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Gibelli F, Bailo P, Pesel G, Ricci G. Preserving Patient Stories: Bioethical and Legal Implications Related to the Shift from Traditional to Digital Anamnesis. Clin Pract 2024; 14:1196-1213. [PMID: 39051289 PMCID: PMC11270254 DOI: 10.3390/clinpract14040095] [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: 03/17/2024] [Revised: 04/22/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
It is since the beginning of the so-called 'digital revolution' in the 1950s that technological tools have been developed to simplify and optimise traditional, time-consuming, and laborious anamnestic collection for many physicians. In recent years, more and more sophisticated 'automated' anamnestic collection systems have been developed, to the extent that they can actually enter daily clinical practice. This article not only provides a historical overview of the evolution of such tools, but also explores the ethical and medico-legal implications of the transition from traditional to digital anamnesis, including the protection of data confidentiality, the preservation of the communicative effectiveness of the doctor-patient dialogue and the safety of care in patients with poor digital and health literacy.
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Affiliation(s)
| | - Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.P.); (G.R.)
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2
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Villagrán Castro KN, Hernández Rincón EH, García Zárate G, Jaimes Peñuela CL. [Communication with a culturally and linguistically diverse population from Primary Care]. Semergen 2024; 50:102149. [PMID: 38157756 DOI: 10.1016/j.semerg.2023.102149] [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: 06/27/2023] [Revised: 09/27/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024]
Abstract
The care of a culturally and linguistically diverse population is a challenge in primary health care due to language barriers and cultural differences. For this reason, good communication and cultural competence of health personnel is key within medical consultation. Thus, during consultations with this group of people, it is the doctor's duty to identify the patient's culture, their perception of the concept of health, in what way and to what extent they want to be informed, and the role they want to assign to the members of their family before the treatment process begins. For this reason, there are interventions that seek to optimize the care provided to these patients and mitigate the cultural barrier, including the use of multimodal digital tools, the use of translators or interpreters, and training of health personnel in communication and intercultural skills.
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Affiliation(s)
- K N Villagrán Castro
- Médica de Atención Primaria, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia
| | - E H Hernández Rincón
- Médico, Máster en Investigación en Atención Primaria, Doctor en Investigación Clínica, Departamento de Medicina Familiar y Salud Pública, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia.
| | - G García Zárate
- Médica de Atención Primaria, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia
| | - C L Jaimes Peñuela
- Médica, especialista en Medicina Familiar y Comunitaria, Máster en Educación Médica, Departamento de Medicina Familiar y Salud Pública, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia
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3
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Kiblinger T, Daniels K, Calamaro C. Point-of-care communication for patients with limited language proficiency: A scoping review of healthcare interpretation applications. PATIENT EDUCATION AND COUNSELING 2024; 119:108060. [PMID: 37976669 DOI: 10.1016/j.pec.2023.108060] [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: 03/10/2023] [Revised: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Linguistic diversity has the potential to create barriers for limited language proficiency (LLP) patients when navigating the healthcare system. When a verified interpretation method is utilized, there are improvements in LLP patient outcomes. The purpose of this scoping review is to identify articles that outline applications used for point-of-care tasks between LLP patients and providers. METHODS The Arksey and O'Malley methodologic framework was utilized for study selection, data charting and analysis. Each application was evaluated on patient and provider satisfaction, overall feasibility, and time associated with interpretation. RESULTS Eight peer-reviewed journals are included (four pilot studies, one prospective study, two participatory studies, and one mixed methods design). Applications ranged in number of unique phrases (32-1800 phrases) and number of languages supported (1-39 languages). Overall, the applications were feasible to use and assisted with basic communication between providers and patients. CONCLUSIONS As patients and families become more comfortable with using technology, interpretation applications provide an innovative approach to streamline the interpretation process for point-of-care healthcare encounters. PRACTICE IMPLICATIONS Interpretation applications may increase an LLP patient's access to interpretation tools which can improve outcomes. Further studies should focus on implementing robust evaluation methods to assess these tools and evaluate the LLP patient's perspectives of interpretation applications.
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Affiliation(s)
- Theresa Kiblinger
- Children's Healthcare of Atlanta, Atlanta, USA; Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, USA.
| | | | - Christina Calamaro
- Children's Healthcare of Atlanta, Atlanta, USA; Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, USA
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4
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Coumans JVF, Wark S. A scoping review on the barriers to and facilitators of health services utilisation related to refugee settlement in regional or rural areas of the host country. BMC Public Health 2024; 24:199. [PMID: 38229057 PMCID: PMC10792843 DOI: 10.1186/s12889-024-17694-9] [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: 08/29/2023] [Accepted: 01/07/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Healthcare access and equity are human rights. Worldwide conflicts, violence, and persecution have increased the number of people from refugee or refugee-like backgrounds. Because urban areas are already densely populated, governments have aimed to increase refugee resettlement in rural and/or regional areas. Because of the complex healthcare needs of refugees, this creates challenges for healthcare service providers. Identifying barriers to accessing healthcare in rural areas is therefore important to better inform policy settings and programmes that will provide culturally appropriate patient-centred care to the refugee community. METHODS This review scoped 22 papers written in English between 2018 and July 2023 from five countries (Australia, New Zealand, Germany, Bangladesh, and Lebanon) in order to provide an overview of the barriers and possible solutions to facilitate refugees' access to healthcare. RESULTS The reviewed literature summarised the perceptions of at least 3,561 different refugees and 259 rural health service providers and/or administrators and identified major challenges. These include communication (illiteracy in the resettlement country language and lack of a suitable interpreter), lack of cultural awareness of health services, discrimination, and access difficulties (transportation, availability of health specialist services, cost). As a consequence, it was identified that improving access to affordable housing, employment through credential recognition, competence-level education for children, facilitating language training, and adapting health information would increase resettlement and encourage access to healthcare. CONCLUSIONS Refugees face significant barriers to accessing and engaging with healthcare services. This impacts their integration into rural communities and increases the prevalence of psychosocial issues like feelings of loneliness, low self-esteem, a lack of autonomy, and a lack of empowerment over informed decision-making, especially for women, jobless men, and the elderly. These findings support the need for additional support for refugees and healthcare providers to improve language proficiency and cultural competency. Policymakers need to improve the availability and accessibility of employment, housing accessibility, and service mobility. Additionally, more research is needed to assess the efficacy of emerging innovative programmes that aim to close the gap by delivering culturally appropriate patient-centred care to refugee communities in rural areas.
