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Watson JD, Xia B, Dini ME, Silverman AL, Pierce BS, Chang CN, Perrin PB. Barriers and facilitators to physicians' telemedicine uptake during the beginning of the COVID-19 pandemic. PLOS DIGITAL HEALTH 2025; 4:e0000818. [PMID: 40198620 PMCID: PMC11977993 DOI: 10.1371/journal.pdig.0000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 03/08/2025] [Indexed: 04/10/2025]
Abstract
Despite decades of low utilization, telemedicine adoption expanded at an unprecedented rate during the COVID-19 pandemic. This study examined quantitative and qualitative data provided by a national online sample of 228 practicing physicians (64% were women, and 75% were White) to identify facilitators and barriers to the adoption of telemedicine in the United States (U.S.) at the beginning of the COVID-19 pandemic. Logistic regressions were used to predict the most frequently endorsed (20% or more) barriers and facilitators based on participant demographics and practice characteristics. The top five reported barriers were: lack of patient access to technology (77.6%), insufficient insurance reimbursement (53.5%), diminished doctor-patient relationship (46.9%), inadequate video/audio technology (46.1%), and diminished quality of delivered care (42.1%). The top five reported facilitators were: better access to care (75.4%), increased safety (70.6%), efficient use of time (60.5%), lower cost for patients (43%), and effectiveness (28.9%). Physicians' demographic and practice setting characteristics significantly predicted their endorsement of telemedicine barriers and facilitators. Older physicians were less likely to endorse inefficient use of time (p < 0.001) and potential for medical errors (p = 0.034) as barriers to telemedicine use compared to younger physicians. Physicians working in a medical center were more likely to endorse inadequate video/audio technology (p = 0.037) and lack of patient access to technology (p = 0.035) as a barrier and more likely to endorse lower cost for patients as a facilitator (p = 0.041) than providers working in other settings. Male physicians were more likely to endorse inefficient use of time as a barrier (p = 0.007) than female physicians, and White physicians were less likely to endorse lower costs for patients as a facilitator (p = 0.012) than physicians of color. These findings provide important context for future implementation strategies for healthcare systems attempting to increase telemedicine utilization.
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Affiliation(s)
- Jack D. Watson
- Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City, Salt Lake City, Utah, United States of America
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Bridget Xia
- School of Data Science, University of Virginia, Charlottesville, Virginia, United States of America
| | - Mia E. Dini
- Department of Psychology, University of Virginia, Charlottesville, Virginia, United States of America
| | - Alexandra L. Silverman
- McLean Hospital/Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts, United States of America
| | - Bradford S. Pierce
- James A. Haley Veterans Affairs Medical Center, Tampa, Florida, United States of America
| | - Chi-Ning Chang
- School of Education, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Paul B. Perrin
- School of Data Science, University of Virginia, Charlottesville, Virginia, United States of America
- Department of Psychology, University of Virginia, Charlottesville, Virginia, United States of America
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Rosenstrøm S, Groth S, Risom SS, Hove JD, Brødsgaard A. Nurses' Experiences With Virtual Consultations and Home-Monitoring in Patients With Cardiac Disease: A Systematic Review and Qualitative Meta-Synthesis of Results. Nurs Health Sci 2024; 26:e13180. [PMID: 39437992 DOI: 10.1111/nhs.13180] [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: 04/10/2024] [Revised: 08/20/2024] [Accepted: 10/02/2024] [Indexed: 10/25/2024]
Abstract
To explore how nurses experience facilitators and barriers to the use of video-consultations for home-monitoring of patients with cardiac disease. A systematic literature search in PubMed, CINAHL, Scopus, and Web of Science was undertaken, inclusion criteria were qualitative data published between 2013 and 2023 written in English, Norwegian, Swedish, or Danish. Ten studies were included in the qualitative synthesis conducted as described by Braun and Clarke. From the synthesis, a main theme emerged: Nurses' uncertainty toward telemedicine is a risk toward the use of video-consultations and home-monitoring. The essence of the findings range from nurses' positive experiences to their frustration concerning the implementation process and the lack of technical support for clinicians and patients. Nurses often felt frustration and uncertainty about the quality of delivered care through virtual consultations. Working with technology in caring for patients with cardiac disease, including video-consultations and home-monitoring, nurses experienced a sense of insecurity. Insecurity was identified as a lack of technological knowledge, nurses' feelings of apathy, poorer observation through a video-consultation, and the lack of organizational support.
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Affiliation(s)
- Stine Rosenstrøm
- Department of Cardiology, Copenhagen University Hospital, Amager Hvidovre, Copenhagen, Denmark
| | - Sissel Groth
- Department of Cardiology, Copenhagen University Hospital, Amager Hvidovre, Copenhagen, Denmark
| | - Signe Stelling Risom
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark
- Institute of Nursing and Nutrition, University College, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Jens Dahlgaard Hove
- Department of Cardiology, Copenhagen University Hospital, Amager Hvidovre, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine, and Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Amager Hvidovre, Hvidovre, Denmark
- Department of Public Health, Nursing and Health Care, Aarhus University, Aarhus, Denmark
- Department of People and Technology, University of Roskilde, Roskilde, Denmark
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Keuper J, van Tuyl LHD, de Geit E, Rijpkema C, Vis E, Batenburg R, Verheij R. The impact of eHealth use on general practice workload in the pre-COVID-19 era: a systematic review. BMC Health Serv Res 2024; 24:1099. [PMID: 39300456 DOI: 10.1186/s12913-024-11524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 09/02/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND In recent years, eHealth has received much attention as an opportunity to increase efficiency within healthcare organizations. Adoption of eHealth might consequently help to solve perceived health workforce challenges, including labor shortages and increasing workloads among primary care professionals, who serve as the first point of contact for healthcare in many countries. The purpose of this systematic review was to investigate the impact of general eHealth use and specific eHealth services use on general practice workload in the pre-COVID-19 era. METHODS The databases of CINAHL, Cochrane, Embase, IEEE Xplore, Medline ALL, PsycINFO, Web of Science, and Google Scholar were searched, using combinations of keywords including 'eHealth', 'workload', and 'general practice'. Data extraction and quality assessment of the included studies were independently performed by at least two reviewers. Publications were included for the period 2010 - 2020, before the start of the COVID-19 pandemic. RESULTS In total, 208 studies describing the impact of eHealth services use on general practice workload were identified. We found that two eHealth services were mainly investigated within this context, namely electronic health records and digital communication services, and that the largest share of the included studies used a qualitative study design. Overall, a small majority of the studies found that eHealth led to an increase in general practice workload. However, results differed between the various types of eHealth services, as a large share of the studies also reported a reduction or no change in workload. CONCLUSIONS The impact of eHealth services use on general practice workload is ambiguous. While a small majority of the effects indicated that eHealth increased workload in general practice, a large share of the effects also showed that eHealth use reduced workload or had no impact. These results do not imply a definitive conclusion, which underscores the need for further explanatory research. Various factors, including the study setting, system design, and the phase of implementation, may influence this impact and should be taken into account when general practices adopt new eHealth services. STUDY REGISTRATION NUMBER PROSPERO (International Prospective Register of Systematic Reviews) CRD42020199897; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=199897 .
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Affiliation(s)
- Jelle Keuper
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands.
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037DB, Netherlands.
| | - Lilian H D van Tuyl
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
| | - Ellemarijn de Geit
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
| | - Corinne Rijpkema
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037DB, Netherlands
| | - Elize Vis
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
- Department of Sociology, Radboud University Nijmegen, Thomas van Aquinostraat 4, Nijmegen, 6525GD, Netherlands
| | - Robert Verheij
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037DB, Netherlands
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Tan AJQ, McKenna L, Bramley A, van Houwelingen T, Tan LLC, Lim YJ, Lau ST, Liaw SY. Telemedicine entrustable professional activities for nurses in long-term care: A modified Delphi study. NURSE EDUCATION TODAY 2024; 140:106264. [PMID: 38823089 DOI: 10.1016/j.nedt.2024.106264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 04/04/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND As the use of telemedicine proliferates in community care, it is essential to ensure practice recommendations and guidelines are available to assist healthcare providers in providing telemedicine-based care. This study aimed to develop entrustable professional activities (EPAs) for nursing home nurses involved in telemedicine consultations. AIM To develop entrustable professional activities (EPAs) for nursing home nurses involved in telemedicine consultations. DESIGN Modified Delphi study. METHODS The study was conducted in two stages. First, content analysis of 28 healthcare provider interviews and literature review on telemedicine competencies was conducted to develop an initial list of EPAs. An expert workgroup comprising of an international panel of academics and clinicians reviewed the activities. In the second stage, a three-round e-Delphi technique was used to develop telemedicine EPAs for nurses in long-term care. Descriptive statistics and qualitative feedback were distributed to participants after each round. Agreement within survey rounds was computed. RESULTS Six core telemedicine EPAs with 28 descriptors were developed, from preparing the resident for the teleconsultation encounter to follow-up care post-teleconsultation. Agreement coefficients were high across all Delphi rounds. CONCLUSION This study identifies the core functions that long-term care nurses' are expected to perform in telemedicine consultations. The internationally relevant EPAs are sufficiently broad to be adapted to design telemedicine training and workplace-based assessment for nurses. Organisations may utilise the EPAs as a resource during the implementation process of telemedicine services in long-term care in designing nursing workflow and complement the learning and development of nurses for telemedicine services. Equipping long-term care nurses with this resource can ensure consistency, patient safety and quality of teleconsultations delivered to nursing home residents. However, further work is required to expand the EPAs for application to practice.
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Affiliation(s)
- Apphia Jia Qi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Australia
| | - Andrea Bramley
- Department of Dietetics, Nutrition and Sport, School of Allied Health, Human Service, and Sport, La Trobe University, Australia; Monash Health, Clayton, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Thijs van Houwelingen
- Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, The Netherlands
| | - Laurence Lean Chin Tan
- Division of Palliative Care and Supportive Care, Department of Geriatric Medicine, Yishun Health, Singapore; Population Health Campus, National Healthcare Group, Singapore
| | - Yu Jun Lim
- Population Health Campus, National Healthcare Group, Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Melman A, Vella SP, Dodd RH, Coombs DM, Richards B, Rogan E, Teng MJ, Maher CG, Ghinea N, Machado GC. Clinicians' Perspective on Implementing Virtual Hospital Care for Low Back Pain: Qualitative Study. JMIR Rehabil Assist Technol 2023; 10:e47227. [PMID: 37988140 DOI: 10.2196/47227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/02/2023] [Accepted: 09/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Alternate "hospital avoidance" models of care are required to manage the increasing demand for acute inpatient beds. There is currently a knowledge gap regarding the perspectives of hospital clinicians on barriers and facilitators to a transition to virtual care for low back pain. We plan to implement a virtual hospital model of care called "Back@Home" and use qualitative interviews with stakeholders to develop and refine the model. OBJECTIVE We aim to explore clinicians' perspectives on a virtual hospital model of care for back pain (Back@Home) and identify barriers to and enablers of successful implementation of this model of care. METHODS We conducted semistructured interviews with 19 purposively sampled clinicians involved in the delivery of acute back pain care at 3 metropolitan hospitals. Interview data were analyzed using the Theoretical Domains Framework. RESULTS A total of 10 Theoretical Domains Framework domains were identified as important in understanding barriers and enablers to implementing virtual hospital care for musculoskeletal back pain. Key barriers to virtual hospital care included patient access to videoconferencing and reliable internet, language barriers, and difficulty building rapport. Barriers to avoiding admission included patient expectations, social isolation, comorbidities, and medicolegal concerns. Conversely, enablers of implementing a virtual hospital model of care included increased health care resource efficiency, clinician familiarity with telehealth, as well as a perceived reduction in overmedicalization and infection risk. CONCLUSIONS The successful implementation of Back@Home relies on key stakeholder buy-in. Addressing barriers to implementation and building on enablers is crucial to clinicians' adoption of this model of care. Based on clinicians' input, the Back@Home model of care will incorporate the loan of internet-enabled devices, health care interpreters, and written resources translated into community languages to facilitate more equitable access to care for marginalized groups.
