1
|
Cook R, Haydon HM, Thomas EE, Ward EC, Ross JA, Webb C, Harris M, Hartley C, Burns CL, Vivanti AP, Carswell P, Caffery LJ. Digital divide or digital exclusion? Do allied health professionals' assumptions drive use of telehealth? J Telemed Telecare 2023:1357633X231189846. [PMID: 37543369 DOI: 10.1177/1357633x231189846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Telehealth use within allied health services currently lacks structure and consistency, ultimately affecting who can, and cannot, access services. This study aimed to investigate the factors influencing allied health professionals' (AHP) selection of consumers and appointments for telehealth. METHODS This study was conducted across 16 allied health departments from four Australian hospitals. Semi-structured focus groups were conducted with 58 AHPs. Analysis was underpinned by Qualitative Description methodology with inductive coding guided by Braun and Clarke's thematic analysis approach. RESULTS Six themes were identified that influenced AHPs' evaluation of telehealth suitability and selection of consumers. These included the following: (1) ease, efficiency and comfort of telehealth for clinicians; (2) clear benefits of telehealth for the consumer, yet the consumers were not always given the choice; (3) consumers' technology access and ability; (4) establishing and maintaining effective therapeutic relationships via telehealth; (5) delivering clinically appropriate and effective care via telehealth; and (6) external influences on telehealth service provision. A further theme of 'assumption versus reality' was noted to pervade all six themes. DISCUSSION Clinicians remain the key decision makers for whether telehealth is offered within allied health services. Ease and efficiency of use is a major driver in AHP's willingness to use telehealth. Assumptions and pre-conceived frames-of-reference often underpin decisions to not offer telehealth and present major barriers to telehealth adoption. The development of evidence-based, decision-support frameworks that engage the consumer and clinician in determining when telehealth is used is required. Services need to actively pursue joint decision-making between the clinician and consumer about service delivery preferences.
Collapse
Affiliation(s)
- Renee Cook
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Health, Brisbane, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research (CFAHR), Metro South Health, Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Julie-Anne Ross
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Clare Webb
- Allied Health, Queen Elizabeth II Jubilee Hospital, Metro South Health, Brisbane, Australia
| | - Michael Harris
- Allied Health, Bayside Health Service, Metro South Health, Brisbane, Australia
| | - Carina Hartley
- Allied Health, Logan Hospital, Metro South Health, Brisbane, Australia
| | - Clare L Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology Department, Royal Brisbane & Women's Hospital, Metro North Health, Brisbane, Australia
| | - Angela P Vivanti
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- School of Human Movement and Nutrition Studies, The University of Queensland, Brisbane, Australia
| | - Phillip Carswell
- Consumer Advisor, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| |
Collapse
|
2
|
Ulltang M, Vivanti AP, Murray E. Malnutrition prevalence in a medical assessment and planning unit and its association with hospital readmission. AUST HEALTH REV 2014; 37:636-41. [PMID: 24200115 DOI: 10.1071/ah13051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/14/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate malnutrition prevalence on presentation to a Medical Assessment and Planning Unit (MAPU) in a setting designed to prevent hospital admission, the association of nutritional status with hospital readmission at 90 days, and agreement of nutritional risk between the Malnutrition Screening Tool (MST) and Subjective Global Assessment (SGA). METHODS Prospective longitudinal cohort study of consecutive patients admitted to MAPU during the first 6 weeks of operation. The main outcome measures were prevalence of malnutrition and hospital readmission at 90 days. Sensitivity and specificity of the MST was assessed against the criterion standard of SGA. RESULTS The mean participant age was 62 years (n = 153, s.d. 17.4 years) with 50% male (77/153, 95% CI 42-58%). According to the SGA, 17% (95% CI 8-26%) were assessed as malnourished on admission. The MST identified that 18% (95% CI 12-24%) were at nutritional risk, and participants screening positive for nutritional risk had significantly increased odds of hospital readmission at 90 days (OR 3.4, 95% CI, 1.3-9.1, P < 0.029). The MST was practical and successfully identified patients assessed as malnourished within the MAPU setting (sensitivity 73%, specificity 76%, negative predictive value 93%, positive predictive value 38%). CONCLUSIONS Malnutrition is a significant problem in a MAPU setting, and patients screened at nutritional risk are at significantly higher risk of hospital readmission within 90 days.
