The qualitative experience of telehealth access and clinical encounters in Australian health care during COVID-19: Implications for policy

Abstract BackgroundAdaptive models of health care delivery, such as telehealth consultations, have rapidly been adopted to ensure ongoing delivery of essential health care services during COVID-19. However there remain gaps in our understanding of how clinicians have adapted to telehealth. This study aims to explore the telehealth experiences or specialists, based at tertiary hospital in the Hunter Region, and General Practitioners (GP) including barriers, enables and opportunities. Methods In-depth interviews explored the telehealth experiences of specialists, based at tertiary hospital in the Hunter Region of Australia, and General Practitioners (GP) including barriers, enablers and opportunities. Data were analyzed using an inductive thematic approach with constant comparison.ResultsIndividual interviews were conducted with 10 specialist and 5 GPs. Key themes were identified: (1) Transition to telehealth has been valuable but challenging; (2) Persisting telehealth process barriers need addressing; (3) Establishing when face-to-face consults are essential; (4) Changes in workload pressures and potential for double up; (5) Essential modification of work practices and (6) Exploring what is needed going forwardDiscussionWhile there is a need to rationalise and optimise health access during a pandemic, we suggest that more needs to be done improve telehealth going forward. Our results have important policy implications. Specifically, there is a specific need to effectively train clinicians to competently utilize and be confident using this telehealth and to educate patients on necessary skills and etiquette.

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Analysis of Facilitators and Barriers to the Delivery of Routine Care during the COVID-19 Global Pandemic: A Systematic Review

Healthcare ◽

10.3390/healthcare9050528 ◽

2021 ◽

Vol 9 (5) ◽

pp. 528

Author(s):

Cristian Lieneck ◽

Brooke Herzog ◽

Raven Krips

Keyword(s):

Systematic Review ◽

Health Care ◽

Health Care Services ◽

Care Delivery ◽

Routine Care ◽

Future Research ◽

Healthcare Organizations ◽

Care Services ◽

Global Pandemic ◽

Facilitators And Barriers

The delivery of routine health care during the COVID-19 global pandemic continues to be challenged as public health guidelines and other local/regional/state and other policies are enforced to help prevent the spread of the virus. The objective of this systematic review is to identify the facilitators and barriers affecting the delivery of routine health care services during the pandemic to provide a framework for future research. In total, 32 articles were identified for common themes surrounding facilitators of routine care during COVID-19. Identified constructed in the literature include enhanced education initiatives for parents/patients regarding routine vaccinations, an importance of routine vaccinations as compared to the risk of COVID-19 infection, an enhanced use of telehealth resources (including diagnostic imagery) and identified patient throughput/PPE initiatives. Reviewers identified the following barriers to the delivery of routine care: conservation of medical providers and PPE for non-routine (acute) care delivery needs, specific routine care services incongruent the telehealth care delivery methods, and job-loss/food insecurity. Review results can assist healthcare organizations with process-related challenges related to current and/or future delivery of routine care and support future research initiatives as the global pandemic continues.

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Continuity of care experienced by patients in a multi-institutional pancreatic care network: a pilot study

BMC Health Services Research ◽

10.1186/s12913-021-06431-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

J. S. Hopstaken ◽

D. van Dalen ◽

B. M. van der Kolk ◽

E. J. M. van Geenen ◽

J. J. Hermans ◽

...

Keyword(s):

Health Care ◽

Pilot Study ◽

Continuity Of Care ◽

Health Care Services ◽

Pancreatic Surgery ◽

Tertiary Hospital ◽

Tumor Board ◽

Pancreatic Tumors ◽

Care Network ◽

Care Services

Abstract Background Over the past decades, health care services for pancreatic surgery were reorganized. Volume norms were applied with the result that only a limited number of expert centers perform pancreatic surgery. As a result of this centralization of pancreatic surgery, the patient journey of patients with pancreatic tumors has become multi-institutional. To illustrate, patients are referred to a center of expertise for pancreatic surgery whereas other parts of pancreatic care, such as chemotherapy, take place in local hospitals. This fragmentation of health care services could affect continuity of care (COC). The aim of this study was to assess COC perceived by patients in a pancreatic care network and investigate correlations with patient-and care-related characteristics. Methods This is a pilot study in which patients with (pre) malignant pancreatic tumors discussed in a multidisciplinary tumor board in a Dutch tertiary hospital were asked to participate. Patients were asked to fill out the Nijmegen Continuity of Care-questionnaire (NCQ) (5-point Likert scale). Additionally, their patient-and care-related data were retrieved from medical records. Correlations of NCQ score and patient-and care-related characteristics were calculated with Spearman’s correlation coefficient. Results In total, 44 patients were included (92% response rate). Pancreatic cancer was the predominant diagnosis (32%). Forty percent received a repetition of diagnostic investigations in the tertiary hospital. Mean scores for personal continuity were 3.55 ± 0.74 for GP, 3.29 ± 0.91 for the specialist and 3.43 ± 0.65 for collaboration between GPs and specialists. Overall COC was scored with a mean 3.38 ± 0.72. No significant correlations were observed between NCQ score and certain patient-or care-related characteristics. Conclusion Continuity of care perceived by patients with pancreatic tumors was scored as moderate. This outcome supports the need to improve continuity of care within multi-institutional pancreatic care networks.