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Affiliation(s)
- J V F Coumans
- School of Rural Medicine, University of New England, Armidale, NSW, 2351, Australia.
| | - S Wark
- School of Rural Medicine, University of New England, Armidale, NSW, 2351, Australia
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5
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Albrink K, Schröder D, Joos C, Müller F, Noack EM. Usability of an App for Medical History Taking in General Practice From the Patients' Perspective: Cross-Sectional Study. JMIR Hum Factors 2024; 11:e47755. [PMID: 38180798 PMCID: PMC10799287 DOI: 10.2196/47755] [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: 03/31/2023] [Revised: 10/10/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND A future shortage of physicians, especially in general practice, will result in an increasing workload for health care providers as a whole. Therefore, it is important to optimize patient-encounter processes to increase time efficiency related to visits. Utilizing digital tools to record patients' medical histories prior to a consultation offers great potential to achieve this goal. The collected information can be stored into the practice's electronic medical record, allowing for the general practitioner to review structured information of the patients' complaints and related medical history beforehand, thereby saving time during the encounter. However, the low usability of new digital developments in this setting often hinders implementation. OBJECTIVE The aim of this study was to evaluate the usability of an app designed for medical history taking in general practice to capture the patients' perspective. METHODS Between November 2021 and January 2022, we recruited 406 patients with acute complaints in one out-of-hour urgent care and seven general practice clinics. These study participants used the app during their waiting time and subsequently assessed its usability by completing the System Usability Scale (SUS), a robust and well-established 10-question survey measuring the perceived usability of products and technologies. Additionally, we collected general participant information, including age, sex, media usage, health literacy, and native language. Descriptive and inferential statistics were applied to identify patient characteristics associated with low or high SUS scores. RESULTS We analyzed data from 397 patients (56.7% female, 43.3% male). The mean total SUS score was 77.8 points; 54.4% (216/397) of participants had SUS scores of 80 points or higher, indicating high usability of the app. In a multiple linear regression predicting SUS score, male sex and higher age (65 years or older) were significantly negatively associated with the SUS score. Conversely, a higher health literacy score and German as the native language were significantly positively associated with the SUS score. CONCLUSIONS Usability testing based on the SUS anticipates successful implementation of the app. However, not all patients will easily adapt to utilizing the app, as exemplified by the participants of older age in this study who reported lower perceived usability. Further research should examine these groups of people, identify the exact problems in operating such an app, and provide targeted solutions. TRIAL REGISTRATION German Clinical Trials Register World Health Organization Trial Registration Data Set DRKS00026659; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00026659.
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Affiliation(s)
- Klara Albrink
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Carla Joos
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Eva Maria Noack
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
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Brown C, Roucoux G, Dimi S, Fahmi S, Banou Jeevan R, Chassany O, Chaplin JE, Duracinsky M. Exploring the limitations of language interpretation: A qualitative study on clinicians' experiences at French Office of Immigration and Integration. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002436. [PMID: 38109295 PMCID: PMC10727366 DOI: 10.1371/journal.pgph.0002436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023]
Abstract
The concordance of communication between patients and health professionals is essential to promoting positive health outcomes. However, concordance may be broken where language barriers exist therefore creating a need to use interpretation services. This is the case when rapid diagnostic testing (RDT) of HIV, HBV, and HCV is offered to migrants. The use of interpreters to establish communication with patients having limited French proficiency (LFP) however, is often not used and can be problematic. Despite being offered, interpretation services are frequently underutilised, which makes communication challenging. This problem has not received enough attention in the literature, particularly in a technologically advanced setting where solutions may be found. Our objective was to explore how interpreters are used within the context of medical consultations when RDT for HIV, HBV, and HCV is offered to legal migrants with LFP. A cross-sectional qualitative study was used with a purposive sample that included doctors and nurses who had conducted rapid screening tests with migrants in four centers in France and who had access to interpretive services. Semi-structured interviews explored healthcare providers' (HP) use of interpreters at the OFII. The use of professional or ad hoc interpreters, telephone interpreters, and the equivalence of concepts such as health literacy between the HP and the interpreter were explored. The utility of a new tool to promote communication concordance was evaluated. Twenty interviews were conducted with eleven doctors and nine nurses with a median age of 58 years (25-67 years). All participants had access to interpretive services although many did not solicit them because of 1) unawareness on how to use the services, 2) preconceived notions of the length of time to involve an interpreter and how this would add to consultation times, or 3) the proximity of an ad hoc interpreter. Not using interpreter services could result in RDTs not being offered to immigrants. Subjects such as confidentiality, the embarrassment of a third party's presence, the lack of appropriate training and differing levels of health literacy were also discussed by participants. Insight from HPs allows us to better understand how both telephone and in-person interpretation are used, viewed, and why they are underused to communicate with limited French language skills patients. Our findings will help us develop a conceptual model for a digital communication tool to overcome barriers with migrant patients with limited French language skills.
