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Blytt KM, Kolltveit BCH, Graue M, Robberstad M, Ternowitz T, Carlsen S, Iversen MM. The implementation of telemedicine in wound care: a qualitative study of nurses' and patients' experiences. BMC Health Serv Res 2024; 24:1146. [PMID: 39343892 PMCID: PMC11439246 DOI: 10.1186/s12913-024-11620-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/20/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND The increasing use of telemedicine (TM) represents a major shift for health workers and patients alike. Thus, there is a need for more knowledge on how these interventions work and are implemented. We conducted a qualitative process-evaluation alongside a larger randomized controlled trial designed to evaluate a telemedicine follow-up intervention for patients with a leg- or foot-ulcer, who either have or do not have diabetes. Accordingly, the aim of this study was to explore how both health care professionals and patients experienced the implementation of TM follow-up in primary care. METHODS The intervention comprised an interactive TM platform facilitating guidance and counselling regarding wound care between nurses in primary care and nurses in specialist health care in Norway. Nurses and patients from seven clusters in the intervention arm were included in the study. We conducted 26 individual interviews (14 patients and 12 nurses) in primary care between December 2021 and March 2022. Thematic analyses were conducted. RESULTS The analyses revealed the following themes: (1) enhancing professional self-efficacy for wound care, (2) a need to redesign the approach to implementing TM technology and (3) challenging to facilitate behavioral changes in relation to preventive care. As to patients' experiences with taking part in the intervention, we found the following three themes: (1) experience with TM promotes a feeling of security over time, (2) patients' preferences and individual needs on user participation in TM are not met, and (3) experiencing limited focus on prevention of re-ulceration. CONCLUSIONS TM presents both opportunities and challenges. Future implementation should focus on providing nurses with improved technological equipment and work on how to facilitate the use of TM in regular practice in order to fully capitalize on this new technology. Future TM interventions need to tailor the level of information and integrate a more systematic approach for working with preventive strategies. CLINICAL TRIAL REGISTRATION NCT01710774. Registration Date 2012-10-17.
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Affiliation(s)
- Kjersti Marie Blytt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway.
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway
| | - Mari Robberstad
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Thomas Ternowitz
- Department for Dermatology, Stavanger University Hospital, Stavanger, Norway
| | - Siri Carlsen
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Marjolein Memelink Iversen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
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Kaburi BB, Wyss K, Kenu E, Asiedu-Bekoe F, Hauri AM, Laryea DO, Klett-Tammen CJ, Leone F, Walter C, Krause G. Facilitators and Barriers in the Implementation of a Digital Surveillance and Outbreak Response System in Ghana Before and During the COVID-19 Pandemic: Qualitative Analysis of Stakeholder Interviews. JMIR Form Res 2023; 7:e45715. [PMID: 37862105 PMCID: PMC10625076 DOI: 10.2196/45715] [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: 01/18/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND In the past 2 decades, many countries have recognized the use of electronic systems for disease surveillance and outbreak response as an important strategy for disease control and prevention. In low- and middle-income countries, the adoption of these electronic systems remains a priority and has attracted the support of global health players. However, the successful implementation and institutionalization of electronic systems in low- and middle-income countries have been challenged by the local capacity to absorb technologies, decisiveness and strength of leadership, implementation costs, workforce attitudes toward innovation, and organizational factors. In November 2019, Ghana piloted the Surveillance Outbreak Response Management and Analysis System (SORMAS) for routine surveillance and subsequently used it for the national COVID-19 response. OBJECTIVE This study aims to identify the facilitators of and barriers to the sustainable implementation and operation of SORMAS in Ghana. METHODS Between November 2021 and March 2022, we conducted a qualitative study among 22 resource persons representing different stakeholders involved in the implementation of SORMAS in Ghana. We interviewed study participants via telephone using in-depth interview guides developed consistent with the model of diffusion of innovations in health service organizations. We transcribed the interviews verbatim and performed independent validation of transcripts and pseudonymization. We performed deductive coding using 7 a priori categories: innovation, adopting health system, adoption and assimilation, diffusion and dissemination, outer context, institutionalization, and linkages among the aspects of implementation. We used MAXQDA Analytics Pro for transcription, coding, and analysis. RESULTS The facilitators of SORMAS implementation included its coherent design consistent with the Integrated Disease Surveillance and Response system, adaptability to evolving local needs, relative advantages for task performance (eg, real-time reporting, generation of case-base data, improved data quality, mobile offline capability, and integration of laboratory procedures), intrinsic motivation of users, and a smartphone-savvy workforce. Other facilitators were its alignment with health system goals, dedicated national leadership, political endorsement, availability of in-country IT capacities, and financial and technical support from inventors and international development partners. The main barriers were unstable technical interoperability between SORMAS and existing health information systems, reliance on a private IT company for data hosting, unreliable internet connectivity, unstable national power supply, inadequate numbers and poor quality of data collection devices, and substantial dependence on external funding. CONCLUSIONS The facilitators of and barriers to SORMAS implementation are multiple and interdependent. Important success conditions for implementation include enhanced scope and efficiency of task performance, strong technical and political stewardship, and a self-motivated workforce. Inadequate funding, limited IT infrastructure, and lack of software development expertise are mutually reinforcing barriers to implementation and progress to country ownership. Some barriers are external, relate to the overall national infrastructural development, and are not amenable even to unlimited project funding.
