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Saigí-Rubió F, Borges do Nascimento IJ, Robles N, Ivanovska K, Katz C, Azzopardi-Muscat N, Novillo Ortiz D. The Current Status of Telemedicine Technology Use Across the World Health Organization European Region: An Overview of Systematic Reviews. J Med Internet Res 2022; 24:e40877. [DOI: 10.2196/40877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Several systematic reviews evaluating the use of telemedicine by clinicians, patients, and health authorities to improve the delivery of care in the 53 member states of the World Health Organization (WHO) European Region have been conducted in recent years. However, a study summarizing the findings of these reviews has not been conducted.
Objective
This overview of systematic reviews aimed to summarize findings regarding the use of telemedicine across the 53 member states and identify the medical fields and levels of care in and at which the effectiveness, feasibility, and applicability of telemedicine have been demonstrated. The barriers to and facilitators of telemedicine use were also evaluated and collated to help with the design and implementation of telemedicine interventions.
Methods
Through a comprehensive systematic evaluation of the published and unpublished literature, we extracted clinical, epidemiological, and technology-related data from each review included in the study. We focused on evaluating the barriers to and facilitators of the use of telemedicine apps across the 53 member states considered. We rated the methodological quality of each of the included reviews based on A Measurement Tool to Assess Systematic Review 2 approach and judged the overall certainty of evidence by using the Grading of Recommendations, Assessment, Development, and Evaluations methodology. The entire process was performed by 2 independent authors.
Results
This overview drew on data from >2239 primary studies, with >20,000 enrolled patients in total, within the WHO European Region. On the basis of data from randomized trials, observational studies, and economic evaluations from several countries, the results show a clear benefit of telemedicine technologies in the screening, diagnosis, management, treatment, and long-term follow-up of a series of chronic diseases. However, we were unable to pool the results into a reliable numeric parameter because of the high heterogeneity of intervention methodologies, scheduling, primary study design discrepancies, settings, and geographical locations. In addition to the clinical outcomes of the interventions, the social and economic outcomes are highlighted.
Conclusions
The application of telemedicine is well established across countries in the WHO European Region; however, some countries could still benefit from the many uses of these digital solutions. Barriers related to users, technology, and infrastructure were the largest. Conversely, the provision of health services using technological devices was found to significantly enhance patients’ clinical outcomes, improve the long-term follow-up of patients by medical professionals, and offer logistical benefits for both patients and health workers.
Trial Registration
PROSPERO (International Prospective Register of Systematic Reviews) CRD42022309375; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309375
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Temple A, Hamilton K, Bryce C, Griffiths F, Sturt J. Perspective on digital communication with health professions from close supporters of young people with long-term health conditions (The LYNC Study). Digit Health 2022; 8:20552076221092536. [PMID: 35433015 PMCID: PMC9005813 DOI: 10.1177/20552076221092536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To understand the impact of digital communication using email and text between young people and their health care team on those in close supporting roles. Methods Twelve people (nine parents and three partners) of young people with long-term health conditions were interviewed between November 2014 and March 2016. Thematic analysis was performed followed Braun and Clarke's (2006) 6-phase method. Results Four main themes were identified. Close supporters felt that digital clinical communication was useful for young persons’ self-management. As well as young patients, close supporters would also like to have direct access to the clinicians, but it was necessary to build up a trusting relationship between close supporters and clinicians initially. Video appointments were suggested for future digital communication technology. Conclusions Close supporters were encouraging digital communication for their young person with diabetes. Clinicians should put an emphasis on establishing trusting relationships with both young people and close supporters which would be beneficial for their digital clinical communications.
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Affiliation(s)
- Ayako Temple
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | - Kathryn Hamilton
- Department of Clinical, Educational and Health Psychology, Hunter Street Health Centre, London, UK
| | - Carol Bryce
- Warwick Medical School – Social Science and Systems in Health, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Warwick Medical School – Social Science and Systems in Health, University of Warwick, Coventry, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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3
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Parent-mediated intervention delivered through telehealth for children with autism spectrum disorder. Hippokratia 2021. [DOI: 10.1002/14651858.cd014793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Harris B, Ajisola M, Alam RM, Watkins JA, Arvanitis TN, Bakibinga P, Chipwaza B, Choudhury NN, Kibe P, Fayehun O, Omigbodun A, Owoaje E, Pemba S, Potter R, Rizvi N, Sturt J, Cave J, Iqbal R, Kabaria C, Kalolo A, Kyobutungi C, Lilford RJ, Mashanya T, Ndegese S, Rahman O, Sayani S, Yusuf R, Griffiths F. Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: A mixed-methods study. Digit Health 2021; 7:20552076211033425. [PMID: 34777849 PMCID: PMC8580492 DOI: 10.1177/20552076211033425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Remote or mobile consulting is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during coronavirus disease 2019 and beyond. We explored whether mobile consulting is a viable option for communities with minimal resources in low- and middle-income countries. METHODS We reviewed evidence published since 2018 about mobile consulting in low- and middle-income countries and undertook a scoping study (pre-coronavirus disease) in two rural settings (Pakistan and Tanzania) and five urban slums (Kenya, Nigeria and Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites) and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mobile consulting providers, and local and national decision-makers. Project advisory groups guided the study in each country. RESULTS We reviewed four empirical studies and seven reviews, analysed data from 5322 urban slum households and engaged with 424 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. Mobile consulting services are operating through provider platforms (n = 5-17) and, at the community level, some direct experience of mobile consulting with healthcare workers using their own phones was reported - for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. Mobile consulting can reduce affordability barriers and facilitate care-seeking practices. CONCLUSIONS There are indications of readiness for mobile consulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply chains to fully realise the continuity of care and responsiveness that mobile consulting services offer, particularly during/beyond coronavirus disease 2019.
