How Professionals Share an E-Care Plan for the Elderly in Primary Care: Evaluating the Use of an E-Communication Tool by Different Combinations of Professionals

Using digital communication tools to improve interprofessional collaboration and satisfaction in a student-run free clinic

BACKGROUND

Interprofessional collaboration can improve the quality of care in complex health conditions often seen in underserved populations. Communication is key to effective collaboration, and digital communication tools can enhance information sharing, collaboration, and satisfaction between professionals, especially when teams are distanced.

LOCAL PROBLEM

In a semirural student-run free clinic that provides care to uninsured and underinsured patients with multifaceted health issues, there is a gap in communication and collaboration across interprofessional teams because of the frequent rotation of various staff, part-time hours, and electronic health record (EHR) function and interoperability limitations.

METHODS

The aim of this nurse practitioner-led quality improvement project was to determine whether implementing digital communication tools could enhance communication and improve provider collaboration and satisfaction during clinical decision-making among the several interprofessional teams at the student-run free clinic.

INTERVENTIONS

Digital communication tools were implemented in a two-part intervention: (1) virtual case conferences to discuss patient care plans and (2) an EHR-linked tool to document the care plans.

RESULTS

Survey evaluation across six virtual case conferences found above-average ratings for collaboration, satisfaction, and usability of the EHR-linked tool. There was a 15.78% improvement in global collaboration from the first to third conference, with a sustained improvement of 11.49%. Satisfaction improved by 4.62% from the first to the fourth conference.

CONCLUSION

Digital communication tools can facilitate efficient communication and collaboration among staff while providing a more streamlined approach to patient care. These technologies can be useful in similar settings, especially when teams are distanced.

Care Partner Perspectives on the Use of a Patient Portal Intervention to Promote Care Partner Identification in Dementia Care

Care partners are crucial to supporting the complex health needs of older adults with dementia, but they are not systematically identified in care delivery. As part of a real-world implementation project in geriatric primary care, we adapted a portal-based agenda setting intervention, OurNotes, by incorporating items to help care partners self-identify. Semi-structured interviews were conducted with care partners (N = 15) who completed the adapted OurNotes to explore their perceptions of the tool (usability, benefits, and challenges) and recommendations for refinement. The data were analyzed using thematic analysis. Benefits included enhancing care partners' preparedness for the visit and opening a direct channel to express concerns about patients' cognition and memory loss to clinicians. Challenges pertained to clinician responsiveness; recommendations focused on enabling the submitted OurNotes responses to be edited and updated by multiple care partners. Such refinements may help to maximize the impact of adapted OurNotes' and potential for future implementation and dissemination.

Technologies for Managing the Health of Older Adults with Multiple Chronic Conditions: A Systematic Literature Review

Multimorbidity is defined as the presence of two or more chronic medical conditions in a person, whether physical, mental or long-term infectious diseases. This is especially common in older populations, affecting their quality of life and emotionally impacting their caregivers and family. Technology can allow for monitoring, managing, and motivating older adults in their self-care, as well as supporting their caregivers. However, when several conditions are present at once, it may be necessary to manage several types of technologies, or for technology to manage the interaction between conditions. This work aims to understand and describe the technologies that are used to support the management of multimorbidity for older adults. We conducted a systematic review of ten years of scientific literature from four online databases. We reviewed a corpus of 681 research papers, finally including 25 in our review. The technologies used most frequently by older adults with multimorbidity are mobile applications and websites, and they are mostly focused on communication and connectivity. We then propose opportunities for future research on addressing the challenges in the management of several simultaneous health conditions, potentially creating a better approach than managing each condition as if it were independent.

Implementation of interprofessional digital communication tools in primary care for frail older adults: An interview study

Communication and coordination between primary healthcare professionals and informal caregivers involved in the care for frail older adults is suboptimal and could benefit from interprofessional digital communication tools. Implementation in daily practice however frequently fails. We aim to identify generic barriers and facilitators experienced by healthcare professionals and informal caregivers during implementation of interprofessional communication tools to improve their long-term use. Qualitative content analysis using individual semi-structured interviews was used for evaluating three different digital communication tools used by interprofessional primary care networks for frail older adults by 28 professionals and 10 caregivers. After transcription and open coding, categories and themes were identified. Barriers and facilitators were related to: tool characteristics, context of use, involvement of professionals and caregivers. The tool improved availability, approachability and users' involvement. The large number of digital systems professionals simultaneously use, and different work agreements hampered tool use. The tools facilitated care coordination, and professionals declared to be better informed about patients' current situations. Overall, interprofessional digital communication tools can facilitate communication in networks for primary elderly care. However, integration between digital systems is needed to reduce the number of tools. Organizations and policy makers have an important role in realizing the tools' long-term use.

