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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 2024; 30:1555-1562. [PMID: 36927220 DOI: 10.1177/1357633x231160333] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
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Rees GH, Batenburg R, Scotter C. Responding to COVID-19: an exploration of EU country responses and directions for further research. BMC Health Serv Res 2024; 24:1198. [PMID: 39379943 PMCID: PMC11460164 DOI: 10.1186/s12913-024-11671-z] [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: 04/08/2024] [Accepted: 09/27/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND During COVID-19, scientists advising policymakers were forced to deal with high uncertainty and risks in an environment of unknowns. Evidence on which policies and measures were effective in responding to the pandemic remains underdeveloped to answer the key question 'what worked and why?'. This study aims to provide a basis for studies to go further to answer this critical question, by starting to look efficacy or how countries ensured that health services remained available and what measures were enacted to protect and treat their populations and workers. METHODS We applied a three-phase sequential mixed methods design. In phase one, we started with a qualitative content analysis of the EU Country Profile reports to retrieve and analyse data on COVID-19 responses taken by 29 countries in the European region. Phase two is the step of data transformation, converting qualitative data into numerical codes that can be statistically analysed, which are then used in a quantitative cross-national comparative analysis that comprises phase three. The quantifying process resulted in a numerical indicator to measure the 'response efficacy' of the 29 countries, which is used in phase three's association of the response measure with country performance indicators that were derived from European Centre for Disease Control (ECDC) COVID-19 case and death rate data. RESULTS Through comparing the frequency of COVID-19 measures taken, we found that many countries in the European region undertook similar actions but with differing effects. The cross-national analysis revealed an expected relationship: a lower COVID-19 response efficacy appeared to be related to a higher case and death rates. Still, marked variation for countries with similar response efficacy indicators was found, signalling that the combination and sequence of implementation of COVID-19 responses is possibly just as important as their efficacy in terms of which response measures were implemented. CONCLUSIONS Many European countries employed similar COVID-19 measures but still had a wide variation in their case and death rates. To unravel the question 'what worked and why?', we suggest directions from which more refined research can be designed that will eventually contribute to mitigate the impact of future pandemics and to be better prepared for their economic and human burden.
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Affiliation(s)
- Gareth H Rees
- Faculty of Economic Sciences and Administration, Universidad ESAN, Alonso Molina 1652, Monterrico Chico, Surco 33, Lima, Peru.
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3500 BN, Utrecht, the Netherlands
| | - Cris Scotter
- World Health Organization Regional Office for Europe, 2100, Copenhagen, Denmark
- Adjunct Faculty, Royal College of Surgeons in Ireland (RCSI) Graduate School of Healthcare Management, Dublin, Republic of Ireland
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Sari N, Omar M, Pasinringi SA, Zulkifli A, Sidin AI, Irwandy I, Thamrin Y, Saleh LM, Ayuningtyas D. Toward hospital resilience: a qualitative study on the identification of hospital shocks during disruption era in Indonesia. BMC Health Serv Res 2024; 24:1185. [PMID: 39367426 PMCID: PMC11453058 DOI: 10.1186/s12913-024-11385-2] [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: 02/23/2024] [Accepted: 08/01/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND Hospital resilience has been well recognized among healthcare managers and providers as disruption of hospital services that threatens their business environment. However, the shocks identified in the recent hospital resilience concept are mainly related to disaster situations. This study aims to identify potential shocks that hospitals face during disruptions in Indonesia. METHOD This qualitative study was conducted in Makassar, Indonesia in August-November 2022. Data was collected through semi-structured interviews with hospital managers and resilience experts using a semi-structured interview guide. 20 key informants were interviewed and data were analyzed by thematic analysis. RESULTS The study identified seven shocks to hospitals during the disruption era: policy, politics, economics, hospital management shifting paradigms, market and consumer behavior changes, disasters, and conflicts. It also identified barriers to making hospitals resilient, such as inappropriate organizational culture, weak cooperation across sectors, the traditional approach of hospital management, inadequate managerial and leadership skills, human resources inadequacies, a lack of business mindset and resistance to change. CONCLUSION This study provides a comprehensive understanding of hospital shocks during disruptions. This may serve as a guide to redesigning the instruments and capabilities needed for a resilient hospital.
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Affiliation(s)
- Nurmala Sari
- Hospital Management Department, Public Health Faculty, Hasanuddin University, Makassar, Indonesia.
| | - Mayeh Omar
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Syahrir A Pasinringi
- Master of Hospital Management Study Program, Public Health Faculty, Hasanuddin University, Makassar, Indonesia
| | - Andi Zulkifli
- Master of Hospital Management Study Program, Public Health Faculty, Hasanuddin University, Makassar, Indonesia
| | - Andi Indahwaty Sidin
- Master of Hospital Management Study Program, Public Health Faculty, Hasanuddin University, Makassar, Indonesia
- Hasanuddin University Hospital, Makassar, Indonesia
| | - Irwandy Irwandy
- Master of Hospital Management Study Program, Public Health Faculty, Hasanuddin University, Makassar, Indonesia
- Hasanuddin University Hospital, Makassar, Indonesia
| | - Yahya Thamrin
- Occupational Health and Safety Department, Public Health Faculty, Hasanuddin University, Makassar, Indonesia
| | - Lalu Muhammad Saleh
- Occupational Health and Safety Department, Public Health Faculty, Hasanuddin University, Makassar, Indonesia
| | - Dumilah Ayuningtyas
- Department of Administration and Health Policy, Public Health Faculty, University of Indonesia, Makassar, Indonesia
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Mariño RJ, Capurro D, Merolli M. Pilot implementation of a telehealth course for health professions students. BMC MEDICAL EDUCATION 2024; 24:963. [PMID: 39232771 PMCID: PMC11373492 DOI: 10.1186/s12909-024-05931-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/20/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVES This study examined the level of technology proficiency amongst healthcare professions students. Additionally, the study provides an evaluation of the pilot implementation, as well as the effect of a 7-module telehealth course on the level of adoption and future use of telehealth amongst future Australian healthcare workforce. METHODS Students from four health-sciences departments at the University of Melbourne, Australia, participated in this pilot study by completing the course and an online questionnaire, which included both structured and open-ended questions. The questionnaire included: 12-items on socio-demographic and Internet utilization; 34-items about acceptance and use of telehealth adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT2) questionnaire; and 22-items about confidence in using the Internet and ICT, adapted from Technology Proficiency Self-Assessment Questionnaire for 21st Century Learning (TPSA-C-21). RESULTS The evaluation included 26 students who expressed confidence in their Internet/ICT skills They showed enthusiasm for telehealth and recognized its potential benefits, but also emphasized the value of face-to-face interactions. They requested information on legal and aspects and additional learning. Post-test assessments indicated improvements in overall acceptance and use attitudes towards telehealth and on six dimensions of the UTAUT2 instrument. Participation in the course indicated improvements in students' overall acceptance and use attitudes and on six of the ten dimensions of the UTAUT2 instrument (p < 0.05). CONCLUSION This preliminary evaluation indicated that the telehealth course was a positive and enjoyable learning experience for students with appropriate structure and information. The course was successful in improving students' acceptance and use of health technology. The study identified areas in which further development might be required. As such, the course represents a helpful approach for telehealth training among health professions students. Further evaluation with larger samples is required.
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Affiliation(s)
- Rodrigo J Mariño
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.
- Melbourne Dental School, University of Melbourne, Melbourne, Australia.
| | - Daniel Capurro
- Melbourne Faculty of Engineering and IT, School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Mark Merolli
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
- Deptartment of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Australia
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Wu X, Kuang Y, Guo Y, Wei N, Fan Z, Ling J. Analyzing the barriers and enablers to internet hospital implementation: a qualitative study of a tertiary hospital using TDF and COM-B framework. Front Digit Health 2024; 6:1362395. [PMID: 39175961 PMCID: PMC11340510 DOI: 10.3389/fdgth.2024.1362395] [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: 01/23/2024] [Accepted: 05/28/2024] [Indexed: 08/24/2024] Open
Abstract
Background Internet hospitals have become an important way to improve the accessibility of medical services and promote medical equity in China. However, there is still lack of research on the behavior of medical personnel during the process of using Internet medical services, and the elements of behavior that motivate doctors to actively use or resist the use of Internet hospitals are still not fully analyzed. The study applied the Theoretical Domains Framework to examine the factors affecting the engagement of medical personnel in Internet hospitals, with the aim of guiding the design of intervention to enhance Internet hospital participation. Methods This study utilized qualitative analysis. Semi-structured questionnaires based on the Theoretical Domains Framework (TDF) and Capability-Opportunity-Motivation-Behavior (COM-B) model was developed and administered to 40 doctors and nurses at a Grade A tertiary hospital in Guangdong Province. Data was coded and analyzed using qualitative methods including Nvivo software. Results The research displayed 19 barriers and 7 enablers for the implementation of Internet hospitals, all 14 TDF domains impacted participation with motivation cited most frequently. Despite challenges, medical personnel exhibited a generally optimistic stance towards utilization of the Internet hospital. Major barriers include the higher requirement of diagnostic ability, objective difficulties brought by online consultation to the decision-making process, limitation of time and other resources, not ideal technological and institutional environment, lack of self-efficacy and negative expectation of results in online consultation. Key enablers include patient needs and the positive impact of online care on the medical process and patient experience. Discussion This qualitative study identified a range of barriers and enablers to Internet hospital participation according to medical personnel, providing an conceptual framework to guide further research evaluating implementation strategies. Expanded research and targeted interventions design can help optimize participation in this evolving healthcare delivery model.
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Affiliation(s)
- Xiaolong Wu
- Business School, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yulin Kuang
- Business School, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yonglin Guo
- School of Government, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Ning Wei
- Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Zichun Fan
- Business School, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Jingru Ling
- Business School, Sun Yat-sen University, Shenzhen, Guangdong, China
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Fluck A, Fry CH, Robin J, Fluck D, Han TS. Impact of the COVID-19 pandemic on care-quality outcomes in older adults admitted to hospital with altered mental status. Int J Geriatr Psychiatry 2024; 39:e6125. [PMID: 39030777 DOI: 10.1002/gps.6125] [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] [Received: 05/05/2023] [Accepted: 07/07/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVES During the coronavirus disease (COVID-19) pandemic, patients with altered mental status (AMS: dementia, delirium and delirium superimposed on dementia) were profoundly affected by an abrupt transformation in healthcare systems. Here, we evaluated quality-care outcomes, including length of stay (LOS), in-hospital mortality, early readmission and mortality after hospital discharge, in older adults admitted for AMS during the pandemic and compared them to patients admitted prior to the pandemic. METHODS Chi-squared and Fisher's exact tests were used to examine changes to admissions for AMS before and during the pandemic, and their outcomes. Logistic regression analyses, with reference to pre-pandemic data, were conducted to examine the impact of the pandemic on outcomes. DESIGN Prospective data of 21,192 non-COVID admissions to an acute general medical department in a Surrey (UK) hospital were collected from patients admitted before (1st April 2019 to 29th February 2020) and during the pandemic (1st March 2020 to 31st March 2021). RESULTS There were 10,173 (47.7% men) from the pre-pandemic and 11,019 (47.5% men) from the pandemic periods; overall mean age = 68.3yr. During the pandemic AMS patients had significantly higher admission rates (1.1% vs 0.6%, P < 0.001). However, median LOS in hospital was shorter (9.0 days [IQR = 5.3-16.2] vs 15.5 days [IQR = 6.2-25.7], P < 0.001) and thus were less likely to stay in hospital >3 weeks: adjusted OR = 0.26 (95%CI = 0.12-0.57). In-hospital mortality and readmission within 28 days of discharge did not change during the pandemic, but were less likely to die within 30 days of discharge: adjusted OR = 0.32 (95%CI = 0.11-0.96). CONCLUSIONS This combination of higher admission rate, shorter LOS, and an unchanging early readmission suggests a higher admission-discharge turnover of different patients with AMS and provides important insights into the potential impact of the COVID-19 pandemic on healthcare delivery to individuals with AMS.
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Affiliation(s)
- Adam Fluck
- Faculty of Medical Sciences, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Jonathan Robin
- Department of Medicine, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK
| | - Thang S Han
- Department of Endocrinology, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK
- Institute of Cardiovascular Research, Royal Holloway, University of London, Surrey, UK
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Al Khatib I, Chembakath JJ, Ndiaye M. Benchmarking Sweden's Digitalization Transformation Strategy-Is It a Good Fit for the UAE? Telemed J E Health 2024. [PMID: 38916743 DOI: 10.1089/tmj.2024.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Background: The ongoing revolution in health care, driven by wearable technology, virtual reality, and the Internet of Things, is reshaping both health care operations and our daily lives. This digital transformation ensures broader access to health care options, fosters patient-centered care and affects both health care institutions and individuals. In Sweden, health care is undergoing a digital shift, with initiatives like personal health management, remote monitoring, and virtual care enhancing patient involvement. This article reviews Sweden's health care digital transformation and compares it with the United Arab Emirates (UAE's) initiatives to assess viability. Methods: Using systematic literature review methods, databases from 2011 to 2023 were searched, supplemented by reference lists. Results: Database searches identified 761 records. A total of 480 articles were screened on basis of title and abstract, yielding 184 that were assessed for eligibility, leading to 40 academic studies to be included and 12 grey literature. Conclusions: The findings highlight Sweden's success in empowering patients through enhanced connectivity with clinical teams, knowledge sharing, and care management. However, due to contextual differences, the UAE should not blindly replicate Sweden's strategy. In conclusion, Sweden's efforts have positively engaged patients in health care, but challenges such as emerging technologies, demographic shifts, and budget constraints persist. Proactive planning and adaptation are crucial, with lessons applicable to the UAE market. Establishing a clear regulatory framework for digital care is imperative for future resilience.
