Development of a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Research (Preprint)

2021 ◽  
Author(s):  
Rochelle K Rosen ◽  
Stephanie C Garbern ◽  
Monique Gainey ◽  
Ryan Lantini ◽  
Sabiha Nasrin ◽  
...  
Keyword(s):  
Decision Support ◽  
Focus Group ◽  
Acute Diarrhea ◽  
Clinical Utility ◽  
Qualitative Data ◽  
Care Delivery ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Final Analysis ◽  
Support Tool

BACKGROUND The availability of mobile clinical decision-support (CDS) tools has grown substantially with the increased prevalence of smartphone devices and applications (apps). Though healthcare providers express interest in integrating mobile health (mHealth) technologies into their clinical settings, concerns raised include perceived disagreements between information provided by mobile CDS tools and standard guidelines. Despite their potential to transform health care delivery, there remains limited literature on the provider’s perspective of the clinical utility of mobile CDS tools for improving patient outcomes, especially in low- and middle- income countries. OBJECTIVE The aim of this study is to describe providers’ perceptions about the utility of a mobile CDS tool accessed via a smartphone app for diarrhea management in Bangladesh. In addition, feedback was collected on preliminary components of the mobile CDS tool to address clinicians’ concerns and incorporate their preferences. METHODS From November to December 2020, qualitative data were gathered through eight virtual focus group discussions with physicians and nurses from three Bangladeshi hospitals. Each discussion was conducted in the local language, Bangla, and audio recorded for transcription and translation by the local research team. Transcripts and codes were entered into NVivo12 and applied thematic analysis was used to identify themes that explore the clinical utility of a mHealth app to assess dehydration severity in patients with acute diarrhea. Summaries of concepts and themes were generated from reviews of the aggregated coded data, and thematic memos were written and used for the final analysis. RESULTS Of the 27 focus group participants, 14 were nurses and 13 doctors; 15 worked at a diarrhea specialty hospital and 12 worked in government district or subdistrict hospitals. The participants’ experience in their current position ranged from 2 to 14 years, with an average of 10.3 years. Key themes from the qualitative data analysis, including: current experience with CDS, overall perception of the app utility and its potential role in clinical care, barriers and facilitators to app use, considerations of overtreatment and undertreatment, and guidelines for the app’s clinical recommendations. CONCLUSIONS Participants were positive about the mHealth app and its potential to inform diarrhea management. They provided detailed feedback, which developers used to further the design and programming. Participants felt that the tool would initially take time to use, but once learned could be useful during epidemic cholera. Some felt that clinical experience remains an important part of treatment that can be supplemented, but not replaced, by a CDS tool. Additionally, diagnostic information, including mid-upper arm circumference and blood pressure, might not be available to directly inform programming decisions. These formative qualitative data provided timely and relevant feedback to improve the utility of a CDS tool for diarrhea treatment in Bangladesh.

scholarly journals Rural healthcare providers coping with clinical care delivery challenges: lessons from three health centres in Ghana

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Vitalis Bawontuo ◽  
Augustine Adomah-Afari ◽  
Williams W. Amoah ◽  
Desmond Kuupiel ◽  
Irene Akua Agyepong
Keyword(s):  
Service Delivery ◽  
Coping Strategies ◽  
Knowledge Sharing ◽  
Care Delivery ◽  
Clinical Care ◽  
Health Centre ◽  
Healthcare Providers ◽  
Rural Healthcare ◽  
Quality Healthcare ◽  
Health Centres

Abstract Background Rural settings in low- and middle-income countries are bedeviled with poverty and high disease burden, and lack adequate resources to deliver quality healthcare to the population. Drug shortage and inadequate number and skill-mix of healthcare providers is very common in rural health facilities. Hence, rural healthcare providers have no choice but to be innovative and introduce some strategies to cope with health delivery challenges at the health centre levels. This study explored how and why rural healthcare providers cope with clinical care delivery challenges at the health centre levels in Ghana. Methods This study was a multiple case studies involving three districts: Bongo, Kintampo North, and Juaboso districts. In each case study district, a cross-sectional design was used to explore the research question. Purposive sampling technique was used to select study sites and the study participants. The authors conducted 11 interviews, 9 focus group discussions (involving 61 participants), and 9-week participant observation (in 3 health centres). Transcription of the voice-recordings was done verbatim, cleaned and imported into the Nvivo version 11 platform for analysis. Data was analysed using the inductive content analysis approach. Ethical clearance was granted by the Ethics Review Committee of the Ghana Health Service. Results The study found three main coping strategies (borrowing, knowledge sharing and multi-tasking). First, borrowing arrangements among primary health care institutions help to address the periodic shortage of medical supplies at the health centres. Secondly, knowledge sharing among healthcare providers mitigates skills gap during service delivery; and finally, rural healthcare providers use multi-tasking to avert staff inadequacy challenges during service delivery at the health centre levels. Conclusion Borrowing, knowledge sharing, and multi-tasking are coping strategies that are sustaining and potentially improving health outcomes at the district levels in Ghana. We recommend that health facilities across all levels of care in Ghana and other settings with similar challenges could adopt and modify these strategies in order to ensure quality healthcare delivery amidst delivery challenges.

scholarly journals Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Protocol for Qualitative Study (Preprint)

2021 ◽  
Author(s):  
Paula Koppel ◽  
Jennie C De Gagne
Keyword(s):  
Qualitative Methodology ◽  
Research Team ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Final Analysis ◽  
Analysis Data ◽  
Personal Connection ◽  
Patients With Cancer ◽  
Patient Relationships ◽  
The Impact

