data. RESULTS Data analysis revealed that the perception of providers was represented by the following two themes: lessons learnt; and the sustainability of telehealth. Lessons learnt included the need for rapid adaptation to telehealth, use of technology, and the pandemic being a catalyst for long-term change. The sustainability of telehealth in PHC comprised four subthemes around challenges: the funding model, maintaining patient and provider safety, hybrid service models, and access to support. CONCLUSION Providers required resilience and flexibility to adapt to telehealth. Funding models must reward providers from an outcome focus, rather than placing limits on telehealth's use. Hybrid approaches to service delivery will best meet the needs of the community but must be accompanied by support and education for PHC professionals.
Collapse
Affiliation(s)
- Christine Ashley
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Anna Williams
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
- School of Nursing and Midwifery, University of Notre Dame Australia, Sydney, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Susan McInnes
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Nicholas A Zwar
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| |
Collapse
|
22
|
Godinho MA, Liaw ST, Kanjo C, Marin HF, Martins H, Quintana Y. Digital vaccine passports and digital health diplomacy: an online model WHO simulation. J Am Med Inform Assoc 2023; 30:712-717. [PMID: 35866622 PMCID: PMC9384525 DOI: 10.1093/jamia/ocac126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/04/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
In the wake of Coronavirus disease 2019 (COVID-19), several nations have sought to implement digital vaccine passports (DVPs) to enable the resumption of international travel. Comprising a minimum dataset for each unique individual, DVPs have the makings of a global electronic health record, broaching key issues involved in building a global digital health ecosystem. Debate simulations offer a safe, interactive space to foster participatory policy discussions for advancing digital health diplomacy. This study used an online simulation of a Model World Health Assembly to critically analyze the sociotechnical issues associated with the global implementation of DVPs, and to generate useful insights and questions about the role of diplomacy in global digital health. The debate arguments addressed and provided insights into the technological, scientific, ethical, legal, policy, and societal aspects of DVPs. Reflecting on the simulation, we discuss its opportunities and challenges for the digitalization, decolonization, decentralization, and democratization of participatory policymaking.
Collapse
Affiliation(s)
- Myron Anthony Godinho
- WHO Collaborating Centre for eHealth, School of Population Health, UNSW Sydney, Sydney, Australia
| | - Siaw-Teng Liaw
- WHO Collaborating Centre for eHealth, School of Population Health, UNSW Sydney, Sydney, Australia
| | - Chipo Kanjo
- Department of Computer Science, University of Malawi, Zomba, Malawi
| | | | - Henrique Martins
- ISCTE Business School, ISCTE-IUL, Lisbon, Portugal.,Faculty of Health Sciences, Universidade da Beira Interior, Covilhã, Portugal
| | - Yuri Quintana
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
23
|
Thomas LT, Lee CMY, McClelland K, Nunis G, Robinson S, Norman R. Health workforce perceptions on telehealth augmentation opportunities. BMC Health Serv Res 2023; 23:182. [PMID: 36810089 PMCID: PMC9943033 DOI: 10.1186/s12913-023-09174-4] [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: 11/30/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The availability and use of telehealth to support health care access from a distance has expanded in response to the COVID-19 pandemic. Telehealth services have supported regional and remote health care access for many years and could be augmented to improve health care accessibility, acceptability and overall experiences for both consumers and clinicians. This study aimed to explore health workforce representatives' needs and expectations to move beyond existing telehealth models and plan for the future of virtual care. METHODS To inform recommendations for augmentation, semi-structured focus group discussions were held (November-December 2021). Health workforce representatives with experience in health care delivery via telehealth across country Western Australia were approached and invited to join a discussion. RESULTS Focus group participants included 53 health workforce representatives, with between two and eight participants per discussion. In total, 12 focus groups were conducted: seven were specific to regions, three with staff in centralised roles, and two with a mixture of participants from regional and central roles. Findings identified four key areas for telehealth augmentation: improvements required to existing service practice and processes; equity and access considerations; health workforce-focussed opportunities; and consumer-focussed opportunities. CONCLUSIONS Following the onset of the COVID-19 pandemic and the rapid increase in health services delivered via telehealth modalities, it is timely to explore opportunities to augment pre-existing models of care. Workforce representatives consulted in this study suggested modifications to existing process and practice that would improve the current models of care, and recommendations on ways to improve clinician and consumer experiences with telehealth. Improving experiences with virtual delivery of health care is likely to support continued use and acceptance of this modality in health care delivery.
