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Maaß L, Angoumis K, Freye M, Pan CC. Mapping Digital Public Health Interventions Among Existing Digital Technologies and Internet-Based Interventions to Maintain and Improve Population Health in Practice: Scoping Review. J Med Internet Res 2024; 26:e53927. [PMID: 39018096 PMCID: PMC11292160 DOI: 10.2196/53927] [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: 10/24/2023] [Revised: 01/31/2024] [Accepted: 05/15/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The rapid progression and integration of digital technologies into public health have reshaped the global landscape of health care delivery and disease prevention. In pursuit of better population health and health care accessibility, many countries have integrated digital interventions into their health care systems, such as web-based consultations, electronic health records, and telemedicine. Despite the increasing prevalence and relevance of digital technologies in public health and their varying definitions, there has been a shortage of studies examining whether these technologies align with the established definition and core characteristics of digital public health (DiPH) interventions. Hence, the imperative need for a scoping review emerges to explore the breadth of literature dedicated to this subject. OBJECTIVE This scoping review aims to outline DiPH interventions from different implementation stages for health promotion, primary to tertiary prevention, including health care and disease surveillance and monitoring. In addition, we aim to map the reported intervention characteristics, including their technical features and nontechnical elements. METHODS Original studies or reports of DiPH intervention focused on population health were eligible for this review. PubMed, Web of Science, CENTRAL, IEEE Xplore, and the ACM Full-Text Collection were searched for relevant literature (last updated on October 5, 2022). Intervention characteristics of each identified DiPH intervention, such as target groups, level of prevention or health care, digital health functions, intervention types, and public health functions, were extracted and used to map DiPH interventions. MAXQDA 2022.7 (VERBI GmbH) was used for qualitative data analysis of such interventions' technical functions and nontechnical characteristics. RESULTS In total, we identified and screened 15,701 records, of which 1562 (9.94%) full texts were considered relevant and were assessed for eligibility. Finally, we included 185 (11.84%) publications, which reported 179 different DiPH interventions. Our analysis revealed a diverse landscape of interventions, with telemedical services, health apps, and electronic health records as dominant types. These interventions targeted a wide range of populations and settings, demonstrating their adaptability. The analysis highlighted the multifaceted nature of digital interventions, necessitating precise definitions and standardized terminologies for effective collaboration and evaluation. CONCLUSIONS Although this scoping review was able to map characteristics and technical functions among 13 intervention types in DiPH, emerging technologies such as artificial intelligence might have been underrepresented in our study. This review underscores the diversity of DiPH interventions among and within intervention groups. Moreover, it highlights the importance of precise terminology for effective planning and evaluation. This review promotes cross-disciplinary collaboration by emphasizing the need for clear definitions, distinct technological functions, and well-defined use cases. It lays the foundation for international benchmarks and comparability within DiPH systems. Further research is needed to map intervention characteristics in this still-evolving field continuously. TRIAL REGISTRATION PROSPERO CRD42021265562; https://tinyurl.com/43jksb3k. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/33404.
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Affiliation(s)
- Laura Maaß
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- Digital Health Section, European Public Health Association - EUPHA, Utrecht, Netherlands
| | - Konstantinos Angoumis
- University of Bielefeld, Bielefeld, Germany
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Merle Freye
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- University of Bremen, Institute for Information, Health and Medical Law - IGMR, Bremen, Germany
| | - Chen-Chia Pan
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research - IPP, Bremen, Germany
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Rzewuska Díaz M, Locock L, Keen A, Melvin M, Myhill A, Ramsay C. Implementation of a Web-Based Outpatient Asynchronous Consultation Service: Mixed Methods Study. J Med Internet Res 2024; 26:e48092. [PMID: 38833695 PMCID: PMC11185905 DOI: 10.2196/48092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 12/15/2023] [Accepted: 03/12/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Asynchronous outpatient patient-to-provider communication is expanding in UK health care, requiring evaluation. During the pandemic, Aberdeen Royal Infirmary in Scotland expanded its outpatient asynchronous consultation service from dermatology (deployed in May 2020) to gastroenterology and pain management clinics. OBJECTIVE We conducted a mixed methods study using staff, patient, and public perspectives and National Health Service (NHS) numerical data to obtain a rounded picture of innovation as it happened. METHODS Focus groups (3 web-based and 1 face-to-face; n=22) assessed public readiness for this service, and 14 interviews with staff focused on service design and delivery. The service's effects were examined using NHS Grampian service use data, a patient satisfaction survey (n=66), and 6 follow-up patient interviews. Survey responses were descriptively analyzed. Demographics, acceptability, nonattendance rates, and appointment outcomes of users were compared across levels of area deprivation in which they live and medical specialties. Interviews and focus groups underwent theory-informed thematic analysis. RESULTS Staff anticipated a simple technical system transfer from dermatology to other receptive medical specialties, but despite a favorable setting and organizational assistance, it was complicated. Key implementation difficulties included pandemic-induced technical integration delays, misalignment with existing administrative processes, and discontinuity in project management. The pain management clinic began asynchronous consultations (digital appointments) in December 2021, followed by the gastroenterology clinic in February 2022. Staff quickly learned how to explain and use this service. It was thought to function better for pain management as it fitted preexisting practices. From May to September 2022, the dermatology (adult and pediatric), gastroenterology, and pain management clinics offered 1709 appointments to a range of patients (n=1417). Digital appointments reduced travel by an estimated 44,712 miles (~71,956.81 km) compared to the face-to-face mode. The deprivation profile of people who chose to use this service closely mirrored that of NHS Grampian's population overall. There was no evidence that deprivation impacted whether digital appointment users subsequently received treatment. Only 18% (12/66) of survey respondents were unhappy or very unhappy with being offered a digital appointment. The benefits mentioned included better access, convenience, decreased travel and waiting time, information sharing, and clinical flexibility. Overall, patients, the public, and staff recognized its potential as an NHS service but highlighted informed choice and flexibility. Better communication-including the use of the term assessment instead of appointment-may increase patient acceptance. CONCLUSIONS Asynchronous pain management and gastroenterology consultations are viable and acceptable. Implementing this service is easiest when existing administrative processes face minimal disruption, although continuous support is needed. This study can inform practical strategies for supporting staff in adopting asynchronous consultations (eg, preparing for nonlinearity and addressing task issues). Patients need clear explanations and access to technical support, along with varied consultation options, to ensure digital inclusion.
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Affiliation(s)
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Andrew Keen
- NHS Grampian, Grampian, Aberdeen, United Kingdom
| | - Mike Melvin
- Public Research Partner, University of Aberdeen, Aberdeen, United Kingdom
| | - Anthony Myhill
- Public Research Partner, University of Aberdeen, Aberdeen, United Kingdom
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
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Seuren LM, Gilbert A, Ramdharry G, Walumbe J, Shaw SE. Video analysis of communication by physiotherapists and patients in video consultations: a qualitative study using conversation analysis. Physiotherapy 2024; 123:30-37. [PMID: 38262264 DOI: 10.1016/j.physio.2023.10.002] [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: 07/10/2022] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To investigate the challenges of doing physical examinations and exercises by video, and the communication strategies used by physiotherapists and patients to overcome them. DESIGN A qualitative study of talk and social actions, examining the verbal and non-verbal communication practices used by patients and physiotherapists. Video consultations between physiotherapists and patients were video recorded using MS Teams, transcribed and analysed in detail using Conversation Analysis. SETTING Video consultations were recorded in three specialist settings (long-term pain, orthopaedics, and neuromuscular rehabilitation) across two NHS hospitals. PARTICIPANTS 15 adult patients (10 female, 5 male; aged 20-77) with a scheduled video consultation. RESULTS Examinations and exercises retain-->were successfully accomplished in all 15 consultations. Two key challenges were identified for physiotherapists and patients when doing video assessments: (1) managing safety and clinical risk, and (2) making exercises and movements visible. Challenges were addressed by through communication practices that were patient-centred and tailored to the video context (e.g., explaining how to frame the body to the camera or adjust the camera to make the body visible). CONCLUSIONS Video is being used by physiotherapists to consult with their patients. This can work well, but tailored communication strategies are critical to help participants overcome the challenges of remote physical examinations and exercises. CONTRIBUTION OF THE PAPER This paper is a first to use video-based analysis to determine the challenges of video consulting for doing remote assessments and exercises in physiotherapy settings. It demonstrates how patients and physiotherapists use communication strategies to raise concerns around safety and visibility and how they overcome these concerns.
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Affiliation(s)
- Lucas M Seuren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom; Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON L5B 1B8, Canada.
| | - Anthony Gilbert
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom
| | - Gita Ramdharry
- University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, United Kingdom
| | - Jackie Walumbe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom; University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, United Kingdom
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom
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Papadopoulos P, Soflano M, Connolly T. A Digital Health Intervention Platform (Active and Independent Management System) to Enhance the Rehabilitation Experience for Orthopedic Joint Replacement Patients: Usability Evaluation Study. JMIR Hum Factors 2024; 11:e50430. [PMID: 38743479 PMCID: PMC11134252 DOI: 10.2196/50430] [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: 06/30/2023] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Optimal rehabilitation programs for orthopedic joint replacement patients ensure faster return to function, earlier discharge from hospital, and improved patient satisfaction. Digital health interventions show promise as a supporting tool for re-enablement. OBJECTIVE The main goal of this mixed methods study was to examine the usability of the AIMS platform from the perspectives of both patients and clinicians. The aim of this study was to evaluate a re-enablement platform that we have developed that uses a holistic systems approach to address the de-enablement that occurs in hospitalized inpatients, with the older adult population most at risk. The Active and Independent Management System (AIMS) platform is anticipated to deliver improved patient participation in recovery and self-management through education and the ability to track rehabilitation progression in hospital and after patient discharge. METHODS Two well-known instruments were used to measure usability: the System Usability Scale (SUS) with 10 items and, for finer granularity, the User Experience Questionnaire (UEQ) with 26 items. In all, 26 physiotherapists and health care professionals evaluated the AIMS clinical portal; and 44 patients in hospital for total knee replacement, total hip replacement, or dynamic hip screw implant evaluated the AIMS app. RESULTS For the AIMS clinical portal, the mean SUS score obtained was 82.88 (SD 13.07, median 86.25), which would be considered good/excellent according to a validated adjective rating scale. For the UEQ, the means of the normalized scores (range -3 to +3) were as follows: attractiveness=2.683 (SD 0.100), perspicuity=2.775 (SD 0.150), efficiency=2.775 (SD 0.130), dependability=2.300 (SD 0.080), stimulation=1.950 (SD 0.120), and novelty=1.625 (SD 0.090). All dimensions were thus classed as excellent against the benchmarks, confirming the results from the SUS questionnaire. For the AIMS app, the mean SUS score obtained was 74.41 (SD 10.26), with a median of 77.50, which would be considered good according to the aforementioned adjective rating scale. For the UEQ, the means of the normalized scores were as follows: attractiveness=2.733 (SD 0.070), perspicuity=2.900 (SD 0.060), efficiency=2.800 (SD 0.090), dependability=2.425 (SD 0.060), stimulation=2.200 (SD 0.010), and novelty=1.450 (0.260). All dimensions were thus classed as excellent against the benchmarks (with the exception of novelty, which was classed as good), providing slightly better results than the SUS questionnaire. CONCLUSIONS The study has shown that both the AIMS clinical portal and the AIMS app have good to excellent usability scores, and the platform provides a solid foundation for the next phase of research, which will involve evaluating the effectiveness of the platform in improving patient outcomes after total knee replacement, total hip replacement, or dynamic hip screw.
