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Mavragani A, Tan MWJ, Towle RM, Lee JSW, Lei X, Liu Y, Goh RSM, Chee Ping FT, Tan TC, Ting DSW, Lee CE, Low LL. mHealth App to Facilitate Remote Care for Patients With COVID-19: Rapid Development of the DrCovid+ App. JMIR Form Res 2023; 7:e38555. [PMID: 36649223 PMCID: PMC9907569 DOI: 10.2196/38555] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 12/23/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The 2019 novel COVID-19 has severely burdened the health care system through its rapid transmission. Mobile health (mHealth) is a viable solution to facilitate remote monitoring and continuity of care for patients with COVID-19 in a home environment. However, the conceptualization and development of mHealth apps are often time and labor-intensive and are laden with concerns relating to data security and privacy. Implementing mHealth apps is also a challenging feat as language-related barriers limit adoption, whereas its perceived lack of benefits affects sustained use. The rapid development of an mHealth app that is cost-effective, secure, and user-friendly will be a timely enabler. OBJECTIVE This project aimed to develop an mHealth app, DrCovid+, to facilitate remote monitoring and continuity of care for patients with COVID-19 by using the rapid development approach. It also aimed to address the challenges of mHealth app adoption and sustained use. METHODS The Rapid Application Development approach was adopted. Stakeholders including decision makers, physicians, nurses, health care administrators, and research engineers were engaged. The process began with requirements gathering to define and finalize the project scope, followed by an iterative process of developing a working prototype, conducting User Acceptance Tests, and improving the prototype before implementation. Co-designing principles were applied to ensure equal collaborative efforts and collective agreement among stakeholders. RESULTS DrCovid+ was developed on Telegram Messenger and hosted on a cloud server. It features a secure patient enrollment and data interface, a multilingual communication channel, and both automatic and personalized push messaging. A back-end dashboard was also developed to collect patients' vital signs for remote monitoring and continuity of care. To date, 400 patients have been enrolled into the system, amounting to 2822 hospital bed-days saved. CONCLUSIONS The rapid development and implementation of DrCovid+ allowed for timely clinical care management for patients with COVID-19. It facilitated early patient hospital discharge and continuity of care while addressing issues relating to data security and labor-, time-, and cost-effectiveness. The use case for DrCovid+ may be extended to other medical conditions to advance patient care and empowerment within the community, thereby meeting existing and rising population health challenges.
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Affiliation(s)
| | - Michelle W J Tan
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore.,Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
| | - Rachel Marie Towle
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore.,Nursing, Singapore General Hospital, Singapore, Singapore
| | - Joanne Sze Win Lee
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
| | - Xiaofeng Lei
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore, Singapore
| | - Yong Liu
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore, Singapore
| | - Rick Siow Mong Goh
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore, Singapore
| | | | - Teck Choon Tan
- Office for Service Transformation, Singapore Health Services, Singapore, Singapore
| | - Daniel Shu Wei Ting
- Department of Ophthalmology, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Chen Ee Lee
- Innovation and Transformation, Singapore Health Services, Singapore, Singapore
| | - Lian Leng Low
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore.,Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore.,Outram Community Hospital, SingHealth Community Hospitals, Singapore, Singapore.,Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
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2
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Liljeroos M, Arkkukangas M. Implementation of Telemonitoring in Health Care: Facilitators and Barriers for Using eHealth for Older Adults with Chronic Conditions. Risk Manag Healthc Policy 2023; 16:43-53. [PMID: 36647422 PMCID: PMC9840402 DOI: 10.2147/rmhp.s396495] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Purpose The retrospective study used a hybrid design aimed to a) describe the implementation process of telemonitoring from stakeholders' perspectives and b) identify facilitators and barriers perceived by the care team. Patients and Methods Qualitative interview data were analyzed using manifest inductive qualitative content analysis to describe what was perceived as barriers and what facilitated the implementation. Participating healthcare professionals recruited from a multi-professional care team in Sweden. Overall, 14 healthcare professionals comprising 8 assistant nurses, 3 nurses, 1 physiotherapist, 1 occupational therapist, and one general practitioner participated in five interviews. Results Four categories were derived from the interview analysis: previous experience with digital technology, the need for preparation before implementation, perceptions of using telemonitoring in daily practice from the patient's perspective, and perceptions of the relevance and reasons for applying telemonitoring from the care team's perspective. The identification of stakeholders and the need to plan carefully when proposing the introduction of telemonitoring systems into work practices are both crucial. Conclusion The attitudes of healthcare professionals can be a significant factor in the acceptance and efficiency of the use of telemonitoring in practice. Therefore, implementing new technology in healthcare should involve healthcare professionals at an early stage to gain common understanding.
