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Rzewuska Díaz M, Locock L, Keen A, Melvin M, Myhill A, Ramsay C. Implementation of a Web-Based Outpatient Asynchronous Consultation Service: Mixed Methods Study. J Med Internet Res 2024; 26:e48092. [PMID: 38833695 PMCID: PMC11185905 DOI: 10.2196/48092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 12/15/2023] [Accepted: 03/12/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Asynchronous outpatient patient-to-provider communication is expanding in UK health care, requiring evaluation. During the pandemic, Aberdeen Royal Infirmary in Scotland expanded its outpatient asynchronous consultation service from dermatology (deployed in May 2020) to gastroenterology and pain management clinics. OBJECTIVE We conducted a mixed methods study using staff, patient, and public perspectives and National Health Service (NHS) numerical data to obtain a rounded picture of innovation as it happened. METHODS Focus groups (3 web-based and 1 face-to-face; n=22) assessed public readiness for this service, and 14 interviews with staff focused on service design and delivery. The service's effects were examined using NHS Grampian service use data, a patient satisfaction survey (n=66), and 6 follow-up patient interviews. Survey responses were descriptively analyzed. Demographics, acceptability, nonattendance rates, and appointment outcomes of users were compared across levels of area deprivation in which they live and medical specialties. Interviews and focus groups underwent theory-informed thematic analysis. RESULTS Staff anticipated a simple technical system transfer from dermatology to other receptive medical specialties, but despite a favorable setting and organizational assistance, it was complicated. Key implementation difficulties included pandemic-induced technical integration delays, misalignment with existing administrative processes, and discontinuity in project management. The pain management clinic began asynchronous consultations (digital appointments) in December 2021, followed by the gastroenterology clinic in February 2022. Staff quickly learned how to explain and use this service. It was thought to function better for pain management as it fitted preexisting practices. From May to September 2022, the dermatology (adult and pediatric), gastroenterology, and pain management clinics offered 1709 appointments to a range of patients (n=1417). Digital appointments reduced travel by an estimated 44,712 miles (~71,956.81 km) compared to the face-to-face mode. The deprivation profile of people who chose to use this service closely mirrored that of NHS Grampian's population overall. There was no evidence that deprivation impacted whether digital appointment users subsequently received treatment. Only 18% (12/66) of survey respondents were unhappy or very unhappy with being offered a digital appointment. The benefits mentioned included better access, convenience, decreased travel and waiting time, information sharing, and clinical flexibility. Overall, patients, the public, and staff recognized its potential as an NHS service but highlighted informed choice and flexibility. Better communication-including the use of the term assessment instead of appointment-may increase patient acceptance. CONCLUSIONS Asynchronous pain management and gastroenterology consultations are viable and acceptable. Implementing this service is easiest when existing administrative processes face minimal disruption, although continuous support is needed. This study can inform practical strategies for supporting staff in adopting asynchronous consultations (eg, preparing for nonlinearity and addressing task issues). Patients need clear explanations and access to technical support, along with varied consultation options, to ensure digital inclusion.
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Affiliation(s)
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Andrew Keen
- NHS Grampian, Grampian, Aberdeen, United Kingdom
| | - Mike Melvin
- Public Research Partner, University of Aberdeen, Aberdeen, United Kingdom
| | - Anthony Myhill
- Public Research Partner, University of Aberdeen, Aberdeen, United Kingdom
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
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Schuessler N, Glarcher M. Caregivers' Perspectives on Ethical Challenges and Patient Safety in Tele-Palliative Care: An Integrative Review. J Hosp Palliat Nurs 2024; 26:E1-E12. [PMID: 37747961 DOI: 10.1097/njh.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Tele-palliative care enables people with a life-limiting illness to consult with palliative care staff without having to leave their homes but requires commitment from all stakeholders, particularly on ethical challenges and patient safety issues. When using telecommunications and virtual technology, ethical challenges and patient safety aspects must be taken into account. The aim was to describe formal and informal caregivers' opportunities in tele-palliative care and the associated ethical and safety challenges using a Whittemore and Knafl integrative review method. Ethical and patient safety perspectives were extracted from studies reporting on tele-palliative care interventions. Content on ethically considerable information on the intervention was coded, categorized, and summarized into a matrix developed in advance from literature on socio-technical arrangements and eHealth applications. Nine studies from experimental and nonexperimental research were included. Four studies reported exclusively on the perspective of formal caregivers, 3 studies addressed the perspective of patients and informal caregivers, and 2 studies covered the perspectives of both. Studies of tele-palliative care interventions implicate effects on patient-caregiver relationships but also show that technology is not seen as a replacement of holistic palliative care. However, the authors do not address other relevant ethical issues (eg, sustainability) or consider aspects of patient safety. There is a need for further research to assess privacy, data security, and patient safety in tele-palliative care from the perspective of caregivers as telehealth becomes increasingly important.
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Cheng KW, Shih HM, Ng CJ, Shih CL, Chen WK. National emergency medical teleconsultation: A novel system applied during the COVID-19 pandemic in Taiwan. J Telemed Telecare 2023:1357633X231217326. [PMID: 38128920 DOI: 10.1177/1357633x231217326] [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: 12/23/2023]
Abstract
OBJECTIVE Telemedicine can facilitate social distancing during an infectious disease pandemic and reduce the burden on health-care resources. Moreover, telemedicine can be utilized for medical care in remote island regions, in home health care, and during isolated major disasters such as regional earthquakes. However, the effectiveness of telemedicine for emergency consultation remains unclear. This study introduced and analyzed the national emergency medical teleconsultation (NEMTC) established in Taiwan in 2022 during the COVID-19 pandemic. METHODS In response to the COVID-19 pandemic, Taiwan's Centers for Disease Control established a temporary 24-h NEMTC contingency system. Patient information was collected from consultations through the NEMTC from April 28 to June 28, 2022. After successful consultation, physicians made recommendations for home observation, emergency department (ED) visit, or outpatient follow-up. ED visits were divided into two categories, namely self-transport and transport, by the emergency medical service system (EMSS). RESULTS During the aforementioned period, 20,902 consultation requests were made through the NEMTC, and 11,804 consultations (56.5% of 20,902) were successful. Consultation success rates were significantly higher for those who had a consultation between 08:00 and 16:00, had a waiting time of less than 10 min, and were not aged between 18 and 45 years. Moreover, 8.2% of the analyzed patients were advised to visit the ED, and only 0.4% required ambulance transportation. Children and older individuals and patients with cardiovascular symptoms, shortness of breath, or neurological or abdominal symptoms had a significantly higher chance of being referred to the ED than did other individuals. CONCLUSIONS The NEMTC response system can enhance the efficiency of the EMSS and can reduce the burden of patients with mild conditions overloading the EMSS and EDs. The NEMTC could serve as an effective rapid response system during future pandemics.
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Affiliation(s)
- Kai-Wen Cheng
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hong-Mo Shih
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chung-Liang Shih
- Ministry of Health and Welfare, National Health Insurance Administration, Taipei, Taiwan
| | - Wei-Kung Chen
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Rauzi MR, Abbate LM, Lum HD, Cook PF, Stevens-Lapsley JE. Multicomponent telerehabilitation programme for older veterans with multimorbidity: a programme evaluation. BMJ Mil Health 2023:e002535. [PMID: 37709508 PMCID: PMC10937321 DOI: 10.1136/military-2023-002535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Older veterans with multimorbidity experience physical, mental and social factors which may negatively impact health and healthcare access. Physical function, behaviour change skills and loneliness may not be addressed during traditional physical rehabilitation. Thus, a multicomponent telerehabilitation programme could address these unmet needs. This programme evaluation assessed the safety, feasibility and change in patient outcomes for a multicomponent telerehabilitation programme. METHODS Individuals were eligible if they were a veteran/spouse, age ≥50 years and had ≥3 comorbidities. The telerehabilitation programme included four core components: (1) High-intensity rehabilitation, (2) Coaching interventions, (3) Social support and (4) Technology. Physical therapists delivered the 12-week programme and collected patient outcomes at baseline, 4 weeks, 8 weeks and 12 weeks. Programme evaluation measures included safety events (occurrence and type), feasibility (adherence) and patient outcomes (physical function). Safety and feasibility outcomes were analysed using descriptive statistics. The mean pre-post programme difference and 95% CI for patient outcomes were generated using paired t-tests. RESULTS Twenty-one participants enrolled in the telerehabilitation programme; most were male (81%), white (72%) and non-Hispanic (76%), with an average of 5.7 (3.0) comorbidities. Prevalence of insession safety events was 3.2% (0.03 events/session). Fifteen (71.4%) participants adhered to the programme (attended ≥80% of sessions). Mean (95% CI) improvements for physical function are as follows: 4.7 (2.4 to 7.0) repetitions for 30 s sit to stand, 6.0 (4.0 to 9.0) and 5.0 (2.0 to 9.0) repetitions for right arm curl and left arm curl, respectively, and 31.8 (15.9 to 47.7) repetitions for the 2 min step test. CONCLUSION The telerehabilitation programme was safe, feasible and demonstrated preprogramme to postprogramme improvements in physical function measures while addressing unmet needs in a vulnerable population. These results support a randomised clinical trial while informing programme and process adaptations.
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Affiliation(s)
- Michelle R Rauzi
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - L M Abbate
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - H D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - P F Cook
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - J E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
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O'Sullivan S, Schneider H. Comparing effects and application of telemedicine for different specialties in emergency medicine using the Emergency Talk Application (U-Sim ETA Trial). Sci Rep 2023; 13:13332. [PMID: 37587222 PMCID: PMC10432512 DOI: 10.1038/s41598-023-40501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023] Open
Abstract
Telemedicine as a technology can support processes in the field of emergency medicine (EM) including therapies and diagnostics, but technically is often based on hardware solutions for local EM structures, especially when involving the field of pre-hospital EM. By developing an open-source, data protection compliant solution (EU GDPR and HIPAA) as well as using standardized web and open-source based technology the Emergency Talk Application (ETA) can be used as a technology that can connect emergency medical providers and include already available regional structures. By actively involving patients and connecting these with emergency or urgent care physicians ETA can be used not only as a teleconsultation system for paramedics and physicians, but in a wider network. Randomised simulation trial, comparing EM scenarios from the field of internal medicine, trauma and neurology. Participants were qualified as certified paramedics or emergency physicians (EP). Paramedics performed as ambulances crews and involved an EP if needed via ETA as Tele-Emergency Physicians (TEP). EP participated from a device of their choice, while being able to stay within their clinical workspace. From 141 scenarios 129 used ETA. Significant differences were found for the length of scenarios, duration of time the TEP was on scene, TEP arrival after scenario start, duration until TEP was called and the duration until a diagnosis was made. Also a strong positive and significant correlation between duration of the scenario and the time a TEP was bound could be described. Telemedicine is a technology that is increasingly used in the field of EM. Improving the use of telemedicine by using up-to date technology while allowing an integration of available technical and human resources is a challenge in the field of emergency medicine especially with its regional but also broad medical variety. When using one technical solution, understanding that different cases need a different medical and also telemedical approach can help in the understanding and improving therapies, diagnostics but also the involved processes and solutions. Such results are not only relevant for healthcare providers but especially by law and decision makers as to which type of solution could be introduced in each regional setting.