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Affiliation(s)
| | - Motunrayo Ajisola
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Raisa Meher Alam
- Centre for Health, Population and Development, Independent University
Bangladesh, Bangladesh
| | | | | | | | - Beatrice Chipwaza
- St Francis University College of Health and Allied Sciences,
Tanzania
| | | | - Peter Kibe
- African Population and Health Research
Center, Kenya
| | - Olufunke Fayehun
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Akinyinka Omigbodun
- Department of Obstetrics and Gynaecology, Faculty of Clinical
Sciences, College of Medicine, University of Ibadan, Nigeria
| | - Eme Owoaje
- Department of Community Medicine, Faculty of Public Health, College
of Medicine, University of Ibadan, Nigeria
| | - Senga Pemba
- St Francis University College of Health and Allied Sciences,
Tanzania
| | - Rachel Potter
- Clinical Trials Unit Warwick Medical School, University of Warwick, University of Warwick, UK
| | - Narjis Rizvi
- Community Health Sciences Department, Aga Khan University, Pakistan
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King’s
College London, UK
| | | | - Romaina Iqbal
- Community Health Sciences Department, Aga Khan University, Pakistan
| | | | - Albino Kalolo
- St Francis University College of Health and Allied Sciences,
Tanzania
| | | | - Richard J Lilford
- Institute of Applied Health Research, College of Medical and Dental
Sciences, University of Birmingham, UK
| | - Titus Mashanya
- St Francis University College of Health and Allied Sciences,
Tanzania
| | - Sylvester Ndegese
- St Francis University College of Health and Allied Sciences,
Tanzania
| | - Omar Rahman
- University of Liberal Arts
Bangladesh, Bangladesh
| | - Saleem Sayani
- Aga Khan Development Network Digital Health Resource Centre (Asia
and Africa), Aga Khan University, Pakistan
| | - Rita Yusuf
- Centre for Health, Population and Development, Independent University
Bangladesh, Bangladesh
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, UK
- Centre for Health Policy, University of the Witwatersrand, South
Africa
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Gacto-Sánchez P, Molina-Morales J, Rodríguez-Vela F, Moreno-Conde J, Sendin-Martin M, Parra-Calderon C, Gomez-Cía T, Pereyra-Rodriguez JJ. Diagnostic accuracy of a telemedicine tool for acute burns diagnosis. Burns 2020; 46:1799-1804. [DOI: 10.1016/j.burns.2020.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
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Goodrich KM, Kingsley KV, Sands HC. Digitally Responsive School Counseling Across the ASCA National Model. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2020. [DOI: 10.1007/s10447-020-09396-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vusio F, Thompson A, Birchwood M, Clarke L. Experiences and satisfaction of children, young people and their parents with alternative mental health models to inpatient settings: a systematic review. Eur Child Adolesc Psychiatry 2020; 29:1621-1633. [PMID: 31637520 PMCID: PMC7641947 DOI: 10.1007/s00787-019-01420-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/03/2019] [Indexed: 01/08/2023]
Abstract
Community-based mental health services for children and young people (CYP) can offer alternatives to inpatient settings and treat CYP in less restrictive environments. However, there has been limited implementation of such alternative models, and their efficacy is still inconclusive. Notably, little is known of the experiences of CYP and their parents with these alternative models and their level of satisfaction with the care provided. Therefore, the main aim of this review was to understand those experiences of the accessibility of alternative models to inpatient care, as well as overall CYP/parental satisfaction. A searching strategy of peer-reviewed articles was conducted from January 1990 to December 2018, with updated searches conducted in June 2019. The initial search resulted in 495 articles, of which 19 were included in this review. A narrative synthesis grouped the studies according to emerging themes: alternative models, tele-psychiatry and interventions applied to crisis, and experiences and satisfaction with crisis provision. The identified articles highlighted increased satisfaction in CYP with alternative models in comparison with care as usual. However, the parental experiential data identified high levels of parental burden and a range of complex emotional reactions associated with engagement with crisis services. Furthermore, we identified a number of interventions, telepsychiatric and mobile solutions that may be effective when applied to urgent and emergency care for CYP experiencing a mental health crisis. Lastly, both parental and CYP experiences highlighted a number of perceived barriers associated with help-seeking from crisis services.
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Affiliation(s)
- Frane Vusio
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Andrew Thompson
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Latoya Clarke
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Ignatowicz A, Atherton H, Bernstein CJ, Bryce C, Court R, Sturt J, Griffiths F. Internet videoconferencing for patient-clinician consultations in long-term conditions: A review of reviews and applications in line with guidelines and recommendations. Digit Health 2019; 5:2055207619845831. [PMID: 31069105 PMCID: PMC6495459 DOI: 10.1177/2055207619845831] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/28/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The use of internet videoconferencing in healthcare settings is widespread, reflecting the normalisation of this mode of communication in society and current healthcare policy. As the use of internet videoconferencing is growing, increasing numbers of reviews of literature are published. METHODS The authors conducted a review of the existing reviews of literature relating to the use of internet videoconferencing for consultations between healthcare professionals and patients with long-term conditions in their own home. The review was followed with an assessment of United Kingdom National Institute for Health and Clinical Excellence guidelines for patient care in the context of common long-term illnesses to examine where videoconferencing could be implemented in line with these recommendations. RESULTS The review of reviews found no formal evidence in favour of or against the use of internet videoconferencing. Patients were satisfied with the use of videoconferencing but there was limited evidence that it led to a change in health outcomes. Evidence of healthcare professional satisfaction when using this mode of communication with patients was limited. The review of guidelines suggested a number of opportunities for adoption and expansion of internet videoconferencing. Implementing videoconferencing in line with current evidence for patient care could offer support and provide information on using a communication channel that suits individual patient needs and circumstances. The evidence base for videoconferencing is growing, but there is still a lack of data relating to cost, ethics and safety. CONCLUSIONS While the current evidence base for internet videoconferencing is equivocal, it is likely to change as more research is undertaken and evidence published. With more videoconferencing services added in more contexts, research needs to explore how internet videoconferencing can be implemented in ways that it is valued by patients and clinicians, and how it can fit within organisational and technical infrastructure of the healthcare services.
