Awareness, experiences and perceptions of telehealth in a rural Queensland community

Access to Otolaryngologic Telemedicine Care Across the COVID-19 Pandemic at an Urban Tertiary Hospital System

Objective: To describe associations between patients' demographic characteristics and access to telemedicine services in an urban tertiary academic medical system across the COVID-19 pandemic, and to identify potential barriers to access. Methods: This was a retrospective cohort study conducted at a single-center tertiary academic medical center. The study included adult patients undergoing outpatient otolaryngologic care in person or via telemedicine during 8 week timeframes: before the pandemic, at the onset of the pandemic, and during later parts of the pandemic. Patients were characterized by age, sex, race, insurance type, primary language, portal activation status, income estimate, and visit type. Where appropriate, chi-squared tests, Wilcoxon signed-rank tests, and logistic regression were used to compare demographic factors between the cohorts. Results: A total of 14,240 unique patients [median age, 58 years (range, 18-107 years); 56.5% were female] resulting in a total of 29,457 visits (94.8% in-person and 5.2% telemedicine) were analyzed. Patients seen in person were older than those using telemedicine. Telemedicine visits included a higher proportion of patients with private insurance, and fewer patients with government or no insurance compared to in-person visits. Race, income, and English as primary language were not found to have a significant effect on telemedicine use. Conclusion: In an urban tertiary medical center, we found significant differences in sociodemographic characteristics between patients who accessed otolaryngologic care in person versus via telemedicine through different phases of the COVID pandemic, reflecting possible barriers to care associated with telemedicine. Further studies are needed to develop interventions to improve access.

Patient Perceptions on Telepsychiatry as an In-Consult Alternative During COVID-19 Pandemic: Peruvian Adaptation of the Telehealth Usability Questionnaire

Objective: To identify the perceptions of the patients who received alternative care by telepsychiatry at the Cayetano Heredia Hospital (HCH). Methods: This research consisted of two phases: (1) transcultural adaptation of the Telehealth Usability Questionnaire (TUQ) with three experts and (2) application of the questionnaire in 183 patients from psychiatry in HCH. Nonparametric tests were used to determine the association between variables. Results: We applied 20 questions to 60 men and 123 women, with a median age of 45. The ease of using the virtual consultation service, the comfort with its use, and the general satisfaction had a score of 6 out of 7 and are associated with the number of devices that patients have and their degree of education. The usefulness, communication by virtual means, and the solution of technical problems had scores higher than 6, being considered acceptable by the patients. Willingness to have a teleconsultation again was high and was associated with patient satisfaction with the consultation. Conclusions: Most patients were satisfied with telepsychiatry via telemonitoring during the COVID-19 pandemic. The usage of validated tools such as TUQ might be included as part of evaluations of new telemedicine services.

This Bloke Who Helps Me With My Tractor, He's Been the Best Psychologist: The Experience of Seeking Mental Health Support in Rural Australia

Mental illness is difficult to discuss among men due to notions of remaining tough, being a man, and societal expectations. In rural communities this is particularly evident which is further exacerbated by poor health care access. The aim of this study is to understand the lived experiences of men and their significant others when seeking mental health support in rural areas. A qualitative study was conducted using purposeful sampling. Data were collected using semi-structured interviews in rural or regional areas of Australia. Open-ended questions were asked but more questions were developed from the responses given. Data analysis was conducted using thematic analysis. Four key themes emerged. These encompassed triggers and help-seeking caused by stressors such as work, family, and poor physical health, with support seeking from professional or informal supports. The second theme included challenges securing professional support appointments, while the third was centered on access to medication and travel time. Finally, the final theme encompassed relationships being impacted by poor mental health or created insights into the need to seek help. The experiences explored throughout this study highlight that as men are impacted, so too are married or romantic partners and children; however, they are the catalyst for help-seeking. The study further highlights even when men are psychologically prepared to seek help, it may be difficult to do so. Improving access goes beyond mere medical professionals in rural areas and must focus on supporting families and loved ones to support men.

General Public Perceptions and Perceived Barriers Toward the Use of Telehealth: A Cross-Sectional Study from Jordan

Background: Telemedicine implies the provision of health care services, such as diagnosis, treatment, and consultation related to different disease states remotely through harnessing a variety of technologies. Aim: Despite the widespread global applications related to telehealth, there are limited research articles exploring the perceptions and barriers related to telehealth implementation in developing countries such as Jordan. Thus, this study was conducted to explore general public perceptions regarding the provision of health care services through different technological devices and to examine perceived barriers and facilitators. Methods: A cross-sectional study was conducted for 6 months. Participants were recruited through different social media portals. A convenient sample from the Jordanian population was approached. A total of 1,136 responses were collected and included in the final analysis, which was done by the Statistical Package for Social Sciences (SPSS version 25). Results: A total of 1,136 responses were valid for further analysis. The results of this study expressed that the public has positive perceptions toward the use of telemedicine with the majority being capable of using telehealth based on having an active internet connection, technological devices, and the ability to use social media accounts or instant messaging services. Logistic regression analysis revealed that those with comorbid diseases and higher summated capability scores (p = -0.017 and p < 0.001, respectively) had a statistically significant relationship with willingness to use telehealth as reflected by stating a clear intention to use telehealth services once available. Conclusion: In conclusion, the Jordanians had positive perceptions toward the use of telehealth services. However, their willingness to use telehealth services was affected by limited knowledge about the service. Telehealth offers the opportunity to provide quality care and improve patient outcomes, especially for the inhabitants of rural areas or in cases where access to health care facilities is compromised such as pandemics.

Exploring the Challenges and Opportunities of Adopting and Using Telemedicine for Diabetes Care and Management: Qualitative Semistructured Interview Study Among Health Care Providers and Patients With Diabetes

BACKGROUND

Around the world, over half of the global population experiences noncommunicable diseases, resulting in premature death. Health care providers (HCPs) can deliver medical treatment from a distance by using digital advancements such as telemedicine. However, there is a limited understanding of the difficulties and opportunities of implementing telemedicine solutions in different socioeconomic and cultural environments, including Kuwait.

OBJECTIVE

The purpose of this study is to (1) examine the obstacles and benefits of telemedicine in the context of diabetes treatment and management, as perceived by both HCPs and patients with diabetes; (2) investigate the nonfunctional requirements for telemedicine applications used in diabetes care and management; and (3) provide suggestions to enhance the integration and adoption of telemedicine in Kuwait's health care system for diabetes care and management.

METHODS

The research used a qualitative and exploratory design, with semistructured interviews as the main data collection method. Participants were recruited on the internet through social media platforms due to the COVID-19 pandemic. The results were analyzed using thematic analysis and the Framework Method. The "diffusion of innovation" model was used as a perspective to interpret the findings.

RESULTS

A total of 20 participants were included in this study-10 HCPs and 10 patients with diabetes-all of whom supported telemedicine. The HCPs reported that many diabetes cases could be managed through telemedicine, with only a few requiring in-person visits. Patients with diabetes noted the convenience and time-saving aspect of telemedicine. Both groups recommended the creation of a secure and user-friendly telemedicine system similar to popular social media platforms. Additionally, participants emphasized the importance of telemedicine during the pandemic as a way to prioritize patient safety.

CONCLUSIONS

The results of this study provide valuable insights into the needs and preferences of both HCPs and patients with diabetes in a resource-rich country like Kuwait to embrace telemedicine. The COVID-19 pandemic has changed the way medical care is provided and has pushed both groups to consider digital solutions for ongoing diabetes management and treatment.