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Affiliation(s)
- Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Marina Arkkukangas
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden,Department of Medicine and Sport Sciences, School of Health and Welfare, Dalarna University, Falun, Sweden,Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden,Correspondence: Marina Arkkukangas, Research and Development in Sörmland, Eskilstuna, Sweden, Tel +46 706468868, Email
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Tickner C, Heinsch M, Brosnan C, Kay-Lambkin F. "Another tool in our toolbox": a scoping review of the use of eHealth technologies in health social work practice. SOCIAL WORK IN HEALTH CARE 2023; 62:1-18. [PMID: 36587833 DOI: 10.1080/00981389.2022.2163450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/16/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
There is increasing recognition of the salience of eHealth technologies in enhancing health service capacity. Yet social work remains "behind the curve" in progressing digital practices. As the demand for digital health care increases, particularly following COVID-19, it is becoming increasingly urgent to understand how social workers engage with eHealth technologies, and how technological engagement impacts on social work practice. In this scoping review, we sought to examine eHealth use in health social work practice. Our findings suggest that, while social workers recognize the strengths and opportunities to broaden the scope of their practice, they remain concerned that eHealth may not be congruent with the values and approaches of the profession. This review provides a broad overview of health social workers' engagement with eHealth technologies and considers implications for future research that examines the nuanced and complex nature of professional values, risk, and assessment in the digital space.
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Affiliation(s)
- Campbell Tickner
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Milena Heinsch
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Caragh Brosnan
- School of Humanities, Creative Industries and Social Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
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4
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Pöyhiä R, Ohvanainen A, Rapo-Pylkkö S, Niemi-Murola L. Influences of COVID-19 pandemic on hospital-at-home functions in Finland - a questionnaire survey. Scand J Prim Health Care 2022; 40:379-384. [PMID: 36325735 PMCID: PMC9848305 DOI: 10.1080/02813432.2022.2139475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To investigate functions of Finnish hospital-at-home (HAH) during the first year of COVID19-pandemic 2020 compared with the previous year 2019. DESIGN Retrospective questionnaire survey. SETTING Finnish HAHs from Northern, Eastern, Southern, Western and Central parts of Finland participated in a questionnaire web-based questionnaire survey. The numbers of patients, activities and staff in 2019 and 2020, participation in the care of COVID19 patients, availability of protective clothing, attitudes of patients towards home care and development of new practices in the corona era were asked using both predefined and free questions. SUBJECTS questionnaire was sent to the nurses and physicians in charge of the HAHs (N = 13), 77% responded. The HAHs provided services to a total of 1,196,783 inhabitants in their municipalities. RESULTS There were no significant changes in the numbers of patients, staff or activities between the years 2019 and 2020. Although nurses did viral tests, COVID19 patients were cared only in 40% of HAHs. Protective clothing was well available. New instructions for infection management were created. CONCLUSIONS The COVID-19 pandemic did not largely influence the functions of the examined Finnish HAHs in 2020. Most activities and patients' characteristics remained unchanged from 2019. The role of HAHs should be further developed in Scandinavian countries, particularly during pandemics.Key PointsHospital-at-home (HAH) is a cost-effective model to provide hospital-like services.Data about the role of HAHs during COVID19 pandemics is lacking in the Nordic countries.This study shows that, the large Finnish municipal HAHs have been not influenced by pandemics.