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Affiliation(s)
- Seán O'Sullivan
- Faculty of Health Sciences, Technische Hochschule Mittelhessen, Gießen, Germany.
| | - Henning Schneider
- Faculty of Health Sciences, Technische Hochschule Mittelhessen, Gießen, Germany
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Clay-Williams R, Hibbert P, Carrigan A, Roberts N, Austin E, Fajardo Pulido D, Meulenbroeks I, Nguyen HM, Sarkies M, Hatem S, Maka K, Loy G, Braithwaite J. The diversity of providers' and consumers' views of virtual versus inpatient care provision: a qualitative study. BMC Health Serv Res 2023; 23:724. [PMID: 37400807 DOI: 10.1186/s12913-023-09715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 06/16/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND A broad-based international shift to virtual care models over recent years has accelerated following COVID-19. Although there are increasing numbers of studies and reviews, less is known about clinicians' and consumers' perspectives concerning virtual modes in contrast to inpatient modes of delivery. METHODS We conducted a mixed-methods study in late 2021 examining consumers' and providers' expectations of and perspectives on virtual care in the context of a new facility planned for the north-western suburbs of Sydney, Australia. Data were collected via a series of workshops, and a demographic survey. Recorded qualitative text data were analysed thematically, and surveys were analysed using SPSS v22. RESULTS Across 12 workshops, 33 consumers and 49 providers from varied backgrounds, ethnicities, language groups, age ranges and professions participated. Four advantages, strengths or benefits of virtual care reported were: patient factors and wellbeing, accessibility, better care and health outcomes, and additional health system benefits, while four disadvantages, weaknesses or risks of virtual care were: patient factors and wellbeing, accessibility, resources and infrastructure, and quality and safety of care. CONCLUSIONS Virtual care was widely supported but the model is not suitable for all patients. Health and digital literacy and appropriate patient selection were key success criteria, as was patient choice. Key concerns included technology failures or limitations and that virtual models may be no more efficient than inpatient care models. Considering consumer and provider views and expectations prior to introducing virtual models of care may facilitate greater acceptance and uptake.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia.
| | - Peter Hibbert
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
- Centre for Elite Performance, Macquarie University, Expertise & Training, Sydney, NSW, Australia
| | - Natalie Roberts
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Mitchell Sarkies
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Graeme Loy
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
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Hellfritz MS, Waschkau A, Steinhäuser J. Experiences with the quality of telemedical care in an offshore setting - a qualitative study. BMC Health Serv Res 2023; 23:661. [PMID: 37340414 DOI: 10.1186/s12913-023-09664-5] [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: 02/28/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The evaluation and the improvement of the quality of telemedical care become increasingly important in times where this type of care is offered to a broad number of patients more and more. As telemedical care in an offshore setting has already been in use for decades, analyzing the extensive experience of offshore paramedics using telemedical care can help identify determinants of quality. Therefore, the aim of this study was to explore determinants of the quality of telemedical care using the experiences of experienced offshore paramedics. METHODS We conducted a qualitative analysis of 22 semi-structured interviews with experienced offshore paramedics. The results were categorized in a hierarchical category system using content analysis as described by Mayring. RESULTS All 22 participants were males, having a mean of 3.9 years of experience working with telemedicine support offshore. Generally, participants stated that for them telemedical interaction did not differ much from personal interaction. However, the offshore paramedics personality and way to communicate were mentioned to impact the quality of telemedical care as it influenced the way cases were presented. Furthermore, interviewees described it to be impossible to use telemedicine in cases of an emergency as it was too time-consuming, technically too complex, and lead to cognitive overload as other tasks with higher priority needed their attention. Three determinants of a successful consultation were mentioned: low levels of complexity in the reason for consultation, telemedical guidance training for the teleconsultant physician and for the delegatee. CONCLUSION Appropriate indications for telemedical consultation, communication training of consultation partners, and the impact of personality need to be addressed to enhance the quality of future telemedical care.
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Affiliation(s)
- Michael Stefan Hellfritz
- Universität zu Lübeck, Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Alexander Waschkau
- Universität zu Lübeck, Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Jost Steinhäuser
- Universität zu Lübeck, Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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Martiniuk A, Toepfer A, Lane-Brown A. A review of risks, adverse effects and mitigation strategies when delivering mental health services using telehealth. J Ment Health 2023:1-24. [PMID: 36866784 DOI: 10.1080/09638237.2023.2182422] [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: 02/21/2022] [Revised: 08/31/2022] [Accepted: 01/07/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND This paper presents a scoping review of the peer-reviewed literature regarding reported risks, adverse effects and mitigation factors related to providing mental health services using telehealth. AIMS The paper aims to describe risks and risk management strategies. METHODS Publications were included if they reported upon risks, adverse events or mitigation factors experienced, hypothesised or discussed for: any population (any country, any age), service (any mental health services), intervention (telehealth), English language, 2010 to 10 July 2021, any publication type (commentary, research, policy), excluding protocol papers, and self-help tools. The following databases were searched: PsycINFO (from 2010 to 10 July 2021), MEDLINE (2010 to 10 July 2021) and the Cochrane Database from 2010 to 10 July 2021. RESULTS The search strategy resulted in 1,497 papers and after exclusions a final 55 articles were selected. Results of this scoping review are presented in terms of types of risk, risk by client population, risk by modality (eg group therapy using telehealth) and risk management. CONCLUSIONS Recommendations for future research include gathering and publishing more detailed information regarding near-miss and actual adverse events when delivering mental health assessment and care using telehealth. In clinical practice, training is required for potential adverse events, and to prevent them and reporting mechanisms in place to collate and learn from these.
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Affiliation(s)
| | - Amy Toepfer
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Amanda Lane-Brown
- Work: Clinical Psychologist, KidsRehab, Children's Hospital Westmead, South Turramurra, NSW, Australia
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Healy A, Davidson C, Allbert J, Bauer S, Toner L, Combs CA. Society for Maternal-Fetal Medicine Special Statement: Telemedicine in obstetrics-quality and safety considerations. Am J Obstet Gynecol 2023; 228:B8-B17. [PMID: 36481188 DOI: 10.1016/j.ajog.2022.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The frequency of telemedicine encounters has increased dramatically in recent years. This review summarizes the literature regarding the safety and quality of telemedicine for pregnancy-related services, including prenatal care, postpartum care, diabetes mellitus management, medication abortion, lactation support, hypertension management, genetic counseling, ultrasound examination, contraception, and mental health services. For many of these, telemedicine has several potential or proven benefits, including expanded patient access, improved patient satisfaction, decreased disparities in care delivery, and health outcomes at least comparable to those of traditional in-person encounters. Considering these benefits, it is suggested that payers should reimburse providers at least as much for telemedicine as for in-person services. Areas for future research are considered.
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How COVID-19 Broke the Barriers Related to the Implementation of Telecare-Patients' Experiences with a New form of Providing Health Services in Primary Health Care. Healthcare (Basel) 2023; 11:healthcare11040497. [PMID: 36833033 PMCID: PMC9956090 DOI: 10.3390/healthcare11040497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly contributed to accelerating the development of telemedicine and eHealth. The main aim of this study was to assess the attitudes of patients towards remote care implemented in general practice (GP) during the pandemic. METHODS The study was a pilot study conducted in March-April 2021, considering technical aspects of using teleconsultations, and evaluating the difficulties, advantages and disadvantages for patients. When assessing opinions, a simple Likert scale was used, where a value of 1 meant the worst possible assessment or strong disagreement and the upper value the best or full agreement of the respondent. RESULTS The study covered 408 respondents. Their biggest organizational challenge reaching GPs by telephone, regardless of the patients' home location (p = 0.23698). Obtaining e-documents was not problematic but was rated as worse by men (p = 0.048295). Respondents rated the overall effectiveness of teleconsultations more highly if they could speak directly with a doctor (p = 0.0005). There were no differences in willingness to recommend teleconsultations based on gender (p = 0.2432), place of residence (p = 0.7878), age (p = 0.290355) or education (p = 0.9109), but people assessing the overall effectiveness of telemedicine more highly were more willing to recommend it (p = 0.000). CONCLUSIONS Respondents assess teleconsultations in a differentiated way, noticing both positive and negative features of the remote form of providing health services.
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Ree E, Wiig S, Seljemo C, Wibe T, Lyng HB. Managers' strategies in handling the COVID-19 pandemic in Norwegian nursing homes and homecare services. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print:200-218. [PMID: 36448830 PMCID: PMC10433966 DOI: 10.1108/lhs-05-2022-0052] [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: 05/13/2022] [Revised: 08/19/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aims to explore nursing home and home care managers' strategies in handling the COVID-19 pandemic. DESIGN/METHODOLOGY/APPROACH This study has a qualitative design with semistructured individual interviews conducted digitally by videophone (Zoom). Eight managers from nursing homes and five managers from home care services located in a large urban municipality in eastern Norway participated. Systematic text condensation methodology was used for the analysis. FINDINGS The managers used several strategies to handle challenges related to the COVID-19 pandemic, including being proactive and thinking ahead in terms of possible scenarios that might occur, continuously training of staff in new procedures and routines and systematic information sharing at all levels, as well as providing different ways of disseminating information for staff, service users and next-of-kins. To handle staffing challenges, managers used strategies such as hiring short-term staff that were temporary laid off from other industries and bringing in students. ORIGINALITY/VALUE The COVID-19 pandemic heavily affected health-care systems worldwide, which has led to many health-care studies. The situation in nursing homes and home care services, which were strongly impacted by the pandemic and in charge of a vulnerable group of people, has not yet received enough attention in research. This study, therefore, seeks to contribute to this research gap by investigating how managers in nursing homes and home care services used different strategies to handle the COVID-19 pandemic.