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Affiliation(s)
- Agnieszka Ignatowicz
- Institute of Applied Health Research, University of Birmingham,
Birmingham, United Kingdom
- Warwick Medical School, The University of Warwick, Coventry,
United Kingdom
| | - Helen Atherton
- Warwick Medical School, The University of Warwick, Coventry,
United Kingdom
| | | | - Carol Bryce
- Warwick Medical School, The University of Warwick, Coventry,
United Kingdom
| | - Rachel Court
- Warwick Medical School, The University of Warwick, Coventry,
United Kingdom
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and
Palliative Care, King’s College London, London, United Kingdom
| | - Frances Griffiths
- Warwick Medical School, The University of Warwick, Coventry,
United Kingdom
- Centre for Health Policy, School of Public Health, University of
the Witwatersrand, Johannesburg, South Africa
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Kim SW, Madan J, Dritsaki M, Bryce C, Forjaz V, Fraser J, Griffiths F, Hamilton K, Huxley C, Sturt J. Benefits and Costs of Digital Consulting in Clinics Serving Young People With Long-Term Conditions: Mixed-Methods Approach. JMIR Med Inform 2018; 6:e48. [PMID: 30377145 PMCID: PMC6234335 DOI: 10.2196/medinform.9577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/28/2018] [Accepted: 07/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the introduction of digital health technologies in National Health Service (NHS), health professionals are starting to use email, text, and other digital methods to consult with their patients in a timely manner. There is lack of evidence regarding the economic impact of digital consulting in the United Kingdom (UK) NHS. OBJECTIVE This study aimed to estimate the direct costs associated with digital consulting as an adjunct to routine care at 18 clinics serving young people aged 16-24 years with long-term conditions. METHODS This study uses both quantitative and qualitative approaches. Semistructured interviews were conducted with 173 clinical team members on the impacts of digital consulting. A structured questionnaire was developed and used for 115 health professionals across 12 health conditions at 18 sites in the United Kingdom to collect data on time and other resources used for digital consulting. A follow-up semistructured interview was conducted with a single senior clinician at each site to clarify the mechanisms through which digital consulting use might lead to outcomes relevant to economic evaluation. We used the two-part model to see the association between the time spent on digital consulting and the job role of staff, type of clinic, and the average length of the working hours using digital consulting. RESULTS When estimated using the two-part model, consultants spent less time on digital consulting compared with nurses (95.48 minutes; P<.001), physiotherapists (55.3 minutes; P<.001), and psychologists (31.67 minutes; P<.001). Part-time staff spent less time using digital consulting than full-time staff despite insignificant result (P=.15). Time spent on digital consulting differed across sites, and no clear pattern in using digital consulting was found. Health professionals qualitatively identified the following 4 potential economic impacts for the NHS: decreasing adverse events, improving patient well-being, decreasing wait lists, and staff workload. We did not find evidence to suggest that the clinical condition was associated with digital consulting use. CONCLUSIONS Nurses and physiotherapists were the greatest users of digital consulting. Teams appear to use an efficient triage system with the most expensive members digitally consulting less than lower-paid team members. Staff report showed concerns regarding time spent digitally consulting, which implies that direct costs increase. There remain considerable gaps in evidence related to cost-effectiveness of digital consulting, but this study has highlighted important cost-related outcomes for assessment in future cost-effectiveness trials of digital consulting.
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Affiliation(s)
- Sung Wook Kim
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Jason Madan
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Melina Dritsaki
- Oxford Clinical Trials Research Unit, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Carol Bryce
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Vera Forjaz
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Joe Fraser
- Joe's Diabetes Ltd, Coventry, United Kingdom
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Kathryn Hamilton
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Caroline Huxley
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Jackie Sturt
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Thompson LK, Sugg MM, Runkle JR. Adolescents in crisis: A geographic exploration of help-seeking behavior using data from Crisis Text Line. Soc Sci Med 2018; 215:69-79. [PMID: 30216891 DOI: 10.1016/j.socscimed.2018.08.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/22/2018] [Accepted: 08/22/2018] [Indexed: 12/19/2022]
Abstract
Nearly 3 out of 4 all lifelong mental disorders occur by the age of twenty-four. Remote crisis support holds great potential in filling a critical gap in complementing and expanding access to mental health services for acute episodes of mental distress in adolescents and young adults; yet little is understood about the individual factors that influence help-seeking behavior in this group. Recent evidence suggests technology-based mental health services have high acceptability among youth and may be used to treat anxiety and depression. The objective of this study was to examine county-level help-seeking behavior among adolescents and young adults using Crisis Text Line (CTL). CTL is a free, text-based crisis counseling service that has been available nationally since 2013. Spatial error regression was used to (1) identify the individual-level factors that correlate with help-seeking behavior for depression, anxiety, and suicidal thoughts and (2) to explore the geographic trends in text-based help-seeking behavior between adolescents and young adults across the rural-urban continuum. Increased rates of text-based help-seeking occurred in counties with higher mean household incomes, higher divorce rates, and lower residential stability. Rurality was the strongest predictor for low rates of help-seeking, and this finding is particularly concerning in light of elevated rates of suicide among rural counties. Rural communities, particularly those with low support-seeking behavior and comparatively high suicide rates, should be the target of future research and outreach.
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Affiliation(s)
- Laura K Thompson
- Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, NC, 28608, United States.
| | - Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, NC, 28608, United States.
| | - Jennifer R Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC, 28801, United States.
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Verran A, Uddin A, Court R, Taggart F, Sutcliffe P, Sturt J, Griffiths F, Atherton H. Effectiveness and impact of networked communication interventions in young people with mental health conditions: A rapid review. Digit Health 2018; 4:2055207618762209. [PMID: 29942626 PMCID: PMC6005403 DOI: 10.1177/2055207618762209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/18/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To describe the latest evidence of effectiveness and impact of networked communication interventions for young people with mental health conditions. Methods Searching five databases from 2009 onwards, we included studies of any design investigating two-way communication interventions for the treatment of young people (mean age 12–25) with a chronic mental health disorder. The data were synthesised using narrative summary. Results Six studies met the inclusion criteria, covering a range of mental health conditions (depression, psychosis, OCD). Interventions included an online chat room (n = 2), videoconferencing (n = 3) and telephone (n = 1). Where studies compared two groups, equivalence or a statistically significant improvement in symptoms was observed compared to control. Views of patients and clinicians included impact on the patient-clinician interaction. Clinicians did not feel it hindered their diagnostic ability. Conclusion Networked communication technologies show promise in the treatment of young people with mental health problems but the current available evidence remains limited and the evidence base has not advanced much since the previous inception of this review in 2011. Practice implications Although the available research is generally positive, robust evidence relating to the provision of care for young persons via these technologies is lacking and healthcare providers should be mindful of this.