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Affiliation(s)
- Reino Pöyhiä
- Department of Anaesthesia and Intensive Care, University of Helsinki, Helsinki, Finland
- Palliative Medicine, Department of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Palliative Center, The South Savo Social and Health Care Authority, Mikkeli, Finland
- CONTACT Reino Pöyhiä Department of Anaesthesia and Intensive Care, University of Helsinki, Helsinki, Finland
| | - Antti Ohvanainen
- Palliative Center, Joint Municipal Authority for North Karelia Social and Health Service, Siun sote, Joensuu, Finland
| | | | - Leila Niemi-Murola
- Department of Anaesthesia and Intensive Care, University of Helsinki, Helsinki, Finland
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Tossaint-Schoenmakers R, Kasteleyn MJ, Rauwerdink A, Chavannes N, Willems S, Talboom-Kamp EPWA. Development of a quality management model and self-assessment questionnaire for hybrid health care: a concept mapping study (Preprint). JMIR Form Res 2022; 6:e38683. [PMID: 35797097 PMCID: PMC9305399 DOI: 10.2196/38683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rosian Tossaint-Schoenmakers
- Saltro Diagnostic Centre, Unilabs Netherlands, Utrecht, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Marise J Kasteleyn
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Anneloek Rauwerdink
- Department of Surgery, Gastroenterology and Metabolism, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Niels Chavannes
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Sofie Willems
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Esther P W A Talboom-Kamp
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- Unilabs Group, Geneve, Switzerland
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Husebø AML. Stakeholders' Perspectives on eHealth Support in Colorectal Cancer Survivorship: Qualitative Interview Study. JMIR Cancer 2021; 7:e28279. [PMID: 34491210 PMCID: PMC8456333 DOI: 10.2196/28279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/06/2021] [Accepted: 07/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background eHealth interventions may represent the way forward in following up patients with colorectal cancer (CRC) after hospital discharge to support them in coping with the illness, strengthen their self-management, and increase their quality of life. By involving end users of eHealth in cocreation processes when designing eHealth solutions, an acceptable and relevant product can be secured. Stakeholders’ perspectives could aid in closing the gap between research-developed products and the implementation of eHealth services in real-life scenarios. Objective This study aims to explore the views of patients with CRC, their informal caregivers, and health care professionals (HCPs) on information technology and the design of eHealth support in CRC care. Methods A qualitative, explorative design was used to conduct 31 semistructured individual interviews with 41% (13/31) patients with CRC, 29% (9/31) informal caregivers, and 29% (9/31) HCPs recruited from the gastrosurgical ward of a university hospital in southwestern Norway. A semistructured interview guide was used for data collection, and the data were analyzed by systematic text condensation. Results Participants described the diverse experiences of patients with CRC seeking web-based information. Age and digital competence were highlighted as influencers of the use of information technology. Patients rarely received advice from HCPs about relevant and secure websites containing information on CRC diagnosis and treatment. Features of desired eHealth interventions in following up patients with CRC were patient education, health monitoring, and communication with HCPs. Conclusions Several elements affect the activities of patients with CRC seeking health information. Age, inexperience with computer technology, and lack of access to web-based health information may reduce the ability of patients with CRC to engage in decision-making processes regarding illness and treatment. An eHealth service for patients with CRC should comprise features for information, education, and support for self-management and should aim to be individually adapted to the patient’s age and digital competence. Involving end users of eHealth services is necessary to ensure high-quality tailored services that are perceived as user friendly and relevant to the end users.
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Affiliation(s)
- Anne Marie Lunde Husebø
- Research Group of Nursing and Health Sciences, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Kasteleyn MJ, Versluis A, van Peet P, Kirk UB, van Dalfsen J, Meijer E, Honkoop P, Ho K, Chavannes NH, Talboom-Kamp EPWA. SERIES: eHealth in primary care. Part 5: A critical appraisal of five widely used eHealth applications for primary care - opportunities and challenges. Eur J Gen Pract 2021; 27:248-256. [PMID: 34432601 PMCID: PMC8405089 DOI: 10.1080/13814788.2021.1962845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Given the pressure on modern healthcare systems, eHealth can offer valuable opportunities. However, understanding the potential and challenges of eHealth in daily practice can be challenging for many general practitioners (GPs) and their staff. Objectives To critically appraise five widely used eHealth applications, in relation to safe, evidence-based and high-quality eHealth. Using these applications as examples, we aim to increase understanding of eHealth among GPs and highlight the opportunities and challenges presented by eHealth. Discussion eHealth applications can support patients while increasing efficiency for GPs. A three-way division (inform, monitor, track; interaction; data utilisation) characterises many eHealth applications, with an increasing degree of complexity depending on the domain. All applications provide information and some have extra functionalities that promote interaction, while data analysis and artificial intelligence may be applied to support or (fully) automate care processes. Applications in the inform domain are relatively easy to use and implement but their impact on clinical outcomes may be limited. More demanding applications, in terms of privacy and ethical aspects, are found in the data utilisation domain and may potentially have a more significant impact on care processes and patient outcomes. When selecting and implementing eHealth applications, we recommend that GPs remain critical regarding preconditions on safe, evidence-based and high-quality eHealth, particularly in the case of more complex applications in the data utilisation domain.