Collapse
Affiliation(s)
- L. T. Thomas
- grid.1032.00000 0004 0375 4078 School of Population Health, Curtin University, Perth, WA Australia
| | - C. M. Y. Lee
- grid.1032.00000 0004 0375 4078 School of Population Health, Curtin University, Perth, WA Australia
| | - K. McClelland
- grid.413880.60000 0004 0453 2856Government of Western Australia Department of Health, Perth, WA Australia
| | - G. Nunis
- WA Primary Health Alliance, Perth, WA Australia
| | - S. Robinson
- grid.1032.00000 0004 0375 4078 School of Population Health, Curtin University, Perth, WA Australia ,grid.1021.20000 0001 0526 7079Deakin University, Melbourne, VIC Australia
| | - R. Norman
- grid.1032.00000 0004 0375 4078 School of Population Health, Curtin University, Perth, WA Australia
| |
Collapse
|
24
|
Ndayishimiye C, Lopes H, Middleton J. A systematic scoping review of digital health technologies during COVID-19: a new normal in primary health care delivery. HEALTH AND TECHNOLOGY 2023; 13:273-284. [PMID: 36628261 PMCID: PMC9816012 DOI: 10.1007/s12553-023-00725-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
This scoping review compiled information concerning digital health technologies (DHTs) evolution to support primary health care (PHC) during COVID-19 and lessons for the future of PHC. The identified literature was published during the COVID-19 peak years (2019-2021), retrieved from PubMed, Scopus, and Google Scholar, as well as hand searched on the internet. Predefined inclusion criteria were used, thematic analysis was applied, and reporting followed the PRISMA for Scoping Reviews. A total of 46 studies were included in the final synthesis (40 articles, one book, two book chapters, one working paper, and two technical reports). These studies scrutinized various aspects of DHTs, entailing 19 types of DHTs with 20 areas of use that can be compressed into five bigger PHC functions: general PHC service delivery (teleconsultations, e-diagnosis, e-prescription, etc.); behavior promotion and digital health literacy (e.g., combating vaccine hesitancy); surveillance functions; vaccination and drugs; and enhancing system decision-making for proper follow-up of ongoing PHC interventions during COVID-19. DHTs have the potential to solve some of the problems that have plagued us even prior to COVID-19. Therefore, this study uses a forward-looking viewpoint to further stimulate the use of evidence-based DHT, making it more inclusive, educative, and satisfying to people's needs, both under normal conditions and during outbreaks. More research with narrowed research questions is needed, with a particular emphasis on quality assurance in the use of DHTs, technical aspects (standards for digital health tools, infrastructure, and platforms), and financial perspectives (payment for digital health services and adoption incentives). Supplementary Information The online version contains supplementary material available at 10.1007/s12553-023-00725-7.
Collapse
Affiliation(s)
- Costase Ndayishimiye
- Association of Schools of Public Health in the European Region (ASPHER), 1150 Brussels, Belgium
- Health Economics and Social Security Department, Jagiellonian University Medical College, 8 Skawińska, 31-066 Krakow, Poland
| | - Henrique Lopes
- Association of Schools of Public Health in the European Region (ASPHER), 1150 Brussels, Belgium
- Comité mondial pour les apprentissages tout au long de la vie (CMAtlv), partenaire officiel de l’UNESCO, 75004 Paris, France
| | - John Middleton
- Association of Schools of Public Health in the European Region (ASPHER), 1150 Brussels, Belgium
| |
Collapse
|
25
|
Seidler ZE, Wilson MJ, Oliffe JL, Kealy D, Ogrodniczuk JS, Walther A, Rice SM. "I could hang up if the practitioner was a prat": Australian men's feedback on telemental healthcare during COVID-19. PLoS One 2022; 17:e0279127. [PMID: 36516184 PMCID: PMC9749969 DOI: 10.1371/journal.pone.0279127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic restrictions, uncertainties and management inconsistencies have been implicated in men's rising distress levels, which in turn have somewhat normed the uptake of telemental healthcare services (i.e., phone and/or video-conference-based therapy). Given past evidence of poor engagement with telemental health among men, this mixed-methods study examined Australian men's use of, and experiences with telemental health services relative to face-to-face care during the pandemic. A community sample of Australian-based men (N = 387; age M = 47.5 years, SD = 15.0 years) were recruited via Facebook advertising, and completed an online survey comprising quantitative items and open-response qualitative questions with the aim of better understanding men's experiences with telemental healthcare services. In total, 62.3% (n = 241) of participants reported experience with telemental health, and regression analyses revealed those who engaged with telemental health were on average younger, more likely to be gay and university educated. Men who had used telemental health were, on average, more satisfied with their therapy experience than those who had face-to-face therapy. Among those who had telemental healthcare, marginally lower satisfaction was observed among regional/rural based relative to urban men, and those who had to wait longer than 2 months to commence therapy. Qualitative findings highlighted positive aspects of telemental healthcare including comfort with accessing therapy from familiar home environments and the convenience and accessibility of telemental health alongside competing commitments and COVID-19 restrictions. Conversely, drawbacks included technical limitations such as crosstalk impeding therapeutic progress, disconnects and audio-visual lag-times and the 'impersonal' nature of telemental healthcare services. Findings broadly signal COVID-19 induced shifts norming of the use of virtual therapy services, with clear scope for improvement in the delivery of therapeutic practice using digital modalities, especially among help-seeking men.
