1
|
Seuren LM, Shaw S. How Informal Carers Support Video Consulting in Physiotherapy, Heart Failure, and Cancer: Qualitative Study Using Linguistic Ethnography. J Med Internet Res 2024; 26:e51695. [PMID: 38819900 PMCID: PMC11179022 DOI: 10.2196/51695] [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: 08/08/2023] [Revised: 11/24/2023] [Accepted: 04/19/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Informal carers play an important role in the everyday care of patients and the delivery of health care services. They aid patients in transportation to and from appointments, and they provide assistance during the appointments (eg, answering questions on the patient's behalf). Video consultations are often seen as a way of providing patients with easier access to care. However, few studies have considered how this affects the role of informal carers and how they are needed to make video consultations safe and feasible. OBJECTIVE This study aims to identify how informal carers, usually friends or family who provide unpaid assistance, support patients and clinicians during video consultations. METHODS We conducted an in-depth analysis of the communication in a sample of video consultations drawn from 7 clinical settings across 4 National Health Service Trusts in the United Kingdom. The data set consisted of 52 video consultation recordings (of patients with diabetes, gestational diabetes, cancer, heart failure, orthopedic problems, long-term pain, and neuromuscular rehabilitation) and interviews with all participants involved in these consultations. Using Linguistic Ethnography, which embeds detailed analysis of verbal and nonverbal communication in the context of the interaction, we examined the interactional, technological, and clinical work carers did to facilitate video consultations and help patients and clinicians overcome challenges of the remote and video-mediated context. RESULTS Most patients (40/52, 77%) participated in the video consultation without support from an informal carer. Only 23% (12/52) of the consultations involved an informal carer. In addition to facilitating the clinical interaction (eg, answering questions on behalf of the patient), we identified 3 types of work that informal carers did: facilitating the use of technology; addressing problems when the patient could not hear or understand the clinician; and assisting with physical examinations, acting as the eyes, ears, and hands of the clinician. Carers often stayed in the background, monitoring the consultation to identify situations where they might be needed. In doing so, copresent carers reassured patients and helped them conduct the activities that make up a consultation. However, carers did not necessarily help patients solve all the challenges of a video consultation (eg, aiming the camera while laying hands on the patient during an examination). We compared cases where an informal carer was copresent with cases where the patient was alone, which showed that carers provided an important safety net, particularly for patients who were frail and experienced mobility difficulties. CONCLUSIONS Informal carers play a critical role in making video consultations safe and feasible, particularly for patients with limited technological experience or complex needs. Guidance and research on video consulting need to consider the availability and work done by informal carers and how they can be supported in providing patients access to digital health care services.
Collapse
Affiliation(s)
- Lucas Martinus Seuren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
2
|
Babaei N, Zamanzadeh V, Valizadeh L, Lotfi M, Kousha A, Samad-Soltani T, Avazeh M. Virtual care in the health care system: A concept analysis. Scand J Caring Sci 2024; 38:35-46. [PMID: 38009448 DOI: 10.1111/scs.13227] [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: 08/05/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Health care providers need a better understanding of virtual care to recognise and use it for service delivery. AIM To provide a more comprehensive definition of the concept of virtual care. METHOD This study was conducted based on Walker and Avant's concept analysis method. A comprehensive review of the published texts in English from 2012 to 2022 was performed using the PubMed, Web of Science, Scopus, ProQuest, Science Direct, Ovid, CINAHL and Google Scholar databases. RESULTS The main aspects and attributes of virtual care, including the use of any information and communication technology in various formats such as platforms, telephone calls, messages, email consultation, remote monitoring, secure and two-way digital communication between health care providers and patients, the possibility of providing remote care synchronously or asynchronously, more interaction between patients and caregivers, the possibility of transferring information between patients and health care providers and within the teams themselves, symptom management, sending diagnostic results in the form of video visits, and providing follow-up care, are attributes that distinguish virtual care from telehealth, telemedicine and other methods of providing remote healthcare services. CONCLUSION Considering the positive and negative consequences of implementing virtual care, the findings of this study developed a basis for an operational definition of the concept so that providers can understand the meaning of virtual care and consider it when providing virtual care to patients. The findings of this study can be used in many international and national contexts in the health care system and in future studies on interventions to increase the use of virtual care.
Collapse
Affiliation(s)
- Nasib Babaei
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Vahid Zamanzadeh
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Valizadeh
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Lotfi
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Kousha
- Department of Health Education and Health Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taha Samad-Soltani
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Marziyeh Avazeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
3
|
Flores-Sandoval C, Sibbald SL, Ryan BL, Adams TL, Suskin N, McKelvie R, Elliott J, Orange JB. Virtual care during COVID-19: The perspectives of older adults and their healthcare providers in a cardiac rehabilitation setting. Can J Aging 2024:1-8. [PMID: 38389488 DOI: 10.1017/s0714980824000102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
The present study aimed to explore the perspectives of older adults and health providers on cardiac rehabilitation care provided virtually during COVID-19. A qualitative exploratory methodology was used. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers. Five themes emerged from the data: (1) Lack of emotional intimacy when receiving virtual care, (2) Inadequacy of virtual platforms, (3) Saving time with virtual care, (4) Virtual care facilitated accessibility, and (5) Loss of connections with patients and colleagues. Given that virtual care continues to be implemented, and in some instances touted as an optimal option for the delivery of cardiac rehabilitation, it is critical to address the needs of older adults living with cardiovascular disease and their healthcare providers. This is particularly crucial related to issues accessing and using technology, as well as older adults' need to build trust and emotional connection with their providers.
Collapse
Affiliation(s)
| | - Shannon L Sibbald
- Faculty of Health Sciences, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
- Interfaculty Program in Public Health, Western University, London, Ontario, Canada
| | - Bridget L Ryan
- Departments of Family Medicine and Epidemiology and Biostatistics, Centre for Studies in Family Medicine
| | - Tracey L Adams
- Department of Sociology, Western University, London, Ontario, Canada
| | - Neville Suskin
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- St Joseph's Hospital Cardiac Rehabilitation & Secondary Prevention Program, London, Ontario, Canada
- St. Joseph's Health Care London, Ontario, Canada
| | - Robert McKelvie
- St Joseph's Hospital Cardiac Rehabilitation & Secondary Prevention Program, London, Ontario, Canada
- St. Joseph's Health Care London, Ontario, Canada
| | - Jacobi Elliott
- Lawson Health Research Institute, London, Ontario, Canada
| | - Joseph B Orange
- Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Communication Sciences and Disorders, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Canadian Centre for Activity and Aging, Western University, London, Ontario, Canada
| |
Collapse
|
4
|
Spithoff S, McPhail B, Vesely L, Rowe RK, Mogic L, Grundy Q. How the commercial virtual care industry gathers, uses and values patient data: a Canadian qualitative study. BMJ Open 2024; 14:e074019. [PMID: 38331904 PMCID: PMC10860095 DOI: 10.1136/bmjopen-2023-074019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES To understand and report on the direct-to-consumer virtual care industry in Canada, focusing on how companies collect, use and value patient data. DESIGN Qualitative study using situational analysis methodology. SETTING Canadian for-profit virtual care industry. PARTICIPANTS 18 individuals employed by or affiliated with the Canadian virtual care industry. METHODS Semistructured interviews were conducted between October 2021 and January 2022 and publicly available documents on websites of commercial virtual care platforms were retrieved. Analysis was informed by situational analysis, a constructivist grounded theory methodology, with a continuous and iterative process of data collection and analysis; theoretical sampling and creation of theoretical concepts to explain findings. RESULTS Participants described how companies in the virtual care industry highly valued patient data. Companies used data collected as patients accessed virtual care platforms and registered for services to generate revenue, often by marketing other products and services. In some cases, virtual care companies were funded by pharmaceutical companies to analyse data collected when patients interacted with a healthcare provider and adjust care pathways with the goal of increasing uptake of a drug or vaccine. Participants described these business practices as expected and appropriate, but some were concerned about patient privacy, industry influence over care and risks to marginalised communities. They described how patients may have agreed to these uses of their data because of high levels of trust in the Canadian health system, problematic consent processes and a lack of other options for care. CONCLUSIONS Patients, healthcare providers and policy-makers should be aware that the direct-to-consumer virtual care industry in Canada highly values patient data and appears to view data as a revenue stream. The industry's data handling practices of this sensitive information, in the context of providing a health service, have implications for patient privacy, autonomy and quality of care.
Collapse
Affiliation(s)
- Sheryl Spithoff
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Brenda McPhail
- Faculty of Social Sciences, McMaster University, Toronto, Ontario, Canada
| | | | - Robyn K Rowe
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Lana Mogic
- Women's College Hospital, Toronto, Ontario, Canada
| | - Quinn Grundy
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Wang T, Giunti G, Goossens R, Melles M. Timing, Indicators, and Approaches to Digital Patient Experience Evaluation: Umbrella Systematic Review. J Med Internet Res 2024; 26:e46308. [PMID: 38315545 PMCID: PMC10877490 DOI: 10.2196/46308] [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: 02/06/2023] [Revised: 06/05/2023] [Accepted: 11/29/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The increasing prevalence of DH applications has outpaced research and practice in digital health (DH) evaluations. Patient experience (PEx) was reported as one of the challenges facing the health system by the World Health Organization. To generate evidence on DH and promote the appropriate integration and use of technologies, a standard evaluation of PEx in DH is required. OBJECTIVE This study aims to systematically identify evaluation timing considerations (ie, when to measure), evaluation indicators (ie, what to measure), and evaluation approaches (ie, how to measure) with regard to digital PEx. The overall aim of this study is to generate an evaluation guide for further improving digital PEx evaluation. METHODS This is a 2-phase study parallel to our previous study. In phase 1, literature reviews related to PEx in DH were systematically searched from Scopus, PubMed, and Web of Science databases. Two independent raters conducted 2 rounds of paper screening, including title and abstract screening and full-text screening, and assessed the interrater reliability for 20% (round 1: 23/115 and round 2: 12/58) random samples using the Fleiss-Cohen coefficient (round 1: k1=0.88 and round 2: k2=0.80). When reaching interrater reliability (k>0.60), TW conducted the rest of the screening process, leaving any uncertainties for group discussions. Overall, 38% (45/119) of the articles were considered eligible for further thematic analysis. In phase 2, to check if there were any meaningful novel insights that would change our conclusions, we performed an updated literature search in which we collected 294 newly published reviews, of which 102 (34.7%) were identified as eligible articles. We considered them to have no important changes to our original results on the research objectives. Therefore, they were not integrated into the synthesis of this review and were used as supplementary materials. RESULTS Our review highlights 5 typical evaluation objectives that serve 5 stakeholder groups separately. We identified a set of key evaluation timing considerations and classified them into 3 categories: intervention maturity stages, timing of the evaluation, and timing of data collection. Information on evaluation indicators of digital PEx was identified and summarized into 3 categories (intervention outputs, patient outcomes, and health care system impact), 9 themes, and 22 subthemes. A set of evaluation theories, common study designs, data collection methods and instruments, and data analysis approaches was captured, which can be used or adapted to evaluate digital PEx. CONCLUSIONS Our findings enabled us to generate an evaluation guide to help DH intervention researchers, designers, developers, and program evaluators evaluate digital PEx. Finally, we propose 6 directions for encouraging further digital PEx evaluation research and practice to address the challenge of poor PEx.
Collapse
Affiliation(s)
- Tingting Wang
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Guido Giunti
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Clinical Medicine Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Richard Goossens
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Marijke Melles
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| |
Collapse
|
6
|
Lifford KJ, Grozeva D, Cannings-John R, Quinn-Scoggins H, Moriarty Y, Gjini A, Goddard M, Hepburn J, Hughes J, Moore G, Osborne K, Robling M, Townson J, Waller J, Whitelock V, Whitaker KL, Brain K. Satisfaction with remote consultations in primary care during COVID-19: a population survey of UK adults. Br J Gen Pract 2024; 74:e96-e103. [PMID: 38253548 PMCID: PMC10824329 DOI: 10.3399/bjgp.2023.0092] [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: 02/17/2023] [Accepted: 08/21/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Mode of access to primary care changed during the COVID-19 pandemic; remote consultations became more widespread. With remote consultations likely to continue in UK primary care, it is important to understand people's perceptions of remote consultations and identify potential resulting inequalities. AIM To assess satisfaction with remote GP consultations in the UK during the COVID-19 pandemic and identify demographic variation in satisfaction levels. DESIGN AND SETTING A cross-sectional survey from the second phase of a large UK-based study, which was conducted during the COVID-19 pandemic. METHOD In total, 1426 adults who self-reported having sought help from their doctor in the past 6 months completed an online questionnaire (February to March 2021). Items included satisfaction with remote consultations and demographic variables. Associations were analysed using multivariable regression. RESULTS A novel six-item scale of satisfaction with remote GP consultations had good psychometric properties. Participants with higher levels of education had significantly greater satisfaction with remote consultations than participants with mid-level qualifications (B = -0.82, 95% confidence interval [CI] = -1.41 to -0.23) or those with low or no qualifications (B = -1.65, 95% CI = -2.29 to -1.02). People living in Wales reported significantly higher satisfaction compared with those living in Scotland (B = -1.94, 95% CI = -3.11 to -0.78), although caution is warranted due to small group numbers. CONCLUSION These findings can inform the use and adaptation of remote consultations in primary care. Adults with lower educational levels may need additional support to improve their experience and ensure equitable care via remote consultations.
