scholarly journals Challenges and Lessons Learned From a Telehealth Community Paramedicine Program for the Prevention of Hypoglycemia: Pre-Post Pilot Feasibility Study

JMIR Diabetes ◽  
10.2196/26941 ◽  
2021 ◽  
Vol 6 (3) ◽  
pp. e26941
Author(s):  
Mohanraj Thirumalai ◽  
Ayse G Zengul ◽  
Eric Evans
Keyword(s):  
Self Efficacy ◽  
Underserved Populations ◽  
Retention Rate ◽  
Lessons Learned ◽  
Underserved Area ◽  
Implementation Challenges ◽  
Fear Of Hypoglycemia ◽  
Community Paramedicine ◽  
Feasibility Evaluation ◽  
Telehealth Intervention

Background Prevention through Intervention is a community paramedicine program developed by Birmingham Fire and Rescue Services in Alabama. This program aims to reduce dependency on emergency medical services (EMS) for nonemergency-related events through education and to lower the frequency of emergency calls in underserved populations. A telehealth intervention with an emphasis on hypoglycemia was implemented to (1) tailor the intervention to meet the educational needs of participants and (2) facilitate follow-ups. A pre-post pilot feasibility evaluation of the telehealth intervention was conducted. Objective This paper describes the results of the feasibility evaluation, implementation challenges, and the lessons learned about the deployment of a hypoglycemia prevention program in an underserved area and its evaluation. Methods This single-arm pretest-posttest intervention included (1) an initial in-person visit (week 1), (2) 3 weekly telecoaching calls (weeks 2-4), (3) 1 biweekly call (week 6), and (4) a final in-person visit (week 8) for collecting posttest data from individuals who called EMS due to hypoglycemic events. In-person visits included educational sessions conducted by EMS personnel. Participants’ education included tailored content related to hypoglycemia. Weekly telecoaching calls focused on hypoglycemia symptom monitoring and education reinforcement via a telehealth dashboard. The primary measures focused on feasibility measures, and exploratory measures focused on the fear of hypoglycemia, self-efficacy, and a knowledge of diabetes. Results A total of 40 participants participated in the intervention. However, the study was marred with high attrition. The various factors behind the low retention rate were discussed. There was a decreasing trend in all three subdomains of the fear of hypoglycemia from pretest to posttest. There was also a significant increase in participants’ self-efficacy in hypoglycemia self-management (P=.03). Conclusions This study shows preliminary and promising results for a community-based intervention specifically for hypoglycemia. However, the socioeconomic setting in which the intervention was delivered may have resulted in high dropout rates and low attendance during the intervention, which are considerations for future telehealth studies. Trial Registration ClinicalTrials.gov NCT03665870; https://clinicaltrials.gov/ct2/show/NCT03665870

scholarly journals Challenges and Lessons Learned From a Telehealth Community Paramedicine Program for the Prevention of Hypoglycemia: Pre-Post Pilot Feasibility Study (Preprint)

2021 ◽  
Author(s):  
Mohanraj Thirumalai ◽  
Ayse G Zengul ◽  
Eric Evans
Keyword(s):  
Self Efficacy ◽  
Underserved Populations ◽  
Retention Rate ◽  
Lessons Learned ◽  
Underserved Area ◽  
Implementation Challenges ◽  
Fear Of Hypoglycemia ◽  
Community Paramedicine ◽  
Feasibility Evaluation ◽  
Telehealth Intervention

BACKGROUND Prevention through Intervention is a community paramedicine program developed by Birmingham Fire and Rescue Services in Alabama. This program aims to reduce dependency on emergency medical services (EMS) for nonemergency-related events through education and to lower the frequency of emergency calls in underserved populations. A telehealth intervention with an emphasis on hypoglycemia was implemented to (1) tailor the intervention to meet the educational needs of participants and (2) facilitate follow-ups. A pre-post pilot feasibility evaluation of the telehealth intervention was conducted. OBJECTIVE This paper describes the results of the feasibility evaluation, implementation challenges, and the lessons learned about the deployment of a hypoglycemia prevention program in an underserved area and its evaluation. METHODS This single-arm pretest-posttest intervention included (1) an initial in-person visit (week 1), (2) 3 weekly telecoaching calls (weeks 2-4), (3) 1 biweekly call (week 6), and (4) a final in-person visit (week 8) for collecting posttest data from individuals who called EMS due to hypoglycemic events. In-person visits included educational sessions conducted by EMS personnel. Participants’ education included tailored content related to hypoglycemia. Weekly telecoaching calls focused on hypoglycemia symptom monitoring and education reinforcement via a telehealth dashboard. The primary measures focused on feasibility measures, and exploratory measures focused on the fear of hypoglycemia, self-efficacy, and a knowledge of diabetes. RESULTS A total of 40 participants participated in the intervention. However, the study was marred with high attrition. The various factors behind the low retention rate were discussed. There was a decreasing trend in all three subdomains of the fear of hypoglycemia from pretest to posttest. There was also a significant increase in participants’ self-efficacy in hypoglycemia self-management (<i>P</i>=.03). CONCLUSIONS This study shows preliminary and promising results for a community-based intervention specifically for hypoglycemia. However, the socioeconomic setting in which the intervention was delivered may have resulted in high dropout rates and low attendance during the intervention, which are considerations for future telehealth studies. CLINICALTRIAL ClinicalTrials.gov NCT03665870; https://clinicaltrials.gov/ct2/show/NCT03665870