Collapse
Affiliation(s)
- Zac E. Seidler
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Movember, Melbourne, Australia
- * E-mail:
| | - Michael J. Wilson
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
- Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Andreas Walther
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Simon M. Rice
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
26
|
Ward K, Vagholkar S, Sakur F, Khatri NN, Lau AYS. Visit Types in Primary Care With Telehealth Use During the COVID-19 Pandemic: Systematic Review. JMIR Med Inform 2022; 10:e40469. [PMID: 36265039 DOI: 10.2196/40469] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 10/02/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Telehealth was rapidly incorporated into primary care during the COVID-19 pandemic. However, there is limited evidence on which primary care visits used telehealth. OBJECTIVE The objective of this study was to conduct a systematic review to assess what visit types in primary care with use of telehealth during the COVID-19 pandemic were reported; for each visit type identified in primary care, under what circumstances telehealth was suitable; and reported benefits and drawbacks of using telehealth in primary care during the COVID-19 pandemic. METHODS This study was a systematic review using narrative synthesis. Studies were obtained from four databases (Ovid [MEDLINE], CINAHL Complete, PDQ-Evidence, and ProQuest) and gray literature (NSW Health, Royal Australian College of General Practitioners guidelines, and World Health Organization guidelines). In total, 3 independent reviewers screened studies featuring telehealth use during the COVID-19 pandemic in primary care. Levels of evidence were assessed according to the Grading of Recommendations Assessment, Development, and Evaluation. Critical appraisal was conducted using the Mixed Methods Appraisal Tool. Benefits and drawbacks of telehealth were assessed according to the National Quality Forum Telehealth Framework. RESULTS A total of 19 studies, predominately cross-sectional surveys or interviews (13/19, 68%), were included. Seven primary care visit types were identified: chronic condition management (17/19, 89%), existing patients (17/19, 89%), medication management (17/19, 89%), new patients (16/19, 84%), mental health/behavioral management (15/19, 79%), post-test result follow-up (14/19, 74%), and postdischarge follow-up (7/19, 37%). Benefits and drawbacks of telehealth were reported across all visit types, with chronic condition management being one of the visits reporting the greatest use because of a pre-existing patient-provider relationship, established diagnosis, and lack of complex physical examinations. Both patients and clinicians reported benefits of telehealth, including improved convenience, focused discussions, and continuity of care despite social distancing. Reported drawbacks included technical barriers, impersonal interactions, and semi-established reimbursement models. CONCLUSIONS Telehealth was used for different visit types during the COVID-19 pandemic in primary care, with most visits for chronic condition management, existing patients, and medication management. Further research is required to validate our findings and explore the long-term impact of hybrid models of care for different visit types in primary care. TRIAL REGISTRATION PROSPERO CRD42022312202; https://tinyurl.com/5n82znf4.
Collapse
Affiliation(s)
- Kanesha Ward
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| | - Sanjyot Vagholkar
- Primary Care, Faculty of Medicine, Health & Human Sciences, Macquarie University, North Ryde, Australia
| | - Fareeya Sakur
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| | - Neha Nafees Khatri
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| |
Collapse
|
27
|
The Benefits and Challenges of Virtual Education for Interprofessional Teams in a Post-COVID Environment. Healthcare (Basel) 2022; 10:healthcare10112195. [PMID: 36360536 PMCID: PMC9690166 DOI: 10.3390/healthcare10112195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
|
28
|
Keeves J, Gabbe B, Arnup S, Ekegren C, Beck B. Serious Injury in Metropolitan and Regional Victoria: Exploring Travel to Treatment and Utilisation of Post-Discharge Health Services by Injury Type. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114063. [PMID: 36360940 PMCID: PMC9657338 DOI: 10.3390/ijerph192114063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 06/01/2023]
Abstract
This study aimed to describe regional variations in service use and distance travelled to post-discharge health services in the first three years following hospital discharge for people with transport-related orthopaedic, brain, and spinal cord injuries. Using linked data from the Victorian State Trauma Registry (VSTR) and Transport Accident Commission (TAC), we identified 1597 people who had sustained transport-related orthopaedic, brain, or spinal cord injuries between 2006 and 2016 that met the study inclusion criteria. The adjusted odds of GP service use for regional participants were 76% higher than for metropolitan participants in the orthopaedic and traumatic brain injury (TBI) groups. People with spinal cord injury (SCI) living in regional areas had 72% lower adjusted odds of accessing mental health, 76% lower adjusted odds of accessing OT services, and 82% lower adjusted odds of accessing physical therapies compared with people living in major cities. People with a TBI living in regional areas on average travelled significantly further to access all post-discharge health services compared with people with TBI in major cities. For visits to medical services, the median trip distance for regional participants was 76.61 km (95%CI: 16.01-132.21) for orthopaedic injuries, 104.05 km (95% CI: 51.55-182.78) for TBI, and 68.70 km (95%CI: 8.34-139.84) for SCI. Disparities in service use and distance travelled to health services exist between metropolitan Melbourne and regional Victoria following serious injury.