Collapse
Affiliation(s)
- Kate J Lifford
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
| | | | | | - Harriet Quinn-Scoggins
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
| | | | - Ardiana Gjini
- Public Health Wales; senior lecturer, Cardiff University, Cardiff
| | - Mark Goddard
- Centre for Trials Research, Cardiff University, Cardiff
| | - Julie Hepburn
- Public Involvement Community, Health and Care Research Wales Support Centre, Cardiff
| | | | - Graham Moore
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, Cardiff
| | | | | | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff
| | - Jo Waller
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine & Dentistry, Queen Mary University of London, London; reader of cancer screening & early diagnosis, School of Cancer and Pharmaceutical Sciences, King's College London, London
| | | | | | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
| |
Collapse
|
7
|
Zanaboni P, Bergmo TS, Kristiansen E. Patients' experiences with receiving sick leave certificates via remote consultations in Norway during the COVID-19 pandemic: a nationwide online survey. BMJ Open 2024; 14:e075352. [PMID: 38272547 PMCID: PMC10824015 DOI: 10.1136/bmjopen-2023-075352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES To explore patients' experiences with receiving sick leave certificates via remote consultations during the COVID-19 pandemic and investigate whether there were differences among the types of remote consultation (telephone, video or text). DESIGN A nationwide online patient survey consisting of quantitative data supplemented by qualitative opinions conducted in Norway. SETTING Primary care. PARTICIPANTS Patients who received a sick leave certificate via remote consultation in the period from 16 November to 15 December 2020. RESULTS Of the 5429 respondents, 3233 (59.6%) received a sick leave certificate via telephone consultation, 657 (12.1%) via video consultation and 1539 (28.3%) via text-based e-consultation. Most respondents (76.8%) were satisfied. Only 10% of the respondents thought that the doctor would have obtained more information through an office appointment. The majority of the respondents (59.6%) found that they had as much time to explain the problem as at an office appointment. Some patients also thought that it was easier to formulate the problem via a remote consultation (18.2%) and agree with the doctor on the sick leave (10.3%).The users of text-based e-consultations were the most satisfied (79.3%, p<0.001) compared with those using telephone or video consultations. Among users of text-based e-consultations, there was a higher proportion of patients who thought that they had more time to explain the problem compared with an office appointment (p<0.001), it was easier to explain the problem (p<0.001) and agree with the doctor (p<0.001). Most respondents would use the same type of remote consultation if they were to contact the general practitioner (GP) for the same problem, with the highest proportion among the users of video consultations (62.1%, p<0.001). CONCLUSIONS Patients were satisfied with communicating and receiving sick leave certificates via remote consultations. Future studies should investigate patients' and GPs' use and experiences in a postpandemic setting.
Collapse
Affiliation(s)
- Paolo Zanaboni
- University Hospital of North Norway, Tromso, Norway
- UiT The Arctic University of Norway, Tromso, Norway
| | | | | |
Collapse
|
8
|
Rey Velasco E, Pedersen HS, Laursen DH, Skinner T. A meta-narrative review of coding tools for healthcare interactions and their applicability to written communication. PEC INNOVATION 2023; 3:100211. [PMID: 37711399 PMCID: PMC10498410 DOI: 10.1016/j.pecinn.2023.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023]
Abstract
Background Although healthcare professionals (HCP) undergo communicative skills training, these are sometimes unsatisfactory for patients (empathy, discussion managing). Existing coding tools overlook the interaction and patients' responses. Meanwhile, remote consultations are redefining communication channels. While some researchers adapt those tools to telehealth, few investigate written interactions. Objective To identify and evaluate coding tools for healthcare interactions and examine their suitability for written interactions. Methods We conducted a meta-narrative review in PubMed, PsycINFO, Embase, Web of Science, CINAHL, and Scopus databases up to December 2022 with Communicati* AND Human* AND Linguistic* AND Professional-Patient Relation* as search terms. We extracted data regarding methodology, unit of analysis (UoA), coding categories, reliability, strengths, weaknesses, and inter-rater reliability (IRR). Results We identified 11 mixed-methods tools. Qualitatively, coding dimension was focused (n = 6) or comprehensive (n = 5). Main quantitative methods were descriptive statistics (n = 4) and cross-tabulations (n = 4). Main UoA was utterance (n = 7). Relevant categories were processes (n = 4), content (n = 3), emotional expressions and responses (n = 3), and grammatical format (n = 2). IRR ranged from 0.68 to 0.85 for coding categories. Conclusion Despite similarities, category terminologies were inconsistent, one-sided, and mostly covered conversation topics and behaviours. A tool with emotional and grammar categories could bridge the gap between a speaker's intended meaning and the receiver's interpretation to enhance patient-HCP communication. Furthermore, we need empirical research to determine whether these tools are suitable for written interactions. Innovation This review presents a comprehensive and state-of-the-art overview of healthcare interactions' coding tools and identifies their barriers. Our findings will support communication researchers in selecting appropriate coding tools for evaluating health interactions and enhancing HCP training.
Collapse
Affiliation(s)
- Elena Rey Velasco
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
- Liva Healthcare, Danneskiold-Samsøes Allé 41, 1434, Copenhagen K, Denmark
| | - Hanne Sæderup Pedersen
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
| | | | - Timothy Skinner
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
| |
Collapse
|
9
|
Ramachandran M, Brinton C, Wiljer D, Upshur R, Gray CS. The impact of eHealth on relationships and trust in primary care: a review of reviews. BMC PRIMARY CARE 2023; 24:228. [PMID: 37919688 PMCID: PMC10623772 DOI: 10.1186/s12875-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships. METHODS A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed. RESULTS A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively. CONCLUSIONS Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.
Collapse
Affiliation(s)
- Meena Ramachandran
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Christopher Brinton
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - David Wiljer
- Education Technology Innovation, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| |
Collapse
|
10
|
Lüchau EC, Atherton H, Olesen F, Søndergaard J, Assing Hvidt E. Interpreting technology: Use and non-use of doctor-patient video consultations in Danish general practice. Soc Sci Med 2023; 334:116215. [PMID: 37690154 DOI: 10.1016/j.socscimed.2023.116215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/15/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
This study uses socio-cognitive theory on technological frames to understand how and why general practitioners in Denmark use or choose not to use video consultations. Video consultations play a vital role in the digitalisation of the Danish healthcare system. Whilst political decision-makers continuously push for increased use of video consultations, uptake accounts for less than 2% of all consultations. Research is needed that explores the actual circumstances and conditions of video consultation use. Our data corpus consists of 30 semi-structured interviews conducted from August 2021 to August 2022 with 27 Danish general practitioners. Interviews were analysed following reflexive thematic analysis. Our findings show that video consultations are interpreted as 1) compromising occupational values, 2) a crisis tool, 3) the future, and 4) a tool to improve work conditions. Video consultations are differently adopted across clinics due to different interpretations of the technology and its relative advantage in specific clinical contexts. We argue that the concept of technological frames offers a useful analytic perspective for elucidating and anticipating attitudes and actions towards a technology. It increases our understanding of the uptake and rejection of video consultations. This knowledge is valuable for clinicians and politicians working with technological innovation in general practice.
Collapse
Affiliation(s)
- Elle Christine Lüchau
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark; Warwick Medical School, Unit of Academic Primary Care, University of Warwick, Coventry, CV4 7AL, United Kingdom.
| | - Helen Atherton
- Warwick Medical School, Unit of Academic Primary Care, University of Warwick, Coventry, CV4 7AL, United Kingdom.
| | - Finn Olesen
- School of Communication and Culture, Department of Digital Design and Information Studies, Aarhus University, Helsingforsgade 14, 8200, Århus N, Denmark.
| | - Jens Søndergaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Elisabeth Assing Hvidt
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| |
Collapse
|
11
|
Anchors Z, Jones B, Thomas R, Berry A, Walsh N. The impact of remote consultations on the health and wellbeing of first contact physiotherapists in primary care: A mixed methods study. Musculoskeletal Care 2023; 21:655-666. [PMID: 36762885 DOI: 10.1002/msc.1737] [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: 01/12/2023] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND First Contact Physiotherapists (FCPs) were introduced to reduce demands on GPs by providing improving access to expert musculoskeletal care. FCPs experience similar workplace stressors to GPs and there is an emerging concern that remote consultations are causing further impacts to their wellbeing. AIM To explore the impact of remote consultations on FCPs. METHODS A mixed methods sequential explanatory study with FCPs was conducted. An online survey measured the usage and impact of remote consultations. Semi-structured interviews explored the lived experiences of using remote consultations. RESULTS The online survey was completed by 109 FCPs. A key benefit of remote consultations was patient convenience; perceived challenges included IT issues, poor efficacy, FCP anxiety, isolation, and increased workload. FCPs viewed remote consultations as a 'challenge' rather than a 'threat'. Nearly two thirds of the FCPs had not received relevant training, yet over half were interested. Follow-up interviews with 16 FCPs revealed 4 themes: (1) Remote consultations provide logistical benefits to the patient; (2) Compromised efficacy is the key challenge of remote consultations; (3) Challenges for FCPs working in areas of high deprivation; and (4) Remote consultations impact the health, wellbeing and work satisfaction of FCPs. CONCLUSIONS Remote consultations offer a convenient alternative for patients, but may add to FCP stress particularly in areas of high socioeconomic deprivation. Further research is required to understand how remote consultations can be enhanced when communication barriers and lower levels of digital literacy exist. Continued monitoring of job satisfaction and resilience levels is important to ensure FCPs remain in their role.
Collapse
Affiliation(s)
- Zoe Anchors
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Bethan Jones
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Rachel Thomas
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Alice Berry
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Nicola Walsh
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- NIHR ARC West, Bristol, UK
| |
Collapse
|
12
|
Chappell P, Dias A, Bakhai M, Ledger J, Clarke GM. How is primary care access changing? A retrospective, repeated cross-sectional study of patient-initiated demand at general practices in England using a modern access model, 2019-2022. BMJ Open 2023; 13:e072944. [PMID: 37591638 PMCID: PMC10441067 DOI: 10.1136/bmjopen-2023-072944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES To explore trends in patient-initiated requests for general practice services and the association between patient characteristics including demographics, preferences for care and clinical needs and modes of patient contact (online vs telephone), and care delivery (face-to-face vs remote) at practices using a modern access model. DESIGN Retrospective repeated cross-sectional study spanning March 2019 to February 2022. SETTING General practices in England using the askmyGP online consultation system to implement a modern general practice access model using digital and non-digital (multimodal) access pathways and digitally supported triage to manage patient-initiated requests. PARTICIPANTS 10 435 465 patient-initiated requests from 1 488 865 patients at 154 practices. RESULTS Most requests were initiated online (72.1% in 2021/2022) rather than by telephone. Online users were likely to be female, younger than 45 years, asking about existing medical problems, had used the system before and frequent attenders (familiar patients). During the pandemic, request rates for face-to-face consultations fell while those for telephone consultations and online messages increased, with telephone consultations being most popular (53.8% in 2021/2022). Video was seldom requested. More than 60% of requests were consistently delivered in the mode requested. Face-to-face consultations were more likely to be used for the youngest and oldest patients, new medical problems, non-frequent attenders (unfamiliar patients) and those who requested a face-to-face consultation. Over the course of the study, request rates for patients aged over 44 years increased, for example, by 15.4% (p<0.01) for patients aged over 74 years. Rates for younger patients decreased by 32.6% (p<0.001) in 2020/2021, compared with 2019/2020, before recovering to prepandemic levels in 2021/2022. CONCLUSIONS Demand patterns shed light on the characteristics of patients making requests for general practice services and the composition of the care backlog with implications for policy and practice. A modern general practice access model can be used effectively to manage patient-initiated demand.
Collapse
Affiliation(s)
- Paul Chappell
- NHS England, London, UK
- Improvement Analytics Unit, The Health Foundation, London, UK
| | - Alison Dias
- NHS England, London, UK
- Improvement Analytics Unit, The Health Foundation, London, UK
| | | | | | | |
Collapse
|
13
|
Assing Hvidt E, Atherton H, Keuper J, Kristiansen E, Lüchau EC, Lønnebakke Norberg B, Steinhäuser J, van den Heuvel J, van Tuyl L. Low Adoption of Video Consultations in Post-COVID-19 General Practice in Northern Europe: Barriers to Use and Potential Action Points. J Med Internet Res 2023; 25:e47173. [PMID: 37213196 DOI: 10.2196/47173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023] Open
Abstract
In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post-COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries' general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism.