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Affiliation(s)
- Eline Ree
- SHARE Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Siri Wiig
- SHARE Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Camilla Seljemo
- SHARE Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Torunn Wibe
- Centre for Development of Institutional and Home Care Services, Oslo, Norway
| | - Hilda Bø Lyng
- SHARE Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Baluszek JB, Wiig S, Myrnes-Hansen KV, Brønnick KK. Specialized healthcare practitioners' challenges in performing video consultations to patients in Nordic Countries - a systematic review and narrative synthesis. BMC Health Serv Res 2022; 22:1432. [PMID: 36443770 PMCID: PMC9706945 DOI: 10.1186/s12913-022-08837-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Video consultations are becoming an important telemedicine service in Nordic countries. Its use in specialized healthcare increased significantly during COVID-19 pandemic. Despite advantages video consultations have, it may also produce challenges for practitioners. Identifying and understanding these challenges may contribute to how managers can support these practitioners and thereby improve work related wellbeing and quality of care. METHODS We designed this study as systematic review of the literature with narrative synthesis and conducted a thematic analysis. We conducted review about the use of video consultations in specialized healthcare in Nordic countries to identify and categorize challenges experienced and/or perceived by practitioners. We searched Ovid MEDLINE(R), EMBASE, APA PsycINFO, and CINAH, from 2011 to 2021. Eligibility criteria were population - practitioners in specialized healthcare with experience in video consultations to patients, interest - challenges experienced and/or perceived by practitioners and, context - outpatient clinics in Nordic countries. RESULTS We included four qualitative and one mixed method studies, published between 2018 and 2021 in Norway, Denmark, and Sweden. By thematic analysis we identified three main themes: challenges related to video consultation, challenges related to practitioner and, challenges related to patient. These themes are composed of 8 categories: technology uncertainties, environment and surroundings, preparation for requirements, clinical judgment, time management, practitioners' idiosyncrasies, patients' idiosyncrasies and patients' suitability and appropriateness. Challenges from technology uncertainties category were most frequent (dominant) across all clinical specializations. CONCLUSION Findings indicate the scarcity of the research and provide rationale for further research addressing challenges in providing video consultations in the Nordic context. We suggest updating this review when the amount of available research increases.
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Affiliation(s)
- Joanna Barbara Baluszek
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway. .,Cognitive Lab: Cognitive and Behavioral Neuroscience Lab, University of Stavanger, Stavanger, Norway. .,SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway.
| | - Siri Wiig
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.,SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Kai Victor Myrnes-Hansen
- Norwegian School of Hotel Management, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Kolbjørn Kallesten Brønnick
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.,Cognitive Lab: Cognitive and Behavioral Neuroscience Lab, University of Stavanger, Stavanger, Norway.,SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway.,SESAM, Stavanger University Hospital, Stavanger, Norway
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Ward K, Vagholkar S, Sakur F, Khatri NN, Lau AYS. Visit Types in Primary Care With Telehealth Use During the COVID-19 Pandemic: Systematic Review. JMIR Med Inform 2022; 10:e40469. [PMID: 36265039 DOI: 10.2196/40469] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 10/02/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Telehealth was rapidly incorporated into primary care during the COVID-19 pandemic. However, there is limited evidence on which primary care visits used telehealth. OBJECTIVE The objective of this study was to conduct a systematic review to assess what visit types in primary care with use of telehealth during the COVID-19 pandemic were reported; for each visit type identified in primary care, under what circumstances telehealth was suitable; and reported benefits and drawbacks of using telehealth in primary care during the COVID-19 pandemic. METHODS This study was a systematic review using narrative synthesis. Studies were obtained from four databases (Ovid [MEDLINE], CINAHL Complete, PDQ-Evidence, and ProQuest) and gray literature (NSW Health, Royal Australian College of General Practitioners guidelines, and World Health Organization guidelines). In total, 3 independent reviewers screened studies featuring telehealth use during the COVID-19 pandemic in primary care. Levels of evidence were assessed according to the Grading of Recommendations Assessment, Development, and Evaluation. Critical appraisal was conducted using the Mixed Methods Appraisal Tool. Benefits and drawbacks of telehealth were assessed according to the National Quality Forum Telehealth Framework. RESULTS A total of 19 studies, predominately cross-sectional surveys or interviews (13/19, 68%), were included. Seven primary care visit types were identified: chronic condition management (17/19, 89%), existing patients (17/19, 89%), medication management (17/19, 89%), new patients (16/19, 84%), mental health/behavioral management (15/19, 79%), post-test result follow-up (14/19, 74%), and postdischarge follow-up (7/19, 37%). Benefits and drawbacks of telehealth were reported across all visit types, with chronic condition management being one of the visits reporting the greatest use because of a pre-existing patient-provider relationship, established diagnosis, and lack of complex physical examinations. Both patients and clinicians reported benefits of telehealth, including improved convenience, focused discussions, and continuity of care despite social distancing. Reported drawbacks included technical barriers, impersonal interactions, and semi-established reimbursement models. CONCLUSIONS Telehealth was used for different visit types during the COVID-19 pandemic in primary care, with most visits for chronic condition management, existing patients, and medication management. Further research is required to validate our findings and explore the long-term impact of hybrid models of care for different visit types in primary care. TRIAL REGISTRATION PROSPERO CRD42022312202; https://tinyurl.com/5n82znf4.
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Affiliation(s)
- Kanesha Ward
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| | - Sanjyot Vagholkar
- Primary Care, Faculty of Medicine, Health & Human Sciences, Macquarie University, North Ryde, Australia
| | - Fareeya Sakur
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| | - Neha Nafees Khatri
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
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Telemedicine System Applicability Using Drones in Pandemic Emergency Medical Situations. ELECTRONICS 2022. [DOI: 10.3390/electronics11142160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Drones have evolved significantly in recent years, acquiring greater autonomy and carrier capacity. Therefore, drones can play a substantial role in civil medicine, especially in emergency situations or for the detection and monitoring of disease spread, such as during the COVID-19 pandemic. The aim of this paper is to present the real possibilities of using drones in field rescue operations, as well as in nonsegregated airspace, in order to obtain solutions for monitoring activities and aerial work in support of the public health system in crisis situations. The particularity of our conceptual system is the use of a “swarm” of fast drones for aerial reconnaissance that operate in conjunction, thus optimizing both the search and identification time while also increasing the information area and the operability of the system. We also included a drone with an RF relay, which was connected to a hub drone. If needed, a carrier drone with medical supplies or portable devices can be integrated, which can also offer two-way audio and video communication capabilities. All of these are controlled from a mobile command center, in real time, connected also to the national dispatch center to shorten the travel time to the patient, provide support with basic but life-saving equipment, and offer the opportunity to access remote or difficult-to-reach places. In conclusion, the use of drones for medical purposes brings many advantages, such as quick help, shortened travel time to the patient, support with basic but life-saving equipment, and the opportunity to access remote or difficult-to-reach places.
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Hashemlu L, Esmaeili R, Bahramnezhad F, Rohani C. The experiences of home care team members regarding the needs of family caregivers of heart failure patients in home health care services in Iran: A qualitative study. ARYA ATHEROSCLEROSIS 2022; 18:1-10. [PMID: 36817345 PMCID: PMC9937671 DOI: 10.48305/arya.2022.24350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/06/2021] [Indexed: 02/24/2023]
Abstract
BACKGROUND Home healthcare guidelines emphasize the engagement of family caregivers of heart failure (HF) patients in patient care at home. Thus, this study was conducted with the aim to explore the deep experiences of home care team members regarding the needs of family caregivers of HF patients in home healthcare services in Iran. METHODS The present qualitative study was performed with a conventional content analysis approach. Data were collected through in-depth, semi-structured interviews with 23 participants who were recruited through purposive sampling. The Data were analyzed using the Graneheim and Lundman method for conventional content analysis in MAXQDA Software. RESULTS The participants included 14 women and 9 men with the mean age of 46.21 ± 11.44 years. After analyzing the interviews, 3 main categories and 15 subcategories were extracted. The main categories were "family caregiver's unmet needs" (with 5 subcategories), "Empowering Informal Caregivers" (with 3 subcategories), and "access to a standard home healthcare system" (with 7 subcategories). CONCLUSION Deep understanding of the needs of family caregivers of HF patients in home health care services increases the quality of services, the quality of life (QOL) of the family, and prevents patients' hospital readmissions. Moreover, it will contribute to our next project of the home healthcare guideline for HF patients in the health care system of Iran. Identifying the training needs of caregivers within the home health care services has an important role in the designing of education strategies in policy making programs at the level of the Ministry of Health or planning at lower levels of the health network.
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Affiliation(s)
- Leila Hashemlu
- PhD Student in Nursing, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roghayeh Esmaeili
- Associate Professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Address for correspondence: Roghayeh Esmaeili; Associate Professor, Department of Medical-Surgical Nursing, School of Nursing and
Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
| | - Fatemeh Bahramnezhad
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery AND Department of Spiritual Health, Research Center of Quran, Hadith and Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Camelia Rohani
- Affiliated Researcher, Department of Health Care Sciences, Palliative Care Center, Marie Cederschiöld Högskola, Campus Ersta, Stockholm, Sweden AND Associate Professor, Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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De Micco F, Fineschi V, Banfi G, Frati P, Oliva A, Travaini GV, Picozzi M, Curcio G, Pecchia L, Petitti T, Alloni R, Rosati E, De Benedictis A, Tambone V. From COVID-19 Pandemic to Patient Safety: A New “Spring” for Telemedicine or a Boomerang Effect? Front Med (Lausanne) 2022; 9:901788. [PMID: 35783642 PMCID: PMC9240206 DOI: 10.3389/fmed.2022.901788] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/26/2022] [Indexed: 12/22/2022] Open
Abstract
During the Covid-19 health emergency, telemedicine was an essential asset through which health systems strengthened their response during the critical phase of the pandemic. According to the post-pandemic economic reform plans of many countries, telemedicine will not be limited to a tool for responding to an emergency condition but it will become a structural resource that will contribute to the reorganization of Healthcare Systems and enable the transfer of part of health care from the hospital to the home-based care. However, scientific evidences have shown that health care delivered through telemedicine can be burdened by numerous ethical and legal issues. Although there is an emerging discussion on patient safety issues related to the use of telemedicine, there is a lack of reseraches specifically designed to investigate patient safety. On the contrary, it would be necessary to determine standards and specific application rules in order to ensure safety. This paper examines the telemedicine-risk profiles and proposes a position statement for clinical risk management to support continuous improvement in the safety of health care delivered through telemedicine.
