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Ramachandran M, Brinton C, Wiljer D, Upshur R, Gray CS. The impact of eHealth on relationships and trust in primary care: a review of reviews. BMC PRIMARY CARE 2023; 24:228. [PMID: 37919688 PMCID: PMC10623772 DOI: 10.1186/s12875-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships. METHODS A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed. RESULTS A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively. CONCLUSIONS Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.
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Affiliation(s)
- Meena Ramachandran
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Christopher Brinton
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - David Wiljer
- Education Technology Innovation, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
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Neufeld A, Babenko O, Bhella V. Family Physician Motivation and Well-Being in the Digital Era. Ann Fam Med 2023; 21:496-501. [PMID: 38012032 PMCID: PMC10681703 DOI: 10.1370/afm.3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/05/2023] [Accepted: 07/25/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Family physicians rapidly shifted to using virtual care during the COVID-19 pandemic, yet it is largely unknown if this change has impacted their workplace motivation. A better understanding of this matter is essential for optimizing the integration of virtual care into standard practice and for supporting family physician well-being. Using a self-determination theory lens, we examined if family physicians experienced autonomous (vs controlled) motivation toward using virtual care, how this related to their subjective well-being, and whether satisfaction (vs frustration) of their basic psychological needs at work mediated that relationship. METHODS Using cross-sectional survey methodology, quantitative data was collected from 156 family physicians in Alberta, Canada. The questionnaire contained validated scales for measuring motivational quality, workplace need fulfillment, and subjective well-being. Descriptive, correlational, and mediation analyses were performed. RESULTS Family physicians varied significantly in their quality of motivation towards using virtual care. Controlled motivation toward using virtual care was associated with lower well-being, and workplace need frustration fully mediated that relationship. Conversely, workplace need satisfaction, but not autonomous motivation toward using virtual care, was associated with higher well-being. CONCLUSIONS In line with self-determination theory, findings suggest that when family physicians' motivation toward using virtual care is less self-determined, it will lead to poorer subjective well-being, because of basic psychological need frustration. Potential implications of the findings are discussed within the contexts of virtual health and primary care.
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Affiliation(s)
- Adam Neufeld
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Oksana Babenko
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vishal Bhella
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Babenko O, Neufeld A. Profiles of physician motivation towards using virtual care: differences in workplace need fulfillment. BMC Health Serv Res 2023; 23:1101. [PMID: 37845679 PMCID: PMC10580539 DOI: 10.1186/s12913-023-10057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/24/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Physicians appear to vary in their motivation towards using virtual care, but to what extent is unclear. To better understand this variance, which is important for supporting physician wellbeing and therefore patient care, the authors used self-determination theory's (SDT) framework. According to SDT, different types of motivation exist, ranging from controlled to autonomous, that lend to differences in engagement, performance, and wellbeing. The authors aimed to determine: (a) if there were distinct groups of physicians based on their quality of motivation towards using virtual care, and if so, (b) how these groups varied in fulfillment of basic psychological needs (autonomy, competence, and relatedness) in the workplace. METHODS In March-August 2022, the authors collected quantitative, survey-based data from a cross-section of 156 family physicians in Alberta, Canada. The survey contained existing scales that measure types of motivation (autonomous vs. controlled) and basic psychological need satisfaction/frustration at work. Cluster analysis was used to explore profiles of physician motivation towards using virtual care, and analysis of variance was used to determine how each profile differed with respect to workplace need fulfillment. RESULTS With motivation towards using virtual care, three higher-order profiles of physician motivation were identified: autonomous (19% family physicians), controlled (16% of family physicians), and ambivalent (66% of family physicians). The three profiles differed significantly in terms of psychological need fulfillment at work. CONCLUSIONS This study identifies specific profiles that family physicians currently fall into when it comes to motivation towards using virtual care. In line with SDT, findings suggest that basic psychological needs are fundamental nutrients for physicians to internalize and endorse the value of using virtual care in their practices. Implications for physician wellbeing are discussed.