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Affiliation(s)
- Carter Brown
- Patient-Reported Outcomes Unit (PROQOL), UMR 1123, INSERM, Paris, France
- Pierre Louis Doctoral School of Public Health Sorbonne University, Paris, France
| | - Guillaume Roucoux
- Patient-Reported Outcomes Unit (PROQOL), UMR 1123, INSERM, Paris, France
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO) AP-HP Hôpital Hôtel-Dieu, Paris, France
| | - Svetlane Dimi
- International Vaccination and Travel Medicine Center, Centre de Santé Familia Sol, Creil, France
| | - Saleh Fahmi
- Patient-Reported Outcomes Unit (PROQOL), UMR 1123, INSERM, Paris, France
| | - Raj Banou Jeevan
- Patient-Reported Outcomes Unit (PROQOL), UMR 1123, INSERM, Paris, France
| | - Olivier Chassany
- Patient-Reported Outcomes Unit (PROQOL), UMR 1123, INSERM, Paris, France
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO) AP-HP Hôpital Hôtel-Dieu, Paris, France
| | - John Eric Chaplin
- Institute of Health and Care Sciences The University of Gothenburg Centre for Person-Centred Care—GPCC Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Martin Duracinsky
- Patient-Reported Outcomes Unit (PROQOL), UMR 1123, INSERM, Paris, France
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO) AP-HP Hôpital Hôtel-Dieu, Paris, France
- Service de Médecine Interne et d’Immunologie Clinique, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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van Stormbroek K, van der Merwe T, O'Brien L, Myezwa H. "Surthriving" Hand Rehabilitation: Proposing Interventions to Support Novice Occupational Therapists Working in Underserved Contexts. Occup Ther Int 2023; 2023:5562025. [PMID: 38130935 PMCID: PMC10735728 DOI: 10.1155/2023/5562025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
Hand rehabilitation delivered to underserved South African communities is often the responsibility of novice or generalist occupational therapists. Novice therapists typically work with restricted supervision, support, and resources. Little is known about how these therapists should be supported in order to strengthen the services that they deliver. This study is aimed at understanding how novice occupational therapists in their first year of practice describe their experience of delivering hand rehabilitation in order to identify their support and development needs and propose interventions to address these needs. A qualitative instrumental case study design was used. Data were collected from novice occupational therapists (n = 9) who participated in an online community of practice. Data collection techniques included photoelicitation, facilitated reflection activities, and case discussion. Reflexive thematic analysis was employed. Trustworthiness strategies included reflexive writing, prolonged engagement, data source triangulation, member checking, and peer audit. Analysis generated three themes: (1) "submerged: I had to drown a little" captured participants' experience of being saturated by contextual features including poverty and poor basic management of hand injuries. (2) "Starting somewhere" captured participants' journey of treating patients with hand injuries. They transitioned from an initial sense of having "no idea" to developing "some idea"; their clinical reasoning was challenged when working with no diagnosis, unfamiliar presentations, or when contextual features rendered traditional approaches to therapy inappropriate. Finally, (3) "dynamics of 'surthrival'" captured elements that contributed to participants either thriving or merely surviving their hand rehabilitation experience. The proposed strategies identified in this study to address the support and development needs of novice therapists include interventions focused on systems and health services; learning opportunities to support competency and physical resources; and emotional support. Beyond application to the South African context, these strategies may be considered for supporting generalist or novice therapists delivering hand rehabilitation in other low- to middle-income countries.
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Affiliation(s)
- Kirsty van Stormbroek
- Department of Occupational Therapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tania van der Merwe
- Department of Occupational Therapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa O'Brien
- Swinburne University of Technology Hawthorn Campus, John Street, Hawthorn, Australia
| | - Hellen Myezwa
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Radu I, Scheermesser M, Spiess MR, Schulze C, Händler-Schuster D, Pehlke-Milde J. Digital Health for Migrants, Ethnic and Cultural Minorities and the Role of Participatory Development: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6962. [PMID: 37887700 PMCID: PMC10606156 DOI: 10.3390/ijerph20206962] [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: 07/06/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
Digital health interventions (DHIs) are increasingly used to address the health of migrants and ethnic minorities, some of whom have reduced access to health services and worse health outcomes than majority populations. This study aims to give an overview of digital health interventions developed for ethnic or cultural minority and migrant populations, the health problems they address, their effectiveness at the individual level and the degree of participation of target populations during development. We used the methodological approach of the scoping review outlined by Tricco. We found a total of 2248 studies, of which 57 were included, mostly using mobile health technologies, followed by websites, informational videos, text messages and telehealth. Most interventions focused on illness self-management, mental health and wellbeing, followed by pregnancy and overall lifestyle habits. About half did not involve the target population in development and only a minority involved them consistently. The studies we found indicate that the increased involvement of the target population in the development of digital health tools leads to a greater acceptance of their use.
