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Emmett A, Kent B, James A, March-McDonald J. Experiences of health professionals towards using mobile electrocardiogram (ECG) technology: A qualitative systematic review. J Clin Nurs 2022. [PMID: 35765173 DOI: 10.1111/jocn.16434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify and explore the experiences of health professionals towards using mobile electrocardiogram (ECG) technology. INTRODUCTION Mobile technology is increasingly being incorporated into healthcare systems, and when implemented well, has the potential to revolutionise the way in which care is delivered. The uptake of mobile ECG technology enables health professionals to record and transmit ECGs electronically, at the point of care. It is important to explore both the impact of this technology and staff experiences to help understand how readily it is accepted and how effectively it is used in practice. There is a paucity of knowledge and understanding from primary healthcare providers and a lack of qualitative evidence offering insight into the monitoring and use of mobile ECG technology. Therefore, this review adds to the available body of knowledge by giving insight from the perspectives of health professionals on its use. METHODS TRIP, CINAHL, MEDLINE, Scopus and sources of grey literature were searched for eligible studies. Databases were searched from their inception dates, with a restriction on studies written in English. The results of the search are presented in a PRISMA flow diagram. Two reviewers independently screened studies and assessed methodological quality in accordance with JBI methodology for systematic reviews of qualitative evidence. Data were extracted from the included studies and meta-aggregation methodology adopted to identify categories and create synthesised findings related to the healthcare professionals' experiences. RESULTS A total of six studies were included, which resulted in 18 findings and five categories. Three synthesised findings were generated: Quick, easy and feasible in both urban and remote settings; Increased accessibility of AF screening opportunities for all; Enhanced support in staff resources, time and technology are required. The level of confidence of synthesised findings varied from low to moderate according to ConQual. CONCLUSIONS This systematic review synthesised the experiences of healthcare professionals using mobile ECG technology. The methodological quality of the included studies was high, and findings indicated healthcare professionals (HCPs) generally found mobile ECG technology simple, quick, easy to use and non-invasive. Enablers regarding mobile ECG technology were time, workload, and remuneration for improved interoperability with current systems and sustainability for screening long term. Data on the experiences of HCPs came from studies capturing mainly proactive, lower-risk patients; therefore, this review was unable to demonstrate if there are any differences between the experiences of HCPs working in primary care settings, such as GP practices/pharmacies, and those working remotely in the community. This highlights a gap in provision for those patients requiring HCPs to record an ECG in their own home. RELEVANCE TO CLINICAL PRACTICE The experiences of HCPs towards using Mobile ECG technology in practice is quick, easy and feasible in both urban and remote settings. HCPs and organisations should consider identifying key staff as "change champions" and use change/leadership models to support the integration (with current workflows), transformation, and evaluation of mobile ECG technology in their practice setting. HCPs and providers using mobile ECG technology should ensure it prioritises at-risk individuals and includes the "housebound" population.
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Affiliation(s)
- Aimee Emmett
- University of Plymouth Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK.,Cornwall Partnership NHS Foundation Trust, Carew House, Beacon Technology Park, Bodmin, UK
| | - Bridie Kent
- University of Plymouth Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK.,The University of Plymouth Centre for Innovations in Health and Social Care, A JBI Centre of Excellence, Plymouth, UK
| | - Alison James
- University of Plymouth Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Jane March-McDonald
- University of Plymouth Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
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Wong KC, Nguyen TN, Marschner S, Turnbull S, Burns MJ, Ne JYA, Gopal V, Indrawansa AB, Trankle SA, Usherwood T, Kumar S, Lindley RI, Chow CK. Patient-Led Mass Screening for Atrial Fibrillation in the Older Population Using Handheld Electrocardiographic Devices Integrated With a Clinician-Coordinated Remote Central Monitoring System: Protocol for a Randomized Controlled Trial and Process Evaluation. JMIR Res Protoc 2022; 11:e34778. [PMID: 35103614 PMCID: PMC8848249 DOI: 10.2196/34778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Atrial fibrillation (AF) is common in older people and increases the risk of stroke. The feasibility and effectiveness of the implementation of a patient-led AF screening program for older people are unknown. Objective This study aims to examine the feasibility and effectiveness of an AF screening program comprising patient-led monitoring of single-lead electrocardiograms (ECGs) with clinician-coordinated central monitoring to diagnose AF among community-dwelling people aged ≥75 years in Australia. Methods This is a nationwide randomized controlled implementation trial conducted via the internet and remotely among 200 community-dwelling adults aged ≥75 years with no known AF. Randomization will be performed in a 1:1 allocation ratio for the intervention versus control. Intervention group participants will be enrolled in the monitoring program at randomization. They will receive a handheld single-lead ECG device and training on the self-recording of ECGs on weekdays and submit their ECGs via their smartphones. The control group participants will receive usual care from their general practitioners for the initial 6 months and then commence the 6-month monitoring program. The ECGs will be reviewed centrally by trained personnel. Participants and their general practitioners will be notified of AF and other clinically significant ECG abnormalities. Results This study will establish the feasibility and effectiveness of implementing the intervention in this patient population. The primary clinical outcome is the AF detection rate, and the primary feasibility outcome is the patient satisfaction score. Other outcomes include appropriate use of anticoagulant therapy, participant recruitment rate, program engagement (eg, frequency of ECG transmission), agreement in ECG interpretation between the device automatic algorithm and clinicians, the proportion of participants who complete the trial and number of dropouts, and the impact of frailty on feasibility and outcomes. We will conduct a qualitative evaluation to examine the barriers to and acceptability and enablers of implementation. Ethics approval was obtained from the human research ethics committee at the University of Sydney (project number 2020/680). The results will be disseminated via conventional scientific forums, including peer-reviewed publications and presentations at national and international conferences. Conclusions By incorporating an integrated health care approach involving patient empowerment, centralized clinician-coordinated ECG monitoring, and facilitation of primary care and specialist services, it is possible to diagnose and treat AF early to reduce stroke risk. This study will provide new information on how to implement AF screening using digital health technology practicably and feasibly for older and frail populations residing in the community. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12621000184875; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380877 International Registered Report Identifier (IRRID) DERR1-10.2196/34778
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Affiliation(s)
- Kam Cheong Wong
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, Australia
- School of Rural Health, Faculty of Medicine and Health, The University of Sydney, Orange, Australia
| | - Tu N Nguyen
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | - Samual Turnbull
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Department of Cardiology, Westmead Hospital, Westmead, Australia
| | - Mason Jenner Burns
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | - Jia Yi Anna Ne
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Department of Cardiology, Westmead Hospital, Westmead, Australia
| | - Vishal Gopal
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | | | - Steven A Trankle
- General Practice Department, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Tim Usherwood
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Saurabh Kumar
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Department of Cardiology, Westmead Hospital, Westmead, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Department of Cardiology, Westmead Hospital, Westmead, Australia
- The George Institute for Global Health, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
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