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Affiliation(s)
- Inas Al Khatib
- College of Industrial Engineering, American University of Sharjah, Sharjah, United Arab Emirates
| | - Junu Jahana Chembakath
- College of Industrial Engineering, American University of Sharjah, Sharjah, United Arab Emirates
| | - Malick Ndiaye
- College of Industrial Engineering, American University of Sharjah, Sharjah, United Arab Emirates
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Magnusson C, Ollis L, Munro S, Maben J, Coe A, Fitzgerald O, Taylor C. Video livestreaming from medical emergency callers' smartphones to emergency medical dispatch centres: a scoping review of current uses, opportunities, and challenges. BMC Emerg Med 2024; 24:99. [PMID: 38862922 PMCID: PMC11165798 DOI: 10.1186/s12873-024-01015-9] [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: 11/03/2023] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Timely dispatch of appropriate emergency medical services (EMS) resources to the scene of medical incidents, and/or provision of treatment at the scene by bystanders and medical emergency lay callers (referred to as 'callers' in this review) can improve patient outcomes. Currently, in dispatch systems worldwide, prioritisation of dispatch relies mostly on verbal telephone information from callers, but advances in mobile phone technology provide means for sharing video footage. This scoping review aimed to map and identify current uses, opportunities, and challenges for using video livestreaming from callers' smartphones to emergency medical dispatch centres. METHODS A scoping review of relevant published literature between 2007 and 2023 in the English language, searched within MEDLINE; CINAHL and PsycINFO, was descriptively synthesised, adhering to the PRISMA extension for scoping reviews. RESULTS Twenty-four articles remained from the initial search of 1,565 articles. Most studies were simulation-based and focused on emergency medical dispatchers' (referred to as 'dispatcher/s' in this review) assisted video cardiopulmonary resuscitation (CPR), predominantly concerned with measuring how video impacts CPR performance. Nine studies were based on real-life practice. Few studies specifically explored experiences of dispatchers or callers. Only three articles explored the impact that using video had on the dispatch of resources. Opportunities offered by video livestreaming included it being: perceived to be useful; easy to use; reassuring for both dispatchers and callers; and informing dispatcher decision-making. Challenges included the potential emotional impact for dispatchers and callers. There were also concerns about potential misuse of video, although there was no evidence that this was occurring. Evidence suggests a need for appropriate training of dispatchers and video-specific dispatch protocols. CONCLUSION Research is sparse in the context of video livestreaming. Few studies have focussed on the use of video livestreaming outside CPR provision, such as for trauma incidents, which are by their nature time-critical where visual information may offer significant benefit. Further investigation into acceptability and experience of the use of video livestreaming is warranted, to understand the potential psychological impact on dispatchers and callers.
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Affiliation(s)
- Carin Magnusson
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Lucie Ollis
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Scott Munro
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Jill Maben
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Anthony Coe
- South East Coast Ambulance Service NHS Foundation Trust, Crawley, West Sussex, UK
| | - Oliver Fitzgerald
- South East Coast Ambulance Service NHS Foundation Trust, Crawley, West Sussex, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK.
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Seuren LM, Shaw S. How Informal Carers Support Video Consulting in Physiotherapy, Heart Failure, and Cancer: Qualitative Study Using Linguistic Ethnography. J Med Internet Res 2024; 26:e51695. [PMID: 38819900 PMCID: PMC11179022 DOI: 10.2196/51695] [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: 08/08/2023] [Revised: 11/24/2023] [Accepted: 04/19/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Informal carers play an important role in the everyday care of patients and the delivery of health care services. They aid patients in transportation to and from appointments, and they provide assistance during the appointments (eg, answering questions on the patient's behalf). Video consultations are often seen as a way of providing patients with easier access to care. However, few studies have considered how this affects the role of informal carers and how they are needed to make video consultations safe and feasible. OBJECTIVE This study aims to identify how informal carers, usually friends or family who provide unpaid assistance, support patients and clinicians during video consultations. METHODS We conducted an in-depth analysis of the communication in a sample of video consultations drawn from 7 clinical settings across 4 National Health Service Trusts in the United Kingdom. The data set consisted of 52 video consultation recordings (of patients with diabetes, gestational diabetes, cancer, heart failure, orthopedic problems, long-term pain, and neuromuscular rehabilitation) and interviews with all participants involved in these consultations. Using Linguistic Ethnography, which embeds detailed analysis of verbal and nonverbal communication in the context of the interaction, we examined the interactional, technological, and clinical work carers did to facilitate video consultations and help patients and clinicians overcome challenges of the remote and video-mediated context. RESULTS Most patients (40/52, 77%) participated in the video consultation without support from an informal carer. Only 23% (12/52) of the consultations involved an informal carer. In addition to facilitating the clinical interaction (eg, answering questions on behalf of the patient), we identified 3 types of work that informal carers did: facilitating the use of technology; addressing problems when the patient could not hear or understand the clinician; and assisting with physical examinations, acting as the eyes, ears, and hands of the clinician. Carers often stayed in the background, monitoring the consultation to identify situations where they might be needed. In doing so, copresent carers reassured patients and helped them conduct the activities that make up a consultation. However, carers did not necessarily help patients solve all the challenges of a video consultation (eg, aiming the camera while laying hands on the patient during an examination). We compared cases where an informal carer was copresent with cases where the patient was alone, which showed that carers provided an important safety net, particularly for patients who were frail and experienced mobility difficulties. CONCLUSIONS Informal carers play a critical role in making video consultations safe and feasible, particularly for patients with limited technological experience or complex needs. Guidance and research on video consulting need to consider the availability and work done by informal carers and how they can be supported in providing patients access to digital health care services.
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Affiliation(s)
- Lucas Martinus Seuren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Newman C. What can the Defence Medical Services learn from the COVID-19 pandemic in order to be ready for the future? BMJ Mil Health 2024; 170:248-250. [PMID: 35926915 DOI: 10.1136/military-2022-002205] [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: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 01/25/2023]
Abstract
The COVID-19 pandemic placed significant global pressure on public health, with the demand for specialist clinical input, equipment and therapeutics often outweighing supply in many well-established healthcare systems. The UK was no exception to this burden, resulting in unprecedented demands being placed on its NHS. Throughout the pandemic, the UK Defence Medical Services (DMS) aided the civilian healthcare sector, while concurrently adapting as an organisation to meet its enduring commitment in promoting the operational output of the wider UK Armed Forces. This paper serves to provide an overview of some of these key activities while offering proposed lessons which can be learnt, in order to promote the DMS' output in times of future crises. Of note, the DMS aided to mitigate surge demands placed on the NHS' supply chain, assisting in promoting its resilience to provide key materials to civilian clinical personnel. Adaptation of military policy generation mechanisms, together with adoption of novel technological approaches to promote remote working, empowered efficient DMS operational output throughout the pandemic. Direct provision of personnel to assist in the NHS' clinical output served to foster mutually beneficial interorganisational relationships, while providing objective benefit for the UK public.This paper was selected as the BMJ Military Health Royal Society of Medicine Colt Foundation National Essay Prize Winner 2021.
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Rousseau A, Baumann S, Constant J, Deplace S, Multon O, Lenoir-Delpierre L, Gaucher L. Defining practices suitable for care via teleconsultation in gynaecological and obstetrical care: a French Delphi survey. BMJ Open 2024; 14:e085621. [PMID: 38719331 PMCID: PMC11086368 DOI: 10.1136/bmjopen-2024-085621] [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] [Received: 02/21/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE Delineate the scope of teleconsultation services that can be effectively performed to provide women with comprehensive gynaecological and obstetrical care. DESIGN Based on the literature and experts' insights, we identified a list of gynaecological and obstetrical care practices suitable for teleconsultation. A three-round Delphi consensus survey was then conducted online among a panel of French experts. Experts using a 9-point Likert scale assessed the relevance of each teleconsultation practice in four key domains: prevention, gynaecology and antenatal and postnatal care. Consensus was determined by applying a dual-criteria approach: the median score on a 9-point Likert scale and the percentage of votes either below 5 or 5 and higher. SETTING The study was conducted at a national level in France and involved multiple healthcare centres and professionals from various geographical locations. PARTICIPANTS The panel comprised 22 French experts with 19 healthcare professionals, including 12 midwives, 3 obstetricians-gynaecologists, 4 general practitioners and 3 healthcare system users. Participants were selected to include diverse practice settings encompassing hospital and private practices in both rural and urban areas. PRIMARY AND SECONDARY OUTCOME MEASURES The study's primary outcome was the identification of gynaecological and obstetrical care practices suitable for teleconsultation. Secondary outcomes included the level of professional consensus on these practices. RESULTS In total, 71 practices were included in the Delphi survey. The practices approved for teleconsultation were distributed as follows: 92% in prevention (n=12/13), 55% in gynaecology (n=18/33), 31% in prenatal care (n=5/16) and 12% in postnatal care (n=1/9). Lastly, 10 practices remained under discussion: 7 in gynaecology, 2 in prenatal care and 1 in postnatal care. CONCLUSIONS Our consensus survey highlights both the advantages and limitations of teleconsultations for women's gynaecological and obstetrical care, emphasising the need for careful consideration and tailored implementation.
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Affiliation(s)
- Anne Rousseau
- CESP, Villejuif, France
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
| | | | | | | | - Olivier Multon
- Department of Obstetrics and Gynecology, Saint Herblain, France
| | | | - Laurent Gaucher
- Midwifery, Geneva School of Health Sciences, Genève, Switzerland
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Hinton L, Dakin FH, Kuberska K, Boydell N, Willars J, Draycott T, Winter C, McManus RJ, Chappell LC, Chakrabarti S, Howland E, George J, Leach B, Dixon-Woods M. Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system-level stakeholders. BMJ Qual Saf 2024; 33:301-313. [PMID: 35552252 PMCID: PMC11041557 DOI: 10.1136/bmjqs-2021-014329] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND High-quality antenatal care is important for ensuring optimal birth outcomes and reducing risks of maternal and fetal mortality and morbidity. The COVID-19 pandemic disrupted the usual provision of antenatal care, with much care shifting to remote forms of provision. We aimed to characterise what quality would look like for remote antenatal care from the perspectives of those who use, provide and organise it. METHODS This UK-wide study involved interviews and an online survey inviting free-text responses with: those who were or had been pregnant since March 2020; maternity professionals and managers of maternity services and system-level stakeholders. Recruitment used network-based approaches, professional and community networks and purposively selected hospitals. Analysis of interview transcripts was based on the constant comparative method. Free-text survey responses were analysed using a coding framework developed by researchers. FINDINGS Participants included 106 pregnant women and 105 healthcare professionals and managers/stakeholders. Analysis enabled generation of a framework of the domains of quality that appear to be most relevant to stakeholders in remote antenatal care: efficiency and timeliness; effectiveness; safety; accessibility; equity and inclusion; person-centredness and choice and continuity. Participants reported that remote care was not straightforwardly positive or negative across these domains. Care that was more transactional in nature was identified as more suitable for remote modalities, but remote care was also seen as having potential to undermine important aspects of trusting relationships and continuity, to amplify or create new forms of structural inequality and to create possible risks to safety. CONCLUSIONS This study offers a provisional framework that can help in structuring thinking, policy and practice. By outlining the range of domains relevant to remote antenatal care, this framework is likely to be of value in guiding policy, practice and research.
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Affiliation(s)
- Lisa Hinton
- THIS Institute (The Healthcare Improvement Studies), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Francesca H Dakin
- Nuffield Department of Primary Health Care Sciences, Oxford University, Oxford, UK
| | - Karolina Kuberska
- THIS Institute (The Healthcare Improvement Studies), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Tim Draycott
- Royal College of Obstetricians and Gynaecologists, London, UK
| | | | - Richard J McManus
- Nuffield Department of Primary Health Care Sciences, Oxford University, Oxford, UK
| | - Lucy C Chappell
- Maternal and Fetal Research Unit Division of Women's Health, St Thomas' Hospital, London, UK
| | | | - Elizabeth Howland
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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13
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Chukwusa E, Barclay S, Gulliford M, Harding R, Higginson I, Verne J. General practice service use at the end-of-life before and during the COVID-19 pandemic: a population-based cohort study using primary care electronic health records. BJGP Open 2024; 8:BJGPO.2023.0108. [PMID: 37993135 PMCID: PMC11169988 DOI: 10.3399/bjgpo.2023.0108] [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: 06/09/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Globally, the COVID-19 pandemic has caused unprecedented strain in healthcare systems, but little is known about how it affected patients requiring palliative and end-of-life care from GPs. AIM To evaluate the impact of the pandemic on primary care service use in the last 3 months of life, including consultations and prescribing, and to identify associated factors. DESIGN AND SETTING A retrospective cohort study in UK, using data from the Clinical Practice Research Datalink. METHOD The study cohort included those who died between 2019 and 2020. Poisson regression models using generalised estimation equations were used to examine the association between primary care use and patient characteristics. Adjusted rate ratios (aRRs) and 95% confidence intervals (95% CIs) were estimated. RESULTS A total of 44 534 patients died during the study period. The pandemic period was associated with an 8.9% increase in the rate of consultations from 966.4 to 1052.9 per 1000 person-months, and 14.3% longer telephone consultation duration (from 10.1 to 11.5 minutes), with a switch from face-to-face to telephone or video consultations. The prescription of end-of-life care medications increased by 6.3%, from 1313.7 to 1396.3 per 1000 person-months. The adjusted rate ratios for consultations (aRR = 1.08, 95% CI = 1.06 to 1.10, P<0.001) and prescriptions (aRR 1.05: 95% CI = 1.03 to 1.07, P<0.001) also increased during the pandemic. CONCLUSION The pandemic had a major impact on GP service use, leading to longer consultations, shifts from face-to-face to telephone or video consultations, and increased prescriptions. GP workload-related issues must be addressed urgently to ease the pressure on GPs.