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Affiliation(s)
- Basil Benduri Kaburi
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- PhD Programme Epidemiology, Braunschweig-Hannover, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Programme, University of Ghana, Accra, Ghana
| | | | - Anja M Hauri
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | | | - Frédéric Leone
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Christin Walter
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- PhD Programme Epidemiology, Braunschweig-Hannover, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
- German Center for Infection Research, Braunschweig, Germany
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The internet of medical things and artificial intelligence: trends, challenges, and opportunities. Biocybern Biomed Eng 2022. [DOI: 10.1016/j.bbe.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Odendaal WA, Anstey Watkins J, Leon N, Goudge J, Griffiths F, Tomlinson M, Daniels K. Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 3:CD011942. [PMID: 32216074 PMCID: PMC7098082 DOI: 10.1002/14651858.cd011942.pub2] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mobile health (mHealth), refers to healthcare practices supported by mobile devices, such as mobile phones and tablets. Within primary care, health workers often use mobile devices to register clients, track their health, and make decisions about care, as well as to communicate with clients and other health workers. An understanding of how health workers relate to, and experience mHealth, can help in its implementation. OBJECTIVES To synthesise qualitative research evidence on health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services, and to develop hypotheses about why some technologies are more effective than others. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, Science Citation Index and Social Sciences Citation Index in January 2018. We searched Global Health in December 2015. We screened the reference lists of included studies and key references and searched seven sources for grey literature (16 February to 5 March 2018). We re-ran the search strategies in February 2020. We screened these records and any studies that we identified as potentially relevant are awaiting classification. SELECTION CRITERIA We included studies that used qualitative data collection and analysis methods. We included studies of mHealth programmes that were part of primary healthcare services. These services could be implemented in public or private primary healthcare facilities, community and workplace, or the homes of clients. We included all categories of health workers, as well as those persons who supported the delivery and management of the mHealth programmes. We excluded participants identified as technical staff who developed and maintained the mHealth technology, without otherwise being involved in the programme delivery. We included studies conducted in any country. DATA COLLECTION AND ANALYSIS We assessed abstracts, titles and full-text papers according to the inclusion criteria. We found 53 studies that met the inclusion criteria and sampled 43 of these for our analysis. For the 43 sampled studies, we extracted information, such as country, health worker category, and the mHealth technology. We used a thematic analysis process. We used GRADE-CERQual to assess our confidence in the findings. MAIN RESULTS Most of the 43 included sample studies were from low- or middle-income countries. In many of the studies, the mobile devices had decision support software loaded onto them, which showed the steps the health workers had to follow when they provided health care. Other uses included in-person and/or text message communication, and recording clients' health information. Almost half of the studies looked at health workers' use of mobile devices for mother, child, and newborn health. We have moderate or high confidence in the following findings. mHealth changed how health workers worked with each other: health workers appreciated being more connected to colleagues, and thought that this improved co-ordination and quality of care. However, some described problems when senior colleagues did not respond or responded in anger. Some preferred face-to-face connection with colleagues. Some believed that mHealth improved their reporting, while others compared it to "big brother watching". mHealth changed how health workers delivered care: health workers appreciated how mHealth let them take on new tasks, work flexibly, and reach clients in difficult-to-reach areas. They appreciated mHealth when it improved feedback, speed and workflow, but not when it was slow or time consuming. Some health workers found decision support software useful; others thought it threatened their clinical skills. Most health workers saw mHealth as better than paper, but some preferred paper. Some health workers saw mHealth as creating more work. mHealth led to new forms of engagement and relationships with clients and communities: health workers felt that communicating with clients by mobile phone improved