1
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Mihas P, Rosman L, Armbruster T, Walker J, Deyo Z, Gehi A. Assessing a Virtual Education Intervention for Patients With Atrial Fibrillation: A Qualitative Study of Patient Perceptions. J Cardiovasc Nurs 2024; 39:E1-E11. [PMID: 37088903 DOI: 10.1097/jcn.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Authors of studies of patients with atrial fibrillation (AF) have identified several knowledge gaps and misconceptions regarding the condition and its management. The COVID-19 pandemic heightened isolation of patients and underscored the need for education and knowledge building in order for patients to effectively manage AF during times of increased health risk. OBJECTIVE The aim of this study was to assess, using a qualitative approach, the experiences and perceived benefits of patients with AF regarding an 8-session virtual education intervention (AF-at-Home) during the early months of the COVID-19 pandemic. METHODS A qualitative study with 3 focus groups using a semistructured focus group guide was conducted and recorded online with the same trained moderator. RESULTS We identified 7 primary themes emerging from patients' experiences: (1) building knowledge beyond information available in clinic visits, (2) managing anxiety, (3) generating self-efficacy, (4) providing social comparison, (5) perceived benefits of both experiential and informational content, (6) facilitating self-management behaviors, and (7) facilitating communication with providers. CONCLUSIONS The analysis of the focus groups shows the benefits of a virtual education program in building knowledge, skills, and self-efficacy as well as reducing anxiety and normalizing one's experience by attending a program alongside other patients with AF.
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Mann HK, Streiff M, Schultz KC, Halpern DV, Ferry D, Johnson AE, Magnani JW. Rurality and Atrial Fibrillation: Patient Perceptions of Barriers and Facilitators to Care. J Am Heart Assoc 2023; 12:e031152. [PMID: 37889198 PMCID: PMC10727401 DOI: 10.1161/jaha.123.031152] [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: 07/23/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023]
Abstract
Background Patients experience atrial fibrillation (AF) as a complex disease given its adversity, chronicity, and necessity for long-term treatments. Few studies have examined the experience of rural individuals with AF. We conducted qualitative assessments of patients with AF residing in rural, western Pennsylvania to identify barriers and facilitators to care. Methods and Results We conducted 8 semistructured virtual focus groups with 42 individuals living in rural western Pennsylvania using contextually tailored questions to assess participant perspectives. We inductively analyzed focus group transcripts using paragraph-by-paragraph and focused coding to identify themes with the qualitative description approach. We used Krippendorff α scoring to determine interreviewer reliability. We harnessed investigator triangulation to augment the reliability of our findings. We reached thematic saturation after coding 8 focus groups. Participants were 52.4% women, with a median age of 70.9 years (range, 54.5-82.0 years), and most were White race (92.9%). Participants identified medication costliness, invisibility of AF to others, and lack of emergent transportation as barriers to care. Participants described interpersonal support and use of technology as important for AF self-care, and expressed ambivalence about how relationships with health care providers affected AF care. Conclusions Focus group participants described multiple social and structural barriers to care for AF. Our findings highlight the complexity of the experience of individuals with AF residing in rural western Pennsylvania. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04076020.
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Affiliation(s)
| | - Meg Streiff
- University Center for Social and Urban ResearchUniversity of PittsburghPA
| | - Kevan C. Schultz
- University Center for Social and Urban ResearchUniversity of PittsburghPA
| | - David V. Halpern
- University Center for Social and Urban ResearchUniversity of PittsburghPA
| | - Danielle Ferry
- Center for Research on Health Care, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Amber E. Johnson
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Jared W. Magnani
- Center for Research on Health Care, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
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3
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Aglan A, Fath AR, Khurana A, Aboasbeh J, Eldaly AS, Wadid M, Olagunju A, Nayak HM. Variations in Atrial Fibrillation Ablation Use and Charges in a Modern Cohort of Medicare Beneficiaries. Am J Cardiol 2023; 202:24-29. [PMID: 37413703 DOI: 10.1016/j.amjcard.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
Catheter ablation of atrial fibrillation (CAF) is increasingly being used in the United States. This study aimed to identify variations in CAF use among Medicare beneficiaries (MBs) over a 6-year period (2013 to 2019). Using the Center of Medicare and Medicaid Services database, a 100% sample of MBs who underwent CAF from 2013 to 2019 was included. We stratified CAF use data geographically (Northeast, South, West, and Midwest) and identified the number of CAFs per 100,000 MBs, number of electrophysiologists performing CAFs per 100,000 MBs, number of CAFs per individual electrophysiologist, and average submitted charge for CAF. In addition, we stratified the data per urban versus rural areas and gender of the operator. We found that the mean atrial fibrillation (AF) prevalence, rates of CAFs, number of electrophysiologists performing CAFs, and number of CAFs per electrophysiologist have increased steadily in all regions. The mean AF prevalence was different among regions, with the highest prevalence in the Northeast (p <0.001); however, there was a pattern of higher CAFs rates in the West and the South (p ≥0.057). The number of electrophysiologists performing CAFs was not different among regions; however, the number of CAFs per electrophysiologist was higher in the West and the South (p <0.001). The average submitted charge for CAF has decreased over years and was the lowest in the West and the South (p <0.001). There was no major difference in these variables regarding operator gender. In conclusion, there are significant variations in CAF use among MBs in the United States according to geographic and urban versus rural regions. These variations have the potential to impact the outcomes in MBs diagnosed with AF.
