Offering an app to book cervical screening appointments: A service evaluation

Health technologies for tackling client absenteeism in primary and secondary care services

BACKGROUND

Tackling client absenteeism in primary and secondary care settings is crucial to ensure the continuity of care for individuals, families and communities, as well as preventing waste of resources within healthcare systems.

METHODOLOGY

This article is an integrative review to identify advancements in health technologies that address client absenteeism in primary and secondary care. The databases Medical Literature and Retrieval System Online (MEDLINE/PubMed®), Scientific Electronic Library Online and Virtual Health Library were consulted. The inclusion criteria were as follows: full papers, published between 2013 and 2023, in English, Portuguese or Spanish. The descriptors used were the following: patients, mobile applications, health services management, absenteeism and primary care, and secondary care. Eleven articles published from 2014 to 2021 were included.

RESULTS

Most articles were identified in the MEDLINE/PUBMED database, employed a randomized controlled trial methodology (36.36%), and were published between 2019 and 2021 (90.0%) in English (63.7%). The applications had managerial, assistive and/or educational purposes. In addition to absenteeism control, these applications strived to promote client engagement with health services, increase health literacy and tackle structural barriers to care, such as language barriers.

CONCLUSION

Efforts are needed to ensure that providers receive training to educate clients on the applications. Moreover, community-based participatory studies to ensure the feasibility of applications are warranted.

How do young women approaching screening age interpret the NHS cervical screening leaflet? A mixed methods study of identifying interpretation difficulties, barriers, facilitators, and leaflet interpretation, engagement and future screening behaviour

BACKGROUND

Cervical cancer is a common cancer among young women aged 25-29 in England, and the NHS cervical screening leaflet is the first point of contact for those being invited for their first screening. This study aimed to explore how young women (18-24) understand and engage with the leaflet, as well as the barriers and facilitators associated with its interpretation, engagement, and screening intentions.

METHODS

The study used a mixed-methods approach, including a survey (n = 120) to identify interpretation difficulties and how they were affected by different characteristics, and a follow-up interview (n = 10) to assess the utility of the leaflet, identify issues with its practicality, and determine the factors that influence screening intentions.

RESULTS

The survey results showed that interpretation difficulties were common, particularly regarding HPV assessment, screening results, additional tests/treatment, and screening risks. Lower interpretation accuracy was associated with lower numeracy scores and non-white ethnicity. Despite these difficulties, participants had high confidence and motivation to engage with the leaflet. The interviews revealed knowledge gaps, issues with the leaflet's practicality, and a preference for digital information. Factors that were identified as barriers and facilitators of leaflet interpretation, engagement, and screening intentions included knowledge, social influence, beliefs about consequences, environmental context and resources, social role and identity, emotions and intentions.

CONCLUSION

The current leaflet does not provide enough information for young women to make an informed decision about screening attendance. Implementing a digital invitation featuring simplified gist representation, targeted behaviour change techniques (BCTs), videos, and interactive tools can enhance education and promote screening behaviour. Future research should consider using digital tools and strategies to address existing barriers related to interpretation and engagement.

Evaluation of Experiences and Attitudes of Patients Towards Patient Portal-Enabled Access to Their Health Information or Medical Records: A Qualitative Grounded Theory Study

The demand for patient-centred care and patient engagement in their healthcare has driven patient portal introduction. The widespread adoption and use of patient portals, however, has been a rather slow process in the United Kingdom. Hence, a limited number of studies have explored patient perceptions and experiences of general portal use, which forms a foundation for successful implementation of a portal. This study, therefore, focuses on the experiences and attitudes of patients regarding use of patient portals and access to their health information. It further explores various factors perceived by patients that may influence portal use and uptake. The overall findings from this study highlight positive patient perceptions of portal use. Nevertheless, it demonstrates various areas of improvement essential to ensure future success of portal implementation and acceptance.

The Positive Effect of an Online Appointment Portal on a Breast Cancer Screening Program

BACKGROUND

The adoption of web-based appointment methods by health care systems is increasing.

OBJECTIVES

This study primarily aimed to evaluate in the setting of an organized breast cancer screening program the actual usage of an online appointment portal by the target population, i.e., how the online tool was used (type and timing of the actions performed) and by whom (users' characteristics); the effect of coronavirus disease 2019 (COVID-19) on its usage was also investigated. The effect of adopting this tool on the attendance to breast cancer screening was contextually investigated.

