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Ryan M, Ward EC, Burns C, Carrington C, Cuff K, Mackinnon M, Snoswell CL. Telepharmacy for outpatients with cancer: An implementation evaluation of videoconsults compared to telephone consults using the CFIR 2.0. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 16:100501. [PMID: 39308557 PMCID: PMC11415766 DOI: 10.1016/j.rcsop.2024.100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/02/2024] [Accepted: 09/03/2024] [Indexed: 09/25/2024] Open
Abstract
Background Medication history telepharmacy consults are conducted prior to patients commencing their systemic anti-cancer therapy. At the study institution, this has historically been carried out as an unscheduled telephone consult. However, due to challenges with telephone consults, a scheduled videoconsult model was established. Funding, time efficiency, and completion rate for videoconsults compared to telephone consults have been examined previously. Objective The aim of this study was to determine staff perceptions of the factors that influence implementation, including enablers and barriers, for videoconsults compared to telephone consults, to inform model sustainability. Methods Semi-structured interviews were conducted with staff (n = 14) involved with the videoconsult service, or who provided care for patients who had a videoconsult. Interviews were coded for positive or negative influence and strength using the Consolidated Framework for Implementation Research (CFIR) 2.0, to understand which constructs influence implementation. Results Thirty-nine of the 79 constructs, from across four domains were identified as influences for the telephone and videoconsult models. Six constructs were strongly differentiating for videoconsults over telephone consults. Of the 25 positively influencing constructs for the videoconsult model, strongest ratings (+2) were given for innovation advantages, critical incidents, support persons assisting in the consult, financing related to funding reimbursement, and telehealth coordinator capability and motivation. Barriers unique to the videoconsult model included the many steps that were involved, compatibility with workflows, and pharmacist resource. Similarities and differences unique to each model were identified. Conclusion Findings demonstrated a number of strongly differentiating constructs highlighting superiority of the videoconsult model. However, implementation of both models had multiple enablers and barriers that may influence adoption. The potential of a hybrid service, using both telephone consults and videoconsults, may help optimise delivery of services.
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Affiliation(s)
- Marissa Ryan
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Elizabeth C. Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Clare Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Christine Carrington
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Katharine Cuff
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Mhairi Mackinnon
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Centaine L. Snoswell
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
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Osman S, Churruca K, Ellis LA, Luo D, Braithwaite J. The Unintended Consequences of Telehealth in Australia: Critical Interpretive Synthesis. J Med Internet Res 2024; 26:e57848. [PMID: 39190446 PMCID: PMC11387926 DOI: 10.2196/57848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Despite more than 2 decades of telehealth use in Australia and the rapid uptake during the COVID-19 pandemic, little is known about its unintended consequences beyond its planned and intended outcomes. OBJECTIVE The aim of this review was to synthesize evidence on the unintended consequences of telehealth use in Australia to clarify its impact beyond its planned and intended outcomes. METHODS We conducted a search of 4 electronic databases: Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, and Scopus. A critical interpretive synthesis approach was adopted for its flexibility and interpretive nature. We extracted data about study characteristics and the types and models of telehealth services. The extracted unintended consequences were coded and mapped into the domains and dimensions of the Australian Health Performance Framework. RESULTS Of the 4241 records identified by the search, 94 (2.22%) studies were eligible for data extraction and analysis. Of these 94 studies, 23 (24%) reported largely positive unintended consequences of telehealth associated with health status, while 6 (6%) noted a potential negative impact of telehealth on socioeconomic status. The findings of 4 (4%) of the 94 studies highlighted societal and financial consequences of telehealth beyond the health system. Almost all studies (93/94, 99%) reported unintended consequences under the 5 dimensions of the Australian Health Performance Framework. CONCLUSIONS Our synthesis offers a framework for understanding the unintended consequences of the use of telehealth as an alternative to in-person care in Australia. While we have documented many unintended benefits of telehealth use, our findings also shed light on many challenges of delivering care via telehealth across different domains and dimensions. These findings hold significant practice and policy-making implications for ensuring safe and high-quality care delivery via telehealth.