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Affiliation(s)
- Alla Melman
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Simon P Vella
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Rachael H Dodd
- The Daffodil Centre, Faculty of Medicine and Health, a joint venture between The University of Sydney and Cancer Council New South Wales, Sydney, Australia
| | - Danielle M Coombs
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Bethan Richards
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- Rheumatology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Min Jiat Teng
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- RPA Virtual Hospital, Sydney, Australia
| | - Chris G Maher
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Narcyz Ghinea
- Department of Philosophy, Macquarie University, Sydney, Australia
| | - Gustavo C Machado
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
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Herlitz L, Crellin N, Vindrola-Padros C, Ellins J, Georghiou T, Litchfield I, Massou E, Ng PL, Sherlaw-Johnson C, Sidhu MS, Tomini SM, Walton H, Fulop NJ. Patient and staff experiences of using technology-enabled and analogue models of remote home monitoring for COVID-19 in England: A mixed-method evaluation. Int J Med Inform 2023; 179:105230. [PMID: 37774428 DOI: 10.1016/j.ijmedinf.2023.105230] [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: 06/02/2023] [Revised: 08/24/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To evaluate patient and staff experiences of using technology-enabled ('tech-enabled') and analogue remote home monitoring models for COVID-19, implemented in England during the pandemic. METHODS Twenty-eight sites were selected for diversity in a range of criteria (e.g. pre-hospital or early discharge service, mode of patient data submission). Between February and May 2021, we conducted quantitative surveys with patients, carers and staff delivering the service, and interviewed patients, carers, and staff from 17 of the 28 services. Quantitative data were analysed using descriptive statistics and both univariate and multivariate analyses. Qualitative data were interpreted using thematic analysis. RESULTS Twenty-one sites adopted mixed models whereby patients could submit their symptoms using either tech-enabled (app, weblink, or automated phone calls) or analogue (phone calls with a health professional) options; seven sites offered analogue-only data submission (phone calls or face-to-face visits with a health professional). Sixty-two patients and carers were interviewed, and 1069 survey responses were received (18 % response rate). Fifty-eight staff were interviewed, and 292 survey responses were received (39 % response rate). Patients who used tech-enabled modes tended to be younger (p = 0.005), have a higher level of education (p = 0.011), and more likely to identify as White British (p = 0.043). Most patients found relaying symptoms easy, regardless of modality, though many received assistance from family or friends. Staff considered the adoption of mixed delivery models beneficial, enabling them to manage large patient numbers and contact patients for further assessment as needed; however, they suggested improvements to the functionality of systems to better fit clinical and operational needs. Human contact was important in all remote home monitoring options. CONCLUSIONS Organisations implementing tech-enabled remote home monitoring at scale should consider adopting mixed models which can accommodate patients with different needs; focus on the usability and interoperability of tech-enabled platforms; and encourage digital inclusivity for patients.
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Affiliation(s)
- Lauren Herlitz
- NIHR Children and Families Policy Research Unit, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Nadia Crellin
- Nuffield Trust, 59 New Cavendish St, London W1G 7LP, UK
| | - Cecilia Vindrola-Padros
- Department of Targeted Intervention, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Jo Ellins
- Health Services Management Centre, School of Social Policy, University of Birmingham, 40 Edgbaston Park Road, Birmingham, B15 2RT, UK
| | | | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, 40 Edgbaston Park Road, Birmingham, B15 2RT, UK
| | - Efthalia Massou
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Pei Li Ng
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, UK
| | | | - Manbinder S Sidhu
- Health Services Management Centre, School of Social Policy, University of Birmingham, 40 Edgbaston Park Road, Birmingham, B15 2RT, UK
| | - Sonila M Tomini
- Global Business School for Health, University College London, Gower Street. Bloomsbury London SC1E 6BT, UK
| | - Holly Walton
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, UK
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Man REK, Ho AXY, Lee EPX, Fenwick EKD, Aravindhan A, Ho KC, Wei Tan GS, Wei Ting DS, Wong TY, Yeo KK, Goh SY, Gupta P, Lamoureux EL. Awareness and attitudes of elderly Southeast Asian adults towards telehealth during the COVID-19 pandemic: a qualitative study. Singapore Med J 2023:384056. [PMID: 37675683 DOI: 10.4103/singaporemedj.smj-2022-117] [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: 09/08/2023]
Abstract
Introduction We aimed to understand the awareness and attitudes of elderly Southeast Asians towards telehealth services during the coronavirus disease 2019 (COVID-19) pandemic in this study. Methods In this qualitative study, 78 individuals from Singapore (51.3% female, mean age 73.0 ± 7.6 years) were interviewed via telephone between 13 May 2020 and 9 June 2020 during Singapore's first COVID-19 'circuit breaker'. Participants were asked to describe their understanding of telehealth, their experience of and willingness to utilise these services, and the barriers and facilitators underlying their decision. Transcripts were analysed using thematic analysis, guided by the United Theory of Acceptance Use of Technology framework. Results Of the 78 participants, 24 (30.8%) were able to describe the range of telehealth services available and 15 (19.2%) had previously utilised these services. Conversely, 14 (17.9%) participants thought that telehealth comprised solely home medication delivery and 50 (51.3%) participants did not know about telehealth. Despite the advantages offered by telehealth services, participants preferred in-person consultations due to a perceived lack of human interaction and accuracy of diagnoses, poor digital literacy and a lack of access to telehealth-capable devices. Conclusion Our results showed poor overall awareness of the range of telehealth services available among elderly Asian individuals, with many harbouring erroneous views regarding their use. These data suggest that public health education campaigns are needed to improve awareness of and correct negative perceptions towards telehealth services in elderly Asians.
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Affiliation(s)
- Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Aricia Xin Yi Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ester Pei Xuan Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Eva Katie Diana Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Amudha Aravindhan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Kam Chun Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; School of Optometry and Vision Science, University of New South Wales, Sydney; Discipline of Optometry and Vision Science, Faculty of Health, University of Canberra, Canberra, Australia
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore, Singapore; Discipline of Optometry and Vision Science, Faculty of Health, University of Canberra, Canberra, Australia
| | - Khung Keong Yeo
- Duke-NUS Medical School, National University of Singapore; Department of Cardiology, National Heart Centre, Singapore
| | - Su-Yen Goh
- Duke-NUS Medical School, National University of Singapore; Department of Endocrinology, Singapore General Hospital, Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ecosse Luc Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School; Department of Ophthalmology, National University of Singapore, Singapore; Department of Surgery and Medicine, University of Melbourne, Melbourne, Australia
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Dowding D, Skyrme S, Randell R, Newbould L, Faisal M, Hardiker N. Researching nurses' use of digital technology during the COVID-19 pandemic. Nurs Stand 2023; 38:63-68. [PMID: 37157913 DOI: 10.7748/ns.2023.e12013] [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] [Accepted: 09/05/2022] [Indexed: 05/10/2023]
Abstract
The adoption of digital technology by nurses accelerated during the coronavirus disease 2019 (COVID-19) pandemic. However, not all nurses were familiar with the various digital systems used in their organisations and there were reports of digital technology not being fit for purpose. This article describes a service evaluation that used an online survey to obtain nurses' feedback on the digital systems used to support patient care during the pandemic. Fifty-five respondents provided details about 85 separate digital systems. The usability of these systems varied significantly across technology types, while barriers to their use included nurses' lack of digital literacy and inadequate access to IT infrastructure. However, most of the nurse respondents felt that digital technology had supported effective patient care during the COVID-19 pandemic.
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Affiliation(s)
- Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England
| | - Sarah Skyrme
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England
| | - Rebecca Randell
- faculty of health studies, University of Bradford, Bradford, England
| | - Louise Newbould
- Department For Social Policy And Social Work, University of York, York, England
| | - Muhammad Faisal
- Faculty of Health Studies, University of Bradford, Bradford, England
| | - Nick Hardiker
- School of Human And Health Sciences, University of Huddersfield, Huddersfield, England
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Fulop NJ, Walton H, Crellin N, Georghiou T, Herlitz L, Litchfield I, Massou E, Sherlaw-Johnson C, Sidhu M, Tomini SM, Vindrola-Padros C, Ellins J, Morris S, Ng PL. A rapid mixed-methods evaluation of remote home monitoring models during the COVID-19 pandemic in England. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-151. [PMID: 37800997 DOI: 10.3310/fvqw4410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Background Remote home monitoring services were developed and implemented for patients with COVID-19 during the pandemic. Patients monitored blood oxygen saturation and other readings (e.g. temperature) at home and were escalated as necessary. Objective To evaluate effectiveness, costs, implementation, and staff and patient experiences (including disparities and mode) of COVID-19 remote home monitoring services in England during the COVID-19 pandemic (waves 1 and 2). Methods A rapid mixed-methods evaluation, conducted in two phases. Phase 1 (July-August 2020) comprised a rapid systematic review, implementation and economic analysis study (in eight sites). Phase 2 (January-June 2021) comprised a large-scale, multisite, mixed-methods study of effectiveness, costs, implementation and patient/staff experience, using national data sets, surveys (28 sites) and interviews (17 sites). Results Phase 1 Findings from the review and empirical study indicated that these services have been implemented worldwide and vary substantially. Empirical findings highlighted that communication, appropriate information and multiple modes of monitoring facilitated implementation; barriers included unclear referral processes, workforce availability and lack of administrative support. Phase 2 We received surveys from 292 staff (39% response rate) and 1069 patients/carers (18% response rate). We conducted interviews with 58 staff, 62 patients/carers and 5 national leads. Despite national roll-out, enrolment to services was lower than expected (average enrolment across 37 clinical commissioning groups judged to have completed data was 8.7%). There was large variability in implementation of services, influenced by patient (e.g. local population needs), workforce (e.g. workload), organisational (e.g. collaboration) and resource (e.g. software) factors. We found that for every 10% increase in enrolment to the programme, mortality was reduced by 2% (95% confidence interval: 4% reduction to 1% increase), admissions increased by 3% (-1% to 7%), in-hospital mortality fell by 3% (-8% to 3%) and lengths of stay increased by 1.8% (-1.2% to 4.9%). None of these results are statistically significant. We found slightly longer hospital lengths of stay associated with virtual ward services (adjusted incidence rate ratio 1.05, 95% confidence interval 1.01 to 1.09), and no statistically significant impact on subsequent COVID-19 readmissions (adjusted odds ratio 0.95, 95% confidence interval 0.89 to 1.02). Low patient enrolment rates and incomplete data may have affected chances of detecting possible impact. The mean running cost per patient varied for different types of service and mode; and was driven by the number and grade of staff. Staff, patients and carers generally reported positive experiences of services. Services were easy to deliver but staff needed additional training. Staff knowledge/confidence, NHS resources/workload, dynamics between multidisciplinary team members and patients' engagement with the service (e.g. using the oximeter to record and submit readings) influenced delivery. Patients and carers felt services and human contact received reassured them and were easy to engage with. Engagement was conditional on patient, support, resource and service factors. Many sites designed services to suit the needs of their local population. Despite adaptations, disparities were reported across some patient groups. For example, older adults and patients from ethnic minorities reported more difficulties engaging with the service. Tech-enabled models helped to manage large patient groups but did not completely replace phone calls. Limitations Limitations included data completeness, inability to link data on service use to outcomes at a patient level, low survey response rates and under-representation of some patient groups. Future work Further research should consider the long-term impact and cost-effectiveness of these services and the appropriateness of different models for different groups of patients. Conclusions We were not able to find quantitative evidence that COVID-19 remote home monitoring services have been effective. However, low enrolment rates, incomplete data and varied implementation reduced our chances of detecting any impact that may have existed. While services were viewed positively by staff and patients, barriers to implementation, delivery and engagement should be considered. Study registration This study is registered with the ISRCTN (14962466). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (RSET: 16/138/17; BRACE: 16/138/31) and NHSEI and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 13. See the NIHR Journals Library website for further project information. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.