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Affiliation(s)
- Emeka Chukwusa
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Martin Gulliford
- Department of Population Health Sciences, King's College London, Faculty of Life Science & Medicine, London, UK
| | - Richard Harding
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Irene Higginson
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
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14
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Cooper-Stanton G, Gale N, Sidhu M, Allen K. UK survey on experiences of men with non-cancer-related lymphoedema: part one. Br J Community Nurs 2024; 29:S27-S31. [PMID: 38578925 DOI: 10.12968/bjcn.2024.29.sup4.s27] [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] [Indexed: 04/07/2024]
Abstract
This initial article delves into the methodology, methods and theories, while the subsequent article will centre on the discoveries, discussion and conclusion. The study aimed to address the research question: how do men perceive their engagement in the self-management of non-cancer-related lymphoedema? An interpretivist qualitative methodology was employed, utilising an online survey based on the validated lymphoedema quality of life tool (LYMQoL). The data underwent inductive narrative inquiry. The study incorporated theories such as hegemonic masculinity and the health, illness, men and masculinities (HIMM) framework. The findings will be detailed in the second article in this series. This article has delineated the objective, methodologyand methods, employing a qualitative interpretivist approach through narrative inquiry. The study incorporated masculinity theories, including hegemonic masculinity and HIMM. The second article will present the findings and their significance within the broader literature.
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Affiliation(s)
- Garry Cooper-Stanton
- Doctoral Researcher, Associate Dean UCLan, Clinical Nurse Specialist Lymphoedema, University of Birmingham, Health Services Management Centre (HSMC), 40 Edgbaston Park Road, Birmingham, B15 2RT
| | - Nicola Gale
- Head of School of Social Policy, Professor of Health Policy and Sociology, University of Birmingham, School of Social Policy, Muirhead Tower, Edgbaston, Birmingham, B15 2TT
| | - Manbinder Sidhu
- Associate Professor, School of Social Policy, HSMC, Park House, Edgbaston, Birmingham, B15 2RT
| | - Kerry Allen
- Associate Professor Head of Education, University of Birmingham, School of Social Policy, HSMC, Park House, Edgbaston, Birmingham, B15 2RT
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15
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Moore L, Hughes G, Wherton J, Shaw S. 'When the visible body is no longer the seer': The phenomenology of perception and the clinical gaze in video consultations. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:418-436. [PMID: 37746806 DOI: 10.1111/1467-9566.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023]
Abstract
Video technology enabled professionals and patients to conduct consultations during the COVID-19 pandemic when in-person health care was minimised to reduce the spread of the virus. We present findings of a study of video-consulting through in-depth qualitative remote interviews with 40 health professionals, managers, support staff and 10 patients in health-care services across the UK from 2020 to 2021. Drawing on Foucault's concept of the clinical gaze, Merleau-Ponty's work on the phenomenology of perception and Ihde's postphenomenology we interpreted the ways in which remote consultations shaped patient-professional interactions, mediating and framing what was seen, revealed and known. We found that participating in video consultations not only involved creative adaption and adjustment to a virtual clinic but also changed how professionals and patients saw and were seen. We argue that this mode of consulting can transform boundaries and perceptions, alter aspects of clinical presence, knowledge and embodiment and thus both change and incorporate the clinical gaze.
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Affiliation(s)
- Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- School of Business, University of Leicester, Leicester, UK
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Rostron H, Wright JM, Gilbert AW, Dillon B, Pini S, Redmond AC, Livermore P. Adoption of technology enabled care to support the management of children and teenagers in rheumatology services: a protocol for a mixed-methods systematic review. BMJ Open 2024; 14:e082515. [PMID: 38387983 PMCID: PMC10882409 DOI: 10.1136/bmjopen-2023-082515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION COVID-19 catalysed a rapid move to provide care away from the hospital using online communication platforms. Technology enabled care (TEC) continues to be an important driver in progressing future healthcare services. Due to the complex and chronic nature of conditions seen within paediatric rheumatology, TEC may lead to better outcomes. Despite some growth in published literature into the adoption of TEC in paediatric rheumatology, there is limited synthesis. The aim of this review is to provide a comprehensive understanding and evaluation of the adoption of TEC by patients in paediatric rheumatology services, to establish best practices. METHODS AND ANALYSIS This proposed mixed-methods systematic review will be conducted by searching a wide variety of healthcare databases, grey literature resources and associated charities and societies, for articles reported in English language. Data extraction will include population demographics, technology intervention, factors affecting adoption of intervention and consequent study outcomes. A parallel-results convergent synthesis design is planned, with independent syntheses of quantitative and qualitative data, followed by comparison of the findings of each synthesis using a narrative approach. Normalisation process theory will be used to identify, characterise and explain implementation factors. The quality of included articles will be assessed using the Mixed Methods Appraisal Tool for research papers and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for grey literature. Overall confidence in quality and strength of evidence will be assessed using the Confidence in the Evidence from Reviews of Qualitative Research tool. ETHICS AND DISSEMINATION Ethical approval is not required due to the nature of this mixed-methods systematic review. The findings will be disseminated via a peer-reviewed journal, relevant conferences and any other methods (eg, via NHS Trust or NIHR YouTube channels) as advised by paediatric rheumatology patients. PROSPERO REGISTRATION NUMBER CRD42023443058.
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Affiliation(s)
- Heather Rostron
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Children's Research Team, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Simon Pini
- Psychological and Social Medicine, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Polly Livermore
- Infection, Immunity & Inflammation Department, University College London, London, UK
- NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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17
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Adinkrah EK, Bazargan S, Cobb S, Kibe LW, Vargas R, Waller J, Sanchez H, Bazargan M. Mobilizing faith-based COVID-19 health ambassadors to address COVID-19 health disparities among African American older adults in under-resourced communities: A hybrid, community-based participatory intervention. PLoS One 2024; 19:e0285963. [PMID: 38358995 PMCID: PMC10868749 DOI: 10.1371/journal.pone.0285963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/26/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic disproportionately affected older adults, particularly those with pre-existing chronic health conditions. To address the health disparity and challenges faced by under-resourced African American older adults in South Los Angeles during this period, we implemented a hybrid (virtual/in-person), pre-post, community-based participatory intervention research project utilizing a faith-based lay health advisor model (COVID-19 Health Ambassador Program (CHAP)). We recruited COVID-19 Health Ambassadors (CHAs) and African American older adults (participants) from faith-based organizations who partook in CHA-led meetings and follow-ups that educated and supported the participants. This paper seeks to evaluate this intervention's implementation using the Consolidated Framework for Implementation Research (CFIR) as a reporting tool with an emphasis on fidelity, challenges, and adaptations based on data collected via stakeholder interviews and surveys. RESULTS CHAP was delivered to 152 participants by 19 CHAs from 17 faith-based organizations. CHAs assisted with chronic disease management, resolved medication-related challenges, encouraged COVID-19 vaccination, reduced psychological stress and addressed healthcare avoidance behaviors such as COVID-19 vaccine hesitancy among the participants. Challenges encountered include ensuring participant engagement and retention in the virtual format and addressing technological barriers for CHAs and participants. Adaptations made to better suit the needs of participants included providing communication tools and additional training to CHAs to improve their proficiency in using virtual platforms in addition to adapting scientific/educational materials to suit our participants' diverse cultural and linguistic needs. CONCLUSION The community-centered hybrid approach in addition to our partnership with faith-based organizations and their respective COVID-19 health ambassadors proved to be essential in assisting underserved African American older adults manage chronic health conditions and address community-wide health disparities during the COVID-19 pandemic. Adaptability, cultural sensitivity, and teamwork are key to implementing health interventions especially in underserved populations.
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Affiliation(s)
- Edward K. Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Shahrzad Bazargan
- Departments of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, United States of America
| | - Sharon Cobb
- Mervyn M. Dymally College of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Lucy W. Kibe
- Physician Associate Program, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Roberto Vargas
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Joe Waller
- Office of Research, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Humberto Sanchez
- Office of Research, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, United States of America
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Keyworth C, Conner M, Johnson J, Epton T, Vogt KS, Armitage CJ. Impacts of the COVID-19 public health emergency on healthcare professional delivery of opportunistic behaviour change interventions: a retrospective cohort study. BMC Health Serv Res 2024; 24:167. [PMID: 38317160 PMCID: PMC10845453 DOI: 10.1186/s12913-023-10522-7] [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: 09/09/2022] [Accepted: 12/23/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The public health policy "Making Every Contact Count" (MECC) compels healthcare professionals to deliver health behaviour change interventions during routine consultations. As healthcare systems continue their recovery from the impacts of the COVID-19 public health emergency, supporting people to modify health behaviours is more important now than when the policy was introduced. The present study aims to: (a) examine changes in healthcare professionals' awareness of, and engagement with the policy over a five-year period, (b) examine the psychosocial drivers associated with delivering behaviour change interventions, and (c) identify targets to increase healthcare professionals' delivery of interventions. METHODS Comparison of data from two independent representative surveys of NHS healthcare professionals working in the UK. In both surveys (July-September 2017; N = 1387, and February-March 2022; N = 1008), participants were asked to report: (1) awareness of the MECC policy, (2) the prevalence of MECC-related practice (perceived patient benefit, how often interventions were delivered, and time spent delivering interventions), and (3) perceptions of capabilities, opportunities and motivations to deliver behaviour change interventions. T- tests (independent-samples), MANOVA, multiple linear regression, and chi-square analyses were used to generate comparisons between the surveys. RESULTS Awareness of the policy increased from 2017 (31.4%) to 2022 (52.0%). However, in 2022 compared with 2017, healthcare professionals reported (a) fewer patients would benefit from behaviour change interventions (49.1% versus 55.9%), (b) they delivered behaviour change interventions to a lower proportion of patients (38.0% versus 50.0%), and (c) they spent a lower proportion of the consultation time delivering interventions (26.5% versus 35.3%). Further, in 2022, compared with 2017, healthcare professionals reported fewer physical opportunities, fewer social opportunities, and fewer psychological capabilities to deliver behaviour change interventions. In the 2022 survey, perceptions of patient benefit and delivery of interventions was associated with greater perceptions of opportunities and motivations. CONCLUSIONS Health behaviour change interventions remain an important part of routine healthcare in the continued recovery from COVID-19 public health emergency, however reported engagement with MECC-related practices appears to have reduced over time. Future research should consider how healthcare professionals identify patients who might benefit from opportunistic behaviour change interventions, and to increase capabilities, opportunities, and motivations to deliver interventions during routine consultations.
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Affiliation(s)
- Chris Keyworth
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK.
| | - Mark Conner
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, Manchester, UK
| | - Katharina S Vogt
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9PL, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, M13 9PL, Manchester, UK
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Zanaboni P, Bergmo TS, Kristiansen E. Patients' experiences with receiving sick leave certificates via remote consultations in Norway during the COVID-19 pandemic: a nationwide online survey. BMJ Open 2024; 14:e075352. [PMID: 38272547 PMCID: PMC10824015 DOI: 10.1136/bmjopen-2023-075352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES To explore patients' experiences with receiving sick leave certificates via remote consultations during the COVID-19 pandemic and investigate whether there were differences among the types of remote consultation (telephone, video or text). DESIGN A nationwide online patient survey consisting of quantitative data supplemented by qualitative opinions conducted in Norway. SETTING Primary care. PARTICIPANTS Patients who received a sick leave certificate via remote consultation in the period from 16 November to 15 December 2020. RESULTS Of the 5429 respondents, 3233 (59.6%) received a sick leave certificate via telephone consultation, 657 (12.1%) via video consultation and 1539 (28.3%) via text-based e-consultation. Most respondents (76.8%) were satisfied. Only 10% of the respondents thought that the doctor would have obtained more information through an office appointment. The majority of the respondents (59.6%) found that they had as much time to explain the problem as at an office appointment. Some patients also thought that it was easier to formulate the problem via a remote consultation (18.2%) and agree with the doctor on the sick leave (10.3%).The users of text-based e-consultations were the most satisfied (79.3%, p<0.001) compared with those using telephone or video consultations. Among users of text-based e-consultations, there was a higher proportion of patients who thought that they had more time to explain the problem compared with an office appointment (p<0.001), it was easier to explain the problem (p<0.001) and agree with the doctor (p<0.001). Most respondents would use the same type of remote consultation if they were to contact the general practitioner (GP) for the same problem, with the highest proportion among the users of video consultations (62.1%, p<0.001). CONCLUSIONS Patients were satisfied with communicating and receiving sick leave certificates via remote consultations. Future studies should investigate patients' and GPs' use and experiences in a postpandemic setting.
