scholarly journals eHealth Technologies, Multimorbidity, and the Office Visit: Qualitative Interview Study on the Perspectives of Physicians and Nurses (Preprint)

2017 ◽  
Author(s):  
Graham G Macdonald ◽  
Anne F Townsend ◽  
Paul Adam ◽  
Linda C Li ◽  
Sheila Kerr ◽  
...  
Keyword(s):  
Information And Communication Technologies ◽  
Health Care Professionals ◽  
Chronic Conditions ◽  
Health Sector ◽  
Office Visit ◽  
Best Interests ◽  
Multiple Chronic Conditions ◽  
Management Support ◽  
Web Based ◽  
Qualitative Interview Study

BACKGROUND eHealth is a broad term referring to the application of information and communication technologies in the health sector, ranging from health records to telemedicine and multiple forms of health education and digital tools. By providing increased and anytime access to information, opportunities to exchange experiences with others, and self-management support, eHealth has been heralded as transformational. It has created a group of informed, engaged, and empowered patients as partners, equipped to take part in shared decision making and effectively self-manage chronic illness. Less attention has been given to health care professionals’ (HCPs) experiences of the role of eHealth in patient encounters. OBJECTIVE The objective of this study was to examine HCPs’ perspectives on how eHealth affects their relationships with patients living with multiple chronic conditions, as well as its ethical and practical ramifications. METHODS We interviewed HCPs about their experiences with eHealth and its impact on the office visit. Eligible participants needed to report a caseload of ≥25% of patients with multimorbidity to address issues of managing complex chronic conditions and coordination of care. We used a semistructured discussion guide for in-depth interviews, and follow-up interviews served to clarify and expand upon initial discussions. Constant comparisons and a narrative approach guided the analyses, and a relational ethics conceptual lens was applied to the data to identify emergent themes. RESULTS A total of 12 physicians and nurses (6 male, 6 female; median years of practice=13) participated. eHealth tools most frequently described were Web-based educational resources for patients and Web-based resources for HCPs such as curated scientific summaries on diagnostic criteria, clinical therapies, and dosage calculators. Analysis centered on a grand theme of the two-way conversation between HCPs and patients, which addresses a general recentering of the ethical relationship between HCPs and patients around engagement. Subthemes explain the evolution of the two-way conversation, and having, using, and supporting the two-way conversation with patients, primarily as this relates to achieving adherence and health outcomes. CONCLUSIONS Emerging ethical concerns were related to the ambiguity of the ideal of empowered patients and the ways in which health professionals described enacting those ideals in practice, showing how the cultural shift toward truly mutually respectful and collaborative practice is in transition. HCPs aim to act in the best interests of their patients; the challenge is to benefit from emergent technologies that may enhance patient-HCP interactions and effective care, while abiding by regulations, dealing with the strictures of the technology itself, and managing changing demands on their time.

A self‐management support program for older Australians with multiple chronic conditions: a randomised controlled trial

2018 ◽  
Vol 208 (2) ◽  
pp. 69-74 ◽  
Author(s):  
Richard L Reed ◽  
Leigh Roeger ◽  
Sara Howard ◽  
Jodie M Oliver‐Baxter ◽  
Malcolm W Battersby ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Chronic Conditions ◽  
Controlled Trial ◽  
Support Program ◽  
Self Management ◽  
Multiple Chronic Conditions ◽  
Management Support ◽  
Randomised Controlled

e-Learning competency for practice nurses: an evaluation report

2013 ◽  
Vol 19 (4) ◽  
pp. 287 ◽  
Author(s):  
Marie Heartfield ◽  
Andrea Morello ◽  
Melanie Harris ◽  
Sharon Lawn ◽  
Vincenza Pols ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Chronic Disease Management ◽  
Learning Experience ◽  
Self Management ◽  
Policy Outcomes ◽  
Management Support ◽  
Web Based ◽  
Practice Nurses ◽  
Web Based Learning ◽  
E Learning