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Affiliation(s)
| | - Mario Soflano
- Glasgow Caledonian University, Glasgow, United Kingdom
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Møller OM, Vange SS, Borsch AS, Dam TN, Jensen AM, Jervelund SS. Medical specialists' use and opinion of video consultation in Denmark: a survey study. BMC Health Serv Res 2024; 24:516. [PMID: 38658946 PMCID: PMC11044495 DOI: 10.1186/s12913-024-10868-6] [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: 07/20/2023] [Accepted: 03/14/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic accelerated the use of telemedicine which is seen as a possibility to reduce the pressure on healthcare systems globally. However, little research has been carried out on video as a consultation medium in medical specialists' practice. This study investigated the use of and opinion on video consultation among specialists in Denmark. METHODS An online survey on use of video consultation, as well as relevance of and opinion on video consultation, was distributed to all 963 medical specialists in private practice in Denmark throughout May and June 2022, resulting in 499 complete answers (response rate: 51.8%). Data were analysed using descriptive and logistic regression analyses, and data from open text fields were analysed using thematic network analysis. RESULTS Among the respondents, 62.2% had never used video consultation, while 23.4% were currently using video consultation, most particularly among psychiatrists. A total of 47.3% found video consultation medically irrelevant to their specialty, especially radiologists, plastic surgeons, ophthalmologists and otorhinolaryngologists. According to the specialists, video consultation was most suitable for follow-up consultations and simple medical issues, where the patient had an established diagnosis. In these cases, mutual trust remained present in video consultations. Better access for the patients and fewer cancellations, especially for psychiatrists, were highlighted as benefits. IT problems were reported as obstacles hindering optimal use of video consultation. CONCLUSION The political aspiration to digitization in healthcare systems should be rooted in professionals' and patients' perceptions and experiences with video consultation which emphasize that it is not a standard tool for all consultations.
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Affiliation(s)
- Olivia Mandal Møller
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark.
| | - Sif Sofie Vange
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark
| | - Anne Sofie Borsch
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark
| | | | - Anja Mb Jensen
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark
| | - Signe Smith Jervelund
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark
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Nebsbjerg MA, Vestergaard CH, Bomholt KB, Christensen MB, Huibers L. Use of Video in Telephone Triage in Out-of-Hours Primary Care: Register-Based Study. JMIR Med Inform 2024; 12:e47039. [PMID: 38596835 PMCID: PMC11007381 DOI: 10.2196/47039] [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: 03/10/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 04/11/2024] Open
Abstract
Background Out-of-hours primary care (OOH-PC) is challenging due to high workloads, workforce shortages, and long waiting and transportation times for patients. Use of video enables triage professionals to visually assess patients, potentially ending more contacts in a telephone triage contact instead of referring patients to more resource-demanding clinic consultations or home visits. Thus, video use may help reduce use of health care resources in OOH-PC. Objective This study aimed to investigate video use in telephone triage contacts to OOH-PC in Denmark by studying rate of use and potential associations between video use and patient- and contact-related characteristics and between video use and triage outcomes and follow-up contacts. We hypothesized that video use could serve to reduce use of health care resources in OOH-PC. Methods This register-based study included all telephone triage contacts to OOH-PC in 4 of the 5 Danish regions from March 15, 2020, to December 1, 2021. We linked data from the OOH-PC electronic registration systems to national registers and identified telephone triage contacts with video use (video contact) and without video use (telephone contact). Calculating crude incidence rate ratios and adjusted incidence rate ratios (aIRRs), we investigated the association between patient- and contact-related characteristics and video contacts and measured the frequency of different triage outcomes and follow-up contacts after video contact compared to telephone contact. Results Of 2,900,566 identified telephone triage contacts to OOH-PC, 9.5% (n=275,203) were conducted as video contacts. The frequency of video contact was unevenly distributed across patient- and contact-related characteristics; it was used more often for employed young patients without comorbidities who contacted OOH-PC more than 4 hours before the opening hours of daytime general practice. Compared to telephone contacts, notably more video contacts ended with advice and self-care (aIRR 1.21, 95% CI 1.21-1.21) and no follow-up contact (aIRR 1.08, 95% CI 1.08-1.09). Conclusions This study supports our hypothesis that video contacts could reduce use of health care resources in OOH-PC. Video use lowered the frequency of referrals to a clinic consultation or a home visit and also lowered the frequency of follow-up contacts. However, the results could be biased due to confounding by indication, reflecting that triage GPs use video for a specific set of reasons for encounters.
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Affiliation(s)
| | | | | | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
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Thomas EE, Taylor ML, Ward EC, Hwang R, Cook R, Ross JA, Webb C, Harris M, Hartley C, Carswell P, Burns CL, Caffery LJ. Beyond forced telehealth adoption: A framework to sustain telehealth among allied health services. J Telemed Telecare 2024; 30:559-569. [PMID: 35130099 DOI: 10.1177/1357633x221074499] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION As COVID-19 restrictions reduce globally, services will determine what components of care will continue via telehealth. We aimed to determine the clinician, service, and system level factors that influence sustained use of telehealth and develop a framework to enhance sustained use where appropriate. METHODS This study was conducted across 16 allied health departments over four health service facilities (Brisbane, Australia). It used a multi-method observational study design, involving telehealth service activity data from hospital administrative databases and qualitative interviews with allied health staff (n = 80). Data were integrated and analysed using Greenhalgh's Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. RESULTS Increased telehealth use during the peak COVID period reverted to in-person activity as restrictions eased. Telehealth is unlikely to be sustained without a clear strategy including determination of roles and responsibilities across the organisation. Clinician resistance due to forced adoption remains a key issue. The main motivator for clinicians to use telehealth was improved consumer-centred care. Benefits beyond this are needed to sustain telehealth and improvements are required to make the telehealth experience seamless for providers and recipients. Data were synthesised into a comprehensive framework that can be used as a blueprint for system-wide improvements and service enhancement or redesign. DISCUSSION Sustainability of telehealth activity beyond the peak COVID period is unlikely without implementation strategies to address consumer, clinician, service, and system factors. The framework can inform how these strategies can be enacted. Whilst developed for allied health disciplines, it is likely applicable to other disciplines.
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Affiliation(s)
- Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Health, and, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Rita Hwang
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Renee Cook
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, and, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Julie-Anne Ross
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Clare Webb
- Allied Health, Queen Elizabeth II Jubilee Hospital, Metro South Health, Brisbane, Australia
| | - Michael Harris
- Allied Health, Bayside Health Service, Metro South Health, Brisbane, Australia
| | - Carina Hartley
- Allied Health, Logan Hospital, Metro South Health, Brisbane, Australia
| | - Phillip Carswell
- Consumer Advisor, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Clare L Burns
- Speech Pathology Department, Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Moore L, Hughes G, Wherton J, Shaw S. 'When the visible body is no longer the seer': The phenomenology of perception and the clinical gaze in video consultations. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:418-436. [PMID: 37746806 DOI: 10.1111/1467-9566.13714] [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: 01/06/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023]
Abstract
Video technology enabled professionals and patients to conduct consultations during the COVID-19 pandemic when in-person health care was minimised to reduce the spread of the virus. We present findings of a study of video-consulting through in-depth qualitative remote interviews with 40 health professionals, managers, support staff and 10 patients in health-care services across the UK from 2020 to 2021. Drawing on Foucault's concept of the clinical gaze, Merleau-Ponty's work on the phenomenology of perception and Ihde's postphenomenology we interpreted the ways in which remote consultations shaped patient-professional interactions, mediating and framing what was seen, revealed and known. We found that participating in video consultations not only involved creative adaption and adjustment to a virtual clinic but also changed how professionals and patients saw and were seen. We argue that this mode of consulting can transform boundaries and perceptions, alter aspects of clinical presence, knowledge and embodiment and thus both change and incorporate the clinical gaze.
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Affiliation(s)
- Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- School of Business, University of Leicester, Leicester, UK
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Weik L, Fehring L, Mortsiefer A, Meister S. Big 5 Personality Traits and Individual- and Practice-Related Characteristics as Influencing Factors of Digital Maturity in General Practices: Quantitative Web-Based Survey Study. J Med Internet Res 2024; 26:e52085. [PMID: 38252468 PMCID: PMC10845021 DOI: 10.2196/52085] [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: 08/22/2023] [Revised: 11/18/2023] [Accepted: 12/16/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Various studies propose the significance of digital maturity in ensuring effective patient care and enabling improved health outcomes, a successful digital transformation, and optimized service delivery. Although previous research has centered around inpatient health care settings, research on digital maturity in general practices is still in its infancy. OBJECTIVE As general practitioners (GPs) are the first point of contact for most patients, we aimed to shed light on the pivotal role of GPs' inherent characteristics, especially their personality, in the digital maturity of general practices. METHODS In the first step, we applied a sequential mixed methods approach involving a literature review and expert interviews with GPs to construct the digital maturity scale used in this study. Next, we designed a web-based survey to assess digital maturity on a 5-point Likert-type scale and analyze the relationship with relevant inherent characteristics using ANOVAs and regression analysis. RESULTS Our web-based survey with 219 GPs revealed that digital maturity was overall moderate (mean 3.31, SD 0.64) and substantially associated with several characteristics inherent to the GP. We found differences in overall digital maturity based on GPs' gender, the expected future use of digital health solutions, the perceived digital affinity of medical assistants, GPs' level of digital affinity, and GPs' level of extraversion and neuroticism. In a regression model, a higher expected future use, a higher perceived digital affinity of medical assistants, a higher digital affinity of GPs, and lower neuroticism were substantial predictors of overall digital maturity. CONCLUSIONS Our study highlights the impact of GPs' inherent characteristics, especially their personality, on the digital maturity of general practices. By identifying these inherent influencing factors, our findings support targeted approaches to drive digital maturity in general practice settings.
