Investigating the Use of Telemedicine for Digitally Mediated Delegation in Team-based Primary Care: A Mixed-method Study (Preprint)

BACKGROUND Due to shortages of medical professionals, as well as demographic and structural challenges, new care models have emerged for finding innovative solutions to counter medical undersupply. Team-based primary care utilizing medical delegation appears to be a promising approach to address these challenges, but demands efficient communication structures and mechanisms to reinsure patients and caregivers receiving a delegated, treatment-related task. Here, digital healthcare technologies hold the potential to render these novel processes effective and demand-driven. OBJECTIVE The goal of this study is to recreate the daily work routines of general practitioners (GPs) and medical assistants (MAs) in order to explore promising approaches for the digital moderation of delegation processes and to deepen the understanding of subjective and perceptual factors that influence their technology assessment and use. METHODS In total, 19 interviews with 12 GPs and 14 MAs were conducted, seeking to identify relevant technologies for delegation purposes as well as the stakeholders’ perceptions of their effectiveness. Further, an online survey was conducted asking the interviewees to order identified technologies by their assessed applicability in multi-actor patient care. Interview data was analyzed using a three-fold inductive coding procedure. Multidimensional scaling was applied to analyze and visualize survey data, leading to a triangulation of results. RESULTS Our results suggest that digital mediation of delegation underlies complex, reciprocal processes and biases that need to be identified and analyzed in order to improve the development and distribution of innovative technologies, as well as to improve our understanding of technology use in team-based primary care. Nevertheless, medical delegation enhanced by digital technologies, such as video consultation, portable electrocardiograms (ECGs), or telemedical stethoscopes, is able to counteract current challenges in primary care due to its unique ability to ensure both personal, patient-centered care for patients and create efficient and needs-based treatment processes. CONCLUSIONS Technology-mediated delegation appears to be a promising approach to implement innovative, case-sensitive, and cost-effective ways to treat patients within the paradigm of primary care. The relevance for such innovative approaches increases at times of tremendous need for differentiated and effective care, like during the ongoing COVID-19 pandemic. For successful and sustainable adoption of innovative technologies, MAs represent essential team members. In their role of mediators between GPs and patients, MAs are potentially able to counteract resistance towards using innovative technology on both sides and compensate for patients’ limited access to technology and care facilities.

Download Full-text

Telemedicine: The art of innovative technology in family medicine

The International Journal of Psychiatry in Medicine ◽

10.1177/0091217420951038 ◽

2020 ◽

Vol 55 (5) ◽

pp. 341-348

Author(s):

Julia Jenkins ◽

Oliver Oyama

Keyword(s):

Family Medicine ◽

Healthcare Delivery ◽

High Standard ◽

Cost Effective ◽

Lessons Learned ◽

Innovative Technology ◽

Patient Centered ◽

Centered Care ◽

History Of ◽

Healthcare Innovation

Technology in medicine has been rapidly evolving over the past decade, greatly improving the quality and types of services providers can offer to patients. Physicians in training are eager to embrace these novel innovations, and medical school and residency educators strive to offer learning experiences of a high standard that are relevant. One example of an emerging healthcare innovation is telemedicine, which permits the provision of medical care to patients away from clinics and hospitals, bringing patient-centered care to the patient. It has proven to be cost-effective, improve health outcomes, and enhance patient satisfaction. This article describes the development and structure of our family medicine residency program’s telemedicine curriculum, first created in 2016 in response to the growing demand for this type of healthcare delivery model. There is discussion about the history of telemedicine, and about what contributed to its growth. A timeline of the steps taken to create our new telemedicine residency curriculum is reviewed, along with the key components that contributed to its success. The Lessons Learned section provides other educators insight into the strengths and opportunities revealed during the creation of the curriculum, and guidance on how the curriculum could be further enhanced.

Download Full-text

Harnessing COVID-Driven Technical Innovations for Improved Multi-Disciplinary Cancer Care in the Post-COVID Era: The Virtual Patient Room

Cancer Control ◽

10.1177/1073274820964800 ◽

2020 ◽

Vol 27 (1) ◽

pp. 107327482096480 ◽

Cited By ~ 1

Author(s):

Austin J. Sim ◽

Gage Redler ◽

Jeffrey Peacock ◽

Cristina Naso ◽

Stuart Wasserman ◽

...