Practice nurses in Australia are now funded to facilitate chronic condition management, including self-management support. Chronic disease management requires an established rapport, support and proactivity between general practitioners, patients and the practice nurses. To achieve this, training in shared decision making is needed. e-Learning supports delivery and achievement of such policy outcomes, service improvements and skill development. However, e-learning effectiveness for health care professionals’ is determined by several organisational, economic, pedagogical and individual factors, with positive e-learning experience linked closely to various supports. This paper reinforces previous studies showing nurses’ expanding role across general practice teams and reports on some of the challenges of e-learning. Merely providing practice nurses with necessary information via web-based learning systems does not ensure successful learning or progress toward improving health outcomes for patients.

scholarly journals Using a Web-Based App to Deliver Rehabilitation Strategies to Persons With Chronic Conditions: Development and Usability Study

10.2196/19519 ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e19519
Author(s):  
Julie Richardson ◽  
Lori Letts ◽  
Susanne Sinclair ◽  
David Chan ◽  
Jordan Miller ◽  
...  
Keyword(s):  
Focus Group ◽  
Chronic Conditions ◽  
Management Strategies ◽  
Group Analysis ◽  
End Users ◽  
Self Management ◽  
Management Support ◽  
Web Based ◽  
Usability Tests ◽  
Rehabilitation Strategies

Background The global rise in the incidence of chronic conditions and aging is associated with increased disability. Physiotherapists and occupational therapists can mitigate the resulting burden on the health care system with their expertise in optimizing function. Rehabilitation self-management strategies can assist people with chronic conditions to accept, adjust, and manage different aspects of their daily functioning. Interventions delivered using technology have the potential to increase the accessibility, availability, and affordability of rehabilitation self-management support and services. Objective This study aims to describe the development and usability evaluation of iamable, a web-based app created to provide rehabilitation self-management support for people with chronic conditions. Methods The development and evaluation of iamable were undertaken in several phases. We used user-centered design principles and an iterative process that included consultations with rehabilitation experts; developed a prototype; and conducted usability tests, heuristic evaluations, and a focus group analysis. Results The iamable app was developed to provide rehabilitation self-management strategies in the areas of exercise, fall prevention, fatigue management, pain management, physical activity, and stress management. We engaged adults aged ≥45 years with at least one chronic condition (N=11) in usability testing. They identified navigation and the understanding of instructions as the primary issues for end users. During the heuristic evaluation, clinicians (N=6) recommended that some areas of app content should be more succinct and that help should be more readily available. The focus group provided input to help guide clinical simulation testing, including strategies for selecting patients and overcoming barriers to implementation. Conclusions We engaged end users and clinicians in the development and evaluation of the iamable app in an effort to create a web-based tool that was useful to therapists and their patients. By addressing usability issues, we were able to ensure that patients had access to rehabilitation strategies that could be used to help them better manage their health. Our app also provides therapists with a platform that they can trust to empower their patients to be more active in the management of chronic conditions. This paper provides a resource that can be used by others to develop and evaluate web-based health apps.

scholarly journals A Web-Based Intervention to Help Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: Qualitative Study

JMIR Aging ◽  
2018 ◽  
Vol 1 (1) ◽  
pp. e2 ◽  
Author(s):  
Jenny Ploeg ◽  
Carrie McAiney ◽  
Wendy Duggleby ◽  
Tracey Chambers ◽  
Annie Lam ◽  
...  
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Chronic Conditions ◽  
Multiple Chronic Conditions ◽  
Web Based

scholarly journals Using a Web-Based App to Deliver Rehabilitation Strategies to Persons With Chronic Conditions: Development and Usability Study (Preprint)

