Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Qualitative Study (Preprint)

2022 ◽  
Author(s):  
Wenwen Chen ◽  
Ashley Flanagan ◽  
Pria MD Nippak ◽  
Michael Nicin ◽  
Samir K Sinha

BACKGROUND Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be employed to meet the needs of geriatric care professionals in providing care to frail older patients and their caregivers, and families. OBJECTIVE This study aimed to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and families, and how to maximize the benefits of this method of providing care. METHODS We conducted a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine and participate in a semi-structured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). RESULTS We obtained quantitative and qualitative data from 30 practicing geriatric care professionals (22 geriatricians, 5 geriatric psychiatrists, and 3 geriatric specialist nurses) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (Complexity, Design quality and packaging, Patient needs and resources, Readiness for implementation, and Culture) and 13 CFIR contextual facilitators (Relative Advantage, Adaptability, Tension for Change, Available Resources, Access to Knowledge, Network and Communications, Compatibility, Knowledge and Beliefs, Self-Efficacy, Champions, External Agents, Executing, and Reflecting and Evaluating). The CFIR concept of External Policy and Incentives was found to be a neutral construct. CONCLUSIONS This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person, but is less useful in providing specific aspects of geriatric care to frail older patients and their caregivers, and families.

2021 ◽  
Vol 2 ◽  
pp. 263348952199419
Author(s):  
Cara C Lewis ◽  
Kayne Mettert ◽  
Aaron R Lyon

Background: Despite their inclusion in Rogers’ seminal diffusion of innovations theory, few implementation studies empirically evaluate the role of intervention characteristics. Now, with growing evidence on the role of adaptation in implementation, high-quality measures of characteristics such as adaptability, trialability, and complexity are needed. Only two systematic reviews of implementation measures captured those related to the intervention or innovation and their assessment of psychometric properties was limited. This manuscript reports on the results of eight systematic reviews of measures of intervention characteristics with nuanced data regarding a broad range of psychometric properties. Methods: The systematic review proceeded in three phases. Phase I, data collection, involved search string generation, title and abstract screening, full text review, construct assignment, and citation searches. Phase II, data extraction, involved coding psychometric information. Phase III, data analysis, involved two trained specialists independently rating each measure using PAPERS (Psychometric And Pragmatic Evidence Rating Scales). Results: Searches identified 16 measures or scales: zero for intervention source, one for evidence strength and quality, nine for relative advantage, five for adaptability, six for trialability, nine for complexity, and two for design quality and packaging. Information about internal consistency and norms was available for most measures, whereas information about other psychometric properties was most often not available. Ratings for psychometric properties fell in the range of “poor” to “good.” Conclusion: The results of this review confirm that few implementation scholars are examining the role of intervention characteristics in behavioral health studies. Significant work is needed to both develop new measures (e.g., for intervention source) and build psychometric evidence for existing measures in this forgotten domain. Plain Language Summary Intervention characteristics have long been perceived as critical factors that directly influence the rate of adopting an innovation. It remains unclear the extent to which intervention characteristics including relative advantage, complexity, trialability, intervention source, design quality and packaging, evidence strength and quality, adaptability, and cost impact implementation of evidence-based practices in behavioral health settings. To unpack the differential influence of these factors, high quality measures are needed. Systematic reviews can identify measures and synthesize the data regarding their quality to identify gaps in the field and inform measure development and testing efforts. Two previous reviews identified measures of intervention characteristics, but they did not provide information about the extent of the existing evidence nor did they evaluate the host of evidence available for identified measures. This manuscript summarizes the results of nine systematic reviews (i.e., one for each of the factors listed above) for which 16 unique measures or scales were identified. The nuanced findings will help direct measure development work in this forgotten domain.


Author(s):  
Courtney Celian ◽  
Veronica Swanson ◽  
Maahi Shah ◽  
Caitlin Newman ◽  
Bridget Fowler-King ◽  
...  

