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Siebelink NM, Gaasterland A, Gielissen M, van der Weegen S, Boon B, van der Poel A. Barriers and facilitators influencing implementation of care technology for people with intellectual disabilities: A cross-sectional study among care professionals. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13262. [PMID: 38946655 DOI: 10.1111/jar.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 02/26/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Implementation issues often hinder reaching the potential of care technology to improve daily lives of people with intellectual disabilities. We investigated barriers to and facilitators of implementing different technology modalities (app/social robot/sensor/domotics) in long-term care. METHOD Care professionals (N = 83) from 12 Dutch disability care organisations completed a customised measurement instrument for determinants of innovations (MIDI) questionnaire. RESULTS Out of 27 determinants, 20 were identified as facilitators and 16 as barriers. We highlight common barriers: few colleagues who work with the technology; no (awareness of) formal ratification of technology use; no arrangements regarding turnover of staff using the technology; unsettling organisational changes; technological defects and limited IT preconditions. CONCLUSIONS The results, which could be combined and compared across study sites, provide insight into which implementation determinants were already well addressed, and where there is ground to gain when implementing care technology in disability care organisations.
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Affiliation(s)
- Nienke M Siebelink
- Research & Advisory on Technology in Long-term Care, Academy Het Dorp, Arnhem, The Netherlands
| | | | - Marieke Gielissen
- Research & Advisory on Technology in Long-term Care, Academy Het Dorp, Arnhem, The Netherlands
- Center for Long-term Care for People with Disabilities, Siza, Arnhem, The Netherlands
| | - Sanne van der Weegen
- National Centre of Expertise for Long-term Care, Vilans, Utrecht, The Netherlands
| | - Brigitte Boon
- Research & Advisory on Technology in Long-term Care, Academy Het Dorp, Arnhem, The Netherlands
- Center for Long-term Care for People with Disabilities, Siza, Arnhem, The Netherlands
- Tranzo Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Agnes van der Poel
- Research & Advisory on Technology in Long-term Care, Academy Het Dorp, Arnhem, The Netherlands
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Li L, Miguel M, Phillips C, Verweel L, Wasilewski MB, MacKay C. A qualitative study exploring healthcare professionals' perceptions of lower limb 3D printed sockets. Disabil Rehabil 2024; 46:4033-4039. [PMID: 37766382 DOI: 10.1080/09638288.2023.2258345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/15/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The purpose of this study was to explore healthcare professionals' (HCPs) perceptions and experiences related to 3D scanning and 3D printing for fabricating lower limb prosthetic sockets. MATERIALS AND METHODS This study used a qualitative descriptive approach. Participants were recruited through HCPs' professional associations, social media posts, and snowball sampling. Purposive sampling was used to attain variation in provider type. One-on-one telephone interviews were conducted using a semi-structured interview guide. Inductive thematic analysis was performed to identify the main themes. RESULTS Three themes were identified: (1) 3D scanning of the residual limb for designing prosthetic sockets is perceived as clean, quick, and convenient; (2) concerns about the strength and safety of 3D printed sockets for long-term use; (3) Adoption of 3D scanning and 3D printing technology for fabricating prosthetic sockets. CONCLUSION We identified perceived benefits and challenges with digital technologies for fabricating prosthetic sockets. To increase adoption, more research demonstrating its efficacy compared to conventional methods, increasing 3D printing material quality, and improving software training programs are needed.Implications for Rehabilitation3D printing and 3D scanning are emerging digital technologies that can be used as alternative methods for prosthetic socket manufacturing in the field of rehabilitation.Our research identified perceived benefits of using digital technologies for fabricating prosthetics sockets (3D scanning is perceived as clean, quick, and convenient) and perceived challenges (concerns about the strength and safety of 3D printed sockets for long-term use and a prolonged learning curve).To increase adoption of these digital technologies, more training should be provided to prosthetists and support provided to integrate new processes into staff workloads.
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Affiliation(s)
- Lynn Li
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Marian Miguel
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Clara Phillips
- West Park Healthcare Centre, Toronto, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Lee Verweel
- West Park Healthcare Centre, Toronto, Canada
| | - Marina B Wasilewski
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Crystal MacKay
- West Park Healthcare Centre, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Park J, Ahn H. Translating innovative technology-based interventions into nursing practice. Res Nurs Health 2024; 47:366-367. [PMID: 38752681 DOI: 10.1002/nur.22392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 07/11/2024]
Affiliation(s)
- Juyoung Park
- College of Nursing, The University of Arizona, Tucson, Arizona, USA
| | - Hyochol Ahn
- College of Nursing, The University of Arizona, Tucson, Arizona, USA
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Elkefi S. Supporting patients' workload through wearable devices and mobile health applications, a systematic literature review. ERGONOMICS 2024; 67:954-970. [PMID: 37830977 DOI: 10.1080/00140139.2023.2270780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 08/25/2023] [Indexed: 10/14/2023]
Abstract
Patients face a challenging workload in their course of care. In this study, we investigate the impact of using mobile health technologies in supporting this workload and identify the system challenges of its application through a systematic review of the literature published in the last two decades following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Reviews and Meta-Analysis guidelines PRISMA guidelines. Twenty-two studies that satisfied the inclusion criteria were included. The review revealed various mobile health and wearable devices used to support mental demand, physical demand, frustration, and performance. Better outcomes were related to mobile health use in healthcare for patients in different settings. There were no applications of health that supported the temporal demand of patients. Some populations, such as cancer patients, need more than only physical demand. Mhealth devices are important in supporting the patients' workload in their daily activities and clinical settings.Practitioner summary: This review study shows the importance of mHealth and wearables in supporting patients' workload (physical, mental, emotional) but not the temporal load.
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Affiliation(s)
- Safa Elkefi
- Nursing School, Columbia University, New York, NY, USA
- HPHACTORS Lab, NYC, USA
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Andersen ER, Hofmann BM, Brandsæter IØ, Kjelle E. Reducing low-value imaging-A qualitative evaluation of a pilot intervention in Norway. J Eval Clin Pract 2024. [PMID: 39031620 DOI: 10.1111/jep.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/02/2024] [Indexed: 07/22/2024]
Abstract
RATIONAL Low-value radiological imaging threatens patient safety and efficient use of limited health resources. It is important to evaluate measures for reducing low-value utilisation, to learn and to improve. Accordingly, the objective of this study was to qualitatively evaluate a pilot intervention for reducing low-value imaging in Norway. METHODS Semi-structured interviews were conducted aimed at describing stakeholders' experience with a multicomponent pilot intervention consisting of a standardised procedure for referral assessment, a standardised return letter, and information about the value and possible risks of magnetic resonance imaging-examinations to the public. Data were analysed in line with qualitative content analysis with a deductive approach. RESULTS Seven healthcare providers were interviewed, including two radiologists, two radiographers, one manual therapist, one practice consultant and one general practitioner. Data analysis yielded four categories: (1) information and reception, (2) referral- and assessment processes, (3) suggestions for improvement and facilitation and (4) outcomes of the pilot intervention. CONCLUSIONS The pilot intervention was deemed acceptable, feasible, engaging and relevant. Specific training in the use of the new procedure was suggested to improve the intervention. The simple design, as well as the positive acceptance demonstrated and the few resources needed, make the pilot intervention and methodology highly relevant for other settings or when aiming to reduce the number of other low-value radiology examinations.
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Affiliation(s)
- Eivind Richter Andersen
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Ingrid Øfsti Brandsæter
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Elin Kjelle
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
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Soames J, Pettigrew LM. Electronic health record-based behaviour change interventions aimed at general practitioners in the UK: a mixed methods systematic review using behaviour change theory. BMJ Open 2024; 14:e080546. [PMID: 38816046 PMCID: PMC11141199 DOI: 10.1136/bmjopen-2023-080546] [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: 10/04/2023] [Accepted: 03/24/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVES Electronic health record (EHR) systems are used extensively in healthcare; their design can influence clinicians' behaviour. We conducted a systematic review of EHR-based interventions aimed at changing the clinical practice of general practitioners in the UK, assessed their effectiveness and applied behaviour change theory to identify lessons for other settings. DESIGN Mixed methods systematic review. DATA SOURCES MEDLINE, EMBASE, CENTRAL and APA PsycINFO were searched up to March 2023. ELIGIBILITY CRITERIA Quantitative and qualitative findings from randomised controlled trials (RCTs) controlled before-and-after studies and interrupted time series of EHR-based interventions in UK general practice were included. DATA EXTRACTION AND SYNTHESIS Quantitative synthesis was based on Cochrane's Synthesis without Meta-analysis. Interventions were categorised using the Behaviour Change Wheel and MINDSPACE frameworks and effectiveness determined by vote-counting using direction of effect. Inductive thematic synthesis was used for qualitative studies. RESULTS Database searching identified 3824 unique articles; 10 were included (from 2002 to 2021), comprising eight RCTs and two associated qualitative studies. Four of seven quantitative studies showed a positive effect on clinician behaviour and three on patient-level outcomes. Behaviour change techniques that may trigger emotions and required less cognitive engagement appeared to have positive effects. Qualitative findings indicated that interventions reassured clinicians of their decisions but were sometimes ignored. CONCLUSION Despite widespread use, there is little high quality, up-to-date experimental evidence evaluating the effectiveness of EHR-based interventions in UK general practice. The evidence suggested EHR-based interventions may be effective at changing behaviour. Persistent, simple action-oriented prompts appeared more effective than complex interventions requiring greater cognitive engagement. However, studies lacked detail in intervention design and theory behind design choices. Future research should seek to optimise EHR-based behaviour change intervention design and delineate limitations, providing theory-based justification for interventions. This will be of increasing importance with the growing use of EHRs to influence clinicians' decisions. PROSPERO REGISTRATION NUMBER CRD42022341009.
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Affiliation(s)
- Jamie Soames
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Luisa M Pettigrew
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Jutai JW, Hatoum F, Bhardwaj D, Hosseini M. Implementation of digital health technologies for older adults: a scoping review. FRONTIERS IN AGING 2024; 5:1349520. [PMID: 38784681 PMCID: PMC11112488 DOI: 10.3389/fragi.2024.1349520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/17/2024] [Indexed: 05/25/2024]
Abstract
The critical importance of technological innovation in home care for older adults is indisputable. Less well understood is the question of how to measure its performance and impact on the delivery of healthcare to older adults who are living with chronic illness and disability. Knowing how well digital technologies, such as smartphones, tablets, wearable devices, and Ambient Assisted Living Technologies (AAL) systems "work" should certainly include assessing their impact on older adults' health and ability to function in daily living but that will not guarantee that it will necessarily be adopted by the user or implemented by a healthcare facility or the healthcare system. Technology implementation is a process of planned and guided activities to launch, introduce and support technologies in a certain context to innovate or improve healthcare, which delivers the evidence for adoption and upscaling a technology in healthcare practices. Factors in addition to user acceptance and clinical effectiveness require investigation. Failure to appreciate these factors can result in increased likelihood of technology rejection or protracted procurement decision at the "adoption decision" stage or delayed or incomplete implementation or discontinuance (following initial adoption) during implementation. The aim of our research to analyze research studies on the effectiveness of digital health technologies for older adults to answer the question, "How well do these studies address factors that affect the implementation of technology?" We found common problems with the conceptualization, design, and methodology in studies of digital technology that have contributed to the slow pace of implementation in home care and long-term care. We recommend a framework for improving the quality of research in this critical area. Systematic Review Registration: https://archive.org/details/osf-registrations-f56rb-v1, identifier osf-registrations-f56rb-v1.
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Affiliation(s)
- Jeffrey W. Jutai
- Interdisciplinary School of Health Sciences and AGE-WELL Network of Centres of Excellence, University of Ottawa, Ottawa, ON, Canada
| | - Farah Hatoum
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Devvrat Bhardwaj
- School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, ON, Canada
| | - Marjan Hosseini
- School of Rehabilitation Sciences and AGE-WELL Network of Centres of Excellence, University of Ottawa, Ottawa, ON, Canada
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Vasiliou VS, Philia I, Drosatou C, Mitsi E, Tsakonas I. LeadinCare: A Qualitative Informed Digital Training Platform Development to Increase Physicians' Soft Communication Skills After COVID-19. PSYCHOL HEALTH MED 2024; 29:39-54. [PMID: 37131299 DOI: 10.1080/13548506.2023.2206144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
The post-COVID-19 pandemic era has placed new demands on physicians. One of these demands is the need to use targeted knowledge and soft communication skills, to address the psychosocial problems (e.g. vaccine hesitancy, fears) of individuals with Chronic Physical Illnesses (CPIs). Focusing on training physicians in targeted soft communication skills can help health care systems to address psychosocial-type problems. Yet, such training programs are rarely implemented, effectively.This study aimed to (a) understand physicians' implementation challenges when using soft communication skills during the COVID-19 pandemic; (b) identify beliefs, barriers, and facilitators that can influence physicians' behaviours to use soft communication skills; and (c) inform the content of the LeadinCare; a new digital training platform, designed to improve physicians' soft communication skills, by leveraging the TDF Theoretical Domain Framework (TDF).We conducted 14 in-depth semi-structured interviews with physicians in Greece, supporting non-COVID-19 cases with CPIs. We analyzed their data using inductive and deductive approaches.Physicians highlighted time, inability to see patients in person, absence of space for non-COVID-19 cases, and poor organizational procedures as barriers to using soft communication skills. Five TDF domains (beliefs) were identified as the most salient to inform the LeadinCare platform: (1) practical and well-organized knowledge; (2) skills that support patients and their relatives; (3) physicians' beliefs about capabilities to use the skills; (4) beliefs about consequences of using the skills (job satisfaction); and (5) the use of digital, interactive, and on-demand platforms (environmental context & resources). We mapped the domains in six narrative-based practices that informed the content of the LeadinCare.Physicians need skills that go beyond talking and towards cultivating resilience and flexibility.
