School nurse perception of asthma care in school-based telehealth

Reporting of asthma mobile health data for clinical practice: a qualitative study of pediatric provider perspectives

OBJECTIVE

Mobile health (mHealth), defined as the use of mobile phones or applications in healthcare, has been developed to enhance asthma care; yet implementation is inconsistent, and few studies have focused on provider perspectives on use in daily practice. The purpose of this study was to explore primary care pediatric provider perspectives regarding mHealth use in clinical practice for children with asthma.

METHODS

A qualitative, descriptive approach was utilized to perform semi-structured interviews on asthma mHealth use with providers caring for children with asthma. Interview transcripts were coded by two independent investigators and any differences were reconciled. Interviews continued until thematic saturation was achieved.

RESULTS AND CONCLUSIONS

Seventeen pediatric providers were recruited and interviewed. Three themes identified included implementation benefits, implementation barriers, and reporting desires, with 11 subthemes. Many subthemes were consistent across providers (e.g. self-management benefits and electronic medical record integration), while others such as provider clinical burden and approach to integrating mHealth data reports into daily workflow demonstrated variability. Provider perspectives highlight the potential of mHealth applications in asthma self-management while offering challenges related to clinical burden and suggestions for reporting and workflow integration. These results provide valuable perspectives on mHealth use and reporting to ensure provider efficiency and technology-enhanced asthma care. This study investigates pediatric provider perspectives on asthma mobile health use and reporting in daily practice, a topic that has not sufficiently been explored within the literature. Results can guide best practices, encourage more consistent use, and maximize the benefits of asthma mHealth tools by providers.

Exploring Innovative U.S. School Health Delivery Models: A Narrative Review

School health services have been described as the "hidden healthcare" system because of their isolation within schools and from other healthcare providers. This isolation may inhibit innovations in school healthcare delivery. Hence, there is a need to identify and characterize various delivery models. This review examines models to identify innovative approaches and formulate suggestions for public health departments, local and state educational agencies, and policymakers. Toward this goal, published and gray literature were studied and synthesized, identifying three delivery models: the traditional model of school-based nursing and two alternative models: school-based health centers and community partnerships. Mechanisms of delivery included telehealth, mobile clinics, and system-level care. Although no innovative, comprehensive approaches to school health services models were found, innovation generally focused on improving equitable delivery to vulnerable populations. Policies must be formulated and funded to integrate such innovations into a comprehensive, preventative approach, including improved care coordination and data sharing.

Development of the Dissemination and Implementation Science Collaborative (DISC): Opportunities to enhance implementation science capacity among researchers and practitioners in South Carolina

This paper explores the development of the Dissemination and Implementation Science Collaborative (DISC) at the Medical University of South Carolina, established through the Clinical and Translational Science Award program. DISC aims to accelerate clinical and translational science by providing training, mentorship, and collaboration opportunities in dissemination and implementation (D&I) science. Through DISC, investigators, trainees, and community partners are equipped with the knowledge and skills to conduct D&I research and translate findings into practice, particularly in South Carolina's public health and healthcare landscape. We describe efforts to achieve the major overarching aims of DISC, which include conducting scientific workforce training, providing mentorship and consultation, and advancing methods and processes for D&I research. By sharing DISC experiences, successes, and challenges, this paper aims to support the growth of D&I research and capacity-building programs, fostering collaboration and shared resources in the field.

The Management of Pediatric Asthma Using Telehealth: An Integrative Review

Introduction: Asthma is one of the most chronic noncommunicable diseases of childhood, affecting 1 in 12 children in the United States. The use of telemedicine for the management of pediatric asthma has shown improved health outcomes; however, it is important to understand what can impact its acceptance. The purpose of this review was to identify the facilitators and barriers to pediatric asthma management, as viewed by stakeholders. Methods: An electronic literature search was performed using PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature Complete. Articles included in the review contained perceptions of the use of telemedicine for the management of pediatric asthma, as viewed by stakeholders. The socioecological model was used as the theoretical framework to extract data based on its five levels. Results: After reviewing full texts of 143 articles, 118 were excluded, leaving 25 articles included in this review. A majority of included articles focused on mobile health (m-Health) studies for the management of pediatric asthma, with the remaining articles studying synchronous telemedicine or a combination of modalities. Common themes were identified; however, most were focused on the use of m-Health and few studies contained the viewpoints of the caregiver, children, or providers regarding synchronous telemedicine. Discussion: This integrative review identified a number of facilitators and barriers for the management of asthma using telemedicine. However, more qualitative studies are needed to evaluate the perceptions of caregivers, patients, and primary providers regarding synchronous telehealth. It was also recognized that telemedicine may increase instead of reduce health care disparities.