Abstract Background Neurorehabilitation engineering faces numerous challenges to translating new technologies, but it is unclear which of these challenges are most limiting. Our aim is to improve understanding of rehabilitation therapists’ real-time decision-making processes on the use of rehabilitation technology (RT) in clinical treatment. Methods We used a phenomenological qualitative approach, in which three OTs and two PTs employed at a major, technology-encouraging rehabilitation hospital wrote vignettes from a written prompt describing their RT use decisions during treatment sessions with nine patients (4 with stroke, 2 traumatic brain injury, 1 spinal cord injury, 1 with multiple sclerosis). We then coded the vignettes using deductive qualitative analysis from 17 constructs derived from the RT literature and the Consolidated Framework for Implementation Research (CFIR). Data were synthesized using summative content analysis. Results Of the constructs recorded, the five most prominent are from CFIR determinants of: (i) relative advantage, (ii) personal attributes of the patients, (iii) clinician knowledge and beliefs of the device/intervention, (iv) complexity of the devices including time and setup, and (v) organizational readiness to implement. Therapists characterized candidate RT as having a relative disadvantage compared to conventional treatment due to lack of relevance to functional training. RT design also often failed to consider the multi-faceted personal attributes of the patients, including diagnoses, goals, and physical and cognitive limitations. Clinicians’ comfort with RT was increased by their previous training but was decreased by the perceived complexity of RT. Finally, therapists have limited time to gather, setup, and use RT. Conclusions Despite decades of design work aimed at creating clinically useful RT, many lack compatibility with clinical translation needs in inpatient neurologic rehabilitation. New RT continue to impede the immediacy, versatility, and functionality of hands-on therapy mediated treatment with simple everyday objects.


Author(s):  
Sabrina R Raizada ◽  
Natasha Cleaton ◽  
James Bateman ◽  
Diarmuid M Mulherin ◽  
Nick Barkham

Abstract Objectives During the COVID-19 pandemic, face-to-face rheumatology follow-up appointments were mostly replaced with telephone or virtual consultations in order to protect vulnerable patients. We aimed to investigate the perspectives of rheumatology patients on the use of telephone consultations compared with the traditional face-to-face consultation. Methods We carried out a retrospective survey of all rheumatology follow-up patients at the Royal Wolverhampton Trust who had received a telephone consultation from a rheumatology consultant during a 4-week period via an online survey tool. Results Surveys were distributed to 1213 patients, of whom 336 (27.7%) responded, and 306 (91.1%) patients completed all components of the survey. Overall, an equal number of patients would prefer telephone clinics or face-to-face consultations for their next routine appointment. When divided by age group, the majority who preferred the telephone clinics were <50 years old [χ2 (d.f. = 3) = 10.075, P = 0.018]. Prevalence of a smartphone was higher among younger patients (<50 years old: 46 of 47, 97.9%) than among older patients (≥50 years old: 209 of 259, 80.7%) [χ2 (d.f. = 3) = 20.919, P < 0.001]. More patients reported that they would prefer a telephone call for urgent advice (168, 54.9%). Conclusion Most patients interviewed were happy with their routine face-to-face appointment being switched to a telephone consultation. Of those interviewed, patients >50 years old were less likely than their younger counterparts to want telephone consultations in place of face-to-face appointments. Most patients in our study would prefer a telephone consultation for urgent advice. We must ensure that older patients and those in vulnerable groups who value in-person contact are not excluded. Telephone clinics in some form are here to stay in rheumatology for the foreseeable future.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Staci L Benoit ◽  
Rachel F. Mauldin

