Assessment of Challenges and Opportunities and Identification of Approaches and Innovations in COVID-19 Pandemic Management by Different States in India: A Qualitative Approach

Abstract Objective The primary objective of the study was to compare the challenges in implementing various COVID-19-related public health strategies and activities between the selected high health index and low health index states. The secondary objective was to identify the differently managed mechanisms adopted by the health-care delivery system across the states to maintain their functioning during the COVID-19 pandemic. Setting Eight states were divided into two groups; based on their health index and vulnerability index ranking—Kerala, Maharashtra, Gujarat, and Karnataka in top four (Group 1) and Delhi, Tripura, Rajasthan, and Orissa in bottom four states (Group 2). Results There was lack of private sector involvement in both the groups of the states, more so in Group 2. Although transport-related issues were similar in both groups, lack of provision of vehicles for transport for carrying out various COVID and non-COVID activities seemed to be more prominent in Group 2. More obstacles related to infrastructure were observed in Group 1 states. In terms of innovations, commonalities lay in convergence of multiple departments for monitoring, contact tracing, essential supplies, and transportation. Both groups managed routine health services and fund allocation with nearly equal vigour. Major challenges faced were related to human resource, policy management, transportation, routine health services, data management, and infrastructure. HR-related challenges in top four states included confusion due to frequent change in guidelines, unclear micro-containment, and testing guidelines. Discharge guidelines and SOPs related to home isolation of slum dwellers, inter-departmental cooperation and coordination issues faced in greater proportion in top four states; issues with fund allocation for local needs were faced by the Group 2 states. Innovations implemented to meet hurdles faced during the pandemic could be categorized under heads of ‘human resource’, ‘community actions’, ‘policy management’, ‘inter-departmental coordination’, ‘use of technology and media’, and ‘fund allocations’. There was private–public partnership; use of other human resource for health-care delivery; use of technology for health-care delivery was seen in all states but more so in Group 1 states. Conclusion States with higher health index and lower vulnerability index, i.e., Group 1 states faced fewer challenges than those in Group 2. Innovative measures taken at local level to tackle problems posed by the pandemic were unique to the situations presented to them and helped control the disease as effectively as they could.

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Improving Care in the Pediatric Emergency Department With Virtual Reality (Preprint)

10.2196/preprints.11796 ◽

2018 ◽

Author(s):

Jessica DeClercq ◽

Marie Bowen ◽

Shelia R. Cotten ◽

Aileen Hansen ◽

Kelly Hebert ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Virtual Reality ◽

Health Care Delivery ◽

Care Delivery ◽

Group Versus ◽

Human Interaction ◽

Psychosocial Needs ◽

Care Experience ◽

Use Of Technology

BACKGROUND Emergency departments (EDs) are often perceived as scary and have been shown to induce anxiety in children. Some hospitals utilize Certified Child Life Specialists (CCLS), hospital staff trained to meet the psychosocial needs of children, to assist when children show signs of anxiety and/or pain during treatment. The CCLS will distract the child, such as with an iPad; however, the child may still watch the IV start, which could result in a failure of the distraction. Digital distraction, distracting a child with technology during stressful procedures, has shown to reduce pain and anxiety better than medications or no distraction at all. Virtual reality (VR) is one form of digital distraction and is increasingly being used in hospitals, as both vision and hearing are blocked by the headset. Previous research shows that the more senses used in the distraction, the less likely the patient will experience pain and anxiety. OBJECTIVE The main goal of this study was to improve care delivery for children in the ED while receiving IV placements. To achieve this, we utilized VR to determine whether it could decrease pain and anxiety for children by acting as a form of digital distraction. METHODS The intervention included patients between the ages of 5 and 12 who needed an IV in the ED at a public, Michigan hospital. Each participant was randomly assigned to either VR or the standard of care distraction (SD). For those in the VR group, the child played a game while wearing a VR headset. For those in the SD group, the CCLS used standard distraction methods, such as watching a video on an iPad. The guardian then completed a survey to measure the effectiveness and satisfaction of the distraction. RESULTS Thirty children participated in the study. Of those who participated, 12 guardians from the VR group and 16 from the SD completed surveys. Seventy-five percent of the VR group and 94 percent of the SD agreed that the distraction reduced the child’s anxiety, while 75 percent of the VR group and 88 percent of the SD agreed that the distraction reduced the child’s pain during the IV placement. Sixty-seven percent of the VR group versus 94 percent of the SD were more satisfied with health care delivery because of the distraction, and 83 percent of the VR group while 88 percent of the SD were more likely to choose this hospital again because of the distraction. CONCLUSIONS Although there is potential for the use of VR in health care settings, the use of technology in addition to the CCLS shows great potential to reduce pain and anxiety while improving health care delivery and patient satisfaction. Because most guardians reported positive outcomes with both VR and the SD, the use of technology compared to no distraction should be examined in larger studies to fully understand the effect of digital distraction along with human interaction. With the option of technology in conjunction with caregiver guidance, pediatric patients may perceive less pain and have a better care experience during IV placements in the Emergency Department.

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Assessment of Use and Preferences Regarding Internet-Based Health Care Delivery: Cross-Sectional Questionnaire Study (Preprint)

10.2196/preprints.12416 ◽

2018 ◽

Author(s):

Georgios Paslakis ◽

Josefine Fischer-Jacobs ◽

Lars Pape ◽

Mario Schiffer ◽

Raoul Gertges ◽

...

Keyword(s):

Health Care ◽

Electronic Medical Records ◽

Health Care Delivery ◽

Educational Level ◽

Medical Records ◽

Care Delivery ◽

Adult Population ◽

Cross Sectional ◽

Income Status ◽

Use Of Technology

BACKGROUND There has been an incremental increase in the use of technology in health care delivery. Feasibility, acceptability, and efficacy of interventions based on internet technologies are supported by a growing body of evidence. OBJECTIVE The aim of this study was to investigate use and preferences in the general adult population in Germany for remote, internet-based interaction (eg, email, videoconferencing, electronic medical records, apps). METHODS A nationwide cross-sectional questionnaire survey in adults that was representative in terms of age, sex and educational level was carried out. RESULTS A total of 22.16% (538/2428) of survey participants reported not using the internet for work or private use. The nonuser phenotype can be described as being older, having lower educational and income status, and living in less populated areas. The majority of participants within the cohort of internet users reported that they would not consider using electronic medical records (973/1849, 52.62%), apps (988/1854, 53.29%), or emails to report symptoms (1040/1838, 56.58%); teleconference with one (1185/1852, 63.98%) or more experts (1239/1853, 66.86%); or participate in video psychotherapy (1476/1853, 79.65%) for the purpose of medical consultation or treatment. Older age and lower educational level were the most robust predictors of assumed future denial of use. CONCLUSIONS Our results point toward low use and preference rates among the general population for the use of telemedicine. It also seems that those who might benefit from telemedical interventions the most, are, in fact, those who are most hesitating. These low use and preference rates of eHealth should be considered prior to designing and providing future telemedical care, supporting the need for easy-to-use, data secure solutions.

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