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Affiliation(s)
- Amro Aglan
- Department of Internal Medicine, Beth Israel Lahey Health, Burlington, Massachusetts.
| | - Ayman R Fath
- Division of Cardiology, University of Texas Health, San Antonio, Texas
| | - Aditya Khurana
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jumanah Aboasbeh
- Department of Internal Medicine, Creighton University, Phoenix, Arizona
| | | | - Mark Wadid
- Department of Internal Medicine, Beth Israel Lahey Health, Burlington, Massachusetts
| | | | - Hemal M Nayak
- Division of Cardiology, University of Texas Health, San Antonio, Texas
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4
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Pullyblank K. A Scoping Literature Review of Rural Beliefs and Attitudes toward Telehealth Utilization. West J Nurs Res 2023; 45:375-384. [PMID: 36324263 DOI: 10.1177/01939459221134374] [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] [Indexed: 11/06/2022]
Abstract
The purpose of this scoping literature review was to understand what is known about how the rural profile influences beliefs regarding telehealth utilization. Rural nursing theory (RNT) provided a framework for the review. Search criteria were limited to peer-reviewed studies conducted in Europe, the United States, Canada, Australia, and New Zealand. A variety of search terms related to patient telehealth perceptions generated 213 unique articles, of which 10 met the inclusion criteria. Included studies incorporated qualitative methodologies and were from Australia, Canada, Sweden, or the United States. The review highlighted four themes related to the rural profile's influence on telehealth beliefs: importance of familiar relationships, concerns with privacy and confidentiality, acceptance of limited access to care, and resourcefulness and frugality. These themes echo concepts within RNT. Nurses and other health professionals must acknowledge the rural profile's influence on a person's decision to use telehealth in order to provide optimal care.
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Affiliation(s)
- Kristin Pullyblank
- Bassett Research Institute, Center for Rural Community Health, Cooperstown, NY, USA
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5
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Gao H, Yous ML, Connelly D, Hung L, Garnett A, Hay M, Snobelen N. Implementation and impacts of virtual team-based care planning for older persons in formal care settings: A scoping review. Digit Health 2023; 9:20552076231151567. [PMID: 36714541 PMCID: PMC9880593 DOI: 10.1177/20552076231151567] [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: 06/23/2022] [Accepted: 12/08/2022] [Indexed: 01/25/2023] Open
Abstract
Objective This scoping review aimed to summarize current knowledge about the implementation, impacts, facilitators and barriers of virtual team-based care planning for older persons in formal care settings (e.g. home and community, primary, long-term and acute care). Methods The Joanna Briggs Institute (JBI) methodology was used. The Arksey and O'Malley and Levac, Colquhoun, and O'Brien methodologies provided additional frameworks. Databases accessed included PubMed, EMBASE, CINAHL, AgeLine, PsycInfo and Scopus. Reference lists of selected articles and grey literature retrieved through Google and Google Scholar were also reviewed. Three researchers screened titles, abstracts and conducted full-text reviews. Extracted data were mapped in a table and analysed for summative themes. Older persons and family partners assisted in interpreting findings based on their lived experiences. Results A total of 27 studies were included. Virtual team-based care planning led to many positive outcomes for older persons (e.g. decreased depression, reduced falls and improved medication management) and their families (e.g. reduced caregiver stress and improved caregiving skills). Only four studies reported the involvement of older persons and/or families in virtual team-based care planning. Multiple barriers to adopting virtual team-based care planning were found including lack of education/training for older persons and families in using technology. Conclusion Despite the multiple advantages that virtual team-based care planning offers for older persons and families, it is important to ensure that this care can be offered to all. There is a need to ensure that health equity is addressed to promote access to care and respond to social determinants of health.