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Affiliation(s)
- Vasilis S Vasiliou
- Postdoctoral Research Associate in Clinical and Health Psychology, Cardiff University, Cardiff, UK
- Clinical Psychologist & Postdoctoral Mixed Methods Research Associate, University of Oxford, Oxford, UK
| | - Issari Philia
- Department of Psychology, Laboratory for Qualitative Research in Psychology and Psychosocial Well-Being, National and Kapodistrian University of Athens, Athens Greece
| | - Constantina Drosatou
- Department of Psychology, Laboratory for Qualitative Research in Psychology and Psychosocial Well-Being, National and Kapodistrian University of Athens, Athens Greece
| | - Efi Mitsi
- Department of Psychology, Laboratory for Qualitative Research in Psychology and Psychosocial Well-Being, National and Kapodistrian University of Athens, Athens Greece
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Hareem A, Lee J, Stupans I, Park JS, Wang K. Benefits and barriers associated with e-prescribing in community pharmacy - A systematic review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100375. [PMID: 38145236 PMCID: PMC10746557 DOI: 10.1016/j.rcsop.2023.100375] [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: 08/06/2023] [Revised: 10/26/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Background The utilization of electronic prescribing is growing, prompted by lockdown measures during the COVID-19 pandemic. However, despite this increasing adoption, there is a notable dearth of consolidated evidence regarding the challenges and opportunities associated with the integration of electronic prescribing systems within the daily clinical practices of community pharmacists. Objective This paper aims to systematically review the community pharmacists' perspectives on barriers and facilitators to electronic prescribing, addressing the significant need for understanding how electronic prescribing impacts the workflow and decision-making processes of pharmacists, ultimately influencing the quality of patient care. Methods PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched from January 1, 2000, to October 25, 2022, using search terms related to electronic prescribing, computerised physician order entry, community/retail pharmacies, and pharmacists. Results A total of 28 studies were included in the systematic review. In these studies, community pharmacists perceived that design, interoperability, attitude towards e-prescribing technology, information quality, workflow, productivity, and accessible resources facilitated e-prescribing. In addition, the included studies emphasized the importance of technological support for the successful implementation of electronic prescribing systems. The system's design characteristics significantly improve e-prescribing technology's favourable effects. According to our review, it has been proposed that a poorly designed e-prescribing system can have a negative impact on the quality of care, implementation, and user satisfaction. In contrast, a well-designed system can significantly contribute to improvements. Conclusions The review highlighted that e-prescribing has both barriers and facilitators, with the quality of the system and its implementation influencing these factors. Technical issues and user acceptance (patient/prescribers/pharmacists) can act as barriers or enablers, highlighting the need for comprehensive consideration and monitoring of e-prescribing to identify and address potential issues.
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Thomassen EEK, Berg IJ, Kristianslund EK, Tveter AT, Østerås N. Willingness, perceived facilitators and barriers to use remote care among healthcare professionals - a cross-sectional study. BMC Health Serv Res 2023; 23:1307. [PMID: 38012633 PMCID: PMC10683299 DOI: 10.1186/s12913-023-10301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Remote care has the potential of improving access to timely care for people with inflammatory joint diseases (IJD), but there is limited knowledge on how this approach is regarded by healthcare professionals (HCP). This study aimed to examine willingness, perceived facilitators, and barriers to use remote care among HCP. METHODS Employees at 20 rheumatology departments in Norway received a digital survey containing 16 statements regarding willingness, perceived facilitators and barriers to use remote care. Statements were scored using numeric rating scales (NRS, 0-10, 10 = strongly agree), and analysed in linear regression models. Open-ended responses with participant-defined facilitators and barriers were analysed using qualitative manifest analysis. RESULTS A total of 130 participants from 17 departments completed the survey. The majority of participants were 45 years or older (n = 84, 54%), 54 (42%) were medical doctors, 48 (37%) nurses, and 27 (21%) were allied healthcare professionals, clinical leaders, or secretaries. A high willingness to use remote care was observed (median NRS: 9, IQR 8-10). The facilitator statement with the highest score was that patients save time and costs by using remote care, whereas the barrier statement with the highest score was the lack of physical examination. Willingness to use remote care was positively associated with the belief that patients wish to use it (β: 0.18, 95% CI: 0.00, 0.34), that patients in remission need less hospital visits (β: 0.30, 95% CI: 0.16, 0.43), and if remote care is widely adopted by co-workers (β: 0.27, 95% CI: 0.15, 0.39). Willingness was negatively associated with mistrust in the technical aspects of remote care (β: -0.26, 95% CI:-0.40, -0.11), and lack of physical examination (β: -0.24, 95% CI: -0.43, -0.06). The open-ended responses showed that technological equipment, eligible patients, user-friendly software, adequate training and work flow could be facilitators, but also that lack of these factors were considered barriers to use remote care. CONCLUSION This study showed that HCP have a high willingness to use remote care, and provides important new knowledge on perceived facilitators and barriers among HCP relevant for implementation of remote care for eligible patients with IJD.
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Affiliation(s)
| | - Inger Jorid Berg
- Centre for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Klami Kristianslund
- Centre for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Therese Tveter
- Centre for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Nina Østerås
- Centre for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Yudkin JS, Allicock MA, Atem FD, Galeener CA, Messiah SE, Barlow SE. The Use of Electronic Health Record Data to Identify Variation in Referral, Consent, and Engagement in a Pediatric Intervention for Overweight and Obesity: A Cross-Sectional Study. Popul Health Manag 2023; 26:365-377. [PMID: 37792388 DOI: 10.1089/pop.2023.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Clinical weight management programs face low participation. The authors assessed whether using electronic health record (EHR) data can identify variation in referral, consent, and engagement in a pediatric overweight and obesity (OW/OB) intervention. Using Epic EHR data collected between August 2020 and April 2021, sociodemographic and clinical diagnostic data (ie, International Classification of Disease [ICD] codes from visit and problem list [PL]) were analyzed to determine their association with referral, consent, and engagement in an OW/OB intervention. Bivariate analyses and multivariable logistic regression modeling were performed, with Bayesian inclusion criterion score used for model selection. Compared with the 581 eligible patients, referred patients were more likely to be boys (60% vs. 54%, respectively; P = 0.04) and have a higher %BMIp95 (119% vs. 112%, respectively; P < 0.01); consented patients were more likely to have a higher %BMIp95 (120% vs. 112%, respectively; P < 0.01) and speak Spanish (71% vs. 59%, respectively; P = 0.02); and engaged patients were more likely to have a higher %BMIp95 (117% vs. 112%, respectively; P = 0.03) and speak Spanish (78% vs. 59%, respectively; P < 0.01). The regression model without either ICD codes or PL diagnoses was the best fit across all outcomes, which were associated with baseline %BMIp95 and health clinic location. Neither visit nor PL diagnoses helped to identify variation in referral, consent, and engagement in a pediatric OW/OB intervention, and their role in understanding participation in such interventions remains unclear. However, additional efforts are needed to refer and engage younger girls with less extreme cases of OW/OB, and to support non-Hispanic families to consent.
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Affiliation(s)
- Joshua S Yudkin
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
| | - Marlyn A Allicock
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
| | - Folefac D Atem
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
| | - Carol A Galeener
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
| | - Sarah E Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
- Department of Pediatrics, McGovern Medical School, Houston, Texas, USA
| | - Sarah E Barlow
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Children's Health, Children's Medical Center Dallas, Dallas, Texas, USA
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Borges do Nascimento IJ, Abdulazeem H, Vasanthan LT, Martinez EZ, Zucoloto ML, Østengaard L, Azzopardi-Muscat N, Zapata T, Novillo-Ortiz D. Barriers and facilitators to utilizing digital health technologies by healthcare professionals. NPJ Digit Med 2023; 6:161. [PMID: 37723240 PMCID: PMC10507089 DOI: 10.1038/s41746-023-00899-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/01/2023] [Indexed: 09/20/2023] Open
Abstract
Digital technologies change the healthcare environment, with several studies suggesting barriers and facilitators to using digital interventions by healthcare professionals (HPs). We consolidated the evidence from existing systematic reviews mentioning barriers and facilitators for the use of digital health technologies by HP. Electronic searches were performed in five databases (Cochrane Database of Systematic Reviews, Embase®, Epistemonikos, MEDLINE®, and Scopus) from inception to March 2023. We included reviews that reported barriers or facilitators factors to use technology solutions among HP. We performed data abstraction, methodological assessment, and certainty of the evidence appraisal by at least two authors. Overall, we included 108 reviews involving physicians, pharmacists, and nurses were included. High-quality evidence suggested that infrastructure and technical barriers (Relative Frequency Occurrence [RFO] 6.4% [95% CI 2.9-14.1]), psychological and personal issues (RFO 5.3% [95% CI 2.2-12.7]), and concerns of increasing working hours or workload (RFO 3.9% [95% CI 1.5-10.1]) were common concerns reported by HPs. Likewise, high-quality evidence supports that training/educational programs, multisector incentives, and the perception of technology effectiveness facilitate the adoption of digital technologies by HPs (RFO 3.8% [95% CI 1.8-7.9]). Our findings showed that infrastructure and technical issues, psychological barriers, and workload-related concerns are relevant barriers to comprehensively and holistically adopting digital health technologies by HPs. Conversely, deploying training, evaluating HP's perception of usefulness and willingness to use, and multi-stakeholders incentives are vital enablers to enhance the HP adoption of digital interventions.
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Affiliation(s)
- Israel Júnior Borges do Nascimento
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226-3522, USA
| | - Hebatullah Abdulazeem
- Department of Sport and Health Science, Techanische Universität München, Munich, 80333, Germany
| | - Lenny Thinagaran Vasanthan
- Physical Medicine and Rehabilitation Department, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Edson Zangiacomi Martinez
- Department of Social Medicine and Biostatistics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Miriane Lucindo Zucoloto
- Department of Social Medicine and Biostatistics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Lasse Østengaard
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University Library of Southern Denmark, Odense, 5230, Denmark
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
| | - Tomas Zapata
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark.
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13
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Ong H, Ong J, Cheng R, Wang C, Lin M, Ong D. GPT Technology to Help Address Longstanding Barriers to Care in Free Medical Clinics. Ann Biomed Eng 2023; 51:1906-1909. [PMID: 37355478 DOI: 10.1007/s10439-023-03256-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/26/2023]
Abstract
The implementation of technology in healthcare has revolutionized patient-centered decision making by providing contextualized information about a patient's healthcare journey, leading to increased efficiency (Keyworth et al. in BMC Med Inform Decis Mak 18:93, 2018, https://doi.org/10.1186/s12911-018-0661-3 ). Artificial intelligence has been integrated within Electronic Health Records (EHR) to prompt screenings or diagnostic tests based on a patient's holistic health profile. While larger hospitals have already widely adopted these technologies, free clinics hold lower utilization of these advanced capability EHRs. The patient population at a free clinic faces a multitude of factors that limits their access to comprehensive care, thus requiring necessary efforts and measures to close the gap in healthcare disparities. Emerging Artificial Intelligence (AI) technology, such as OpenAI's ChatGPT, GPT-4, and other large language models (LLMs) have remarkable potential to improve patient care outcomes, promote health equity, and enhance comprehensive and holistic care in resource-limited settings. This paper aims to identify areas in which integrating these LLM AI advancements into free clinics operations can optimize and streamline healthcare delivery to underserved patient populations. This paper also identifies areas of improvements in GPT that are necessary to deliver those services.
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Affiliation(s)
- Hannah Ong
- College of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rebekah Cheng
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, USA
| | - Calvin Wang
- College of Medicine - Robert Wood Johnson, Rutgers University, New Brunswick, NJ, USA
| | - Murong Lin
- Distinguished Engineer, Verizon, San Jose, CA, USA
| | - Dennis Ong
- Amazon Web Services, Amazon, Seattle, WA, USA
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14
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Benziger CP, Suess M, Allen CI, Freitag LA, Asche SE, Ekstrom HL, Essien IJ, Muthineni A, Thirumalai V, Vo PH, Kromrey KA, Ronkainen EA, Saman DM, O'Connor PJ, Kharbanda EO. Adapting a clinical decision support system to improve identification of pediatric hypertension in a rural health system: Design of a pragmatic trial. Contemp Clin Trials 2023; 132:107293. [PMID: 37454727 PMCID: PMC11027719 DOI: 10.1016/j.cct.2023.107293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Identifying hypertension (HTN) early is crucial in preventing and lowering the long-term risk of heart disease, yet HTN in children often goes undiagnosed. An electronic health record linked, web-based clinical decision support (CDS) called PedsBP can help address this care gap and has been previously shown to increase recognition of HTN by primary care clinicians. OBJECTIVES To adapt the PedsBP tool for use in a mostly rural health system and then to evaluate the effectiveness of PedsBP for repeat of hypertensive level blood pressure (BP) measurements and HTN recognition among youth 6-17 years of age in primary care settings, comparing low-intensity and high-intensity implementation approaches. METHODS AND DESIGN PedsBP was evaluated through a pragmatic, clinic-randomized trial. The tool was piloted in 2 primary care clinics and modified prior to the full trial. Forty community-based, primary care clinics (or clusters of clinics) were randomly allocated in a 1:1:1 ratio to usual care, low-intensity implementation (CDS only), or high-intensity implementation (CDS plus in-person training, monthly use reports, and ongoing communication between study staff and clinics). Accrual of eligible patients started on August 1, 2022 and will continue for 18 months. Primary outcomes include repeating hypertensive level BP measurements at office visits and clinical recognition of HTN. Secondary outcomes include lifestyle counseling, dietician referral, and BP at follow-up. CONCLUSION This report focuses on the design and feasibility of adapting and implementing PedsBP in a rural primary care setting. The trial and analysis are ongoing with main results expected in mid-2024.
