scholarly journals Barriers and Facilitators to the Implementation of a Mobile Insulin Titration Intervention for Patients With Uncontrolled Diabetes: A Qualitative Analysis

10.2196/13906 ◽  
2019 ◽  
Vol 7 (7) ◽  
pp. e13906 ◽  
Author(s):  
Erin Rogers ◽  
Sneha R Aidasani ◽  
Rebecca Friedes ◽  
Lu Hu ◽  
Aisha T Langford ◽  
...  
Keyword(s):  
Health Care ◽  
Text Messaging ◽  
Diabetes Management ◽  
Unmet Need ◽  
Health Care Facilities ◽  
Future Research ◽  
Management Support ◽  
Implementation Climate ◽  
Time Saving ◽  
Provider Perceptions

Background In 2016, a short message service text messaging intervention to titrate insulin in patients with uncontrolled type 2 diabetes was implemented at two health care facilities in New York City. Objective This study aimed to conduct a qualitative evaluation assessing barriers to and the facilitators of the implementation of the Mobile Insulin Titration Intervention (MITI) program into usual care. Methods We conducted in-depth interviews with 36 patients enrolled in the MITI program and the staff involved in MITI (n=19) in the two health care systems. Interviews were transcribed and iteratively coded by two study investigators, both inductively and deductively using a codebook guided by the Consolidated Framework for Implementation Research. Results Multiple facilitator themes emerged: (1) MITI had strong relative advantages to in-person titration, including its convenience and time-saving design, (2) the free cost of MITI was important to the patients, (3) MITI was easy to use and the patients were confident in their ability to use it, (4) MITI was compatible with the patients’ home routines and clinic workflow, (5) the patients and staff perceived MITI to have value beyond insulin titration by reminding and motivating the patients to engage in healthy behaviors and providing a source of patient support, and (6) implementation in clinics was made easy by having a strong implementation climate, communication networks to spread information about MITI, and a strong program champion. The barriers identified included the following: (1) language limitations, (2) initial nurse concerns about the scope of practice changes required to deliver MITI, (3) initial provider knowledge gaps about the program, and (4) provider perceptions that MITI might not be appropriate for some patients (eg, older or not tech-savvy). There was also a theme that emerged during the patient and staff interviews of an unmet need for long-term additional diabetes management support among this population, specifically diet, nutrition, and exercise support. Conclusions The patients and staff were overwhelmingly supportive of MITI and believed that it had many benefits and that it was compatible with the clinic workflow and patients’ lives. Initial implementation efforts should address staff training and nurse concerns. Future research should explore options for integrating additional diabetes support for patients.

scholarly journals Barriers and Facilitators to the Implementation of a Mobile Insulin Titration Intervention for Uncontrolled Diabetes Patients: A Qualitative Analysis (Preprint)

2019 ◽  
Author(s):  
Erin Rogers ◽  
Sneha R Aidasani ◽  
Rebecca Friedes ◽  
Lu Hu ◽  
Aisha T. Langford ◽  
...  
Keyword(s):  
Health Care ◽  
Text Messaging ◽  
Diabetes Management ◽  
Health Care Systems ◽  
Unmet Need ◽  
Future Research ◽  
Management Support ◽  
Implementation Climate ◽  
Time Saving ◽  
Care Systems

BACKGROUND In 2016, a text-messaging intervention to titrate insulin in patients with uncontrolled type 2 diabetes was implemented at two health care systems in New York City. OBJECTIVE This study conducted a qualitative evaluation assessing barriers to, and facilitators of, implementation of the mobile insulin titration intervention (called “MITI”) into usual care. METHODS We conducted in-depth interviews with patients enrolled in the MITI program (N=36) and staff involved in MITI (N=19) at the two health care systems. Interviews were transcribed and iteratively coded by two study investigators both inductively and deductively using a codebook guided by the Consolidated Framework for Implementation Research. RESULTS Multiple facilitator themes emerged: 1) MITI had strong relative advantages to in-person titration including its convenience and time-saving design; 2) the free cost of MITI was important to patients; 3) MITI was easy to use and patients were confident in their ability to use MITI; 4) MITI was compatible with patients’ home routines and clinic workflow; 5) patients and staff perceived MITI to have value beyond insulin titration by reminding and motivating patients to engage in healthy behaviors and providing a source of patient support; and 6) implementation in clinics was made easy by having a strong implementation climate, communication networks to spread information about MITI, and a strong program champion. Barriers identified included: 1) language limitations; 2) initial nurse concerns about scope of practice changes required to deliver MITI; 2) initial provider knowledge gaps about the program; and 3) provider perceptions that MITI may not be appropriate for some patients (e.g., older, not tech-savvy). There was also a theme that emerged during patient and staff interviewees of an unmet need for longer-term, additional diabetes management support among this population, specifically diet, nutrition and exercise support. CONCLUSIONS Patients and staff were overwhelmingly supportive of MITI, believed it had many benefits and believed it was compatible with the clinic workflow and patient’s lives. Initial implementation efforts should address staff training and nurse concerns. Future research should explore options for integrating additional diabetes support for patients.