Collapse
Affiliation(s)
- Jemma Keeves
- Department of Physiotherapy, Epworth Hospital, Melbourne 3122, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Sarah Arnup
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Christina Ekegren
- Rehabilitation, Ageing and Independent Living Unit, Monash University, Melbourne 3004, Australia
| | - Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| |
Collapse
|
29
|
Borgelt K, Siose TK, Taape IV, Nunan M, Beek K, Craig AT. The impact of digital communication and data exchange on primary health service delivery in a small island developing state setting. PLOS DIGITAL HEALTH 2022; 1:e0000109. [PMID: 36812579 PMCID: PMC9931309 DOI: 10.1371/journal.pdig.0000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Abstract
Tuvalu is one of the smallest and most remote countries in the world. Due partly to its geography, the limited availability of human resources for health, infrastructure weaknesses, and the economic situation, Tuvalu faces many health systems challenges to delivering primary health care and achieving universal health coverage. Advancements in information communication technology are anticipated to change the face of health care delivery, including in developing settings. In 2020 Tuvalu commenced installation of Very Small Aperture Terminals (VSAT) at health facilities on remote outer islands to allow the digital exchange of data and information between facilities and healthcare workers. We documented the impact that the installation of VSAT has had on supporting health workers in remote locations, clinical decision-making, and delivering primary health more broadly. We found that installation of VSAT in Tuvalu has enabled regular peer-to-peer communication across facilities; supported remote clinical decision-making and reduced the number of domestic and overseas medical referrals required; and supported formal and informal staff supervision, education, and development. We also found that VSAT's stability is dependent on access to services (such as a reliable electricity supply) for which responsibility sits outside of the health sector. We stress that digital health is not a panacea for all health service delivery challenges and should be seen as a tool (not the solution) to support health service improvement. Our research provides evidence of the impact digital connectivity offers primary health care and universal health coverage efforts in developing settings. It provides insights into factors that enable and inhibit sustainable adoption of new health technologies in low- and middle-income countries.
Collapse
Affiliation(s)
- Kaye Borgelt
- Digital health consultant, Melbourne, Victoria, Australia
| | | | - Isaia V. Taape
- Ministry of Health Social Welfare and Gender Affairs, Tuvalu
| | - Michael Nunan
- Beyond Essential Systems, Melbourne, Victoria, Australia
| | - Kristen Beek
- School of Population Health, University of New South Wales, New South Wales, Australia
| | - Adam T. Craig
- School of Population Health, University of New South Wales, New South Wales, Australia
- * E-mail:
| |
Collapse
|
30
|
Allen J. Exploring Adult Patients’ Perceptions and Experiences of Telemedicine Consultations in Primary Care: A Qualitative Systematic Review. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2022. [DOI: 10.5195/ijms.2022.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The COVID-19 pandemic transformed a gradual uptake of telemedicine, into a sudden worldwide implementation of telemedicine consultations. Primary care is a particular area affected and one where telemedicine consultations are expected to be the future. However, for effective long-term implementation it is vital that patient perceptions and experiences are understood. The aim of this qualitative systematic review was to explore the perceptions and experiences of adults who have used telemedicine consultations in primary care. Studies were identified through a search of four electronic databases (MEDLINE, EMBASE, CINAHL, and CENTRAL) alongside reference list and citation searches. Quality assessment was conducted using the CASP checklist and data was synthesized using a simplified approach to thematic analysis. From 2492 identified records, ten studies met the eligibility criteria all of which were judged as either good or moderate quality. Three themes were identified which were potential benefits, potential barriers, and beneficial prerequisites for telemedicine consultations in primary care. Within these themes, sixteen sub-themes were identified with examples including accessibility and convenience for potential benefits, lack of face-to-face interaction and impersonal consultations for potential barriers, and continuity of care for beneficial prerequisites. Analysing these subthemes, four main recommendations for practice can be made which are to utilise continuity of care, offer both video and telephone consultations, provide adequate support, and that healthcare professionals should demonstrate an explicit understanding of the patient’s health issues. Further research is needed to explore and expand on this topic area and future research should be viewed as a continuous process.
Collapse
|
31
|
Alami H, Lehoux P, Shaw SE, Papoutsi C, Rybczynska-Bunt S, Fortin JP. Virtual Care and the Inverse Care Law: Implications for Policy, Practice, Research, Public and Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710591. [PMID: 36078313 PMCID: PMC9518297 DOI: 10.3390/ijerph191710591] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 05/31/2023]
Abstract
Virtual care spread rapidly at the outbreak of the COVID-19 pandemic. Restricting in-person contact contributed to reducing the spread of infection and saved lives. However, the benefits of virtual care were not evenly distributed within and across social groups, and existing inequalities became exacerbated for those unable to fully access to, or benefit from virtual services. This "perspective" paper discusses the extent to which challenges in virtual care access and use in the context of COVID-19 follow the Inverse Care Law. The latter stipulates that the availability and quality of health care is inversely proportionate to the level of population health needs. We highlight the inequalities affecting some disadvantaged populations' access to, and use of public and private virtual care, and contrast this with a utopian vision of technology as the "solution to everything". In public and universal health systems, the Inverse Care Law may manifests itself in access issues, capacity, and/or lack of perceived benefit to use digital technologies, as well as in data poverty. For commercial "Direct-To-Consumer" services, all of the above may be encouraged via a consumerist (i.e., profit-oriented) approach, limited and episodic services, or the use of low direct cost platforms. With virtual care rapidly growing, we set out ways forward for policy, practice, and research to ensure virtual care benefits for everyone, which include: (1) pay more attention to "capabilities" supporting access and use of virtual care; (2) consider digital technologies as a basic human right that should be automatically taken into account, not only in health policies, but also in social policies; (3) take more seriously the impact of the digital economy on equity, notably through a greater state involvement in co-constructing "public health value" through innovation; and (4) reconsider the dominant digital innovation research paradigm to better recognize the contexts, factors, and conditions that influence access to and use of virtual care by different groups.