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Affiliation(s)
- Catherine P Benziger
- Essentia Health Heart and Vascular Center, Duluth, MN, United States of America.
| | - Madison Suess
- University of Minnesota Medical School, Duluth Campus, Duluth, MN, United States of America
| | - Clayton I Allen
- Essentia Institute of Rural Health, Duluth, MN, United States of America
| | - Laura A Freitag
- Essentia Institute of Rural Health, Duluth, MN, United States of America
| | - Stephen E Asche
- HealthPartners Institute, Bloomington, MN, United States of America
| | - Heidi L Ekstrom
- HealthPartners Institute, Bloomington, MN, United States of America
| | - Inih J Essien
- HealthPartners Institute, Bloomington, MN, United States of America
| | | | | | - Phuong H Vo
- HealthPartners Institute, Bloomington, MN, United States of America
| | - Kay A Kromrey
- HealthPartners Institute, Bloomington, MN, United States of America
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15
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McCall MP, Anton MT, Highlander A, Loiselle R, Forehand R, Khavjou O, Jones DJ. Technology-Enhanced Behavioral Parent Training: The Relationship Between Technology Use and Efficiency of Service Delivery. Behav Modif 2023; 47:1094-1114. [PMID: 37086169 PMCID: PMC10403959 DOI: 10.1177/01454455231165937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Behavior disorders (BDs) are common and, without treatment, can have long-term impacts on child and family health. Behavioral Parent Training (BPT) is the standard of care intervention for early-onset BDs; however, structural socioeconomic barriers hinder treatment outcomes for low-income families. While digital technologies have been proposed as a mechanism to improve engagement in BPT, research exploring the relationship between technology use and outcomes is lacking. Thus, this study with 34 low-income families examined the impact of parents' use of adjunctive mobile app components on treatment efficiency in one technology-enhanced (TE-) BPT program, Helping the Noncompliant Child (HNC). While parent use of the TE-HNC app and its impact on the efficiency of service delivery varied across specific components, increased app use significantly reduced the number of weeks required for families to achieve skill mastery. Implications for the design and development of behavior intervention technologies in general, as well as for BPT in particular, are discussed.
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Affiliation(s)
| | | | | | - Raelyn Loiselle
- The University of North Carolina at Chapel Hill, USA
- NYU Langone Health, New York City, NY, USA
| | | | - Olga Khavjou
- RTI International Research Institute, Triangle Park, NC, USA
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16
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Evans REC, Waller J, Nicholson BD, Round T, Gildea C, Smith D, Scott SE. Should we? Could we? Feasibility of interventions to support prevention or early diagnosis of future cancer following urgent referral: A qualitative study. PATIENT EDUCATION AND COUNSELING 2023; 112:107757. [PMID: 37099888 DOI: 10.1016/j.pec.2023.107757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 05/09/2023]
Abstract
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.
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Affiliation(s)
| | | | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | | | | | | | - Suzanne E Scott
- King's College London, UK; Queen Mary University of London, UK.
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17
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Hilty DM, Groshong LW, Coleman M, Maheu MM, Armstrong CM, Smout SA, Crawford A, Drude KP, Krupinski EA. Best Practices for Technology in Clinical Social Work and Mental Health Professions to Promote Well-being and Prevent Fatigue. CLINICAL SOCIAL WORK JOURNAL 2023; 51:1-35. [PMID: 37360756 PMCID: PMC10233199 DOI: 10.1007/s10615-023-00865-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 06/28/2023]
Abstract
The shift to communication technologies during the pandemic has had positive and negative effects on clinical social worker practice. Best practices are identified for clinical social workers to maintain emotional well-being, prevent fatigue, and avoid burnout when using technology. A scoping review from 2000 to 21 of 15 databases focused on communication technologies for mental health care within four areas: (1) behavioral, cognitive, emotional, and physical impact; (2) individual, clinic, hospital, and system/organizational levels; (3) well-being, burnout, and stress; and (4) clinician technology perceptions. Out of 4795 potential literature references, full text review of 201 papers revealed 37 were related to technology impact on engagement, therapeutic alliance, fatigue and well-being. Studies assessed behavioral (67.5%), emotional (43.2%), cognitive (57.8%), and physical (10.8%) impact at the individual (78.4%), clinic (54.1%), hospital (37.8%) and system/organizational (45.9%) levels. Participants were clinicians, social workers, psychologists, and other providers. Clinicians can build a therapeutic alliance via video, but this requires additional skill, effort, and monitoring. Use of video and electronic health records were associated with clinician physical and emotional problems due to barriers, effort, cognitive demands, and additional workflow steps. Studies also found high user ratings on data quality, accuracy, and processing, but low satisfaction with clerical tasks, effort required and interruptions. Studies have overlooked the impact of justice, equity, diversity and inclusion related to technology, fatigue and well-being, for the populations served and the clinicians providing care. Clinical social workers and health care systems must evaluate the impact of technology in order to support well-being and prevent workload burden, fatigue, and burnout. Multi-level evaluation and clinical, human factor, training/professional development and administrative best practices are suggested.
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Affiliation(s)
- Donald M. Hilty
- Department of Psychiatry & Behavioral Sciences, UC Davis, 2230 Stockton Boulevard, Sacramento, CA 95817 USA
| | | | - Mirean Coleman
- National Association of Social Workers, Washington, DC USA
| | - Marlene M. Maheu
- Coalition for Technology in Behavioral Sciences, Telebehavioral Health Institute, Inc, 5173 Waring Road #124, San Diego, CA 92120 USA
| | - Christina M. Armstrong
- Department of Veterans Affairs, Connected Health Implementation Strategies, Office of Connected Care, Office of Health Informatics, U.S., 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Shelby A. Smout
- Virginia Commonwealth University, 3110 Kensington Ave Apt 3, Richmond, VA 23221 USA
| | - Allison Crawford
- Ontario Mental Health at CAMH, Toronto, Canada
- University of Toronto, Toronto, Canada
- Suicide Prevention Service, 1001 Queen St West, Toronto, ON M6J 1H4 Canada
| | - Kenneth P. Drude
- Coalition Technology in Behavioral Science, 680 E. Dayton Yellow Springs Rd, Fairborn, OH 45324 USA
| | - Elizabeth A. Krupinski
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
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18
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Falana H, Najjar S, Mimi Y, Al-Shami N. Physicians' perceptions of electronic prescribing of controlled medications in the West Bank, Palestine: A pre-implementation assessment. Int J Med Inform 2023; 176:105109. [PMID: 37247470 DOI: 10.1016/j.ijmedinf.2023.105109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/12/2023] [Accepted: 05/21/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND In Palestine, prescribing controlled medications is still done on paper. Despite valuable regulatory efforts, there is a high risk of undetected abuse and "doctor shopping". These problems can be addressed with electronic prescribing of controlled medicines (EPCM). User adoption is essential to the successful implementation of any technology. Therefore, it is crucial to determine the perception of end users at an early stage. This topic has never been addressed in Palestine. Our study aims to investigate the perception of Palestinian physicians towards the introduction of EPCM. METHODS This cross-sectional study was conducted among Palestinian physicians in the West Bank who are familiar with controlled medications prescribing. Data were collected using a self-administered questionnaire based on the Unified Theory of User Acceptance and Use of Technology (UTAUT) from a convenience sample of 300 physicians. Data were analyzed using SPSS version 26. Bivariate analysis and binary and multivariate logistic regression were performed to identify factors associated with physicians' perceptions of ECPM. RESULTS Most physicians expressed their willingness to use EPCM, with an acceptance rate of 85%. This perception was significantly affected by performance expectancy, effort expectancy and trust. None was moderated by age, gender, or experience with electronic prescribing. Age and specialization level were independent factors significantly influencing the intention to use EPCM. The level of current workflow challenges did not correlate with the intent to use EPCM. CONCLUSION Palestinian physicians will accept EPCM. Based on the results of this study, it is recommended that the following be considered: ensuring maximum efficiency of the system, selecting user-friendly interfaces and high-security measures to prevent system breaches.
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Affiliation(s)
- Hiba Falana
- Department of Pharmacy, Nursing and Health Professions, Birzeit University, Ramallah P.O. Box 14, Palestine
| | - Shahenaz Najjar
- Faculty of Graduate Studies, Arab American University, Ramallah P.O. Box 240, Palestine; Leuven Institute for Healthcare Policy, Pillar Quality and Safety, Department of Public Health and Primary Care, KU Leuven.
| | - Yousef Mimi
- Faculty of Graduate Studies, Arab American University, Ramallah P.O. Box 240, Palestine
| | - Ni'meh Al-Shami
- Department of Pharmacy, Nursing and Health Professions, Birzeit University, Ramallah P.O. Box 14, Palestine
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Dugan S, Schwab SM, Seward R, Avant J, Zhang T, Li SR, Eary K, Mast TD, Riley MA, Boyce S. A Qualitative Analysis of Clinician Perspectives of Ultrasound Biofeedback for Speech Sound Disorders. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1252-1274. [PMID: 36961960 PMCID: PMC10484626 DOI: 10.1044/2023_ajslp-22-00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/14/2022] [Accepted: 01/14/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE Ultrasound biofeedback therapy (UBT) is a relatively new type of technology-assisted speech-language therapy and has shown promise in remediating speech sound disorders. However, there is a current lack of understanding of the barriers and benefits that may influence the usage behavior and clinical decision making for the implementation of UBT from a clinician perspective. In this qualitative study, we explore the perspectives of speech-language pathologists (SLPs) who have used ultrasound biofeedback in programs of speech sound therapy using the unified theory of acceptance and use of technology (UTAUT) model. METHOD Seven SLPs who had clinical experience treating speech sound disorders with UBT participated. Semistructured in-depth interviews were conducted and video-recorded. Two coders coded and categorized the transcribed data, with consensus established with a third coder. Using thematic analysis, the data were exploratorily grouped into themes along components of the UTAUT model. RESULTS The highest number of codes was sorted into the "effort expectancy" theme, followed by "performance expectancy," "social influence," and "facilitating conditions" themes of the UTAUT model. Clinicians identified multiple perceived barriers and benefits to the use of ultrasound technology. The top identified barrier was limited accessibility, and the top benefit was the ability to visualize a client's articulatory response to cues on a display. CONCLUSIONS Clinicians prioritized "effort expectancy" and "performance expectancy" when reflecting on the use of ultrasound biofeedback for speech sound disorders. Clinicians spoke favorably about using UBT for speech sound disorder treatment but acknowledged institutional barriers and limitations at organizational and social levels.
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Affiliation(s)
- Sarah Dugan
- Department of Rehabilitation, Exercise, & Nutrition Sciences, University of Cincinnati, OH
| | - Sarah M. Schwab
- Department of Rehabilitation, Exercise, & Nutrition Sciences, University of Cincinnati, OH
| | - Reneé Seward
- Myron E. Ullman, Jr. School of Design, University of Cincinnati, OH
| | - James Avant
- Myron E. Ullman, Jr. School of Design, University of Cincinnati, OH
| | - Ting Zhang
- Myron E. Ullman, Jr. School of Design, University of Cincinnati, OH
| | - Sarah R. Li
- Department of Biomedical Engineering, University of Cincinnati, OH
| | - Kathryn Eary
- Department of Biomedical Engineering, University of Cincinnati, OH
| | - T. Douglas Mast
- Department of Biomedical Engineering, University of Cincinnati, OH
| | - Michael A. Riley
- Department of Rehabilitation, Exercise, & Nutrition Sciences, University of Cincinnati, OH
| | - Suzanne Boyce
- Department of Communication Sciences & Disorders, University of Cincinnati, OH
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20
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Hurley R, Jury F, van Staa TP, Palin V, Armitage CJ. Clinician acceptability of an antibiotic prescribing knowledge support system for primary care: a mixed-method evaluation of features and context. BMC Health Serv Res 2023; 23:367. [PMID: 37060063 PMCID: PMC10103677 DOI: 10.1186/s12913-023-09239-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/02/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Overprescribing of antibiotics is a major concern as it contributes to antimicrobial resistance. Research has found highly variable antibiotic prescribing in (UK) primary care, and to support more effective stewardship, the BRIT Project (Building Rapid Interventions to optimise prescribing) is implementing an eHealth Knowledge Support System. This will provide unique individualised analytics information to clinicians and patients at the point of care. The objective of the current study was to gauge the acceptability of the system to prescribing healthcare professionals and highlight factors to maximise intervention uptake. METHODS Two mixed-method co-design workshops were held online with primary care prescribing healthcare professionals (n = 16). Usefulness ratings of example features were collected using online polls and online whiteboards. Verbal discussion and textual comments were analysed thematically using inductive (participant-centred) and deductive perspectives (using the Theoretical Framework of Acceptability). RESULTS Hierarchical thematic coding generated three overarching themes relevant to intervention use and development. Clinician concerns (focal issues) were safe prescribing, accessible information, autonomy, avoiding duplication, technical issues and time. Requirements were ease and efficiency of use, integration of systems, patient-centeredness, personalisation, and training. Important features of the system included extraction of pertinent information from patient records (such as antibiotic prescribing history), recommended actions, personalised treatment, risk indicators and electronic patient communication leaflets. Anticipated acceptability and intention to use the knowledge support system was moderate to high. Time was identified as a focal cost/ burden, but this would be outweighed if the system improved patient outcomes and increased prescribing confidence. CONCLUSION Clinicians anticipate that an eHealth knowledge support system will be a useful and acceptable way to optimise antibiotic prescribing at the point of care. The mixed method workshop highlighted issues to assist person-centred eHealth intervention development, such as the value of communicating patient outcomes. Important features were identified including the ability to efficiently extract and summarise pertinent information from the patient records, provide explainable and transparent risk information, and personalised information to support patient communication. The Theoretical Framework of Acceptability enabled structured, theoretically sound feedback and creation of a profile to benchmark future evaluations. This may encourage a consistent user-focused approach to guide future eHealth intervention development.