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Affiliation(s)
- Lisa Weik
- Health Care Informatics, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Leonard Fehring
- Helios University Hospital Wuppertal, Department of Gastroenterology, Witten/Herdecke University, Wuppertal, Germany
- Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Achim Mortsiefer
- General Practice II and Patient-Centredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Sven Meister
- Health Care Informatics, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- Department Healthcare, Fraunhofer Institute for Software and Systems Engineering ISST, Dortmund, Germany
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Lapointe-Shaw L, Salahub C, Austin PC, Bai L, Bhatia RS, Bird C, Glazier RH, Hedden L, Ivers NM, Martin D, Shuldiner J, Spithoff S, Tadrous M, Kiran T. Virtual Visits With Own Family Physician vs Outside Family Physician and Emergency Department Use. JAMA Netw Open 2023; 6:e2349452. [PMID: 38150254 PMCID: PMC10753397 DOI: 10.1001/jamanetworkopen.2023.49452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/13/2023] [Indexed: 12/28/2023] Open
Abstract
Importance Virtual visits became more common after the COVID-19 pandemic, but it is unclear in what context they are best used. Objective To investigate whether there was a difference in subsequent emergency department use between patients who had a virtual visit with their own family physician vs those who had virtual visits with an outside physician. Design, Setting, and Participants This propensity score-matched cohort study was conducted among all Ontario residents attached to a family physician as of April 1, 2021, who had a virtual family physician visit in the subsequent year (to March 31, 2022). Exposure The type of virtual family physician visit, with own or outside physician, was determined. In a secondary analysis, own physician visits were compared with visits with a physician working in direct-to-consumer telemedicine. Main Outcome and Measure The primary outcome was an emergency department visit within 7 days after the virtual visit. Results Among 5 229 240 Ontario residents with a family physician and virtual visit, 4 173 869 patients (79.8%) had a virtual encounter with their own physician (mean [SD] age, 49.3 [21.5] years; 2 420 712 females [58.0%]) and 1 055 371 patients (20.2%) had an encounter with an outside physician (mean [SD] age, 41.8 [20.9] years; 605 614 females [57.4%]). In the matched cohort of 1 885 966 patients, those who saw an outside physician were 66% more likely to visit an emergency department within 7 days than those who had a virtual visit with their own physician (30 748 of 942 983 patients [3.3%] vs 18 519 of 942 983 patients [2.0%]; risk difference, 1.3% [95% CI, 1.2%-1.3%]; relative risk, 1.66 [95% CI, 1.63-1.69]). The increase in the risk of emergency department visits was greater when comparing 30 216 patients with definite direct-to-consumer telemedicine visits with 30 216 patients with own physician visits (risk difference, 4.1% [95% CI, 3.8%-4.5%]; relative risk, 2.99 [95% CI, 2.74-3.27]). Conclusions and Relevance In this study, patients whose virtual visit was with an outside physician were more likely to visit an emergency department in the next 7 days than those whose virtual visit was with their own family physician. These findings suggest that primary care virtual visits may be best used within an existing clinical relationship.
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Affiliation(s)
- Lauren Lapointe-Shaw
- University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | | | - Peter C. Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Li Bai
- ICES, Toronto, Ontario, Canada
| | - R. Sacha Bhatia
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Cardiology, University Health Network, Toronto, Ontario, Canada
| | | | - Richard H. Glazier
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Noah M. Ivers
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women’s College Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Danielle Martin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
| | - Jennifer Shuldiner
- Women’s College Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
| | - Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
| | - Mina Tadrous
- ICES, Toronto, Ontario, Canada
- Women’s College Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Tara Kiran
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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11
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Tan MS, Kang GCY, Fong RJK, Cheong NK, Shi H, Tan NC. Patients' perspectives on video consultation for non-communicable diseases: a qualitative study in Singapore. BJGP Open 2023; 7:BJGPO.2023.0103. [PMID: 37591556 PMCID: PMC11176708 DOI: 10.3399/bjgpo.2023.0103] [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: 06/05/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic increased the use of telemedicine in primary care services. Understanding patients' perspectives on telemedicine is pivotal for its wider adoption in managing non-communicable diseases (NCDs) in the community. AIM To explore the views and concerns of patients who have yet to use video consultation (VC) for NCD management in Singapore. DESIGN & SETTING This qualitative study was conducted in a primary care clinic in Singapore. METHOD In total, 16 patients participated in individual in-depth interviews. The participants had type 2 diabetes mellitus and/or hypertension and/or hyperlipidaemia without prior VC experience. They were purposively enrolled in the polyclinic. Audited transcripts were independently coded by two investigators. Thematic analysis was performed to identify perspectives on telemedicine based on the health, information, and technology zones of the Health Information Technology Acceptance Model. RESULTS The following three themes emerged: perceived benefits of VC utility; perceived barriers of VC adoption; and potential challenges of VC. Participants viewed VC as safe and convenient if they had stable NCD. They voiced concerns on possible suboptimal care owing to the absence of physical examination, network connectivity, and personal medical data security. Participants highlighted challenges of VC uptake such as digital health familiarity, availability of their own mobile and telemonitoring devices, and healthcare costs consideration. CONCLUSION Addressing the concerns and challenges highlighted by non-VC users can help physicians and policymakers explore ways to scale up telemedicine in Singapore. A hybrid clinical care model comprising in-person visits and VC may be the way forward for NCD management.
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Affiliation(s)
- Mui Suan Tan
- SingHealth Polyclinics, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore
| | - Gary Chun-Yun Kang
- SingHealth Polyclinics, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore
| | | | - Nian Kai Cheong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Haixiao Shi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore
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12
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Borrelli S, Fumagalli S, Colciago E, Downey J, Spiby H, Nespoli A. How should a video-call service for early labour be provided? A qualitative study of midwives' perspectives in the United Kingdom and Italy. Women Birth 2023; 36:504-510. [PMID: 37365096 DOI: 10.1016/j.wombi.2023.06.006] [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: 01/20/2023] [Revised: 05/23/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
PROBLEM Women in early labour are typically encouraged to delay admission to the maternity unit, but they may find this challenging without appropriate professional support. BACKGROUND Prior to the pandemic, research conducted with midwives and women showed positivity towards using video-technology for early labour, with concerns raised about privacy. AIM To explore midwives' perspectives on potential use of video-calls during early labour METHODS: A multi-centre descriptive qualitative study was undertaken in UK and Italy. Ethical approval was gained prior to commencing the study and ethical processes were followed. Seven virtual focus groups were conducted with 36 participants, 17 midwives working in the UK and 19 midwives working in Italy. Line-by-line thematic analysis was performed and themes agreed by the research team. FINDINGS The findings include three main themes: 1) who, where, when and how: key aspects to consider for an effective video-call service in early labour; 2) video-call content and expected contribution; 3) potential barriers to address. DISCUSSION Midwives responded positively to the concept of video-calling in early labour and provided detailed suggestions on how an ideal video-call service for early labour should be provided to maximise effectiveness, safety and quality of care. CONCLUSION Guidance, support and training should be provided to midwives and healthcare professionals, with dedicated resources for an early labour video-call service that is accessible, acceptable, safe, individualised and respectful for mothers and families. Further research should systematically explore clinical, psychosocial and service feasibility and acceptability.
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Affiliation(s)
- Sara Borrelli
- University of Nottingham, School of Health Sciences, Queen's Medical School, B Floor, Nottingham NG7 2UH, United Kingdom.
| | - Simona Fumagalli
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy
| | - Elisabetta Colciago
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy
| | - Joshua Downey
- Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Rd, Nottingham NG5 1PB, United Kingdom
| | - Helen Spiby
- University of Nottingham, School of Health Sciences, Queen's Medical School, B Floor, Nottingham NG7 2UH, United Kingdom
| | - Antonella Nespoli
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy
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13
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Stummer FO, Voggenberger L, Gomez Pellin MDLC, van Poel E, Willems S, Hoffmann K. Insights into the use of telemedicine in primary care in times of the SARS-CoV-2 pandemic - a cross-sectional analysis based on the international PRICOV-19 study in Austria. BMC PRIMARY CARE 2023; 24:218. [PMID: 37875808 PMCID: PMC10598885 DOI: 10.1186/s12875-023-02113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/18/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The SARS-CoV2 pandemic as well as the implementation of public health measures to decrease the spread of the virus re-sparked the call for "virtual" health or "distance" treatments. This paper aimed to assess the use of video consultations, the up-to-dateness of practice websites, and the views of GPs on whether eHealth is a positive aspect for the future of their practices in publicly -funded primary healthcare facilities in Austria. METHODS The cross-sectional online questionnaire, part of the PRICOV-19 study, was conducted from December 2020 until July 2021. We randomly recruited 176 GP practices across Austria. Descriptive statistics as well as binary logistic regression models were applied to examine the associations between telemedicine use and practice factors. RESULTS Compared with before the pandemic (3.8%), 7.6% of publicly funded GP practices have been using video consultations since the pandemic. In line with this, 93.9% of the practices had no increase in video consultation use. Fewer than half (44.3%) had an up-to-date webpage, and 27.8% assumed that the pandemic might have been a positive driver for eHealth in their practices. Positive associations with video consultation use could be found in practices with fewer patients aged 70 years and over than the average and more patients with chronic diseases than the average. CONCLUSION The use of video consultations in general practice and the readiness for other telemedicine approaches are both very low in Austria. Austria has to urgently follow the example of countries with a transparent and comprehensive national digital health strategy that includes video consultation. Without a proper payment system, patient inclusion, and support with regard to administrative and organizational aspects, no substantial change will occur in spite of an increase in need due to the pandemic and changes in the patient population.