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Affiliation(s)
- Irina Radu
- Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
| | - Mandy Scheermesser
- Institute of Physiotherapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
| | - Martina Rebekka Spiess
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (M.R.S.); (C.S.)
| | - Christina Schulze
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (M.R.S.); (C.S.)
| | - Daniela Händler-Schuster
- Institute of Nursing, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
- UMIT TIROL Institute for Nursing Science, Private University of Health Sciences and Health Technology, 6060 Hall in Tirol, Austria
- School of Nursing, Midwifery, and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington 6012, New Zealand
| | - Jessica Pehlke-Milde
- Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
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Holman H, Müller F, Bhangu N, Kottutt J, Alshaarawy O. Impact of limited English proficiency on the control of diabetes and associated cardiovascular risk factors. The National Health and Nutrition Examination Survey, 2003-2018. Prev Med 2023; 167:107394. [PMID: 36563970 DOI: 10.1016/j.ypmed.2022.107394] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
Language barriers pose a challenge to managing health conditions for various personal, interpersonal, and structural reasons. This study estimates the impact of limited English proficiency (LEP) on diabetes mellitus control and associated cardiovascular risk factors in a large representative sample of United States adults. Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES, 2003-18) was used to estimate the impact of language proficiency on glycemic control (glycated hemoglobin [HbA1c]) and cardiovascular risk status (blood pressure [BP] and low-density lipoprotein [LDL]) in adult participants with known diabetes disease. The analysis included descriptive statistics and generalized linear models to adjust for sociodemographic characteristics. The study sample included 5017 participants with self-reported, physician-diagnosed diabetes mellitus. Most participants completed NHANES interview in English (90.8%), whereas some participants completed the interview in Spanish (LEP-Spanish; 6.6%) or requested an interpreter (LEP-interpreter; 2.6%). Compared to English-speaking participants, LEP-interpreter participants were more likely to have HbA1c ≥ 7% (OR = 1.6, 95% CI = 1.1, 2.4) or a combination of HbA1c ≥ 7%, LDL ≥ 2.6 mmol/L, and BP ≥ 130/80 mmHg (OR = 3.1; 95% CI = 1.2, 8.2). We observed no differences in the odds of diabetes control. between English-speaking and LEP-Spanish participants, whereas LEP-interpreter participants had worse diabetes control, possibly owing to the greater likelihood of patient-provider language discordance for non-English non-Spanish-speaking patients. Given that many patients, yet few providers, speak languages other than English or Spanish, innovative ways are needed to facilitate patient-provider communications (e.g., digital communication assistance tools).
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Affiliation(s)
- Harland Holman
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Spectrum Health Family Medicine Residency Clinic, Grand Rapids, MI 49503, USA
| | - Frank Müller
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Spectrum Health Family Medicine Residency Clinic, Grand Rapids, MI 49503, USA; Department of General Practice, University Medical Center Göttingen, Germany.
| | - Nikita Bhangu
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Jepkoech Kottutt
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Omayma Alshaarawy
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
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Müller F, Abdelnour AM, Rutaremara DN, Arnetz JE, Achtyes ED, Alshaarawy O, Holman HT. Mental Health Screening Differences in Non-English Speaking Patients: Results From a Retrospective Cohort Study. J Prim Care Community Health 2023; 14:21501319231200304. [PMID: 37714820 PMCID: PMC10504842 DOI: 10.1177/21501319231200304] [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: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE To assess differences in mental health screening based on patient's preferred language. METHODS For this retrospective cohort study, data for 85 725 unique patients from 10 primary care clinics in West Michigan were analyzed if patients received at least 1 mental health screening with the Patient Health Questionnaire 4 (PHQ-4) within a 12-month period (10/15/2021-10/14/2022). A general linear regression model was used to assess the adjusted odds ratios (aOR) of being screened. RESULTS Patients having a preferred language other than English (n = 2755) had an 87.0% chance of receiving the recommended mental health screening, compared to 76.7% of English-speaking patients (P < .001). A multivariable model revealed decreased screening odds for Kinyarwanda (aOR 0.29, 95% CI 0.19-0.45) and Persian/Dari/Pashto (aOR 0.46, 95% CI 0.23-0.91) speaking patients and higher screening odds for Spanish (aOR 1.45, 95% CI 1.19-1.77), Bosnian (aOR 2.13, 95% CI 1.11-4.11), and Vietnamese (aOR 2.25 95% CI 1.64-3.08) speaking patients compared to English speaking patients. CONCLUSIONS Results highlight the inequities between the language groups that are probably the result of the challenges to access multilingual depression and anxiety screening instruments. Furthermore, providers may be prone to bias about who they think "needs" a mental health screening. We suggest that measures are implemented to ensure consistency in mental health screening regardless of a patients' preferred language.
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Affiliation(s)
- Frank Müller
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Alyssa M. Abdelnour
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Diana N. Rutaremara
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Judith E. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Eric D. Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Omayma Alshaarawy
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Harland T. Holman
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA
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11
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Berdahl CT, Henreid AJ, Pevnick JM, Zheng K, Nuckols TK. Digital Tools Designed to Obtain the History of Present Illness From Patients: Scoping Review. J Med Internet Res 2022; 24:e36074. [PMID: 36394945 PMCID: PMC9716422 DOI: 10.2196/36074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/25/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Many medical conditions, perhaps 80% of them, can be diagnosed by taking a thorough history of present illness (HPI). However, in the clinical setting, situational factors such as interruptions and time pressure may cause interactions with patients to be brief and fragmented. One solution for improving clinicians’ ability to collect a thorough HPI and maximize efficiency and quality of care could be to use a digital tool to obtain the HPI before face-to-face evaluation by a clinician.