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Affiliation(s)
- Ruth Hurley
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Francine Jury
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tjeerd P van Staa
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Victoria Palin
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
- Academic Health Science Centre, Manchester University NHS Foundation Trust (MFT), NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
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21
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Mpasa F, van Rooyen DRM, Jordan PJ, Venter D, ten Ham-Baloyi W. Malawian critical care nurses' views on the implementation of an educational intervention to enhance sustained use of an evidence-based endotracheal tube cuff pressure management guideline: A survey study. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2023; 39:10.7196/SAJCC.2023.v39i1.550. [PMID: 37521961 PMCID: PMC10378196 DOI: 10.7196/sajcc.2023.v39i1.550] [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: 04/14/2022] [Accepted: 02/09/2023] [Indexed: 08/01/2023] Open
Abstract
Background Evidence-based guidelines can assist critical care nurses in promoting best practices, including those related to endotracheal tube cuff pressure management. However, these guidelines require tailored strategies to enhance their implementation, uptake, and sustained use in practice. Objectives To evaluate Malawian critical care nurses' views on the implementation of an endotracheal tube cuff pressure management guideline to enhance sustained guideline use. Methods An explorative-descriptive survey design was employed, using a questionnaire with closed- and open-ended questions that was distributed after implementation of an educational intervention based on an endotracheal tube cuff pressure management guideline. The questionnaire had a Cronbach's alpha score of 0.85. Results A total of 47 nurses working in four public and two private hospital intensive care units in Malawi participated. Quantitative findings showed that the majority of the participants (92%) indicated that the strategies used for the group that received the full intervention including both active (monitoring visits) and passive (a half-day educational session using a PowerPoint presentation, and a printed guideline and algorithm) strategies (intervention 1 group) were useful, clear and applicable and enhanced implementation of the guideline. These results were statistically significant (mean (standard deviation) 1.86 (0.84); t=6.07; p<0.0005). Qualitative data revealed three major themes related to recommendations for uptake and sustained use of the guideline in nursing practice: the guideline needs to be translated, updated, and made available to ICU staff; implementation strategies (continuous supervision and follow-up); and facilitating factors for successful implementation (education and training on guideline content, resources, and commitment to best practices). Conclusion The study highlighted that although the implementation strategies used were positively received by participants, they need to be further tailored to their context to enhance guideline uptake and sustained use in practice. Further study is required to ensure that tailored implementation strategies facilitate guideline uptake and sustained use, specifically in resource-constrained contexts. Contributions of the study The study findings can be used by nurses and academics when developing educational interventions for critical care units to enhance implementation of guidelines in this context.
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Affiliation(s)
- F Mpasa
- Lecturer, Department of Nursing and Midwifery Science, Faculty of Health Sciences, Mzuzu University, Luwinga, Malawi; Former PhD candidate,
Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Dalena R M van Rooyen
- Deputy Dean, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - P J Jordan
- Associate Professor and Head, Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town,
South Africa
| | - D Venter
- Consultant Statistician, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - W ten Ham-Baloyi
- Research Associate, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
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22
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Keightley S, Duncan M, Gardner B. An intervention to promote positive homeworker health and wellbeing through effective home-working practices: a feasibility and acceptability study. BMC Public Health 2023; 23:614. [PMID: 36997955 PMCID: PMC10063430 DOI: 10.1186/s12889-023-15347-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/28/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND In the wake of Covid-19, the prevalence of working from home ('home-working') is expected to rise. Yet, working from home can have negative health and wellbeing impacts. Interventions are needed to promote effective ways of working that also protect workers' health and wellbeing. This study explored the feasibility and acceptability of an intervention intended to promote home-working practices that would protect and promote health behaviour and wellbeing. METHODS An uncontrolled, single-arm mixed-methods trial design was employed. Forty-two normally-office-based UK workers, working from home between January-February 2021 (during the Covid pandemic), consented to receive the intervention. The intervention: a digital document offering evidence-based recommendations for home-working in ways conducive to health behaviour and wellbeing. Feasibility and acceptability were quantitatively indexed by: expressions of interest within 1 week (target threshold ≥ 35); attrition across the one-week study period (threshold ≤ 20%); and the absence of any apparent detriments in self-reported physical activity, sedentary behaviour, snacking, and work-related wellbeing prior to and one week after receiving the intervention. Qualitative think-aloud data, obtained while participants read through the intervention, and analysed using reflexive thematic analysis, explored acceptability. Semi-structured interviews conducted one week after intervention exposure were content-analysed to identify whether and which behaviour changes were adopted. RESULTS Two feasibility criteria were met: 85 expressions of interest indicated satisfactory intervention demand, and no detriments were observed in health behaviours or wellbeing. Forty-two participants (i.e., maximum capacity for the study; 26 females, 16 males, aged 22-63) consented to take part. 31% dropped out over the one-week study period leaving a final sample of 29 (18 females, 11 males, aged 22-63), exceeding identified attrition thresholds. Think-aloud data showed that participants concurred with intervention guidance, but felt it lacked novelty and practicality. Follow-up interviews produced 18 (62%) participant reports of intervention adherence, where nine recommendations reportedly prompted behaviour change in at least one participant. CONCLUSIONS Mixed evidence was found for intervention feasibility and acceptability. Whilst the information was deemed relevant and of value, further development is required to increase its novelty. It may also be more fruitful to provide this information via employers, to encourage and emphasise employer endorsement.
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Affiliation(s)
- Samuel Keightley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Myanna Duncan
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Benjamin Gardner
- Department of Psychology, University of Surrey, Guildford, GU2 7XH, Surrey, UK
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23
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Channon S, Coulman E, Cannings-John R, Henley J, Lau M, Lugg-Widger F, Strange H, Davies F, Sanders J, Scherf C, Couzens Z, Morantz L. Acceptability and feasibility of a planned preconception weight loss intervention in women with long-acting reversible contraception: the Plan-it mixed-methods study. Health Technol Assess 2023; 27:1-224. [PMID: 36688498 PMCID: PMC9885302 DOI: 10.3310/nkix8285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention. OBJECTIVES The objectives were to understand if routine NHS data captured the pathway from long-acting reversible contraception removal to pregnancy and included body mass index; to identify the suitable components of a preconception weight loss intervention; and to engage with key stakeholders to determine the acceptability and feasibility of asking women with overweight/obesity to delay the removal of their long-acting reversible contraception in order to take part in a preconception weight loss intervention. DESIGN This was a preparatory mixed-methods study, assessing the acceptability and feasibility of a potential intervention, using routine NHS data and purposefully collected qualitative data. PARTICIPANTS The NHS routine data included all women with a long-acting reversible contraception code. There were three groups of participants in the surveys and interviews: health-care practitioners who remove long-acting reversible contraception; weight management consultants; and women of reproductive age with experience of overweight/obesity and of using long-acting reversible contraception. SETTING UK-based health-care practitioners recruited at professional meetings; and weight management consultants and contraceptive users recruited via social media. DATA SOURCES Anonymised routine data from UK sexual health clinics and the Clinical Practice Research Datalink, including the Pregnancy Register; and online surveys and qualitative interviews with stakeholders. RESULTS The records of 2,632,871 women aged 16-48 years showed that 318,040 had at least one long-acting reversible contraception event, with 62% of records including a body mass index. Given the identified limitations of the routine NHS data sets, it would not be feasible to reliably identify women with overweight/obesity who request a long-acting reversible contraception removal with an intention to become pregnant. Online surveys were completed by 100 health-care practitioners, four weight management consultants and 243 contraceptive users. Ten health-care practitioners and 20 long-acting reversible contraception users completed qualitative interviews. A realist-informed approach generated a hypothesised programme theory. The combination of weight discussions and the delay of long-acting reversible contraception removal was unacceptable as an intervention to contraceptive users for ethical and practical reasons. However, a preconception health intervention incorporating weight loss could be acceptable, and one potential programme is outlined. LIMITATIONS There was very limited engagement with weight management consultants, and the sample of participating stakeholders may not be representative. CONCLUSIONS An intervention that asks women to delay long-acting reversible contraception removal to participate in a preconception weight loss intervention would be neither feasible nor acceptable. A preconception health programme, including weight management, would be welcomed but requires risk communication training of health-care practitioners. FUTURE WORK Work to improve routine data sets, increase awareness of the importance of preconception health and overcome health-care practitioner barriers to discussing weight as part of preconception care is a priority. TRIAL REGISTRATION This trial is registered as ISRCTN14733020. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 1.
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Affiliation(s)
- Susan Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Josie Henley
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mandy Lau
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Freya Davies
- The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Caroline Scherf
- Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
| | - Zoë Couzens
- Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
| | - Leah Morantz
- 1Centre for Trials Research, Cardiff University, Cardiff, UK
- 2The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
- 3School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
- 4Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
- 5Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
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Arkkukangas M, Cederbom S. Movement toward an evidence-Based, digital fall prevention future-Perceptions from a physiotherapy perspective. Physiother Theory Pract 2023; 39:128-136. [PMID: 34791975 DOI: 10.1080/09593985.2021.2005198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Physiotherapy plays an important role in fall prevention, and is a science- and evidence-based profession that is constantly undergoing development. Currently, the possibility of digital fall prevention is being explored; however, the perception of physiotherapists (PTs) toward a digital approach is still a sparsely investigated topic. PURPOSE This study aimed to explore the PT's experiences with a fall prevention exercise program used in their daily work and their thoughts regarding the use of digital support in this context. METHODS Discussions were held in two focus groups with seven PTs (age: 26-48 years). A qualitative content analysis was performed. RESULTS We identified two main categories: 1) The importance of evidence-based fall prevention exercise; and 2) Transition toward a digital fall prevention exercise approach. The participants expressed that they had time- and resource-related limitations affecting evidence-based work and adherence to fall prevention exercise programs. They stated that education and management support were required. CONCLUSION There is a need for fall prevention exercise to be evidence-based and prioritized in physiotherapy. The study results provide insights into the lack of adherence to fall prevention exercise programs and highlighted the need for a transition toward working digitally in the future.
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Affiliation(s)
- Marina Arkkukangas
- Research and Development in Sörmland, Eskilstuna, Sweden.,Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,School of Education, Health and Social Studies, Department of Medicine, Sport and Fitness Science, Dalarna University, Falun, Sweden
| | - Sara Cederbom
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo Norway
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Jordan M, Hauser J, Cota S, Li H, Wolf L. The Impact of Cultural Embeddedness on the Implementation of an Artificial Intelligence Program at Triage: A Qualitative Study. J Transcult Nurs 2023; 34:32-39. [PMID: 36214065 DOI: 10.1177/10436596221129226] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Triage requires rapid determination of acuity and resources. Current modalities allow for individual judgment, with varied application of algorithmic rules. Although artificial intelligence can improve triage accuracy, gaps remain in understanding implementation facilitators and barriers, especially those related to the cultural understandings by nurses of emergency department presentations. The purpose of this study was to explore the cultural and technological elements of the implementation of an artificial intelligence clinical decision support aid (i.e., KATE) in an emergency nursing triage process in an urban community hospital on the West Coast of the United States. METHOD An exploratory qualitative study using semi-structured small group and individual interviews and constant comparison analysis strategies. The sample comprised 13 emergency department triage nurses at one site. Campinha-Bacote's theory of cultural competence framed the study. RESULTS Responses yielded the overall theme of We know these people and we know these things. Supporting categories included the problem of aire; just another checkbox; gut trumps data; higher acuity with no resources; and technology as a safety net. Participants reported reliance on clinical experience and cultural knowledge to assign acuity. DISCUSSION The implementation of an artificial intelligence program was initially received skeptically due to the acontextual nature of AI, but grew to be perceived as a safety net for triage decision making among emergency nurses.
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Affiliation(s)
| | | | | | - Hong Li
- Azusa Pacific University, CA, USA
| | - Lisa Wolf
- Emergency Nurses Association, Schaumburg, IL, USA
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Jain S, Jain BK, Jain PK, Marwaha V. "Technology Proficiency" in Medical Education: Worthiness for Worldwide Wonderful Competency and Sophistication. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1497-1514. [PMID: 36545441 PMCID: PMC9762172 DOI: 10.2147/amep.s378917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Advances in bioinformatics, information technology, advanced computing, imaging techniques are changing fundamentally the way physicians define, diagnose, treat, and prevent disease. New disciplines - Artificial Intelligence, Machine Learning, Computational Biology - are improving healthcare. Digital health solutions have immense scope. Education and practice need to keep pace. METHODS We aimed at assessment of "Technology proficiency" required by medical graduates and its implementation, if found useful. All this in a conceptual framework of "TP" model, having categories (a) proper assessment (b) pertinent treatment (c) progress monitoring (d) prevention applications (e) professional standards. A search of the literature was performed using MedLine & Cochrane Central Register of Controlled Trials databases, for systematic reviews and meta-analysis articles published in the last five years using keyword "technology". Analysis of those relevant to the role all medical graduates should play. An analysis of worldwide statutory medical institutions guidelines. RESULTS Twenty-three systematic studies and meta-analysis were studied. Eighteen show clear evidence for 'Technology proficiency", while 5 recommend further studies. The findings are discussed suiting the roles of doctors in the "TP" model. Medical institutions guidelines worldwide diligence suggests need of including "Technology proficiency" as a definite and distinct strategic plan. Medical Council of India mandates "use information technology for appropriate patient care and continued learning". General Medical Council, UK and Medical Council India have been proactive in technology training. GMC recommends technology use for learning, prescribing, communication, and interpersonal skills. It should be expanding technology proficiency in practice as an essential professional capability. CONCLUSION "Technology proficiency" is found pertinently fruitful. It should be included as a definitive requirement and a distinct strategic plan worldwide. Modern curriculum development is proposed (i) Educational goals and objectives as the proposed Conceptual framework "Technology proficiency" model (ii) Instructional strategies 'Five Bs' (iii) Implementation 'Five Ms'.
