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Smart S, Imms D, Brewer M. Virtual nourishment: Paediatric feeding disorder management with telepractice amidst COVID-19: An allied health perspective. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-11. [PMID: 37933463 DOI: 10.1080/17549507.2023.2264550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE The rapid adoption of telepractice services by health professionals was necessary to maintain service continuity for children with paediatric feeding disorders during the COVID-19 pandemic, during periods where in-person therapy was restricted. The aim of this study was to explore clinical perspectives and reflections on the use of telepractice for managing paediatric feeding disorders during the pandemic. METHOD A post-positivist qualitative approach using thematic analysis was adopted. This study seeks to understand participants' experiences and thoughts from allied health professionals from speech-language pathology, occupational therapy, and dietetics working with paediatric feeding in Western Australia. All participants delivered at least 10 telepractice sessions to children from birth to 12 years with a paediatric feeding disorder. Braun and Clarke's six-step thematic analysis process was used to analyse the data inductively. RESULT Eleven allied health professionals representing eight clinical settings in Western Australia, including speech-language pathology, occupational therapy, and dietetics, working with paediatric feeding were recruited. The results revealed four themes: families becoming the catalyst of change, clinician comfort over confidence, insights into authentic mealtimes, and the paradox of choice. CONCLUSION This study highlighted the need to build clinicians' confidence and competence, and the provision of service guidelines and training. Although many clinicians had positive experiences with telepractice, most returned to in-person delivery once COVID-19 restrictions were lifted, emphasising the importance of comfort in service delivery selection. We recognise that the findings of this study are constrained by the fact that it was conducted in a single geographical region and utilised a small qualitative sample. While telepractice was successful in managing paediatric feeding disorders, further development and implementation of telepractice guidelines are needed for telepractice to be a viable service delivery option for families and children with feeding disorders.
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Harshman S, Sierra‐Velez D, Daigle K, Hersh C, Risley K, Arauz Boudreau AD, Matathia S, Fiechtner L, Simione M. Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening. Pediatr Investig 2023; 7:43-48. [PMID: 36967737 PMCID: PMC10030687 DOI: 10.1002/ped4.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/03/2023] [Indexed: 02/12/2023] Open
Affiliation(s)
- Stephanie Harshman
- Neuroendocrine UnitMassachusetts General HospitalBostonMassachusettsUSA
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA
- Department of Gastroenterology and NutritionMass General for ChildrenBostonMassachusettsUSA
| | - Desiree Sierra‐Velez
- Department of Gastroenterology and NutritionMass General for ChildrenBostonMassachusettsUSA
| | - Kelly Daigle
- Neuroendocrine UnitMassachusetts General HospitalBostonMassachusettsUSA
| | - Cheryl Hersh
- Department of SpeechLanguage and Swallowing DisordersMassachusetts General HospitalBostonMassachusettsUSA
| | - Kristen Risley
- Performance Analysis and Improvement UnitMassachusetts General Hospital BostonBostonMassachusettsUSA
- Massachusetts General Physicians OrganizationBostonMassachusettsUSA
| | - Alexy D. Arauz Boudreau
- Massachusetts General Physicians OrganizationBostonMassachusettsUSA
- Division of General Academic PediatricsMass General for ChildrenBostonMassachusettsUSA
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
| | - Sarah Matathia
- Division of General Academic PediatricsMass General for ChildrenBostonMassachusettsUSA
- Division of General Internal MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Lauren Fiechtner
- Department of Gastroenterology and NutritionMass General for ChildrenBostonMassachusettsUSA
- Division of General Academic PediatricsMass General for ChildrenBostonMassachusettsUSA
- Greater Boston Food BankBostonMassachusettsUSA
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
| | - Meg Simione
- Division of General Academic PediatricsMass General for ChildrenBostonMassachusettsUSA
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
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Hawks C, Al-Zubaidi M, Viswambaram P, Gonsalves J, Brown M, Byrnes J, Hayne D. Analysis of the financial impact and efficiency of the One Stop Prostate Clinic: A same day prostate cancer diagnostic clinic in the Australian public health system. J Public Health Res 2023; 12:22799036221146882. [PMID: 36643606 PMCID: PMC9834939 DOI: 10.1177/22799036221146882] [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: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023] Open
Abstract
Background Access to prostate cancer diagnostic clinics are challenging for rural men in Western Australia due to remoteness and long travel distances. The One Stop Prostate Clinic (OSPC) provided same day assessment and diagnosis for prostate cancer in a public tertiary hospital to reduce access barriers for rural men. The objective of this study was to determine the financial and resource utilisation impact of the OSPC compared to a usual care pathway (UCP). Design and methods Study design: Cost minimisation analysis of the OSPC model (assuming 100% new referrals) compared with a UCP, including impact on the Patient Assisted Transport Scheme (PATS) for rural men. An estimate of total cost comparison of OSPC and UCP pathways of outpatient and diagnostic costs was calculated based on journey mapping of attendance and follow up. Methods Prospective data collection between August 2011 and November 2017 of referral, attendance and follow up outcomes. Journey mapping to identify time from referral to diagnosis, number of outpatient appointment (OPA) and travel savings. Results A total of 1000 men attended - 466 (47%) rural and 534 (53%) metro. Mean time from referral to diagnosis was 57 days (rural) versus 63 (metro; p = 0.034)). The OSPC saved 543 travel episodes (distance of 1.5M km) and 658 OPA's. Total episode of care costs for the OSPC (100% new) pathway estimated as $2237.34, compared to $2847.00 for a UCP, generating savings of $609.66 per attendance ($609,658.22 overall). Conclusion The OSPC was more cost effective and efficient in comparison to a UCP.