METHODS

Electronic data records of 75,903 women (45-74 years old, residing in the territory of Bologna Local Health Authority) were retrospectively reviewed.

RESULTS

In total, 12.4% of women logged into the online portal at least once. Most of them (79.9%) rescheduled, 15.7% viewed, and 4.4% cancelled their own appointment. In addition, 40.6% of all rescheduling actions were performed by the online portal; the remaining was performed by the toll-free number/dedicated email address. The highest peak (13.8%) of web accesses was registered at 10 a.m. Monday to Friday, when the toll-free number service is available. Percentages of portal usage were higher: (1) among the younger women, of Italian nationality, and for the first time invited to mammographic screening (p < 0.0001), and (2) in the pandemic period versus the prepandemic period (12.5 vs. 8.6%, respectively; p < 0.001). Finally, when compared to not using, the online portal usage led to an overall reduction in the no-show rate of almost 20% (p < 0.0001).

CONCLUSION

The action mainly performed by using the online appointment portal was the appointment rescheduling. The usage of this tool had a positive effect on the no-show rate and it can be speculated that has led to a reduction of the request load to be handled by the center's screening staff. Finally, this study confirmed that the COVID-19 pandemic boosted the use of digital technologies.

Investigating the national implementation of SMS and mobile messaging in population screening (The SIPS study)

BACKGROUND

The increasing use of mobile messaging within healthcare, poses challenges for screening programmes, which involve communicating with large, diverse populations. This modified Delphi study aimed to create guidance regarding the use of mobile messaging for screening programmes, to facilitate greater, and equitable screening uptake.

METHODS

Initial recommendations were derived from a literature review, expert scoping questionnaire, public consultation, and discussion with relevant national organisations. Experts from the fields of public health, screening commissioning, industry and academia voted upon the importance and feasibility of these recommendations across two consensus rounds, using a 5-point Likert scale. Items reaching consensus, defined a priori at 70%, on importance and feasibility formed 'core' recommendations. Those reaching this threshold on importance only, were labelled 'desirable'. All items were subsequently discussed at an expert meeting to confirm suitability.

FINDINGS

Of the initial 101 items, 23 reached consensus regarding importance and feasibility. These 'core' items were divided across six domains: message content, timing, delivery, evaluation, security, and research considerations. 'Core' items such as explicitly specifying the sender and the role of patient involvement in development of screening message research had the highest agreement. A further 17 'desirable' items reached consensus regarding importance, but not feasibility, including the integration into GP services to enable telephone verification.

INTERPRETATION

These findings forming national guidance for services, will enable programmes to overcome implementation challenges and facilitate uptake of screening invitations. By providing a list of desirable items, this study provides areas for future consideration, as technological innovation in messaging continues to grow.

FUNDING

NIHR Imperial Patient Safety Translational Research Centre.

Should we? Could we? Feasibility of interventions to support prevention or early diagnosis of future cancer following urgent referral: A qualitative study

OBJECTIVE

This study investigated perspectives of healthcare professionals (HCPs) on the feasibility of giving additional support to patients after cancer is not found following urgent referral. We sought to understand key facilitators or barriers to offering such support.

METHODS

A convenience sample of primary and secondary care healthcare professionals (n = 36) participated in semi-structured interviews. Interviews were transcribed verbatim and analysed using Framework Analysis, inductively and deductively, guided by the Theoretical Domains Framework.

RESULTS

HCPs indicated that support should be offered if proven to be efficacious. It needs to avoid potential negative consequences such as patient anxiety and information overload. HCPs were more hesitant about whether support could feasibly be offered, due to resource restrictions and perceived remit of the urgent pathway for suspected cancer.

CONCLUSION

HCP support after discharge from urgent cancer referral pathways needs to be resource efficient, developed in collaboration with patients and should have proven efficacy. Development of brief interventions for delivery by a range of staff, and use of technology could mitigate barriers to implementation.

PRACTICE IMPLICATIONS

Changes to discharge procedures to provide information, endorsement or direction to services could offer much needed support. Additional support would need to overcome logistical challenges and address limited capacity.

Automated patient self-scheduling: case study

This case study assesses the uptake, user characteristics, and outcomes of automated self-scheduling in a community-based physician group affiliated with an academic health system. We analyzed 1 995 909 appointments booked between January 1, 2019, and June 30, 2021 at more than 30 practice sites. Over the study period, uptake of self-scheduling increased from 4% to 15% of kept appointments. Younger, commercially insured patients were more likely to be users. Missed appointments were lower and cancelations were higher for self-scheduled patients. An examination of characteristics, benefits, and usage of automated self-scheduling provides insight to those organizations contemplating the implementation or expansion of similar consumer-facing digital self-scheduling platforms.