Collapse
Affiliation(s)
- Hassane Alami
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Pascale Lehoux
- Center for Public Health Research and Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC H3C 3J7, Canada
| | - Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Sarah Rybczynska-Bunt
- Community and Primary Care Research Group, Faculty of Health, Plymouth University, Plymouth PL6 8BX, UK
| | - Jean-Paul Fortin
- VITAM Research Centre on Sustainable Health, Faculty of Medicine, Laval University, Quebec, QC G1J 2G1, Canada
| |
Collapse
|
32
|
Videon TM, Rosati RJ, Landers SH. Early versus late COVID‐19 Home Health Care patient population: Shifting sociodemographics and comparable outcomes. Res Nurs Health 2022; 45:446-455. [PMID: 35462419 PMCID: PMC9088655 DOI: 10.1002/nur.22230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Tami M. Videon
- The Visiting Nurse Association Health Group Inc. Holmdel New Jersey USA
| | - Robert J. Rosati
- The Visiting Nurse Association Health Group Inc. Holmdel New Jersey USA
| | - Steven H. Landers
- The Visiting Nurse Association Health Group Inc. Holmdel New Jersey USA
| |
Collapse
|
33
|
Dyer SM, Suen J, Williams H, Inacio MC, Harvey G, Roder D, Wesselingh S, Kellie A, Crotty M, Caughey GE. Impact of relational continuity of primary care in aged care: a systematic review. BMC Geriatr 2022; 22:579. [PMID: 35836118 PMCID: PMC9281225 DOI: 10.1186/s12877-022-03131-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background Greater continuity of care has been associated with lower hospital admissions and patient mortality. This systematic review aims to examine the impact of relational continuity between primary care professionals and older people receiving aged care services, in residential or home care settings, on health care resource use and person-centred outcomes. Methods Systematic review of five databases, four trial registries and three grey literature sources to October 2020. Included studies (a) aimed to increase relational continuity with a primary care professional, (b) focused on older people receiving aged care services (c) included a comparator and (d) reported outcomes of health care resource use, quality of life, activities of daily living, mortality, falls or satisfaction. Cochrane Collaboration or Joanna Briggs Institute criteria were used to assess risk of bias and GRADE criteria to rate confidence in evidence and conclusions. Results Heterogeneity in study cohorts, settings and outcome measurement in the five included studies (one randomised) precluded meta-analysis. None examined relational continuity exclusively with non-physician providers. Higher relational continuity with a primary care physician probably reduces hospital admissions (moderate certainty evidence; high versus low continuity hazard ratio (HR) 0.94; 95% confidence interval (CI) 0.92–0.96, n = 178,686; incidence rate ratio (IRR) 0.99, 95%CI 0.76–1.27, n = 246) and emergency department (ED) presentations (moderate certainty evidence; high versus low continuity HR 0.90, 95%CI 0.89–0.92, n = 178,686; IRR 0.91, 95%CI 0.72–1.15, n = 246) for older community-dwelling aged care recipients. The benefit of providing on-site primary care for relational continuity in residential settings is uncertain (low certainty evidence, 2 studies, n = 2,468 plus 15 care homes); whilst there are probably lower hospitalisations and may be fewer ED presentations, there may also be an increase in reported mortality and falls. The benefit of general practitioners’ visits during hospital admission is uncertain (very low certainty evidence, 1 study, n = 335). Conclusion Greater relational continuity with a primary care physician probably reduces hospitalisations and ED presentations for community-dwelling aged care recipients, thus policy initiatives that increase continuity may have cost offsets. Further studies of approaches to increase relational continuity of primary care within aged care, particularly in residential settings, are needed. Review registration CRD42021215698. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03131-2.