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Affiliation(s)
| | - Mohammed Al-Zubaidi
- Fiona Stanley Hospital, Murdoch, WA,
Australia,Mohammed AM Ali Al-Zubaidi, Fiona Stanley
Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia.
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DiFabio D, Moodie S, O’Hagan R, Pardal S, Glista D. Barriers and facilitators to paediatric caregivers' participation in virtual speech, language, and hearing services: A scoping review. Digit Health 2023; 9:20552076231216684. [PMID: 38033515 PMCID: PMC10687955 DOI: 10.1177/20552076231216684] [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: 11/08/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose Virtual care-related technologies are transforming the way in which health services are delivered. A growing number of studies support the use of virtual care in the field of audiology and speech-language pathology; however, there remains a need to identify and understand what influences caregiver participation within the care that is virtual and family-focused. This review aimed to identify, synthesize, and summarize the literature around the reported barriers and facilitators to caregiver participation in virtual speech/hearing assessment and/or intervention appointments for their child. Methods A scoping review was conducted following the Joanna Briggs Institute manual for evidence synthesis. A search was conducted using six databases including MEDLINE, CINAHL, SCOPUS, ERIC, Nursing and Allied Health, and Web of Science to collect peer-reviewed studies of interest. Data was extracted according to a protocol published on Figshare, outlining a predefined data extraction form and search strategy. Results A variety of service delivery models and technology requirements were identified across the 48 included studies. Caregiver participation was found to vary across levels of attendance and involvement according to eight categories: Attitudes, child behavioral considerations, environment, opportunities, provider-family relationship, role in care process, support, and technology. Conclusions This review presents a description of the key categories reported to influence caregiver participation in virtual care appointments. Future research is needed to explore how the findings can be used within family-centered care models to provide strategic support benefiting the use and outcomes of virtual care.
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Affiliation(s)
- Danielle DiFabio
- School of Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Sheila Moodie
- School of Health and Rehabilitation Sciences, Western University, London, ON, Canada
- The National Centre for Audiology, Western University, London, ON, Canada
- The School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - Robin O’Hagan
- The National Centre for Audiology, Western University, London, ON, Canada
| | - Simrin Pardal
- School of Health Studies, Western University, London, ON, Canada
| | - Danielle Glista
- School of Health and Rehabilitation Sciences, Western University, London, ON, Canada
- The National Centre for Audiology, Western University, London, ON, Canada
- The School of Communication Sciences and Disorders, Western University, London, ON, Canada
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Ward EC, Raatz M, Marshall J, Wishart LR, Burns CL. Telepractice and Dysphagia Management: The Era of COVID-19 and Beyond. Dysphagia 2022; 37:1386-1399. [PMID: 35428923 PMCID: PMC9012247 DOI: 10.1007/s00455-022-10444-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic drove rapid and widespread uptake of telepractice across all aspects of healthcare. The delivery of dysphagia care was no exception, with telepractice recognized as a service modality that could support social distancing/infection control, overcome service delivery challenges created by lockdowns/service closures, and address consumer concerns about attending in-person appointments. Now, almost two years since most services first rapidly deployed telepractice, it is time to reflect on the big picture, and consider how telepractice will continue as a service option that is sustained and integrated into mainstream dysphagia care. It is also timely to consider the research agenda needed to support this goal. To this end, in this paper we present 4 discussion topics, which raise key considerations for the current and future use of telepractice within adult and pediatric dysphagia services. These are (1) Dysphagia services must meet consumer and service needs; (2) Aspects of dysphagia services can be safely and reliably provided via telepractice; (3) Telepractice can be used in flexible ways to support the delivery of dysphagia services; and (4) Providing quality dysphagia services via telepractice requires planned implementation and evaluation. Then directions for future research are discussed. These considerations are presented to help shift perspectives away from viewing telepractice as simply a COVID-19 "interim-care solution". Rather, we encourage clinicians, services, and researchers to embrace a future of "integrated care", where traditional dysphagia services are combined with telepractice models, to enhance the quality of care provided to our clients.