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Affiliation(s)
- Florian Odilo Stummer
- Department of Primary Care Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Lisa Voggenberger
- Institute for General Medicine, Johannes-Kepler-University, Linz, Austria
| | | | - Esther van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kathryn Hoffmann
- Department of Primary Care Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
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14
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Tay Wee Teck J, Gittins R, Zlatkute G, Oteo Pérez A, Galea-Singer S, Baldacchino A. Developing a Theoretically Informed Implementation Model for Telemedicine-Delivered Medication for Opioid Use Disorder: Qualitative Study With Key Informants. JMIR Ment Health 2023; 10:e47186. [PMID: 37851506 PMCID: PMC10620637 DOI: 10.2196/47186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/16/2023] [Accepted: 09/02/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Telemedicine-delivered medication for opioid use disorder (TMOUD) has become more prevalent during the COVID-19 pandemic, particularly in North America. This is considered a positive development as TMOUD has the potential to increase access to evidence-based treatment for a population heavily affected by the opioid crisis and consequent rising mortality and morbidity rates in relation to opioid use disorder. Despite the increase in the use of TMOUD, there are no established service- and process-focused models to guide the implementation of this intervention. OBJECTIVE This study aims to develop a process- and service-focused implementation model in collaboration with key stakeholders and bring together peer-reviewed literature, practice-based knowledge, and expert opinions. METHODS The simple rules for evidence translation in complex systems framework was applied to guide the development of a 6-step qualitative study. The steps were definition of the scope and objectives of the model, identification of evidence, stakeholder engagement, draft model development, key informant consultation, and final model specification. RESULTS The final specification for the TMOUD implementation model incorporated key strategic priorities, service delivery prerequisites, service design elements, stakeholder identification and engagement, key process domains, and iterative cycles of evaluation and improvement. CONCLUSIONS Through stakeholder engagement and key informant consultation, we produced a process- and service-focused TMOUD implementation model. The model is modifiable to different contexts and settings while also in keeping with the current evidence base and national and international standards of high-quality opioid use disorder care.
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Affiliation(s)
- Joseph Tay Wee Teck
- Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | | | - Giedre Zlatkute
- Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Alberto Oteo Pérez
- Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | | | - Alexander Baldacchino
- Digital Health Interventions in Addiction Services Project, Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
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15
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Boldea GJ, Caragea DC, Nicolcescu P, Pădureanu V, Rădulescu D, Boldea AM, Georgescu I, Georgescu EF. Effect of the COVID‑19 pandemic on the management and outcomes of patients with traumatic injuries (Review). Biomed Rep 2023; 19:76. [PMID: 37746590 PMCID: PMC10511947 DOI: 10.3892/br.2023.1658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 09/26/2023] Open
Abstract
During the COVID-19 pandemic, ~10% of the global population was officially affected, resulting in diverse changes, ranging from shopping habits to stringent hospital protocols. This article sought to provide a concise summary of relevant data concerning the interplay between COVID-19 and trauma, encompassing the entire trajectory from presentation to hospital discharge. Throughout the pandemic, there was a noticeable reduction in trauma presentations, while the ranking of injury mechanisms remained largely unchanged. To ensure essential surgical support, protocols were adjusted accordingly. Although there were some less significant changes in injury severity score, hospital length of stay, intensive care unit stay and mortality, the overall patient outcomes appeared to improve. In conclusion, the COVID-19 pandemic led to a decline in trauma cases and an enhancement in patient outcomes. However, regrettably, certain mechanisms of injury saw an increase in frequency. To cope with the epidemiological context, management strategies were adapted, and unutilized resources were redirected to cater to the care of COVID-19 patients.
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Affiliation(s)
- Gheorghe-Jean Boldea
- UMF Craiova Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Daniel Cosmin Caragea
- Department of Nephrology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Pantelie Nicolcescu
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Pharmacy, Sibiu 550169, Romania
| | - Vlad Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Dumitru Rădulescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Ana Maria Boldea
- UMF Craiova Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Ion Georgescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Eugen Florin Georgescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
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16
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Chappell P, Dias A, Bakhai M, Ledger J, Clarke GM. How is primary care access changing? A retrospective, repeated cross-sectional study of patient-initiated demand at general practices in England using a modern access model, 2019-2022. BMJ Open 2023; 13:e072944. [PMID: 37591638 PMCID: PMC10441067 DOI: 10.1136/bmjopen-2023-072944] [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: 02/27/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES To explore trends in patient-initiated requests for general practice services and the association between patient characteristics including demographics, preferences for care and clinical needs and modes of patient contact (online vs telephone), and care delivery (face-to-face vs remote) at practices using a modern access model. DESIGN Retrospective repeated cross-sectional study spanning March 2019 to February 2022. SETTING General practices in England using the askmyGP online consultation system to implement a modern general practice access model using digital and non-digital (multimodal) access pathways and digitally supported triage to manage patient-initiated requests. PARTICIPANTS 10 435 465 patient-initiated requests from 1 488 865 patients at 154 practices. RESULTS Most requests were initiated online (72.1% in 2021/2022) rather than by telephone. Online users were likely to be female, younger than 45 years, asking about existing medical problems, had used the system before and frequent attenders (familiar patients). During the pandemic, request rates for face-to-face consultations fell while those for telephone consultations and online messages increased, with telephone consultations being most popular (53.8% in 2021/2022). Video was seldom requested. More than 60% of requests were consistently delivered in the mode requested. Face-to-face consultations were more likely to be used for the youngest and oldest patients, new medical problems, non-frequent attenders (unfamiliar patients) and those who requested a face-to-face consultation. Over the course of the study, request rates for patients aged over 44 years increased, for example, by 15.4% (p<0.01) for patients aged over 74 years. Rates for younger patients decreased by 32.6% (p<0.001) in 2020/2021, compared with 2019/2020, before recovering to prepandemic levels in 2021/2022. CONCLUSIONS Demand patterns shed light on the characteristics of patients making requests for general practice services and the composition of the care backlog with implications for policy and practice. A modern general practice access model can be used effectively to manage patient-initiated demand.
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Affiliation(s)
- Paul Chappell
- NHS England, London, UK
- Improvement Analytics Unit, The Health Foundation, London, UK
| | - Alison Dias
- NHS England, London, UK
- Improvement Analytics Unit, The Health Foundation, London, UK
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17
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Williams J, Johns G, Phipps K, Khalil S, Ogonovsky M, Ahuja A. Online survey and interview evaluation to explore the use of video consulting among Allied Health Professionals during the COVID-19 pandemic. BMJ Open 2023; 13:e068176. [PMID: 37197825 DOI: 10.1136/bmjopen-2022-068176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES Allied Health Professionals (AHP) consist of 13 different specialty roles in Wales, sharing the responsibility of promoting and supporting the health and well-being of the population. During the COVID-19 pandemic, there was a shift in care provision, with the increased use of online consultations, such as those using video consultation platforms. However, this shift was associated with uncertainty and hesitancy, and, thus, to understand the usage and reasons for using video consultations, this study aimed to capture the experiences of both AHP and their patients, while investigating each role individually. PARTICIPANTS A survey was distributed to and completed by n=8928 patients and n=4974 clinicians, all AHP were included except for orthoptists and paramedics due to ambiguities in the data. A further 86 clinicians participated in phone interviews. RESULTS All professions had a high prevention of face-to-face with the use of video consultations (68.6% overall and 81.4% of clinicians reported the prevention). However, this was lower for certain professions such as podiatrists, potentially due to the specific patient needs, such as physical assessments. Also, a range of different appointment types were being conducted, and there was a high acceptance of these alternative methods among participants. The interviews with clinicians revealed five important aspects of video consultations: the perceived benefits, the perceived challenges, technology issues and necessary improvements, clinician preference and the future of video consulting. Specifically, the future of video consulting evidenced clinicians' desire for a blended approach to working, selecting the appropriate modality depending on the situation and patient-specific needs. CONCLUSIONS Integrating the traditional methods of service delivery (face-to-face), and novel, innovative ways, such as video consultations, can motivate positive transformations for the efficiency and efficacy of health and social care.
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Affiliation(s)
- Jessica Williams
- Technology Enabled Care Cymru, Aneurin Bevan Health Board, Newport, Wales, UK
| | - Gemma Johns
- Technology Enabled Care Cymru, Aneurin Bevan Health Board, Newport, Wales, UK
| | - Kerrie Phipps
- Technology Enabled Care Cymru, Aneurin Bevan Health Board, Newport, Wales, UK
| | - Sara Khalil
- Technology Enabled Care Cymru, Aneurin Bevan Health Board, Newport, Wales, UK
| | - Mike Ogonovsky
- Technology Enabled Care Cymru, Aneurin Bevan Health Board, Newport, Wales, UK
| | - Alka Ahuja
- Technology Enabled Care Cymru, Aneurin Bevan Health Board, Newport, Wales, UK
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18
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Hughes G, Rybczynska-Bunt S, Shasha'h S, Greene S, Shaw S, Greenhalgh T. Protocol: How can people with social care needs be supported through processes of digital care navigation to access remote primary care? A multi-site case study in UK general practice of remote care as the 'new normal'. NIHR OPEN RESEARCH 2023; 3:17. [PMID: 37881454 PMCID: PMC10593327 DOI: 10.3310/nihropenres.13385.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 10/27/2023]
Abstract
Background Care navigation refers to support for patients accessing primary care and other related services. The expansion of digitally enabled care in the UK since the coronavirus disease 2019 (COVID-19) pandemic has led to a greater need for digital care navigation: supporting people to access primary care digitally and, if necessary, to help them find alternative non-digital routes of access. Support to patients with social care needs (including but not limited to those who are homeless and insecurely housed, living in residential care and supported by domiciliary carers) increasingly involves work to navigate primary care provided remotely and accessed digitally. There is little knowledge about how this work is being done. Methods Care Navigation involves embedded researchers identifying digital care navigation for patients accessing services in 11 GP practices recruited to a linked study of remote primary care ( Remote care as the 'new normal?'). Digital care navigation will be studied through go-along (in-person or remote) interviews with a sample of 20 people offering formal (paid or voluntary) support, 6 national and regional stakeholders who plan, commission or provide digital care navigation and a focus group with 12 social prescribers engaged in digital care navigation. A co-design workshop with people working in, or commissioning, social care settings will consider how findings can inform improved digital care navigation, for example through the development of resources or guidance for care navigators. Results anticipated Findings are anticipated to include evidence of how digital care navigation is practised, the work that is done to support patients in accessing remote primary care, and how this work is shaped by material resources and variations in the configuration of services and infrastructure. Conclusions New explanations of the work needed to navigate digital care will inform policy and service developments aimed at helping patients benefit from remote primary care.