care and their relationships with clients, but felt that some clients needed face-to-face contact. Health workers were aware of the importance of protecting confidential client information when using mobile devices. Some health workers did not mind being contacted by clients outside working hours, while others wanted boundaries. Health workers described how some community members trusted health workers that used mHealth while others were sceptical. Health workers pointed to problems when clients needed to own their own phones. Health workers' use and perceptions of mHealth could be influenced by factors tied to costs, the health worker, the technology, the health system and society, poor network access, and poor access to electricity: some health workers did not mind covering extra costs. Others complained that phone credit was not delivered on time. Health workers who were accustomed to using mobile phones were sometimes more positive towards mHealth. Others with less experience, were sometimes embarrassed about making mistakes in front of clients or worried about job security. Health workers wanted training, technical support, user-friendly devices, and systems that were integrated into existing electronic health systems. The main challenges health workers experienced were poor network connections, access to electricity, and the cost of recharging phones. Other problems included damaged phones. Factors outside the health system also influenced how health workers experienced mHealth, including language, gender, and poverty issues. Health workers felt that their commitment to clients helped them cope with these challenges. AUTHORS' CONCLUSIONS Our findings propose a nuanced view about mHealth programmes. The complexities of healthcare delivery and human interactions defy simplistic conclusions on how health workers will perceive and experience their use of mHealth. Perceptions reflect the interplay between the technology, contexts, and human attributes. Detailed descriptions of the programme, implementation processes and contexts, alongside effectiveness studies, will help to unravel this interplay to formulate hypotheses regarding the effectiveness of mHealth.
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Affiliation(s)
- Willem A Odendaal
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Stellenbosch UniversityDepartment of PsychiatryCape TownSouth Africa
| | | | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Brown UniversitySchool of Public HealthProvidenceRhode IslandUSA
| | - Jane Goudge
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Frances Griffiths
- University of WarwickWarwick Medical SchoolCoventryUK
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Mark Tomlinson
- Stellenbosch UniversityInstitute for Life Course Health Research, Department of Global HealthCape TownSouth Africa
- Queens UniversitySchool of Nursing and MidwiferyBelfastUK
| | - Karen Daniels
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- University of Cape TownHealth Policy and Systems Division, School of Public Health and Family MedicineCape TownWestern CapeSouth Africa7925
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Piaggesi A, Låuchli S, Bassetto F, Biedermann T, Marques A, Najafi B, Palla I, Scarpa C, Seimetz D, Triulzi I, Turchetti G, Vaggelas A. Advanced therapies in wound management: cell and tissue based therapies, physical and bio-physical therapies smart and IT based technologies. J Wound Care 2018; 27:S1-S137. [DOI: 10.12968/jowc.2018.27.sup6a.s1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Alberto Piaggesi
- Prof, Director, EWMA Scientific Recorder (Editor), Diabetic Foot Section of the Pisa University Hospital, Department of Endocrinology and Metabolism, University of Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Severin Låuchli
- Chief of Dermatosurgery and Woundcare, EWMA Immediate Past President (Co-editor), Department of Dermatology, University Hospital, Zurich, Råmistrasse 100, 8091 Zärich, Schwitzerland
| | - Franco Bassetto
- Prof, Head of Department, Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Thomas Biedermann
- Tissue Biology Research Unit, Department of Surgery, University Children's Hospital Zurich, August Forel-Strasse 7, 8008 Zürich, Switzerland
| | - Alexandra Marques
- University of Minho, 3B's Research Group in Biomaterials, Biodegradables and Biomimetics, Avepark - Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco GMR, Portugal
| | - Bijan Najafi
- Professor of Surgery, Director of Clinical Research, Division of Vascular Surgery and Endovascular Therapy, Director of Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030-3411, US
| | - Ilaria Palla
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Carlotta Scarpa
- Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Diane Seimetz
- Founding Partner, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
| | - Isotta Triulzi
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Giuseppe Turchetti
- Fulbright Scholar, Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Annegret Vaggelas
- Consultant, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