BACKGROUND Telehealth videoconferencing has largely been embraced by healthcare providers and patients during the COVID-19 pandemic; however, little is known about specific techniques for building rapport and provider-patient relationships in this care environment. Although research suggests videoconferencing is feasible and can be effective for some types of care, concerns about the impact of technology on provider-patient relationships are evident across health disciplines. Suggestions for adapting some in-person rapport techniques, such as the use of small talk, eye contact, body language, and touch to facilitate trust, personal connection, and communication during videoconferencing encounters, have been discussed in the popular press and clinical commentaries. Notably, the evidence is lacking regarding the effects of these strategies on rapport and clinical care outcomes. Understanding how to establish rapport in videoconferencing visits is especially important in oncology nursing, where rapport with patients enables nurses to become a source of emotional support, helping patients adapt and navigate the cancer journey. OBJECTIVE This study will investigate the nature of nurse-patient rapport in ambulatory cancer care videoconferencing visits. Objectives include exploring (1) how patients with cancer and nurses describe experiences of rapport and strategies for cultivating rapport in videoconferencing visits and (2) similarities and differences identified by patients with cancer and nurses between rapport in videoconferencing and in-person visits. METHODS Semi-structured narrative interviews of patients with cancer and nurses will be conducted to understand the experience of rapport-building in videoconferencing visits. Nurses and patients will be interviewed separately to facilitate understanding the perspectives of both types of participants. Interviews will be conducted on a secure videoconferencing platform. This qualitative descriptive study will describe participant experiences in a manner that, while not without interpretation, is as close to the data as possible. The research team will meet regularly to discuss, define, and document codes, categories, and themes, keeping a detailed audit trail of analytical decisions. In addition, member checking will enhance the study’s rigor. Nurse and patient interviews will be analyzed separately using identical procedures and may be explored side-by-side in the final analysis to provide comparative analysis. Data management and analysis will be performed using NVivo 12. RESULTS Data collection will begin during April 2021 with results from data analysis anticipated by July 2021. A research team trained in qualitative methodology will use conventional content analysis to analyze the data using first- and second-level codes derived directly from the transcribed text data. CONCLUSIONS This study aims to determine what behaviors, communication techniques, and relational practices need to be adapted, setting the foundation for future development of interventions and evidence-based practice guidelines for relationship building during videoconferencing telehealth visits.

scholarly journals Designing a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Research (Preprint)

10.2196/33325 ◽  
2021 ◽  
Author(s):  
Rochelle K Rosen ◽  
Stephanie C Garbern ◽  
Monique Gainey ◽  
Ryan Lantini ◽  
Sabiha Nasrin ◽  
...  
Keyword(s):  
Qualitative Research ◽  
Decision Support ◽  
Acute Diarrhea ◽  
Decision Support Tool ◽  
Support Tool

A decision support tool for healthcare providers to evaluate readiness and impacts of adopting supply chain data standards

2013 ◽  
Vol 3 (2) ◽  
pp. 110-126 ◽  
Author(s):  
Raja Jayaraman ◽  
Ronald L. Rardin ◽  
Nebil Buyurgan ◽  
Vijith Varghese ◽  
Angelica Burbano Collazos
Keyword(s):  
Supply Chain ◽  
Decision Support ◽  
Healthcare Providers ◽  
Decision Support Tool ◽  
Data Standards ◽  
Support Tool

Developing a decision support tool for responding to patients’ reported levels of information needs, family anxiety, depression, and breathlessness.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 173-173
Author(s):  
Liesbeth van Vliet ◽  
Richard Harding ◽  
Claudia Bausewein ◽  
Sheila Payne ◽  
Irene J. Higginson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Decision Support ◽  
Delphi Study ◽  
Information Needs ◽  
Clinical Care ◽  
Decision Support Tool ◽  
Psychosocial Interventions ◽  
Social Needs ◽  
Support Tool ◽  
Patient Reported

173 Background: Routine clinical use of Patient Reported Outcome Measures (PROMs) such as the Palliative Care Outcome Scale (POS) may be prevented by a lack of guidance on how to respond to reported symptoms. When using POS in clinical care, clinicians encounter the most difficulties with responding to information needs, depression and family anxiety while breathlessness remains a difficult to treat symptom. We aimed to create a Decision Support Tool (DST) on how to respond to different levels of these patient-reported symptoms. Methods: A systematic search for guidelines and systematic reviews on these topics was conducted (in Pubmed, Cochrane and York DARE databases, Googlescholar, NICE, National Guideline Clearinghouse, Canadian Medical Association, Google.com). In a two-round online Delphi study purposefully sampled international experts (clinicians, researchers, patient representatives) judged the appropriateness (1-9 scale + do not know option) of drafted recommendations for each POS answer category (0-4) and provided qualitative remarks. Recommendations with a median of 7-9 and <30% of scores between 1-3 and 7-9 were included in the DST. Quality was assessed using an adapted GRADE approach. Results: Twenty-five out of 38 (66%) experts participated in round 1, 23 out of 37 (62%) in round 2. Higher POS scores were related to more included recommendations. The DST consists of both a manual and flow-charts of included recommendations for each topic. Overall, psychosocial interventions were recommended for lower levels of depression and breathlessness than drug interventions (e.g., goal-setting/coping versus morphine for breathlessness). Good communication and emotional support were recommended for low family anxiety levels, but a social needs assessment only for higher levels. For information needs recommendations were least discriminative; almost all recommendations (e.g., assess patients’ understanding of information, show empathy) seemed always relevant. Conclusions: The developed DST can assist clinical responses to patient-reported symptoms in palliative care. Future work is needed to test the effect of using the DST on patients’ outcomes.

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