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Affiliation(s)
- Alice Verran
- 1Warwick Medical School, University of Warwick, UK
| | - Ayesha Uddin
- 1Warwick Medical School, University of Warwick, UK
| | - Rachel Court
- 1Warwick Medical School, University of Warwick, UK
| | | | | | - Jackie Sturt
- The Florence Nightingale Faculty of Nursing & Midwifery, King's College London, UK
| | - Frances Griffiths
- 1Warwick Medical School, University of Warwick, UK.,University of the Witwatersrand, South Africa
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Ignatowicz A, Slowther AM, Elder P, Bryce C, Hamilton K, Huxley C, Forjaz V, Sturt J, Griffiths F. Ethical implications of digital communication for the patient-clinician relationship: analysis of interviews with clinicians and young adults with long term conditions (the LYNC study). BMC Med Ethics 2018; 19:11. [PMID: 29475437 PMCID: PMC5824603 DOI: 10.1186/s12910-018-0250-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/13/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. METHODS A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom (UK)-based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites (cancer, liver, renal, cystic fibrosis and mental health) were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. RESULTS Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician's duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. CONCLUSIONS The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to.
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Affiliation(s)
| | | | - Patrick Elder
- Warwick Medical School, The University of Warwick, Coventry, CV4 7AL UK
| | - Carol Bryce
- Warwick Medical School, The University of Warwick, Coventry, CV4 7AL UK
| | - Kathryn Hamilton
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Caroline Huxley
- Warwick Medical School, The University of Warwick, Coventry, CV4 7AL UK
| | - Vera Forjaz
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Frances Griffiths
- Warwick Medical School, The University of Warwick, Coventry, CV4 7AL UK
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Griffiths FE, Armoiry X, Atherton H, Bryce C, Buckle A, Cave JAK, Court R, Hamilton K, Dliwayo TR, Dritsaki M, Elder P, Forjaz V, Fraser J, Goodwin R, Huxley C, Ignatowicz A, Karasouli E, Kim SW, Kimani P, Madan JJ, Matharu H, May M, Musumadi L, Paul M, Raut G, Sankaranarayanan S, Slowther AM, Sujan MA, Sutcliffe PA, Svahnstrom I, Taggart F, Uddin A, Verran A, Walker L, Sturt J. The role of digital communication in patient–clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundYoung people (aged 16–24 years) with long-term health conditions tend to disengage from health services, resulting in poor health outcomes. They are prolific users of digital communications. Innovative UK NHS clinicians use digital communication with these young people. The NHS plans to use digital communication with patients more widely.ObjectivesTo explore how health-care engagement can be improved using digital clinical communication (DCC); understand effects, impacts, costs and necessary safeguards; and provide critical analysis of its use, monitoring and evaluation.DesignObservational mixed-methods case studies; systematic scoping literature reviews; assessment of patient-reported outcome measures (PROMs); public and patient involvement; and consensus development through focus groups.SettingTwenty NHS specialist clinical teams from across England and Wales, providing care for 13 different long-term physical or mental health conditions.ParticipantsOne hundred and sixty-five young people aged 16–24 years living with a long-term health condition; 13 parents; 173 clinical team members; and 16 information governance specialists.InterventionsClinical teams and young people variously used mobile phone calls, text messages, e-mail and voice over internet protocol.Main outcome measuresEmpirical work – thematic and ethical analysis of qualitative data; annual direct costs; did not attend, accident and emergency attendance and hospital admission rates plus clinic-specific clinical outcomes. Scoping reviews–patient, health professional and service delivery outcomes and technical problems. PROMs: scale validity, relevance and credibility.Data sourcesObservation, interview, structured survey, routinely collected data, focus groups and peer-reviewed publications.ResultsDigital communication enables access for young people to the right clinician when it makes a difference for managing their health condition. This is valued as additional to traditional clinic appointments. This access challenges the nature and boundaries of therapeutic relationships, but can improve them, increase patient empowerment and enhance activation. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information and communication failures, but clinicians and young people mitigate these risks. Workload increases and the main cost is staff time. Clinical teams had not evaluated the impact of their intervention and analysis of routinely collected data did not identify any impact. There are no currently used generic outcome measures, but the Patient Activation Measure and the Physicians’ Humanistic Behaviours Questionnaire are promising. Scoping reviews suggest DCC is acceptable to young people, but with no clear evidence of benefit except for mental health.LimitationsQualitative data were mostly from clinician enthusiasts. No interviews were achieved with young people who do not attend clinics. Clinicians struggled to estimate workload. Only eight full sets of routine data were available.ConclusionsTimely DCC is perceived as making a difference to health care and health outcomes for young people with long-term conditions, but this is not supported by evidence that measures health outcomes. Such communication is challenging and costly to provide, but valued by young people.Future workFuture development should distinguish digital communication replacing traditional clinic appointments and additional timely communication. Evaluation is needed that uses relevant generic outcomes.Study registrationTwo of the reviews in this study are registered as PROSPERO CRD42016035467 and CRD42016038792.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Xavier Armoiry
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Carol Bryce
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Abigail Buckle
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Kathryn Hamilton
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Thandiwe R Dliwayo
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | | | - Patrick Elder
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Vera Forjaz
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Joe Fraser
- Patient and public involvement representative, London, UK
| | - Richard Goodwin
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | | | | | | | - Sung Wook Kim
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Kimani
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jason J Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Harjit Matharu
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mike May
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Moli Paul
- Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Gyanu Raut
- King’s College Hospital NHS Foundation Trust, London, UK
| | | | | | - Mark A Sujan
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | | | - Ayesha Uddin
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Alice Verran
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Leigh Walker
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
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14
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Armoiry X, Sturt J, Phelps EE, Walker CL, Court R, Taggart F, Sutcliffe P, Griffiths F, Atherton H. Digital Clinical Communication for Families and Caregivers of Children or Young People With Short- or Long-Term Conditions: Rapid Review. J Med Internet Res 2018; 20:e5. [PMID: 29305339 PMCID: PMC5775486 DOI: 10.2196/jmir.7999] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/15/2017] [Accepted: 11/04/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The communication relationship between parents of children or young people with health conditions and health professionals is an important part of treatment, but it is unclear how far the use of digital clinical communication tools may affect this relationship. OBJECTIVE The objective of our study was to describe, assess the feasibility of, and explore the impact of digital clinical communication between families or caregivers and health professionals. METHODS We searched the literature using 5 electronic databases. We considered all types of study design published in the English language from January 2009 to August 2015. The population of interest included families and caregivers of children and young people aged less than 26 years with any type of health condition. The intervention was any technology permitting 2-way communication. RESULTS We included 31 articles. The main designs were randomized controlled trials (RCTs; n=10), cross-sectional studies (n=9), pre- and postintervention uncontrolled (pre/post) studies (n=7), and qualitative interview studies (n=2); 6 had mixed-methods designs. In the majority of cases, we considered the quality rating to be fair. Many different types of health condition were represented. A breadth of digital communication tools were included: videoconferencing or videoconsultation (n=14), and Web messaging or emails (n=12). Health care professionals were mainly therapists or cognitive behavioral therapists (n=10), physicians (n=8), and nurses (n=6). Studies were very heterogeneous in terms of outcomes. Interventions were mainly evaluated using satisfaction or acceptance, or outcomes relating to feasibility. Clinical outcomes were rarely used. The RCTs showed that digital clinical communication had no impact in comparison with standard care. Uncontrolled pre/post studies showed good rates of satisfaction or acceptance. Some economic studies suggested that digital clinical communication may save costs. CONCLUSIONS This rapid review showed an emerging body of literature on the use of digital clinical communication to improve families' and caregivers' involvement in the health management of children or young people. Further research with appropriate study designs and longer-term outcome measures should be encouraged. TRIAL REGISTRATION PROSPERO CRD42016035467; http://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD 42016 035467(Archived by WebCite at http://www.webcitation.org/6vpgZU1FU).
