1
|
Wong AKC, Kwok VWY, Wong FKY, Tong DWK, Yuen BMK, Fong CS, Chan ST, Li WC, Zhou S, Lee AYL. Improving post-acute stroke follow-up care by adopting telecare consultations in a nurse-led clinic: Study protocol of a hybrid implementation-effectiveness trial. J Adv Nurs 2024; 80:1222-1231. [PMID: 37950400 DOI: 10.1111/jan.15960] [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: 08/31/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
AIM To evaluate the clinical effectiveness and implementation strategies of telecare consultations in post-stroke nurse-led clinics. BACKGROUND Telecare consultations could be an alternative to conventional in-person consultations and improve continuity of care for stroke survivors following their discharge from hospital. Previous studies utilizing telecare consultations only focused on testing their clinical effectiveness on stroke survivors; the appropriateness and feasibility of adopting this new delivery modality in a real-world setting were not examined. DESIGN A Type II hybrid effectiveness-implementation design will be adopted. METHODS Eligible stroke survivor participants will be randomly assigned to the intervention group (telecare consultation) or control group (usual in-person clinic consultation). Both groups will receive the same nursing intervention but delivered through different channels. The Reach, Effectiveness, Adoption, Implementation, Maintenance framework will be used to evaluate the clinical effectiveness and implementation outcomes. The primary outcome is the non-inferiority of the degree of disability between the two groups at 3 months into the intervention and at 3 months post-intervention. The paper complies with the SPIRIT guidelines for study protocols adapted for designing and reporting parallel group randomized trials. CONCLUSION The findings of this study will provide key insights into the processes for implementing and adopting telecare consultations into long-term services for post-stroke patients. IMPACT This study contributes to the translation of telecare consultations for stroke survivors into real-life settings. If effective, this program may provide guidance for expanding telecare consultations to other post-stroke nurse-led clinics or to patients with other chronic diseases. TRIAL REGISTRATION This study has been registered at clinicaltrials.gov (identifier: NCT05183672). Registered on 10 January 2022.
Collapse
Affiliation(s)
| | | | | | - Danny Wah Kun Tong
- Hospital Authority Head Office, Hospital Authority Building, Homantin, Hong Kong
| | | | - Ching Sing Fong
- Queen Elizabeth Hospital, Hospital Authority, Homantin, Hong Kong
| | - Shun Tim Chan
- Queen Elizabeth Hospital, Hospital Authority, Homantin, Hong Kong
| | - Wah Chun Li
- Queen Elizabeth Hospital, Hospital Authority, Homantin, Hong Kong
| | - Shiyi Zhou
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | | |
Collapse
|
2
|
Eitenberger M, Gerger G, Klomfar S, Gabriel MA, Kletecka-Pulker M, Schaden E, Atanasov AG, Maleczek M, Völkl-Kernstock S, Klager E. Focusing on experts: Expectations of healthcare professionals regarding the use of telemedicine in intensive care units. Digit Health 2024; 10:20552076241257042. [PMID: 38836049 PMCID: PMC11149446 DOI: 10.1177/20552076241257042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024] Open
Abstract
Objectives Telemedical applications are solutions to challenges in the healthcare system. However, it is unclear what intensive care unit healthcare professionals expect from such solutions. This study investigated the expectations and concerns of nurses and physicians when implementing telemedicine tools in intensive care units (tele-ICU). Methods The study was conducted in intensive care units in 2020 during the second wave of the COVID-19 pandemic. It used a mixed-methods approach targeted at physicians and nurses and involved 14 qualitative interviews and 63 quantitative questionnaires. Results The qualitative and quantitative data showed that both nurses and physicians were willing to use tele-ICU. Nurses recognised the advantages of real-time access to expertise offered by tele-ICU, but feared this would reduce physicians' on-site patient time. Physicians, in turn, were concerned that they would be expected to be continuously on call. The majority in both groups agreed that any tele-ICU solution must be simple to use and integrate easily into existing organisational structures, networks, and work routines. Additionally, COVID-19 significantly influenced expectations: those who reported having more personal health concerns during the pandemic were more predisposed to favour the use of tele-ICU. Conclusions Overall, tele-ICU supports better care, but a successful implementation depends on its ease of use and context-sensitive approaches. Effectively integrating tele-ICU solutions into daily clinical routines requires input from nurses and physicians and their involvement in the implementation process from the outset, as well as consideration of existing organisational structures. Such measures will vastly increase the chance of acceptance and successful adoption of telemedical solutions in clinical practice.
Collapse
Affiliation(s)
- Magdalena Eitenberger
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Political Science, University of Vienna, Vienna, Austria
| | - Gernot Gerger
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Sophie Klomfar
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | | | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, Vienna Austria
| | - Eva Schaden
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Atanas G Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Poland
| | - Mathias Maleczek
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Sabine Völkl-Kernstock
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Klager
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
3
|
Russo V, Mennini FS. COVID-19 Outbreak: A Call to Arms for the World Healthcare Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7175. [PMID: 38131726 PMCID: PMC10743049 DOI: 10.3390/ijerph20247175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/19/2023] [Indexed: 12/23/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) outbreak has placed a strong pressure on worldwide healthcare systems over the last years, testing their capacity to withstand stress [...].