Collapse
Affiliation(s)
- Suzanne M Dyer
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.
| | - Jenni Suen
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | | | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - David Roder
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Maria Crotty
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| |
Collapse
|
34
|
Valdes D, Alqazlan L, Procter R, Dale J. Global evidence on the rapid adoption of telemedicine in primary care during the first 2 years of the COVID-19 pandemic: a scoping review protocol. Syst Rev 2022; 11:124. [PMID: 35718770 PMCID: PMC9206865 DOI: 10.1186/s13643-022-01934-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Before the declaration of the COVID-19 pandemic in March 2020, primary care in most countries relied on face-to-face consultations, with relatively limited use of telemedicine. Lockdowns and social distancing measures during the early stages of the pandemic led to rapid, widely spread telemedicine adoption in healthcare settings. The rapid uptake that occurred following the onset of these pandemic-induced measures in countries such as the UK, Canada and New Zealand prompts questions around the drivers, extent and sustainability of this transformation in clinical practice at the global level, as the research in this area is still emerging. The purpose of this scoping review is to explore the global evidence surrounding the rapid adoption of telemedicine in primary care settings during the first 2 years of the COVID-19 pandemic through three lenses: patient experience, health inequalities and patient-clinician trust, with the purpose of identifying elements contributing to the sustainability of this innovation. METHODS A draft protocol was tested through an initial search on Ovid Medline, Web of Science and Google Scholar with additional searches on the Cochrane Database. This informed the final selection of terms which will be used to search Ovid, Web of Science, Google Scholar, PROSPERO, Cochrane Library and others, filtering for studies from the pandemic declaration onwards. Additional grey literature reports will be sourced through simplified searches on Google in widely spoken languages. Duplicates will be removed by screening titles. Abstracts and grey literature text extracts will be screened based on pre-set eligibility criteria by two researchers. Abstracts (and extracts in the case of grey literature) will be mapped against the domains of the Non-adoption, Abandonment, and challenges to Scale-up, Spread and Sustainability (NASSS) framework by two researchers. Data will be presented in table format. DISCUSSION This review will map the current literature to identify current gaps in evidence related to the adoption of telemedicine after the declaration of the pandemic in March 2020. The use of simplified searches in the several spoken languages in the world is aimed at capturing more immediate non-academic reflections and experiences on this major service change at a global level. SYSTEMATIC REVIEW REGISTRATION The study has been registered on Open Science Framework and can be accessed through the following URL: https://osf.io/4z5ut/.
Collapse
Affiliation(s)
- Daniela Valdes
- Department of Computer Science, University of Warwick, Coventry, CV4 7AL, UK.
| | - Lama Alqazlan
- Department of Computer Science, University of Warwick, Coventry, CV4 7AL, UK
| | - Rob Procter
- Department of Computer Science, University of Warwick, Coventry, CV4 7AL, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| |
Collapse
|
35
|
Lee CMY, Thomas E, Norman R, Wells L, Shaw T, Nesbitt J, Frean I, Baxby L, Bennett S, Robinson S. Educational attainment and willingness to use technology for health and to share health information - The reimagining healthcare survey. Int J Med Inform 2022; 164:104803. [PMID: 35644052 DOI: 10.1016/j.ijmedinf.2022.104803] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Australia has seen a rapid uptake of virtual care since the start of the COVID-19 pandemic. We aimed to describe the willingness of consumers to use digital technology for health and to share their health information; and explore differences by educational attainment and area of remoteness. METHODS We conducted an online survey on consumer preferences for virtual modes of healthcare delivery between June and September 2021. Participants were recruited through the study's partner organisations and an online market research company. Australian residents aged ≥18 years who provided study consent and completed the survey were included in the analysis. We reported the weighted percentages of participants who selected negative response to the questions to understand the size of the population that were unlikely to adopt virtual care. Age-adjusted Poisson regression models were used to estimate the prevalence ratios for selecting negative response associated with education and remoteness. RESULTS Of the 1778 participants included, 29% were not aware of digital technologies for monitoring/supporting health, 22% did not have access to technologies to support their health, and 19% were not willing to use technologies for health. Over a fifth of participants (range: 21-34%) were not at all willing to use seven of the 15 proposed alternative methods of care. Between 21% and 36% of participants were not at all willing to share de-identified health information tracked in apps/devices with various not-for-profit organisations compared to 47% with private/for-profit health businesses. Higher proportions of participants selected negative response to the questions in the lower educational attainment groups than those with bachelor's degree or above. No difference was observed between area of remoteness. CONCLUSIONS Improving the digital health literacy of people, especially those with lower educational attainment, will be required for virtual care to become an equitable part of normal healthcare delivery in Australia.