Objective
Our objective was to identify and characterize digital tools that have been designed to obtain the HPI directly from patients or caregivers and present this information to clinicians before a face-to-face encounter. We also sought to describe outcomes reported in testing of these tools, especially those related to usability, efficiency, and quality of care.
Methods
We conducted a scoping review using predefined search terms in the following databases: MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, IEEE Xplore Digital Library, ACM Digital Library, and ProQuest Dissertations & Theses Global. Two reviewers screened titles and abstracts for relevance, performed full-text reviews of articles meeting the inclusion criteria, and used a pile-sorting procedure to identify distinguishing characteristics of the tools. Information describing the tools was primarily obtained from identified peer-reviewed sources; in addition, supplementary information was obtained from tool websites and through direct communications with tool creators.
Results
We identified 18 tools meeting the inclusion criteria. Of these 18 tools, 14 (78%) used primarily closed-ended and multiple-choice questions, 1 (6%) used free-text input, and 3 (17%) used conversational (chatbot) style. More than half (10/18, 56%) of the tools were tailored to specific patient subpopulations; the remaining (8/18, 44%) tools did not specify a target subpopulation. Of the 18 tools, 7 (39%) included multilingual support, and 12 (67%) had the capability to transfer data directly into the electronic health record. Studies of the tools reported on various outcome measures related to usability, efficiency, and quality of care.
Conclusions
The HPI tools we identified (N=18) varied greatly in their purpose and functionality. There was no consensus on how patient-generated information should be collected or presented to clinicians. Existing tools have undergone inconsistent levels of testing, with a wide variety of different outcome measures used in evaluation, including some related to usability, efficiency, and quality of care. There is substantial interest in using digital tools to obtain the HPI from patients, but the outcomes measured have been inconsistent. Future research should focus on whether using HPI tools can lead to improved patient experience and health outcomes, although surrogate end points could instead be used so long as patient safety is monitored.
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Affiliation(s)
- Carl T Berdahl
- Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | | | | | - Kai Zheng
- University of California Irvine Donald Bren School of Information and Computer Sciences, Irvine, CA, United States
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Sonoda K, Takedai T, Salter C. Communication sheet eases barriers for Japanese patients and health professionals. BMC Health Serv Res 2022; 22:976. [PMID: 35907847 PMCID: PMC9339196 DOI: 10.1186/s12913-022-08371-x] [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: 11/12/2021] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Language and cultural barriers can affect healthcare outcomes of minority populations. However, limited data are available on communication tools developed to address health disparities resulting from language and cultural barriers. Our study aimed to reduce communication barriers between Japanese patients and non-Japanese-speaking clinic staff by developing a Japanese-English Communication Sheet (JECS) to create more equitable clinical environments for Japanese patients in ambulatory care. Methods This study was conducted at a family health center in a United States urban setting, in the city of Pittsburgh, between November 2019 and August 2020. This study included Japanese adult patients who had health care office visits with one of two Japanese-speaking physicians and who completed a survey about the JECS. The JECS, written in Japanese and English, targets common sources of confusion by presenting common health questions, written in Japanese, and by explaining differences between common healthcare processes in Japan and the United States. Clinic staff who used the JECS with Japanese-speaking patients also were surveyed about the tool. Results Sixty Japanese patients met inclusion criteria and completed the survey. More than half of participants found the JECS useful, and those with self-reported limited English proficiency were most likely to report that the JECS was useful (p = 0.02). All nine non-Japanese speaking staff surveyed found the sheet helpful. Conclusions The JECS is a useful communication tool for addressing common barriers faced by Japanese patients seeking care at an American health center where Japanese-speaking physicians work but no clinic staff speak Japanese. A focused communication sheet can facilitate communication between patients and clinic staff and also reduce health inequities resulting from linguistic and cultural barriers. Additionally, using a communication sheet can advance quality and safety of patient care at the individual and institutional level. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08371-x.
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Affiliation(s)
- Kento Sonoda
- Department of Family Medicine, University of Pittsburgh Medical Center Shadyside, 5215 Centre Avenue, Pittsburgh, PA, 15232, USA. .,Department of Family and Community Medicine, Saint Louis University, Saint Louis, MO, USA.
| | - Teiichi Takedai
- Department of Family Medicine, University of Pittsburgh Medical Center Shadyside, 5215 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Cynthia Salter
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Albrink K, Joos C, Schröder D, Müller F, Hummers E, Noack EM. Obtaining patients' medical history using a digital device prior to consultation in primary care: study protocol for a usability and validity study. BMC Med Inform Decis Mak 2022; 22:189. [PMID: 35854290 PMCID: PMC9297616 DOI: 10.1186/s12911-022-01928-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background With the help of digital tools patients’ medical histories can be collected quickly and transferred into their electronic medical records. This information can facilitate treatment planning, reduce documentation work, and improve care. However, it is still unclear whether the information collected from patients in this way is reliable. In this study, we assess the accuracy of the information collected by patients using an app for medical history taking by comparing it with the information collected in a face-to-face medical interview. We also study the app’s usability from the patients’ point of view and analysing usage data. Methods We developed a software application (app) for symptom-oriented medical history taking specialized for general practice. Medical history taking will take place involving patients with acute somatic or psychological complaints (1) using the app and (2) verbally with trained study staff. To assess the perceived usability, patients will complete a questionnaire for the System Usability Scale. We will collect sociodemographic data, information about media use and health literacy, and app usage data.