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Affiliation(s)
- Harrison Gao
- Schulich School of Medicine and Dentistry, Western University,
London, ON, Canada,Denise Connelly, School of Physical
Therapy, Rm 1000 Elborn College, Western University, London, ON N6G 1H1, Canada.
| | - Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Denise Connelly
- School of Physical Therapy, Western University, London, ON,
Canada
| | - Lillian Hung
- School of Nursing, The University of British Columbia, Vancouver,
BC, Canada
| | - Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London,
ON, Canada
| | - Melissa Hay
- School of Physical Therapy, Western University, London, ON,
Canada
| | - Nancy Snobelen
- Registered Practical Nurses Association
of Ontario (WeRPN), Mississauga, ON, Canada
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6
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Rush KL, Singh S, Seaton CL, Burton L, Li E, Jones C, Davis JC, Hasan K, Kern B, Janke R. Telehealth Use for Enhancing the Health of Rural Older Adults: A Systematic Mixed Studies Review. THE GERONTOLOGIST 2022; 62:e564-e577. [PMID: 34661675 DOI: 10.1093/geront/gnab141] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Telehealth holds potential for inclusive and cost-saving health care; however, a better understanding of the use and acceptance of telehealth for health promotion among rural older adults is needed. This systematic review aimed to synthesize evidence for telehealth use among rural-living older adults and to explore cost-effectiveness for health systems and patients. RESEARCH DESIGN AND METHODS This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study designs reporting health promotion telehealth interventions with rural-living adults aged 55 and older were eligible for review. Following screening and inclusion, articles were quality-rated and ranked by level of evidence. Data extraction was guided by the Technology Acceptance Model and organized into outcomes related to ease of use, usefulness, intention to use, and usage behavior along with cost-effectiveness. RESULTS Of 2,247 articles screened, 42 were included. Positive findings for the usefulness of telehealth for promoting rural older adults' health were reported in 37 studies. Evidence for ease of use and usage behavior was mixed. Five studies examined intention to continue to use telehealth and in 4 of these, patients preferred telehealth. Telehealth was cost-effective for health care delivery (as a process) compared to face to face. However, findings were mixed for cost-effectiveness with both reports of savings (e.g., reduced travel) and increased costs (e.g., insurance). DISCUSSION AND IMPLICATIONS Telehealth was useful for promoting health among rural-living older adults. Technological supports are needed to improve telehealth ease of use and adherence. Cost-effectiveness of telehealth needs more study, particularly targeting older adults.
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Affiliation(s)
- Kathy L Rush
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Sarah Singh
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Cherisse L Seaton
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Lindsay Burton
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Eric Li
- Faculty of Management, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Charlotte Jones
- Faculty of Medicine, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Khalad Hasan
- Department of Computer Science, Mathematics, Physics and Statistics, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Brodie Kern
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Robert Janke
- Research and Administration, Library Administration, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
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7
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Telemedicine practices in adult patients with atrial fibrillation. J Am Assoc Nurse Pract 2022; 34:957-962. [PMID: 36330550 DOI: 10.1097/jxx.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Atrial fibrillation is a cardiac rhythm disorder associated with embolic stroke risk, decreased functional capacity, and worsening quality of life. Increasing patient access to atrial fibrillation specialists via telemedicine has the potential to improve patient outcomes. OBJECTIVES The purpose of this systematic review was to describe atrial fibrillation telehealth education treatment programs unrelated to postablation or early detection of atrial fibrillation. DATA SOURCES PubMed and CINAHL databases were searched using key terms identified by the authors and informed by a panel of clinicians with expertise in cardiac electrophysiology. CONCLUSIONS Little literature exists on educational telehealth programs for atrial fibrillation treatment unrelated to postablation or early detection of atrial fibrillation. Only three studies met our inclusion criteria. Three themes emerged from review of these studies: (a) atrial fibrillation requires specialty care that is difficult to obtain; (b) comprehensive atrial fibrillation education should include a broad overview of the condition, management options, stroke prevention, and symptom management; and (c) telemedicine is effective for diagnosing and managing atrial fibrillation. IMPLICATIONS FOR PRACTICE Telemedicine clinics for atrial fibrillation represent an emerging form of clinically important health care delivery. These clinics can potentially decrease wait time for specialty care access, reduce unnecessary emergency department visits, reduce stroke risk, and increase guideline adherence. Nurse practitioners are well suited to create and lead telemedicine atrial fibrillation clinics with relevant clinical expertise and collaborative skills.