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Affiliation(s)
- Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sarah Rybczynska-Bunt
- Penisula Medical School (Faculty of Health), University of Plymouth, Plymouth, PL6 8BX, UK
| | - Sara Shasha'h
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sarah Greene
- Penisula Medical School (Faculty of Health), University of Plymouth, Plymouth, PL6 8BX, UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
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19
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Borrelli S, Downey J, Colciago E, Fumagalli S, Nespoli A, Spiby PH. Mothers' perspectives on the potential use of video-calling during early labour in the United Kingdom and Italy: A qualitative study. Women Birth 2023:S1871-5192(23)00017-3. [PMID: 36682951 DOI: 10.1016/j.wombi.2023.01.004] [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: 10/28/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
PROBLEM Women in early labour are typically encouraged to delay maternity unit admission, but they may find this challenging without appropriate professional support. BACKGROUND Despite pre-pandemic research which identified potential advantages of video-calling in early labour, implementation of such service has not been reported. AIM To explore mothers' perspectives on potential use of video-calls during early labour. METHODS A multi-centre descriptive qualitative study was undertaken in UK and Italy. Ethical approval was gained and ethical processes were followed. Six virtual focus groups were conducted with 37 participants, 24 mothers who gave birth in the UK and 13 who gave birth in Italy. Line-by-line thematic analysis was performed and themes agreed. FINDINGS Two themes emerged: 1) women's expectations of video-calls' content and features; 2) technological challenges and solutions. Mothers responded positively to the concept of video-calling in early labour. Receiving guidance, information on coping with pain and advice on timely access in early labour was perceived as key. Women highlighted the importance of accessible, reliable and user-friendly technology. Equitable access, technological literacy, acceptability and privacy were considered as challenges to implementation, with solutions proposed to overcome disparities. DISCUSSION AND CONCLUSION Guidance and training should be provided to midwives, with designated resources to build a service that is accessible, acceptable, safe, individualised and respectful for mothers and birth companions. Further research should explore feasibility, acceptability, clinical and cost-effectiveness.
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Affiliation(s)
- Sara Borrelli
- University of Nottingham, School of Health Sciences, Queen's Medical School, B Floor, Nottingham NG7 2UH, United Kingdom.
| | - Joshua Downey
- Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Rd, Nottingham NG5 1PB, United Kingdom.
| | - Elisabetta Colciago
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy.
| | - Simona Fumagalli
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy.
| | - Antonella Nespoli
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy.
| | - Prof Helen Spiby
- University of Nottingham, School of Health Sciences, Queen's Medical School, B Floor, Nottingham NG7 2UH, United Kingdom.
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20
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Mavragani A, Torous J, Jacobs R. IT and the Quality and Efficiency of Mental Health Care in a Time of COVID-19: Case Study of Mental Health Providers in England. JMIR Form Res 2022; 6:e37533. [PMID: 36423321 PMCID: PMC9822565 DOI: 10.2196/37533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 10/26/2022] [Accepted: 11/24/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In England, COVID-19 has significantly affected mental health care and tested the resilience of health care providers. In many areas, the increased use of IT has enabled traditional modes of service delivery to be supported or even replaced by remote forms of provision. OBJECTIVE This study aimed to assess the use and impact of IT, in remote service provision, on the quality and efficiency of mental health care during the pandemic. We drew on sociotechnical systems theory as a conceptual framework to help structure the gathering, analysis, and interpretation of data. METHODS We conducted a national scoping survey that involved documentary analysis and semistructured interviews with 6 national stakeholders and case studies of 4 purposefully selected mental health providers in England involving interviews with 53 staff members. RESULTS Following the outbreak of COVID-19, mental health providers rapidly adjusted their traditional forms of service delivery, switching to digital and telephone consultations for most services. The informants provided nuanced perspectives on the impact on the quality and efficiency of remote service delivery during the pandemic. Notably, it has allowed providers to attend to as many patients as possible in the face of COVID-19 restrictions, to the convenience of both patients and staff. Among its negative effects are concerns about the unsuitability of remote consultation for some people with mental health conditions and the potential to widen the digital divide and exacerbate existing inequalities. Sociotechnical systems theory was found to be a suitable framework for understanding the range of systemic and sociotechnical factors that influence the use of technology in mental health care delivery in times of crisis and normalcy. CONCLUSIONS Although the use of IT has boosted mental health care delivery during the pandemic, it has had mixed effects on quality and efficiency. In general, patients have benefited from the convenience of remote consultation when face-to-face contact was impossible. In contrast, patient choice was often compromised, and patient experience and outcomes might have been affected for some people with mental health conditions for which remote consultation is less suitable. However, the full impact of IT on the quality and efficiency of mental health care provision along with the systemic and sociotechnical determinants requires more sustained and longitudinal research.
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Affiliation(s)
| | | | - Rowena Jacobs
- Centre for Health Economics, University of York, York, United Kingdom
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21
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Leung T, Greenhalgh T, Hughes G, Finlay T, Wherton J. Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage. J Med Internet Res 2022; 24:e42358. [PMID: 36383632 PMCID: PMC9773024 DOI: 10.2196/42358] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Digital consultations between patients and clinicians increased markedly during the COVID-19 pandemic, raising questions about equity. OBJECTIVE This study aimed to review the literature on how multiple disadvantage-specifically, older age, lower socioeconomic status, and limited English proficiency-has been conceptualized, theorized, and studied empirically in relation to digital consultations. We focused mainly on video consultations as they have wider disparities than telephone consultations and relevant data on e-consultations are sparse. METHODS Using keyword and snowball searching, we identified relevant papers published between 2012 and 2022 using Ovid MEDLINE, Web of Science, Google Scholar, and PubMed. The first search was completed in July 2022. Papers meeting the inclusion criteria were analyzed thematically and summarized, and their key findings were tabulated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research criteria. Explanations for digital disparities were critically examined, and a search was undertaken in October 2022 to identify theoretical lenses on multiple disadvantage. RESULTS Of 663 articles from the initial search, 27 (4.1%) met our inclusion criteria. In total, 37% (10/27) were commentaries, and 63% (17/27) were peer-reviewed empirical studies (11/27, 41% quantitative; 5/27, 19% qualitative; 1/27, 4% mixed methods; 1/27, 4% systematic reviews; and 1/27, 4% narrative reviews). Empirical studies were mostly small, rapidly conducted, and briefly reported. Most studies (25/27, 93%) identified marked digital disparities but lacked a strong theoretical lens. Proposed solutions focused on identifying and removing barriers, but the authors generally overlooked the pervasive impact of multiple layers of disadvantage. The data set included no theoretically informed studies that examined how different dimensions of disadvantage combined to affect digital health disparities. In our subsequent search, we identified 3 theoretical approaches that might help account for these digital disparities. Fundamental cause theory by Link and Phelan addresses why the association between socioeconomic status and health is pervasive and persists over time. Digital capital theory by Ragnedda and Ruiu explains how people mobilize resources to participate in digitally mediated activities and services. Intersectionality theory by Crenshaw states that systems of oppression are inherently bound together, creating singular social experiences for people who bear the force of multiple adverse social structures. CONCLUSIONS A limitation of our initial sample was the sparse and undertheorized nature of the primary literature. The lack of attention to how digital health disparities emerge and play out both within and across categories of disadvantage means that solutions proposed to date may be oversimplistic and insufficient. Theories of multiple disadvantage have bearing on digital health, and there may be others of relevance besides those discussed in this paper. We call for greater interdisciplinary dialogue between theoretical research on multiple disadvantage and empirical studies on digital health disparities.
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Affiliation(s)
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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22
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Pickard Strange M, Booth A, Akiki M, Wieringa S, Shaw SE. The role of virtual consulting in developing environmentally sustainable healthcare: a systematic literature review (Preprint). J Med Internet Res 2022; 25:e44823. [PMID: 37133914 DOI: 10.2196/44823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Health systems globally need to rapidly set and achieve targets for reaching net zero carbon emissions. Virtual consulting (including video- and telephone-based consulting) is regarded as one means by which this might be achieved, largely through reduced patient travel. Little is currently known about the ways in which forms of virtual consulting might contribute to the net zero agenda or how countries may develop and implement programs at scale that can support increased environmental sustainability. OBJECTIVE In this paper, we asked, What is the impact of virtual consulting on environmental sustainability in health care? and What can we learn from current evaluations that can inform future reductions in carbon emissions? METHODS We conducted a systematic review of published literature according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. We searched the MEDLINE, PubMed, and Scopus databases using key terms relating to "carbon footprint," "environmental impact," "telemedicine," and "remote consulting," using citation tracking to identify additional articles. The articles were screened, and full texts that met the inclusion criteria were obtained. Data on the approach to carbon footprinting reported reductions in emissions, and the opportunities and challenges associated with the environmental sustainability of virtual consultations were extracted into a spreadsheet, analyzed thematically, and theorized using the Planning and Evaluating Remote Consultation Services framework to consider the various interacting influences, including environmental sustainability, that shape the adoption of virtual consulting services. RESULTS A total of 1672 papers were identified. After removing duplicates and screening for eligibility, 23 papers that focused on a range of virtual consulting equipment and platforms across different clinical conditions and services were included. The focus on the environmental sustainability potential of virtual consulting was unanimously reported through carbon savings achieved by a reduction in travel related to face-to-face appointments. The shortlisted papers used a range of methods and assumptions to determine carbon savings, reporting these using different units and across varied sample sizes. This limited the potential for comparison. Despite methodological inconsistencies, all papers concluded that virtual consulting significantly reduced carbon emissions. However, there was limited consideration of wider factors (eg, patient suitability, clinical indication, and organizational infrastructure) influencing the adoption, use, and spread of virtual consultations and the carbon footprint of the entire clinical pathway in which the virtual consultation was provided (eg, risk of missed diagnoses from virtual consultations that result in the need for subsequent in-person consultations or admissions). CONCLUSIONS There is overwhelming evidence that virtual consulting can reduce health care carbon emissions, largely through reducing travel related to in-person appointments. However, the current evidence fails to look at system factors associated with implementing virtual health care delivery and wider research into carbon emissions across the entire clinical pathway.