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Basatneh R, Najafi B, Armstrong DG. Health Sensors, Smart Home Devices, and the Internet of Medical Things: An Opportunity for Dramatic Improvement in Care for the Lower Extremity Complications of Diabetes. J Diabetes Sci Technol 2018; 12:577-586. [PMID: 29635931 PMCID: PMC6154231 DOI: 10.1177/1932296818768618] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The prevalent and long-neglected diabetic foot ulcer (DFU) and its related complications rank among the most debilitating and costly sequelae of diabetes. With the rise of the Internet of medical things (IoMT), along with smart devices, the med-tech industry is on the cusp of a home-care revolution, which could also create opportunity for developing effective solutions with significant potential to reduce DFU-associated costs and saving limbs. This article discusses potential applications of IoMT to the DFU patient population and beyond. METHODS To better understand potential opportunities and challenges associated with implementing IoMT for management of DFU, the authors reviewed recent relevant literatures and included their own expert opinions from a multidisciplinary point of view including podiatry, engineering, and data security. RESULTS The IoMT has opened digital transformation of home-based diabetic foot care, as it enables promoting patient engagement, personalized care and smart management of chronic and noncommunicable diseases through individual data-driven treatment regimens, telecommunication, data mining, and comprehensive feedback tailored to individual requirements. In particular, with recent advances in voice-activated commands technology and its integration as a part of IoMT, new opportunities have emerged to improve the patient's central role and responsibility in enabling an optimized health care ecosystem. CONCLUSIONS The IoMT has opened new opportunities in health care from remote monitoring to smart sensors and medical device integration. While it is at its early stage of development, ultimately we envisage a connected home that, using voice-controlled technology and Bluetooth-radio-connected add-ons, may augment much of what home health does today.
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Affiliation(s)
- Rami Basatneh
- School of Podiatric Medicine, Temple
University, Philadelphia, PA, USA
| | - Bijan Najafi
- Interdisciplinary Consortium for
Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery,
Baylor College of Medicine, Houston, TX, USA
- Bijan Najafi, PhD, Interdisciplinary
Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department
of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston,
TX 77030, USA.
| | - David G. Armstrong
- Southwestern Academic Limb Salvage
Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of
Southern California, Los Angeles, CA, USA
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Kolltveit BCH, Thorne S, Graue M, Gjengedal E, Iversen MM, Kirkevold M. Telemedicine follow-up facilitates more comprehensive diabetes foot ulcer care: A qualitative study in home-based and specialist health care. J Clin Nurs 2018; 27:e1134-e1145. [PMID: 29193527 DOI: 10.1111/jocn.14193] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2017] [Indexed: 12/20/2022]
Abstract
AIMS AND OBJECTIVES To investigate the application of a telemedicine intervention in diabetes foot ulcer care, and its implications for the healthcare professionals in the clinical field. BACKGROUND Contextual factors are found to be important when applying technology in health care and applying telemedicine in home-based care has been identified as particularly complex. DESIGN AND METHODS We conducted field observations and individual interviews among healthcare professionals in home-based care and specialist health care in a diabetes foot care telemedicine RCT (Clin.Trial.gov: NCT01710774) during 2016. This study was guided by Interpretive Description, an inductive qualitative methodology. RESULTS Overall, we identified unequal possibilities for applying telemedicine in diabetes foot ulcer care within the hospital and home care contexts. Different circumstances and possibilities in home-based care made the application of telemedicine as intended more difficult. The healthcare professionals in both care contexts perceived the application of telemedicine to facilitate a more comprehensive approach towards the patients, but with different possibilities to enact it. CONCLUSIONS Application of telemedicine in home-based care was more challenging than in the outpatient clinic setting. Introducing more updated equipment and minor structural adjustments in consultation time and resources could make the use of telemedicine in home-based care more robust. RELEVANCE TO CLINICAL PRACTICE Application of telemedicine in diabetes foot ulcer follow-up may enhance the nursing staff's ability to conduct comprehensive assessment and care of the foot ulcer as well as the patient's total situation. Access to adequate equipment and time, particularly in home-based care, is necessary to capitalise on this new technology.