Health Service Implementation and Antifragile Characteristics in Rural Communities: A Dirt Research Approach

The implementation of health and care services within rural communities requires necessary sensitivity to the unique facets of rural places. Often, rural service implementation is executed with inappropriate frameworks based on assumptions derived from urban centres. To understand the characteristics of rural communities that can facilitate successful program implementation better, ethnographic accounts of rural health and care services were compiled in rural communities within Canada, Australia, and Iceland. Ethnographic accounts are presented in the first and third person, with an accompanying reflexive analysis immediately following these accounts. Antifragility was the guiding concept of interest when investigating rural implementation environments, a concept that posits that a system can gain stability from uncertainty rather than lose integrity. These ethnographic accounts provide evidence of antifragile operators such as optionality, hybrid leadership, starting small, nonlinear evaluation, and avoiding suboptimisation. It is shown that the integration of these antifragile operators allows programs to function better in complex rural systems. Further, the presence of capable individuals with sufficient knowledge in several disciplines and with depth in a single discipline allows for innovative local thinking initiatives.

Stakeholders' Initial Experience With Telemedicine Services Introduced at 13 Government Medical Colleges in Uttar Pradesh, India During the COVID-19 Lockdown: A Qualitative Study

BACKGROUND

India went into a stringent lockdown in response to the coronavirus disease 2019 (COVID-19) pandemic in March 2020, and routine outpatient and elective health services were suspended. Thus, access to healthcare services got significantly disrupted. To mitigate the impact, 21 state-owned medical colleges in Uttar Pradesh, the most populous and among the most resource-constrained states in India, had to hastily launch telemedicine (TM) services. This created an opportunity to understand how stakeholders would react to such services and what initial challenges could be faced during service delivery. Through this study, we explored the experiences of stakeholders from 13 such "new-adopter" TM centres with the main objective to identify the perceived benefits and gaps related to TM services, and what "people-centric" TM services could look like going forward.

METHODS

We used an exploratory-descriptive qualitative design with a constructivist paradigm. Using interview schedules with open-ended questions and unstructured probes, we interviewed 13 nodal officers, 20 doctors, and 20 patients (i.e., one nodal officer and one to two doctors and patients from each of the 13 new-adopter centres) and stopped thereafter since we reached saturation of information. We analysed the data on NVivo (QSR International, Burlington, MA) and reported the findings using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

RESULTS

The perceived benefits that were reported included non-dependency on physical contact, economic benefit, better management of patient load, and ease of access to healthcare services. The common gaps identified in the TM services were lack of physical clinical examination, impeded communication due to lack of face-to-face interaction, technological challenges (e.g., inconsistent internet connectivity and unavailability of smartphones), lack of human resources and resources to manage the TM centres, cumbersome compliance requirements coupled with unclarity on medico-legal implications, and limited awareness of services among clients. Need for adequate promotion of TM services through information-education-communication efforts and frontline workers, strengthening of logistics for long-term sustainability, setting up a dedicated TM department at the hospitals, capacity building of the existing staff, reducing gaps in communication between doctors and patients for better consultation, and improved access to the prescribed medicines were some of the suggestions from different stakeholders.

CONCLUSION

The stakeholders clearly appreciated the benefits of TM services offered through the new-adopter centres amidst the pandemic disruptions. However, there were certain gaps and unmet expectations, which, if addressed, could improve the TM centres' performance with further people-centricity and enhance healthcare access and the popularity of system-based services. Avenues for sustaining the TM services and their efficient scale-up should be explored.

Spectrum of Population Availing COVID-19 Teleconsultation Services during COVID-19 Pandemic: A Cross-Sectional Study in a Tertiary Care Center of Eastern India

The COVID-19 pandemic has created a defining situation globally, and the outpatient services were also affected due to the closure of many healthcare facilities. The study was conducted to know the spectrum of the population availing teleconsultation and their needs for consultation. A cross-sectional study conducted in AIIMS Bhubaneswar, India, from May 2021 to June 2021in which the beneficiaries availing of the COVID-19 teleconsultation service were taken as study was participants and a total of 423 participants participated in the study. The proportion of participants who availed of the services in the age group 20-39 years was 67.8%. The participants from the urban area were 81%. Very few or almost nil participation were observed in the category of semiskilled, unskilled, and unemployed occupations. The reasons for availing of teleconsultation services were, for the treatment of COVID-19 disease (45%), distressed consultation for the medication (21%), and seeking advice for testing (13%), related to COVID-19 vaccination (6%) and 9% consulted to know the prognosis of the disease. Steps should be taken to expand the teleconsultation services to the underserved rural community and the people with lower educational status.

Patients With Cardiovascular Disease Revisiting Specialist Physicians via Remote Treatment: Interview Study of Experiences

BACKGROUND

Access to health care for an aging population with growing needs presents major challenges in northern Sweden's sparsely populated regions. Few people, the lack of professionals, and long distances make it difficult to provide health care on equitable terms according to the Swedish legislation. Remote treatment (RT) using information and communication technology has been suggested to overcome these difficulties, and person-centered care (PCC) is a desired philosophy to improve the quality of health care. However, there is scarce knowledge about how patients experience RT meetings.

OBJECTIVE

This study aimed to describe the experiences of patients with cardiovascular disease revisiting specialist physicians via RT guided by a PCC perspective in northern Sweden's sparsely populated regions.

METHODS

A qualitative study was conducted based on interviews with 8 patients with cardiovascular disease revisiting their physician through RT, from a digital health room to a health care center or from a health care center to a hospital. The interviews were recorded, transcribed verbatim, and analyzed using inductive content analysis. The results are discussed from a PCC perspective.

RESULTS

The analysis resulted in 6 categories: good accessibility, safety with good relationships, proximity and distance with technology, habit and quality of the technology facilitating the meeting, cherishing personal integrity, and participation in own care. These categories were interpreted as the theme, participation and relationships are important for good and close care via RT.

CONCLUSIONS

The study shows that participation and relationships are important for good and close care via RT. To improve the quality of an RT meeting, PCC can be applied but needs to be extended to the digital domain-electronic PCC, especially the communication component, as it is the most salient difference from a face-to-face meeting. Important factors that should be considered before, during, and after the RT meeting have been identified.

Telehealth services for global emergencies: implications for COVID-19: a scoping review based on current evidence

INTRODUCTION

The availability of low-cost computing and digital telecommunication in the 1980s made telehealth practicable. Telehealth has the capacity to improve healthcare access and outcomes for patients while reducing healthcare costs across a wide range of health conditions and situations.

OBJECTIVE

This study compares the adoption, advantages, and challenges of telehealth services between high-income (HICs) and low-and-middle-income countries (LMICs) before and during the COVID-19 pandemic.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The key search terms were: "Telehealth", "Telehealth in HICs", "Telehealth in LMICs", "Telehealth before COVID-19", "Telehealth during COVID-19". We searched exhaustively ProQuest, Scopus, Web of Science, Google Scholar, CINAHL, and EMBASE databases from 2012. Booleans OR/AND were combined with key search terms to increase relevant search results. The literature search and selection process followed the Sample, Phenomena of Interest, Design, Evaluation, and Research (SPIDER) question format.

