scholarly journals Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study

2021 ◽  
Vol 18 (24) ◽  
pp. 13127
Author(s):  
Felix Muehlensiepen ◽  
Johannes Knitza ◽  
Wenke Marquardt ◽  
Susann May ◽  
Martin Krusche ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Musculoskeletal Diseases ◽  
Patient Survey ◽  
Routine Care ◽  
Mixed Methods Study ◽  
Personal Contact ◽  
Exact Integration ◽  
Scarce Resources ◽  
Organizational Challenges ◽  
Patient Representatives

Despite all its promises, telemedicine is still not widely implemented in the care of rheumatic and musculoskeletal diseases (RMDs). The aim of this study is to investigate opportunities, barriers, acceptance, and preferences concerning telemedicine among RMD patients and professional stakeholders. From November 2017 to December 2019, a participatory, mixed-methods study was conducted, consisting of (1) expert interviews (n = 27) with RMD patients and professional stakeholders, (2) a national paper-based patient survey (n = 766), and (3) focus groups (n = 2) with patient representatives and rheumatologists. The qualitative findings indicate that patients equate personal contact with physical face-to-face contact, which could be reduced by implementing telemedicine, thus negatively influencing the patient–doctor relationship. Correspondingly “no personal contact with the doctor” is the main reason (64%) why 38% of the surveyed patients refuse to try telemedicine. Professional stakeholders expect telemedicine to contribute to the effective allocation of scarce resources in rheumatology care. The main barriers reported by stakeholders were the scarcity of time resources in RMD care, the absence of physical examinations, and organizational challenges associated with the implementation of telemedicine in RMD care. While the exact integration of telemedicine into routine care has yet to be found, the consequences on the patient-physician relationship must be permanently considered.

Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory Mixed-Methods-Study (Preprint)

2021 ◽  
Author(s):  
Felix Muehlensiepen ◽  
Johannes Knitza ◽  
Wenke Marquardt ◽  
Susann May ◽  
Martin Krusche ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Quantitative Research ◽  
Information Needs ◽  
Musculoskeletal Diseases ◽  
Mixed Methods Study ◽  
Personal Contact ◽  
Main Concern ◽  
Exact Integration ◽  
Survey Results

BACKGROUND The global burden of rheumatic and musculoskeletal diseases (RMDs) is rising. Professional ressources in rheumatology are scarce. The use of telemedicine could improve access to RMD care. Despite all its promises, telemedicine is still not widely implemented in RMD care. OBJECTIVE To investigate opportunities, barriers, acceptance, and preferences concerning telemedicine among RMD patients and professional stakeholders involved in RMD patient management. METHODS From November 2017 to December 2019 a participatory mixed-methods-study was conducted based on three parts: (1) qualitative expert interviews with RMD patients and professional stakeholders that were used to participatively design (2) a national paper-based patient survey. The survey results were hence discussed in (3) focus groups with patient representatives and rheumatologists. RESULTS Fifteen patients and 26 professional stakeholders participated in the qualitative and further 766 patients took part in the quantitative research. The qualitative interview data reveals opportunities and barriers from the patients' (n=5) and professional stakeholders’(n=23) perspectives: Patients appreciate the potentials of telemedicine to overcome space and time in health care. In contrast, the loss of personal patient-doctor contact is the main concern of patients regarding telemedicine use. Personal contact is equated with physical face-to-face contact, which could be reduced by implementing telemedicine, thus negatively influencing the patient-doctor relationship. Professional stakeholders expect telemedicine to contribute to effective allocation of scarce resources in rheumatology care. This is countered by the absence of physical examinations and organizational challenges as barriers of the use of telemedicine. Both, patients and professional stakeholders describe telemedicine as something broad and complex to define. These qualitative findings align with the survey results: 38% (264/690) of the surveyed patients refuse to try telemedicine, 32% (216/690) are not sure, and 30% (210/690) would like to try telemedicine. ‘No personal contact with the doctor’ (64%, 220/346) was most frequently chosen as a reason against telemedicine, followed by ‘Data security’ (28%, 96/346). Patients prefer to use the telephone (60%, 206/341) over video-consultations (35%, 118/341) as telemedicine use cases. Only 2 (0.3%, 2/714) survey participants indicated that they already had a video consultation with their physician. The focus groups revealed a homogeneous spectrum of opinions with participants confirming the survey results. Patients (n=10) emphasize the high relevance of physical doctor-patient contact. Rheumatologists (n=4) highlight the potential of telemedicine, as a support of existing care structures. However, the exact integration of telemedicine into medical routines remains unclear, especially in view of scarce time resources in rheumatology care. CONCLUSIONS As digital transformation of rheumatology care progresses, the desire for a close patient-doctor relationship persists. Many study participants fear that the use of telemedicine will have negative effects on patient-doctor relationship and therefore oppose the use of telemedicine. We identified further barriers and opportunities, such as information needs, digital infrastructure and equipment requirements, and patient preferences on the composition of digital services, to guide the design and implementation of telemedicine in rheumatology care.