Collapse
Affiliation(s)
- Marte Ulltang
- Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | | | | |
Collapse
|
4
|
Vivanti AP, Campbell KL, Suter MS, Hannan-Jones MT, Hulcombe JA. Contribution of thickened drinks, food and enteral and parenteral fluids to fluid intake in hospitalised patients with dysphagia. J Hum Nutr Diet 2009; 22:148-55. [PMID: 19302120 DOI: 10.1111/j.1365-277x.2009.00944.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies amongst older people with acute dysphagic stroke requiring thickened fluids have assessed fluid intakes from combinations of beverage, food, enteral and parenteral sources, but not all sources simultaneously. The present study aimed to comprehensively assess total water intake from food, beverages, enteral and parenteral sources amongst dysphagic adult in-patients receiving thickened fluids. METHODS Patients requiring thickened fluid following dysphagia diagnosis were recruited consecutively from a tertiary teaching hospital's medical and neurosurgical wards. Fluid intake from food and beverages was assessed by wastage, direct observation and quantified from enteral and parenteral sources through clinical medical records. RESULTS No patients achieved their calculated fluid requirements unless enteral or parenteral fluids were received. The mean daily fluid intake from food was greater than from beverages whether receiving diet alone (food: 807 +/- 363 mL, food and beverages: 370 +/- 179 mL; P < 0.001) or diet with enteral or parenteral fluid support (food: 455 +/- 408 mL, food and beverages: 263 +/- 232 mL; P < 0.001). Greater daily fluid intakes occurred when receiving enteral and parenteral fluid in addition to oral dietary intake, irrespective of age group, whether assistance was required, diagnosis and whether stage 3 or stage 2 thickened fluids were required (P < 0.05). After enteral and parenteral sources, food provided the most important contribution to daily fluid intakes. CONCLUSIONS The greatest contribution to oral fluid intake was from food, not beverages. Designing menus and food services that promote and encourage the enjoyment of fluid dense foods, in contrast to thickened beverages, may present an important way to improve fluid intakes of those with dysphagia. Supplemental enteral or parenteral fluid may be necessary to achieve minimum calculated fluid requirements.
Collapse
Affiliation(s)
- A P Vivanti
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Queensland, Australia.
| | | | | | | | | |
Collapse
|
5
|
Vivanti AP, Banks MD. Length of stay patterns for patients of an acute care hospital: implications for nutrition and food services. AUST HEALTH REV 2007; 31:282-7. [PMID: 17470050 DOI: 10.1071/ah070282] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 10/31/2005] [Accepted: 08/07/2006] [Indexed: 11/23/2022]
Abstract
Objective: Shortened hospital average length of
stay (ALOS) has been used to justify rationalisation
of some services, but, by definition, some patients
stay for longer than the average. The objective of this
study was to explore lengths of stay and proportions
of hospital occupied bed-days (OBDs) of those
admitted for longer time periods to inform service
planning.
Methods: The proportion and ALOS of overnight
separations at an Australian tertiary hospital were
assessed for admissions of up to 4 days and 4 days
or more. This was repeated for 7, 14 and 28 days.
The proportion of OBD?s for each time period was
determined.
Results: While the proportion of total hospital
patients staying for 4, 7, 14 and 28 days or more is
relatively small (21.9%, 13.5%, 6.2%, 2.6%, respectively),
they represent a large proportion of OBD?s
(74.9%, 67.2%, 50.8%, 34.2%) with an ALOS of
14.0, 20.3, 33.7, and 54.4 days, respectively. The
majority of long-stay patients were in acute care.
Conclusion: Substantial proportions of OBD?s are
due to patients admitted for time periods far greater
than reflected by ALOS. Hospitals need to rethink
how to optimally accommodate the nutrition and
food requirements of the large patient numbers
admitted for longer time periods, many of whom are
at increased risk of malnutrition.
Collapse
Affiliation(s)
- Angela P Vivanti
- Nutrition and Dietetics, Princess Alexandra Hospital, Nutrition and Operational Support Services, Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia.
| | | |
Collapse
|