RESULTS

The adoption of telehealth before COVID-19 was generally low in both HICs and LMICs. The impact of COVID-19 accelerated the adoption of telehealth at the facility level but not nationwide in both high-income countries and LMICs. The rapid adoption of telehealth at the facility level in both high-income and LMICs introduced several challenges that are unique to each country and need to be addressed.

CONCLUSION

The lack of national policies and regulations is making the adoption of telehealth at the national level challenging in both high and low-middle-income countries. Governments and Stakeholders of healthcare must consider telehealth as a healthcare procedure that should be deployed in clinical working procedures. Primary quantitative and qualitative studies must be conducted to address challenges encountered during the pilot implementation of telehealth services in both high-income countries and LMICs before and during pandemics.

A Scoping Literature Review of Rural Beliefs and Attitudes toward Telehealth Utilization

The purpose of this scoping literature review was to understand what is known about how the rural profile influences beliefs regarding telehealth utilization. Rural nursing theory (RNT) provided a framework for the review. Search criteria were limited to peer-reviewed studies conducted in Europe, the United States, Canada, Australia, and New Zealand. A variety of search terms related to patient telehealth perceptions generated 213 unique articles, of which 10 met the inclusion criteria. Included studies incorporated qualitative methodologies and were from Australia, Canada, Sweden, or the United States. The review highlighted four themes related to the rural profile's influence on telehealth beliefs: importance of familiar relationships, concerns with privacy and confidentiality, acceptance of limited access to care, and resourcefulness and frugality. These themes echo concepts within RNT. Nurses and other health professionals must acknowledge the rural profile's influence on a person's decision to use telehealth in order to provide optimal care.

A comparative analysis of digital health usage intentions towards the adoption of virtual reality in telerehabilitation

BACKGROUND

With the rapid development of the metaverse and the problem of non-attendance in traditional rehabilitation, virtual reality in telerehabilitation has become increasingly vital in modern medicine. However, research on determining predictors that influence the public's behavioral intention to adopt VR-based telerehabilitation has not been extensively studied.

OBJECTIVE

This study aims to propose a new research model with a comparative analysis on understanding factors affecting the public's behavioral intention to adopt VR in telerehabilitation for different user groups.

METHODS

A total of 215 respondents from the general public completed an online questionnaire to validate the proposed research model. The collected data was analyzed using SPSS and AMOS. The proposed model was additionally validated using CFA and multiple linear regression.

RESULTS

This study found that effort expectancy, threat appraisals, and trust had a positive significant influence on the public's behavioral intention to adopt VR in telerehabilitation. However, performance expectancy and facilitating conditions had no significant relationship with behavioral intention. Notably, the average of the primary factors for older adults was generally higher than for younger adults.

CONCLUSIONS

The present study confirms the applicability of the proposed research model. Our findings contribute up-to-date insights for related stakeholders to minimize implementation failures and develop successful adoption strategies for the future expansion of telerehabilitation.

Predictors of patients' acceptance of video consultation in general practice during the coronavirus disease 2019 pandemic applying the unified theory of acceptance and use of technology model

Background

The coronavirus disease 2019 pandemic has led to an increase in remote consultations in health care. This study aimed to assess the acceptance of video consultation as an alternative to face-to-face in-office visits in general practice (GP) and to investigate its drivers and barriers.

Methods

A cross-sectional study was conducted in Germany during the coronavirus disease 2019 pandemic from December 2020 to April 2021. Participants were recruited among patients in 16 GP surgeries. Assessed were sociodemographic and medical data as well as information and communications technology related data. Acceptance of video consultation and its predictors were determined using a modified questionnaire based on a short version of the renowned unified theory of acceptance and use of technology model.

Results

In total, 371 participants were included in the data analysis. Acceptance of video consultation was moderate. A hierarchical regression revealed acceptance was significantly predicted by the PHQ-2, taking no regular medication, computer proficiency, knowledge about digital health care solutions, no prior use of video consultation, and the unified theory of acceptance and use of technology predictors performance expectancy, effort expectancy, and social influence. The extended unified theory of acceptance and use of technology model explained significantly more variance than the restricted unified theory of acceptance and use of technology model in acceptance of video consultation.

Conclusions

In this study computer proficiency, existing knowledge about digital health care solutions and depressive symptoms functioned as drivers to acceptance, no prior use of video consultation could be identified as a potential barrier. Patients with regular medication have been particularly receptive to video consultation. The study confirmed the validity of the unified theory of acceptance and use of technology model in determining acceptance of video consultation. Considering that there is growing demand and acceptance for different approaches to engage with health care providers, additional steps should be taken to establish video consultation as a genuine alternative.

Telehealth v. face-to-face provision of care to patients with depression: a systematic review and meta-analysis

Ensuring continuity of care for patients with major depressive disorders poses multiple challenges. We conducted a systematic review and meta-analysis of randomised controlled trials comparing real-time telehealth to face-to-face therapy for individuals with depression. We searched Medline, Embase, and Cochrane Central (to November 2020), conducted a citation analysis (January 2021), and searched clinical trial registries (March 2021). We included randomised controlled trials comparing similar or identical care, delivered via real-time telehealth (phone, video) to face-to-face. Outcomes included: depression severity, quality of life, therapeutic alliance, and care satisfaction. Where data were sufficient, mean differences were calculated. Nine trials (1268 patients) were included. There were no differences between telehealth and face-to-face care for depression severity at post-treatment (SMD -0.04, 95% CI -0.21 to 0.13, p = 0.67) or at other time points, except at 9 months post-treatment (SMD -0.39, 95% CI -0.75 to -0.02, p = 0.04). One trial reported no differences in quality-of-life scores at 3- or 12-months post-treatment. One trial found no differences in therapeutic alliance at weeks 4 and 14 of treatment. There were no differences in treatment satisfaction between telehealth and face-to-face immediately post-treatment (SMD -0.14, 95% CI -0.56 to 0.28, p = 0.51) or at 3 or 12-months. Evidence suggests that for patients with depression or depression symptoms, the provision of care via telehealth may be a viable alternative to the provision of care face-to-face. However, additional trials are needed with longer follow-up, conducted in a wider range of settings, and with younger patients.

Uncovering healthcare staff attitudes to the rapid deployment of telehealth in Victoria, 2020-2021: a 12-month telehealth experience

BACKGROUND

Telehealth was widely adopted in health services during the Covid-19 pandemic. It is unknown what the attitudes and ongoing needs of healthcare staff are after a rapid implementation of telehealth.

AIMS

To evaluate staff attitudes to telehealth utilisation after a rapid implementation.

METHODS

A health service-wide bespoke survey was sent to all clinicians, managers, and administration staff in June-July 2021. We evaluated attitudes to (i) telehealth application in the model of care and (ii) the barriers and enablers to use of telehealth. Descriptive statistics were used for quantitative data, and content analysis for the textual data.

RESULTS

A hundred and thirty-four respondents completed the survey (response rate = 22.5% of healthdirect users (71/315), and = 3.2% of total healthcare staff population). Most commonly, telehealth was identified as being important (78%) and safe (79%) by clinicians; important (100%) and encouraged (88%) by managers. In contrast, telehealth was identified as not the same as face-to-face (56%, 50%); but easy to add to usual work arrangements (43%, 44%) by clinicians and managers, respectively. The most common enablers of telehealth were: (i) having others use the same telehealth platform (74.3%, 100%), and (ii) completing training (68.9%, 72.7%) by clinicians and managers, respectively. The most common barriers were having (i) reliable internet connectivity (39.2%, 45.5%) by clinicians and managers respectively, (ii) the right equipment (clinician 37.8%), and (iii) a private area (managers 36.3%).