Nursing Practice and Telehealth in School Health Services: A Scoping Review

BACKGROUND

The COVID-19 pandemic has propelled the adoption of telehealth in school settings, emphasising the pivotal role of nurses. This review explores the last decade's evidence on telehealth interventions in school nursing practice; Methods: Following Joanna Briggs Institute guidelines, we conducted a systematic search in PubMed, CINHAL, and Web of Science in March 2023. Out of 518 articles across 21 journals, 32 satisfied the review criteria. The selection process rigorously adhered to PRISMA-ScR guidelines for scoping reviews; Results: The results were categorised into three main areas: (a) the purpose of telehealth and intervention strategies, (b) the role of nursing in school-based telehealth practice, and (c) perceived benefits and limitations of school-based telehealth studies. Telehealth interventions encompass health promotion, mental health management, and early diagnosis. School nurses play a multifaceted role, including management, education, and remote monitoring. While telehealth offers advantages like improved health and cost savings, challenges include digital literacy, device access, and costs; Conclusion: This review underscores the crucial role of telehealth in schools for enhancing healthcare delivery in educational settings. However, more empirical evidence is required to specify nurses' contributions to school-based telehealth interventions. Promoting their leadership through stakeholder collaboration is essential. Further research should address challenges and opportunities in school nursing practice, enriching healthcare in educational settings.

Development of an Implementation Science Telehealth Toolkit to Promote Research Capacity in Evaluation of Telehealth Programs

Background

The field of telehealth is rapidly growing and expanding access to quality health care, although there have been varied implementation outcomes in telehealth modalities. Dissemination and implementation (D&I) research can provide a systematic approach to identifying barriers and facilitators to telehealth implementation processes and outcomes.

Methods

An interdisciplinary research and clinical team developed an implementation science telehealth toolkit to guide D&I evaluations of new and existing telehealth innovations.

Results

The toolkit includes a separate section to correspond to each step in the D&I evaluation process. Each section includes resources to guide evaluation steps, telehealth specific considerations, and case study examples based on three completed telehealth evaluations.

Discussion

The field of telehealth is forecasted to continue to expand, with potential to increase health care access to populations in need. This toolkit can help guide health care stakeholders to develop and carry out evaluations to improve understanding of telehealth processes and outcomes to maximize implementation and sustainability of these valuable innovations.

Use of Telemedicine in Pediatric Services for 4 Representative Clinical Conditions: Scoping Review

BACKGROUND

Telemedicine is becoming routine in health care. Postpandemic, a universal return to face-to-face consultations may risk a loss of some of the advantages of telemedicine. However, rapid implementation and adoption without robust evaluation of usability, efficacy, and effectiveness could potentially lead to suboptimal health outcomes and downstream challenges to providers.

OBJECTIVE

This review assesses telemedicine interventions against international guidance and sufficiency of evidence to support postpandemic utilization in pediatric settings.

METHODS

This scoping review was performed following searches on PubMed, Embase, and CINAHL databases on April 15, 2021, and May 31, 2022, and examined studies focused on telemedicine, remote consultation, video call, or remote patient monitoring in children (0-18 years) receiving outpatient care for diabetes, asthma, epilepsy, or renal disease. Exclusion criteria included studies published before 2011 as the technologies used have likely been improved or replaced, studies in adult populations or where it was not possible to disaggregate data for participants younger than 18 years as the focus of the review was on pediatric care, and studies not published in English. Data were extracted by 4 authors, and the data were corroborated by a second reviewer. Studies were examined for feasibility and usability, clinical and process outcomes, and cost-effectiveness.

RESULTS

Of the 3158 studies identified, 56 were suitable for final inclusion and analysis. Data on feasibility or usability of interventions (48 studies) were overwhelmingly positive in support of telemedicine interventions, with common themes including convenience, perceived cost savings, and ease of use. However, use in preference to usual care was rarely explored. Clinical and process outcome data (31 studies) were mostly positive. Across all studies, there was limited measurement of standardized clinical outcomes, although these were more commonly reported in asthma (peak flow) and diabetes (glycated hemoglobin [HbA1c]). Implementation science data generally supported cost-effectiveness of telemedicine with a reduction of health care costs.