A Systems Framework for Understanding the Environment’s Relation to Clinical Teamwork: A Systematic Literature Review of Empirical Studies

2018 ◽  
Vol 52 (7) ◽  
pp. 726-760
Author(s):  
Erin Peavey ◽  
Hui Cai
Keyword(s):  
Health Care ◽  
Systems Engineering ◽  
Physical Environment ◽  
Empirical Studies ◽  
Health Care Facilities ◽  
Future Research ◽  
Health Care Outcomes ◽  
Care Facilities ◽  
Care Outcomes ◽  
Systems Framework

Clinician teamwork is effective at improving many health care outcomes, and the physical environment is an important part of a system that facilitates teamwork. This review critically evaluates and synthesizes the empirical evidence on the impacts of the physical environment and surrounding ecosystem on clinician teamwork in health care facilities using a systems-based lens. The systematic search yielded 2,323 titles and abstracts between 2007 and 2017, which were reviewed and resulted in 34 articles examining physical environment’s impact on clinician teamwork. The Systems Engineering for Patient Safety (SEIPS) framework is utilized to thematically structure findings to examine the interdependent nature of built and nonbuilt factors that have a documented impact on clinician teamwork. This study found consistent evidence of the interdependence of these systems factors in facilitating or hampering teamwork, as defined by Salas and colleagues’ “Big Five.” The review identifies current gaps in the literature and suggests where future research is needed.

scholarly journals Exchange of experience in the field of medical services as a form of international cooperation between Ukraine and Poland

2021 ◽  
pp. 53
Author(s):  
Viktoriia Adamyk ◽  
Khrystyna Shcherbiak
Keyword(s):  
Health Care ◽  
Local Governments ◽  
Technical Assistance ◽  
Well Being ◽  
Health Care Facilities ◽  
Medical Services ◽  
Future Research ◽  
Technical Equipment ◽  
Bilateral Relations ◽  
The Impact

Introduction. The development of bilateral relations in the context of globalization and European integration involves expanding the range of forms of cooperation, as well as those areas covered by cooperation. The implementation of medical reform in Ukraine necessitates the intensification of the exchange of experience in the medical field with other countries, including Poland. The rapid processes of digitalization against the background of the Kovid-19 pandemic determine the modernization of communication tools and cooperation in the field of health services.The purpose of the article is to study the state and prospects of exchange of experience in the field of medical services between Ukraine and Poland.Research methods. To achieve the goal set in the article, general scientific and special methods were used, namely: analysis and synthesis, induction and deduction, abstraction and concretization, systematization, as well as elements of comparative analysis. The methodological basis for the study are national and international regulations of Ukraine and Poland, which regulate the functioning of health care and bilateral relations in the field of medical services, scientific works of domestic and foreign researchers, statistical reports and more.Results. The exchange of experience in the provision of medical services between Ukraine and Poland is carried out in a slightly different state of health care and taking into account Ukraine’s integration intentions using tools such as conferences, seminars, webinars, academic mobility of scientists and students, bilateral agreements between medical institutions with the support of local governments and self-government, etc. Digitalization, on the one hand, expands opportunities for collaboration, and on the other - necessitates the need to improve the quality of technical equipment of hospitals and makes new demands on human capital. Improving the exchange of experience in the field of  medical services is enhanced by receiving technical assistance from Polish partners, including under the auspices of international institutions, such as the EU, WHO, UNICEF, etc. Perspective areas are the introduction of the eHealth system in Ukraine, as well as the involvement of Polish specialists to modernize the management system in domestic health care facilities. The article details the recommendations for intensifying the exchange of experience between Ukraine and Poland in areas and tools.Perspectives. Future research is important to focus on an interdisciplinary analysis of the consequences of health care reform in Ukraine and Poland in the context of the impact on the well-being of citizens.