Discussion Digital tools offer the opportunity to improve patient care. However, it is not self-evident that the medical history taken by digital tools corresponds to the medical history that would be taken in an interview. If simply due to a design flaw patients answer questions about signs and symptoms that indicate possible serious underlying conditions ‘wrong’, this could have severe consequences. By additionally assessing the app’s usability as perceived by a diverse group of patients, potential weaknesses in content, design and navigation can be identified and subsequently improved. This is essential in order to ensure that the app meets the need of different groups of patients.
Trial registration German Clinical Trials Register DRKS00026659, registered Nov 03 2021. World Health Organization Trial Registration Data Set, https://trialsearch.who.int/Trial2.aspx? TrialID = DRKS00026659.
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Affiliation(s)
- Klara Albrink
- Department of General Practice, University Medical Center Göttingen, Georg-August-University of Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Carla Joos
- Department of General Practice, University Medical Center Göttingen, Georg-August-University of Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Georg-August-University of Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Georg-August-University of Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Georg-August-University of Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Eva Maria Noack
- Department of General Practice, University Medical Center Göttingen, Georg-August-University of Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
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14
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Dinari F, Bahaadinbeigy K, Moulaei K. Analysis of requirements for developing a mobile device‐based medicines management application for people who are blind and visually impaired. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Fatemeh Dinari
- Medical Informatics Research Centre Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Centre Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
| | - Khadijeh Moulaei
- Medical Informatics Research Centre Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
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15
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Scheder-Bieschin J, Blümke B, de Buijzer E, Cotte F, Echterdiek F, Nacsa J, Ondresik M, Ott M, Paul G, Schilling T, Schmitt A, Wicks P, Gilbert S. Improving Emergency Department Patient-Physician Conversation Through an Artificial Intelligence Symptom-Taking Tool: Mixed Methods Pilot Observational Study. JMIR Form Res 2022; 6:e28199. [PMID: 35129452 PMCID: PMC8861871 DOI: 10.2196/28199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/21/2021] [Accepted: 12/14/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Establishing rapport and empathy between patients and their health care provider is important but challenging in the context of a busy and crowded emergency department (ED). OBJECTIVE We explore the hypotheses that rapport building, documentation, and time efficiency might be improved in the ED by providing patients a digital tool that uses Bayesian reasoning-based techniques to gather relevant symptoms and history for handover to clinicians. METHODS A 2-phase pilot evaluation was carried out in the ED of a German tertiary referral and major trauma hospital that treats an average of 120 patients daily. Phase 1 observations guided iterative improvement of the digital tool, which was then further evaluated in phase 2. All patients who were willing and able to provide consent were invited to participate, excluding those with severe injury or illness requiring immediate treatment, with traumatic injury, incapable of completing a health assessment, and aged <18 years. Over an 18-day period with 1699 patients presenting to the ED, 815 (47.96%) were eligible based on triage level. With available recruitment staff, 135 were approached, of whom 81 (60%) were included in the study. In a mixed methods evaluation, patients entered information into the tool, accessed by clinicians through a dashboard. All users completed evaluation Likert-scale questionnaires rating the tool's performance. The feasibility of a larger trial was evaluated through rates of recruitment and questionnaire completion. RESULTS Respondents strongly endorsed the tool for facilitating conversation (61/81, 75% of patients, 57/78, 73% of physician ratings, and 10/10, 100% of nurse ratings). Most nurses judged the tool as potentially time saving, whereas most physicians only agreed for a subset of medical specialties (eg, surgery). Patients reported high usability and understood the tool's questions. The tool was recommended by most patients (63/81, 78%), in 53% (41/77) of physician ratings, and in 76% (61/80) of nurse ratings. Questionnaire completion rates were 100% (81/81) by patients and 96% (78/81 enrolled patients) by physicians. CONCLUSIONS This pilot confirmed that a larger study in the setting would be feasible. The tool has clear potential to improve patient-health care provider interaction and could also contribute to ED efficiency savings. Future research and development will extend the range of patients for whom the history-taking tool has clinical utility. TRIAL REGISTRATION German Clinical Trials Register DRKS00024115; https://drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024115.
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Affiliation(s)
- Justus Scheder-Bieschin
- Department of Interdisciplinary Acute, Emergency and Intensive Care Medicine (DIANI), Klinikum Stuttgart, Stuttgart, Germany
| | | | | | | | | | | | | | - Matthias Ott
- Department of Interdisciplinary Acute, Emergency and Intensive Care Medicine (DIANI), Klinikum Stuttgart, Stuttgart, Germany
| | - Gregor Paul
- Department of Infectious Diseases, Klinikum Stuttgart, Stuttgart, Germany
| | - Tobias Schilling
- Department of Interdisciplinary Acute, Emergency and Intensive Care Medicine (DIANI), Klinikum Stuttgart, Stuttgart, Germany
| | | | | | - Stephen Gilbert
- Ada Health, Berlin, Germany.,The Else Kröner Fresenius Center for Digital Health, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
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16
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Benda NC, Bisantz AM, Butler RL, Fairbanks RJ, Higginbotham J. The active role of interpreters in medical discourse - An observational study in emergency medicine. PATIENT EDUCATION AND COUNSELING 2022; 105:62-73. [PMID: 34052053 DOI: 10.1016/j.pec.2021.05.029] [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: 12/08/2020] [Revised: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study communicative tasks executed and related strategies used by patients, health professionals, and medical interpreters. METHODS English proficient and limited English proficient emergency department patients were observed. The content of patient-hospital staff communication was documented via pen and paper. Key themes and differences across interpreter types were established through qualitative analysis. Themes and differences across interpreter type were vetted and updated through member checking interviews. RESULTS 6 English proficient and 9 limited English proficient patients were observed. Key themes in communicative tasks included: establishing, maintaining, updating, and repairing understanding and rapport. All tasks were observed with English proficient and limited English proficient patients. The difference with limited English proficient patients was that medical interpreters played an active role in completing communicative tasks. Telephone-based interpreters faced challenges in facilitating communicative tasks based on thematic comparisons with in-person interpreters, including issues hearing and lost information due to the lack of visual cues. CONCLUSIONS Professional interpreters play an important role in communication between language discordant patients and health professionals that goes beyond verbatim translation. PRACTICAL IMPLICATIONS Training for interpreters and health professionals, and the design of tools for facilitating language discordant communication, should consider the role of interpreters beyond verbatim translation.