Keyword(s):

New Technology ◽

Multidisciplinary Care ◽

Virtual Patient ◽

Paradigm Shifts ◽

Patient Room ◽

Patient Centered ◽

Team Members ◽

The Road ◽

Centered Care ◽

Virtual Visits

Emergence of the COVID-19 crisis has catalyzed rapid paradigm shifts throughout medicine. Even after the initial wave of the virus subsides, a wholesale return to the prior status quo is not prudent. As a specialty that values the proper application of new technology, radiation oncology should strive to be at the forefront of harnessing telehealth as an important tool to further optimize patient care. We remain cognizant that telehealth cannot and should not be a comprehensive replacement for in-person patient visits because it is not a one for one replacement, dependent on the intention of the visit and patient preference. However, we envision the opportunity for the virtual patient “room” where multidisciplinary care may take place from every specialty. How we adapt is not an inevitability, but instead, an opportunity to shape the ideal image of our new normal through the choices that we make. We have made great strides toward genuine multidisciplinary patient-centered care, but the continued use of telehealth and virtual visits can bring us closer to optimally arranging the spokes of the provider team members around the central hub of the patient as we progress down the road through treatment.

Download Full-text

Point-of-Care Virtual Radiology Consultations in Primary Care: A Feasibility Study of a New Model for Patient-Centered Care in Radiology

Journal of the American College of Radiology ◽

10.1016/j.jacr.2021.07.007 ◽

2021 ◽

Author(s):

Dania Daye ◽

Evita Joseph ◽

Efren Flores ◽

Avinash Kambadakone ◽

Garrett Chinn ◽

...

Keyword(s):

Primary Care ◽

Feasibility Study ◽

Point Of Care ◽

Patient Centered Care ◽

Patient Centered ◽

New Model ◽

Centered Care

Download Full-text

Healthcare Providers’ Attitudes, Knowledge, and Practice Behaviors for Educating Patients About Advance Directives: A National Survey

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118813720 ◽

2018 ◽

Vol 36 (5) ◽

pp. 387-395 ◽

Cited By ~ 5

Author(s):

Frances R. Nedjat-Haiem ◽

Tamara J. Cadet ◽

Anup Amatya ◽

Shiraz I. Mishra

Keyword(s):

Online Survey ◽

Survey Design ◽

Healthcare Providers ◽

Medical Decision ◽

Cross Sectional Survey ◽

Patient Centered ◽

Cross Sectional ◽

Practice Behaviors ◽

Centered Care ◽

Seriously Ill Patients

Background: Advance care planning for end-of-life care emerged in the mid-1970’s to address the need for tools, such as the advance directive (AD) legal document, to guide medical decision-making among seriously ill patients, their families, and healthcare providers. Objective: Study aims examine providers’ perspectives on AD education that involve examining (1) a range of attitudes about educating patients, (2) whether prior knowledge was associated with practice behaviors in educating patients, and (3) specific factors among healthcare providers such as characteristics of work setting, knowledge, attitudes, and behaviors that may influence AD education and documentation. Design: To examine providers’ views, we conducted a cross-sectional, online survey questionnaire of healthcare providers using social media outreach methods for recruitment. Methods: This study used a cross-sectional survey design to examine the proposed aims. Healthcare providers, recruited through a broad approach using snowball methods, were invited to participate in an online survey. Logistic regression analyses were used to examine providers’ views toward AD education. Results: Of 520 participants, findings indicate that most healthcare providers said that they were knowledgeable about AD education. They also viewed providing education as beneficial to their practice. These findings suggest that having a positive attitude toward AD education and experiencing less organizational barriers indicate a higher likelihood that providers will educate patients regarding ADs. Conclusion: Various disciplines are represented in this study, which indicates that attitudes and knowledge influence AD discussions. The importance of AD discussions initiated by healthcare providers is critical to providing optimal patient-centered care.

Download Full-text

Sickle cell disease pain management and the medical home

Hematology ◽

10.1182/asheducation.v2013.1.433.3850724 ◽

2013 ◽

Vol 2013 (1) ◽

pp. 433-438 ◽

Cited By ~ 1

Author(s):

Jean L. Raphael ◽

Suzette O. Oyeku

Keyword(s):

Pain Management ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Medical Home ◽

Cost Effective ◽

Cell Disease ◽

Patient Centered ◽

Centered Care ◽

The Individual ◽

Effective Models

Pain is the most common cause for hospitalization and acute morbidity in sickle cell disease (SCD). The consequences of SCD-related pain are substantial, affecting both the individual and the health care system. The emergence of the patient-centered medical home (PCMH) provides new opportunities to align efforts to improve SCD management with innovative and potentially cost-effective models of patient-centered care. The Department of Health and Human Services has designated SCD as a priority area with emphasis on creating PCMHs for affected patients. The question for patients, clinicians, scientists, and policy-makers is how the PCMH can be designed to address pain, the hallmark feature of SCD. This article provides a framework of pain management within the PCMH model. We present an overview of pain and pain management in SCD, gaps in pain management, and current care models used by patients and discuss core PCMH concepts and multidisciplinary team–based PCMH care strategies for SCD pain management.