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Affiliation(s)
- Martha Pickard Strange
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Amy Booth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Melissa Akiki
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- University of Oslo, Oslo, Norway
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Greenhalgh T, Shaw SE, Alvarez Nishio A, Byng R, Clarke A, Dakin F, Faulkner S, Hemmings N, Husain L, Kalin A, Ladds E, Moore L, Rosen R, Rybczynska-Bunt S, Wherton J, Wieringa S. Remote care in UK general practice: baseline data on 11 case studies. NIHR OPEN RESEARCH 2022; 2:47. [PMID: 36814638 PMCID: PMC7614213 DOI: 10.3310/nihropenres.13290.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
Background Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs. Methods Mixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data. Results Reflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features-notably system-level stressors such as high workload and staff shortages, and UK's technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the 'digital front door' (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts. Conclusions General practices' responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | | | - Aileen Clarke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Francesca Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Asli Kalin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | | | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
- Centre for Sustainable Health Education, University of Oslo, Oslo, NO-0316, Norway
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24
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Greenhalgh T, Shaw SE, Alvarez Nishio A, Byng R, Clarke A, Dakin F, Faulkner S, Hemmings N, Husain L, Kalin A, Ladds E, Moore L, Rosen R, Rybczynska-Bunt S, Wherton J, Wieringa S. Remote care in UK general practice: baseline data on 11 case studies. NIHR OPEN RESEARCH 2022; 2:47. [PMID: 36814638 PMCID: PMC7614213 DOI: 10.3310/nihropenres.13290.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 10/27/2023]
Abstract
BACKGROUND Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs. METHODS Mixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data. RESULTS Reflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features-notably system-level stressors such as high workload and staff shortages, and UK's technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the 'digital front door' (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts. CONCLUSIONS General practices' responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | | | - Aileen Clarke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Francesca Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Asli Kalin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | | | | | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OXFORDSHIRE, OX2 6GG, UK
- Centre for Sustainable Health Education, University of Oslo, Oslo, NO-0316, Norway
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25
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McCloy K, Hughes C, Dunwoody L, Marley J, Gracey J. Effects of mindfulness-based interventions on fatigue and psychological wellbeing in women with cancer: A systematic review and meta-analysis of randomised control trials. Psychooncology 2022; 31:1821-1834. [PMID: 36221152 PMCID: PMC9828570 DOI: 10.1002/pon.6046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/01/2022] [Accepted: 09/27/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cancer diagnosis and treatment can cause fatigue, stress and anxiety which can have a detrimental effect on patients, families and the wider community. Mindfulness-based interventions appear to have positive effects on managing these cancer-related symptoms. OBJECTIVE To investigate the efficacy of mindfulness on cancer related fatigue (CRF) and psychological well-being in female cancer patients. METHODS Five databases (CINHAL, Ovid Medline, Ovid Psych Info, Scopus, and Cochrane), and two trial registers (WHO and Clinicaltrials.gov) were searched for randomised control trials from inception to April 2021 and updated in August 2022. Meta-analysis was performed using Review Manager 5.4. The standardised mean difference (SMD) and 95% confidence intervals (CI) were used to determine the intervention effect. Subgroup analysis was performed for adaptation to types of mindfulness, length of intervention and types of comparator used. RESULTS Twenty-one studies with a total of 2326 participants were identified. Mindfulness significantly improved CRF (SMD -0.81, 95% CI -1.17 to -0.44), depression (SMD-0.74, 95% CI -1.08 to -0.39) and anxiety (SMD -0.92, 95% CI -1.50 to -0.33). No effect was observed for quality of life (SMD 0.32, 95% CI -0.13-0.87) and sleep (SMD -0.65, 95% CI -1.34-0.04). Subgroup analysis revealed that there was little difference in SMD for adapted type of mindfulness (p = 0.42), wait list control compared to active comparator (p = 0.05) or length of intervention (p = 0.29). CONCLUSION Mindfulness appears to be effective in reducing CRF and other cancer related symptoms in women. Adaptations to mindfulness delivery did not have negative impact on results which may aid delivery in the clinical settings.
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26
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Loría-Rebolledo LE, Ryan M, Bond C, Porteous T, Murchie P, Adam R. Using a discrete choice experiment to develop a decision aid tool to inform the management of persistent pain in pharmacy: a protocol for a randomised feasibility study. BMJ Open 2022; 12:e066379. [PMID: 36137622 PMCID: PMC9511577 DOI: 10.1136/bmjopen-2022-066379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In an era of personalised healthcare, it has become increasingly important to elicit individual-level preferences. While discrete choice experiments (DCEs) are widely used to measure patient preferences in the delivery of healthcare, the focus has been sample-level analysis. Using the DCE methodology, this project has designed a digital decision aid tool (DAT) with the potential to estimate individual preferences in real time to inform clinical consultation decisions in persistent pain management. METHODS Using a feasibility randomised control trial, this study aims to assess the feasibility of using this Understanding Persistent Pain (UPP) DAT in a pharmacy-based clinical setting and to test processes for a future definite randomised trial. Community and practice-based pharmacists (up to 10) will be recruited in The National Health Service (NHS) Grampian and trained in the use of the digital UPP DAT. Pharmacists will recruit up to 60 patients who are living with persistent pain. Patients will be randomised to one of two groups: using the UPP DAT or usual care. Pharmacists will follow-up patients as needed according to clinical need and following standard practice. DCE response data collected by the UPP DAT will be analysed using the penalised logit model, allowing estimation of individual preferences in real time. We will follow-up pharmacists and patients who use the UPP DAT to gather feedback on their experiences. ETHICS AND DISSEMINATION This study received ethical approval from the North of Scotland Research Ethics Committee (21/NS/0059) and received Research & Development Management Permission to proceed from NHS Grampian (2021UA003E). The study has been registered in the ClinicalTrials.gov database. Findings will be disseminated in peer-reviewed publications, presentations and newsletters and made available in the University of Aberdeen and Pharmacy Research UK websites. Participants gave informed consent to participate in the study before taking part. TRIAL REGISTRATION NUMBER NCT05102578; clinicaltrials.gov.
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Affiliation(s)
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Terry Porteous
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Rosalind Adam
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
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27
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Wherton J, Greenhalgh T, Hughes G, Shaw SE. The role of information infrastructures in scaling up video consultations during Covid-19: a mixed-methods case study into opportunity, disruption and exposure (Preprint). J Med Internet Res 2022; 24:e42431. [PMID: 36282978 PMCID: PMC9651004 DOI: 10.2196/42431] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022] Open
Abstract
Background Until COVID-19, implementation and uptake of video consultations in health care was slow. However, the pandemic created a “burning platform” for scaling up such services. As health care organizations look to expand and maintain the use of video in the “new normal,” it is important to understand infrastructural influences and changes that emerged during the pandemic and that may influence sustainability going forward. Objective This study aims to draw lessons from 4 National Health Service (NHS) organizations on how information infrastructures shaped, and were shaped by, the rapid scale-up of video consultations during COVID-19. Methods A mixed methods case study of 4 NHS trusts in England was conducted before and during the pandemic. Data comprised 90 interviews with 49 participants (eg, clinicians, managers, administrators, and IT support), ethnographic field notes, and video consultation activity data. We sought examples of infrastructural features and challenges related to the rapid scale-up of video. Analysis was guided by Gkeredakis et al’s 3 perspectives on crisis and digital change: as opportunity (for accelerated innovation and removal of barriers to experimentation), disruption (to organizational practices, generating new dependencies and risks), and exposure (of vulnerabilities in both people and infrastructure). Results Before COVID-19, there was a strong policy push for video consultations as a way of delivering health care efficiently. However, the spread of video was slow, and adopting clinicians described their use as ad hoc rather than business as usual. When the pandemic hit, video was rapidly scaled up. The most rapid increase in use was during the first month of the pandemic (March-April 2020), from an average of 8 video consultations per week to 171 per week at each site. Uptake continued to increase during the pandemic, averaging approximately 800 video consultations per week by March 2021. From an opportunity perspective, participants talked about changes to institutional elements of infrastructure, which had historically restricted the introduction and use of video. This was supported by an “organizing vision” for video, bringing legitimacy and support. Perspectives on disruption centered on changes to social, technical, and material work environments and the emergence of new patterns of action. Retaining positive elements of such change required a judicious balance between managerial (top-down) and emergent (bottom-up) approaches. Perspectives on exposure foregrounded social and technical impediments to video consulting. This highlighted the need to attend to the materiality and dependability of the installed base, as well as the social and cultural context of use. Conclusions For sustained adoption at scale, health care organizations need to enable incremental systemic change and flexibility through agile governance and knowledge transfer pathways, support process multiplicity within virtual clinic workflows, attend to the materiality and dependability of the IT infrastructure within and beyond organizational boundaries, and maintain an overall narrative within which the continued use of video can be framed.
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Affiliation(s)
- Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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28
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Alami H, Lehoux P, Shaw SE, Papoutsi C, Rybczynska-Bunt S, Fortin JP. Virtual Care and the Inverse Care Law: Implications for Policy, Practice, Research, Public and Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710591. [PMID: 36078313 PMCID: PMC9518297 DOI: 10.3390/ijerph191710591] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 05/31/2023]
Abstract
Virtual care spread rapidly at the outbreak of the COVID-19 pandemic. Restricting in-person contact contributed to reducing the spread of infection and saved lives. However, the benefits of virtual care were not evenly distributed within and across social groups, and existing inequalities became exacerbated for those unable to fully access to, or benefit from virtual services. This "perspective" paper discusses the extent to which challenges in virtual care access and use in the context of COVID-19 follow the Inverse Care Law. The latter stipulates that the availability and quality of health care is inversely proportionate to the level of population health needs. We highlight the inequalities affecting some disadvantaged populations' access to, and use of public and private virtual care, and contrast this with a utopian vision of technology as the "solution to everything". In public and universal health systems, the Inverse Care Law may manifests itself in access issues, capacity, and/or lack of perceived benefit to use digital technologies, as well as in data poverty. For commercial "Direct-To-Consumer" services, all of the above may be encouraged via a consumerist (i.e., profit-oriented) approach, limited and episodic services, or the use of low direct cost platforms. With virtual care rapidly growing, we set out ways forward for policy, practice, and research to ensure virtual care benefits for everyone, which include: (1) pay more attention to "capabilities" supporting access and use of virtual care; (2) consider digital technologies as a basic human right that should be automatically taken into account, not only in health policies, but also in social policies; (3) take more seriously the impact of the digital economy on equity, notably through a greater state involvement in co-constructing "public health value" through innovation; and (4) reconsider the dominant digital innovation research paradigm to better recognize the contexts, factors, and conditions that influence access to and use of virtual care by different groups.