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Affiliation(s)
- Oksana Babenko
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Adam Neufeld
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Mathijssen E, de Lange W, Bleijenberg N, van Houwelingen T, Jaarsma T, Trappenburg J, Westland H. Factors That Influence the Use of eHealth in Home Care: Scoping Review and Cross-sectional Survey. J Med Internet Res 2023; 25:e41768. [PMID: 36892935 PMCID: PMC10037173 DOI: 10.2196/41768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In home care, eHealth implementation requires health care professionals and home care clients to change their behavior because they have to incorporate the use of eHealth into their daily routines. Knowledge of factors that influence the use of eHealth in home care is needed to optimize implementation strategies. However, a comprehensive overview of such factors is lacking. OBJECTIVE The aims of this study were to (1) provide insight into the types of eHealth that are used and preferred in home care and (2) identify factors that influence the use of eHealth in home care according to health care professionals and home care clients. METHODS A scoping review and online, cross-sectional survey were conducted sequentially. The survey was conducted among Dutch health care professionals with a nursing background who were working for a home care organization at the time. The capability, opportunity, motivation, behavior (COM-B) model, which posits that for any behavior (B) to occur, a person must have the capability (C), opportunity (O), and motivation (M) to perform the behavior, was used to identify influencing factors. The use of a theoretical model may contribute to a better understanding of how to achieve and sustain behavior change in clinical practice. RESULTS We included 30 studies in the scoping review. The most frequently studied type of eHealth was a telecommunication/telemonitoring system. The survey was completed by 102 participants. The most frequently used types of eHealth were electronic health records, social alarms, and online client portals. A health app was the most frequently preferred type of eHealth. We identified 22 factors that influence the use of eHealth in home care according to health care professionals and home care clients. Influencing factors were organized into the components of the COM-B model, namely capability (n=6), opportunity (n=10), and motivation (n=6). We found that there is no single influencing factor that is key to the complexity of eHealth implementation. CONCLUSIONS Different types of eHealth are used, and many types of eHealth are preferred by health care professionals. The identified factors that influence the use of eHealth in home care relate to all components of the COM-B model. These factors need to be addressed and embedded in implementation strategies of eHealth to optimize the use of eHealth in home care.
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Affiliation(s)
- Elke Mathijssen
- The Healthcare Innovation Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Wendela de Lange
- The Healthcare Innovation Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nienke Bleijenberg
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Research Group Proactive Care for Older People Living at Home, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Thijs van Houwelingen
- Research Group Technology for Innovations in Healthcare, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Tiny Jaarsma
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jaap Trappenburg
- The Healthcare Innovation Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heleen Westland
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Tickner C, Heinsch M, Brosnan C, Kay-Lambkin F. "Another tool in our toolbox": a scoping review of the use of eHealth technologies in health social work practice. SOCIAL WORK IN HEALTH CARE 2023; 62:1-18. [PMID: 36587833 DOI: 10.1080/00981389.2022.2163450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/16/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
There is increasing recognition of the salience of eHealth technologies in enhancing health service capacity. Yet social work remains "behind the curve" in progressing digital practices. As the demand for digital health care increases, particularly following COVID-19, it is becoming increasingly urgent to understand how social workers engage with eHealth technologies, and how technological engagement impacts on social work practice. In this scoping review, we sought to examine eHealth use in health social work practice. Our findings suggest that, while social workers recognize the strengths and opportunities to broaden the scope of their practice, they remain concerned that eHealth may not be congruent with the values and approaches of the profession. This review provides a broad overview of health social workers' engagement with eHealth technologies and considers implications for future research that examines the nuanced and complex nature of professional values, risk, and assessment in the digital space.
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Affiliation(s)
- Campbell Tickner
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Milena Heinsch
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Caragh Brosnan
- School of Humanities, Creative Industries and Social Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
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Hsieh HL, Lai JM, Chuang BK, Tsai CH. Determinants of Telehealth Continuance Intention: A Multi-Perspective Framework. Healthcare (Basel) 2022; 10:2038. [PMID: 36292485 PMCID: PMC9601836 DOI: 10.3390/healthcare10102038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/04/2022] Open
Abstract
Owing to the COVID-19 pandemic, many countries' physicians in the world have used telehealth to visit patients via telehealth. The study aimed to integrate the theory of planned behavior (TPB), the technology acceptance model (TAM), and self-determination theory (SDT) to explore the adoption behavior of a telehealth system. A convenient sample of residents was drawn from the population of Nantou County in Taiwan and analyzed via structural equation modeling. The findings revealed that attitude, perceived behavioral control, perceived usefulness, and perceived autonomy support jointly have significantly positive effects on continuance intention. Results also confirmed that perceived autonomy support, perceived ease of use, and perceived usefulness jointly have significantly positive effects on attitude. Furthermore, this study also showed that a crucial mediators' role is played by perceived ease of use, perceived usefulness, and attitude. The conclusions and practical implications of the research will hopefully provide health organizations and institutions with some innovative insights and foresights, which in turn will promote better practices and services of telehealth technology.