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Affiliation(s)
- Francesco De Micco
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Rome, Italy
- *Correspondence: Vittorio Fineschi
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Rome, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mario Picozzi
- Department of Biotechnology and Science of Life, Center for Clinical Ethics, Insubria University, Varese, Italy
| | - Giuseppe Curcio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Tommasangelo Petitti
- Hygiene, Public Health and Statistics, Campus Bio-Medico University of Rome, Rome, Italy
- Department of Medical Affairs, Fondazione Don Carlo Gnocchi Onlus, Rome, Italy
| | - Rossana Alloni
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Enrico Rosati
- Casa di Cura “Auxologico Roma–Buon Pastore”, Rome, Italy
| | - Anna De Benedictis
- Nursing Science Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vittoradolfo Tambone
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
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González-Revuelta ME, Novas N, Gázquez JA, Rodríguez-Maresca MÁ, García-Torrecillas JM. User Perception of New E-Health Challenges: Implications for the Care Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073875. [PMID: 35409566 PMCID: PMC8998025 DOI: 10.3390/ijerph19073875] [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: 01/30/2022] [Revised: 03/04/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023]
Abstract
Establishing new models of health care and new forms of professional health-patient communication are lines of development in the field of health care. The onset of the COVID-19 pandemic has accelerated the evolution of information systems and communication platforms to guarantee continuity of care and compliance with social distancing measures. Our objective in this article was, firstly, to know the expectations of patients treated in the healthcare processes "cervical cancer" and "pregnancy, childbirth and puerperium" regarding online access to their clinical history and follow-up in the care process. Secondly, we analyzed times involved in the cervical cancer process to find points of improvement in waiting times when digital tools were used for communication with the patient. A descriptive cross-sectional study was carried out on 120 women included in any of the aforementioned processes using a hetero-administered questionnaire. The analysis of times was carried out using the Business Intelligence tool Biwer Analytics®. Patients showed interest in knowing their results before the appointment with the doctor and would avoid appointments with their doctor if the right conditions were met. Most recognized that this action would relieve their restlessness and anxiety. They were highly interested in receiving recommendations to improve their health status. It was estimated that there was room for improvement in the times involved in the care process, which could be shortened by 34.48 days if communication of results were through digital information access technologies. This would favor the optimization of time, resources and user perception.
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Affiliation(s)
- María Esther González-Revuelta
- Grupo Investigación TIC019 Electrónica, Comunicaciones y Telemedicina (04120) Servicio Informática y Sistemas de Información, Equipo Provincial TIC, Hospital Universitario Torrecárdenas, 04009 Almería, Spain;
| | - Nuria Novas
- Grupo Investigación TIC019 Electrónica, Comunicaciones y Telemedicina, Universidad de Almería, 04120 Almería, Spain;
| | - Jose Antonio Gázquez
- Grupo Investigación TIC019 Electrónica, Comunicaciones y Telemedicina, Universidad de Almería, 04120 Almería, Spain;
- Correspondence:
| | | | - Juan Manuel García-Torrecillas
- Unidad de Investigación Biomedica, Hospital Universitario Torrecárdenas, 04009 Almería, Spain;
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Biomédica Ibs. Granada, 18012 Granada, Spain
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Sousa P, Paiva SG, Lobão MJ, Van-Innis AL, Pereira C, Fonseca V. Contributions to the Portuguese National Plan for Patient Safety 2021–2026: A Robust Methodology Based on the Mixed-Method Approach. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2022. [DOI: 10.1159/000521722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Several countries prioritize patient safety in their health policies. In Portugal, following the implementation of the National Plan for Patient Safety (NPPS) 2015–2020, the research team of the National School of Public Health (NSPH) carried out extensive work to continue improving aspects of the previous Plan. This work was focused on identifying the strengths and weaknesses of NPPS 2015–2020 and aspects related to its applicability and main challenges and opportunities for the implementation of the NPPS 2021–2026. <b><i>Methods:</i></b> Methodological dynamic process was based on the most relevant international and national guidelines and the feedback from key patient safety stakeholders. We developed a cross-sectional mixed-methods study from January to August 2021. We used documentation and periodical reports from National Health Service (NHS) healthcare institutions as secondary sources of information. For primary data collection, we used an online survey (applied to elements in the different quality and safety structures of hospitals and primary care units), interviews, and focus groups to collect information from patient safety experts. <b><i>Results and Discussion:</i></b> Strengthening safety culture, patient safety training, communication, leadership involvement, patient and family engagement, and monitorization process is considered essential. We also identified local limitations such as the lack of resources and protected time for the healthcare professionals and lack of leadership involvement on patient safety strategies for dedicating to patient safety actions. Most of the patient safety stakeholders agreed that the safety and health of clinical teams and new modalities of healthcare (such as telemedicine, home hospitalization, home care) should be a priority for patient safety strategies. <b><i>Conclusions:</i></b> In our study, we used a robust methodology with a participatory process involving different stakeholders. An alignment between local, regional, and national levels in terms of measuring indicators, the definition of priorities, and actions and activities to improve patient safety is recommended. Reinforced partnerships and alignment between the institution’s mission, and safety priorities will be crucial to enhance patient safety. Additionally, this work highlights the added value for health systems achieved through strong partnerships between public administration and academic institutions to improve healthcare quality and patient safety.
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McVeigh C, Ace L, Ski CF, Carswell C, Burton S, Rej S, Noble H. Mindfulness-Based Interventions for Undergraduate Nursing Students in a University Setting: A Narrative Review. Healthcare (Basel) 2021; 9:1493. [PMID: 34828538 PMCID: PMC8621067 DOI: 10.3390/healthcare9111493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
(1) Introduction: Undergraduate (UG) nursing students are vulnerable to stress throughout their education, known to result in burnout, with high attrition rates of up to 33%. There is a growing body of evidence to suggest that mindfulness-based interventions are effective for the management of anxiety, depression and wellbeing, thereby reducing stress in healthcare provider populations. The aim of this narrative review was to synthesize and provide a critical overview of the current evidence in relation to mindfulness-based interventions for UG nursing students in a university setting. (2) Methods: A review of the literature was conducted in March 2020 and updated in May 2021, utilising the databases CINAHL, Medline and PsycINFO. (3) Results: Fifteen studies were included in the review, with three common themes identified: (i) the positive impact of mindfulness on holistic wellbeing, (ii) mindfulness-based techniques as a positive coping mechanism within academic and clinical practice, and (iii) approaches to the delivery of mindfulness-based interventions. (4) Conclusions: Mindfulness-based interventions are effective strategies for the management of stress, development of self-awareness and enhanced academic and clinical performance in undergraduate nursing students. No ideal approach to delivery or duration of these interventions was evident from the literature. Best practice in relation to delivery of mindfulness-based interventions for nursing students is recommended for future studies.
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Affiliation(s)
- Clare McVeigh
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (L.A.); (C.C.); (S.B.); (H.N.)
| | - Lindsay Ace
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (L.A.); (C.C.); (S.B.); (H.N.)
| | - Chantal F. Ski
- Integrated Care Academy, University of Suffolk, Ipswich IP4 1QJ, UK;
| | - Claire Carswell
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (L.A.); (C.C.); (S.B.); (H.N.)
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Stephanie Burton
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (L.A.); (C.C.); (S.B.); (H.N.)
| | - Soham Rej
- McGill Meditation and Mind-Body Medicine Research Clinic (MMMM-RC) and Geri-PARTy Research Group, Jewish General Hospital/Lady Davis Institute, Montreal, QC H3T 1E2, Canada;
- Department of Psychiatry, McGill University, Montreal, QC H3A 0GA, Canada
| | - Helen Noble
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (L.A.); (C.C.); (S.B.); (H.N.)
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Clarke J, Flott K, Fernandez Crespo R, Ashrafian H, Fontana G, Benger J, Darzi A, Elkin S. Assessing the safety of home oximetry for COVID-19: a multisite retrospective observational study. BMJ Open 2021; 11:e049235. [PMID: 34521666 PMCID: PMC8441226 DOI: 10.1136/bmjopen-2021-049235] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To determine the safety and effectiveness of home oximetry monitoring pathways for patients with COVID-19 in the English National Health Service. DESIGN Retrospective, multisite, observational study of home oximetry monitoring for patients with suspected or proven COVID-19. SETTING This study analysed patient data from four COVID-19 home oximetry pilot sites in England across primary and secondary care settings. PARTICIPANTS A total of 1338 participants were enrolled in a home oximetry programme across four pilot sites. Participants were excluded if primary care data and oxygen saturations at rest at enrolment were not available. Data from 908 participants were included in the analysis. INTERVENTIONS Home oximetry monitoring was provided to participants with a known or suspected diagnosis of COVID-19. Participants were enrolled following attendance to emergency departments, hospital admission or referral through primary care services. RESULTS Of 908 patients enrolled into four different COVID-19 home oximetry programmes in England, 771 (84.9%) had oxygen saturations at rest of 95% or more, and 320 (35.2%) were under 65 years of age and without comorbidities. 52 (5.7%) presented to hospital and 28 (3.1%) died following enrolment, of which 14 (50%) had COVID-19 as a named cause of death. All-cause mortality was significantly higher in patients enrolled after admission to hospital (OR 8.70 (2.53-29.89)), compared with those enrolled in primary care. Patients enrolled after hospital discharge (OR 0.31 (0.15-0.68)) or emergency department presentation (OR 0.42 (0.20-0.89)) were significantly less likely to present to hospital than those enrolled in primary care. CONCLUSIONS This study finds that home oximetry monitoring can be a safe pathway for patients with COVID-19; and indicates increases in risk to vulnerable groups and patients with oxygen saturations <95% at enrolment, and in those enrolled on discharge from hospital. Findings from this evaluation have contributed to the national implementation of home oximetry across England.
