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Banbury A, Taylor ML, Gray LC, Reid N, Smith AC. Sustaining and expanding telehealth activity: Training requirements for Australian residential aged care front-line staff. PEC INNOVATION 2023; 2:100109. [PMID: 37214526 PMCID: PMC10194154 DOI: 10.1016/j.pecinn.2022.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/30/2022] [Accepted: 11/26/2022] [Indexed: 05/24/2023]
Abstract
Objective To identify the training needs of front-line aged care staff as perceived by senior clinicians and managers at selected residential aged care facilities (RACFs). Methods A qualitative explorative designed study using semi-structured interviews with a convenience sample of RACF senior managers and nurses. A hybrid analysis approach using a framework deductive analysis followed by inductive analysis for sub-themes. Results Four sub-themes emerged to sustain increased telehealth activity: technology knowledge and digital literacy skills, including understanding telehealth ecosystems and technical skills; evidence-based reviews and clinical frameworks for telehealth consultations to identify appropriate consultations and successful use cases; telehealth best practice guidelines and workflows including telehealth consultations protocols, communicating by videoconferencing, how to support families in attending telehealth consultations and optimal training models; and telehealth policy and legal guidance. Conclusion Staff require comprehensive training to sustain and expand telehealth use in RACFs. Training should focus on knowledge, skills and competencies in using telehealth as well as the broad factors of policies and understanding ICT systems to support staffs' abilities and confidence. Innovation This study provides innovative findings that identify key components and associated activities and resources for training RACF staff to ensure they have sufficient knowledge, competency, skills and confidence to integrate telehealth into care provision.
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Affiliation(s)
- Annie Banbury
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Ground Floor, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Monica L. Taylor
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Ground Floor, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Leonard C. Gray
- Centre for Health Services Research, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Anthony C. Smith
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Ground Floor, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Odense University Hospital, Kløvervænget 8C, entrance 101, 3. Floor, DK-5000 Odense C, Denmark
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Rohowsky A, Offermann J, Ziefle M. Everybody hurts sometimes: perceptions of benefits and barriers in telemedical consultations. Front Public Health 2023; 11:1223661. [PMID: 37546320 PMCID: PMC10399594 DOI: 10.3389/fpubh.2023.1223661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Shifts in the age structure, rising needs of care and support, and a lack of (in)formal caregivers require innovative solutions to relieve the whole healthcare system. Applying digital approaches, such as telemedicine, has the potential to support people in need of care, to relieve caregivers in families and professional environments, and to assist medical professionals in their working everyday life: e.g., using telemedicine for acute consultations could contribute to avoid hospitalizations of older people, whereas consultations with the general practitioner could reduce efforts and relive medical personnel. Beyond technical opportunities and potential, the acceptance of future users represents a prerequisite for a sustainable adoption of such innovative approaches, especially in sensitive contexts such as life in older age in nursing homes. Methods This study aimed at collecting users' perceptions and evaluations of telemedicine in nursing homes. Two scenarios of telemedical consultations were applied which were either carried out by an emergency physician in acute situations or by the attending general practitioner. In a first approach, advantages and disadvantages of telemedicine were collected with the help of a qualitative interview study (N = 12) with laypersons and medical staff. The identified acceptance-relevant factors were then quantified in a second study using an online questionnaire (N = 204). Results Outcomes revealed that both types of telemedicial consultations would be gladly used. However, for telemedical consultations in acute situations, the perceived disadvantages outweighed the advantages; for telemedical consultations with the general practitioner, the advantages outweighed the disadvantages. A prominent barrier in both scenarios was perceived impersonality, which limited the willingness to use. Nevertheless, participants indicated that telemedical consultations can be a support for nursing staff. Discussion Outcomes may help to derive specific implications and recommendations to develop and realize digital technologies tailored to the requirements, needs, and wishes of diverse stakeholders (i.e., patients, medical professionals) as potential future users.
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Ford JH, Jolles SA, Heller D, Crnich C. Characteristics of telemedicine workflows in nursing homes during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:301. [PMID: 36991421 PMCID: PMC10052227 DOI: 10.1186/s12913-023-09249-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
The use of telemedicine increased dramatically in nursing homes (NHs) during the COVID-19 pandemic. However, little is known about the actual process of conducting a telemedicine encounter in NHs. The objective of this study was to identify and document the work processes associated with different types of telemedicine encounters conducted in NHs during the COVID-19 pandemic.
Methods
A mixed methods convergent study was utilized. The study was conducted in a convenience sample of two NHs that had newly adopted telemedicine during the COVID-19 pandemic. Participants included NH staff and providers involved in telemedicine encounters conducted in the study NHs. The study involved semi-structured interviews and direct observation of telemedicine encounters and post-encounter interviews with staff and providers involved in telemedicine encounters observed by research staff. The semi-structured interviews were structured using the Systems Engineering Initiative for Patient Safety (SEIPS) model to collect information about telemedicine workflows. A structured checklist was utilized to document steps performed during direct observations of telemedicine encounters. Information from interviews and observations informed the creation of a process map of the NH telemedicine encounter.
Results
A total of 17 individuals participated in semi-structured interviews. Fifteen unique telemedicine encounters were observed. A total of 18 post-encounter interviews with 7 unique providers (15 interviews in total) and three NH staff were performed. A 9-step process map of the telemedicine encounter, along with two microprocess maps related to encounter preparation and activities within the telemedicine encounter, were created. Six main processes were identified: encounter planning, family or healthcare authority notification, pre-encounter preparation, pre-encounter huddle, conducting the encounter, and post-encounter follow-up.
Conclusion
The COVID-19 pandemic changed the delivery of care in NHs and increased reliance on telemedicine services in these facilities. Workflow mapping using the SEIPS model revealed that the NH telemedicine encounter is a complex multi-step process and identified weaknesses related to scheduling, electronic health record interoperability, pre-encounter planning, and post-encounter information exchange, which represent opportunities to improve and enhance the telemedicine encounter process in NHs. Given public acceptance of telemedicine as a care delivery model, expanding the use of telemedicine beyond the COVID-19 pandemic, especially for certain NH telemedicine encounters, could improve quality of care.
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