2020 ◽  
Author(s):  
Julie Richardson ◽  
Lori Letts ◽  
Susanne Sinclair ◽  
David Chan ◽  
Jordan Miller ◽  
...  
Keyword(s):  
Focus Group ◽  
Chronic Conditions ◽  
Management Strategies ◽  
Group Analysis ◽  
End Users ◽  
Self Management ◽  
Management Support ◽  
Web Based ◽  
Usability Tests ◽  
Rehabilitation Strategies

BACKGROUND The global rise in the incidence of chronic conditions and aging is associated with increased disability. Physiotherapists and occupational therapists can mitigate the resulting burden on the health care system with their expertise in optimizing function. Rehabilitation self-management strategies can assist people with chronic conditions to accept, adjust, and manage different aspects of their daily functioning. Interventions delivered using technology have the potential to increase the accessibility, availability, and affordability of rehabilitation self-management support and services. OBJECTIVE This study aims to describe the development and usability evaluation of iamable, a web-based app created to provide rehabilitation self-management support for people with chronic conditions. METHODS The development and evaluation of iamable were undertaken in several phases. We used user-centered design principles and an iterative process that included consultations with rehabilitation experts; developed a prototype; and conducted usability tests, heuristic evaluations, and a focus group analysis. RESULTS The iamable app was developed to provide rehabilitation self-management strategies in the areas of exercise, fall prevention, fatigue management, pain management, physical activity, and stress management. We engaged adults aged ≥45 years with at least one chronic condition (N=11) in usability testing. They identified navigation and the understanding of instructions as the primary issues for end users. During the heuristic evaluation, clinicians (N=6) recommended that some areas of app content should be more succinct and that help should be more readily available. The focus group provided input to help guide clinical simulation testing, including strategies for selecting patients and overcoming barriers to implementation. CONCLUSIONS We engaged end users and clinicians in the development and evaluation of the iamable app in an effort to create a web-based tool that was useful to therapists and their patients. By addressing usability issues, we were able to ensure that patients had access to rehabilitation strategies that could be used to help them better manage their health. Our app also provides therapists with a platform that they can trust to empower their patients to be more active in the management of chronic conditions. This paper provides a resource that can be used by others to develop and evaluate web-based health apps.

scholarly journals INTERPROFESSIONAL SKILLS AND CULTURAL AWARENESS OF STUDENTS CARING FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S761-S762
Author(s):  
Kathryn M Daniel ◽  
Mary Lou Bond
Keyword(s):  
Older Adults ◽  
Cultural Differences ◽  
Health Care Professionals ◽  
Interprofessional Education ◽  
Chronic Conditions ◽  
Cultural Awareness ◽  
Social Work Students ◽  
Multiple Chronic Conditions ◽  
Delivery Of Care ◽  
Cultural Programming

Abstract Based on rapidly increasing numbers of older adults and growing populations of culturally diverse citizens, we developed and provided an interprofessional education program for graduate nursing and social work students that focused on the delivery of care to older adults and veterans with multiple chronic conditions. The students participated in multiple activities together over a year long period. Activities included an introductory IPE day with all students together and simulated patient cases that had required roles for the students’ specialties. Knowledge and skills of interprofessional collaborative practice were measured with the Interprofessional Self Assessment Competencies (IPEC) and Assessment of Interprofessional Team Collaboration Scale (AITCS). We also measured attitudes toward cultural differences using the Cultural Awareness Scale (CAS). The entire project was repeated a second year with a second cohort of students. Overall, our students were better able to understand and work collaboratively with other health care professionals after participating in this program. Regarding cultural awareness, both NP and SW students were more aware of and comfortable with cultural differences after participating in the program. After one year of experience, we wanted to know more about our students’ skills and attitudes. Focus groups were added to the design to dive deeper into the students’ perceptions about which activities were most impactful and recommendations for future IPE activities. This paper will describe these data and implications for future planning of more effective interprofessional and cultural programming for students caring for older adults and veterans.

scholarly journals Women’s Caregiving Experience of Older Persons Living With Alzheimer Disease and Related Dementias and Multiple Chronic Conditions: Using Wuest’s Theory

