Digital Health Technology for Remote Care in Primary Care During the COVID-19 Pandemic: Experience from Dubai

The global COVID-19 pandemic has led to drastic changes in the management of patients with rheumatic diseases. Due to the imminent risk of infection, monitoring intervals of rheumatic patients have prolonged. The aim of this study is to present insights from patients, rheumatologists, and digital product developers on the ongoing digital health transition in rheumatology. A qualitative and participatory semi-structured fishbowl approach was conducted to gain detailed insights from a total of 476 participants. The main findings show that digital health and remote care are generally welcomed by the participants. Five key themes emerged from the qualitative content analysis: (1) digital rheumatology use cases, (2) user descriptions, (3) adaptation to different environments of rheumatology care, and (4) potentials of and (5) barriers to digital rheumatology implementation. Codes were scaled by positive and negative ratings as well as on micro, meso, and macro levels. A main recommendation resulting from the insights is that both patients and rheumatologists need more information and education to successfully implement digital health tools into clinical routine.

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Digitally-enabled approach to improving primary care in a rural and remote low-resource setting

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.043 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

L Ansell

Keyword(s):

Primary Care ◽

Public Sector ◽

Low Income ◽

Digital Health ◽

Health Priorities ◽

Rural And Remote ◽

Low Resource Settings ◽

Digital Platform ◽

Low Resource ◽

Out Of Pocket Payments

Abstract Introduction An innovative digitally-supported multi-sectoral solution for supporting end-to-end primary care for rural and remote low-income populations in Western Visayas, Philippines was examined to determine its efficacy in supporting health access. This solution brings together multisectoral stakeholders using a digital platform to coordinate the provision of a virtual primary care system. The solution also supports ordering and delivery of low-cost insurance and medicines, with the aim of reducing out-of-pocket payments and complementing public-sector services. Methods Processes and outputs for a novel data-driven digital health solution were documented and analyzed through a mixed methods approach. Researchers conducted interviews with a range of stakeholders, including program beneficiaries and partners. Quantitative data focusing on the project outputs were also examined. Results Through an integrated digital platform to coordinate inputs from the public sector (Department of Health); private sector (pharmaceutical, insurance, and telecom firms); and community (in the form of a peer-worker network), this model offers an example of an innovative approach to primary health delivery in low-resource settings. These inputs are leveraged and informed by a 'big-data' precision approach, based on detailed epidemiological profiles of community residents. This dataset allows for the evidence-based identification of village-specific health priorities and development of corresponding interventions. This approach has contributed to increased access to medicines; affordability of medicines and health services; and community resilience among the target populations. However, barriers involving a local shortage of health human resources and cumbersome eHealth regulations affect program impact. Conclusions This research provides evidence for the scale-up of a multisectoral digital approach to support the implementation of UHC targets in Philippines. Key messages Implementing digital health solutions in low-resource settings is possible. Changes are needed in Philippines health regulations for digital health to properly support UHC implementation.

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Driving digital transformation of comprehensive primary health services at scale in India: an enterprise architecture framework

BMJ Global Health ◽

10.1136/bmjgh-2021-005242 ◽

2021 ◽

Vol 6 (Suppl 5) ◽

pp. e005242

Author(s):

Sunita Nadhamuni ◽

Oommen John ◽

Mallari Kulkarni ◽

Eshan Nanda ◽

Sethuraman Venkatraman ◽

...

Keyword(s):

Primary Care ◽

Health Services ◽

Primary Healthcare ◽

Enterprise Architecture ◽

Digital Health ◽

Security And Privacy ◽

Primary Health ◽

Architecture Framework ◽

Primary Health Services ◽

Enterprise Architecture Framework

In its commitment towards Sustainable Development Goals, India envisages comprehensive primary health services as a key pillar in achieving universal health coverage. Embedded in siloed vertical programmes, their lack of interoperability and standardisation limits sustainability and hence their benefits have not been realised yet. We propose an enterprise architecture framework that overcomes these challenges and outline a robust futuristic digital health infrastructure for delivery of efficient and effective comprehensive primary healthcare. Core principles of an enterprise platform architecture covering four platform levers to facilitate seamless service delivery, monitor programmatic performance and facilitate research in the context of primary healthcare are listed. A federated architecture supports the custom needs of states and health programmes through standardisation and decentralisation techniques. Interoperability design principles enable integration between disparate information technology systems to ensure continuum of care across referral pathways. A responsive data architecture meets high volume and quality requirements of data accessibility in compliance with regulatory requirements. Security and privacy by design underscore the importance of building trust through role-based access, strong user authentication mechanisms, robust data management practices and consent. The proposed framework will empower programme managers with a ready reference toolkit for designing, implementing and evaluating primary care platforms for large-scale deployment. In the context of health and wellness centres, building a responsive, resilient and reliable enterprise architecture would be a fundamental path towards strengthening health systems leveraging digital health interventions. An enterprise architecture for primary care is the foundational building block for an efficient national digital health ecosystem. As citizens take ownership of their health, futuristic digital infrastructure at the primary care level will determine the health-seeking behaviour and utilisation trajectory of the nation.

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Barriers and facilitators of the uptake of digital health technology in cardiovascular care: a systematic scoping review

European Heart Journal - Digital Health ◽

10.1093/ehjdh/ztab005 ◽

2021 ◽

Author(s):

Sera Whitelaw ◽

Danielle M Pellegrini ◽

Mamas A Mamas ◽

Martin Cowie ◽

Harriette G C Van Spall

Keyword(s):

Organizational Support ◽

Quantitative Methods ◽

Digital Health ◽

Healthcare Delivery ◽

Health Technology ◽

Barriers And Facilitators ◽

User Friendliness ◽

Eligibility Criteria ◽

Patient Level ◽

Cardiovascular Care

Abstract Digital health technology (DHT) has the potential to revolutionize healthcare delivery but its uptake has been low in clinical and research settings. The factors that contribute to the limited adoption of DHT, particularly in cardiovascular settings, are unclear. The objective of this review was to determine the barriers and facilitators of DHT uptake from the perspective of patients, clinicians, and researchers. We searched MEDLINE, EMBASE, and CINAHL databases for studies published from inception to May 2020 that reported barriers and/or facilitators of DHT adoption in cardiovascular care. We extracted data on study design, setting, cardiovascular condition, and type of DHT. We conducted a thematic analysis to identify barriers and facilitators of DHT uptake. The search identified 3075 unique studies, of which 29 studies met eligibility criteria. Studies employed: qualitative methods (n = 13), which included interviews and focus groups; quantitative methods (n = 5), which included surveys; or a combination of qualitative and quantitative methods (n = 11). Twenty-five studies reported patient-level barriers, most common of which were difficult-to-use technology (n = 7) and a poor internet connection (n = 7). Six studies reported clinician-level barriers, which included increased workload (n = 4) and a lack of integration with electronic medical records (n = 3).Twenty-four studies reported patient-level facilitators, which included improved communication with clinicians (n = 10) and personalized technology (n = 6). Four studies reported clinician-level facilitators, which included approval and organizational support from cardiology departments and/or hospitals (n = 3) and technologies that improved efficiency (n = 3). No studies reported researcher-level barriers or facilitators. In summary, internet access, user-friendliness, organizational support, workflow efficiency, and data integration were reported as important factors in the uptake of DHT by patients and clinicians. These factors can be considered when selecting and implementing DHTs in cardiovascular clinical settings.

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