Collapse
Affiliation(s)
- Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical School, Coventry, United Kingdom
| | - Jelle Keuper
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg Universit, Tilburg, Netherlands
| | - Eli Kristiansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Elle Christine Lüchau
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - Lilian van Tuyl
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| |
Collapse
|
14
|
Norberg BL, Getz LO, Johnsen TM, Austad B, Zanaboni P. General Practitioners' Experiences With Potentials and Pitfalls of Video Consultations in Norway During the COVID-19 Lockdown: Qualitative Analysis of Free-Text Survey Answers. J Med Internet Res 2023; 25:e45812. [PMID: 36939814 PMCID: PMC10131921 DOI: 10.2196/45812] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND The use of video consultations (VCs) in Norwegian general practice rapidly increased during the COVID-19 pandemic. During societal lockdowns, VCs were used for nearly all types of clinical problems, as in-person consultations were kept to a minimum. OBJECTIVE This study aimed to explore general practitioners' (GPs') experiences of potentials and pitfalls associated with the use of VCs during the first pandemic lockdown. METHODS Between April 14 and May 3, 2020, all regular Norwegian GPs (N=4858) were invited to answer a web-based survey, which included open-ended questions about their experiences with the advantages and pitfalls of VCs. A total of 2558 free-text answers were provided by 657 of the 1237 GPs who participated in the survey. The material was subjected to reflexive thematic analysis. RESULTS Four main themes were identified. First, VCs are described as being particularly convenient, informative, and effective for consultations with previously known patients. Second, strategically planned VCs may facilitate effective tailoring of clinical trajectories that optimize clinical workflow. VCs allow for an initial overview of the problem (triage), follow-up evaluation after an in-person consultation, provision of advice and information concerning test results and discharge notes, extension of sick leaves, and delivery of other medical certificates. VCs may, in certain situations, enhance the GPs' insight in their patients' relational and socioeconomical resources and vulnerabilities, and even facilitate relationship-building with patients in need of care who might otherwise be reluctant to seek help. Third, VCs are characterized by a demarcated communication style and the "one problem approach," which may entail effectiveness in the short run. However, the web-based communication climate implies degradation of valuable nonverbal signals that are more evidently present in in-person consultations. Finally, overreliance on VCs may, in a longer perspective, undermine the establishment and maintenance of relational trust, with a negative impact on the quality of care and patient safety. Compensatory mechanisms include clarifying with the patient what the next step is, answering any questions and giving further advice on treatment if conditions do not improve or there is a need for follow-up. Participation of family members can also be helpful to improve reciprocal understanding and safety. CONCLUSIONS The findings have relevance for future implementation of VCs and deserve further exploration under less stressful circumstances.
Collapse
Affiliation(s)
- Børge Lønnebakke Norberg
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Centre for E-health Research, Tromsø, Norway
| | - Linn Okkenhaug Getz
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Bjarne Austad
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | | |
Collapse
|
15
|
Lenhard J, Margetts M, Meng E. Of not passing: homelessness, addiction, mental health and care during COVID-19. MEDICAL HUMANITIES 2023; 49:55-63. [PMID: 35820777 PMCID: PMC9985758 DOI: 10.1136/medhum-2021-012367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 06/11/2023]
Abstract
People experiencing homelessness in the UK were unconditionally offered housing (and support) from the beginning of the first lockdown in March 2020. For many, that meant '(re)entering' the support system and having a chance to 'move on' to longer-term housing. This beneficial effect of some of the policy reactions to the pandemic on people experiencing homelessness was unexpected. On the flip side, however, particularly for people struggling with drug use and mental health issues, adequate support was not available for long periods of time; support was either suspended temporarily or people were excluded from institutional support for not adhering to, for instance, lockdown rules. Similarly, digital support alternatives-modelled on increasingly widespread telemedicine-did often not work specifically for people struggling with complex needs or women experiencing homelessness. This research paper reports detailed evidence of what we observed as continued and catalysed exclusions based on interviews and ethnographic observations with both people experiencing homelessness and service providers from the beginning of the COVID-19 pandemic. Referring to our insights and learnings from three locally and temporally overlapping research projects between May 2020 and April 2021, we also propose changes to redesign future (health)care provision to prevent such impasses-which extend beyond lockdown situations to general conditional housing and support.
Collapse
Affiliation(s)
| | | | - Eana Meng
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Sauchelli S, Pickles T, Voinescu A, Choi H, Sherlock B, Zhang J, Colyer S, Grant S, Sundari S, Lasseter G. Public attitudes towards the use of novel technologies in their future healthcare: a UK survey. BMC Med Inform Decis Mak 2023; 23:38. [PMID: 36814262 PMCID: PMC9944774 DOI: 10.1186/s12911-023-02118-2] [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: 11/26/2021] [Accepted: 01/23/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Innovation in healthcare technologies can result in more convenient and effective treatment that is less costly, but a persistent challenge to widespread adoption in health and social care is end user acceptability. The purpose of this study was to capture UK public opinions and attitudes to novel healthcare technologies (NHTs), and to better understand the factors that contribute to acceptance and future use. METHODS An online survey was distributed to the UK public between April and May 2020. Respondents received brief information about four novel healthcare technologies (NHTs) in development: a laser-based tool for early diagnosis of osteoarthritis, a virtual reality tool to support diabetes self-management, a non-invasive continuous glucose monitor using microwave signals, a mobile app for patient reported monitoring of rheumatoid arthritis. They were queried on their general familiarity and attitudes to technology, and their willingness to accept each NHT in their future care. Responses were analysed using summary statistics and content analysis. RESULTS Knowledge about NHTs was diverse, with respondents being more aware about the health applications of mobile apps (66%), followed by laser-based technology (63.8%), microwave signalling (28%), and virtual reality (18.3%). Increasing age and the presence of a self-reported medical condition favoured acceptability for some NHTs, whereas self-reported understanding of how the NHT works resulted in elevated acceptance scores across all NHTs presented. Common contributors to hesitancy were safety and risks from use. Respondents wanted more information and evidence to help inform their decisions, ideally provided verbally by a general practitioner or health professional. Other concerns, such as privacy, were NHT-specific but equally important in decision-making. CONCLUSIONS Early insight into the knowledge and preconceptions of the public about NHTs in development can assist their design and prospectively mitigate obstacles to acceptance and adoption.
Collapse
Affiliation(s)
- Sarah Sauchelli
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals of Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
| | - Tim Pickles
- grid.5600.30000 0001 0807 5670Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Alexandra Voinescu
- grid.7340.00000 0001 2162 1699Department of Psychology, University of Bath, Bath, UK
| | - Heungjae Choi
- grid.5600.30000 0001 0807 5670School of Engineering, Cardiff University, Cardiff, UK
| | - Ben Sherlock
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jingjing Zhang
- grid.8356.80000 0001 0942 6946Department of Mathematical Sciences, University of Essex, Colchester, UK
| | - Steffi Colyer
- grid.7340.00000 0001 2162 1699Department of Health, University of Bath, Bath, UK
| | - Sabrina Grant
- grid.5337.20000 0004 1936 7603Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sethu Sundari
- grid.189530.60000 0001 0679 8269School of Nursing and Midwifery, University of Worcester, Worcester, UK
| | - Gemma Lasseter
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol in Collaboration with UK Health Security Agency (UKHSA), Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
17
|
Sheikh Y, Ali A, Khasati A, Hasanic A, Bihani U, Ohri R, Muthukumar K, Barlow J. Benefits and Challenges of Video Consulting for Mental Health Diagnosis and Follow-Up: A Qualitative Study in Community Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2595. [PMID: 36767957 PMCID: PMC9915222 DOI: 10.3390/ijerph20032595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Mental health services continue to experience rising demand that exceeds capacity. The COVID-19 pandemic exacerbated this crisis, with access to services being reduced. Although video consultations (VCs) are a solution, usage in UK community mental healthcare settings remains limited. This study aims to investigate psychiatrists' and general practitioners' (GPs) perceptions of the benefits and challenges of VC for the diagnosis and follow-up of general adult mental health patients in the community during the COVID-19 pandemic. Semi-structured interviews in NHS community mental healthcare settings were conducted. Psychiatrists (n = 11) and GPs (n = 12) were recruited through purposive sampling. An explorative qualitative approach was employed. Data were analysed using thematic analysis. Four key themes were identified: (1) patient access to VC, (2) suitability of VC for mental health consultations, (3) information gathering with VC and (4) clinician satisfaction with VC. This study provides valuable insights into the experiences of psychiatrists and GPs working in the UK during the COVID-19 pandemic. To facilitate a digital-first future for the NHS, greater investment in remote technologies is required, particularly in the context of growing mental healthcare demand. Though face-to-face consultations remain the gold standard, VC provides an efficient way of communicating with patients, particularly those with less severe forms of mental illness.
Collapse
|
18
|
Viana Pereira F, Tavares J, Oliveira T. Adoption of video consultations during the COVID-19 pandemic. Internet Interv 2023; 31:100602. [PMID: 36694630 PMCID: PMC9852263 DOI: 10.1016/j.invent.2023.100602] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/20/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Video consultations have the potential to play a significant role for the future of healthcare by solving some of the imminently arising healthcare challenges, as pointed by the European Commission in Europe and the National Academy of Medicine in the United States of America. This technology can improve quality, efficiency, and enhance access to healthcare. OBJECTIVE The aim of this study is to explore and understand individual video consultations acceptance drivers. METHODS An extended technology acceptance model was created based on the diffusion of innovation theory (DOI), unified theory of acceptance and use of technology (UTAUT), health belief model (HBM), and concerns for information privacy framework (CFIP). 346 valid responses were collected through an online questionnaire, and the partial least squares (PLS) modeling approach was used to test the model. RESULTS The model explained 77.6 % (R2) of the variance on intention to use, and 71.4 % (R2) of the variance in attitude. The predictors of intention to use are attitude (beta = 0.504, p-value<0.001), performance expectancy (beta = 0.196, p-value = 0.002), and COVID-19 (beta = 0.151, p-value<0.001). The predictors of attitude are performance expectancy (beta = 0.643, p-value>0.001), effort expectancy (beta = 0.138, p-value = 0.001), and COVID-19 (beta = 0.170, p-value<0.001). CONCLUSIONS This research model highlights the importance of creating extended acceptance models to capture the specificities of each technology in healthcare. The model created helps to understand the most important drivers of video consultation acceptance, highlighting the importance of the COVID-19 pandemic and perceived health risks.
Collapse
|
19
|
Rebnord IK, Rortveit G, Huibers L, Dale JN, Smits M, Morken T. Pandemic preparedness and management in European out-of-hours primary care services - a descriptive study. BMC Health Serv Res 2023; 23:54. [PMID: 36658520 PMCID: PMC9849833 DOI: 10.1186/s12913-023-09059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Primary care is the first point of contact for all acute health problems. As such, primary care was at the frontline in the COVID-19 pandemic, playing a significant role in clinical responses and information to the public. This study aimed to describe the variations in patient management strategies used in the out-of-hours services in different European countries during the first phase of the pandemic. METHOD We conducted a cross-sectional web-based survey in August 2020, selecting key informants from European countries using European networks. The questionnaire was developed in collaboration with researchers in the field of out-of-hours primary care. We performed descriptive analyses per region, structuring results into themes. RESULTS Key informants from 38 regions in 20 European countries responded. Seven regions reported that their out-of-hours services had a pandemic preparedness plan, three had trained on the plan, and two had stockpiles of personal protection equipment before the outbreak. Extension of telephone triage lines and establishment of local infection-control teams and clinics were the main patient management strategies. Other strategies for patient contacts were also used in the regions, such as video-consultations (13 regions), electronic consultations (21 regions), patient's car as alternative waiting room (19 regions), outside tents for testing (24 regions), "drive-through" testing (26 regions), and separate departments for infected patients (14 regions). CONCLUSION Few out-of-hours services were well prepared for a pandemic, but all expanded and reorganized rapidly, adopting new strategies for patient management and treatment. The results could be useful for planning of organization preparedness of out-of-hours primary care service for future pandemics.
Collapse
Affiliation(s)
- Ingrid Keilegavlen Rebnord
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen , Norway ,grid.509009.5National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Guri Rortveit
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen , Norway ,grid.509009.5Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Linda Huibers
- grid.7048.b0000 0001 1956 2722Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Jonas Nordvik Dale
- grid.509009.5National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Marleen Smits
- grid.10417.330000 0004 0444 9382Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands
| | - Tone Morken
- grid.509009.5National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| |
Collapse
|
20
|
Esber A, Teufel M, Jahre L, in der Schmitten J, Skoda EM, Bäuerle A. Predictors of patients' acceptance of video consultation in general practice during the coronavirus disease 2019 pandemic applying the unified theory of acceptance and use of technology model. Digit Health 2023; 9:20552076221149317. [PMID: 36815005 PMCID: PMC9940186 DOI: 10.1177/20552076221149317] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 12/18/2022] [Indexed: 01/20/2023] Open
Abstract
Background The coronavirus disease 2019 pandemic has led to an increase in remote consultations in health care. This study aimed to assess the acceptance of video consultation as an alternative to face-to-face in-office visits in general practice (GP) and to investigate its drivers and barriers. Methods A cross-sectional study was conducted in Germany during the coronavirus disease 2019 pandemic from December 2020 to April 2021. Participants were recruited among patients in 16 GP surgeries. Assessed were sociodemographic and medical data as well as information and communications technology related data. Acceptance of video consultation and its predictors were determined using a modified questionnaire based on a short version of the renowned unified theory of acceptance and use of technology model. Results In total, 371 participants were included in the data analysis. Acceptance of video consultation was moderate. A hierarchical regression revealed acceptance was significantly predicted by the PHQ-2, taking no regular medication, computer proficiency, knowledge about digital health care solutions, no prior use of video consultation, and the unified theory of acceptance and use of technology predictors performance expectancy, effort expectancy, and social influence. The extended unified theory of acceptance and use of technology model explained significantly more variance than the restricted unified theory of acceptance and use of technology model in acceptance of video consultation. Conclusions In this study computer proficiency, existing knowledge about digital health care solutions and depressive symptoms functioned as drivers to acceptance, no prior use of video consultation could be identified as a potential barrier. Patients with regular medication have been particularly receptive to video consultation. The study confirmed the validity of the unified theory of acceptance and use of technology model in determining acceptance of video consultation. Considering that there is growing demand and acceptance for different approaches to engage with health care providers, additional steps should be taken to establish video consultation as a genuine alternative.