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Affiliation(s)
- Hassane Alami
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Pascale Lehoux
- Center for Public Health Research and Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC H3C 3J7, Canada
| | - Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Sarah Rybczynska-Bunt
- Community and Primary Care Research Group, Faculty of Health, Plymouth University, Plymouth PL6 8BX, UK
| | - Jean-Paul Fortin
- VITAM Research Centre on Sustainable Health, Faculty of Medicine, Laval University, Quebec, QC G1J 2G1, Canada
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Greenhalgh T, Shaw SE, Alvarez Nishio A, Booth A, Byng R, Clarke A, Dakin F, Davies R, Faulkner S, Hemmings N, Husain L, Kalin A, Ladds E, Moore L, Rosen R, Rybczynska-Bunt S, Wherton J, Wieringa S. Protocol: Remote care as the 'new normal'? Multi-site case study in UK general practice. NIHR OPEN RESEARCH 2022; 2:46. [PMID: 37881300 PMCID: PMC10593351 DOI: 10.3310/nihropenres.13289.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 10/27/2023]
Abstract
Background Following a pandemic-driven shift to remote service provision, UK general practices offer telephone, video or online consultation options alongside face-to-face. This study explores practices' varied experiences over time as they seek to establish remote forms of accessing and delivering care. Methods This protocol is for a mixed-methods multi-site case study with co-design and national stakeholder engagement. 11 general practices were selected for diversity in geographical location, size, demographics, ethos, and digital maturity. Each practice has a researcher-in-residence whose role is to become familiar with its context and activity, follow it longitudinally for two years using interviews, public-domain documents and ethnography, and support improvement efforts. Research team members meet regularly to compare and contrast across cases. Practice staff are invited to join online learning events. Patient representatives work locally within their practice patient involvement groups as well as joining an online patient learning set or linking via a non-digital buddy system. NHS Research Ethics Approval has been granted. Governance includes a diverse independent advisory group with lay chair. We also have policy in-reach (national stakeholders sit on our advisory group) and outreach (research team members sit on national policy working groups). Results anticipated We expect to produce rich narratives of contingent change over time, addressing cross-cutting themes including access, triage and capacity; digital and wider inequities; quality and safety of care (e.g. continuity, long-term condition management, timely diagnosis, complex needs); workforce and staff wellbeing (including non-clinical staff, students and trainees); technologies and digital infrastructure; patient perspectives; and sustainability (e.g. carbon footprint). Conclusion By using case study methods focusing on depth and detail, we hope to explain why digital solutions that work well in one practice do not work at all in another. We plan to inform policy and service development through inter-sectoral network-building, stakeholder workshops and topic-focused policy briefings.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Amy Booth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Aileen Clarke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Francesca Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Asli Kalin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | | | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
- Centre for Sustainable Health Education, University of Oslo, Oslo, Norway
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30
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Physician eye contact in telemedicine video consultations: A cross-cultural experiment. Int J Med Inform 2022; 165:104825. [DOI: 10.1016/j.ijmedinf.2022.104825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 11/15/2022]
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31
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Duncan Millar J, Mason H, Kidd L. What is important in supporting self-management in community stroke rehabilitation? A Q methodology study. Disabil Rehabil 2022:1-9. [PMID: 35757835 DOI: 10.1080/09638288.2022.2087766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Supported self-management (SSM) is an important part of adapting to life after stroke however it is a complex concept. It is unclear what SSM in stroke consists of or how stroke survivors, families, and clinicians can most effectively work together to support person-centred self-management. In this study, we aimed to explore what was most important in making SSM work in community stroke rehabilitation. METHODS We conducted a Q-methodology study with stroke survivors (n = 20), community-based stroke clinicians (n = 20), and team managers (n = 8) across four health boards in Scotland, United Kingdom. Participants ranked 32 statements according to their importance in making SSM work. Factor analysis was used to identify shared viewpoints. RESULTS We identified four viewpoints: (i) A person-centred approach to build self-confidence and self-worth; (ii) Feeling heard, understood, and supported by everybody; (iii) Preparation of appropriate resources; and (iv) Right thing, right place, right time for the individual. Important across all viewpoints were: a trusting supportive relationship; working in partnership; focusing on meaningful goals; and building self-confidence. CONCLUSIONS Differing views exist on what is most important in SSM. These views could be used to inform quality improvement strategies to support the delivery of SSM that considers the preferences of stroke survivors. IMPLICATIONS FOR REHABILITATIONClinicians should be aware of their own viewpoint of supported self-management and consider how their perspective may differ from stroke survivors' and colleagues' perspectives of what's important to support self-management.Working in partnership with stroke survivors plus developing a trusting and supportive relationship with them are core components of supporting self-management in the longer term after stroke.Building a sense of self-worth and self-confidence, a focus on meaningful goals, training and support for staff, and tailoring support to people's needs at the right time are important considerations for supporting longer-term engagement in self-management.
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Affiliation(s)
- Julie Duncan Millar
- School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Lisa Kidd
- School of Health & Life Sciences/Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
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32
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Clinical risk in remote consultations in general practice: findings from in-Covid-19 pandemic qualitative research. BJGP Open 2022; 6:BJGPO.2021.0204. [PMID: 35487581 DOI: 10.3399/bjgpo.2021.0204] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/05/2022] [Accepted: 01/18/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The Covid-19 pandemic-related rise in remote consulting raises questions about the nature and type of risks in remote general practice AIM: To develop an empirically-based and theory-informed taxonomy of risks associated with remote consultations. DESIGN AND SETTING Qualitative sub-study of data selected from the wider datasets of three large, multi-site, mixed-method studies of remote care in general practice prior to and during the Covid-19 pandemic in the UK METHOD: Semi-structured interviews and focus groups with a total of 176 clinicians, and 45 patients. We analysed data thematically, taking account of an existing framework of domains of clinical risk. RESULTS The Covid-19 pandemic brought changes to estates (eg, how waiting rooms were used), access pathways, technologies, and interpersonal interactions. Six domains of risk were evident in relation to[1] practice organisation and set-up (including digital inequalities of access, technology failure and reduced service efficiency); [2] communication and the therapeutic relationship (including a shift to more transactional consultations); [3] quality of clinical care (including missed diagnoses, safeguarding challenges, over-investigation and over-treatment); [4] increased burden on the patient (eg, to self-examine and navigate between services); [5] reduced opportunities for screening and managing the social determinants of health; and [6] workforce (including increased clinician stress and fewer opportunities for learning). CONCLUSION Notwithstanding potential benefits, if remote consultations are to work safely, risks must be actively mitigated by measures that include digital inclusion strategies, enhanced safety-netting and training and support for staff.
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33
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Enam A, Dreyer HC, Boer LD. Individual's Perceptions as a Substitute for Guidelines and Evidence: A Qualitative Study on How Clinicians Choose Between In-person and Remote Consultation. JMIR Form Res 2022; 6:e35950. [PMID: 35475503 PMCID: PMC9178453 DOI: 10.2196/35950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/24/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Video consultation (VC) is increasingly seen as a cost-effective way of providing outpatient care in the face of dwindling resources and growing demand for health care worldwide. Therefore, the sustainable implementation of VC is a phenomenon of interest to medical practitioners, researchers, and citizens alike. Studies are often criticized for not being sufficiently robust because the research settings are mostly small-scale pilot projects and are unable to reflect long-term implementation. The COVID-19 pandemic has compelled clinicians worldwide to conduct remote consultation, creating a favorable context to study large-scale remote consultation implementation. Objective The aim of this study was to thoroughly investigate how clinicians reason their choice of different consultation modes in the routine of consultation and what the underlying reasons are for their choices. We posited that a deeper understanding of clinicians’ perceptions of remote consultation is essential to deduce whether and how remote consultation will be adopted on a large scale and sustained as a regular service. Methods A qualitative approach was taken, in which the unit of analysis was clinicians in one of the largest university hospitals in Norway. In total, 29 interviews were conducted and transcribed, which were used as the primary data source. Using the performative model of routine as the theoretical framework, data were analyzed using deductive content analysis. Results Clinicians have mixed opinions on the merits and demerits of VC and its position between in-person and telephone consultation. Totally, 6 different planning criteria were identified, and individual clinicians used different combinations of these criteria when choosing a mode of consultation. The ideals that clinicians hold for conducting consultation can be divided into three aspects: clinical, interpersonal, and managerial. VC engenders a new ideal and endangers the existing ideals. VC causes minor changes in the tasks the clinicians perform during a consultation; thus, these changes do not play a significant role in their choice of consultation. Clinicians could not identify any changes in the outcome of consultation as a result of incorporating a remote mode of consultation. Conclusions Clinicians feel that there is a lack of scientific evidence on the long-term effect of remote consultation on clinical efficacy and interpersonal and managerial aspects, which are crucial for consultation service. The absence of sufficient scientific evidence and a clear understanding of the merits and demerits of VC and standard practices and shared norms among clinicians regarding the use of video for consultation both create a void in the consultation practice. This void leads clinicians to use their personal judgments and preferences to justify their choices regarding the consultation mode. Thus, diverse opinions emerge, including some paradoxical ones, resulting in an uncertain future for sustainable large-scale implementation, which can reduce the quality of consultation service.
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Affiliation(s)
- Amia Enam
- Norwegian University of Science and Technology, Høgskoleringen 1, TRONDHEIM, NO
| | - Heidi C Dreyer
- Norwegian University of Science and Technology, Trondeheim, NO
| | - Luitzen De Boer
- Norwegian University of Science and Technology, Trondheim, NO
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34
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Bacon R, Hopkins S, Kellett J, Millar C, Smillie L, Sutherland R. The Benefits, Challenges and Impacts of Telehealth Student Clinical Placements for Accredited Health Programs During the COVID-19 Pandemic. Front Med (Lausanne) 2022; 9:842685. [PMID: 35433770 PMCID: PMC9005869 DOI: 10.3389/fmed.2022.842685] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/08/2022] [Indexed: 12/16/2022] Open
Abstract
Introduction Despite the advantages of telehealth, there has been a reluctance in its widespread adoption. During the COVID-19 pandemic, telehealth services and related placements increased internationally. Yet, there is currently limited research on the use of telehealth for student clinical placements. Aim To explore the perceived benefits, challenges, and impacts of telehealth placements for key stakeholders (clients, students, clinical educators, and placement co-ordinators) in allied health courses. Methods Stakeholder experiences with telehealth placements, undertaken within an Australian Allied Health University Clinic, were explored in virtual focus groups held between November 2020 and March 2021. These discussions used semi-structured interview questions, were audiotaped and transcribed verbatim. They were then thematically analyzed independently by two researchers, then cross-checked for consistency, using a qualitative descriptive approach, with reflexivity applied. Results Twenty-six stakeholders from six allied health disciplines participated in seven homogeneous focus groups. Three themes were identified: (1) telehealth placements support competency development and graduate employability; (2) telehealth placements enable students to provide person centered-care; and (3) telehealth placements enabled innovation. Conclusion Telehealth placements can make a valuable contribution as part of an overall placement program within accredited health courses and offer distinct advantages to student learning outcomes.