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Affiliation(s)
- Naomi J Fulop
- Department of Applied Health Research, University College London, UK
| | - Holly Walton
- Department of Applied Health Research, University College London, UK
| | | | | | - Lauren Herlitz
- Department of Applied Health Research, University College London, UK
| | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Efthalia Massou
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | - Manbinder Sidhu
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Sonila M Tomini
- Department of Applied Health Research, University College London, UK
| | | | - Jo Ellins
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Pei Li Ng
- Department of Applied Health Research, University College London, UK
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10
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Tomlinson SRL, Gore N, McGill P. Family carer and professional perceptions of the potential use of telehealth for behavioural support. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:531-546. [PMID: 36919000 DOI: 10.1111/jir.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Telehealth (i.e. the use of technology across distance) is widespread in many fields. Although its use for behavioural support for people with intellectual or developmental disabilities (IDD) is emerging, there are no known studies examining stakeholder perceptions of this. METHODS A four-round Delphi consultation was conducted with 11 professionals and six family carers of children with IDD to generate consensus on what would influence participants' use of telehealth for behavioural support. Data were collected prior to the coronavirus pandemic. RESULTS Thirty-six items reached consensus for professionals (26 advantages and 10 disadvantages/barriers) and 22 for family carers (8 advantages and 14 disadvantages/barriers). A range of solutions were also identified for the disadvantages/barriers. CONCLUSIONS Participants were willing to use telehealth for behavioural support. However, disadvantages/barriers need to be addressed, and guidelines relating to the use of telehealth in this field are needed. We report a number of practice recommendations including combining telehealth with in-person supports where possible, incorporating video technologies, and considering client perspectives and confidence with telehealth methodologies.
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Affiliation(s)
| | - N Gore
- Tizard Centre, University of Kent, Canterbury, UK
| | - P McGill
- Tizard Centre, University of Kent, Canterbury, UK
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11
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Paterson C, Jack E, McKinstry B, Whyte S, Denison FC, Cheyne H. Qualitative evaluation of rapid implementation of remote blood pressure self-monitoring in pregnancy during Covid-19. PLoS One 2023; 18:e0278156. [PMID: 36862687 PMCID: PMC9980805 DOI: 10.1371/journal.pone.0278156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/10/2022] [Indexed: 03/03/2023] Open
Abstract
In March 2020, the World Health Organisation named the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), which causes corona virus disease 2019 (COVID -19), as a pandemic. Pregnant women were considered at increased risk of developing severe COVID-19 after viral infection. In response maternity services reduced face-to-face consultations with high-risk pregnant women by supplying blood pressure monitors for supported self-monitoring. This paper explores the experiences of patients and clinicians of the rapid roll-out of supported self-monitoring programme in Scotland during the first and second wave of the COVID-19 pandemic. We conducted semi-structured telephone interviews with high-risk women and healthcare professionals who were using supported self-monitoring of blood pressure (BP) In four case studies during the COVID-19 pandemic. 20 women, 15 midwives and 4 obstetricians took part in the interviews. Interviews with healthcare professionals showed that while implementation occurred at pace and at scale across the National Health Service (NHS) in Scotland, implementation differed locally, resulting in mixed experiences. Study Participants observed several barriers and facilitators to implementation. Women value the simplicity of use and convenience of the digital communications platforms while health professionals were more interested in their impact on reducing workload for both women and health professionals largely found self-monitoring acceptable, with only a few exceptions. These results show that rapid change can occur in the NHS at a national level when there is a shared motivation. While self-monitoring is acceptable to most women, decisions regarding self-monitoring should be made jointly and on an individual basis.
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Affiliation(s)
- Charlotte Paterson
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Elaine Jack
- MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Brian McKinstry
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Sonia Whyte
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, United Kingdom
| | - Fiona C. Denison
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Helen Cheyne
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
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12
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Kushniruk A, Teo SH, Tang WE, Ng DWL, Koh GCH, Teo VHY. Trust and Uncertainty in the Implementation of a Pilot Remote Blood Pressure Monitoring Program in Primary Care: Qualitative Study of Patient and Health Care Professional Views. JMIR Hum Factors 2023; 10:e36072. [PMID: 36602847 PMCID: PMC9853336 DOI: 10.2196/36072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/10/2022] [Accepted: 10/06/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Trust is of fundamental importance to the adoption of technologies in health care. The increasing use of telemedicine worldwide makes it important to consider user views and experiences. In particular, we ask how the mediation of a technological platform alters the trust relationship between patient and health care provider. OBJECTIVE To date, few qualitative studies have focused on trust in the use of remote health care technologies. This study examined the perspectives of patients and clinical staff who participated in a remote blood pressure monitoring program, focusing on their experiences of trust and uncertainty in the use of technology and how this telehealth intervention may have affected the patient-provider relationship. METHODS A secondary qualitative analysis using inductive thematic analysis was conducted on interview data from 13 patients and 8 staff members who participated in a remote blood pressure monitoring program to elicit themes related to trust. RESULTS In total, 4 themes were elicited that showed increased trust (patients felt reassured, patients trusted the telehealth program, staff felt that the data were trustworthy, and a better patient-provider partnership based on the mutually trusted data), and 4 themes were elicited that reflected decreased trust (patients' distrust of technology, clinicians' concerns about the limitations of technologically mediated interactions, experiences of uncertainty, and institutional risk). CONCLUSIONS Managing trust relationships plays an important role in the successful implementation of telemedicine. Ensuring that trust building is incorporated in the design of telehealth interventions can contribute to improved effectiveness and quality of care.
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Affiliation(s)
| | - Sok Huang Teo
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics, Singapore, Singapore
| | | | - Gerald Choon Huat Koh
- Ministry of Health Office for Healthcare Transformation, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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13
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‘The plural of silo is not ecosystem’: Qualitative study on the role of innovation ecosystems in supporting ‘Internet of Things’ applications in health and care. Digit Health 2023. [DOI: 10.1177/20552076221147114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Background Internet of Things (IoT) innovations such as wearables and sensors promise improved health outcomes and service efficiencies. Yet, most applications remain experimental with little routine use in health and care settings. We sought to examine the multiple interacting influences on IoT implementation, spread and scale-up, including the role of regional innovation ‘ecosystems’ and the impact of the COVID-19 context. Methods Qualitative study involving 20 participants with clinical, entrepreneurial and broader innovation experience in 18 in-depth interviews, focusing primarily on heart monitoring and assistive technology applications. Data analysis was informed by the NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework. Results Interviewees discussed multiple tensions and trade-offs, including lack of organisational capacity for routine IoT use, limited ability to receive and interpret data, complex procurement and governance processes, and risk of health disparities and inequalities without system support and funding. Although the pandemic highlighted opportunities for IoT use, it was unclear whether these would be sustained, with framings of innovation as ‘disruption’ coming at odds with immediate needs in healthcare settings. Even in an ‘ecosystem’ with strong presence of academic and research institutions, support was viewed as limited, with impressions of siloed working, conflicting agendas, fragmentation and lack of collaboration opportunities. Conclusions IoT development, implementation and roll-out require support from multiple ecosystem actors to be able to articulate a value proposition beyond experimental or small-scale applications. In contexts where clinical, academic and commercial worlds collide, sustained effort is needed to align needs, priorities and motives, and to strengthen potential for good value IoT innovation.
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14
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Montazeri M, Galavi Z, Ahmadian L. The role of mobile health in prevention, diagnosis, treatment and self-care of COVID-19 from the healthcare professionals' perspectives. Digit Health 2023; 9:20552076231171969. [PMID: 37152239 PMCID: PMC10159248 DOI: 10.1177/20552076231171969] [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: 03/06/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Background To facilitate disease management, understanding the attitude of healthcare professionals regarding the use of this tool can help mobile health (mHealth) program developers develop appropriate interventions. Aims To assess the perspective of healthcare professionals regarding the contribution of mobile-based interventions in the prevention, diagnosis, self-care, and treatment (PDST) of COVID-19. Methods This is a survey study conducted in 2020 in Iran with 81 questions. In this study mHealth functionalities were categorized into four dimensions including innovative, monitoring and screening, remote services, and education and decision-making. The data were analyzed using descriptive statistics, ANOVA, and the Kruskal-Wallis test to compare the attitudes of the different job groups. Results In total, 123 providers participated, and 87.4% of them reported that mHealth technology is moderate to most helpful for the management of COVID-19. Healthcare professionals believed that mHealth technology could be most helpful in self-care and least helpful in the diagnosis of COVID-19. Regarding the functionalities of the mobile application, the results showed that the use of patient decision aids can be most helpful in self-care and the use of computer games can be least helpful in treatment. The participants believed that mHealth is more effective in monitoring and screening dimensions and less effective in providing remote services. Conclusions This study showed that healthcare professionals believed that mHealth technology could have a better contribution to self-care for patients with COVID-19. Therefore, it is better to plan and invest more in the field of self-care to help patients to combat COVID-19. The results of this study revealed which mhealth functionalities work better in four domains of prevention, treatment, self-care, and diagnosis of COVID-19. This can help healthcare authorities to implement appropriate IT-based interventions to combat COVID-19.
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Affiliation(s)
- Mahdieh Montazeri
- Department of Health Information Sciences, Faculty
of Management and Medical Information Sciences, Kerman University of Medical
Sciences, Kerman, Iran
| | - Zahra Galavi
- Department of Health Information Sciences, Faculty
of Management and Medical Information Sciences, Kerman University of Medical
Sciences, Kerman, Iran
| | - Leila Ahmadian
- Department of Health Information Sciences, Faculty
of Management and Medical Information Sciences, Kerman University of Medical
Sciences, Kerman, Iran
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15
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Karlin NJ, Weil J. Need and Potential Use of Telemedicine in Two Rural Areas. ACTIVITIES, ADAPTATION & AGING 2022. [DOI: 10.1080/01924788.2022.2160689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Nancy J. Karlin
- School of Psychological Sciences, University of Northern Colorado, Greeley, Colorado, USA
| | - Joyce Weil
- Gerontology, Towson University, Towson, Maryland, USA
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16
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Qi Tan AJ, Chua WL, McKenna L, Chin Tan LL, Lim YJ, Liaw SY. Enablers and barriers to nurse-facilitated geriatric teleconsultations in nursing homes: a qualitative descriptive multi-site study. Age Ageing 2022; 51:6936403. [PMID: 36580553 DOI: 10.1093/ageing/afac268] [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: 05/14/2022] [Revised: 08/25/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Nurses play a major role in facilitating teleconsultations in nursing homes with remote physicians. Currently, evidence explicating their role in teleconsultations is lacking. As telemedicine usage grows, understanding the factors that enable or impede nurses' role in teleconsultations allows for more support in the provision of patient care through this modality. OBJECTIVE This study sought to explore enablers and barriers nurses faced in facilitating geriatric teleconsultations in nursing homes. METHODS A qualitative descriptive study using semi-structured interviews was conducted in Singapore, from July to November 2021. Purposive sampling of nursing home nurses was undertaken. Data were inductively analysed using Braun and Clarke's thematic analysis approach. RESULTS Twenty-two nursing home nurses participated in the study. Six key themes were identified as enablers and barriers in nurse-facilitated geriatrics teleconsultations. Enablers included nurses' acknowledgement of teleconsultations as needs-orientated service, close partnership with the hospital-based geriatric service for training and workflow support and nurses' sense of empowerment in teleconsultation involvement. Barriers that existed were the nurses' lack of confidence in physical assessment and communication competencies, role conflict due to nurses' perceived inability to meet physicians' expectations and limited scope of practice in performing teleconsultation-related tasks and the presence of technology-related challenges. CONCLUSION The identification of enablers and barriers in teleconsultations for nursing home residents provides insights for future research and development in telemedicine-related implementation and educational interventions in long-term care. Developing strong partnerships between telemedicine providers and nursing homes, further enhancement of nurses' telemedicine competencies and optimising digital infrastructure are warranted.