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Affiliation(s)
- Paolo Zanaboni
- University Hospital of North Norway, Tromso, Norway
- UiT The Arctic University of Norway, Tromso, Norway
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Merolli M, Ahmed O, McCreesh K, Remedios L, Butler-Henderson K. Are physiotherapists expected to be competent in digital health practice? Meta-synthesis of international physiotherapy practice competency standards. Physiother Theory Pract 2024:1-12. [PMID: 38214509 DOI: 10.1080/09593985.2023.2299202] [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: 05/31/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Digital health technology is progressively transforming physiotherapy practice. Despite a maturing body of literature relating to physiotherapy digital health capability, research examining digital health physiotherapy competency standards is both lacking and lagging. OBJECTIVE Examine international professional practice competency standards for physiotherapists to identify themes common to digital health practice competency, published by international peak organizations governing physiotherapy practice. METHODS Systematic meta-synthesis of international peak organization physiotherapy practice competency standards. The study was undertaken over nine stages. Competency statements related to digital health were extracted, and further coded into resultant themes. RESULTS Eleven documents were analyzed. Fifty-two statements explicitly referenced digital health competency. Identified themes were as follows: 1) digital health data governance; 2) digital health data translation; and 3) digital health technologies. Where digital health-related competency statements do exist, they are skewed toward health information management activities. CONCLUSIONS Digital health practice is currently under-represented in competency standards for physiotherapists. Workforce advancement in light of the burgeoning impact of digital health will prompt further updates to professional competency standards set by our peak organizations. This will have a flow on effect, whereby education providers (e.g. universities and other professional development providers) should consider curriculum and training that prepares individuals for digitally enabled practice.
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Affiliation(s)
- Mark Merolli
- Centre for Health Exercise, and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Parkville, Australia
- Centre for Digital Transformation of Health, University of Melbourne, Carlton, Australia
| | - Osman Ahmed
- Department of Physiotherapy, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Louisa Remedios
- Department of Physiotherapy, School of Health Sciences, University of Melbourne, Parkville, Australia
- Institute of Health and Wellbeing, Federation University, Parkville, Australia
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Cammisa E, La Verde M, Coliva F, Favero A, Sassoli I, Fratini S, Alesi D, Lullini G, Zaffagnini S, Marcheggiani Muccioli GM. Low Response Rate to Follow-Up Using Telemedicine after Total Knee Replacement during the COVID-19 Pandemic in Italy. J Clin Med 2024; 13:360. [PMID: 38256494 PMCID: PMC10816610 DOI: 10.3390/jcm13020360] [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: 08/27/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the survival rate and medium-term outcomes of patients after cemented posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasty (TKA) using a telemedicine platform during the COVID-19 pandemic in Italy. METHODS A total of 100 consecutive patients (mean age 73.5 ± 13.2 years) who received a cemented PS MB TKA were enrolled. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. A dedicated software that makes it possible to perform video calls, online questionnaires, and acquire X-rays remotely was used. Subjective clinical scores and objective range-of-motion (ROM) measurements were observed at an average follow-up of 54 ± 11.3 months. RESULTS A total of 42 of 100 enrolled patients (mean age 70.3 ± 8.4 years) completed the telemedicine follow-up. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. Age was found to be a statistically significant difference between the group that completed the telemedicine follow-up and the one that did not (p < 0.004). KOOS scores improved from 56.1 ± 11.3 to 77.4 ± 16.2, VAS scores decreased from 7.2 ± 2.1 to 2.8 ± 1.6, KSSf scores increased from 47.2 ± 13.3 to 77.1 ± 21.1, FJS scores improved from 43.4 ± 12.3 to 76.9 ± 22.9, and OKS scores increased from 31.9 ± 8.8 to 40.4 ± 9.9. All the differences were statistically significant (p < 0.05). The mean flexion improved from 88° ± 8° to 120° ± 12°. A radiographic evaluation showed a mean pre-operative mechanical axis deviation of 5.3 ± 8.0 degrees in varus, which improved to 0.4 ± 3.4 degrees of valgus post-operation. The survivorship at 5 years was 99%. CONCLUSIONS Subject to small numbers, telemedicine presented as a useful instrument for performing remote monitoring after TKA. The most important factor in telemedicine success remains the patient's skill, which is usually age-related, as older patients have much more difficulty in approaching a technological tool.
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Affiliation(s)
- Eugenio Cammisa
- Operational Unit of Orthopedics and Traumatology, Imola Hospital Santa Maria della Scaletta, 40026 Imola, Italy;
| | - Matteo La Verde
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Federico Coliva
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Antongiulio Favero
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Iacopo Sassoli
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Stefano Fratini
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Domenico Alesi
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Giada Lullini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa e Neuroriabilitazione, 40139 Bologna, Italy;
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Giulio Maria Marcheggiani Muccioli
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
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Brown CL, Chartrand L, Vollebregt B, Kaur D, Crawford T, Thille P. Primary care occupational, physical, and respiratory therapy role adaptation in the first year of the COVID-19 pandemic. BMC PRIMARY CARE 2024; 25:3. [PMID: 38166661 PMCID: PMC10759467 DOI: 10.1186/s12875-023-02247-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Occupational, physical and respiratory therapists are relatively new to primary care settings, and thus their roles are still emerging. The COVID-19 pandemic was a time of abrupt changes in professional roles. Professional role adaptations are integral to the ability of health care teams to respond to day-to-day care delivery challenges, such as the current physician and nurse shortage, as well as disaster situations. This study explored the role adaptation of occupational, physical, and respiratory therapists in Canadian primary care settings throughout the first year of the COVID-19 pandemic, as well as barriers and facilitators to adaptation. METHODS This longitudinal interpretative descriptive study purposively sampled primary care occupational, physical, and respiratory therapists from two Canadian provinces (Manitoba and Ontario). We asked participants to prepare at least 10 semi-structured audio-diary entries during a 12-week period (April - Oct 2020), followed by two semi-structured interviews (Dec 2020, Apr 2021). Questions focused on changes happening in their practice over time. Analysis was iterative, including developing a individual summaries and coding data using both inductive and pre-determined codes. We then entered an immersion/crystallization process to develop key themes related to role adaptation. RESULTS We represent our findings with the metaphor of the game of Role Adaptation Snakes and Ladders (aka Chutes and Ladders). The pandemic was certainly not a game, but this metaphor represents the tension of being a pawn to circumstance while also being expected to take control of one's professional and personal life during a disaster. The object of the game is to move through three phases of role adaptation, from Disorienting, through Coping and Waiting, to Adapting. In the Adapting phase, the therapists creatively found ways to provide vital services for the pandemic response. The therapists were influenced both negatively and positively (snakes and ladders) by their personal circumstances, and professional meso and macro contexts. Each therapist moved across the board in a unique trajectory and timeline based on these contexts. CONCLUSIONS Rehabilitation professionals, with adequate meso and macro system supports, can maximize their role on primary care teams by adapting their services to work to their full scope of practice.
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Affiliation(s)
- Cara L Brown
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, R125, 771 McDermot Ave, Winnipeg, Manitoba, R3E 0T6, Canada.
| | - Louise Chartrand
- Department of Respiratory Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brontë Vollebregt
- Applied Health Sciences Program, Faculty of Graduate Studies, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dayajyot Kaur
- Rehabilitation Sciences Program, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tory Crawford
- Rehabilitation Sciences Program, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia Thille
- Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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23
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Myklebust-Hansen HJ, Hasvik E, Solyga VM, Ghanima W. The feasibility of self-performing measurements of peripheral oxygen saturation and respiratory exercises in home-isolated COVID-19 patients-a single-arm prospective trial. Pilot Feasibility Stud 2023; 9:195. [PMID: 38042811 PMCID: PMC10693052 DOI: 10.1186/s40814-023-01415-x] [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: 01/23/2023] [Accepted: 10/25/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND COVID-19 is a highly contagious disease where isolation of infected individuals is deemed warranted. If possible, home isolation is preferred over hospitalization. This implies a need for methods of observation that can ensure the safety of these patients. Preventive treatment methods that can both decrease the probability for development of critical disease and hopefully decrease the need for hospitalization would be an added benefit. This was a single-arm prospective pilot study performed to assess the feasibility of performing self-measurements of SpO2 and respiratory exercises in at-home isolated COVID-19 patients. METHOD A total of 40 ambulant SARS-CoV-2-positive individuals in home isolation were followed up for a period of 14 days. At baseline, they were equipped with a pulse oximeter, PEF meter, a project diary to note all measurements, and simple instructions on how to perform respiratory exercises. No other contact was made, but participants were instructed to contact the hospital based on given criteria for blood oxygenation levels and dyspnea severity and to return study equipment and the project diary at the end of study. RESULTS During the follow-up period, 35 participants (87.5%) recorded daily SpO2 measurements, and 12 (30%) adhered to daily respiratory exercises as instructed. Four participants (10%) were admitted to hospital during the follow-up period. Five participants terminated follow-up prematurely. CONCLUSIONS Performing self-measurements of SpO2 during home isolation due to COVID-19 infection is feasible. The feasibility of performing respiratory exercises in ambulant patients is questionable and may require more motivational interventions to increase adherence. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04647747.
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Affiliation(s)
| | - Eivind Hasvik
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway
| | - Volker M Solyga
- Department of Acute Medicine, Østfold Hospital Trust, 1714, Grålum, Norway
| | - Waleed Ghanima
- Department of Acute Medicine, Østfold Hospital Trust, 1714, Grålum, Norway
- Department of Hematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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24
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Warr H, Gandhi A, Hussain S, Greenwood D. Community pharmacy services during the COVID-19 pandemic: Insights from providers and policy makers. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100344. [PMID: 37860224 PMCID: PMC10582732 DOI: 10.1016/j.rcsop.2023.100344] [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] [Received: 09/04/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
Background Readily accessible to the public, community pharmacies (CPs) were placed under increased pressure during the COVID-19 pandemic. In England, dispensing volume increased by 25% between February and March 2020. This followed a decade of stagnant government funding, which has been attributed to CP closures. If another pandemic emerged, the reduced number of CPs may face increased pressures. Objective To explore CP service provision in England throughout the COVID-19 pandemic from the perspectives of providers and policy makers, including what can be learned in preparation for any future pandemic. Methods CP providers (n = 10) and policy makers (n = 6) were interviewed via telephone between June and September 2021. Interviews were transcribed and then analysed thematically using NVivo. Results Pandemic specific pressures were identified, as well as long-term issues which preceded the pandemic. Increased workload was recognised by both providers and policy makers due to changes in prescribing habits and was exacerbated by staff shortages. CP staff safety was a major concern, with limited personal protective equipment provided despite being open to the public. General Practitioner (GP) surgeries received more protective equipment than CP and still referred patients to pharmacy e.g., for a blood pressure check. Conclusions The pandemic re-confirmed CPs role of providing accessible healthcare, particularly medicines provision, but also highlighted the demand for in-person clinical services. Improved communication channels between CP and GP surgeries are required, as is pandemic prescribing guidance to ensure appropriate prescribing to safeguard the medicines supply chain. To ensure the health of all providers is fairly protected, activities which require in-person contact or can be undertaken remotely by CP, GP surgeries and other providers should be reviewed. For pandemic preparation, legislative changes are required which empower pharmacy to fully contribute to patient care. A review of pharmacy funding and staffing is also needed to ensure services are sustainable.
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Affiliation(s)
- Harriet Warr
- School of Medicine, Anglia Ruskin University, Chelmsford, CM1 1SQ, United Kingdom
| | - Ankesh Gandhi
- School of Medicine, Anglia Ruskin University, Chelmsford, CM1 1SQ, United Kingdom
| | - Syed Hussain
- School of Medicine, Anglia Ruskin University, Chelmsford, CM1 1SQ, United Kingdom
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25
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Wieringa S, Neves AL, Rushforth A, Ladds E, Husain L, Finlay T, Pope C, Greenhalgh T. Safety implications of remote assessments for suspected COVID-19: qualitative study in UK primary care. BMJ Qual Saf 2023; 32:732-741. [PMID: 35260414 PMCID: PMC8927927 DOI: 10.1136/bmjqs-2021-013305] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 02/05/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND The introduction of remote triage and assessment early in the pandemic raised questions about patient safety. We sought to capture patients and clinicians' experiences of the management of suspected acute COVID-19 and generate wider lessons to inform safer care. SETTING AND SAMPLE UK primary healthcare. A subset of relevant data was drawn from five linked in-pandemic qualitative studies. The data set, on a total of 87 participants recruited via social media, patient groups and snowballing, comprised free text excerpts from narrative interviews (10 survivors of acute COVID-19), online focus groups (20 patients and 30 clinicians), contributions to a Delphi panel (12 clinicians) and fieldnotes from an online workshop (15 patients, clinicians and stakeholders). METHODS Data were uploaded onto NVivo. Coding was initially deductive and informed by WHO and Institute of Medicine frameworks of quality and safety. Further inductive analysis refined our theorisation using a wider range of theories-including those of risk, resilience, crisis management and social justice. RESULTS In the early weeks of the pandemic, patient safety was compromised by the driving logic of 'stay home' and 'protect the NHS', in which both patients and clinicians were encouraged to act in a way that helped reduce pressure on an overloaded system facing a novel pathogen with insufficient staff, tools, processes and systems. Furthermore, patients and clinicians observed a shift to a more transactional approach characterised by overuse of algorithms and decision support tools, limited empathy and lack of holistic assessment. CONCLUSION Lessons from the pandemic suggest three key strategies are needed to prevent avoidable deaths and inequalities in the next crisis: (1) strengthen system resilience (including improved resourcing and staffing; support of new tools and processes; and recognising primary care's role as the 'risk sink' of the healthcare system); (2) develop evidence-based triage and scoring systems; and (3) address social vulnerability.