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Affiliation(s)
- Natalie C Benda
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA; MedStar Health National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA; Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61st St., Suite 301, New York 10065, NY, USA.
| | - Ann M Bisantz
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA
| | - Rebecca L Butler
- MedStar Health National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA; MedStar Quality and Safety, MedStar Health, Columbia, MD, USA
| | - Rollin J Fairbanks
- MedStar Health National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA; MedStar Quality and Safety, MedStar Health, Columbia, MD, USA
| | - Jeff Higginbotham
- Department of Communicative Disorders and Sciences, Buffalo, NY, USA
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17
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P Iqbal M, Walpola R, Harris-Roxas B, Li J, Mears S, Hall J, Harrison R. Improving primary health care quality for refugees and asylum seekers: A systematic review of interventional approaches. Health Expect 2021; 25:2065-2094. [PMID: 34651378 PMCID: PMC9615090 DOI: 10.1111/hex.13365] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 12/30/2022] Open
Abstract
Background It has been widely acknowledged that refugees are at risk of poorer health outcomes, spanning mental health and general well‐being. A common point of access to health care for the migrant population is via the primary health care network in the country of resettlement. This review aims to synthesize the evidence of primary health care interventions to improve the quality of health care provided to refugees and asylum seekers. Methods A systematic review was undertaken, and 55 articles were included in the final review. The Preferred Reporting Items for Systematic Reviews was used to guide the reporting of the review, and articles were managed using a reference‐management software (Covidence). The findings were analysed using a narrative empirical synthesis. A quality assessment was conducted for all the studies included. Results The interventions within the broad primary care setting could be organized into four categories, that is, those that focused on developing the skills of individual refugees/asylum seekers and their families; skills of primary health care workers; system and/or service integration models and structures; and lastly, interventions enhancing communication services. Promoting effective health care delivery for refugees, asylum seekers and their families is a complex challenge faced by primary care professionals, the patients themselves and the communication between them. Conclusion This review highlights the innovative interventions in primary care promoting refugee health. Primary care interventions mostly focused on upskilling doctors, with a paucity of research exploring the involvement of other health care members. Further research can explore the involvement of interprofessional team members in providing effective refugee/migrant health. Patient or Public Contribution Patient and public involvement was explored in terms of interventions designed to improve health care delivery for the humanitarian migrant population, that is, specifically refugees and asylum seekers.
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Affiliation(s)
- Maha P Iqbal
- School of Population Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ramesh Walpola
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,South Eastern Sydney Research Collaboration Hub (SEaRCH), Population and Community Health, South Eastern Sydney Local Health District, Darlinghurst, New South Wales, Australia
| | - Jiadai Li
- School of Population Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Mears
- Hunter New England Medical Library, New Lambton, New South Wales, Australia
| | - John Hall
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation; Level 6, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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18
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Noack EM, Schulze J, Müller F. Designing an App to Overcome Language Barriers in the Delivery of Emergency Medical Services: Participatory Development Process. JMIR Mhealth Uhealth 2021; 9:e21586. [PMID: 33851933 PMCID: PMC8082383 DOI: 10.2196/21586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/29/2020] [Accepted: 02/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background In emergencies, language barriers may have dangerous consequences for the patients. There have been some technical approaches to overcome language barriers in medical care but not yet in the prehospital emergency care setting. The use of digital technologies in health care is expanding rapidly. Involving end users at all stages of the development process may help to ensure such technologies are usable and can be implemented. Objective We aimed to develop a digital communication tool that addresses paramedic needs in the specific circumstances of prehospital emergency care and helps paramedics to overcome language barriers when providing care to foreign-language patients. Methods We actively engaged paramedics and software designers in an action-oriented, participatory, iterative development process, which included field observations, workshops, background conversations, questionnaires on rescue missions, studying the literature, and preliminary testing in the field. Results With input from paramedics, we created an app with 600 fixed phrases supporting 18 languages. The app includes medical history–taking questions, phrases asking for consent, and phrases providing specific additional information. Children as patients, as well as their carers and other third parties, can be addressed with appropriate wording. All phrases can be played back audibly or displayed as text. The comprehensive content is grouped into categories and adapted to diverse scenarios, which makes the tool rapidly usable. The app includes a function to document patient responses and the conversation history. For evaluation in a clinical study, the app is run on a smartphone with extra speakers to be of use in noisy environments. The use of prototypes proved valuable to verify that the content, structure, and functions discussed in theory were of value and genuinely needed in practice and that the various device control elements were intuitive. Conclusions The nature of the paramedic work environment places specific demands on the communication options used and need for such devices. The active involvement of paramedics in the development process allowed us to understand and subsequently consider their experience-based knowledge. Software designers could understand the paramedics’ work environment and consider respective needs in the menu navigation and design principles of the app. We argue that the development of any medical software product should actively involve both end users and developers in all phases of the development process. Providing the users with the opportunity to influence technology development ensures that the result is closer to their needs, which can be seen as crucial for successful implementation and sustainable use. Trial Registration German Clinical Trials Register DRKS00016719; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016719 International Registered Report Identifier (IRRID) RR2-10.1186/s12913-020-05098-5