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Affiliation(s)
- Sunil Jain
- Department of Paediatrics, Military Hospital Secunderabad, Telangana, India
| | | | - Prem Kamal Jain
- Department of Computational Biology, Indraprastha Institute of Information Technology, New Delhi, India
| | - Vishal Marwaha
- School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Cochin, Kerala, India
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Patel Y, Vassilev I, du Toit SHJ. Implementing a digital tool to support meaningful engagement with socially isolated or lonely older adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6456-e6466. [PMID: 36308765 PMCID: PMC10092141 DOI: 10.1111/hsc.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/18/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Social isolation and loneliness are significant concerns in community dwelling older adults due to associated poorer health outcomes, inadequate crises responsiveness and increased societal burdens of care and cost. Generating Engagement in Networks Involvement (GENIE) is an online evidence-based, client-centred social network tool piloted by community-aged care services in Sydney, Australia. GENIE facilitates access to community resources, activities and people to extend or re-establish a client's social connections. This study aimed to identify GENIE's potential to maintain and promote social connections in older adults from the perspective of allied health professionals who could deliver GENIE. This qualitative exploratory study involved 33 participants on an emerging placement across two organisations who piloted GENIE. Data included consensus and priority statements produced from six nominal group technique-facilitated discussions, and an inductive thematic analysis of student documentation and all consensus statements. The main findings indicated that participants prioritised GENIE's clinical advantages, implementation barriers and recommendations for future implementation. The inductive thematic analysis revealed the two themes of practice applications, and client and professional experiences when using GENIE. As a time-efficient and personalised intervention, the research team concluded that GENIE could empower service providers to address the overarching needs of clients through rapidly connecting older adults to resources of their interests within the overburdened Australian-aged care system.
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Affiliation(s)
- Yasheeka Patel
- Discipline of Occupational Therapy, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
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Liebhart JL, Goodman AB, Lindros J, Krafft C, Cook SR, Baker A, Hassink SG. Key Predictors of Primary Care Providers' Self-Efficacy in Caring for Children with Overweight or Obesity. Acad Pediatr 2022; 22:1158-1166. [PMID: 35247645 PMCID: PMC10291564 DOI: 10.1016/j.acap.2022.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Self-efficacy is a crucial factor in enabling pediatric primary care providers (PCPs) to deliver recommended care to children with overweight and obesity. This study, conducted with a large, national sample of PCPs, aimed to identify key factors, which may contribute to PCP self-efficacy for obesity-related care, from a list of previously reported barriers and facilitators. METHODS A national random sample of American Academy of Pediatrics members was surveyed in 2017 (analytic n = 704). Factor analysis was used to identify self-efficacy variables from relevant indicators and assess fit. Multivariable linear regression analyses were conducted to identify key predictors of PCP self-efficacy from reported facilitators or barriers to care, including characteristics of the PCP, practice, community, and payment systems. RESULTS Two PCP self-efficacy variables were identified: health risk assessment and patient-centered counseling. Both were positively predicted by relevant training, the belief that pediatricians play an important role in obesity, and awareness of barriers to payment for dietitians or weight management programs. Both were negatively predicted by a perceived lack of available PCP time for counseling and inadequacy of available referral resources to assist with treatment. Additional predictors of counseling self-efficacy included PCP beliefs that they are paid for treatment (+) and that patients/families lack time for healthy behaviors (-). Electronic health record clinical decision supports or registries and patient social disadvantage were not predictive. CONCLUSIONS Results suggest multiple potential roles and strategies for local and national organizations seeking to facilitate improvements to PCP self-efficacy in caring for children with overweight and obesity.
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Affiliation(s)
- Janice L Liebhart
- Institute for Healthy Childhood Weight, American Academy of Pediatrics (JL Liebhart, J Lindros, A Baker, and SG Hassink), Itasca, Ill.
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention (AB Goodman), Atlanta, Ga
| | - Jeanne Lindros
- Institute for Healthy Childhood Weight, American Academy of Pediatrics (JL Liebhart, J Lindros, A Baker, and SG Hassink), Itasca, Ill
| | - Catherine Krafft
- Golisano Children's Ambulatory Care Facility, University of Rochester Medical Center (C Krafft and SR Cook), Rochester, NY
| | - Stephen R Cook
- Golisano Children's Ambulatory Care Facility, University of Rochester Medical Center (C Krafft and SR Cook), Rochester, NY
| | - Alison Baker
- Institute for Healthy Childhood Weight, American Academy of Pediatrics (JL Liebhart, J Lindros, A Baker, and SG Hassink), Itasca, Ill
| | - Sandra G Hassink
- Institute for Healthy Childhood Weight, American Academy of Pediatrics (JL Liebhart, J Lindros, A Baker, and SG Hassink), Itasca, Ill
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Leonardsen AC, Bruun AMG, Valeberg BT. Anaesthesia personnels' perspectives on digital anaesthesia information management systems - a qualitative study. BMC Nurs 2022; 21:208. [PMID: 35915471 PMCID: PMC9340760 DOI: 10.1186/s12912-022-00998-9] [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: 02/05/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background In Norway, the anaesthesia team normally consists of a nurse anaesthetist and an anaesthetist. Digital anesthesia information management systems (AIMS) that collect patient information directly from the anaesthesia workstation, and transmit the data into documentation systems have recently been implemented in Norway. Earlier studies have indicated that implementation of digital AIMS impacts the clinical workflow patterns and distracts the anaesthesia providers. These studies have mainly had a quantitative design and focused on functionality, installation designs, benefits and challenges associated with implementing and using AIMS. Hence, the aim of this study was to qualitatively explore anaesthesia personnel’s perspectives on implementing and using digital AIMS. Methods The study had an exploratory and descriptive design. The study was conducted within three non-university hospitals in Southern Norway. Qualitative, individual interviews with nurse anaesthetists (n = 9) and anaesthetists (n = 9) were conducted in the period September to December 2020. Data were analysed using qualitative content analysis according to the recommendations of Graneheim and Lundman. Results Four categories were identified: 1) Balance between clinical assessment and monitoring, 2) Vigilance in relation to the patient, 3) The nurse-physician collaboration, and 4) Software issues. Participants described that anaesthesia included a continuous balance between clinical assessment and monitoring. They experienced that the digital AIMS had an impact on their vigilance in relation to the patient during anaesthesia. The digital AIMS affected the nurse-physician collaboration. Moreover, participants emphasised a lack of user participation and aspects of user-friendliness regarding the implementation of digital AIMS. Conclusion Digital AIMS impacts vigilance in relation to the patient. Hence, collaboration and acceptance of the mutual responsibility between nurse anaesthetists and anaesthetists for both clinical observation and digital AIMS administration is essential. Anaesthesia personnel should be included in development and implementation processes to facilitate implementation.
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Affiliation(s)
- Ann-Chatrin Leonardsen
- Østfold University College/Østfold Hospital Trust, Postal box code 700, 1757, Halden, Norway.
| | | | - Berit T Valeberg
- Oslo Metropolitan University / University of Southeastern Norway, Pilestredet 32, 0166, Oslo, Norway
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Riveros Perez E, Kerko R, Lever N, White A, Kahf S, Avella-Molano B. Operating room relay strategy for turnover time improvement: a quality improvement project. BMJ Open Qual 2022; 11:bmjoq-2022-001957. [PMID: 35902182 PMCID: PMC9341176 DOI: 10.1136/bmjoq-2022-001957] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/21/2022] [Indexed: 11/04/2022] Open
Abstract
IntroductionOperating room (OR) management plays a pivotal role in the healthcare system due to the high cash flow it yields. Enhancing communication in the OR, which is the common root problem for delays, might improve OR efficiency and revenues for healthcare. This study aims to evaluate the impact of an OR relay strategy on turnover time (TOT).MethodsA quality improvement project was conducted. In the intervention group, a certified registered nurse anaesthetist (CRNA) remained outside of the OR, coordinating the steps to get the next patient ready. This CRNA communicated with the anaesthesia providers within the OR via a Microsoft Team chat. The TOT for the control group was recorded from the electronic anaesthesia record system.Results/data analysisAnalysis of 636 turnovers was performed with non-parametric tests. The OR relay strategy decreased TOT for most ORs, with statistically significant results for three of the ORs and the overall ORs system. A decreased in variability between TOTs was evidenced for the overall OR and the majority of the ORs evaluated individually.ConclusionThe OR relay strategy has a positive impact on TOT.
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Parchment A, Lawrence W, Rahman E, Townsend N, Wainwright E, Wainwright D. How useful is the Making Every Contact Count Healthy Conversation Skills approach for supporting people with musculoskeletal conditions? J Public Health (Oxf) 2022; 30:2389-2405. [PMID: 35530417 PMCID: PMC9067897 DOI: 10.1007/s10389-022-01718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/16/2022] [Indexed: 11/29/2022] Open
Abstract
Aim To explore the current use and perceptions of the Wessex model of Making Every Contact Count (MECC), incorporating Healthy Conversation Skills (HCS), focussing specifically on physiotherapists supporting people living with musculoskeletal conditions. Methods A mixed method, sequential explanatory design was employed. This article reports the first phase of the study, in which an online questionnaire was administered, consisting of items relating to perceived acceptability, appropriateness, feasibility, sustainability, and uptake of MECC HCS. Barriers and facilitators to MECC HCS delivery were additionally explored and mapped to the Theoretical Domains Framework. Results Seventy-one professionals responded, including 15 physiotherapists supporting people with MSK conditions. Across professional groups, MECC HCS was found to be highly acceptable, appropriate, and feasible. A significant interaction between perceived sustainability of MECC HCS and the location in which professionals worked was observed. Physiotherapists reported using their MECC HCS at least daily; however, there were discrepancies between the number of their patients they believed could benefit from behaviour change intervention, and the number to whom they reported actually delivering MECC HCS. Perceived barriers and facilitators to MECC HCS implementation mapped mostly to ‘Environmental Context and Resources’ on the Theoretical Domains Framework. Conclusions The Wessex model of MECC is a promising brief or very brief intervention for physiotherapists supporting individuals with musculoskeletal conditions. Barriers associated with the sustainability of the intervention within organisations must be addressed in order to enhance future implementation. Further rollout of this intervention may be beneficial for meeting the goals of the NHS and Public Health England in prevention of chronic MSK conditions and promotion of musculoskeletal health.
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Affiliation(s)
- Amelia Parchment
- Department for Health, University of Bath, Bath, England BA2 7AY UK
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, England SO16 6YD UK
| | - Em Rahman
- Public Health Workforce Development, Southern House, Health Education England, Winchester, England SO21 2RU UK
| | - Nick Townsend
- Department for Health, University of Bath, Bath, England BA2 7AY UK
| | - Elaine Wainwright
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - David Wainwright
- Department for Health, University of Bath, Bath, England BA2 7AY UK
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Price JL, Bates ME, Morgano J, Todaro S, Uhouse SG, Vaschillo E, Vaschillo B, Pawlak A, Buckman JF. Effects of arousal modulation via resonance breathing on craving and affect in women with substance use disorder. Addict Behav 2022; 127:107207. [PMID: 34953433 DOI: 10.1016/j.addbeh.2021.107207] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/12/2021] [Accepted: 12/03/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Craving for alcohol and other drugs is a complex in-the-moment experience that involves within-person changes in physiological arousal and affect. We evaluated the utility of a just-in-time, self-administered resonance breathing smartphone application (app) to reduce craving and improve affect in women during outpatient treatment for substance use disorders (SUD). METHODS Women (N = 57) receiving outpatient addiction treatment were randomized to practice either cardiovascular resonance breathing (0.1 Hz/6 breaths per minute) or a sham (∼0.23 Hz/14 breaths per minute) in the face of urges over an 8-week intervention. Craving (Penn Alcohol Craving Scale) and affect (Positive and Negative Affect Scale) were collected weekly throughout the intervention. App data were uploaded weekly to assess frequency of use. Generalized Estimated Equations modeled craving and affect as a function of group randomization and app use frequency across the 8-week intervention. FINDINGS Higher levels of craving were associated with more frequent app use. The group X app use interaction was significant for craving. Frequent app use during the intervention phase was associated with lower craving levels in the resonance breathing group relative to the sham group over the 8-week intervention. There was no effect of app use frequency on affect measures. CONCLUSIONS Women assigned to practice sham breathing who used the intervention frequently experienced elevations in craving that are commonly reported during outpatient SUD treatment. Women assigned to resonance breathing who used the intervention frequently did not experience such increases. Resonance breathing may be protective against triggers in outpatient treatment. Physiological mechanisms are discussed.