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Affiliation(s)
- Beate-Christin Hope Kolltveit
- Faculty of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Sally Thorne
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Marit Graue
- Faculty of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Eva Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Faculty of Health and Social Care, Molde University College, Molde, Norway
| | - Marjolein M Iversen
- Faculty of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Section of Endocrinology, Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Marit Kirkevold
- Faculty of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
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Pruim L, Wind A, van Harten WH. Assessing and comparing the quality of wound centres: a literature review and benchmarking pilot. Int Wound J 2017; 14:1120-1136. [PMID: 28612454 PMCID: PMC7949638 DOI: 10.1111/iwj.12768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/21/2017] [Accepted: 04/26/2017] [Indexed: 11/30/2022] Open
Abstract
Multidisciplinary wound centres are currently facing an increase in both the incidence of wounds and the complexity of care. This has resulted in rising costs and increased interest in the effectiveness of treatments. Little evidence is available regarding optimal wound centre organisation and effectiveness; therefore, measuring the quality of wound centres has become more important. This study aims to assess the evidence concerning quality by describing the state of the art of wound centres and organisational effectiveness by developing indicators of quality and by assessing their suitability in a pilot study. A multi-method approach was used: a literature review performed resulted in the development of an indicator list that was consequently subjected to expert review, and a benchmark study was completed comparing eight wound centres in the Netherlands. We thus provide a description of the relevant state-of-the-art aspects of wound centre organisation, which were multidisciplinary collaborations and standardisation of the organisation of care. In literature, significant patient-related effects were observed in improved healing rates and decreased costs. A total of 48 indicators were selected. The indicator list was tested by a benchmark study pilot. In practice, the outcome indicators were especially difficult to generate. Six indicators regarding structure, three regarding process and five regarding outcome proved feasible to measure and improve quality of wound centres.
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Affiliation(s)
- Lotte Pruim
- Department of Health Technology and Services ResearchUniversity of TwenteEnschedeThe Netherlands
- Rijnstate HospitalArnhemThe Netherlands
| | - Anke Wind
- Department of Health Technology and Services ResearchUniversity of TwenteEnschedeThe Netherlands
- Division of Psychosocial Research and EpidemiologyNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Wim H. van Harten
- Department of Health Technology and Services ResearchUniversity of TwenteEnschedeThe Netherlands
- Rijnstate HospitalArnhemThe Netherlands
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Winpenny E, Miani C, Pitchforth E, Ball S, Nolte E, King S, Greenhalgh J, Roland M. Outpatient services and primary care: scoping review, substudies and international comparisons. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AimThis study updates a previous scoping review published by the National Institute for Health Research (NIHR) in 2006 (Roland M, McDonald R, Sibbald B.Outpatient Services and Primary Care: A Scoping Review of Research Into Strategies For Improving Outpatient Effectiveness and Efficiency. Southampton: NIHR Trials and Studies Coordinating Centre; 2006) and focuses on strategies to improve the effectiveness and efficiency of outpatient services.Findings from the scoping reviewEvidence from the scoping review suggests that, with appropriate safeguards, training and support, substantial parts of care given in outpatient clinics can be transferred to primary care. This includes additional evidence since our 2006 review which supports general practitioner (GP) follow-up as an alternative to outpatient follow-up appointments, primary medical care of chronic conditions and minor surgery in primary care. Relocating specialists to primary care settings is popular with patients, and increased joint working between specialists and GPs, as suggested in the NHS Five Year Forward View, can be of substantial educational value. However, for these approaches there is very limited information on cost-effectiveness; we do not know whether they increase or reduce overall demand and whether the new models cost more or less than traditional approaches. One promising development is the increasing use of e-mail between GPs and specialists, with some studies suggesting that better communication (including the transmission of results and images) could substantially reduce the need for some referrals.Findings from the substudiesBecause of the limited literature on some areas, we conducted a number of substudies in England. The first was of referral management centres, which have been established to triage and, potentially, divert referrals away from hospitals. These centres encounter practical and administrative challenges and have difficulty getting buy-in from local clinicians. Their effectiveness is uncertain, as is the effect of schemes which provide systematic review of referrals within GP practices. However, the latter appear to have more positive educational value, as shown in our second substudy. We also studied consultants who held contracts with community-based organisations rather than with hospital trusts. Although these posts offer opportunities in terms of breaking down artificial and unhelpful primary–secondary care barriers, they may be constrained by their idiosyncratic nature, a lack of clarity around roles, challenges to professional identity and a lack of opportunities for professional development. Finally, we examined the work done by other countries to reform activity at the primary–secondary care interface. Common approaches included the use of financial mechanisms and incentives, the transfer of work to primary care, the relocation of specialists and the use of guidelines and protocols. With the possible exception of financial incentives, the lack of robust evidence on the effect of these approaches and the contexts in which they were introduced limits the lessons that can be drawn for the English NHS.ConclusionsFor many conditions, high-quality care in the community can be provided and is popular with patients. There is little conclusive evidence on the cost-effectiveness of the provision of more care in the community. In developing new models of care for the NHS, it should not be assumed that community-based care will be cheaper than conventional hospital-based care. Possible reasons care in the community may be more expensive include supply-induced demand and addressing unmet need through new forms of care and through loss of efficiency gained from concentrating services in hospitals. Evidence from this study suggests that further shifts of care into the community can be justified only if (a) high value is given to patient convenience in relation to NHS costs or (b) community care can be provided in a way that reduces overall health-care costs. However, reconfigurations of services are often introduced without adequate evaluation and it is important that new NHS initiatives should collect data to show whether or not they have added value, and improved quality and patient and staff experience.FundingThe NIHR Health Services and Delivery Research programme.