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Affiliation(s)
- Apphia Jia Qi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Laurence Lean Chin Tan
- Division of Palliative and Supportive Care, Department of Geriatric Medicine, Yishun Health, Singapore.,GeriCare@North, Yishun Health, Singapore
| | - Yu Jun Lim
- GeriCare@North, Yishun Health, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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17
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Búřilová P, Pokorná A, Búřil J, Kantorová L, Slezaková S, Svobodová Z, Táborský M. Identification of telehealth nursing approaches in the light of the COVID-19 pandemic-A literature review. J Nurs Manag 2022; 30:3996-4004. [PMID: 36208135 PMCID: PMC9874863 DOI: 10.1111/jonm.13864] [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: 03/12/2022] [Revised: 09/21/2022] [Accepted: 10/02/2022] [Indexed: 01/27/2023]
Abstract
AIMS This study aimed to identify recommendations for quality nursing care provision, focusing on the possibilities of delivering telehealth nursing at the national level in the Czech Republic. BACKGROUND The significant growth in the use of technology in health care has changed the environment for patient care and how health care is provided. The COVID-19 pandemic has shown the requirement for telemedicine use in everyday clinical practice. EVALUATION A literature review aims to find guidelines, recommendations, manuals, standards or consensus papers published in 2017-2022. KEY ISSUES In total, 12 guidelines were identified. Based on a critical evaluation carried out by two experts, the World Health Organization guideline focused on digital interventions to strengthen the health system has been identified. This guideline was evaluated to be of the highest quality and in line with the Grading of Recommendations, Assessment, Development and Evaluations methodology. CONCLUSION The provision of telemedicine nursing interventions is currently limited at the national level and is not entirely accepted in reimbursement yet. The interprofessional collaboration will be initiated to make recommendations for specific patient groups. IMPLICATIONS FOR NURSING MANAGEMENT Selected guidelines can be recommended for national adoption to set up and support nursing interventions in telemedicine, including nursing management settings.
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Affiliation(s)
- Petra Búřilová
- Department of Health Sciences, Faculty of MedicineMasaryk UniversityBrnoCzech Republic,Department of Public Health, Faculty of MedicineMasaryk UniversityBrnoCzech Republic,Czech National Centre for Evidence‐Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of MedicineMasaryk UniversityBrnoCzech Republic,Institute of Health Information and Statistics of the Czech RepublicPragueCzech Republic
| | - Andrea Pokorná
- Department of Health Sciences, Faculty of MedicineMasaryk UniversityBrnoCzech Republic,Czech National Centre for Evidence‐Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of MedicineMasaryk UniversityBrnoCzech Republic,Institute of Health Information and Statistics of the Czech RepublicPragueCzech Republic
| | - Jiří Búřil
- First Department of Neurology, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Lucia Kantorová
- Department of Health Sciences, Faculty of MedicineMasaryk UniversityBrnoCzech Republic,Department of Public Health, Faculty of MedicineMasaryk UniversityBrnoCzech Republic,Czech National Centre for Evidence‐Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Simona Slezaková
- Czech National Centre for Evidence‐Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Zuzana Svobodová
- Czech National Centre for Evidence‐Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
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18
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A'Court C, Jenkins W, Reidy C, Papoutsi C. Patient-initiated cardiovascular monitoring with commercially available devices: How useful is it in a cardiology outpatient setting? Mixed methods, observational study. BMC Cardiovasc Disord 2022; 22:428. [PMID: 36175861 PMCID: PMC9520849 DOI: 10.1186/s12872-022-02860-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 09/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The availability, affordability and utilisation of commercially available self-monitoring devices is increasing, but their impact on routine clinical decision-making remains little explored. We sought to examine how patient-generated cardiovascular data influenced clinical evaluation in UK cardiology outpatient clinics and to understand clinical attitudes and experiences with using data from commercially available self-monitoring devices. METHODS Mixed methods study combining: a) quantitative and qualitative content analysis of 1373 community cardiology clinic letters, recording consultations between January-September 2020 including periods with different Covid-19 related restrictions, and b) semi-structured qualitative interviews and group discussions with 20 cardiology-affiliated clinicians at the same NHS Trust. RESULTS Patient-generated cardiovascular data were described in 185/1373 (13.5%) clinic letters overall, with the proportion doubling following onset of the first Covid-19 lockdown in England, from 8.3% to 16.6% (p < 0.001). In 127/185 (69%) cases self-monitored data were found to: provide or facilitate cardiac diagnoses (34/127); assist management of previously diagnosed cardiac conditions (55/127); be deployed for cardiovascular prevention (16/127); or be recommended for heart rhythm evaluation (10/127). In 58/185 (31%) cases clinicians did not put the self-monitored data to any evident use and in 12/185 (6.5%) cases patient-generated data prompted an unnecessary referral. In interviews and discussions, clinicians expressed mixed views on patient-generated data but foresaw a need to embrace and plan for this information flow, and proactively address challenges with integration into traditional care pathways. CONCLUSIONS This study suggests patient-generated data are being used for clinical decision-making in ad hoc and opportunistic ways. Given shifts towards remote monitoring in clinical care, accelerated by the pandemic, there is a need to consider how best to incorporate patient-generated data in clinical processes, introduce relevant training, pathways and governance frameworks, and manage associated risks.
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Affiliation(s)
- Christine A'Court
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Wilfred Jenkins
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Claire Reidy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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19
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Coffetti E, Paans W, Roodbol PF, Zuidersma J. Individual and Team Factors Influencing the Adoption of Information and Communication Technology by Nurses: A Systematic Review. Comput Inform Nurs 2022; 41:00024665-990000000-00006. [PMID: 36150090 PMCID: PMC10090364 DOI: 10.1097/cin.0000000000000931] [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: 11/26/2022]
Abstract
The aim of this review was to explore which factors influence nurses' adoption of information and communication technology. A systematic review was conducted using qualitative and quantitative studies. The authors performed the search strategy in the databases of PubMed, CINAHL, and IEEE and included articles published between January 2011 and July 2021. This review explores the following factors: collaboration, leadership, and individual and team factors-that, according to qualitative and quantitative research, seem to influence nurses' adoption of information and communication technology. A gradual implementation process of the information and communication technology, involvement from care professionals in the implementation process, and team functioning are important factors to consider when adopting information and communication technology. In addition to these, individual factors such as age, experience, attitude, and knowledge are also influencing factors. The review suggests that collaboration is important within the implementation of information and communication technology in care and that it positively influences nurses' adoption of it. Individual factors are researched more extensively than collaboration, leadership, and team factors. Although they also appear to influence the adoption of information and communication technology, there is insufficient evidence to convincingly substantiate this.
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20
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Gijsbers H, Feenstra TM, Eminovic N, van Dam D, Nurmohamed SA, van de Belt T, Schijven MP. Enablers and barriers in upscaling telemonitoring across geographic boundaries: a scoping review. BMJ Open 2022; 12:e057494. [PMID: 35443957 PMCID: PMC9021767 DOI: 10.1136/bmjopen-2021-057494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/29/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Telemonitoring is a method to monitor a person's vital functions via their physiological data at distance, using technology. While pilot studies on the proposed benefits of telemonitoring show promising results, it appears challenging to implement telemonitoring on a larger scale. The aim of this scoping review is to identify the enablers and barriers for upscaling of telemonitoring across different settings and geographical boundaries in healthcare. METHODS PubMed, Embase, Cinahl, Web of Science, ProQuest and IEEE databases were searched. Resulting outcomes were assessed by two independent reviewers. Studies were considered eligible if they focused on remote monitoring of patients' vital functions and data was transmitted digitally. Using scoping review methodology, selected studies were systematically assessed on their factors of influence on upscaling of telemonitoring. RESULTS A total of 2298 titles and abstracts were screened, and 19 articles were included for final analysis. This analysis revealed 89 relevant factors of influence: 26 were reported as enabler, 18 were reported as barrier and 45 factors were reported being both. The actual utilisation of telemonitoring varied widely across studies. The most frequently mentioned factors of influence are: resources such as costs or reimbursement, access or interface with electronic medical record and knowledge of frontline staff. CONCLUSION Successful upscaling of telemonitoring requires insight into its critical success factors, especially at an overarching national level. To future-proof and facilitate upscaling of telemonitoring, it is recommended to use this type of technology in usual care and to find means for reimbursement early on. A wide programme on change management, nationally or regionally coordinated, is key. Clear regulatory conditions and professional guidelines may further facilitate widespread adoption and use of telemonitoring. Future research should focus on converting the 'enablers and barriers' as identified by this review into a guideline supporting further nationwide upscaling of telemonitoring.
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Affiliation(s)
- Harm Gijsbers
- Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Rehabilitation, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam, the Netherlands, Amsterdam, The Netherlands
| | - Tim M Feenstra
- Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam, the Netherlands, Amsterdam, The Netherlands
| | - Nina Eminovic
- Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Dutch Hospital Association, Utrecht, The Netherlands
| | - Debora van Dam
- Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Shaikh Azam Nurmohamed
- Internal Medicine (Nephrology), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Tom van de Belt
- Health Innovations Lab, Radboudumc, Nijmegen, The Netherlands
| | - Marlies P Schijven
- Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam, the Netherlands, Amsterdam, The Netherlands
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May S, Fehler G, Jonas K, Zahn T, Heinze M, Muehlensiepen F. [Opportunities and challenges for the use of video consultations in nursing homes from the caregiver perspective: a qualitative pre-post study]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 169:48-58. [PMID: 35165047 DOI: 10.1016/j.zefq.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The implementation of medical video consultations in nursing homes can support primary care in rural areas and counteract the shortage of physicians. So far, video consultations have been limited to pilot projects and have not yet been comprehensively implemented. The present study addresses potentials of video consultations and challenges that may arise during the implementation of medical video consultations. METHODS Twenty-one guided interviews (pre-implementation: n = 13; post-implementation: n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). The data was analyzed using qualitative content analysis. The results were contrasted in a pre-post analysis. RESULTS Almost all of the interviewees' expectations regarding video consultations described prior to implementation have been met: time savings, improved communication, reduction of information breaks and increase in the quality of care. After implementation, other unexpected advantages of telemedical care became apparent, such as the possibility of regular monitoring or the improved ability to plan routine visits without interrupting the daily schedule. At the same time, the implementation of video consultations is associated with the following challenges: defining responsibilities, acquiring experience in handling video consultation tools, providing for sufficient qualification and training, dealing with new billing modalities as well as missing links between nursing documentation and medical information systems. DISCUSSION Video consultations can improve health care routines in nursing homes, lead to a wider availability of medical services, and contribute to improving patient safety and the quality of care. However, various aspects and contextual factors need to be addressed when implementing video consultations. These include: implementation of technical requirements, initial training with test consultations, continuous interactive development of potential fields of application, and the definition of the respective responsibilities of caregivers, physicians and medical assistants.
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Affiliation(s)
- Susann May
- Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland.
| | - Georgia Fehler
- Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland
| | - Kai Jonas
- bbw Hochschule Berlin, Berlin, Deutschland
| | | | - Martin Heinze
- Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland; Abteilung Psychiatrie und Psychotherapie, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Deutschland
| | - Felix Muehlensiepen
- Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland; Fakultät für Gesundheitswissenschaften, Gemeinsame Fakultät der Universität Potsdam, der Brandenburgischen Technischen Universität Cottbus- Senftenberg und der Medizinischen Hochschule Brandenburg Theodor Fontane, Potsdam, Deutschland
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22
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Beauséjour W, Hagens S. Uncovering Important Drivers of the Increase in the Use of Virtual Care Technologies in Nursing Care: Quantitative Analysis From the 2020 National Survey of Canadian Nurses. JMIR Nurs 2022; 5:e33586. [PMID: 35357326 PMCID: PMC9015777 DOI: 10.2196/33586] [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: 09/14/2021] [Revised: 12/15/2021] [Accepted: 01/23/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Canadian nurses are at the forefront of patient care delivery. Although the use of digital health technologies for care delivery is gaining momentum in Canada, nurses are encouraged to integrate virtual care into their practice. In early 2020, more Canadian nurses delivered care virtually compared with 3 years ago. OBJECTIVE This study seeks to uncover the professional characteristics of Canadian nurses accessing virtual care in 2020, understand how these characteristics differ across types of technologies, investigate whether the nurses accessing virtual care possess the skills and knowledge needed to use these technologies, and determine the important drivers of the uptake of virtual care observed in 2020. METHODS We used data from the 2017 and 2020 National Survey of Canadian Nurses. This survey collected data on the use of digital health technologies in nursing practice. It concerned regulated nursing professionals working in different health care settings and from different domains of nursing practice. We combined the chi-square independence test and logistic regression analysis to uncover the most relevant drivers of virtual care uptake by nurses in 2020. RESULTS In early 2020, before the declaration of the COVID-19 pandemic, nurses who delivered care virtually were predominantly nurse practitioners (135/159, 84.9%) and more likely to work in a primary or community care setting (202/367, 55%) and in an urban setting (194/313, 61.9%). Factors such as nursing designation (P<.001), perceived quality of care at the health facility where the nurses practiced (P<.001), and the type of patient record-keeping system they had access to (P=.04) had a statistically significant effect on the probability of nurses to deliver care virtually in early 2020. Furthermore, nurses' perception of the quality of care they delivered through virtual technologies was statistically associated with their perception of the skills (χ24=308.7; P<.001) and knowledge (χ24=283.4; P<.001) to use these technologies. CONCLUSIONS This study emphasizes the critical importance of nursing designation, geographic location, and type of patient record-keeping system in predicting virtual care integration in nursing practice. The findings related to geographic location can be used by decision-makers for better allocation of digital health resources among care settings in rural and urban areas. Similarly, the disparities observed across nursing designations have some implications for the digital training of nurses at all levels of practice. Finally, the association between electronic medical record use and uptake of virtual care could accelerate the implementation of more modernized record-keeping systems in care settings. Hence, this could advance interoperability and improve health care delivery.