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Armstrong CM, Wilck NR, Murphy J, Herout J, Cone WJ, Johnson AK, Zipper K, Britz B, Betancourt-Flores G, LaFleur M, Vetter B, Dameron B, Frizzell N. Results and Lessons Learned when Implementing Virtual Health Resource Centers to Increase Virtual Care Adoption During the COVID-19 Pandemic. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 7:81-99. [PMID: 34722860 PMCID: PMC8542493 DOI: 10.1007/s41347-021-00227-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 09/25/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022]
Abstract
Implementation efforts to increase adoption of health technologies (e.g., telehealth, mobile health, electronic health records, patient portals) have commonly focused on increasing the adoption of specific health technologies in specific service lines. To facilitate adoption of multiple health technologies across a hospital setting, four Virtual Health Resource Centers (VHRCs) were established to provide clinical adoption support to healthcare staff and patients in four hospitals in a large healthcare system. This study spanned a 3-year period, with the first half including pre-implementation efforts, and the second half involved in implementation efforts. In order to compare sites to the national population, a binomial regression was used which allowed for adjustment of relevant covariates (e.g., differences in number of enrollees, level of complexity of facility). The pre-implementation phase and the initial year-and-a-half of the implementation phase resulted in an increase in internal facilitators’ knowledge and skills of virtual care technologies, an increase in facilitator and site capacity, and high levels of adherence to implementation strategies were maintained across sites. Virtual care utilization increased across all sites and across the healthcare system during the implementation phase; however, a comparison to the increase in national level virtual care utilization metrics yielded no meaningful difference. While many implementation strategies aim to increase the adoption of a particular health technology product (e.g., a particular app or remote monitoring use case), the establishment of VHRCs may increase efficiencies in delivery of virtual care training and consultation to healthcare staff and patients, which may increase capacity and decrease barriers to adoption. However, due to the impact of the COVID-19 pandemic on the need for rapid adoption of technology and decreased in person care and services, it is not yet known the longer term impact that the establishment of VHRCs may have on the sustained adoption of health technologies.
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Affiliation(s)
- Christina M. Armstrong
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Nancy R. Wilck
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - John Murphy
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Jennifer Herout
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Whitney J. Cone
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Adama K. Johnson
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Kimberly Zipper
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Bridget Britz
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Gabriella Betancourt-Flores
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Melissa LaFleur
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Brian Vetter
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Betty Dameron
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Noelle Frizzell
- Office of Connected Care, Department of Veterans Affairs, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420 USA
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Myren BJ, de Hullu JA, Hermens RPMG, Koksma JJ, Zusterzeel PLM. Patient involvement via videoconference at the morbidity and mortality (M&M) meeting during COVID-19. BMJ Open Qual 2022; 11:bmjoq-2021-001691. [PMID: 35121576 PMCID: PMC8819547 DOI: 10.1136/bmjoq-2021-001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/13/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Britt Jose Myren
- Department of Gynaecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Department of Gynaecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboudumc, Nijmegen, The Netherlands
| | - Jur J Koksma
- Health Academy, Radboudumc, Nijmegen, The Netherlands
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Fagerström C, Wickström H, Tuvesson H. Still engaged – healthcare staff’s engagement when introducing a new eHealth solution for wound management: a qualitative study. BMC Health Serv Res 2022; 22:103. [PMID: 35078483 PMCID: PMC8788143 DOI: 10.1186/s12913-022-07515-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background eHealth solutions have often been considered favourable for improved effectiveness and quality in healthcare services for wound management. Staff engagement related to organisational changes is a key factor for successful development and implementation of a new eHealth solution, like a digital decision support systems (DDSS). It is essential to understand the engagement process in terms of sustainability, wellbeing in staff and efficiency in a long-term perspective. The aim of this study was to describe healthcare staff’s engagement during a 6-month test of an eHealth solution (DDSS) for wound management. Methods A qualitative design, including interviews conducted with healthcare staff working with wound management within primary, community and specialist care (n = 11) on two occasions: at the introduction of the solution and after 6 months, when the test period was over. Data were interpreted with qualitative content analysis. Results Healthcare staff’s descriptions from a 6-month test of an eHealth solution for wound management can be summarised as Engaging through meaning, but draining. The analysis revealed a result with three subcategories: Having a shared interest is stimulating, Good but not perfect and Exciting, but sometimes exhausting. The staff described their engagement as sustained through feelings of meaningfulness when using the eHealth solution, but limited by feelings of exhaustion due to heavy workload and lack of support and understanding from others. Conclusions The results indicate that the healthcare staff who tested the eHealth solution described themselves as individuals who easily become engaged when an idea and efforts felt meaningful. The staff needed resources to nourish engagement in their new role when implementing eHealth in the clinical everyday work of wound management. Allocating time and support are important to consider when planning for sustainable implementation of eHealth solutions in healthcare organisations.
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Walker LE, Abuzour AS, Bollegala D, Clegg A, Gabbay M, Griffiths A, Kullu C, Leeming G, Mair FS, Maskell S, Relton S, Ruddle RA, Shantsila E, Sperrin M, Van Staa T, Woodall A, Buchan I. The DynAIRx Project Protocol: Artificial Intelligence for dynamic prescribing optimisation and care integration in multimorbidity. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221145493. [PMID: 36545235 PMCID: PMC9761229 DOI: 10.1177/26335565221145493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Structured Medication Reviews (SMRs) are intended to help deliver the NHS Long Term Plan for medicines optimisation in people living with multiple long-term conditions and polypharmacy. It is challenging to gather the information needed for these reviews due to poor integration of health records across providers and there is little guidance on how to identify those patients most urgently requiring review. OBJECTIVE To extract information from scattered clinical records on how health and medications change over time, apply interpretable artificial intelligence (AI) approaches to predict risks of poor outcomes and overlay this information on care records to inform SMRs. We will pilot this approach in primary care prescribing audit and feedback systems, and co-design future medicines optimisation decision support systems. DESIGN DynAIRx will target potentially problematic polypharmacy in three key multimorbidity groups, namely, people with (a) mental and physical health problems, (b) four or more long-term conditions taking ten or more drugs and (c) older age and frailty. Structured clinical data will be drawn from integrated care records (general practice, hospital, and social care) covering an ∼11m population supplemented with Natural Language Processing (NLP) of unstructured clinical text. AI systems will be trained to identify patterns of conditions, medications, tests, and clinical contacts preceding adverse events in order to identify individuals who might benefit most from an SMR. DISCUSSION By implementing and evaluating an AI-augmented visualisation of care records in an existing prescribing audit and feedback system we will create a learning system for medicines optimisation, co-designed throughout with end-users and patients.
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Affiliation(s)
- Lauren E Walker
- Wolfson Centre for Personalized
Medicine, University
of Liverpool, Liverpool, UK
| | - Aseel S Abuzour
- Academic Unit for Ageing &
Stroke Research, University of
Leeds, Bradford Teaching Hospitals NHS
Foundation Trust, Bradford, UK
| | | | - Andrew Clegg
- Academic Unit for Ageing &
Stroke Research, University of
Leeds, Bradford Teaching Hospitals NHS
Foundation Trust, Bradford, UK
| | - Mark Gabbay
- Institute of Population Health,
University
of Liverpool, Liverpool, UK
| | | | - Cecil Kullu
- Mersey Care NHS Foundation
Trust, Liverpool, UK
| | - Gary Leeming
- Civic Data Cooperative,
University
of Liverpool, Liverpool, UK
| | - Frances S Mair
- General Practice and Primary Care,
School of Health and Wellbeing, University of
Glasgow, UK
| | - Simon Maskell
- School of Electrical Engineering,
Electronics and Computer Science, University of
Liverpool, UK
| | - Samuel Relton
- Institute of Health Sciences,
University
of Leeds, UK
| | - Roy A Ruddle
- School of Computing and Leeds
Institute for Data Analytics, University of
Leeds, UK
| | - Eduard Shantsila
- Institute of Population Health,
University
of Liverpool, Liverpool, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging
& Data Sciences, University of
Manchester, Manchester, UK
| | - Tjeerd Van Staa
- Division of Informatics, Imaging
& Data Sciences, University of
Manchester, Manchester, UK
| | - Alan Woodall
- Directorate of Mental Health and
Learning Disabilities, Powys Teaching Health
Board, Bronllys, UK
| | - Iain Buchan
- Institute of Population Health,
University
of Liverpool, Liverpool, UK
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Price JL, Bruce MA, Adinoff B. Addressing Structural Racism in Psychiatry With Steps to Improve Psychophysiologic Research. JAMA Psychiatry 2022; 79:70-74. [PMID: 34613345 DOI: 10.1001/jamapsychiatry.2021.2663] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The American Medical Association has acknowledged the public health threat posed by racism in medicine. While clinicians in psychiatry have echoed the sentiment, the research community has largely been silent. Current understanding of the biological domains that underlie psychiatric disorders was historically established by studying White populations, often leaving widely used treatments ineffective for Asian, Black, Hispanic, Indigenous, and other racial and ethnic minority individuals. This article addresses how undersampling of racial and ethnic minority individuals has led to overgeneralized physiological findings, the implications for development of psychiatric treatments, and steps to improve service to racially diverse communities. OBSERVATIONS Three primary observations regarding differences associated with race and ethnicity have been addressed in the existing psychiatric research: misdiagnosis, medication nonadherence, and treatment efficacy and expression of adverse effects. While cultural factors have been discussed as potential factors associated with these differences, a lack of understanding of physiologic systems may be foundational to each of these issues. Recent evidence points to race differences in psychophysiological measures, likely attributed to factors including the lived experience of racism as opposed to inherent biological differences. This mounting evidence supports a reassessment of existing work to examine potential divergent patterns within racial and ethnic groups. The following strategies may improve understanding of the influence of racism on physiology, allowing clinicians to better address psychiatric symptoms and improve existing treatment approaches. Thus, psychiatric researchers need to (1) understand the historic and current terminology for race and ethnicity and use appropriate terms and categories as defined by sociologists, population health experts, and databases while respecting individuals' right to self-identify, (2) refine research questions, and (3) reexamine research data to determine whether patterns observed in largely White populations can extend to other groups. To appropriately implement these steps, researchers must accept the discomfort that accompanies growth, invite scientists from diverse backgrounds to participate, and use resources to increase diversity in recruitment of study participants. This will require a commitment from funding agencies to provide adequate support to recruit and investigate large, diverse samples. CONCLUSIONS AND RELEVANCE To create more suitable medical treatments and improve the quality of care received by those with psychiatric conditions, further discussion is needed surrounding the physiologic toll that racism has had on multiple generations of racial and ethnic minority groups and how that may alter responsivity to biobehavioral interventions. To better inform psychiatric research, the resources provided must be expanded, basic physiologic studies should be replicated with more diverse samples and adequate analyses, and psychiatry scientists must reconsider approaches to clinical research.
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Affiliation(s)
- Julianne L Price
- Department of Kinesiology and Health, Center of Alcohol and Substance Use Studies, Rutgers University, New Brunswick, New Jersey
| | - Marino A Bruce
- Program for Research on Faith, Justice, and Health, Department of Behavioral and Social Sciences, University of Houston College of Medicine, Houston, Texas
| | - Bryon Adinoff
- Anschutz Medical Campus, University of Colorado, Denver
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Su Z, Meyer K, Li Y, McDonnell D, Joseph NM, Li X, Du Y, Advani S, Cheshmehzangi A, Ahmad J, da Veiga CP, Chung RYN, Wang J, Hao X. Technology-based interventions for nursing home residents: a systematic review protocol. BMJ Open 2021; 11:e056142. [PMID: 34853115 PMCID: PMC8638465 DOI: 10.1136/bmjopen-2021-056142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19. METHODS AND ANALYSIS Databases including the PubMed, PsycINFO, CINAHL and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between 1 January 2010 to 30 September 2021. Titles, abstracts and full-text papers will be reviewed against the eligibility criteria. The Cochrane Collaboration evaluation framework will be adopted to examine the risk of bias of the included study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process and implications for existing interventions and research evaluated by a multidisciplinary research team. ETHICS AND DISSEMINATION As the study is a protocol for a systematic review, ethical approval is not required. The study findings will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER CRD 42020191880.