Assessing Progress Toward the Vision of a Comprehensive, Shared Electronic Care Plan: Scoping Review

Background

Care plans are central to effective care delivery for people with multiple chronic conditions. But existing care plans—which typically are difficult to share across care settings and care team members—poorly serve people with multiple chronic conditions, who often receive care from numerous clinicians in multiple care settings. Comprehensive, shared electronic care (e-care) plans are dynamic electronic tools that facilitate care coordination and address the totality of health and social needs across care contexts. They have emerged as a potential way to improve care for individuals with multiple chronic conditions.

Objective

To review the landscape of e-care plans and care plan–related initiatives that could allow the creation of a comprehensive, shared e-care plan and inform a joint initiative by the National Institutes of Health and the Agency for Healthcare Research and Quality to develop e-care planning tools for people with multiple chronic conditions.

Methods

We conducted a scoping review, searching literature from 2015 to June 2020 using Scopus, Clinical Key, and PubMed; we also searched the gray literature. To identify initiatives potentially missing from this search, we interviewed expert informants. Relevant data were then identified and extracted in a structured format for data synthesis and analysis using an expanded typology of care plans adapted to our study context. The extracted data included (1) the perspective of the initiatives; (2) their scope, (3) network, and (4) context; (5) their use of open syntax standards; and (6) their use of open semantic standards.

Results

We identified 7 projects for e-care plans and 3 projects for health care data standards. Each project provided critical infrastructure that could be leveraged to promote the vision of a comprehensive, shared e-care plan. All the e-care plan projects supported both broad goals and specific behaviors; 1 project supported a network of professionals across clinical, community, and home-based networks; 4 projects included social determinants of health. Most projects specified an open syntax standard, but only 3 specified open semantic standards.

Conclusions

A comprehensive, shared, interoperable e-care plan has the potential to greatly improve the coordination of care for individuals with multiple chronic conditions across multiple care settings. The need for such a plan is heightened in the wake of the ongoing COVID-19 pandemic. While none of the existing care plan projects meet all the criteria for an optimal e-care plan, they all provide critical infrastructure that can be leveraged as we advance toward the vision of a comprehensive, shared e-care plan. However, critical gaps must be addressed in order to achieve this vision.

Health information technology to improve care for people with multiple chronic conditions

OBJECTIVE

To review evidence regarding the use of Health Information Technology (health IT) interventions aimed at improving care for people living with multiple chronic conditions (PLWMCC) in order to identify critical knowledge gaps.

DATA SOURCES

We searched MEDLINE, CINAHL, PsycINFO, EMBASE, Compendex, and IEEE Xplore databases for studies published in English between 2010 and 2020.

STUDY DESIGN

We identified studies of health IT interventions for PLWMCC across three domains as follows: self-management support, care coordination, and algorithms to support clinical decision making.

DATA COLLECTION/EXTRACTION METHODS

Structured search queries were created and validated. Abstracts were reviewed iteratively to refine inclusion and exclusion criteria. The search was supplemented by manually searching the bibliographic sections of the included studies. The search included a forward citation search of studies nested within a clinical trial to identify the clinical trial protocol and published clinical trial results. Data were extracted independently by two reviewers.

PRINCIPAL FINDINGS

The search yielded 1907 articles; 44 were included. Nine randomized controlled trials (RCTs) and 35 other studies including quasi-experimental, usability, feasibility, qualitative studies, or development/validation studies of analytic models were included. Five RCTs had positive results, and the remaining four RCTs showed that the interventions had no effect. The studies address individual patient engagement and assess patient-centered outcomes such as quality of life. Few RCTs assess outcomes such as disability and none assess mortality.

CONCLUSIONS

Despite a growing body of literature on health IT interventions or multicomponent interventions including a health IT component for chronic disease management, current evidence for applying health IT solutions to improve care for PLWMCC is limited. The body of literature included in this review provides critical information on the state of the science as well as the many gaps that need to be filled for digital health to fulfill its promise in supporting care delivery that meets the needs of PLWMCC.

A Proactive Mobile Health Application Program for Promoting Self-Care Health Management among Older Adults in the Community: Study Protocol of a Three-Arm Randomized Controlled Trial

BACKGROUND

The use of mobile health (mHealth) has become common in recent years and is regarded as one of the most effective interventions for developing disease-specific management skills and establishing confidence in making preventive health behavior changes and accomplishing health-related goals among community-dwelling older adults. Most mHealth designs adopt a reactive care approach whereby health care professionals do not respond until they receive abnormal assessment results from the database or a message or signal from the client. The purpose of this study is to determine the effectiveness of a proactive mobile health application program with the support of a community health-social care team for older adults dwelling in the community on improving their self-care health management.