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Affiliation(s)
- Sagda Osman
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Dan Luo
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
- The Daffodil Centre, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
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3
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Tiet QQ, Davis L, Rosen C, Norman SB, Leyva YE, Duong H. Factors Associated With Increased Substance Use Disorder Care in VA PTSD Specialty Outpatient Treatment. J Dual Diagn 2024; 20:223-235. [PMID: 38710212 DOI: 10.1080/15504263.2024.2348105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Substance use disorders (SUDs) commonly co-occur with posttraumatic stress disorder (PTSD). Understanding PTSD clinics that serve higher percentages of patients with PTSD/SUD is crucial for improving SUD care in clinics with lower percentages of such patients. This study examined the differences between Veterans Affairs (VA) PTSD treatment sites with higher percentages ("High%") and lower percentages ("Low%") of patients with PTSD/SUD as well as exploring the roles of the PTSD/SUD specialists. METHODS The study collected quantitative and qualitative data from 18 clinic directors and 21 specialists from 33 VA PTSD specialty outpatient clinics from 2014 to 2016. The clinics were chosen from the top and bottom quartiles based on two criteria: (1) the percentage of patients with PTSD/SUD and (2) the percentage of patients with PTSD/SUD who completed at least three SUD visits within the first month of their SUD treatment. The interviews sought to identify distinguishing characteristics between the High% and Low% clinics in terms of treatment access and practices for patients with PTSD/SUD. RESULTS More of the High% clinics reported providing evidence-based, patient-centered, and integrated/concurrent PTSD/SUD treatment and had staff members with more up-to-date knowledge and skills than the Low% clinics. We also found the roles of the PTSD/SUD specialists were demanding and confusing, leading to high turnover rates. CONCLUSIONS The two groups of PTSD clinics differed in three key factors: Resources, knowledge and skills of staff members, and local policies. Future research should focus on addressing resource limitations, knowledge gaps, and local policy disparities in Low% clinics. By emulating the practices of High% clinics, VA PTSD clinics can improve SUD care for patients with PTSD/SUD.
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Affiliation(s)
- Quyen Q Tiet
- California School of Professional Psychology, Alliant International University, San Francisco Bay Area, CA, USA
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Laila Davis
- Kaiser Permanente Rancho Cordova Medical Center, Rancho Cordova, CA, USA
| | - Craig Rosen
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Sonya B Norman
- National Center for PTSD, White River Junction, VT, USA
- University of California San Diego School of Medicine, San Diego, CA, USA
| | - Yani E Leyva
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Heather Duong
- Kaiser Permanente San Leandro Medical Center, San Leandro, CA, USA
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Ryan M, Poke T, Ward EC, Carrington C, Snoswell CL. A systematic review of synchronous telepharmacy service models for adult outpatients with cancer. Res Social Adm Pharm 2024; 20:25-33. [PMID: 38490859 DOI: 10.1016/j.sapharm.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/21/2024] [Accepted: 02/23/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Telephone and videoconsults are known synchronous telepharmacy modalities being used to respond to the demand for outpatient pharmacy services. However, little is known about the evidence for cancer telepharmacy service models. OBJECTIVES To review existing evidence regarding synchronous telepharmacy service models for adult outpatients with cancer, with a secondary focus on outcomes, enablers, and barriers. METHODS A PROSPERO registered systematic review was conducted using PubMed, CINAHL, and EMBASE in March 2023. Key search terms included pharmacy, telepharmacy, and outpatient. During article selection in Covidence, an extra inclusion criterion of synchronous cancer-focused services was applied; data extraction and narrative analysis were then performed. RESULTS From 2129 non-duplicate articles, 8 were eligible for inclusion, describing 7 unique patient populations. The service models included pre-treatment medication history taking, adherence monitoring, toxicity assessment, and discharge follow-up. Studies found synchronous telepharmacy services can improve timeliness of care, optimise workload management, and provide individualised and convenient efficacy monitoring and counselling. One study of 177 patients on immune checkpoint inhibitors found 38% of the 726 telephone consults involved at least one intervention. When videoconsults were compared directly with telephone consults for pre-treatment medication history, it was found scheduled videoconsults had a significantly higher success rate than unscheduled telephone consults, and that videoconsults also represented increased funding and equivalent time efficiency. When telephone follow-up was compared to no follow-up, improved treatment adherence was seen, and progression-free survival was significantly higher for the telephone group (6.1 months vs 3.7 months, p = 0.001). Reported enablers included physician buy-in, staff resources, and correct utilisation of technology, while identified barriers included time investment required and technical issues. CONCLUSION Both telephone and videoconsult modalities are being used to deliver synchronous telepharmacy services across a range of outpatient services. Although more evidence is needed, data to date supports positive service benefits and enhanced care.