Barriers to and Facilitators of Automated Patient Self-scheduling for Health Care Organizations: Scoping Review

Background

Appointment management in the outpatient setting is important for health care organizations, as waits and delays lead to poor outcomes. Automated patient self-scheduling of outpatient appointments has demonstrable advantages in the form of patients’ arrival rates, labor savings, patient satisfaction, and more. Despite evidence of the potential benefits of self-scheduling, the organizational uptake of self-scheduling in health care has been limited.

Objective

The objective of this scoping review is to identify and to catalog existing evidence of the barriers to and facilitators of self-scheduling for health care organizations.

Methods

A scoping review was conducted by searching 4 databases (PubMed, CINAHL, Business Source Ultimate, and Scopus) and systematically reviewing peer-reviewed studies. The Consolidated Framework for Implementation Research was used to catalog the studies.

Results

In total, 30 full-text articles were included in this review. The results demonstrated that self-scheduling initiatives have increased over time, indicating the broadening appeal of self-scheduling. The body of literature regarding intervention characteristics is appreciable. Outer setting factors, including national policy, competition, and the response to patients’ needs and technology access, have played an increasing role in influencing implementation over time. Self-scheduling, compared with using the telephone to schedule an appointment, was most often cited as a relative advantage. Scholarly pursuit lacked recommendations related to the framework’s inner setting, characteristics of individuals, and processes as determinants of implementation. Future discoveries regarding these Consolidated Framework for Implementation Research domains may help detect, categorize, and appreciate organizational-level barriers to and facilitators of self-scheduling to advance knowledge regarding this solution.

Conclusions

This scoping review cataloged evidence of the existence, advantages, and intervention characteristics of patient self-scheduling. Automated self-scheduling may offer a solution to health care organizations striving to positively affect access. Gaps in knowledge regarding the uptake of self-scheduling by health care organizations were identified to inform future research.

Barriers and Facilitators to Automated Self-Scheduling: Consensus from a Delphi Panel of Key Stakeholders

INTRODUCTION

Automated self-scheduling may benefit healthcare organizations, yet uptake has been slow. The aim of this study was to develop a consensus statement regarding the organizational-level determinants of implementation success based on the collective knowledge of experts. A three-stage modified Delphi method was used to reach consensus on the top determinants of implementation of self-scheduling solutions by healthcare organizations. A panel of 53 experts representing 41 academic health systems identified barriers and facilitators involving the organization's inner and outing settings, as well as the characteristics of the intervention and the individuals engaged in the solution. Offering convenience for patients is the leading enabler for organizations to implement the technology. The consensus may aid healthcare organizations and suppliers engaged in adopting and developing self-scheduling technology to improve implementation success. Further research is recommended to diagnose and examine each barrier and facilitator and how these factors interact.

OBJECTIVE

The aim of this study was to develop a consensus statement regarding the determinants of implementation success based on the collective knowledge of experts working in the field.

METHODS

A Delphi panel was constructed based on selected participants employed by academic health systems and experienced with self-scheduling implementation. Panelists were recruited based on participation in an educational event that featured the topic. Purposive and snowball sampling were used. Panelists participated in surveys collected over three rounds. An 80 percent agreement among panelists and interquartile range (IQR) <1 determined the barriers and facilitators. The top-10 determinants were presented in rank order.

RESULTS

Between January 6, 2021, and May 26, 2021, 53 panelists representing 41 academic health systems participated in three rounds of surveys to reach consensus on the barriers and facilitators to implementation of self-scheduling by healthcare organizations in the United States. In round one, panelists documented 530 determinants. In round two, the determinants were grouped into 72 barriers and 85 facilitators, each of which participants rated on a five-point Likert scale. Fifteen determinants met the 80 percent threshold and 1.0 IQR. The final round concluded with a top-10, rank-ordered listing of determinants (seven facilitators and three barriers) that also incorporated a median rating score using five-point Likert scale.

CONCLUSION

A three-stage modified Delphi method was used to reach consensus on the top determinants of implementation of self-scheduling solutions by academic health systems. The consensus may aid healthcare organizations and suppliers engaged in adopting and developing self-scheduling technology to improve implementation success. Further research is recommended to diagnose and examine each barrier and facilitator and how these factors interact.