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Affiliation(s)
- Marise J Kasteleyn
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Petra van Peet
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
| | - Ulrik Bak Kirk
- The Research Unit for General Practice, Aarhus, Denmark.,The European Society for Quality and Safety in Family Practice (EQuiP), Aarhus, Denmark
| | - Jens van Dalfsen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | | | - Kendall Ho
- Faculty of Medicine, eHealth Strategy Office, University of British Columbia, Vancouver, Canada
| | - Niels H Chavannes
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Esther P W A Talboom-Kamp
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands.,Saltro Diagnostic Center, Utrecht, The Netherlands
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8
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Andersson U, Bengtsson U, Ranerup A, Midlöv P, Kjellgren K. Patients and Professionals as Partners in Hypertension Care: Qualitative Substudy of a Randomized Controlled Trial Using an Interactive Web-Based System Via Mobile Phone. J Med Internet Res 2021; 23:e26143. [PMID: 34081021 PMCID: PMC8212623 DOI: 10.2196/26143] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/15/2021] [Accepted: 04/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of technology has the potential to support the patient´s active participation regarding treatment of hypertension. This might lead to changes in the roles of the patient and health care professional and affect the partnership between them. OBJECTIVE The aim of this qualitative study was to explore the partnership between patients and health care professionals and the roles of patients and professionals in hypertension management when using an interactive web-based system for self-management of hypertension via the patient's own mobile phone. METHODS Focus group interviews were conducted with 22 patients and 15 professionals participating in a randomized controlled trial in Sweden aimed at lowering blood pressure (BP) using an interactive web-based system via mobile phones. The interviews were audiorecorded and transcribed and analyzed using thematic analysis. RESULTS Three themes were identified: the technology, the patient, and the professional. The technology enabled documentation of BP treatment, mainly for sharing knowledge between the patient and the professional. The patients gained increased knowledge of BP values and their relation to daily activities and treatment. They were able to narrate about their BP treatment and take a greater responsibility, inspired by new insights and motivation for lifestyle changes. Based on the patient's understanding of hypertension, professionals could use the system as an educational tool and some found new ways of communicating BP treatment with patients. Some reservations were raised about using the system, that it might be too time-consuming to function in clinical practice and that too much measuring could result in stress for the patient and an increased workload for the professionals. In addition, not all professionals and patients had adopted the instructions regarding the use of the system, resulting in less realization of its potential. CONCLUSIONS The use of the system led to the patients taking on a more active role in their BP treatment, becoming more of an expert of their BP. When using the system as intended, the professionals experienced it as a useful resource for communication regarding BP and lifestyle. Patients and professionals described a consultation on more equal grounds. The use of technology in hypertension management can promote a constructive and person-centered partnership between patient and professional. However, implementation of a new way of working should bring benefits and not be considered a burden for the professionals. To establish a successful partnership, both the patient and the professional need to be motivated toward a new way of working. TRIAL REGISTRATION ClinicalTrials.gov NCT03554382; https://clinicaltrials.gov/ct2/show/NCT03554382.
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Affiliation(s)
- Ulrika Andersson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Ulrika Bengtsson
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Ranerup
- Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Karin Kjellgren
- University of Gothenburg Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Houlding E, Mate KKV, Engler K, Ortiz-Paredes D, Pomey MP, Cox J, Hijal T, Lebouché B. Barriers to Use of Remote Monitoring Technologies Used to Support Patients With COVID-19: Rapid Review. JMIR Mhealth Uhealth 2021; 9:e24743. [PMID: 33769943 PMCID: PMC8059785 DOI: 10.2196/24743] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic has acted as a catalyst for the development and adoption of a broad range of remote monitoring technologies (RMTs) in health care delivery. It is important to demonstrate how these technologies were implemented during the early stages of this pandemic to identify their application and barriers to adoption, particularly among vulnerable populations. Objective The purpose of this knowledge synthesis was to present the range of RMTs used in delivering care to patients with COVID-19 and to identify perceived benefits of and barriers to their use. The review placed a special emphasis on health equity considerations. Methods A rapid review of published research was conducted using Embase, MEDLINE, and QxMD for records published from the inception of COVID-19 (December 2019) to July 6, 2020. Synthesis involved content analysis of reported benefits of and barriers to the use of RMTs when delivering health care to patients with COVID-19, in addition to health equity considerations. Results Of 491 records identified, 48 publications that described 35 distinct RMTs were included in this review. RMTs included use of existing technologies (eg, videoconferencing) and development of new ones that have COVID-19–specific applications. Content analysis of perceived benefits generated 34 distinct codes describing advantages of RMTs, mapped to 10 themes overall. Further, 52 distinct codes describing barriers to use of RMTs were mapped to 18 themes. Prominent themes associated with perceived benefits included a lower burden of care (eg, for hospitals, health care practitioners; 28 records), reduced infection risk (n=33), and support for vulnerable populations (n=14). Prominent themes reflecting barriers to use of RMTs included equity-related barriers (eg, affordability of technology for users, poor internet connectivity, poor health literacy; n=16), the need for quality “best practice” guidelines for use of RMTs in clinical care (n=12), and the need for additional resources to develop and support new technologies (n=11). Overall, 23 of 48 records commented on equity characteristics that stratify health opportunities and outcomes, including general characteristics that vary over time (eg, age, comorbidities; n=17), place of residence (n=11), and socioeconomic status (n=7). Conclusions Results of this rapid review highlight the breadth of RMTs being used to monitor and inform treatment of COVID-19, the potential benefits of using these technologies, and existing barriers to their use. Results can be used to prioritize further efforts in the implementation of RMTs (eg, developing “best practice” guidelines for use of RMTs and generating strategies to improve equitable access for marginalized populations).
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Affiliation(s)
- Elizabeth Houlding
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Kedar K V Mate
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Marie-Pascale Pomey
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Département de gestion, évaluation et politique de santé, École de santé publique de l'Université de Montréal, Montréal, QC, Canada
| | - Joseph Cox
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.,Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montréal, QC, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.,Department of Family Medicine, McGill University, Montréal, QC, Canada
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10
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Björndell C, Premberg Å. Physicians' experiences of video consultation with patients at a public virtual primary care clinic: a qualitative interview study. Scand J Prim Health Care 2021; 39:67-76. [PMID: 33650941 PMCID: PMC7971243 DOI: 10.1080/02813432.2021.1882082] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To describe physicians' experiences of video consultation with new patients visiting a publicly owned virtual primary care clinic. DESIGN In this qualitative study, data were collected from semi-structured individual interviews and analysed by systematic text condensation. SETTING A publicly owned virtual primary care clinic in Region Västra Götaland, Sweden. SUBJECTS Ten primary care physicians working at the clinic. RESULTS Connecting with a patient over video could be either straightforward or deficient, depending on communication and the patient's condition. Clinical experience, communication skills, and involving patients throughout the consultation and examination were crucial for assessments over video where patients were guided to perform self-examination. The flexibility of work and the regulated assignment online were positive for the physicians' work situation and wellbeing. Providing video consultation within the same organisation as the patient's regular health centre was considered to facilitate patient care and safety. Video consultation was considered suitable for some diagnoses and for some patients not able to reach a primary healthcare centre, though doubts were expressed about the healthcare and social benefits of this virtual care service. CONCLUSION For the physicians, video consultation induced changes in the basis for assessment of primary care patients. The limitations on informational exchange demanded an extended form of patient involvement founded upon consultation skills, clinical experience and new skills for virtual examination. Combining virtual care with traditional general practice has the potential to reduce the workload for the individual physician and ensure medical competence in virtual primary care. Video consultation experienced suitable in some situations, but easy access to it expressed problematic in terms of medical prioritisation in healthcare.KEY POINTSVideo consultation is suitable for primary care visits for some patients, but physicians' experiences of this are rarely studied. •Clinical experience and consultation skills are important for video assessment of primary care patients which involves physician-guided patient self-examination.•Video consultation facilitates care in some situations and could benefit from the provider being connected to patient's regular health centre.•Virtual care offers a flexible way of working but challenges healthcare prioritisation from the primary care physician's perspective.