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Affiliation(s)
- Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ana Luisa Neves
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Alexander Rushforth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- CWTS, University of Leiden, Leiden, The Netherlands
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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26
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Fox D, Hall M, Thibodeau C, Coldwell K, Lauder L, Dewell S, Davidson S. Impact of the COVID-19 pandemic on Canadian transplant journeys: a mixed methods study. BMJ Open 2023; 13:e068347. [PMID: 38040429 PMCID: PMC10693860 DOI: 10.1136/bmjopen-2022-068347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/20/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Navigating the organ donation and transplantation system in Canada can be challenging for individuals on transplant journeys. Although it is likely that the COVID-19 pandemic has further contributed to these challenges, the experiences of individuals during the pandemic in Canada have not been well elicited. OBJECTIVE To illuminate how the COVID-19 pandemic has impacted individuals on transplant journeys in Canada. DESIGN Convergent parallel mixed-methods study. SETTING Canada. PARTICIPANTS Adult patients, caregivers, and donors on transplant journeys across Canada. DATA COLLECTION Eight focus groups and an online survey between May and November 2021. Focus group transcripts were analysed using an inductive conventional content analysis approach. Survey data were analysed using descriptive statistics. The study was guided by individuals with lived experience of organ donation and transplantation. RESULTS A total of 830 participants completed three COVID-19 related survey questions, with 21 participating in the focus groups. Survey results: over 50% of patients and caregivers reported that the pandemic impacted their access to their healthcare team, their mental health (60% and 65%, respectively) and their comfort going out in public (80% and 75%, respectively). Although many donors reported several factors that impacted their transplant journey, the impact appeared to be greater for patients and caregivers. Qualitative results: three themes emerged from the qualitative data that contextualise participant's experiences: compounding isolation, disruption amid uncertainty and unforeseen benefits. CONCLUSION The COVID-19 pandemic has exacerbated many of the challenges that individuals on transplant journeys experience. It will be critical for transplant programmes to consider these factors in future care provision.
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Affiliation(s)
- Danielle Fox
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Marc Hall
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | | | - Kristi Coldwell
- Transplant Research Foundation of British Columbia, Vancouver, British Columbia, Canada
| | - Lydia Lauder
- Kidney Foundation of Canada, Montreal, Québec, Canada
| | - Sarah Dewell
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Sandra Davidson
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Villalobos-Quesada M, Ho K, Chavannes NH, Talboom-Kamp EPWA. Direct-to-patient digital diagnostics in primary care: Opportunities, challenges, and conditions necessary for responsible digital diagnostics. Eur J Gen Pract 2023; 29:2273615. [PMID: 37947197 PMCID: PMC10653613 DOI: 10.1080/13814788.2023.2273615] [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: 04/04/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Diagnostics are increasingly shifting to patients' home environment, facilitated by new digital technologies. Digital diagnostics (diagnostic services enabled by digital technologies) can be a tool to better respond to the challenges faced by primary care systems while aligning with patients' and healthcare professionals' needs. However, it needs to be clarified how to determine the success of these interventions. OBJECTIVES We aim to provide practical guidance to facilitate the adequate development and implementation of digital diagnostics. STRATEGY Here, we propose the quadruple aim (better patient experiences, health outcomes and professional satisfaction at lower costs) as a framework to determine the contribution of digital diagnostics in primary care. Using this framework, we critically analyse the advantages and challenges of digital diagnostics in primary care using scientific literature and relevant casuistry. RESULTS Two use cases address the development process and implementation in the Netherlands: a patient portal for reporting laboratory results and digital diagnostics as part of hybrid care, respectively. The third use case addresses digital diagnostics for sexually transmitted diseases from an international perspective. CONCLUSIONS We conclude that although evidence is gathering, the often-expected value of digital diagnostics needs adequate scientific evidence. We propose striving for evidence-based 'responsible digital diagnostics' (sustainable, ethically acceptable, and socially desirable digital diagnostics). Finally, we provide a set of conditions necessary to achieve it. The analysis and actionable guidance provided can improve the chance of success of digital diagnostics interventions and overall, the positive impact of this rapidly developing field.
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Affiliation(s)
- María Villalobos-Quesada
- Department of Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kendall Ho
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Cloud Innovation Centre for Community Health and Wellbeing, University of British Columbia, Vancouver, Canada
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands
| | - Esther PWA Talboom-Kamp
- Department of Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands
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28
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Mazouri-Karker S, Lüchinger R, Braillard O, Bajwa N, Achab S, Hudelson P, Dominicé Dao M, Junod Perron N. Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians. JMIR Hum Factors 2023; 10:e50740. [PMID: 37934574 PMCID: PMC10664018 DOI: 10.2196/50740] [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: 07/25/2023] [Accepted: 08/12/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND While the use of telemedicine (TLM) increased worldwide during the early phases of the COVID-19 pandemic, little is known about the use and acceptance of TLM post the COVID-19 pandemic. OBJECTIVE This study aims to evaluate patients' and physicians' self-reported use, preferences, and acceptability of different types of TLM after the initial phases of the COVID-19 pandemic. METHODS We conducted a cross-sectional survey among patients and physicians in Geneva, Switzerland, between September 2021 and January 2022. Patients in waiting rooms of both private and public medical centers and emergency services were invited to answer a web-based questionnaire. Physicians working in private and public settings were invited by email to answer a similar questionnaire. The questionnaires assessed participants' sociodemographics and digital literacy; self-reported use of TLM; as well as preferences and acceptability of TLM for different clinical situations. RESULTS A total of 567 patients (309/567, 55% women) and 448 physicians (230/448, 51% women and 225/448, 50% in private practice) responded to the questionnaire. Patients (263/567, 46.5%) and physicians (247/448, 55.2%) generally preferred the phone over other TLM formats and considered it to be acceptable for most medical situations. Email (417/567, 73.6% and 308/448, 68.8%) was acceptable for communicating exam results, and medical certificates (327/567, 67.7% and 297/448, 66.2%) and video (302/567, 53.2% and 288/448, 64.3%) was considered acceptable for psychological support by patients and physicians, respectively. Older age was associated with lower acceptability of video for both patients and physicians (odds ratio [OR] 0.03, 95% CI 0.00-0.33 and OR 0.23, 95% CI 0.08-0.66) while previous use of video was positively associated with video acceptability (OR 3.16, 95% CI 1.84-5.43 and OR 3.34, 95% CI 2.91-5.54). Psychiatrists and hospital physicians were more likely to consider video to be acceptable (OR 10.79, 95% CI 3.96-29.30 and OR 3.97, 95% CI 2.23-7.60). CONCLUSIONS Despite the development of video, the acceptability of video remains lower than that of the phone for most health issues or patient requests. There is a need to better define for which patients and in which medical situations video can become safe and efficient.
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Affiliation(s)
- Sanae Mazouri-Karker
- E-health and Telemedicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Lüchinger
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivia Braillard
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Bajwa
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of General Pediatrics at the Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Sophia Achab
- Treatment Centre ReConnecte, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Clinical and Sociological Research Unit, WHO Collaborating Centre for Training and Research in Mental Health, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Melissa Dominicé Dao
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Noelle Junod Perron
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Medical Directory, Geneva University Hospitals, Geneva, Switzerland
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29
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Stummer FO, Voggenberger L, Gomez Pellin MDLC, van Poel E, Willems S, Hoffmann K. Insights into the use of telemedicine in primary care in times of the SARS-CoV-2 pandemic - a cross-sectional analysis based on the international PRICOV-19 study in Austria. BMC PRIMARY CARE 2023; 24:218. [PMID: 37875808 PMCID: PMC10598885 DOI: 10.1186/s12875-023-02113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/18/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The SARS-CoV2 pandemic as well as the implementation of public health measures to decrease the spread of the virus re-sparked the call for "virtual" health or "distance" treatments. This paper aimed to assess the use of video consultations, the up-to-dateness of practice websites, and the views of GPs on whether eHealth is a positive aspect for the future of their practices in publicly -funded primary healthcare facilities in Austria. METHODS The cross-sectional online questionnaire, part of the PRICOV-19 study, was conducted from December 2020 until July 2021. We randomly recruited 176 GP practices across Austria. Descriptive statistics as well as binary logistic regression models were applied to examine the associations between telemedicine use and practice factors. RESULTS Compared with before the pandemic (3.8%), 7.6% of publicly funded GP practices have been using video consultations since the pandemic. In line with this, 93.9% of the practices had no increase in video consultation use. Fewer than half (44.3%) had an up-to-date webpage, and 27.8% assumed that the pandemic might have been a positive driver for eHealth in their practices. Positive associations with video consultation use could be found in practices with fewer patients aged 70 years and over than the average and more patients with chronic diseases than the average. CONCLUSION The use of video consultations in general practice and the readiness for other telemedicine approaches are both very low in Austria. Austria has to urgently follow the example of countries with a transparent and comprehensive national digital health strategy that includes video consultation. Without a proper payment system, patient inclusion, and support with regard to administrative and organizational aspects, no substantial change will occur in spite of an increase in need due to the pandemic and changes in the patient population.
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Affiliation(s)
- Florian Odilo Stummer
- Department of Primary Care Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Lisa Voggenberger
- Institute for General Medicine, Johannes-Kepler-University, Linz, Austria
| | | | - Esther van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kathryn Hoffmann
- Department of Primary Care Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
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30
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Eriksen S, Dahler AM, Øye C. The informal way to success or failure? Findings from a comparative case study on video consultation training and implementation in two Danish hospitals. BMC Health Serv Res 2023; 23:1135. [PMID: 37865741 PMCID: PMC10590501 DOI: 10.1186/s12913-023-10163-w] [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: 11/01/2022] [Accepted: 10/12/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND This study evaluated an attempt to implement video consultations through a novel education intervention in telehealth training and implementation in two middle-sized hospitals in Denmark. Three units tested the education intervention along with a regional decision to strengthen multidisciplinary and cross-sectoral collaboration through technology to improve service delivery by making the process more coherent and saving time and resources. This study aims to identify what contextual factors enable workplace learning, skills acquisition, and utilization of new digital skills to use and routinize video consultations in workplace practice. METHODS This qualitative case study draws on the principles of the realist evaluation framework using cross-case comparisons to test and refine program theories by exploring the complex and dynamic interaction among context, mechanism, and outcome. The methods in this study include participant observations, document analysis, semi-structured individual interviews, and focus groups. We performed an interpretive cross-case analysis, which explored the context-mechanism-outcome relationship using the guiding question, "What works, for whom, under what circumstances, and why?". RESULTS Two broad mechanisms appeared to enable skills acquisition and routinization of video consultations: informal workplace learning and adjusting video consultations to professional judgment. The three units had different approaches to the implementation and training and, as such, had different outcomes. First, the skills acquired in the units differed; therefore, how and with whom they used video consultations varied. Second, video consultation use was more likely to be adjusted to workflows if unit managers were responsive to staff's professional judgments regarding patients, as was evident in all three units. CONCLUSION Our study shows that a formal training course alone is insufficient to provide healthcare professionals with the skills needed to use video consultations in workplace practice. Informal workplace learning with support on the spot and continuous follow-up seems to equip healthcare professionals with the skills to use video consultations. Video consultations are more likely to be used confidently if novel workflows are adjusted to health care professionals' knowledge, skills, and judgment and their concerns regarding patient soundness.
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Affiliation(s)
- Susanne Eriksen
- Faculty of Health and Social Science, Western Norway University of Applied Sciences, Bjørnsonsgate 45, 5528, Haugesund, Norway.
| | - Anne Marie Dahler
- Centre for Applied Welfare Research, UCL University College, Niels Bohrs Allé 1, 5230, Odense M, Denmark
| | - Christine Øye
- Faculty of Health and Social Science, Western Norway University of Applied Sciences, Klingenbergvegen 4, 5414, Stord, Norway
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Hägglund M, Ekwall AK, Davoody N, Farrokhnia N. Escape to the future - a qualitative study of physicians' views on the work environment, education, and support in a digital context. BMC Med Inform Decis Mak 2023; 23:231. [PMID: 37858147 PMCID: PMC10588019 DOI: 10.1186/s12911-023-02337-7] [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: 05/18/2021] [Accepted: 10/11/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The use of remote services such as video consultations (VCs) has increased significantly in the wake of the COVID-19 pandemic. In Sweden, private healthcare providers offering VCs have grown substantially since 2016 and have been controversial. Few studies have focused on physicians' experiences providing care in this context. Our aim was to study physicians' experiences of VCs, focusing on the work environment, quality of care, and educational needs. METHODS Twenty-two semi-structured interviews were performed with physicians working with VCs in Sweden, and analyzed through inductive content analysis. RESULTS We identified five categories; flexibility, social work environment, impact on care and society, continuous learning and career development, and organizational support. Flexibility and accessibility were considered positive features of working digitally by giving physicians control over their time and workplace and increasing patients' timely access to healthcare. Regarding collegial contact and social activities in a digital context, the majority of the participants did not experience any significant difference compared to the physical context. Access to technical support services, educational support, and collegial support in decision-making, guidance, and consultations were described as well-functioning. Satisfied patients positively impacted the work environment, and participants felt that VCs have a positive socio-economic effect. Continuity of care was considered supported, but patients did not always prioritize this. Privacy risks were considered a challenge, as were poor development of clinical skills due to the low variation of patient cases. Working for an online healthcare provider was contributing to career advancements for junior clinicians. CONCLUSIONS Physicians appreciate the flexibility of the digital context and seem satisfied with a work environment where they have a high level of control, but few consider this a full-time career option. The pandemic year 2020 has led to a significant increase in the implementation of VCs in traditional care systems. How this affects the work environment and continuous education needs and career development remains to be seen.
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Affiliation(s)
- Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 752 37, Sweden.
- Uppsala University Hospital, Uppsala, Sweden.
- Health Informatics Center, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden.
| | | | - Nadia Davoody
- Health Informatics Center, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Nasim Farrokhnia
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Antonacci G, Benevento E, Bonavitacola S, Cannavacciuolo L, Foglia E, Fusi G, Garagiola E, Ponsiglione C, Stefanini A. Healthcare professional and manager perceptions on drivers, benefits, and challenges of telemedicine: results from a cross-sectional survey in the Italian NHS. BMC Health Serv Res 2023; 23:1115. [PMID: 37853448 PMCID: PMC10585875 DOI: 10.1186/s12913-023-10100-x] [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: 11/29/2022] [Accepted: 10/01/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service. METHODS An online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis. RESULTS Key factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations' semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can't completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers. CONCLUSIONS Respondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK.
