1
|
Hettiarachchi Senarath GM, Delir Haghighi P, Bai L, Shannon MM, Andrew NE, Srikanth V, Snowdon DA, O’Connor DA. Barriers and facilitators to the uptake of electronic collection and use of patient-reported measures in routine care of older adults: a systematic review with qualitative evidence synthesis. JAMIA Open 2024; 7:ooae068. [PMID: 39100988 PMCID: PMC11296862 DOI: 10.1093/jamiaopen/ooae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/20/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024] Open
Abstract
Objective The aims of this systematic review were to (1) synthesize the available qualitative evidence on the barriers and facilitators influencing implementation of the electronic collection and use of patient-reported measures (PRMs) in older adults' care from various stakeholder perspectives and (2) map these factors to the digital technology implementation framework Non-adoption, Abandonment, challenges to the Scale-up, Spread, Sustainability (NASSS) and behavior change framework Capability, Opportunity, Motivation, Behaviour (COM-B). Materials and Methods A search of MEDLINE, CINAHL Plus, and Web of Science databases from 1 January 2001 to 27 October 2021 was conducted and included English language qualitative studies exploring stakeholder perspectives on the electronic collection and use of PRMs in older adults' care. Two authors independently screened studies, conducted data extraction, quality appraisal using the Critical Appraisal Skills Programme (CASP), data coding, assessed confidence in review findings using Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE CERQual), and mapped the findings to NASSS and COM-B. An inductive approach was used to synthesize findings describing the stakeholder perspectives of barriers and facilitators. Results Twenty-two studies were included from the 3368 records identified. Studies explored older adult, caregiver, healthcare professional, and administrative staff perspectives. Twenty nine of 34 review findings (85%) were graded as having high or moderate confidence. Key factors salient to older adults related to clinical conditions and socio-cultural factors, digital literacy, access to digital technology, and user interface. Factors salient to healthcare professionals related to resource availability to collect and use PRMs, and value of PRMs collection and use. Conclusion Future efforts to implement electronic collection and use of PRMs in older adults' care should consider addressing the barriers, facilitators, and key theoretical domains identified in this review. Older adults are more likely to adopt electronic completion of PRMs when barriers associated with digital technology access, digital literacy, and user interface are addressed. Future research should explore the perspectives of other stakeholders, including those of organizational leaders, digital technology developers and implementation specialists, in various healthcare settings and explore factors influencing implementation of PREMs. PROSPERO registration number CRD42022295894.
Collapse
Affiliation(s)
| | - Pari Delir Haghighi
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Clayton, VIC 3800, Australia
| | - Lu Bai
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Clayton, VIC 3800, Australia
| | - Michelle M Shannon
- Academic Unit, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia
| | - Nadine E Andrew
- Academic Unit, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC 3199, Australia
- National Centre for Healthy Ageing, Frankston, VIC 3199, Australia
| | - Velandai Srikanth
- Academic Unit, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC 3199, Australia
- National Centre for Healthy Ageing, Frankston, VIC 3199, Australia
| | - David A Snowdon
- Academic Unit, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC 3199, Australia
- National Centre for Healthy Ageing, Frankston, VIC 3199, Australia
| | - Denise A O’Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| |
Collapse
|
2
|
Kaseweter K, Nazemi M, Gregoire N, Louw WF, Walsh Z, Holtzman S. Physician perspectives on chronic pain management: barriers and the use of eHealth in the COVID-19 era. BMC Health Serv Res 2023; 23:1131. [PMID: 37864210 PMCID: PMC10588239 DOI: 10.1186/s12913-023-10157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Chronic pain is a highly prevalent and disabling condition which is often undertreated and poorly managed in the community. The emergence of COVID-19 has further complicated pain care, with an increased prevalence of chronic pain and mental health comorbidities, and burnout among physicians. While the pandemic has led to a dramatic increase in virtual health care visits, the uptake of a broader range of eHealth technologies remains unclear. The present study sought to better understand physicians' current needs and barriers in providing effective pain care within the context of COVID-19, as well as gauge current use, interest, and ongoing barriers to eHealth implementation. METHODS A total of 100 practicing physicians in British Columbia, Canada, completed a brief online survey. RESULTS The sample was comprised of physicians practicing in rural and urban areas (rural = 48%, urban = 42%; both = 10%), with the majority (72%) working in family practice. The most prominent perceived barriers to providing chronic pain care were a lack of interdisciplinary treatment and allied health care for patients, challenges related to opioid prescribing and management, and a lack of time to manage the complexities of chronic pain. Moreover, despite expressing considerable interest in eHealth for chronic pain management (82%), low adoption rates were observed for several technologies. Specifically, only a small percentage of the sample reported using eHealth for the collection of intake data (21%), patient-reported outcomes (14%), and remote patient monitoring (26%). The most common perceived barriers to implementation were cost, complexity, and unfamiliarity with available options. CONCLUSIONS Findings provide insight into physicians' ongoing needs and barriers in providing effective pain management during the COVID-19 pandemic. Despite the potential for eHealth technologies to help address barriers in pain care, and strong interest from physicians, enhanced useability, education and training, and funding are likely required to achieve successful implementation of a broader range of eHealth technologies in the future.