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Affiliation(s)
- Jonathan Clarke
- Centre for Mathematics of Precision Healthcare, Imperial College London, London, UK
| | - Kelsey Flott
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Gianluca Fontana
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Sarah Elkin
- National Heart and Lung Institute, Imperial College London, London, UK
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21
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What next for COVID Oximetry and virtual ward? Br J Gen Pract 2021; 71:425-426. [PMID: 34446418 DOI: 10.3399/bjgp21x717041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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22
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Stokke R, Melby L, Isaksen J, Obstfelder A, Andreassen H. A qualitative study of what care workers do to provide patient safety at home through telecare. BMC Health Serv Res 2021; 21:553. [PMID: 34090450 PMCID: PMC8180066 DOI: 10.1186/s12913-021-06556-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In health care, the work of keeping the patient safe and reducing the risk of harm is defined as safety work. In our digitised and technology-rich era, safety work usually involves a relationship between people and technologies. Telecare is one of the fastest-growing technology-domains in western health care systems. In the marketing of telecare, the expectation is that safety is implicit simply by the presence of technology in patients' homes. Whilst both researchers and health authorities are concerned with developing cost-benefit analyses and measuring effects, there is a lack of attention to the daily work needed to ensure that technologies contribute to patient safety. This paper aims to describe how patient safety in home care is addressed through and with telecare. We base our exploration on the social alarm, an established technology that care workers are expected to handle as an integrated part of their ordinary work. METHODS The study has a qualitative explorative design where we draw on empirical data from three case studies, involving five Norwegian municipalities that use social alarm systems in home care services. We analyse observations of practice and interviews with the actors involved, following King's outline of template analysis. RESULTS We identified three co-existing work processes that contributed to patient safety: "Aligning people and technologies"; "Being alert and staying calm"; and "Coordinating activities based on people and technology". Attention to these work processes exposes safety practices, and how safety is constructed in relational practices involving multiple people and technologies. CONCLUSIONS We conclude that the three work processes identified are essential if the safety alarm is to function for the end user's safety. The safety of home-dwelling patients is reliant on the person-technology interface. The efforts of care workers and their interface with technology are a central feature of creating safety in a patient's home, and in doing so, they utilise a repertoire of skills and knowledge.
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Affiliation(s)
- Randi Stokke
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway.
| | - Line Melby
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway
| | - Jørn Isaksen
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Gudbrandsdalsvegen 350, 2624, Lillehammer, Norway
| | - Aud Obstfelder
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway
| | - Hege Andreassen
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway
- Centre for Women and Gender Research, UiT, The Arctic University of Norway, P.O Box 6050 Langnes, 9037, Tromsø, Norway
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Shamim-Uzzaman QA, Bae CJ, Ehsan Z, Setty AR, Devine M, Dhankikar S, Donskoy I, Fields B, Hearn H, Hwang D, Jain V, Kelley D, Kirsch DB, Martin W, Troester M, Trotti LM, Won CH, Epstein LJ. The use of telemedicine for the diagnosis and treatment of sleep disorders: an American Academy of Sleep Medicine update. J Clin Sleep Med 2021; 17:1103-1107. [PMID: 33599202 DOI: 10.5664/jcsm.9194] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
NONE The COVID-19 pandemic led to widespread use of telemedicine and highlighted its importance in improving access to sleep care and advocating for sleep health. This update incorporates the lessons learned from such widespread utilization of telehealth to build on the American Academy of Sleep Medicine's 2015 position paper on the use of telemedicine for diagnosing and treating sleep disorders. Important key factors in this update include an emphasis on quality and value, privacy and safety, health advocacy through sleep telemedicine, and future directions.
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Affiliation(s)
- Qurratul Afifa Shamim-Uzzaman
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan.,Sleep Medicine Section/Ambulatory Care Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Charles J Bae
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, Missouri.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | | | | | | | - Barry Fields
- Emory University School of Medicine, Atlanta, Georgia and Atlanta VA Medical Center, Decatur, Georgia
| | - Hunter Hearn
- Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | | | | | - Dennis Kelley
- Veterans Affairs Northeast Ohio Health System, Cleveland, Ohio
| | | | | | | | - Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, and Emory Sleep Center, Emory Healthcare, Atlanta, Georgia
| | - Christine H Won
- Yale Center for Sleep Medicine, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lawrence J Epstein
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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24
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Haveland S, Islam S. Key Considerations in Ensuring a Safe Regional Telehealth Care Model: A Systematic Review. Telemed J E Health 2021; 28:602-612. [PMID: 33956524 DOI: 10.1089/tmj.2020.0580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: This literature review sets out to increase the knowledge on patient safety within the telehealth modality of care, to inform the relevant local health service departments on the key considerations to minimize patient harm. Methods: A systematic search in Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, and the University of New England (UNE) Library Search was conducted. A combination of key terms "Telehealth" OR "Telecare" OR "Telemedicine" AND "patient safety" AND "rural" was used. Based on the screening and eligibility criteria, 21 peer-reviewed articles published in English between 2015 and 2020 were included in the review. Results and Discussion: On evaluating the included studies, three main themes and various corresponding subthemes emerged. The main themes were that of telehealth experience (TE), telehealth outcomes (TO), and telehealth risks (TR), with the corresponding subthemes of telehealth experience from a patient perspective (TE-PT), telehealth experience from a carer perspective (TE-CR), telehealth experience from a clinician perspective (TE-CN), positive telehealth (TO-P), and negative telehealth outcomes (TO-N), and patient (TR-PT) and clinician telehealth risks (TR-CN). Conclusions: The results suggest that patients generally have positive experiences and are accepting telehealth as a modality of care. Furthermore, patient outcomes appear to be comparable with in-person care, with additional benefits of lower costs to both the service and patients.
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Affiliation(s)
- Siggy Haveland
- Mid North Coast Local Health District, New South Wales, Health, Port Macquarie, New South Wales, Australia
| | - Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
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25
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Haroon S, Lau T, Tan GL, Davenport A. Telemedicine in the Satellite Dialysis Unit: Is It Feasible and Safe? Front Med (Lausanne) 2021; 8:634203. [PMID: 33996850 PMCID: PMC8116595 DOI: 10.3389/fmed.2021.634203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Telemedicine has gained popularity during the recent COVID-19 pandemic. Regular and timely physician review is an essential component of care for the maintenance of hemodialysis patients. While it is widely acknowledged that telemedicine cannot fully replace the role of physical review in this group of patients with organ failure, it can perhaps reduce the reliance on physical review or serve as a filter and triage in determining which patient requires actual physical review. The use of technology in any healthcare setting should always align with existing clinical workflow and protocols. We discuss the safety and quality aspects of this new concept applied to the satellite dialysis unit.
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Affiliation(s)
| | - Titus Lau
- National University Hospital, Singapore, Singapore
| | - Gan Liang Tan
- Department of General Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Andrew Davenport
- University College London (UCL) Centre for Nephrology, Royal Free Hospital, University College London, London, United Kingdom
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26
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von Drygalski A, Pasta G, de la Corte-Rodriguez H. Ultrasound and patient self-imaging in hemophilia. Haemophilia 2020; 27:e298-e301. [PMID: 33236460 DOI: 10.1111/hae.14208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/16/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Annette von Drygalski
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA.,Department of Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Gianluigi Pasta
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, Pavia, Italy
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27
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Stokke R, Furnes M, Vifladt A, Ringsby Odberg K. Pasientsikkerhet og velferdsteknologi – parhester i utakt. TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-02-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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28
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Mulroy E, Menozzi E, Lees AJ, Lynch T, Lang AE, Bhatia KP. Telemedicine in Movement Disorders: Leçons du COVID-19. Mov Disord 2020; 35:1893-1896. [PMID: 32881108 DOI: 10.1002/mds.28297] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Elisa Menozzi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, UK
| | - Timothy Lynch
- Centre for Brain Health, Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movements Disorder Clinic, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
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29
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Hare N, Bansal P, Bajowala SS, Abramson SL, Chervinskiy S, Corriel R, Hauswirth DW, Kakumanu S, Mehta R, Rashid Q, Rupp MR, Shih J, Mosnaim GS. Work Group Report: COVID-19: Unmasking Telemedicine. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:2461-2473.e3. [PMID: 32603900 PMCID: PMC7320693 DOI: 10.1016/j.jaip.2020.06.038] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023]
Abstract
Telemedicine adoption has rapidly accelerated since the onset of the COVID-19 pandemic. Telemedicine provides increased access to medical care and helps to mitigate risk by conserving personal protective equipment and providing for social/physical distancing to continue to treat patients with a variety of allergic and immunologic conditions. During this time, many allergy and immunology clinicians have needed to adopt telemedicine expeditiously in their practices while studying the complex and variable issues surrounding its regulation and reimbursement. Some concerns have been temporarily alleviated since March 2020 to aid with patient care in the setting of COVID-19. Other changes are ongoing at the time of this publication. Members of the Telemedicine Work Group in the American Academy of Allergy, Asthma & Immunology (AAAAI) completed a telemedicine literature review of online and Pub Med resources through May 9, 2020, to detail Pre-COVID-19 telemedicine knowledge and outline up-to-date telemedicine material. This work group report was developed to provide guidance to allergy/immunology clinicians as they navigate the swiftly evolving telemedicine landscape.
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Affiliation(s)
- Nathan Hare
- UPMC Susquehanna Health Allergy, Williamsport, Pa
| | - Priya Bansal
- Department of Allergy and Immunology, Asthma and Allergy Wellness Center, Saint Charles, Ill
| | - Sakina S Bajowala
- Kaneland Allergy & Asthma Center, North Aurora, Ill; Advocate Sherman Hospital, Elgin, Ill
| | | | | | | | - David W Hauswirth
- Ohio ENT and Allergy Physicians, Columbus, Ohio; Nationwide Children's Hospital, Columbus, Ohio
| | - Sujani Kakumanu
- University of Wisconsin School of Medicine and Public Health and William S. Middleton Veterans Memorial Hospital, Madison, Wis
| | | | - Quratulain Rashid
- Division of Allergy Immunology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Michael R Rupp
- The Allergy & Asthma Clinic of Southern New Mexico, Las Cruces, NM
| | - Jennifer Shih
- Pediatrics and Medicine Emory University, Atlanta, Ga
| | - Giselle S Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University HealthSystem, Evanston, Ill.
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30
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Fouquet SD, Miranda AT. Asking the Right Questions-Human Factors Considerations for Telemedicine Design. Curr Allergy Asthma Rep 2020; 20:66. [PMID: 32862299 PMCID: PMC7456356 DOI: 10.1007/s11882-020-00965-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose of Review The goal of this paper was to provide a narrative review of human factors considerations for telemedicine. It also sought to provide readers a foundation of human factors thinking and methods that could be employed within their own practice. Recent Findings There are only a handful of articles that discuss the importance of user-centered design and human factors principles in relation to telemedicine systems. Summary Most articles come to the conclusion that design flaws could have been avoided by involving stakeholders in the design and implementation of telemedicine. However, many of them lack the guidance for those who find themselves having to choose, implement, or use unwieldy systems. With this in mind, this paper provides a series of human factors principles, real-world questions, methods, and resources for those who may find themselves considering, implementing, sustaining, or using telemedicine in their own healthcare settings.
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Affiliation(s)
- Sarah D Fouquet
- The Human Factors Collaborative, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City, MO, USA.