scholarly journals Implementation of Remote Interventions in Older Adults: Lessons Learned During COVID-19 Isolation

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 950-950
Author(s):  
Jamie Rincker ◽  
Jessica Wallis ◽  
Angela Fruik ◽  
Alyssa King ◽  
Kenlyn Young ◽  
...  
Keyword(s):  
Older Adults ◽  
Weight Loss ◽  
Nutrition Education ◽  
Underserved Populations ◽  
Smart Phone ◽  
Dropout Rate ◽  
Lessons Learned ◽  
Drop Out ◽  
Electronic Submission ◽  
Weight Loss Interventions

Abstract Recommendations for older adults to socially isolate during the COVID-19 pandemic will have lasting impacts on body weight and physical activity. Due to the pandemic, two in-person RCT weight-loss interventions in obese older adults with prediabetes, Veterans Achieving Weight Loss and Optimizing Resilience-Using Protein (VALOR-UP, n=12) and the Egg-Supplemented Pre-Diabetes Intervention Trial (EGGSPDITE, n=7), were converted to remote formats and weekly nutrition (EGGSPDITE and VALOR-UP) and exercise (VALOR-UP only) classes were delivered using synchronous videoconference technology (Webex); classes were accessed via tablet/desktop/laptop or smart phone. Steps taken to transition participants to remote formats included technology training, implementation of staff tech-support, and delivery of nutrition education, tablets, scales, and exercise bands. The time to successfully transition participants was 1 week for early adopters (n=10) and up to 4 weeks for those with significant technology barriers (n=9); their difficulties included internet access, camera and microphone access and use, and electronic submission of weight and food records. Even with these challenges, in the first 3 months of remote delivery, participant dropout rate was low (10.5%, n=2), attendance was high (87.6% nutrition class (n=19); 76.4% exercise class (VALOR-UP, n=12)), and weight loss was successful (&gt;2.5% loss (n=13); &gt;5% loss (n=8)), showing that lifestyle interventions can be successfully adapted for remote delivery. Remote interventions also have potential for use in non-pandemic times to reach underserved populations who often have high drop-out rates due to caretaker roles, transportation limitations, and work schedules. These barriers were significantly reduced using a virtual intervention platform.

Securing the future of statistics in Africa through National Strategies for the Development of Statistic

2020 ◽  
Vol 36 ◽  
pp. 15-25
Author(s):  
Ben Kiregyera
Keyword(s):  
Ad Hoc ◽  
Lessons Learned ◽  
Global Level ◽  
African Countries ◽  
Implementation Challenges ◽  
Statistical Systems ◽  
Development Agendas ◽  
Different Levels ◽  
Statistical Development

Adoption of development agendas at different levels – national, regional, continental, and global level – has led to an unprecedented increase in demand for official statistics. This increase has not only brought to the fore a litany of challenges facing National Statistical Systems (NSSs) in Africa but also it has created opportunities for strengthening statistical production and development. This paper underscores the need for countries to take full advantage of these opportunities and increase investments in statistics, undertake data innovation, and expand and diversify data ecosystems, leveraging on the foundations of the data revolution for sustainable development and in line with current international statistical frameworks. The paper posits that these improvements will not happen coincidentally nor through ad hoc, piecemeal and uncoordinated approaches. Rather they will happen through more systematic, coordinated and multi-sectoral approaches to statistical development. The National Strategy for the Development of Statistics (NSDS) is presented as a comprehensive and robust framework for building statistical capacity and turning around NSSs in African countries. The paper unpacks the NSDS; elaborates the NSDS processes including; mainstreaming sectors into the NSDS, the stages of the NSDS lifecycle and the role of leadership in the NSDS proces; highlights NSDS extension; presents the design and implementation challenges, and the key lessons learned from the NSDS processes in Africa in the last 15 years or so.

scholarly journals Conceptualization and Realization of a National Trail in a Small Island-Nation: The Commonwealth of Dominica’s Experience

2021 ◽  
Vol 2 (1) ◽  
pp. 79-94
Author(s):  
Colmore S. Christian
Keyword(s):  
Rural Communities ◽  
Socioeconomic Development ◽  
Research Question ◽  
Strong Support ◽  
Lessons Learned ◽  
Small Island ◽  
Implementation Challenges ◽  
Face To Face ◽  
Research Themes ◽  
Socioeconomic Benefits