Abstract P167: Patient Perspectives on Experience During Collection, Results Communication and Overall Impact of Patient-reported Outcomes in Heart Failure: A Mixed Methods Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Favel L Mondesir ◽  
Susan Zickmund ◽  
Patrick Galyean ◽  
Serena Yang ◽  
Grace Perry ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mixed Methods ◽  
Cardiovascular Health ◽  
Well Being ◽  
Routine Care ◽  
Patient Reported Outcome ◽  
Mixed Methods Study ◽  
Successful Implementation ◽  
Quantitative Survey ◽  
Patient Reported

Background: Patient-reported outcome (PRO) assessments are commonly used in clinical heart failure (HF) trials and have been shown to be valid, reliable, sensitive measures of patients’ symptoms, function and quality of life, as well as prognostic of clinical events. To be used in routine care, they also need to be interpretable to providers and patients. Patients’ perspectives on PRO collection and results communication have not been studied. Methods: We conducted a mixed methods study of 24 ambulatory adult HF patients (50% men) who completed PROs as part of care at a HF clinic. Study procedures included (1) qualitative telephone interviews and (2) quantitative surveys following interviews. We employed thematic analysis to analyze and code transcripts using an iterative coding process and descriptive statistics to analyze the survey. Qualitative findings were purposefully linked to quantitative results. Findings: Three themes in qualitative analyses were linked to the quantitative survey: 1. Utility of data: Most participants noted that PRO questionnaires were a useful tool to better understand their health if their providers discussed the results with them, and to provide additional information to help improve their treatment. Ninety-two % (22/24) of participants strongly agreed or agreed (SA/A) and 8% (2/24) were neutral that completing the questionnaires changed their care and improved their health. Ninety-six % (23/24) of participants SA/A and 4% (1/24) were neutral that completing the questionnaires would make evaluation of their well-being more accurate. 2. Length and frequency of data collection: Most participants felt that questionnaire length (13-29 questions completed in 3-8 minutes on average) and frequency of implementation (at every visit) were satisfactory. Sixty-three % (15/24) and 37% (9/24) of participants felt that maximum number of questions should be 5-15 and >15, respectively. Eighty-three % (20/24) and 17% (4/24) of participants felt that maximum time required for completion should be 5 or 10 and >10 minutes, respectively. 3. Communication with providers: Most participants noted that their providers discussed results of PRO questionnaires with them only once or not at all and participants who had this discussion with their providers felt that providers understood their responses. Sixty-two % (15/24), 21% (5/24) and 17% (4/24) of participants SA/A, were neutral and disagreed or strongly disagreed that their providers effectively discussed results of their PROs with them. Conclusions: Qualitative results provided depth and interpretability of quantitative survey results. These results indicate successful implementation and utility of PRO questionnaires in the HF clinic, while highlighting a need for more frequent discussion of PRO results between providers and patients. Further use of PROs may lead to improved cardiovascular health and prognosis in HF.

scholarly journals Countermeasures against COVID-19: how to navigate medical practice through a nascent, evolving evidence base — a European multicentre mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043015 ◽  
Author(s):  
Fabian Eibensteiner ◽  
Valentin Ritschl ◽  
Tanja Stamm ◽  
Asil Cetin ◽  
Claus Peter Schmitt ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Expert Opinion ◽  
Tertiary Care ◽  
Rapid Change ◽  
Evidence Base ◽  
Routine Care ◽  
Resource Dependency ◽  
Mixed Methods Study ◽  
European Countries ◽  
Factors Affecting

ObjectivesIn a previously published Delphi exercise the European Pediatric Dialysis Working Group (EPDWG) reported widely variable counteractive responses to COVID-19 during the first week of statutory public curfews in 12 European countries with case loads of 4–680 infected patients per million. To better understand these wide variations, we assessed different factors affecting countermeasure implementation rates and applied the capability, opportunity, motivation model of behaviour to describe their determinants.DesignWe undertook this international mixed methods study of increased depth and breadth to obtain more complete data and to better understand the resulting complex evidence.SettingThis study was conducted in 14 paediatric nephrology centres across 12 European countries during the COVID-19 pandemic.ParticipantsThe 14 participants were paediatric nephrologists and EPDWG members from 12 European centres.Main outcome measures52 countermeasures clustered into eight response domains (access control, patient testing, personnel testing, personal protective equipment policy, patient cohorting, personnel cohorting, suspension of routine care, remote work) were categorised by implementation status, drivers (expert opinion, hospital regulations) and resource dependency. Governmental strictness and media attitude were independently assessed for each country and correlated with relevant countermeasure implementation factors.ResultsImplementation rates varied widely among response domains (median 49.5%, range 20%–71%) and centres (median 46%, range 31%–62%). Case loads were insufficient to explain response rate variability. Increasing case loads resulted in shifts from expert opinion-based to hospital regulation-based decisions to implement additional countermeasures despite increased resource dependency. Higher governmental strictness and positive media attitude towards countermeasure implementation were associated with higher implementation rates.ConclusionsCOVID-19 countermeasure implementation by paediatric tertiary care centres did not reflect case loads but rather reflected heterogeneity of local rules and of perceived resources. These data highlight the need of ongoing reassessment of current practices, facilitating rapid change in ‘institutional behavior’ in response to emerging evidence of countermeasure efficacy.