scholarly journals Preventing Airborne Disease Transmission: Review of Methods for Ventilation Design in Health Care Facilities

2011 ◽  
Vol 2011 ◽  
pp. 1-21 ◽  
Author(s):  
Amir A. Aliabadi ◽  
Steven N. Rogak ◽  
Karen H. Bartlett ◽  
Sheldon I. Green
Keyword(s):  
Health Care ◽  
Disease Transmission ◽  
Care Facility ◽  
Health Care Facility ◽  
Building Design ◽  
Health Care Facilities ◽  
Control Measures ◽  
Design Parameters ◽  
Future Research ◽  
Care Facilities

Health care facility ventilation design greatly affects disease transmission by aerosols. The desire to control infection in hospitals and at the same time to reduce their carbon footprint motivates the use of unconventional solutions for building design and associated control measures. This paper considers indoor sources and types of infectious aerosols, and pathogen viability and infectivity behaviors in response to environmental conditions. Aerosol dispersion, heat and mass transfer, deposition in the respiratory tract, and infection mechanisms are discussed, with an emphasis on experimental and modeling approaches. Key building design parameters are described that include types of ventilation systems (mixing, displacement, natural and hybrid), air exchange rate, temperature and relative humidity, air flow distribution structure, occupancy, engineered disinfection of air (filtration and UV radiation), and architectural programming (source and activity management) for health care facilities. The paper describes major findings and suggests future research needs in methods for ventilation design of health care facilities to prevent airborne infection risk.

scholarly journals Nurses’ Encountered Challenges with Patient-centered Care in Rural Primary Health Care Centers: A Case Study of Nigeria

2021 ◽  
Author(s):  
Adepeju Lateef ◽  
Euphemia Mbali Mhlongo
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Patient Centered Care ◽  
Health Care Facilities ◽  
Management Support ◽  
Patient Centered ◽  
Primary Health ◽  
Care Facilities ◽  
Centered Care ◽  
Primary Health Care Facilities

Abstract BackgroundGlobally, patient-centered care has become the focus of the healthcare system. Therefore, it is imperative to note that patient-centered care seeks to empower partnering approaches to primary health care and has recently gained prominence in nursing practice and applied nursing research. However, nurses are faced with numerous challenges in achieving the desired results and objectives related to Patient-centered care in the Primary Health Care system. Thus, the study explores the negative factors influencing the implementation of Patient-centered care in rural Primary Health Care facilities in Nigeria.MethodA qualitative participatory action research design was used. Data collection was conducted with the nurses from Primary Health Care facilities through individual interviews and focus group discussions. Data saturation was achieved with 35 participants from 30 Primary Health Care facilities in Osun State, Southwest Nigeria, using a purposive sampling technique. All interviews were audio-recorded, which were later transcribed verbatim and analyzed using a thematic content analysis approach. NVivo 12 software was used for data management.ResultsThe results from this study was categorized into two: organizational factors and individual factors. Five themes that emerged from the study include: inadequate management support, insufficient operational skills and knowledge /equipped learning, increased workload and time constraints, health personnel readiness, dearth enthusiasm for change and accountability of the staff.ConclusionThe results of this study show that nurses encountered diverse challenges in the implementation of patient-centered care. To improve healthcare delivery quality in the Primary Health Care facilities, there is a need to reinforce adequate management support, education, training, and the nurses’ internal motivation to achieve a transformative healthcare outcome.

Application of Handheld Computing and Mobile Phones in Diabetes Self-Care

2013 ◽  
pp. 254-275 ◽  
Author(s):  
Abdullah Wahbeh
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Mobile Phones ◽  
Text Messaging ◽  
Information Technologies ◽  
Diabetes Management ◽  
Self Care ◽  
Handheld Devices ◽  
Health Information Technologies ◽  
Handheld Computing

Advances in technology have accelerated self-care activities, making them more practical and possible than before using these technologies. The utilization of new Health Information Technologies (HIT) is becoming more and more apparent in self-care. Many patients incorporate the use of PDAs in diabetes self-care (Forjuoh, et al., 2007; Jones & Curry, 2006). Mobile phones are used in diabetes self-management by diabetes patients (Carroll, DiMeglio, Stein, & Marrero, 2011; Faridi, et al., 2008; Mulvaney, et al., 2012). Also, reminders based on SMS cell phone text messaging are used to support diabetes management (Hanauer, Wentzell, Laffel, & Laffel, 2009). Given the current advances in the field of health care, health care technologies, and handheld computing, this case explores the possible primary usages of mobile phones, PDAs, and handheld devices in self-care management. More specifically, the case illustrates how such technologies can be used in diabetes management by patients and health care providers.