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Affiliation(s)
- Cajsa Björndell
- Närhälsan Brämaregården Health Centre, Gothenburg, Sweden
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development Primary Health Care, Research and Development Centre Gothenburg and Södra Bohuslän, Gothenburg, Sweden
| | - Åsa Premberg
- Research and Development Primary Health Care, Research and Development Centre Gothenburg and Södra Bohuslän, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lohmiller J, Schäffeler N, Zipfel S, Stengel A. Higher Acceptance of Videotelephonic Counseling Formats in Psychosomatic Medicine in Times of the COVID-19 Pandemic. Front Psychiatry 2021; 12:747648. [PMID: 34777051 PMCID: PMC8578375 DOI: 10.3389/fpsyt.2021.747648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/04/2021] [Indexed: 01/15/2023] Open
Abstract
Background: Due to the COVID-19 pandemic, the healthcare system in general and psychosomatics in particular were forced to change counseling-specific services and break up established structures. At the beginning of 2020, phone as well as videotelephonic counseling options had to be quickly established. Methods: Patients (n = 278) of the department of psychosomatic medicine and psychotherapy at the University Hospital Tübingen were asked to complete an ad hoc questionnaire to assess the acceptance of the counseling format following each counseling session (office, phone, video) in the period between July 2020 and February 2021. Results: Satisfaction and acceptance of the three counseling formats (office, phone, video) were rated (1-6) on average as "good" to "very good" in the three subgroups (1.5 ± 0.9). Likewise, the "therapeutic relationship" scored high in all three subgroups in terms of establishing a strong therapeutic relationship (4.4 ± 1.5). "Hurdles" were rated as low and tolerable (1.8 ± 1.3). The global assessment of therapeutic contact was significantly better in the video group compared to phone and office consultation (p < 0.05). Predictor analyses showed that there was an influence of age, but not gender, on the acceptance of digital counseling formats in the present sample [F (1, 277) = 4.50, p = 0.04]. Discussion & Conclusion: Digital consultation formats were perceived by patients as promising addition to the classic face-to-face setting. Digital formats (phone, video) were not generally preferred to face-to-face counseling, but especially video counseling was accepted and perceived with great satisfaction and acceptance. Accordingly, the additional use of digital counseling formats, especially video-telephony, could be an opportunity to enrich the existing structures also after the pandemic.
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Affiliation(s)
- Jacqueline Lohmiller
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department for Psychosomatic Medicine, Charite-Universitätsmedizin Berlin, Charité Center for Internal Medicine and Dermatology, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Jonsson JS, Sigurdsson EL. The power of primary health care. Scand J Prim Health Care 2020; 38:361-362. [PMID: 33377429 PMCID: PMC7782152 DOI: 10.1080/02813432.2020.1841507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Jon Steinar Jonsson
- Department of Family Medicine, University of Iceland, Reykjavík, Iceland
- Development Centre for Primary Health Care in Iceland
| | - Emil Larus Sigurdsson
- Department of Family Medicine, University of Iceland, Reykjavík, Iceland
- Development Centre for Primary Health Care in Iceland
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Windak A, Frese T, Hummers E, Klemenc Ketis Z, Tsukagoshi S, Vilaseca J, Vinker S, Ungan M. Academic general practice/family medicine in times of COVID-19 - Perspective of WONCA Europe. Eur J Gen Pract 2020; 26:182-188. [PMID: 33337939 PMCID: PMC7751383 DOI: 10.1080/13814788.2020.1855136] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/16/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022] Open
Abstract
COVID-19 outbreak has significantly changed all aspects of general practice in Europe. This article focuses on the academic challenges for the discipline, mainly in the field of education, research, and quality assurance. The efforts of the European Region of the World Organisation of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA Europe) to support academic sustainability of the discipline in the time of pandemic are presented. Medical education was affected by the pandemic, threatening both its productivity and quality. Emerging new educational methods might be promising, but the results of their rapid implementation remain uncertain. A relatively small number of publications related to COVID-19 and general practice is available in the medical literature. There is a shortage of original data from general practice settings. This contrasts with the crucial role of GPs in fighting a pandemic. COVID-19 outbreak has opened widely new research areas, which should be explored by GPs. Maintaining the quality of care and safety of all patients during the COVID-19 pandemic is the utmost priority. Many of them suffer from poor access or inadequate management of their problems. Rapid implementation of telemedicine brought both threats and opportunities. The COVID-19 pandemic also challenged doctors' safety and well-being. These aspects will require discussion and remedy to prevent deterioration of the quality of primary care. WONCA Europe is making a multi-faceted effort to support GPs in difficult times of the pandemic. It is ready to support future efforts to uphold the integrity of family medicine as an academic discipline.
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Affiliation(s)
- Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Thomas Frese
- Institute of General Practice & Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Eva Hummers
- Department of General Practice, Georg-August-Universitat Gottingen, Gottingen, Germany
| | - Zalika Klemenc Ketis
- Community Health Centre Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Josep Vilaseca
- Consorci d'Atenció Primàrìa Barcelona Esquerra, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
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