2020 ◽  
Vol 6 ◽  
pp. 237796082097481
Author(s):  
Shelley Peacock ◽  
Melanie Bayly ◽  
Wendy Duggleby ◽  
Jenny Ploeg ◽  
Lori Pollard ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Health Care Providers ◽  
Chronic Conditions ◽  
Active Role ◽  
Qualitative Description ◽  
Control Group ◽  
Multiple Chronic Conditions ◽  
Care Providers ◽  
Web Based

Introduction Care of persons living with chronic conditions rests heavily on women within the context of the family. Research demonstrates that women experience more caregiving strain compared to men, yet less is known about the differences in experiences between women carers: namely, wives and daughters. Objective The purpose of this study was to examine and compare the experiences of wife and daughter carers of older adults living with Alzheimer disease and related dementias, plus at least two other chronic conditions. Methods Using qualitative description with Wuest’s feminist caring theory of precarious ordering as an analytic framework, interview transcripts of women carer participants who were from the control group of a larger multi-site mixed methods study evaluating the web-based intervention My Tools 4 Care were analyzed. Findings Both wives and daughters experienced daily struggles, altered prospects, and ambivalent feelings around their caring role. Negotiating the role of professional carer was an important part of balancing caring demands and anticipating the future, and women took an active role in trying to harness caring resources. Findings indicated wives and daughters were generally similar in how they described their caregiving, although daughters reported more shared caring and decision-making, and needed to balance paid employment with caregiving. Conclusion Wives and daughters face similar challenges caring for persons with a dementia and multiple chronic conditions, and actively engage in strategies to manage caring demands. The findings illuminate the importance of accessible, appropriate support from professional carers/health care providers, and suggest that assistance navigating such supports would benefit women carers.

scholarly journals Electronic Health Record Documentation Patterns of Recorded Primary Care Visits Focused on Complex Communication: A Qualitative Study

2019 ◽  
Vol 10 (02) ◽  
pp. 247-253
Author(s):  
Laura Prater ◽  
Anthony Sanchez ◽  
Gabriella Modan ◽  
Jennifer Burgess ◽  
Kim Frier ◽  
...  
Keyword(s):  
Disease Prevention ◽  
Electronic Health Record ◽  
Chronic Conditions ◽  
Emotional Health ◽  
Office Visit ◽  
Multiple Chronic Conditions ◽  
Health Record ◽  
Social And Emotional ◽  
Therapeutic Decisions ◽  
Electronic Health

Background In a time-constrained clinical environment, physicians cannot feasibly document all aspects of an office visit in the electronic health record (EHR). This is especially true for patients with multiple chronic conditions requiring complex clinical reasoning. It is unclear how physicians prioritize the documentation of health information in the EHR. Objective The goal of this study is to examine documentation tradeoffs made by physicians when caring for complex patients by comparing the content of office visit conversations with resulting EHR documentation. Methods We used grounded theory method of qualitative analysis to assess emergent themes in the transcripts of 10 office visits, and then compared the themes to documentation in the EHR. Differences between discussion and subsequent documentation of social and emotional health topics and each of the other key categories were compared using the Wilcoxon signed-rank test. Results The categories that emerged included “chronic conditions,” “acute/new problems,” “disease prevention,” and “social and emotional health.” We found that when social and emotional topics were discussed in the office visit, it was documented in the medical record only 30.6% of the time. Chronic conditions, acute/new problems, and disease prevention were documented in the EHR between 87.5 and 91.7% of the time after discussion. The differences between discussion and documentation of social and emotional topics were significantly greater than the differences for chronic conditions, acute/new problems, and disease prevention (all p < 0.05). Conclusion Social and emotional factors, while extremely relevant to health management, are less likely than medical concerns to be documented after discussion in an office visit. This lack of documentation may hinder interdisciplinary communication between teams informing individualized therapeutic decisions during acute care handoffs, such as outpatient to inpatient care.

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