The island-nation of Dominica, 790 km2 in area, is located approximately 1126.5 km Southeast of Florida, USA. In the mid-1990s, Dominica embarked on developing the 183.5 km Waitukubuli National Trail (WNT), the first and only national trail model in the Eastern Caribbean. The 14-segment WNT, officially opened in May 2013, passes through some of the island’s most diverse landscapes. WNT was designed to link as many rural communities as possible and promote ecotourism and community socioeconomic development. Rehabilitation work continues on the WNT and the rest of Dominica, following the devastation caused by Hurricane Maria of 2017. This article, based primarily on a limited questionnaire survey, selected interviews, and literature review, explored the research question ‘What were the challenges faced by a small-island nation in the development of a National Trail? Five specific research objectives focused on the conceptualization, implementation challenges, partnerships fostered, national and sub-regional significance, and future outlook of the Trail were considered. Questionnaire respondents identified the island’s topography and negotiations with private landowners as significant trail construction challenges. A 100% of survey respondents anticipate that reliable funding to support timely maintenance would likely be a critical future issue. Some respondents identified marketing, public engagement, and visitor safety as potential issues. Face-to-face interviews found strong support for the WNT. The interviewees were confident that Dominica would realize sustainable socioeconomic benefits from the Trail. The article concludes with lessons learned and proposes strategies and research themes to ensure the Trail’s sustainability.

scholarly journals Construct Validation of the Self-Efficacy Teaching and Knowledge Instrument for Science Teachers-Revised (SETAKIST-R): Lessons Learned

2013 ◽  
Vol 24 (7) ◽  
pp. 1133-1156 ◽  
Author(s):  
Linda A. Pruski ◽  
Sharon L. Blanco ◽  
Rosemary A. Riggs ◽  
Kandi K. Grimes ◽  
Chase W. Fordtran ◽  
...  
Keyword(s):  
Science Teachers ◽  
Self Efficacy ◽  
Construct Validation ◽  
Lessons Learned ◽  
The Self

Virtual Primary Care Implementation during COVID-19 in High-Income Countries: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Kristina De Vera ◽  
Priyanka Challa ◽  
Rebecca H Liu ◽  
Kaitlin Fuller ◽  
Anam Shahil Feroz ◽  
...  
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
Primary Care Physicians ◽  
Underserved Populations ◽  
High Income ◽  
Lessons Learned ◽  
Regulatory Policies ◽  
Care Services ◽  
Virtual Care ◽  
Primary Care Services

BACKGROUND Primary care physicians across the world are grappling with adopting virtual services to provide appropriate patient care during the COVID-19 pandemic. As the crisis continues, it is imperative to recognize the wide-scale barriers and seek strategies to mitigate the challenges of rapid adoption to virtual care felt by patients and physicians alike. OBJECTIVE The purpose of this scoping review was to map the challenges, strategies, and lessons learned from high-income countries that can be mobilized to inform decision-makers on how to best implement virtual primary care services during and after the COVID-19 pandemic. Moreover, the findings of our scoping review identified the barriers and strategies within the Quadruple Aim components, which may prove to be an effective implementation strategy for virtual care adoption in primary care settings. METHODS The two concepts of virtual care and COVID-19 were searched in MEDLINE, EMBASE, and CINAHL on Aug 10, 2020, and Scopus was searched on Aug 15, 2020. The database searches returned 10,549 citations and an additional 766 citations were retrieved from searching the citations from the reference lists of articles that met all inclusion criteria. After deduplication, 6,580 unique citations remained. Following title and abstract screening, 1,260 full-text articles were reviewed, of which 49 articles were included for data extraction, and 38 articles met the eligibility criteria for inclusion in the review. RESULTS Seven factors were identified as major barriers to the implementation of virtual primary care. Of the 38 articles included in this scoping review, 20 (53%) articles focused on challenges to equitable access to care, specifically regarding the lack of access to internet, smartphones, and Internet bandwidth for rural, seniors, and underserved populations. The second most common factor discussed in the articles was the lack of funding for virtual care (n= 14; 37%), such as inadequate reimbursement policies for virtual care. Other factors included negative patient and clinician perceptions of virtual care (n=11; 29%), lack of appropriate regulatory policies (n= 10, 26%), inappropriate clinical workflows (n= 9, 24%), lack of virtual care infrastructure (n= 8; 21%), and lastly, a need for appropriate virtual care training and education for clinicians (n=5;13%). CONCLUSIONS This review identified several barriers and strategies to mitigate those barriers that address the challenges of virtual primary care implementation related to equity, regulatory policies, technology and infrastructure, education, clinician and patient experience, clinical workflows, and funding for virtual care. These strategies included providing equitable alternatives to access care for patients with limited technical literacy and English proficiency and altering clinical workflows to integrate virtual care services. As many countries enter potential subsequent waves of the COVID-19 pandemic, applying early lessons learned to mitigate implementation barriers can help with the transition to equitable and appropriate virtual primary care services.