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Affiliation(s)
- Marissa Ryan
- Pharmacy Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Brisbane, QLD, Australia; Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia; Centre for Health Services Research, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia.
| | - Tara Poke
- Pharmacy Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Brisbane, QLD, Australia.
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Suite 304, 3rd Floor, Buranda Village, Corner Cornwall Street and Ipswich Road, Buranda, Brisbane, QLD, 4102, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, 84a Services Rd, St Lucia, Brisbane, QLD, 4067, Australia.
| | - Christine Carrington
- Pharmacy Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Brisbane, QLD, Australia; School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Brisbane, QLD, 4102, Australia.
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia; Centre for Health Services Research, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia; School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Brisbane, QLD, 4102, Australia.
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5
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Snoswell CL, De Guzman KR, Barras M. Advanced-scope pharmacist roles in medical outpatient clinics: a cost-consequence analysis. Intern Med J 2024; 54:404-413. [PMID: 38050932 DOI: 10.1111/imj.16280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/19/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND There is a growing body of evidence that supports the clinical effectiveness of pharmacist roles in outpatient settings. However, limited studies have investigated the economic efficiency of advanced-scope outpatient pharmacist roles, particularly in the Australian setting. Assessing the overall costs and benefits of these outpatient pharmacist roles is needed to ensure service sustainability. AIMS To use a cost-consequence approach to evaluate the advanced-scope outpatient pharmacist roles across multiple clinic disciplines from the hospital perspective. METHODS A cost-consequence analysis was undertaken using data from a previous clinical-effectiveness study. All outpatient pharmacist consults conducted from 1 June 2019 to 31 May 2020 across 18 clinic disciplines were evaluated. Consequences from the pharmacist services included number of consults conducted, number of medication-related activities and number of resolved recommendations. RESULTS The overall cost to the hospital for the outpatient pharmacist service across all clinics was AU$1 991 122, with a potential remuneration of AU$3 895 247. There were 10 059 pharmacist consults undertaken for the 12-month period. Medication-related activities performed by pharmacists primarily included 6438 counselling and education activities and 4307 medication list activities. When the specialist pharmacist roles were added to the outpatient clinics, several health service benefits were also realised. CONCLUSIONS The addition of pharmacist roles to outpatient clinics can increase the cost of services; however, they also can increase medication optimisation activities. Future research should examine a societal perspective that includes broader cost and effectiveness outcomes. This study could justify the implementation of advanced-scope outpatient pharmacist roles in other Australian hospitals.