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Affiliation(s)
- Elizabeth C. Ward
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD 4102 Australia ,School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Madeline Raatz
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Queensland Children’s Hospital, Brisbane, QLD Australia
| | - Jeanne Marshall
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Queensland Children’s Hospital, Brisbane, QLD Australia
| | - Laurelie R. Wishart
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD 4102 Australia ,School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Clare L. Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Brisbane, QLD Australia
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Ryan M, Carrington C, Ward EC, Burns CL, Cuff K, Mackinnon M, Snoswell CL. Changing from telephone to videoconference for pre-treatment pharmacist consults in cancer services: Impacts to funding and time efficiency. J Telemed Telecare 2021; 27:680-684. [PMID: 34726996 DOI: 10.1177/1357633x211048393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: This study examined the reimbursement opportunity and the time efficiency of a standard care model of unscheduled telephone consults compared to scheduled videoconference consults for obtaining pre-treatment medication histories for patients with cancer. Methods: Data related to (a) the available and the claimed activity-based funding for both models and (b) the number of contacts and the duration of each contact to complete the patient's medication history via either unscheduled telephone or scheduled videoconference consults were collected and compared. Results: Data was collected for 86 telephone and 56 videoconference consults. The actual activity-based funding claimed for telephone consults was $0, even though $86 of activity-based funding was available for each consult. This represented a $0 reimbursement for the staff time spent conducting the telephone consults, and a missed opportunity to claim $86 per consult. Activity-based funding was claimed for all but one videoconference consult with an average of $205 received per consult, when $221 per consult was available. Videoconference consults were an average of 2.3 min shorter than telephone consults. Discussion: When compared to unscheduled telephone consults, the scheduled videoconference consults represented increased reimbursement and equivalent time efficiency for the cancer pharmacist completing pre-treatment medication histories.
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Affiliation(s)
- Marissa Ryan
- Pharmacy Department, 1966Princess Alexandra Hospital, Brisbane, Australia.,Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Christine Carrington
- Pharmacy Department, 1966Princess Alexandra Hospital, Brisbane, Australia.,School of Pharmacy, 1974The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, 157829Metro South Hospital and Health Service, Brisbane, Australia.,School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, Australia.,Speech Pathology Department, 3883Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Katharine Cuff
- Division of Cancer Services, 1966Princess Alexandra Hospital, Brisbane, Australia
| | - Mhairi Mackinnon
- Division of Cancer Services, 1966Princess Alexandra Hospital, Brisbane, Australia
| | - Centaine L Snoswell
- Pharmacy Department, 1966Princess Alexandra Hospital, Brisbane, Australia.,Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia.,School of Pharmacy, 1974The University of Queensland, Brisbane, Australia
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Evaluating the Use of Telepractice for Bottle-Feeding Assessments. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8110989. [PMID: 34828701 PMCID: PMC8625576 DOI: 10.3390/children8110989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
There is currently limited evidence supporting the use of telepractice to conduct bottle-feeding assessments. This study aimed to investigate the inter-rater reliability of bottle-feeding assessments conducted via synchronous telepractice (real-time videoconferencing). Secondary aims were to investigate parent and clinician satisfaction. Bottle-feeding skills of 30 children (aged 1 month-2 years) were simultaneously assessed by a telepractice SP (T-SP) at a remote location and an in-person SP (IP-SP) at the family home. A purpose-designed assessment form was used to evaluate: (1) developmental level (screen only), (2) state, color, and respiration, (3) oral motor skills, (4), infant oral reflexes, (5) tongue tie (screen only), (6) non-nutritive suck, (7) bottle-feeding, (8) overall feeding skills and (9) recommendations. Results of the T-SP and IP-SP assessments were compared using agreement statistics. Parents reported perceptions of telepractice pre and post session, and also rated post-session satisfaction. The telepractice SP completed a satisfaction questionnaire post-appointment. The majority of assessment components (45/53, 85%) met the agreement criteria (≥80% exact agreement). Difficulties were noted for the assessment of palate integrity, gagging during non-nutritive suck assessment, and 6 components of the tongue tie screen. Parent and clinician satisfaction was high; SPs reported that they would offer telepractice services to 93% of families again in the future. Overall, the results demonstrated that most components of a bottle-feeding assessment could be reliably completed via synchronous telepractice in family homes. However, further research is required to improve the reliability of some intra-oral assessment components.
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