CONCLUSIONS

Despite training and having support from colleagues to implement telehealth, ongoing needs were identified that may promote uptake in specific health settings. This article is protected by copyright. All rights reserved.

Understanding digital health ecosystem from Australian citizens' perspective: A scoping review

BACKGROUND

Digital health (DH) and the benefits of related services are fairly well understood. However, it still is critical to map the digital health care landscape including the key elements that define it as an ecosystem. Particularly, knowing the perspectives of citizens on this digital transformation is an important angle to capture. In this review we aim to analyze the relevant studies to identify how DH is understood and experienced by Australian citizens and what they may require from DH platforms.

MATERIALS AND METHODS

A scoping literature review was conducted across several electronic databases (ACM Digital Library, OVID, PubMed, Scopus, IEEE, Science Direct, SAGE), as well as grey literature. Additionally, citation mining was conducted to identify further relevant studies. Identified studies were subjected to eligibility criteria and the final set of articles was independently reviewed, analyzed, discussed and interpreted by three reviewers.

RESULTS

Of 3811 articles, 98 articles met the inclusion criteria with research-based articles-as opposed to review articles or white papers- comprising the largest proportion (72%) of the selected literature. The qualitative analysis of the literature revealed five key elements that capture the essence of the digital health ecosystem interventions from the viewpoint of the Australian citizens. The identified elements were "consumer/user", "health care", "technology", "use and usability", "data and information". These elements were further found to be associated with 127 subcategories.

CONCLUSIONS

This study is the first of its kind to analyze and synthesize the relevant literature on DH ecosystems from the citizens' perspective. Through the lens of two research questions, this study defines the key components that were found crucial to understanding citizens' experiences with DH. This understanding lays a strong foundation for designing and fostering DH ecosystem. The results provide a solid ground for empirical testing.

Information needs and preferences among rural cancer survivors in Queensland, Australia: a qualitative examination

OBJECTIVE

This study aimed to understand how cancer survivors in rural Queensland seek and receive information, as well as their preferences regarding the content and delivery of health-related information.

METHODS

This study explored cancer survivors' experiences in seeking and comprehending health information using a qualitative descriptive approach. Semi-structured interviews were conducted with 24 participants. Data were analysed using reflexive thematic analysis.

RESULTS

Two major themes and six sub-themes were identified including 1) information content and gaps - a) information about diagnosis and treatment, b) survivorship information gaps and c) practical support needs and 2) delivery and acceptance of information - a) sources of information, b) personalised information needs and c) information seeking or avoidance. Findings suggested that health information provision was inconsistent; survivors' attitudes towards seeking information varied greatly; and survivors' had difficulty processing information due to emotional distress.

CONCLUSION

The role of the health professional is critical in providing information and support to rural cancer survivors. Information provided should be tailored to meet the needs and preferences of individuals taking into consideration demographic factors and attitudes. Implications for public health: The current findings imply that quality information provision after cancer treatment would facilitate improvements in satisfaction among rural cancer survivors.

The COVID-19 pandemic altered the modality, but not the frequency, of formal cognitive assessment

PURPOSE

We investigated the impacts of the COVID-19 pandemic on the modality of formal cognitive assessments (in-person versus remote assessments).

MATERIALS AND METHODS

We created a web-based survey with 34 items and collected data from 114 respondents from a range of health care professions and settings. We established the proportion of cognitive assessments which were face-to-face or via video or telephone conferencing, both pre- and post-March 2020. Further, we asked respondents about the assessment tools used and perceived barriers, challenges, and facilitators for the remote assessment of cognition. In addition, we asked questions specifically about the use of the Oxford Cognitive Screen.

RESULTS

We found that the frequency of assessing cognition was stable compared to pre-pandemic levels. Use of telephone and video conferencing cognitive assessments increased by 10% and 18% respectively. Remote assessment increased accessibility to participants and safety but made observing the subtleties of behaviour during test administration difficult. The respondents called for an increase in the availability of standardised, validated, and normed assessments.

CONCLUSIONS

We conclude that the pandemic has not been detrimental to the frequency of cognitive assessments. In addition, a shift in clinical practice to include remote cognitive assessments is clear and wider availability of validated and standardised remote assessments is necessary.IMPLICATIONS FOR REHABILITATIONWe caution the wider use and interpretation of remote formal cognitive assessments due to lack of validated, standardised, and normed assessments in a remote format.Clinicians should seek out the latest validation and normative data papers to ensure they are using the most up to date tests and respective cut offs.Support is needed for individuals who lack knowledge/have anxiety over the use of technology in formal cognitive assessments.

Informing telehealth service delivery for cardiovascular disease management: exploring the perceptions of rural health professionals

Objective To explore the perceptions of rural health professionals who use telehealth services for cardiovascular health care, including the potential role of telehealth in enhancing services for this patient group. Methods Semi-structured interviews were conducted with ten rural health professionals across a range of disciplines, including medicine, nursing and allied health. All study participants were based in the same rural region in New South Wales, Australia. Results Participant responses emphasised the importance of including rural communities in ongoing dialogue to enhance telehealth services for cardiovascular care. Divergent expectations about the purpose of telehealth and unresolved technology issues were identified as factors to be addressed. Rural health professionals highlighted the importance of all stakeholders coming together to overcome barriers and enhance telehealth services in a collaborative manner. Conclusion This study contributes to an evolving understanding of how health professionals based in regional Australia experience telehealth services. Future telehealth research should proceed in collaboration with rural communities, supported by policy that actively facilitates the meaningful inclusion of rural stakeholders in telehealth dialogue. What is known about the topic? Telehealth is frequently discussed as a potential solution to overcome aspects of rural health, such as poor outcomes and limited access to services compared with metropolitan areas. In the context of telehealth and cardiovascular disease (CVD), research that focuses on rural communities is limited, particularly regarding the experiences of these communities with telehealth. What does this paper add? This paper offers insight into how telehealth is experienced by rural health professionals. The paper highlights divergent expectations of telehealth's purpose and unresolved technological issues as barriers to telehealth service delivery. It suggests telehealth services may be enhanced by collaborative approaches that engage multiple stakeholder groups. What are the implications for practitioners? The use and development of telehealth in rural communities requires a collaborative approach that considers the views of rural stakeholders in their specific contexts. To improve telehealth services for people living with CVD in rural communities, it is important that rural stakeholders have opportunities to engage with non-rural clinicians, telehealth developers and policy makers.

Patient perceptions of surgical telehealth consultations during the COVID 19 pandemic in Australia: Lessons for future implementation

Introduction

Prior studies of telehealth report high levels of patient satisfaction, but within carefully selected clinical scenarios. The COVID‐19 pandemic led to telehealth replacing face‐to‐face care for many surgical consultations across a variety of situations. More evidence is needed regarding patient perceptions of telehealth in surgery, in particular, exploring barriers and facilitators associated with its sustained implementation beyond the pandemic.

Methods

Survey invitations were emailed to a convenience sample of surgical patients by their surgeon following a telehealth consultation during the COVID‐19 pandemic. Surgeons were recruited from a sample (n = 683) who completed a survey on telehealth (distributed via email to all Australian Fellows of the Royal Australasian College of Surgeons). Mixed methods analysis was performed of the patient survey data.