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Affiliation(s)
| | - Jhih-Ming Lai
- Department of Information Technology and Management, Tzu Chi University of Science and Technology, Hualien 973302, Taiwan
| | | | - Chung-Hung Tsai
- Department of Information Technology and Management, Tzu Chi University of Science and Technology, Hualien 973302, Taiwan
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Fernandes BCG, Silva Júnior JNDB, Guedes HCDS, Macedo DBG, Nogueira MF, Barrêto AJR. Use of technologies by nurses in the management of primary health care. ACTA ACUST UNITED AC 2021; 42:e20200197. [PMID: 34037179 DOI: 10.1590/1983-1447.2021.20200197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/22/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the management actions of nurses in Primary Health Care services from the perspective of technologies. METHOD Descriptive-exploratory study with a quantitative approach, carried out from February to April 2019. Through the snowball technique, the sample consisted of 42 nurses from Primary Health Care, using an electronic tool for data collection. The data were analyzed using descriptive statistics techniques. RESULTS 54.8% of nurses use technologies through SISREG and PEC electronic systems, care training related to permanent health education, online and face-to-face courses, in addition to care technologies such as telehealth and telemedicine. CONCLUSION Management actions focused on technology showed restricted use. Nurses need to empower themselves with these organizational devices, with the aim of improving the provision and quality of care for users.
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McDonald AP, Rizzotti R, Rivera JM, D'Arcy RCN, Park G, Song X. Toward improved homecare of frail older adults: A focus group study synthesizing patient and caregiver perspectives. Aging Med (Milton) 2021; 4:4-11. [PMID: 33738374 PMCID: PMC7954833 DOI: 10.1002/agm2.12144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Adopting a better understanding of how both older adults and health care providers view the community management of frailty is necessary for improving home health, especially facing the coronavirus disease 2019 (COVID-19) pandemic. We conducted a qualitative focus group study to assess how both older adults and health care providers view frailty and virtual health care in home health. METHODS Two focus groups enrolled home-living older adults and health care professionals, respectively (n = 15). Questions targeting the use of virtual / telehealth technologies in-home care for frail older adults were administered at audio-recorded group interviews. Transcribed discussions were coded and analyzed using NVivo software. RESULTS The older adult group emphasized the autonomy related to increasing frailty and social isolation and the need for transparent dissemination of health care planning. They were optimistic about remote technology-based supports and suggested that telehealth / health-monitoring/tracking were in high demand. Health care professionals emphasized the importance of a holistic biopsychosocial approach to frailty management. They highlighted the need for standardized early assessment and management of frailty. CONCLUSIONS The integrated perspectives provided an updated understanding of what older adults and practitioners value in home-living supports. This knowledge is helpful to advancing virtual home care, providing better care for frail individuals with complex health care needs.
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Affiliation(s)
- Andrew P. McDonald
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Joanna M. Rivera
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Ryan C. N. D'Arcy
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of Applied SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Grace Park
- Community Actions and Resources Empowering Seniors (CARES)Fraser HealthSurreyBritish ColumbiaCanada
- Home and Community Care MedicineFraser HealthSurreyBritish ColumbiaCanada
| | - Xiaowei Song
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of ScienceSimon Fraser UniversityBurnabyBritish ColumbiaCanada
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Garcia-Huidobro D, Rivera S, Valderrama Chang S, Bravo P, Capurro D. System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation. J Med Internet Res 2020; 22:e22146. [PMID: 32903195 PMCID: PMC7541041 DOI: 10.2196/22146] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/20/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. Objective The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. Methods This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. Results A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% versus 50.9%, P=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (P<.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (P=.046, P<.001, and P=.02, respectively). Conclusions Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently.
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Affiliation(s)
- Diego Garcia-Huidobro
- Department of Family Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Solange Rivera
- Department of Family Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Sebastián Valderrama Chang
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.,Office of Innovation and Digital Transformation, UC Christus Health Network, Santiago, Chile
| | - Paula Bravo
- Office of Innovation and Digital Transformation, UC Christus Health Network, Santiago, Chile
| | - Daniel Capurro
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.,School of Computing and Information Systems, University of Melbourne, Melbourne, Australia.,Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
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