Determining Emotional Tone and Verbal Behavior in Patients With Tinnitus and Hyperacusis: An Exploratory Mixed-Methods Study

2019 ◽  
Vol 28 (3) ◽  
pp. 660-672
Author(s):  
Suzanne H. Kimball ◽  
Toby Hamilton ◽  
Erin Benear ◽  
Jonathan Baldwin
Keyword(s):  
Mixed Methods ◽  
Verbal Behavior ◽  
Coping Strategies ◽  
Mixed Methods Study ◽  
Self Report ◽  
Anxiety And Depression ◽  
Negative Consequences ◽  
Emotional Tone ◽  
Explanatory Mixed Methods ◽  
Quantitative Results

Purpose The purpose of this study was to evaluate the emotional tone and verbal behavior of social media users who self-identified as having tinnitus and/or hyperacusis that caused self-described negative consequences on daily life or health. Research Design and Method An explanatory mixed-methods design was utilized. Two hundred “initial” and 200 “reply” Facebook posts were collected from members of a tinnitus group and a hyperacusis group. Data were analyzed via the LIWC 2015 software program and compared to typical bloggers. As this was an explanatory mixed-methods study, we used qualitative thematic analyses to explain, interpret, and illustrate the quantitative results. Results Overall, quantitative results indicated lower overall emotional tone for all categories (tinnitus and hyperacusis, initial and reply), which was mostly influenced by higher negative emotion. Higher levels of authenticity or truth were found in the hyperacusis sample but not in the tinnitus sample. Lower levels of clout (social standing) were indicated in all groups, and a lower level of analytical thinking style (concepts and complex categories rather than narratives) was found in the hyperacusis sample. Additional analysis of the language indicated higher levels of sadness and anxiety in all groups and lower levels of anger, particularly for initial replies. These data support prior findings indicating higher levels of anxiety and depression in this patient population based on the actual words in blog posts and not from self-report questionnaires. Qualitative results identified 3 major themes from both the tinnitus and hyperacusis texts: suffering, negative emotional tone, and coping strategies. Conclusions Results from this study suggest support for the predominant clinical view that patients with tinnitus and hyperacusis have higher levels of anxiety and depression than the general population. The extent of the suffering described and patterns of coping strategies suggest clinical practice patterns and the need for research in implementing improved practice plans.

EXPERIENCES, FRUSTRATIONS, AND BARRIERS, OF IPAD USAGE IN THE SPECIAL EDUCATION: LIFE SKILLS CLASSROOM FROM EDUCATORS PERSPECTIVE

2018 ◽  
pp. 61-67
Author(s):  
D. J. Sullivan ◽  
S. Labby ◽  
A. Koptelov ◽  
S. L. Sullivan
Keyword(s):  
Special Education ◽  
Mixed Methods ◽  
Communication Systems ◽  
Life Skills ◽  
Mixed Methods Study ◽  
Educational Tool ◽  
Special Educator ◽  
Communications Systems ◽  
Communication Device ◽  
Communication Devices

The purpose of this mixed methods study was to determine the barriers that special educator teachers encounter when using iPads within the Life Skills classroom. The research investigates the experiences, frustrations, and barriers through educators’ perceptions of iPad implementation. The influence of these issues suggests why iPad usage is not a device that special education classrooms are using in a widespread daily manner. Exploration of iPads as an educational tool and as a communication device is also discussed, along with considerations of other communications systems such as Picture Exchange Communication Systems and Alternative and Augmented Communication Devices is considered. Recommendations for further possible research are also discussed.

Rapid Evaluation of the Special Measures for Quality and Challenged Provider Regimes: A mixed-methods study

2020 ◽  
Author(s):  
Naomi Fulop ◽  
Estela Capelas Barbosa ◽  
Melissa Hill ◽  
Jean Ledger ◽  
Pei Li Ng ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Study ◽  
Rapid Evaluation
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