Collapse
Affiliation(s)
- André Esber
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Lisa Jahre
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Jürgen in der Schmitten
- Institute of General Practice, Center for Translational Neuro- and Behavioral Sciences, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany,Alexander Bäuerle, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| |
Collapse
|
21
|
Luong HN, Shahin A, Porter KR, Chavez A. Experience and Attitudes Toward Telehealth in Student-Run Free Clinics (SRFC). J Prim Care Community Health 2023; 14:21501319221148795. [PMID: 36651590 PMCID: PMC9869237 DOI: 10.1177/21501319221148795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION/OBJECTIVES Telehealth services expanded during the coronavirus disease 2019 (COVID-19) pandemic. Student-run free clinics (SRFC) deliver important health care services to underserved populations, who may face barriers to telehealth use. This study characterizes telehealth usage, experiences, and attitudes among individuals working in SRFCs. METHODS In November 2021, a survey adapted from the COVID-19 Healthcare Coalition Telehealth Impact Physician Survey was sent to all registrants who identified themselves as students at the 2020 Society of Student-Run Free Clinics Annual Conference. RESULTS Thirty-eight individuals of 576 registrants (7%) representing 21 of 88 (24%) SRFCs completed the survey. Twenty-one (58%) individuals reported using telehealth in their clinic. Those that did not cited lack of infrastructure as a barrier (eg, broadband, Internet challenges, technology investments), were more likely to serve homeless (P = .01), and less likely to serve non-English speaking populations (P = .02). There were increases in telehealth and decreases in in-person visits after March 11, 2020 though changes did not reach statistical significance. At least 15 (68%) wanted to continue chronic disease management, preventative care, and mental/behavioral health via telehealth after COVID-19. Most felt that telehealth was easy to use and improved the health, safety, and timeliness of care of patients, but not work satisfaction or access to care. Difficulty accessing physical devices, Internet, and data was the most-cited barrier to maintaining and accessing telehealth. CONCLUSIONS Nearly all participants cited significant benefits and barriers to telehealth that impacted perceived access to care and sustainability. SRFCs' experiences may be modulated by their underserved populations and role in student education. Addressing barriers, particularly patient- and clinic-level technology challenges, could work to improve inequities in telehealth uptake.
Collapse
Affiliation(s)
- Hanna N. Luong
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA,Hanna N. Luong, Mayo Clinic Alix School of Medicine, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
| | - Ahmad Shahin
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | | |
Collapse
|
22
|
Haun MW, Oeljeklaus L, Hoffmann M, Tönnies J, Wensing M, Szecsenyi J, Peters-Klimm F, Krisam R, Kronsteiner D, Hartmann M, Friederich HC. Primary care patients' experiences of video consultations for depression and anxiety: a qualitative interview study embedded in a randomized feasibility trial. BMC Health Serv Res 2023; 23:9. [PMID: 36600264 PMCID: PMC9811759 DOI: 10.1186/s12913-022-09012-z] [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: 09/28/2021] [Accepted: 12/26/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Integrated mental health care models that provide rapid access to video consultations with mental health specialists for primary care patients are a promising short-term, low-threshold treatment option and may reduce waiting times for specialist care. This qualitative study, nested within a randomized feasibility trial, aimed to explore participants' views on this type of care model, its influence on the lived experience of patients, and barriers and facilitators for its delivery. METHODS In five primary care practices, 50 adults with depression and/or anxiety were randomly assigned to either an integrated care model (maximum of five video consultations with a mental health specialist) or usual care (primary care or another treatment option). Prior to obtaining the trial results, interviews were held with participants who had received video consultations. Interviews were transcribed and analysed thematically. RESULTS Twenty of the 23 patients who received video consultations participated in the interviews. Patients engaged well with the care model and reported positive effects on their most pressing needs, while denying safety concerns. Generally, they perceived the usability of video consultations as high, and temporary connectivity failures were not considered a substantial barrier. We identified two key mechanisms of impacts on the patients' lived experience: fast access to specialist mental healthcare and the emerging rapport with the specialist. In particular, patients with no prior mental healthcare experience indicated that familiarity with the primary practice and their physician as a gatekeeper were important facilitators of proactive treatment. CONCLUSIONS From the patients' perspective, mental health care models integrating video consultations with mental health specialists into primary care are linked to positive lived experiences. Our findings imply that primary care physicians should promote their role as gatekeepers to (1) actively engage patients, (2) apply integrated care models to provide a familiar and safe environment for conducting mental health care video consultations, and (3) be able to regularly assess whether certain patients need in-person services. Scaling up such models may be worthwhile in real-world service settings, where primary care physicians are faced with high workloads and limited specialist services. TRIAL REGISTRATION DRKS00015812.
Collapse
Affiliation(s)
- Markus W. Haun
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Lydia Oeljeklaus
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Mariell Hoffmann
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Justus Tönnies
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Michel Wensing
- grid.7700.00000 0001 2190 4373Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- grid.7700.00000 0001 2190 4373Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Frank Peters-Klimm
- grid.7700.00000 0001 2190 4373Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Regina Krisam
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Dorothea Kronsteiner
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Hans-Christoph Friederich
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| |
Collapse
|
23
|
Lantheaume S, Doublet L, Mory JE, Durand T, Lebosse W, Heudel PE. A qualitative study of teleconsultation practices among French oncologists in a post-COVID-19 period. Digit Health 2023; 9:20552076231215906. [PMID: 38033511 PMCID: PMC10685777 DOI: 10.1177/20552076231215906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
Background The Covid-19 pandemic has prompted healthcare professionals to adapt and implement new tools to ensure continuity of patient care. Teleconsultation became the only option for some practitioners who had never used it previously and boosted its use for others who already used it. Several studies have reviewed the use of teleconsultation in oncology during the epidemic, but few have addressed its continued use and how practitioners view it in a post-epidemic period. The aim of this survey was to conduct a qualitative exploration of how oncologists use teleconsultation in their daily practice in a post-COVID 19 period. Materials and Methods For this qualitative study, semi-structured interviews were conducted with oncologists in France who utilized teleconsultation in the field of oncology during the COVID-19 period. The interview guide included questions on the interests and limitations of using teleconsultation in oncology, on reluctance to use it among oncologists, and invited participants to formulate proposals for more optimal use. Results Fourteen oncologists participated in the survey. Currently, 12% of the consultations of the surveyed practitioners are conducted via teleconsultation. Seven themes were identified in the analysis of the interviews: (a) The oncologist and teleconsultation; (b) Clinical motivations for using teleconsultation; (c) Comparison between teleconsultation and in-person consultation; (d) Advantages and disadvantages of teleconsultation; (e) Technical modalities of teleconsultation; (f) Role of Covid and confinement in the use of teleconsultation; (h) Epistemic judgments about teleconsultation. Optimal teleconsultation occurs when seamlessly incorporated into patient care, offering reduced patient inconvenience, and providing economic and environmental benefits. Although there's a lack of unified agreement in research literature regarding time efficiency, teleconsultation facilitates more customized patient monitoring and addresses the challenge of "medical deserts" nationally. Considering patient preferences is crucial when contemplating the use of teleconsultation. Predominantly, technical issues stand as the principal barriers to teleconsultation implementation. Conclusion Even after the end of the health crisis, teleconsultation is still used in clinical practice. Recommendations for effective use are suggested.
Collapse
Affiliation(s)
- Sophie Lantheaume
- Ramsay Santé Hôpital Privé Drôme Ardèche, 07500 Guilherand-Granges, France
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France
| | - Louis Doublet
- Ramsay Santé Hôpital Privé Drôme Ardèche, 07500 Guilherand-Granges, France
| | - Jean-Eudes Mory
- Ramsay Santé Hôpital Privé Drôme Ardèche, 07500 Guilherand-Granges, France
- Centre de Coordination de Cancérologie Drôme Ardèche, 26000 Valence, France
| | - Thierry Durand
- Direction des systèmes d’information, centre Léon Bérard, 69008 Lyon, France
| | - William Lebosse
- Centre de Coordination de Cancérologie Rhodanien, Centre Léon Bérard, 69008 Lyon, France
| | - Pierre-Etienne Heudel
- Centre de Coordination de Cancérologie Rhodanien, Centre Léon Bérard, 69008 Lyon, France
- Département d’Oncologie Médicale, Centre Léon Bérard, 69008 Lyon, France
| |
Collapse
|
24
|
Bavngaard MV, Lüchau EC, Hvidt EA, Grønning A. Exploring patient participation during video consultations: A qualitative study. Digit Health 2023; 9:20552076231180682. [PMID: 37325071 PMCID: PMC10265318 DOI: 10.1177/20552076231180682] [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: 10/08/2022] [Accepted: 05/19/2023] [Indexed: 06/17/2023] Open
Abstract
Objective Video consultations enable a digital point of contact between the general practitioner and patient. With their medium-specific characteristics, video consultations may create novel conditions for the enactment of patient participation during consultations. Although numerous studies have explored patients' experiences of video consultations, research explicitly investigating patient participation within this new consultation setting remains sparse. This qualitative study explores how patients participate during interactions with their general practitioner by drawing on the affordances of video consultations. Methods The data corpus comprises eight recorded video consultations (59 minutes and 19 seconds in total) between patients and their general practitioner, all subjected to reflexive thematic analysis yielding three themes illustrating concrete participatory use cases. Results We find that video consultations provide an accessible format for patients otherwise unable to attend a physical consultation due to physical and mental barriers. Moreover, patients participate by drawing on resources situated in their spatial setting to settle health-related questions of doubt arising during the consultation. Lastly, we posit that patients enact participation by visually communicating their impromptu engagement in decision-making and reporting to their general practitioner by making use of the qualities of their smartphone during their consultation. Conclusions Our findings illustrate how video consultations provide a communicative context in which patients may enact distinct forms of participation by drawing on its technologically contingent affordances during interactions with their general practitioner. More research is needed to explore the participatory opportunities of video consultations in telemedical healthcare services for different patient groups.
Collapse
Affiliation(s)
- Martin Vinther Bavngaard
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Elle Christine Lüchau
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anette Grønning
- Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
25
|
Rey Velasco E, Pedersen HS, Skinner T. Analysis of Patient Cues in Asynchronous Health Interactions: Pilot Study Combining Empathy Appraisal and Systemic Functional Linguistics. JMIR Form Res 2022; 6:e40058. [PMID: 36538352 PMCID: PMC9812272 DOI: 10.2196/40058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lifestyle-related diseases are among the leading causes of death and disability. Their rapid increase worldwide has called for low-cost, scalable solutions to promote health behavior changes. Digital health coaching has proved to be effective in delivering affordable, scalable programs to support lifestyle change. This approach increasingly relies on asynchronous text-based interventions to motivate and support behavior change. Although we know that empathy is a core element for a successful coach-user relationship and positive patient outcomes, we lack research on how this is realized in text-based interactions. Systemic functional linguistics (SFL) is a linguistic theory that may support the identification of empathy opportunities (EOs) in text-based interactions, as well as the reasoning behind patients' linguistic choices in their formulation. OBJECTIVE This study aims to determine whether empathy and SFL approaches correspond and complement each other satisfactorily to study text-based communication in a health coaching context. We sought to explore whether combining empathic assessment with SFL categories can provide a means to understand client-coach interactions in asynchronous text-based coaching interactions. METHODS We retrieved 148 text messages sent by 29 women who participated in a randomized trial of telecoaching for the prevention of gestational diabetes mellitus (GDM) and postnatal weight loss. We conducted a pilot study to identify users' explicit and implicit EOs and further investigated these statements using the SFL approach, focusing on the analysis of transitivity and thematic analysis. RESULTS We identified 164 EOs present in 42.37% (3478/8209) of the word count in the corpus. These were mainly negative (n=90, 54.88%) and implicit (n=55, 60.00%). We distinguished opening, content and closing messages structures. Most of the wording was found in the content (n=7077, 86.21%) with a declarative structure (n=7084, 86.30%). Processes represented 22.4% (n=1839) of the corpus, with half being material (n=876, 10.67%) and mostly related to food and diet (n=196, 54.92%), physical activity (n=96, 26.89%), and lifestyle goals (n=40, 11.20%). CONCLUSIONS Our findings show that empathy and SFL approaches are compatible. The results from our transitivity analysis reveal novel insights into the meanings of the users' EOs, such as their seek for help or praise, often missed by health care professionals (HCPs), and on the coach-user relationship. The absence of explicit EOs and direct questions could be attributed to low trust on or information about the coach's abilities. In the future, we will conduct further research to explore additional linguistic features and code coach messages. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020.