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK.
| | - Elisabetta Benevento
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Pisa, Italy
| | | | | | - Emanuela Foglia
- Healthcare Datascience LAB, LIUC- Carlo Cattaneo University, Castellanza, VA, Italy
| | - Giulia Fusi
- LIUC- Cattaneo University, Castellanza, VA, Italy
| | - Elisabetta Garagiola
- Healthcare Datascience LAB, LIUC- Carlo Cattaneo University, Castellanza, VA, Italy
| | - Cristina Ponsiglione
- Department of Industrial Engineering, University of Naples Federico II, Naples, Italy
| | - Alessandro Stefanini
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Pisa, Italy
- School of Economics and Business, Kaunas University of Technology, Kaunas, Lithuania
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Hohenschurz-Schmidt D, Scott W, Park C, Christopoulos G, Vogel S, Draper-Rodi J. [Remote management of musculoskeletal pain : A pragmatic approach to the implementation of video and phone consultations in musculoskeletal practice. German version]. Schmerz 2023; 37:360-371. [PMID: 35834004 PMCID: PMC9281242 DOI: 10.1007/s00482-022-00659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Remote consultations through phone or video are gaining in importance for the treatment of musculoskeletal pain across a range of health care providers. However, there is a plethora of technical options for practitioners to choose from, and there are various challenges in the adaptation of clinical processes as well as several special considerations regarding regulatory context and patient management. Practitioners are faced with a lack of high-quality peer-reviewed resources to guide the planning and practical implementation of remote consultations. OBJECTIVES This Clinical Update seeks to provide practical guidance for the planning and implementation of remote consultations for the management and treatment of people with musculoskeletal pain. METHODS Recommendations are based on a brief overview of the relevant research regarding phone and video consultations for musculoskeletal practice and derived from the literature, relevant guidelines, and practical experience. RESULTS The technical feasibility of remote consultations for musculoskeletal complaints is good, patient satisfaction is high, and a growing body of evidence supports its comparative effectiveness to in-person consultations in some circumstances for improving pain and functioning. We consider in detail practical aspects such as the choosing of hardware and software, we touch on the legal and regulatory context, and we focus on the adaptation of clinical processes and communication. CONCLUSION This Clinical Update draws together best-practice evidence in a practically applicable format, enabling therapists who are working with people with pain to directly apply this knowledge to their individual clinical settings and the requirements of their patients.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Department, Surgery and Cancer, Pain Research Group, Faculty of Medicine, Chelsea and Westminster Hospital Campus, Imperial College London, 4th Floor, 369 Fulham Road, SW10 9NH, London, Großbritannien.
| | - Whitney Scott
- Psychology Department, Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, Großbritannien
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, Großbritannien
| | - Charlie Park
- IPRS Triage and Remote Management Team, IPRS Health Limited, Little Blakenham, Suffolk, Großbritannien
| | - Georgios Christopoulos
- First Contact Practitioner, MSc Neuromusculoskeletal Care, BSc (Hons) Physiotherapy, HCPC CSP, Staffordshire, Großbritannien
| | - Steven Vogel
- Research Centre, University College of Osteopathy, London, Großbritannien
| | - Jerry Draper-Rodi
- Research Centre, University College of Osteopathy, London, Großbritannien
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Boldea GJ, Caragea DC, Nicolcescu P, Pădureanu V, Rădulescu D, Boldea AM, Georgescu I, Georgescu EF. Effect of the COVID‑19 pandemic on the management and outcomes of patients with traumatic injuries (Review). Biomed Rep 2023; 19:76. [PMID: 37746590 PMCID: PMC10511947 DOI: 10.3892/br.2023.1658] [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: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 09/26/2023] Open
Abstract
During the COVID-19 pandemic, ~10% of the global population was officially affected, resulting in diverse changes, ranging from shopping habits to stringent hospital protocols. This article sought to provide a concise summary of relevant data concerning the interplay between COVID-19 and trauma, encompassing the entire trajectory from presentation to hospital discharge. Throughout the pandemic, there was a noticeable reduction in trauma presentations, while the ranking of injury mechanisms remained largely unchanged. To ensure essential surgical support, protocols were adjusted accordingly. Although there were some less significant changes in injury severity score, hospital length of stay, intensive care unit stay and mortality, the overall patient outcomes appeared to improve. In conclusion, the COVID-19 pandemic led to a decline in trauma cases and an enhancement in patient outcomes. However, regrettably, certain mechanisms of injury saw an increase in frequency. To cope with the epidemiological context, management strategies were adapted, and unutilized resources were redirected to cater to the care of COVID-19 patients.
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Affiliation(s)
- Gheorghe-Jean Boldea
- UMF Craiova Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Daniel Cosmin Caragea
- Department of Nephrology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Pantelie Nicolcescu
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Pharmacy, Sibiu 550169, Romania
| | - Vlad Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Dumitru Rădulescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Ana Maria Boldea
- UMF Craiova Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Ion Georgescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Eugen Florin Georgescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
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Grīnfelde M. Body objectified? Phenomenological perspective on patient objectification in teleconsultation. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:335-349. [PMID: 37031309 PMCID: PMC10085784 DOI: 10.1007/s11019-023-10148-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 06/19/2023]
Abstract
The global crisis of COVID-19 pandemic has considerably accelerated the use of teleconsultation (consultation between the patient and the doctor via video platforms). While it has some obvious benefits and drawbacks for both the patient and the doctor, it is important to consider-how teleconsultation impacts the quality of the patient-doctor relationship? I will approach this question through the lens of phenomenology of the body, focusing on the question-what happens to the patient objectification in teleconsultation? To answer this question I will adopt a phenomenological approach combining both insights drawn from the phenomenological tradition, i.e., the concepts of the lived body and the object body, and the results from the phenomenologically informed qualitative research study on the patient experience of teleconsultation. The theoretical background against which I have developed this study comprises discussions within the field of phenomenology of medicine regarding the different sources of patient objectification within clinical encounter and the arguments concerning the negative impact that objectification has on the quality of care. I will argue that a factor that has frequently been identified within phenomenology of medicine as the main source of patient objectification in clinical encounters, namely, the internalized gaze of the clinician, is diminished during teleconsultation, increasing patient's sense of agency, decreasing her sense of alienation and opening up the possibility for a closer relationship between the patient and the health care provider, all of which lead to the transformation of the hierarchical patient-health care professional relationship.
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Affiliation(s)
- Māra Grīnfelde
- University of Latvia Institute of Philosophy and Sociology, University of Latvia, Kalpaka boulevard 4 - 322, Riga, 1050, Latvia.
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DeBolt CL, Rheuban KS, Harris D. Telehealth Services: Improving Equity in Pulmonary Health Outcomes. Clin Chest Med 2023; 44:651-660. [PMID: 37517842 DOI: 10.1016/j.ccm.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Expansion of telehealth services has the potential to attenuate health inequities in pulmonary medicine, by improving access to care and health outcomes in patients with lung disease. These telehealth services include remote patient monitoring, synchronous telemedicine, and remote pulmonary rehabilitation. Currently, patients who are White, well-educated, wealthy, and from urban areas are the most likely to benefit from telehealth services. Without clear policy decisions and planning to overcome the "Digital Divide," telehealth services will only exacerbate existing disparities within the pulmonary disease. We describe the benefits and limitations of these new technologies and their impact on improving equity in pulmonary medicine.
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Affiliation(s)
| | - Karen S Rheuban
- Department of Pediatrics, University of Virginia, Center for Telehealth, Charlottesville, VA, USA
| | - Drew Harris
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
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Cook R, Haydon HM, Thomas EE, Ward EC, Ross JA, Webb C, Harris M, Hartley C, Burns CL, Vivanti AP, Carswell P, Caffery LJ. Digital divide or digital exclusion? Do allied health professionals' assumptions drive use of telehealth? J Telemed Telecare 2023:1357633X231189846. [PMID: 37543369 DOI: 10.1177/1357633x231189846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Telehealth use within allied health services currently lacks structure and consistency, ultimately affecting who can, and cannot, access services. This study aimed to investigate the factors influencing allied health professionals' (AHP) selection of consumers and appointments for telehealth. METHODS This study was conducted across 16 allied health departments from four Australian hospitals. Semi-structured focus groups were conducted with 58 AHPs. Analysis was underpinned by Qualitative Description methodology with inductive coding guided by Braun and Clarke's thematic analysis approach. RESULTS Six themes were identified that influenced AHPs' evaluation of telehealth suitability and selection of consumers. These included the following: (1) ease, efficiency and comfort of telehealth for clinicians; (2) clear benefits of telehealth for the consumer, yet the consumers were not always given the choice; (3) consumers' technology access and ability; (4) establishing and maintaining effective therapeutic relationships via telehealth; (5) delivering clinically appropriate and effective care via telehealth; and (6) external influences on telehealth service provision. A further theme of 'assumption versus reality' was noted to pervade all six themes. DISCUSSION Clinicians remain the key decision makers for whether telehealth is offered within allied health services. Ease and efficiency of use is a major driver in AHP's willingness to use telehealth. Assumptions and pre-conceived frames-of-reference often underpin decisions to not offer telehealth and present major barriers to telehealth adoption. The development of evidence-based, decision-support frameworks that engage the consumer and clinician in determining when telehealth is used is required. Services need to actively pursue joint decision-making between the clinician and consumer about service delivery preferences.
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Affiliation(s)
- Renee Cook
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Health, Brisbane, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research (CFAHR), Metro South Health, Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Julie-Anne Ross
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Clare Webb
- Allied Health, Queen Elizabeth II Jubilee Hospital, Metro South Health, Brisbane, Australia
| | - Michael Harris
- Allied Health, Bayside Health Service, Metro South Health, Brisbane, Australia
| | - Carina Hartley
- Allied Health, Logan Hospital, Metro South Health, Brisbane, Australia
| | - Clare L Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology Department, Royal Brisbane & Women's Hospital, Metro North Health, Brisbane, Australia
| | - Angela P Vivanti
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- School of Human Movement and Nutrition Studies, The University of Queensland, Brisbane, Australia
| | - Phillip Carswell
- Consumer Advisor, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Ma M, Li Y, Gao L, Xie Y, Zhang Y, Wang Y, Zhao L, Liu X, Jiang D, Fan C, Wang Y, Demuyakor I, Jiao M, Li Y. The need for digital health education among next-generation health workers in China: a cross-sectional survey on digital health education. BMC MEDICAL EDUCATION 2023; 23:541. [PMID: 37525126 PMCID: PMC10388510 DOI: 10.1186/s12909-023-04407-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/26/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Digital health is important for sustainable health systems and universal health coverage. Since the outbreak of COVID-19, many countries, including China, have promoted the introduction of digital health in their medical services. Developing the next generation of physicians with digital health knowledge and skills is a prerequisite for maximizing the potential of digital health. OBJECTIVE We aimed to understand the perception of digital health among Chinese medical students, the current implementation of digital health education in China, and the urgent need of medical students. METHODS Our cross-sectional survey was conducted online and anonymously among current medical students in China. We used descriptive statistical analysis to examine participant demographic characteristics and the demand for digital health education. Additional analysis was conducted by grouping responses by current participation in a digital health course. RESULTS A total of 2122 valid responses were received from 467 medical schools. Most medical students had positive expectations that digital health will change the future of medicine. Compared with wearable devices (85.53%), telemedicine (84.16%), and medical big data (86.38%), fewer respondents believed in the benefits of clinical decision support systems (CDSS) (63.81%). Most respondents said they urgently needed digital health knowledge and skills, and the teaching method of practical training and internship (78.02%) was more popular than the traditional lecture (10.54%). However, only 41.45% wanted to learn about the ethical and legal issues surrounding digital health. CONCLUSIONS Our study shows that the current needs of Chinese medical students for digital health education remain unmet. A national initiative on digital health education, is necessary and attention should be paid to digital health equity and education globally, focusing on CDSS and artificial intelligence. Ethics knowledge must also be included in medical curriculum. Students as Partners (SAP) is a promising approach for designing digital health courses.
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Affiliation(s)
- Mingxue Ma
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yuanheng Li
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Lei Gao
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yuzhuo Xie
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yuwei Zhang
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yazhou Wang
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Lu Zhao
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Xinyan Liu
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Deyou Jiang
- Heilongjiang University of Traditional Chinese Medicine, 24 Heping Road, Xiangfang District, Harbin, 150006, Heilongjiang, China
| | - Chao Fan
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yushu Wang
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Isaac Demuyakor
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Mingli Jiao
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
| | - Ye Li
- Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
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Smits M, van Dalen D, Popping D, Bleeker R, Stommel MWJ, van Goor H. Designing a video consultation area for hybrid care delivery: the Garden Room with a view. Front Digit Health 2023; 5:1198565. [PMID: 37564883 PMCID: PMC10411545 DOI: 10.3389/fdgth.2023.1198565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Accelerated by the coronavirus pandemic, the healthcare landscape is rapidly evolving, with a shift towards hybrid care models combining in-person and online care. To support this shift, the Radboudumc, an academic hospital in the Netherlands, decided to redesign an existing space facilitating the conduction of video consultations. Method The design process involved participation of end-users to ensure that the physical space met their needs. The look and feel of the area was based on evidence-based design guidelines. Two prototype setups were built and tested, and the feedback informed the final design of the Garden Room. Results Identified end-user needs were divided into 3 major categories entailing consultation room setup, optimal use of technology and practical issues involving room availability. Combined with the look and feel of the hospital, final design requirements were developed. The Garden Room consists of 18 video consultation rooms, 4 shared workspaces, relaxation area with kitchen, and meeting rooms. Specific attention is given to the ergonomics, technology and privacy in the rooms to facilitate optimal video conversations between patients and healthcare providers. In the Garden Room, natural elements and an open design supports working in a healing environment. Discussion Next challenge will be optimizing the use of the Garden Room, which may be hindered by various barriers like resistance to change, existing work processes, and lack of skills training. To address these barriers and support use of the Garden Room, the hospital should focus on the implementation of education, changes in work processes, and the presence of advocates for telehealth.