A Blueprint for the Conduct of Large, Multi-Site Trials in Telemedicine (Preprint)

2021 ◽  
Author(s):  
Patricia Commiskey ◽  
April W Armstrong ◽  
Tumaini Rucker Coker ◽  
Earl Ray Dorsey ◽  
John Fortney ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Care Delivery ◽  
Mental Healthcare ◽  
Stroke Care ◽  
Lessons Learned ◽  
Patient Centered ◽  
Implementation Challenges ◽  
Home Based ◽  
Family Based ◽  
Key Aspects

BACKGROUND Recent literature supports the efficacy and efficiency of telemedicine in improving various health outcomes, despite the wide variability in results. OBJECTIVE Understanding site-specific issues in the implementation of telemedicine trials for broader replication and generalizability of results is needed. Lessons can be learned from existing trials, and a blueprint can guide researchers to conduct these challenging studies using telemedicine more efficiently and effectively. METHODS This viewpoint presents relevant challenges and solutions for conducting multi-site telemedicine trials using seven ongoing and completed studies funded by the Patient Centered Outcomes Research Institute (PCORI) portfolio of large multi-site trials to highlight the challenges in implementing telemedicine trials. RESULTS Implementation challenges related to clinical, informatics, regulatory, legal, quality and billing were identified and described. CONCLUSIONS Lessons learned from these studies were used to create a blueprint of key aspects to consider for the design and implementation of multi-site telemedicine trials. CLINICALTRIAL NCT02358135: Improving Specialty-Care Delivery in Chronic Skin Diseases (PI: AWArmstrong) NCT02396576: Using Telehealth to Deliver Developmental, Behavioral, and Mental Health Services in Primary Care Settings for Children in Underserved Areas (PI: TRCoker) NCT02038959: Connect.Parkinson (PI: RDorsey) NCT04000971: C3FIT (Coordinated, Collaborative, Comprehensive, Family-based, Integrated, Technology-enabled Care) Stroke Care Trial (PI: KGaines) NCT03694431: Noninferiority Comparative Effectiveness Trial of Home-Based Palliative Care (HomePal) Trial (PI: HNguyen, KMularski) NCT04153864: SUMMIT (Scaling Up Maternal Mental healthcare by Increasing access to Treatments) Trial (PI: DRSingla) NCT03985800: Specialty Medical Homes to Improve Outcomes for Patients with Inflammatory Bowel Disease (IBD) and Behavioral Health Conditions Trial (PI: ESzigethy)

Implementation of a Service Management Office Into a World Food Company in Latin America

2021 ◽  
Vol 14 (1) ◽  
pp. 116-135
Author(s):  
Teresa Lucio-Nieto ◽  
Dora Luz Gonzalez-Bañales
Keyword(s):  
Portfolio Management ◽  
Service Management ◽  
Case Study Research ◽  
Lessons Learned ◽  
It Services ◽  
Service Model ◽  
Implementation Challenges ◽  
Technology Service ◽  
Information Technology Service

Research on service management office (SMO) related with its implementation, challenges, relevance, and outcomes is scarce. The purpose of this case study research is to contribute with the lessons learned from the implementation of an SMO into a big sized company. The lessons include the experience of the company designing and implementing an SMO. A general roadmap and main challenges for the creation of an SMO are presented through the lessons learned of three perspectives: people, processes, and technology. The results in the SMO implementation reveal that it could become a strategic complement for IT services in order to ensure quality, efficiency, and continuous improvement for information technology service management (ITSM). The main changes derived from the SMO implementation were migrate from a function model to a service model, go from management of cost by function to management by service, from an order taker to a focus on business transformation initiatives, from a portfolio management based on applications to a process based on flexible governance.

Apple’s iBooks Author

2014 ◽  
pp. 119-139 ◽  
Author(s):  
Jackie HeeYoung Kim
Keyword(s):  
South Korea ◽  
Lessons Learned ◽  
Controversial Issues ◽  
Implementation Challenges

This chapter discusses Apple’s iBooks Author, a brand-new Mac application intended for textbook writers and publishers to create e-textbooks. This chapter provides insight on why IBA holds a prominent place in the field of education and will change our classroom landscape, that is, how we teach and learn. The main purpose of this chapter is to explore IBA’s potential, possible controversial issues, pedagogical meanings, and implementation challenges of using it as a classroom textbook. The chapter includes lessons learned from the leading countries in implementing e-textbooks in the classroom, such as South Korea and Malaysia.

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