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23
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Lowe E, Banner D, Estefan A, King-Shier K. Being Uncertain: Rural-Living Cardiac Patients' Experience of Seeking Health Care. QUALITATIVE HEALTH RESEARCH 2022; 32:609-621. [PMID: 33840281 DOI: 10.1177/10497323211005431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Secondary prevention strategies reduce disease progression to heart failure. Rural cardiac patients typically have less access to health care resources to support them in managing secondary prevention, and services to improve quality of life tend to be lacking in rural settings. The study aim was to examine the process that rural cardiac patients go through to access health care and cardiac rehabilitation (CR) following myocardial infarction (MI). In-depth interviews with 11 post-MI participants using Straussian grounded theory were undertaken. Analysis revealed a linear process from hospital discharge to maintaining health. There were five elements: comfort with health information, relationship with health care providers, social support, taking ownership, and availability of/for CR. The core category was "being uncertain." Findings can be used to identify ways to improve access and address uncertainty stemming from a lack of perceived information and supports following discharge.
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Affiliation(s)
- Erin Lowe
- University of Calgary, Calgary, Alberta, Canada
- Red Deer College, Red Deer, Alberta, Canada
| | - Davina Banner
- University of Northern British Columbia, Prince George, British Columbia, Canada
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Artanian V, Ware P, Rac VE, Ross HJ, Seto E. Experiences and Perceptions of Patients and Providers Participating in Remote Titration of Heart Failure Medication Facilitated by Telemonitoring: Qualitative Study. JMIR Cardio 2021; 5:e28259. [PMID: 34842546 PMCID: PMC8663515 DOI: 10.2196/28259] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/29/2021] [Accepted: 09/18/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Guideline-directed medical therapy (GDMT), optimized to target doses, improves health outcomes in patients with heart failure. However, GDMT remains underused, with <25% of patients receiving target doses in clinical practice. A randomized controlled trial was conducted at the Peter Munk Cardiac Centre in Toronto to compare a remote GDMT titration intervention with standard in-office titration. This randomized controlled trial found that remote titration increased the proportion of patients who achieved optimal GDMT doses, decreased the time to dose optimization, and reduced the number of essential clinic visits. This paper presents findings from the qualitative component of the mixed methods study, which evaluated the implementation of the remote titration intervention. OBJECTIVE The objective of the qualitative component is to assess the perceptions and experiences of clinicians and patients with heart failure who participated in the remote titration intervention to identify factors that affected the implementation of the intervention. METHODS We conducted semistructured interviews with clinicians (n=5) and patients (n=11) who participated in the remote titration intervention. Questions probed the experiences of the participants to identify factors that can serve as barriers and facilitators to its implementation. Conventional content analysis was first used to analyze the interviews and gain direct information based on the participants' unique perspectives. Subsequently, the generated themes were delineated and mapped following a multilevel framework. RESULTS Patients and clinicians indicated that the intervention was easy to use, integrated well into their routines, and removed practical barriers to titration. Key implementation facilitators from the patients' perspective included the reduction in clinic visits and daily monitoring of their condition, whereas clinicians emphasized the benefits of rapid drug titration and efficient patient management. Key implementation barriers included the resources necessary to support the intervention and lack of physician remuneration. CONCLUSIONS This study presents results from a real-world implementation assessment of remote titration facilitated by telemonitoring. It is among the first to provide insight into the perception of the remote titration process by clinicians and patients. Our findings indicate that the relative advantages that remote titration presents over standard care strongly appeal to both clinicians and patients. However, to ensure uptake and adherence, it is important to ensure that suitable patients are enrolled and the impact on the physicians' workload is minimized. The implementation of remote titration is now more critical than ever, as it can help provide access to care for patients during times when physical distancing is required. TRIAL REGISTRATION ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/19705.
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Affiliation(s)
- Veronica Artanian
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Patrick Ware
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Valeria E Rac
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
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25
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Guyatt S, Ferguson M, Beckmann M, Wilkinson SA. Using the Consolidated Framework for Implementation Research to design and implement a perinatal education program in a large maternity hospital. BMC Health Serv Res 2021; 21:1077. [PMID: 34635125 PMCID: PMC8507156 DOI: 10.1186/s12913-021-07024-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation science aims to embed evidence-based practice as 'usual care' using theoretical underpinnings to guide these processes. Conceptualising the complementary purpose and application of theoretical approaches through all stages of an implementation project is not well understood and is not routinely reported in implementation research, despite call for this. This paper presents the synthesis and a collective approach to application of a co-design model, a model for understanding need, theories of behaviour change with frameworks and tools to guide implementation and evaluation brought together with the Consolidated Framework for Implementation Research (CFIR). METHOD Using a determinant framework such as the CFIR provides a lens for understanding, influencing, and explaining the complex and multidimensional variables at play within a health service that contribute to planning for and delivering effective patient care. Complementary theories, models, frameworks, and tools support the research process by providing a theoretical and practical structure to understanding the local context and guiding successful local implementation. RESULTS This paper provides a rationale for conceptualising the multidimensional approach for implementation using the worked example of a pregnancy, birth, postnatal and early parenting education intervention for expectant and new parents at a large maternity hospital. CONCLUSION This multidimensional theoretical approach provides useful, practical guidance to health service researchers and clinicians to develop project specific rationale for their theoretical approach to implementation projects.
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Affiliation(s)
- Sheridan Guyatt
- Physiotherapy Department, Mater Misericordiae Ltd, Level 2 Mater Hospital, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4006, Australia.
- Mater Research, The University of Queensland, Brisbane, Queensland, 4101, Australia.
| | - Megan Ferguson
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4072, Australia
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, 0810, Australia
| | - Michael Beckmann
- Physiotherapy Department, Mater Misericordiae Ltd, Level 2 Mater Hospital, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4006, Australia
- Mater Research, The University of Queensland, Brisbane, Queensland, 4101, Australia
| | - Shelley A Wilkinson
- Mater Research, The University of Queensland, Brisbane, Queensland, 4101, Australia
- School of Human Movements and Nutrition Science, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, 4072, Australia
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26
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Summers AI, Kuo A, Zaback T, Loh AR, Brinks MV, Hribar MR. Pediatric Ophthalmology Provider and Staff Attitudes and Patient Satisfaction in Telehealth Implementation During COVID-19. Telemed J E Health 2021; 28:675-681. [PMID: 34520277 PMCID: PMC9127835 DOI: 10.1089/tmj.2021.0189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose: Describe a comprehensive overview of a telehealth implementation process that highlights attitudes and satisfaction scores toward telehealth from patients, providers, and staff in an academic pediatric ophthalmology practice during the early months of the coronavirus disease 2019 (COVID-19) pandemic. Methods: The electronic medical record data for telehealth and in-person visits, as well as a patient experience survey in pediatric ophthalmology were retrospectively reviewed for March 1 to July 31, 2020 and March 1 to July 31, 2019. Patient experience survey results were retrospectively reviewed. All current providers and staff were invited to participate in an anonymous and voluntary survey focused on attitudes at the time of telehealth implementation. Results: During March 1 to July 31, 2020, there was significant increase in telehealth visits (n = 1,006) compared with the same period in 2019 (n = 22). Evaluation and management (E & M) codes (n = 527) were the most commonly used billing codes, and strabismus, nystagmus, and irregular eye movement (n = 496) were the most common telehealth primary diagnoses. The telehealth attitudes survey showed more positive responses from providers than staff. The patient experience survey showed more favorable scores for telehealth visits compared with clinic visits. However, only about 50% of the respondents were satisfied with the technology in terms of ease and quality of connection during their telehealth visits. Conclusions: Telehealth was a satisfactory alternative to clinic visits in our academic pediatric ophthalmology practice during the early phase of the COVID-19 pandemic. Providers and staff had largely positive attitudes toward telehealth; however, future efforts should include strategies to increase staff buy in. Patients had high satisfaction scores with telehealth visits despite connection challenges.
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Affiliation(s)
- Allison I Summers
- Elks Children's Eye Clinic, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Annie Kuo
- Elks Children's Eye Clinic, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Tosha Zaback
- Elks Children's Eye Clinic, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Allison R Loh
- Elks Children's Eye Clinic, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Mitchell V Brinks
- Comprehensive Ophthalmology and Community Outreach Program, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Michelle R Hribar
- Department of Medical Informatics and Clinical Epidemiology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
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Al-Naher A, Downing J, Scott KA, Pirmohamed M. Factors affecting patient and physician engagement in remote healthcare for heart failure: a systematic review (Preprint). JMIR Cardio 2021; 6:e33366. [PMID: 35384851 PMCID: PMC9021943 DOI: 10.2196/33366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/18/2021] [Accepted: 01/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Ahmed Al-Naher
- Institute of Systems Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Jennifer Downing
- Institute of Systems Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Kathryn A Scott
- Institute of Systems Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Munir Pirmohamed
- Institute of Systems Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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28
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Heo H, Lee K, Jung E, Lee H. Developing the First Telenursing Service for COVID-19 Patients: The Experience of South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136885. [PMID: 34206977 PMCID: PMC8296892 DOI: 10.3390/ijerph18136885] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 06/23/2021] [Indexed: 01/10/2023]
Abstract
This study aimed to examine the process of establishing a telenursing service for COVID-19 patients with mild or no symptoms admitted to a community treatment center (CTC). The process of establishing the service was reviewed, and the degree of satisfaction with the provided service was investigated based on the medical records the patients submitted at their discharge from the CTC. A total of 113 patients were admitted; the patients themselves entered the self-measured vital signs and symptoms of COVID-19 infection to the electronic questionnaires and mobile application. The nurses implemented remote nursing based on the patients’ input data. The educational materials, including the video for self-measuring vital signs and the living guidelines, were prepared and arranged in advance. The telenursing protocol regarding the whole process from the patients’ admission to their discharge was used and applied to five other CTCs. The non-contact counseling service’s satisfaction and convenience scores were 4.65 points and 4.62 points, respectively, out of 5 points. The non-contact nursing counseling service played an important role in monitoring patients’ medical conditions during the spread of COVID-19. This experience of establishing telenursing services to the CTC provides a clear direction to innovate healthcare services in future disasters.
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Affiliation(s)
- Hyunsook Heo
- Comprehensive Community Care Center, Seoul National University Hospital, Seoul 03080, Korea;
| | - Kyungyi Lee
- Nursing Service Department, Seoul National University Hospital, Seoul 03080, Korea; (K.L.); (E.J.)
| | - Eunhee Jung
- Nursing Service Department, Seoul National University Hospital, Seoul 03080, Korea; (K.L.); (E.J.)
| | - Hyangyuol Lee
- College of Nursing, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-2-2258-7406
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29
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Weaver MS, Lukowski J, Wichman B, Navaneethan H, Fisher AL, Neumann ML. Human Connection and Technology Connectivity: A Systematic Review of Available Telehealth Survey Instruments. J Pain Symptom Manage 2021; 61:1042-1051.e2. [PMID: 33068709 PMCID: PMC7556265 DOI: 10.1016/j.jpainsymman.2020.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/03/2020] [Accepted: 10/09/2020] [Indexed: 12/20/2022]
Abstract
CONTEXT The current upsurge in telehealth use in palliative and hospice care warrants consideration of patient, family caregiver, and interdisciplinary palliative perspectives on telehealth modality and communication experiences. Currently, telehealth experiences and encounters are being described but not yet extensively evaluated by palliative care teams. OBJECTIVES To locate survey instruments available to assess telehealth interactions, to determine the content and constructs covered by the available instruments, and to describe the patient populations previously surveyed by the existing instruments. METHODS This study and its reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with the protocol registered in The International Prospective Register of Systematic Reviews. Three databases were searched with over 3100 articles analyzed for use of a telehealth survey instrument. RESULTS Twelve telehealth communication assessment instruments were identified with a mean length of 20 questions, primarily Likert-scale responses with one inclusive of free text and one qualitative inquiry survey. Three inquired only into modality, four queried communication, and five studied both modality and communication experience. Existing telehealth survey instruments are unidirectional in exploring patient or family experience, with two inclusive of provider perspectives. Participant demographics are notably underreported in telehealth experience studies with a frank lack of diversity in ethnic/racial, geographic, age, educational, and income representativeness in current telehealth survey instrument respondents. CONCLUSION Palliative care teams may consider familiarity with telehealth survey instrument as an essential component to progress from description of telehealth use to evaluation of telehealth encounters. Current survey instrument outcome reports do not represent inclusivity or diversity, although telehealth is now being clinically applied across settings.