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Affiliation(s)
| | - Demi van Dalen
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Danny Popping
- Radboud University Medical Center, Nijmegen, Netherlands
| | - René Bleeker
- Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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Woods L, Dendere R, Eden R, Grantham B, Krivit J, Pearce A, McNeil K, Green D, Sullivan C. Perceived Impact of Digital Health Maturity on Patient Experience, Population Health, Health Care Costs, and Provider Experience: Mixed Methods Case Study. J Med Internet Res 2023; 25:e45868. [PMID: 37463008 PMCID: PMC10394505 DOI: 10.2196/45868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/05/2023] [Accepted: 05/26/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Health care organizations understand the importance of new technology implementations; however, the best strategy for implementing successful digital transformations is often unclear. Digital health maturity assessments allow providers to understand the progress made toward technology-enhanced health service delivery. Existing models have been criticized for their lack of depth and breadth because of their technology focus and neglect of meaningful outcomes. OBJECTIVE We aimed to examine the perceived impacts of digital health reported by health care staff employed in health care organizations across a spectrum of digital health maturity. METHODS A mixed methods case study was conducted. The digital health maturity of public health care systems (n=16) in Queensland, Australia, was examined using the quantitative Digital Health Indicator (DHI) self-assessment survey. The lower and upper quartiles of DHI scores were calculated and used to stratify sites into 3 groups. Using qualitative methods, health care staff (n=154) participated in interviews and focus groups. Transcripts were analyzed assisted by automated text-mining software. Impacts were grouped according to the digital maturity of the health care worker's facility and mapped to the quadruple aims of health care: improved patient experience, improved population health, reduced health care cost, and enhanced provider experience. RESULTS DHI scores ranged between 78 and 193 for the 16 health care systems. Health care systems in the high-maturity category (n=4, 25%) had a DHI score of ≥166.75 (the upper quartile); low-maturity sites (n=4, 25%) had a DHI score of ≤116.75 (the lower quartile); and intermediate-maturity sites (n=8, 50%) had a DHI score ranging from 116.75 to 166.75 (IQR). Overall, 18 perceived impacts were identified. Generally, a greater number of positive impacts were reported in health care systems of higher digital health maturity. For patient experiences, higher maturity was associated with maintaining a patient health record and tracking patient experience data, while telehealth enabled access and flexibility across all digital health maturity categories. For population health, patient journey tracking and clinical risk mitigation were reported as positive impacts at higher-maturity sites, and telehealth enabled health care access and efficiencies across all maturity categories. Limited interoperability and organizational factors (eg, strategy, policy, and vision) were universally negative impacts affecting health service delivery. For health care costs, the resource burden of ongoing investments in digital health and a sustainable skilled workforce was reported. For provider experiences, the negative impacts of poor usability and change fatigue were universal, while network and infrastructure issues were negative impacts at low-maturity sites. CONCLUSIONS This is one of the first studies to show differences in the perceived impacts of digital maturity of health care systems at scale. Higher digital health maturity was associated with more positive reported impacts, most notably in achieving outcomes for the population health aim.
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Affiliation(s)
- Leanna Woods
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
- Digital Health Cooperative Research Centre, Sydney, Australia
| | - Ronald Dendere
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Rebekah Eden
- UQ Business School, The University of Queensland, Brisbane, Australia
| | - Brittany Grantham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Jenna Krivit
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Andrew Pearce
- Healthcare Information and Management Systems Society, Singapore, Singapore
| | - Keith McNeil
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
| | | | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
- Metro North Hospital and Health Service, Brisbane, Australia
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Palmar-Santos AM, Pedraz Marcos A, Rubio-Casado LA, Pulido-Fuentes M, García-Perea ME, Navarta-Sanchez MV. Resilience among primary care professionals in a time of pandemic: a qualitative study in the Spanish context. BMJ Open 2023; 13:e069606. [PMID: 37399436 DOI: 10.1136/bmjopen-2022-069606] [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] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES This study explores the impact of the COVID-19 pandemic on the Spanish primary care structure and services and the mechanisms implemented by the primary care workforce to restore and reinforce their reference care model. DESIGN An exploratory, qualitative study with semistructured interviews and a focus group discussion conducted during the fall semester of 2020. SETTING Primary health centres in Madrid (Spain), chosen based on factors such as infection rates during the earliest stages of the pandemic and demographic and socioeconomic aspects. PARTICIPANTS A total of 19 primary health and social care professionals were purposively selected. Criteria for inclusion were gender (male/female), at least 5 years of experience in their current position, category (health/social/administrative worker), and whether they worked in a rural or urban healthcare setting. RESULTS Two main themes were identified: (1) reflecting on a model in crisis-particularly the reopening of centres to users and the proactive, participative strategies implemented by primary care professionals to reach their community; and (2) regaining a sense of purpose-how healthcare professionals implemented strategies to sustain their vision of their reference model. The COVID-19 pandemic exposed leadership deficiencies that, together with the initial unavailability of resources and difficulties maintaining face-to-face contact with users, triggered a sense of loss of professional identity. On the other hand, the analysis revealed potential strategies to restore and reinforce the traditional model, such as the adoption of digital technologies and reliance on community networks. CONCLUSION This study highlights the importance of a solid reference framework and enhances the strengths and skills of the workforce to reinforce the community-based service provision model.
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Affiliation(s)
- Ana María Palmar-Santos
- Deparment of Nursing, Autonomous University of Madrid, Madrid, Spain
- Nursing and Health Care Research Group, Puerta de Hierro-Segovia Arana Health Research Institute, Madrid, Spain
| | | | | | | | | | - Maria Victoria Navarta-Sanchez
- Deparment of Nursing, Autonomous University of Madrid, Madrid, Spain
- Nursing and Health Care Research Group, Puerta de Hierro-Segovia Arana Health Research Institute, Madrid, Spain
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Sidhu M, Walton H, Crellin N, Ellins J, Herlitz L, Litchfield I, Massou E, Tomini SM, Vindrola-Padros C, Fulop NJ. Staff experiences of training and delivery of remote home monitoring services for patients diagnosed with COVID-19 in England: A mixed-methods study. J Health Serv Res Policy 2023:13558196231172586. [PMID: 37366220 PMCID: PMC10300624 DOI: 10.1177/13558196231172586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Remote home monitoring services for patients at risk of rapid deterioration introduced during the COVID-19 pandemic had important implications for the health workforce. This study explored the nature of 'work' that health care staff in England undertook to manage patients with COVID-19 remotely, how they were supported to deliver these new services, and the factors that influenced delivery of COVID-19 remote home monitoring services for staff. METHODS We conducted a rapid mixed-methods evaluation of COVID-19 remote home monitoring services during November 2020 to July 2021 using a cross-sectional survey of a purposive sample of staff involved in delivering the service (clinical leads, frontline delivery staff and those involved in data collection and management) from 28 sites across England. We also conducted interviews with 58 staff in a subsample of 17 sites. Data collection and analysis were carried out in parallel. We used thematic analysis to analyse qualitative data while quantitative survey data were analysed using descriptive statistics. RESULTS A total of 292 staff responded to the surveys (39% response rate). We found that prior experience of remote monitoring had some, albeit limited benefit for delivering similar services for patients diagnosed with COVID-19. Staff received a range of locally specific training and clinical oversight along with bespoke materials and resources. Staff reported feeling uncertain about using their own judgement and being reliant on seeking clinical oversight. The experience of transitioning from face-to-face to remote service delivery led some frontline delivery staff to reconsider their professional role, as well as their beliefs around their own capabilities. There was a general perception of staff being able to adapt, acquire new skills and knowledge and they demonstrated a commitment to continuity of care for patients, although there were reports of struggling with the increased accountability and responsibility attached to their adapted roles at times. CONCLUSIONS Remote home monitoring models can play an important role in managing a large number of patients for COVID-19 and possibly a range of other conditions. Successful delivery of such service models depends on staff competency and the nature of training received to facilitate effective care and patient engagement.
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Affiliation(s)
- Manbinder Sidhu
- Associate Professor, Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Holly Walton
- Research Fellow, Department of Applied Health Research, University College London, UK
| | | | - Jo Ellins
- Senior Fellow, Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Lauren Herlitz
- Research Fellow, Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London, UK
| | - Ian Litchfield
- Senior Research Fellow, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Efthalia Massou
- Research Associate, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Sonila M Tomini
- Assistant Professor, Global Business School for Health, University College London, UK
| | - Cecilia Vindrola-Padros
- Professorial Research Fellow, Department of Targeted Intervention, University College London, UK
| | - Naomi J Fulop
- Professor of Health Care Organisation and Management, Department of Applied Health Research, University College London, UK
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Sadek O, Baldwin F, Gray R, Khayyat N, Fotis T. Impact of Virtual and Augmented Reality on Quality of Medical Education During the COVID-19 Pandemic: A Systematic Review. J Grad Med Educ 2023; 15:328-338. [PMID: 37363680 PMCID: PMC10286921 DOI: 10.4300/jgme-d-22-00594.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/20/2022] [Accepted: 03/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background The COVID-19 pandemic and the subsequent mandatory social distancing led to widespread disruption of medical education. This contributed to the accelerated introduction of virtual reality (VR) and augmented reality (AR) technology in medical education. Objective The objective of this quantitative narrative synthesis review is to summarize the recent quantitative evidence on the impact of VR and AR on medical education. Methods A literature search for articles published between March 11, 2020 and January 31, 2022 was conducted using the following electronic databases: Embase, PubMed, MEDLINE, CINAHL, PsycINFO, AMED, EMCARE, BNI, and HMIC. Data on trainee confidence, skill transfer, information retention, and overall experience were extracted. Results The literature search generated 448 results, of which 13 met the eligibility criteria. The studies reported positive outcomes in trainee confidence and self-reported knowledge enhancement. Additionally, studies identified significant improvement in the time required to complete surgical procedures in those trained on VR (mean procedure time 97.62±35.59) compared to traditional methods (mean procedure time 121.34±12.17). However, participants also reported technical and physical challenges with the equipment (26%, 23 of 87). Conclusions Based on the studies reviewed, immersive technologies offer the greatest benefit in surgical skills teaching and as a replacement for lecture- and online-based learning. The review identified gaps that could be areas for future research.
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Affiliation(s)
- Omar Sadek
- All authors are with Brighton and Sussex Medical School, Brighton, England
- Omar Sadek, A Levels, is a Medical Student
| | - Fiona Baldwin
- All authors are with Brighton and Sussex Medical School, Brighton, England
- Fiona Baldwin, MBBS, is a Consultant, Intensive Care Medicine
| | - Rebecca Gray
- All authors are with Brighton and Sussex Medical School, Brighton, England
- Rebecca Gray, MBBS, is a Consultant, Intensive Care Medicine
| | - Nadine Khayyat
- All authors are with Brighton and Sussex Medical School, Brighton, England
- Nadine Khayyat, A Levels, is a Medical Student
| | - Theofanis Fotis
- All authors are with Brighton and Sussex Medical School, Brighton, England
- Theofanis Fotis, PhD, is Principal Lecturer, Associate Director (Outreach) Research Centre for Secure Intelligent & Usable Systems, and Academic Lead, Brighton and Hove Digital Health Living Lab, School of Health Science
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Paruzel-Czachura M, Wojciechowska D, Bostyn D. Online Moral Conformity: how powerful is a Group of Strangers when influencing an Individual's Moral Judgments during a video meeting? CURRENT PSYCHOLOGY 2023; 43:1-11. [PMID: 37359603 PMCID: PMC10233534 DOI: 10.1007/s12144-023-04765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 06/28/2023]
Abstract
People make moral decisions every day. When making such decisions, they may be influenced by their companions (a so-called moral conformity effect). Increasingly, people make decisions in online environments, like video meetings. In the current preregistered experiment, we studied the moral conformity effect in an online context. We applied an Asch conformity paradigm by asking participants (N = 120) to reply to sacrificial moral dilemmas through the online video communication tool Zoom either when sitting in a "virtual" room with strangers (confederates instructed on how to answer; experimental condition) or when sitting alone (control condition). We found that people displayed a moral conformity effect on half the dilemmas included in our study as well as in the aggregate. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-023-04765-0.