Collapse
Affiliation(s)
- Crystal Man Ying Lee
- School of Population Health, Curtin University, Perth, Western Australia, Australia.
| | - Elizabeth Thomas
- School of Population Health, Curtin University, Perth, Western Australia, Australia; Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Leanne Wells
- Consumers Health Forum of Australia, Canberra, Australian Capital Territory, Australia
| | - Tim Shaw
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Julia Nesbitt
- Consumers Health Forum of Australia, Canberra, Australian Capital Territory, Australia
| | - Isobel Frean
- Digital Health Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Luke Baxby
- Deloitte, Brisbane, Queensland, Australia
| | | | - Suzanne Robinson
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
36
|
Tu K, Sarkadi Kristiansson R, Gronsbell J, de Lusignan S, Flottorp S, Goh LH, Hallinan CM, Hoang U, Kang SY, Kim YS, Li Z, Ling ZJ, Manski-Nankervis JA, Ng APP, Pace WD, Wensaas KA, Wong WC, Stephenson E. Changes in primary care visits arising from the COVID-19 pandemic: an international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID). BMJ Open 2022; 12:e059130. [PMID: 35534063 PMCID: PMC9086267 DOI: 10.1136/bmjopen-2021-059130] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Through the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID), we compared the pandemic impact on the volume of primary care visits and uptake of virtual care in Australia, Canada, China, Norway, Singapore, South Korea, Sweden, the UK and the USA. METHODS Visit definitions were agreed on centrally, implemented locally across the various settings in INTRePID countries, and weekly visit counts were shared centrally for analysis. We evaluated the weekly rate of primary care physician visits during 2019 and 2020. Rate ratios (RRs) of total weekly visit volume and the proportion of weekly visits that were virtual in the pandemic period in 2020 compared with the same prepandemic period in 2019 were calculated. RESULTS In 2019 and 2020, there were 80 889 386 primary care physician visits across INTRePID. During the pandemic, average weekly visit volume dropped in China, Singapore, South Korea, and the USA but was stable overall in Australia (RR 0.98 (95% CI 0.92 to 1.05, p=0.59)), Canada (RR 0.96 (95% CI 0.89 to 1.03, p=0.24)), Norway (RR 1.01 (95% CI 0.88 to 1.17, p=0.85)), Sweden (RR 0.91 (95% CI 0.79 to 1.06, p=0.22)) and the UK (RR 0.86 (95% CI 0.72 to 1.03, p=0.11)). In countries that had negligible virtual care prepandemic, the proportion of visits that were virtual were highest in Canada (77.0%) and Australia (41.8%). In Norway (RR 8.23 (95% CI 5.30 to 12.78, p<0.001), the UK (RR 2.36 (95% CI 2.24 to 2.50, p<0.001)) and Sweden (RR 1.33 (95% CI 1.17 to 1.50, p<0.001)) where virtual visits existed prepandemic, it increased significantly during the pandemic. CONCLUSIONS The drop in primary care in-person visits during the pandemic was a global phenomenon across INTRePID countries. In several countries, primary care shifted to virtual visits mitigating the drop in in-person visits.
Collapse
Affiliation(s)
- Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Departments of Research and Innovation and Family Medicine-North York General Hospital, Toronto Western Family Health Team-University Health Network, Toronto, Ontario, Canada
| | | | - Jessica Gronsbell
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Signe Flottorp
- Norwegian Institute of Public Health, Oslo, Norway
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Uy Hoang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seo Young Kang
- International Healthcare Center, Asan Medical Center, Seoul, South Korea
| | - Young Sik Kim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Zhou Li
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zheng Jye Ling
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Amy Pui Pui Ng
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Knut-Arne Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - William Cw Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ellen Stephenson
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
37
|
Godinho MA, Martins H, Al-Shorbaji N, Quintana Y, Liaw ST. "Digital Health Diplomacy" in Global Digital Health? A call for critique and discourse. J Am Med Inform Assoc 2022; 29:1019-1024. [PMID: 34927681 PMCID: PMC9006682 DOI: 10.1093/jamia/ocab282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022] Open
Abstract
Actualizing the vision of Global Digital Health is a central issue on the Global Health Diplomacy agenda. The COVID-reinforced need for accelerated digital health progress will require political structures and processes to build a foundation for Global Digital Health. Simultaneously, Global Health Diplomacy uses digital technologies in its enactment. Both phenomena have driven interest in the term "Digital Health Diplomacy." A review of the literature revealed 2 emerging but distinct definitions that have been published very recently, each with its associated discourse and practice. This multiplicity of ideas demonstrates the myriad ways in which global digital and political systems are becoming increasingly entangled. Untangling these, this paper proposes and discusses 3 dimensions of Digital Health Diplomacy: "Diplomacy for digital health," "Digital health for diplomacy," and "Digital health in diplomacy." It calls upon digital health professionals, diplomats, political and social scientists, epidemiologists, and clinicians to discuss, critique, and advance this emerging domain.