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Affiliation(s)
- Meaghann S Weaver
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA.
| | - Joe Lukowski
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Brittany Wichman
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Hema Navaneethan
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Alfred L Fisher
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Marie L Neumann
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA
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30
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Chang YHA, Folmer RL, Shasha B, Shea JA, Sarmiento K, Stepnowsky CJ, Lim D, Pack A, Kuna ST. Barriers and facilitators to the implementation of a novel web-based sleep apnea management platform. Sleep 2021; 44:5995904. [PMID: 33216916 DOI: 10.1093/sleep/zsaa243] [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: 03/30/2020] [Revised: 11/01/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVE Obstructive sleep apnea (OSA) is a highly prevalent yet underdiagnosed disorder affecting US military Veterans. The Remote Veterans Apnea Management Platform (REVAMP) is a web-based OSA management program created to improve access to care. REVAMP was launched within the Veterans Health Administration (VHA) in July 2017, with variable patient recruitment rates (from 0 to 573 patients per site) at the first 10 Veterans Affairs (VA) medical centers (Wave-1 sites). This study aimed to examine the contextual circumstances surrounding the implementation of REVAMP from the provider perspective to inform strategies to increase its uptake at future rollout sites. METHODS A purposive sample of REVAMP site leaders from the Wave-1 sites was recruited with additional staff members being solicited as well. Semi-structured interviews were conducted. Two independent coders reviewed individual transcripts using content analysis to identify emerging themes. RESULTS Fifteen individuals from Wave-1 sites were interviewed. Implementation of REVAMP was facilitated by the presence of leadership support, staff, and time dedicated to REVAMP, and perceived usefulness of REVAMP by staff as well as positive feedback from the Veterans using REVAMP. The difficulty of supporting Veteran creation of login credentials to the program and integrating REVAMP into the existing workflow were major barriers to its implementation. CONCLUSION Improving leadership engagement, simplifying the enrollment process, and enhancing the medical staff experience through shared best practice alerts were identified as actions needed to improve the penetration of REVAMP at future rollout sites.
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Affiliation(s)
- Yoon Hee A Chang
- EvergreenHealth Sleep Disorders Center, Kirkland, WA.,Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Robert L Folmer
- VA National Center for Rehabilitative Auditory Research, VA Portland Medical Center, Portland, OR.,Department of Otolaryngology, Oregon Health and Science University, Portland, OR
| | - Becky Shasha
- Veterans Integrated Service Network 4, Center for Evaluation of PACT (CEPACT), Philadelphia, PA
| | - Judy A Shea
- Department of Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kathleen Sarmiento
- San Francisco VA Health Care System, San Francisco, CA.,University of California San Francisco, San Francisco, CA
| | - Carl J Stepnowsky
- VA San Diego Healthcare System, San Diego, CA.,University of California San Diego, La Jolla, CA
| | - Diane Lim
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA.,Department of Medicine, Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Allan Pack
- Department of Medicine, Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Samuel T Kuna
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA.,Department of Medicine, Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Dyb K, Berntsen GR, Kvam L. Adopt, adapt, or abandon technology-supported person-centred care initiatives: healthcare providers' beliefs matter. BMC Health Serv Res 2021; 21:240. [PMID: 33731078 PMCID: PMC7968358 DOI: 10.1186/s12913-021-06262-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/08/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Technology support and person-centred care are the new mantra for healthcare programmes in Western societies. While few argue with the overarching philosophy of person-centred care or the potential of information technologies, there is less agreement on how to make them a reality in everyday clinical practice. In this paper, we investigate how individual healthcare providers at four innovation arenas in Scandinavia experienced the implementation of technology-supported person-centred care for people with long-term care needs by using the new analytical framework nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability (NASSS) of health and care technologies. We also discuss the usability and sensitivity of the NASSS framework for those seeking to plan, implement, and evaluate technology-supported healthcare programmes. This study is part of an interdisciplinary research and development project called Patients and Professionals in Partnership (2016-2020). It originates at one of ten work packages in this project. METHOD The main data consist of ethnographic field observations at the four innovation arenas and 29 interviews with involved healthcare providers. To ensure continuous updates and status on work in the four innovation arenas, we have also participated in a total of six annual network meetings arranged by the project. RESULTS While the NASSS framework is very useful for identifying and communicating challenges with the adoption and spread of technology-supported person-centred care initiatives, we found it less sensitive towards capturing the dedication, enthusiasm, and passion for care transformation that we found among the healthcare providers in our study. When it comes to technology-supported person-centred care, the point of no return has passed for the involved healthcare providers. To them, it is already a definite part of the future of healthcare services. How to overcome barriers and obstacles is pragmatically approached. CONCLUSION Increased knowledge about healthcare providers and their visions as potential assets for care transformation might be critical for those seeking to plan, implement, and evaluate technology-supported healthcare programmes.
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Affiliation(s)
- Kari Dyb
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, N-9038, Tromsø, Norway.
| | - Gro Rosvold Berntsen
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, N-9038, Tromsø, Norway
| | - Lisbeth Kvam
- Department of Mental Health, Faculty of Medicine and Health Sciences, Trondheim, Norway
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Cremers HP, Theunissen L, Hiddink J, Kemps H, Dekker L, van de Ven R, Monroy M, van Waes L, Scheele K, van Veghel D. Successful implementation of ehealth interventions in healthcare: Development of an ehealth implementation guideline. Health Serv Manage Res 2021; 34:269-278. [PMID: 33590794 DOI: 10.1177/0951484821994421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION eHealth interventions have the potential to improve the quality of healthcare and reduce costs. However, to implement eHealth interventions successfully instruments are needed to facilitate this process. This study aims to develop an eHealth implementation guideline for implementation of eHealth interventions in daily practice. METHODS In June and July 2019 a literature research was conducted and, subsequently, a two-round Delphi study including 13 international eHealth experts in the field of healthcare, ICT & technology, and research was performed. Within the Delphi study, experts scored specific determinants using an online survey. Based on mean scores and interquartile ranges (IQRs) in the online survey, consensus between the experts was assessed. RESULTS A total of five domains (i.e., Technology, Acceptance, Financing, Organizational, and Legislation & Policy) with 24 corresponding determinants were assessed by the experts. After the second Delphi round, consensus was achieved on the five domains and 23 determinants (mean scores ≥ 8; IQR ≤ 2). Only for the determinant 'Evidence-Based Medicine' was no consensus reached (mean score < 8; IQR = 2). Based on the 23 determinants, the eHealth implementation guideline is developed for eHealth implementations in healthcare in order to increase their effectiveness. CONCLUSION The eHealth implementation guideline developed in this study may help healthcare providers/researchers assess the determinants of successful eHealth intervention prior to the implementation of the eHealth program.
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Affiliation(s)
| | - Luc Theunissen
- Maxima Medical Centre, Eindhoven, Noord-Brabant, the Netherlands
| | - Julia Hiddink
- Netherlands Heart Network, Veldhoven, the Netherlands
| | - Hareld Kemps
- Maxima Medical Centre, Eindhoven, Noord-Brabant, the Netherlands
| | - Lukas Dekker
- Catharina Hospital, Eindhoven, North Brabant, the Netherlands
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Papworth A, Fraser L, Taylor J. Development of a managed clinical network for children's palliative care - a qualitative evaluation. BMC Palliat Care 2021; 20:20. [PMID: 33482795 PMCID: PMC7824916 DOI: 10.1186/s12904-021-00712-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Consistent evidence suggests that children's palliative care is not equitable and managed clinical networks (MCNs) have been recommended as a solution. This study explored the perspectives of health professionals involved in the development of a children's palliative care MCN, with an aim to identify barriers and enablers of successful implementation. METHODS Thematic analysis of semi-structured interviews and focus groups with 45 healthcare staff with a role in developing the MCN or in the delivery of children's palliative care (September 2019-March 2020). RESULTS The study explored health professionals' perceptions of the MCN features that had helped to formalise governance processes, establish training and networking opportunities, standardise practice, and improve collaboration between organisations. These include the funded MCN co-ordinator, committed individuals who lead the MCN, and a governance structure that fosters collaboration. However, the MCN's development was impeded by cross-cutting barriers including limited funding for the MCN and children's palliative care more generally, no shared technology, lack of standards and evidence base for children's palliative care, and shortage of palliative care staff. These barriers impacted on the MCN's ability to improve and evaluate palliative care provision and affected member engagement. Competing organisational priorities and differences between NHS and non-NHS members also impeded progress. Training provision was well received, although barriers to access were identified. CONCLUSIONS Key features of children's palliative care can act as barriers to developing a managed clinical network. Managing expectations and raising awareness, providing accessible and relevant training, and sharing early achievements through ongoing evaluation can help to sustain member engagement, which is crucial to a network's success.
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Affiliation(s)
- Andrew Papworth
- Martin House Research Centre, Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK.
| | - Lorna Fraser
- Department of Health Sciences, University of York, York, UK
| | - Jo Taylor
- Department of Health Sciences, University of York, York, UK
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Bidmead E, McShane C. Barriers and Facilitators to Implementation of Digital Solutions. Health (London) 2021. [DOI: 10.4236/health.2021.1311097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Moorthy V. Regarding "Telemedicine for the Spine Surgeon in the Age of COVID-19: Multicenter Experiences of Feasibility and Implementation Strategies" by Franco et al. Global Spine J 2020; 10:1082-1083. [PMID: 33148030 PMCID: PMC7645092 DOI: 10.1177/2192568220956607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Vikaesh Moorthy
- Yong Loo Lin School of Medicine, National University Singapore, Singapore,Vikaesh Moorthy, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore 119228, Singapore.
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'It's like trying to ice a cake that's not been baked': a qualitative exploration of the contextual factors associated with implementing an evidence-based information intervention for family carers at the end of life. Prim Health Care Res Dev 2020; 21:e52. [PMID: 33213603 PMCID: PMC7681137 DOI: 10.1017/s146342362000050x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Aim: To explore the introduction of an evidence-based information intervention – the ‘Caring for Someone with Cancer’ booklet – within home care and end-of-life care, to inform future implementation and practice development within this setting. Background: Family carers’ contribution is crucial to enable care and death of people at home. The ‘Caring for Someone with Cancer’ booklet received positive responses from family carers and District Nurses and is an evidence-based intervention designed to support carers to deliver basic nursing tasks. Further feasibility work was required to establish how it should be implemented. Little is known about how to successfully translate interventions into practice, particularly within home care settings and end-of-life care. Methods: Implementation of the ‘Caring for Someone with Cancer’ booklet, utilising a qualitative case study approach, in four home care sites. Semi-structured interviews, informed by Normalization Process Theory (NPT), were undertaken at implementation sites in May 2016–June 2017. Participants were generalist and specialist nurses, managers, and Healthcare Assistants (HCAs). A framework approach to analysis was adopted. Findings: Forty-five members of staff participated. Failed implementation was associated with organisational-level characteristics and conditions, including workforce composition and predictability of processes. Unstable work environments meant home care providers focused on short-term rather than long-term goals, precluding practice development. Staff’s perceptions of the time available to engage with and implement the intervention inhibited adoption, as many participants were “just getting through the day”. Implementation was successful in sites with explicit management support, including proactive implementation attempts by managers, which legitimatised the change process, and if all staff groups were engaged. To encourage uptake of evidence-based interventions in home care settings, practitioners should be given opportunities to critically reflect upon taken-for-granted practices. Future implementation should focus on work pertaining to the NPT construct ‘Collective Action’, including how staff interact and build confidence in new practices.