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31
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Eze ND, Mateus C, Cravo Oliveira Hashiguchi T. Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation. PLoS One 2020; 15:e0237585. [PMID: 32790752 PMCID: PMC7425977 DOI: 10.1371/journal.pone.0237585] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Patients and policy makers alike have high expectations for the use of digital technologies as tools to improve health care service quality at a sustainable cost. Many countries within the Organisation for Economic Co-operation and Development (OECD) are investing in telemedicine initiatives, and a large and growing body of peer-reviewed studies on the topic has developed, as a consequence. Nonetheless, telemedicine is still not used at scale within the OECD. Seeking to provide a snapshot of the evidence on the use of telemedicine in the OECD, this umbrella review of systematic reviews summarizes findings on four areas of policy relevance: clinical and cost-effectiveness, patient experience, and implementation. Methods This review followed a prior written, unregistered protocol. Four databases (PubMed/Medline, CRD, and Cochrane Library) were searched for systematic reviews or meta-analyses published between January 2014 and February 2019. Based on the inclusion criteria, 98 systematic reviews were selected for analysis. Due to substantial heterogeneity, a meta-analysis was not conducted. The quality of included reviews was assessed using the AMSTAR 2 tool. Results Most reviews (n = 53) focused on effectiveness, followed by cost-effectiveness (n = 18), implementation (n = 17) and patient experience (n = 15). Eighty-three percent of clinical effectiveness reviews found telemedicine at least as effective as face-to-face care, and thirty-nine percent of cost-effectivenss reviews found telemedicine to be cost saving or cost-effective. Patients reported high acceptance of telemedicine and the most common barriers to implementation were usability and lack of reimbursement. However, the methodological quality of most reviews was low to critically low which limits generalizability and applicability of findings. Conclusion This umbrella review finds that telemedicine interventions can improve glycemic control in diabetic patients; reduce mortality and hospitalization due to chronic heart failure; help patients manage pain and increase their physical activity; improve mental health, diet quality and nutrition; and reduce exacerbations associated with respiratory diseases like asthma. In certain disease and specialty areas, telemedicine may be a less effective way to deliver care. While there is evidence that telemedicine can be cost-effective, generalizability is hindered by poor quality and reporting standards. This umbrella review also finds that patients report high levels of acceptance and satisfaction with telemedicine interventions, but that important barriers to wider use remain.
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Affiliation(s)
- Nkiruka D Eze
- Division of Health Research, Health Economics at Lancaster, Lancaster University, Lancaster, United Kingdom
| | - Céu Mateus
- Division of Health Research, Health Economics at Lancaster, Lancaster University, Lancaster, United Kingdom
| | - Tiago Cravo Oliveira Hashiguchi
- Health Division Organisation for Economic Co-operation and Development, Directorate for Employment, Labour and Social Affairs, Paris, France
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32
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Brand D, DiGennaro Reed FD, Morley MD, Erath TG, Novak MD. A Survey Assessing Privacy Concerns of Smart-Home Services Provided to Individuals with Disabilities. Behav Anal Pract 2020; 13:11-21. [PMID: 32231963 PMCID: PMC7070117 DOI: 10.1007/s40617-018-00329-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Privacy has been identified as a primary concern among stakeholders (i.e., service recipients, advocates, administrators, family) when using technology to provide residential services to individuals in need. This paper summarizes a study that distributed a survey to agencies that provide services (e.g., clinical, recreational) and resources (e.g., advocacy groups) to people with various types of disabilities (e.g., physical, sensory, intellectual, developmental) across the United States. The results led to several recommendations about how smart-home service providers can use technology in a way that promotes client privacy. In addition, we make several suggestions for how remote staff (i.e., individuals monitoring the information gathered by technology) can assist in the process of ensuring client privacy.
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Affiliation(s)
- Denys Brand
- 1Department of Applied Behavioral Science, University of Kansas, Lawrence, KS 66045 USA
- 2Present Address: Department of Psychology, California State University, Sacramento, 6000 J Street, Sacramento, CA 95819-6007 USA
| | | | - Mariah D Morley
- 1Department of Applied Behavioral Science, University of Kansas, Lawrence, KS 66045 USA
| | - Tyler G Erath
- 1Department of Applied Behavioral Science, University of Kansas, Lawrence, KS 66045 USA
| | - Matthew D Novak
- 1Department of Applied Behavioral Science, University of Kansas, Lawrence, KS 66045 USA
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Johannessen TB, Holm AL, Storm M. Trygg og sikker bruk av velferdsteknologi i hjemmebaserthelse- og omsorgstjeneste. TIDSSKRIFT FOR OMSORGSFORSKNING 2019. [DOI: 10.18261/issn.2387-5984-2019-03-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Anne Lise Holm
- Institutt for helse- og omsorgsvitskap, Høgskulen på Vestlandet, Haugesund
| | - Marianne Storm
- Avdeling for folkehelse, Det helsevitenskapelige fakultet, Universitetet i Stavanger
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Johannessen TB, Storm M, Holm AL. Safety for older adults using telecare: Perceptions of homecare professionals. Nurs Open 2019; 6:1254-1261. [PMID: 31367452 PMCID: PMC6650660 DOI: 10.1002/nop2.328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 11/11/2022] Open
Abstract
AIM The aim of this study was to explore homecare professionals' perceptions of safety related to the use of telecare by older adults. DESIGN An exploratory qualitative design was employed. METHODS Two focus group interviews with ten female homecare professionals (nine Registered Nurses and one occupational therapist) were carried out between June-December 2017. The participants were recruited from six community homecare services in two Norwegian municipalities. Data were analysed using qualitative content analysis. RESULTS The participants perceived that the use of telecare protects older adults against injury and insecurity by preventing harm and giving them a feeling of safety. However, they also stated that the use of telecare involves challenges that could lead to harm to older adults due to technological limitations and difficulties managing and understanding the technology. Although telecare can enhance safety, it is necessary to develop reliable technology and adapt it to the user's abilities, skills and resources.
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Affiliation(s)
- Torunn Beate Johannessen
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesHaugesundNorway
| | - Marianne Storm
- Department of Public Health, Faculty of Health SciencesUniversity of StavangerStavangerNorway
| | - Anne Lise Holm
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesHaugesundNorway
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35
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Dawson-Squibb JJ, Davids EL, Harrison AJ, Molony MA, de Vries PJ. Parent Education and Training for autism spectrum disorders: Scoping the evidence. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:7-25. [DOI: 10.1177/1362361319841739] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Empowering families of children with autism spectrum disorder through education and training is best practice. A wide range of Parent Education and Training programmes are delivered around the globe, but there is limited knowledge about the characteristics of these programmes, or about the research methods and outcomes used to evaluate them, particularly in countries outside the United States. We, therefore, performed a scoping review of all peer-reviewed Parent Education and Training publications outside the United States. A search was conducted between March and May 2017. Four reviewers extracted data and performed a mixed-methods quality appraisal of publications. Thirty-seven publications representing 32 unique programmes were identified. Publications described a highly diverse range of Parent Education and Training programmes across 20 countries and all continents except South America. The majority were group-based, but varied significantly in goals, modalities and duration. The majority of studies (86.4%) reported positive outcomes in relation to the core study objectives and only two studies reported some negative findings. Quality appraisal rated only 27% of studies to have met all the methodological quality criteria. Implementation factors such as manualisation, fidelity and cost were commented on infrequently. In spite of the clear need for Parent Education and Training programmes, our findings show that the research evidence-base in autism spectrum disorder outside the United States is relatively small, non-representative and in need of methodological quality improvements.
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Affiliation(s)
| | - Eugene L Davids
- Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, University of Cape Town, South Africa
| | | | | | - Petrus J de Vries
- Division of Child and Adolescent Psychiatry, University of Cape Town, South Africa
- Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, University of Cape Town, South Africa
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Schwarz CM, Hoffmann M, Schwarz P, Kamolz LP, Brunner G, Sendlhofer G. A systematic literature review and narrative synthesis on the risks of medical discharge letters for patients' safety. BMC Health Serv Res 2019; 19:158. [PMID: 30866908 PMCID: PMC6417275 DOI: 10.1186/s12913-019-3989-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background The medical discharge letter is an important communication tool between hospitals and other healthcare providers. Despite its high status, it often does not meet the desired requirements in everyday clinical practice. Occurring risks create barriers for patients and doctors. This present review summarizes risks of the medical discharge letter. Methods The research question was answered with a systematic literature research and results were summarized narratively. A literature search in the databases PubMed and Cochrane Library for Studies between January 2008 and May 2018 was performed. Two authors reviewed the full texts of potentially relevant studies to determine eligibility for inclusion. Literature on possible risks associated with the medical discharge letter was discussed. Results In total, 29 studies were included in this review. The major identified risk factors are the delayed sending of the discharge letter to doctors for further treatments, unintelligible (not patient-centered) medical discharge letters, low quality of the discharge letter, and lack of information as well as absence of training in writing medical discharge letters during medical education. Conclusions Multiple risks factors are associated with the medical discharge letter. There is a need for further research to improve the quality of the medical discharge letter to minimize risks and increase patients’ safety.
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Affiliation(s)
- Christine Maria Schwarz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Magdalena Hoffmann
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria. .,Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1/3, 8036, Graz, Austria.
| | - Petra Schwarz
- Carinthia University of Applied Science, Feldkirchen, Austria
| | - Lars-Peter Kamolz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1/3, 8036, Graz, Austria
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Stevens WJM, van der Sande R, Beijer LJ, Gerritsen MG, Assendelft WJ. eHealth Apps Replacing or Complementing Health Care Contacts: Scoping Review on Adverse Effects. J Med Internet Res 2019; 21:e10736. [PMID: 30821690 PMCID: PMC6421717 DOI: 10.2196/10736] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 10/31/2018] [Accepted: 11/22/2018] [Indexed: 01/22/2023] Open
Abstract
Background The use of eHealth has increased tremendously in recent years. eHealth is generally considered to have a positive effect on health care quality and to be a promising alternative to face-to-face health care contacts. Surprisingly little is known about possible adverse effects of eHealth apps. Objective We conducted a scoping review on empirical research into adverse effects of eHealth apps that aim to deliver health care at a distance. We investigated whether adverse effects were reported and the nature and quality of research into these possible adverse effects. Methods For this scoping review, we followed the five steps of Arksey and O’Malley’s scoping review methodology. We searched specifically for studies into eHealth apps that replaced or complemented the face-to-face contact between a health professional and a patient in the context of treatment, health monitoring, or supporting self-management. Studies were included when eHealth and adverse effects were mentioned in the title or abstract and when empirical data on adverse effects were provided. All health conditions, with the exception of mental health conditions, all ages, and all sample sizes were included. We examined the literature published between December 2012 and August 2017 in the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and the Cochrane Library. The methodological quality of the studies was assessed using the Critical Appraisal Skills Programme (CASP) checklists. Results Our search identified 79 papers that were potentially relevant; 11 studies met our inclusion criteria after screening. These studies differed in many ways and the majority were characterized by small research populations and low study quality. Adverse effects are rarely subject to systematic scientific research. So far, information on real adverse effects is mainly limited to incidental reporting or as a bycatch from qualitative pilot studies. Despite the shortage of solid research, we found some indications of possible negative impact on patient-centeredness and efficiency, such as less transparency in the relationship between health professionals and patients and time-consuming work routines. Conclusions There is a lack of high-quality empirical research on adverse effects of eHealth apps that replace or complement face-to-face care. While the development of eHealth apps is ongoing, the knowledge with regard to possible adverse effects is limited. The available research often focuses on efficacy, added value, implementation issues, use, and satisfaction, whereas adverse effects are underexplored. A better understanding of possible adverse effects could be a starting point in improving the positive impact of eHealth-based health care delivery.