Collapse
Affiliation(s)
- Elena Rey Velasco
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Liva Healthcare, Copenhagen, Denmark
| | | | - Timothy Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
26
|
Massie J, Block SS, Morjaria P. The Role of Optometry in the Delivery of Eye Care via Telehealth: A Systematic Literature Review. Telemed J E Health 2022; 28:1753-1763. [PMID: 35612473 PMCID: PMC9805855 DOI: 10.1089/tmj.2021.0537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective: Optometrists are increasingly adopting teleoptometry as an approach to delivering eye care. The coronavirus disease 2019 (COVID-19) pandemic has created further opportunities for optometrists to utilize innovation in telehealth to deliver eye care to individuals who experience access barriers. A systematic literature review is presented detailing the evidence to support the use of teleoptometry. Methods: Databases of MEDLINE, Global Health, and Web of Science were searched, and articles were included if they reported any involvement of optometrists in the delivery of telehealth. Findings were reported according to the mode of telehealth used to deliver eye care, telehealth collaboration type, and the format and geographical areas where eye care via telehealth is being delivered. Results: Twenty-seven relevant studies were identified. Only 11 studies included the role of optometrists as a member of the telehealth team where the scope of practice extended beyond creating and receiving referrals, collecting clinical data at in-person services, and continuing in-person care following consultation with an ophthalmologist. Both synchronous and asynchronous telehealth services were commonly utilized. Optometrists were most commonly involved in ophthalmology-led telehealth collaborations (n = 19). Eight studies reported optometrists independently delivering primary eye care via telehealth, and commonly included videoconferencing. Conclusion: The application of teleoptometry to deliver eye care is rapidly emerging, and appears to be a viable adjunct to the delivery of in-person optometry services. The review highlighted the scarcity of evidence surrounding the clinical benefits, safety, and outcomes of teleoptometry. Further research is required in this area.
Collapse
Affiliation(s)
- Jessica Massie
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Address correspondence to: Jessica Massie, BVisSci/MOptom, MScPHEC, International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | | | - Priya Morjaria
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
27
|
Hoffman B, Braund H, McKeown S, Dalgarno N, Godfrey C, Appireddy R. Telemedicine and medical education: a mixed methods systematic review protocol. JBI Evid Synth 2022; 20:3045-3057. [PMID: 35946805 DOI: 10.11124/jbies-21-00481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to synthesize and appraise the available research on educational strategies required to prepare medical learners for engaging in telemedicine and virtual care. INTRODUCTION The COVID-19 pandemic has resulted in significant uptake of virtual care and telemedicine, highlighting the growing need for health care organizations and medical institutions to support physicians and learners navigating this new model of health care delivery, clinical learning, and assessment. Developing a better understanding of how best to prepare medical trainees across the continuum of undergraduate, postgraduate, and continuing professional development to engage in virtual care is critical in ensuring our continued ability to meet educational mandates and provide ambulatory care that is safe, efficient, and timely. INCLUSION CRITERIA Eligible studies will include medical learners who receive education on how to deliver telemedicine. The quantitative component of the review will compare learners exposed to educational interventions with learners not exposed to an intervention, or to a different intervention. Outcomes will include competencies in telemedicine delivery, knowledge, and behaviors. The qualitative component of the review will explore learners' experiences with the delivery of educational strategies that address telemedicine. METHODS Embase, MEDLINE, Evidence-Based Medicine Reviews: Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Education Source, and ProQuest Dissertations and Theses Global will be searched to identify published and unpublished studies. No date or language restrictions will be applied. This systematic review will be conducted in accordance with the JBI methodology for mixed methods systematic reviews using a convergent segregated approach. Titles and abstracts of potential studies will be screened, and potentially relevant studies will undergo full-text review for eligibility and critical appraisal of the study methodology. Data will be extracted from those studies selected for inclusion. Findings will be described relating to the effectiveness of educational curricula, initiatives, and best practices in trainee engagement in telemedicine and virtual care. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021264332.
Collapse
Affiliation(s)
- Bryn Hoffman
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Heather Braund
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sandra McKeown
- Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Christina Godfrey
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University School of Nursing, Queen's University, Kingston, ON, Canada
| | - Ramana Appireddy
- Faculty of Health Sciences, Queen's University; Division of Neurology, Department of Medicine, School of Medicine, Queen's University, Kingston, ON, Canada
| |
Collapse
|
28
|
Tang M, Holmgren AJ, McElrath EE, Bhatt AS, Varshney AS, Lee SG, Vaduganathan M, Adler DS, Huckman RS. Investigating the Association Between Telemedicine Use and Timely Follow-Up Care After Acute Cardiovascular Hospital Encounters. JACC ADVANCES 2022; 1:100156. [PMID: 36620529 PMCID: PMC9802537 DOI: 10.1016/j.jacadv.2022.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/30/2022] [Accepted: 10/24/2022] [Indexed: 01/01/2023]
Abstract
Background Telemedicine use increased dramatically during the COVID-19 pandemic; however, questions remain as to how telemedicine use impacts care. Objectives The purpose of this study was to examine the association of increased telemedicine use on rates of timely follow-up and unplanned readmission after acute cardiovascular hospital encounters. Methods We examined hospital encounters for acute coronary syndrome, arrhythmia disorders, heart failure (HF), and valvular heart disease from a large U.S., multisite, integrated academic health system among patients with established cardiovascular care within the system. We evaluated 14-day postdischarge follow-up and 30-day all-cause unplanned readmission rates for encounters from the pandemic "steady state" period from May 24, 2020 through December 31, 2020, when telemedicine use was high and compared them to those of encounters from the week-matched period in 2019 (May 26, 2019, through December 31, 2019), adjusting for patient and encounter characteristics. Results The study population included 6,026 hospital encounters. In the pandemic steady-state period, 40% of follow-ups after these encounters were conducted via telemedicine vs 0% during the week-matched period in 2019. Overall, 14-day follow-up rates increased from 41.7% to 44.9% (adjusted difference: +2.0 percentage points [pp], 95% CI: -1.1 to +5.1 pp, P = 0.20). HF encounters experienced the largest improvement from 50.1% to 55.5% (adjusted difference: +6.5 pp, 95% CI: +0.5 to +12.4 pp, P = 0.03). Overall 30-day all-cause unplanned readmission rates fell slightly, from 18.3% to 16.9% (adjusted difference -1.6 pp; 95% CI: -4.0 to +0.8 pp, P = 0.20). Conclusions Increased telemedicine use during the COVID-19 pandemic was associated with earlier follow-ups, particularly after HF encounters. Readmission rates did not increase, suggesting that the shift to telemedicine did not compromise care quality.
Collapse
Affiliation(s)
- Mitchell Tang
- Harvard University, Cambridge, Massachusetts, USA,Harvard Business School, Boston, Massachusetts, USA,Address for correspondence: Mr Mitchell Tang, Harvard Business School, 203E Wyss House, Soldiers Field Road, Boston, Massachusetts 02163, USA
| | - A Jay Holmgren
- Department of Medicine and Center for Clinical Informatics and Improvement Research, University of California-San Francisco, San Francisco, California, USA
| | - Erin E. McElrath
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ankeet S. Bhatt
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA,Kaiser Permanente Division of Research, Oakland, California, USA
| | - Anubodh S. Varshney
- Division of Cardiovascular Medicine, Stanford University, Palo Alto, California, USA
| | - Simin G. Lee
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Dale S. Adler
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert S. Huckman
- Harvard Business School, Boston, Massachusetts, USA,National Bureau of Economic Research, Cambridge, Massachusetts, USA
| |
Collapse
|
29
|
Muacevic A, Adler JR, Brauer B, Nabaty R, Opara IN, Levine DL. Patient Satisfaction With Medical and Social Concerns Addressed During Telemedicine Visits. Cureus 2022; 14:e32529. [PMID: 36654607 PMCID: PMC9839388 DOI: 10.7759/cureus.32529] [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: 11/29/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose The use of telemedicine dramatically increased during the COVID-19 pandemic. Assessing patient satisfaction with this mode of healthcare delivery is an important metric of success as it is broadly implemented across various settings. Of additional importance are the ways social determinants of health impact health outcomes, with the first step in determining the scale of this impact being the identification of contributing factors. This study assesses patient satisfaction with the medical and social aspects of the care they receive via telemedicine at a university-affiliated primary care training clinic in Detroit, Michigan. Methods A survey was designed to assess patient satisfaction with the technical aspects of the visit, the visit itself, and with the social determinants screening tool used. During July 2020, 167 patients who had at least one telemedicine visit with a primary care physician from the clinic in the preceding months were contacted to assess their impression of the service provided. The responses were used to evaluate patient satisfaction with the comprehensive care provided via the telemedicine visit. Results Of the 167 patients contacted, 79 (47%) completed the survey. Respondents' age ranged from 18-74 years, with 66% identifying as female and 34% as male. For many, this was their first experience with telemedicine. The vast majority expressed comfort in sharing details about their health concerns via telemedicine, with only 3% reporting they were "uncomfortable." More than half of the patients (60%) felt some level of comfort with telemedicine after their first encounter; 14% stated that they were still uncomfortable, and 26% were neutral. Most of the patients (88%) asserted their willingness to participate in future telemedicine visits. Just under two-thirds (63%) of participants "strongly agreed" that concerns related to their social determinants of health were addressed, and 59% "strongly agreed" that the resources provided by their physician were helpful. Conclusion This survey evaluates multiple dimensions of patient satisfaction with their physician using technology to deliver a telemedicine visit instead of an in-office visit. Telemedicine was well received, with high satisfaction for addressing medical and social concerns. The results of this study support the use of telemedicine to assess social determinants of health in an underserved minoritized patient population and will help physicians optimize future interactions with patients through telemedicine.
Collapse
|
30
|
Maria ARJ, Serra H, Castro MG, Heleno B. Interaction at the primary–secondary care interface: Patients’ and physicians’ perceptions of teleconsultations. Digit Health 2022; 8:20552076221133698. [PMCID: PMC9716594 DOI: 10.1177/20552076221133698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 10/02/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Previous qualitative research on teleconsultations has focused on synchronous communication between a patient and a clinician. This study aims to explore physicians' and patients' perceptions of the interaction on the interface between primary care and the Cardiology service of a referral hospital through teleconsultations. Methods This qualitative study was embedded in an organizational case study concerning the introduction and rollout of a new service model that took place at the point of care. The patients and physicians were recruited for semi-structured interviews until thematic saturation was achieved, between September 2019 - January 2020. The interviews were audiorecorded and anonymized. The transcribed interviews were stored, coded, and analyzed in MAXQDA, following the steps for conventional content analysis. Results A total of 29 participants were interviewed. Patients and physicians presented clear views about the role of the GP and the cardiologist and their function in overall structure of healthcare. GPs felt their role was to bring expertise in the patient which could supplement the cardiologists' expertise on the condition. However, GPs had to renegotiate roles in the teleconsultations when they saw themselves in a new situation, together with another physician and the patient. Conclusions Our findings suggest that joint teleconsultations can promote continuity of care for patients in the primary/secondary care interface. Active coordination between physicians with delineation of roles throughout primary-secondary care interface is needed to manage selected patients who may benefit the most from shared care.
Collapse
Affiliation(s)
- Ana Rita J Maria
- Regional Health Administration of Lisbon and Tagus Valley, Comprehensive Health Research Centre (CHRC), Nova Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal,Ana Rita J Maria, Campo dos Mártires da Pátria 130, 1169–056, Lisboa, Portugal.
| | - Helena Serra
- Interdisciplinary Centre of Social Sciences (CICS. NOVA), NOVA School of Social Sciences and Humanities
- Faculdade de Ciências Sociais e Humanas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria G Castro
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Bruno Heleno
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa; General Practitioner, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal
| |
Collapse
|
31
|
Yermukhanova L, Buribayeva Z, Abdikadirova I, Tursynbekova A, Kurganbekova M. SWOT Analysis and Expert Assessment of the Effectiveness of the Introduction of Healthcare Information Systems in Polyclinics in Aktobe, Kazakhstan. J Prev Med Public Health 2022; 55:539-548. [PMID: 36475319 DOI: 10.3961/jpmph.22.360] [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: 08/15/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess the organizational effectiveness of the introduction of a healthcare information system (electronic medical records and databases) in healthcare in Kazakhstan. METHODS The authors used a combination of 2. METHODS expert assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis. SWOT analysis is a necessary element of research, constituting a mandatory preliminary stage both when drawing up strategic plans and for taking corrective measures in the future. The expert survey was conducted using 2 questionnaires. RESULTS The study involved 40 experts drawn from specialists in primary healthcare in Aktobe: 15 representatives of administrative and managerial personnel (chief doctors and their deputies, heads of medical statistics offices, organizational and methodological offices, and internal audit services) and 25 general practitioners. CONCLUSIONS The following functional indicators of the medical and organizational effectiveness of the introduction of information systems in polyclinics were highlighted: first, improvement of administrative control, followed in descending order by registration and movement of medical documentation, statistical reporting and process results, and the cost of employees' working time. There has been no reduction in financial costs, namely in terms of the costs of copying, delivery of information in paper form, technical equipment, and paper.