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Papoutsi C, A'Court C, Wherton J, Shaw S, Greenhalgh T. Explaining the mixed findings of a randomised controlled trial of telehealth with centralised remote support for heart failure: multi-site qualitative study using the NASSS framework. Trials 2020; 21:891. [PMID: 33109254 PMCID: PMC7590600 DOI: 10.1186/s13063-020-04817-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 10/16/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The SUPPORT-HF2 randomised controlled trial compared telehealth technology alone with the same technology combined with centralised remote support, in which a clinician responds promptly to biomarker changes. The intervention was implemented differently in different sites; no overall impact was found on the primary endpoint (proportion of patients on optimum treatment). We sought to explain the trial's findings in a qualitative evaluation. METHODS Fifty-one people (25 patients, 3 carers, 18 clinicians, 4 additional researchers) were interviewed and observed in 7 UK trial sites in 2016-2018. We collected 110 pages of documents. The analysis was informed by the NASSS framework, a multi-level theoretical lens which considers non-adoption and abandonment of technologies by individuals and challenges to scale-up, spread and sustainability. In particular, we used NASSS to tease out why a 'standardised' socio-technical intervention played out differently in different sites. RESULTS Patients' experiences of the technology were largely positive, though influenced by the nature and severity of their illness. In each trial site, existing services, staffing levels, technical capacity and previous telehealth experiences influenced how the complex intervention of 'telehealth technology plus centralised specialist remote support' was interpreted and the extent to which it was adopted and used to its full potential. In some sites, the intervention was quickly mobilised to fill significant gaps in service provision. In others, it was seen as usefully extending the existing care model for selected patients. Elsewhere, the new model was actively resisted and the technology little used. In one site, centralised provision of specialist advice aligned awkwardly with an existing community-based heart failure support service. CONCLUSIONS Complex socio-technical interventions, even when implemented in a so-called standardised way with uniform inclusion and exclusion criteria, are inevitably implemented differently in different local settings because of how individual staff members interpret the technology and the trial protocol and because of the practical realities and path dependencies of local organisations. Site-specific iteration and embedding of a new technology-supported complex intervention may be required (in addition to co-design of the user interface) before such interventions are ready for testing in clinical trials. TRIAL REGISTRATION BMC ISRCTN Registry 86212709 . Retrospectively registered on 5 September 2014.
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Christine A'Court
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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Nolan SJ, Hendricks J, Williamson M, Ferguson SL. Social networking sites: Can midwives and nurses working with adolescent mothers harness their potential value? Int J Nurs Pract 2020; 27:e12895. [PMID: 33047440 DOI: 10.1111/ijn.12895] [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: 04/10/2019] [Revised: 12/01/2019] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
AIM This paper aims to discuss social networking sites as potentially salutogenic, culturally relevant extensions to maternity care provision for adolescent mothers. BACKGROUND Studies report that online networking may enhance social capital, a concept linked to enhanced well-being, particularly for marginalized individuals. Improving outcomes for adolescent mothers is an ongoing global strategy; thus, this paper has relevance for all professionals involved in their care. DESIGN This is a discussion paper. DATA SOURCES This paper draws on the authors' research and is supported by literature and theory. Key terms and Boolean operators were used to identifiy English-language papers published in January 1995 to January 2019 in nine databases and Google Scholar databases. IMPLICATIONS FOR NURSING Despite limited evidence specific to adolescent mothers, contextual studies suggest that social networking sites may enhance well-being. Nurses and midwives need to understand adolescent mothers' use of online networks to aid development of innovative, health-enhancing care strategies using adolescent-familiar modalities. CONCLUSION This paper highlights the need for further research regarding the value of professional engagement in online networks to enhance an adolescent's transition to motherhood.
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Affiliation(s)
- Samantha J Nolan
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Burleigh Waters, Australia
| | - Joyce Hendricks
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Burleigh Waters, Australia
| | - Moira Williamson
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Burleigh Waters, Australia
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Pamplin JC, Davis KL, Mbuthia J, Cain S, Hipp SJ, Yourk DJ, Colombo CJ, Poropatich R. Military Telehealth: A Model For Delivering Expertise To The Point Of Need In Austere And Operational Environments. Health Aff (Millwood) 2020; 38:1386-1392. [PMID: 31381391 DOI: 10.1377/hlthaff.2019.00273] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Austere clinical environments are those in which limited resources hamper the achievement of optimal patient outcomes. Operational environments are those in which caregivers and resources are at risk for harm. Military and civilian caregivers experience these environments in the context of war, natural disasters, humanitarian assistance missions, and mass casualty events. The military has a particular interest in enhancing local caregiver capabilities within austere and operational environments to improve casualty outcomes when evacuation is delayed or impossible, reduce the cost and the risk of unnecessary evacuations, enhance the medical response during aid missions, and increase combat effectiveness by keeping service members in the fight as long as possible. This article describes military telehealth as it relates to care in austere and operational environments, and it suggests implications for policy, particularly with respect to the current emphasis on telehealth solutions that might not be feasible in those settings.
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Affiliation(s)
- Jeremy C Pamplin
- Jeremy C. Pamplin ( ) is director of the Telemedicine and Advanced Technology Research Center, Medical Research and Development Command, in Frederick, Maryland, and an associate professor of medicine at the Uniformed Services University of the Health Sciences (USUHS), in Bethesda, Maryland
| | - Konrad L Davis
- Konrad L. Davis is director of the Virtual Medical Center, Naval Medical Center San Diego, in California, and an assistant professor of medicine at USUHS
| | - Jennifer Mbuthia
- Jennifer Mbuthia is director of the Pacific Asynchronous Telehealth Portal at Tripler Army Medical Center, in Oahu, Hawaii, and an assistant professor of pediatrics in the Allergy/Immunology Service at USUHS
| | - Steven Cain
- Steven Cain is an adviser in the Connected Health Branch Clinical Support Division, Defense Health Agency, in Silver Spring, Maryland
| | - Sean J Hipp
- Sean J. Hipp is the director of the Virtual Medical Center, Brooke Army Medical Center, in San Antonio, Texas, and an assistant professor of pediatrics at USUHS
| | - Daniel J Yourk
- Daniel J. Yourk is the deputy director of operations at the Virtual Medical Center, Brooke Army Medical Center
| | - Christopher J Colombo
- Christopher J. Colombo is director of Virtual Critical Care at the Madigan Army Medical Center, in Tacoma, Washington, and an associate professor of medicine at USUHS
| | - Ron Poropatich
- Ron Poropatich is the director of the Center for Military Medicine Research, Health Sciences, and a professor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pittsburgh, in Pennsylvania
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Kho J, Gillespie N, Martin-Khan M. A systematic scoping review of change management practices used for telemedicine service implementations. BMC Health Serv Res 2020; 20:815. [PMID: 32873295 PMCID: PMC7461334 DOI: 10.1186/s12913-020-05657-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Telemedicine improves access to health care services enabling remote care diagnosis and treatment of patients at a distance. However, the implementation of telemedicine services often pose challenges stemming from the lack of attention to change management (CM). Health care practitioners and researchers agree that successful telemedicine services require significant organizational and practice change. Despite recognizing the importance of the "people-side" of implementation, research on what constitutes best practice CM strategies for telemedicine implementations remains fragmented, offering little cohesive insight into the specific practices involved in the change process. We conducted a systematic scoping review of the literature to examine what and how CM practices have been applied to telemedicine service implementation, spanning a variety of health care areas and countries. METHODS Three bibliographic databases (CINAHL, PubMed, and ISI Web of Science) and four specialist telehealth journals were searched. To keep the review manageable and relevant to contemporary telemedicine technologies and contexts, the search was limited to articles published from 2008 to 2019. Forty-eight articles were selected for inclusion. RESULTS From the 48 articles, 16 CM practices were identified relating to either strategic or operational aspects of telemedicine implementations. We identify the key CM practices that are recognized in the broader CM literature as essential for successful and sustained change but are not commonly reported in telemedicine implementation studies. We draw on the CM literature to provide a comprehensive process-based, researched-informed, organizing framework to guide future telemedicine service implementations and research. CONCLUSIONS Our findings suggest that the slow rate of adoption of telemedicine may be due to a piecemeal approach to the change process, and a lack of understanding of how to plan, manage and reinforce change when implementing telemedicine services.
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Affiliation(s)
- Joanna Kho
- UQ Business School, The University of Queensland, Colin Clark Building 39 Blair Drive, St Lucia, Brisbane, QLD, 4072, Australia.
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, Colin Clark Building 39 Blair Drive, St Lucia, Brisbane, QLD, 4072, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Wang CJ, Ma J, Zuckerman B, Car J. The Opportunities for Telehealth in Pediatric Practice and Public Health. Pediatr Clin North Am 2020; 67:603-611. [PMID: 32650856 DOI: 10.1016/j.pcl.2020.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Telehealth can be delivered asynchronously, synchronously, or through remote patient monitoring. The cost of telehealth, patient use, and effectiveness vary by the technology deployed and by specialty. Telehealth use requires patient and provider adaptability. The improvement of telehealth is restricted by state and federal policies as well as privacy and security concerns. Current telehealth literature provides more consistent evidence of benefits for communication and counseling, and from remote patient monitoring of chronic conditions. However, the benefits and costs of telehealth programs are highly dependent on the technology used, the medical condition studied, and the health care context.
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Affiliation(s)
- C Jason Wang
- Center for Policy, Outcomes, and Prevention, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA 94305, USA.
| | - Jasmin Ma
- Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, Stanford, CA, USA
| | - Barry Zuckerman
- Department of Pediatrics, Boston University School of Medicine, 801 Harrison Avenue, Boston, MA 02118, USA
| | - Josip Car
- Department of Primary Care and Public Health, Imperial College London, London, UK; Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Clinical Sciences Building, 11 Mandalay Road, Singapore 308232, Singapore
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Hammersley V, Parker R, Paterson M, Hanley J, Pinnock H, Padfield P, Stoddart A, Park HG, Sheikh A, McKinstry B. Telemonitoring at scale for hypertension in primary care: An implementation study. PLoS Med 2020; 17:e1003124. [PMID: 32555625 PMCID: PMC7299318 DOI: 10.1371/journal.pmed.1003124] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 05/22/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While evidence from randomised controlled trials shows that telemonitoring for hypertension is associated with improved blood pressure (BP) control, healthcare systems have been slow to implement it, partly because of inadequate integration with existing clinical practices and electronic records. Neither is it clear if trial findings will be replicated in routine clinical practice at scale. We aimed to explore the feasibility and impact of implementing an integrated telemonitoring system for hypertension into routine primary care. METHODS AND FINDINGS This was a quasi-experimental implementation study with embedded qualitative process evaluation set in primary care in Lothian, Scotland. We described the overall uptake of telemonitoring and uptake in a subgroup of representative practices, used routinely acquired data for a records-based controlled before-and-after study, and collected qualitative data from staff and patient interviews and practice observation. The main outcome measures were intervention uptake, change in BP, change in clinician appointment use, and participants' views on features that facilitated or impeded uptake of the intervention. Seventy-five primary care practices enrolled 3,200 patients with established hypertension. In an evaluation subgroup of 8 practices (905 patients of whom 427 [47%] were female and with median age of 64 years [IQR 56-70, range 22-89] and median Scottish Index of Multiple Deprivation 2012 decile of 8 [IQR 6-10]), mean systolic BP fell by 6.55 mm Hg (SD 15.17), and mean diastolic BP by 4.23 mm Hg (SD 8.68). Compared with the previous year, participating patients made 19% fewer face-to-face appointments, compared with 11% fewer in patients with hypertension who were not telemonitoring. Total consultation time for participants fell by 15.4 minutes (SD 68.4), compared with 5.5 minutes (SD 84.4) in non-telemonitored patients. The convenience of remote collection of BP readings and integration of these readings into routine clinical care was crucial to the success of the implementation. Limitations include the fact that practices and patient participants were self-selected, and younger and more affluent than non-participating patients, and the possibility that regression to the mean may have contributed to the reduction in BP. Routinely acquired data are limited in terms of completeness and accuracy. CONCLUSIONS Telemonitoring for hypertension can be implemented into routine primary care at scale with little impact on clinician workload and results in reductions in BP similar to those in large UK trials. Integrating the telemonitoring readings into routine data handling was crucial to the success of this initiative.