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Jacob C, Sezgin E, Sanchez-Vazquez A, Ivory C. Sociotechnical Factors Affecting Patients' Adoption of Mobile Health Tools: Systematic Literature Review and Narrative Synthesis. JMIR Mhealth Uhealth 2022; 10:e36284. [PMID: 35318189 PMCID: PMC9121221 DOI: 10.2196/36284] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) tools have emerged as a promising health care technology that may contribute to cost savings, better access to care, and enhanced clinical outcomes; however, it is important to ensure their acceptance and adoption to harness this potential. Patient adoption has been recognized as a key challenge that requires further exploration. OBJECTIVE The aim of this review was to systematically investigate the literature to understand the factors affecting patients' adoption of mHealth tools by considering sociotechnical factors (from technical, social, and health perspectives). METHODS A structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the MEDLINE, PubMed, Cochrane Library, and SAGE databases for studies published between January 2011 and July 2021 in the English language, yielding 5873 results, of which 147 studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with thematic analysis and narrative synthesis of emergent themes. RESULTS The technical factors affecting patients' adoption of mHealth tools were categorized into six key themes, which in turn were divided into 20 subthemes: usefulness, ease of use, data-related, monetary factors, technical issues, and user experience. Health-related factors were categorized into six key themes: the disease or health condition, the care team's role, health consciousness and literacy, health behavior, relation to other therapies, integration into patient journey, and the patients' insurance status. Social and personal factors were divided into three key clusters: demographic factors, personal characteristics, and social and cultural aspects; these were divided into 19 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. CONCLUSIONS This review builds on the growing body of research that investigates patients' adoption of mHealth services and highlights the complexity of the factors affecting adoption, including personal, social, technical, organizational, and health care aspects. We recommend a more patient-centered approach by ensuring the tools' fit into the overall patient journey and treatment plan, emphasizing inclusive design, and warranting comprehensive patient education and support. Moreover, empowering and mobilizing clinicians and care teams, addressing ethical data management issues, and focusing on health care policies may facilitate adoption.
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Affiliation(s)
- Christine Jacob
- University of Applied Sciences Northwestern Switzerland, Olten, Switzerland
| | - Emre Sezgin
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
- NORC at the University of Chicago, Chicago, IL, United States
| | - Antonio Sanchez-Vazquez
- Innovative Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovative Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
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9
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Alexander DS, Kiser S, North S, Roberts CA, Carpenter DM. Exploring community members' perceptions to adopt a Tele-COPD program in rural counties. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 2:100023. [PMID: 35481132 PMCID: PMC9031410 DOI: 10.1016/j.rcsop.2021.100023] [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: 01/14/2021] [Revised: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 12/05/2022] Open
Abstract
Background Patients diagnosed with COPD residing in rural areas report a lower quality of life. Telehealth addresses geographic barriers by offering routine, technology-based visits, and remote patient monitoring. Objective The study objective was to explore adoption perceptions of a tele-COPD program among community members in rural Western North Carolina (WNC) counties. Methods A convenience sample of 17 community members were recruited to participate in one of five 45-min focus groups. Before the focus group, all participants completed a brief demographic survey. Focus groups were digitally recorded, transcribed verbatim, imported into MAXQDA v10, and analyzed thematically using established qualitative coding procedures. SPSS v22 was used to calculate descriptive statistics. Results Participants were primarily Non-Hispanic White (100%), male (59%), insured (100%), and had at least a high school education (80%). Only 25% of participants had any prior knowledge of telehealth programs. The majority (94%) of participants expressed interest in receiving a tele-COPD program due to convenience factors. Yet, most participants expressed a lack of interest and comfort in using Internet-capable devices (e.g., mobile devices, tablets, computers). Participants noted that to be successful, telehealth visits must be described and shown to them by their own provider or other trusted individual(s), such as a pharmacist. Privacy and cost were also expressed as telehealth concerns. Conclusion Interest in a tele-COPD program was high among community residents in rural WNC. However, to increase patient willingness to adopt a tele-COPD program, patients' providers must overcome challenges, such as patients' awareness and knowledge of telehealth, privacy and cost concerns, and access to and comfort with using new technologies. Pharmacists may mitigate these challenges by increasing patients' trust and comfort with telehealth programs. Telehealth offers video-based visits and remote patient monitoring in rural areas. Participants expressed concerns about privacy, cost, and using Internet-capable devices. Participants stated successful, telehealth visits must be described and shown by provider(s) or other trusted individual(s). Pharmacists may mitigate these concerns by increasing patients' trust and comfort with telehealth programs.