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Affiliation(s)
- Xavier Armoiry
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, London, United Kingdom
| | | | | | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frances Taggart
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Paul Sutcliffe
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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15
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Orlowski S, Lawn S, Matthews B, Venning A, Jones G, Winsall M, Antezana G, Bidargaddi N, Musiat P. People, processes, and systems: An observational study of the role of technology in rural youth mental health services. Int J Ment Health Nurs 2017; 26:259-272. [PMID: 27878940 DOI: 10.1111/inm.12262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 11/27/2022]
Abstract
The merits of technology-based mental health service reform have been widely debated among academics, practitioners, and policy makers. The design of new technologies must first be predicated on a detailed appreciation of how the mental health system works before it can be improved or changed through the introduction of new products and services. Further work is required to better understand the nature of face-to-face mental health work and to translate this knowledge to computer scientists and system designers responsible for creating technology-based solutions. Intensive observation of day-to-day work within two rural youth mental health services in South Australia, Australia, was undertaken to understand how technology could be designed and implemented to enhance young people's engagement with services and improve their experience of help seeking. Data were analysed through a lens of complexity theory. Results highlight the variety of professional roles and services that can comprise the mental health system. The level of interconnectedness evident in the system contrasted with high levels of service self-organization and disjointed information flow. A mental health professional's work was guided by two main constructs: risk and engagement. Most clients presented with a profile of disability, disadvantage, and isolation, so complex client presentations and decision-making were core practices. Clients (and frequently, their families) engaged with services in a crisis-dependent manner, characterized by multiple disengagements and re-engagements over time. While significant opportunities exist to integrate technology into existing youth mental health services, technologies for this space must be usable for a broad range of medical, psychological and cognitive disability, social disadvantage, and accommodate repeat cycles of engagement/disengagement over time.
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Affiliation(s)
- Simone Orlowski
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.,Young and Well Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Ben Matthews
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Venning
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Gabrielle Jones
- Country and Outback Health, Port Augusta, South Australia, Australia
| | - Megan Winsall
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.,Young and Well Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Gaston Antezana
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.,Young and Well Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Niranjan Bidargaddi
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.,Young and Well Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Peter Musiat
- Institute of Psychiatry, King's College London, London, UK
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16
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Griffiths F, Bryce C, Cave J, Dritsaki M, Fraser J, Hamilton K, Huxley C, Ignatowicz A, Kim SW, Kimani PK, Madan J, Slowther AM, Sujan M, Sturt J. Timely Digital Patient-Clinician Communication in Specialist Clinical Services for Young People: A Mixed-Methods Study (The LYNC Study). J Med Internet Res 2017; 19:e102. [PMID: 28396301 PMCID: PMC5404145 DOI: 10.2196/jmir.7154] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 11/28/2022] Open
Abstract
Background Young people (aged 16-24 years) with long-term health conditions can disengage from health services, resulting in poor health outcomes, but clinicians in the UK National Health Service (NHS) are using digital communication to try to improve engagement. Evidence of effectiveness of this digital communication is equivocal. There are gaps in evidence as to how it might work, its cost, and ethical and safety issues. Objective Our objective was to understand how the use of digital communication between young people with long-term conditions and their NHS specialist clinicians changes engagement of the young people with their health care; and to identify costs and necessary safeguards. Methods We conducted mixed-methods case studies of 20 NHS specialist clinical teams from across England and Wales and their practice providing care for 13 different long-term physical or mental health conditions. We observed 79 clinical team members and interviewed 165 young people aged 16-24 years with a long-term health condition recruited via case study clinical teams, 173 clinical team members, and 16 information governance specialists from study NHS Trusts. We conducted a thematic analysis of how digital communication works, and analyzed ethics, safety and governance, and annual direct costs. Results Young people and their clinical teams variously used mobile phone calls, text messages, email, and voice over Internet protocol. Length of clinician use of digital communication varied from 1 to 13 years in 17 case studies, and was being considered in 3. Digital communication enables timely access for young people to the right clinician at the time when it can make a difference to how they manage their health condition. This is valued as an addition to traditional clinic appointments and can engage those otherwise disengaged, particularly at times of change for young people. It can enhance patient autonomy, empowerment and activation. It challenges the nature and boundaries of therapeutic relationships but can improve trust. The clinical teams studied had not themselves formally evaluated the impact of their intervention. Staff time is the main cost driver, but offsetting savings are likely elsewhere in the health service. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information, and communication failures, which are mostly mitigated by young people and clinicians using common-sense approaches. Conclusions As NHS policy prompts more widespread use of digital communication to improve the health care experience, our findings suggest that benefit is most likely, and harms are mitigated, when digital communication is used with patients who already have a relationship of trust with the clinical team, and where there is identifiable need for patients to have flexible access, such as when transitioning between services, treatments, or lived context. Clinical teams need a proactive approach to ethics, governance, and patient safety.