METHODS

This is a three-armed, randomized controlled trial. The study will be conducted in 7 community centers with an estimated sample size of 282 participants. The participants will be randomly assigned to mHealth with interactivity, mHealth, and control groups when they are (1) aged 60 or above, (2) complaining chiefly of pain, hypertension, or diabetes mellitus, (3) living within the service areas, and (4) smartphone users. Subjects in the mHealth with interactivity group will receive 2 main elements, the mHealth application and nurse case management supported by a social service team. The mHealth group will receive the mHealth application only. The primary outcome measure will be self-efficacy, and secondary outcomes will include self-management outcomes (pain score, blood pressure, capillary blood glucose), client outcomes (quality of life, depression), and health service utilization outcomes (institutionalization and health service utilization [general practitioner, outpatient clinic, emergency room, hospital admission]). Data will be collected before intervention, after intervention, and 3 months after intervention.

DISCUSSION

The incremental benefits of adding interactivity in the mHealth program have not been confirmed. This present study will add valuable information to the knowledge gap of whether mHealth with nurse interaction supported by a health-social partnership can improve self-care management among community-dwelling older adults.

The Interactive Web-Based Program MSmonitor for Self-Management and Multidisciplinary Care in Persons With Multiple Sclerosis: Quasi-Experimental Study of Short-Term Effects on Patient Empowerment

BACKGROUND

Empowerment helps persons with a chronic disease to self-manage their condition and increase their autonomy and participation. MSmonitor (Curavista bv) is an interactive Web-based program for self-management and multidisciplinary care in multiple sclerosis (MS). It includes, among others, short questionnaires on fatigue (Modified Fatigue Impact Scale-5 [MFIS-5]) and health-related quality of life (HRQoL, Leeds Multiple Sclerosis Quality of Life [LMSQoL]); long questionnaires on disabilities, perception of disabilities (Multiple Sclerosis Impact Profile), and HRQoL (Multiple Sclerosis Quality of Life-54); a Medication and Adherence Inventory and an Activity Diary. The combination MFIS-5, LMSQoL, and Medication and Adherence Inventory constitutes the Quick Scan.

OBJECTIVE

This study aimed to investigate the short-term effects of MSmonitor on empowerment in patients with MS.

METHODS

We conducted a quasi-experimental study in a general hospital. Of the 180 patients with MS, 125 were eligible, 30 used MSmonitor, and 21 participated in the study (mean age 45.4 years, SD 10.2 years). A total of 24 eligible patients who did not use MSmonitor constituted the control group (mean age 49.3 years, SD 11.4 years). At baseline and at 4 months, we assessed self-efficacy (Multiple Sclerosis Self-Efficacy Scale [MSSES]), participation and autonomy (Impact on Participation and Autonomy [IPA] questionnaire), and self-management (Partners In Health [PIH] questionnaire). Differences between time points and groups were tested with paired t tests and χ² tests.

RESULTS

In the MSmonitor group, follow-up values remained unchanged for MSSES control (P=.19), MSSES function (P=.62), IPA limitations (P=.26), IPA problems (P=.40), PIH recognition and management of symptoms (P=.52), PIH adherence to treatment (P=.80), and PIH coping (P=.73), whereas the PIH knowledge score had improved (mean 27.8, SD 1.7 vs mean 28.7, SD 2.0; P=.02). The overall utilization rate of the program components was 83% and that of the Quick Scan was 95%. In the control group, all outcomes had remained unchanged.

CONCLUSIONS

The results suggest that for first-time users of the MSmonitor program and their health care providers, it may not be justified to expect a short-term improvement in empowerment in terms of self-efficacy, self-management, autonomy, or participation. Furthermore, a lack of effect on empowerment is not because of nonusage of the program components.

The Association Between Willingness of Frontline Care Providers' to Adaptively Use Telehealth Technology and Virtual Service Performance in Provider-to-Provider Communication: Quantitative Study

Background

Telehealth technology can create a disruptive communication environment for frontline care providers who mediate virtual communication with specialists in electronic consultations. As providers are dealing with various technology features when communicating with specialists, their flexible attitude and behaviors to use various telehealth-related technology features can change the outcome of virtual care service.

Objective

The objective of this study is to examine frontline care providers’ technology adaptation behaviors in the electronic consultation context. From the perspective of frontline care providers, we reapply and retest a theoretical model, reflecting a mechanism through which technology users’ personal characteristics and technology adaptation behavior enhance virtual service performance, which is an important performance enabler in this online meeting context. In provider-to-provider communication, particularly, we explore the association among providers’ information technology (IT)–related personal characteristics, adaptive telehealth technology use, and virtual service performance.