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Affiliation(s)
| | - Stephanie Kiser
- UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States
| | - Steve North
- Center for Rural Health Innovation, Spruce Pine, NC, United States
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10
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Buyting R, Melville S, Chatur H, White CW, Légaré JF, Lutchmedial S, Brunt KR. Virtual Care With Digital Technologies for Rural Canadians Living With Cardiovascular Disease. CJC Open 2022; 4:133-147. [PMID: 35198931 PMCID: PMC8843960 DOI: 10.1016/j.cjco.2021.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/26/2021] [Indexed: 01/14/2023] Open
Abstract
Canada is a wealthy nation with a geographically diverse population, seeking health innovations to better serve patients in accordance with the Canada Health Act. In this country, population and geography converge with social determinants, policy, procurement regulations, and technological advances with the goal to achieve equity in the management and distribution of health care. Rural and remote patients are a vulnerable population; when managing chronic conditions like cardiovascular disease, there is currently inequity to accessing specialist physicians at the recommended frequency-increasing the likelihood of poor health outcomes. Ensuring equitable care for this population is an unrealized priority of several provincial and federal government mandates. Virtual care technology might provide practical, economical, and innovative solutions to remedy this discrepancy. We conducted a scoping review of the literature pertaining to the use of virtual care technologies to monitor patients living in rural areas of Canada with cardiovascular disease. A search strategy was developed to identify the literature specific to this context across 3 bibliographic databases. Two hundred thirty-two unique citations were ultimately assessed for eligibility, of which 37 met the inclusion criteria. In our assessment of these articles, we provide a summary of the interventions studied, their reported effectiveness in reducing adverse events and mortality, the challenges to implementation, and the receptivity of these technologies among patients, providers, and policy-makers. Furthermore, we glean insight into the barriers and opportunities to ensure equitable care for rural patients and conclude that there is an ongoing need for clinical trials on virtual care technologies in this context.
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Affiliation(s)
- Ryan Buyting
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
- Division of Cardiac Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Division of Cardiology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Sarah Melville
- Division of Cardiology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Hanif Chatur
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Christopher W. White
- Division of Cardiac Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Jean-François Légaré
- Division of Cardiac Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Sohrab Lutchmedial
- Division of Cardiology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Keith R. Brunt
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
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Abstract
Telemedicine is the use of information and communication technology to deliver healthcare at a distance. It has been resorted to during the COVID-19 pandemic to lessen the need for in-person patient care decreasing the risk of transmission, and it can be of benefit afterward in the management of cardiac disease. The elderly population has unique challenges concerning the use of telehealth technologies. We thus review the advances in telemedicine technologies in treating elderly cardiac patients including in our discussion only studies with a mean age of participants above 60. Remote monitoring of blood pressure, weight, and symptoms, along with home ECG recording has been found to be superior to usual in-clinic follow up. Combining remote monitoring with video conferencing with physicians, patient education websites, and applications is also of benefit. Remote monitoring of Implantable Cardioverter Defibrillators (ICD) and Cardiac Resynchronization Therapy Defibrillators (CRT-D) is also beneficial but can be at the cost of an increase in both appropriate and inappropriate interventions. Implantable sensing devices compatible with remote monitoring have been developed and have been shown to improve care and cost-effectiveness. New smartphone software can detect arrhythmias using home ECG recordings and can detect atrial fibrillation using smartphone cameras. Remote monitoring of implanted pacemakers has shown non-inferiority to in clinic follow up. On the other hand, small-scale questionnaire-based studies demonstrated the willingness of the elderly cardiac patients to use such technologies, and their satisfaction with their use and ease of use. Large-scale studies should further investigate useability in samples more representative of the general elderly population with more diverse socioeconomic and educational backgrounds. Accordingly, it seems that studying integrating multiple technologies into telehealth programs is of great value. Further efforts should also be put in validating the technologies for specific diseases along with the legal and reimbursement aspects of the use of telehealth.
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Crump CA, Wernz C, Schlachta-Fairchild L, Steidle E, Duncan A, Cathers L. Closing the Digital Health Evidence Gap: Development of a Predictive Score to Maximize Patient Outcomes. Telemed J E Health 2021; 27:1029-1038. [DOI: 10.1089/tmj.2020.0334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Cindy A. Crump
- Doctoral Program in Health-Related Sciences, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Christian Wernz
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Statistical Sciences, Operations Research, and College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Loretta Schlachta-Fairchild
- Doctoral Program in Health-Related Sciences, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ernest Steidle
- Doctoral Program in Health-Related Sciences, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Angela Duncan
- Department of Patient Counseling, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lauretta Cathers
- Doctoral Program in Health-Related Sciences, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
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13
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Rush KL, Seaton C, Li E, Oelke ND, Pesut B. Rural use of health service and telemedicine during COVID-19: The role of access and eHealth literacy. Health Informatics J 2021; 27:14604582211020064. [PMID: 34041936 DOI: 10.1177/14604582211020064] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The COVID-19 pandemic has driven a greater reliance on telemedicine, yet rural access, use, and satisfaction with telemedicine and the role of eHealth literacy are unknown. Using a cross-sectional design, 279 (70.6% female) western rural Canadians completed an online survey. The majority of participants reported access to telemedicine, but nearly 1/5 lacked access to online or virtual mental health services. The majority of participants had used health care services following the declared COVID-19 pandemic in North America, and just under half had used telemedicine. Telemedicine satisfaction scores were higher among participants who had used video (M = 4.18) compared to those who used phone alone (M = 3.79) (p = 0.031). Telemedicine satisfaction and eHealth literacy were correlated (r = 0.26, p = 0.005). Participants did not want telemedicine to replace in-person consultations. Telemedicine practice requires that rural residents have the resources, ability and willingness to engage with remote care.