Results

A total of 1166 consultations were captured: 50% routine reviews, 17% initial appointments and 20% post‐operative reviews. Video‐link was used in 49% of consultations. The majority of patients (94%), were satisfied with the quality of their surgical telehealth consultation and 75% felt it delivered the same level of care as face‐to‐face encounters. Telehealth was convenient to use (96%) and led to cost savings for 60% of patients. When asked about future appointment preferences after the pandemic, 41% indicated they would prefer telehealth (24% video‐link and 17% telephone) over face‐to‐face appointments. There was a perception by patients that telehealth consultation fees should be less than face‐to‐face consultation fees.

Conclusion

Patient satisfaction with surgical telehealth consultations is high. Barriers to more widespread implementation include financial, clinical appropriateness, technical and confidentiality concerns.

Patient perceptions of 1166 Australian surgical telehealth consultations during the COVID‐19 pandemic were captured by this survey. Patient satisfaction with telehealth was high with there is significant demand for its continuation. Barriers to more widespread implementation include financial, clinical appropriateness, technical and confidentiality concerns.

Primary healthcare clinicians' positive perceptions of the implementation of telehealth during the COVID-19 pandemic using normalisation process theory

The objective of the study was to measure implementation of telehealth for client consultations from Allied Health and Community Health clinicians' perspectives during the COVID-19 pandemic. Purposeful sampling was used to invite allied and community health clinicians to complete the survey. An online survey design, underpinned by normalisation process theory, utilising the NoMAD tool, which consists of 19 implementation assessment items. Descriptive statistics are reported. A 66% (n =24) response rate was obtained. Fifty-two percent indicated they were using telehealth for the first time. Despite the rapid implementation of telehealth for client consultations due to the pandemic crisis, participants reported positive perceptions of the use of telehealth when measured using the NoMAD. Fifty-eight percent (n =14) of respondents agreed or strongly agreed that telehealth will become a normal part of their work. Despite unplanned and under-resourced implementation of telehealth, Allied Health and Community Health clinicians reported very positive perceptions. However, further education and training to ensure 'normalisation' of this model may be required.

Patient preferences for using technology in communication about symptoms post hospital discharge

Background

Technology is increasingly transforming the way we interact with others and undertake activities in our daily lives. The healthcare setting has, however, not yet realised the potential of technology solutions to facilitate communication between patients and healthcare providers. While the procedural and policy requirements of healthcare systems will ultimately drive such solutions, understanding the preferences and attitudes of patients is essential to ensure that technology implemented in the healthcare setting facilitates communication in safe, acceptable, and appropriate ways. Therefore, the purpose of this study was to examine patient preferences for using technology to communicate with health service providers about symptoms experienced following discharge from the hospital.

Methods

Primary data were collected from patients admitted to a large metropolitan hospital in Australia during three consecutive months in 2018. Participants were asked about their daily use of technology including use of computers, email, phone, text messaging, mobile applications, social media, online discussion forums, and videoconference. They were then asked about their use of technologies in managing their health, and preferences for use when communicating about symptoms with health service providers following discharge from hospital.

Results

Five hundred and twenty-five patients with a wide range of differing clinical conditions and demographics participated. Patients indicated they used a range of technologies in their everyday lives and to manage their health. Almost 60% of patients would prefer to return to hospital if they were experiencing symptoms of concern. However, if patients experienced symptoms that were not of concern, over 60% would prefer to communicate with the hospital via telephone or using technology. Admitting condition, income, and age were significantly associated with preferences for communication about symptoms following hospital discharge.

Conclusions

Patients have varied preferences for communicating with their health service providers post-hospital discharge. Findings suggest that some, but not all patients, would prefer to use technology to traditional methods of communicating with the healthcare team. Health services should offer patients multiple options for communicating about their recovery to ensure individual needs are appropriately met.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06119-7.

Changing attitudes towards teletherapy in Austrian therapists during the COVID-19 pandemic

INTRODUCTION

Telehealth and its usage strongly depend on regulatory frameworks and user acceptance. During the COVID-19 pandemic, physiotherapists, occupational therapists, speech-language therapists and their patients experienced restrictions regarding the usual face-to-face therapy. Teletherapy has become a highly discussed medium for providing therapy services. This study aimed at assessing Austrian therapists' attitudes towards teletherapy, including perceived barriers, during and before the COVID-19 lockdown. Further interest referred to therapists' technical affinity and experiences with the application of teletherapy.

METHODS

Therapists (n = 325) completed an online survey amid the COVID-19 lockdown in 2020. Retrospective indications referred to the time prior to the lockdown. Ratings were opposed across the three therapeutic professions. Subgroup analyses investigated the role of gender and age regarding technical affinity. Measures included custom-made attitudinal statements towards teletherapy and the standardized TA-EG survey.

RESULTS

The COVID-19 lockdown caused attitude changes towards teletherapy - for example, in terms of interest (r = 0.57, p > 0.01), perceived skills for performance of teletherapy (r = 0.33, p > 0.01) and perceived need for physical contact with patients (r = 0.35, p > 0.01). Regarding technical affinity, women reported significantly higher values than men did (r = 0.32, p > 0.01). Nearly half of the participants already applied teletherapy, with mainly positive ratings regarding perceived skills and feasibility. Barriers identified were missing or unstable reimbursement policies by insurance companies and therapeutic software with guaranteed data security.

DISCUSSION

Austrian therapists indicate a relatively high level of telehealth positivity, with an improvement in the course of the COVID-19 lockdown. However, therapists outline the need for stable reimbursement policies and secure software solutions.

"Don't … Break Down on Tuesday Because the Mental Health Services are Only in Town on Thursday": A Qualitative Study of Service Provision Related Barriers to, and Facilitators of Farmers' Mental Health Help-Seeking

The suicide rate of farmers is approximately double that of the general Australian population, yet farmers employ fewer help-seeking behaviours (Arnautovska et al. in Soc Psychiatry Psychiatr Epidemiol 49:593-599, 2014; Brew et al. in BMC Public Health 16:1-11, 2016). Therefore, it is crucial to understand if, and how health services and system might influence farmer help-seeking. To shed light on this, the current study employed qualitative semi-structured interviews with 10 farmers, 10 farmers' partners and 8 medical practitioners. Thematic analysis, guided by Braun and Clarke's (Qual Res Psychol 3:77-101, 2006) techniques, was used to analyse the data. Three themes were devised concerning the interaction between farmers and health services, including 'health service interactions', 'services are provided within a complex system' and 'emerging technologies: the users, practitioners, and systems'. The findings underscore the importance of interactions between a farmer and a service provider, with farmers wanting their provider to have an understanding of farming life. Help-seeking was also shaped by access, availability, and practitioner constancy. Lastly, a complex relationship between digital mental health services and farmer help-seeking was reported, with factors related to the farmers, the practitioners and the infrastructure/systems discussed. The outcomes have implications for health service and policy reform, developing and providing interventions for farmers to promote health services interaction as a way of mental health help-seeking.