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Affiliation(s)
- Centaine L Snoswell
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Keshia R De Guzman
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Michael Barras
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
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6
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Thomas EE, Cartledge S, Murphy B, Abell B, Gallagher R, Astley C. Expanding access to telehealth in Australian cardiac rehabilitation services: a national survey of barriers, enablers, and uptake. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:21-29. [PMID: 38264703 PMCID: PMC10802819 DOI: 10.1093/ehjdh/ztad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 01/25/2024]
Abstract
Aims Cardiac rehabilitation (CR) is traditionally delivered in-person; however, the COVID-19 pandemic provided impetus for alternative offerings such as telehealth. We investigated uptake, barriers, and enablers in a national survey during the pandemic in Australia. Methods and results We surveyed CR programmes between April and June 2021 using professional association networks. The anonymous online questionnaire addressed programme characteristics, COVID-19 impacts, and barriers to and enablers of telehealth use. Open-text responses were coded and presented as themes. In total, there were responses from 105 programmes (33% response rate). All states and geographical areas were represented. The use of every modality of telehealth care (telephone, video conferencing, text messaging, and web-based) increased significantly during and after COVID with a strong preference for telephone (85% of services). Respondents perceived video (53%) and telephone (47%) formats as safe and effective for delivering CR. The most common barriers to telehealth were difficulties conducting assessments and reduced engagement with patients. Prominent enablers were increased reach and reduced patient barriers to CR access. Conclusion Telehealth use by CR programmes increased during the peak pandemic period. However, additional support is required to ensure that telehealth services can be maintained. There is considerable potential to increase the reach of CR by embedding telehealth into existing models of care.
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Affiliation(s)
- Emma E Thomas
- Centre for Online Health, The University of Queensland, Bldg 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland 4103, Australia
- Centre for Health Services Research, The University of Queensland, Bldg 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland 4103, Australia
| | - Susie Cartledge
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Western Ave, Camperdown, Sydney, New South Wales 2050, Australia
| | - Barbara Murphy
- Australian Centre for Heart Health, 75-79 Chetwynd St, North Melbourne, Victoria 3051, Australia
- School of Psychological Sciences, University of Melbourne, Redmond Barry Bldg, Victoria 3052, Australia
| | - Bridget Abell
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, Brisbane, Queensland 4059, Australia
- School of Public Health and Social Work, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, Brisbane, Queensland 4059, Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Western Ave, Camperdown, Sydney, New South Wales 2050, Australia
| | - Carolyn Astley
- College of Nursing and Health Science, Flinders University, North Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia
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7
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Snoswell CL, Haydon HM, Kelly JT, Thomas EE, Caffery LJ, Smith AC. How do consumers prefer their care delivered: In-person, telephone or videoconference? J Telemed Telecare 2023:1357633X231160333. [PMID: 36927220 DOI: 10.1177/1357633x231160333] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
AIM To gain a better understanding of consumer experiences with and preferences for telephone and videoconference consultations (telehealth), and how these compare to traditional in-person consultations. METHODS A national cross-sectional survey was administered to a representative sample of Australian adults who have received a telehealth service within the last year. Consumers were recruited by Qualtrics® through their online sampling service. The sample was representative of the broader Australian population according to gender, age, location (state/territory), and place of residence (urban or remote). Information on demographics (e.g., age, gender, employment status), recent telehealth experience, and preferences for consultation modality was collected. To measure preferences consumers were asked to indicate which modality they would prefer (in-person, telephone, or videoconference) for different scenarios. These included consultations of various time lengths, and for the top ten conditions for which individuals sought a general practitioner. RESULTS A total of 1069 consumers completed the survey. When consumers were asked to describe their most recent telehealth appointment, most were for follow-up appointments (67%) and completed by telephone (77%) rather than by videoconference, and with a general practitioner (75%). In-person consultations at a clinic were the top preference in all clinical scenarios presented, except when needing a prescription or to receive test results. In these cases, a telephone consultation was the preferred modality. Inexperience with videoconference and duration of consultation influenced preference for consultation mode. Consumers preferred to have short consultations of around five minutes done by telehealth (telephone or videoconference), while they preferred in-person for longer consultations (up to 60 minutes). CONCLUSIONS Many Australians have used telehealth in the past year to access healthcare, with telephone being the most common form of communication. Given the option and the experience to date, consumers prefer telephone when consultations related to either prescriptions or test results. Experience with videoconference for consultations increased consumer preferences for using it for future consultations.