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Affiliation(s)
- Vicky Hammersley
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Richard Parker
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Mary Paterson
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Janet Hanley
- School of Health and Social Care. Edinburgh Napier University, Edinburgh, United Kingdom
| | - Hilary Pinnock
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul Padfield
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Stoddart
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Brian McKinstry
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Dunnigan A. Letter to the Editor: In response to "Role of Telehealth in the Management of COVID-19: Lessons Learned from Previous SARS, MERS, and Ebola Outbreaks". Telemed J E Health 2020; 26:1209-1210. [PMID: 32471331 DOI: 10.1089/tmj.2020.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Anna Dunnigan
- Institute of Clinical Trials and Methodology, University College London, London, United Kingdom of Great Britain and Northern Ireland
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Bidmead E, Lie M, Marshall A, Robson S, Smith VJ. Service user and staff acceptance of fetal ultrasound telemedicine. Digit Health 2020; 6:2055207620925929. [PMID: 32477585 PMCID: PMC7232054 DOI: 10.1177/2055207620925929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 04/01/2020] [Indexed: 11/27/2022] Open
Abstract
Objective We present qualitative findings from interviews with frontline clinicians and
service users of a fetal telemedicine service. Methods Semi-structured interviews with clinical stakeholders and service users were
conducted, undertaken as part of a service evaluation. Data collection was
undertaken by different teams, using interview schedules aligned to
independent evaluation aims. Data were subjected to thematic analysis. Results Sonographers reported four main challenges: delivering a shared consultation;
the requirement to resist scanning intuitively; communications during the
scan; and restricted room space. Notwithstanding, all clinicians reported
that participating women were accepting of the technology. Service users
reported few concerns. The main benefits of fetal telemedicine were
identified as upskilled staff, increased access to specialist support and
improved management of complex pregnancies. Convenience was identified as
the main benefit by service users, including savings in time and money from
not having to travel, take time off work, and arrange childcare. Conclusions Service users and clinical stakeholders were accepting of the service.
Service users reported satisfaction with communications during the
consultation and awareness that telemedicine had facilitated local access to
clinical expertise. Whilst clinical stakeholders reported challenges, the
iterative nature of the evaluation meant that concerns were discussed,
responded to, and overcome as the pilot developed. Clinical stakeholders’
perception of benefits for service users encouraged their acceptance.
Moreover, the evaluation established that fetal ultrasound telemedicine is a
viable method to access expertise safely and remotely. It provided
demonstrable evidence of a potential solution to some of the healthcare
challenges facing rural hospitals.
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Affiliation(s)
| | - Mabel Lie
- Population and Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | | | - Stephen Robson
- Institute of Cellular Medicine, Newcastle University, UK
| | - Vikki J Smith
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, University of Northumbria, UK
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Schweitzer M, Huber L, Gorfer T, Hörbst A. Experiences With Developing and Using Vital Sign Telemonitoring to Support Mobile Nursing in Rural Regions: Feasibility and Usability Study. JMIR Nurs 2020; 3:e17113. [PMID: 34345782 PMCID: PMC8279444 DOI: 10.2196/17113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/02/2020] [Accepted: 03/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background Modern information and communication technology has the potential to support mobile care in rural regions such as the Alpine region, which is characterized by long distances or even physically unreachable areas. Objective This study investigated the potential of supporting mobile nursing organizations in rural regions with the use of mobile telemonitoring systems in a case study setting. Methods As a subproject of the European Union–funded project INTESI, the VITAl parameter MOnitoring (VITAMO) project gathered stakeholders’ requirements for telemonitoring support of mobile care in rural regions and then developed and implemented a prototype system that was used for a 3-month test period with a local nursing organization in Austria. Log analysis, surveys, and interviews were used to evaluate the system according to the Technology Acceptance Model. The focus was technology assessment and user satisfaction of both patients and nurses. Results Participants were provided Bluetooth devices to measure blood pressure, body weight, and blood glucose and to track activity. They also received a tablet with a mobile internet connection to see the results. The nurses were able to access the results remotely. Regularly executed speed tests and log analysis demonstrated the availability of high-speed mobile internet in the rural test region. Log analysis, surveys, and interviews revealed the suitability of the technology environment and showed that the system was easy to use and potentially useful. The perceived usefulness for supporting mobile care was rated meaningfully low, and the frequency of nurses using the tool declined continuously over the field test period. Further group discussions investigated this issue. Conclusions While the technology environment with mobile internet, Bluetooth devices, and smart vital sign monitoring devices was adequate and suitable to support mobile nursing in rural regions, the potential benefit for the nursing organization could not be confirmed. Further analysis revealed that operational care processes did not follow a well-defined care strategy. Technology has the potential to leverage the available environment for developing meaningful solutions. These experiences could contribute to further investigations that need to identify and analyze existing mobile care processes at an organizational level.
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Affiliation(s)
- Marco Schweitzer
- Institute for Biomedical Computer Sciences and Mechatronics UMIT - Private University for Health Sciences, Medical Informatics and Technology Hall in Tyrol Austria
| | - Lukas Huber
- Institute for Biomedical Computer Sciences and Mechatronics UMIT - Private University for Health Sciences, Medical Informatics and Technology Hall in Tyrol Austria
| | - Thilo Gorfer
- Institute for Biomedical Computer Sciences and Mechatronics UMIT - Private University for Health Sciences, Medical Informatics and Technology Hall in Tyrol Austria
| | - Alexander Hörbst
- Medical Technologies Department MCI Management Center Innsbruck Innsbruck Austria
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Woo K, Dowding DW. Decision-making Factors Associated With Telehealth Adoption by Patients With Heart Failure at Home: A Qualitative Study. Comput Inform Nurs 2020; 38:204-214. [PMID: 31929355 PMCID: PMC7138739 DOI: 10.1097/cin.0000000000000589] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Telehealth has been reported to be effective in helping patients with heart failure manage their symptoms at home. Despite this, the adoption rate for telehealth among home care patients with heart failure is low, and there is limited research on reasons for this. This study was undertaken to explore factors associated with patients' decisions to adopt telehealth at home. A qualitative descriptive study underpinned by the Unified Theory of Acceptance Use of Technology model was conducted using semi-structured telephone interviews with patients with heart failure (N = 20) referred for telehealth. Interviews were analyzed using a mixture of deductive and inductive coding. Among the theoretical model elements, the perceived usefulness of the technology (performance expectancy), the availability of clinical/technical support (facilitating conditions), and the opinion of other individuals important to the patient (social influence) were associated with telehealth initiation. However, the ease of use (effort expectancy) was not an associated factor. Other factors such as experience, knowledge, confidence, satisfaction, and attitudes were also associated with the decision. Identification of factors related to higher telehealth initiation rates can be used to inform individualized care planning by nurses. Knowledge of such associations can inform referral process to improve the efficiency and utilization of telehealth.
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Affiliation(s)
- Kyungmi Woo
- Author Affiliations: Columbia University School of Nursing (Dr Woo), New York, NY; and Division of Nursing, Midwifery and Social Work, University of Manchester (Dr Dowding), United Kingdom
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Gjestsen MT, Wiig S, Testad I. Health Care Personnel's Perspective on Potential Electronic Health Interventions to Prevent Hospitalizations for Older Persons Receiving Community Care: Qualitative Study. J Med Internet Res 2020; 22:e12797. [PMID: 31895045 PMCID: PMC6966552 DOI: 10.2196/12797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/30/2019] [Accepted: 06/03/2019] [Indexed: 11/13/2022] Open
Abstract
Background The use of electronic health (eHealth) interventions is suggested to help monitor and treat degenerative and chronic diseases through the use of sensors, alarms, and reminders and can potentially prevent hospitalizations for home-dwelling older persons receiving community care. It is increasingly recognized that the health care personnel’s acceptance of a technological application remains a key challenge in adopting an intervention, thus interventions must be perceived to be useful and fit for purpose by the actual users. Objective The aim of this study was to identify and explore the perspectives of managers and health care personnel in community care regarding the use of eHealth interventions in terms of prevention of hospitalizations for home-dwelling older persons receiving community care. Methods A case study with a qualitative approach was carried out in community care in a Norwegian municipality, comprising individual interviews and focus group interviews. A total of 5 individual interviews and 2 focus group interviews (n=12) were undertaken to provide the health care personnel’s and managers’ perspective regarding the use of eHealth interventions, which could potentially prevent hospitalizations for home-dwelling older persons receiving community care. Data were analyzed by way of systematic text condensation, as described by Malterud. Results The data analysis of focus group interviews and individual interviews resulted in 2 categories: potential technological applications and potential patient groups. Discussions in the focus groups generated several suggestions and wishes related to technical applications that they could make use of in their day-to-day practice. The health care personnel warranted tools and measures to enhance and document their clinical observations in contact with patients. They also identified patient groups, such as patients with chronic obstructive pulmonary disease or dehydration or urinary tract infections, for whom hospitalizations could potentially have been prevented. Conclusions We have shown that the health care personnel in community care warrant various technological applications that have the potential to improve quality of care and resource utilization in the studied municipality. We have identified needs and important matters in practice, which are paramount for acceptance and adoption of an intervention in community care.
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Affiliation(s)
| | - Siri Wiig
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ingelin Testad
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway.,Exeter University Medical School, Exeter University, Exeter, United Kingdom
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Qureshi W. The Role of Human Capital in the Implementation of Healthcare Innovation in the UAE. HUMAN CAPITAL IN THE MIDDLE EAST 2020. [DOI: 10.1007/978-3-030-42211-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Jøranson N, Lausund H. Hvordan kan avstandsomsorg påvirke omsorgsforståelser? TIDSSKRIFT FOR OMSORGSFORSKNING 2019. [DOI: 10.18261/issn.2387-5984-2019-03-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kozikowski A, Shotwell J, Wool E, Slaboda JC, Abrashkin KA, Rhodes K, Smith KL, Pekmezaris R, Norman GJ. Care Team Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: Qualitative Study. JMIR Aging 2019; 2:e12415. [PMID: 31518266 PMCID: PMC6716443 DOI: 10.2196/12415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/08/2019] [Accepted: 04/25/2019] [Indexed: 12/13/2022] Open
Abstract
Background Novel and sustainable approaches to optimizing home-based primary care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the United States. Telehealth may be a viable option for scaling HBPC programs. Objective The purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to increase the reach of HBPC to more homebound patients. Methods We collected qualitative data from HBPC staff (ie, physicians, registered nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York metropolitan area through 16 semistructured interviews and three focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (ie, relatedness, competence, and autonomy) as an analytical lens. Results Four broad themes—pros and cons of scaling, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship—and multiple second-level themes emerged from the analysis. Staff acknowledged the need to scale the program without diminishing effective patient-centered care. Participants perceived alerts generated from patients and caregivers using telehealth as potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. However, they also noted that telehealth could increase efficiency and enable more informed care provision. Telehealth could enhance the patient-provider relationship by enabling caregivers to be an integral part of the patient’s care team. Staff members raised the concern that patients or caregivers might unnecessarily overutilize the technology, and that some home visits are more appropriate in person rather than via telehealth. Conclusions These findings suggest the importance of considering the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program will hopefully facilitate the optimal integration of telehealth innovations.
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Affiliation(s)
- Andrzej Kozikowski
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, United States
| | - Jillian Shotwell
- Northwell Health Solutions, Northwell Health, Manhasset, NY, United States
| | - Eve Wool
- Northwell Health Solutions, Northwell Health, Manhasset, NY, United States
| | | | - Karen A Abrashkin
- Northwell Health Solutions, Northwell Health, Manhasset, NY, United States
| | - Karin Rhodes
- Northwell Health Solutions, Northwell Health, Manhasset, NY, United States
| | - Kristofer L Smith
- Northwell Health Solutions, Northwell Health, Manhasset, NY, United States
| | - Renee Pekmezaris
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, United States
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