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Affiliation(s)
- Mariola Paruzel-Czachura
- Institute of Psychology, University of Silesia in Katowice, Grazynskiego 53, Katowice, 40-126 Poland
- Penn Center for Neuroaesthetics, Goddard Laboratories, 3710 Hamilton Walk, Philadelphia, PA 1910 USA
| | - Dominika Wojciechowska
- Fylde and Wyre CAMHS (Child and Adolescents Mental Health Services), NHS Lancashire and South Cumbria Foundation Trust, Preston, UK
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Choi DT, Sada YH, Sansgiry S, Kaplan DE, Taddei TH, Aguilar JK, Strayhorn M, Hernaez R, Davila JA. Using Telemedicine to Facilitate Patient Communication and Treatment Decision-Making Following Multidisciplinary Tumor Board Review for Patients with Hepatocellular Carcinoma. J Gastrointest Cancer 2023; 54:623-631. [PMID: 35773376 PMCID: PMC9247952 DOI: 10.1007/s12029-022-00844-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS A rapid increase in the use of telemedicine for delivering healthcare has occurred since the onset of the Covid-19 pandemic. There is evidence for using telemedicine to facilitate cancer care delivery for patients with hepatocellular carcinoma (HCC). Examining how telemedicine can be used to communicate multidisciplinary tumor board (MTB) recommendations for HCC has not been studied. This study has two specific aims: (1) to evaluate the patient perspective of the MTB review process and identify best strategies for communicating treatment recommendations for HCC and (2) to pilot test a telemedicine intervention following MTB review to assess patient feasibility and satisfaction with using telemedicine to facilitate treatment decision-making and treatment referral. METHODS We conducted a mixed-methods study. First, semi-structured qualitative interviews were conducted among patients diagnosed with HCC who were discussed in MTB review at one of three VA Medical Centers (VAMC). We collected information about the MTB process from the patient perspective and identified strategies for improving communication and delivery of care. Rapid qualitative analysis was used to inform intervention development. Using our qualitative data, a MTB telemedicine pilot intervention was developed and implemented to assess the feasibility of using this approach for patients with HCC. RESULTS Almost all patients (94%) in the pilot study would recommend telemedicine to other patients with HCC, and half of the patients (50%) preferred telemedicine over in-person visits. Many patients (81%) found communication through telemedicine an acceptable platform to deliver difficult cancer information. Overall, patients felt they understood their treatment recommendations and found them clear and useful. Further, patients reported that they enjoyed being included in the decision-making process and appreciated being able to have family members easily join them for the telemedicine visit. CONCLUSIONS Using telemedicine to communicate treatment recommendations following MTB review was found to be feasible and an acceptable alternative to an in-person visit for patient with HCC. Future studies could include expanding this approach for communicating MTB recommendations to patients with other types of cancers.
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Affiliation(s)
- Debra T Choi
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA.
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Yvonne H Sada
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Shubhada Sansgiry
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Veterans Affairs South Central Mental Illness Research Education and Clinical Center, Houston, TX, USA
| | - David E Kaplan
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Tamar H Taddei
- VA Connecticut Healthcare System, West Haven, CT, USA
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jason K Aguilar
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Michael Strayhorn
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ruben Hernaez
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, USA
| | - Jessica A Davila
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Francheska BK, Lee R, Oni G, Wilson E. Patients' experience of teleconsultations in the UK. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S24-S29. [PMID: 37219975 DOI: 10.12968/bjon.2023.32.10.s24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Teleconsultations were introduced for cancer surgery follow-up to ease pressure on hospital services and facilitate patients' access to those services. There is limited evidence on patients' perceptions of this swift shift in service provision. AIMS The purpose of this qualitative systematic review was to explore patient experiences of teleconsultations within NHS cancer surgery follow-up services to better understand patient perceptions, satisfaction and acceptability of teleconsultations within cancer services. METHODS Medline, Embase, PubMed and Google Scholar were searched up to 1 July 2022. Qualitative studies were synthesised using the Braun and Clarke framework. FINDINGS There were three overarching themes: accessibility; patient experience; and consultation. CONCLUSION Teleconsultations were widely accepted among cancer surgical patients. However, there were reports of a lack of rapport building and emotional support because of the absence of visual cues and patient camaraderie.
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Affiliation(s)
| | - Rachel Lee
- General Surgery Registrar, Nottingham University Hospitals NHS Trust
| | - Georgette Oni
- Consultant Oncoplastic Breast Surgeon, Nottingham Breast Institute, Nottingham University Hospitals NHS Trust
| | - Emma Wilson
- Professor of Public Health, Nottingham Centre for Public Health and Epidemiology, University of Nottingham
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Lawes-Wickwar S, Lovat E, Alao A, Hamer-Hunt J, Yurtoglu N, Jensen C, Clarke N, Roberts N, Park S. Digital undergraduate medical education and patient and carer involvement: a rapid systematic review of current practice. BMC MEDICAL EDUCATION 2023; 23:335. [PMID: 37193974 DOI: 10.1186/s12909-023-04218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/31/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Involving patients and carers in medical students' learning aims to centralise the perspective of healthcare users and supports our future medical workforce in the development of key skills. Medical schools are increasingly using digital technology for teaching and it is timely to understand how to maintain patient and carer involvement in this context. METHODS Ovid MEDLINE, Ovid EMBASE and medRxiv were searched in October 2020 and reference lists of key articles were hand searched. Eligible studies reported authentic patient or carer involvement in undergraduate medical education where technology was also used. Study quality was assessed by the Mixed Methods Appraisal Tool (MMAT). Levels of patient or carer involvement were assessed using Towle et al.'s (2010) taxonomy, from Level 1 (lowest level) to Level 6 (highest level). RESULTS Twenty studies were included in this systematic review. In 70% of studies, patients and carers featured in video or web-based case scenarios with no interaction between healthcare users and students. The remaining 30% of studies reported real-time interactions between students and patients via remote clinical encounters. Digital teaching sessions involving patients or carers were perceived to be valuable by students and educators, and increased student engagement, patient-centred attitudes, clinical knowledge, and communication skills. No studies reported the perspective of patients or carers. DISCUSSION Digital technology has not yet driven higher levels of patient and carer involvement in medical training. "Live" interactions between students and patients are becoming more common but challenges need addressing to ensure positive experiences for all involved. Future teaching should enhance the role of patients and carers in medical education and support them to overcome any potential barriers to doing so remotely.
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Affiliation(s)
- Sadie Lawes-Wickwar
- Department of Primary Care & Population Health, University College London, London, UK.
| | - Eitan Lovat
- Department of Primary Care & Population Health, University College London, London, UK
| | - Adedoyin Alao
- School of Medical Education, Newcastle University Medical School, Newcastle Upon Tyne, UK
| | | | - Nesrin Yurtoglu
- Department of Primary Care & Population Health, University College London, London, UK
| | - Cherise Jensen
- School of Medical Education, Newcastle University Medical School, Newcastle Upon Tyne, UK
| | - Nicola Clarke
- Department of Primary Care & Population Health, University College London, London, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, Medical Sciences, University of Oxford, Oxford, UK
| | - Sophie Park
- Department of Primary Care & Population Health, University College London, London, UK
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Hedden L, Spencer S, Mathews M, Marshall EG, Lukewich J, Asghari S, Brown JB, Gill PS, Freeman TR, McCracken RK, Ryan BL, Vaughan C, Wong E, Buote R, Meredith L, Moritz L, Ryan D, McKay M, Schacter G. "There's nothing like a good crisis for innovation": a qualitative study of family physicians' experiences with virtual care during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:338. [PMID: 37016330 PMCID: PMC10072815 DOI: 10.1186/s12913-023-09256-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/07/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Prior to the pandemic, Canada lagged behind other Organisation for Economic Cooperation and Development countries in the uptake of virtual care. The onset of COVID-19, however, resulted in a near-universal shift to virtual primary care to minimise exposure risks. As jurisdictions enter a pandemic recovery phase, the balance between virtual and in-person visits is reverting, though it is unlikely to return to pre-pandemic levels. Our objective was to explore Canadian family physicians' perspectives on the rapid move to virtual care during the COVID-19 pandemic, to inform both future pandemic planning for primary care and the optimal integration of virtual care into the broader primary care context beyond the pandemic. METHODS We conducted semi-structured interviews with 68 family physicians from four regions in Canada between October 2020 and June 2021. We used a purposeful, maximum variation sampling approach, continuing recruitment in each region until we reached saturation. Interviews with family physicians explored their roles and experiences during the pandemic, and the facilitators and barriers they encountered in continuing to support their patients through the pandemic. Interviews were audio-recorded, transcribed, and thematically analysed for recurrent themes. RESULTS We identified three prominent themes throughout participants' reflections on implementing virtual care: implementation and evolution of virtual modalities during the pandemic; facilitators and barriers to implementing virtual care; and virtual care in the future. While some family physicians had prior experience conducting remote assessments, most had to implement and adapt to virtual care abruptly as provinces limited in-person visits to essential and urgent care. As the pandemic progressed, initial forays into video-based consultations were frequently replaced by phone-based visits, while physicians also rebalanced the ratio of virtual to in-person visits. Medical record systems with integrated capacity for virtual visits, billing codes, supportive clinic teams, and longitudinal relationships with patients were facilitators in this rapid transition for family physicians, while the absence of these factors often posed barriers. CONCLUSION Despite varied experiences and preferences related to virtual primary care, physicians felt that virtual visits should continue to be available beyond the pandemic but require clearer regulation and guidelines for its appropriate future use.
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Affiliation(s)
- Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Family Medicine, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Rita K McCracken
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Crystal Vaughan
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Richard Buote
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lauren Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | - Gordon Schacter
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Hickey MD, Sergi F, Zhang K, Spinelli MA, Black D, Sola C, Blaz V, Nguyen JQ, Oskarsson J, Gandhi M, Havlir DV. Pragmatic randomized trial of a pre-visit intervention to improve the quality of telemedicine visits for vulnerable patients living with HIV. J Telemed Telecare 2023; 29:187-195. [PMID: 33342328 PMCID: PMC8214632 DOI: 10.1177/1357633x20976036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has required a shift of many routine primary care visits to telemedicine, potentially widening disparities in care access among vulnerable populations. In a publicly-funded HIV clinic, we aimed to evaluate a pre-visit phone-based planning intervention to address anticipated barriers to telemedicine. METHODS We conducted a pragmatic randomized controlled trial of patients scheduled for a phone-based HIV primary care visit at the Ward 86 HIV clinic in San Francisco from 15 April to 15 May 2020. Once reached by phone, patients were randomized to either have a structured pre-visit planning intervention to address barriers to an upcoming telemedicine visit versus a standard reminder call. The primary outcome was telemedicine visit attendance. RESULTS Of 476 scheduled telemedicine visits, 280 patients were reached by a pre-visit call to offer enrollment. Patients were less likely to be reached if virally unsuppressed (odds ratio (OR) 0.11, 95% confidence intervals (CI) 0.03-0.48), CD4 < 200 (OR 0.24, 95% CI 0.07-0.85), or were homeless (OR 0.24, 95% CI 0.07-0.87). There was no difference between intervention and control in scheduled visit attendance (83% v. 78%, OR 1.38, 95% CI 0.67-2.81). CONCLUSIONS A structured phone-based planning call to address barriers to telemedicine in a public HIV clinic was less likely to reach patients with poorly-controlled HIV and patients experiencing homelessness, suggesting additional interventions may be needed in this population to ensure access to telemedicine-based care. Among patients reachable by phone, telemedicine visit attendance was high and not improved with a structured pre-visit intervention, suggesting that standard reminders may be adequate in this population.
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Affiliation(s)
- Matthew D Hickey
- Division of HIV, ID and Global Medicine, University of California, USA
| | | | - Kevin Zhang
- Feinberg School of Medicine, Northwestern University, USA
| | | | - Douglas Black
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Cyril Sola
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Vanessa Blaz
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Janet Q Nguyen
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Jon Oskarsson
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Monica Gandhi
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Diane V Havlir
- Division of HIV, ID and Global Medicine, University of California, USA
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Norberg BL, Getz LO, Johnsen TM, Austad B, Zanaboni P. General Practitioners' Experiences With Potentials and Pitfalls of Video Consultations in Norway During the COVID-19 Lockdown: Qualitative Analysis of Free-Text Survey Answers. J Med Internet Res 2023; 25:e45812. [PMID: 36939814 PMCID: PMC10131921 DOI: 10.2196/45812] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND The use of video consultations (VCs) in Norwegian general practice rapidly increased during the COVID-19 pandemic. During societal lockdowns, VCs were used for nearly all types of clinical problems, as in-person consultations were kept to a minimum. OBJECTIVE This study aimed to explore general practitioners' (GPs') experiences of potentials and pitfalls associated with the use of VCs during the first pandemic lockdown. METHODS Between April 14 and May 3, 2020, all regular Norwegian GPs (N=4858) were invited to answer a web-based survey, which included open-ended questions about their experiences with the advantages and pitfalls of VCs. A total of 2558 free-text answers were provided by 657 of the 1237 GPs who participated in the survey. The material was subjected to reflexive thematic analysis. RESULTS Four main themes were identified. First, VCs are described as being particularly convenient, informative, and effective for consultations with previously known patients. Second, strategically planned VCs may facilitate effective tailoring of clinical trajectories that optimize clinical workflow. VCs allow for an initial overview of the problem (triage), follow-up evaluation after an in-person consultation, provision of advice and information concerning test results and discharge notes, extension of sick leaves, and delivery of other medical certificates. VCs may, in certain situations, enhance the GPs' insight in their patients' relational and socioeconomical resources and vulnerabilities, and even facilitate relationship-building with patients in need of care who might otherwise be reluctant to seek help. Third, VCs are characterized by a demarcated communication style and the "one problem approach," which may entail effectiveness in the short run. However, the web-based communication climate implies degradation of valuable nonverbal signals that are more evidently present in in-person consultations. Finally, overreliance on VCs may, in a longer perspective, undermine the establishment and maintenance of relational trust, with a negative impact on the quality of care and patient safety. Compensatory mechanisms include clarifying with the patient what the next step is, answering any questions and giving further advice on treatment if conditions do not improve or there is a need for follow-up. Participation of family members can also be helpful to improve reciprocal understanding and safety. CONCLUSIONS The findings have relevance for future implementation of VCs and deserve further exploration under less stressful circumstances.
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Affiliation(s)
- Børge Lønnebakke Norberg
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Centre for E-health Research, Tromsø, Norway
| | - Linn Okkenhaug Getz
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Bjarne Austad
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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