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Affiliation(s)
- Centaine L Snoswell
- 430948Faculty of Medicine, Centre for Online Health, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Helen M Haydon
- 430948Faculty of Medicine, Centre for Online Health, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Jaimon T Kelly
- 430948Faculty of Medicine, Centre for Online Health, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Emma E Thomas
- 430948Faculty of Medicine, Centre for Online Health, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Liam J Caffery
- 430948Faculty of Medicine, Centre for Online Health, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- 430948Faculty of Medicine, Centre for Online Health, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia.,Centre for Innovative Medical Technology, 6174University of Southern Denmark, Odense, Denmark
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8
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Paradissis C, De Guzman KR, Barras M, La Caze A, Winckel K, Taufatofua N, Falconer N. Experiences and learnings of pharmacists, students, and clinical assistants working collaboratively in a COVID-19 vaccination clinic: a qualitative study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100241. [PMID: 36923065 PMCID: PMC9991331 DOI: 10.1016/j.rcsop.2023.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/15/2023] [Accepted: 02/26/2023] [Indexed: 03/09/2023] Open
Abstract
Background The involvement of pharmacists and pharmacy clinical assistants (CAs) in hospital clinics has demonstrated benefits for improving medication safety and care delivery. Internationally, pharmacy staff played a crucial role in the safe storage, provision and administration of vaccines, as well as reinforcement of pharmacovigilance efforts during the COVID-19 pandemic. In Australia, healthcare providers collaborated to rapidly facilitate a phased COVID-19 vaccination program. The perspectives of the pharmacy team, including pharmacy students, involved in implementing novel health services are underexplored in the literature. Objective To describe the key learnings in how a team of pharmacists, CAs and pharmacy students contributed to the COVID-19 vaccine service, and to explore their preparedness and experiences working at a vaccination clinic within a quaternary hospital. Method This study involved semi-structured interviews with pharmacy students, CAs and pharmacists. All pharmacy staff who worked in the clinic were invited to participate in the study and a snowball strategy was used to maximise recruitment. The interviews were audio-recorded, transcribed, and analysed using inductive thematic techniques to identify major themes. Results A total of 11 participants were interviewed including: four pharmacists, four CAs and three undergraduate students. Using thematic analysis, five main themes were identified: (1) Potential for student value and experiential learning; (2) Adaptive procedures and work practices in a rapidly changing environment; (3) Clear leadership, with role clarity, role expansion and interchangeability; (4) Supportive learning environment and (5) Stakeholder drivers for service delivery and to optimise societal benefit. These five themes often interacted with each other, highlighting the complexities of implementing and operating the service. Conclusions The vaccine clinic service provided a novel and valuable opportunity for students, CAs, and pharmacists to work collaboratively, extending their scope of practice to contribute to better national health outcomes. Participants expressed their support for future initiatives involving pharmacy students and healthcare staff collaborating in hospital settings.
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Affiliation(s)
| | - Keshia R De Guzman
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Michael Barras
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Karl Winckel
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Natasha Taufatofua
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Nazanin Falconer
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
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9
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Pool J, Namvar M, Akhlaghpour S, Fatehi F. Exploring public opinion about telehealth during COVID-19 by social media analytics. J Telemed Telecare 2022; 28:718-725. [PMID: 36346934 PMCID: PMC9646901 DOI: 10.1177/1357633x221122112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2023]
Abstract
While COVID-19 catalyzed the acceptance and use of telehealth, our understanding of how it is perceived by multi-stakeholders such as patients, clinicians, and health authorities is limited. Drawing on social media analytics, this research examines social media discourses and users' opinions about telehealth during the COVID-19 pandemic. It applies natural language processing and deep learning to explore word of mouth on telehealth with a contextualized focus on the COVID-19 pandemic. We conducted topic modeling, sentiment analysis, and emotion analysis (fearful, happy, sad, surprised, and angry emotions). The topic modeling analysis led to the identification of 18 topics, representing 6 themes of digital health service delivery, pandemic response, communication and promotion, government action, health service domains (e.g. mental health, cancer, aged care), as well as pharma and drug. The sentiment analysis revealed that while most opinions expressed in tweets were positive, the public expressed mostly negative opinions about certain aspects of COVID-19 such as lockdowns and cyberattacks. Emotion analysis of tweets showed a dominant pattern of fearful and sad emotions in particular topics. The results of this study that inductively emerged from our social media analysis can aid public health authorities and health professionals to address the concerns of telehealth users and improve their experiences.