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Affiliation(s)
- Eva Maria Noack
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Jennifer Schulze
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
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19
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Whitelaw S, Pellegrini DM, Mamas MA, Cowie M, Van Spall HGC. Barriers and facilitators of the uptake of digital health technology in cardiovascular care: a systematic scoping review. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:62-74. [PMID: 34048508 PMCID: PMC8139413 DOI: 10.1093/ehjdh/ztab005] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/12/2021] [Accepted: 01/24/2021] [Indexed: 01/31/2023]
Abstract
Digital health technology (DHT) has the potential to revolutionize healthcare delivery but its uptake has been low in clinical and research settings. The factors that contribute to the limited adoption of DHT, particularly in cardiovascular settings, are unclear. The objective of this review was to determine the barriers and facilitators of DHT uptake from the perspective of patients, clinicians, and researchers. We searched MEDLINE, EMBASE, and CINAHL databases for studies published from inception to May 2020 that reported barriers and/or facilitators of DHT adoption in cardiovascular care. We extracted data on study design, setting, cardiovascular condition, and type of DHT. We conducted a thematic analysis to identify barriers and facilitators of DHT uptake. The search identified 3075 unique studies, of which 29 studies met eligibility criteria. Studies employed: qualitative methods (n = 13), which included interviews and focus groups; quantitative methods (n = 5), which included surveys; or a combination of qualitative and quantitative methods (n = 11). Twenty-five studies reported patient-level barriers, most common of which were difficult-to-use technology (n=7) and a poor internet connection (n=7). Six studies reported clinician-level barriers, which included increased workload (n=4) and a lack of integration with electronic medical records (n=3).Twenty-four studies reported patient-level facilitators, which included improved communication with clinicians (n=10) and personalized technology (n=6). Four studies reported clinician-level facilitators, which included approval and organizational support from cardiology departments and/or hospitals (n=3) and technologies that improved efficiency (n=3). No studies reported researcher-level barriers or facilitators. In summary, internet access, user-friendliness, organizational support, workflow efficiency, and data integration were reported as important factors in the uptake of DHT by patients and clinicians. These factors can be considered when selecting and implementing DHTs in cardiovascular clinical settings.
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Affiliation(s)
- Sera Whitelaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
| | - Danielle M Pellegrini
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Mamas A Mamas
- Institute of Population Health, University of Manchester, Oxford Rd, Manchester M13 9PL, UK,Keele Cardiovascular Research Group, Keele University, Newcastle ST5 5BG, UK
| | - Martin Cowie
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London SW7 2AZ, UK
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada,Department of Medicine, McMaster University, 20 Copeland Avenue, David Braley Research Building, Suite C3-117, Hamilton, ON L8L 0A3, Canada,Population Health Research Institute, 20 Copeland Ave, Hamilton, Ontario L8L 2X2, Canada,ICES, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada,Corresponding author. Tel: +1 905 521 2100, ext: 40601, Fax: +1 905 297 3785,
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20
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Kleinert E, Müller F, Kruse S, Furaijat G, Simmenroth A. [Usability and Efficiency of a Digital Communication Assistance Tool to Obtain Medical History from Non-German-Speaking Patients]. DAS GESUNDHEITSWESEN 2020; 83:531-537. [PMID: 32413911 DOI: 10.1055/a-1144-2848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM In the DICTUM-Friedland study, a medical history-taking app was implemented in an initial reception facility for refugees and asylum seekers. This app can be used to obtain from patients information about the most frequent general medical complaints and risk factors in 13 different languages or dialects. A report (synopsis) is generated, based on each patient's given data, in the German language. Usability and efficiency of obtaining medical history were the criteria evaluated in order to test and optimize the app for use in a broader general medical setting. METHODS From May to December 2018, the app was tested in the waiting room of the general medical ward in the refugee camp in Friedland in southern Lower Saxony, Germany. Patients were asked to complete a short digital questionnaire about the usability of the app immediately after finishing the query. Sociodemographic data were partly collected with the same questionnaire and partly extracted from patient records. The efficiency was evaluated on the basis of the correspondence between the entered complaints (ICPC-2) and the diagnoses of the doctors (ICD-10). RESULTS In total, the app was used 353 times, and based on these, 283 medical histories were taken. The median time for entering the complaints was 10:27 minutes. The use of the audio output (60% of patients used this option) did not influence the usability. The majority of the users (76%) rated the app as easy to use and 65% of the users stated that they were able to enter their main complaints. Both assessments were independent of the age and sex of the users, but the educational level had a slightly more positive influence. The efficiency test showed that 51% (n=144) of the synopses matched fully and 28% (n=79) of the synopses matched partially with the medical diagnoses. CONCLUSION The systematic survey of the most frequent general medical complaints enables a more precise medical history taking in patients with whom a normal interview is not possible due to language barriers. Thus it serves as a support for the medical history taking. The app is easy to use and not prone to the errors of online translations.
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Affiliation(s)
- Evelyn Kleinert
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen
| | - Frank Müller
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen
| | - Stefan Kruse
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen
| | - Ghefar Furaijat
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen
| | - Anne Simmenroth
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen.,Institut für Allgemeinmedizin, Universitätsklinikum Würzburg, Wurzburg
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