Collapse
Affiliation(s)
- Lyudmila Yermukhanova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Zhanar Buribayeva
- Department of Health Policy and Organization, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Indira Abdikadirova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Anar Tursynbekova
- Department of Work with Regions, Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - Meruyert Kurganbekova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| |
Collapse
|
32
|
de Varge Maldonado JMS, de Paula AC, Gadelha CAG. Perception of Health Care Providers and Users on Teleconsultation in Times of COVID-19 in Brazil: An Exploratory Interview Study. Telemed J E Health 2022; 29:717-725. [PMID: 36282808 DOI: 10.1089/tmj.2022.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In the context of the COVID-19 pandemic in Brazil, teleconsultation was considered an important instrument in the fight against the health crisis, with temporary mandates changing the current legislation to expand its use. This study examined the perceptions of health care providers and users regarding teleconsultation. Methods: The study consisted of a national survey of 1,089 participants, of which 480 were health care providers and 609 were users, carried out through two semistructured questionnaires administered between June and August 2020, using six categories of analysis for teleconsultation-quality, remuneration, duties and responsibilities, experience and positioning regarding use, and technology-and an additional question about the benefits and harms of telemedicine. Results: The research indicated that, although face-to-face care is favored, there is an important movement toward accepting virtual care, even though there are relative differences in perception regarding the six categories analyzed. Discussion: Regarding the benefits of telemedicine, issues such as access, practicality, agility, convenience, easiness, and speed stood out as well as concerns such as contact, quality, impersonality, distance, errors, and falsehood, among others. Conclusions: Although there is evidence of benefits and limitations, bringing to light that contributions from the perception of health care providers and users can help promote debates to establish teleconsultation on a permanent basis in Brazil.
Collapse
Affiliation(s)
| | - Antonio Cruz de Paula
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | |
Collapse
|
33
|
Parsons J, Rahman S, Bryce C, Atherton H. Use of a pharmacy-based GP video consultation service: a mixed methods study. Fam Pract 2022; 40:241-247. [PMID: 36169402 PMCID: PMC10047609 DOI: 10.1093/fampra/cmac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about private general practice appointment services offered via video. This study aimed to explore which patients are using a video pharmacy-based general practitioner (GP) appointment service, including patterns of use, reasons for using the service, and satisfaction with the service. METHODS Descriptive statistics and parametric and nonparametric tests were used to conduct a retrospective cross-sectional analysis of routinely collected data on consultations, and postconsultation questionnaires. Interviews were conducted with patients and GPs. RESULTS A total of 7,928 consultations were included in the analysis. More than half of appointments were booked for the same day, with lunchtime appointments being popular. The most common health condition was respiratory conditions, and 9% of consultations were used by patients using the service more than once. At least one prescription was issued in over half of all consultations. Overall, satisfactions of consultations were high. CONCLUSIONS The characteristics of those patients using the video consultation service match data on who uses online services in general practice. This study shows that some patients are willing to pay to use this private service because they feel it is more convenient, NHS services do not have capacity to see them at the time they need, or they do not have access to regular GP services.
Collapse
Affiliation(s)
- Joanne Parsons
- Corresponding author: Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Gibett Hill, Coventry CV4 7AL, United Kingdom. E-mail:
| | - Sameur Rahman
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Carol Bryce
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| |
Collapse
|
34
|
Allen J. Exploring Adult Patients’ Perceptions and Experiences of Telemedicine Consultations in Primary Care: A Qualitative Systematic Review. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2022. [DOI: 10.5195/ijms.2022.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The COVID-19 pandemic transformed a gradual uptake of telemedicine, into a sudden worldwide implementation of telemedicine consultations. Primary care is a particular area affected and one where telemedicine consultations are expected to be the future. However, for effective long-term implementation it is vital that patient perceptions and experiences are understood. The aim of this qualitative systematic review was to explore the perceptions and experiences of adults who have used telemedicine consultations in primary care. Studies were identified through a search of four electronic databases (MEDLINE, EMBASE, CINAHL, and CENTRAL) alongside reference list and citation searches. Quality assessment was conducted using the CASP checklist and data was synthesized using a simplified approach to thematic analysis. From 2492 identified records, ten studies met the eligibility criteria all of which were judged as either good or moderate quality. Three themes were identified which were potential benefits, potential barriers, and beneficial prerequisites for telemedicine consultations in primary care. Within these themes, sixteen sub-themes were identified with examples including accessibility and convenience for potential benefits, lack of face-to-face interaction and impersonal consultations for potential barriers, and continuity of care for beneficial prerequisites. Analysing these subthemes, four main recommendations for practice can be made which are to utilise continuity of care, offer both video and telephone consultations, provide adequate support, and that healthcare professionals should demonstrate an explicit understanding of the patient’s health issues. Further research is needed to explore and expand on this topic area and future research should be viewed as a continuous process.
Collapse
|
35
|
Undergraduate medical teaching with remote consultations in general practice: a realist evaluation. BJGP Open 2022; 6:BJGPO.2021.0185. [PMID: 35210228 PMCID: PMC9680759 DOI: 10.3399/bjgpo.2021.0185] [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: 10/04/2021] [Revised: 01/13/2022] [Accepted: 02/22/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Supervisors historically educated students in primary care in face-to-face contexts; as a result of COVID-19, students now experience patient consultations predominantly remotely. There is a paucity of evidence regarding the facilitators and barriers to supervising students for excellent educational impact in the remote consultation environment. AIM To understand the facilitators and barriers to educating medical students using remote consultations in primary care, and the consequences for students in terms of educational impact. DESIGN & SETTING A realist evaluation methodology was adopted to identify causal chains of contexts, mechanisms, and outcomes, describing how the teaching and learning functioned on a sample of medical students and GP tutors from two medical schools in London, UK. METHOD An initial programme theory was developed from the literature and a scoping exercise informed the data collection tools. Qualitative data were collected through online questionnaires (49 students, 19 tutors) and/or a semi-structured interview (eight students, two tutors). The data were coded to generate context-mechanisms-outcome configurations outlining how the teaching and learning operated. RESULTS The results demonstrated a sequential style of supervision can positively impact student engagement and confidence, and highlighted a need to address student preparation for remote patient examinations. Students found passive observation of remote patient encounters disengaging, and, in addition, reported isolation that impacted negatively on their experiences and perceptions of primary care. CONCLUSION Student and tutor experiences may improve through considering the supervision style adopted by tutors, and through interventions to reduce student isolation and disengagement when using remote patient consultations in primary care.
Collapse
|
36
|
Toll K, Spark L, Neo B, Norman R, Elliott S, Wells L, Nesbitt J, Frean I, Robinson S. Consumer preferences, experiences, and attitudes towards telehealth: Qualitative evidence from Australia. PLoS One 2022; 17:e0273935. [PMID: 36044536 PMCID: PMC9432716 DOI: 10.1371/journal.pone.0273935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022] Open
Abstract
In Australia, telehealth is not new, with several telehealth specialist services being available for those living in rural and remote communities. However, prior to the COVID-19 pandemic, telehealth was not routinely available for primary care or urban specialist appointments. There has been an increased focus in the use of telehealth within primary care, and particularly general practice, but overall, there has been limited research to date to guide telehealth best-practice based on consumer experiences and preferences within these settings. We aimed to capture the consumer experience of telehealth during the COVID-19 pandemic, through a novel Kitchen Table Discussion (KTD) method. This increases access to a broader community consumer cohort, with consumer hosts leading discussions in a safe environment. The KTDs were conducted in May 2021, with 10 community members each hosting a group of up to 10 participants. A total of 90 participants took part from across Australia, with the majority living in major cities, although a significant proportion lived in inner and outer regional areas of Australia, or had experience living in rural, regional or remote areas. Seventy percent of participants reported using telehealth in the past. Data were analysed sequentially using thematic analysis and identified key themes: modality, convenience, access, wait time, existing relationship, communication, connectivity, cost, and privacy. Overall, the future of telehealth looks hopeful from the perspective of the consumer, but significant improvements are required to improve consumer engagement and experience. It is evident that ‘one size does not fit all’, with results suggesting consumers value the availability of telehealth and having choice and flexibility to use telehealth when appropriate, but do not want to see telehealth replacing face-to-face delivery. Participants tended to agree that telehealth was not a preferred method when physical examination was required but would suit certain points of the patient journey.
Collapse
Affiliation(s)
- Kaylie Toll
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- * E-mail:
| | - Lauren Spark
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Belinda Neo
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Richard Norman
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Sarah Elliott
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Consumers Health Forum of Australia, Canberra, Australian Capital Territory, Australia
| | - Leanne Wells
- Consumers Health Forum of Australia, Canberra, Australian Capital Territory, Australia
| | - Julia Nesbitt
- Consumers Health Forum of Australia, Canberra, Australian Capital Territory, Australia
| | - Isobel Frean
- Digital Health CRC Limited (DHCRC), Sydney, New South Wales, Australia
| | - Suzanne Robinson
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
| |
Collapse
|
37
|
Ruyobeza B, Grobbelaar SS, Botha A. Hurdles to developing and scaling remote patients' health management tools and systems: a scoping review. Syst Rev 2022; 11:179. [PMID: 36042505 PMCID: PMC9427160 DOI: 10.1186/s13643-022-02033-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite all the excitement and hype generated regarding the expected transformative impact of digital technology on the healthcare industry, traditional healthcare systems around the world have largely remained unchanged and resultant improvements in developed countries are slower than anticipated. One area which was expected to significantly improve the quality of and access to primary healthcare services in particular is remote patient monitoring and management. Based on a combination of rapid advances in body sensors and information and communication technologies (ICT), it was hoped that remote patient management tools and systems (RPMTSs) would significantly reduce the care burden on traditional healthcare systems as well as health-related costs. However, the uptake or adoption of above systems has been extremely slow and their roll out has not yet properly taken off especially in developing countries where they ought to have made the greatest positive impact. AIM The aim of the study was to assess whether or not recent, relevant literature would support the development of in-community, design, deployment and implementation framework based on three factors thought to be important drivers and levers of RPMTS's adoption and scalability. METHODS A rapid, scoping review conducted on relevant articles obtained from PubMed, MEDLINE, PMC and Cochrane databases and grey literature on Google and published between 2012 and May 2020, by combining a number of relevant search terms and phrases. RESULTS Most RPMTSs are targeted at and focused on a single disease, do not extensively involve patients and clinicians in their early planning and design phases, are not designed to best serve a specific catchment area and are mainly directed at post-hospital, disease management settings. This may be leading to a situation where patients, potential patients and clinicians simply do not make use of these tools, leading to low adoption and scalability thereof. CONCLUSION The development of a user-centred, context-dependent, customizable design and deployment framework could potentially increase the adoption and scalability of RPMTSs, if such framework addressed a combination of diseases, prevalent in a given specific catchment area, especially in developing countries with limited financial resources.
Collapse
Affiliation(s)
- Barimwotubiri Ruyobeza
- Department of Industrial Engineering, Stellenbosch University, Stellenbosch, South Africa
| | - Sara S Grobbelaar
- Department of Industrial Engineering, Stellenbosch University, South Africa AND DSI-NRF Centre of Excellence in Scientometrics and Science, Technology and Innovation Policy (SciSTIP), Stellenbosch University, Stellenbosch, South Africa.
| | - Adele Botha
- Department of Industrial Engineering, Stellenbosch University and CSIR Next Generation Enterprises and Institutions, Stellenbosch, South Africa
| |
Collapse
|
38
|
Greenhalgh T, Shaw SE, Alvarez Nishio A, Booth A, Byng R, Clarke A, Dakin F, Davies R, Faulkner S, Hemmings N, Husain L, Kalin A, Ladds E, Moore L, Rosen R, Rybczynska-Bunt S, Wherton J, Wieringa S. Protocol: Remote care as the 'new normal'? Multi-site case study in UK general practice. NIHR OPEN RESEARCH 2022; 2:46. [PMID: 37881300 PMCID: PMC10593351 DOI: 10.3310/nihropenres.13289.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 10/27/2023]
Abstract
Background Following a pandemic-driven shift to remote service provision, UK general practices offer telephone, video or online consultation options alongside face-to-face. This study explores practices' varied experiences over time as they seek to establish remote forms of accessing and delivering care. Methods This protocol is for a mixed-methods multi-site case study with co-design and national stakeholder engagement. 11 general practices were selected for diversity in geographical location, size, demographics, ethos, and digital maturity. Each practice has a researcher-in-residence whose role is to become familiar with its context and activity, follow it longitudinally for two years using interviews, public-domain documents and ethnography, and support improvement efforts. Research team members meet regularly to compare and contrast across cases. Practice staff are invited to join online learning events. Patient representatives work locally within their practice patient involvement groups as well as joining an online patient learning set or linking via a non-digital buddy system. NHS Research Ethics Approval has been granted. Governance includes a diverse independent advisory group with lay chair. We also have policy in-reach (national stakeholders sit on our advisory group) and outreach (research team members sit on national policy working groups). Results anticipated We expect to produce rich narratives of contingent change over time, addressing cross-cutting themes including access, triage and capacity; digital and wider inequities; quality and safety of care (e.g. continuity, long-term condition management, timely diagnosis, complex needs); workforce and staff wellbeing (including non-clinical staff, students and trainees); technologies and digital infrastructure; patient perspectives; and sustainability (e.g. carbon footprint). Conclusion By using case study methods focusing on depth and detail, we hope to explain why digital solutions that work well in one practice do not work at all in another. We plan to inform policy and service development through inter-sectoral network-building, stakeholder workshops and topic-focused policy briefings.