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Affiliation(s)
| | - Rob van der Sande
- Faculty of Health, Hogeschool van Arnhem en Nijmegen University of Applied Sciences, Nijmegen, Netherlands
| | - Lilian J Beijer
- Faculty of Health, Hogeschool van Arnhem en Nijmegen University of Applied Sciences, Nijmegen, Netherlands
| | | | - Willem Jj Assendelft
- Department for Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
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38
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Greenup EP, Potts BA. Road deaths relating to the attendance of medical appointments in Queensland. AUST HEALTH REV 2018; 44:121-124. [PMID: 30526798 DOI: 10.1071/ah18159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/04/2018] [Indexed: 11/23/2022]
Abstract
Objective This study sought to estimate and observe the risks imposed on patients as they travel to hospital for referred treatment. Factors such as distance and remoteness were compared to understand how they affect this risk. Methods This study focused on Queensland residents attending specialist out-patient appointments in a Queensland public hospital throughout 2016. Deidentified information on all recipients of a specialist out-patient appointment in 2016 (n=2946584) were included in the study. This study also contained a theoretical component: using a data model to estimate the number of fatalities that could be expected from a travelling population of this size and complexity. The modelling results were compared with the frequency of actual fatalities among individuals travelling to receive treatment, as determined by a review of the Queensland Police Road Database. The data model and empirical values from police reports were used to independently measure what risk, if any, individuals travelling to obtain specialist out-patient treatment are exposed to. Differences between the model and observed values were evaluated using statistical tests. Results A direct relationship between increasing remoteness and travel risk was established in both the model and observed data (CV(RMSD)=0.660773). Conclusion Fatal risk is present in any road journey regardless of distance, duration or the purpose of travel. Individuals living in regional and remote Queensland are exposed to a larger risk than those living in the major cities of Queensland when travelling to obtain public health care. What is already known on this subject? Road safety remains one of Australia's most serious public health issues, with 1295 road-related fatalities recorded throughout Australia in 2016. Although the potential dangers of road travel are well understood, extended journeys by road to attend hospital appointments are often undertaken despite available alternatives to travel in some instances. What this paper adds? Travelling to attend medical appointments exposes a patient to a small but potentially catastrophic risk that can be observed in state road crash data. This risk is measurably greater for individuals in regional Queensland. What are the implications for practitioners? Clinical models of care that reduce patient travel may represent a new standard in patient safety when of the risks associated travel are considered.
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Affiliation(s)
- Edwin Phillip Greenup
- Clinical Excellence Division, Queensland Health, Level 2, 15 Butterfield Street, Herston, Qld 4006, Australia
| | - Boyd Alexander Potts
- Menzies University School of Health Research, Level 1, 147 Wharf Street, Spring Hill, Qld 4001, Australia. Email
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Melchiorre MG, Lamura G, Barbabella F. eHealth for people with multimorbidity: Results from the ICARE4EU project and insights from the "10 e's" by Gunther Eysenbach. PLoS One 2018; 13:e0207292. [PMID: 30427924 PMCID: PMC6241125 DOI: 10.1371/journal.pone.0207292] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/29/2018] [Indexed: 12/16/2022] Open
Abstract
Background People with multimorbidity, especially older people, have complex health and social needs, and require an integrated care approach. In this respect, eHealth could be of support. This paper aims to describe the implementation of eHealth technologies in integrated care programs for people with multimorbidity in Europe, and to analyse related benefits and barriers according to outcomes from ICARE4EU study and within the more general conceptual framework of the “10 e's” in eHealth by Gunther Eysenbach. Methods In 2014, ICARE4EU project identified 101 integrated care programs in 24 European countries. Expert organizations and managers of the programs completed an on-line questionnaire addressing several aspects including the adoption of eHealth. Findings from this questionnaire were analyzed, by linking in particular benefits and barriers of eHealth with the “10 e's” by Eysenbach (Efficiency, Enhancing, Evidence-based, Empowerment, Encouragement, Education, Enabling, Extending, Ethics, and Equity). Results Out of 101 programs, 85 adopted eHealth tools, of which 42 focused explicitly on older people. eHealth could improve care integration/management, quality of care/life and cost-efficiency, whereas inadequate funding represents a major barrier. The “10 e's” by Eysenbach seem to show contact points with ICARE4EU findings, in particular when referring to positive aspects of eHealth such as Efficiency and Enhancing quality of care/life, although Empowerment/Education of patients, care Equity and Ethics issues seem crucial in this respect. Encouragement of a new relationship patient-health professional, and Enabling standardized exchange of electronic information, represent further aspects impacting integration/management of care. Conclusions Aspects of eHealth, which emerged as benefits and barriers impacting integration/management of care, as well as cost-efficiency and quality of care/life, can be identified on the basis of both ICARE4EU findings and the “10 e's” in eHealth by Eysenbach. They could represent objectives of new policies for supporting the deployment of eHealth technologies within integrated care across Europe.
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Affiliation(s)
- Maria Gabriella Melchiorre
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Ancona, Italy
- * E-mail:
| | - Giovanni Lamura
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Ancona, Italy
| | - Francesco Barbabella
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Ancona, Italy
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Farver-Vestergaard I, O'Connor M, Smith NC, Løkke A, Bendstrup E, Zachariae R. Tele-delivered mindfulness-based cognitive therapy in chronic obstructive pulmonary disease: A mixed-methods feasibility study. J Telemed Telecare 2018; 25:468-475. [PMID: 29940797 DOI: 10.1177/1357633x18780563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Mindfulness-based cognitive therapy has been shown to reduce psychological distress in chronic obstructive pulmonary disease, but uptake and attendance rates of hospital-based, face-to-face mindfulness-based cognitive therapy are low. The present mixed-methods study evaluates the clinical feasibility of home-based, tele-delivered mindfulness-based cognitive therapy in chronic obstructive pulmonary disease. METHODS Eight patients with chronic obstructive pulmonary disease (mean age: 72.6 years; 50% female) received a standardised eight-week mindfulness-based cognitive therapy programme delivered via home-based video-conferences in groups of four. Feasibility in relation to (a) clinical change, (b) attendance and (c) instructor-patient working alliance were evaluated with questionnaires and semi-structured interviews. RESULTS Statistically non-significant reductions in psychological distress (Cohen's d = 0.504; p = 0.399) and physical health status impairment (d = 0.743; p = 0.156) were observed from pre- to post-intervention. Participant narratives about clinical outcomes focused on changes in how to relate to unpleasant sensations, i.e. through attentional flexibility, taking a pause and acceptance. The average attendance rate was 7.5 (standard deviation = 0.8) out of eight sessions and no participants dropped out. The tele-based format appeared to accommodate participants' planning difficulties and promoted their ability and wish to participate. Although participant narratives suggested the tele-based format to be a barrier to developing a trusting and safe therapeutic environment, working alliance questionnaire scores were comparable to those found for face-to-face mindfulness-based cognitive therapy. DISCUSSION The preliminary results indicate that tele-delivered mindfulness-based cognitive therapy is a clinically feasible intervention in chronic obstructive pulmonary disease. Future large-scale, randomised controlled trials testing its efficacy on the outcomes of psychological distress and physical health status should include analyses of potential mediators and moderators of the effect as well as and careful monitoring of attendance and adverse events.
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Affiliation(s)
| | - Maja O'Connor
- 1 Unit for Psychooncology and Health Psychology, Aarhus University and Aarhus University Hospital, Denmark
| | - Nina C Smith
- 1 Unit for Psychooncology and Health Psychology, Aarhus University and Aarhus University Hospital, Denmark
| | - Anders Løkke
- 2 Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark
| | - Elisabeth Bendstrup
- 2 Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark
| | - Robert Zachariae
- 1 Unit for Psychooncology and Health Psychology, Aarhus University and Aarhus University Hospital, Denmark
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Wiig S, Ree E, Johannessen T, Strømme T, Storm M, Aase I, Ullebust B, Holen-Rabbersvik E, Hurup Thomsen L, Sandvik Pedersen AT, van de Bovenkamp H, Bal R, Aase K. Improving quality and safety in nursing homes and home care: the study protocol of a mixed-methods research design to implement a leadership intervention. BMJ Open 2018; 8:e020933. [PMID: 29599394 PMCID: PMC5875614 DOI: 10.1136/bmjopen-2017-020933] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/07/2018] [Accepted: 02/20/2018] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Nursing homes and home care face challenges across different countries as people are living longer, often with chronic conditions. There is a lack of knowledge regarding implementation and impact of quality and safety interventions as most research evidence so far is generated in hospitals. Additionally, there is a lack of effective leadership tools for quality and safety improvement work in this context. METHODS AND ANALYSIS The aim of the 'Improving Quality and Safety in Primary Care-Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) study is to develop and evaluate a research-based leadership guide for managers to increase quality and safety competence. The project applies a mixed-methods design and explores the implications of the leadership guide on managers' and staffs' knowledge, attitudes and practices. Four nursing homes and four home care services from different Norwegian municipalities will participate in the intervention. Surveys, process evaluation (interviews, observations) and document analyses will be conducted to evaluate the implementation and impact of the leadership intervention. A comparative study of Norway and the Netherlands will establish knowledge of the context dependency of the intervention. ETHICS AND DISSEMINATION The study is approved by the Norwegian Centre for Research Data (2017/52324 and 54855). The results will be disseminated through scientific articles, two PhD dissertations, an anthology, presentations at national and international conferences, and in social media, newsletters and in the press. The results will generate knowledge to inform leadership practices in nursing homes and home care. Moreover, the study will build new theory on leadership interventions and the role of contextual factors in nursing homes and home care.