Download Full-text

The University Medical Centre: A student’s perspective

10.32920/ryerson.14635596 ◽

2021 ◽

Author(s):

Gabrielle Hubert ◽

Cameron Pow ◽

Sandra Tullio-Pow

Keyword(s):

Primary Care ◽

Healthcare Professionals ◽

Care Physician ◽

Medical Centre ◽

First Year ◽

Patient Centered ◽

First Year Students ◽

Centered Care ◽

The University ◽

University Setting

Over 515,000 students attended Ontario Universities in 2015/16, including 60,000 international students from abroad (https://ontario universityes.ca/resources/data/numbers). First-year students who are away from home find themselves needing a new primary care physician. While a few researchers have examined student health care within the university setting in regard to mental health (Evans, 1999), sexual health (Habel et al., 2018)., and health promotion (Griebler et al., 2017), there has been little research focused on the first-year student experience in finding primary care. Our study examined communication pathways, wayfinding and misconceptions students have related to the university medical centre. Patient centered care involves a partnership between a healthcare provider and their patient. In this partnership healthcare professionals must consider the patient experience and be more informative, mindful, empathic and collaborative to provide the best possible care (Epstein & Street, 2011).

Download Full-text

The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting

BMC Health Services Research ◽

10.1186/s12913-018-3818-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 18

Author(s):

Sanne Jannick Kuipers ◽

Jane Murray Cramm ◽

Anna Petra Nieboer

Keyword(s):

Primary Care ◽

Care Setting ◽

Primary Care Setting ◽

Well Being ◽

Patient Centered Care ◽

Satisfaction With Care ◽

Patient Centered ◽

Centered Care

Download Full-text

Soldier-Centered Care: A Concept Analysis

Military Medicine ◽

10.1093/milmed/usz448 ◽

2020 ◽

Vol 185 (3-4) ◽

pp. e422-e430

Author(s):

Tanekkia M Taylor-Clark ◽

Patricia A Patrician

Keyword(s):

Primary Care ◽

Physical Performance ◽

Patient Centered Care ◽

Concept Analysis ◽

Medical Department ◽

Patient Centered ◽

Medical Needs ◽

Leadership Support ◽

Centered Care ◽

The U.S

Abstract Introduction It is critical for the U.S. Army Medical Department to acknowledge the distinctive medical needs of soldiers and conceptualize soldier-centered care as a unique concept. In addition to the nationally recognized standards of patient-centered care, soldier-centered care includes provisions for the priorities of soldier health and wellness, injury prevention, illness and injury management, and the preservation of physical performance and medical readiness. The development of soldier-centered care as a distinctive concept may strengthen the evidence base for interventions that support improvements to soldier care and thus, enhance health outcomes specific to soldiers. The purpose of this article is to analyze the concept of soldier-centered care, clarify the meaning of soldier-centered care, and propose a theoretical definition. Methods Rodgers’ evolutionary concept analysis method was used to search and analyze the literature for related terms, attributes, antecedents, and consequences and to create a theoretical definition for soldier-centered care. Results The results of this concept analysis indicated that soldier-centered care is realized through the presence of nine attributes: operational alignment of care, provider and support staff therapeutic competence, management of transitions and care coordination, technology and accessibility, management of limited and lost work days, trust and expectation management, leadership support, continuity, and access to care. Soldier-centered care is focused on health and wellness promotion, disease and injury prevention, and early diagnosis and treatment of acute injuries in the primary care setting to facilitate timely injury recovery, reduce reinjury, and prevent long-term disabilities. The result of soldier-centered care is enhanced physical performance, medical readiness, and deployability for soldiers. Based on the literature analysis, the following theoretical definition of soldier-centered care is proposed: Soldier-centered care is individualized, comprehensive healthcare tailored to the soldier’s unique medical needs delivered by a care team of competent primary care providers and support staff who prioritize trust and expectation management, operational alignment of care, leadership support, care coordination, and the management of limited and lost workdays through the use of evidence-based practice approaches that employ innovative information technology to balance access to care and continuity. Conclusions The concept of soldier-centered care often emerges in discussions about optimal physical performance and medical readiness for soldiers. Although soldier-centered care and patient-centered care have similar conceptual underpinning, it is important to clarify the unique physical and medical requirements for soldiers that differentiate soldier-centered care from patient-centered care. Implementing the defining attributes of soldier-centered care in the U.S. Army primary care setting may improve the quality of care and health outcomes for soldiers. When defining performance metrics for primary care models of care, the U.S. Army Medical Department must consider assessing outcomes specific to the soldier population. Developing empirical indicators for the attributes of soldier-centered care will support meaningful testing of the concept.

Download Full-text