scholarly journals The Comparison Of Service Quality For Bpjs And Non Bpjs Users In Batam Health Facilities

2021 ◽  
Vol 2 (6) ◽  
pp. 2260-2266
Author(s):  
Rini Susanti ◽  
Victor E. D Palapessy
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Sector ◽  
Health Care Facilities ◽  
Future Research ◽  
Cross Sectional ◽  
Significant Difference ◽  
Care Facilities ◽  
The Government

BPJS and Non BPJS dependent patients have the same rights as other general patients to receive satisfying services just like other health care facilities. Considering that, this new program from the government in the health sector is aimed at controlling the quality and costs of health, so that it can be accessed by all levels of society, as well as having good prospects for hospitals and other health care facilities. Thus, hospitals are responsible for being able to provide satisfying and quality services so that they can be chosen by the community, both BPJS and non BPJS participants. The purpose of this study was to compare the quality of BPJS and Non BPJS dependent health services on the satisfaction of inpatients in health care facilities in the Riau Archipelago. This type of research is quantitative using a cross-sectional approach. The sample in this study was 60 people. The instrument used is a questionnaire. Data analysis in this study used the independent t-test. The results of the study found that there were significant differences between the quality of health services for the BPJS and Non BPJS respondent groups. And there is a significant difference between the satisfaction of inpatients in the BPJS and Non BPJS respondent groups. It is hoped that this research can be a reference for future research.

scholarly journals Meeting the Needs of Maori with Diabetes: an Evaluation of a Nurse-Led Service

2021 ◽  
Author(s):  
◽  
Josephine Mary Elizabeth Janssen
Keyword(s):  
Health Care ◽  
Transtheoretical Model ◽  
Local Community ◽  
Diabetes Management ◽  
Service Providers ◽  
Management Support ◽  
Health Providers ◽  
Lifestyle Behaviour ◽  
Co Morbidity ◽  
Maori Health

<p>Designated Maori health service providers and specialised Maori nursing roles using "culturally appropriate" practices have been developed in New Zealand to address health disparities between Maori and non-Maori citizens. This study considers the effectiveness, from several perspectives, of a Maori nurse-led diabetes programme offered by Te Hauora O Ngati Rarua. It also identifies salient features of the experience of having diabetes and being on the programme, which consists of the combination of a six week course of group education sessions with one-to-one case management, involving health care, education and support. Programme evaluation was conducted using an embedded case study design. Seven programme participants were followed for 9-12 months, during which time multiple sources of data were accessed, including programme documents, clinical notes, laboratory results and stakeholder interviews. Client outcomes were measured in terms of physiological measures, knowledge acquisition, diabetes management and lifestyle behaviour. Some participants demonstrated improved diabetes management and lifestyle behaviour while actively engaged with the programme, but efforts tended to lapse once support was reduced. This highlighted the importance of optimising the level of long-term self-management support for clients with diabetes. High levels of co-morbidity were common and tended to complicate management. The Transtheoretical Model of Change, Chronic Care Model and Systems Theory shaped the evaluation. The study makes four important contributions to knowledge in this area: 1) it confirms the importance of Maori values and processes in "by Maori for Maori" services as they help to keep clients engaged, 2) it describes how small Maori health providers meet the needs of the local community, and 3) it identifies the value of the Maori Diabetes Nurse Educator (MDNE) role in primary health care. Thus it serves as an affirmation of the importance of the Maori Health Strategy and Maori self-determination in organising and delivering health care for Maori clients. The fourth valuable contribution is the insight gained into the dynamics of Pakeha researchers working in partnership with Maori organisations.</p>

scholarly journals Supporting Self-Management of Cardiovascular Diseases Through Remote Monitoring Technologies: Metaethnography Review of Frameworks, Models, and Theories Used in Research and Development

10.2196/16157 ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. e16157 ◽  
Author(s):  
Roberto Rafael Cruz-Martínez ◽  
Jobke Wentzel ◽  
Rikke Aune Asbjørnsen ◽  
Peter Daniel Noort ◽  
Johan Magnus van Niekerk ◽  
...  
Keyword(s):  
Health Care ◽  
Cardiovascular Diseases ◽  
Research And Development ◽  
Remote Monitoring ◽  
Well Being ◽  
Self Management ◽  
Cochrane Library ◽  
Future Research ◽  
Management Support ◽  
Monitoring Technologies