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Affiliation(s)
- Rachel Bacon
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Sian Hopkins
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Jane Kellett
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - CaraJane Millar
- Faculty of Health, University of Canberra, Bruce, ACT, Australia.,Speech Pathology, College of Health and Biomedicine, Victoria University, Footscray Park, VIC, Australia
| | - Linda Smillie
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Rebecca Sutherland
- Faculty of Health, University of Canberra, Bruce, ACT, Australia.,Discipline of Speech Pathology, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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Walthall H, Schutz S, Snowball J, Vagner R, Fernandez N, Bartram E. Patients' and clinicians' experiences of remote consultation? A narrative synthesis. J Adv Nurs 2022; 78:1954-1967. [PMID: 35362191 PMCID: PMC9321562 DOI: 10.1111/jan.15230] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/09/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
Aims To identify, evaluate and summarize evidence of patient and clinician experiences of being involved in video or telephone consultations as a replacement for in‐person consultations. Design Narrative synthesis. Data sources Medline; EMBASE; EMCARE; CINAHL and BNI. Searching took place from January 2021 to April 2021. Papers included were published between 2013 and 2020. Review Methods Papers were appraised by two independent reviewers for methodological quality. Data extraction was conducted according to the standardized tool from Joanna Briggs Institute. Results Seven qualitative studies were included, from five countries and from the perspective of patients, relatives, administrators, nurses, physiotherapists and physicians. We developed two main themes: Pragmatic Concerns and Therapeutic Concerns. Each theme contained two categories: Pragmatic Concerns: (a) the convenience of non‐face to face consultations; (b) using technology and equipment in a consultation; Therapeutic Concerns (c) building therapeutic relationships; and (d) embracing benefits and addressing challenges. Conclusion This narrative synthesis presents the existing evidence on clinician and patient experience of participating in non‐face to face consultations. Experiences are varied but largely focus on communication and forming relationships, using the technology successfully and the ability for patients to self‐manage with support from clinicians who are not in‐person. More high‐quality studies are required to explore the experiences of patients and clinicians accessing remote consultations as a result of global implementation post‐SARS‐CoV‐2 pandemic to identify any learning and education opportunities. Impact Health care staff can provide high‐quality care through video or telephone appointments as well as face to face appointments. This review has, however, identified that the evidence is limited and weak in this area and recommends there is research further to inform practice and influence future care.
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Affiliation(s)
- Helen Walthall
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Sue Schutz
- Oxford Brookes University and Oxford Biomedical Research Centre, Oxford, UK
| | - Joanne Snowball
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Raluca Vagner
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Nicola Fernandez
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Emilia Bartram
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
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36
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Why do GPs rarely do video consultations? Qualitative study in UK. Br J Gen Pract 2022; 72:e351-e360. [DOI: 10.3399/bjgp.2021.0658] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/21/2021] [Indexed: 10/31/2022] Open
Abstract
Background: Fewer than 1% of UK general practice consultations occur by video. Aim: To explain why video consultations are not more widely used in general practice. Design and setting: Analysis of a sub-sample of data from three mixed-method case studies of remote consultation services in various UK settings 2019-2021. Methods: The dataset included interviews and focus groups with 121 participants from primary care (33 patients, 55 GPs, 11 other clinicians, 9 managers, 4 support staff, 4 national policymakers, 5 technology industry). Data were transcribed, coded thematically and then analysed using the Planning and Evaluating Remote Consultations (PERCS) Framework. Results: With few exceptions, video consultations were either never adopted or soon abandoned in general practice despite a strong policy push, short-term removal of regulatory and financial barriers and advances in functionality, dependability and usability of video technologies (though some products remained “fiddly” and unreliable). The relative advantage of video was perceived as minimal for most of the case load of general practice, since many presenting problems could be sorted adequately and safely by telephone and in-person assessment was considered necessary for the remainder. Some patients found video appointments convenient, appropriate and reassuring but others found therapeutic presence was only achieved in person. Video sometimes added value for out-of-hours and nursing home consultations and statutory functions (e.g. death certification). Conclusion: Efforts to introduce video consultations in general practice should focus on situations where this modality has a clear relative advantage (e.g. strong patient or clinician preference, remote localities, out-of-hours services, nursing homes).
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Morton L, Stelfox K, Beasley M, Jones GT, Macfarlane GJ, Murchie P, Paton J, Hollick R. Lessons from experiences of accessing healthcare during the pandemic for remobilising rheumatology services: a national mixed methods study. Rheumatol Adv Pract 2022; 6:rkac013. [PMID: 35350717 PMCID: PMC8946474 DOI: 10.1093/rap/rkac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To understand the impact of the COVID-19 pandemic on access to healthcare services for patients with inflammatory and non-inflammatory MSK conditions.
Methods
Three established cohorts which included individuals with axial spondyloarthritis, psoriatic arthritis, and musculoskeletal pain completed a questionnaire between July and December 2020. In parallel, a subset of individuals participated in semi-structured interviews.
Results
1054 people (45% female, median age 59 years) were included in the quantitative analyses. Qualitative data included 447 free-text questionnaire responses and 23 interviews. 57% respondents had tried to access care since the start of UK national lockdown. Over a quarter reported being unable to book any type of healthcare appointment. GP appointments were less likely to be delayed or cancelled compared with hospital appointments. Younger age, unemployment/health-related retirement, DMARD therapy, anxiety or depression and being extremely clinically vulnerable was associated with a greater likelihood of attempting to access healthcare. People not in work, those reporting anxiety or depression and poorer quality of life were less likely to be satisfied with remotely-delivered healthcare. Participants valued clear, timely and transparent care pathways across primary care and specialist services. Whilst remote consultations were convenient for some, in-person appointments enabled physical assessment and facilitated development and maintenance of clinical relationships with care providers.
Conclusions
We have identified patient factors that predict access to and satisfaction with care, and aspects of care that patients value. This is important to inform remobilisation of rheumatology services to better meet the needs of patients.
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Affiliation(s)
- LaKrista Morton
- Epidemiology Group, University of Aberdeen, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, Aberdeen, UK
| | - Kevin Stelfox
- Epidemiology Group, University of Aberdeen, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, Aberdeen, UK
| | - Marcus Beasley
- Epidemiology Group, University of Aberdeen, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, Aberdeen, UK
| | - Gareth T Jones
- Epidemiology Group, University of Aberdeen, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, Aberdeen, UK
| | - Gary J Macfarlane
- Epidemiology Group, University of Aberdeen, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, Aberdeen, UK
| | - Peter Murchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - John Paton
- Scottish Patient Ambassador, National Rheumatoid Arthritis Society
| | - Rosemary Hollick
- Epidemiology Group, University of Aberdeen, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, Aberdeen, UK
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Weatherburn C. Digital Inclusion As a Foundation for Health Equity. Comment on "Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study". J Med Internet Res 2022; 24:e34702. [PMID: 35038303 PMCID: PMC8855287 DOI: 10.2196/34702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/14/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Christopher Weatherburn
- NHS National Services Scotland, Gyle Square, Edinburgh, GB.,NHS Tayside, King's Cross, Clepington Road, Dundee, GB
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Shaw SE, Hughes G, Wherton J, Moore L, Rosen R, Papoutsi C, Rushforth A, Morris J, Wood GW, Faulkner S, Greenhalgh T. Achieving Spread, Scale Up and Sustainability of Video Consulting Services During the COVID-19 Pandemic? Findings From a Comparative Case Study of Policy Implementation in England, Wales, Scotland and Northern Ireland. Front Digit Health 2021; 3:754319. [PMID: 34988546 PMCID: PMC8720935 DOI: 10.3389/fdgth.2021.754319] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Requirements for physical distancing as a result of COVID-19 and the need to reduce the risk of infection prompted policy supporting rapid roll out of video consulting across the four nations of the UK-England, Northern Ireland, Scotland and Wales. Drawing on three studies of the accelerated implementation and uptake of video consulting across the four nations, we present a comparative and interpretive policy analysis of the spread and scale-up of video consulting during the pandemic. Data include interviews with 59 national level stakeholders, 55 health and social care staff and 30 patients, 20 national documents, responses to a UK-wide survey of NHS staff and analysis of routine activity data. Sampling ensured variations in geography, clinical context and adoption progress across the combined dataset. Comparative analysis was guided by theory on policy implementation and crisis management. The pandemic provided a "burning platform" prompting UK-wide policy supporting the use of video consulting in health care as a critical means of managing the risk of infection and a standard mode of provision. This policy push facilitated interest in video consulting across the UK. There was, however, marked variation in how this was put into practice across the four nations. Pre-existing infrastructure, policies and incentives for video consulting in Scotland, combined with a collaborative system-level approach, a program dedicated to developing video-based services and resourcing and supporting staff to deliver them enabled widespread buy-in and rapid spread. In England, Wales and Northern Ireland, pre-existing support for digital health (e.g., hardware, incentives) and virtual care, combined with reduced regulation and "light touch" procurement managed to override some (but by no means all) cultural barriers and professional resistance to implementing digital change. In Northern Ireland and Wales, limited infrastructure muted spread. In all three countries, significant effort at system level to develop, review and run video consulting programs enabled a substantial number of providers to change their practice, albeit variably across settings. Across all four nations ongoing uncertainty, potential restructuring and tightening of regulations, along with difficulties inherent in addressing inequalities in digital access, raise questions about the longer-term sustainability of changes to-date.
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Affiliation(s)
- Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Alex Rushforth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joanne Morris
- Joint Research Management Office, Barts Health NHS Trust, London, United Kingdom
| | - Gary W. Wood
- Independent Research Consultant, Birmingham, United Kingdom
| | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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