Collapse
Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Amy Booth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Aileen Clarke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Francesca Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Asli Kalin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | | | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
- Centre for Sustainable Health Education, University of Oslo, Oslo, Norway
| |
Collapse
|
39
|
von Weinrich P, Kong Q, Liu Y. Would you zoom with your doctor? A discrete choice experiment to identify patient preferences for video and in-clinic consultations in German primary care. J Telemed Telecare 2022:1357633X221111975. [PMID: 35915997 DOI: 10.1177/1357633x221111975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The popularity of video consultations in healthcare has accelerated during the COVID-19 pandemic. Despite increased availability and obvious benefits, many patients remain hesitant to use video consultations. This study investigates the relative importance of the consultation mode compared to other attributes in patients' appointment choices in Germany. METHODS A discrete choice experiment was conducted to examine the influence of appointment attributes on preferences for video over in-clinic consultations. A total of 350 participants were included in the analysis. RESULTS The level of continuity of care (46%) and the waiting time until the next available appointment (22%) were shown to have higher relative importance than consultation mode (18%) and other attributes. Participants with fewer data privacy concerns, higher technology proficiency, and more fear of COVID-19 tended to prefer video over in-clinic consultations. The predicted choice probability of a video over a typical in-clinic consultation and opting out increased from <1% to 40% when the video consultation was improved from the worst-case to the best-case scenario. CONCLUSION This study provides insight into the effect of the consultation mode on appointment choice at a time when telemedicine gains momentum. The results suggest that participants preferred in-clinic over video consultations. Policymakers and service providers should focus on increasing the level of continuity of care and decreasing the time until the next available appointment to prompt the adoption of video consultations. Although participants preferred to talk to their physician in person over consulting via video per se, the demand for video consultations can be increased significantly by improving the other appointment attributes of video consultations such as the level of continuity of care.
Collapse
Affiliation(s)
- Philipp von Weinrich
- Rotterdam School of Management, 6984Erasmus University Rotterdam, The Netherlands
| | - Qingxia Kong
- Rotterdam School of Management, 6984Erasmus University Rotterdam, The Netherlands
| | - Yun Liu
- Erasmus School of Health Policy and Management, 84857Erasmus University Rotterdam, The Netherlands
| |
Collapse
|
40
|
Valdes D, Alqazlan L, Procter R, Dale J. Global evidence on the rapid adoption of telemedicine in primary care during the first 2 years of the COVID-19 pandemic: a scoping review protocol. Syst Rev 2022; 11:124. [PMID: 35718770 PMCID: PMC9206865 DOI: 10.1186/s13643-022-01934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Before the declaration of the COVID-19 pandemic in March 2020, primary care in most countries relied on face-to-face consultations, with relatively limited use of telemedicine. Lockdowns and social distancing measures during the early stages of the pandemic led to rapid, widely spread telemedicine adoption in healthcare settings. The rapid uptake that occurred following the onset of these pandemic-induced measures in countries such as the UK, Canada and New Zealand prompts questions around the drivers, extent and sustainability of this transformation in clinical practice at the global level, as the research in this area is still emerging. The purpose of this scoping review is to explore the global evidence surrounding the rapid adoption of telemedicine in primary care settings during the first 2 years of the COVID-19 pandemic through three lenses: patient experience, health inequalities and patient-clinician trust, with the purpose of identifying elements contributing to the sustainability of this innovation. METHODS A draft protocol was tested through an initial search on Ovid Medline, Web of Science and Google Scholar with additional searches on the Cochrane Database. This informed the final selection of terms which will be used to search Ovid, Web of Science, Google Scholar, PROSPERO, Cochrane Library and others, filtering for studies from the pandemic declaration onwards. Additional grey literature reports will be sourced through simplified searches on Google in widely spoken languages. Duplicates will be removed by screening titles. Abstracts and grey literature text extracts will be screened based on pre-set eligibility criteria by two researchers. Abstracts (and extracts in the case of grey literature) will be mapped against the domains of the Non-adoption, Abandonment, and challenges to Scale-up, Spread and Sustainability (NASSS) framework by two researchers. Data will be presented in table format. DISCUSSION This review will map the current literature to identify current gaps in evidence related to the adoption of telemedicine after the declaration of the pandemic in March 2020. The use of simplified searches in the several spoken languages in the world is aimed at capturing more immediate non-academic reflections and experiences on this major service change at a global level. SYSTEMATIC REVIEW REGISTRATION The study has been registered on Open Science Framework and can be accessed through the following URL: https://osf.io/4z5ut/.
Collapse
Affiliation(s)
- Daniela Valdes
- Department of Computer Science, University of Warwick, Coventry, CV4 7AL, UK.
| | - Lama Alqazlan
- Department of Computer Science, University of Warwick, Coventry, CV4 7AL, UK
| | - Rob Procter
- Department of Computer Science, University of Warwick, Coventry, CV4 7AL, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| |
Collapse
|
41
|
Connolly SL, Miller CJ, Gifford AL, Charness ME. Perceptions and Use of Telehealth Among Mental Health, Primary, and Specialty Care Clinicians During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2216401. [PMID: 35671053 PMCID: PMC9175071 DOI: 10.1001/jamanetworkopen.2022.16401] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Clinician attitudes toward telehealth may impact utilization rates, and findings may differ based on specialty. OBJECTIVE To determine whether clinician beliefs regarding telehealth quality and ease of use were associated with the proportion of care delivered via video, phone, and in-person across specialties. DESIGN, SETTING, AND PARTICIPANTS This survey study used a voluntary, anonymous survey conducted from August to September 2021 in the Department of Veterans Affairs New England Healthcare System (VANEHS). Mental health (MH), primary care (PC), and specialty care (SC) clinicians were invited to participate. Data were analyzed from October 2021 to January 2022. EXPOSURES Participation in a 32-item survey. MAIN OUTCOMES AND MEASURES The main outcomes were clinicians' views on relative quality of video, phone, and in-person care; factors contributing to clinicians' modality choice; telehealth challenges; and clinician modality preferences and utilization when treating new and established patients. RESULTS There were 866 survey respondents (estimated 64% response rate); 52 respondents reported no video or phone telehealth use in the 3 months prior to survey completion and were excluded, resulting in a final sample of 814 respondents. Respondents were divided among MH (403 respondents [49.5%]), PC (153 respondents [18.8%]), and SC (258 respondents [31.7%]). Compared with PC and SC clinicians, MH clinicians rated the quality of video care the highest (eg, compared with in-person care with masks when treating new patients: χ2 = 147.8; P < .001) and were more likely to prefer video over phone when treating both new (χ2 = 26.6; P < .001) and established (χ2 = 100.4; P < .001) patients remotely. PC and SC clinicians were more likely to rate phone care as being at least equivalent in quality to video for both new (χ2 = 26.3; P < .001) and established (χ2 = 33.5; P < .001) patients. PC and SC clinicians were also more likely to endorse challenges of video care, including patient barriers and the inability to conduct a physical examination (χ2 = 292.0; P < .001). Most PC and SC clinicians either had no preference (46 PC respondents [36.2%]; 59 SC respondents [28.4%]) or preferred phone (36 PC respondents [28.3%]; 67 SC respondents [32.2%]) for remote care of established patients. Findings aligned with utilization rates within VANEHS, with MH clinicians conducting significantly more of their encounters via video (36 734 encounters [40.3%]) than PC (3201 encounters [3.9%]) and SC (1157 encounters [4.9%]) clinicians. CONCLUSIONS AND RELEVANCE These findings suggest that clinician attitudes regarding telehealth quality and ease of use were associated with utilization rates. Moving forward, clinician use of telehealth may be impacted by additional data regarding the relative effectiveness of modalities as well as improvements in video telehealth workflows.
Collapse
Affiliation(s)
- Samantha L. Connolly
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Christopher J. Miller
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Allen L. Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
- Boston University School of Public Health, Boston, Massachusetts
| | - Michael E. Charness
- Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
42
|
Razavi S, Farrokhnia N, Davoody N. Nurses’ experience of using video consultation in a digital care setting and its impact on their workflow and communication. PLoS One 2022; 17:e0264876. [PMID: 35552539 PMCID: PMC9098015 DOI: 10.1371/journal.pone.0264876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/07/2022] [Indexed: 11/19/2022] Open
Abstract
Sweden as many other countries uses video consultation to increase patients’ access to primary healthcare services particularly during the COVID-19 pandemic. Working in digital care settings and using new technologies, in this case video consultations, require learning new skills and adoption to new workflow. The aim of this study is to explore nurses’ experience of using video consultation in a digital care setting and its impact on their workflow and communication. Fifteen semi-structured interviews were carried out with registered nurses recruited from a private digital healthcare provider. Interviews were recorded, transcribed, and analysed using an abductive approach. Nurses’ workflow was modeled, and several categories and subcategories were identified: nurses’ workflow (efficiency, flexibility, and information accessibility); communication (interaction with patients and interprofessional communication); user experience (change and development of the platform, challenges, and combining digital and physical care). Even though providing online care has its limitations, the nurses were positive towards using video consultations.
Collapse
Affiliation(s)
- SeyedehMaryam Razavi
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Nasim Farrokhnia
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Nadia Davoody
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| |
Collapse
|
43
|
Bennett SE, Almeida C, Bachmair EM, Gray SR, Lovell K, Paul L, Wearden A, Macfarlane GJ, Basu N, Dures E, Aucott L, Martin K, Dhaun N, Emsley R, Kidd E, Kumar V, MacLennan G, Paul M, Norrie J, Packham J, Ralston SH, Siebert S, Nicol A, Norris K, Mann S, Van Lierop L, Gomez E, McCurdy F, Findlay V, Hastie N, Morgan E, Emmanuel R, Whibley D, Urquart A, MacPerson L, Rowland J, Kiddie G, Pankhurst D, Paul J, Nicholson H, Dunsmore A, Knight A, Ellis J, Maclean C, Crighton L, Shearer C, Coyle J, Begg S, Ackerman L, Carnevale J, Arbuthnot S, Watters H, Dockrell D, Hamilton D, Salutous D, Cathcart S, Rimmer D, Hughes E, Harvey J, Gillies M, Webster S, Milne L, Semple G, Duffy K, Turner L, Alexander J, Innes J, Clark C, Meek C, McKenna E, Routledge C, Hinchcliffe-Hume H, Traianos E, Dibnah B, Storey D, O'Callaghan G, Baron JY, Hunt S, Wheat N, Smith P, Barcroft EA, Thompson A, Tomlinson J, Barber J, MacPerson G, White P, Hewlett S. Remotely delivered cognitive-behavioural and personalized exercise interventions to lessen the impact of fatigue: a qualitative evaluation. Rheumatol Adv Pract 2022; 6:rkac051. [PMID: 35795008 PMCID: PMC9252174 DOI: 10.1093/rap/rkac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/13/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Fatigue can be a disabling symptom of inflammatory rheumatic diseases. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial) is a randomized trial of remotely delivered cognitive-behavioural approach or personalized exercise programme interventions, compared with usual care. The aim of this nested qualitative study was to evaluate participants’ experiences of taking part in the intervention, including their ideas about future service delivery.
Methods
Semi-structured telephone interviews were conducted with a subgroup of LIFT participants to discuss their views and experiences of the interventions.
Results
Forty-three participants (30 women) from six sites who had participated in the cognitive-behavioural approach (n = 22) or personalized exercise programme (n = 21) interventions took part. Five themes were identified in the thematic analysis. In the theme ‘not a miracle cure, but a way to better manage fatigue’, LIFT could not cure fatigue; however, most felt better able to manage after participating. Participants valued ‘building a therapeutic relationship’ with the same therapist throughout the intervention. In ‘structure, self-monitoring and being accountable’, participants liked the inclusion of goal-setting techniques and were motivated by reporting back to the therapist.
After taking part in the interventions, participants felt ‘better equipped to cope with fatigue’; more confident and empowered. Lastly, participants shared ideas for ‘a tailored programme delivered remotely’, including follow-up sessions, video calling, and group-based sessions for social support.
Conclusion
Many participants engaged with the LIFT interventions and reported benefits of taking part. This suggests an important future role for the remote delivery of fatigue self-management.
Collapse
Affiliation(s)
- Sarah E Bennett
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol
| | - Celia Almeida
- School of Health and Social Wellbeing, University of the West of England
- Academic Rheumatology, Bristol Royal Infirmary , Bristol
| | - Eva-Maria Bachmair
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen , Aberdeen
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester , Manchester
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University , Glasgow
| | - Alison Wearden
- Division of Psychology and Mental Health, University of Manchester , Manchester
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen , Aberdeen
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow , Glasgow, UK
| | - Emma Dures
- School of Health and Social Wellbeing, University of the West of England
- Academic Rheumatology, Bristol Royal Infirmary , Bristol
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Assing Hvidt E, Christensen NP, Grønning A, Jepsen C, Lüchau EC. What are patients' first-time experiences with video consulting? A qualitative interview study in Danish general practice in times of COVID-19. BMJ Open 2022; 12:e054415. [PMID: 35428624 PMCID: PMC9013986 DOI: 10.1136/bmjopen-2021-054415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the experiences of Danish patients using video consultation (VC) to consult their general practitioner (GP) during COVID-19 lockdown and their attitudes towards continued use beyond COVID-19. DESIGN A qualitative design was employed, consisting of individual semi-structured interviews where participants were asked to retrospectively describe their experiences and reflections. Data were analysed using thematic analysis. SETTING Capital and Southern Regions of Denmark. PARTICIPANTS 27 patients (17 women and 10 men) aged between 23 and 76 years who had used VC once or more during the COVID-19 pandemic participated. The data were collected from February to October 2020. We used a convenience sampling technique and sample size was based on the principle of information power. RESULTS Three overarching themes, each containing subthemes, were developed. Participants described pre-use reactions and concerns relating to VC as being 'better than nothing' given the COVID-19 circumstances, and preferred VC over a telephone consultation. Salient pre-use concerns related to whether the technology 'would work' and whether VC would influence consultation length and GP behaviour. Overall, participants reported positive experiences of VC use and communication attributing these mainly to 'knowing the GP' and 'feeling seen and heard'. Participants were interested in future VC use for many needs as a natural consequence of an increasingly digitalised society, not least due to COVID-19. CONCLUSIONS Our findings contribute with knowledge about first-user experiences of VC against the background of COVID-19. Participants showed positive attitudes towards future use of VC as either a supplementary or alternative consultation form in general practice.