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Revising the ERDs for the 21st Century

Ethics & Medics ◽

10.5840/em202146815 ◽

2021 ◽

Vol 46 (8) ◽

pp. 1-2

Author(s):

John F. Brehany ◽

Keyword(s):

United States ◽

Health Care ◽

21St Century ◽

Health Care Services ◽

Care Delivery ◽

The United States ◽

Care Services ◽

Moral Tradition ◽

Modern Health Care ◽

Catholic Health Care

Since their inception in 1948, The Ethical and Religious Directives for Catholic Health Care Services (ERDs) have guided Catholic health care ministries in the United States, aiding in the application of Catholic moral tradition to modern health care delivery. The ERDs have undergone two major revisions in that time, with about twenty years separating each revision. The first came in 1971 and the second came twenty-six years ago, in 1995. As such, a third major revision is due and will likely be undertaken soon.

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When Clock Time Governs Interaction: How Time Influences Health Professionals’ Intersectoral Collaboration

Qualitative Health Research ◽

10.1177/1049732318779046 ◽

2018 ◽

Vol 28 (13) ◽

pp. 2059-2070 ◽

Cited By ~ 4

Author(s):

Anne Bendix Andersen ◽

Kirsten Beedholm ◽

Raymond Kolbæk ◽

Kirsten Frederiksen

Keyword(s):

Health Care ◽

Elderly Patients ◽

Health Care Delivery ◽

Health Professionals ◽

Health Care Services ◽

Care Delivery ◽

Intersectoral Collaboration ◽

Clock Time ◽

Care Services ◽

Patient Pathways

When setting up patient pathways that cross health care sectors, professionals in emergency units strive to fulfill system requirements by creating efficient patient pathways that comply with standards for length of stay. We conducted an ethnographic field study, focusing on health professionals’ collaboration, of 10 elderly patients with chronic illnesses, following them from discharge to their home or other places where they received health care services. We found that clock time not only governed the professionals’ ways of collaborating, but acceleration of patient pathways also became an overall goal in health care delivery. Professionals’ efforts to save time came to represent a “monetary value,” leading to speedier planning of patient pathways and consequent risks of disregarding important issues when treating and caring for elderly patients. We suggest that such issues are significant to the future planning and improvement of patient pathways that involve elderly citizens who are in need of intersectoral health care delivery.

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First Step in Obtaining Child Health Care: Selecting a Physician

PEDIATRICS ◽

10.1542/peds.81.3.333 ◽

1988 ◽

Vol 81 (3) ◽

pp. 333-338

Author(s):

Gerald B. Hickson ◽

David W. Stewart ◽

William A. Altemeier ◽

James M. Perrin

Keyword(s):

Health Care ◽

Child Health ◽

General Practitioners ◽

Health Care Services ◽

Child Health Care ◽

Sources Of Information ◽

Patient Decision Making ◽

Care Services ◽

Patient Decision ◽

Study Results

To investigate the process by which families identified and selected their children's current physicians, a close-ended questionnaire was administered to 750 families in a mail panel. Of 630 responses (84.0%), 244 had children in the home; 229 (93.9%) identified a regular and current physician for their youngest child. However, parents did not spend much time or energy selecting a physician and rarely explored medical expertise in their decisions. Families averaged 1.2 sources of information consulted per decision; few considered more than two physician choices and infrequently considered alternative types of doctors (pediatricians v family or general practitioners). selection priorities ranked in order of importance concerned parents' perceptions of their doctors' communication skills, accessibility, and quality as determined by recommendations of friends or physicians. Parents appeared less concerned with issues of cost and convenience. Families selecting pediatricians differed from those selecting family and general practitioners in sources of information used and selection priorities. The survey also identified 84 families who had changed or seriously considered changing the physician who was caring for their youngest child. The most frequent dissatisfaction was the perception that an illness was not being managed adequately, followed by believing that the doctor or staff were rude or unconcerned. Families unhappy with pediatricians expressed different reasons from those unhappy with family or general practitioners. The study results provide insight about the first step in obtaining child health care services, a relatively unexplored area of patient decision making.

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iKure Techsoft: Providing Technology Enabled Affordable Health Care in Rural India

Asian Case Research Journal ◽

10.1142/s0218927518500165 ◽

2018 ◽

Vol 22 (02) ◽

pp. 385-411

Author(s):

Atanu Chaudhuri ◽

Venkatramanaiah Saddikutti ◽

Thim Prætorius

Keyword(s):