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Affiliation(s)
| | | | - Eric Li
- University of British Columbia-Okanagan, Canada
| | - Nelly D Oelke
- University of British Columbia-Okanagan, Canada.,Rural Coordination Centre of British Columbia, Canada
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Al-Busaidi IS, Clare GC, Joyce LR, Pearson S, Lainchbury J, Than M, Troughton RW. Presentation, Treatment and Long-Term Outcomes of a Multidisciplinary Acute Atrial Fibrillation Pathway: A 12-Month Follow-Up Study. Heart Lung Circ 2021; 31:216-223. [PMID: 34210615 DOI: 10.1016/j.hlc.2021.05.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/01/2021] [Accepted: 05/16/2021] [Indexed: 11/17/2022]
Abstract
AIM Atrial fibrillation/flutter (AF/AFL) is associated with high rates of emergency department (ED) visits and acute hospitalisation. A recently established multidisciplinary acute AF treatment pathway seeks to avoid hospital admissions by early discharge of haemodynamically stable, low risk patients from the ED with next-working-day return to a ward-based AF clinic for further assessment. We conducted a preliminary analysis of the clinical outcomes of this pathway. METHODS We retrospectively reviewed clinical records of all patients assessed at the AF clinic at Christchurch Hospital over a 12-month period. Data related to presentation, patient characteristics, treatment, and 12-month outcomes were analysed. RESULTS A total of 143 patients (median age 65, interquartile range: 57-74 years, 59% male, 87% European) were assessed. Of these, 87 (60.8%) presented with their first episode of AF/AFL. Spontaneous cardioversion occurred in 41% at ED discharge, and this increased to 73% at AF clinic review. Electrical cardioversion was subsequently performed in 16 patients (11.2%), and 16 (11.2%) ultimately required hospital admission (eight to facilitate electrical cardioversion). At a median of 1 day, 83.9% were discharged from the AF clinic in sinus rhythm. During 12-month follow-up, there were 25 AF-related hospitalisations (20 patients, 14%) and one patient underwent electrical cardioversion; additionally, one patient had had a stroke and eight had bleeding complications giving a combined outcome rate of 6.3%. CONCLUSION Utilising a rate-control strategy with ED discharge and early return to a dedicated AF clinic can safely prevent the majority of hospitalisations, avert unnecessary procedures, and facilitate longitudinal care.
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Affiliation(s)
- Ibrahim S Al-Busaidi
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand.
| | - Geoffrey C Clare
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Laura R Joyce
- Department of Surgery, University of Otago, Christchurch, New Zealand; Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - Scott Pearson
- Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - John Lainchbury
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Martin Than
- Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - Richard W Troughton
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
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15
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16
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Cacchione PZ. Special Issue: Nursing Research Advancing Cardiac Care. Clin Nurs Res 2020; 28:127-129. [PMID: 30789030 DOI: 10.1177/1054773818822855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rush KL, Burton L, Van Der Merwe F, Hatt L, Galloway C. Atrial fibrillation care in rural communities: a mixed methods study of physician and patient perspectives. BMC FAMILY PRACTICE 2019; 20:144. [PMID: 31651259 PMCID: PMC6813979 DOI: 10.1186/s12875-019-1029-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/20/2019] [Indexed: 02/04/2023]
Abstract
Background Atrial fibrillation (AF) is a serious heart arrhythmia associated with devastating outcomes such as stroke. Inequitable rural AF care may put patients at risk. Virtually delivered specialty AF care offers a viable option, but stakeholder perceptions of this option within the context of rural AF care is unknown. The study purpose was to obtain patient and primary care physician perspectives of rural AF care and virtually delivered AF care as a potential option. Methods Using a mixed methods design, AF patients (n = 101) and physicians (n = 15) from three rural communities participated in focus groups and/or surveys. Focus group data were thematically analyzed, survey data were descriptively analyzed, and data were triangulated. Results Findings captured patients’ and physicians’ perceptions of prioritized, needs, concerns and problems in AF management, available/unavailable services, and their ideas about virtual AF care. Patients and physicians identified eclectic problems in managing AF. Overall, patients felt ill informed about managing their AF and their most salient problems related to fatigue, exercise intolerance, weight maintenance, sleep apnea, and worry about stroke and bleeding. Physicians found treating patients with co-morbidities and cognitive decline problematic and balancing risks related to anticoagulation challenging. Patients and physicians identified education as a pressing need, which physicians lacked time and resources to meet. Despite available rural services, access to primary and cardiology care was a recurring challenge, and emergency department (ED) use highly contentious but often the only option for accessing care. Physicians’ managed AF care and varied in the referrals they made, often reserving them for complex situations to avoid patient travel. Patients and providers supported a broad approach to virtual AF care, tailored to an inclusive rural patient demographic. Conclusions The study offered valuable physician and patient perspectives on AF care in rural communities including diverse management challenges, gaps in access to primary and specialty services that made ED an often used but contentious option. Findings point to the potential value of virtual care designed to reach patients with AF across the spectrum and geared to local contexts that preserve the vital role of primary care physicians in AF care in their communities.
