TY - JOUR AU - Vannelli, Sara AU - Visintin, Filippo AU - Gitto, Simone PY - 2025/4/25 TI - Investigating Continuance Intention for Telehealth Visits in Children?s Hospitals: Survey-Based Study JO - J Med Internet Res SP - e60694 VL - 27 KW - telehealth visit KW - continuance intention KW - partial least squares structural equation modeling KW - PLS-SEM KW - children?s hospital N2 - Background: Telehealth visits are remote health care consultations conducted using digital technologies, such as video calls, phone calls, or web-based platforms. This type of service offers numerous benefits for both health care users and health care providers. Users save time and money by avoiding traveling to health care facilities. At the same time, health care providers can expand access to care for users in remote areas and enhance the continuity of care. These advantages are even more evident in pediatric settings, where attending in-person services must align with the commitments of the patient (eg, school activities) and the caregiver. Although the potential benefits of telehealth visits for users and health care providers were already known before the COVID-19 pandemic, its widespread adoption only occurred during it. Having experienced its benefits, hospitals are now, in the postpandemic phase, determined to maintain and strengthen their remote service offerings. It has, therefore, become crucial for them to understand the factors influencing users? intention to continue using telehealth visits (or ?continuance intention?), even now after the access restrictions to health care facilities imposed during the COVID-19 pandemic have been lifted. However, the literature lacks comprehensive, valid, and reliable models explaining users? continuance intention toward telehealth visit services. Objective: This study aims to investigate the variables impacting users? continuance intention toward telehealth visits and identify suggestions for improvement. Methods: Two models of variables impacting users? continuance intention toward telehealth visits were developed. The first model applied to all users undergoing telehealth visits, while the second one applied only to patients who received a telehealth visit using videoconferencing tools. The models were created based on the literature and a qualitative study comprising interviews with physicians with extensive experience in telehealth visits. The models were then tested using partial least squares structural equation modeling on 477 responses obtained by administering a survey to guardians of patients who had received at least 1 telehealth visit in a major European children?s hospital. Results: Both models showed that the variable information quality positively influenced the variables continuance intention and perceived usefulness and that perceived usefulness positively influenced continuance intention. The first model was robust to the medical specialty and the channel used to deliver the visit. The second model also showed that systems quality positively influenced information quality. Conclusions: This study has identified and tested 2 comprehensive, valid, and reliable models on the variables influencing users? continuance intention toward telehealth visits. Moreover, the study?s results provide insights for hospitals to improve telehealth visit services. UR - https://www.jmir.org/2025/1/e60694 UR - http://dx.doi.org/10.2196/60694 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60694 ER - TY - JOUR AU - Staehelin, Dario AU - Schmid, Damaris AU - Gerber, Felix AU - Dolata, Mateusz AU - Schwabe, Gerhard PY - 2025/4/23 TI - Empowering Community Health Workers With Scripted Medicine: Design Science Research Study JO - JMIR Hum Factors SP - e57545 VL - 12 KW - community-based health care KW - community health workers KW - collaboration engineering KW - algorithmic management KW - Scripted Medicine KW - task shifting KW - empowerment KW - mobile health KW - mHealth KW - digital health N2 - Background: The World Health Organization anticipates a shortage of 14 million health workers by 2030, particularly affecting the Global South. Community health workers (CHWs) may mitigate the shortages of professional health care workers. Recent studies have explored the feasibility and effectiveness of shifting noncommunicable disease (NCD) services to CHWs. Challenges, such as high attrition rates and variable performance, persist due to inadequate organizational support and could hamper such efforts. Research on employee empowerment highlights how organizational structures affect employees? perception of empowerment and retention. Objective: This study aims to develop Scripted Medicine to empower CHWs to accept broader responsibilities in NCD care. It aims to convey relevant medical and counseling knowledge through medical algorithms and ThinkLets (ie, social scripts). Collaboration engineering research offers insights that could help address the structural issues in community-based health care and facilitate task shifting. Methods: This study followed a design science research approach to implement a mobile health?supported, community-based intervention in 2 districts of Lesotho. We first developed the medical algorithms and ThinkLets based on insights from collaboration engineering and algorithmic management literature. We then evaluated the designed approach in a field study in the ComBaCaL (Community Based Chronic Disease Care Lesotho) project. The field study included 10 newly recruited CHWs and spanned over 2 weeks of training and 12 weeks of field experience. Following an abductive approach, we analyzed surveys, interviews, and observations to study how Scripted Medicine empowers CHWs to accept broader responsibilities in NCD care. Results: Scripted Medicine successfully conveyed the required medical and counseling knowledge through medical algorithms and ThinkLets. We found that medical algorithms predominantly influenced CHWs? perception of structural empowerment, while ThinkLets affected their psychological empowerment. The different perceptions between the groups of CHWs from the 2 districts highlighted the importance of considering the cultural and economic context. Conclusions: We propose Scripted Medicine as a novel approach to CHW empowerment inspired by collaboration engineering and algorithmic management. Scripted Medicine broadens the perspective on mobile health?supported, community-based health care. It emphasizes the need to script not only essential medical knowledge but also script counseling expertise. These scripts allow CHWs to embed medical knowledge into the social interactions in community-based health care. Scripted Medicine empowers CHW to accept broader responsibilities to address the imminent shortage of medical professionals in the Global South. UR - https://humanfactors.jmir.org/2025/1/e57545 UR - http://dx.doi.org/10.2196/57545 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57545 ER - TY - JOUR AU - Goh, Huat Kim AU - Yeow, Kwang Adrian Yong AU - Wang, Le AU - Poh, Hermione AU - Ng, Hui Hannah Jia AU - Tan, Gamaliel AU - Wee, Khai Soon AU - Lim, Luen Er AU - D?Souza, Andre Jared Louis PY - 2025/4/22 TI - The Benefits of Integrating Electronic Medical Record Systems Between Primary and Specialist Care Institutions: Mixed Methods Cohort Study JO - J Med Internet Res SP - e49363 VL - 27 KW - EMR integration KW - primary care KW - specialist care KW - medical neighborhood KW - efficiency N2 - Background: The benefits of a fully integrated electronic medical record (EMR) system across primary and specialist care institutions have yet to be formally established. Integrating the EMR systems between primary and specialist care is the first step in building a medical neighborhood. A medical neighborhood is a set of policies and procedures implemented through integrated systems and processes that support the joint management of patient care across primary care physicians, specialist physicians, and other health care providers. Objective: This study aims to quantify the impacts of integrating the EMR systems of primary and specialist care institutions in the process of developing a medical neighborhood. The impacts are operationalized in both quantitative and qualitative measures, measuring the benefits of such an integration in 3 specific areas, namely, patient diagnosis tracking, patient care management, and patient coordination. Methods: A comprehensive, mixed methods examination was conducted using 3 different data sources (EMR consultation data, clinician survey data, and in-depth interviews). The EMR data consist of patient encounters referred to a specialist clinic from 6 primary care providers before and after integrating the EMR system into the primary and specialist care institutions. We analyzed 25,404 specialist consultation referrals to the specialist clinics by the primary care partners for a 12-month period, during which the integration of the EMR system was conducted. A cohort empirical investigation was used to identify the quantitative impacts of the EMR integration, and a follow-up survey was conducted with the clinicians 18 months post integration. The clinicians? perceptions of the integration were measured to triangulate the empirical observation from the patient encounters, and the postimplementation perception survey was analyzed to triangulate the empirical investigation of consultation instances of the earlier cohort. Concurrently, a total of 30 interviews were conducted between March 16, 2021, and July 28, 2021, with clinicians and operations staff to gather on-the-ground sentiments engendered by this integration, which further informed our quantitative findings. Results: The integration of EMR systems between primary and specialist care institutions was associated with benefits in patient diagnosis tracking, patient care management, and patient coordination. Specifically, it was found that the integration resulted in a decrease in wait time for specialist appointments of an average of 16.5 days (P<.001). Patients were also subjected to fewer repeated procedures and tests; the number of procedures (P=.006), radiographies (P=.02), and overall bill sizes (P=.004) all decreased by between 4.08% and 39.7%, resulting in reduced health care resource wastage while maintaining similar medical outcomes (P=.37). Conclusions: Our study?s results are among the first instances of empirical evidence to show that the integration and sharing of data between primary and specialist care institutions promote continuity in health care delivery and joint patient management in a medical neighborhood. The findings go beyond the traditional benefits of improved referral communication, as shown in prior literature. UR - https://www.jmir.org/2025/1/e49363 UR - http://dx.doi.org/10.2196/49363 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49363 ER - TY - JOUR AU - Hoogendoorn, Petra AU - Shokralla, Mariam AU - Willemsen, Romy AU - Guldemond, Nick AU - Villalobos-Quesada, María PY - 2025/4/21 TI - Compatibility of the CEN-ISO/TS 82304-2 Health App Assessment Framework With Catalan and Italian Health Authorities? Needs: Qualitative Interview Study JO - JMIR Form Res SP - e67855 VL - 9 KW - assessment frameworks KW - mobile health KW - mHealth KW - health apps KW - wellness apps KW - digital transformation KW - Italy KW - Catalonia KW - diffusion of innovations KW - value proposition canvas N2 - Background: Health authorities of European Union (EU) member states are increasingly working to integrate quality health apps into their health care systems. Given the current lack of unified EU assessment criteria, the European Commission initiated Technical Specification (TS) CEN-ISO 82304-2:2021?Health and wellness apps?Quality and reliability (hereinafter the ?TS?) to address the scattered EU landscape of assessment frameworks (AFs) for health apps. The adoption of an AF, such as the TS, falls within member state competence and is considered an uncertainty-reduction process. Evaluations by peers as well as ensuring the compatibility of the TS with the needs of health authorities can reduce uncertainty and mediate harmonization. Objective: This study aims to examine the compatibility of the TS with the needs of Catalan and Italian health authorities. Methods: Semistructured interviews were conducted with key informants from a regional (Catalonia in Spain) and national (Italy) health authority, and a thematic analysis was carried out. Main themes were established deductively, following the aspects defined by the value proposition canvas: (1) health authorities? needs (?gains,? ?pains,? and ?jobs?) and (2) the TS ?products and services? and their distinct characteristics (?gain creators? and ?pain relievers?). Subthemes were generated inductively. The compatibility of the needs with the TS was theoretically determined by the researchers. The results were visualized using the value proposition canvas. Two participant validation steps confirmed that the most relevant aspects of the predefined themes had been captured. Results: Despite the diversity of the 2 health authorities, subthemes were common and categorized into 9 gains, 9 pains, and 11 jobs. Key findings include the health authorities? perceived value of, and need for, integrating quality health apps and using an AF (gains), along with the related policy, implementation, and operational activities (jobs). The lack of enabling EU legislation and standardization, resulting in a need for the multiple authorities involved to consent, made achieving an AF challenging (pains). Nine products and services related to the TS and 17 distinct characteristics (eg, its multistakeholder evidence base) were found to be compatible with 3 gains (eg, stimulating the prescription and use of apps), 7 pains (eg, legislation and harmonization issues), and 6 jobs (eg, assessing apps). Indirect effects, 3 anticipated future services, and 1 anticipated gain creator and pain reliever increase this compatibility. Conclusions: Our results suggest that the health authorities share common fundamental needs, and that the TS is compatible with these needs. The identified needs and compatibility can potentially reduce peer authorities? uncertainties in adopting an AF in general and the TS in particular. More research is recommended to confirm and translate our results in other contexts and further fine-tune compatibility to achieve wide adoption of the TS and accelerate the uptake of health apps. UR - https://formative.jmir.org/2025/1/e67855 UR - http://dx.doi.org/10.2196/67855 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67855 ER - TY - JOUR AU - Seo, Woosuk AU - Li, Jiaqi AU - Zhang, Zhan AU - Zheng, Chuxuan AU - Singh, Hardeep AU - Pasupathy, Kalyan AU - Mahajan, Prashant AU - Park, Young Sun PY - 2025/4/21 TI - Designing Health Care Provider?Centered Emergency Department Interventions: Participatory Design Study JO - JMIR Form Res SP - e68891 VL - 9 KW - emergency departments KW - participatory design KW - health care providers KW - technology KW - interventions KW - artificial intelligence N2 - Background: In the emergency department (ED), health care providers face extraordinary pressures in delivering accurate diagnoses and care, often working with fragmented or inaccessible patient histories while managing severe time constraints and constant interruptions. These challenges and pressures may lead to potential errors in the ED diagnostic process and risks to patient safety. With advances in technology, interventions have been developed to support ED providers in such pressured settings. However, these interventions may not align with the current practices of ED providers. To better design ED provider?centered interventions, identifying their needs in the diagnostic process is critical. Objective: This study aimed to identify ED providers? needs in the diagnostic process through participatory design sessions and to propose design guidelines for provider?centered technological interventions that support decision?making and reduce errors. Methods: We conducted a participatory design study with ED providers to validate their needs and identify considerations for designing ED provider?centered interventions to improve diagnostic safety. We used 9 technological intervention ideas as storyboards to address the study participants? needs. We had participants discuss the use cases of each intervention idea to assess their needs during the ED care process and facilitated co-design activities with the participants to improve the technological intervention designs. We audio- and video-recorded the design sessions. We then analyzed session transcripts, field notes, and design sketches. In total, we conducted 6 design sessions with 17 ED frontline providers. Results: Through design sessions with ED providers, we identified 4 key needs in the diagnostic process: information integration, patient prioritization, ED provider-patient communication, and care coordination. We interpreted them as insights for designing technological interventions for ED patients. Hence, we discussed the design implications for technological interventions in four key areas: (1) enhancing ED provider?ED provider communication, (2) enhancing ED provider-patient communication, (3) optimizing the integration of advanced technology, and (4) unleashing the potential of artificial intelligence tools in the ED to improve diagnosis. This work offers evidence-based technology design suggestions for improving diagnostic processes. Conclusions: This study provides unique insights for designing technological interventions to support ED diagnostic processes. By inviting ED providers into the design process, we present unique insights into the diagnostic process and design considerations for designing novel technological interventions that meet ED providers? needs in the diagnostic process. International Registered Report Identifier (IRRID): RR2-10.2196/55357 UR - https://formative.jmir.org/2025/1/e68891 UR - http://dx.doi.org/10.2196/68891 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68891 ER - TY - JOUR AU - de França, Galvão Caroline Villela AU - Segalla, Boaro Paola AU - Reis, Assis Felipe Sebastião de AU - Pereira, Silveira José Ricardo AU - de Mattos, Oliveira Alexandre AU - Ferron, Moura Roberta de AU - de Oliveira, Zanardo Cleyton AU - Borges, Bassani Jéssica AU - Hoffmann, Quintal Lilian AU - Caboclo, Giaimo Edmundo Di PY - 2025/4/16 TI - Patients' and Physicians' Experience With and Acceptability of a Telemedicine Cabin: Mixed Methods Study JO - JMIR Hum Factors SP - e55430 VL - 12 KW - telemedicine cabin KW - telehealth KW - teleservice KW - e-health KW - connected offices N2 - Background: Telemedicine represents an essential tool with the potential to reduce health costs, thus avoiding patient displacement and improving patient care outcomes, positioning it as a significant social technology. Objective: This study aims to analyze the implementation of a telehealth cabin at BP Hospital (A Beneficência Portuguesa de São Paulo), focusing on the evaluation of the experiences of both patients and health care professionals, as well as the acceptability of this tool. Methods: A mixed methods study was conducted with 229 participants, divided into 2 phases. The first phase involved 40 apparently healthy individuals to assess the usability, experience, and satisfaction of this group for the later safe application in the group with clinical complaints. The second phase included 189 participants, with complaints to assess the usability, experience, and satisfaction of patients and doctors. In both phases, participants completed screening questionnaires (to assess the eligibility criteria), a socioeconomic demographic questionnaire before using the cabin, and a questionnaire including the System Usability Scale and the Net Promoter Score (NPS) after using the cabin. Results: The data analysis of the first phase showed high acceptance of the telehealth cabin, which supported the progression to the second phase. In the second phase, a high usability score was observed among participants with clinical complaints (mean System Usability Scale score of 85.97, SD 15.50) and a high favorability rating (NPS score of 9.4). Health care professionals also reported favorable results, with a usability score of 67.8 and an NPS of 8.0. Conclusions: The results of this study reinforce the potential for scaling up this practice based on usability outcomes, and highlight its relevance for the development of public policies aimed at expanding access to quality health care in Brazil. This approach improves the interaction of patients with the health care system, while providing professionals with an extended view of clinical conditions through integrated devices, particularly in areas with limited access to medical care. UR - https://humanfactors.jmir.org/2025/1/e55430 UR - http://dx.doi.org/10.2196/55430 ID - info:doi/10.2196/55430 ER - TY - JOUR AU - Tsou, Christina AU - Yeung, Justin AU - Goode, Melanie AU - Mcdonnell, Josephine AU - Williams, Aled AU - Andrew, Colin Stephen AU - Tetlow, Jenny AU - Jamieson, Andrew AU - Hendrie, Delia AU - Reid, Christopher AU - Thompson, Sandra PY - 2025/4/15 TI - Perceived Risks, Mitigation Strategies, and Modifiability of Telehealth in Rural and Remote Emergency Departments: Qualitative Exploration Study JO - JMIR Hum Factors SP - e58851 VL - 12 KW - emergency telemedicine KW - implementation effectiveness KW - clinical effectiveness KW - risk aversion KW - risk mitigation KW - rural and remote KW - emergency departments N2 - Background: Telehealth is a recognized and rapidly evolving domain in the delivery of emergency medicine. Research suggests a positive impact of telehealth in patients presenting for emergency care; however, the regional challenges of acute telemedicine delivery have not been studied. The WA Country Health Service (WACHS) established the Emergency Telehealth Service (ETS) in 2012 to provide telehealth and other technology-enabled services to regional Western Australian hospitals and clinics. The WACHS ETS supports 87 rural and remote WACHS-operated hospitals as well as 10 non-WACHS health clinics via high-definition audio-visual equipment installed in the resuscitation bay of the emergency department (ED) at each site. This 12-year practical application of emergency telemedicine offers a unique opportunity to explore the experiences and perceptions of clinicians delivering virtual care to rural and remote communities. Objective:  This study explores the perceptions of ETS clinicians regarding acceptability, appropriateness, and clinical decision-making when delivering emergency telemedicine in rural and remote settings. Methods: This qualitative study used semistructured interviews to explore the perspectives of ETS clinicians regarding the factors influencing their clinical decision-making. It explored how ETS clinicians determine and modify clinical risks associated with using audio-visual equipment to deliver care. Emerging themes were compared with the concepts arising from the interim guidance of the Medical Board of Australia, and both the Australian and New Zealand, and American Colleges of Emergency Medicine. Results: Overall, 16 doctors, 4 clinical nurse coordinators, and a nurse educator from WACHS ETS provided their experiences and perspectives. Accurate clinical decisions, especially regarding patient disposition, were crucial to virtual care. Timeliness and accuracy were enhanced through a mutual learning model grounded in the local context. Mitigation strategies such as improvisation and flexible technology use compensated for technological barriers. Nonmodifiable risk factors included patients? presenting complaints, clinical urgency of presentation, ED capability, clinician scope of practice, and, if a transfer was required, the distance between the ED of original presentation and the hospital of definitive care. Conclusions: Telehealth can enhance clinical decision-making in rural and remote EDs, and ETS clinicians can prioritize patient safety through a lens incorporating both local hospital capabilities and community contexts. Even for the most experienced clinicians, telehealth was not comparable to face-to-face communication in all circumstances. The impact of the ETS on the scope of the regional emergency medicine practice and on the building of clinical skills warrants further study in relation to its overall effectiveness and cost-effectiveness in rural and remote EDs. These findings identify areas for further qualitative research while providing a rich contextual background for rigorous quantitative analysis of the effectiveness of the ETS. UR - https://humanfactors.jmir.org/2025/1/e58851 UR - http://dx.doi.org/10.2196/58851 UR - http://www.ncbi.nlm.nih.gov/pubmed/40232817 ID - info:doi/10.2196/58851 ER - TY - JOUR AU - Chernick, Rachel AU - Sy, Amanda AU - Dauber, Sarah AU - Vuolo, Lindsey AU - Allen, Bennett AU - Muench, Fred PY - 2025/4/14 TI - Demographics and Use of an Addiction Helpline for Concerned Significant Others: Observational Study JO - J Med Internet Res SP - e55621 VL - 27 KW - family KW - hotline KW - helpline KW - warmline KW - crisis continuum KW - substance abuse KW - addiction KW - youth KW - concerned significant other KW - digital behavioral health KW - parents KW - substance use disorders KW - well-being KW - public health intervention KW - cannabis KW - treatment KW - opioids KW - men KW - women KW - assessments N2 - Background: Concerned significant others (CSOs) play a significant role in supporting individuals with substance use disorders. There is a lack of tailored support services for these CSOs, despite their substantial contributions to the well-being of their loved ones (LOs). The emergence of helplines as a potential avenue for CSO support is outlined, culminating in the focus on the Partnership to End Addiction?s helpline service, an innovative public health intervention aimed at aiding CSOs concerned about an LO?s substance use. Objective: The article analyzes the demographics and use patterns of the Partnership to End Addiction?s helpline service, highlighting the critical role of such services, and advocating for expanded, tailored support models. Methods: This observational study draws data from 8 data platforms spanning April 2011 to December 2021, encompassing 24,096 client records. Surveys were completed by helpline specialists during synchronous telephone calls or self-reported by CSOs before helpline engagement. Collected information encompasses demographics, interaction language, substance of concern, CSO-LO relationship, and the LO?s ?use state,? that is, their location on the continuum of substance use. Results: CSOs primarily comprised women (13,980/18,373, 76.1%) seeking support for their children (1062/1542, 68.9%). LOs were mostly male (1090/1738, 62.7%), aged 18-25 years (2380/7208, 33%), with primary substance concerns being cannabis (5266/12,817, 40.9%), opioids (2445/12,817, 19%), and stimulants (1563/12,817, 12.1%). CSOs primarily sought aid for LOs struggling with substances who were not in treatment (1102/1753, 62.9%). The majority of CSOs were looking for support in English (14,738/17,920, 82.2%), while the rest (3182/17,920, 17.8%) preferred to communicate in Spanish. Spanish-speaking CSOs were significantly more likely to call about cannabis (n=963, 53.7% vs n=4026, 38.6%) and stimulants (n=304, 16.9% vs n=1185, 11.3%) than English-speaking CSOs (P<.001). On the other hand, English-speaking CSOs were more likely to be concerned about opioids than Spanish-speaking CSOs (n=2215, 21.3% vs n=94, 5.2%; P<.001). Conclusions: The study illuminates the helpline?s pioneering role in aiding CSOs grappling with an LO?s substance use. It highlights helplines as crucial resources for CSOs, revealing key demographic, substance-related, and use-state trends. The dominant presence of women among users aligns with other helpline patterns and reflects traditional caregiving roles. While parents form a significant percentage of those reaching out, support is also sought by siblings, friends, and other family members, emphasizing the need for assistance for other members of an LO?s social network. Spanish-speaking individuals? significant outreach underscores the necessity for bilingual support services. Substance concerns revolve around cannabis, opioids, and stimulants, influenced by age and language preferences. The helpline serves as an essential intermediary for CSOs, filling a gap between acute crisis intervention services and formalized health care and treatment services. Overall, the study highlights this helpline?s crucial role in aiding CSOs with tailored, accessible support services. UR - https://www.jmir.org/2025/1/e55621 UR - http://dx.doi.org/10.2196/55621 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55621 ER - TY - JOUR AU - Glover, Audrey Nicole AU - Sathar, Farzana AU - Mokome, Pride AU - Mathabela, Nkululeko AU - Taleni, Sipokazi AU - van Blydenstein, Alexandra Sarah AU - Mekota, Anna-Maria AU - Charalambous, Salome AU - Rachow, Andrea AU - Ivanova, Olena PY - 2025/4/10 TI - Improving Health and Well-Being of People With Post?COVID-19 Consequences in South Africa: Situation Analysis and Pilot Intervention Design JO - JMIR Form Res SP - e58436 VL - 9 KW - post?COVID-19 KW - rehabilitation KW - support KW - quality of life KW - group care KW - well-being KW - South Africa KW - COVID-19 KW - situation analysis KW - pilot KW - intervention KW - context-adapted KW - physical health KW - mental health KW - cross-sectional KW - mixed method KW - questionnaire KW - in-depth KW - interviews KW - survey KW - focus group KW - quantitative KW - qualitative KW - support group KW - hospital KW - patients KW - health care workers KW - health worker N2 - Background: Multisystemic complications post?COVID-19 infection are increasingly described in the literature, yet guidance on the management remains limited. Objectives: This study aimed to assess the needs, preferences, challenges, and existing interventions for individuals with post?COVID-19 symptoms. Based on this, we aimed to develop a context-adapted intervention to improve the overall health and well-being of individuals with post?COVID-19 complications. Methods: We conducted a cross-sectional mixed-methods situation analysis assessing the needs, preferences, challenges, and existing interventions for patients with post?COVID-19 symptoms. We collected data through questionnaires, semistructured in-depth interviews, and focus group discussions (FGDs) from individuals diagnosed with COVID-19 within the previous 18-month period and health care providers who managed patients with COVID-19 in both inpatient and outpatient settings. Quantitative data were summarized using descriptive statistics, qualitative data were transcribed, and deductive analysis focused on suggestions for future interventions. Findings guided the development of a group intervention. Results: We conducted 60 questionnaires, 13 interviews, and 3 FGDs. Questionnaires showed limited knowledge of post?COVID-19 complications at 26.7% (16/60). Of those who received any rehabilitation for COVID-19 (19/60, 31.7%), 94.7% (18/19) found it helpful for their recovery. Just over half (23/41, 56%) of those who did not receive rehabilitation reported that they would have liked to. The majority viewed rehabilitation as an important adjunct to post?COVID-19 care (56/60, 93.3%) and that support groups would be helpful (53/60, 88.3%). Qualitative results highlighted the need for mental health support, structured post?COVID-19 follow-up, and financial aid in post?COVID-19 care. Based on the insights from the situation analysis, the theory of change framework, and existing post?COVID-19 evidence, we designed and conducted a pilot support group and rehabilitation intervention for individuals with post?COVID-19 complications. Our main objective was to assess the change in physical and psychological well-being pre- and postintervention. The intervention included 8 weekly themed group sessions supplemented by home tasks. Effectiveness of the intervention was evaluated by questionnaires pre- and postintervention on post?COVID-19 symptoms, quality of life with the EuroQoL 5-Dimension 5-Level, short Warwick-Edinburgh Mental Wellbeing Scale, and physical function by spirometry and 1-minute sit-to-stand test. We also assessed the feasibility and acceptability of the intervention by questionnaires and semistructured in-depth interviews. The intervention outcome analysis is yet to be conducted. Conclusions: Insights from patients and health care providers on the characteristics of post?COVID-19 complications helped guide the development of a context-adapted intervention program with potential to improve health and well-being post?COVID-19. UR - https://formative.jmir.org/2025/1/e58436 UR - http://dx.doi.org/10.2196/58436 ID - info:doi/10.2196/58436 ER - TY - JOUR AU - Mohammed, Tallah Heba AU - Corcoran, Kathleen AU - Lavergne, Kyle AU - Graham, Angela AU - Gill, Daniel AU - Jones, Kwame AU - Singal, Shivika AU - Krishnamoorthy, Malini AU - Cassata, Amy AU - Mannion, David AU - Fraser, J. Robert D. PY - 2025/4/8 TI - Clinical, Operational, and Economic Benefits of a Digitally Enabled Wound Care Program in Home Health: Quasi-Experimental, Pre-Post Comparative Study JO - JMIR Nursing SP - e71535 VL - 8 KW - home health care KW - artificial intelligence KW - AI KW - digital wound care KW - wound assessment KW - operational efficiency KW - clinical outcomes KW - healing time KW - cost saving KW - skilled nursing visits N2 - Background: The demand for home health care and nursing visits has steadily increased, requiring significant allocation of resources for wound care. Many home health agencies operate below capacity due to clinician shortages, meeting only 61% to 70% of demand and frequently declining wound care referrals. Implementing artificial intelligence?powered digital wound care solutions (DWCSs) offers an opportunity to enhance wound care programs by improving scalability and effectiveness through better monitoring and risk identification. Objective: This study assessed clinical and operational outcomes across 14 home health branches that adopted a DWCS, comparing pre- and postadoption data and outcomes with 27 control branches without the technology. Methods: This pre-post comparative study analyzed clinical outcomes, including average days to wound healing, and operational outcomes, such as skilled nursing (SN) visits per episode (VPE) and in-home visit durations, during two 7-month intervals (from November to May in 2020-2021 and 2021-2022). Data were extracted from 14,278 patients who received wound care across adoption and control branches. Projected cost savings were also calculated based on reductions in SN visits. Results: The adoption branches showed a 4.3% reduction in SN VPE and a 2.5% reduction in visit duration, saving approximately 309 staff days. In contrast, control branches experienced a 4.5% increase in SN VPE and a 2.2% rise in visit duration, adding 42 days. Healing times improved significantly in the adoption branches, with a reduction of 4.3 days on average per wound compared to 1.6 days in control branches (P<.001); pressure injuries, venous ulcers, and surgical wounds showed the most substantial improvements. Conclusions: Integrating digital wound management technology enhances clinical outcomes, operational efficiencies, and cost savings in home health settings. A reduction of 0.3 SN VPE could generate annual savings of up to US $958,201 across the organization. The adoption branches avoided 1187 additional visits during the study period. If control branches had implemented the DWCS and achieved similar outcomes, they would have saved 18,546 healing days. These findings emphasize the importance of incorporating DWCSs into wound care programs to address increasing demands, clinician shortages, and rising health care costs while maintaining positive clinical outcomes. UR - https://nursing.jmir.org/2025/1/e71535 UR - http://dx.doi.org/10.2196/71535 UR - http://www.ncbi.nlm.nih.gov/pubmed/40198913 ID - info:doi/10.2196/71535 ER - TY - JOUR AU - Thorup, Brun Charlotte AU - Uitto, Mika AU - Butler-Henderson, Kerryn AU - Wamala-Andersson, Sarah AU - Hoffrén-Mikkola, Merja AU - Schack Thoft, Diana AU - Korsbakke Emtekær Hæsum, Lisa AU - Irrazabal, Gabriela AU - Pruneda González, Laura AU - Valkama, Katja PY - 2025/4/8 TI - Choosing the Best Digital Health Literacy Measure for Research: Mixed Methods Study JO - J Med Internet Res SP - e59807 VL - 27 KW - digital health literacy KW - digital literacy KW - Horizon Europe KW - EU KW - health technology KW - life expectancy KW - health literacy KW - chronic disease KW - digitalization KW - digital health service KW - digital health intervention KW - technology KW - healthcare N2 - Background: The global demographic shift towards longer life expectancy and complex health needs is increasing the number of people with chronic diseases, placing pressure on health and care systems. With the digitalization of healthcare, digital Health Literacy (dHL), or the use of digital skills in health, is gaining importance. It involves navigating digital health information, using digital tools effectively, and making informed health decisions. Measuring dHL can help identify gaps and develop strategies to improve dHL and health, ensuring citizens equal opportunity to participate in a digital healthcare system. The European project ?The Improving Digital Empowerment for Active and Healthy Living (IDEAHL)? with the objective to empower European Union citizens to use digital instruments to take a more active role in managing their health and well-being creates the base for this overview Objective: This paper aims to conduct an overview of existing assessment tools for measuring dHL and recommend strategies for choosing relevant assessment tools. Methods: This study was carried out as a mixed method study initiated by a scoping review (10 scientific databases, 14 databases with grey literature and 14 predefined reports) in addition to three papers published after finalisations the literature search in IDEAHL, followed by a qualitative workshop study and a final analysis combining results. Results: The literature search resulted in 33 papers on dHL instruments, that was analyzed together with three recently published reviews and findings from a workshop with 13 champions (understood as professionals with expertise in HL and dHL) from five countries (Spain, Denmark, Sweden, Australia, and Germany) representing the health sector or health literacy research. Future tools should adapt to the latest trends and technologies, considering attitudes towards digital health and trust in its services. They should identify beneficiaries of digital health services, measure the impact of dHL interventions, and objectively evaluate functional skills. These tools should be evidence-based, validate instruments, interpret dHL results, and capture diverse experiences to reveal health behaviour changes. Conclusions: The eHealth Literacy Scale (eHEALS), despite being the most frequently utilized tool, has limitations in scope and adaptability. Future tools need to reflect digital trends, encompassing individual skills. However, it is important to note that the ?adequacy? of dHL is context-specific and relies on healthcare systems and the technology provided, particularly the user interface. The focus should be on health improvement, not just elevating dHL levels. A comprehensive approach to dHL assessments addressing diversity and relevance is crucial. Ethical considerations in dHL, including privacy and data security, are important due to potential feelings of shame among those with low literacy levels. UR - https://www.jmir.org/2025/1/e59807 UR - http://dx.doi.org/10.2196/59807 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59807 ER - TY - JOUR AU - Zheng, Rui AU - Jiang, Xiao AU - Shen, Li AU - He, Tianrui AU - Ji, Mengting AU - Li, Xingyi AU - Yu, Guangjun PY - 2025/4/7 TI - Investigating Clinicians? Intentions and Influencing Factors for Using an Intelligence-Enabled Diagnostic Clinical Decision Support System in Health Care Systems: Cross-Sectional Survey JO - J Med Internet Res SP - e62732 VL - 27 KW - artificial intelligence KW - clinical decision support systems KW - task-technology fit KW - technology acceptance model KW - perceived risk KW - performance expectations KW - intention to use N2 - Background: An intelligence-enabled clinical decision support system (CDSS) is a computerized system that integrates medical knowledge, patient data, and clinical guidelines to assist health care providers make clinical decisions. Research studies have shown that CDSS utilization rates have not met expectations. Clinicians? intentions and their attitudes determine the use and promotion of CDSS in clinical practice. Objective: The aim of this study was to enhance the successful utilization of CDSS by analyzing the pivotal factors that influence clinicians? intentions to adopt it and by putting forward targeted management recommendations. Methods: This study proposed a research model grounded in the task-technology fit model and the technology acceptance model, which was then tested through a cross-sectional survey. The measurement instrument comprised demographic characteristics, multi-item scales, and an open-ended query regarding areas where clinicians perceived the system required improvement. We leveraged structural equation modeling to assess the direct and indirect effects of ?task-technology fit? and ?perceived ease of use? on clinicians? intentions to use the CDSS when mediated by ?performance expectation? and ?perceived risk.? We collated and analyzed the responses to the open-ended question. Results: We collected a total of 247 questionnaires. The model explained 65.8% of the variance in use intention. Performance expectations (?=0.228; P<.001) and perceived risk (?=?0.579; P<.001) were both significant predictors of use intention. Task-technology fit (?=?0.281; P<.001) and perceived ease of use (?=?0.377; P<.001) negatively affected perceived risk. Perceived risk (?=?0.308; P<.001) negatively affected performance expectations. Task-technology fit positively affected perceived ease of use (?=0.692; P<.001) and performance expectations (?=0.508; P<.001). Task characteristics (?=0.168; P<.001) and technology characteristics (?=0.749; P<.001) positively affected task-technology fit. Contrary to expectations, perceived ease of use (?=0.108; P=.07) did not have a significant impact on use intention. From the open-ended question, 3 main themes emerged regarding clinicians? perceived deficiencies in CDSS: system security risks, personalized interaction, seamless integration. Conclusions: Perceived risk and performance expectations were direct determinants of clinicians? adoption of CDSS, significantly influenced by task-technology fit and perceived ease of use. In the future, increasing transparency within CDSS and fostering trust between clinicians and technology should be prioritized. Furthermore, focusing on personalized interactions and ensuring seamless integration into clinical workflows are crucial steps moving forward. UR - https://www.jmir.org/2025/1/e62732 UR - http://dx.doi.org/10.2196/62732 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62732 ER - TY - JOUR AU - Karschuck, Philipp AU - Groeben, Christer AU - Koch, Rainer AU - Krones, Tanja AU - Neisius, Andreas AU - von Ahn, Sven AU - Klopf, Peter Christian AU - Weikert, Steffen AU - Siebels, Michael AU - Haseke, Nicolas AU - Weissflog, Christian AU - Baunacke, Martin AU - Thomas, Christian AU - Liske, Peter AU - Tosev, Georgi AU - Benusch, Thomas AU - Schostak, Martin AU - Stein, Joachim AU - Spiegelhalder, Philipp AU - Ihrig, Andreas AU - Huber, Johannes PY - 2025/4/7 TI - Urologists? Estimation of Online Support Group Utilization Behavior of Their Patients With Newly Diagnosed Nonmetastatic Prostate Cancer in Germany: Predefined Secondary Analysis of a Randomized Controlled Trial JO - J Med Internet Res SP - e56092 VL - 27 KW - peer support KW - prostate cancer KW - online support KW - health services research KW - randomized controlled trial KW - decision aid N2 - Background: Due to its high incidence, prostate cancer (PC) imposes a burden on Western societies. Individualized treatment decision for nonmetastatic PC (eg, surgery, radiation, focal therapy, active surveillance, watchful waiting) is challenging. The range of options might make affected persons seek peer-to-peer counseling. Besides traditional face-to-face support groups (F2FGs), online support groups (OSGs) became important, especially during COVID-19. Objective: This study aims to investigate utilization behavior and physician advice concerning F2FGs and OSGs for patients with newly diagnosed PC. We hypothesized greater importance of OSGs to support treatment decisions. We assumed that this form of peer-to-peer support is underestimated by the treating physicians. We also considered the effects of the COVID-19 pandemic. Methods: This was a secondary analysis of data from a randomized controlled trial comparing an online decision aid versus a printed brochure for patients with nonmetastatic PC. We investigated 687 patients from 116 urological practices throughout Germany before primary treatment. Of these, 308 were included before and 379 during the COVID-19 pandemic. At the 1-year follow-up visit, patients filled an online questionnaire about their use of traditional or online self-help, including consultation behaviors or attitudes concerning initial treatment decisions. We measured secondary outcomes with validated questionnaires such as Distress Thermometer and the Patient Health Questionnaire-4 items to assess distress, anxiety, and depression. Physicians were asked in a paper-based questionnaire whether patients had accessed peer-to-peer support. Group comparisons were made using chi-square or McNemar tests for nominal variables and 2-sided t tests for ordinally scaled data. Results: Before COVID-19, 2.3% (7/308) of the patients attended an F2FG versus none thereafter. The frequency of OSG use did not change significantly: OSGs were used by 24.7% (76/308) and 23.5% (89/308) of the patients before and during COVID-19, respectively. OSG users had higher levels of anxiety and depression; 38% (46/121) reported OSG as helpful for decision-making. Although 4% (19/477) of OSG nonusers regretted treatment decisions, only 0.7% (1/153) of OSG users did (P=.03). More users than nonusers reported that OSGs were mentioned by physicians (P<.001). Patients and physicians agreed that F2FGs and OSGs were not mentioned in conversations or visited by patients. For 86% (6/7) of the patients, the physician was not aware of F2FG attendance. Physicians underestimated OSG usage by 2.6% (18/687) versus 24% (165/687) of actual use (P<.001). Conclusions: Physicians are more aware of F2FGs than OSGs. Before COVID-19, F2FGs played a minor role. One out of 4 patients used OSGs. One-third considered them helpful for treatment decision-making. OSG use rarely affects the final treatment decision. Urologists significantly underestimate OSG use by their patients. Peer-to-peer support is more likely to be received by patients with anxiety and depression. Comparative interventional trials are needed to recommend peer-to-peer interventions for suitable patients. Trial Registration: German Clinical Trials Register DRKS-ID DRKS00014627; https://drks.de/search/en/trial/DRKS00014627 UR - https://www.jmir.org/2025/1/e56092 UR - http://dx.doi.org/10.2196/56092 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56092 ER - TY - JOUR AU - Song, Jiafeng AU - Sridhar, Iytha Rishika AU - Rogers, Marie Darlene AU - Hiddleson, Cheryl AU - Davis, Carolyn AU - Holden, Lynn Tina AU - Ramsey-Haynes, Shanna AU - Reif, Lisa AU - Swann, Julie AU - Jabaley, S. Craig AU - Gullatte, Mary AU - Kamaleswaran, Rishikesan PY - 2025/3/28 TI - Clinicians? Perceptions and Potential Applications of Robotics for Task Automation in Critical Care: Qualitative Study JO - J Med Internet Res SP - e62957 VL - 27 KW - robotics KW - intensive care units KW - critical care KW - health care technology KW - qualitative study N2 - Background: Interest in integrating robotics within intensive care units (ICUs) has been propelled by technological advancements, workforce challenges, and heightened clinical demands, including during the COVID-19 pandemic. The integration of robotics in ICUs could potentially enhance patient care and operational efficiency amid existing challenges faced by health care professionals, including high workload and decision-making complexities. Objective: This qualitative study aimed to explore ICU clinicians? perceptions of robotic technology and to identify the types of tasks that might benefit from robotic assistance. We focused on the degree of acceptance, perceived challenges, and potential applications for improving patient care in 5 Southeastern US hospitals between January and August 2023. Methods: A qualitative study through semistructured interviews and questionnaires was conducted with 15 ICU clinicians (7 nurses, 6 physicians, and 2 advanced practice providers) from 5 hospitals in the Southeast United States. Directed content analysis was used to categorize and interpret participants? statements, with statistical tests used to examine any role-based differences in how they viewed robotic integration. Results: Among the 15 participants, 73% (11/15) were female, with an average of 6.4 (SD 6.3) years of ICU experience. We identified 78 distinct tasks potentially suitable for robotic assistance, of which 50 (64%) involved direct patient care (eg, repositioning patients and assisting with simple procedures), 19 (24%) concerned indirect patient care (eg, delivering supplies and cleaning), 6 (8%) addressed administrative tasks (eg, answering call lights), and 3 (4%) were classified as mixed direct and indirect (eg, sitting with a patient to keep them calm). Most participants supported the automation of routine, noncritical tasks (eg, responding to nurse calls and measuring glucose levels), viewing this strategy as a way to alleviate workload and enhance efficiency. Conversely, high-complexity tasks requiring nuanced clinical judgment (eg, ventilator settings) were deemed unsuitable for full automation. Statistical analysis revealed no significant difference in how nurses, physicians, and advanced practice providers perceived these tasks (P=.22). Conclusions: Our findings indicate a significant opportunity to use robotic systems to perform noncomplex tasks in ICUs, thereby potentially improving efficiency and reducing staff burden. Clinicians largely view robots as supportive tools rather than substitutes for human expertise. However, concerns persist regarding privacy, patient safety, and the loss of human touch, particularly for tasks requiring high-level clinical decision-making. Future research should involve broader, more diverse clinician samples and investigate the long-term impact of robotic assistance on patient outcomes while also incorporating patient perspectives to ensure ethical, patient-centered adoption of robotic technology. UR - https://www.jmir.org/2025/1/e62957 UR - http://dx.doi.org/10.2196/62957 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62957 ER - TY - JOUR AU - Norberg, Lønnebakke Børge AU - Austad, Bjarne AU - Kristiansen, Eli AU - Zanaboni, Paolo AU - Getz, Okkenhaug Linn PY - 2025/3/27 TI - The Dynamics of Doctor-Patient Communication During Remote Consultations: Qualitative Study Among Norwegian Contract General Practitioners JO - J Med Internet Res SP - e57679 VL - 27 KW - remote consultations KW - digital consultations KW - telemedicine KW - eHealth KW - communication KW - safety KW - general practice KW - family medicine KW - focus groups KW - telehealth KW - digital health KW - relationship KW - patient-physician KW - general practitioner KW - thematic analysis KW - qualitative analysis N2 - Background: Patient consultations in general practice are undergoing a digital transformation, embracing diverse modalities such as video, text-based, and telephone consultations. The quality of communication in medical consultations is pivotal for successful outcomes, necessitating a comprehensive assessment of the impact of this transformation on doctor-patient communication and interaction. Objective: This study aims to explore general practitioners? (GPs?) perspectives on how the communication between Norwegian contract GPs and patients has been affected by the large-scale implementation of remote consultations following the onset of the COVID-19 pandemic. Methods: Five focus groups, comprising 18 purposefully recruited GPs from diverse settings and geographical regions in Norway, were carried out in 2022. We applied thematic analysis guided by the framework proposed by Braun and Clarke. Results: Six themes resulted from the analysis. First, suitability regarding remote communication is context-dependent: knowing the characteristics of the patient as a person and the clinical relationship is more important than the reason for contact or type of health problem?even more so than during ordinary physical consultations. Second, remote consultations favor a demarcated communication style, ?keeping things simple?the one-problem approach,? which can increase work effectiveness. Third, a downside of such effective minimalism is that the uncritical use of remote consultations may undermine the quality of care. Communication becomes too transactional, limiting the chances of addressing more implicit and complex issues, with the risk of missing vital information. Fourth, remote modalities can help engage hesitant and vulnerable patients. Fifth, GPs make communicative trade-offs in the name of continuity to be able to maintain relationships with patients they see as vulnerable or fugitive. Finally, there are advantages and dilemmas stemming from text-based consultations. Although they offer benefits such as multimedia-enabled patient expression and sharing of digital information, some concerns include the risk of information loss through triage errors, managing informal language, and ending chat-like interactions between patients and doctors. Conclusions: The implementation of remote consultations has many effects on clinical interaction and communication. Although these modalities can enhance efficiency, there is a discernible risk of compromised retrieval of essential information and unvoiced problems, potentially resulting in unintended consequences. The preservation of continuity of care emerges as a pivotal strategy to mitigate some of these challenges. UR - https://www.jmir.org/2025/1/e57679 UR - http://dx.doi.org/10.2196/57679 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57679 ER - TY - JOUR AU - Immel, Diana AU - Hilpert, Bernhard AU - Schwarz, Patricia AU - Hein, Andreas AU - Gebhard, Patrick AU - Barton, Simon AU - Hurlemann, René PY - 2025/3/26 TI - Patients? and Health Care Professionals? Expectations of Virtual Therapeutic Agents in Outpatient Aftercare: Qualitative Survey Study JO - JMIR Form Res SP - e59527 VL - 9 KW - socially interactive agent KW - e-mental health KW - mental illness KW - mental disorder KW - depression KW - major depressive disorder KW - suicide prevention KW - suicidal ideation KW - outpatient aftercare KW - artificial intelligence KW - virtual therapeutic assistant KW - public health KW - digital technology KW - digital intervention KW - digital health care N2 - Background: Depression is a serious mental health condition that can have a profound impact on the individual experiencing the disorder and those providing care. While psychotherapy and medication can be effective, there are gaps in current approaches, particularly in outpatient care. This phase is often associated with a high risk of relapse and readmission, and patients often report a lack of support. Socially interactive agents represent an innovative approach to the provision of assistance. Often powered by artificial intelligence, these virtual agents can interact socially and elicit humanlike emotions. In health care, they are used as virtual therapeutic assistants to fill gaps in outpatient aftercare. Objective: We aimed to explore the expectations of patients with depression and health care professionals by conducting a qualitative survey. Our analysis focused on research questions related to the appearance and role of the assistant, the assistant-patient interaction (time of interaction, skills and abilities of the assistant, and modes of interaction) and the therapist-assistant interaction. Methods: A 2-part qualitative study was conducted to explore the perspectives of the 2 groups (patients and care providers). In the first step, care providers (n=30) were recruited during a regional offline meeting. After a short presentation, they were given a link and were asked to complete a semistructured web-based questionnaire. Next, patients (n=20) were recruited from a clinic and were interviewed in a semistructured face-to-face interview. Results: The survey findings suggested that the assistant should be a multimodal communicator (voice, facial expressions, and gestures) and counteract negative self-evaluation. Most participants preferred a female assistant or wanted the option to choose the gender. In total, 24 (80%) health care professionals wanted a selectable option, while patients exhibited a marked preference for a female or diverse assistant. Regrading patient-assistant interaction, the assistant was seen as a proactive recipient of information, and the patient as a passive one. Gaps in aftercare could be filled by the unlimited availability of the assistant. However, patients should retain their autonomy to avoid dependency. The monitoring of health status was viewed positively by both groups. A biofeedback function was desired to detect early warning signs of disease. When appropriate to the situation, a sense of humor in the assistant was desirable. The desired skills of the assistant can be summarized as providing structure and emotional support, especially warmth and competence to build trust. Consistency was important for the caregiver to appear authentic. Regarding the assistant?care provider interaction, 3 key areas were identified: objective patient status measurement, emergency suicide prevention, and an information tool and decision support system for health care professionals. Conclusions: Overall, the survey conducted provides innovative guidelines for the development of virtual therapeutic assistants to fill the gaps in patient aftercare. UR - https://formative.jmir.org/2025/1/e59527 UR - http://dx.doi.org/10.2196/59527 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59527 ER - TY - JOUR AU - Hood, Carol AU - Hunt, Sally AU - Metse, P. Alexandra AU - Hodder, K. Rebecca AU - Colyvas, Kim AU - Sheather-Reid, Rachel AU - Duerden, David AU - Bowman, Jenny PY - 2025/3/26 TI - Use of e-Mental Health Tools for Suicide Prevention in Clinical Practice by Mental Health Professionals in NSW, Australia: Cross-Sectional Survey JO - J Med Internet Res SP - e64746 VL - 27 KW - suicide prevention KW - digital mental health KW - mental health professionals KW - peer support KW - internet KW - mobile apps KW - clinical practice KW - cross-sectional survey KW - Australia KW - e-mental health tools N2 - Background: Suicide is a significant global health concern. In the context of increased demand for mental health services and workforce shortages, exacerbated by the COVID-19 pandemic, electronic mental health (eMH) tools represent a promising means of augmenting mental health care generally and for suicide prevention specifically. A significant research gap exists however with respect to the use and uptake of eMH tools, especially electronic mental health tools for suicide prevention (eMH-SP). Objective: This study aimed to investigate the use of eMH tools by Australian mental health professionals, both in general and with respect to suicide prevention specifically, examining changes in use since COVID-19. Further, it explored factors associated with frequent use of eMH-SP, including sociodemographic and professional characteristics. Methods: A web-based cross-sectional survey was conducted across 15 local health districts (LHDs) in New South Wales, Australia, from May 2022 to July 2023. The sample was drawn from over 10,000 mental health professionals working in government services statewide. The survey explored the use of electronic mental health tools for general mental health issues (eMH-gen) and eMH-SP, explored the changes in the use of both since COVID-19, and used multivariable logistic regression to identify factors associated with the current use of eMH-SP. Results: Among 469 participants, increased use since COVID-19 was reported by over half (247/469, 52.7%) for eMH-gen, and by approximately one-third (141/386, 36.6%) for eMH-SP. The proportion reporting frequent use increased significantly from before to after COVID-19 for both eMH-gen (243/469, 51.8% to 283/469, 60.3%; P<.001) and eMH-SP (152/386, 39.4% to 170/385, 44.2%; P=.01). Since COVID-19, the most frequently used types of eMH tools for eMH-gen and eMH-SP, respectively, were information sites (231/469, 49.3% and 130/385, 33.8%), phone/online counseling (173/469, 36.9% and 130/385, 33.8%), and apps (145/469, 30.9% and 107/385, 27.8%). Professionals more likely to use eMH-SP frequently were females (odds ratio [OR] 3.32, 95% CI 1.88-5.87; P<.001) compared with males; peer workers (OR 2.17, 95% CI 1.0-4.71; P<.001) compared with nurses; those located in regional/rural LHDs (OR 1.65, 95% CI 1.04-2.61; P=.03) compared with metropolitan LHDs; and those practicing in emergency health care settings (OR 8.31, 95% CI 2.17-31.75; P=.03) compared with inpatient settings. Conclusions: The study?s findings highlight the increasing adoption of eMH tools and delivery of remote care by mental health professionals and provide valuable new insights into sociodemographic factors associated with the use of eMH for suicide prevention specifically. Continued research on the role eMH is playing is essential for guiding policy, optimizing resources, and enhancing mental health care and suicide prevention efforts. UR - https://www.jmir.org/2025/1/e64746 UR - http://dx.doi.org/10.2196/64746 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64746 ER - TY - JOUR AU - Zhou, Xu-Hua AU - Chen, Hui AU - Yang, Weiwei AU - Wang, Li AU - Chen, Lin AU - Zhu, Ying AU - Zhang, Yingjun AU - Shi, Mei AU - Zhang, Qin PY - 2025/3/26 TI - Efficacy of eHealth Interventions for Hemodialysis Patients: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e67246 VL - 27 KW - hemodialysis KW - eHealth interventions KW - quality of life KW - treatment adherence KW - anxiety KW - depression KW - meta-analysis KW - kidney KW - systematic review KW - kidney diseases KW - kidney function KW - chronic diseases N2 - Background: Within hemodialysis patient populations, eHealth interventions have been considered as an alternative and complementary option to routine care services. However, the efficacy of eHealth interventions for hemodialysis patients remains poorly understood owing to a lack of rigorous quantitative evidence synthesis. Objective: This meta-analysis aimed to evaluate the efficacy of eHealth interventions in improving quality of life, treatment adherence, and psychological outcomes (anxiety and depression) among hemodialysis patients. In addition, the study sought to identify specific intervention components and methodological quality associated with enhanced quality of life and health outcomes in this population. Methods: A comprehensive search was performed across PubMed, Web of Science, Embase, CINAHL, Cochrane Library, PsycINFO, China National Knowledge Infrastructure, WanFang, China Science and Technology Journal Database, and China BioMedical Literature Database databases from their inception to September 7, 2024. Randomized controlled trials on eHealth interventions for hemodialysis patients published in English or Chinese were included. Critical appraisal was carried out independently by 2 reviewers to assess the bias risk of the studies included. Quantitative synthesis of the outcomes of interest was conducted using a random-effects model. The quality of evidence for the outcomes was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: A total of 17 randomized controlled trials involving 1728 participants were included in this meta-analysis out of 5741 articles identified in the initial database search and additional search references. In the 17 studies, 8 kinds of eHealth intervention delivery formats were used, including text messages, telephone sessions, video, network platforms, social media, computers, websites, and mobile apps. The majority of research studies used a single form of eHealth intervention, and 7 studies adopted a combined approach of 2 or more eHealth technologies. The duration of eHealth interventions demonstrated substantial variability across studies, spanning from 4 weeks to 12 months, of which 3 months was the most common. A total of 14 (82%) studies were considered to have ?some concern? about selection bias. In addition, 15 (88%) trials were classified as having a ?high risk? of performance and detection bias, and all trials were judged to be at ?low risk? of attrition and reporting bias. The pooled results revealed a significant difference between the eHealth interventions and control groups on quality of life (standardized mean difference [SMD]=0.87, 95?% CI 0.38 to 1.37, low certainty evidence), treatment adherence (SMD=1.11, 95?% CI 0.30 to 1.91, moderate certainty evidence), anxiety (SMD=?2.11, 95?% CI ?3.25 to ?0.97, moderate certainty evidence), and depression (SMD=?2.46, 95?% CI ?3.68 to ?1.25, moderate certainty evidence). Conclusions: eHealth interventions could be a beneficial approach for improving quality of life and treatment adherence and reducing anxiety and depression among hemodialysis patients. However, future high-quality randomized controlled trials are essential to draw more reliable conclusions. Trial Registration: PROSPERO CRD42024589799; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024589799 UR - https://www.jmir.org/2025/1/e67246 UR - http://dx.doi.org/10.2196/67246 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67246 ER - TY - JOUR AU - Lin, Chih-Yuan AU - Liu, Chih-Ching AU - Huang, Yu-Tung AU - Lee, Yue-Chune PY - 2025/3/25 TI - Policy Spotlight Effects on Critical Time-Sensitive Diseases: Nationwide Retrospective Cohort Study on Taiwan?s Hospital Emergency Capability Categorization Policy JO - Interact J Med Res SP - e54651 VL - 14 KW - categorization of hospital emergency capability KW - quality KW - time-sensitive diseases KW - emergency care KW - difference-in-differences N2 - Background: Taiwan?s categorization of hospital emergency capability (CHEC) policy is designed to regionalize and dispatch critical patients. The policy was designed in 2009 to improve the quality of emergency care for critical time-sensitive diseases (CTSDs). The CHEC policy primarily uses time-based quality surveillance indicators. Objective: We aimed to investigate the impact of Taiwan?s CHEC policy on CTSDs. Methods: Using Taiwan?s 2005 Longitudinal Health Insurance Database, this nationwide retrospective cohort study examined the CHEC policy?s impact from 2005 to 2011. Propensity score matching and difference-in-differences analysis within a generalized estimating equation framework were used to compare pre- and postimplementation periods. The study focused on acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), septic shock, and major trauma. AIS and STEMI cases, monitored with time-based indicators, were evaluated for adherence to diagnostic and treatment guidelines as process quality measures. Mortality and medical use served as outcome indicators. Major trauma, with evolving guidelines and no time-based monitoring, acted as a control to test for policy spotlight effects. Results: In our cohort of 9923 patients, refined through 1:1 propensity score matching, 5566 (56.09%) were male and were mostly older adults. Our analysis revealed that the CHEC policy effectively improved system efficiency and patient outcomes, resulting in significant reductions in medical orders (?7.29 items, 95% CI ?10.09 to ?4.48; P<.001), short-term mortality rates (?0.09%, 95% CI ?0.17% to ?0.02%; P=.01) and long-term mortality rates (?0.09%, 95% CI ?0.15% to ?0.04%; P=.001), and total medical expenses (?5328.35 points per case, 95% CI ?10,387.10 to ?269.60; P=.04), despite a modest increase in diagnostic fees (376.37 points, 95% CI 92.42-660.33; P=.01). The CHEC policy led to notable increases in diagnostic fees, major treatments, and medical orders for AIS and STEMI cases. For AIS cases, significant increases were observed in major treatments (?=0.77; 95% CI 0.21-1.33; P=.007) and medical orders (?=15.20; 95% CI 5.28-25.11; P=.003) compared to major trauma. In STEMI cases, diagnostic fees significantly increased (?=1983.75; 95% CI 84.28-3883.21; P=.04), while upward transfer rates significantly decreased (?=?0.59; 95% CI ?1.18 to ?0.001; P=.049). There were also trends toward increased major treatments (?=0.30; 95% CI ?0.03 to 0.62, P=.07), medical orders (?=11.92; 95% CI ?0.90 to 24.73; P=.07), and medical expenses (?=24,275.54; 95% CI ?640.71 to 4,991,991.78; P=.06), although these were not statistically significant. In contrast, no significant changes were identified in process or outcome quality indicators for septic shock. These findings suggest policy spotlight effects, reflecting a greater emphasis on diseases directly prioritized under the CHEC policy. Conclusions: The CHEC policy demonstrated the dual benefits of reducing costs and improving patient outcomes. We observed unintended consequences of policy spotlight effects, which led to a disproportionate improvement in guideline adherence and process quality for CTSDs with time-based surveillance indicators. UR - https://www.i-jmr.org/2025/1/e54651 UR - http://dx.doi.org/10.2196/54651 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54651 ER - TY - JOUR AU - Holetzek, Tim AU - Häusler, Andreas AU - Gödde, Kathrin AU - Rapp, Michael AU - Spallek, Jacob AU - Holmberg, Christine PY - 2025/3/24 TI - The Role of the Installed Base in Information Exchange Among General Practitioners in Germany: Mixed Methods Study JO - J Med Internet Res SP - e65241 VL - 27 KW - digitalization KW - general practitioners KW - Germany KW - information and communication technologies KW - information exchange KW - primary health care KW - digital transformation KW - mixed methods study KW - digital health KW - health application KW - qualitative interview N2 - Background: Digitalization is steadily advancing on a global scale, exerting a profound influence on health care systems. To facilitate acceptance of the digital transformation, guiding principles emphasize the need for digital health structures to be person-centered and promote high-quality care. This paper examines the implementation challenges within the German health care system, with a particular focus on how change initiatives engage with existing infrastructures and organizational modes of health care delivery. This approach provides a framework for analyzing how established infrastructure determines new developments while also highlighting the procedural dynamics of change and the integration of innovations within existing information infrastructures. These established infrastructures are referred to as the installed base. Objective: The aim of the study is to examine the installed base encountered by the digital transformation within the German health care system by investigating information exchange practices among general practitioners (GPs) and their communication with other health care actors. Methods: A mixed methods study including a quantitative survey and semistructured qualitative interviews was conducted. The study sample consisted of all publicly accessible GP practices (N=1348) situated in the state of Brandenburg, Germany. The survey captured demographic data, communication practices, and perceived barriers to digitalization. The interviews explored experiences with digital applications. Quantitative data were analyzed using R (R Foundation for Statistical Computing), and qualitative data were managed and analyzed in MAXQDA (VERBI Software GmbH) through content analysis. Results: A total of 250 questionnaires (response rate 18.5%) and 10 interviews with GPs were included in the analysis. GPs primarily use the telephone (n=138, 55.2%, SD 24.64), fax (n=109, 43.9%, SD 25.40), or post (n=50, 20.2%, SD 9.46) to exchange information. Newer digital communication channels such as messenger applications (n=2, 0.8%, SD 0.72) and Communication in the Medical Sector (n=1, 0.5%, SD 0.97) play a minor role. We identified three intertwined clusters displaying diverse barriers to the digitalization of GPs? communication practices: (1) incompatibility issues and technical immaturity, (2) lack of knowledge and technical requirements, and (3) additional technical, financial, and time-related burdens. These barriers were perceived as significant deterrents to the adoption of digital tools, with older GPs more reliant on analog systems and more likely to view digitalization as a source of frustration. Conclusions: Newly established communication channels in the German health care system compete with the existing information infrastructure, which is deeply integrated into GPs? practice routines and care processes. However, this installed base has been largely overlooked in digital transformation initiatives. While newer channels hold potential, they often malfunction and are incompatible with long-established, individualized GP workflows. Addressing these issues rather than imposing coercive measures is crucial for increasing adoption. Incorporating health care providers? perspectives and aligning new channels with established routines can prevent frustration and facilitate a smoother digital transformation. UR - https://www.jmir.org/2025/1/e65241 UR - http://dx.doi.org/10.2196/65241 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65241 ER - TY - JOUR AU - Lazo-Porras, Maria AU - Tateishi-Serruto, Jose Francisco AU - Butler, Christopher AU - Cuba-Fuentes, Sofía María AU - Rossini-Vilchez, Daniela AU - Perez-Leon, Silvana AU - Lúcar-Flores, Miriam AU - Miranda, Jaime J. AU - Bernabe-Ortiz, Antonio AU - Diez-Canseco, Francisco AU - Moore, Graham AU - Landeiro, Filipa AU - Cardenas, Kathia Maria AU - Vera Tudela, Carlos Juan AU - White, Lee AU - Calvo, A. Rafael AU - Whiteley, William AU - Hawkins, Jemma AU - PY - 2025/3/21 TI - Assessment of Health System Readiness and Quality of Dementia Services in Peru: Protocol for a Qualitative Study With Stakeholder Interviews and Documentation Review JO - JMIR Res Protoc SP - e60296 VL - 14 KW - dementia KW - health system readiness KW - caregiver KW - comorbidities KW - Peru KW - study protocol KW - quality of care KW - comorbidity KW - patient journey KW - mHealth N2 - Background: Dementia is a global health priority with significant challenges due to its complex nature and increasing prevalence. Health systems worldwide struggle to address chronic conditions like dementia, often providing fragmented care. However, information about how health systems respond to the needs of people with dementia and their carers, and the quality of care provided, is scarce in low- and middle-income countries. Objective: This study aims to assess the quality of the health system to provide diagnosis and care for people with dementia and their carers in Peru. In order to do this, the study will explore the response of the Peruvian health system to people with dementia and their carers, and explore the experiences of people with dementia of receiving their diagnosis, management, and quality of care for this condition. Methods: This study is part of a research program called ?IMPACT Salud: Innovations using Mhealth for people with dementia and Co-morbidities,? aimed at strengthening health systems to provide care for people with dementia and their carers. The study has a descriptive, cross-sectional design that uses a qualitative methodology, including stakeholder interviews and documentation review, and consists of 2 substudies, a health system assessment (HSA) and an exploration of the patient journey. The first substudy uses an HSA methodology suitable for low- and middle-income countries, conducting 160 structured interviews with 12 different stakeholder types across 3 levels of the health system (micro, meso, and macro) in 4 Peruvian regions, each with distinct geographical and urbanization profiles. The second substudy uses a patient journey methodology, which involves conducting 40 in-depth interviews with people with dementia, carers, and health care workers from the same 4 regions. The insights into the people with dementia patient and caregiver experience within the health system from the interviews will be used to produce a patient journey map. The analysis will be guided by the high-quality health system framework, and the findings from the HSA and patient journey will be structured using the domains included in the framework through the lens of quality of services. Results: Data collection began in March 2024. As of the end of September 2024, a total of 156 interviews from the HSA and 38 interviews from the patient journey study have been conducted across 4 regions. Conclusions: This study will provide a national, multilevel insight into the current operation of the Peruvian health system, including an analysis of the quality of services provided with regard to dementia diagnosis, management, and care from the perspectives of stakeholders, patients, and their carers. International Registered Report Identifier (IRRID): DERR1-10.2196/60296 UR - https://www.researchprotocols.org/2025/1/e60296 UR - http://dx.doi.org/10.2196/60296 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60296 ER - TY - JOUR AU - Skjelvik, Alvhild AU - West, Nicholas AU - Görges, Matthias PY - 2025/3/19 TI - Identifying Contextual Factors That Shape Cybersecurity Risk Perception for Assisted Living and Health Care Technologies and Wearables: Mixed Methods Study JO - J Med Internet Res SP - e64388 VL - 27 KW - digital health KW - health care technology KW - cybersecurity KW - risk perception KW - health care stakeholders KW - contextual factors N2 - Background: Over the last decade, the health care technology landscape has expanded significantly, introducing new and innovative solutions to address health care needs. The implications of cybersecurity incidents in the health care context extend beyond data breaches to potentially harming individuals? health and safety. Risk perception is influenced by various contextual factors, contributing to cybersecurity concerns that technological safeguards alone cannot address. Thus, it is imperative to study risk perceptions, contextual factors, and technological benefits to guide policy development, risk management, education, and implementation strategies. Objective: This study aims to investigate the differences in cybersecurity risk perception among various stakeholders in the health care sector in Norway and British Columbia (BC), Canada, and identify specific contextual factors that shape these perceptions. We expect to identify differences in risk perceptions for the explored health care technologies. Methods: We used a mixed methods approach comprising surveys and semistructured interviews to sample health care?related wearable technology stakeholders, including health care workers, patients (adults and adolescents) and their families, health authorities and hospital staff (biomedical engineers, information technology support, research staff), and device vendors/industry professionals in Norway and BC. Surveys explored information security scenarios based on the Behavioral-Cognitive Internet Security Questionnaire (BCISQ), risk perception, and contextualizing variables. We analyzed both survey data sets to summarize participants? characteristics and responses to questions related to the BCISQ (behavior and attitude) and risk perception. Interviews were analyzed thematically using an inductive-deductive approach to explore risk perception and contextual factors. Results: Data from 274 survey respondents were available for analysis: 185 from Norway, including 139 (75.1%) females, and 89 from BC, including 57 (64%) females. A total of 45 respondents (31 in Norway and 14 in BC) participated in interviews. The BCISQ showed minor differences between locations; respondents demonstrated generally low-risk behavior and robust information security awareness. However, password simulation demonstrated discrepancies between self-assessed and ?real? behavior by sharing or willingness to share passwords. Perceived risk is generally considered low, yet consequences of cybersecurity risks were evaluated as major but unlikely. Risk perception was stronger for assisted living and diabetes technologies than for smartwatches. The most important contextual factors shaping risk perceptions are human factors encompassing knowledge, competence, familiarity, feelings of dread, perceived benefit, and trust, as well as the technological factor of device functionality. Organizational and technological factors had lesser effects. Conclusions: We found minimal differences in behavior and risk perception among Norwegian and BC participants. Human factors and device functionality were most influential in shaping cybersecurity risk perceptions. Considering the rising need for assisted living technologies and wearables, insights into risk perceptions can strengthen risk management, awareness, and competence building. Further, it can address potential concerns among stakeholders to enable quicker technology adoption. UR - https://www.jmir.org/2025/1/e64388 UR - http://dx.doi.org/10.2196/64388 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64388 ER - TY - JOUR AU - Valkonen, Paula AU - Hölsä, Sini AU - Viitanen, Johanna AU - Leinonen, Sini AU - Karisalmi, Nina AU - Rauta, Virpi PY - 2025/3/18 TI - Illustrating User Needs for eHealth With Experience Map: Interview Study With Chronic Kidney Disease Patients JO - JMIR Hum Factors SP - e48221 VL - 12 KW - user need KW - chronic illness KW - kidney disease KW - older adult KW - eHealth KW - experience map KW - human-centered design KW - home dialysis N2 - Background: Chronic kidney disease (CKD) is a common condition worldwide and home dialysis (HD) provides economic, quality of life, and clinical advantages compared to other dialysis modalities. Human-centered design aims to support the development of eHealth solutions with high usability and user experience. However, research on the eHealth needs of patients using HD is scarce. Objective: This study aimed to support the design of eHealth for patients with CKD, particularly for patients using HD, by developing a kidney disease experience map that illustrates user needs, concerns, and barriers. The research questions were (1) what experiences do patients, particularly older adults, have in their everyday lives with CKD? (2) what user needs do patients with CKD have for HD eHealth? (3) how can these needs be illustrated using the experience map technique? The study focused on patients aged >60 years, as they are at a higher risk of chronic conditions. The study was conducted as part of the eHealth in HD project, coordinated by Hospital District of Helsinki and Uusimaa, Finland. Methods: In total, 18 patients in different care modalities participated in retrospective interviews conducted between October 2020 and April 2021. The interviews included a preliminary task with patient journey illustrations and questions about their experiences and everyday lives with CKD. The data analysis was conducted using a thematic analysis approach and the process included several phases. Results: On the basis of the thematic analysis, 5 categories were identified: healthy habits, concerns about and barriers to eHealth use, digital communication, patients? emotions, and everyday life with CKD. These were illustrated in the first version of the kidney disease experience map. The patients had different healthy habits regarding social life, sports, and other activities. They had challenges with poorly functioning eHealth software and experienced other factors, such as a lack of interest and lack of skills for eHealth use. Technical devices do not always meet the emotional or physical needs of their users. This caused feelings of frustration, worry, and fear in patients, yet also fostered situational awareness and hope. Conclusions: The experience map is a promising method for illustrating user needs and communicating the patient?s voice for eHealth development. eHealth offers possibilities to support patient?s everyday life with chronic disease. The patient?s situation and capacity to use eHealth solutions vary with their everyday challenges, opportunities, and their current stage of treatment. The kidney disease experience map will be used and further developed in the ongoing research project ?Better Health at Home?Optimized Human-Centered Care of Predialysis and Home Dialysis Patients? (2022 to 2026). UR - https://humanfactors.jmir.org/2025/1/e48221 UR - http://dx.doi.org/10.2196/48221 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48221 ER - TY - JOUR AU - Li, Hongmin AU - Li, Dongxu AU - Zhai, Min AU - Lin, Li AU - Cao, ZhiHeng PY - 2025/3/14 TI - Associations Among Online Health Information Seeking Behavior, Online Health Information Perception, and Health Service Utilization: Cross-Sectional Study JO - J Med Internet Res SP - e66683 VL - 27 KW - online health information seeking (OHIS) KW - online health information perception (OHIP) KW - mediating effect KW - health service utilization KW - health information KW - health perception KW - data KW - China KW - Chinese General Social Survey (CGSS) KW - database KW - medical information KW - survey N2 - Background: Seeking online health information can empower individuals to better understand their health concerns, facilitating their ability to manage their health conditions more effectively. It has the potential to change the likelihood and frequency of health service usage. Although existing literature has demonstrated the prevalence of seeking online health information among different populations, the factors affecting online health information perception and discussions on the associations between seeking online health information and health service utilization are limited. Objective: We analyzed the associations between online health information seeking behavior and health service utilization, as well as the online health information perception delivery mechanism. Methods: We analyzed data from the Chinese General Social Survey, the first national representative survey conducted in mainland China. The independent variable was the online health information seeking behavior. The outcome variable was health service utilization by the respondents, and online health information perception was selected as the mediating variable in this analysis. Factor analysis was conducted to obtain online health information perception. Multiple regressions were performed to investigate the effect of online health information seeking behavior on physician visits. Bootstrap methods were conducted to test the mediation effects of online health information perception. Results: This analysis included 1475 cases. Among the participants, 939 (63.66%) sought online health information in the last 12 months. The mean age of the respondents was 46.72 (SD 15.86) years, and 794 (53.83%) were females. After controlling for other variables, individuals with online health information seeking behaviors showed 0.289 times more outpatient visits (P=.003), 0.131 times more traditional Chinese medicine outpatient visits (P=.01), and 0.158 times more Western medicine outpatient visits (P=.007) over the past year compared to those who did not seek health information online. Additionally, multiple regression analyses revealed statistically significant effects of gender, age, and health status on physician visits. The total effect revealed that seeking online health information significantly influenced the total physician visits (?=0.290; P=.003), indicating a certain correlation between online health information seeking behavior and physician visits. Seeking online health information had a significant positive impact on the perception (?=0.265; P<.001). The mediation effects analysis identified that online health information perception led to a significant increase in physician visits with the increase in the online health information seeking behaviors (?=0.232; P=.02). Conclusions: The online health information perception of an individual influences the effect online health information seeking has on the frequency of physician visits. The online health information seeking behavior impacts outpatient service utilization both directly and indirectly through online health information perception and significantly increases the frequency of clinic visits after controlling for other variables. Interventions can be explored to improve the health utilization of residents by increasing their online health information perception. UR - https://www.jmir.org/2025/1/e66683 UR - http://dx.doi.org/10.2196/66683 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66683 ER - TY - JOUR AU - Spierings, Jelle AU - Willinge, Gijs AU - Kokke, Marike AU - Repping, Sjoerd AU - de Lange, Wendela AU - Geerdink, Thijs AU - van Veen, Ruben AU - van der Velde, Detlef AU - Goslings, Carel AU - Twigt, Bas AU - PY - 2025/3/14 TI - Patient Experiences With a Mobile Self-Care Solution for Low-Complex Orthopedic Injuries: Mixed Methods Study JO - JMIR Hum Factors SP - e53074 VL - 12 KW - self-care application KW - mHealth KW - experience KW - traumasurgery KW - orthopedic surgery KW - virtual fracture clinic KW - patient perspective KW - direct discharge KW - musculoskeletal injury KW - mobile self-care KW - method study KW - health care system KW - hospital KW - mobile health KW - app KW - smartphone KW - satisfactory KW - effectiveness KW - treatment KW - virtual clinic KW - virtual care KW - digital health N2 - Background: The Dutch acute health care system faces challenges with limited resources and increasing patient numbers. To reduce outpatient follow-up, direct discharge (DD) has been implemented in over 30 out of 80 Dutch hospitals. With DD, no routine follow-up appointments are scheduled after the emergency department (ED) visit for low-complex, isolated, and stable musculoskeletal injuries. This policy is supported by information leaflets, a smartphone app, and a telephone helpline with human support. Growing evidence shows that DD is satisfactory, safe, and effective in reducing secondary health care use, but thorough patient experiences are lacking. Objective: The aim of this study was to explore the experiences of patients with DD to ensure durable adoption and to improve the treatment protocol. Methods: A mixed method study was conducted parallel to the implementation of DD in 3 hospitals. Data were collected through a survey directly after the ED visit, a survey 3 months post injury, and semistructured interviews. Quantitative data were reported descriptively, and qualitative data used thematic analysis. Outcomes included the Bowen feasibility parameters: implementation, acceptance, preliminary efficacy, and demand. All patients who consented to the study face-to-face with one of the 12 low-complex musculoskeletal injuries were included in the study during the implementation period. Results: Of the 429 patients who started the primary survey, 138 patients completed both surveys. A total of 18 semistructured interviews were conducted and analyzed. Patients reported a median treatment satisfaction score of 7.8 (IQR 6.6-8.8) on a 10-point scale of DD at the ED. Information quality was experienced as good (106/138, 77%), and most preferred DD over face-to-face follow-up (79/138, 59%). Patient information demands and app use varied among patients, with a median frequency of use of 4 times (ranging from 1 to 30). Conclusions: This study shows that patients consider DD a feasible and safe alternative to traditional treatment, with a favorable perception of its acceptability, efficacy, applicability, and demand. Nevertheless, response rates were relatively low, and personal nuances and preferences must be considered when implementing DD. Clinicians and policy makers can use the insights to improve DD and work towards the integration of DD into clinical practice and future guidelines. UR - https://humanfactors.jmir.org/2025/1/e53074 UR - http://dx.doi.org/10.2196/53074 ID - info:doi/10.2196/53074 ER - TY - JOUR AU - Hüer, Theresa AU - Walendzik, Anke AU - Kleinschmidt, Lara AU - Höfer, Klemens AU - Nauendorf, Beatrice AU - Malsch, Juliane AU - Brittner, Matthias AU - Brandenburg, Paul AU - Aeustergerling, André AU - Schneider, Udo AU - Wadeck, Anja AU - Liersch, Sebastian AU - Sehlen, Stephanie AU - Schwarze, Katharina AU - Wasem, Jürgen PY - 2025/3/14 TI - Use of Video Consultation Between 2017 and 2020 in Outpatient Medical Care in Germany and Characteristics of Their User Groups: Analysis of Claims Data JO - JMIR Form Res SP - e60170 VL - 9 KW - video consultation KW - outpatient medical care KW - user groups KW - claims data analysis KW - Germany KW - physician KW - psychotherapist KW - sociodemographic KW - healthcare KW - digital health KW - digital consultation KW - telehealth KW - telemonitoring KW - telemedicine N2 - Background: Supplementing outpatient medical care with the use of video consultations could, among other benefits, improve access, especially in structurally disadvantaged areas. Objective: This claims data analysis, carried out as part of the German research project ?Preference-based use of video consultation in urban and rural regions,? aimed to analyze the use of video consultations and the characteristics of its user groups. Methods: Claims data from 3 Statutory Health Insurance Funds (SHIFs) and 4 Associations of Statutory Health Insurance Physicians (ASHIPs) from the period April 2017 to the end of 2020 were used. Data from a sample of about 6.1 million insured and 33,100 physicians and psychotherapists were analyzed. In addition to data on the use of video consultations, patient data on sociodemographic characteristics, diagnoses, and place of residence were included. To analyze the physicians? perspectives, specialty groups, demographic characteristics, and the type of practice location were also included. In consideration of the principles of data economy and the fact that data analysis represents merely a preliminary phase within the broader project, the SHIFs and ASHIPs transmitted aggregated data (cross-tabulations per subgroup analysis) to the evaluator. For this reason, the analyses were constrained to a comparison of video consultation users versus nonusers, differentiated according to the aforementioned subgroups. Furthermore, the association between place of residence or type of region of the practice location and the use of video consultation was examined. A significance level of P<.05 was set for chi-square tests. Results: From 2017 to 2019, almost no video consultations were used in outpatient care in the German health care system. Although this changed considerably in relative terms with the start of the COVID-19 pandemic (but still at a very low absolute level), there was also a clear decline in the use of video consultations as the number of infections flattened out. Physicians working in psychotherapy and psychological psychotherapists used video consultations with around 16% (44,808/282,530) of their treatment cases in the second quarter of 2020, followed by psychotherapists using video consultations for children (10,828/113,293, 10%). Although the absolute number of treatment cases with video consultations among general practitioners was very high compared with other specialist groups, their share of video consultations in all treatment cases was very low at 0.3% (29,600/9,837,118). Younger age groups and those located in urban areas used video consultations more frequently; this applies to both patients (age groups: ?27=9903.2, P<.001; region types: ?22=3746.2, P<.001) and service providers (age groups: ?23=11,338.2, P<.001; region types: ?22=8474.1, P<.001). Conclusions: The current use of video consultations is below its potential in terms of scope and user groups. The widespread and lasting use of video consultations will only succeed if the potential user groups accept this form of service provision and recognize its advantages. Further analyses (both qualitative, such as focus group discussions, and quantitative, such as preference surveys) should therefore investigate the preferences of user groups for the use of video consultations. International Registered Report Identifier (IRRID): RR2-10.2196/50932 UR - https://formative.jmir.org/2025/1/e60170 UR - http://dx.doi.org/10.2196/60170 UR - http://www.ncbi.nlm.nih.gov/pubmed/40085136 ID - info:doi/10.2196/60170 ER - TY - JOUR AU - Gao, Yu AU - Magin, Parker AU - Tapley, Amanda AU - Holliday, Elizabeth AU - Dizon, Jason AU - Fisher, Katie AU - van Driel, Mieke AU - Davis, S. Joshua AU - Davey, Andrew AU - Ralston, Anna AU - Fielding, Alison AU - Moad, Dominica AU - Mulquiney, Katie AU - Clarke, Lisa AU - Turner, Alexandria PY - 2025/3/13 TI - Prevalence of Antibiotic Prescribing for Acute Respiratory Tract Infection in Telehealth Versus Face-to-Face Consultations: Cross-Sectional Analysis of General Practice Registrars? Clinical Practice JO - J Med Internet Res SP - e60831 VL - 27 KW - antimicrobial resistance KW - antibiotics stewardship KW - telehealth KW - general practice KW - registrars KW - acute respiratory tract infection KW - antibiotics KW - prescription KW - respiratory tract infection KW - RTIs KW - Australia KW - consultations KW - teleconsultation KW - teleconsult KW - bronchitis KW - sore throat KW - acute otitis KW - sinusitis KW - in-consultation KW - upper respiratory tract infection N2 - Background: Antimicrobial resistance is a global threat. Australia has high antibiotic prescribing rates with the majority of antibiotics prescribed by general practitioners (GPs) for self-limiting acute respiratory tract infection (ARTIs). Australian GP trainees? (registrars?) prescribing for ARTIs may have been affected by the introduction of remunerated telehealth consultations in 2020. Understanding of the impact of telehealth on antibiotic stewardship may inform registrar educational programs. Objective: This study aimed to compare the prevalence of antibiotic prescribing by GP registrars in telehealth versus face-to-face (F2F) consultations for common cold (upper respiratory tract infection [URTI]), bronchitis, sore throat, acute otitis media, and sinusitis. Methods: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, a multicenter inception cohort study of registrars? in-consultation clinical and educational experiences. Analysis used univariable and multivariable logistic regression using 2020-2023 ReCEnT data. The outcome variable was ?antibiotic prescribed? for new presentations of URTI, acute sore throat, acute bronchitis, acute sinusitis, and acute otitis media. The study factor was consultation type (telehealth or F2F). Results: A total of 2392 registrars participated (response rate=93.4%). The proportions of diagnoses that were managed via telehealth were 25% (5283/21384) overall, 19% (641/3327) for acute sore throat, 29% (3733/12773) for URTI, 21% (364/1772), for acute bronchitis, 4.1% (72/1758) for acute otitis media, and 27% (473/1754) for acute sinusitis. Antibiotics were prescribed for 51% (1685/3327) of sore throat diagnoses, 6.9% (880/12773) of URTI diagnoses, 64% (1140/1772) of bronchitis diagnoses, 61% (1067/1754) of sinusitis diagnoses, and 73% (1278/1758) of otitis media diagnoses. On multivariable analysis, antibiotics were less often prescribed in telehealth than F2F consultations for sore throat (adjusted odds ratio [OR] 0.69, 95% CI 0.55-0.86; P=.001), URTI (adjusted OR 0.64, 95% CI 0.51-0.81; P<.001), and otitis media (adjusted OR 0.47, 95% CI 0.26-0.84; P=.01). There were no significant differences for acute bronchitis (adjusted OR 1.07, 95% CI 0.79-1.45; P=.66) or acute sinusitis (adjusted OR 1, 95% CI 0.76-1.32; P=.99). Conclusions: GP registrars are less likely to prescribe antibiotics for sore throat, URTI, and otitis media when seeing patients by telehealth versus F2F. Understanding the reason for this difference is essential to help guide educational efforts aimed at decreasing antibiotic prescribing by GPs for conditions such as ARTIs where they are of little to no benefit. There was no evidence in this study that telehealth consultations were associated with greater registrar antibiotic prescribing for ARTIs. Therefore, there is no deleterious effect on antibiotic stewardship. UR - https://www.jmir.org/2025/1/e60831 UR - http://dx.doi.org/10.2196/60831 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60831 ER - TY - JOUR AU - Zupa, Margaret AU - Hamm, Megan AU - Alexander, Lane AU - Rosland, Ann-Marie PY - 2025/3/11 TI - Patient and Clinician Perspectives on the Effectiveness of Current Telemedicine Approaches in Endocrinology Care for Type 2 Diabetes: Qualitative Study JO - JMIR Diabetes SP - e60765 VL - 10 KW - diabetes KW - telemedicine KW - video visit KW - endocrinology KW - effectiveness KW - type 2 diabetes mellitus KW - patient KW - perspectives KW - qualitative interviews KW - clinicians N2 - Background: Since the rapid widespread uptake in 2020, the use of telemedicine to deliver diabetes specialty care has persisted. However, evidence evaluating patient and clinician perspectives on benefits, shortcomings, and approaches to improve telemedicine care for type 2 diabetes is limited. Objective: This study aims to assess clinician and patient perspectives on specific benefits and limitations of current telemedicine care delivery for type 2 diabetes and views on approaches to enhance telemedicine effectiveness for patients who rely on it. Methods: We conducted semistructured qualitative interviews with diabetes specialty clinicians and adults with type 2 diabetes. We used a qualitative description approach to characterize participant perspectives on care delivery for type 2 diabetes via telemedicine. Results: Both clinicians (n=15) and patients (n=13) identify significant benefits of telemedicine in overcoming both physical (geographic and transportation) and scheduling (work commitments and wait times) barriers to specialty care for type 2 diabetes. In addition, telemedicine may enhance communication around diabetes care by improving information sharing between patients and clinicians. However, clinicians identify limited availability of home blood glucose data and vital signs as factors, which impair the optimal management of type 2 diabetes and related comorbid conditions via telemedicine. Previsit preparation, involvement of multidisciplinary providers, and frequent brief check-ins were identified by patients and clinicians as potential strategies to improve the quality of telemedicine care for adults with type 2 diabetes. Conclusions: Patients and clinicians identify key strengths of telemedicine in enhancing access to diabetes specialty care for adults with type 2 diabetes and describe approaches to ensure that telemedicine delivers high-quality diabetes care to patients who rely on it. UR - https://diabetes.jmir.org/2025/1/e60765 UR - http://dx.doi.org/10.2196/60765 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60765 ER - TY - JOUR AU - Shi, Xiaoyu AU - Wang, Yijun AU - Wang, Yuhong AU - Wang, Jun AU - Peng, Chen AU - Cheng, Siyi AU - Song, Lingpeng AU - Li, Rui AU - Guo, Fuding AU - Li, Zeyan AU - Duan, Shoupeng AU - Yang, Xiaomeng AU - Zhou, Liping AU - Jiang, Hong AU - Yu, Lilei PY - 2025/3/11 TI - The Effectiveness of Digital Animation?Based Multistage Education for Patients With Atrial Fibrillation Catheter Ablation: Randomized Clinical Trial JO - J Med Internet Res SP - e65685 VL - 27 KW - animation education KW - digital health care KW - atrial fibrillation KW - catheter ablation KW - video KW - mHealth KW - digital care KW - digital health KW - digital animation KW - randomized clinical trial KW - RCT KW - digital education KW - outpatient KW - AFCA KW - atrial fibrillation catheter ablation KW - therapeutic KW - cardiac arrhythmia KW - Asian KW - animations KW - comics N2 - Background: Digital education for outpatient patients with atrial fibrillation (AF) has gradually increased. However, research on digital education for patients undergoing atrial fibrillation catheter ablation (AFCA) is limited. Objective: This study aimed to develop a novel digital animation-based multistage education system and evaluate its quality-of-life benefits for patients with AFCA. Methods: This randomized controlled clinical trial included 208 patients with AF who underwent catheter ablation in the Department of Cardiology at Renmin Hospital of Wuhan University between January 2022 and August 2023. The patients were randomly assigned to the digital animation intervention (n=104) and standard treatment (n=104) groups. The primary outcome was the difference in the quality of life of patients with atrial fibrillation (AF-QoL-18) scores at 3 months. Secondary outcomes included differences in scores on the 5-item Medication Adherence Report Scale (MARS-5), Self-rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) at 3 months. Results: In the digital animation intervention group, the AF-QoL-18 score increased from 38.02 (SD 6.52) to 47.77 (SD 5.74), the MARS-5 score increased from 17.04 (SD 3.03) to 20.13 (SD 2.12), the SAS score decreased from 52.82 (SD 8.08) to 45.39 (SD 6.13), and the SDS score decreased from 54.12 (SD 6.13) to 45.47 (SD 5.94), 3 months post discharge from the hospital. In the conventional treatment group, the AF-QoL-18 score increased from 36.97 (SD 7.00) to 45.31 (SD 5.71), the MARS-5 score increased from 17.14 (SD 3.01) to 18.47 (SD 2.79), the SAS score decreased from 51.83 (SD 7.74) to 47.31 (SD 5.87), and the SDS score decreased from 52.78 (SD 5.21) to 45.37 (SD 6.18). The mean difference in AF-QoL-18 score change between the 2 groups was 1.41 (95% CI 2.42-0.40, P=.006) at 3 months. The mean difference in MARS-5 score change was 1.76 (95% CI 2.42-1.10, P<.001). The mean difference in SAS score was ?2.91 (95% CI ?3.88 to ?1.95, P<.001). Additionally, the mean difference in SDS score was ?1.23 (95% CI ?0.02 to ?2.44, P=.047). Conclusions: Our study introduces a novel digital animation educational approach that provides multidimensional, easily understandable, and multistage education for patients with AF undergoing catheter ablation. This educational model effectively improves postoperative anxiety, depression, medication adherence, and quality of life in patients at 3 months post discharge. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400081673; https://www.chictr.org.cn/showproj.html?proj=201059 UR - https://www.jmir.org/2025/1/e65685 UR - http://dx.doi.org/10.2196/65685 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65685 ER - TY - JOUR AU - Khairat, Saif AU - Ottmar, Paige AU - Chourasia, Prabal AU - Obeid, Jihad PY - 2025/3/5 TI - Effectiveness of Telehealth Versus In-Person Informed Consent: Randomized Study of Comprehension and Decision-Making JO - J Med Internet Res SP - e63473 VL - 27 KW - telehealth KW - informed KW - consent KW - comprehension KW - decision-making KW - cross-sectional study KW - cross-section KW - telemedicine KW - eHealth KW - health care services KW - mHealth KW - effectiveness KW - informed consent KW - statistical analysis KW - feasibility N2 - Background: Obtaining informed consent (IC) is vital for ethically and effectively recruiting participants in research projects. However, traditional in-person IC approaches encounter notable obstacles, such as geographic barriers, transportation expenses, and literacy challenges, which can lead to delays in enrollment and increased costs. Telehealth, especially teleconsent, offers a potential way to overcome these obstacles by facilitating the IC process in a digital setting. Nonetheless, there are concerns about whether teleconsent can achieve levels of understanding and involvement that are equivalent to those of in-person IC meetings. Objective: This study aims to evaluate comprehension and decision-making in participants undergoing teleconsent versus traditional in-person IC. We used validated assessments to determine whether teleconsent is a viable alternative that maintains participants? understanding and decision-making abilities. Methods: A randomized comparative study design was used, recruiting potential participants for a parent study assessing patient experiences with patient portals. Participants were randomly assigned to 2 groups: teleconsent and in-person consent. The teleconsent group used Doxy.me software, allowing real-time interaction between researchers and participants while reviewing and electronically signing the IC documents. Recruitment involved using an institutional web-based platform to identify interested individuals, who were then contacted to assess eligibility and gather demographic information. The Decision-Making Control Instrument (DMCI) survey was used to assess the perceived voluntariness, trust, and decision self-efficacy. The Quality of Informed Consent (QuIC) was used to measure the comprehension level of the consent form. The validated Short Assessment of Health Literacy-English tool was used to measure participants' health literacy levels. Results: A total of 64 participants were enrolled in the study, with 32 in the teleconsent group and 32 in the in-person group. Of 64 participants, 32 (50%) were in the teleconsent group, 54 (84.4%) were females, 44 (68.7%) were aged 18-34 years, 50 (78.1%) were White, and 31 (48.4%) had a bachelor degree. The mean SAHL-E scores were different between the teleconsent and in-person groups (16.72, SD 1.88 vs 17.38, SD 0.95; P=.03). No significant differences were found between the average scores at baseline and follow-up for QuIC part A (P=.29), QuIC part B (P=.25), and DMCI (P=.38) within the teleconsent and in-person groups. Additionally, there were no significant differences in QuIC or DMCI between subgroups based on age, sex, and ethnicity. Conclusions: This study assessed the effectiveness of IC processes through telehealth compared to traditional in-person visits. Findings indicate that telehealth offers similar participant understanding and engagement while overcoming geographic and accessibility barriers. As health care adopts digital solutions, these results highlight telehealth?s potential to improve recruitment and retention in clinical research, suggesting that policy makers should integrate telehealth practices into regulations for better access and health outcomes. UR - https://www.jmir.org/2025/1/e63473 UR - http://dx.doi.org/10.2196/63473 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053795 ID - info:doi/10.2196/63473 ER - TY - JOUR AU - Yan, Mengyao AU - Sun, Wendi AU - Tan, Cheng AU - Wu, Yibo AU - Liu, Yuanli PY - 2025/3/4 TI - Analysis of Factors Influencing the Willingness of Chinese Older Adults to Use mHealth Devices: Nationwide Cross-Sectional Survey Study JO - J Med Internet Res SP - e66804 VL - 27 KW - older adults KW - mobile health devices KW - health management KW - medical services KW - mobile phone N2 - Background: In addition to standard older adult care services, mobile medical devices have proved to be an effective tool for controlling the health of older adults. However, little is known about the variables driving the acceptance of these gadgets and the willingness of older adults in China to use them. Objective: This study aims to explore the factors that affect the use of mobile health (mHealth) devices by older adults in China, focusing on individual, social, and family influences. Methods: The Psychology and Behavior Investigation of Chinese Residents survey database provided the data for this study. The survey was conducted in 148 Chinese cities between June 20 and August 31, 2022. The parameters linked to older persons? desire to use mobile medical devices were determined by this study using a combination model of multiple stepwise linear regression and a classification and regression tree decision tree. Results: In total, 4085 older adults took part in the poll. On a scale of 0 to 100, the average score for willingness to adopt mHealth devices was 63.70 (SD 25.11). The results of the multiple stepwise linear regression showed that having a postgraduate degree and higher (?=.040; P=.007), being unemployed (?=.037; P=.02), having a high social status (?=.085; P<.001), possessing high health literacy (?=.089; P<.001), demonstrating high self-efficacy (?=.043; P=.02), not living with children (?=.0340; P=.02), having a household per capita monthly income of >Y4000 (US $550) (?=.048; P=.002), experiencing high perceived social support (?=.096; P<.001), reporting a high quality of life (?=.149; P<.001), having higher levels of family communication (?=?.071; P<.001), having an identity bubble (?=.085; P<.001), not having chronic diseases (?=.049; P=.001), and experiencing mild depression (?=?.035; P=.02) were associated with older adults? willingness to use mHealth devices. The classification and regression tree decision tree model?s findings demonstrated that the primary determinants of older adults? desire to use mHealth devices are quality of life, identity bubble, social status, health literacy, family health, and perceived social support. Conclusions: This study uses the Andersen Healthcare Utilization Model to investigate the effects of demand variables, enabling resources, and predisposing traits on older persons? propensity to use mHealth devices. These results offer reference data for the marketing and use of mHealth devices for older individuals in the future. The ultimate goal of this strategy is to create a balanced and harmonious integration of technology and humanistic care. UR - https://www.jmir.org/2025/1/e66804 UR - http://dx.doi.org/10.2196/66804 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053781 ID - info:doi/10.2196/66804 ER - TY - JOUR AU - O'Connor, I. Mary AU - Chudy, Carolyn AU - Peters, C. Kaitlyn AU - Ribaudo, Megan AU - McCulloch, Carrie AU - Aguilar, Jared AU - Taylor, Trista AU - Grant, A. Ryan PY - 2025/3/3 TI - Patients? Experience With Evaluation by Both a Musculoskeletal Physician and Physical Therapist in the Same Digital Visit: Survey Study JO - JMIR Form Res SP - e66744 VL - 9 KW - telemedicine KW - musculoskeletal care KW - patient satisfaction KW - multidisciplinary care KW - digital visit N2 - Background: Patients undergoing evaluation for musculoskeletal concerns are often seen by a physician and physical therapist in the in-person setting in a sequential manner. This process typically delays the onset of nonoperative care, inclusive of physical therapy, and creates the risk of inadequate clinical collaboration between physician and physical therapist. To address these issues, we designed a novel initial patient evaluation to a group visit in which both a specialty-trained musculoskeletal physician and physical therapist simultaneously evaluate a patient together in the digital encounter. Objective: The aim of the study is to gain insights from patients on their experience with this innovative digital simultaneous musculoskeletal medical doctor and physical therapist (MD+PT) visit format for the initial evaluation of musculoskeletal concerns. Methods: An electronic 7-question survey was sent to 750 patients who completed an MD+PT visit asking them to comment on prior musculoskeletal evaluations and their experience with the MD+PT format. Results: In total, 195 (26%) patients responded to the survey with the frequent body regions of diagnosis being lumbar spine (n=65), knee (n=32), shoulder (n=21), cervical spine (n=20), hip (n=14), and hand (n=11). Most patients had prior musculoskeletal experience with a physician or nurse practitioner (171/195, 87.7%) or physical therapist (148/195, 75.9%) with nearly all such encounters in the in-person setting (161/171,94.2% for physician or nurse practitioner and 144/148, 97.3% for physical therapy). Only 3.1% (6/193) of patients reported seeing both a physician and physical therapist during the same in-person visit. Patients rated the simultaneous MD+PT visit very favorably: this type of digital evaluation saved them time (179/192, 93.2%) and permitted them to promptly start their treatment plan (174/192, 90.6%). Overall, 87.5% (168/192) rated the MD+PT visit as enjoyable, and 92.2% (177/192) responded that it increased their confidence with understanding their medical condition and how to start treating it. Conclusions: Our early experience with the evaluation of patients with musculoskeletal conditions by both a specialty-trained musculoskeletal physician and physical therapist simultaneously in the same digital visit resulted in patients reporting a very positive experience with high satisfaction, engagement, and confidence in understanding their diagnosis and how to start treating it. UR - https://formative.jmir.org/2025/1/e66744 UR - http://dx.doi.org/10.2196/66744 ID - info:doi/10.2196/66744 ER - TY - JOUR AU - Wang, Weiyi AU - Chu, Yuntian AU - Cui, Fangfang AU - Shi, Xiaobing AU - Zhang, Xu AU - Sun, Dongxu AU - Shi, Jinming AU - Zhao, Jie PY - 2025/2/26 TI - Correlation Between the Online Visiting Time and Frequency Increase in Telemedicine Services Offered by Health Care Providers Before, During, and After the COVID-19 Pandemic in China: Cross-Sectional Study JO - J Med Internet Res SP - e65092 VL - 27 KW - telemedicine KW - post?COVID-19 KW - provider?s perspective KW - length of online visit KW - COVID-19 KW - pandemic KW - China KW - prevention KW - questionnaire KW - survey KW - healthcare provider N2 - Background: China has changed its COVID-19 prevention and control status since 2023. However, what role telemedicine will play post?COVID-19 is still uncertain. Objective: We aimed to determine the frequency change in health care providers offering telemedicine services before, during, and after COVID-19, as well as the correlation between the frequency change and telemedicine visit time. Methods: The Telemedicine Informationization Professional Committee of China (TIPC) carried out a nationwide questionnaire survey. We adopted data from part of the questionnaires that answered questions regarding the frequency of offering telemedicine services before, during, and after the COVID-19 explosion. Chi-square tests were applied to compare general differences in the between-group telemedicine frequency. Regression models were performed to analyze correlations between the frequency change and the time spent in online versus in-person visits. Results: Questionnaires from 428 providers were included. As reported, 39 (9.11%) providers often and 159 (37.15%) always offered telemedicine services before COVID-19 exploded. The component ratio increased to 12.38% (n=53) of providers often and 45.79% (n=196) always offering telemedicine during COVID-19 explosion and 12.62% (n=54) often and 50% (n=214) always offering telemedicine after pandemic control was relaxed. The increase in frequency shown as a difference between the before and during groups (?2=17.21, P.002) and between the before and after groups (?2=30.17, P<.001) was significant, while it was insignificant between the during and after groups (?2=2.89, P.57). Senior professional titles (odds ratio [OR] 4.38, 95% CI 1.72-11.6) and longer (OR 3.87, 95% CI 1.95-7.89) and shorter (OR 2.04, 95% CI 1.11-3.87) online visits were correlated with the increase in frequency during versus before COVID-19. In addition, senior professional titles (OR 3.47, 95% CI 1.46-8.49), longer (OR 3.14, 95% CI 1.64-6.11) and shorter (OR=2.27, 95% CI 1.31-4.07) online visits, and using third-party telemedicine platforms (OR 0.51, 95% CI 0.29-0.86) were correlated with the increase in frequency after versus before COVID-19. No factor was significantly correlated with the frequency change after versus during COVID-19. In stratified analysis, longer online visits were correlated with both during versus before (OR 3.84, 95% CI 1.73-8.83) and after versus before (OR 3.40, 95% CI 1.61-7.34) groups for providers using hospital-run platforms, while shorter online visits were correlated with both during versus before (OR 8.16, 95% CI 1.39-68.3) and after versus before (OR 5.70, 95% CI 1.22-33.6) groups for providers using third-party platforms. Conclusions: The frequency of telemedicine has increased since the COVID-19 pandemic exploded and is correlated with the time spent in online versus in-person visits. The correlation is different for providers using hospital-run and third party platforms. On a hospital-run platform, providers with longer online visits have a higher frequency of offering telemedicine, while on a third-party platform, providers with shorter online visits are more likely to offer telemedicine. UR - https://www.jmir.org/2025/1/e65092 UR - http://dx.doi.org/10.2196/65092 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65092 ER - TY - JOUR AU - Chen, Yu-Ting AU - Lehman, Michelle AU - Van Denend, Toni AU - Kish, Jacqueline AU - Wu, Yue AU - Preissner, Katharine AU - Plow, Matthew AU - Packer, L. Tanya PY - 2025/2/26 TI - Features of Structured, One-to-One Videoconference Interventions That Actively Engage People in the Management of Their Chronic Conditions: Scoping Review JO - J Med Internet Res SP - e58543 VL - 27 KW - videoconference KW - chronic disease management KW - active participation KW - intervention program KW - self-management KW - scoping review KW - Taxonomy of Every Day Self-Management Strategies KW - TEDSS KW - Behavior Change Technique Taxonomy version 1 KW - BCTTv1 KW - behavior change KW - mobile phone N2 - Background: A dramatic increase in the use of videoconferencing occurred as a response to the COVID-19 pandemic, including delivery of chronic disease management programs. With this increase, clients? openness to and confidence in receiving any type of telehealth care has dramatically improved. However, the rapidity of the response was accomplished with little time to learn from existing knowledge and research. Objective: The purpose of this scoping review was to identify features, barriers, and facilitators of synchronous videoconference interventions that actively engage clients in the management of chronic conditions. Methods: Using scoping review methodology, MEDLINE, CINAHL, and 6 other databases were searched from 2003 onward. The included studies reported on structured, one-on-one, synchronous videoconferencing interventions that actively engaged adults in the management of their chronic conditions at home. Studies reporting assessment or routine care were excluded. Extracted text data were analyzed using thematic analysis and published taxonomies. Results: The 33 included articles reported on 25 distinct programs. Most programs targeted people with neurological conditions (10/25, 40%) or cancer (7/25, 28%). Analysis using the Taxonomy of Every Day Self-Management Strategies and the Behavior Change Technique Taxonomy version 1 identified common program content and behavior change strategies. However, distinct differences were evident based on whether program objectives were to improve physical activity or function (7/25, 28%) or mental health (7/25, 28%). Incorporating healthy behaviors was addressed in all programs designed to improve physical activity or function, whereas only 14% (1/7) of the programs targeting mental health covered content about healthy lifestyles. Managing emotional distress and social interaction were commonly discussed in programs with objectives of improving mental health (6/25, 24% and 4/25, 16%, respectively) but not in programs aiming at physical function (2/25, 8% and 0%, respectively). In total, 13 types of behavior change strategies were identified in the 25 programs. The top 3 types of strategies applied in programs intent on improving physical activity or function were feedback and monitoring, goals and planning, and social support, in contrast to shaping knowledge, regulation, and identity in programs with the goal of improving mental health. The findings suggest that chronic condition interventions continue to neglect evidence that exercise and strong relationships improve both physical and mental health. Videoconference interventions were seen as feasible and acceptable to clients. Challenges were mostly technology related: clients? comfort, technology literacy, access to hardware and the internet, and technical breakdowns and issues. Only 15% (5/33) of the studies explicitly described compliance with health information or privacy protection regulations. Conclusions: Videoconferencing is a feasible and acceptable delivery format to engage clients in managing their conditions at home. Future program development could reduce siloed approaches by adding less used content and behavior change strategies. Addressing client privacy and technology issues should be priorities. UR - https://www.jmir.org/2025/1/e58543 UR - http://dx.doi.org/10.2196/58543 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58543 ER - TY - JOUR AU - Mess, Veronica Elisabeth AU - Regner, Matthias AU - Balic, Sabahudin AU - Kleybolte, Lukas AU - Daufratshofer, Lisa AU - Mahler, Andreas AU - Tilmes, Sabrina AU - Werlitz, Viktor AU - Reuter, Claudia AU - Teynor, Alexandra PY - 2025/2/21 TI - Detailed Analysis and Road Map Proposal for Care Transition Records and Their Transmission Process: Mixed Methods Study JO - JMIR Nursing SP - e60810 VL - 8 KW - care transition record KW - transmission management KW - observations KW - process modeling KW - telematics infrastructure KW - TI KW - Fast Healthcare Interoperability Resources KW - FHIR KW - Health Level 7 KW - HL7 KW - medical information object KW - MIO KW - care information object care transition record KW - CIO-CTR KW - Pflegerisches Informationsobjekt-Überleitungsbogen KW - PIO-ULB KW - artificial intelligence KW - AI N2 - Background: The digitalization of health care in Germany holds great potential to improve patient care, resource management, and efficiency. However, strict data protection regulations, fragmented infrastructures, and resistance to change hinder progress. These challenges leave care institutions reliant on outdated paper-based workflows, particularly for patient data transmission, despite the pressing need for efficient tools to support health care professionals amid a nursing shortage and rising demand for care. Objective: This paper aims to analyze Germany?s care transition record (CTR) and CTR transmission process as part of transition management and suggests improvements toward a seamless digital solution. Methods: To understand the current challenges of manual CTR transfers, we used a mixed methods approach, which included a web-based questionnaire with nursing professionals, field observations, business process model and notation modeling, semantic and frequency analysis of CTR entries, and user story mapping. Results: A web-based questionnaire involving German nursing professionals (N=59) revealed considerable delays in patient care due to manual, patient-transferred CTRs. Of the 33 usable responses (n=33), 70% (n=23) of the respondents advocating for digital transmission to improve efficiency. Observations (N=11) in care facilities (n=5, 45%) and a hospital (n=6, 55%) confirmed the high administrative burden, averaging 34.67 (SD 10.78) minutes per CTR within a hospital and 44.6 (SD 20.5) minutes in care facilities. A semantic analysis of various CTRs (N=4) highlighted their differences and complexity, stressing the need for standardization. Analyzing a new CTR standard (care information object CTR) and manually mapping an existing CTR to it showed that the procedure was ambiguous, and some associations remained unclear. A frequency analysis of CTR entities revealed which were most used. In addition, discussions with care staff pointed out candidates for the most relevant entities. On the basis of the key findings, a stepwise transition approach toward a road map proposal for a standardized, secure transfer of CTRs was conceptualized. This road map in the form of a user story map, encompassing a ?CTR transformer? (mapping of traditional CTRs to a new standard) and ?care information object CTR viewer/editor? (in short, CIO-CTR viewer and editor; a new standard for viewing, editing, and exporting), shows a possibility to bridge the transition time until all institutions fully support the new standard. Conclusions: A future solution should simplify the overall CTR transmission process by minimizing manual transfers into in-house systems, standardizing the CTR, and providing a secure digital transfer. This could positively impact the overall care process and patient experience. With our solutions, we attempt to support care staff in their daily activities and processes until nationwide state regulations are implemented successfully, though the timeline for this remains uncertain. UR - https://nursing.jmir.org/2025/1/e60810 UR - http://dx.doi.org/10.2196/60810 UR - http://www.ncbi.nlm.nih.gov/pubmed/39982779 ID - info:doi/10.2196/60810 ER - TY - JOUR AU - Wankah, Paul AU - Chandra, Shivani AU - Lofters, Aisha AU - Mohamednur, Nebila AU - Osei, Beverley AU - Makuwaza, Tutsirai AU - Sayani, Ambreen PY - 2025/2/19 TI - Improving Digital Cancer Care for Older Black Adults: Qualitative Study JO - J Med Internet Res SP - e63324 VL - 27 KW - digital care KW - cancer care KW - older Black adults KW - health equity KW - social determinants of health KW - access to care KW - health quality N2 - Background: Health systems are rapidly promoting digital cancer care models to improve cancer care of their populations. However, there is growing evidence that digital cancer care can exacerbate inequities in cancer care for communities experiencing social disadvantage, such as Black communities. Despite the increasing recognition that older Black adults face significant challenges in accessing and using health care services due to multiple socioeconomic and systemic factors, there is still limited evidence regarding how older Black adults? access and use digital cancer care. Objective: This study aims to better understand the digital cancer care experience of older Black adults, their caregivers, and health care providers to identify strategies that can better support patient-centered digital cancer care. Methods: A total of 6 focus group interviews were conducted with older Black adults living with cancer, caregivers, and health care providers (N=55 participants) across 10 Canadian provinces. Focus group interviews were recorded and transcribed. Through a theory-informed thematic analysis approach, experienced qualitative researchers used the Patient Centered Care model and the synergies of oppression conceptual lens to inductively and deductively code interview transcripts in order to develop key themes that captured the digital cancer care experiences of older Black adults. Results: In total, 5 overarching themes describe the experience of older Black adults, caregivers, and health care providers in accessing and using digital cancer care: (1) barriers to access and participation in digital care services, (2) shifting caregivers? dynamics, (3) autonomy of choice and choosing based on the purpose of care, (4) digital accessibility, and (5) effective digital communication. We identify 8 barriers and 6 facilitators to optimal digital cancer for older Black adults. Barriers include limited digital literacy, linguistic barriers in traditional African or Caribbean languages, and patient concerns of shifting power dynamics when supported by their children for digital cancer care; and facilitators include community-based cancer support groups, caregiver support, and key features of digital technologies. Conclusions: These findings revealed a multifaceted range of barriers and facilitators to digital cancer care for older Black adults. This means that a multipronged approach that simultaneously focuses on addressing barriers and leveraging community strengths can improve access and usage of digital cancer care. A redesign of digital cancer care programs, tailored to the needs of most structurally marginalized groups like older Black adults, can enhance the digital care experience for all population groups. Public policies and organizational practices that address issues like availability of internet in remote areas, resources to support linguistic barriers, or culturally sensitive training are important in responding to the complexity of access to digital l cancer care. These findings have implications for other structurally marginalized and underresourced communities that have suboptimal access and usage of digital care. UR - https://www.jmir.org/2025/1/e63324 UR - http://dx.doi.org/10.2196/63324 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63324 ER - TY - JOUR AU - Zhao, Ting AU - Tang, Chulei AU - Ma, Jun AU - Yan, Huang AU - Su, Xinyi AU - Zhong, Xueyuan AU - Wang, Honghong PY - 2025/2/17 TI - User Personas for eHealth Regarding the Self-Management of Depressive Symptoms in People Living With HIV: Mixed Methods Study JO - J Med Internet Res SP - e56289 VL - 27 KW - HIV KW - depressive symptoms KW - depression KW - self-management KW - eHealth KW - personas N2 - Background: eHealth has enormous potential to support the self-management of depressive symptoms in people living with HIV. However, a lack of personalization is an important barrier to user engagement with eHealth. According to goal-directed design, personalized eHealth requires the identification of user personas before concrete design to understand the goals and needs of different users. Objective: This study aimed to identify user personas for eHealth regarding the self-management of depressive symptoms in people living with HIV and explore the goals and needs of different user personas for future eHealth. Methods: We used an explanatory sequential mixed methods design at the First Hospital of Changsha City, Hunan Province, China, from April to October 2022. In the quantitative phase, 572 people living with HIV completed validated questionnaires with questions related to demographics, self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Latent profile analysis was performed to identify different user personas. In the qualitative phase, 43 one-to-one semistructured interviews across different user personas were conducted, transcribed verbatim, and analyzed using conventional content analysis. The findings from both phases were integrated during the interpretation phase. Results: Three types of user personas could be identified, including ?high-level self-managers? (254/572, 44.4%), ?medium-level self-managers? (283/572, 49.5%), and ?low-level self-managers? (35/572, 6.1%). High-level self-managers had relatively high levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. High-level self-managers had a positive attitude toward using eHealth for the self-management of depressive symptoms and desired access to self-management support for depressive symptoms from eHealth with high usability. Medium-level self-managers had relatively medium levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Medium-level self-managers felt burdened by using eHealth for the self-management of depressive symptoms and preferred to access self-management support for HIV from eHealth with privacy. Low-level self-managers had relatively low levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Low-level self-managers had an acceptable attitude toward using eHealth for the self-management of depressive symptoms and desired access to professional guidance from eHealth with privacy and no cost (?free of charge?). Conclusions: The 3 user personas shed light on the possibility of personalized eHealth to support the self-management of depressive symptoms in different people living with HIV. Further research is needed to examine the generalizability of the user personas across study sites. UR - https://www.jmir.org/2025/1/e56289 UR - http://dx.doi.org/10.2196/56289 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56289 ER - TY - JOUR AU - Snow, Martha AU - Silva-Ribeiro, Wagner AU - Baginsky, Mary AU - Di Giorgio, Sonya AU - Farrelly, Nicola AU - Larkins, Cath AU - Poole, Karen AU - Steils, Nicole AU - Westwood, Joanne AU - Malley, Juliette PY - 2025/2/14 TI - Best Practices for Implementing Electronic Care Records in Adult Social Care: Rapid Scoping Review JO - JMIR Aging SP - e60107 VL - 8 KW - digital care records KW - adult social care KW - digitization KW - domiciliary care KW - care homes KW - electronic care records KW - PRISMA N2 - Background: In the past decade, the use of digital or electronic records in social care has risen worldwide, capturing key information for service delivery. The COVID-19 pandemic accelerated digitization in health and social care. For example, the UK government created a fund specifically for adult social care provider organizations to adopt digital social care records. These developments offer valuable learning opportunities for implementing digital care records in adult social care settings. Objective: This rapid scoping review aimed to understand what is known about the implementation of digital care records in adult social care and how implementation varies across use cases, settings, and broader contexts. Methods: A scoping review methodology was used, with amendments made to enable a rapid review. Comprehensive searches based on the concepts of digital care records, social care, and interoperability were conducted across the MEDLINE, EmCare, Web of Science Core Collection, HMIC Health Management Information Consortium, Social Policy and Practice, and Social Services Abstracts databases. Studies published between 2018 and 2023 in English were included. One reviewer screened titles and abstracts, while 2 reviewers extracted data. Thematic analysis mapped findings against the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. Results: Our search identified 2499 references. After screening titles and abstracts, 71 records were selected for full-text review, resulting in 31 references from 29 studies. Studies originated from 11 countries, including 1 multicountry study, with the United Kingdom being the most represented (10/29, 34%). Studies were most often conducted in nursing homes or facilities (7/29, 24%) with older people as the target population (6/29, 21%). Health records were the most investigated record type (12/29, 41%). We identified 45 facilitators and 102 barriers to digital care record implementation across 28 studies, spanning 6 of the 7 NASSS framework domains and aligning with 5 overarching themes that require greater active management regarding implementation. Intended or actual implementation outcomes were reported in 17 (59%) of the 29 studies. Conclusions: The findings suggest that implementation is complex due to a lack of consensus on what digital care records and expected outcomes and impacts should look like. The literature often lacks clear definitions and robust study designs. To be successful, implementation should consider complexity, while studies should use robust frameworks and mixed methods or quantitative designs where appropriate. Future research should define the target population, gather data on carer or service user experiences, and focus on digital care records specifically used in social care. UR - https://aging.jmir.org/2025/1/e60107 UR - http://dx.doi.org/10.2196/60107 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60107 ER - TY - JOUR AU - Shamebo, Dessalegn AU - Derseh Mebratie, Anagaw AU - Arsenault, Catherine PY - 2025/2/13 TI - Using an Interactive Voice Response Survey to Assess Patient Satisfaction in Ethiopia: Development and Feasibility Study JO - JMIR Form Res SP - e67452 VL - 9 KW - mobile phone surveys KW - patient satisfaction KW - interactive voice response KW - global health KW - surveys KW - Ethiopia KW - IVR KW - Africa N2 - Background: Patient satisfaction surveys can offer crucial information on the quality of care but are rarely conducted in low-income settings. In contrast with in-person exit interviews, phone-based interactive voice response (IVR) surveys may offer benefits including standardization, patient privacy, reduced social desirability bias, and cost and time efficiency. IVR surveys have rarely been tested in low-income settings, particularly for patient satisfaction surveys. Objective: In this study, we tested the feasibility of using an IVR system to assess patient satisfaction with primary care services in Addis Ababa, Ethiopia. We described the methodology, response rates, and survey costs and identified factors associated with survey participation, completion, and duration. Methods: Patients were recruited in person from 18 public and private health facilities in Addis Ababa. Patients? sex, age, education, reasons for seeking care, and mobile phone numbers were collected. The survey included 15 questions that respondents answered using their phone keypad. We used a Heckman probit regression model to identify factors influencing the likelihood of IVR survey participation (picking up and answering at least 1 question) and completion (answering all survey questions) and a Weibull regression model to identify factors influencing the survey completion time. Results: A total of 3403 individuals were approached across 18 health facilities. Nearly all eligible patients approached (2985/3167, 94.3%) had a functioning mobile phone, and 89.9% (2415/2685) of those eligible agreed to be enrolled in the study. Overall, 92.6% (2236/2415) picked up the call, 65.6% (1584/2415) answered at least 1 survey question, and 42.9% (1037/2415) completed the full survey. The average survey completion time was 8.1 (SD 1.7) minutes for 15 Likert-scale questions. We found that those aged 40-49 years and those aged 50+ years were substantially less likely to participate in (odds ratio 0.63, 95% CI 0.53-0.74) and complete the IVR survey (odds ratio 0.77, 95% CI 0.65-0.90) compared to those aged 18-30 years. Higher education levels were also strongly associated with survey participation and completion. In adjusted models, those enrolled in private facilities were less likely to participate and complete the survey compared to those in public health centers. Being male, younger, speaking Amharic, using a private hospital, and being called after 8 PM were associated with a shorter survey duration. The average survey costs were US $7.90 per completed survey. Conclusions: Our findings reveal that an IVR survey is a feasible, low-cost, and rapid solution to assess patient satisfaction in an urban context in Ethiopia. However, survey implementation must be carefully planned and tailored to local challenges. Governments and health facilities should consider IVR to routinely collect patient satisfaction data to inform quality improvement strategies. UR - https://formative.jmir.org/2025/1/e67452 UR - http://dx.doi.org/10.2196/67452 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67452 ER - TY - JOUR AU - Wallraf, Simon AU - Köthemann, Sara AU - Wiesemann, Claudia AU - Wöhlke, Sabine AU - Dierks, Marie-Luise AU - Schmidt, Andrea Marion AU - van Gils-Schmidt, Jasper Henk AU - Lander, Jonas PY - 2025/2/13 TI - Digital Transformation in Patient Organizations: Interview and Focus Group Study JO - J Med Internet Res SP - e62750 VL - 27 KW - patient organization KW - patient support KW - digitalization KW - digital transformation KW - health research N2 - Background: Patient organizations (POs) are an integral part of the health care landscape, serving as advocates and support systems for patients and their families. As the digitalization of health care accelerates, POs are challenged to adapt their diverse roles to digital formats. However, the extent and form of POs? digital adaptation and the challenges POs encounter in their digital transformation remain unexplored. Objective: This study aims to investigate the digital transformation processes within POs. We examined the types of digital activities and processes implemented, people involved in respective tasks, challenges encountered, and attitudes toward the digitalization of POs. Methods: The study was carried out by the multicenter interdisciplinary research network Pandora. We adopted a qualitative exploratory approach by conducting 37 semistructured interviews and 2 focus groups with representatives and members of POs in Germany. Results were obtained using a deductive-inductive approach based on a qualitative content analysis. Methods and results were reported in accordance with the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Results: POs primarily apply basic digital tools to engage in communication, health education, and information dissemination. Some also develop specific mobile apps and collect health data through patient registries. Volunteers cover a considerable part of the workload. Sometimes, POs collaborate with external partners, such as health professionals or other nonprofit organizations. Furthermore, many (13/46, 28%) interviewees referred to the importance of involving members in digitalization efforts to better meet their needs. However, they described the actual practices used to involve members in, for example, developing digital services as limited, passive, or implicit. When evaluating digital transformation processes, representatives and members of POs expressed generally positive attitudes and acknowledged their potential to improve the accessibility of support services, management efficiency, and outreach. Still, resource constraints; the complexity of digital initiatives; and accessibility issues for certain demographic groups, especially older persons, were frequently mentioned as challenges. Several (15/46, 33%) interviewees highlighted POs? increasing responsibility to support their members? digital competencies and digital health literacy. Conclusions: POs are actively involved in the digital transformation of health services. To navigate challenges and further shape and sustain digital activities and processes, POs may benefit from governance frameworks, that is, a clear plan outlining with whom, how, and with what objectives digital projects are being realized. Support from public, scientific, and policy institutions to enhance the process through training, mentorship, and fostering collaborative networks seems warranted. UR - https://www.jmir.org/2025/1/e62750 UR - http://dx.doi.org/10.2196/62750 UR - http://www.ncbi.nlm.nih.gov/pubmed/39946181 ID - info:doi/10.2196/62750 ER - TY - JOUR AU - Xiao, Jian AU - Li, Mengyao AU - Cai, Ruwen AU - Huang, Hangxing AU - Yu, Huimin AU - Huang, Ling AU - Li, Jingyang AU - Yu, Ting AU - Zhang, Jiani AU - Cheng, Shuqiao PY - 2025/2/11 TI - Smart Pharmaceutical Monitoring System With Personalized Medication Schedules and Self-Management Programs for Patients With Diabetes: Development and Evaluation Study JO - J Med Internet Res SP - e56737 VL - 27 KW - pharmaceutical services KW - diabetes KW - self-management KW - intelligent medication scheduling system KW - drug database KW - GPT-4 N2 - Background: With the climbing incidence of type 2 diabetes, the health care system is under pressure to manage patients with this condition properly. Particularly, pharmacological therapy constitutes the most fundamental means of controlling blood glucose levels and preventing the progression of complications. However, its effectiveness is often hindered by factors such as treatment complexity, polypharmacy, and poor patient adherence. As new technologies, artificial intelligence and digital technologies are covering all aspects of the medical and health care field, but their application and evaluation in the domain of diabetes research remain limited. Objective: This study aims to develop and establish a stand-alone diabetes management service system designed to enhance self-management support for patients, as well as to assess its performance with experienced health care professionals. Methods: Diabetes Universal Medication Schedule (DUMS) system is grounded in official medicine instructions and evidence-based data to establish medication constraints and drug-drug interaction profiles. Individualized medication schedules and self-management programs were generated based on patient-specific conditions and needs, using an app framework to build patient-side contact pathways. The system?s ability to provide medication guidance and health management was assessed by senior health care professionals using a 5-point Likert scale across 3 groups: outputs generated by the system (DUMS group), outputs refined by pharmacists (intervention group), and outputs generated by ChatGPT-4 (GPT-4 group). Results: We constructed a cloud-based drug information management system loaded with 475 diabetes treatment?related medications; 684 medication constraints; and 12,351 drug-drug interactions and theoretical supports. The generated personalized medication plan and self-management program included recommended dosing times, disease education, dietary considerations, and lifestyle recommendations to help patients with diabetes achieve correct medication use and active disease management. Reliability analysis demonstrated that the DUMS group outperformed the GPT-4 group in medication schedule accuracy and safety, as well as comprehensiveness and richness of the self-management program (P<.001). The intervention group outperformed the DUMS and GPT-4 groups on all indicator scores. Conclusions: DUMS?s treatment monitoring service can provide reliable self-management support for patients with diabetes. ChatGPT-4, powered by artificial intelligence, can act as a collaborative assistant to health care professionals in clinical contexts, although its performance still requires further training and optimization. UR - https://www.jmir.org/2025/1/e56737 UR - http://dx.doi.org/10.2196/56737 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56737 ER - TY - JOUR AU - Kalla, Mahima AU - O'Brien, Teresa AU - Metcalf, Olivia AU - Hoda, Rashina AU - Chen, Xiao AU - Li, Andy AU - Parker, Catriona AU - Franco, Edward Michael AU - Georgy, Sam AU - Huckvale, Kit AU - Bain, Christopher AU - Poon, Peter PY - 2025/2/11 TI - Understanding Experiences of Telehealth in Palliative Care: Photo Interview Study JO - JMIR Hum Factors SP - e53913 VL - 12 KW - consultation summary KW - digital scribe KW - qualitative research KW - telehealth KW - digital health KW - photo-elicitation KW - palliative care KW - photo interview KW - photographs KW - intertextual analysis N2 - Background: It is widely accepted that the COVID-19 pandemic has accelerated the era of online health care delivery, including within community palliative care. This study was part of a larger project involving a collaboration between universities, health care services, government agencies, and software developers that sought to enhance an existing telehealth (video call) platform with additional features to improve both patient and health care professional (HCP) experience in a palliative care context. Objective: The aim of this study was to understand palliative care patients? and HCPs? experiences of telehealth delivery in a palliative care context in Victoria, Australia. For the purposes of this study, telehealth included consultations by both video and telephone calls. By better understanding users? experiences and perceptions of telehealth, we hoped to determine users? preferences for new telehealth enhancement features. Methods: A total of 6 health care professionals and 6 patients were recruited from a major tertiary hospital network?s palliative care unit in Victoria, Australia. Participants were asked to generate 3?5 photographs depicting their telehealth experiences. These photographs were used as visual aids to prompt discussion during subsequent one-on-one interviews. Intertextual analysis was conducted to identify key themes. Results: A total of 3 overarching themes emerged: comfort (or lack thereof) afforded by telehealth, connection considerations in telehealth, and care quality impacts of telehealth. Patients (n=6) described telehealth as supporting their physical and psychological comfort and maintaining connection with HCPs, yet there were specific situations where it failed to meet their needs or impacted care quality and delayed treatment. HCPs (n=6) recognized the benefit of telehealth for patients but reported several limitations of telehealth, in particular due to lack of physical examination opportunities. Participants indicated that 2 types of connection were imperative for effective telehealth delivery: technical connection (eg, good internet connectivity or clear phone line) and interpersonal connection (ie, good rapport and therapeutic alliance between the HCPs and patients). Often technical connection issues impeded the development of interpersonal connection between the HCPs and patients in telehealth. Conclusions: The findings presented in this study combined with other co-design activities, which are outside the scope of this paper, indicated the potential value of a telehealth enhancement feature that generates patient-facing clinical consultation summaries. Our team has developed a video telehealth enhancement feature (or ?add-on?), which will enable clinicians to distill key actionable advice and self-management guidance discussed during teleconsultations for a take-home summary document for patients. The add-on?s prototype has also been subjected to an initial simulation study, which will be reported in a future publication. UR - https://humanfactors.jmir.org/2025/1/e53913 UR - http://dx.doi.org/10.2196/53913 ID - info:doi/10.2196/53913 ER - TY - JOUR AU - Monreal-Bartolomé, Alicia AU - Castro, Adoración AU - Pérez-Ara, Ángeles M. AU - Gili, Margalida AU - Mayoral, Fermín AU - Hurtado, Magdalena María AU - Varela Moreno, Esperanza AU - Botella, Cristina AU - García-Palacios, Azucena AU - Baños, M. Rosa AU - López-Del-Hoyo, Yolanda AU - García-Campayo, Javier AU - Montero-Marin, Jesus PY - 2025/2/10 TI - Efficacy of a Blended Low-Intensity Internet-Delivered Psychological Program in Patients With Multimorbidity in Primary Care: Randomized Controlled Trial JO - J Med Internet Res SP - e56203 VL - 27 KW - multimorbidity KW - depression KW - type 2 diabetes KW - low back pain KW - primary care KW - blended KW - internet KW - randomized controlled trial KW - RCT N2 - Background: Multimorbidity is a highly prevalent phenomenon whose presence causes a profound physical, psychological, and economic impact. It hinders help seeking, diagnosis, quality of care, and adherence to treatment, and it poses a significant dilemma for present-day health care systems. Objective: This study aimed to assess the effectiveness of improved treatment as usual (iTAU) combined with a blended low-intensity psychological intervention delivered using information and communication technologies for the treatment of multimorbidity (depression and type 2 diabetes or low back pain) in primary care settings. Methods: A 2-armed, parallel-group, superiority randomized controlled trial was designed for this study. Participants diagnosed with depression and either type 2 diabetes or low back pain (n=183) were randomized to ?intervention + iTAU? (combining a face-to-face intervention with a supporting web-based program) or ?iTAU? alone. The main outcome consisted of a standardized composite score to consider (1) severity of depressive symptoms and (2a) diabetes control or (2b) pain intensity and physical disability 3 months after the end of treatment as the primary end point. Differences between the groups were estimated using mixed effects linear regression models, and mediation evaluations were conducted using path analyses to evaluate the potential mechanistic role of positive and negative affectivity and openness to the future. Results: At 3-month follow-up, the intervention + iTAU group (vs iTAU) exhibited greater reductions in composite multimorbidity score (B=?0.34, 95% CI ?0.64 to ?0.04; Hedges g=0.39) as well as in depression and negative affect and improvements in perceived health, positive affect, and openness to the future. Similar positive effects were observed after the intervention, including improvements in physical disability. No significant differences were found in glycosylated hemoglobin, pain intensity, or disability at 3-month follow-up (P=.60; P=.79; and P=.43, respectively). Path analyses revealed that the intervention had a significant impact on the primary outcome, mediated by both positive and negative affect (positive affect: indirect effect=?0.15, bootstrapped 95% CI ?0.28 to ?0.03; negative affect: indirect effect=?0.14, bootstrapped 95% CI ?0.28 to ?0.02). Conclusions: This study supports the efficacy of a low-intensity psychological intervention applied in a blended format on multimorbidity in primary care. It justifies the exploration of the conceptualization of depression in type 2 diabetes as well as the analysis of the implementation of such interventions in routine clinical practice. Trial Registration: ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709 International Registered Report Identifier (IRRID): RR2-10.1186/S12888-019-2037-3 UR - https://www.jmir.org/2025/1/e56203 UR - http://dx.doi.org/10.2196/56203 UR - http://www.ncbi.nlm.nih.gov/pubmed/39928931 ID - info:doi/10.2196/56203 ER - TY - JOUR AU - Sugawara, Yuka AU - Hirakawa, Yosuke AU - Iwagami, Masao AU - Inokuchi, Ryota AU - Wakimizu, Rie AU - Nangaku, Masaomi PY - 2025/1/31 TI - Metrics for Evaluating Telemedicine in Randomized Controlled Trials: Scoping Review JO - J Med Internet Res SP - e67929 VL - 27 KW - patient experience KW - patient-reported outcome KW - quality of life KW - quality-adjusted life year KW - telehealth KW - eHealth KW - mobile phone KW - metrics KW - telemedicine KW - systematic review KW - scoping review KW - review KW - telecommunications KW - database KW - health care KW - patient-centeredness KW - patient satisfaction KW - patient outcome KW - clinical parameter KW - cost-effectiveness KW - evaluation metrics KW - mHealth KW - mobile health N2 - Background: Telemedicine involves medical, diagnostic, and treatment-related services using telecommunication technology. Not only does telemedicine contribute to improved patient quality of life and satisfaction by reducing travel time and allowing patients to be seen in their usual environment, but it also has the potential to improve disease management by making it easier for patients to see a doctor. Recently, owing to IT developments, research on telemedicine has been increasing; however, its usefulness and limitations in randomized controlled trials remain unclear because of the multifaceted effects of telemedicine. Furthermore, the specific metrics that can be used as cross-disciplinary indicators when comparing telemedicine and face-to-face care also remain undefined. Objective: This review aimed to provide an overview of the general and cross-disciplinarity metrics used to compare telemedicine with in-person care in randomized controlled trials. In addition, we identified previously unevaluated indicators and suggested those that should be prioritized in future clinical trials. Methods: MEDLINE and Embase databases were searched for publications that met the inclusion criteria according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews). Original, English-language articles on randomized controlled trials comparing some forms of telemedicine with face-to-face care from January 2019 to March 2024 were included, and the basic information and general metrics used in these studies were summarized. Results: Of the 2275 articles initially identified, 79 were included in the final analysis. The commonly used metrics that can be used across medical specialties were divided into the following 3 categories: (1) patient-centeredness (67/79, 85%), including patient satisfaction, workload, and quality of life; (2) patient outcomes (57/79, 72%), including general clinical parameters such as death, admission, and adverse events; and (3) cost-effectiveness (40/79, 51%), including cost assessment and quality-adjusted life year. Notably, only 25 (32%) of 79 studies evaluated all the 3 categories. Other metrics, such as staff convenience, system usability, and environmental impact, were extracted as indicators in different directions from the three categories above, although few previous reports have evaluated them (staff convenience: 8/79, 10%; system usability: 3/79, 4%; and environmental impact: 2/79, 3%). Conclusions: A significant variation was observed in the metrics used across previous studies. Notably, general indicators should be used to enhance the understandability of the results for people in other areas, even if disease-specific indicators are used. In addition, indicators should be established to include all three commonly used categories of measures to ensure a comprehensive evaluation: patient-centeredness, patient outcomes, and cost-effectiveness. Staff convenience, system usability, and environmental impact are important indicators that should be used in future trials. Moreover, standardization of the evaluation metrics is desired for future clinical trials and studies. Trial Registration: Open Science Forum Registries YH5S7; https://doi.org/10.17605/OSF.IO/YH5S7 UR - https://www.jmir.org/2025/1/e67929 UR - http://dx.doi.org/10.2196/67929 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67929 ER - TY - JOUR AU - Amhaz, Haneen AU - Chen, Xuanping Sally AU - Elchehimi, Amanee AU - Han, Jialin Kylin AU - Gil, Morales Jade AU - Yao, Lu AU - Vidler, Marianne AU - Berry-Einarson, Kathryn AU - Dewar, Kathryn AU - Tuason, May AU - Prestley, Nicole AU - Doan, Quynh AU - van Rooij, Tibor AU - Costa, Tina AU - Ogilvie, Gina AU - Payne, A. Beth PY - 2025/1/30 TI - The Research Agenda for Perinatal Innovation and Digital Health Project: Human-Centered Approach to Multipartner Research Agenda Codevelopment JO - JMIR Hum Factors SP - e60825 VL - 12 KW - digital health KW - co-design KW - digital strategy KW - human-centered design KW - eHealth KW - cocreation KW - codevelopment KW - perinatal intervention KW - quality of care KW - digital tools KW - pregnancy KW - patient autonomy KW - patient support KW - mobile phone N2 - Background: Digital health innovations provide an opportunity to improve access to care, information, and quality of care during the perinatal period, a critical period of health for mothers and infants. However, research to develop perinatal digital health solutions needs to be informed by actual patient and health system needs in order to optimize implementation, adoption, and sustainability. Objective: Our aim was to co-design a research agenda with defined research priorities that reflected health system realities and patient needs. Methods: Co-design of the research agenda involved a series of activities: (1) review of the provincial Digital Health Strategy and Maternity Services Strategy to identify relevant health system priorities, (2) anonymous survey targeting perinatal care providers to ascertain their current use and perceived need for digital tools, (3) engagement meetings using human-centered design methods with multilingual patients who are currently or recently pregnant to understand their health experiences and needs, and (4) a workshop that brought together patients and other project partners to prioritize identified challenges and opportunities for perinatal digital health in a set of research questions. These questions were grouped into themes using a deductive analysis approach starting with current BC Digital Health Strategy guiding principles. Results: Between September 15, 2022, and August 31, 2023, we engaged with more than 150 perinatal health care providers, researchers, and health system stakeholders and a patient advisory group of women who were recently pregnant to understand the perceived needs and priorities for digital innovation in perinatal care in British Columbia, Canada. As a combined group, partners were able to define 12 priority research questions in 3 themes. The themes prioritized are digital innovation for (1) patient autonomy and support, (2) standardized educational resources for patients and providers, and (3) improved access to health information. Conclusions: Our research agenda highlights the needs for perinatal digital health research to support improvements in the quality of care in British Columbia. By using a human-centered design approach, we were able to co-design research priorities that are meaningful to patients and health system stakeholders. The identified priority research questions are merely a stepping stone in the research process and now need to be actioned by research teams and health systems partners. UR - https://humanfactors.jmir.org/2025/1/e60825 UR - http://dx.doi.org/10.2196/60825 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60825 ER - TY - JOUR AU - Alharbi, A. Abdullah AU - Aljerian, A. Nawfal AU - Binhotan, S. Meshary AU - Alghamdi, A. Hani AU - Alsultan, K. Ali AU - Arafat, S. Mohammed AU - Aldhabib, Abdulrahman AU - Alaska, A. Yasser AU - Alwahbi, B. Eid AU - Muaddi, A. Mohammed AU - Alqassim, Y. Ahmad AU - Horner, D. Ronnie PY - 2025/1/24 TI - Digital Surveillance of Mental Health Care Services in Saudi Arabia: Cross-Sectional Study of National e-Referral System Data JO - JMIR Public Health Surveill SP - e64257 VL - 11 KW - digital health KW - mental health KW - health policy KW - epidemiology KW - Saudi Arabia KW - SMARC KW - health care transformation KW - e-referral KW - Saudi Medical Appointments and Referrals Centre N2 - Background: Mental illness affects an estimated 25% of the global population, with treatment gaps persisting worldwide. The COVID-19 pandemic has exacerbated these challenges, leading to a significant increase in mental health issues globally. In Saudi Arabia, the lifetime prevalence of mental disorders is estimated at 34.2%, yet 86.1% of those with a 12-month mental disorder report no service use. To address these challenges, digital health solutions, particularly electronic referral (e-referral) systems, have emerged as powerful tools to improve care coordination and access. Saudi Arabia has pioneered the nationwide Saudi Medical Appointments and Referrals Centre (SMARC), a centralized e-referral system using artificial intelligence and predictive analytics. Objectives: This study aims to analyze Saudi Arabia?s novel nationwide e-referral system for mental health services, using SMARC platform data to examine referral patterns, and service accessibility. This study also aims to demonstrate how digital health technology can inform and improve mental health care delivery and policy making. Methods: This retrospective, cross-sectional study used secondary data from SMARC on 10,033 psychiatric e-referrals in Saudi Arabia during 2020?2021. Referrals were assessed by patient sociodemographic variables, geographic data, and e-referral characteristics including date, type, bed type, and reason for e-referral. Descriptive statistical analyses identified referral patterns, while regression modeling determined predictors of external referrals to other regions. Results: Analysis of 10,033 psychiatric e-referrals revealed that 58.99% (n=5918) were for patients aged 18?44 years, 63.93% (n=6414) were for men, and 87.10% (n=8739) were for Saudi nationals. The Western Business Unit generated 45.17% (n=4532) of all e-referral requests. Emergency cases were the most common type of referral overall, followed by routine inpatient and routine outpatient department referrals. However, in the Northern Business Unit, routine inpatient referrals were most frequent. Two-thirds of requests were for ward beds, while critical beds were rarely requested. ?Unavailable subspecialty? was the primary reason for referrals across all regions. The utilization of the mental health e-referral system varied across regions, with the Northern Border and Albaha regions showing the highest rates, while Madinah, Eastern, and Riyadh regions demonstrated lower use. Temporal analysis showed almost similar monthly patterns in 2020 and 2021. There was an overall increase in referrals in 2021 compared with 2020. Conclusions: This pioneering study of mental health e-referrals in Saudi Arabia demonstrates how digital health transformation, particularly through an e-referral system, has significantly enhanced access to mental health services nationwide in Saudi Arabia. The success of this digital initiative demonstrates how digital health solutions can transform health care access, particularly in mental health services, offering a valuable model for other health care systems. UR - https://publichealth.jmir.org/2025/1/e64257 UR - http://dx.doi.org/10.2196/64257 ID - info:doi/10.2196/64257 ER - TY - JOUR AU - Seringa, Joana AU - Hirata, Anna AU - Pedro, Rita Ana AU - Santana, Rui AU - Magalhães, Teresa PY - 2025/1/20 TI - Health Care Professionals and Data Scientists? Perspectives on a Machine Learning System to Anticipate and Manage the Risk of Decompensation From Patients With Heart Failure: Qualitative Interview Study JO - J Med Internet Res SP - e54990 VL - 27 KW - heart failure KW - machine learning system KW - decompensation KW - qualitative research KW - cardiovascular diseases KW - heart failure management KW - interview N2 - Background: Heart failure (HF) is a significant global health problem, affecting approximately 64.34 million people worldwide. The worsening of HF, also known as HF decompensation, is a major factor behind hospitalizations, contributing to substantial health care costs related to this condition. Objective: This study aimed to explore the perspectives of health care professionals and data scientists regarding the relevance, challenges, and potential benefits of using machine learning (ML) models to predict decompensation from patients with HF. Methods: A total of 13 individual, semistructured, qualitative interviews were conducted in Portugal between October 31, 2022, and June 23, 2023. Participants represented different health care specialties and were selected from different contexts and regions of the country to ensure a comprehensive understanding of the topic. Data saturation was determined as the point at which no new themes emerged from participants? perspectives, ensuring a sufficient sample size for analysis. The interviews were audio recorded, transcribed, and analyzed using MAXQDA (VERBI Software GmbH) through a reflexive thematic analysis. Two researchers (JS and AH) coded the interviews to ensure the consistency of the codes. Ethical approval was granted by the NOVA National School of Public Health ethics committee (CEENSP 14/2022), and informed consent was obtained from all participants. Results: The participants recognized the potential benefits of ML models for early detection, risk stratification, and personalized care of patients with HF. The importance of selecting appropriate variables for model development, such as rapid weight gain and symptoms, was emphasized. The use of wearables for recording vital signs was considered necessary, although challenges related to adoption among older patients were identified. Risk stratification emerged as a crucial aspect, with the model needing to identify patients at high-, medium-, and low-risk levels. Participants emphasized the need for a response model involving health care professionals to validate ML-generated alerts and determine appropriate interventions. Conclusions: The study?s findings highlight ML models? potential benefits and challenges for predicting HF decompensation. The relevance of ML models for improving patient outcomes, reducing health care costs, and promoting patient engagement in disease management is highlighted. Adequate variable selection, risk stratification, and response models were identified as essential components for the effective implementation of ML models in health care. In addition, the study identified technical, regulatory and ethical, and adoption and acceptance challenges that need to be overcome for the successful integration of ML models into clinical workflows. Interpretation of the findings suggests that future research should focus on more extensive and diverse samples, incorporate the patient perspective, and explore the impact of ML models on patient outcomes and personalized care in HF management. Incorporation of this study?s findings into practice is expected to contribute to developing and implementing ML-based predictive models that positively impact HF management. UR - https://www.jmir.org/2025/1/e54990 UR - http://dx.doi.org/10.2196/54990 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54990 ER - TY - JOUR AU - Toben, Daan AU - de Wind, Astrid AU - van der Meij, Eva AU - Huirne, F. Judith A. AU - Anema, R. Johannes PY - 2025/1/14 TI - A Patient-Oriented Implementation Strategy for a Perioperative mHealth Intervention: Feasibility Cohort Study JO - JMIR Perioper Med SP - e58878 VL - 8 KW - perioperative care KW - recovery KW - feasibility KW - convalescence KW - patient-oriented KW - surgery KW - perioperative KW - eHealth KW - mHealth KW - tailor KW - customize KW - patient care KW - digital intervention KW - health intervention KW - patient education KW - surgical care KW - hospital care KW - digital health KW - perioperative medicine KW - elective surgery KW - technology KW - caregiver KW - mobile app KW - digital care N2 - Background: Day surgery is being increasingly implemented across Europe, driven in part by capacity problems. Patients recovering at home could benefit from tools tailored to their new care setting to effectively manage their convalescence. The mHealth application ikHerstel is one such tool, but although it administers its functions in the home, its implementation hinges on health care professionals within the hospital. Objective: We conducted a feasibility study of an additional patient-oriented implementation strategy for ikHerstel. This strategy aimed to empower patients to access and use ikHerstel independently, in contrast to implementation as usual, which hinges on the health care professional acting as gatekeeper. Our research question was ?How well are patients able to use ikHerstel independently of their health care professional?? Methods: We investigated the implementation strategy in terms of its recruitment, reach, dose delivered, dose received, and fidelity. Patients with a recent or prospective elective surgery were recruited using a wide array of materials to simulate patient-oriented dissemination of ikHerstel. Data were collected through web-based surveys. Descriptive analysis and open coding were used to analyze the data. Results: Recruitment yielded 213 registrations, with 55 patients ultimately included in the study. The sample was characterized by patients undergoing abdominal surgery, with high literacy and above average digital health literacy, and included an overrepresentation of women (48/55, 87%). The implementation strategy had a reach of 81% (63/78), with 87% (55/67) of patients creating a recovery plan. Patients were satisfied with their independent use of ikHerstel, rating it an average 7.0 (SD 1.9) of 10, and 54% (29/54) of patients explicitly reported no difficulties in using it. A major concern of the implementation strategy was conflicts in recommendations between ikHerstel and the health care professionals, as well as the resulting feelings of insecurity experienced by patients. Conclusions: In this small feasibility study, most patients were satisfied with the patient-oriented implementation strategy. However, the lack of involvement of health care professionals due to the strategy contributed to patient concerns regarding conflicting recommendations between ikHerstel and health care professionals. UR - https://periop.jmir.org/2025/1/e58878 UR - http://dx.doi.org/10.2196/58878 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58878 ER - TY - JOUR AU - Vestergaard, Bech Sofie AU - Roost, Mette AU - Christiansen, Høyrup David AU - Schougaard, Valen Liv Marit PY - 2025/1/14 TI - Determinants of Dropping Out of Remote Patient-Reported Outcome?Based Follow-Up Among Patients With Epilepsy: Prospective Cohort Study JO - JMIR Form Res SP - e58258 VL - 9 KW - patient-reported outcome measures KW - dropouts KW - digital solutions KW - outpatient care KW - epilepsy KW - seizure disorder KW - neurological condition KW - cohort study KW - health care KW - Denmark KW - self-reported KW - self-management KW - mental health KW - patient satisfaction KW - logistic regression KW - social support N2 - Background: The use of patient-reported outcome (PRO) measures is an emerging field in health care. In the Central Denmark Region, epilepsy outpatients can participate in remote PRO-based follow-up by completing a questionnaire at home instead of attending a traditional outpatient appointment. This approach aims to encourage patient engagement and is used in approximately half of all epilepsy outpatient consultations. However, dropout in this type of follow-up is a challenging issue. Objective: This study aimed to examine the association between potential self-reported determinants and dropout in remote PRO-based follow-up for patients with epilepsy. Methods: This prospective cohort study (n=2282) explored the association between dropout in remote PRO-based follow-up for patients with epilepsy and 9 potential determinants covering 3 domains: health-related self-management, general and mental health status, and patient satisfaction. The associations were examined using multiple logistic regression analyses with adjustment for sex, age, education, and cohabitation. Results: A total of 770 patients (33.7%) dropped out of remote PRO-based follow-up over 5 years. Statistically significant associations were identified between all potential determinants and dropouts in PRO-based follow-up. Patients with low social support had an odds ratio of 2.20 (95% CI 1.38-3.50) for dropout. Patients with poor health ratings had an odds ratio of 2.17 (95% CI 1.65-2.85) for dropout. Similar estimates were identified for the remaining determinants in question. Conclusions: Patients with reduced self-management, poor health status, and low patient satisfaction had higher odds of dropout in remote PRO-based follow-up. However, further research is needed to determine the reasons for dropout. UR - https://formative.jmir.org/2025/1/e58258 UR - http://dx.doi.org/10.2196/58258 ID - info:doi/10.2196/58258 ER - TY - JOUR AU - Weimar, Noel Sascha AU - Martjan, Sophie Rahel AU - Terzidis, Orestis PY - 2025/1/9 TI - Business Venturing in Regulated Markets?Taxonomy and Archetypes of Digital Health Business Models in the European Union: Mixed Methods Descriptive and Exploratory Study JO - J Med Internet Res SP - e65725 VL - 27 KW - digital health KW - telemedicine KW - mobile health KW - business model KW - European Union KW - classification KW - archetypes KW - medical device regulations KW - mobile phone KW - artificial intelligence KW - AI N2 - Background: Digital health technology (DHT) has the potential to revolutionize the health care industry by reducing costs and improving the quality of care in a sector that faces significant challenges. However, the health care industry is complex, involving numerous stakeholders, and subject to extensive regulation. Within the European Union, medical device regulations impose stringent requirements on various ventures. Concurrently, new reimbursement pathways are also being developed for DHTs. In this dynamic context, establishing a sustainable and innovative business model around DHTs is fundamental for their successful commercialization. However, there is a notable lack of structured understanding regarding the overarching business models within the digital health sector. Objective: This study aims to address this gap and identify key elements and configurations of business models for DHTs in the European Union, thereby establishing a structured understanding of the archetypal business models in use. Methods: The study was conducted in 2 phases. First, a business model taxonomy for DHTs was developed based on a systematic literature review, the analysis of 169 European real-world business models, and qualitative evaluation through 13 expert interviews. Subsequently, a 2-step clustering analysis was conducted on the 169 DHT business models to identify distinct business model archetypes. Results: The developed taxonomy of DHT business models revealed 11 central dimensions organized into 4 meta-dimensions. Each dimension comprises 2 to 9 characteristics capturing relevant aspects of DHT business models. In addition, 6 archetypes of DHT business models were identified: administration and communication supporter (A1), insurer-to-consumer digital therapeutics and care (A2), diagnostic and treatment enabler (A3), professional monitoring platforms (A4), clinical research and solution accelerators (A5), and direct-to-consumer wellness and lifestyle (A6). Conclusions: The findings highlight the critical elements constituting business models in the DHT domain, emphasizing the substantial impact of medical device regulations and revenue models, which often involve reimbursement from stakeholders such as health insurers. Three drivers contributing to DHT business model innovation were identified: direct targeting of patients and private individuals, use of artificial intelligence as an enabler, and development of DHT-specific reimbursement pathways. The study also uncovered surprising business model patterns, including shifts between regulated medical devices and unregulated research applications, as well as wellness and lifestyle solutions. This research enriches the understanding of business models in digital health, offering valuable insights for researchers and digital health entrepreneurs. UR - https://www.jmir.org/2025/1/e65725 UR - http://dx.doi.org/10.2196/65725 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65725 ER - TY - JOUR AU - Valkonen, Paula AU - Kujala, Sari AU - Savolainen, Kaisa AU - Helminen, Riina-Riitta PY - 2025/1/8 TI - Exploring Older Adults? Needs for a Healthy Life and eHealth: Qualitative Interview Study JO - JMIR Hum Factors SP - e50329 VL - 12 KW - older adults KW - eHealth KW - needs KW - retirement KW - well-being KW - cultural probes KW - sentence completion KW - human-computer interaction N2 - Background: Aging brings physical and life changes that could benefit from eHealth services. eHealth holistically combines technology, tasks, individuals, and contexts, and all these intertwined elements should be considered in eHealth development. As users? needs change with life situations, including aging and retirement, it is important to identify these needs at different life stages to develop eHealth services for well-being and active, healthy lives. Objective: This study aimed to (1) understand older adults? everyday lives in terms of well-being and health, (2) investigate older adults? needs for eHealth services, and (3) create design recommendations based on the findings. Methods: A total of 20 older adults from 2 age groups (55 to 74 years: n=12, 60%; >75 years: n=8, 40%) participated in this qualitative interview study. The data were collected remotely using a cultural probes package that included diary-based tasks, sentence completion tasks, and 4 background questionnaires; we also performed remote, semistructured interviews. The data were gathered between the fall of 2020 and the spring of 2021 in Finland as a part of the Toward a Socially Inclusive Digital Society: Transforming Service Culture (DigiIN) project (2019 to 2025). Results: In the daily lives of older adults, home-based activities, such as exercising (72/622, 11.6% of mentions), sleeping (51/622, 8.2% of mentions), and dining and cooking (96/622, 15.4% of mentions), promoted well-being and health. When discussing their needs for eHealth services, participants highlighted a preference for a chat function. However, they frequently mentioned barriers and concerns such as the lack of human contact, inefficiency, and difficulties using eHealth systems. Older adults value flexibility; testing possibilities (eg, trial versions); support for digital services; and relevant, empathetically offered content with eHealth services on short-term and long-term bases in their changing life situations. Conclusions: Many older adults value healthy routines and time spent at home. The diversity of older adults? needs should be considered by making it possible for them to manage their health safely and flexibly on different devices and channels. eHealth services should adapt to older adults? life changes through motivation, personalized content, and appropriate functions. Importantly, older adults should still have the option to not use eHealth services. UR - https://humanfactors.jmir.org/2025/1/e50329 UR - http://dx.doi.org/10.2196/50329 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50329 ER - TY - JOUR AU - Kristiansen, Eli AU - Atherton, Helen AU - Austad, Bjarne AU - Bergmo, Strand Trine AU - Norberg, Lønnebakke Børge AU - Salisbury, Chris AU - Zanaboni, Paolo PY - 2025/1/8 TI - Patients? Use of e-Consultations as an Alternative to Other General Practitioner Services: Cross-Sectional Survey Study JO - J Med Internet Res SP - e55158 VL - 27 KW - e-consultation KW - remote consultation KW - telehealth KW - primary care KW - general practitioner KW - patient experience KW - cross-sectional KW - digital health KW - survey N2 - Background: e-Consultations, defined as asynchronous text-based messaging, have transformed how patients interact with their general practitioner (GP). While e-consultations can improve patient access to GP care, concerns about increased workload for GPs are raised. Objective: This study aimed to address three research questions: (1) For what purpose and with what expectations do patients initiate e-consultations? (2) If e-consultations had not been available, what alternative actions would the patient have taken? and (3) How are the alternative actions associated with patient and e-consultation characteristics? Methods: A cross-sectional study was conducted through a web-based survey on Helsenorge. Helsenorge is the national citizen portal for digital health services in Norway, including e-consultations with the GP. All users who sent e-consultations through Helsenorge were invited to participate between January and February 2023. The survey addressed questions on users? expectations and experience with e-consultations. The association between patient and e-consultation characteristics and alternative actions to e-consultations were analyzed using multinomial logistic regression. Results: Overall, 13,011 users answered the survey. The most common reason for initiating an e-consultation was requesting a sick certificate (4940/13,011, 38%). Overall, 68.7% (8802/13,011) of respondents expected an answer within 24 hours, and 17.7% (2310/13,011) anticipated that the GP would ask them to attend a physical examination. If e-consultations had not been available, 45.5% (5917/13,011) of respondents would have booked a GP appointment, and 44.9% (5846/13,011) would have called the front desk. Users who expected a quicker response (odds ratio [OR] 1.64, 95% CI 1.46-1.85) and were less concerned about their health issues (OR 1.29, 95% CI 1.18-1.40) were more likely to call the front desk. Only 2.5% (323/13,011) of respondents would have contacted out-of-hours services. Users with longer travel time to the GP office (OR 6.08, 95% CI 3.46-10.66) and with a new health problem (OR 2.71, 95% CI 2.09-3.51) were more likely to choose this option. In addition, 4.7% (609/13,011) of the users would not have sought help if e-consultations had not been available. Younger patients (OR 2.16, 95% CI 1.38-3.37) and those with a longer travel time to the GP office (OR 2.19, 95% CI 1.27-3.80) or a new health issue (OR 1.74, 95% CI 1.43-2.12) had higher odds for not seeking help. Conclusions: e-Consultations were often the patients? first choice of access route, and users expected a fast response. e-Consultations were mostly perceived as an alternative to GP appointments or calling the front desk. Patients with lower availability to the GP office had higher odds of using e-consultations as an alternative to out-of-hours service or waiting and not seeking GP care. Guidance for patient use should be developed to ensure appropriate and safe use. Further research should assess the effect of e-consultations on health outcomes and efficiency. UR - https://www.jmir.org/2025/1/e55158 UR - http://dx.doi.org/10.2196/55158 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55158 ER - TY - JOUR AU - Gehder, Sara AU - Goeldner, Moritz PY - 2025/1/6 TI - Unpacking Performance Factors of Innovation Systems and Studying Germany?s Attempt to Foster the Role of the Patient Through a Market Access Pathway for Digital Health Applications (DiGAs): Exploratory Mixed Methods Study JO - J Med Internet Res SP - e66356 VL - 27 KW - regulatory market access pathways KW - digital health application KW - DiGA KW - patient-relevant structural and procedural improvement KW - pSVV pathway analysis KW - qualitative and systemic analysis KW - policy and stakeholder insights KW - innovation system analysis N2 - Background: Health care innovation faces significant challenges, including system inertia and diverse stakeholders, making regulated market access pathways essential for facilitating the adoption of new technologies. The German Digital Healthcare Act, introduced in 2019, offers a model by enabling digital health applications (DiGAs) to be reimbursed by statutory health insurance, improving market access and patient empowerment. However, the factors influencing the success of these pathways in driving innovation remain unclear. Objective: This study aims to identify the key performance factors of the innovation system shaped by the patient-relevant structural and procedural improvement (pSVV) pathway within the DiGA model. By examining how this pathway supports the entry of innovative digital health technologies, we seek to uncover the systemic dynamics that influence its effectiveness in fostering patient-centered digital health solutions. Methods: This study, conducted from May 2023 to November 2024, used a mixed methods approach. A descriptive analysis assessed how DiGA manufacturers use positive health care effects, giving a market overview of the pSVV technology. A qualitative analysis using grounded theory and Gioia methodology provided insights into stakeholder perspectives, focusing on manufacturers and regulatory bodies. A functional-structural analysis examined how components of the innovation system, such as actors, institutions, interactions, and infrastructure, interact and impact the effectiveness of the pathway. Results: The descriptive analysis showed that only 11 (20%) of the 56 DiGAs available in Germany used the pSVV pathway, with only 1 (2%) provisionally listed DiGA using pSVV as a primary end point; 6 of 9 (67%) pSVV key areas were used. The qualitative analysis revealed that manufacturers prioritize demonstrating medical benefits over pSVV due to evidence requirements and uncertainties around pSVV acceptance. Operational barriers hindered the adoption of pSVV, despite a positive reception among stakeholders. The systemic analysis identified key issues, including a lack of entrepreneurial focus on pSVV, limited regulatory experience, inadequate measurement methods, and entrenched practices prioritizing medical benefits, that hinder market formation and legitimacy. Conclusions: This study identifies key factors for effectively implementing innovation systems through regulated market access pathways, including content and format security, clearer framework specification, active innovation process management, and market formation stimulation. Addressing these factors can reduce uncertainties and promote wider adoption of digital health technologies. The findings highlight the need for future research on patient empowerment and the development of methodologies beyond traditional therapeutic outcomes. UR - https://www.jmir.org/2025/1/e66356 UR - http://dx.doi.org/10.2196/66356 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66356 ER - TY - JOUR AU - Hossain, Tasnim Aniqa AU - Rahman, Hafizur Md AU - Manna, Maher Ridwana AU - Akter, Ema AU - Islam, Hasibul S. M. AU - Hossain, Alamgir Md AU - Ara, Tasnu AU - Usmani, Ghani Nasimul AU - Chandra, Pradip AU - Khan, Ahmed Maruf AU - Rahman, Mustafizur S. M. AU - Ahmed, Uddin Helal AU - Mozumder, Kamruzzaman Muhammad AU - Juthi, Mahmuda Jesmin AU - Shahrin, Fatema AU - Shams, Afrose Sadia AU - Afroze, Fahmida AU - Banu, Jahan Mukta AU - Ameen, Shafiqul AU - Jabeen, Sabrina AU - Ahmed, Anisuddin AU - Amin, Robed Mohammad AU - Arifeen, El Shams AU - Shomik, Sohel Mohammad AU - Rahman, Ehsanur Ahmed PY - 2025/1/3 TI - Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research JO - JMIR Pediatr Parent SP - e65912 VL - 8 KW - Wellbeing Centers KW - antepartum KW - postpartum KW - depression KW - anxiety KW - implementation N2 - Background: Globally, 10% of pregnant women and 13% of postpartum women experience mental disorders. In Bangladesh, nearly 50% of mothers face common mental disorders, but mental health services and trained professionals to serve their needs are scarce. To address this, the government of Bangladesh?s Non-Communicable Disease Control program initiated ?Wellbeing Centers,? telemental health services in selected public hospitals. Objective: This study examines implementation outcomes, including adoption, accessibility, acceptability, feasibility, usefulness, need, experience, perception, and expectations of the Wellbeing Centers, with a focus on antepartum and postpartum women. Methods: Between January 2023 and August 2024, we interviewed 911 antepartum and postpartum women receiving mental health services and 168 health care providers at 6 Wellbeing Centers in 4 districts in Bangladesh. Data collection involved both quantitative and qualitative methods. Implementation outcomes were measured following the World Health Organization?s implementation research framework. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 questionnaires. Descriptive statistics and adjusted odds ratios (aORs) with 95% CIs were used to evaluate the implementation outcomes. Qualitative information was obtained through in-depth interviews and key-informant interviews. Results: Almost all health care providers (165/168, 98.2%) reported that the Wellbeing Centers were feasible to implement in their health facilities; however, about half (84/168, 50%) felt that trained staff to operate them were insufficient. Almost all women agreed that the Wellbeing Centers were acceptable (906/911, 99.8%), useful (909/911, 99.8%), and enhanced access to mental health care (906/911, 99.5%). Patients visiting district-level hospitals had higher odds of access (aOR 1.5, 95% CI 1.1-2.0) to Wellbeing Centers. Moreover, 77.4% (705/911) of women experienced depression symptoms, and 76.7% (699/911) experienced anxiety symptoms. About 51.8% (472/911) experienced tiredness or lack of energy, 50.9% (464/911) felt nervous, anxious, or on edge, 57.2% (521/911) felt worried, and 3.8% (35/911) had suicidal ideation almost every day. Patients visiting district hospitals had higher odds (aOR 2.6, 95% CI 1.8-3.78) of depression and anxiety symptoms compared to the patients visiting subdistrict-level hospitals. Decreasing trends in Patient Health Questionnaire-9 scores (from mean 14.4, SD 0.47 to mean 12.9, SD 0.47) and Generalized Anxiety Disorder-7 scores (from mean 13.3, SD 0.49 to mean 12.5, SD 0.48) between 2 counseling sessions indicated improved mental health in the antepartum and postpartum women. The Wellbeing Centers? services were appreciated for their privacy and being free and accessible. However, stigma, postpartum illness, and long waiting times prevented some women from using these services. Conclusions: To our knowledge, this is the first implementation research assessing telemental health in public health facilities involving trained psychologists and psychiatrists. Our study highlighted the increased accessibility, feasibility, acceptability, and utility of Wellbeing Centers for antepartum and postpartum women in Bangladesh, supporting their scale-up in similar settings. UR - https://pediatrics.jmir.org/2025/1/e65912 UR - http://dx.doi.org/10.2196/65912 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65912 ER - TY - JOUR AU - Scruton, Sarah AU - Wong, Geoff AU - Babinski, Stephanie AU - Squires, R. Lauren AU - Berlin, Alejandro AU - Easley, Julie AU - McGee, Sharon AU - Noel, Ken AU - Rodin, Danielle AU - Sussman, Jonathan AU - Urquhart, Robin AU - Bender, L. Jacqueline PY - 2025/1/3 TI - Optimizing Virtual Follow-Up Care: Realist Evaluation of Experiences and Perspectives of Patients With Breast and Prostate Cancer JO - J Med Internet Res SP - e65148 VL - 27 KW - cancer KW - follow-up KW - virtual KW - outcomes KW - realist evaluation KW - survivorship N2 - Background: Virtual follow-up (VFU) has the potential to enhance cancer survivorship care. However, a greater understanding is needed of how VFU can be optimized. Objective: This study aims to examine how, for whom, and in what contexts VFU works for cancer survivorship care. Methods: We conducted a realist evaluation of VFU among patients with breast cancer and prostate cancer at an urban cancer center during the COVID-19 pandemic. Realist evaluations examine how underlying causal processes of an intervention (mechanisms) in specific circumstances (contexts) interact to produce results (outcomes). Semistructured interviews were conducted with a purposive sample of patients ?5 years after diagnosis. Interviews were audio-recorded and analyzed using a realist logic of analysis. Results: Participants (N=24; n=12, 50% with breast cancer and n=12, 50% with prostate cancer) had an average age of 59.6 (SD 10.7) years. Most participants (20/24, 83%) were satisfied with VFU and wanted VFU options to continue after the COVID-19 pandemic. However, VFU impacted patient perceptions of the quality of their care, particularly in terms of its effectiveness and patient centeredness. Whether VFU worked well for patients depended on patient factors (eg, needs, psychosocial well-being, and technological competence), care provider factors (eg, socioemotional behaviors and technological competence), and virtual care system factors (eg, modality, functionality, usability, virtual process of care, and communication workflows). Key mechanisms that interacted with contexts to produce positive outcomes (eg, satisfaction) were visual cues, effective and empathetic communication, and a trusting relationship with their provider. Conclusions: Patients value VFU; however, VFU is not working as well as it could for patients. To optimize VFU, it is critical to consider contexts and mechanisms that impact patient perceptions of the patient centeredness and effectiveness of their care. Offering patients the choice of in-person, telephone, or video visits when possible, coupled with streamlined access to in-person care when required, is important. Prioritizing and addressing patient needs; enhancing physician virtual socioemotional behaviors and technology competency; and enhancing VFU functionality, usability, and processes of care and communication workflows will improve patient perceptions of the patient centeredness and effectiveness of virtual care. UR - https://www.jmir.org/2025/1/e65148 UR - http://dx.doi.org/10.2196/65148 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65148 ER - TY - JOUR AU - Hoffman, Jane AU - Hattingh, Laetitia AU - Shinners, Lucy AU - Angus, L. Rebecca AU - Richards, Brent AU - Hughes, Ian AU - Wenke, Rachel PY - 2024/12/30 TI - Allied Health Professionals? Perceptions of Artificial Intelligence in the Clinical Setting: Cross-Sectional Survey JO - JMIR Form Res SP - e57204 VL - 8 KW - allied health KW - artificial intelligence KW - hospital KW - digital health KW - impact KW - AI KW - mHealth KW - cross sectional KW - survey KW - health professional KW - medical professional KW - perception KW - clinical setting KW - opportunity KW - challenge KW - healthcare KW - delivery KW - Australia KW - clinician KW - confirmatory factor analysis KW - linear regression N2 - Background: Artificial intelligence (AI) has the potential to address growing logistical and economic pressures on the health care system by reducing risk, increasing productivity, and improving patient safety; however, implementing digital health technologies can be disruptive. Workforce perception is a powerful indicator of technology use and acceptance, however, there is little research available on the perceptions of allied health professionals (AHPs) toward AI in health care. Objective: This study aimed to explore AHP perceptions of AI and the opportunities and challenges for its use in health care delivery. Methods: A cross-sectional survey was conducted at a health service in, Queensland, Australia, using the Shinners Artificial Intelligence Perception tool. Results: A total of 231 (22.1%) participants from 11 AHPs responded to the survey. Participants were mostly younger than 40 years (157/231, 67.9%), female (189/231, 81.8%), working in a clinical role (196/231, 84.8%) with a median of 10 years? experience in their profession. Most participants had not used AI (185/231, 80.1%), had little to no knowledge about AI (201/231, 87%), and reported workforce knowledge and skill as the greatest challenges to incorporating AI in health care (178/231, 77.1%). Age (P=.01), profession (P=.009), and AI knowledge (P=.02) were strong predictors of the perceived professional impact of AI. AHPs generally felt unprepared for the implementation of AI in health care, with concerns about a lack of workforce knowledge on AI and losing valued tasks to AI. Prior use of AI (P=.02) and years of experience as a health care professional (P=.02) were significant predictors of perceived preparedness for AI. Most participants had not received education on AI (190/231, 82.3%) and desired training (170/231, 73.6%) and believed AI would improve health care. Ideas and opportunities suggested for the use of AI within the allied health setting were predominantly nonclinical, administrative, and to support patient assessment tasks, with a view to improving efficiencies and increasing clinical time for direct patient care. Conclusions: Education and experience with AI are needed in health care to support its implementation across allied health, the second largest workforce in health. Industry and academic partnerships with clinicians should not be limited to AHPs with high AI literacy as clinicians across all knowledge levels can identify many opportunities for AI in health care. UR - https://formative.jmir.org/2024/1/e57204 UR - http://dx.doi.org/10.2196/57204 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57204 ER - TY - JOUR AU - Khatun, Fatema AU - Das, Chandra Novel AU - Hoque, Rakibul Md AU - Saqeeb, Nazmus Kazi AU - Rahman, Monjur AU - Park, Ryul Kyung AU - Rasheed, Sabrina AU - Reidpath, D. Daniel PY - 2024/12/23 TI - Users? Perceived Service Quality of National Telemedicine Services During the COVID-19 Pandemic in Bangladesh: Cross-Sectional Study JO - JMIR Hum Factors SP - e46566 VL - 11 KW - telemedicine KW - COVID-19 KW - LMIC KW - low- and middle-income countries KW - Bangladesh KW - service quality KW - user satisfaction KW - structural equation modeling KW - digital health N2 - Background: COVID-19 created an opportunity for using teleconsultation as an alternative way of accessing expert medical advice. Bangladesh has seen a 20-fold increase in the use of teleconsultation during the pandemic. Objective: The aim of our study was to assess the influence of service quality and user satisfaction on the intention to use teleconsultation in the future among users of national teleconsultation services during the pandemic. Methods: A cross-sectional survey was conducted in 2020 among users of the national teleconsultation service?Shastho Batayon for acute respiratory infection. A validated mobile health service quality model based on structural equation modeling and confirmatory factor analysis was used to analyze the data with SmartPLS (version 3.0). Results: Among the 2097 study participants, 1646 (78.5%) were male, 1416 (67.5%) were aged 18?39 years, 1588 (75.7%) were urban residents, 1348 (64.2%) had more than 10 years of schooling, and 1657 (79%) were from middle-income households. From a consumer perspective, the quality of the service platform (?=.946), service interaction (?=.974), and outcome (?=.955) contributed to service quality. Service quality was positively associated with user satisfaction (?=.327; P<.001) and intention to use teleconsultation services (?=.102; P<.001). User satisfaction was positively associated with the intention to use teleconsultation services (?=.311; P<.001). Conclusions: The increase in the use of teleconsultation during the pandemic indicated that such services were potentially used for emergencies. However, the future use of teleconsultation will be dependent on the quality of service and user satisfaction. Our findings are relevant for low-income contexts where teleconsultation services are used to address gaps in service delivery. UR - https://humanfactors.jmir.org/2024/1/e46566 UR - http://dx.doi.org/10.2196/46566 ID - info:doi/10.2196/46566 ER - TY - JOUR AU - Neunaber, Timo AU - Mortsiefer, Achim AU - Meister, Sven PY - 2024/12/19 TI - Dimensions and Subcategories of Digital Maturity in General Practice: Qualitative Study JO - J Med Internet Res SP - e57786 VL - 26 KW - digital health KW - eHealth KW - digital maturity KW - maturity assessment KW - primary care KW - general practice KW - general practitioner KW - qualitative research KW - expert interviews KW - interview KW - explorative KW - dimension KW - subcategory KW - expert KW - care provider KW - content analysis N2 - Background: The status of the digitalization of companies and institutions is usually measured using maturity models. However, the concept of maturity in general practice is currently unclear, and herewith we examine the question of how maturity can be measured. There is a lack of empirical work on the dimensions and subcategories of digital maturity that provide information on the assessment framework. Objective: The aim of the study was to answer the question of how many and which dimensions and subcategories describe digital maturity in general practice. Methods: An explorative, qualitative research design based on semistructured expert interviews was used to investigate the dimensions of digital maturity. Twenty experts from various areas of the health care sector (care providers, interest groups, health care industry, and patient organizations) were interviewed. The interviews were analyzed based on a content-structuring analysis according to Kuckartz and Rädiker using MAXQDA software (VERBI GmbH). Results: In total, 6 dimensions with a total of 26 subcategories were identified. Of these, 4 dimensions with a total of 16 subcategories (1) digitally supported processes, (2) practice staff, (3) organizational structures and rules, and (4) technical infrastructure and were deductively linked to digital maturity. In addition to the use of digital solutions, digital maturity included, for example, individual, organizational, and technical capabilities and resources of the medical practice. The 2 further dimensions, (5) benefits and outcomes and (6) external framework conditions of the medical practice, were identified inductively with a total of 10 subcategories. Digital maturity was associated with the beneficial use of digitalization, for example, with efficiency benefits for the practice, and external framework conditions were associated with influencing factors such as the local patient situation in the medical practice. Conclusions: The results indicate that digital maturity is a multidimensional construct that is associated with many dimensions and variables. It is a holistic approach with human, organizational, and technical factors and concerns the way digitalization is used to shape patient care and processes. Furthermore, it is related to the maturity of the organizational environment as well as the benefits of a digitalized medical practice; however, this still needs to be confirmed. To measure the level of digital maturity in outpatient care as accurately as possible, maturity models should therefore be multilayered and take external influencing factors into account. Future research should statistically validate the identified dimensions. At the same time, correlations and dependencies between the measurement dimensions and their subcategories should be analyzed. UR - https://www.jmir.org/2024/1/e57786 UR - http://dx.doi.org/10.2196/57786 UR - http://www.ncbi.nlm.nih.gov/pubmed/39699948 ID - info:doi/10.2196/57786 ER - TY - JOUR AU - Norberg, Lønnebakke Børge AU - Austad, Bjarne AU - Kristiansen, Eli AU - Zanaboni, Paolo AU - Getz, Okkenhaug Linn PY - 2024/12/17 TI - The Impact and Wider Implications of Remote Consultations for General Practice in Norway: Qualitative Study Among Norwegian Contract General Practitioners JO - JMIR Form Res SP - e63068 VL - 8 KW - remote consultations KW - e-health KW - digital medicine KW - telemedicine KW - impact KW - downsides KW - disadvantages KW - pitfalls KW - safety KW - general practice KW - family medicine KW - practice organization KW - ecology of healthcare KW - remote consultation KW - monitoring KW - teleconsultation KW - social determinants of health N2 - Background: The digital shift toward remote consultations in general practice needs ongoing monitoring to understand its impact on general practice organizations and the wider health care system. Objective: This study aimed to explore how remote consultations impact on contracted general practitioner (GP) practices and how GPs perceive the implications of this uptake for the overall health care system. Methods: In total, 5 focus groups were conducted with a total of 18 GPs from all 4 health regions of Norway in 2022. The material was subjected to Braun and Clarke?s thematic analysis. Results: The analysis yielded six themes: (1) the design of novel effective clinical pathways: remote consultations empower GPs to tailor new effective clinical trajectories, blending modalities to address diverse needs across clinical episodes?from initial triage, through investigations to case closure; (2) increased workday flexibility: remote consultations introduce variability into daily work, allowing GPs to adjust patient contact intensity, and leading to a less stressful work-home balance; (3) erosion of organizational boundaries: easy remote access to GPs appears to reduce patients? tolerance for minor illness and self-care, hindering effective gatekeeping and shifting GPs? focus from proactive to more reactive work, increasing work-related stress; (4) degradation of clinical shrewdness: confronted with an increasing amount of unsorted and trivial remote inquiries, GPs observe challenges in detecting and prioritizing serious cases; (5) dilemmas related to responsibility, ethics, and legislation: remote consultations highlight a tension for contract GPs between legal responsibilities and ethical obligations, with implications for patients with limited health literacy; this may entail suboptimal evaluation or delayed treatment?potentially contributing to increased health care inequity; and (6) retaining clinical core values in a changing world. Overall, GPs affirm that remote consultations have come to stay and describe efforts to effectively manage the advantages and disadvantages inherent in such interactions to safeguard clinical effectiveness and organizational sustainability of primary health care. Conclusions: The widespread adoption of remote consultations in the Norwegian contract GP scheme fundamentally reshapes the dynamics of GP work and the overall health care system. Awareness and proactive management of these changes are essential for maintaining sustainable, high-quality primary health care. UR - https://formative.jmir.org/2024/1/e63068 UR - http://dx.doi.org/10.2196/63068 UR - http://www.ncbi.nlm.nih.gov/pubmed/39688890 ID - info:doi/10.2196/63068 ER - TY - JOUR AU - Alfozan, Mohammed AU - Alshahrani, Saad AU - Alasmi, Raed PY - 2024/12/16 TI - Emerging Use of Social Media in Clinical Urology Practice in the 21st Century: Survey Study JO - JMIR Form Res SP - e58510 VL - 8 KW - delivery of health care KW - social media KW - urologists KW - urology KW - Saudi Arabia KW - professional communication KW - physician behavior N2 - Background: Social media (So-Me) platforms are valuable resources for health care professionals and academics to discover, discuss, and distribute current advances in research and clinical practices, including technology trends. Objective: This study aims to assess the role of So-Me in urological practice in Saudi Arabia. It explores the influence of digital platforms on patient interaction, professional communication, decision-making, and education. Methods: The survey was conducted among 145 urologists from July 2021 to July 2022 following institutional review board approval. A questionnaire designed using the SurveyMonkey platform examined urologists? knowledge of So-Me. The survey was conducted using the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines and was open for 17 weeks. Data analysis was performed using SPSS 21.0. Results: Of the 145 participants, 70% (n=102) were Saudi Arabians. The most common age groups were 30?40 (n=68, 46.8%) and 41?50 (n=61, 42.2%) years, with a gender distribution of 44.8% (n=65) women and 55.2% (n=80) men. A total of 61.5% (n=89) of urologists reported using So-Me accounts for professional purposes, with 54.9% (n=80) sharing health-related information. Social media enhanced patient connections beyond clinic visits for 55.8% (n=81) of respondents, while 57.2% (n=83) used it to provide educational resources. Additionally, 56.5% (n=82) believed So-Me facilitated patient feedback and improved their practice. In terms of professional communication, 60.6% (n=88) of urologists agreed that So-Me facilitated collaboration with colleagues, while 63.3% (n=92) used it to stay updated on the latest advances in urology. Furthermore, 62% (n=90) followed professional societies or journals on So-Me, and 63.3% (n=92) used it for continuing medical education. A majority (n=94, 64.7%) reported that So-Me influenced treatment decisions based on new research findings, and 85.3% (n=124) learned about novel technologies and treatment options through these platforms. Regression analysis showed a significant positive correlation between gender and social media usage patterns (R=0.653, R2=0.426), indicating that approximately 42.6% of the differences in usage patterns can be attributed to gender. However, the Pearson ?2 analysis showed that gender did not significantly affect most aspects of social media use, except information sharing and participating in online discussions (both P<.05). Conclusions: This study highlights the widespread use of So-Me among urologists in Saudi Arabia, underscoring its role in enhancing patient interaction, professional development, and clinical decision-making. Strategically designed health care programs using social media could improve and modernize professional and patient-centered care in Saudi Arabia through legislative assistance and guidelines. UR - https://formative.jmir.org/2024/1/e58510 UR - http://dx.doi.org/10.2196/58510 ID - info:doi/10.2196/58510 ER - TY - JOUR AU - Kamat, Samir AU - Agarwal, Aneesh AU - Lavin, Leore AU - Verma, Hannah AU - Martin, Lily AU - Lipoff, B. Jules PY - 2024/12/13 TI - Dermatology in Student-Run Clinics in the United States: Scoping Review JO - JMIR Dermatol SP - e59368 VL - 7 KW - dermatology KW - dermatologist KW - dermatological KW - volunteerism KW - underserved population KW - medical education KW - student-run clinic KW - scoping review KW - review KW - PRISMA N2 - Background: Student-run clinics (SRCs) for dermatology hold potential to significantly advance skin-related health equity, and a comprehensive analysis of these clinics may inform strategies for optimizing program effectiveness. Objective: We aimed to perform a scoping review of the literature about dermatology SRCs across the United States. Methods: We conducted systematic literature searches of Ovid MEDLINE, Ovid Embase, and Scopus on March 1, 2023, and June 19, 2024. No date, language, or paper-type restrictions were included in the search strategy. A total of 229 references were uploaded to Covidence for screening by 2 independent reviewers (SK and LL), and 23 full-text documents were assessed for eligibility. After an additional 8 documents were identified through a gray literature search, a total of 31 studies were included in the final analysis. Inclusion criteria were as follows: (1) studies set in an SRC, which was operationally led by medical students and could render condition-relevant treatments to patients, with dermatology care; (2) published in English; (3) within the United States; (4) included characterization of any of the following: logistics, care, patients, or design; and (5) included all study or document types, including gray literature that was not peer reviewed (eg, conference abstracts, preprints, and letters to the editor). Exclusion criteria were (1) papers not published in English and (2) those with duplicated data or that were limited in scope or not generalizable. Data were extracted qualitatively using Microsoft Excel to categorize the studies by several domains, including clinic location, demographics, services offered, and barriers to care. Results: There are at least 19 dermatology SRCs across the United States. The most common conditions encountered included atopic dermatitis; acne; fungal infections; benign nevi; psoriasis; and neoplasms, such as basal cell carcinoma, squamous cell carcinoma, and melanoma. Key facilitators for the clinics included faculty oversight, attending physician participation for biopsy histopathology, and dedicated program coordinators. Major barriers included lack of follow-up, medication nonadherence, and patient no-shows. Conclusions: Dermatology SRCs serve a diverse patient population, many of whom are underrepresented in traditional dermatology settings. This scoping review provides insights to help build stronger program foundations that better address community dermatologic health needs. UR - https://derma.jmir.org/2024/1/e59368 UR - http://dx.doi.org/10.2196/59368 ID - info:doi/10.2196/59368 ER - TY - JOUR AU - Veyron, Jacques-Henri AU - Deparis, François AU - Al Zayat, Noel Marie AU - Belmin, Joël AU - Havreng-Théry, Charlotte PY - 2024/12/10 TI - Postimplementation Evaluation in Assisted Living Facilities of an eHealth Medical Device Developed to Predict and Avoid Unplanned Hospitalizations: Pragmatic Trial JO - J Med Internet Res SP - e55460 VL - 26 KW - digital technology KW - unplanned hospitalization KW - machine learning KW - predictive tool KW - assisted living facility KW - eHealth KW - pragmatic trial KW - artificial intelligence KW - AI KW - gerontology KW - older people KW - aging KW - quality of life KW - uncontrolled multicenter trial KW - France KW - smartphone KW - app KW - telehealth KW - telemonitoring KW - remote monitoring of patients KW - electronic patient-reported outcome measure KW - ePROM N2 - Background: The proportion of very old adults in the population is increasing, representing a significant challenge. Due to their vulnerability, there is a higher frequency of unplanned hospitalizations in this population, leading to adverse events. Digital tools based on artificial intelligence (AI) can help to identify early signs of vulnerability and unfavorable health events and can contribute to earlier and optimized management. Objective: This study aims to report the implementation in assisted living facilities of an innovative monitoring system (Presage Care) for predicting the short-term risk of emergency hospitalization. We describe its use and assess its performance. Methods: An uncontrolled multicenter intervention study was conducted between March and August 2022 in 7 assisted living facilities in France that house very old and vulnerable adults. The monitoring system was set up to provide alerts in cases of a high risk of emergency hospitalization. Nurse assistants (NAs) at the assisted living facilities used a smartphone app to complete a questionnaire on the functional status of the patients, comprising electronic patient-reported outcome measures (ePROMs); these were analyzed in real time by a previously designed machine learning algorithm. This remote monitoring of patients using ePROMs allowed notification of a coordinating nurse or a coordinating NA who subsequently informed the patient?s nurses or physician. The primary outcomes were the acceptability and feasibility of the monitoring system in the context and confirmation of the effectiveness and efficiency of AI in risk prevention and detection in practical, real-life scenarios. The secondary outcome was the hospitalization rate after alert-triggered interventions. Results: In this study, 118 of 194 (61%) eligible patients were included who had at least 1 follow-up visit. A total of 38 emergency hospitalizations were documented. The system generated 92 alerts for 47 of the 118 (40%) patients. Of these 92 alerts, 46 (50%) led to 46 health care interventions for 14 of the 118 (12%) patients and resulted in 4 hospitalizations. The other 46 of the 92 (50%) alerts did not trigger a health care intervention and resulted in 25 hospitalizations (P<.001). Almost all hospitalizations were associated with a lack of alert-triggered interventions (P<.001). System performance to predict hospitalization had a high specificity (96%) and negative predictive value (99.4%). Conclusions: The Presage Care system has been implemented with success in assisted living facilities. It was well accepted by coordinating nurses and performed well in predicting emergency hospitalizations. However, its use by NAs was less than expected. Overall, the system performed well in terms of performance and clinical impact in this setting. Nevertheless, further work is needed to improve the moderate use rate by NAs. Trial Registration: ClinicalTrials.gov NCT05221697; https://clinicaltrials.gov/study/NCT05221697 UR - https://www.jmir.org/2024/1/e55460 UR - http://dx.doi.org/10.2196/55460 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55460 ER - TY - JOUR AU - Tonkikh, Orly AU - Young, M. Heather AU - Bell, F. Janice AU - Famula, Jessica AU - Whitney, Robin AU - Mongoven, Jennifer AU - Kelly, Kathleen PY - 2024/12/10 TI - The Implementation Outcomes and Population Impact of a Statewide IT Deployment for Family Caregivers: Mixed Methods Study JO - JMIR Aging SP - e63355 VL - 7 KW - web-based assessment KW - caregiver KW - technology implementation KW - Consolidated Framework for Implementation Research KW - CFIR KW - information technology KW - IT KW - family caregivers KW - eHealth N2 - Background: In 2022, the US Department of Health and Human Services released the first National Strategy to Support Family Caregivers, identifying actions for both government and the private sector. One of the major goals is to expand data, research, and evidence-based practices to support family caregivers. While IT tools are widely deployed in health care settings, they are rarely available at scale in community agencies. In 2019, the state of California recognized the importance of a statewide database and a platform to serve caregivers remotely by enhancing existing service supports and investing in a web-based platform, CareNav. Implementation commenced in early 2020 across all 11 California Caregiver Resource Centers. Objective: This paper describes the implementation strategies and outcomes of the statewide implementation of CareNav, a web-based platform to support family caregivers. Methods: The Consolidated Framework for Implementation Research (CFIR), including a recent addendum, guided this mixed methods evaluation. Two major approaches were used to evaluate the implementation process: in-depth qualitative interviews with key informants (n=82) and surveys of staff members (n=112) and caregivers (n=2229). We analyzed the interview transcripts using qualitative descriptive methods; subsequently, we identified subthemes and relationships among the ideas, mapping the findings to the CFIR addendum. For the surveys, we used descriptive statistics. Results: We present our findings about implementation strategies, implementation outcomes (ie, adoption, fidelity, and sustainment), and the impact on population health (organizational effectiveness and equity, as well as caregiver satisfaction, health, and well-being). The platform was fully adopted within 18 months, and the system is advancing toward sustainment through statewide collaboration. The deployment has augmented organizational effectiveness and quality, enhanced equity, and improved caregiver health and well-being. Conclusions: This study provides a use case for technological implementation across a multisite system with diverse community-based agencies. Future research can expand the understanding of the barriers and facilitators to achieving relevant outcomes and population impact. UR - https://aging.jmir.org/2024/1/e63355 UR - http://dx.doi.org/10.2196/63355 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63355 ER - TY - JOUR AU - Höfer, Klemens AU - Plescher, Felix AU - Schlierenkamp, Sarah AU - Solar, Stefanie AU - Neusser, Silke AU - Schneider, Udo AU - Best, Dieter AU - Wasem, Jürgen AU - Abels, Carina AU - Bußmann, Anna PY - 2024/12/10 TI - mHealth Apps in German Outpatient Mental Health Care: Protocol for a Mixed Methods Approach JO - JMIR Res Protoc SP - e56205 VL - 13 KW - mental health care KW - mHealth KW - digital health applications KW - Digitale Gesundheitsanwendungen KW - mental disorders KW - health care research KW - applications KW - app KW - mental health KW - outpatient KW - digital health KW - adults KW - Germany KW - mobile health apps KW - treatment N2 - Background: Mental disorders are complex diseases that affect 28% (about 17.8 million people) of the adult population in Germany annually. Since 2020, certain mobile health (mHealth) apps, so-called digital health applications (DiGA), are reimbursable in the German statutory health insurance system. A total of 27 of the 56 currently available DiGA are approved for the treatment of mental and behavioral diseases. An indicator of existing problems hindering the use of DiGA is the rather hesitant prescribing behavior. Objective: This project aims to develop health policy recommendations for the optimal integration of DiGA into outpatient psychotherapeutic care. The project is funded by the Innovation Fund of the Joint Federal Committee (grant 01VSF22029). The current status quo of the use of DiGA will be analyzed. Furthermore, concepts for the integration of mHealth apps, as well as their transfer into the care process will be investigated. In addition, barriers will be identified, and existing expectations of different perspectives captured. Methods: The project will be based on a mixed methods approach. A scoping review and a qualitative analysis of focus groups and expert interviews will be carried out. Additionally, an analysis of claims data of the statutory health insurance will be conducted. This will be followed by a written survey of insured persons and health care providers. Finally, health policy recommendations will be derived in cooperation with stakeholders. Results: The scoping reviews and qualitative analyses have been completed, and the quantitative surveys are currently being carried out. The target number of responses in the survey of insured persons has already been achieved. Furthermore, the analysis claims data of the statutory health insurance is currently being conducted. Conclusions: There is a need for research on how DiGA can be optimally integrated into the care process of patients with mental disorders as evidence regarding the topic is limited and prescribing behavior low. Although the potential of DiGA in mental health care has not yet fully unfolded, Germany serves as a model for other countries regarding reimbursable mHealth apps. This project aims to explore the potentials of DiGA and to describe the organizational, institutional, and procedural steps necessary for them to best support mental health care. International Registered Report Identifier (IRRID): DERR1-10.2196/56205 UR - https://www.researchprotocols.org/2024/1/e56205 UR - http://dx.doi.org/10.2196/56205 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56205 ER - TY - JOUR AU - Li, Qingqing AU - Cheng, Feng AU - Zeng, Huatang AU - Xu, Junfang PY - 2024/12/9 TI - Health Insurance Payment for Telehealth Services: Scoping Review and Narrative Synthesis JO - J Med Internet Res SP - e56699 VL - 26 KW - telehealth KW - internet-based health care KW - reimbursement KW - health insurance payment KW - health care KW - scoping review KW - narrative synthesis KW - mobile phone N2 - Background: As telehealth services have demonstrated significant advantages in providing qualified and accessible care, health insurance payments for telehealth services have been issued by various countries. However, the optimization of health insurance payments for telehealth services remains uncertain. Objective: We conducted a scoping review of the current situation regarding health insurance payments for telehealth services, with the aim of providing evidence to enhance policies related to health insurance payments for such services. Methods: This scoping review was conducted by comprehensively retrieving data from 6 electronic bibliographic databases from inception to October 2023. The databases included China National Knowledge Infrastructure, Wan Fang, Weipu, Web of Science, PubMed, and Embase, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Two authors independently assessed search results, extracted data, and evaluated the quality of the included studies using the Critical Appraisal Skills Programme checklist. After the initial screening of titles and abstracts, full texts were obtained and examined. The data regarding the first author, date of publication, country, type of telehealth services introduced in health insurance, health insurance reimbursement providers, reimbursement standards for telehealth (eg, the condition for the reimbursement and reimbursement rate), and key findings of studies were extracted and analyzed. Moreover, we also conducted a narrative synthesis to summarize and report the findings. Results: A total of 7232 papers were retrieved. Following quality assessment, 23 papers were finally included, with the covered countries including China, the United States, Australia, France, Japan, the United Kingdom, and Germany. The forms of the services vary across different regions, mainly including consultation services, medical monitoring services, mental health services, health education services, and other services. Payment standards are generally categorized into fee-for-service and global budget payment, with clear health insurance payment quotas or proportions and certain restrictions (eg, specifying the location of medical visits and setting the limitation on distance from home to hospitals). The paying entities for health insurance payment include national health insurance and commercial health insurance. In addition, there are 2 kinds of reimbursement rates?a comparable rate for both telehealth and in-person health care services, and a lower rate for telehealth services compared to in-person health care services. Conclusions: To enhance the accessibility of telehealth services through health insurance payment, it is crucial to further refine the design of health insurance payment for telehealth and strengthen the supervision of services quality, bridging the gap between telehealth and in-person health care services. Additionally, this review did not include studies from all countries, and we recommend that future reviews should include a broader range of countries to provide a more comprehensive view of global telehealth insurance systems. UR - https://www.jmir.org/2024/1/e56699 UR - http://dx.doi.org/10.2196/56699 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56699 ER - TY - JOUR AU - Zhang, Xinmeng AU - Kang, Kaidi AU - Yan, Chao AU - Feng, Yubo AU - Vandekar, Simon AU - Yu, Danxia AU - Rosenbloom, Trent S. AU - Samuels, Jason AU - Srivastava, Gitanjali AU - Williams, Brandon AU - Albaugh, L. Vance AU - English, J. Wayne AU - Flynn, R. Charles AU - Chen, You PY - 2024/12/9 TI - Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health Records JO - J Med Internet Res SP - e56573 VL - 26 KW - patient portal KW - patient engagement KW - bariatric surgery KW - retrospective KW - longitudinal study KW - data-driven KW - weight loss KW - obesity KW - electronic health records KW - postoperative care N2 - Background: Bariatric surgery is an effective intervention for obesity, but comprehensive postoperative self-management is essential for optimal outcomes. While patient portals are generally seen as beneficial in engaging patients in health management, the link between their use and post?bariatric surgery weight loss remains unclear. Objective: This study aimed to investigate the association between patient portal engagement and postoperative BMI reduction among patients after bariatric surgery. Methods: This retrospective longitudinal study included patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy at Vanderbilt University Medical Center between January 2018 and March 2021. Patient portal engagement was measured during 4 stages: early (within 3 months after surgery), early midterm (3-6 months), late midterm (6-9 months), and late (9-12 months). Using generalized estimating equations, we estimated the associations between patients? portal engagements at these stages and the percentage of BMI reduction (%BMIR) at 3, 6, and 12 months after surgery. Covariates included duration since surgery, patient?s age at the time of surgery, sex, race and ethnicity, type of bariatric surgery, severity of comorbid conditions, and socioeconomic disadvantage. Results: The study included 1415 patients, predominantly female (n=1145, 80.9%), with a racial composition of 76.9% (n=1088) White and 19.9% (n=282) Black. Overall, 805 (56.9%) patients underwent Roux-en-Y gastric bypass and 610 (43.1%) underwent sleeve gastrectomy. By 1 year after surgery, the median %BMIR was 31.5% (IQR 25.2%-36.8%), and the median number of active days on the patient portal was 54 (IQR 33-80). Early portal engagement was significantly associated with %BMIR at various postoperative times. Specifically, each additional 10 days of early portal engagement was associated with a 0.37% (95% CI ?0.55% to ?0.18%; P<.001) lower expected %BMIR at 3 months, a 1.11% (95% CI 0.82%-1.41%; P<.001) higher expected %BMIR at 6 months, and a 0.78% (95% CI 0.25%-1.31%; P=.004) higher expected %BMIR at 12 months. Furthermore, early midterm portal engagement was associated with a 0.36% (95% CI ?0.69 to ?0.03; P=.03) lower expected %BMIR at 6 months, but it was not significant at 12 months (P=.88). Late midterm and late portal engagement were not significantly associated with %BMIR at 12 months (P=.27 and P=.12, respectively). Furthermore, early engagement in various portal functions, such as messaging and accessing medical records, was significantly associated with a lower %BMIR at 3 months and a higher %BMIR at both 6 and 12 months (all P<.05). Conclusions: Higher patient portal engagement within 3 months after surgery?suggestive of stronger adherence to postoperative instructions and improved communication with care teams?is associated with less favorable weight loss immediately after surgery but enhanced postoperative weight loss outcomes at 6 and 12 months. However, the limitations of retrospective data-driven studies highlight the need for future intervention-based studies to validate these associations and establish causality. UR - https://www.jmir.org/2024/1/e56573 UR - http://dx.doi.org/10.2196/56573 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56573 ER - TY - JOUR AU - Huang, Xuan AU - Wang, Ying AU - Yang, Xixian AU - Jiang, Ruo AU - Liu, Yicheng AU - Wang, Hui PY - 2024/12/4 TI - Patient-Centric Mobile Medical Services Accessed Through Smartphones in the Top 100 Chinese Public Hospitals: Cross-Sectional Survey Study JO - JMIR Form Res SP - e45763 VL - 8 KW - mobile health technology KW - smartphones KW - mobile phone KW - internet hospital KW - China N2 - Background: Smartphone-based technology has been used to enhance the delivery of health care services to the public in numerous countries. Objective: This study aims to investigate the application of patient-centric mobile medical services accessed through smartphones in the top 100 Chinese public hospitals. Methods: Data on 124 tertiary public hospitals, ranked among the top 100 by the China Hospital Science and Technology Evaluation Metrics of the Chinese Academy of Medical Sciences (2019) and China?s Hospital Rankings of the Hospital Management Institute of Fudan University (2019), were collected from the WeChat platform (Tencent Inc), mobile phone apps, and official websites until February 10, 2021. Results: A total of 124 tertiary public hospitals, all of which were among the top 100 hospitals according to the 2 ranking lists, were selected for this study. Almost all (122/124, 98.39%) of the hospitals offered basic services such as appointment scheduling, registration, and health education. The majority also provided online access to test reports (95/124, 76.61%), consultations (72/124, 58.06%), and prescriptions (61/124, 49.19%). Among the hospitals offering online prescriptions, the majority (54/61, 88.52%) supported home delivery through third-party carriers. Slightly less than half (57/124, 45.97%) used artificial intelligence for medical guidance. Only a small fraction (8/124, 6.45%) managed chronic diseases through online monitoring and supervision by experienced doctors. Approximately half (60/124, 48.39%) of the included hospitals were officially licensed as internet hospitals approved to provide full online services. Hospitals with official internet hospital licenses provided more extensive digital health offerings. A significantly higher proportion of approved hospitals offered online consultations (29.69% vs 88.33%, r=43.741; P<.001), test reports (62.5% vs 91.67%, r=14.703; P<.001), and chronic disease management (1.56% vs 11.67%, r=5.238; P<.05). These officially approved hospitals tended to provide over 6 mobile medical services, mainly in the regions of Shanghai and Guangdong. This geographic distribution aligned with the overall layout of hospitals included in the study. Conclusions: Patient-centric mobile medical services offered by the top 100 Chinese public hospitals accessed through smartphones primarily focus on online appointment scheduling, registration, health education, and accessing test reports. The most popular features include online consultations, prescriptions, medication delivery, medical guidance, and early-stage chronic disease management. Approved internet hospitals offer a significantly greater variety of patient-centric mobile medical services compared with unapproved ones. UR - https://formative.jmir.org/2024/1/e45763 UR - http://dx.doi.org/10.2196/45763 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/45763 ER - TY - JOUR AU - Spethmann, Sebastian AU - Hindricks, Gerhard AU - Koehler, Kerstin AU - Stoerk, Stefan AU - Angermann, E. Christiane AU - Böhm, Michael AU - Assmus, Birgit AU - Winkler, Sebastian AU - Möckel, Martin AU - Mittermaier, Mirja AU - Lelgemann, Monika AU - Reuter, Daniel AU - Bosch, Ralph AU - Albrecht, Alexander AU - von Haehling, Stephan AU - Helms, M. Thomas AU - Sack, Stefan AU - Bekfani, Tarek AU - Gröschel, Wolfgang Jan AU - Koehler, Magdalena AU - Melzer, Christoph AU - Wintrich, Jan AU - Zippel-Schultz, Bettina AU - Ertl, Georg AU - Vogelmeier, Claus AU - Dagres, Nikolaos AU - Zernikow, Jasmin AU - Koehler, Friedrich PY - 2024/12/4 TI - Telemonitoring for Chronic Heart Failure: Narrative Review of the 20-Year Journey From Concept to Standard Care in Germany JO - J Med Internet Res SP - e63391 VL - 26 KW - telemedicine KW - e-counseling KW - heart decompensation KW - Europe KW - patient care management N2 - Background: Chronic heart failure (CHF) is a major cause of morbidity and mortality worldwide, placing a significant burden on health care systems. The concept of telemedicine for CHF was first introduced in the late 1990s, and since 2010, studies have demonstrated its potential to improve patient outcomes and reduce health care costs. Over the following decade, technological advancements and changes in health care policy led to the development of more sophisticated telemedicine solutions for CHF, including remote patient management through invasive or noninvasive telemonitoring devices, mobile apps, and virtual consultations. Years of public funding in Germany have generated evidence that remote patient management improves outcomes for patients with CHF, such as quality of life, and reduces hospital admissions. Based on these data, the Federal Joint Committee (Gemeinsamer Bundesausschuss; G-BA) decided, independently of the current European Society of Cardiology recommendations, to incorporate telemedicine as a standard digital intervention for high-risk patients with reduced left ventricular ejection fraction in Germany in 2020. Objective: This review aims to illustrate the journey from the initial concept through pioneering studies that led to telemedicine?s integration into standard care, and to share current experiences that have positioned Germany as a leader in cardiovascular telemedicine. Methods: We review and discuss existing literature and evidence on the development and implementation of telemonitoring for CHF in Germany over the past 20 years. Relevant studies, reports, and guidelines were identified through a comprehensive search of electronic databases, including PubMed, Google Scholar, and specialized journals focused on CHF telemonitoring. Results: Pioneering studies, such as the TIM-HF2 (Telemedical Interventional Management in Heart Failure II) and IN-TIME (Influence of Home Monitoring on Mortality and Morbidity in Heart Failure Patients with Impaired Left Ventricular Function) trials, demonstrated the effectiveness of remote patient management applications for patients with CHF in Germany and their applicability to current practices involving both invasive and noninvasive methods. Collaborations between researchers and technology developers overcame barriers, leading to sustainable improvements in patient care. Ongoing research on artificial intelligence applications for prioritizing and interpreting individual health data will continue to transform digital health care. Conclusions: The establishment of telemedical care for patients with HF across Europe is likely to benefit from experiences in Germany, where significant improvements have been achieved in the care of patients with HF. UR - https://www.jmir.org/2024/1/e63391 UR - http://dx.doi.org/10.2196/63391 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63391 ER - TY - JOUR AU - Linstad, Helen Line AU - Bjørnå, Hilde AU - Moen, Anne AU - Tunby Kristiansen, Truls AU - Hansen, Helen Anne PY - 2024/12/4 TI - Investigating the Norwegian eHealth Governance Model: Document Study JO - J Med Internet Res SP - e59717 VL - 26 KW - eHealth policy KW - fragmented decision authority KW - top-down governance KW - bottom-up network KW - participation KW - electronic health record N2 - Background: Governments and policy makers struggle to achieve a balance between hierarchical steering and horizontal governance in systems characterized by fragmented decision authority and multiple interests. To realize its One Citizen?One Journal eHealth policy vision, the Norwegian government established a special eHealth board of stakeholders to create an inclusive governance model that aligned stakeholders? interests with the government?s ambitions through coordination and consensus. Little empirical knowledge exists on how countries realize inclusive governance models. Objective: This study aims to investigate how the Norwegian inclusive eHealth governance model was developed as a tool to align the government?s policy ambitions with stakeholders? concerns from January 2012 to December 2022. Methods: This document study used a thematic analysis based on a constructivist research approach. We included 16 policy documents and 175 consultation response documents issued between January 2012 and December 2022 related to the Norwegian One Citizen?One Journal policy implementation process. The themes were constructed deductively from a review of governance models and public governance theory and were applied as our analytical lens to each document. The findings were interpreted, analyzed, and synthesized. Results: The national policy implementation process progressed through 3 phases, with changes in stakeholder inclusion and perceived influence on the decision-making process characterizing transitions from phase to phase. Tension developed between 2 contrasting views regarding top-down government authority and stakeholders? autonomy. The view of the regional health trusts, municipalities, health care professional organizations, and industry actors contrasted with that of the patient organizations. Governmental insensitivity to participation, lack of transparency, and decreasing trust by stakeholder groups challenged the legitimacy of the inclusive governance model. Conclusions: We illustrated that Norway?s One Citizen?One Journal policy trajectory was characterized by a process that unfolded across 3 distinct phases. The process was characterized by 2 contrasting stakeholder perspectives. Finally, it was shaped by diminishing trust in the inclusive governance model. The National eHealth Governance Board faced challenges in establishing legitimacy as a top-down inclusive governance model, primarily attributed to its addressing of participation, transparency, and trust dilemmas. Such dilemmas represent significant obstacles to inclusive governance models and require ongoing governmental vigilance and responsiveness from governmental entities. UR - https://www.jmir.org/2024/1/e59717 UR - http://dx.doi.org/10.2196/59717 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59717 ER - TY - JOUR AU - Jolliff, Anna AU - Holden, J. Richard AU - Valdez, Rupa AU - Coller, J. Ryan AU - Patel, Himalaya AU - Zuraw, Matthew AU - Linden, Anna AU - Ganci, Aaron AU - Elliott, Christian AU - Werner, E. Nicole PY - 2024/12/3 TI - Investigating the Best Practices for Engagement in Remote Participatory Design: Mixed Methods Analysis of 4 Remote Studies With Family Caregivers JO - J Med Internet Res SP - e60353 VL - 26 KW - user-centered design KW - family caregivers KW - mobile health KW - digital health KW - web-based intervention KW - stakeholder engagement KW - patient engagement KW - community-based participatory action research KW - community participation KW - qualitative evaluation N2 - Background: Digital health interventions are a promising method for delivering timely support to underresourced family caregivers. The uptake of digital health interventions among caregivers may be improved by engaging caregivers in participatory design (PD). In recent years, there has been a shift toward conducting PD remotely, which may enable participation by previously hard-to-reach groups. However, little is known regarding how best to facilitate engagement in remote PD among family caregivers. Objective: This study aims to (1) understand the context, quality, and outcomes of family caregivers? engagement experiences in remote PD and (2) learn which aspects of the observed PD approach facilitated engagement or need to be improved. Methods: We analyzed qualitative and quantitative data from evaluation and reflection surveys and interviews completed by research and community partners (family caregivers) across 4 remote PD studies. Studies focused on building digital health interventions for family caregivers. For each study, community partners met with research partners for 4 to 5 design sessions across 6 months. After each session, partners completed an evaluation survey. In 1 of the 4 studies, research and community partners completed a reflection survey and interview. Descriptive statistics were used to summarize quantitative evaluation and reflection survey data, while reflexive thematic analysis was used to understand qualitative data. Results: In 62.9% (83/132) of evaluations across projects 1-3, participants described the session as ?very effective.? In 74% (28/38) of evaluations for project 4, participants described feeling ?extremely satisfied? with the session. Qualitative data relating to the engagement context identified that the identities of partners, the technological context of remote PD, and partners? understanding of the project and their role all influenced engagement. Within the domain of engagement quality, relationship-building and co-learning; satisfaction with prework, design activities, time allotted, and the final prototype; and inclusivity and the distribution of influence contributed to partners? experience of engagement. Outcomes of engagement included partners feeling an ongoing interest in the project after its conclusion, gratitude for participation, and a sense of meaning and self-esteem. Conclusions: These results indicate high satisfaction with remote PD processes and few losses specific to remote PD. The results also demonstrate specific ways in which processes can be changed to improve partner engagement and outcomes. Community partners should be involved from study inception in defining the problem to be solved, the approach used, and their roles within the project. Throughout the design process, online tools may be used to check partners? satisfaction with design processes and perceptions of inclusivity and power-sharing. Emphasis should be placed on increasing the psychosocial benefits of engagement (eg, sense of community and purpose) and increasing opportunities to participate in disseminating findings and in future studies. UR - https://www.jmir.org/2024/1/e60353 UR - http://dx.doi.org/10.2196/60353 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60353 ER - TY - JOUR AU - McCann, Lisa AU - Lewis, Liane AU - Oduntan, Olubukola AU - Harris, Jenny AU - Darley, Andrew AU - Berg, V. Geir AU - Lubowitzki, Simone AU - Cheevers, Katy AU - Miller, Morven AU - Armes, Jo AU - Ream, Emma AU - Fox, Patricia AU - Furlong, Patricia Eileen AU - Gaiger, Alexander AU - Kotronoulas, Grigorios AU - Patiraki, Elisabeth AU - Katsaragakis, Stylianos AU - McCrone, Paul AU - Miaskowski, Christine AU - Cardone, Antonella AU - Orr, Dawn AU - Flowerday, Adrian AU - Skene, Simon AU - Moore, Margaret AU - De Souza, Nicosha AU - Donnan, Peter AU - Maguire, Roma PY - 2024/12/3 TI - Patients? and Clinicians? Experiences Using a Real-Time Remote Monitoring System for Chemotherapy Symptom Management (ASyMS): Qualitative Study JO - J Med Internet Res SP - e53834 VL - 26 KW - cancer KW - clinician experiences KW - digital interventions KW - patient experiences KW - remote monitoring KW - qualitative methods N2 - Background: Patients receiving chemotherapy require ongoing symptom monitoring and management to optimize their outcomes. In recent years, digital remote monitoring interventions have emerged to provide enhanced cancer care delivery experiences to patients and clinicians. However, patient and clinician experiential evaluations of these technologies are rare. Therefore, we explored user experiences and perceptions of one such intervention?Advanced Symptom Management System (ASyMS)?after its scaled deployment in the context of the Electronic Symptom Management System Remote Technology (eSMART) trial. The eSMART trial was a large, multicenter randomized controlled trial to evaluate the efficacy of ASyMS in 12 clinical sites in 5 European countries. Objective: In this qualitative study, both patients? and clinicians? experiences of using ASyMS for up to 6 cycles of chemotherapy were explored to understand the impact of ASyMS on patients? experiences, clinical practice, and supportive care delivery. Methods: For this analysis, individual, semistructured, one-to-one interviews with 29 patients with breast, colorectal, and hematological cancers and 18 clinicians from Austria, Greece, Ireland, Norway, and the United Kingdom were conducted. Interviews focused on patients? and clinicians? experiences of using ASyMS, care organization and changes in practice following the introduction of ASyMS, perceived changes in care associated with the use of ASyMS, and its potential for future integration into routine chemotherapy care pathways. Results: Thematic analysis identified several themes that describe patients? and clinicians? experiences using ASyMS. One central orienting theme?ASyMS as a facilitator of change?was supported by 5 key themes associated with human and technology monitoring: reassurance, enhanced communications and relationships, knowing what is ?normal? and what is to be expected, enhancing cancer care experiences, and informing future cancer care. Conclusions: This study is the first to evaluate both patients? and clinicians? experiences of using a digital health intervention to remotely monitor chemotherapy symptoms across 5 countries. Experiences with ASyMS were positive from both patients? and clinicians? perspectives, although some improvements to support the wider-scale rollout and sustained implementation were identified. Overall, this study demonstrates that real-time remote monitoring systems can help patients feel more reassured during their chemotherapy treatments and can help clinicians provide the right care, at the right time, and in the right place. Trial Registration: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-015016 UR - https://www.jmir.org/2024/1/e53834 UR - http://dx.doi.org/10.2196/53834 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53834 ER - TY - JOUR AU - Luo, Lingzi AU - Li, Gen AU - Tang, Weiming AU - Wu, Dan AU - Hall, Brian PY - 2024/12/2 TI - Intention to Seek Mental Health Services During the 2022 Shanghai COVID-19 City-Wide Lockdown: Web-Based Cross-Sectional Study JO - JMIR Form Res SP - e51470 VL - 8 KW - COVID-19 KW - mental health services KW - intention KW - mobile KW - digital KW - lockdowns KW - depression KW - anxiety KW - help-seeking KW - regression KW - applications KW - mHealth KW - WeChat KW - pandemic KW - social isolation KW - mental health KW - intent KW - outbreak KW - SARS-CoV-2 KW - survey KW - usage KW - service N2 - Background: The implementation of COVID-19 lockdown measures had immediate and delayed psychological effects. From March 27, 2022, to June 1, 2022, the Shanghai government enforced a city-wide lockdown that affected 25 million residents. During this period, mental health services were predominantly provided through digital platforms. However, limited knowledge exists regarding the general population?s intention to use mental health services during this time. Objective: This study aimed to assess the intention of Shanghai residents to use mental health services during the 2022 Shanghai lockdown and identify factors associated with the intention to use mobile mental health services. Methods: An online survey was distributed from April 29 to June 1, 2022, using a purposive sampling approach across 16 districts in Shanghai. Eligible participants were adults over 18 years of age who were physically present in Shanghai during the lockdown. Multivariable logistic regression was used to estimate the associations between demographic factors, lockdown-related stressors and experiences, physical and mental health status, and study outcomes?mobile mental health service use intention (mobile applications and WeChat Mini Programs [Tencent Holdings Limited]). Results: The analytical sample comprised 3230 respondents, among whom 29.7% (weighted percentage; n=1030) screened positive for depression or anxiety based on the 9-item Patient Health Questionnaire or the 7-item Generalized Anxiety Disorder Scale. Less than one-fourth of the respondents (24.4%, n=914) expressed an intention to use any form of mental health services, with mobile mental health service being the most considered option (19.3%, n=728). Only 10.9% (n=440) used digital mental health services during the lockdown. Factors associated with increased odds of mobile mental health service use intention included being female, being employed, being a permanent resident, experiencing COVID-19?related stressors (such as loss of income, food insecurity, and potentially traumatic experiences), and having social and financial support. Individuals with moderate or severe anxiety, as well as those with comorbid anxiety and depression, demonstrated a higher intention to use mobile mental health services. However, individuals with depression alone did not exhibit a significantly higher intention compared with those without common mental disorders. Conclusions: Despite a high prevalence of common mental disorders among Shanghai residents, less than one-fourth of the study respondents expressed an intention to use any form of mental health services during the lockdown. Mobile apps or WeChat Mini Programs were the most considered mental health service formats. The study provided insights for developing more person-centered mobile mental health services to meet the diverse needs of different populations. UR - https://formative.jmir.org/2024/1/e51470 UR - http://dx.doi.org/10.2196/51470 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51470 ER - TY - JOUR AU - Allers, Sanne AU - Carboni, Chiara AU - Eijkenaar, Frank AU - Wehrens, Rik PY - 2024/12/2 TI - A Cross-Disciplinary Analysis of the Complexities of Scaling Up eHealth Innovation JO - J Med Internet Res SP - e58007 VL - 26 KW - innovation KW - eHealth KW - remote patient monitoring KW - scale-up KW - cross-disciplinary KW - qualitative case study KW - health care systems KW - adaptation KW - complexity KW - health care KW - framework KW - ecological perspective KW - barriers and facilitators UR - https://www.jmir.org/2024/1/e58007 UR - http://dx.doi.org/10.2196/58007 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58007 ER - TY - JOUR AU - Härkönen, Henna AU - Myllykangas, Kirsi AU - Kärppä, Mikko AU - Rasmus, Maaria Kirsi AU - Gomes, Francis Julius AU - Immonen, Milla AU - Hyvämäki, Piia AU - Jansson, Miia PY - 2024/12/2 TI - Perspectives of Clients and Health Care Professionals on the Opportunities for Digital Health Interventions in Cerebrovascular Disease Care: Qualitative Descriptive Study JO - J Med Internet Res SP - e52715 VL - 26 KW - cerebrovascular disease KW - stroke KW - digitalization KW - interventions KW - health care professional KW - client KW - patient KW - mHealth KW - mobile health KW - application KW - digital health KW - smartphones KW - health system KW - qualitative KW - descriptive study KW - brain KW - blood vessel disease KW - cerebrovascular disorder KW - Finland KW - interviews KW - efficiency KW - information KW - quality KW - accountability KW - neurology KW - neuroscience KW - brain injury KW - mobile phone N2 - Background: Cerebrovascular diseases (CVDs) are a major and potentially increasing burden to public health. Digital health interventions (DHIs) could support access to and provision of high-quality health care (eg, outcomes, safety, and satisfaction), but the design and development of digital solutions and technologies lack the assessment of user needs. Research is needed to identify opportunities to address health system challenges and improve CVD care with primary users of services as the key informants of everyday requirements. Objective: This study aims to identify opportunities for DHIs from clients? and health care professionals? perspectives to address health system challenges and improve CVD care. Methods: This study used a qualitative, descriptive approach. Semistructured, in-person interviews were conducted with 22 clients and 26 health care professionals in a single tertiary-level hospital in Finland between August 2021 and March 2022. The data were analyzed using a deductive and inductive content analysis. Results: Identified opportunities for DHIs in CVD care were organized according to clients, health care professionals, and data services and classified into 14 main categories and 27 generic categories, with 126 subcategories of requirements. DHIs for clients could support the long-term management of health and life changes brought on by CVD. They could provide access to personal health data and offer health information, support, and communication possibilities for clients and their caregivers. Health care professionals would benefit from access to relevant patient data, along with systems and tools that support competence and decision-making. Intersectoral and professional collaboration could be promoted with digital platforms and care pathways. DHIs for data services could enhance care planning and coordination with novel predictive data and interoperable systems for data exchange. Conclusions: The combined study of client and health care professional perspectives identified several opportunities and requirements for DHIs that related to the information, availability, quality, acceptability, utilization, efficiency, and accountability challenges of health systems. These findings provide valuable social insights into digital transformation and the emerging design, development, and use of user-centered technologies and applications to address challenges and improve CVD care and health care. UR - https://www.jmir.org/2024/1/e52715 UR - http://dx.doi.org/10.2196/52715 UR - http://www.ncbi.nlm.nih.gov/pubmed/39622027 ID - info:doi/10.2196/52715 ER - TY - JOUR AU - Barnes, Keely AU - Sveistrup, Heidi AU - Bayley, Mark AU - Egan, Mary AU - Bilodeau, Martin AU - Rathbone, Michel AU - Taljaard, Monica AU - Karimijashni, Motahareh AU - Marshall, Shawn PY - 2024/11/27 TI - Investigation of Study Procedures to Estimate Sensitivity and Reliability of a Virtual Physical Assessment Developed for Workplace Concussions: Method-Comparison Feasibility Study JO - JMIR Neurotech SP - e57661 VL - 3 KW - brain injury KW - virtual KW - assessment KW - remote KW - evaluation KW - concussion KW - adult KW - clinician review KW - in-person KW - comparison KW - sensitivity KW - reliability KW - acceptability survey KW - feasibility study KW - psychometric properties KW - vestibular/ocular motor screening KW - VOMS KW - workplace KW - clinician KW - hospital KW - rehabilitation center KW - brain KW - neurology KW - neuroscience KW - neurotechnology KW - technology KW - digital intervention KW - digital health KW - psychometrics KW - physical assessment KW - clinical assessment KW - workplace safety KW - mobile phone N2 - Background: Remote approaches to workplace concussion assessment have demonstrated value to end users. The feasibility of administering physical concussion assessment measures in a remote context has been minimally explored, and there is limited information on important psychometric properties of physical assessment measures used in remote contexts. Objective: The objectives of this feasibility study were to determine recruitment capability for a future larger-scale study aimed at determining sensitivity and reliability of the remote assessment, time required to complete study assessments, and acceptability of remote assessment to people with brain injuries and clinicians; document preliminary results of the sensitivity of the remote assessment when compared to the in-person assessment; and estimate the preliminary interrater and intrarater reliability of the remote assessments to inform procedures of a future larger-scale study that is adequately powered to reliably estimate these parameters of interest. Methods: People living with acquired brain injury attended 2 assessments (1 in-person and 1 remote) in a randomized order. The measures administered in these assessments included the finger-to-nose test; balance testing; and the Vestibular/Ocular Motor Screening (VOMS) tool, including documentation of change in symptoms and distance for near point convergence, saccades, cervical spine range of motion, and evaluation of effort. Both assessments occurred at the Ottawa Hospital Rehabilitation Center. After the assessments, a clinician different from the person who completed the original assessments then viewed and documented findings independently on the recordings of the remote assessment. The same second clinician viewed the recording again approximately 1 month following the initial observation. Results: The rate of recruitment was 61% (20/33) of people approached, with a total of 20 patient-participants included in the feasibility study. A total of 3 clinicians participated as assessors. The length of time required to complete the in-person and remote assessment procedures averaged 9 and 13 minutes, respectively. The majority of clinicians and patient-participants agreed or strongly agreed that they were confident in the findings on both in-person and remote assessments. Feedback obtained revolved around technology (eg, screen size), lighting, and fatigue of participants in the second assessment. Preliminary estimates of sensitivity of the remote assessment ranged from poor (finger-to-nose testing: 0.0) to excellent (near point convergence: 1.0). Preliminary estimates of reliability of the remote assessment ranged from poor (balance testing, saccades, and range of motion: ?