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Affiliation(s)
- Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol Bryce
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jonathan Cave
- Department of Economics, University of Warwick, Coventry, United Kingdom
| | - Melina Dritsaki
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Fraser
- Patient and Public Involvement, Coventry, United Kingdom
| | - Kathryn Hamilton
- Florence Nightingale Faculty of Nursing and Midwidery, King's College London, London, United Kingdom
| | - Caroline Huxley
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Agnieszka Ignatowicz
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sung Wook Kim
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Peter K Kimani
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jason Madan
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Anne-Marie Slowther
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Mark Sujan
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwidery, King's College London, London, United Kingdom
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17
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Graves TA, Tabri N, Thompson-Brenner H, Franko DL, Eddy KT, Bourion-Bedes S, Brown A, Constantino MJ, Flückiger C, Forsberg S, Isserlin L, Couturier J, Paulson Karlsson G, Mander J, Teufel M, Mitchell JE, Crosby RD, Prestano C, Satir DA, Simpson S, Sly R, Lacey JH, Stiles-Shields C, Tasca GA, Waller G, Zaitsoff SL, Rienecke R, Le Grange D, Thomas JJ. A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders. Int J Eat Disord 2017; 50:323-340. [PMID: 28152196 DOI: 10.1002/eat.22672] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/12/2016] [Accepted: 12/12/2016] [Indexed: 12/11/2022]
Abstract
The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.
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Affiliation(s)
- Tiffany A Graves
- Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Nassim Tabri
- Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Heather Thompson-Brenner
- Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Debra L Franko
- Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | | | - Amy Brown
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, England, United Kingdom
| | - Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts-Amherst, Amherst, Massachusetts, United States
| | - Christoph Flückiger
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States and Institute fur Psychologie, University of Bern, Bern, Switzerland
| | - Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, United States
| | - Leanna Isserlin
- Division of Child & Adolescent Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer Couturier
- Pediatric Eating Disorders Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | - Johannes Mander
- ZZP Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany and Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - James E Mitchell
- Neuropsychiatric Research Institute, Fargo, North Dakota, United States and University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, United States
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota, United States and University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, United States
| | | | - Dana A Satir
- Department of Psychiatry, University of Colorado Denver, Denver, Colorado, United States
| | - Susan Simpson
- School of Psychology, Social Work, and Social Policy, University of South Australia, South Australia, Australia
| | - Richard Sly
- School of Nursing Science, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - J Hubert Lacey
- Department of Health and Social Care Sciences, St. George's, University of London, London, England, United Kingdom
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine and The School of Social Service Administration, University of Chicago, Chicago, Illinois, United States
| | - Giorgio A Tasca
- Brain and Mind Research Institute, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Shannon L Zaitsoff
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Renee Rienecke
- The University of Michigan Comprehensive Eating Disorders Program, Ann Arbor, Michigan, United States
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, California, United States
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
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18
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Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice. Br J Gen Pract 2016; 65:e813-21. [PMID: 26622034 DOI: 10.3399/bjgp15x687853] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Increasingly, the NHS is embracing the use of digital communication technology for communication between clinicians and patients. Policymakers deem digital clinical communication as presenting a solution to the capacity issues currently faced by general practice. There is some concern that these technologies may exacerbate existing inequalities in accessing health care. It is not known what impact they may have on groups who are already marginalised in their ability to access general practice. AIM To assess the potential impact of the availability of digital clinician-patient communication on marginalised groups' access to general practice in the UK. DESIGN AND SETTING Realist review in general practice. METHOD A four-step realist review process was used: to define the scope of the review; to search for and scrutinise evidence; to extract and synthesise evidence; and to develop a narrative, including hypotheses. RESULTS Digital communication has the potential to overcome the following barriers for marginalised groups: practical access issues, previous negative experiences with healthcare service/staff, and stigmatising reactions from staff and other patients. It may reduce patient-related barriers by offering anonymity and offers advantages to patients who require an interpreter. It does not impact on inability to communicate with healthcare professionals or on a lack of candidacy. It is likely to work best in the context of a pre-existing clinician-patient relationship. CONCLUSION Digital communication technology offers increased opportunities for marginalised groups to access health care. However, it cannot remove all barriers to care for these groups. It is likely that they will remain disadvantaged relative to other population groups after their introduction.
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19
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Das JK, Salam RA, Lassi ZS, Khan MN, Mahmood W, Patel V, Bhutta ZA. Interventions for Adolescent Mental Health: An Overview of Systematic Reviews. J Adolesc Health 2016; 59:S49-S60. [PMID: 27664596 PMCID: PMC5026677 DOI: 10.1016/j.jadohealth.2016.06.020] [Citation(s) in RCA: 242] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/28/2016] [Accepted: 07/01/2016] [Indexed: 01/08/2023]
Abstract
Many mental health disorders emerge in late childhood and early adolescence and contribute to the burden of these disorders among young people and later in life. We systematically reviewed literature published up to December 2015 to identify systematic reviews on mental health interventions in adolescent population. A total of 38 systematic reviews were included. We classified the included reviews into the following categories for reporting the findings: school-based interventions (n = 12); community-based interventions (n = 6); digital platforms (n = 8); and individual-/family-based interventions (n = 12). Evidence from school-based interventions suggests that targeted group-based interventions and cognitive behavioral therapy are effective in reducing depressive symptoms (standard mean difference [SMD]: -.16; 95% confidence interval [CI]: -.26 to -.05) and anxiety (SMD: -.33; 95% CI: -.59 to -.06). School-based suicide prevention programs suggest that classroom-based didactic and experiential programs increase short-term knowledge of suicide (SMD: 1.51; 95% CI: .57-2.45) and knowledge of suicide prevention (SMD: .72; 95% CI: .36-1.07) with no evidence of an effect on suicide-related attitudes or behaviors. Community-based creative activities have some positive effect on behavioral changes, self-confidence, self-esteem, levels of knowledge, and physical activity. Evidence from digital platforms supports Internet-based prevention and treatment programs for anxiety and depression; however, more extensive and rigorous research is warranted to further establish the conditions. Among individual- and family-based interventions, interventions focusing on eating attitudes and behaviors show no impact on body mass index (SMD: -.10; 95% CI: -.45 to .25); Eating Attitude Test (SMD: .01; 95% CI: -.13 to .15); and bulimia (SMD: -.03; 95% CI: -.16 to .10). Exercise is found to be effective in improving self-esteem (SMD: .49; 95% CI: .16-.81) and reducing depression score (SMD: -.66; 95% CI: -1.25 to -.08) with no impact on anxiety scores. Cognitive behavioral therapy compared to waitlist is effective in reducing remission (odds ratio: 7.85; 95% CI: 5.31-11.6). Psychological therapy when compared to antidepressants have comparable effect on remission, dropouts, and depression symptoms. The studies evaluating mental health interventions among adolescents were reported to be very heterogeneous, statistically, in their populations, interventions, and outcomes; hence, meta-analysis could not be conducted in most of the included reviews. Future trials should also focus on standardized interventions and outcomes for synthesizing the exiting body of knowledge. There is a need to report differential effects for gender, age groups, socioeconomic status, and geographic settings since the impact of mental health interventions might vary according to various contextual factors.