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Affiliation(s)
| | | | | | | | - Ellen Nolte
- RAND Europe, Cambridge, UK
- European Observatory on Health Systems and Policies, London School of Economics and Political Science and London School of Hygiene and Tropical Medicine, London, UK
| | | | - Joanne Greenhalgh
- Faculty of Education, Social Sciences and Law, University of Leeds, Leeds, UK
| | - Martin Roland
- Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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O'Leary DP, Zaheer A, Redmond HP, Corrigan MA. Integration of advances in social media and mHealth technology are pivotal to successful cancer prevention and control. Mhealth 2016; 2:38. [PMID: 28293611 PMCID: PMC5344161 DOI: 10.21037/mhealth.2016.09.02] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/22/2016] [Indexed: 01/09/2023] Open
Abstract
The successful prevention and treatment of cancer is dependent upon efficient and reliable communication between healthcare workers and patients. Advances in social media and mHealth platforms have provided new ways in which to enhance the sharing of cancer related information. Other benefits of embracing this technology include utilising its analytic capabilities which can process the vast quantity of information generated from genome exploration in a highly efficient manner. The aim of this review is to provide an overview of the rapidly evolving areas through which digital engagement is proving useful in the prevention and control of cancer.
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Affiliation(s)
- D Peter O'Leary
- Cork Breast Research Centre, Cork University Hospital, Wilton, Cork, Ireland
| | - Amir Zaheer
- Cork Breast Research Centre, Cork University Hospital, Wilton, Cork, Ireland
| | - H Paul Redmond
- Cork Breast Research Centre, Cork University Hospital, Wilton, Cork, Ireland
| | - Mark A Corrigan
- Cork Breast Research Centre, Cork University Hospital, Wilton, Cork, Ireland
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A qualitative study of the key factors in implementing telemedical monitoring of diabetic foot ulcer patients. Int J Med Inform 2015; 84:799-807. [DOI: 10.1016/j.ijmedinf.2015.05.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 05/22/2015] [Accepted: 05/23/2015] [Indexed: 11/17/2022]
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12
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Moore Z, Angel D, Bjerregaard J, O'Connor T, McGuiness W, Kröger K, Rasmussen BSB, Yderstrœde KB. eHealth in Wound Care: from conception to implementation. J Wound Care 2015; 24:S1-S44. [DOI: 10.12968/jowc.2015.24.sup5.s1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Zena Moore
- Professor, Head of School, Previous President of the European Wound Management Association, School of Nursing & Midwifery, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Donna Angel
- Nurse Practitioner, Secretary of the Australian Wound Management Association, Royal Perth Hospital, 197 Wellington Street, Perth WA 6000, Australia
| | - Julie Bjerregaard
- The European Wound Management Association, Nordre Fasanvej 113, Frederiksberg, Denmark
| | - Tom O'Connor
- Deputy Head of School/Director of Academic Affairs, Senior Lecturer, School of Nursing & Midwifery, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - William McGuiness
- Associate Professor, Previous President of the Australian Wound Management Association, Monash Health, 246 Clayton Rd, ClaytonVIC 3168, Australia
| | - Knut Kröger
- Director, Vice President of the Initiative Chronic Wounds e.V., Germany, Department of Angiology, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | | | - Knud Bonnet Yderstrœde
- Associate professor, Consultant Medical Endocrinology and Internal Medicine, Odense University Hospital, Region of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C
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