=0.38?0.49) to excellent (VOMS change in symptoms: ?=1.0). Conclusions: The results of this feasibility study indicate that our study procedures are feasible and acceptable to participants. Certain measures show promising psychometric properties (reliability and sensitivity); however, wide CIs due to the small sample size limit the ability to draw definitive conclusions. A planned follow-up study will expand on this work and include a sufficiently large sample to estimate these important properties with acceptable precision. International Registered Report Identifier (IRRID): RR2-10.2196/57663 UR - https://neuro.jmir.org/2024/1/e57661 UR - http://dx.doi.org/10.2196/57661 ID - info:doi/10.2196/57661 ER - TY - JOUR AU - Van De Sijpe, Greet AU - Gijsen, Matthias AU - Van der Linden, Lorenz AU - Strouven, Stephanie AU - Simons, Eline AU - Martens, Emily AU - Persan, Nele AU - Grootaert, Veerle AU - Foulon, Veerle AU - Casteels, Minne AU - Verelst, Sandra AU - Vanbrabant, Peter AU - De Winter, Sabrina AU - Spriet, Isabel PY - 2024/11/27 TI - A Prediction Model to Identify Clinically Relevant Medication Discrepancies at the Emergency Department (MED-REC Predictor): Development and Validation Study JO - J Med Internet Res SP - e55185 VL - 26 KW - medication reconciliation KW - medication discrepancy KW - emergency department KW - prediction model KW - risk stratification KW - MED-REC predictor KW - MED-REC KW - predictor KW - patient KW - medication KW - hospital KW - software-implemented prediction model KW - software KW - geographic validation KW - geographic N2 - Background: Many patients do not receive a comprehensive medication reconciliation, mostly owing to limited resources. We hence need an approach to identify those patients at the emergency department (ED) who are at increased risk for clinically relevant discrepancies. Objective: The aim of our study was to develop and externally validate a prediction model to identify patients at risk for at least 1 clinically relevant medication discrepancy upon ED presentation. Methods: A prospective, multicenter, observational study was conducted at the University Hospitals Leuven and General Hospital Sint-Jan Brugge-Oostende AV, Belgium. Medication histories were obtained from patients admitted to the ED between November 2017 and May 2022, and clinically relevant medication discrepancies were identified. Three distinct datasets were created for model development, temporal external validation, and geographic external validation. Multivariable logistic regression with backward stepwise selection was used to select the final model. The presence of at least 1 clinically relevant discrepancy was the dependent variable. The model was evaluated by measuring calibration, discrimination, classification, and net benefit. Results: We included 824, 350, and 119 patients in the development, temporal validation, and geographic validation dataset, respectively. The final model contained 8 predictors, for example, age, residence before admission, number of drugs, and number of drugs of certain drug classes based on Anatomical Therapeutic Chemical coding. Temporal validation showed excellent calibration with a slope of 1.09 and an intercept of 0.18. Discrimination was moderate with a c-index (concordance index) of 0.67 (95% CI 0.61-0.73). In the geographic validation dataset, the calibration slope and intercept were 1.35 and 0.83, respectively, and the c-index was 0.68 (95% CI 0.58-0.78). The model showed net benefit over a range of clinically reasonable threshold probabilities and outperformed other selection criteria. Conclusions: Our software-implemented prediction model shows moderate performance, outperforming random or typical selection criteria for medication reconciliation. Depending on available resources, the probability threshold can be customized to increase either the specificity or the sensitivity of the model. UR - https://www.jmir.org/2024/1/e55185 UR - http://dx.doi.org/10.2196/55185 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55185 ER - TY - JOUR AU - Blaß, Marlene AU - Gimpel, Henner AU - Karnebogen, Philip PY - 2024/11/27 TI - A Taxonomy and Archetypes of AI-Based Health Care Services: Qualitative Study JO - J Med Internet Res SP - e53986 VL - 26 KW - healthcare KW - artificial intelligence KW - AI KW - taxonomy KW - services KW - cluster analysis KW - archetypes N2 - Background: To cope with the enormous burdens placed on health care systems around the world, from the strains and stresses caused by longer life expectancy to the large-scale emergency relief actions required by pandemics like COVID-19, many health care companies have been using artificial intelligence (AI) to adapt their services. Nevertheless, conceptual insights into how AI has been transforming the health care sector are still few and far between. This study aims to provide an overarching structure with which to classify the various real-world phenomena. A clear and comprehensive taxonomy will provide consensus on AI-based health care service offerings and sharpen the view of their adoption in the health care sector. Objective: The goal of this study is to identify the design characteristics of AI-based health care services. Methods: We propose a multilayered taxonomy created in accordance with an established method of taxonomy development. In doing so, we applied 268 AI-based health care services, conducted a structured literature review, and then evaluated the resulting taxonomy. Finally, we performed a cluster analysis to identify the archetypes of AI-based health care services. Results: We identified 4 critical perspectives: agents, data, AI, and health impact. Furthermore, a cluster analysis yielded 13 archetypes that demonstrate our taxonomy?s applicability. Conclusions: This contribution to conceptual knowledge of AI-based health care services enables researchers as well as practitioners to analyze such services and improve their theory-led design. UR - https://www.jmir.org/2024/1/e53986 UR - http://dx.doi.org/10.2196/53986 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53986 ER - TY - JOUR AU - Nabelsi, Veronique AU - Leclerc, Chantal Marie AU - Plouffe, Véronique PY - 2024/11/27 TI - Nurses? and Nursing Assistants? Experiences With Teleconsultation in Small Rural Long-Term Care Facilities: Semistructured Interview Pilot Study JO - JMIR Aging SP - e65111 VL - 7 KW - teleconsultation KW - long-term care facilities KW - nursing KW - nursing practices KW - workflow optimization KW - residents KW - rural KW - telehealth KW - Quebec N2 - Background: In Quebec, the shortage of nurses during night shifts compromises the safety and quality of resident care, particularly in small residential and long-term care centers (?Centres d?hébergement et de soins de longue durée?; CHSLDs) located in rural areas. The need to ensure the continuous presence of nurses 24 hours a day in CHSLDs has become more pressing, forcing some facilities to implement exceptional measures such as on-call telephone services to ensure access to a nurse. In light of these challenging circumstances, the Direction nationale des soins et des services infirmiers of Quebec?s Ministère de la Santé et des Services sociaux has rolled out a teleconsultation pilot project. Objective: This study aims to explore nurses? and nursing assistants? experience of integrating teleconsultation during night shifts in rural CHSLDs with ?50 residents. Methods: The 6-month pilot project was rolled out sequentially in 3 rural CHSLDs located in 2 administrative regions of Quebec between July 2022 and March 2023. A total of 18 semistructured interviews were conducted with 9 nurses and nursing assistants between February and July 2023. Results: Participants? experiences revealed that teleconsultation provided significant added value by improving clinical, administrative, and organizational practices. Some practices remained unchanged, indicating stable workflows. Workflow optimization through an expanded scope of practice ensured efficient and safe continuity of care. Enhanced collaboration between nurses and nursing assistants led to improved care coordination and communication. The leadership played a significant role in clarifying professionals? roles and in supporting effective adaptation to teleconsultation. Conclusions: This pilot project represents a significant step forward in improving care for CHSLD residents in Quebec. Teleconsultation not only makes it possible to overcome recruitment challenges and ensure the continuous presence of nurses during night shifts but also optimizes professional practices while ensuring the safety and quality of care provided to residents. UR - https://aging.jmir.org/2024/1/e65111 UR - http://dx.doi.org/10.2196/65111 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65111 ER - TY - JOUR AU - McGowan, J. Laura AU - Graham, Fiona AU - Lecouturier, Jan AU - Goffe, Louis AU - Echevarria, Carlos AU - Kelly, P. Michael AU - Sniehotta, F. Falko PY - 2024/11/27 TI - The Views and Experiences of Integrated Care System Commissioners About the Adoption and Implementation of Virtual Wards in England: Qualitative Exploration Study JO - J Med Internet Res SP - e56494 VL - 26 KW - virtual wards KW - remote monitoring KW - whole systems KW - qualitative KW - implementation science KW - integrated care system KW - England KW - digital technology KW - acute care KW - clinical practice KW - semistructured interviews KW - thematic analysis KW - patient-centered care KW - hospital-centric language KW - eHealth KW - health services N2 - Background: Virtual wards (VWs) are being introduced within the National Health Service (NHS) in England as a new way of delivering care to patients who would otherwise be hospitalized. Using digital technologies, patients can receive acute care, remote monitoring, and treatment in their homes. Integrated care system commissioners are employees involved in the planning of, agreeing to, and monitoring of services within NHS England and have an important role in the adoption and implementation of VWs in clinical practice. Objective: This study aims to develop an understanding of the acceptability and feasibility of adopting and implementing VWs in England from integrated care system commissioners? perspectives, including the identification of barriers and facilitators to implementation. Methods: Qualitative semistructured interviews were conducted with 20 commissioners employed by NHS England (NHSE) in various geographic regions of England. Thematic analysis was conducted, structured using the framework approach, and informed by the Consolidated Framework for Implementation Research. The COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines were followed. Results: Four overarching themes were identified reflecting the acceptability and feasibility of key adoption and implementation processes: (1) assessing the need for VWs, (2) coordinating a system approach, (3) agreeing to Program Outcomes: NHSE Versus Organizational Goals, and (4) planning and adapting services. Commissioners expressed the need for system-level change in care provision within the NHS, with VWs perceived as a promising model that could reform patient-centered care. However, there was uncertainty over the financial sustainability of VWs, with questions raised as to whether they would be funded by the closure of hospital beds. There was also uncertainty over the extent to which VWs should be technology-enabled, and the specific ways technology may enhance condition-specific pathways. Differing interpretations of the NHSE instructions between different health care sectors and a lack of clarity in definitions, as well as use of hospital-centric language within national guidance, were considered hindrances to convening a system approach. Furthermore, narrow parameters of success measures in terms of goals and outcomes of VWs, unrealistic timescales for planning and delivery, lack of interoperability of technology and time-consuming procurement procedures, liability concerns, and patient suitability for technology-enabled home-based care were identified as barriers to implementation. Motivated and passionate clinical leads were considered key to successful implementation. Conclusions: VWs have the potential to reform patient-centered care in England and were considered a promising approach by commissioners in this study. However, there should be greater clarity over definitions and specifications for technology enablement and evidence provided about how technology can enhance patient care. The use of less hospital-centric language, a greater focus on patient-centered measures of success, and more time allowance to ensure the development of technology-enabled VW services that meet the needs of patients and staff could enhance adoption and implementation. UR - https://www.jmir.org/2024/1/e56494 UR - http://dx.doi.org/10.2196/56494 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56494 ER - TY - JOUR AU - Ivanova, Julia AU - Wilczewski, Hattie AU - Klocksieben, Farina AU - Cummins, Mollie AU - Soni, Hiral AU - Ong, Triton AU - Barrera, Janelle AU - Harvey, Jillian AU - O'Connell, Nathaniel AU - McElligott, James AU - Welch, Brandon AU - Bunnell, Brian PY - 2024/11/27 TI - Patient Preferences for Direct-to-Consumer Telemedicine Services: Replication and Extension of a Nationwide Survey JO - JMIR Hum Factors SP - e51056 VL - 11 KW - telemedicine KW - survey KW - patient preferences KW - direct-to-consumer telemedicine KW - patient-provider relationship KW - inequity KW - consumer KW - patient experience KW - willingness KW - income KW - association KW - satisfaction KW - mobile phone N2 - Background: A 2017 survey of patient perspectives showed overall willingness and comfort to use telemedicine, but low actual use. Given recent growth and widespread exposure of patients to telemedicine, patient preferences are likely to have changed. Objective: This study aimed to (1) identify demographic trends in patient preferences and experiences; (2) measure ease of use and satisfaction of telemedicine; and (3) measure changes in telemedicine use, willingness, and comfort since 2017. Methods: We replicated a 2017 study with a nationwide survey of US adults. The survey, an extended version of the previous study, measured patient health care access as well as knowledge, experiences, and preferences regarding telemedicine encounters. We recruited participants using SurveyMonkey Audience in July 2022. We used descriptive statistics and generalized estimating equations to measure change and identify trends. Results: We accrued 4577 complete responses. Patient experience with telemedicine was substantially higher in 2022 than in 2017, with 61.1% (vs 5.3%) of participants aware that their primary care provider offered telemedicine and 34.5% (vs 3.5%) reporting use of telemedicine with their primary care provider. This study also reported ease of use and satisfaction rates to be similar to in-person visits, while overall willingness and comfort in using telemedicine increased from 2017. Individuals at the poverty line were significantly less likely to report satisfaction with telemedicine visits. We found increased interpersonal distance in a patient and health care professional relationship significantly reduced patient ease of use, willingness, and comfort in using telemedicine. Conclusions: This study identified an association between income and patient satisfaction, conveying the importance of understanding telemedicine in relation to health care access and equity. Telemedicine ease of use and satisfaction were comparable to in-person visits. Individuals reported greater use and higher positive perceptions of telemedicine willingness and comfort since 2017. UR - https://humanfactors.jmir.org/2024/1/e51056 UR - http://dx.doi.org/10.2196/51056 ID - info:doi/10.2196/51056 ER - TY - JOUR AU - Nabelsi, Véronique AU - Plouffe, Véronique PY - 2024/11/26 TI - Enhancing Care Coordination in Oncology and Nononcology Thoracic Surgery Care Pathways Through a Digital Health Solution: Mixed Methods Study JO - JMIR Form Res SP - e60222 VL - 8 KW - digital health solution KW - care coordination KW - optimization KW - health care providers KW - oncology KW - nononcology KW - thoracic surgery KW - pathways KW - continuity of care KW - interfacility KW - Quebec N2 - Background: Health-system fragmentation in Quebec significantly impacts care coordination, leading to interruptions in patients? care pathways and adverse effects on their health. Coordinating interfacility service corridors is complex and requires collaboration between multiple health care providers (HCPs) and care settings. Effective care coordination is essential to ensure optimal patient management at transition points. Objective: This study aims to improve oncology and nononcology thoracic surgery care pathways by enhancing care coordination during interfacility transfers through a digital health solution. Methods: A multicenter implementation study was conducted across 2 health regions and 2 health care facilities in Quebec. We conducted 27 semistructured interviews with HCPs and managers to better understand the care pathways. Participatory design workshops were held with future users and key stakeholders at an early stage of the technology?s design to validate the prototype?s functionalities and workflows. A web survey was sent to all end users (N=13) to assess their experience with the platform. Results: All participants (100%) either ?agreed? or ?strongly agreed? that the platform provided significant benefits. It enhanced interestablishment coordination (4/13, 31% agreed and 9/13, 69% strongly agreed) and continuity of care and services (8/13, 62% agreed and 5/13, 38% strongly agreed), and it contributed to better management and patient intake (10/13, 77% agreed and 3/13, 23% strongly agreed) and process fluidity (3/13, 77% agreed and 3/13, 23% strongly agreed). Surgeons from the McGill University Health Centre confirmed that the platform facilitated and secured information transmission (2/5, 40% agreed and 3/5, 60% strongly agreed) and kept track of oncology patient referrals, follow-up needs, and cases where surgery is unnecessary (2/5, 40% agreed and 3/5, 60% strongly agreed). Nursing staff from the Centre intégré de santé et de services sociaux de l?Outaouais and McGill University Health Centre reported high satisfaction with the platform?s support during preoperative visit, surgery, and discharge processes. All participants perceived the platform as intuitive and easy to use. Additionally, participants valued its efficiency in providing rapid access to patient data, which reduces task time and ensures document security, thereby improving care coordination across facilities. The project?s success has convinced the HCPs and senior management at both health care facilities to pursue long-term use of the Akinox digital health platform. Conclusions: This pilot project represents a significant advancement in thoracic surgery care pathways and the coordination of interfacility health care service corridors. The project provides care pathways that are adaptable to other surgical specialties. It also paves the way for improving care in cancer and other health care networks while highlighting the key role of nurse navigators in patient care management. The project underscores the value of strategic leadership and stakeholders? collaboration to improve care coordination and operational efficiency by demonstrating technology?s essential role in patient care pathways. UR - https://formative.jmir.org/2024/1/e60222 UR - http://dx.doi.org/10.2196/60222 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60222 ER - TY - JOUR AU - McCaffrey, Graham AU - Wilson, Erin AU - Zimmer, V. Lela AU - Singh, Anurag AU - Jonatansdottir, Steinunn AU - Zimmer, Peter AU - Snadden, David AU - Graham, D. Ian AU - MacLeod, Martha PY - 2024/11/26 TI - Effects of Virtual Care on Patient and Provider Experience of the Clinical Encounter: Qualitative Hermeneutic Study JO - J Med Internet Res SP - e52552 VL - 26 KW - virtual medicine KW - telehealth KW - professional-patient relations KW - hermeneutics KW - kidney KW - health care facility KW - British Columbia KW - Canada KW - qualitative research KW - eHealth KW - health informatics KW - physician KW - COVID-19 KW - pandemic KW - patient experience N2 - Background: Virtual health care has transformed health care delivery, with its use dramatically increasing since the COVID-19 pandemic. While it has been quickly adopted for its convenience and efficiency, there has been a relative lack of in-depth exploration of its human impact, specifically how both patients and providers experience clinical encounters. Objective: This analysis aims to identify and explore themes of change in how patients and providers in a geographically dispersed renal service described their experiences with virtual care, including those changes that occurred during the COVID-19 pandemic. Methods: Hermeneutics is an interpretive research methodology that treats human experience as inherently interpretive, generating meaning through interactions with others in specific, historically conditioned, social contexts. A total of 17 patients and 10 providers from various disciplines were interviewed by phone as part of a study on health care implementation in the context of a kidney care service in northern British Columbia, Canada. The interview data were analyzed using a hermeneutic approach, which emphasizes careful attention to reported experiences in relation to the relationships and contexts of care. Results: During analysis, the interdisciplinary team identified themes related to changes in the clinical encounter and how virtual care influenced perceptions of care among both providers and patients. We organized these themes into 2 categories: the structure and content of the encounter. The structure category included the convenience for patients, who no longer had to travel long distances for appointments, as well as changes in care networks. For example, communication between specialist services and local primary care providers became more crucial for ensuring continuity of care. The content category included issues related to trust-building and assessment. Providers expressed concerns about the difficulty in assessing and understanding their patients? physical and social well-being beyond laboratory results. Conclusions: Patients in the study appreciated the convenience of not needing to travel for appointments, while still having the option for in-person contact with local providers or specialists if their condition changed. Providers were more concerned about the loss of visual cues and sensory data for assessments, as well as the reduced opportunity to build relationships through conversation with patients. Providers also described changes in the locus of control and boundaries, as patients could join phone encounters from anywhere, bypassing traditional privacy and confidentiality boundaries. The study offers a nuanced view of the effects of virtual care on clinical encounters in one setting, seen through the experiences of both patients and providers. UR - https://www.jmir.org/2024/1/e52552 UR - http://dx.doi.org/10.2196/52552 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52552 ER - TY - JOUR AU - Wang, Yipei AU - Zhang, Pei AU - Xing, Yan AU - Shi, Huifeng AU - Cui, Yunpu AU - Wei, Yuan AU - Zhang, Ke AU - Wu, Xinxia AU - Ji, Hong AU - Xu, Xuedong AU - Dong, Yanhui AU - Jin, Changxiao PY - 2024/11/19 TI - Telemedicine Integrated Care Versus In-Person Care Mode for Patients With Short Stature: Comprehensive Comparison of a Retrospective Cohort Study JO - J Med Internet Res SP - e57814 VL - 26 KW - telemedicine KW - telemedicine integrated care mode KW - short stature KW - clinical outcomes KW - health-seeking behaviors KW - cost analysis KW - in-person care KW - mobile health KW - mHealth KW - telehealth KW - eHealth KW - video virtual visit KW - access to care KW - children KW - pediatrics KW - China KW - accessibility KW - temporal KW - spatial constraints KW - chronic disease N2 - Background: Telemedicine has demonstrated efficacy as a supplement to traditional in-person care when treating certain diseases. Nevertheless, more investigation is needed to comprehensively assess its potential as an alternative to in-person care and its influence on access to care. The successful treatment of short stature relies on timely and regular intervention, particularly in rural and economically disadvantaged regions where the disease is more prevalent. Objective: This study evaluated the clinical outcomes, health-seeking behaviors, and cost of telemedicine integrated into care for children with short stature in China. Methods: Our study involved 1241 individuals diagnosed with short stature at the pediatric outpatient clinic of Peking University Third Hospital between 2012 and 2023. Patients were divided into in-person care (IPC; 1183 patients receiving only in-person care) and telemedicine integrated care (TIC; 58 patients receiving both in-person and virtual care) groups. For both groups, the initial 71.43% (average of 58 percentages, with each percentage representing the ratio of patients in the treatment group) of visits were categorized into the pretelemedicine phase. We used propensity score matching to select individuals with similar baseline conditions. We used 7 variables such as age, gender, and medical insurance for the 1:5 closest neighbor match. Eventually, 115 patients in the IPC group and 54 patients in the TIC group were selected. The primary clinical outcome was the change in the standard height percentage. Health-seeking behavior was described by visit intervals in the pre- and post-telemedicine phases. The cost analysis compared costs both between different groups and between different visit modalities of the TIC group in the post-telemedicine phase. Results: In terms of clinical effectiveness, we demonstrated that the increase in height among the TIC group (?zTIC=0.74) was more substantial than that for the IPC group (?zIPC=0.51, P=.01; paired t test), while no unfavorable changes in other endpoints such as BMI or insulin-like growth factor 1 (IGF-1) levels were observed. As for health-seeking behaviors, the results showed that, during the post-telemedicine phase, the IPC group had a visit interval of 71.08 (IQR 50.75-90.73) days, significantly longer than the prior period (51.25 [IQR 34.75-82.00] days, P<.001; U test), whereas the TIC group?s visit interval remained unchanged. As for the cost per visit, there was no difference in the average cost per visit between the 2 groups nor between the pre- and post-telemedicine phases. During the post-telemedicine phase, within the TIC group, in-person visits had a higher average total cost, elevated medical and labor expenses, and greater medical cost compared with virtual visits. Conclusions: We contend that the rise in medical visits facilitated by integrating telemedicine into care effectively restored the previously constrained number of medical visits to their usual levels, without increasing costs. Our research underscores that administering prompt treatment may enable physicians to seize a crucial treatment opportunity for children with short stature, thus attaining superior results. UR - https://www.jmir.org/2024/1/e57814 UR - http://dx.doi.org/10.2196/57814 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57814 ER - TY - JOUR AU - Piera-Jiménez, Jordi AU - Carot-Sans, Gerard AU - Ramiro-Pareta, Marina AU - Nogueras, Mercedes Maria AU - Folguera-Profitós, Júlia AU - Ródenas, Pepi AU - Jiménez-Rueda, Alba AU - de Pando Navarro, Thais AU - Mira Palacios, Antoni Josep AU - Fajardo, Carles Joan AU - Ustrell Campillo, Joan AU - Vela, Emili AU - Monterde, David AU - Valero-Bover, Damià AU - Bonet, Tara AU - Tarrasó-Urios, Guillermo AU - Cantenys-Sabà, Roser AU - Fabregat-Fabregat, Pau AU - Gómez Oliveros, Beatriz AU - Berdún, Jesús AU - Michelena, Xabier AU - Cano, Isaac AU - González-Colom, Rubèn AU - Roca, Josep AU - Solans, Oscar AU - Pontes, Caridad AU - Pérez-Sust, Pol PY - 2024/11/18 TI - A 25-Year Retrospective of Health IT Infrastructure Building: The Example of the Catalonia Region JO - J Med Internet Res SP - e58933 VL - 26 KW - health ITs KW - eHealth KW - integrated care KW - open platforms KW - interoperability KW - Catalonia KW - digitalization KW - health care structure KW - health care delivery KW - integrated pathway KW - integrated treatment plan KW - process management UR - https://www.jmir.org/2024/1/e58933 UR - http://dx.doi.org/10.2196/58933 UR - http://www.ncbi.nlm.nih.gov/pubmed/39556831 ID - info:doi/10.2196/58933 ER - TY - JOUR AU - Zhou, Zhiheng AU - Jin, Danian AU - He, Jinghua AU - Zhou, Shengqing AU - Wu, Jiang AU - Wang, Shuangxi AU - Zhang, Yang AU - Feng, Tianyuan PY - 2024/11/18 TI - Digital Health Platform for Improving the Effect of the Active Health Management of Chronic Diseases in the Community: Mixed Methods Exploratory Study JO - J Med Internet Res SP - e50959 VL - 26 KW - information platform KW - active health KW - chronic disease management KW - effectiveness KW - community KW - digital health KW - health literacy KW - cardio-cerebrovascular disease KW - China N2 - Background: China is vigorously promoting the health management of chronic diseases and exploring digital active health management. However, as most medical information systems in China have been built separately, there is poor sharing of medical information. It is difficult to achieve interconnectivity among community residents? self-testing information, community health care information, and hospital health information, and digital chronic disease management has not been widely applied in China. Objective: This study aimed to build a digital health platform and improve the effectiveness of full-cycle management for community chronic diseases through digital active health management. Methods: This was a single-arm pre-post intervention study involving the development and use of a digital health platform (2-year intervention; 2020 to 2022). The digital health platform included the ?i Active Health? applet for residents and the active health information system (cardio-cerebrovascular disease risk management system) for medical teams. The digital active health management of chronic diseases involved creating health streets, providing internet-assisted full-cycle active health services for residents, implementing internet-based community management for hypertension and diabetes, and performing real-time quantitative assessment and hierarchical management of residents? risks of cardio-cerebrovascular disease. After the 2-year intervention, management effectiveness was evaluated. Results: We constructed a digital health platform with interconnected health information and implemented a digital active health management model. After the intervention, the 2-way referral between community health care institutions and hospitals increased. Residents? health literacy rate increased from 30.6% (3062/10,000) in 2020 to 49.9% (4992/10,000) in 2022, with improvements in health knowledge, health behavior, and health skills. Moreover, the risk of cardio-cerebrovascular disease decreased after the intervention. The community hypertension and diabetes standardized management rates increased from 59.6% (2124/3566) and 55.8% (670/1200) in 2020 to 75.0% (3212/4285) and 69.4% (1686/2430) in 2022, respectively. The control rates of blood pressure in patients with hypertension and blood sugar in patients with diabetes increased from 51.7% (1081/2091) and 42.0% (373/888) in 2020 to 81.2% (1698/2091) and 73.0% (648/888) in 2022, respectively. The intervention improved patients? BMI, waist circumference, blood uric acid levels, and low-density lipoprotein cholesterol levels. The drug compliance rate of patients with hypertension and diabetes increased from 33.6% (703/2091) and 36.0% (320/888) in 2020 to 73.3% (1532/2091) and 75.8% (673/888) in 2022, respectively. The intervention greatly improved the diet behavior, exercise behavior, and drinking behavior of patients with hypertension and diabetes. Conclusions: Our digital health platform can effectively achieve the interconnection and exchange of different health information. The digital active health management carried out with the assistance of this platform improved the effectiveness of community chronic disease management. Thus, the platform is worth promoting and applying in practice. UR - https://www.jmir.org/2024/1/e50959 UR - http://dx.doi.org/10.2196/50959 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50959 ER - TY - JOUR AU - Nebsbjerg, Amalie Mette AU - Bomholt, Bjørnshave Katrine AU - Vestergaard, Høstrup Claus AU - Christensen, Bondo Morten AU - Huibers, Linda PY - 2024/11/15 TI - The Added Value of Using Video in Out-of-Hours Primary Care Telephone Triage Among General Practitioners: Cross-Sectional Survey Study JO - JMIR Hum Factors SP - e52301 VL - 11 KW - primary health care KW - after-hours care KW - referral and consultation KW - general practitioners KW - triage KW - remote consultation KW - telemedicine N2 - Background: Many countries have introduced video consultations in primary care both inside and outside of office hours. Despite some relational and technical limitations, general practitioners (GPs) have reported the benefits of video use in the daytime as it provides faster and more flexible access to health care. Studies have indicated that video may be specifically valuable in out-of-hours primary care (OOH-PC), but additional information on the added value of video use is needed. Objective: This study aimed to investigate triage GPs? perspectives on video use in GP-led telephone triage in OOH-PC by exploring their reasons for choosing video use and its effect on triage outcome, the decision-making process, communication, and invested time. Methods: We conducted a cross-sectional questionnaire study among GPs performing telephone triage in the OOH-PC service in the Central Denmark Region from September 5, 2022, until December 21, 2022. The questionnaire was integrated into the electronic patient registration system as a pop-up window appearing after every third video contact. This setup automatically linked background data on the contact, patient, and GP to the questionnaire data. We used descriptive analyses to describe reasons for and effects of video use and GP evaluation, stratified by patient age. Results: A total of 2456 questionnaires were completed. The most frequent reasons for video use were to assess the severity (n=1951, 79.4%), to increase the probability of self-care (n=1279, 52.1%), and to achieve greater certainty in decision-making (n=810, 33%) (multiple answers were possible for reasons of video use). In 61.9% (n=1516) of contacts, the triage GPs anticipated that the contact would have resulted in a different triage outcome if video had not been used. Use of video resulted in a downgrading of severity level in 88.3% (n=1338) of cases. Triage GPs evaluated the use of video as positive in terms of their decision-making process (n=2358, 96%), communication (n=2214, 90.1%), and invested time (n=2391, 97.3%). Conclusions: Triage GPs assessed that the use of video in telephone triage did affect their triage outcome, mostly by downgrading the level of care needed. The participating triage GPs found video in OOH-PC to be of added value, particularly in communication and the decision-making process. UR - https://humanfactors.jmir.org/2024/1/e52301 UR - http://dx.doi.org/10.2196/52301 ID - info:doi/10.2196/52301 ER - TY - JOUR AU - Song, Faying AU - Gong, Xue AU - Yang, Yuting AU - Guo, Rui PY - 2024/11/14 TI - Comparing the Quality of Direct-to-Consumer Telemedicine Dominated and Delivered by Public and Private Sector Platforms in China: Standardized Patient Study JO - J Med Internet Res SP - e55400 VL - 26 KW - telemedicine KW - direct-to-consumer telemedicine KW - standardized patient KW - China KW - public KW - private KW - platform KW - objective evaluation KW - quality of care KW - effectiveness KW - safety KW - timeliness KW - regression model KW - management N2 - Background: Telemedicine is expanding rapidly, with public direct-to-consumer (DTC) telemedicine representing 70% of the market. A key priority is establishing clear quality distinctions between the public and private sectors. No studies have directly compared the quality of DTC telemedicine in the public and private sectors using objective evaluation methods. Objective: Using a standardized patient (SP) approach, this study aimed to compare the quality of DTC telemedicine provided by China?s public and private sectors. Methods: We recruited 10 SPs presenting fixed cases (urticaria and childhood diarrhea), with 594 interactions between them and physicians. The SPs evaluated various aspects of the quality of care, effectiveness, safety, patient-centeredness (PCC), efficiency, and timeliness using the Institute of Medicine (IOM) quality framework. Ordinary least-squares (OLS) regression models with fixed effects were used for continuous variables, while logistic regression models with fixed effects were used for categorical variables. Results: Significant quality differences were observed between public and private DTC telemedicine. Physicians from private platforms were significantly more likely to adhere to clinical checklists (adjusted ? 15.22, P<.001); provide an accurate diagnosis (adjusted odds ratio [OR] 3.85, P<.001), an appropriate prescription (adjusted OR 3.87, P<.001), and lifestyle modification advice (adjusted OR 6.82, P<.001); ensure more PCC (adjusted ? 3.34, P<.001); and spend more time with SPs (adjusted ? 839.70, P<.001), with more responses (adjusted ? 1.33, P=.001) and more words (adjusted ? 50.93, P=.009). However, SPs on private platforms waited longer for the first response (adjusted ? 505.87, P=.001) and each response (adjusted ? 168.33, P=.04) and paid more for the average visit (adjusted ? 40.03, P<.001). Conclusions: There is significant quality inequality in different DTC telemedicine platforms. Private physicians might provide a higher quality of service regarding effectiveness and safety, PCC, and response times and words. However, private platforms have longer wait times for their first response, as well as higher costs. Refining online reviews, establishing standardized norms and pricing, enhancing the performance evaluation mechanism for public DTC telemedicine, and imposing stricter limitations on the first response time for private physicians should be considered practical approaches to optimizing the management of DTC telemedicine. UR - https://www.jmir.org/2024/1/e55400 UR - http://dx.doi.org/10.2196/55400 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55400 ER - TY - JOUR AU - ten Klooster, Iris AU - Kip, Hanneke AU - Beyer, L. Sina AU - van Gemert-Pijnen, C. Lisette J. E. W. AU - Kelders, M. Saskia PY - 2024/11/13 TI - Clarifying the Concepts of Personalization and Tailoring of eHealth Technologies: Multimethod Qualitative Study JO - J Med Internet Res SP - e50497 VL - 26 KW - eHealth KW - personalization KW - tailoring KW - segmentation KW - adaptation KW - interviews KW - definition N2 - Background: Although personalization and tailoring have been identified as alternatives to a ?one-size-fits-all? approach for eHealth technologies, there is no common understanding of these two concepts and how they should be applied. Objective: This study aims to describe (1) how tailoring and personalization are defined in the literature and by eHealth experts, and what the differences and similarities are; (2) what type of variables can be used to segment eHealth users into more homogeneous groups or at the individual level; (3) what elements of eHealth technologies are adapted to these segments; and (4) how the segments are matched with eHealth adaptations. Methods: We used a multimethod qualitative study design. To gain insights into the definitions of personalization and tailoring, definitions were collected from the literature and through interviews with eHealth experts. In addition, the interviews included questions about how users can be segmented and how eHealth can be adapted accordingly, and responses to 3 vignettes of examples of eHealth technologies, varying in personalization and tailoring strategies to elicit responses about views from stakeholders on how the two components were applied and matched in different contexts. Results: A total of 28 unique definitions of tailoring and 16 unique definitions of personalization were collected from the literature and interviews. The definitions of tailoring and personalization varied in their components, namely adaptation, individuals, user groups, preferences, symptoms, characteristics, context, behavior, content, identification, feedback, channel, design, computerization, and outcomes. During the interviews, participants mentioned 9 types of variables that can be used to segment eHealth users, namely demographics, preferences, health variables, psychological variables, behavioral variables, individual determinants, environmental information, intervention interaction, and technology variables. In total, 5 elements were mentioned that can be adapted to those segments, namely channeling, content, graphical, functionalities, and behavior change strategy. Participants mentioned substantiation methods and variable levels as two components for matching the segmentations with adaptations. Conclusions: Tailoring and personalization are multidimensional concepts, and variability and technology affordances seem to determine whether and how personalization and tailoring should be applied to eHealth technologies. On the basis of our findings, tailoring and personalization can be differentiated by the way that segmentations and adaptations are matched. Tailoring matches segmentations and adaptations based on general group characteristics using if-then algorithms, whereas personalization involves the direct insertion of user information (such as name) or adaptations based on individual-level inferences. We argue that future research should focus on how inferences can be made at the individual level to further develop the field of personalized eHealth. UR - https://www.jmir.org/2024/1/e50497 UR - http://dx.doi.org/10.2196/50497 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50497 ER - TY - JOUR AU - Carter, Michela AU - Linton, C. Samuel AU - Zeineddin, Suhail AU - Pitt, Benjamin J. AU - De Boer, Christopher AU - Figueroa, Angie AU - Gosain, Ankush AU - Lanning, David AU - Lesher, Aaron AU - Islam, Saleem AU - Sathya, Chethan AU - Holl, L. Jane AU - Ghomrawi, MK Hassan AU - Abdullah, Fizan PY - 2024/11/12 TI - Impact of Consumer Wearables Data on Pediatric Surgery Clinicians? Management: Multi-Institutional Scenario-Based Usability Study JO - JMIR Perioper Med SP - e58663 VL - 7 KW - postoperative care KW - telehealth KW - consultation KW - remote KW - appendectomy KW - pediatric hospital KW - children KW - wearable device KW - minimally invasive surgery KW - pediatric surgery KW - remote simulation study N2 - Background: At present, parents lack objective methods to evaluate their child?s postoperative recovery following discharge from the hospital. As a result, clinicians are dependent upon a parent?s subjective assessment of the child?s health status and the child?s ability to communicate their symptoms. This subjective nature of home monitoring contributes to unnecessary emergency department (ED) use as well as delays in treatment. However, the integration of data remotely collected using a consumer wearable device has the potential to provide clinicians with objective metrics for postoperative patients to facilitate informed longitudinal, remote assessment. Objective: This multi-institutional study aimed to evaluate the impact of adding actual and simulated objective recovery data that were collected remotely using a consumer wearable device to simulated postoperative telephone encounters on clinicians? management. Methods: In total, 3 simulated telephone scenarios of patients after an appendectomy were presented to clinicians at 5 children?s hospitals. Each scenario was then supplemented with wearable data concerning or reassuring against a postoperative complication. Clinicians rated their likelihood of ED referral before and after the addition of wearable data to evaluate if it changed their recommendation. Clinicians reported confidence in their decision-making. Results: In total, 34 clinicians participated. Compared with the scenario alone, the addition of reassuring wearable data resulted in a decreased likelihood of ED referral for all 3 scenarios (P<.01). When presented with concerning wearable data, there was an increased likelihood of ED referral for 1 of 3 scenarios (P=.72, P=.17, and P<.001). At the institutional level, there was no difference between the 5 institutions in how the wearable data changed the likelihood of ED referral for all 3 scenarios. With the addition of wearable data, 76% (19/25) to 88% (21/24 and 22/25) of clinicians reported increased confidence in their recommendations. Conclusions: The addition of wearable data to simulated telephone scenarios for postdischarge patients who underwent pediatric surgery impacted clinicians? remote patient management at 5 pediatric institutions and increased clinician confidence. Wearable devices are capable of providing real-time measures of recovery, which can be used as a postoperative monitoring tool to reduce delays in care and avoidable health care use. UR - https://periop.jmir.org/2024/1/e58663 UR - http://dx.doi.org/10.2196/58663 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58663 ER - TY - JOUR AU - Han, Tao AU - Wei, Qinpeng AU - Wang, Ruike AU - Cai, Yijin AU - Zhu, Hongyi AU - Chen, Jiani AU - Zhang, Zhiruo AU - Li, Sisi PY - 2024/11/8 TI - Service Quality and Patient Satisfaction of Internet Hospitals in China: Cross-Sectional Evaluation With the Service Quality Questionnaire JO - J Med Internet Res SP - e55140 VL - 26 KW - service quality KW - SERVQUAL KW - Service Quality Questionnaire KW - internet hospital KW - e-hospital KW - digital medical care KW - health care professionals KW - Chinese digital health care N2 - Background: Internet hospitals, which refer to service platforms that integrate consultation, prescription, payment, and drug delivery based on hospital entities, have been developing at a rapid pace in China since 2014. However, assessments regarding their service quality and patient satisfaction have not been well developed. There is an urgent need to comprehensively evaluate and improve the service quality of internet hospitals. Objective: This study aims to investigate the current status of patients? use of internet hospitals, as well as familiarity and willingness to use internet hospitals, to evaluate patients? expected and perceived service qualities of internet hospitals using the Chinese version of the Service Quality Questionnaire (SERVQUAL-C) with a national representative sample, and to explore the association between service quality of internet hospitals and patients? overall satisfaction toward associated medical platforms. Methods: This cross-sectional survey was conducted through face-to-face or digital interviews from June to September 2022. A total of 1481 outpatient participants (635 men and 846 women; mean age 33.22, SD 13.22). Participants reported their use of internet hospitals, and then rated their expectations and perceptions of service quality toward internet hospitals via the SERVQUAL-C, along with their demographic information. Results: Among the surveyed participants, 51.2% (n=758) of participants had used internet hospital service or services. Use varied across age, education level, and annual income. Although the majority of them (n=826, 55.8%) did not know internet hospital services well, 68.1% (n=1009) of participants expressed the willingness to adopt this service. Service quality evaluation revealed that the perceived service quality did not match with the expectation, especially the responsiveness dimension. Important-performance analysis results further alerted that reliable diagnosis, prompt response, clear feedback pathway, and active feedback handling were typically the services awaiting substantial improvement. More importantly, multiple linear regressions revealed that familiarity and willingness to use internet hospital services were significant predictors of satisfaction, above and over tangibles, reliability, and empathy service perspectives, and demographic characteristics such as gender, age, education level, and annual income. Conclusions: In the future, internet hospitals should focus more on how to narrow the gaps between the expected and perceived service quality. Promotion of internet hospitals should also be facilitated to increase patients? familiarity with and willingness to use these services. UR - https://www.jmir.org/2024/1/e55140 UR - http://dx.doi.org/10.2196/55140 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55140 ER - TY - JOUR AU - Sakhuja, Mayank AU - Yelton, Brooks AU - Kavarana, Simone AU - Schaurer, Lauren AU - Rumthao, Rachel Jancham AU - Noblet, Samuel AU - Arent, A. Michelle AU - Macauda, M. Mark AU - Donelle, Lorie AU - Friedman, B. Daniela PY - 2024/10/31 TI - How Do Scholars Conceptualize and Conduct Health and Digital Health Literacy Research? Survey of Federally Funded Scholars JO - J Med Internet Res SP - e57040 VL - 26 KW - health literacy KW - digital health literacy KW - eHealth literacy KW - social determinants of health KW - SDoH KW - research scholarship KW - health care KW - public health research KW - digital health tools KW - community health N2 - Background: The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research. Objective: This study examined scholars? conceptualization and scope of work focused on HL and DHL. Methods: Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from the grantee websites of the National Institutes of Health RePORTER (RePORT Expenditures and Results) and the Canadian Institutes of Health Research. The investigators were emailed a survey via Qualtrics. Survey questions examined the focus of work; whether the investigators studied HL/DHL in combination with other SDoH; the frameworks, definitions, and approaches used; and research settings. We analyzed survey data using SPSS Statistics version 28 and descriptive analysis, including frequencies and percentages, was conducted. Chi-square tests were performed to explore the association between the focus of work, settings, and age groups included in the investigators? research. Results: A total of 193 (9.5%) of 2042 investigators responded to the online survey. Most investigators (76/153, 49.7%) were from public health, 83/193 (43%) reported their research focused on HL alone, 46/193 (23.8%) mentioned DHL, and 64/193 (33.2%) mentioned both. The majority (133/153, 86.9%) studied HL/DHL in combination with other SDoH, 106/135 (78.5%) conducted HL/DHL work in a community setting, and 100/156 (64.1%) reported not using any specific definition to guide their work. Digital tools (89/135, 65.9%), plain-language materials (82/135, 60.7%), and visual guides (56/135, 41.5%) were the top 3 approaches used. Most worked with adults (131/139, 94.2%) and all races and ethnicities (47/121, 38.8%). Conclusions: HL and DHL research largely considered SDoH. Multiple HL tools and approaches were used that support the examination and improvement of literacy and communication surrounding health care issues. UR - https://www.jmir.org/2024/1/e57040 UR - http://dx.doi.org/10.2196/57040 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57040 ER - TY - JOUR AU - Nordberg, S. Samuel AU - Jaso-Yim, A. Brittany AU - Sah, Pratha AU - Schuler, Keke AU - Eyllon, Mara AU - Pennine, Mariesa AU - Hoyler, H. Georgia AU - Barnes, Ben J. AU - Murillo, Hong Lily AU - O'Dea, Heather AU - Orth, Laura AU - Rogers, Elizabeth AU - Welch, George AU - Peloquin, Gabrielle AU - Youn, Jeong Soo PY - 2024/10/30 TI - Evaluating the Implementation and Clinical Effectiveness of an Innovative Digital First Care Model for Behavioral Health Using the RE-AIM Framework: Quantitative Evaluation JO - J Med Internet Res SP - e54528 VL - 26 KW - digital mental health interventions KW - implementation KW - clinical effectiveness KW - practice-oriented research KW - access to care N2 - Background: In the United States, innovation is needed to address the increasing need for mental health care services and widen the patient-to-provider ratio. Despite the benefits of digital mental health interventions (DMHIs), they have not been effective in addressing patients? behavioral health challenges as stand-alone treatments. Objective: This study evaluates the implementation and effectiveness of precision behavioral health (PBH), a digital-first behavioral health care model embedded within routine primary care that refers patients to an ecosystem of evidence-based DMHIs with strategically placed human support. Methods: Patient demographic information, triage visit outcomes, multidimensional patient-reported outcome measure, enrollment, and engagement with the DMHIs were analyzed using data from the electronic health record and vendor-reported data files. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to evaluate the implementation and clinical effectiveness outcomes of PBH. Results: PBH had a 47.58% reach rate, defined as patients accepting the PBH referral from their behavioral health integrated clinician. PBH patients had high DMHI registration rates (79.62%), high activation rates (76.54%), and high retention rates at 15 days (57.69%) and 30 days (44.58%) compared to literature benchmarks. In total, 74.01% (n=168) of patients showed clinical improvement, 22.47% (n=51) showed no clinical change, and 3.52% (n=8) showed clinical deterioration in symptoms. PBH had high adoption rates, with behavioral health integrated clinicians referring on average 4.35 (SD 0.46) patients to PBH per month and 90%-100% of clinicians (n=12) consistently referring at least 1 patient to PBH each month. A third (32%, n=1114) of patients were offered PBH as a treatment option during their triage visit. Conclusions: PBH as a care model with evidence-based DMHIs, human support for patients, and integration within routine settings offers a credible service to support patients with mild to moderate mental health challenges. This type of model has the potential to address real-life access to care problems faced by health care settings. UR - https://www.jmir.org/2024/1/e54528 UR - http://dx.doi.org/10.2196/54528 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54528 ER - TY - JOUR AU - Erdt, Mojisola AU - Yusof, Binte Sakinah AU - Chai, Liquan AU - Md Salleh, Umairah Siti AU - Liu, Zhengyuan AU - Sarim, Binte Halimah AU - Lim, Choo Geok AU - Lim, Hazel AU - Suhaimi, Ain Nur Farah AU - Yulong, Lin AU - Guo, Yang AU - Ng, Angela AU - Ong, Sharon AU - Choo, Peide Bryan AU - Lee, Sheldon AU - Weiliang, Huang AU - Oh, Choon Hong AU - Wolters, Klara Maria AU - Chen, F. Nancy AU - Krishnaswamy, Pavitra PY - 2024/10/30 TI - Characterization of Telecare Conversations on Lifestyle Management and Their Relation to Health Care Utilization for Patients with Heart Failure: Mixed Methods Study JO - J Med Internet Res SP - e46983 VL - 26 KW - telehealth KW - telecare KW - heart failure KW - chronic disease KW - self-management KW - lifestyle management KW - behavior KW - health care utilization KW - conversation KW - dialogue KW - medical informatics N2 - Background: Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how they relate to health care utilization remains incomplete. Objective: This study aimed to characterize the content and structure of telecare conversations on lifestyle management for patients with HF and investigate how these conversations relate to health care utilization. Methods: We leveraged real-world data from 50 patients with HF enrolled in a postdischarge telehealth program, with the primary intervention comprising a series of telephone calls from nurse telecarers over a 12-month period. For the full cohort, we transcribed 729 English-language calls and annotated conversation topics. For a subcohort (25 patients with both HF and T2DM), we annotated lifestyle management content with fine-grained dialogue acts describing typical conversational structures. For each patient, we identified calls with unusually high ratios of utterances on lifestyle management as lifestyle-focused calls. We further extracted structured data for inpatient admissions from 6 months before to 6 months after the intervention period. First, to understand conversational structures and content of lifestyle-focused calls, we compared the number of utterances, dialogue acts, and symptom attributes in lifestyle-focused calls to those in calls containing but not focused on lifestyle management. Second, to understand the perspectives of nurse telecarers on these calls, we conducted an expert evaluation where 2 nurse telecarers judged levels of concern and follow-up actions for lifestyle-focused and other calls (not focused on lifestyle management content). Finally, we assessed how the number of lifestyle-focused calls relates to the number of admissions, and to the average length of stay per admission. Results: In comparative analyses, lifestyle-focused calls had significantly fewer utterances (P=.01) and more dialogue acts (Padj=.005) than calls containing but not focused on lifestyle management. Lifestyle-focused calls did not contain deeper discussions on clinical symptoms. These findings indicate that lifestyle-focused calls entail short, intense discussions with greater emphasis on understanding patient experience and coaching than on clinical content. In the expert evaluation, nurse telecarers identified 24.2% (29/120) of calls assessed as concerning enough for follow-up. For these 29 calls, nurse telecarers were more attuned to concerns about symptoms and vitals (19/29, 65.5%) than lifestyle management concerns (4/29, 13.8%). The number of lifestyle-focused calls a patient had was modestly (but not significantly) associated with a lower average length of stay for inpatient admissions (Spearman ?=-0.30; Padj=.06), but not with the number of admissions (Spearman ?=-0.03; Padj=.84). Conclusions: Our approach and findings offer novel perspectives on the content, structure, and clinical associations of telehealth conversations on lifestyle management for patients with HF. Hence, our study could inform ways to enhance telehealth programs for self-care management in chronic conditions. UR - https://www.jmir.org/2024/1/e46983 UR - http://dx.doi.org/10.2196/46983 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/46983 ER - TY - JOUR AU - Fava, Dalfior Virgínia Maria AU - Lapão, Velez Luís PY - 2024/10/29 TI - Provision of Digital Primary Health Care Services: Overview of Reviews JO - J Med Internet Res SP - e53594 VL - 26 KW - primary health care KW - digital health KW - implementation KW - health service quality KW - patients? clinical conditions KW - digital skills KW - mobile phone N2 - Background: Digital health is a growing field, and many digital interventions have been implemented on a large scale since the COVID-19 pandemic, mainly in primary health care (PHC). The development of digital health interventions and their application in PHC are encouraged by the World Health Organization. The increased number of published scientific papers on this topic has resulted in an overwhelming amount of information, but there is no overview of reviews to summarize this evidence. Objective: This study aims to provide policy makers, health managers, and researchers with a summary of evidence on digital interventions used in PHC. Methods: This overview of reviews searched the Web of Science and MEDLINE databases for systematic and scoping reviews on assessments of digital technologies implemented in PHC published from January 2007 to March 2023. Only reviews that addressed digital interventions whose targets were real patients or health care providers (HCPs) were included. Results: A total of 236 records were identified from the search strategy, of which 42 (17.8%) full-text papers were selected for analysis, and 18 (7.6%) reviews met the eligibility criteria. In total, 61% (11/18) of the reviews focused their analysis on specific digital health interventions (client-to-provider telemedicine, provider-to-provider telemedicine, health worker decision support systems, systems for tracking patients? health status, client participation and self-care platforms, and provision of education and training to health workers), and 39% (7/18) of the reviews focused on specific topics related to PHC (preventive care, chronic disease management, behavioral health disorders, the COVID-19 pandemic, multicomponent PHC interventions, and care coordination). Most studies in the included reviews agreed on barriers to implementation, such as software and apps developed without involving end users, the lack of training of HCPs and patients in digital technology use, and the lack of reimbursement and billing strategies for remote consultations. However, they showed several mixed results related to health service quality and patients? clinical conditions and behavior changes. Conclusions: Research in digital health applied to PHC is still concentrated in high-income countries, mainly in North America and Europe. The mixed results related to health service quality and patients? clinical conditions or behavior changes may have been caused by deficiencies in the process of implementing digital interventions. It is necessary to examine the entire impact pathway and the causal relationship among implementation, health service quality, and clinical condition outcomes to support the spread of digital health in PHC settings. UR - https://www.jmir.org/2024/1/e53594 UR - http://dx.doi.org/10.2196/53594 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53594 ER - TY - JOUR AU - Areias, C. Anabela AU - Janela, Dora AU - Molinos, Maria AU - Bento, Virgílio AU - Moreira, Carolina AU - Yanamadala, Vijay AU - Cohen, P. Steven AU - Correia, Dias Fernando AU - Costa, Fabíola PY - 2024/10/29 TI - Exploring the Importance of Race and Gender Concordance Between Patients and Physical Therapists in Digital Rehabilitation for Musculoskeletal Conditions: Observational, Longitudinal Study JO - J Med Internet Res SP - e65354 VL - 26 KW - musculoskeletal pain KW - physical therapy KW - telerehabilitation KW - eHealth KW - racial/ethnic concordance KW - patient?provider concordance KW - digital rehabilitation KW - musculoskeletal conditions N2 - Background: Race/ethnicity and gender concordance between patients and providers is a potential strategy to improve health care interventions. In digital health, where human interactions occur both synchronously and asynchronously, the effect of concordance between patients and providers is unknown. Objective: This study aimed to evaluate the impact of race/ethnicity or gender concordance between patients and physical therapists (PTs) in engagement and the clinical outcomes following a digital care program (DCP) in patients with musculoskeletal (MSK) conditions. Methods: This secondary analysis of 2 prospective longitudinal studies (originally focused on assessing the acceptance, engagement, and clinical outcomes after a remote DCP) examined the impact of both race/ethnicity concordance and gender concordance between patients and PTs on outcomes for a digital intervention for MSK conditions. Outcomes included engagement (measured by the completion rate and communication, assessed by text interactions), satisfaction, and clinical outcomes (response rate, ie, percentage of patients achieving at least a minimal clinically important change in pain, measured by the Numerical Pain Rating Scale [NPRS]; anxiety, measured by the Generalized Anxiety Disorder 7-item scale [GAD-7]; depression, measured by the Patient Health Questionnaire 9-item [PHQ-9]; and daily activity impairment, measured by the Work Productivity and Activity Impairment [WPAI] questionnaire). Results: Of 71,201 patients, 63.9% (n=45,507) were matched with their PT in terms of race/ethnicity, while 61.2% (n=43,560) were matched for gender. Concordant dyads showed a higher completion rate among White (adjusted odds ratio [aOR] 1.11, 95% CI 1.05-1.19, P<.001) and Hispanic (aOR 1.27, 95% CI 1.08-1.54, P=.009) groups, as well as women (aOR 1.10, 95% CI 1.06-1.18, P<.001), when compared to discordant dyads. High and similar levels of interaction between patients and PTs were observed across race/ethnicity and gender dyads, except for Asian concordant dyads (adjusted ? coefficient 5.32, 95% CI 3.28-7.36, P<.001). Concordance did not affect satisfaction, with high values (>8.52, 95% CI 8.27-8.77) reported across all dyads. Response rates for pain, anxiety, and daily activity impairment were unaffected by race/ethnicity concordance. An exception was observed for depression, with White patients reporting a higher response rate when matched with PTs from other races/ethnicities (aOR 1.20, 95% CI 1.02-1.39, P=.02). In terms of gender, men had a slightly higher pain response rate in discordant dyads (aOR 1.08, 95% CI 1.01-1.15, P=.03) and a higher depression response rate in concordant dyads (aOR 1.23, 95% CI 1.05-1.47, P=.01). Conclusions: Race/ethnicity and gender concordance between patients and PTs does not translate into higher satisfaction or improvement for most clinical outcomes, aside from a positive effect on treatment completion. These results highlight the importance of other PT characteristics, in addition to race/ethnicity or gender concordance, suggesting the potential benefit of experience, languages spoken, and cultural safety training as ways to optimize care. Trial Registration: ClinicalTrials.gov NCT04092946, NCT05417685; https://clinicaltrials.gov/study/NCT05417685, https://clinicaltrials.gov/study/NCT04092946 UR - https://www.jmir.org/2024/1/e65354 UR - http://dx.doi.org/10.2196/65354 UR - http://www.ncbi.nlm.nih.gov/pubmed/39470695 ID - info:doi/10.2196/65354 ER - TY - JOUR AU - Rousaki, Anastasia AU - Zamani, D. Efpraxia AU - Sbaffi, Laura AU - Hamblin, Kate AU - Black, Rachael PY - 2024/10/24 TI - The Digitalization of Social Care in England and Implications for Older, Unpaid Carers: Constructionist Thematic Analysis JO - J Med Internet Res SP - e60056 VL - 26 KW - social care KW - England KW - digitalization KW - digital transformation KW - unpaid care KW - mobile phone N2 - Background: Globally, populations are aging, generating concerns about the sustainability of health and social care provision. In terms of the public provision of social care in particular, unpaid carers provide much of the support to people with disabilities and older people. In addition, there is an increased onus in many countries on digital transformation projects, in the hope that the digitalization of services can create efficiencies and savings in both costs and care labor. In England, the focus of this paper, the shift to digital services is also framed as a means to enhance choice and control for older unpaid carers, while being part of a broader offering that includes nondigital alternatives and support to mitigate digital exclusion. Objective: This study examines the impact of digitalization on older, unpaid carers?a group more likely to be both expected to engage digitally with services and at risk of digital exclusion?in England, focusing on their lived experiences in terms of caring and access to social care. Methods: We used a constructionist approach to thematic analysis, where data from 48 older unpaid carers collected through focus groups were analyzed using thematic analysis, resulting in 4 prevailing themes. Results: Our findings indicated that while unpaid carers largely acknowledge the benefits of digitalization, they also highlight several points of failure, whereby engagement with digital spaces is experienced as coercive and exacerbates feelings of exclusion. These are further worsened by government failures to address issues of connectivity, imposing additional financial burdens and complicating tasks such as benefit applications. Conclusions: In this study, we have highlighted the need for greater involvement in shaping both policy and technological solutions, which in turn will be more inclusive and aligned to the aspirations and circumstances of older carers. UR - https://www.jmir.org/2024/1/e60056 UR - http://dx.doi.org/10.2196/60056 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60056 ER - TY - JOUR AU - Wang, Kun AU - Zou, Wenxin AU - Lai, Yingsi AU - Hao, Chun AU - Liu, Ning AU - Ling, Xiang AU - Liu, Xiaohan AU - Liu, Ting AU - Yang, Xin AU - Zu, Chenxi AU - Wu, Shaolong PY - 2024/10/21 TI - Accessibility, Cost, and Quality of an Online Regular Follow-Up Visit Service at an Internet Hospital in China: Mixed Methods Study JO - J Med Internet Res SP - e54902 VL - 26 KW - internet hospital KW - medical service KW - accessibility KW - cost KW - quality KW - regular follow-up N2 - Background: Telemedicine provides remote health care services to overcome constraints of time and space in accessing medical care. Similarly, internet hospitals in China support and provide remote health care services. Due to the COVID-19 pandemic, there has been a proliferation of internet hospitals. Many new services, including online consultations and regular online follow-up visit services, can now be accessed via internet hospitals in China. However, the accessibility, cost, and quality advantages of regular online follow-up visit services remain unclear. Objective: This study aimed to evaluate the accessibility, costs, and quality of an online regular follow-up visit service provided by an internet hospital in China. By analyzing the accessibility, costs, and quality of this service from the supply and demand sides, we can summarize the practical and theoretical experiences. Methods: A mixed methods study was conducted using clinical records from 18,473 patients receiving 39,239 online regular follow-up visit services at an internet hospital in 2021, as well as interviews with 7 physicians, 2 head nurses, and 3 administrative staff members. The quantitative analysis examined patient demographics, diagnoses, prescriptions, geographic distribution, physician characteristics, accessibility (travel time and costs), and service hours. The qualitative analysis elucidated physician perspectives on ensuring the quality of online health care. Results: Patients were predominantly middle-aged men with chronic diseases like viral hepatitis who were located near the hospital. The vast majority were from Guangdong province where the hospital is based, especially concentrated in Guangzhou city. The online regular follow-up visit service reduced travel time by 1 hour to 9 hours and costs by ¥6 to ¥991 (US $0.86-$141.32) depending on proximity, with greater savings for patients farther from the hospital. Consultation times were roughly equivalent between online and in-person visits. Physicians provided most online services during lunch breaks (12 PM to 2 PM) or after work hours (7 PM to 11 PM), indicating increased workload. The top departments providing online regular follow-up visit services were Infectious Diseases, Rheumatology, and Dermatology. The most commonly prescribed medications aligned with the prevalent chronic diagnoses. To ensure quality, physicians conducted initial in-person consultations to fully evaluate patients before allowing online regular follow-up visits, during which they communicated with patients to assess conditions and determine if in-person care was warranted. They also periodically reminded patients to come in person for more comprehensive evaluations. However, they acknowledged online visits cannot fully replace face-to-face care. Conclusions: Telemedicine services such as online regular follow-up visit services provided by internet hospitals must strictly adhere to fundamental medical principles of diagnosis, prescription, and treatment. For patients with chronic diseases, online regular follow-up visit services improve accessibility and reduce cost but cannot fully replace in-person evaluations. Physicians leverage various strategies to ensure the quality of online care. UR - https://www.jmir.org/2024/1/e54902 UR - http://dx.doi.org/10.2196/54902 UR - http://www.ncbi.nlm.nih.gov/pubmed/39432365 ID - info:doi/10.2196/54902 ER - TY - JOUR AU - Cengil, Betul Aysenur AU - Eksioglu, Sandra AU - Eksioglu, Burak AU - Eswaran, Hari AU - Hayes, J. Corey AU - Bogulski, A. Cari PY - 2024/10/18 TI - Statistical Analysis of Telehealth Use and Pre- and Postpandemic Insurance Coverage in Selected Health Care Specialties in a Large Health Care System in Arkansas: Comparative Cross-Sectional Study JO - J Med Internet Res SP - e49190 VL - 26 KW - appointment scheduling metrics KW - insurance coverage KW - statistical hypothesis testing KW - telehealth N2 - Background: The COVID-19 pandemic triggered policy changes in 2020 that allowed insurance companies to reimburse telehealth services, leading to increased telehealth use, especially in rural and underserved areas. However, with many emergency rules ending in 2022, patients and health care providers face potential challenges in accessing these services. Objective: This study analyzed telehealth use across specialties in Arkansas before and after the pandemic (2017-2022) using data from electronic medical records from the University of Arkansas for Medical Sciences Medical Center. We explored trends in insurance coverage for telehealth visits and developed metrics to compare the performance of telehealth versus in-person visits across various specialties. The results inform insurance coverage decisions for telehealth services. Methods: We used pre- and postpandemic data to determine the impacts of the COVID-19 pandemic and changes in reimbursement policies on telehealth visits. We proposed a framework to calculate 3 appointment metrics: indirect waiting time, direct waiting time, and appointment length. Statistical analysis tools were used to compare the performance of telehealth and in-person visits across the following specialties: obstetrics and gynecology, psychiatry, family medicine, gerontology, internal medicine, neurology, and neurosurgery. We used data from approximately 4 million in-person visits and 300,000 telehealth visits collected from 2017 to 2022. Results: Our analysis revealed a statistically significant increase in telehealth visits across all specialties (P<.001), showing an 89% increase from 51,589 visits in 2019 to 97,461 visits in 2020, followed by a 21% increase to 117,730 visits in 2021. Around 92.57% (134,221/145,001) of telehealth patients from 2020 to 2022 were covered by Medicare, Blue Cross and Blue Shield, commercial and managed care, Medicaid, and Medicare Managed Care. In-person visits covered by Medicare and Medicaid decreased by 15%, from 313,196 in 2019 to 264,696 in 2022. During 2020 to 2022, about 22.84% (33,123/145,001) of total telehealth visits during this period were covered by Medicare and 53.58% (86,317/161,092) were in psychiatry, obstetrics and gynecology, and family medicine. We noticed a statistically significant decrease (P<.001) in the average indirect waiting time for telehealth visits, from 48.4 to 27.7 days, and a statistically significant reduction in appointment length, from 93.2 minutes in 2020 to 39.59 minutes in 2022. The indirect waiting time for psychiatry telehealth visits was almost 50% shorter than that for in-person visits. These findings highlight the potential benefits of telehealth in providing access to health care, particularly for patients needing psychiatric care. Conclusions: Reverting to prepandemic regulations could negatively affect Arkansas, where many live in underserved areas. Our analysis shows that telehealth use remained stable beyond 2020, with psychiatry visits continuing to grow. These findings may guide insurance and policy decisions in Arkansas and other regions facing similar access challenges. UR - https://www.jmir.org/2024/1/e49190 UR - http://dx.doi.org/10.2196/49190 UR - http://www.ncbi.nlm.nih.gov/pubmed/39423000 ID - info:doi/10.2196/49190 ER - TY - JOUR AU - You, Guan-Ting Jacqueline AU - Leung, I. Tiffany AU - Pandita, Deepti AU - Sakumoto, Matthew PY - 2024/10/15 TI - Primary Care Informatics: Vitalizing the Bedrock of Health Care JO - J Med Internet Res SP - e60081 VL - 26 KW - health care delivery KW - primary care KW - primary health care KW - primary prevention KW - quality of health care KW - holistic care KW - holistic medicine KW - people-centric care KW - person-centric care KW - medical informatics applications KW - primary care informatics KW - medical informatics KW - health informatics KW - information science KW - data science UR - https://www.jmir.org/2024/1/e60081 UR - http://dx.doi.org/10.2196/60081 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60081 ER - TY - JOUR AU - Mechael, Patricia AU - Gilani, Sara AU - Ahmad, Ahsan AU - LeFevre, Amnesty AU - Mohan, Diwakar AU - Memon, Asra AU - Shah, Taighoon Mubarak AU - Siddiqi, Arif Danya AU - Chandir, Subhash AU - Soundardjee, Riswana PY - 2024/10/11 TI - Evaluating the ?Zindagi Mehfooz? Electronic Immunization Registry and Suite of Digital Health Interventions to Improve the Coverage and Timeliness of Immunization Services in Sindh, Pakistan: Mixed Methods Study JO - J Med Internet Res SP - e52792 VL - 26 KW - electronic immunization registry KW - registry KW - Zindagi Mehfooz KW - vaccination KW - alert KW - reminder KW - dashboard KW - survey KW - cost KW - economic KW - digital health KW - immunization KW - children KW - pediatrics KW - equity KW - accessibility KW - text messages KW - SMS KW - zero dose N2 - Background: The Zindagi Mehfooz (safe life; ZM) electronic immunization registry (EIR) is a comprehensive suite of digital health interventions that aims to improve equitable access, timeliness, and coverage of child immunizations through a smartphone-based app for vaccinators, web-based dashboards for supervisors and managers, text message alerts and reminders for caregivers, and a call center. It has been implemented at scale in Sindh Province, Pakistan. Objective: This study aimed to present findings from an evaluation of the ZM-EIR suite of digital health interventions in order to improve data availability and use as a contribution, among other immunization program interventions, to enhanced immunization outcomes for children aged 12-23 months in Sindh Province. Methods: The mixed methods study included (1) analysis of ZM-EIR system data to identify high-, moderate-, and low-adoption and compliance sites; (2) in-depth interviews with caregivers, vaccinators, supervisors, and managers in the Expanded Program for Immunization (EPI); and (3) pre-post outcome evaluation using vaccine coverage from the Multiple Indicator Cluster Surveys (MICS) 2014 and 2018-2019. Key outcomes of interest were improved data availability, use and contribution to immunization outcomes, including receipt of individual antigens (Bacillus Calmette-Guérin [BCG], pentavalent [Penta] 1-3, measles), full immunization (all antigens), and zero-dose children defined as children aged 6-23 months who have not received the first dosage of the diphtheria-pertussis-tetanus 1/Penta vaccine. Results: By registering newborns, providing alerts and reminders, and tracking their immunization completion, the ZM-EIR improved data availability and use in the EPI. The ZM-EIR was well received by EPI administrators, supervisors, vaccinators, and caregivers. The key benefit highlighted by ZM-EIR users was a list of children who missed scheduled vaccines (defaulters). Through greater availability and use of data, the ZM-EIR implementation, as part of a broader package of immunization program?strengthening activities in Sindh Province, may have contributed to an increase in immunization coverage and timeliness for BCG vaccinations and a decrease in zero-dose children in 2018-2019 from 2014. Additional findings from the study included the dual burden of reporting on paper and gender-related considerations of female caregivers not wanting to provide their phone numbers to male vaccinators, creating barriers to greater uptake of the ZM-EIR. Conclusions: The ZM-EIR is a promising technology platform that has increased the availability and use of immunization data, which may have contributed, along with other intensive immunization program interventions, to improvements in immunization outcomes through systematic registration of children, alerts and reminders, and increased use of data for planning and monitoring by the EPI. Trial Registration: ISRCTN Registry ISRCTN23078223; https://doi.org/10.1186/ISRCTN23078223 UR - https://www.jmir.org/2024/1/e52792 UR - http://dx.doi.org/10.2196/52792 UR - http://www.ncbi.nlm.nih.gov/pubmed/39162666 ID - info:doi/10.2196/52792 ER - TY - JOUR AU - Bjarnadóttir, Vilborg Margrét AU - Anderson, David AU - Anderson, M. Kelley AU - Aljwfi, Omar AU - Peluso, Alina AU - Ghannoum, Adam AU - Balba, Gayle AU - Shara, Nawar PY - 2024/10/3 TI - Health Care Usage During the COVID-19 Pandemic and the Adoption of Telemedicine: Retrospective Study of Chronic Disease Cohorts JO - J Med Internet Res SP - e54991 VL - 26 KW - telehealth utilization KW - health care utilization KW - demographic differences KW - cohort study KW - telehealth KW - COVID-19 KW - telehealth adaption N2 - Background: The COVID-19 pandemic accelerated telehealth adoption across disease cohorts of patients. For many patients, routine medical care was no longer an option, and others chose not to visit medical offices in order to minimize COVID-19 exposure. In this study, we take a comprehensive multidisease approach in studying the impact of the COVID-19 pandemic on health care usage and the adoption of telemedicine through the first 12 months of the COVID-19 pandemic. Objective: We studied the impact of the COVID-19 pandemic on in-person health care usage and telehealth adoption across chronic diseases to understand differences in telehealth adoption across disease cohorts and patient demographics (such as the Social Vulnerability Index [SVI]). Methods: We conducted a retrospective cohort study of 6 different disease cohorts (anxiety: n=67,578; depression: n=45,570; diabetes: n=81,885; kidney failure: n=29,284; heart failure: n=21,152; and cancer: n=35,460). We used summary statistics to characterize changes in usage and regression analysis to study how patient characteristics relate to in-person health care and telehealth adoption and usage during the first 12 months of the pandemic. Results: We observed a reduction in in-person health care usage across disease cohorts (ranging from 10% to 24%). For most diseases we study, telehealth appointments offset the reduction in in-person visits. Furthermore, for anxiety and depression, the increase in telehealth usage exceeds the reduction in in-person visits (by up to 5%). We observed that younger patients and men have higher telehealth usage after accounting for other covariates. Patients from higher SVI areas are less likely to use telehealth; however, if they do, they have a higher number of telehealth visits, after accounting for other covariates. Conclusions: The COVID-19 pandemic affected health care usage across diseases, and the role of telehealth in replacing in-person visits varies by disease cohort. Understanding these differences can inform current practices and provides opportunities to further guide modalities of in-person and telehealth visits. Critically, further study is needed to understand barriers to telehealth service usage for patients in higher SVI areas. A better understanding of the role of social determinants of health may lead to more support for patients and help individual health care providers improve access to care for patients with chronic conditions. UR - https://www.jmir.org/2024/1/e54991 UR - http://dx.doi.org/10.2196/54991 UR - http://www.ncbi.nlm.nih.gov/pubmed/39361360 ID - info:doi/10.2196/54991 ER - TY - JOUR AU - Dilimulati, Diliqingna AU - Shao, Xiaowen AU - Wang, Lihua AU - Cai, Meili AU - Zhang, Yuqin AU - Lu, Jiayi AU - Wang, Yao AU - Liu, Hongying AU - Kuang, Ming AU - Chen, Haibing AU - Zhang, Manna AU - Qu, Shen PY - 2024/10/2 TI - Efficacy of WeChat-Based Digital Intervention Versus Metformin in Women With Polycystic Ovary Syndrome: Randomized Controlled Trial JO - J Med Internet Res SP - e55883 VL - 26 KW - polycystic ovary syndrome KW - insulin resistance KW - digital intervention KW - metformin KW - women?s health N2 - Background: The first-line treatment for polycystic ovary syndrome (PCOS) is lifestyle modification. However, it is currently unknown whether digital medicine can assist patients with PCOS in maintaining a healthy lifestyle while alleviating PCOS symptoms. Objective: This study aims to evaluate the efficacy of WeChat-based digital intervention versus metformin treatment in women with PCOS and insulin resistance. Methods: A total of 80 women with PCOS and insulin resistance were recruited from an endocrinology clinic and randomly assigned to receive either a WeChat-based digital intervention (n=40, 50%) or metformin (n=40, 50%) for 12 weeks. The WeChat-based digital intervention consisted of 3 modules; a coach assisted the patients in using the intervention. The primary outcome was the change in a homeostatic model assessment for insulin resistance. At baseline and after the 12-week intervention, anthropometric parameters, menstruation frequency, sex hormone levels, metabolic factors, and body fat distribution were measured in the clinic. Furthermore, self-assessed web-based questionnaires on diet, exercise, sleep, anxiety, and depression were obtained. Results: A total of 72 participants completed the follow-up (for a 90% follow-up rate), including 35 of 40 (88%) participants from the digital intervention group and 37 of 40 (93%) participants from the metformin group. The homeostatic model assessment for insulin resistance in the digital intervention group was significantly improved after 12 weeks of treatment with a mean change of ?0.93 (95% CI ?1.64 to ?0.23), but no statistical difference was observed between the groups (least squares mean difference ?0.20; 95% CI ?0.98 to 0.58; P=.62). Both digital intervention and metformin treatment significantly improved menstruation frequency (digital intervention: P<.001; metformin: P<.001) and reduced body weight (digital intervention: P<.001; metformin: P<.001) and total fat mass (digital intervention: P<.001; metformin: P<.001). Furthermore, the digital intervention had a significant advantage over metformin in improving waist circumference (least squares mean difference ?1.84; 95% CI ?3.44 to ?0.24; P=.03), waist-to-hip ratio (least squares mean difference ?0.02; 95% CI ?0.03 to 0.00; P=.03), total fat mass (least squares mean difference ?1.59; 95% CI ?2.88 to ?0.30; P=.02), and dehydroepiandrosterone sulfate (least squares mean difference ?69.73; 95% CI ?129.70 to ?9.75; P=.02). In terms of safety, the main adverse events were sensations of hunger in the digital intervention group (2/40, 5%) and gastrointestinal adverse events in the metformin group (12/40, 30%). Conclusions: Our data suggest that digital intervention is an effective treatment option for patients with PCOS, with an efficacy comparable to that of metformin, and that it can also alleviate the negative effects of medications and make it easier and more efficient to adhere to lifestyle treatments. WeChat-based digital interventions have the potential to provide a new path for the improvement and health of women with PCOS in China. Trial Registration: ClinicalTrials.gov NCT05386706; https://clinicaltrials.gov/study/NCT05386706 UR - https://www.jmir.org/2024/1/e55883 UR - http://dx.doi.org/10.2196/55883 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55883 ER - TY - JOUR AU - Musheghyan, Lusine AU - Harutyunyan, M. Nika AU - Sikder, Abu AU - Reid, W. Mark AU - Zhao, Daniel AU - Lulejian, Armine AU - Dickhoner, W. James AU - Andonian, T. Nicole AU - Aslanyan, Lusine AU - Petrosyan, Varduhi AU - Sargsyan, Zhanna AU - Shekherdimian, Shant AU - Dorian, Alina AU - Espinoza, C. Juan PY - 2024/9/30 TI - Managing Patients With COVID-19 in Armenia Using a Remote Monitoring System: Descriptive Study JO - JMIR Public Health Surveill SP - e57703 VL - 10 KW - COVID-19 KW - remote patient monitoring KW - Armenia KW - web platform KW - home oxygen therapy KW - pandemic KW - global health care KW - low and middle-income countries KW - health care infrastructure KW - Yerevan KW - home monitoring KW - resource-constrained N2 - Background: The COVID-19 pandemic has imposed immense stress on global health care systems, especially in low- and middle-income countries (LMICs). Armenia, a middle-income country in the Caucasus region, contended with the pandemic and a concurrent war, resulting in significant demand on its already strained health care infrastructure. The COVID@home program was a multi-institution, international collaboration to address critical hospital bed shortages by implementing a home-based oxygen therapy and remote monitoring program. Objective: The objective of this study was to describe the program protocol and clinical outcomes of implementing an early discharge program in Armenia through a collaboration of partner institutions, which can inform the future implementation of COVID-19 remote home monitoring programs, particularly in LMICs or low-resource settings. Methods: Seven hospitals in Yerevan participated in the COVID@home program. A web app based on OpenMRS was developed to facilitate data capture and care coordination. Patients meeting eligibility criteria were enrolled during hospitalization and monitored daily while on oxygen at home. Program evaluation relied on data extraction from (1) eligibility and enrollment forms, (2) daily monitoring forms, and (3) discharge forms. Results: Over 11 months, 439 patients were screened, and 221 patients were managed and discharged. Around 94% (n=208) of participants safely discontinued oxygen therapy at home, with a median home monitoring duration of 26 (IQR 15-45 days; mean 32.33, SD 25.29) days. Women (median 28.5, mean 35.25 days) had similar length of stay to men (median 26, mean 32.21 days; P=.75). Despite challenges in data collection and entry, the program demonstrated feasibility and safety, with a mortality rate below 1% and low re-admission rate. Opportunities for operational and data quality improvements were identified. Conclusions: This study contributes practical evidence on the implementation and outcomes of a remote monitoring program in Armenia, offering insights into managing patients with COVID-19 in resource-constrained settings. The COVID@home program?s success provides a model for remote patient care, potentially alleviating strain on health care resources in LMICs. Policymakers can draw from these findings to inform the development of adaptable health care solutions during public health crises, emphasizing the need for innovative approaches in resource-limited environments. UR - https://publichealth.jmir.org/2024/1/e57703 UR - http://dx.doi.org/10.2196/57703 UR - http://www.ncbi.nlm.nih.gov/pubmed/39348686 ID - info:doi/10.2196/57703 ER - TY - JOUR AU - Zigdon, Avi AU - Zwilling, Moti AU - Zigdon, Ofek AU - Reges, Orna PY - 2024/9/30 TI - Health Maintenance Organization?mHealth Versus Face-to-Face Interaction for Health Care in Israel: Cross-Sectional Web-Based Survey Study JO - J Med Internet Res SP - e55350 VL - 26 KW - HMO-mHealth KW - mHealth KW - face-to-face KW - digital health KW - digital health apps KW - eHealth KW - HMO-mHealth adoption KW - health care KW - mHealth adoption KW - mobile phone KW - HMO KW - health maintenance organization N2 - Background: Health maintenance organization?mobile health (HMO-mHealth) services have a direct impact on patients? daily lives, and HMOs regularly expand their range of mHealth services. HMO-mHealth apps are saving HMOs time and money, as services are becoming more accessible to patients. However, the willingness to use mHealth apps depends on user perception. Although mHealth apps can change the relationship dynamic between HMOs and patients, patients prefer to use them to facilitate face-to-face interactions rather than replace them. Objective: This study aims to examine the extent to which Israeli adults prefer adopting health care services using HMO-mHealth as a replacement for face-to-face interaction. Methods: Israeli adults aged ?18 years completed an electronic questionnaire. Data were collected from December 2020 to February 2021. All services in the main HMO-mHealth apps of the 4 Israeli HMOs were mapped. The 29 health care services used in this study were identical in all 4 HMO-mHealth apps in Israel. The association between sociodemographic characteristics and health condition with preference for HMO-mHealth or face-to-face interaction was analyzed separately for each health service by using a logistic model. Results: A total of 6321 respondents completed the questionnaire (female: 4296/6321, 68%; male: 2025/6321, 32%). Approximately 80.9% (5115/6321) to 88.2% (5578/6321) of the respondents preferred using HMO-mHealth apps for administrative matters. However, 55.3% (3498/6321), 52.2% (3301/6321), and 46.9% (2969/6321) preferred face-to-face meetings for the initial medical diagnosis, medical treatment, and medical diagnosis results, respectively. Seven main variables were found to be associated with HMO-mHealth adoption, including gender, age, education, marital status, religious affiliation, and subjective health condition. Female respondents were more likely than male respondents to prefer HMO-mHealth apps for administrative matters and face-to-face interaction for personal medical diagnosis and treatment (odds ratio [OR] 0.74, 95% CI 0.67-0.83; P<.001 and OR 0.82, 95% CI 0.74-0.92; P<.001, respectively). Married individuals preferred using HMO-mHealth apps over face-to-face meetings for a new medical diagnosis (OR 1.31, 95% CI 1.15-1.49; P<.001) or treatment (OR 1.34, 95% CI 1.18-1.52; P<.001). Improved health perception was associated with higher preference for HMO-mHealth apps across all health care services in this study (OR 1.11, 95% CI 1.02-1.22; P<.02 to OR 1.38, 95% CI 1.25-1.53; P<.001). No significant association was found between the presence of a chronic disease and the preferred mode of interaction for most services. Conclusions: HMO-mHealth is proving to be a robust and efficient tool for health care service delivery. However, there are barriers that affect vulnerable populations when adopting HMO-mHealth. Therefore, it is important to tailor HMO-mHealth apps for older adults, the chronically ill, and minorities in society, as these groups have a greater need for these services. Future studies should focus on identifying the barriers that affect the utilization of HMO-mHealth in these groups. UR - https://www.jmir.org/2024/1/e55350 UR - http://dx.doi.org/10.2196/55350 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55350 ER - TY - JOUR AU - Lee, Seung-Yup AU - Hayes, W. Leslie AU - Ozaydin, Bunyamin AU - Howard, Steven AU - Garretson, M. Alison AU - Bradley, M. Heather AU - Land, M. Andrew AU - DeLaney, W. Erin AU - Pritchett, O. Amy AU - Furr, L. Amanda AU - Allgood, Ashleigh AU - Wyatt, C. Matthew AU - Hall, G. Allyson AU - Banaszak-Holl, C. Jane PY - 2024/9/25 TI - Integrating Social Determinants of Health in Machine Learning?Driven Decision Support for Diabetes Case Management: Protocol for a Sequential Mixed Methods Study JO - JMIR Res Protoc SP - e56049 VL - 13 KW - diabetes KW - case management KW - case manager KW - social work KW - case mix KW - social determinants of health KW - clinical decision support KW - decision support KW - predictive analytics KW - disparities KW - health disparities KW - data warehouse KW - tertiary care KW - health care system KW - chronic disease management N2 - Background: The use of both clinical factors and social determinants of health (SDoH) in referral decision-making for case management may improve optimal use of resources and reduce outcome disparities among patients with diabetes. Objective: This study proposes the development of a data-driven decision-support system incorporating interactions between clinical factors and SDoH into an algorithm for prioritizing who receives case management services. The paper presents a design for prediction validation and preimplementation assessment that uses a mixed methods approach to guide the implementation of the system. Methods: Our study setting is a large, tertiary care academic medical center in the Deep South of the United States, where SDoH contribute to disparities in diabetes-specific hospitalizations and emergency department (ED) visits. This project will develop an interpretable artificial intelligence model for a population with diabetes using SDoH and clinical data to identify which posthospitalization cases have a higher likelihood of subsequent ED use. The electronic health record data collected for the study include demographics, SDoH, comorbidities, hospitalization-related factors, laboratory test results, and medication use to predict posthospitalization ED visits. Subsequently, a mixed methods approach will be used to validate prediction outcomes and develop an implementation strategy from insights into patient outcomes from case managers, clinicians, and quality and patient safety experts. Results: As of December 2023, we had abstracted data on 174,871 inpatient encounters between January 2018 and September 2023, involving 89,355 unique inpatients meeting inclusion criteria. Both clinical and SDoH data items were included for these patient encounters. In total, 85% of the inpatient visits (N=148,640) will be used for training (learning from the data) and the remaining 26,231 inpatient visits will be used for mixed-methods validation (testing). Conclusions: By integrating a critical suite of SDoH with clinical data related to diabetes, the proposed data-driven risk stratification model can enable individualized risk estimation and inform health professionals (eg, case managers) about the risk of patients? upcoming ED use. The prediction outcome could potentially automate case management referrals, helping to better prioritize services. By taking a mixed methods approach, we aim to align the model with the hospital?s specific quality and patient safety considerations for the quality of patient care and the optimization of case management resource allocation. International Registered Report Identifier (IRRID): DERR1-10.2196/56049 UR - https://www.researchprotocols.org/2024/1/e56049 UR - http://dx.doi.org/10.2196/56049 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56049 ER - TY - JOUR AU - Brunton, Lisa AU - Cotterill, Sarah AU - Wilson, Paul PY - 2024/9/25 TI - Evaluating the National Rollout of a Type 2 Diabetes Self-Management Intervention: Qualitative Interview Study With Local National Health Service Leads Responsible for Implementation JO - J Med Internet Res SP - e55546 VL - 26 KW - type 2 diabetes KW - structured education KW - self-management KW - digital interventions KW - implementation KW - qualitative methods KW - evaluation N2 - Background: Approximately 4.5 million people live with type 2 diabetes mellitus (T2DM) in the United Kingdom. Evidence shows that structured education programs can improve glycemic control and reduce the risk of complications from T2DM, but they have low attendance rates. To widen access to T2DM structured education, National Health Service England commissioned a national rollout of Healthy Living, a digital self-management program. Objective: The objectives were to understand the barriers and enablers to adopting, implementing, and integrating Healthy Living into existing T2DM care pathways across England. Methods: We undertook a cross-sectional, qualitative telephone semistructured interview study to address the objectives. In total, 17 local National Health Service leads responsible for implementing Healthy Living across their locality were recruited. We conducted 16 one-time interviews across 16 case sites (1 of the interviews was conducted with 2 local leads from the same case site). Interview data were analyzed using thematic analysis. Results: Three overarching themes were generated: (1) implementation activities, (2) where Healthy Living fits within existing pathways, and (3) contextual factors affecting implementation. Of the 16 sites, 14 (88%) were implementing Healthy Living; the barrier to not implementing it in 2 case sites was not wanting Healthy Living to compete with their current education provision for T2DM. We identified 6 categories of implementation activities across sites: communication strategies to raise awareness of Healthy Living, developing bespoke local resources to support general practices with referrals, providing financial reimbursement or incentives to general practices, promoting Healthy Living via public events, monitoring implementation across their footprint, and widening access across high-need groups. However, outside early engagement sites, most implementation activities were ?light touch,? consisting mainly of one-way communications to raise awareness. Local leads were generally positive about Healthy Living as an additional part of their T2DM structured education programs, but some felt it was more suited to specific patient groups. Barriers to undertaking more prolonged, targeted implementation campaigns included implementation not being mandated, sites not receiving data on uptake across their footprint, and confusion in understanding where Healthy Living fit within existing care pathways. Conclusions: A passive process of disseminating information about Healthy Living to general practices rather than an active process of implementation occurred across most sites sampled. This study identified that there is a need for clearer communications regarding the type of patients that may benefit from the Healthy Living program, including when it should be offered and whether it should be offered instead of or in addition to other education programs. No sites other than early engagement sites received data to monitor uptake across their footprint. Understanding variability in uptake across practices may have enabled sites to plan targeted referral campaigns in practices that were not using the service. UR - https://www.jmir.org/2024/1/e55546 UR - http://dx.doi.org/10.2196/55546 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55546 ER - TY - JOUR AU - Savage, C. Leah AU - Soto-Cossio, Estefhany Luz AU - Minardi, Francesca AU - Beyrouty, Matthew AU - Schoonover, Julie AU - Musella, Jay AU - Frazier, Michaela AU - Villagra, N. Cristina AU - Sly, R. Jamilia AU - Erblich, Joel AU - Itzkowitz, H. Steven AU - Jandorf, H. Lina AU - Calman, S. Neil AU - Atreja, Ashish AU - Miller, J. Sarah PY - 2024/9/25 TI - The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing JO - JMIR Form Res SP - e53224 VL - 8 KW - digital navigation KW - digital health KW - Federally Qualified Health Center KW - colorectal cancer KW - cancer screening KW - mobile phone N2 - Background: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. Objective: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. Methods: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a ?think aloud? exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website?s acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. Results: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website?s content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. Conclusions: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool?s usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs. UR - https://formative.jmir.org/2024/1/e53224 UR - http://dx.doi.org/10.2196/53224 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53224 ER - TY - JOUR AU - Hertz, T. Julian AU - Sakita, M. Francis AU - Rahim, O. Faraan AU - Mmbaga, T. Blandina AU - Shayo, Frida AU - Kaboigora, Vivian AU - Mtui, Julius AU - Bloomfield, S. Gerald AU - Bosworth, B. Hayden AU - Bettger, P. Janet AU - Thielman, M. Nathan PY - 2024/9/24 TI - Multicomponent Intervention to Improve Acute Myocardial Infarction Care in Tanzania: Protocol for a Pilot Implementation Trial JO - JMIR Res Protoc SP - e59917 VL - 13 KW - myocardial infarction KW - Tanzania KW - sub-Saharan Africa KW - implementation science KW - quality improvement N2 - Background: Although the incidence of acute myocardial infarction (AMI) is rising in sub-Saharan Africa, the uptake of evidence-based care for the diagnosis and treatment of AMI is limited throughout the region. In Tanzania, studies have revealed common misdiagnosis of AMI, infrequent administration of aspirin, and high short-term mortality rates following AMI. Objective: This study aims to evaluate the implementation and efficacy outcomes of an intervention, the Multicomponent Intervention to Improve Acute Myocardial Infarction Care (MIMIC), which was developed to improve the delivery of evidence-based AMI care in Tanzania. Methods: This single-arm pilot trial will be conducted in the emergency department (ED) at a referral hospital in northern Tanzania. The MIMIC intervention will be implemented by the ED staff for 1 year. Approximately 400 adults presenting to the ED with possible AMI symptoms will be enrolled, and research assistants will observe their care. Thirty days later, a follow-up survey will be administered to assess mortality and medication use. The primary outcome will be the acceptability of the MIMIC intervention, which will be measured by the Acceptability of Intervention Measurement (AIM) instrument. Acceptability will further be assessed via in-depth interviews with key stakeholders. Secondary implementation outcomes will include feasibility and fidelity. Secondary efficacy outcomes will include the following: the proportion of participants who receive electrocardiogram and cardiac biomarker testing, the proportion of participants with AMI who receive aspirin, 30-day mortality among participants with AMI, and the proportion of participants with AMI taking aspirin 30 days following enrollment. Results: Implementation of MIMIC began on September 1, 2023. Enrollment is expected to be completed by September 1, 2024, and the first results are expected to be published by December 31, 2024. Conclusions: This study will be the first to evaluate an intervention for improving AMI care in sub-Saharan Africa. If MIMIC is found to be acceptable, the findings from this study will inform a future cluster-randomized trial to assess effectiveness and scalability. Trial Registration: ClinicalTrials.gov NCT04563546; https://clinicaltrials.gov/study/NCT04563546 International Registered Report Identifier (IRRID): DERR1-10.2196/59917 UR - https://www.researchprotocols.org/2024/1/e59917 UR - http://dx.doi.org/10.2196/59917 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59917 ER - TY - JOUR AU - Delaney, Tessa AU - Jackson, K. Jacklyn AU - Brown, L. Alison AU - Lecathelinais, Christophe AU - Wolfenden, Luke AU - Hudson, Nayerra AU - Young, Sarah AU - Groombridge, Daniel AU - Pinfold, Jessica AU - Craven, David Paul AU - Redman, Sinead AU - Wiggers, John AU - Kingsland, Melanie AU - Hayes, Margaret AU - Sutherland, Rachel PY - 2024/9/24 TI - Perceived Acceptability of Technology Modalities for the Provision of Universal Child and Family Health Nursing Support in the First 6-8 Months After Birth: Cross-Sectional Study JO - JMIR Pediatr Parent SP - e59191 VL - 7 KW - maternal KW - postnatal KW - postpartum KW - acceptability KW - technology KW - digital health KW - first 2000 days KW - child health KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - cross sectional KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - pediatric KW - pediatrics KW - infant KW - infants KW - infancy KW - baby KW - babies KW - neonate KW - neonates KW - neonatal KW - newborn KW - newborns KW - nurse KW - nurses KW - nursing N2 - Background: Child and Family Health Nursing (CFHN) services provide universal care to families during the first 2000 days (conception: 5 years) to support optimal health and developmental outcomes of children in New South Wales, Australia. The use of technology represents a promising means to encourage family engagement with CFHN services and enable universal access to evidenced-based age and stage information. Currently, there is little evidence exploring the acceptability of various models of technology-based support provided during the first 2000 days, as well as the maternal characteristics that may influence this. Objective: This study aims to describe (1) the acceptability of technology-based models of CFHN support to families in the first 6 months, and (2) the association between the acceptability of technology-based support and maternal characteristics. Methods: A cross-sectional survey was undertaken between September and November 2021 with women who were 6-8 months post partum within the Hunter New England Local Health District of New South Wales, Australia. Survey questions collected information on maternal demographics and pregnancy characteristics, perceived stress, access to CFHN services, as well as preferences and acceptability of technology-based support. Descriptive statistics were used to describe the characteristics of the sample, the proportion of women accessing CFHN services, maternal acceptability of technology-based support from CFHN services, and the appropriateness of timing of support. Multivariable logistic regression models were conducted to assess the association between maternal characteristics and the acceptability of technology-based CFHN support. Results: A total of 365 women participated in the study, most were 25 to 34 years old (n=242, 68%), had completed tertiary level education or higher (n=250, 71%), and were employed or on maternity leave (n=280, 78%). Almost all (n=305, 89%) women reported accessing CFHN services in the first 6 months following their child?s birth. The majority of women (n=282-315, 82%-92%) ?strongly agreed or agreed? that receiving information from CFHN via technology would be acceptable, and most (n=308) women ?strongly agreed or agreed? with being provided information on a variety of relevant health topics. Acceptability of receiving information via websites was significantly associated with maternal employment status (P=.01). The acceptability of receiving support via telephone and email was significantly associated with maternal education level (adjusted odds ratio 2.64, 95% CI 1.07-6.51; P=.03 and adjusted odds ratio 2.90, 95% CI 1.20-7.00; P=.02, respectively). Maternal age was also associated with the acceptability of email support (P=.04). Conclusions: Technology-based CFHN support is generally acceptable to mothers. Maternal characteristics, including employment status, education level, and age, were found to modify the acceptability of specific technology modalities. The findings of this research should be considered when designing technology-based solutions to providing universal age and stage child health and developmental support for families during the first 2000 days. UR - https://pediatrics.jmir.org/2024/1/e59191 UR - http://dx.doi.org/10.2196/59191 UR - http://www.ncbi.nlm.nih.gov/pubmed/39316424 ID - info:doi/10.2196/59191 ER - TY - JOUR AU - Uhl, Laura AU - Augusto, Vincent AU - Dalmas, Benjamin AU - Alexandre, Youenn AU - Bercelli, Paolo AU - Jardinaud, Fanny AU - Aloui, Saber PY - 2024/9/23 TI - Evaluating the Bias in Hospital Data: Automatic Preprocessing of Patient Pathways Algorithm Development and Validation Study JO - JMIR Med Inform SP - e58978 VL - 12 KW - preprocessing KW - framework KW - health care data KW - patient pathway KW - bed management N2 - Background: The optimization of patient care pathways is crucial for hospital managers in the context of a scarcity of medical resources. Assuming unlimited capacities, the pathway of a patient would only be governed by pure medical logic to meet at best the patient?s needs. However, logistical limitations (eg, resources such as inpatient beds) are often associated with delayed treatments and may ultimately affect patient pathways. This is especially true for unscheduled patients?when a patient in the emergency department needs to be admitted to another medical unit without disturbing the flow of planned hospitalizations. Objective: In this study, we proposed a new framework to automatically detect activities in patient pathways that may be unrelated to patients? needs but rather induced by logistical limitations. Methods: The scientific contribution lies in a method that transforms a database of historical pathways with bias into 2 databases: a labeled pathway database where each activity is labeled as relevant (related to a patient?s needs) or irrelevant (induced by logistical limitations) and a corrected pathway database where each activity corresponds to the activity that would occur assuming unlimited resources. The labeling algorithm was assessed through medical expertise. In total, 2 case studies quantified the impact of our method of preprocessing health care data using process mining and discrete event simulation. Results: Focusing on unscheduled patient pathways, we collected data covering 12 months of activity at the Groupe Hospitalier Bretagne Sud in France. Our algorithm had 87% accuracy and demonstrated its usefulness for preprocessing traces and obtaining a clean database. The 2 case studies showed the importance of our preprocessing step before any analysis. The process graphs of the processed data had, on average, 40% (SD 10%) fewer variants than the raw data. The simulation revealed that 30% of the medical units had >1 bed difference in capacity between the processed and raw data. Conclusions: Patient pathway data reflect the actual activity of hospitals that is governed by medical requirements and logistical limitations. Before using these data, these limitations should be identified and corrected. We anticipate that our approach can be generalized to obtain unbiased analyses of patient pathways for other hospitals. UR - https://medinform.jmir.org/2024/1/e58978 UR - http://dx.doi.org/10.2196/58978 UR - http://www.ncbi.nlm.nih.gov/pubmed/39312289 ID - info:doi/10.2196/58978 ER - TY - JOUR AU - Anthony, J. Samantha AU - Pol, J. Sarah AU - Selkirk, K. Enid AU - Matthiesen, Amarens AU - Klaassen, J. Robert AU - Manase, Dorin AU - Silva, Amanda AU - Barwick, Melanie AU - Stinson, N. Jennifer AU - Damer, Alameen AU - Ayibiowu, Mowa AU - Dong, X. Selina AU - Oreskovich, Stephan AU - Brudno, Michael PY - 2024/9/19 TI - User-Centered Design and Usability of Voxe as a Pediatric Electronic Patient-Reported Outcome Measure Platform: Mixed Methods Evaluation Study JO - JMIR Hum Factors SP - e57984 VL - 11 KW - eHealth KW - end user engagement KW - mobile phone KW - patient-reported outcome KW - patient-reported outcome measures KW - pediatric KW - user-centered design N2 - Background: Electronic patient-reported outcome measures (ePROMs) are standardized digital instruments integrated into clinical care to collect subjective data regarding patients? health-related quality of life, functional status, and symptoms. In documenting patient-reported progress, ePROMs can guide treatment decisions and encourage measurement-based care practices. Voxe is a pediatric and user-centered ePROM platform for patients with chronic health conditions. Objective: We aimed to describe the user-centered design approach involving feedback from end users and usability testing of Voxe?s platform features to support implementation in a pediatric health care setting. Methods: Purposive sampling was used to recruit patients aged 8-17 years from 2 chronic illness populations in 2 pediatric hospitals in Canada. Patients? health care team members were also purposively recruited. One-on-one iterative testing sessions were conducted digitally by research team members with participants to obtain feedback on the appearance and functionalities of the Voxe platform prototype. Patients and health care providers (HCPs) completed Voxe-related task-based activities. International Organization for Standardization key performance indicators were tracked during HCP task-based activities. HCPs also completed the System Usability Scale. To test platform usability, the think-aloud technique was used by participants during the completion of structured tasks. After completing all task-based activities, patient participants selected 5 words from the Microsoft Desirability Toolkit to describe their overall impression and experience with the Voxe platform. Qualitative data about likes, dislikes, and ease of use were collected through semistructured interviews. Feedback testing sessions were conducted with patients and HCPs until Voxe was acceptable to participating end users, with no further refinements identified. Quantitative and qualitative data analysis were completed using descriptive statistics and content analysis. Results: A total of 49 patients and 38 HCPs were recruited. Patients were positive about Voxe?s child-centered design characteristics and notification settings. HCPs rated Voxe as user-friendly and efficient, with the time to complete tasks decreasing over time. HCPs were satisfied with the Voxe platform functionalities and identified the value of Voxe?s system notifications, summarized display of ePROM results, and its capacity to integrate with electronic medical records. Patients? and HCPs? high satisfaction rates with the Voxe prototype highlight the importance of being responsive to user suggestions from the inception of eHealth platform developments to ensure their efficient and effective design. Conclusions: This paper describes the user-centered creation and usability testing of Voxe as an ePROM platform for implementation into clinical care for pediatric patients with chronic health conditions. As a patient-facing platform that can be integrated into electronic medical records, Voxe aligns with measurement-based care practices to foster quality patient-centered approaches to care. End users? positive feedback and evaluation of the platform?s user-friendliness and efficiency suggest that Voxe represents a valuable and promising solution to systematically integrate patient-related outcome (PRO) data into complex and dynamic clinical health care settings. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-053119 UR - https://humanfactors.jmir.org/2024/1/e57984 UR - http://dx.doi.org/10.2196/57984 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57984 ER - TY - JOUR AU - Turkington, Robin AU - Potts, Courtney AU - Mulvenna, Maurice AU - Bond, Raymond AU - O'Neill, Siobhán AU - Ennis, Edel AU - Hardcastle, Katie AU - Scowcroft, Elizabeth AU - Moore, Ciaran AU - Hamra, Louise PY - 2024/9/19 TI - Talk Time Differences Between Interregional and Intraregional Calls to a Crisis Helpline: Statistical Analysis JO - JMIR Ment Health SP - e58162 VL - 11 KW - crisis helplines KW - call duration KW - mental health KW - suicide KW - suicidal KW - suicide prevention KW - population-based KW - help-seeking behavior KW - Samaritans KW - UK KW - telephony KW - telephone KW - telephones KW - one-way analysis KW - call KW - calls KW - talk time KW - support KW - talk time differences N2 - Background: National suicide prevention strategies are general population-based approaches to prevent suicide by promoting help-seeking behaviors and implementing interventions. Crisis helplines are one of the suicide prevention resources available for public use, where individuals experiencing a crisis can talk to a trained volunteer. Samaritans UK operates on a national scale, with a number of branches located within each of the United Kingdom?s 4 countries or regions. Objectives: The aim of this study was to identify any differences in call duration across the helpline service in order to determine whether service varied interregionally and intraregionally and to determine the impact of calls answered in the same region as the caller, compared with calls answered in a different region on the duration of calls made from landlines to Samaritans UK. Methods: Calls may be routed by Samaritans, wherein the telephony system sends the call to the next available volunteer, irrespective of location; therefore, individuals may be routed to a branch within the same region as the caller?s current region (intraregional calls) or routed to a branch that is in a different region from that of the caller?s current region (interregional calls). The origin of calls by region was identified using the landline prefix of the anonymized caller identifier, along with the region of the destination branch (as branch details are recorded in the call details record). First, a Levene?s test of homogeneity of variance was carried out for each condition, that is, England calls and Scotland calls. Thereafter, for each condition, a one-way ANOVA or one-way analysis of means was carried out to evaluate any significant differences in call duration. Results: ANOVA results showed that there are significant differences in call durations between intraregional calls and interregional calls (P<.001). Across all conditions within this study, callers stayed on the phone for a shorter period of time when routed to a branch that is within the same region as the call origin than if they were put through to a branch within a different region than the call origin. Conclusions: Statistical analyses showed that there were significant differences between interregional and intraregional calls. On average, callers to crisis helplines stayed on the phone for a shorter period of time if they were routed to a branch within the same region in which the call originated than if they were routed to a branch in a different region of origin. The findings from this study have practical applications, which may allow crisis helplines to manage their resources more effectively and improve caller satisfaction with the service. UR - https://mental.jmir.org/2024/1/e58162 UR - http://dx.doi.org/10.2196/58162 ID - info:doi/10.2196/58162 ER - TY - JOUR AU - Koo, Dae-Jeong AU - Moon, Sun-Joon AU - Moon, Suhyeon AU - Park, Eun Se AU - Rhee, Eun-Jung AU - Lee, Won-Young AU - Park, Cheol-Young PY - 2024/9/11 TI - Long-Term Glycemic Control Improvement After the Home and Self-Care Program for Patients With Type 1 Diabetes: Real-World?Based Cohort Study JO - J Med Internet Res SP - e60023 VL - 26 KW - type 1 diabetes KW - structured education KW - home health care KW - glycated hemoglobin KW - continuous glucose monitoring KW - mobile phone N2 - Background: The prevalence of type 1 diabetes (T1D) is increasing worldwide, with a much higher proportion of adult patients. However, achieving stable glycemic control is difficult in these patients. Objective: After periodic implementation of structured education for patients with T1D through the Home and Self-Care Program, a pilot home health care project promoted by the Korean government, we evaluated the program?s effects on glycemic control. Methods: This study was conducted from April 2020 to March 2023. We analyzed 119 participants with T1D aged >15 years. Nursing and nutrition education were provided separately up to 4 times per year, with physician consultation up to 6 times per year. A distinguishing feature of this study compared with previous ones was the provision of remote support using a general-purpose smartphone communication app offered up to 12 times annually on an as-needed basis to enhance the continuity of in-person education effects. Patients were followed up on at average intervals of 3 months for up to 24 months. The primary end point was the mean difference in glycated hemoglobin (HbA1c) at each follow-up visit from baseline. For continuous glucose monitoring (CGM) users, CGM metrics were also evaluated. Results: The mean HbA1c level of study participants was 8.6% at baseline (mean duration of T1D 10.02, SD 16.10 y). The HbA1c level reduction in participants who received at least 1 structured educational session went from 1.63% (SD 2.03%; P<.001; adjustment model=1.69%, 95% CI 1.24%-2.13% at the first follow-up visit) to 1.23% (SD 1.31%; P=.01; adjustment model=1.28%, 95% CI 0.78%-1.79% at the eighth follow-up visit). In the adjustment model, the actual mean HbA1c values were maintained between a minimum of 7.33% (95% CI 7.20%-7.46% at the first follow-up visit) and a maximum of 7.62% (95% CI 7.41%-7.82% at the sixth follow-up visit). Among CGM users, after at least 1 session, the mean time in the target range was maintained between 61.59% (adjusted model, 95% CI 58.14%-65.03% at the second follow-up visit) and 54.7% (95% CI 50.92%-58.48% at the eighth follow-up visit), consistently staying above 54.7% (corresponding to an HbA1c level of <7.6%). The mean time below the target range (TBR) also gradually improved to the recommended range (?4% for TBR of <70 mg/dL and ?1% for TBR of <54 mg/dL). Conclusions: The Home and Self-Care Program protocol for glycemic control in patients with T1D is effective, producing significant improvement immediately and long-term maintenance effects, including on CGM indexes. UR - https://www.jmir.org/2024/1/e60023 UR - http://dx.doi.org/10.2196/60023 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60023 ER - TY - JOUR AU - Zhang, Kechun AU - Cao, Bolin AU - Fang, Yuan AU - Liang, Xue AU - Ye, Danhua AU - Chen, Qi Ya AU - Zhong, Ruilan AU - Cao, He AU - Hu, Tian AU - Li, Ting AU - Cai, Yong AU - Zou, Huachun AU - Wang, Zixin PY - 2024/9/9 TI - Comparing the Efficacy of 2 WeChat Mini Programs in Reducing Nonmarital Heterosexual Contact by Male Factory Workers: Randomized Controlled Trial JO - J Med Internet Res SP - e49362 VL - 26 KW - nonmarital heterosexual contacts KW - male factory workers KW - WeChat mini program KW - randomized controlled trial KW - China KW - mobile phone N2 - Background: Male factory workers in China are vulnerable to HIV transmission. Commercial and nonmarital noncommercial contacts are the driving forces of heterosexual HIV transmission among male factory workers in China. There is a lack of effective HIV interventions for male factory workers in China. Objective: The primary objective of this randomized controlled trial was to compare the efficacy of an enhanced versus the standard version of a WeChat mini program in reducing sexual intercourse with nonregular female sex partners and female sex workers among male factory workers in Shenzhen, China. Methods: A nonblinded 2-arm parallel randomized controlled trial was conducted between December 2021 and April 2023. Participants were adult male factory workers in Shenzhen who had access to a smartphone and WeChat. Those who had oral or anal sex with a man or self-reported as HIV positive were excluded. A total of 247 participants were randomly assigned to the intervention group (n=125, 50.6%) or the control group (n=122, 49.4%); 221 (89.5%) and 220 (89.1%) completed follow-up surveys at T1 (6 months after completion of the interventions) and T2 (6 months after T1). Participants in the control group had access to the standard WeChat mini program that provided basic HIV-related knowledge and information about local free HIV testing services. Participants in the intervention group had access to the enhanced WeChat mini program. The enhanced mini program covered all the information in the standard mini program. In addition, the enhanced mini program assessed users? behaviors and invited users to watch different web-based videos on reducing nonmarital sexual contacts and promoting HIV testing based on their behavioral characteristics at months 0 and 1. The videos were developed based on in-depth interviews with male factory workers. Intention-to-treat analysis was used for outcome analyses. Multiple imputation was used to replace missing outcome values at T1 and T2. Results: At T1, fewer participants in the intervention group reported sexual intercourse with a nonregular female sex partner in the past 6 months compared with the control group (1/125, 0.8% vs 8/122, 6.6%; relative risk=0.12, 95% CI 0.02-0.96; P=.02). However, there were no between-group differences in sexual intercourse with a nonregular female sex partner at T2 (10/125, 8% vs 14/122, 11.5%; P=.36) or sexual intercourse with a female sex worker at T1 (2/125, 1.6% vs 2/122, 1.6%; P=.98) or T2 (8/125, 6.4% vs 8/122, 6.6%; P=.96). Conclusions: The enhanced WeChat mini program was more effective than the standard WeChat mini program in reducing sexual intercourse with nonregular female sex partners among male factory workers in the short term but not in the longer term. Improvements should be made to the WeChat mini program before implementation. Trial Registration: ClinicalTrials.gov NCT05811611; https://clinicaltrials.gov/study/NCT05811611 UR - https://www.jmir.org/2024/1/e49362 UR - http://dx.doi.org/10.2196/49362 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250213 ID - info:doi/10.2196/49362 ER - TY - JOUR AU - Ferguson, M. Jacqueline AU - Van Campen, James AU - Slightam, Cindie AU - Greene, Liberty AU - Heyworth, Leonie AU - Zulman, M. Donna PY - 2024/9/9 TI - Evaluation of the Veterans Health Administration?s Digital Divide Consult for Tablet Distribution and Telehealth Adoption: Cohort Study JO - J Med Internet Res SP - e59089 VL - 26 KW - veterans KW - health care access KW - video-based care KW - telehealth KW - barriers to care KW - telemedicine N2 - Background: Video telehealth offers a mechanism to help Veterans Health Administration (VHA) patients overcome health care access barriers; however, many veterans lack a suitable device and sufficient internet connectivity. To address disparities in technology access, VHA established a Connected Device Program that offers veterans loaned video-capable tablets and internet service. In 2020, VHA introduced a national Digital Divide Consult to facilitate and standardize referrals for this resource. Objective: We sought to evaluate the reach and impact of VHA?s Connected Device Program, leveraging Digital Divide Consult data to determine whether resources are supporting veterans with health care needs and access barriers. Methods: We examined the reach of VHA?s Connected Device Program using national secondary data from VHA?s electronic health records among 119,926 tablet recipients who received a tablet (April 1, 2020, to February 28, 2023) and 683,219 veterans from the general VHA population. We assessed changes in tablet recipients? demographic and clinical characteristics before and after implementation of the Digital Divide Consult compared with the general VHA population. We examined the impact of tablets and the consult on adoption of telehealth (ie, video visit use and number of visits) adjusting for differences between tablet recipients and the general VHA population. Finally, we evaluated consult implementation by assessing the use of video-based services by tablet referral reason. Results: Common reasons for tablet referral included mental health diagnoses (50,367/79,230, 63.9%), distance from a VHA facility >30 miles (17,228/79,230, 21.7%), and social isolation (16,161/79,230, 20.4%). Moreover, 63.0% (49,925/79,230) of individuals who received a tablet after implementation of the Digital Divide Consult had a video visit in the first 6 months of tablet receipt. Some consult reasons were associated with a higher-than-average percentage of video telehealth use, including enrollment in evidence-based mental health programs (74.8% [830/1100] with video use), living >30 miles from a VHA facility (68.3% [10,557/17,228] with video use), and having a mental health diagnosis (68.1% [34,301/50,367] with video use). Tablet recipients had nearly 3 times the likelihood of having a video visit within a month once provided a tablet compared to the general VHA population, with an adjusted risk ratio of 2.95 (95% CI 2.91-2.99) before consult implementation and 2.73 (95% CI 2.70-2.76) after consult implementation. Analyses of telehealth adoption suggested that veterans receiving tablets for mental health care and evidence-based programs have higher rates of video visits, while those who are homebound or receiving tablets for hospice have higher rates of nonuse. Conclusions: This evaluation of VHA?s Connected Device Program suggests that tablets are facilitating video-based care among veterans with complex needs. Standardization of referrals through the Digital Divide Consult has created opportunities to identify groups of tablet recipients with lower telehealth adoption rates who might benefit from a targeted intervention. UR - https://www.jmir.org/2024/1/e59089 UR - http://dx.doi.org/10.2196/59089 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250183 ID - info:doi/10.2196/59089 ER - TY - JOUR AU - Liu, Jingkun AU - Tai, Jiaojiao AU - Han, Junying AU - Zhang, Meng AU - Li, Yang AU - Yang, Hongjuan AU - Yan, Ziqiang PY - 2024/9/4 TI - Constructing a Hospital Department Development?Level Assessment Model: Machine Learning and Expert Consultation Approach in Complex Hospital Data Environments JO - JMIR Form Res SP - e54638 VL - 8 KW - machine algorithms KW - hospital management KW - model construction KW - support vector machine KW - clustering N2 - Background: Every hospital manager aims to build harmonious, mutually beneficial, and steady-state departments. Therefore, it is important to explore a hospital department development assessment model based on objective hospital data. Objective: This study aims to use a novel machine learning algorithm to identify key evaluation indexes for hospital departments, offering insights for strategic planning and resource allocation in hospital management. Methods: Data related to the development of a hospital department over the past 3 years were extracted from various hospital information systems. The resulting data set was mined using neural machine algorithms to assess the possible role of hospital departments in the development of a hospital. A questionnaire was used to consult senior experts familiar with the hospital to assess the actual work in each hospital department and the impact of each department?s development on overall hospital discipline. We used the results from this questionnaire to verify the accuracy of the departmental risk scores calculated by the machine learning algorithm. Results: Deep machine learning was performed and modeled on the hospital system training data set. The model successfully leveraged the hospital?s training data set to learn, predict, and evaluate the working and development of hospital departments. A comparison of the questionnaire results with the risk ranking set from the departments machine learning algorithm using the cosine similarity algorithm and Pearson correlation analysis showed a good match. This indicates that the department development assessment model and risk score based on the objective data of hospital systems are relatively accurate and objective. Conclusions: This study demonstrated that our machine learning algorithm provides an accurate and objective assessment model for hospital department development. The strong alignment of the model's risk assessments with expert opinions, validated through statistical analysis, highlights its reliability and potential to guide strategic hospital management decisions. UR - https://formative.jmir.org/2024/1/e54638 UR - http://dx.doi.org/10.2196/54638 UR - http://www.ncbi.nlm.nih.gov/pubmed/39230941 ID - info:doi/10.2196/54638 ER - TY - JOUR AU - Beuthin, Oliver AU - Shahid, Sadiya AU - Yu, Ly-Mee AU - Bhui, Kamaldeep PY - 2024/9/2 TI - Feasibility and Acceptability Study of a Culturally Adapted Web-Based Intervention to Reduce Suicidal Ideation for Syrian Asylum Seekers and Refugees in the United Kingdom: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e56957 VL - 13 KW - cultural adaptation KW - digital mental health KW - suicidal ideation KW - refugee mental health KW - Syrian refugee KW - experience-based co-design KW - mental health KW - suicide KW - suicidal KW - refugee KW - immigrant KW - ethnic minority KW - asylum KW - user experience KW - cultural KW - Syria KW - Syrian KW - refugees KW - feasibility KW - acceptability KW - depression KW - anxiety KW - posttraumatic stress disorder KW - United Kingdom KW - Arabic-speaking N2 - Background: The war in Syria has displaced over 6.8 million people, more than any other conflict since the Second World War. As a result, Syrian asylum seekers and refugees have experienced several life-changing events, resulting in high rates of anxiety, depression, posttraumatic stress disorder, and suicidal ideation (SI). To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI developed for general populations was culturally adapted for and with Syrian asylum seekers and refugees in the United Kingdom. The study revealed the importance of understanding their lived experience with migration and the acculturative process in providing treatment for SI. This study will now assess the feasibility and acceptability of the culturally adapted intervention for this population. Objective: The first phase of the study will include recruiting participants and delivering the web-based intervention (1) to assess the feasibility of meeting recruitment goals and recruitment rates and (2) to assess the feasibility of outcome measures. The second phase of the study will include one-to-one semistructured interviews (1) to assess the suitability of the culturally adapted intervention in terms of recruitment and adherence rates and barriers and facilitators to engagement and (2) to assess the acceptability of the intervention in terms of its cultural relevance and appropriateness. Methods: This is a protocol for a single-group, noncontrolled, mixed methods feasibility and acceptability study of a culturally adapted web-based intervention to reduce SI for Syrian asylum seekers and refugees in the United Kingdom. The study will assess the feasibility of recruitment goals, recruitment rates, adherence rates, and outcome measures using individual participant tracking forms, which will be analyzed quantitatively. The suitability and acceptability of the intervention will be assessed using one-to-one semistructured interviews with 12 participants who completed the intervention, which will be analyzed qualitatively. Results: Recruitment began in February 2024 and will run until 30 participants are recruited to the study or until the end of July 2024. Thus far, 19 participants have provided informed consent, 16 were eligible and enrolled, and 12 have completed a postintervention interview. No data have been analyzed. The study, including the write-up period, is expected to end in December 2024. Conclusions: Despite experiencing several stressors related to forced displacement and high rates of mental health issues, access to treatment is still limited for Syrian asylum seekers and refugees in the United Kingdom. To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI was culturally adapted in collaboration with Syrian asylum seekers and refugees in the United Kingdom. This study will now assess the feasibility and acceptability of the intervention and culturally appropriate recruitment strategies. Trial Registration: ISRCTN ISRCTN11417025; https://www.isrctn.com/ISRCTN11417025 International Registered Report Identifier (IRRID): PRR1-10.2196/56957 UR - https://www.researchprotocols.org/2024/1/e56957 UR - http://dx.doi.org/10.2196/56957 UR - http://www.ncbi.nlm.nih.gov/pubmed/39222345 ID - info:doi/10.2196/56957 ER - TY - JOUR AU - Pradhan, Apoorva AU - Wright, A. Eric AU - Hayduk, A. Vanessa AU - Berhane, Juliana AU - Sponenberg, Mallory AU - Webster, Leeann AU - Anderson, Hannah AU - Park, Siyeon AU - Graham, Jove AU - Friedenberg, Scott PY - 2024/8/29 TI - Impact of an Electronic Health Record?Based Interruptive Alert Among Patients With Headaches Seen in Primary Care: Cluster Randomized Controlled Trial JO - JMIR Med Inform SP - e58456 VL - 12 KW - headache management KW - migraine management KW - electronic health record?based alerts KW - primary care KW - clinician decision support tools KW - electronic health record KW - EHR N2 - Background: Headaches, including migraines, are one of the most common causes of disability and account for nearly 20%?30% of referrals from primary care to neurology. In primary care, electronic health record?based alerts offer a mechanism to influence health care provider behaviors, manage neurology referrals, and optimize headache care. Objective: This project aimed to evaluate the impact of an electronic alert implemented in primary care on patients? overall headache management. Methods: We conducted a stratified cluster-randomized study across 38 primary care clinic sites between December 2021 to December 2022 at a large integrated health care delivery system in the United States. Clinics were stratified into 6 blocks based on region and patient-to?health care provider ratios and then 1:1 randomized within each block into either the control or intervention. Health care providers practicing at intervention clinics received an interruptive alert in the electronic health record. The primary end point was a change in headache burden, measured using the Headache Impact Test 6 scale, from baseline to 6 months. Secondary outcomes included changes in headache frequency and intensity, access to care, and resource use. We analyzed the difference-in-differences between the arms at follow-up at the individual patient level. Results: We enrolled 203 adult patients with a confirmed headache diagnosis. At baseline, the average Headache Impact Test 6 scores in each arm were not significantly different (intervention: mean 63, SD 6.9; control: mean 61.8, SD 6.6; P=.21). We observed a significant reduction in the headache burden only in the intervention arm at follow-up (3.5 points; P=.009). The reduction in the headache burden was not statistically different between groups (difference-in-differences estimate ?1.89, 95% CI ?5 to 1.31; P=.25). Similarly, secondary outcomes were not significantly different between groups. Only 11.32% (303/2677) of alerts were acted upon. Conclusions: The use of an interruptive electronic alert did not significantly improve headache outcomes. Low use of alerts by health care providers prompts future alterations of the alert and exploration of alternative approaches. Trial Registration: ClinicalTrials.gov NCT05067725; https://clinicaltrials.gov/study/NCT05067725 UR - https://medinform.jmir.org/2024/1/e58456 UR - http://dx.doi.org/10.2196/58456 ID - info:doi/10.2196/58456 ER - TY - JOUR AU - Goeldner, Moritz AU - Gehder, Sara PY - 2024/8/29 TI - Digital Health Applications (DiGAs) on a Fast Track: Insights From a Data-Driven Analysis of Prescribable Digital Therapeutics in Germany From 2020 to Mid-2024 JO - J Med Internet Res SP - e59013 VL - 26 KW - digital health application KW - DiGA KW - data-driven analysis KW - clinical evidence KW - health economics KW - positive care effect KW - medical benefit KW - patient-relevant structural and procedural improvements KW - pSVV KW - digital health care act N2 - Background: This study aimed to analyze the rapidly evolving ecosystem of digital health applications (Digitale Gesundheitsanwendung; DiGAs) in Germany, spurred by the 2019 Digital Healthcare Act. With over 73 million people in Germany now having access to DiGAs, these prescribable digital health apps and web-based applications represent a substantial stride in health care modernization, supporting both patients and health care providers with digital solutions for disease management and care improvement. Objective: Through a data-driven approach, this research aimed to unpack the complexities of DiGA market dynamics, economic factors, and clinical evidence, offering insights into their impact over the past years. Methods: The analysis draws from a range of public data sources, including the DiGA directory, statutory health insurance reports, app store feedback, and clinical study results. Results: As of July 1, 2024, there are 56 DiGAs listed by the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte), divided into 35 permanently and 21 preliminarily listed applications. Our findings reveal that a majority of DiGAs extend beyond the intended 1-year period to achieve permanent listing, reflecting the extensive effort required to demonstrate clinical efficacy. Economic analysis uncovered a dynamic pricing landscape, with initial prices ranging from approximately ?200 to ?700 (?1=US $1.07), averaging at a median of ?514 for a 3-month DiGA prescription. Following negotiations or arbitration board decisions, prices typically see a 50% reduction, settling at a median of ?221. Prescription data offer valuable insights into DiGA acceptance, with total prescriptions jumping from around 41,000 in the first period to 209,000 in the latest reporting period. The analysis of the top 15 DiGAs, representing 82% of the total prescriptions, shows that these best-performing apps receive from a minimum of 8 to a maximum of 77 daily prescriptions, with native apps and early market entrants achieving higher rates. Clinical evidence from all 35 permanently listed DiGAs indicates a uniform preference for randomized controlled trials to validate primary end points, with no noteworthy use of alternative study designs encouraged in the Digital Healthcare Act and related regulations. Moreover, all evaluated DiGAs focused on medical benefits, with health status improvement as a key end point, suggesting an underuse of patient-relevant structural and procedural improvement in demonstrating health care impact. Conclusions: This study highlights the growth and challenges within the DiGA sector, suggesting areas for future research, such as the exploration of new study designs and the potential impact of patient-relevant structural and procedural improvements. For DiGA manufacturers, the strategic advantage of early market entry is emphasized. Overall, this paper underscores the evolving landscape of digital health, advocating for a nuanced understanding of digital health technology integration in Germany and beyond. UR - https://www.jmir.org/2024/1/e59013 UR - http://dx.doi.org/10.2196/59013 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59013 ER - TY - JOUR AU - Osman, Sagda AU - Churruca, Kate AU - Ellis, A. Louise AU - Luo, Dan AU - Braithwaite, Jeffrey PY - 2024/8/27 TI - The Unintended Consequences of Telehealth in Australia: Critical Interpretive Synthesis JO - J Med Internet Res SP - e57848 VL - 26 KW - telehealth KW - telemedicine KW - unintended consequences KW - digital health KW - eHealth KW - critical interpretive synthesis KW - review methodology KW - literature review KW - Australia N2 - Background: Despite more than 2 decades of telehealth use in Australia and the rapid uptake during the COVID-19 pandemic, little is known about its unintended consequences beyond its planned and intended outcomes. Objective: The aim of this review was to synthesize evidence on the unintended consequences of telehealth use in Australia to clarify its impact beyond its planned and intended outcomes. Methods: We conducted a search of 4 electronic databases: Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, and Scopus. A critical interpretive synthesis approach was adopted for its flexibility and interpretive nature. We extracted data about study characteristics and the types and models of telehealth services. The extracted unintended consequences were coded and mapped into the domains and dimensions of the Australian Health Performance Framework. Results: Of the 4241 records identified by the search, 94 (2.22%) studies were eligible for data extraction and analysis. Of these 94 studies, 23 (24%) reported largely positive unintended consequences of telehealth associated with health status, while 6 (6%) noted a potential negative impact of telehealth on socioeconomic status. The findings of 4 (4%) of the 94 studies highlighted societal and financial consequences of telehealth beyond the health system. Almost all studies (93/94, 99%) reported unintended consequences under the 5 dimensions of the Australian Health Performance Framework. Conclusions: Our synthesis offers a framework for understanding the unintended consequences of the use of telehealth as an alternative to in-person care in Australia. While we have documented many unintended benefits of telehealth use, our findings also shed light on many challenges of delivering care via telehealth across different domains and dimensions. These findings hold significant practice and policy-making implications for ensuring safe and high-quality care delivery via telehealth. UR - https://www.jmir.org/2024/1/e57848 UR - http://dx.doi.org/10.2196/57848 UR - http://www.ncbi.nlm.nih.gov/pubmed/39190446 ID - info:doi/10.2196/57848 ER - TY - JOUR AU - Franzoi, Alice Maria AU - Pages, Arnaud AU - Papageorgiou, Loula AU - Di Meglio, Antonio AU - Laparra, Ariane AU - Martin, Elise AU - Barbier, Aude AU - Renvoise, Nathalie AU - Arvis, Johanna AU - Scotte, Florian AU - Vaz-Luis, Ines PY - 2024/8/26 TI - Evaluating the Implementation of Integrated Proactive Supportive Care Pathways in Oncology: Master Protocol for a Cohort Study JO - JMIR Res Protoc SP - e52841 VL - 13 KW - care delivery KW - pathway of care KW - oncology KW - supportive care KW - quality of life KW - cohort study N2 - Background: Supportive care (SC) refers to the prevention and management of complications of cancer and its treatment. While it has long been recognized as an important cancer care delivery component, a high proportion of patients face unaddressed SC needs, calling for innovative approaches to deliver SC. Objective: The objective of this master protocol is to evaluate the implementation of different integrated proactive SC pathways across the cancer care continuum in our institution (Gustave Roussy, Villejuif, France). Pathways studied in this master protocol may occur shortly after diagnosis to prevent treatment-related burden; during treatment to monitor the onset of toxicities and provide timely symptom management; and after treatment to improve rehabilitation, self-management skills, and social reintegration. Methods: This study is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. The primary objective is to evaluate the impact of SC pathways on patients? distress and unmet needs after 12 weeks, measured by the National Comprehensive Cancer Network?s Distress Thermometer and Problem List. Secondary objectives will focus on the pathways (macrolevel) and each SC intervention (microlevel), evaluating their reach (administrative data review of the absolute number and proportion of clinical and sociodemographic characteristics of patients included in the pathways); short-term and long-term efficacy through their impact on quality of life (EQ-5D-5L and the 30-item European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire) and symptom burden (MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and 22-item European Organization for Research and Treatment of Cancer Sexual Health Questionnaire); adoption by patients and providers (administrative data review of SC referrals and attendance or use of SC strategies); barriers to and leverage for implementation (surveys and focus groups with patients, providers, and the hospital organization); and maintenance (cost-consequence analysis). Pilot evaluations with a minimum of 70 patients per pathway will be performed to generate mean Distress Thermometer scores and SDs informing the calculation of formal sample size needed for efficacy evaluation (cohorts will be enriched accordingly). Results: The study was approved by the ethics committee, and as of February 2024, a total of 12 patients were enrolled. Conclusions: This study will contribute toward innovative models of SC delivery and will inform the implementation of integrated SC pathways of care. Trial Registration: ClinicalTrials.gov NCT06479057; https://clinicaltrials.gov/study/NCT06479057 International Registered Report Identifier (IRRID): PRR1-10.2196/52841 UR - https://www.researchprotocols.org/2024/1/e52841 UR - http://dx.doi.org/10.2196/52841 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52841 ER - TY - JOUR AU - Funer, Florian AU - Schneider, Diana AU - Heyen, B. Nils AU - Aichinger, Heike AU - Klausen, Diana Andrea AU - Tinnemeyer, Sara AU - Liedtke, Wenke AU - Salloch, Sabine AU - Bratan, Tanja PY - 2024/8/23 TI - Impacts of Clinical Decision Support Systems on the Relationship, Communication, and Shared Decision-Making Between Health Care Professionals and Patients: Multistakeholder Interview Study JO - J Med Internet Res SP - e55717 VL - 26 KW - clinical decision support system KW - CDSS KW - health care professionals KW - patients KW - relationships KW - communication KW - shared decision-making KW - Germany N2 - Background: Clinical decision support systems (CDSSs) are increasingly being introduced into various domains of health care. Little is known so far about the impact of such systems on the health care professional?patient relationship, and there is a lack of agreement about whether and how patients should be informed about the use of CDSSs. Objective: This study aims to explore, in an empirically informed manner, the potential implications for the health care professional?patient relationship and to underline the importance of this relationship when using CDSSs for both patients and future professionals. Methods: Using a methodological triangulation, 15 medical students and 12 trainee nurses were interviewed in semistructured interviews and 18 patients were involved in focus groups between April 2021 and April 2022. All participants came from Germany. Three examples of CDSSs covering different areas of health care (ie, surgery, nephrology, and intensive home care) were used as stimuli in the study to identify similarities and differences regarding the use of CDSSs in different fields of application. The interview and focus group transcripts were analyzed using a structured qualitative content analysis. Results: From the interviews and focus groups analyzed, three topics were identified that interdependently address the interactions between patients and health care professionals: (1) CDSSs and their impact on the roles of and requirements for health care professionals, (2) CDSSs and their impact on the relationship between health care professionals and patients (including communication requirements for shared decision-making), and (3) stakeholders? expectations for patient education and information about CDSSs and their use. Conclusions: The results indicate that using CDSSs could restructure established power and decision-making relationships between (future) health care professionals and patients. In addition, respondents expected that the use of CDSSs would involve more communication, so they anticipated an increased time commitment. The results shed new light on the existing discourse by demonstrating that the anticipated impact of CDSSs on the health care professional?patient relationship appears to stem less from the function of a CDSS and more from its integration in the relationship. Therefore, the anticipated effects on the relationship between health care professionals and patients could be specifically addressed in patient information about the use of CDSSs. UR - https://www.jmir.org/2024/1/e55717 UR - http://dx.doi.org/10.2196/55717 UR - http://www.ncbi.nlm.nih.gov/pubmed/39178023 ID - info:doi/10.2196/55717 ER - TY - JOUR AU - Fealy, Shanna AU - McLaren, Suzanne AU - Seaman, Ellen Claire AU - Nott, Melissa AU - Jones, Donovan AU - Irwin, Pauletta AU - Logan, Patricia AU - Rossiter, Rachel AU - McDonald, Simon PY - 2024/8/23 TI - Exploring the Sociodemographic and Health-Related Determinants of Telehealth Use Among a Cohort of Older Australians During the COVID-19 Pandemic: Repeated Cross-Sectional Study JO - JMIR Aging SP - e58594 VL - 7 KW - telehealth KW - telemedicine KW - aging KW - older people KW - COVID-19 KW - Australia KW - 45 and Up Study KW - health-related determinates KW - Technology Acceptance Model KW - mobile phone N2 - Background: During the COVID-19 pandemic, there was a rapid adoption of telehealth care services as a public health strategy to maintain access to essential health care. In Australia, there has been increasing optimism for the expansion of telehealth services. However, little is known about the patterns and determinants of telehealth adoption among older adults, with concerns that an expansion of telehealth services may only be of benefit to those who already have better access to health care. Objective: Leveraging data collected by The Sax Institute?s 45 and Up COVID Insights study between November 2020 and April 2022, the objective of this study was to identify and describe the sociodemographic and health-related determinants of telehealth adoption and use among a cohort of older Australians. We hypothesized that health-related factors would be key determinants of telehealth adoption for Australians aged ?65 years during the COVID-19 pandemic. Methods: A repeated cross-sectional design was used. The relationships between telehealth use (classified as low, moderate, or high) and selected sociodemographic and health-related characteristics were assessed using logistic regression techniques. Variable selection and findings were situated within the Technology Acceptance Model, the Unified Theory of Acceptance, and the Use of Technology theoretical frameworks. Results: Of the 21,830 participants aged ?65 years, the proportion who indicated adopting telehealth ranged from 50.77% (11,082/21,830) at survey 1 in 2020 to 39.4% (7401/18,782) at survey 5 in 2022. High levels of telehealth use were associated with being female, aged <85 years, living in a major city, cohabiting with others, and being from the most socioeconomically disadvantaged areas (deciles 1-3). Individuals with a disability, chronic disease, multimorbidity, and lower perceived quality of life and those experiencing missed or delayed care were significantly more likely to use telehealth across all levels (P<.001). A temporal association was observed, whereby participants who engaged with telehealth services before or early in the pandemic (as assessed in survey 1) were more likely to continue telehealth use when assessed in survey 5 in 2022 (P<.001). Conclusions: This research contributes to the broader understanding of telehealth adoption and use among older adults. As telehealth models of care expand, there is an opportunity to tailor these services to the needs of older adults, particularly those living with chronic diseases and multimorbidity, by using targeted strategies that overcome barriers to accessing specialized health care services. UR - https://aging.jmir.org/2024/1/e58594 UR - http://dx.doi.org/10.2196/58594 UR - http://www.ncbi.nlm.nih.gov/pubmed/39178035 ID - info:doi/10.2196/58594 ER - TY - JOUR AU - Muehlensiepen, Felix AU - Petit, Pascal AU - Knitza, Johannes AU - Welcker, Martin AU - Vuillerme, Nicolas PY - 2024/8/19 TI - Identification of Motivational Determinants for Telemedicine Use Among Patients With Rheumatoid Arthritis in Germany: Secondary Analysis of Data From a Nationwide Cross-Sectional Survey Study JO - J Med Internet Res SP - e47733 VL - 26 KW - telemedicine KW - rheumatoid arthritis KW - rheumatology KW - primary care KW - health services research KW - eHealth KW - data analysis KW - survey KW - Germany KW - tool KW - care KW - willingness KW - sociodemographic KW - age KW - telehealth KW - digital transition N2 - Background: Previous studies have demonstrated telemedicine to be an effective tool to complement rheumatology care and address workforce shortage. With the COVID-19 outbreak, telemedicine experienced a massive upswing. An earlier analysis revealed that the motivation of patients with rheumatic and musculoskeletal diseases to use telemedicine is closely connected to their disease. It remains unclear which factors are associated with patients? motivation to use telemedicine in certain rheumatic and musculoskeletal diseases groups, such as rheumatoid arthritis (RA). Objective: This study aims to identify factors that determine the willingness to try telemedicine among patients diagnosed with RA. Methods: We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with RA. Bayesian univariate logistic regression analysis was applied to the data to determine which factors were associated with willingness to try telemedicine. Predictor variables (covariates) studied individually included sociodemographic factors (eg, age, sex) and health characteristics (eg, health status). All the variables positively and negatively associated with willingness to try telemedicine in the univariate analyses were then considered for Bayesian model averaging analysis after a selection based on the variance inflation factor (? 2.5) to identify determinants of willingness to try telemedicine. Results: Among 438 surveyed patients in the initial study, 210 were diagnosed with RA (47.9%). Among them, 146 (69.5%) answered either yes or no regarding willingness to try telemedicine and were included in the analysis. A total of 22 variables (22/55, 40%) were associated with willingness to try telemedicine (region of practical equivalence %?5). A total of 9 determinant factors were identified using Bayesian model averaging analysis. Positive determinants included desiring telemedicine services provided by a rheumatologist (odds ratio [OR] 13.7, 95% CI 5.55-38.3), having prior knowledge of telemedicine (OR 2.91, 95% CI 1.46-6.28), residing in a town (OR 2.91, 95% CI 1.21-7.79) or city (OR 0.56, 95% CI 0.23-1.27), and perceiving one?s health status as moderate (OR 1.87, 95% CI 0.94-3.63). Negative determinants included the lack of an electronic device (OR 0.1, 95% CI 0.01-0.62), absence of home internet access (OR 0.1, 95% CI 0.02-0.39), self-assessment of health status as bad (OR 0.44, 95% CI 0.21-0.89) or very bad (OR 0.47, 95% CI 0.06-2.06), and being aged between 60 and 69 years (OR 0.48, 95% CI 0.22-1.04) or older than 70 years (OR 0.38, 95% CI 0.16-0.85). Conclusions: The results suggest that some patients with RA will not have access to telemedicine without further support. Older patients, those not living in towns, those without adequate internet access, reporting a bad health status, and those not owning electronic devices might be excluded from the digital transformation in rheumatology and might not have access to adequate RA care. These patient groups certainly require support for the use of digital rheumatology care. UR - https://www.jmir.org/2024/1/e47733 UR - http://dx.doi.org/10.2196/47733 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47733 ER - TY - JOUR AU - Choucair, Kareem AU - Corrigan, Mark AU - O'Sullivan, Adrian AU - Barber, Sean AU - Stankiewicz, Lucja AU - Henn, Patrick AU - Dennehy, Oscar AU - Kayyal, Yasser Mohd AU - Tan, Yu Yong AU - Fadahunsi, Philip Kayode AU - O'Donoghue, John PY - 2024/8/19 TI - Acceptability, Perceptions, and Experiences Regarding Electronic Patient-Reported Outcomes After Laparoscopic Cholecystectomy: Protocol for a Mixed Methods Feasibility Study JO - JMIR Res Protoc SP - e57344 VL - 13 KW - patient-reported outcomes KW - digital technology KW - hepatobiliary surgery KW - surgery KW - laparoscopic cholecystectomy KW - electronic patient KW - general surgeon KW - mixed methods KW - prospective study KW - quantitative KW - qualitative KW - Qualtrics KW - interview KW - Microsoft Teams KW - data collection KW - patient care KW - patient-centric KW - patient-doctor communication KW - eHealth N2 - Background: Patient-reported outcomes (PROs) can be defined as any report of a patient?s health taken directly from the patient. Routine collection of PRO data has been shown to offer potential benefits to patient-doctor communication. Electronic forms of PRO measures (PROMs) could be more beneficial in comparison to traditional PROMs in obtaining PROs from patients. However, it is currently unclear whether the routine collection of electronic PRO data could result in better outcomes for patients undergoing laparoscopic cholecystectomy (LC). Objective: This study aims to explore the perspectives of patients and surgeons on the use of electronic PROMs. Based on prior research, technical skill and experience level of the surgeon, long-term quality of life, patient involvement in decision-making, communication skills of the surgeon, cleanliness of the ward environment, and standards of nursing care are identified to be the most important factors for the patients. Methods: This is a mixed methods prospective study that will collect both quantitative (survey) and qualitative (interview) data. The study has two components. The first involves the distribution of an electronic presurvey to patients who received elective LC within 48 hours of their surgery (n=80). This survey will explore the perspective of patients regarding the procedure, hospital experience, long-term outcomes, and the perceived value of using PROMs. These patients will then be followed up after 1 year and given another survey. The second component involves the distribution of the same survey and the completion of structured interviews with general surgeons (n=10). The survey will ascertain what PROs from the participants are most useful for the surgeons and the interviews will focus on how the surgeons view routine PRO collection. A convenience sampling approach will be used. Surveys will be distributed through Qualtrics and interviews will be completed on Microsoft Teams. Results: Data collection began on February 14, 2023. As of February 12, 2024, 71 of 80 recruited patients have been given the presurvey. The follow-up with the patients and the general surgeon components of the study have not begun. The expected completion date of this study is in April 2025. Conclusions: Overall, this study will investigate the potential of electronic PRO collection to offer value for patients and general surgeons. This approach will ensure that patient care is investigated in a multifaceted way, offering patient-centric guidance to surgeons in their approach to care. International Registered Report Identifier (IRRID): DERR1-10.2196/57344 UR - https://www.researchprotocols.org/2024/1/e57344 UR - http://dx.doi.org/10.2196/57344 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57344 ER - TY - JOUR AU - Bradshaw, Andy AU - Birtwistle, Jacqueline AU - Evans, J. Catherine AU - Sleeman, E. Katherine AU - Richards, Suzanne AU - Foy, Robbie AU - Millares Martin, Pablo AU - Carder, Paul AU - Allsop, J. Matthew AU - Twiddy, Maureen PY - 2024/8/16 TI - Factors Influencing the Implementation of Digital Advance Care Planning: Qualitative Interview Study JO - J Med Internet Res SP - e50217 VL - 26 KW - palliative care KW - electronic palliative care coordination systems KW - electronic health record systems KW - advance care planning KW - end of life care KW - technology KW - Normalization Process Theory KW - NPT KW - qualitative N2 - Background: Palliative care aims to improve the quality of life for people with life-limiting illnesses. Advance care planning conversations that establish a patient?s wishes and preferences for care are part of a person-centered approach. Internationally, electronic health record systems are digital interventions used to record and share patients? advance care plans across health care services and settings. They aim to provide tools that support electronic information sharing and care coordination. Within the United Kingdom, Electronic Palliative Care Coordination Systems (EPaCCS) are an example of this. Despite over a decade of policy promoting EPaCCS nationally, there has been limited implementation and consistently low levels of use by health professionals. Objective: The aim of this study is to explore the factors that influence the implementation of EPaCCS into routine clinical practice across different care services and settings in 2 major regions of England. Methods: A qualitative interview study design was used, guided by Normalization Process Theory (NPT). NPT explores factors affecting the implementation of complex interventions and consists of 4 primary components (coherence, cognitive participation, collective action, and reflexive monitoring). Health care and social care practitioners were purposively sampled based on their professional role and work setting. Individual web-based semistructured interviews were conducted. Data were analyzed using thematic framework analysis to explore issues which affected the implementation of EPaCCS across different settings at individual, team, organizational, and technical levels. Results: Participants (N=52) representing a range of professional roles were recruited across 6 care settings (hospice, primary care, care home, hospital, ambulatory, and community). In total, 6 themes were developed which mapped onto the 4 primary components of NPT and represented the multilevel influences affecting implementation. At an individual level, these included (1) EPaCCS providing a clear and distinct way of working and (2) collective contributions and buy-in. At a team and organizational level, these included (3) embedding EPaCCS into everyday practice and (4) championing driving implementation. At a technical level, these included (5) electronic functionality, interoperability, and access. Breakdowns in implementation at different levels led to variations in (6) confidence and trust in EPaCCS in terms of record accuracy and availability of access. Conclusions: EPaCCS implementation is influenced by individual, organizational, and technical factors. Key challenges include problems with access alongside inconsistent use and engagement across care settings. EPaCCS, in their current format as digital advance care planning systems are not consistently facilitating electronic information sharing and care coordination. A redesign of EPaCCS is likely to be necessary to determine configurations for their optimal implementation across different settings and locations. This includes supporting health care practitioners to document, access, use, and share information across multiple care settings. Lessons learned are relevant to other forms of digital advance care planning approaches being developed internationally. UR - https://www.jmir.org/2024/1/e50217 UR - http://dx.doi.org/10.2196/50217 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50217 ER - TY - JOUR AU - Zheng, Yingbin AU - Cai, Yunping AU - Yan, Yiwei AU - Chen, Sai AU - Gong, Kai PY - 2024/8/15 TI - Novel Approach to Personalized Physician Recommendations Using Semantic Features and Response Metrics: Model Evaluation Study JO - JMIR Hum Factors SP - e57670 VL - 11 KW - web-based medical service KW - text analysis KW - Sentence Bidirectional Encoder Representations From Transformers KW - SBERT KW - smart triage systems KW - patient-physician hybrid recommendation KW - PPHR KW - PPHR model N2 - Background: The rapid growth of web-based medical services has highlighted the significance of smart triage systems in helping patients find the most appropriate physicians. However, traditional triage methods often rely on department recommendations and are insufficient to accurately match patients? textual questions with physicians? specialties. Therefore, there is an urgent need to develop algorithms for recommending physicians. Objective: This study aims to develop and validate a patient-physician hybrid recommendation (PPHR) model with response metrics for better triage performance. Methods: A total of 646,383 web-based medical consultation records from the Internet Hospital of the First Affiliated Hospital of Xiamen University were collected. Semantic features representing patients and physicians were developed to identify the set of most similar questions and semantically expand the pool of recommended physician candidates, respectively. The physicians? response rate feature was designed to improve candidate rankings. These 3 characteristics combine to create the PPHR model. Overall, 5 physicians participated in the evaluation of the efficiency of the PPHR model through multiple metrics and questionnaires as well as the performance of Sentence Bidirectional Encoder Representations from Transformers and Doc2Vec in text embedding. Results: The PPHR model reaches the best recommendation performance when the number of recommended physicians is 14. At this point, the model has an F1-score of 76.25%, a proportion of high-quality services of 41.05%, and a rating of 3.90. After removing physicians? characteristics and response rates from the PPHR model, the F1-score decreased by 12.05%, the proportion of high-quality services fell by 10.87%, the average hit ratio dropped by 1.06%, and the rating declined by 11.43%. According to whether those 5 physicians were recommended by the PPHR model, Sentence Bidirectional Encoder Representations from Transformers achieved an average hit ratio of 88.6%, while Doc2Vec achieved an average hit ratio of 53.4%. Conclusions: The PPHR model uses semantic features and response metrics to enable patients to accurately find the physician who best suits their needs. UR - https://humanfactors.jmir.org/2024/1/e57670 UR - http://dx.doi.org/10.2196/57670 UR - http://www.ncbi.nlm.nih.gov/pubmed/39146009 ID - info:doi/10.2196/57670 ER - TY - JOUR AU - Perrin, B. Paul AU - Haun, N. Jolie AU - Klyce, W. Daniel AU - Melillo, Christine AU - Nakase-Richardson, Risa AU - Seel, T. Ronald AU - Martindale-Adams, Jennifer AU - Nichols, O. Linda AU - Perera, A. Robert AU - Xia, Bridget AU - Hahm, Bridget AU - Zuber, Jeffrey PY - 2024/8/15 TI - Efficacy and Implementation Planning Across the Veterans Affairs Polytrauma System of Care: Protocol for the REACH Intervention for Caregivers of Veterans and Service Members With Traumatic Brain Injury JO - JMIR Res Protoc SP - e57692 VL - 13 KW - traumatic brain injury KW - telehealth KW - caregiver KW - methodology KW - veterans KW - service members N2 - Background: The responsibility of care for Veterans and Service Members (V/SMs) with traumatic brain injury (TBI) often defaults to informal family caregivers. Caregiving demands considerable knowledge, skill, and support to facilitate the health and well-being of V/SMs and themselves. Persistent and common TBI caregiver issues include strain, depression, and anxiety. While evidence-based, brief interventions have been developed and implemented for family caregivers in Veteran neurodegenerative populations, few interventions have been developed, adapted, or tested to support the unique needs of caregivers of V/SMs with TBI. Objective: This study will adapt and test an evidence-based, personalized, 6-session telehealth caregiver intervention, ?Resources for Enhancing All Caregivers? Health? (REACH), to meet the unique needs of caregivers of V/SMs with TBI. If successful, a community-based participatory research team will develop an implementation plan to roll out REACH TBI across the national Veterans Affairs Polytrauma System of Care. Methods: This mixed methods, crossover waitlist control clinical trial will use a Type 1 Hybrid Effectiveness-Implementation approach to adapt and then test the effects of REACH TBI on key TBI caregiver outcomes. Results: This study was funded by the Department of Defense in September 2023. Participant enrollment and data collection will begin in 2024. Conclusions: If effective, REACH TBI will be the first evidence-based intervention for caregivers of V/SMs with TBI that can be scaled to implement across the Veterans Affairs Polytrauma System of Care and fill a notable gap in clinical services. International Registered Report Identifier (IRRID): PRR1-10.2196/57692 UR - https://www.researchprotocols.org/2024/1/e57692 UR - http://dx.doi.org/10.2196/57692 UR - http://www.ncbi.nlm.nih.gov/pubmed/39145996 ID - info:doi/10.2196/57692 ER - TY - JOUR AU - Wu, XiuLi AU - Kang, Aimei PY - 2024/8/14 TI - Demand Forecasting of Nurse Talents in China Based on the Gray GM (1,1) Model: Model Development Study JO - Asian Pac Isl Nurs J SP - e59484 VL - 8 KW - nursing human resource KW - nursing manpower KW - Gray GM (1,1) model KW - forecasting KW - nursing N2 - Background: In a global context, the shortage of nursing personnel has emerged as a significant challenge, particularly in countries such as China experiencing population aging. The inadequacy of nursing human resources has become one of the primary threats affecting the quality of health services available to Chinese residents. Therefore, forecasting the demand for nursing personnel has become an important issue. Objective: This study presents a Gray GM (1,1) forecasting model for predicting the future 10-year demand for nursing workforce and the number of specialized geriatric nurses, aiming to provide a scientific basis for the development of policies in health care institutions in China. Methods: Based on data from the China Statistical Yearbook 2022, the Gray GM (1,1) model was used to predict the demand for nursing jobs and geriatric nurses over the next 10 years (2024-2033). Results: The results indicate that from 2024 to 2033, amidst a continuous growth in the overall population and an increasingly pronounced trend of population aging, the demand for nursing workforce in China, especially for specialized geriatric nurses, is projected to steadily increase. Conclusions: The paper provides a reference basis for the establishment of China?s health care workforce system and the involvement of government departments in health care workforce planning. UR - https://apinj.jmir.org/2024/1/e59484 UR - http://dx.doi.org/10.2196/59484 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59484 ER - TY - JOUR AU - Sriharan, Abi AU - Sekercioglu, Nigar AU - Mitchell, Cheryl AU - Senkaiahliyan, Senthujan AU - Hertelendy, Attila AU - Porter, Tracy AU - Banaszak-Holl, Jane PY - 2024/8/14 TI - Leadership for AI Transformation in Health Care Organization: Scoping Review JO - J Med Internet Res SP - e54556 VL - 26 KW - AI implementation KW - innovation KW - health care KW - leadership KW - AI KW - artificial intelligence KW - management KW - organization KW - health care organization KW - strategy N2 - Background: The leaders of health care organizations are grappling with rising expenses and surging demands for health services. In response, they are increasingly embracing artificial intelligence (AI) technologies to improve patient care delivery, alleviate operational burdens, and efficiently improve health care safety and quality. Objective: In this paper, we map the current literature and synthesize insights on the role of leadership in driving AI transformation within health care organizations. Methods: We conducted a comprehensive search across several databases, including MEDLINE (via Ovid), PsycINFO (via Ovid), CINAHL (via EBSCO), Business Source Premier (via EBSCO), and Canadian Business & Current Affairs (via ProQuest), spanning articles published from 2015 to June 2023 discussing AI transformation within the health care sector. Specifically, we focused on empirical studies with a particular emphasis on leadership. We used an inductive, thematic analysis approach to qualitatively map the evidence. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines. Results: A comprehensive review of 2813 unique abstracts led to the retrieval of 97 full-text articles, with 22 included for detailed assessment. Our literature mapping reveals that successful AI integration within healthcare organizations requires leadership engagement across technological, strategic, operational, and organizational domains. Leaders must demonstrate a blend of technical expertise, adaptive strategies, and strong interpersonal skills to navigate the dynamic healthcare landscape shaped by complex regulatory, technological, and organizational factors. Conclusions: In conclusion, leading AI transformation in healthcare requires a multidimensional approach, with leadership across technological, strategic, operational, and organizational domains. Organizations should implement a comprehensive leadership development strategy, including targeted training and cross-functional collaboration, to equip leaders with the skills needed for AI integration. Additionally, when upskilling or recruiting AI talent, priority should be given to individuals with a strong mix of technical expertise, adaptive capacity, and interpersonal acumen, enabling them to navigate the unique complexities of the healthcare environment. UR - https://www.jmir.org/2024/1/e54556 UR - http://dx.doi.org/10.2196/54556 UR - http://www.ncbi.nlm.nih.gov/pubmed/39009038 ID - info:doi/10.2196/54556 ER - TY - JOUR AU - Metsallik, Janek AU - Draheim, Dirk AU - Sabic, Zlatan AU - Novak, Thomas AU - Ross, Peeter PY - 2024/8/8 TI - Assessing Opportunities and Barriers to Improving the Secondary Use of Health Care Data at the National Level: Multicase Study in the Kingdom of Saudi Arabia and Estonia JO - J Med Internet Res SP - e53369 VL - 26 KW - health data governance KW - secondary use KW - health information sharing maturity KW - large-scale interoperability KW - health data stewardship KW - health data custodianship KW - health information purpose KW - health data policy N2 - Background: Digitization shall improve the secondary use of health care data. The Government of the Kingdom of Saudi Arabia ordered a project to compile the National Master Plan for Health Data Analytics, while the Government of Estonia ordered a project to compile the Person-Centered Integrated Hospital Master Plan. Objective: This study aims to map these 2 distinct projects? problems, approaches, and outcomes to find the matching elements for reuse in similar cases. Methods: We assessed both health care systems? abilities for secondary use of health data by exploratory case studies with purposive sampling and data collection via semistructured interviews and documentation review. The collected content was analyzed qualitatively and coded according to a predefined framework. The analytical framework consisted of data purpose, flow, and sharing. The Estonian project used the Health Information Sharing Maturity Model from the Mitre Corporation as an additional analytical framework. The data collection and analysis in the Kingdom of Saudi Arabia took place in 2019 and covered health care facilities, public health institutions, and health care policy. The project in Estonia collected its inputs in 2020 and covered health care facilities, patient engagement, public health institutions, health care financing, health care policy, and health technology innovations. Results: In both cases, the assessments resulted in a set of recommendations focusing on the governance of health care data. In the Kingdom of Saudi Arabia, the health care system consists of multiple isolated sectors, and there is a need for an overarching body coordinating data sets, indicators, and reports at the national level. The National Master Plan of Health Data Analytics proposed a set of organizational agreements for proper stewardship. Despite Estonia?s national Digital Health Platform, the requirements remain uncoordinated between various data consumers. We recommended reconfiguring the stewardship of the national health data to include multipurpose data use into the scope of interoperability standardization. Conclusions: Proper data governance is the key to improving the secondary use of health data at the national level. The data flows from data providers to data consumers shall be coordinated by overarching stewardship structures and supported by interoperable data custodians. UR - https://www.jmir.org/2024/1/e53369 UR - http://dx.doi.org/10.2196/53369 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53369 ER - TY - JOUR AU - Knudsen, Anne-Maj AU - Dalgård Dunvald, Ann-Cathrine AU - Hangaard, Stine AU - Hejlesen, Ole AU - Kronborg, Thomas PY - 2024/8/8 TI - The Effectiveness of Collaborative Care Interventions for the Management of Patients With Multimorbidity: Protocol for a Systematic Review, Meta-Analysis, and Meta-Regression Analysis JO - JMIR Res Protoc SP - e58296 VL - 13 KW - multimorbidity KW - comorbidity KW - multiple chronic conditions KW - patient care team KW - multidisciplinary teams KW - collaborative care KW - quality of life KW - systematic review KW - meta-analysis N2 - Background: Collaborative care interventions have been proposed as a promising strategy to support patients with multimorbidity. Despite this, the effectiveness of collaborative care interventions requires further evaluation. Existing systematic reviews describing the effectiveness of collaborative care interventions in multimorbidity management tend to focus on specific interventions, patient subgroups, and settings. This necessitates a comprehensive review that will provide an overview of the effectiveness of collaborative care interventions for adult patients with multimorbidity. Objective: This systematic review aims to systematically assess the effectiveness of collaborative care interventions in comparison to usual care concerning health-related quality of life (HRQoL), mental health, and mortality among adult patients with multimorbidity. Methods: Randomized controlled trials evaluating collaborative care interventions designed for adult patients (18 years and older) with multimorbidity compared with usual care will be considered for inclusion in this review. HRQoL will be the primary outcome. Mortality and mental health outcomes such as rating scales for anxiety and depression will serve as secondary outcomes. The systematic search will be conducted in the CENTRAL, PubMed, CINAHL, and Embase databases. Additional reference and citation searches will be performed in Google Scholar, Web of Science, and Scopus. Data extraction will be comprehensive and include information about participant characteristics, study design, intervention details, and main outcomes. Included studies will be assessed for limitations according to the Cochrane Risk of Bias tool. Meta-analysis will be conducted to estimate the pooled effect size. Meta-regression or subgroup analysis will be undertaken to explore if certain factors can explain the variation in effect between studies, if feasible. The certainty of evidence will be evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Results: The preliminary literature search was performed on February 16, 2024, and yielded 5255 unique records. A follow-up search will be performed across all databases before submission. The findings will be presented in forest plots, a summary of findings table, and in narrative format. This systematic review is expected to be completed by late 2024. Conclusions: This review will provide an overview of pooled estimates of treatment effects across HRQoL, mental health, and mortality from randomized controlled trials evaluating collaborative care interventions for adults with multimorbidity. Furthermore, the intention is to clarify the participant, intervention, or study characteristics that may influence the effect of the interventions. This review is expected to provide valuable insights for researchers, clinicians, and other decision-makers about the effectiveness of collaborative care interventions targeting adult patients with multimorbidity. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42024512554; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=512554 International Registered Report Identifier (IRRID): DERR1-10.2196/58296 UR - https://www.researchprotocols.org/2024/1/e58296 UR - http://dx.doi.org/10.2196/58296 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58296 ER - TY - JOUR AU - Erbas, Ege Mert AU - Ziehfreund, Stefanie AU - Wecker, Hannah AU - Biedermann, Tilo AU - Zink, Alexander PY - 2024/8/7 TI - Digital Media Usage Behavior and Its Impact on the Physician-Patient Relationship: Cross-Sectional Study Among Individuals Affected by Psoriasis in Germany JO - J Med Internet Res SP - e57823 VL - 26 KW - psoriasis KW - dermatology KW - digital health KW - digital media KW - internet use KW - questionnaire KW - physician-patient relationship N2 - Background: Psoriasis is a chronic skin disorder with a high burden of disease. People affected with psoriasis increasingly use the internet for health-related reasons, especially those with younger age, higher education, and higher disease severity. Despite advantages such as enhancing the individuals? knowledge with the use of digital media for health-related issues, disadvantages were also present such as quality control, and variability in the individuals? health information literacy. While patients with psoriasis within medical settings generally trust physicians over digital media, they commonly withhold their web-based research findings from health care providers. Objective: The study aims to (1) identify further factors associated with regular psoriasis-related internet use, (2) rank specific digital media platforms used, and (3) examine digital media within the physician-patient relationship among individuals with and without dermatological treatment. Methods: A cross-sectional, questionnaire-based study was conducted among individuals with self-reported psoriasis in Germany between September 2021 and February 2022. Participants were recruited via digital media platforms and in person at a University Hospital Department of Dermatology in southern Germany. The questionnaire asked about demographic and medical information, individual psoriasis-related digital media use, and the impact of digital media on the physician-patient relationship. Data were analyzed descriptively, and logistic regression models were performed to assess the factors associated with regular psoriasis-related internet use. Results: Among 321 individuals with a median age of 53 (IQR 41-61) years (nonnormally distributed; females: 195/321), female sex, shorter disease duration, moderate mental burden of disease, and good self-assessed psoriasis-related knowledge were associated with regular psoriasis-related internet use. Of the 188 participants with a mean age of 51.2 (SD 13.9) years (normally distributed) who used digital media 106 (56.4%) usually searched for information on psoriasis-based websites and 98 (52.1%) on search engines, primarily for obtaining information about the disease and therapy options, while social media were less frequently used (49/188, 26.1%). Nearly two-thirds of internet users (125/188) claimed that their physicians did not recommend digital media platforms. About 44% (82/188) of the individuals reported to seek for additional information due to the insufficient information provided by their physician. Conclusions: This study revealed the importance of digital media in the context of psoriasis, especially among women, individuals with shorter disease duration, and moderate mental disease severity. The lack of physicians? digital media recommendations despite their patients? desire to receive such and being more involved in health-related decisions seems to be a shortcoming within the physician-patient relationships. Physicians should guide their patients on digital media by recommending platforms with evidence-based information, thereby potentially creating an adequate framework for shared decision-making. Future research should focus on strategies to prevent the spread of false information on digital media and address the needs of patients and physicians to enhance health-related digital media offerings. UR - https://www.jmir.org/2024/1/e57823 UR - http://dx.doi.org/10.2196/57823 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57823 ER - TY - JOUR AU - Winder, Rachel AU - Campbell, L. John AU - Akter, Nurunnahar AU - Aminu, Q. Abodunrin AU - Lambert, Jeffrey AU - Cockcroft, Emma AU - Thomas, Chloe AU - Clark, E. Christopher AU - Bryce, Carol AU - Sussex, Jon AU - Atherton, Helen AU - Marriott, Christine AU - Abel, Gary PY - 2024/8/7 TI - Exploring How Patients Are Supported to Use Online Services in Primary Care in England Through ?Digital Facilitation?: Survey Study JO - J Med Internet Res SP - e56528 VL - 26 KW - primary care KW - online services KW - access to online health care services KW - general practice KW - survey KW - digital support KW - inequalities KW - remote consultation KW - health services research KW - digital technology N2 - Background: Health service policy in many jurisdictions is driving greater investment into digital primary care services. While some patients and practices may benefit, there are concerns that not all are able or wish to access primary care services online. ?Digital facilitation? is the ?range of processes, procedures, and personnel seeking to support patients in their uptake and use of online services? and may address such concerns. Objective: As part of a multimethod research program, we undertook surveys of practice staff and patients to gain insight into the support being offered by practices and explore patients? experiences of this support. Methods: General practices from 4 regions of England were sent a questionnaire exploring the modes of digital facilitation offered, the personnel involved in its delivery, and views on the motivations and drivers for providing support. Moreover, 12,822 patients registered with 62 general practices (predominantly those providing practice survey responses) were sent a questionnaire exploring their experiences of any support offered by their practice to use online services. Results: Almost one-third of practices (156/500, 31.2%) responded to the practice survey, with most reporting using passive modes of digital facilitation (eg, display, leaflets, and SMS text messages) and few using active modes (eg, offering tablets or computers or using practice champions). However, 90.9% (130/143) reported providing ad hoc support. Practices agreed that it was the responsibility of both the practice (105/144, 72.9%) and the wider National Health Service (118/143, 82.5%) to support patients in using online services and that providing such support benefited the practice (126/144, 87.5%) and their patients (132/144, 91.7%). Nearly a quarter of the patients (3051/12,822, 23.8%) responded to the patient survey, with few (522/3051, 17.11% or less) reporting awareness of any modes of digital facilitation apart from text messages and emails (1205/3051, 39.5%) and only 13.36% (392/2935) reporting receiving support to use online services. Adjusted logistic regression analyses showed that older patients had a lower likelihood of 4 outcomes: being aware of, or of using, digital facilitation efforts, or being told about or being helped to use online services (all P<.05), particularly with regard to being helped to use online services (adjusted odds ratio for patients aged 85 years versus those aged 55-64 years: 0.08, 95% CI 0.02-0.36). However, ethnic minority participants or those for whom their first language was not English had positive associations with these outcomes. Conclusions: General practices recognize that patients would benefit from support to access online services. However, the support provided is often passive or ad hoc, and patients were seldom aware of digital facilitation efforts that their practice provided. There is potential to increase engagement with online primary care services by providing more support for all patients, particularly to provide targeted support for older patients. UR - https://www.jmir.org/2024/1/e56528 UR - http://dx.doi.org/10.2196/56528 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56528 ER - TY - JOUR AU - Chiang, Byron AU - Law, Wa Yik AU - Yip, Fai Paul Siu PY - 2024/8/7 TI - Using Discrete-Event Simulation to Model Web-Based Crisis Counseling Service Operation: Evaluation Study JO - JMIR Form Res SP - e46823 VL - 8 KW - discrete-event simulation KW - community operational research KW - queuing KW - web-based counseling KW - service management KW - repeat users N2 - Background: According to the Organisation for Economic Co-operation and Development, its member states experienced worsening mental health during the COVID-19 pandemic, leading to an increase of 60% to 1000% in digital counseling access. Hong Kong, too, witnessed a surge in demand for crisis intervention services during the pandemic, attracting both nonrepeat and repeat service users during the process. As a result of the continuing demand, platforms offering short-term emotional support are facing an efficiency challenge in managing caller responses. Objective: This aim of this paper was to assess the queuing performance of a 24-hour text-based web-based crisis counseling platform using a Python-based discrete-event simulation (DES) model. The model evaluates the staff combinations needed to meet demand and informs service priority decisions. It is able to account for unbalanced and overlapping shifts, unequal simultaneous serving capacities among custom worker types, time-dependent user arrivals, and the influence of user type (nonrepeat users vs repeat users) and suicide risk on service durations. Methods: Use and queue statistics by user type and staffing conditions were tabulated from past counseling platform database records. After calculating the data distributions, key parameters were incorporated into the DES model to determine the supply-demand equilibrium and identify potential service bottlenecks. An unobserved-components time-series model was fitted to make 30-day forecasts of the arrival rate, with the results piped back to the DES model to estimate the number of workers needed to staff each work shift, as well as the number of repeat service users encountered during a service operation. Results: The results showed a marked increase (from 3401/9202, 36.96% to 5042/9199, 54.81%) in the overall conversion rate after the strategic deployment of human resources according to the values set in the simulations, with an 85% chance of queuing users receiving counseling service within 10 minutes and releasing an extra 39.57% (3631/9175) capacity to serve nonrepeat users at potential risk. Conclusions: By exploiting scientifically informed data models with DES, nonprofit web-based counseling platforms, even those with limited resources, can optimize service capacity strategically to manage service bottlenecks and increase service uptake. UR - https://formative.jmir.org/2024/1/e46823 UR - http://dx.doi.org/10.2196/46823 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/46823 ER - TY - JOUR AU - Koenig, R. Leah AU - Ko, Jennifer AU - Upadhyay, D. Ushma PY - 2024/8/5 TI - Virtual Clinic Telehealth Abortion Services in the United States One Year After Dobbs: Landscape Review JO - J Med Internet Res SP - e50749 VL - 26 KW - medication abortion KW - telehealth KW - virtual clinics KW - abortion KW - access KW - policy KW - health equity N2 - Background: Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women?s Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021. Objective: This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care. Methods: We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic?s policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits. Results: We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US $259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available. Conclusions: Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available. UR - https://www.jmir.org/2024/1/e50749 UR - http://dx.doi.org/10.2196/50749 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50749 ER - TY - JOUR AU - Hassan, Ayman AU - Benlamri, Rachid AU - Diner, Trina AU - Cristofaro, Keli AU - Dillistone, Lucas AU - Khallouki, Hajar AU - Ahghari, Mahvareh AU - Littlefield, Shalyn AU - Siddiqui, Rabail AU - MacDonald, Russell AU - Savage, W. David PY - 2024/8/1 TI - An App for Navigating Patient Transportation and Acute Stroke Care in Northwestern Ontario Using Machine Learning: Retrospective Study JO - JMIR Form Res SP - e54009 VL - 8 KW - stroke care KW - acute stroke KW - northwestern KW - Ontario KW - prediction KW - models KW - machine learning KW - stroke KW - cardiovascular KW - brain KW - neuroscience KW - TIA KW - transient ischemic attack KW - coordinated care KW - navigation KW - navigating KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - geomapping KW - geography KW - geographical KW - location KW - spatial KW - predict KW - predictions KW - predictive N2 - Background: A coordinated care system helps provide timely access to treatment for suspected acute stroke. In Northwestern Ontario (NWO), Canada, communities are widespread with several hospitals offering various diagnostic equipment and services. Thus, resources are limited, and health care providers must often transfer patients with stroke to different hospital locations to ensure the most appropriate care access within recommended time frames. However, health care providers frequently situated temporarily (locum) in NWO or providing care remotely from other areas of Ontario may lack sufficient information and experience in the region to access care for a patient with a time-sensitive condition. Suboptimal decision-making may lead to multiple transfers before definitive stroke care is obtained, resulting in poor outcomes and additional health care system costs. Objective: We aimed to develop a tool to inform and assist NWO health care providers in determining the best transfer options for patients with stroke to provide the most efficient care access. We aimed to develop an app using a comprehensive geomapping navigation and estimation system based on machine learning algorithms. This app uses key stroke-related timelines including the last time the patient was known to be well, patient location, treatment options, and imaging availability at different health care facilities. Methods: Using historical data (2008-2020), an accurate prediction model using machine learning methods was developed and incorporated into a mobile app. These data contained parameters regarding air (Ornge) and land medical transport (3 services), which were preprocessed and cleaned. For cases in which Ornge air services and land ambulance medical transport were both involved in a patient transport process, data were merged and time intervals of the transport journey were determined. The data were distributed for training (35%), testing (35%), and validation (30%) of the prediction model. Results: In total, 70,623 records were collected in the data set from Ornge and land medical transport services to develop a prediction model. Various learning models were analyzed; all learning models perform better than the simple average of all points in predicting output variables. The decision tree model provided more accurate results than the other models. The decision tree model performed remarkably well, with the values from testing, validation, and the model within a close range. This model was used to develop the ?NWO Navigate Stroke? system. The system provides accurate results and demonstrates that a mobile app can be a significant tool for health care providers navigating stroke care in NWO, potentially impacting patient care and outcomes. Conclusions: The NWO Navigate Stroke system uses a data-driven, reliable, accurate prediction model while considering all variations and is simultaneously linked to all required acute stroke management pathways and tools. It was tested using historical data, and the next step will to involve usability testing with end users. UR - https://formative.jmir.org/2024/1/e54009 UR - http://dx.doi.org/10.2196/54009 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54009 ER - TY - JOUR AU - Mazzocato, Pamela AU - Luckhaus, Linnea Jamie AU - Malmqvist Castillo, Moa AU - Burnett, Johan AU - Hager, Andreas AU - Oates, Gabriela AU - Wannheden, Carolina AU - Savage, Carl PY - 2024/7/31 TI - A Patient-Driven Mobile Health Innovation in Cystic Fibrosis Care: Comparative Cross-Case Study JO - J Med Internet Res SP - e50527 VL - 26 KW - chronic illness KW - implementation KW - adoption KW - spread KW - patient-driven innovation KW - mHealth KW - mobile health KW - innovation KW - health care provider KW - motivation KW - interdependency KW - adaptability N2 - Background: Patient-driven innovation in health care is an emerging phenomenon with benefits for patients with chronic conditions, such as cystic fibrosis (CF). However, previous research has not examined what may facilitate or hinder the implementation of such innovations from the provider perspective. Objective: The aim of this study was to explain variations in the adoption of a patient-driven innovation among CF clinics. Methods: A comparative multiple-case study was conducted on the adoption of a patient-controlled app to support self-management and collaboration with health care professionals (HCPs). Data collection and analysis were guided by the nonadoption, abandonment, spread, scale-up, and sustainability and complexity assessment tool (NASSS-CAT) framework. Data included user activity levels of patients and qualitative interviews with staff at 9 clinics (n=8, 88.9%, in Sweden; n=1, 11.1%, in the United States). We calculated the maximum and mean percentage of active users at each clinic and performed statistical process control (SPC) analysis to explore how the user activity level changed over time. Qualitative data were subjected to content analysis and complexity analysis and used to generate process maps. All data were then triangulated in a cross-case analysis. Results: We found no evidence of nonadoption or clear abandonment of the app. Distinct patterns of innovation adoption were discernable based on the maximum end-user activity for each clinic, which we labeled as low (16%-23%), middle (25%-47%), or high (58%-95%) adoption. SPC charts illustrated that the introduction of new app features and research-related activity had a positive influence on user activity levels. Variation in adoption was associated with providers? perceptions of care process complexity. A higher perceived complexity of the value proposition, adopter system, and organization was associated with lower adoption. In clinics that adopted the innovation early or those that relied on champions, user activity tended to plateau or decline, suggesting a negative impact on sustainability. Conclusions: For patient-driven innovations to be adopted and sustained in health care, understanding patient-provider interdependency and providers? perspectives on what generates value is essential. UR - https://www.jmir.org/2024/1/e50527 UR - http://dx.doi.org/10.2196/50527 UR - http://www.ncbi.nlm.nih.gov/pubmed/39083342 ID - info:doi/10.2196/50527 ER - TY - JOUR AU - Sacher, M. Paul AU - Fulton, Emily AU - Rogers, Victoria AU - Wilson, Julia AU - Gramatica, Marco AU - Dent, E. Jennifer AU - Aarts, O. Edo AU - Eccleston, David AU - Greve, Willem Jan AU - Palm-Meinders, Inge AU - Chuttani, Ram PY - 2024/7/31 TI - Impact of a Health Coach?Led, Text-Based Digital Behavior Change Intervention on Weight Loss and Psychological Well-Being in Patients Receiving a Procedureless Intragastric Balloon Program: Prospective Single-Arm Study JO - JMIR Form Res SP - e54723 VL - 8 KW - intragastric balloon KW - obesity KW - behavior change KW - health coaching KW - digital health KW - weight management KW - well-being KW - mobile phone N2 - Background: Digital health interventions show promise for weight management. However, few text-based behavior change interventions have been designed to support patients receiving intragastric balloons, and none have simultaneously evaluated weight loss, psychological well-being, and behavior change despite the crucial interplay of these factors in weight management. Objective: This study aims to assess whether a health coach?led, asynchronous, text-based digital behavior change coaching intervention (DBCCI) delivered to participants receiving an intragastric balloon and its aftercare program was feasible and acceptable to participants and supported improved outcomes, including weight loss, psychological well-being, and lifestyle behavior change conducive to weight loss maintenance. Methods: This 12-month, single-arm prospective study enrolled adults aged 21 to 65 years with BMI ?27 kg/m2 receiving a procedureless intragastric balloon (PIGB) at 5 bariatric clinics in the United Kingdom and the Netherlands. Participants received the DBCCI and the clinic-led PIGB aftercare program (remotely delivered) for 6 months after PIGB placement and then no intervention for an additional 6 months. The DBCCI was an evidence-based, personalized intervention wherein health coaches supported participants via exchanged asynchronous in-app text-based messages. Over the 12-month study, we assessed percentage of total body weight loss and psychological well-being via self-administered validated questionnaires (Warwick-Edinburgh Mental Wellbeing Scale, Generalized Anxiety Disorder Scale, Impact of Weight on Quality of Life?Lite?Clinical Trials Version, Loss of Control Over Eating Scale?Brief, Weight Efficacy Lifestyle Questionnaire?Short Form, and Barriers to Being Active Quiz). Participant engagement with and acceptability of the intervention were assessed via self-reported surveys. Results: Overall, 107 participants (n=96, 89.7% female; mean baseline BMI 35.4, SD 5.4 kg/m2) were included in the analysis. Mean total body weight loss was 13.5% (SEM 2.3%) at the end of the DBCCI and 11.22% (SEM 2.3%) at the 12-month follow-up (P<.001). Improvements were observed for all psychological well-being measures throughout the 12 months except for the Generalized Anxiety Disorder Scale (improvement at month 1) and Barriers to Being Active Quiz (improvements at months 3 and 6). Surveys showed high levels of engagement with and acceptability of the DBCCI. Conclusions: This study provides evidence that the health coach?led, asynchronous, text-based DBCCI was engaging and acceptable to participants with overweight and obesity. The DBCCI, delivered alongside the PIGB and its aftercare program, supported improved weight loss outcomes and psychological well-being versus baseline and was associated with lifestyle behavior changes known to help achieve and maintain long-term weight loss and improved health outcomes. Follow-up findings suggest a potential need for longer-term, more intense coaching to focus on weight loss maintenance and support ongoing self-coaching. This could be achieved by leveraging generative artificial intelligence to provide ongoing automated behavior change coaching support to augment human-led care. Trial Registration: ClinicalTrials.gov NCT05884606; https://clinicaltrials.gov/study/NCT05884606 UR - https://formative.jmir.org/2024/1/e54723 UR - http://dx.doi.org/10.2196/54723 UR - http://www.ncbi.nlm.nih.gov/pubmed/39083340 ID - info:doi/10.2196/54723 ER - TY - JOUR AU - Sides, Teresa AU - Kbaier, Dhouha PY - 2024/7/29 TI - Investigating How the Use of Technology Can Reduce Missed Appointments: Quantitative Case Study at a General Practitioner Surgery JO - J Med Internet Res SP - e43894 VL - 26 KW - National Health Service KW - primary care KW - SMS text messaging KW - SMS reminders KW - missed appointments KW - quantitative research KW - Kruskal-Wallis test KW - Mann-Whitney test N2 - Background: SMS texting systems have been considered a potential solution to reduce missed appointments in primary care. Existing research in this area focuses on qualitative studies investigating the attitudes of SMS text users and receivers. Objective: This study aimed to examine appointment data from an independent general practitioner (GP) surgery in Wrexham, United Kingdom, with approximately 15,000 patients, to determine the impact of text messaging systems on reducing missed appointments. The objective of this study was to investigate whether the use of text messages can effectively reduce missed appointments. Methods: To collect data for the study, SQL reports were run on EMIS Web, the United Kingdom?s most widely used clinical system. The data spanned 10 years, from September 1, 2010, to March 31, 2020. Data accuracy was verified by cross-referencing with appointment diary records. Mann-Whitney and Kruskal-Wallis tests, chosen for their suitability in comparing groups in nonparametric settings, were conducted in Microsoft Excel due to its accessibility. Results: Statistical analyses were conducted to compare data before and after implementation of the text messaging system. The results revealed a significant 42.8% reduction in missed appointments (before: 5848; after: 3343; P<.001). Further analysis of demographic characteristics revealed interesting trends, with no significant difference in missed appointments between genders, and variations observed across different age groups. The median number of missed appointments was not significantly different between genders (women: 1.55, IQR 1.11-2.16; men: 1.61, IQR 1.08-2.12; P=.73). Despite the prevalence of mobile phone use among young adults aged 20-25 years, the highest rates of missed appointments (848/7256, 11.7%) were noted in this group, whereas the lowest rates were noted in the 75-80 years age group (377/7256; 5.2%; P<.001). Analysis by age and gender indicated inconsistencies: women aged 20-25 years (571/4216) and men aged 35-40 years (306/3040) had the highest rates of missed appointments, whereas women aged 70-75 years (177/4216) and men aged 75-80 years (129/3040) had the lowest rates (P<.001 for both). Conclusions: This study demonstrates that SMS text messaging in primary care can significantly reduce missed appointments. Implementing technology such as SMS text messaging systems enables patients to cancel appointments on time, leading to improved efficiency in primary care settings. UR - https://www.jmir.org/2024/1/e43894 UR - http://dx.doi.org/10.2196/43894 UR - http://www.ncbi.nlm.nih.gov/pubmed/39073855 ID - info:doi/10.2196/43894 ER - TY - JOUR AU - Akhter-Khan, C. Samia AU - Tao, Qiushan AU - Ang, Alvin Ting Fang AU - Karjadi, Cody AU - Itchapurapu, Swetha Indira AU - Libon, J. David AU - Alosco, Michael AU - Mez, Jesse AU - Qiu, Qiao Wei AU - Au, Rhoda PY - 2024/7/29 TI - Cerebral Microbleeds in Different Brain Regions and Their Associations With the Digital Clock-Drawing Test: Secondary Analysis of the Framingham Heart Study JO - J Med Internet Res SP - e45780 VL - 26 KW - cerebral microbleeds KW - CMB KW - digital clock-drawing test KW - DCT KW - Alzheimer disease KW - dementia KW - early screening KW - Boston Process Approach KW - cerebral microbleed KW - neuroimaging KW - cerebrovascular diseases KW - aging KW - MRI KW - magnetic resonance imaging KW - clock-drawing test KW - cognitive function N2 - Background: Cerebral microbleeds (CMB) increase the risk for Alzheimer disease. Current neuroimaging methods that are used to detect CMB are costly and not always accessible. Objective: This study aimed to explore whether the digital clock-drawing test (DCT) may provide a behavioral indicator of CMB. Methods: In this study, we analyzed data from participants in the Framingham Heart Study offspring cohort who underwent both brain magnetic resonance imaging scans (Siemens 1.5T, Siemens Healthcare Private Limited; T2*-GRE weighted sequences) for CMB diagnosis and the DCT as a predictor. Additionally, paper-based clock-drawing tests were also collected during the DCT. Individuals with a history of dementia or stroke were excluded. Robust multivariable linear regression models were used to examine the association between DCT facet scores with CMB prevalence, adjusting for relevant covariates. Receiver operating characteristic (ROC) curve analyses were used to evaluate DCT facet scores as predictors of CMB prevalence. Sensitivity analyses were conducted by further including participants with stroke and dementia. Results: The study sample consisted of 1020 (n=585, 57.35% female) individuals aged 45 years and older (mean 72, SD 7.9 years). Among them, 64 (6.27%) participants exhibited CMB, comprising 46 with lobar-only, 11 with deep-only, and 7 with mixed (lobar+deep) CMB. Individuals with CMB tended to be older and had a higher prevalence of mild cognitive impairment and higher white matter hyperintensities compared to those without CMB (P<.05). While CMB were not associated with the paper-based clock-drawing test, participants with CMB had a lower overall DCT score (CMB: mean 68, SD 23 vs non-CMB: mean 76, SD 20; P=.009) in the univariate comparison. In the robust multiple regression model adjusted for covariates, deep CMB were significantly associated with lower scores on the drawing efficiency (?=?0.65, 95% CI ?1.15 to ?0.15; P=.01) and simple motor (?