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Affiliation(s)
- Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Marium Naveed Khan
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Vikram Patel
- London School of Hygiene & Tropical Medicine, London, United Kingdom; Public Health Foundation of India, New Delhi, India; Sangath, Goa, India
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan.
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20
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Sansom-Daly UM, Wakefield CE, McGill BC, Wilson HL, Patterson P. Consensus Among International Ethical Guidelines for the Provision of Videoconferencing-Based Mental Health Treatments. JMIR Ment Health 2016; 3:e17. [PMID: 27192931 PMCID: PMC4889868 DOI: 10.2196/mental.5481] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/08/2016] [Accepted: 02/13/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Online technologies may reduce barriers to evidence-based mental health care, yet they also create numerous ethical challenges. Recently, numerous professional organizations and expert groups have produced best-practice guidelines to assist mental health professionals in delivering online interventions in an ethically and clinically sound manner. However, there has been little critical examination of these international best-practice guidelines regarding appropriate electronic mental health (e-mental health) service delivery via technologies such as videoconferencing (including Skype), particularly for specific, vulnerable populations. Further, the extent to which concordance exists between these guidelines remains unclear. Synthesizing this literature to provide clear guidance to both mental health professionals and researchers is critical to ensure continued progress in the field of e-mental health. OBJECTIVE This study aims to review all currently available ethical and best-practice guidelines relating to videoconferencing-delivered mental health treatments in order to ascertain the recommendations for which international consensus could be found. Additionally, this review examines the extent to which each set of guidance addresses several key special populations, including children and young people, and populations living with illness. METHODS This systematic review examined guidelines using a two-armed search strategy, examining (1) professional organizations' published guidance; and (2) MEDLINE, PsycINFO, and EMBASE for the past ten years. In order to determine consensus for best-practice, a recommendation was considered "firm" if 50% or more of the reviewed guidelines endorsed it and "tentative" if recommended by fewer guidelines than these. The professional guidelines were also scored by two raters using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) criteria. RESULTS In the study, 19 guidelines were included, yielding 11 specific "firm" and a further 123 "tentative-level" recommendations regarding the appropriateness of e-mental health, competence, legal and regulatory issues, confidentiality, consent, professional boundaries, and crisis management. International consensus yielded firm guidance across almost all areas except professional boundaries and some aspects of determining the appropriateness of e-mental health. Few guidelines specifically addressed special populations. Overall guideline quality varied; however, 42% (8/19) of the guidelines scored at least 5 out of 7. CONCLUSIONS This synthesis of guidelines provides a foundation for clinicians and researchers utilizing e-mental health worldwide. The lack of specific guidance relating to special populations is an area warranting further attention in order to strengthen mental health professionals' and researchers' capacity to ethically and effectively tailor e-mental health interventions to these groups.
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Affiliation(s)
- Ursula M Sansom-Daly
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Randwick, Australia.
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21
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Ricketts EJ, Goetz AR, Capriotti MR, Bauer CC, Brei NG, Himle MB, Espil FM, Snorrason Í, Ran D, Woods DW. A randomized waitlist-controlled pilot trial of voice over Internet protocol-delivered behavior therapy for youth with chronic tic disorders. J Telemed Telecare 2016; 22:153-62. [PMID: 26169350 PMCID: PMC6033263 DOI: 10.1177/1357633x15593192] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/14/2015] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Comprehensive Behavioral Intervention for Tics (CBIT) has been shown to be efficacious for chronic tic disorders (CTDs), but utilization is limited by a lack of treatment providers and perceived financial and time burden of commuting to treatment. A promising alternative to in-person delivery is voice over Internet protocol (VoIP), allowing for remote, real-time treatment delivery to patients' homes. However, little is known about the effectiveness of VoIP for CTDs. Therefore, the present study examined the preliminary efficacy, feasibility, and acceptability of VoIP-delivered CBIT (CBIT-VoIP). METHODS Twenty youth (8-16 years) with CTDs participated in a randomized, waitlist-controlled pilot trial of CBIT-VoIP. The main outcome was pre- to post-treatment change in clinician-rated tic severity (Yale Global Tic Severity Scale). The secondary outcome was clinical responder rate (Clinical Global Impressions - Improvement Scale), assessed using ratings of 'very much improved' or 'much improved' indicating positive treatment response. RESULTS Intention-to-treat analyses with the last observation carried forward were performed. At post-treatment (10-weeks), significantly greater reductions in clinician-rated, (F(1,18) = 3.05, p < 0.05, partial η(2 )= 0.15), and parent-reported tic severity, (F(1,18) = 6.37, p < 0.05, partial η(2 )= 0.26) were found in CBIT-VoIP relative to waitlist. One-third (n = 4) of those in CBIT-VoIP were considered treatment responders. Treatment satisfaction and therapeutic alliance were high. DISCUSSION CBIT can be delivered via VoIP with high patient satisfaction, using accessible, low-cost equipment. CBIT-VoIP was generally feasible to implement, with some audio and visual challenges. Modifications to enhance treatment delivery are suggested.
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Affiliation(s)
- Emily J Ricketts
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, USA Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Amy R Goetz
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | | | | | - Natalie G Brei
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | | | - Flint M Espil
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Ívar Snorrason
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Dagong Ran
- Department of Psychology, University of Wisconsin-Milwaukee, USA
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22
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Dempsey AF, Zimet GD. Interventions to Improve Adolescent Vaccination: What May Work and What Still Needs to Be Tested. Am J Prev Med 2015; 49:S445-54. [PMID: 26272849 DOI: 10.1016/j.amepre.2015.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 02/03/2023]
Abstract
Since the development of the "adolescent platform" of vaccination in 1997, hundreds of studies have been conducted, identifying barriers to and facilitators of adolescent vaccination. More recent research has focused on developing and evaluating interventions to increase uptake of adolescent vaccines. This review describes a selection of recent intervention studies for increasing adolescent vaccination, divided into three categories: those with promising results that may warrant more widespread implementation, those with mixed results requiring more research, and those with proven effectiveness in other domains that have not yet been tested with regard to adolescent vaccination.