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Affiliation(s)
- Javad Pool
- Business School, The University of
Queensland, Brisbane, Australia
| | - Morteza Namvar
- Business School, The University of
Queensland, Brisbane, Australia
| | | | - Farhad Fatehi
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
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10
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Gallegos-Rejas VM, Thomas EE, Kelly JT, Smith AC. A multi-stakeholder approach is needed to reduce the digital divide and encourage equitable access to telehealth. J Telemed Telecare 2022; 29:73-78. [PMID: 35733379 DOI: 10.1177/1357633x221107995] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the COVID-19 pandemic onset, there has been exponential growth in the uptake of telehealth, globally. However, evidence suggests that people living in lower socioeconomic areas, cultural and linguistically diverse communities, people with disabilities, and with low health literacy are less likely to receive telehealth services. These population groups have disproportionately higher health needs and face additional barriers to healthcare access. Barriers that reduce access to telehealth further exacerbate existing gaps in care delivery. To improve equity of access to telehealth, we need to reduce the digital divide through a multi-stakeholder approach. This article proposes practical steps to reduce the digital divide and encourage equitable access to telehealth. Enabling more equitable access to telehealth requires improvements in digital health literacy, workforce training in clinical telehealth, co-design of new telehealth-enabled models of care, change management, advocacy for culturally appropriate services, and sustainable funding models.
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Affiliation(s)
- Victor M Gallegos-Rejas
- Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Emma E Thomas
- Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Jaimon T Kelly
- Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia.,Centre for Innovative Medical Technology, 6174University of Southern Denmark, Odense, Denmark
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Snoswell CL, Cossart AR, Chevalier B, Barras M. Benefits, challenges and contributors to the introduction of new hospital-based outpatient clinic pharmacist positions. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100119. [PMID: 35478521 PMCID: PMC9029912 DOI: 10.1016/j.rcsop.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/08/2021] [Accepted: 02/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pharmacists working within interprofessional teams in the outpatient setting are well placed to address medication-related problems before and after hospital admission. Therefore, exploration of these roles is warranted. Objective(s) To explore pharmacists' and other health professionals' perspectives of the impact of pharmacists working within interprofessional teams in outpatient clinics. Furthermore, we endeavoured to identify both the challenges and contributors to success with the introduction of pharmacists into these settings. Methods This qualitative study involved semi-structured interviews with both hospital outpatient clinic pharmacists and other clinic health professionals to gain an in-depth understanding of how the introduction of pharmacists into clinics impacted clinic processes, patient care, and relationships with other health professionals. Participants were recruited from the outpatient clinics who had recently added a pharmacist to their service. Participants involved in setting up the roles were invited to participate in a voluntary interview, the transcripts from which were analysed into themes and sub-themes using an inductive and deductive approach. Results A total of 34 staff were interviewed of which 68% were female and 74% were aged between 31 and 50 years. The cohort included 16 outpatient pharmacists, nine pharmacist team leaders, five clinic nurses and four clinic doctors (specialist consultant or registrar). Three overall themes were identified: the benefits, the contributors, and the challenges of introducing clinical pharmacy services to outpatient clinics. When establishing a clinic role, pharmacists' awareness, adaptability, and strong communication were shown to be key traits to building rapport and trustworthiness with the established clinic team. Conclusions When pharmacists are integrated into multidisciplinary outpatient clinics they and their colleagues believe that they provide benefits to the patients and the clinics. Decision makers need to be cognizant of factors that contribute to, as well as those that impede, the successful implementation of outpatient pharmacist roles.
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Affiliation(s)
- Centaine L. Snoswell
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Corresponding author at: Centre for Online Health, Centre for Health Services Research, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
| | - Amelia R. Cossart
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Bernadette Chevalier
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Michael Barras
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
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