Background Electronic health (eHealth) is a rapidly evolving field informed by multiple scientific disciplines. Because of this, the use of different terms and concepts to explain the same phenomena and lack of standardization in reporting interventions often leaves a gap that hinders knowledge accumulation. Interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies are a cross-disciplinary area potentially affected by this gap. A review of the underlying frameworks, models, and theories that have informed projects at this crossroad could advance future research and development efforts. Objective This research aimed to identify and compare underlying approaches that have informed interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies. The objective was to achieve an understanding of the distinct approaches by highlighting common or conflicting principles, guidelines, and methods. Methods The metaethnography approach was used to review and synthesize researchers’ reports on how they applied frameworks, models, and theories in their projects. Literature was systematically searched in 7 databases: Scopus, Web of Science, EMBASE, CINAHL, PsycINFO, Association for Computing Machinery Digital Library, and Cochrane Library. Included studies were thoroughly read and coded to extract data for the synthesis. Studies were mainly related by the key ingredients of the underlying approaches they applied. The key ingredients were finally translated across studies and synthesized into thematic clusters. Results Of 1224 initial results, 17 articles were included. The articles described research and development of 10 different projects. Frameworks, models, and theories (n=43) applied by the projects were identified. Key ingredients (n=293) of the included articles were mapped to the following themes of eHealth development: (1) it is a participatory process; (2) it creates new infrastructures for improving health care, health, and well-being; (3) it is intertwined with implementation; (4) it integrates theory, evidence, and participatory approaches for persuasive design; (5) it requires continuous evaluation cycles; (6) it targets behavior change; (7) it targets technology adoption; and (8) it targets health-related outcomes. Conclusions The findings of this review support and exemplify the numerous possibilities in the use of frameworks, models, and theories to guide research and development of eHealth. Participatory, user-centered design, and integration with empirical evidence and theoretical modeling were widely identified principles in the literature. On the contrary, less attention has been given to the integration of implementation in the development process and supporting novel eHealth-based health care infrastructures. To better integrate theory and evidence, holistic approaches can combine patient-centered studies with consolidated knowledge from expert-based approaches. Trial Registration PROSPERO CRD42018104397; https://tinyurl.com/y8ajyajt International Registered Report Identifier (IRRID) RR2-10.2196/13334

scholarly journals How clinicians experience a simulated antiretroviral therapy adherence exercise: A qualitative study

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Justin G. Engelbrecht ◽  
Fidele K. Mukinda ◽  
Beryl Green ◽  
Donald Skinner
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Antiretroviral Therapy ◽  
Health Care Providers ◽  
Text Messaging ◽  
Health Care Facilities ◽  
Care Providers ◽  
Simulation Exercise ◽  
Primary Health ◽  
Adherence Counselling

Background: With the shift of paediatric antiretroviral therapy (ART) from tertiary to primary health care, there has been a need to train clinicians working in primary health care facilities to support adherence to treatment. An adherence simulation exercise was included in a course on paediatric human immunodeficiency virus (HIV) and tuberculosis (TB) to stimulate health care providers’ awareness and generate empathy of complex paediatric adherence practices.Aim: The aim of this study was to describe the experience of clinicians completing the simulation exercise and to assess whether enhancing their empathy with patients and treatment supporters would improve their perceived clinical and counselling skills.Setting: The study was conducted at the Faculty of Medicine and Health Sciences, Stellenbosch University, and a guesthouse in Cape Town.Methods: The adherence module used blended learning methodology consisting of face-to-face contact sessions and distance learning. A qualitative thematic approach was used to understand the participant experiences through focus-group discussions and semi-structured interviews.Results: Three thematic clusters emerged, namely, experiences of the simulated exercise, patient–provider relationships and adherence strategies. Their experiences were both positive and challenging, especially when a ‘caregiver and/or treatment supporter’ scenario encouraged participants to reflect on their own relationships with their patients. Clinicians had also considered how empathy fits into their scope of responsibilities. Text messaging and adherence counselling strategies were identified.Conclusion: Simulated learning activities have the potential to create awareness of relationships between clinicians and their patients and generate ideas and discussion that could lead to improvements in clinical practice, and adherence promotion strategies.

Sign in / Sign up

Export Citation Format

Share Document