Collapse
Affiliation(s)
- Elisabeth Assing Hvidt
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | | | - Anette Grønning
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Carole Jepsen
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Elle Christine Lüchau
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
45
|
Chu C, Nayyar D, Bhattacharyya O, Martin D, Agarwal P, Mukerji G. Patient and provider experience with virtual care in a large, ambulatory care hospital in Ontario, Canada during the COVID-19 pandemic: An observational study (Preprint). J Med Internet Res 2022; 24:e38604. [PMID: 36194862 PMCID: PMC9605083 DOI: 10.2196/38604] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Virtual care use increased during the COVID-19 pandemic. The impact of that shift on patient and provider experiences is unclear. Objective We evaluated patient and provider experiences with virtual visits across an academic, ambulatory hospital in Toronto, Canada and assessed predictors of positive experience with virtual care. Methods Survey data were analyzed from consenting patients who attended at least one virtual visit (video or telephone) and from consenting providers who delivered at least one virtual visit. Distributions for demographic variables and responses to survey questions are reported, with statistical significance assessed using chi-square tests and t tests. Ordinal logistic regression analysis was used to identify any patient predictors of responses. Results During the study period, 253 patients (mean age 45.1, SD 15.6 years) completed 517 video visit surveys, and 147 patients (mean age 41.6, SD 16.4 years) completed 209 telephone visit surveys. A total of 75 and 94 providers completed the survey in June 2020 and June 2021, respectively. On a scale from 1 to 10 regarding likelihood to recommend virtual care to others, fewer providers rated a score of 8 or above compared with patients (providers: 62/94, 66% for video and 49/94, 52% for telephone; patients: 415/517, 80% for video and 150/209, 72% for telephone). Patients of non-White ethnicity had lower odds of rating a high score of 9 or 10 compared with White patients (odds ratio 0.52, 95% CI 0.28-0.99). Conclusions Patient experiences with virtual care were generally positive, but provider experiences were less so. Findings suggest potential differences in patient experience by ethnicity, warranting further investigation into equity concerns with virtual care.
Collapse
Affiliation(s)
- Cherry Chu
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
| | - Dhruv Nayyar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Danielle Martin
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Payal Agarwal
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Geetha Mukerji
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| |
Collapse
|
46
|
Kinley E, Skene I, Steed E, Pinnock H, McClatchey K. Delivery of supported self-management in remote asthma reviews: A systematic rapid realist review. Health Expect 2022; 25:1200-1214. [PMID: 35411670 PMCID: PMC9327809 DOI: 10.1111/hex.13441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background The COVID‐19 pandemic forced health care systems globally to adapt quickly to remote modes of health care delivery, including for routine asthma reviews. A core component of asthma care is supporting self‐management, a guideline‐recommended intervention that reduces the risk of acute attacks, and improves asthma control and quality of life. Objective We aimed to explore context and mechanisms for the outcomes of clinical effectiveness, acceptability and safety of supported self‐management delivery within remote asthma consultations. Design The review followed standard methodology for rapid realist reviews. An External Reference Group (ERG) provided expert advice and guidance throughout the study. We systematically searched four electronic databases and, with ERG advice, selected 18 papers that explored self‐management delivery during routine asthma reviews. Setting, Participants and Intervention Health care professional delivery of supported self‐management for asthma patients during remote (specifically including telephone and video) consultations. Main Outcome Measures Data were extracted using Context‐Mechanism‐Outcome (C‐M‐O) configurations and synthesised into overarching themes using the PRISMS taxonomy of supported self‐management as a framework to structure the findings. Results The review findings identified how support for self‐management delivered remotely was acceptable (often more acceptable than in‐person consultations), and was a safe and effective alternative to face‐to‐face reviews. In addition, remote delivery of supported self‐management was associated with; increased patient convenience, improved access to and attendance at remote reviews, and offered continuity of care. Discussion Remote delivery of supported self‐management for asthma was generally found to be clinically effective, acceptable, and safe with the added advantage of increasing accessibility. Remote reviews could provide the core content of an asthma review, including remote completion of asthma action plans. Conclusion Our findings support the option of remote delivery of routine asthma care for those who have this preference, and offer healthcare professionals guidance on embedding supported self‐management into remote asthma reviews. Patient and Public Contribution Patient and public contribution was provided by a representative of the Asthma UK Centre for Applied Research (AUKCAR) patient and public involvement (PPI) group. The PPI representative reviewed the findings, and feedback and comments were considered. This lead to further interpretations of the data which were included in the final manuscript.
Collapse
Affiliation(s)
- Emma Kinley
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Imogen Skene
- Asthma UK Centre for Applied Research, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University London, London, England
| | - Elizabeth Steed
- Asthma UK Centre for Applied Research, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University London, London, England
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Kirstie McClatchey
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| |
Collapse
|
47
|
Walthall H, Schutz S, Snowball J, Vagner R, Fernandez N, Bartram E. Patients' and clinicians' experiences of remote consultation? A narrative synthesis. J Adv Nurs 2022; 78:1954-1967. [PMID: 35362191 PMCID: PMC9321562 DOI: 10.1111/jan.15230] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/09/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
Aims To identify, evaluate and summarize evidence of patient and clinician experiences of being involved in video or telephone consultations as a replacement for in‐person consultations. Design Narrative synthesis. Data sources Medline; EMBASE; EMCARE; CINAHL and BNI. Searching took place from January 2021 to April 2021. Papers included were published between 2013 and 2020. Review Methods Papers were appraised by two independent reviewers for methodological quality. Data extraction was conducted according to the standardized tool from Joanna Briggs Institute. Results Seven qualitative studies were included, from five countries and from the perspective of patients, relatives, administrators, nurses, physiotherapists and physicians. We developed two main themes: Pragmatic Concerns and Therapeutic Concerns. Each theme contained two categories: Pragmatic Concerns: (a) the convenience of non‐face to face consultations; (b) using technology and equipment in a consultation; Therapeutic Concerns (c) building therapeutic relationships; and (d) embracing benefits and addressing challenges. Conclusion This narrative synthesis presents the existing evidence on clinician and patient experience of participating in non‐face to face consultations. Experiences are varied but largely focus on communication and forming relationships, using the technology successfully and the ability for patients to self‐manage with support from clinicians who are not in‐person. More high‐quality studies are required to explore the experiences of patients and clinicians accessing remote consultations as a result of global implementation post‐SARS‐CoV‐2 pandemic to identify any learning and education opportunities. Impact Health care staff can provide high‐quality care through video or telephone appointments as well as face to face appointments. This review has, however, identified that the evidence is limited and weak in this area and recommends there is research further to inform practice and influence future care.
Collapse
Affiliation(s)
- Helen Walthall
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Sue Schutz
- Oxford Brookes University and Oxford Biomedical Research Centre, Oxford, UK
| | - Joanne Snowball
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Raluca Vagner
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Nicola Fernandez
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Emilia Bartram
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| |
Collapse
|
48
|
Collins C, Petek D, Diaz E, Muñoz MA. General Practice/Family Medicine Research During the Pandemic: Showing The Links to the EGPRN Research Strategy. EURASIAN JOURNAL OF FAMILY MEDICINE 2022. [DOI: 10.33880/ejfm.2022110101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
General Practice/Family Medicine is at the forefront of the clinical response to the COVID-19 crisis just as it is known to be a critical component of healthcare systems globally.
A large number of COVID-19 related papers have been published and dedicated funding calls were available in many countries and across the European Union. However, General Practice/Family Medicine does not feature as strongly as it should in COVID-19 high impact publications or successful funding applications.
In this paper, we take a look at the findings on which the recommendations of the “European General Practice Research Network (EGPRN) Research Strategy for General Practice in Europe 2021” are based and highlight how these align with the COVID-19 experience of General Practice/Family research.
To elaborate on this, the issues identified and the recommendations of the EGPRN Research Strategy are grouped into three broad areas on which we need to focus – capacity, collaboration, and complexity (3-Cs).
Apparent or presumed deficiencies in these 3-Cs are possibly why the General Practice/Family research impact during COVID-19 does not match its position on the ground in fighting the pandemic and supporting patients. The EGPRN Research Strategy identifies how we might work to position ourselves better in the future and gain the recognition deserved, in terms of publications, research funding, and prominence.
Keywords: general practice, research, pandemics, publications, financing
Collapse
Affiliation(s)
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana
| | | | | |
Collapse
|
49
|
Ewart C, Baharani J, Wilkie M, Thomas N. Patient perspectives and experiences of remote consultations in people receiving kidney care: A scoping review. J Ren Care 2022; 48:143-153. [PMID: 35338610 PMCID: PMC9545432 DOI: 10.1111/jorc.12419] [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: 11/03/2021] [Revised: 02/04/2022] [Accepted: 02/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic resulted in a rapid and sometimes chaotic change in how clinical care was delivered for people living with kidney disease, with increased reliance on digital technologies and the introduction of remote services. OBJECTIVES To conduct a scoping review of studies about patients' experiences and perspectives in receipt of remote consultations for kidney care. DESIGN Using Arksey and O'Malley's framework, three databases were searched on EBSCO (CINAHL, MEDLINE and Psych INFO). The search included studies published in English from August 2010 to August 2021. RESULTS Eight studies met the scoping review criteria (two cross-sectional, two mixed-method and four qualitative). Five themes were identified: overall satisfaction with remote services, benefits to patients (convenience, involvement in care and patient safety), barriers to remote consultations (technical difficulties, digital literacy and loss of interpersonal communication), patient concerns (need for physical examination, privacy and confidentiality) and prerequisites for successful remote care (existing patient-practitioner relationship, stable illness phase and access to technology). CONCLUSION Remote consultations confer multiple advantages to patients; therefore, remote consultations should be offered as an option to patients living with kidney disease beyond the COVID-19 pandemic. However, there are several barriers to remote consultation that need to be addressed and understood before implementing remote care long-term. Future research should examine the impact of remote consultations on people living with kidney disease from under-served groups to identify barriers and ensure their suitability and accessibility to the wider population for a more patient-centred approach to kidney care.
Collapse
Affiliation(s)
- Catriona Ewart
- Institute of Health and Social Care, London South Bank University, London, UK
| | | | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Nicola Thomas
- Institute of Health and Social Care, London South Bank University, London, UK
| |
Collapse
|
50
|
Russell A, de Wildt G, Grut M, Greenfield S, Clarke J. What can general practice learn from primary care nurses' and healthcare assistants' experiences of the COVID-19 pandemic? A qualitative study. BMJ Open 2022; 12:e055955. [PMID: 35292497 PMCID: PMC8927928 DOI: 10.1136/bmjopen-2021-055955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES UK general practice has radically altered in response to COVID-19. The general practice nursing team has been central to these changes. To help learn from COVID-19 and maintain a sustainable nursing workforce, general practice should reflect on their support needs and perceptions of organisational strategies. This study aimed to explore primary care nurses' and healthcare assistants' experiences and perceptions of general practice, and the changes made to it, during the pandemic. DESIGN Exploratory qualitative study using semistructured interviews. Interview data were analysed using Braun and Clarke's 'codebook' thematic analysis. SETTING General practices in the Midlands, South East and South West England. Interviews were conducted in February and March 2021, as England began to unlock from its third national lockdown. PARTICIPANTS Practice nurses (n=12), healthcare assistants (n=7), advanced nurse practitioners (n=4) and nursing associates (n=1) recruited using convenience and snowball sampling. RESULTS Three themes were identified. Difficult changes describes dramatic changes made to general practice at the onset of the pandemic, creating confusion and anxiety. Dealing with change characterises how negative emotions were intensified by fear of infection, problematic government guidance, personal protective equipment (PPE) shortages and friction with doctors; but could be mitigated through effective practice communication, peer support and individual coping strategies. An opportunity for improvement highlights certain changes (eg, the increased use of telehealth) that participants believed could be adopted long term to improve efficiency. CONCLUSION General practice should learn from the COVID-19 pandemic to nurture the clinical role and resilience of nurses and healthcare assistants in the postpandemic 'new normal'. Robust PPE provision could enable them to undertake their patient-facing duties safely and confidently. Judicious implementation of telehealth could help preserve the practical and caring nature of nursing. Improving channels of communication and interprofessional collaboration could help realise their potential within the primary care team.
Collapse
Affiliation(s)
- Alice Russell
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Gilles de Wildt
- Institute of Clinical Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Minka Grut
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Joanne Clarke
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| |
Collapse
|