Collapse
Affiliation(s)
- Kimberley Kaseweter
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada.
| | - Mark Nazemi
- Clinical and Wellbeing Solutions, Thrive Health Inc, 200 - 116 West Hastings Street, Vancouver, BC, V6B 1G8, Canada
| | - Nina Gregoire
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - W Francois Louw
- Department of Family Practice, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Bill Nelems Pain and Research Centre, 309-2755 Tutt St, Kelowna, BC, V1Y 0G1, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Susan Holtzman
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| |
Collapse
|
3
|
He W, Li M, Cao L, Liu R, You J, Jing F, Zhang J, Zhang W, Feng M. Introducing value-based healthcare perspectives into hospital performance assessment: A scoping review. J Evid Based Med 2023. [PMID: 37228246 DOI: 10.1111/jebm.12534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Value-based healthcare (VBHC) puts patient outcomes at the center of the healthcare process while optimizing the use of hospital resources across multiple stakeholders. This scoping review was conducted to summarize how VBHC had been represented in theory and in practice, how it had been applied to assess hospital performance, and how well it had been ultimately implemented. METHODS For this review, we followed the PRISMA-ScR protocol and searched five major online databases for articles published between January 2006 and July 2022. We included original articles that used the concept of VBHC to conduct performance assessments of healthcare organizations. We extracted and analyzed key concepts and information on the dimensions of VBHC, specific strategies and methods for using VBHC in performance assessment, and the effectiveness of the assessment. RESULTS We identified 48 eligible studies from 7866 articles. Nineteen nonempirical studies focused on the development of a VBHC performance assessment indicator system, and 29 empirical studies reported on the ways and points of introducing VBHC into performance assessment and its effectiveness. Ultimately, we summarized the key dimensions, processes, and effects of performance assessment after introducing VBHC. CONCLUSION Current healthcare performance assessment has begun to focus on implementing VBHC as an integrated strategy, and future work should further clarify the reliability of metrics and their association with evaluation outcomes and consider the effective integration of clinical outcomes and patient-reported outcomes.
Collapse
Affiliation(s)
- Wenbo He
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
- Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore, Singapore
| | - Meixuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Liujiao Cao
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Rui Liu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuhong You
- School of Rehabilitation Sciences, West China Hospital of Sichuan University, Chengdu, China
| | - Fangyuan Jing
- Basic Discipline of Chinese and Western Integrative, West China Hospital, Sichuan University, Chengdu, China
| | - Jiawen Zhang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
| | - Mengling Feng
- Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore, Singapore
| |
Collapse
|
4
|
Kristensen S, Holmskov J, Baandrup L, Videbech P, Bonde M, Mainz J. Evaluating the implementation and use of patient-reported outcome measures in a mental health hospital in Denmark: a qualitative study. Int J Qual Health Care 2022; 34:ii49-ii58. [PMID: 35357442 DOI: 10.1093/intqhc/mzab155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Reporting of barriers and successes associated with the implementation and use of patient-reported outcomes (PROs) is limited as a means to ensure enhanced patient involvement, shared decision-making and improved treatment and care. We set out to evaluate the implementation and use of the PRO-Psychiatry initiative on patient-reported outcome measures in Danish mental health care. We aimed to described four specific areas: the quality of the clinical consultations before and after the implementation of PRO-Psychiatry as perceived by the patients (objective A), the motivation for participating in PRO-Psychiatry as perceived by patients and clinicians (objective B), the implementation process as perceived by patients, clinicians and managers (objective C) and suggestions for improvement (objective D). METHODS The PRO-Psychiatry initiative was evaluated through a participatory approach, including patients, clinicians and managers. A repeated cross-sectional interview-based survey explored the quality of the clinical consultation before and after the implementation of PRO-Psychiatry. A three-step semi-structured group interview, inspired by the modified mini-Delphi method, was used to establish consensus on the evaluation of the implementation and use of the initiative. RESULTS The evaluation pointed at PRO-Psychiatry as a meaningful initiative, which motivated patients and supported clinicians. The patients emphasised the importance of PROs, but they also found that PROs were not used enough. Clinically relevant improvements were detected after the implementation of the initiative; more patients felt heard and experienced that clinicians took a greater interest in their problems. The clinicians valued the easily accessible real-time graphical display of the PRO responses in the electronic health record (EHR). Clinicians and managers agreed that clinical PRO practices, patient compliance and use of PROs in treatment and care should be supported during implementation. CONCLUSION The evaluation was overall positive. Patients and clinicians were willing to participate, found the online reporting easy and valued the direct access to PRO responses in the EHR. An essential feature was the integration of well-defined and functional PRO practices into the existing clinical workflow. Using PROs in the clinical sessions in a way that was palpable to the patient was found to be a significant improvement need. At the individual level, PRO-Psychiatry can use patient outcome information to support dialogue, encourage shared decision-making and promote self-management during recovery. At the aggregated patient level, the PROs can be used for monitoring the patient-perceived quality of care and for research.