=?0.86, 95% CI ?1.43 to ?0.30; P=.003) domains of the command DCT. In the ROC curve analysis, DCT facets discriminated between no CMB and the CMB subtypes. The area under the ROC curve was 0.76 (95% CI 0.69-0.83) for lobar CMB, 0.88 (95% CI 0.78-0.98) for deep CMB, and 0.98 (95% CI 0.96-1.00) for mixed CMB, where the area under the ROC curve value nearing 1 indicated an accurate model. Conclusions: The study indicates a significant association between CMB, especially deep and mixed types, and reduced performance in drawing efficiency and motor skills as assessed by the DCT. This highlights the potential of the DCT for early detection of CMB and their subtypes, providing a reliable alternative for cognitive assessment and making it a valuable tool for primary care screening before neuroimaging referral. UR - https://www.jmir.org/2024/1/e45780 UR - http://dx.doi.org/10.2196/45780 UR - http://www.ncbi.nlm.nih.gov/pubmed/39073857 ID - info:doi/10.2196/45780 ER - TY - JOUR AU - Oliver, Amy AU - Chandler, Ella AU - Gillard, A. Julia PY - 2024/7/26 TI - Impact of Digital Inclusion Initiative to Facilitate Access to Mental Health Services: Service User Interview Study JO - JMIR Ment Health SP - e51315 VL - 11 KW - digital exclusion KW - digital inclusion KW - video consultation KW - COVID-19 KW - tablet loan scheme KW - mental health KW - telemedicine KW - digital divide KW - digital inequality KW - technology N2 - Background: Digital exclusion, characterized by a lack of access to digital technology, connectivity, or digital skills, disproportionally affects marginalized groups. An important domain impacted by digital exclusion is access to health care. During COVID-19, health care services had to restrict face-to-face contact to limit the spread of the virus. The subsequent shift toward remote delivery of mental health care exacerbated the digital divide, with limited access to remote mental health care delivery. In response, Camden and Islington National Health Service Foundation Trust launched the innovative Digital Inclusion Scheme (DIS). Objective: This study aimed to examine the impact of facilitating digital inclusion in mental health access. Camden and Islington National Health Service Foundation Trust implemented the trust-wide DIS for service users who were digitally excluded, that is, were without devices or connectivity or reported poor digital skills. The scheme provided access to a loan digital device (a tablet), internet connectivity devices, and mobile data, as well as personalized digital skills support. Methods: The DIS went live in October 2021 and received 106 referrals by June 2022. Semistructured interviews were conducted with 12 service users to ask about their experience of accessing the DIS. A thematic analysis identified themes and subthemes relating to the extent of their digital exclusion before engaging with the scheme and the impact of accessing a scheme on their ability to engage with digital technology and well-being. Results: There were 10 major themes. A total of 6 themes were related to factors impacting the engagement with the scheme, including digital exclusion, relationship to the trust, the importance of personalized digital support, partnership working, device usability and accessibility, and personal circumstances. The remaining 4 themes spoke to the impact of accessing the scheme, including improved access to services, impact on well-being, financial implications, and a greater sense of empowerment. Conclusions: Participants reported an increased reliance on technology driving the need for digital inclusion; however, differences in motivation for engaging with the scheme were noted, as well as potential barriers, including lack of awareness, disability, and age. Overall, the experience of accessing the DIS was reported as positive, with participants feeling supported to access the digital world. The consequences of engaging with the scheme included greater perceived access to and control of physical and mental health care, improved well-being, and a greater sense of empowerment. An overview of the lessons learned are provided along with suggestions for other health care settings that are looking to implement similar schemes. UR - https://mental.jmir.org/2024/1/e51315 UR - http://dx.doi.org/10.2196/51315 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51315 ER - TY - JOUR AU - Subramani, Yamini AU - Querney, Jill AU - Singh, Priyanka AU - Zhang, Yifan AU - Fochesato, Lee-Anne AU - Fatima, Nida AU - Wood, Natasha AU - Nagappa, Mahesh PY - 2024/7/25 TI - Preoperative Anesthesia Virtual Video Consultations in a Preadmission Clinic: Quality Improvement Study JO - JMIR Perioper Med SP - e57541 VL - 7 KW - preoperative evaluation KW - preadmission clinic KW - telemedicine KW - remote KW - virtual care KW - remote consultation KW - video consultation KW - telehealth KW - online health KW - digital health KW - perioperative medicine KW - preoperative KW - eMedicine KW - surgery KW - consultation KW - safety KW - assessment KW - workflow KW - implementation KW - integration KW - hospital N2 - Background: The preadmission clinic (PAC) is crucial in perioperative care, offering evaluations, education, and patient optimization before surgical procedures. During the COVID-19 pandemic, the PAC adapted by implementing telephone visits due to a lack of infrastructure for video consultations. While the pandemic significantly increased the use of virtual care, including video appointments as an alternative to in-person consultations, our PAC had not used video consultations for preoperative assessments. Objective: This study aimed to develop, implement, and integrate preoperative video consultations into the PAC workflow. Methods: A prospective quality improvement project was undertaken using the Plan-Do-Study-Act (PDSA) methodology. The project focused on developing, implementing, and integrating virtual video consultations at London Health Sciences Centre and St. Joseph Health Care (London, Ontario, Canada) in the PAC. Data were systematically collected to monitor the number of patients undergoing video consultations, address patient flow concerns, and increase the percentage of video consultations. Communication between the PAC, surgeon offices, and patients was analyzed for continuous improvement. Technological challenges were addressed, and procedures were streamlined to facilitate video calls on appointment days. Results: The PAC team, which includes professionals from medicine, anesthesia, nursing, pharmacy, occupational therapy, and physiotherapy, offers preoperative evaluation and education to surgical patients, conducting approximately 8000 consultations annually across 3 hospital locations. Following the initial PDSA cycles, the interventions consistently improved the video consultation utilization rate to 17%, indicating positive progress. With the onset of PDSA cycle 3, there was a notable surge to a 29% utilization rate in the early phase. This upward trend continued, culminating in a 38% utilization rate of virtual video consultations in the later stages of the cycle. This heightened level was consistently maintained throughout 2023, highlighting the sustained success of our interventions. Conclusions: The quality improvement process significantly enhanced the institution?s preoperative video consultation workflow. By understanding the complexities within the PAC, strategic interventions were made to integrate video consultations without compromising efficiency, morale, or safety. This project highlights the potential for transformative improvements in health care delivery through the thoughtful integration of virtual care technologies. UR - https://periop.jmir.org/2024/1/e57541 UR - http://dx.doi.org/10.2196/57541 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57541 ER - TY - JOUR AU - Avanceña, V. Anton L. AU - Brody, Carinne AU - Chhoun, Pheak AU - Tuot, Sovannary AU - Yi, Siyan PY - 2024/7/25 TI - Connecting Female Entertainment Workers in Cambodia to Health Care Services Using mHealth: Economic Evaluation of Mobile Link JO - JMIR Form Res SP - e52734 VL - 8 KW - female entertainment workers KW - Cambodia KW - mHealth KW - mobile health KW - economic evaluation KW - stigmatized populations KW - women's health KW - sexual health KW - STI KW - sexually transmitted infection KW - STD KW - sexually transmitted disease KW - economic KW - cost KW - costs KW - affordable KW - affordability KW - budget KW - finance KW - financial N2 - Background: Mobile Link is a mobile phone?based intervention to increase access to, and use of, health care services among female entertainment workers in Cambodia who face higher risks for specific diseases and gender-based violence. A multisite randomized controlled trial showed that Mobile Link connected female entertainment workers with outreach workers for information and escorted referrals after 6 months but did not lead to statistically significant improvements in HIV and sexually transmitted infection testing, contraceptive use, and condom use. Objective: This study aims to conduct a 3-part economic evaluation of Mobile Link to understand its costs, value, and affordability. Methods: We conducted cost, cost-effectiveness, and budget impact analyses of Mobile Link using cost and outcomes data from the Mobile Link trial and other sources. For the cost analysis, we estimated the total, per-person, and incremental costs of Mobile Link compared with usual care. Using probabilistic decision-analytic models, we estimated the 1-year cost-effectiveness of Mobile Link from payer and combined payer and patient perspectives by converting selected primary and secondary outcomes from the trial to disability-adjusted life years (DALYs) averted. Finally, we estimated the financial costs of scaling up Mobile Link?s messaging and outreach services to 70% of female entertainment workers in 5 years. Results: The incremental costs of Mobile Link were US $199 from a payer perspective and US $195 per person from a combined payer and patient perspective. With an average of 0.018 (95% predicted interval ?0.088 to 0.126) DALYs averted, Mobile Link?s cost-effectiveness was US $10,955 per DALY from a payer perspective (US $10,755 per DALY averted from a payer and patient perspective). The costs of Mobile Link would have to decrease by 85%, or its effectiveness would have to be 5.56 times higher, for the intervention to meet the upper limit of recommended cost-effectiveness thresholds in Cambodia (US $1671 per DALY averted). The 5-year cost of scaling Mobile Link to 34,790 female entertainment workers was estimated at US $1.64 million or US $46 per person per year. Conclusions: This study provided a comprehensive economic evaluation of Mobile Link. We found that Mobile Link is not likely to be cost-effective unless its costs decrease or its effectiveness increases. Scaling up Mobile Link to more female entertainment workers is estimated to cost less than the costs of the trial. Given the importance of linking female entertainment workers to essential services, future research should focus on enhancing the effectiveness of Mobile Link or developing new mobile health interventions for this population. Trial Registration: ClinicalTrials.gov NCT03117842; https://clinicaltrials.gov/study/NCT03117842 UR - https://formative.jmir.org/2024/1/e52734 UR - http://dx.doi.org/10.2196/52734 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52734 ER - TY - JOUR AU - Bulcha, Gebeyehu AU - Abdissa, Gutema Hordofa AU - Noll, Josef AU - Sori, Amenu Demisew AU - Koricha, Birhanu Zewdie PY - 2024/7/23 TI - Effectiveness of a Mobile Phone Messaging?Based Message Framing Intervention for Improving Maternal Health Service Uptake and Newborn Care Practice in Rural Jimma Zone, Ethiopia: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e52395 VL - 13 KW - message framing KW - mHealth KW - digital health KW - SMS KW - maternal health KW - newborn health KW - cluster randomized controlled trials KW - RCT KW - Ethiopia KW - mobile phone KW - effectiveness KW - SMS-based interventions KW - text messaging KW - maternal KW - newborn care practice KW - randomized KW - controlled trial KW - controlled trials KW - mobile phone messaging KW - phone-based intervention N2 - Background: Ethiopia has high rates of maternal and neonatal mortality. In 2019 and 2020, the maternal and newborn mortality rates were estimated at 412 per 1,000,000 births and 30 per 10,000 births, respectively. While mobile health interventions to improve maternal and neonatal health management have shown promising results, there are still insufficient scientific studies to assess the effectiveness of mobile phone messaging?based message framing for maternal and newborn health. Objective: This research aims to examine the effectiveness of mobile phone messaging?based message framing for improving the use of maternal and newborn health services in the Jimma Zone, Ethiopia. Methods: A 3-arm cluster-randomized trial design was used to evaluate the effects of mobile phone?based intervention on maternal and newborn health service usage. The trial arms were (1) gain-framed messages (2) loss-framed messages, and (3) usual care. A total of 21 health posts were randomized, and 588 pregnant women who had a gestational age of 16-20 weeks, irrespective of their antenatal care status, were randomly assigned to the trial arms. The intervention consisted of a series of messages dispatched from the date of enrolment until 6-8 months. The control group received existing care without messages. The primary outcomes were maternal health service usage and newborn care practice, while knowledge, attitude, self-efficacy, iron supplementation, and neonatal and maternal morbidity were secondary outcomes. The outcomes will be analyzed using a generalized linear mixed model and the findings will be reported according to the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement for randomized controlled trials. Results: Recruitment of participants was conducted and the baseline survey was administered in March 2023. The intervention was rolled out from May 2023 till December 2023. The end-line assessment was conducted in February 2024. Conclusions: This trial was carried out to understand how mobile phone?based messaging can improve maternal and newborn health service usage. It provides evidence for policy guidelines around mobile health strategies to improve maternal and newborn health. Trial Registration: Pan African Clinical Trials Registry PACTR202201753436676; https://tinyurl.com/ykhnpc49 International Registered Report Identifier (IRRID): DERR1-10.2196/52395 UR - https://www.researchprotocols.org/2024/1/e52395 UR - http://dx.doi.org/10.2196/52395 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52395 ER - TY - JOUR AU - Hu, Zhiyuan AU - Qin, Xiaoping AU - Chen, Kaiyan AU - Huang, Yu-Ni AU - Wang, Szewei Richard AU - Tung, Tao-Hsin AU - Chuang, Yen-Ching AU - Wang, Bing-Long PY - 2024/7/23 TI - Chinese Health Insurance in the Digital Era: Bibliometric Study JO - Interact J Med Res SP - e52020 VL - 13 KW - telemedicine KW - health insurance KW - internet plus healthcare KW - bibliometric KW - VOSviewer N2 - Background: China has entered the era of digital health care after years of reforms in the health care system. The use of digital technologies in healthcare services is rapidly increasing, indicating the onset of a new period. The reform of health insurance has also entered a new phase. Objective: This study aims to investigate the evolution of health care insurance within the context of telemedicine and Internet Plus Healthcare (IPHC) during the digital health care era by using scientometric methods to analyze publication patterns, influential keywords, and research hot spots. It seeks to understand how health care insurance has adapted to the growing integration of IPHC and telemedicine in health care services and the implications for policy and practice. Methods: A total of 411 high-quality studies were curated from the China National Knowledge Infrastructure (CNKI) database in the Chinese language, scientometric analysis was conducted, and VOSviewer software was used to conduct a visualized analysis of keywords and hot spots in the literature. Results: The number of articles in this field has increased notably from 2000 to 2022 and has increased annually based on a curve of y=0.332exp (0.4002x) with R2=0.6788. In total, 62 institutions and 811 authors have published research articles in the Chinese language in this field. This study included 290 keywords and formulated a total of 5 hot-topic clusters of ?telemedicine,? ?IPHC,? ?internet hospital,? ?health insurance payments,? and ?health insurance system.? Conclusions: Studies on the application of digital technologies in health care insurance has evolved from foundational studies to a broader scope. The emergence of internet hospitals has showcased the potential for integrating IPHC services into insurance payment systems. However, this development also highlights the necessity for enhanced interregional coordination mechanisms. The reform of health insurance payment is contingent upon ongoing advancements in digital technology and increased investment in electronic medical records and primary health care services. Future efforts should focus on integrating technology with administrative systems, advancing mobile health care solutions, and ensuring interoperability among various payment systems to improve efficiency and standardize health care services. UR - https://www.i-jmr.org/2024/1/e52020 UR - http://dx.doi.org/10.2196/52020 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52020 ER - TY - JOUR AU - Hamline, Y. Michelle AU - Xing, Guibo AU - Kravitz, L. Richard AU - Miller, Marykate AU - Melnikow, Joy PY - 2024/7/17 TI - Physician and Practice Characteristics Influencing Telemedicine Uptake Among Frontline Clinicians in the Early COVID-19 Pandemic Response: National Survey Study JO - JMIR Form Res SP - e50751 VL - 8 KW - telemedicine KW - telehealth KW - COVID-19 pandemic KW - frontline clinicians KW - telemonitoring KW - frontliners KW - virtual care KW - influence KW - clinician KW - physician KW - pre-pandemic KW - pandemic KW - survey KW - health outcome N2 - Background:  Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability. Objective:  This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response. Methods:  We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse. Results:  Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice. Conclusions:  Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies. UR - https://formative.jmir.org/2024/1/e50751 UR - http://dx.doi.org/10.2196/50751 UR - http://www.ncbi.nlm.nih.gov/pubmed/39018095 ID - info:doi/10.2196/50751 ER - TY - JOUR AU - Tarride, Jean-Eric AU - Hall, N. Justin AU - Mondoux, Shawn AU - Dainty, N. Katie AU - McCarron, Joy AU - Paterson, Michael J. AU - Plumptre, Lesley AU - Borgundvaag, Emily AU - Ovens, Howard AU - McLeod, L. Shelley PY - 2024/7/15 TI - Cost Evaluation of the Ontario Virtual Urgent Care Pilot Program: Population-Based, Matched Cohort Study JO - J Med Internet Res SP - e50483 VL - 26 KW - virtual urgent care KW - health care expenditures KW - Canada KW - virtual care KW - economic evaluation KW - pilot program KW - pilot KW - Ontario KW - urgent care KW - care KW - emergency department KW - users KW - patient KW - patients KW - resources KW - resource allocation KW - policy decision KW - decision-making KW - policy N2 - Background: In 2020, the Ministry of Health (MoH) in Ontario, Canada, introduced a virtual urgent care (VUC) pilot program to provide alternative access to urgent care services and reduce the need for in-person emergency department (ED) visits for patients with low acuity health concerns. Objective: This study aims to compare the 30-day costs associated with VUC and in-person ED encounters from an MoH perspective. Methods: Using administrative data from Ontario (the most populous province of Canada), a population-based, matched cohort study of Ontarians who used VUC services from December 2020 to September 2021 was conducted. As it was expected that VUC and in-person ED users would be different, two cohorts of VUC users were defined: (1) those who were promptly referred to an ED by a VUC provider and subsequently presented to an ED within 72 hours (these patients were matched to in-person ED users with any discharge disposition) and (2) those seen by a VUC provider with no referral to an in-person ED (these patients were matched to patients who presented in-person to the ED and were discharged home by the ED physician). Bootstrap techniques were used to compare the 30-day mean costs of VUC (operational costs to set up the VUC program plus health care expenditures) versus in-person ED care (health care expenditures) from an MoH perspective. All costs are expressed in Canadian dollars (a currency exchange rate of CAD $1=US $0.76 is applicable). Results: We matched 2129 patients who presented to an ED within 72 hours of VUC referral and 14,179 patients seen by a VUC provider without a referral to an ED. Our matched populations represented 99% (2129/2150) of eligible VUC patients referred to the ED by their VUC provider and 98% (14,179/14,498) of eligible VUC patients not referred to the ED by their VUC provider. Compared to matched in-person ED patients, 30-day costs per patient were significantly higher for the cohort of VUC patients who presented to an ED within 72 hours of VUC referral ($2805 vs $2299; difference of $506, 95% CI $139-$885) and significantly lower for the VUC cohort of patients who did not require ED referral ($907 vs $1270; difference of $362, 95% CI 284-$446). Overall, the absolute 30-day costs associated with the 2 VUC cohorts were $18.9 million (ie, $6.0 million + $12.9 million) versus $22.9 million ($4.9 million + $18.0 million) for the 2 in-person ED cohorts. Conclusions: This costing evaluation supports the use of VUC as most complaints were addressed without referral to ED. Future research should evaluate targeted applications of VUC (eg, VUC models led by nurse practitioners or physician assistants with support from ED physicians) to inform future resource allocation and policy decisions. UR - https://www.jmir.org/2024/1/e50483 UR - http://dx.doi.org/10.2196/50483 UR - http://www.ncbi.nlm.nih.gov/pubmed/39008348 ID - info:doi/10.2196/50483 ER - TY - JOUR AU - Straw, Isabel AU - Brass, Irina AU - Mkwashi, Andrew AU - Charles, Inika AU - Soares, Amelie AU - Steer, Caroline PY - 2024/7/11 TI - Insights From a Clinically Orientated Workshop on Health Care Cybersecurity and Medical Technology: Observational Study and Thematic Analysis JO - J Med Internet Res SP - e50505 VL - 26 KW - digital health KW - clinical medicine KW - biotechnology KW - medical device KW - device regulation KW - medical education KW - eHealth KW - digital medicine KW - health care KW - health care cybersecurity KW - internet of medical things N2 - Background: Health care professionals receive little training on the digital technologies that their patients rely on. Consequently, practitioners may face significant barriers when providing care to patients experiencing digitally mediated harms (eg, medical device failures and cybersecurity exploits). Here, we explore the impact of technological failures in clinical terms. Objective: Our study explored the key challenges faced by frontline health care workers during digital events, identified gaps in clinical training and guidance, and proposes a set of recommendations for improving digital clinical practice. Methods: A qualitative study involving a 1-day workshop of 52 participants, internationally attended, with multistakeholder participation. Participants engaged in table-top exercises and group discussions focused on medical scenarios complicated by technology (eg, malfunctioning ventilators and malicious hacks on health care apps). Extensive notes from 5 scribes were retrospectively analyzed and a thematic analysis was performed to extract and synthesize data. Results: Clinicians reported novel forms of harm related to technology (eg, geofencing in domestic violence and errors related to interconnected fetal monitoring systems) and barriers impeding adverse event reporting (eg, time constraints and postmortem device disposal). Challenges to providing effective patient care included a lack of clinical suspicion of device failures, unfamiliarity with equipment, and an absence of digitally tailored clinical protocols. Participants agreed that cyberattacks should be classified as major incidents, with the repurposing of existing crisis resources. Treatment of patients was determined by the role technology played in clinical management, such that those reliant on potentially compromised laboratory or radiological facilities were prioritized. Conclusions: Here, we have framed digital events through a clinical lens, described in terms of their end-point impact on the patient. In doing so, we have developed a series of recommendations for ensuring responses to digital events are tailored to clinical needs and center patient care. UR - https://www.jmir.org/2024/1/e50505 UR - http://dx.doi.org/10.2196/50505 UR - http://www.ncbi.nlm.nih.gov/pubmed/38990611 ID - info:doi/10.2196/50505 ER - TY - JOUR AU - Cummings, Camilla AU - Raja, Pushpa AU - Gabrielian, Sonya AU - Doran, Neal PY - 2024/7/9 TI - Impacts of Telehealth Adoption on the Quality of Care for Individuals With Serious Mental Illness: Retrospective Observational Analysis of Veterans Affairs Administrative Data JO - JMIR Ment Health SP - e56886 VL - 11 KW - telemedicine KW - quality of care KW - serious mental illness KW - telehealth KW - adoption KW - mental illness KW - patients KW - patient KW - veterans KW - veteran KW - psychotherapy KW - psychosocial KW - mental healthcare KW - suicide KW - rehabilitation KW - mental health care N2 - Background: Telehealth implementation can be challenging for persons with serious mental illness (SMI), which may impact their quality of care and health outcomes. The literature on telehealth?s impacts on SMI care outcomes is mixed, necessitating further investigation. Objective: We examined the impacts of facility-level telehealth adoption on quality of care metrics over time among patients with SMI. Methods: We analyzed Veterans Affairs (VA) administrative data across 138 facilities from January 2021 to December 2022. We performed longitudinal mixed-effects regressions to identify the relationships between the proportion of facility-level telehealth visits and SMI specialty care quality metrics: engagement with primary care; access and continuity of care across a range of mental health services including psychotherapy or psychosocial rehabilitation, SMI-specific intensive outpatient programs, and intensive case management; and continuity of mental health care after a high-risk event (eg, suicide attempt). Results: Facilities with a higher proportion of telehealth visits had reduced access and continuity of physical and mental health care for patients with SMI (P<.05). Higher telehealth adoption was associated with reduced primary care engagement (z=?4.04; P<.001), reduced access to and continuity in SMI-specific intensive case management (z=?4.49; P<.001; z=?3.15; P<.002), reductions in the continuity of care within psychotherapy and psychosocial rehabilitation (z=?3.74; P<.001), and continuity of care after a high-risk event (z=?2.46; P<.01). Telehealth uptake initially increased access to intensive outpatient but did not improve its continuity over time (z=?4.47; P<.001). Except for continuity within SMI-specific intensive case management (z=2.62; P<.009), continuity did not improve over time as telehealth became routinized. Conclusions: Although telehealth helped preserve health care access during the pandemic, telehealth may have tradeoffs with regard to quality of care for some individuals with SMI. These data suggest that engagement strategies used by SMI-specific intensive case management may have preserved quality and could benefit other settings. Strategies that enhance telehealth implementation?selected through a health equity lens?may improve quality of care among patients with SMI. UR - https://mental.jmir.org/2024/1/e56886 UR - http://dx.doi.org/10.2196/56886 ID - info:doi/10.2196/56886 ER - TY - JOUR AU - Atherton, Helen AU - Eccles, Abi AU - Poltawski, Leon AU - Dale, Jeremy AU - Campbell, John AU - Abel, Gary PY - 2024/7/8 TI - Investigating Patient Use and Experience of Online Appointment Booking in Primary Care: Mixed Methods Study JO - J Med Internet Res SP - e51931 VL - 26 KW - appointment KW - patient appointments KW - online systems KW - primary health care KW - general practice KW - qualitative research KW - secondary data analysis KW - mobile phone N2 - Background: Online appointment booking is a commonly used tool in several industries. There is limited evidence about the benefits and challenges of using online appointment booking in health care settings. Potential benefits include convenience and the ability to track appointments, although some groups of patients may find it harder to engage with online appointment booking. We sought to understand how patients in England used and experienced online appointment booking. Objective: This study aims to describe and compare the characteristics of patients in relation to their use of online appointment booking in general practice and investigate patients? views regarding online appointment booking arrangements. Methods: This was a mixed methods study set in English general practice comprising a retrospective analysis of the General Practice Patient Survey (GPPS) and semistructured interviews with patients. Data used in the retrospective analysis comprised responses to the 2018 and 2019 GPPS analyzed using mixed-effects logistic regression. Semistructured interviews with purposively sampled patients from 11 general practices in England explored experiences of and views on online appointment booking. Framework analysis was used to allow for comparison with the findings of the retrospective analysis. Results: The retrospective analysis included 1,327,693 GPPS responders (2018-2019 combined). We conducted 43 interviews with patients with a variety of experiences and awareness of online appointment booking; of these 43 patients, 6 (14%) were from ethnic minority groups. In the retrospective analysis, more patients were aware that online appointment booking was available (581,224/1,288,341, 45.11%) than had experience using it (203,184/1,301,694, 15.61%). There were deprivation gradients for awareness and use and a substantial decline in both awareness and use in patients aged >75 years. For interview participants, age and life stage were factors influencing experiences and perceptions, working patients valued convenience, and older patients preferred to use the telephone. Patients with long-term conditions were more aware of (odds ratio [OR] 1.43, 95% CI 1.41-1.44) and more likely to use (OR 1.65, 95% CI 1.63-1.67) online appointment booking. Interview participants with long-term conditions described online appointment booking as useful for routine nonurgent appointments. Patients in deprived areas were clustered in practices with low awareness and use of online appointment booking among GPPS respondents (OR for use 0.65, 95% CI 0.64-0.67). Other key findings included the influence of the availability of appointments online and differences in the registration process for accessing online booking. Conclusions: Whether and how patients engage with online appointment booking is influenced by the practice with which they are registered, whether they live with long-term conditions, and their deprivation status. These factors should be considered in designing and implementing online appointment booking and have implications for patient engagement with the wider range of online services offered in general practice. UR - https://www.jmir.org/2024/1/e51931 UR - http://dx.doi.org/10.2196/51931 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51931 ER - TY - JOUR AU - Villarreal-Zegarra, David AU - García-Serna, Jackeline AU - Segovia-Bacilio, Piero AU - Mayo-Puchoc, Nikol AU - Navarro-Flores, Alba AU - Huarcaya-Victoria, Jeff PY - 2024/7/8 TI - In-Person and Teleconsultation Services at a National Hospital in Peru: Time Series Analysis of General and Psychiatric Care Amid the COVID-19 Pandemic JO - JMIR Ment Health SP - e53980 VL - 11 KW - health care utilization KW - mental health use KW - COVID-19 KW - mental health KW - health care KW - psychiatric care KW - teleconsultation KW - hospital KW - Peru KW - chronic KW - patient KW - patients KW - telemonitoring N2 - Background: The COVID-19 pandemic led to a global reduction in health care accessibility for both infected and noninfected patients, posing a particular burden on those with chronic conditions, including mental health issues. Peru experienced significant devastation from the pandemic, resulting in a collapsed health care system and leading to the world?s highest per capita mortality rate as a result of COVID-19. Understanding the trends in health care utilization, particularly in mental health care, is crucial for informing pandemic response efforts and guiding future recovery strategies. Objective: This study aims to analyze the trends of outpatient medical and psychiatric consultations during the COVID-19 pandemic in a national hospital in Peru. Methods: This observational study was conducted at a national hospital in Lima, Peru. We analyzed data on user care across all services, including psychiatric services, from May 2019 to December 2022. The data were calculated for users served per month, including the number of users seen monthly in mental health services. Sociodemographic variables such as sex (female or male), age (?0 years), type of medical appointment (regular or additional), and modality of care (in-person or teleconsultations) were taken into account. An interrupted time series regression model was conducted to assess the number of outpatient medical and psychiatric consultations. Subgroup analyses were performed based on service modality, including overall consultations, telemonitoring/teleconsultations only, or face-to-face only, for all service users and for mental health service users. Results: A total of 1,515,439 participants were included, with females comprising 275,444/484,994 (56.80%) of the samples. Only 345,605/1,515,439 (22.81%) visits involved telemedicine. The total monthly outpatient visits were significantly reduced compared with the expected projection (P<.001) at the beginning of the pandemic, followed by a later monthly increment of 298.7 users. Face-to-face interventions experienced a significant reduction at the beginning of the pandemic (P<.001), gradually recovering in the following months. By contrast, telemedicine use initially increased but subsequently declined toward the end of the pandemic. A similar trend was observed in mental health units. Conclusions: During the pandemic years, health care utilization in both general and psychiatric services experienced a significant decrease, particularly at the beginning of the pandemic (March 2020). However, no significant trends were observed in either case throughout the pandemic period. Telemedicine consultations witnessed a significant increase overall during this period, particularly among mental health users. UR - https://mental.jmir.org/2024/1/e53980 UR - http://dx.doi.org/10.2196/53980 UR - http://www.ncbi.nlm.nih.gov/pubmed/38976320 ID - info:doi/10.2196/53980 ER - TY - JOUR AU - Ansaldo, Inés Ana AU - Masson-Trottier, Michèle AU - Delacourt, Barbara AU - Dubuc, Jade AU - Dubé, Catherine PY - 2024/7/4 TI - Efficacy of COMPAs, an App Designed to Support Communication Between Persons Living With Dementia in Long-Term Care Settings and Their Caregivers: Mixed Methods Implementation Study JO - JMIR Aging SP - e47565 VL - 7 KW - dementia KW - communication KW - caregivers KW - technology KW - burden KW - mixed methods design KW - quality of life KW - mobile phone KW - tablet N2 - Background: Persons living with dementia experience autonomy loss and require caregiver support on a daily basis. Dementia involves a gradual decline in communication skills, leading to fewer interactions and isolation for both people living with dementia and their caregivers, negatively impacting the quality of life for both members of the dyad. The resulting stress and burden on caregivers make them particularly susceptible to burnout. Objective: This study aims to examine the efficacy of Communication Proches Aidants (COMPAs), an app designed following the principles of person-centered and emotional communication, which is intended to improve well-being in persons living with dementia and caregivers and reduce caregiver burden. Methods: In this implementation study, volunteer caregivers in 2 long-term care facilities (n=17) were trained in using COMPAs and strategies to improve communication with persons living with dementia. Qualitative and quantitative analyses, semistructured interviews, and questionnaires were completed before and after 8 weeks of intervention with COMPAs. Results: Semistructured interviews revealed that all caregivers perceived a positive impact following COMPAs interventions, namely, improved quality of communication and quality of life among persons living with dementia and caregivers. Improved quality of life was also supported by a statistically significant reduction in the General Health Questionnaire-12 scores (caregivers who improved: 9/17, 53%; z=2.537; P=.01). COMPAs interventions were also associated with a statistically significant increased feeling of personal accomplishment (caregivers improved: 11/17, 65%; t15=2.430; P=.03; d=0.61 [medium effect size]). Conclusions: COMPAs intervention improved well-being in persons living with dementia and their caregivers by developing person-centered communication within the dyad, increasing empathy, and reducing burden in caregivers although most caregivers were unfamiliar with technology. The results hold promise for COMPAs interventions in long-term care settings. Larger group-controlled studies with different populations, in different contexts, and at different stages of dementia will provide a clearer picture of the benefits of COMPAs interventions. UR - https://aging.jmir.org/2024/1/e47565 UR - http://dx.doi.org/10.2196/47565 UR - http://www.ncbi.nlm.nih.gov/pubmed/38963691 ID - info:doi/10.2196/47565 ER - TY - JOUR AU - Bratches, R. Reed W. AU - Cohen, Jeffrey AU - Carpenter-Song, Elizabeth AU - Mistler, Lisa AU - Barr, J. Paul PY - 2024/6/26 TI - The Feasibility and Acceptability of Sharing Video Recordings of Amyotrophic Lateral Sclerosis Clinical Encounters With Patients and Their Caregivers: Pilot Randomized Clinical Trial JO - JMIR Form Res SP - e57519 VL - 8 KW - feasibility KW - acceptability KW - amyotrophic lateral sclerosis KW - digital intervention KW - ALS KW - video recording N2 - Background: Multidisciplinary clinics (MDCs) provide benefits to patients with amyotrophic lateral sclerosis (ALS) and their caregivers, but MDC visits are information-heavy and can last 4 hours, with patients and caregivers meeting with multiple specialists within each MDC visit. There are questions about the effectiveness of current methods of sharing information from MDCs with patients. Video recordings are a promising new method of sharing information that may allow patients and caregivers to revisit the MDC and remind them of clinical recommendations and conversations. Objective: The objective of this trial is to determine the feasibility and acceptability of sharing information through video recordings of ALS MDC visits with patients and caregivers. Methods: This study was a randomized, controlled pilot trial with 3 months of follow-up from April 2021 to March 2022 in a rural multidisciplinary neurology clinic. We recruited patients with ALS, their caregivers, and their clinicians. Patients and their caregivers were randomized to either receive their normal after-visit summary (treatment as usual) or to receive their normal after-visit summary and a video recording of their MDC visit (video). Each specialist visit had its own recording and was accessible by patients and caregivers using a secure web-based platform called HealthPAL over a 3-month follow-up period. Primary study outcomes were feasibility and acceptability of the video intervention measured by recruitment rate (target: 70%), percentage of participants watching videos (target: 75%), and the Feasibility of Intervention Measure and Acceptability of Intervention Measure (targets: 3/5). We hypothesized that video recording would be feasible and acceptable to patients and their caregivers. Results: Of the 30 patients approached, 24 were recruited, while all caregivers (n=21) and clinicians (n=34) approached were recruited. A total of 144 specialist visits were recorded, approximately 12 specialist visits at a median of one MDC visit per patient. Of the recorded patients, 75% (9/12) viewed videos. High median intervention feasibility (4, SD 0.99) and acceptability (4, SD 1.22) of intervention measures were reported by patients and caregivers in the intervention arm. High median intervention feasibility (5, SD 0.21) and acceptability (4.88, SD 0.4) were reported by clinicians. Of the 24 patients, 50% (n=12) did not complete a 3-month follow-up, primarily due to death (n=10). Conclusions: Video recording is highly feasible and acceptable for patients, caregivers, and clinicians at a rural ALS clinic. Our level of attrition is a useful benchmark for future studies in MDC populations. Despite high rates of patient death, 1-week assessments highlight the value of recordings for both patients and caregivers. Trial Registration: ClinicalTrials.gov NCT04719403; https://clinicaltrials.gov/study/NCT04719403 UR - https://formative.jmir.org/2024/1/e57519 UR - http://dx.doi.org/10.2196/57519 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57519 ER - TY - JOUR AU - Wallman, Andy AU - Svärdsudd, Kurt AU - Bobits, Kent AU - Wallman, Thorne PY - 2024/6/26 TI - Antibiotic Prescribing by Digital Health Care Providers as Compared to Traditional Primary Health Care Providers: Cohort Study Using Register Data JO - J Med Internet Res SP - e55228 VL - 26 KW - telehealth prescribing KW - physical-primary health care KW - internet-primary health care KW - antibiotics KW - prescription KW - infectious disease KW - antibiotic KW - prescriptions KW - prescribing KW - telehealth KW - health care KW - traditional KW - digital KW - telemedicine KW - virtual care KW - Swedish KW - Sweden KW - primary care KW - quality of care KW - online setting KW - ePrescription KW - ePrescriptions KW - ePrescribing KW - eHealth KW - compare KW - comparison KW - online consultation KW - digital care KW - patient record KW - patient records KW - mobile phone N2 - Background:  ?Direct-to-consumer (DTC) telemedicine? is increasing worldwide and changing the map of primary health care (PHC). Virtual care has increased in the last decade and with the ongoing COVID-19 pandemic, patients? use of online care has increased even further. In Sweden, online consultations are a part of government-supported health care today, and there are several digital care providers on the Swedish market, which makes it possible to get in touch with a doctor within a few minutes. The fast expansion of this market has raised questions about the quality of primary care provided only in an online setting without any physical appointments. Antibiotic prescribing is a common treatment in PHC. Objective:  This study aimed to compare antibiotic prescribing between digital PHC providers (internet-PHC) and traditional physical PHC providers (physical-PHC) and to determine whether prescriptions for specific diagnoses differed between internet-PHC and physical-PHC appointments, adjusted for the effects of attained age at the time of appointment, gender, and time relative to the COVID-19 pandemic. Methods:  Antibiotic prescribing data based on Anatomical Therapeutic Chemical (ATC) codes were obtained for Region Sörmland residents from January 2020 until March 2021 from the Regional Administrative Office. In total, 160,238 appointments for 68,332 Sörmland residents were included (124,398 physical-PHC and 35,840 internet-PHC appointments). Prescriptions issued by internet-PHC or physical-PHC physicians were considered. Information on the appointment date, staff category serving the patient, ICD-10 (International Statistical Classification of Diseases, Tenth Revision) diagnosis codes, ATC codes of prescribed medicines, and patient-attained age and gender were used. Results:  A total of 160,238 health care appointments were registered, of which 18,433 led to an infection diagnosis. There were large differences in gender and attained age distributions among physical-PHC and internet-PHC appointments. Physical-PHC appointments peaked among patients aged 60-80 years while internet-PHC appointments peaked at 20-30 years of age for both genders. Antibiotics with the ATC codes J01A-J01X were prescribed in 9.3% (11,609/124,398) of physical-PHC appointments as compared with 6.1% (2201/35,840) of internet-PHC appointments. In addition, 61.3% (6412/10,454) of physical-PHC infection appointments resulted in antibiotic prescriptions, as compared with only 25.8% (2057/7979) of internet-PHC appointments. Analyses of the prescribed antibiotics showed that internet-PHC followed regional recommendations for all diagnoses. Physical-PHC also followed the recommendations but used a wider spectrum of antibiotics. The odds ratio of receiving an antibiotic prescription (after adjustments for attained age at the time of appointment, patient gender, and whether the prescription was issued before or during the COVID-19 pandemic) during an internet-PHC appointment was 0.23-0.39 as compared with a physical-PHC appointment. Conclusions:  Internet-PHC appointments resulted in a significantly lower number of antibiotics prescriptions than physical-PHC appointments, adjusted for the large differences in the characteristics of patients who consult internet-PHC and physical-PHC. Internet-PHC prescribers showed appropriate prescribing according to guidelines. UR - https://www.jmir.org/2024/1/e55228 UR - http://dx.doi.org/10.2196/55228 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55228 ER - TY - JOUR AU - Turnbull, Sophie AU - Cabral, Christie PY - 2024/6/25 TI - Inequalities in the Ability for People With Type 2 Diabetes and Prediabetes to Adapt to the Reduction in In-Person Health Support and Increased Use of Digital Support During the COVID-19 Pandemic and Beyond: Qualitative Study JO - JMIR Diabetes SP - e55201 VL - 9 KW - diabetes KW - diabetic KW - DM KW - diabetes mellitus KW - type 2 diabetes KW - type 1 diabetes KW - prediabetes KW - prediabetic KW - COVID-19 pandemic KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - severe acute respiratory syndrome KW - coronavirus infections KW - novel coronavirus KW - motivation KW - health inequalities KW - self-care KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - digital health KW - digital intervention KW - digital interventions KW - telemedicine KW - telehealth KW - virtual care KW - virtual health KW - virtual medicine KW - remote consultation KW - telephone consultation KW - video consultation KW - remote consultations KW - telephone consultations KW - video consultations N2 - Background: The COVID-19 pandemic created unprecedented challenges for people with type 2 diabetes (T2D) and prediabetes to access in-person health care support. Primary care teams accelerated plans to implement digital health technologies (DHTs), such as remote consultations and digital self-management. There is limited evidence about whether there were inequalities in how people with T2D and prediabetes adjusted to these changes. Objective: This study aimed to explore how people with T2D and prediabetes adapted to the reduction in in-person health support and the increased provision of support through DHTs during the COVID-19 pandemic and beyond. Methods: A purposive sample of people with T2D and prediabetes was recruited by text message from primary care practices that served low-income areas. Semistructured interviews were conducted by phone or video call, and data were analyzed thematically using a hybrid inductive and deductive approach. Results: A diverse sample of 30 participants was interviewed. There was a feeling that primary care had become harder to access. Participants responded to the challenge of accessing support by rationing or delaying seeking support or by proactively requesting appointments. Barriers to accessing health care support were associated with issues with using the total triage system, a passive interaction style with health care services, or being diagnosed with prediabetes at the beginning of the pandemic. Some participants were able to adapt to the increased delivery of support through DHTs. Others had lower capacity to use DHTs, which was caused by lower digital skills, fewer financial resources, and a lack of support to use the tools. Conclusions: Inequalities in motivation, opportunity, and capacity to engage in health services and DHTs lead to unequal possibilities for people with T2D and prediabetes to self-care and receive care during the COVID-19 pandemic. These issues can be addressed by proactive arrangement of regular checkups by primary care services and improving capacity for people with lower digital skills to engage with DHTs. UR - https://diabetes.jmir.org/2024/1/e55201 UR - http://dx.doi.org/10.2196/55201 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55201 ER - TY - JOUR AU - Wong, Chi-Wai David AU - Bonnici, Timothy AU - Gerry, Stephen AU - Birks, Jacqueline AU - Watkinson, J. Peter PY - 2024/6/20 TI - Effect of Digital Early Warning Scores on Hospital Vital Sign Observation Protocol Adherence: Stepped-Wedge Evaluation JO - J Med Internet Res SP - e46691 VL - 26 KW - vital signs KW - early warning score KW - track and trigger KW - electronic charting KW - stepped-wedge KW - vital KW - charting KW - documentation KW - deterioration KW - hospital management KW - clinical intervention KW - decision-making KW - patient risk KW - hospital KW - ICU KW - intensive care unit KW - UK KW - United Kingdom KW - intervention N2 - Background: Early warning scores (EWS) are routinely used in hospitals to assess a patient?s risk of deterioration. EWS are traditionally recorded on paper observation charts but are increasingly recorded digitally. In either case, evidence for the clinical effectiveness of such scores is mixed, and previous studies have not considered whether EWS leads to changes in how deteriorating patients are managed. Objective: This study aims to examine whether the introduction of a digital EWS system was associated with more frequent observation of patients with abnormal vital signs, a precursor to earlier clinical intervention. Methods: We conducted a 2-armed stepped-wedge study from February 2015 to December 2016, over 4 hospitals in 1 UK hospital trust. In the control arm, vital signs were recorded using paper observation charts. In the intervention arm, a digital EWS system was used. The primary outcome measure was time to next observation (TTNO), defined as the time between a patient?s first elevated EWS (EWS ?3) and subsequent observations set. Secondary outcomes were time to death in the hospital, length of stay, and time to unplanned intensive care unit admission. Differences between the 2 arms were analyzed using a mixed-effects Cox model. The usability of the system was assessed using the system usability score survey. Results: We included 12,802 admissions, 1084 in the paper (control) arm and 11,718 in the digital EWS (intervention) arm. The system usability score was 77.6, indicating good usability. The median TTNO in the control and intervention arms were 128 (IQR 73-218) minutes and 131 (IQR 73-223) minutes, respectively. The corresponding hazard ratio for TTNO was 0.99 (95% CI 0.91-1.07; P=.73). Conclusions: We demonstrated strong clinical engagement with the system. We found no difference in any of the predefined patient outcomes, suggesting that the introduction of a highly usable electronic system can be achieved without impacting clinical care. Our findings contrast with previous claims that digital EWS systems are associated with improvement in clinical outcomes. Future research should investigate how digital EWS systems can be integrated with new clinical pathways adjusting staff behaviors to improve patient outcomes. UR - https://www.jmir.org/2024/1/e46691 UR - http://dx.doi.org/10.2196/46691 UR - http://www.ncbi.nlm.nih.gov/pubmed/38900529 ID - info:doi/10.2196/46691 ER - TY - JOUR AU - Hartford, Anna AU - Stein, J. Dan PY - 2024/6/18 TI - The Machine Speaks: Conversational AI and the Importance of Effort to Relationships of Meaning JO - JMIR Ment Health SP - e53203 VL - 11 KW - artificial intelligence KW - AI KW - conversational AIs KW - generative AI KW - intimacy KW - human-machine interaction KW - interpersonal relationships KW - effort KW - psychotherapy KW - conversation UR - https://mental.jmir.org/2024/1/e53203 UR - http://dx.doi.org/10.2196/53203 UR - http://www.ncbi.nlm.nih.gov/pubmed/38889401 ID - info:doi/10.2196/53203 ER - TY - JOUR AU - Masanneck, Lars AU - Schmidt, Linea AU - Seifert, Antonia AU - Kölsche, Tristan AU - Huntemann, Niklas AU - Jansen, Robin AU - Mehsin, Mohammed AU - Bernhard, Michael AU - Meuth, G. Sven AU - Böhm, Lennert AU - Pawlitzki, Marc PY - 2024/6/14 TI - Triage Performance Across Large Language Models, ChatGPT, and Untrained Doctors in Emergency Medicine: Comparative Study JO - J Med Internet Res SP - e53297 VL - 26 KW - emergency medicine KW - triage KW - artificial intelligence KW - large language models KW - ChatGPT KW - untrained doctors KW - doctor KW - doctors KW - comparative study KW - digital health KW - personnel KW - staff KW - cohort KW - Germany KW - German N2 - Background: Large language models (LLMs) have demonstrated impressive performances in various medical domains, prompting an exploration of their potential utility within the high-demand setting of emergency department (ED) triage. This study evaluated the triage proficiency of different LLMs and ChatGPT, an LLM-based chatbot, compared to professionally trained ED staff and untrained personnel. We further explored whether LLM responses could guide untrained staff in effective triage. Objective: This study aimed to assess the efficacy of LLMs and the associated product ChatGPT in ED triage compared to personnel of varying training status and to investigate if the models? responses can enhance the triage proficiency of untrained personnel. Methods: A total of 124 anonymized case vignettes were triaged by untrained doctors; different versions of currently available LLMs; ChatGPT; and professionally trained raters, who subsequently agreed on a consensus set according to the Manchester Triage System (MTS). The prototypical vignettes were adapted from cases at a tertiary ED in Germany. The main outcome was the level of agreement between raters? MTS level assignments, measured via quadratic-weighted Cohen ?. The extent of over- and undertriage was also determined. Notably, instances of ChatGPT were prompted using zero-shot approaches without extensive background information on the MTS. The tested LLMs included raw GPT-4, Llama 3 70B, Gemini 1.5, and Mixtral 8x7b. Results: GPT-4?based ChatGPT and untrained doctors showed substantial agreement with the consensus triage of professional raters (?=mean 0.67, SD 0.037 and ?=mean 0.68, SD 0.056, respectively), significantly exceeding the performance of GPT-3.5?based ChatGPT (?=mean 0.54, SD 0.024; P<.001). When untrained doctors used this LLM for second-opinion triage, there was a slight but statistically insignificant performance increase (?=mean 0.70, SD 0.047; P=.97). Other tested LLMs performed similar to or worse than GPT-4?based ChatGPT or showed odd triaging behavior with the used parameters. LLMs and ChatGPT models tended toward overtriage, whereas untrained doctors undertriaged. Conclusions: While LLMs and the LLM-based product ChatGPT do not yet match professionally trained raters, their best models? triage proficiency equals that of untrained ED doctors. In its current form, LLMs or ChatGPT thus did not demonstrate gold-standard performance in ED triage and, in the setting of this study, failed to significantly improve untrained doctors? triage when used as decision support. Notable performance enhancements in newer LLM versions over older ones hint at future improvements with further technological development and specific training. UR - https://www.jmir.org/2024/1/e53297 UR - http://dx.doi.org/10.2196/53297 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875696 ID - info:doi/10.2196/53297 ER - TY - JOUR AU - Tyagi, Pranjal AU - Bouldin, D. Erin AU - Hathaway, A. Wendy AU - D'Arcy, Derek AU - Nasr, Zacharia Samer AU - Intrator, Orna AU - Dang, Stuti PY - 2024/6/14 TI - Preimplementation Evaluation of a Self-Directed Care Program in a Veterans Health Administration Regional Network: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e57341 VL - 13 KW - long-term institutional care KW - self-directed care KW - veteran directed care KW - veteran KW - veterans KW - institutional care KW - long term care KW - mixed-methods KW - caregivers KW - caregiver KW - United States KW - nursing home KW - homecare KW - community-based KW - home-based KW - unmet KW - pre-implementation KW - barriers KW - barrier KW - facilitators KW - facilitator KW - quantitative data N2 - Background: The Veteran-Directed Care (VDC) program serves to assist veterans at risk of long-term institutional care to remain at home by providing funding to hire veteran-selected caregivers. VDC is operated through partnerships between Department of Veterans Affairs (VA) Medical Centers (VAMCs) and third-party Aging and Disability Network Agency providers. Objective: We aim to identify facilitators, barriers, and adaptations in VDC implementation across 7 VAMCs in 1 region: Veterans Integrated Service Network (VISN) 8, which covers Florida, South Georgia, Puerto Rico, and the US Virgin Islands. We also attempted to understand leadership and stakeholder perspectives on VDC programs? reach and implementation and identify veterans served by VISN 8?s VDC programs and describe their home- and community-based service use. Finally, we want to compare veterans served by VDC programs in VISN 8 to the veterans served in VDC programs across the VA. This information is intended to be used to identify strategies and propose recommendations to guide VDC program expansion in VISN 8. Methods: The mixed methods study design encompasses electronically delivered surveys, semistructured interviews, and administrative data. It is guided by the Consolidated Framework for Implementation Research (CFIR version 2.0). Participants included the staff of VAMCs and partnering aging and disability network agencies across VISN 8, leadership at these VAMCs and VISN 8, veterans enrolled in VDC, and veterans who declined VDC enrollment and their caregivers. We interviewed selected VAMC site leaders in social work, Geriatrics and Extended Care, and the Caregiver Support Program. Each interviewee will be asked to complete a preinterview survey that includes information about their personal characteristics, experiences with the VDC program, and perceptions of program aspects according to the CFIR (version 2.0) framework. Participants will complete a semistructured interview that covers constructs relevant to the respondent and facilitators, barriers, and adaptations in VDC implementation at their site. Results: We will calculate descriptive statistics including means, SDs, and percentages for survey responses. Facilitators, barriers, number of patients enrolled, and staffing will also be presented. Interviews will be analyzed using rapid qualitative techniques guided by CFIR domains and constructs. Findings from VISN 8 will be collated to identify strategies for VDC expansion. We will use administrative data to describe veterans served by the programs in VISN 8. Conclusions: The VA has prioritized VDC rollout nationwide and this study will inform these expansion efforts. The findings from this study will provide information about the experiences of the staff, leadership, veterans, and caregivers in the VDC program and identify program facilitators and barriers. These results may be used to improve program delivery, facilitate growth within VISN 8, and inform new program establishment at other sites nationwide as the VDC program expands. International Registered Report Identifier (IRRID): DERR1-10.2196/57341 UR - https://www.researchprotocols.org/2024/1/e57341 UR - http://dx.doi.org/10.2196/57341 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875003 ID - info:doi/10.2196/57341 ER - TY - JOUR AU - Fisher, Emily AU - Venkatesan, Shreenila AU - Benevides, Pedro AU - Bertrand, Elodie AU - Brum, Schimidt Paula AU - El Baou, Céline AU - Ferri, P. Cleusa AU - Fossey, Jane AU - Jelen, Maria AU - Laks, Jerson AU - Liu, Lisa AU - Mograbi, C. Daniel AU - Natarajan, Nirupama AU - Naylor, Renata AU - Pantouli, Despina AU - Ramanujam, Vaishnavi AU - Rangaswamy, Thara AU - Santos de Carvalho, L. Raquel AU - Stoner, Charlotte AU - Vaitheswaran, Sridhar AU - Spector, Aimee PY - 2024/6/11 TI - Online Cognitive Stimulation Therapy for Dementia in Brazil and India: Acceptability, Feasibility, and Lessons for Implementation JO - JMIR Aging SP - e55557 VL - 7 KW - psychosocial KW - intervention KW - technology KW - COVID-19 KW - LMIC KW - low and middle income countries N2 - Background: Cognitive stimulation therapy (CST) is an evidence-based, group psychosocial intervention for people with dementia, and it has a positive impact on cognition and quality of life. CST has been culturally adapted for use globally. It was developed as a face-to-face intervention but has recently been adapted for online delivery. Objective: In this study, we aimed to explore the feasibility and acceptability of online or virtual CST (vCST) delivery in India and Brazil, emphasizing barriers and facilitators to implementation. Methods: A single-group, multisite, mixed methods, feasibility study was conducted, with nested qualitative interviews. Primary feasibility outcomes were recruitment rate, attendance, attrition, acceptability, and outcome measure completion. Exploratory pre- and postintervention measures, including cognition and quality of life, were assessed. Qualitative interviews were conducted with people with dementia, family caregivers, and group and organizational leaders following intervention delivery, and the data were analyzed using the Consolidated Framework for Implementation Research. Results: A total of 17 vCST group sessions with 59 participants were conducted for 7 weeks, with 53% (31/59) of participants attending all 14 sessions. Attrition rate was 7% (4/59), and outcome measure completion rate at follow-up was 68% (40/59). Interviews took place with 36 stakeholders. vCST was acceptable to participants and group leaders and enabled vital access to services during pandemic restrictions. While online services broadened geographic access, challenges emerged concerning inadequate computer literacy, poor technology access, and establishing interpersonal connections online. Exploratory, uncontrolled analyses indicated positive trends in quality of life but negative trends in cognition and activities of daily living, but these results were not statistically significant. Conclusions: vCST demonstrated feasibility and acceptability, serving as a crucial resource during the pandemic but raised challenges related to technology access, computer literacy, and long-term implementation. The study highlights the potential of vCST while emphasizing ongoing development and solutions to address implementation challenges. UR - https://aging.jmir.org/2024/1/e55557 UR - http://dx.doi.org/10.2196/55557 UR - http://www.ncbi.nlm.nih.gov/pubmed/38861708 ID - info:doi/10.2196/55557 ER - TY - JOUR AU - Tegenaw, Sahle Geletaw AU - Sori, Amenu Demisew AU - Teklemariam, Ketema Girum AU - Verbeke, Frank AU - Cornelis, Jan AU - Jansen, Bart PY - 2024/6/11 TI - Evaluation of a Computer-Aided Clinical Decision Support System for Point-of-Care Use in Low-Resource Primary Care Settings: Acceptability Evaluation Study JO - JMIR Hum Factors SP - e47631 VL - 11 KW - low-resource setting KW - clinical decision support system KW - point-of-care instrument KW - evaluation KW - user acceptance KW - structural equation modeling KW - partial least squares structural equation modeling KW - decision-making KW - decision making KW - decision support KW - caregiver KW - users KW - acceptance KW - system quality N2 - Background: A clinical decision support system (CDSS) based on the logic and philosophy of clinical pathways is critical for managing the quality of health care and for standardizing care processes. Using such a system at a point-of-care setting is becoming more frequent these days. However, in a low-resource setting (LRS), such systems are frequently overlooked. Objective: The purpose of the study was to evaluate the user acceptance of a CDSS in LRSs. Methods: The CDSS evaluation was carried out at the Jimma Health Center and the Jimma Higher Two Health Center, Jimma, Ethiopia. The evaluation was based on 22 parameters organized into 6 categories: ease of use, system quality, information quality, decision changes, process changes, and user acceptance. A Mann-Whitney U test was used to investigate whether the difference between the 2 health centers was significant (2-tailed, 95% CI; ?=.05). Pearson correlation and partial least squares structural equation modeling (PLS-SEM) was used to identify the relationship and factors influencing the overall acceptance of the CDSS in an LRS. Results: On the basis of 116 antenatal care, pregnant patient care, and postnatal care cases, 73 CDSS evaluation responses were recorded. We found that the 2 health centers did not differ significantly on 16 evaluation parameters. We did, however, detect a statistically significant difference in 6 parameters (P<.05). PLS-SEM results showed that the coefficient of determination, R2, of perceived user acceptance was 0.703. More precisely, the perceived ease of use (?=.015, P=.91) and information quality (?=.149, P=.25) had no positive effect on CDSS acceptance but, rather, on the system quality and perceived benefits of the CDSS, with P<.05 and ?=.321 and ?=.486, respectively. Furthermore, the perceived ease of use was influenced by information quality and system quality, with an R2 value of 0.479, indicating that the influence of information quality on the ease of use is significant but the influence of system quality on the ease of use is not, with ?=.678 (P<.05) and ?=.021(P=.89), respectively. Moreover, the influence of decision changes (?=.374, P<.05) and process changes (?=.749, P<.05) both was significant on perceived benefits (R2=0.983). Conclusions: This study concludes that users are more likely to accept and use a CDSS at the point of care when it is easy to grasp the perceived benefits and system quality in terms of health care professionals? needs. We believe that the CDSS acceptance model developed in this study reveals specific factors and variables that constitute a step toward the effective adoption and deployment of a CDSS in LRSs. UR - https://humanfactors.jmir.org/2024/1/e47631 UR - http://dx.doi.org/10.2196/47631 UR - http://www.ncbi.nlm.nih.gov/pubmed/38861298 ID - info:doi/10.2196/47631 ER - TY - JOUR AU - Oliveira, Alves Clara Rodrigues AU - Pires, Carvalho Magda AU - Meira, Cardoso Karina AU - de Jesus, Cristina Jordana AU - Borges, Nascimento Isabela AU - Paixão, Cristina Maria AU - Mendes, Santos Mayara AU - Ribeiro, Bonisson Leonardo AU - Marcolino, Soriano Milena AU - Alkmim, Moreira Maria Beatriz AU - Ribeiro, Pinho Antonio Luiz PY - 2024/6/10 TI - Effect of a Structured Multilevel Telehealth Service on Hospital Admissions and Mortality During COVID-19 in a Resource-Limited Region in Brazil: Retrospective Cohort Study JO - J Med Internet Res SP - e48464 VL - 26 KW - COVID-19 KW - telehealth KW - health care KW - clinical outcomes KW - hospital admission KW - mortality KW - adoption KW - effectiveness KW - digital health tool KW - flu KW - teleconsultation KW - digital health KW - digital literacy KW - telemonitoring N2 - Background: The COVID-19 pandemic represented a great stimulus for the adoption of telehealth and many initiatives in this field have emerged worldwide. However, despite this massive growth, data addressing the effectiveness of telehealth with respect to clinical outcomes remain scarce.  Objective: The aim of this study was to evaluate the impact of the adoption of a structured multilevel telehealth service on hospital admissions during the acute illness course and the mortality of adult patients with flu syndrome in the context of the COVID-19 pandemic. Methods: A retrospective cohort study was performed in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-MG) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through a chatbot software or phone call center, (2) teleconsultations with nurses and medical doctors, and (3) a telemonitoring system. For this analysis, we included data of adult patients registered in the Flu Syndrome notification databases who were diagnosed with flu syndrome between June 1, 2020, and May 31, 2021. The exposed group comprised patients with flu syndrome who used TeleCOVID-MG at least once during the illness course and the control group comprised patients who did not use this telehealth service during the respiratory illness course. Sociodemographic characteristics, comorbidities, and clinical outcomes data were extracted from the Brazilian official databases for flu syndrome, Severe Acute Respiratory Syndrome (due to any respiratory virus), and mortality. Models for the clinical outcomes were estimated by logistic regression. Results: The final study population comprised 82,182 adult patients with a valid registry in the Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4%), patients supported by TeleCOVID-MG (n=14,493, 17.6%) had a lower chance of hospitalization during the acute respiratory illness course, even after adjusting for sociodemographic characteristics and underlying medical conditions (odds ratio [OR] 0.82, 95% CI 0.71-0.94; P=.005). No difference in mortality was observed between groups (OR 0.99, 95% CI 0.86-1.12; P=.83). Conclusions: A telehealth service applied on a large scale in a limited-resource region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality rate. Quality health care using inexpensive and readily available telehealth and digital health tools may be delivered in areas with limited resources and should be considered as a potential and valuable health care strategy. The success of a telehealth initiative relies on a partnership between the involved stakeholders to define the roles and responsibilities; set an alignment between the different modalities and levels of health care; and address the usual drawbacks related to the implementation process, such as infrastructure and accessibility issues. UR - https://www.jmir.org/2024/1/e48464 UR - http://dx.doi.org/10.2196/48464 UR - http://www.ncbi.nlm.nih.gov/pubmed/38857068 ID - info:doi/10.2196/48464 ER - TY - JOUR AU - Goerss, Doreen AU - Köhler, Stefanie AU - Rong, Eleonora AU - Temp, Gesine Anna AU - Kilimann, Ingo AU - Bieber, Gerald AU - Teipel, Stefan PY - 2024/6/7 TI - Smartwatch-Based Interventions for People With Dementia: User-Centered Design Approach JO - JMIR Aging SP - e50107 VL - 7 KW - assistive technology KW - user-centered design KW - usability KW - dementia KW - smartwatch KW - mobile phone N2 - Background: Assistive technologies can help people living with dementia maintain their everyday activities. Nevertheless, there is a gap between the potential and use of these materials. Involving future users may help close this gap, but the impact on people with dementia is unclear. Objective: We aimed to determine if user-centered development of smartwatch-based interventions together with people with dementia is feasible. In addition, we evaluated the extent to which user feedback is plausible and therefore helpful for technological improvements. Methods: We examined the interactions between smartwatches and people with dementia or people with mild cognitive impairment. All participants were prompted to complete 2 tasks (drinking water and a specific cognitive task). Prompts were triggered using a smartphone as a remote control and were repeated up to 3 times if participants failed to complete a task. Overall, 50% (20/40) of the participants received regular prompts, and 50% (20/40) received intensive audiovisual prompts to perform everyday tasks. Participants? reactions were observed remotely via cameras. User feedback was captured via questionnaires, which included topics like usability, design, usefulness, and concerns. The internal consistency of the subscales was calculated. Plausibility was also checked using qualitative approaches. Results: Participants noted their preferences for particular functions and improvements. Patients struggled with rating using the Likert scale; therefore, we assisted them with completing the questionnaire. Usability (mean 78 out of 100, SD 15.22) and usefulness (mean 9 out of 12) were rated high. The smartwatch design was appealing to most participants (31/40, 76%). Only a few participants (6/40, 15%) were concerned about using the watch. Better usability was associated with better cognition. The observed success and self-rated task comprehension were in agreement for most participants (32/40, 80%). In different qualitative analyses, participants? responses were, in most cases, plausible. Only 8% (3/40) of the participants were completely unaware of their irregular task performance. Conclusions: People with dementia can have positive experiences with smartwatches. Most people with dementia provided valuable information. Developing assistive technologies together with people with dementia can help to prioritize the future development of functional and nonfunctional features. UR - https://aging.jmir.org/2024/1/e50107 UR - http://dx.doi.org/10.2196/50107 UR - http://www.ncbi.nlm.nih.gov/pubmed/38848116 ID - info:doi/10.2196/50107 ER - TY - JOUR AU - Thomas, Claire Donna AU - Litherland, Frances Eva AU - Masso, Sarah AU - Raymundo, Gianina AU - Keep, Melanie PY - 2024/6/7 TI - Clinicians? Decision-Making Regarding Telehealth Services: Focus Group Study in Pediatric Allied Health JO - JMIR Form Res SP - e46300 VL - 8 KW - telehealth KW - pediatric KW - allied health KW - focus group KW - decision-making KW - community-based KW - counseling KW - speech pathology KW - occupational therapy KW - clinical services N2 - Background: Many allied health services now provide both telehealth and in-person services following a rapid integration of telehealth as a response to the COVID-19 pandemic. However, little is known about how decisions are made about which clinical appointments to provide via telehealth versus in person. Objective: The aim of this study is to explore clinicians? decision-making when contemplating telehealth for their clients, including the factors they consider and how they weigh up these different factors, and the clinicians? perceptions of telehealth utility beyond COVID-19 lockdowns. Methods: We used reflexive thematic analysis with data collected from focus groups with 16 pediatric community?based allied health clinicians from the disciplines of speech-language pathology, occupational therapy, social work, psychology, and counseling. Results: The findings indicated that decision-making was complex with interactions across 4 broad categories: technology, clients and families, clinical services, and clinicians. Three themes described their perceptions of telehealth use beyond COVID-19 lockdowns: ?flexible telehealth use,? ?telehealth can be superior to in-person therapy,? and ?fear that in-person services may be replaced.? Conclusions: The findings highlight the complexity of decision-making in a community-allied health setting and the challenges experienced by clinicians when reconciling empirical evidence with their own clinical experience. UR - https://formative.jmir.org/2024/1/e46300 UR - http://dx.doi.org/10.2196/46300 UR - http://www.ncbi.nlm.nih.gov/pubmed/38848121 ID - info:doi/10.2196/46300 ER - TY - JOUR AU - Kabukye, K. Johnblack AU - Namagembe, Rosemary AU - Nakku, Juliet AU - Kiberu, Vincent AU - Sjölinder, Marie AU - Nilsson, Susanne AU - Wamala-Larsson, Caroline PY - 2024/6/6 TI - Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach JO - JMIR Hum Factors SP - e53976 VL - 11 KW - mHealth KW - mobile health KW - digital health KW - digital solution KW - digital solutions KW - digital intervention KW - digital interventions KW - mental health KW - awareness KW - Uganda KW - Africa KW - African KW - user centred KW - user centered KW - design KW - qualitative KW - focus group KW - focus groups KW - call centre KW - call centres KW - call center KW - call centers KW - mental KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - cocreated KW - cocreation KW - service KW - services KW - mobile phone N2 - Background: Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. Objective: This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. Methods: This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants? experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. Results: Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants? enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24×7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4%) calls stopped at the interactive voice response, 231 (64.7%) calls were answered by call agents, and 22 (6.2%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. Conclusions: This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption. UR - https://humanfactors.jmir.org/2024/1/e53976 UR - http://dx.doi.org/10.2196/53976 UR - http://www.ncbi.nlm.nih.gov/pubmed/38843515 ID - info:doi/10.2196/53976 ER - TY - JOUR AU - Martin, Tobias AU - Veldeman, Sarah AU - Großmann, Heidrun AU - Fuchs-Frohnhofen, Paul AU - Czaplik, Michael AU - Follmann, Andreas PY - 2024/6/6 TI - Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study JO - JMIR Aging SP - e55471 VL - 7 KW - telemedicine KW - televisits KW - telehealth KW - eHealth KW - electronic health KW - older adult care KW - nursing homes KW - change management KW - implementation science KW - technology transfer KW - innovation transfer KW - long-term adoption KW - COVID-19 crisis KW - postpandemic KW - coronavirus KW - digitalization N2 - Background: There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis. Objective: This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses? workload and their nursing practice. Methods: A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements. Results: In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs. Conclusions: Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine. UR - https://aging.jmir.org/2024/1/e55471 UR - http://dx.doi.org/10.2196/55471 UR - http://www.ncbi.nlm.nih.gov/pubmed/38842915 ID - info:doi/10.2196/55471 ER - TY - JOUR AU - Rzewuska Díaz, Magdalena AU - Locock, Louise AU - Keen, Andrew AU - Melvin, Mike AU - Myhill, Anthony AU - Ramsay, Craig PY - 2024/6/4 TI - Implementation of a Web-Based Outpatient Asynchronous Consultation Service: Mixed Methods Study JO - J Med Internet Res SP - e48092 VL - 26 KW - outpatient care KW - teleconsultation KW - asynchronous communication KW - implementation KW - mixed methods research KW - qualitative research KW - hospital data N2 - Background: Asynchronous outpatient patient-to-provider communication is expanding in UK health care, requiring evaluation. During the pandemic, Aberdeen Royal Infirmary in Scotland expanded its outpatient asynchronous consultation service from dermatology (deployed in May 2020) to gastroenterology and pain management clinics. Objective: We conducted a mixed methods study using staff, patient, and public perspectives and National Health Service (NHS) numerical data to obtain a rounded picture of innovation as it happened. Methods: Focus groups (3 web-based and 1 face-to-face; n=22) assessed public readiness for this service, and 14 interviews with staff focused on service design and delivery. The service?s effects were examined using NHS Grampian service use data, a patient satisfaction survey (n=66), and 6 follow-up patient interviews. Survey responses were descriptively analyzed. Demographics, acceptability, nonattendance rates, and appointment outcomes of users were compared across levels of area deprivation in which they live and medical specialties. Interviews and focus groups underwent theory-informed thematic analysis. Results: Staff anticipated a simple technical system transfer from dermatology to other receptive medical specialties, but despite a favorable setting and organizational assistance, it was complicated. Key implementation difficulties included pandemic-induced technical integration delays, misalignment with existing administrative processes, and discontinuity in project management. The pain management clinic began asynchronous consultations (digital appointments) in December 2021, followed by the gastroenterology clinic in February 2022. Staff quickly learned how to explain and use this service. It was thought to function better for pain management as it fitted preexisting practices. From May to September 2022, the dermatology (adult and pediatric), gastroenterology, and pain management clinics offered 1709 appointments to a range of patients (n=1417). Digital appointments reduced travel by an estimated 44,712 miles (~71,956.81 km) compared to the face-to-face mode. The deprivation profile of people who chose to use this service closely mirrored that of NHS Grampian?s population overall. There was no evidence that deprivation impacted whether digital appointment users subsequently received treatment. Only 18% (12/66) of survey respondents were unhappy or very unhappy with being offered a digital appointment. The benefits mentioned included better access, convenience, decreased travel and waiting time, information sharing, and clinical flexibility. Overall, patients, the public, and staff recognized its potential as an NHS service but highlighted informed choice and flexibility. Better communication?including the use of the term assessment instead of appointment?may increase patient acceptance. Conclusions: Asynchronous pain management and gastroenterology consultations are viable and acceptable. Implementing this service is easiest when existing administrative processes face minimal disruption, although continuous support is needed. This study can inform practical strategies for supporting staff in adopting asynchronous consultations (eg, preparing for nonlinearity and addressing task issues). Patients need clear explanations and access to technical support, along with varied consultation options, to ensure digital inclusion. UR - https://www.jmir.org/2024/1/e48092 UR - http://dx.doi.org/10.2196/48092 UR - http://www.ncbi.nlm.nih.gov/pubmed/38833695 ID - info:doi/10.2196/48092 ER - TY - JOUR AU - Turnbull, Joanne AU - Prichard, Jane AU - MacLellan, Jennifer AU - Pope, Catherine PY - 2024/6/4 TI - eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey JO - J Med Internet Res SP - e50376 VL - 26 KW - urgent care KW - digital health KW - access to health care KW - eHealth KW - health care system KW - COVID-19 KW - urgent KW - emergency KW - health literacy KW - eHealth literacy KW - digital literacy KW - access KW - cross-sectional N2 - Background: Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. ?Digital first? may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. Objective: This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. Methods: A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. Results: Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (?12=138.57; P<.001). Conclusions: These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand. UR - https://www.jmir.org/2024/1/e50376 UR - http://dx.doi.org/10.2196/50376 UR - http://www.ncbi.nlm.nih.gov/pubmed/38833297 ID - info:doi/10.2196/50376 ER - TY - JOUR AU - Ewoh, Pius AU - Vartiainen, Tero PY - 2024/5/31 TI - Vulnerability to Cyberattacks and Sociotechnical Solutions for Health Care Systems: Systematic Review JO - J Med Internet Res SP - e46904 VL - 26 KW - health care systems KW - cybersecurity KW - sociotechnical KW - medical device KW - secure systems development KW - training KW - ransomware KW - data breaches KW - protected health information KW - patient safety N2 - Background: Health care organizations worldwide are faced with an increasing number of cyberattacks and threats to their critical infrastructure. These cyberattacks cause significant data breaches in digital health information systems, which threaten patient safety and privacy. Objective: From a sociotechnical perspective, this paper explores why digital health care systems are vulnerable to cyberattacks and provides sociotechnical solutions through a systematic literature review (SLR). Methods: An SLR using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted by searching 6 databases (PubMed, Web of Science, ScienceDirect, Scopus, Institute of Electrical and Electronics Engineers, and Springer) and a journal (Management Information Systems Quarterly) for articles published between 2012 and 2022 and indexed using the following keywords: ?(cybersecurity OR cybercrime OR ransomware) AND (healthcare) OR (cybersecurity in healthcare).? Reports, review articles, and industry white papers that focused on cybersecurity and health care challenges and solutions were included. Only articles published in English were selected for the review. Results: In total, 5 themes were identified: human error, lack of investment, complex network-connected end-point devices, old legacy systems, and technology advancement (digitalization). We also found that knowledge applications for solving vulnerabilities in health care systems between 2012 to 2022 were inconsistent. Conclusions: This SLR provides a clear understanding of why health care systems are vulnerable to cyberattacks and proposes interventions from a new sociotechnical perspective. These solutions can serve as a guide for health care organizations in their efforts to prevent breaches and address vulnerabilities. To bridge the gap, we recommend that health care organizations, in partnership with educational institutions, develop and implement a cybersecurity curriculum for health care and intelligence information sharing through collaborations; training; awareness campaigns; and knowledge application areas such as secure design processes, phase-out of legacy systems, and improved investment. Additional studies are needed to create a sociotechnical framework that will support cybersecurity in health care systems and connect technology, people, and processes in an integrated manner. UR - https://www.jmir.org/2024/1/e46904 UR - http://dx.doi.org/10.2196/46904 UR - http://www.ncbi.nlm.nih.gov/pubmed/38820579 ID - info:doi/10.2196/46904 ER - TY - JOUR AU - Seuren, Martinus Lucas AU - Shaw, Sara PY - 2024/5/31 TI - How Informal Carers Support Video Consulting in Physiotherapy, Heart Failure, and Cancer: Qualitative Study Using Linguistic Ethnography JO - J Med Internet Res SP - e51695 VL - 26 KW - delivery of health care KW - remote consultation KW - carer KW - telemedicine KW - videoconferencing KW - language KW - linguistics KW - gestures KW - physiotherapy KW - heart failure KW - care KW - patient care KW - feasibility KW - safety KW - communication KW - mobile phone N2 - Background: Informal carers play an important role in the everyday care of patients and the delivery of health care services. They aid patients in transportation to and from appointments, and they provide assistance during the appointments (eg, answering questions on the patient?s behalf). Video consultations are often seen as a way of providing patients with easier access to care. However, few studies have considered how this affects the role of informal carers and how they are needed to make video consultations safe and feasible. Objective: This study aims to identify how informal carers, usually friends or family who provide unpaid assistance, support patients and clinicians during video consultations. Methods: We conducted an in-depth analysis of the communication in a sample of video consultations drawn from 7 clinical settings across 4 National Health Service Trusts in the United Kingdom. The data set consisted of 52 video consultation recordings (of patients with diabetes, gestational diabetes, cancer, heart failure, orthopedic problems, long-term pain, and neuromuscular rehabilitation) and interviews with all participants involved in these consultations. Using Linguistic Ethnography, which embeds detailed analysis of verbal and nonverbal communication in the context of the interaction, we examined the interactional, technological, and clinical work carers did to facilitate video consultations and help patients and clinicians overcome challenges of the remote and video-mediated context. Results: Most patients (40/52, 77%) participated in the video consultation without support from an informal carer. Only 23% (12/52) of the consultations involved an informal carer. In addition to facilitating the clinical interaction (eg, answering questions on behalf of the patient), we identified 3 types of work that informal carers did: facilitating the use of technology; addressing problems when the patient could not hear or understand the clinician; and assisting with physical examinations, acting as the eyes, ears, and hands of the clinician. Carers often stayed in the background, monitoring the consultation to identify situations where they might be needed. In doing so, copresent carers reassured patients and helped them conduct the activities that make up a consultation. However, carers did not necessarily help patients solve all the challenges of a video consultation (eg, aiming the camera while laying hands on the patient during an examination). We compared cases where an informal carer was copresent with cases where the patient was alone, which showed that carers provided an important safety net, particularly for patients who were frail and experienced mobility difficulties. Conclusions: Informal carers play a critical role in making video consultations safe and feasible, particularly for patients with limited technological experience or complex needs. Guidance and research on video consulting need to consider the availability and work done by informal carers and how they can be supported in providing patients access to digital health care services. UR - https://www.jmir.org/2024/1/e51695 UR - http://dx.doi.org/10.2196/51695 UR - http://www.ncbi.nlm.nih.gov/pubmed/38819900 ID - info:doi/10.2196/51695 ER - TY - JOUR AU - Meng, Yingying AU - Yu, Ran AU - Bai, Huixin AU - Han, Junqiang PY - 2024/5/30 TI - Evidence From the China Family Panel Studies Survey on the Effect of Integrating the Basic Medical Insurance System for Urban and Rural Residents on the Health Equity of Residents: Difference-in-Differences Analysis JO - JMIR Public Health Surveill SP - e50622 VL - 10 KW - medical insurance system integration KW - Urban and Rural Resident Basic Medical Insurance KW - URRBMI KW - urban and rural residents KW - health equity KW - China KW - difference-in-differences KW - DID KW - staggered DID N2 - Background: The fragmentation of the medical insurance system is a major challenge to achieving health equity. In response to this problem, the Chinese government is pushing to establish the unified Urban and Rural Resident Basic Medical Insurance (URRBMI) system by integrating the New Rural Cooperative Medical Scheme and the Urban Resident Basic Medical Insurance. By the end of 2020, URRBMI had been implemented almost entirely across China. Has URRBMI integration promoted health equity for urban and rural residents? Objective: This study aims to examine the effect of URRBMI integration on the health level of residents and whether the integration can contribute to reducing health disparities and promoting health equity. Methods: We used the staggered difference-in-differences method based on the China Family Panel Studies survey from 2014 to 2018. Our study had a nationally representative sample of 27,408 individuals from 98 cities. We chose self-rated health as the measurement of health status. In order to more accurately discern whether the sample was covered by URRBMI, we obtained the exact integration time of URRBMI according to the official documents issued by local governments. Finally, we grouped the sample by urban and rural areas, regions, and household income to examine the impact of the integration on health equity. Results: We found that overall, the URRBMI integration has improved the health level of Chinese residents (B=0.066, 95% CI 0.014-0.123; P=.01). In terms of health equity, the results showed that first, the integration has improved the health level of rural residents (B=0.070, 95% CI 0.012-0.128; P=.02), residents in western China (B=0.159, 95% CI 0.064-0.255; P<.001), and lower-middle-income groups (B=0.113, 95% CI 0.004-0.222, P=.04), so the integration has played a certain role in narrowing the health gap between urban and rural areas, different regions, and different income levels. Through further mechanism analysis, we found that the URRBMI integration reduced health inequity in China by facilitating access to higher-rated hospitals and increasing reimbursement rates for medical expenses. However, the integration did not improve the health of the central region and low-income groups, and the lack of access to health care for low-income groups was not effectively reduced. Conclusions: The role of URRBMI integration in promoting health equity among urban and rural residents was significant (P=.02), but in different regions and income groups, it was limited. Focusing on the rational allocation of medical resources between regions and increasing the policy tilt toward low-income groups could help improve the equity of health insurance integration. UR - https://publichealth.jmir.org/2024/1/e50622 UR - http://dx.doi.org/10.2196/50622 UR - http://www.ncbi.nlm.nih.gov/pubmed/38815256 ID - info:doi/10.2196/50622 ER - TY - JOUR AU - Wei, Xia AU - Yu, Shubin AU - Li, (Victor) Changxu PY - 2024/5/30 TI - Influence of Physical Attractiveness and Gender on Patient Preferences in Digital Doctor Consultations: Experimental Study JO - J Med Internet Res SP - e46551 VL - 26 KW - digital doctor consultations KW - health care providers KW - gender stereotype KW - physical attractiveness KW - qualification information KW - experimental KW - telemedicine KW - digital consultation KW - disease severity KW - sex KW - gender KW - gender stereotypes KW - digital health N2 - Background: The rise of digital health services, particularly digital doctor consultations, has created a new paradigm in health care choice. While patients traditionally rely on digital reviews or referrals to select health care providers, the digital context often lacks such information, leading to reliance on visual cues such as profile pictures. Previous research has explored the impact of physical attractiveness in general service settings but is scant in the context of digital health care. Objective: This study aims to fill the research gap by investigating how a health care provider?s physical attractiveness influences patient preferences in a digital consultation setting. We also examine the moderating effects of disease severity and the availability of information on health care providers? qualifications. The study uses signal theory and the sexual attribution bias framework to understand these dynamics. Methods: Three experimental studies were conducted to examine the influence of health care providers? physical attractiveness and gender on patient preferences in digital consultations. Study 1 (n=282) used a 2×2 between-subjects factorial design, manipulating doctor attractiveness and gender. Study 2 (n=158) focused on women doctors and manipulated disease severity and participant gender. Study 3 (n=150) replicated study 2 but added information about the providers? abilities. Results: This research found that patients tend to choose attractive doctors of the opposite gender but are less likely to choose attractive doctors of the same gender. In addition, our studies revealed that such an effect is more prominent when the disease severity is high. Furthermore, the influence of gender stereotypes is mitigated in both the high and low disease severity conditions when service providers? qualification information is present. Conclusions: This research contributes to the literature on medical information systems research and sheds light on what information should be displayed on digital doctor consultation platforms. To counteract stereotype-based attractiveness biases, health care platforms should consider providing comprehensive qualification information alongside profile pictures. UR - https://www.jmir.org/2024/1/e46551 UR - http://dx.doi.org/10.2196/46551 UR - http://www.ncbi.nlm.nih.gov/pubmed/38814690 ID - info:doi/10.2196/46551 ER - TY - JOUR AU - Nabelsi, Véronique AU - Lévesque-Chouinard, Annabelle PY - 2024/5/30 TI - Successful Electronic Consultation Service Initiative in Quebec, Canada With Primary Care Physicians? and Specialists? Experiences on Acceptance and Use of Technological Innovation: Cross-Sectional Exploratory Study JO - JMIR Form Res SP - e52921 VL - 8 KW - eConsult KW - electronic consultation KW - digital health solutions KW - primary care providers KW - specialists KW - United Theory of Acceptance and Use of Technology KW - UTAUT KW - Task-Technology Fit KW - TTF KW - technology acceptance N2 - Background: Electronic consultation (eConsult) is an eHealth service that allows primary care providers (PCPs) to electronically consult specialists regarding their patients? medical issues. Many studies have demonstrated that eConsult services improve timely access to specialist care; prevent unnecessary referrals; improve PCPs?, specialists?, and patients? satisfaction; and therefore have a large impact on costs. However, no studies have evaluated PCPs? and specialists? acceptance of eConsult services in Quebec, Canada, and worldwide. Objective: This exploratory study aims to identify factors affecting eConsult service acceptance by PCPs and specialists in urban and rural primary care clinics across 3 regions in the province of Quebec, Canada, by integrating the Unified Theory of Acceptance and Use of Technology and Task-Technology Fit (TTF) models and user satisfaction. This research was designed to broaden and assist in scaling up this effective eHealth service innovation across the province. Methods: A cross-sectional web-based survey was sent to all PCPs (n=263) and specialists (n=62) who used the eConsult Quebec Service between July 2017 and May 2021. We proposed a unified model integrating the Unified Theory of Acceptance and Use of Technology model and TTF model and user satisfaction by endorsing 11 hypotheses. The partial least squares was used to investigate factors influencing the acceptance of the eConsult Quebec Service. Results: Of the 325 end users, 136 (41.8%) users responded (PCPs: 101/263, 38.4%; specialists: 35/62, 57%). The results of the analysis with partial least squares method indicate that 9 of our 11 hypotheses are supported. The direct relationships uniting the various constructs of the model highlighted the importance of several key constructs and predominant correlations. The results suggest that satisfaction is the key driver behind the use of the eConsult Quebec Service. Performance expectancy (P<.001) and effort expectancy (P=.03) can have a positive impact on behavioral intention (BI), and BI (P<.001) can impact adoption. TTF has an influence on performance expectancy (P<.001), adoption (P=.02), and satisfaction (P<.001). However, the results show that there is no direct effect between social influence (P=.38) and BI or between facilitating conditions (P=.17) and adoption. Conclusions: This study provides a better understanding of the factors influencing PCPs? and specialists? intention to adopt the eConsult Quebec Service. Furthermore, this study tests a research model and a technology that have never been explored in Quebec until now. On the basis of the results, the service is a good fit to meet the users? need to improve access to specialized medical advice. Therefore, the results of our study have made a valuable contribution to the implementation of the service by policy makers in order to maximize acceptance, use, adoption, and success across the province of Quebec. Moreover, after 4 successful years, the eConsult Quebec pilot project is now the Conseil Numérique digital consultation service. UR - https://formative.jmir.org/2024/1/e52921 UR - http://dx.doi.org/10.2196/52921 UR - http://www.ncbi.nlm.nih.gov/pubmed/38814689 ID - info:doi/10.2196/52921 ER - TY - JOUR AU - Albright, Liam AU - Ko, Woojin AU - Buvanesh, Meyhaa AU - Haraldsson, Harald AU - Polubriaginof, Fernanda AU - Kuperman, J. Gilad AU - Levy, Michelle AU - Sterling, R. Madeline AU - Dell, Nicola AU - Estrin, Deborah PY - 2024/5/30 TI - Opportunities and Challenges for Augmented Reality in Family Caregiving: Qualitative Video Elicitation Study JO - JMIR Form Res SP - e56916 VL - 8 KW - augmented reality KW - extended reality KW - family caregiver KW - home care KW - virtual care KW - telemedicine KW - telehealth KW - oncology KW - artificial intelligence KW - mobile phone N2 - Background: Although family caregivers play a critical role in care delivery, research has shown that they face significant physical, emotional, and informational challenges. One promising avenue to address some of caregivers? unmet needs is via the design of digital technologies that support caregivers? complex portfolio of responsibilities. Augmented reality (AR) applications, specifically, offer new affordances to aid caregivers as they perform care tasks in the home. Objective: This study explored how AR might assist family caregivers with the delivery of home-based cancer care. The specific objectives were to shed light on challenges caregivers face where AR might help, investigate opportunities for AR to support caregivers, and understand the risks of AR exacerbating caregiver burdens. Methods: We conducted a qualitative video elicitation study with clinicians and caregivers. We created 3 video elicitations that offer ways in which AR might support caregivers as they perform often high-stakes, unfamiliar, and anxiety-inducing tasks in postsurgical cancer care: wound care, drain care, and rehabilitative exercise. The elicitations show functional AR applications built using Unity Technologies software and Microsoft Hololens2. Using elicitations enabled us to avoid rediscovering known usability issues with current AR technologies, allowing us to focus on high-level, substantive feedback on potential future roles for AR in caregiving. Moreover, it enabled nonintrusive exploration of the inherently sensitive in-home cancer care context. Results: We recruited 22 participants for our study: 15 clinicians (eg, oncologists and nurses) and 7 family caregivers. Our findings shed light on clinicians? and caregivers? perceptions of current information and communication challenges caregivers face as they perform important physical care tasks as part of cancer treatment plans. Most significant was the need to provide better and ongoing support for execution of caregiving tasks in situ, when and where the tasks need to be performed. Such support needs to be tailored to the specific needs of the patient, to the stress-impaired capacities of the caregiver, and to the time-constrained communication availability of clinicians. We uncover opportunities for AR technologies to potentially increase caregiver confidence and reduce anxiety by supporting the capture and review of images and videos and by improving communication with clinicians. However, our findings also suggest ways in which, if not deployed carefully, AR technologies might exacerbate caregivers? already significant burdens. Conclusions: These findings can inform both the design of future AR devices, software, and applications and the design of caregiver support interventions based on already available technology and processes. Our study suggests that AR technologies and the affordances they provide (eg, tailored support, enhanced monitoring and task accuracy, and improved communications) should be considered as a part of an integrated care journey involving multiple stakeholders, changing information needs, and different communication channels that blend in-person and internet-based synchronous and asynchronous care, illness, and recovery. UR - https://formative.jmir.org/2024/1/e56916 UR - http://dx.doi.org/10.2196/56916 UR - http://www.ncbi.nlm.nih.gov/pubmed/38814705 ID - info:doi/10.2196/56916 ER - TY - JOUR AU - Cermak, A. Carly AU - Read, Heather AU - Jeffs, Lianne PY - 2024/5/28 TI - Health Care Professionals? Experiences With Using Information and Communication Technologies in Patient Care During the COVID-19 Pandemic: Qualitative Study JO - JMIR Form Res SP - e53056 VL - 8 KW - COVID-19 KW - information and communication technology KW - health care provider experiences KW - web-based care KW - interview N2 - Background: The COVID-19 pandemic acted as a catalyst for the use of information and communication technology (ICT) in inpatient and outpatient health care settings. Digital tools were used to connect patients, families, and providers amid visitor restrictions, while web-based platforms were used to continue care amid COVID-19 lockdowns. What we have yet to learn is the experiences of health care providers (HCPs) regarding the use of ICT that supported changes to clinical care during the COVID-19 pandemic. Objective: The aim of this paper was to describe the experiences of HCPs in using ICT to support clinical care changes during the COVID-19 pandemic. This paper is reporting on a subset of a larger body of data that examined changes to models of care during the pandemic. Methods: This study used a qualitative, descriptive study design. In total, 30 HCPs were recruited from 3 hospitals in Canada. One-on-one semistructured interviews were conducted between December 2022 and June 2023. Qualitative data were analyzed using an inductive thematic approach to identify themes across participants. Results: A total of 30 interviews with HCPs revealed 3 themes related to their experiences using ICT to support changes to clinical care during the COVID-19 pandemic. These included the use of ICT (1) to support in-person communication with patients, (2) to facilitate connection between provider to patient and patient to family, and (3) to provide continuity of care. Conclusions: HCP narratives revealed the benefits of digital tools to support in-person communication between patient and provider, the need for thoughtful consideration for the use of ICT at end-of-life care, and the decision-making that is needed when choosing service delivery modality (eg, web based or in person). Moving forward, organizations are encouraged to provide education and training on how to support patient-provider communication, find ways to meet patient and family wishes at end-of-life care, and continue to give autonomy to HCPs in their clinical decision-making regarding service delivery modality. UR - https://formative.jmir.org/2024/1/e53056 UR - http://dx.doi.org/10.2196/53056 UR - http://www.ncbi.nlm.nih.gov/pubmed/38805250 ID - info:doi/10.2196/53056 ER - TY - JOUR AU - Batterham, J. Philip AU - Gulliver, Amelia AU - Heffernan, Cassandra AU - Calear, L. Alison AU - Werner-Seidler, Aliza AU - Turner, Alyna AU - Farrer, M. Louise AU - Chatterton, Lou Mary AU - Mihalopoulos, Cathrine AU - Berk, Michael PY - 2024/5/24 TI - A Brief Workplace Training Program to Support Help-Seeking for Mental Ill-Health: Protocol for the Helipad Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e55529 VL - 13 KW - help seeking KW - mental health KW - workplace KW - employee KW - implementation KW - internet KW - psychiatry KW - psychology KW - mobile phone N2 - Background: Most people with mental health problems do not seek help, with delays of even decades in seeking professional help. Lack of engagement with professional mental health services can lead to poor outcomes and functional impairment. However, few effective interventions have been identified to improve help-seeking in adults, and those that exist are not widely implemented to deliver public health impact. Co-designing interventions with people with lived experience of mental ill-health and other relevant stakeholders is critical to increase the likelihood of uptake and engagement with these programs. Objective: This study aims to (1) test the effectiveness of a co-designed help-seeking program on increasing professional help-seeking intentions in employees in a workplace setting; (2) determine whether the program reduces mental illness stigma and improves help-seeking intentions and behavior, mental health literacy, mental health symptoms, and work and activity functioning relative to the control condition; (3) explore factors that facilitate broader implementation of the co-designed program; and (4) explore the cost-effectiveness of the co-designed program compared to the control condition over 6 months. Methods: A 2-arm cluster randomized controlled trial will be conducted (target sample: N=900 from 30 to 36 workplaces, with n=25 to 35 participants per workplace). The trial will compare the relative effectiveness of an enhanced interactive program (intervention condition) with a standard psychoeducation-alone program (active control condition) on the primary outcome of professional help-seeking intentions as measured by the General Help-Seeking Questionnaire. Secondary outcomes include the impact on mental illness stigma; mental health literacy; help-seeking attitudes and behavior; work and activity functioning; quality of life; and symptoms of mental ill-health including depression, anxiety, and general psychological distress. Results: Facilitators of and risks to the trial are identified and addressed in this protocol. Recruitment of workplaces is scheduled to commence in the first quarter of 2024. Conclusions: If effective, the program has the potential to be ready for rapid dissemination throughout Australia, with the potential to increase appropriate and efficient service use across the spectrum of evidence-based services. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000270617p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385376 International Registered Report Identifier (IRRID): PRR1-10.2196/55529 UR - https://www.researchprotocols.org/2024/1/e55529 UR - http://dx.doi.org/10.2196/55529 UR - http://www.ncbi.nlm.nih.gov/pubmed/38787608 ID - info:doi/10.2196/55529 ER - TY - JOUR AU - Glassman, Jill AU - Humphreys, L. Kathryn AU - Jauregui, Adam AU - Milstein, Arnold AU - Sanders, Lee PY - 2024/5/22 TI - Evidence for Changes in Screen Use in the United States During Early Childhood Related to COVID-19 Pandemic Parent Stressors: Repeated Cross-Sectional Study JO - JMIR Pediatr Parent SP - e43315 VL - 7 KW - child health KW - parent-child relationship KW - screen time KW - technoference KW - health equity N2 - Background: The COVID-19 pandemic transformed the home lives of many families in the United States, especially those with young children. Understanding the relationship between child and parent screen time and family stressors exacerbated by the pandemic may help inform interventions that aim to support early child development. Objective: We aim to assess the changing relationship between family screen time and factors related to pandemic-induced remote work and childcare or school closures. Methods: In the spring of 2021 we administered a survey, similar to one administered in the spring of 2019, to a national sample of parents of young children (aged 6 to 60 months). Using iterative sampling with propensity scores, we recruited participants whose sociodemographic characteristics matched the 2019 survey. Participants were aged >18 years, proficient in English or Spanish, and residing in the United States. The main outcomes were changes in child screen time (eg, mobile phone, tablet, computer, and television) and parenting technoference, defined as perceived screen-related interference with parent-child interactions. Additional survey items reported pandemic-related job loss, and changes to work hours, work location, caregiving responsibilities, day care or school access, and family health and socioeconomic status. Results: We enrolled 280 parents, from diverse backgrounds. Parents reported pandemic-related changes in child screen time (mean increase of 1.1, SD 0.9 hours), and greater parenting technoference (3.0 to 3.4 devices interfering per day; P=.01). Increased child screen time and parenting technoference were highest for parents experiencing job loss (mean change in child screen time 1.46, SD 1.03; mean parenting technoference score 3.89, SD 2.05), second highest for working parents who did not lose their job (mean change in child screen time 1.02, SD 0.83; mean parenting technoference score 3.37, SD 1.94), and lowest for nonworking parents (mean change in child screen time 0.68, SD 0.66; mean parenting technoference score 2.66, SD 1.70), with differences significant at P<.01. School closure and job loss were most associated with increased child screen time during the pandemic after controlling for other stressors and sociodemographic characteristics (d=0.52, P<.001; d=0.31, P=.01). Increased child screen time and school closure were most associated with increased parenting technoference (d=0.78, P<.001; d=0.30, P=.01). Conclusions: Work and school changes due to the COVID-19 pandemic were associated with increased technology interference in the lives of young children. This study adds to our understanding of the interaction between technology use at home and social factors that are necessary to support early childhood health and development. It also supports possible enhanced recommendations for primary care providers and childcare educators to guide parents in establishing home-based ?screen time rules? not only for their children but also for themselves. UR - https://pediatrics.jmir.org/2024/1/e43315 UR - http://dx.doi.org/10.2196/43315 UR - http://www.ncbi.nlm.nih.gov/pubmed/38446995 ID - info:doi/10.2196/43315 ER - TY - JOUR AU - Scheibl, Fiona AU - Boots, Lizzy AU - Eley, Ruth AU - Fox, Christopher AU - Gracey, Fergus AU - Harrison Dening, Karen AU - Oyebode, Jan AU - Penhale, Bridget AU - Poland, Fiona AU - Ridel, Gemma AU - West, Juniper AU - Cross, L. Jane PY - 2024/5/22 TI - Adapting a Dutch Web-Based Intervention to Support Family Caregivers of People With Dementia in the UK Context: Accelerated Experience-Based Co-Design JO - JMIR Form Res SP - e52389 VL - 8 KW - adaptation KW - caregivers KW - dementia KW - intervention KW - web-based resources KW - United Kingdom KW - co-design KW - web-based intervention KW - support KW - carer KW - caregiver KW - family carer KW - community-based KW - services KW - web-based support KW - staff KW - self-help, web-based N2 - Background: Around 700,000 family caregivers provide unpaid care for 900,000 people living with dementia in the United Kingdom. Few family caregivers receive support for their own psychological needs and funding for community respite services has declined. These trends are seen across Europe as demographic and budgetary pressures have intensified due to public spending cuts arising from the 2008 financial crisis and the COVID-19 pandemic. The World Health Organization has prioritized the need to expand the provision of support for caregivers and families of people with dementia by 2025. Web-based interventions have the potential for development as they require modest investment and can be accessed by family caregivers at home. Further cost benefits can be realized by adapting existing interventions with demonstrated effectiveness for new contexts. This paper reports initial findings from the CareCoach study, which is adapting Partner in Balance (PiB), a web-based coaching intervention developed in the Netherlands, for family caregivers in the United Kingdom. Objective: This study aims to work with unpaid family caregivers and staff in adapting the Dutch web-based support tool PiB to improve its acceptability and usability for use in the United Kingdom. Methods: Accelerated Experience-Based Co-Design (AEBCD) was used with caregivers, staff, and core stakeholders. Interviews, workshops, and stakeholder consultations were conducted. Data were analyzed iteratively. Recommendations for the redesign of PiB for use across the United Kingdom were adjudicated by the study Adaptation Working Party. Results: Sixteen caregivers and 17 staff took part in interviews. Thirteen caregivers and 17 staff took part in workshops. Most (n=26) participants were White, female, and retired. All except 4 caregivers (2 male and 2 female) found the PiB?s offer of web-based self-help learning acceptable. Caregivers identified complexity and lack of inclusivity in some wording and video resources as problematic. The staff took a stronger perspective on the lack of inclusivity in PiB video resources. Staff and caregivers coproduced new inclusive wording and recommended creating new videos to adapt PiB for the UK context. Conclusions: AEBCD methods facilitated the engagement of caregivers and staff and advanced the adaptation of the PiB complex intervention. An important addition to the AEBCD method in this process was the work of an Adaptation Working Party, which adjudicated and agreed to new wording where this could not be established in consultation with caregivers and staff. Trial Registration: ISRCTN Registry ISRCTN12540555; https://doi.org/10.1186/ISRCTN12540555 UR - https://formative.jmir.org/2024/1/e52389 UR - http://dx.doi.org/10.2196/52389 UR - http://www.ncbi.nlm.nih.gov/pubmed/38776139 ID - info:doi/10.2196/52389 ER - TY - JOUR AU - Yardley, Elizabeth AU - Davis, Alice AU - Eldridge, Chris AU - Vasilakis, Christos PY - 2024/5/21 TI - Data-Driven Exploration of National Health Service Talking Therapies Care Pathways Using Process Mining: Retrospective Cohort Study JO - JMIR Ment Health SP - e53894 VL - 11 KW - electronic health record KW - EHR KW - electronic health records KW - EHRs KW - health record KW - data science KW - secondary data analysis KW - mental health services KW - mental health KW - health information system KW - HIS KW - information system KW - information systems KW - process mining KW - flow KW - flows KW - path KW - pathway KW - pathways KW - delivery KW - visualization N2 - Background: The National Health Service (NHS) Talking Therapies program treats people with common mental health problems in England according to ?stepped care,? in which lower-intensity interventions are offered in the first instance, where clinically appropriate. Limited resources and pressure to achieve service standards mean that program providers are exploring all opportunities to evaluate and improve the flow of patients through their service. Existing research has found variation in clinical performance and stepped care implementation across sites and has identified associations between service delivery and patient outcomes. Process mining offers a data-driven approach to analyzing and evaluating health care processes and systems, enabling comparison of presumed models of service delivery and their actual implementation in practice. The value and utility of applying process mining to NHS Talking Therapies data for the analysis of care pathways have not been studied. Objective: A better understanding of systems of service delivery will support improvements and planned program expansion. Therefore, this study aims to demonstrate the value and utility of applying process mining to NHS Talking Therapies care pathways using electronic health records. Methods: Routine collection of a wide variety of data regarding activity and patient outcomes underpins the Talking Therapies program. In our study, anonymized individual patient referral records from two sites over a 2-year period were analyzed using process mining to visualize the care pathway process by mapping the care pathway and identifying common pathway routes. Results: Process mining enabled the identification and visualization of patient flows directly from routinely collected data. These visualizations illustrated waiting periods and identified potential bottlenecks, such as the wait for higher-intensity cognitive behavioral therapy (CBT) at site 1. Furthermore, we observed that patients discharged from treatment waiting lists appeared to experience longer wait durations than those who started treatment. Process mining allowed analysis of treatment pathways, showing that patients commonly experienced treatment routes that involved either low- or high-intensity interventions alone. Of the most common routes, >5 times as many patients experienced direct access to high-intensity treatment rather than stepped care. Overall, 3.32% (site 1: 1507/45,401) and 4.19% (site 2: 527/12,590) of all patients experienced stepped care. Conclusions: Our findings demonstrate how process mining can be applied to Talking Therapies care pathways to evaluate pathway performance, explore relationships among performance issues, and highlight systemic issues, such as stepped care being relatively uncommon within a stepped care system. Integration of process mining capability into routine monitoring will enable NHS Talking Therapies service stakeholders to explore such issues from a process perspective. These insights will provide value to services by identifying areas for service improvement, providing evidence for capacity planning decisions, and facilitating better quality analysis into how health systems can affect patient outcomes. UR - https://mental.jmir.org/2024/1/e53894 UR - http://dx.doi.org/10.2196/53894 UR - http://www.ncbi.nlm.nih.gov/pubmed/38771630 ID - info:doi/10.2196/53894 ER - TY - JOUR AU - de Weger, Esther AU - Drewes, Hanneke AU - Luijkx, Katrien AU - Baan, Caroline PY - 2024/5/15 TI - Tracking the Development of Community Engagement Over Time: Realist Qualitative Study JO - J Particip Med SP - e47500 VL - 16 KW - community engagement KW - citizen involvement KW - health care KW - decentralization KW - realist evaluation N2 - Background: A growing interest in engaging communities in the development of health care services and communities has not automatically led to progress or consensus as to how to engage communities successfully, despite the evidence base showing how to leverage enablers and alleviate barriers. Objective: To bridge the gap between the evidence base and which community engagement (CE) approaches have actually been applied in practice over time, this study aims to investigate how CE approaches have changed over the past 4 years in 6 different regions in the Netherlands and citizens? and professionals? experiences underlying these changes. Methods: For the last stage of a multiple case study following the development of CE approaches in 6 different regions in the Netherlands, a realist qualitative case study was conducted. To investigate how CE approaches had changed over the past 4 years, data from the entire 4 years of the study were used, including documents, interview transcripts, and observations. To examine citizens? and professionals? experiences underlying these changes, new interviews were conducted. The latest interview results were discussed with a panel to ensure the results had face validity. Results: The regions had implemented different types of CE approaches over the past 4 years and were adapting these approaches over time. Many of the (remaining) approaches may be operating on a smaller scale. The study identified the following overarching themes along which CE had been adapted: fewer region-wide approaches and more community-focused approaches, more focus on building relationships with (already engaged) citizens and community-led initiatives, and more focus on practical and tangible health promotion and social cohesion activities and less focus on complex ?abstract? programs. The study identified a further 4 overarching themes highlighting citizens? and professionals? experiences underlying these changes in the CE approaches: a lack of engagement environment, need for facilitative leadership from organizations, need for a clear and shared vision underscoring the importance of CE, and misalignment between citizens? and professionals? perspectives and motivations for CE. All participants had experienced the engagement environment as insufficient. To support CE, professionals experienced the need to develop and receive more facilitative leadership and to develop approaches better equipped to involve citizens in the decision-making process. Citizens experienced the need to better align citizens? and professionals? motivations and aims for CE approaches and to receive longer-term financial support for their community-led initiatives. Conclusions: This study suggests that CE has not yet been embedded within organizational cultures. This has arguably meant that the (remaining) CE approaches are operating on a smaller scale. To enable the further development of CE approaches, an investment in the engagement environment and a shared vision is required. Only then could CE within the regions move beyond the more seemingly smaller-scale CE approaches. UR - https://jopm.jmir.org/2024/1/e47500 UR - http://dx.doi.org/10.2196/47500 UR - http://www.ncbi.nlm.nih.gov/pubmed/38748458 ID - info:doi/10.2196/47500 ER - TY - JOUR AU - Cailhol, Johann AU - Bihan, Hélène AU - Bourovali-Zade, Chloé AU - Boloko, Annie AU - Duclos, Catherine PY - 2024/5/13 TI - Quality Improvement Intervention Using Social Prescribing at Discharge in a University Hospital in France: Quasi-Experimental Study JO - JMIR Form Res SP - e51728 VL - 8 KW - social prescription KW - discharge coordination KW - language barriers KW - readmission rates KW - ethnic matching KW - trust KW - personalized care KW - discharge KW - social determinant KW - social need KW - tool KW - quality of care KW - readmission KW - quality improvement N2 - Background: Social prescription is seen as a public health intervention tool with the potential to mitigate social determinants of health. On one side, social prescription is not yet well developed in France, where social workers usually attend to social needs, and historically, there is a deep divide between the health and social sectors. On the other side, discharge coordination is gaining attention in France as a critical tool to improve the quality of care, assessed indirectly using unplanned rehospitalization rates. Objective: This study aims to combine social prescription and discharge coordination to assess the need for social prescription and its effect on unplanned rehospitalization rates. Methods: We conducted a quasi-experimental study in two departments of medicine in a French university hospital in a disadvantaged suburb of Paris over 2 years (October 2019-October 2021). A discharge coordinator screened patients for social prescribing needs and provided services on the spot or referred the patient to the appropriate service when needed. The primary outcome was the description of the services delivered by the discharge coordinator and of its process, as well as the characteristics of the patients in terms of social needs. The secondary outcome was the comparison of unplanned rehospitalization rates after data chaining. Results: A total of 223 patients were included in the intervention arm, with recruitment being disrupted by the COVID-19 pandemic. More than two-thirds of patients (n=154, 69.1%) needed help understanding discharge information. Slightly less than half of the patients (n=98, 43.9%) seen by the discharge coordinator needed social prescribing, encompassing language, housing, health literacy, and financial issues. The social prescribing covered a large range of services, categorized into finding a general practitioner or private sector nurse, including language-matching; referral to a social worker; referral to nongovernmental organization or group activities; support for transportation issues; support for health-related administrative procedures; and support for additional appointments with nonmedical clinicians. All supports were delivered in a highly personalized way. Ethnic data collection was not legally permitted, but for 81% (n=182) of the patients, French was not the mother tongue. After data chaining, rehospitalization rates were compared between 203 patients who received the intervention (n=5, 3.1%) versus 2095 patients who did not (n=51, 2.6%), and there was no statistical difference. Conclusions: First, our study revealed the breadth of patient?s unmet social needs in our university hospital, which caters to an area where the immigrant population is high. The study also revealed the complexity of the discharge coordinator?s work, who provided highly personalized support and managed to gain trust. Hospital discharge could be used in France as an opportunity in disadvantaged settings. Eventually, indicators other than the rehospitalization rate should be devised to evaluate the effect of social prescribing and discharge coordination. UR - https://formative.jmir.org/2024/1/e51728 UR - http://dx.doi.org/10.2196/51728 UR - http://www.ncbi.nlm.nih.gov/pubmed/38739912 ID - info:doi/10.2196/51728 ER - TY - JOUR AU - Szczepura, Ala AU - Khan, Jahan Amir AU - Wild, Deidre AU - Nelson, Sara AU - Woodhouse, Sonja AU - Collinson, Mark PY - 2024/5/13 TI - Digital Adoption by an Organization Supporting Informal Caregivers During COVID-19 Pandemic Showing Impact on Service Use, Organizational Performance, and Carers? Well-Being: Retrospective Population-Based Database Study With Embedded User Survey JO - JMIR Aging SP - e46414 VL - 7 KW - digital adoption KW - COVID-19 KW - informal caregivers KW - carer support organization KW - organization performance KW - integrated care systems KW - care systems KW - health policy KW - aging in place KW - digital divide N2 - Background: The COVID-19 pandemic has catalyzed a move from face-to-face to digital delivery of services by hospitals and primary care. However, little is known about the impact of digital transformation on organizations supporting unpaid caregivers. Since the start of the COVID-19 pandemic, the value of care provided by such informal caregivers is estimated to be £111 billion (US$ 152.7 billion) in England. Objective: This study aims to analyze service uptake patterns (including digital service options) over the pandemic period in an English caregivers? support organization covering a population of 0.98 million; measure changes in organizational performance, service efficiency, and quality; and identify the views of caregivers on service provision and future digital delivery. Methods: This was a retrospective analysis of the use of digital versus nondigital support services (January 2019 to June 2021) by caregivers in city and rural geographic areas. We compared organizational performance and service quality indicators for 2 financial years (2019-2020 and 2020-2021). A survey was conducted to identify barriers and facilitators to digital service uptake, the computer proficiency of caregivers (the Computer Proficiency Questionnaire, 12-item version), and preferences for future digital service provision. Quantitative data were analyzed using Stata 13 (StataCorp LLC). Thematic analysis was used for open-text survey responses. Results: The number of caregivers registered with the organization rose from 14,817 in 2019 to 20,237 in 2021. Monthly contacts rose from 1929 to 6741, with remote contacts increasing from 48.89% (943/1929) to 86.68% (5843/6741); distinctive patterns were observed for city versus rural caregivers. There was an increase in one-to-one contacts (88.8%) and caregiver assessments (20.9%), with no expansion in staffing. Service quality indicators showed an improvement in 5 of 8 variables (all P<.05). The 152 carers completing the survey had similar demographics to all registered caregivers. The Computer Proficiency Questionnaire, 12-item version, mean score of 25.61 (SD 4.40) indicated relatively high computer proficiency. The analysis of open-text responses identified a preference for the organization to continue to offer face-to-face services as well as web-based options. The digital services that were the most highly rated were carers? well-being assessments, support needs checks, and peer support groups. Conclusions: Our findings show that staff in the caregiver support organization were agile in adapting their services to digital delivery while dealing with increased numbers of registered clients and higher monthly contacts, all without obvious detriment to service quality. Caregivers indicated a preference for blended services, even while recording high computer proficiency. Considering the economic importance of unpaid caregivers, more attention should be given to organizations funded to provide support for them and to the potential for technology to enhance caregivers? access to, and engagement with, such services. UR - https://aging.jmir.org/2024/1/e46414 UR - http://dx.doi.org/10.2196/46414 UR - http://www.ncbi.nlm.nih.gov/pubmed/38739915 ID - info:doi/10.2196/46414 ER - TY - JOUR AU - Zhou, Yaxu AU - Zhou, Ying AU - Xu, Di AU - Min, Jie AU - Du, Yu AU - Duan, Qi AU - Bao, Wen AU - Sun, Yingying AU - Xi, Huiqin AU - Wang, Chunming AU - Bischof, Evelyne PY - 2024/5/13 TI - Practice Standards in International Medical Departments of Public Academic Hospitals in China: Cross-Sectional Study JO - JMIR Form Res SP - e53898 VL - 8 KW - patients KW - international medical service KW - demand KW - satisfaction KW - strategy KW - health care optimization KW - smart hospital N2 - Background: Improving health care in cities with a diverse, international population is crucial for ensuring health equity, particularly for foreigners facing challenges due to cultural and language barriers. This situation is especially relevant in China, a major destination for expatriates and travelers, where optimizing health care services and incorporating international standards in the public sector are vital. Achieving this involves understanding the operational details, cultural and linguistic nuances, and advancing medical digitalization. A strategic approach focusing on cultural competence and awareness of health care systems is essential for effectively navigating health care for foreigners and expatriates in China. Objective: The aim of this study was to perform an in-depth analysis of the subjective and objective experiences of local and international patients in public hospitals in China to provide a basis for enhancing the medical experience of all patients. Methods: A structured questionnaire was provided to patients at an international outpatient service of a top-tier university hospital in China. Qualitative analysis of the survey responses was performed to methodically categorize and analyze medical treatment, focusing on patient demand and satisfaction across four main category elements (?high demand, high satisfaction?; ?high demand, low satisfaction?; ?low demand, high satisfaction?; and ?low demand, low satisfaction?), enabling a detailed cross-sectional analysis to identify areas for improvement. Results: Elements falling under ?high demand, high satisfaction? for both Chinese and international patients were primarily in the realms of medical quality and treatment processes. In contrast, elements identified as ?high demand, low satisfaction? were significantly different between the two patient groups. Conclusions: The findings highlight the importance of systematic, objective research in advancing the quality of international health care services within China?s leading academic medical centers. Key to this improvement is rigorous quality control involving both patients and providers. This study highlights the necessity of certifying such centers and emphasizes the role of digital platforms in disseminating information about medical services. This strategy is expected to cater to diverse patient needs, enhancing the overall patient experience. Furthermore, by developing comprehensive diagnosis and treatment services and highlighting the superior quality and costs associated with international health care, these efforts aim to foster a sense of belonging among international patients and increase the attractiveness of China?s medical services for this demographic. UR - https://formative.jmir.org/2024/1/e53898 UR - http://dx.doi.org/10.2196/53898 UR - http://www.ncbi.nlm.nih.gov/pubmed/38739428 ID - info:doi/10.2196/53898 ER - TY - JOUR AU - Spaulding, M. Erin AU - Fang, Michael AU - Commodore-Mensah, Yvonne AU - Himmelfarb, R. Cheryl AU - Martin, S. Seth AU - Coresh, Josef PY - 2024/5/10 TI - Prevalence and Disparities in Telehealth Use Among US Adults Following the COVID-19 Pandemic: National Cross-Sectional Survey JO - J Med Internet Res SP - e52124 VL - 26 KW - telehealth KW - telemedicine KW - delivery of health care KW - health care disparities KW - COVID-19 N2 - Background: Telemedicine expanded during the COVID-19 pandemic, though use differed by age, sex, race or ethnicity, educational attainment, income, and location. It is unclear if high telehealth use or inequities persisted late into the pandemic. Objective: This study aims to evaluate the prevalence of, inequities in, and primary reasons for telehealth visits a year after telemedicine expansion. Methods: We used cross-sectional data from the 2022 Health Information National Trends Survey (HINTS 6), the first cycle with data on telemedicine. In total, 4830 English- and Spanish-speaking US adults (aged ?18 years) were included in this study. The primary outcomes were telehealth visit attendance in the 12 months before March 7, 2022, to November 8, 2022, and the primary reason for the most recent telehealth visit. We evaluated sociodemographic and clinical predictors of telehealth visit attendance and the primary reason for the most recent telehealth visit through Poisson regression. Analyses were weighted according to HINTS 6 standards. Results: We included 4830 participants (mean age 48.3, SD 17.5 years; 50.28% women; 65.21% White). Among US adults, 38.78% reported having a telehealth visit in the previous year. Telehealth visit attendance rates were similar across age, race or ethnicity, income, and urban versus rural location. However, individuals with a telehealth visit were less likely to live in the Midwest (adjusted prevalence ratio [aPR] 0.65, 95% CI 0.54-0.77), and more likely to be women (aPR 1.21, 95% CI 1.06-1.38), college graduates or postgraduates (aPR 1.24, 95% CI 1.05-1.46), covered by health insurance (aPR 1.56, 95% CI 1.08-2.26), and married or cohabitating (aPR 1.17, 95% CI 1.03-1.32), adjusting for sociodemographic characteristics, frequency of health care visits, and comorbidities. Among participants with a telehealth visit in the past year, the primary reasons for their most recent visit were minor or acute illness (32.15%), chronic disease management (21%), mental health or substance abuse (16.94%), and an annual exam (16.22%). Older adults were more likely to report that the primary reason for their most recent telehealth visit was for chronic disease management (aPR 2.08, 95% CI 1.33-3.23), but less likely to report that it was for a mental health or substance abuse issue (aPR 0.19, 95% CI 0.10-0.35), adjusting for sociodemographic characteristics and frequency of health care visits. Conclusions: Among US adults, telehealth visit attendance was high more than a year after telemedicine expansion and did not differ by age, race or ethnicity, income, or urban versus rural location. Telehealth could continue to be leveraged following COVID-19 to improve access to care and health equity. UR - https://www.jmir.org/2024/1/e52124 UR - http://dx.doi.org/10.2196/52124 UR - http://www.ncbi.nlm.nih.gov/pubmed/38728070 ID - info:doi/10.2196/52124 ER - TY - JOUR AU - Arsenault-Lapierre, Genevieve AU - Lemay-Compagnat, Alexandra AU - Guillette, Maxime AU - Couturier, Yves AU - Massamba, Victoria AU - Dufour, Isabelle AU - Maubert, Eric AU - Fournier, Christine AU - Denis, Julie AU - Morin, Caroline AU - Vedel, Isabelle PY - 2024/5/8 TI - Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations JO - JMIR Form Res SP - e55064 VL - 8 KW - dashboard KW - learning health system KW - health policy KW - dementia care KW - health care regionalization KW - dementia KW - Alzheimer disease KW - qualitative KW - collaborative KW - focus group KW - primary care KW - implementation KW - attitude KW - opinion KW - perception KW - perspective KW - service KW - health care management N2 - Background: Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. Objective: The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. Methods: An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization?s jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled ?university/peripheral?; organizations for which only part of the territory is in rural areas, labeled ?mixed?; and organizations in remote or isolated areas, labeled ?remote/isolated?) and according to different types of participants (managers, leading clinicians, and other participants). Results: Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. Conclusions: These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards. UR - https://formative.jmir.org/2024/1/e55064 UR - http://dx.doi.org/10.2196/55064 UR - http://www.ncbi.nlm.nih.gov/pubmed/38717803 ID - info:doi/10.2196/55064 ER - TY - JOUR AU - Trojan, Andreas AU - Kühne, Christian AU - Kiessling, Michael AU - Schumacher, Johannes AU - Dröse, Stefan AU - Singer, Christian AU - Jackisch, Christian AU - Thomssen, Christoph AU - Kullak-Ublick, A. Gerd PY - 2024/5/6 TI - Impact of Electronic Patient-Reported Outcomes on Unplanned Consultations and Hospitalizations in Patients With Cancer Undergoing Systemic Therapy: Results of a Patient-Reported Outcome Study Compared With Matched Retrospective Data JO - JMIR Form Res SP - e55917 VL - 8 KW - systemic cancer therapy KW - electronic patient-reported outcome KW - ePRO KW - ePROs KW - Consilium Care KW - medidux KW - unplanned consultation KW - hospitalization KW - hospitalizations KW - hospitalized KW - cancer KW - oncology KW - side effect KW - side effects KW - adverse KW - chemotherapy KW - patient reported outcome KW - PRO KW - PROs KW - mobile health KW - mHealth KW - app KW - apps KW - application KW - applications KW - mobile phone N2 - Background: The evaluation of electronic patient-reported outcomes (ePROs) is increasingly being used in clinical studies of patients with cancer and enables structured and standardized data collection in patients? everyday lives. So far, few studies or analyses have focused on the medical benefit of ePROs for patients. Objective: The current exploratory analysis aimed to obtain an initial indication of whether the use of the Consilium Care app (recently renamed medidux; mobile Health AG) for structured and regular self-assessment of side effects by ePROs had a recognizable effect on incidences of unplanned consultations and hospitalizations of patients with cancer compared to a control group in a real-world care setting without app use. To analyze this, the incidences of unplanned consultations and hospitalizations of patients with cancer using the Consilium Care app that were recorded by the treating physicians as part of the patient reported outcome (PRO) study were compared retrospectively to corresponding data from a comparable population of patients with cancer collected at 2 Swiss oncology centers during standard-of-care treatment. Methods: Patients with cancer in the PRO study (178 included in this analysis) receiving systemic therapy in a neoadjuvant or noncurative setting performed a self-assessment of side effects via the Consilium Care app over an observational period of 90 days. In this period, unplanned (emergency) consultations and hospitalizations were documented by the participating physicians. The incidence of these events was compared with retrospective data obtained from 2 Swiss tumor centers for a matched cohort of patients with cancer. Results: Both patient groups were comparable in terms of age and gender ratio, as well as the distribution of cancer entities and Joint Committee on Cancer stages. In total, 139 patients from each group were treated with chemotherapy and 39 with other therapies. Looking at all patients, no significant difference in events per patient was found between the Consilium group and the control group (odds ratio 0.742, 90% CI 0.455-1.206). However, a multivariate regression model revealed that the interaction term between the Consilium group and the factor ?chemotherapy? was significant at the 5% level (P=.048). This motivated a corresponding subgroup analysis that indicated a relevant reduction of the risk for the intervention group in the subgroup of patients who underwent chemotherapy. The corresponding odds ratio of 0.53, 90% CI 0.288-0.957 is equivalent to a halving of the risk for patients in the Consilium group and suggests a clinically relevant effect that is significant at a 2-sided 10% level (P=.08, Fisher exact test). Conclusions: A comparison of unplanned consultations and hospitalizations from the PRO study with retrospective data from a comparable cohort of patients with cancer suggests a positive effect of regular app-based ePROs for patients receiving chemotherapy. These data are to be verified in the ongoing randomized PRO2 study (registered on ClinicalTrials.gov; NCT05425550). Trial Registration: ClinicalTrials.gov NCT03578731; https://www.clinicaltrials.gov/ct2/show/NCT03578731 International Registered Report Identifier (IRRID): RR2-10.2196/29271 UR - https://formative.jmir.org/2024/1/e55917 UR - http://dx.doi.org/10.2196/55917 UR - http://www.ncbi.nlm.nih.gov/pubmed/38710048 ID - info:doi/10.2196/55917 ER - TY - JOUR AU - Avdagovska, Melita AU - Kuziemsky, Craig AU - Koosha, Helia AU - Hadizadeh, Maliheh AU - Pauly, P. Robert AU - Graham, Timothy AU - Stafinski, Tania AU - Bigam, David AU - Kassam, Narmin AU - Menon, Devidas PY - 2024/4/29 TI - Exploring the Impact of In Basket Metrics on the Adoption of a New Electronic Health Record System Among Specialists in a Tertiary Hospital in Alberta: Descriptive Study JO - J Med Internet Res SP - e53122 VL - 26 KW - electronic health records KW - In Basket KW - metrics KW - descriptive study KW - inpatients N2 - Background: Health care organizations implement electronic health record (EHR) systems with the expectation of improved patient care and enhanced provider performance. However, while these technologies hold the potential to create improved care and system efficiencies, they can also lead to unintended negative consequences, such as patient safety issues, communication problems, and provider burnout. Objective: This study aims to document metrics related to the In Basket communication hub (time in In Basket per day, time in In Basket per appointment, In Basket messages received per day, and turnaround time) of the EHR system implemented by Alberta Health Services, the province-wide health delivery system called Connect Care (Epic Systems). The objective was to identify how a newly implemented EHR system was used, the timing of its use, and the duration of use specifically related to In Basket activities. Methods: A descriptive study was conducted. Due to the diversity of specialties, the providers were grouped into medical and surgical based on previous similar studies. The participants were further subgrouped based on their self-reported clinical full-time equivalent (FTE ) measure. This resulted in 3 subgroups for analysis: medical FTE <0.5, medical FTE >0.5, and surgical (all of whom reported FTE >0.5). The analysis was limited to outpatient clinical interactions and explicitly excluded inpatient activities. Results: A total of 72 participants from 19 different specialties enrolled in this study. The providers had, on average, 8.31 appointments per day during the reporting periods. The providers received, on average, 21.93 messages per day, and they spent 7.61 minutes on average in the time in In Basket per day metric and 1.84 minutes on average in the time in In Basket per appointment metric. The time for the providers to mark messages as done (turnaround time) was on average 11.45 days during the reporting period. Although the surgical group had, on average, approximately twice as many appointments per scheduled day, they spent considerably less connected time (based on almost all time metrics) than the medical group. However, the surgical group took much longer than the medical group to mark messages as done (turnaround time). Conclusions: We observed a range of patterns with no consistent direction. There does not seem to be evidence of a ?learning curve,? which would have shown a consistent reduction in time spent on the system over time due to familiarity and experience. While this study does not show how the included metrics could be used as predictors of providers? satisfaction or feelings of burnout, the use trends could be used to start discussions about future Canadian studies needed in this area. UR - https://www.jmir.org/2024/1/e53122 UR - http://dx.doi.org/10.2196/53122 UR - http://www.ncbi.nlm.nih.gov/pubmed/38684079 ID - info:doi/10.2196/53122 ER - TY - JOUR AU - Harnik, Alexander Michael AU - Scheidegger, Alina AU - Blättler, Larissa AU - Nemecek, Zdenek AU - Sauter, C. Thomas AU - Limacher, Andreas AU - Reisig, Florian AU - grosse Holtforth, Martin AU - Streitberger, Konrad PY - 2024/4/29 TI - Acceptance, Satisfaction, and Preference With Telemedicine During the COVID-19 Pandemic in 2021-2022: Survey Among Patients With Chronic Pain JO - JMIR Form Res SP - e53154 VL - 8 KW - acceptance KW - satisfaction KW - patient preferences KW - COVID-19 pandemic KW - health care providers KW - phone consultations KW - pain therapy KW - eHealth services KW - patient care KW - health care delivery KW - telemedicine KW - chronic pain KW - preference N2 - Background: The COVID-19 pandemic has forced many health care providers to make changes in their treatment, with telemedicine being expanded on a large scale. An earlier study investigated the acceptance of telephone calls but did not record satisfaction with treatment or patients? preferences. This warranted a follow-up study to investigate acceptance, satisfaction, and preferences regarding telemedicine, comprising of phone consultations, among health care recipients. Objective: The primary aim was to assess the acceptance and satisfaction of telemedicine during the subsequent months of 2021-2022, after the initial wave of the COVID-19 pandemic in Switzerland. Furthermore, we aimed to assess patients? preferences and whether these differed in patients who had already experienced telemedicine in the past, as well as correlations between acceptance and satisfaction, pain intensity, general condition, perception of telemedicine, and catastrophizing. Finally, we aimed to investigate whether more governmental restrictions were correlated with higher acceptance. Methods: An anonymous cross-sectional web-based survey was conducted between January 27, 2021, and February 4, 2022, enrolling patients undergoing outpatient pain therapy in a tertiary university clinic. We conducted a descriptive analysis of acceptance and satisfaction with telemedicine and investigated patients? preferences. Further, we conducted a descriptive and correlational analysis of the COVID-19 stringency index. Spearman correlation analysis and a chi-square test for categorical data were used with Cramer V statistic to assess effect sizes. Results: Our survey was completed by 60 patients. Telemedicine acceptance and satisfaction were high, with an average score of 7.6 (SD 3.3; on an 11-point Numeric Rating Scale from 0=not at all to 10=completely), and 8.8 (SD 1.8), respectively. Respondents generally preferred on-site consultations to telemedicine (n=35, 58% vs n=24, 40%). A subgroup analysis revealed that respondents who already had received phone consultation, showed a higher preference for telemedicine (n/N=21/42, 50% vs n/N=3/18, 17%; ?22 [N=60]=7.5, P=.02, Cramer V=0.354), as well as those who had been treated for more than 3 months (n/N=17/31, 55% vs n/N=7/29, 24%; ?22 [N=60]=6.5, P=.04, Cramer V=0.329). Acceptance of telemedicine showed a moderate positive correlation with satisfaction (rs{58}=0.41, P<.05), but there were no correlations between the COVID-19 stringency index and the other variables. Conclusions: Despite high acceptance of and satisfaction with telemedicine, patients preferred on-site consultations. Preference for telemedicine was markedly higher in patients who had already received phone consultations or had been treated for longer than 3 months. This highlights the need to convey knowledge of eHealth services to patients and the value of building meaningful relationships with patients at the beginning of treatment. During the COVID-19 pandemic, the modality of patient care should be discussed individually. UR - https://formative.jmir.org/2024/1/e53154 UR - http://dx.doi.org/10.2196/53154 UR - http://www.ncbi.nlm.nih.gov/pubmed/38684086 ID - info:doi/10.2196/53154 ER - TY - JOUR AU - Loriot, Amélie AU - Larceneux, Fabrice AU - Guillard, Valérie AU - Bertocchio, Jean-Philippe PY - 2024/4/26 TI - Patients? Representations of Perceived Distance and Proximity to Telehealth in France: Qualitative Study JO - J Med Internet Res SP - e45702 VL - 26 KW - telehealth KW - teleconsultation KW - social representations KW - perceived proximity KW - semiotic square N2 - Background: In the last 2 decades, new technologies have emerged in health care. The COVID-19 pandemic further accelerated the adoption of technology by both health care professionals and patients. These technologies create remote care practices that bring several benefits to the health care system: easier access to care, improved communication with physicians, and greater continuity of care. However, disparities in the acceptance and use of telehealth tools still exist among patients. These tools also disrupt conventional medical practices and prompt a new reassessment of the perceptions of distance and proximity as physical (ie, time and space dimensions) and nonphysical (ie, behavioral dimensions) concepts. The reasons why patients do or do not adopt telehealth tools for their care and therefore their perspectives on telehealth remain unanswered questions. Objective: We explored the barriers as well as the motivations for patients to adopt telehealth tools. We specifically focused on the social representations of telehealth to establish a comprehensive conceptual framework to get a better understanding of how telehealth is perceived by patients. Methods: This study uses a qualitative design through in-depth individual interviews. Participants were recruited using a convenience sampling method with balanced consideration of gender, age, location (urban/rural), and socioeconomic background. After collecting informed consent, interviews were transcribed and analyzed using the thematic analysis methodology. Results: We conducted 14 interviews, with which data saturation was reached. The 2 main opposed dimensions, perceived proximity and distance, emerged as an essential structure for understanding the social representations of telehealth. A logic of engagement versus hostility emerged as the main tension in adopting telehealth, almost ideological. Interestingly, practical issues emerged regarding the adoption of telehealth: A logic of integration was opposed to a logic of constraints. Altogether, those dimensions enabled us to conceptualize a semiotic square, providing 4 categories with a coherent body of social representations. Due to the dynamic nature of these representations, we proposed 2 ?paths? through which adherence to telehealth may improve. Conclusions: Our semiotic square illustrating patients? adherence to telehealth differentiates socially beneficial versus socially dangerous considerations and pragmatic from ideological postures. It shows how crucial it is to consider perceived distance and proximity to better understand barriers and motivations to adopting telehealth. These representations can also be considered as leverage that could be modified to encourage the step-by-step adhesion process. Even if reducing the perceived temporal distance to in-person meeting and enhancing the perceived proximity of access to care may be seen as efficient ways to adopt telehealth tools, telehealth can also be perceived as a care practice that threatens the patient-physician relationship. The patient-oriented perceived value turns out to be critical in the future development of and adherence to telehealth tools. UR - https://www.jmir.org/2024/1/e45702 UR - http://dx.doi.org/10.2196/45702 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669676 ID - info:doi/10.2196/45702 ER - TY - JOUR AU - Kim, Jiyeong AU - Cai, Ran Zhuo AU - Chen, L. Michael AU - Onyeka, Sonia AU - Ko, M. Justin AU - Linos, Eleni PY - 2024/4/26 TI - Telehealth Utilization and Associations in the United States During the Third Year of the COVID-19 Pandemic: Population-Based Survey Study in 2022 JO - JMIR Public Health Surveill SP - e51279 VL - 10 KW - telehealth KW - telemedicine KW - digital health KW - e-health KW - e-medicine KW - utilization KW - population-based study KW - clinical practice KW - healthcare delivery KW - sociodemographic factor KW - COVID-19 KW - pandemic N2 - Background: The COVID-19 pandemic rapidly changed the landscape of clinical practice in the United States; telehealth became an essential mode of health care delivery, yet many components of telehealth use remain unknown years after the disease?s emergence. Objective: We aim to comprehensively assess telehealth use and its associated factors in the United States. Methods: This cross-sectional study used a nationally representative survey (Health Information National Trends Survey) administered to US adults (?18 years) from March 2022 through November 2022. To assess telehealth adoption, perceptions of telehealth, satisfaction with telehealth, and the telehealth care purpose, we conducted weighted descriptive analyses. To identify the subpopulations with low adoption of telehealth, we developed a weighted multivariable logistic regression model. Results: Among a total of 6252 survey participants, 39.3% (2517/6252) reported telehealth use in the past 12 months (video: 1110/6252, 17.8%; audio: 876/6252, 11.6%). The most prominent reason for not using telehealth was due to telehealth providers failing to offer this option (2200/3529, 63%). The most common reason for respondents not using offered telehealth services was a preference for in-person care (527/578, 84.4%). Primary motivations to use telehealth were providers? recommendations (1716/2517, 72.7%) and convenience (1516/2517, 65.6%), mainly for acute minor illness (600/2397, 29.7%) and chronic condition management (583/2397, 21.4%), yet care purposes differed by age, race/ethnicity, and income. The satisfaction rate was predominately high, with no technical problems (1829/2517, 80.5%), comparable care quality to that of in-person care (1779/2517, 75%), and no privacy concerns (1958/2517, 83.7%). Younger individuals (odd ratios [ORs] 1.48-2.23; 18-64 years vs ?75 years), women (OR 1.33, 95% CI 1.09-1.61), Hispanic individuals (OR 1.37, 95% CI 1.05-1.80; vs non-Hispanic White), those with more education (OR 1.72, 95% CI 1.03-2.87; at least a college graduate vs less than high school), unemployed individuals (OR 1.25, 95% CI 1.02-1.54), insured individuals (OR 1.83, 95% CI 1.25-2.69), or those with poor general health status (OR 1.66, 95% CI 1.30-2.13) had higher odds of using telehealth. Conclusions: To our best knowledge, this is among the first studies to examine patient factors around telehealth use, including motivations to use, perceptions of, satisfaction with, and care purpose of telehealth, as well as sociodemographic factors associated with telehealth adoption using a nationally representative survey. The wide array of descriptive findings and identified associations will help providers and health systems understand the factors that drive patients toward or away from telehealth visits as the technology becomes more routinely available across the United States, providing future directions for telehealth use and telehealth research. UR - https://publichealth.jmir.org/2024/1/e51279 UR - http://dx.doi.org/10.2196/51279 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669075 ID - info:doi/10.2196/51279 ER - TY - JOUR AU - Wang, Di AU - Li, Peifan AU - Huang, Xiaoling AU - Liu, Yixuan AU - Mao, Shihang AU - Yin, Haoning AU - Wang, Na AU - Luo, Yan AU - Sun, Shan PY - 2024/4/24 TI - Exploring the Prevalence of Tinnitus and Ear-Related Symptoms in China After the COVID-19 Pandemic: Online Cross-Sectional Survey JO - JMIR Form Res SP - e54326 VL - 8 KW - COVID-19 pandemic KW - tinnitus KW - ear-related symptoms KW - online survey KW - prevalence KW - ear-related KW - China KW - cross-sectional KW - complex KW - heterogeneous KW - symptom KW - symptoms KW - Chinese KW - population KW - investigate KW - health care KW - exploratory KW - teen KW - teens KW - teenager KW - teenagers KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - COVID-19 KW - regression analysis N2 - Background: Tinnitus is a complex and heterogeneous disease that has been identified as a common manifestation of COVID-19. To gain a comprehensive understanding of tinnitus symptoms in individuals following COVID-19 infection, we conducted an online survey called the China Ear Nose and Throat Symptom Survey in the COVID-19 Pandemic (CENTSS) among the Chinese population. Objective: Our objective was to investigate tinnitus and ear-related symptoms after COVID-19 infection in the Chinese population, with the aim of providing a solid empirical foundation for improved health care. The findings from CENTSS can contribute to the development of enhanced management strategies for tinnitus in the context of long COVID. By gaining a better understanding of the factors contributing to tinnitus in individuals with COVID-19, health care providers can tailor interventions to address the specific needs of affected patients. Furthermore, this study serves as a basis for research on the long-term consequences of COVID-19 infection and its associated tinnitus symptoms. Methods: A quantitative, online, cross-sectional survey study design was used to explore the impact of the COVID-19 pandemic on experiences with tinnitus in China. Data were collected through an online questionnaire designed to identify the presence of tinnitus and its impacts. Descriptive statistics were used to analyze individuals' demographic characteristics, COVID-19 infection?related ear symptoms, and the cognitive and emotional implications of tinnitus. Univariable and multivariable logistic regression analyses were used to model the cross-sectional baseline associations between demographic characteristics, noise exposure, educational level, health and lifestyle factors, and the occurrence of tinnitus. Results: Between December 19, 2022, and February 1, 2023, we obtained responses from 1262 Chinese participants representing 24 regions, with an average age of 37 years. Among them, 540 patients (42.8%) reported experiencing ear-related symptoms after COVID-19 infection. Only 114 (9%) of these patients sought medical attention specifically for their ear symptoms, while 426 (33.8%) did not seek hospital care. Tinnitus emerged as the most prevalent and impactful symptom among all ear-related symptoms experienced after COVID-19 infection. Of the respondents, female participants (688/888, 77.78%), younger individuals (<30 years), individuals with lower education levels, participants residing in western China, and those with a history of otolaryngology diseases were more likely to develop tinnitus following COVID-19 infection. Conclusions: In summary, tinnitus was identified as the most common ear-related symptom during COVID-19 infection. Individuals experiencing tinnitus after COVID-19 infection were found to have poorer cognitive and emotional well-being. Different ear-related symptoms in patients post?COVID-19 infection may suggest viral invasion of various parts of the ear. It is therefore crucial to monitor and manage hearing-related changes resulting from COVID-19 as clinical services resume. UR - https://formative.jmir.org/2024/1/e54326 UR - http://dx.doi.org/10.2196/54326 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54326 ER - TY - JOUR AU - Hasan, Zahid Md AU - Rabbani, Golam Md AU - Akter, Orin AU - Mehdi, Golam Gazi AU - Ahmed, Wahid Mohammad AU - Ahmed, Sayem AU - Chowdhury, Elahi Mahbub PY - 2024/4/24 TI - Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study JO - JMIR Form Res SP - e49815 VL - 8 KW - Shasthyo Surokhsha Karmasuchi KW - health care services KW - health care utilization KW - satisfaction KW - below poverty line KW - Bangladesh KW - patient satisfaction KW - physician behavior N2 - Background: Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients? experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme. Objective: We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh. Methods: A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients? socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed. Results: We found that 55.1% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians? behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses? behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ?15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services. Conclusions: More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility. UR - https://formative.jmir.org/2024/1/e49815 UR - http://dx.doi.org/10.2196/49815 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656783 ID - info:doi/10.2196/49815 ER - TY - JOUR AU - Grove, Engelst Birgith AU - de Thurah, Annette AU - Ivarsen, Per AU - Kvisgaard, Katrine Ann AU - Hjollund, Henrik Niels AU - Grytnes, Regine AU - Schougaard, Valen Liv Marit PY - 2024/4/24 TI - Remote Symptom Monitoring Using Patient-Reported Outcomes in Patients With Chronic Kidney Disease: Process Evaluation of a Randomized Controlled Trial JO - JMIR Form Res SP - e48173 VL - 8 KW - chronic kidney disease KW - pragmatic randomized controlled trial KW - process evaluation KW - patient-reported outcome measures KW - remote monitoring KW - monitoring KW - patient-reported outcome KW - chronic kidney KW - intervention N2 - Background: In Denmark, outpatient follow-up for patients with chronic kidney disease (CKD) is changing from in-hospital visits toward more remote health care delivery. The nonuse of remote patient-reported outcomes (PROs) is a well-known challenge, and it can be difficult to explain which mechanisms of interventions influence the outcome. Process evaluation may, therefore, be used to answer important questions on how and why interventions work, aiming to enhance the implications for clinical practice. Objective: This study aimed to provide insight into the intervention process by evaluating (1) the representativity of the study population, (2) patient and physician use patterns, (3) patient adherence to the intervention, and (4) clinical engagement. Methods: A process evaluation determining the reach, dose, fidelity, and clinical engagement was carried out, alongside a multicenter randomized controlled trial (RCT). We developed and implemented an intervention using PRO measures to monitor outpatients remotely. Data were collected for the PRO intervention arms in the RCT from 4 sources: (1) PRO data from the participants to determine personal factors, (2) the web-based PRO system to identify key usage intervention patterns, (3) medical records to identify clinical factors relating to the use of the intervention, and (4) semistructured interviews conducted with involved physicians. Results: Of the 320 patients invited, 152 (47.5%) accepted to participate. The study population reflected the target population. The mean adherence rate to the PRO intervention arms was 82% (95% CI 76-87). The questionnaire response rate was 539/544 (99.1%). A minority of 13 (12.9%) of 101 patients needed assistance to complete study procedures. Physicians assessed 477/539 (88.5%) of the questionnaires. Contact was established in 417/539 (77.4%) of the cases, and 122/539 (22.6%) of the patients did not have contact. Physicians initiated 288/417 (69.1%) and patients requested 129/417 (30.9%) of all the contacts. The primary causes of contact were clinical data (242/417, 58%), PRO data (92/417, 22.1%), and medication concerns and precautionary reasons (83/417, 19.9%). Physicians found the use of PRO measures in remote follow-up beneficial for assessing the patient?s health. The inclusion of self-reported clinical data in the questionnaire motivated physicians to assess patient responses. However, some barriers were emphasized, such as loss of a personal relationship with the patient and the risk of missing important symptoms in the absence of a face-to-face assessment. Conclusions: This study demonstrates the importance and practical use of remote monitoring among patients with CKD. Overall, the intervention was implemented as intended. We observed high patient adherence rates, and the physicians managed most questionnaires. Some physicians worried that distance from the patients made it unfeasible to use their ?clinical glance,? posing a potential risk of overlooking crucial patients? symptoms. These findings underscore key considerations for the implementation of remote follow-up. Introducing a hybrid approach combining remote and face-to-face consultations may address these concerns. Trial Registration: ClinicalTrials.gov NCT03847766; https://clinicaltrials.gov/study/NCT03847766 UR - https://formative.jmir.org/2024/1/e48173 UR - http://dx.doi.org/10.2196/48173 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656781 ID - info:doi/10.2196/48173 ER - TY - JOUR AU - Neumann, Ariana AU - König, Hans-Helmut AU - Hajek, André PY - 2024/4/23 TI - Determinants of Telemedicine Service Use Among Middle-Aged and Older Adults in Germany During the COVID-19 Pandemic: Cross-Sectional Survey Study JO - JMIR Aging SP - e50938 VL - 7 KW - telemedicine KW - telehealth KW - digital health KW - service use KW - COVID-19 N2 - Background: The occurrence of the COVID-19 pandemic demanded fast changes in the delivery of health care. As a result, significant growth in the use of telemedicine services occurred. Research, especially from nationally representative German samples, is needed to better understand determinants of telemedicine use. Objective: The purpose of this study was to identify determinants of telemedicine service use among middle-aged and older adults during the COVID-19 pandemic in Germany. Methods: Cross-sectional, nationally representative data were taken from the German sample of the Survey of Health, Ageing and Retirement in Europe (SHARE). The German Corona Survey 2 (n=2039), which was conducted between June and August 2021, was used for this study. Reporting experience with remote medical consultations during the COVID-19 pandemic served as the outcome measure. Associations with socioeconomic, psychological, social, health-related, and COVID-19?related determinants were examined using multiple Firth logistic regressions. Results: Psychological factors including feeling nervous, anxious, or on edge (odds ratio [OR] 1.61, 95% CI 1.04-2.50; P=.03), feeling sad or depressed (OR 1.62, 95% CI 1.05-2.51; P=.03) and feelings of loneliness (OR 1.66, 95% CI 1.07-2.58; P=.02) were positively associated with telemedicine use. Moreover, forgoing medical treatment because of being afraid of being infected by SARS-CoV-2 (OR 1.81, 95% CI 1.10-2.97; P=.02) and describing limitations because of a health problem as severe were positively associated with the outcome (OR 2.11, 95% CI 1.12-4.00; P=.02). Socioeconomic and social factors were not significantly associated with telemedicine use in our sample. Conclusions: Middle-aged and older individuals in Germany seem to use telemedicine services according to psychological needs and health limitations. Especially when psychological symptoms are experienced, telemedicine seems to be a promising service option in this age group. Future research is needed to confirm these initial findings in postpandemic circumstances. UR - https://aging.jmir.org/2024/1/e50938 UR - http://dx.doi.org/10.2196/50938 ID - info:doi/10.2196/50938 ER - TY - JOUR AU - Aggarwal, Monica AU - Hutchison, G. Brian AU - Kokorelias, M. Kristina AU - Ramsden, R. Vivian AU - Ivers, M. Noah AU - Pinto, Andrew AU - Uphsur, G. Ross E. AU - Wong, T. Sabrina AU - Pimlott, Nick AU - Slade, Steve PY - 2024/4/23 TI - The Conceptualization and Measurement of Research Impact in Primary Health Care: Protocol for a Rapid Scoping Review JO - JMIR Res Protoc SP - e55860 VL - 13 KW - research impact KW - primary health care KW - measurement KW - definition KW - concept KW - development KW - implementation KW - health policy KW - policy KW - health service KW - rapid review KW - review KW - research KW - policies KW - societal KW - productivity KW - literature database N2 - Background: The generation of research evidence and knowledge in primary health care (PHC) is crucial for informing the development and implementation of interventions and innovations and driving health policy, health service improvements, and potential societal changes. PHC research has broad effects on patients, practices, services, population health, community, and policy formulation. The in-depth exploration of the definition and measures of research impact within PHC is essential for broadening our understanding of research impact in the discipline and how it compares to other health services research. Objective: The objectives of the study are (1) to understand the conceptualizations and measures of research impact within the realm of PHC and (2) to identify methodological frameworks for evaluation and research impact and the benefits and challenges of using these approaches. The forthcoming review seeks to guide future research endeavors and enhance methodologies used in assessing research impact within PHC. Methods: The protocol outlines the rapid review and environmental scan approach that will be used to explore research impact in PHC and will be guided by established frameworks such as the Canadian Academy of Health Sciences Impact Framework and the Canadian Health Services and Policy Research Alliance. The rapid review follows scoping review guidelines (PRISMA-ScR; Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews). The environmental scan will be done by consulting with professional organizations, academic institutions, information science, and PHC experts. The search strategy will involve multiple databases, citation and forward citation searching, and manual searches of gray literature databases, think tank websites, and relevant catalogs. We will include gray and scientific literature focusing explicitly on research impact in PHC from high-income countries using the World Bank classification. Publications published in English from 1978 will be considered. The collected papers will undergo a 2-stage independent review process based on predetermined inclusion criteria. The research team will extract data from selected studies based on the research questions and the CRISP (Consensus Reporting Items for Studies in Primary Care) protocol statement. The team will discuss the extracted data, enabling the identification and categorization of key themes regarding research impact conceptualization and measurement in PHC. The narrative synthesis will evolve iteratively based on the identified literature. Results: The results of this study are expected at the end of 2024. Conclusions: The forthcoming review will explore the conceptualization and measurement of research impact in PHC. The synthesis will offer crucial insights that will guide subsequent research, emphasizing the need for a standardized approach that incorporates diverse perspectives to comprehensively gauge the true impact of PHC research. Furthermore, trends and gaps in current methodologies will set the stage for future studies aimed at enhancing our understanding and measurement of research impact in PHC. International Registered Report Identifier (IRRID): PRR1-10.2196/55860 UR - https://www.researchprotocols.org/2024/1/e55860 UR - http://dx.doi.org/10.2196/55860 UR - http://www.ncbi.nlm.nih.gov/pubmed/38652900 ID - info:doi/10.2196/55860 ER - TY - JOUR AU - Blanchard, Marc AU - Koller, Nadana Cinja AU - Azevedo, Ming Pedro AU - Prétat, Tiffany AU - Hügle, Thomas PY - 2024/4/19 TI - Development of a Management App for Postviral Fibromyalgia-Like Symptoms: Patient Preference-Guided Approach JO - JMIR Form Res SP - e50832 VL - 8 KW - digital health KW - patient preference KW - user experience KW - patient-centricity KW - platform KW - development KW - fibromyalgia KW - self-management KW - quality of life KW - patient outcome KW - musculoskeletal KW - usability testing KW - digital health solution N2 - Background: Persistent fibromyalgia-like symptoms have been increasingly reported following viral infections, including SARS-CoV-2. About 30% of patients with post?COVID-19 syndrome fulfill the fibromyalgia criteria. This complex condition presents significant challenges in terms of self-management. Digital health interventions offer a viable means to assist patients in managing their health conditions. However, the challenge of ensuring their widespread adoption and adherence persists. This study responds to this need by developing a patient-centered digital health management app, incorporating patient preferences to enhance usability and effectiveness, ultimately aiming to improve patient outcomes and quality of life. Objective: This research aims to develop a digital health self-management app specifically for patients experiencing postviral fibromyalgia-like symptoms. By prioritizing patient preferences and engagement through the app?s design and functionality, the study intends to facilitate better self-management practices and improve adherence. Methods: Using an exploratory study design, the research used patient preference surveys and usability testing as primary tools to inform the development process of the digital health solution. We gathered and analyzed patients? expectations regarding design features, content, and usability to steer the iterative app development. Results: The study uncovered crucial insights from patient surveys and usability testing, which influenced the app?s design and functionality. Key findings included a preference for a symptom list over an automated chatbot, a desire to report on a moderate range of symptoms and activities, and the importance of an intuitive onboarding process. While usability testing identified some challenges in the onboarding process, it also confirmed the importance of aligning the app with patient needs to enhance engagement and satisfaction. Conclusions: Incorporating patient feedback has been a significant factor in the development of the digital health app. Challenges encountered with user onboarding during usability testing have highlighted the importance of this process for user adoption. The study acknowledges the role of patient input in developing digital health technologies and suggests further research to improve onboarding procedures, aiming to enhance patient engagement and their ability to manage digital health resources effectively. International Registered Report Identifier (IRRID): RR2-10.2196/32193 UR - https://formative.jmir.org/2024/1/e50832 UR - http://dx.doi.org/10.2196/50832 UR - http://www.ncbi.nlm.nih.gov/pubmed/38639986 ID - info:doi/10.2196/50832 ER - TY - JOUR AU - Lammers, J. Eline M. AU - Zijlstra, M. Josée AU - Retèl, P. Valesca AU - Aleman, P. Berthe M. AU - van Leeuwen, E. Flora AU - Nijdam, Annelies AU - PY - 2024/4/18 TI - Effectiveness and Cost-Effectiveness of Survivorship Care for Survivors of Hodgkin Lymphoma (INSIGHT Study): Protocol for a Multicenter Retrospective Cohort Study With a Quasi-Experimental Design JO - JMIR Res Protoc SP - e55601 VL - 13 KW - research design KW - Hodgkin lymphoma KW - late effects of cancer treatment KW - survivorship care KW - screening KW - cost-effectiveness analysis N2 - Background: Hodgkin lymphoma (HL) occurs at young ages, with the highest incidence between 20 and 40 years. While cure rates have improved to 80%-90% over the past decades, survivors of HL are at substantial risk of late treatment?related complications, such as cardiovascular diseases, breast cancer, severe infections, and hypothyroidism. To reduce morbidity and mortality from late treatment effects, the Dutch Better care after lymphoma, Evaluation of long-term Treatment Effects and screening Recommendations (BETER) consortium developed a survivorship care program for 5-year survivors of HL that includes risk-based screening for and treatment of (risk factors for) late adverse events. Even though several cancer survivorship care programs have been established worldwide, there is a lack of knowledge about their effectiveness in clinical practice. Objective: The Improving Nationwide Survivorship care Infrastructure and Guidelines after Hodgkin lymphoma Treatment (INSIGHT) study evaluates whether Dutch BETER survivorship care for survivors of HL decreases survivors? burden of disease from late adverse events after HL treatment and associated health care costs and improves their quality of life. Methods: The INSIGHT study is a multicenter retrospective cohort study with a quasi-experimental design and prospective follow-up, embedded in the national BETER survivorship care infrastructure. The first BETER clinics started in 2013-2016 and several other centers started or will start BETER clinics in 2019-2024. This allows us to compare survivors who did and those who did not receive BETER survivorship care in the last decade. Survivors in the intervention group are matched to controls (n=450 per group) based on sex, age at diagnosis (±5 years), age in 2013 (±5 years), and treatment characteristics. The primary outcome is the burden of disease in disability-adjusted life years from cardiovascular disease, breast cancer, severe infections, and hypothyroidism. In a cost-effectiveness analysis, we will assess the cost of BETER survivorship care per averted or gained disability-adjusted life year and quality-adjusted life year. Secondary outcomes are BETER clinic attendance, adherence to screening guidelines, and knowledge and distress about late effects among survivors of HL. Study data are collected from a survivor survey, a general practitioner survey, medical records, and through linkages with national disease registries. Results: The study was funded in November 2020 and approved by the institutional review board of the Netherlands Cancer Institute in July 2021. We expect to finalize recruitment by October 2024, data collection by early 2025, and data analysis by May 2025. Conclusions: INSIGHT is the first evaluation of a comprehensive survivorship program using real-world data; it will result in new information on the (cost-)effectiveness of survivorship care in survivors of HL in clinical practice. The results of this study will be used to improve the BETER program where necessary and contribute to more effective evidence-based long-term survivorship care for lymphoma survivors. International Registered Report Identifier (IRRID): PRR1-10.2196/55601 UR - https://www.researchprotocols.org/2024/1/e55601 UR - http://dx.doi.org/10.2196/55601 UR - http://www.ncbi.nlm.nih.gov/pubmed/38635308 ID - info:doi/10.2196/55601 ER - TY - JOUR AU - Castro, Aimee AU - Lalonde-LeBlond, Gabrielle AU - Freitas, Zelda AU - Arnaert, Antonia AU - Bitzas, Vasiliki AU - Kildea, John AU - Moffatt, Karyn AU - Phillips, Devon AU - Wiseblatt, Lorne AU - Hall, Audrey-Jane AU - Després, Véronique AU - Tsimicalis, Argerie PY - 2024/4/16 TI - In-Home Respite Care Services Available to Families With Palliative Care Needs in Quebec: Novel Digital Environmental Scan JO - JMIR Nursing SP - e53078 VL - 7 KW - respite care KW - palliative care KW - caregiving KW - environmental scan KW - digital methodology KW - accessibility N2 - Background: Caregiving dyads in palliative care are confronted with complex care needs. Respite care services can be highly beneficial in alleviating the caregiving burden, supporting survivorship and dying at home. Yet, respite care services are difficult to locate and access in the province of Quebec, Canada, particularly when navigating ubiquitous sources of online health information of varying quality. Objective: This project aimed to (1) compile a list of at-home palliative respite care services in Quebec, Canada; (2) describe key accessibility features for each respite care service; (3) identify accessibility gaps and opportunities; and (4) describe a novel method for conducting environmental scans using internet search engines, internet-based community health databases, and member checking. Methods: A novel environmental scan methodology using 2 internet-based targeted databases and 1 internet search engine was conducted. Results were screened and data were extracted, descriptively analyzed, and geographically schematized. Results: A total of 401 services were screened, and 52 at-home respite care services specific to palliative populations were identified, compiled, and analyzed. These respite care services were characterized by various types of assistance, providers, fees, and serviced geographical regions. Accessibility was explored through the lens of service amenability, availability, eligibility, and compatibility. The data revealed important barriers to accessing respite care services, such as a lack of readily available information on service characteristics, limited availability, and a time-consuming, technical search process for potential respite care users and clinicians to identify appropriate services. Conclusions: Both methodological and contextual knowledge have been gained through this environmental scan. Few methodologies for conducting internet-based environmental scans have been clearly articulated, so we applied several learnings from other scans and devised a methodology for conducting an environmental scan using the mixed methods of internet search engines, internet-based community health databases, and member checking. We have carefully reported our methods, so that others conducting community health environmental scans may replicate our process. Furthermore, through this scan, we identified assorted respite care services and pinpointed needs in the provision of these services. The findings highlighted that more easily accessible and centralized information about respite care services is needed in Quebec. The data will enable the creation of a user-friendly tool to share with community support services across Quebec and ultimately help alleviate the added burden caregivers and clinicians face when looking for respite care services in fragmented and complex digital spaces. UR - https://nursing.jmir.org/2024/1/e53078 UR - http://dx.doi.org/10.2196/53078 UR - http://www.ncbi.nlm.nih.gov/pubmed/38625735 ID - info:doi/10.2196/53078 ER - TY - JOUR AU - Nwosu, Chinonyelum AU - Khan, Hamda AU - Masese, Rita AU - Nocek, M. Judith AU - Gollan, Siera AU - Varughese, Taniya AU - Bourne, Sarah AU - Clesca, Cindy AU - Jacobs, R. Sara AU - Baumann, Ana AU - Klesges, M. Lisa AU - Shah, Nirmish AU - Hankins, S. Jane AU - Smeltzer, P. Matthew PY - 2024/4/16 TI - Recruitment Strategies in the Integration of Mobile Health Into Sickle Cell Disease Care to Increase Hydroxyurea Utilization Study (meSH): Multicenter Survey Study JO - JMIR Form Res SP - e48767 VL - 8 KW - sickle cell KW - recruitment KW - eHealth KW - multicenter KW - utilization KW - strategy KW - hydroxyurea KW - mobile health KW - mhealth KW - intervention N2 - Background: Hydroxyurea is an evidence-based disease-modifying therapy for sickle cell disease (SCD) but is underutilized. The Integration of Mobile Health into Sickle Cell Disease Care to Increase Hydroxyurea Utilization (meSH) multicenter study leveraged mHealth to deliver targeted interventions to patients and providers. SCD studies often underenroll; and recruitment strategies in the SCD population are not widely studied. Unanticipated events can negatively impact enrollment, making it important to study strategies that ensure adequate study accrual. Objective: The goal of this study was to evaluate enrollment barriers and the impact of modified recruitment strategies among patients and providers in the meSH study in response to a global emergency. Methods: Recruitment was anticipated to last 2 months for providers and 6 months for patients. The recruitment strategies used with patients and providers, new recruitment strategies, and recruitment rates were captured and compared. To document recruitment adaptations and their reasons, study staff responsible for recruitment completed an open-ended 9-item questionnaire eliciting challenges to recruitment and strategies used. Themes were extrapolated using thematic content analysis. Results: Total enrollment across the 7 sites included 89 providers and 293 patients. The study acceptance rate was 85.5% (382/447) for both patients and providers. The reasons patients declined participation were most frequently a lack of time and interest in research, while providers mostly declined because of self-perceived high levels of SCD expertise, believing they did not need the intervention. Initially, recruitment involved an in-person invitation to participate during clinic visits (patients), staff meetings (providers), or within the office (providers). We identified several important recruitment challenges, including (1) lack of interest in research, (2) lack of human resources, (3) unavailable physical space for recruitment activities, and (4) lack of documentation to verify eligibility. Adaptive strategies were crucial to alleviate enrollment disruptions due to the COVID-19 pandemic. These included remote approaching and consenting (eg, telehealth, email, and telephone) for patients and providers. Additionally, for patients, recruitment was enriched by simplification of enrollment procedures (eg, directly approaching patients without a referral from the provider) and a multitouch method (ie, warm introductions with flyers, texts, and patient portal messages). We found that patient recruitment rates were similar between in-person and adapted (virtual with multitouch) approaches (167/200, 83.5% and 126/143, 88.1%, respectively; P=.23). However, for providers, recruitment was significantly higher for in-person vs remote recruitment (48/50, 96% and 41/54, 76%, respectively, P<.001). Conclusions: We found that timely adaptation in recruitment strategies secured high recruitment rates using an assortment of enriched remote recruitment strategies. Flexibility in approach and reducing the burden of enrollment procedures for participants aided enrollment. It is important to continue identifying effective recruitment strategies in studies involving patients with SCD and their providers and the impact and navigation of recruitment challenges. Trial Registration: ClinicalTrials.Gov NCT03380351; https://clinicaltrials.gov/study/NCT03380351 International Registered Report Identifier (IRRID): RR2-10.2196/16319 UR - https://formative.jmir.org/2024/1/e48767 UR - http://dx.doi.org/10.2196/48767 UR - http://www.ncbi.nlm.nih.gov/pubmed/38625729 ID - info:doi/10.2196/48767 ER - TY - JOUR AU - Tuot, S. Delphine AU - Mukherjee, Aarya AU - Churape, Amanda AU - DeFries, Triveni AU - Su, George AU - Khoong, C. Elaine AU - Lyles, Courtney PY - 2024/4/15 TI - Lessons From the Field From a Volunteer Telehealth Ambassador Program to Enhance Video Visits Among Low-Income Patients: Qualitative Improvement Study JO - JMIR Form Res SP - e49993 VL - 8 KW - digital barriers KW - digital support KW - digital technologies KW - equity KW - health care delivery KW - safety-net KW - telehealth N2 - Background: The prevalence of telehealth video use across the United States is uneven, with low uptake in safety-net health care delivery systems, which care for patient populations who face barriers to using digital technologies. Objective: This study aimed to increase video visit use in an urban safety-net delivery system. We piloted a telehealth ambassador program, in which volunteers offered technical support to patients with access to digital technologies to convert primary care visits already scheduled as telehealth audio-only visits to telehealth video visits. Methods: We used a descriptive approach to assess the feasibility, efficacy, and acceptability of the pilot telehealth ambassador program. Feasibility was quantified by the percentage of eligible patients who answered calls from telehealth ambassadors. Program efficacy was measured in two ways: (1) the percentage of patients with access to digital technology who interacted with the navigators and were successfully prepared for a telehealth video visit, and (2) the percentage of prepared patients who completed their scheduled video visits. Program acceptability was ascertained by a structured telephone survey. Results: Telehealth ambassadors attempted to contact 776 eligible patients; 43.6% (338/776) were reached by phone, among whom 44.4% (150/338) were provided digital support between March and May 2021. The mean call duration was 8.8 (range 0-35) minutes. Overall, 67.3% (101/150) of patients who received support successfully completed a telehealth video visit with their provider. Among the 188 patients who were contacted but declined video visit digital support, 61% (114/188) provided a reason for their decline; 42% (48/114) did not see added value beyond a telehealth audio-only visit, 20% (23/114) had insufficient internet access, and 27% (31/114) declined learning about a new technology. The acceptability of the telehealth ambassador program was generally favorable, although some patients preferred having in-real-time technology support on the day of their telehealth video visit. Conclusions: This high-touch program reached approximately one-half of eligible patients and helped two-thirds of interested patients with basic video visit capability successfully complete a video visit. Increasing the program?s reach will require outreach solutions that do not rely solely on phone calls. Routinely highlighting the benefits of video visits, partnering with community-based organizations to overcome structural barriers to telehealth use, and offering in-real-time technology support will help increase the program?s efficacy. UR - https://formative.jmir.org/2024/1/e49993 UR - http://dx.doi.org/10.2196/49993 UR - http://www.ncbi.nlm.nih.gov/pubmed/38619874 ID - info:doi/10.2196/49993 ER - TY - JOUR AU - Kleinschmidt, Lara AU - Walendzik, Anke AU - Wasem, Jürgen AU - Höfer, Klemens AU - Nauendorf, Beatrice AU - Brittner, Matthias AU - Brandenburg, Paul AU - Aeustergerling, André AU - Schneider, Udo AU - Wadeck, Anja AU - Sehlen, Stephanie AU - Liersch, Sebastian AU - Schwarze, Katharina AU - Schwenke, Carsten AU - Hüer, Theresa PY - 2024/4/11 TI - Preference-Based Implementation of Video Consultations in Urban and Rural Regions in Outpatient Care in Germany: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e50932 VL - 13 KW - study protocol KW - video consultation KW - preference elicitation KW - discrete choice experiment KW - implementation KW - telemedicine KW - teleconsultation KW - e-consultation KW - outpatient KW - rural area KW - remote KW - preferences KW - strategy N2 - Background: Particularly in rural regions, factors such as lower physician density and long travel distances complicate adequate outpatient care. However, urban regions can also be affected by deficits in care, for example, long waiting times. One model of care intending to improve the situation is the implementation of video consultations. The study protocol presents the methodology of the research project titled ?Preference-based implementation of the video consultation in urban and rural regions? funded by the German Federal Joint Committee (funding number 01VSF20011). Objective: This study aims to identify existing barriers to the use of video consultation and the preferences of insured individuals and physicians as well as psychotherapists in order to optimize its design and thus increase acceptance and use of video consultations in urban and rural regions. Methods: Built on a mixed methods approach, this study first assesses the status quo of video consultation use through claims data analysis and carries out a systematic literature review on barriers and promoting factors for the use of video consultations. Based on this preliminary work, focus groups are conducted in order to prepare surveys with insureds as well as physicians and psychotherapists in the second study phase. The central element of the survey is the implementation of discrete choice experiments to elicit relevant preferences of (potential) user groups and service providers. The summarized findings are discussed in a stakeholder workshop and translated into health policy recommendations. Results: The methodological approach used in this study is the focus of this paper. The study is still ongoing and will continue until March 2024. The first study phase has already been completed, in which preliminary work has been done on potential applications and hurdles for the use of video consultations. Currently, the survey is being conducted and analyses are being prepared. Conclusions: This study is intended to develop a targeted strategy for health policy makers based on actual preferences and perceived obstacles to the use of video consultations. The results of this study will contribute to further user-oriented development of the implementation of video consultations in German statutory health insurance. Furthermore, the iterative and mixed methods approach used in this study protocol is also suitable for a variety of other research projects. International Registered Report Identifier (IRRID): DERR1-10.2196/50932 UR - https://www.researchprotocols.org/2024/1/e50932 UR - http://dx.doi.org/10.2196/50932 UR - http://www.ncbi.nlm.nih.gov/pubmed/38602749 ID - info:doi/10.2196/50932 ER - TY - JOUR AU - Nau, Maria Lara AU - Laux, Gunter AU - Altiner, Attila AU - Szecsenyi, Joachim AU - Leutgeb, Rüdiger PY - 2024/4/10 TI - The Use of Medical Services for Low-Acuity Emergency Cases in Germany: Protocol for a Multicenter Observational Pilot Study JO - JMIR Res Protoc SP - e54002 VL - 13 KW - emergency medical service KW - EMS KW - ambulance misuse KW - low-acuity calls KW - emergency department KW - paramedics KW - rescue operations N2 - Background: The increasing number of requests for help for acutely ill patients and their management is a major problem in the health systems of many countries, but especially in Germany. Rescue coordination centers and ambulances in Germany are increasingly overloaded. As a result, rides as a part of rescue operations have been increasing in length for years, yet a relevant proportion of these operations represent low-acuity calls (LACs). The basic objective of this pilot study is the quantitative analysis of the potential misuse of requests to the rescue control center. Indications for alternative treatment options and how to handle these treatment options in nonacute, non?life-threatening health conditions, such as minor injuries or minor infectious diseases, will be assessed. The identification of these LACs is vital in order to prevent health care resources in emergency medical care becoming inadequate. Objective: The overarching goal of this study is to determine the percentage of unnecessary rescue missions on site and subsequently to obtain an impression of the paramedics? assessment of alternative treatment options or alternative methods of rescue transportation. Methods: This will be an exploratory, noninterventional, cross-sectional study with a quantitative approach. The study is multicentric, with 21 ambulances in 12 different locations. The data for this study were collected via a questionnaire, newly developed for this study, for rescue personnel. Additionally, secondary data from the responsible control center will be linked and processed in an initial descriptive analysis. This descriptive analysis will form the basis for a subsequent variance analysis. Results: Data collection started as projected on September 18, 2023, and was ongoing until end of November 2023. We expect the documentation of several thousand rescue operations. We expect the following study results: (1) many unnecessary rescue operations, (2) immediate on-site assessment of correct care and treatment, and (3) patients? reasons for calling a rescue coordination center. Conclusions: To our knowledge, this is the first observational study in which acute rescue operations are recorded on site. The focus of this study is on the trained paramedics? assessment of whether rescue operations are necessary or not. Additionally, alternative treatments, such as out-of-hours care service or primary care service, are shown for each individual case. The study also intends to cover the question of which factors are relevant and statistically significantly connected to the misuse of ambulances. Trial Registration: German Register for Clinical Studies (Deutsches Register für Klinische Studien) DRKS00032510; https://drks.de/search/en/trial/DRKS00032510 International Registered Report Identifier (IRRID): DERR1-10.2196/54002 UR - https://www.researchprotocols.org/2024/1/e54002 UR - http://dx.doi.org/10.2196/54002 UR - http://www.ncbi.nlm.nih.gov/pubmed/38598281 ID - info:doi/10.2196/54002 ER - TY - JOUR AU - Sánchez-Quiñones, Beatriz AU - Antón-Maldonado, Cristina AU - Ibarra Vega, Nataly AU - Martorell Mariné, Isabel AU - Santamaria, Amparo PY - 2024/4/8 TI - Development and Implementation of an eHealth Oncohematonootric Program: Descriptive, Observational, Prospective Cohort Pilot Study JO - JMIR Form Res SP - e49574 VL - 8 KW - Nootric app KW - oncohematology patient KW - physical-nutritional well-being KW - multidisciplinary team N2 - Background: In oncohematology, both the development of the disease and the side effects of antineoplastic treatment often take a toll on patients? physical and nutritional well-being. In this era of digital transformation, we launched a pioneering project for oncohematologic patients to promote adherence to a healthy lifestyle and improve their physical and nutritional well-being. We aim to achieve this goal by involving doctors and nutritionists through the Nootric app. Objective: This study aims to assess the impact of the use of eHealth tools to facilitate nutrition and well-being in oncohematologic patients. We also aim to determine the usefulness of physical-nutritional management in improving tolerance to chemotherapy treatments within routine clinical practice. Methods: We designed a descriptive, observational, longitudinal, prospective cohort pilot study that included a total of 22 patients from March to May 2022 in the Vinalopó University Hospital. The inclusion criteria were adults over 18 years of age diagnosed with oncohematological pathology in active chemotherapy treatment. An action plan was created to generate alerts between the doctor and the nutritionist. In the beginning, the patients were trained to use the app and received education highlighting the importance of nutrition and physical exercise. Sociodemographic, clinical-biological-analytical (eg, malnutrition index), health care impact, usability, and patient adherence data were collected. Tolerance to chemotherapy treatment and its health care impact were evaluated. Results: We included 22 patients, 11 (50%) female and 11 (50%) male, ranging between 42 and 84 years of age. Among them, 13 (59%) were adherents to the program. The most frequent diseases were lymphoproliferative syndromes (13/22, 59%) and multiple myeloma (4/22, 18%). Moreover, 15 (68%) out of 22 patients received immunochemotherapy, while 7 (32%) out of 22 patients received biological treatment. No worsening of clinical-biological parameters was observed. Excluding dropouts and abandonments (n=9/22, 41%), the adherence rate was 81%, established by calculating the arithmetic mean of the adherence rates of 13 patients. No admission was observed due to gastrointestinal toxicity or discontinuation of treatment related to alterations in physical and nutritional well-being. In addition, only 5.5% of unscheduled consultations were increased due to incidents in well-being, mostly telematic (n=6/103 consultation are unscheduled). Additionally, 92% of patients reported an improvement in their nutritional habits (n=12/13), and up to 45% required adjustment of medical supportive treatment (n=5/11). There were no cases of grade 3 or greater gastrointestinal toxicity. All of this reflects improved tolerance to treatments. Patients reported a satisfaction score of 4.3 out of 5, while professionals rated their satisfaction at 4.8 out of 5. Conclusions: We demonstrated the usefulness of integrating new technologies through a multidisciplinary approach. The Nootric app facilitated collaboration among the medical team, nutritionists, and patients. It enabled us to detect health issues related to physical-nutritional well-being, anticipate major complications, and mitigate potentially avoidable risks. Consequently, there was a decrease in unscheduled visits and admissions related to this condition. UR - https://formative.jmir.org/2024/1/e49574 UR - http://dx.doi.org/10.2196/49574 UR - http://www.ncbi.nlm.nih.gov/pubmed/38588522 ID - info:doi/10.2196/49574 ER - TY - JOUR AU - Haslam-Larmer, Lynn AU - Grigorovich, Alisa AU - Shum, Leia AU - Bianchi, Andria AU - Newman, Kristine AU - Iaboni, Andrea AU - McMurray, Josephine PY - 2024/4/8 TI - Factors That Influence Successful Adoption of Real-Time Location Systems for Use in a Dementia Care Setting: Mixed Methods Study JO - JMIR Aging SP - e45978 VL - 7 KW - remote sensing technologies KW - dementia KW - real-time location systems KW - Fit between Individuals, Tasks, and Technology framework KW - FITT framework KW - technology implementation N2 - Background: Technology has been identified as a potential solution to alleviate resource gaps and augment care delivery in dementia care settings such as hospitals, long-term care, and retirement homes. There has been an increasing interest in using real-time location systems (RTLS) across health care settings for older adults with dementia, specifically related to the ability to track a person?s movement and location. Objective: In this study, we aimed to explore the factors that influence the adoption or nonadoption of an RTLS during its implementation in a specialized inpatient dementia unit in a tertiary care rehabilitation hospital. Methods: The study included data from a brief quantitative survey and interviews from a convenience sample of frontline participants. Our deductive analysis of the interview used the 3 categories of the Fit Between Individuals, Task, and Technology framework as follows: individual and task, individual and technology, and task and technology. The purpose of using this framework was to assess the quality of the fit between technology attributes and an individual?s self-reported intentions to adopt RTLS technology. Results: A total of 20 health care providers (HCPs) completed the survey, of which 16 (80%) participated in interviews. Coding and subsequent analysis identified 2 conceptual subthemes in the individual-task fit category, including the identification of the task and the perception that participants were missing at-risk patient events. The task-technology fit category consisted of 3 subthemes, including reorganization of the task, personal control in relation to the task, and efficiency or resource allocation. A total of 4 subthemes were identified in the individual-technology fit category, including privacy and personal agency, trust in the technology, user interfaces, and perceptions of increased safety. Conclusions: By the end of the study, most of the unit?s HCPs were using the tablet app based on their perception of its usefulness, its alignment with their comfort level with technology, and its ability to help them perform job responsibilities. HCPs perceived that they were able to reduce patient search time dramatically, yet any improvements in care were noted to be implied, as this was not measured. There was limited anecdotal evidence of reduced patient risk or adverse events, but greater reported peace of mind for HCPs overseeing patients? activity levels. UR - https://aging.jmir.org/2024/1/e45978 UR - http://dx.doi.org/10.2196/45978 UR - http://www.ncbi.nlm.nih.gov/pubmed/38587884 ID - info:doi/10.2196/45978 ER - TY - JOUR AU - Palakshappa, A. Jessica AU - Hale, R. Erica AU - Brown, D. Joshua AU - Kittel, A. Carol AU - Dressler, Emily AU - Rosenthal, E. Gary AU - Cutrona, L. Sarah AU - Foley, L. Kristie AU - Haines, R. Emily AU - Houston II, K. Thomas PY - 2024/4/8 TI - Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System JO - J Med Internet Res SP - e54008 VL - 26 KW - telehealth KW - telemedicine KW - e-health KW - eHealth KW - video visits KW - video KW - ICT KW - information and communication technology KW - survey KW - surveys KW - adoption KW - usability KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - COVID-19 N2 - Background: Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic. Objective: This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges. Methods: A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations. Results: A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits (?Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video??) was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5% (156/511) selecting it as a challenge in 2020 and 37.1% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3% in 2020 and 137/615, 22.3% in 2021, P=.73). Conclusions: During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology. UR - https://www.jmir.org/2024/1/e54008 UR - http://dx.doi.org/10.2196/54008 UR - http://www.ncbi.nlm.nih.gov/pubmed/38587889 ID - info:doi/10.2196/54008 ER - TY - JOUR AU - Atefi, L. Golnaz AU - van Knippenberg, M. Rosalia J. AU - Bartels, Laureen Sara AU - Losada-Baltar, Andrés AU - Márquez-González, María AU - Verhey, J. Frans R. AU - de Vugt, E. Marjolein PY - 2024/4/4 TI - A Web-Based Intervention Based on Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Mixed Methods Feasibility Study JO - JMIR Aging SP - e53489 VL - 7 KW - acceptance and commitment therapy KW - ACT KW - psychological flexibility KW - behavior change KW - theory-guided eHealth KW - web-based intervention KW - supported self-help KW - family caregivers KW - dementia N2 - Background: Acceptance and commitment therapy (ACT), as an empirically based third-wave cognitive behavioral therapy, has shown promise in enhancing well-being and functioning across diverse populations. However, in the context of caregiving, the effect size of available ACT interventions remains at best moderate, sometimes accompanied by high dropout rates, highlighting the need for more effective and feasible intervention designs. Objective: The objective of our study was to evaluate the feasibility and acceptability of a fully online ACT program designed for family caregivers of people with dementia. This study aimed to boost psychological flexibility and support caregivers, enabling them to realize and prioritize their own life values alongside their caregiving responsibilities. Methods: A mixed methods feasibility study using an uncontrolled pretest-posttest design was conducted. This intervention included a 9-week web-based self-help program based on ACT incorporating collaborative goal setting and weekly web-based motivational coaching for family caregivers of people with dementia. This study involved 30 informal caregivers recruited through memory clinics and social media platforms in the Netherlands and received approval from the Medical Ethics Committee of the Maastricht University Medical Center+ (NL77389.068.21/metc21-029). Results: A total of 24 caregivers completed the postintervention assessment, indicating a high adherence rate (24/29, 83%). Caregivers reported positive feedback regarding collaborative goal setting, but some found challenges in implementing new skills due to their own habitual responses or the unpredictable context of dementia caregiving. Personalizing the intervention based on individual value preferences was highlighted as beneficial. Conclusions: Compared to other web-based self-help ACT interventions for family caregivers, this intervention showed a high adherence and sufficient level of feasibility, which underscores the use of personalization in delivering web-based interventions. Moreover, the potential of this ACT-based intervention for family caregivers of people with dementia was demonstrated, suggesting that further research and a larger-scale controlled trial are warranted to validate its effectiveness. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-070499 UR - https://aging.jmir.org/2024/1/e53489 UR - http://dx.doi.org/10.2196/53489 UR - http://www.ncbi.nlm.nih.gov/pubmed/38574360 ID - info:doi/10.2196/53489 ER - TY - JOUR AU - Esper, Andrew Stephen AU - Holder-Murray, Jennifer AU - Meister, Ann Katie AU - Lin, Sylvia Hsing-Hua AU - Hamilton, Kojo David AU - Groff, Jan Yram AU - Zuckerbraun, Scott Brian AU - Mahajan, Aman PY - 2024/4/4 TI - A Novel Digital Health Platform With Health Coaches to Optimize Surgical Patients: Feasibility Study at a Large Academic Health System JO - JMIR Perioper Med SP - e52125 VL - 7 KW - digital health solution KW - feasibility KW - length of stay reduction KW - patient engagement KW - patient satisfaction KW - perioperative medicine N2 - Background: Pip is a novel digital health platform (DHP) that combines human health coaches (HCs) and technology with patient-facing content. This combination has not been studied in perioperative surgical optimization. Objective: This study?s aim was to test the feasibility of the Pip platform for deploying perioperative, digital, patient-facing optimization guidelines to elective surgical patients, assisted by an HC, at predefined intervals in the perioperative journey. Methods: We conducted an institutional review board?approved, descriptive, prospective feasibility study of patients scheduled for elective surgery and invited to enroll in Pip from 2.5 to 4 weeks preoperatively through 4 weeks postoperatively at an academic medical center between November 22, 2022, and March 27, 2023. Descriptive primary end points were patient-reported outcomes, including patient satisfaction and engagement, and Pip HC evaluations. Secondary end points included mean or median length of stay (LOS), readmission at 7 and 30 days, and emergency department use within 30 days. Secondary end points were compared between patients who received Pip versus patients who did not receive Pip using stabilized inverse probability of treatment weighting. Results: A total of 283 patients were invited, of whom 172 (60.8%) enrolled in Pip. Of these, 80.2% (138/172) patients had ?1 HC session and proceeded to surgery, and 70.3% (97/138) of the enrolled patients engaged with Pip postoperatively. The mean engagement began 27 days before surgery. Pip demonstrated an 82% weekly engagement rate with HCs. Patients attended an average of 6.7 HC sessions. Of those patients that completed surveys (95/138, 68.8%), high satisfaction scores were recorded (mean 4.8/5; n=95). Patients strongly agreed that HCs helped them throughout the perioperative process (mean 4.97/5; n=33). The average net promoter score was 9.7 out of 10. A total of 268 patients in the non-Pip group and 128 patients in the Pip group had appropriate overlapping distributions of stabilized inverse probability of treatment weighting for the analytic sample. The Pip cohort was associated with LOS reduction when compared to the non-Pip cohort (mean 2.4 vs 3.1days; median 1.9, IQR 1.0-3.1 vs median 3.0, IQR 1.1-3.9 days; mean ratio 0.76; 95% CI 0.62-0.93; P=.009). The Pip cohort experienced a 49% lower risk of 7-day readmission (relative risk [RR] 0.51, 95% CI 0.11-2.31; P=.38) and a 17% lower risk of 30-day readmission (RR 0.83, 95% CI 0.30-2.31; P=.73), though these did not reach statistical significance. Both cohorts had similar 30-day emergency department returns (RR 1.06, 95% CI 0.56-2.01, P=.85). Conclusions: Pip is a novel mobile DHP combining human HCs and perioperative optimization content that is feasible to engage patients in their perioperative journey and is associated with reduced hospital LOS. Further studies assessing the impact on clinical and patient-reported outcomes from the use of Pip or similar DHPs HC combinations during the perioperative journey are required. UR - https://periop.jmir.org/2024/1/e52125 UR - http://dx.doi.org/10.2196/52125 UR - http://www.ncbi.nlm.nih.gov/pubmed/38573737 ID - info:doi/10.2196/52125 ER - TY - JOUR AU - Yoon, Sungwon AU - Tan, Min Chao AU - Phang, Kie Jie AU - Liu, Xi Venice AU - Tan, Boon Wee AU - Kwan, Heng Yu AU - Low, Leng Lian PY - 2024/4/4 TI - Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study JO - JMIR Form Res SP - e51848 VL - 8 KW - decision-making KW - diabetes KW - health coach KW - health coaching KW - healthcare professional KW - hypertension KW - patient KW - patient-centered care KW - person-centered care KW - qualitative research KW - self-management KW - shared decision-making N2 - Background: An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension. Objective: This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs. Methods: We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Participants agreed that the main responsibility of HCPs should be identifying the patient?s stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach?s personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority). Conclusions: The findings shed light on the appropriate roles of health coaches vis-à-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process. UR - https://formative.jmir.org/2024/1/e51848 UR - http://dx.doi.org/10.2196/51848 UR - http://www.ncbi.nlm.nih.gov/pubmed/38573763 ID - info:doi/10.2196/51848 ER - TY - JOUR AU - Sigaard, Andersen Jarl Voss AU - Henneberg, Celina Nanna AU - Schacksen, Skov Cathrine AU - Kronborg, Højsted Sissel AU - Petrini, Laura AU - Kidholm, Kristian AU - Birgisdóttir, Rósa Una AU - Spindler, Helle AU - Dinesen, Birthe PY - 2024/4/2 TI - A Digital Platform (Telepalliation) for Patients in Palliative Care and Their Relatives: Protocol for a Multimethod Randomized Controlled Trial JO - JMIR Res Protoc SP - e49946 VL - 13 KW - palliative care KW - digital health KW - quality of life KW - telehealth KW - interdisciplinary research KW - randomized controlled trial N2 - Background: The World Health Organization defines end-of-life palliative care as ?prevention and relief of suffering, by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.? Over 20 million people worldwide are in need of palliative care. In Denmark, palliative care is given at a general and a specialist level. The general level comprises health care professionals (HCPs) who do not perform palliative care full-time. The specialist level comprises specialized palliative care (SPC), where HCPs perform palliative care full-time. In total, 20%-30% of patients who need palliative care are referred to SPC. Challenges with SPC include a short time span from referral to end of life, patients who are very ill and may therefore find it hard to travel to an outpatient clinic, and the SPC unit having a relatively small staff. The need for SPC is expected to rise, as the number of patients dying from terminal diseases is increasing. Telehealth has been successfully implemented in different home care settings, including palliative care. Objective: The aim of the study is to present the research design of the clinical testing of a telepalliation program by the use of a digital platform for patients in palliative care and their relatives. Methods: The telepalliation program will be conducted as a multimethod randomized controlled trial. The intervention group will follow the telepalliation program, while the control group will follow the traditional standard of care program for palliative care. The primary outcome of the study is increased quality of life. Secondary outcomes include enhanced sense of security; reduced experience of pain; satisfactory experiences of patients and relatives with the TelePal platform and degree of satisfaction in being a part of the program; experiences with the use of the TelePal platform on the part of HCPs and the professionals? experiences of being a part of the program; the use of a cross-sector communication platform and the telepalliation program by patients, relatives, and HCPs; and the projected lower cost of health care services. These outcomes will be assessed using questionnaires, data generated by digital technologies, and semistructured interviews. Results: The collection of data began in May 2021 and will be completed in August 2024. The results of the study will be published in peer-reviewed journals and presented at international conferences. Results from the telepalliation program are expected to be published by fall 2024. Conclusions: The expected outcomes of the study are increased quality of life and increased sense of security. We also expect that the study will have a clinical impact on future telepalliation for those patients who are referred to a palliative team. Trial Registration: ClinicalTrials.gov NCT04995848; https://clinicaltrials.gov/study/NCT04995848 International Registered Report Identifier (IRRID): DERR1-10.2196/49946 UR - https://www.researchprotocols.org/2024/1/e49946 UR - http://dx.doi.org/10.2196/49946 UR - http://www.ncbi.nlm.nih.gov/pubmed/38564264 ID - info:doi/10.2196/49946 ER - TY - JOUR AU - Zhang, Chunyu AU - Hu, Ning AU - Li, Rui AU - Zhu, Aiping AU - Yu, Zhongguang PY - 2024/3/29 TI - Factors Explaining the Use of Web-Based Consultations With Physicians by Young and Middle-Aged Individuals in China: Qualitative Comparative Analysis JO - JMIR Form Res SP - e50036 VL - 8 KW - web-based consultation KW - Andersen Behavioral Model KW - qualitative comparative analysis KW - perceived convenience KW - complementary role KW - user's confidence KW - China N2 - Background: It was only upon the occurrence of the COVID-19 pandemic that the demand for web-based consultations with physicians grew at unprecedented rates. To meet the demand, the service environment developed rapidly during the pandemic. Objective: This study aimed to identify the current status of the use of web-based consultations with physicians among young and middle-aged Chinese individuals and explore users? perspectives on key factors that influence its use in terms of optimizing benefits and compensating for disadvantages. Methods: We conducted semistructured interviews with 65 individuals (aged 18 to 60 years) across China between September and October 2022. The interviewees were selected through snowball sampling. They described their experiences of using web-based physician consultations and the reasons for using or not using the service. Based on the Andersen Behavioral Model, a qualitative comparative analysis was used to analyze the factors associated with the use of web-based physician consultations and explore the combinations of these factors. Results: In all, 31 (48%) of the 65 interviewees used web-based consultation services. The singular necessary condition analysis revealed that the complementary role of the service and perceived convenience are necessary conditions for the use of web-based consultation services, and user?s confidence in the service was a sufficient condition. Based on the Andersen Behavioral Model, the configuration analysis uncovered 2 interpretation models: an enabling-oriented model and a need-oriented model. The basic combination of the enabling-oriented model included income and perceived convenience. The basic combination of the need-oriented model included complementary role and user?s confidence. Conclusions: Among the factors associated with the use of web-based consultations, perceived convenience, complementary role, and user?s confidence were essential factors. Clear instructions on the conduct of the service, cost regulations, provider qualifications guarantee, privacy and safety supervision, the consultations? application in chronic disease management settings, and subsequent visits can promote the positive development of web-based consultations. UR - https://formative.jmir.org/2024/1/e50036 UR - http://dx.doi.org/10.2196/50036 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551645 ID - info:doi/10.2196/50036 ER - TY - JOUR AU - Dietrich, Damien AU - Bornet dit Vorgeat, Helena AU - Perrin Franck, Caroline AU - Ligier, Quentin PY - 2024/3/28 TI - A Mobile App (Concerto) to Empower Hospitalized Patients in a Swiss University Hospital: Development, Design, and Implementation Report JO - JMIR Med Inform SP - e47914 VL - 12 KW - patient empowerment KW - mobile apps KW - digital health KW - mobile health KW - implementation science KW - health care system KW - hospital information system KW - health promotion N2 - Background: Patient empowerment can be associated with better health outcomes, especially in the management of chronic diseases. Digital health has the potential to promote patient empowerment. Objective: Concerto is a mobile app designed to promote patient empowerment in an in-patient setting. This implementation report focuses on the lessons learned during its implementation. Methods: The app was conceptualized and prototyped during a hackathon. Concerto uses hospital information system (HIS) data to offer the following key functionalities: a care schedule, targeted medical information, practical information, information about the on-duty care team, and a medical round preparation module. Funding was obtained following a feasibility study, and the app was developed and implemented in four pilot divisions of a Swiss University Hospital using institution-owned tablets. Implementation (Results): The project lasted for 2 years with effective implementation in the four pilot divisions and was maintained within budget. The induced workload on caregivers impaired project sustainability and warranted a change in our implementation strategy. The presence of a killer function would have facilitated the deployment. Furthermore, our experience is in line with the well-accepted need for both high-quality user training and a suitable selection of superusers. Finally, by presenting HIS data directly to the patient, Concerto highlighted the data that are not fit for purpose and triggered data curation and standardization initiatives. Conclusions: This implementation report presents a real-world example of designing, developing, and implementing a patient-empowering mobile app in a university hospital in-patient setting with a particular focus on the lessons learned. One limitation of the study is the lack of definition of a ?key success? indicator. UR - https://medinform.jmir.org/2024/1/e47914 UR - http://dx.doi.org/10.2196/47914 UR - http://www.ncbi.nlm.nih.gov/pubmed/38546728 ID - info:doi/10.2196/47914 ER - TY - JOUR AU - Sheng, Yiyang AU - Bond, Raymond AU - Jaiswal, Rajesh AU - Dinsmore, John AU - Doyle, Julie PY - 2024/3/28 TI - Augmenting K-Means Clustering With Qualitative Data to Discover the Engagement Patterns of Older Adults With Multimorbidity When Using Digital Health Technologies: Proof-of-Concept Trial JO - J Med Internet Res SP - e46287 VL - 26 KW - aging KW - digital health KW - multimorbidity KW - chronic disease KW - engagement KW - k-means clustering N2 - Background: Multiple chronic conditions (multimorbidity) are becoming more prevalent among aging populations. Digital health technologies have the potential to assist in the self-management of multimorbidity, improving the awareness and monitoring of health and well-being, supporting a better understanding of the disease, and encouraging behavior change. Objective: The aim of this study was to analyze how 60 older adults (mean age 74, SD 6.4; range 65-92 years) with multimorbidity engaged with digital symptom and well-being monitoring when using a digital health platform over a period of approximately 12 months. Methods: Principal component analysis and clustering analysis were used to group participants based on their levels of engagement, and the data analysis focused on characteristics (eg, age, sex, and chronic health conditions), engagement outcomes, and symptom outcomes of the different clusters that were discovered. Results: Three clusters were identified: the typical user group, the least engaged user group, and the highly engaged user group. Our findings show that age, sex, and the types of chronic health conditions do not influence engagement. The 3 primary factors influencing engagement were whether the same device was used to submit different health and well-being parameters, the number of manual operations required to take a reading, and the daily routine of the participants. The findings also indicate that higher levels of engagement may improve the participants? outcomes (eg, reduce symptom exacerbation and increase physical activity). Conclusions: The findings indicate potential factors that influence older adult engagement with digital health technologies for home-based multimorbidity self-management. The least engaged user groups showed decreased health and well-being outcomes related to multimorbidity self-management. Addressing the factors highlighted in this study in the design and implementation of home-based digital health technologies may improve symptom management and physical activity outcomes for older adults self-managing multimorbidity. UR - https://www.jmir.org/2024/1/e46287 UR - http://dx.doi.org/10.2196/46287 UR - http://www.ncbi.nlm.nih.gov/pubmed/38546724 ID - info:doi/10.2196/46287 ER - TY - JOUR AU - Saravanakumar, Sanjeev AU - Ostrovsky, Andrey PY - 2024/3/28 TI - Evaluation of Telehealth Services that are Clinically Appropriate for Reimbursement in the US Medicaid Population: Mixed Methods Study JO - J Med Internet Res SP - e46412 VL - 26 KW - mobile phone KW - telehealth KW - Medicaid reimbursement KW - health equity KW - Center for Medicare & Medicaid Services KW - telemedicine KW - reimbursement KW - digital health KW - Medicaid KW - Public Health Emergency KW - access KW - equity KW - health insurance KW - coverage KW - reimburse KW - equitable KW - health policy KW - telehealth expansion N2 - Background: When the US Department of Health and Human Services instituted a State of Public Health Emergency (PHE) during the COVID-19 pandemic, many telehealth flexibilities were fast-tracked to allow state Medicaid agencies to reimburse new specialty services, sites of care, and mediums such as FaceTime to communicate with patients.. This resulted in expanded access to care for financially vulnerable Medicaid patients, as evidenced by an uptick in telehealth use. Research has mostly focused on telehealth reimbursement for limited use cases such as rural primary care, without broader consideration for how telehealth can be appropriately mainstreamed and maintained. Objective: This study sought to (1) evaluate the continuation of flexible telehealth reimbursement broadly, beyond the COVID-19 pandemic; (2) analyze the clinical effectiveness of the new telehealth services; and (3) offer code-by-code reimbursement guidance to state Medicaid leaders. Methods: We surveyed 10 state Medicaid medical directors (MMDs) who are responsible for the scientific and clinical appropriateness of Medicaid policies in their respective states. Participants were asked to complete an internet-based survey with a list of medical billing codes, grouped by service type, and asked if they believed they should be reimbursed by Medicaid on a permanent basis. Additional questions covered more detailed recommendations, such as reimbursing video with audio versus audio-only, guardrails for certain specialty services, and motivations behind responses. Results: The MMDs felt that the majority of services should be reimbursed via some modality of telehealth after the PHE, with the most support for video combined with audio compared to audio-only. There were exceptions on both ends of the spectrum, where services such as pulmonary diagnostics were not recommended to be reimbursed in any form and services such as psychotherapy for mental health had the most support for audio-only. The vast majority of MMDs were supportive of reimbursement for remote monitoring services, but some preferred to have some reimbursement guardrails. We found that 90% (n=9) of MMDs were supportive of reimbursement for telehealth interprofessional services, while half (n=5) of the respondents felt that there should be continued guardrails for reimbursement. Motivations for continuing reimbursement flexibility were largely attributed to improving access to care, improving outcomes, and improving equity among the Medicaid patient population. Conclusions: There is a strong clinical endorsement to continue the telehealth flexibility enabled by the PHE, primarily for video combined with audio telehealth, with caution against audio-only telehealth in situations where hands-on intervention is necessary for diagnosis or treatment. There is also support for reimbursing remote monitoring services and telehealth interprofessional services, albeit with guardrails. These results are primarily from a perspective of improving access, outcomes, and equity; other state-specific factors such as fiscal impact and technical implementation may need to be taken into account when considering reimbursement decisions on telehealth. UR - https://www.jmir.org/2024/1/e46412 UR - http://dx.doi.org/10.2196/46412 UR - http://www.ncbi.nlm.nih.gov/pubmed/38546706 ID - info:doi/10.2196/46412 ER - TY - JOUR AU - van den Bosch, C. Stefanie AU - van Dalen, Demi AU - Meinders, Marjan AU - van Goor, Harry AU - Bergé, Stefaan AU - Stommel, Martijn AU - van Dulmen, Sandra PY - 2024/3/27 TI - Outpatient Video Visits During the COVID-19 Pandemic: Cross-Sectional Survey Study of Patients? Experiences and Characteristics JO - J Med Internet Res SP - e49058 VL - 26 KW - telemedicine KW - video visit KW - remote consultation KW - eHealth KW - patient-centered care KW - COVID-19 KW - mobile phone N2 - Background: During the first lockdown of the COVID-19 pandemic, an exponential increase in video consultations replacing in-person outpatient visits was observed in hospitals. Insight into patients? experiences with this type of consultation is helpful for a broad, sustainable, and patient-centered implementation of video consultation. Objective: This study aims to examine patients? experiences with video consultation during the COVID-19 pandemic and identify discriminative patient and consultation characteristics to determine when video consultation is most feasible. Methods: A cross-sectional survey study was conducted. Patients aged ?18 years and scheduled for a video consultation at the outpatient clinic of a Dutch university medical center from August 2020 to December 2020 for all medical specialties were eligible. Patients? experiences were explored through a study-specific survey using descriptive quantitative statistics. Open-ended questions were qualitatively analyzed and thematically categorized into appreciated aspects and aspects for improvement. Discriminative patient and consultation characteristics were identified using 3 distinctive survey items. Characteristics of patients who scored and those who did not score all 3 items positively were analyzed using binary logistic regression. Results: A total of 1054 patients were included in the analysis. Most patients (964/1054, 91.46%) were satisfied with their video consultation, with a mean overall grade of 8.6 (SD 1.3) of 10. In the qualitative analyses, 70.02% (738/1054) of the patients cited aspects they appreciated and 44.97% (474/1054) mentioned aspects for improvement during their consultation. Patients with better self-rated health reported a positive evaluation significantly more often (P=.001), which also held true for other medical specialties (vs surgical and nonsurgical specialties; P<.001). Conclusions: Video consultation was perceived as highly satisfactory by patients during the COVID-19 pandemic, with the best experience reported by healthy participants and those undergoing their first consultation. Appreciated aspects are mainly at the individual professional level, organizational level, and innovation level itself. The aspects that were mentioned for improvement can be changed for the better. UR - https://www.jmir.org/2024/1/e49058 UR - http://dx.doi.org/10.2196/49058 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536236 ID - info:doi/10.2196/49058 ER - TY - JOUR AU - Yao, Jiasi AU - Roth, Heike AU - Anderson, Debra AU - Lu, Hong AU - Rong, Huijuan AU - Baird, Kathleen PY - 2024/3/26 TI - Comparison of Spontaneous Pushing and Directed Pushing During the Second Stage of Labor Among Chinese Women Without Epidural Analgesia: Protocol for a Noninferior Feasibility Study JO - JMIR Res Protoc SP - e55701 VL - 13 KW - spontaneous pushing KW - directed pushing KW - labour stage, labour KW - labor KW - obstetric KW - obstetrics KW - child KW - birth KW - delivery KW - second KW - feasibility study KW - China KW - Chinese KW - women KW - protocol KW - maternal-neonatal outcomes KW - maternal KW - healthcare KW - labouring women KW - cohort KW - effectiveness KW - Midwives KW - midwife KW - midwifery KW - childbirth N2 - Background: Maternal pushing during the second stage of labor could influence labor progress and maternal-neonatal outcomes. Although the image of health care providers directing the laboring women to push during the second stage of labor could be commonly observed globally, this practice is not sufficiently researched and is questioned regarding its effectiveness and outcomes on the mother and baby. Meanwhile, a strategy referred to as ?spontaneous pushing,? which supports women to push by following their bodily urges, has been evaluated in several trials. However, in China, spontaneous pushing is not common practice. Notwithstanding the evaluation of spontaneous pushing, there is a lack of high-quality evidence to support either strategies of directed pushing or spontaneous pushing. Objective: This study aims to test the feasibility of a future randomized controlled trial to compare the effects of spontaneous pushing and directed pushing during the second stage of labor for maternal and neonatal outcomes in China. Methods: A nonrandomized, single-group, noninferiority feasibility study will be conducted in a public hospital in Hebei Province, China. In total, 105 women meeting the selection criteria will be recruited to receive the intervention (spontaneous pushing), while 105 sets of medical notes from women who received routine care (directed pushing) will be identified and reviewed to compare outcomes for both cohorts. A mixed methods approach will be used to assess primary outcomes (feasibility and acceptability) and secondary outcomes (effectiveness). Results: Data collection took place between May and October 2023. A total of 110 women were invited to participate in the intervention of spontaneous pushing. Midwives? interviews were conducted and will be transcribed for analysis in March 2024. The data analysis is planned to be completed by May 2024. Conclusions: This feasibility study will provide important information by conducting a full-scale clinical trial in the future as well as the potential facilitators and barriers of it. A future randomized controlled trial is likely to have considerable policy and funding impacts regarding pushing management during the second stage of labor and improvement in women?s childbirth experience. Trial Registration: Chinese Clinical Trial Register ChiCTR2300071178; https://tinyurl.com/mudtnbft International Registered Report Identifier (IRRID): DERR1-10.2196/55701 UR - https://www.researchprotocols.org/2024/1/e55701 UR - http://dx.doi.org/10.2196/55701 UR - http://www.ncbi.nlm.nih.gov/pubmed/38530330 ID - info:doi/10.2196/55701 ER - TY - JOUR AU - Haimi, Motti AU - Wheeler, Quilter Sheila PY - 2024/3/25 TI - Safety in Teletriage by Nurses and Physicians in the United States and Israel: Narrative Review and Qualitative Study JO - JMIR Hum Factors SP - e50676 VL - 11 KW - telephone triage KW - teletriage KW - telehealth KW - telemedicine KW - safety KW - system error KW - human error KW - triage KW - outcome KW - patient safety N2 - Background: The safety of telemedicine in general and telephone triage (teletriage) safety in particular have been a focus of concern since the 1970s. Today, telehealth, now subsuming teletriage, has a basic structure and process intended to promote safety. However, inadequate telehealth systems may also compromise patient safety. The COVID-19 pandemic accelerated rapid but uneven telehealth growth, both technologically and professionally. Within 5-10 years, the field will likely be more technologically advanced; however, these advances may still outpace professional standards. The need for an evidence-based system is crucial and urgent. Objective: Our aim was to explore ways that developed teletriage systems produce safe outcomes by examining key system components and questioning long-held assumptions. Methods: We examined safety by performing a narrative review of the literature using key terms concerning patient safety in teletriage. In addition, we conducted system analysis of 2 typical formal systems, physician led and nurse led, in Israel and the United States, respectively, and evaluated those systems? respective approaches to safety. Additionally, we conducted in-depth interviews with representative physicians and 1 nurse using a qualitative approach. Results: The review of literature indicated that research on various aspects of telehealth and teletriage safety is still sparse and of variable quality, producing conflicting and inconsistent results. Researchers, possibly unfamiliar with this complicated field, use an array of poorly defined terms and appear to design studies based on unfounded assumptions. The interviews with health care professionals demonstrated several challenges encountered during teletriage, mainly making diagnosis from a distance, treating unfamiliar patients, a stressful atmosphere, working alone, and technological difficulties. However, they reported using several measures that help them make accurate diagnoses and reasonable decisions, thus keeping patient safety, such as using their expertise and intuition, using structured protocols, and considering nonmedical factors and patient preferences (shared decision-making). Conclusions: Remote encounters about acute, worrisome symptoms are time sensitive, requiring decision-making under conditions of uncertainty and urgency. Patient safety and safe professional practice are extremely important in the field of teletriage, which has a high potential for error. This underregulated subspecialty lacks adequate development and substantive research on system safety. Research may commingle terminology and widely different, ill-defined groups of decision makers with wide variation in decision-making skills, clinical training, experience, and job qualifications, thereby confounding results. The rapid pace of telehealth?s technological growth creates urgency in identifying safe systems to guide developers and clinicians about needed improvements. UR - https://humanfactors.jmir.org/2024/1/e50676 UR - http://dx.doi.org/10.2196/50676 UR - http://www.ncbi.nlm.nih.gov/pubmed/38526526 ID - info:doi/10.2196/50676 ER - TY - JOUR AU - Yan, Yiwei AU - Xing, Congyan AU - Chen, Jian AU - Zheng, Yingbin AU - Li, Xiaobin AU - Liu, Yirong AU - Wang, Zhanxiang AU - Gong, Kai PY - 2024/3/25 TI - Provincial Maternal and Child Information System in Inner Mongolia, China: Descriptive Implementation Study JO - JMIR Pediatr Parent SP - e46813 VL - 7 KW - information system KW - maternal and child health care KW - system construction KW - system implementation KW - regional health KW - Inner Mongolia Autonomous Region N2 - Background: After the implementation of 2- and 3-child policies, the rising proportion of high-age and high-risk pregnancies put enormous pressure on maternal and child health (MCH) services for China. This populous nation with an increasing population flow imperatively required the support of large-scale information systems for management. Municipal MCH information systems were commonly applied in developed cities of eastern provinces in China. However, implementation of provincial MCH information systems in relatively low-income areas is lacking. In 2020, the implementation of a regional maternal and child information system (RMCIS) in Inner Mongolia filled this gap. Objective: This paper aimed to demonstrate the construction process and evaluate the implementation effect of an RMCIS in improving the regional MCH in Inner Mongolia. Methods: We conducted a descriptive study for the implementation of an RMCIS in Inner Mongolia. Based on the role analysis and information reporting process, the system architecture design had 10 modules, supporting basic health care services, special case management, health support, and administration and supervision. Five-color management was applied for pregnancy risk stratification. We collected data on the construction cost, key characteristics of patients, and use count of the main services from January 1, 2020, to October 31, 2022, in Inner Mongolia. Descriptive analysis was used to demonstrate the implementation effects of the RMCIS. Results: The construction and implementation of the RMCIS cost CNY 8 million (US $1.1 million), with a duration of 13 months. Between 2020 and 2022, the system recorded 221,772 registered pregnant women, with a 44.75% early pregnancy registry rate and 147,264 newborns, covering 278 hospitals and 225 community health care centers in 12 cities. Five-color management of high-risk pregnancies resulted in 76,975 (45.45%) pregnancies stratified as yellow (general risk), 36,627 (21.63%) as orange (relatively high risk), 156 (0.09%) as red (high risk), and 3888 (2.30%) as purple (infectious disease). A scarred uterus (n=28,159, 36.58%), BMI?28 (n=14,164, 38.67%), aggressive placenta praevia (n=32, 20.51%), and viral hepatitis (n=1787, 45.96%) were the top factors of high-risk pregnancies (yellow, orange, red, and purple). In addition, 132,079 pregnancies, including 65,018 (49.23%) high-risk pregnancies, were registered in 2022 compared to 32,466 pregnancies, including 21,849 (67.30%) high-risk pregnancies, registered in 2020. Conclusions: The implementation of an RMCIS in Inner Mongolia achieved the provincial MCH data interconnection for basic services and obtained both social and economic benefits, which could provide valuable experience to medical administration departments, practitioners, and medical informatics constructors worldwide. UR - https://pediatrics.jmir.org/2024/1/e46813 UR - http://dx.doi.org/10.2196/46813 UR - http://www.ncbi.nlm.nih.gov/pubmed/38526553 ID - info:doi/10.2196/46813 ER - TY - JOUR AU - Pomey, Marie-Pascale AU - Le Roux, Enora AU - Nadon, Nathalie AU - Perron, Jessie AU - Barry, Angèle AU - Bémeur, Chantal AU - Poder, G. Thomas AU - Duford, Fernand AU - Laviolette, Louise AU - Tétrault-Lassonde, Johanne AU - Vialaron, Cécile AU - Escalona, J. Manuel AU - Normandin, Louise AU - Huard, Geneviève AU - Girardin, Catherine AU - Rose, Christopher AU - Malas, Kathy AU - Ouellet, Denis AU - Vincent, Catherine PY - 2024/3/22 TI - Telehealth-Delivered Program and Accompanying Patients to Enhance the Clinical Condition of Patients Throughout a Liver Transplant: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e54440 VL - 13 KW - liver transplantation KW - accompanying patients KW - connected objects KW - health care model KW - digital platform N2 - Background: Liver transplantation (LT) is indicated in patients with severe acute or chronic liver failure for which no other therapy is available. With the increasing number of LTs in recent years, liver centers worldwide must manage their patients according to their clinical situation and the expected waiting time for transplantation. The LT clinic at the Centre hospitalier de l?Université de Montréal (CHUM) is developing a new health care model across the entire continuum of pre-, peri-, and posttransplant care that features patient monitoring by an interdisciplinary team, including an accompanying patient; a digital platform to host a clinical plan; a learning program; and data collection from connected objects. Objective: This study aims to (1) evaluate the outcomes following the implementation of a patient platform with connected devices and an accompanying patient, (2) identify implementation barriers and facilitators, (3) describe service outcomes in terms of health outcomes and the rates and nature of contact with the accompanying patient, (4) describe patient outcomes, and (5) assess the intervention?s cost-effectiveness. Methods: Six types of participants will be included in the study: (1) patients who received transplants and reached 1 year after transplantation before September 2023 (historical cohort or control group), (2) patients who will receive an LT between December 2023 and November 2024 (prospective cohort/intervention group), (3) relatives of those patients, (4) accompanying patients who have received an LT and are interested in supporting patients who will receive an LT, (5) health care professionals, and (6) decision makers. To describe the study sample and collect data to achieve all the objectives, a series of validated questionnaires, accompanying patient logbooks, transcripts of interviews and focus groups, and clinical indicators will be collected throughout the study. Results: In total, 5 (steering, education, clinical-technological, nurse prescription, and accompanying patient) working committees have been established for the study. Recruitment of patients is expected to start in November 2023. All questionnaires and technological platforms have been prepared, and the clinicians, stakeholders, and accompanying patient personnel have been recruited. Conclusions: The implementation of this model in the trajectory of LT recipients at the CHUM may allow for better monitoring and health of patients undergoing transplantation, ultimately reducing the average length of hospital stay and promoting better use of medical resources. In the event of positive results, this model could be transposed to all transplant units at the CHUM and across Quebec (potentially affecting 888 patients per year) but could also be applied more widely to the monitoring of patients with other chronic diseases. The lessons learned from this project will be shared with decision makers and will serve as a model for other initiatives involving accompanying patients, connected objects, or digital platforms. International Registered Report Identifier (IRRID): PRR1-10.2196/54440 UR - https://www.researchprotocols.org/2024/1/e54440 UR - http://dx.doi.org/10.2196/54440 UR - http://www.ncbi.nlm.nih.gov/pubmed/38517464 ID - info:doi/10.2196/54440 ER - TY - JOUR AU - Dimitropoulos, Gina AU - Lindenbach, David AU - Potestio, Melissa AU - Mogan, Tom AU - Richardson, Amanda AU - Anderson, Alida AU - Heintz, Madison AU - Moskovic, Karen AU - Gondziola, Jason AU - Bradley, Jessica AU - LaMonica, M. Haley AU - Iorfino, Frank AU - Hickie, Ian AU - Patten, B. Scott AU - Arnold, D. Paul PY - 2024/3/20 TI - Using a Rapid Learning Health System for Stratified Care in Emerging Adult Mental Health Services: Protocol for the Implementation of Patient-Reported Outcome Measures JO - JMIR Res Protoc SP - e51667 VL - 13 KW - learning health system KW - stratified care KW - patient-reported outcome measures KW - mental health KW - emerging adults KW - protocol papers KW - pragmatic clinical trials KW - e-mental health KW - RE-AIM KW - Reach, Effectiveness, Adoption, Implementation, and Maintenance KW - implementation science KW - adult KW - health system KW - treatment KW - implementation KW - acceptability KW - measurement-based care N2 - Background: Mental illness among emerging adults is often difficult to ameliorate due to fluctuating symptoms and heterogeneity. Recently, innovative approaches have been developed to improve mental health care for emerging adults, including (1) implementing patient-reported outcome measures (PROMs) to assess illness severity and inform stratified care to assign emerging adults to a treatment modality commensurate with their level of impairment and (2) implementing a rapid learning health system in which data are continuously collected and analyzed to generate new insights, which are then translated to clinical practice, including collaboration among clients, health care providers, and researchers to co-design and coevaluate assessment and treatment strategies. Objective: The aim of the study is to determine the feasibility and acceptability of implementing a rapid learning health system to enable a measurement-based, stratified care treatment strategy for emerging adults. Methods: This study takes place at a specialty clinic serving emerging adults (age 16-24 years) in Calgary, Canada, and involves extensive collaboration among researchers, providers, and youth. The study design includes six phases: (1) developing a transdiagnostic platform for PROMs, (2) designing an initial stratified care model, (3) combining the implementation of PROMs with stratified care, (4) evaluating outcomes and disseminating results, (5) modification of stratified care based on data derived from PROMs, and (6) spread and scale to new sites. Qualitative and quantitative feedback will be collected from health care providers and youth throughout the implementation process. These data will be analyzed at regular intervals and used to modify the way future services are delivered. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is used to organize and evaluate implementation according to 3 key objectives: improving treatment selection, reducing average wait time and treatment duration, and increasing the value of services. Results: This project was funded through a program grant running from 2021 to 2026. Ethics approval for this study was received in February 2023. Presently, we have developed a system of PROMs and organized clinical services into strata of care. We will soon begin using PROMs to assign clients to a stratum of care and using feedback from youth and clinicians to understand how to improve experiences and outcomes. Conclusions: This study has key implications for researchers and clinicians looking to understand how to customize emerging adult mental health services to improve the quality of care and satisfaction with care. This study has significant implications for mental health care systems as part of a movement toward value-based health care. International Registered Report Identifier (IRRID): PRR1-10.2196/51667 UR - https://www.researchprotocols.org/2024/1/e51667 UR - http://dx.doi.org/10.2196/51667 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506921 ID - info:doi/10.2196/51667 ER - TY - JOUR AU - Ganeshan, Smitha AU - Liu, W. Andrew AU - Kroeger, Anne AU - Anand, Prerna AU - Seefeldt, Richard AU - Regner, Alexis AU - Vaughn, Diana AU - Odisho, Y. Anobel AU - Mourad, Michelle PY - 2024/3/19 TI - An Electronic Health Record?Based Automated Self-Rescheduling Tool to Improve Patient Access: Retrospective Cohort Study JO - J Med Internet Res SP - e52071 VL - 26 KW - appointment KW - consultation KW - cost KW - digital health KW - digital tools KW - electronic health record KW - EHR KW - informatics KW - patient access KW - retrospective review KW - revenue KW - self-rescheduling tool KW - self-scheduling KW - waiting time N2 - Background: In many large health centers, patients face long appointment wait times and difficulties accessing care. Last-minute cancellations and patient no-shows leave unfilled slots in a clinician?s schedule, exacerbating delays in care from poor access. The mismatch between the supply of outpatient appointments and patient demand has led health systems to adopt many tools and strategies to minimize appointment no-show rates and fill open slots left by patient cancellations. Objective: We evaluated an electronic health record (EHR)?based self-scheduling tool, Fast Pass, at a large academic medical center to understand the impacts of the tool on the ability to fill cancelled appointment slots, patient access to earlier appointments, and clinical revenue from visits that may otherwise have gone unscheduled. Methods: In this retrospective cohort study, we extracted Fast Pass appointment offers and scheduling data, including patient demographics, from the EHR between June 18, 2022, and March 9, 2023. We analyzed the outcomes of Fast Pass offers (accepted, declined, expired, and unavailable) and the outcomes of scheduled appointments resulting from accepted Fast Pass offers (completed, canceled, and no-show). We stratified outcomes based on appointment specialty. For each specialty, the patient service revenue from appointments filled by Fast Pass was calculated using the visit slots filled, the payer mix of the appointments, and the contribution margin by payer. Results: From June 18 to March 9, 2023, there were a total of 60,660 Fast Pass offers sent to patients for 21,978 available appointments. Of these offers, 6603 (11%) were accepted across all departments, and 5399 (8.9%) visits were completed. Patients were seen a median (IQR) of 14 (4-33) days sooner for their appointments. In a multivariate logistic regression model with primary outcome Fast Pass offer acceptance, patients who were aged 65 years or older (vs 20-40 years; P=.005 odds ratio [OR] 0.86, 95% CI 0.78-0.96), other ethnicity (vs White; P<.001, OR 0.84, 95% CI 0.77-0.91), primarily Chinese speakers (P<.001; OR 0.62, 95% CI 0.49-0.79), and other language speakers (vs English speakers; P=.001; OR 0.71, 95% CI 0.57-0.87) were less likely to accept an offer. Fast Pass added 2576 patient service hours to the clinical schedule, with a median (IQR) of 251 (216-322) hours per month. The estimated value of physician fees from these visits scheduled through 9 months of Fast Pass scheduling in professional fees at our institution was US $3 million. Conclusions: Self-scheduling tools that provide patients with an opportunity to schedule into cancelled or unfilled appointment slots have the potential to improve patient access and efficiently capture additional revenue from filling unfilled slots. The demographics of the patients accepting these offers suggest that such digital tools may exacerbate inequities in access. UR - https://www.jmir.org/2024/1/e52071 UR - http://dx.doi.org/10.2196/52071 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502159 ID - info:doi/10.2196/52071 ER - TY - JOUR AU - Griffiths, Lowri Siân AU - Murray, K. Graham AU - Logeswaran, Yanakan AU - Ainsworth, John AU - Allan, M. Sophie AU - Campbell, Niyah AU - Drake, J. Richard AU - Katshu, Haq Mohammad Zia Ul AU - Machin, Matthew AU - Pope, A. Megan AU - Sullivan, A. Sarah AU - Waring, Justin AU - Bogatsu, Tumelo AU - Kane, Julie AU - Weetman, Tyler AU - Johnson, Sonia AU - Kirkbride, B. James AU - Upthegrove, Rachel PY - 2024/3/19 TI - Implementing and Evaluating a National Integrated Digital Registry and Clinical Decision Support System in Early Intervention in Psychosis Services (Early Psychosis Informatics Into Care): Co-Designed Protocol JO - JMIR Res Protoc SP - e50177 VL - 13 KW - Early Intervention in Psychosis KW - digital registry KW - clinical decision support system KW - participatory co-design KW - participatory KW - co-design KW - registry KW - psychosis KW - mental health KW - psychiatry KW - decision support KW - study protocol N2 - Background: Early intervention in psychosis (EIP) services are nationally mandated in England to provide multidisciplinary care to people experiencing first-episode psychosis, which disproportionately affects deprived and ethnic minority youth. Quality of service provision varies by region, and people from historically underserved populations have unequal access. In other disease areas, including stroke and dementia, national digital registries coupled with clinical decision support systems (CDSSs) have revolutionized the delivery of equitable, evidence-based interventions to transform patient outcomes and reduce population-level disparities in care. Given psychosis is ranked the third most burdensome mental health condition by the World Health Organization, it is essential that we achieve the same parity of health improvements. Objective: This paper reports the protocol for the program development phase of this study, in which we aimed to co-design and produce an evidence-based, stakeholder-informed framework for the building, implementation, piloting, and evaluation of a national integrated digital registry and CDSS for psychosis, known as EPICare (Early Psychosis Informatics into Care). Methods: We conducted 3 concurrent work packages, with reciprocal knowledge exchange between each. In work package 1, using a participatory co-design framework, key stakeholders (clinicians, academics, policy makers, and patient and public contributors) engaged in 4 workshops to review, refine, and identify a core set of essential and desirable measures and features of the EPICare registry and CDSS. Using a modified Delphi approach, we then developed a consensus of data priorities. In work package 2, we collaborated with National Health Service (NHS) informatics teams to identify relevant data currently captured in electronic health records, understand data retrieval methods, and design the software architecture and data model to inform future implementation. In work package 3, observations of stakeholder workshops and individual interviews with representative stakeholders (n=10) were subject to interpretative qualitative analysis, guided by normalization process theory, to identify factors likely to influence the adoption and implementation of EPICare into routine practice. Results: Stage 1 of the EPICare study took place between December 2021 and September 2022. The next steps include stage 2 building, piloting, implementation, and evaluation of EPICare in 5 demonstrator NHS Trusts serving underserved and diverse populations with substantial need for EIP care in England. If successful, this will be followed by stage 3, in which we will seek NHS adoption of EPICare for rollout to all EIP services in England. Conclusions: By establishing a multistakeholder network and engaging them in an iterative co-design process, we have identified essential and desirable elements of the EPICare registry and CDSS; proactively identified and minimized potential challenges and barriers to uptake and implementation; and addressed key questions related to informatics architecture, infrastructure, governance, and integration in diverse NHS Trusts, enabling us to proceed with the building, piloting, implementation, and evaluation of EPICare. International Registered Report Identifier (IRRID): DERR1-10.2196/50177 UR - https://www.researchprotocols.org/2024/1/e50177 UR - http://dx.doi.org/10.2196/50177 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502175 ID - info:doi/10.2196/50177 ER - TY - JOUR AU - Killian, A. Jackson AU - Jain, Manish AU - Jia, Yugang AU - Amar, Jonathan AU - Huang, Erich AU - Tambe, Milind PY - 2024/3/15 TI - New Approach to Equitable Intervention Planning to Improve Engagement and Outcomes in a Digital Health Program: Simulation Study JO - JMIR Diabetes SP - e52688 VL - 9 KW - chronic disease KW - type-2 diabetes KW - T2D KW - restless multiarmed bandits KW - multi-armed bandit KW - multi-armed bandits KW - machine learning KW - resource allocation KW - digital health KW - equity N2 - Background: Digital health programs provide individualized support to patients with chronic diseases and their effectiveness is measured by the extent to which patients achieve target individual clinical outcomes and the program?s ability to sustain patient engagement. However, patient dropout and inequitable intervention delivery strategies, which may unintentionally penalize certain patient subgroups, represent challenges to maximizing effectiveness. Therefore, methodologies that optimize the balance between success factors (achievement of target clinical outcomes and sustained engagement) equitably would be desirable, particularly when there are resource constraints. Objective: Our objectives were to propose a model for digital health program resource management that accounts jointly for the interaction between individual clinical outcomes and patient engagement, ensures equitable allocation as well as allows for capacity planning, and conducts extensive simulations using publicly available data on type 2 diabetes, a chronic disease. Methods: We propose a restless multiarmed bandit (RMAB) model to plan interventions that jointly optimize long-term engagement and individual clinical outcomes (in this case measured as the achievement of target healthy glucose levels). To mitigate the tendency of RMAB to achieve good aggregate performance by exacerbating disparities between groups, we propose new equitable objectives for RMAB and apply bilevel optimization algorithms to solve them. We formulated a model for the joint evolution of patient engagement and individual clinical outcome trajectory to capture the key dynamics of interest in digital chronic disease management programs. Results: In simulation exercises, our optimized intervention policies lead to up to 10% more patients reaching healthy glucose levels after 12 months, with a 10% reduction in dropout compared to standard-of-care baselines. Further, our new equitable policies reduce the mean absolute difference of engagement and health outcomes across 6 demographic groups by up to 85% compared to the state-of-the-art. Conclusions: Planning digital health interventions with individual clinical outcome objectives and long-term engagement dynamics as considerations can be both feasible and effective. We propose using an RMAB sequential decision-making framework, which may offer additional capabilities in capacity planning as well. The integration of an equitable RMAB algorithm further enhances the potential for reaching equitable solutions. This approach provides program designers with the flexibility to switch between different priorities and balance trade-offs across various objectives according to their preferences. UR - https://diabetes.jmir.org/2024/1/e52688 UR - http://dx.doi.org/10.2196/52688 UR - http://www.ncbi.nlm.nih.gov/pubmed/38488828 ID - info:doi/10.2196/52688 ER - TY - JOUR AU - Jensen, Høpfner Lili Worre AU - Rahbek, Ole AU - Lauritsen, Kildahl Rikke Emilie AU - Kold, Søren AU - Dinesen, Birthe PY - 2024/3/8 TI - Health Care Professionals? Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study JO - JMIR Hum Factors SP - e53391 VL - 11 KW - CFIR KW - Consolidated Framework for Implementation Research KW - digital communication KW - hospital discharge KW - implementation science KW - interdisciplinary communication KW - orthopedic surgery KW - patient-provider communication KW - postoperative care KW - qualitative research KW - text messaging N2 - Background: Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs? needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. Objective: This study aimed to (1) investigate HCPs? perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). Methods: We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. Results: HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. Conclusions: eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources. UR - https://humanfactors.jmir.org/2024/1/e53391 UR - http://dx.doi.org/10.2196/53391 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457798 ID - info:doi/10.2196/53391 ER - TY - JOUR AU - Jiang, Yun AU - Hwang, Misun AU - Cho, Youmin AU - Friese, R. Christopher AU - Hawley, T. Sarah AU - Manojlovich, Milisa AU - Krauss, C. John AU - Gong, Yang PY - 2024/3/8 TI - The Acceptance and Use of Digital Technologies for Self-Reporting Medication Safety Events After Care Transitions to Home in Patients With Cancer: Survey Study JO - J Med Internet Res SP - e47685 VL - 26 KW - digital technology KW - patient safety KW - patient participation KW - patient-reported outcomes KW - drug-related side effects and adverse reactions N2 - Background: Actively engaging patients with cancer and their families in monitoring and reporting medication safety events during care transitions is indispensable for achieving optimal patient safety outcomes. However, existing patient self-reporting systems often cannot address patients? various experiences and concerns regarding medication safety over time. In addition, these systems are usually not designed for patients? just-in-time reporting. There is a significant knowledge gap in understanding the nature, scope, and causes of medication safety events after patients? transition back home because of a lack of patient engagement in self-monitoring and reporting of safety events. The challenges for patients with cancer in adopting digital technologies and engaging in self-reporting medication safety events during transitions of care have not been fully understood. Objective: We aim to assess oncology patients? perceptions of medication and communication safety during care transitions and their willingness to use digital technologies for self-reporting medication safety events and to identify factors associated with their technology acceptance. Methods: A cross-sectional survey study was conducted with adult patients with breast, prostate, lung, or colorectal cancer (N=204) who had experienced care transitions from hospitals or clinics to home in the past 1 year. Surveys were conducted via phone, the internet, or email between December 2021 and August 2022. Participants? perceptions of medication and communication safety and perceived usefulness, ease of use, attitude toward use, and intention to use a technology system to report their medication safety events from home were assessed as outcomes. Potential personal, clinical, and psychosocial factors were analyzed for their associations with participants? technology acceptance through bivariate correlation analyses and multiple logistic regressions. Results: Participants reported strong perceptions of medication and communication safety, positively correlated with medication self-management ability and patient activation. Although most participants perceived a medication safety self-reporting system as useful (158/204, 77.5%) and easy to use (157/204, 77%), had a positive attitude toward use (162/204, 79.4%), and were willing to use such a system (129/204, 63.2%), their technology acceptance was associated with their activation levels (odds ratio [OR] 1.83, 95% CI 1.12-2.98), their perceptions of communication safety (OR 1.64, 95% CI 1.08-2.47), and whether they could receive feedback after self-reporting (OR 3.27, 95% CI 1.37-7.78). Conclusions: In general, oncology patients were willing to use digital technologies to report their medication events after care transitions back home because of their high concerns regarding medication safety. As informed and activated patients are more likely to have the knowledge and capability to initiate and engage in self-reporting, developing a patient-centered reporting system to empower patients and their families and facilitate safety health communications will help oncology patients in addressing their medication safety concerns, meeting their care needs, and holding promise to improve the quality of cancer care. UR - https://www.jmir.org/2024/1/e47685 UR - http://dx.doi.org/10.2196/47685 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457204 ID - info:doi/10.2196/47685 ER - TY - JOUR AU - Chen, Chih-Wei AU - Walter, Paul AU - Wei, Cheng-Chung James PY - 2024/2/27 TI - Using ChatGPT-Like Solutions to Bridge the Communication Gap Between Patients With Rheumatoid Arthritis and Health Care Professionals JO - JMIR Med Educ SP - e48989 VL - 10 KW - rheumatoid arthritis KW - ChatGPT KW - artificial intelligence KW - communication gap KW - privacy KW - data management UR - https://mededu.jmir.org/2024/1/e48989 UR - http://dx.doi.org/10.2196/48989 UR - http://www.ncbi.nlm.nih.gov/pubmed/38412022 ID - info:doi/10.2196/48989 ER - TY - JOUR AU - Chmielewski, Marta AU - Meyer, J. Matthew PY - 2024/2/27 TI - Discussions With End Users to Inform the Vision for a Shared Care Record in Ontario: Qualitative Interview Study JO - Online J Public Health Inform SP - e51231 VL - 16 KW - population health management KW - shared care record KW - health information exchange N2 - Background: Improving the health outcomes of populations of individuals through population health management requires the use of electronic health records that can exchange real-time digital information using an accurate and complete shared care record that is accessible to health care providers, services, and patients. Objective: The aims of this study were to understand end users? (health care providers) experiences, attitudes, and insights using current electronic health records; their expectations of what is required to establish a shared care record; and how they anticipate adapting to the use of a shared care record in daily practice. This work is the result of a quality improvement initiative deemed not to require ethics approval according to the Western research ethics board checklist. Methods: Clinicians were contacted using voluntary response sampling and interviewed via Zoom (Zoom Video Communications) between June 2022 and July 2022. The participants were from various health care sectors and at various stages of career development. Results: Overall, adaptation to the use of a shared care record was viewed positively by health care providers, highlighting the benefits of a centralized, shared, and accessible location for real-time data, promoting patient continuity of care. The main concerns included the privacy, confidentiality, and security of the record along with patients? ability to interpret their own medical information found in a patient portal. The resources requested by end users included multifaceted ongoing training on the use of a shared care record. Conclusions: This study provides practical findings that will help emphasize factors that facilitate clinicians? practical use and process of adaptation to the use of a shared care record. UR - https://ojphi.jmir.org/2024/1/e51231 UR - http://dx.doi.org/10.2196/51231 UR - http://www.ncbi.nlm.nih.gov/pubmed/384 ID - info:doi/10.2196/51231 ER - TY - JOUR AU - Funnell, L. Erin AU - Spadaro, Benedetta AU - Martin-Key, A. Nayra AU - Benacek, Jiri AU - Bahn, Sabine PY - 2024/2/23 TI - Perception of Apps for Mental Health Assessment With Recommendations for Future Design: United Kingdom Semistructured Interview Study JO - JMIR Form Res SP - e48881 VL - 8 KW - app design KW - digital health KW - eHealth KW - interviews KW - mental health KW - mHealth KW - mobile phone N2 - Background: Mental health care provision in the United Kingdom is overwhelmed by a high demand for services. There are high rates of under-, over-, and misdiagnosis of common mental health disorders in primary care and delays in accessing secondary care. This negatively affects patient functioning and outcomes. Digital tools may offer a time-efficient avenue for the remote assessment and triage of mental health disorders that can be integrated directly into existing care pathways to support clinicians. However, despite the potential of digital tools in the field of mental health, there remain gaps in our understanding of how the intended user base, people with lived experiences of mental health concerns, perceive these technologies. Objective: This study explores the perspectives and attitudes of individuals with lived experiences of mental health concerns on mental health apps that are designed to support self-assessment and triage. Methods: A semistructured interview approach was used to explore the perspectives of the interviewees using 5 open-ended questions. Interviews were transcribed verbatim from audio data recordings. The average interview lasted 46 minutes (rounded to the nearest min; SD 12.93 min). A thematic analysis was conducted. Results: Overall, 16 individuals were interviewed in this study. The average age was 42.25 (SD 15.18) years, half of the interviewees identified as women (8/16, 50%), and all were White (16/16, 100%). The thematic analysis revealed six major themes: (1) availability and accessibility, (2) quality, (3) attitudes, (4) safety, (5) impact, and (6) functionality. Conclusions: Engaging in clear communication regarding data security and privacy policies, adopting a consent-driven approach to data sharing, and identifying gaps in the app marketplace to foster the inclusion of a range of mental health conditions and avoid oversaturation of apps for common mental health disorders (eg, depression and anxiety) were identified as priorities from interviewees? comments. Furthermore, reputation was identified as a driver of uptake and engagement, with endorsement from a respected source (ie, health care provider, academic institution) or direct recommendation from a trusted health care professional associated with increased interest and trust. Furthermore, there was an interest in the role that co-designed digital self-assessments could play in existing care pathways, particularly in terms of facilitating informed discussions with health care professionals during appointments and by signposting individuals to the most appropriate services. In addition, interviewees discussed the potential of mental health apps to provide waiting list support to individuals awaiting treatment by providing personalized psychoeducation, self-help tips, and sources of help. However, concerns regarding the quality of care being affected because of digital delivery have been reported; therefore, frequent monitoring of patient acceptability and care outcomes is warranted. In addition, communicating the rationale and benefits of digitizing services will likely be important for securing interest and uptake from health care service users. UR - https://formative.jmir.org/2024/1/e48881 UR - http://dx.doi.org/10.2196/48881 UR - http://www.ncbi.nlm.nih.gov/pubmed/38393760 ID - info:doi/10.2196/48881 ER - TY - JOUR AU - Haverinen, Jari AU - Harju, Terttu AU - Mikkonen, Hanna AU - Liljamo, Pia AU - Turpeinen, Miia AU - Reponen, Jarmo PY - 2024/2/22 TI - Digital Care Pathway for Patients With Sleep Apnea in Specialized Care: Mixed Methods Study JO - JMIR Hum Factors SP - e47809 VL - 11 KW - health services KW - telehealth KW - telemedicine KW - health personnel KW - sleep apnea syndromes KW - mobile phone N2 - Background: Sleep apnea is a significant public health disorder in Finland, with a prevalence of 3.7%. Continuous positive airway pressure (CPAP) therapy is the first-line treatment for moderate or severe sleep apnea. From November 18, 2019, all patients who started their CPAP therapy at Oulu University Hospital were attached to a sleep apnea digital care pathway (SA-DCP) and were instructed on its use. Some patients still did not use the SA-DCP although they had started their CPAP therapy. Objective: We aimed to study health care professionals? (HCPs?) perspectives on the SA-DCP and its usefulness for their work; whether the main targets of SA-DCP can be reached: shortening the initial guiding sessions of CPAP therapy, reducing patient calls and contact with HCPs, and improving patients? adherence to CPAP therapy; and patients? perspectives on the SA-DCP and its usefulness to them. Methods: Overall, 6 HCPs were interviewed in May and June 2021. The survey for SA-DCP users (58/91, 64%) and SA-DCP nonusers (33/91, 36%) was conducted in 2 phases: from May to August 2021 and January to June 2022. CPAP device remote monitoring data were collected from SA-DCP users (80/170, 47.1%) and SA-DCP nonusers (90/170, 52.9%) in May 2021. The registered phone call data were collected during 2019, 2020, and 2021. Feedback on the SA-DCP was collected from 446 patients between February and March 2022. Results: According to HCPs, introducing the SA-DCP had not yet significantly improved their workload and work practices, but it had brought more flexibility in some communication situations. A larger proportion of SA-DCP users familiarized themselves with prior information about CPAP therapy before the initial guiding session than nonusers (43/58, 74% vs 16/33, 49%; P=.02). Some patients still had not received prior information about CPAP therapy; therefore, most of the sessions were carried out according to their needs. According to the patient survey and remote monitoring data of CPAP devices, adherence to CPAP therapy was high for both SA-DCP users and nonusers. The number of patients? phone calls to HCPs did not decrease during the study. SA-DCP users perceived their abilities to use information and communications technology to be better than nonusers (mean 4.2, SD 0.8 vs mean 3.2, SD 1.2; P<.001). Conclusions: According to this study, not all the goals set for the introduction of the SA-DCP have been achieved. Despite using the SA-DCP, some patients still wanted to communicate with HCPs by phone. The most significant factors explaining the nonuse of the SA-DCP were lower digital literacy and older age of the patients. In the future, more attention should be paid to these user groups when designing and introducing upcoming digital care pathways. UR - https://humanfactors.jmir.org/2024/1/e47809 UR - http://dx.doi.org/10.2196/47809 UR - http://www.ncbi.nlm.nih.gov/pubmed/38386368 ID - info:doi/10.2196/47809 ER - TY - JOUR AU - Agarwal, K. Anish AU - Gonzales, Rachel AU - Scott, Kevin AU - Merchant, Raina PY - 2024/2/22 TI - Investigating the Feasibility of Using a Wearable Device to Measure Physiologic Health Data in Emergency Nurses and Residents: Observational Cohort Study JO - JMIR Form Res SP - e51569 VL - 8 KW - digital health KW - emergency medicine training KW - wearable devices KW - burnout KW - mobile health KW - feasibility KW - wearable device KW - wearable KW - physiologic health data KW - nurse KW - resident KW - emergency department KW - acceptability KW - well-being N2 - Background: Emergency departments play a pivotal role in the US health care system, with high use rates and inherent stress placed on patients, patient care, and clinicians. The impact of the emergency department environment on the health and well-being of emergency residents and nurses can be seen in worsening rates of burnout and cardiovascular health. Research on clinician health has historically been completed outside of clinical areas and not personalized to the individual. The expansion of digital technology, specifically wearable devices, may enhance the ability to understand how health care environments impact clinicians. Objective: The primary objective of this pilot study was to assess the feasibility and acceptability of using wearable devices to measure and record physiologic data from emergency nurses and resident physicians. Understanding strategies that are accepted and used by clinicians is critical prior to launching larger investigations aimed at improving outcomes. Methods: This was a longitudinal pilot study conducted at an academic, urban, level 1 trauma center. A total of 20 participants, including emergency medicine resident physicians and nurses, were equipped with a wearable device (WHOOP band) and access to a mobile health platform for 6 weeks. Baseline surveys assessed burnout, mental health, and expectations of the device and experience. Participants provided open-ended feedback on the device and platform, contributing to the assessment of acceptance, adoption, and use of the wearable device. Secondary measures explored early signs and variations in heart rate variability, sleep, recovery, burnout, and mental health assessments. Results: Of the 20 participants, 10 consistently used the wearable device. Feedback highlighted varying experiences with the device, with a preference for more common wearables like the Apple Watch or Fitbit. Resident physicians demonstrated higher engagement with the device and platform as compared with nurses. Baseline mental health assessments indicated mild anxiety and depressive symptoms among participants. The Professional Fulfillment Index revealed low professional fulfillment, moderate workplace exhaustion, and interpersonal disengagement. Conclusions: This pilot study underscores the potential of wearable devices in monitoring emergency clinicians? physiologic data but reveals challenges related to device preferences and engagement. The key takeaway is the necessity to optimize device and platform design for clinician use. Larger, randomized trials are recommended to further explore and refine strategies for leveraging wearable technology to support the well-being of the emergency workforce. UR - https://formative.jmir.org/2024/1/e51569 UR - http://dx.doi.org/10.2196/51569 UR - http://www.ncbi.nlm.nih.gov/pubmed/38386373 ID - info:doi/10.2196/51569 ER - TY - JOUR AU - Melman, Alla AU - Teng, Jiat Min AU - Coombs, M. Danielle AU - Li, Qiang AU - Billot, Laurent AU - Lung, Thomas AU - Rogan, Eileen AU - Marabani, Mona AU - Hutchings, Owen AU - Maher, G. Chris AU - Machado, C. Gustavo AU - PY - 2024/2/22 TI - A Virtual Hospital Model of Care for Low Back Pain, Back@Home: Protocol for a Hybrid Effectiveness-Implementation Type-I Study JO - JMIR Res Protoc SP - e50146 VL - 13 KW - length of stay KW - back pain KW - musculoskeletal pain KW - telemedicine KW - hospital-based home care KW - mobile phone KW - home care KW - virtual care KW - remote care KW - virtual hospital KW - pain KW - telehealth KW - eHealth KW - musculoskeletal KW - implementation KW - model of care KW - back KW - cost KW - economic KW - readmission KW - hospital stay N2 - Background: Low back pain (LBP) was the fifth most common reason for an emergency department (ED) visit in 2020-2021 in Australia, with >145,000 presentations. A total of one-third of these patients were subsequently admitted to the hospital. The admitted patient care accounts for half of the total health care expenditure on LBP in Australia. Objective: The primary aim of the Back@Home study is to assess the effectiveness of a virtual hospital model of care to reduce the length of admission in people presenting to ED with musculoskeletal LBP. A secondary aim is to evaluate the acceptability and feasibility of the virtual hospital and our implementation strategy. We will also investigate rates of traditional hospital admission from the ED, representations and readmissions to the traditional hospital, demonstrate noninferiority of patient-reported outcomes, and assess cost-effectiveness of the new model. Methods: This is a hybrid effectiveness-implementation type-I study. To evaluate effectiveness, we plan to conduct an interrupted time-series study at 3 metropolitan hospitals in Sydney, New South Wales, Australia. Eligible patients will include those aged 16 years or older with a primary diagnosis of musculoskeletal LBP presenting to the ED. The implementation strategy includes clinician education using multimedia resources, staff champions, and an ?audit and feedback? process. The implementation of ?Back@Home? will be evaluated over 12 months and compared to a 48-month preimplementation period using monthly time-series trends in the average length of hospital stay as the primary outcome. We will construct a plot of the observed and expected lines of trend based on the preimplementation period. Linear segmented regression will identify changes in the level and slope of fitted lines, indicating immediate effects of the intervention, as well as effects over time. The data will be fully anonymized, with informed consent collected for patient-reported outcomes. Results: As of December 6, 2023, a total of 108 patients have been cared for through Back@Home. A total of 6 patients have completed semistructured interviews regarding their experience of virtual hospital care for nonserious back pain. All outcomes will be evaluated at 6 months (August 2023) and 12 months post implementation (February 2024). Conclusions: This study will serve to inform ongoing care delivery and implementation strategies of a novel model of care. If found to be effective, it may be adopted by other health districts, adapting the model to their unique local contexts. International Registered Report Identifier (IRRID): PRR1-10.2196/50146 UR - https://www.researchprotocols.org/2024/1/e50146 UR - http://dx.doi.org/10.2196/50146 UR - http://www.ncbi.nlm.nih.gov/pubmed/38386370 ID - info:doi/10.2196/50146 ER - TY - JOUR AU - Hashtarkhani, Soheil AU - Schwartz, L. David AU - Shaban-Nejad, Arash PY - 2024/2/21 TI - Enhancing Health Care Accessibility and Equity Through a Geoprocessing Toolbox for Spatial Accessibility Analysis: Development and Case Study JO - JMIR Form Res SP - e51727 VL - 8 KW - geographical information system KW - geoprocessing tool KW - health disparities KW - health equity KW - health services management KW - hemodialysis services KW - spatial accessibility N2 - Background: Access to health care services is a critical determinant of population health and well-being. Measuring spatial accessibility to health services is essential for understanding health care distribution and addressing potential inequities. Objective: In this study, we developed a geoprocessing toolbox including Python script tools for the ArcGIS Pro environment to measure the spatial accessibility of health services using both classic and enhanced versions of the 2-step floating catchment area method. Methods: Each of our tools incorporated both distance buffers and travel time catchments to calculate accessibility scores based on users? choices. Additionally, we developed a separate tool to create travel time catchments that is compatible with both locally available network data sets and ArcGIS Online data sources. We conducted a case study focusing on the accessibility of hemodialysis services in the state of Tennessee using the 4 versions of the accessibility tools. Notably, the calculation of the target population considered age as a significant nonspatial factor influencing hemodialysis service accessibility. Weighted populations were calculated using end-stage renal disease incidence rates in different age groups. Results: The implemented tools are made accessible through ArcGIS Online for free use by the research community. The case study revealed disparities in the accessibility of hemodialysis services, with urban areas demonstrating higher scores compared to rural and suburban regions. Conclusions: These geoprocessing tools can serve as valuable decision-support resources for health care providers, organizations, and policy makers to improve equitable access to health care services. This comprehensive approach to measuring spatial accessibility can empower health care stakeholders to address health care distribution challenges effectively. UR - https://formative.jmir.org/2024/1/e51727 UR - http://dx.doi.org/10.2196/51727 UR - http://www.ncbi.nlm.nih.gov/pubmed/38381503 ID - info:doi/10.2196/51727 ER - TY - JOUR AU - Kufoof, Lara AU - Hajjeh, Rana AU - Al Nsour, Mohannad AU - Saad, Randa AU - Bélorgeot, Victoria AU - Abubakar, Abdinasir AU - Khader, Yousef AU - Rawaf, Salman PY - 2024/2/15 TI - Learning From COVID-19: What Would It Take to Be Better Prepared in the Eastern Mediterranean Region? JO - JMIR Public Health Surveill SP - e40491 VL - 10 KW - COVID-19 KW - integration KW - pandemic preparedness KW - primary health care KW - public health UR - https://publichealth.jmir.org/2024/1/e40491 UR - http://dx.doi.org/10.2196/40491 UR - http://www.ncbi.nlm.nih.gov/pubmed/38359418 ID - info:doi/10.2196/40491 ER - TY - JOUR AU - Swift, Jim AU - O'Kelly, Noel AU - Barker, Chris AU - Woodward, Alex AU - Ghosh, Sudip PY - 2024/2/13 TI - A Digital Respiratory Ward in Leicester, Leicestershire, and Rutland, England, for Patients With COVID-19: Economic Evaluation of the Impact on Acute Capacity and Wider National Health Service Resource Use JO - JMIR Form Res SP - e47441 VL - 8 KW - Covid-19 KW - telemedicine KW - digital technology KW - home transition KW - length of stay KW - cost-effectiveness analysis KW - cost KW - costs KW - economic KW - economics KW - telehealth KW - hospitalization KW - hospital KW - hospitals KW - hospitalizations KW - resource KW - resources KW - hospital stay KW - ward KW - wards KW - virtual care KW - remote care KW - financial KW - finance KW - finances KW - remote KW - respiratory KW - SARS-CoV-2 KW - pulmonary KW - lung KW - lungs KW - service KW - services KW - delivery N2 - Background: The COVID-19 pandemic stressed global health care systems? acute capacity and caused a diversion of resources from elective care to the treatment of acute respiratory disease. In preparing for a second wave of COVID-19 infections, England?s National Health Service (NHS) in Leicester, Leicestershire, and Rutland sought to protect acute capacity in the winter of 2020-2021. Their plans included the introduction of a digital ward where patients were discharged home early and supported remotely by community-based respiratory specialists, who were informed about patient health status by a digital patient monitoring system. Objective: The objective of the digital ward was to maintain acute capacity through safe, early discharge of patients with COVID-19 respiratory disease. The study objective was to establish what impact this digital ward had on overall NHS resource use. Methods: There were no expected differences in patient outcomes. A cost minimization was performed to demonstrate the impact on the NHS resource use from discharging patients into a digital COVID-19 respiratory ward, compared to acute care length of stay (LOS). This evaluation included all 310 patients enrolled in the service from November 2020 (service commencement) to November 2021. Two primary methods, along with sensitivity analyses, were used to help overcome the uncertainty associated with the estimated comparators for the observational data on COVID-19 respiratory acute LOS, compared with the actual LOS of the 279 (90%) patients who were not discharged on oxygen nor were in critical care. Historic comparative LOS and an ordinary least squares model based on local monthly COVID-19 respiratory median LOS were used as comparators. Actual comparator data were sourced for the 31 (10%) patients who were discharged home and into the digital ward for oxygen weaning. Resource use associated with delivering care in the digital ward was sourced from the digital system and respiratory specialists. Results: In the base case, the digital ward delivered estimated health care system savings of 846.5 bed-days and US $504,197 in net financial savings across the 2 key groups of patients?those on oxygen and those not on oxygen at acute discharge (both P<.001). The mean gross and net savings per patient were US $1850 and US $1626 in the base case, respectively, without including any savings associated with a potential reduction in readmissions. The 30-day readmission rate was 2.9%, which was below comparative data. The mean cost of the intervention was US $223.53 per patient, 12.1% of the estimated gross savings. It was not until the costs were increased and the effect reduced simultaneously by 78.4% in the sensitivity analysis that the intervention was no longer cost saving. Conclusions: The digital ward delivered increased capacity and substantial financial savings and did so with a high degree of confidence, at a very low absolute and relative cost. UR - https://formative.jmir.org/2024/1/e47441 UR - http://dx.doi.org/10.2196/47441 UR - http://www.ncbi.nlm.nih.gov/pubmed/38349716 ID - info:doi/10.2196/47441 ER - TY - JOUR AU - van Veelen, Maria Nicole AU - van de Wall, M. Bryan J. AU - Hoepelman, J. Ruben AU - IJpma, A. Frank F. AU - Link, Björn-Christian AU - Babst, Reto AU - Groenwold, H. Rolf H. AU - van der Velde, Detlef AU - Diwersi, Nadine AU - van Heijl, Mark AU - Houwert, Marijn R. AU - Beeres, P. Frank J. PY - 2024/2/13 TI - Let?s Agree to Disagree on Operative Versus Nonoperative Treatment for Distal Radius Fractures in Older People: Protocol for a Prospective International Multicenter Cohort Study JO - JMIR Res Protoc SP - e52917 VL - 13 KW - distal radius fracture KW - older patients KW - natural experiment KW - study protocol KW - observational study N2 - Background: Distal radius fractures are the most frequently encountered fractures in Western societies, typically affecting patients aged 50 years and older. Although this is a common injury, the best treatment for these fractures in older patients is still under debate. Objective: This prospective study aims to compare the outcome of operatively and nonoperatively treated distal radius fractures in the older population. Only patients with distal radius fractures for which equipoise regarding the optimal treatment exists will be included. Methods: This prospective international multicenter observational cohort study will be designed as a natural experiment. Natural experiments are observational studies in which treatment allocation is determined by factors outside the control of the investigators but also (largely) independent of patient characteristics. Patients aged 65 years and older with an acute distal radius fracture will be considered for inclusion. Treatment allocation (operative vs nonoperative) will be based on the local preferences of the treating hospital either in Switzerland or the Netherlands. Hence, the process governing treatment allocation resembles that of randomization. Patients will be identified after treatment has been initiated. Based on the radiographs and baseline information of the patient, an expert panel of 6 certified trauma surgeons from 2 regions will provide their treatment recommendation. Only patients for whom the experts disagree on treatment recommendations will ultimately be included in the study (ie, for whom there is a clinical equipoise). For these patients, both operative and nonoperative treatment of distal radius fractures are viable, and treatment choice is predominantly determined by personal or local preference. The primary outcome will be the Patient-Rated Wrist Evaluation score at 12 weeks. Secondary outcomes will include the Physical Activity Score for the Elderly, the EQ questionnaire, pain, the living situation, range of motion, complications, and radiological outcomes. By including outcomes such as living situation and the Physical Activity Score for the Elderly, which are not relevant for younger cohorts, valuable information to tailor treatment to the needs of the older population can be gained. According to the sample size collection, which was based on the minimal important clinical difference of the Patient-Rated Wrist Evaluation, 92 patients will have to be included, with at least 46 patients in each treatment group. Results: Enrollment began in July 2023 and is expected to continue until summer 2024. The final follow-up will be 2 years after the last patient is included. Conclusions: Although many trials on this topic have previously been published, there remains an ongoing debate regarding the optimal treatment for distal radius fractures in older patients. This observational study, which will use a fairly new methodological study design, will provide further information on treatment outcomes for older patients with distal radius fractures for which to date equipoise exists regarding the optimal treatment. International Registered Report Identifier (IRRID): DERR1-10.2196/52917 UR - https://www.researchprotocols.org/2024/1/e52917 UR - http://dx.doi.org/10.2196/52917 UR - http://www.ncbi.nlm.nih.gov/pubmed/38349719 ID - info:doi/10.2196/52917 ER - TY - JOUR AU - Augustin, Matthias AU - Reinders, Patrick AU - Janke, Maria Toni AU - Strömer, Klaus AU - von Kiedrowski, Ralph AU - Kirsten, Natalia AU - Zink, Alexander AU - Otten, Marina PY - 2024/2/12 TI - Attitudes Toward and Use of eHealth Technologies Among German Dermatologists: Repeated Cross-Sectional Survey in 2019 and 2021 JO - J Med Internet Res SP - e45817 VL - 26 KW - acceptance KW - adoption KW - attitude KW - COVID-19 KW - dermatology KW - digital medicine KW - digitalization KW - pandemic KW - perception KW - teledermatology KW - telehealth KW - telemedicine N2 - Background: In recent years, legal and infrastructural conditions have been set to improve the adoption of digital applications in health care in Germany. The impact of these actions was amplified by the COVID-19 pandemic. So far, no studies have confirmed this progress in dermatology. Objective: The aim of this study was to measure changes in knowledge, interest, expectation, and use of digital applications in health care among dermatologists in Germany in 2019 and 2021. Methods: We administered a repeated cross-sectional survey among dermatologists in medical practices and clinics in Germany at 2 time points: t1 (2019; before the COVID-19 pandemic) and t2 (2021; during the COVID-19 pandemic). We used a standardized questionnaire, including items on respondents? knowledge, interest, expectation, and use of digital applications, as well as their demographics. The survey was distributed by post and email. The data were analyzed descriptively as well as with multiple logistic regressions. Results: At t1, 585 (272/571, 47.6% female; mean age 52.4, SD 8.9 years) dermatologists and at t2, 792 (360/736, 48.9% female; mean age 54.3, SD 8.6 years) dermatologists participated in this survey. Interest in digital medicine was higher at t1 than at t2 (381/585, 65.1% vs 458/792, 57.8%; P?.001). Nevertheless, 38.6% (306/792) had used digital applications more often since the beginning of the pandemic. For example, real-time telemedicine with patients (12/585, 2.1% vs 160/792, 7.6%; P?.001) and other specialists did increase (33/385, 5.7% vs 181/792, 22.8%; P?.001). Almost one-third expressed great concerns about digitalization (272/792, 34.3% vs 294/792, 37.1%; P=.21). Spatial analysis revealed higher interest in, more positive expectations toward, and higher use of digital applications in urban areas in comparison to rural areas. For instance, dermatologists from urban areas assessed future applications as having less risk (adjusted odds ratio [aOR] 0.51, 95% CI 0.35-0.76) than did dermatologists from rural areas. The situation was similar with the age groups, as, for example, dermatologists aged <50 years also expected lower risks (aOR 0.51, 95% CI 0.34-0.77) than those aged ?50 years. There were no differences between sexes in use, but there were differences in knowledge and expectation; for example, male participants assessed their confidence in using digital applications as higher (aOR 1.44, 95% CI 1.01-2.04) than did female participants. Conclusions: During the pandemic, the use of digital applications in dermatology increased but still remained at a moderate level. The regional and age-related disparities identified indicate the need for further action to ensure equal access to digital care. UR - https://www.jmir.org/2024/1/e45817 UR - http://dx.doi.org/10.2196/45817 UR - http://www.ncbi.nlm.nih.gov/pubmed/38345855 ID - info:doi/10.2196/45817 ER - TY - JOUR AU - Kvale, Elizabeth AU - Phillips, Farya AU - Ghosh, Samiran AU - Lea, Jayanthi AU - Hoppenot, Claire AU - Costales, Anthony AU - Sunde, Jan AU - Badr, Hoda AU - Nwogu-Onyemkpa, Eberechi AU - Saleem, Nimrah AU - Ward, Rikki AU - Balasubramanian, Bijal PY - 2024/2/9 TI - Survivorship Care for Women Living With Ovarian Cancer: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e48069 VL - 13 KW - chronic survivorship KW - metastatic survivor KW - metavivor KW - ovarian cancer KW - persons living with cancer KW - quality of life KW - survivor KW - survivorship care KW - survivorship transition N2 - Background: Ovarian cancer ranks 12th in cancer incidence among women in the United States and 5th among causes of cancer-related death. The typical treatment of ovarian cancer focuses on disease management, with little attention given to the survivorship needs of the patient. Qualitative work alludes to a gap in survivorship care; yet, evidence is lacking to support the delivery of survivorship care for individuals living with ovarian cancer. We developed the POSTCare survivorship platform with input from survivors of ovarian cancer and care partners as a means of delivering patient-centered survivorship care. This process is framed by the chronic care model and relevant behavioral theory. Objective: The overall goal of this study is to test processes of care that support quality of life (QOL) in survivorship. The specific aims are threefold: first, to test the efficacy of the POSTCare platform in supporting QOL, reducing depressive symptom burden, and reducing recurrence worry. In our second aim, we will examine factors that mediate the effect of the intervention. Our final aim focuses on understanding aspects of care platform design and delivery that may affect the potential for dissemination. Methods: We will enroll 120 survivors of ovarian cancer in a randomized controlled trial and collect data at 12 and 24 weeks. Each participant will be randomized to either the POSTCare platform or the standard of care process for survivorship. Our population will be derived from 3 clinics in Texas; each participant will have received some combination of treatment modalities; continued maintenance therapy is not exclusionary. Results: We will examine the impact of the POSTCare-O platform on QOL at 12 weeks after intervention as the primary end point. We will look at secondary outcomes, including depressive symptom burden, recurrence anxiety, and physical symptom burden. We will identify mediators important to the impact of the intervention to inform revisions of the intervention for subsequent studies. Data collection was initiated in November 2023 and will continue for approximately 2 years. We expect results from this study to be published in early 2026. Conclusions: This study will contribute to the body of survivorship science by testing a flexible platform for survivorship care delivery adapted for the specific survivorship needs of patients with ovarian cancer. The completion of this project will contribute to the growing body of science to guide survivorship care for persons living with cancer. Trial Registration: ClinicalTrials.gov NCT05752448; https://clinicaltrials.gov/study/NCT05752448 International Registered Report Identifier (IRRID): PRR1-10.2196/48069 UR - https://www.researchprotocols.org/2024/1/e48069 UR - http://dx.doi.org/10.2196/48069 UR - http://www.ncbi.nlm.nih.gov/pubmed/38335019 ID - info:doi/10.2196/48069 ER - TY - JOUR AU - Ramamoorthi, Karishini AU - Stamenova, Vess AU - Liu, H. Rebecca AU - Bhattacharyya, Onil PY - 2024/2/8 TI - The Implementation of Federated Digital Identifiers in Health Care: Rapid Review JO - J Med Internet Res SP - e45751 VL - 26 KW - digital identity KW - electronic health record KW - environmental scan KW - identity management KW - identity verification KW - national electronic health record KW - online access KW - PAEHR KW - patient records KW - patient-accessible electronic health records N2 - Background: Federated digital identifiers (FDIs) have been cited to improve the interoperability of data and information management while enhancing the privacy of individuals verifying their identity on the web. Many countries around the world have implemented FDIs in various sectors, such as banking and government. Similarly, FDIs could improve the experience for those wanting to access their health care information; however, they have only been introduced in a few jurisdictions around the world, and their impact remains unclear. Objective: The main objective of this environmental scan was to describe how FDIs have been established and implemented to enable patients? access to health care. Methods: We conducted this study in 2 stages, with the primary stage being a rapid review, which was supplemented by a targeted gray literature search. Specifically, the rapid review was conducted through a database search of MEDLINE and Embase, which generated a list of countries and their services that use FDIs in health care. This list was then used to conduct a targeted gray literature search using the Google search engine. Results: A total of 93 references from the database and targeted Google searches were included in this rapid review. FDIs were implemented in health care in 11 countries (Australia, Belgium, Canada, Denmark, Estonia, Finland, Iceland, Norway, Singapore, Sweden, and Taiwan) and exclusively used with a patient-accessible electronic health record system through a single sign-on interface. The most common FDIs were implemented nationally or provincially, and establishing them usually required individuals to visit a bank or government office in person. In contrast, some countries, such as Australia, allow individuals to verify their identities entirely on the web. We found that despite the potential of FDIs for use in health care to facilitate the amalgamation of health information from different data sources into one platform, the adoption of most health care services that use FDIs remained below 30%. The exception to this was Australia, which had an adoption rate of 90%, which could be correlated with the fact that it leveraged an opt-out consent model. Conclusions: This rapid review highlights key features of FDIs across regions and elements associated with higher adoption of the patient-accessible electronic health record systems that use them, like opt-out registration. Although FDIs have been reported to facilitate the collation of data from multiple sources through a single sign-on interface, there is little information on their impact on care or patient experience. If FDIs are used to their fullest potential and implemented across sectors, adoption rates within health care may also improve. UR - https://www.jmir.org/2024/1/e45751 UR - http://dx.doi.org/10.2196/45751 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329799 ID - info:doi/10.2196/45751 ER - TY - JOUR AU - Hollestelle, J. Marieke AU - van der Graaf, Rieke AU - Sturkenboom, M. Miriam C. J. AU - Cunnington, Marianne AU - van Delden, M. Johannes J. PY - 2024/2/8 TI - Building a Sustainable Learning Health Care System for Pregnant and Lactating People: Interview Study Among Data Access Providers JO - JMIR Pediatr Parent SP - e47092 VL - 7 KW - ethics KW - learning health care systems KW - pregnancy KW - lactation KW - real-world data KW - governance KW - qualitative research N2 - Background: In many areas of health care, learning health care systems (LHSs) are seen as promising ways to accelerate research and outcomes for patients by reusing health and research data. For example, considering pregnant and lactating people, for whom there is still a poor evidence base for medication safety and efficacy, an LHS presents an interesting way forward. Combining unique data sources across Europe in an LHS could help clarify how medications affect pregnancy outcomes and lactation exposures. In general, a remaining challenge of data-intensive health research, which is at the core of an LHS, has been obtaining meaningful access to data. These unique data sources, also called data access providers (DAPs), are both public and private organizations and are important stakeholders in the development of a sustainable and ethically responsible LHS. Sustainability is often discussed as a challenge in LHS development. Moreover, DAPs are increasingly expected to move beyond regulatory compliance and are seen as moral agents tasked with upholding ethical principles, such as transparency, trustworthiness, responsibility, and community engagement. Objective: This study aims to explore the views of people working for DAPs who participate in a public-private partnership to build a sustainable and ethically responsible LHS. Methods: Using a qualitative interview design, we interviewed 14 people involved in the Innovative Medicines Initiative (IMI) ConcePTION (Continuum of Evidence from Pregnancy Exposures, Reproductive Toxicology and Breastfeeding to Improve Outcomes Now) project, a public-private collaboration with the goal of building an LHS for pregnant and lactating people. The pseudonymized transcripts were analyzed thematically. Results: A total of 3 themes were identified: opportunities and responsibilities, conditions for participation and commitment, and challenges for a knowledge-generating ecosystem. The respondents generally regarded the collaboration as an opportunity for various reasons beyond the primary goal of generating knowledge about medication safety during pregnancy and lactation. Respondents had different interpretations of responsibility in the context of data-intensive research in a public-private network. Respondents explained that resources (financial and other), scientific output, motivation, agreements collaboration with the pharmaceutical industry, trust, and transparency are important conditions for participating in and committing to the ConcePTION LHS. Respondents also discussed the challenges of an LHS, including the limitations to (real-world) data analyses and governance procedures. Conclusions: Our respondents were motivated by diverse opportunities to contribute to an LHS for pregnant and lactating people, primarily centered on advancing knowledge on medication safety. Although a shared responsibility for enabling real-world data analyses is acknowledged, their focus remains on their work and contribution to the project rather than on safeguarding ethical data handling. The results of our interviews underline the importance of a transparent governance structure, emphasizing the trust between DAPs and the public for the success and sustainability of an LHS. UR - https://pediatrics.jmir.org/2024/1/e47092 UR - http://dx.doi.org/10.2196/47092 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329780 ID - info:doi/10.2196/47092 ER - TY - JOUR AU - Dawson, Rik AU - Gilchrist, Heidi AU - Pinheiro, Marina AU - Nelson, Karn AU - Bowes, Nina AU - Sherrington, Cathie AU - Haynes, Abby PY - 2024/2/7 TI - Experiences of Older Adults, Physiotherapists, and Aged Care Staff in the TOP UP Telephysiotherapy Program: Interview Study of the TOP UP Interventions JO - JMIR Aging SP - e53010 VL - 7 KW - physiotherapy KW - telehealth KW - telephysiotherapy KW - exercise KW - aged care KW - qualitative methods KW - behavior change KW - technology KW - virtual care N2 - Background: Telehealth provides opportunities for older adults to access health care. However, limited research exists on the use of telehealth within aged care services, particularly regarding physiotherapy-led fall prevention and mobility programs. Understanding the experiences and interactions of older adults, physiotherapists, and aged care service providers is crucial for the scale-up and sustainability of such essential programs. The TOP UP study, a hybrid type 1 effectiveness-implementation randomized controlled trial in aged care, used a supported multidisciplinary telephysiotherapy model to motivate older adults to engage in exercises to improve mobility and reduce falls. Objective: This qualitative substudy aims to achieve 2 primary objectives: to describe the experiences and acceptability of the TOP UP intervention for older people, physiotherapists, and aged care support workers and managers and to gain an in-depth understanding of program implementation. Methods: A purposive recruitment strategy was used to select 18 older adults who participated in the TOP UP intervention, ensuring variation in age, gender, residential status (home or residential aged care), geographic location, and cognitive levels. In addition, 7 physiotherapists, 8 aged care support workers, and 6 managers from 7 different aged care provider partners participated in this study. Semistructured interviews were conducted to explore stakeholders? experiences with the TOP UP program, gather suggestions for improvement, and obtain insights for the future implementation of similar telephysiotherapy programs. The interview framework and coding processes were informed by behavior changes and implementation frameworks. Data were analyzed using an abductive approach, informed by 2 behavioral change theories (Capability, Opportunity, Motivation, and Behavior Model and Self-Determination Theory) and the Nonadoption, Abandonment and Challenges to the Scale-Up, Spread and Sustainability of Health and Care Technologies framework. Results: All participants (n=39) reported high levels of acceptability for the TOP UP program and cited multiple perceived benefits. The thematic analysis generated 6 main themes: telephysiotherapy expands opportunity; tailored physiotherapy care with local support enhances motivation; engaging, older adult?friendly educational resources build capability; flexible reablement approach fosters autonomy; telephysiotherapy is safe, effective, and acceptable for many; and organizational commitment is required to embed telehealth. The motivation to exercise was enhanced by Zoom?s convenience, use of tailored web-based exercise resources, and companionable local support. Conclusions: This study highlights the inherent value of telephysiotherapy in aged care, emphasizing the need for investment in staff training, local support, and older adult?friendly resources in future telephysiotherapy iterations. TOP UP represents a convenient and flexible web-based care model that empowers many older adults to receive sustainable, high-quality care precisely when and where they need it. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN 1261000734864; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000734864 UR - https://aging.jmir.org/2024/1/e53010 UR - http://dx.doi.org/10.2196/53010 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324369 ID - info:doi/10.2196/53010 ER - TY - JOUR AU - Li, Yiwen AU - Pope, Charlene AU - Damonte, Jennifer AU - Spates, Tanika AU - Maa, April AU - Chen, Suephy AU - Yeung, Howa PY - 2024/2/7 TI - Barriers and Facilitators to Teledermatology and Tele-Eye Care in Department of Veterans Affairs Provider Settings: Qualitative Content Analysis JO - JMIR Dermatol SP - e50352 VL - 7 KW - telemedicine KW - dermatology KW - eye KW - implementation science KW - stakeholder participation KW - veterans? health N2 - Background: Veterans Affairs health care systems have been early adopters of asynchronous telemedicine to provide access to timely and high-quality specialty care services in primary care settings for veterans living in rural areas. Scant research has examined how to expand primary care team members? engagement in telespecialty care. Objective: This qualitative study aimed to explore implementation process barriers and facilitators to using asynchronous telespecialty care (teledermatology and tele-eye care services). Methods: In total, 30 participants including primary care providers, nurses, telehealth clinical technicians, medical and program support assistants, and administrators from 2 community-based outpatient clinics were interviewed. Semistructured interviews were conducted using an interview guide, digitally recorded, and transcribed. Interview transcripts were analyzed using a qualitative content analysis summative approach. Two coders reviewed transcripts independently. Discrepancies were resolved by consensus discussion. Results: In total, 3 themes were identified from participants? experiences: positive perception of telespecialty care, concerns and challenges of implementation, and suggestions for service refinement. Participants voiced that the telemedicine visits saved commute and waiting times and provided veterans in rural areas more access to timely medical care. The mentioned concerns were technical challenges and equipment failure, staffing shortages to cover both in-person and telehealth visit needs, overbooked schedules leading to delayed referrals, the need for a more standardized operation protocol, and more hands-on training with formative feedback among supporting staff. Participants also faced challenges with appointment cancellations and struggled to find ways to efficiently manage both telehealth and in-person visits to streamline patient flow. Nonetheless, most participants feel motivated and confident in implementing telespecialty care going forward. Conclusions: This study provided important insights into the positive perceptions and ongoing challenges in telespecialty care implementation. Feedback from primary care teams is needed to improve telespecialty care service delivery for rural veterans. UR - https://derma.jmir.org/2024/1/e50352 UR - http://dx.doi.org/10.2196/50352 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324360 ID - info:doi/10.2196/50352 ER - TY - JOUR AU - Spierings, Jelle AU - Willinge, Gijs AU - Kokke, Marike AU - Twigt, Bas AU - de Lange, Wendela AU - Geerdink, Thijs AU - van der Velde, Detlef AU - Repping, Sjoerd AU - Goslings, Carel PY - 2024/2/2 TI - Health Care Professionals? Experiences With a Mobile Self-Care Solution for Low Complex Orthopedic Injuries: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e51510 VL - 12 KW - application KW - direct discharge KW - eHealth KW - experience KW - healthcare professional KW - mixed method study KW - orthopaedic surgery KW - orthopaedic KW - policy KW - policymaker KW - self-care application KW - self-care KW - trauma surgery KW - utilization KW - virtual fracture clinic N2 - Background: To cope with the rising number of patients with trauma in an already constrained Dutch health care system, Direct Discharge (DD) has been introduced in over 25 hospitals in the Netherlands since 2019. With DD, no routine follow-up appointments are scheduled after the emergency department (ED) visit, and patients are supported through information leaflets, a smartphone app, and a telephone helpline. DD reduces secondary health care use, with comparable patient satisfaction and primary health care use. Currently, little is known about the experiences of in-hospital health care professionals with DD. Objective: The aim of this study was to explore the experiences of health care professionals with the DD protocol to enhance durable adoption and improve the protocol. Methods: We conducted a mixed methods study parallel to the implementation of DD in 3 hospitals. Data were collected through a preimplementation survey, a postimplementation survey, and semistructured interviews. Quantitative data were reported descriptively, and qualitative data were reported using thematic analysis. Outcomes included the Bowen feasibility parameters: implementation, acceptability, preliminary efficacy, demand, and applicability. Preimplementation expectations were compared with postimplementation experiences. Health care professionals involved in the daily clinical care of patients with low-complex, stable injuries were eligible for this study. Results: Of the 217 eligible health care professionals, 128 started the primary survey, 37 completed both surveys (response rate of 17%), and 15 participated in semistructured interviews. Health care professionals expressed satisfaction with the DD protocol (median 7.8, IQR 6.8-8.9) on a 10-point scale, with 82% (30/37) of participants noting improved information quality and uniformity and 73% (27/37) of patients perceiving reduced outpatient follow-up and imaging. DD was perceived as safe by 79% (28/37) of participants in its current form, but a feedback system to reassure health care professionals that patients had recovered adequately was suggested to improve DD. The introduction of DD had varying effects on workload and job satisfaction among different occupations. Health care professionals expressed intentions to continue using DD due to increased efficiency, patient empowerment, and self-management. Conclusions: Health care professionals perceive DD as an acceptable, applicable, safe, and efficacious alternative to traditional treatment. A numerical in-app feedback system (eg, in-app communication tools or recovery scores) could alleviate health care professionals? concerns about adequate recovery and further improve DD protocols. DD can reduce health care use, which is important in times of constrained resources. Nonetheless, both advantages and disadvantages should be considered while evaluating this type of treatment. In the future, clinicians and policy makers can use these insights to further optimize and implement DD in clinical practice and guidelines. UR - https://mhealth.jmir.org/2024/1/e51510 UR - http://dx.doi.org/10.2196/51510 UR - http://www.ncbi.nlm.nih.gov/pubmed/38306162 ID - info:doi/10.2196/51510 ER - TY - JOUR AU - Kepplinger, Anja AU - Braun, Alexander AU - Fringer, André AU - Roes, Martina PY - 2024/2/2 TI - Understanding Employee Voice Behavior Through the Use of Digital Voice Channel in Long-Term Care: Protocol for an Embedded Multiple-Case Study JO - JMIR Res Protoc SP - e48601 VL - 13 KW - digital voice channel KW - employee participation KW - employee voice KW - health care provider KW - home care facilities KW - long-term care KW - nursing home N2 - Background: Specific challenges in the health care sector, such as hierarchical structures, shortages of nursing staff, and high turnover of nursing staff, can be addressed by a change process of organizational culture into shared governance. Data from business organizations show that the use of digital voice channels provides employee voice. This approach makes concrete the opportunity for employees to raise their voices by answering surveys and making comments in an anonymous forum, which subsequently positively influences staff turnover and sick leave. Since there is no clear understanding of how a digital voice channel can be used in long-term care to address employee voice, a research gap has been identified. Objective: The purpose of ADVICE (Understanding Employee Voice Behavior; the acronym for this study) is to understand how the use of a digital voice channel performs in long-term care (residential long-term care and home care facilities). The aim of this study is to understand how the digital voice channel can support staff in making their voices heard and to see what managers need to use the voice channel to change the work environment. Methods: An embedded multiple-case study will be used to explore the experiences of 2 health care providers who have already implemented a digital voice channel. ADVICE is organized into two main phases: (1) a scoping review and (2) an embedded multiple-case study. For this purpose, focus group interviews with employees, discursive-dialogical interviews with managers, meeting protocols, and data from the digital voice channel will be analyzed. First, all units of analysis from every embedded unit will be separately analyzed and then comprehensively analyzed to obtain a case vignette from every embedded unit (within-analysis). In the second stage, the analyzed data from the embedded units will be compared with each other in a comparative analysis (cross-analysis). Results: The results will provide insight into how digital voice channels can be used in long-term care to address employee voice. We expect to find how the digital voice channel can empower nurses to speak up and, consequently, create a better work environment. Data collection began in August 2023, and from a current perspective, the first results are expected in summer 2024. Conclusions: In summary, the results may help to better understand the use of a digital voice channel in the health care sector and its transformative potential for leadership. At the organizational level, research can help to improve the attractiveness of the workplace by understanding how to give employees a voice. International Registered Report Identifier (IRRID): PRR1-10.2196/48601 UR - https://www.researchprotocols.org/2024/1/e48601 UR - http://dx.doi.org/10.2196/48601 UR - http://www.ncbi.nlm.nih.gov/pubmed/38306164 ID - info:doi/10.2196/48601 ER - TY - JOUR AU - Yakob, Najia AU - Laliberté, Sandrine AU - Doyon-Poulin, Philippe AU - Jouvet, Philippe AU - Noumeir, Rita PY - 2024/2/1 TI - Data Representation Structure to Support Clinical Decision-Making in the Pediatric Intensive Care Unit: Interview Study and Preliminary Decision Support Interface Design JO - JMIR Form Res SP - e49497 VL - 8 KW - data representation KW - decision support KW - critical care KW - clinical workflow KW - clinical decision-making KW - prototype KW - design KW - intensive care unit N2 - Background: Clinical decision-making is a complex cognitive process that relies on the interpretation of a large variety of data from different sources and involves the use of knowledge bases and scientific recommendations. The representation of clinical data plays a key role in the speed and efficiency of its interpretation. In addition, the increasing use of clinical decision support systems (CDSSs) provides assistance to clinicians in their practice, allowing them to improve patient outcomes. In the pediatric intensive care unit (PICU), clinicians must process high volumes of data and deal with ever-growing workloads. As they use multiple systems daily to assess patients? status and to adjust the health care plan, including electronic health records (EHR), clinical systems (eg, laboratory, imaging and pharmacy), and connected devices (eg, bedside monitors, mechanical ventilators, intravenous pumps, and syringes), clinicians rely mostly on their judgment and ability to trace relevant data for decision-making. In these circumstances, the lack of optimal data structure and adapted visual representation hinder clinician?s cognitive processes and clinical decision-making skills. Objective: In this study, we designed a prototype to optimize the representation of clinical data collected from existing sources (eg, EHR, clinical systems, and devices) via a structure that supports the integration of a home-developed CDSS in the PICU. This study was based on analyzing end user needs and their clinical workflow. Methods: First, we observed clinical activities in a PICU to secure a better understanding of the workflow in terms of staff tasks and their use of EHR on a typical work shift. Second, we conducted interviews with 11 clinicians from different staff categories (eg, intensivists, fellows, nurses, and nurse practitioners) to compile their needs for decision support. Third, we structured the data to design a prototype that illustrates the proposed representation. We used a brain injury care scenario to validate the relevance of integrated data and the utility of main functionalities in a clinical context. Fourth, we held design meetings with 5 clinicians to present, revise, and adapt the prototype to meet their needs. Results: We created a structure with 3 levels of abstraction?unit level, patient level, and system level?to optimize clinical data representation and display for efficient patient assessment and to provide a flexible platform to host the internally developed CDSS. Subsequently, we designed a preliminary prototype based on this structure. Conclusions: The data representation structure allows prioritizing patients via criticality indicators, assessing their conditions using a personalized dashboard, and monitoring their courses based on the evolution of clinical values. Further research is required to define and model the concepts of criticality, problem recognition, and evolution. Furthermore, feasibility tests will be conducted to ensure user satisfaction. UR - https://formative.jmir.org/2024/1/e49497 UR - http://dx.doi.org/10.2196/49497 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300695 ID - info:doi/10.2196/49497 ER - TY - JOUR AU - Castillo-Rodenas, Marta AU - Vidal-Alaball, Josep AU - Solanas-Bacardit, Núria AU - Farràs-Company, Clotilde AU - Fuster-Casanovas, Aïna AU - Miró Catalina, Queralt AU - López Seguí, Francesc PY - 2024/2/1 TI - Feasibility of a Pediatric Acute Video Consultation Process Among Health Care Professionals in Primary Care in a Rural Setting: Protocol for a Prospective Validation Study JO - JMIR Res Protoc SP - e52946 VL - 13 KW - primary health care KW - pediatrics KW - remote consultation KW - telemedicine KW - rural health services KW - video consultation N2 - Background: For years, in Catalonia and in the rest of Spain, there has been a deficit and an unequal geographical distribution of health professionals specializing in pediatrics, especially in rural areas. Among the proposals to improve this situation is the promotion of the use of information and communication technologies (ICT) among users and professionals. Moreover, with the outbreak of COVID-19, the use of telehealth has become an essential tool, with an overall increase in non?face-to-face visits, including in primary care pediatrics. In this context, telemedicine, when used in primary care pediatrics, can be an effective means of improving families? access to medical care. Currently, in Catalonia, telemedicine involving patients and health professionals is used in pediatric primary care through telephone consultation and asynchronous teleconsultation (eConsulta). Video consultation is in practice not used, although it could have different applications. Objective: The aim of this study is to evaluate the feasibility of a video consultation process with physical examination in acute pediatric pathology in rural areas among primary care professionals. In addition, the level of satisfaction with these remote consultations will be assessed from the perspective of both the users and the health care professionals. Methods: We will conduct a prospective experimental study to analyze the possibility of using video consultation in pediatric acute care in primary care in central Catalonia (Spain). A minimum of 170 children aged between 0 and 14 years attending the primary care center (PCC) for acute illness for a period of 1 year will be included in the study. Initially, the telemetric visit, including a physical examination, will include a nurse at the patient and family?s side and a pediatrician who will participate remotely. Subsequently, the pediatrician will visit the patient in person and the physical examination and diagnosis made during the remote visit will be compared with the physical examination and diagnosis of the face-to-face visit, which is considered the gold standard. Results: Recruitment was planned to begin in the second half of 2023 and continue for at least 1 year. It is anticipated to be a good resource for a variety of acute pediatric conditions in primary care. The evaluation will focus on the feasibility of performing live remote visits and comparing their diagnostic accuracy with that of face-to-face visits. Conclusions: We believe that this study could provide evidence on the feasibility and diagnostic accuracy of video consultation in pediatric acute primary care in a rural setting, as well as on satisfaction with video consultations among both users and professionals. If proven useful in addressing the acute needs of children in a variety of situations, it could become a digital health tool that improves the overall pediatric primary care service in rural areas, for both families and professionals. International Registered Report Identifier (IRRID): PRR1-10.2196/52946 UR - https://www.researchprotocols.org/2024/1/e52946 UR - http://dx.doi.org/10.2196/52946 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300693 ID - info:doi/10.2196/52946 ER - TY - JOUR AU - Basnet, Syaron AU - Chaiton, Michael PY - 2024/1/30 TI - Effectiveness of the Wellness Together Canada Portal as a Digital Mental Health Intervention in Canada: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e48703 VL - 13 KW - Wellness Together Portal KW - randomized trial KW - COVID-19 KW - mental health KW - digital health KW - digital intervention KW - substance use KW - portal KW - effectiveness KW - well-being N2 - Background: The Wellness Together Canada (WTC) portal is a digital mental health intervention that was developed in response to an unprecedented rise in mental health and substance use concerns due to the COVID-19 pandemic, with funding from the Government of Canada. It is a mental health and substance use website to support people across Canada providing digital interventions and services at no cost. Two million people have visited the WTC portal over the course of 1 year since launching; however, rigorous evaluation of this potential solution to access to mental health care during and after the COVID-19 pandemic is urgently required. Objective: This study aims to better understand the effectiveness of the existing digital interventions in improving population mental health in Canada. Methods: The Let?s Act on Mental Health study is designed as a longitudinal fully remote, equally randomized (1:1), double-blind, alternative intervention?controlled, parallel-group randomized controlled trial to be conducted between October 2023 and April 2024 with a prospective follow-up study period of 26 weeks. This trial will evaluate whether a digital intervention such as the WTC improves population mental health trajectories over time. Results: The study was approved by the research ethics board of CAMH (Centre for Addiction and Mental Health, Toronto, Ontario, Canada). It is ongoing and participant recruitment is underway. As of August 2023, a total of 453 participants in the age group of 18-72 years have participated, of whom 70% (n=359) are female. Conclusions: This initiative provides a unique opportunity to match people?s specific unmet mental health and substance use needs to evidence-based digital interventions. UR - https://www.researchprotocols.org/2024/1/e48703 UR - http://dx.doi.org/10.2196/48703 UR - http://www.ncbi.nlm.nih.gov/pubmed/38289642 ID - info:doi/10.2196/48703 ER - TY - JOUR AU - Shih, Chia-Ding AU - Scholten, Jan Henk AU - Ripp, Gavin AU - Srikanth, Kirthana AU - Smith, Caileigh AU - Ma, Ran AU - Fu, Jie AU - Reyzelman, M. Alexander PY - 2024/1/29 TI - Effectiveness of a Continuous Remote Temperature Monitoring Program to Reduce Foot Ulcers and Amputations: Multicenter Postmarket Registry Study JO - JMIR Diabetes SP - e46096 VL - 9 KW - neuropathy KW - neuropathic foot ulcer KW - diabetes KW - diabetic foot ulcer KW - amputation KW - remote patient monitoring KW - temperature monitoring KW - prevention KW - socks N2 - Background: Neuropathic foot ulcers are the leading cause of nontraumatic foot amputations, particularly among patients with diabetes. Traditional methods of monitoring and managing these patients are periodic in-person clinic visits, which are passive and may be insufficient for preventing neuropathic foot ulcers and amputations. Continuous remote temperature monitoring has the potential to capture the critical period before the foot ulcers develop and to improve outcomes by providing real-time data and early interventions. For the first time, the effectiveness of such a strategy to prevent neuropathic foot ulcers and related complications among high-risk patients in a real-world commercial setting is reported. Objective: This study aims to evaluate the effectiveness of a real-world continuous remote temperature monitoring program in preventing neuropathic foot ulcers and amputations in patients with diabetes. Methods: In this retrospective analysis of a real-world continuous remote temperature monitoring program, 115 high-risk patients identified by clinical providers from 15 geographically diverse private podiatry offices were analyzed. Patients received continuous remote monitoring socks as part of the program. The enrollment was based on medical necessity as decided by their managing physician. We evaluated data from up to 2 years before enrollment and up to 3 years during the program. The primary outcome was the rate of wound development. Secondary outcomes included amputation rate, the severity of the foot ulcers, and the number of visits to an outpatient podiatry clinic after enrolling in the program. Results: We observed significantly lower rates of foot ulceration (relative risk reduction [RRR] 0.68; 95% CI 0.52-0.79; number needed to treat [NNT] 5.0; P<.001), less moderate to severe ulcers (RRR 0.86; 95% CI 0.70-0.93; NNT 16.2; P<.001), less amputations (RRR 0.83; 95% CI 0.39-0.95; NNT 41.7; P=.006), and less hospitalizations (RRR 0.63; 95% CI 0.33-0.80; NNT 5.7; P<.002). We found a decrease in outpatient podiatry office visits during the program (RRR 0.31; 95% CI 0.24-0.37; NNT 0.46; P<.001). Conclusions: Our findings suggested that a real-world continuous remote temperature monitoring program was an effective strategy to prevent foot ulcer development and nontraumatic foot amputation among high-risk patients. UR - https://diabetes.jmir.org/2024/1/e46096 UR - http://dx.doi.org/10.2196/46096 UR - http://www.ncbi.nlm.nih.gov/pubmed/38285493 ID - info:doi/10.2196/46096 ER - TY - JOUR AU - Azzolini, Claudio AU - Premi, Elias AU - Donati, Simone AU - Falco, Andrea AU - Torreggiani, Aldo AU - Sicurello, Francesco AU - Baj, Andreina AU - Azzi, Lorenzo AU - Orro, Alessandro AU - Porta, Giovanni AU - Azzolini, Giovanna AU - Sorrentino, Marco AU - Melillo, Paolo AU - Testa, Francesco AU - Simonelli, Francesca AU - Giardina, Gianfranco AU - Paolucci, Umberto PY - 2024/1/26 TI - Ten Years of Experience With a Telemedicine Platform Dedicated to Health Care Personnel: Implementation Report JO - JMIR Med Inform SP - e42847 VL - 12 KW - telemedicine KW - ophthalmology KW - eHealth KW - informatics platform KW - health care professional KW - patient care KW - information technology KW - data warehouse N2 - Background: Telemedicine, a term that encompasses several applications and tasks, generally involves the remote management and treatment of patients by physicians. It is known as transversal telemedicine when practiced among health care professionals (HCPs). Objective: We describe the experience of implementing our telemedicine Eumeda platform for HCPs over the last 10 years. Methods: A web-based informatics platform was developed that had continuously updated hypertext created using advanced technology and the following features: security, data insertion, dedicated software for image analysis, and the ability to export data for statistical surveys. Customizable files called ?modules? were designed and built for different fields of medicine, mainly in the ophthalmology subspecialty. Each module was used by HCPs with different authorization profiles. Implementation (Results): Twelve representative modules for different projects are presented in this manuscript. These modules evolved over time, with varying degrees of interconnectivity, including the participation of a number of centers in 19 cities across Italy. The number of HCP operators involved in each single module ranged from 6 to 114 (average 21.8, SD 28.5). Data related to 2574 participants were inserted across all the modules. The average percentage of completed text/image fields in the 12 modules was 65.7%. All modules were evaluated in terms of access, acceptability, and medical efficacy. In their final evaluation, the participants judged the modules to be useful and efficient for clinical use. Conclusions: Our results demonstrate the usefulness of the telemedicine platform for HCPs in terms of improved knowledge in medicine, patient care, scientific research, teaching, and the choice of therapies. It would be useful to start similar projects across various health care fields, considering that in the near future medicine as we know it will completely change. UR - https://medinform.jmir.org/2024/1/e42847 UR - http://dx.doi.org/10.2196/42847 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277199 ID - info:doi/10.2196/42847 ER - TY - JOUR AU - Yu, Yang AU - Wang, Sufen AU - You, Lijue PY - 2024/1/24 TI - Understanding the Integrated Health Management System Policy in China From Multiple Perspectives: Systematic Review and Content Analysis JO - J Med Internet Res SP - e47197 VL - 26 KW - integrated health management system KW - medical association KW - medical consortium KW - policy tools KW - content analysis KW - PRISMA KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses N2 - Background: The integrated health management system (IHMS), which unites all health care?related institutions under a health-centered organizational framework, is of great significance to China in promoting the hierarchical treatment system and improving the new health care reform. China?s IHMS policy consists of multiple policies at different levels and at different times; however, there is a lack of comprehensive interpretation and analysis of these policies, which is not conducive to the further development of the IHMS in China. Objective: This study aims to comprehensively analyze and understand the characteristics, development, and evolution of China?s IHMS policy to inform the design and improvement of the system. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to collect 152 policy documents. With the perspective of policy tools and policy orientation as the core, a comprehensive 6D framework including policy level, policy nature, release time, policy tools, stakeholders, and policy orientation was established by combining the content of policy texts. These dimensions were then analyzed using content analysis. Results: First, we found that, regarding the coordination of policy tools and stakeholders, China?s IHMS policy was more inclined to use environment-based policy tools (1089/1929, 56.45%), which suggests a need for further balance in the internal structure of policy tools. Attention to different actors varied, and the participation of physicians and residents needs further improvement (65/2019, 3.22% and 11/2019, 0.54%, respectively). Second, in terms of level differences, Shanghai?s IHMS policy used fewer demand-based policy tools (43/483, 8.9%), whereas the national IHMS policy and those of other provinces and cities used fewer supply-based tools (61/357, 17.1% and 248/357, 69.5%, respectively). The national IHMS strategy placed more emphasis on the construction of smart health care (including digital health; 10/275, 3.6%), whereas Shanghai was a leader in the development of healthy community and healthy China (9/158, 5.7% and 4/158, 2.5%, respectively). Third, in terms of time evolution, the various policy tools showed an increasing and then decreasing trend from 2014 to 2021, with relatively more use of environment-based policy tools and less use of demand-based policy tools in the last 3 years. The growth of China?s IHMS policy can be divided into 3 stages: the disease-centered period (2014-2017), the e-health technology development period (2017-2019), and the health-centered period (2018-2021). Conclusions: Policy makers should make several adjustments, such as coordinating policy tools and the uneven relationships among stakeholders; grasping key policy priorities in the context of local characteristics; and focusing on horizontal, multidimensional integration of health resources starting from the community. This study expands the objects of policy research and improves the framework for policy analysis. The findings provide some possible lessons for future policy formulation and optimization. UR - https://www.jmir.org/2024/1/e47197 UR - http://dx.doi.org/10.2196/47197 UR - http://www.ncbi.nlm.nih.gov/pubmed/38265862 ID - info:doi/10.2196/47197 ER - TY - JOUR AU - Modi, Shikha AU - Feldman, S. Sue AU - Berner, S. Eta AU - Schooley, Benjamin AU - Johnston, Allen PY - 2024/1/24 TI - Value of Electronic Health Records Measured Using Financial and Clinical Outcomes: Quantitative Study JO - JMIR Med Inform SP - e52524 VL - 12 KW - acceptance KW - admission KW - adoption KW - clinical outcome KW - cost KW - economic KW - EHR adoption KW - EHR KW - electronic health record KW - finance KW - financial outcome KW - financial KW - health outcome KW - health record KW - hospital KW - hospitalization KW - length of stay KW - margin KW - moderation analysis KW - multivariate KW - operating margin KW - operating KW - operation KW - operational KW - profit KW - project management KW - readmission rate KW - readmission KW - total margin KW - value analysis KW - value engineering KW - value management N2 - Background: The Health Information Technology for Economic and Clinical Health Act of 2009 was legislated to reduce health care costs, improve quality, and increase patient safety. Providers and organizations were incentivized to exhibit meaningful use of certified electronic health record (EHR) systems in order to achieve this objective. EHR adoption is an expensive investment, given the resources and capital that are invested. Due to the cost of the investment, a return on the EHR adoption investment is expected. Objective: This study performed a value analysis of EHRs. The objective of this study was to investigate the relationship between EHR adoption levels and financial and clinical outcomes by combining both financial and clinical outcomes into one conceptual model. Methods: We examined the multivariate relationships between different levels of EHR adoption and financial and clinical outcomes, along with the time variant control variables, using moderation analysis with a longitudinal fixed effects model. Since it is unknown as to when hospitals begin experiencing improvements in financial outcomes, additional analysis was conducted using a 1- or 2-year lag for profit margin ratios. Results: A total of 5768 hospital-year observations were analyzed over the course of 4 years. According to the results of the moderation analysis, as the readmission rate increases by 1 unit, the effect of a 1-unit increase in EHR adoption level on the operating margin decreases by 5.38%. Hospitals with higher readmission payment adjustment factors have lower penalties. Conclusions: This study fills the gap in the literature by evaluating individual relationships between EHR adoption levels and financial and clinical outcomes, in addition to evaluating the relationship between EHR adoption level and financial outcomes, with clinical outcomes as moderators. This study provided statistically significant evidence (P<.05), indicating that there is a relationship between EHR adoption level and operating margins when this relationship is moderated by readmission rates, meaning hospitals that have adopted EHRs could see a reduction in their readmission rates and an increase in operating margins. This finding could further be supported by evaluating more recent data to analyze whether hospitals increasing their level of EHR adoption would decrease readmission rates, resulting in an increase in operating margins. Hospitals would incur lower penalties as a result of improved readmission rates, which would contribute toward improved operating margins. UR - https://medinform.jmir.org/2024/1/e52524 UR - http://dx.doi.org/10.2196/52524 UR - http://www.ncbi.nlm.nih.gov/pubmed/38265848 ID - info:doi/10.2196/52524 ER - TY - JOUR AU - Trofimchuk, Vitaliy AU - Dossanov, Bolatbek AU - Lozovoy, Vassiliy AU - Khmyzov, Sergey AU - Dossanova, Assem AU - Angelov, Aleksandr AU - Pashenko, Andrey AU - Zhukenov, Olzhas PY - 2024/1/24 TI - Quality of Life in Children With Achondroplasia Undergoing Paired Limb Lengthening With an External Fixator and Modified Distraction Control: Observational Nonrandomized Study JO - JMIR Rehabil Assist Technol SP - e49261 VL - 11 KW - achondroplasia KW - external fixator KW - quality of life KW - transosseous osteosynthesis KW - paired limb lengthening KW - bone growth disorder KW - dwarfism KW - limb lengthening KW - circular multiaxial system KW - hereditary disease KW - limb reconstruction KW - children KW - youth KW - pediatric KW - bone disorder KW - orthopedics KW - rehabilitation KW - bone KW - growth KW - disorder KW - genetic N2 - Background: Transosseous distraction osteosynthesis is prioritized in orthopedic care for children with achondroplasia. However, difficulties encountered during treatment and rehabilitation directly impact patients? quality of life. Using rod external fixators within a semicircular frame for osteosynthesis is less traumatic compared to spoke circular devices. Their straightforward assembly and mounting on the limb segment can help significantly reduce treatment duration, thereby improving children?s quality of life during treatment and rehabilitation. Objective: This study aimed to conduct a comparative analysis of the quality of life (measured by postoperative pain syndrome, physical activity, and emotional state) among children with achondroplasia undergoing paired limb lengthening using either an external fixator with modified distraction control or a circular multiaxial system developed by the authors. Methods: This was an observational, prospective, nonrandomized, and longitudinal study with historical control. The study group consisted of 14 patients ranging from 5 to 15 (mean 7.6, SD 2.3) years old with a genetically confirmed diagnosis of achondroplasia. All patients underwent paired limb lengthening with a rod external fixator and a modified distraction control developed by the authors. A total of 28 limb segments, among them 4 (14%) humeri, 8 (29%) femurs, and 16 (57%) tibias, were lengthened in 1 round. Unpublished data from the previous study served as the control group, comprising 9 patients (18 limb segments) of the same age group (mean age at surgery 8.6, SD 2.3 years), who underwent limb lengthening surgery using a circular multiaxial system?2 (11%) humeri, 6 (33%) femurs, and 10 (56%) tibias. The Wong-Baker Faces Rating Scale was used to measure pain symptoms, while the Russified Pediatric Quality of Life (PedsQL) v4.0 questionnaire assessed quality of life. Results: During the latent phase (7 to 10 days after surgery), a more pronounced decrease in the indicators of physical activity and emotional state on the PedsQL v4.0 questionnaire was noted in the control group (mean 52.4, SD 4.8 versus mean 52.8, SD 5.5 points according to children?s responses and their parents? responses, respectively) compared to the experimental group (mean 59.5, SD 6.8 points and mean 61.33, SD 6.5 points according to the children?s responses and their parents? responses, respectively). The differences between the groups were statistically significant (P<.05 for children's responses and P<.01 for parents? responses). Importantly, 6 months after surgery, these quality-of-life indicators, as reported by children in the experimental group, averaged 70.25 (SS 4.8) points. Similarly, their parents reported a mean of 70.54 (SD 4.2) points. In the control group, the corresponding values were 69.64 (SD 5.6) and 69.35 (SD 6.2), respectively. There was no statistically significant difference between the groups. Conclusions: The external fixator with modified distraction control developed by the authors provides a higher standard of living compared with the circular multiaxial system during the latency phase. UR - https://rehab.jmir.org/2024/1/e49261 UR - http://dx.doi.org/10.2196/49261 UR - http://www.ncbi.nlm.nih.gov/pubmed/38265860 ID - info:doi/10.2196/49261 ER - TY - JOUR AU - Zhou, Linyun AU - Jiang, Minghuan AU - Duan, Ran AU - Zuo, Feng AU - Li, Zongfang AU - Xu, Songhua PY - 2024/1/23 TI - Barriers and Implications of 5G Technology Adoption for Hospitals in Western China: Integrated Interpretive Structural Modeling and Decision-Making Trial and Evaluation Laboratory Analysis JO - JMIR Mhealth Uhealth SP - e48842 VL - 12 KW - 5G health care KW - 5G adoption barriers KW - 5G adoption strategy KW - smart health care KW - Western China hospitals N2 - Background: 5G technology is gaining traction in Chinese hospitals for its potential to enhance patient care and internal management. However, various barriers hinder its implementation in clinical settings, and studies on their relevance and importance are scarce. Objective: This study aimed to identify critical barriers hampering the effective implementation of 5G in hospitals in Western China, to identify interaction relationships and priorities of the above-identified barriers, and to assess the intensity of the relationships and cause-and-effect relations between the adoption barriers. Methods: This paper uses the Delphi expert consultation method to determine key barriers to 5G adoption in Western China hospitals, the interpretive structural modeling to uncover interaction relationships and priorities, and the decision-making trial and evaluation laboratory method to reveal cause-and-effect relationships and their intensity levels. Results: In total, 14 barriers were determined by literature review and the Delphi method. Among these, ?lack of policies on ethics, rights, and responsibilities in core health care scenarios? emerged as the fundamental influencing factor in the entire system, as it was the only factor at the bottom level of the interpretive structural model. Overall, 8 barriers were classified as the ?cause group,? and 6 as the ?effect group? by the decision-making trial and evaluation laboratory method. ?High expense? and ?organizational barriers within hospitals? were determined as the most significant driving barrier (the highest R?C value of 1.361) and the most critical barrier (the highest R+C value of 4.317), respectively. Conclusions: Promoting the integration of 5G in hospitals in Western China faces multiple complex and interrelated barriers. The study provides valuable quantitative evidence and a comprehensive approach for regulatory authorities, hospitals, and telecom operators, helping them develop strategic pathways for promoting widespread 5G adoption in health care. It is suggested that the stakeholders cooperate to explore and solve the problems in the 5G medical care era, aiming to achieve the coverage of 5G medical care across the country. To our best knowledge, this study is the first academic exploration systematically analyzing factors resisting 5G integration in Chinese hospitals, and it may give subsequent researchers a solid foundation for further studying the application and development of 5G in health care. UR - https://mhealth.jmir.org/2024/1/e48842 UR - http://dx.doi.org/10.2196/48842 UR - http://www.ncbi.nlm.nih.gov/pubmed/38261368 ID - info:doi/10.2196/48842 ER - TY - JOUR AU - Weik, Lisa AU - Fehring, Leonard AU - Mortsiefer, Achim AU - Meister, Sven PY - 2024/1/22 TI - Big 5 Personality Traits and Individual- and Practice-Related Characteristics as Influencing Factors of Digital Maturity in General Practices: Quantitative Web-Based Survey Study JO - J Med Internet Res SP - e52085 VL - 26 KW - digital health KW - eHealth KW - digital maturity KW - maturity assessment KW - general practitioners KW - primary care physicians KW - primary care KW - family medicine KW - personality KW - digital affinity KW - digital health adoption N2 - Background: Various studies propose the significance of digital maturity in ensuring effective patient care and enabling improved health outcomes, a successful digital transformation, and optimized service delivery. Although previous research has centered around inpatient health care settings, research on digital maturity in general practices is still in its infancy. Objective: As general practitioners (GPs) are the first point of contact for most patients, we aimed to shed light on the pivotal role of GPs? inherent characteristics, especially their personality, in the digital maturity of general practices. Methods: In the first step, we applied a sequential mixed methods approach involving a literature review and expert interviews with GPs to construct the digital maturity scale used in this study. Next, we designed a web-based survey to assess digital maturity on a 5-point Likert-type scale and analyze the relationship with relevant inherent characteristics using ANOVAs and regression analysis. Results: Our web-based survey with 219 GPs revealed that digital maturity was overall moderate (mean 3.31, SD 0.64) and substantially associated with several characteristics inherent to the GP. We found differences in overall digital maturity based on GPs? gender, the expected future use of digital health solutions, the perceived digital affinity of medical assistants, GPs? level of digital affinity, and GPs? level of extraversion and neuroticism. In a regression model, a higher expected future use, a higher perceived digital affinity of medical assistants, a higher digital affinity of GPs, and lower neuroticism were substantial predictors of overall digital maturity. Conclusions: Our study highlights the impact of GPs? inherent characteristics, especially their personality, on the digital maturity of general practices. By identifying these inherent influencing factors, our findings support targeted approaches to drive digital maturity in general practice settings. UR - https://www.jmir.org/2024/1/e52085 UR - http://dx.doi.org/10.2196/52085 UR - http://www.ncbi.nlm.nih.gov/pubmed/38252468 ID - info:doi/10.2196/52085 ER - TY - JOUR AU - Schnoor, Kyma AU - Versluis, Anke AU - Chavannes, H. Niels AU - Talboom-Kamp, A. Esther P. W. PY - 2024/1/22 TI - Digital Triage Tools for Sexually Transmitted Infection Testing Compared With General Practitioners? Advice: Vignette-Based Qualitative Study With Interviews Among General Practitioners JO - JMIR Hum Factors SP - e49221 VL - 11 KW - eHealth KW - digital triage tool KW - sexually transmitted infection KW - STI KW - human immunodeficiency virus KW - general practitioners KW - GPs decision-making KW - digital health KW - diagnostic KW - sexually transmitted disease KW - STD KW - sexually transmitted KW - sexual transmission KW - triage KW - artificial intelligence KW - HIV KW - diagnostics KW - diagnosis KW - vignette KW - vignettes KW - interview KW - interviews KW - best practice KW - best practices KW - thematic analysis KW - referral KW - medical advice N2 - Background: Digital triage tools for sexually transmitted infection (STI) testing can potentially be used as a substitute for the triage that general practitioners (GPs) perform to lower their work pressure. The studied tool is based on medical guidelines. The same guidelines support GPs? decision-making process. However, research has shown that GPs make decisions from a holistic perspective and, therefore, do not always adhere to those guidelines. To have a high-quality digital triage tool that results in an efficient care process, it is important to learn more about GPs? decision-making process. Objective: The first objective was to identify whether the advice of the studied digital triage tool aligned with GPs? daily medical practice. The second objective was to learn which factors influence GPs? decisions regarding referral for diagnostic testing. In addition, this study provides insights into GPs? decision-making process. Methods: A qualitative vignette-based study using semistructured interviews was conducted. In total, 6 vignettes representing patient cases were discussed with the participants (GPs). The participants needed to think aloud whether they would advise an STI test for the patient and why. A thematic analysis was conducted on the transcripts of the interviews. The vignette patient cases were also passed through the digital triage tool, resulting in advice to test or not for an STI. A comparison was made between the advice of the tool and that of the participants. Results: In total, 10 interviews were conducted. Participants (GPs) had a mean age of 48.30 (SD 11.88) years. For 3 vignettes, the advice of the digital triage tool and of all participants was the same. In those vignettes, the patients? risk factors were sufficiently clear for the participants to advise the same as the digital tool. For 3 vignettes, the advice of the digital tool differed from that of the participants. Patient-related factors that influenced the participants? decision-making process were the patient?s anxiety, young age, and willingness to be tested. Participants would test at a lower threshold than the triage tool because of those factors. Sometimes, participants wanted more information than was provided in the vignette or would like to conduct a physical examination. These elements were not part of the digital triage tool. Conclusions: The advice to conduct a diagnostic STI test differed between a digital triage tool and GPs. The digital triage tool considered only medical guidelines, whereas GPs were open to discussion reasoning from a holistic perspective. The GPs? decision-making process was influenced by patients? anxiety, willingness to be tested, and age. On the basis of these results, we believe that the digital triage tool for STI testing could support GPs and even replace consultations in the future. Further research must substantiate how this can be done safely. UR - https://humanfactors.jmir.org/2024/1/e49221 UR - http://dx.doi.org/10.2196/49221 UR - http://www.ncbi.nlm.nih.gov/pubmed/38252474 ID - info:doi/10.2196/49221 ER - TY - JOUR AU - Khairat, Saif AU - John, Roshan AU - Pillai, Malvika AU - McDaniel, Philip AU - Edson, Barbara PY - 2024/1/19 TI - Patient Characteristics Associated With Phone and Video Visits at a Tele-Urgent Care Center During the Initial COVID-19 Response: Cross-Sectional Study JO - Online J Public Health Inform SP - e50962 VL - 16 KW - telehealth KW - telemedicine KW - tele-urgent care KW - virtual urgent care KW - nonemergency care KW - televisit KW - phone visit KW - video visit KW - urgent care KW - health services research KW - COVID-19 KW - health disparities KW - insurance status KW - cross-sectional study N2 - Background: Health systems rapidly adopted telemedicine as an alternative health care delivery modality in response to the COVID-19 pandemic. Demographic factors, such as age and gender, may play a role in patients? choice of a phone or video visit. However, it is unknown whether there are differences in utilization between phone and video visits. Objective: This study aimed to investigate patients? characteristics, patient utilization, and service characteristics of a tele-urgent care clinic during the initial response to the pandemic. Methods: We conducted a cross-sectional study of urgent care patients using a statewide, on-demand telemedicine clinic with board-certified physicians during the initial phases of the pandemic. The study data were collected from March 3, 2020, through May 3, 2020. Results: Of 1803 telemedicine visits, 1278 (70.9%) patients were women, 730 (40.5%) were aged 18 to 34 years, and 1423 (78.9%) were uninsured. There were significant differences between telemedicine modalities and gender (P<.001), age (P<.001), insurance status (P<.001), prescriptions given (P<.001), and wait times (P<.001). Phone visits provided significantly more access to rural areas than video visits (P<.001). Conclusions: Our findings suggest that offering patients a combination of phone and video options provided additional flexibility for various patient subgroups, particularly patients living in rural regions with limited internet bandwidth. Differences in utilization were significant based on patient gender, age, and insurance status. We also found differences in prescription administration between phone and video visits that require additional investigation. UR - https://ojphi.jmir.org/2024/1/e50962 UR - http://dx.doi.org/10.2196/50962 UR - http://www.ncbi.nlm.nih.gov/pubmed/38241073 ID - info:doi/10.2196/50962 ER - TY - JOUR AU - Fuster-Casanovas, Aïna AU - Miró Catalina, Queralt AU - Vidal-Alaball, Josep AU - Escalé-Besa, Anna AU - Carrión, Carme PY - 2024/1/18 TI - eHealth in the Management of Depressive Episodes in Catalonia?s Primary Care From 2017 to 2022: Retrospective Observational Study JO - JMIR Ment Health SP - e52816 VL - 11 KW - eHealth KW - depression KW - depressive disorder KW - primary health care KW - mental health patient KW - patient KW - patients KW - healthcare system KW - digital transformation KW - mental disorder KW - mental disorders KW - diagnostic KW - clinical practice KW - clinical practices KW - retrospective KW - observational KW - regression KW - digital tool KW - digital tools N2 - Background: The reasons for mental health consultations are becoming increasingly relevant in primary care. The Catalan health care system is undergoing a process of digital transformation, where eHealth is becoming increasingly relevant in routine clinical practice. Objective: This study aimed to analyze the approach to depressive episodes and the role of eHealth in the Catalan health care system from 2017 to 2022. Methods: A retrospective observational study was conducted on diagnostic codes related to depressive episodes and mood disorders between 2017 and 2022 using data from the Catalan Institute of Health. The sociodemographic evolution and prevalence of depression and mood disorders in Catalonia were analyzed between 2017 and 2022. Sociodemographic variables were analyzed using absolute frequency and percentage. The prevalence of depressive episodes was calculated, highlighting the year-to-year changes. The use of eHealth for related consultations was assessed by comparing the percentages of eHealth and face-to-face consultations. A comparison of sociodemographic variables based on attendance type was conducted. Additionally, a logistic regression model was used to explore factors influencing face-to-face attendance. The analysis used R software (version 4.2.1), with all differences examined using 95% CIs. Results: From 2017 to 2022, there was an 86.6% increase in the prevalence of depression and mood disorders, with women consistently more affected (20,950/31,197, 67.2% in 2017 and 22,078/33,169, 66.6% in 2022). In 2022, a significant rise in depression diagnoses was observed in rural areas (difference 0.71%, 95% CI 0.04%-1.43%), contrasting with a significant decrease in urban settings (difference ?0.7%, 95% CI ?1.35% to ?0.05%). There was a significant increase in antidepressant use in 2022 compared to 2017 (difference 2.4%, 95% CI 1.87%-3.06%) and the proportion of eHealth visits rose from 4.34% (1240/28,561) in 2017 to 26.3% (8501/32,267) in 2022. Logistic regression analysis indicated that men (odds ratio [OR] 1.06, 95% CI 1.04-1.09) and younger individuals had a higher likelihood of eHealth consultations in 2022. Furthermore, individuals using eHealth consultations were more likely to use antidepressants (OR 1.54, 95% CI 1.50-1.57) and anxiolytics (OR 1.06, 95% CI 1.03-1.09). Conclusions: The prevalence of depression in Catalonia has significantly increased in the last 6 years, likely influenced by the COVID-19 pandemic. Despite ongoing digital transformation since 2011, eHealth usage remained limited as of 2017. During the lockdown period, eHealth accounted for nearly half of all health care consultations, representing a quarter of consultations by 2022. In the immediate aftermath of the COVID-19 pandemic, emerging evidence suggests a significant role of eHealth in managing depression-related consultations, along with an apparent likelihood of patients being prescribed antidepressants and anxiolytics. Further research is needed to understand the long-term impact of eHealth on diagnostic practices and medication use. UR - https://mental.jmir.org/2024/1/e52816 UR - http://dx.doi.org/10.2196/52816 UR - http://www.ncbi.nlm.nih.gov/pubmed/38236631 ID - info:doi/10.2196/52816 ER - TY - JOUR AU - Waheed, Atif Muhammad AU - Al Mannai, Lolwa AU - Khudadad, Hanan AU - Alenbawi, Jamil AU - Mansaray, Aminata Mariama AU - Al Abdulla, Samya PY - 2024/1/18 TI - Assessment of Qatar?s Health Care Community Call Center Efficacy in Addressing COVID-19 Pandemic Health Care Challenges: Cross-Sectional Study JO - JMIR Form Res SP - e42753 VL - 8 KW - COVID-19 KW - COVID Response Service KW - community call center KW - virtual consultations N2 - Background: The global COVID-19 pandemic caused by SARS-CoV-2 created many unprecedented challenges for health care organizations worldwide, placing a great deal of strain on the health care systems, especially access to health care services. To address these challenges, Qatar established a centralized digital platform as a community call center, initially offering digital consultations via its hotline (number: 16000) and later expanding to include a COVID-19 vaccination hotline (number: 7077) for mass immunization. Objective: This study aims to comprehensively examine the community call center?s operations and their significant role during the COVID-19 pandemic. Methods: Retrospective data were collected from the Health Information and Technology Department of the Primary Health Care Corporation, Qatar, from March 29, 2020, to January 27, 2022. Data analysis for the hotline (number: 16000) focused on telephone and video call volumes, call response rates, abandonment rates, and call classification. In addition, data from the COVID-19 vaccination hotline (number: 7077) were analyzed for call volumes, call response rates, abandonment rates, appointment booking rates, confirmations, rescheduling, and cancellations. Results: The hotline (number: 16000) received a substantial total of 429,212 calls, with 284,849 (66.37%) calls effectively answered. The average number of calls received per day during the study period was 640.61 (SD 470.53), and the average number of calls answered per day was 425.14 (SD 206.64). Notably, of the total 128,468 consultations, video consultations were conducted for 3810 (2.96%). Among the diverse call categories, diabetes mellitus (6284/84,299, 7.45%), prescriptions and medications (4709/84,299, 5.59%), hypertension (3874/84,299, 4.6%), vitamin D-related issues (3770/84,299, 4.47%), upper respiratory tract infections (2690/84,299, 3.19%), and COVID-19?related inquiries (2590/84,299, 3.07%) were most frequently addressed. For the COVID-19 vaccination hotline (number: 7077), an impressive total of 1,512,354 calls were received, with a 58.27% (n=881,305) call response rate. The average number of calls per day during the study period was 3828.74 (SD 2931.94), and the average number of calls answered per day was 2231.15 (SD 1496.02). Appointment booking accounted for 26.37% (265,721/1,007,596), appointment confirmation accounted for 10.24% (103,136/1,007,596), rescheduling accounted for 7.95% (80,124/1,007,596), and cancellations accounted for 1.6% (16,128/1,007,596) of the calls. Conclusions: The findings of this research highlight the crucial significance of the community call center hotline (number: 16000) and the COVID-19 vaccination hotline (number: 7077) in effectively addressing the multifaceted challenges posed by the global COVID-19 pandemic. In Qatar, the community call center emerged as an indispensable and accessible centralized resource, facilitating streamlined digital consultations and vaccination appointments. The impressive call response rate highlights its operational efficiency, adeptly managing a diverse range of health-related issues. This study emphasizes the critical role of community call centers in health care emergency response, signaling their potential as invaluable assets for future preparedness and effective mitigation strategies during similar public health crises. UR - https://formative.jmir.org/2024/1/e42753 UR - http://dx.doi.org/10.2196/42753 UR - http://www.ncbi.nlm.nih.gov/pubmed/38085918 ID - info:doi/10.2196/42753 ER - TY - JOUR AU - Manschel, Jonas AU - Porthun, Jan AU - Winkler, Ulrike AU - Beuckels, T. Jean Marie A. AU - Martin, David PY - 2024/1/17 TI - Characteristics, Opportunities, and Challenges of Osteopathy Based on the Perceptions of Osteopaths in Austria: Qualitative Interview Study JO - JMIR Hum Factors SP - e45302 VL - 11 KW - osteopathy KW - osteopath KW - osteopaths KW - osteopathic profession KW - health care system KW - Austria N2 - Background: There are no uniform regulations for the osteopathic profession in Europe. It is subject to country-specific regulations defining who shall be allowed to practice osteopathy and which qualification shall be required. In recent years, legal regulations have been established in several European countries for the profession of osteopathy; however, these are also still pending for Austria. Currently, physiotherapists and physicians with osteopathic training are practicing osteopathy in Austria. Objective: This study aims to examine the characteristics, challenges, and opportunities of osteopaths in Austria. Methods: Guideline-based interviews with osteopaths (N=10) were conducted. The different research questions were examined using a qualitative content analysis. Results: The study provided a differentiated insight into the professional situation of osteopaths in Austria. The most important result was that all interviewees unanimously supported a legal regulation of their profession. However, owing to their different professional self-image?on the one hand, individuals working on a structural basis, and, on the other hand, individuals working on a cranial or biodynamic basis?they were able to imagine a uniform professional regulation only to a limited extent. Additional topics for the interviewed osteopaths in Austria were the quality assurance of training and the urgent need for scientific research. Furthermore, the study also dealt with the influence of the COVID-19 pandemic on daily practice and on education and training in osteopathy. Conclusions: This study is a pioneering study with regard to systematic basic research on osteopathy in Austria. The obtained results and the newly acquired research questions not only have the potential to serve as a basis for further studies but also provide insight into the working and professional situation of osteopaths in Austria for universities, schools, professional associations, politics, and?last but not least?all interested parties. International Registered Report Identifier (IRRID): RR2-10.2196/15399 UR - https://humanfactors.jmir.org/2024/1/e45302 UR - http://dx.doi.org/10.2196/45302 UR - http://www.ncbi.nlm.nih.gov/pubmed/38231542 ID - info:doi/10.2196/45302 ER - TY - JOUR AU - Thomson, Patrick AU - Stoler, Justin AU - Byford, Michelle AU - Bradley, J. David PY - 2024/1/16 TI - The Impact of Rapid Handpump Repairs on Diarrhea Morbidity in Children: Cross-Sectional Study in Kwale County, Kenya JO - JMIR Public Health Surveill SP - e42462 VL - 10 KW - water KW - Kenya KW - WASH KW - water, sanitation, and hygiene KW - maintenance KW - diarrhea KW - diarrhoea KW - SDG 6 KW - service provision KW - handpump KW - child health N2 - Background: Handpumps are used by millions of people as their main source of water. Although handpumps represent only a basic form of water provision, there have been continuous efforts to improve the performance of these systems as they are likely to remain in use for many years to come. The introduction of a professional maintenance service in southern Kenya has shown an order of magnitude improvement in operational performance over community-based management, with 90% of handpump faults repaired within 3 days of being reported. One driver behind these efforts is the assumption that a more reliable water supply will lead to a reduction in water-related disease. However, it is not clear if operational improvements lead to health gains. Despite limited empirical evidence, some modeling studies suggest that even short periods of drinking contaminated water can lead to disproportionate negative health impacts. Objective: The aim of this study was to assess whether the improvements in operational performance from the rapid professional maintenance of rural handpumps lead to improved household health outcomes. Methods: From a sample of households using handpumps as their primary water source in Kwale County, Kenya, we measured the 2-week prevalence of World Health Organization?defined diarrhea in children, reported by the adult respondent for each household. We compared the rates before and after a period during which the households? handpumps were being professionally maintained. We then conducted a cross-sectional analysis, fitting logistic regression models with reported diarrhea as the dependent variable and speed of repair as the independent exposure of interest, adjusting for household socioeconomic characteristics; dwelling construction; and Water, Sanitation, and Hygiene (WASH)-related factors. We fitted an additional model to examine select interactions between covariates. Results: Reported diarrhea in children was lower in households whose pumps had been repaired within 24 hours (adjusted odds ratio 0.35, 95% CI 0.24-0.51). This effect was robust to the inclusion of multiple categories of covariates. No reduction was seen in households whose pump repairs took more than 24 hours. Analysis of interaction terms showed that certain interventions associated with improved WASH outcomes were only associated with reductions in diarrhea in conjunction with socioeconomic improvements. Conclusions: Only pump repairs consistently made within 24 hours of failure led to a reduction in diarrhea in the children of families using handpumps. While the efficacy of reduction in diarrhea is substantial, the operational challenges of guaranteeing same-day repairs limits the effectiveness of even best-in-class pump maintenance. Maintenance regimes that cannot bring handpump downtimes close to zero will struggle to generate health benefits. Other factors that reduce diarrhea prevalence have limited effect in isolation, suggesting that WASH interventions will be more effective when undertaken as part of more holistic poverty-reduction efforts. UR - https://publichealth.jmir.org/2024/1/e42462 UR - http://dx.doi.org/10.2196/42462 UR - http://www.ncbi.nlm.nih.gov/pubmed/38227359 ID - info:doi/10.2196/42462 ER - TY - JOUR AU - Burns, K. Sarah AU - Krishnamurti, Tamar AU - Doan, T. Tran AU - Hanmer, Janel AU - Hoberman, Alejandro AU - Kahn, M. Jeremy AU - Schweiberger, Kelsey AU - Ray, N. Kristin PY - 2024/1/16 TI - Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study JO - JMIR Pediatr Parent SP - e49170 VL - 7 KW - telemedicine KW - telehealth KW - acute care KW - acute KW - pediatrics KW - pediatric KW - family medicine KW - family-centered KW - child KW - children KW - parent KW - parents KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - expectation KW - expectations N2 - Background: Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs). Objective: This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine. Methods: We performed a sequential mixed methods analysis to examine how parents assess telemedicine for their children?s acute care. We used ARTIs as a case study for examining parent perceptions of telemedicine. First, we analyzed semistructured interviews focused on parent responses about the use of telemedicine. Each factor discussed by parents was coded to reflect whether parents indicated it incentivized or disincentivized their preferences for telemedicine versus in-person care. Results were organized by a 7-dimension framework of parental health care seeking that was generated previously, which included dimensions related to care sites (expected access, affordability, clinical quality, and site quality) and dimensions related to child or family factors (perceived illness severity, perceived child susceptibility, and parent self-efficacy). Second, we analyzed responses to a national survey, which inquired about parental expectations of primary care telemedicine, commercial DTC telemedicine, and 3 in-person sites of care (primary care, urgent care, and emergency department) across 21 factors identified through prior qualitative work. To assess whether parents had different expectations of different telemedicine models, we compared survey responses for primary care telemedicine and commercial DTC telemedicine using weighted logistic regression. Results: Interview participants (n=40) described factors affecting their perceptions of telemedicine as a care modality for pediatric ARTIs. Generally, factors aligned with access and affordability (eg, decreased wait time and lower out-of-pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility, and clinician quality (eg, trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial DTC telemedicine were rated similarly on items related to expected accessibility and affordability. In contrast, on items related to expected quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial DTC telemedicine was rated lower. For example, 69.7% (weighted; 842/1197) of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7% (weighted; 584/1193) with commercial DTC telemedicine (P<.001). Conclusions: In a mixed methods analysis focused on telemedicine for ARTIs, parents expressed more concerns about telemedicine quality in commercial DTC models compared with primary care?based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care. UR - https://pediatrics.jmir.org/2024/1/e49170 UR - http://dx.doi.org/10.2196/49170 UR - http://www.ncbi.nlm.nih.gov/pubmed/38227360 ID - info:doi/10.2196/49170 ER - TY - JOUR AU - Li, Shuning AU - Felix Gomez, Gomez Grace AU - Xu, Huiping AU - Rajapuri, Singh Anushri AU - Dixon, E. Brian AU - Thyvalikakath, Thankam PY - 2024/1/11 TI - Dentists? Information Needs and Opinions on Accessing Patient Information via Health Information Exchange: Survey Study JO - JMIR Form Res SP - e51200 VL - 8 KW - dentistry KW - medical history KW - integrated medical and dental records KW - health information exchange KW - medical record KW - dental record KW - dental KW - medical information KW - dental care KW - adverse drug effect KW - medication KW - allergies KW - cost KW - data safety KW - data accuracy N2 - Background: The integration of medical and dental records is gaining significance over the past 2 decades. However, few studies have evaluated the opinions of practicing dentists on patient medical histories. Questions remain on dentists? information needs; their perception of the reliability of patient-reported medical history; satisfaction with the available information and the methods to gather this information; and their attitudes to other options, such as a health information exchange (HIE) network, to collect patient medical history. Objective: This study aims to determine Indiana dentists? information needs regarding patients? medical information and their opinions about accessing it via an HIE. Methods: We administered a web-based survey to Indiana Dental Association members to assess their current medical information-retrieval approaches, the information critical for dental care, and their willingness to access or share information via an HIE. We used descriptive statistics to summarize survey results and multivariable regression to examine the associations between survey respondents? characteristics and responses. Results: Of the 161 respondents (161/2148, 7.5% response rate), 99.5% (n=160) respondents considered patients? medical histories essential to confirm no contraindications, including allergies or the need for antibiotic prophylaxis during dental care and other adverse drug events. The critical information required were medical conditions or diagnosis, current medications, and allergies, which were gathered from patient reports. Furthermore, 88.2% (n=142) of respondents considered patient-reported histories reliable; however, they experienced challenges obtaining information from patients and physicians. Additionally, 70.2% (n=113) of respondents, especially those who currently access an HIE or electronic health record, were willing to use an HIE to access or share their patient?s information, and 91.3% (n=147) shared varying interests in such a service. However, usability, data accuracy, data safety, and cost are the driving factors in adopting an HIE. Conclusions: Patients? medical histories are essential for dentists to optimize dental care, especially for those with chronic conditions. In addition, most dentists are interested in using an HIE to access patient medical histories. The findings from this study can provide an alternative option for improving communications between dental and medical professionals and help the health information technology system or tool developers identify critical requirements for more user-friendly designs. UR - https://formative.jmir.org/2024/1/e51200 UR - http://dx.doi.org/10.2196/51200 UR - http://www.ncbi.nlm.nih.gov/pubmed/38206667 ID - info:doi/10.2196/51200 ER - TY - JOUR AU - Buawangpong, Nida AU - Pinyopornpanish, Kanokporn AU - Pliannuom, Suphawita AU - Nantsupawat, Nopakoon AU - Wiwatkunupakarn, Nutchar AU - Angkurawaranon, Chaisiri AU - Jiraporncharoen, Wichuda PY - 2024/1/10 TI - Designing Telemedicine for Older Adults With Multimorbidity: Content Analysis Study JO - JMIR Aging SP - e52031 VL - 7 KW - telemedicine KW - telehealth KW - chronic disease KW - multimorbidity KW - older adults KW - mobile phone N2 - Background: Telemedicine is a potential option for caring for older adults with multimorbidity. There is a need to explore the perceptions about telemedicine among older adults with multimorbidity to tailor it to the needs of older adults with multiple chronic conditions. Objective: This study aims to explore the perceptions about telemedicine among older patients with multimorbidity. Methods: A qualitative study was conducted using semistructured interviews. The interview questions examined older adults? perspectives about telemedicine, including their expectations regarding telemedicine services and the factors that affect its use. Thematic analysis was performed using NVivo (version 12; Lumivero). The study was reported using the Standards for Reporting Qualitative Research guidelines. Results: In total, 29 patients with multimorbidity?21 (72%) female patients and 8 (28%) male patients with a mean age of 69 (SD 10.39) years?were included. Overall, 4 themes and 7 subthemes emerged: theme 1?perceived benefit of telemedicine among older adults with multimorbidities, theme 2?appropriate use of telemedicine for multimorbid care, theme 3?telemedicine system catering to the needs of older patients, and theme 4?respect patients? decision to decline to use telemedicine. Conclusions: Telemedicine for older adults with multimorbidity should focus on those with stable conditions. This can help increase access to care for those requiring continuous condition monitoring. A structured telemedicine program and patient-centered services can help increase patient acceptance of telemedicine. However, health care providers must accept the limitations of older patients that may prevent them from receiving telemedicine services. UR - https://aging.jmir.org/2024/1/e52031 UR - http://dx.doi.org/10.2196/52031 UR - http://www.ncbi.nlm.nih.gov/pubmed/38198201 ID - info:doi/10.2196/52031 ER - TY - JOUR AU - He, Xianying AU - Cui, Fangfang AU - Lyu, Minzhao AU - Sun, Dongxu AU - Zhang, Xu AU - Shi, Jinming AU - Zhang, Yinglan AU - Jiang, Shuai AU - Zhao, Jie PY - 2024/1/5 TI - Key Factors Influencing the Operationalization and Effectiveness of Telemedicine Services in Henan Province, China: Cross-Sectional Analysis JO - J Med Internet Res SP - e45020 VL - 26 KW - telemedicine KW - service statistics KW - efficiency KW - quality management N2 - Background: Telemedicine has demonstrated its potential in alleviating the unbalanced distribution of medical resources across different regions. Henan, a province in China with a population of approximately 100 million, is especially affected by a health care divide. The province has taken a proactive step by establishing a regional collaborative platform for telemedicine services provided by top-tier provincial hospitals. Objective: We aim to identify the key factors that influence the current operationalization and effectiveness of telemedicine services in Henan province. The insights gained from this study will serve as valuable references for enhancing the efficient operation of telemedicine platforms in low- and middle-income regions. Methods: We analyzed service reports from the performance management system of telemedicine services in Henan province throughout 2020. Using descriptive statistics and graphical methods, we examined key influencing factors, such as management competency; device configuration; and hospital capability, capacity, and service efficacy, across hospitals at 2 different tiers. In addition, we used generalized linear models and multiple linear regression models to identify key operational factors that significantly affect the service volume and efficacy of 2 major telemedicine services, namely teleconsultation and tele-education. Results: Among the 89 tier 3 hospitals and 97 tier 2 hospitals connected to the collaborative telemedicine platform, 65 (73%) and 55 (57%), respectively, have established standardized management procedures for telemedicine services. As the primary delivery method for telemedicine services, 90% (80/89) of the tier 3 hospitals and 94% (91/97) of the tier 2 hospitals host videoconferencing consultations through professional hardware terminals rather than generic computers. Teleconsultation is the dominant service type, with an average annual service volume per institution of 173 (IQR 37-372) and 60 (IQR 14-271) teleconsultations for tier 3 and tier 2 hospitals, respectively. Key factors influencing the service volume at each hospital include available funding, management competency, the number of connected upper tiers, and the number of professional staff. After receiving teleconsultations from tier 3 (65/89, 73%) and tier 2 (61/97, 63%) hospitals, patients reported significant improvements in their medical conditions. In addition, we observed that service efficacy is positively influenced by management competency, financial incentives, the number of connected upper or lower tiers, and the involvement of participating medical professionals. Conclusions: Telemedicine has become increasingly popular in Henan province, with a notable focus on teleconsultation and tele-education services. Despite its popularity, many medical institutions, especially tier 2 hospitals, face challenges related to management competency. In addition to enhancing the effectiveness of existing telemedicine services, health care decision-makers in Henan province and other low- and middle-income regions should consider expanding the service categories, such as including remote emergency care and telesurgery, which have promise in addressing crucial health care needs in these regions. UR - https://www.jmir.org/2024/1/e45020 UR - http://dx.doi.org/10.2196/45020 UR - http://www.ncbi.nlm.nih.gov/pubmed/38180795 ID - info:doi/10.2196/45020 ER - TY - JOUR AU - Leo, P. Hannah AU - Folk, B. Johanna AU - Rodriguez, Christopher AU - Tolou-Shams, Marina PY - 2023/12/29 TI - Implementation Considerations for Family-Based Telehealth Interventions for Youth in Foster Care: Focus Group Study With Child Welfare System Professionals JO - JMIR Form Res SP - e45905 VL - 7 KW - foster youth KW - telehealth KW - family-based interventions KW - mental health N2 - Background: Between 2016 and 2020, over 600,000 youth were served annually by the foster care system. Despite approximately half of foster youth struggling with emotional or behavioral challenges, few receive much-needed services to address their mental health concerns. Family-based interventions are efficacious in addressing both youth and caregiver mental health needs; however, foster youth participation in these family-based interventions is limited by many barriers, including out-of-home placement far from their family of origin. Telehealth is a promising tool for mitigating barriers to access to treatment interventions for foster youth and their families. Objective: This study aims to understand child welfare system professionals? perspectives on enabling factors and barriers to providing family-based interventions via telehealth to youth in out-of-county foster care placement. Methods: This qualitative study derived themes from 3 semistructured focus groups with child welfare system professionals. Participants were asked to discuss how family-based interventions are delivered to foster youth and their caregivers in their jurisdictions, as well as to share their thoughts about how to use telehealth to improve access to family-based interventions for families with youth in out-of-home placement. Data were analyzed using constant comparative analysis and inductive thematic analysis, with the Behavioral Model for Vulnerable Populations as the theoretical framework. Results: Participants were 19 child welfare system professionals (eg, social workers, residential treatment staff, and supervisors) who participated in 1 of the 3 focus groups (6-7/group). Most participants were women (n=13, 68%), White individuals (n=10, 53%), and social workers (n=8, 42%). On average, participants worked in the child welfare system for 16.6 (SD 8.3) years. Participants identified multilevel factors impacting family-based intervention delivery including environmental factors (eg, Medicare billing and presumptive transfer), predisposing characteristics (eg, psychological resources), enabling factors (eg, transportation and team-based youth-centered care), and need factors (eg, motivation to engage). Participants expressed optimism that telehealth could increase access to needed mental health care, diverse providers, and longevity of care while also expressing some concerns regarding telehealth access and literacy. Conclusions: Child welfare system professionals highlight the need to develop policies and telehealth interventions that are youth versus placement centered, include resources that limit barriers and bolster motivation for engagement, and follow a team-based care model. Findings from this study inform how telehealth can be used to increase access to and engagement with family-based interventions for youth in out-of-home placements and their caregivers of origin. UR - https://formative.jmir.org/2023/1/e45905 UR - http://dx.doi.org/10.2196/45905 UR - http://www.ncbi.nlm.nih.gov/pubmed/38157238 ID - info:doi/10.2196/45905 ER - TY - JOUR AU - Rochon, A. Elizabeth AU - Sy, Maimouna AU - Phillips, Mirelle AU - Anderson, Erik AU - Plys, Evan AU - Ritchie, Christine AU - Vranceanu, Ana-Maria PY - 2023/12/29 TI - Bio-Experiential Technology to Support Persons With Dementia and Care Partners at Home (TEND): Protocol for an Intervention Development Study JO - JMIR Res Protoc SP - e52799 VL - 12 KW - dementia KW - dyadic KW - bio-experiential KW - serious gaming KW - psychosocial N2 - Background: Alzheimer disease and related dementias are debilitating and incurable diseases. Persons with dementia and their informal caregivers (ie, dyads) experience high rates of emotional distress and negative health outcomes. Several barriers prevent dyads from engaging in psychosocial care including cost, transportation, and a lack of treatments that target later stages of dementia and target the dyad together. Technologically informed treatment and serious gaming have been shown to be feasible and effective among persons living with dementia and their care partners. To increase access, there is a need for technologically informed psychosocial interventions which target the dyad, together in the home. Objective: This study aims to develop the toolkit for experiential well-being in dementia, a dyadic, ?bio-experiential? intervention for persons with dementia and their caregivers. Per our conceptual model, the toolkit for experiential well-being in dementia platform aims to target sustained attention, positive emotions, and active engagement among dyads. In this paper, we outline the protocol and conceptual model for intervention development and partnership with design and development experts. Methods: We followed the National Institutes of Health (NIH) stage model (stage 1A) and supplemented the model with principles of user-centered design. The first step includes understanding user needs, goals, and strengths. We met this step by engaging in methodology and definition synthesis and conducting focus groups with dementia care providers (N=10) and persons with dementia and caregivers (N=11). Step 2 includes developing and refining the prototype. We will meet this step by engaging dyads in up to 20 iterations of platform ? testing workshops. Step 3 includes observing user interactions with the prototype. We will meet this step by releasing the platform for feasibility testing. Results: Key takeaways from the focus groups include balancing individualization and the dyadic relationship and avoiding confusing stimuli. As of September 2023, we have completed focus groups with providers, persons with dementia, and their caregivers. Additionally, we have conducted 4 iterations of ? testing workshops with dyads. Feedback from focus groups informed the ? testing workshops; data have not yet been formally analyzed and will be reported in future publications. Conclusions: Technological interventions, particularly ?bio-experiential? technology, can be used in dementia care to support emotional health among persons with a diagnosis and caregivers. Here, we outline a collaborative intervention development process of bio-experiential technology through a research, design, and development partnership. Next, we are planning to test the platform?s feasibility as well as its impact on clinical outcomes and mechanisms of action. International Registered Report Identifier (IRRID): DERR1-10.2196/52799 UR - https://www.researchprotocols.org/2023/1/e52799 UR - http://dx.doi.org/10.2196/52799 UR - http://www.ncbi.nlm.nih.gov/pubmed/38157239 ID - info:doi/10.2196/52799 ER - TY - JOUR AU - Young, Karen AU - Xiong, Ting AU - Lee, Rachel AU - Banerjee, Tina Ananya AU - Leslie, Myles AU - Ko, Yu Wellam AU - Guo, Jia Julia Yu AU - Pham, Quynh PY - 2023/12/28 TI - Honoring the Care Experiences of Chinese Canadian Survivors of Prostate Cancer to Cultivate Cultural Safety and Relationality in Digital Health: Exploratory-Descriptive Qualitative Study JO - J Med Internet Res SP - e49349 VL - 25 KW - digital health KW - virtual care KW - digital therapeutics KW - prostate cancer KW - cancer survivorship KW - social determinants of health KW - structural determinants of health KW - supportive care KW - cultural adaptation KW - Chinese Canadians N2 - Background: Prostate cancer (PCa) is the most commonly diagnosed nonskin cancer for Canadian men and has one of the highest 5-year survival rates, straining systems to provide care. Virtual care can be one way to relieve this strain, but survivors? care needs and technology use are influenced by intersecting social and cultural structures. Cultural adaptation has been posited as an effective method to tailor existing interventions to better serve racialized communities, including Chinese men. However, cultural adaptations may inadvertently draw attention away from addressing structural inequities. Objective: This study used qualitative methods to (1) explore the perceptions and experiences of Chinese Canadian PCa survivors with follow-up and virtual care, and (2) identify implications for the cultural adaptation of a PCa follow-up care app, the Ned (no evidence of disease) Clinic. Methods: An axiology of relational accountability and a relational paradigm underpinned our phenomenologically informed exploratory-descriptive qualitative study design. A community-based participatory approach was used, informed by cultural safety and user-centered design principles, to invite Chinese Canadian PCa survivors and their caregivers to share their stories. Data were inductively analyzed to explore their unmet needs, common experiences, and levels of digital literacy. Results: Unmet needs and technology preferences were similar to broader trends within the wider community of PCa survivors. However, participants indicated that they felt uncomfortable, unable to, or ignored when expressing their needs. Responses spoke to a sense of isolation and reflected a reliance on culturally informed coping mechanisms, such as ?eating bitterness,? and familial assistance to overcome systemic barriers and gaps in care. Moreover, virtual care was viewed as ?better than nothing;? it did not change a perceived lack of focus on improving quality of life or care continuity in survivorship care. Systemic changes were identified as likely to be more effective in improving care delivery and well-being rather than the cultural adaptation of Ned for Chinese Canadians. Participants? desires for care reflected accessibility issues that were not culturally specific to Chinese Canadians. Conclusions: Chinese Canadian survivors are seeking to strengthen their connections in a health care system that provides privacy and accessibility, protects relationality, and promotes transparency, accountability, and responsibility. Designing ?trickle-up? adaptations that address structural inequities and emphasize accessibility, relationality, and privacy may be more effective and efficient at improving care than creating cultural adaptations of interventions. UR - https://www.jmir.org/2023/1/e49349 UR - http://dx.doi.org/10.2196/49349 UR - http://www.ncbi.nlm.nih.gov/pubmed/38153784 ID - info:doi/10.2196/49349 ER - TY - JOUR AU - Muschol, Jennifer AU - Heinrich, Martin AU - Heiss, Christian AU - Hernandez, Mauricio Alher AU - Knapp, Gero AU - Repp, Holger AU - Schneider, Henning AU - Thormann, Ulrich AU - Uhlar, Johanna AU - Unzeitig, Kai AU - Gissel, Christian PY - 2023/12/25 TI - Digitization of Follow-Up Care in Orthopedic and Trauma Surgery With Video Consultations: Health Economic Evaluation Study From a Health Provider?s Perspective JO - J Med Internet Res SP - e46714 VL - 25 KW - digital health KW - economic evaluation KW - health economics KW - orthopedic KW - personnel costs KW - productivity gains KW - telemedicine KW - trauma surgery KW - utility KW - video consultations N2 - Background: Recommendations for health care digitization as issued with the Riyadh Declaration led to an uptake in telemedicine to cope with the COVID-19 pandemic. Evaluations based on clinical data are needed to support stakeholders? decision-making on the long-term implementation of digital health. Objective: This health economic evaluation aims to provide the first German analysis of the suitability of video consultations in the follow-up care of patients in orthopedic and trauma surgery, investigate the financial impact on hospital operations and personnel costs, and provide a basis for decisions on digitizing outpatient care. Methods: We conducted a randomized controlled trial that evaluated video consultations versus face-to-face consultations in the follow-up care of patients in orthopedic and trauma surgery at a German university hospital. We recruited 60 patients who had previously been treated conservatively or surgically for various knee or shoulder injuries. A digital health app and a browser-based software were used to conduct video consultations. The suitability of telemedicine was assessed using the Telemedicine Satisfaction Questionnaire and the EQ-5D-5L questionnaire. Economic analyses included average time spent by physician per consultation, associated personnel costs and capacities for additional treatable patients, and the break-even point for video consultation software fees. Results: After 4 withdrawals in each arm, data from a total of 52 patients (telemedicine group: n=26; control group: n=26) were used for our analyses. In the telemedicine group, 77% (20/26) of all patients agreed that telemedicine provided for their health care needs, and 69% (18/26) found telemedicine an acceptable way to receive health care services. In addition, no significant difference was found in the change of patient utility between groups after 3 months (mean 0.02, SD 0.06 vs mean 0.07, SD 0.17; P=.35). Treatment duration was significantly shorter in the intervention group (mean 8.23, SD 4.45 minutes vs mean 10.92, SD 5.58 minutes; P=.02). The use of telemedicine saved 25% (?2.14 [US $2.35]/?8.67 [US $9.53]) in personnel costs and increased the number of treatable patients by 172 annually, assuming 2 hours of video consultations per week. Sensitivity analysis for scaling up video consultations to 10% of the hospital?s outpatient cases resulted in personnel cost savings of ?73,056 (US $ 80,275.39) for a senior physician. A total of 23 video consultations per month were required to recoup the software fees of telemedicine through reduced personnel costs (break-even point ranging from 12-38 in the sensitivity analysis). Conclusions: Our study supports stakeholders? decision-making on the long-term implementation of digital health by demonstrating that video consultations in the follow-up care of patients in orthopedic and trauma surgery result in cost savings and productivity gains for clinics with no negative impact on patient utility. Trial Registration: German Clinical Trials Register DRKS00023445; https://drks.de/search/en/trial/DRKS00023445 UR - https://www.jmir.org/2023/1/e46714 UR - http://dx.doi.org/10.2196/46714 UR - http://www.ncbi.nlm.nih.gov/pubmed/38145481 ID - info:doi/10.2196/46714 ER - TY - JOUR AU - Novak Lauscher, Helen AU - Blacklaws, Brydon AU - Pritchard, Erika AU - Wang, Jiaxi Elsie AU - Stewart, Kurtis AU - Beselt, Jeff AU - Ho, Kendall AU - Pawlovich, John PY - 2023/12/22 TI - Real-Time Virtual Support as an Emergency Department Strategy for Rural, Remote, and Indigenous Communities in British Columbia: Descriptive Case Study JO - J Med Internet Res SP - e45451 VL - 25 KW - telemedicine KW - access KW - rural KW - emergency medicine KW - interprofessional collaboration N2 - Background: British Columbia has over 200 rural, remote, and Indigenous communities that have limited health care resources due to physician isolation, sparsity in clinical resources, the lack of collegial support, and provider burnout. Real-time virtual support (RTVS) peer-to-peer pathways provide support to patients and providers. Amid the COVID-19 pandemic exacerbating existing health care disparities and equitable access to timely care, RTVS presents a portable and additional opportunity to be deployed in a hospital or patient home setting in rural communities. We highlight the story of the Rural Urgent Doctor in-aid (RUDi) pathway within RTVS that successfully supported the Dawson Creek District Hospital (DCDH) emergency department (ED) in 2021. Objective: This study aims to describe the rapid implementation process and identify facilitators and barriers to successful implementation. Methods: This case study is grounded in the Quadruple Aim and Social Accountability frameworks for health systems learning. The entire study period was approximately 6 months. After 1 week of implementation, we interviewed RUDi physicians, DCDH staff, health authority leadership, and RTVS staff to gather their experiences. Content analysis was used to identify themes that emerged from the interviews. Results: RUDi physicians covered 39 overnight shifts and were the most responsible providers (MRPs) for 245 patients who presented to the DCDH ED. A total of 17 interviews with key informants revealed important themes related to leadership and relationships as facilitators of the coverage?s success, the experience of remote physician support, providing a ?safety net,? finding new ways of interprofessional collaboration, and the need for extensive IT support throughout. Quality improvement findings identified barriers and demonstrated tangible recommendations for how this model of support can be improved in future cases. Conclusions: By acting as the MRP during overnight ED shifts, RUDi prevented the closure of the DCDH ED and the diversion of patients to another rural hospital. Rapid codevelopment and implementation of digital health solutions can be leveraged with existing partnerships and mutual trust between RTVS and rural EDs to ease the pressures of a physician shortage, particularly during COVID-19. By establishing new and modified clinical workflows, RTVS provides a safety net for rural patients and providers challenged by burnout. This case study provides learnings to be implemented to serve future rural, remote, and Indigenous communities in crisis. UR - https://www.jmir.org/2023/1/e45451 UR - http://dx.doi.org/10.2196/45451 UR - http://www.ncbi.nlm.nih.gov/pubmed/38133906 ID - info:doi/10.2196/45451 ER - TY - JOUR AU - Bogdanski, Erin PY - 2023/12/22 TI - The Effects of Virtual Reality Telemedicine With Pediatric Patients Diagnosed With Posttraumatic Stress Disorder: Exploratory Research Method Case Report JO - JMIR Form Res SP - e34346 VL - 7 KW - virtual reality KW - psychology KW - neuroscience KW - behavioral health KW - telehealth KW - eHealth KW - telemedicine KW - trauma KW - traumatic KW - PTSD KW - posttraumatic stress disorder KW - mental health KW - mental condition KW - mental illness KW - cognitive behavioral therapy KW - CBT KW - avatar KW - case study KW - pediatric KW - child KW - youth KW - psychiatric disorder N2 - Background: Trauma-focused cognitive behavioral therapy (TF-CBT) strategies are common interventions to treat child trauma and a posttraumatic stress disorder (PTSD) diagnosis in children with histories of sexual and physical abuse. With the advent of COVID-19, the disruption of child development combined with intense exposure to technology and screen time indicate a need for delivering other novel approaches to treat pediatric PTSD. Virtual reality (VR) has been used with evidence-based TF-CBT as an intervention in lab-based settings, but never as telehealth. Such technologies, including a VR head-mounted device (HMD) programmed with novel TheraVR software, for psychotherapy and treating trauma-related symptoms could redefine how pediatric populations respond to treatment. Objective: The aim of this exploratory single-case study was to reflect symptom improvement and patient engagement using VR as telehealth. Methods: The patient was a 10-year-old girl of Middle Eastern descent diagnosed with trauma and comorbid medical conditions. The patient was in divorced joint parental custody and a Child Protective Services report was made with referral for therapy. Night terrors, hallucinations, depression, anxiety, isolation, and encopresis symptoms were assessed at the beginning of treatment. Clinical analysis met the criteria for a diagnosis of early onset PTSD, which was treated over the course of 7 months using TF-CBT. A cross-analysis design was used to compare improved effectiveness in treatment and patient outcomes when moving from delivery of care with telehealth using desktop and tablet synchronous technology to 2D VR desktop telehealth with TheraVR software and subsequently HMD VR telehealth with TheraVR software. Sessions were conducted in private practice providing psychotherapy for remote patient care, collateral care with the family, and coordination of clinical care with the patient?s pediatrician. Safety and protocols for reducing triggers were clinically monitored by the provider. Results: Over the course of treatment, and moving from standard telehealth to 2D VR to TheraVR with a standalone HMD, there was a significant reduction in PTSD symptoms. The transfer from using the standard video conferencing with face-to-face video to using customizable avatar technology with an assigned scene environment presented an increase in patient retention and follow-through with the treatment goals. The continuous use of delivery of care using VR with the TheraVR software demonstrated breakthrough clinical observations where the patient devised her own interventions for coping with mood, emotional regulation, and negative cognitive processes using the 10 different VR environments. Conclusions: This study shows the potential efficacy in using VR specifically for younger populations as a better modality of pediatrics care, while improving engagement with the provider through telehealth. These findings suggest the value of further research through larger clinical trials including pediatric patients diagnosed with severe trauma or trauma-related symptoms to assess the effectiveness of TheraVR software. UR - https://formative.jmir.org/2023/1/e34346 UR - http://dx.doi.org/10.2196/34346 UR - http://www.ncbi.nlm.nih.gov/pubmed/38133920 ID - info:doi/10.2196/34346 ER - TY - JOUR AU - Dunlop, Emma AU - Ferguson, Aimee AU - Mueller, Tanja AU - Baillie, Kelly AU - Laskey, Jennifer AU - Clarke, Julie AU - Kurdi, Amanj AU - Wales, Ann AU - Connolly, Thomas AU - Bennie, Marion PY - 2023/12/21 TI - Involving Patients and Clinicians in the Design of Wireframes for Cancer Medicines Electronic Patient Reported Outcome Measures in Clinical Care: Mixed Methods Study JO - JMIR Form Res SP - e48296 VL - 7 KW - cancer KW - clinicians KW - mHealth KW - mixed methods study KW - patient reported outcome measures KW - patients KW - technology acceptance model N2 - Background: Cancer treatment is a key component of health care systems, and the increasing number of cancer medicines is expanding the treatment landscape. However, evidence of the impact on patients has been focused more on chemotherapy toxicity and symptom control and less on the effect of cancer medicines more broadly on patients? lives. Evolving electronic patient-reported outcome measures (ePROMs) presents the opportunity to secure early engagement of patients and clinicians in shaping the collection of quality-of-life metrics and presenting these data to better support the patient-clinician decision-making process. Objective: The aim of this study was to obtain initial feedback from patients and clinicians on the wireframes of a digital solution (patient app and clinician dashboard) for the collection and use of cancer medicines ePROMs. Methods: We adopted a 2-stage, mixed methods approach. Stage 1 (March to June 2019) consisted of interviews and focus groups with cancer clinicians and patients with cancer to explore the face validity of the wireframes, informed by the technology acceptance model constructs (perceived ease of use, perceived usefulness, and behavioral intention to use). In stage 2 (October 2019 to February 2020), the revised wireframes were assessed through web-based, adapted technology acceptance model questionnaires. Qualitative data (stage 1) underwent a framework analysis, and descriptive statistics were performed on quantitative data (stage 2). Clinicians and patients with cancer were recruited from NHS Greater Glasgow & Clyde, the largest health board in Scotland. Results: A total of 14 clinicians and 19 patients participated in a combination of stage 1 interviews and focus groups. Clinicians and patients indicated that the wireframes of a patient app and clinician dashboard for the collection of cancer medicines ePROMs would be easy to use and could focus discussions, and they would be receptive to using such tools in the future. In stage 1, clinicians raised the potential impact on workload, and both groups identified the need for adequate IT skills to use each technology. Changes to the wireframes were made, and in stage 2, clinicians (n=8) and patients (n=16) indicated it was ?quite likely? that the technologies would be easy to use and they would be ?quite likely? to use them in the future. Notably, clinicians indicated that they would use the dashboard to enable treatment decisions ?with around half? of their patients. Conclusions: This study emphasizes the importance of consulting both patients and clinicians in the design of digital solutions. The wireframes were perceived positively by patients and clinicians who were willing to use such technologies if available in the future as part of routine care. However, challenges were raised, and some differences were identified between participant groups, which warrant further research. UR - https://formative.jmir.org/2023/1/e48296 UR - http://dx.doi.org/10.2196/48296 UR - http://www.ncbi.nlm.nih.gov/pubmed/38127422 ID - info:doi/10.2196/48296 ER - TY - JOUR AU - John, Alby AU - M, Jagadeesan AU - Rubeshkumar, Polani AU - Ganeshkumar, Parasuraman AU - Masanam Sriramulu, Hemalatha AU - Narnaware, Manish AU - Singh Bedi, Gagandeep AU - Kaur, Prabhdeep PY - 2023/12/18 TI - Implementation of a Triage Protocol Outside the Hospital Setting for Timely Referral During the COVID-19 Second Wave in Chennai, India JO - JMIR Form Res SP - e42798 VL - 7 KW - COVID-19 KW - triage KW - low- and middle-income countries KW - LMIC KW - India KW - pulse oximeter KW - implementation KW - health care system KW - self-management KW - patient care KW - community health KW - low income KW - health disparity KW - low-resource setting UR - https://formative.jmir.org/2023/1/e42798 UR - http://dx.doi.org/10.2196/42798 UR - http://www.ncbi.nlm.nih.gov/pubmed/37235721 ID - info:doi/10.2196/42798 ER - TY - JOUR AU - Persson, Inger AU - Grünwald, Adam AU - Morvan, Ludivine AU - Becedas, David AU - Arlbrandt, Martin PY - 2023/12/14 TI - A Machine Learning Algorithm Predicting Acute Kidney Injury in Intensive Care Unit Patients (NAVOY Acute Kidney Injury): Proof-of-Concept Study JO - JMIR Form Res SP - e45979 VL - 7 KW - acute kidney injury KW - AKI KW - algorithm KW - early detection KW - electronic health records KW - ICU KW - intensive care unit KW - machine learning KW - nephrology KW - prediction KW - software as a medical device N2 - Background: Acute kidney injury (AKI) represents a significant global health challenge, leading to increased patient distress and financial health care burdens. The development of AKI in intensive care unit (ICU) settings is linked to prolonged ICU stays, a heightened risk of long-term renal dysfunction, and elevated short- and long-term mortality rates. The current diagnostic approach for AKI is based on late indicators, such as elevated serum creatinine and decreased urine output, which can only detect AKI after renal injury has transpired. There are no treatments to reverse or restore renal function once AKI has developed, other than supportive care. Early prediction of AKI enables proactive management and may improve patient outcomes. Objective: The primary aim was to develop a machine learning algorithm, NAVOY Acute Kidney Injury, capable of predicting the onset of AKI in ICU patients using data routinely collected in ICU electronic health records. The ultimate goal was to create a clinical decision support tool that empowers ICU clinicians to proactively manage AKI and, consequently, enhance patient outcomes. Methods: We developed the NAVOY Acute Kidney Injury algorithm using a hybrid ensemble model, which combines the strengths of both a Random Forest (Leo Breiman and Adele Cutler) and an XGBoost model (Tianqi Chen). To ensure the accuracy of predictions, the algorithm used 22 clinical variables for hourly predictions of AKI as defined by the Kidney Disease: Improving Global Outcomes guidelines. Data for algorithm development were sourced from the Massachusetts Institute of Technology Lab for Computational Physiology Medical Information Mart for Intensive Care IV clinical database, focusing on ICU patients aged 18 years or older. Results: The developed algorithm, NAVOY Acute Kidney Injury, uses 4 hours of input and can, with high accuracy, predict patients with a high risk of developing AKI 12 hours before onset. The prediction performance compares well with previously published prediction algorithms designed to predict AKI onset in accordance with Kidney Disease: Improving Global Outcomes diagnosis criteria, with an impressive area under the receiver operating characteristics curve (AUROC) of 0.91 and an area under the precision-recall curve (AUPRC) of 0.75. The algorithm?s predictive performance was externally validated on an independent hold-out test data set, confirming its ability to predict AKI with exceptional accuracy. Conclusions: NAVOY Acute Kidney Injury is an important development in the field of critical care medicine. It offers the ability to predict the onset of AKI with high accuracy using only 4 hours of data routinely collected in ICU electronic health records. This early detection capability has the potential to strengthen patient monitoring and management, ultimately leading to improved patient outcomes. Furthermore, NAVOY Acute Kidney Injury has been granted Conformite Europeenne (CE)?marking, marking a significant milestone as the first CE-marked AKI prediction algorithm for commercial use in European ICUs. UR - https://formative.jmir.org/2023/1/e45979 UR - http://dx.doi.org/10.2196/45979 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096015 ID - info:doi/10.2196/45979 ER - TY - JOUR AU - Zhang, Melody AU - Scandiffio, Jillian AU - Younus, Sarah AU - Jeyakumar, Tharshini AU - Karsan, Inaara AU - Charow, Rebecca AU - Salhia, Mohammad AU - Wiljer, David PY - 2023/12/7 TI - The Adoption of AI in Mental Health Care?Perspectives From Mental Health Professionals: Qualitative Descriptive Study JO - JMIR Form Res SP - e47847 VL - 7 KW - artificial intelligence KW - education KW - mental health KW - behavioral health KW - educators KW - curriculum N2 - Background: Artificial intelligence (AI) is transforming the mental health care environment. AI tools are increasingly accessed by clients and service users. Mental health professionals must be prepared not only to use AI but also to have conversations about it when delivering care. Despite the potential for AI to enable more efficient and reliable and higher-quality care delivery, there is a persistent gap among mental health professionals in the adoption of AI. Objective: A needs assessment was conducted among mental health professionals to (1) understand the learning needs of the workforce and their attitudes toward AI and (2) inform the development of AI education curricula and knowledge translation products. Methods: A qualitative descriptive approach was taken to explore the needs of mental health professionals regarding their adoption of AI through semistructured interviews. To reach maximum variation sampling, mental health professionals (eg, psychiatrists, mental health nurses, educators, scientists, and social workers) in various settings across Ontario (eg, urban and rural, public and private sector, and clinical and research) were recruited. Results: A total of 20 individuals were recruited. Participants included practitioners (9/20, 45% social workers and 1/20, 5% mental health nurses), educator scientists (5/20, 25% with dual roles as professors/lecturers and researchers), and practitioner scientists (3/20, 15% with dual roles as researchers and psychiatrists and 2/20, 10% with dual roles as researchers and mental health nurses). Four major themes emerged: (1) fostering practice change and building self-efficacy to integrate AI into patient care; (2) promoting system-level change to accelerate the adoption of AI in mental health; (3) addressing the importance of organizational readiness as a catalyst for AI adoption; and (4) ensuring that mental health professionals have the education, knowledge, and skills to harness AI in optimizing patient care. Conclusions: AI technologies are starting to emerge in mental health care. Although many digital tools, web-based services, and mobile apps are designed using AI algorithms, mental health professionals have generally been slower in the adoption of AI. As indicated by this study?s findings, the implications are 3-fold. At the individual level, digital professionals must see the value in digitally compassionate tools that retain a humanistic approach to care. For mental health professionals, resistance toward AI adoption must be acknowledged through educational initiatives to raise awareness about the relevance, practicality, and benefits of AI. At the organizational level, digital professionals and leaders must collaborate on governance and funding structures to promote employee buy-in. At the societal level, digital and mental health professionals should collaborate in the creation of formal AI training programs specific to mental health to address knowledge gaps. This study promotes the design of relevant and sustainable education programs to support the adoption of AI within the mental health care sphere. UR - https://formative.jmir.org/2023/1/e47847 UR - http://dx.doi.org/10.2196/47847 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060307 ID - info:doi/10.2196/47847 ER - TY - JOUR AU - Praha, Nattaya AU - Sriyuktasuth, Aurawamon AU - Puwarawuttipanit, Wimolrat AU - Chuengsaman, Piyatida AU - Kusakunniran, Worapan PY - 2023/12/5 TI - Factors Influencing Telehealth Service Use and Health Outcomes in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Cross-Sectional Study JO - J Med Internet Res SP - e48623 VL - 25 KW - acceptance KW - cross-sectional study KW - health system and access KW - mHealth KW - mobile health KW - peritoneal dialysis KW - telehealth N2 - Background: Several studies have demonstrated the efficacy and user acceptance of telehealth in managing patients with chronic conditions, including continuous ambulatory peritoneal dialysis (CAPD). However, the rates of telehealth service use in various patient groups have been low and have declined over time, which may affect important health outcomes. Telehealth service use in patients undergoing CAPD has been recognized as a key challenge that needs to be examined further. Objective: This study aimed to explore the rates of telehealth service use over 4 months, identify factors influencing its use, and examine the relationship between telehealth service use and health outcomes in Thai people undergoing CAPD. Methods: This cross-sectional study, which was a part of a pragmatic randomized controlled trial study, was conducted at a dialysis center in Bangkok, Thailand. The study included patients who were undergoing CAPD. These patients were randomly enrolled in the intervention group to receive telehealth service and additional standard care for 4 months. Data were collected using self-reported questionnaires, including a demographic form, Functional, Communicative, and Critical Health Literacy Scale, Perceived Usefulness Questionnaire, Brief Illness Perception Questionnaire, Patient-Doctor Relationship Questionnaire, and Kidney Disease Quality of Life 36 Questionnaire. Additionally, Google Analytics was used to obtain data on the actual use of the telehealth service. These data were analyzed using descriptive statistics, repeated-measures ANOVA, and regression analyses. Results: A total of 159 patients were included in this study. The mean rate of telehealth service use throughout the period of 4 months was 62.06 (SD 49.71) times. The rate of telehealth service use was the highest in the first month (mean 23.48, SD 16.28 times) and the lowest in the third month (mean 11.09, SD 11.48 times). Independent variables explained 27.6% of the sample variances in telehealth service use. Older age (?=.221; P=.002), higher perceived usefulness (?=.414; P<.001), unemployment (?=?.155; P=.03), and positive illness perception (?=?.205; P=.004) were associated with a significantly higher rate of telehealth service use. Regarding the relationship between telehealth service use and health outcomes, higher rates of telehealth service use were linked to better quality of life (?=.241; P=.002) and lower peritonitis (odds ratio 0.980, 95% CI 0.962-0.997; P=.03). Conclusions: This study provides valuable insights into factors impacting telehealth service use, which in turn affect health outcomes in patients undergoing CAPD. UR - https://www.jmir.org/2023/1/e48623 UR - http://dx.doi.org/10.2196/48623 UR - http://www.ncbi.nlm.nih.gov/pubmed/38051557 ID - info:doi/10.2196/48623 ER - TY - JOUR AU - Fuad, Anis AU - Tiara, Agi AU - Kusumasari, Amalia Rizqiani AU - Rimawati, Rimawati AU - Murhandarwati, Herdiana E. Elsa PY - 2023/12/5 TI - Introducing a Regulatory Sandbox Into the Indonesian Health System Using e-Malaria as a Use Case: Participatory Action Study JO - J Med Internet Res SP - e47706 VL - 25 KW - regulatory sandbox KW - digital health KW - disruptive technologies KW - e-malaria KW - participatory action research KW - Indonesia N2 - Background: Regulatory sandboxes offer an alternative solution to address regulatory challenges in adopting disruptive technologies. Although regulatory sandboxes have been widely implemented in the financial sector across more than 50 countries, their application to the health sector remains limited. Objective: This study aims to explore stakeholders? perspectives on introducing a regulatory sandbox into the Indonesian health system using e-malaria as a use case. Methods: Using a participatory action research approach, this study conducted qualitative research, including desk reviews, focus group discussions, and in-depth interviews with stakeholders. This study sought to understand stakeholders? concerns and interests regarding the regulatory sandbox and to collaboratively develop a regulatory sandbox model to support the malaria program. Results: The study revealed that most stakeholders had limited awareness of the regulatory sandbox concept. Concerns have been raised regarding the time required to establish regulations, knowledge gaps among stakeholders, data protection issues, and limited digital infrastructure in malaria endemic areas. Existing regulations have been found to be inadequate to accommodate disruptive healthtech for malaria. Nevertheless, through a collaborative process, stakeholders successfully developed a regulatory sandbox model specifically for e-malaria, with the crucial support of the Ministry of Health. Conclusions: The regulatory sandbox holds the potential for adoption in the Indonesian health system to address the limited legal framework and to facilitate the rapid and safe adoption of disruptive healthtech in support of the malaria elimination program. Through stakeholder involvement, guidelines for implementing the regulatory sandbox were developed and innovators were successfully invited to participate in the first-ever trial of a health regulatory sandbox for e-malaria in Indonesia. Future studies should provide further insights into the challenges encountered during the e-malaria regulatory sandbox pilot study, offering a detailed account of the implementation process. UR - https://www.jmir.org/2023/1/e47706 UR - http://dx.doi.org/10.2196/47706 UR - http://www.ncbi.nlm.nih.gov/pubmed/38051555 ID - info:doi/10.2196/47706 ER - TY - JOUR AU - Shuldiner, Jennifer AU - Srinivasan, Diya AU - Desveaux, Laura AU - Hall, N. Justin PY - 2023/12/5 TI - The Implementation of a Virtual Emergency Department: Multimethods Study Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework JO - JMIR Form Res SP - e49786 VL - 7 KW - emergency care KW - virtual care KW - implementation science KW - mixed methods evaluation KW - emergency department KW - pilot KW - evaluation KW - triage KW - digital emergency department N2 - Background: While the COVID-19 pandemic dramatically increased virtual care uptake across many health settings, it remains significantly underused in urgent care. Objective: This study evaluated the implementation of a pilot virtual emergency department (VED) at an Ontario hospital that connected patients to emergency physicians through a web-based portal. We sought to (1) assess the acceptability of the VED model, (2) evaluate whether the VED was implemented as intended, and (3) explore the impact on quality of care, access to care, and continuity of care. Methods: This evaluation used a multimethods approach informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Data included semistructured interviews with patients and physicians as well as postvisit surveys from patients. Interviews were transcribed and analyzed using thematic analysis. Data from the surveys were described using summary statistics. Results: From December 2020 to December 2021, the VED had a mean of 153 (SD 25) visits per month. Among them, 67% (n=677) were female, and 75% (n=758) had a family physician. Patients reported that the VED provided high-quality, timely access to care and praised the convenience, shorter appointments, and benefit of the calm, safe space afforded through virtual appointments. In instances where patients were directed to come into the emergency department (ED), physicians were able to provide a ?warm handoff? to improve efficiency. This helped manage patient expectations, and the direct advice of the ED physician reassured them that the visit was warranted. There was broad initial uptake of VED shifts among ED physicians with 60% (n=22) completing shifts in the first 2 months and 42% (n=15) completing 1 or more shifts per month over the course of the pilot. There were no difficulties finding sufficient ED physicians for shifts. Most physicians enjoyed working in the VED, saw value for patients, and were motivated by patient satisfaction. However, some physicians were hesitant as they felt their expertise and skills as ED physicians were underused. The VED was implemented using an iterative staged approach with increased service capabilities over time, including access to ultrasounds, virtual follow-ups after a recent ED visit, and access to blood work, urine tests, and x-rays (at the hospital or a local community laboratory). Physicians recognized the value in supporting patients by advising on the need for an in-person visit, booking a diagnostic test, or referring them to a specialist. Conclusions: The VED had the support of physicians and facilitated care for low-acuity presentations with immediate benefits for patients. It has the potential to benefit the health care system by seeing patients through the web and guiding patients to in-person care only when necessary. Long-term sustainability requires a focus on understanding digital equity and enhanced access to rapid testing or investigations. UR - https://formative.jmir.org/2023/1/e49786 UR - http://dx.doi.org/10.2196/49786 UR - http://www.ncbi.nlm.nih.gov/pubmed/38051562 ID - info:doi/10.2196/49786 ER - TY - JOUR AU - Faber, S. Jasper AU - Al-Dhahir, Isra AU - Kraal, J. Jos AU - Breeman, D. Linda AU - van den Berg-Emons, G. Rita J. AU - Reijnders, Thomas AU - van Dijk, Sandra AU - Janssen, R. Veronica AU - Kraaijenhagen, A. Roderik AU - Visch, T. Valentijn AU - Chavannes, H. Niels AU - Evers, M. Andrea W. PY - 2023/12/4 TI - Guide Development for eHealth Interventions Targeting People With a Low Socioeconomic Position: Participatory Design Approach JO - J Med Internet Res SP - e48461 VL - 25 KW - eHealth KW - guide KW - guidelines professionals KW - intervention development KW - intervention evaluation KW - low socioeconomic position KW - low socioeconomic status KW - risk groups KW - tailored care N2 - Background: People with a low socioeconomic position (SEP) are less likely to benefit from eHealth interventions, exacerbating social health inequalities. Professionals developing eHealth interventions for this group face numerous challenges. A comprehensive guide to support these professionals in their work could mitigate these inequalities. Objective: We aimed to develop a web-based guide to support professionals in the development, adaptation, evaluation, and implementation of eHealth interventions for people with a low SEP. Methods: This study consisted of 2 phases. The first phase involved a secondary analysis of 2 previous qualitative and quantitative studies. In this phase, we synthesized insights from the previous studies to develop the guide?s content and information structure. In the second phase, we used a participatory design process. This process included iterative development and evaluation of the guide?s design with 11 professionals who had experience with both eHealth and the target group. We used test versions (prototypes) and think-aloud testing combined with semistructured interviews and a questionnaire to identify design requirements and develop and adapt the guide accordingly. Results: The secondary analysis resulted in a framework of recommendations for developing the guide, which was categorized under 5 themes: development, reach, adherence, evaluation, and implementation. The participatory design process resulted in 16 requirements on system, content, and service aspects for the design of the guide. For the system category, the guide was required to have an open navigation strategy leading to more specific information and short pages with visual elements. Content requirements included providing comprehensible information, scientific evidence, a user perspective, information on practical applications, and a personal and informal tone of voice. Service requirements involved improving suitability for different professionals, ensuring long-term viability, and a focus on implementation. Based on these requirements, we developed the final version of ?the inclusive eHealth guide.? Conclusions: The inclusive eHealth guide provides a practical, user-centric tool for professionals aiming to develop, adapt, evaluate, and implement eHealth interventions for people with a low SEP, with the aim of reducing health disparities in this population. Future research should investigate its suitability for different end-user goals, its external validity, its applicability in specific contexts, and its real-world impact on social health inequality. UR - https://www.jmir.org/2023/1/e48461 UR - http://dx.doi.org/10.2196/48461 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048148 ID - info:doi/10.2196/48461 ER - TY - JOUR AU - Santamaria, Amparo AU - Antón Maldonado, Cristina AU - Sánchez-Quiñones, Beatriz AU - Ibarra Vega, Nataly AU - Ayo González, Maikel AU - Gonzalez Cabezas, Pedro AU - Carrasco Moreno, Rafael PY - 2023/12/4 TI - Implementing Telemedicine in Clinical Practice in the First Digital Hematology Unit: Feasibility Study JO - JMIR Form Res SP - e48987 VL - 7 KW - telemedicine KW - digital unit KW - hybrid hematology department KW - hematology KW - hybrid KW - implementation KW - telehealth KW - monitor KW - monitoring KW - remote care KW - virtual care KW - hematological KW - hematologist KW - hematologists KW - service KW - services KW - delivery KW - holistic KW - digital health intervention KW - digital transformation N2 - Background: Currently, there are no telemedicine models that fully integrate all areas of hematology into daily practice. Objective: The objectives of this feasibility study were to assess the practicality of implementing telemedicine into our clinical practice in the first Digital Hematology Unit and propose an innovative integrative design for clinical practice. Methods: We designed the Digital Hematology Unit, which is a specific physical space dedicated to carrying out telemedicine and monitoring patients in a holistic way. Also, a satisfaction questionnaire was performed and health care indicators were measured. Results: In 2021, there were 1331 first visits and 7534 follow-up visits. Of the first visits, 12.2% (n=163) were face-to-face and 87.8% (n=1168) were telematic. For follow-up visits, 29.9% (n=2251) were face-to-face and 70.1% (n=5283) were telematic. The health care management indicators showed that we had a waiting time of less than 4 days and took less than 4 hours to answer interconsultations among specialists. Moreover, patients reported a high level of satisfaction with the services provided. Conclusions: Our Digital Hematology Unit, as a case of success, serves as an example of how innovative digital solutions can contribute to the quality of care and excellence in health care achieved through a digital transformation process led by hematologists. UR - https://formative.jmir.org/2023/1/e48987 UR - http://dx.doi.org/10.2196/48987 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048143 ID - info:doi/10.2196/48987 ER - TY - JOUR AU - Benito-Garcia, Elizabeth AU - Vega, Julio AU - Daza, J. Eric AU - Lee, Wei-Nchih AU - Kennedy, Adee AU - Chantelot, Jean-Marc PY - 2023/11/30 TI - Patient and Physician Perspectives on the Use of a Connected Ecosystem for Diabetes Management: International Cross-Sectional Observational Study JO - JMIR Form Res SP - e47145 VL - 7 KW - type 2 diabetes mellitus KW - insulin treatment KW - connected ecosystems KW - surveys KW - diabetes KW - diabetic KW - ecosystem KW - ecosystems KW - telehealth KW - telemedicine KW - eHealth KW - digital health KW - health technology KW - adoption KW - perception KW - attitude KW - intention KW - acceptance N2 - Background: Collaboration between people with type 2 diabetes (T2DM) and their health care teams is important for optimal control of the disease and outcomes. Digital technologies could potentially tie together several health care-related devices and platforms into connected ecosystems (CES), but attitudes about CES are unknown. Objective: We surveyed convenience samples of patients and physicians to better understand which patient characteristics are associated with higher likelihoods of (1) participating in a potential CES program, as self-reported by patients with T2DM and (2) clinical benefit from participation in a potential CES program, as reported by physicians. Methods: Adults self-reporting a diagnosis of T2DM and current insulin use (n=197), and 33 physicians whose practices included ?20% of such patients, were enrolled in the United States, France, and Germany. We surveyed both groups about the likelihood of patient participation in a CES. We then examined the associations between patients? clinical and sociodemographic characteristics and this likelihood. We also described characteristics of patients likely to clinically benefit from CES use, according to physicians. Results: Compared with patients in Germany and France, US patients were younger (mean age 45.3 [SD 11.9] years vs 61.9 [SD 9.2] and 65.8 [SD 9.4] years, respectively), more often female, more highly educated, and more often working full-time. In all, 51 (44.7%) US patients, 16 (36.4%) German patients, and 18 (46.3%) French patients indicated strong interest in a CES program, and 115 (78.7%) reported currently using ?1 connected device or app. However, physicians believed that only 11.3%-19.2% of their patients were using connected devices or apps to manage their disease. Physicians also reported infrequently recommending or prescribing connected devices to their patients, although ?80% (n=28) of them thought that a CES could help support their patients in managing their disease. The factors most predictive of patient likelihood of participating in a CES program were cost, inclusion of medication reminders, and linking blood glucose levels to behaviors such as eating and exercise. In all countries, the most common patient expectations for a CES program were that it could help them eat more healthfully, increase their physical activity, increase their understanding of how blood glucose relates to behavior such as exercise and eating, and reduce stress. Physicians thought that newly diagnosed patients, sicker patients?those who had been hospitalized for diabetes, were currently using insulin, or who had any comorbid condition?and patients who were nonadherent to treatment were most likely to benefit from CES use. Conclusions: In this study, there was a high degree of interest in the future use of CES, although additional education is needed among both patients with T2DM and their physicians to achieve the full potential of such systems to improve self-management and clinical care for the disease. UR - https://formative.jmir.org/2023/1/e47145 UR - http://dx.doi.org/10.2196/47145 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032701 ID - info:doi/10.2196/47145 ER - TY - JOUR AU - Esumi, Ryo AU - Ito-Masui, Asami AU - Kawamoto, Eiji AU - Ito, Mami AU - Hayashi, Tomoyo AU - Shinkai, Toru AU - Hane, Atsuya AU - Okuno, Fumito AU - Park, Jeong Eun AU - Kaku, Ryuji AU - Shimaoka, Motomu PY - 2023/11/29 TI - Correlation Between the Social Network Structure and Well-Being of Health Care Workers in Intensive Care Units: Prospective Observational Study JO - Interact J Med Res SP - e50148 VL - 12 KW - social network analysis KW - Center for Epidemiological Studies?Depression KW - CES-D KW - distributed leadership KW - intensive care unit KW - wearable sensor KW - face-to-face interaction N2 - Background: Effective communication strategies are becoming increasingly important in intensive care units (ICUs) where patients at high risk are treated. Distributed leadership promotes effective communication among health care professionals (HCPs). Moreover, beyond facilitating patient care, it may improve well-being among HCPs by fostering teamwork. However, the impact of distributed leadership on the communication structure and well-being of HCPs remains unclear. Objective: We performed a social network analysis (SNA) to assess the characteristics of each HCP in the network, identify the number of HCP connections, analyze 4 centralities that can measure an HCP?s importance, and evaluate the impact of distributed leadership structure on the well-being and communication structure of the medical staff. Methods: Wearable sensors were used to obtain face-to-face interaction data from the ICU medical staff at Mie University Hospital, Japan. Participants wore a badge on the front of their clothing during working hours to measure the total frequency of face-to-face interactions. We collected data about the well-being of medical staff using the Center for Epidemiological Studies?Depression (CES-D) questionnaire and measured 4 centralities using SNA analysis. A CES-D questionnaire was administered during the study to measure the well-being of the HCPs. Results: Overall, 247 ICU workers participated in this clinical study for 4 weeks yearly in February 2016, 2017, and 2018. The distributed leadership structure was established within the ICU in 2017 and 2018. We compared these results with those of the traditional leadership structure used in 2016. Most face-to-face interactions in the ICU were among nurses or between nurses and other professionals. In 2016, overall, 10 nurses could perform leadership tasks, which significantly increased to 24 in 2017 (P=.046) and 20 in 2018 (P=.046). Considering the increased number of nurses who could perform leadership duties and the collaboration created within the organization, SNA in 2018 showed that the betweenness (P=.001), degree (P<.001), and closeness (P<.001) centralities significantly increased compared with those in 2016. However, the eigenvector centrality significantly decreased in 2018 compared with that in 2016 (P=.01). The CES-D scores in 2018 also significantly decreased compared with those in 2016 (P=.01). The betweenness (r=0.269; P=.02), degree (r=0.262; P=.03), and eigenvector (r=0.261; P=.03) centralities and CES-D scores were positively correlated in 2016, whereas the closeness centrality and CES-D scores were negatively correlated (r=?0.318; P=.01). In 2018, the degree (r=?0.280; P=.01) and eigenvector (r=?0.284; P=.01) centralities were negatively correlated with CES-D scores. Conclusions: Face-to-face interactions of HCPs in the ICU were measured using wearable sensors, and nurses were found to be centrally located. However, the introduction of distributed leadership created collaboration and informal leadership in the organization, altering the social network structure of HCPs and increasing organizational well-being. Trial Registration: University Hospital Medical Information Network (UMIN) UMIN000037046; https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000042211 UR - https://www.i-jmr.org/2023/1/e50148 UR - http://dx.doi.org/10.2196/50148 UR - http://www.ncbi.nlm.nih.gov/pubmed/37935050 ID - info:doi/10.2196/50148 ER - TY - JOUR AU - Rønn, Camille AU - Wieland, Andreas AU - Lehrer, Christiane AU - Márton, Attila AU - LaRoche, Jason AU - Specker, Adrien AU - Leroy, Pascal AU - Fürstenau, Daniel PY - 2023/11/24 TI - Circular Business Model for Digital Health Solutions: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e47874 VL - 12 KW - business model KW - circular economy KW - digital health solution KW - digital health KW - digital tool KW - digital KW - healthcare KW - life cycle KW - MedTech device KW - monitoring device KW - technology N2 - Background: The circular economy reshapes the linear ?take, make, and dispose? approach and evolves around minimizing waste and recapturing resources in a closed-loop system. The health sector accounts for 4.6% of global greenhouse gas emissions and has, over the decades, been built to rely on single-use devices and deal with high volumes of medical waste. With the increase in the adoption of digital health solutions in the health care industry, leading the industry into a new paradigm of how we provide health care, a focus must be put on the amount of waste that will follow. Digital health solutions will shape health care through the use of technology and lead to improved patient care, but they will also make medical waste more complex to deal with due to the e-waste component. Therefore, a transformation of the health care industry to a circular economy is a crucial cornerstone in decreasing the impact on the environment. Objective: This study aims to address the lack of direction in the current literature on circular business models. It will consider micro, meso, and macro factors that would impact the operational validity of circular models using the digital health solutions ePaper label (medical packaging), smart wearable sensor (health monitoring devices), smart pill box (medication management), and endo-cutter (surgical equipment) as examples. Methods: The study will systematically perform a scoping review through a database and snowball search. We will analyze and classify the studies from a predetermined set of categories and then summarize them into an evidence map. Based on the review, the study will develop a 2D framework for businesses to follow or for future research to take a standpoint from. Results: Preliminarily, the review has analyzed 26 studies in total. The results are close to equally distributed among the micro (8/26, 31%), meso (10/26, 38%), and macro (8/26, 31%) levels. Circular economy studies emphasize several circular practices such as recycling (17/26, 65%), reusing (18/26, 69%), reducing (15/26, 58%), and remanufacturing (8/26, 31%). The value proposition in the examined business model is mostly dominated by stand-alone products (18/26, 69%) compared to product as a service (7/26, 27%), involving stakeholders such as health care professionals or hospitals (20/26, 77%), manufacturers (11/26, 42%), and consumers (9/26, 35%). All studies encompass societal (12/26, 46%), economic (23/26, 88%), and environmental (24/26, 92%) viewpoints. Conclusions: The study argues that each digital health solution would have to be accessed individually to find the optimal business model to follow. This is due to their differing life cycles and complexity. The manufacturer will need a layered value proposition, implementing several business models dependent on their respective product portfolios. The need to incorporate several business models implies an ecosystem perspective that is relevant to consider. International Registered Report Identifier (IRRID): DERR1-10.2196/47874 UR - https://www.researchprotocols.org/2023/1/e47874 UR - http://dx.doi.org/10.2196/47874 UR - http://www.ncbi.nlm.nih.gov/pubmed/37999949 ID - info:doi/10.2196/47874 ER - TY - JOUR AU - Quintal, Ariane AU - Carreau, Isabelle AU - Grenier, Annie-Danielle AU - Hébert, Caroline AU - Yergeau, Christine AU - Berthiaume, Yves AU - Racine, Eric PY - 2023/11/23 TI - An Ethics Action Plan for Rare Disease Care: Participatory Action Research Approach JO - J Particip Med SP - e46607 VL - 15 KW - community-based participatory research KW - rare diseases KW - bioethics KW - delivery of health care KW - ethics KW - clinical KW - patient participation KW - empowerment KW - education KW - medical KW - attitude of health personnel KW - patient education as topic KW - patient partnership N2 - Background: Owing to their low prevalence, rare diseases are poorly addressed in the scientific literature and clinical practice guidelines. Thus, health care workers are inadequately equipped to provide timely diagnoses, appropriate treatment, and support for these poorly understood conditions. These clinical tribulations are experienced as moral challenges by patients, jeopardizing their life trajectories, dreams, and aspirations. Objective: This paper presents an ethical action plan for rare disease care and the process underlying its development. Methods: This action plan was designed through an ethical inquiry conducted by the Ethics and Rare Diseases Working Group, which included 3 patient partners, 2 clinician researchers, and 1 representative from Québec?s rare disease association. Results: The plan is structured into 4 components. Component A presents the key moral challenges encountered by patients, which are the lack of knowledge on rare diseases among health care workers, the problematic attitudes that it sometimes elicits, and the distress and powerlessness experienced by patients. Component B emphasizes a vision for patient partnership in rare disease care characterized by open-mindedness, empathy, respect, and support of patient autonomy from health care workers. Component C outlines 2 courses of action prompted by this vision: raising awareness among health care workers and empowering patients to better navigate their care. Component D compares several interventions that could help integrate these 2 courses of action in rare disease care. Conclusions: Overall, this action plan represents a toolbox that provides a review of multiple possible interventions for policy makers, hospital managers, practitioners, researchers, and patient associations to critically reflect on key moral challenges experienced by patients with rare diseases and ways to mitigate them. This paper also prompts reflection on the values underlying rare disease care, patient experiences, and health care workers? beliefs and behaviors. Health care workers and patients were the primary beneficiaries of this action plan. UR - https://jopm.jmir.org/2023/1/e46607 UR - http://dx.doi.org/10.2196/46607 UR - http://www.ncbi.nlm.nih.gov/pubmed/37995128 ID - info:doi/10.2196/46607 ER - TY - JOUR AU - Keim-Malpass, Jessica AU - Lunsford, Christopher AU - Letzkus, C. Lisa AU - Scheer, Eleanore AU - Valdez, S. Rupa PY - 2023/11/23 TI - Establishing the Need for Anticipatory Symptom Guidance and Networked Models of Disease in Adaptive Family Management Among Children With Medical Complexity: Qualitative Study JO - JMIR Form Res SP - e52454 VL - 7 KW - anticipatory symptom management KW - children with medical complexity KW - social network KW - qualitative KW - self-management KW - care coordination KW - precision health KW - disease progression models KW - disability KW - networked models of disease KW - social networking KW - web-based network KW - web-based networks KW - social networks KW - symptom management KW - family management KW - coordinated care KW - precision KW - pediatric KW - pediatrics KW - child KW - children KW - caregiver KW - caregivers KW - social support KW - interview KW - interviews KW - family KW - informal care KW - caregiving KW - conceptual KW - grounded theory KW - constructivist KW - situational analysis KW - model KW - mobile phone N2 - Background: Caregivers of children with medical complexity navigate complex family management tasks for their child both in the hospital and home-based setting. The roles and relationships of members of their social network and the dynamic evolution of these family management tasks have been underexamined. Objective: The purpose of this study was to explore the structures and processes of family management among caregivers of children with medical complexity, with a focus on the underlying dynamic nature of family management practices and the role of members of their social network. Methods: This study used a qualitative approach to interview caregivers of children with medical complexity and members of their social network. Caregivers of children with medical complexity were recruited through an academic Children?s Hospital Complex Care Clinic in the mid-Atlantic region and interviewed over a period of 1 to 3 days. Responses were analyzed using constructivist grounded theory and situational analysis to construct a new conceptual model. Only caregiver responses are reported here. Results: In total, 20 caregivers were included in this analysis. Caregiver perspectives revealed the contextual processes that allowed for practices of family management within the setting of rapidly evolving symptoms and health concerns. The dynamic and adaptive nature of this process is a key underlying action supporting this novel conceptual model. The central themes underpinning the adaptive family management model include symptom cues, ongoing surveillance, information gathering, and acute on chronic health concerns. The model also highlights facilitators and threats to successful family management among children with medical complexity and the networked relationship among the structures and processes. Conclusions: The adaptive family management model provides a basis for further quantitative operationalization and study. Previously described self- or family management frameworks do not account for the underlying dynamic nature of the disease trajectory and the developmental stage progression of the child or adolescent, and our work extends existing work. For future work, there is a defined role for technology-enhanced personalized approaches to home-based monitoring. Due to the disparities caregivers and the children in this population already experience, technology-enhanced approaches must be built alongside key stakeholders with an equity orientation to technology co-development. International Registered Report Identifier (IRRID): RR2-10.2196/14810 UR - https://formative.jmir.org/2023/1/e52454 UR - http://dx.doi.org/10.2196/52454 UR - http://www.ncbi.nlm.nih.gov/pubmed/37801346 ID - info:doi/10.2196/52454 ER - TY - JOUR AU - Reston, Elizabeth Riley AU - Caskey, J. Fergus AU - Hole, Barnaby AU - Udayaraj, Udaya AU - Weinman, John PY - 2023/11/23 TI - CareKnowDo?A Multichannel Digital and Telephone Support Program for People With Chronic Kidney Disease: Feasibility Randomized Controlled Trial JO - JMIR Form Res SP - e33147 VL - 7 KW - kidney disease KW - chronic KW - blood pressure KW - randomized controlled trial KW - telemedicine KW - mobile health KW - mHealth KW - self-management KW - guideline adherence KW - medication adherence KW - illness beliefs KW - medication beliefs KW - health psychology KW - preventative medicine KW - qualitative research N2 - Background: Chronic kidney disease (CKD) is a common, progressive condition. Lifestyle changes and antihypertensive medication can slow the progression to end-stage kidney disease, which requires renal replacement therapy. However, adherence to these recommendations is often low. Objective: The aim of CareKnowDo was to assess the feasibility of rolling out a digital self-management support and adherence program integrated with a patient-facing electronic health record, Patient View (PV). Methods: A 2-arm, parallel, individual-level pragmatic feasibility pilot randomized controlled trial was conducted at 2 National Health Service (NHS) sites in the United Kingdom. A total of 61 patients with CKD were randomized 1:1 into 2 groups and provided with either a new, tailored digital and telephone support program (CareKnowDo: 31/61, 51%) integrated with PV or standard care (PV alone: 30/61, 49%). Quantitative measures included clinical and psychosocial measures. The primary outcomes were feasibility based: recruitment rate, dropout, and the exploration of associations. Results: Of the 1392 patients screened in local kidney clinics, 269 (19.32%) met the basic inclusion criteria; the first 22.7% (61/269) who met the eligibility criteria were recruited to participate in the study. Of the 69 patients, 23 (38%) patients completed the final 6-month follow-up web-based survey. Reasons for the attrition were explored. A higher belief in the ability of the treatment to control CKD was associated with lower blood pressure at baseline (r=0.52; P=.005), and a higher perceived understanding of CKD at baseline was associated with lower blood pressure at follow-up (r=0.66; P<.001). Beliefs about medicines at baseline were associated with blood pressure at baseline but not at follow-up. This was true for both concerns about medicines (r=0.58; P=.001) and perceived necessity of medicines (r=0.42; P=.03). Conclusions: A tailored digital and nurse call?based program to enhance support for patients with CKD was piloted in 2 NHS sites and found to be feasible and acceptable. However, to maximize the effectiveness of the intervention (and of future trials), consideration should be given to the target audience most likely to benefit, as well as how to help them access the program as quickly and easily as possible. Trial Registration: NHS Health Research Authority, IRAS ID 184206; https://www.hra.nhs.uk/planning-and-improving -research/application-summaries/research-summaries/careknowdo-pilot-version-1/ UR - https://formative.jmir.org/2023/1/e33147 UR - http://dx.doi.org/10.2196/33147 UR - http://www.ncbi.nlm.nih.gov/pubmed/37995117 ID - info:doi/10.2196/33147 ER - TY - JOUR AU - Ge, Ying AU - Yao, Dongning AU - Ung, Lam Carolina Oi AU - Xue, Yan AU - Li, Meng AU - Lin, Jiabao AU - Hu, Hao AU - Lai, Yunfeng PY - 2023/11/17 TI - Digital Medical Information Services Delivered by Pharmaceutical Companies via WeChat: Qualitative Analytical Study JO - J Med Internet Res SP - e43812 VL - 25 KW - digital medical information service KW - pharmaceutical company KW - WeChat KW - social media KW - digital health N2 - Background: Social media has become one of the primary information sources for medical professionals and patients. Pharmaceutical companies are committed to using various social media platforms to provide stakeholders with digital medical information services (DMISs), which remain experimental and immature. In China, WeChat tops the list of popular social media platforms. To date, little is known about the service model of DMISs delivered by pharmaceutical companies via WeChat. Objective: This study aims to explore the emerging service model of DMISs delivered by pharmaceutical companies via WeChat in China. Methods: This study applied a qualitative research design combining case study and documentary analysis to explore the DMISs of 6 leading pharmaceutical companies in China. Materials were collected from their official WeChat platforms. Thematic analysis was conducted on the data. Results: The DMISs of 6 pharmaceutical companies were investigated. Themes emerged regarding 2 essential information services delivered by pharmaceutical companies via WeChat: business operation services and DMISs (ie, public information services, professional services, science and education services, and e-commerce services). Business operation services mainly function to assist or facilitate the company?s operations and development trends for general visitors. Public-oriented information services are realized through health science popularization, academic frontiers, product information, and road maps to hospitals and pharmacies. Internet hospital and pharmacy services are the main patient-oriented professional services. Medical staff?oriented science and education services commonly include continuing education, clinical assistance, academic research, and journal searching. Public-oriented e-commerce services include health products and health insurance. Conclusions: Pharmaceutical companies in China use WeChat to provide stakeholders with diversified DMISs, which remain in the exploratory stage. The service model of DMISs requires more distinct innovations to provide personalized digital health and patient-centric services. Moreover, specific regulations on the DMISs of pharmaceutical companies need to be established to guard public health interests. UR - https://www.jmir.org/2023/1/e43812 UR - http://dx.doi.org/10.2196/43812 UR - http://www.ncbi.nlm.nih.gov/pubmed/37976079 ID - info:doi/10.2196/43812 ER - TY - JOUR AU - Coumoundouros, Chelsea AU - El Arab, Adel Rabie AU - Farrand, Paul AU - Hamilton, Alexander AU - Sanderman, Robbert AU - von Essen, Louise AU - Woodford, Joanne PY - 2023/11/17 TI - Potential Implementers? Perspectives on the Development and Implementation of an e?Mental Health Intervention for Caregivers of Adults With Chronic Kidney Disease: Qualitative Interview Study JO - JMIR Hum Factors SP - e51461 VL - 10 KW - health care professional KW - implementation KW - informal caregiver KW - chronic kidney disease KW - e?mental health KW - Consolidated Framework for Implementation Research N2 - Background: e?Mental health interventions can improve access to mental health support for caregivers of people living with chronic kidney disease (CKD). However, implementation challenges often prevent effective interventions from being put into practice. To develop an e?mental health intervention for caregivers of people living with CKD that is optimized for future implementation, it is important to engage professionals that may endorse or deliver the intervention (ie, potential implementers) during intervention development. Objective: This study aims to explore the perspectives of potential implementers working in kidney care, in mental health care, or at nonprofit organizations regarding the design and implementation of an e?mental health intervention for caregivers of people living with CKD. Methods: Potential implementers (N=18) were recruited via National Health Service Trusts, email, and social media advertisements to participate in semistructured video interviews. Interview questions were informed by the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using a deductive analysis approach using the CFIR, with inductive coding applied to relevant data not captured by the framework. Results: A total of 29 generic categories, related to 17 CFIR constructs, were identified. The perceived fit between the intervention and implementation context (ie, existing service delivery models and work routines) and existing social networks among potential implementers were perceived as important factors in enhancing implementation potential. However, a need for capacity building among potential implementers to create systems to support the identification and referral of caregivers to an e?mental health intervention was identified. Equity concerns were raised regarding the intervention, highlighting the importance of incorporating an equity lens during intervention design to enhance accessibility and adoption. Conclusions: Potential implementers provided valuable insights into key design and implementation factors to help inform the development of an e?mental health intervention for caregivers of people living with CKD. Incorporating their feedback can help ensure the intervention is acceptable and inform the selection of future implementation strategies to enhance the implementation potential of the intervention. Potential implementers should continue to be engaged throughout intervention development. UR - https://humanfactors.jmir.org/2023/1/e51461 UR - http://dx.doi.org/10.2196/51461 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792676 ID - info:doi/10.2196/51461 ER - TY - JOUR AU - Babayan, Katherine AU - Keilty, Krista AU - Esufali, Jessica AU - Grajales III, J. Francisco AU - PY - 2023/11/8 TI - An After-Hours Virtual Care Service for Children With Medical Complexity and New Medical Technology: Mixed Methods Feasibility Study JO - JMIR Pediatr Parent SP - e41393 VL - 6 KW - children with medical complexity KW - technology dependence KW - medical devices KW - family caregivers KW - virtual care KW - home and community care KW - emergency department visits KW - enteral feeding tubes KW - hospital-to-home transition KW - feasibility KW - mixed methods N2 - Background: Family caregivers (FCs) of children with medical complexity require specialized support to promote the safe management of new medical technologies (eg, gastrostomy tubes) during hospital-to-home transitions. With limited after-hours services available to families in home and community care, medical device complications that arise often lead to increased FC stress and unplanned emergency department (ED) visits. To improve FC experiences, enable safer patient discharge, and reduce after-hours ED visits, this study explores the feasibility of piloting a 24/7 virtual care service (Connected Care Live) with families to provide real-time support by clinicians expert in the use of pediatric home care technologies. Objective: This study aims to establish the economic, operational, and technical feasibility of piloting the expansion of an existing nurse-led after-hours virtual care service offered to home and community care providers to FCs of children with newly inserted medical devices after hospital discharge at Toronto?s Hospital for Sick Children (SickKids). Methods: This exploratory study, conducted from October 2020 to August 2021, used mixed data sources to inform service expansion feasibility. Semistructured interviews were conducted with FCs, nurses, and hospital leadership to assess the risks, benefits, and technical and operational requirements for sustainable and cost-effective future service operations. Time and travel savings were estimated using ED visit data in SickKids? electronic medical records (Epic) with a chief complaint of ?medical device problems,? after-hours medical device inquiries from clinician emails and voicemails, and existing service operational data. Results: A total of 30 stakeholders were interviewed and voiced the need for the proposed service. Safer and more timely management of medical device complications, improved caregiver and provider experiences, and strengthened partnerships were identified as expected benefits, while service demand, nursing practice, and privacy and security were identified as potential risks. A total of 47 inquiries were recorded over 2 weeks from March 26, 2021, to April 8, 2021, with 51% (24/47) assessed as manageable via service expansion. This study forecasted annual time and travel savings of 558 hours for SickKids and 904 hours and 22,740 km for families. Minimal technical and operational requirements were needed to support service expansion by leveraging an existing platform and clinical staff. Of the 212 ED visits related to ?medical device problems? over 6 months from September 1, 2020, to February 28, 2021, enteral feeding tubes accounted for nearly two-thirds (n=137, 64.6%), with 41.6% (57/137) assessed as virtually manageable. Conclusions: Our findings indicate that it is feasible to pilot the expansion of Connected Care Live to FCs of children with newly inserted enteral feeding tubes. This nurse-led virtual caregiver service is a promising tool to promote safe hospital-to-home transitions, improve FC experiences, and reduce after-hours ED visits. UR - https://pediatrics.jmir.org/2023/1/e41393 UR - http://dx.doi.org/10.2196/41393 UR - http://www.ncbi.nlm.nih.gov/pubmed/37938869 ID - info:doi/10.2196/41393 ER - TY - JOUR AU - Rindal, Brad D. AU - Pasumarthi, Prasad Dhavan AU - Thirumalai, Vijayakumar AU - Truitt, R. Anjali AU - Asche, E. Stephen AU - Worley, C. Donald AU - Kane, M. Sheryl AU - Gryczynski, Jan AU - Mitchell, G. Shannon PY - 2023/11/7 TI - Clinical Decision Support to Reduce Opioid Prescriptions for Dental Extractions using SMART on FHIR: Implementation Report JO - JMIR Med Inform SP - e45636 VL - 11 KW - clinical decision support systems KW - dentistry KW - analgesics KW - electronic health records KW - EHR KW - algorithm KW - design KW - implementation KW - decision support KW - development KW - dentists KW - pain management KW - patient care KW - application KW - tool KW - Fast Healthcare Interoperability Resources KW - FHIR KW - Substitutable Medical Applications and Reusable Technologies KW - SMART N2 - Background: Clinical decision support (CDS) has the potential to improve clinical decision-making consistent with evidence-based care. CDS can be designed to save health care providers time and help them provide safe and personalized analgesic prescribing. Objective: The aim of this report is to describe the development of a CDS system designed to provide dentists with personalized pain management recommendations to reduce opioid prescribing following extractions. The use of CDS is also examined. Methods: This study was conducted in HealthPartners, which uses an electronic health record (EHR) system that integrates both medical and dental information upon which the CDS application was developed based on SMART (Substitutable Medical Applications and Reusable Technologies) on FHIR (Fast Healthcare Interoperability Resources). The various tools used to bring relevant medical conditions, medications, patient history, and other relevant data into the CDS interface are described. The CDS application runs a drug interaction algorithm developed by our organization and provides patient-specific recommendations. The CDS included access to the state Prescription Monitoring Program database. Implementation (Results): The pain management CDS was implemented as part of a study examining opioid prescribing among patients undergoing dental extraction procedures from February 17, 2020, to May 14, 2021. Provider-level use of CDS at extraction encounters ranged from 0% to 87.4% with 12.1% of providers opening the CDS for no encounters, 39.4% opening the CDS for 1%-20% of encounters, 36.4% opening it for 21%-50% of encounters, and 12.1% opening it for 51%-87% of encounters. Conclusions: The pain management CDS is an EHR-embedded, provider-facing tool to help dentists make personalized pain management recommendations following dental extractions. The SMART on FHIR?based pain management CDS adapted well to the point-of-care dental setting and led to the design of a scalable CDS tool that is EHR vendor agnostic. Trial Registration: ClinicalTrials.gov NCT03584789; https://clinicaltrials.gov/study/NCT03584789 UR - https://medinform.jmir.org/2023/1/e45636 UR - http://dx.doi.org/10.2196/45636 UR - http://www.ncbi.nlm.nih.gov/pubmed/37934572 ID - info:doi/10.2196/45636 ER - TY - JOUR AU - Ho, Vy AU - Brown Johnson, Cati AU - Ghanzouri, Ilies AU - Amal, Saeed AU - Asch, Steven AU - Ross, Elsie PY - 2023/11/6 TI - Physician- and Patient-Elicited Barriers and Facilitators to Implementation of a Machine Learning?Based Screening Tool for Peripheral Arterial Disease: Preimplementation Study With Physician and Patient Stakeholders JO - JMIR Cardio SP - e44732 VL - 7 KW - artificial intelligence KW - cardiovascular disease KW - machine learning KW - peripheral arterial disease KW - preimplementation study N2 - Background: Peripheral arterial disease (PAD) is underdiagnosed, partially due to a high prevalence of atypical symptoms and a lack of physician and patient awareness. Implementing clinical decision support tools powered by machine learning algorithms may help physicians identify high-risk patients for diagnostic workup. Objective: This study aims to evaluate barriers and facilitators to the implementation of a novel machine learning?based screening tool for PAD among physician and patient stakeholders using the Consolidated Framework for Implementation Research (CFIR). Methods: We performed semistructured interviews with physicians and patients from the Stanford University Department of Primary Care and Population Health, Division of Cardiology, and Division of Vascular Medicine. Participants answered questions regarding their perceptions toward machine learning and clinical decision support for PAD detection. Rapid thematic analysis was performed using templates incorporating codes from CFIR constructs. Results: A total of 12 physicians (6 primary care physicians and 6 cardiovascular specialists) and 14 patients were interviewed. Barriers to implementation arose from 6 CFIR constructs: complexity, evidence strength and quality, relative priority, external policies and incentives, knowledge and beliefs about intervention, and individual identification with the organization. Facilitators arose from 5 CFIR constructs: intervention source, relative advantage, learning climate, patient needs and resources, and knowledge and beliefs about intervention. Physicians felt that a machine learning?powered diagnostic tool for PAD would improve patient care but cited limited time and authority in asking patients to undergo additional screening procedures. Patients were interested in having their physicians use this tool but raised concerns about such technologies replacing human decision-making. Conclusions: Patient- and physician-reported barriers toward the implementation of a machine learning?powered PAD diagnostic tool followed four interdependent themes: (1) low familiarity or urgency in detecting PAD; (2) concerns regarding the reliability of machine learning; (3) differential perceptions of responsibility for PAD care among primary care versus specialty physicians; and (4) patient preference for physicians to remain primary interpreters of health care data. Facilitators followed two interdependent themes: (1) enthusiasm for clinical use of the predictive model and (2) willingness to incorporate machine learning into clinical care. Implementation of machine learning?powered diagnostic tools for PAD should leverage provider support while simultaneously educating stakeholders on the importance of early PAD diagnosis. High predictive validity is necessary for machine learning models but not sufficient for implementation. UR - https://cardio.jmir.org/2023/1/e44732 UR - http://dx.doi.org/10.2196/44732 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930755 ID - info:doi/10.2196/44732 ER - TY - JOUR AU - Gopwani, Sumeet AU - Bahrun, Ehab AU - Singh, Tanvee AU - Popovsky, Daniel AU - Cramer, Joseph AU - Geng, Xue PY - 2023/11/3 TI - Efficacy of Electronic Reminders in Increasing the Enhanced Recovery After Surgery Protocol Use During Major Breast Surgery: Prospective Cohort Study JO - JMIR Perioper Med SP - e44139 VL - 6 KW - ERAS protocol KW - electronic notification system KW - clinical decision support system KW - postoperative outcomes KW - breast surgery KW - surgery KW - surgical KW - postoperative KW - decision support KW - notification KW - recovery KW - anesthesia KW - cohort study KW - patient outcome KW - enhanced recovery KW - patient education KW - surgical stress N2 - Background: Enhanced recovery after surgery (ERAS) protocols are patient-centered, evidence-based guidelines for peri-, intra-, and postoperative management of surgical candidates that aim to decrease operative complications and facilitate recovery after surgery. Anesthesia providers can use these protocols to guide decision-making and standardize aspects of their anesthetic plan in the operating room. Objective: Research across multiple disciplines has demonstrated that clinical decision support systems have the potential to improve protocol adherence by reminding providers about departmental policies and protocols via notifications. There remains a gap in the literature about whether clinical decision support systems can improve patient outcomes by improving anesthesia providers? adherence to protocols. Our hypothesis is that the implementation of an electronic notification system to anesthesia providers the day prior to scheduled breast surgeries will increase the use of the already existing but underused ERAS protocols. Methods: This was a single-center prospective cohort study conducted between October 2017 and August 2018 at an urban academic medical center. After obtaining approval from the institutional review board, anesthesia providers assigned to major breast surgery cases were identified. Patient data were collected pre- and postimplementation of an electronic notification system that sent the anesthesia providers an email reminder of the ERAS breast protocol the night before scheduled surgeries. Each patient?s record was then reviewed to assess the frequency of adherence to the various ERAS protocol elements. Results: Implementation of an electronic notification significantly improved overall protocol adherence and several preoperative markers of ERAS protocol adherence. Protocol adherence increased from 16% (n=14) to 44% (n=44; P<.001), preoperative administration of oral gabapentin (600 mg) increased from 13% (n=11) to 43% (n=43; P<.001), and oral celebrex (400 mg) use increased from 16% (n=14) to 35% (n=35; P=.006). There were no statistically significant differences in the use of scopolamine transdermal patch (P=.05), ketamine (P=.35), and oral acetaminophen (P=.31) between the groups. Secondary outcomes such as intraoperative and postoperative morphine equivalent administered, postanesthesia care unit length of stay, postoperative pain scores, and incidence of postoperative nausea and vomiting did not show statistical significance. Conclusions: This study examines whether sending automated notifications to anesthesia providers increases the use of ERAS protocols in a single academic medical center. Our analysis exhibited statistically significant increases in overall protocol adherence but failed to show significant differences in secondary outcome measures. Despite the lack of a statistically significant difference in secondary postoperative outcomes, our analysis contributes to the limited literature on the relationship between using push notifications and clinical decision support in guiding perioperative decision-making. A variety of techniques can be implemented, including technological solutions such as automated notifications to providers, to improve awareness and adherence to ERAS protocols. UR - https://periop.jmir.org/2023/1/e44139 UR - http://dx.doi.org/10.2196/44139 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921854 ID - info:doi/10.2196/44139 ER - TY - JOUR AU - Cross, Shane AU - Nicholas, Jennifer AU - Mangelsdorf, Shaminka AU - Valentine, Lee AU - Baker, Simon AU - McGorry, Patrick AU - Gleeson, John AU - Alvarez-Jimenez, Mario PY - 2023/11/3 TI - Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study JO - JMIR Form Res SP - e49846 VL - 7 KW - adolescence KW - adolescent KW - blended care KW - blended KW - co-design KW - development KW - digital health KW - digital intervention KW - digital mental health KW - framework KW - hybrid KW - mental health KW - model KW - platform KW - self-determination theory KW - service KW - services KW - theory of change KW - therapy KW - youth mental health KW - youth N2 - Background: Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital technologies offer promise, yet challenges in real-world integration and uptake persist. Moderated Online Social Therapy (MOST) aims to overcome these problems by integrating a comprehensive digital platform into existing youth mental health services. Theory of change (ToC) frameworks can help articulate how and why complex interventions work and what conditions are required for success. Objective: The objective of this study is to create a ToC for MOST to explain how it works, why it works, who benefits and how, and what conditions are required for its success. Methods: We used a multimethod approach to construct a ToC for MOST. The synthesis aimed to assess the real-world impact of MOST, a digital platform designed to enhance face-to-face youth mental health services, and to guide its iterative refinement. Data were gathered from 2 completed and 4 ongoing randomized controlled trials, 11 pilot studies, and over 1000 co-design sessions using MOST. Additionally, published qualitative findings from diverse clinical contexts and a review of related digital mental health literature were included. The study culminated in an updated ToC framework informed by expert feedback. The final ToC was produced in both narrative and table form and captured components common in program logic and ToC frameworks. Results: The MOST ToC captured several assumptions about digital mental health adoption, including factors such as the readiness of young people and service providers to embrace digital platforms. External considerations included high service demand and a potential lack of infrastructure to support integration. Young people and service providers face several challenges and pain points MOST seeks to address, such as limited accessibility, high demand, poor engagement, and a lack of personalized support. Self-determination theory, transdiagnostic psychological treatment approaches, and evidence-based implementation theories and their associated mechanisms are drawn upon to frame the intervention components that make up the platform. Platform usage data are captured and linked to short-, medium-, and long-term intended outcomes, such as reductions in mental health symptoms, improvements in functioning and quality of life, reductions in hospital visits, and reduced overall mental health care costs. Conclusions: The MOST ToC serves as a strategic framework for refining MOST over time. The creation of the ToC helped guide the development of therapeutic content personalization, user engagement enhancement, and clinician adoption through specialized implementation frameworks. While powerful, the ToC approach has its limitations, such as a lack of standardized methodology and the amount of resourcing required for its development. Nonetheless, it provides an invaluable roadmap for iterative development, evaluation, and scaling of MOST and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact. UR - https://formative.jmir.org/2023/1/e49846 UR - http://dx.doi.org/10.2196/49846 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921858 ID - info:doi/10.2196/49846 ER - TY - JOUR AU - Brommeyer, Mark AU - Liang, Zhanming AU - Whittaker, Maxine AU - Mackay, Mark PY - 2023/11/3 TI - Developing Health Management Competency for Digital Health Transformation: Protocol for a Qualitative Study JO - JMIR Res Protoc SP - e51884 VL - 12 KW - health care management KW - health service manager KW - digital health KW - health informatics KW - competency KW - workforce development KW - innovation KW - research protocol KW - informatics KW - manager KW - managers KW - service KW - services KW - delivery KW - organization KW - organizational KW - workforce KW - management KW - managerial KW - qualification KW - qualifications KW - focus group KW - focus groups KW - interview KW - interviews KW - scoping KW - review methods KW - review methodology N2 - Background: Globally, the health care system is experiencing a period of rapid and radical change. In response, innovative service models have been adopted for the delivery of high-quality care that require a health workforce with skills to support transformation and new ways of working. Objective: The aim of this research protocol is to describe research that will contribute to developing the capability of health service managers in the digital health era and enabling digital transformation within the Australian health care environment. It also explains the process of preparing and finalizing the research design and methodologies by seeking answers to the following three research questions: (1) To what extent can the existing health service management and digital health competency frameworks guide the development of competence for health service managers in understanding and managing in the digital health space? (2) What are the competencies that are necessary for health service managers to acquire in order to effectively work with and manage in the digital health context? (3) What are the key factors that enable and inhibit health service managers to develop and demonstrate digital health competence in the workplace? Methods: The study has adopted a qualitative approach, guided by the empirically validated management competency identification process, using four steps: (1) health management and digital health competency mapping, (2) scoping review of literature and policy analysis, (3) focus group discussions with health service managers, and (4) semistructured interviews with digital health leaders. The first 2 steps were to confirm the need for updating the current health service management curriculum to address changing competency requirements of health service managers in the digital health context. Results: Two initial steps have been completed confirming the significance of the study and study design. Step 1, competency mapping, found that nearly half of the digital competencies were only partially or not addressed at all by the health management competency framework. The scoping review articulated the competencies health service managers need to effectively demonstrate digital health competence in the workplace. The findings effectively support the importance of the current research and also the appropriateness of the proposed steps 3 and 4 in answering the research questions and achieving the research aim. Conclusions: This study will provide insights into the health service management workforce performance and development needs for digital health and inform credentialing and professional development requirements. This will guide health service managers in leading and managing the adoption and implementation of digital health as a contemporary tool for health care delivery. The study will develop an in-depth understanding of Australian health service managers? experiences and views. This research process could be applied in other contexts, noting that the results need contextualization to individual country jurisdictions and environments. International Registered Report Identifier (IRRID): DERR1-10.2196/51884 UR - https://www.researchprotocols.org/2023/1/e51884 UR - http://dx.doi.org/10.2196/51884 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921855 ID - info:doi/10.2196/51884 ER - TY - JOUR AU - Schwalbe, Daria AU - Sodemann, Morten AU - Iachina, Maria AU - Nørgård, Mertz Bente AU - Chodkiewicz, Høy Nina AU - Ammentorp, Jette PY - 2023/11/3 TI - Causes of Patient Nonattendance at Medical Appointments: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e46227 VL - 12 KW - missed appointments KW - nonattendance KW - hospital appointments KW - Danish health care KW - prevention strategies KW - positive deviance KW - quality of treatment KW - mixed methods N2 - Background: Approximately one-third of patient appointments in Danish health care result in failures, leading to patient risk and sizable resource waste. Existing interventions to alleviate no-shows often target the patients. The underlying reason behind these interventions is a view that attendance or nonattendance is solely the patient?s problem. However, these interventions often prove to be ineffective and can perpetuate social biases and health inequalities, leaving behind patients who are more vulnerable or disadvantaged (in terms of social, economical, and linguistic factors, etc). A more holistic understanding of no-shows is needed to optimize processes, reduce waste, and support patients who are vulnerable. Objective: This study aims to gain a deep and more comprehensive understanding of the causes, mechanisms, and recurring patterns and elements contributing to nonattendance at Danish hospitals in the Region of Southern Denmark. It emphasizes the patient perspective and analyzes the relational and organizational processes surrounding no-shows in health care. In addition, the study aims to identify effective communicative strategies and organizational processes that can support the development and implementation of successful interventions. Methods: The study uses mixed quantitative-qualitative methods, encompassing 4 analytical projects focusing on nonattendance patterns, patient knowledge and behavior, the management of hospital appointments, and in situ communication. To address the complexity of no-shows in health care, the study incorporates various data sources. The quantitative data sources include the electronic patient records, Danish central registries, Danish National Patient Registry, and Register of Medicinal Product Statistics. Baseline characteristics of patients at different levels are compared using chi-square tests and Kruskal-Wallis tests. The qualitative studies involve observational data, individual semistructured interviews with patients and practitioners, and video recordings of patient consultations. Results: This paper presents the protocol of the study, which was funded by the Novo Nordisk Foundation in July 2022. Recruitment started in February 2023. It is anticipated that the quantitative data analysis will be completed by the end of September 2023, with the qualitative investigation starting in October 2023. The first study findings are anticipated to be available by the end of 2024. Conclusions: The existing studies of nonattendance in Danish health care are inadequate in addressing relational and organizational factors leading to hospital no-shows. Interventions have had limited effect, highlighting the Danish health care system?s failure to accommodate patients who are vulnerable. Effective interventions require a qualitative approach and robust ethnographic data to supplement the description and categorization of no-shows at hospitals. Obtaining comprehensive knowledge about the causes of missed patient appointments will yield practical benefits, enhancing the safety, coherence, and quality of treatment in health care. International Registered Report Identifier (IRRID): PRR1-10.2196/46227 UR - https://www.researchprotocols.org/2023/1/e46227 UR - http://dx.doi.org/10.2196/46227 UR - http://www.ncbi.nlm.nih.gov/pubmed/37723870 ID - info:doi/10.2196/46227 ER - TY - JOUR AU - Marks, A. Victoria AU - Hsiang, R. Walter AU - Nie, James AU - Umer, Waez AU - Haleem, Afash AU - Galal, Bayan AU - Pak, Irene AU - Kim, Dana AU - Salazar, C. Michelle AU - Pantel, Haddon AU - Berger, R. Elizabeth AU - Boffa, J. Daniel AU - Cavallo, A. Jaime AU - Leapman, S. Michael PY - 2023/11/2 TI - Telehealth Availability for Cancer Care During the COVID-19 Pandemic: Cross-Sectional Study JO - JMIR Cancer SP - e45518 VL - 9 KW - telehealth KW - colorectal cancer KW - breast cancer KW - melanoma KW - access to care KW - COVID-19 pandemic KW - telemedicine KW - national survey KW - cross-sectional KW - cancer KW - oncology N2 - Background: Telehealth was an important strategy for maintaining continuity of cancer care during the coronavirus pandemic and has continued to play a role in outpatient care; however, it is unknown whether services are equally available across cancer hospitals. Objective: This study aimed to assess telehealth availability at cancer hospitals for new and established patients with common cancers to contextualize the impact of access barriers to technology on overall access to health care. Methods: We conducted a national cross-sectional secret shopper study from June to November 2020 to assess telehealth availability at cancer hospitals for new and established patients with colorectal, breast, and skin (melanoma) cancer. We examined facility-level factors to determine predictors of telehealth availability. Results: Of the 312 investigated facilities, 97.1% (n=303) provided telehealth services for at least 1 cancer site. Telehealth was less available to new compared to established patients (n=226, 72% vs n=301, 97.1%). The surveyed cancer hospitals more commonly offered telehealth visits for breast cancer care (n=266, 85%) and provided lower access to telehealth for skin (melanoma) cancer care (n=231, 74%). Most hospitals (n=163, 52%) offered telehealth for all 3 cancer types. Telehealth availability was weakly correlated across cancer types within a given facility for new (r=0.16, 95% CI 0.09-0.23) and established (r=0.14, 95% CI 0.08-0.21) patients. Telehealth was more commonly available for new patients at National Cancer Institute?designated facilities, medical school?affiliated facilities, and major teaching sites, with high total admissions and below-average timeliness of care. Telehealth availability for established patients was highest at Academic Comprehensive Cancer Programs, nongovernment and nonprofit facilities, medical school?affiliated facilities, Accountable Care Organizations, and facilities with a high number of total admissions. Conclusions: Despite an increase in telehealth services for patients with cancer during the COVID-19 pandemic, we identified differences in access across cancer hospitals, which may relate to measures of clinical volume, affiliation, and infrastructure. UR - https://cancer.jmir.org/2023/1/e45518 UR - http://dx.doi.org/10.2196/45518 UR - http://www.ncbi.nlm.nih.gov/pubmed/37917149 ID - info:doi/10.2196/45518 ER - TY - JOUR AU - Guo, Lin Lin AU - Guo, Ying Lin AU - Li, Jiao AU - Gu, Wen Yao AU - Wang, Yang Jia AU - Cui, Ying AU - Qian, Qing AU - Chen, Ting AU - Jiang, Rui AU - Zheng, Si PY - 2023/11/1 TI - Characteristics and Admission Preferences of Pediatric Emergency Patients and Their Waiting Time Prediction Using Electronic Medical Record Data: Retrospective Comparative Analysis JO - J Med Internet Res SP - e49605 VL - 25 KW - pediatric emergency department KW - characteristics KW - admission preferences KW - waiting time KW - machine learning KW - electronic medical record N2 - Background: The growing number of patients visiting pediatric emergency departments could have a detrimental impact on the care provided to children who are triaged as needing urgent attention. Therefore, it has become essential to continuously monitor and analyze the admissions and waiting times of pediatric emergency patients. Despite the significant challenge posed by the shortage of pediatric medical resources in China?s health care system, there have been few large-scale studies conducted to analyze visits to the pediatric emergency room. Objective: This study seeks to examine the characteristics and admission patterns of patients in the pediatric emergency department using electronic medical record (EMR) data. Additionally, it aims to develop and assess machine learning models for predicting waiting times for pediatric emergency department visits. Methods: This retrospective analysis involved patients who were admitted to the emergency department of Children?s Hospital Capital Institute of Pediatrics from January 1, 2021, to December 31, 2021. Clinical data from these admissions were extracted from the electronic medical records, encompassing various variables of interest such as patient demographics, clinical diagnoses, and time stamps of clinical visits. These indicators were collected and compared. Furthermore, we developed and evaluated several computational models for predicting waiting times. Results: In total, 183,024 eligible admissions from 127,368 pediatric patients were included. During the 12-month study period, pediatric emergency department visits were most frequent among children aged less than 5 years, accounting for 71.26% (130,423/183,024) of the total visits. Additionally, there was a higher proportion of male patients (104,147/183,024, 56.90%) compared with female patients (78,877/183,024, 43.10%). Fever (50,715/183,024, 27.71%), respiratory infection (43,269/183,024, 23.64%), celialgia (9560/183,024, 5.22%), and emesis (6898/183,024, 3.77%) were the leading causes of pediatric emergency room visits. The average daily number of admissions was 501.44, and 18.76% (34,339/183,204) of pediatric emergency department visits resulted in discharge without a prescription or further tests. The median waiting time from registration to seeing a doctor was 27.53 minutes. Prolonged waiting times were observed from April to July, coinciding with an increased number of arrivals, primarily for respiratory diseases. In terms of waiting time prediction, machine learning models, specifically random forest, LightGBM, and XGBoost, outperformed regression methods. On average, these models reduced the root-mean-square error by approximately 17.73% (8.951/50.481) and increased the R2 by approximately 29.33% (0.154/0.525). The SHAP method analysis highlighted that the features ?wait.green? and ?department? had the most significant influence on waiting times. Conclusions: This study offers a contemporary exploration of pediatric emergency room visits, revealing significant variations in admission rates across different periods and uncovering certain admission patterns. The machine learning models, particularly ensemble methods, delivered more dependable waiting time predictions. Patient volume awaiting consultation or treatment and the triage status emerged as crucial factors contributing to prolonged waiting times. Therefore, strategies such as patient diversion to alleviate congestion in emergency departments and optimizing triage systems to reduce average waiting times remain effective approaches to enhance the quality of pediatric health care services in China. UR - https://www.jmir.org/2023/1/e49605 UR - http://dx.doi.org/10.2196/49605 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910168 ID - info:doi/10.2196/49605 ER - TY - JOUR AU - Moon, Hui-Woun AU - Park, Me Da Som AU - Jung, Young Se PY - 2023/10/30 TI - Use of the Smart Excretion Care System Linked to Electronic Medical Records to Alleviate Nursing Burden and Enhance Patient Convenience: Mixed Methods Study JO - JMIR Form Res SP - e36324 VL - 7 KW - care KW - caregiving KW - instrument development KW - elderly KW - quality of life KW - ergonomics KW - focus groups KW - musculoskeletal KW - usability KW - feasibility KW - digital health intervention KW - digital health KW - health intervention KW - nursing KW - electronic medical record N2 - Background: The surge in older demographics has inevitably resulted in a heightened demand for health care, and a shortage of nursing staff is impending. Consequently, there is a growing demand for the development of nursing robots to assist patients with urinary and bowel elimination. However, no study has examined nurses? opinions of smart devices that provide integrated nursing for patients? urinary and bowel elimination needs. Objective: This study aimed to evaluate the feasibility of the Smart Excretion Care System tethered to electronic medical records in a tertiary hospital and community care setting and discuss the anticipated reductions in the burden of nursing care. Methods: Focus group interviews were conducted using the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The interviews were conducted in March 2021 and involved 67 nurses who had worked at Seoul National University Bundang Hospital for more than 1 year and had experience in assisting patients with excretion care. Data were collected using purposive and snowball sampling methods. Results: A total of four themes relevant to the Smart Excretion Care System were found: (1) expected reductions in the burden of nursing care, (2) applicable indications (by departments and diseases), (3) preferred features/functions, and (4) expected benefits of using the Smart Excretion Care System in clinical facilities. Nurses from comprehensive nursing care wards had the highest burden when it came to excretion care. It was a common opinion that the Smart Excretion Care System would be very useful in intensive care units and should be applied first to patients with stroke or dementia. Conclusions: Excretion care is one of the most burdensome tasks for nurses, increasing their workload. The development of the Smart Excretion Care System as a digital health intervention could help improve nurses? work efficiency, reduce their burden, and extend to caregivers and guardians. UR - https://formative.jmir.org/2023/1/e36324 UR - http://dx.doi.org/10.2196/36324 UR - http://www.ncbi.nlm.nih.gov/pubmed/37902820 ID - info:doi/10.2196/36324 ER - TY - JOUR AU - Sant?Anna, Anita AU - Nygren, Jens PY - 2023/10/25 TI - A Pragmatic Mapping of Perceptions and Use of Digital Information Systems in Primary Care in Sweden: Survey Study JO - Interact J Med Res SP - e49973 VL - 12 KW - digital information systems KW - implementation KW - primary care KW - health care professionals KW - information system KW - information systems KW - usability KW - adoption KW - perception KW - perceptions KW - technology use KW - perspective KW - perspectives N2 - Background: Electronic health records and IT infrastructure in primary care allow for digital documentation and access to information, which can be used to guide evidence-based care and monitor patient safety and quality of care. Quality indicators specified by regulatory authorities can be automatically computed and presented to primary care staff. However, the implementation of digital information systems (DIS) in health care can be challenging, and understanding factors such as relative advantage, compatibility, complexity, trialability, and observability is needed to improve the success and rate of adoption and diffusion. Objective: This study aims to explore how DIS are used and perceived by health care professionals in primary care. Methods: This study used quantitative assessment to gather survey data on the use and potential of DIS in health care in Sweden from the perspectives of primary care personnel in various roles. The digital questionnaire was designed to be short and contained 3 sections covering respondent characteristics, current use of platforms, and perceptions of decision support tools. Data were analyzed using descriptive statistics, nonparametric hypothesis testing, ordinal coefficient ?, and confirmatory factor analysis. Results: The study collected responses from participants across 10 regions of Sweden, comprising 31.9% (n=22) from private clinics and 68.1% (n=47) from public clinics. Participants included administrators (18/69, 26.1%), a medical strategist (1/69, 1.4%), and physicians (50/69, 72.5%). Usage frequency varied as follows: 11.6% (n=8) used DIS weekly, 24.6% (n=17) monthly, 27.5% (n=19) a few times a year, 26.1% (n=18) very rarely, and 10.1% (n=7) lacked access. Administrators used DIS more frequently than physicians (P=.005). DIS use centered on quality improvement and identifying high-risk patients, with differences by role. Physicians were more inclined to use DIS out of curiosity (P=.01). Participants desired DIS for patient follow-up, lifestyle guidance, treatment suggestions, reminders, and shared decision-making. Administrators favored predictive analysis (P<.001), while physicians resisted immediate patient identification (P=.03). The 5 innovation attributes showed high internal consistency (?