Collapse
Affiliation(s)
- Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy
| | - Francesco Saverio Mennini
- Centre for Economics and International Studies—Economic Evaluation and Health Technology Assessment, Faculty of Economics, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| |
Collapse
|
4
|
Alanzi TM. Impact of ChatGPT on Teleconsultants in Healthcare: Perceptions of Healthcare Experts in Saudi Arabia. J Multidiscip Healthc 2023; 16:2309-2321. [PMID: 37601325 PMCID: PMC10438433 DOI: 10.2147/jmdh.s419847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose This study aims to investigate the impact of ChatGPT on teleconsultants in managing their operations and services. Methods A qualitative approach with focus groups is adopted in this study. A total of 54 participants with varying degrees of experience using AI such as ChatGPT in healthcare, including 11 physicians, 24 nurses, eight dieticians, six pharmacists, and five physiotherapists providing teleconsultations participated in this study. Results Twelve themes including informational support, diagnostic assistance, communication, enhancing efficiency, cost and time saving, personalizing care, multilingual support, assisting in medical research, decision-making, documentation, continuing education, and enhanced team collaboration reflecting positive impact were identified from the data analysis of seven focus groups. In addition, six themes including misdiagnosis and errors, issues in personalized care, ethical and legal issues, limited medical context/knowledge, communication challenges, and increased dependency reflecting negative impact were identified. Conclusion Although ChatGPT has several advantages for teleconsultants in the healthcare sector, it is associated with ethical issues.
Collapse
Affiliation(s)
- Turki M Alanzi
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
5
|
How COVID-19 Broke the Barriers Related to the Implementation of Telecare-Patients' Experiences with a New form of Providing Health Services in Primary Health Care. Healthcare (Basel) 2023; 11:healthcare11040497. [PMID: 36833033 PMCID: PMC9956090 DOI: 10.3390/healthcare11040497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly contributed to accelerating the development of telemedicine and eHealth. The main aim of this study was to assess the attitudes of patients towards remote care implemented in general practice (GP) during the pandemic. METHODS The study was a pilot study conducted in March-April 2021, considering technical aspects of using teleconsultations, and evaluating the difficulties, advantages and disadvantages for patients. When assessing opinions, a simple Likert scale was used, where a value of 1 meant the worst possible assessment or strong disagreement and the upper value the best or full agreement of the respondent. RESULTS The study covered 408 respondents. Their biggest organizational challenge reaching GPs by telephone, regardless of the patients' home location (p = 0.23698). Obtaining e-documents was not problematic but was rated as worse by men (p = 0.048295). Respondents rated the overall effectiveness of teleconsultations more highly if they could speak directly with a doctor (p = 0.0005). There were no differences in willingness to recommend teleconsultations based on gender (p = 0.2432), place of residence (p = 0.7878), age (p = 0.290355) or education (p = 0.9109), but people assessing the overall effectiveness of telemedicine more highly were more willing to recommend it (p = 0.000). CONCLUSIONS Respondents assess teleconsultations in a differentiated way, noticing both positive and negative features of the remote form of providing health services.
Collapse
|
6
|
Gillam J, Evans C, Aworinde J, Ellis-Smith C, Ross J, Davies N. Co-design of a theory-based implementation plan for a holistic eHealth assessment and decision support framework for people with dementia in care homes. Digit Health 2023; 9:20552076231211118. [PMID: 38033518 PMCID: PMC10685752 DOI: 10.1177/20552076231211118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023] Open
Abstract
Background Despite positive findings around the use of eHealth in dementia care, it is rarely translated into routine practice. This can be facilitated by early involvement of end-users in the development of an implementation plan. This study aimed to co-design strategies to implement an eHealth intervention, the EMBED-Care Framework, to support assessment and decision-making for people with dementia in care homes. Methods A qualitative co-design method was applied through a series of workshops. Participants included family carers and health and social care practitioners. People with dementia were included through a series of stakeholder engagement meetings. The workshops focused on co-developing strategies in response to identified determinants of implementation. A codebook thematic analytic approach was taken, guided by the Normalisation Process Theory (NPT). Results Three workshops were conducted from July 2021 to November 2021, attended by 39 participants. Three overarching phases of implementation were identified which aligned with the constructs of the NPT: (a) incentivising adoption of the Framework, which requires promotion of its benefits and alignment with recommendations for good quality dementia care to engage stakeholders, relating to 'coherence' and 'cognitive participation' constructs; (b) enabling its operation, which requires ensuring compatibility with care home processes, provision of training and support from 'champions', relating to 'collective action'; (c) sustaining use of the Framework, which requires monitoring of implementation and appraisal of its effects, relating to 'reflexive monitoring'. Conclusions We have developed a multi-strategy, theoretically driven plan to implement eHealth to support assessment and decision-making for people with dementia in care homes. Successful implementation requires incentivisation to adopt, ability to operate and motivation to sustain use of eHealth. The plan is strengthened through collaborating with end-users to increase its value, credibility and real-world relevance. The theoretically informed strategies target mechanisms of the NPT, demonstrated to shape the implementation process and outcomes, ready for testing.
Collapse
Affiliation(s)
- Juliet Gillam
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, King's College London, London, UK
| | - Catherine Evans
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, King's College London, London, UK
- Brighton General Hospital, Sussex Community NHS Foundation Trust, Brighton, UK
| | - Jesutofunmi Aworinde
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, King's College London, London, UK
| | - Clare Ellis-Smith
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, King's College London, London, UK
| | - Jamie Ross
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| |
Collapse
|