Collapse
Affiliation(s)
- Solvejg Kristensen
- Psychiatry, North Denmark Region, Moelleparkej 10, Aalborg 9000, Denmark
| | - Jens Holmskov
- Brønderslev Psychiatric Hospital, Hjørringvej 180, Brønderslev 9700, Denmark
| | - Lone Baandrup
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark.,Mental Health Center Copenhagen, Gentofte Hospitalsvej 15, Hellerup 2900, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research, Mental Health Centre Glostrup, Nordstjernevej 41, Glostrup 2600, Denmark
| | - Maria Bonde
- Psychiatry, North Denmark Region, Moelleparkej 10, Aalborg 9000, Denmark
| | - Jan Mainz
- Psychiatry, North Denmark Region, Moelleparkej 10, Aalborg 9000, Denmark.,Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 7, Aalborg 9220, Denmark.,Department for Community Mental Health, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa 3498838, Israel
| |
Collapse
|
5
|
Ryland H, Cook J, Fitzpatrick R, Fazel S. Ten outcome measures in forensic mental health: A survey of clinician views on comprehensiveness, ease of use and relevance. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2021; 31:372-386. [PMID: 34755402 PMCID: PMC9299034 DOI: 10.1002/cbm.2221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/04/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND Measurement of outcomes in forensic mental health services is essential to ensure that these services are delivering good quality care and treatment. Instruments for outcome measurement should cover all important domains, be easy to implement in a routine clinical context and facilitate transfer of relevant information between clinicians as the patient progresses along a recovery and rehabilitation pathway. AIMS We sought the views of clinicians on 10 common instruments used as outcome measures in forensic mental health services, especially on their perceived comprehensiveness and ease of use. METHODS An online survey was used to gather the views of clinicians from a range of professional backgrounds working in forensic mental health services in the United Kingdom. The selected instruments were identified from a previous systematic review of instruments for measuring outcomes in this context. Questions covered comprehensiveness, ease of use, patient involvement, relevance and use for progressing tracking and care planning. RESULTS Complete responses were received from 229 individuals. The range of respondents either agreeing or strongly agreeing that individual instruments were comprehensive was 6-39%; easy to use 19%-69%; relevant 31%-78%; useful to measure progress 7-70%; and useful for care planning 33-81%. Respondents reported that, for each of the 10 instruments, full involvement of patients varied between 3% and 22%; partial involvement 12-45%, patients informed, but not involved 11%-28%; and patients not involved or informed 21%-64%. CONCLUSIONS The Health of the Nation Outcome Scale Secure, the only instrument designed as an outcome measure, is not regarded by clinicians as useful in that respect and the majority of clinicians do not inform patients they are using it. Clinicians appear most familiar with the Historical Clinical Risk 20 (HCR-20), which some respondents considered potentially useful as a progress measure but with limited patient involvement. Most respondents did not think that the HCR-20 is comprehensive. There is a need for outcome measures that are comprehensive, easy to use and have adequate patient involvement in their development and rating.
Collapse
Affiliation(s)
- Howard Ryland
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Jonathan Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK
| | - Ray Fitzpatrick
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Seena Fazel
- Department of PsychiatryUniversity of OxfordOxfordUK
| |
Collapse
|