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Affiliation(s)
- Amanda F Dempsey
- Adult and Child Center for Outcomes Research and Dissemination Science program, University of Colorado Denver, Aurora, Colorado.
| | - Gregory D Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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23
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24
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Griffiths FE, Atherton H, Barker JR, Cave JAK, Dennick K, Dowdall P, Fraser J, Huxley C, Kim SW, Madan JJ, Matharu H, Musumadi L, Palmer TM, Paul M, Sankaranarayanan S, Slowther AM, Sujan MA, Sutcliffe PA, Sturt J. Improving health outcomes for young people with long term conditions: The role of digital communication in current and future patient-clinician communication for NHS providers of specialist clinical services for young people - LYNC study protocol. Digit Health 2015; 1:2055207615593698. [PMID: 29942543 PMCID: PMC5999058 DOI: 10.1177/2055207615593698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Young people living with long term conditions are vulnerable to health service disengagement. This endangers their long term health. Studies report requests for digital forms of communication - email, text, social media - with their health care team. Digital clinical communication is troublesome for the UK NHS. AIM In this article we aim to present the research protocol for evaluating the impacts and outcomes of digital clinical communications for young people living with long term conditions and provide critical analysis of their use, monitoring and evaluation by NHS providers (LYNC study: Long term conditions, Young people, Networked Communications). METHODS The research involves: (a) patient and public involvement activities with 16-24 year olds with and without long term health conditions; (b) six literature reviews; (c) case studies - the main empirical part of the study - and (d) synthesis and a consensus meeting. Case studies use a mixed methods design. Interviews and non-participant observation of practitioners and patients communicating in up to 20 specialist clinical settings will be combined with data, aggregated at the case level (non-identifiable patient data) on a range of clinical outcomes meaningful within the case and across cases. We will describe the use of digital clinical communication from the perspective of patients, clinical staff, support staff and managers, interviewing up to 15 young people and 15 staff per case study. Outcome data includes emergency admissions, A&E attendance and DNA (did not attend) rates. Case studies will be analysed to understand impacts of digital clinical communication on patient health outcomes, health care costs and consumption, ethics and patient safety.
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Affiliation(s)
| | - Helen Atherton
- Nuffield Department of Primary Care
Health Sciences, University of Oxford, UK
| | | | | | - Kathryn Dennick
- Florence Nightingale Faculty of Nursing
and Midwifery, King’s College London, UK
| | | | - Joe Fraser
- Patient and Public Involvement (PPI)
representative, UK
| | | | | | | | - Harjit Matharu
- University Hospitals Coventry and
Warwickshire NHS Trust, UK
| | | | - Tom M Palmer
- Warwick Medical School, University of
Warwick, UK
| | - Moli Paul
- Warwick Medical School, University of
Warwick, UK
| | | | | | - Mark A Sujan
- Warwick Medical School, University of
Warwick, UK
| | | | - Jackie Sturt
- Florence Nightingale Faculty of Nursing
and Midwifery, King’s College London, UK
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25
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Jones RB, Ashurst EJ. Online anonymous discussion between service users and health professionals to ascertain stakeholder concerns in using e-health services in mental health. Health Informatics J 2014; 19:281-99. [PMID: 24255052 DOI: 10.1177/1460458212474908] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Implementation of e-health in mental health services requires that we are aware of stakeholders' concerns. We ascertained the views of mental health professionals and mental health service users through the (1) development of 12 topics based on the research literature, (2) presentation to 31 participants (19 mental health professionals and 12 mental health service users) and discussion in three 1-week programmes, (3) thematic analysis of transcripts, and (4) comparison with the literature to identify areas requiring attention in e-health implementation. This method of engaging mental health service users and mental health professionals was effective. We identified areas that (1) should be the first to implement (e.g. discussion forums, email, and Skype), (2) where further education and engagement are necessary before e-health methods could be used (e.g. unsupported computerised cognitive behavioural therapy, computer-patient interviewing, and patient access to online medical records), and (3) for further research (e.g. the impact of bad online experiences).
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26
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The feasibility of an internet-based intervention for Chinese people with mental illness: A survey of willingness and attitude. Int J Nurs Sci 2014. [DOI: 10.1016/j.ijnss.2014.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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27
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Le S, Shafer PO, Bartfeld E, Fisher RS. An online diary for tracking epilepsy. Epilepsy Behav 2011; 22:705-9. [PMID: 21975298 DOI: 10.1016/j.yebeh.2011.08.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/25/2011] [Accepted: 08/26/2011] [Indexed: 11/24/2022]
Abstract
My Epilepsy Diary is a free Web-based application on the public website epilepsy.com, available for patients to track epilepsy and to aid clinicians with data-based, individualized management. The first aim of this descriptive study was to outline electronic diary functions. Second, the study retrospectively profiled a large cohort of 2010 calendar year diary users including demographics, seizure types, temporal distribution of seizures, triggers, and use and side effects of antiepileptic drugs (AEDs). A total of 1944 users provided demographic information and 1877 recorded seizure data. Most (64%) users were women. Average age was 29.9±16.0 years. A total of 70,990 seizure entries and 15,630 AED entries were logged. Events were apportioned as 79% seizures and 21% seizure clusters. Specific AEDs were detailed in 7331 entries: monotherapy was used in 18% and polytherapy in 82%. Mood-related side effects were most commonly reported in 19% of 1027 users.
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Affiliation(s)
- Scheherazade Le
- Department of Neurology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Smith RJ, Bryant RG. Metal substitutions incarbonic anhydrase: a halide ion probe study. Biochem Biophys Res Commun 1975; 66:1281-6. [PMID: 0000-0003-1376-8556 PMCID: PMC10704303 DOI: 10.1016/0006-291x(75)90498-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 09/26/2023] [Indexed: 02/07/2023]
Abstract
Monitoring of the mental health status of the population and assessment of its determinants are 2 of the most relevant pillars of public mental health, and data from population health surveys could be instrumental to support them. Although these surveys could be an important and suitable resource for these purposes, due to different limitations and challenges, they are often relegated to the background behind other data sources, such as electronic health records. These limitations and challenges include those related to measurement properties and cross-cultural validity of the tools used for the assessment of mental disorders, their degree of representativeness, and possible difficulties in the linkage with other data sources. Successfully addressing these limitations could significantly increase the potential of health surveys in the monitoring of mental disorders and ultimately maximize the impact of the relevant policies to reduce their burden at the population level. The widespread use of data from population health surveys, ideally linked to electronic health records data, would enhance the quality of the information available for research, public mental health decision-making, and ultimately addressing the growing burden of mental disorders.
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