Collapse
Affiliation(s)
- Myron Anthony Godinho
- WHO Collaborating Centre for eHealth (AUS-135), School of Population Health, UNSW Sydney, Sydney, Australia
| | - Henrique Martins
- ISCTE Business School, ISCTE-IUL, Lisbon, Portugal
- Faculty of Health Sciences, Universidade da Beira Interior, Covilhã, Portugal
| | | | - Yuri Quintana
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Siaw-Teng Liaw
- WHO Collaborating Centre for eHealth (AUS-135), School of Population Health, UNSW Sydney, Sydney, Australia
| |
Collapse
|
38
|
Harrison R, Manias E. How Safe is Virtual Healthcare? Int J Qual Health Care 2022; 34:6560333. [DOI: 10.1093/intqhc/mzac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/16/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Elizabeth Manias
- School of Nursing and Midwifery, Faculty of Health, Burwood, Victoria 3125, Australia
| |
Collapse
|
39
|
Liaw ST, Kuziemsky C, Farin H. Editorial: Special issue on “The Primary Care Informatics response to COVID-19”. Int J Med Inform 2022; 160:104690. [PMID: 35067452 PMCID: PMC8761021 DOI: 10.1016/j.ijmedinf.2022.104690] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
40
|
Eapen V, Woolfenden S, Schmied V, Jalaludin B, Lawson K, Liaw ST, Lingam R, Page A, Cibralic S, Winata T, Mendoza Diaz A, Lam-Cassettari C, Burley J, Boydell K, Lin P, Masi A, Katz I, Dadich A, Preddy J, Bruce J, Raman S, Kohlhoff J, Descallar J, Karlov L, Kaplun C, Arora A, Di Mento B, Smead M, Doyle K, Grace R, McClean T, Blight V, Wood A, Raine KH. "Watch Me Grow- Electronic (WMG-E)" surveillance approach to identify and address child development, parental mental health, and psychosocial needs: study protocol. BMC Health Serv Res 2021; 21:1240. [PMID: 34789234 PMCID: PMC8596348 DOI: 10.1186/s12913-021-07243-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an already increased risk of health inequality. The increased mental health and psychosocial needs were compounded by the closure of in-person preventive and health promotion programs resulting in health organisations embracing technology and online services. Watch Me Grow- Electronic (WMG-E) – developmental surveillance platform- exemplifies one such service. WMG-E was developed to monitor child development and guide parents towards more detailed assessments when risk is identified. This Randomised Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also incorporating parents’ mental health and psychosocial needs. Children and families needing additional assessments and supports will be electronically directed to relevant resources in the ‘care-as-usual’ group. In contrast, the intervention group will receive continuity of care, with additional in-person assessment and ‘warm hand over’ by a ‘service navigator’ to ensure their needs are met. Methods Using an RCT we will determine: (1) parental engagement with developmental surveillance; (2) access to services for those with mental health and social care needs; and (3) uptake of service recommendations. Three hundred parents/carers of children aged 6 months to 3 years (recruited from a culturally diverse, or rural/regional site) will be randomly allocated to the ‘care-as-usual’ or ‘intervention’ group. A mixed methods implementation evaluation will be completed, with semi-structured interviews to ascertain the acceptability, feasibility and impact of the WMG-E platform and service navigator. Conclusions Using WMG-E is expected to: normalise and de-stigmatise mental health and psychosocial screening; increase parental engagement and service use; and result in the early identification and management of child developmental needs, parental mental health, and family psychosocial needs. If effective, digital solutions such as WMG-E to engage and empower parents alongside a service navigator for vulnerable families needing additional support, will have significant practice and policy implications in the pandemic/post pandemic period. Trial registration The trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.
Collapse
Affiliation(s)
- V Eapen
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia. .,South Western Sydney Local Health District, Liverpool, Australia.
| | - S Woolfenden
- Sydney Children's Hospital Randwick, Randwick, Australia
| | - V Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - B Jalaludin
- South Western Sydney Local Health District, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - K Lawson
- School of Business, Western Sydney University, Sydney, Australia
| | - S T Liaw
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,WHO Collaborating Centre for eHealth, University of New South Wales, Sydney, Australia
| | - R Lingam
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - A Page
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - S Cibralic
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - T Winata
- South Western Sydney Local Health District, Liverpool, Australia
| | - A Mendoza Diaz
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - C Lam-Cassettari
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - J Burley
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - K Boydell
- Black Dog Institute, Sydney, Australia
| | - P Lin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,South Western Sydney Local Health District, Liverpool, Australia
| | - A Masi
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - I Katz
- Social Policy Research Centre, Faculty of Arts, Design, & Architecture, University of New South Wales, Sydney, Australia
| | - A Dadich
- School of Business, Western Sydney University, Sydney, Australia
| | - J Preddy
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - J Bruce
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - S Raman
- South Western Sydney Local Health District, Liverpool, Australia
| | - J Kohlhoff
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Karitane, Carramar, Australia
| | - J Descallar
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - L Karlov
- South Western Sydney Local Health District, Liverpool, Australia
| | - C Kaplun
- Ingham Institute for Applied Medical Research, Liverpool, Australia.,TeEACH -Transforming early Education and Child Health Research Centre, Western Sydney University, Sydney, Australia
| | - A Arora
- School of Health Sciences, Western Sydney University, Sydney, Australia.,Sydney Local Health District, Camperdown, Australia
| | - B Di Mento
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - M Smead
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - K Doyle
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - R Grace
- TeEACH -Transforming early Education and Child Health Research Centre, Western Sydney University, Sydney, Australia
| | | | - V Blight
- South Western Sydney Local Health District, Liverpool, Australia
| | - A Wood
- Karitane, Carramar, Australia
| | | |
Collapse
|