>.7). These factors explained 78.5% of questionnaire variance, relating to complexity, competitive advantage, compatibility, trialability, and observability. Factors 2, 3, and 4 predicted intention to use DIS, with factor 2 alone achieving the best accuracy (root-mean-square=0.513). Conclusions: Administrators and physicians exhibited role-based DIS use patterns highlighting the need for tailored approaches to promote DIS adoption. The study reveals a link between positive perceptions and intention to use DIS, emphasizing the significance of considering all factors for successful health care integration. The results suggest various directions for future studies. These include refining the trialability and observability questions for increased reliability and validity, investigating a larger sample with more specific target groups to improve generalization, and exploring the relevance of different groups? perspectives and needs in relation to decisions about and use of DIS. UR - https://www.i-jmr.org/2023/1/e49973 UR - http://dx.doi.org/10.2196/49973 UR - http://www.ncbi.nlm.nih.gov/pubmed/37878357 ID - info:doi/10.2196/49973 ER - TY - JOUR AU - Palazzolo, Beatrice AU - Carbone, Loretta AU - James, G. Tyler AU - Heizelman, Robert AU - Sen, Ananda AU - Mahmoudi, Elham AU - McKee, Michael PY - 2023/10/25 TI - Model Clinic to Increase Preventive Screenings Among Patients With Physical Disabilities: Protocol for a Mixed Methods Intervention Pilot Study JO - JMIR Res Protoc SP - e50105 VL - 12 KW - clinical decision support KW - electronic health records KW - mixed methods KW - people with physical disabilities KW - primary care N2 - Background: People with physical disabilities often experience premature multimorbidity and adverse health events. A tailored primary care approach for this vulnerable population that also accounts for social and functional risk factors could promote healthier aging and more equitable health care. Objective: This project will evaluate the implementation of a health program designed for people with physical disabilities. The proposed evaluation result is to generate the first best-practice protocol focused specifically on developing primary care to help reduce preventable causes of morbidity and improve functioning among people with physical disabilities. Methods: We will design and implement a pilot health program for people with physical disabilities at a primary care clinic within Michigan Medicine. The health program for people with physical disabilities will be an integrated intervention involving a tailored best practice alert designed to prompt family medicine providers to screen and monitor for common, preventable health conditions. The program will also collect social and functional status information to determine the patient?s need for further care coordination and support. Adult participants from this clinic with identified physical disabilities will be targeted for potential enrollment. To create a quasi-experimental setting, a separate departmental clinic will serve as a control site for comparison purposes. A quantitative analysis to estimate the treatment effect of implementing this health program will be conducted using a difference-in-differences approach. Outcomes of interest will include the use of preventative services (eg, hemoglobin A1c for diabetes screening), social work assistance, and emergency and hospital services. These data will be extracted from electronic health records. Time-invariant covariates, particularly sociodemographic covariates, will be included in the models. A qualitative analysis of patient and health care provider interviews will also be completed to assess the effect of the health program. Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scores will be assessed to both screen for depression and anxiety as well as explore program impacts related to addressing health and functioning needs related to physical disabilities in a primary care setting. These will be summarized through descriptive analyses. Results: This study was funded in September 2018, data collection started in September 2021, and data collection is expected to be concluded in September 2023. Conclusions: This study is a mixed methods evaluation of the effectiveness of an integrated health program designed for people with physical disabilities, based on a quasi-experimental comparison between an intervention and a control clinic site. The intervention will be considered successful if it leads to improvements in greater use of screening and monitoring for preventable health conditions, increased social worker referrals to assist with health and functioning needs, and improvements in emergency and hospital-based services. The findings will help inform best practices for people with physical disabilities in a primary care setting. International Registered Report Identifier (IRRID): DERR1-10.2196/50105 UR - https://www.researchprotocols.org/2023/1/e50105 UR - http://dx.doi.org/10.2196/50105 UR - http://www.ncbi.nlm.nih.gov/pubmed/37878375 ID - info:doi/10.2196/50105 ER - TY - JOUR AU - Yan, Xinghui AU - Newman, W. Mark AU - Park, Young Sun AU - Sander, Angelle AU - Choi, Won Sung AU - Miner, Jennifer AU - Wu, Zhenke AU - Carlozzi, Noelle PY - 2023/10/24 TI - Identifying Design Opportunities for Adaptive mHealth Interventions That Target General Well-Being: Interview Study With Informal Care Partners JO - JMIR Form Res SP - e47813 VL - 7 KW - mHealth intervention KW - mobile health KW - behavior change KW - qualitative study KW - user adherence KW - behavioral messages KW - general well-being N2 - Background: Mobile health (mHealth) interventions can deliver personalized behavioral support to users in daily contexts. These interventions have been increasingly adopted to support individuals who require low-cost and low-burden support. Prior research has demonstrated the feasibility and acceptability of an mHealth intervention app (CareQOL) designed for use with informal care partners. To further optimize the intervention delivery, we need to investigate how care partners, many of whom lack the time for self-care, react and act in response to different behavioral messages. Objective: The goal of this study was to understand the factors that impact care partners? decision-making and actions in response to different behavioral messages. Insights from this study will help optimize future tailored and personalized behavioral interventions. Methods: We conducted semistructured interviews with participants who had recently completed a 3-month randomized controlled feasibility trial of the CareQOL mHealth intervention app. Of the 36 participants from the treatment group of the randomized controlled trial, 23 (64%) participated in these interviews. To prepare for each interview, the team first selected representative behavioral messages (eg, targeting different health dimensions) and presented them to participants during the interview to probe their influence on participants? thoughts and actions. The time of delivery, self-reported perceptions of the day, and user ratings of a message were presented to the participants during the interviews to assist with recall. Results: The interview data showed that after receiving a message, participants took various actions in response to different messages. Participants performed suggested behaviors or adjusted them either immediately or in a delayed manner (eg, sometimes up to a month later). We identified 4 factors that shape the variations in user actions in response to different behavioral messages: uncertainties about the workload required to perform suggested behaviors, concerns about one?s ability to routinize suggested behaviors, in-the-moment willingness and ability to plan for suggested behaviors, and overall capability to engage with the intervention. Conclusions: Our study showed that care partners use mHealth behavioral messages differently regarding the immediacy of actions and the adaptation to suggested behaviors. Multiple factors influence people?s perceptions and decisions regarding when and how to take actions. Future systems should consider these factors to tailor behavioral support for individuals and design system features to support the delay or adaptation of the suggested behaviors. The findings also suggest extending the assessment of user adherence by considering the variations in user actions on behavioral support (ie, performing suggested or adjusted behaviors immediately or in a delayed manner). International Registered Report Identifier (IRRID): RR2-10.2196/32842 UR - https://formative.jmir.org/2023/1/e47813 UR - http://dx.doi.org/10.2196/47813 UR - http://www.ncbi.nlm.nih.gov/pubmed/37874621 ID - info:doi/10.2196/47813 ER - TY - JOUR AU - Kgasi, Mmamolefe AU - Chimbo, Bester AU - Motsi, Lovemore PY - 2023/10/23 TI - mHealth Self-Monitoring Model for Medicine Adherence of Patients With Diabetes in Resource-Limited Countries: Structural Equation Modeling Approach JO - JMIR Form Res SP - e49407 VL - 7 KW - diabetes KW - mobile health KW - mHealth KW - self-monitoring KW - self-management KW - chronic diseases KW - health care provision N2 - Background: The COVID-19 pandemic has led to serious challenges and emphasized the importance of using technology for health care operational transformation. Consequently, the need for technological innovations has increased, thus empowering patients with chronic conditions to tighten their adherence to medical prescriptions. Objective: This study aimed to develop a model for a mobile health (mHealth) self-monitoring system for patients with diabetes in rural communities within resource-limited countries. The developed model could be based on the implementation of a system for the self-monitoring of patients with diabetes to increase medical adherence. Methods: This study followed a quantitative approach, in which data were collected from health care providers using a questionnaire with close-ended questions. Data were collected from district hospitals in 3 South African provinces that were selected based on the prevalence rates of diabetes and the number of patients with diabetes treated. The collected data were analyzed using smart partial least squares to validate the model and test the suggested hypotheses. Results: Using variance-based structural equation modeling that leverages smart partial least squares, the analysis indicated that environmental factors significantly influence all the independent constructs that inform patients? change of behavior toward the use of mHealth for self-monitoring of medication adherence. Technology characteristics such as effort expectancy, self-efficacy, and performance expectancy were equally significant; hence, their hypotheses were accepted. In contrast, the contributions of culture and social aspects were found to be insignificant, and their hypotheses were rejected. In addition, an analysis was conducted to determine the interaction effects of the moderating variables on the independent constructs. The results indicated that with the exception of cultural and social influences, there were significant interacting effects on other independent constructs influencing mHealth use for self-monitoring. Conclusions: On the basis of the findings of this study, we conclude that behavioral changes are essential for the self-monitoring of chronic diseases. Therefore, it is important to enhance those effects that stimulate the behavior to change toward the use of mHealth for self-monitoring. Motivational aspects were also found to be highly significant as they triggered changes in behavior. The developed model can be used to extend the research on the self-monitoring of patients with chronic conditions. Moreover, the model will be used as a basic architecture for the implementation of fully fledged systems for self-monitoring of patients with diabetes. UR - https://formative.jmir.org/2023/1/e49407 UR - http://dx.doi.org/10.2196/49407 UR - http://www.ncbi.nlm.nih.gov/pubmed/37870902 ID - info:doi/10.2196/49407 ER - TY - JOUR AU - Chen, Yanhua AU - Wu, Ziye AU - Wang, Peicheng AU - Xie, Linbo AU - Yan, Mengsha AU - Jiang, Maoqing AU - Yang, Zhenghan AU - Zheng, Jianjun AU - Zhang, Jingfeng AU - Zhu, Jiming PY - 2023/10/19 TI - Radiology Residents? Perceptions of Artificial Intelligence: Nationwide Cross-Sectional Survey Study JO - J Med Internet Res SP - e48249 VL - 25 KW - artificial intelligence KW - technology acceptance KW - radiology KW - residency KW - perceptions KW - health care services KW - resident KW - residents KW - perception KW - adoption KW - readiness KW - acceptance KW - cross sectional KW - survey N2 - Background: Artificial intelligence (AI) is transforming various fields, with health care, especially diagnostic specialties such as radiology, being a key but controversial battleground. However, there is limited research systematically examining the response of ?human intelligence? to AI. Objective: This study aims to comprehend radiologists? perceptions regarding AI, including their views on its potential to replace them, its usefulness, and their willingness to accept it. We examine the influence of various factors, encompassing demographic characteristics, working status, psychosocial aspects, personal experience, and contextual factors. Methods: Between December 1, 2020, and April 30, 2021, a cross-sectional survey was completed by 3666 radiology residents in China. We used multivariable logistic regression models to examine factors and associations, reporting odds ratios (ORs) and 95% CIs. Results: In summary, radiology residents generally hold a positive attitude toward AI, with 29.90% (1096/3666) agreeing that AI may reduce the demand for radiologists, 72.80% (2669/3666) believing AI improves disease diagnosis, and 78.18% (2866/3666) feeling that radiologists should embrace AI. Several associated factors, including age, gender, education, region, eye strain, working hours, time spent on medical images, resilience, burnout, AI experience, and perceptions of residency support and stress, significantly influence AI attitudes. For instance, burnout symptoms were associated with greater concerns about AI replacement (OR 1.89; P<.001), less favorable views on AI usefulness (OR 0.77; P=.005), and reduced willingness to use AI (OR 0.71; P<.001). Moreover, after adjusting for all other factors, perceived AI replacement (OR 0.81; P<.001) and AI usefulness (OR 5.97; P<.001) were shown to significantly impact the intention to use AI. Conclusions: This study profiles radiology residents who are accepting of AI. Our comprehensive findings provide insights for a multidimensional approach to help physicians adapt to AI. Targeted policies, such as digital health care initiatives and medical education, can be developed accordingly. UR - https://www.jmir.org/2023/1/e48249 UR - http://dx.doi.org/10.2196/48249 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856181 ID - info:doi/10.2196/48249 ER - TY - JOUR AU - Solomon, Jeffrey AU - Dauber-Decker, Katherine AU - Richardson, Safiya AU - Levy, Sera AU - Khan, Sundas AU - Coleman, Benjamin AU - Persaud, Rupert AU - Chelico, John AU - King, D'Arcy AU - Spyropoulos, Alex AU - McGinn, Thomas PY - 2023/10/19 TI - Integrating Clinical Decision Support Into Electronic Health Record Systems Using a Novel Platform (EvidencePoint): Developmental Study JO - JMIR Form Res SP - e44065 VL - 7 KW - clinical decision support system KW - cloud based KW - decision support KW - development KW - EHR KW - electronic health record KW - evidence-based medicine KW - health information technology KW - platform KW - user-centered design N2 - Background: Through our work, we have demonstrated how clinical decision support (CDS) tools integrated into the electronic health record (EHR) assist providers in adopting evidence-based practices. This requires confronting technical challenges that result from relying on the EHR as the foundation for tool development; for example, the individual CDS tools need to be built independently for each different EHR. Objective: The objective of our research was to build and implement an EHR-agnostic platform for integrating CDS tools, which would remove the technical constraints inherent in relying on the EHR as the foundation and enable a single set of CDS tools that can work with any EHR. Methods: We developed EvidencePoint, a novel, cloud-based, EHR-agnostic CDS platform, and we will describe the development of EvidencePoint and the deployment of its initial CDS tools, which include EHR-integrated applications for clinical use cases such as prediction of hospitalization survival for patients with COVID-19, venous thromboembolism prophylaxis, and pulmonary embolism diagnosis. Results: The results below highlight the adoption of the CDS tools, the International Medical Prevention Registry on Venous Thromboembolism-D-Dimer, the Wells? criteria, and the Northwell COVID-19 Survival (NOCOS), following development, usability testing, and implementation. The International Medical Prevention Registry on Venous Thromboembolism-D-Dimer CDS was used in 5249 patients at the 2 clinical intervention sites. The intervention group tool adoption was 77.8% (4083/5249 possible uses). For the NOCOS tool, which was designed to assist with triaging patients with COVID-19 for hospital admission in the event of constrained hospital resources, the worst-case resourcing scenario never materialized and triaging was never required. As a result, the NOCOS tool was not frequently used, though the EvidencePoint platform?s flexibility and customizability enabled the tool to be developed and deployed rapidly under the emergency conditions of the pandemic. Adoption rates for the Wells? criteria tool will be reported in a future publication. Conclusions: The EvidencePoint system successfully demonstrated that a flexible, user-friendly platform for hosting CDS tools outside of a specific EHR is feasible. The forthcoming results of our outcomes analyses will demonstrate the adoption rate of EvidencePoint tools as well as the impact of behavioral economics ?nudges? on the adoption rate. Due to the EHR-agnostic nature of EvidencePoint, the development process for additional forms of CDS will be simpler than traditional and cumbersome IT integration approaches and will benefit from the capabilities provided by the core system of EvidencePoint. UR - https://formative.jmir.org/2023/1/e44065 UR - http://dx.doi.org/10.2196/44065 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856193 ID - info:doi/10.2196/44065 ER - TY - JOUR AU - Auener, L. Stefan AU - van Dulmen, A. Simone AU - Atsma, Femke AU - van der Galiën, Onno AU - Bellersen, Louise AU - van Kimmenade, Roland AU - Westert, P. Gert AU - Jeurissen, T. Patrick P. PY - 2023/10/18 TI - Characteristics Associated With Telemonitoring Use Among Patients With Chronic Heart Failure: Retrospective Cohort Study JO - J Med Internet Res SP - e43038 VL - 25 KW - heart failure KW - telemonitoring KW - remote monitoring KW - eHealth KW - chronic heart failure KW - heart KW - disease KW - patient KW - self-management KW - prevention KW - utilization KW - Netherlands KW - hospital KW - treatment N2 - Background: Chronic heart failure (HF) is a chronic disease affecting more than 64 million people worldwide, with an increasing prevalence and a high burden on individual patients and society. Telemonitoring may be able to mitigate some of this burden by increasing self-management and preventing use of the health care system. However, it is unknown to what degree telemonitoring has been adopted by hospitals and if the use of telemonitoring is associated with certain patient characteristics. Insight into the dissemination of this technology among hospitals and patients may inform strategies for further adoption. Objective: We aimed to explore the use of telemonitoring among hospitals in the Netherlands and to identify patient characteristics associated with the use of telemonitoring for HF. Methods: We performed a retrospective cohort study based on routinely collected health care claim data in the Netherlands. Descriptive analyses were used to gain insight in the adoption of telemonitoring for HF among hospitals in 2019. We used logistic multiple regression analyses to explore the associations between patient characteristics and telemonitoring use. Results: Less than half (31/84, 37%) of all included hospitals had claims for telemonitoring, and 20% (17/84) of hospitals had more than 10 patients with telemonitoring claims. Within these 17 hospitals, a total of 7040 patients were treated for HF in 2019, of whom 5.8% (409/7040) incurred a telemonitoring claim. Odds ratios (ORs) for using telemonitoring were higher for male patients (adjusted OR 1.90, 95% CI 1.50-2.41) and patients with previous hospital treatment for HF (adjusted OR 1.76, 95% CI 1.39-2.24). ORs were lower for higher age categories and were lowest for the highest age category, that is, patients older than 80 years (OR 0.30, 95% CI 0.21-0.44) compared to the reference age category (18-59 years). Socioeconomic status, degree of multimorbidity, and excessive polypharmacy were not associated with the use of telemonitoring. Conclusions: The use of reimbursed telemonitoring for HF was limited up to 2019, and our results suggest that large variation exists among hospitals. A lack of adoption is therefore not only due to a lack of diffusion among hospitals but also due to a lack of scaling up within hospitals that already deploy telemonitoring. Future studies should therefore focus on both kinds of adoption and how to facilitate these processes. Older patients, female patients, and patients with no previous hospital treatment for HF were less likely to use telemonitoring for HF. This shows that some patient groups are not served as much by telemonitoring as other patient groups. The underlying mechanism of the reported associations should be identified in order to gain a deeper understanding of telemonitoring use among different patient groups. UR - https://www.jmir.org/2023/1/e43038 UR - http://dx.doi.org/10.2196/43038 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851505 ID - info:doi/10.2196/43038 ER - TY - JOUR AU - Tay Wee Teck, Joseph AU - Gittins, Rosalind AU - Zlatkute, Giedre AU - Oteo Pérez, Alberto AU - Galea-Singer, Susanna AU - Baldacchino, Alexander PY - 2023/10/18 TI - Developing a Theoretically Informed Implementation Model for Telemedicine-Delivered Medication for Opioid Use Disorder: Qualitative Study With Key Informants JO - JMIR Ment Health SP - e47186 VL - 10 KW - telemedicine KW - medication for opioid use disorder KW - implementation model KW - telebuprenorphine KW - opioid use disorder KW - mobile phone N2 - Background: Telemedicine-delivered medication for opioid use disorder (TMOUD) has become more prevalent during the COVID-19 pandemic, particularly in North America. This is considered a positive development as TMOUD has the potential to increase access to evidence-based treatment for a population heavily affected by the opioid crisis and consequent rising mortality and morbidity rates in relation to opioid use disorder. Despite the increase in the use of TMOUD, there are no established service- and process-focused models to guide the implementation of this intervention. Objective: This study aims to develop a process- and service-focused implementation model in collaboration with key stakeholders and bring together peer-reviewed literature, practice-based knowledge, and expert opinions. Methods: The simple rules for evidence translation in complex systems framework was applied to guide the development of a 6-step qualitative study. The steps were definition of the scope and objectives of the model, identification of evidence, stakeholder engagement, draft model development, key informant consultation, and final model specification. Results: The final specification for the TMOUD implementation model incorporated key strategic priorities, service delivery prerequisites, service design elements, stakeholder identification and engagement, key process domains, and iterative cycles of evaluation and improvement. Conclusions: Through stakeholder engagement and key informant consultation, we produced a process- and service-focused TMOUD implementation model. The model is modifiable to different contexts and settings while also in keeping with the current evidence base and national and international standards of high-quality opioid use disorder care. UR - https://mental.jmir.org/2023/1/e47186 UR - http://dx.doi.org/10.2196/47186 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851506 ID - info:doi/10.2196/47186 ER - TY - JOUR AU - Castor, Charlotte AU - Lindkvist, Rose-Marie AU - Hallström, Kristensson Inger AU - Holmberg, Robert PY - 2023/10/18 TI - Health Care Professionals? Experiences and Views of eHealth in Pediatric Care: Qualitative Interview Study Applying a Theoretical Framework for Implementation JO - JMIR Pediatr Parent SP - e47663 VL - 6 KW - communication KW - digital KW - experiences KW - eHealth KW - health care professionals KW - implementation KW - NASSS KW - pediatric care N2 - Background: The development and evaluation of eHealth interventions in clinical care should be accompanied by a thorough assessment of their implementation. The NASSS (Non-adoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies) framework was designed to facilitate the implementation and scale-up of health technology programs, providing an option for analyzing the progression of these initiatives as they are implemented in real-time. Considering health care provider perspectives within the framework for implementation offers valuable insights into the early identification of barriers and facilitators in the implementation of potentially effective eHealth innovations. Nevertheless, there is a dearth of studies on eHealth interventions that encompass longer time frames and delve into the complexities of scaling up and sustaining such interventions within real-world health care environments. Objective: This study aims to investigate the perspectives and insights of health care professionals (HCPs) regarding the implementation of an eHealth intervention in pediatric health care while applying the NASSS framework to theorize and evaluate the conditions influencing the implementation of eHealth solutions. Methods: Semistructured interviews were performed with health care providers, including both staff and management personnel, within a university pediatric hospital (N=10). The data collection process occurred concurrently with a clinical trial focused on developing and assessing an eHealth app for self-management in pediatric care following hospital discharge. Using an abductive approach, the interviews were initially analyzed qualitatively and subsequently mapped onto the 7 domains of the NASSS framework to identify factors influencing implementation, encompassing facilitators, barriers, and varying levels of complexity. Results: In the realm of pediatric care, the family was identified as the primary unit of care, and patient heterogeneity was a prominent feature. The implementation of eHealth tools, while deemed usable and flexible, was also seen as a delicate balance between safety and adaptability, highlighting challenges related to health care integration. Child participation and secrecy, especially for adolescents, contributed to the complexity of using eHealth. HCPs had high eHealth literacy, and thus challenges concerning adoption were related to work adaptations and the risk of ?app overload.? The readiness for implementation was experienced as induced through the research study and the pandemic situation. However, to move from research to implementation in clinical practice, organizational challenges identified a need to update the concept of care and ensure activity measurements. In a wider context, HCPs raised concerns related to regulatory requirements for documentation, public procurement, and data safety. Implementation became more complex due to a lack of overview in a large organization. Conclusions: Important perspectives for implementation were considerations of regulatory requirements, as well as the need for a shared vision of eHealth and the establishment of eHealth-related work as part of regular health care. Key contextual factors that support reach and impact are communication channels between different levels at the hospital and a need for paths and procedures compatible with legal, technological, and security concerns. Further research should focus on how eHealth interventions are perceived by children, adolescents, their parents, and other stakeholders. Trial Registration: ClinicalTrials.gov NCT04150120; https://clinicaltrials.gov/ct2/show/NCT04150120 UR - https://pediatrics.jmir.org/2023/1/e47663 UR - http://dx.doi.org/10.2196/47663 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851500 ID - info:doi/10.2196/47663 ER - TY - JOUR AU - Raff, Christian AU - Dörr-Harim, Colette AU - Otto, Stephanie AU - Thiele, Johanna AU - Mihaljevic, Andre AU - Kramer, Klaus PY - 2023/10/18 TI - Prehabilitation in an Integrative Medicine Day Clinic for Patients Undergoing Neoadjuvant Treatment: Single-Center Feasibility Pilot Study JO - JMIR Res Protoc SP - e46765 VL - 12 KW - supportive care KW - prehabilitation KW - neoadjuvant treatment KW - integrative medicine KW - multimodal prehabilitation KW - cancer KW - oncology KW - surgery KW - preoperative KW - feasibility KW - integrative KW - naturopathy KW - naturopathic KW - diet KW - nutrition N2 - Background: Patients with cancer receiving neoadjuvant treatment prior to surgery are in a very stressful situation. Chemotherapy and radiation therapy put a strain on the quality of life and the pending surgery poses a relevant burden for many patients. Preparation of these patients for the intervention in terms of prehabilitation has great potential to reduce the burden of postoperative complications and may improve the clinical outcome. A prehabilitation approach also yields the possibility to address unmet patients? needs and to help them modify their lifestyle in a maintainable way. Therefore, a multimodal approach is mandatory during this critical period. Objective: The aim of this study is to assess the feasibility of prehabilitation in an integrative medicine day clinic (PRIME-DC) prior to cancer surgery at a major university clinic. PRIME-DC is considered feasible if 80% of enrolled patients are willing and able to complete at least 6 out of the 8 weekly meetings, each lasting 6.5 hours, at such a clinic. Secondary end points aim to evaluate this multimodal program. Methods: The PRIME-DC intervention combines mind-body medicine, exercise therapy, nutrition therapy, naturopathic counseling, and the application of a yarrow liver compress. Adult patients with cancer, with a primary tumor in the abdomen (including intraperitoneal cancer, stomach cancer, and extraperitoneal cancers such as pancreatic, bladder, rectal, esophageal, endometrial, ovarian, and cervical cancer) or the breast requiring a neoadjuvant oncological treatment setting are eligible to participate. The addressed cancer entities imply either an extensive surgical intervention with an expected need for prehabilitation (eg, abdominal surgery) or a neoadjuvant treatment of several months with a high burden of treatment-associated side effects (breast cancer). Adherence to the day clinic program is the primary end point being defined as presence during the day clinic session. Secondary end points are physical assessment and quality of life, together with a structured assessment of neoadjuvant treatment-associated side effects. Furthermore, to collect qualitative data voluntary participants of the day clinic will be interviewed in a semistructured way after completion of the day clinic program on each component of the study (mind-body intervention, exercise, nutrition, naturopathic counseling, and a yarrow liver compress). Results: The procedures used in this study adhere to the tenets of the Declaration of Helsinki. As of February 2023, we enrolled 23 patients; the dominant cancer entity is breast cancer (18 enrolled patients). Conclusions: The presented protocol combines prehabilitation, lifestyle modification, naturopathic counseling, dietary assistance, and naturopathic treatment in an innovative and integrative way. Trial Registration: Deutsches Register Klinischer Studien German Clinical Trials Register DRKS00028126; https://drks.de/search/de/trial/DRKS00028126 International Registered Report Identifier (IRRID): DERR1-10.2196/46765 UR - https://www.researchprotocols.org/2023/1/e46765 UR - http://dx.doi.org/10.2196/46765 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851493 ID - info:doi/10.2196/46765 ER - TY - JOUR AU - Shalev, Ligat AU - Bistre, Moises AU - Lubin, Gadi AU - Avirame, Keren AU - Raskin, Sergey AU - Linkovski, Omer AU - Eitan, Renana AU - Rose, J. Adam PY - 2023/10/17 TI - Enabling Expedited Disposition of Emergencies Using Telepsychiatry in Israel: Protocol for a Hybrid Implementation Study JO - JMIR Res Protoc SP - e49405 VL - 12 KW - eHealth KW - telepsychiatry KW - digital health service KW - emergency department KW - mental health KW - implementation science KW - Promoting Action on Research Implementation in Health Services KW - organizational innovation N2 - Background: Telepsychiatry is the use of virtual communication, such as a video link, to deliver mental health assessment, treatment, and follow-up. Previous studies have shown telepsychiatry to be feasible, accurate compared with in-person practice, and satisfying for psychiatrists and patients. Telepsychiatry has also been associated with reduced waiting times for evaluation and, in some studies, lower admission rates. However, most previous studies focused on using telepsychiatry in community settings and not on involuntary admission. Objective: The aim of this study is to examine the effectiveness and implementation process of patient assessment for involuntary admissions in the psychiatric emergency department (ED) using a video link. Methods: This type 1 hybrid implementation study will examine telepsychiatry effectiveness and the implementation process, by comparing telepsychiatry (n=240) with historical controls who had a face-to-face evaluation (n=240) during the previous, usual care period in 5 psychiatric EDs in Israel. A temporary waiver of the standing policy requiring in-person evaluations only, for the purpose of research, was obtained from the Israeli Ministry of Health. During the telepsychiatry phase, clinical staff and patients will join a video call from the ED, while the attending physician will log in elsewhere. The Promoting Action on Research Implementation in Health Services (PARIHS) framework will guide the evaluation of the telepsychiatry implementation process in the ED. PARIHS has the following 3 constructs: (1) evidence: staff's opinions regarding the innovation?s viability and practicality, their satisfaction levels with its use, and patients' perceptions of the change; (2) context: level of approval of new strategies in the ED, decision-making processes, and the manner in which clinical teams converse and work together; (3) facilitation: adequacy of the facilitation efforts using champions reports. Primary clinical outcomes include ED length of stay and violent incidents obtained from medical records. Results: This study received Helsinki approval from the Ethics Committee of Abarbanel Mental Health Center (174; March 13, 2023), Jerusalem Mental Health Center (22-21; November 6, 2022), Lev-Hasharon Mental Health Medical Center (LH12023; February 12, 2023), Tel-Aviv Medical Center (TLV-22-0656; January 3, 2023), and Sha'ar Menashe (1-4-23; April 18, 2023). Data collection began in July 2023 in 2 study sites and will begin soon at the others. Conclusions: Telepsychiatry could have significant benefits for patients in the psychiatric ED. Examining telepsychiatry effectiveness in the ED, in addition to identifying the facilitators and barriers of implementing it in different emergency settings, will facilitate better policy decisions regarding its implementation. Trial Registration: ClinicalTrials.gov NCT05771545; https://clinicaltrials.gov/study/NCT05771545 International Registered Report Identifier (IRRID): DERR1-10.2196/49405 UR - https://www.researchprotocols.org/2023/1/e49405 UR - http://dx.doi.org/10.2196/49405 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847548 ID - info:doi/10.2196/49405 ER - TY - JOUR AU - Wang, Liying AU - Yuwen, Weichao AU - Hua, Wenzhe AU - Chen, Lingxiao AU - Forsythe Cox, Vibh AU - Zheng, Huang AU - Ning, Zhen AU - Zhao, Zhuojun AU - Liu, Zhaoyu AU - Jiang, Yunzhang AU - Li, Xinran AU - Guo, Yawen AU - Simoni, M. Jane PY - 2023/10/13 TI - Enhancing Mental Health and Medication Adherence Among Men Who Have Sex With Men Recently Diagnosed With HIV With a Dialectical Behavior Therapy?Informed Intervention Incorporating mHealth, Online Skills Training, and Phone Coaching: Development Study Using Human-Centered Design Approach JO - JMIR Form Res SP - e47903 VL - 7 KW - intervention mapping KW - participatory approach KW - cultural adaptation KW - dialectical behavior therapy KW - DBT KW - men who have sex with men KW - MSM KW - coping skill training N2 - Background: Mental health problems are common among men who have sex with men (MSM) living with HIV and may negatively affect medication adherence. Psychosocial interventions designed to address these urgent needs are scarce in China. Incorporating behavioral health theories into intervention development strengthens the effectiveness of these interventions. The absence of a robust theoretical basis for interventions may also present challenges to identify active intervention ingredients. Objective: This study aims to systematically describe the development of a mobile health?based intervention for MSM recently diagnosed with HIV in China, including the theoretical basis for the content and the considerations for its technological delivery. Methods: We used intervention mapping (IM) to guide overall intervention development, a behavioral intervention technology model for technological delivery design, and a human-centered design and cultural adaptation model for intervention tailoring throughout all steps of IM. Results: The dialectical behavior therapy (DBT)?informed intervention, Turning to Sunshine, comprised 3 components: app-based individual skills learning, group-based skills training, and on-demand phone coaching. The theoretical basis for the intervention content is based on the DBT model of emotions, which fits our conceptualization of the intervention user?s mental health needs. The intervention aims to help MSM recently diagnosed with HIV (1) survive moments of high emotional intensity and strong action urges, (2) change emotional expression to regulate emotions, and (3) reduce emotional vulnerability, as well as (4) augment community resources for mental health services. Technological delivery considerations included rationale of the medium, complexity, and esthetics of information delivery; data logs; data visualization; notifications; and passive data collection. Conclusions: This study laid out the steps for the development of a DBT-informed mobile health intervention that integrated app-based individual learning, group-based skills training, and phone coaching. This intervention, Turning to Sunshine, aims to improve mental health outcomes for MSM newly diagnosed with HIV in China. The IM framework informed by human-centered design principles and cultural adaptation considerations offered a systematic approach to develop the current intervention and tailor it to the target intervention users. The behavioral intervention technology model facilitated the translation of behavioral intervention strategies into technological delivery components. The systematic development and reporting of the current intervention can serve as a guide for similar intervention studies. The content of the current intervention could be adapted for a broader population with similar emotional struggles to improve their mental health outcomes. UR - https://formative.jmir.org/2023/1/e47903 UR - http://dx.doi.org/10.2196/47903 UR - http://www.ncbi.nlm.nih.gov/pubmed/37831497 ID - info:doi/10.2196/47903 ER - TY - JOUR AU - Stara, Vera AU - Soraci, Luca AU - Takano, Eiko AU - Kondo, Izumi AU - Möller, Johanna AU - Maranesi, Elvira AU - Luzi, Riccardo AU - Riccardi, Renato Giovanni AU - Browne, Ryan AU - Dacunha, Sébastien AU - Palmier, Cecilia AU - Wieching, Rainer AU - Ogawa, Toshimi AU - Bevilacqua, Roberta PY - 2023/10/12 TI - Intrinsic Capacity and Active and Healthy Aging Domains Supported by Personalized Digital Coaching: Survey Study Among Geriatricians in Europe and Japan on eHealth Opportunities for Older Adults JO - J Med Internet Res SP - e41035 VL - 25 KW - intrinsic capacity KW - functional ability, active and healthy aging KW - digital coaching KW - eHealth interventions KW - older adults N2 - Background: The worldwide aging trend requires conceptually new prevention, care, and innovative living solutions to support human-based care using smart technology, and this concerns the whole world. Enabling access to active and healthy aging through personalized digital coaching services like physical activity coaching, cognitive training, emotional well-being, and social connection for older adults in real life could offer valuable advantages to both individuals and societies. A starting point might be the analysis of the perspectives of different professionals (eg, geriatricians) on such technologies. The perspectives of experts in the sector may allow the individualization of areas of improvement of clinical interventions, supporting the positive perspective pointed out by the intrinsic capacity framework. Objective: The overall aim of this study was to explore the cross-national perspectives and experiences of different professionals in the field of intrinsic capacity, and how it can be supported by eHealth interventions. To our knowledge, this is the first study to explore geriatric care providers? perspectives about technology-based interventions to support intrinsic capacity. Methods: A survey involving 20 geriatricians or clinical experts in the fields of intrinsic capacity and active and healthy aging was conducted in Italy, France, Germany, and Japan between August and September 2021. Results: The qualitative findings pointed out relevant domains for eHealth interventions and provided examples for successful practices that support subjective well-being under the intrinsic capacity framework (the benefits offered by personalized interventions, especially by promoting health literacy but avoiding intrusiveness). Moreover, eHealth interventions could be used as a bridge that facilitates and enables social engagement; an instrument that facilitates communication between doctors and patients; and a tool to enrich the monitoring actions of medical staff. Conclusions: There is an unexplored and significant role for such geriatric perspectives to help the development process and evaluate the evidence-based results on the effectiveness of technologies for older people. This is possible only when clinicians collaborate with data scientists, engineers, and developers in order to match the complex daily needs of older adults. UR - https://www.jmir.org/2023/1/e41035 UR - http://dx.doi.org/10.2196/41035 UR - http://www.ncbi.nlm.nih.gov/pubmed/37824183 ID - info:doi/10.2196/41035 ER - TY - JOUR AU - Ndlovu, Kagiso AU - Stein, Nate AU - Gaopelo, Ruth AU - Annechino, Michael AU - Molwantwa, C. Mmoloki AU - Monkge, Mosadikhumo AU - Forrestel, Amy AU - Williams, L. Victoria PY - 2023/10/10 TI - Evaluating the Feasibility and Acceptance of a Mobile Clinical Decision Support System in a Resource-Limited Country: Exploratory Study JO - JMIR Form Res SP - e48946 VL - 7 KW - VisualDx KW - eHealth KW - technology acceptance model KW - clinical decision support KW - Botswana KW - dermatology KW - mobile phone N2 - Background: In resource-limited countries, access to specialized health care services such as dermatology is limited. Clinical decision support systems (CDSSs) offer innovative solutions to address this challenge. However, the implementation of CDSSs is commonly associated with unique challenges. VisualDx?an exemplar CDSS?was recently implemented in Botswana to provide reference materials in support of the diagnosis and management of dermatological conditions. To inform the sustainable implementation of VisualDx in Botswana, it is important to evaluate the intended users? perceptions about the technology. Objective: This study aims to determine health care workers? acceptance of VisualDx to gauge the feasibility of future adoption in Botswana and other similar health care systems. Methods: The study?s design was informed by constructs of the Technology Acceptance Model. An explanatory, sequential, mixed methods study involving surveys and semistructured interviews was conducted. The REDCap (Research Electronic Data Capture; Vanderbilt University) platform supported web-based data capture from March 2021 through August 2021. In total, 28 health care workers participated in the study. Descriptive statistics were generated and analyzed using Excel (Microsoft Corp), and thematic analysis of interview transcripts was performed using Delve software. Results: All survey respondents (N=28) expressed interest in using mobile health technology to support their work. Before VisualDx, participants referenced textbooks, journal articles, and Google search engines. Overall, participants? survey responses showed their confidence in VisualDx (18/19, 95%); however, some barriers were noted. Frequently used VisualDx features included generating a differential diagnosis through manual entry of patient symptoms (330/681, 48.5% of total uses) or using the artificial intelligence feature to analyze skin conditions (150/681, 22% of total uses). Overall, 61% (17/28) of the survey respondents were also interviewed, and 4 thematic areas were derived. Conclusions: Participants? responses indicated their willingness to accept VisualDx. The ability to access information quickly without internet connection is crucial in resource-constrained environments. Selected enhancements to VisualDx may further increase its feasibility in Botswana. Study findings can serve as the basis for improving future CDSS studies and innovations in Botswana and similar resource-limited countries. UR - https://formative.jmir.org/2023/1/e48946 UR - http://dx.doi.org/10.2196/48946 UR - http://www.ncbi.nlm.nih.gov/pubmed/37815861 ID - info:doi/10.2196/48946 ER - TY - JOUR AU - Layer, Erica AU - Slim, Salim AU - Mussa, Issa AU - Al-Mafazy, Abdul-Wahid AU - Besana, R. Giulia V. AU - Msellem, Mwinyi AU - Fulcher, Isabel AU - Hornung, Heiko AU - Lampariello, Riccardo PY - 2023/10/9 TI - The Journey of Zanzibar?s Digitally Enabled Community Health Program to National Scale: Implementation Report JO - JMIR Med Inform SP - e48097 VL - 11 KW - Zanzibar KW - digital health KW - community health KW - health systems strengthening KW - maternal health KW - child health KW - data for decision-making KW - implementation science KW - health systems KW - healthcare infrastructure KW - health care KW - implementation report N2 - Background: While high-quality primary health care services can meet 80%-90% of health needs over a person?s lifetime, this potential is severely hindered in many low-resource countries by a constrained health care system. There is a growing consensus that effectively designed, resourced, and managed community health worker programs are a critical component of a well-functioning primary health system, and digital technology is recognized as an important enabler of health systems transformation. Objective: In this implementation report, we describe the design and rollout of Zanzibar?s national, digitally enabled community health program?Jamii ni Afya. Methods: Since 2010, D-tree International has partnered with the Ministry of Health Zanzibar to pilot and generate evidence for a digitally enabled community health program, which was formally adopted and scaled nationally by the government in 2018. Community health workers use a mobile app that guides service delivery and data collection for home-based health services, resulting in comprehensive service delivery, access to real-time data, efficient management of resources, and continuous quality improvement. Results: The Zanzibar government has documented increases in the delivery of health facilities among pregnant women and reductions in stunting among children younger than 5 years since the community health program has scaled. Key success factors included starting with the health challenge and local context rather than the technology, usage of data for decision-making, and extensive collaboration with local and global partners and funders. Lessons learned include the significant time it takes to scale and institutionalize a digital health systems innovation due to the time to generate evidence, change opinions, and build capacity. Conclusions: Jamii ni Afya represents one of the world?s first examples of a nationally scaled digitally enabled community health program. This implementation report outlines key successes and lessons learned, which may have applicability to other governments and partners working to sustainably strengthen primary health systems. UR - https://medinform.jmir.org/2023/1/e48097 UR - http://dx.doi.org/10.2196/48097 UR - http://www.ncbi.nlm.nih.gov/pubmed/37812488 ID - info:doi/10.2196/48097 ER - TY - JOUR AU - Kazi, Samia AU - Truesdale, Chloe AU - Ryan, Pauline AU - Wiesner, Glen AU - Jennings, Garry AU - Chow, Clara PY - 2023/10/5 TI - Initial Implementation of the My Heart, My Life Program by the National Heart Foundation of Australia: Pilot Mixed Methods Evaluation Study JO - JMIR Cardio SP - e43889 VL - 7 KW - cardiology KW - prevention KW - digital health KW - heart KW - text message KW - text messaging KW - SMS KW - health communication KW - demographic KW - preventative KW - cardio N2 - Background: Coronary heart disease (CHD) remains the leading cause of death in Australia, with a high residual risk of repeat events in survivors. Secondary prevention therapy is crucial for reducing the risk of both death and other major adverse cardiac events. The National Heart Foundation of Australia has developed a consumer-facing support program called My Heart, My Life (MHML) to address the gap in the secondary prevention of CHD in Australia. The MHML pilot program supplies advice and support for both patients and their caregivers, and it was conducted over 8 months from November 2019 to June 2020. Objective: This study aims to describe and examine the implementation of a novel multimodality secondary CHD prevention pilot program called MHML, which was delivered through booklets, text messages, emails, and telephone calls. Methods: This pilot study consists of a mixed methods evaluation involving surveys of participants (patients and caregivers) and health professionals, in-depth interviews, and digital communication (SMS text message, electronic direct mail, and call record analytics). This study was performed in people older than 18 years with acute coronary syndrome or angina and their caregivers in 38 Australian hospitals from November 2019 to June 2020 through the National Heart Foundation of Australia web page. The main outcome measures were reach, accessibility, feasibility, barriers, and enablers to implementation of this program. Results: Of the 1004 participants (838 patients and 164 caregivers; 2 missing), 60.9% (608/1001) were males, 50.7% (491/967) were aged between 45 and 64 years, 27.4% (276/1004) were from disadvantaged areas, 2.5% (24/946) were from Aboriginal or Torres Strait Islander background, and 16.9% (170/1004) reported English as their second language. The participants (patients and their caregivers) and health professionals reported high satisfaction with the MHML program (55/62, 88.7% and 33/38, 87%, respectively). Of the 62 participants who took the survey, 88% (55/62) used the text messaging service and reported a very high level of satisfaction. Approximately 94% (58/62) and 89% (55/62) of the participants were satisfied with the quick guide booklets 1 and 2, respectively; 79% (49/62) were satisfied with the monthly email journey and 71% (44/62) were satisfied with the helpline calls. Most participants reported that the MHML program improved preventive behaviors, that is, 73% (45/62) of them reported that they maintained increased physical activity and 84% (52/62) reported that they maintained a healthy diet even after the MHML program. Conclusions: The findings of our pilot study suggest that a multimodal support program, including digital, print, phone, and web-based media, for the secondary prevention of CHD is useful and could be a potential means of providing customized at-scale secondary prevention support for survivors of acute coronary syndrome. UR - https://cardio.jmir.org/2023/1/e43889 UR - http://dx.doi.org/10.2196/43889 UR - http://www.ncbi.nlm.nih.gov/pubmed/37796544 ID - info:doi/10.2196/43889 ER - TY - JOUR AU - Holmqvist, Malin AU - Johansson, Linda AU - Lindenfalk, Bertil AU - Thor, Johan AU - Ros, Axel PY - 2023/10/5 TI - Older Persons? and Health Care Professionals? Design Choices When Co-Designing a Medication Plan Aiming to Promote Patient Safety: Case Study JO - JMIR Aging SP - e49154 VL - 6 KW - co-design KW - engagement KW - medications KW - medication plan KW - older people KW - older adults KW - participatory KW - patient experience KW - patient safety KW - remote N2 - Background: Harm from medications is a major patient safety challenge among older persons. Adverse drug events tend to arise when prescribing or evaluating medications; therefore, interventions targeting these may promote patient safety. Guidelines highlight the value of a joint plan for continued treatment. If such a plan includes medications, a medication plan promoting patient safety is advised. There is growing evidence for the benefits of including patients and health care professionals in initiatives for improving health care products and services through co-design. Objective: This study aimed to identify participants? needs and requirements for a medication plan and explore their reasoning for different design choices. Methods: Using a case study design, we collected and analyzed qualitative and quantitative data and compared them side by side. We explored the needs and requirements for a medication plan expressed by 14 participants (older persons, nurses, and physicians) during a co-design initiative in a regional health system in Sweden. We performed a directed content analysis of qualitative data gathered from co-design sessions and interviews. Descriptive statistics were used to analyze the quantitative data from survey answers. Results: A medication plan must provide an added everyday value related to safety, effort, and engagement. The physicians addressed challenges in setting aside time to apply a medication plan, whereas the older persons raised the potential for increased patient involvement. According to the participants, a medication plan needs to support communication, continuity, and interaction. The nurses specifically addressed the need for a plan that was easy to gain an overview of. Important function requirements included providing instant access, automation, and attention. Content requirements included providing detailed information about the medication treatment. Having the plan linked to the medication list and instantly obtainable information was also requested. Conclusions: After discussing the needs and requirements for a medication plan, the participants agreed on an iteratively developed medication plan prototype linked to the medication list within the existing electronic health record. According to the participants, the medication plan prototype may promote patient safety and enable patient engagement, but concerns were raised about its use in daily clinical practice. The last step in the co-design framework is testing the intervention to explore how it works and connects with users. Therefore, testing the medication plan prototype in clinical practice would be a future step. UR - https://aging.jmir.org/2023/1/e49154 UR - http://dx.doi.org/10.2196/49154 UR - http://www.ncbi.nlm.nih.gov/pubmed/37796569 ID - info:doi/10.2196/49154 ER - TY - JOUR AU - Dart, Martin AU - Ahmed, Mohiuddin PY - 2023/10/4 TI - Evaluating Staff Attitudes, Intentions, and Behaviors Related to Cyber Security in Large Australian Health Care Environments: Mixed Methods Study JO - JMIR Hum Factors SP - e48220 VL - 10 KW - computer security KW - cyber security KW - surveys KW - governance KW - mixed methods KW - Australia KW - delivery of health care N2 - Background: Previous studies have identified that the effective management of cyber security in large health care environments is likely to be significantly impacted by human and social factors, as well as by technical controls. However, there have been limited attempts to confirm this by using measured and integrated studies to identify specific user motivations and behaviors that can be managed to achieve improved outcomes. Objective: This study aims to document and analyze survey and interview data from a diverse range of health care staff members, to determine the primary motivations and behaviors that influence their acceptance and application of cyber security messaging and controls. By identifying these issues, recommendations can be made to positively influence future cyber security governance in health care. Methods: An explanatory sequential mixed methods approach was undertaken to analyze quantitative data from a web-based staff survey (N=103), with a concurrent qualitative investigation applied to data gathered via in-depth staff interviews (N=9). Data from both stages of this methodology were mapped to descriptive variables based on a modified version of the Technology Acceptance Model (TAM; TAM2). After normalization, the quantitative data were verified and analyzed using descriptive statistics, distribution and linearity measures, and a bivariate correlation of the TAM variables to identify the Pearson coefficient (r) and significance (P) values. Finally, after confirming Cronbach ?, the determinant score for multicollinearity, and the Kaiser-Meyer-Olkin measure, and applying the Bartlett test of sphericity (?2), an exploratory factor analysis (EFA) was conducted to identify the primary factors with an eigenvalue (?) >1.0. Comments captured during the qualitative interviews were coded using NVivo software (QSR International) to create an emic-to-etic understanding, which was subsequently integrated with the quantitative results to produce verified conclusions. Results: Using the explanatory sequential methodology, this study showed that the perceived usefulness of security controls emerged as the most significant factor influencing staff beliefs and behaviors. This variable represented 24% of all the variances measured in the EFA and was also the most common category identified across all coded interviews (281/692, 40.6%). The word frequency analysis showed that systems, patients, and people represented the top 3 recurring themes reported by the interviewees. Conclusions: To improve cyber security governance in large health care environments, efforts should be focused on demonstrating how confidentiality, integrity, availability, policies, and cloud or vendor-based controls (the main contributors of usefulness measured by the EFA) can directly improve outcomes for systems, staff, and patients. Further consideration also needs to be given to how clinicians should share data and collaborate on patient care, with tools and processes provided to support and manage data sharing securely and to achieve a consistent baseline of secure and normalized behaviors. UR - https://humanfactors.jmir.org/2023/1/e48220 UR - http://dx.doi.org/10.2196/48220 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792450 ID - info:doi/10.2196/48220 ER - TY - JOUR AU - Pfisterer, J. Kaylen AU - Lohani, Raima AU - Janes, Elizabeth AU - Ng, Denise AU - Wang, Dan AU - Bryant-Lukosius, Denise AU - Rendon, Ricardo AU - Berlin, Alejandro AU - Bender, Jacqueline AU - Brown, Ian AU - Feifer, Andrew AU - Gotto, Geoffrey AU - Saha, Shumit AU - Cafazzo, A. Joseph AU - Pham, Quynh PY - 2023/10/4 TI - An Actionable Expert-System Algorithm to Support Nurse-Led Cancer Survivorship Care: Algorithm Development Study JO - JMIR Cancer SP - e44332 VL - 9 KW - prostate cancer KW - patient-reported outcomes KW - nurse-led model of care KW - expert system KW - artificial intelligence?powered decision support KW - digital health KW - nursing KW - algorithm development KW - cancer treatment KW - AI KW - survivorship KW - cancer N2 - Background: Comprehensive models of survivorship care are necessary to improve access to and coordination of care. New models of care provide the opportunity to address the complexity of physical and psychosocial problems and long-term health needs experienced by patients following cancer treatment. Objective: This paper presents our expert-informed, rules-based survivorship algorithm to build a nurse-led model of survivorship care to support men living with prostate cancer (PCa). The algorithm is called No Evidence of Disease (Ned) and supports timelier decision-making, enhanced safety, and continuity of care. Methods: An initial rule set was developed and refined through working groups with clinical experts across Canada (eg, nurse experts, physician experts, and scientists; n=20), and patient partners (n=3). Algorithm priorities were defined through a multidisciplinary consensus meeting with clinical nurse specialists, nurse scientists, nurse practitioners, urologic oncologists, urologists, and radiation oncologists (n=17). The system was refined and validated using the nominal group technique. Results: Four levels of alert classification were established, initiated by responses on the Expanded Prostate Cancer Index Composite for Clinical Practice survey, and mediated by changes in minimal clinically important different alert thresholds, alert history, and clinical urgency with patient autonomy influencing clinical acuity. Patient autonomy was supported through tailored education as a first line of response, and alert escalation depending on a patient-initiated request for a nurse consultation. Conclusions: The Ned algorithm is positioned to facilitate PCa nurse-led care models with a high nurse-to-patient ratio. This novel expert-informed PCa survivorship care algorithm contains a defined escalation pathway for clinically urgent symptoms while honoring patient preference. Though further validation is required through a pragmatic trial, we anticipate the Ned algorithm will support timelier decision-making and enhance continuity of care through the automation of more frequent automated checkpoints, while empowering patients to self-manage their symptoms more effectively than standard care. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-045806 UR - https://cancer.jmir.org/2023/1/e44332 UR - http://dx.doi.org/10.2196/44332 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792435 ID - info:doi/10.2196/44332 ER - TY - JOUR AU - Green, B. James AU - Rodriguez, Joey AU - Keshavan, Matcheri AU - Lizano, Paulo AU - Torous, John PY - 2023/10/3 TI - Implementing Technologies to Enhance Coordinated Specialty Care Framework: Implementation Outcomes From a Development and Usability Study JO - JMIR Form Res SP - e46491 VL - 7 KW - psychosis KW - digital health KW - digital mental health KW - coordinated specialty care KW - digital navigator KW - clinical high risk KW - schizophrenia KW - implementation science KW - technology KW - mobile phone N2 - Background: Coordinated specialty care (CSC) has demonstrated efficacy in improving outcomes in individuals at clinical high risk for psychosis and individuals with first-episode psychosis. Given the limitations of scalability and staffing needs, the augmentation of services using digital mental health interventions (DMHIs) may be explored to help support CSC service delivery. Objective: In this study, we aimed to understand the methods to implement and support technology in routine CSC and offered insights from a quality improvement study assessing the implementation outcomes of DMHIs in CSC. Methods: Patients and clinicians including psychiatrists, therapists, and supported education and employment specialists from a clinical-high-risk-for-psychosis clinic (Center for Early Detection Assessment and Response to Risk [CEDAR]) and a first-episode?psychosis clinic (Advancing Services for Psychosis Integration and Recovery [ASPIRE]) participated in a quality improvement project exploring the feasibility of DMHIs following the Access, Alignment, Connection, Care, and Scalability framework to implement mindLAMP, a flexible and evidenced-based DMHI. Digital navigators were used at each site to assist clinicians and patients in implementing mindLAMP. To explore the differences in implementation outcomes associated with the app format, a menu-style format was delivered at CEDAR, and a modular approach was used at ASPIRE. Qualitative baseline and follow-up data were collected to assess the specific implementation outcomes. Results: In total, 5 patients (ASPIRE: n=3, 60%; CEDAR: n=2, 40%) were included: 3 (60%) White individuals, 2 (40%) male and 2 (40%) female patients, and 1 (20%) transgender man, with a mean age of 19.6 (SD 2.05) years. Implementation outcome data revealed that patients and clinicians demonstrated high accessibility, acceptability, interest, and belief in the sustainability of DMHIs. Clinicians and patients presented a wide range of interest in unique use cases of DMHI in CSC and expressed variable feasibility and appropriateness associated with nuanced barriers and needs. In addition, the results suggest that adoption, penetration, feasibility, and appropriateness outcomes were moderate and might continue to be explored and targeted. Conclusions: Implementation outcomes from this project suggest the need for a patient- and clinician-centered approach that is guided by digital navigators and provides versatility, autonomy, and structure. Leveraging these insights has the potential to build on growing research regarding the need for versatility, autonomy, digital navigator support, and structured applications. We anticipate that by continuing to research and improve implementation barriers impeding the adoption and penetration of DMHIs in CSC, accessibility and uptake of DMHIs will improve, therefore connecting patients to the demonstrated benefits of technology-augmented care. UR - https://formative.jmir.org/2023/1/e46491 UR - http://dx.doi.org/10.2196/46491 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788066 ID - info:doi/10.2196/46491 ER - TY - JOUR AU - Kanninen, Carita Jonna AU - Holm, Anu AU - Koivisto, Anna-Liisa AU - Hietasalo, Pauliina AU - Heikkilä, Anna-Maija AU - Kunvik, Susanna AU - Bergman, Jussi AU - Airaksinen, Marja AU - Puustinen, Juha PY - 2023/10/3 TI - Development of a Preventive Health Screening Procedure Enabling Supportive Service Planning for Home-Dwelling Older Adults (PORI75): Protocol for an Action Research Study JO - JMIR Res Protoc SP - e48753 VL - 12 KW - health screening KW - older adults KW - community health care KW - secondary use KW - Finland KW - screening KW - supportive service KW - clinical patient data KW - community KW - develop KW - primary care KW - self-assessment KW - pilot test KW - testing KW - planning KW - data collection N2 - Background: In Finland, at least 1 in 4 residents will be >75 years of age in 2030. The national aging policy has emphasized the need to improve supportive services to enable older people to live in their own homes for as long as possible. Objective: This study aimed to develop a preventive health screening procedure for home-dwelling older adults aged 75 years to enable the use of clinical patient data for purposes of strategic planning of supportive services in primary care. Methods: The action research method was applied to develop the health screening procedure with selected validated health measures in cooperation with the local practicing interprofessional health care teams from 10 primary care centers in the Social Security Center of Pori, Western Finland (99,485 residents, n=11,938, 12% of them >75 years). The selection of evidence-based validated health measures was based on the national guide to screen factors increasing fall risk and the national functioning measures database. The cut-off points of the selected health measures and laboratory tests were determined in consecutive consensus meetings with the local primary care physicians, with decisions based on internationally validated measures, national current care guidelines, and local policies in clinical practice. Results: The health screening procedure for 75-year-old residents comprised 30 measures divided into three categories: (1) validated self-assessments (9 measures), (2) nurse-conducted screenings (14 measures), and (3) laboratory tests (7 measures). The procedure development process comprised the following steps: (1) inventory and selection of the validated health measures and laboratory tests, (2) training of practical nurses to perform screenings for the segment of 75-year-old residents and to guide them to possible further medical actions, (3) creation of research data from clinical patient data for secondary use purposes, (4) secondary data analysis, and (5) consensus meeting after the pilot test of the health screening procedure for 75-year-old residents procedure in 2019 based on the experiences of health care professionals and collected research data. Conclusions: The developed preventive health screening procedure for 75-year-old residents enables the use of clinical patient data for purposes of strategic planning of supportive services in primary care if the potential bias by a low participation rate is controlled. International Registered Report Identifier (IRRID): DERR1-10.2196/48753 UR - https://www.researchprotocols.org/2023/1/e48753 UR - http://dx.doi.org/10.2196/48753 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788079 ID - info:doi/10.2196/48753 ER - TY - JOUR AU - Hunsbedt Fjellså, Marie Hilde AU - Husebø, Lunde Anne Marie AU - Braut, Harald AU - Mikkelsen, Aslaug AU - Storm, Marianne PY - 2023/10/2 TI - Older Adults? Experiences With Participation and eHealth in Care Coordination: Qualitative Interview Study in a Primary Care Setting JO - J Particip Med SP - e47550 VL - 15 KW - care coordination KW - older adults KW - participation KW - eHealth KW - primary health care N2 - Background: Owing to the demographic changes in the elderly population worldwide, delivering coordinated care at home to multimorbid older adults is of great importance. Older adults living with multiple chronic conditions need information to manage and coordinate their care. eHealth can be effective for gaining sufficient information, communicating, and self-managing chronic conditions. However, incorporating older adults? health preferences and ensuring active involvement remain challenging. More knowledge is needed to ensure successful participation and eHealth use in care coordination. Objective: This study aimed to explore multimorbid older adults? experiences with participation and eHealth in care coordination with general practitioners (GPs) and district nurses (DNs). Methods: The study had a qualitative explorative approach. Data collection included semistructured interviews with 20 older adults with multimorbidity receiving primary care services from their GPs and DNs. The participants were included by their GPs or nurses at a local intermunicipal acute inpatient care unit. The data analysis was guided by systematic text condensation. Results: We identified 2 categories: (1) older adults in charge of and using eHealth in care coordination, and (2) older adults with a loss of control in care coordination. The first category describes how communication with GPs and DNs can facilitate participation, the importance of managing own medication, and how eHealth can support older adults? information needs. The second category focuses on older adults who depend on guidance and help from their GPs and DNs to manage their health, describing how a lack of capacity and system support to be involved makes these adults lose control of their care coordination. Conclusions: Being in charge of care coordination is important for older multimorbid adults. The results show that older adults are willing to use eHealth to be informed and to seek information, which ensures high levels of participation in care coordination. Future research should investigate how older adults can be involved in electronic information sharing with health care providers. UR - https://jopm.jmir.org/2023/1/e47550 UR - http://dx.doi.org/10.2196/47550 UR - http://www.ncbi.nlm.nih.gov/pubmed/37782538 ID - info:doi/10.2196/47550 ER - TY - JOUR AU - Buis, R. Lorraine AU - Brown, K. Lindsay AU - Plegue, A. Melissa AU - Kadri, Reema AU - Laurie, R. Anna AU - Guetterman, C. Timothy AU - Vydiswaran, Vinod V. G. AU - Li, Jiazhao AU - Veinot, C. Tiffany PY - 2023/9/29 TI - Identifying Inequities in Video and Audio Telehealth Services for Primary Care Encounters During COVID-19: Repeated Cross-Sectional, Observational Study JO - J Med Internet Res SP - e49804 VL - 25 KW - COVID-19 KW - telemedicine KW - health equity KW - clinical encounters KW - electronic health records N2 - Background: The COVID-19 pandemic resulted in rapid changes in how patient care was provided, particularly through the expansion of telehealth and audio-only phone-based care. Objective: The goal of this study was to evaluate inequities in video and audio-only care during various time points including the initial wave of the COVID-19 pandemic, later stages of the pandemic, and a historical control. We sought to understand the characteristics of care during this time for a variety of different groups of patients that may experience health care inequities. Methods: We conducted a retrospective analysis of electronic health record (EHR) data from encounters from 34 family medicine and internal medicine primary care clinics in a large, Midwestern health system, using a repeated cross-sectional, observational study design. These data included patient demographic data, as well as encounter, diagnosis, and procedure records. Data were obtained for all in-person and telehealth encounters (including audio-only phone-based care) that occurred during 3 separate time periods: an initial COVID-19 period (T2: March 16, 2020, to May 3, 2020), a later COVID-19 period (T3: May 4, 2020, to September 30, 2020), and a historical control period from the previous year (T1: March 16, 2019, to September 30, 2019). Primary analysis focused on the status of each encounter in terms of whether it was completed as scheduled, it was canceled, or the patient missed the appointment. A secondary analysis was performed to evaluate the likelihood of an encounter being completed based on visit modality (phone, video, in-person). Results: In total, there were 938,040 scheduled encounters during the 3 time periods, with 178,747 unique patients, that were included for analysis. Patients with completed encounters were more likely to be younger than 65 years old (71.8%-74.1%), be female (58.8%-61.8%), be White (75.6%-76.7%), and have no significant comorbidities (63.2%-66.8%) or disabilities (53.2%-61.1%) in all time periods than those who had only canceled or missed encounters. Effects on different subpopulations are discussed herein. Conclusions: Findings from this study demonstrate that primary care utilization across delivery modalities (in person, video, and phone) was not equivalent across all groups before and during the COVID-19 pandemic and different groups were differentially impacted at different points. Understanding how different groups of patients responded to these rapid changes and how health care inequities may have been affected is an important step in better understanding implementation strategies for digital solutions in the future. UR - https://www.jmir.org/2023/1/e49804 UR - http://dx.doi.org/10.2196/49804 UR - http://www.ncbi.nlm.nih.gov/pubmed/37773609 ID - info:doi/10.2196/49804 ER - TY - JOUR AU - Willemsen, Fleur Romy AU - Meijer, Eline AU - van den Berg, Nicoline Liselot AU - van der Burg, Luuk AU - Chavannes, Henrik Niels AU - Aardoom, Joelle Jiska PY - 2023/9/29 TI - A Health App Platform Providing a Budget to Purchase Preselected Apps as an Innovative Way to Support Public Health: Qualitative Study With End Users and Other Stakeholders JO - JMIR Form Res SP - e49473 VL - 7 KW - eHealth KW - health apps KW - health app platform KW - prevention KW - public health KW - health platform KW - health promotion KW - digital health KW - app evaluation KW - Framework Method KW - focus group KW - focus groups KW - evaluate KW - evaluation KW - platform KW - acceptability KW - feasibility KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - mobile phone N2 - Background: eHealth has the potential to improve health outcomes. However, this potential is largely untapped. Individuals face an overload of apps and have difficulties choosing suitable apps for themselves. In the FitKnip experiment, individuals were given access to a health app platform, where they could purchase reliable preselected health apps with a personal budget of ?100 (US $107.35). By conducting a prospective study, we aimed to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. Objective: The aim of the experiment was to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. More specifically, we conducted an in-depth qualitative evaluation of the concept and acceptability of FitKnip, its perceived impact on health empowerment, as well as the roles of stakeholders for the future implementation of a health app platform through focus group interviews. Methods: This study followed a phenomenological research design and included 7 focus group interviews with end users and 1 with stakeholders, held between July and December 2020. End users were recruited through various institutions in the Netherlands, for example, insurance companies and local governments. All focus groups were semistructured using interview guides and were held via videoconferencing due to the COVID-19 pandemic measures. Each participant received access to a health app platform where they were enabled to purchase reliable, preselected health apps with a budget of ?100 (US $107.35). The budget was valid for the entire research period. The health app platform offered 38 apps. A third party, a health care coalition, selected the apps to be included in FitKnip. The analyses were conducted according to the principles of the Framework Method. Results: A priori formulated themes were concept, acceptability, health empowerment, and outcomes, and the roles of stakeholders for the future implementation of a health app platform. Both end users (n=31) and stakeholders (n=5) were enthusiastic about the concept of a health app platform. End users indicated missing apps regarding physical health and lifestyle and needing more guidance toward suitable apps. End users saw health empowerment as a precondition to using a health app platform and achieving health outcomes depending on the purchased mobile apps. End users and stakeholders identified potential providers and financing parties of FitKnip. Stakeholders recommended the establishment of a reputable national or international quality guidelines or certification for health and wellbeing apps, that can demonstrate the quality and reliability of mobile health applications. Conclusions: This study showed the need for a personalized and flexible platform. Next to this, a deeper understanding of the roles of stakeholders in such initiatives is needed especially on financing and reimbursement of health promotion and digital health services. A personalized, flexible health app platform is a promising initiative to support individuals in their health. UR - https://formative.jmir.org/2023/1/e49473 UR - http://dx.doi.org/10.2196/49473 UR - http://www.ncbi.nlm.nih.gov/pubmed/37773608 ID - info:doi/10.2196/49473 ER - TY - JOUR AU - Li, Zhong AU - Merrell, A. Melinda AU - Eberth, M. Jan AU - Wu, Dezhi AU - Hung, Peiyin PY - 2023/9/28 TI - Successes and Barriers of Health Information Exchange Participation Across Hospitals in South Carolina From 2014 to 2020: Longitudinal Observational Study JO - JMIR Med Inform SP - e40959 VL - 11 KW - health information exchange KW - electronic health records KW - interoperability KW - meaningful use KW - hospital N2 - Background: The 2009 Health Information Technology for Economic and Clinical Health Act sets three stages of Meaningful Use requirements for the electronic health records incentive program. Health information exchange (HIE) technologies are critical in the meaningful use of electronic health records to support patient care coordination. However, HIE use trends and barriers remain unclear across hospitals in South Carolina (SC), a state with the earliest HIE implementation. Objective: This study aims to explore changes in the proportion of HIE participation and factors associated with HIE participation, and barriers to exchange and interoperability across SC hospitals. Methods: This study derived data from a longitudinal data set of the 2014-2020 American Hospital Association Information Technology Supplement for 69 SC hospitals. The primary outcome was whether a hospital participated in HIE in a year. A cross-sectional multivariable logistic regression model, clustered at the hospital level and weighted by bed size, was used to identify factors associated with HIE participation. The second outcome was barriers to sending, receiving, or finding patient health information to or from other organizations or hospital systems. The frequency of hospitals reporting each barrier related to exchange and interoperability were then calculated. Results: Hospitals in SC have been increasingly participating in HIE, improving from 43% (24/56) in 2014 to 82% (54/66) in 2020. After controlling for other hospital factors, teaching hospitals (adjusted odds ratio [AOR] 3.7, 95% CI 1.0-13.3), system-affiliated hospitals (AOR 6.6, 95% CI 3.2-13.7), and rural referral hospitals (AOR 8.0, 95% CI 1.2-53.4) had higher odds to participate in HIE than their counterparts, whereas critical access hospitals (AOR 0.1, 95% CI 0.02-0.6) were less likely to participate in HIE than their counterparts reimbursed by the prospective payment system. Hospitals with greater ratios of Medicare or Medicaid inpatient days to total inpatient days also reported higher odds of HIE participation. Despite the majority of hospitals reporting HIE participation in 2020, barriers to exchange and interoperability remained, including lack of provider contacts (27/40, 68%), difficulty in finding patient health information (27/40, 68%), adapting different vendor platforms (26/40, 65%), difficulty matching or identifying same patients between systems (23/40, 58%), and providers that do not typically exchange patient data (23/40, 58%). Conclusions: HIE participation has been widely adopted in SC hospitals. Our findings highlight the need to incentivize optimization of HIE and seamless information exchange by facilitating and implementing standardization of health information across various HIE systems and by addressing other technical issues, including providing providers? addresses and training HIE stakeholders to find relevant information. Policies and efforts should include more collaboration with vendors to reduce platform compatibility issues and more user engagement and technical training and support to facilitate effective, accurate, and efficient exchange of provider contacts and patient health information. UR - https://medinform.jmir.org/2023/1/e40959 UR - http://dx.doi.org/10.2196/40959 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768730 ID - info:doi/10.2196/40959 ER - TY - JOUR AU - Svanholm, Frida AU - Turesson, Christina AU - Löfgren, Monika AU - Björk, Mathilda PY - 2023/9/28 TI - Acceptability of the eHealth Intervention Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers (SWEPPE): Questionnaire and Interview Study JO - JMIR Hum Factors SP - e46878 VL - 10 KW - chronic pain KW - digital support KW - eHealth KW - return to work KW - rehabilitation KW - support KW - quality of life KW - implementation KW - acceptability KW - interview KW - questionnaire KW - qualitative KW - barrier KW - users KW - mobile phone N2 - Background: Sick leave and decreased ability to work are the consequences of chronic pain. Interdisciplinary pain rehabilitation programs (IPRPs) aim to improve health-related quality of life and participation in work activities, although implementing rehabilitation strategies at work after IPRPs can be difficult. Employers? knowledge about pain and the role of rehabilitation needs to be strengthened. The self-management of chronic pain can be improved through eHealth interventions. However, these interventions do not involve communicating with employers to improve work participation. To address this deficiency, a new eHealth intervention, Sustainable Worker Digital Support for Persons with Chronic Pain and Their Employers (SWEPPE), was developed. Objective: This study aimed to describe the acceptability of SWEPPE after IPRPs from the perspective of patients with chronic pain and their employers. Methods: This study included 11 patients and 4 employers who were recruited to test SWEPPE in daily life for 3 months after IPRPs. Data were collected using individual interviews at the end of the 3-month test period and questionnaires, which were completed when SWEPPE was introduced (questionnaire 1) and at a 3-month follow-up (questionnaire 2). Data were also collected on how often SWEPPE was used. Qualitative data were analyzed through a qualitative content analysis using an abductive approach. The framework used for the deductive approach was the theoretical framework of acceptability. Quantitative data were analyzed through descriptive statistics and the differences between the responses to questionnaires 1 and questionnaire 2 using the Wilcoxon signed rank test. Results: Both patients and employers reported that SWEPPE increased their knowledge and understanding of how to improve work participation and helped them identify goals, barriers, and strategies for return to work. In addition, participants noted that SWEPPE improved employer-employee communication and collaboration. However, experiences and ratings varied among participants and the different SWEPPE modules. The acceptability of SWEPPE was lower in patients who experienced significant pain and fatigue. A high degree of flexibility and choice of ratings in SWEPPE were generally described as helpful. Conclusions: This study shows promising results on the user acceptability of SWEPPE from both patient and employer perspectives. However, the variations among patients and modules indicate a need for further testing and research to refine the content and identify the group of patients who will best benefit from SWEPPE. UR - https://humanfactors.jmir.org/2023/1/e46878 UR - http://dx.doi.org/10.2196/46878 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768708 ID - info:doi/10.2196/46878 ER - TY - JOUR AU - Alqurashi, Heba AU - Mohammed, Rafiuddin AU - AlGhanmi, Shlyan Amany AU - Alanazi, Farhan PY - 2023/9/28 TI - The Perception of Health Care Practitioners Regarding Telemedicine During COVID-19 in Saudi Arabia: Mixed Methods Study JO - JMIR Form Res SP - e47065 VL - 7 KW - telemedicine KW - health care practitioners KW - COVID-19 KW - Saudi Arabia KW - mobile phone N2 - Background: Telemedicine is a rapidly evolving field that uses information and communication technology to provide remote health care services, such as diagnosis, treatment, consultation, patient monitoring, and medication delivery. With advancements in technology, telemedicine has become increasingly popular during the COVID-19 lockdown and has expanded beyond remote consultations via telephone or video to include comprehensive and reliable services. The integration of telemedicine platforms can enable patients and health care providers to communicate more efficiently and effectively. Objective: This study aims to investigate the awareness, knowledge, requirements, and perceptions of health care practitioners in Saudi Arabia during the pandemic health crisis from the end-user perspective. The findings of this study will inform policy makers regarding the sustainability of telemedicine and how it affects the process of provision of health care and improves the patients? journey. Methods: This study adopted a mixed methods design with a quantitative-based cross-sectional design and qualitative interviews to assess the perceptions of various health care professionals working in outpatient departments that have a telemedicine system that was used during the COVID-19 pandemic. For both approaches, ethics approval was obtained, and informed consent forms were signed. In total, 81 completed questionnaires were used in this study. In the second phase, general interviews were conducted with managerial staff and health care professionals to obtain their view of telemedicine services in their hospitals. Results: The study revealed that most participants (67/81, 83%) were familiar with telemedicine technology, and the study proved to be statistically significant at P<.05 with a proportion of the participants (52/81, 64%) believing that continuous training was essential for its effective use. The study also found that consultations (55/153, 35.9%) and monitoring patients (35/153, 22.9%) were the major components of telemedicine used by health care professionals, with telephones being the most commonly used mode of interaction with patients (74/117, 63.2%). In addition, 54% (44/81) of the respondents expressed concerns about patient privacy and confidentiality, highlighting this as a major issue. Furthermore, the majority of participants (58/81, 72%) reported the necessity of implementing national standards essential for telemedicine technology in Saudi Arabia. The interviews conducted as part of the study revealed 5 major themes: culture, barriers and difficulties, communication, implementation, and evaluation. These themes highlighted the importance of a culture of acceptance and flexibility, effective communication, and ongoing evaluation of telemedicine technologies in health care systems. Conclusions: This study provides a crucial message with insights into the perceptions and experiences of health care professionals with telemedicine during the COVID-19 pandemic in Saudi Arabia. UR - https://formative.jmir.org/2023/1/e47065 UR - http://dx.doi.org/10.2196/47065 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768720 ID - info:doi/10.2196/47065 ER - TY - JOUR AU - Nguyen, Anna AU - Nagykaldi, Zsolt AU - Bui, Thanh AU - Chen, Sixia AU - Businelle, Michael AU - Eschiti, Valerie AU - Dwyer, Kathleen PY - 2023/9/28 TI - mHealth Intervention for Vietnamese Living With Diabetes: Protocol for a Stepped Wedge Pilot Study JO - JMIR Res Protoc SP - e48585 VL - 12 KW - Vietnamese KW - type 2 diabetes KW - diabetes self-management KW - mobile health technology KW - intervention study KW - stepped wedge design KW - mobile health KW - intervention KW - mobile app KW - digital health KW - diabetes KW - self-management KW - awareness KW - mhealth KW - implementation N2 - Background: Evidence indicates participation in a diabetes self-management education and support program improves self-care behaviors and hemoglobin A1c. Language and cultural differences may be barriers to program participation resulting in ineffective self-management, but these factors can be addressed with appropriate interventions. Given the high health care costs associated with diabetes complications, we developed a multicomponent, culturally tailored Self-Management Mobile Health Intervention for US Vietnamese With Diabetes (SMart-D). Objective: This study aims to evaluate the SMart-D intervention?s feasibility, acceptability, and effectiveness with intentions to scale up the intervention in the future. This mixed methods study incorporates the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to evaluate the intervention. Methods: This stepped wedge randomized controlled pilot study will be conducted over 2 years in collaboration with primary care clinics. Eligible participants are patients with type 2 diabetes who are receiving health care from participating clinics. Clinics will be randomly assigned to an implementation date and will begin with patients enrolling in the control period while receiving standard care, then cross over to the intervention period where patients receive standard care plus the SMart-D intervention for over 12 weeks. Focus groups or interviews will be conducted with clinicians and patients after study completion. Qualitative data will be analyzed using NVivo. Outcomes on self-care behavior changes will be measured with the Summary of Diabetes Self-Care Activities scale and clinical changes will be measured using laboratory tests. A generalized linear mixed-effect model will be used to compute time effect, clustering effect, and the interaction of the control and intervention periods using SAS (version 9.4; SAS Institute). Results: We hypothesize that (1) at least 50% (n=5) of eligible clinics and 50% (n=40) of eligible patients who are invited will participate, and at least 70% (n=56) of patients will complete the program, and (2) patients who receive the intervention will have improved self-care behaviors and clinical test results with at least 75% (n=60) of the patients maintaining improved outcomes at follow-up visits compared with baseline, and participants will verbalize that the intervention is feasible and acceptable. As of August 2023, we enrolled 10 clinics and 60 patients. Baseline data results will be available by the end of 2023 and outcome data will be published in 2025. Conclusions: This is the first Vietnamese diabetes self-management education and support intervention that leverages mobile health technology to address the barriers of language and culture differences through collaboration with primary care clinics. This study will provide a better understanding of the implementation process, demonstrate the potential effectiveness of the intervention, accelerate the pace of moving evidence-based interventions to practice among the US Vietnamese population, and potentially provide a replicable implementation model that can be culturally adapted to other non-English speaking ethnic minorities. International Registered Report Identifier (IRRID): DERR1-10.2196/48585 UR - https://www.researchprotocols.org/2023/1/e48585 UR - http://dx.doi.org/10.2196/48585 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768716 ID - info:doi/10.2196/48585 ER - TY - JOUR AU - Palm, Klas AU - Kronlid, Carl AU - Brantnell, Anders AU - Elf, Marie AU - Borg, Johan PY - 2023/9/28 TI - Identifying and Addressing Barriers and Facilitators for the Implementation of Internet of Things in Distributed Care: Protocol for a Case Study JO - JMIR Res Protoc SP - e44562 VL - 12 KW - barriers KW - digital health KW - facilitators KW - health care KW - implementation KW - internet of things KW - IoT solution KW - older people KW - person-centered care KW - technology N2 - Background:  The internet of things (IoT) is recognized as a valuable approach to supporting health care to achieve quality and person-centered care. This study aims to identify the facilitators and barriers associated with implementing IoT solutions in health care within a Scandinavian context. It addresses the pressing need to adapt health care systems to the demographic changes occurring in Scandinavia. The vision of ?Vision eHealth 2025,? a long-term strategic direction for digitalization in Sweden, serves as the background for this project. The implementation of IoT solutions is a crucial aspect of achieving the vision?s goal of making Sweden a global leader in using digitalization and eHealth opportunities by 2025. IoT is recognized as a valuable approach to supporting health care to achieve quality and person-centered care. Previous research has shown that there is a gap in our understanding of social and organizational challenges related to IoT and that the implementation and introduction of new technology in health care is often problematic. Objective:  In this study, we will identify facilitating and hindering factors for the implementation of IoT solutions in social and health care. Methods:  We will use an explorative design with a case study approach. The data collection will comprise questionnaires and qualitative interviews. Also, a literature review will be conducted at the start of the project. Thus, quantitative and qualitative data will be collected concurrently and integrated into a convergent mixed methods approach. Results:  As of June 2023, data for the review and 22 interviews with the stakeholders have been performed. The co-design with stakeholders will be performed in the fall of 2023. Conclusions:  This study represents a unique and innovative opportunity to gain new knowledge relevant and useful for future implementation of new technology at health care organizations so they can continue to offer high-quality, person-centered care. The outcomes of this research will contribute to a better understanding of the conditions necessary to implement and fully use the potential of IoT solutions. By developing cocreated implementation strategies, the study seeks to bridge the gap between theory and practice. Ultimately, this project aims to facilitate the adoption of IoT solutions in health care for promoting improved patient care and using technology to meet the evolving needs of health care. International Registered Report Identifier (IRRID): DERR1-10.2196/44562 UR - https://www.researchprotocols.org/2023/1/e44562 UR - http://dx.doi.org/10.2196/44562 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768725 ID - info:doi/10.2196/44562 ER - TY - JOUR AU - Cardwell, Trey Ethan AU - Ludwick, Teralynn AU - Fairley, Christopher AU - Bourne, Christopher AU - Chang, Shanton AU - Hocking, S. Jane AU - Kong, S. Fabian Y. PY - 2023/9/22 TI - Web-Based STI/HIV Testing Services Available for Access in Australia: Systematic Search and Analysis JO - J Med Internet Res SP - e45695 VL - 25 KW - STI/HIV testing KW - STI/HIV KW - self-testing KW - sexual health KW - web-based STI testing KW - web-based STI/HIV testing N2 - Background: Sexually transmitted infection (STI) rates continue to rise in Australia, and timely access to testing and treatment is crucial to reduce transmission. Web-based services have been viewed as a way to improve timely access to STI/HIV testing and have proliferated in recent years. However, the regulation of these services in Australia is minimal, leading to concerns about their quality. The purpose of this review was to systematically identify web-based STI/HIV testing services available in Australia and assess them on aspects of quality, reliability, and accessibility. Objective: We aim to systematically identify and assess web-based STI/HIV testing services available in Australia. Methods: A Google search of Australian web-based services was conducted in March 2022 and repeated in September 2022 using Boolean operators and search terms related to test services (eg, on the internet or home), STIs (eg, chlamydia or gonorrhea), and test type (eg, self-test). The first 10 pages were assessed, and services were categorized as self-testing (ST; test at home), self-sampling (SS; sample at home and return to laboratory), or self-navigated pathology (SNP; specimens collected at pathology center). Website reliability was assessed against the Health on the Net Foundation code of conduct, and service quality was assessed using a scorecard that was developed based on similar reviews, Australian guidelines for in-person services, and UK standards. Additionally, we looked at measures of accessibility including cost, rural access, and time to test results. Results: Seventeen services were identified (8 ST, 2 SS, and 7 SNP). Only 4 services offered recommended testing for all 4 infections (chlamydia, gonorrhea, syphilis, and HIV) including genital, anorectal, and oropharyngeal sites, and 5 offered tests other than those recommended by Australian testing guidelines (eg, Ureaplasma). Nine services (1 SNP, 8 self-test) had no minimum age requirements for access. Reliability scores (scale 0-8) were similar between all services (range 4.75-8.0). Quality weighted scores (scale 0-58) were similar between SNP and SS services (average 44.89, SD 5.56 and 44.75, SD 1.77, respectively) but lower for ST services (22.66, SD 8.93; P=.002). Government-funded services were of higher quality than private services (43.54, SD 6.71 vs 29.43, SD 13.55; P=.03). The cost for services varied between SNP (Aus $0-$595; ie, US $0-$381.96), self-sample (Aus $0; ie, US $0), and ST (Aus $0-$135; ie, US $0-$86.66). The time to test results was much shorter for SNP services (~4 days) than for SS (~12 days) and ST (~14 days). Conclusions: This review identified considerable variability in the quality and reliability of the web-based STI/HIV testing services in Australia. Given the proliferation and use of these services will likely increase, it is imperative that Australia develops national standards to ensure the standard-of-care offered by web-based STI/HIV testing services is appropriate to protect Australian users from the impact of poorly performing and inappropriate tests. UR - https://www.jmir.org/2023/1/e45695 UR - http://dx.doi.org/10.2196/45695 UR - http://www.ncbi.nlm.nih.gov/pubmed/37738083 ID - info:doi/10.2196/45695 ER - TY - JOUR AU - Schick, Sofie Teresa AU - Höllerl, Lea AU - Biedermann, Tilo AU - Zink, Alexander AU - Ziehfreund, Stefanie PY - 2023/9/22 TI - Impact of Digital Media on the Patient Journey and Patient-Physician Relationship Among Dermatologists and Adult Patients With Skin Diseases: Qualitative Interview Study JO - J Med Internet Res SP - e44129 VL - 25 KW - digital media KW - dermatology KW - patient journey KW - patient-physician relationship KW - semistructured interview KW - qualitative content analysis N2 - Background: Digital media are easily accessible without time restrictions and are widely used for health- or disease-related purposes. However, their influence on the patient journey and the patient-physician relationship has not yet been sufficiently investigated. Objective: This qualitative interview study was designed to explore dermatologists? and patients? experiences with digital media for medical purposes in the context of patient journeys and patient-physician relationships. Methods: Twenty-eight semistructured video conference?based interviews were conducted and audiorecorded by experienced interviewers between November 2021 and June 2022 in Germany. Eligible patients were those who were aged ?18 years, were affected by at least one physician-confirmed skin disease, and were fluent in the German language. The eligibility criterion for dermatologists was that they were currently practicing dermatology in an outpatient setting or in a hospital. Randomly selected dermatologists from the listing of the German National Association of Statutory Health Insurance Physicians and dermatologists from personal academic and professional networks were invited for participation via postal mail and asked to identify potential patient volunteers from their patient bases. All recorded data were pseudonymized, fully transcribed verbatim, and subsequently analyzed according to Mayring?s qualitative content analysis by 2 researchers, allowing for both a qualitative interview text analysis and a quantitative assessment of category assignments. Results: In total, 28 participants were interviewed: 16 adult patients and 12 dermatologists. Eight main categories emerged as key areas of interest: (1) the search for diagnosis and symptom triggers, (2) preconsultation digital media use, (3) in-depth information and exchange with other patients, (4) self-treatment, (5) patient-physician interaction, (6) roles of dermatologists and patients, (7) patient eHealth literacy, and (8) opportunities and risks. Categories 1 and 2 were only coded for patients; the other categories were coded for both patients and dermatologists. Patients reported searches for diagnosis or treatment options were most frequently (8/16) caused by a mismatch of symptoms and diagnosis or dissatisfaction with current therapies. Concerns regarding a potentially severe diagnosis prompted searches for initial or in-depth information before or after dermatological consultations. However, the large volume of information of varying quality often confused patients, leading dermatologists to assume the role of evaluating information from preinformed patients. Dermatologists generally encouraged the use of digital media, considered teledermatology advantageous, and viewed big data and artificial intelligence as being potentially beneficial, particularly when searching for rare diagnoses. A single, easily accessible, and free-of-charge platform with high quality information in lay language was recommended by the dermatologists and desired by patients. Conclusions: Digital media are widely accepted by both patients and dermatologists and can positively influence both the dermatological patient journey and patient-physician relationship. Digital media may therefore have great potential to improve specialized health care if patients and dermatologists embrace their new roles. UR - https://www.jmir.org/2023/1/e44129 UR - http://dx.doi.org/10.2196/44129 UR - http://www.ncbi.nlm.nih.gov/pubmed/37738078 ID - info:doi/10.2196/44129 ER - TY - JOUR AU - Werkmeister, Benjamin AU - Haase, M. Anne AU - Fleming, Theresa AU - Officer, N. Tara PY - 2023/9/22 TI - Global Implications From the Rise and Recession of Telehealth in Aotearoa New Zealand Mental Health Services During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Form Res SP - e50486 VL - 7 KW - telehealth KW - mental health services KW - Aotearoa New Zealand KW - mixed methods research KW - clinician KW - COVID-19 N2 - Background: The COVID-19 pandemic accelerated the adoption of telehealth services for remote mental health care provision. Although studies indicate that telehealth can enhance the efficiency of service delivery and might be favored or even preferred by certain clients, its use varied after the pandemic. Once the pandemic-related restrictions eased, some regions curtailed their telehealth offerings, whereas others sustained them. Understanding the factors that influenced these decisions can offer valuable insights for evidence-based decision-making concerning the future of telehealth in mental health services. Objective: This study explored the factors associated with the uptake of and retreat from telehealth across a multiregional outpatient mental health service in Aotearoa New Zealand. We aimed to contribute to the understanding of the factors influencing clinicians? use of telehealth services to inform policy and practice. Methods: Applying an interpretive description methodology, this sequential mixed methods study involved semistructured interviews with 33 mental health clinicians, followed by a time-series analysis of population-level quantitative data on clinician appointment activities before and throughout the COVID-19 pandemic. The interviews were thematically analyzed, and select themes were reframed for quantitative testing. The time-series analysis was conducted using administrative data to explore the extent to which these data supported the themes. In total, 4,117,035 observations were analyzed between September 2, 2019, and August 1, 2022. The findings were then synthesized through the rereview of qualitative themes. Results: The rise and recession of telehealth in the study regions were related to 3 overarching themes: clinician preparedness and role suitability, population determinants, and service capability. Participants spoke about the importance of familiarity and training but noted differences between specialist roles. Quantitative data further suggested differences based on the form of telehealth services offered (eg, audiovisual or telephone). In addition, differences were noted based on age, gender, and ethnicity; however, clinicians recognized that effective telehealth use enabled clinicians? flexibility and client choice. In turn, clinicians spoke about system factors such as telehealth usability and digital exclusion that underpinned the daily functionality of telehealth. Conclusions: For telehealth services to thrive when they are not required by circumstances such as pandemic, investment is needed in telehealth training for clinicians, digital infrastructure, and resources for mental health teams. The strength of this study lies in its use of population-level data and consideration of a telehealth service operating across a range of teams. In turn, these findings reflect the voice of a variety of mental health clinicians, including teams operating from within specific cultural perspectives. UR - https://formative.jmir.org/2023/1/e50486 UR - http://dx.doi.org/10.2196/50486 UR - http://www.ncbi.nlm.nih.gov/pubmed/37738075 ID - info:doi/10.2196/50486 ER - TY - JOUR AU - Dale, Jeremy AU - Nanton, Veronica AU - Day, Theresa AU - Apenteng, Patricia AU - Bernstein, Janine Celia AU - Grason Smith, Gillian AU - Strong, Peter AU - Procter, Rob PY - 2023/9/21 TI - Uptake and Use of Care Companion, a Web-Based Information Resource for Supporting Informal Carers of Older People: Mixed Methods Study JO - JMIR Aging SP - e41185 VL - 6 KW - informal carers KW - information technology KW - internet KW - information needs KW - mixed methods evaluation KW - Reach, Effectiveness, Adoption, Implementation, and Maintenance KW - RE-AIM KW - mobile phone N2 - Background: Informal carers play a major role in supporting relatives and friends who are sick, disabled, or frail. Access to information, guidance, and support that are relevant to the lives and circumstances of carers is critical to carers feeling supported in their role. When unmet, this need is known to adversely affect carer resilience and well-being. To address this problem, Care Companion was co-designed with current and former carers and stakeholders as a free-to-use, web-based resource to provide access to a broad range of tailored information, including links to local and national resources. Objective: This study aimed to investigate the real-world uptake and use of Care Companion in 1 region of England (with known carer population of approximately 100,000), with local health, community, and social care teams being asked to actively promote its use. Methods: The study had a convergent parallel, mixed methods design and drew on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Data included metrics from carers? use of Care Companion, surveys completed by users recruited through general practice, and interviews with carers and health and social care providers regarding their views about Care Companion and their response to it. Quantitative data were analyzed using descriptive statistics. Interview data were analyzed thematically and synthesized to create overarching themes. The qualitative findings were used for in-depth exploration and interpretation of quantitative results. Results: Despite awareness-raising activities by relevant health, social care, and community organizations, there was limited uptake with only 556 carers (0.87% of the known carer population of 100,000) registering to use Care Companion in total, with median of 2 (mean 7.2; mode 2) visits per registered user. Interviews with carers (n=29) and stakeholders (n=12) identified 7 key themes that influenced registration, use, and perceived value: stakeholders? signposting of carers to Care Companion, expectations about Care Companion, activity levels and conflicting priorities, experience of using Care Companion, relevance to personal circumstances, social isolation and networks, and experience with digital technology. Although many interviewed carers felt that it was potentially useful, few considered it as being of direct relevance to their own circumstances. For some, concerns about social isolation and lack of hands-on support were more pressing issues than the need for information. Conclusions: The gap between the enthusiastic views expressed by carers during Care Companion?s co-design and the subsequent low level of uptake and user experience observed in this evaluation suggests that the co-design process may have lacked a sufficiently diverse set of viewpoints. Numerous factors were identified as contributing to Care Companion?s level of use, some of which might have been anticipated during its co-design. More emphasis on the development and implementation, including continuing co-design support after deployment, may have supported increased use. UR - https://aging.jmir.org/2023/1/e41185 UR - http://dx.doi.org/10.2196/41185 UR - http://www.ncbi.nlm.nih.gov/pubmed/37733406 ID - info:doi/10.2196/41185 ER - TY - JOUR AU - Wang, M. Sabrina AU - Hogg, Jeffry H. D. AU - Sangvai, Devdutta AU - Patel, R. Manesh AU - Weissler, Hope E. AU - Kellogg, C. Katherine AU - Ratliff, William AU - Balu, Suresh AU - Sendak, Mark PY - 2023/9/21 TI - Development and Integration of Machine Learning Algorithm to Identify Peripheral Arterial Disease: Multistakeholder Qualitative Study JO - JMIR Form Res SP - e43963 VL - 7 KW - machine learning KW - implementation KW - integration KW - support KW - quality KW - peripheral arterial disease KW - algorithm KW - efficacy KW - structure KW - barrier KW - clinical KW - engagement KW - development KW - translation KW - detection N2 - Background: Machine learning (ML)?driven clinical decision support (CDS) continues to draw wide interest and investment as a means of improving care quality and value, despite mixed real-world implementation outcomes. Objective: This study aimed to explore the factors that influence the integration of a peripheral arterial disease (PAD) identification algorithm to implement timely guideline-based care. Methods: A total of 12 semistructured interviews were conducted with individuals from 3 stakeholder groups during the first 4 weeks of integration of an ML-driven CDS. The stakeholder groups included technical, administrative, and clinical members of the team interacting with the ML-driven CDS. The ML-driven CDS identified patients with a high probability of having PAD, and these patients were then reviewed by an interdisciplinary team that developed a recommended action plan and sent recommendations to the patient?s primary care provider. Pseudonymized transcripts were coded, and thematic analysis was conducted by a multidisciplinary research team. Results: Three themes were identified: positive factors translating in silico performance to real-world efficacy, organizational factors and data structure factors affecting clinical impact, and potential challenges to advancing equity. Our study found that the factors that led to successful translation of in silico algorithm performance to real-world impact were largely nontechnical, given adequate efficacy in retrospective validation, including strong clinical leadership, trustworthy workflows, early consideration of end-user needs, and ensuring that the CDS addresses an actionable problem. Negative factors of integration included failure to incorporate the on-the-ground context, the lack of feedback loops, and data silos limiting the ML-driven CDS. The success criteria for each stakeholder group were also characterized to better understand how teams work together to integrate ML-driven CDS and to understand the varying needs across stakeholder groups. Conclusions: Longitudinal and multidisciplinary stakeholder engagement in the development and integration of ML-driven CDS underpins its effective translation into real-world care. Although previous studies have focused on the technical elements of ML-driven CDS, our study demonstrates the importance of including administrative and operational leaders as well as an early consideration of clinicians? needs. Seeing how different stakeholder groups have this more holistic perspective also permits more effective detection of context-driven health care inequities, which are uncovered or exacerbated via ML-driven CDS integration through structural and organizational challenges. Many of the solutions to these inequities lie outside the scope of ML and require coordinated systematic solutions for mitigation to help reduce disparities in the care of patients with PAD. UR - https://formative.jmir.org/2023/1/e43963 UR - http://dx.doi.org/10.2196/43963 UR - http://www.ncbi.nlm.nih.gov/pubmed/37733427 ID - info:doi/10.2196/43963 ER - TY - JOUR AU - Heeres, J. Tjitske AU - Tran, Mikael Tri AU - Noort, A.C. Bart PY - 2023/9/20 TI - Drivers and Barriers to Implementing the Internet of Things in the Health Care Supply Chain: Mixed Methods Multicase Study JO - J Med Internet Res SP - e48730 VL - 25 KW - digital health KW - drivers and barriers KW - healthcare logistics KW - healthcare supply chain KW - implementation KW - Internet of Things KW - supply chain management N2 - Background: Over the past 2 years, the COVID-19 pandemic has placed enormous pressure on the health care industry. There has been an increase in demand and, at the same time, a shortage of supplies. This has shown that supply chain management in the health care industry cannot be taken for granted. Furthermore, the health care industry is also facing other major challenges, such as the current labor market shortage. In the literature, the Internet of Things (IoT) is highlighted as an effective tool to build a more resilient and efficient supply chain that can manage these challenges. Although using IoT in supply chain management has been extensively examined in other types of supply chains, its use in the health care supply chain has largely been overlooked. Given that the health care supply chain, compared to others, is more complex and is under growing pressure, a more in-depth understanding of the opportunities brought by IoT is necessary. Objective: This study aims to address this research gap by identifying and ranking the drivers of and barriers to implementing IoT in the health care supply chain. Methods: We conducted a 2-stage study. In the first, exploratory stage, a total of 12 semistructured interviews were conducted to identify drivers and barriers. In the second, confirmatory stage, a total of 26 health care supply chain professionals were asked in a survey to rank the drivers and barriers. Results: The results show that there are multiple financial, operational, strategy-related, and supply chain-related drivers for implementing IoT. Similarly, there are various financial, strategy-related, supply chain-related, technology-related, and user-related barriers. The findings also show that supply chain-related drivers (eg, increased transparency, traceability, and collaboration with suppliers) are the strongest drivers, while financial barriers (eg, high implementation costs and difficulties in building a business case) are the biggest barriers to overcome. Conclusions: The findings of this study add to the limited literature regarding IoT in the health care supply chain by empirically identifying the most important drivers and barriers to IoT implementation. The ranking of drivers and barriers provides guidance for practitioners and health care provider leaders intending to implement IoT in the health care supply chain. UR - https://www.jmir.org/2023/1/e48730 UR - http://dx.doi.org/10.2196/48730 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728990 ID - info:doi/10.2196/48730 ER - TY - JOUR AU - Haque, Saira AU - DeStefano, Sydney AU - Banger, Alison AU - Rutledge, Regina AU - Romaire, Melissa PY - 2023/9/20 TI - Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation JO - JMIR Form Res SP - e49591 VL - 7 KW - telehealth KW - virtual care KW - rural health KW - critical access hospital KW - access KW - telehealth impact KW - methods evaluation KW - mixed methods KW - thematic analysis KW - cost efficiency KW - telehealth cost KW - qualitative analysis KW - claims analysis N2 - Background: Frontier areas are sparsely populated counties in states where 65% of the counties have 6 or fewer residents per square mile. Residents access primary care at critical access hospitals (CAHs) located in these rural communities but must travel great distances for specialty care. Telehealth could address access challenges; however, there are barriers to broader use, including reimbursement and the need for practical implementation support. The Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) Demonstration to assess the impact of telehealth payment change and technical assistance to adopt and sustainably use telehealth for CAHs treating Medicare fee-for-service patients in frontier regions. Objective: We evaluated the impact of the FCHIP Demonstration telehealth payment change and technical assistance on telehealth adoption and ongoing use using a mixed methods approach. Methods: We conducted a mixed methods evaluation of the 8 CAHs in Montana, Nevada, and North Dakota that participated in the FCHIP program. Key informant interviews and FCHIP program document review were conducted and analyzed using thematic analysis to understand how CAHs implemented their telehealth programs and the facilitators of program adoption and maintenance. Medicare fee-for-service claims were analyzed from August 2013 to July 2019 relative to a group of CAHs that did not participate in the demonstration project to understand the frequency of telehealth use for Medicare fee-for-service beneficiaries receiving care at the participating CAHs before and during the Demonstration program. Results: CAH staff noted several key factors for establishing and sustaining a telehealth program: clinical and administrative staff champions, infrastructure changes, training on telehealth processes, and establishing strong relationships with specialists at distant facilities to deliver telehealth services to patients of CAH. There was a modest increase in telehealth services billed to Medicare during the FCHIP Demonstration that were limited to a handful of CAHs. Conclusions: The frontier setting is characterized by a low population; and thus, the volumes of telehealth services provided in both the CAHs and comparison sites are low. Overall, CAHs reported that patient satisfaction was high and expressed the desire for more virtual services. Telehealth service selection was informed by perceived community needs and specialist availability. CAHs made infrastructure changes to support telehealth and expressed the desire for more virtual services. Implementation support services helped CAHs integrate telehealth into clinical and operational workflows. There was some increase in telehealth services billed to Medicare, but the volume billed was low and not enough to substantially improve hospital revenue. Future work to inform policy and practice could include standardized, formal community need assessments and assistance finding distant providers to meet those needs and further technical assistance around billing, service selection, and ongoing use to support sustainability. UR - https://formative.jmir.org/2023/1/e49591 UR - http://dx.doi.org/10.2196/49591 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728991 ID - info:doi/10.2196/49591 ER - TY - JOUR AU - Butters, Alexandra AU - Blanch, Bianca AU - Kemp-Casey, Anna AU - Do, Judy AU - Yeates, Laura AU - Leslie, Felicity AU - Semsarian, Christopher AU - Nedkoff, Lee AU - Briffa, Tom AU - Ingles, Jodie AU - Sweeting, Joanna PY - 2023/9/20 TI - The Australian Genetic Heart Disease Registry: Protocol for a Data Linkage Study JO - JMIR Res Protoc SP - e48636 VL - 12 KW - data linkage KW - genetic heart diseases KW - health care use KW - cardiomyopathies KW - arrhythmia KW - cardiology KW - heart KW - genetics KW - registry KW - registries KW - risk KW - mortality KW - national KW - big data KW - harmonization KW - probabilistic matching N2 - Background: Genetic heart diseases such as hypertrophic cardiomyopathy can cause significant morbidity and mortality, ranging from syncope, chest pain, and palpitations to heart failure and sudden cardiac death. These diseases are inherited in an autosomal dominant fashion, meaning family members of affected individuals have a 1 in 2 chance of also inheriting the disease (?at-risk relatives?). The health care use patterns of individuals with a genetic heart disease, including emergency department presentations and hospital admissions, are poorly understood. By linking genetic heart disease registry data to routinely collected health data, we aim to provide a more comprehensive clinical data set to examine the burden of disease on individuals, families, and health care systems. Objective: The objective of this study is to link the Australian Genetic Heart Disease (AGHD) Registry with routinely collected whole-population health data sets to investigate the health care use of individuals with a genetic heart disease and their at-risk relatives. This linked data set will allow for the investigation of differences in outcomes and health care use due to disease, sex, socioeconomic status, and other factors. Methods: The AGHD Registry is a nationwide data set that began in 2007 and aims to recruit individuals with a genetic heart disease and their family members. In this study, demographic, clinical, and genetic data (available from 2007 to 2019) for AGHD Registry participants and at-risk relatives residing in New South Wales (NSW), Australia, were linked to routinely collected health data. These data included NSW-based data sets covering hospitalizations (2001-2019), emergency department presentations (2005-2019), and both state-wide and national mortality registries (2007-2019). The linkage was performed by the Centre for Health Record Linkage. Investigations stratifying by diagnosis, age, sex, socioeconomic status, and gene status will be undertaken and reported using descriptive statistics. Results: NSW AGHD Registry participants were linked to routinely collected health data sets using probabilistic matching (November 2019). Of 1720 AGHD Registry participants, 1384 had linkages with 11,610 hospital records, 7032 emergency department records, and 60 death records. Data assessment and harmonization were performed, and descriptive data analysis is underway. Conclusions: We intend to provide insights into the health care use patterns of individuals with a genetic heart disease and their at-risk relatives, including frequency of hospital admissions and differences due to factors such as disease, sex, and socioeconomic status. Identifying disparities and potential barriers to care may highlight specific health care needs (eg, between sexes) and factors impacting health care access and use. International Registered Report Identifier (IRRID): DERR1-10.2196/48636 UR - https://www.researchprotocols.org/2023/1/e48636 UR - http://dx.doi.org/10.2196/48636 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728963 ID - info:doi/10.2196/48636 ER - TY - JOUR AU - Cheung, Wang Ka AU - Au, Sin-Tung Tiffany AU - Wai, On Joan Kar AU - Seto, Tin-Yan Mimi PY - 2023/9/19 TI - Perceptions and Challenges of Telehealth Obstetric Clinics Among Pregnant Women in Hong Kong: Cross-Sectional Questionnaire Study JO - J Med Internet Res SP - e46663 VL - 25 KW - delivery KW - digital KW - portable electronic applications KW - smartphone KW - pregnancy KW - virtual clinics KW - telehealth KW - telemedicine N2 - Background: Integrating telehealth in an obstetric care model is important to prepare for possible infection outbreaks that require social distancing and limit in-person consultations. To ensure the successful implementation of obstetric telehealth in Hong Kong, it is essential to understand and address pregnant women?s concerns. Objective: This study aimed to assess pregnant women?s attitudes, concerns, and perceptions regarding telehealth obstetric clinic services in Hong Kong. Methods: We conducted a prospective cross-sectional questionnaire study at Queen Mary Hospital between November 2021 and August 2022. Utilizing a 5-point rating scale, the questionnaire aimed to capture pregnant women?s preferences, expectations, feasibility perceptions, and privacy concerns related to telehealth clinic services. We used statistical analyses, including chi-square tests and multinomial logistic regression, to compare questionnaire responses and investigate the association between advancing gestation and attitudes toward telehealth clinics. Results: The study included 664 participants distributed across different pregnancy stages: 269 (40.5%) before 18 gestational weeks, 198 (29.8%) between 24 and 31 weeks, and 197 (29.7%) after delivery. Among them, 49.8% (329/664) favored face-to-face consultations over telehealth clinics, and only 7.3% (48/664) believed the opposite. Additionally, 24.2% (161/664) agreed that telehealth clinics should be launched for obstetric services. However, the overall preference for telehealth clinics was <20% for routine prenatal checkups (81/664, 12.2%) and addressing pregnancy-related concerns, such as vaginal bleeding (76/664, 11.5%), vaginal discharge (128/664, 19.4%), reduced fetal movement (64/664, 9.7%), uterine contractions (62/664, 9.4%), and suspected leakage of amniotic fluid (54/664, 8.2%). Conversely, 76.4% (507/664) preferred telehealth clinics to in-person visits for prenatal education talks, prenatal and postpartum exercise, and addressing breastfeeding problems. Participants were more comfortable with telehealth clinic tasks for tasks like explaining pregnancy exam results (418/664, 63.1%), self-administering urinary dipsticks at home (373/664, 56.4%), medical history-taking (341/664, 51.5%), and self-monitoring blood pressure using an electronic machine (282/664, 42.8%). %). During the postpartum period, compared to before 18 weeks of gestation, significantly more participants agreed that telehealth clinics could be an option for assessing physical symptoms such as vaginal bleeding (aOR 2.105, 95% CI 1.448-3.059), reduced fetal movement (aOR 1.575, 95% CI 1.058-2.345), uterine contractions (aOR 2.906, 95% CI 1.945-4.342), suspected leakage of amniotic fluid (aOR 2.609, 95% CI 1.721-3.954), fever (aOR 1.526, 95% CI 1.109-2.100), and flu-like symptoms (aOR 1.412, 95% CI 1.030-1.936). They were also more confident with measuring the symphysis-fundal height, arranging further investigations, and making diagnoses with the doctor via the telehealth clinic. The main perceived public health advantage of telehealth clinics was the shorter traveling and waiting time (526/664, 79.2%), while the main concern was legal issues from wrong diagnosis and treatment (511/664, 77.4%). Conclusions: Face-to-face consultation remained the preferred mode of consultation among the participants. However, telehealth clinics could be an alternative for services that do not require physical examination or contact. An increased acceptance of and confidence in telehealth was found with advancing gestation and after delivery. Enforcing stricter laws and guidelines could facilitate the implementation of telehealth clinics and increase confidence in their use among pregnant women for obstetric care. UR - https://www.jmir.org/2023/1/e46663 UR - http://dx.doi.org/10.2196/46663 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725425 ID - info:doi/10.2196/46663 ER - TY - JOUR AU - Sreepada, Syamala Rama AU - Chang, Ching Ai AU - West, C. Nicholas AU - Sujan, Jonath AU - Lai, Brendan AU - Poznikoff, K. Andrew AU - Munk, Rebecca AU - Froese, R. Norbert AU - Chen, C. James AU - Görges, Matthias PY - 2023/9/19 TI - Dashboard of Short-Term Postoperative Patient Outcomes for Anesthesiologists: Development and Preliminary Evaluation JO - JMIR Perioper Med SP - e47398 VL - 6 KW - quality improvement KW - feedback KW - anesthesiologists KW - patient reported outcome measures KW - data display KW - user-centered design KW - surgical outcome KW - discharge KW - anesthesiology KW - postoperative care KW - registry KW - dashboard KW - interactive KW - practice KW - performance KW - patient outcome KW - mobile phone N2 - Background: Anesthesiologists require an understanding of their patients? outcomes to evaluate their performance and improve their practice. Traditionally, anesthesiologists had limited information about their surgical outpatients? outcomes due to minimal contact post discharge. Leveraging digital health innovations for analyzing personal and population outcomes may improve perioperative care. BC Children?s Hospital?s postoperative follow-up registry for outpatient surgeries collects short-term outcomes such as pain, nausea, and vomiting. Yet, these data were previously not available to anesthesiologists. Objective: This quality improvement study aimed to visualize postoperative outcome data to allow anesthesiologists to reflect on their care and compare their performance with their peers. Methods: The postoperative follow-up registry contains nurse-reported postoperative outcomes, including opioid and antiemetic administration in the postanesthetic care unit (PACU), and family-reported outcomes, including pain, nausea, and vomiting, within 24 hours post discharge. Dashboards were iteratively co-designed with 5 anesthesiologists, and a department-wide usability survey gathered anesthesiologists? feedback on the dashboards, allowing further design improvements. A final dashboard version has been deployed, with data updated weekly. Results: The dashboard contains three sections: (1) 24-hour outcomes, (2) PACU outcomes, and (3) a practice profile containing individual anesthesiologist?s case mix, grouped by age groups, sex, and surgical service. At the time of evaluation, the dashboard included 24-hour data from 7877 cases collected from September 2020 to February 2023 and PACU data from 8716 cases collected from April 2021 to February 2023. The co-design process and usability evaluation indicated that anesthesiologists preferred simpler designs for data summaries but also required the ability to explore details of specific outcomes and cases if needed. Anesthesiologists considered security and confidentiality to be key features of the design and most deemed the dashboard information useful and potentially beneficial for their practice. Conclusions: We designed and deployed a dynamic, personalized dashboard for anesthesiologists to review their outpatients? short-term postoperative outcomes. This dashboard facilitates personal reflection on individual practice in the context of peer and departmental performance and, hence, the opportunity to evaluate iterative practice changes. Further work is required to establish their effect on improving individual and department performance and patient outcomes. UR - https://periop.jmir.org/2023/1/e47398 UR - http://dx.doi.org/10.2196/47398 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725426 ID - info:doi/10.2196/47398 ER - TY - JOUR AU - Noort, C. Bart A. AU - Buijs, Paul AU - Roemeling, Oskar PY - 2023/9/19 TI - Outsourcing the Management of Reusable Medical Devices in a Chain-Wide Care Setting: Mixed Methods Feasibility Study JO - Interact J Med Res SP - e41409 VL - 12 KW - health care logistics KW - outsourcing KW - web ordering portal KW - medical devices KW - feasibility study KW - device management N2 - Background: Managing reusable medical devices incurs substantial health care costs and complexity, particularly in integrated care settings. This complexity hampers care quality, safety, and costs. Studying logistical innovations within integrated care can provide insights to medical devices use among staff effectively. Objective: This study aimed to establish the feasibility of a logistical intervention through outsourcing and a web portal. The goal was to provide insights into users? acceptability of the intervention, on whether the intervention was successfully implemented, and on the intervention?s preliminary efficacy, thus benefiting practitioners and researchers. Methods: This paper presents a mixed methods feasibility study at a large chain-wide health care provider in the Netherlands. The intervention entailed outsourcing noncritical reusable medical devices and introducing a web portal for device management. A questionnaire gauged perceived ordering and delivery times, satisfaction with the ordering and delivery process, compliance with safety and hygiene certification, and effects on the care delivery process. Qualitative data in the form of observations, documentation, and interviews were used to identify implementing challenges. Using on-site stocktaking and data from information systems, we analyzed the utilization, costs, and rental time of medical devices before and after the intervention for wheelchairs and anti?pressure ulcer mattresses. Results: Looking at the acceptability of the intervention, a high user satisfaction with the ordering and delivery process was reported (rated on a 5-point Likert scale). With respect to preliminary efficacy, we noted a reduction in the utilization of wheelchairs (on average, 1106, SD 106 fewer utilization d/mo), and a halted increase in the utilization of anti?pressure ulcer mattresses. In addition, nurses who used the web portal reported shorter ordering times for wheelchairs (?2.7 min) and anti?pressure ulcer mattresses (?3.1 min), as well as shorter delivery times for wheelchairs (?0.5 d). Moreover, an increase in device certification was reported (average score of 1.9, SD 1.0), indicating higher levels of safety and hygiene standards. In theory, these improvements should translate into better outcomes in terms of costs and the quality of care. However, we were unable to establish a reduction in total care costs or a reduced rental time per device. Furthermore, respondents did not identify improvements in safety or the quality of care. Although implementation challenges related to the diverse supply base and complexities with different care financers were observed, the overall implementation of the intervention was considered successful. Conclusions: This study confirms the feasibility of our intervention, in terms of acceptability, implementation success, and preliminary efficacy. The integrated management of medical devices should enable a reduction in costs, required devices, and material waste, as well as higher quality care. However, several challenges remain related to the implementation of such interventions. UR - https://www.i-jmr.org/2023/1/e41409 UR - http://dx.doi.org/10.2196/41409 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725420 ID - info:doi/10.2196/41409 ER - TY - JOUR AU - Gaetz, Stephen AU - Bonakdar, Ahmad AU - Ecker, John AU - MacDonald, Cora AU - Ilyniak, Sophia AU - Ward, Ashley AU - Kimura, Lauren AU - Vijayaratnam, Aranie AU - Banchani, Emmanuel PY - 2023/9/19 TI - Evaluating the Effectiveness of the Housing First for Youth Intervention for Youth Experiencing Homelessness in Canada: Protocol for a Multisite, Mixed Methods Randomized Controlled Trial JO - JMIR Res Protoc SP - e46690 VL - 12 KW - youth homelessness KW - Housing First for Youth KW - Canada KW - randomized controlled trial KW - RCT KW - Making the Shift N2 - Background: Emerging evidence at the international level suggests that the Housing First approach could improve the housing stability of young people experiencing homelessness. However, there is a dearth of literature in Canada on whether the Housing First intervention for young people experiencing homelessness can improve outcomes including housing stability, health and well-being, and access to complementary supports. Adapted from the original Housing First model, Housing First for Youth (HF4Y) was developed in Canada as a rights-based approach tailored specifically for young people aged 16 to 24 years who are experiencing or are at risk of homelessness. Objective: The Making the Shift Youth Homelessness Social Innovation Lab is testing the effectiveness of the HF4Y intervention in Canada. The objective of this study is to determine whether the HF4Y model results in better participant-level outcomes than treatment-as-usual services for young people experiencing homelessness in 2 urban settings: Ottawa and Toronto, Ontario. Primary outcomes include housing stability, health and well-being, and complementary supports, and secondary outcomes include employment and educational attainment and social inclusion. Methods: The HF4Y study used a multisite, mixed methods, randomized controlled trial research approach for data collection and analysis. Eligible participants included young people aged 16 to 24 years who were experiencing homelessness or housing precarity. The participants were randomly assigned to either the treatment-as-usual group or the housing first intervention group. Survey and interview data in Ottawa and Toronto, Ontario are being collected at multiple time points (3-6 months) over 4 years to capture a range of outcomes. Analytic strategies for quantitative data will include mixed-effects modeling for repeated measures and logistic models. A thematic analysis will be used to analyze qualitative data based on participants? narratives and life journeys through homelessness. Furthermore, program fidelity evaluations are conducted within each HF4Y program. These evaluations assess how well the intervention aligns with the HF4Y model and identify any areas that may require adjustments or additional support. Results: The HF4Y study has received human participant research ethics approval from the Office of Research Ethics at York University. Recruitment was conducted between February 2018 and March 2020. Data collection is expected to be completed at both sites by March 2024. A preliminary analysis of the quantitative and qualitative data collected between baseline and 24 months is underway. Conclusions: This pilot randomized controlled trial is the first to test the effectiveness of the HF4Y intervention in Canada. The findings of this study will enhance our understanding of how to effectively deliver and scale up the HF4Y intervention, with the aim of continually improving the HF4Y model to promote better outcomes for youth. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) ISRCTN10505930; https://www.isrctn.com/ISRCTN10505930 International Registered Report Identifier (IRRID): DERR1-10.2196/46690 UR - https://www.researchprotocols.org/2023/1/e46690 UR - http://dx.doi.org/10.2196/46690 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725430 ID - info:doi/10.2196/46690 ER - TY - JOUR AU - Ward, M. Marcia AU - Ullrich, Fred AU - Bhagianadh, Divya AU - Nelson, Eve-Lynn AU - Marcin, P. James AU - Carter, D. Knute AU - Law, Beth Kari AU - McCord, Carly AU - Neufeld, Jonathan AU - Merchant, S. Kimberly A. PY - 2023/9/18 TI - Telehealth and In-Person Behavioral Health Services in Rural Communities Before and During the COVID-19 Pandemic: Multisite Prospective Cohort Study JO - JMIR Ment Health SP - e47047 VL - 10 KW - anxiety KW - behavior KW - behavioral health KW - COVID-19 KW - depression KW - digital health KW - eHealth KW - mental health KW - mHealth KW - pandemic KW - rural health services KW - rural KW - telehealth KW - telemedicine N2 - Background: The COVID-19 pandemic triggered widespread adjustments across the US health care system. Telehealth use showed a substantial increase in mental health conditions and services due to acute public health emergency (PHE) behavioral health needs on top of long-standing gaps in access to behavioral health services. How health systems that were already providing behavioral telehealth services adjusted services and staffing during this period has not been well documented, particularly in rural areas with chronic shortages of behavioral health providers and services. Objective: This study investigates patient and treatment characteristic changes from before the COVID-19 PHE to during the PHE within both telehealth and in-person behavioral health services provided in 95 rural communities across the United States. Methods: We used a nonrandomized, prospective, multisite research design involving 2 active treatment groups. The telehealth cohort included all patients who initiated telehealth treatment regimens during the data collection period. A comparison group included a cohort of patients who initiated in-person treatment regimen. Patient enrollment occurred on a rolling basis, and data collection was extended for 3 months after treatment initiation for each patient. Chi-square tests compared changes from pre-PHE to PHE time periods within telehealth and in-person treatment cohorts. The dependent measures included patient diagnosis, clinicians providing treatment services, and type of treatment services provided at each encounter. The 4780 patients in the telehealth cohort and the 6457 patients in the in-person cohort had an average of 3.5 encounters during the 3-month follow-up period. Results: The encounters involving anxiety, dissociative, and stress-related disorders in the telehealth cohort increased from 30% (698/2352) in the pre-PHE period to 35% (4632/12,853) in the PHE period (P<.001), and encounters involving substance use disorders in the in-person cohort increased from 11% (468/4249) in the pre-PHE period to 18% (3048/17,047) in the PHE period (P<.001). The encounters involving treatment service codes for alcohol, drug, and medication-assisted therapy in the telehealth cohort increased from 1% (22/2352) in the pre-PHE period to 11% (1470/13,387) in the PHE period (P<.001); likewise, encounters for this type of service in the in-person cohort increased from 0% (0/4249) in the pre-PHE period to 16% (2687/17,047) in the PHE period (P<.001). From the pre-PHE to the PHE period, encounters involving 60-minute psychotherapy in the telehealth cohort increased from 8% (190/2352) to 14% (1802/13,387; P<.001), while encounters involving group therapy in the in-person cohort decreased from 12% (502/4249) to 4% (739/17,047; P<.001). Conclusions: The COVID-19 pandemic challenged health service providers, and they adjusted the way both telehealth and in-person behavioral therapy services were delivered. Looking forward, future research is needed to explicate the interaction of patient, provider, setting, and intervention factors that influenced the patterns observed as a result of the COVID-19 pandemic. UR - https://mental.jmir.org/2023/1/e47047 UR - http://dx.doi.org/10.2196/47047 UR - http://www.ncbi.nlm.nih.gov/pubmed/37721793 ID - info:doi/10.2196/47047 ER - TY - JOUR AU - O'Reilly, L. Sharleen AU - Laws, Rachel AU - Maindal, Terkildsen Helle AU - Teede, Helena AU - Harrison, Cheryce AU - McAuliffe, M. Fionnuala AU - Geraghty, Aisling AU - Campoy, Cristina AU - Bermúdez, G. Mercedes AU - Pirhonen, Laura AU - Burden, Christy AU - Davies, Anna AU - Laursen, Hjorth Ditte AU - Skinner, Timothy AU - PY - 2023/9/18 TI - A Complex mHealth Coaching Intervention to Prevent Overweight, Obesity, and Diabetes in High-Risk Women in Antenatal Care: Protocol for a Hybrid Type 2 Effectiveness-Implementation Study JO - JMIR Res Protoc SP - e51431 VL - 12 KW - hybrid type 2 effectiveness-implementation KW - gestational diabetes KW - obesity KW - mHealth KW - mobile health KW - health behavior change KW - pregnancy KW - postpartum KW - weight management KW - health coaching KW - maternal health N2 - Background: Women with overweight and obesity are at higher risk of developing complications in pregnancy such as gestational diabetes and longer-term chronic conditions. Research concerning health behavior change interventions during pregnancy and postpartum shows promising effects, but implementation into routine services is sparsely investigated. Most interventions focus on the antenatal or postpartum life stages, failing to meet the needs of women. IMPACT DIABETES Bump2Baby is a multicenter project across 4 high-income countries developed to test the implementation of an antenatal and postpartum evidence-based mobile health (mHealth) coaching intervention called Bump2Baby and Me (B2B&Me) designed to sit alongside usual care in the perinatal period. Objective: We aim to explore the feasibility and implementation of the B2B&Me intervention and investigate the effectiveness of this intervention in women at risk of gestational diabetes. Methods: IMPACT DIABETES Bump2Baby is a hybrid type 2 effectiveness-implementation study, which integrates an evidence-based mHealth coaching app that includes personalized health behavior change coaching provided by health care professionals alongside antenatal care from the first antenatal visit to 12 months postpartum. The mHealth app offers the possibility of synchronous calls, asynchronous contact (including coach-participant text and video messaging exchanges tailored to the participant?s needs), and ongoing access to an extensive library of bespoke intervention materials. Participants will interact asynchronously with their health coach throughout the intervention via the app. This randomized controlled trial across 4 clinical sites within Ireland, the United Kingdom, Spain, and Australia will recruit 800 women in early pregnancy to evaluate the effectiveness on postpartum weight. The Exploration, Preparation, Implementation, and Sustainment implementation framework is the theoretical underpinning of the study. The implementation evaluation will be assessed at the individual, hospital staff, and broader community levels using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources for the RE-AIM evaluation will include app and platform analytics, screening and training records, participant medical records, key informant interviews, participant and partner exit interviews, cost data, study questionnaires, staff surveys, and blood sample analyses. Results: The study was approved and registered with the Australian New Zealand Clinical Trials Registry on November 19, 2020. Recruitment commenced on February 9, 2021, and data collection is ongoing. Publication of the results is expected in 2024. Conclusions: This is the first hybrid effectiveness-implementation study of an 18-month mHealth coaching intervention in at-risk women that we are aware of. As research aims to move toward real-world implementable solutions, it is critical that hybrid studies are conducted. The data from this large multicenter study will be useful in planning the potential implementation and scale-up of evidence-based perinatal health behavior change interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/51431 UR - https://www.researchprotocols.org/2023/1/e51431 UR - http://dx.doi.org/10.2196/51431 UR - http://www.ncbi.nlm.nih.gov/pubmed/37721798 ID - info:doi/10.2196/51431 ER - TY - JOUR AU - Ose, Dominik AU - Adediran, Emmanuel AU - Owens, Robert AU - Gardner, Elena AU - Mervis, Matthew AU - Turner, Cindy AU - Carlson, Emily AU - Forbes, Danielle AU - Jasumback, Lydia Caitlyn AU - Stuligross, John AU - Pohl, Susan AU - Kiraly, Bernadette PY - 2023/9/15 TI - Electronic Health Record?Driven Approaches in Primary Care to Strengthen Hypertension Management Among Racial and Ethnic Minoritized Groups in the United States: Systematic Review JO - J Med Internet Res SP - e42409 VL - 25 KW - hypertension KW - electronic health record (EHR) KW - health data KW - EHR-driven KW - primary care KW - racial and ethnic minority groups N2 - Background: Managing hypertension in racial and ethnic minoritized groups (eg, African American/Black patients) in primary care is highly relevant. However, evidence on whether or how electronic health record (EHR)?driven approaches in primary care can help improve hypertension management for patients of racial and ethnic minoritized groups in the United States remains scarce. Objective: This review aims to examine the role of the EHR in supporting interventions in primary care to strengthen the hypertension management of racial and ethnic minoritized groups in the United States. Methods: A search strategy based on the PICO (Population, Intervention, Comparison, and Outcome) guidelines was utilized to query and identify peer-reviewed articles on the Web of Science and PubMed databases. The search strategy was based on terms related to racial and ethnic minoritized groups, hypertension, primary care, and EHR-driven interventions. Articles were excluded if the focus was not hypertension management in racial and ethnic minoritized groups or if there was no mention of health record data utilization. Results: A total of 29 articles were included in this review. Regarding populations, Black/African American patients represented the largest population (26/29, 90%) followed by Hispanic/Latino (18/29, 62%), Asian American (7/29, 24%), and American Indian/Alaskan Native (2/29, 7%) patients. No study included patients who identified as Native Hawaiian/Pacific Islander. The EHR was used to identify patients (25/29, 86%), drive the intervention (21/29, 72%), and monitor results and outcomes (7/29, 59%). Most often, EHR-driven approaches were used for health coaching interventions, disease management programs, clinical decision support (CDS) systems, and best practice alerts (BPAs). Regarding outcomes, out of 8 EHR-driven health coaching interventions, only 3 (38%) reported significant results. In contrast, all the included studies related to CDS and BPA applications reported some significant results with respect to improving hypertension management. Conclusions: This review identified several use cases for the integration of the EHR in supporting primary care interventions to strengthen hypertension management in racial and ethnic minoritized patients in the United States. Some clinical-based interventions implementing CDS and BPA applications showed promising results. However, more research is needed on community-based interventions, particularly those focusing on patients who are Asian American, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander. The developed taxonomy comprising ?identifying patients,? ?driving intervention,? and ?monitoring results? to classify EHR-driven approaches can be a helpful tool to facilitate this. UR - https://www.jmir.org/2023/1/e42409 UR - http://dx.doi.org/10.2196/42409 UR - http://www.ncbi.nlm.nih.gov/pubmed/37713256 ID - info:doi/10.2196/42409 ER - TY - JOUR AU - Tolou-Shams, Marina AU - Ramaiya, Megan AU - Lara Salas, Jannet AU - Ezimora, Ifunanya AU - Shumway, Martha AU - Duerr Berrick, Jill AU - Aguilera, Adrian AU - Borsari, Brian AU - Dauria, Emily AU - Friedling, Naomi AU - Holmes, Crystal AU - Grandi, Adam PY - 2023/9/12 TI - A Family-Based Mental Health Navigator Intervention for Youth in the Child Welfare System: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e49999 VL - 12 KW - randomized clinical trial KW - foster care KW - child welfare?involved youth KW - navigator interventions KW - digital health technology KW - implementation science KW - community engagement N2 - Background: Youth in the child welfare system (child welfare?involved [CWI] youth) have high documented rates of mental health symptoms and experience significant disparities in mental health care services access and engagement. Adolescence is a developmental stage that confers increased likelihood of experiencing mental health symptoms and the emergence of disorders that can persist into adulthood. Despite a high documented need for evidence-based mental health services for CWI youth, coordination between child welfare and mental health service systems to increase access to care remains inadequate, and engagement in mental health services is low. Navigator models developed in the health care field to address challenges of service access, fragmentation, and continuity that affect the quality of care provide a promising approach to increase linkage to, and engagement in, mental health services for CWI youth. However, at present, there is no empirically supported mental health navigator model to address the unique and complex mental health needs of CWI youth and their families. Objective: Using a randomized controlled trial, this study aims to develop and test a foster care family navigator (FCFN) model to improve mental health service outcomes for CWI adolescents (aged 12-17 years). Methods: The navigator model leverages an in-person navigator and use of adjunctive digital health technology to engage with, and improve, care coordination, tracking, and monitoring of mental health service needs for CWI youth and families. In total, 80 caregiver-youth dyads will be randomized to receive either the FCFN intervention or standard of care (clinical case management services): 40 (50%) to FCFN and 40 (50%) to control. Qualitative exit interviews will inform the feasibility and acceptability of the services received during the 6-month period. The primary trial outcomes are mental health treatment initiation and engagement. Other pre- and postservice outcomes, such as proportion screened and time to screening, will also be evaluated. We hypothesize that youth receiving the FCFN intervention will have higher rates of mental health treatment initiation and engagement than youth receiving standard of care. Results: We propose enrollment of 80 dyads by March 2024, final data collection by September 2024, and the publication of main findings in March 2025. After final data analysis and writing of the results, the resulting manuscripts will be submitted to journals for dissemination. Conclusions: This study will be the first to produce empirically driven conclusions and recommendations for implementing a family mental health navigation model for CWI youth with long-standing and unaddressed disparities in behavioral health services access. The study findings have potential to have large-scale trial applicability and be feasible and acceptable for eventual system implementation and adoption. Trial Registration: ClinicalTrials.gov NCT04506437; https://www.clinicaltrials.gov/study/NCT04506437 International Registered Report Identifier (IRRID): DERR1-10.2196/49999 UR - https://www.researchprotocols.org/2023/1/e49999 UR - http://dx.doi.org/10.2196/49999 UR - http://www.ncbi.nlm.nih.gov/pubmed/37698896 ID - info:doi/10.2196/49999 ER - TY - JOUR AU - Edwards, Abagail AU - Nuño, Aries AU - Kemp, Christopher AU - Tillett, Emily AU - Armington, Gretchen AU - Fink, Rachel AU - Hamill, M. Matthew AU - Manabe, C. Yukari PY - 2023/9/11 TI - A Web-Based, Mail-Order Sexually Transmitted Infection Testing Program: Qualitative Analysis of User Feedback JO - JMIR Form Res SP - e48670 VL - 7 KW - sexually transmitted infection KW - STI KW - HIV KW - direct-to-consumer screening and testing KW - web-based systems KW - feedback KW - web-based KW - user KW - testing program N2 - Background: The incidence of sexually transmitted infections (STIs) is increasing in the United States. The COVID-19 pandemic resulted in significant reductions in access to health care services, including STI testing and treatment, leading to underreporting of STI cases and a need for alternatives to clinic-based testing. Moreover, concerns around confidentiality, accessibility, and stigma continue to limit access to clinic-based STI testing, particularly for high-priority populations. IWantTheKit (IWTK) is a web-based platform that mails free, confidential, self-administered sample collection kits for testing for gonorrhea, chlamydia (both genital and extragenital sites), and vaginal trichomonas. Individuals visiting the IWTK website may select genital, pharyngeal, and rectal samples for chlamydia and gonorrhea testing. Vaginal samples are tested for trichomoniasis. Self-collected samples are processed in a College of American Pathologists?accredited laboratory, and results are posted to an individual?s secure digital account. Objective: This study aimed to (1) describe users? experience with the IWTK service through analysis of routine data and (2) optimize retention among current users and expand reach among high-priority populations by responding to user needs through programmatic and functional changes to the IWTK service. Methods: Free-text entries were submitted by IWTK users via a confidential ?Contact Us? page on the IWTK website from May 17, 2021, to January 31, 2022. All entries were deidentified prior to analysis. Two independent analysts coded these entries using a predefined codebook developed inductively for thematic analysis. Results: A total of 254 free-text entries were analyzed after removing duplicates and nonsensical entries. Themes emerged regarding the functionality of the website and personal experiences using IWTK?s services. Users? submissions included requests related to order status, address changes, replacement of old kits, clinical information (eg, treatment options and symptom reports), and reported risk behaviors. Conclusions: This analysis demonstrates how routine data can be used to propose potential programmatic improvements. IWTK implemented innovations on the website based on the study results to improve users? experience, including a tracking system for orders, address verification for each order, a physical drop box, additional textual information, direct linkage to care navigation, and printable results. Web-based, mail-order STI testing programs can leverage user feedback to optimize implementation and retention among current users and potentially expand reach among high-priority populations. This analysis is supported by other data that demonstrate how comprehensive support and follow-up care for individuals testing positive are critical components of any self-testing service. Additional formal assessments of the IWTK user experience and efforts to optimize posttesting linkage to care may be needed. UR - https://formative.jmir.org/2023/1/e48670 UR - http://dx.doi.org/10.2196/48670 UR - http://www.ncbi.nlm.nih.gov/pubmed/37695644 ID - info:doi/10.2196/48670 ER - TY - JOUR AU - Riihimies, Riikka AU - Kosunen, Elise AU - Koskela, H. Tuomas PY - 2023/9/8 TI - Segmenting Patients With Diabetes With the Navigator Service in Primary Care and a Description of the Self-Acting Patient Group: Cross-Sectional Study JO - J Med Internet Res SP - e40560 VL - 25 KW - patient segmentation KW - Navigator KW - self-acting patient KW - diabetes KW - primary care KW - self-management KW - skills KW - care KW - nurse KW - medication KW - quality of life KW - well-being KW - digital KW - patient N2 - Background: The aim of patient segmentation is to recognize patients with similar health care needs. The Finnish patient segmentation service Navigator segregates patients into 4 groups, including a self-acting group, who presumably manages their everyday life and coordinates their health care. Digital services could support their self-care. Knowledge on self-acting patients? characteristics is lacking. Objective: The study aims are to describe how Navigator assigns patients with diabetes to the 4 groups at nurses? appointments at a health center, the self-acting patient group?s characteristics compared with other patient groups, and the concordance between the nurse?s evaluation of the patient?s group and the actual group assigned by Navigator (criterion validity). Methods: Patients with diabetes ?18 years old visiting primary care were invited to participate in this cross-sectional study. Patients with disability preventing informed consent for participation were excluded. Nurses estimated the patients? upcoming group results before the appointment. We describe the concordance (%) between the evaluation and actual groups. Nurses used Navigator patients with diabetes (n=304) at their annual follow-up visits. The self-acting patients? diabetes care values (glycated hemoglobin [HbA1c], urine albumin to creatinine ratio, low-density lipoprotein cholesterol, blood pressure, BMI), chronic conditions, medication, smoking status, self-rated health, disability (World Health Organization Disability Assessment Schedule [WHODAS] 2.0), health-related quality of life (EQ-5D-5L), and well-being (Well-being Questionnaire [WBQ-12]) and the patients? responses to Navigator?s question concerning their digital skills as outcome variables were compared with those of the other patients. We used descriptive statistics for the patients? distribution into the 4 groups and demographic data. We used the Mann-Whitney U test with nonnormally distributed variables, independent samples t test with normally distributed variables, and Pearson chi-square tests with categorized variables to compare the groups. Results: Most patients (259/304, 85.2%) were in the self-acting group. Hypertension, hyperlipidemia, and joint ailments were the most prevalent comorbidities among all patients. Self-acting patients had less ischemic cardiac disease (P=.001), depression or anxiety (P=.03), asthma or chronic obstructive pulmonary disease (P<.001), long-term pain (P<.001), and related medication. Self-acting patients had better self-rated health (P<.001), functional ability (P<.001), health-related quality of life (P<.001), and general well-being (P<.001). All patients considered their skills at using electronic services to be good. Conclusions: The patients in the self-acting group had several comorbidities. However, their functional ability was not yet diminished compared with patients in the other groups. Therefore, to prevent diabetic complications and disabilities, support for patients? self-management should be emphasized in their integrated care services. Digital services could be involved in the care of patients willing to use them. The study was performed in 1 health center, the participants were volunteers, and most patients were assigned to self-acting patient group. These facts limit the generalizability of our results. International Registered Report Identifier (IRRID): RR2-10.2196/20570 UR - https://www.jmir.org/2023/1/e40560 UR - http://dx.doi.org/10.2196/40560 UR - http://www.ncbi.nlm.nih.gov/pubmed/37682585 ID - info:doi/10.2196/40560 ER - TY - JOUR AU - Shoemaker, E. Holly AU - Thorpe, Alistair AU - Stevens, Vanessa AU - Butler, M. Jorie AU - Drews, A. Frank AU - Burpo, Nicole AU - Scherer, D. Laura AU - Fagerlin, Angela PY - 2023/9/8 TI - Telehealth Use During the COVID-19 Pandemic Among Veterans and Nonveterans: Web-Based Survey Study JO - JMIR Form Res SP - e42217 VL - 7 KW - telehealth KW - telemedicine KW - veterans KW - COVID-19 KW - health care KW - nationwide web-based survey KW - underserved population KW - accessible health care KW - health inequality KW - health care disparity N2 - Background: In the first year of the COVID-19 pandemic, studies reported delays in health care usage due to safety concerns. Delays in care may result in increased morbidity and mortality from otherwise treatable conditions. Telehealth provides a safe alternative for patients to receive care when other circumstances make in-person care unavailable or unsafe, but information on patient experiences is limited. Understanding which people are more or less likely to use telehealth and their experiences can help tailor outreach efforts to maximize the impact of telehealth. Objective: This study aims to examine the characteristics of telehealth users and nonusers and their reported experiences among veteran and nonveteran respondents. Methods: A nationwide web-based survey of current behaviors and health care experiences was conducted in December 2020-March 2021. The survey consisted of 3 waves, and the first wave is assessed here. Respondents included US adults participating in Qualtrics web-based panels. Primary outcomes were self-reported telehealth use and number of telehealth visits. The analysis used a 2-part regression model examining the association between telehealth use and the number of visits with respondent characteristics. Results: There were 2085 participants in the first wave, and 898 (43.1%) reported using telehealth since the pandemic began. Most veterans who used telehealth reported much or somewhat preferring an in-person visit (336/474, 70.9%), while slightly less than half of nonveterans (189/424, 44.6%) reported this preference. While there was no significant difference between veteran and nonveteran likelihood of using telehealth (odds ratio [OR] 1.33, 95% CI 0.97-1.82), veterans were likely to have more visits when they did use it (incidence rate ratio [IRR] 1.49, 95% CI 1.07-2.07). Individuals were less likely to use telehealth and reported fewer visits if they were 55 years and older (OR 0.39, 95% CI 0.25-0.62 for ages 55-64 years; IRR 0.43, 95% CI 0.28-0.66) or lived in a small city (OR 0.63, 95% CI 0.43-0.92; IRR 0.71, 95% CI 0.51-0.99). Receiving health care partly or primarily at the Veterans Health Administration (VA) was associated with telehealth use (primarily VA: OR 3.25, 95% CI 2.20-4.81; equal mix: OR 2.18, 95% CI 1.40-3.39) and more telehealth visits (primarily VA: IRR 1.5, 95% CI 1.10-2.04; equal mix: IRR 1.57, 95% CI 1.11-2.24). Conclusions: Telehealth will likely continue to be an important source of health care for patients, especially following situations like the COVID-19 pandemic. Some groups who may benefit from telehealth are still underserved. Telehealth services and outreach should be improved to provide accessible care for all. UR - https://formative.jmir.org/2023/1/e42217 UR - http://dx.doi.org/10.2196/42217 UR - http://www.ncbi.nlm.nih.gov/pubmed/37527547 ID - info:doi/10.2196/42217 ER - TY - JOUR AU - O'Brien, Niki AU - Li, Edmond AU - Chaibva, N. Cynthia AU - Gomez Bravo, Raquel AU - Kovacevic, Lana AU - Kwame Ayisi-Boateng, Nana AU - Lounsbury, Olivia AU - Nwabufo, F. Ngnedjou Francoise AU - Senkyire, Kumi Ephraim AU - Serafini, Alice AU - Surafel Abay, Eleleta AU - van de Vijver, Steven AU - Wanjala, Mercy AU - Wangari, Marie-Claire AU - Moosa, Shabir AU - Neves, Luisa Ana PY - 2023/9/7 TI - Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study JO - J Med Internet Res SP - e45224 VL - 25 KW - digital health KW - digital health technology KW - telemedicine KW - remote care KW - primary care KW - primary health carel PHC KW - COVID-19 KW - global health KW - sub-Saharan Africa KW - eHealth N2 - Background: Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. Objective: This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. Methods: A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers? contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. Results: A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. Conclusions: The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle. UR - https://www.jmir.org/2023/1/e45224 UR - http://dx.doi.org/10.2196/45224 UR - http://www.ncbi.nlm.nih.gov/pubmed/37676721 ID - info:doi/10.2196/45224 ER - TY - JOUR AU - Wennerberg, Camilla AU - Hellström, Amanda AU - Schildmeijer, Kristina AU - Ekstedt, Mirjam PY - 2023/9/6 TI - Effects of Web-Based and Mobile Self-Care Support in Addition to Standard Care in Patients After Radical Prostatectomy: Randomized Controlled Trial JO - JMIR Cancer SP - e44320 VL - 9 KW - eHealth KW - linear mixed model KW - prostatic neoplasms KW - radical prostatectomy KW - randomized controlled trial KW - self-care KW - telemedicine KW - mobile health KW - mHealth KW - prostate cancer KW - sexual dysfunction KW - urinary incontinence KW - web-based KW - pelvic exercise KW - physical activity N2 - Background: Prostate cancer is a common form of cancer that is often treated with radical prostatectomy, which can leave patients with urinary incontinence and sexual dysfunction. Self-care (pelvic floor muscle exercises and physical activity) is recommended to reduce the side effects. As more and more men are living in the aftermath of treatment, effective rehabilitation support is warranted. Digital self-care support has the potential to improve patient outcomes, but it has rarely been evaluated longitudinally in randomized controlled trials. Therefore, we developed and evaluated the effects of digital self-care support (electronic Patient Activation in Treatment at Home [ePATH]) on prostate-specific symptoms. Objective: This study aimed to investigate the effects of web-based and mobile self-care support on urinary continence, sexual function, and self-care, compared with standard care, at 1, 3, 6, and 12 months after radical prostatectomy. Methods: A multicenter randomized controlled trial with 2 study arms was conducted, with the longitudinal effects of additional digital self-care support (ePATH) compared with those of standard care alone. ePATH was designed based on the self-determination theory to strengthen patients? activation in self-care through nurse-assisted individualized modules. Men planned for radical prostatectomy at 3 county hospitals in southern Sweden were included offline and randomly assigned to the intervention or control group. The effects of ePATH were evaluated for 1 year after surgery using self-assessed questionnaires. Linear mixed models and ordinal regression analyses were performed. Results: This study included 170 men (85 in each group) from January 2018 to December 2019. The participants in the intervention and control groups did not differ in their demographic characteristics. In the intervention group, 64% (53/83) of the participants used ePATH, but the use declined over time. The linear mixed model showed no substantial differences between the groups in urinary continence (?=?5.60; P=.09; 95% CI ?12.15 to ?0.96) or sexual function (?=?.12; P=.97; 95% CI ?7.05 to ?6.81). Participants in the intervention and control groups did not differ in physical activity (odds ratio 1.16, 95% CI 0.71-1.89; P=.57) or pelvic floor muscle exercises (odds ratio 1.51, 95% CI 0.86-2.66; P=.15). Conclusions: ePATH did not affect postoperative side effects or self-care but reflected how this support may work in typical clinical conditions. To complement standard rehabilitation, digital self-care support must be adapted to the context and individual preferences for use and effect. Trial Registration: ISRCTN Registry ISRCTN18055968; https://www.isrctn.com/ISRCTN18055968 International Registered Report Identifier (IRRID): RR2-10.2196/11625 UR - https://cancer.jmir.org/2023/1/e44320 UR - http://dx.doi.org/10.2196/44320 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672332 ID - info:doi/10.2196/44320 ER - TY - JOUR AU - Joshi, Vibha AU - Joshi, Kumar Nitin AU - Bhardwaj, Pankaj AU - Singh, Kuldeep AU - Ojha, Deepika AU - Jain, Kumar Yogesh PY - 2023/9/4 TI - The Health Impact of mHealth Interventions in India: Systematic Review and Meta-Analysis JO - Online J Public Health Inform SP - e50927 VL - 15 KW - mobile applications KW - mobile apps KW - cost-benefit analysis KW - telemedicine KW - technology KW - India KW - patient satisfaction KW - pregnancy N2 - Background: Considerable use of mobile health (mHealth) interventions has been seen, and these interventions have beneficial effects on health and health service delivery processes, especially in resource-limited settings. Various functionalities of mobile phones offer a range of opportunities for mHealth interventions. Objective: This review aims to assess the health impact of mHealth interventions in India. Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies conducted in India, and published between April 1, 2011, and March 31, 2021, were considered. A literature search was conducted using a combination of MeSH (Medical Subject Headings) terms in different databases to identify peer-reviewed publications. Thirteen out of 1350 articles were included for the final review. Risk of bias was assessed using the Risk of Bias 2 tool for RCTs and Risk Of Bias In Non-randomised Studies - of Interventions tool (for nonrandomized trials), and a meta-analysis was performed using RevMan for 3 comparable studies on maternal, neonatal, and child health. Results: The meta-analysis showed improved usage of maternal and child health services including iron?folic acid supplementation (odds ratio [OR] 14.30, 95% CI 6.65-30.75), administration of both doses of the tetanus toxoid (OR 2.47, 95% CI 0.22-27.37), and attending 4 or more antenatal check-ups (OR 1.82, 95% CI 0.65-5.09). Meta-analysis for studies concerning economic evaluation and chronic diseases could not be performed due to heterogeneity. However, a positive economic impact was observed from a societal perspective (ReMiND [reducing maternal and newborn deaths] and ImTeCHO [Innovative Mobile Technology for Community Health Operation] interventions), and chronic disease interventions showed a positive impact on clinical outcomes, patient and provider satisfaction, app usage, and improvement in health behaviors. Conclusions: This review provides a comprehensive overview of mHealth technology in all health sectors in India, analyzing both health and health care usage indicators for interventions focused on maternal and child health and chronic diseases. Trial Registration: PROSPERO 2021 CRD42021235315; https://tinyurl.com/yh4tp2j7 UR - https://ojphi.jmir.org/2023/1/e50927 UR - http://dx.doi.org/10.2196/50927 UR - http://www.ncbi.nlm.nih.gov/pubmed/38046564 ID - info:doi/10.2196/50927 ER - TY - JOUR AU - Spiess, T. Saskia AU - Gardner, Elena AU - Turner, Cindy AU - Galt, Annie AU - Fortenberry, Katherine AU - Ho, Tiffany AU - Knox, Jordan AU - Ose, Dominik PY - 2023/8/31 TI - We Cannot Put This Genie Back in the Bottle: Qualitative Interview Study Among Family Medicine Providers About Their Experiences With Virtual Visits During the COVID-19 Pandemic JO - J Med Internet Res SP - e43877 VL - 25 KW - family medicine KW - primary care KW - virtual visits KW - telemedicine KW - COVID-19 N2 - Background: When a genie is freed from its bottle, things cannot be restored to the way they were before. At the beginning of the global COVID-19 pandemic, health care systems adjusted how they delivered care overnight. Primary care practices switched from seeing patients in person to virtual care applications, including video and phone visits, e-visits, e-consults, and messaging with clinicians. Prior to the pandemic, these applications were not as widely used, but discussions around their advantages and disadvantages in some settings were being explored. Emergency regulatory changes spurred by the pandemic freed this virtual care ?genie? from its bottle. Wide-scale adoption of virtual care in family medicine has much potential, as primary care services are often a patient?s first point of contact with the health care system. Objective: This study aims to analyze family medicine providers? experiences using virtual visits during the pandemic, perceived outcomes of the shift to virtual visits, and discusses its implications for the future of family medicine. Methods: This qualitative study took place at 3 academic primary care clinics between June and December 2020. Data were collected through one-on-one Zoom (version 5.2.1) interviews with family medicine clinical faculty who experienced the rapid transition of in-person visits to mostly ?virtual? visits. The interviews were recorded, deidentified, and transcribed. We adopted a constructivist approach to qualitative content analysis to evaluate the results. Results: In total, 25 participants were eligible, and 20 individuals participated in this study (80% participation rate). The mean age was 43.4 years, and 85% (17/20) of the participants were female. We identified 3 main themes: the care process, patient engagement, and team-based care. Conclusions: This study highlights the transition from in-person to virtual visits during the pandemic from the perspective of family medicine providers. Generally, family medicine providers? perceptions of the shift to virtual visits were positive, especially regarding team-based care. Challenges involved virtual inhibition, particularly for providers. Providers described ways they integrated virtual care with aspects of in-person care, creating a hybrid environment. The genie is out of the bottle?things will not be the same?but family medicine now has the opportunity to evolve. UR - https://www.jmir.org/2023/1/e43877 UR - http://dx.doi.org/10.2196/43877 UR - http://www.ncbi.nlm.nih.gov/pubmed/37651162 ID - info:doi/10.2196/43877 ER - TY - JOUR AU - Flynn, Nichols Anne AU - Koelper, C. Nathanael AU - Sonalkar, Sarita PY - 2023/8/28 TI - Telephone-Based Intervention to Improve Family Planning Care in Pregnancies of Unknown Location: Retrospective Pre-Post Study JO - J Med Internet Res SP - e42559 VL - 25 KW - contraception KW - electronic medical record KW - family planning KW - pregnancy intendedness KW - pregnancy of unknown location KW - pre-post study KW - telephone-based intervention N2 - Background: Patients followed for a pregnancy of unknown location are generally followed by a team of clinicians through telephone calls, and their contraceptive needs at the time of pregnancy resolution may not be addressed. Objective: This study aimed to assess contraceptive counseling and contraceptive uptake before and after a telephone-based intervention. Methods: This was a retrospective pre-post study assessing pregnancy intendedness in patients with a pregnancy of unknown location and the proportion of patients who received contraceptive counseling and a contraceptive prescription before and after the initiation of a telephone-based intervention. We reviewed medical records 1 year before and 1 year after implementation of our intervention for demographic characteristics, pregnancy intendedness, pregnancy outcome, contraceptive counseling documentation, receipt of contraception, and repeat pregnancy within 6 months. We assessed the effects of an implementation strategy to address family planning needs once pregnancy was resolved by comparing the proportions of patients who were counseled and received contraception before and after our intervention was implemented. We performed logistic regression to identify associations between covariates and the outcomes of contraceptive counseling documentation and receipt of contraception. Results: Of the 220 patients in the combined cohort, the majority were Black (161/220, 73%) and ultimately had a resolved pregnancy of unknown location (162/220, 74%), and the proportion of pregnancies documented as unintended was 60% (132/220). Before our intervention, 27 of 100 (27%) patients received contraceptive counseling, compared with 94 of 120 (78%) patients after the intervention (odds ratio [OR] 9.77, 95% CI 5.26-18.16). Before the intervention, 17 of 90 (19%) patients who did not desire repeat pregnancy received contraception, compared with 32 of 86 (37%) patients after the intervention (OR 2.54, 95% CI 1.28-5.05). Our postintervention cohort had an increased odds of receiving contraceptive counseling (OR 9.77, 95% CI 5.26-18.16) and of receiving a contraceptive prescription (OR 2.54, 95% CI 1.28-5.05) compared with our preintervention cohort. Conclusions: We found that over half of patients with a pregnancy of unknown location have an unintended pregnancy, and standardization of care through a telephone-based intervention improves contraceptive counseling and prescribing in patients with a resolved pregnancy of unknown location. This intervention could be used at any institution that follows patients with a pregnancy of unknown location remotely to improve care. UR - https://www.jmir.org/2023/1/e42559 UR - http://dx.doi.org/10.2196/42559 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639302 ID - info:doi/10.2196/42559 ER - TY - JOUR AU - Wu, Chenguang Doris AU - Zhao, Xianduo AU - Wu, Ji PY - 2023/8/24 TI - Online Physician-Patient Interaction and Patient Satisfaction: Empirical Study of the Internet Hospital Service JO - J Med Internet Res SP - e39089 VL - 25 KW - internet hospital KW - online health service KW - online physician-patient interaction KW - patient satisfaction KW - COVID-19 N2 - Background: In China, a form of online health service called the internet hospital became a prominent means of patient care when face-to-face visits were not possible during the COVID-19 pandemic to minimize transmission of the SARS-CoV-2 virus. Patients? internet hospital experiences largely depend on online physician-patient interaction. Yet, little is known about how physicians can improve patient satisfaction by using specific communication strategies online. Objective: This study aimed to identify specific communication strategies to help physicians deliver better quality internet hospital services. We also outline recommendations for hospitals to operate internet hospital platforms more effectively. Methods: A longitudinal data set was collected from an internet hospital platform operated by a top hospital in China. By extracting communication patterns from approximately 20,000 records of online health care services and by controlling the features of service requests, we tested the impacts of response load, more detailed style, and emotional comfort on patient satisfaction. We further explored the effects of these communication patterns in different service contexts. Results: Physicians with a low response load, a more detailed style, and expressions of emotional comfort received more positive patient feedback. Response load did not affect patient satisfaction with free online health service, whereas a more detailed style and emotional comfort enhanced satisfaction with free service. Response load significantly reduced patient satisfaction with paid online health service, while a more detailed style had no effect. Compared with free service, emotional comfort more strongly promoted patient satisfaction with paid service. Conclusions: The communication strategies identified can help physicians provide patients with a better internet hospital experience. These strategies require hospitals to schedule each physician?s online service period more appropriately. In addition, tailoring the strategies to service situations can facilitate more targeted and effective internet hospital service for patients. UR - https://www.jmir.org/2023/1/e39089 UR - http://dx.doi.org/10.2196/39089 UR - http://www.ncbi.nlm.nih.gov/pubmed/37616031 ID - info:doi/10.2196/39089 ER - TY - JOUR AU - Gautam, Kamal AU - Paudel, Kiran AU - Jacobs, Jerome AU - Wickersham, A. Jeffrey AU - Ikhtiaruddin, Mohd Wan AU - Azwa, Iskandar AU - Saifi, Rumana AU - Lim, How Sin AU - Shrestha, Roman PY - 2023/8/24 TI - An mHealth-Delivered Sexual Harm Reduction Tool (PartyPack) for Men Who Have Sex With Men in Malaysia: Usability Study JO - JMIR Form Res SP - e48113 VL - 7 KW - chemsex KW - party and play KW - sexualized drug use KW - PartyPack KW - harm reduction tool KW - men who have sex with men KW - Malaysia KW - health promotion KW - sexual health KW - mHealth intervention KW - HIV prevention N2 - Background: Chemsex?the use of psychoactive drugs to enhance the sexual experience?is an increasing phenomenon globally. Despite the increasing burden and associated harms of chemsex, evidence-based interventions (ie, behavioral and pharmacological) for chemsex users are nonexistent. Objective: In this study, we assessed the usability and acceptability of a mobile health (mHealth)?delivered safer chemsex package (?PartyPack?) as a sexual harm reduction strategy among men who have sex with men in Malaysia?a setting where chemsex is becoming increasingly prevalent. Methods: This study is part of a larger smartphone app-based intervention (ie, JomPrEP; University of Connecticut) designed to improve access to HIV prevention services among Malaysian men who have sex with men. A total of 50 participants were recruited from the Greater Kuala Lumpur region of Malaysia to use the JomPrEP app, which included a feature allowing participants to order PartyPack, for 30 days (March-April 2022). The usability and acceptability of the PartyPack were assessed using self-report, app analytics, and exit interviews (n=20). Results: Overall, 8% (4/50) of participants reported having engaged in chemsex in the past 6 months; however, engagement in condomless sex (34/50, 68%) and group sex (9/50, 18%) was much higher. A total of 43 (86%) participants ordered PartyPack, of which 27 (63%) made multiple orders during the 30 days. Most participants (41/43, 95%) reported being satisfied with the PartyPack order feature in the app, with 91% (39/43) indicating the order and tracking process was easy. Thematic data exploration further revealed important information for understanding (eg, items included in the package, use of mHealth platform to order package, and discreetness of the PartyPack box and order and delivery) and refining the logistical preferences (eg, using branded items and allowing customization during order). Conclusions: Our findings provide strong evidence of the usability and acceptability of a mHealth-delivered safer chemsex package as a potential sexual harm reduction tool among this underserved population. Replication in a study with a larger sample size to test the efficacy of the PartyPack is warranted. UR - https://formative.jmir.org/2023/1/e48113 UR - http://dx.doi.org/10.2196/48113 UR - http://www.ncbi.nlm.nih.gov/pubmed/37616034 ID - info:doi/10.2196/48113 ER - TY - JOUR AU - Nair, Monika AU - Andersson, Jonas AU - Nygren, M. Jens AU - Lundgren, E. Lina PY - 2023/8/23 TI - Barriers and Enablers for Implementation of an Artificial Intelligence?Based Decision Support Tool to Reduce the Risk of Readmission of Patients With Heart Failure: Stakeholder Interviews JO - JMIR Form Res SP - e47335 VL - 7 KW - implementation KW - AI systems KW - health care KW - interviews KW - artificial Intelligence KW - AI KW - decision support tool KW - readmission KW - prediction KW - heart failure KW - digital tool N2 - Background: Artificial intelligence (AI) applications in health care are expected to provide value for health care organizations, professionals, and patients. However, the implementation of such systems should be carefully planned and organized in order to ensure quality, safety, and acceptance. The gathered view of different stakeholders is a great source of information to understand the barriers and enablers for implementation in a specific context. Objective: This study aimed to understand the context and stakeholder perspectives related to the future implementation of a clinical decision support system for predicting readmissions of patients with heart failure. The study was part of a larger project involving model development, interface design, and implementation planning of the system. Methods: Interviews were held with 12 stakeholders from the regional and municipal health care organizations to gather their views on the potential effects implementation of such a decision support system could have as well as barriers and enablers for implementation. Data were analyzed based on the categories defined in the nonadoption, abandonment, scale-up, spread, sustainability (NASSS) framework. Results: Stakeholders had in general a positive attitude and curiosity toward AI-based decision support systems, and mentioned several barriers and enablers based on the experiences of previous implementations of information technology systems. Central aspects to consider for the proposed clinical decision support system were design aspects, access to information throughout the care process, and integration into the clinical workflow. The implementation of such a system could lead to a number of effects related to both clinical outcomes as well as resource allocation, which are all important to address in the planning of implementation. Stakeholders saw, however, value in several aspects of implementing such system, emphasizing the increased quality of life for those patients who can avoid being hospitalized. Conclusions: Several ideas were put forward on how the proposed AI system would potentially affect and provide value for patients, professionals, and the organization, and implementation aspects were important parts of that. A successful system can help clinicians to prioritize the need for different types of treatments but also be used for planning purposes within the hospital. However, the system needs not only technological and clinical precision but also a carefully planned implementation process. Such a process should take into consideration the aspects related to all the categories in the NASSS framework. This study further highlighted the importance to study stakeholder needs early in the process of development, design, and implementation of decision support systems, as the data revealed new information on the potential use of the system and the placement of the application in the care process. UR - https://formative.jmir.org/2023/1/e47335 UR - http://dx.doi.org/10.2196/47335 UR - http://www.ncbi.nlm.nih.gov/pubmed/37610799 ID - info:doi/10.2196/47335 ER - TY - JOUR AU - Brown-Johnson, G. Cati AU - Lessios, Sophia Anna AU - Thomas, Samuel AU - Kim, Mirini AU - Fukaya, Eri AU - Wu, Siqi AU - Kling, R. Samantha M. AU - Brown, Gretchen AU - Winget, Marcy PY - 2023/8/23 TI - A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study JO - JMIR Form Res SP - e43258 VL - 7 KW - nursing KW - telehealth KW - telemedicine KW - follow-up KW - wound care KW - capacity building KW - mobile phone N2 - Background: Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth. Objective: This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients. Methods: Patients and part-time or per-diem, wound care?certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys. Results: This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care?specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2). Conclusions: This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients? technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care. UR - https://formative.jmir.org/2023/1/e43258 UR - http://dx.doi.org/10.2196/43258 UR - http://www.ncbi.nlm.nih.gov/pubmed/37610798 ID - info:doi/10.2196/43258 ER - TY - JOUR AU - Wilson, Sarah AU - Tolley, Clare AU - Mc Ardle, Riona AU - Beswick, Emily AU - Slight, P. Sarah PY - 2023/8/22 TI - Key Considerations When Developing and Implementing Digital Technology for Early Detection of Dementia-Causing Diseases Among Health Care Professionals: Qualitative Study JO - J Med Internet Res SP - e46711 VL - 25 KW - qualitative KW - health care professional KW - early detection of disease KW - dementia KW - digital technology KW - early detection of dementia KW - digital health KW - health care worker KW - digital tool N2 - Background: The World Health Organization (WHO) promotes using digital technologies to accelerate global attainment of health and well-being. This has led to a growth in research exploring the use of digital technology to aid early detection and preventative interventions for dementia-causing diseases such as Alzheimer disease. The opinions and perspectives of health care professionals must be incorporated into the development and implementation of technology to promote its successful adoption in clinical practice. Objective: This study aimed to explore health care professionals? perspectives on the key considerations of developing and implementing digital technologies for the early detection of dementia-causing diseases in the National Health Service (NHS). Methods: Health care professionals with patient-facing roles in primary or secondary care settings in the NHS were recruited through various web-based NHS clinical networks. Participants were interviewed to explore their experiences of the current dementia diagnostic practices, views on early detection and use of digital technology to aid these practices, and the challenges of implementing such interventions in health care. An inductive thematic analysis approach was applied to identify central concepts and themes in the interviews, allowing the data to determine our themes. A list of central concepts and themes was applied systematically to the whole data set using NVivo (version 1.6.1; QSR International). Using the constant comparison technique, the researchers moved backward and forward between these data and evolving explanations until a fit was made. Results: Eighteen semistructured interviews were conducted, with 11 primary and 7 secondary care health care professionals. We identified 3 main categories of considerations relevant to health care service users, health care professionals, and the digital health technology itself. Health care professionals recognized the potential of using digital technology to collect real-time data and the possible benefits of detecting dementia-causing diseases earlier if an effective intervention were available. However, some were concerned about postdetection management, questioning the point of an early detection of dementia-causing diseases if an effective intervention cannot be provided and feared this would only lead to increased anxiety in patients. Health care professionals also expressed mixed opinions on who should be screened for early detection. Some suggested it should be available to everyone to mitigate the chance of excluding those who are not in touch with their health care or are digitally excluded. Others were concerned about the resources that would be required to make the technology available to everyone. Conclusions: This study highlights the need to design digital health technology in a way that is accessible to all and does not add burden to health care professionals. Further work is needed to ensure inclusive strategies are used in digital research to promote health equity. UR - https://www.jmir.org/2023/1/e46711 UR - http://dx.doi.org/10.2196/46711 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606986 ID - info:doi/10.2196/46711 ER - TY - JOUR AU - Nan, Jingwen AU - Xu, Li-Qun PY - 2023/8/21 TI - Designing Interoperable Health Care Services Based on Fast Healthcare Interoperability Resources: Literature Review JO - JMIR Med Inform SP - e44842 VL - 11 KW - Health level 7 Fast Healthcare Interoperability Resources KW - HL7 FHIR KW - interoperability KW - literature review KW - practice guideline KW - mobile phone N2 - Background: With the advent of the digital economy and the aging population, the demand for diversified health care services and innovative care delivery models has been overwhelming. This trend has accelerated the urgency to implement effective and efficient data exchange and service interoperability, which underpins coordinated care services among tiered health care institutions, improves the quality of oversight of regulators, and provides vast and comprehensive data collection to support clinical medicine and health economics research, thus improving the overall service quality and patient satisfaction. To meet this demand and facilitate the interoperability of IT systems of stakeholders, after years of preparation, Health Level 7 formally introduced, in 2014, the Fast Healthcare Interoperability Resources (FHIR) standard. It has since continued to evolve. FHIR depends on the Implementation Guide (IG) to ensure feasibility and consistency while developing an interoperable health care service. The IG defines rules with associated documentation on how FHIR resources are used to tackle a particular problem. However, a gap remains between IGs and the process of building actual services because IGs are rules without specifying concrete methods, procedures, or tools. Thus, stakeholders may feel it nontrivial to participate in the ecosystem, giving rise to the need for a more actionable practice guideline (PG) for promoting FHIR?s fast adoption. Objective: This study aimed to propose a general FHIR PG to facilitate stakeholders in the health care ecosystem to understand FHIR and quickly develop interoperable health care services. Methods: We selected a collection of FHIR-related papers about the latest studies or use cases on designing and building FHIR-based interoperable health care services and tagged each use case as belonging to 1 of the 3 dominant innovation feature groups that are also associated with practice stages, that is, data standardization, data management, and data integration. Next, we reviewed each group?s detailed process and key techniques to build respective care services and collate a complete FHIR PG. Finally, as an example, we arbitrarily selected a use case outside the scope of the reviewed papers and mapped it back to the FHIR PG to demonstrate the effectiveness and generalizability of the PG. Results: The FHIR PG includes 2 core elements: one is a practice design that defines the responsibilities of stakeholders and outlines the complete procedure from data to services, and the other is a development architecture for practice design, which lists the available tools for each practice step and provides direct and actionable recommendations. Conclusions: The FHIR PG can bridge the gap between IGs and the process of building actual services by proposing actionable methods, procedures, and tools. It assists stakeholders in identifying participants? roles, managing the scope of responsibilities, and developing relevant modules, thus helping promote FHIR-based interoperable health care services. UR - https://medinform.jmir.org/2023/1/e44842 UR - http://dx.doi.org/10.2196/44842 UR - http://www.ncbi.nlm.nih.gov/pubmed/37603388 ID - info:doi/10.2196/44842 ER - TY - JOUR AU - Gompels, Ben AU - Rusby, Tobin AU - Limb, Richard AU - Ralte, Peter PY - 2023/8/18 TI - Diagnostic Accuracy and Confidence in Management of Forearm and Hand Fractures Among Foundation Doctors in the Accident and Emergency Department: Survey Study JO - JMIR Form Res SP - e45820 VL - 7 KW - education KW - diagnostic accuracy KW - doctor KW - fracture KW - x-ray KW - radiograph KW - diagnostic error KW - patient safety N2 - Background: Accurate interpretation of radiographs is crucial for junior doctors in the accident and emergency (A&E) department (the emergency medicine department). However, it remains a significant challenge and a leading cause of diagnostic errors. Objective: This study aimed to evaluate the accuracy and confidence of foundation doctors (doctors within their first 2 years of qualifying) in correctly interpreting and managing forearm and hand fractures on plain radiographs. Methods: A total of 42 foundation doctors with less than 2 years of experience and no prior emergency medicine training who worked in a large district general hospital participated in a web-based questionnaire. The questionnaire consisted of 3 case studies: distal radius fracture, scaphoid fracture, and a normal radiograph. Respondents were required to identify the presence or absence of a fracture, determine the fracture location, suggest appropriate management, and rate their confidence on a Likert scale. Results: Overall, 48% (61/126) of respondents accurately identified the presence and location of fractures. The correct management option was chosen by 64% (81/126) of respondents. The median diagnostic confidence score was 4 of 10, with a mean diagnostic certainty of 4.4 of 10. Notably, respondents exhibited a significantly lower confidence score for the normal radiograph compared to the distal radius fracture radiograph (P=.01). Conclusions: This study reveals diagnostic uncertainty among foundation doctors in interpreting plain radiographs, with a notable inclination toward overdiagnosing fractures. The findings emphasize the need for close supervision and senior support to mitigate diagnostic errors. Further training and educational interventions are warranted to improve the accuracy and confidence of junior doctors in radiographic interpretation. This study has several limitations, including a small sample size and reliance on self-reported data. The findings may not be generalizable to other health care settings or specialties. Future research should aim for larger, more diverse samples and explore the impact of specific educational interventions on diagnostic accuracy and confidence. UR - https://formative.jmir.org/2023/1/e45820 UR - http://dx.doi.org/10.2196/45820 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594796 ID - info:doi/10.2196/45820 ER - TY - JOUR AU - Thomas, Elizabeth AU - Lee, Ying Crystal Man AU - Norman, Richard AU - Wells, Leanne AU - Shaw, Tim AU - Nesbitt, Julia AU - Frean, Isobel AU - Baxby, Luke AU - Bennett, Sabine AU - Robinson, Suzanne PY - 2023/8/17 TI - Patient Use, Experience, and Satisfaction With Telehealth in an Australian Population (Reimagining Health Care): Web-Based Survey Study JO - J Med Internet Res SP - e45016 VL - 25 KW - telehealth KW - consumer experience KW - demographic influence KW - population survey KW - health care survey KW - telemedicine KW - Australia KW - participant recruitment N2 - Background: The COVID-19 pandemic triggered a rapid scale-up of telehealth services in Australia as a means to provide continued care through periods of physical restrictions. The factors that influence engagement in telehealth remain unclear. Objective: The purpose of this study is to understand the experience of Australian people who engaged in a telehealth consultation during the pandemic period (2020-2021) and the demographic factors that influence engagement. Methods: A web-based survey was distributed to Australians aged over 18 years that included 4 questions on frequency and type of clinical consultation, including with a general practitioner (GP), specialist, allied health, or nurse; 1 question on the experience of telehealth; and 2 questions on the quality of and satisfaction with telehealth. Statistical analysis included proportion of responses (of positive responses where a Likert scale was used) and regression analyses to determine the effect of demographic variables. Results: Of the 1820 participants who completed the survey, 88.3% (1607/1820) had engaged in a health care consultation of some type in the previous 12 months, and 69.3% (1114/1607) of those had used telehealth. The most common type of consultation was with a GP (959/1114, 86.1%). Older people were more likely to have had a health care consultation but less likely to have had a telehealth consultation. There was no difference in use of telehealth between metropolitan and nonmetropolitan regions; however, people with a bachelor?s degree or above were more likely to have used telehealth and to report a positive experience. A total of 87% (977/1114) of participants agreed or strongly agreed that they had received the information they required from their consultation, 71% (797/1114) agreed or strongly agreed that the outcome of their consultation was the same as it would have been face-to-face, 84% (931/1114) agreed or strongly agreed that the doctor or health care provider made them feel comfortable, 83% (924/1114) agreed or strongly agreed that the doctor or health care provider was equally as knowledgeable as providers they have seen in person; 57% (629/1114) of respondents reported that they would not have been able to access their health consultation if it were not for telehealth; 69% (765/1114) of respondents reported that they were satisfied with their telehealth consultation, and 60% (671/1114) reported that they would choose to continue to use telehealth in the future. Conclusions: There was a relatively high level of engagement with telehealth over the 12 months leading up to the study period, and the majority of participants reported a positive experience and satisfaction with their telehealth consultation. While there was no indication that remoteness influenced telehealth usage, there remains work to be done to improve access to older people and those with less than a bachelor?s degree. UR - https://www.jmir.org/2023/1/e45016 UR - http://dx.doi.org/10.2196/45016 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590037 ID - info:doi/10.2196/45016 ER - TY - JOUR AU - Wang, Jiamin AU - Zhen, Xuemei AU - Coyte, C. Peter AU - Shao, Di AU - Zhao, Ni AU - Chang, Lele AU - Feng, Yujia AU - Sun, Xiaojie PY - 2023/8/16 TI - Association Between Online Health Information?Seeking Behaviors by Caregivers and Delays in Pediatric Cancer: Mixed Methods Study in China JO - J Med Internet Res SP - e46953 VL - 25 KW - online health information?seeking behaviors KW - patient delay KW - diagnostic delay KW - treatment delay KW - mixed methods study N2 - Background: Pediatric cancer patients in China often present at an advanced stage of disease resulting in lower survival and poorer health outcomes. One factor hypothesized to contribute to delays in pediatric cancer has been the online health information?seeking (OHIS) behaviors by caregivers. Objective: This study aims to examine the association between OHIS behaviors by caregivers and delays for Chinese pediatric cancer patients using a mixed methods approach. Methods: This study used a mixed methods approach, specifically a sequential explanatory design. OHIS behavior by the caregiver was defined as the way caregivers access information relevant to their children?s health via the Internet. Delays in pediatric cancer were defined as any one of the following 3 types of delay: patient delay, diagnosis delay, or treatment delay. The quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and binary logistic regression analysis, all performed using Stata. The qualitative analysis methods included conceptual content analysis and the Colaizzi method. Results: A total of 303 pediatric cancer patient-caregiver dyads was included in the quantitative survey, and 29 caregivers completed the qualitative interview. Quantitative analysis results revealed that nearly one-half (151/303, 49.8%) of patients experienced delays in pediatric cancer, and the primary type of delay was diagnosis delay (113/303, 37.3%), followed by patient delay (50/303, 16.5%) and treatment delay (24/303, 7.9%). In this study, 232 of the 303 (76.6%) caregiver participants demonstrated OHIS behaviors. When those engaged in OHIS behaviors were compared with their counterparts, the likelihood of patient delay more than doubled (odds ratio=2.21; 95% CI 1.03-4.75). Qualitative analysis results showed that caregivers? OHIS behaviors impacted the cancer care pathway by influencing caregivers? symptom appraisal before the first medical contact and caregivers? acceptance of health care providers? diagnostic and treatment decisions. Conclusions: Our ?ndings suggest that OHIS among Chinese pediatric caregivers may be a risk factor for increasing the likelihood of patient delay. Our government and society should make a concerted effort to regulate online health information and improve its quality. Specialized freemium consultations provided by health care providers via online health informatic platforms are needed to shorten the time for caregivers? cancer symptom appraisal before the first medical contact. UR - https://www.jmir.org/2023/1/e46953 UR - http://dx.doi.org/10.2196/46953 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585244 ID - info:doi/10.2196/46953 ER - TY - JOUR AU - Livesay, Karen AU - Petersen, Sacha AU - Walter, Ruby AU - Zhao, Lin AU - Butler-Henderson, Kerryn AU - Abdolkhani, Robab PY - 2023/8/16 TI - Sociotechnical Challenges of Digital Health in Nursing Practice During the COVID-19 Pandemic: National Study JO - JMIR Nursing SP - e46819 VL - 6 KW - nursing informatics KW - digital health KW - COVID-19 pandemic KW - workforce KW - sociotechnical approach N2 - Background: The COVID-19 pandemic has accelerated the use of digital health innovations, which has greatly impacted nursing practice. However, little is known about the use of digital health services by nurses and how this has changed during the pandemic. Objective: This study explored the sociotechnical challenges that nurses encountered in using digital health services implemented during the pandemic and, accordingly, what digital health capabilities they expect from the emerging workforce. Methods: Five groups of nurses, including chief nursing information officers, nurses, clinical educators, nurse representatives at digital health vendor companies, and nurse representatives in government bodies across Australia were interviewed. They were asked about their experience of digital health during the pandemic, their sociotechnical challenges, and their expectations of the digital health capabilities of emerging nurses to overcome these challenges. Interviews were deductively analyzed based on 8 sociotechnical themes, including technical challenges, nurse-technology interaction, clinical content management, training and human resources, communication and workflow, internal policies and guidelines, external factors, and effectiveness assessment of digital health for postpandemic use. Results: Sixteen participants were interviewed. Human factors and clinical workflow challenges were highly mentioned. Nurses? lack of knowledge and involvement in digital health implementation and evaluation led to inefficient use of these technologies during the pandemic. They expected the emerging workforce to be digitally literate and actively engaged in digital health interventions beyond documentation, such as data analytics and decision-making. Conclusions: Nurses should be involved in digital health interventions to efficiently use these technologies and provide safe and quality care. Collaborative efforts among policy makers, vendors, and clinical and academic industries can leverage digital health capabilities in the nursing workforce. UR - https://nursing.jmir.org/2023/1/e46819 UR - http://dx.doi.org/10.2196/46819 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585256 ID - info:doi/10.2196/46819 ER - TY - JOUR AU - Dalko, Katharina AU - Kraft, Bernhard AU - Jahn, Patrick AU - Schildmann, Jan AU - Hofstetter, Sebastian PY - 2023/8/15 TI - Cocreation of Assistive Technologies for Patients With Long COVID: Qualitative Analysis of a Literature Review on the Challenges of Patient Involvement in Health and Nursing Sciences JO - J Med Internet Res SP - e46297 VL - 25 KW - cocreation KW - participatory development KW - transdisciplinary research KW - technological development KW - long COVID syndrome KW - mobile phone N2 - Background: Digital assistive technologies have the potential to address the pressing need for adequate therapy options for patients with long COVID (also known as post?COVID-19 condition) by enabling the implementation of individual and independent rehabilitation programs. However, the involvement of the target patient group is necessary to develop digital devices that are closely aligned to the needs of this particular patient group. Objective: Participatory design approaches, such as cocreation, may be a solution for achieving usability and user acceptance. However, there are currently no set methods for implementing cocreative development processes incorporating patients. This study addresses the following research questions: what are the tasks and challenges associated with the involvement of patient groups? What lessons can be learned regarding the adequate involvement of patients with long COVID? Methods: First, a literature review based on a 3-stage snowball process was conducted to identify the tasks and challenges emerging in the context of the cocreation of digital assistive devices and services with patient groups. Second, a qualitative analysis was conducted in an attempt to extract relevant findings and criteria from the identified studies. Third, using the method of theory adaptation, this paper presents recommendations for the further development of the existing concepts of cocreation in relation to patients with long COVID. Results: The challenges of an active involvement of patients in cocreative development in health care include hierarchical barriers and differences in the levels of specific knowledge between professionals and patients. In the case of long COVID, patients themselves are still inexperienced in dealing with their symptoms and are hardly organized into established groups. This amplifies general hurdles and leads to questions of group identity, power structure, and knowledge creation, which are not sufficiently addressed by the current methods of cocreation. Conclusions: The adaptation of transdisciplinary methods to cocreative development approaches focusing on collaborative and inclusive communication can address the recurring challenges of actively integrating patients with long COVID into development processes. UR - https://www.jmir.org/2023/1/e46297 UR - http://dx.doi.org/10.2196/46297 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581906 ID - info:doi/10.2196/46297 ER - TY - JOUR AU - Boskey, R. Elizabeth AU - Quint, Meg AU - Xu, Rena AU - Kremen, Jessica AU - Estrada, Carlos AU - Tham, Regina AU - Kane, Kaiden AU - Reisner, L. Sari PY - 2023/8/15 TI - Gender Affirmation?Related Information-Seeking Behaviors in a Diverse Sample of Transgender and Gender-Diverse Young Adults: Survey Study JO - JMIR Form Res SP - e45952 VL - 7 KW - web-based health KW - information seeking KW - transgender youth KW - health communication KW - survey KW - gender diverse KW - youth KW - United States KW - support KW - gender identity KW - accessibility KW - transgender community KW - web-based information N2 - Background: Of the 1.6 million transgender and gender-diverse (TGD) people in the United States, approximately 700,000 are youth aged 13-24 years. Many factors make it difficult for TGD young people to identify resources for support and information related to gender identity and medical transition. These range from lack of knowledge to concerns about personal safety in the setting of increased antitransgender violence and legislative limitations on transgender rights. Web-based resources may be able to address some of the barriers to finding information and support, but youth may have difficulty finding relevant content or have concerns about the quality and content of information they find on the internet. Objective: We aim to understand ways TGD young adults look for web-based information about gender and health. Methods: In August 2022, 102 young adults completed a 1-time survey including closed- and open-ended responses. Individuals were recruited through the Prolific platform. Eligibility was restricted to people between the ages of 18-25 years who identified as transgender and were residents of the United States. The initial goal was to recruit 50 White individuals and 50 individuals who identified as Black, indigenous, or people of color. In total, 102 people were eventually enrolled. Results: Young adults reported looking on the internet for information about a broad range of topics related to both medical- and social-gender affirmation. Most participants preferred to obtain information via personal stories. Participants expressed a strong preference for obtaining information from other trans people. Conclusions: There is a need for accessible, expert-informed information for TGD youth, particularly more information generated for the transgender community by members of the community. UR - https://formative.jmir.org/2023/1/e45952 UR - http://dx.doi.org/10.2196/45952 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581925 ID - info:doi/10.2196/45952 ER - TY - JOUR AU - Maul, Valeska Lara AU - Jahn, Sophie Anna AU - Pamplona, P. Gustavo S. AU - Streit, Markus AU - Gantenbein, Lorena AU - Müller, Simon AU - Nielsen, Mia-Louise AU - Greis, Christian AU - Navarini, A. Alexander AU - Maul, Julia-Tatjana PY - 2023/8/11 TI - Acceptance of Telemedicine Compared to In-Person Consultation From the Providers' and Users? Perspectives: Multicenter, Cross-Sectional Study in Dermatology JO - JMIR Dermatol SP - e45384 VL - 6 KW - acceptance KW - patient KW - physician KW - satisfaction KW - teledermatology N2 - Background: Teledermatology is currently finding its place in modern health care worldwide as a rapidly evolving field. Objective: The aim of this study was to investigate the acceptance of teledermatology compared to in-person consultation from the perspective of patients and professionals. Methods: This multicenter, cross-sectional pilot study was performed at secondary and tertiary referral centers of dermatology in Switzerland from August 2019 to January 2020. A customized questionnaire addressing demographics and educational data, experience with telemedicine, and presumed willingness to replace in-patient consultations with teledermatology was completed by dermatological patients, dermatologists, and health care workers in dermatology. Results: Among a total of 664 participants, the ones with previous telemedicine experience (171/664, 25.8%) indicated a high level of overall experience with it (patients: 73/106, 68.9%, dermatologists: 6/8, 75.0%, and health care workers: 27/34, 79.4%). Patients, dermatologists, and health care workers were most likely willing to replace in-person consultations with teledermatology for minor health issues (353/512, 68.9%; 37/45, 82.2%; and 89/107, 83.2%, respectively). We observed a higher preference for telemedicine among individuals who have already used telemedicine (patients: P<.001, dermatologists: P=.03, and health care workers, P=.005), as well as among patients with higher educational levels (P=.003). Conclusions: This study indicates that the preference for teledermatology has a high potential to increase over time since previous experience with telemedicine and a higher level of education were associated with a higher willingness to replace in-patient consultations with telemedicine. We assume that minor skin problems are the most promising issue in teledermatology. Our findings emphasize the need for dermatologists to be actively involved in the transition to teledermatology. Trial Registration: ClinicalTrials.gov NCT04495036; https://classic.clinicaltrials.gov/ct2/show/NCT04495036 UR - https://derma.jmir.org/2023/1/e45384 UR - http://dx.doi.org/10.2196/45384 UR - http://www.ncbi.nlm.nih.gov/pubmed/37582265 ID - info:doi/10.2196/45384 ER - TY - JOUR AU - Fischer, Ann-Kathrin AU - Mühlbacher, C. Axel PY - 2023/8/10 TI - Patient and Public Acceptance of Digital Technologies in Health Care: Protocol for a Discrete Choice Experiment JO - JMIR Res Protoc SP - e46056 VL - 12 KW - health preference research KW - stated preference survey KW - discrete choice experiment KW - study protocol KW - digital transformation KW - digital technologies KW - digital interventions KW - health care KW - rehabilitation KW - stroke KW - mobile phone N2 - Background: Strokes pose a particular challenge to the health care system. Although stroke-related mortality has declined in recent decades, the absolute number of new strokes (incidence), stroke deaths, and survivors of stroke has increased. With the increasing need of neurorehabilitation and the decreasing number of professionals, innovations are needed to ensure adequate care. Digital technologies are increasingly used to meet patients? unfilled needs during their patient journey. Patients must adhere to unfamiliar digital technologies to engage in health interventions. Therefore, the acceptance of the benefits and burdens of digital technologies in health interventions is a key factor in implementing these innovations. Objective: This study aims to describe the development of a discrete choice experiment (DCE) to weigh criteria that impact patient and public acceptance. Secondary study objectives are a benefit-burden assessment (estimation of the maximum acceptable burden of technical features and therapy-related characteristics for the patient or individual, eg, no human contact), overall comparison (assessment of the relative importance of attributes for comparing digital technologies), and adherence (identification of key attributes that influence patient adherence). The exploratory objectives include heterogeneity assessment and subgroup analysis. The methodological aims are to investigate the use of DCE. Methods: To obtain information on the criteria impacting acceptance, a DCE will be conducted including 7 attributes based on formative qualitative research. Patients with stroke (experimental group) and the general population (control group) are surveyed. The final instrument includes 6 best-best choice tasks in partial design. The experimental design is a fractional-factorial efficient Bayesian design (D-error). A conditional logit regression model and mixed logistic regression models will be used for analysis. To consider the heterogeneity of subgroups, a latent class analysis and an analysis of heteroscedasticity will be performed. Results: The literature review, qualitative preliminary study, survey development, and pretesting were completed. Data collection and analysis will be completed in the last quarter of 2023. Conclusions: Our results will inform decision makers about patients? and publics? acceptance of digital technologies used in innovative interventions. The patient preference information will improve decisions regarding the development, adoption, and pricing of innovative interventions. The behavioral changes in the choice of digital intervention alternatives are observable and can therefore be statistically analyzed. They can be translated into preferences, which define the value. This study will investigate the influences on the acceptance of digital interventions and thus support decisions and future research. International Registered Report Identifier (IRRID): DERR1-10.2196/46056 UR - https://www.researchprotocols.org/2023/1/e46056 UR - http://dx.doi.org/10.2196/46056 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561559 ID - info:doi/10.2196/46056 ER - TY - JOUR AU - Avramovi?, Petra AU - Rietdijk, Rachael AU - Kenny, Belinda AU - Power, Emma AU - Togher, Leanne PY - 2023/8/9 TI - Developing a Digital Health Intervention for Conversation Skills After Brain Injury (convers-ABI-lity) Using a Collaborative Approach: Mixed Methods Study JO - J Med Internet Res SP - e45240 VL - 25 KW - brain injury KW - cognitive-communication KW - communication partner training KW - digital health KW - co-design N2 - Background: People with acquired brain injury (ABI) experience communication breakdown in everyday interactions many years after injury, negatively impacting social and vocational relationships. Communication partner training (CPT) is a recommended intervention approach in communication rehabilitation after ABI. Access to long-term services is essential, both in rural and remote locations. Digital health has potential to overcome the challenges of travel and improve cost efficiencies, processes, and clinical outcomes. Objective: We aimed to collaboratively develop a novel, multimodal web-based CPT intervention (convers-ABI-lity) with key stakeholders and evaluate its feasibility for improving conversation skills after brain injury. Methods: This mixed methods study consisted of 3 key stages guided by the Integrate, Design, Assess, and Share (IDEAS) framework for developing effective digital health interventions. Stage 1 included the integration of current end-user needs and perspectives with key treatment and theoretical components of existing evidence-based interventions, TBI Express and TBIconneCT. Stage 2 included the iterative design of convers-ABI-lity with feedback from end-user interviews (n=22) analyzed using content analysis. Participants were individuals with ABI, family members, health professionals, and paid support workers. Stage 3 included the evaluation of the feasibility through a proof-of-concept study (n=3). A total of 3 dyads (a person with ABI and their communication partner [CP]) completed 7 weeks of convers-ABI-lity, guided by a clinician. The outcome measures included blinded ratings of conversation samples and self-report measures. We analyzed postintervention participant interviews using content analysis to inform further intervention refinement and development. Results: Collaborative and iterative design and development during stages 1 and 2 resulted in the development of convers-ABI-lity. Results in stage 3 indicated positive changes in the blinded ratings of conversation samples for the participants with traumatic brain injury and their CPs. Statistically reliable positive changes were also observed in the self-report measures of social communication skills and quality of life. Intervention participants endorsed aspects of convers-ABI-lity, such as its complementary nature, self-guided web-based modules, clinician sessions, engaging content, and novel features. They reported the intervention to be relevant to their personal experience with cognitive-communication disorders. Conclusions: This study presents the outcome of using the IDEAS framework to guide the development of a web-based multimodal CPT intervention with input from key stakeholders. The results indicate promising outcomes for improving the conversation skills of people with ABI and their CPs. Further evaluation of intervention effectiveness and efficacy using a larger sample size is required. UR - https://www.jmir.org/2023/1/e45240 UR - http://dx.doi.org/10.2196/45240 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556179 ID - info:doi/10.2196/45240 ER - TY - JOUR AU - Powell, R. Kimberly AU - Popescu, Mihail AU - Lee, Suhwon AU - Mehr, R. David AU - Alexander, L. Gregory PY - 2023/8/9 TI - Examining the Use of Text Messages Among Multidisciplinary Care Teams to Reduce Avoidable Hospitalization of Nursing Home Residents with Dementia: Protocol for a Secondary Analysis JO - JMIR Res Protoc SP - e50231 VL - 12 KW - age-friendly health systems KW - Alzheimer disease KW - communication KW - dementia KW - nursing homes KW - older adults N2 - Background: Reducing avoidable nursing home (NH)?to-hospital transfers of residents with Alzheimer disease or a related dementia (ADRD) has become a national priority due to the physical and emotional toll it places on residents and the high costs to Medicare and Medicaid. Technologies supporting the use of clinical text messages (TMs) could improve communication among health care team members and have considerable impact on reducing avoidable NH-to-hospital transfers. Although text messaging is a widely accepted mechanism of communication, clinical models of care using TMs are sparsely reported in the literature, especially in NHs. Protocols for assessing technologies that integrate TMs into care delivery models would be beneficial for end users of these systems. Without evidence to support clinical models of care using TMs, users are left to design their own methods and protocols for their use, which can create wide variability and potentially increase disparities in resident outcomes. Objective: Our aim is to describe the protocol of a study designed to understand how members of the multidisciplinary team communicate using TMs and how salient and timely communication can be used to avert poor outcomes for NH residents with ADRD, including hospitalization. Methods: This project is a secondary analysis of data collected from a Centers for Medicare & Medicaid Services (CMS)?funded demonstration project designed to reduce avoidable hospitalizations for long-stay NH residents. We will use two data sources: (1) TMs exchanged among the multidisciplinary team across the 7-year CMS study period (August 2013-September 2020) and (2) an adapted acute care transfer tool completed by advanced practice registered nurses to document retrospective details about NH-to-hospital transfers. The study is guided by an age-friendly model of care called the 4Ms (What Matters, Medications, Mentation, and Mobility) framework. We will use natural language processing, statistical methods, and social network analysis to generate a new ontology and to compare communication patterns found in TMs occurring around the time NH-to-hospital transfer decisions were made about residents with and without ADRD. Results: After accounting for inclusion and exclusion criteria, we will analyze over 30,000 TMs pertaining to over 3600 NH-to-hospital transfers. Development of the 4M ontology is in progress, and the 3-year project is expected to run until mid-2025. Conclusions: To our knowledge, this project will be the first to explore the content of TMs exchanged among a multidisciplinary team of care providers as they make decisions about NH-to-hospital resident transfers. Understanding how the presence of evidence-based elements of high-quality care relate to avoidable hospitalizations among NH residents with ADRD will generate knowledge regarding the future scalability of behavioral interventions. Without this knowledge, NHs will continue to rely on ineffective and outdated communication methods that fail to account for evidence-based elements of age-friendly care. International Registered Report Identifier (IRRID): DERR1-10.2196/50231 UR - https://www.researchprotocols.org/2023/1/e50231 UR - http://dx.doi.org/10.2196/50231 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556199 ID - info:doi/10.2196/50231 ER - TY - JOUR AU - Ribbons, Karen AU - Johnson, Sarah AU - Ditton, Elizabeth AU - Wills, Adrian AU - Mason, Gillian AU - Flynn, Traci AU - Cochrane, Jodie AU - Pollack, Michael AU - Walker, Rohan Frederick AU - Nilsson, Michael PY - 2023/8/9 TI - Using Presurgical Biopsychosocial Features to Develop an Advanced Clinical Decision-Making Support Tool for Predicting Recovery Trajectories in Patients Undergoing Total Knee Arthroplasty: Protocol for a Prospective Observational Study JO - JMIR Res Protoc SP - e48801 VL - 12 KW - biopsychosocial KW - total knee arthroplasty KW - prospective KW - recovery trajectories KW - patient-reported outcomes KW - predictive clinical decision tool KW - clinical decision support KW - knee arthroplasty KW - rehabilitation KW - psychosocial KW - patient-reported outcome KW - quality of life KW - patient recruitment KW - presurgery KW - patient stratification N2 - Background: Following total knee arthroplasty (TKA), 10% to 20% of patients report dissatisfaction with procedural outcomes. There is growing recognition that postsurgical satisfaction is shaped not only by the quality of surgery but also by psychological and social factors. Surprisingly, information on the psychological and social determinants of surgical outcomes is rarely collected before surgery. A comprehensive collection of biopsychosocial information could assist clinicians in making recommendations in relation to rehabilitation, particularly if there is robust evidence to support the ability of presurgical constructs to predict postsurgical outcomes. Clinical decision support tools can help identify factors influencing patient outcomes and support the provision of interventions or services that can be tailored to meet individuals? needs. However, despite their potential clinical benefit, the application of such tools remains limited. Objective: This study aims to develop a clinical decision tool that will assist with patient stratification and more precisely targeted clinical decision-making regarding prehabilitation and rehabilitation for TKA, based on the identified individual biopsychosocial needs. Methods: In this prospective observational study, all participants provided written or electronic consent before study commencement. Patient-completed questionnaires captured information related to a broad range of biopsychosocial parameters during the month preceding TKA. These included demographic factors (sex, age, and rurality), psychological factors (mood status, pain catastrophizing, resilience, and committed action), quality of life, social support, lifestyle factors, and knee symptoms. Physical measures assessing mobility, balance, and functional lower body strength were performed via video calls with patients in their home. Information related to preexisting health issues and concomitant medications was derived from hospital medical records. Patient recovery outcomes were assessed 3 months after the surgical procedure and included quality of life, patient-reported knee symptoms, satisfaction with the surgical procedure, and mood status. Machine learning data analysis techniques will be applied to determine which presurgery parameters have the strongest power for predicting patient recovery following total knee replacement. On the basis of these analyses, a predictive model will be developed. Predictive models will undergo internal validation, and Bayesian analysis will be applied to provide additional metrics regarding prediction accuracy. Results: Patient recruitment and data collection commenced in November 2019 and was completed in June 2022. A total of 1050 patients who underwent TKA were enrolled in this study. Conclusions: Our findings will facilitate the development of the first comprehensive biopsychosocial prediction tool, which has the potential to objectively predict a patient?s individual recovery outcomes following TKA once selected by an orthopedic surgeon to undergo TKA. If successful, the tool could also inform the evolution rehabilitation services, such that factors in addition to physical performance can be addressed and have the potential to further enhance patient recovery and satisfaction. International Registered Report Identifier (IRRID): DERR1-10.2196/48801 UR - https://www.researchprotocols.org/2023/1/e48801 UR - http://dx.doi.org/10.2196/48801 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556181 ID - info:doi/10.2196/48801 ER - TY - JOUR AU - Coulibaly, Abou AU - Kouanda, Séni PY - 2023/8/9 TI - Effects of the Pregnancy and Newborn Diagnostic Assessment (PANDA) App on Antenatal Care Quality in Burkina Faso: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e37136 VL - 12 KW - telemedicine KW - PANDA KW - pregnancy and newborn diagnostic assessment KW - quality KW - antenatal care KW - Burkina Faso KW - trial KW - pregnancy KW - pregnant KW - newborn KW - diagnostic KW - mobile app KW - prenatal care KW - randomized trial KW - first trimester KW - postpartum KW - qualitative research KW - maternity KW - prenatal KW - antenatal KW - mobile phone N2 - Background: The Pregnancy and Newborn Diagnostic Assessment (PANDA) system is a digital clinical decision support tool that can facilitate diagnosis and decision-making by health care personnel in antenatal care (ANC). Studies conducted in Madagascar and Burkina Faso showed that PANDA is a feasible system acceptable to various stakeholders. Objective: This study primarily aims to evaluate the effects of the PANDA system on ANC quality at rural health facilities in Burkina Faso. The secondary objectives of this study are to test the effects of the PANDA system on women?s satisfaction, women?s knowledge on birth preparedness and complication readiness, maternal and child health service use, men?s involvement in maternal health service utilization, and women?s contraception use at 6 weeks postpartum. Further, we will identify the factors that hinder or promote such an app and contribute to cost-effectiveness analysis. Methods: This is a randomized controlled trial implementing the PANDA system in 2 groups of health facilities (intervention and comparison groups) randomized using a matched-pair method. We included pregnant women who were <20 weeks pregnant during their first antenatal consultation in health facilities, and we followed up with them until their sixth week postpartum. Thirteen health centers were included, and 423 and 272 women were enrolled in the intervention and comparison groups, respectively. The primary outcome is a binary variable derived from the quality score, coded 1 (yes) for women with at least 75% of the total score and 0 if not. Data were collected electronically using tablets by directly interviewing the women and by extracting data from ANC registers, delivery registers, ANC cards, and health care records. The study procedures were standardized across all sites. We will compare unadjusted and adjusted primary outcome results (ANC quality scores) between the 2 study arms. We added a qualitative evaluation of the implementation of the PANDA system to identify barriers and catalysts. We also included an economic evaluation to determine whether the PANDA strategy is more cost-effective than the usual ANC strategy. Results: The enrollment ran from July 2020 to January 2021 due to the COVID-19 pandemic. Data collection ended in September 2022. Data analyses started in January 2023, ended in June 2023, and the results are expected to be published in February 2024. Conclusions: The PANDA system is one of the most comprehensive apps for ANC because it has many features. However, the use of computerized systems for ANC is limited. Therefore, our trial will be beneficial for evaluating the intrinsic capacity of the PANDA system to improve the quality of care. By including qualitative research and economic evaluation, our findings will be significant because electronic consultation registries are expected to be used for maternal health care in the future in Burkina Faso. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR202009861550402; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12374 International Registered Report Identifier (IRRID): DERR1-10.2196/37136 UR - https://www.researchprotocols.org/2023/1/e37136 UR - http://dx.doi.org/10.2196/37136 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556195 ID - info:doi/10.2196/37136 ER - TY - JOUR AU - Spadaro, Benedetta AU - Martin-Key, A. Nayra AU - Funnell, Erin AU - Bená?ek, Ji?í AU - Bahn, Sabine PY - 2023/8/7 TI - Opportunities for the Implementation of a Digital Mental Health Assessment Tool in the United Kingdom: Exploratory Survey Study JO - JMIR Form Res SP - e43271 VL - 7 KW - assessment KW - digital mental health KW - development KW - implementation KW - mental health KW - provision KW - support KW - mobile phone N2 - Background: Every year, one-fourth of the people in the United Kingdom experience diagnosable mental health concerns, yet only a proportion receive a timely diagnosis and treatment. With novel developments in digital technologies, the potential to increase access to mental health assessments and triage is promising. Objective: This study aimed to investigate the current state of mental health provision in the United Kingdom and understand the utility of, and interest in, digital mental health technologies. Methods: A web-based survey was generated using Qualtrics XM. Participants were recruited via social media. Data were explored using descriptive statistics. Results: The majority of the respondents (555/618, 89.8%) had discussed their mental health with a general practitioner. More than three-fourths (503/618, 81.4%) of the respondents had been diagnosed with a mental health disorder, with the most common diagnoses being depression and generalized anxiety disorder. Diagnostic waiting times from first contact with a health care professional varied by diagnosis. Neurodevelopmental disorders (30/56, 54%), bipolar disorder (25/52, 48%), and personality disorders (48/101, 47.5%) had the longest waiting times, with almost half (103/209, 49.3%) of these diagnoses taking >6 months. Participants stated that waiting times resulted in symptoms worsening (262/353, 74.2%), lower quality of life (166/353, 47%), and the necessity to seek emergency care (109/353, 30.9%). Of the 618 participants, 386 (62.5%) stated that they felt that their mental health symptoms were not always taken seriously by their health care provider and 297 (48.1%) were not given any psychoeducational information. The majority of the respondents (416/595, 77.5%) did not have the chance to discuss mental health support and treatment options. Critically, 16.1% (96/595) did not find any treatment or support provided at all helpful, with 63% (48/76) having discontinued treatment with no effective alternatives. Furthermore, 88.3% (545/617) of the respondents) had sought help on the web regarding mental health symptoms, and 44.4% (272/612) had used a web application or smartphone app for their mental health. Psychoeducation (364/596, 61.1%), referral to a health care professional (332/596, 55.7%), and symptom monitoring (314/596, 52.7%) were the most desired app features. Only 6.8% (40/590) of the participants said that they would not be interested in using a mental health assessment app. Respondents were the most interested to receive an overall severity score of their mental health symptoms (441/546, 80.8%) and an indication of whether they should seek mental health support (454/546, 83.2%). Conclusions: Key gaps in current UK mental health care provision are highlighted. Assessment and treatment waiting times together with a lack of information regarding symptoms and treatment options translated into poor care experiences. The participants? responses provide proof-of-concept support for the development of a digital mental health assessment app and valuable recommendations regarding desirable app features. UR - https://formative.jmir.org/2023/1/e43271 UR - http://dx.doi.org/10.2196/43271 UR - http://www.ncbi.nlm.nih.gov/pubmed/37549003 ID - info:doi/10.2196/43271 ER - TY - JOUR AU - Zhang, Jinghui AU - Peng, Sha AU - Hou, Jianmei AU - Ma, Guiyuan AU - Liu, Yanhui AU - Fan, Yuhua AU - Luo, Lingxia AU - Shi, Zhengkun PY - 2023/8/4 TI - Nurses? Willingness and Demand for Internet+Home Care Services and the Associated Factors in Municipal Hospitals in China: Cross-Sectional Survey JO - J Med Internet Res SP - e45602 VL - 25 KW - Internet+home care services KW - willingness KW - demand KW - clinical nurses KW - municipal hospitals N2 - Background: Developing Internet+home care (IHC) services is a promising way to address the problems related to population aging, which is an important global issue. However, IHC services are in their infancy in China. Limited studies have investigated the willingness and demand of nurses in municipal hospitals to provide IHC services. Objective: This study aims to investigate the willingness and demand of nurses in municipal hospitals in China to provide IHC services and analyze the factors to promote IHC development in China. Methods: This cross-sectional study used multistage sampling to recruit 9405 nurses from 10 hospitals in 5 regions of China. A self-designed questionnaire with good reliability and validity was used to measure nurses? willingness and demand for providing IHC services. Data analysis used the chi-square test, Welch t test, binary logistic regression analysis, and multiple linear regression analysis. Results: Nurses were highly willing to provide IHC services and preferred service distances of <5 km and times from 8 AM to 6 PM. An individual share >60% was the expected service pay sharing. Job title, educational level, monthly income, and marital status were associated with nurses? willingness to provide IHC services in binary logistic regression analysis. Supervising nurses were 1.177 times more likely to express a willingness to provide IHC services than senior nurses. Nurses with a bachelor's degree had a 1.167 times higher likelihood of expressing willingness to provide IHC services than those with a junior college education or lower. Married nurses were 1.075 times more likely to express a willingness than unmarried nurses. A monthly income >¥10,000 increased the likelihood of nurses? willingness to provide IHC services, by 1.187 times, compared with an income <¥5000. Nurses? total mean demand score for IHC services was 17.38 (SD 3.67), with the highest demand being privacy protection. Multiple linear regression analysis showed that job title, monthly income, and educational level were associated with nurses? demand for IHC services. Supervising nurses (B=1.058, P<.001) and co-chief nurses or those with higher positions (B=2.574, P<.001) reported higher demand scores than senior nurses. Monthly incomes of ¥5000 to ¥10,000 (B=0.894, P<.001) and >¥10,000 (B=1.335, P<.001), as well as a bachelor's degree (B=0.484, P=.002) and at least a master's degree (B=1.224, P=.02), were associated with higher demand scores compared with a monthly income <¥5000 and junior college education or lower, respectively. Conclusions: Nurses in municipal hospitals showed a high willingness and demand to provide IHC services, with differences in willingness and demand by demographic characteristics. Accordingly, government and hospitals should regulate the service period, service distance, and other characteristics according to nurses? willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of IHC services. UR - https://www.jmir.org/2023/1/e45602 UR - http://dx.doi.org/10.2196/45602 UR - http://www.ncbi.nlm.nih.gov/pubmed/37540546 ID - info:doi/10.2196/45602 ER - TY - JOUR AU - Sakumoto, Matthew PY - 2023/8/3 TI - Virtual First Emergency Medicine Visits: The Future of Convenient and Efficient Emergency Care JO - J Med Internet Res SP - e47637 VL - 25 KW - telehealth KW - virtual care KW - emergency medicine KW - telemedicine KW - emergency department KW - acute care facilities KW - virtual visit KW - COVID-19 KW - virtual KW - utilization KW - medicine KW - acute illness KW - illness KW - injury KW - patient KW - infection KW - care KW - physician UR - https://www.jmir.org/2023/1/e47637 UR - http://dx.doi.org/10.2196/47637 UR - http://www.ncbi.nlm.nih.gov/pubmed/36976827 ID - info:doi/10.2196/47637 ER - TY - JOUR AU - Potter, Jennifer AU - Watson Gans, Dana AU - Gardner, Alison AU - O'Neill, James AU - Watkins, Christopher AU - Husain, Iltifat PY - 2023/8/3 TI - Using Virtual Emergency Medicine Clinicians as a Health System Entry Point (Virtual First): Cross-Sectional Survey Study JO - J Med Internet Res SP - e42840 VL - 25 KW - telehealth KW - virtual care KW - emergency medicine KW - telemedicine KW - emergency department KW - acute care facilities KW - virtual visit KW - COVID-19 KW - virtual KW - utilization KW - medicine KW - acute illness KW - illness KW - injury KW - patient KW - efficacy KW - infection KW - care KW - physician N2 - Background: The COVID-19 pandemic accelerated the use and acceptance of telemedicine. Simultaneously, emergency departments (EDs) have experienced increased ED boarding. With this acceptance of telemedicine and the weighty increase in patient boarding, we proposed the innovative Virtual First (VF) program to leverage emergency medicine clinicians? (EMCs) ability to triage patients. VF seeks to reduce unnecessary ED visits by connecting patients with EMCs prior to seeking in-person care rather than using traditional ED referral systems. Objective: The goal of this study is to investigate how patients? access to EMCs from home via the establishment of VF changed how patients sought care for acute care needs. Methods: VF is a synchronous virtual video visit at a tertiary care academic hospital. VF was staffed by EMCs and enabled full management of patient complaints or, if necessary, referral to the appropriate level of care. Patients self-selected this service as an alternative to seeking in-person care at a primary care provider, urgent care center, or ED. A postvisit convenience sample survey was collected through a phone SMS text message or email to VF users. This is a cross-sectional survey study. The primary outcome measure is based on responses to the question ?How would you have sought care if a VF visit was not available to you?? Secondary outcome measures describe valued aspects and criticisms. Results were analyzed using descriptive statistics. Results: There were 3097 patients seen via VF from July 2021 through May 2022. A total of 176 (5.7%) patients completed the survey. Of these, 87 (49.4%) would have sought care at urgent care centers if VF had not been available. There were 28 (15.9%) patients, 26 (14.8%) patients, and 1 (0.6%) patient that would have sought care at primary care providers, EDs, or other locations, respectively. Interestingly, 34 (19.3%) patients would not have sought care. The most valued aspect of VF was receiving care in the comfort of the home (n=137, 77.8%). For suggested improvements, 58 (33%) patients most commonly included ?Nothing? as free text. Conclusions: VF has the potential to restructure how patients seek medical care by connecting EMCs with patients prior to ED arrival. Without the option of VF, 64.2% (113/177) of patients would have sought care at an acute care facility. VF?s innovative employment of EMCs allows for acute care needs to be treated virtually if feasible. If not, EMCs understand the local resources to better direct patients to the appropriate site. This has the potential to substantially decrease patient costs because patients are given the appropriate destination for in-person care, reducing the likelihood of the need for transfer and multiple ED visits. UR - https://www.jmir.org/2023/1/e42840 UR - http://dx.doi.org/10.2196/42840 UR - http://www.ncbi.nlm.nih.gov/pubmed/37276547 ID - info:doi/10.2196/42840 ER - TY - JOUR AU - Figg, Lauren AU - Addala, Ananta AU - Jain, Ishaan AU - Anez, Claudia AU - Midney, Paul AU - DeChirico, Corin AU - Symanski, Colleen AU - Fitzgerald, C. Brian AU - Colbert, Kristi AU - Raymer, Terry AU - Stockton-Joreteg, Candy AU - Murphy, Elizabeth AU - Collins, Leah AU - Bernstein, Cyd AU - Hechavarria, Melanie AU - Sheehan, P. Eleni AU - Bernier, Angelina AU - Westen, C. Sarah AU - Hood, K. Korey AU - Zaharieva, P. Dessi AU - Basina, Marina AU - Cuttriss, Nicolas AU - Filipp, L. Stephanie AU - Gurka, J. Matthew AU - Walker, F. Ashby AU - Maahs, M. David AU - Haller, J. Michael AU - Lal, A. Rayhan PY - 2023/8/3 TI - The Promising Success of Project Extension for Community Healthcare Outcomes (ECHO) Diabetes: Case Series JO - JMIR Diabetes SP - e46050 VL - 8 KW - type 1 diabetes KW - care delivery KW - primary care KW - community health care N2 - Background: In the United States, there are over 37 million people with diabetes but only 8000 endocrinologists. Therefore, many people with diabetes receive care exclusively from primary care providers (PCPs). To democratize knowledge regarding insulin-requiring diabetes through tele-education, Stanford University and the University of Florida developed Project Extension for Community Healthcare Outcomes (ECHO) Diabetes. Objective: ECHO Diabetes uses a Hub and Spoke model connecting specialists (the ?Hub?) with PCPs (the ?Spokes?). One-hour, weekly sessions include Hub diabetes didactic presentations and Spoke deidentified case presentations. Lessons learned during these sessions target provider knowledge and confidence surrounding diabetes management and patient care. Methods: Spokes were asked to provide short descriptions of people with diabetes whose diabetes management improved directly or indirectly from their providers? participation or their involvement with a Diabetes Support Coach (DSC). We provide a case series to describe individuals and outcomes. Because this study was not a randomized controlled trial and was a prospective observation of patients with the intervention delivered to providers, the trial is not registered in a public trials registry. Results: A case series of 11 people with diabetes was compiled from 10 PCPs and 1 DSC from California and Florida between 2021 and 2022. The principal impact of ECHO Diabetes is the education amplified from PCPs and DSCs to people with diabetes. In all cases, people with diabetes reported increased engagement and improved diabetes management. Several cases reflected increased access to diabetes technology, improvement in glycemic outcomes, and positive trends in mental health measures. Conclusions: This case series elucidates the potential value of the ECHO Diabetes program to people with diabetes who receive their diabetes care from PCPs. Those matched with a DSC saw clinically significant improvements in hemoglobin A1c and mental health outcomes. UR - https://diabetes.jmir.org/2023/1/e46050 UR - http://dx.doi.org/10.2196/46050 UR - http://www.ncbi.nlm.nih.gov/pubmed/37535407 ID - info:doi/10.2196/46050 ER - TY - JOUR AU - El-Khatib, Ziad AU - Richter, Lukas AU - Reich, Andreas AU - Benka, Bernhard AU - Assadian, Ojan PY - 2023/8/3 TI - Implementation of a Surveillance System for Severe Acute Respiratory Infections at a Tertiary Care Hospital in Austria: Protocol for a Retrospective Longitudinal Feasibility Study JO - JMIR Res Protoc SP - e47547 VL - 12 KW - severe acute respiratory infection KW - SARI KW - Austria KW - influenza KW - European Union KW - COVID-19 KW - respiratory KW - data retrieval KW - information retrieval KW - electronic health record KW - EHR KW - health records KW - health record KW - surveillance KW - risk KW - database structure KW - incidence KW - data collection N2 - Background: The risk of a large number of severe acute respiratory infection (SARI) cases emerging is a global concern. SARI can overwhelm the health care capacity and cause several deaths. Therefore, the Austrian Agency for Health and Food Safety will explore the feasibility of implementing an automatic electronically based SARI surveillance system at a tertiary care hospital in Austria as part of the hospital network, initiated by the European Centre for Disease Prevention and Control. Objective: We aim to investigate the availability of routinely collected health record data pertaining to respiratory infections and the optimal approach to use such available data for systematic surveillance of SARI in a real-world setting, describe the characteristics of patients with SARI before and after the beginning of the COVID-19 pandemic, and investigate the feasibility of identifying the risk factors for a severe outcome (intensive care unit admission or death) in patients with SARI. Methods: We will test the feasibility of a surveillance system, as part of a large European network, at a tertiary care hospital in the province of Lower Austria (called Regional Hospital Wiener Neustadt). It will be a cross-sectional study for the inventory of the electronic data records and implementation of automatic data retrieval for the period of January 2019 through the end of December 2022. The analysis will include an exploration of the database structure, descriptive analysis of the general characteristics of the patients with SARI, estimation of the SARI incidence rate, and assessment of the risk factors and different levels of severity of patients with SARI using logistic regression analysis. Results: This will be the first study to assess the feasibility of SARI surveillance at a large 800-bed tertiary care hospital in Austria. It will provide a general overview of the potential for establishing a hospital-based surveillance system for SARI. In addition, if successful, the electronic surveillance will be able to improve the response to early warning signs of new SARI, which will better inform policy makers in strengthening the surveillance system. Conclusions: The findings will support the expansion of the SARI hospital-based surveillance system to other hospitals in Austria. This network will be of use to Austria in preparing for future pandemics. International Registered Report Identifier (IRRID): PRR1-10.2196/47547 UR - https://www.researchprotocols.org/2023/1/e47547 UR - http://dx.doi.org/10.2196/47547 UR - http://www.ncbi.nlm.nih.gov/pubmed/37535414 ID - info:doi/10.2196/47547 ER - TY - JOUR AU - Mahmoudi Asl, Aysan AU - Kouters, Suzanne AU - Castro-González, Álvaro AU - Van der Roest, Henriëtte AU - Franco Martin, Manuel AU - Dröes, Rose-Marie PY - 2023/8/2 TI - Potential Facilitators of and Barriers to Implementing the MINI Robot in Community-Based Meeting Centers for People With Dementia and Their Carers in the Netherlands and Spain: Explorative Qualitative Study JO - J Med Internet Res SP - e44125 VL - 25 KW - dementia KW - meeting centers KW - mild cognitive impairment KW - social robots N2 - Background: Social robots, as a form of digital health technologies, are used to support emotional, cognitive, and physical care and have shown promising outcomes in enhancing social well-being in people with dementia (PwD) by boosting emotions, social interactions, and activity participation. Objective: The goal is to investigate the attitude of stakeholders and potential facilitators and the barriers to implementing the social robot MINI in community-based meeting centers (MCs) for PwD and carers in the Netherlands and Spain. Methods: Based on the British Medical Research Council guidance for process evaluation of the implementation of complex interventions and the model for tracing the facilitators of and barriers to the adaptive implementation of innovations in dementia care, an explorative qualitative study was conducted. Following the introduction of the MINI robot, 11 stakeholders were interviewed in 3 MCs in the Netherlands and 1 in Spain, as well as stakeholders in health and welfare organizations in both countries. In addition, 12 adults with dementia participated in focus groups. The data were thematically analyzed and narratively described. Results: Overall, the stakeholder opinion and interest in the MINI robot were positive. The most important (expected) facilitating factors mentioned by stakeholders appeared to be human resources, funding, the impact of the MINI robot on the users and programs of the MCs, characteristics of the innovation, and collaboration with other care and welfare organizations. However, the (expected) barriers mentioned concerned the physical context and functionalities of the MINI robot, the user context, and MC activity policies. Conclusions: The findings will inform professional stakeholders, such as MC directors and managers, as well as care and welfare organizations, on the practicality of using the MINI robot in MCs. Furthermore, our research will aid MINI robot developers in tailoring its features to PwD?s preferences and demands and MC policies, which will contribute to the MINI robot?s effective adoption and deployment. UR - https://www.jmir.org/2023/1/e44125 UR - http://dx.doi.org/10.2196/44125 UR - http://www.ncbi.nlm.nih.gov/pubmed/37531190 ID - info:doi/10.2196/44125 ER - TY - JOUR AU - Sapanel, Yoann AU - Tadeo, Xavier AU - Brenna, A. Connor T. AU - Remus, Alexandria AU - Koerber, Florian AU - Cloutier, Martin L. AU - Tremblay, Gabriel AU - Blasiak, Agata AU - Hardesty, L. Chris AU - Yoong, Joanne AU - Ho, Dean PY - 2023/8/1 TI - Economic Evaluation Associated With Clinical-Grade Mobile App?Based Digital Therapeutic Interventions: Systematic Review JO - J Med Internet Res SP - e47094 VL - 25 KW - digital health KW - digital therapeutics KW - economic evaluation KW - cost-effectiveness KW - mobile phone KW - systematic review N2 - Background: Digital therapeutics (DTx), a class of software-based clinical interventions, are promising new technologies that can potentially prevent, manage, or treat a spectrum of medical disorders and diseases as well as deliver unprecedented portability for patients and scalability for health care providers. Their adoption and implementation were accelerated by the need for remote care during the COVID-19 pandemic, and awareness about their utility has rapidly grown among providers, payers, and regulators. Despite this, relatively little is known about the capacity of DTx to provide economic value in care. Objective: This study aimed to systematically review and summarize the published evidence regarding the cost-effectiveness of clinical-grade mobile app?based DTx and explore the factors affecting such evaluations. Methods: A systematic review of economic evaluations of clinical-grade mobile app?based DTx was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Major electronic databases, including PubMed, Cochrane Library, and Web of Science, were searched for eligible studies published from inception to October 28, 2022. Two independent reviewers evaluated the eligibility of all the retrieved articles for inclusion in the review. Methodological quality and risk of bias were assessed for each included study. Results: A total of 18 studies were included in this review. Of the 18 studies, 7 (39%) were nonrandomized study?based economic evaluations, 6 (33%) were model-based evaluations, and 5 (28%) were randomized clinical trial?based evaluations. The DTx intervention subject to assessment was found to be cost-effective in 12 (67%) studies, cost saving in 5 (28%) studies, and cost-effective in 1 (6%) study in only 1 of the 3 countries where it was being deployed in the final study. Qualitative deficiencies in methodology and substantial potential for bias, including risks of performance bias and selection bias in participant recruitment, were identified in several included studies. Conclusions: This systematic review supports the thesis that DTx interventions offer potential economic benefits. However, DTx economic analyses conducted to date exhibit important methodological shortcomings that must be addressed in future evaluations to reduce the uncertainty surrounding the widespread adoption of DTx interventions. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022358616; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022358616 UR - https://www.jmir.org/2023/1/e47094 UR - http://dx.doi.org/10.2196/47094 UR - http://www.ncbi.nlm.nih.gov/pubmed/37526973 ID - info:doi/10.2196/47094 ER - TY - JOUR AU - Bettencourt, Nicholas AU - Wilson, John Conor AU - Johnson, Jaye Philippa AU - D'Souza, Fabian PY - 2023/7/31 TI - A Rebalancing of Financial Valuations and Expectations Moving Forward in the Telehealth Sector as the United States Moves Toward a Post-COVID-19 Reality JO - J Med Internet Res SP - e35857 VL - 25 KW - telehealth KW - telemedicine KW - remote consultation KW - eHealth KW - internet KW - mHealth KW - mobile health KW - digital health KW - delivery of health care KW - telecommunication KW - web-based care KW - web-based medicine KW - customer KW - economy KW - economics UR - https://www.jmir.org/2023/1/e35857 UR - http://dx.doi.org/10.2196/35857 UR - http://www.ncbi.nlm.nih.gov/pubmed/37523216 ID - info:doi/10.2196/35857 ER - TY - JOUR AU - Mitchell, Eileen AU - O?Reilly, Dermot AU - O?Donovan, Diarmuid AU - Bradley, Declan PY - 2023/7/27 TI - Predictors and Consequences of Homelessness: Protocol for a Cohort Study Design Using Linked Routine Data JO - JMIR Res Protoc SP - e42404 VL - 12 KW - administrative data KW - data linkage KW - health care use KW - homelessness KW - housing KW - mortality N2 - Background: Homelessness is a global burden, estimated to impact more than 100 million people worldwide. Individuals and families experiencing homelessness are more likely to have poorer physical and mental health than the general population. Administrative data is being increasingly used in homelessness research. Objective: The objective of this study is to combine administrative health care data and social housing data to better understand the consequences and predictors associated with being homeless. Methods: We will be linking health and social care administrative databases from Northern Ireland, United Kingdom. We will conduct descriptive analyses to examine trends in homelessness and investigate risk factors for key outcomes. Results: The results of our analyses will be shared with stakeholders, reported at conferences and in academic journals, and summarized in policy briefing notes for policymakers. Conclusions: This study will aim to identify predictors and consequences of homelessness in Northern Ireland using linked housing, health, and social care data. The findings of this study will examine trends and outcomes in this vulnerable population using routinely collected health and social care administrative data. International Registered Report Identifier (IRRID): DERR1-10.2196/42404 UR - https://www.researchprotocols.org/2023/1/e42404 UR - http://dx.doi.org/10.2196/42404 UR - http://www.ncbi.nlm.nih.gov/pubmed/37498664 ID - info:doi/10.2196/42404 ER - TY - JOUR AU - Rome, Danielle AU - Sales, Alyssa AU - Cornelius, Talea AU - Malhotra, Sujata AU - Singer, Jessica AU - Ye, Siqin AU - Moise, Nathalie PY - 2023/7/26 TI - Impact of Telemedicine Modality on Quality Metrics in Diverse Settings: Implementation Science?Informed Retrospective Cohort Study JO - J Med Internet Res SP - e47670 VL - 25 KW - telemedicine KW - telehealth KW - implementation science KW - quality metrics KW - screening KW - adoption KW - diverse KW - socioeconomic KW - audio based KW - video based KW - video consultation N2 - Background: Video-based telemedicine (vs audio only) is less frequently used in diverse, low socioeconomic status settings. Few prior studies have evaluated the impact of telemedicine modality (ie, video vs audio-only visits) on clinical quality metrics. Objective: The aim of this study was to assess telemedicine uptake and impact of visit modality (in-person vs video and phone visits) on primary care quality metrics in diverse, low socioeconomic status settings through an implementation science lens. Methods: Informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we evaluated telemedicine uptake, assessed targeted primary care quality metrics by visit modality, and described provider-level qualitative feedback on barriers and facilitators to telemedicine implementation. Results: We found marginally better quality metrics (ie, blood pressure and depression screening) for in-person care versus video and phone visits; de-adoption of telemedicine was marked within 2 years in our population. Conclusions: Following the widespread implementation of telemedicine during the COVID-19 pandemic, the impact of visit modality on quality outcomes, provider and patient preferences, as well as technological barriers in historically marginalized settings should be considered. UR - https://www.jmir.org/2023/1/e47670 UR - http://dx.doi.org/10.2196/47670 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494087 ID - info:doi/10.2196/47670 ER - TY - JOUR AU - Groeneveld, M. Sjors W. AU - den Ouden, M. Marjolein E. AU - van Gemert-Pijnen, C. J. E. W. AU - Verdaasdonk, M. Rudolph AU - van Os-Medendorp, Harmieke PY - 2023/7/26 TI - Underestimated Factors Regarding the Use of Technology in Daily Practice of Long-Term Care: Qualitative Study Among Health Care Professionals JO - JMIR Nursing SP - e41032 VL - 6 KW - health technology KW - eHealth KW - digital health KW - nurse KW - nurse assistant KW - health care professionals KW - implementation KW - adoption KW - acceptance KW - competencies N2 - Background: Increasing life expectancy is resulting in a growing demand for long-term care; however, there is a shortage of qualified health care professionals (HCPs) to deliver it. If used optimally, technology can provide a solution to this challenge. HCPs play an important role in the use of technology in long-term care. However, technology influences several core aspects of the work that HCPs do, and it is therefore important to have a good understanding of their viewpoint regarding the use of technology in daily practice of long-term care. Objective: The aim of this study was to identify the factors that HCPs consider as relevant for using technology in daily practice of long-term care. Methods: In this qualitative study, 11 focus groups were organized with 73 HCPs. The focus group discussions were guided by an innovative game, which was specifically developed for this study. The content of the game was categorized into 4 categories: health care technology and me; health care technology, the patient, and me; health care technology, the organization, and me; and facilitating conditions. The perspectives of HCPs about working with technology were discussed based on this game. The focus groups were recorded and transcribed, followed by an inductive thematic analysis using ATLAS.ti 9x (ATLAS.ti Scientific Software Development GmbH). Results: Overall, 2 main domain summaries were developed from the data: technology should improve the quality of care and acceptance and use of technology in care. The first factor indicates the need for tailored and personalized care and balance between human contact and technology. The second factor addresses several aspects regarding working with technology such as trusting technology, learning to work with technology, and collaboration with colleagues. Conclusions: HCPs are motivated to use technology in daily practice of long-term care when it adds value to the quality of care and there is sufficient trust, expertise, and collaboration with colleagues. Their perspectives need to be considered as they play a crucial part in the successful use of technology, transcending their role as an actor in implementation. On the basis of the findings from this study, we recommend focusing on developing technology for situations where both efficiency and quality of care can be improved; redefining the roles of HCPs and the impact of technology hereon; involving HCPs in the design process of technology to enable them to link it to their daily practice; and creating ambassadors in care teams who are enthusiastic about working with technology and can support and train their colleagues. UR - https://nursing.jmir.org/2023/1/e41032 UR - http://dx.doi.org/10.2196/41032 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494092 ID - info:doi/10.2196/41032 ER - TY - JOUR AU - Muthiah, Shareen AU - Craig, E. Fiona AU - Sinclair, Siobhan AU - Wylie, Grant AU - Torley, Donna AU - Wong, H. Terence AU - Morton, A. Colin PY - 2023/7/26 TI - Rapid Expansion of a Teledermatology Web Application for Digital Dermatology Assessment Necessitated by the COVID-19 Pandemic: Retrospective Evaluation JO - JMIR Dermatol SP - e36307 VL - 6 KW - dermatology KW - asynchronous KW - outpatient KW - consultation KW - teledermatology KW - telehealth KW - telemedicine KW - digital health KW - eHealth KW - digital consultation KW - dermatologist KW - skin KW - return patient KW - digital assessment KW - online platform N2 - Background: The COVID-19 pandemic necessitated a change in the provision of outpatient care in dermatology. Objective: A novel, asynchronous, digital consultation platform was codeveloped with 2 National Health Service dermatology teams to improve access and enhance choice in outpatient care. Methods: The rollout of the platform was accelerated during the initial COVID-19 lockdown, and its wider use across 2 Scottish health boards was retrospectively evaluated. Integrated with the hospital booking system and electronic patient record, the platform provides an alternative to face-to-face consultations, using information and images submitted by the patients. Results: In total, 297 new patient consultations and 108 return patient consultations were assessed, and 80% (324/405) of the images submitted were of satisfactory quality. The consultations were, on average, 3 minutes shorter than equivalent face-to-face interactions, and a total of 5758 km of patient travel was avoided. Outcomes included web-based reviews (66/405, 16.3%), face-to-face reviews (190/405, 46.9%), biopsies (46/405, 11.4%), discharge (89/405, 22%), and other treatments or investigations (14/405, 3.5%). High levels of patient satisfaction (92/112, 82.1%) were reported. Conclusions: Digital dermatology assessments are now included in the choices for consultation types that are available to patients, helping to augment service capacity during pandemic recovery. UR - https://derma.jmir.org/2023/1/e36307 UR - http://dx.doi.org/10.2196/36307 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632929 ID - info:doi/10.2196/36307 ER - TY - JOUR AU - Pujolar-Díaz, Georgina AU - Vidal-Alaball, Josep AU - Forcada, Anna AU - Descals-Singla, Elisabet AU - Basora, Josep AU - PY - 2023/7/26 TI - Creation of a Laboratory for Statistics and Analysis of Dependence and Chronic Conditions: Protocol for the Bages Territorial Specialization and Competitiveness Project (PECT BAGESS) JO - JMIR Res Protoc SP - e46542 VL - 12 KW - chronic disease KW - multiple chronic conditions KW - primary health care KW - diffusion of innovation KW - health data KW - data sharing N2 - Background: With the increasing prevalence of chronic diseases, partly due to the increase in life expectancy and the aging of the population, the complexity of the approach faced by the structures, dynamics, and actors that are part of the current care and attention systems is evident. The territory of Bages (Catalonia, Spain) presents characteristics of a highly complex ecosystem where there is a need to develop new, more dynamic structures for the various actors in the health and social systems, aimed at incorporating new actors in the technological and business field that would allow innovation in the management of this context. Within the framework of the Bages Territorial Specialization and Competitiveness Project (PECT BAGESS), the aim is to address these challenges through various entities that will develop 7 interrelated operations. Of these, the operation of the IDIAP Jordi Gol-Catalan Health Institute focuses on the creation of a Laboratory for Statistics and Analysis of Dependence and Chronic Conditions in the Bages region, in the form of a database that will collect the most relevant information from the different environments that affect the management of chronic conditions and dependence: health, social, economic, and environment. Objective: This study aims to create a laboratory for statistical, dependence, and chronic condition analysis in the Bages region, to determine the chronic conditions and conditions that generate dependence in the Bages area, in order to propose products and services that respond to the needs of people in these situations. Methods: PECT BAGESS originated from the Shared Agenda initiative, which was established in the Bages region with the goal of enhancing the quality of life and fostering social inclusion for individuals with chronic diseases. This study presents part of this broader project, consisting of the creation of a database. Data from chronic conditions and dependence service providers will be combined, using a unique identifier for the different sources of information. A thorough legal analysis was conducted to establish a secure data sharing mechanism among the entities participating in the project. Results: The laboratory will be a key piece in the structure generated in the environment of the PECT BAGESS, which will allow relevant information to be passed on from the different sectors involved to respond to the needs of people with chronic conditions and dependence, as well as to generate opportunities for products and services. Conclusions: The emerging organizational dynamics and structures are expected to demonstrate a health and social management model that may have a remarkable impact on these sectors. Products and services developed may be very useful for generating synergies and facilitating the living conditions of people who can benefit from all these services. However, secure data sharing circuits must be considered. International Registered Report Identifier (IRRID): PRR1-10.2196/46542 UR - https://www.researchprotocols.org/2023/1/e46542 UR - http://dx.doi.org/10.2196/46542 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494102 ID - info:doi/10.2196/46542 ER - TY - JOUR AU - Gijsbers, Harm AU - Nurmohamed, Azam AU - van de Belt, H. Tom AU - Schijven, Marlies AU - PY - 2023/7/26 TI - The National Coordinated Citrien eHealth Program to Scale Up Telemonitoring: Protocol for a Before-and-After Evaluation Study JO - JMIR Res Protoc SP - e45201 VL - 12 KW - study protocol KW - implementation KW - upscaling KW - telemonitoring KW - telemedicine KW - e-health KW - eHealth KW - healthcare KW - health care N2 - Background: Sustainable implementation of telemonitoring in health care is challenging, especially if one aims to scale up telemonitoring initiatives nationwide. The National collaborative eHealth program in the Netherlands is supporting the nationwide upscaling of telemonitoring in 3 clinical domains by implementing telemonitoring in all Dutch university medical centers (UMCs). The chosen telemonitoring concepts are (1) telemonitoring solutions in the domain of cardiology, (2) telemonitoring solutions providing care from a distance in obstetrics, and (3) telemonitoring solutions monitoring vital functions in hospital wards. Objective: The aim of this study is to evaluate the upscaling of telemonitoring in Dutch university hospitals in order to gain a better knowledge of the process, methods, and outcomes of nationwide upscaling strategies. Our hypothesis is that by the completion of the Citrien program?s scale-up, telemonitoring will be operational in all UMCs but not normalized in routine care. Methods: A before-and-after study will be conducted to assess upscaling. The theoretical frameworks used are the framework for nonadoption, abandonment, scale-up, spread, and sustainability; the Normalization Process Theory; and a project management tool Project Canvas. The primary outcome of the study is the degree of normalization to which health care providers at UMCs consider telemonitoring a part of their routine practice, measured using the Normalization MeAsurement Development tool (NoMAD). Our secondary outcome is the uptake of telemonitoring at the Dutch UMCs, using management data from UMCs? business intelligence systems query. Results: Data will be collected between May 2020 and December 2022. Results were retrieved in June 2023. UMCs? business intelligence systems are queried for data for the secondary outcome measures. There is a risk that the UMCs will not be able to provide this management information. The laws and regulations governing telemonitoring in the Netherlands are changing, with the Electronic Data Exchange in Health Care Act (Wet elektronische gegevensuitwisseling in de zorg) and the European Health Data Space Act expected to positively influence implementation and upscaling. Conclusions: The Citrien program is a nationally coordinated change management program that is scaling up telemonitoring across contexts and settings. This study will produce original data on the uptake and upscaling of telemonitoring at Dutch UMCs. Future initiatives to implement eHealth in the health care sector may be guided by the wide range of success factors, obstacles, and experiences collected through this program. The network itself may be of great value impacting future acceleration of eHealth initiatives. International Registered Report Identifier (IRRID): DERR1-10.2196/45201 UR - https://www.researchprotocols.org/2023/1/e45201 UR - http://dx.doi.org/10.2196/45201 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494085 ID - info:doi/10.2196/45201 ER - TY - JOUR AU - McKenna, Sarah AU - Piper, Sarah AU - Capon, William AU - Crowley, Alison AU - Lira, Lucas AU - LaMonica, M. Haley AU - Chong, Kyung Min AU - Scott, Elizabeth AU - Hickie, Ian AU - Iorfino, Frank PY - 2023/7/25 TI - The Polarization of Clinician and Service Staff Perspectives After the Use of Health Information Technology in Youth Mental Health Services: Implementation and Evaluation Study JO - JMIR Hum Factors SP - e42993 VL - 10 KW - mental health KW - youth KW - adolescent KW - service delivery KW - implementation science KW - digital technologies KW - measurement-based care KW - health information technology KW - information system KW - perspective KW - provider KW - health care staff KW - health care worker KW - health care professional N2 - Background: Highly personalized care is substantially improved by technology platforms that assess and track patient outcomes. However, evidence regarding how to successfully implement technology in real-world mental health settings is limited. Objective: This study aimed to naturalistically monitor how a health information technology (HIT) platform was used within 2 real-world mental health service settings to gain practical insights into how HIT can be implemented and sustained to improve mental health service delivery. Methods: An HIT (The Innowell Platform) was naturally implemented in 2 youth mental health services in Sydney, Australia. Web-based surveys (n=19) and implementation logs were used to investigate staff attitudes toward technology before and after implementation. Descriptive statistics were used to track staff attitudes over time, whereas qualitative thematic analysis was used to explore implementation log data to gain practical insights into useful implementation strategies in real-world settings. Results: After the implementation, the staff were nearly 3 times more likely to agree that the HIT would improve care for their clients (3/12, 25% agreed before the implementation compared with 7/10, 70% after the implementation). Despite this, there was also an increase in the number of staff who disagreed that the HIT would improve care (from 1/12, 8% to 2/10, 20%). There was also decreased uncertainty (from 6/12, 50% to 3/10, 30%) about the willingness of the service to implement the technology for its intended purpose, with similar increases in the number of staff who agreed and disagreed with this statement. Staff were more likely to be uncertain about whether colleagues in my service are receptive to changes in clinical processes (not sure rose from 5/12, 42% to 7/10, 70%). They were also more likely to report that their service already provides the best mental health care (agreement rose from 7/12, 58% to 8/10, 80%). After the implementation, a greater proportion of participants reported that the HIT enabled shared or collaborative decision-making with young people (2/10, 20%, compared with 1/12, 8%), enabled clients to proactively work on their mental health care through digital technologies (3/10, 30%, compared with 2/12, 16%), and improved their response to suicidal risk (4/10, 40% compared with 3/12, 25%). Conclusions: This study raises important questions about why clinicians, who have the same training and support in using technology, develop more polarized opinions on its usefulness after implementation. It seems that the uptake of HIT is heavily influenced by a clinician?s underlying beliefs and attitudes toward clinical practice in general as well as the role of technology, rather than their knowledge or the ease of use of the HIT in question. UR - https://humanfactors.jmir.org/2023/1/e42993 UR - http://dx.doi.org/10.2196/42993 UR - http://www.ncbi.nlm.nih.gov/pubmed/37490321 ID - info:doi/10.2196/42993 ER - TY - JOUR AU - Howard, Michelle AU - Aubrey-Bassler, Kris AU - Drummond, Neil AU - Lussier, Marie-Thérèse AU - Queenan, A. John AU - Vanstone, Meredith AU - Nicholson, Kathryn AU - Ramdyal, Amanda AU - Lawson, Jennifer AU - Hafid, Shuaib AU - Freeman, Karla AU - Clark, Rebecca AU - Mangin, Dee PY - 2023/7/21 TI - Effects of the COVID-19 Pandemic on Primary Health Care for Chronic Conditions in Canada: Protocol for a Retrospective Pre-Post Study Using National Practice-Based Research Network Data JO - JMIR Res Protoc SP - e49131 VL - 12 KW - COVID-19 KW - chronic disease KW - primary health care KW - electronic health record KW - health services research KW - retrospective studies N2 - Background: Since the COVID-19 pandemic began, there have been concerns that interruptions to the health care system may have led to changes in primary care, especially for care of chronic conditions such as diabetes and heart failure. Such changes may have longer term implications for population health. Objective: This study aims to describe the impacts of the COVID-19 pandemic on indicators of primary care access, comprehensiveness, and appropriateness among adult patients, as well as on specific indictors of chronic conditions. Additionally, this study aims to determine whether any identified changes were associated with patient sociodemographic characteristics and multimorbidity. Methods: This is a retrospective, single-arm, pre-post study using Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data. CPCSSN is a research network supported by a primary care electronic medical record database, comprising over 1500 physicians and nearly 2 million patients. We are examining changes in care (eg, frequency of contacts, laboratory tests and investigations, referrals, medications prescribed, etc) among adults. We will also examine indicators specific to evidence-based recommendations for care in patients with diabetes and those with heart failure. We will compare rates of outcomes during key periods of the pandemic between March 13, 2020, and December 31, 2022, with equal time periods before the pandemic. Differences will be examined among specific subgroups of adults, including by decade of age, number of comorbidities, and socioeconomic status. Regression models appropriate to outcome distributions will be used to estimate changes, adjusting for potential confounders. This analysis is part of a mixed-methods study with a qualitative component investigating how patients with diabetes with or without concurrent heart failure perceived the impact of the pandemic on access to primary care and health care?related decisions. This study was approved by the Hamilton Integrated Research Ethics Board (14782-C). Results: The start date of this study was October 5, 2022, and the prospective end date is January 31, 2024. As of May 2023, the study cohort (n=875,934) is defined, data cleaning is complete, and exploratory analyses have begun. Extended analyses using 2022 data are planned once the new data becomes available. We will disseminate results through peer-reviewed publications and academic conference, as well as creating evidence briefs, infographics, and a video for policy maker and patient audiences. Conclusions: This study will investigate whether the COVID-19 pandemic has resulted in changes in the provision of primary care in Canada and whether these potential changes have led to gaps in care. This study will also identify patient-level characteristics associated with changes in care patterns across the COVID-19 pandemic. Indicators specific to chronic conditions, namely diabetes and heart failure, will also be explored to determine whether there were changes in care of these conditions. Trial Registration: ClinicalTrials.gov NCT05813652; https://clinicaltrials.gov/ct2/show/NCT05813652 International Registered Report Identifier (IRRID): RR1-10.2196/49131 UR - https://www.researchprotocols.org/2023/1/e49131 UR - http://dx.doi.org/10.2196/49131 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477967 ID - info:doi/10.2196/49131 ER - TY - JOUR AU - Woods, Leanna AU - Dendere, Ronald AU - Eden, Rebekah AU - Grantham, Brittany AU - Krivit, Jenna AU - Pearce, Andrew AU - McNeil, Keith AU - Green, Damian AU - Sullivan, Clair PY - 2023/7/18 TI - Perceived Impact of Digital Health Maturity on Patient Experience, Population Health, Health Care Costs, and Provider Experience: Mixed Methods Case Study JO - J Med Internet Res SP - e45868 VL - 25 KW - digital health KW - health information systems KW - digital maturity KW - digital hospital KW - evaluation study KW - impact KW - outcome assessment KW - qualitative research KW - health services research N2 - Background: Health care organizations understand the importance of new technology implementations; however, the best strategy for implementing successful digital transformations is often unclear. Digital health maturity assessments allow providers to understand the progress made toward technology-enhanced health service delivery. Existing models have been criticized for their lack of depth and breadth because of their technology focus and neglect of meaningful outcomes. Objective: We aimed to examine the perceived impacts of digital health reported by health care staff employed in health care organizations across a spectrum of digital health maturity. Methods: A mixed methods case study was conducted. The digital health maturity of public health care systems (n=16) in Queensland, Australia, was examined using the quantitative Digital Health Indicator (DHI) self-assessment survey. The lower and upper quartiles of DHI scores were calculated and used to stratify sites into 3 groups. Using qualitative methods, health care staff (n=154) participated in interviews and focus groups. Transcripts were analyzed assisted by automated text-mining software. Impacts were grouped according to the digital maturity of the health care worker?s facility and mapped to the quadruple aims of health care: improved patient experience, improved population health, reduced health care cost, and enhanced provider experience. Results: DHI scores ranged between 78 and 193 for the 16 health care systems. Health care systems in the high-maturity category (n=4, 25%) had a DHI score of ?166.75 (the upper quartile); low-maturity sites (n=4, 25%) had a DHI score of ?116.75 (the lower quartile); and intermediate-maturity sites (n=8, 50%) had a DHI score ranging from 116.75 to 166.75 (IQR). Overall, 18 perceived impacts were identified. Generally, a greater number of positive impacts were reported in health care systems of higher digital health maturity. For patient experiences, higher maturity was associated with maintaining a patient health record and tracking patient experience data, while telehealth enabled access and flexibility across all digital health maturity categories. For population health, patient journey tracking and clinical risk mitigation were reported as positive impacts at higher-maturity sites, and telehealth enabled health care access and efficiencies across all maturity categories. Limited interoperability and organizational factors (eg, strategy, policy, and vision) were universally negative impacts affecting health service delivery. For health care costs, the resource burden of ongoing investments in digital health and a sustainable skilled workforce was reported. For provider experiences, the negative impacts of poor usability and change fatigue were universal, while network and infrastructure issues were negative impacts at low-maturity sites. Conclusions: This is one of the first studies to show differences in the perceived impacts of digital maturity of health care systems at scale. Higher digital health maturity was associated with more positive reported impacts, most notably in achieving outcomes for the population health aim. UR - https://www.jmir.org/2023/1/e45868 UR - http://dx.doi.org/10.2196/45868 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463008 ID - info:doi/10.2196/45868 ER - TY - JOUR AU - Sun, Chun-An AU - Shenk, Zachary AU - Renda, Susan AU - Maruthur, Nisa AU - Zheng, Stanley AU - Perrin, Nancy AU - Levin, Scott AU - Han, Hae-Ra PY - 2023/7/18 TI - Experiences and Perceptions of Telehealth Visits in Diabetes Care During and After the COVID-19 Pandemic Among Adults With Type 2 Diabetes and Their Providers: Qualitative Study JO - JMIR Diabetes SP - e44283 VL - 8 KW - telehealth KW - type 2 diabetes mellitus KW - adults KW - user experience KW - care continuity N2 - Background: Since the COVID-19 pandemic, telehealth has been widely adopted in outpatient settings in the United States. Although telehealth visits are publicly accepted in different settings, little is known about the situation after the wide adoption of telehealth from the perspectives of adults with type 2 diabetes mellitus (T2D) and their providers. Objective: This study aims to identify barriers and facilitators of maintaining continuity of care using telehealth for patients with T2D in a diabetes specialty clinic. Methods: As the second phase of a multimethod study to understand missed appointments among adults with T2D, we conducted semistructured, individual, in-depth phone or Zoom interviews with 23 adults with T2D (14/23, 61% women; mean age 55.1, SD 14.4, range 35-77 years) and 10 providers from diabetes clinics in a tertiary academic medical center in Maryland. Interviews were audio-recorded, transcribed, and analyzed using thematic content analysis by the research team. Results: Adults with T2D and their providers generally reported positive experiences with telehealth visits for diabetes care with some technical challenges resulting in the need for in-person visits. We identified the following 3 themes: (1) ?perceived benefits of telehealth visits,? such as convenience, time and financial efficiencies, and independence from caregivers, benefits shared by both patients and providers; (2) ?perceived technological challenges of telehealth visits,? such as disparities in digital health literacy, frustration caused by unstable internet connection, and difficulty sharing glucose data, challenges shared by both patients and providers; and (3) ?impact of telehealth visits on the quality of diabetes care,? including lack of diabetes quality measures and needs and preferences for in-person visits, shared mainly from providers? perspectives with some patient input. Conclusions: Telehealth is generally received positively in diabetes care with some persistent challenges that might compromise the quality of diabetes care. Telehealth technology and glucose data platforms must incorporate user experience and user-centered design to optimize telehealth use in diabetes care. Clinical practices need to consider new workflows for telehealth visits to facilitate easier follow-up scheduling and lab completion. Future research to investigate the ideal balance between in-person and telehealth visits in diabetes care is warranted to enhance the quality of diabetes care and to optimize diabetes outcomes. Policy flexibilities should also be considered to broaden access to diabetes care for all patients with T2D. UR - https://diabetes.jmir.org/2023/1/e44283 UR - http://dx.doi.org/10.2196/44283 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463021 ID - info:doi/10.2196/44283 ER - TY - JOUR AU - Chen, Kay-Yut AU - Lang, Yan AU - Zhou, Yuan AU - Kosmari, Ludmila AU - Daniel, Kathryn AU - Gurses, Ayse AU - Xiao, Yan PY - 2023/7/13 TI - Assessing Interventions on Crowdsourcing Platforms to Nudge Patients for Engagement Behaviors in Primary Care Settings: Randomized Controlled Trial JO - J Med Internet Res SP - e41431 VL - 25 KW - Amazon Mechanical Turk KW - behavioral interventions KW - crowdsourcing KW - medication safety KW - Mturk KW - patient engagement KW - primary care N2 - Background: Engaging patients in health behaviors is critical for better outcomes, yet many patient partnership behaviors are not widely adopted. Behavioral economics?based interventions offer potential solutions, but it is challenging to assess the time and cost needed for different options. Crowdsourcing platforms can efficiently and rapidly assess the efficacy of such interventions, but it is unclear if web-based participants respond to simulated incentives in the same way as they would to actual incentives. Objective: The goals of this study were (1) to assess the feasibility of using crowdsourced surveys to evaluate behavioral economics interventions for patient partnerships by examining whether web-based participants responded to simulated incentives in the same way they would have responded to actual incentives, and (2) to assess the impact of 2 behavioral economics?based intervention designs, psychological rewards and loss of framing, on simulated medication reconciliation behaviors in a simulated primary care setting. Methods: We conducted a randomized controlled trial using a between-subject design on a crowdsourcing platform (Amazon Mechanical Turk) to evaluate the effectiveness of behavioral interventions designed to improve medication adherence in primary care visits. The study included a control group that represented the participants? baseline behavior and 3 simulated interventions, namely monetary compensation, a status effect as a psychological reward, and a loss frame as a modification of the status effect. Participants? willingness to bring medicines to a primary care visit was measured on a 5-point Likert scale. A reverse-coding question was included to ensure response intentionality. Results: A total of 569 study participants were recruited. There were 132 in the baseline group, 187 in the monetary compensation group, 149 in the psychological reward group, and 101 in the loss frame group. All 3 nudge interventions increased participants? willingness to bring medicines significantly when compared to the baseline scenario. The monetary compensation intervention caused an increase of 17.51% (P<.001), psychological rewards on status increased willingness by 11.85% (P<.001), and a loss frame on psychological rewards increased willingness by 24.35% (P<.001). Responses to the reverse-coding question were consistent with the willingness questions. Conclusions: In primary care, bringing medications to office visits is a frequently advocated patient partnership behavior that is nonetheless not widely adopted. Crowdsourcing platforms such as Amazon Mechanical Turk support efforts to efficiently and rapidly reach large groups of individuals to assess the efficacy of behavioral interventions. We found that crowdsourced survey-based experiments with simulated incentives can produce valid simulated behavioral responses. The use of psychological status design, particularly with a loss framing approach, can effectively enhance patient engagement in primary care. These results support the use of crowdsourcing platforms to augment and complement traditional approaches to learning about behavioral economics for patient engagement. UR - https://www.jmir.org/2023/1/e41431 UR - http://dx.doi.org/10.2196/41431 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440308 ID - info:doi/10.2196/41431 ER - TY - JOUR AU - Weber, Franziska AU - Kloek, Corelien AU - Arntz, Angela AU - Grüneberg, Christian AU - Veenhof, Cindy PY - 2023/7/7 TI - Blended Care in Patients With Knee and Hip Osteoarthritis in Physical Therapy: Delphi Study on Needs and Preconditions JO - JMIR Rehabil Assist Technol SP - e43813 VL - 10 KW - telerehabilitation KW - osteoarthritis KW - physical therapy KW - knee KW - hip KW - blended KW - preconditions KW - Delphi KW - focus group KW - user need N2 - Background: Osteoarthritis is a major public health concern. Despite existing evidence-based treatment options, the health care situation remains unsatisfactory. Digital care options, especially when combined with in-person sessions, seem to be promising. Objective: The aim of this study was to investigate the needs, preconditions, barriers, and facilitators of blended physical therapy for osteoarthritis. Methods: This Delphi study consisted of interviews, an online questionnaire, and focus groups. Participants were physical therapists, patients with hip and/or knee osteoarthritis with or without experience in digital care, and stakeholders of the health care system. In the first phase, interviews were conducted with patients and physical therapists. The interview guide was based on the Consolidated Framework For Implementation Research. The interviews focused on experiences with digital and blended care. Furthermore, needs, facilitators, and barriers were discussed. In the second phase, an online questionnaire and focus groups served the process to confirm the needs and collect preconditions. The online questionnaire contained statements drawn by the results of the interviews. Patients and physical therapists were invited to complete the questionnaire and participate in one of the three focus groups including (1) patients; (2) physical therapists; and (3) a patient, a physical therapist, and stakeholders from the health care system. The focus groups were used to determine concordance with the results of the interviews and the online questionnaire. Results: Nine physical therapists, seven patients, and six stakeholders confirmed that an increase of acceptance of the digital care part by physical therapists and patients is crucial. One of the most frequently mentioned facilitators was conducting regular in-person sessions. Physical therapists and patients concluded that blended physical therapy must be tailored to the patients? needs. Participants of the last focus group stated that the reimbursement of blended physical therapy needs to be clarified. Conclusions: Most importantly, it is necessary to strengthen the acceptance of patients and physical therapists toward digital care. Overall, for development and usage purposes, it is crucial to take the needs and preconditions into account. Trial Registration: German Clinical Trials Register DRKS00023386; https://drks.de/search/en/trial/DRKS00023386 UR - https://rehab.jmir.org/2023/1/e43813 UR - http://dx.doi.org/10.2196/43813 UR - http://www.ncbi.nlm.nih.gov/pubmed/37418301 ID - info:doi/10.2196/43813 ER - TY - JOUR AU - Darwich, S. Adam AU - Boström, Anne-Marie AU - Guidetti, Susanne AU - Raghothama, Jayanth AU - Meijer, Sebastiaan PY - 2023/6/30 TI - Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study JO - JMIR Hum Factors SP - e42283 VL - 10 KW - aging KW - intervention KW - health policy KW - health services administration and management KW - health care intervention KW - home care KW - home support KW - in-home assistance KW - personal care KW - policy KW - reablement KW - rehabilitation KW - rehabilitation medicine KW - social support KW - stress KW - support KW - systems thinking KW - user N2 - Background: Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use. Objective: The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems. Methods: The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods. Results: The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements ?workload? and ?distress? were important determinants of home care staff health, provision, and quality of care. Conclusions: The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored. UR - https://humanfactors.jmir.org/2023/1/e42283 UR - http://dx.doi.org/10.2196/42283 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389904 ID - info:doi/10.2196/42283 ER - TY - JOUR AU - Mirbaha, Shaghayegh AU - Morgan, Ashley AU - Tang, Ada AU - Smith-Turchyn, Jenna AU - Richardson, Julie PY - 2023/6/29 TI - Models of Telehealth Service Delivery in Adults With Spinal Cord Injuries: Scoping Review JO - JMIR Rehabil Assist Technol SP - e41186 VL - 10 KW - community-dwelling adults with spinal cord injury KW - models of telehealth services KW - remotely delivery of health care KW - SCI KW - scoping review KW - spinal cord injury KW - telehealth KW - telemedicine KW - telerehabilitation KW - web-based care N2 - Background: In Canada, approximately 86,000 people live with spinal cord injury (SCI), and there are an estimated 3675 new cases of traumatic or nontraumatic etiology per year. Most people with SCI will experience secondary health complications, such as urinary and bowel issues, pain syndrome, pressure ulcers, and psychological disorders, resulting in severe chronic multimorbidity. Moreover, people with SCI may face barriers in accessing health care services, such as primary care physicians? expert knowledge regarding secondary complications related to SCI. Telehealth, defined as the delivery of information and health-related services through telecommunication technologies, may help address some of the barriers, and indeed, the present global COVID-19 pandemic has emphasized the importance of integration of telehealth in health care systems. As a result of this crisis, health care providers have increased the usage of telehealth services, providing health services to individuals in need of community-based supportive care. However, the evidence on models of telehealth service delivery for adults with SCI has not been previously synthesized. Objective: The purpose of this scoping review was to identify, describe, and compare models of telehealth services for community-dwelling adults with SCI. Methods: This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Studies published between 1990 and December 31, 2022, were identified by searching the Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Web of Science, and CINAHL databases. Papers with specified inclusion criteria were screened by 2 investigators. Included articles focused on identifying, implementing, or evaluating telehealth interventions, including primary health care services and self-management services delivered in the community and home-based settings. One investigator performed a full-text review of each article, and data extraction included (1) study characteristics; (2) participant characteristics; (3) key characteristics of the interventions, programs, and services; and (4) outcome measures and results. Results: A total of 61 articles reported telehealth services used for preventing, managing, or treating the most common secondary complications and consequences of SCI, including chronic pain, low physical activity, pressure ulcers, and psychosocial dysfunction. Where evidence exists, improvements in community participation, physical activity, and reduction in chronic pain, pressure ulcers, etc, following SCI were demonstrated. Conclusions: Telehealth may offer an efficient and effective option for health service delivery for community-dwelling individuals with SCI, ensuring continuity of rehabilitation, follow-up after hospital discharge, and early detection, management, or treatment of potential secondary complications following SCI. We recommend that the stakeholders involved with patients with SCI consider the uptake of hybridized (blend of web-based and in-person) health care delivery models to optimize the care continuum and self-management of SCI-related care. The findings of this scoping review may be used to inform policy makers, health care professionals, and stakeholders engaged in establishing web-based clinics for individuals with SCI. UR - https://rehab.jmir.org/2023/1/e41186 UR - http://dx.doi.org/10.2196/41186 UR - http://www.ncbi.nlm.nih.gov/pubmed/37384377 ID - info:doi/10.2196/41186 ER - TY - JOUR AU - Grimm, Michael AU - Link, Elena AU - Albrecht, Martina AU - Czerwinski, Fabian AU - Baumann, Eva AU - Suhr, Ralf PY - 2023/6/28 TI - Exploring Functions and Predictors of Digital Health Engagement Among German Internet Users: Survey Study JO - J Med Internet Res SP - e44024 VL - 25 KW - eHealth KW - mobile health KW - digital health engagement KW - health information seeking KW - self-monitoring KW - digital health care KW - mobile phone N2 - Background: Digital health engagement may serve many support functions, such as providing access to information; checking or evaluating one?s state of health; and tracking, monitoring, or sharing health data. Many digital health engagement behaviors are associated with the potential to reduce inequalities in information and communication. However, initial studies suggest that health inequalities may persist in the digital realm. Objective: This study aimed to explore the functions of digital health engagement by describing how frequently respective services are used for a range of purposes and how these purposes can be categorized from the users? perspective. This study also aimed to identify the prerequisites for successfully implementing and using digital health services; therefore, we shed light on the predisposing, enabling, and need factors that may predict digital health engagement for different functions. Methods: Data were gathered via computer-assisted telephone interviews during the second wave of the German adaption of the Health Information National Trends Survey in 2020 (N=2602). The weighted data set allowed for nationally representative estimates. Our analysis focused on internet users (n=2001). Engagement with digital health services was measured by their reported use for 19 different purposes. Descriptive statistics showed the frequency with which digital health services were used for these purposes. Using a principal component analysis, we identified the underlying functions of these purposes. Using binary logistic regression models, we analyzed which predisposing factors (age and sex), enabling factors (socioeconomic status, health- and information-related self-efficacy, and perceived target efficacy), and need factors (general health status and chronic health condition) can predict the use of the distinguished functions. Results: Digital health engagement was most commonly linked to acquiring information and less frequently to more active or interactive purposes such as sharing health information with other patients or health professionals. Across all purposes, the principal component analysis identified 2 functions. Information-related empowerment comprised items on acquiring health information in various forms, critically assessing one?s state of health, and preventing health problems. In total, 66.62% (1333/2001) of internet users engaged in this behavior. Health care?related organization and communication included items on patient-provider communication and organizing health care. It was applied by 52.67% (1054/2001) of internet users. Binary logistic regression models showed that the use of both functions was determined by predisposing factors (female and younger age) and certain enabling factors (higher socioeconomic status) and need factors (having a chronic condition). Conclusions: Although a large share of German internet users engage with digital health services, predictors show that existing health-related disparities prevail in the digital realm. To make use of the potential of digital health services, fostering digital health literacy at different levels, especially in vulnerable groups, is key. UR - https://www.jmir.org/2023/1/e44024 UR - http://dx.doi.org/10.2196/44024 UR - http://www.ncbi.nlm.nih.gov/pubmed/37379058 ID - info:doi/10.2196/44024 ER - TY - JOUR AU - de Batlle, Jordi AU - Benítez, D. Ivan AU - Moncusí-Moix, Anna AU - Androutsos, Odysseas AU - Angles Barbastro, Rosana AU - Antonini, Alessio AU - Arana, Eunate AU - Cabrera-Umpierrez, Fernanda Maria AU - Cea, Gloria AU - Dafoulas, ?. George AU - Folkvord, Frans AU - Fullaondo, Ane AU - Giuliani, Francesco AU - Huang, Hsiao-Ling AU - Innominato, F. Pasquale AU - Kardas, Przemyslaw AU - Lou, Q. Vivian W. AU - Manios, Yannis AU - Matsangidou, Maria AU - Mercalli, Franco AU - Mokhtari, Mounir AU - Pagliara, Silvio AU - Schellong, Julia AU - Stieler, Lisa AU - Votis, Konstantinos AU - Currás, Paula AU - Arredondo, Teresa Maria AU - Posada, Jorge AU - Guillén, Sergio AU - Pecchia, Leandro AU - Barbé, Ferran AU - Torres, Gerard AU - Fico, Giuseppe AU - PY - 2023/6/28 TI - GATEKEEPER?s Strategy for the Multinational Large-Scale Piloting of an eHealth Platform: Tutorial on How to Identify Relevant Settings and Use Cases JO - J Med Internet Res SP - e42187 VL - 25 KW - big data KW - chronic diseases KW - eHealth KW - healthy aging KW - integrated care KW - large-scale pilots N2 - Background: The World Health Organization?s strategy toward healthy aging fosters person-centered integrated care sustained by eHealth systems. However, there is a need for standardized frameworks or platforms accommodating and interconnecting multiple of these systems while ensuring secure, relevant, fair, trust-based data sharing and use. The H2020 project GATEKEEPER aims to implement and test an open-source, European, standard-based, interoperable, and secure framework serving broad populations of aging citizens with heterogeneous health needs. Objective: We aim to describe the rationale for the selection of an optimal group of settings for the multinational large-scale piloting of the GATEKEEPER platform. Methods: The selection of implementation sites and reference use cases (RUCs) was based on the adoption of a double stratification pyramid reflecting the overall health of target populations and the intensity of proposed interventions; the identification of a principles guiding implementation site selection; and the elaboration of guidelines for RUC selection, ensuring clinical relevance and scientific excellence while covering the whole spectrum of citizen complexities and intervention intensities. Results: Seven European countries were selected, covering Europe?s geographical and socioeconomic heterogeneity: Cyprus, Germany, Greece, Italy, Poland, Spain, and the United Kingdom. These were complemented by the following 3 Asian pilots: Hong Kong, Singapore, and Taiwan. Implementation sites consisted of local ecosystems, including health care organizations and partners from industry, civil society, academia, and government, prioritizing the highly rated European Innovation Partnership on Active and Healthy Aging reference sites. RUCs covered the whole spectrum of chronic diseases, citizen complexities, and intervention intensities while privileging clinical relevance and scientific rigor. These included lifestyle-related early detection and interventions, using artificial intelligence?based digital coaches to promote healthy lifestyle and delay the onset or worsening of chronic diseases in healthy citizens; chronic obstructive pulmonary disease and heart failure decompensations management, proposing integrated care management based on advanced wearable monitoring and machine learning (ML) to predict decompensations; management of glycemic status in diabetes mellitus, based on beat to beat monitoring and short-term ML-based prediction of glycemic dynamics; treatment decision support systems for Parkinson disease, continuously monitoring motor and nonmotor complications to trigger enhanced treatment strategies; primary and secondary stroke prevention, using a coaching app and educational simulations with virtual and augmented reality; management of multimorbid older patients or patients with cancer, exploring novel chronic care models based on digital coaching, and advanced monitoring and ML; high blood pressure management, with ML-based predictions based on different intensities of monitoring through self-managed apps; and COVID-19 management, with integrated management tools limiting physical contact among actors. Conclusions: This paper provides a methodology for selecting adequate settings for the large-scale piloting of eHealth frameworks and exemplifies with the decisions taken in GATEKEEPER the current views of the WHO and European Commission while moving forward toward a European Data Space. UR - https://www.jmir.org/2023/1/e42187 UR - http://dx.doi.org/10.2196/42187 UR - http://www.ncbi.nlm.nih.gov/pubmed/37379060 ID - info:doi/10.2196/42187 ER - TY - JOUR AU - Steiner, Artur AU - Farmer, Jane AU - Kamstra, Peter AU - Carlisle, Karen AU - McCosker, Anthony AU - Kilpatrick, Sue PY - 2023/6/28 TI - Online Mental Health Forums and Rural Resilience: Mixed Methods Study and Logic Model JO - JMIR Ment Health SP - e47459 VL - 10 KW - online forums KW - personal resilience KW - mental health KW - rurality KW - logic model N2 - Background: Rural mental health is a growing area of concern internationally, and online mental health forums offer a potential response to addressing service gaps in rural communities. Objective: The objective of this study was to explore and identify pathways by which online peer support mental health forums help to build resilience for rural residents experiencing mental ill-health by contributing to overcoming their specific contextual challenges. Methods: We developed a Theoretical Resilience Framework and applied it to 3000 qualitative posts from 3 Australian online mental health forums and to data from 30 interviews with rural forum users. Results: Drawing on the findings and an abductive approach, a logic model was developed to illustrate links between the resilience resources built and enabling features of forums that make them spaces that facilitate resilience. Conclusions: The study demonstrated that online forums make valuable contributions to social well-being and access to a range of timely support services for rural people experiencing mental ill-health, and, while doing so, involve users in the processes of resilience building. The study provides a new way for practitioners to frame the work of and value produced by forums. It gives a logic model that can be used in evaluation and audit as it facilitates a causal framing of how forums, as an intervention, link with resilience outcomes. Ultimately, the study contributes to developing new knowledge about how rural resilience building can be conceptualized and measured while showing how forums are part of contemporary health service provision in rural places. UR - https://mental.jmir.org/2023/1/e47459 UR - http://dx.doi.org/10.2196/47459 UR - http://www.ncbi.nlm.nih.gov/pubmed/37379080 ID - info:doi/10.2196/47459 ER - TY - JOUR AU - Zaman, Sameer AU - Padayachee, Yorissa AU - Shah, Moulesh AU - Samways, Jack AU - Auton, Alice AU - Quaife, M. Nicholas AU - Sweeney, Mark AU - Howard, P. James AU - Tenorio, Indira AU - Bachtiger, Patrik AU - Kamalati, Tahereh AU - Pabari, A. Punam AU - Linton, F. Nick W. AU - Mayet, Jamil AU - Peters, S. Nicholas AU - Barton, Carys AU - Cole, D. Graham AU - Plymen, M. Carla PY - 2023/6/23 TI - Smartphone-Based Remote Monitoring in Heart Failure With Reduced Ejection Fraction: Retrospective Cohort Study of Secondary Care Use and Costs JO - JMIR Cardio SP - e45611 VL - 7 KW - heart failure KW - remote monitoring KW - smartphone care KW - telemonitoring KW - self-management KW - admission prevention KW - cohort study KW - hospitalization KW - noninvasive KW - smartphone KW - vital signs KW - diagnosis N2 - Background: Despite effective therapies, the economic burden of heart failure with reduced ejection fraction (HFrEF) is driven by frequent hospitalizations. Treatment optimization and admission avoidance rely on frequent symptom reviews and monitoring of vital signs. Remote monitoring (RM) aims to prevent admissions by facilitating early intervention, but the impact of noninvasive, smartphone-based RM of vital signs on secondary health care use and costs in the months after a new diagnosis of HFrEF is unknown. Objective: The purpose of this study is to conduct a secondary care health use and health-economic evaluation for patients with HFrEF using smartphone-based noninvasive RM and compare it with matched controls receiving usual care without RM. Methods: We conducted a retrospective study of 2 cohorts of newly diagnosed HFrEF patients, matched 1:1 for demographics, socioeconomic status, comorbidities, and HFrEF severity. They are (1) the RM group, with patients using the RM platform for >3 months and (2) the control group, with patients referred before RM was available who received usual heart failure care without RM. Emergency department (ED) attendance, hospital admissions, outpatient use, and the associated costs of this secondary care activity were extracted from the Discover data set for a 3-month period after diagnosis. Platform costs were added for the RM group. Secondary health care use and costs were analyzed using Kaplan-Meier event analysis and Cox proportional hazards modeling. Results: A total of 146 patients (mean age 63 years; 42/146, 29% female) were included (73 in each group). The groups were well-matched for all baseline characteristics except hypertension (P=.03). RM was associated with a lower hazard of ED attendance (hazard ratio [HR] 0.43; P=.02) and unplanned admissions (HR 0.26; P=.02). There were no differences in elective admissions (HR 1.03, P=.96) or outpatient use (HR 1.40; P=.18) between the 2 groups. These differences were sustained by a univariate model controlling for hypertension. Over a 3-month period, secondary health care costs were approximately 4-fold lower in the RM group than the control group, despite the additional cost of RM itself (mean cost per patient GBP £465, US $581 vs GBP £1850, US $2313, respectively; P=.04). Conclusions: This retrospective cohort study shows that smartphone-based RM of vital signs is feasible for HFrEF. This type of RM was associated with an approximately 2-fold reduction in ED attendance and a 4-fold reduction in emergency admissions over just 3 months after a new diagnosis with HFrEF. Costs were significantly lower in the RM group without increasing outpatient demand. This type of RM could be adjunctive to standard care to reduce admissions, enabling other resources to help patients unable to use RM. UR - https://cardio.jmir.org/2023/1/e45611 UR - http://dx.doi.org/10.2196/45611 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351921 ID - info:doi/10.2196/45611 ER - TY - JOUR AU - Khatib, Rasha AU - McCue, Maggie AU - Blair, Chris AU - Roy, Anit AU - Franco, John AU - Fehnert, Ben AU - King, James AU - Sarkey, Sara AU - Chrones, Lambros AU - Martin, Michael AU - Kabir, Christopher AU - Kemp, E. David PY - 2023/6/23 TI - Design and Implementation of a Digitally Enabled Care Pathway to Improve Management of Depression in a Large Health Care System: Protocol for the Implementation of a Patient Care Platform JO - JMIR Res Protoc SP - e43788 VL - 12 KW - mental health KW - depression KW - depressive KW - major depressive disorder KW - depression management KW - primary care KW - patient engagement KW - measurement-based care KW - shared decision-making KW - user-centered design KW - mobile app KW - digital platform KW - mobile phone KW - mobile health KW - adherence N2 - Background: Major depressive disorder (MDD) is a serious public health concern worldwide. A treatment approach that incorporates measurement-based care (MBC) and shared decision-making between patients with MDD and their providers may foster patient engagement and improve clinical outcomes. While digital tools such as mobile apps show promise for expanding health interventions, these apps are rarely integrated into clinical practice. Objective: The primary objective of this ongoing study is to determine whether implementation of a digital tool?the Pathway Platform?in primary care improves adherence to MBC practices; here, we present the study methods. Methods: This large-scale, real-world implementation study is based on a pilot study of an earlier iteration of a mobile app (the Pathway app) that confirmed the feasibility of using the app in patients with MDD and showed a positive trend in patient engagement in the app arm. In addition, a user-centered design approach that included qualitative assessments from patients and providers was used to improve understanding of the patient journey and care team workflows. User feedback highlighted the need for enhanced features, education modules, and real-time data sharing via integration with the electronic health record. The current iteration of the Platform includes the newest version of the Pathway app, education modules for both patients and providers, and real-time patient-level data sharing with the electronic health record. The study takes place in primary care sites within the Advocate Aurora Health system in Illinois and includes adult patients with MDD who were recently prescribed monotherapy antidepressant medication (defined as a new start, medication switch, or dose change in the past 3 months). Clinical performance and selected patient outcomes will be compared before and after the implementation of the Platform. Results: Patient recruitment was completed in July 2022, with initial results expected in mid-2023. Conclusions: This study will provide useful insights into real-world integration of a digital platform within a large health system. The methods presented here highlight the unique user-centric development of the Pathway Platform, which has resulted in an enhanced digital tool with the potential to foster MBC and shared decision-making, improve patient-provider communication, and ultimately lead to optimized treatment outcomes for patients with MDD. Trial Registration: ClinicalTrials.gov NCT04891224; https://clinicaltrials.gov/ct2/show/NCT04891224 International Registered Report Identifier (IRRID): DERR1-10.2196/43788 UR - https://www.researchprotocols.org/2023/1/e43788 UR - http://dx.doi.org/10.2196/43788 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351941 ID - info:doi/10.2196/43788 ER - TY - JOUR AU - Duffy, V. Lisa AU - Evans, Rebecka AU - Bennett, Veronica AU - Hady, Marie Joan AU - Palaniappan, Priya PY - 2023/6/22 TI - Therapeutic Relational Connection in Telehealth: Concept Analysis JO - J Med Internet Res SP - e43303 VL - 25 KW - therapeutic relational connection KW - telehealth KW - telemedicine KW - eHealth KW - concept analysis KW - provider-patient relationship KW - therapeutic relationship KW - relationship KW - connection KW - patient-provider KW - patient-physician N2 - Background:  Therapeutic relational connection (TRC) in telehealth is a new concept that refers to the intentional use of relationship connection between health care providers and their patients as both parties work toward a therapeutic aim. It has been demonstrated that TRC positively affects patient-centered outcomes including adherence, self-management, and satisfaction with care. What is not known are best practices for establishing TRC during telehealth visits. The rapid emergence of telehealth during the COVID-19 pandemic has identified a number of challenges. These challenges include lack of human contact, distance creating mistrust, the inability to rely on nonverbal communication, and a sense of depersonalization. Training for health care providers in these interpersonal communication skills needed to establish TRC during telehealth visits is needed. Objective:  This paper aims to explore the evolutionary concept of TRC in telehealth. The purpose of this paper is to provide a concept analysis of TRC during telehealth interactions between providers and patients through a comprehensive review of the existing published literature. Methods:  Rodgers? evolutionary concept analysis method was used to guide this study. PubMed, Embase, PsycINFO, and CINAHL were used to search for relevant publications. An integrative review strategy aided by Rayyan software was used to identify a final sample of 13 papers for analysis. Results:  The proposed definition of TRC in telehealth is the experience of a mutually responsive patient-provider relationship that is built on mutual respect and understanding and informed by cultural humility, presence, empathy, and the ability to effectively evaluate patient concerns to work toward a therapeutic aim. The key attributes of TRC in telehealth are the provider?s ability to evaluate patient concerns, interpersonal communication, cultural humility, mutual trust and respect, presence, empathy, and building relationships. Clinical presence, proper environment, knowledge about the use of technology (both patient and provider), use of verbal and nonverbal communication, and knowledge about community and culture are important antecedents of TRC. Consequences of TRC include improved communication resulting in mutual respect and caring, adherence to follow-up recommendations, increased coping, collaborative decision-making, and satisfaction with care. Conclusions:  Telehealth visits necessitate alternative approaches to establishing TRC as compared to in-person clinic visits. With the rapid expansion of telehealth platforms and a heightened acceptance of the technology, there is a need to integrate knowledge and provide a clear conceptualization of TRC in telehealth as TRC has been demonstrated to result in positive patient-centered outcomes. Identifying the attributes and antecedents of TRC in telehealth allows us the opportunity to develop guidelines and educational interventions aimed at training health care providers in the skills needed to establish TRC during telehealth visits. UR - https://www.jmir.org/2023/1/e43303 UR - http://dx.doi.org/10.2196/43303 UR - http://www.ncbi.nlm.nih.gov/pubmed/37347526 ID - info:doi/10.2196/43303 ER - TY - JOUR AU - Silva, Mindy AU - Hay-Smith, Jean E. AU - Graham, Fiona PY - 2023/6/21 TI - Exploring the Use of the Behavior Change Technique Taxonomy and the Persuasive System Design Model in Defining Parent-Focused eHealth Interventions: Scoping Review JO - J Med Internet Res SP - e42083 VL - 25 KW - persuasive technology KW - behavior change KW - parent-focused eHealth KW - Capability, Opportunity, and Motivation?Behavior KW - COM-B KW - Fogg Behavior Model KW - FBM KW - behavior intervention KW - publications KW - effectiveness KW - usability KW - active ingredient KW - scoping review KW - mobile phone N2 - Background: Taxonomies and models are useful tools for defining eHealth content and intervention features, enabling comparison and analysis of research across studies and disciplines. The Behavior Change Technique Taxonomy version 1 (BCTTv1) was developed to decrease ambiguity in defining specific characteristics inherent in health interventions, but it was developed outside the context of digital technology. In contrast, the Persuasive System Design Model (PSDM) was developed to define and evaluate the persuasive content in software solutions but did not have a specific focus on health. Both the BCTTv1 and PSDM have been used to define eHealth interventions in the literature, with some researchers combining or reducing the taxonomies to simplify their application. It is unclear how well the taxonomies accurately define eHealth and whether they should be used alone or in combination. Objective: This scoping review explored how the BCTTv1 and PSDM capture the content and intervention features of parent-focused eHealth as part of a program of studies investigating the use of technology to support parents with therapy home programs for children with special health care needs. It explored the active ingredients and persuasive technology features commonly found in parent-focused eHealth interventions for children with special health care needs and how the descriptions overlap and interact with respect to the BCTTv1 and PSDM taxonomies. Methods: A scoping review was used to clarify concepts in the literature related to these taxonomies. Keywords related to parent-focused eHealth were defined and used to systematically search several electronic databases for parent-focused eHealth publications. Publications referencing the same intervention were combined to provide comprehensive intervention details. The data set was coded using codebooks developed from the taxonomies in NVivo (version 12; QSR International) and qualitatively analyzed using matrix queries. Results: The systematic search found 23 parent-focused eHealth interventions described in 42 articles from various countries; delivered to parents with children aged 1 to 18 years; and covering medical, behavioral, and developmental issues. The predominant active ingredients and intervention features in parent-focused eHealth were concerned with teaching parents behavioral skills, encouraging them to practice and monitor the new skills, and tracking the outcomes of performing the new skills. No category had a complete set of active ingredients or intervention features coded. The two taxonomies conceptually captured different constructs even when their labels appeared to overlap in meaning. In addition, coding by category missed important active ingredients and intervention features. Conclusions: The taxonomies were found to code different constructs related to behavior change and persuasive technology, discouraging the merging or reduction of the taxonomies. This scoping review highlighted the benefit of using both taxonomies in their entirety to capture active ingredients and intervention features important for comparing and analyzing eHealth across different studies and disciplines. International Registered Report Identifier (IRRID): RR2-doi.org/10.15619/nzjp/47.1.05 UR - https://www.jmir.org/2023/1/e42083 UR - http://dx.doi.org/10.2196/42083 UR - http://www.ncbi.nlm.nih.gov/pubmed/37342082 ID - info:doi/10.2196/42083 ER - TY - JOUR AU - Fountaine, R. Alex AU - Iyar, M. Megumi AU - Lutes, D. Lesley PY - 2023/6/20 TI - Examining the Utility of a Telehealth Warm Handoff in Integrated Primary Care for Improving Patient Engagement in Mental Health Treatment: Randomized Video Vignette Study JO - JMIR Form Res SP - e40274 VL - 7 KW - integrated primary care KW - integrated care KW - patient-centered medical home KW - warm handoff KW - treatment engagement KW - collaborative care N2 - Background: A warm handoff from a physician to a mental health provider is often patients? first contact with psychological services and provides a unique opportunity for improving treatment engagement in integrated primary care (IPC) settings. Objective: In light of the COVID-19 pandemic, this study sought to examine the impact of different types of telehealth mental health referrals on both the anticipated likelihood of accepting treatment services and anticipated likelihood of continued treatment engagement. Methods: A convenience sample of young adults (N=560) was randomized to view 1 of 3 video vignettes: warm handoff in IPC, referral as usual (RAU) in IPC, or RAU in standard primary care. Results: Logistic associations between referral type and the likelihood of referral acceptance (?21=10.9, P=.004) and the likelihood of continued engagement (?21=32.6, P<.001) were significant. Participants who received a warm handoff were significantly more likely to anticipate both accepting the referral (b=0.35; P=.002; odds ratio 1.42, 95% CI 1.15-1.77) and engaging in continued treatment (b=0.62; P<.001; odds ratio 1.87, 95% CI 1.49-2.34) compared with those who received RAU in the standard primary care condition. Furthermore, 77.9% (436/560) of the sample indicated that they would be at least somewhat likely to access IPC mental health services for their own mental health concerns if they were readily available in their own primary care physician?s office. Conclusions: A telehealth warm handoff resulted in the increased anticipated likelihood of both initial and continued engagement in mental health treatment. A telehealth warm handoff may have utility in fostering the uptake of mental health treatment. Nonetheless, a longitudinal assessment in a primary care clinic of the utility of a warm handoff for fostering referral acceptance and continued treatment engagement is needed to hone the adoptability of a warm handoff process and demonstrate practical evidence of effectiveness. The optimization of a warm handoff would also benefit from additional studies examining patient and provider perspectives about the factors affecting treatment engagement in IPC settings. UR - https://formative.jmir.org/2023/1/e40274 UR - http://dx.doi.org/10.2196/40274 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338963 ID - info:doi/10.2196/40274 ER - TY - JOUR AU - Touzani, Rajae AU - Dembele, Elodie AU - Schultz, Emilien AU - Rouquette, Alexandra AU - Seguin, Lorène AU - Dufour, Jean-Charles AU - Bannier, Marie AU - Mancini, Julien PY - 2023/6/16 TI - The French General Population?s Perception of New Information and Communication Technologies for Medical Consultations: National Survey JO - J Med Internet Res SP - e45822 VL - 25 KW - new ICT KW - video recording KW - mHealth apps KW - video broadcasting KW - health literacy KW - telehealth KW - teleconsultation KW - HLS19 KW - COVID-19 KW - France N2 - Background: The development of telehealth and telemedicine, in the form of increased teleconsultation and medical telemonitoring, accelerated during the COVID-19 health crisis in France to ensure continued access to care for the population. Since these new information and communication technologies (ICTs) are diverse and likely to transform how the health care system is organized, there is a need better to understand public attitudes toward them and their relationship with peoples? current experience of health care. Objective: This study aimed to determine the French general population?s perception of the usefulness of video recording/broadcasting (VRB) and mobile Health (mHealth) apps for medical consultations in France during the COVID-19 health crisis and the factors associated with this perception. Methods: Data were collected for 2003 people in 2 waves of an online survey alongside the Health Literacy Survey 2019 (1003 in May 2020 and 1000 in January 2021) based on quota sampling. The survey collected sociodemographic characteristics, health literacy levels, trust in political representatives, and perceived health status. The perceived usefulness of VRB in medical consultations was measured by combining 2 responses concerning this technology for consultations. The perceived usefulness of mHealth apps was measured by combining 2 responses concerning their usefulness for booking doctor appointments and for communicating patient-reported outcomes to doctors. Results: The majority (1239/2003, 62%) of respondents considered the use of mHealth apps useful, while only 27.6% (551/2003) declared VRB useful. The factors associated with the perceived usefulness of both technologies were younger age (? 55 years), trust in political representatives (VRB: adjusted odds ratio [aOR] 1.68, 95% CI 1.31-2.17; mHealth apps: aOR 1.88, 95% CI 1.42-2.48), and higher (sufficient and excellent) health literacy. The period of the beginning of the COVID-19 epidemic, living in an urban area, and being limited in daily activities were also associated with perceiving VRB positively. The perceived usefulness of mHealth apps increased with the level of education. It was also higher in people who had 3 or more consultations with a medical specialist. Conclusions: There are important differences in attitudes toward new ICTs. Perceived usefulness was lower for VRB than for mHealth apps. Moreover, it decreased after the initial months of the COVID-19 pandemic. There is also the possibility of new inequalities. Hence, despite the potential benefits of VRB and mHealth apps, people with low health literacy considered them to be of little use for their health care, possibly increasing their difficulties in accessing health care in the future. As such, health care providers and policy makers need to consider those perceptions to guarantee that new ICTs are accessible and beneficial to all. UR - https://www.jmir.org/2023/1/e45822 UR - http://dx.doi.org/10.2196/45822 UR - http://www.ncbi.nlm.nih.gov/pubmed/37327032 ID - info:doi/10.2196/45822 ER - TY - JOUR AU - Norgren, Therese AU - Richardson, X. Matt AU - Wamala-Andersson, Sarah PY - 2023/6/15 TI - Obstacles to Evidence-Based Procurement, Implementation, and Evaluation of Health and Welfare Technologies in Swedish Municipalities: Mixed Methods Study JO - JMIR Form Res SP - e45626 VL - 7 KW - evaluation KW - evidence KW - health and welfare technology KW - implementation KW - mixed methods KW - municipalities KW - procurement KW - social care KW - effectiveness KW - Sweden KW - support KW - design KW - survey KW - interview KW - welfare KW - technology N2 - Background: Health and welfare technologies (HWTs) are interventions that aim at maintaining or promoting health, well-being, quality of life, and increasing efficiency in the service delivery system of welfare, social, and health care services, while improving the working conditions of the staff. Health and social care must be evidence-based according to national policy, but there are indications that evidence for HWT effectiveness is lacking in related Swedish municipal work processes. Objective: This study aimed to investigate whether the evidence is used when Swedish municipalities procure, implement, and evaluate HWT, and if so, the kinds of evidence and the manner of their use. The study also aimed to identify if municipalities currently receive adequate support in using evidence for HWT, and if not, what support is desired. Methods: An explanatory sequential mixed methods design was used with quantitative surveys and subsequent semistructured interviews with officials in 5 nationally designated ?model? municipalities regarding HWT implementation and use. Results: In the past 12 months, 4 of 5 municipalities had required some form of evidence during procurement processes, but the frequency of this varied and often consisted of references from other municipalities instead of other objective sources. Formulating requirements or requests for evidence during procurement was viewed as difficult, and gathered evidence was often only assessed by procurement administration personnel. In total, 2 of 5 municipalities used an established process for the implementation of HWT, and 3 of 5 had a plan for structured follow-up, but the use and dissemination of evidence within these were varying and often weakly integrated. Standardized processes for follow-up and evaluation across municipalities did not exist, and those processes used by individual municipalities were described as inadequate and difficult to follow. Most municipalities desired support for using evidence when procuring, establishing evaluation frameworks for, and following up effectiveness of HWT, while all municipalities suggested tools or methods for this kind of support. Conclusions: Structured use of evidence in procurement, implementation, and evaluation of HWT is inconsistent among municipalities, and internal and external dissemination of evidence for effectiveness is rare. This may establish a legacy of ineffective HWT in municipal settings. The results suggest that existing national agency guidance is not sufficient to meet current needs. New, more effective types of support to increase the use of evidence in critical phases of municipal procurement and implementation of HWT are recommended. UR - https://formative.jmir.org/2023/1/e45626 UR - http://dx.doi.org/10.2196/45626 UR - http://www.ncbi.nlm.nih.gov/pubmed/37318831 ID - info:doi/10.2196/45626 ER - TY - JOUR AU - Herranz, Carmen AU - Martín-Moreno Banegas, Laura AU - Dana Muzzio, Fernando AU - Siso-Almirall, Antoni AU - Roca, Josep AU - Cano, Isaac PY - 2023/6/14 TI - A Practice-Proven Adaptive Case Management Approach for Innovative Health Care Services (Health Circuit): Cluster Randomized Clinical Pilot and Descriptive Observational Study JO - J Med Internet Res SP - e47672 VL - 25 KW - continuum of care management KW - innovative healthcare services KW - collaborative tools KW - digital health transformation KW - usability KW - acceptability KW - health care service KW - Health Circuit KW - health management KW - management KW - support KW - digital aid KW - aid KW - care KW - prototype KW - surgery KW - testing N2 - Background: Digital health tools may facilitate the continuity of care. Enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans. Objective: The study presents Health Circuit, an adaptive case management approach that empowers health care professionals and patients to implement personalized evidence-based interventions, thanks to dynamic communication channels and patient-centered service workflows; analyze the health care impact; and determine its usability and acceptability among health care professionals and patients. Methods: From September 2019 to March 2020, the health impact, usability (measured with the system usability scale; SUS), and acceptability (measured with the net promoter score; NPS) of an initial prototype of Health Circuit were tested in a cluster randomized clinical pilot (n=100) in patients with high risk for hospitalization (study 1). From July 2020 to July 2021, a premarket pilot study of usability (with the SUS) and acceptability (with the NPS) was conducted among 104 high-risk patients undergoing prehabilitation before major surgery (study 2). Results: In study 1, Health Circuit resulted in a reduction of emergency room visits (4/7, 13% vs 7/16, 44%), enhanced patients? empowerment (P<.001) and showed good acceptability and usability scores (NPS: 31; SUS: 54/100). In study 2, the NPS was 40 and the SUS was 85/100. The acceptance rate was also high (mean score of 8.4/10). Conclusions: Health Circuit showed potential for health care value generation and good acceptability and usability despite being a prototype system, prompting the need for testing a completed system in real-world scenarios. Trial Registration: ClinicalTrials.gov NCT04056663; https://clinicaltrials.gov/ct2/show/NCT04056663 UR - https://www.jmir.org/2023/1/e47672 UR - http://dx.doi.org/10.2196/47672 UR - http://www.ncbi.nlm.nih.gov/pubmed/37314850 ID - info:doi/10.2196/47672 ER - TY - JOUR AU - Budak, Beliz Kübra AU - Laporte Uribe, Franziska AU - Meiland, Franka AU - Felding, Anna Simone AU - Teupen, Sonja AU - Bergmann, Michael Johannes AU - Mueller-Widmer, Rene AU - Roes, Martina PY - 2023/6/14 TI - Implementing Active Assisted Living Technology in the Long-term Care of People Living With Dementia to Address Loneliness: European Survey JO - JMIR Aging SP - e45231 VL - 6 KW - loneliness KW - social isolation KW - active assisted living technology KW - long-term care KW - dementia KW - Alzheimer KW - implementation KW - CFIR N2 - Background: In the lives of people with dementia, loneliness is an important issue with psychological and physical consequences. Active assisted living (AAL) technology has been gaining visibility in the care of persons living with dementia, including addressing loneliness. However, to the best of our knowledge, there is a lack of evidence concerning the factors influencing the implementation of AAL technology within the context of dementia, loneliness, and long-term care (LTC). Objective: We aimed to identify the familiarity with AAL technology that is promising for addressing loneliness in persons living with dementia in LTC in Europe and the factors influencing AAL technology implementation. Methods: A web-based survey was developed based on findings from our previous literature review. The Consolidated Framework for Implementation Research guided the development and analysis of the survey. Participants included 24 representatives of Alzheimer Europe member associations from 15 European countries. The data were analyzed using basic statistical methods (descriptive statistics). Results: The baby seal robot Paro was reported to be the most familiar AAL technology by 19 of 24 participants addressing loneliness in people with dementia living in LTC. Participants from Norway (n=2) reported familiarity with 14 AAL technologies, and participants from Serbia (n=1) reported zero familiarity. It seems that countries that invest less in LTC facilities are familiar with fewer AAL technologies. At the same time, these countries report a more positive attitude toward AAL technology, express a higher need for it, and see more advantages than disadvantages than those countries that invest more in LTC. However, a country's investment in LTC facilities does not seem to be linked to other implementation aspects such as costs, planning, and the impact of infrastructure. Conclusions: Implementation of AAL technology to address loneliness in dementia seems to be linked to familiarity with the technology in a country as well as national investment in LTC facilities. This survey confirms the literature on higher investment countries? critical stance in regard to AAL technology implementation to address loneliness in persons living with dementia living in LTC. Further research is needed to clarify the potential reasons why familiarity with more AAL technology does not seem to be directly linked with acceptance, positive attitude, or satisfaction with AAL technology addressing loneliness in persons living with dementia. UR - https://aging.jmir.org/2023/1/e45231 UR - http://dx.doi.org/10.2196/45231 UR - http://www.ncbi.nlm.nih.gov/pubmed/37314840 ID - info:doi/10.2196/45231 ER - TY - JOUR AU - Yotsu, R. Rie AU - Almamy, Diabate AU - Vagamon, Bamba AU - Ugai, Kazuko AU - Itoh, Sakiko AU - Koffi, Didier Yao AU - Kaloga, Mamadou AU - Dizoé, Sylvestre Ligué Agui AU - Kouadio, Kouamé AU - Aka, N?guetta AU - Yeboue, Gontran Luc Kowaci AU - Yao, Aubin Koffi AU - Blanton, E. Ronald PY - 2023/6/14 TI - An mHealth App (eSkinHealth) for Detecting and Managing Skin Diseases in Resource-Limited Settings: Mixed Methods Pilot Study JO - JMIR Dermatol SP - e46295 VL - 6 KW - dermatology KW - developing countries KW - digital health tool KW - LMICs KW - low- and middle-income countries KW - skin KW - teledermatology KW - eHealth application KW - skin disease KW - digital health intervention KW - health platform KW - system usability N2 - Background: In sub-Saharan Africa, the disease burden from skin diseases, including skin-related neglected tropical diseases (skin NTDs), is extremely high. These diseases often are overlooked due to limited access to health care stemming from, for example, remote geographical locations and a lack of experts. To address these gaps, we developed a mobile health app, eSkinHealth, which is a field-adapted platform to serve as a portable electronic patient chart and for teledermatology. Objective: The purpose of the study is to evaluate the usability and effectiveness of the app in rural Côte d?Ivoire for diagnosing and managing skin NTDs and other skin diseases. Methods: A 2-arm trial with local health care providers and patients with skin diseases was implemented over a 3-month period. The providers were assigned to an intervention receiving the eSkinHealth app or control with usual care. Four nurses and 8 community health care workers participated in each arm. The training was provided on the use of the app to the intervention arm only, while both arms were trained on skin diseases. For the usability study, we evaluated our approach with the System Usability Scale (SUS) and in-depth interviews. For the effectiveness study, our primary outcome was to evaluate the detection and management of 5 skin NTDs as our targeted diseases, namely, Buruli ulcer, leprosy, lymphatic filariasis, scabies, and yaws, using the eSkinHealth app. Procedures of our methods were reviewed and approved by the institutional review board of the Ministry of Health and by Tulane University. Results: The mean age of our participants (providers) was 40.5 and 42.5 years for the intervention and control arms, respectively, and all were male (n=24). The average SUS scores taken from the intervention arm at baseline, the midpoint (6 weeks), and the end of study (12 weeks) were 72.3 (SD 11.5), 72.3 (SD 12.4), and 86.3 (SD 10.8), respectively. All participants interviewed, including 4 dermatologists and program managers, were satisfied with the app. Especially community health care workers felt empowered by being equipped with the tool. A total of 79 cases of skin NTDs were reported in the intervention arm as compared to 17 cases in the control arm (P=.002). Besides the skin NTDs, more skin diseases and conditions were reported from the control than from the intervention arm (P<.001). However, 100 cases (66%) were not given any particular diagnosis in the control arm and were documented only as a ?dermatosis.? In the intervention arm, 151 cases (72.9%) were diagnosed within the eSkinHealth platform, and the remaining were diagnosed on-site by dermatologists. Conclusions: The study provided evidence for the usability and effectiveness of the eSkinHealth app embedded into our surveillance approach to improve the detection and management of skin NTDs and other skin diseases in Côte d?Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin diseases in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/NCT05300399 UR - https://derma.jmir.org/2023/1/e46295 UR - http://dx.doi.org/10.2196/46295 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632977 ID - info:doi/10.2196/46295 ER - TY - JOUR AU - Tensen, Esmée AU - Kuziemsky, Craig AU - Jaspers, W. Monique AU - Peute, W. Linda PY - 2023/6/13 TI - General Practitioners? Perspectives About Remote Dermatology Care During the COVID-19 Pandemic in the Netherlands: Questionnaire-Based Study JO - JMIR Dermatol SP - e46682 VL - 6 KW - teledermatology KW - teledermoscopy KW - dermatology KW - dermoscopy KW - telemedicine KW - telehealth KW - remote care KW - general practitioner KW - GP KW - general practice KW - family physician KW - COVID-19 KW - questionnaire KW - perspective KW - mobile phone N2 - Background: The COVID-19 pandemic affected the delivery of primary care and stimulated the use of digital health solutions such as remote digital dermatology care. In the Netherlands, remote store-and-forward dermatology care was already integrated into Dutch general practice before the COVID-19 pandemic. However, it is unclear how general practitioners (GPs) experienced this existing digital dermatology care during the pandemic period. Objective: We investigated GPs? perspectives about facilitators and barriers related to store-and-forward digital dermatology care during the COVID-19 pandemic in the Netherlands, using a sociotechnical approach. Methods: In December 2021, a web-based questionnaire was distributed via email to approximately 3257 GPs who could perform a digital dermatology consultation and who had started a digital consultation (not necessarily dermatology) in the previous 2 years. The questionnaire consisted of general background questions, questions from a previously validated telemedicine service user satisfaction questionnaire, and newly added questions related to the pandemic and use of the digital dermatology service in general practice. The open-ended and free-text responses were analyzed for facilitators and barriers using content analysis, guided by an 8-dimensional sociotechnical model. Results: In total, 71 GPs completed the entire questionnaire, and 66 (93%) questionnaires were included in the data analysis. During the questionnaire distribution period, another national lockdown, social distancing, and stay-at-home mandates were announced; thus, GPs may have had increased workload and limited time to complete the questionnaire. Of the 66 responding GPs, 36 (55%) were female, 25 (38%) were aged 35-44 years, 33 (50%) were weekly platform users, 34 (52%) were working with the telemedicine organization for >5 years, 42 (64%) reported that they used the store-and-forward platform as often during as before the pandemic, 61 (92%) would use the platform again, 53 (80%) would recommend the platform to a colleague, and 10 (15%) used digital dermatology home consultation. Although GPs were generally satisfied with the digital dermatology service, platform, and telemedicine organization, they also experienced crucial barriers to the use of the service during the pandemic. These barriers were GPs? and patients? limited digital photography skills, costs and the lack of appropriate equipment, human-computer interface and interoperability issues on the telemedicine platform, and different use procedures of the digital dermatology service. Conclusions: Although remote dermatology care was already integrated into Dutch GP practice before the pandemic, which may have facilitated the positive responses of GPs about the use of the service, barriers impeded the full potential of its use during the pandemic. Training is needed to improve the use of equipment and quality of (dermoscopy) images taken by GPs and to inform GPs in which circumstances they can or cannot use digital dermatology. Furthermore, the dermatology platform should be improved to also guide patients in taking photographs with sufficient quality. UR - https://derma.jmir.org/2023/1/e46682 UR - http://dx.doi.org/10.2196/46682 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632975 ID - info:doi/10.2196/46682 ER - TY - JOUR AU - Andrews, Brooke AU - Klein, Britt AU - Van Nguyen, Huy AU - Corboy, Denise AU - McLaren, Suzanne AU - Watson, Shaun PY - 2023/6/12 TI - Efficacy of a Digital Mental Health Biopsychosocial Transdiagnostic Intervention With or Without Therapist Assistance for Adults With Anxiety and Depression: Adaptive Randomized Controlled Trial JO - J Med Internet Res SP - e45135 VL - 25 KW - video chat therapy KW - therapist assistance KW - self-help KW - transdiagnostic KW - digital intervention KW - anxiety KW - depression KW - comorbidity N2 - Background: Digital mental health (DMH) interventions incorporating elements that adapt to the evolving needs of consumers have the potential to further our understanding of the optimal intensity of therapist assistance and inform stepped-care models. Objective: The primary objective was to compare the efficacy of a transdiagnostic biopsychosocial DMH program, with or without therapist assistance for adults with subthreshold symptoms or a diagnosis of anxiety or depression. Methods: In a randomized adaptive clinical trial design, all participants had access to the DMH program, with eligibility to have their program augmented with therapist assistance determined by program engagement or symptom severity. Participants who met stepped-care criteria were randomized to have their treatment program augmented with either low-intensity (10 min/week of video chat support for 7 weeks) or high-intensity (50 min/week of video chat support for 7 weeks) therapist assistance. A total of 103 participants (mean age 34.17, SD 10.50 years) were assessed before (week 0), during (weeks 3 and 6), and after the intervention (week 9) and at the 3-month follow-up (week 21). The effects of 3 treatment conditions (DMH program only, DMH program+low-intensity therapist assistance, and DMH program+high-intensity therapist assistance) on changes in the 2 primary outcomes of anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were assessed using the Cohen d, reliable change index, and mixed-effects linear regression analyses. Results: There were no substantial differences in the outcome measures among intervention conditions. However, there were significant time effect changes in most outcomes over time. All 3 intervention conditions demonstrated strong and significant treatment effect changes in GAD-7 and PHQ-9 scores, with absolute Cohen d values ranging from 0.82 to 1.79 (all P<.05). The mixed-effects models revealed that, in the Life Flex program?only condition at week 3, mean GAD-7 and PHQ-9 scores significantly decreased from baseline by 3.54 and 4.38 (all P<.001), respectively. At weeks 6, 9, and 21, GAD-7 and PHQ-9 scores significantly decreased from baseline by at least 6 and 7 points (all P<.001), respectively. Nonresponders at week 3 who were stepped up to therapist assistance increased program engagement and treatment response. At the postintervention time point and 3-month follow-up, 67% (44/65) and 69% (34/49) of the participants, respectively, no longer met diagnostic criteria for anxiety or depression. Conclusions: The findings highlight that early detection of low engagement and non?treatment response presents an opportunity to effectively intervene by incorporating an adaptive design. Although the study findings indicate that therapist assistance was no more effective than the DMH intervention program alone for reducing symptoms of anxiety or depression, the data highlight the potential influence of participant selection bias and participant preferences within stepped-care treatment models. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000422921; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378317&isReview=true International Registered Report Identifier (IRRID): RR2-10.2196/45040 UR - https://www.jmir.org/2023/1/e45135 UR - http://dx.doi.org/10.2196/45135 UR - http://www.ncbi.nlm.nih.gov/pubmed/37307046 ID - info:doi/10.2196/45135 ER - TY - JOUR AU - Kloka, Andreas Jan AU - Holtmann, C. Sophie AU - Nürenberg-Goloub, Elina AU - Piekarski, Florian AU - Zacharowski, Kai AU - Friedrichson, Benjamin PY - 2023/6/12 TI - Expectations of Anesthesiology and Intensive Care Professionals Toward Artificial Intelligence: Observational Study JO - JMIR Form Res SP - e43896 VL - 7 KW - anesthesiology KW - artificial intelligence KW - health care KW - intensive care KW - medical informatics KW - technology acceptance KW - Europe-wide survey N2 - Background: Artificial intelligence (AI) applications offer numerous opportunities to improve health care. To be used in the intensive care unit, AI must meet the needs of staff, and potential barriers must be addressed through joint action by all stakeholders. It is thus critical to assess the needs and concerns of anesthesiologists and intensive care physicians related to AI in health care throughout Europe. Objective: This Europe-wide, cross-sectional observational study investigates how potential users of AI systems in anesthesiology and intensive care assess the opportunities and risks of the new technology. The web-based questionnaire was based on the established analytic model of acceptance of innovations by Rogers to record 5 stages of innovation acceptance. Methods: The questionnaire was sent twice in 2 months (March 11, 2021, and November 5, 2021) through the European Society of Anaesthesiology and Intensive Care (ESAIC) member email distribution list. A total of 9294 ESAIC members were reached, of whom 728 filled out the questionnaire (response rate 728/9294, 8%). Due to missing data, 27 questionnaires were excluded. The analyses were conducted with 701 participants. Results: A total of 701 questionnaires (female: n=299, 42%) were analyzed. Overall, 265 (37.8%) of the participants have been in contact with AI and evaluated the benefits of this technology higher (mean 3.22, SD 0.39) than participants who stated no previous contact (mean 3.01, SD 0.48). Physicians see the most benefits of AI application in early warning systems (335/701, 48% strongly agreed, and 358/701, 51% agreed). Major potential disadvantages were technical problems (236/701, 34% strongly agreed, and 410/701, 58% agreed) and handling difficulties (126/701, 18% strongly agreed, and 462/701, 66% agreed), both of which could be addressed by Europe-wide digitalization and education. In addition, the lack of a secure legal basis for the research and use of medical AI in the European Union leads doctors to expect problems with legal liability (186/701, 27% strongly agreed, and 374/701, 53% agreed) and data protection (148/701, 21% strongly agreed, and 343/701, 49% agreed). Conclusions: Anesthesiologists and intensive care personnel are open to AI applications in their professional field and expect numerous benefits for staff and patients. Regional differences in the digitalization of the private sector are not reflected in the acceptance of AI among health care professionals. Physicians anticipate technical difficulties and lack a stable legal basis for the use of AI. Training for medical staff could increase the benefits of AI in professional medicine. Therefore, we suggest that the development and implementation of AI in health care require a solid technical, legal, and ethical basis, as well as adequate education and training of users. UR - https://formative.jmir.org/2023/1/e43896 UR - http://dx.doi.org/10.2196/43896 UR - http://www.ncbi.nlm.nih.gov/pubmed/37307038 ID - info:doi/10.2196/43896 ER - TY - JOUR AU - Garcia-Davis, Sandra AU - Palacio, Ana AU - Bast, Elizabeth AU - Penney, S. Lauren AU - Finley, Erin AU - Kinosian, Bruce AU - Intrator, Orna AU - Dang, Stuti PY - 2023/6/12 TI - Peer-to?Patient-Aligned Care Team (Peer-to-PACT; P2P), a Peer-Led Home Visit Intervention Program for Targeting and Improving Long-term Care Services and Support for Veterans With High Needs and High Risk: Protocol for a Mixed Methods Feasibility Study JO - JMIR Res Protoc SP - e46156 VL - 12 KW - older veterans with high needs and high risk KW - peer support specialists KW - unmet needs KW - home visit KW - patient engagement KW - home services KW - care coordination N2 - Background: Keeping older veterans with high needs and high risk (HNHR) who are at risk of long-term institutional care safely in their homes for as long as possible is a Department of Veterans Affairs priority. Older veterans with HNHR face disproportionate barriers and disparities to engaging in their care, including accessing care and services. Veterans with HNHR often have poor ability to maintain health owing to complicated unmet health and social needs. The use of peer support specialists (peers) is a promising approach to improving patient engagement and addressing unmet needs. The Peer-to?Patient-Aligned Care Team (Peer-to-PACT; P2P) intervention is a multicomponential home visit intervention designed to support older veterans with HNHR to age in place. Participants receive a peer-led home visit to identify unmet needs and home safety risks aligned with the age-friendly health system model; care coordination, health care system navigation, and linking to needed services and resources in collaboration with their PACT; and patient empowerment and coaching using Department of Veterans Affairs whole health principles. Objective: The primary aim of this study is to evaluate the preliminary effect of the P2P intervention on patient health care engagement. The second aim is to identify the number and types of needs and unmet needs as well as needs addressed using the P2P needs identification tool. The third aim is to evaluate the feasibility and acceptability of the P2P intervention delivered over 6 months. Methods: We will use a quantitative-qualitative convergent mixed methods approach to evaluate the P2P intervention outcomes. For our primary outcome, we will conduct an independent, 2-tailed, 2-sample t test to compare the means of the 6-month pre-post differences in the number of outpatient PACT encounters between the intervention and matched comparison groups. Qualitative data analysis will follow a structured rapid approach using deductive coding as well as the Consolidated Framework for Implementation Research. Results: Study enrollment began in July 2020 and was completed in March 2022. Our sample size consists of 114 veterans: 38 (33.3%) P2P intervention participants and 76 (66.7%) matched comparison group participants. Study findings are expected to be published in late 2023. Conclusions: Peers may help bridge the gap between PACT providers and veterans with HNHR by evaluating veterans? needs outside of the clinic, summarizing identified unmet needs, and developing team-based solutions in partnership with the PACT. The home visit component of the intervention provides eyes in the home and may be a promising and innovative tool to improve patient engagement. International Registered Report Identifier (IRRID): DERR1-10.2196/46156 UR - https://www.researchprotocols.org/2023/1/e46156 UR - http://dx.doi.org/10.2196/46156 UR - http://www.ncbi.nlm.nih.gov/pubmed/37307055 ID - info:doi/10.2196/46156 ER - TY - JOUR AU - Kuschke, Silva AU - Moodie, Sheila AU - Kirubalingam, Keshinisuthan AU - O'Hagan, Robin AU - Glista, Danielle PY - 2023/6/6 TI - Parents? Perceptions of the Factors Influencing the Uptake of Remote Pediatric Hearing Aid Support: Development of a Conceptual Framework JO - JMIR Pediatr Parent SP - e47358 VL - 6 KW - audiology KW - care KW - child engagement KW - children KW - concept mapping KW - cost KW - hearing aid KW - hearing loss KW - hearing KW - integration KW - parents KW - pediatric audiology KW - pediatric KW - remote hearing aid support KW - support KW - virtual care N2 - Background: To achieve effective integration of virtual care into family-centered audiology practices, participatory research methods, including parents as vital participants in the delivery of pediatric audiology care, should be considered. A better understanding of the barriers and facilitators influencing the adoption of virtual care for families is warranted. Objective: This study aimed to develop a conceptual framework of the factors perceived to influence the adoption of remote pediatric hearing aid support among the parents of children with hearing loss. Methods: A total of 12 parents of children who wear hearing aids, between the ages of 0-17 years, were recruited to participate in group or individual interviews as part of the 6-step participatory-based concept mapping (CM) process. Data collection was specific to parents in a Canadian context. Analyses included multidimensional scaling and hierarchical cluster analysis. Results: The CM process resulted in 6 main themes, displayed in a cluster map according to their order of importance. These themes include access to timely, consistent care; technology considerations; convenience; child engagement; cost; and partnership considerations. Key underlying statements and subthemes are highlighted per theme. Conclusions: Findings from this study demonstrate the use of CM in participatory research with parents and as part of a family-centered care model. Future research should aim to investigate the factors that influence the uptake of remote hearing aid support in different contexts, for example, in low- to middle-income countries versus those in high-income countries. UR - https://pediatrics.jmir.org/2023/1/e47358 UR - http://dx.doi.org/10.2196/47358 UR - http://www.ncbi.nlm.nih.gov/pubmed/37279061 ID - info:doi/10.2196/47358 ER - TY - JOUR AU - Karasz, Alison AU - Merchant, Krupa AU - Arnsten, Julia AU - Feinberg, Judith AU - Kim, Y. Arthur AU - Lum, J. Paula AU - McKee, Diane Melissa AU - Mehta, H. Shruti AU - Meissner, Paul AU - Norton, L. Brianna AU - Page, Kimberly AU - Pericot-Valverde, Irene AU - Singh, Reena AU - Stein, Ellen AU - Taylor, E. Lynn AU - Tsui, I. Judith AU - Wagner, Katherine AU - Litwin, Alain PY - 2023/6/2 TI - A Video-Observed Treatment Strategy to Improve Adherence to Treatment Among Persons Who Inject Drugs Infected With Hepatitis C Virus: Qualitative Study of Stakeholder Perceptions and Experiences JO - J Med Internet Res SP - e38176 VL - 25 KW - mHealth KW - video-observed therapy KW - directly observed treatment KW - hepatitis C virus KW - persons who inject drugs KW - antiviral KW - adherence KW - HCV KW - opioid treatment KW - mobile health KW - adherence behavior KW - behavior intervention KW - telemedicine KW - digital health KW - perception KW - therapy KW - treatment N2 - Background: Direct-acting antiviral medications have the potential to eliminate the hepatitis C virus (HCV) epidemic among people who inject drugs; yet, suboptimal adherence remains a barrier. Directly observed treatment (DOT), an effective strategy for optimizing adherence, has been frequently implemented in opioid treatment programs but less commonly in community health settings due to the heavy burden of daily visits. An alternative is video-observed therapy (VOT), which uses mobile health technology to monitor adherence. VOT has not been widely studied among people who inject drugs with HCV. Objective: This qualitative study, part of a larger implementation evaluation, investigates stakeholder perceptions and experiences with VOT in Project HERO (Hepatitis C Real Outcomes), a multisite pragmatic trial testing treatment delivery models for people who inject drugs with HCV. Our goal was to understand the potential barriers and facilitators to the implementation of the VOT technology. Methods: Qualitative interviews were conducted with 27 Project HERO study staff and 7 patients. Interviews focused on perceptions and experiences with the VOT app and barriers and facilitators to implementation. Team meeting minutes over the first 2 years of the project were transcribed. A coding system was developed and applied to the data. We summarized thematic data and compared participant perceptions to generate a close understanding of the data. Results: Frequent barriers to VOT included mechanical failure, stolen or lost phones, and a steep learning curve for participants and study staff. In sites with older and less technically skilled participants, staff found it difficult to implement the VOT app. Research staff found that the routine monitoring of app use led to closer engagement with participants. This was both a benefit and a potential threat to the validity of this pragmatic trial. Patient participants reported mixed experiences. Conclusions: VOT may be a useful alternative to DOT for some patients, but it may not be feasible for all. Significant staff involvement may be required. UR - https://www.jmir.org/2023/1/e38176 UR - http://dx.doi.org/10.2196/38176 UR - http://www.ncbi.nlm.nih.gov/pubmed/37266986 ID - info:doi/10.2196/38176 ER - TY - JOUR AU - Naghdi, Rozhin AU - Nguyen, Gianhu AU - Vazquez, Maria Cecile AU - Antonio, Mark Christian AU - Cabrera, Carlos AU - Chandra, Austin AU - Chok, Jay PY - 2023/6/2 TI - Assessing Health Care Professionals' Mindset in Adopting Telemedicine Post COVID-19: Pilot Questionnaire Study JO - JMIR Form Res SP - e44806 VL - 7 KW - digital health KW - patient perspective KW - creative destruction of medicine KW - pilot study KW - patient-centered health KW - willingness KW - delivery model KW - questionnaire KW - telehealth KW - accessibility KW - implementation N2 - Background: Amidst the COVID-19 pandemic, the traditional health care model has evolved toward a more patient-centric model. In relation to this trend, digital health services have seen an acceleration, which may have significant implications for the health care model. Due to the impact of COVID-19 on health care facilities, it is important to explore health professionals? willingness to adopt a patient-centric digital health delivery model for medicine and health care. Objective: The aim of this study was to pilot a survey that assesses the impact and implementation of telehealth in view of health care providers prior to and post COVID-19. Methods: A total of 26 volunteer health care professionals participated in the pilot study, of which 19/26 (73%) completed the general demographics portion. Among these respondents, 9/26 (35%) completed the entirety of the survey. The questionnaire included questions relating to general demographics, accessibility and benefits, usability, and engagements with telemedicine. Participants were randomly assigned to 1 of the 4 questionnaire designs (A-D) based on their expertise in telehealth. Of the 9 total participants who completed their randomly assigned questionnaire, 1 (11%) was randomly assigned to A, 3 (33%) were randomly assigned to B, 2 (22%) were randomly assigned to C, and 3 (33%) were randomly assigned to D. Results: Responses and data from the study questionnaire were collected from Qualtrics. Microsoft Excel was used for data organization. Due to limited responses and data, no advanced statistical software was implemented. From the 9 participants who completed the entirety of the survey, responses from those with telehealth experience (n=4) showed that telehealth was preferred for follow-ups, lab results, and consultations, and that with telehealth, there was greater flexibility with appointment times and a decrease in the number of patients seen. Among the 4 health care providers with telehealth experience, all of them believed it improved accessibility and reduced physical barriers; health care professionals believed telehealth reduced translational barriers with patients. Among health care professionals without telehealth experience (n=5), 60% (3/5) reported a decrease in appointments for in-office visits post COVID-19 and strongly agreed or agreed that telehealth could influence the quality of care for patients. All 5 participants also reported no general concerns about telehealth prior to the pandemic and agreed that it would provide accessibility for patients. Conclusions: Preliminary findings of our pilot study showed initial support of a dynamical shift within the health care model due to the rise in the use of telehealth services between health care providers and patients but no statistically significant results. Further research and investigation with a larger sample size is warranted to better understand the mindset of health care professionals in adopting telemedicine post COVID-19. UR - https://formative.jmir.org/2023/1/e44806 UR - http://dx.doi.org/10.2196/44806 UR - http://www.ncbi.nlm.nih.gov/pubmed/37266997 ID - info:doi/10.2196/44806 ER - TY - JOUR AU - Ek, Charlott AU - Liljegren, Per-Daniel AU - Edin-Liljegren, Anette PY - 2023/6/1 TI - Patients With Cardiovascular Disease Revisiting Specialist Physicians via Remote Treatment: Interview Study of Experiences JO - JMIR Hum Factors SP - e43125 VL - 10 KW - remote treatment KW - sparsely populated region KW - telemedicine KW - content analysis KW - experiences KW - person-centered care KW - rural KW - eHealth KW - mobile phone N2 - Background: Access to health care for an aging population with growing needs presents major challenges in northern Sweden?s sparsely populated regions. Few people, the lack of professionals, and long distances make it difficult to provide health care on equitable terms according to the Swedish legislation. Remote treatment (RT) using information and communication technology has been suggested to overcome these difficulties, and person-centered care (PCC) is a desired philosophy to improve the quality of health care. However, there is scarce knowledge about how patients experience RT meetings. Objective: This study aimed to describe the experiences of patients with cardiovascular disease revisiting specialist physicians via RT guided by a PCC perspective in northern Sweden?s sparsely populated regions. Methods: A qualitative study was conducted based on interviews with 8 patients with cardiovascular disease revisiting their physician through RT, from a digital health room to a health care center or from a health care center to a hospital. The interviews were recorded, transcribed verbatim, and analyzed using inductive content analysis. The results are discussed from a PCC perspective. Results: The analysis resulted in 6 categories: good accessibility, safety with good relationships, proximity and distance with technology, habit and quality of the technology facilitating the meeting, cherishing personal integrity, and participation in own care. These categories were interpreted as the theme, participation and relationships are important for good and close care via RT. Conclusions: The study shows that participation and relationships are important for good and close care via RT. To improve the quality of an RT meeting, PCC can be applied but needs to be extended to the digital domain?electronic PCC, especially the communication component, as it is the most salient difference from a face-to-face meeting. Important factors that should be considered before, during, and after the RT meeting have been identified. UR - https://humanfactors.jmir.org/2023/1/e43125 UR - http://dx.doi.org/10.2196/43125 UR - http://www.ncbi.nlm.nih.gov/pubmed/37261892 ID - info:doi/10.2196/43125 ER - TY - JOUR AU - Desveaux, Laura AU - Wu, Kelly AU - Rouleau, Geneviève AU - Srinivasan, Diya AU - Azavedo, Rhea AU - Dang Nguyen, Marlena AU - Martin, Danielle AU - Steele Gray, Carolyn PY - 2023/5/31 TI - Building Compassionate Experience Through Compassionate Action: Qualitative Behavioral Analysis JO - JMIR Form Res SP - e43981 VL - 7 KW - technology-based care KW - compassion KW - primary care KW - behavior change KW - communication competency KW - continuing professional development KW - qualitative N2 - Background: The acceleration of technology-based primary care during the COVID-19 pandemic outpaced the ability to understand whether and how it impacts care delivery and outcomes. As technology-based care continues to evolve, focusing on the core construct of compassion in a primary care context will help ensure high-quality patient care and increased patient autonomy and satisfaction. The ability to successfully operationalize the use of technology in patient-clinician interactions hinges on understanding not only how compassionate care is experienced in this context but also how clinicians can create it. Objective: The objectives of this study were to understand whether and how compassionate behaviors are experienced in technology-based primary care interactions and identify the individual and contextual drivers that influence whether and how these behaviors occur. Methods: We conducted a series of qualitative one-on-one interviews with primary care physicians, nurses, and patients. Qualitative data were initially analyzed using an inductive thematic analysis approach to identify preliminary themes for each participant group independently. We then looked across participant groups to identify areas of alignment and distinction. Descriptions of key behaviors that participants identified as elements of a compassionate interaction and descriptions of key drivers of these behaviors were inductively coded and defined at this stage. Results: A total of 74 interviews were conducted with 40 patients, 20 nurses, and 14 primary care physicians. Key behaviors that amplified the experience of compassion included asking the patient?s modality preference, using video to establish technology-based presence, sharing the screen, and practicing effective communication. Participants? knowledge or skills as well as their beliefs and emotions influenced whether or not these behaviors occurred. Contextual elements beyond participants? control influenced technology-based interactions, including resource access, funding structures, culture, regulatory standards, work structure, societal influence, and patient characteristics and needs. A high-yield, evidence-based approach to address the identified drivers of compassion-focused clinician behavior includes a combination of education, training, and enablement. Conclusions: Much of the patient experience is influenced by clinician behavior; however, clinicians need a supportive system and adequate supports to evolve new ways of working to create the experience of compassionate care. The current state of technology-based care operationalization has led to widespread burnout, societal pressure, and shifting expectations of both clinicians and the health system more broadly, threatening the ability to deliver compassionate care. For clinicians to exhibit compassionate behaviors, they need more than just adequate supports; they also need to receive compassion from and experience the humanity of their patients. UR - https://formative.jmir.org/2023/1/e43981 UR - http://dx.doi.org/10.2196/43981 UR - http://www.ncbi.nlm.nih.gov/pubmed/37256678 ID - info:doi/10.2196/43981 ER - TY - JOUR AU - Leddy, Anna AU - Ggita, Joseph AU - Berger, A. Christopher AU - Kityamuwesi, Alex AU - Sanyu, Nakate Agnes AU - Tinka, Kunihira Lynn AU - Crowder, Rebecca AU - Turyahabwe, Stavia AU - Katamba, Achilles AU - Cattamanchi, Adithya PY - 2023/5/30 TI - Barriers and Facilitators to Implementing a Digital Adherence Technology for Tuberculosis Treatment Supervision in Uganda: Qualitative Study JO - J Med Internet Res SP - e38828 VL - 25 KW - digital adherence technology KW - gender norms KW - tuberculosis KW - adherence KW - sub-Saharan Africa N2 - Background: Ensuring the completion of treatment for tuberculosis (TB) remains a key challenge in many high-burden countries. 99DOTS is a low-cost digital adherence technology that has emerged as a promising tool for monitoring and supporting TB treatment completion. Objective: We aimed to understand the feasibility and acceptability of 99DOTS, a mobile phone?based TB treatment support method, and characterize barriers and facilitators to its implementation during a pragmatic trial in Uganda. Methods: Between April 1 and August 31, 2021, we conducted in-depth interviews with people with TB and key informant interviews with health workers and district and regional TB officers involved in the implementation of 99DOTS at 18 health facilities in Uganda. Semistructured interview guides were informed by the capability, opportunity, motivation, and behavior (COM-B) model and explored perceptions of, and experiences with, 99DOTS, including barriers and facilitators to its use. Qualitative analysis was conducted using the framework approach. Results: Interviews were conducted with 30 people with TB, 12 health workers, and 7 TB officers. All people with TB, health workers, and TB officers noted that 99DOTS supported and encouraged people with TB to take their anti-TB medication, facilitated treatment monitoring, and improved relationships between people with TB and health workers. Participants also liked that the platform was free, easy to use, and improved TB treatment outcomes. Barriers to 99DOTS implementation for some people with TB were related to limited literacy, including technology literacy; limited access to electricity to charge their mobile phone to make dosing confirmation calls; and poor network connection. Gender differences in 99DOTS uptake also emerged. Specifically, women with TB were described to be more concerned that 99DOTS use would expose them to TB stigma and to be more likely to have mobile phone?access issues than men with TB. By contrast, men with TB not only had access to mobile phones but also received substantial support from their female partners to take their anti-TB medication and make 99DOTS dosing confirmation calls. Finally, although women with TB were described to face more barriers to 99DOTS use than men with TB, the women?s narratives centered on the ways the platform facilitated and improved their adherence, whereas the men?s narratives did not. Conclusions: Overall, 99DOTS seems to be a feasible and acceptable strategy to support anti-TB medication adherence in Uganda. However, access to mobile phones, inability to charge mobile phones, and concerns about stigma should be considered and addressed as part of programmatic implementation to maximize uptake among all people with TB, particularly women and those with fewer financial resources. UR - https://www.jmir.org/2023/1/e38828 UR - http://dx.doi.org/10.2196/38828 UR - http://www.ncbi.nlm.nih.gov/pubmed/37252774 ID - info:doi/10.2196/38828 ER - TY - JOUR AU - Ahmad, Awais AU - Premanandan, Shweta AU - Langegård, Ulrica AU - Cajander, Åsa AU - Johansson, Birgitta AU - Carlsson, Maria AU - Tiblom Ehrsson, Ylva PY - 2023/5/30 TI - Positive Design Framework for Carer eSupport: Qualitative Study to Support Informal Caregivers of Patients With Head and Neck Cancer in Sweden JO - JMIR Cancer SP - e45748 VL - 9 KW - eHealth KW - subjective well-being KW - positive design KW - adaptability KW - informal caregivers KW - head and neck cancer KW - preparedness to care N2 - Background: Informal caregivers of patients with head and neck cancer (HNC), such as the patient?s spouse, other close relatives, or friends, can play an important role in home-based treatment and health care. Research shows that informal caregivers are usually unprepared for this responsibility and need support with taking care of patients and other daily life activities. These circumstances place them in a vulnerable position, and their well-being may be compromised. This study is part of our ongoing project Carer eSupport, which aims to develop a web-based intervention to facilitate informal caregivers in the home environment. Objective: This study aimed to explore the situation and context of informal caregivers of patients with HNC and their needs for designing and developing a web-based intervention (Carer eSupport). In addition, we proposed a novel framework for the development of a web-based intervention aimed at promoting the well-being of informal caregivers. Methods: Focus groups were conducted with 15 informal caregivers and 13 health care professionals. Both informal caregivers and health care professionals were recruited from 3 university hospitals in Sweden. We adopted a thematic data analysis process to analyze the data. Results: We investigated informal caregivers? needs, critical factors for adoption, and desired functionalities of Carer eSupport. A total of 4 major themes, including information, web-based forum, virtual meeting place, and chatbot, emerged and were discussed by informal caregivers and health care professionals for Carer eSupport. However, most study participants did not like the idea of a chatbot for asking questions and retrieving information and expressed their concerns such as a lack of trust in robotic technologies and missing human contact while communicating with chatbots. The results from the focus groups were discussed through the lens of positive design research approaches. Conclusions: This study provided an in-depth understanding of informal caregivers? contexts and their preferred functions for a web-based intervention (Carer eSupport). Using the theoretical foundation of designing for well-being and positive design in the informal caregiving context, we proposed a positive design framework to support informal caregivers? well-being. Our proposed framework might be helpful for human-computer interaction and user experience researchers to design meaningful eHealth interventions with a clear focus on users? well-being and positive emotions, especially for informal caregivers of patients with HNC. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-057442 UR - https://cancer.jmir.org/2023/1/e45748 UR - http://dx.doi.org/10.2196/45748 UR - http://www.ncbi.nlm.nih.gov/pubmed/37252765 ID - info:doi/10.2196/45748 ER - TY - JOUR AU - Castro, R. Aimee AU - Ould Brahim, Lydia AU - Chen, Qirong AU - Arnaert, Antonia AU - Quesnel-Vallée, Amélie AU - Moffatt, Karyn AU - Kildea, John AU - Bitzas, Vasiliki AU - Pang, Carolyn AU - Hall, Audrey-Jane AU - Pagnotta, Ariana AU - Tsimicalis, Argerie PY - 2023/5/30 TI - Information and Communication Technologies to Support the Provision of Respite Care Services: Scoping Review JO - JMIR Nursing SP - e44750 VL - 6 KW - caregivers KW - eHealth KW - health services accessibility KW - home care services KW - mHealth KW - respite care KW - short break care N2 - Background: Respite care is one of the most frequently requested support services by family caregivers. Yet, too often, respite care services are inaccessible, due in part to families? lack of knowledge regarding available services and a lack of service flexibility. Information and communication technologies (ICTs) may help to improve the flexibility of services available and families? knowledge of such services. However, an understanding of the use of ICTs and research in this area is lacking. Objective: The objective of this study was to provide a comprehensive overview of the academic literature on ICTs for supporting the provision of respite care services. Methods: A scoping review study was conducted. Six library databases were systematically searched for relevant literature. Key data were extracted into a summary chart. Text and quantitative data were coded using descriptive qualitative content analysis techniques, and the results were collated and summarized into a comprehensive narrative. Results: A total of 23 papers describing 15 unique ICT programs exploring the potential of ICTs to support respite care services met the inclusion criteria. ICTs supported the provision of respite care by facilitating information-sharing with families and providers, recruiting and training respite care providers, and coordinating services. Key design considerations for developing respite care ICTs were trustworthiness and participatory design methods. Implementation considerations included designing for complementarity with existing services, assessing the appropriate timing for introducing the ICT-based services, and ensuring adequate promotion strategies to raise awareness about the services. Conclusions: There is limited but promising research on the potential of ICTs to support the provision of respite care services. Further research should be conducted to advance the results of this review, ultimately aiming to build ICTs that can improve the quality of, and access to, respite care services. UR - https://nursing.jmir.org/2023/1/e44750 UR - http://dx.doi.org/10.2196/44750 UR - http://www.ncbi.nlm.nih.gov/pubmed/37252760 ID - info:doi/10.2196/44750 ER - TY - JOUR AU - Officer, N. Tara AU - Tait, Marika AU - McBride-Henry, Karen AU - Burnet, Laura AU - Werkmeister, J. Benjamin PY - 2023/5/26 TI - Mental Health Client Experiences of Telehealth in Aotearoa New Zealand During the COVID-19 Pandemic: Lessons and Implications JO - JMIR Form Res SP - e47008 VL - 7 KW - telehealth KW - mental health service delivery KW - COVID-19 KW - Aotearoa New Zealand KW - clients KW - patient-centered care KW - telemedicine KW - mental health KW - experience KW - satisfaction KW - perception KW - perspective KW - attitude N2 - Background: The COVID-19 pandemic and consequent lockdowns disrupted mental health service delivery worldwide, accelerating the adoption of telehealth services to provide care continuity. Telehealth-based research largely highlights the value of this service delivery method for a range of mental health conditions. However, only limited research exists exploring client perspectives of mental health services delivered via telehealth during the pandemic. Objective: This study aimed to increase understanding of the perspectives of mental health clients around services provided via telehealth over the 2020 COVID-19 lockdown in Aotearoa New Zealand. Methods: Interpretive description methodology underpinned this qualitative inquiry. Semistructured interviews were conducted with 21 individuals (15 clients and 7 support people; 1 person was both a client and support person) to explore their experiences of outpatient mental health care delivered via telehealth during the COVID-19 pandemic in Aotearoa New Zealand. A thematic analysis approach supported by field notes was used to analyze interview transcripts. Results: The findings reveal that mental health services delivered via telehealth differed from those provided in person and led some participants to feel they need to manage their own care more actively. Participants highlighted several factors affecting their telehealth journey. These included the importance of maintaining and building relationships with clinicians, the creation of safe spaces within client and clinician home environments, and clinician readiness in facilitating care for clients and their support people. Participants noted weaknesses in the ability of clients and clinicians to discern nonverbal cues during telehealth conversations. Participants also emphasized that telehealth was a viable option for service delivery but that the reason for telehealth consultations and the technicalities of service delivery needed to be addressed. Conclusions: Successful implementation requires ensuring solid relationship foundations between clients and clinicians. To safeguard minimum standards in delivering telehealth-based care, health professionals must ensure that the intent behind telehealth appointments is clearly articulated and documented for each person. In turn, health systems must ensure that health professionals have access to training and professional guidance to deliver effective telehealth consultations. Future research should aim to identify how therapeutic engagement with mental health services has changed, following a return to usual service delivery processes. UR - https://formative.jmir.org/2023/1/e47008 UR - http://dx.doi.org/10.2196/47008 UR - http://www.ncbi.nlm.nih.gov/pubmed/37234041 ID - info:doi/10.2196/47008 ER - TY - JOUR AU - May, P. Heather AU - Griffin, M. Joan AU - Herges, R. Joseph AU - Kashani, B. Kianoush AU - Kattah, G. Andrea AU - Mara, C. Kristin AU - McCoy, G. Rozalina AU - Rule, D. Andrew AU - Tinaglia, G. Angeliki AU - Barreto, F. Erin PY - 2023/5/22 TI - Comprehensive Acute Kidney Injury Survivor Care: Protocol for the Randomized Acute Kidney Injury in Care Transitions Pilot Trial JO - JMIR Res Protoc SP - e48109 VL - 12 KW - acute kidney injury KW - acute renal failure KW - care transitions KW - chronic kidney disease KW - nephrologists KW - randomized controlled trials N2 - Background: Innovative care models are needed to address gaps in kidney care follow-up among acute kidney injury (AKI) survivors. We developed the multidisciplinary AKI in Care Transitions (ACT) program, which embeds post-AKI care in patients? primary care clinic. Objective: The objective of this randomized pilot trial is to test the feasibility and acceptability of the ACT program and study protocol, including recruitment and retention, procedures, and outcome measures. Methods: The study will be conducted at Mayo Clinic in Rochester, Minnesota, a tertiary care center with a local primary care practice. Individuals who are included have stage 3 AKI during their hospitalization, do not require dialysis at discharge, have a local primary care provider, and are discharged to their home. Patients unable or unwilling to provide informed consent and recipients of any transplant within 100 days of enrollment are excluded. Consented patients are randomized to receive the intervention (ie, ACT program) or usual care. The ACT program intervention includes predischarge kidney health education from nurses and coordinated postdischarge laboratory monitoring (serum creatinine and urine protein assessment) and follow-up with a primary care provider and pharmacist within 14 days. The usual care group receives no specific study-related intervention, and any aspects of AKI care are at the direction of the treating team. This study will examine the feasibility of the ACT program, including recruitment, randomization and retention in a trial setting, and intervention fidelity. The feasibility and acceptability of participating in the ACT program will also be examined in qualitative interviews with patients and staff and through surveys. Qualitative interviews will be deductively and inductively coded and themes compared across data types. Observations of clinical encounters will be examined for discussion and care plans related to kidney health. Descriptive analyses will summarize quantitative measures of the feasibility and acceptability of ACT. Participants? knowledge about kidney health, quality of life, and process outcomes (eg, type and timing of laboratory assessments) will be described for both groups. Clinical outcomes (eg, unplanned rehospitalization) up to 12 months will be compared with Cox proportional hazards models. Results: This study received funding from the Agency for Health Care Research and Quality on April 21, 2021, and was approved by the Institutional Review Board on December 14, 2021. As of March 14, 2023, seventeen participants each have been enrolled in the intervention and usual care groups. Conclusions: Feasible and generalizable AKI survivor care delivery models are needed to improve care processes and health outcomes. This pilot trial will test the ACT program, which uses a multidisciplinary model focused on primary care to address this gap. Trial Registration: ClinicalTrials.gov NCT05184894; https://www.clinicaltrials.gov/ct2/show/NCT05184894 International Registered Report Identifier (IRRID): DERR1-10.2196/48109 UR - https://www.researchprotocols.org/2023/1/e48109 UR - http://dx.doi.org/10.2196/48109 UR - http://www.ncbi.nlm.nih.gov/pubmed/37213187 ID - info:doi/10.2196/48109 ER - TY - JOUR AU - Lee, Hocheol AU - Koh, Baek Sang AU - Jo, Sug Heui AU - Lee, Ho Tae AU - Nam, Kweun Hae AU - Zhao, Bo AU - Lim, Subeen AU - Lim, Aeh Joo AU - Lee, Hee Ho AU - Hwang, Seong Yu AU - Kim, Hyun Dong AU - Nam, Woo Eun PY - 2023/5/22 TI - Global Trends in Social Prescribing: Web-Based Crawling Approach JO - J Med Internet Res SP - e46537 VL - 25 KW - social prescribing KW - social loneliness KW - National Health Service KW - aging population KW - web crawling KW - sustainable model KW - Google Trend KW - web-based data KW - NPI KW - health care model KW - primary care KW - digital health intervention KW - implementation KW - health care professional N2 - Background: Social loneliness is a prevalent issue in industrialized countries that can lead to adverse health outcomes, including a 26% increased risk of premature mortality, coronary heart disease, stroke, depression, cognitive impairment, and Alzheimer disease. The United Kingdom has implemented a strategy to address loneliness, including social prescribing?a health care model where physicians prescribe nonpharmacological interventions to tackle social loneliness. However, there is a need for evidence-based plans for global social prescribing dissemination. Objective: This study aims to identify global trends in social prescribing from 2018. To this end, we intend to collect and analyze words related to social prescribing worldwide and evaluate various trends of related words by classifying the core areas of social prescribing. Methods: Google?s searchable data were collected to analyze web-based data related to social prescribing. With the help of web crawling, 3796 news items were collected for the 5-year period from 2018 to 2022. Key topics were selected to identify keywords for each major topic related to social prescribing. The topics were grouped into 4 categories, namely Healthy, Program, Governance, and Target, and keywords for each topic were selected thereafter. Text mining was used to determine the importance of words collected from new data. Results: Word clouds were generated for words related to social prescribing, which collected 3796 words from Google News databases, including 128 in 2018, 432 in 2019, 566 in 2020, 748 in 2021, and 1922 in 2022, increasing nearly 15-fold between 2018 and 2022 (5 years). Words such as health, prescribing, and GPs (general practitioners) were the highest in terms of frequency in the list for all the years. Between 2020 and 2021, COVID, gardening, and UK were found to be highly related words. In 2022, NHS (National Health Service) and UK ranked high. This dissertation examines social prescribing?related term frequency and classification (2018-2022) in Healthy, Program, Governance, and Target categories. Key findings include increased ?Healthy? terms from 2020, ?gardening? prominence in ?Program,? ?community? growth across categories, and ?Target? term spikes in 2021. Conclusions: This study?s discussion highlights four key aspects: (1) the ?Healthy? category trends emphasize mental health, cancer, and sleep; (2) the ?Program? category prioritizes gardening, community, home-schooling, and digital initiatives; (3) ?Governance? underscores the significance of community resources in social prescribing implementation; and (4) ?Target? focuses on 4 main groups: individuals with long-term conditions, low-level mental health issues, social isolation, or complex social needs impacting well-being. Social prescribing is gaining global acceptance and is becoming a global national policy, as the world is witnessing a sharp rise in the aging population, noncontagious diseases, and mental health problems. A successful and sustainable model of social prescribing can be achieved by introducing social prescribing schemes based on the understanding of roles and the impact of multisectoral partnerships. UR - https://www.jmir.org/2023/1/e46537 UR - http://dx.doi.org/10.2196/46537 UR - http://www.ncbi.nlm.nih.gov/pubmed/37086427 ID - info:doi/10.2196/46537 ER - TY - JOUR AU - Xiang, Tao AU - Zhang, Yong Pei AU - Zhuo, Ying Guang AU - Dai, Hang PY - 2023/5/22 TI - Contribution of the 5G Smart First-Aid Care Platform to Achieving High-Quality Prehospital Care JO - J Med Internet Res SP - e43374 VL - 25 KW - fifth generation KW - 5G KW - prehospital first-aid care KW - smart medical care KW - telemedicine UR - https://www.jmir.org/2023/1/e43374 UR - http://dx.doi.org/10.2196/43374 UR - http://www.ncbi.nlm.nih.gov/pubmed/37213169 ID - info:doi/10.2196/43374 ER - TY - JOUR AU - Cernadas Ramos, Andrés AU - Fernández Da Silva, Ángela AU - Barral Buceta, Bran AU - Bouzas-Lorenzo, Ramón PY - 2023/5/18 TI - Offerings and User Demands of eHealth Services in Spain: National Survey JO - J Med Internet Res SP - e42304 VL - 25 KW - Spanish eHealth KW - health policies KW - digital health KW - COVID-19 KW - eHealth offers KW - eHealth demands N2 - Background: The accelerated development of information and communication technologies has made health care one of the pioneering fields in the incorporation of these tools. As new technologies have been applied, existing technologies have been sophisticated and improved and the concept of eHealth has expanded. However, these advances and expansion of eHealth do not seem to have served to adapt the supply of services to users? demands; rather, supply seems to be governed by other variables. Objective: The main objective of this work was to review the existing differences between user demands and the supply of eHealth services in Spain and their causes. The aim is to provide information on the level of use of the services and the causes of the variation in demand for these services, which can be useful in correcting existing differences and adapting them to the needs of users. Methods: A survey, ?Use and Attitudes Toward eHealth in Spain,? was applied by telephone to a sample of 1695 people aged 18 years and over, taking into account sociodemographic profile characteristics (sex, age, habitat, educational level). The confidence level was set at 95% and the margin of error was ±2.45 for the whole sample. Results: The survey results showed that the online doctor?s appointment service is the most frequently used eHealth service by users: 72.48% of respondents used this service at some point and 21.28% stated that they use it regularly. The other services showed significantly lower percentages of use, including ?managing health cards? (28.04%), ?consulting medical history? (20.37%), ?managing test results? (20.22%), ?communicating with health professionals? (17.80%), and ?requesting a change of doctor? (13.76%). Despite this low usage, a large majority of respondents (80.00%) attach great importance to all the services offered. Overall, 16.52% of the users surveyed were willing to make new service requests to the regional websites, with 9.33% of them highlighting services such as ?the availability of a complaints and claims mailbox,? ?the possibility of consulting medical records,? and ?the availability of more detailed information on medical centers (location, medical directory, waiting lists, etc).? Other outstanding requests (8.00%) were to simplify the procedures for using certain existing services. Conclusions: The data from the survey show that eHealth services are widely known and highly valued by users, but not all services are used with the same frequency or intensity. It appears that users find it difficult to suggest new services that might be useful to them in terms of demand for new services that do not currently exist. It would be useful to use qualitative studies to gain a deeper understanding of currently unmet needs and the possibilities of eHealth. The lack of access to and use of these services and the unmet needs particularly affect more vulnerable populations who have the greatest difficulty in meeting their needs through alternative means to eHealth. UR - https://www.jmir.org/2023/1/e42304 UR - http://dx.doi.org/10.2196/42304 UR - http://www.ncbi.nlm.nih.gov/pubmed/37200072 ID - info:doi/10.2196/42304 ER - TY - JOUR AU - D'Amico, Rachel AU - Schnell, M. Patrick AU - Foraker, Randi AU - Olayiwola, Nwando J. AU - Jonas, E. Daniel AU - Brill, Bose Seuli PY - 2023/5/17 TI - The Evolution of Primary Care Telehealth Disparities During COVID-19: Retrospective Cohort Study JO - J Med Internet Res SP - e43965 VL - 25 KW - primary care KW - health care disparities KW - COVID-19 KW - office visits KW - telemedicine KW - telehealth KW - health inequality KW - patient care KW - telehealth access KW - health care access N2 - Background: Telehealth has become widely used as a novel way to provide outpatient care during the COVID-19 pandemic, but data about telehealth use in primary care remain limited. Studies in other specialties raise concerns that telehealth may be widening existing health care disparities, requiring further scrutiny of trends in telehealth use. Objective: Our study aims to further characterize sociodemographic differences in primary care via telehealth compared to in-person office visits before and during the COVID-19 pandemic and determine if these disparities changed throughout 2020. Methods: We conducted a retrospective cohort study in a large US academic center with 46 primary care practices from April-December 2019 to April-December 2020. Data were subdivided into calendar quarters and compared to determine evolving disparities throughout the year. We queried and compared billed outpatient encounters in General Internal Medicine and Family Medicine via binary logic mixed effects regression model and estimated odds ratios (ORs) with 95% CIs. We used sex, race, and ethnicity of the patient attending each encounter as fixed effects. We analyzed socioeconomic status of patients in the institution?s primary county based on the patient?s residence zip code. Results: A total of 81,822 encounters in the pre?COVID-19 time frame and 47,994 encounters in the intra?COVID-19 time frame were analyzed; in the intra?COVID-19 time frame, a total of 5322 (11.1%) of encounters were telehealth encounters. Patients living in zip code areas with high utilization rate of supplemental nutrition assistance were less likely to use primary care in the intra?COVID-19 time frame (OR 0.94, 95% CI 0.90-0.98; P=.006). Encounters with the following patients were less likely to be via telehealth compared to in-person office visits: patients who self-identified as Asian (OR 0.74, 95% CI 0.63-0.86) and Nepali (OR 0.37, 95% CI 0.19-0.72), patients insured by Medicare (OR 0.77, 95% CI 0.68-0.88), and patients living in zip code areas with high utilization rate of supplemental nutrition assistance (OR 0.84, 95% CI 0.71-0.99). Many of these disparities persisted throughout the year. Although there was no statistically significant difference in telehealth use for patients insured by Medicaid throughout the whole year, subanalysis of quarter 4 found encounters with patients insured by Medicaid were less likely to be via telehealth (OR 0.73, 95% CI 0.55-0.97; P=.03). Conclusions: Telehealth was not used equally by all patients within primary care throughout the first year of the COVID-19 pandemic, specifically by patients who self-identified as Asian and Nepali, insured by Medicare, and living in zip code areas with low socioeconomic status. As the COVID-19 pandemic and telehealth infrastructure change, it is critical we continue to reassess the use of telehealth. Institutions should continue to monitor disparities in telehealth access and advocate for policy changes that may improve equity. UR - https://www.jmir.org/2023/1/e43965 UR - http://dx.doi.org/10.2196/43965 UR - http://www.ncbi.nlm.nih.gov/pubmed/37146176 ID - info:doi/10.2196/43965 ER - TY - JOUR AU - Fields, Beth AU - Still, Catherine AU - Medlin, Austin AU - Strayer, Andrea AU - Arbaje, I. Alicia AU - Gilmore-Bykovskyi, Andrea AU - Werner, Nicole PY - 2023/5/16 TI - Care Partner Inclusion of People Hospitalized With Alzheimer Disease and Related Dementias: Protocol for a Mixed Methods Systems Engineering Approach to Designing a Health Care System Toolkit JO - JMIR Res Protoc SP - e45274 VL - 12 KW - caregiving KW - co-design KW - dementia KW - health care KW - systems KW - mixed methods N2 - Background: Research and policy demonstrate the value and need for the systematic inclusion of care partners in hospital care delivery of people living with Alzheimer disease and related dementias (ADRD). Support provided to care partners through information and training regarding caregiving responsibilities is important to facilitating their active inclusion and ultimately improving hospital outcomes of people living with ADRD. To promote care partners? active inclusion, a toolkit that guides health systems in the identification, assessment, and training of care partners is needed. User-centered approaches can address this gap in practice by creating toolkits that are practical and responsive to the needs of care partners and their hospitalized family members and friends living with ADRD. Objective: This paper describes the study protocol for the development and refinement of the ADRD Systematic Hospital Inclusion Family Toolkit (A-SHIFT). A-SHIFT will provide health care systems with guidance on how to effectively identify, assess, and train care partners of hospitalized persons living with ADRD. Methods: The A-SHIFT study protocol will use a 3-aimed, convergent mixed method approach to iteratively develop and refine the toolkit. In Aim 1, we will use a systems-engineering approach to characterize patterns of care partner inclusion in hospital care for people living with ADRD. In Aim 2, we will partner with stakeholders to identify and prioritize health care system facilitators and barriers to the inclusion for care partners of hospitalized people living with ADRD. In Aim 3, we will work with stakeholders to co-design an adaptable toolkit to be used by health systems to facilitate the identification, assessment, and training of care partners of hospitalized people living with ADRD. Our convergent mixed method approach will facilitate triangulation across all 3 aims to increase the credibility and transferability of results. We anticipate this study to take 24 months between September 1, 2022, and August 31, 2024. Results: The A-SHIFT study protocol will yield (1) optimal points in the hospital workflow for care partner inclusion, (2) a prioritized list of potentially modifiable barriers and facilitators to including care partners in the hospitalization of people living with ADRD, and (3) a converged-upon, ready for feasibility testing of the toolkit to guide the inclusion of care partners of people living with ADRD in hospital care. Conclusions: We anticipate that the resultant A-SHIFT will provide health systems with a readiness checklist, implementation plan, and resources for identifying, assessing, and training care partners on how to fulfill their caregiving roles for people living with ADRD after hospital discharge. A-SHIFT has the potential to not only improve care partner preparedness but also help reduce health and service use outcomes for people living with ADRD after hospital discharge. International Registered Report Identifier (IRRID): DERR1-10.2196/45274 UR - https://www.researchprotocols.org/2023/1/e45274 UR - http://dx.doi.org/10.2196/45274 UR - http://www.ncbi.nlm.nih.gov/pubmed/37191978 ID - info:doi/10.2196/45274 ER - TY - JOUR AU - Williams, Cynthia AU - Shang, Di PY - 2023/5/12 TI - Telehealth Usage Among Low-Income Racial and Ethnic Minority Populations During the COVID-19 Pandemic: Retrospective Observational Study JO - J Med Internet Res SP - e43604 VL - 25 KW - COVID-19 KW - telehealth KW - health equity KW - minority health KW - low income KW - healthcare access KW - pandemic KW - USA KW - United States KW - healthcare system KW - health care KW - risk KW - minority KW - database KW - utilization KW - education N2 - Background: Despite considerable efforts to encourage telehealth use during the COVID-19 pandemic, we witnessed a potential widening of health inequities that may continue to plague the US health care system unless we mitigate modifiable risk factors. Objective: This study aimed to examine the hypothesis that there are systemic differences in telehealth usage among people who live at or below 200% of the federal poverty level. Factors that we consider are age, gender, race, ethnicity, education, employment status, household size, and income. Methods: A retrospective observational study was performed using the COVID-19 Research Database to analyze factors contributing to telehealth inequities. The study period ranged from March 2020 to April 2021. The Office Ally database provided US claims data from 100 million unique patients and 3.4 billion claims. The Analytics IQ PeopleCore Consumer database is nationally representative of 242.5 million US adults aged 19 years and older. We analyzed medical claims to investigate the influence of demographic and socioeconomic factors on telehealth usage among the low-income racial and ethnic minority populations. We conducted a multiple logistic regression analysis to determine the odds of patients in diverse groups using telehealth during the study period. Results: Among 2,850,831 unique patients, nearly 60% of them were female, 75% of them had a high school education or less, 49% of them were unemployed, and 62% of them identified as non-Hispanic White. Our results suggest that 9.84% of the patients had ?1 telehealth claims during the study period. Asian (odds ratio [OR] 1.569, 95% CI 1.528-1.611, P<.001) and Hispanic (OR 1.612, 95% CI 1.596-1.628, P<.001) patients were more likely to use telehealth than non-Hispanic White and -Black patients. Patients who were employed full-time were 15% (OR 1.148, 95% CI 1.133-1.164, P<.001) more likely to use telehealth than unemployed patients. Patients who identified as male were 12% (OR 0.875, 95% CI 0.867-0.883, P<.001) less likely to use telehealth than those who identified as female. Patients with high school education or less were 5% (OR 0.953, 95% CI 0.944-0.962, P<.001) less likely to use telehealth than those with a bachelor?s degree or higher. Patients in the 18-44?year age group were 32% (OR 1.324, 95% CI 1.304-1.345, P<.001) more likely to use telehealth than those in the ?65-year age group. Conclusions: Factors that impact telehealth usage include age, gender, race, education, employment status, and income. While low-income racial and ethnic minority communities are at greater risk for health inequities among this group, Hispanic communities are more likely to use telehealth, and non-Hispanic Black patients continue to demonstrate telehealth inequity. Gender, age, and household income contribute to health inequities across gradients of poverty. Strategies to improve health use should consider characteristics of subgroups, as people do not experience poverty equally. UR - https://www.jmir.org/2023/1/e43604 UR - http://dx.doi.org/10.2196/43604 UR - http://www.ncbi.nlm.nih.gov/pubmed/37171848 ID - info:doi/10.2196/43604 ER - TY - JOUR AU - Carswell, Claire AU - Coventry, A. Peter AU - Brown, E. Jennifer V. AU - Alderson, L. Sarah AU - Double, Keith AU - Gilbody, Simon AU - Holt, G. Richard I. AU - Jacobs, Rowena AU - Lister, Jennie AU - Osborn, David AU - Shiers, David AU - Siddiqi, Najma AU - Taylor, Johanna AU - Kellar, Ian AU - PY - 2023/5/12 TI - Development of a Supported Self-management Intervention for People With Severe Mental Illness and Type 2 Diabetes: Theory and Evidence-Based Co-design Approach JO - J Med Internet Res SP - e43597 VL - 25 KW - severe mental illness KW - diabetes KW - intervention development KW - co-design KW - mental health KW - comorbidity KW - mobile phone N2 - Background: Type 2 diabetes is 2 to 3 times more common among people with severe mental illness (SMI). Self-management is crucial, with additional challenges faced by people with SMI. Therefore, it is essential that any diabetes self-management program for people with SMI addresses the unique needs of people living with both conditions and the inequalities they experience within health care services. Objective: We combined theory, empirical evidence, and co-design approaches to develop a type 2 diabetes self-management intervention for people with SMI. Methods: The development process encompassed 4 steps: step 1 involved prioritizing the mechanisms of action (MoAs) and behavior change techniques (BCTs) for the intervention. Using findings from primary qualitative research and systematic reviews, we selected candidate MoAs to target in the intervention and candidate BCTs to use. Expert stakeholders then ranked these MoAs and BCTs using a 2-phase survey. The average scores were used to generate a prioritized list of MoAs and BCTs. During step 2, we presented the survey results to an expert consensus workshop to seek expert agreement with the definitive list of MoAs and BCTs for the intervention and identify potential modes of delivery. Step 3 involved the development of trigger films using the evidence from steps 1 and 2. We used animations to present the experiences of people with SMI managing diabetes. These films were used in step 4, where we used a stakeholder co-design approach. This involved a series of structured workshops, where the co-design activities were informed by theory and evidence. Results: Upon the completion of the 4-step process, we developed the DIAMONDS (diabetes and mental illness, improving outcomes and self-management) intervention. It is a tailored self-management intervention based on the synthesis of the outputs from the co-design process. The intervention incorporates a digital app, a paper-based workbook, and one-to-one coaching designed to meet the needs of people with SMI and coexisting type 2 diabetes. Conclusions: The intervention development work was underpinned by the MoA theoretical framework and incorporated systematic reviews, primary qualitative research, expert stakeholder surveys, and evidence generated during co-design workshops. The intervention will now be tested for feasibility before undergoing a definitive evaluation in a pragmatic randomized controlled trial. UR - https://www.jmir.org/2023/1/e43597 UR - http://dx.doi.org/10.2196/43597 UR - http://www.ncbi.nlm.nih.gov/pubmed/37171868 ID - info:doi/10.2196/43597 ER - TY - JOUR AU - Alaqra, Sarah Ala AU - Khumalo, C. Akhona PY - 2023/5/12 TI - Handling Public Well-being During the COVID-19 Crisis: Empirical Study With Representatives From Municipalities in Sweden JO - JMIR Form Res SP - e40669 VL - 7 KW - COVID-19 KW - Sweden KW - government KW - well-being KW - public health KW - information and communications technology KW - recreational activities N2 - Background: COVID-19 has had a significant impact on the public?s health and well-being due to infections and restrictions imposed during the crisis. Recreational activities are important for the public?s well-being; however, the public?s safety from the COVID-19 virus is the top priority. Sweden, a country with a decentralized public health and welfare system, relied on less stringent approaches for handling the crisis. The limited restrictions in Sweden allowed recreational activities to take place despite the pandemic, which could be attributed to considerations for the public?s well-being. Objective: The objective of this study was to investigate municipal approaches for handling and supporting recreational activities during the COVID-19 crisis. Methods: We conducted an empirical study (qualitative and quantitative), using an online survey for data collection, with 23 participants. They were representatives holding mostly managerial roles in 18 distinct municipalities (18 counties). A thematic analysis was conducted to analyze open-ended responses, and descriptive statistics were used to summarize the closed-ended responses. Results: In this study, we report on the status of municipalities during the COVID-19 pandemic. The highlighted results showed a significant impact on the municipalities as a result of COVID-19, where 78% (18/23) of participants stated significant changes due to the pandemic. Moreover, 91% (21/23) indicated efforts and approaches for supporting recreational activities during COVID-19. Following national guidelines for the public?s health and safety was indicated by 78% (18/23) of participants. Information and communications technology (ICT) was considered significant for dealing with COVID-19 according to 87% (20/23) of participants. Our qualitative results further showed details of the public?s health and safety considerations, the efforts to support recreational activities particularly for youth, and the role and requirements of ICT. Challenges relating to the usability of ICT were also highlighted. Conclusions: Despite the critique of Sweden?s lenient strategy for handling the COVID-19 crisis, our results showed significant considerations for the public?s safety and well-being by the municipalities (regional and local levels) in this study. The Swedish approach to handling the crisis involved trusting the public with safety guidelines in addition to efforts for the public?s safety, supporting the public?s well-being with approaches for maintaining recreational activities, and giving special care to the youth. Despite having technological solutions in place, challenges in using digital solutions and requirements for future development were noted. UR - https://formative.jmir.org/2023/1/e40669 UR - http://dx.doi.org/10.2196/40669 UR - http://www.ncbi.nlm.nih.gov/pubmed/37053098 ID - info:doi/10.2196/40669 ER - TY - JOUR AU - Masiero, Marianna AU - Filipponi, Chiara AU - Pizzoli, Maria Silvia Francesca AU - Munzone, Elisabetta AU - Guido, Luca AU - Guardamagna, Andrea Vittorio AU - Marceglia, Sara AU - Caruso, Annamaria AU - Prandin, Roberto AU - Prenassi, Marco AU - Manzelli, Vania AU - Savino, Chiara AU - Conti, Costanza AU - Rizzi, Federica AU - Casalino, Alice AU - Candiani, Giulia AU - Memini, Francesca AU - Chiveri, Luca AU - Vitali, Luigi Andrea AU - Corbo, Massimo AU - Milani, Alessandra AU - Grasso, Roberto AU - Traversoni, Silvia AU - Fragale, Elisa AU - Didier, Florence AU - Pravettoni, Gabriella PY - 2023/5/12 TI - Usability Testing of a New Digital Integrated Health Ecosystem (PainRELife) for the Clinical Management of Chronic Pain in Patients With Early Breast Cancer: Protocol for a Pilot Study JO - JMIR Res Protoc SP - e41216 VL - 12 KW - decision-making KW - decision aid KW - chronic pain KW - eHealth KW - patient electronic health record KW - clinical KW - technology KW - mobile application KW - pilot study KW - breast cancer KW - chronic KW - patient KW - cancer KW - pain N2 - Background: Chronic pain (CP) and its management are critical issues in the care pathway of patients with breast cancer. Considering the complexity of CP experience in cancer, the international scientific community has advocated identifying cutting-edge approaches for CP management. Recent advances in the field of health technology enable the adoption of a novel approach to care management by developing integrated ecosystems and mobile health apps. Objective: The primary end point of this pilot study is to evaluate patients? usability experience at 3 months of a new digital and integrated technological ecosystem, PainRELife, for CP in a sample of patients with breast cancer. The PainRELife ecosystem is composed of 3 main technological assets integrated into a single digital ecosystem: Fast Healthcare Interoperability Resources?based cloud platform (Nu platform) that enables care pathway definition and data collection; a big data infrastructure connected to the Fast Healthcare Interoperability Resources server that analyzes data and implements dynamic dashboards for aggregate data visualization; and an ecosystem of personalized applications for patient-reported outcomes collection, digital delivery of interventions and tailored information, and decision support of patients and caregivers (PainRELife app). Methods: This is an observational, prospective pilot study. Twenty patients with early breast cancer and chronic pain will be enrolled at the European Institute of Oncology at the Division of Medical Senology and the Division of Pain Therapy and Palliative Care. Each patient will use the PainRELife mobile app for 3 months, during which data extracted from the questionnaires will be sent to the Nu Platform that health care professionals will manage. This pilot study is nested in a large-scale project named ?PainRELife,? which aims to develop a cloud technology platform to interoperate with institutional systems and patients' devices to collect integrated health care data. The study received approval from the Ethical Committee of the European Cancer Institute in December 2021 (number R1597/21-IEO 1701). Results: The recruitment process started in May 2022 and ended in October 2022. Conclusions: The new integrated technological ecosystems might be considered an encouraging affordance to enhance a patient-centered approach to managing patients with cancer. This pilot study will inform about which features the health technological ecosystems should have to be used by cancer patients to manage CP. International Registered Report Identifier (IRRID): DERR1-10.2196/41216 UR - https://www.researchprotocols.org/2023/1/e41216 UR - http://dx.doi.org/10.2196/41216 UR - http://www.ncbi.nlm.nih.gov/pubmed/37171843 ID - info:doi/10.2196/41216 ER - TY - JOUR AU - Haun, N. Jolie AU - Nakase-Richardson, Risa AU - Melillo, Christine AU - Kean, Jacob AU - Benzinger, C. Rachel AU - Schneider, Tali AU - Pugh, V. Mary Jo PY - 2023/5/9 TI - Traumatic Brain Injury Intensive Evaluation and Treatment Program: Protocol for a Partnered Evaluation Initiative Mixed Methods Study JO - JMIR Res Protoc SP - e44776 VL - 12 KW - service member KW - rehabilitation KW - traumatic brain injury KW - TBI KW - posttraumatic stress disorder KW - PTSD KW - pain KW - military KW - brain injury KW - trauma KW - traumatic KW - participatory KW - recovery KW - veteran KW - implementation KW - service delivery KW - protocol KW - treatment program KW - health care implementation KW - Consolidated Framework for Implementation Research KW - CFIR KW - cognitive KW - cognition KW - brain KW - script KW - Bayesian KW - network analysis KW - directed acyclic graph KW - effect size KW - missing data KW - inpatient KW - modality N2 - Background: The traumatic brain injury (TBI) Intensive Evaluation and Treatment Program (IETP) is an innovative modality for delivering evidence-based treatments in a residential, inpatient format to special operational forces service members and veterans with mild TBI. IETPs provide bundled evidence-based assessment, treatment, referral, and case management in concordance with the existing guidelines for mild TBI and commonly co-occurring comorbidities. To date, there has been no formal characterization or evaluation of the IETP to understand the determinants of implementation across the system of care. The goal of our partnered evaluation initiative (PEI) with an operational partner, the Physical Medicine and Rehabilitation National Program Office, is to facilitate the full implementation of the IETP across all 5 Veterans Health Administration TBI?Centers of Excellence (TBI-COE) and to inform minimum standards while supporting the unique characteristics of each site. Objective: This IETP partnered evaluation will describe each of the 5 TBI-COE IETP services and state of implementation to identify opportunities for adaptation and scale, characterize the relationship between patient characteristics and clinical services received, evaluate the outcomes for participants in the IETP, and inform ongoing implementation and knowledge translation efforts to support IETP expansion. In alignment with the goals of the protocol, ineffective treatment components will be targeted for deimplementation. Methods: A 3-year concurrent mixed methods evaluation using a participatory approach in collaboration with the operational partner and TBI-COE site leadership will be conducted. Qualitative observations, semistructured focus groups, and interviewing methods will be used to describe IETP, stakeholder experiences and needs, and suggestions for IETP implementation. Quantitative methods will include primary data collection from patients in the IETP at each site to characterize long-term outcomes and patient satisfaction with treatment and secondary data collection to quantitatively characterize patient-level and care system?level data. Finally, data sets will be triangulated to share data findings with partners to inform ongoing implementation efforts. Results: Data collection began in December 2021 and is currently ongoing. The results and deliverables will inform IETP characterization, evaluation, implementation, and knowledge translation. Conclusions: The results of this evaluation seek to provide an understanding of the determinants affecting the implementation of IETPs. Service member, staff, and stakeholder insights will inform the state of implementation at each site, and quantitative measures will provide options for standardized outcome measures. This evaluation is expected to inform national Physical Medicine and Rehabilitation Office policies and processes and knowledge translation efforts to improve and expand the IETP. Future work may include cost evaluations and rigorous research, such as randomized controlled trials. International Registered Report Identifier (IRRID): DERR1-10.2196/44776 UR - https://www.researchprotocols.org/2023/1/e44776 UR - http://dx.doi.org/10.2196/44776 UR - http://www.ncbi.nlm.nih.gov/pubmed/37159250 ID - info:doi/10.2196/44776 ER - TY - JOUR AU - Pickard Strange, Martha AU - Booth, Amy AU - Akiki, Melissa AU - Wieringa, Sietse AU - Shaw, E. Sara PY - 2023/5/3 TI - The Role of Virtual Consulting in Developing Environmentally Sustainable Health Care: Systematic Literature Review JO - J Med Internet Res SP - e44823 VL - 25 KW - virtual consulting KW - environmental sustainability KW - systematic review KW - carbon footprinting KW - net zero KW - mobile phone N2 - Background: Health systems globally need to rapidly set and achieve targets for reaching net zero carbon emissions. Virtual consulting (including video- and telephone-based consulting) is regarded as one means by which this might be achieved, largely through reduced patient travel. Little is currently known about the ways in which forms of virtual consulting might contribute to the net zero agenda or how countries may develop and implement programs at scale that can support increased environmental sustainability. Objective: In this paper, we asked, What is the impact of virtual consulting on environmental sustainability in health care? and What can we learn from current evaluations that can inform future reductions in carbon emissions? Methods: We conducted a systematic review of published literature according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. We searched the MEDLINE, PubMed, and Scopus databases using key terms relating to ?carbon footprint,? ?environmental impact,? ?telemedicine,? and ?remote consulting,? using citation tracking to identify additional articles. The articles were screened, and full texts that met the inclusion criteria were obtained. Data on the approach to carbon footprinting reported reductions in emissions, and the opportunities and challenges associated with the environmental sustainability of virtual consultations were extracted into a spreadsheet, analyzed thematically, and theorized using the Planning and Evaluating Remote Consultation Services framework to consider the various interacting influences, including environmental sustainability, that shape the adoption of virtual consulting services. Results: A total of 1672 papers were identified. After removing duplicates and screening for eligibility, 23 papers that focused on a range of virtual consulting equipment and platforms across different clinical conditions and services were included. The focus on the environmental sustainability potential of virtual consulting was unanimously reported through carbon savings achieved by a reduction in travel related to face-to-face appointments. The shortlisted papers used a range of methods and assumptions to determine carbon savings, reporting these using different units and across varied sample sizes. This limited the potential for comparison. Despite methodological inconsistencies, all papers concluded that virtual consulting significantly reduced carbon emissions. However, there was limited consideration of wider factors (eg, patient suitability, clinical indication, and organizational infrastructure) influencing the adoption, use, and spread of virtual consultations and the carbon footprint of the entire clinical pathway in which the virtual consultation was provided (eg, risk of missed diagnoses from virtual consultations that result in the need for subsequent in-person consultations or admissions). Conclusions: There is overwhelming evidence that virtual consulting can reduce health care carbon emissions, largely through reducing travel related to in-person appointments. However, the current evidence fails to look at system factors associated with implementing virtual health care delivery and wider research into carbon emissions across the entire clinical pathway. UR - https://www.jmir.org/2023/1/e44823 UR - http://dx.doi.org/10.2196/44823 UR - http://www.ncbi.nlm.nih.gov/pubmed/37133914 ID - info:doi/10.2196/44823 ER - TY - JOUR AU - Hickey, Grainne AU - Dunne, Claire AU - Maguire, Lauren AU - McCarthy, Niamh PY - 2023/4/28 TI - An Exploration of Practitioners? Experiences of Delivering Digital Social Care Interventions to Children and Families During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Form Res SP - e43498 VL - 7 KW - digital social care KW - social care practice KW - children and families KW - COVID-19 KW - mobile phone N2 - Background: Digital technology is an increasing feature of social care practice, and its use has accelerated greatly in response to the COVID-19 pandemic. Objective: This study aimed to assess social care practitioners? experiences of delivering digital interventions to vulnerable children and families during the pandemic. Methods: A mixed methods study combining survey and qualitative research was conducted. In total, 102 social care practitioners working in the Republic of Ireland who delivered a range of digital social care support took part in a web-based survey. This survey captured practitioners? engagement and experiences of delivering digital social care interventions to children and families as well as training and capacity building needs. Subsequently, 19 focus groups with 106 social care practitioners working with children and families were also conducted. These focus groups were directed by a topic guide and explored in more depth practitioners? perceptions of digital social care practice, the perceived impact of digital technology on their work with children and families, and the future application of digital social care interventions. Results: The survey findings revealed that 52.9% (54/102) and 45.1% (46/102) of practitioners, respectively, felt ?confident? and ?comfortable? engaging in digital service delivery. The vast majority of practitioners (93/102, 91.2%) identified maintaining connection during the pandemic as a benefit of digital social care practice; approximately three-quarters of practitioners (74/102, 72.5%) felt that digital social care practice offered service users ?increased access and flexibility?; however, a similar proportion of practitioners (70/102, 68.6%) identified inadequate home environments (eg, lack of privacy) during service provision as a barrier to digital social care practice. More than half of the practitioners (54/102, 52.9%) identified poor Wi-Fi or device access as a challenge to child and family engagement with digital social care. In total, 68.6% (70/102) of practitioners felt that they needed further training on the use of digital platforms for service delivery. Thematic analysis of qualitative (focus group) data revealed 3 overarching themes: perceived advantages and disadvantages for service users, practitioners? challenges in working with children and families through digital technologies, and practitioners? personal challenges and training needs. Conclusions: These findings shed light on practitioners? experiences of delivering digital child and family social care services during the COVID-19 pandemic. Both benefits and challenges within the delivery of digital social care support as well as conflicting findings across the experiences of practitioners were identified. The implications of these findings for the development of therapeutic practitioner?service user relationships through digital practice as well as confidentiality and safeguarding are discussed. Training and support needs for the future implementation of digital social care interventions are also outlined. UR - https://formative.jmir.org/2023/1/e43498 UR - http://dx.doi.org/10.2196/43498 UR - http://www.ncbi.nlm.nih.gov/pubmed/36888555 ID - info:doi/10.2196/43498 ER - TY - JOUR AU - Andrews, Brooke AU - Klein, Britt AU - McLaren, Suzanne AU - Watson, Shaun AU - Corboy, Denise PY - 2023/4/28 TI - Evaluation of Various Support Intensities of Digital Mental Health Treatment for Reducing Anxiety and Depression in Adults: Protocol for a Mixed Methods, Adaptive, Randomized Clinical Trial JO - JMIR Res Protoc SP - e45040 VL - 12 KW - video chat therapy KW - therapist assistance KW - self-help KW - transdiagnostic KW - digital intervention KW - anxiety KW - depression KW - comorbidity N2 - Background: Anxiety and depression are leading causes of disease worldwide, requiring timely access to evidence-based treatment. Digital mental health (dMH) interventions increase accessibility to evidence-based psychological services delivered in a variety of web-based formats (eg, self-help and therapist-assisted interventions). Robust and rigorous studies of adaptive web-based intervention designs are scarce. No identified randomized clinical trial has investigated the efficacy of a 2-stage adaptive design, whereby the program-only condition or no support dMH treatment program is augmented by either low or high therapist assistance, if a participant does not improve or engage in the program-only condition. Objective: The primary objective is to assess whether low or high therapist-assisted support delivered via video chat is more effective in reducing anxiety and depressive symptoms compared with a dMH program?only condition. The secondary objective is to evaluate the role of motivation; self-efficacy; and preferences in participant engagement, adherence, and clinical outcomes (anxiety and depression symptoms) among the 3 treatment conditions (program only, low-intensity therapist assistance, and high-intensity therapist assistance). A mixed methods analysis of factors affecting participant attrition, participant reasons for nonengagement and withdrawal, and therapist training and implementation of dMH interventions will be completed. Qualitative data regarding participant and therapist experiences and satisfaction with video chat assessment and treatment will also be analyzed. Methods: Australian adults (N=137) with symptoms or a diagnosis of anxiety or depression will be screened for eligibility and given access to the 8-module Life Flex dMH treatment program. On day 15, participants who meet the augmentation criteria will be stepped up via block randomization to receive therapist assistance delivered via video chat for either 10 minutes (low intensity) or 50 minutes (high intensity) per week. This adaptive trial will implement a mixed methods design, with outcomes assessed before the intervention (week 0), during the intervention (weeks 3 and 6), after the intervention (week 9), and at the 3-month follow-up (week 21). Results: The primary outcome measures are for anxiety (Generalized Anxiety Disorder?7) and depression severity (Patient Health Questionnaire?9). Measures of working alliance, health status, health resources, preferences, self-efficacy, and motivation will be used for secondary outcomes. Qualitative methods will be used to explore participant and therapist experiences of video chat assessment and treatment, participant reasons for withdrawal and nonengagement, and therapist training and implementation experiences. Data collection commenced in November 2020 and was completed at the end of March 2022. Conclusions: This is the first mixed methods adaptive trial to explore the comparative efficacy of different intensity levels of self-help and a therapist-assisted dMH intervention program delivered via video chat for adults with anxiety or depression. Anticipated results may have implications for the implementation of dMH interventions. Trial Registration: Australian and New Zealand Clinical Trials Registry 12620000422921; https://tinyurl.com/t9cyu372 International Registered Report Identifier (IRRID): RR1-10.2196/45040 UR - https://www.researchprotocols.org/2023/1/e45040 UR - http://dx.doi.org/10.2196/45040 UR - http://www.ncbi.nlm.nih.gov/pubmed/37115623 ID - info:doi/10.2196/45040 ER - TY - JOUR AU - Kwan, Ho Tsz AU - Chan, Chung Denise Pui AU - Wong, Yeung-shan Samuel AU - Lee, Shan Shui PY - 2023/4/26 TI - Implementation Cascade of a Social Network?Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study JO - J Med Internet Res SP - e46514 VL - 25 KW - community-based testing service KW - cross-sectional study KW - HIV self-test KW - HIV testing KW - HIV KW - implementation cascade KW - men who have sex with men KW - social network KW - virus transmission N2 - Background: HIV testing is the cornerstone of strategies for achieving the fast-track target to end the AIDS epidemic by 2030. Self-testing has been proven to be an effective health intervention for men who have sex with men (MSM). While social network?based approaches for distributing HIV self-tests are recommended by the World Health Organization, their implementation consists of multiple steps that need to be properly evaluated. Objective: This study aimed to assess the implementation cascade of a social network?based HIV self-test approach for reaching MSM who had never undergone testing in Hong Kong. Methods: This is a cross-sectional study. Seed MSM participants were recruited through different web-based channels, who in turn invited their peers to participate in this study. A web-based platform was set up to support the recruitment and referral process. Participants could request for an oral fluid or a finger-prick HIV self-test, with or without real-time support, after completing a self-administered questionnaire. Referrals could be made upon uploading the test result and passing the web-based training. Characteristics of participants completing each of these steps and their preferences for the type of HIV self-test were evaluated. Results: A total of 463 MSM were recruited, including 150 seeds. Participants recruited by seeds were less likely to have previously been tested for HIV (odds ratio [OR] 1.80, 95% CI 1.06-3.04, P=.03) and have lower confidence in performing self-tests (OR 0.66, 95% CI 0.45-0.99, P=.045). Almost all (434/442, 98%) MSM who completed the questionnaire requested a self-test, of whom 82% (354/434) had uploaded their test results. Participants requesting support were new to self-testing (OR 3.65, 95% CI 2.10-6.35, P<.001) and less confident in carrying out the self-test correctly (OR 0.35, 95% CI 0.22-0.56, P<.001). More than half (216/354, 61%) of the eligible participants initiated the referral process by attempting the web-based training with a passing rate of 93% (200/216). They were more likely to have sought sex partners (OR 2.20, 95% CI 1.14-4.25, P=.02), especially through location-based networking apps (OR 2.13, 95% CI 1.31-3.49, P=.002). They also gave higher usability scores along the implementation cascade (median 81 vs 75, P=.003). Conclusions: The social network approach was effective in diffusing HIV self-tests in the MSM community and reaching nontesters. Support and option to choose a preferable type of self-test are essential to address users? individual needs when delivering HIV self-tests. A positive user experience throughout the processes along the implementation cascade is vital to transform a tester into a promoter. Trial Registration: ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206 UR - https://www.jmir.org/2023/1/e46514 UR - http://dx.doi.org/10.2196/46514 UR - http://www.ncbi.nlm.nih.gov/pubmed/37099364 ID - info:doi/10.2196/46514 ER - TY - JOUR AU - Bond, Sarah AU - Kyfonidis, Charalampos AU - Jamieson, Matthew AU - Maguire, Roma AU - McCann, Lisa AU - Watson, Angus AU - Brogan, Michelle AU - Lennon, Marilyn PY - 2023/4/14 TI - Evaluation of an Innovative Colon Capsule Endoscopy Service in Scotland From the Perspective of Patients: Mixed Methods Study JO - J Med Internet Res SP - e45181 VL - 25 KW - digital health KW - patient experience KW - colonoscopy KW - colon capsule endoscopy? N2 - Background: Colonoscopy is the gold standard for lower gastrointestinal diagnostics. The procedure is invasive, and its demand is high, resulting in long waiting times. Colon capsule endoscopy (CCE) is a procedure that uses a video capsule to investigate the colon, meaning that it can be carried out in a person?s own home. This type of ?hospital-at-home? service could potentially reduce costs and waiting times, and increase patient satisfaction. Little is currently understood, however, about how CCE is actually experienced and accepted by patients. Objective: The aim of this study was to capture and report patient experiences of the CCE technology (the capsule and associated belt and recorder) and of the new clinical pathway for the CCE service being rolled out as part of routine service in Scotland. Methods: This was a mixed methods service evaluation of patient experiences of a real-world, deployed, managed service for CCE in Scotland.?Two hundred and nine patients provided feedback via a survey about their experiences of the CCE service. Eighteen of these patients took part in a further telephone interview to capture more in-depth lived experiences to understand the barriers and opportunities for the further adoption and scaling up of the CCE service in a way that supports the patient experience and journey. Results: Patients overall perceived the CCE service to be of significant value (eg, mentioning reduced travel times, reduced waiting times, and freedom to complete the procedure at home as perceived benefits). Our findings also highlighted the importance of clear and accessible information (eg, what to expect and how to undertake the bowel preparation) and the need for managing expectations of patients (eg, being clear about when results will be received and what happens if a further colonoscopy is required). Conclusions: The findings led to recommendations for future implementations of managed CCE services in National Health Service (NHS) Scotland that could also apply more widely (United Kingdom and beyond) and at a greater scale (with more patients in more contexts).?These include promoting CCE with, for, and among clinical teams to ensure adoption and success; capturing and understanding reasons why patients do and do not opt for CCE; providing clear information in a variety of appropriate ways to patients (eg, around the importance of bowel preparation instructions); improving the bowel preparation (this is not specific to CCE alone); providing flexible options for issuing and returning the kit (eg, dropping off at a pharmacy); and embedding formative evaluation within the service itself (eg, capturing patient-reported experiences via surveys in the information pack when the equipment is returned). UR - https://www.jmir.org/2023/1/e45181 UR - http://dx.doi.org/10.2196/45181 UR - http://www.ncbi.nlm.nih.gov/pubmed/37058337 ID - info:doi/10.2196/45181 ER - TY - JOUR AU - Dinh, Alana AU - Tseng, Emily AU - Yin, Lukas Andrew AU - Estrin, Deborah AU - Greenwald, Peter AU - Fortenko, Alexander PY - 2023/3/28 TI - Perceptions About Augmented Reality in Remote Medical Care: Interview Study of Emergency Telemedicine Providers JO - JMIR Form Res SP - e45211 VL - 7 KW - augmented reality KW - telemedicine KW - telehealth KW - emergency medicine KW - education KW - mobile phone N2 - Background: Augmented reality (AR) and virtual reality (VR) have increasingly appeared in the medical literature in the past decade, with AR recently being studied for its potential role in remote health care delivery and communication. Recent literature describes AR?s implementation in real-time telemedicine contexts across multiple specialties and settings, with remote emergency services in particular using AR to enhance disaster support and simulation education. Despite the introduction of AR in the medical literature and its potential to shape the future of remote medical services, studies have yet to investigate the perspectives of telemedicine providers regarding this novel technology. Objective: This study aimed to understand the applications and challenges of AR in telemedicine anticipated by emergency medicine providers with a range of experiences in using telemedicine and AR or VR technology. Methods: Across 10 academic medical institutions, 21 emergency medicine providers with variable exposures to telemedicine and AR or VR technology were recruited for semistructured interviews via snowball sampling. The interview questions focused on various potential uses of AR, anticipated obstacles that prevent its implementation in the telemedicine area, and how providers and patients might respond to its introduction. We included video demonstrations of a prototype using AR during the interviews to elicit more informed and complete insights regarding AR?s potential in remote health care. Interviews were transcribed and analyzed via thematic coding. Results: Our study identified 2 major areas of use for AR in telemedicine. First, AR is perceived to facilitate information gathering by enhancing observational tasks such as visual examination and granting simultaneous access to data and remote experts. Second, AR is anticipated to supplement distance learning of both minor and major procedures and nonprocedural skills such as cue recognition and empathy for patients and trainees. AR may also supplement long-distance education programs and thereby support less specialized medical facilities. However, the addition of AR may exacerbate the preexisting financial, structural, and literacy barriers to telemedicine. Providers seek value demonstrated by extensive research on the clinical outcome, satisfaction, and financial benefits of AR. They also seek institutional support and early training before adopting novel tools such as AR. Although an overall mixed reception is anticipated, consumer adoption and awareness are key components in AR?s adoption. Conclusions: AR has the potential to enhance the ability to gather observational and medical information, which would serve a diverse set of applications in remote health care delivery and education. However, AR faces obstacles similar to those faced by the current telemedicine technology, such as lack of access, infrastructure, and familiarity. This paper discusses the potential areas of investigation that would inform future studies and approaches to implementing AR in telemedicine. UR - https://formative.jmir.org/2023/1/e45211 UR - http://dx.doi.org/10.2196/45211 UR - http://www.ncbi.nlm.nih.gov/pubmed/36976628 ID - info:doi/10.2196/45211 ER - TY - JOUR AU - Norberg, Lønnebakke Børge AU - Getz, Okkenhaug Linn AU - Johnsen, Magne Tor AU - Austad, Bjarne AU - Zanaboni, Paolo PY - 2023/3/20 TI - General Practitioners? Experiences With Potentials and Pitfalls of Video Consultations in Norway During the COVID-19 Lockdown: Qualitative Analysis of Free-Text Survey Answers JO - J Med Internet Res SP - e45812 VL - 25 KW - general practice KW - video consultations KW - remote consultations KW - e-consultations KW - communication KW - patient safety KW - COVID-19 KW - pandemic KW - lockdown KW - telehealth KW - telemedicine KW - healthcare KW - health care KW - user experience N2 - Background: The use of video consultations (VCs) in Norwegian general practice rapidly increased during the COVID-19 pandemic. During societal lockdowns, VCs were used for nearly all types of clinical problems, as in-person consultations were kept to a minimum. Objective: This study aimed to explore general practitioners? (GPs?) experiences of potentials and pitfalls associated with the use of VCs during the first pandemic lockdown. Methods: Between April 14 and May 3, 2020, all regular Norwegian GPs (N=4858) were invited to answer a web-based survey, which included open-ended questions about their experiences with the advantages and pitfalls of VCs. A total of 2558 free-text answers were provided by 657 of the 1237 GPs who participated in the survey. The material was subjected to reflexive thematic analysis. Results: Four main themes were identified. First, VCs are described as being particularly convenient, informative, and effective for consultations with previously known patients. Second, strategically planned VCs may facilitate effective tailoring of clinical trajectories that optimize clinical workflow. VCs allow for an initial overview of the problem (triage), follow-up evaluation after an in-person consultation, provision of advice and information concerning test results and discharge notes, extension of sick leaves, and delivery of other medical certificates. VCs may, in certain situations, enhance the GPs? insight in their patients? relational and socioeconomical resources and vulnerabilities, and even facilitate relationship-building with patients in need of care who might otherwise be reluctant to seek help. Third, VCs are characterized by a demarcated communication style and the ?one problem approach,? which may entail effectiveness in the short run. However, the web-based communication climate implies degradation of valuable nonverbal signals that are more evidently present in in-person consultations. Finally, overreliance on VCs may, in a longer perspective, undermine the establishment and maintenance of relational trust, with a negative impact on the quality of care and patient safety. Compensatory mechanisms include clarifying with the patient what the next step is, answering any questions and giving further advice on treatment if conditions do not improve or there is a need for follow-up. Participation of family members can also be helpful to improve reciprocal understanding and safety. Conclusions: The findings have relevance for future implementation of VCs and deserve further exploration under less stressful circumstances. UR - https://www.jmir.org/2023/1/e45812 UR - http://dx.doi.org/10.2196/45812 UR - http://www.ncbi.nlm.nih.gov/pubmed/36939814 ID - info:doi/10.2196/45812 ER - TY - JOUR AU - Zaleski, Amanda AU - Sigler, Brittany AU - Leggitt, Alan AU - Choudhary, Shruti AU - Berns, Ryan AU - Rhee, Kyu AU - Schwarzwald, Heidi PY - 2023/3/14 TI - The Influence of a Wearable-Based Reward Program on Health Care Costs: Retrospective, Propensity Score?Matched Cohort Study JO - J Med Internet Res SP - e45064 VL - 25 KW - digital health intervention KW - mobile app KW - wellness KW - physical activity KW - wearable KW - cost-effectiveness KW - mobile health app KW - health plan KW - medical cost KW - health care cost N2 - Background: Mobile health (mHealth) technology holds great promise as an easily accessible and effective solution to improve population health at scale. Despite the abundance of mHealth offerings, only a minority are grounded in evidence-based practice, whereas even fewer have line of sight into population-level health care spending, limiting the clinical utility of such tools. Objective: This study aimed to explore the influence of a health plan?sponsored, wearable-based, and reward-driven digital health intervention (DHI) on health care spending over 1 year. The DHI was delivered through a smartphone-based mHealth app available only to members of a large commercial health plan and leveraged a combination of behavioral economics, user-generated sensor data from the connected wearable device, and claims history to create personalized, evidence-based recommendations for each user. Methods: This study deployed a propensity score?matched, 2-group, and pre-post observational design. Adults (?18 years of age) enrolled in a large, national commercial health plan and self-enlisted in the DHI for ?7 months were allocated to the intervention group (n=56,816). Members who were eligible for the DHI but did not enlist were propensity score?matched to the comparison group (n=56,816). Average (and relative change from baseline) medical and pharmacy spending per user per month was computed for each member of the intervention and comparison groups during the pre- (ie, 12 months) and postenlistment (ie, 7-12 months) periods using claims data. Results: Baseline characteristics and medical spending were similar between groups (P=.89). On average, the total included sample population (N=113,632) consisted of young to middle-age (mean age 38.81 years), mostly White (n=55,562, 48.90%), male (n=46,731, 41.12%) and female (n=66,482, 58.51%) participants. Compared to a propensity score?matched cohort, DHI users demonstrated approximately US $10 per user per month lower average medical spending (P=.02) with a concomitant increase in preventive care activities and decrease in nonemergent emergency department admissions. These savings translated to approximately US $6.8 million in avoidable health care costs over the course of 1 year. Conclusions: This employer-sponsored, digital health engagement program has a high likelihood for return on investment within 1 year owing to clinically meaningful changes in health-seeking behaviors and downstream medical cost savings. Future research should aim to elucidate health behavior?related mechanisms in support of these findings and continue to explore novel strategies to ensure equitable access of DHIs to underserved populations that stand to benefit the most. UR - https://www.jmir.org/2023/1/e45064 UR - http://dx.doi.org/10.2196/45064 UR - http://www.ncbi.nlm.nih.gov/pubmed/36917152 ID - info:doi/10.2196/45064 ER - TY - JOUR AU - Bian, Dongsheng AU - Xiao, Yuyin AU - Song, Keyu AU - Dong, Minye AU - Li, Li AU - Millar, Ross AU - Shi, Chenshu AU - Li, Guohong PY - 2023/3/10 TI - Determinants Influencing the Adoption of Internet Health Care Technology Among Chinese Health Care Professionals: Extension of the Value-Based Adoption Model With Burnout Theory JO - J Med Internet Res SP - e37671 VL - 25 KW - internet health care technology KW - value-based adoption model KW - employee burnout KW - China KW - health care KW - health care workers KW - internet KW - technology KW - cross-sectional study KW - burnout KW - internet hospitals N2 - Background: The global COVID-19 pandemic has been widely regarded as a catalyst for adopting internet health care technology (IHT) in China. IHT consists of new health care technologies that are shaping health services and medical consultations. Health care professionals play a substantial role in the adoption of any IHT, but the consequences of doing so can often be challenging, particularly when employee burnout is prevalent. Few studies have explored whether employee burnout influences the adoption intention of IHT in health care professionals. Objective: This study aims to explain the determinants influencing the adoption of IHT from the perspective of health care professionals. To do so, the study extends the value-based adoption model (VAM) with consideration for employee burnout as a determining factor. Methods: A cross-sectional web-based survey using a sample of 12,031 health care professionals selected through multistage cluster sampling from 3 provinces in mainland China was conducted. The hypotheses of our research model were developed based on the VAM and employee burnout theory. Structural equation modeling was then used to test the research hypotheses. Results: The results indicate that perceived usefulness, perceived enjoyment, and perceived complexity positively correlate with perceived value (?=.131, P=.01; ?=.638, P<.001; ?=.198, P<.001, respectively). Perceived value had a positive direct effect on adoption intention (?=.725, P<.001), perceived risk negatively correlated with perceived value (?=?.083, P<.001), and perceived value negatively correlated with employee burnout (?=?.308, P<.001). In addition, employee burnout was negatively related to adoption intention (?=?.170, P<.001) and mediated the relationship between perceived value and adoption intention (?=.052, P<.001). Conclusions: Perceived value, perceived enjoyment, and employee burnout were the most important determinants of IHT adoption intention by health care professionals. In addition, while employee burnout was negatively related to adoption intention, perceived value inhibited employee burnout. Therefore, this study finds that it is necessary to develop strategies to improve the perceived value and reduce employee burnout, which will benefit the promotion of the adoption intention of IHT in health care professionals. This study supports the use of the VAM and employee burnout in explaining health care professionals? adoption intention regarding IHT. UR - https://www.jmir.org/2023/1/e37671 UR - http://dx.doi.org/10.2196/37671 UR - http://www.ncbi.nlm.nih.gov/pubmed/36897630 ID - info:doi/10.2196/37671 ER - TY - JOUR AU - González-Colom, Rubèn AU - Herranz, Carmen AU - Vela, Emili AU - Monterde, David AU - Contel, Carles Joan AU - Sisó-Almirall, Antoni AU - Piera-Jiménez, Jordi AU - Roca, Josep AU - Cano, Isaac PY - 2023/2/16 TI - Prevention of Unplanned Hospital Admissions in Multimorbid Patients Using Computational Modeling: Observational Retrospective Cohort Study JO - J Med Internet Res SP - e40846 VL - 25 KW - health risk assessment KW - health risk profiles KW - transitional care KW - hospital readmissions KW - mortality N2 - Background: Enhanced management of multimorbidity constitutes a major clinical challenge. Multimorbidity shows well-established causal relationships with the high use of health care resources and, specifically, with unplanned hospital admissions. Enhanced patient stratification is vital for achieving effectiveness through personalized postdischarge service selection. Objective: The study has a 2-fold aim: (1) generation and assessment of predictive models of mortality and readmission at 90 days after discharge; and (2) characterization of patients? profiles for personalized service selection purposes. Methods: Gradient boosting techniques were used to generate predictive models based on multisource data (registries, clinical/functional and social support) from 761 nonsurgical patients admitted in a tertiary hospital over 12 months (October 2017 to November 2018). K-means clustering was used to characterize patient profiles. Results: Performance (area under the receiver operating characteristic curve, sensitivity, and specificity) of the predictive models was 0.82, 0.78, and 0.70 and 0.72, 0.70, and 0.63 for mortality and readmissions, respectively. A total of 4 patients? profiles were identified. In brief, the reference patients (cluster 1; 281/761, 36.9%), 53.7% (151/281) men and mean age of 71 (SD 16) years, showed 3.6% (10/281) mortality and 15.7% (44/281) readmissions at 90 days following discharge. The unhealthy lifestyle habit profile (cluster 2; 179/761, 23.5%) predominantly comprised males (137/179, 76.5%) with similar age, mean 70 (SD 13) years, but showed slightly higher mortality (10/179, 5.6%) and markedly higher readmission rate (49/179, 27.4%). Patients in the frailty profile (cluster 3; 152/761, 19.9%) were older (mean 81 years, SD 13 years) and predominantly female (63/152, 41.4%, males). They showed medical complexity with a high level of social vulnerability and the highest mortality rate (23/152, 15.1%), but with a similar hospitalization rate (39/152, 25.7%) compared with cluster 2. Finally, the medical complexity profile (cluster 4; 149/761, 19.6%), mean age 83 (SD 9) years, 55.7% (83/149) males, showed the highest clinical complexity resulting in 12.8% (19/149) mortality and the highest readmission rate (56/149, 37.6%). Conclusions: The results indicated the potential to predict mortality and morbidity-related adverse events leading to unplanned hospital readmissions. The resulting patient profiles fostered recommendations for personalized service selection with the capacity for value generation. UR - https://www.jmir.org/2023/1/e40846 UR - http://dx.doi.org/10.2196/40846 UR - http://www.ncbi.nlm.nih.gov/pubmed/36795471 ID - info:doi/10.2196/40846 ER - TY - JOUR AU - Bønes, Erlend AU - Granja, Conceição AU - Solvoll, Terje PY - 2023/2/9 TI - Experiences and Expectations of Information and Communication Technologies in Flexible Assertive Community Treatment Teams: Qualitative Study JO - JMIR Form Res SP - e42796 VL - 7 KW - mental health KW - FACT KW - electronic health records KW - eHealth KW - EHR KW - electronic whiteboards KW - community KW - treatment KW - qualitative KW - COVID-19 KW - patient care KW - mental illness KW - information technology KW - thematic analysis KW - data access KW - information and communication solutions KW - ICT KW - Norway KW - semistructured interviews N2 - Background: Flexible Assertive Community Treatment (FACT) is a model of integrated care for patients with long-term serious mental illness. FACT teams deliver services using assertive outreach to treat patients who can be hard to reach by the health care service, and focus on both the patient?s health and their social situation. However, in Norway, FACT team members have challenges with their information and communication (ICT) solutions. Objective: The aim of this study was to explore Norwegian FACT teams? experiences and expectations of their ICT solutions, including electronic health records, electronic whiteboards, and calendars. Methods: We gathered data in two phases. In the first phase, we conducted semistructured interviews with team leaders and team coordinators, and made observations in FACT teams targeting adults. In the second phase, we conducted semistructured group interviews in FACT teams targeting youth. We performed a thematic analysis of the data in a theoretical manner to address the specific objectives of the study. Results: A total of 8 teams were included, with 5 targeting adults and 3 targeting youth. Due to the COVID-19 pandemic, we were not able to perform observations in 2 of the teams targeting adults. Team leaders and coordinators in all 5 teams targeting adults were interviewed, with a total of 7 team members participating in the teams targeting youth. We found various challenges with communication, documentation, and organization for FACT teams. The COVID-19 pandemic was challenging for the teams and changed the way they used ICT solutions. There were issues with some technical solutions used in the teams, including electronic health records, electronic whiteboards, and calendars. Lack of integration and access to data were some of the main issues identified. Conclusions: Despite the FACT model being successfully implemented in Norway, there are several issues regarding the ICT solutions they use, mainly related to access to data and integration. Further research is required to detail how improved ICT solutions should be designed. While FACT teams targeting adults and youth differ in some ways, their needs for ICT solutions are largely similar. UR - https://formative.jmir.org/2023/1/e42796 UR - http://dx.doi.org/10.2196/42796 UR - http://www.ncbi.nlm.nih.gov/pubmed/36730062 ID - info:doi/10.2196/42796 ER - TY - JOUR AU - Wathne, Hege AU - Morken, Margreta Ingvild AU - Storm, Marianne AU - Husebø, Lunde Anne Marie PY - 2023/2/6 TI - Designing a Future eHealth Service for Posthospitalization Self-management Support in Long-term Illness: Qualitative Interview Study JO - JMIR Hum Factors SP - e39391 VL - 10 KW - colorectal cancer KW - eHealth service KW - heart failure KW - noncommunicable diseases KW - self-management KW - qualitative research KW - mobile phone N2 - Background: For patients with noncommunicable diseases (NCDs; eg, heart failure [HF] and colorectal cancer [CRC]), eHealth interventions could meet their posthospital discharge needs and strengthen their ability to self-manage. However, inconclusive evidence exists regarding how to design eHealth services to meet the complex needs of patients. To foster patient acceptability and ensure the successful development and implementation of eHealth solutions, it is beneficial to include different stakeholders (ie, patients and health care professionals) in the design and development phase of such services. The involvement of different stakeholders could contribute to ensuring feasible, acceptable, and usable solutions and that eHealth services are developed in response to users? supportive care needs when transitioning to home after hospitalization. This study is the first step of a larger complex intervention study aimed at meeting the postdischarge needs of 2 NCD populations. Objective: This study aimed to explore the perspectives of patients with HF and CRC and health care professionals on patient self-management needs following hospital discharge and investigate how a future nurse-assisted eHealth service could be best designed to foster patient acceptability, support self-management, and smooth the transition from hospital to home. Methods: A qualitative, explorative, and descriptive approach was used. We conducted 38 semistructured interviews with 10 patients with HF, 9 patients surgically treated for CRC with curative intent, 6 registered nurses recruited as nurse navigators of a planned eHealth service, and 13 general practitioners experienced in HF and CRC treatment and follow-up care. Patients were recruited conveniently from HF and CRC outpatient clinics, and the nurses were recruited from the cardiology and gastro-surgical departments at a university hospital in the southwest of Norway. The general practitioners were recruited from primary care in surrounding municipalities. Semistructured interview guides were used for data collection, and the data were analyzed using thematic analysis. Results: In total, 3 main themes were derived from the data analysis: expecting information, reassurance, and guidance when using eHealth for HF and CRC self-management; expecting eHealth to be comprehensible, supportive, and knowledge promoting; and recognizing both the advantages and disadvantages of eHealth for HF and CRC self-management. The data generated from this interview study depicted the diverse needs for self-management support of patients with CRC and HF after hospital discharge. In addition, valuable suggestions were identified regarding the design and content of the eHealth service. However, participants described both possible advantages and disadvantages of a remote eHealth service. Conclusions: This study is the first step in the development of an eHealth service for posthospitalization self-management support for long-term illnesses. It concerns patients? supportive care needs and user requirements of an eHealth service. The findings of this study may add value to the planning and development of eHealth interventions for patients with NCDs. UR - https://humanfactors.jmir.org/2023/1/e39391 UR - http://dx.doi.org/10.2196/39391 UR - http://www.ncbi.nlm.nih.gov/pubmed/36745492 ID - info:doi/10.2196/39391 ER - TY - JOUR AU - Muehlensiepen, Felix AU - Petit, Pascal AU - Knitza, Johannes AU - Welcker, Martin AU - Vuillerme, Nicolas PY - 2023/1/27 TI - Factors Associated With Telemedicine Use Among Patients With Rheumatic and Musculoskeletal Disease: Secondary Analysis of Data From a German Nationwide Survey JO - J Med Internet Res SP - e40912 VL - 25 KW - telemedicine KW - rheumatology KW - primary care KW - secondary analysis KW - health services research N2 - Background: Previous studies have demonstrated telemedicine (TM) to be an effective tool to complement rheumatology care and address workforce shortage. With the outbreak of the COVID-19 pandemic, TM experienced a massive upswing. A previous study revealed that physicians? willingness to use TM and actual use of TM are closely connected to their knowledge of TM. However, it remains unclear which factors are associated with patients? motivation to use TM. Objective: This study aims to identify the factors that determine patients? willingness to try TM (TM try) and their wish that their rheumatologists offer TM services (TM wish). Methods: We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with rheumatic and musculoskeletal disease (RMD). Bayesian univariate and multivariate logistic regression analyses were applied to the data to determine which factors were associated with TM try and TM wish. The predictor variables (covariates) studied individually included sociodemographic factors (eg, age and sex) and health characteristics (eg, disease type and health status). All the variables positively or negatively associated with TM try or TM wish in the univariate analyses were then considered for the Bayesian model averaging analysis after a selection based on the variance inflation factor (?2.5). All the analyses were stratified by sex. Results: Of the total 102 variables, 59 (57.8%) and 45 (44.1%) variables were found to be positively or negatively associated (region of practical equivalence ?5%) with TM try and TM wish, respectively. A total of 16 and 8 determinant factors were identified for TM try and TM wish, respectively. Wishing that TM services were offered by rheumatologists, having internet access at home, residing 5 to 10 km away from the general practitioner?s office, owning an electronic device, and being aged 40 to 60 years were among the factors positively associated with TM try and TM wish. By contrast, not yet being diagnosed with an RMD, having no prior knowledge of TM, having a bad health status, living in a rural area, not documenting one?s health status, not owning an electronic device, and being aged 60 to 80 years were negatively associated with TM try and TM wish. Conclusions: Our results suggest that health status, knowledge, age, and access to technical equipment and infrastructure influence the motivation of patients with RMD to use telehealth services. In particular, older patients with RMD living in rural areas, who could likely benefit from using TM, are currently not motivated to use TM and seem to need additional TM support. UR - https://www.jmir.org/2023/1/e40912 UR - http://dx.doi.org/10.2196/40912 UR - http://www.ncbi.nlm.nih.gov/pubmed/36705950 ID - info:doi/10.2196/40912 ER - TY - JOUR AU - Schnoor, Kyma AU - Versluis, Anke AU - Chavannes, H. Niels AU - Talboom-Kamp, A. Esther P. W. PY - 2023/1/26 TI - The Usability of Homelab, a Digital Self-service at a Dutch General Practice, for Diagnostic Tests: Pilot Study With a Questionnaire JO - JMIR Form Res SP - e42151 VL - 7 KW - eHealth KW - diagnostic testing KW - general practitioner KW - general practice KW - GP KW - referral KW - online testing KW - diagnostic KW - laboratory test KW - usability KW - digital health KW - health care service KW - service delivery N2 - Background: eHealth potentially can make health care more accessible and efficient and help reduce the workload in primary health care. Homelab is an eHealth tool implemented in a general practice environment, and it offers relatively simple laboratory diagnostic tests without the referral of the general practitioner. After logging in this eHealth tool, patients select and order a diagnostic test based on their symptoms. The test results are presented online to the general practitioner and the patient. Objective: This study aims to evaluate the use, usability, and user characteristics of Homelab. Further, it aims to evaluate whether Homelab replaces an appointment with the general practitioner. Methods: Homelab has been implemented since May 2021 as a pilot in a Dutch general practice. The number of requests and the ordered diagnostic packages are monitored. After using Homelab, patients are invited to complete a short questionnaire. The questionnaire contains demographic questions and assesses usability using the System Usability Scale (10 items). In addition, questions about requesting an appointment with the general practitioner without Homelab are included. All data were anonymous. Results: The questionnaire was filled by 74 individual patients. The mean age of the patients was 40.33 (SD 12.11) years, and half of them were females (39/74, 53%). The majority of the patients were highly educated (56/74, 76%) and employed (53/74, 72%). Approximately 81% (60/74) of the patients reported that they would use Homelab again in the future and 66% (49/74) reported that they would have gone to the general practitioner if they had not used Homelab. The usability of Homelab was perceived higher by the younger age group (mean 73.96, SD 14.74) than by the older age group (mean 61.59, SD 14.37). In total, 106 test packages were ordered over 1 year, and the most requested diagnostic package was ?Am I still healthy? I want to do my annual health checkup.? Homelab was used the most during the months of the COVID-19 lockdown. Conclusions: The use of Homelab, a digital self-service for ordering diagnostic tests, was monitored in this study, and its usability was perceived as above average. Our findings showed that patients are willing to use Homelab in the future and they would use it most of the time as a replacement for regular consultations. Homelab offers opportunities for more accessible and efficient health care for both the patient and the general practitioner. UR - https://formative.jmir.org/2023/1/e42151 UR - http://dx.doi.org/10.2196/42151 UR - http://www.ncbi.nlm.nih.gov/pubmed/36701183 ID - info:doi/10.2196/42151 ER - TY - JOUR AU - Lapointe-Shaw, Lauren AU - Salahub, Christine AU - Bird, Cherryl AU - Bhatia, Sacha R. AU - Desveaux, Laura AU - Glazier, H. Richard AU - Hedden, Lindsay AU - Ivers, M. Noah AU - Martin, Danielle AU - Na, Yingbo AU - Spithoff, Sheryl AU - Tadrous, Mina AU - Kiran, Tara PY - 2023/1/12 TI - Characteristics and Health Care Use of Patients Attending Virtual Walk-in Clinics in Ontario, Canada: Cross-sectional Analysis JO - J Med Internet Res SP - e40267 VL - 25 KW - virtual walk-in clinic KW - telemedicine KW - virtual care KW - primary health care KW - family practice KW - family physicians KW - Canada KW - health care use KW - emergency department KW - walk-in clinic KW - use KW - engagement KW - virtual health care KW - integration N2 - Background: Funding changes in response to the COVID-19 pandemic supported the growth of direct-to-consumer virtual walk-in clinics in several countries. Little is known about patients who attend virtual walk-in clinics or how these clinics contribute to care continuity and subsequent health care use. Objective: The objective of the present study was to describe the characteristics and measure the health care use of patients who attended virtual walk-in clinics compared to the general population and a subset that received any virtual family physician visit. Methods: This was a retrospective, cross-sectional study in Ontario, Canada. Patients who had received a family physician visit at 1 of 13 selected virtual walk-in clinics from April 1 to December 31, 2020, were compared to Ontario residents who had any virtual family physician visit. The main outcome was postvisit health care use. Results: Virtual walk-in patients (n=132,168) had fewer comorbidities and lower previous health care use than Ontarians with any virtual family physician visit. Virtual walk-in patients were also less likely to have a subsequent in-person visit with the same physician (309/132,168, 0.2% vs 704,759/6,412,304, 11%; standardized mean difference [SMD] 0.48), more likely to have a subsequent virtual visit (40,030/132,168, 30.3% vs 1,403,778/6,412,304, 21.9%; SMD 0.19), and twice as likely to have an emergency department visit within 30 days (11,003/132,168, 8.3% vs 262,509/6,412,304, 4.1%; SMD 0.18), an effect that persisted after adjustment and across urban/rural resident groups. Conclusions: Compared to Ontarians attending any family physician virtual visit, virtual walk-in patients were less likely to have a subsequent in-person physician visit and were more likely to visit the emergency department. These findings will inform policy makers aiming to ensure the integration of virtual visits with longitudinal primary care. UR - https://www.jmir.org/2023/1/e40267 UR - http://dx.doi.org/10.2196/40267 UR - http://www.ncbi.nlm.nih.gov/pubmed/36633894 ID - info:doi/10.2196/40267 ER - TY - JOUR AU - Miles, M. Lisa AU - Hawkes, E. Rhiannon AU - French, P. David PY - 2023/1/11 TI - How the Behavior Change Content of a Nationally Implemented Digital Diabetes Prevention Program Is Understood and Used by Participants: Qualitative Study of Fidelity of Receipt and Enactment JO - J Med Internet Res SP - e41214 VL - 25 KW - diabetes prevention KW - digital interventions KW - behavior change KW - fidelity KW - receipt KW - enactment KW - mobile phone N2 - Background: The National Health Service Digital Diabetes Prevention Programme (NHS-DDPP) is a program for adults in England at risk of developing type 2 diabetes mellitus (T2DM). It is based on NHS England specifications that stipulate specific behavior change techniques (BCTs), that is, active ingredients to produce behavior change to target diet and physical activity. Now rolled out nationally, the NHS-DDPP is being delivered by 4 independent providers as a 9-month intervention via apps, educational material, and remote health coaching. To optimize effectiveness, participants need to be able to understand and use behavior change content (eg, goal setting and problem solving) of an intervention delivered to them digitally. Previous research has shown that people benefit from support to aid the understanding and use of BCTs. Objective: The objectives of this qualitative study were to evaluate how participants in the NHS-DDPP understand and use BCT content, investigate how participants describe the role of health coaches in supporting their behavior change, and examine how the understanding and use of behavior change content of the NHS-DDPP varies across providers. Methods: In total, 45 service users were interviewed twice by telephone at 2 to 4 months into, and at the end of, the program. Topics included participants? understanding and use of key BCTs to support self-regulation (eg, goal setting) and the support they received via the program. Transcripts were analyzed thematically, informed by the framework method. Results: Participants described their understanding and use of some behavior change content of the program as straightforward: use of BCTs (eg, self-monitoring of behavior) delivered digitally via provider apps. Participants valued the role of health coaches in supporting their behavior change through the emotional support they offered and their direct role in delivery and application of some BCTs (eg, problem solving) to their specific circumstances. Participants expressed frustration over the lack of monitoring or feedback regarding their T2DM risk within the program. Variations in the understanding and use of behavior change content of the NHS-DDPP were present across provider programs. Conclusions: Health coaches? support in delivery of key components of the program seems to be pivotal. To improve the understanding and use of BCTs in digital interventions, it is important to consider routes of delivery that offer additional interactive human support. Understanding of some self-regulatory BCTs may benefit from this support more than others; thus, identifying the optimal mode of delivery for behavior change content is a priority for future research. The NHS-DDPP could be improved by explicitly setting out the need for health coaches to support understanding of some self-regulatory BCT content such as problem solving in the service specification and amending the discharge process so that knowledge of any change in T2DM risk is available to participants. UR - https://www.jmir.org/2023/1/e41214 UR - http://dx.doi.org/10.2196/41214 UR - http://www.ncbi.nlm.nih.gov/pubmed/36630165 ID - info:doi/10.2196/41214 ER - TY - JOUR AU - Bin, Jia Kaio AU - Santana Alves, Gabriela Patrícia AU - Costa, Raquel AU - Eiras, Cruz Paula AU - Nader de Araujo, Luciano AU - Pereira, Rodrigues Antonio José AU - Carvalho, Carlos AU - Malik, Maria Ana PY - 2023/1/11 TI - User Experience Regarding Digital Primary Health Care in Santarém, Amazon: Evaluation of Patient Satisfaction and Doctor?s Feedback JO - JMIR Form Res SP - e39034 VL - 7 KW - telemedicine KW - primary health care KW - user?s experience KW - Amazon KW - digital health KW - pilot KW - patient KW - pilot model KW - pandemic KW - medical care KW - assist KW - urban KW - community KW - Brazil KW - technology KW - consultation KW - physician KW - survey N2 - Background: With the arrival of the pandemic, telemedicine has been widely used to provide medical care and can be used to assist patients in regions far from urban centers that are difficult to access, such as riverside communities in the Brazilian Amazon region. A telemedicine project connecting São Paulo, a mega-metropolis, to Paysandú, a riverside district in the Amazon, was built to serve the local population where access to the nearest medical care is 6 hours away by speedboat. Objective: This study aims to assess the feedback from patients and doctors regarding the use of telemedicine in outpatient care at Paysandú, a riverside district in the Amazon. Methods: This is a single-center study following the guidelines ?Evaluating digital health products? from Public Health England, with local adaptations for the project and the Brazilian reality, that was conducted between São Paulo and Santarém in Brazil. A survey was carried out with patients who were treated by a doctor in the city of São Paulo, about 2500 km from the local basic health unit, between September 27 to December 15, 2021. At the end of each teleconsultation, the attending physician answered an administrative survey form, and the patient answered a satisfaction survey. Results: A total of 111 patients completed the satisfaction survey from a total of 220 consultations carried out during the period (95% CI margin error 0.22%). According to the survey, more than 95% of patients were satisfied with the service, 87.4% (n=97) had previous experience with videoconferencing, and 76.6% (n=85) reported that their demand was fully solved. Additionally, according to the hired doctor?s feedback, the average duration of the consultations was between 15 and 20 minutes. Of the 220 teleconsultations performed, 90.9% (n=200) of the demands were solved with support from the local health team, and 99.1% (n=218) of the appointments had a problem with audio or video. Conclusions: This teleconsultation project between São Paulo and Paysandú showed that it is possible to offer medical care from more developed locations to communities far from urban centers, as is the case with Paysandú District. Beyond the feasibility of the infrastructure, acceptance and satisfaction among patients were high. This health care supply model has proven to be functional and should be expanded nationally or perhaps internationally to regions lacking medical assistance. Escalation of the project does not seem too difficult once infrastructure issues are solved. UR - https://formative.jmir.org/2023/1/e39034 UR - http://dx.doi.org/10.2196/39034 UR - http://www.ncbi.nlm.nih.gov/pubmed/36630164 ID - info:doi/10.2196/39034 ER - TY - JOUR AU - Yu, Tianzhi AU - Jin, Chunjie AU - Wu, Xiaodan AU - Yue, Dianmin PY - 2023/1/6 TI - Implementation of Shared Decision-Making Within Internet Hospitals in China Based on Patients? Needs: Feasibility Study and Content Analysis JO - JMIR Form Res SP - e39965 VL - 7 KW - internet hospital KW - shared decision-making between doctors and patients KW - patient needs KW - feasibility N2 - Background: Internet hospitals are developing rapidly in China, and their convenient and efficient medical services are being increasingly recognized by patients. Many hospitals have set up their own internet hospitals to provide web-based medical services. Tianjin Medical University General Hospital has established a multidisciplinary and comprehensive internet hospital to provide diversified medical services according to the needs of patients. A way to further improve web-based medical services is by examining how shared decision-making (SDM) can be carried out in internet hospital diagnosis and treatment services, thereby improving patients? medical experience. Objective: The aim of this study was to analyze the feasibility of implementing doctor-patient SDM in internet hospital diagnosis and treatment services based on patients? needs in China. Methods: In this study, the medical data of 10 representative departments in the internet hospital of Tianjin Medical University General Hospital from January 1 to January 31, 2022, were extracted as a whole; 25,266 cases were selected. After excluding 2056 cases with incomplete information, 23,210 cases were finally included in this study. A chi-square test was performed to analyze the characteristics and medical service needs of internet hospital patients in order to identify the strengths of SDM in internet hospitals. Results: The internet hospital patients from 10 clinical departments were significantly different in terms of gender (?29=3425.6; P<.001), age (?236=27,375.8; P<.001), mode of payment (?29=3501.1; P<.001), geographic distribution (?29=347.2; P<.001), and duration of illness (?236=2863.3; P<.001). Patient medical needs included drug prescriptions, examination prescriptions, medical record explanations, drug use instructions, prehospitalization preparations, further consultations with doctors (unspecified purpose), treatment plan consultations, initial diagnoses based on symptoms, and follow-up consultations after discharge. The medical needs of the patients in different clinical departments were significantly different (?272=8465.5; P<.001). Conclusions: Our study provides a practical and theoretical basis for the feasibility of doctor-patient SDM in internet hospitals and offers some implementation strategies. We focus on the application of SDM in web-based diagnosis and treatment in internet hospitals rather than on a disease or a disease management software. The medical service needs of different patient groups can be effectively obtained from an internet hospital, which provides the practical conditions for the promotion of doctor-patient SDM. Our findings show that the internet hospital platform expands the scope of SDM and is a new way for the large-scale application of doctor-patient SDM. UR - https://formative.jmir.org/2023/1/e39965 UR - http://dx.doi.org/10.2196/39965 UR - http://www.ncbi.nlm.nih.gov/pubmed/36607710 ID - info:doi/10.2196/39965 ER - TY - JOUR AU - Yabumoto, Megan AU - Miller, Emily AU - Rao, Anoushka AU - Tabor, K. Holly AU - Ormond, E. Kelly AU - Halley, C. Meghan PY - 2022/12/21 TI - Perspectives of Rare Disease Social Media Group Participants on Engaging With Genetic Counselors: Mixed Methods Study JO - J Med Internet Res SP - e42084 VL - 24 IS - 12 KW - social media KW - rare disease KW - genetic counseling KW - genetics KW - genomics KW - delivery of health care N2 - Background: Social media provides a potential avenue for genetic counselors to address gaps in access to reliable genetics information for rare disease communities. However, only limited research has examined patient and family attitudes toward engaging with genetic counselors through social media. Objective: Our study assessed the attitudes of members of rare disease social media groups toward engaging with genetic counselors through social media, characteristics associated with greater interest, and the benefits and potential pitfalls of various approaches to such engagement. Methods: We conducted a mixed methods survey of patients and family members recruited from a systematic sample of rare disease Facebook groups. Patient characteristics and their associations with interest in engagement with genetic counselors were evaluated using univariate and bivariate statistics. Responses to open-ended questions were analyzed using thematic content analysis. Results: In total, 1053 individuals from 103 rare disease groups participated. The median overall interest in engaging with genetic counselors on social media was moderately high at 7.0 (IQR 4.0-9.0, range 0-10). No past experience with a genetic counselor was associated with greater interest in engaging with one through social media (µ=6.5 vs 6.0, P=.04). Participants expressed greatest interest (median 9.0, IQR 5.0-10.0) in engagement models allowing direct communication with genetic counselors, which was corroborated by the majority (n=399, 61.3%) of individuals who responded to open-ended questions explicitly stating their interest in 1-on-1 interactions. When asked what forms of support they would request from genetic counselors through social media, participants desired individualized support and information about how to access services. However, participants also expressed concerns regarding privacy and confidentiality. Conclusions: Patients and family members in rare disease social media groups appear interested in engaging with genetic counselors through social media, particularly for individualized support. This form of engagement on social media is not meant to replace the current structure and content of genetic counseling (GC) services, but genetic counselors could more actively use social media as a communication tool to address gaps in knowledge and awareness about genetics services and gaps in accessible patient information. Although encouraging, concerns regarding privacy and feasibility require further consideration, pointing to the need for professional guidelines in this area. UR - https://www.jmir.org/2022/12/e42084 UR - http://dx.doi.org/10.2196/42084 UR - http://www.ncbi.nlm.nih.gov/pubmed/36542454 ID - info:doi/10.2196/42084 ER - TY - JOUR AU - Pigott, Sarah Jennifer AU - Armstrong, Megan AU - Chesterman, Elizabeth AU - Read, Joy AU - Nimmons, Danielle AU - Walters, Kate AU - Davies, Nathan AU - Schrag, Anette PY - 2022/12/2 TI - Remote Consultations for People With Parkinson Disease and Cognitive Impairment: Interview Study With Patients, Caregivers, and Health Care Professionals JO - JMIR Neurotech SP - e39974 VL - 1 IS - 1 KW - remote consultations KW - telehealth KW - telemedicine KW - Parkinson disease KW - cognitive impairment KW - Parkinson dementia KW - neurodegenerative condition KW - telephone appointments KW - video appointments KW - qualitative N2 - Background: The COVID-19 pandemic led to many consultations being conducted remotely. Cognitive impairment is recognized as a potential barrier to remote health care interactions and is common and heterogeneous in Parkinson disease. Studies have shown remote consultations in Parkinson disease to be feasible, but little is known about real-life experience, especially for those with cognitive impairment. We explored the experiences and perceptions of remote consultations for people with Parkinson disease and cognitive impairment. Objective: This study aimed to explore the experiences of remote consultations for people with Parkinson disease and cognitive impairment from the perspective of service users and professionals and investigate considerations for future service delivery. Methods: Semistructured interviews were conducted remotely with 11 people with Parkinson disease and cognitive impairment, 10 family caregivers, and 24 health care professionals (HCPs) between 2020 and 2021. Purposive sampling was used. Interviews were audio-recorded, transcribed, and analyzed using reflexive thematic analysis. Results: Overall, four themes were identified: ?the nature of remote interactions,? ?challenges exacerbated by being remote,? ?expectation versus reality,? and ?optimizing for the future.? Remote consultations were considered as ?transactional? and less personal, with difficulties in building rapport, and considered to play a different role from that of in-person consultations. The loss of nonverbal communication and ability of HCPs to sense led to remote consultations being perceived as riskier by all groups. Issues arising from communication and cognitive impairment, balancing the voices of the person with Parkinson disease and the caregiver, and discussions of the future affect this population specifically. Remote consultations were reported to have been more successful than anticipated in all 3 groups. Obstacles were not always as expected; for example, age was less of a barrier than predicted. Video consultations were perceived as being preferable to telephone consultations by many participants, but not accessible to all people with Parkinson disease. With widespread expectation of ongoing remote consultations, potential improvements for these 3 groups and health care services were identified, including practice, preparation, increased awareness of issues, expectation management by HCPs, and more time and flexibility for consultations. Conclusions: Advantages and challenges of remote consultations for this population are identified. Consultations could be improved with increased support, practice, preparation, awareness of issues, and more time and flexibility within services. UR - https://neuro.jmir.org/2022/1/e39974 UR - http://dx.doi.org/10.2196/39974 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/39974 ER - TY - JOUR AU - Kim, Sunghak AU - Park, Young Jin AU - Chung, Kyungmi PY - 2022/11/30 TI - The Relationship Between the Big Five Personality Traits and the Theory of Planned Behavior in Using Mindfulness Mobile Apps: Cross-sectional Survey JO - J Med Internet Res SP - e39501 VL - 24 IS - 11 KW - personality traits KW - Theory of Planned Behavior KW - mindfulness KW - mobile apps KW - mental health N2 - Background: Mindfulness has emerged as a promising approach toward improving mental health. Interest in mindfulness mobile app services has also increased in recent years. Understanding the determinants of mindfulness behavior is essential to predict people?s utilization of mindfulness mobile apps and beneficial for developing and implementing relevant intervention strategies. Nevertheless, little has been done to determine the predictors of mindfulness behavior. Objective: This study investigates the association between the Big Five personality traits and the Theory of Planned Behavior (TPB) variables in the context of using mindfulness mobile apps to explore the potential indirect effects of conscientiousness and neuroticism on people?s behavioral intention for mindfulness, mediated by their attitude toward mindfulness, subjective norm about mindfulness, and perceived behavior control over mindfulness. Methods: The authors conducted an online, cross-sectional survey in December 2021. Structural equation modeling was conducted to evaluate the overall model fit and test possible linkages among conscientiousness, neuroticism, attitude toward mindfulness, subjective norm about mindfulness, perceived behavior control over mindfulness, and behavioral intention for mindfulness. Bootstrapping mediation analyses were also conducted to test the potential mediating effect in the model. Results: A total of 297 Korean participants? responses (153 males and 144 females) were analyzed. The proposed model had a good fit. Conscientiousness was correlated with attitude toward mindfulness (?=.384, P<.001), subjective norm about mindfulness (?=.249, P<.001), and perceived behavior control over mindfulness (?=.443, P<.001). Neuroticism was not correlated with attitude toward mindfulness (?=?.072, P=.28), but was correlated with subjective norm about mindfulness (?=.217, P=.003) and perceived behavior control over mindfulness (?=?.235, P<.001). Attitude toward mindfulness (?=.508, P<.001), subjective norm about mindfulness (?=.132, P=.01), and perceived behavior control over mindfulness (?=.540, P<.001) were separately correlated with behavioral intention for mindfulness. Conscientiousness was not directly correlated with behavioral intention for mindfulness (?=?.082, P=.27), whereas neuroticism was directly correlated with behavioral intention for mindfulness (?=.194, P=.001). Conscientiousness was indirectly linked with behavioral intention for mindfulness through attitude toward mindfulness (B=0.171, 95% CI 0.103-0.251) and perceived behavior control over mindfulness (B=0.198, 95% CI 0.132-0.273) but not through subjective norm about mindfulness (B=0.023, 95% CI ?0.002 to 0.060). Neuroticism was indirectly linked with behavioral intention for mindfulness via perceived behavior control over mindfulness (B=?0.138, 95% CI ?0.197 to ?0.088) but not via subjective norm about mindfulness (B=0.021, 95% CI ?0.002 to 0.059). Conclusions: The results show that the integration of the Big Five personality traits and TPB constructs is useful in predicting the use of mindfulness mobile apps. Focusing on conscientiousness and neuroticism in developing information dissemination and implementation strategies for enhancing mindfulness behavior using mobile apps may lead to the successful promotion of mindfulness mobile apps and adherence to mindfulness techniques. UR - https://www.jmir.org/2022/11/e39501 UR - http://dx.doi.org/10.2196/39501 UR - http://www.ncbi.nlm.nih.gov/pubmed/36449344 ID - info:doi/10.2196/39501 ER - TY - JOUR AU - Lear, Rachael AU - Freise, Lisa AU - Kybert, Matthew AU - Darzi, Ara AU - Neves, Luisa Ana AU - Mayer, K. Erik PY - 2022/11/17 TI - Perceptions of Quality of Care Among Users of a Web-Based Patient Portal: Cross-sectional Survey Analysis JO - J Med Internet Res SP - e39973 VL - 24 IS - 11 KW - electronic health records KW - personal health records KW - patient participation KW - patient safety KW - care quality KW - digital health literacy N2 - Background: Web-based patient portals enable patients access to, and interaction with, their personal electronic health records. However, little is known about the impact of patient portals on quality of care. Users of patient portals can contribute important insights toward addressing this knowledge gap. Objective: We aimed to describe perceived changes in the quality of care among users of a web-based patient portal and to identify the characteristics of patients who perceive the greatest benefit of portal use. Methods: A cross-sectional web-based survey study was conducted to understand patients? experiences with the Care Information Exchange (CIE) portal. Patient sociodemographic data were collected, including age, sex, ethnicity, educational level, health status, geographic location, motivation to self-manage, and digital health literacy (measured by the eHealth Literacy Scale). Patients with experience using CIE, who specified both age and sex, were included in these analyses. Relevant survey items (closed-ended questions) were mapped to the Institute of Medicine?s 6 domains of quality of care. Users? responses were examined to understand their perceptions of how portal use has changed the overall quality of their care, different aspects of care related to the 6 domains of care quality, and patient?s satisfaction with care. Multinomial logistic regression analyses were performed to identify patient characteristics associated with perceived improvements in overall care quality and greater satisfaction with care. Results: Of 445 CIE users, 38.7% (n=172) reported that the overall quality of their care was better; 3.2% (n=14) said their care was worse. In the patient centeredness domain, 61.2% (273/445) of patients felt more in control of their health care, and 53.9% (240/445) felt able to play a greater role in decision-making. Regarding timeliness, 40.2% (179/445) of patients reported they could access appointments, diagnoses, and treatment more quickly. Approximately 30% of CIE users reported better care related to the domains of effectiveness (123/445, 27.6%), safety (138/445, 31%), and efficiency (174/445, 28.6%). Regarding equity, patients self-reporting higher digital health literacy (odds ratio 2.40, 95% CI 1.07-5.42; P=.03) and those belonging to ethnic minority groups (odds ratio 2.27, 95% CI 1.26-3.73; P<.005) were more likely to perceive improvements in care quality. Across ethnic groups, Asian and British Asian patients perceived the greatest benefits. Increased frequency of CIE use also predicted perceived better care quality and greater satisfaction with care. Conclusions: A large proportion of CIE users perceived better care quality and greater satisfaction with care, although many portal users reported no change. The most favorable perceived improvements related to the domain of patient centeredness. With national policy directed toward addressing health disparities, patient portals could be valuable in improving care quality for ethnic minority groups. Future research should test the causal relationship between patient portal use and care quality. UR - https://www.jmir.org/2022/11/e39973 UR - http://dx.doi.org/10.2196/39973 UR - http://www.ncbi.nlm.nih.gov/pubmed/36394922 ID - info:doi/10.2196/39973 ER - TY - JOUR AU - von Wedel, Philip AU - Hagist, Christian AU - Liebe, Jan-David AU - Esdar, Moritz AU - Hübner, Ursula AU - Pross, Christoph PY - 2022/11/10 TI - Effects of Hospital Digitization on Clinical Outcomes and Patient Satisfaction: Nationwide Multiple Regression Analysis Across German Hospitals JO - J Med Internet Res SP - e40124 VL - 24 IS - 11 KW - health care information technology KW - electronic health records KW - hospital digitization KW - quality of care KW - clinical outcomes KW - patient satisfaction KW - user-perceived value N2 - Background: The adoption of health information technology (HIT) by health care providers is commonly believed to improve the quality of care. Policy makers in the United States and Germany follow this logic and deploy nationwide HIT adoption programs to fund hospital investments in digital technologies. However, scientific evidence for the beneficial effects of HIT on care quality at a national level remains mostly US based, is focused on electronic health records (EHRs), and rarely accounts for the quality of digitization from a hospital user perspective. Objective: This study aimed to examine the effects of digitization on clinical outcomes and patient experience in German hospitals. Hence, this study adds to the small stream of literature in this field outside the United States. It goes beyond assessing the effects of mere HIT adoption and also considers user-perceived HIT value. In addition, the impact of a variety of technologies beyond EHRs was examined. Methods: Multiple linear regression models were estimated using emergency care outcomes, elective care outcomes, and patient satisfaction as dependent variables. The adoption and user-perceived value of HIT represented key independent variables, and case volume, hospital size, ownership status, and teaching status were included as controls. Care outcomes were captured via risk-adjusted, observed-to-expected outcome ratios for patients who had stroke, myocardial infarction, or hip replacement. The German Patient Experience Questionnaire of Weisse Liste provided information on patient satisfaction. Information on the adoption and user-perceived value of 10 subdomains of HIT and EHRs was derived from the German 2020 Healthcare IT Report. Results: Statistical analysis was based on an overall sample of 383 German hospitals. The analyzed data set suggested no significant effect of HIT or EHR adoption on clinical outcomes or patient satisfaction. However, a higher user-perceived value or quality of the installed tools did improve outcomes. Emergency care outcomes benefited from user-friendly overall digitization (?=?.032; P=.04), which was especially driven by the user-friendliness of admission HIT (?=?.023; P=.07). Elective care outcomes were positively impacted by user-friendly EHR installations (?=?.138; P=.008). Similarly, the results suggested user-friendly, overall digitization to have a moderate positive effect on patient satisfaction (?=?.009; P=.01). Conclusions: The results of this study suggest that hospital digitization is not an end in itself. Policy makers and hospitals are well advised to not only focus on the mere adoption of digital technologies but also continuously work toward digitization that is perceived as valuable by physicians and nurses who rely on it every day. Furthermore, hospital digitization strategies should consider that the assumed benefits of single technologies are not realized across all care domains. UR - https://www.jmir.org/2022/11/e40124 UR - http://dx.doi.org/10.2196/40124 UR - http://www.ncbi.nlm.nih.gov/pubmed/36355423 ID - info:doi/10.2196/40124 ER - TY - JOUR AU - Li, Xingyi AU - Xie, Shirong AU - Ye, Zhengqiang AU - Ma, Shishi AU - Yu, Guangjun PY - 2022/11/7 TI - Investigating Patients' Continuance Intention Toward Conversational Agents in Outpatient Departments: Cross-sectional Field Survey JO - J Med Internet Res SP - e40681 VL - 24 IS - 11 KW - conversational agent KW - continuance intention KW - expectation-confirmation model KW - partial least squares KW - structural equation modeling KW - chatbot KW - virtual assistant KW - cross-sectional KW - field study KW - optimization KW - outpatient KW - interview KW - qualitative KW - questionnaire KW - satisfaction KW - perceived usefulness KW - intention KW - adoption KW - attitude KW - perception N2 - Background: Conversational agents (CAs) have been developed in outpatient departments to improve physician-patient communication efficiency. As end users, patients? continuance intention is essential for the sustainable development of CAs. Objective: The aim of this study was to facilitate the successful usage of CAs by identifying key factors influencing patients? continuance intention and proposing corresponding managerial implications. Methods: This study proposed an extended expectation-confirmation model and empirically tested the model via a cross-sectional field survey. The questionnaire included demographic characteristics, multiple-item scales, and an optional open-ended question on patients? specific expectations for CAs. Partial least squares structural equation modeling was applied to assess the model and hypotheses. The qualitative data were analyzed via thematic analysis. Results: A total of 172 completed questionaries were received, with a 100% (172/172) response rate. The proposed model explained 75.5% of the variance in continuance intention. Both satisfaction (?=.68; P<.001) and perceived usefulness (?=.221; P=.004) were significant predictors of continuance intention. Patients' extent of confirmation significantly and positively affected both perceived usefulness (?=.817; P<.001) and satisfaction (?=.61; P<.001). Contrary to expectations, perceived ease of use had no significant impact on perceived usefulness (?=.048; P=.37), satisfaction (?=?.004; P=.63), and continuance intention (?=.026; P=.91). The following three themes were extracted from the 74 answers to the open-ended question: personalized interaction, effective utilization, and clear illustrations. Conclusions: This study identified key factors influencing patients? continuance intention toward CAs. Satisfaction and perceived usefulness were significant predictors of continuance intention (P<.001 and P<.004, respectively) and were significantly affected by patients? extent of confirmation (P<.001 and P<.001, respectively). Developing a better understanding of patients? continuance intention can help administrators figure out how to facilitate the effective implementation of CAs. Efforts should be made toward improving the aspects that patients reasonably expect CAs to have, which include personalized interactions, effective utilization, and clear illustrations. UR - https://www.jmir.org/2022/11/e40681 UR - http://dx.doi.org/10.2196/40681 UR - http://www.ncbi.nlm.nih.gov/pubmed/36342768 ID - info:doi/10.2196/40681 ER - TY - JOUR AU - Lee, Katherine AU - Bolton, Shay-Lee AU - Shterenberg, Ravit AU - Bolton, M. James AU - Hensel, M. Jennifer PY - 2022/11/4 TI - Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study JO - JMIR Form Res SP - e39861 VL - 6 IS - 11 KW - virtual ward KW - mental health KW - COVID-19 KW - implementation KW - driver diagram KW - virtual care KW - virtual health care KW - acceptance KW - psychiatric support KW - crisis support KW - provider perspectives N2 - Background: The COVID-19 pandemic was accompanied by the accelerated uptake of virtual care, leading to a proliferation of virtual ward models as alternatives to facility-based care. Early in the pandemic, our program implemented a virtual mental health crisis ward (vWard) to provide options for individuals requiring intense psychiatric and/or crisis support but who preferred to remain in the community and were deemed safe to do so. Objective: The aim of this study was to identify early learnings from the vWard, which was implemented rapidly in a resource-constrained environment, to inform the future state should it be sustained beyond the pandemic. Methods: Mixed methods of data collection were used to evaluate provider perspectives on the vWard, develop archetypes for individuals who are a good fit for the vWard model, and create a driver diagram. Data sources included an anonymous survey of clinical and managerial staff involved in the vWard, a service planning workshop, and program discharge forms for all individuals admitted between March 2020 and April 2021. Survey responses were coded for themes under categories of ?benefits? and ?challenges.? Discharge forms where the team indicated that the vWard was a good fit for an individual were examined for characteristics common to these admissions. These findings were reviewed in the service planning workshop and refined with input from the participants into patient archetypes. A driver diagram was created for the future state. Results: Survey respondents (N=60) represented diverse roles in crisis services and the vWard team. Ten providers took part in the service planning workshop. A total of 467 discharge forms were reviewed. The vWard was felt to be a model that worked by 39 survey respondents, one respondent felt it did not work, and the remaining participants had no response. Several benefits for the individual and the system were identified alongside challenges, including certain processes and materials related to the nature of rapid implementation during the pandemic, and others due to lack of fit for certain individuals. The model was felt to be a good fit for 67.5% of admissions. Four patient archetypes representing a good fit with the model were developed. The driver diagram connected the program aim with primary drivers of (1) reduce barriers to care; (2) improve outcomes; and (3) provide collaborative, patient- and family-centered care to secondary drivers and interventions that leveraged virtual technology among other crisis care interventions. Conclusions: Despite some challenges, the vWard demonstrated high levels of provider acceptance and a range of mechanisms by which the model works for a variety of patient archetypes. These early learnings provide a foundation for growth, sustainability, and spread of this model going forward beyond the pandemic. UR - https://formative.jmir.org/2022/11/e39861 UR - http://dx.doi.org/10.2196/39861 UR - http://www.ncbi.nlm.nih.gov/pubmed/36252139 ID - info:doi/10.2196/39861 ER - TY - JOUR AU - Imai, Chisato AU - Amin, Janaki AU - Prgomet, Mirela AU - Pearce, Christopher AU - Georgiou, Andrew PY - 2022/10/18 TI - An Increase in Antibiotic Prescribing for Respiratory Tract Infections Through Telehealth Consultations: Retrospective Study in Australian General Practice JO - J Med Internet Res SP - e40876 VL - 24 IS - 10 KW - general practice KW - anti-infective agents KW - antibiotics KW - medication KW - prescriptions KW - respiratory tract infections KW - infection KW - telehealth KW - telemedicine KW - Australia UR - https://www.jmir.org/2022/10/e40876 UR - http://dx.doi.org/10.2196/40876 UR - http://www.ncbi.nlm.nih.gov/pubmed/36256826 ID - info:doi/10.2196/40876 ER - TY - JOUR AU - Messner, Eva-Maria AU - Sturm, Niklas AU - Terhorst, Yannik AU - Sander, B. Lasse AU - Schultchen, Dana AU - Portenhauser, Alexandra AU - Schmidbaur, Simone AU - Stach, Michael AU - Klaus, Jochen AU - Baumeister, Harald AU - Walter, M. Benjamin PY - 2022/10/5 TI - Mobile Apps for the Management of Gastrointestinal Diseases: Systematic Search and Evaluation Within App Stores JO - J Med Internet Res SP - e37497 VL - 24 IS - 10 KW - gastrointestinal diseases KW - mHealth KW - mobile health KW - MARS KW - Mobile Application Rating Scale KW - systematic review KW - app quality KW - gastrointestinal KW - mobile app KW - app N2 - Background: Gastrointestinal diseases are associated with substantial cost in health care. In times of the COVID-19 pandemic and further digitalization of gastrointestinal tract health care, mobile health apps could complement routine health care. Many gastrointestinal health care apps are already available in the app stores, but the quality, data protection, and reliability often remain unclear. Objective: This systematic review aimed to evaluate the quality characteristics as well as the privacy and security measures of mobile health apps for the management of gastrointestinal diseases. Methods: A web crawler systematically searched for mobile health apps with a focus on gastrointestinal diseases. The identified mobile health apps were evaluated using the Mobile Application Rating Scale (MARS). Furthermore, app characteristics, data protection, and security measures were collected. Classic user star rating was correlated with overall mobile health app quality. Results: The overall quality of the mobile health apps (N=109) was moderate (mean 2.90, SD 0.52; on a scale ranging from 1 to 5). The quality of the subscales ranged from low (mean 1.89, SD 0.66) to good (mean 4.08, SD 0.57). The security of data transfer was ensured only by 11 (10.1%) mobile health apps. None of the mobile health apps had an evidence base. The user star rating did not correlate with the MARS overall score or with the individual subdimensions of the MARS (all P>.05). Conclusions: Mobile health apps might have a positive impact on diagnosis, therapy, and patient guidance in gastroenterology in the future. We conclude that, to date, data security and proof of efficacy are not yet given in currently available mobile health apps. UR - https://www.jmir.org/2022/10/e37497 UR - http://dx.doi.org/10.2196/37497 UR - http://www.ncbi.nlm.nih.gov/pubmed/36197717 ID - info:doi/10.2196/37497 ER - TY - JOUR AU - El-Dassouki, Noor AU - Pfisterer, Kaylen AU - Benmessaoud, Camila AU - Young, Karen AU - Ge, Kelly AU - Lohani, Raima AU - Saragadam, Ashish AU - Pham, Quynh PY - 2022/9/7 TI - The Value of Technology to Support Dyadic Caregiving for Individuals Living With Heart Failure: Qualitative Descriptive Study JO - J Med Internet Res SP - e40108 VL - 24 IS - 9 KW - heart failure KW - digital therapeutics KW - remote patient management KW - caregiving KW - dyadic management N2 - Background: The demand for health services to meet the chronic health needs of the aging population is significant and remains unmet because of the limited supply of clinical resources. Specifically, in managing heart failure (HF), digital health sought to address this gap during the COVID-19 pandemic but highlighted an access issue for those who could not use technology-mediated health care services without the support of their informal caregivers (ICs). The complexity of managing HF symptoms and recurrent exacerbations requires many patients to comanage their illness with their ICs in a care dyad, working together to optimize patient outcomes and health-related quality of life. However, most HF programs have missed the opportunity to consider the dyadic perspective despite interdependencies on HF outcomes. Objective: This study aims to characterize the value of technology in supporting caregiving for individuals living with HF. Methods: Motivated by an observed unique pattern of engagement in patients enrolled in our Medly HF management program at the Peter Munk Cardiac Centre in Toronto, Canada, we conducted 20 semistructured interviews with a convenience sample of ICs. All interviews were analyzed using the iterative refinement of a codeveloped codebook. The team maintained reflexivity journals to reflect the impact of their positionality on their coding. Themes were first derived deductively using HF typologies (patient-oriented dyads, caregiver-oriented dyads, and collaboratively oriented dyads) and then inductively refined and recategorized based on concepts from the van Houtven et al framework. Results: We believe that there is a need to formally and intentionally expand HF technologies to include dyadic needs and goals. We suggest defining 3 opportunities in which value can be added to technological design. First, identify how technology may be leveraged to increase psychological bandwidth by reducing uncertainty and providing peace of mind. We found that actionable feedback was highly desired by both partners. Second, develop technology that can serve as a member of the dyad?s support system. In our experience, automated prompts for patients to take measurements can mimic the support typically provided by ICs and ease their workload. Third, consider how technology can mitigate the dyad?s clinical knowledge requirements and learning curve. Our approach includes real-time actionable feedback paired with a human-in-the-loop, nurse-led model of care. Conclusions: Our findings identified a need to focus on improving the dyadic experience as a whole by building IC functionality into digital health self-management interventions. Through a shared model of care that supports the role of the patient in their own HF management, includes ICs to expand and enhance the patient?s capacity to care, and acknowledges the need of ICs to care for themselves, we anticipate improved outcomes for both partners. UR - https://www.jmir.org/2022/9/e40108 UR - http://dx.doi.org/10.2196/40108 UR - http://www.ncbi.nlm.nih.gov/pubmed/36069782 ID - info:doi/10.2196/40108 ER - TY - JOUR AU - Mathiasen, Kim AU - Andersen, E. Tonny AU - Lichtenstein, Beck Mia AU - Ehlers, Holger Lars AU - Riper, Heleen AU - Kleiboer, Annet AU - Roessler, K. Kirsten PY - 2022/9/7 TI - The Clinical Effectiveness of Blended Cognitive Behavioral Therapy Compared With Face-to-Face Cognitive Behavioral Therapy for Adult Depression: Randomized Controlled Noninferiority Trial JO - J Med Internet Res SP - e36577 VL - 24 IS - 9 KW - depression KW - depressive disorder, major KW - cognitive therapy KW - CBT KW - treatment outcome KW - blended care KW - blended cognitive behavioral therapy KW - effectiveness KW - Denmark N2 - Background: Internet-based cognitive behavioral therapy (iCBT) has been demonstrated to be cost- and clinically effective. There is a need, however, for increased therapist contact for some patient groups. Combining iCBT with traditional face-to-face (FtF) consultations in a blended format may produce a new treatment format (B-CBT) with multiple benefits from both traditional CBT and iCBT, such as individual adaptation, lower costs than traditional therapy, wide geographical and temporal availability, and possibly lower threshold to implementation. Objective: The primary aim of this study is to compare directly the clinical effectiveness of B-CBT with FtF-CBT for adult major depressive disorder. Methods: A 2-arm randomized controlled noninferiority trial compared B-CBT for adult depression with treatment as usual (TAU). The trial was researcher blinded (unblinded for participants and clinicians). B-CBT comprised 6 sessions of FtF-CBT alternated with 6-8 web-based CBT self-help modules. TAU comprised 12 sessions of FtF-CBT. All participants were aged 18 or older and met the diagnostic criteria for major depressive disorder and were recruited via a national iCBT clinic. The primary outcome was change in depression severity on the 9-item Patient Health Questionnaire (PHQ-9). Secondary analyses included client satisfaction (8-item Client Satisfaction Questionnaire [CSQ-8]), patient expectancy (Credibility and Expectancy Questionnaire [CEQ]), and working (Working Alliance Inventory [WAI] and Technical Alliance Inventory [TAI]). The primary outcome was analyzed by a mixed effects model including all available data from baseline, weekly measures, 3-, 6, and 12-month follow-up. Results: A total of 76 individuals were randomized, with 38 allocated to each treatment group. Age ranged from 18 to 71 years (SD 13.96) with 56 (74%) females. Attrition rate was 20% (n=15), which was less in the FtF-CBT group (n=6, 16%) than in the B-CBT group (n=9, 24%). As many as 53 (70%) completed 9 or more sessions almost equally distributed between the groups (nFtF-CBT=27, 71%; nB-CBT=26, 68%). PHQ-9 reduced 11.38 points in the FtF-CBT group and 8.10 in the B-CBT group. At 6 months, the mean difference was a mere 0.17 points. The primary analyses confirmed large and significant within-group reductions in both groups (FtF-CBT: ?=?.03; standard error [SE] 0.00; P<.001 and B-CBT: ?=?.02; SE 0.00; P<.001). A small but significant interaction effect was observed between groups (?=.01; SE 0.00; P=.03). Employment status influenced the outcome differently between groups, where the B-CBT group was seen to profit more from not being full-time employed than the FtF group. Conclusions: With large within-group effects in both treatment arms, the study demonstrated feasibility of B-CBT in Denmark. At 6 months? follow-up, there appeared to be no difference between the 2 treatment formats, with a small but nonsignificant difference at 12 months. The study seems to demonstrate that B-CBT is capable of producing treatment effects that are close to FtF-CBT and that completion rates and satisfaction rates were comparable between groups. However, the study was limited by small sample size and should be interpreted with caution. Trial Registration: ClinicalTrials.gov NCT02796573; https://clinicaltrials.gov/ct2/show/NCT02796573 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-016-1140-y UR - https://www.jmir.org/2022/9/e36577 UR - http://dx.doi.org/10.2196/36577 UR - http://www.ncbi.nlm.nih.gov/pubmed/36069798 ID - info:doi/10.2196/36577 ER - TY - JOUR AU - Partogi, Michelle AU - Gaviria-Valencia, Simon AU - Alzate Aguirre, Mateo AU - Pick, J. Nancy AU - Bhopalwala, M. Huzefa AU - Barry, A. Barbara AU - Kaggal, C. Vinod AU - Scott, G. Christopher AU - Kessler, E. Maya AU - Moore, M. Matthew AU - Mitchell, D. Jay AU - Chaudhry, Rajeev AU - Bonacci, P. Robert AU - Arruda-Olson, M. Adelaide PY - 2022/8/22 TI - Sociotechnical Intervention for Improved Delivery of Preventive Cardiovascular Care to Rural Communities: Participatory Design Approach JO - J Med Internet Res SP - e27333 VL - 24 IS - 8 KW - sociotechnical KW - secondary prevention KW - atherosclerotic cardiovascular diseases KW - community health KW - rural health KW - participatory design KW - team-based care N2 - Background: Clinical practice guidelines recommend antiplatelet and statin therapies as well as blood pressure control and tobacco cessation for secondary prevention in patients with established atherosclerotic cardiovascular diseases (ASCVDs). However, these strategies for risk modification are underused, especially in rural communities. Moreover, resources to support the delivery of preventive care to rural patients are fewer than those for their urban counterparts. Transformative interventions for the delivery of tailored preventive cardiovascular care to rural patients are needed. Objective: A multidisciplinary team developed a rural-specific, team-based model of care intervention assisted by clinical decision support (CDS) technology using participatory design in a sociotechnical conceptual framework. The model of care intervention included redesigned workflows and a novel CDS technology for the coordination and delivery of guideline recommendations by primary care teams in a rural clinic. Methods: The design of the model of care intervention comprised 3 phases: problem identification, experimentation, and testing. Input from team members (n=35) required 150 hours, including observations of clinical encounters, provider workshops, and interviews with patients and health care professionals. The intervention was prototyped, iteratively refined, and tested with user feedback. In a 3-month pilot trial, 369 patients with ASCVDs were randomized into the control or intervention arm. Results: New workflows and a novel CDS tool were created to identify patients with ASCVDs who had gaps in preventive care and assign the right care team member for delivery of tailored recommendations. During the pilot, the intervention prototype was iteratively refined and tested. The pilot demonstrated feasibility for successful implementation of the sociotechnical intervention as the proportion of patients who had encounters with advanced practice providers (nurse practitioners and physician assistants), pharmacists, or tobacco cessation coaches for the delivery of guideline recommendations in the intervention arm was greater than that in the control arm. Conclusions: Participatory design and a sociotechnical conceptual framework enabled the development of a rural-specific, team-based model of care intervention assisted by CDS technology for the transformation of preventive health care delivery for ASCVDs. UR - https://www.jmir.org/2022/8/e27333 UR - http://dx.doi.org/10.2196/27333 UR - http://www.ncbi.nlm.nih.gov/pubmed/35994324 ID - info:doi/10.2196/27333 ER - TY - JOUR AU - Ma, S. Jennifer AU - O?Riordan, Megan AU - Mazzer, Kelly AU - Batterham, J. Philip AU - Bradford, Sally AU - Kõlves, Kairi AU - Titov, Nickolai AU - Klein, Britt AU - Rickwood, J. Debra PY - 2022/8/5 TI - Consumer Perspectives on the Use of Artificial Intelligence Technology and Automation in Crisis Support Services: Mixed Methods Study JO - JMIR Hum Factors SP - e34514 VL - 9 IS - 3 KW - consumer KW - community KW - help-seeker KW - perspective KW - technology KW - artificial intelligence KW - crisis KW - support KW - acceptability N2 - Background: Emerging technologies, such as artificial intelligence (AI), have the potential to enhance service responsiveness and quality, improve reach to underserved groups, and help address the lack of workforce capacity in health and mental health care. However, little research has been conducted on the acceptability of AI, particularly in mental health and crisis support, and how this may inform the development of responsible and responsive innovation in the area. Objective: This study aims to explore the level of support for the use of technology and automation, such as AI, in Lifeline?s crisis support services in Australia; the likelihood of service use if technology and automation were implemented; the impact of demographic characteristics on the level of support and likelihood of service use; and reasons for not using Lifeline?s crisis support services if technology and automation were implemented in the future. Methods: A mixed methods study involving a computer-assisted telephone interview and a web-based survey was undertaken from 2019 to 2020 to explore expectations and anticipated outcomes of Lifeline?s crisis support services in a nationally representative community sample (n=1300) and a Lifeline help-seeker sample (n=553). Participants were aged between 18 and 93 years. Quantitative descriptive analysis, binary logistic regression models, and qualitative thematic analysis were conducted to address the research objectives. Results: One-third of the community and help-seeker participants did not support the collection of information about service users through technology and automation (ie, via AI), and approximately half of the participants reported that they would be less likely to use the service if automation was introduced. Significant demographic differences were observed between the community and help-seeker samples. Of the demographics, only older age predicted being less likely to endorse technology and automation to tailor Lifeline?s crisis support service and use such services (odds ratio 1.48-1.66, 99% CI 1.03-2.38; P<.001 to P=.005). The most common reason for reluctance, reported by both samples, was that respondents wanted to speak to a real person, assuming that human counselors would be replaced by automated robots or machine services. Conclusions: Although Lifeline plans to always have a real person providing crisis support, help-seekers automatically fear this will not be the case if new technology and automation such as AI are introduced. Consequently, incorporating innovative use of technology to improve help-seeker outcomes in such services will require careful messaging and assurance that the human connection will continue. UR - https://humanfactors.jmir.org/2022/3/e34514 UR - http://dx.doi.org/10.2196/34514 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930334 ID - info:doi/10.2196/34514 ER - TY - JOUR AU - Chu, Cherry AU - Stamenova, Vess AU - Fang, Jiming AU - Shakeri, Ahmad AU - Tadrous, Mina AU - Bhatia, Sacha R. PY - 2022/8/4 TI - The Association Between Telemedicine Use and Changes in Health Care Usage and Outcomes in Patients With Congestive Heart Failure: Retrospective Cohort Study JO - JMIR Cardio SP - e36442 VL - 6 IS - 2 KW - telemedicine KW - telehealth KW - eHealth KW - digital health KW - population KW - outcomes KW - health service KW - health system KW - utilization KW - congestive heart failure KW - cardiology KW - health outcome KW - clinical outcome KW - patient outcome KW - heart KW - cardiac KW - ambulatory KW - COVID-19 N2 - Background: Telemedicine use has become widespread owing to the COVID-19 pandemic, but its impact on patient outcomes remains unclear. Objective: We sought to investigate the effect of telemedicine use on changes in health care usage and clinical outcomes in patients diagnosed with congestive heart failure (CHF). Methods: We conducted a population-based retrospective cohort study using administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14 and September 30, 2020, and a heart failure diagnosis any time prior to March 14, 2020. Telemedicine users were propensity score?matched with unexposed users based on several baseline characteristics. Monthly use of various health care services was compared between the 2 groups during 12 months before to 3 months after their index in-person or telemedicine ambulatory visit after March 14, 2020, using generalized estimating equations. Results: A total of 11,131 pairs of telemedicine and unexposed patients were identified after matching (49% male; mean age 78.9, SD 12.0 years). All patients showed significant reductions in health service usage from pre- to postindex visit. There was a greater decline across time in the unexposed group than in the telemedicine group for CHF admissions (ratio of slopes for high- vs low-frequency users 1.02, 95% CI 1.02-1.03), cardiovascular admissions (1.03, 95% CI 1.02-1.04), any-cause admissions (1.03, 95% CI 1.02-1.04), any-cause ED visits (1.03, 95% CI 1.03-1.04), visits with any cardiologist (1.01, 95% CI 1.01-1.02), laboratory tests (1.02, 95% CI 1.02-1.03), diagnostic tests (1.04, 95% CI 1.03-1.05), and new prescriptions (1.02, 95% CI 1.01-1.03). However, the decline in primary care visit rates was steeper among telemedicine patients than among unexposed patients (ratio of slopes 0.99, 95% CI 0.99-1.00). Conclusions: Overall health care usage over time appeared higher among telemedicine users than among low-frequency users or nonusers, suggesting that telemedicine was used by patients with the greatest need or that it allowed patients to have better access or continuity of care among those who received it. UR - https://cardio.jmir.org/2022/2/e36442 UR - http://dx.doi.org/10.2196/36442 UR - http://www.ncbi.nlm.nih.gov/pubmed/35881831 ID - info:doi/10.2196/36442 ER - TY - JOUR AU - Kling, R. Samantha M. AU - Saliba-Gustafsson, A. Erika AU - Winget, Marcy AU - Aleshin, A. Maria AU - Garvert, W. Donn AU - Amano, Alexis AU - Brown-Johnson, G. Cati AU - Kwong, Y. Bernice AU - Calugar, Ana AU - El-Banna, Ghida AU - Shaw, G. Jonathan AU - Asch, M. Steven AU - Ko, M. Justin PY - 2022/8/3 TI - Teledermatology to Facilitate Patient Care Transitions From Inpatient to Outpatient Dermatology: Mixed Methods Evaluation JO - J Med Internet Res SP - e38792 VL - 24 IS - 8 KW - teledermatology KW - telemedicine KW - telehealth KW - video visits KW - care transitions KW - care coordination KW - discharge planning KW - follow-up KW - inpatient KW - outpatient KW - mixed methods KW - dermatology KW - mobile phone KW - smartphone N2 - Background: Both clinicians and patients have increasingly turned to telemedicine to improve care access, even in physical examination?dependent specialties such as dermatology. However, little is known about whether teledermatology supports effective and timely transitions from inpatient to outpatient care, which is a common care coordination gap. Objective: Using mixed methods, this study sought to retrospectively evaluate how teledermatology affected clinic capacity, scheduling efficiency, and timeliness of follow-up care for patients transitioning from inpatient to outpatient dermatology care. Methods: Patient-level encounter scheduling data were used to compare the number and proportion of patients who were scheduled and received in-clinic or video dermatology follow-ups within 14 and 90 days after discharge across 3 phases: June to September 2019 (before teledermatology), June to September 2020 (early teledermatology), and February to May 2021 (sustained teledermatology). The time from discharge to scheduling and completion of patient follow-up visits for each care modality was also compared. Dermatology clinicians and schedulers were also interviewed between April and May 2021 to assess their perceptions of teledermatology for postdischarge patients. Results: More patients completed follow-up within 90 days after discharge during early (n=101) and sustained (n=100) teledermatology use than at baseline (n=74). Thus, the clinic?s capacity to provide follow-up to patients transitioning from inpatient increased from baseline by 36% in the early (101 from 74) and sustained (100 from 74) teledermatology periods. During early teledermatology use, 61.4% (62/101) of the follow-ups were conducted via video. This decreased significantly to 47% (47/100) in the following year, when COVID-19?related restrictions started to lift (P=.04), indicating more targeted but still substantial use. The proportion of patients who were followed up within the recommended 14 days after discharge did not differ significantly between video and in-clinic visits during the early (33/62, 53% vs 15/39, 38%; P=.15) or sustained (26/53, 60% vs 28/47, 49%; P=.29) teledermatology periods. Interviewees agreed that teledermatology would continue to be offered. Most considered postdischarge follow-up patients to be ideal candidates for teledermatology as they had undergone a recent in-person assessment and might have difficulty attending in-clinic visits because of competing health priorities. Some reported patients needing technological support. Ultimately, most agreed that the choice of follow-up care modality should be the patient?s own. Conclusions: Teledermatology could be an important tool for maintaining accessible, flexible, and convenient care for recently discharged patients needing follow-up care. Teledermatology increased clinic capacity, even during the pandemic, although the timeliness of care transitions did not improve. Ultimately, the care modality should be determined through communication with patients to incorporate their and their caregivers? preferences. UR - https://www.jmir.org/2022/8/e38792 UR - http://dx.doi.org/10.2196/38792 UR - http://www.ncbi.nlm.nih.gov/pubmed/35921146 ID - info:doi/10.2196/38792 ER - TY - JOUR AU - Jedwab, M. Rebecca AU - Manias, Elizabeth AU - Hutchinson, M. Alison AU - Dobroff, Naomi AU - Redley, Bernice PY - 2022/7/26 TI - Nurses? Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study JO - JMIR Nursing SP - e39596 VL - 5 IS - 1 KW - computerized medical records systems KW - COVID-19 KW - implementation science KW - motivation KW - nurses KW - qualitative research N2 - Background: Reports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses? experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce; therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses? work, and nurses themselves are not negatively impacted. Objective: This study aims to explore Australian nurses? postimplementation experiences of an organization-wide EMR system. Methods: This qualitative descriptive study used focus group and individual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses? use of the EMR using the Theoretical Domains Framework. Results: A total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses? work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional divide captured nurses? feelings of division related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it?s personal detailed nurses? beliefs about the EMR implementation leading to bigger changes to nurses as individuals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation. Conclusions: Nurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses? perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses? adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses. UR - https://nursing.jmir.org/2022/1/e39596 UR - http://dx.doi.org/10.2196/39596 UR - http://www.ncbi.nlm.nih.gov/pubmed/35881417 ID - info:doi/10.2196/39596 ER - TY - JOUR AU - Hodge, E. Sarah AU - Johnson-Turbes, Ashani AU - Flemming, Clair Shauna St AU - Passero, Meredith AU - Tinsley, Melinda AU - Iheanyichukwu, Thelma AU - PY - 2022/7/25 TI - Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men Who Have Sex With Men (Black MSM Initiative): Protocol for Program Evaluation JO - JMIR Res Protoc SP - e36025 VL - 11 IS - 7 KW - HIV infections KW - sexual and gender minorities KW - outcome assessment, health care KW - delivery of health care KW - African Americans KW - homosexuality, male KW - mental health services KW - HIV epidemic KW - minority population KW - epidemiology KW - peer support KW - health service KW - health outcomes KW - HIV KW - public health N2 - Background: The HIV epidemic in the United States disproportionately affects Black communities. Nearly half of Black men who have sex with men (MSM) will be diagnosed with HIV in their lifetime. There is a significant unmet need for behavioral health care services among Black MSM, and untreated behavioral health needs make it less likely the person is retained in HIV care. Objective: This paper offers a description of the Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men (Black MSM) Initiative, a program to integrate clinical care and behavioral health/supportive services for Black MSM with HIV. The Black MSM Initiative is funded through the Health Resources & Services Administration HIV/AIDS Bureau Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance. Methods: The components of the Black MSM Initiative include providing technical assistance to 8 Initiative demonstration sites; conducting a comprehensive and culturally responsive, mixed method, multisite evaluation; and disseminating evaluation findings and lessons learned to the RWHAP community. Results: As of December 31, 2020, demonstration sites enrolled 809 clients in the multisite evaluation. The research team will continue evaluation data collection through December 2021 for analysis and dissemination starting in 2022. The Black MSM Initiative fully supports the US Department of Health and Human Services? Ending the HIV Epidemic in the United States Initiative. Conclusions: In order to succeed, providers and programs will need to engage populations traditionally considered ?hard to reach,? like many people receiving RWHAP services. Findings and lessons learned from the Black MSM Initiative will expand the tool kit of solutions to support and retain Black MSM in HIV care, furthering the goals of the Ending the HIV Epidemic Initiative and the RWHAP. International Registered Report Identifier (IRRID): DERR1-10.2196/36025 UR - https://www.researchprotocols.org/2022/7/e36025 UR - http://dx.doi.org/10.2196/36025 UR - http://www.ncbi.nlm.nih.gov/pubmed/35877157 ID - info:doi/10.2196/36025 ER - TY - JOUR AU - Shih, Emily AU - Aylward, S. Brandon AU - Kunkle, Sarah AU - Graziani, Grant PY - 2022/7/22 TI - Association Between Care Modality and Use With Treatment Response Among Members Accessing Virtual Mental Health Services: Real-world Observational Study JO - JMIR Form Res SP - e36956 VL - 6 IS - 7 KW - behavioral coaching KW - engagement KW - mental health KW - telehealth KW - treatment response N2 - Background: There is a growing bottleneck in mental health care, as the demand for services has outpaced the availability of mental health professionals. Consequently, many health systems have shifted to teletherapy as a scalable approach to increasing accessibility to care. Within these care models, various treatment modalities (eg, coaching and clinical care) are used to deliver support for anxiety and depression. However, more research is needed to better understand the differences in treatment responses. Objective: The purpose of this study was to examine the association between different care modalities and the levels of use with symptom score changes for members seeking virtual care services. Methods: We conducted an observational study of 4219 members who accessed Ginger, an on-demand mental health service, between September 2020 and September 2021. Using a mobile app, members can access text-based behavioral health coaching and virtual clinical services. This study focused on members with clinically elevated depression or anxiety levels at baseline. Logistic regressions were used to assess the association between care modalities and the levels of use with treatment response in depression and anxiety, using the Patient Health Questionnaire and Generalized Anxiety Disorder Assessment, respectively. Results: Of the 4219 members, 1623 (38.47%) demonstrated a full response to depression, and 1684 (39.91%) demonstrated a full response to anxiety. Members who completed care (ie, text-based coaching, virtual clinical therapy, hybrid of coaching, and clinical care) beyond the introductory session showed significantly increased odds of a full response compared with those who completed only limited care. Members who completed a hybrid of care had the highest odds of improvement; the odds of showing a full response in depression were 2.31 times higher (95% CI 1.91-2.80; P<.001) and in anxiety were 2.23 times higher (95% CI 1.84-2.70; P<.001) compared with members who completed limited care. For members who completed only coaching or clinical care, the largest effects were observed among those with high use. For members who completed a hybrid care program, we observed similar treatment responses across all levels of use. Conclusions: Our real-world study found that members who completed text-based coaching achieved full treatment responses at similar rates compared with members who completed virtual clinical care and members who completed a hybrid of care. There were no significant differences in the predicted probabilities of full treatment response between coaching and clinical care. Generally, the odds for a full response were highest among members with high use within each care modality; however, there were no differences in full-response treatment odds across levels of use with hybrid care. The results support the utility of digital behavioral health interventions and further highlight text-based coaching protocols as an accessible and suitable option when considering virtual care for treating anxiety and depression. UR - https://formative.jmir.org/2022/7/e36956 UR - http://dx.doi.org/10.2196/36956 UR - http://www.ncbi.nlm.nih.gov/pubmed/35867401 ID - info:doi/10.2196/36956 ER - TY - JOUR AU - Arayasirikul, Sean AU - Turner, M. Caitlin AU - Trujillo, Dillon AU - Maycott, Jarett AU - Wilson, C. Erin PY - 2022/7/18 TI - The Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression Among Young People Living With HIV: Single-Arm, Prospective Study With a Pre-Post Design JO - J Med Internet Res SP - e33990 VL - 24 IS - 7 KW - HIV KW - digital HIV care navigation KW - young people living with HIV KW - mHealth KW - mental health KW - viral suppression KW - health equity KW - digital health KW - equity KW - effect KW - suppression KW - disparity KW - men who have sex with men KW - MSM KW - transgender KW - sex N2 - Background: The HIV epidemic has revealed considerable disparities in health among sexual and gender minorities of color within the Unites States, disproportionately affecting cisgender men who have sex with men (MSM) and trans women. Social inequities further disadvantage those with intersectional identities through homophobia, antitrans discrimination, and racism, shaping not only those at risk for HIV infection but also HIV prevention and care outcomes. Digital interventions have great potential to address barriers and improve HIV care among cisgender MSM and trans women; however, efficacy of digital HIV care interventions vary and need further examination. Objective: This study assessed the 12-month efficacy of a 6-month digital HIV care navigation intervention among young people living with HIV in San Francisco, California. We examined dose-response relationships among intervention exposure (eg, text messaging), viral suppression, and mental health. Health electronic navigation (eNav) is a 6-month, text message?based, digital HIV care navigation intervention, in which young people living with HIV are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. Methods: This study had a single-arm, prospective, pre-post design. Eligibility criteria for the study included the following: identifying as cisgender MSM or trans women, being between the ages of 18 and 34 years, being newly diagnosed with HIV, or not being engaged or retained in HIV care or having a detectable viral load. We assessed and analyzed sociodemographics, intervention exposure, and HIV care and mental health outcome data for participants who completed the 6-month Health eNav intervention. We assessed all outcomes using generalized estimating equations to account for within-subjects correlation, and marginal effects of texting engagement on all outcomes were calculated over the entire 12-month study period. Finally, we specified an interaction between texting engagement and time to evaluate the effects of texting engagement on outcomes. Results: Over the entire 12-month period, this study shows that every one-text increase in engagement was associated with an increased odds of undetectable viral load (adjusted odds ratio 1.01, 95% CI 1.00-1.02; P=.03). Mean negative mental health experiences decreased significantly at 12 months compared to baseline for every one-text increase in engagement (coefficient on interaction term 0.97, 95% CI 0.96-0.99; P<.01). Conclusions: Digital care navigation interventions including Health eNav may be a critical component in the health delivery service system as the digital safety net for those whose social vulnerability is exacerbated in times of crisis, disasters, or global pandemics owing to multiple social inequities. We found that increased engagement in a digital HIV care navigation intervention helped improve viral suppression and mental health?intersecting comorbid conditions?6 months after the intervention concluded. Digital care navigation may be a promising, effective, sustainable, and scalable intervention. International Registered Report Identifier (IRRID): RR2-10.2196/16406 UR - https://www.jmir.org/2022/7/e33990 UR - http://dx.doi.org/10.2196/33990 UR - http://www.ncbi.nlm.nih.gov/pubmed/35849442 ID - info:doi/10.2196/33990 ER - TY - JOUR AU - van Kasteren, Yasmin AU - Strobel, Jörg AU - Bastiampillai, Tarun AU - Linedale, Ecushla AU - Bidargaddi, Niranjan PY - 2022/7/5 TI - Automated Decision Support For Community Mental Health Services Using National Electronic Health Records: Qualitative Implementation Case Study JO - JMIR Hum Factors SP - e35403 VL - 9 IS - 3 KW - implementation KW - computerised clinical decision system KW - decision system KW - decision support KW - participatory action framework KW - psychotropic medication KW - psychotropic KW - nonadherence KW - monitoring KW - medication adherence KW - algorithms KW - algorithm KW - electronic health records KW - EHR KW - health record KW - normalization process theory KW - automated alerts KW - automated alert KW - mental health KW - mental illness KW - adherence KW - medication KW - eHealth KW - web-based N2 - Background: A high proportion of patients with severe mental illness relapse due to nonadherence to psychotropic medication. In this paper, we use the normalization process theory (NPT) to describe the implementation of a web-based clinical decision support system (CDSS) for Community Mental Health Services (CMHS) called Actionable Intime Insights or AI2. AI2 has two distinct functions: (1) it provides an overview of medication and treatment history to assist in reviewing patient adherence and (2) gives alerts indicating nonadherence to support early intervention. Objective: Our objective is to evaluate the pilot implementation of the AI2 application to better understand the challenges of implementing a web-based CDSS to support medication adherence and early intervention in CMHS. Methods: The NPT and participatory action framework were used to both explore and support implementation. Qualitative data were collected over the course of the 14-month implementation, in which researchers were active participants. Data were analyzed and coded using the NPT framework. Qualitative data included discussions, meetings, and work products, including emails and documents. Results: This study explores the barriers and enablers of implementing a CDSS to support early intervention within CMHS using Medicare data from Australia?s national electronic record system, My Health Record (MyHR). The implementation was a series of ongoing negotiations, which resulted in a staged implementation with compromises on both sides. Clinicians were initially hesitant about using a CDSS based on MyHR data and expressed concerns about the changes to their work practice required to support early intervention. Substantial workarounds were required to move the implementation forward. This pilot implementation allowed us to better understand the challenges of implementation and the resources and support required to implement and sustain a model of care based on automated alerts to support early intervention. Conclusions: The use of decision support based on electronic health records is growing, and while implementation is challenging, the potential benefits of early intervention to prevent relapse and hospitalization and ensure increased efficiency of the health care system are worth pursuing. UR - https://humanfactors.jmir.org/2022/3/e35403 UR - http://dx.doi.org/10.2196/35403 UR - http://www.ncbi.nlm.nih.gov/pubmed/35788103 ID - info:doi/10.2196/35403 ER - TY - JOUR AU - Laur, Celia AU - Agarwal, Payal AU - Thai, Kelly AU - Kishimoto, Vanessa AU - Kelly, Shawna AU - Liang, Kyle AU - Bhatia, Sacha R. AU - Bhattacharyya, Onil AU - Martin, Danielle AU - Mukerji, Geetha PY - 2022/6/28 TI - Implementation and Evaluation of COVIDCare@Home, a Family Medicine?Led Remote Monitoring Program for Patients With COVID-19: Multimethod Cross-sectional Study JO - JMIR Hum Factors SP - e35091 VL - 9 IS - 2 KW - virtual care KW - COVID-19 pandemic KW - remote monitoring programs KW - social determinants of health KW - digital health KW - COVID-19 KW - pandemic KW - health care KW - remote monitoring KW - clinical outcome KW - patient KW - health care cost KW - patient experience N2 - Background: COVIDCare@Home (CC@H) is a multifaceted, interprofessional team-based remote monitoring program led by family medicine for patients diagnosed with COVID-19, based at Women?s College Hospital (WCH), an ambulatory academic center in Toronto, Canada. CC@H offers virtual visits (phone and video) to address the clinical needs and broader social determinants of the health of patients during the acute phase of COVID-19 infection, including finding a primary care provider (PCP) and support for food insecurity. Objective: The objective of this evaluation is to understand the implementation and quality outcomes of CC@H within the Quadruple Aim framework of patient experience, provider experience, cost, and population health. Methods: This multimethod cross-sectional evaluation follows the Quadruple Aim framework to focus on implementation and service quality outcomes, including feasibility, adoption, safety, effectiveness, equity, and patient centeredness. These measures were explored using clinical and service utilization data, patient experience data (an online survey and a postdischarge questionnaire), provider experience data (surveys, interviews, and focus groups), and stakeholder interviews. Descriptive analysis was conducted for surveys and utilization data. Deductive analysis was conducted for interviews and focus groups, mapping to implementation and quality domains. The Ontario Marginalization Index (ON-Marg) measured the proportion of underserved patients accessing CC@H. Results: In total, 3412 visits were conducted in the first 8 months of the program (April 8-December 8, 2020) for 616 discrete patients, including 2114 (62.0%) visits with family physician staff/residents and 149 (4.4%) visits with social workers/mental health professionals. There was a median of 5 (IQR 4) visits per patient, with a median follow-up of 7 days (IQR 27). The net promoter score was 77. In addition, 144 (23.3%) of the patients were in the most marginalized populations based on the residential postal code (as per ON-Marg). Interviews with providers and stakeholders indicated that the program continued to adapt to meet the needs of patients and the health care system. Conclusions: Future remote monitoring should integrate support for addressing the social determinants of health and ensure patient-centered care through comprehensive care teams. UR - https://humanfactors.jmir.org/2022/2/e35091 UR - http://dx.doi.org/10.2196/35091 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499974 ID - info:doi/10.2196/35091 ER - TY - JOUR AU - Ye, Jiancheng AU - Woods, Donna AU - Bannon, Jennifer AU - Bilaver, Lucy AU - Kricke, Gayle AU - McHugh, Megan AU - Kho, Abel AU - Walunas, Theresa PY - 2022/6/24 TI - Identifying Contextual Factors and Strategies for Practice Facilitation in Primary Care Quality Improvement Using an Informatics-Driven Model: Framework Development and Mixed Methods Case Study JO - JMIR Hum Factors SP - e32174 VL - 9 IS - 2 KW - quality improvement KW - practice facilitation KW - primary care KW - mixed-methods KW - practice facilitator KW - informatics KW - electronic health record KW - implementation science KW - implementation KW - challenge KW - strategy KW - framework KW - perspective N2 - Background: The past decade has seen increasing opportunities and efforts to integrate quality improvement into health care. Practice facilitation is a proven strategy to support redesign and improvement in primary care practices that focuses on building organizational capacity for continuous improvement. Practice leadership, staff, and practice facilitators all play important roles in supporting quality improvement in primary care. However, little is known about their perspectives on the context, enablers, barriers, and strategies that impact quality improvement initiatives. Objective: This study aimed to develop a framework to enable assessment of contextual factors, challenges, and strategies that impact practice facilitation, clinical measure performance, and the implementation of quality improvement interventions. We also illustrated the application of the framework using a real-world case study. Methods: We developed the TITO (task, individual, technology, and organization) framework by conducting participatory stakeholder workshops and incorporating their perspectives to identify enablers and barriers to quality improvement and practice facilitation. We conducted a case study using a mixed methods approach to demonstrate the use of the framework and describe practice facilitation and factors that impact quality improvement in a primary care practice that participated in the Healthy Hearts in the Heartland study. Results: The proposed framework was used to organize and analyze different stakeholders? perspectives and key factors based on framework domains. The case study showed that practice leaders, staff, and practice facilitators all influenced the success of the quality improvement program. However, these participants faced different challenges and used different strategies. The framework showed that barriers stemmed from patients? social determinants of health, a lack of staff and time, and unsystematic facilitation resources, while enablers included practice culture, staff buy-in, implementation of effective practice facilitation strategies, practice capacity for change, and shared complementary resources from similar, ongoing programs. Conclusions: Our framework provided a useful and generalizable structure to guide and support assessment of future practice facilitation projects, quality improvement initiatives, and health care intervention implementation studies. The practice leader, staff, and practice facilitator all saw value in the quality improvement program and practice facilitation. Practice facilitators are key liaisons to help the quality improvement program; they help all stakeholders work toward a shared target and leverage tailored strategies. Taking advantage of resources from competing, yet complementary, programs as additional support may accelerate the effective achievement of quality improvement goals. Practice facilitation?supported quality improvement programs may be opportunities to assist primary care practices in achieving improved quality of care through focused and targeted efforts. The case study demonstrated how our framework can support a better understanding of contextual factors for practice facilitation, which could enable well-prepared and more successful quality improvement programs for primary care practices. Combining implementation science and informatics thinking, our TITO framework may facilitate interdisciplinary research in both fields. UR - https://humanfactors.jmir.org/2022/2/e32174 UR - http://dx.doi.org/10.2196/32174 UR - http://www.ncbi.nlm.nih.gov/pubmed/35749211 ID - info:doi/10.2196/32174 ER - TY - JOUR AU - Norton, M. Jenna AU - Ip, Alex AU - Ruggiano, Nicole AU - Abidogun, Tolulope AU - Camara, Souleymane Djibril AU - Fu, Helen AU - Hose, Bat-Zion AU - Miran, Saadia AU - Hsiao, Chun-Ju AU - Wang, Jing AU - Bierman, S. Arlene PY - 2022/6/10 TI - Assessing Progress Toward the Vision of a Comprehensive, Shared Electronic Care Plan: Scoping Review JO - J Med Internet Res SP - e36569 VL - 24 IS - 6 KW - electronic care plan KW - care planning KW - care plan KW - care coordination KW - multiple conditions KW - multiple chronic conditions KW - chronic disease KW - chronic condition KW - electronic care KW - digital health KW - electronic tools KW - e-care KW - healthcare data KW - eHealth N2 - Background: Care plans are central to effective care delivery for people with multiple chronic conditions. But existing care plans?which typically are difficult to share across care settings and care team members?poorly serve people with multiple chronic conditions, who often receive care from numerous clinicians in multiple care settings. Comprehensive, shared electronic care (e-care) plans are dynamic electronic tools that facilitate care coordination and address the totality of health and social needs across care contexts. They have emerged as a potential way to improve care for individuals with multiple chronic conditions. Objective: To review the landscape of e-care plans and care plan?related initiatives that could allow the creation of a comprehensive, shared e-care plan and inform a joint initiative by the National Institutes of Health and the Agency for Healthcare Research and Quality to develop e-care planning tools for people with multiple chronic conditions. Methods: We conducted a scoping review, searching literature from 2015 to June 2020 using Scopus, Clinical Key, and PubMed; we also searched the gray literature. To identify initiatives potentially missing from this search, we interviewed expert informants. Relevant data were then identified and extracted in a structured format for data synthesis and analysis using an expanded typology of care plans adapted to our study context. The extracted data included (1) the perspective of the initiatives; (2) their scope, (3) network, and (4) context; (5) their use of open syntax standards; and (6) their use of open semantic standards. Results: We identified 7 projects for e-care plans and 3 projects for health care data standards. Each project provided critical infrastructure that could be leveraged to promote the vision of a comprehensive, shared e-care plan. All the e-care plan projects supported both broad goals and specific behaviors; 1 project supported a network of professionals across clinical, community, and home-based networks; 4 projects included social determinants of health. Most projects specified an open syntax standard, but only 3 specified open semantic standards. Conclusions: A comprehensive, shared, interoperable e-care plan has the potential to greatly improve the coordination of care for individuals with multiple chronic conditions across multiple care settings. The need for such a plan is heightened in the wake of the ongoing COVID-19 pandemic. While none of the existing care plan projects meet all the criteria for an optimal e-care plan, they all provide critical infrastructure that can be leveraged as we advance toward the vision of a comprehensive, shared e-care plan. However, critical gaps must be addressed in order to achieve this vision. UR - https://www.jmir.org/2022/6/e36569 UR - http://dx.doi.org/10.2196/36569 UR - http://www.ncbi.nlm.nih.gov/pubmed/35687382 ID - info:doi/10.2196/36569 ER - TY - JOUR AU - Kantor, Daniel AU - Farlow, Martin AU - Ludolph, Albert AU - Montaner, Joan AU - Sankar, Raman AU - Sawyer Jr, N. Robert AU - Stocchi, Fabrizio AU - Lara, Agnès AU - Clark, Sarah AU - Deschet, Karine AU - Ouyahia, Loucif AU - Hadjiat, Yacine PY - 2022/6/9 TI - Digital Scientific Platform for Independent Content in Neurology: Rigorous Quality Guideline Development and Implementation JO - Interact J Med Res SP - e35698 VL - 11 IS - 1 KW - digital health KW - Neurodiem KW - neurology KW - neuroscience KW - eHealth KW - methodology KW - content quality KW - guideline KW - platform KW - development KW - implementation KW - quality KW - brain KW - communication KW - health information KW - health care professional KW - assessment KW - monitoring N2 - Background: Digital communication has emerged as a major source of scientific and medical information for health care professionals. There is a need to set up an effective and reliable methodology to assess and monitor the quality of content that is published on the internet. Objective: The aim of this project was to develop content quality guidelines for Neurodiem, an independent scientific information platform dedicated to neurology for health care professionals and neuroscientists. These content quality guidelines are intended to be used by (1) content providers as a framework to meet content quality standards and (2) reviewers as a tool for analyzing and scoring quality of content. Methods: Specific scientific criteria were designed using a 5-point scale to measure the quality of curated and original content published on the website: for Summaries, (1) source reliability and topic relevance for neurologists, (2) structure, and (3) scientific and didactic value; for Congress highlights, (1) relevance of congress selection, (2) congress coverage based on the original program, and (3) scientific and didactic value of individual abstracts; for Expert points of view and talks, (1) credibility (authorship) and topic relevance for neurologists, (2) scientific and didactic value, and (3) reliability (references) and format. The criteria were utilized on a monthly basis and endorsed by an independent scientific committee of widely recognized medical experts in neurology. Results: Summary content quality for the 3 domains (reliability and relevance, structure, and scientific and didactic value) increased in the second month after the implementation of the guidelines. The domain scientific and didactic value had a mean score of 8.20/10. Scores for the domains reliability and relevance (8-9/10) and structure (45-55/60) showed that the maintenance of these 2 quality items over time was more challenging. Talks (either in the format of interviews or slide deck?supported scientific presentations) and expert point of view demonstrated high quality after the implementation of the content quality guidelines that was maintained over time (15-25/25). Conclusions: Our findings support that content quality guidelines provide both (1) a reliable framework for generating independent high-quality content that addresses the educational needs of neurologists and (2) are an objective evaluation tool for improving and maintaining scientific quality level. The use of these criteria and this scoring system could serve as a standard and reference to build an editorial strategy and review process for any medical news or platforms. UR - https://www.i-jmr.org/2022/1/e35698 UR - http://dx.doi.org/10.2196/35698 UR - http://www.ncbi.nlm.nih.gov/pubmed/35485280 ID - info:doi/10.2196/35698 ER - TY - JOUR AU - Teng, Rachel AU - Ding, Yichen AU - See, Choong Kay PY - 2022/5/16 TI - Use of Robots in Critical Care: Systematic Review JO - J Med Internet Res SP - e33380 VL - 24 IS - 5 KW - COVID-19 KW - intensive care KW - high dependency KW - telepresence KW - intubation N2 - Background: The recent focus on the critical setting, especially with the COVID-19 pandemic, has highlighted the need for minimizing contact-based care and increasing robotic use. Robotics is a rising field in the context of health care, and we sought to evaluate the use of robots in critical care settings. Objective: Although robotic presence is prevalent in the surgical setting, its role in critical care has not been well established. We aimed to examine the uses and limitations of robots for patients who are critically ill. Methods: This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Embase, IEEE Xplore, and ACM Library were searched from their inception to December 23, 2021. Included studies involved patients requiring critical care, both in intensive care units or high-dependency units, or settings that required critical care procedures (eg, intubation and cardiopulmonary resuscitation). Randomized trials and observational studies were included. Results: A total of 33 studies were included. The greatest application of robots in the intensive care unit was in the field of telepresence, whereby robots proved advantageous in providing a reduced response time, earlier intervention, and lower mortality rates. Challenges of telepresence included regulatory and financial barriers. In therapy and stroke rehabilitation, robots achieved superior clinical outcomes safely. Robotic use in patient evaluation and assessment was mainly through ultrasound evaluation, obtaining satisfactory to superior results with the added benefits of remote assessment, time savings, and increased efficiency. Robots in drug dispensing and delivery increased efficiency and generated cost savings. All the robots had technological limitations and hidden costs. Conclusions: Overall, our results show that robotic use in critical care settings is a beneficial, effective, and well-received intervention that delivers significant benefits to patients, staff, and hospitals. Looking ahead, it is necessary to form strong ethical and legislative frameworks and overcome various regulatory and financial barriers. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021234162; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=234162 UR - https://www.jmir.org/2022/5/e33380 UR - http://dx.doi.org/10.2196/33380 UR - http://www.ncbi.nlm.nih.gov/pubmed/35576567 ID - info:doi/10.2196/33380 ER - TY - JOUR AU - Schmieding, L. Malte AU - Kopka, Marvin AU - Schmidt, Konrad AU - Schulz-Niethammer, Sven AU - Balzer, Felix AU - Feufel, A. Markus PY - 2022/5/10 TI - Triage Accuracy of Symptom Checker Apps: 5-Year Follow-up Evaluation JO - J Med Internet Res SP - e31810 VL - 24 IS - 5 KW - digital health KW - triage KW - symptom checker KW - patient-centered care KW - eHealth apps KW - mobile phone N2 - Background: Symptom checkers are digital tools assisting laypersons in self-assessing the urgency and potential causes of their medical complaints. They are widely used but face concerns from both patients and health care professionals, especially regarding their accuracy. A 2015 landmark study substantiated these concerns using case vignettes to demonstrate that symptom checkers commonly err in their triage assessment. Objective: This study aims to revisit the landmark index study to investigate whether and how symptom checkers? capabilities have evolved since 2015 and how they currently compare with laypersons? stand-alone triage appraisal. Methods: In early 2020, we searched for smartphone and web-based applications providing triage advice. We evaluated these apps on the same 45 case vignettes as the index study. Using descriptive statistics, we compared our findings with those of the index study and with publicly available data on laypersons? triage capability. Results: We retrieved 22 symptom checkers providing triage advice. The median triage accuracy in 2020 (55.8%, IQR 15.1%) was close to that in 2015 (59.1%, IQR 15.5%). The apps in 2020 were less risk averse (odds 1.11:1, the ratio of overtriage errors to undertriage errors) than those in 2015 (odds 2.82:1), missing >40% of emergencies. Few apps outperformed laypersons in either deciding whether emergency care was required or whether self-care was sufficient. No apps outperformed the laypersons on both decisions. Conclusions: Triage performance of symptom checkers has, on average, not improved over the course of 5 years. It decreased in 2 use cases (advice on when emergency care is required and when no health care is needed for the moment). However, triage capability varies widely within the sample of symptom checkers. Whether it is beneficial to seek advice from symptom checkers depends on the app chosen and on the specific question to be answered. Future research should develop resources (eg, case vignette repositories) to audit the capabilities of symptom checkers continuously and independently and provide guidance on when and to whom they should be recommended. UR - https://www.jmir.org/2022/5/e31810 UR - http://dx.doi.org/10.2196/31810 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536633 ID - info:doi/10.2196/31810 ER - TY - JOUR AU - Hawkes, E. Rhiannon AU - Miles, M. Lisa AU - French, P. David PY - 2022/4/27 TI - Fidelity to Program Specification of the National Health Service Digital Diabetes Prevention Program Behavior Change Technique Content and Underpinning Theory: Document Analysis JO - J Med Internet Res SP - e34253 VL - 24 IS - 4 KW - diabetes prevention KW - digital interventions KW - behavior change KW - fidelity N2 - Background: The National Health Service (NHS) Diabetes Prevention Program is a behavior change intervention for adults in England who are identified as being at high risk of developing type 2 diabetes. The face-to-face service was launched in 2016, followed by a digital service (NHS Digital Diabetes Prevention Program [NHS-DDPP]) in 2019. A total of 4 service providers were commissioned to deliver the NHS-DDPP and were required to deliver the digital service in line with a program specification detailing the key intervention content. The fidelity of the behavior change content in the digital service (ie, the extent to which the program is delivered as intended) is currently unknown. Digital interventions may allow higher fidelity as staff do not have to be trained to deliver all intervention content. Assessing fidelity of the intervention design is particularly important to establish the planned behavior change content in the NHS-DDPP and the extent to which this adheres to the program specification. This is the first known independent assessment of design fidelity in a large-scale digital behavior change intervention. Objective: This study aims to assess the fidelity of the behavior change content in each of the 4 NHS-DDPP providers? intervention designs to the full program specification. Methods: We conducted a document review of each provider?s NHS-DDPP intervention design, along with interviews with program developers employed by the 4 digital providers (n=6). Providers? intervention design documents and interview transcripts were coded for behavior change techniques (BCTs; ie, the active ingredients of the intervention) using the Behavior Change Technique Taxonomy version 1 and underpinning theory using the Theory Coding Scheme framework. The BCTs identified in each digital provider?s intervention design were compared with the 19 BCTs included in the program specification. Results: Of the 19 BCTs specified in the program specification, the 4 providers planned to deliver 16 (84%), 17 (89%), 16 (84%), and 16 (84%) BCTs, respectively. An additional 41 unspecified BCTs were included in at least one of the 4 digital providers? intervention designs. By contrast, inconsistent use of the underpinning theory was apparent across providers, and none of the providers had produced a logic model to explain how their programs were expected to work. All providers linked some of their planned BCTs to theoretical constructs; however, justification for the inclusion of other BCTs was not described. Conclusions: The fidelity of BCT content in the NHS-DDPP was higher than that previously documented for the face-to-face service. Thus, if service users engage with the NHS-DDPP, this should increase the effectiveness of the program. However, given that a clear theoretical underpinning supports the translation of BCTs in intervention designs to intervention delivery, the absence of a logic model describing the constructs to be targeted by specific BCTs is potentially problematic. UR - https://www.jmir.org/2022/4/e34253 UR - http://dx.doi.org/10.2196/34253 UR - http://www.ncbi.nlm.nih.gov/pubmed/35476035 ID - info:doi/10.2196/34253 ER - TY - JOUR AU - Burton, Lindsay AU - Rush, L. Kathy AU - Smith, A. Mindy AU - Davis, Selena AU - Rodriguez Echeverria, Patricia AU - Suazo Hidalgo, Lina AU - Görges, Matthias PY - 2022/4/27 TI - Empowering Patients Through Virtual Care Delivery: Qualitative Study With Micropractice Clinic Patients and Health Care Providers JO - JMIR Form Res SP - e32528 VL - 6 IS - 4 KW - virtual care KW - micropractice KW - focus groups KW - patient portals KW - COVID-19 KW - family practice KW - rural care KW - digital health technology KW - telehealth N2 - Background: Prior to the wider adoption of digital health technologies during the COVID-19 pandemic, applications of virtual care were largely limited to specialist visits and remote care using telehealth (phone or video) applications. Data sharing approaches using tethered patient portals were mostly built around hospitals and larger care systems. These portals offer opportunities for improved communication, but despite a belief that care has improved, they have so far shown few outcome improvements beyond medication adherence. Less is known about use of virtual care and related tools in the outpatient context and particularly in rural community contexts. Objective: This study aims to reflect on the opportunities and barriers for sustainable virtual care through an example of a digitally enabled rural micropractice, which has provided 10%-15% virtual care since 2016 and 70% virtual care since March 2020. Methods: Three focus groups, 1 with providers (physician and medical office manager) and 2 with a total of 8 patients from a rural micropractice in British Columbia, were conducted in November 2020 and December 2020. Virtual care delivery was explored through the topics of communication approach, mixing virtual and in-person care, the practice team?s journey in developing these approaches, and provider and patient satisfaction with the care model. Interviews were transcribed, checked for accuracy against recordings, and thematically analyzed. Results: Both patients and providers reported ease of communication and high satisfaction. Either could initiate communication, and patients found the ability to share health information asynchronously through the portal allowed time to reflect and prepare their thoughts. Patients were highly engaged and reported feeling empowered and true partners in their health care, although they noted limited care coordination with specialists. The mix of virtual and in-person visits was highly regarded by patients and providers, and patients reported feeling safe and cared for 24/7, although both expressed concern about work spilling into the provider?s home life. The physician worried about missed diagnoses with virtual care. With respect to establishing the micropractice, solutions took about 5 years to optimize, with providers noting a learning curve requiring technical support for both themselves and their patients and a willingness to respond to patient feedback to identify the best solutions. Despite a mature virtual practice, patients reported deferred care due to COVID-19. Conclusions: The micropractice?s hybrid care model encouraged patients to be true partners in their care and resulted in high patient engagement and satisfaction; yet, success may rely on the patient population being willing to engage and being comfortable with technology. Barriers lie in gaps in care coordination and provider fear that signs or symptoms more evident with an in-person exam could be missed. Even in this setting, deferral of care in light of COVID-19 was present, and opportunities to address care gaps should be sought. UR - https://formative.jmir.org/2022/4/e32528 UR - http://dx.doi.org/10.2196/32528 UR - http://www.ncbi.nlm.nih.gov/pubmed/35413002 ID - info:doi/10.2196/32528 ER - TY - JOUR AU - Miranda, N. Rafael AU - Bhuiya, R. Aunima AU - Thraya, Zak AU - Hancock-Howard, Rebecca AU - Chan, CF Brian AU - Steele Gray, Carolyn AU - Wodchis, P. Walter AU - Thavorn, Kednapa PY - 2022/4/20 TI - An Electronic Patient-Reported Outcomes Tool for Older Adults With Complex Chronic Conditions: Cost-Utility Analysis JO - JMIR Aging SP - e35075 VL - 5 IS - 2 KW - eHealth KW - multimorbidity KW - primary care KW - cost-effectiveness KW - older adult KW - elder KW - cost KW - patient reported outcome KW - community KW - complex care KW - aging KW - Canada KW - North America KW - chronic disease KW - chronic condition KW - decision tree KW - model KW - sensitivity analysis N2 - Background: eHealth technologies for self-management can improve quality of life, but little is known about whether the benefits gained outweigh their costs. The electronic patient-reported outcome (ePRO) mobile app and portal system supports patients with multiple chronic conditions to collaborate with primary health care providers to set and monitor health-related goals. Objective: This study aims to estimate the cost of ePRO and the cost utility of the ePRO intervention compared with usual care provided to patients with multiple chronic conditions and complex needs living in the community, from the perspective of the publicly funded health care payer in Ontario, Canada. Methods: We developed a decision tree model to estimate the incremental cost per quality-adjusted life year (QALY) gained for the ePRO tool versus usual care over a time horizon of 15 months. Resource utilization and effectiveness of the ePRO tool were drawn from a randomized clinical trial with 6 family health teams involving 45 participants. Unit costs associated with health care utilization (adjusted to 2020 Canadian dollars) were drawn from literature and publicly available sources. A series of sensitivity analyses were conducted to assess the robustness of the findings. Results: The total cost of the ePRO tool was CAD $79,467 (~US $ 63,581; CAD $1733 [~US $1386] per person). Compared with standard care, the ePRO intervention was associated with higher costs (CAD $1710 [~US $1368]) and fewer QALYs (?0.03). The findings were consistent with the clinical evidence, suggesting no statistical difference in health-related quality of life between ePRO and usual care groups. However, the tool would be considered a cost-effective option if it could improve by at least 0.03 QALYs. The probability that the ePRO is cost-effective was 17.3% at a willingness-to-pay (WTP) threshold of CAD $50,000 (~US $40,000)/QALY. Conclusions: The ePRO tool is not a cost-effective technology at the commonly used WTP value of CAD $50,000 (~US $40,000)/QALY, but long-term and the societal impacts of ePRO were not included in this analysis. Further research is needed to better understand its impact on long-term outcomes and in real-world settings. The present findings add to the growing evidence about eHealth interventions? capacity to respond to complex aging populations within finite-resourced health systems. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 UR - https://aging.jmir.org/2022/2/e35075 UR - http://dx.doi.org/10.2196/35075 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442194 ID - info:doi/10.2196/35075 ER - TY - JOUR AU - Luo, Xueyan AU - Xu, Wei AU - Ming, Wai-Kit AU - Jiang, Xinchan AU - Yuan, Quan AU - Lai, Han AU - Huang, Chunji AU - Zhong, Xiaoni PY - 2022/4/19 TI - Cost-Effectiveness of Mobile Health?Based Integrated Care for Atrial Fibrillation: Model Development and Data Analysis JO - J Med Internet Res SP - e29408 VL - 24 IS - 4 KW - mobile health KW - integrated care KW - ABC pathway KW - atrial fibrillation KW - model-based KW - cost-effectiveness KW - health economic evaluation N2 - Background: Mobile health (mHealth) technology is increasingly used in disease management. Using mHealth tools to integrate and streamline care has improved clinical outcomes of patients with atrial fibrillation (AF). Objective: The aim of this study was to investigate the potential clinical and health economic outcomes of mHealth-based integrated care for AF from the perspective of a public health care provider in China. Methods: A Markov model was designed to compare outcomes of mHealth-based care and usual care in a hypothetical cohort of patients with AF in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to examine the robustness of the base-case results. Results: In the base-case analysis, mHealth-based care gained higher QALYs of 0.0730 with an incurred cost of US $1090. Using US $33,438 per QALY (three times the gross domestic product) as the willingness-to-pay threshold, mHealth-based care was cost-effective, with an ICER of US $14,936 per QALY. In one-way sensitivity analysis, no influential factor with a threshold value was identified. In probabilistic sensitivity analysis, mHealth-based care was accepted as cost-effective in 92.33% of 10,000 iterations. Conclusions: This study assessed the expected cost-effectiveness of applying mHealth-based integrated care for AF according to a model-based health economic evaluation. The exploration suggested the potential cost-effective use of mHealth apps in streamlining and integrating care via the Atrial fibrillation Better Care (ABC) pathway for AF in China. Future economic evaluation alongside randomized clinical trials is highly warranted to verify the suggestion and investigate affecting factors such as geographical variations in patient characteristics, identification of subgroups, and constraints on local implementation. UR - https://www.jmir.org/2022/4/e29408 UR - http://dx.doi.org/10.2196/29408 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438646 ID - info:doi/10.2196/29408 ER - TY - JOUR AU - Cullington, Helen AU - Kitterick, Padraig AU - Darnton, Philippa AU - Finch, Tracy AU - Greenwell, Kate AU - Riggs, Carol AU - Weal, Mark AU - Walker, Dawn-Marie AU - Sibley, Andrew PY - 2022/4/13 TI - Telemedicine for Adults With Cochlear Implants in the United Kingdom (CHOICE): Protocol for a Prospective Interventional Multisite Study JO - JMIR Res Protoc SP - e27207 VL - 11 IS - 4 KW - cochlear implants KW - hearing KW - deafness KW - telemedicine KW - patient-centered care N2 - Background: Cochlear implants provide hearing to approximately 750,000 people with deafness worldwide; these patients require lifelong follow-up. Care for adults with implants in the United Kingdom occurs at one of 19 centers, which may be far from the patients? homes. In a previous randomized controlled trial, we successfully introduced person-centered care. We designed, implemented, and evaluated the following remote care pathway: a personalized web-based support tool, home hearing check, self?device adjustment, and upgrading of sound processors at home rather than in the clinic. The remote care group had a significant increase in empowerment after using the tools, and the patients and clinicians were keen to continue. We would now like to scale up these improvements as an option for >12,000 UK adults using implants; we are commissioning an independent evaluation of this intervention and rollout to establish if it achieves its aims of more empowered and confident patients; more accessible and equitable care; stable hearing; more efficient, person-centered, and scalable service; and more satisfied and engaged patients and clinicians. Objective: This study aims to evaluate the impact and rollout of a person-centered clinical care pathway via telemedicine for adults with cochlear implants in the United Kingdom, using both outcomes and process evaluation. Methods: This project will scale up and evaluate a person-centered long-term follow-up pathway for adults using cochlear implants through a personalized website, including a home hearing check, uploading photos of cochlear implant site, listening in noise and music practice, ordering of spares, questionnaires, and other resources. Both quantitative and qualitative analyses will be conducted, and they will be both an outcome and process evaluation. Results: As of July 2021, the trial is closed, and all data collection is complete. The evaluation report is expected to be published in December 2021, and the research data have not yet been analyzed. Conclusions: This project will present the results of the first scaling up of a remote care pathway for adults with cochlear implants in the United Kingdom. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN51668922; https://www.isrctn.com/ISRCTN51668922 International Registered Report Identifier (IRRID): DERR1-10.2196/27207 UR - https://www.researchprotocols.org/2022/4/e27207 UR - http://dx.doi.org/10.2196/27207 UR - http://www.ncbi.nlm.nih.gov/pubmed/35416780 ID - info:doi/10.2196/27207 ER - TY - JOUR AU - Manning Hutson, Michelle AU - Hosking, M. Sarah AU - Mantalvanos, Soula AU - Berk, Michael AU - Pasco, Julie AU - Dunning, Trisha PY - 2022/4/7 TI - What Injured Workers With Complex Claims Look For in Online Communities: Netnographic Analysis JO - J Med Internet Res SP - e17180 VL - 24 IS - 4 KW - work-related injury KW - care coordination KW - case management KW - netnography N2 - Background: Improved understanding of social constructs around injury may help insurance case managers to understand how best to support people after injury. Objective: This study sought to explore what people who sustain work-related injuries may seek from online communities. The study highlights potential opportunities for improved engagement with insurance case management practice. Methods: An observational netnographic analysis was undertaken on anonymous, publicly available messages posted on Australian message boards. All research data were drawn from anonymous, online communities. A person (author SM) with experience of making a claim through an Australian workers? compensation system and online engagement was involved in study conception, design, and analysis. Data were analyzed using NVivo12 in an iterative, multistage process including coding, journaling, and member checking. A total of 141 people were engaged in discussion across 47 threads housed on 4 Australian forums. Results: In this qualitative study, themes emerged from the data, describing how injured workers use online communities to help make decisions, get support, and solve problems. The key motivators for action and engagement were seeking information, connection, or justice. Establishment of relationships was a key mediator of each of these parameters. Conclusions: Some work-related injuries may involve medical and medicolegal complexity as well as changed lifestyle and routine during convalescence and recovery. The mechanism used by some injured workers to seek information and problem solve suggests a capacity for self-management and self-care after work-related injury. Netnography provides information on a community that may not regularly engage with research because of the complexity of their situation and their vulnerability. UR - https://www.jmir.org/2022/4/e17180 UR - http://dx.doi.org/10.2196/17180 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389358 ID - info:doi/10.2196/17180 ER - TY - JOUR AU - Velayati, Farnia AU - Ayatollahi, Haleh AU - Hemmat, Morteza AU - Dehghan, Reza PY - 2022/3/29 TI - Telehealth Business Models and Their Components: Systematic Review JO - J Med Internet Res SP - e33128 VL - 24 IS - 3 KW - telehealth KW - telemedicine KW - mobile health KW - business model KW - value KW - commerce KW - revenue KW - market KW - systematic review KW - health care N2 - Background: Telehealth technology is an excellent solution to resolve the problems of health care delivery. However, this technology may fail during large-scale implementation. As a result, business models can be used to facilitate commercialization of telehealth products and services. Objective: The purpose of this study was to review different types of business models or frameworks and their components used in the telehealth industry. Methods: This was a systematic review conducted in 2020. The databases used for searching related articles included Ovid, PubMed, Scopus, Web of Science, Emerald, and ProQuest. Google Scholar was also searched. These databases and Google Scholar were searched until the end of January 2020 and duplicate references were removed. Finally, articles meeting the inclusion criteria were selected and the Critical Appraisal Skills Programme (CASP) checklist was used for appraising the strengths and limitations of each study. Data were extracted using a data extraction form, and the results were synthesized narratively. Results: Initially, 4998 articles were found and after screening, 23 were selected to be included in the study. The results showed that new telehealth business models were presented in 13 studies, and the applications of the existing business models were reported in 10 studies. These studies were related to different types of services, namely, telemonitoring (4 studies), telemedicine (3 studies), mobile health (3 studies), telerehabilitation (3 studies), telehealth (2 studies), assisted living technologies (2 studies), sensor-based systems (2 studies), and mobile teledermoscopy, teleradiology, telecardiology, and teletreatment (1 study related to each area). In most of the business models, value proposition, financial variables, and revenue streams were the main components. Conclusions: Applying business models in the commercialization of telehealth services will be useful to gain a better understanding of the required components, market challenges, and possible future changes. The results showed that different business models can be used for different telehealth technologies in various health systems and cultures. However, it is necessary to evaluate the effectiveness of these models in practice. Moreover, comparing the usefulness of these models in different domains of telehealth services will help identify the strengths and weaknesses of these models for future optimization. UR - https://www.jmir.org/2022/3/e33128 UR - http://dx.doi.org/10.2196/33128 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348471 ID - info:doi/10.2196/33128 ER - TY - JOUR AU - Mariathas, H. Hensley AU - Hurley, Oliver AU - Anaraki, Rahimipour Nahid AU - Young, Christina AU - Patey, Christopher AU - Norman, Paul AU - Aubrey-Bassler, Kris AU - Wang, Peter Peizhong AU - Gadag, Veeresh AU - Nguyen, V. Hai AU - Etchegary, Holly AU - McCrate, Farah AU - Knight, C. John AU - Asghari, Shabnam PY - 2022/3/24 TI - A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial JO - JMIR Res Protoc SP - e30454 VL - 11 IS - 3 KW - SurgeCon KW - emergency department KW - stepped wedge design KW - cluster randomized trials KW - wait time N2 - Background: Despite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for Economic Co-operation and Development countries. From a patient?s perspective, this challenge has been described as ?patients wait in pain or discomfort for hours before being seen at EDs.? To overcome the challenge of increased wait times, we developed an innovative ED management platform called SurgeCon that was designed based on continuous quality improvement principles to maintain patient flow and mitigate the impact of patient surge on ED efficiency. The SurgeCon quality improvement intervention includes a protocol-driven software platform, restructures ED organization and workflow, and aims to establish a more patient-centric environment. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador, and found that there was a 32% reduction in ED wait times. Objective: The primary objective of this trial is to determine the effects of SurgeCon on ED performance by assessing its impact on length of stay, the time to a physician?s initial assessment, and the number of patients leaving the ED without being seen by a physician. The secondary objectives of this study are to evaluate SurgeCon?s effects on patient satisfaction and patient-reported experiences with ED wait times and its ability to create better-value care by reducing the per-patient cost of delivering ED services. Methods: The implementation of the intervention will be assessed using a comparative effectiveness-implementation hybrid design. This type of hybrid design is known to shorten the amount of time associated with transitioning interventions from being the focus of research to being used for practice and health care services. All EDs with 24/7 on-site physician support (category A hospitals) will be enrolled in a 31-month, pragmatic, stepped wedge cluster randomized trial. All clusters (hospitals) will start with a baseline period of usual care and will be randomized to determine the order and timing of transitioning to intervention care until all hospitals are using the intervention to manage and operationalize their EDs. Results: Data collection for this study is continuing. As of February 2022, a total of 570 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. The first of the 4 EDs was randomly selected, and it is currently using SurgeCon?s eHealth platform and applying efficiency principles that have been learned through training since September 2021. The second randomly selected site will begin intervention implementation in winter 2022. Conclusions: By assessing the impact of SurgeCon on ED services, we hope to be able to improve wait times and create better-value ED care in this health care context. Trial Registration: ClinicalTrials.gov NCT04789902; https://clinicaltrials.gov/ct2/show/NCT04789902 International Registered Report Identifier (IRRID): DERR1-10.2196/30454 UR - https://www.researchprotocols.org/2022/3/e30454 UR - http://dx.doi.org/10.2196/30454 UR - http://www.ncbi.nlm.nih.gov/pubmed/35323121 ID - info:doi/10.2196/30454 ER - TY - JOUR AU - Yao, Rui AU - Zhang, Wenli AU - Evans, Richard AU - Cao, Guang AU - Rui, Tianqi AU - Shen, Lining PY - 2022/3/21 TI - Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review JO - J Med Internet Res SP - e34144 VL - 24 IS - 3 KW - health inequities KW - digital health technologies KW - health care services KW - socially disadvantaged groups KW - scoping review KW - mobile phone N2 - Background: Digital health technologies (ie, the integration of digital technology and health information) aim to increase the efficiency of health care delivery; they are rapidly adapting to health care contexts to provide improved medical services for citizens. However, contrary to expectations, their rapid adoption appears to have led to health inequities, with differences in health conditions or inequality in the distribution of health care resources among different populations. Objective: This scoping review aims to identify and describe the inequities of health care services brought about by the adoption of digital health technologies. The factors influencing such inequities, as well as the corresponding countermeasures to ensure health equity among different groups of citizens, were also studied. Methods: Primary studies and literature, including articles and reviews, published in English between 1990 and 2020 were retrieved using appropriate search strategies across the following three electronic databases: Clarivate Analytics? Web of Science, PubMed, and Scopus. Data management was performed by two authors (RY and WZ) using Thomson Endnote (Clarivate Analytics, Inc), by systematically screening and identifying eligible articles for this study. Any conflicts of opinion were resolved through discussions with the corresponding author. A qualitative descriptive synthesis was performed to determine the outcomes of this scoping review. Results: A total of 2325 studies were collected during the search process, of which 41 (1.76%) papers were identified for further analysis. The quantity of literature increased until 2016, with a peak in 2020. The United States, the United Kingdom, and Norway ranked among the top 3 countries for publication output. Health inequities caused by the adoption of digital health technologies in health care services can be reflected in the following two dimensions: the inability of citizens to obtain and adopt technology and the different disease outcomes found among citizens under technical intervention measures. The factors that influenced inequities included age, race, region, economy, and education level, together with health conditions and eHealth literacy. Finally, action can be taken to alleviate inequities in the future by government agencies and medical institutions (eg, establishing national health insurance), digital health technology providers (eg, designing high-quality tools), and health care service recipients (eg, developing skills to access digital technologies). Conclusions: The application of digital health technologies in health care services has caused inequities to some extent. However, existing research has certain limitations. The findings provide a comprehensive starting point for future research, allowing for further investigation into how digital health technologies may influence the unequal distribution of health care services. The interaction between individual subjective factors as well as social support and influencing factors should be included in future studies. Specifically, access to and availability of digital health technologies for socially disadvantaged groups should be of paramount importance. UR - https://www.jmir.org/2022/3/e34144 UR - http://dx.doi.org/10.2196/34144 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311682 ID - info:doi/10.2196/34144 ER - TY - JOUR AU - Nwosu, Callistus Amara AU - McGlinchey, Tamsin AU - Sanders, Justin AU - Stanley, Sarah AU - Palfrey, Jennifer AU - Lubbers, Patrick AU - Chapman, Laura AU - Finucane, Anne AU - Mason, Stephen PY - 2022/3/21 TI - Identification of Digital Health Priorities for Palliative Care Research: Modified Delphi Study JO - JMIR Aging SP - e32075 VL - 5 IS - 1 KW - palliative care KW - terminal care KW - supportive care KW - quality of life KW - symptom management KW - digital health KW - technology N2 - Background: Developments in digital health have the potential to transform the delivery of health and social care to help citizens manage their health. Currently, there is a lack of consensus about digital health research priorities in palliative care and a lack of theories about how these technologies might improve care outcomes. Therefore, it is important for health care leaders to identify innovations to ensure that an increasingly frail population has appropriate access to palliative care services. Consequently, it is important to articulate research priorities as the first step in determining how finite resources should be allocated to a field saturated with rapidly developing innovation. Objective: The aim of this study is to identify research priority areas for digital health in palliative care. Methods: We selected digital health trends, most relevant to palliative care, from a list of emerging trends reported by a leading institute of quantitative futurists. We conducted 2 rounds of the Delphi questionnaire, followed by a consensus meeting and public engagement workshop to establish a final consensus on research priorities for digital technology in palliative care. We used the views of public representatives to gain their perspectives on the agreed priorities. Results: A total of 103 experts (representing 11 countries) participated in the first Delphi round. Of the 103 experts, 55 (53.3%) participated in the second round. The final consensus meetings were attended by 10.7% (11/103) of the experts. We identified 16 priority areas, which involved many applications of technologies, including care for patients and caregivers, self-management and reporting of diseases, education and training, communication, care coordination, and research methodology. We summarized the priority areas into eight topics: big data, mobile devices, telehealth and telemedicine, virtual reality, artificial intelligence, smart home, biotechnology, and digital legacy. Conclusions: The priorities identified in this study represent a wide range of important emerging areas in the fields of digital health, personalized medicine, and data science. Human-centered design and robust governance systems should be considered in future research. It is important that the risks of using these technologies in palliative care are properly addressed to ensure that these tools are used meaningfully, wisely, and safely and do not cause unintentional harm. UR - https://aging.jmir.org/2022/1/e32075 UR - http://dx.doi.org/10.2196/32075 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311674 ID - info:doi/10.2196/32075 ER - TY - JOUR AU - Guilabert, Mercedes AU - Prades, Joan AU - Borras, M. Josep AU - Maestu, Inmaculada AU - Guerra, Antonio Juan AU - Fumadó, Lluís AU - Mira, Joaquin José AU - PY - 2022/3/10 TI - A Web-Based Self-assessment Model for Evaluating Multidisciplinary Cancer Teams in Spain: Development and Validation Pilot Study JO - J Med Internet Res SP - e29063 VL - 24 IS - 3 KW - web-based tool KW - multidisciplinary care KW - cancer KW - evaluation KW - quality assurance N2 - Background: Tumor boards constitute the main consensus and clinical decision?making body of multidisciplinary teams (MDTs) in cancer care. With the increasing clinical complexity of treatment options (eg, targeted therapies, multimodal treatments) and the progressive incorporation of new areas of intervention (eg, survivorship care), tumor boards are now required to play a central role in all cancer processes. However, although frameworks are in place to evaluate MDT quality, only few web-based tools are available for this purpose; indeed, no web-based MDT evaluation tools have been developed for or adapted to the Spanish National Health System. Objective: The first aim of this study was to develop a web-based self-assessment model (Autoevaluación de Equipos Multidisciplinares de Atención al Cáncer [AEMAC]) for evaluating multidisciplinary cancer teams in Spain and the second aim was to validate this tool by testing its metric properties, acceptability, and usability. Methods: We designed and validated the AEMAC program in 3 stages. In the first stage (research), we reviewed the available scientific evidence and performed a qualitative case study of good practice in multidisciplinary care within the Spanish National Health System (n=4 centers and 28 health care professionals). The results were used to define the thematic areas and quality criteria for the self-evaluation model, which were then discussed and validated by a group of experts. The second stage (development) involved the technological development of a web app that would be accessible from any mobile device. In the third stage (piloting and validation), we conducted 4 pilot tests (n=15 tumor boards, 243 professionals) and used the results to analyze the acceptability and usefulness of the tool. Results: We designed a self-assessment model based on 5 thematic areas encompassing a total of 25 quality components, which users rated on a 3-option development scale. The evaluation process, which was managed entirely from the web app, consisted of individual self-assessment, group prioritization, and creation of an improvement plan. Cronbach alpha (.86), McDonald?s omega (0.88), and various fit indices (comparative fit index between 0.95 and 1 and goodness-of-fit index between 0.97 and 0.99 for all 5 aspects) confirmed internal consistency. The mean rating for overall satisfaction with the tool and for consistency between the content of the tool and the reality of tumor boards was 7.6 out of 10. Conclusions: The results obtained during the period of research and piloting of the AEMAC program showed that it has an appropriate structure and metric properties and could therefore be implemented in a real context and generalized to other hospitals. As a virtual tool, it helps to measure the key aspects of MDT quality, such as effectiveness of collaboration and communication, leadership, and the organizational environment. UR - https://www.jmir.org/2022/3/e29063 UR - http://dx.doi.org/10.2196/29063 UR - http://www.ncbi.nlm.nih.gov/pubmed/35266870 ID - info:doi/10.2196/29063 ER - TY - JOUR AU - Graf, Joachim AU - Sickenberger, Nina AU - Brusniak, Katharina AU - Matthies, Maria Lina AU - Deutsch, M. Thomas AU - Simoes, Elisabeth AU - Plappert, Claudia AU - Keilmann, Lucia AU - Hartkopf, Andreas AU - Walter, Barbara Christina AU - Hahn, Markus AU - Engler, Tobias AU - Wallwiener, Stephanie AU - Schuetz, Florian AU - Fasching, A. Peter AU - Schneeweiss, Andreas AU - Brucker, Yvonne Sara AU - Wallwiener, Markus PY - 2022/2/8 TI - Implementation of an Electronic Patient-Reported Outcome App for Health-Related Quality of Life in Breast Cancer Patients: Evaluation and Acceptability Analysis in a Two-Center Prospective Trial JO - J Med Internet Res SP - e16128 VL - 24 IS - 2 KW - eHealth KW - electronic patient-reported outcomes KW - evaluation KW - acceptability KW - breast cancer N2 - Background: One in eight women is diagnosed with breast cancer in the course of their life. As systematic palliative treatment has only a limited effect on survival rates, the concept of health-related quality of life (HRQoL) was developed for measurement of patient-centered outcomes. Various studies have already demonstrated the reliability of paper-based patient-reported outcome (pPRO) and electronic patient-reported outcome (ePRO) surveys and that the 2 means of assessment are equally valid. Objective: The aim of this study was to analyze the acceptance and evaluation of a tablet-based ePRO app for breast cancer patients and to examine its suitability, effort, and difficulty in the context of HRQoL and sociodemographic factors. Methods: Overall, 106 women with adjuvant or advanced breast cancer were included in a 2-center study at 2 major university hospitals in Germany. Patients were asked to answer HRQoL and PRO questionnaires both on a tablet on-site using a specific eHealth assessment website and on paper. The suitability, effort, and difficulty of the app and self-reported technical skills were also assessed. Only the results of the electronically acquired data are presented here. The results of the reliability of the pPRO data have already been published elsewhere. Results: Patients regarded the ePRO assessment as more suitable (80/106, 75.5%), less stressful (73/106, 68.9%), and less difficult (69/106, 65.1%) than pPRO. The majority of patients stated that ePRO assessment improves health care in hospitals (87/106, 82.1%). However, evaluation of ePROs depended on the level of education (P=.003) in the dimensions of effort and difficulty (regression analysis). The app was rated highly in all categories. HRQoL data and therapy setting did not show significant correlations with the app?s evaluation parameters. Conclusions: The results indicate that ePRO surveys are feasible for measuring HRQoL in breast cancer patients and that those patients prefer ePRO assessment to pPRO assessment. It can also be seen that patients consider ePRO assessment to improve hospital health care. However, studies with larger numbers of patients are needed to develop apps that address the needs of patients with lower levels of education and technical skills. UR - https://www.jmir.org/2022/2/e16128 UR - http://dx.doi.org/10.2196/16128 UR - http://www.ncbi.nlm.nih.gov/pubmed/35133288 ID - info:doi/10.2196/16128 ER - TY - JOUR AU - Gillam, Juliet AU - Davies, Nathan AU - Aworinde, Jesutofunmi AU - Yorganci, Emel AU - Anderson, E. Janet AU - Evans, Catherine PY - 2022/2/3 TI - Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review JO - J Med Internet Res SP - e29837 VL - 24 IS - 2 KW - telemedicine KW - implementation science KW - dementia KW - long-term care KW - systematic review N2 - Background: As dementia progresses, symptoms and concerns increase, causing considerable distress for the person and their caregiver. The integration of care between care homes and health care services is vital to meet increasing care needs and maintain quality of life. However, care home access to high-quality health care is inequitable. eHealth can facilitate this by supporting remote specialist input on care processes, such as clinical assessment and decision-making, and streamlining care on site. How to best implement eHealth in the care home setting is unclear. Objective: The aim of this review was to identify the key factors that influence the implementation of eHealth for people living with dementia in long-term care. Methods: A systematic search of Embase, PsycINFO, MEDLINE, and CINAHL was conducted to identify studies published between 2000 and 2020. Studies were eligible if they focused on eHealth interventions to improve treatment and care assessment or decision-making for residents with dementia in care homes. Data were thematically analyzed and deductively mapped onto the 6 constructs of the adapted Consolidated Framework for Implementation Research (CFIR). The results are presented as a narrative synthesis. Results: A total of 29 studies were included, focusing on a variety of eHealth interventions, including remote video consultations and clinical decision support tools. Key factors that influenced eHealth implementation were identified across all 6 constructs of the CFIR. Most concerned the inner setting construct on requirements for implementation in the care home, such as providing a conducive learning climate, engaged leadership, and sufficient training and resources. A total of 4 novel subconstructs were identified to inform the implementation requirements to meet resident needs and engage end users. Conclusions: Implementing eHealth in care homes for people with dementia is multifactorial and complex, involving interaction between residents, staff, and organizations. It requires an emphasis on the needs of residents and the engagement of end users in the implementation process. A novel conceptual model of the key factors was developed and translated into 18 practical recommendations on the implementation of eHealth in long-term care to guide implementers or innovators in care homes. Successful implementation of eHealth is required to maximize uptake and drive improvements in integrated health and social care. UR - https://www.jmir.org/2022/2/e29837 UR - http://dx.doi.org/10.2196/29837 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113029 ID - info:doi/10.2196/29837 ER - TY - JOUR AU - Weatherburn, Christopher PY - 2022/2/3 TI - Digital Inclusion as a Foundation for Health Equity. Comment on ?Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study? JO - J Med Internet Res SP - e34702 VL - 24 IS - 2 KW - technology-enabled care KW - video consultations KW - quality improvement KW - COVID-19 KW - PERCS framework KW - remote consultation KW - Scotland KW - general practice KW - digital inclusion KW - digital divide KW - digital health equity UR - https://www.jmir.org/2022/2/e34702 UR - http://dx.doi.org/10.2196/34702 UR - http://www.ncbi.nlm.nih.gov/pubmed/35038303 ID - info:doi/10.2196/34702 ER - TY - JOUR AU - Milos Nymberg, Veronica AU - Ellegård, Maria Lina AU - Kjellsson, Gustav AU - Wolff, Moa AU - Borgström Bolmsjö, Beata AU - Wallman, Thorne AU - Calling, Susanna PY - 2022/2/2 TI - Trends in Remote Health Care Consumption in Sweden: Comparison Before and During the First Wave of the COVID-19 Pandemic JO - JMIR Hum Factors SP - e33034 VL - 9 IS - 1 KW - remote health care KW - telemedicine KW - primary health care KW - respiratory tract infections KW - COVID-19 N2 - Background: Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been put against a questionable quality of care as well as risks of increased utilization and costs. The COVID-19 pandemic has contributed to a changed management of patient care to decrease viral spread, with an expected shift in contact types from in-person to remote ones. Objective: The main aim of this study was to compare health care consumption and type of contacts (in-person or remote) for RTIs before and during the COVID-19 pandemic. The second aim was to study whether the number of follow-up contacts after an index contact for RTIs changed during the study period, and whether the number of follow-up contacts differed if the index contact was in-person or remote. A third aim was to study whether the pattern of follow-up contacts differed depending on whether the index contact was with a traditional or a private telemedicine provider. Methods: The study design was an observational retrospective analysis with a description of all index contacts and follow-up contacts with physicians in primary care and emergency rooms in a Swedish region (Skåne) for RTIs including patients of all ages and comparison for the same periods in 2018, 2019, and 2020. Results: Compared with 2018 and 2019, there were fewer index contacts for RTIs per 1000 inhabitants in 2020. By contrast, the number of follow-up contacts, both per 1000 inhabitants and per index contact, was higher in 2020. The composition of both index and follow-up contacts changed as the share of remote contacts, in particular for traditional care providers, increased. Conclusions: During the COVID-19 pandemic in 2020, fewer index contacts for RTIs but more follow-up contacts were conducted, compared with 2018-2019. The share of both index and follow-up contacts that were conducted remotely increased. Further studies are needed to study the reasons behind the increase in remote contacts, and if it will last after the pandemic, and more clinical guidelines for remote assessments of RTI are warranted. UR - https://humanfactors.jmir.org/2022/1/e33034 UR - http://dx.doi.org/10.2196/33034 UR - http://www.ncbi.nlm.nih.gov/pubmed/34846304 ID - info:doi/10.2196/33034 ER - TY - JOUR AU - Yu, Jiyeon AU - de Antonio, Angelica AU - Villalba-Mora, Elena PY - 2022/1/28 TI - Design of an Integrated Acceptance Framework for Older Users and eHealth: Influential Factor Analysis JO - J Med Internet Res SP - e31920 VL - 24 IS - 1 KW - eHealth KW - older people KW - older user KW - health technology KW - acceptance factors KW - adoption KW - acceptance framework KW - systematic review KW - thematic analysis KW - influential factor analysis KW - mobile phone N2 - Background: eHealth and telehealth play a crucial role in assisting older adults who visit hospitals frequently or who live in nursing homes and can benefit from staying at home while being cared for. Adapting to new technologies can be difficult for older people. Thus, to better apply these technologies to older adults? lives, many studies have analyzed the acceptance factors for this particular population. However, there is not yet a consensual framework that can be used in further development and to search for solutions. Objective: This paper aims to present an integrated acceptance framework (IAF) for older users? acceptance of eHealth based on 43 studies selected through a systematic review. Methods: We conducted a 4-step study. First, through a systematic review in the field of eHealth from 2010 to 2020, the acceptance factors and basic data for analysis were extracted. Second, we conducted a thematic analysis to group the factors into themes to propose an integrated framework for acceptance. Third, we defined a metric to evaluate the impact of the factors addressed in the studies. Finally, the differences among the important IAF factors were analyzed according to the participants? health conditions, verification time, and year. Results: Through a systematic review, 731 studies were found in 5 major databases, resulting in 43 (5.9%) selected studies using the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) methodology. First, the research methods and acceptance factors for eHealth were compared and analyzed, extracting a total of 105 acceptance factors, which were grouped later, resulting in an IAF. A total of 5 dimensions (ie, personal, user?technology relational, technological, service-related, and environmental) emerged, with a total of 23 factors. In addition, we assessed the quality of evidence and then conducted a stratification analysis to reveal the more appropriate factors depending on the health condition and assessment time. Finally, we assessed the factors and dimensions that have recently become more important. Conclusions: The result of this investigation is a framework for conducting research on eHealth acceptance. To elaborately analyze the impact of the factors of the proposed framework, the criteria for evaluating the evidence from the studies that have the extracted factors are presented. Through this process, the impact of each factor in the IAF has been presented, in addition to the framework proposal. Moreover, a meta-analysis of the current status of research is presented, highlighting the areas where specific measures are needed to facilitate eHealth acceptance. UR - https://www.jmir.org/2022/1/e31920 UR - http://dx.doi.org/10.2196/31920 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089155 ID - info:doi/10.2196/31920 ER - TY - JOUR AU - Skime, K. Michelle AU - Puspitasari, J. Ajeng AU - Gentry, T. Melanie AU - Heredia Jr, Dagoberto AU - Sawchuk, N. Craig AU - Moore, R. Wendy AU - Taylor-Desir, J. Monica AU - Schak, M. Kathryn PY - 2022/1/28 TI - Patient Satisfaction and Recommendations for Delivering a Group-Based Intensive Outpatient Program via Telemental Health During the COVID-19 Pandemic: Cross-sectional Cohort Study JO - JMIR Ment Health SP - e30204 VL - 9 IS - 1 KW - COVID-19 KW - telemental health KW - teletherapy KW - telepsychiatry KW - telemedicine KW - intensive outpatient KW - patient satisfaction N2 - Background: Although group-based intensive outpatient programs (IOPs) are a level of care commonly utilized by adults with serious mental illness, few studies have examined the acceptability of group-based IOPs that required rapid transition to a telemental health (TMH) format during the COVID-19 pandemic. Objective: The aim of this study was to evaluate patient satisfaction and future recommendations for a group-based IOP that was transitioned to a TMH format during the COVID-19 pandemic. Methods: A 17-item patient satisfaction questionnaire was completed by patients at discharge and covered 3 areas: IOP TMH satisfaction, future recommendations, and video technology challenges. Descriptive and content analyses were conducted for the quantitative and open-ended questions, respectively. Results: A total of 76 patients completed the program in 2020. A subset of patients (n=40, 53%) responded to the survey at program discharge. The results indicated that the patients were satisfied overall with the TMH program format; 50% (n=20) of the patients preferred the program continue offering the TMH format, and the rest preferred returning to in-person formats after the pandemic. The patients indicated the elements of the program that they found most valuable and provided recommendations for future program improvement. Conclusions: Overall, adults with serious mental illness reported high satisfaction with the group-based IOP delivered via TMH. Health care systems may want to consider offering both TMH and in-person formats regardless of the state of the pandemic. Patients? feedback on future improvements should be considered to help ensure long-term success. UR - https://mental.jmir.org/2022/1/e30204 UR - http://dx.doi.org/10.2196/30204 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878999 ID - info:doi/10.2196/30204 ER - TY - JOUR AU - Eze, E. Chinwe AU - West, T. Brady AU - Dorsch, P. Michael AU - Coe, B. Antoinette AU - Lester, A. Corey AU - Buis, R. Lorraine AU - Farris, Karen PY - 2022/1/24 TI - Predictors of Smartphone and Tablet Use Among Patients With Hypertension: Secondary Analysis of Health Information National Trends Survey Data JO - J Med Internet Res SP - e33188 VL - 24 IS - 1 KW - hypertension KW - mHealth KW - remote monitoring KW - telemonitoring KW - smartphones KW - tablets KW - text messaging KW - Health Information National Trends Survey KW - mobile health KW - digital health KW - mobile phone N2 - Background: Uncontrolled hypertension leads to significant morbidity and mortality. The use of mobile health technology, such as smartphones, for remote blood pressure (BP) monitoring has improved BP control. An increase in BP control is more significant when patients can remotely communicate with their health care providers through technologies and receive feedback. Little is known about the predictors of remote BP monitoring among hypertensive populations. Objective: The objective of this study is to quantify the predictors of smartphone and tablet use in achieving health goals and communicating with health care providers via SMS text messaging among hypertensive patients in the United States. Methods: This study was a cross-sectional, secondary analysis of the 2017 and 2018 Health Information National Trends Survey 5, cycles 1 and 2 data. A total of 3045 respondents answered ?Yes? to the question ?Has a doctor or other healthcare provider ever told you that you had high blood pressure or hypertension??, which defined the subpopulation used in this study. We applied the Health Information National Trends Survey full sample weight to calculate the population estimates and 50 replicate weights to calculate the SEs of the estimates. We used design-adjusted descriptive statistics to describe the characteristics of respondents who are hypertensive based on relevant survey items. Design-adjusted multivariable logistic regression models were fitted to estimate predictors of achieving health goals with the help of smartphone or tablet and sending or receiving an SMS text message to or from a health care provider in the last 12 months. Results: An estimated 36.9%, SE 0.9% (183,285,150/497,278,883) of the weighted adult population in the United States had hypertension. The mean age of the hypertensive population was 58.3 (SE 0.48) years. Electronic communication with the doctor or doctor?s office through email or internet (odds ratio 2.93, 95% CI 1.85-4.63; P<.001) and having a wellness app (odds ratio 1.82, 95% CI 1.16-2.86; P=.02) were significant predictors of using SMS text message communication with a health care professional, adjusting for other demographic and technology-related variables. The odds of achieving health-related goals with the help of a tablet or smartphone declined significantly with older age (P<.001) and ownership of basic cellphones (P=.04). However, they increased significantly with being a woman (P=.045) or with being married (P=.03), having a wellness app (P<.001), using devices other than smartphones or tablets to monitor health (P=.008), making health treatment decisions (P=.048), and discussing with a provider (P=.02) with the help of a tablet or smartphone. Conclusions: Intervention measures accounting for age, gender, marital status, and the patient?s technology-related health behaviors are required to increase smartphone and tablet use in self-care and SMS text message communication with health care providers. UR - https://www.jmir.org/2022/1/e33188 UR - http://dx.doi.org/10.2196/33188 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072647 ID - info:doi/10.2196/33188 ER - TY - JOUR AU - Andrade, Q. Andre AU - Calabretto, Jean-Pierre AU - Pratt, L. Nicole AU - Kalisch-Ellett, M. Lisa AU - Kassie, M. Gizat AU - LeBlanc, T. Vanessa AU - Ramsay, Emmae AU - Roughead, E. Elizabeth PY - 2022/1/10 TI - Implementation and Evaluation of a Digitally Enabled Precision Public Health Intervention to Reduce Inappropriate Gabapentinoid Prescription: Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e33873 VL - 24 IS - 1 KW - audit and feedback KW - digital health KW - precision public health KW - digital intervention KW - primary care KW - physician KW - health professional KW - health education N2 - Background: Digital technologies can enable rapid targeted delivery of audit and feedback interventions at scale. Few studies have evaluated how mode of delivery affects clinical professional behavior change and none have assessed the feasibility of such an initiative at a national scale. Objective: The aim of this study was to develop and evaluate the effect of audit and feedback by digital versus postal (letter) mode of delivery on primary care physician behavior. Methods: This study was developed as part of the Veterans? Medicines Advice and Therapeutics Education Services (MATES) program, an intervention funded by the Australian Government Department of Veterans? Affairs that provides targeted education and patient-specific audit with feedback to Australian general practitioners, as well as educational material to veterans and other health professionals. We performed a cluster randomized controlled trial of a multifaceted intervention to reduce inappropriate gabapentinoid prescription, comparing digital and postal mode of delivery. All veteran patients targeted also received an educational intervention (postal delivery). Efficacy was measured using a linear mixed-effects model as the average number of gabapentinoid prescriptions standardized by defined daily dose (individual level), and number of veterans visiting a psychologist in the 6 and 12 months following the intervention. Results: The trial involved 2552 general practitioners in Australia and took place in March 2020. Both intervention groups had a significant reduction in total gabapentinoid prescription by the end of the study period (digital: mean reduction of 11.2%, P=.004; postal: mean reduction of 11.2%, P=.001). We found no difference between digital and postal mode of delivery in reduction of gabapentinoid prescriptions at 12 months (digital: ?0.058, postal: ?0.058, P=.98). Digital delivery increased initiations to psychologists at 12 months (digital: 3.8%, postal: 2.0%, P=.02). Conclusions: Our digitally delivered professional behavior change intervention was feasible, had comparable effectiveness to the postal intervention with regard to changes in medicine use, and had increased effectiveness with regard to referrals to a psychologist. Given the logistical benefits of digital delivery in nationwide programs, the results encourage exploration of this mode in future interventions. UR - https://www.jmir.org/2022/1/e33873 UR - http://dx.doi.org/10.2196/33873 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006086 ID - info:doi/10.2196/33873 ER - TY - JOUR AU - Zhong, Yang AU - Tao, Wenjuan AU - Yang, Yanlin AU - Wu, Hao AU - Li, Weimin AU - Wen, Jin PY - 2021/12/29 TI - Comparison of User-Oriented Information Services on the Websites of Large Hospitals in China and the United States: Cross-sectional Study JO - J Med Internet Res SP - e27392 VL - 23 IS - 12 KW - hospital websites KW - internet KW - information services KW - marketing mix KW - 7Ps KW - health care information services KW - hospital management KW - hospitals KW - patient services KW - eHealth N2 - Background: Many people use the internet to access health care information to support health care decisions, and hospital websites can be the first point of contact to provide health care information services for consumers. However, little is known about the current information services provided by the websites of large Chinese hospitals. Objective: The aim of this study is to evaluate and compare the information services of the websites of large hospitals in China and the United States. We hope that our findings will benefit hospital managers worldwide in providing service information on the web. Methods: This study adopted a cross-sectional analytical approach to evaluate the websites of large hospitals in China and the United States in 2020. A total of 300 large hospitals were randomly selected, of which half were in China and half were in the United States. Based on the 7Ps marketing mix, we identified 39 items that represent typical hospital website information services, covering the following seven dimensions: product, price, place, propagation, people, process, and physical evidence. Results: Most of the items (34/39, 87%) related to information services offered by hospital websites were less covered in China than in the United States; however, 5 items (appointments by a third-party platform, mobile payment, hospital value, hospital environment display, and physicians? profiles) had higher coverage in China. The average scores for hospital websites in China and the United States were 13.25 (SD 2.99) points and 23.16 (SD 2.76) points, respectively. Generally, high scores were given to the south areas of China and north areas of the United States. Conclusions: Hospital websites in China lagged behind those in the United States with regard to information services offered. We recommend that hospital managers in China place more emphasis on the people, product, and propagation dimensions of the 7Ps marketing mix in the construction of information services on hospital websites. Through the comparison of the websites of large hospitals in China and the United States, our study findings can provide suggestions for forming standard hospital website construction guidelines worldwide. UR - https://www.jmir.org/2021/12/e27392 UR - http://dx.doi.org/10.2196/27392 UR - http://www.ncbi.nlm.nih.gov/pubmed/34964717 ID - info:doi/10.2196/27392 ER - TY - JOUR AU - Ahadzadeh, Sadat Ashraf AU - Wu, Ling Shin AU - Ong, Sim Fon AU - Deng, Ruolan PY - 2021/12/29 TI - The Mediating Influence of the Unified Theory of Acceptance and Use of Technology on the Relationship Between Internal Health Locus of Control and Mobile Health Adoption: Cross-sectional Study JO - J Med Internet Res SP - e28086 VL - 23 IS - 12 KW - mobile health KW - mHealth KW - internal health locus of control KW - performance expectancy KW - effort expectancy KW - social influence KW - mediation N2 - Background: Mobile health (mHealth) as an innovative form of information and communications technology can efficiently deliver high-quality health care by enhancing communication and health management, reducing costs, and increasing access to health services. An individual?s internal health locus of control (HLOC) is found to be associated with the behavioral intent to adopt mHealth. However, little is known about the underlying mechanism of this association. Objective: The primary objective of this study was to test the mediation influence of the Unified Theory of Acceptance and Use of Technology (UTAUT) on the relationship between internal HLOC and the behavioral intention to use mHealth. Methods: A total of 374 responses were collected from Malaysian adult users of mHealth, using convenience and snowball sampling methods. Partial least squares structural equation modeling was used to analyze the data. Data were collected for variables, including demographics, internal HLOC, and modified UTAUT constructs (ie, performance expectancy, effort expectancy, and social influence). Results: The results showed that there was no direct relationship between internal HLOC and the behavioral intention to use mHealth (?=?0.039, P=.32). The indirect relationship between internal HLOC and the intent to adopt mHealth was supported, indicating that the UTAUT constructs performance expectancy (?=0.104, P<.001), effort expectancy (?=0.056, P=.02), and social influence (?=0.057, P=.002) mediated this relationship. The results showed full mediation, with total variance explained at 47.2%. Conclusions: This study developed an integrative model, where a health-related disposition (internal HLOC), mHealth-related beliefs (performance expectancy and effort expectancy), and normative pressure (social influence) were combined to explain the underlying mechanism of the behavioral intent to adopt mHealth. The results showed that the intention to adopt mHealth is mediated by the influence of UTAUT factors, while HLOC has no direct effect on adoption intention. The findings provide insights into augmenting mHealth adoption among the public by enhancing the perceived benefits of mHealth, helping design more effective and user-friendly mHealth tools, and capitalizing on social normative influence to adopt mHealth. This study utilized the constructs of the UTAUT model to determine the intention to use mHealth. Future research should focus on other health- and technology-related theories to ascertain other possible factors influencing the behavioral intent of mHealth adoption. UR - https://www.jmir.org/2021/12/e28086 UR - http://dx.doi.org/10.2196/28086 UR - http://www.ncbi.nlm.nih.gov/pubmed/34964718 ID - info:doi/10.2196/28086 ER - TY - JOUR AU - Cho, Sylvia AU - Weng, Chunhua AU - Kahn, G. Michael AU - Natarajan, Karthik PY - 2021/12/23 TI - Identifying Data Quality Dimensions for Person-Generated Wearable Device Data: Multi-Method Study JO - JMIR Mhealth Uhealth SP - e31618 VL - 9 IS - 12 KW - patient-generated health data KW - data accuracy KW - data quality KW - wearable device KW - fitness trackers KW - qualitative research N2 - Background: There is a growing interest in using person-generated wearable device data for biomedical research, but there are also concerns regarding the quality of data such as missing or incorrect data. This emphasizes the importance of assessing data quality before conducting research. In order to perform data quality assessments, it is essential to define what data quality means for person-generated wearable device data by identifying the data quality dimensions. Objective: This study aims to identify data quality dimensions for person-generated wearable device data for research purposes. Methods: This study was conducted in 3 phases: literature review, survey, and focus group discussion. The literature review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline to identify factors affecting data quality and its associated data quality challenges. In addition, we conducted a survey to confirm and complement results from the literature review and to understand researchers? perceptions on data quality dimensions that were previously identified as dimensions for the secondary use of electronic health record (EHR) data. We sent the survey to researchers with experience in analyzing wearable device data. Focus group discussion sessions were conducted with domain experts to derive data quality dimensions for person-generated wearable device data. On the basis of the results from the literature review and survey, a facilitator proposed potential data quality dimensions relevant to person-generated wearable device data, and the domain experts accepted or rejected the suggested dimensions. Results: In total, 19 studies were included in the literature review, and 3 major themes emerged: device- and technical-related, user-related, and data governance?related factors. The associated data quality problems were incomplete data, incorrect data, and heterogeneous data. A total of 20 respondents answered the survey. The major data quality challenges faced by researchers were completeness, accuracy, and plausibility. The importance ratings on data quality dimensions in an existing framework showed that the dimensions for secondary use of EHR data are applicable to person-generated wearable device data. There were 3 focus group sessions with domain experts in data quality and wearable device research. The experts concluded that intrinsic data quality features, such as conformance, completeness, and plausibility, and contextual and fitness-for-use data quality features, such as completeness (breadth and density) and temporal data granularity, are important data quality dimensions for assessing person-generated wearable device data for research purposes. Conclusions: In this study, intrinsic and contextual and fitness-for-use data quality dimensions for person-generated wearable device data were identified. The dimensions were adapted from data quality terminologies and frameworks for the secondary use of EHR data with a few modifications. Further research on how data quality can be assessed with respect to each dimension is needed. UR - https://mhealth.jmir.org/2021/12/e31618 UR - http://dx.doi.org/10.2196/31618 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941540 ID - info:doi/10.2196/31618 ER - TY - JOUR AU - Pecina, L. Jennifer AU - Nigon, M. Leah AU - Penza, S. Kristine AU - Murray, A. Martha AU - Kronebusch, J. Beckie AU - Miller, E. Nathaniel AU - Jensen, B. Teresa PY - 2021/12/20 TI - Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study JO - J Med Internet Res SP - e25899 VL - 23 IS - 12 KW - strep pharygitis KW - e-visit KW - electronic visit KW - telemedicine KW - telecare KW - virtual visit KW - McIssac score KW - nurse phone triage KW - scoring system KW - sore throat KW - group A streptococcus KW - telehealth KW - nurse KW - phone KW - triage N2 - Background: The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. Objective: We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. Methods: This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. Results: There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. Conclusions: McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing. UR - https://www.jmir.org/2021/12/e25899 UR - http://dx.doi.org/10.2196/25899 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932016 ID - info:doi/10.2196/25899 ER - TY - JOUR AU - Ankersen, Vedel Dorit AU - Weimers, Petra AU - Bennedsen, Mette AU - Haaber, Birgitte Anne AU - Fjordside, Lund Eva AU - Beber, Emanuel Moritz AU - Lieven, Christian AU - Saboori, Sanaz AU - Vad, Nicolai AU - Rannem, Terje AU - Marker, Dorte AU - Paridaens, Kristine AU - Frahm, Suzanne AU - Jensen, Lisbeth AU - Rosager Hansen, Malte AU - Burisch, Johan AU - Munkholm, Pia PY - 2021/12/14 TI - Long-Term Effects of a Web-Based Low-FODMAP Diet Versus Probiotic Treatment for Irritable Bowel Syndrome, Including Shotgun Analyses of Microbiota: Randomized, Double-Crossover Clinical Trial JO - J Med Internet Res SP - e30291 VL - 23 IS - 12 KW - irritable bowel syndrome KW - web-based low-FODMAP diet KW - probiotics KW - randomized trial KW - web-based KW - IBS KW - symptom management KW - treatment outcomes KW - outcomes KW - treatment KW - microbiota KW - microbiome KW - gastroenterology KW - mobile app KW - mHealth KW - eHealth N2 - Background: The long-term management of irritable bowel syndrome (IBS) poses many challenges. In short-term studies, eHealth interventions have been demonstrated to be safe and practical for at-home monitoring of the effects of probiotic treatments and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). IBS has been linked to alterations in the microbiota. Objective: The aim of this study was to determine whether a web-based low-FODMAP diet (LFD) intervention and probiotic treatment were equally good at reducing IBS symptoms, and whether the response to treatments could be explained by patients? microbiota. Methods: Adult IBS patients were enrolled in an open-label, randomized crossover trial (for nonresponders) with 1 year of follow-up using the web application IBS Constant Care (IBS CC). Patients were recruited from the outpatient clinic at the Department of Gastroenterology, North Zealand University Hospital, Denmark. Patients received either VSL#3 for 4 weeks (2 × 450 billion colony-forming units per day) or were placed on an LFD for 4 weeks. Patients responding to the LFD were reintroduced to foods high in FODMAPs, and probiotic responders received treatments whenever they experienced a flare-up of symptoms. Treatment response and symptom flare-ups were defined as a reduction or increase, respectively, of at least 50 points on the IBS Severity Scoring System (IBS-SSS). Web-based ward rounds were performed daily by the study investigator. Fecal microbiota were analyzed by shotgun metagenomic sequencing (at least 10 million 2 × 100 bp paired-end sequencing reads per sample). Results: A total of 34 IBS patients without comorbidities and 6 healthy controls were enrolled in the study. Taken from participating subjects, 180 fecal samples were analyzed for their microbiota composition. Out of 21 IBS patients, 12 (57%) responded to the LFD and 8 (38%) completed the reintroduction of FODMAPs. Out of 21 patients, 13 (62%) responded to their first treatment of VSL#3 and 7 (33%) responded to multiple VSL#3 treatments. A median of 3 (IQR 2.25-3.75) probiotic treatments were needed for sustained symptom control. LFD responders were reintroduced to a median of 14.50 (IQR 7.25-21.75) high-FODMAP items. No significant difference in the median reduction of IBS-SSS for LFD versus probiotic responders was observed, where for LFD it was ?126.50 (IQR ?196.75 to ?76.75) and for VSL#3 it was ?130.00 (IQR ?211.00 to ?70.50; P>.99). Responses to either of the two treatments were not able to be predicted using patients? microbiota. Conclusions: The web-based LFD intervention and probiotic treatment were equally efficacious in managing IBS symptoms. The response to treatments could not be explained by the composition of the microbiota. The IBS CC web application was shown to be practical, safe, and useful for clinical decision making in the long-term management of IBS. Although this study was underpowered, findings from this study warrant further research in a larger sample of patients with IBS to confirm these long-term outcomes. Trial Registration: ClinicalTrials.gov NCT03586622; https://clinicaltrials.gov/ct2/show/NCT03586622 UR - https://www.jmir.org/2021/12/e30291 UR - http://dx.doi.org/10.2196/30291 UR - http://www.ncbi.nlm.nih.gov/pubmed/34904950 ID - info:doi/10.2196/30291 ER - TY - JOUR AU - Steele Gray, Carolyn AU - Chau, Edward AU - Tahsin, Farah AU - Harvey, Sarah AU - Loganathan, Mayura AU - McKinstry, Brian AU - Mercer, W. Stewart AU - Nie, Xin Jason AU - Palen, E. Ted AU - Ramsay, Tim AU - Thavorn, Kednapa AU - Upshur, Ross AU - Wodchis, P. Walter PY - 2021/12/2 TI - Assessing the Implementation and Effectiveness of the Electronic Patient-Reported Outcome Tool for Older Adults With Complex Care Needs: Mixed Methods Study JO - J Med Internet Res SP - e29071 VL - 23 IS - 12 KW - older adults KW - goal-oriented care KW - quality of life KW - self-management KW - primary care KW - eHealth KW - pragmatic trial KW - mobile phone N2 - Background: Goal-oriented care is being adopted to deliver person-centered primary care to older adults with multimorbidity and complex care needs. Although this model holds promise, its implementation remains a challenge. Digital health solutions may enable processes to improve adoption; however, they require evaluation to determine feasibility and impact. Objective: This study aims to evaluate the implementation and effectiveness of the electronic Patient-Reported Outcome (ePRO) mobile app and portal system, designed to enable goal-oriented care delivery in interprofessional primary care practices. The research questions driving this study are as follows: Does ePRO improve quality of life and self-management in older adults with complex needs? What mechanisms are likely driving observed outcomes? Methods: A multimethod, pragmatic randomized controlled trial using a stepped-wedge design and ethnographic case studies was conducted over a 15-month period in 6 comprehensive primary care practices across Ontario with a target enrollment of 176 patients. The 6 practices were randomized into either early (3-month control period; 12-month intervention) or late (6-month control period; 9-month intervention) groups. The primary outcome measure of interest was the Assessment of Quality of Life-4D (AQoL-4D). Data were collected at baseline and at 3 monthly intervals for the duration of the trial. Ethnographic data included observations and interviews with patients and providers at the midpoint and end of the intervention. Outcome data were analyzed using linear models conducted at the individual level, accounting for cluster effects at the practice level, and ethnographic data were analyzed using qualitative description and framework analysis methods. Results: Recruitment challenges resulted in fewer sites and participants than expected; of the 176 target, only 142 (80.6%) patients were identified as eligible to participate because of lower-than-expected provider participation and fewer-than-expected patients willing to participate or perceived as ready to engage in goal-setting. Of the 142 patients approached, 45 (32%) participated. Patients set a variety of goals related to self-management, mental health, social health, and overall well-being. Owing to underpowering, the impact of ePRO on quality of life could not be definitively assessed; however, the intervention group, ePRO plus usual care (mean 15.28, SD 18.60) demonstrated a nonsignificant decrease in quality of life (t24=?1.20; P=.24) when compared with usual care only (mean 21.76, SD 2.17). The ethnographic data reveal a complex implementation process in which the meaningfulness (or coherence) of the technology to individuals? lives and work acted as a key driver of adoption and tool appraisal. Conclusions: This trial experienced many unexpected and significant implementation challenges related to recruitment and engagement. Future studies could be improved through better alignment of the research methods and intervention to the complex and diverse clinical settings, dynamic goal-oriented care process, and readiness of provider and patient participants. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 UR - https://www.jmir.org/2021/12/e29071 UR - http://dx.doi.org/10.2196/29071 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860675 ID - info:doi/10.2196/29071 ER - TY - JOUR AU - Nadav, Janna AU - Kaihlanen, Anu-Marja AU - Kujala, Sari AU - Laukka, Elina AU - Hilama, Pirjo AU - Koivisto, Juha AU - Keskimäki, Ilmo AU - Heponiemi, Tarja PY - 2021/12/1 TI - How to Implement Digital Services in a Way That They Integrate Into Routine Work: Qualitative Interview Study Among Health and Social Care Professionals JO - J Med Internet Res SP - e31668 VL - 23 IS - 12 KW - digital services KW - implementation KW - health and social care professionals KW - integration KW - normalization process theory KW - interview KW - social work KW - health care KW - focus groups N2 - Background: Although the COVID-19 pandemic has significantly boosted the implementation of digital services worldwide, it has become increasingly important to understand how these solutions are integrated into professionals? routine work. Professionals who are using the services are key influencers in the success of implementations. To ensure successful implementations, it is important to understand the multiprofessional perspective, especially because implementations are likely to increase even more. Objective: The aim of this study is to examine health and social care professionals? experiences of digital service implementations and to identify factors that support successful implementations and should be considered in the future to ensure that the services are integrated into professionals? routine work. Methods: A qualitative approach was used, in which 8 focus group interviews were conducted with 30 health and social care professionals from 4 different health centers in Finland. Data were analyzed using qualitative content analysis. The resulting categories were organized under the components of normalization process theory. Results: Our results suggested 14 practices that should be considered when implementing new digital services into routine work. To get professionals to understand and make sense of the new service, (1) the communication related to the implementation should be comprehensive and continuous and (2) the implementation process should be consistent. (3) A justification for the service being implemented should also be given. The best way to engage the professionals with the service is (4) to give them opportunities to influence and (5) to make sure that they have a positive attitude toward the service. To enact the new service into professionals? routine work, it is important that (6) the organization take a supportive approach by providing support from several easy and efficient sources. The professionals should also have (7) enough time to become familiar with the service, and they should have (8) enough know-how about the service. The training should be (9) targeted individually according to skills and work tasks, and (10) it should be diverse. The impact of the implementation on the professionals? work should be evaluated. The service (11) should be easy to use, and (12) usage monitoring should happen. An opportunity (13) to give feedback on the service should also be offered. Moreover, (14) the service should support professionals? work tasks. Conclusions: We introduce 14 practices for organizations and service providers on how to ensure sustainable implementation of new digital services and the smooth integration into routine work. It is important to pay more attention to comprehensive and continuing communication. Organizations should conduct a competence assessment before training in order to ensure proper alignment. Follow-ups to the implementation process should be performed to guarantee sustainability of the service. Our findings from a forerunner country of digitalization can be useful for countries that are beginning their service digitalization or further developing their digital services. UR - https://www.jmir.org/2021/12/e31668 UR - http://dx.doi.org/10.2196/31668 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855610 ID - info:doi/10.2196/31668 ER - TY - JOUR AU - Esmaeilzadeh, Pouyan AU - Mirzaei, Tala AU - Dharanikota, Spurthy PY - 2021/11/25 TI - Patients? Perceptions Toward Human?Artificial Intelligence Interaction in Health Care: Experimental Study JO - J Med Internet Res SP - e25856 VL - 23 IS - 11 KW - AI clinical applications KW - collective intelligence KW - in-person examinations KW - perceived benefits KW - perceived risks N2 - Background: It is believed that artificial intelligence (AI) will be an integral part of health care services in the near future and will be incorporated into several aspects of clinical care such as prognosis, diagnostics, and care planning. Thus, many technology companies have invested in producing AI clinical applications. Patients are one of the most important beneficiaries who potentially interact with these technologies and applications; thus, patients? perceptions may affect the widespread use of clinical AI. Patients should be ensured that AI clinical applications will not harm them, and that they will instead benefit from using AI technology for health care purposes. Although human-AI interaction can enhance health care outcomes, possible dimensions of concerns and risks should be addressed before its integration with routine clinical care. Objective: The main objective of this study was to examine how potential users (patients) perceive the benefits, risks, and use of AI clinical applications for their health care purposes and how their perceptions may be different if faced with three health care service encounter scenarios. Methods: We designed a 2×3 experiment that crossed a type of health condition (ie, acute or chronic) with three different types of clinical encounters between patients and physicians (ie, AI clinical applications as substituting technology, AI clinical applications as augmenting technology, and no AI as a traditional in-person visit). We used an online survey to collect data from 634 individuals in the United States. Results: The interactions between the types of health care service encounters and health conditions significantly influenced individuals? perceptions of privacy concerns, trust issues, communication barriers, concerns about transparency in regulatory standards, liability risks, benefits, and intention to use across the six scenarios. We found no significant differences among scenarios regarding perceptions of performance risk and social biases. Conclusions: The results imply that incompatibility with instrumental, technical, ethical, or regulatory values can be a reason for rejecting AI applications in health care. Thus, there are still various risks associated with implementing AI applications in diagnostics and treatment recommendations for patients with both acute and chronic illnesses. The concerns are also evident if the AI applications are used as a recommendation system under physician experience, wisdom, and control. Prior to the widespread rollout of AI, more studies are needed to identify the challenges that may raise concerns for implementing and using AI applications. This study could provide researchers and managers with critical insights into the determinants of individuals? intention to use AI clinical applications. Regulatory agencies should establish normative standards and evaluation guidelines for implementing AI in health care in cooperation with health care institutions. Regular audits and ongoing monitoring and reporting systems can be used to continuously evaluate the safety, quality, transparency, and ethical factors of AI clinical applications. UR - https://www.jmir.org/2021/11/e25856 UR - http://dx.doi.org/10.2196/25856 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842535 ID - info:doi/10.2196/25856 ER - TY - JOUR AU - Hurst, Rachel AU - Liljenquist, Kendra AU - Lowry, J. Sarah AU - Szilagyi, G. Peter AU - Fiscella, A. Kevin AU - Weaver, R. Marcia AU - Porras-Javier, Lorena AU - Ortiz, Janette AU - Sotelo Guerra, J. Laura AU - Coker, R. Tumaini PY - 2021/11/25 TI - A Parent Coach?Led Model of Well-Child Care for Young Children in Low-Income Communities: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e27054 VL - 10 IS - 11 KW - preventive care KW - well-child care KW - community health centers N2 - Background: The Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) intervention was created as a team-based approach to well-child care (WCC) that relies on a health educator (Parent Coach) to provide the bulk of WCC services, address specific needs faced by families in low-income communities, and decrease reliance on the clinician as the primary provider of WCC services. Objective: This study aims to evaluate the impact of PARENT using a cluster randomized controlled trial. Methods: This study tested the effectiveness of PARENT at 10 clinical sites in 2 federally qualified health centers in Tacoma, Washington, and Los Angeles, California. We conducted a cluster randomized controlled trial that included 916 families with children aged ?12 months at the time of the baseline survey. Parents will be followed up at 6 and 12 months after enrollment. The Parent Coach, the main element of PARENT, provides anticipatory guidance, psychosocial screening and referral, developmental and behavioral surveillance, screening, and guidance at each WCC visit. The coach is supported by parent-focused previsit screening and visit prioritization, a brief, problem-focused clinician encounter for a physical examination and any concerns that require a clinician?s attention, and an automated text message parent reminder and education service for periodic, age-specific messages to reinforce key health-related information recommended by Bright Futures national guidelines. We will examine parent-reported quality of care (receipt of nationally recommended WCC services, family-centeredness of care, and parental experiences of care), and health care use (WCC, urgent care, emergency department, and hospitalizations), conduct a cost analysis, and conduct a separate time-motion study of clinician time allocation to assess efficiency. We will also collect data on exploratory measures of parent-and parenting-focused outcomes. Our primary outcomes were receipt of anticipatory guidance and emergency department use. Results: Participant recruitment began in March 2019. After recruitment, 6- and 12-month follow-up surveys will be completed. As of August 30, 2021, we enrolled a total of 916 participants. Conclusions: This large pragmatic trial of PARENT in partnership with federally qualified health centers will assess its utility as an evidence-based and financially sustainable model for the delivery of preventive care services to children in low-income communities. Trial Registration: ClinicalTrials.gov: NCT03797898; https://clinicaltrials.gov/ct2/show/NCT03797898 International Registered Report Identifier (IRRID): DERR1-10.2196/27054 UR - https://www.researchprotocols.org/2021/11/e27054 UR - http://dx.doi.org/10.2196/27054 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842563 ID - info:doi/10.2196/27054 ER - TY - JOUR AU - Schopow, Nikolas AU - Osterhoff, Georg AU - von Dercks, Nikolaus AU - Girrbach, Felix AU - Josten, Christoph AU - Stehr, Sebastian AU - Hepp, Pierre PY - 2021/11/18 TI - Central COVID-19 Coordination Centers in Germany: Description, Economic Evaluation, and Systematic Review JO - JMIR Public Health Surveill SP - e33509 VL - 7 IS - 11 KW - telemedical consultation KW - patient allocation KW - algorithm-based treatment KW - telemedicine KW - telehealth KW - consultation KW - allocation KW - algorithm KW - treatment KW - COVID-19 KW - coordination KW - Germany KW - economic KW - review KW - establishment KW - management N2 - Background: During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCCs) have been established at several hospitals across Germany with the intention to assist local health care professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals and therefore to prevent the collapse of local health system structures. In addition, these centers coordinate interhospital transfers of patients with COVID-19 and provide or arrange specialized telemedical consultations. Objective: This study describes the establishment and management of a CCCC at a German university hospital. Methods: We performed economic analyses (cost, cost-effectiveness, use, and utility) according to the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria. Additionally, we conducted a systematic review to identify publications on similar institutions worldwide. The 2 months with the highest local incidence of COVID-19 cases (December 2020 and January 2021) were considered. Results: During this time, 17.3 requests per day were made to the CCCC regarding admission or transfer of patients with COVID-19. The majority of requests were made by emergency medical services (601/1068, 56.3%), patients with an average age of 71.8 (SD 17.2) years were involved, and for 737 of 1068 cases (69%), SARS-CoV-2 had already been detected by a positive polymerase chain reaction test. In 59.8% (639/1068) of the concerned patients, further treatment by a general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2% (291/1068) of patients were admitted to normal wards, and 12.9% (138/1068) were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than ?52,000 (US $60,031) per month. Of the 334 patients with detected SARS-CoV-2 who were referred via EMS or outpatient physicians, 302 (90.4%) were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found. Conclusions: Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefits of the CCCC are that it prevents hospitals from being overrun by patients and that it avoids situations in which physicians must weigh one patient?s life against another?s. UR - https://publichealth.jmir.org/2021/11/e33509 UR - http://dx.doi.org/10.2196/33509 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623955 ID - info:doi/10.2196/33509 ER - TY - JOUR AU - Mallmann, A. Christoph AU - Domröse, M. Christian AU - Schröder, Lars AU - Engelhardt, David AU - Bach, Frederik AU - Rueckel, Helena AU - Abramian, Alina AU - Kaiser, Christina AU - Mustea, Alexander AU - Faridi, Andree AU - Malter, Wolfram AU - Mallmann, Peter AU - Rudlowski, Christian AU - Zivanovic, Oliver AU - Mallmann, R. Michael PY - 2021/11/18 TI - Digital Technical and Informal Resources of Breast Cancer Patients From 2012 to 2020: Questionnaire-Based Longitudinal Trend Study JO - JMIR Cancer SP - e20964 VL - 7 IS - 4 KW - digitalization KW - eHealth KW - breast cancer KW - internet N2 - Background: Digitalization offers enormous potential in medicine. In the era of digitalization, the development of the use of digital, technical, and informal resources of breast cancer patients and factors influencing the degree of digitization of patients has been insufficiently researched. Objective: The aim of this study was to assess the development of the use of digital technical and informal resources in a well-defined patient cohort. Methods: A longitudinal study on 513 breast cancer patients from 2012 to 2020 was conducted using a questionnaire that included the main aspects of the degree of digitalization, including digital device availability and use, stationary and mobile internet access and use, and communication and information seeking regarding breast cancer diagnosis and treatment. Results: The majority of patients (421/513, 82.1%) owned the technical resources to benefit from eHealth, used the internet to obtain information (292/509, 57.4%), and were willing to use new eHealth solutions (379/426, 89%). Two-thirds of the patients discussed information about their cancer on the internet with their doctor, one-third found additional treatment options on the internet, and 15.3% (44/287) of the patients stated that this had changed their cancer therapy. The degree of digitization is increasing yet still significantly depends on 3 factors: (1) age (whereas 100% [39/39] of the <59-year-old group used the internet in 2020, 92% of the 60 to 69-year-old group [11/12] and only 47% [6/13] of the >70-year-old group used the internet), (2) education (internet use significantly depended on education, as only 51.8% [59/114] of patients with primary school education used the internet, but 82.4% [126/153] with middle school education and 90.3% [213/236] with high school education used the internet; P<.001), and (3) household size (67.7% [111/164] of patients living alone used the internet, whereas 84.7% [287/339] of patients living in a house with ?2 people used the internet; P<.001). Conclusions: To implement digital solutions in health care, knowledge of the composition and degree of the use of digital technical and informal resources of the patient group for which the respective solution is developed is crucial for success. Trial Registration: German Register of Clinical Studies DRKS00012364; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012364 UR - https://cancer.jmir.org/2021/4/e20964 UR - http://dx.doi.org/10.2196/20964 UR - http://www.ncbi.nlm.nih.gov/pubmed/34792468 ID - info:doi/10.2196/20964 ER - TY - JOUR AU - Kasturi, N. Suranga AU - Park, Jeremy AU - Wild, David AU - Khan, Babar AU - Haggstrom, A. David AU - Grannis, Shaun PY - 2021/11/15 TI - Predicting COVID-19?Related Health Care Resource Utilization Across a Statewide Patient Population: Model Development Study JO - J Med Internet Res SP - e31337 VL - 23 IS - 11 KW - COVID-19 KW - machine learning KW - population health KW - health care utilization KW - health disparities KW - health information KW - epidemiology KW - public health KW - digital health KW - health data KW - pandemic KW - decision models KW - health informatics KW - healthcare resources N2 - Background: The COVID-19 pandemic has highlighted the inability of health systems to leverage existing system infrastructure in order to rapidly develop and apply broad analytical tools that could inform state- and national-level policymaking, as well as patient care delivery in hospital settings. The COVID-19 pandemic has also led to highlighted systemic disparities in health outcomes and access to care based on race or ethnicity, gender, income-level, and urban-rural divide. Although the United States seems to be recovering from the COVID-19 pandemic owing to widespread vaccination efforts and increased public awareness, there is an urgent need to address the aforementioned challenges. Objective: This study aims to inform the feasibility of leveraging broad, statewide datasets for population health?driven decision-making by developing robust analytical models that predict COVID-19?related health care resource utilization across patients served by Indiana?s statewide Health Information Exchange. Methods: We leveraged comprehensive datasets obtained from the Indiana Network for Patient Care to train decision forest-based models that can predict patient-level need of health care resource utilization. To assess these models for potential biases, we tested model performance against subpopulations stratified by age, race or ethnicity, gender, and residence (urban vs rural). Results: For model development, we identified a cohort of 96,026 patients from across 957 zip codes in Indiana, United States. We trained the decision models that predicted health care resource utilization by using approximately 100 of the most impactful features from a total of 1172 features created. Each model and stratified subpopulation under test reported precision scores >70%, accuracy and area under the receiver operating curve scores >80%, and sensitivity scores approximately >90%. We noted statistically significant variations in model performance across stratified subpopulations identified by age, race or ethnicity, gender, and residence (urban vs rural). Conclusions: This study presents the possibility of developing decision models capable of predicting patient-level health care resource utilization across a broad, statewide region with considerable predictive performance. However, our models present statistically significant variations in performance across stratified subpopulations of interest. Further efforts are necessary to identify root causes of these biases and to rectify them. UR - https://www.jmir.org/2021/11/e31337 UR - http://dx.doi.org/10.2196/31337 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581671 ID - info:doi/10.2196/31337 ER - TY - JOUR AU - Murtas, Rossella AU - Morici, Nuccia AU - Cogliati, Chiara AU - Puoti, Massimo AU - Omazzi, Barbara AU - Bergamaschi, Walter AU - Voza, Antonio AU - Rovere Querini, Patrizia AU - Stefanini, Giulio AU - Manfredi, Grazia Maria AU - Zocchi, Teresa Maria AU - Mangiagalli, Andrea AU - Brambilla, Vittoria Carla AU - Bosio, Marco AU - Corradin, Matteo AU - Cortellaro, Francesca AU - Trivelli, Marco AU - Savonitto, Stefano AU - Russo, Giampiero Antonio PY - 2021/11/15 TI - Algorithm for Individual Prediction of COVID-19?Related Hospitalization Based on Symptoms: Development and Implementation Study JO - JMIR Public Health Surveill SP - e29504 VL - 7 IS - 11 KW - COVID-19 KW - severe outcome KW - prediction KW - monitoring system KW - symptoms KW - risk prediction KW - risk KW - algorithms KW - prediction models KW - pandemic KW - digital data KW - health records N2 - Background: The COVID-19 pandemic has placed a huge strain on the health care system globally. The metropolitan area of Milan, Italy, was one of the regions most impacted by the COVID-19 pandemic worldwide. Risk prediction models developed by combining administrative databases and basic clinical data are needed to stratify individual patient risk for public health purposes. Objective: This study aims to develop a stratification tool aimed at improving COVID-19 patient management and health care organization. Methods: A predictive algorithm was developed and applied to 36,834 patients with COVID-19 in Italy between March 8 and the October 9, 2020, in order to foresee their risk of hospitalization. Exposures considered were age, sex, comorbidities, and symptoms associated with COVID-19 (eg, vomiting, cough, fever, diarrhea, myalgia, asthenia, headache, anosmia, ageusia, and dyspnea). The outcome was hospitalizations and emergency department admissions for COVID-19. Discrimination and calibration of the model were also assessed. Results: The predictive model showed a good fit for predicting COVID-19 hospitalization (C-index 0.79) and a good overall prediction accuracy (Brier score 0.14). The model was well calibrated (intercept ?0.0028, slope 0.9970). Based on these results, 118,804 patients diagnosed with COVID-19 from October 25 to December 11, 2020, were stratified into low, medium, and high risk for COVID-19 severity. Among the overall study population, 67,030 (56.42%) were classified as low-risk patients; 43,886 (36.94%), as medium-risk patients; and 7888 (6.64%), as high-risk patients. In all, 89.37% (106,179/118,804) of the overall study population was being assisted at home, 9% (10,695/118,804) was hospitalized, and 1.62% (1930/118,804) died. Among those assisted at home, most people (63,983/106,179, 60.26%) were classified as low risk, whereas only 3.63% (3858/106,179) were classified at high risk. According to ordinal logistic regression, the odds ratio (OR) of being hospitalized or dead was 5.0 (95% CI 4.6-5.4) among high-risk patients and 2.7 (95% CI 2.6-2.9) among medium-risk patients, as compared to low-risk patients. Conclusions: A simple monitoring system, based on primary care data sets linked to COVID-19 testing results, hospital admissions data, and death records may assist in the proper planning and allocation of patients and resources during the ongoing COVID-19 pandemic. UR - https://publichealth.jmir.org/2021/11/e29504 UR - http://dx.doi.org/10.2196/29504 UR - http://www.ncbi.nlm.nih.gov/pubmed/34543227 ID - info:doi/10.2196/29504 ER - TY - JOUR AU - Guinemer, Camille AU - Boeker, Martin AU - Fürstenau, Daniel AU - Poncette, Akira-Sebastian AU - Weiss, Björn AU - Mörgeli, Rudolf AU - Balzer, Felix PY - 2021/11/3 TI - Telemedicine in Intensive Care Units: Scoping Review JO - J Med Internet Res SP - e32264 VL - 23 IS - 11 KW - tele-ICU KW - telemedicine KW - critical care KW - implementation KW - telehealth KW - health care system KW - intensive care unit KW - health technology KW - digital health KW - care compliance KW - tertiary hospitals KW - hospital KW - review N2 - Background: The role of telemedicine in intensive care has been increasing steadily. Tele?intensive care unit (ICU) interventions are varied and can be used in different levels of treatment, often with direct implications for the intensive care processes. Although a substantial body of primary and secondary literature has been published on the topic, there is a need for broadening the understanding of the organizational factors influencing the effectiveness of telemedical interventions in the ICU. Objective: This scoping review aims to provide a map of existing evidence on tele-ICU interventions, focusing on the analysis of the implementation context and identifying areas for further technological research. Methods: A research protocol outlining the method has been published in JMIR Research Protocols. This review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A core research team was assembled to provide feedback and discuss findings. Results: A total of 3019 results were retrieved. After screening, 25 studies were included in the final analysis. We were able to characterize the context of tele-ICU studies and identify three use cases for tele-ICU interventions. The first use case is extending coverage, which describes interventions aimed at extending the availability of intensive care capabilities. The second use case is improving compliance, which includes interventions targeted at improving patient safety, intensive care best practices, and quality of care. The third use case, facilitating transfer, describes telemedicine interventions targeted toward the management of patient transfers to or from the ICU. Conclusions: The benefits of tele-ICU interventions have been well documented for centralized systems aimed at extending critical care capabilities in a community setting and improving care compliance in tertiary hospitals. No strong evidence has been found on the reduction of patient transfers following tele-ICU intervention. International Registered Report Identifier (IRRID): RR2-10.2196/19695 UR - https://www.jmir.org/2021/11/e32264 UR - http://dx.doi.org/10.2196/32264 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730547 ID - info:doi/10.2196/32264 ER - TY - JOUR AU - Yadav, Lalit AU - Gill, K. Tiffany AU - Taylor, Anita AU - De Young, Jennifer AU - Chehade, J. Mellick PY - 2021/10/28 TI - Identifying Opportunities, and Motivation to Enhance Capabilities, Influencing the Development of a Personalized Digital Health Hub Model of Care for Hip Fractures: Mixed Methods Exploratory Study JO - J Med Internet Res SP - e26886 VL - 23 IS - 10 KW - digital health KW - mixed-methods KW - hip fractures KW - behavior change KW - patient education KW - model of care KW - mobile phone KW - patient networked units N2 - Background: Most older people after a hip fracture injury never return to their prefracture status, and some are admitted to residential aged care facilities. Advancement of digital technology has helped in optimizing health care including self-management and telerehabilitation. Objective: This study aims to understand the perspectives of older patients with hip fracture and their family members and residential aged caregivers on the feasibility of developing a model of care using a personalized digital health hub. Methods: We conducted a mixed methods study in South Australia involving patients aged 50 years and older, their family members, and residential aged caregivers. Quantitative data analysis included basic demographic characteristics, and access to digital devices was analyzed using descriptive statistics. Spearman rank-order correlation was used to examine correlations between the perceived role of a personalized digital health hub in improving health and the likelihood of subsequent use. Findings from qualitative analysis were interpreted using constructs of capability, opportunity, and motivation to help understand the factors influencing the likelihood of potential personalized digital health hub use. Results: This study recruited 100 participants?55 patients, 13 family members, and 32 residential aged caregivers. The mean age of the patients was 76.4 (SD 8.4, range 54-88) years, and 60% (33/55) of the patients were female. Approximately 50% (34/68) of the patients and their family members had access to digital devices, despite less than one-third using computers as part of their occupation. Approximately 72% (72/100) of the respondents thought that personalized digital health hub could improve health outcomes in patients. However, a moderate negative correlation existed with increasing age and likelihood of personalized digital health hub use (Spearman ?=?0.50; P<.001), and the perceived role of the personalized digital health hub in improving health had a strong positive correlation with the likelihood of personalized digital health hub use by self (Spearman ?=0.71; P<.001) and by society, including friends and family members (Spearman ?