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Affiliation(s)
- Siri Wiig
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Eline Ree
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Terese Johannessen
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Torunn Strømme
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Marianne Storm
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ingunn Aase
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Berit Ullebust
- Center for Developing Institutional and Home Care Services Sogn and Fjordane, Førde, Norway
| | - Elisabeth Holen-Rabbersvik
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway
- Songdalen Municipality, Songdalen, Norway
| | - Line Hurup Thomsen
- Center for Developing Institutional and Home Care Services Rogaland, Stavanger, Norway
| | | | | | - Roland Bal
- School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Karina Aase
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Keijser W, Smits J, Penterman L, Wilderom C. Physician leadership in e-health? A systematic literature review. Leadersh Health Serv (Bradf Engl) 2018; 29:331-47. [PMID: 27397753 DOI: 10.1108/lhs-12-2015-0047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose This paper aims to systematically review the literature on roles of physicians in virtual teams (VTs) delivering healthcare for effective "physician e-leadership" (PeL) and implementation of e-health. Design/methodology/approach The analyzed studies were retrieved with explicit keywords and criteria, including snowball sampling. They were synthesized with existing theoretical models on VT research, healthcare team competencies and medical leadership. Findings Six domains for further PeL inquiry are delineated: resources, task processes, socio-emotional processes, leadership in VTs, virtual physician-patient relationship and change management. We show that, to date, PeL studies on socio-technical dynamics and their consequences on e-health are found underrepresented in the health literature; i.e. no single empirical, theoretic or conceptual study with a focus on PeL in virtual healthcare work was identified. Research limitations/implications E-health practices could benefit from organization-behavioral type of research for discerning effective physicians' roles and inter-professional relations and their (so far) seemingly modest but potent impact on e-health developments. Practical implications Although best practices in e-health care have already been identified, this paper shows that physicians' roles in e-health initiatives have not yet received any in-depth study. This raises questions such as are physicians not yet sufficiently involved in e-health? If so, what (dis)advantages may this have for current e-health investments and how can they best become involved in (leading) e-health applications' design and implementation in the field? Originality/value If effective medical leadership is being deployed, e-health effectiveness may be enhanced; this new proposition needs urgent empirical scrutiny.
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Affiliation(s)
- Wouter Keijser
- Faculty of Behavioral, Management and Social Sciences, University of Twente , Enschede, The Netherlands
| | - Jacco Smits
- Faculty of Behavioral, Management and Social Sciences, University of Twente , Enschede, The Netherlands
| | - Lisanne Penterman
- Faculty of Behavioral, Management and Social Sciences, University of Twente , Enschede, The Netherlands
| | - Celeste Wilderom
- Faculty of Behavioral, Management and Social Sciences, University of Twente , Enschede, The Netherlands
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Mira JJ. Tecnologías móviles e inalámbricas para cuidar nuestra salud. J Healthc Qual Res 2018; 33:183-186. [PMID: 31609231 DOI: 10.1016/j.jhqr.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Affiliation(s)
- José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan, Universidad Miguel Hernández de Elche, Grupo Investigación Prometeo-173, Generalitat Valenciana, Editor del Journal Quality Healthcare Research.
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Clay-Williams R, Baysari M, Taylor N, Zalitis D, Georgiou A, Robinson M, Braithwaite J, Westbrook J. Service provider perceptions of transitioning from audio to video capability in a telehealth system: a qualitative evaluation. BMC Health Serv Res 2017; 17:558. [PMID: 28806903 PMCID: PMC5557607 DOI: 10.1186/s12913-017-2514-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 08/07/2017] [Indexed: 11/24/2022] Open
Abstract
Background Telephone consultation and triage services are increasingly being used to deliver health advice. Availability of high speed internet services in remote areas allows healthcare providers to move from telephone to video telehealth services. Current approaches for assessing video services have limitations. This study aimed to identify the challenges for service providers associated with transitioning from audio to video technology. Methods Using a mixed-method, qualitative approach, we observed training of service providers who were required to switch from telephone to video, and conducted pre- and post-training interviews with 15 service providers and their trainers on the challenges associated with transitioning to video. Two full days of simulation training were observed. Data were transcribed and analysed using an inductive approach; a modified constant comparative method was employed to identify common themes. Results We found three broad categories of issues likely to affect implementation of the video service: social, professional, and technical. Within these categories, eight sub-themes were identified; they were: enhanced delivery of the health service, improved health advice for people living in remote areas, safety concerns, professional risks, poor uptake of video service, system design issues, use of simulation for system testing, and use of simulation for system training. Conclusions This study identified a number of unexpected potential barriers to successful transition from telephone to the video system. Most prominent were technical and training issues, and personal safety concerns about transitioning from telephone to video media. Addressing identified issues prior to implementation of a new video telehealth system is likely to improve effectiveness and uptake. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2514-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia.
| | - Melissa Baysari
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Natalie Taylor
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Dianne Zalitis
- Healthdirect Australia, Level 19, 133 Castlereagh St, Sydney, NSW, 2000, Australia
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Maureen Robinson
- Healthdirect Australia, Level 19, 133 Castlereagh St, Sydney, NSW, 2000, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
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Turner P, Kushniruk A, Nohr C. Are We There Yet? Human Factors Knowledge and Health Information Technology - the Challenges of Implementation and Impact. Yearb Med Inform 2017; 26:84-91. [PMID: 29063542 PMCID: PMC6239238 DOI: 10.15265/iy-2017-014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: To review the developments in human factors (HF) research on the challenges of health information technology (HIT) implementation and impact given the continuing incidence of usability problems and unintended consequences from HIT development and use. Methods: A search of PubMed/Medline and Web of Science® identified HF research published in 2015 and 2016. Electronic health records (EHRs) and patient-centred HIT emerged as significant foci of recent HF research. The authors selected prominent papers highlighting ongoing HF and usability challenges in these areas. This selective rather than systematic review of recent HF research highlights these key challenges and reflects on their implications on the future impact of HF research on HIT. Results: Research provides evidence of continued poor design, implementation, and usability of HIT, as well as technology-induced errors and unintended consequences. The paper highlights support for: (i) strengthening the evidence base on the benefits of HF approaches; (ii) improving knowledge translation in the implementation of HF approaches during HIT design, implementation, and evaluation; (iii) increasing transparency, governance, and enforcement of HF best practices at all stages of the HIT system development life cycle. Discussion and Conclusion: HF and usability approaches are yet to become embedded as integral components of HIT development, implementation, and impact assessment. As HIT becomes ever-more pervasive including with patients as end-users, there is a need to expand our conceptualisation of the problems to be addressed and the suite of tactics and strategies to be used to calibrate our pro-active involvement in its improvement.
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Affiliation(s)
- P. Turner
- eHealth Services Research Group (eHSRG), School of Engineering & ICT, University of Tasmania, Australia
| | - A. Kushniruk
- School of Health Information Science, University of Victoria, Victoria, Canada
- Department of Development and Planning, Aalborg University, Aalborg, Denmark
| | - C. Nohr
- Department of Development and Planning, Aalborg University, Aalborg, Denmark
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Pelayo S, Ong M. Human Factors and Ergonomics in the Design of Health Information Technology: Trends and Progress in 2014. Yearb Med Inform 2017; 10:75-8. [PMID: 26293852 DOI: 10.15265/iy-2015-033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To summarize significant contributions to the research on human factors and organizational issues in medical informatics. METHODS An extensive search using PubMed/Medline and Web of Science® was conducted to identify the scientific contributions, published in 2014, to human factors and organizational issues in medical informatics, with a focus on health information technology (HIT) usability. The selection process comprised three steps: (i) 15 candidate best papers were selected by the two section editors, (ii) external reviewers from a pool of international experts reviewed each candidate best paper, and (iii) the final selection of three best papers was made by the editorial board of the IMIA Yearbook. RESULTS Noteworthy papers published in 2014 describe an efficient, easy to implement, and useful process for detecting and mitigating human factors and ergonomics (HFE) issues of HIT. They contribute to promote the HFE approach with interventions based on rigorous and well-conducted methods when designing and implementing HIT. CONCLUSION The application of HFE in the design and implementation of HIT remains limited, and the impact of incorporating HFE principles on patient safety is understudied. Future works should be conducted to advance this field of research, so that the safety and quality of patient care are not compromised by the increasing adoption of HIT.
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Affiliation(s)
- S Pelayo
- Sylvia Pelayo, INSERM CIC-IT 1403, Université Lille 2, CHRU de Lille, Lille, France, E-mail:
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Raskas MD, Gali K, Schinasi DA, Vyas S. Telemedicine and Pediatric Urgent Care: A Vision Into The Future. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Guise V, Wiig S. Perceptions of telecare training needs in home healthcare services: a focus group study. BMC Health Serv Res 2017; 17:164. [PMID: 28231852 PMCID: PMC5324329 DOI: 10.1186/s12913-017-2098-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background The implementation and use of telecare requires significant changes to healthcare service organisation and delivery, including new ways of working for staff. Competency development and training for healthcare professionals is therefore required to enable necessary adaptation of clinical practice and ensure competent provision of telecare services. It is however unclear what skills healthcare staff need when providing care at a distance and there is little empirical evidence on effective training strategies for telecare practice. Training should however emphasise the experiences and preferences of prospective trainees to ensure its relevance to their educational needs. The aim of this study was to explore healthcare professionals’ perceptions of training related to the general use of telecare, and to identify specific training needs associated with the use of virtual visits in the home healthcare services. Methods Six focus group interviews were held with a total of 26 participants working in the home healthcare services in Norway, including registered nurses, enrolled nurses, physiotherapists, occupational therapists, social workers, health workers, and healthcare assistants. The data material was analysed by way of systematic text condensation. Results The analysis resulted in five categories relevant to telecare training for healthcare professionals: Purposeful training creates confidence and changes attitudes; Training needs depend on ability to cope with telecare; The timing of training; Training must facilitate practical insight into the patients’ perspective; and Training content must focus on the telecare process. Findings are discussed in light of implications for the form and content of a training program for healthcare professionals on how to undertake virtual home healthcare visits. Conclusion Appropriate preparation and training for telecare use is important for healthcare professionals and must be taken seriously by healthcare organisations. To facilitate the knowledge, skills and attitudes required for new ways of working and enable quality and safety in telecare practice, staff should be provided with training as part of telecare implementation processes. Telecare training should be hands-on and encourage an overall patient-centred approach to care to ensure good patient-professional relationships at a distance.
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Affiliation(s)
- Veslemøy Guise
- Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway.
| | - Siri Wiig
- Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway
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