Insights Before Flights: How Community Perceptions Can Make or Break Medical Drone Deliveries

Drones are increasingly used to transport health products, but life-saving interventions can be stalled if local community concerns and preferences are not assessed and addressed. In order to inform the introduction of drones in new contexts, this paper analyzed similarities and differences in community perceptions of medical delivery drones in Malawi, Mozambique, the Democratic Republic of the Congo (DRC) and the Dominican Republic (DR). Community perceptions were assessed using focus group discussions (FGDs) and key informant interviews (KIIs) conducted with stakeholders at the national level, at health facilities and in communities. Data were collected on respondents’ familiarity with drones, perceptions of benefits and risks of drones, advice on drone operations and recommendations on sharing information with the community. The comparative analysis found similar perceptions around the potential benefits of using drones, as well as important differences in the perceived risks of flying drones and culturally appropriate communication mechanisms based on the local context. Because community perceptions are heavily influenced by culture and local experiences, a similar assessment should be conducted before introducing drone activities in new areas and two-way feedback channels should be established once drone operations are established in an area. The extent to which a community understands and supports the use of drones to transport health products will ultimately play a critical role in the success or failure of the drone’s ability to bring life-saving products to those who need them.

Implementing internet- and tele-based interventions to prevent mental health disorders in farmers, foresters and gardeners (ImplementIT): study protocol for the multi-level evaluation of a nationwide project

BACKGROUND

Farmers are a vulnerable population for developing depression or other mental health disorders due to a variety of risk factors in their work context. Beyond face-to-face resources, preventive internet- and tele-based interventions could extend available treatment options to overcome barriers to care. The German Social Insurance Company for Agriculture, Forestry and Horticulture (SVLFG) implements several guided internet- and mobile-based interventions and personalised tele-based coaching for this specific target group provided by external companies within a nation-wide prevention project for their insured members. The current study aims to evaluate the implementation process and to identify determinants of successful implementation on various individual and organisational levels.

METHODS

The current study includes two groups of participants: 1) insured persons with an observable need for prevention services, and 2) staff-participants who are involved in the implementation process. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and the Consolidated Framework for Implementation Research (CFIR) will be used to track and evaluate the implementation process. A mixed-method approach will provide insights on individual and organizational level (e.g. degree of normalization, readiness for change) and helps to identify determinants of successful implementation. In-depth insights on experiences of the participants (e.g. acceptance, satisfaction, barriers and facilitating factors of intervention use) will be yielded through qualitative interviews. Focus groups with field workers provide insights into barriers and facilitators perceived during their consultations. Furthermore, intervention as well as implementation costs will be evaluated. According to the stepwise, national rollout, data collection will occur at baseline and continuously across 24 months.

DISCUSSION

The results will show to what extent the implementation of the internet- and tele-based services as a preventive offer will be accepted by the participants and involved employees and which critical implementation aspects will occur within the process. If the implementation of the internet- and tele-based services succeeds, these services may be feasible in the long-term.

TRIAL REGISTRATION

German Clinical Trial Registration: DRKS00017078 . Registered on 18.04.2019.

Assessment of willingness to Tele-monitoring interventions in patients with type 2 diabetes and/or hypertension in the public primary healthcare setting

Background

Tele-monitoring (TM) is remote monitoring of individuals via info-communication technology, enabling them and their relatives or care-providers to recognize their health status conveniently. TM will be successful only if the individuals, often patients with medical conditions, are willing to accept and adopt it in their daily lives. This study aimed to determine the prevalence of willingness of patients with type 2 diabetes mellitus (T2DM) and/or hypertension towards the use of TM, and the factors influencing their uptake.

Methods

A cross-sectional survey was conducted at two public primary care clinics (polyclinics) in north-eastern Singapore, where TM had not been implemented. After the patients with T2DM and/or hypertension consented after fulfilling the eligibility criteria, they were first introduced to the concept of TM using pictogram and explanation by the investigators. Data on their demography, clinical parameters, technological literacy and acceptance of TM based on the Health Information Technology Acceptance Model (HITAM) were subsequently collected, computed, analyzed, followed by regression analyses to identify the factors associated with their willingness to use TM.

Results

Among 1125 eligible multi-ethnic Asian patients approached, 899 of them completed the assisted questionnaire survey, yielding a response rate of 79.9%. Their mean age was 58 ± 8 years, females 51.3% and Chinese 69.3%. Overall, 53.0% of the patients were willing to use TM. Personal beliefs on technology (OR = 3.54, 95%CI = 2.50–4.50, p < 0.001), prior technology utility (OR = 3.18, 95%CI = 1.57–6.42, p = 0.001), Patient’s requirements to be accompanied (OR = 1.48, 95% CI = 1.054–2.082, P = 0.03) Cost considerations (OR = 2.96, 95% CI = 2.257–3.388, P < 0.01) and technological literacy (OR = 2.77, 95%CI = 2.05–3.38, p < 0.001) were associated with willingness to use TM.

Conclusion

Slightly over half of the patients were willing to use TM. Factors such as age, ethnicity, technological literacy, beliefs and previous utility of technology of the patients have to be addressed before implementing TM in primary care.

Systematic review of patient and caregivers' satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients' health

Telehealth is an alternative method of delivering health care to people required to travel long distances for routine health care. The aim of this systematic review was to examine whether patients and their caregivers living in rural and remote areas are satisfied with telehealth videoconferencing as a mode of service delivery in managing their health. A protocol was registered with PROSPERO international prospective register of systematic reviews (#CRD42017083597) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of Ovid Medline, Embase, CINAHL, ProQuest Health Research Premium Collection, Joanna Briggs Institute and the Cochrane Library was conducted. Studies of people living in rural and remote areas who attended outpatient appointments for a health condition via videoconference were included if the studies measured patient and/or caregivers' satisfaction with telehealth. Data on satisfaction was extracted and descriptively synthesised. Methodological quality of the included studies was assessed using a modified version of the McMaster Critical Review Forms for Quantitative or Qualitative Studies. Thirty-six studies of varying study design and quality met the inclusion criteria. The outcomes of satisfaction with telehealth were categorised into system experience, information sharing, consumer focus and overall satisfaction. There were high levels of satisfaction across all these dimensions. Despite these positive findings, the current evidence base lacks clarity in terms of how satisfaction is defined and measured. People living in rural and remote areas are generally satisfied with telehealth as a mode of service delivery as it may improve access to health care and avoid the inconvenience of travel.

Assessing core, e-learning, clinical and technology readiness to integrate telemedicine at public health facilities in Uganda: a health facility - based survey

Background

In developing countries like Uganda, there are shortages of health workers especially medical specialists. The referral process is frustrating to both patients and health workers (HWs). This is due to delays in accessing laboratory results/tests, costs of travel with resultant delay in consulting specialists. Telemedicine can help reduce these problems. To facilitate successful and sustainable telemedicine implementation the eHealth readiness of different stakeholders should be undertaken. This study was conducted at public health facilities (HFs) in Uganda to assess eHealth readiness across four domains; core, e-learning, clinical and technology, that might hamper adoption and integration of telemedicine.

Methods

A cross-sectional study using mixed methods for data collection was conducted at health center IVs, regional and national referral hospitals. The study was conducted in three parts. Quantitative data on core, e-learning and clinical readiness domains were collected from doctors and other healthcare providers (nurses/midwives, public health officers and allied healthcare workers). Respondents were categorised into ‘aware and used telemedicine’, ‘aware and not used’, ‘unaware of telemedicine’. Focus Group Discussions were conducted with patients to further assess core readiness. Technology readiness was assessed using a questionnaire with purposively selected respondents; directors, heads of medical sections, and hospital managers/superintendents. Descriptive statistics and correlations were performed using Spearman’s rank order test for relationship between technology readiness variables at the HFs.