Abstract Background Social media use has become a mainstay of communication and with that comes the exchange of factual and non-factual information. Social media has given many people the opportunity to speak their opinions without repercussions and create coalitionS of like-minded people. This also has led to the development of a community know as anti-vaxxers or vaccine deniers. This research explores the extent to which vaccine knowledge has reached on social media. Methods This cross sectional research explored the relationship between the spread of information regarding vaccines in relation to social media use. A sample of 2515 people over the age of 18 around the world completed the survey via a link distributed on Twitter, Facebook and Instagram. A series of questions on vaccine knowledge and beliefs were compounded to create an individual’s “knowledge score” and a “belief score”. Knowledge scores were ranked from low knowledge to high knowledge with increasing scores. Belief scores were ranked from belief in myths to disbelief in myths with higher scores. This score was then analysed, using a Welch test and post hoc testing when applicable, across demographics and questions relating to social media use. Results Significant relations were found in both the knowledge and belief categories, many of which were similar findings between the two. North Americans had significantly lower knowledge and belief scores compared to all other continents. While the majority of people primarily use Facebook, Twitter users were significantly more knowledgeable. It was also found that higher education was correlated with higher knowledge and belief scores. Conclusions Overall, these correlations are important in determining ways to intervene into the anti-vax movement through the use of social media. Cross demographics were not analysed in this study but could be in future studies. To better understand the social media exposures related to vaccine information a follow up structured interview research study would be beneficial. Note that due to the cross sectional nature of this study, causal relationships could not be made.


BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e046914
Author(s):  
Patrice Ngangue ◽  
Judith Belle Brown ◽  
Catherine Forgues ◽  
Mohamed Ali Ag Ahmed ◽  
Tu Ngoc Nguyen ◽  
...  

ObjectiveA patient-centred care interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of Quebec, Canada. This embedded study aimed to evaluate the process of implementation.DesignA descriptive qualitative study was conducted in 2016–2017 using semistructured individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data coding, analysis and reporting of the findings.SettingThe study took place in seven Family Medicine Groups in one region (Saguenay-Lac-Saint-Jean) of Quebec, Canada.ParticipantsTen managers (including two family physicians) and 19 healthcare professionals (HCPs), nurses, kinesiologists, nutritionists and a respiratory therapist, were interviewed.ResultsMany key elements within the five CFIR domains were identified as impacting the implementation of the intervention : (1) intervention characteristics—evidence strength and quality, design quality and packaging, relative advantage and complexity; (2) outer setting—patients’ needs and resources, external policies and incentives; (3) inner setting—structural characteristics, networks and communication, culture, compatibility, readiness for implementation and leadership engagement; (4) characteristics of the managers and HCPs—knowledge and belief about the intervention; (5) process—planning, opinion leaders, formally appointed internal implementation leaders, reflecting and evaluating.ConclusionThis study revealed the organisational and contextual aspects of the implementation based on different and complementary perspectives. With the growing demand for interdisciplinary teams in primary care, we believe that our insights will be helpful for practices, researchers, and policymakers interested in the implementation of disease prevention and management programmes for people with multiple chronic conditions in primary care.Trial registration numberNCT02789800.


2017 ◽  
Vol 22 (4) ◽  
pp. 315-323
Author(s):  
Thomas Flamini ◽  
Natasha R. Matthews ◽  
George S. Castle ◽  
Elliot M. Jones-Williams

Purpose The purpose of this paper is to investigate perceptions towards a career in psychiatry among medical students and psychiatrists and identify how recruitment into the specialty may be improved. Design/methodology/approach This study locally compares medical student and psychiatric doctor responses to a structured online survey and structured interviews with key managerial figures in the Humber NHS Foundation Trust. Findings Comparison across two main areas (pre-decision exposure to psychiatry and reasons for considering a psychiatric career) found that both students and doctors were influenced to make a choice about a career in psychiatry during medical school. Medical students found compatibility with family life to be more important when considering psychiatry, whereas doctors cited content-based reasons as significant pull factors. Stigma and fear of being harmed deterred some students from choosing a career in psychiatry. Structured interview responses reiterated the importance of pre-medical school and undergraduate mentorship in bolstering future recruitment to psychiatry. Practical implications Medical students perceive certain career issues differently to their postgraduate counterparts. Widening the content-based appeal of psychiatry and optimising the medical school experience of the specialty via varied and high-quality placements may be a key step towards tackling the national shortfall in qualified psychiatrists. Originality/value This is the first published study comparing medical student and psychiatric doctor perceptions of a career in psychiatry.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gijs Hesselink ◽  
Özcan Sir ◽  
Yvonne Schoon