Methods

An online survey was administered to collect individual providers’ personal traits, IT adaptation, and perception on virtual service performance. Partial least squares-structural equation modeling was used to estimate our predictive model of personal traits—IT adaptation, such as exploitative use (use the telehealth technology in a standard way), and exploratory use (use the telehealth technology as innovative way)—and virtual service performance.

Results

We collected 147 responses from graduate nursing students who were training to be nurse practitioners in their master’s program, resulting in 121 valid responses from the cross-section online survey. Our theoretical model explained 60.0% of the variance in exploitative use of telehealth technology, 44% of the variance in exploratory use of telehealth technology, and 66% of the variance in virtual service performance. We found that exploitative IT use is an important driver to increase virtual service performance (β=0.762, P<.001), and personal characteristics such as habit are positively associated with both exploitative (β=0.293, P=.008) and exploratory use behaviors (β=0.414, P=.006), while computer self-efficacy is positively associated with exploitative use of telehealth technology (β=0.311, P=.047).

Conclusions

This study discusses the unique role of frontline care providers in a virtual care service context and highlights the importance of their telehealth adaptation behavior in provider-to-provider communication. We showed that providers perceive that telehealth technologies should function as intended, otherwise it may create frustration or avoidance of the telehealth technology. Moreover, providers’ habitual use of various technologies in daily lives also motivates them to adaptively use telehealth technology for improving virtual care service. Understanding providers’ technology habit and adaptation can inform health care policy and further provide a better view of the design of telehealth technology for online communication.

Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study

Background

Primary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care.

Objective

The objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs.

Methods

This study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data.

Results

We collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation.

Conclusions

We observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach.

Professionals' Use of a Multidisciplinary Communication Tool for Patients With Dementia in Primary Care

In this descriptive study, the use of a professional e-communication tool, Congredi, is evaluated. Ninety-six Congredi records of patients with dementia could be divided into the subgroups low-complex care (n = 43) and high-complex care (n = 53). If Congredi is an adequate communication tool for professionals, the changing involvement of caregivers must also be reflected within the two subgroups. We hypothesized that use would be more intensive in the high-complex group in comparison with the low-complex group. Data were gathered during 42 weeks. Results showed that the mean number of care activities in the high-complex group was significantly higher than in the low-complex group (10.43 vs 5.61, P = .001). The number of professionals involved with the high-complex care group (3.58) was higher compared to the low-complex care group (2.51) (P = .000). The most frequent use was by case managers and nurses (43.4%) in the high-complex group and by several case managers (41.9%) in the low-complex group. It was concluded that professionals used Congredi adequately in the multidisciplinary care of patients with dementia because the changing involvement of caregivers and the level of care activities were reflected in the use of Congredi.

Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project

Background

The current reality of primary care (PC) makes it essential to have telemedicine systems available to facilitate communication between care levels. Communities of practice have great potential in terms of care and education, and that is why the Online Communication Tool between Primary and Hospital Care was created. This tool enables PC and non-GP specialist care (SC) professionals to raise clinical cases for consultation and to share information. The objective of this article is to explore healthcare professionals’ views on communities of clinical practice (CoCPs) and the changes that need to be made in an uncontrolled real-life setting after more than two years of use.

Methods

A descriptive-interpretative qualitative study was conducted on a total of 29 healthcare professionals who were users and non-users of a CoCP using 2 focus groups, 3 triangular groups and 5 individual interviews. There were 18 women, 21 physicians and 8 nurses. Of the interviewees, 21 were PC professionals, 24 were users of a CoCP and 7 held managerial positions.

Results

For a system of communication between PC and SC to become a tool that is habitually used and very useful, the interviewees considered that it would have to be able to find quick, effective solutions to the queries raised, based on up-to-date information that is directly applicable to daily clinical practice. Contact should be virtual – and probably collaborative – via a platform integrated into their habitual workstations and led by PC professionals. Organisational changes should be implemented to enable users to have more time in their working day to spend on the tool, and professionals should have a proactive attitude in order to make the most if its potential. It is also important to make certain technological changes, basically aimed at improving the tool’s accessibility, by integrating it into habitual clinical workstations.

Conclusions

The collaborative tool that provides reliable, up-to-date information that is highly transferrable to clinical practice is valued for its effectiveness, efficiency and educational capacity. In order to make the most of its potential in terms of care and education, organisational changes and techniques are required to foster greater use.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0739-0) contains supplementary material, which is available to authorized users.