CONCLUSIONS

There is promising evidence supporting telemedicine in pediatric settings. However, there is a lack of evaluation of telemedicine in comparison with usual outpatient care for noninferiority of clinical outcomes, and this review highlights the need for a more standardized approach to evaluation of digital interventions.

Telehealth readiness and its influencing factors among Chinese clinical nurses: A cross-sectional study

AIM/OBJECTIVE

This study aimed to assess telehealth readiness among clinical nurses in China and explore the factors that affect their telehealth readiness and the relationships of telehealth readiness and telehealth practice-related variables.

BACKGROUND

Telehealth is a new service model that uses information and communication technology to provide professional health care services for resource-poor areas. With the global spread of COVID-19, nurses urgently need to adapt and apply telehealth technology to replace conventional face-to-face treatment. However, nurse-led telehealth services in China are currently only in the pilot phase and the readiness of clinical nurses needs to be assessed to facilitate successful telehealth implementation.

DESIGN

A cross-sectional, multicentre study was undertaken with the questionnaire survey method.

METHODS

Data were collected in October-December 2020 used online questionnaires. A convenience sample of 3386 nurses from 19 hospitals in China completed the Chinese version of Telehealth Readiness Assessment Tools.

RESULTS

The mean score of the telehealth readiness was in the category between 61 and 80 points (mean 61.23, SD 11.61). The percentages of nurses meeting the following levels of telehealth readiness were as follows: low (49.9%), moderate (42.0%) and high (8.1%). Significantly higher domain scores were recorded for nurses in the unmarried, head of responsible nursing group. Moreover, there were positive correlations between telehealth readiness level and service experience, service willingness, mode cognition, manpower allocation and policy guidance.

CONCLUSIONS

There are still many factors hindering the successful implementation of telehealth. Nursing educators should formulate telehealth education curriculum and service standards to improve the telehealth readiness of nurses.

Facilitators and Barriers to Implementation of School-Based Telehealth Asthma Care: Program Champion Perspectives

OBJECTIVE

Asthma is one of the most common chronic conditions of childhood, conferring an immense burden on children and their caregivers. School-based telehealth approaches for asthma care provide the opportunity to deliver convenient, cost-effective care to more children in the school setting. Our study objective was to characterize school-based telehealth asthma program delivery experiences and examine barriers and facilitators to telehealth program implementation.

METHODS

Interviews were conducted with telehealth program staff and school stakeholders in nine schools engaged in a school-based telehealth asthma program. A structured interview guide was designed using the Exploration, Adoption/Preparation, Implementation, Sustainment (EPIS) framework. A template analysis qualitative approach was used to identify themes related to implementation processes.

RESULTS

Interviews identified key telehealth implementation strategies including building relationships, marketing and provision of technical assistance, education and support to aid program delivery. Key facilitators to successful program implementation included strong partnerships between the telehealth and school teams, a shared commitment to enhancing access to asthma care for children, and strong nurse leadership. Primary barriers to implementation included lack of family/caregiver involvement and competing demands for nurses.

CONCLUSIONS

This study identified barriers and facilitators to implementing a school-based telehealth asthma program that can be used to guide education, training and support strategies to enhance program delivery. Recommended implementation strategies include building strong program-school partnerships, creating a shared vision to improve access to care, and building engagement in families and communities while supporting nurse leaders and family involvement with training and resources. These results can help guide future telehealth interventions.

Nurse Perspectives Regarding Implementation of an Asthma Monitoring Mobile Health Application in the School Setting

Background: School-based telehealth (SBTH) plays a valuable role in child asthma management, although nurses have concerns with caregiver engagement. Mobile technology (m-health) has potential to improve this engagement. Objective: We identified barriers and key desired features of an asthma m-health application as a supplement to an existing SBTH asthma program in rural settings. Methods: Multimethod design using school nurse surveys and interviews with school and SBTH personnel to describe processes related to implementation of an m-health application. Results: Nurses reported SBTH programs were an ideal setting to identify potential families for m-health. Benefits of caregiver education and engagement and barriers related to technology, smart phone data availability, and family buy-in were described. Desired application features included education on inhaler technique, asthma symptom, and medication adherence reports. Conclusions: The feedback identified from nurses can be incorporated into an asthma m-health program within an SBTH program to facilitate implementation.