=0.75; P<.001). Most patients (54/55, 98%) believed they had a family member, friend, or caregiver who would be able to help them use a personalized digital health hub. Qualitative analysis explored capability by understanding aspects of existing knowledge, including willingness to advance digital navigation skills. Access could be improved through supporting opportunities, and factors influencing intrinsic motivation were considered crucial for designing a personalized digital health hub?enabled model of care. Conclusions: This study emphasized the complex relationship between capabilities, motivation, and opportunities for patients, their family members, and formal caregivers as a patient networked unit. The next stage of research will continue to involve a cocreation approach followed by iterative processes and understand the factors influencing the development and successful integration of complex digital health care interventions in real-world scenarios. UR - https://www.jmir.org/2021/10/e26886 UR - http://dx.doi.org/10.2196/26886 UR - http://www.ncbi.nlm.nih.gov/pubmed/34709183 ID - info:doi/10.2196/26886 ER - TY - JOUR AU - Hechinger, Mareike AU - Fringer, André PY - 2021/10/28 TI - Professional Care Experiences of Persons With Suicidal Ideation and Behavior: Model Development Based on a Qualitative Meta-Synthesis JO - JMIR Form Res SP - e27676 VL - 5 IS - 10 KW - nursing care KW - health care professionals KW - suicidal behavior KW - suicidal inclinations KW - suicidal ideation KW - inpatient KW - outpatient KW - eHealth KW - mHealth KW - mental health KW - suicide KW - stress N2 - Background: Health care professionals (HCPs) are challenged in caring for persons with suicidal ideation or behavior. For affected persons, professional care is essential, and being interviewed about their experiences can be stressful. The experiences of persons ideating or attempting suicide are essential to designing eHealth products to support them in crises and provide continuous care. Objective: This study aimed to synthesize published qualitative research about how persons with suicidal thoughts or behavior experience inpatient or outpatient care. A model will be derived from the meta-synthesis to guide HCPs in their work with affected persons and provide a thorough needs assessment for eHealth development. Methods: A qualitative meta-synthesis was conducted using an inductive approach, as proposed by Sandelowski and Barroso. The inclusion criteria were studies in English and German that dealt with persons who ideated or attempted suicide. Relevant articles were identified by searching the PubMed and Cinahl databases and by hand searching relevant journals and reference lists. The findings of each study were analyzed using initial and axial coding, followed by selective coding. Finally, a conceptual model was derived. Results: In total, 3170 articles were identified in the systematic literature search. Articles were screened independently by 2 researchers based on the eligibility criteria. Finally, 12 studies were included. The central phenomenon observed among persons ideating or attempting suicide is their process from feeling unanchored to feeling anchored in life again. During inpatient and outpatient care, they experience being dependent on the skills and attitudes of HCPs. While helpful skills and attitudes support persons ideating or attempting suicide to reach their feeling of being anchored in life again, adverse interactions are experienced negatively and might lead to prolonging or maintaining the feeling of being unanchored in life. Conclusions: The study promotes a differentiated view of the experiences of persons ideating or attempting suicide. The derived conceptual model can guide HCPs in their work with affected persons to support affected persons during their recovery. Moreover, the conceptual model is useable as a springboard to develop eHealth solutions for crisis situations and long-term care. UR - https://formative.jmir.org/2021/10/e27676 UR - http://dx.doi.org/10.2196/27676 UR - http://www.ncbi.nlm.nih.gov/pubmed/34709191 ID - info:doi/10.2196/27676 ER - TY - JOUR AU - Wherton, Joseph AU - Greenhalgh, Trisha AU - Shaw, E. Sara PY - 2021/10/7 TI - Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study JO - J Med Internet Res SP - e31374 VL - 23 IS - 10 KW - technology-enabled care KW - video consultations KW - quality improvement KW - COVID-19 KW - PERCS framework N2 - Background: Scotland?a country of 5.5 million people?has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. Objective: To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland?s video consultation services both before and during the pandemic. Methods: Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. Results: By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations? general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. Conclusions: The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn. UR - https://www.jmir.org/2021/10/e31374 UR - http://dx.doi.org/10.2196/31374 UR - http://www.ncbi.nlm.nih.gov/pubmed/34516389 ID - info:doi/10.2196/31374 ER - TY - JOUR AU - Tong, Yao AU - Liao, C. Zachary AU - Tarczy-Hornoch, Peter AU - Luo, Gang PY - 2021/10/7 TI - Using a Constraint-Based Method to Identify Chronic Disease Patients Who Are Apt to Obtain Care Mostly Within a Given Health Care System: Retrospective Cohort Study JO - JMIR Form Res SP - e26314 VL - 5 IS - 10 KW - asthma KW - chronic kidney disease KW - chronic obstructive pulmonary disease KW - data analysis KW - diabetes mellitus KW - emergency department KW - health care system KW - inpatients KW - patient care management N2 - Background: For several major chronic diseases including asthma, chronic obstructive pulmonary disease, chronic kidney disease, and diabetes, a state-of-the-art method to avert poor outcomes is to use predictive models to identify future high-cost patients for preemptive care management interventions. Frequently, an American patient obtains care from multiple health care systems, each managed by a distinct institution. As the patient?s medical data are spread across these health care systems, none has complete medical data for the patient. The task of building models to predict an individual patient?s cost is currently thought to be impractical with incomplete data, which limits the use of care management to improve outcomes. Recently, we developed a constraint-based method to identify patients who are apt to obtain care mostly within a given health care system. Our method was shown to work well for the cohort of all adult patients at the University of Washington Medicine for a 6-month follow-up period. It is unknown how well our method works for patients with various chronic diseases and over follow-up periods of different lengths, and subsequently, whether it is reasonable to perform this predictive modeling task on the subset of patients pinpointed by our method. Objective: To understand our method?s potential to enable this predictive modeling task on incomplete medical data, this study assesses our method?s performance at the University of Washington Medicine on 5 subgroups of adult patients with major chronic diseases and over follow-up periods of 2 different lengths. Methods: We used University of Washington Medicine data for all adult patients who obtained care at the University of Washington Medicine in 2018 and PreManage data containing usage information from all hospitals in Washington state in 2019. We evaluated our method?s performance over the follow-up periods of 6 months and 12 months on 5 patient subgroups separately?asthma, chronic kidney disease, type 1 diabetes, type 2 diabetes, and chronic obstructive pulmonary disease. Results: Our method identified 21.81% (3194/14,644) of University of Washington Medicine adult patients with asthma. Around 66.75% (797/1194) and 67.13% (1997/2975) of their emergency department visits and inpatient stays took place within the University of Washington Medicine system in the subsequent 6 months and in the subsequent 12 months, respectively, approximately double the corresponding percentage for all University of Washington Medicine adult patients with asthma. The performance for adult patients with chronic kidney disease, adult patients with chronic obstructive pulmonary disease, adult patients with type 1 diabetes, and adult patients with type 2 diabetes was reasonably similar to that for adult patients with asthma. Conclusions: For each of the 5 chronic diseases most relevant to care management, our method can pinpoint a reasonably large subset of patients who are apt to obtain care mostly within the University of Washington Medicine system. This opens the door to building models to predict an individual patient?s cost on incomplete data, which was formerly deemed impractical. International Registered Report Identifier (IRRID): RR2-10.2196/13783 UR - https://formative.jmir.org/2021/10/e26314 UR - http://dx.doi.org/10.2196/26314 UR - http://www.ncbi.nlm.nih.gov/pubmed/34617906 ID - info:doi/10.2196/26314 ER - TY - JOUR AU - Burbach, R. Frank AU - Stiles, M. Katie PY - 2021/9/17 TI - Digital Mental Health and Neurodevelopmental Services: Case-Based Realist Evaluation JO - JMIR Form Res SP - e29845 VL - 5 IS - 9 KW - telehealth KW - young people KW - adolescents KW - online psychological therapy KW - online neurodevelopmental assessments KW - digital services KW - realist evaluation KW - multiple case study KW - CBT KW - autism N2 - Background: The rapid movement of mental health services on the internet following the onset of the COVID-19 pandemic has demonstrated the potential advantages of digital delivery and has highlighted the need to learn from prepandemic digital services. Objective: The aim of this study is to explore the different elements of interconnected digital mental health and neurodevelopmental services of a well-established provider to the UK National Health Service and how web-based delivery enables young people and their families to access high-quality assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. Methods: A realist evaluation multiple case?study design was used, with 9 pediatric cases (aged 8-15 years) identified as representative of the services provided by Healios. Presenting concerns included autism and ADHD, anxiety and panic attacks, low self-esteem, anger and self-harm. The research literature was used to define the program theory and six context-mechanism-outcome (CMO) statements. The CMOs formed the basis for the initial data extraction, with novel elements added via an iterative process. Results: We identified 10 key elements of web-based services: flexible delivery and timely response, personalized care to the individual, comprehensive care enabled by multiple interconnected services, effective client engagement and productive therapeutic alliances, use of multiple communication tools, client satisfaction with the service, good clinical outcomes, ease of family involvement throughout sessions or from different locations, facilitation of multi-agency working and integration with National Health Services, and management of risk and safeguarding. These elements supported the six CMOs; there was clear evidence that young people and their families valued the responsiveness and flexibility of the web-based mental health service and, in particular, how quickly they were seen. There was also clear evidence of individual needs being met, good therapeutic alliances, and client satisfaction. Multiple communication tools appeared to maximize engagement and working digitally facilitated multi-agency communication and delivery of safe care. The abovementioned factors may be related to the finding of good clinical outcomes, but the methodology of this study does not allow any conclusions to be drawn regarding causality. Conclusions: This study demonstrates the effectiveness of interconnected digital mental health and neurodevelopmental services as well as how web-based delivery enables young people and their families to access assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. The 10 key elements of web-based service delivery identified through the 9 case studies suggest the potential advantages of web-based work. These elements can inform future research and aid in the delivery of high-quality digital services. UR - https://formative.jmir.org/2021/9/e29845 UR - http://dx.doi.org/10.2196/29845 UR - http://www.ncbi.nlm.nih.gov/pubmed/34369382 ID - info:doi/10.2196/29845 ER - TY - JOUR AU - Jung, Young Se AU - Kim, Taehyun AU - Hwang, Ju Hyung AU - Hong, Kyungpyo PY - 2021/9/13 TI - Mechanism Design of Health Care Blockchain System Token Economy: Development Study Based on Simulated Real-World Scenarios JO - J Med Internet Res SP - e26802 VL - 23 IS - 9 KW - mechanism design KW - optimization KW - blockchain KW - token economy KW - eHealth KW - electronic health records KW - healthcare KW - economy KW - health records N2 - Background: Despite the fact that the adoption rate of electronic health records has increased dramatically among high-income nations, it is still difficult to properly disseminate personal health records. Token economy, through blockchain smart contracts, can better distribute personal health records by providing incentives to patients. However, there have been very few studies regarding the particular factors that should be considered when designing incentive mechanisms in blockchain. Objective: The aim of this paper is to provide 2 new mathematical models of token economy in real-world scenarios on health care blockchain platforms. Methods: First, roles were set for the health care blockchain platform and its token flow. Second, 2 scenarios were introduced: collecting life-log data for an incentive program at a life insurance company to motivate customers to exercise more and recruiting participants for clinical trials of anticancer drugs. In our 2 scenarios, we assumed that there were 3 stakeholders: participants, data recipients (companies), and data providers (health care organizations). We also assumed that the incentives are initially paid out to participants by data recipients, who are focused on minimizing economic and time costs by adapting mechanism design. This concept can be seen as a part of game theory, since the willingness-to-pay of data recipients is important in maintaining the blockchain token economy. In both scenarios, the recruiting company can change the expected recruitment time and number of participants. Suppose a company considers the recruitment time to be more important than the number of participants and rewards. In that case, the company can increase the time weight and adjust cost. When the reward parameter is fixed, the corresponding expected recruitment time can be obtained. Among the reward and time pairs, the pair that minimizes the company?s cost was chosen. Finally, the optimized results were compared with the simulations and analyzed accordingly. Results: To minimize the company?s costs, reward?time pairs were first collected. It was observed that the expected recruitment time decreased as rewards grew, while the rewards decreased as time cost grew. Therefore, the cost was represented by a convex curve, which made it possible to obtain a minimum?an optimal point?for both scenarios. Through sensitivity analysis, we observed that, as the time weight increased, the optimized reward increased, while the optimized time decreased. Moreover, as the number of participants increased, the optimization reward and time also increased. Conclusions: In this study, we were able to model the incentive mechanism of blockchain based on a mechanism design that recruits participants through a health care blockchain platform. This study presents a basic approach to incentive modeling in personal health records, demonstrating how health care organizations and funding companies can motivate one another to join the platform. UR - https://www.jmir.org/2021/9/e26802 UR - http://dx.doi.org/10.2196/26802 UR - http://www.ncbi.nlm.nih.gov/pubmed/34515640 ID - info:doi/10.2196/26802 ER - TY - JOUR AU - Gilkey, B. Melissa AU - Kong, Yi Wei AU - Huang, Qian AU - Grabert, K. Brigid AU - Thompson, Peyton AU - Brewer, T. Noel PY - 2021/9/10 TI - Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals JO - J Med Internet Res SP - e31240 VL - 23 IS - 9 KW - adolescent health KW - primary care KW - telemedicine KW - health communication KW - health services KW - telehealth KW - adolescent KW - young adult KW - teenager KW - COVID-19 KW - survey KW - policy KW - access N2 - Background: The COVID-19 pandemic has led to unprecedented use of telehealth, including by primary care professionals (PCPs) who serve adolescents. Objective: To inform future practice and policies, we sought to characterize PCPs? recent experience using adolescent telehealth as well as their support for it after the COVID-19 pandemic is over. Methods: From February to March 2021, we conducted a web-based survey of 1047 PCPs in the United States. Our national sample included physicians (747/1047, 71%), advanced practice providers (177/1047, 17%), and nurses (123/1047, 12%) who provided primary care to adolescents aged 11-17 years. Results: Most PCPs reported using telehealth for a low, moderate, or high proportion of their adolescent patients in the three months prior to the survey (424/1047, 40%, 286/1047, 27%, and 219/1047, 21%, respectively); only 11% (118/1047) reported no use. A majority of respondents agreed that adolescent telehealth increases access to care (720/1047, 69%) and enables them to provide high-quality care (560/1047, 53%). Few believed that adolescent telehealth takes too much time (142/1047, 14%) or encourages health care overuse (157/1047, 15%). Most supported giving families the option of adolescent telehealth for primary care after the pandemic is over (683/1047, 65%) and believed that health insurance plans should continue to reimburse for telehealth visits (863/1047, 82%). Approximately two-thirds (702/1047, 67%) wanted to offer adolescent telehealth visits after the pandemic, with intentions being higher among those with recent telehealth experience (P<.001). Conclusions: PCPs in our national sample reported widespread use of and predominantly positive attitudes toward adolescent telehealth. Our findings also suggest broad support among PCPs for continuing to offer adolescent telehealth after the COVID-19 pandemic ends. UR - https://www.jmir.org/2021/9/e31240 UR - http://dx.doi.org/10.2196/31240 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406974 ID - info:doi/10.2196/31240 ER - TY - JOUR AU - Stamenova, Vess AU - Chu, Cherry AU - Pang, Andrea AU - Tadrous, Mina AU - Bhatia, Sacha R. AU - Cram, Peter PY - 2021/9/7 TI - Using Administrative Data to Explore Potentially Aberrant Provision of Virtual Care During COVID-19: Retrospective Cohort Study of Ontario Provincial Data JO - J Med Internet Res SP - e29396 VL - 23 IS - 9 KW - telemedicine KW - virtual care KW - COVID-19 KW - pandemic KW - virtual health KW - telehealth KW - ambulatory visits KW - physicians KW - patients KW - digital health N2 - Background: The COVID-19 pandemic has led to a rapid increase in virtual care use across the globe. Many health care systems have responded by creating virtual care billing codes that allow physicians to see their patients over telephone or video. This rapid liberalization of billing requirements, both in Canada and other countries, has led to concerns about potential abuse, but empirical data are limited. Objective: The objectives of this study were to examine whether there were substantial changes in physicians? ambulatory visit volumes coinciding with the liberalization of virtual care billing rules and to describe the characteristics of physicians who significantly increased their ambulatory visit volumes during this period. We also sought to describe the relationship between visit volume changes in 2020 and the volumes of virtual care use among individual physicians and across specialties. Methods: We conducted a population-based, retrospective cohort study using health administrative data from the Ontario Health Insurance Plan, which was linked to the ICES Physician Database. We identified a unique cohort of providers based on physicians? billings and calculated the ratio of total in-person and virtual ambulatory visits over the period from January to June 2020 (virtual predominating) relative to that over the period from January to June 2019 (in-person predominating) for each physician. Based on these ratios, we then stratified physicians into four groups: low-, same-, high-, and very high?use physicians. We then calculated various demographic and practice characteristics of physicians in each group. Results: Among 28,383 eligible physicians in 2020, the mean ratio of ambulatory visits in January to June 2020:2019 was 0.99 (SD 2.53; median 0.81, IQR 0.59-1.0). Out of 28,383 physicians, only 2672 (9.4%) fell into the high-use group and only 291 (1.0%) fell into the very high?use group. High-use physicians were younger, more recent graduates, more likely female, and less likely to be international graduates. They also had, on average, lower-volume practices. There was a significant positive correlation between percent virtual care and the 2020:2019 ratio only in the group of physicians who maintained their practice (R=0.35, P<.001). There was also a significant positive correlation between the 2020:2019 ratio and the percent virtual care per specialty (R=0.59, P<.01). Conclusions: During the early stages of the pandemic, the introduction of virtual care did not lead to significant increases in visit volume. Our results provide reassuring evidence that relaxation of billing requirements early in the COVID-19 pandemic in Ontario were not associated with widespread and aberrant billing behaviors. Furthermore, the strong relationship between the ability to maintain practice volumes and the use of virtual care suggests that the introduction of virtual care allowed for continued access to care for patients. UR - https://www.jmir.org/2021/9/e29396 UR - http://dx.doi.org/10.2196/29396 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313590 ID - info:doi/10.2196/29396 ER - TY - JOUR AU - Husebø, Lunde Anne Marie PY - 2021/9/7 TI - Stakeholders? Perspectives on eHealth Support in Colorectal Cancer Survivorship: Qualitative Interview Study JO - JMIR Cancer SP - e28279 VL - 7 IS - 3 KW - cancer patients KW - carers KW - colorectal cancer KW - digital competence KW - eHealth KW - health care professionals KW - follow-up service KW - web-based information seeking, self-management support KW - treatment burden KW - mobile phone N2 - Background: eHealth interventions may represent the way forward in following up patients with colorectal cancer (CRC) after hospital discharge to support them in coping with the illness, strengthen their self-management, and increase their quality of life. By involving end users of eHealth in cocreation processes when designing eHealth solutions, an acceptable and relevant product can be secured. Stakeholders? perspectives could aid in closing the gap between research-developed products and the implementation of eHealth services in real-life scenarios. Objective: This study aims to explore the views of patients with CRC, their informal caregivers, and health care professionals (HCPs) on information technology and the design of eHealth support in CRC care. Methods: A qualitative, explorative design was used to conduct 31 semistructured individual interviews with 41% (13/31) patients with CRC, 29% (9/31) informal caregivers, and 29% (9/31) HCPs recruited from the gastrosurgical ward of a university hospital in southwestern Norway. A semistructured interview guide was used for data collection, and the data were analyzed by systematic text condensation. Results: Participants described the diverse experiences of patients with CRC seeking web-based information. Age and digital competence were highlighted as influencers of the use of information technology. Patients rarely received advice from HCPs about relevant and secure websites containing information on CRC diagnosis and treatment. Features of desired eHealth interventions in following up patients with CRC were patient education, health monitoring, and communication with HCPs. Conclusions: Several elements affect the activities of patients with CRC seeking health information. Age, inexperience with computer technology, and lack of access to web-based health information may reduce the ability of patients with CRC to engage in decision-making processes regarding illness and treatment. An eHealth service for patients with CRC should comprise features for information, education, and support for self-management and should aim to be individually adapted to the patient?s age and digital competence. Involving end users of eHealth services is necessary to ensure high-quality tailored services that are perceived as user friendly and relevant to the end users. UR - https://cancer.jmir.org/2021/3/e28279 UR - http://dx.doi.org/10.2196/28279 UR - http://www.ncbi.nlm.nih.gov/pubmed/34491210 ID - info:doi/10.2196/28279 ER - TY - JOUR AU - Peters, M. Guido AU - Kooij, Laura AU - Lenferink, Anke AU - van Harten, H. Wim AU - Doggen, M. Carine J. PY - 2021/9/1 TI - The Effect of Telehealth on Hospital Services Use: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e25195 VL - 23 IS - 9 KW - telehealth KW - systematic review KW - meta-analysis KW - hospitalization KW - health services use KW - eHealth N2 - Background: Telehealth interventions, that is, health care provided over a distance using information and communication technology, are suggested as a solution to rising health care costs by reducing hospital service use. However, the extent to which this is possible is unclear. Objective: The aim of this study is to evaluate the effect of telehealth on the use of hospital services, that is, (duration of) hospitalizations, and to compare the effects between telehealth types and health conditions. Methods: We searched PubMed, Scopus, and the Cochrane Library from inception until April 2019. Peer-reviewed randomized controlled trials (RCTs) reporting the effect of telehealth interventions on hospital service use compared with usual care were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. Results: We included 127 RCTs in the meta-analysis. Of these RCTs, 82.7% (105/127) had a low risk of bias or some concerns overall. High-quality evidence shows that telehealth reduces the risk of all-cause or condition-related hospitalization by 18 (95% CI 0-30) and 37 (95% CI 20-60) per 1000 patients, respectively. We found high-quality evidence that telehealth leads to reductions in the mean all-cause and condition-related hospitalizations, with 50 and 110 fewer hospitalizations per 1000 patients, respectively. Overall, the all-cause hospital days decreased by 1.07 (95% CI ?1.76 to ?0.39) days per patient. For hospitalized patients, the mean hospital stay for condition-related hospitalizations decreased by 0.89 (95% CI ?1.42 to ?0.36) days. The effects were similar between telehealth types and health conditions. A trend was observed for studies with longer follow-up periods yielding larger effects. Conclusions: Small to moderate reductions in hospital service use can be achieved using telehealth. It should be noted that, despite the large number of included studies, uncertainties around the magnitude of effects remain, and not all effects are statistically significant. UR - https://www.jmir.org/2021/9/e25195 UR - http://dx.doi.org/10.2196/25195 UR - http://www.ncbi.nlm.nih.gov/pubmed/34468324 ID - info:doi/10.2196/25195 ER - TY - JOUR AU - Khuntia, Jiban AU - Ning, Xue AU - Stacey, Rulon PY - 2021/8/16 TI - Digital Orientation of Health Systems in the Post?COVID-19 ?New Normal? in the United States: Cross-sectional Survey JO - J Med Internet Res SP - e30453 VL - 23 IS - 8 KW - post?COVID-19 KW - digital orientation KW - health systems KW - digital transformation KW - digital health KW - telehealth KW - telemedicine KW - COVID-19 KW - impact KW - insight KW - cross-sectional KW - survey KW - United States KW - electronic health record KW - EHR N2 - Background: Almost all health systems have developed some form of customer-facing digital technologies and have worked to align these systems to their existing electronic health records to accommodate the surge in remote and virtual care deliveries during the COVID-19 pandemic. Others have developed analytics-driven decision-making capabilities. However, it is not clear how health systems in the United States are embracing digital technologies and there is a gap in health systems? abilities to integrate workflows with expanding technologies to spur innovation and futuristic growth. There is a lack of reliable and reported estimates of the current and futuristic digital orientations of health systems. Periodic assessments will provide imperatives to policy formulation and align efforts to yield the transformative power of emerging digital technologies. Objective: The aim of this study was to explore and examine differences in US health systems with respect to digital orientations in the post?COVID-19 ?new normal? in 2021. Differences were assessed in four dimensions: (1) analytics-oriented digital technologies (AODT), (2) customer-oriented digital technologies (CODT), (3) growth and innovation?oriented digital technologies (GODT), and (4) futuristic and experimental digital technologies (FEDT). The former two dimensions are foundational to health systems? digital orientation, whereas the latter two will prepare for future disruptions. Methods: We surveyed a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 CEOs, 135 (22%) responded to our survey. We considered the above four broad digital technology orientations, which were ratified with expert consensus. Secondary data were collected from the Agency for Healthcare Research and Quality Hospital Compendium, leading to a matched usable dataset of 124 health systems for analysis. We examined the relationship of adopting the four digital orientations to specific hospital characteristics and earlier reported factors as barriers or facilitators to technology adoption. Results: Health systems showed a lower level of CODT (mean 4.70) or GODT (mean 4.54) orientations compared with AODT (mean 5.03), and showed the lowest level of FEDT orientation (mean 4.31). The ordered logistic estimation results provided nuanced insights. Medium-sized (P<.001) health systems, major teaching health systems (P<.001), and systems with high-burden hospitals (P<.001) appear to be doing worse with respect to AODT orientations, raising some concerns. Health systems of medium (P<.001) and large (P=.02) sizes, major teaching health systems (P=.07), those with a high revenue (P=.05), and systems with high-burden hospitals (P<.001) have less CODT orientation. Health systems in the midwest (P=.05) and southern (P=.04) states are more likely to adopt GODT, whereas high-revenue (P=.004) and investor-ownership (P=.01) health systems are deterred from GODT. Health systems of a medium size, and those that are in the midwest (P<.001), south (P<.001), and west (P=.01) are more adept to FEDT, whereas medium (P<.001) and high-revenue (P<.001) health systems, and those with a high discharge rate (P=.04) or high burden (P=.003, P=.005) have subdued FEDT orientations. Conclusions: Almost all health systems have some current foundational digital technological orientations to glean intelligence or service delivery to customers, with some notable exceptions. Comparatively, fewer health systems have growth or futuristic digital orientations. The transformative power of digital technologies can only be leveraged by adopting futuristic digital technologies. Thus, the disparities across these orientations suggest that a holistic, consistent, and well-articulated direction across the United States remains elusive. Accordingly, we suggest that a policy strategy and financial incentives are necessary to spur a well-visioned and articulated digital orientation for all health systems across the United States. In the absence of such a policy to collectively leverage digital transformations, differences in care across the country will continue to be a concern. UR - https://www.jmir.org/2021/8/e30453 UR - http://dx.doi.org/10.2196/30453 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254947 ID - info:doi/10.2196/30453 ER - TY - JOUR AU - Rostad, Marie Hanne AU - Stokke, Randi PY - 2021/8/16 TI - Integrating Welfare Technology in Long-term Care Services: Nationwide Cross-sectional Survey Study JO - J Med Internet Res SP - e22316 VL - 23 IS - 8 KW - ambient assisted living KW - cross-sectional survey KW - home care services KW - innovation KW - long-term care KW - nursing homes KW - telecare KW - welfare technology KW - mobile phone N2 - Background: Welfare technologies are often described as a solution to the increasing pressure on primary health care services. However, despite initiating welfare technology projects in the health care sector and different government incentives, research indicates that it is difficult to integrate welfare technology innovations in a complex and varying setting, such as long-term care. Objective: We aim to describe the types of welfare technology and the extent to which welfare technology is provided in long-term care (ie, nursing homes and home care services); examine whether the extent of welfare technology provision differs on the basis of municipal characteristics (ie, population size, centrality, the proportion of older inhabitants, and income); and identify how local governments (ie, municipalities) describe their efforts toward integrating welfare technologies in long-term care. Methods: Quantitative and qualitative data about welfare technology from a larger cross-sectional survey about the provision of long-term care services in Norwegian municipalities were combined with registry data. Representatives of 422 Norwegian municipalities were invited to participate in the survey. Frequencies were used to describe the distribution of the types and extent of welfare technologies, whereas the Fisher exact test and Kruskal-Wallis one-way analysis of variance were used to determine the association between the extent of welfare technology and municipal characteristics. Free-form text data were analyzed using thematic analysis. Results: A total of 277 municipalities were surveyed. Technology for safety was the most widespread type of welfare technology, whereas technology for social contact was the least prevalent. Two-thirds of the sample (183/277, 66.1%) in nursing home and (197/277, 71.1%) in home care services reported providing one or two different types of welfare technology. There was a statistically significant association between the extent of welfare technology and population size (in both nursing homes and home care services: P=.01), centrality (nursing homes: P=.01; home care services: P<.001), and municipal income (nursing homes: P=.02; home care services: P<.001). The extent of welfare technology was not associated with the proportion of older adults. The municipalities described being in a piloting phase and committing to future investment in welfare technology. Monetary resources were allocated, competency development among staff was initiated, and the municipalities were concerned about establishing collaborations within and between municipalities. Home care services seem to have a more person-centered approach in their efforts toward integrating welfare technologies, whereas nursing homes seem to have a more technology-centered approach. Conclusions: Many municipalities provide welfare technologies; however, their extent is limited and varies according to municipal characteristics. Municipal practices still seem dominated by piloting, and welfare technologies are not fully integrated into long-term care services. Innovation with welfare technology appears top-down and is influenced by national policy but also reflects creating a window of opportunity through the organization of municipal efforts toward integrating welfare technology through, for example, collaborations and committing personnel and financial resources. UR - https://www.jmir.org/2021/8/e22316 UR - http://dx.doi.org/10.2196/22316 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398791 ID - info:doi/10.2196/22316 ER - TY - JOUR AU - Liu, Liyun AU - Shi, Lizheng PY - 2021/8/13 TI - Chinese Patients? Intention to Use Different Types of Internet Hospitals: Cross-sectional Study on Virtual Visits JO - J Med Internet Res SP - e25978 VL - 23 IS - 8 KW - internet hospital KW - direct-to-consumer telemedicine KW - virtual visit KW - trust KW - intention to use KW - sponsorship type N2 - Background: The issuing of regulation schemes and the expanding health insurance coverage for virtual visits of internet hospitals would incentivize Chinese providers and patients to use virtual visits tremendously. China?s internet hospitals vary in sponsorship. However, little is known about patients? intention to use virtual visits delivered by different sponsorship types of internet hospitals. Objective: The goal of the research is to examine patients? intention to use virtual visits, as well as virtual visits delivered by different sponsorship types of internet hospitals. In addition, we will identify determinants of patients? intention to use virtual visits, as well as intention to use virtual visits delivered by different sponsorship types of internet hospitals. Methods: A cross-sectional survey of 1653 participants was conducted in 3-tier hospitals in 3 cities with different income levels in May and June 2019. Binary logistic regression analysis was used to identify the factors that affect patients? intention to use virtual visits. Multinomial logistic regression analysis was conducted to identify the determinants of the intention to use virtual visits delivered by different sponsorship types of internet hospitals (ie, enterprise-sponsored, hospital-sponsored, and government-sponsored). Results: A total of 76.64% (1145/1494) of adult participants were online medical information seekers, and 87.06% (969/1113) of online medical information seekers had intention to use virtual visits. Public hospital?sponsored internet hospitals were the most prevalent ones among Chinese patients (473/894, 52.9%), followed by the provincial government internet hospital platform (238/894, 26.6%), digital health companies (116/894, 13.0%), medical e-commerce companies (48/894, 5.4%), private hospitals (13/894, 1.5%), and other companies (6/894, 0.7%). Gender, education, monthly income, and consumer type were significantly associated with the intention to use virtual visits. Gender, age, education, city income level, consumer type, and trust in the sponsor of a health website were significantly associated with the patient?s intention to use virtual visits delivered by 3 different sponsorship types of internet hospitals. Conclusions: Chinese patients who were online medical information seekers had high intention to use virtual visits and had different intentions to use virtual visits delivered by different sponsorship types of internet hospitals. Public hospitals, the government, and digital health companies were the top 3 sponsorship types of internet hospitals that patients had intention to use. Trust in a health website sponsor significantly influenced the patient?s intention to use virtual visits delivered by different sponsorship types of internet hospitals. Gender, education, and consumer type were the factors significantly associated with both the intention to use virtual visits and the intention to use virtual visits delivered by different sponsorship types of internet hospitals. UR - https://www.jmir.org/2021/8/e25978 UR - http://dx.doi.org/10.2196/25978 UR - http://www.ncbi.nlm.nih.gov/pubmed/34397388 ID - info:doi/10.2196/25978 ER - TY - JOUR AU - Yang, Feng AU - Shu, Huilin AU - Zhang, Xiaoqian PY - 2021/7/26 TI - Understanding ?Internet Plus Healthcare? in China: Policy Text Analysis JO - J Med Internet Res SP - e23779 VL - 23 IS - 7 KW - internet plus health care KW - China KW - policy analysis KW - COVID-19 KW - epidemic N2 - Background: The combination of the internet and healthcare has excellent benefits and far-reaching positive effects in improving service efficiency and promoting social equity. The role of the ?internet plus healthcare? (IPHC) has been recognized, especially during the COVID-19 pandemic. This new healthcare model is also familiar to people and shows a bright prospect. Objective: This article seeks to accurately understand and fully grasp the characteristics of IPHC policies that can enlighten the formulation of future policies. Methods: The content analysis method was used to analyze China?s IPHC policies collected from the Beida Fabao database and several official websites. Results: We found that the development of IPHC policy has gone through 4 stages and is currently entering a phase of rapid development. IPHC policymakers are primarily health administrative departments. In addition, policy instruments are classified into either supply, environment, or demand, and policy themes can be summarized into 4 categories: facilities, technology, service, and management. Conclusions: China?s IPHC policy has good prospects from the perspective of development trends. The health administrative departments mainly lead the development of China?s IPHC policy. It is suggested that these departments involve other stakeholders (ie, medical workers, medical industries, and technology sectors) in formulating policies. Policies prefer to use supply-based and environment-based policy instruments. The policy themes emphasize improving infrastructure construction and high-quality diagnostic and treatment services, strengthening the supporting role of information technology, and ensuring all stakeholders understand their responsibilities. UR - https://www.jmir.org/2021/7/e23779 UR - http://dx.doi.org/10.2196/23779 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309581 ID - info:doi/10.2196/23779 ER - TY - JOUR AU - Winward, Sam AU - Patel, Tejal AU - Al-Saffar, Mazin AU - Noble, Matthew PY - 2021/7/22 TI - The Effect of 24/7, Digital-First, NHS Primary Care on Acute Hospital Spending: Retrospective Observational Analysis JO - J Med Internet Res SP - e24917 VL - 23 IS - 7 KW - primary health care KW - family practice KW - general practice KW - cost KW - cost analysis KW - telemedicine KW - digital technology KW - digital health KW - digital care KW - virtual care KW - hospital KW - retrospective KW - observational KW - cohort KW - finance KW - economics KW - health services research N2 - Background: Digital health has the potential to revolutionize health care by improving accessibility, patient experience, outcomes, productivity, safety, and cost efficiency. In England, the NHS (National Health Service) Long Term Plan promised the right to access digital-first primary care by March 31, 2024. However, there are few global, fully digital-first providers and limited research into their effects on cost from a health system perspective. Objective: The aim of this study was to evaluate the impact of highly accessible, digital-first primary care on acute hospital spending. Methods: A retrospective, observational analysis compared acute hospital spending on patients registered to a 24/7, digital-first model of NHS primary care with that on patients registered to all other practices in North West London Collaboration of Clinical Commissioning Groups. Acute hospital spending data per practice were obtained under a freedom of information request. Three versions of NHS techniques designed to fairly allocate funding according to need were used to standardize or ?weight? the practice populations; hence, there are 3 results for each year. The weighting adjusted the populations for characteristics that impact health care spending, such as age, sex, and deprivation. The total spending was divided by the number of standardized or weighted patients to give the spending per weighted patient, which was used to compare the 2 groups in the NHS financial years (FY) 2018-2019 (FY18/19) and 2019-2020 (FY19/20). FY18/19 costs were adjusted for inflation, so they were comparable with the values of FY19/20. Results: The NHS spending on acute hospital care for 2.43 million and 2.54 million people (FY18/19 and FY19/20) across 358 practices and 49 primary care networks was £1.6 billion and £1.65 billion (a currency exchange rate of £1=US $1.38 is applicable), respectively. The spending on acute care per weighted patient for Babylon GP at Hand members was 12%, 31%, and 54% (£93, P=.047; £223, P<.001; and £389, P<.001) lower than the regional average in FY18/19 for the 3 weighting methodologies used. In FY19/20, it was 15%, 35%, and 51% (£114, P=.006; £246, P<.001; and £362, P<.001) lower. This amounted to lower costs for the Babylon GP at Hand population of £1.37, £4.40 million, and £11.6 million, respectively, in FY18/19; and £3.26 million, £9.54 million, and £18.8 million, respectively, in FY19/20. Conclusions: Patients with access to 24/7, digital-first primary care incurred significantly lower acute hospital costs. UR - https://www.jmir.org/2021/7/e24917 UR - http://dx.doi.org/10.2196/24917 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292160 ID - info:doi/10.2196/24917 ER - TY - JOUR AU - Lai, Yunfeng AU - Chen, Shengqi AU - Li, Meng AU - Ung, Lam Carolina Oi AU - Hu, Hao PY - 2021/7/20 TI - Policy Interventions, Development Trends, and Service Innovations of Internet Hospitals in China: Documentary Analysis and Qualitative Interview Study JO - J Med Internet Res SP - e22330 VL - 23 IS - 7 KW - internet hospital KW - health policy KW - medical service KW - public hospital KW - digital health KW - China N2 - Background: Internet hospitals have been encouraged by the Chinese government to develop an innovative medical service model that mainly uses new internet-based technologies to increase access to health care and improve the quality and efficiency of health care delivery. However, the academic exploration of the institutional and sectoral development of internet hospitals in China is scarce in the existing literature. Objective: This study aimed to investigate the policy interventions, development trends, and service innovations of internet hospitals in China. It is expected that the findings from this study will contribute to the further innovation of internet hospitals in China and provide references for the international development of internet hospitals for personalized digital health and patient-centric services. Methods: This study analyzed official policies related to internet hospitals that were implemented by the government in China since 2005. The data of formally approved internet hospitals were collected from official websites to analyze development trends. In-depth semistructured interviews were conducted with 58 key stakeholders who represented comprehensive viewpoints about the service innovations of internet hospitals between March and November 2019. Results: In total, 25 policies that promoted the development of internet hospitals in China were identified. These policies encompassed informatization infrastructure construction, medical resource integration, development model design, service model design, and payment model design. Of the 268 internet hospitals that had received an official license from the government, 153 public internet hospitals had been built mainly by medical institutions. Public tertiary hospitals were the main actors in founding internet hospitals that were created to provide services that targeted patients with common diseases or chronic diseases or patients living in remote and rural areas. Promoting convenient access to high-quality medical resources and saving patients? and their families? time were the key values of internet hospitals. Conclusions: The policy interventions strongly promoted the development of internet hospitals in China. Public tertiary hospitals led the development of internet hospitals. However, internet hospitals in China have mainly played roles that are complementary to those of physical medical institutions. The service model of internet hospitals needs more distinguished innovations to provide personalized digital health and patient-centric services. UR - https://www.jmir.org/2021/7/e22330 UR - http://dx.doi.org/10.2196/22330 UR - http://www.ncbi.nlm.nih.gov/pubmed/34283025 ID - info:doi/10.2196/22330 ER - TY - JOUR AU - Rose, Susannah AU - Hurwitz, McKee Heather AU - Mercer, Beth Mary AU - Hizlan, Sabahat AU - Gali, Kari AU - Yu, Pei-Chun AU - Franke, Caroline AU - Martinez, Kathryn AU - Stanton, Matthew AU - Faiman, Matthew AU - Rasmussen, Peter AU - Boissy, Adrienne PY - 2021/6/21 TI - Patient Experience in Virtual Visits Hinges on Technology and the Patient-Clinician Relationship: A Large Survey Study With Open-ended Questions JO - J Med Internet Res SP - e18488 VL - 23 IS - 6 KW - telehealth KW - virtual visit KW - patient experience KW - mobile phone N2 - Background: Patient satisfaction with in-person medical visits includes patient-clinician engagement. However, communication, empathy, and other relationship-centered care measures in virtual visits have not been adequately investigated. Objective: This study aims to comprehensively consider patient experience, including relationship-centered care measures, to assess patient satisfaction during virtual visits. Methods: We conducted a large survey study with open-ended questions to comprehensively assess patients? experiences with virtual visits in a diverse patient population. Adults with a virtual visit between June 21, 2017, and July 12, 2017, were invited to complete a survey of 21 Likert-scale items and textboxes for comments following their visit. Factor analysis of the survey items revealed three factors: experience with technology, patient-clinician engagement, and overall satisfaction. Multivariable logistic regression was used to test the associations among the three factors and patient demographics, clinician type, and prior relationship with the clinician. Using qualitative framework analysis, we identified recurrent themes in survey comments, quantitatively coded comments, and computed descriptive statistics of the coded comments. Results: A total of 65.7% (426/648) of the patients completed the survey; 64.1% (273/426) of the respondents were women, and the average age was 46 (range 18-86) years. The sample was geographically diverse: 70.2% (299/426) from Ohio, 6.8% (29/426) from Florida, 4.2% (18/426) from Pennsylvania, and 18.7% (80/426) from other states. With regard to insurance coverage, 57.5% (245/426) were undetermined, 23.7% (101/426) had the hospital?s employee health insurance, and 18.7% (80/426) had other private insurance. Types of virtual visits and clinicians varied. Overall, 58.4% (249/426) of patients had an on-demand visit, whereas 41.5% (177/426) had a scheduled visit. A total of 41.8% (178/426) of patients had a virtual visit with a family physician, 20.9% (89/426) with an advanced practice provider, and the rest had a visit with a specialist. Most patients (393/423, 92.9%) agreed that their virtual visit clinician was interested in them as a person, and their virtual visit made it easy to get the care they needed (383/421, 90.9%). A total of 81.9% (344/420) of respondents agreed or strongly agreed that their virtual visit was as good as an in-person visit by a clinician. Having a prior relationship with their virtual visit clinician was associated with less comfort and ease with virtual technology among patients (odds ratio 0.58, 95% CI 0.35-0.98). In terms of technology, patients found the interface easy to use (392/423, 92.7%) and felt comfortable using it (401/423, 94.8%). Technical difficulties were associated with lower odds of overall satisfaction (odds ratio 0.46, 95% CI 0.28-0.76). Conclusions: Patient-clinician engagement in virtual visits was comparable with in-person visits. This study supports the value and acceptance of virtual visits. Evaluations of virtual visits should include assessments of technology and patient-clinician engagement, as both are likely to influence patient satisfaction. UR - https://www.jmir.org/2021/6/e18488 UR - http://dx.doi.org/10.2196/18488 UR - http://www.ncbi.nlm.nih.gov/pubmed/34152276 ID - info:doi/10.2196/18488 ER - TY - JOUR AU - Dong, Shengjie AU - Millar, Ross AU - Shi, Chenshu AU - Dong, Minye AU - Xiao, Yuyin AU - Shen, Jie AU - Li, Guohong PY - 2021/6/17 TI - Rating Hospital Performance in China: Review of Publicly Available Measures and Development of a Ranking System JO - J Med Internet Res SP - e17095 VL - 23 IS - 6 KW - hospital ranking KW - performance measurement KW - health care quality KW - China health care reform N2 - Background: In China, significant emphasis and investment in health care reform since 2009 has brought with it increasing scrutiny of its public hospitals. Calls for greater accountability in the quality of hospital care have led to increasing attention toward performance measurement and the development of hospital ratings. Despite such interest, there has yet to be a comprehensive analysis of what performance information is publicly available to understand the performance of hospitals in China. Objective: This study aims to review the publicly available performance information about hospitals in China to assess options for ranking hospital performance. Methods: A review was undertaken to identify performance measures based on publicly available data. Following several rounds of expert consultation regarding the utility of these measures, we clustered the available options into three key areas: research and development, academic reputation, and quality and safety. Following the identification and clustering of the available performance measures, we set out to translate these into a practical performance ranking system to assess variation in hospital performance. Results: A new hospital ranking system termed the China Hospital Development Index (CHDI) is thus presented. Furthermore, we used CHDI for ranking well-known tertiary hospitals in China. Conclusions: Despite notable limitations, our assessment of available measures and the development of a new ranking system break new ground in understanding hospital performance in China. In doing so, CHDI has the potential to contribute to wider discussions and debates about assessing hospital performance across global health care systems. UR - https://www.jmir.org/2021/6/e17095 UR - http://dx.doi.org/10.2196/17095 UR - http://www.ncbi.nlm.nih.gov/pubmed/34137724 ID - info:doi/10.2196/17095 ER - TY - JOUR AU - Matthewman, Spencer AU - Spencer, Sarah AU - Lavergne, Ruth M. AU - McCracken, K. Rita AU - Hedden, Lindsay PY - 2021/6/11 TI - An Environmental Scan of Virtual ?Walk-In? Clinics in Canada: Comparative Study JO - J Med Internet Res SP - e27259 VL - 23 IS - 6 KW - virtual care KW - primary care KW - Canada KW - virtual health KW - patients KW - physicians N2 - Background: Canada has been slow to implement virtual care relative to other countries. However, in recent years, the availability of on-demand, ?walk-in? virtual clinics has increased, with the COVID-19 pandemic contributing to the increased demand and provision of virtual care nationwide. Although virtual care facilitates access to physicians while maintaining physical distancing, there are concerns regarding the continuity and quality of care as well as equitable access. There is a paucity of research documenting the availability of virtual care in Canada, thus hampering the efforts to evaluate the impacts of its relatively rapid emergence on the broader health care system and on individual health. Objective: We conducted a national environmental scan to determine the availability and scope of virtual walk-in clinics, cataloging the services they offer and whether they are operating through public or private payment. Methods: We developed a power term and implemented a structured Google search to identify relevant clinics. From each clinic meeting our inclusion criteria, we abstracted data on the payment model, region of operation, services offered, and continuity of care. We compared clinics operating under different payment models using Fisher exact tests. Results: We identified 18 virtual walk-in clinics. Of the 18 clinics, 10 (56%) provided some services under provincial public insurance, although 44% (8/18) operated on a fully private payment model while an additional 39% (7/18) charged patients out of pocket for some services. The most common supplemental services offered included dermatology (15/18, 83%), mental health services (14/18, 78%), and sexual health (11/18, 61%). Continuity, information sharing, or communication with the consumers? existing primary care providers were mentioned by 22% (4/18) of the clinics. Conclusions: Virtual walk-in clinics have proliferated; however, concerns about equitable access, continuity of care, and diversion of physician workforce within these models highlight the importance of supporting virtual care options within the context of longitudinal primary care. More research is needed to support quality virtual care and understand its effects on patient and provider experiences and the overall health system utilization and costs. UR - https://www.jmir.org/2021/6/e27259 UR - http://dx.doi.org/10.2196/27259 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114963 ID - info:doi/10.2196/27259 ER - TY - JOUR AU - Kim, Gyungha AU - Jeon, Hwawoo AU - Park, Kee Sung AU - Choi, Suk Yong AU - Lim, Yoonseob PY - 2021/6/8 TI - A Care Knowledge Management System Based on an Ontological Model of Caring for People With Dementia: Knowledge Representation and Development Study JO - J Med Internet Res SP - e25968 VL - 23 IS - 6 KW - caregiver KW - caregiver for person with dementia KW - knowledge model KW - ontology KW - knowledge management KW - semantic reasoning N2 - Background: Caregivers of people with dementia find it extremely difficult to choose the best care method because of complex environments and the variable symptoms of dementia. To alleviate this care burden, interventions have been proposed that use computer- or web-based applications. For example, an automatic diagnosis of the condition can improve the well-being of both the person with dementia and the caregiver. Other interventions support the individual with dementia in living independently. Objective: The aim of this study was to develop an ontology-based care knowledge management system for people with dementia that will provide caregivers with a care guide suited to the environment and to the individual patient?s symptoms. This should also enable knowledge sharing among caregivers. Methods: To build the care knowledge model, we reviewed existing ontologies that contain concepts and knowledge descriptions relating to the care of those with dementia, and we considered dementia care manuals. The basic concepts of the care ontology were confirmed by experts in Korea. To infer the different care methods required for the individual dementia patient, the reasoning rules as defined in Semantic Web Rule Languages and Prolog were utilized. The accuracy of the care knowledge in the ontological model and the usability of the proposed system were evaluated by using the Pellet reasoner and OntOlogy Pitfall Scanner!, and a survey and interviews were conducted with caregivers working in care centers in Korea. Results: The care knowledge model contains six top-level concepts: care knowledge, task, assessment, person, environment, and medical knowledge. Based on this ontological model of dementia care, caregivers at a dementia care facility in Korea were able to access the care knowledge easily through a graphical user interface. The evaluation by the care experts showed that the system contained accurate care knowledge and a level of assessment comparable to normal assessment tools. Conclusions: In this study, we developed a care knowledge system that can provide caregivers with care guides suited to individuals with dementia. We anticipate that the system could reduce the workload of caregivers. UR - https://www.jmir.org/2021/6/e25968 UR - http://dx.doi.org/10.2196/25968 UR - http://www.ncbi.nlm.nih.gov/pubmed/34100762 ID - info:doi/10.2196/25968 ER - TY - JOUR AU - Solans, Oscar AU - Vidal-Alaball, Josep AU - Roig Cabo, Pasqual AU - Mora, Núria AU - Coma, Ermengol AU - Bonet Simó, Maria Josep AU - Hermosilla Pérez, Eduardo AU - Saigí-Rubió, Francesc AU - Olmos Domínguez, Carmen AU - Piera-Jiménez, Jordi AU - Abizanda González, Mercè AU - López Seguí, Francesc PY - 2021/5/27 TI - Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study JO - J Med Internet Res SP - e28629 VL - 23 IS - 5 KW - teleconsultation KW - primary care KW - remote consultation KW - telehealth KW - COVID-19 KW - e-consultation N2 - Background: eConsulta?that is, asynchronous, two-way teleconsultation in primary care?is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system. Objective: This study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic. Methods: A descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them. Results: During the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas. Conclusions: The COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity. UR - https://www.jmir.org/2021/5/e28629 UR - http://dx.doi.org/10.2196/28629 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970867 ID - info:doi/10.2196/28629 ER - TY - JOUR AU - Huygens, J. Martine W. AU - Voogdt-Pruis, R. Helene AU - Wouters, Myrah AU - Meurs, M. Maaike AU - van Lettow, Britt AU - Kleijweg, Conchita AU - Friele, D. Roland PY - 2021/5/3 TI - The Uptake and Use of Telemonitoring in Chronic Care Between 2014 and 2019: Nationwide Survey Among Patients and Health Care Professionals in the Netherlands JO - J Med Internet Res SP - e24908 VL - 23 IS - 5 KW - eHealth KW - telemonitoring KW - self-management KW - telemedicine KW - telehealth N2 - Background: Telemonitoring could offer solutions to the mounting challenges for health care and could improve patient self-management. Studies have addressed the benefits and challenges of telemonitoring for certain patient groups. Objective: This paper will examine the nationwide uptake of telemonitoring in chronic care in the Netherlands from 2014 to 2019 by means of an annual representative survey among patients and health care professionals. Methods: Between 2014 and 2019, approximately 2900 patients with chronic diseases, 700 nurses, and 500 general practitioners (GPs) and medical specialists received a questionnaire. About 30 questions addressed topics about the use of eHealth and experiences with it, including data about telemonitoring. Results: Between 2014 and 2019, the use of telemonitoring remained stable for all groups except medical specialists. In medical specialist departments, the use of telemonitoring increased from 11.2% (18/161) in 2014 to 19.6% (36/184) in 2019 (?24=12.3; P=.02). In 2019, telemonitoring was used by 5.8% (28/485) of people with chronic disease. This was 18.2% (41/225) in GP organizations and 40.4% (44/109), 38.0% (78/205), and 8.9% (29/325) in the organizations of nurses working in primary, secondary, and elderly care, respectively. Up to 10% of the targeted patient group such as diabetics were regarded by health care professionals as suitable for using telemonitoring. The main benefits mentioned by the patients were ?comfort? (421/1043, 40.4%) and ?living at home for longer/more comfortably? (334/1047, 31.9%). Health care professionals added ?improvement of self-management? (63/176, 35.8% to 57/71, 80.3%), ?better understanding of the patient?s condition? (47/176, 26.7% to 42/71, 59.2%), ?reduction of workload? (53/134, 39.6% of nurses in elderly care), ?better tailoring of care plan to the patient?s situation? (95/225, 42.2% of GPs), and ?saves time for patients/caregivers? (61/176, 34.7% of medical specialists). Disadvantages mentioned by professionals were that ?it takes time to monitor data? (13/130, 10% to 108/225, 48.0%), ?it takes time to follow up alerts? (15/130, 11.5% to 117/225, 52.0%), and ?it is difficult to estimate which patients can work with telemonitoring? (22/113, 19.5% to 94/225, 41.8%). Conclusions: The uptake of telemonitoring in Dutch chronic care remained stable during 2014-2019 but increased among medical specialists. According to both patients and professionals, telemonitoring improves the quality of life and quality of care. Skills for suitably including eligible patients and for allocating the tasks of data monitoring and follow-up care within the team would help to further increase the use of telemonitoring. UR - https://www.jmir.org/2021/5/e24908 UR - http://dx.doi.org/10.2196/24908 UR - http://www.ncbi.nlm.nih.gov/pubmed/33938808 ID - info:doi/10.2196/24908 ER - TY - JOUR AU - Jiang, Ying AU - Koh, Ling Karen Wei AU - Ramachandran, Joann Hadassah AU - Tay, Kian Yee AU - Wu, Xi Vivien AU - Shorey, Shefaly AU - Wang, Wenru PY - 2021/4/27 TI - Patients? Experiences of a Nurse-Led, Home-Based Heart Failure Self-management Program: Findings From a Qualitative Process Evaluation JO - J Med Internet Res SP - e28216 VL - 23 IS - 4 KW - self-care KW - psychosocial educational KW - nurse-led KW - mHealth KW - self-management KW - heart failure KW - process evaluation KW - nursing KW - mobile phone N2 - Background: Heart failure (HF) is a major public health problem that places a significant disease burden on society. Self-care is important in the management of HF because it averts disease progression and reduces the number of hospitalizations. Effective nursing interventions promote HF self-care. Objective: This study aims to explore participants? perspectives on a nurse-led, home-based heart failure self-management program (HOM-HEMP) in a randomized controlled trial conducted in Singapore to gain insight into the effectiveness of the study intervention. Methods: A descriptive, qualitative approach was used. English- or Chinese-speaking participants from the intervention arms were recruited through a purposive sampling method from January 2019 to July 2019. Individual, face-to-face, semistructured interviews were conducted with 11 participants. All interviews were audio recorded and transcribed verbatim, with the participant identifiers omitted to ensure confidentiality. The thematic analysis approach was used to identify, analyze, and report patterns (themes) within the data. Results: A total of six themes emerged from the process evaluation interviews and were categorized according to the Donabedian structure-process-outcome framework as intervention structure, intervention process, and intervention outcome. These six themes were manageability of the intervention, areas for improvement, benefits of visiting, personal accountability in self-care, empowered with knowledge and skills in self-care after the intervention, and increased self-efficacy in cardiac care. Conclusions: The findings of the process evaluation provided additional information on participants? perceptions and experiences with the HOM-HEMP intervention. Although a home visit may be perceived as resource intensive, it remains to be the preferred way of engagement for most patients. Nurses play an important role in promoting HF self-care. The process of interaction with the patient can be an important process for empowering self-care behavior changes. UR - https://www.jmir.org/2021/4/e28216 UR - http://dx.doi.org/10.2196/28216 UR - http://www.ncbi.nlm.nih.gov/pubmed/33904823 ID - info:doi/10.2196/28216 ER - TY - JOUR AU - Orrange, Sharon AU - Patel, Arpna AU - Mack, Jean Wendy AU - Cassetta, Julia PY - 2021/4/22 TI - Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study JO - JMIR Hum Factors SP - e28589 VL - 8 IS - 2 KW - telemedicine KW - patient satisfaction KW - COVID-19 KW - health services research KW - health policy KW - health care delivery KW - physicians KW - medicine N2 - Background: Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient- or visit-related factors and trust play when in-person visits are eliminated. Objective: The aim of this study is to examine correlates of patients? satisfaction with a telemedicine visit. Methods: In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged ?18 years who completed a telemedicine visit between March 10th and April 17th, 2020, were invited for a survey (n=1624). Measures included patient demographics, degree of interpersonal trust in patient-physician relationships (using the Trust in Physician Scale), and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression. Results: Of 1624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (173/365, 47.4%) or satisfied (n=129, 35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.001). Visit-related factors with statistically significant correlation with Trust in Physician score were technical issues with the telemedicine visit (r=?0.16), concerns about privacy (r=?0.19), concerns about cost (r=?0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47; all P<.01). Visit-related factors associated with patients? satisfaction included fewer technical issues (P<.001), less concern about privacy (P<.001) or cost (P=.02), and successful face-to-face video (P<.001). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.001). Younger age was associated with higher satisfaction with the telemedicine visit (P=.005). Conclusions: There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients? satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed. UR - https://humanfactors.jmir.org/2021/2/e28589 UR - http://dx.doi.org/10.2196/28589 UR - http://www.ncbi.nlm.nih.gov/pubmed/33822736 ID - info:doi/10.2196/28589 ER - TY - JOUR AU - Jiang, Xuehan AU - Xie, Hong AU - Tang, Rui AU - Du, Yanmei AU - Li, Tao AU - Gao, Jinsheng AU - Xu, Xiuping AU - Jiang, Siqi AU - Zhao, Tingting AU - Zhao, Wei AU - Sun, Xingzhi AU - Hu, Gang AU - Wu, Dejun AU - Xie, Guotong PY - 2021/4/15 TI - Characteristics of Online Health Care Services From China?s Largest Online Medical Platform: Cross-sectional Survey Study JO - J Med Internet Res SP - e25817 VL - 23 IS - 4 KW - eHealth KW - internet hospital KW - China KW - online health care services KW - mHealth KW - COVID-19 KW - digital health KW - app KW - online consultation KW - user experience N2 - Background: Internet hospitals in China are in great demand due to limited and unevenly distributed health care resources, lack of family doctors, increased burdens of chronic diseases, and rapid growth of the aged population. The COVID-19 epidemic catalyzed the expansion of online health care services. In recent years, internet hospitals have been rapidly developed. Ping An Good Doctor is the largest, national online medical entry point in China and is a widely used platform providing online health care services. Objective: This study aims to give a comprehensive description of the characteristics of the online consultations and inquisitions in Ping An Good Doctor. The analyses tried to answer the following questions: (1) What are the characteristics of the consultations in Ping An Good Doctor in terms of department and disease profiles? (2) Who uses the online health services most frequently? and (3) How is the user experience of the online consultations of Ping An Good Doctor? Methods: A total of 35.3 million consultations and inquisitions over the course of 1 year were analyzed with respect to the distributions of departments and diseases, user profiles, and consulting behaviors. Results: The geographical distribution of the usage of Ping An Good Doctor showed that Shandong (18.4%), Yunnan (15.6%), Shaanxi (7.2%), and Guangdong (5.5%) were the provinces that used it the most; they accounted for 46.6% of the total consultations and inquisitions. In terms of department distribution, we found that gynecology and obstetrics (19.2%), dermatology (17.0%), and pediatrics (14.4%) were the top three departments in Ping An Good Doctor. The disease distribution analysis showed that, except for nondisease-specific consultations, acute upper respiratory infection (AURI) (4.1%), pregnancy (2.8%), and dermatitis (2.4%) were the most frequently consulted diseases. In terms of user profiles, females (60.4%) from 19 to 35 years of age were most likely to seek consultations online, in general. The user behavior analyses showed that the peak times of day for online consultations occurred at 10 AM, 3 PM, and 9 PM. Regarding user experience, 93.0% of users gave full marks following their consultations. For some disease-related health problems, such as AURI, dermatitis, and eczema, the feedback scores were above average. Conclusions: The prevalence of internet hospitals, such as Ping An Good Doctor, illustrated the great demand for online health care services that can go beyond geographical limitations. Our analyses showed that nondisease-specific issues and moderate health problems were much more frequently consulted about than severe clinical conditions. This indicated that internet hospitals played the role of the family doctor, which helped to relieve the stress placed on offline hospitals and facilitated people?s lives. In addition, good user experiences, especially regarding disease-related inquisitions, suggested that online health services can help solve health problems. With support from the government and acceptance by the public, online health care services could develop at a fast pace and greatly benefit people?s daily lives. UR - https://www.jmir.org/2021/4/e25817 UR - http://dx.doi.org/10.2196/25817 UR - http://www.ncbi.nlm.nih.gov/pubmed/33729985 ID - info:doi/10.2196/25817 ER - TY - JOUR AU - Kazevman, Gill AU - Mercado, Marck AU - Hulme, Jennifer AU - Somers, Andrea PY - 2021/4/6 TI - Prescribing Phones to Address Health Equity Needs in the COVID-19 Era: The PHONE-CONNECT Program JO - J Med Internet Res SP - e23914 VL - 23 IS - 4 KW - digital health equity KW - health inequity KW - digital determinants of health KW - emergency medicine KW - COVID-19 KW - public health KW - health policy KW - primary care KW - cell phone UR - https://www.jmir.org/2021/4/e23914 UR - http://dx.doi.org/10.2196/23914 UR - http://www.ncbi.nlm.nih.gov/pubmed/33760753 ID - info:doi/10.2196/23914 ER - TY - JOUR AU - Boet, Sylvain AU - Etherington, Cole AU - Lam, Sandy AU - Lê, Maxime AU - Proulx, Laurie AU - Britton, Meghan AU - Kenna, Julie AU - Przybylak-Brouillard, Antoine AU - Grimshaw, Jeremy AU - Grantcharov, Teodor AU - Singh, Sukhbir PY - 2021/3/16 TI - Implementation of the Operating Room Black Box Research Program at the Ottawa Hospital Through Patient, Clinical, and Organizational Engagement: Case Study JO - J Med Internet Res SP - e15443 VL - 23 IS - 3 KW - patient safety KW - implementation science KW - quality improvement KW - health personnel KW - operating rooms N2 - Background: A large proportion of surgical patient harm is preventable; yet, our ability to systematically learn from these incidents and improve clinical practice remains limited. The Operating Room Black Box was developed to address the need for comprehensive assessments of clinical performance in the operating room. It captures synchronized audio, video, patient, and environmental clinical data in real time, which are subsequently analyzed by a combination of expert raters and software-based algorithms. Despite its significant potential to facilitate research and practice improvement, there are many potential implementation challenges at the institutional, clinician, and patient level. This paper summarizes our approach to implementation of the Operating Room Black Box at a large academic Canadian center. Objective: We aimed to contribute to the development of evidence-based best practices for implementing innovative technology in the operating room for direct observation of the clinical performance by using the case of the Operating Room Black Box. Specifically, we outline the systematic approach to the Operating Room Black Box implementation undertaken at our center. Methods: Our implementation approach included seeking support from hospital leadership; building frontline support and a team of champions among patients, nurses, anesthesiologists, and surgeons; accounting for stakeholder perceptions using theory-informed qualitative interviews; engaging patients; and documenting the implementation process, including barriers and facilitators, using the consolidated framework for implementation research. Results: During the 12-month implementation period, we conducted 23 stakeholder engagement activities with over 200 participants. We recruited 10 clinician champions representing nursing, anesthesia, and surgery. We formally interviewed 15 patients and 17 perioperative clinicians and identified key themes to include in an information campaign run as part of the implementation process. Two patient partners were engaged and advised on communications as well as grant and protocol development. Many anticipated and unanticipated challenges were encountered at all levels. Implementation was ultimately successful, with the Operating Room Black Box installed in August 2018, and data collection beginning shortly thereafter. Conclusions: This paper represents the first step toward evidence-guided implementation of technologies for direct observation of performance for research and quality improvement in surgery. With technology increasingly being used in health care settings, the health care community should aim to optimize implementation processes in the best interest of health care professionals and patients. UR - https://www.jmir.org/2021/3/e15443 UR - http://dx.doi.org/10.2196/15443 UR - http://www.ncbi.nlm.nih.gov/pubmed/33724199 ID - info:doi/10.2196/15443 ER - TY - JOUR AU - Bonet Olivencia, Samuel AU - Sasangohar, Farzan PY - 2021/3/4 TI - Investigating the Food and Drug Administration Biotherapeutics Review and Approval Process: Narrative Review JO - JMIR Form Res SP - e14563 VL - 5 IS - 3 KW - biotherapeutics KW - drug approval KW - drug review process KW - model-based systems engineering N2 - Background: The development, review, and approval process of therapeutic biological products in the United States presents two primary challenges: time and cost. Advancing a biotherapeutic from concept to market may take an average of 12 years, with costs exceeding US $1 billion, and the product may still fail the US Food and Drug Administration (FDA) approval process. Despite the FDA?s practices to expedite the approval of new therapies, seeking FDA approval remains a long, costly, and risky process. Objective: The objective of this paper is to explore the factors and gaps related to the FDA review and approval process that contribute to process inefficiencies and complexities as well as proposed methods and solutions to address such gaps. This paper also aims to investigate the available modeling efforts for the FDA approval process of therapeutic biological products. Methods: A narrative review of literature was conducted to understand the scope of published knowledge about challenges, opportunities, and specific methods to address the factors and gaps related to the review and approval of new drugs, including therapeutic biological products. Relevant peer-reviewed journal articles, conference proceedings, book chapters, official reports from public policy professional centers, and official reports and guidelines from the FDA were reviewed. Results: Of the 23 articles identified in this narrative literature review, none modeled the current FDA review and approval process structure to address issues related to the robustness, reliability, and efficiency of its operations from an external point of view. Although several studies summarize the FDA approval process with clarity, in addition to bringing to light the problems and challenges faced by the regulatory agency, only a few attempts have been made to provide solutions for the problems and challenges identified. In addition, although several reform models have been discussed, these models lack the application of scientific methodologies and modeling techniques in understanding FDA as a complex sociotechnical system. Furthermore, tools and methods to assess the efficacy of the models before implementation are largely absent. Conclusions: The findings suggest the efficacy of model-based systems engineering approaches for identifying opportunities for significant improvements to the FDA review and approval process. Using this holistic approach will serve several investigative purposes: identify influential sources of variability that cause major delays, including individual, team, and organizational decision making; identify the human-system bottlenecks; identify areas of opportunity for design-driven improvements; study the effect of induced changes in the system; and assess the robustness of the structure of the FDA approval process in terms of enforcement and information symmetry. UR - https://formative.jmir.org/2021/3/e14563 UR - http://dx.doi.org/10.2196/14563 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661119 ID - info:doi/10.2196/14563 ER - TY - JOUR AU - Yang, Xin AU - Yang, Ning AU - Lewis, Dwight AU - Parton, Jason AU - Hudnall, Matthew PY - 2021/2/18 TI - Patterns and Influencing Factors of eHealth Tools Adoption Among Medicaid and Non-Medicaid Populations From the Health Information National Trends Survey (HINTS) 2017-2019: Questionnaire Study JO - J Med Internet Res SP - e25809 VL - 23 IS - 2 KW - Medicaid program KW - eHealth KW - internet access KW - digital divide KW - health information technology N2 - Background: Evidence suggests that eHealth tools adoption is associated with better health outcomes among various populations. The patterns and factors influencing eHealth adoption among the US Medicaid population remain obscure. Objective: The objective of this study is to explore patterns of eHealth tools adoption among the Medicaid population and examine factors associated with eHealth adoption. Methods: Data from the Health Information National Trends Survey from 2017 to 2019 were used to estimate the patterns of eHealth tools adoption among Medicaid and non-Medicaid populations. The effects of Medicaid insurance status and other influencing factors were assessed with logistic regression models. Results: Compared with the non-Medicaid population, the Medicaid beneficiaries had significantly lower eHealth tools adoption rates for health information management (11.2% to 17.5% less) and mobile health for self-regulation (0.8% to 9.7% less). Conversely, the Medicaid population had significantly higher adoption rates for using social media for health information than their counterpart (8% higher in 2018, P=.01; 10.1% higher in 2019, P=.01). Internet access diversity, education, and cardiovascular diseases were positively associated with health information management and mobile health for self-regulation among the Medicaid population. Internet access diversity is the only factor significantly associated with social media adoption for acquisition of health information (OR 1.98, 95% CI 1.26-3.11). Conclusions: Our results suggest digital disparities in eHealth tools adoption between the Medicaid and non-Medicaid populations. Future research should investigate behavioral correlates and develop interventions to improve eHealth adoption and use among underserved communities. UR - http://www.jmir.org/2021/2/e25809/ UR - http://dx.doi.org/10.2196/25809 UR - http://www.ncbi.nlm.nih.gov/pubmed/33599619 ID - info:doi/10.2196/25809 ER - TY - JOUR AU - Liang, Jun AU - Li, Ying AU - Zhang, Zhongan AU - Shen, Dongxia AU - Xu, Jie AU - Zheng, Xu AU - Wang, Tong AU - Tang, Buzhou AU - Lei, Jianbo AU - Zhang, Jiajie PY - 2021/2/18 TI - Adoption of Electronic Health Records (EHRs) in China During the Past 10 Years: Consecutive Survey Data Analysis and Comparison of Sino-American Challenges and Experiences JO - J Med Internet Res SP - e24813 VL - 23 IS - 2 KW - medical informatics KW - health information technologies KW - electronic health records KW - hospitals KW - Sino-American N2 - Background: The adoption rate of electronic health records (EHRs) in hospitals has become a main index to measure digitalization in medicine in each country. Objective: This study summarizes and shares the experiences with EHR adoption in China and in the United States. Methods: Using the 2007-2018 annual hospital survey data from the Chinese Health Information Management Association (CHIMA) and the 2008-2017 United States American Hospital Association Information Technology Supplement survey data, we compared the trends in EHR adoption rates in China and the United States. We then used the Bass model to fit these data and to analyze the modes of diffusion of EHRs in these 2 countries. Finally, using the 2007, 2010, and 2014 CHIMA and Healthcare Information and Management Systems Services survey data, we analyzed the major challenges faced by hospitals in China and the United States in developing health information technology. Results: From 2007 to 2018, the average adoption rates of the sampled hospitals in China increased from 18.6% to 85.3%, compared to the increase from 9.4% to 96% in US hospitals from 2008 to 2017. The annual average adoption rates in Chinese and US hospitals were 6.1% and 9.6%, respectively. However, the annual average number of hospitals adopting EHRs was 1500 in China and 534 in the US, indicating that the former might require more effort. Both countries faced similar major challenges for hospital digitalization. Conclusions: The adoption rates of hospital EHRs in China and the United States have both increased significantly in the past 10 years. The number of hospitals that adopted EHRs in China exceeded 16,000, which was 3.3 times that of the 4814 nonfederal US hospitals. This faster adoption outcome may have been a benefit of top-level design and government-led policies, particularly the inclusion of EHR adoption as an important indicator for performance evaluation and the appointment of public hospitals. UR - http://www.jmir.org/2021/2/e24813/ UR - http://dx.doi.org/10.2196/24813 UR - http://www.ncbi.nlm.nih.gov/pubmed/33599615 ID - info:doi/10.2196/24813 ER - TY - JOUR AU - Walcott-Bryant, Aisha AU - Ogallo, William AU - Remy, L. Sekou AU - Tryon, Katherine AU - Shena, Winnie AU - Bosker-Kibacha, Marloes PY - 2021/2/17 TI - Addressing Care Continuity and Quality Challenges in the Management of Hypertension: Case Study of the Private Health Care Sector in Kenya JO - J Med Internet Res SP - e18899 VL - 23 IS - 2 KW - hypertension KW - health information systems KW - mobile phone KW - private sector KW - Kenya N2 - Background: Hypertension is a major risk factor of cardiovascular disease and a leading cause of morbidity and mortality globally. In Kenya, the rise of hypertension strains an already stretched health care system that has traditionally focused on the management of infectious diseases. Health care provision in this country remains fragmented, and little is known about the role of health information technology in care coordination. Furthermore, there is a dearth of literature on the experiences, challenges, and solutions for improving the management of hypertension and other noncommunicable diseases in the Kenyan private health care sector. Objective: The aim of this study is to assess stakeholders? perspectives on the challenges associated with the management of hypertension in the Kenyan private health care sector and to derive recommendations for the design and functionality of a digital health solution for addressing the care continuity and quality challenges in the management of hypertension. Methods: We conducted a qualitative case study. We collected data using in-depth interviews with 18 care providers and 8 business leads, and direct observations at 18 private health care institutions in Nairobi, Kenya. We analyzed the data thematically to identify the key challenges and recommendations for technology-enabled solutions to support the management of hypertension in the Kenyan private health sector. We subsequently used the generated insights to derive and describe the design and range of functions of a digital health wallet platform for enabling care quality and continuity. Results: The management of hypertension in the Kenyan private health care sector is characterized by challenges such as high cost of care, limited health care literacy, lack of self-management support, ineffective referral systems, inadequate care provider training, and inadequate regulation. Care providers lack the tools needed to understand their patients? care histories and effectively coordinate efforts to deliver high-quality hypertension care. The proposed digital health platform was designed to support hypertension care coordination and continuity through clinical workflow orchestration, decision support, and patient-mediated data sharing with privacy preservation, auditability, and trust enabled by blockchain technology. Conclusions: The Kenyan private health care sector faces key challenges that require significant policy, organizational, and infrastructural changes to ensure care quality and continuity in the management of hypertension. Digital health data interoperability solutions are needed to improve hypertension care coordination in the sector. Additional studies should investigate how patients can control the sharing of their data while ensuring that care providers have a holistic view of the patient during any encounter. UR - http://www.jmir.org/2021/2/e18899/ UR - http://dx.doi.org/10.2196/18899 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595446 ID - info:doi/10.2196/18899 ER - TY - JOUR AU - Ferry, R. Olivia AU - Moloney, C. Emma AU - Spratt, T. Owen AU - Whiting, M. Gerald F. AU - Bennett, J. Cameron PY - 2021/2/10 TI - A Virtual Ward Model of Care for Patients With COVID-19: Retrospective Single-Center Clinical Study JO - J Med Internet Res SP - e25518 VL - 23 IS - 2 KW - COVID-19 KW - efficacy KW - hospital KW - innovation KW - model KW - remote care KW - safety KW - telemedicine KW - virtual health care KW - virtual ward N2 - Background: COVID-19 has necessitated the implementation of innovative health care models in preparation for an influx of patients. A virtual ward model delivers clinical care remotely to patients in isolation. We report on an Australian cohort of patients with COVID-19 treated in a virtual ward. Objective: The aim of this study was to describe and evaluate the safety and efficacy of a virtual ward model of care for an Australian cohort of patients with COVID-19. Methods: Retrospective clinical assessment was performed for 223 patients with confirmed COVID-19 treated in a virtual ward in Brisbane, Australia, from March 25 to May 15, 2020. Statistical analysis was performed for variables associated with the length of stay and hospitalization. Results: Of 223 patients, 205 (92%) recovered without the need for escalation to hospital care. The median length of stay in the virtual ward was 8 days (range 1-44 days). In total, 18 (8%) patients were referred to hospital, of which 6 (33.3%) were discharged after assessment at the emergency department. Furthermore, 12 (5.4%) patients were admitted to hospital, of which 4 (33.3%) required supplemental oxygen and 2 (16.7%) required mechanical ventilation. No deaths were recorded. Factors associated with escalation to hospital care were the following: hypertension (odds ratio [OR] 3.6, 95% CI 1.28-9.87; P=.01), sputum production (OR 5.2, 95% CI 1.74-15.49; P=.001), and arthralgia (OR 3.8, 95% CI 1.21-11.71; P=.02) at illness onset and a polymerase chain reaction cycle threshold of ?20 on a diagnostic nasopharyngeal swab (OR 5.0, 95% CI 1.25-19.63; P=.02). Conclusions: Our results suggest that a virtual ward model of care to treat patients with COVID-19 is safe and efficacious, and only a small number of patients would potentially require escalation to hospital care. Further studies are required to validate this model of care. UR - http://www.jmir.org/2021/2/e25518/ UR - http://dx.doi.org/10.2196/25518 UR - http://www.ncbi.nlm.nih.gov/pubmed/33529157 ID - info:doi/10.2196/25518 ER - TY - JOUR AU - James, M. Hannah AU - Papoutsi, Chrysanthi AU - Wherton, Joseph AU - Greenhalgh, Trisha AU - Shaw, E. Sara PY - 2021/1/26 TI - Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework JO - J Med Internet Res SP - e23775 VL - 23 IS - 1 KW - delivery of health care KW - remote consultation KW - telemedicine KW - videoconferencing KW - spread and scale-up KW - sustainability KW - mobile phone KW - COVID-19 KW - remote care KW - consultation KW - review N2 - Background: COVID-19 has thrust video consulting into the limelight, as health care practitioners worldwide shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe, and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption, with limited consideration of how video consulting can be mainstreamed and sustained. Objective: This study sought to do the following: (1) review and synthesize reported opportunities, challenges, and lessons learned in the scale-up, spread, and sustainability of video consultations, and (2) identify transferable insights that can inform policy and practice. Methods: We identified papers through systematic searches in PubMed, CINAHL, and Web of Science. Included articles reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage, and were published since 2010. We used the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework to synthesize findings relating to 7 domains: an understanding of the health condition(s) for which video consultations were being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organizational factors, wider macro-level considerations, and emergence over time. Results: We identified 13 papers describing 10 different video consultation services in 6 regions, covering the following: (1) video-to-home services, connecting providers directly to the patient; (2) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural center; and (3) large-scale top-down evaluations scaled up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, as well as general specialist care and primary care. Potential enablers of spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to be related to service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and the technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorizing the distinct processes required to achieve widespread adoption. Conclusions: There remains a significant lack of evidence that can support the spread and scale-up of video consulting. Given the recent pace of change due to COVID-19, a more definitive evidence base is urgently needed to support global efforts and match enthusiasm for extending use. UR - http://www.jmir.org/2021/1/e23775/ UR - http://dx.doi.org/10.2196/23775 UR - http://www.ncbi.nlm.nih.gov/pubmed/33434141 ID - info:doi/10.2196/23775 ER - TY - JOUR AU - Chen, Zhuo-Jia AU - Liang, Wei-Ting AU - Liu, Qing AU - He, Rong AU - Chen, Qian-Chao AU - Li, Qiu-Feng AU - Zhang, Yao AU - Du, Xiao-Dong AU - Pan, Ying AU - Liu, Shu AU - Li, Xiao-Yan AU - Wei, Xue AU - Huang, He AU - Huang, Hong-Bing AU - Liu, Tao PY - 2021/1/21 TI - Use of a Remote Oncology Pharmacy Service Platform for Patients With Cancer During the COVID-19 Pandemic: Implementation and User Acceptance Evaluation JO - J Med Internet Res SP - e24619 VL - 23 IS - 1 KW - COVID-19 KW - cancer patients KW - remote pharmacy KW - service platform KW - implementation KW - oncology KW - pharmacy KW - online platform KW - cancer KW - health management KW - app KW - online hospital KW - acceptance KW - impact N2 - Background: The COVID-19 outbreak has increased challenges associated with health management, especially cancer management. In an effort to provide continuous pharmaceutical care to cancer patients, Sun Yat-sen University Cancer Center (SYSUCC) implemented a remote pharmacy service platform based on its already existing web-based hospital app known as Cloud SYSUCC. Objective: The aim of this study was to investigate the characteristics, acceptance, and initial impact of the Cloud SYSUCC app during a COVID-19 outbreak in a tertiary cancer hospital in China. Methods: The total number of online prescriptions and detailed information on the service were obtained during the first 6 months after the remote service platform was successfully set up. The patients? gender, age, residence, primary diagnosis, drug classification, weekly number of prescriptions, and prescribed drugs were analyzed. In addition, a follow-up telephonic survey was conducted to evaluate patients? satisfaction in using the remote prescription service. Results: A total of 1718 prescriptions, including 2022 drugs for 1212 patients, were delivered to 24 provinces and municipalities directly under the Central Government of China between February 12, 2020, and August 11, 2020. The majority of patients were female (841/1212, 69.39%), and 90.18% (1093/1212) of them were aged 31-70 years old. The top 3 primary diagnoses for which remote medical prescriptions were made included breast cancer (599/1212, 49.42%), liver cancer (249/1212, 20.54%), and thyroid cancer (125/1212, 10.31%). Of the 1718 prescriptions delivered, 1435 (83.5%) were sent to Guangdong Province and 283 (16.5%) were sent to other provinces in China. Of the 2022 drugs delivered, 1012 (50.05%) were hormonal drugs. The general trend in the use of the remote prescription service declined since the 10th week. A follow-up telephonic survey found that 88% (88/100) of the patients were very satisfied, and 12% (12/100) of the patients were somewhat satisfied with the remote pharmacy service platform. Conclusions: The remote pharmacy platform Cloud SYSUCC is efficient and convenient for providing continuous pharmaceutical care to patients with cancer during the COVID-19 crisis. The widespread use of this platform can help to reduce person-to-person transmission as well as infection risk for these patients. Further efforts are needed to improve the quality and acceptance of the Cloud SYSUCC platform, as well as to regulate and standardize the management of this novel service. UR - http://www.jmir.org/2021/1/e24619/ UR - http://dx.doi.org/10.2196/24619 UR - http://www.ncbi.nlm.nih.gov/pubmed/33395398 ID - info:doi/10.2196/24619 ER - TY - JOUR AU - de Batlle, Jordi AU - Massip, Mireia AU - Vargiu, Eloisa AU - Nadal, Nuria AU - Fuentes, Araceli AU - Ortega Bravo, Marta AU - Miralles, Felip AU - Barbé, Ferran AU - Torres, Gerard AU - PY - 2021/1/14 TI - Implementing Mobile Health?Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study JO - JMIR Mhealth Uhealth SP - e22135 VL - 9 IS - 1 KW - chronic disease KW - cost-benefit analysis KW - delivery of health care, integrated KW - mHealth KW - eHealth KW - quality of life N2 - Background: Integrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care. Objective: The aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients. Methods: As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER). Results: A total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57% less unplanned visits (P=.004) and 50% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program. Conclusions: The implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs, and was cost-effective. These findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement integrated care. UR - https://mhealth.jmir.org/2021/1/e22135 UR - http://dx.doi.org/10.2196/22135 UR - http://www.ncbi.nlm.nih.gov/pubmed/33443486 ID - info:doi/10.2196/22135 ER - TY - JOUR AU - Laur, Violet Celia AU - Agarwal, Payal AU - Mukerji, Geetha AU - Goulbourne, Elaine AU - Baranek, Hayley AU - Pus, Laura AU - Bhatia, Sacha R. AU - Martin, Danielle AU - Bhattacharyya, Onil PY - 2021/1/13 TI - Building Health Services in a Rapidly Changing Landscape: Lessons in Adaptive Leadership and Pivots in a COVID-19 Remote Monitoring Program JO - J Med Internet Res SP - e25507 VL - 23 IS - 1 KW - adaptive leadership KW - pivots KW - acute care KW - COVID-19 KW - leadership KW - remote monitoring KW - monitoring KW - health service KW - framework UR - http://www.jmir.org/2021/1/e25507/ UR - http://dx.doi.org/10.2196/25507 UR - http://www.ncbi.nlm.nih.gov/pubmed/33417588 ID - info:doi/10.2196/25507 ER - TY - JOUR AU - Jimenez, Geronimo AU - Matchar, David AU - Koh, Gerald Choon Huat AU - van der Kleij, Rianne AU - Chavannes, H. Niels AU - Car, Josip PY - 2021/1/11 TI - The Role of Health Technologies in Multicomponent Primary Care Interventions: Systematic Review JO - J Med Internet Res SP - e20195 VL - 23 IS - 1 KW - digital health KW - health system improvements KW - health technologies KW - primary care KW - systematic review N2 - Background: Several countries around the world have implemented multicomponent interventions to enhance primary care, as a way of strengthening their health systems to cope with an aging chronically ill population and rising costs. Some of these efforts have included technology-based enhancements as one of the features to support the overall intervention, but their details and impacts have not been explored. Objective: This study aimed to identify the role of digital/health technologies within wider multifeature interventions that are aimed at enhancing primary care, and to describe their aims and stakeholders, types of technologies used, and potential impacts. Methods: A systematic review was performed following Cochrane guidelines. An electronic search, conducted on May 30, 2019, was supplemented with manual and grey literature searches in December 2019, to identify multicomponent interventions that included at least one technology-based enhancement. After title/abstract and full text screening, selected articles were assessed for quality based on their study design. A descriptive narrative synthesis was used for analysis and presentation of the results. Results: Of 37 articles, 14 (38%) described the inclusion of a technology-based innovation as part of their multicomponent interventions to enhance primary care. The most commonly identified technologies were the use of electronic health records, data monitoring technologies, and online portals with messaging platforms. The most common aim of these technologies was to improve continuity of care and comprehensiveness, which resulted in increased patient satisfaction, increased primary care visits compared to specialist visits, and the provision of more health prevention education and improved prescribing practices. Technologies seem also to increase costs and utilization for some parameters, such as increased consultation costs and increased number of drugs prescribed. Conclusions: Technologies and digital health have not played a major role within comprehensive innovation efforts aimed at enhancing primary care, reflecting that these technologies have not yet reached maturity or wider acceptance as a means for improving primary care. Stronger policy and financial support, and advocacy of key stakeholders are needed to encourage the introduction of efficient technological innovations, which are backed by evidence-based research, so that digital technologies can fulfill the promise of supporting strong sustainable primary care. UR - http://www.jmir.org/2021/1/e20195/ UR - http://dx.doi.org/10.2196/20195 UR - http://www.ncbi.nlm.nih.gov/pubmed/33427676 ID - info:doi/10.2196/20195 ER - TY - JOUR AU - Yu, Qiao AU - Zhu, Chunpeng AU - Feng, Shuyi AU - Xu, Liyi AU - Hu, Shurong AU - Chen, Hao AU - Chen, Hanwen AU - Yao, Sheng AU - Wang, Xiaoying AU - Chen, Yan PY - 2021/1/5 TI - Economic Burden and Health Care Access for Patients With Inflammatory Bowel Diseases in China: Web-Based Survey Study JO - J Med Internet Res SP - e20629 VL - 23 IS - 1 KW - inflammatory bowel disease KW - Crohn disease KW - ulcerative colitis KW - primary care provider KW - emergency room KW - eHealth KW - gastroenterology KW - proctology N2 - Background: The increasing incidence of inflammatory bowel disease (IBD) has imposed heavy financial burdens for Chinese patients; however, data about their financial status and access to health care are still lacking. This information is important for informing patients with IBD about disease treatment budgets and health care strategies. Objective: The aim of this study was to evaluate the economic status and medical care access of patients with IBD through the China Crohn?s & Colitis Foundation web-based platform in China. Methods: Our study was performed in 14 IBD centers in mainland China between 2018 and 2019 through WeChat. Participants were asked to complete a 64-item web-based questionnaire. Data were collected by the Wenjuanxing survey program. We mainly focused on income and insurance status, medical costs, and access to health care providers. Respondents were stratified by income and the associations of income with medical costs and emergency visit times were analyzed. Results: In this study, 3000 patients with IBD, that is, 1922 patients with Crohn disease, 973 patients with ulcerative colitis, and 105 patients with undetermined colitis were included. During the last 12 months, the mean (SD) direct and indirect costs for per patient with IBD were approximately US $11,668.68 ($7944.44) and US $74.90 ($253.60) in China. The average reimbursement ratios for most outpatient and inpatient costs were less than 50%. However, the income of 85.5% (2565/3000) of the patients was less than ¥10,000 (US $1445) per month. Approximately 96.5% (2894/3000) of the patients were covered by health insurance, but only 24.7% (741/3000) of the patients had private commercial insurance, which has higher imbursement ratios. Nearly 98.0% (2954/3000) of the patients worried about their financial situation. Thus, 79.7% (2392/3000) of the patients with IBD tried to save money for health care and even delayed their medical treatments. About half of the respondents (1282/3000, 42.7%) had no primary care provider, and 52.2% (1567/3000) of the patients had to visit the emergency room 1-4 times per year for the treatment of their IBD. Multivariate analysis revealed that lower income (P=.001) and higher transportation (P=.004) and accommodation costs (P=.001) were significantly associated with the increased number of emergency visits of the patients. Conclusions: Chinese patients with IBD have enormous financial burdens and difficulties in accessing health care, which have increased their financial anxiety and inevitably influenced their disease outcomes. Early purchase of private insurance, thereby increasing the reimbursement ratio for medical expenses, and developing the use of telemedicine would be effective strategies for saving on health care costs. UR - https://www.jmir.org/2021/1/e20629 UR - http://dx.doi.org/10.2196/20629 UR - http://www.ncbi.nlm.nih.gov/pubmed/33399540 ID - info:doi/10.2196/20629 ER - TY - JOUR AU - Schweiberger, Kelsey AU - Hoberman, Alejandro AU - Iagnemma, Jennifer AU - Schoemer, Pamela AU - Squire, Joseph AU - Taormina, Jill AU - Wolfson, David AU - Ray, N. Kristin PY - 2020/12/18 TI - Practice-Level Variation in Telemedicine Use in a Pediatric Primary Care Network During the COVID-19 Pandemic: Retrospective Analysis and Survey Study JO - J Med Internet Res SP - e24345 VL - 22 IS - 12 KW - telehealth KW - telemedicine KW - ambulatory pediatrics KW - health services research KW - ambulatory KW - pediatrics KW - health services KW - COVID-19 N2 - Background: Telehealth, the delivery of health care through telecommunication technology, has potential to address multiple health system concerns. Despite this potential, only 15% of pediatric primary care clinicians reported using telemedicine as of 2016, with the majority identifying inadequate payment for these services as the largest barrier to their adoption. The COVID-19 pandemic led to rapid changes in payment and regulations surrounding telehealth, enabling its integration into primary care pediatrics. Objective: Due to limited use of telemedicine in primary care pediatrics prior to the COVID-19 pandemic, much is unknown about the role of telemedicine in pediatric primary care. To address this gap in knowledge, we examined the association between practice-level telemedicine use within a large pediatric primary care network and practice characteristics, telemedicine visit diagnoses, in-person visit volumes, child-level variations in telemedicine use, and clinician attitudes toward telemedicine. Methods: We analyzed electronic health record data from 45 primary care practices and administered a clinician survey to practice clinicians. Practices were stratified into tertiles based on rates of telemedicine use (low, intermediate, high) per 1000 patients per week during a two-week period (April 19 to May 2, 2020). By practice tertile, we compared (1) practice characteristics, (2) telemedicine visit diagnoses, (3) rates of in-person visits to the office, urgent care, and the emergency department, (4) child-level variation in telemedicine use, and (5) clinician attitudes toward telemedicine across these practices. Results: Across pediatric primary care practices, telemedicine visit rates ranged from 5 to 23 telemedicine visits per 1000 patients per week. Across all tertiles, the most frequent telemedicine visit diagnoses were mental health (28%-36% of visits) and dermatologic (15%-28%). Compared to low telemedicine use practices, high telemedicine use practices had fewer in-person office visits (10 vs 16 visits per 1000 patients per week, P=.005) but more total encounters overall (in-office and telemedicine: 28 vs 22 visits per 1000 patients per week, P=.006). Telemedicine use varied with child age, race and ethnicity, and recent preventive care; however, no significant interactions existed between these characteristics and practice-level telemedicine use. Finally, clinician attitudes regarding the usability and impact of telemedicine did not vary significantly across tertiles. Conclusions: Across a network of pediatric practices, we identified significant practice-level variation in telemedicine use, with increased use associated with more varied telemedicine diagnoses, fewer in-person office visits, and increased overall primary care encounter volume. Thus, in the context of the pandemic, when underutilization of primary care was prevalent, higher practice-level telemedicine use supported pediatric primary care encounter volume closer to usual rates. Child-level telemedicine use differed by child age, race and ethnicity, and recent preventive care, building upon prior concerns about differences in access to telemedicine. However, increased practice-level use of telemedicine services was not associated with reduced or increased differences in use, suggesting that further work is needed to promote equitable access to primary care telemedicine. UR - http://www.jmir.org/2020/12/e24345/ UR - http://dx.doi.org/10.2196/24345 UR - http://www.ncbi.nlm.nih.gov/pubmed/33290244 ID - info:doi/10.2196/24345 ER - TY - JOUR AU - Davenport, A. Tracey AU - Cheng, Sze Vanessa Wan AU - Iorfino, Frank AU - Hamilton, Blake AU - Castaldi, Eva AU - Burton, Amy AU - Scott, M. Elizabeth AU - Hickie, B. Ian PY - 2020/12/15 TI - Flip the Clinic: A Digital Health Approach to Youth Mental Health Service Delivery During the COVID-19 Pandemic and Beyond JO - JMIR Ment Health SP - e24578 VL - 7 IS - 12 KW - health information technologies KW - clinical staging KW - youth KW - mental health KW - transdiagnostic KW - eHealth KW - routine outcome monitoring KW - adolescent KW - mental health services KW - health services KW - telemedicine KW - monitoring KW - outcome KW - young adult KW - COVID-19 UR - http://mental.jmir.org/2020/12/e24578/ UR - http://dx.doi.org/10.2196/24578 UR - http://www.ncbi.nlm.nih.gov/pubmed/33206051 ID - info:doi/10.2196/24578 ER - TY - JOUR AU - Góngora Alonso, Susel AU - Sainz-De-Abajo, Beatriz AU - De la Torre-Díez, Isabel AU - Franco-Martin, Manuel PY - 2020/11/30 TI - Health Care Management Models for the Evolution of Hospitalization in Acute Inpatient Psychiatry Units: Comparative Quantitative Study JO - JMIR Ment Health SP - e15776 VL - 7 IS - 11 KW - acute inpatient psychiatry unit KW - database KW - hospitalizations KW - mental health KW - readmission KW - SPSS N2 - Background: Mental health disorders are a problem that affects patients, their families, and the professionals who treat them. Hospital admissions play an important role in caring for people with these diseases due to their effect on quality of life and the high associated costs. In Spain, at the Healthcare Complex of Zamora, a new disease management model is being implemented, consisting of not admitting patients with mental diseases to the hospital. Instead, they are supervised in sheltered apartments or centers for patients with these types of disorders. Objective: The main goal of this research is to evaluate the evolution of hospital days of stay of patients with mental disorders in different hospitals in a region of Spain, to analyze the impact of the new hospital management model. Methods: For the development of this study, a database of patients with mental disorders was used, taking into account the acute inpatient psychiatry unit of 11 hospitals in a region of Spain. SPSS Statistics for Windows, version 23.0 (IBM Corp), was used to calculate statistical values related to hospital days of stay of patients. The data included are from the periods of 2005-2011 and 2012-2015. Results: After analyzing the results, regarding the days of stay in the different health care complexes for the period between 2005 and 2015, we observed that since 2012 at the Healthcare Complex of Zamora, the total number of days of stay were reduced by 64.69%. This trend is due to the implementation of a new hospital management model in this health complex. Conclusions: With the application of a new hospital management model at the Healthcare Complex of Zamora, the number of days of stay of patients with mental diseases as well as the associated hospital costs were considerably reduced. UR - http://mental.jmir.org/2020/11/e15776/ UR - http://dx.doi.org/10.2196/15776 UR - http://www.ncbi.nlm.nih.gov/pubmed/33252351 ID - info:doi/10.2196/15776 ER - TY - JOUR AU - Li, Dehe AU - Hu, Yinhuan AU - Pfaff, Holger AU - Wang, Liuming AU - Deng, Lu AU - Lu, Chuntao AU - Xia, Shixiao AU - Cheng, Siyu AU - Zhu, Ximin AU - Wu, Xiaoyue PY - 2020/10/29 TI - Determinants of Patients? Intention to Use the Online Inquiry Services Provided by Internet Hospitals: Empirical Evidence From China JO - J Med Internet Res SP - e22716 VL - 22 IS - 10 KW - internet hospital KW - health care?seeking intention KW - online inquiry KW - theory of planned behavior KW - chronic disease KW - structural equation modeling KW - China KW - COVID-19 KW - intention KW - online service KW - eHealth KW - behavior KW - modeling N2 - Background: Internet hospitals show great potential for adequately fulfilling people?s demands for high-quality outpatient services, and with the normalization of the epidemic prevention and control of COVID-19, internet hospitals play an increasingly important role in delivering health services to the public. However, the factors that influence patients? intention to use the online inquiry services provided by internet hospitals remain unclear. Understanding the patients? behavioral intention is necessary to support the development of internet hospitals in China and promote patients? intention to use online inquiry services provided by internet hospitals during the prevention and control of the COVID-19 epidemic. Objective: The purpose of this study is to identify the determinants of patients? intention to use the online inquiry services provided by internet hospitals based on the theory of planned behavior (TPB). Methods: The hypotheses of our research model were developed based on the TPB. A questionnaire was developed through patient interviews, verified using a presurvey, and used for data collection for this study. The cluster sampling technique was used to include respondents with chronic diseases. Structural equation modeling was used to test the research hypotheses. Results: A total of 638 valid responses were received from patients with chronic diseases. The goodness-of-fit indexes corroborated that the research model was a good fit for the collected data. The model explained 45.9% of the variance in attitude toward the behavior and 60.5% of the variance in behavioral intention. Perceived behavioral control and perceived severity of disease had the strongest total effects on behavioral intention (?=.624, P=.004 and ?=.544, P=.003, respectively). Moreover, perceived convenience, perceived information risk, emotional preference, and health consciousness had indirect effects on behavioral intention, and these effects were mediated by attitude toward the behavior. Among the four constructs, perceived convenience had the highest indirect effect on behavioral intention (?=.207; P=.001). Conclusions: Perceived behavioral control and perceived severity of disease are the most important determinants of patients? intention to use the online inquiry services provided by internet hospitals. Therefore, internet hospitals should further optimize the design of online service delivery and ensure a reasonable assembly of high-quality experts, which will benefit the promotion of patients? adoption intention toward online inquiry services for health purposes. Perceived convenience, emotional preference, and perceived risks also have effects on behavioral intention. Therefore, the relevant quality control standards and regulations for internet hospitals should be further developed and improved, and the measures to protect personal information should be strengthened to ensure the patient safety. Our study supports the use of the TPB in explaining patients? intention to use online inquiry services provided by internet hospitals. UR - http://www.jmir.org/2020/10/e22716/ UR - http://dx.doi.org/10.2196/22716 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006941 ID - info:doi/10.2196/22716 ER - TY - JOUR AU - Haun, W. Markus AU - Stephan, Isabella AU - Wensing, Michel AU - Hartmann, Mechthild AU - Hoffmann, Mariell AU - Friederich, Hans-Christoph PY - 2020/10/15 TI - Intent to Adopt Video-Based Integrated Mental Health Care and the Characteristics of its Supporters: Mixed Methods Study Among General Practitioners Applying Diffusion of Innovations Theory JO - JMIR Ment Health SP - e23660 VL - 7 IS - 10 KW - video consultations KW - videoconferencing KW - telehealth KW - integrated care KW - mental health KW - preimplementation KW - diffusion of innovations KW - early adopters KW - mixed methods KW - cumulative logit model KW - content analysis N2 - Background: Most people with common mental disorders, including those with severe mental illness, are treated in general practice. Video-based integrated care models featuring mental health specialist video consultations (MHSVC) facilitate the involvement of specialist mental health care. However, the potential uptake by general practitioners (GPs) is unclear. Objective: This mixed method preimplementation study aims to assess GPs? intent to adopt MHSVC in their practice, identify predictors for early intent to adopt (quantitative strand), and characterize GPs with early intent to adopt based on the Diffusion of Innovations Theory (DOI) theory (qualitative strand). Methods: Applying a convergent parallel design, we conducted a survey of 177 GPs and followed it up with focus groups and individual interviews for a sample of 5 early adopters and 1 nonadopter. We identified predictors for intent to adopt through a cumulative logit model for ordinal multicategory responses for data with a proportional odds structure. A total of 2 coders independently analyzed the qualitative data, deriving common characteristics across the 5 early adopters. We interpreted the qualitative findings accounting for the generalized adopter categories of DOI. Results: This study found that about one in two GPs (87/176, 49.4%) assumed that patients would benefit from an MHSVC service model, about one in three GPs (62/176, 35.2%) intended to adopt such a model, the availability of a designated room was the only significant predictor of intent to adopt in GPs (?=2.03, SE 0.345, P<.001), supporting GPs expected to save time and took a solution-focused perspective on the practical implementation of MHSVC, and characteristics of supporting and nonsupporting GPs in the context of MHSVC corresponded well with the generalized adopter categories conceptualized in the DOI. Conclusions: A significant proportion of GPs may function as early adopters and key stakeholders to facilitate the spread of MHSVC. Indeed, our findings correspond well with increasing utilization rates of telehealth in primary care and specialist health care services (eg, mental health facilities and community-based, federally qualified health centers in the United States). Future work should focus on specific measures to foster the intention to adopt among hesitant GPs. UR - http://mental.jmir.org/2020/10/e23660/ UR - http://dx.doi.org/10.2196/23660 UR - http://www.ncbi.nlm.nih.gov/pubmed/33055058 ID - info:doi/10.2196/23660 ER - TY - JOUR AU - Poss-Doering, Regina AU - Kuehn, Lukas AU - Kamradt, Martina AU - Glassen, Katharina AU - Wensing, Michel PY - 2020/10/7 TI - Applying Digital Information Delivery to Convert Habits of Antibiotic Use in Primary Care in Germany: Mixed-Methods Study JO - J Med Internet Res SP - e18200 VL - 22 IS - 10 KW - antimicrobial resistance KW - educative digital solutions KW - health literacy KW - diffusion of innovations N2 - Background: Antimicrobial resistance is an important global health issue. In Germany, the national agenda supports various interventions to convert habits of antibiotic use. In the CHANGE-3 (Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care) study, digital tools were applied for information delivery: tablet computers in primary care practices, e-learning platforms for medical professionals, and a public website to promote awareness and health literacy among primary care physicians, their teams, and their patients. Objective: This study is embedded in the process evaluation of the CHANGE-3 study. The aim of this study was to evaluate the acceptance and uptake of digital devices for the delivery of health-related information to enhance awareness and change habits of antibiotic use in primary care in Germany. Methods: This study used a convergent-parallel mixed-methods design. Audio-recorded semistructured telephone interviews were conducted with physicians, nonphysician health professionals, and patients in the CHANGE-3 program. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was performed based on the inductive category of information provision via digital information tools. Identified themes were related to the main postulates of Diffusion of Innovations theory (DIT) to provide an explanatory frame. In addition, data generated through a structured survey with physicians and nonphysician health professionals in the program were analyzed descriptively and integrated with the qualitative data to explore the complementarity of the findings. Results: Findings regarding the acceptance and uptake of digital devices were related to three postulates of DIT: innovation characteristics, communication channels, and unanticipated consequences. Participants considered the provided digital educative solutions to be supportive for promoting health literacy regarding conversion of habits of antibiotic use. However, health care professionals found it challenging to integrate these solutions into existing routines in primary care and to align them with their professional values. Low technology affinity was a major barrier to the use of digital information in primary care. Patients welcomed the general idea of introducing health-related information in digital formats; however, they expressed concerns about device-related hygiene and the appropriateness of the digital tools for older patients. Conclusions: Patients and medical professionals in German primary care are reluctant to use digital devices for information and education. Using a Diffusion of Innovations approach can support assessment of existing barriers and provide information about setting-specific preconditions that are necessary for future tailoring of implementation strategies. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15061174; http://www.isrctn.com/ISRCTN15061174. UR - http://www.jmir.org/2020/10/e18200/ UR - http://dx.doi.org/10.2196/18200 UR - http://www.ncbi.nlm.nih.gov/pubmed/32960773 ID - info:doi/10.2196/18200 ER - TY - JOUR AU - Serhal, Eva AU - Kirvan, Anne AU - Sanches, Marcos AU - Crawford, Allison PY - 2020/9/29 TI - Client Satisfaction and Experience With Telepsychiatry: Development and Validation of a Survey Using Clinical Quality Domains JO - J Med Internet Res SP - e19198 VL - 22 IS - 9 KW - telemedicine KW - psychiatry KW - mental health KW - patient satisfaction KW - quality of health care N2 - Background: Telepsychiatry is an increasingly used model of mental health care that connects patients with psychiatrists at a distance via videoconference. Telepsychiatry is an effective clinical intervention that improves access to quality care in regions with limited resources or in clinical situations where in-person care is unavailable. Objective: This study aims to develop a validated survey tool to measure patient experience and satisfaction with telepsychiatry based on the quality of care domains. This study also seeks to understand which health service outcomes were most strongly correlated with overall satisfaction in the context of telepsychiatry. Methods: The survey created in this study was developed and validated with a panel of subject matter and process experts and was piloted with 274 patients who received clinical consultations through the TeleMental Health Program at the Centre for Addiction and Mental Health. Factor analysis was used to determine correlations between questions and quality of care domains and was also used to assess model fit. Results: The study provides a validated survey to measure patient satisfaction and experience with telepsychiatry across 4 domains: access and timeliness, appropriateness, effectiveness, and safety. Both safety and access and timeliness were found to be statistically significant predictors of satisfaction in our sample. Conclusions: By situating patient satisfaction and experience within this framework, the survey facilitates patient data collection and interpretation through a clinical quality lens. UR - http://www.jmir.org/2020/9/e19198/ UR - http://dx.doi.org/10.2196/19198 UR - http://www.ncbi.nlm.nih.gov/pubmed/32755896 ID - info:doi/10.2196/19198 ER - TY - JOUR AU - Wannheden, Carolina AU - Revenäs, Åsa PY - 2020/9/21 TI - How People with Parkinson's Disease and Health Care Professionals Wish to Partner in Care Using eHealth: Co-Design Study JO - J Med Internet Res SP - e19195 VL - 22 IS - 9 KW - chronic care KW - Parkinson's disease KW - co-creation KW - co-design KW - participatory design KW - eHealth KW - mHealth KW - clinical decision support N2 - Background: Worldwide, the number of people with Parkinson?s disease (PD) is predicted to double between the years 2005 and 2030. Chronic care management requires active collaboration and knowledge exchange between patients and health care professionals (HCPs) for best possible health outcomes, which we describe as co-care. eHealth services have the potential to support the realization of co-care between people with PD (PwP) and HCPs. Objective: This study aimed to explore how co-care could be operationalized in PD care, supported by eHealth. More specifically, this study explores PwP's and HCPs' expectations and desired eHealth functionalities to achieve co-care. Methods: Principles of participatory design were used to enable the identification of co-care needs and design ideas, in a series of 4 half-day co-design workshops. The sample included 7 (4 women) PwP and 9 (4 women) HCPs, including 4 neurologists, 3 nurses, and 2 physiotherapists. The co-design process resulted in a functional prototype that was evaluated by the co-design participants in the last workshop. Data were collected through note cards produced by the participants during the first 3 workshops and focus group discussions during the 3rd and 4th workshops. The data were analyzed using qualitative thematic analysis. After the workshop series, the prototype was demonstrated at a Mini Fair for ongoing PD research and evaluated using a self-developed questionnaire with 37 respondents: 31 PwP (14 women) and 6 informal caregivers (3 women). Descriptive statistics are reported. Results: The qualitative analysis of data resulted in 2 main themes. The first theme, core eHealth functionalities and their expected values, describes 6 desired eHealth functionalities for supporting PD co-care between PwP and HCPs: (1) self-tracking, (2) previsit forms, (3) graphical visualization, (4) clinical decision support, (5) self-care recommendations, and (6) asynchronous communication. The second theme, individual and organizational constraints, describes constraints that need to be addressed to succeed with an eHealth service for co-care. Individual constraints include eHealth literacy and acceptance; organizational constraints include teamwork and administrative workload. The majority of the questionnaire respondents (31/37, 84%) perceived that they would benefit from an eHealth service similar to the demonstrated prototype. All prototype functionalities were rated as very important or important by the majority of respondents (ranging from 86% to 97% per functionality). Conclusions: This study adds to our knowledge on how PD co-care could be operationalized. Co-care implies a shift from episodic routine-driven care to more flexible care management that is driven by the mutual needs of patients and HCPs and supported by active information exchange between them, as well as automated information processing to generate patient-specific advice. More research is needed to further explore the concept of co-care in chronic care management and what it means for self-care and health care. International Registered Report Identifier (IRRID): RR2-10.2196/11278 UR - http://www.jmir.org/2020/9/e19195/ UR - http://dx.doi.org/10.2196/19195 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955448 ID - info:doi/10.2196/19195 ER - TY - JOUR AU - Ramaswamy, Ashwin AU - Yu, Miko AU - Drangsholt, Siri AU - Ng, Eric AU - Culligan, J. Patrick AU - Schlegel, N. Peter AU - Hu, C. Jim PY - 2020/9/9 TI - Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: Retrospective Cohort Study JO - J Med Internet Res SP - e20786 VL - 22 IS - 9 KW - telemedicine KW - medicine KW - pandemics KW - patient satisfaction KW - remote consultation KW - disruptive technology KW - medical informatics KW - health care delivery KW - practice patterns KW - physicians KW - health policy KW - health services research KW - health care reform KW - COVID-19 N2 - Background: New York City was the international epicenter of the COVID-19 pandemic. Health care providers responded by rapidly transitioning from in-person to video consultations. Telemedicine (ie, video visits) is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter. Objective: This study aimed to determine if patient satisfaction differs between video and in-person visits. Methods: In this retrospective observational cohort study, we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters (620 video visits vs 37,989 in-person visits) at a single-institution, urban, quaternary academic medical center in New York City for patients aged 18 years, from April 1, 2019, to March 31, 2020. Time was categorized as pre?COVID-19 and COVID-19 (before vs after March 4, 2020). Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively. Results: We experienced an 8729% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9% vs 92.5%; P<.001). In adjusted analyses, video visits (parameter estimate [PE] 2.18; 95% CI 1.20-3.16) and the COVID-19 period (PE 0.55; 95% CI 0.04-1.06) were associated with higher patient satisfaction. Younger age (PE ?2.05; 95% CI ?2.66 to ?1.22), female gender (PE ?0.73; 95% CI ?0.96 to ?0.50), and new visit type (PE ?0.75; 95% CI ?1.00 to ?0.49) were associated with lower patient satisfaction. Conclusions: Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. Future research comparing other clinic visit quality indicators is needed to guide and implement the widespread adoption of telemedicine. UR - http://www.jmir.org/2020/9/e20786/ UR - http://dx.doi.org/10.2196/20786 UR - http://www.ncbi.nlm.nih.gov/pubmed/32810841 ID - info:doi/10.2196/20786 ER - TY - JOUR AU - Kazi, Momin Abdul AU - Qazi, Ahmed Saad AU - Ahsan, Nazia AU - Khawaja, Sadori AU - Sameen, Fareeha AU - Saqib, Muhammad AU - Khan Mughal, Ayub Muhammad AU - Wajidali, Zabin AU - Ali, Sikander AU - Ahmed, Moueed Rao AU - Kalimuddin, Hussain AU - Rauf, Yasir AU - Mahmood, Fatima AU - Zafar, Saad AU - Abbasi, Ahmad Tufail AU - Khoumbati, Khalil-Ur-Rahmen AU - Abbasi, A. Munir AU - Stergioulas, K. Lampros PY - 2020/9/3 TI - Current Challenges of Digital Health Interventions in Pakistan: Mixed Methods Analysis JO - J Med Internet Res SP - e21691 VL - 22 IS - 9 KW - digital health KW - eHealth KW - LMICs KW - mHealth KW - Pakistan KW - SWOT KW - telehealth N2 - Background: Digital health is well-positioned in low and middle-income countries (LMICs) to revolutionize health care due, in part, to increasing mobile phone access and internet connectivity. This paper evaluates the underlying factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Objective: The objective of this study is to identify the current digital health projects and studies being carried out in Pakistan, as well as the key stakeholders involved in these initiatives. We aim to follow a mixed-methods strategy and to evaluate these projects and studies through a strengths, weaknesses, opportunities, and threats (SWOT) analysis to identify the internal and external factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Methods: This study aims to evaluate digital health projects carried out in the last 5 years in Pakistan with mixed methods. The qualitative and quantitative data obtained from field surveys were categorized according to the World Health Organization?s (WHO) recommended building blocks for health systems research, and the data were analyzed using a SWOT analysis strategy. Results: Of the digital health projects carried out in the last 5 years in Pakistan, 51 are studied. Of these projects, 46% (23/51) used technology for conducting research, 30% (15/51) used technology for implementation, and 12% (6/51) used technology for app development. The health domains targeted were general health (23/51, 46%), immunization (13/51, 26%), and diagnostics (5/51, 10%). Smartphones and devices were used in 55% (28/51) of the interventions, and 59% (30/51) of projects included plans for scaling up. Artificial intelligence (AI) or machine learning (ML) was used in 31% (16/51) of projects, and 74% (38/51) of interventions were being evaluated. The barriers faced by developers during the implementation phase included the populations? inability to use the technology or mobile phones in 21% (11/51) of projects, costs in 16% (8/51) of projects, and privacy concerns in 12% (6/51) of projects. Conclusions: We conclude that while digital health has a promising future in Pakistan, it is still in its infancy at the time of this study. However, due to the coronavirus disease 2019 (COVID-19) pandemic, there is an increase in demand for digital health and implementation of health outcomes following global social distancing protocols, especially in LMICs. Hence, there is a need for active involvement by public and private organizations to regulate, mobilize, and expand the digital health sector for the improvement of health care systems in countries. UR - https://www.jmir.org/2020/9/e21691 UR - http://dx.doi.org/10.2196/21691 UR - http://www.ncbi.nlm.nih.gov/pubmed/32880584 ID - info:doi/10.2196/21691 ER - TY - JOUR AU - Brantnell, Anders AU - Woodford, Joanne AU - Baraldi, Enrico AU - van Achterberg, Theo AU - von Essen, Louise PY - 2020/8/12 TI - Views of Implementers and Nonimplementers of Internet-Administered Cognitive Behavioral Therapy for Depression and Anxiety: Survey of Primary Care Decision Makers in Sweden JO - J Med Internet Res SP - e18033 VL - 22 IS - 8 KW - mental health KW - internet-administered CBT KW - self-management KW - implementation KW - barriers and facilitators KW - decision-making KW - eHealth KW - primary care N2 - Background: Internet-administered cognitive behavioral therapy (ICBT) has been demonstrated to be an effective intervention for adults with depression and/or anxiety and is recommended in national guidelines for provision within Swedish primary care. However, the number and type of organizations that have implemented ICBT within primary care in Sweden is currently unclear. Further, there is a lack of knowledge concerning barriers and facilitators to ICBT implementation. Objective: The two primary objectives were to identify and describe primary care organizations providing ICBT in Sweden and compare decision makers? (ie, directors of primary care organizations) views on barriers and facilitators to implementation of ICBT among ICBT implementers (ie, organizations that offered ICBT) and nonimplementers (ie, organizations that did not offer ICBT). Methods: An online survey based on a checklist for identifying barriers and facilitators to implementation was developed and made accessible to decision makers from all primary care organizations in Sweden. The survey consisted of background questions (eg, provision of ICBT and number of persons working with ICBT) and barriers and facilitators relating to the following categories: users, therapists, ICBT programs, organizations, and wider society. Results: The participation rate was 35.75% (404/1130). The majority (250/404, 61.8%) of participants were health care center directors and had backgrounds in nursing. Altogether, 89.8% (363/404) of the participating organizations provided CBT. A minority (83/404, 20.5%) of organizations offered ICBT. Most professionals delivering ICBT were psychologists (67/83, 80%) and social workers (31/83, 37%). The majority (61/83, 73%) of organizations had 1 to 2 persons delivering ICBT interventions. The number of patients treated with ICBT during the last 12 months was 1 to 10 in 65% (54/83) of the organizations, ranging between 1 and 400 treated patients across the whole sample. There were 9 significant (P<.05) differences out of 37 possible between implementers and nonimplementers. For example, more implementers (48/51, 94%) than nonimplementers (107/139, 76.9%) perceived few technical problems (P<.001), and more implementers (53/77, 68%) than nonimplementers (103/215, 47.9%) considered that their organization has resources to offer ICBT programs (P<.001). Conclusions: Despite research demonstrating the effectiveness of ICBT for depression and anxiety and national guidelines recommending its use, ICBT is implemented in few primary care organizations in Sweden. Several interesting differences between implementers and nonimplementers were identified, which may help inform interventions focusing on facilitating the implementation of ICBT. UR - https://www.jmir.org/2020/8/e18033 UR - http://dx.doi.org/10.2196/18033 UR - http://www.ncbi.nlm.nih.gov/pubmed/32784186 ID - info:doi/10.2196/18033 ER - TY - JOUR AU - Han, Yangyang AU - Lie, K. Reidar AU - Guo, Rui PY - 2020/7/29 TI - The Internet Hospital as a Telehealth Model in China: Systematic Search and Content Analysis JO - J Med Internet Res SP - e17995 VL - 22 IS - 7 KW - Internet hospital KW - telehealth KW - telemedicine KW - ehealth KW - digital health KW - digital medicine KW - health services research KW - China N2 - Background: The internet hospital is an innovative organizational form and service mode under the tide of internet plus in the Chinese medical industry. It is the product of the interaction between consumer health needs and supply-side reform. However, there has still been no systematic summary of its establishment and definition, nor has there been an analysis of its service content. Objective: The primary purpose of this study was to understand the definition, establishment, and development status of internet hospitals. Methods: Data on internet hospitals were obtained via the Baidu search engine for results up until January 1, 2019. Based on the results of the search, we obtained more detailed information from the official websites and apps of 130 online hospitals and formed a database for descriptive analysis. Results: By January 2019, the number of registered internet hospitals had expanded to approximately 130 in 25 provinces, accounting for 73.5% of all provinces or province-level municipalities in China. Internet hospitals, as a new telehealth model, are distinct but overlap with online health, telemedicine, and mobile medical. They offer four kinds of services?convenience services, online medical services, telemedicine, and related industries. In general, there is an underlying common treatment flowchart of care in ordinary and internet hospitals. There are three different sponsors?government-led integration, hospital-led, and enterprise-led internet hospitals?for which stakeholders have different supporting content and responsibilities. Conclusions: Internet hospitals are booming in China, and it is the joint effort of the government and the market to alleviate the coexistence of shortages of medical resources and wasted medical supplies. The origin of internet hospitals in the eastern and western regions, the purpose of the establishment initiator, and the content of online and offline services are different. Only further standardized management and reasonable industry freedom can realize the original intention of the internet hospital of meeting various health needs. UR - http://www.jmir.org/2020/7/e17995/ UR - http://dx.doi.org/10.2196/17995 UR - http://www.ncbi.nlm.nih.gov/pubmed/32723721 ID - info:doi/10.2196/17995 ER - TY - JOUR AU - Chang, Ernest Shuchih AU - Chen, YiChian AU - Lu, MingFang AU - Luo, Louis Hueimin PY - 2020/7/28 TI - Development and Evaluation of a Smart Contract?Enabled Blockchain System for Home Care Service Innovation: Mixed Methods Study JO - JMIR Med Inform SP - e15472 VL - 8 IS - 7 KW - home care service KW - trust KW - innovation KW - blockchain KW - smart contract KW - automation N2 - Background: In the home care industry, the assignment and tracking of care services are controlled by care centers that are centralized in nature and prone to inefficient information transmission. A lack of trust among the involved parties, information opaqueness, and large manual manipulation result in lower process efficiency. Objective: This study aimed to explore and demonstrate the application of blockchain and smart contract technologies to innovate/renovate home care services for harvesting the desired blockchain benefits of process transparency, traceability, and interoperability. Methods: An object-oriented analysis/design combined with a unified modeling language tool was used to construct the architecture of the proposed home care service system. System feasibility was evaluated via an implementation test, and a questionnaire survey was performed to collect opinions from home care service respondents knowledgeable about blockchain and smart contracts. Results: According to the comparative analysis results, the proposed design outperformed the existing system in terms of traceability, system efficiency, and process automation. Moreover, for the questionnaire survey, the quantitative analysis results showed that the proposed blockchain-based system had significantly (P<.001) higher mean scores (when compared with the existing system) in terms of important factors, including timeliness, workflow efficiency, automatic notifications, insurance functionality, and auditable traceability. In summary, blockchain-based home care service participants will be able to enjoy improved efficiency, better transparency, and higher levels of process automation. Conclusions: Blockchain and smart contracts can provide valuable benefits to the home care service industry via distributed data management and process automation. The proposed system enhances user experiences by mitigating human intervention and improving service interoperability, transparency/traceability, and real-time response to home care service events. Efforts in exploring and integrating blockchain-based home care services with emerging technologies, such as the internet of things and artificial intelligence, are expected to provide further benefits and therefore are subject to future research. UR - https://medinform.jmir.org/2020/7/e15472 UR - http://dx.doi.org/10.2196/15472 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720903 ID - info:doi/10.2196/15472 ER - TY - JOUR AU - Balcombe, Luke AU - De Leo, Diego PY - 2020/7/22 TI - An Integrated Blueprint for Digital Mental Health Services Amidst COVID-19 JO - JMIR Ment Health SP - e21718 VL - 7 IS - 7 KW - digital mental health KW - mental well-being online assessments KW - machine learning KW - automation KW - COVID-19 KW - well-being services UR - https://mental.jmir.org/2020/7/e21718 UR - http://dx.doi.org/10.2196/21718 UR - http://www.ncbi.nlm.nih.gov/pubmed/32668402 ID - info:doi/10.2196/21718 ER - TY - JOUR AU - Huang, Rendong AU - Xu, Mei AU - Li, Xiuting AU - Wang, Yinping AU - Wang, Bin AU - Cui, Naixue PY - 2020/7/22 TI - Internet-Based Sharing Nurse Program and Nurses? Perceptions in China: Cross-Sectional Survey JO - J Med Internet Res SP - e16644 VL - 22 IS - 7 KW - sharing nurse KW - home visiting KW - internet plus nursing program KW - perception KW - China N2 - Background: China is currently piloting a ?Sharing Nurse? program that aims to increase the accessibility of nursing services to at-home patients by enabling patients to order nursing services using mobile apps or online platforms. Objective: This study aims to assess nurses? perceptions of the Sharing Nurse program, including their acceptance, concerns, needs, and willingness to take part in the program. Methods: A total of 694 nurses participated in the questionnaire survey. The survey collected their sociodemographic and work-related information and their perceptions of the Sharing Nurse program using a self-developed questionnaire. Results: The 694 respondents agreed that the Sharing Nurse program could provide patients with better access to nursing care (n=483, 69.6%). Their main concerns about the program were unclear liability division when medical disputes occur (n=637, 90.3%) and potential personal safety issues (n=604, 87%). They reported that insurance (n=611, 88%), permits from their affiliated hospital (n=562, 81.0%), clear instructions concerning rights and duties (n=580, 83.6%), real time positioning while delivering the service (n=567, 81.7%), and one-key alarm equipment (n=590, 85.0%) were necessary for better implementation of the program. More than half of the respondents (n=416, 60%) had an optimistic attitude toward the development of the Sharing Nurse program in China. However, only 19.4% (n=135) of the respondents expressed their willingness to be a ?shared nurse.? Further analyses found that nurses with a master?s degree or above (?23=28.835, P<.001) or from tertiary hospitals (?23=18.669, P<.001) were more likely to be aware of the Sharing Nurse program and that male nurses were more willing to be shared nurses (Z=?2.275, P=.02). Conclusions: The Chinese Sharing Nurse program is still in its infancy and many refinements are needed before it can be implemented nationwide. Generally, Chinese nurses are positive about the Sharing Nurse program and are willing to participate if the program is thoroughly regulated and supervised. UR - http://www.jmir.org/2020/7/e16644/ UR - http://dx.doi.org/10.2196/16644 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706711 ID - info:doi/10.2196/16644 ER - TY - JOUR AU - Talhouk, Reem AU - Akik, Chaza AU - Araujo-Soares, Vera AU - Ahmad, Balsam AU - Mesmar, Sandra AU - Olivier, Patrick AU - Balaam, Madeline AU - Montague, Kyle AU - Garbett, Andrew AU - Ghattas, Hala PY - 2020/7/6 TI - Integrating Health Technologies in Health Services for Syrian Refugees in Lebanon: Qualitative Study JO - J Med Internet Res SP - e14283 VL - 22 IS - 7 KW - Syrian refugees KW - Lebanon KW - health technologies KW - eHealth KW - mHealth KW - primary health care N2 - Background: Lebanon currently hosts around one million Syrian refugees. There has been an increasing interest in integrating eHealth and mHealth technologies into the provision of primary health care to refugees and Lebanese citizens. Objective: We aimed to gain a deeper understanding of the potential for technology integration in primary health care provision in the context of the protracted Syrian refugee crisis in Lebanon. Methods: A total of 17 face-to-face semistructured interviews were conducted with key informants (n=8) and health care providers (n=9) involved in the provision of health care to the Syrian refugee population in Lebanon. Interviews were audio recorded and directly translated and transcribed from Arabic to English. Thematic analysis was conducted. Results: Study participants indicated that varying resources, primarily time and the availability of technologies at primary health care centers, were the main challenges for integrating technologies for the provision of health care services for refugees. This challenge is compounded by refugees being viewed by participants as a mobile population thus making primary health care centers less willing to invest in refugee health technologies. Lastly, participant views regarding the health and technology literacies of refugees varied and that was considered to be a challenge that needs to be addressed for the successful integration of refugee health technologies. Conclusions: Our findings indicate that in the context of integrating technology into the provision of health care for refugees in a low or middle income country such as Lebanon, some barriers for technology integration related to the availability of resources are similar to those found elsewhere. However, we identified participant views of refugees? health and technology literacies to be a challenge specific to the context of this refugee crisis. These challenges need to be addressed when considering refugee health technologies. This could be done by increasing the visibility of refugee capabilities and configuring refugee health technologies so that they may create spaces in which refugees are empowered within the health care system and can work toward debunking the views discovered in this study. UR - https://www.jmir.org/2020/7/e14283 UR - http://dx.doi.org/10.2196/14283 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628121 ID - info:doi/10.2196/14283 ER - TY - JOUR AU - Haun, N. Jolie AU - Alman, C. Amy AU - Melillo, Christine AU - Standifer, Maisha AU - McMahon-Grenz, Julie AU - Shin, Marlena AU - Lapcevic, A. W. AU - Patel, Nitin AU - Elwy, Rani A. PY - 2020/6/26 TI - Using Electronic Data Collection Platforms to Assess Complementary and Integrative Health Patient-Reported Outcomes: Feasibility Project JO - JMIR Med Inform SP - e15609 VL - 8 IS - 6 KW - integrative medicine KW - health information technology KW - health services research KW - mobile phone KW - patient-reported outcomes KW - veteran N2 - Background: The Veteran Administration (VA) Office of Patient-Centered Care and Cultural Transformation is invested in improving veteran health through a whole-person approach while taking advantage of the electronic resources suite available through the VA. Currently, there is no standardized process to collect and integrate electronic patient-reported outcomes (ePROs) of complementary and integrative health (CIH) into clinical care using a web-based survey platform. This quality improvement project enrolled veterans attending CIH appointments within a VA facility and used web-based technologies to collect ePROs. Objective: This study aimed to (1) determine a practical process for collecting ePROs using patient email services and a web-based survey platform and (2) conduct analyses of survey data using repeated measures to estimate the effects of CIH on patient outcomes. Methods: In total, 100 veterans from one VA facility, comprising 11 cohorts, agreed to participate. The VA patient email services (Secure Messaging) were used to manually send links to a 16-item web-based survey stored on a secure web-based survey storage platform (Qualtrics). Each survey included questions about patient outcomes from CIH programs. Each cohort was sent survey links via Secure Messaging (SM) at 6 time points: weeks 1 through 4, week 8, and week 12. Process evaluation interviews were conducted with five primary care providers to assess barriers and facilitators to using the patient-reported outcome survey in usual care. Results: This quality improvement project demonstrated the usability of SM and Qualtrics for ePRO collection. However, SM for ePROs was labor intensive for providers. Descriptive statistics on health competence (2-item Perceived Health Competence Scale), physical and mental health (Patient-Reported Outcomes Measurement Information System Global-10), and stress (4-item Perceived Stress Scale) indicated that scores did not significantly change over time. Survey response rates varied (18/100, 18.0%-42/100, 42.0%) across each of the 12 weekly survey periods. In total, 74 of 100 participants provided ?1 survey, and 90% (66/74) were female. The majority, 62% (33/53) of participants, who reported the use of any CIH modality, reported the use of two or more unique modalities. Primary care providers highlighted specific challenges with SM and offered solutions regarding staff involvement in survey implementation. Conclusions: This quality improvement project informs our understanding of the processes currently available for using SM and web-based data platforms to collect ePROs. The study results indicate that although it is possible to use SM and web-based survey platforms for ePROs, automating scheduled administration will be necessary to reduce provider burden. The lack of significant change in ePROs may be due to standard measures taking a biomedical approach to wellness. Future work should focus on identifying ideal ePRO processes that would include standardized, whole-person measures of wellness. UR - http://medinform.jmir.org/2020/6/e15609/ UR - http://dx.doi.org/10.2196/15609 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589163 ID - info:doi/10.2196/15609 ER - TY - JOUR AU - Ritchie, D. Natalie AU - Gutiérrez-Raghunath, Silvia AU - Durfee, Josh Michael AU - Fischer, Henry PY - 2020/6/18 TI - Supplemental Text Message Support With the National Diabetes Prevention Program: Pragmatic Comparative Effectiveness Trial JO - JMIR Mhealth Uhealth SP - e15478 VL - 8 IS - 6 KW - eHealth KW - prediabetes KW - texting KW - weight loss N2 - Background: The evidence-based National Diabetes Prevention Program (NDPP) is now widely disseminated, yet strategies to increase its effectiveness are needed, especially for underserved populations. The yearlong program promotes lifestyle changes for weight loss and can be offered in-person, online, via distance learning, or a combination of modalities. Less is known about which delivery features are optimal and may help address disparities in outcomes for subgroups. We previously demonstrated the efficacy of a stand-alone text messaging intervention based on the NDPP (SMS4PreDM) in a randomized controlled trial in a safety net health care system. Upon broader dissemination, we then showed that SMS4PreDM demonstrated high retention and modest weight loss at a relatively low cost, suggesting the potential to improve in-person NDPP delivery. Objective: In this study, we aim to compare the effectiveness of in-person NDPP classes with and without supplementary SMS4PreDM on attendance and weight loss outcomes to determine whether text messaging can enhance in-person NDPP delivery for a safety net patient population. Methods: From 2015 to 2017, patients with diabetes risks were identified primarily from provider referrals and enrolled in NDPP classes, SMS4PreDM, or both per their preference and availability. Participants naturally formed three groups: in-person NDPP with SMS4PreDM (n=236), in-person NDPP alone (n=252), and SMS4PreDM alone (n=285). This analysis compares the first two groups to evaluate whether supplemental text messaging may improve in-person NDPP outcomes. Outcomes for SMS4PreDM-only participants were previously reported. NDPP classes followed standard delivery guidelines, including weekly-to-monthly classes over a year. SMS4PreDM delivery included messages promoting lifestyle change and modest weight loss, sent 6 days per week for 12 months. Differences in characteristics between intervention groups were assessed using chi-square and t tests. Differences in NDPP attendance and weight loss outcomes were analyzed with multivariable linear and logistic regressions. Results: The mean age was 50.4 years (SD 13.9). Out of a total of 488 participants, 76.2% (n=372) were female and 59.0% (n=288) were Hispanic. An additional 17.2% (n=84) were non-Hispanic white and 12.9% (n=63) were non-Hispanic black. A total of 48.4% (n=236) of participants elected to receive supplemental text message support in addition to NDPP classes. Participants who chose supplemental text message support were on average 5.7 (SD 1.2) years younger (P<.001) than the 252 participants who preferred in-person classes alone. Relatively more women and Hispanic individuals enrolled in the NDPP with supplemental text messages than in NDPP classes alone, 83.9% (n=198) vs 69.0% (n=174, P<.001) and 68.6% (n=162) vs 50.0% (n=126, P=.001), respectively. Attendance and weight loss outcomes were comparable between groups. Conclusions: Despite its appeal among priority populations, supplemental text messaging did not significantly increase attendance and weight loss for the in-person NDPP. Further research is needed to identify optimal strategies to improve the effectiveness of the NDPP. UR - http://mhealth.jmir.org/2020/6/e15478/ UR - http://dx.doi.org/10.2196/15478 UR - http://www.ncbi.nlm.nih.gov/pubmed/32554385 ID - info:doi/10.2196/15478 ER - TY - JOUR AU - Li, Peiyi AU - Luo, Yunmei AU - Yu, Xuexin AU - Wen, Jin AU - Mason, Elizabeth AU - Li, Weimin AU - Jalali, S. Mohammad PY - 2020/6/11 TI - Patients? Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China JO - J Med Internet Res SP - e17221 VL - 22 IS - 6 KW - innovation adoption KW - e-hospital KW - internet hospital KW - eHealth KW - barriers KW - facilitators N2 - Background: As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users? acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. Objective: This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients? willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. Methods: We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients? sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. Results: Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). Conclusions: We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries. UR - http://www.jmir.org/2020/6/e17221/ UR - http://dx.doi.org/10.2196/17221 UR - http://www.ncbi.nlm.nih.gov/pubmed/32525483 ID - info:doi/10.2196/17221 ER - TY - JOUR AU - Chung, Sukyung AU - Martinez, C. Meghan AU - Frosch, L. Dominick AU - Jones, G. Veena AU - Chan, S. Albert PY - 2020/6/10 TI - Patient-Centric Scheduling With the Implementation of Health Information Technology to Improve the Patient Experience and Access to Care: Retrospective Case-Control Analysis JO - J Med Internet Res SP - e16451 VL - 22 IS - 6 KW - access to care KW - health information technology KW - appointment scheduling KW - patient-centered care N2 - Background: Cancellations and rescheduling of doctor?s appointments are common. An automated rescheduling system has the potential to facilitate the rescheduling process so that newly opened slots are promptly filled by patients who need and can take the slot. Building on an existing online patient portal, a large health care system adopted an automated rescheduling system, Fast Pass, that sends out an earlier appointment offer to patients via email or SMS text messaging and allows patients to reschedule their appointment through the online portal. Objective: We examined the uptake of Fast Pass at its early stage of implementation. We assessed program features and patient and visit characteristics associated with higher levels of Fast Pass utilization and the association between Fast Pass use and no-show and cancellation rates. Methods: This study was a retrospective analysis of Fast Pass offers sent between July and December 2018. Multivariable logistic regression was used to assess the independent contribution of program, patient, and visit characteristics on the likelihood of accepting an offer. We then assessed the appointment outcome (completion, cancellation, or no-show) of Fast Pass offered appointments compared to appointments with the same patient and visit characteristics, but without an offer. Results: Of 177,311 Fast Pass offers sent, 14,717 (8.3%) were accepted. Overall, there was a 1.3 percentage point (38%) reduction in no-show rates among Fast Pass accepted appointments compared to other appointments with matching characteristics (P<.001). The offers were more likely to be accepted if they were sent in the evening (versus early morning), the first (versus repeated) offer for the same appointment, for a slot 1-31 days ahead (versus same-day), for later in a day (versus before 10am), for a primary care (versus specialty) visit, sent via SMS text messaging (versus email only), for an appointment made through the online patient portal (versus via phone call or in-person), or for younger adults aged 18-49 years (versus those aged 65 years or older; all at P<.001). Factors negatively associated with offer acceptance were a higher number of comorbidities (P=.02) and visits scheduled for chronic conditions (versus acute conditions only; P=.002). Conclusions: An automated rescheduling system can improve patients? access by reducing wait times for an appointment, with an added benefit of reducing no-shows by serving as a reminder of an upcoming appointment. Future modifications, such as increasing the adoption of SMS text messaging offers and targeting older adults or patients with complex conditions, may make the system more patient-centered and help promote wider utilization. UR - https://www.jmir.org/2020/6/e16451 UR - http://dx.doi.org/10.2196/16451 UR - http://www.ncbi.nlm.nih.gov/pubmed/32519970 ID - info:doi/10.2196/16451 ER - TY - JOUR AU - Yu, Cheng-Sheng AU - Lin, Yu-Jiun AU - Lin, Chang-Hsien AU - Lin, Shiyng-Yu AU - Wu, L. Jenny AU - Chang, Shy-Shin PY - 2020/6/5 TI - Development of an Online Health Care Assessment for Preventive Medicine: A Machine Learning Approach JO - J Med Internet Res SP - e18585 VL - 22 IS - 6 KW - machine learning KW - online healthcare assessment KW - medical informatics KW - preventive medicine N2 - Background: In the era of information explosion, the use of the internet to assist with clinical practice and diagnosis has become a cutting-edge area of research. The application of medical informatics allows patients to be aware of their clinical conditions, which may contribute toward the prevention of several chronic diseases and disorders. Objective: In this study, we applied machine learning techniques to construct a medical database system from electronic medical records (EMRs) of subjects who have undergone health examination. This system aims to provide online self-health evaluation to clinicians and patients worldwide, enabling personalized health and preventive health. Methods: We built a medical database system based on the literature, and data preprocessing and cleaning were performed for the database. We utilized both supervised and unsupervised machine learning technology to analyze the EMR data to establish prediction models. The models with EMR databases were then applied to the internet platform. Results: The validation data were used to validate the online diagnosis prediction system. The accuracy of the prediction model for metabolic syndrome reached 91%, and the area under the receiver operating characteristic (ROC) curve was 0.904 in this system. For chronic kidney disease, the prediction accuracy of the model reached 94.7%, and the area under the ROC curve (AUC) was 0.982. In addition, the system also provided disease diagnosis visualization via clustering, allowing users to check their outcome compared with those in the medical database, enabling increased awareness for a healthier lifestyle. Conclusions: Our web-based health care machine learning system allowed users to access online diagnosis predictions and provided a health examination report. Users could understand and review their health status accordingly. In the future, we aim to connect hospitals worldwide with our platform, so that health care practitioners can make diagnoses or provide patient education to remote patients. This platform can increase the value of preventive medicine and telemedicine. UR - https://www.jmir.org/2020/6/e18585 UR - http://dx.doi.org/10.2196/18585 UR - http://www.ncbi.nlm.nih.gov/pubmed/32501272 ID - info:doi/10.2196/18585 ER - TY - JOUR AU - Ozaydin, Bunyamin AU - Zengul, Ferhat AU - Oner, Nurettin AU - Feldman, S. Sue PY - 2020/6/4 TI - Healthcare Research and Analytics Data Infrastructure Solution: A Data Warehouse for Health Services Research JO - J Med Internet Res SP - e18579 VL - 22 IS - 6 KW - health services research KW - data warehousing KW - iterative process model KW - systems analysis and design KW - data integration N2 - Background: Health services researchers spend a substantial amount of time performing integration, cleansing, interpretation, and aggregation of raw data from multiple public or private data sources. Often, each researcher (or someone in their team) duplicates this effort for their own project, facing the same challenges and experiencing the same pitfalls discovered by those before them. Objective: This paper described a design process for creating a data warehouse that includes the most frequently used databases in health services research. Methods: The design is based on a conceptual iterative process model framework that utilizes the sociotechnical systems theory approach and includes the capacity for subsequent updates of the existing data sources and the addition of new ones. We introduce the theory and the framework and then explain how they are used to inform the methodology of this study. Results: The application of the iterative process model to the design research process of problem identification and solution design for the Healthcare Research and Analytics Data Infrastructure Solution (HRADIS) is described. Each phase of the iterative model produced end products to inform the implementation of HRADIS. The analysis phase produced the problem statement and requirements documents. The projection phase produced a list of tasks and goals for the ideal system. Finally, the synthesis phase provided the process for a plan to implement HRADIS. HRADIS structures and integrates data dictionaries provided by the data sources, allowing the creation of dimensions and measures for a multidimensional business intelligence system. We discuss how HRADIS is complemented with a set of data mining, analytics, and visualization tools to enable researchers to more efficiently apply multiple methods to a given research project. HRADIS also includes a built-in security and account management framework for data governance purposes to ensure customized authorization depending on user roles and parts of the data the roles are authorized to access. Conclusions: To address existing inefficiencies during the obtaining, extracting, preprocessing, cleansing, and filtering stages of data processing in health services research, we envision HRADIS as a full-service data warehouse integrating frequently used data sources, processes, and methods along with a variety of data analytics and visualization tools. This paper presents the application of the iterative process model to build such a solution. It also includes a discussion on several prominent issues, lessons learned, reflections and recommendations, and future considerations, as this model was applied. UR - https://www.jmir.org/2020/6/e18579 UR - http://dx.doi.org/10.2196/18579 UR - http://www.ncbi.nlm.nih.gov/pubmed/32496199 ID - info:doi/10.2196/18579 ER - TY - JOUR AU - van Dooren, M. Marierose M. AU - Visch, Valentijn AU - Spijkerman, Renske AU - Goossens, M. Richard H. AU - Hendriks, M. Vincent PY - 2020/5/6 TI - Mental Health Therapy Protocols and eHealth Design: Focus Group Study JO - JMIR Form Res SP - e15568 VL - 4 IS - 5 KW - eHealth design KW - mental health care KW - personalization KW - protocol KW - youth addiction care N2 - Background: Electronic health (eHealth) programs are often based on protocols developed for the original face-to-face therapies. However, in practice, therapists and patients may not always follow the original therapy protocols. This form of personalization may also interfere with the intended implementation and effects of eHealth interventions if designers do not take these practices into account. Objective: The aim of this explorative study was to gain insights into the personalization practices of therapists and patients using cognitive behavioral therapy, one of the most commonly applied types of psychotherapy, in a youth addiction care center as a case context. Methods: Focus group discussions were conducted asking therapists and patients to estimate the extent to which a therapy protocol was followed and about the type and reasons for personalization of a given therapy protocol. A total of 7 focus group sessions were organized involving therapists and patients. We used a commonly applied protocol for cognitive behavioral therapy as a therapy protocol example in youth mental health care. The first focus group discussions aimed at assessing the extent to which patients (N=5) or therapists (N=6) adapted the protocol. The second focus group discussions aimed at estimating the extent to which the therapy protocol is applied and personalized based on findings from the first focus groups to gain further qualitative insight into the reasons for personalization with groups of therapists and patients together (N=7). Qualitative data were analyzed using thematic analysis. Results: Therapists used the protocol as a ?toolbox? comprising different therapy tools, and personalized the protocol to enhance the therapeutic alliance and based on their therapy-provision experiences. Therapists estimated that they strictly follow 48% of the protocol, adapt 30%, and replace 22% by other nonprotocol therapeutic components. Patients personalized their own therapy to conform the assignments to their daily lives and routines, and to reduce their levels of stress and worry. Patients estimated that 29% of the provided therapy had been strictly followed by the therapist, 48% had been adjusted, and 23% had been replaced by other nonprotocol therapeutic components. Conclusions: A standard cognitive behavioral therapy protocol is not strictly and fully applied but is mainly personalized. Based on these results, the following recommendations for eHealth designers are proposed to enhance alignment of eHealth to therapeutic practice and implementation: (1) study and copy at least the applied parts of a protocol, (2) co-design eHealth with therapists and patients so they can allocate the components that should be open for user customization, and (3) investigate if components of the therapy protocol that are not applied should remain part of the eHealth applied. To best generate this information, we suggest that eHealth designers should collaborate with therapists, patients, protocol developers, and mental health care managers during the development process. UR - https://formative.jmir.org/2020/5/e15568 UR - http://dx.doi.org/10.2196/15568 UR - http://www.ncbi.nlm.nih.gov/pubmed/32374271 ID - info:doi/10.2196/15568 ER - TY - JOUR AU - Chen, Chien-I Sonia AU - Hu, Ridong AU - McAdam, Rodney PY - 2020/4/28 TI - Smart, Remote, and Targeted Health Care Facilitation Through Connected Health: Qualitative Study JO - J Med Internet Res SP - e14201 VL - 22 IS - 4 KW - connected health care KW - smart health care KW - health care quality KW - access KW - remote monitoring KW - precision medicine KW - self-management N2 - Background: Societies around the world are aging. Widespread aging creates problems for social services and health care practices. In this light, research on connected health (CH) is becoming essential. CH refers to a variety of technological measures that allow health care to be provided remotely with the aim of increasing efficiency, cost-effectiveness, and satisfaction on the part of health care recipients. CH is reshaping health care?s direction to be more proactive, more preventive, and more precisely targeted and, thus, more effective. CH has been demonstrated to have great value in managing and preventing chronic diseases, which create huge burdens on health care and social services. In short, CH provides promising solutions to diseases and social challenges associated with aging populations. However, there are many barriers that need to be overcome before CH can be successfully and widely implemented. Objective: The research question of this study is as follows: How can CH facilitate smart, remote, and targeted health care? The objective is to identify how health care can be managed in more comprehensive ways, such as by providing timely, flexible, accessible, and personalized services to preserve continuity and offer high-quality seamless health care. Methods: A qualitative approach was used based on 60 multistage, semistructured stakeholder interviews. Results: The results can be divided into two functions of CH: ecosystem and platform. On the one hand, the interviews enabled the authors to develop a stakeholder classification and interaction diagram. These stakeholders interacted sequentially to provide technology-based content to end users. On the other hand, interviewees reflected on how CH serves as a platform to address remote monitoring and patient self-management. In the Discussion section, three innovation strategies are discussed to reflect the manner in which CH promotes smart, timely, and precise health care. Conclusions: This study indicates that it is essential to continually revise CH business models, given the ongoing and rapid changes in technology across groups of CH stakeholders. We also found that global trends toward smart, timely, and precise health care shape what individuals expect from products and services, providing firms with unique opportunities for growth. UR - http://www.jmir.org/2020/4/e14201/ UR - http://dx.doi.org/10.2196/14201 UR - http://www.ncbi.nlm.nih.gov/pubmed/32343254 ID - info:doi/10.2196/14201 ER - TY - JOUR AU - Haberlin, Ciaran AU - O' Donnell, M. Dearbhaile AU - Moran, Jonathan AU - Broderick, Julie PY - 2020/4/28 TI - Perceptions of eHealth-Enabled Physical Activity Interventions Among Cancer Survivors: Mixed Methods Study JO - JMIR Cancer SP - e16469 VL - 6 IS - 1 KW - cancer KW - eHealth KW - exercise KW - focus group KW - physical activity KW - qualitative KW - mobile phone N2 - Background: Achieving adequate levels of physical activity (PA) is especially important for cancer survivors to mitigate the side effects of cancer and its treatment as well as for other health benefits. Electronic health (eHealth)-based PA interventions may offer feasible alternatives to traditionally delivered programs and optimize physical recovery after a cancer diagnosis, but perspectives of cancer survivors on this new delivery medium have not been extensively explored. Objective: The overall aim was to explore participants? perspectives of eHealth-enabled PA interventions to inform the design of a future intervention among cancer survivors. Methods: The study took place in a designated cancer center in Dublin, Ireland. A preceding questionnaire-based study was conducted primarily to establish interest in participating in subsequent eHealth-based studies. A follow-on focus group study was conducted to explore the concept of eHealth-based PA interventions for cancer survivors. The data were analyzed using thematic analysis. Results: The questionnaire-based study (N=102) indicated that participants had a high level of interest in participating in follow-on eHealth-based studies. The focus group study (n=23) indicated that, despite some trepidation, overall positivity was expressed by participants toward the concept of eHealth-based PA interventions. Four themes were generated: (1) Health impact, including PA as a barrier and as a motivating factor, (2) Education needs, which emphasized the need for integrated information about PA and to increase technical literacy, (3) Goal setting, which should be integrated within the technical specification as a motivating factor, and (4) Support needs, as well as the importance of personalized human interaction, in tandem with technology. Conclusions: Qualitative research at the pretrial phase adds value to the design of a complex intervention and is especially useful in an area such as eHealth. The findings highlighted an interest in participating in eHealth-focused research as well as barriers, training needs, and key design features that can be applied to optimize the design of future eHealth-based PA interventions in cancer. UR - http://cancer.jmir.org/2020/1/e16469/ UR - http://dx.doi.org/10.2196/16469 UR - http://www.ncbi.nlm.nih.gov/pubmed/32343259 ID - info:doi/10.2196/16469 ER - TY - JOUR AU - Gremyr, Andreas AU - Andersson Gäre, Boel AU - Greenhalgh, Trisha AU - Malm, Ulf AU - Thor, Johan AU - Andersson, Ann-Christine PY - 2020/4/23 TI - Using Complexity Assessment to Inform the Development and Deployment of a Digital Dashboard for Schizophrenia Care: Case Study JO - J Med Internet Res SP - e15521 VL - 22 IS - 4 KW - health care KW - complexity KW - schizophrenia KW - coproduction KW - learning health systems N2 - Background: Health care is becoming more complex. For an increasing number of individuals, interacting with health care means addressing more than just one illness or disorder, engaging in more than one treatment, and interacting with more than one care provider. Individuals with severe mental illnesses such as schizophrenia are disproportionately affected by this complexity. Characteristic symptoms can make it harder to establish and maintain relationships. Treatment failure is common even where there is access to effective treatments, increasing suicide risk. Knowledge of complex adaptive systems has been increasingly recognized as useful in understanding and developing health care. A complex adaptive system is a collection of interconnected agents with the freedom to act based on their own internalized rules, affecting each other. In a complex health care system, relevant feedback is crucial in enabling continuous learning and improvement on all levels. New technology has potential, but the failure rate of technology projects in health care is high, arguably due to complexity. The Nonadoption, Abandonment, and challenges to Scale-up, Spread, and Sustainability (NASSS) framework and complexity assessment tool (NASSS-CAT) have been developed specifically to help identify and manage complexity in technology-related development projects in health care. Objective: This study aimed to use a pilot version of the NASSS-CAT instrument to inform the development and deployment of a point-of-care dashboard supporting schizophrenia care in west Sweden. Specifically, we report on the complexity profile of the project, stakeholders? experiences with using NASSS-CAT, and practical implications. Methods: We used complexity assessment to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We also performed a thematic analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on its usefulness. Results: Application of the NASSS framework revealed different types of complexity across multiple domains, including the condition, technology, value proposition, organizational tasks and pathways, and wider system. Stakeholders perceived the NASSS-CAT tool as useful in gaining perspective and new insights, covering areas that might otherwise have been neglected. Practical implications derived from feedback sessions with managers and developers are described. Conclusions: This case study shows how stakeholders can identify and plan to address complexities during the introduction of a technological solution. Our findings suggest that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general. UR - http://www.jmir.org/2020/4/e15521/ UR - http://dx.doi.org/10.2196/15521 UR - http://www.ncbi.nlm.nih.gov/pubmed/32324143 ID - info:doi/10.2196/15521 ER - TY - JOUR AU - Bleyel, Caroline AU - Hoffmann, Mariell AU - Wensing, Michel AU - Hartmann, Mechthild AU - Friederich, Hans-Christoph AU - Haun, W. Markus PY - 2020/4/20 TI - Patients? Perspective on Mental Health Specialist Video Consultations in Primary Care: Qualitative Preimplementation Study of Anticipated Benefits and Barriers JO - J Med Internet Res SP - e17330 VL - 22 IS - 4 KW - telemedicine KW - remote consultation KW - implementation KW - primary health care KW - mental health services KW - thematic analysis KW - integrated behavioral health KW - health services research N2 - Background: Due to limited access to specialist services, most patients with common mental disorders (depression or anxiety, or both) usually receive treatment in primary care. More recently, innovative technology-based care models (eg, video consultations) have been proposed to facilitate access to specialist services. Against this background, the PROVIDE (Improving Cross-Sectoral Collaboration Between Primary and Psychosocial Care: An Implementation Study on Video Consultations) project aims to improve the provision of psychosocial care through implementing video consultations integrated into routine primary care. Objective: From the patients? perspective, this qualitative preimplementation study explored (1) anticipated benefits from and (2) barriers to implementing mental health specialist video consultations embedded in primary care services and (3) prerequisites for interacting with therapists via video consultations. Methods: Using a purposive (ie, stratified) sampling strategy, we recruited 13 patients from primary care practices and a tertiary care hospital (psychosomatic outpatient clinic) for one-off semistructured interviews. In a computer-assisted thematic analysis, we inductively (bottom-up) derived key themes concerning the practicability of mental health specialist video consultations. To validate our results, we discussed our findings with the interviewees as part of a systematic member checking. Results: Overall, we derived 3 key themes and 10 subthemes. Participants identified specific benefits in 2 areas: the accessibility of mental health specialist care (shorter waiting times: 11/13, 85%; lower threshold for seeking specialist mental health care: 6/13, 46%; shorter travel distances: 3/13, 23%); and the environment in primary care (familiar travel modalities, premises, and employees: 5/13, 38%). The main barriers to the implementation of mental health video consultations from the patients? perspective were the lack of face-to-face contact (13/13, 100%) and technical challenges (12/13, 92%). Notably, participants? prerequisites for interacting with therapists (12/13, 92%) did not seem to differ much from those concerning face-to-face contacts. Conclusions: Mental health service users mostly welcomed mental health specialist video consultations in primary care. Taking a pragmatic stance, service users, who are often frustrated about uncoordinated care, particularly valued the embedment of the consultations in the familiar environment of the primary care practice. With respect to interventional studies and implementation, our findings underscore the need to minimize technical disruptions during video consultations and to ensure optimal resemblance to face-to-face settings (eg, by training therapists in consistently reacting to nonverbal cues). Trial Registration: German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one UR - http://www.jmir.org/2020/4/e17330/ UR - http://dx.doi.org/10.2196/17330 UR - http://www.ncbi.nlm.nih.gov/pubmed/32310139 ID - info:doi/10.2196/17330 ER - TY - JOUR AU - Ratanjee-Vanmali, Husmita AU - Swanepoel, Wet De AU - Laplante-Lévesque, Ariane PY - 2020/3/20 TI - Patient Uptake, Experience, and Satisfaction Using Web-Based and Face-to-Face Hearing Health Services: Process Evaluation Study JO - J Med Internet Res SP - e15875 VL - 22 IS - 3 KW - audiology KW - hearing loss KW - internet-based intervention KW - patient outcome assessment KW - patient satisfaction KW - telemedicine KW - text messaging KW - eHealth KW - mHealth KW - social media KW - patient-centered care N2 - Background: Globally, access to hearing health care is a growing concern with 900 million people estimated to suffer from disabling hearing loss by 2050. Hearing loss is one of the most common chronic health conditions, yet access to hearing health care is limited. Incorporating Web-based (voice calling, messaging, or emailing) service delivery into current treatment pathways could improve access and allow for better scalability of services. Current electronic health studies in audiology have focused on technical feasibility, sensitivity, and specificity of diagnostic hearing testing and not on patient satisfaction, experiences, and sustainable models along the entire patient journey. Objective: This study aimed to investigate a hybrid (Web-based and face-to-face) hearing health service in terms of uptake, experience, and satisfaction in adult patients with hearing loss. Methods: A nonprofit hearing research clinic using online and face-to-face services was implemented in Durban, South Africa, using online recruitment from the clinic?s Facebook page and Google AdWords, which directed persons to an online Web-based hearing screening test. Web-based and face-to-face care pathways included assessment, treatment, and rehabilitation. To evaluate the service, an online survey comprising (1) a validated satisfaction measurement tool (Short Assessment of Patient Satisfaction), (2) a process evaluation of all the 5 steps completed, and (3) personal preferences of communication methods used vs methods preferred was conducted, which was sent to 46 patients who used clinic services. Results: Of the patients invited, 67% (31/46) completed the survey with mean age 66 years, (SD 16). Almost all patients, 92% (30/31) reported that the online screening test assisted them in seeking hearing health care. Approximately 60% (18/31) of the patients accessed the online hearing screening test from an Android device. Patients stayed in contact with the audiologist mostly through WhatsApp instant messaging (27/31, 87%), and most patients (25/31, 81%) preferred to use this method of communication. The patients continuing with hearing health care were significantly older and had significantly poorer speech recognition abilities compared with the patients who discontinued seeking hearing health care. A statistically significant positive result (P=.007) was found between age and the number of appointments per patient. Around 61% (19/31) of patients previously completed diagnostic testing at other practices, with 95% (18/19) rating the services at the hybrid clinic as better. The net promoter score was 87, indicating that patients were highly likely to recommend the hybrid clinic to friends and family. Conclusions: This study applied Web-based and face-to-face components into a hybrid clinic and measured an overall positive experience with high patient satisfaction through a process evaluation. The findings support the potential of a hybrid clinic with synchronous and asynchronous modes of communication to be a scalable hearing health care model, addressing the needs of adults with hearing loss globally. UR - http://www.jmir.org/2020/3/e15875/ UR - http://dx.doi.org/10.2196/15875 UR - http://www.ncbi.nlm.nih.gov/pubmed/32196459 ID - info:doi/10.2196/15875 ER - TY - JOUR AU - Pithara, Christalla AU - Farr, Michelle AU - Sullivan, A. Sarah AU - Edwards, B. Hannah AU - Hall, William AU - Gadd, Caroline AU - Walker, Julian AU - Hebden, Nick AU - Horwood, Jeremy PY - 2020/3/19 TI - Implementing a Digital Tool to Support Shared Care Planning in Community-Based Mental Health Services: Qualitative Evaluation JO - J Med Internet Res SP - e14868 VL - 22 IS - 3 KW - health care technology KW - mental health KW - community health care KW - patient-centered care KW - patient care planning KW - implementation science N2 - Background: Mental health services aim to provide recovery-focused care and facilitate coproduced care planning. In practice, mental health providers can find supporting individualized coproduced care with service users difficult while balancing administrative and performance demands. To help meet this aim and using principles of coproduction, an innovative mobile digital care pathway tool (CPT) was developed to be used on a tablet computer and piloted in the West of England. Objective: The aim of this study was to examine mental health care providers? views of and experiences with the CPT during the pilot implementation phase and identify factors influencing its implementation. Methods: A total of 20 in-depth telephone interviews were conducted with providers participating in the pilot and managers in the host organization. Interviews were audio recorded, transcribed, anonymized, and thematically analyzed guided by the Consolidated Framework for Implementation Research. Results: The tool was thought to facilitate coproduced recovery-focused care planning, a policy and organizational as well as professional priority. Internet connectivity issues, system interoperability, and access to service users? health records affected use of the tool during mobile working. The organization?s resources, such as information technology (IT) infrastructure and staff time and IT culture, influenced implementation. Participants? levels of use of the tool were dependent on knowledge of the tool and self-efficacy; perceived service-user needs and characteristics; and perceptions of impact on the therapeutic relationship. Training and preparation time influenced participants? confidence in using the tool. Conclusions: Findings highlight the importance of congruence between staff, organization, and external policy priorities and digital technologies in aiding intervention engagement, and the need for ongoing training and support of those intended to use the technology during and after the end of implementation interventions. UR - https://www.jmir.org/2020/3/e14868 UR - http://dx.doi.org/10.2196/14868 UR - http://www.ncbi.nlm.nih.gov/pubmed/32191210 ID - info:doi/10.2196/14868 ER - TY - JOUR AU - Shaffer, M. Kelly AU - Tigershtrom, Ashley AU - Badr, Hoda AU - Benvengo, Stephanie AU - Hernandez, Marisol AU - Ritterband, M. Lee PY - 2020/3/4 TI - Dyadic Psychosocial eHealth Interventions: Systematic Scoping Review JO - J Med Internet Res SP - e15509 VL - 22 IS - 3 KW - behavioral medicine KW - caregivers KW - couples therapy KW - dyads KW - eHealth KW - family therapy KW - internet interventions KW - psychosocial interventions KW - review N2 - Background: Dyadic psychosocial interventions have been found beneficial both for people coping with mental or physical health conditions as well as their family members and friends who provide them with support. Delivering these interventions via electronic health (eHealth) may help increase their scalability. Objective: This scoping review aimed to provide the first comprehensive overview of dyadic eHealth interventions for individuals of all ages affected by mental or physical illness and their family members or friends who support them. The goal was to understand how dyadic eHealth interventions have been used and to highlight areas of research needed to advance dyadic eHealth intervention development and dissemination. Methods: A comprehensive electronic literature search of PubMed, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO was conducted for articles published in the English language through March 2019. Eligible records described a psychosocial eHealth intervention that intervened with both care recipients and their support person. Results: A total of 7113 records were reviewed of which 101 met eligibility criteria. There were 52 unique dyadic eHealth interventions identified, which were tested across 73 different trials. Of the unique interventions, 33 were conducted among dyads of children and their supporting parent, 1 was conducted with an adolescent-young adult care recipient population, and the remaining 18 were conducted among adult dyads. Interventions targeting pediatric dyads most commonly addressed a mental health condition (n=10); interventions targeting adult dyads most commonly addressed cancer (n=9). More than three-fourths of interventions (n=40) required some human support from research staff or clinicians. Most studies (n=64) specified one or more primary outcomes for care recipients, whereas less than one-fourth (n=22) specified primary outcomes for support persons. Where specified, primary outcomes were most commonly self-reported psychosocial or health factors for both care recipients (n=43) and support persons (n=18). Results of the dyadic eHealth intervention tended to be positive for care recipients, but evidence of effects for support persons was limited because of few studies specifying primary outcomes for supporters. Trials of dyadic eHealth interventions were most commonly randomized controlled trials (RCTs; n=44), and RCTs most commonly compared the dyadic eHealth intervention to usual care alone (n=22). Conclusions: This first comprehensive review of dyadic eHealth interventions demonstrates that there is substantial, diverse, and growing literature supporting this interventional approach. However, several significant gaps were identified. Few studies were designed to evaluate the unique effects of dyadic interventions relative to individual interventions. There was also limited assessment and reporting of outcomes for support persons, and there were no interventions meeting our eligibility criteria specifically targeting the needs of older adult dyads. Findings highlight areas of research opportunities for developing dyadic eHealth interventions for novel populations and for increasing access to dyadic care. UR - https://www.jmir.org/2020/3/e15509 UR - http://dx.doi.org/10.2196/15509 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130143 ID - info:doi/10.2196/15509 ER - TY - JOUR AU - Pohlmann, Sabrina AU - Kunz, Aline AU - Ose, Dominik AU - Winkler, C. Eva AU - Brandner, Antje AU - Poss-Doering, Regina AU - Szecsenyi, Joachim AU - Wensing, Michel PY - 2020/1/29 TI - Digitalizing Health Services by Implementing a Personal Electronic Health Record in Germany: Qualitative Analysis of Fundamental Prerequisites From the Perspective of Selected Experts JO - J Med Internet Res SP - e15102 VL - 22 IS - 1 KW - personal electronic health record KW - implementation KW - qualitative analysis KW - digitalization KW - health services N2 - Background: The implementation of a personal electronic health record (PHR) is a central objective of digitalization policies in the German health care system. Corresponding legislation was passed with the 2015 Act for Secure Digital Communication and Applications in the Health Sector (eHealth Act). However, compared with other European countries, Germany still lags behind concerning the implementation of a PHR. Objective: In order to explore potential barriers and facilitators for the adoption of a PHR in routine health care in Germany, this paper aims to identify policies, structures, and practices of the German health care system that influence the uptake and use of a PHR. Methods: A total of 33 semistructured interviews were conducted with a purposive sample of experts: 23 interviews with different health care professionals and 10 interviews with key actors of the German health care system who were telematics, eHealth, and information technology experts (eHealth experts). The interviews were transcribed verbatim and subjected to a content analysis. Results: From the expert perspective, a PHR was basically considered desirable and unavoidable. At the same time, a number of challenges for implementation in Germany have been outlined. Three crucial themes emerged: (1) documentation standards: prevailing processes of the analog bureaucratic paper world, (2) interoperability: the plurality of actors and electronic systems, and (3) political structure: the lack of clear political regulations and political incentive structures. Conclusions: With regard to the implementation of a PHR, an important precondition of a successful digitalization will be the precedent reform of the system to be digitized. Whether the recently passed Act for Faster Appointments and Better Care will be a step in the right direction remains to be seen. UR - https://www.jmir.org/2020/1/e15102 UR - http://dx.doi.org/10.2196/15102 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012060 ID - info:doi/10.2196/15102 ER - TY - JOUR AU - Alanezi, Fahad AU - Alanzi, Turki PY - 2020/1/15 TI - A Gig mHealth Economy Framework: Scoping Review of Internet Publications JO - JMIR Mhealth Uhealth SP - e14213 VL - 8 IS - 1 KW - gig economy KW - gigs KW - mHealth KW - sharing economy KW - gig mHealth N2 - Background: The gig economy (characterized by short-term contracts rather than being a full-time employee in an organization) is one of the most recent and important tendencies that have expanded through the global economic market thanks to advances in internet and communication technologies. Similarly, mobile health (mHealth) technologies have also evolved rapidly with the development of the internet and mobile apps, attracting attention globally for their health care benefits. Objective: This study aimed to propose an integration of mHealth within the framework of the gig economy that leads to a new dimension of health care services and the proposal of a new term: gig mHealth. Methods: A review and systematic search of articles, books, and opinions that allowed for answering the research questions were executed through the internet. In this sense, the concept of the gig economy and examples, advantages and disadvantages, were reviewed. Similarly, the general characteristics of mHealth technologies were revised. In addition, the role of technology in supporting the development of the gig economy and mHealth technologies and the interactions between them were investigated. Results: The findings suggested that the gig economy is characterized by its flexibility in working hours, on-demand work, free agents, freelancing, freedom in the choice of work, and independent contracts. In addition, an analysis of an mHealth system indicated that it was composed of patients, specialists, nurses, and database administrators. In this system, patients and specialists or nurses are connected to cloud services for the transmission of data and medical information through a mobile app. Here, the administrators update the database and app features, among other technical tasks. Conversely, a general structure of an integrated gig mHealth system was developed. In this structure, the mHealth care services and the mHealth care activities were incorporated into a gig economy model. In addition, a practical example of an integrated view of a gig economy app in mHealth that illustrates the interaction between the patients (consumers) and providers (partners) of mHealth care services, mHealth care activities, health care professionals, and individual contractors was presented. The consumers and providers were interconnected with the health care company, brand, or firm through digital means using a mobile app or Windows platforms. Conclusions: The analysis carried out in this study suggested the possibility of integrating mHealth within the framework of the gig economy enhancing health care service delivery and the management of health care activities. The following 4 major areas of apps proposed in the mHealth framework that can catalyze the operations using the features of the gig economy were sharing/renting medical and diagnostic equipment and resources, on-demand appointments/self-health management, on-demand health care services, and assigning health care activities/gigs to individual contractors. This integration leads to a new dimension for health care services and the proposal of a new term: gig mHealth. UR - https://mhealth.jmir.org/2020/1/e14213 UR - http://dx.doi.org/10.2196/14213 UR - http://www.ncbi.nlm.nih.gov/pubmed/31939745 ID - info:doi/10.2196/14213 ER - TY - JOUR AU - Parker, Jack AU - Powell, Lauren AU - Mawson, Susan PY - 2020/1/8 TI - Effectiveness of Upper Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: Systematic Review JO - J Med Internet Res SP - e15981 VL - 22 IS - 1 KW - wearable electronic devices KW - stroke KW - rehabilitation KW - upper extremity N2 - Background: With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Upper limb (UL) impairment affects up to 77% of stroke survivors impacting on their ability to carry out everyday activities. However, despite an increase in research exploring these devices for UL rehabilitation, little is known of their effectiveness. Objective: This review aimed to assess the effectiveness of UL wearable technology for improving activity and participation in adult stroke survivors. Methods: Randomized controlled trials (RCTs) and randomized comparable trials of UL wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability, and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs and the Downs and Black Instrument for the quality of non RCTs. Results: In the review, we included 11 studies with collectively 354 participants at baseline and 323 participants at final follow-up including control groups and participants poststroke. Participants? stroke type and severity varied. Only 1 study found significant between-group differences for systems functioning and activity (P?.02). The 11 included studies in this review had small sample sizes ranging from 5 to 99 participants at an average (mean) age of 57 years. Conclusions: This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes and the appropriateness of the methodology for complex interventions. However, technology has the potential to measure outcomes, provide feedback, and engage users outside of clinical sessions. This could provide a platform for motivating stroke survivors to carry out more rehabilitation in the absence of a therapist, which could maximize recovery. Trial Registration: PROSPERO CRD42017057715; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=57715 UR - https://www.jmir.org/2020/1/e15981 UR - http://dx.doi.org/10.2196/15981 UR - http://www.ncbi.nlm.nih.gov/pubmed/31913131 ID - info:doi/10.2196/15981 ER - TY - JOUR AU - Gjestsen, Therese Martha AU - Wiig, Siri AU - Testad, Ingelin PY - 2020/1/2 TI - Health Care Personnel?s Perspective on Potential Electronic Health Interventions to Prevent Hospitalizations for Older Persons Receiving Community Care: Qualitative Study JO - J Med Internet Res SP - e12797 VL - 22 IS - 1 KW - health services research KW - community health services KW - hospitalization KW - health services for the aged KW - qualitative research KW - focus groups KW - eHealth KW - technology N2 - Background: The use of electronic health (eHealth) interventions is suggested to help monitor and treat degenerative and chronic diseases through the use of sensors, alarms, and reminders and can potentially prevent hospitalizations for home-dwelling older persons receiving community care. It is increasingly recognized that the health care personnel?s acceptance of a technological application remains a key challenge in adopting an intervention, thus interventions must be perceived to be useful and fit for purpose by the actual users. Objective: The aim of this study was to identify and explore the perspectives of managers and health care personnel in community care regarding the use of eHealth interventions in terms of prevention of hospitalizations for home-dwelling older persons receiving community care. Methods: A case study with a qualitative approach was carried out in community care in a Norwegian municipality, comprising individual interviews and focus group interviews. A total of 5 individual interviews and 2 focus group interviews (n=12) were undertaken to provide the health care personnel?s and managers? perspective regarding the use of eHealth interventions, which could potentially prevent hospitalizations for home-dwelling older persons receiving community care. Data were analyzed by way of systematic text condensation, as described by Malterud. Results: The data analysis of focus group interviews and individual interviews resulted in 2 categories: potential technological applications and potential patient groups. Discussions in the focus groups generated several suggestions and wishes related to technical applications that they could make use of in their day-to-day practice. The health care personnel warranted tools and measures to enhance and document their clinical observations in contact with patients. They also identified patient groups, such as patients with chronic obstructive pulmonary disease or dehydration or urinary tract infections, for whom hospitalizations could potentially have been prevented. Conclusions: We have shown that the health care personnel in community care warrant various technological applications that have the potential to improve quality of care and resource utilization in the studied municipality. We have identified needs and important matters in practice, which are paramount for acceptance and adoption of an intervention in community care. UR - https://www.jmir.org/2020/1/e12797 UR - http://dx.doi.org/10.2196/12797 UR - http://www.ncbi.nlm.nih.gov/pubmed/31895045 ID - info:doi/10.2196/12797 ER - TY - JOUR AU - Mayer, Gwendolyn AU - Gronewold, Nadine AU - Alvarez, Simone AU - Bruns, Bastian AU - Hilbel, Thomas AU - Schultz, Jobst-Hendrik PY - 2019/11/25 TI - Acceptance and Expectations of Medical Experts, Students, and Patients Toward Electronic Mental Health Apps: Cross-Sectional Quantitative and Qualitative Survey Study JO - JMIR Ment Health SP - e14018 VL - 6 IS - 11 KW - acceptance KW - telemedicine KW - telehealth KW - eHealth KW - mHealth KW - interventions KW - depression KW - patients KW - students KW - experts KW - expectation KW - risk N2 - Background: The acceptability of electronic mental (e-mental) health apps has already been studied. However, the attitudes of medical experts, students, and patients taking into account their knowledge of and previous experiences with e-mental health apps have not been investigated. Objective: The aim of this study was to explore the attitudes, expectations, and concerns of medical experts, including physicians, psychotherapists and nursing staff, students of medicine or psychology, and patients toward e-mental health apps when considering their knowledge of and former experiences with e-mental health apps. Methods: This cross-sectional quantitative and qualitative survey was based on a self-developed questionnaire. A total of 269 participants were included (104 experts, 80 students, and 85 patients), and 124 eligible participants answered a paper version and 145 answered an identical online version of the questionnaire. The measures focused on existing knowledge of and experiences with e-mental health apps, followed by a question on whether electronic health development was generally accepted or disliked. Further, we asked about the expectations for an ideal e-mental health app and possible concerns felt by the participants. All items were either presented on a 5-point Likert scale or as multiple-choice questions. Additionally, 4 items were presented as open text fields. Results: Although 33.7% (35/104) of the experts, 15.0% (12/80) of the students, and 41.2% (35/85) of the patients knew at least one e-mental health app, few had already tried one (9/104 experts [8.7%], 1/80 students [1.3%], 22/85 patients [25.9%]). There were more advocates than skeptics in each group (advocates: 71/104 experts [68.3%], 50/80 students [62.5%], 46/85 patients [54.1%]; skeptics: 31/104 experts [29.8%], 20/80 students [25.0%], 26/85 patients [30.6%]). The experts, in particular, believed, that e-mental health apps will gain importance in the future (mean 1.08, SD 0.68; 95% CI 0.94-1.21). When asked about potential risks, all groups reported slight concerns regarding data security (mean 0.85, SD 1.09; 95% CI 0.72-0.98). Patient age was associated with several attitudes toward e-mental health apps (future expectations: r=?0.31, P=.005; total risk score: r=0.22, P=.05). Attitudes toward e-mental health apps correlated negatively with the professional experience of the experts (rs(94)=?0.23, P=.03). Conclusions: As opposed to patients, medical experts and students lack knowledge of and experience with e-mental health apps. If present, the experiences were assessed positively. However, experts show a more open-minded attitude with less fear of risks. Although some risks were perceived regarding data security, the attitudes and expectations of all groups were rather positive. Older patients and medical experts with long professional experience tend to express more skepticism. Trial Registration: German Clinical Trials Register DRKS00013095; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00013095 UR - http://mental.jmir.org/2019/11/e14018/ UR - http://dx.doi.org/10.2196/14018 UR - http://www.ncbi.nlm.nih.gov/pubmed/31763990 ID - info:doi/10.2196/14018 ER - TY - JOUR AU - Seto, Emily AU - Smith, Dallas AU - Jacques, Matt AU - Morita, Pelegrini Plinio PY - 2019/11/1 TI - Opportunities and Challenges of Telehealth in Remote Communities: Case Study of the Yukon Telehealth System JO - JMIR Med Inform SP - e11353 VL - 7 IS - 4 KW - health care systems KW - telemedicine KW - remote consultation KW - Yukon territory KW - telehealth KW - program evaluation KW - medical informatics N2 - Background: Telehealth has been shown to improve access to health care and to reduce costs to the patient and health care system, especially for patients living in rural settings. However, unique challenges arise when implementing telehealth in remote communities. Objective: The study aimed to explore the current use, challenges, and opportunities of the Yukon Telehealth System. The lessons learned from this study were used to determine important factors to consider when attempting to advance and expand telehealth programs in remote communities. Methods: A mixed methods approach was used to evaluate the Yukon Telehealth System and to determine possible future advances. Quantitative data were obtained through usage logs. Web-based questionnaires were administered to nurses in each of the 14 Yukon community health centers outside of Whitehorse and patients who had used telehealth. Qualitative data included focus groups and semistructured interviews with 36 telehealth stakeholders. Results: Since 2008, there has been a consistent number of telehealth sessions of about 1000 per year, with clinical care as the main use (69.06% [759/1099] of all sessions in 2015). From the questionnaire (11 community nurses and 10 patients) and the interview data, there was a consensus among the clinicians and patients that the system provided timely access and cost savings from reduced travel. However, they believed that it was underutilized, and the equipment was outdated. The following 4 factors were identified, which should be considered when trying to advance and expand a telehealth program: (1) patient and clinician buy-in: past telehealth experiences (eg, negative clinician experiences with outdated technology) should be considered when advancing the system. Expansion of services in orthopedics, dermatology, and psychiatry were found to be particularly feasible and beneficial in Yukon; (2) workflow: the use and scheduling of telehealth should be streamlined and automated as much as possible to reduce dependencies on the single Yukon telehealth coordinator; (3) access to telehealth technology: clinicians and patients should have easy access to up-to-date telehealth technology. The use of consumer products, such as mobile technology, should be leveraged as appropriate; and (4) infrastructure: the required human resources and technology need to be established when expanding and advancing telehealth. Conclusions: While clinicians and patients had generally positive perceptions of the Yukon Telehealth System, there was consensus that it was underutilized. Many opportunities exist to expand the types of telehealth services and the number of telehealth sessions, including the expansion of services in several new specialty areas, updating telehealth equipment to streamline workflows and increase convenience and uptake, and integrating novel technologies. The identified barriers and recommendations from this evaluation can be applied to the development and expansion of telehealth in other remote communities to realize telehealth?s potential for providing efficient, safe, convenient, and cost-effective care delivery. UR - http://medinform.jmir.org/2019/4/e11353/ UR - http://dx.doi.org/10.2196/11353 UR - http://www.ncbi.nlm.nih.gov/pubmed/31682581 ID - info:doi/10.2196/11353 ER - TY - JOUR AU - Fulton, Lawrence AU - Kruse, Scott Clemens PY - 2019/10/29 TI - Hospital-Based Back Surgery: Geospatial-Temporal, Explanatory, and Predictive Models JO - J Med Internet Res SP - e14609 VL - 21 IS - 10 KW - back surgery KW - neurosurgeon KW - elastic net KW - lasso KW - ridge KW - random forest KW - geospatial mapping KW - health economics KW - obesity KW - practice variation N2 - Background: Hospital-based back surgery in the United States increased by 60% from January 2012 to December 2017, yet the supply of neurosurgeons remained relatively constant. During this time, adult obesity grew by 5%. Objective: This study aimed to evaluate the demand and associated costs for hospital-based back surgery by geolocation over time to evaluate provider practice variation. The study then leveraged hierarchical time series to generate tight demand forecasts on an unobserved test set. Finally, explanatory financial, technical, workload, geographical, and temporal factors as well as state-level obesity rates were investigated as predictors for the demand for hospital-based back surgery. Methods: Hospital data from January 2012 to December 2017 were used to generate geospatial-temporal maps and a video of the Current Procedural Terminology codes beginning with the digit 63 claims. Hierarchical time series modeling provided forecasts for each state, the census regions, and the nation for an unobserved test set and then again for the out-years of 2018 and 2019. Stepwise regression, lasso regression, ridge regression, elastic net, and gradient-boosted random forests were built on a training set and evaluated on a test set to evaluate variables important to explaining the demand for hospital-based back surgery. Results: Widespread, unexplained practice variation over time was seen using geographical information systems (GIS) multimedia mapping. Hierarchical time series provided accurate forecasts on a blind dataset and suggested a 6.52% (from 497,325 procedures in 2017 to 529,777 in 2018) growth of hospital-based back surgery in 2018 (529,777 and up to 13.00% by 2019 [from 497,325 procedures in 2017 to 563,023 procedures in 2019]). The increase in payments by 2019 are estimated to be US $323.9 million. Extreme gradient-boosted random forests beat constrained and unconstrained regression models on a 20% unobserved test set and suggested that obesity is one of the most important factors in explaining the increase in demand for hospital-based back surgery. Conclusions: Practice variation and obesity are factors to consider when estimating demand for hospital-based back surgery. Federal, state, and local planners should evaluate demand-side and supply-side interventions for this emerging problem. UR - http://www.jmir.org/2019/10/e14609/ UR - http://dx.doi.org/10.2196/14609 UR - http://www.ncbi.nlm.nih.gov/pubmed/31663856 ID - info:doi/10.2196/14609 ER - TY - JOUR AU - Hansen, Arne AU - Herrmann, Maximilian AU - Ehlers, P. Jan AU - Mondritzki, Thomas AU - Hensel, Oliver Kai AU - Truebel, Hubert AU - Boehme, Philip PY - 2019/10/28 TI - Perception of the Progressing Digitization and Transformation of the German Health Care System Among Experts and the Public: Mixed Methods Study JO - JMIR Public Health Surveill SP - e14689 VL - 5 IS - 4 KW - digitization KW - health care sector KW - transformation KW - mixed method KW - delivery of health care KW - diffusion of innovation KW - reform N2 - Background: Health care systems worldwide are struggling to keep rising costs at bay with only modest outcome improvement among many diseases. Digitization with technologies like Artificial Intelligence or Machine Learning algorithms might address this. Although digital technologies have been successfully applied in clinical studies the effect on the overall health care system so far was limited. The regulatory ecosystem or data privacy might be responsible, but other reasons may also predominate. Objective: We analyzed how the digitization of the German health care market is currently perceived among different stakeholders and investigated reasons for its slow adaption. Methods: This was a mixed methods study split into a qualitative Part A using the conceptual approach of the Grounded Theory and a quantitative Part B using the Delphi method. For Part A we interviewed experts in the health care system and converted the results into 17 hypotheses. The Delphi method consisted of an online survey which was sent to the participants via email and was available for three months. For the assessment of the 17 hypotheses, the participants were given a six-point Likert scale. The participants were grouped into patients, physicians, and providers of services within the German health care market. Results: There was a strong alignment of opinions on the hypotheses between experts (N=21) and survey participants (N=733), with 70.5% overall agreement on 12/17 hypotheses. Physicians demonstrated the lowest level of agreement with the expert panel at 88% (15/17) disagreement, with the hypotheses ?H8: Digitization in the health care system will free up jobs,? and ?H6: Digitization in the health care system will empower the patients,? perceived to be in profound disagreement (P=.036 and P<.001, respectively). Conclusions: Despite the firm agreement among participants and experts regarding the impact of digitization on the health care system, physicians demonstrated a more negative attitude. We assume that this might be a factor contributing to the slow adoption of digitization in practice. Physicians might be struggling with changing power structures, so future measures to transform the market should involve them to a larger degree. UR - http://publichealth.jmir.org/2019/4/e14689/ UR - http://dx.doi.org/10.2196/14689 UR - http://www.ncbi.nlm.nih.gov/pubmed/31661082 ID - info:doi/10.2196/14689 ER - TY - JOUR AU - Allan, Stephanie AU - Bradstreet, Simon AU - Mcleod, Hamish AU - Farhall, John AU - Lambrou, Maria AU - Gleeson, John AU - Clark, Andrea AU - AU - Gumley, Andrew PY - 2019/10/24 TI - Developing a Hypothetical Implementation Framework of Expectations for Monitoring Early Signs of Psychosis Relapse Using a Mobile App: Qualitative Study JO - J Med Internet Res SP - e14366 VL - 21 IS - 10 KW - psychosis KW - self-management KW - implementation science N2 - Background: Relapse is a common experience for people diagnosed with psychosis, which is associated with increased service costs and profound personal and familial distress. EMPOWER (Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery) is a peer worker?supported digital intervention that aims to enable service users to self-monitor their mental health with the aim of encouraging self-management and the shared use of personal data to promote relapse prevention. Digital interventions have not been widely used in relapse prevention and, therefore, little is currently known about their likely implementation?both within trials and beyond. Objective: Seeking the perspectives of all relevant stakeholder groups is recommended in developing theories about implementation because this can reveal important group differences in understandings and assumptions about whether and for whom the intervention is expected to work. However, the majority of intervention implementation research has been retrospective. This study aimed to discover and theoretically frame implementation expectations in advance of testing and synthesize these data into a framework. Methods: To develop a hypothetical implementation framework, 149 mental health professionals, carers, and people diagnosed with psychosis participated in 25 focus groups in both Australia and the United Kingdom. An interview schedule informed by the normalization process theory was used to explore stakeholders? expectations about the implementation of the EMPOWER intervention. Data were analyzed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions. Results: All groups expected that EMPOWER could be successfully implemented if the intervention generated data that were meaningful to mental health staff, carers, and service users within their unique roles. However, there were key differences between staff, carers, and service users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cluster randomized controlled trial stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whereas staff and carers spoke more about the impact upon staff interactions with service users. Conclusions: A hypothetical implementation framework synthesized from stakeholder implementation expectations provides an opportunity to compare actual implementation data gathered during an ongoing clinical trial, giving valuable insights into the accuracy of these stakeholders? previous expectations. This is among the first studies to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial. Trial Registration: ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262 UR - https://www.jmir.org/2019/10/e14366 UR - http://dx.doi.org/10.2196/14366 UR - http://www.ncbi.nlm.nih.gov/pubmed/31651400 ID - info:doi/10.2196/14366 ER - TY - JOUR AU - Wu, Dan AU - Huang, Wenting AU - Zhao, Peipei AU - Li, Chunyan AU - Cao, Bolin AU - Wang, Yifan AU - Stoneking, Shelby AU - Tang, Weiming AU - Luo, Zhenzhou AU - Wei, Chongyi AU - Tucker, Joseph PY - 2019/10/8 TI - A Crowdsourced Physician Finder Prototype Platform for Men Who Have Sex with Men in China: Qualitative Study of Acceptability and Feasibility JO - JMIR Public Health Surveill SP - e13027 VL - 5 IS - 4 KW - gay-friendly doctors KW - social media KW - crowdsourcing KW - prototype evaluation KW - men who have sex with men KW - China N2 - Background: Men who have sex with men (MSM), including both gay and bisexual men, have a high prevalence of HIV and sexually transmitted infections (STIs) in China. However, healthcare seeking behaviors and engagement in clinical services among MSM are often suboptimal. Global evidence shows that embedding online HIV or sexual health services into gay social networking applications holds promise for facilitating higher rates of healthcare utilization among MSM. We developed a prototype of a gay-friendly health services platform, designed for integration within a popular gay social networking app (Blued) in China. Objective: The purpose of this study was to evaluate the acceptability of the platform and ask for user feedback through focus group interviews with young MSM in Guangzhou and Shenzhen, cities in Southern China. Methods: The prototype was developed through an open, national crowdsourcing contest. Open crowdsourcing contests solicit community input on a topic in order to identify potential improvements and implement creative solutions. The prototype included a local, gay-friendly, STI physician finder tool and online psychological consulting services. Semistructured focus group discussions were conducted with MSM to ask for their feedback on the platform, and a short survey was administered following discussions. Thematic analysis was used to analyze the data in NVivo, and we developed a codebook based on the first interview. Double coding was conducted, and discrepancies were discussed with a third individual until consensus was reached. We then carried out descriptive analysis of the survey data. Results: A total of 34 participants attended four focus group discussions. The mean age was 27.3 years old (SD 4.6). A total of 32 (94%) participants obtained at least university education, and 29 (85%) men had seen a doctor at least once before. Our survey results showed that 24 (71%) participants had interest in using the online health services platform and 25 (74%) thought that the system was easy to use. Qualitative data also revealed that there was a high demand for gay-friendly healthcare services which could help with care seeking. Men felt that the platform could bridge gaps in the existing HIV or STI service delivery system, specifically by identifying local gay-friendly physicians and counselors, providing access to online physician consultation and psychological counseling services, creating space for peer support, and distributing pre-exposure prophylaxis and sexual health education. Conclusions: Crowdsourcing can help develop a community-centered online platform linking MSM to local gay-friendly HIV or STI services. Further research on developing social media?based platforms for MSM and evaluating the effectiveness of such platforms may be useful for improving sexual health outcomes. UR - https://publichealth.jmir.org/2019/4/e13027 UR - http://dx.doi.org/10.2196/13027 UR - http://www.ncbi.nlm.nih.gov/pubmed/31596245 ID - info:doi/10.2196/13027 ER - TY - JOUR AU - Kapinos, Kandice AU - Kotzias, Virginia AU - Bogen, Debra AU - Ray, Kristin AU - Demirci, Jill AU - Rigas, Ann Mary AU - Uscher-Pines, Lori PY - 2019/09/03 TI - The Use of and Experiences With Telelactation Among Rural Breastfeeding Mothers: Secondary Analysis of a Randomized Controlled Trial JO - J Med Internet Res SP - e13967 VL - 21 IS - 9 KW - telehealth KW - telemedicine KW - breastfeeding KW - lactation KW - lactation support KW - rural health N2 - Background: Telelactation services connect breastfeeding mothers to remotely located lactation consultants through audio-visual technology and can increase access to professional breastfeeding support in rural areas. Objective: The objective of this study was to identify maternal characteristics associated with the demand for and use of telelactation and to describe visit characteristics. Methods: We conducted a descriptive study within the context of a randomized controlled trial. Participant survey data and vendor electronic medical record data were used to assess video call characteristics like timing, duration, topics discussed, and participant satisfaction. Recruitment occurred from 2016-2018 at a rural critical access hospital in Pennsylvania. The 102 women enrolled in the study were given access to unlimited, on-demand video calls with lactation consultants through a mobile phone app and were tracked for 12 weeks following their postpartum hospitalization. Results: A total of 94 participants out of 102 recruits (92%) participated in the final, 12-week survey assessment were included in the analysis. Of those, 47 (50%) participants reported participating in one or more video calls, and 31 (33%) completed one or more calls that included a substantive discussion of a breastfeeding challenge. Participants who used telelactation (21/31, 68%; P=.02) were more likely to be working at 12 weeks postpartum compared to others (26/63, 41%), were less likely (12/31, 39%; P=.02) to have prior breastfeeding experience on average compared to nonusers (41/63, 65%), and were less likely to have breastfed exclusively (16/31, 52%; P<.001) prior to hospital discharge compared to mothers who didn?t use telelactation services (51/63, 81%). Most video calls (58/83, 70%) occurred during the infant?s first month of life and 41% (34/83) occurred outside of business hours. The most common challenges discussed included: breast pain, soreness, and infection (25/83, 30%), use of nipple shields (21/83, 25%), and latch or positioning (17/83, 24%). Most telelactation users (43/47, 91%) expressed satisfaction with the help received. Conclusions: Telelactation is an innovation in the delivery of professional breastfeeding support. This research documents both demand for and positive experiences with telelactation in an underserved population. Trial Registration: ClinicalTrials.gov NCT02870413; https://clinicaltrials.gov/ct2/show/NCT02870413 UR - https://www.jmir.org/2019/9/e13967/ UR - http://dx.doi.org/10.2196/13967 UR - http://www.ncbi.nlm.nih.gov/pubmed/31482848 ID - info:doi/10.2196/13967 ER - TY - JOUR AU - Balakrishnan, S. Ashwin AU - Nguyen, G. Hao AU - Shinohara, Katsuto AU - Au Yeung, Reuben AU - Carroll, R. Peter AU - Odisho, Y. Anobel PY - 2019/6/2 TI - A Mobile Health Intervention for Prostate Biopsy Patients Reduces Appointment Cancellations: Cohort Study JO - J Med Internet Res SP - e14094 VL - 21 IS - 6 KW - text messaging KW - appointments and schedules KW - mHealth KW - quality improvement KW - urology KW - prostate neoplasm N2 - Background: Inadequate patient education and preparation for office-based procedures often leads to delayed care, poor patient satisfaction, and increased costs to the health care system. We developed and deployed a mobile health (mHealth) reminder and education program for patients scheduled for transrectal prostate biopsy. Objective: We aimed to evaluate the impact of an mHealth reminder and education program on appointment cancellation rates, communication frequency, and patient satisfaction. Methods: We developed a text message (SMS, short message service)?based program with seven reminders containing links to Web-based content and surveys sent over an 18-day period (14 days before through 3 days after prostate biopsy). Messages contained educational content, reminders, and readiness questionnaires. Demographic information, appointment cancellations or change data, and patient/provider communication events were collected for 6 months before and after launching the intervention. Patient satisfaction was evaluated in the postintervention cohort. Results: The preintervention (n=473) and postintervention (n=359) cohorts were composed of men of similar median age and racial/ethnic distribution living a similar distance from clinic. The postintervention cohort had significantly fewer canceled or rescheduled appointments (33.8% vs 21.2%, P<.001) and fewer same-day cancellations (3.8% vs 0.5%, P<.001). There was a significant increase in preprocedural telephone calls (0.6 vs 0.8 calls per patient, P=.02) in the postintervention cohort, but not a detectable change in postprocedural calls. The mean satisfaction with the program was 4.5 out of 5 (SD 0.9). Conclusions: An mHealth periprocedural outreach program significantly lowered appointment cancellation and rescheduling and was associated with high patient satisfaction scores with a slight increase in preprocedural telephone calls. This led to fewer underused procedure appointments and high patient satisfaction. UR - https://www.jmir.org/2019/6/e14094/ UR - http://dx.doi.org/10.2196/14094 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199294 ID - info:doi/10.2196/14094 ER - TY - JOUR AU - Paslakis, Georgios AU - Fischer-Jacobs, Josefine AU - Pape, Lars AU - Schiffer, Mario AU - Gertges, Raoul AU - Tegtbur, Uwe AU - Zimmermann, Tanja AU - Nöhre, Mariel AU - de Zwaan, Martina PY - 2019/05/16 TI - Assessment of Use and Preferences Regarding Internet-Based Health Care Delivery: Cross-Sectional Questionnaire Study JO - J Med Internet Res SP - e12416 VL - 21 IS - 5 KW - telemedicine KW - health care delivery KW - internet KW - eHealth KW - teleconference KW - electronic medical records KW - online psychotherapy N2 - Background: There has been an incremental increase in the use of technology in health care delivery. Feasibility, acceptability, and efficacy of interventions based on internet technologies are supported by a growing body of evidence. Objective: The aim of this study was to investigate use and preferences in the general adult population in Germany for remote, internet-based interaction (eg, email, videoconferencing, electronic medical records, apps). Methods: A nationwide cross-sectional questionnaire survey in adults that was representative in terms of age, sex and educational level was carried out. Results: A total of 22.16% (538/2428) of survey participants reported not using the internet for work or private use. The nonuser phenotype can be described as being older, having lower educational and income status, and living in less populated areas. The majority of participants within the cohort of internet users reported that they would not consider using electronic medical records (973/1849, 52.62%), apps (988/1854, 53.29%), or emails to report symptoms (1040/1838, 56.58%); teleconference with one (1185/1852, 63.98%) or more experts (1239/1853, 66.86%); or participate in video psychotherapy (1476/1853, 79.65%) for the purpose of medical consultation or treatment. Older age and lower educational level were the most robust predictors of assumed future denial of use. Conclusions: Our results point toward low use and preference rates among the general population for the use of telemedicine. It also seems that those who might benefit from telemedical interventions the most, are, in fact, those who are most hesitating. These low use and preference rates of eHealth should be considered prior to designing and providing future telemedical care, supporting the need for easy-to-use, data secure solutions. UR - http://www.jmir.org/2019/5/e12416/ UR - http://dx.doi.org/10.2196/12416 UR - http://www.ncbi.nlm.nih.gov/pubmed/31099338 ID - info:doi/10.2196/12416 ER - TY - JOUR AU - Hansen, Helen Anne AU - Claudi, Tor AU - Årsand, Eirik PY - 2019/04/26 TI - Use of Electronic Health and Its Impact on Doctor-Visiting Decisions Among People With Diabetes: Cross-Sectional Study JO - J Med Internet Res SP - e13678 VL - 21 IS - 4 KW - eHealth KW - internet KW - internet information KW - doctor-seeking behavior KW - cross-sectional study KW - diabetes KW - Norway N2 - Background: Despite the increasing prevalence of diabetes and increasing use of electronic health (eHealth) among people with diabetes, little is known about the association between the use of eHealth and the use of provider-based health services. Objective: The objective of this study was to investigate whether the use of eHealth might change patients? decisions regarding doctor-seeking behavior and whether information acquired from the internet was discussed with a doctor. Methods: We used email survey data collected in 2018 from members of the Norwegian Diabetes Association (aged 18 to 89 years) diagnosed with diabetes. Using logistic regressions, we studied patients? internet-triggered changes in decisions regarding doctor visits; whether they discussed information from the internet with a doctor; and whether these topics were associated with gender, age, education, self-rated health, and self-reported anxiety/depression. Results: Among the 895 informants, 75.4% (645/856) had never made an internet-triggered change of decision in any direction regarding visiting a doctor, whereas 16.4% (41/859) had decided to visit and 17.3% (148/856) had decided not to visit. The probability of changing decisions decreased with higher age and increased with the severity of self-reported anxiety/depression. Around half of the study participants (448/858, 52.2%) had never discussed information from the internet with a doctor. The probability of discussing internet information with a doctor was higher for those in bad/very bad self-rated health (odds ratio 2.12, CI 1.15-3.90) and for those with moderate self-reported anxiety/depression (odds ratio 2.30, CI 1.30-4.10). Conclusions: Our findings suggest that using eHealth has a significant impact on doctor-visiting decisions among people with diabetes, especially among people aged 18 to 39 years and among those reporting anxiety/depression. It is of great importance that the information posted is of high quality and that the large differences between internet-users regarding age as well as mental and somatic health status are taken into account. More research is needed to confirm and further explore the findings of this study. UR - http://www.jmir.org/2019/4/e13678/ UR - http://dx.doi.org/10.2196/13678 UR - http://www.ncbi.nlm.nih.gov/pubmed/31025957 ID - info:doi/10.2196/13678 ER - TY - JOUR AU - Berntsen, Gro AU - Strisland, Frode AU - Malm-Nicolaisen, Kristian AU - Smaradottir, Berglind AU - Fensli, Rune AU - Røhne, Mette PY - 2019/04/22 TI - The Evidence Base for an Ideal Care Pathway for Frail Multimorbid Elderly: Combined Scoping and Systematic Intervention Review JO - J Med Internet Res SP - e12517 VL - 21 IS - 4 KW - systematic review KW - patient-centered care KW - delivery of health care, integrated KW - secondary prevention KW - risk management N2 - Background: There is a call for bold and innovative action to transform the current care systems to meet the needs of an increasing population of frail multimorbid elderly. International health organizations propose complex transformations toward digitally supported (1) Person-centered, (2) Integrated, and (3) Proactive care (Digi-PIP care). However, uncertainty regarding both the design and effects of such care transformations remain. Previous reviews have found favorable but unstable impacts of each key element, but the maturity and synergies of the combination of elements are unexplored. Objective: This study aimed to describe how the literature on whole system complex transformations directed at frail multimorbid elderly reflects (1) operationalization of intervention, (2) maturity, (3) evaluation methodology, and (4) effect on outcomes. Methods: We performed a systematic health service and electronic health literature review of care transformations targeting frail multimorbid elderly. Papers including (1) Person-centered, integrated, and proactive (PIP) care; (2) at least 1 digital support element; and (3) an effect evaluation of patient health and/ or cost outcomes were eligible. We used a previously published ideal for the quality of care to structure descriptions of each intervention. In a secondary deductive-inductive analysis, we collated the descriptions to create an outline of the generic elements of a Digi-PIP care model. The authors then reviewed each intervention regarding the presence of critical elements, study design quality, and intervention effects. Results: Out of 927 potentially eligible papers, 10 papers fulfilled the inclusion criteria. All interventions idealized Person-centered care, but only one intervention made what mattered to the person visible in the care plan. Care coordinators responsible for a whole-person care plan, shared electronically in some instances, was the primary integrated care strategy. Digitally supported risk stratification and management were the main proactive strategies. No intervention included workflow optimization, monitoring of care delivery, or patient-reported outcomes. All interventions had gaps in the chain of care that threatened desired outcomes. After evaluation of study quality, 4 studies remained. They included outcome analyses on patient satisfaction, quality of life, function, disease process quality, health care utilization, mortality, and staff burnout. Only 2 of 24 analyses showed significant effects. Conclusions: Despite a strong common-sense belief that the Digi-PIP ingredients are key to sustainable care in the face of the silver tsunami, research has failed to produce evidence for this. We found that interventions reflect a reductionist paradigm, which forces care workers into standardized narrowly focused interventions for complex problems. There is a paucity of studies that meet complex needs with digitally supported flexible and adaptive teamwork. We predict that consistent results from care transformations for frail multimorbid elderly hinges on an individual care pathway, which reflects a synergetic PIP approach enabled by digital support. UR - http://www.jmir.org/2019/4/e12517/ UR - http://dx.doi.org/10.2196/12517 UR - http://www.ncbi.nlm.nih.gov/pubmed/31008706 ID - info:doi/10.2196/12517 ER - TY - JOUR AU - Van Velthoven, Helena Michelle AU - Cordon, Carlos PY - 2019/03/25 TI - Sustainable Adoption of Digital Health Innovations: Perspectives From a Stakeholder Workshop JO - J Med Internet Res SP - e11922 VL - 21 IS - 3 KW - adoption KW - digital health KW - stakeholders KW - telemedicine N2 - Background: There are various complex reasons that influence sustainable adoption of innovations in health care systems. Low adoption can be caused by a lack of support from one or more stakeholders because their needs and expectations are not always considered or aligned. Objective: This study aimed to identify stakeholders? perceptions of barriers and facilitators toward the sustainable adoption of digital health innovations. Methods: A stakeholder workshop was attended by 12 participants with a range of backgrounds on August 25, 2017, including people representing the views from patients, carers, local hospitals, pharmacy retailers, health insurers, health services researchers, engineers, and technology and pharmaceutical companies in Switzerland. On the basis of adoption of innovation frameworks, we asked participants to interview each other about 3 factors influencing the adoption of digitally delivered health interventions: (1) Facilitators and barriers in the external system, (2) Needs and expectations of stakeholders, and (3) Safety, quality, and usability of innovations. The worksheets and videos generated from the workshop were qualitatively analyzed and summarized. Results: Facilitators for adoption mentioned were high levels of income and education, and digital health is a high priority to stakeholders. Main common interests of different stakeholders were patient satisfaction and job protection. Health care spending was a misaligned interest: although some stakeholders were keen on spending more to obtain or provide the highest quality of care, others were focused on reducing health care spending to provide cost-effective services. Switzerland?s diversity and complexity, in terms of its organization with 26 cantons (administrative divisions), were barriers as these made it harder to ensure interoperability of interventions. A culture of innovation was considered a push factor, but adoption was inhibited by persistent paper-based systems, a fear of change, and unwillingness to share data. The sustainability of interventions can be promoted by making them patient-centered, meaning that patients should be involved throughout their development. Conclusions: Promoting sustainable adoption of digital health remains challenging despite various push factors being in place. Barriers related to fragmentation, patient-centeredness, data security, privacy, trust, and job security need to be addressed. A strength is that people from a wide range of backgrounds attended the workshop. A limitation is that the findings are focused on the macro level. In-depth case studies of specific issues need to be conducted in different settings. UR - http://www.jmir.org/2019/3/e11922/ UR - http://dx.doi.org/10.2196/11922 UR - http://www.ncbi.nlm.nih.gov/pubmed/30907734 ID - info:doi/10.2196/11922 ER - TY - JOUR AU - Hansen, Helen Anne AU - Claudi, Tor AU - Årsand, Eirik PY - 2019/03/21 TI - Associations Between the Use of eHealth and Out-of-Hours Services in People With Type 1 Diabetes: Cross-Sectional Study JO - J Med Internet Res SP - e13465 VL - 21 IS - 3 KW - eHealth KW - internet KW - health care utilization KW - out-of-hours services KW - cross-sectional study KW - diabetes mellitus, type 1 KW - Norway N2 - Background: Despite the increasing prevalence of diabetes and the increasing use of eHealth, little is known about the association between provider-based health services and eHealth among people with diabetes. This is the second study in a project exploring the associations between the use of eHealth and the use of provider-based health services. Objective: The objective of this study was to investigate which eHealth services are used among out-of-hours (OOH) visitors with type 1 diabetes (T1D), and whether the use of eHealth (eg, apps, search engines, video services, and social media) was associated with the use of OOH services. We also wanted to investigate associations between anxiety, reassurance, and change in doctor-seeking behavior because of health information acquired from the Internet, and the use of OOH services. Methods: We used data from a 2018 email survey of members of the Norwegian Diabetes Association (18-89 years old). Respondents with T1D were eligible for analyses. Using descriptive statistics, we estimated the use of OOH services and eHealth. Using logistic regressions, we studied the associations between the use of OOH services and the use of eHealth, as well as associations between the use of OOH services and reported consequences of using Internet-based health information. Results: In the sample of 523 people with T1D (mean age 47 years), 26.7% (129/484) visited OOH services once or more during the previous year. Among the OOH visitors, search engines were used for health purposes by 86.7% (111/128), apps (health apps in general) by 63.6% (82/129), social media by 45.3% (58/128), and video services by 28.4% (36/127). The use of OOH services was positively associated with self-reported anxiety/depression (odds ratio [OR] 4.53, 95% CI 1.43-14.32) and with the use of apps (OR 1.73, 95% CI 1.05-2.85), but not with other types of eHealth. Those who had felt anxious based on information from the Internet were more likely to visit OOH services compared with those who had not felt anxious (OR 2.38, 95% CI 1.50-3.78). People who had decided to consult a doctor based on information from the Internet were more likely to visit OOH services (OR 2.76, 95% CI 1.64-4.66), compared to those who had not made such an Internet-based decision. Conclusions: People with T1D were frequent users of OOH services, and the OOH visitors were frequent users of eHealth. The use of OOH services was positively associated with the use of health apps, with self-reported anxiety/depression, and with feeling anxious based on information from the Internet. Likewise, deciding to consult a doctor based on information from the Internet was positively associated with OOH visits. The use of eHealth seems to have a significant impact on people with T1D. UR - http://www.jmir.org/2019/3/e13465/ UR - http://dx.doi.org/10.2196/13465 UR - http://www.ncbi.nlm.nih.gov/pubmed/30896437 ID - info:doi/10.2196/13465 ER - TY - JOUR AU - He, Cui AU - Zhou, Qiru AU - Chen, Wei AU - Tian, Junzhang AU - Zhou, Lihua AU - Peng, Hong AU - Luan, Shuo AU - Wang, Shengfei PY - 2018/12/21 TI - Using an Internet-Based Hospital to Address Maldistribution of Health Care Resources in Rural Areas of Guangdong Province, China: Retrospective and Descriptive Study JO - JMIR Med Inform SP - e51 VL - 6 IS - 4 KW - telemedicine KW - health care delivery KW - prescription KW - cost KW - patient satisfaction KW - patient compliance N2 - Background: Health care maldistribution is a long-term problem in China. Telemedicine is an efficient way to deliver medical resources to remote areas; however, there are few studies on the effectiveness and challenges in providing health care from rural to urban areas in China. Objective: The objective was to describe the effectiveness and challenges of telemedicine for providing health care from Guangzhou to rural areas in Guangdong Province. Methods: We designed surveys and conducted them immediately after the consultation and 2-4 weeks later. Data were collected from June 2015 to May 2016 including patients? demographic features, patient satisfaction, medicine effect, patient compliance, acceptability of prescription expenses, patients? desire to revisit the department, the top 10 diseases, and self-reported difficulties in telemedicine experience. The monthly average prescription expense was described using a line chart. The monthly consultation and prescription, as well as monthly prescriptions of Western medicines and herbs, were described using a bar chart. Results: Women comprised majority (45,386/67,740, 67.00%) of participants and men comprised the minority (22,354/67,740, 33.00%). The top 3 diseases were upper respiratory diseases (12,371/36,311, 34.07%), laryngopharyngitis (4938/36,311, 13.60%), and menstrual disorders (4669/36,311, 12.86%). The monthly prescription for Western medicine was much more than that for Chinese herbs. The annual average medicine expense per prescription was 62.9 ¥. The participants? perception of expense was acceptable (8775/12,450, 70.48%), mostly acceptable (2497/12,450, 20.01%), accepted but somewhat expensive (980/12,450, 7.9%), and unacceptable because of high cost (198/12,450, 1.6%). The surveys on patient satisfaction demonstrated very satisfied (55,687/67,740, 82.21%), satisfied (5891/67,740, 8.70%), basic satisfaction (3561/67,740, 5.26%), dissatisfaction (1454/67,740, 2.15%), and no comment (1147/67,740, 1.69%). Participants reported their treatment outcome as follows: full recovery (5008/12,450, 40.22%), recovering (4873/12,450, 39.14%), no effect (2153/12,450, 17.29%), or worsening (416/12,450, 3.3%). Approximately 89.01% (20,240/22,740) of participants will revisit the department, whereas 10.99% (2500/22,740) will not. Most patients complied with the doctors? advice completely (5430/10,290, 52.77%), whereas the rest reported partial compliance (3684/10,290, 35.80%) or no compliance at all (1176/10,290, 11.43%). The participants reported poor computer skills (4980/22,740, 21.90%), transportation inconvenience (4670/22,740, 20.50%), unstable internet connection (3820/22,740, 16.80%), language barriers (3708/22,740, 16.30%), medication and medical hardware shortage (2459/22,740, 10.82%), tiring commute (2068/22,740, 9.08%), family care burdens (679/22,740, 3.0%), and other unclassified difficulties (356/22,740, 1.6%) as difficulties in using telemedicine. Conclusions: Telemedicine has a wide disease spectrum, similar to ordinary medicine in China. It saves costs, has high patient satisfaction and price acceptability, and can relieve disease and syndromes. However, certain problems need to be resolved. Telemedicine could be a feasible approach to address the health care maldistribution in rural China. This study may provide useful information for policy making and guidance for further telemedicine practice in China and other developing countries. UR - http://medinform.jmir.org/2018/4/e51/ UR - http://dx.doi.org/10.2196/medinform.9495 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578195 ID - info:doi/10.2196/medinform.9495 ER -