Abstract Background The growing demand for elderly care often exceeds the ability of emergency department (ED) services to provide quality of care within reasonable time. The purpose of this systematic review is to assess the effectiveness of interventions on reducing ED crowding by older patients, and to identify core characteristics shared by successful interventions. Methods Six major biomedical databases were searched for (quasi)experimental studies published between January 1990 and March 2017 and assessing the effect of interventions for older patients on ED crowding related outcomes. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data into a standardized form. Data were synthesized around the study setting, design, quality, intervention content, type of outcome and observed effects. Results Of the 16 included studies, eight (50%) were randomized controlled trials (RCTs), two (13%) were non-RCTs and six (34%) were controlled before-after (CBA) studies. Thirteen studies (81%) evaluated effects on ED revisits and four studies (25%) evaluated effects on ED throughput time. Thirteen studies (81%) described multicomponent interventions. The rapid assessment and streaming of care for older adults based on time-efficiency goals by dedicated staff in a specific ED unit lead to a statistically significant decrease of ED length of stay (LOS). An ED-based consultant geriatrician showed significant time reduction between patient admission and geriatric review compared to an in-reaching geriatrician. Conclusion Inter-study heterogeneity and poor methodological quality hinder drawing firm conclusions on the intervention’s effectiveness in reducing ED crowding by older adults. More evidence-based research is needed using uniform and valid effect measures. Trial registration The protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017075575).


Author(s):  
Gordon Chih Ming Ku ◽  
Chi-Ming Hsieh

The purpose of this study is to assess whether fitness education programs could meet the needs or competencies of fitness professionals such as personal trainers and group fitness instructors. A mixed method was adopted to address the objectives of the study. In the first step, a semi-structured interview was conducted with five fitness experts to identify the five dimensions of professional competencies. In the second step, an online survey and paper questionnaires were utilized to collect data from 324 eligible subjects. Traditional importance-performance analysis, revised importance-performance analysis, and the three-factor theory were used to analyze the collected data. The results indicate that “professional skill,” “career development,” and “public relations” are the three most critical professional competencies. “Nutrition” and “coping with stress” should be strengthened and improved in fitness education programs. “Administrative management” is the least important professional competency. Multi-competencies development and lifelong learning are the factors for a successful fitness trainer.


2011 ◽  
Vol 3 (1) ◽  
pp. 29 ◽  
Author(s):  
Marion Upsdell ◽  
Chrystal Jaye

INTRODUCTION: A number of surveys in New Zealand have documented the growing interest and experience that GPs have in their encounters with complementary and alternative medicine. This study has focussed on reasons why some GPs choose to engage with CAM, how these reflect their aims of health care, the difficulties they encounter and how these are negotiated within the consultation. METHOD: A sample of 12 mainstream GPs from the greater Auckland area agreed to a semi-structured interview, and the transcripts were analysed using grounded theory technique. FINDINGS: All general practitioners interviewed in this study were confronted to a greater or lesser extent with their patients’ interest in CAM. Not all chose to engage with the subject. Those who did engage cited a number of reasons for doing so which included a desire to remain patient-centred, to place their patients’ choices within the context of a good diagnosis, to provide what evidence-based information they could and to minimise potential harms from its use. CONCLUSION: This study adds weight to findings in previous studies that many general practitioners encounter CAM in their consultations and explores reasons why they choose to engage with it. The findings suggest that increased dialogue with non-mainstream health practitioners and access to knowledge sources giving a basic understanding of CAM practices and philosophies that both CAM and mainstream practitioner communities regard as reliable would be of benefit to these GPs. KEYWORDS: Complementary and alternative medicine; family practice; patient-centered medicine


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