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Affiliation(s)
- Kathy L Rush
- School of Nursing, University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Lindsay Burton
- School of Nursing, University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | | | - Linda Hatt
- University of British Columbia Okanagan, Psychology, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Camille Galloway
- School of Nursing, University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
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Alami H, Gagnon MP, Fortin JP. Some Multidimensional Unintended Consequences of Telehealth Utilization: A Multi-Project Evaluation Synthesis. Int J Health Policy Manag 2019; 8:337-352. [PMID: 31256566 PMCID: PMC6600023 DOI: 10.15171/ijhpm.2019.12] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/25/2019] [Indexed: 01/28/2023] Open
Abstract
Background: Telehealth initiatives have bloomed around the globe, but their integration and diffusion remain challenging because of the complex issues they raise. Available evidence around telehealth usually deals with its expected effects and benefits, but its unintended consequences (UCs) and influencing factors are little documented. This study aims to explore, describe and analyze multidimensional UCs that have been associated with the use of telehealth.
Methods: We performed a secondary analysis of the evaluations of 10 telehealth projects conducted over a 22-year period in the province of Quebec (Canada). All material was subjected to a qualitative thematic-pragmatic content analysis with triangulation of methodologies and data sources. We used the conceptual model of the UCs of health information technologies proposed by Bloomrosen et al to structure our analysis.
Results: Four major findings emerged from our analysis. First, telehealth utilization requires many adjustments, changes and negotiations often underestimated in the planning and initial phases of the projects. Second, telehealth may result in the emergence of new services corridors that disturb existing ones and involve several adjustments for organizations, such as additional investments and resources, but also the risk of fragmentation of services and the need to balance between standardization of practices and local innovation. Third, telehealth may accentuate power relations between stakeholders. Fourth, it may lead to significant changes in the responsibilities of each actor in the supply chain of services. Finally, current legislative and regulatory frameworks appear ill-adapted to many of the new realities brought by telehealth.
Conclusion: This study provides a first attempt for an overview of the UCs associated with the use of telehealth. Future research-evaluation studies should be more sensitive to the multidimensional and interdependent factors that influence telehealth implementation and utilization as well as its impacts, intended or unintended, at all levels. Thus, a consideration of potential UCs should inform telehealth projects, from their planning until their scaling-up.
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Affiliation(s)
- Hassane Alami
- Institute of Health and Social Services in Primary Care, Research Center on Healthcare and Services in Primary Care, Laval University, Quebec City, QC, Canada.,Research Center of Quebec City University Hospital Center, St-François d'Assise Hospital, Quebec City, QC, Canada
| | - Marie-Pierre Gagnon
- Institute of Health and Social Services in Primary Care, Research Center on Healthcare and Services in Primary Care, Laval University, Quebec City, QC, Canada.,Research Center of Quebec City University Hospital Center, St-François d'Assise Hospital, Quebec City, QC, Canada.,Faculty of Nursing Science, Laval University, Quebec City, QC, Canada
| | - Jean-Paul Fortin
- Institute of Health and Social Services in Primary Care, Research Center on Healthcare and Services in Primary Care, Laval University, Quebec City, QC, Canada.,Research Center of Quebec City University Hospital Center, St-François d'Assise Hospital, Quebec City, QC, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
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Rush KL, Burton L, Schaab K, Lukey A. The impact of nurse-led atrial fibrillation clinics on patient and healthcare outcomes: a systematic mixed studies review. Eur J Cardiovasc Nurs 2019; 18:526-533. [DOI: 10.1177/1474515119845198] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Atrial fibrillation, the most common arrhythmia worldwide, continues to increase as the population ages. Patients with atrial fibrillation, particularly those newly diagnosed or who have multiple comorbidities, have high healthcare utilisation rates. Nurse-led atrial fibrillation clinics have developed to improve care and guidance for atrial fibrillation patients, with the potential to reduce hospital presentations and healthcare utilisation. Atrial fibrillation clinics that provide specialised and patient-centred care have improved patient symptom management, quality of life and reduced healthcare utilisation and costs. Aims: The aim of this study was to provide the first synthesis of evidence for the impact of nurse-led atrial fibrillation clinics on patient, healthcare utilisation, and quality of care outcomes. Methods: This systematic mixed studies review examined citations from three databases: Medline, CINAHL and Embase, using the search terms ‘atrial fibrillation’ and ‘clinic’, and related concepts. Seventeen moderate to high quality articles were selected. Results: Overall, atrial fibrillation clinics were more cost effective, had shorter wait times and reduced hospitalisation and emergency department visits. Symptoms and sinus rhythm restoration were comparable in the nurse-led compared to physician-led cardioversion clinics. Findings related to patient knowledge and patient satisfaction were mixed, while mortality rates were lower, and patient medication adherence was higher in nurse-led atrial fibrillation compared to usual care. Quality of life and guideline adherence was increased in patients receiving nurse-led atrial fibrillation care compared to usual care. Conclusion: Nurse-led clinics improved healthcare, patient and quality care outcomes. Future research might examine the role of technology in delivery of nurse-led clinics in rural/remote areas as well as patient experiences with nurse-led clinics.