Health Care ◽

Health Care Services ◽

Health Workers ◽

Care Delivery ◽

Rural India ◽

Medical Team ◽

Hub And Spoke ◽

Care Services ◽

Primary Health ◽

Care Delivery Model

iKure Techsoft was established in 2010 with the main objective to provide affordable and high quality primary health care to the rural population in India and to build a sustainable for-profit business model. To that end, iKure’s cloud based, and patent pending, Wireless Health Incident Monitoring System (WHIMS) technology along with their hub-and-spoke operating model are central, but also essential to exploit and explore further if iKure is to scale-up. iKure provides primary health care services through three hub clinics and 28 rural health centres (RHCs). Each hub clinic employs between one and up to six medical teams (each consisting of 1 doctor, 1 nurse, 1 paramedic and 2 health workers stationed at the hub) & 1 mobile medical team (1 doctor, 1 paramedic, 2 health workers) for catering to the RHCs). Each medical team manages six RHCs. Paramount in iKure’s health care delivery model is their self-developed software called WHIMS, which is a cloud-based award-winning application that runs on low internet bandwidths. WHIMS allow for (a) centralized monitoring of key metrics such as doctor’s attendance, treatment prescribed, patient record management, pharmacy stock management, and (b) supports effective communication, integration and contact that connects RHCs with hub clinics, but also city-based multi-specialty hospitals with whom iKure has formal tie-ups. iKure, moreover, also works extensively with Non-Governmental Organizations (NGOs). Collaboration with local NGOs in the target areas helps to build trust with the rural villagers and their local knowledge and access helps to assess service demand. NGOs also provide the necessary local logistical support and basic infrastructure in the rural areas where iKure works. Moreover, collaboration, for example, with corporate organizations are central as they contribute with part of their corporate social responsibility (CSR) funds to support iKure initiatives. At present, iKure is planning to add diagnostic services to its six hub clinics as well as expand its presence in other parts of West Bengal and other states across India. Expanding rural health care services even with the technology support of WHIMS is challenging because, for example, health is a very local issue (due to, among other things, local customs and languages) and it requires investing significant amount of time and resources to build relationship with the rural people as well as collaborators such as NGOs and corporates. The accompanying case describes iKure’s journey so far in terms of understanding: (a) the state of health care and government health care services provided in rural India, (b) the establishment and evolution of the iKure business and health care model, (c) iKure’s operations and health care delivery model including the WHIMS technology solution and hub-and-spoke set-up of operations, (d) the collaborative model which relies on NGOs and private corporates, and (e) finally iKure’s challenges related to scaling-up.

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The ecology of medical care in Norway: wide use of general practitioners may not necessarily keep patients out of hospitals

Journal of Public Health Research ◽

10.4081/jphr.2012.e28 ◽

2012 ◽

Vol 1 (2) ◽

pp. 28 ◽

Cited By ~ 10

Author(s):

Anne Helen Hansen ◽

Peder A. Halvorsen ◽

Olav Helge Førde

Keyword(s):

Health Care ◽

General Practitioner ◽

General Practitioners ◽

Health Care Services ◽

Medical Providers ◽

Specialist Care ◽

Cross Sectional ◽

Care Services ◽

And Gender ◽

Complementary And Alternative

Background. Our aim was to investigate the pattern of self reported symptoms and utilisation of health care services in Norway. Design and methods. With data from the cross-sectional Tromsø Study (2007-8), we estimated population proportions reporting symptoms and use of seven different health services. By logistic regression we estimated differences according to age and gender. Results. 12,982 persons aged 30-87 years participated, 65.7% of those invited. More than 900/1000 reported symptoms or health problems in a year as well as in a month, and 214/1000 and 816/1000 visited a general practitioner once or more in a month and a year, respectively. The corresponding figures were 91/1000 and 421/1000 for specialist outpatient visits, and 14/1000 and 116/1000 for hospitalisations. Physiotherapists were visited by 210/1000, chiropractors by 76/1000, complementary and alternative medical providers by 127/1000, and dentists by 692/1000 in a year. Women used most health care services more than men, but genders used hospitalisations and chiropractors equally. Utilisation of all services increased with age, except chiropractors, dentists and complementary and alternative medical providers. Conclusions. Almost the entire population reported health related problems during the previous year, and most residents visited a general practitioner. Yet there were high rates of inpatient and outpatient specialist utilisation. We suggest that wide use of general practitioners may not necessarily keep patients out of specialist care and hospitals.

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Light Still Shines in the Darkness

Journal of Holistic Nursing ◽

10.1177/0898010109359310 ◽

2010 ◽

Vol 28 (4) ◽

pp. 266-274 ◽

Cited By ~ 5

Author(s):

Ted Karpf ◽

J. Todd Ferguson ◽

Robin Y. Swift

Keyword(s):

Health Care ◽

Health Care Services ◽

Care Delivery ◽

Care Services ◽

Care Giving ◽

Basic Care ◽

The People ◽

British Military ◽

Health Care Models ◽

Care Models

Health care is in crisis at the global, national, and local levels, with hundreds of millions living without basic care, or with insufficient care. Current health care models seem to have ignored, muted, or excluded the voices of the people they were intended to serve, resulting in health systems and care delivery models that do not respond to the needs of the people. This article describes a values-based approach to health and health care services in which the voices of the people are heard and listened to, and in which individuals and communities are informed participants in their own care. We draw parallels between contemporary concerns for decency in care giving to Florence Nightingale’s path-breaking work, first with the British military medical system and then Great Britain as a whole.

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