Results

70% of health professionals surveyed across three levels of HF were aware of telemedicine and 41% had used telemedicine. However, over 40% of HWs at HC-IV and RRH were unaware of telemedicine. All doctors who had used telemedicine were impressed with it. Telemedicine users and non-users who were aware of telemedicine showed core, clinical, and learning readiness. Patients were aware of telemedicine but identified barriers to its use. A weak but positive correlation existed between the different variables in technology readiness.

Conclusion

Respondents who were aware of and used telemedicine across all HF levels indicated core, learning and clinical readiness for adoption and integration of telemedicine at the public HFs in Uganda, although patients noted potential barriers that might need attention. In terms of technology readiness, gaps still exit at the various HF levels.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4057-6) contains supplementary material, which is available to authorized users.

Use of Video Consultations for Patients With Hematological Diseases From a Patient Perspective: Qualitative Study

Background

The need for the use of telemedicine is expected to increase in the coming years. There is, furthermore, a lack of evidence about the use of video consultations for hematological patients, and how the use of video consultations is experienced from the patients’ perspective.

Objective

This study aimed to identify patients’ experiences with the use of video consultations in place of face-to-face consultations, what it means to the patient to save the travel time, and how the roles between patients and health care professionals are experienced when using video consultation. This study concerns stable, not acutely ill, patients with hematological disease.

Methods

The study was designed as an exploratory and qualitative study. Data were collected through participant observations and semistructured interviews and analyzed in a postphenomenological framework.

Results

The data analysis revealed three categories: “Intimacy is not about physical presence,” “Handling technology,” and “Technology increases the freedom that the patients desire.”

Conclusions

This study demonstrates what is important for patients with regards to telemedicine and how they felt about seeing health care professionals through a screen. It was found that intimacy can be mediated through a screen and physical presence is not as important to the patient as other things. The study further pointed out how patients valued being involved in the planning of their treatment. The patients also valued the freedom associated with telemedicine and actively took responsibility for their own course of treatment. Patients felt that video consultations allowed them to be free and active, despite their illness.

Moderators of Effects of Internet-Delivered Exercise and Pain Coping Skills Training for People With Knee Osteoarthritis: Exploratory Analysis of the IMPACT Randomized Controlled Trial

Background

Internet-delivered exercise, education, and pain coping skills training is effective for people with knee osteoarthritis, yet it is not clear whether this treatment is better suited to particular subgroups of patients.

Objective

The aim was to explore demographic and clinical moderators of the effect of an internet-delivered intervention on changes in pain and physical function in people with knee osteoarthritis.

Methods

Exploratory analysis of data from 148 people with knee osteoarthritis who participated in a randomized controlled trial comparing internet-delivered exercise, education, and pain coping skills training to internet-delivered education alone. Primary outcomes were changes in knee pain while walking (11-point Numerical Rating Scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index function subscale) at 3 and 9 months. Separate regression models were fit with moderator variables (age, gender, expectations of outcomes, self-efficacy [pain], education, employment status, pain catastrophizing, body mass index) and study group as covariates, including an interaction between the two.

Results

Participants in the intervention group who were currently employed had significantly greater reductions in pain at 3 months than similar participants in the control group (between-group difference: mean 2.38, 95% CI 1.52-3.23 Numerical Rating Scale units; interaction P=.02). Additionally, within the intervention group, pain at 3 months reduced by mean 0.53 (95% CI 0.28-0.78) Numerical Rating Scale units per unit increase in baseline self-efficacy for managing pain compared to mean 0.11 Numerical Rating Scale units (95% CI –0.13 to 0.35; interaction P=.02) for the control group.

Conclusions

People who were employed and had higher self-efficacy at baseline were more likely to experience greater improvements in pain at 3 months after an internet-delivered exercise, education, and pain coping skills training program. There was no evidence of a difference in the effect across gender, educational level, expectation of treatment outcome, or across age, body mass index, or tendency to catastrophize pain. Findings support the effectiveness of internet-delivered care for a wide range of people with knee osteoarthritis, but future confirmatory research is needed.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12614000243617; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365812&isReview=true (Archived by WebCite at http://www.webcitation.org/6z466oTPs)

Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature

Background

eHealth has an enormous potential to improve healthcare cost, effectiveness, and quality of care. However, there seems to be a gap between the foreseen benefits of research and clinical reality.

Objective

Our objective was to systematically review the factors influencing the outcome of eHealth interventions in terms of success and failure.

Methods

We searched the PubMed database for original peer-reviewed studies on implemented eHealth tools that reported on the factors for the success or failure, or both, of the intervention. We conducted the systematic review by following the patient, intervention, comparison, and outcome framework, with 2 of the authors independently reviewing the abstract and full text of the articles. We collected data using standardized forms that reflected the categorization model used in the qualitative analysis of the outcomes reported in the included articles.

Results

Among the 903 identified articles, a total of 221 studies complied with the inclusion criteria. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The article frequency analysis did not show a significant discrepancy between the number of reports on failure (392/844, 46.5%) and on success (452/844, 53.6%). The qualitative analysis identified 27 categories that represented the factors for success or failure of eHealth interventions. A quantitative analysis of the results revealed the category quality of healthcare (n=55) as the most mentioned as contributing to the success of eHealth interventions, and the category costs (n=42) as the most mentioned as contributing to failure. For the category with the highest unique article frequency, workflow (n=51), we conducted a full-text review. The analysis of the 23 articles that met the inclusion criteria identified 6 barriers related to workflow: workload (n=12), role definition (n=7), undermining of face-to-face communication (n=6), workflow disruption (n=6), alignment with clinical processes (n=2), and staff turnover (n=1).

Conclusions

The reviewed literature suggested that, to increase the likelihood of success of eHealth interventions, future research must ensure a positive impact in the quality of care, with particular attention given to improved diagnosis, clinical management, and patient-centered care. There is a critical need to perform in-depth studies of the workflow(s) that the intervention will support and to perceive the clinical processes involved.

Accepting telemedicine in a circulatory medicine ward in major hospitals in South Korea: patients' and health professionals' perception of real-time electrocardiogram monitoring

Background

South Korean government is currently in progress of expanding the coverage of telemedicine projects as part of an attempt to vitalize service industry, but is facing fierce opposition from KMA. Practice of telemedicine requires sufficient discussions among related parties. Although the participation of medical specialists is important, agreement from the public is essential.

Methods

Three main tertiary care centers in Seoul were selected for data collection. A total of 224 patients (patients n = 180, patient guardian n = 44) and medical professionals (n = 41) were selected using simple random sampling. Mixed method of quantitative survey and qualitative semi-interview was used.

Results

This study analyzed patients’ and medical professionals’ perception about the application of telemedicine in cardiology ward in tertiary care centers to provide baseline data when developing and applying telemedicine services. Results implied high need for encouraging telemedicine projects in order to appeal needs among population by providing experience (p < 0.001) and knowledge (p < 0.001). Other results showed that the need for electrocardiography monitoring was high among not only in remote areas but also in areas close to the capital. 64.52% of all participants thought that telemedicine was needed, and 73.21% of participants were willing to use telemedicine service if provided. Semi-interviews revealed that participants expected more cost and time saving services through remote treatment, by not having to visit long distance hospitals frequently.

Conclusions

Research results oppose Korean Medical Association’s opinion that the population is against enforcing telemedicine related laws. The findings in this study reflect an up-to-date perception of telemedicine among patients and medical professionals in a tertiary care centers’ cardiology ward. Moreover, the study provides a baseline that is needed in order to overcome past failures and to successfully implement telemedicine in South Korea.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3105-y) contains supplementary material, which is available to authorized users.