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Affiliation(s)
- Zhaohui Su
- School of Nursing, Center on Smart and Connected Health Technologies, Mays Cancer Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kylie Meyer
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Yue Li
- Health Services Research & Policy (HSRP) PhD & MS Programs; Director of Research, Division of Health Policy and Outcomes Research (HPOR); Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Dean McDonnell
- Department of Humanities, Institute of Technology Carlow, Carlow, Ireland
| | - Nitha Mathew Joseph
- Department of Under Graduate Studies, Cizik School of Nursing, The University of Texas Health Science Center, Houston, Texas, USA
| | - Xiaoshan Li
- Program of Public Relations and Advertising, Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, Guangdong, China
| | - Yan Du
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Shailesh Advani
- Terasaki Institute of Biomedical Innovation, Los Angeles, California, USA
| | - Ali Cheshmehzangi
- Architecture and Urban Design, Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, Zhejiang, China
| | - Junaid Ahmad
- Department of Public Health, Peshawar Medical College, Peshawar, Pakistan
| | | | - Roger Yat-Nork Chung
- School of Public Health & Primary Care, Faculty of Medicine (RY-NC) and Institute of Health Equity (RY-NC), The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Social Sciences, Faculty of Liberal Arts and Social Sciences, The Education University of Hong Kong, Hong Kong, Hong Kong
| | - Jing Wang
- College of Nursing, Florida State University, Tallahassee, Florida, USA
| | - Xiaoning Hao
- Director of Division, Division of Health Security Research, China National Health Development Research Center, National Health Commission, Beijing, China
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Blackburn NA, Joniak-Grant E, Nocera M, Dorris SW, Dasgupta N, Chelminski PR, Carey TS, Wu LT, Edwards DA, Marshall SW, Ranapurwala SI. Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives. BMC Health Serv Res 2021; 21:1191. [PMID: 34732177 PMCID: PMC8565171 DOI: 10.1186/s12913-021-07230-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent increases in state laws to reduce opioid prescribing have demonstrated a need to understand how they are interpreted and implemented in healthcare systems. The purpose of this study was to explore the systems, strategies, and resources that hospital administrators and prescribers used to implement the 2017 North Carolina Strengthen Opioid Prevention (STOP) Act opioid prescribing limits, which limited initial prescriptions to a five (for acute) or seven (for post-surgical) days' supply. METHODS We interviewed 14 hospital administrators and 38 prescribers with degrees in medicine, nursing, pharmacy, business administration and public health working across North Carolina. Interview guides, informed by the Consolidated Framework for Implementation Research, explored barriers and facilitators to implementation. Interview topics included communication, resources, and hospital system support. Interviews were recorded and transcribed, then analyzed using flexible coding, integrating inductive and deductive coding, to inform analytic code development and identify themes. RESULTS We identified three main themes around implementation of STOP act mandated prescribing limits: organizational communication, prescriber education, and changes in the electronic medical record (EMR) systems. Administrators reflected on implementation in the context of raising awareness and providing reminders to facilitate changes in prescriber behavior, operationalized through email and in-person communications as well as dedicated resources to EMR changes. Prescribers noted administrative communications about prescribing limits often focused on legality, suggesting a directive of the organization's policy rather than a passive reminder. Prescribers expressed a desire for more spaces to have their questions answered and resources for patient communications. While hospital administrators viewed compliance with the law as a priority, prescribers reflected on concerns for adequately managing their patients' pain and limited time for clinical care. CONCLUSIONS Hospital administrators and prescribers approached implementation of the STOP act prescribing limits with different mindsets. While administrators were focused on policy compliance, prescribers were focused on their patients' needs. Strategies to implement the mandate then had to balance patient needs with policy compliance. As states continue to legislate to prevent opioid overdose deaths, understanding how laws are implemented by healthcare systems and prescribers will improve their effectiveness through tailoring and maximizing available resources.
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Affiliation(s)
- Natalie A Blackburn
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA.
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Elizabeth Joniak-Grant
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA
| | - Maryalice Nocera
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA
| | - Samantha Wooten Dorris
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA
| | - Nabarun Dasgupta
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA
- Office of Research, Innovations, and Global Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul R Chelminski
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Timothy S Carey
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Health Center for Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - David A Edwards
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen W Marshall
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shabbar I Ranapurwala
- University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, 27516, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hilty DM, Armstrong CM, Smout SA, Crawford A, Maheu MM, Drude KP, Chan S, Yellowlees PM, Krupinski EA. PROVIDER TECHNOLOGY, FATIGUE AND WELL-BEING: A SCOPING REVIEW (Preprint). J Med Internet Res 2021; 24:e34451. [PMID: 35612880 PMCID: PMC9178447 DOI: 10.2196/34451] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/20/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Video and other technologies are reshaping the delivery of health care, yet barriers related to workflow and possible provider fatigue suggest that a thorough evaluation is needed for quality and process improvement. Objective This scoping review explored the relationship among technology, fatigue, and health care to improve the conditions for providers. Methods A 6-stage scoping review of literature (from 10 databases) published from 2000 to 2020 that focused on technology, health care, and fatigue was conducted. Technologies included synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care in 4 concept areas related to provider experience: behavioral, cognitive, emotional, and physical impact; workplace at the individual, clinic, hospital, and system or organizational levels; well-being, burnout, and stress; and perceptions regarding technology. Qualitative content, discourse, and framework analyses were used to thematically analyze data for developing a spectrum of health to risk of fatigue to manifestations of burnout. Results Of the 4221 potential literature references, 202 (4.79%) were duplicates, and our review of the titles and abstracts of 4019 (95.21%) found that 3837 (90.9%) were irrelevant. A full-text review of 182 studies revealed that 12 (6.6%) studies met all the criteria related to technology, health care, and fatigue, and these studied the behavioral, emotional, cognitive, and physical impact of workflow at the individual, hospital, and system or organizational levels. Video and electronic health record use has been associated with physical eye fatigue; neck pain; stress; tiredness; and behavioral impacts related to additional effort owing to barriers, trouble with engagement, emotional wear and tear and exhaustion, cognitive inattention, effort, expecting problems, multitasking and workload, and emotional experiences (eg, anger, irritability, stress, and concern about well-being). An additional 14 studies that evaluated behavioral, emotional, and cognitive impacts without focusing on fatigue found high user ratings on data quality, accuracy, and processing but low satisfaction with clerical tasks, the effort required in work, and interruptions costing time, resulting in more errors, stress, and frustration. Our qualitative analysis suggests a spectrum from health to risk and provides an outline of organizational approaches to human factors and technology in health care. Business, occupational health, human factors, and well-being literature have not studied technology fatigue and burnout; however, their findings help contextualize technology-based fatigue to suggest guidelines. Few studies were found to contextually evaluate differences according to health professions and practice contexts. Conclusions Health care systems need to evaluate the impact of technology in accordance with the Quadruple Aim to support providers’ well-being and prevent workload burden, fatigue, and burnout. Implementation and effectiveness approaches and a multilevel approach with objective measures for clinical, human factors, training, professional development, and administrative workflow are suggested. This requires institutional strategies and competencies to integrate health care quality, technology and well-being outcomes.
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Affiliation(s)
- Donald M Hilty
- Department of Psychiatry & Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
- Northern California Veterans Affairs Health Care System, Mather, CA, United States
| | - Christina M Armstrong
- Office of Connected Care, Department of Veterans Affairs, Washington, DC, United States
| | - Shelby A Smout
- Virginia Commonwealth University, Richmond, VA, United States
| | - Allison Crawford
- Extension for Community Healthcare Outcomes, Ontario Mental Health at Centre for Addiction and Mental Health, University of Toronto Virtual Mental Health, and Canada Suicide Prevention Service, Toronto, ON, Canada
| | - Marlene M Maheu
- Telebehavioral Health Institute, LLC and Coalition for Technology in Behavioral Science, San Diego, CA, United States
| | - Kenneth P Drude
- Coalition for Technology in Behavioral Science & Ohio Board of Psychology, Dayton, OH, United States
| | - Steven Chan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine & Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Peter M Yellowlees
- Department of Psychiatry & Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Elizabeth A Krupinski
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
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Kjelle E, Andersen ER, Soril LJJ, van Bodegom-Vos L, Hofmann BM. Interventions to reduce low-value imaging - a systematic review of interventions and outcomes. BMC Health Serv Res 2021; 21:983. [PMID: 34537051 PMCID: PMC8449221 DOI: 10.1186/s12913-021-07004-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is estimated that 20-50% of all radiological examinations are of low value. Many attempts have been made to reduce the use of low-value imaging. However, the comparative effectiveness of interventions to reduce low-value imaging is unclear. Thus, the objective of this systematic review was to provide an overview and evaluate the outcomes of interventions aimed at reducing low-value imaging. METHODS An electronic database search was completed in Medline - Ovid, Embase-Ovid, Scopus, and Cochrane Library for citations between 2010 and 2020. The search was built from medical subject headings for Diagnostic imaging/Radiology, Health service misuse or medical overuse, and Health planning. Keywords were used for the concept of reduction and avoidance. Reference lists of included articles were also hand-searched for relevant citations. Only articles written in English, German, Danish, Norwegian, Dutch, and Swedish were included. The Mixed Methods Appraisal Tool was used to appraise the quality of the included articles. A narrative synthesis of the final included articles was completed. RESULTS The search identified 15,659 records. After abstract and full-text screening, 95 studies of varying quality were included in the final analysis, containing 45 studies found through hand-searching techniques. Both controlled and uncontrolled before-and-after studies, time series, chart reviews, and cohort studies were included. Most interventions were aimed at referring physicians. Clinical practice guidelines (n = 28) and education (n = 28) were most commonly evaluated interventions, either alone or in combination with other components. Multi-component interventions were often more effective than single-component interventions showing a reduction in the use of low-value imaging in 94 and 74% of the studies, respectively. The most addressed types of imaging were musculoskeletal (n = 26), neurological (n = 23) and vascular (n = 16) imaging. Seventy-seven studies reported reduced low-value imaging, while 3 studies reported an increase. CONCLUSIONS Multi-component interventions that include education were often more effective than single-component interventions. The contextual and cultural factors in the health care systems seem to be vital for successful reduction of low-value imaging. Further research should focus on assessing the impact of the context in interventions reducing low-value imaging and how interventions can be adapted to different contexts.
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Affiliation(s)
- Elin Kjelle
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802 Gjøvik, Norway
| | - Eivind Richter Andersen
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802 Gjøvik, Norway
| | - Lesley J. J. Soril
- Department of Community Health Sciences and The Health Technology Assessment Unit, O’Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6 Canada
| | - Leti van Bodegom-Vos
- Medical Decision making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802 Gjøvik, Norway
- Centre of Medical Ethics, University of Oslo, Postbox 1130, Blindern, 0318 Oslo, Norway
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Abstract
Health information technology-guided clinical decision support has demonstrated decreases in patient safety errors in the electronic health record. Unknown and re-emerging infectious diseases are a growing concern for many healthcare facilities. The purpose of this project was to develop a modular approach to integrate rapid deployment of clinical decision support for infectious diseases into the clinical workflow and evaluate the usability of the design. This article reports on the results of a quality improvement project to develop, implement, and evaluate rapid deployment of a clinical decision support module using a tuberculosis use case. Important lessons learned from the electronic health record build with previous Ebola and Zika decision support alert strategy are discussed as foundational in guiding the overall design, implementation, and evaluation of improvement strategies. Subject matter expert feedback was sought throughout the project for electronic health record design and build considerations. Usability evaluation was conducted using the classic Task, User, Representation, and Function unified framework of electronic health record usability. Usability satisfaction for both providers and nurses remained high. Tuberculosis cases pre-alert and post-alert had decreased order times for diagnostic studies. Results suggest satisfied clinicians coupled with usable systems create a more efficient workflow resulting in safer and timelier diagnostic testing.
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Gasteiger N, van der Veer SN, Wilson P, Dowding D. Upskilling health and care workers with augmented and virtual reality: protocol for a realist review to develop an evidence-informed programme theory. BMJ Open 2021; 11:e050033. [PMID: 34226234 PMCID: PMC8258595 DOI: 10.1136/bmjopen-2021-050033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/10/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Augmented reality (AR) and virtual reality (VR) are increasingly used to upskill health and care providers, including in surgical, nursing and acute care settings. Many studies have used AR/VR to deliver training, providing mixed evidence on their effectiveness and limited evidence regarding contextual factors that influence effectiveness and implementation. This review will develop, test and refine an evidence-informed programme theory on what facilitates or constrains the implementation of AR or VR programmes in health and care settings and understand how, for whom and to what extent they 'work'. METHODS AND ANALYSIS This realist review adheres to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) standards and will be conducted in three steps: theory elicitation, theory testing and theory refinement. First, a search will identify practitioner, academic and learning and technology adoption theories from databases (MEDLINE, Scopus, CINAHL, Embase, Education Resources Information Center, PsycINFO and Web of Science), practitioner journals, snowballing and grey literature. Information regarding contexts, mechanisms and outcomes will be extracted. A narrative synthesis will determine overlapping configurations and form an initial theory. Second, the theory will be tested using empirical evidence located from the above databases and identified from the first search. Quality will be assessed using the Mixed Methods Appraisal Tool (MMAT), and relevant information will be extracted into a coding sheet. Third, the extracted information will be compared with the initial programme theory, with differences helping to make refinements. Findings will be presented as a narrative summary, and the MMAT will determine our confidence in each configuration. ETHICS AND DISSEMINATION Ethics approval is not required. This review will develop an evidence-informed programme theory. The results will inform and support AR/VR interventions from clinical educators, healthcare providers and software developers. Upskilling through AR/VR learning interventions may improve quality of care and promote evidence-based practice and continued learning. Findings will be disseminated through conference presentations and peer-reviewed journal articles.
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Affiliation(s)
- Norina Gasteiger
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, Centre for Health Informatics, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sabine N van der Veer
- Division of Informatics, Imaging and Data Sciences, Centre for Health Informatics, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Paul Wilson
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Seljelid B, Varsi C, Solberg Nes L, Øystese KA, Børøsund E. A Digital Patient-Provider Communication Intervention (InvolveMe): Qualitative Study on the Implementation Preparation Based on Identified Facilitators and Barriers. J Med Internet Res 2021; 23:e22399. [PMID: 33830063 PMCID: PMC8294341 DOI: 10.2196/22399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/09/2020] [Accepted: 03/18/2021] [Indexed: 01/15/2023] Open
Abstract
Background Chronic health conditions are affecting an increasing number of individuals, who experience various symptoms that decrease their quality of life. Digital communication interventions that enable patients to report their symptoms have been shown to positively impact chronic disease management by improving access to care, patient-provider communication, clinical outcomes, and health-related quality of life. These interventions have the potential to prepare patients and health care providers (HCPs) before visits and improve patient-provider communication. Despite the recent rapid development and increasing number of digital communication interventions that have shown positive research results, barriers to realizing the benefits offered through these types of interventions still exist. Objective The aim of this study is to prepare for the implementation of a digital patient-provider communication intervention in the daily workflow at 2 outpatient clinics by identifying potential determinants of implementation using the Consolidated Framework for Implementation Research (CFIR) to tailor the use of digital communication intervention to the intended context and identify key aspects for an implementation plan. Methods A combination of focus groups, workshops, and project steering committee meetings was conducted with HCPs (n=14) and patients (n=2) from 2 outpatient clinics at a university hospital. The CFIR was used to guide data collection and analysis. Transcripts, written minutes, and notes were analyzed and coded into 5 CFIR domains using thematic analysis. Results Data were examined and analyzed into 18 CFIR constructs relevant to the study purpose. On the basis of the identified determinants, important intervention tailoring includes adjustments to the digital features and adjustments to fit the clinical workflow and a decision to conduct a future pilot study. Furthermore, it was decided to provide the intervention to patients as early as possible in their disease trajectory, with tailored information about its use. Key aspects for the implementation plan encompassed maintaining the identified engagement and positive attitude, involving key stakeholders in the implementation process, and providing the needed support and training. Conclusions This study offers insight into the involvement of stakeholders in the tailoring and implementation planning of a digital communication intervention in clinical practice. Stakeholder involvement in the identification of implementation facilitators and barriers can contribute to the tailoring of digital communication interventions and how they are used and can also inform systematic and targeted implementation planning.