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Affiliation(s)
- Kathy L Rush
- Faculty of Health and Social Development, University of British Columbia, Canada
| | - Lindsay Burton
- School of Nursing, University of British Columbia, Canada
| | - Kira Schaab
- University of Medicine and Health Sciences, St Kitts
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Stroupe KT, Martinez R, Hogan TP, Evans CT, Scholten J, Bidelspach D, Osteen C, Taylor BC, Smith BM. Health Care Utilization and Costs of Veterans Evaluated for Traumatic Brain Injury Through Telehealth. Telemed J E Health 2019; 25:1144-1153. [PMID: 30874499 DOI: 10.1089/tmj.2018.0182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Mild traumatic brain injury (TBI) is prevalent among Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]) Veterans. With clinical video telehealth (CVT), Veterans screening positive for potential deployment-related TBI can receive comprehensive TBI evaluations by providers at specialized centers through interactive video communication. Introduction: We examined health care utilization and costs for Veterans during the 12 months before and after being evaluated through CVT versus in-person. Materials and Methods: We examined OEF/OIF Veterans receiving comprehensive evaluations at specialized Veterans Affairs facilities from October 2012 to September 2014. Veterans evaluated through CVT and in-person at the same facilities were included. We used a difference-in-difference analysis with propensity score weighted regression models to examine health care utilization and costs between TBI evaluation groups. Results: There were 554 Veterans with comprehensive evaluations through CVT (380 with and 174 without confirmed TBI) and 7,159 with in-person evaluations (4,899 with and 2,260 without confirmed TBI). Veterans in the in-person group with confirmed TBI had similar increases in outpatient, inpatient, and total health care costs as Veterans who had TBI confirmed through CVT. However, Veterans with a confirmed TBI evaluated in-person had greater increases in rehabilitation and other specialty costs. Discussion: When visits are in-person, Veterans may have opportunities to discuss more issues and concerns, whether TBI-related or not. Thus, providers might make more referrals to rehabilitation and specialty care after in-person visits. Conclusion: Veterans receiving in-person evaluations who were diagnosed with TBI had similar increases in health care costs as Veterans with TBI confirmed through evaluations through CVT.
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Affiliation(s)
- Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois.,Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Rachael Martinez
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois.,Department of Preventive Medicine and Center for Health Care Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joel Scholten
- Physical Medicine and Rehabilitation, Rehabilitation and Prosthetics Service, VA Central Office, Washington, District of Columbia
| | - Douglas Bidelspach
- Physical Medicine and Rehabilitation, Rehabilitation and Prosthetics Service, VA Central Office, Washington, District of Columbia
| | - Chad Osteen
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois
| | - Brent C Taylor
- Department of Veterans Affairs Health Care System, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota.,Division of Epidemiology, Department of Medicine, Community Health University of Minnesota, Minneapolis, Minnesota
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Salmasi S, Kwan L, MacGillivray J, Bansback N, De Vera MA, Barry AR, Harrison MJ, Andrade J, Lynd LD, Loewen P. Assessment of atrial fibrillation patients' education needs from patient and clinician perspectives: A qualitative descriptive study. Thromb Res 2019; 173:109-116. [DOI: 10.1016/j.thromres.2018.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/13/2018] [Accepted: 11/15/2018] [Indexed: 01/17/2023]
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