Community pharmacist perceptions of their role and the use of social media and mobile health applications as tools in public health

BACKGROUND

A number of barriers prevent community pharmacists (CPs) from impacting public health (PH) outcomes. Social media (SM) and mobile health apps (MH apps) may offer ways to help the public make positive health decisions.

OBJECTIVES

To evaluate CP perceptions of their role in PH and the use of SM and MH apps in this regard.

METHODS

This was a mixed method study using a cross-sectional survey and follow-up interviews. The survey covered: CPs role in PH; CP use of SM; CP use of MH apps; non-identifiable demographic information. Following ethical approval and piloting, responses were collected on paper and online. The study population was CPs in Greater London, UK (n = 2931). A minimum sample size of 340 was calculated (95% confidence interval/5% margin of error). To achieve this, 596 surveys were distributed. Responses (n = 257) were analysed using descriptive statistics. Twenty-five respondents were willing to take part in follow-up one-to-one interviews. Twenty interviews were completed as data saturation was achieved after the 14th. Interviews were transcribed and analysed using framework methodology as described by Ritchie and Spencer in 1994.

RESULTS

Survey response rate was 43%. Respondents represented English CPs in terms of age but males and non-whites were over-represented. The majority of CPs accessed SM and MH apps for personal use but did not recommend these in a professional capacity due to lack of awareness and confidentiality/liability concerns. Most would promote an SM health page (78.6%) or MH app (83.7%) if maintained by healthcare professionals (HCPs). Under 35s were more positive about these tools in PH. Two interview themes emerged: The role of CPs in PH; Concerns and opportunities for the use of technology in PH.

CONCLUSIONS

Most CPs, particularly those under 30, were positive about the use of SM and MH apps in PH. Training on the use of such tools among the pharmacy team, and an awareness of the availability of evidence-based apps will ensure their wider adoption.

Integrating telehealth in to 'business as usual': Is it really possible?

The Royal Children's Hospital, Melbourne, began offering web-based telehealth video consultation in 2011, with the principle being that telehealth should be integrated into 'business as usual'. In telehealth literature, key differences between telehealth and in-person consultations can make this hard to achieve, so an audit was performed that revealed many small gaps in the process.A total of 125 telehealth appointments were booked during the study period. Of these, 13% (n = 16) were rescheduled, cancelled or changed to face-to-face appointments, and up to two main issues were identified for the remaining appointments. Some 69% of the remaining 108 appointments (n = 75) were completed successfully, with 23% (n = 25) completely seamless end to end. Overall, 39 issues were administrative (40%), 34 technical (35%) and 24 scheduling (25%); nine (8%) required some minor troubleshooting.For long-term sustainability, integrating telehealth into business as usual needs to remain the target. Scheduling and technical glitches were the main barriers to seamless telehealth. Several issues have now been addressed with the introduction of an electronic medical record, and the development of standardised processes and staff training.

A qualitative study of Telehealth patient information leaflets (TILs): are we giving patients enough information?

BACKGROUND

The provision of patient information leaflets regarding telehealth has been perceived by potential consumers as a strategy to promote awareness and adoption of telehealth services. However, such leaflets need to be designed carefully if adoption and awareness among potential users is to be promoted. Therefore, the aims of this study were: first, to see how telehealth was portrayed in some of the existing telehealth leaflets (THLs). Second, to explore patients' perceptions of the existing THLs and their engagement with the concept and how THLs can be optimised.

METHODS

A two-step approach was employed to address the aims of this study. The first phase involved the use of discourse analysis to compare 12 electronically and publically available THLs, with the existing THL guidance "Involve Yorkshire and Humber". The second phase involved conducting 14 semi-structured interviews with potential telehealth users/patients to gauge their perception and engagement with the concept, using the two leaflets that were mostly matching with the guidance used. Six interviews were audio-recorded and eight had detailed jotted notes. The interviews were transcribed and thematically analysed to identify key themes.

RESULTS

The discourse analysis showed certain gaps and variations within the screened leaflets when addressing the following aspects: cost of the telehealth service, confidentiality, patients' choices in addition to equipment use and technical support. Analysis of the interviews revealed patients' need for having clear and sufficient information about the telehealth service within the THLs; in addition to, patients' preference for the use of simpler terminologies for telehealth description and the provision of clear simple texts with pictorial presentations. The interviews also revealed certain limitations against adoption of telehealth by the participants, such as: lack of privacy and confidentiality of information, fear of technology breakdown and equipment failure, loss of face-to-face contact with healthcare professionals and being too dependent on the telehealth service.

CONCLUSION

The current study showed a great variation among the screened THLs and highlighted certain gaps within the content and presentation of these leaflets. However, the study also highlighted certain key issues to be considered when designing THLs in the future to enhance telehealth uptake and use by patients.

Telehealth: misconceptions and experiences of healthcare professionals in England

OBJECTIVES

This study aims to look at telehealth awareness and experiences among healthcare professionals (HCPs) from different disciplines, in addition to factors impeding its adoption in healthcare delivery.

METHODS

Qualitative semi-structured interviews were conducted with 36 HCPs from different disciplines such as pharmacists, nurses and doctors in South London. A convenience sampling technique was used whereby HCPs working in local trusts, community pharmacies and general practitioners surgeries were approached for participation. Thematic analysis was used to identify key themes using the NVIVO 10 software.

KEY FINDINGS

The four main themes that emerged were awareness and understanding of telehealth, experiences and benefits of telehealth, barriers and facilitators of telehealth and misconceptions about telehealth. The study showed mixed response regarding telehealth awareness. Lack of telehealth experience was reported mainly among HCPs working in primary care. The barriers identified were cost and lack of funding and resources, whereas facilitators were raising awareness among staff and the public and investment in resources. Misconceptions identified were fear of losing face-to-face contact with patients and vital care information, patients' beliefs and confidence in using technology.

CONCLUSIONS

This study showed experience and awareness level to be still low especially among HCPs working in primary care. Barriers and misconceptions identified are still the same as those reported in the literature which highlights that they have not yet been addressed to facilitate telehealth implementation in the UK.

Introduction of Tele-ICU in rural hospitals: Changing organisational culture to harness benefits

OBJECTIVE

This study evaluates rural hospital staff perceptions of a telemedicine ICU (Tele-ICU) before and after implementation.

METHODS

We conducted a longitudinal qualitative study utilising semistructured group or individual interviews with staff from three rural ICU facilities in the upper Midwest of the United States that received Tele-ICU support. Interviews occurred pre-implementation and at two time points post-implementation. Interviews were conducted with: ICU administrators (n=6), physicians (n=3), nurses (n=9), respiratory therapists (n=5) and other (n=1) from July 2011 to May 2013. Transcripts were analysed for thematic content.

FINDINGS

Overall, rural ICU staff viewed Tele-ICU as a welcome benefit for their facility. Major themes included: (1) beneficial where recruitment and retention of staff can be challenging; (2) extra support for day shifts and evening, night and weekend shifts; (3) reduction in the number of transfers larger tertiary hospitals in the community; (4) improvement in standardisation of care; and (5) organisational culture of rural ICUs may lead to under-utilisation.

CONCLUSIONS

ICU staff at rural facilities view Tele-ICU as a positive, useful tool to provide extra support and assistance. However, more research is needed regarding organisational culture to maximise the potential benefits of Tele-ICU in rural hospitals.