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Affiliation(s)
- Berit Seljelid
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cooperation, Patient Education and Equivalent Health Services, CEO's Staff, Oslo University Hospital, Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, United States
| | - Kristin Astrid Øystese
- Section of Specialized Endocrinology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Department of Medical Biochemistry, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
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Saghafian M, Laumann K, Skogstad MR. Stagewise Overview of Issues Influencing Organizational Technology Adoption and Use. Front Psychol 2021; 12:630145. [PMID: 33815216 PMCID: PMC8009967 DOI: 10.3389/fpsyg.2021.630145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/15/2021] [Indexed: 01/22/2023] Open
Abstract
This paper provides a stagewise overview of the important issues that play a role in technology adoption and use in organizations. In the current literature, there is a lack of consistency and clarity about the different stages of the technology adoption process, the important issues at each stage, and the differentiation between antecedents, after-effects, enablers, and barriers to technology adoption. This paper collected the relevant issues in technology adoption and use, mentioned dispersedly and under various terminologies, in the recent literature. The qualitative literature review was followed by thematic analysis of the data. The resulting themes were organized into a thematic map depicting three stages of the technology adoption process: pre-change, change, and post-change. The relevant themes and subthemes at each stage were identified and their significance discussed. The themes at each stage are antecedents to the next stage. All the themes of the pre-change and change stages are neutral, but the way they are managed and executed makes them enablers or barriers in effect. The thematic map is a continuous cycle where every round of technology adoption provides input for the subsequent rounds. Based on how themes have been addressed and executed in practice, they can either enhance or impair the subsequent technology adoption. This thematic map can be used as a qualitative framework by academics and practitioners in the field to evaluate technological changes.
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Affiliation(s)
- Mina Saghafian
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karin Laumann
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Herter WE, Khuc J, Cinà G, Knottnerus BJ, Numans ME, Wiewel MA, Bonten TN, de Bruin DP, van Esch T, Chavannes NH, Verheij RA. Impact of a machine learning based decision support for Urinary Tract Infections: Prospective observational study in 36 primary care practices (Preprint). JMIR Med Inform 2021; 10:e27795. [PMID: 35507396 PMCID: PMC9118012 DOI: 10.2196/27795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/28/2021] [Accepted: 02/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background There is increasing attention on machine learning (ML)-based clinical decision support systems (CDSS), but their added value and pitfalls are very rarely evaluated in clinical practice. We implemented a CDSS to aid general practitioners (GPs) in treating patients with urinary tract infections (UTIs), which are a significant health burden worldwide. Objective This study aims to prospectively assess the impact of this CDSS on treatment success and change in antibiotic prescription behavior of the physician. In doing so, we hope to identify drivers and obstacles that positively impact the quality of health care practice with ML. Methods The CDSS was developed by Pacmed, Nivel, and Leiden University Medical Center (LUMC). The CDSS presents the expected outcomes of treatments, using interpretable decision trees as ML classifiers. Treatment success was defined as a subsequent period of 28 days during which no new antibiotic treatment for UTI was needed. In this prospective observational study, 36 primary care practices used the software for 4 months. Furthermore, 29 control practices were identified using propensity score-matching. All analyses were performed using electronic health records from the Nivel Primary Care Database. Patients for whom the software was used were identified in the Nivel database by sequential matching using CDSS use data. We compared the proportion of successful treatments before and during the study within the treatment arm. The same analysis was performed for the control practices and the patient subgroup the software was definitely used for. All analyses, including that of physicians’ prescription behavior, were statistically tested using 2-sided z tests with an α level of .05. Results In the treatment practices, 4998 observations were included before and 3422 observations (of 2423 unique patients) were included during the implementation period. In the control practices, 5044 observations were included before and 3360 observations were included during the implementation period. The proportion of successful treatments increased significantly from 75% to 80% in treatment practices (z=5.47, P<.001). No significant difference was detected in control practices (76% before and 76% during the pilot, z=0.02; P=.98). Of the 2423 patients, we identified 734 (30.29%) in the CDSS use database in the Nivel database. For these patients, the proportion of successful treatments during the study was 83%—a statistically significant difference, with 75% of successful treatments before the study in the treatment practices (z=4.95; P<.001). Conclusions The introduction of the CDSS as an intervention in the 36 treatment practices was associated with a statistically significant improvement in treatment success. We excluded temporal effects and validated the results with the subgroup analysis in patients for whom we were certain that the software was used. This study shows important strengths and points of attention for the development and implementation of an ML-based CDSS in clinical practice. Trial Registration ClinicalTrials.gov NCT04408976; https://clinicaltrials.gov/ct2/show/NCT04408976
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Affiliation(s)
- Willem Ernst Herter
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Pacmed, Amsterdam, Netherlands
| | | | | | - Bart J Knottnerus
- Nivel Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Maryse A Wiewel
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Pacmed, Amsterdam, Netherlands
| | - Tobias N Bonten
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | - Thamar van Esch
- Nivel Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Robert A Verheij
- Nivel Netherlands Institute for Health Services Research, Utrecht, Netherlands
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Elliot V, Morgan D, Kosteniuk J, Bayly M, Froehlich Chow A, Cammer A, O’Connell ME. Palliative and end-of-life care for people living with dementia in rural areas: A scoping review. PLoS One 2021; 16:e0244976. [PMID: 33444351 PMCID: PMC7808637 DOI: 10.1371/journal.pone.0244976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background and objectives People living with dementia deserve to experience the benefits of receiving palliative care and end-of-life services and supports, yet they often do not receive this care compared to those with other terminal diseases. People living with dementia in rural areas often face additional challenges to accessing such care. The purpose of this scoping review was to systematically review and synthesize the literature on palliative and end-of-life care for people with dementia living in rural areas, and to identify and describe key findings and gaps in the literature. Methods A collaborative research team approach was used in an iterative process across all stages of this review. Systematic, comprehensive searches were conducted across ten databases and eight targeted websites for relevant peer-reviewed, original research and other less formal literature, published in English, which yielded a total of 4476 results. After duplicate removal, screening, and review, 24 items were included for synthesis. Results All items were described and illustrated by frequency distribution, findings were grouped thematically, and five key themes emerged, including: 1) Knowledge about dementia, 2) Availability, accessibility, and utilization of palliative and end-of-life care services and supports, 3) Decision-making about care, the value of a person-centered approach and collaborative support, 4) Perspectives on artificial nutrition, hydration, and comfort care, and 5) Quality of life and death. The main gap identified was literature pertaining to rural populations, especially from locations other than the United States. The influence of rurality on relevant findings was mixed across rural-urban comparison studies, as was the effect of sex and gender across the literature. Conclusions Several areas were highlighted including the importance of increasing knowledge about dementia, having early conversations about advanced care and treatment options, providing a person-centered approach, and the potential for using technology to address rural access issues. These findings can be used to inform future research and policy and the development of services, supports, and strategies for rural people living with dementia. Further research is recommended.
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Affiliation(s)
- Valerie Elliot
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- * E-mail:
| | - Debra Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Julie Kosteniuk
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Melanie Bayly
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Amanda Froehlich Chow
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Megan E. O’Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Su Z, Meyer K, Li Y, McDonnell D, Joseph NM, Li X, Du Y, Advani S, Cheshmehzangi A, Ahmad J, da Veiga CP, Chung RYN, Wang J. Technology-Based Interventions for Nursing Home Residents: Implications for Nursing Home Practice Amid and Beyond the Influence of COVID-19: A Systematic Review Protocol. RESEARCH SQUARE 2020:rs.3.rs-56102. [PMID: 36597539 PMCID: PMC7444297 DOI: 10.21203/rs.3.rs-56102/v2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19. Methods Databases including PubMed, PsycINFO, CINAHL, and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between January 1st, 2010 to December 4th, 2020. Titles, abstracts, and full-texts papers will be reviewed against the eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process, and implications for existing interventions and research evaluated by a multidisciplinary research team. Results NA-protocol study. Conclusions Our study will fill critical gaps in the literature by providing a review of technology-based interventions tested in the nursing home setting. As the older adult population grows, there is an urgent need to identify effective technology-based interventions that can address the distinctive characteristics and preferences of nursing home residents. Clear and comprehensive understanding of how available technology-based health solutions facilitate healthcare for nursing home residents will shed light on the approaches open to residents to fend off the negative health consequences amid and beyond the influence of COVID-19. Systematic Review Registrations PROSPERO CRD 42020191880.
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Affiliation(s)
- Zhaohui Su
- University of Texas Health Science Center at San Antonio
| | - Kylie Meyer
- University of Texas Health Science Center at San Antonio
| | - Yue Li
- University of Rochester Medical Center
| | | | | | - Xiaoshan Li
- Beijing Normal University-Hong Kong Baptist University United International College
| | - Yan Du
- University of Texas Health Science Center at San Antonio
| | | | | | | | | | | | - Jing Wang
- University of Texas Health Science Center at San Antonio
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49
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Servaty R, Kersten A, Brukamp K, Möhler R, Mueller M. Implementation of robotic devices in nursing care. Barriers and facilitators: an integrative review. BMJ Open 2020; 10:e038650. [PMID: 32958491 PMCID: PMC7507851 DOI: 10.1136/bmjopen-2020-038650] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Robots in healthcare are gaining increasing attention; however, their implementation is challenging due to the complexity of both interventions themselves and the contexts in which they are implemented. The objective of this integrative review is to identify barriers to and facilitators of the implementation of robotic systems in nursing. METHODS Articles published from 2002 to 2019 reporting on projects to implement robotic devices in nursing care were searched on Medline (via PubMed), CINAHL and databases on funded research projects (Community Research and Development Information Services and Technische Informationsbibliothek) and in journals for robotic research in November 2017 and July 2019 for an update. No restrictions regarding study designs were imposed. All included articles underwent quality assessments with design-specific critical appraisal tools. Barriers to and facilitators of implementation were classified using the Context and Implementation of Complex Interventions framework. RESULTS After removing all duplicates, the search revealed 11 204 studies, of which 17 met the inclusion criteria and were included in the synthesis. The majority of the studies dealt with the implementation of robots designed to support individuals, either living at home or in nursing homes (n=11). The studies were conducted in Europe, the USA and New Zealand and were carried out in nursing homes, individual living environments, hospital units and laboratories. The quality of reporting and quality of evidence were low in most studies. The most frequently reported barriers were in socioeconomic and ethical domains and were within the implementation outcomes domain. The most frequently reported facilitators were related to the sociocultural context, implementation process and implementation strategies. DISCUSSION This review identified barriers to and facilitators of the implementation of robotic devices in nursing within different dimensions. The results serve as a basis for the development of suitable implementation strategies to reduce potential barriers and promote the integration of elements to facilitate implementation. PROSPERO REGISTRATION NUMBER CRD42018073486.
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Affiliation(s)
- Ricarda Servaty
- Faculty of Applied Health and Social Sciences, Technical University of Applied Sciences, Rosenheim, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universitaet, Muenchen, Germany
| | | | - Kirsten Brukamp
- Protestant University of Applied Sciences, Ludwigsburg, Germany
| | - Ralph Möhler
- School of Public Health, Universitat Bielefeld, Bielefeld, Germany
| | - Martin Mueller
- Faculty of Applied Health and Social Sciences, Technical University of Applied Sciences, Rosenheim, Germany
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50
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Su Z, Meyer K, Li Y, McDonnell D, Joseph NM, Li X, Du Y, Advani S, Cheshmehzangi A, Ahmad J, da Veiga CP, Chung RYN, Wang J. Technology-Based Interventions for Nursing Home Residents: Implications for Nursing Home Practice Amid and Beyond the Influence of COVID-19: A Systematic Review Protocol. RESEARCH SQUARE 2020:rs.3.rs-56102. [PMID: 32839768 PMCID: PMC7444297 DOI: 10.21203/rs.3.rs-56102/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19. Methods: Databases including PubMed, PsycINFO, CINAHL, and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between January 1 st , 2020 to July 7 th , 2020. Titles, abstracts, and full-texts papers will be reviewed against the eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process, and implications for existing interventions and research evaluated by a multidisciplinary research team. Results: NAâ€"protocol study Conclusions: Our study will fill critical gaps in the literature by providing a review of technology-based interventions tested in the nursing home setting. As the older adult population grows, there is an urgent need to identify effective technology-based interventions that can address the distinctive characteristics and preferences of nursing home residents. Clear and comprehensive understanding of how available technology-based health solutions facilitate healthcare for nursing home residents will shed light on the approaches open to residents to fend off the negative health consequences amid and beyond the influence of COVID-19. Systematic Review Registrations: PROSPERO CRD 42020191880.
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