Using information and communication technologies to involve patients and the public in health education in rural and remote areas: a scoping review.

BACKGROUND: Patient and public involvement (PPI) in health education is a practice whereby research and education are carried in collaboration 'with' patients and/or citizens, maintaining their role as a team member or expert. PPI in health education is of great interest for all stakeholders in the field, as it can make program development more relevant to the public and increase its utilization by the target population. However, little is known about how PPI should be implemented in different settings particularly in rural and remote areas. Therefore, a deeper understanding of how PPI works in different environments is needed. We aim to explore how information and communication technologies (ICT) are used for PPI in health education programs in rural and remote areas. METHODS: We performed a scoping review. Two reviewers independently selected 641 studies from five electronic databases. Data were extracted, charted and validated by the senior researcher and study lead. We performed a narrative synthesis to map the literature. RESULTS: Of the initial 641 articles identified, 5 fit the eligibility criteria. Most of the studies targeted community members at large. Consultation and collaboration were the main levels of PPI, which included communities at large and specific at-risk groups. The main forms of ICT used were telephone and Internet, followed by teleconferences, electronic health records, and weblogs. No study measured the effectiveness of ICT for involving patients in health education in rural and remote areas. CONCLUSION: Telephone and Internet were the most frequently used forms of PPI in health education in rural areas with consultation and collaboration as the main levels of PPI there. No study measured the impact of ICT for PPI in health education in rural areas. Due to this, measuring the impact of ICT in rural and remote areas as a means for PPI in health education of medical students, health professionals and patients requires further study.

Key stakeholders' views on the quality of care and services available to frail seniors in Canada.

BACKGROUND: Frail seniors often receive ineffective care, which does not meet their needs. It is still unclear how healthcare systems should be redesigned to be more sensitive to the needs and values of frail seniors and their caregivers. We thus aimed to describe key stakeholders' perspectives on the current healthcare and services available to frail seniors. METHODS: In this qualitative descriptive study, we conducted semi-structured interviews with a convenience sample of 42 frail seniors, caregivers, clinicians, or healthcare administrators/decision makers involved in frail senior care from five Canadian provinces. We explored participants' perspectives on the quality of care and services for frail seniors. We used an inductive/deductive thematic data analysis approach based on the Square-of-Care model, including emerging themes using the constant comparison method. RESULTS: We grouped participants' perspectives into strengths, weaknesses and opportunities for improvement, and then into nine themes: care processes, continuity of care, social frailty, access to healthcare and services, models of healthcare delivery, cost of care, healthcare staff management and professional development of healthcare providers, material resources and environmental design of healthcare facilities, and coordination of care. Our findings suggest redesigning assessment, communication with frail seniors and their caregivers, targeting care and services to the needs, and integrating care better across settings and in time. CONCLUSIONS: A systematic identification of frail older people is the first step to adapt healthcare systems to this population's needs. Participation of frail older people and their caregivers to decision making would also allow choosing care plans meeting their care goals. The integration of care and services across settings, over time, and with various providers, is also needed to meet frail senior needs.

The influence of a wound care teleassistance service on nursing practice: a case study in Quebec.

BACKGROUND: Although telehealth is a promising solution for healthcare professionals who work in remote and rural regions, the influence of specific telehealth applications on the nursing workforce remains unknown. This case study aimed to explore the potential influence of a teleassistance service in wound care (the acronym in French is TASP) on nursing practices and on nurse retention in peripheral areas. MATERIALS AND METHODS: We carried out an exploratory single case study based on 16 semistructured interviews with two promoters of TASP, five nursing managers, and nine nurses from three levels of expertise associated with this service. RESULTS: According to participants, the main positive influences of TASP were observed in quality of care, professional autonomy, professional development, and decrease of professional isolation. Participants mentioned increased workload associated with global patient data collection at first consultation as a negative effect of TASP. Finally, three possible effects of TASP on nurse retention were identified: none or minimal, imprecise, or mostly positive. CONCLUSIONS: This case study highlights the positive influence of TASP on several dimensions of nursing practice, in addition to its essential role in improving the quality of care. However, it is important to consider that the service cannot be considered as a solution to or replacement for the shortage of nurses.

[The impact of information and communication technologies on nurse retention]. / L'influence des technologies de l'information et des communications sur le maintien en poste des infirmières.

AIM: The purpose of this study was to determine the potential impact of information and communication technologies (ICTs) on nursing practice and nurse retention in remote, intermediate and peripheral regions of Quebec, Canada. METHODS: A qualitative study using semi-structured interviews (n=21) was conducted among nursing managers from 16 health and social services centers (French acronym: CSSS) in the province of Quebec. RESULTS: The study found that a range of ICT applications are used, though not to the same extent in all organizations. The participants assessed the impact of computerization and telehealth applications on nursing practice and emphasized the relationships between telehealth and nurse retention, particularly through professional development. The participants also reported that ICTs can have different impacts on nurse retention (i.e. little or no impact, unclear impact, or indirect positive impact). CONCLUSIONS: The main findings indicate significant heterogeneity, both in terms of the nursing shortage and in terms of the integration of ICT in nursing practice. While focusing on a comparative approach, future research should further explore the impact of ICT on nursing practice and, indirectly, on nurse retention, which requires a contextual approach to ICT applications and workplaces and an analysis of staff characteristics.

Adoption of Electronic Personal Health Records in Canada: Perceptions of Stakeholders.

BACKGROUND: Healthcare stakeholders have a great interest in the adoption and use of electronic personal health records (ePHRs) because of the potential benefits associated with them. Little is known, however, about the level of adoption of ePHRs in Canada and there is limited evidence concerning their benefits and implications for the healthcare system. This study aimed to describe the current situation of ePHRs in Canada and explore stakeholder perceptions regarding barriers and facilitators to their adoption. METHODS: Using a qualitative descriptive study design, we conducted semi-structured phone interviews between October 2013 and February 2014 with 35 individuals from seven Canadian provinces. The participants represented six stakeholder groups (patients, ePHR administrators, healthcare professionals, organizations interested in health technology development, government agencies, and researchers). A detailed summary of each interview was created and thematic analysis was conducted. RESULTS: We observed that there was no consensual definition of ePHR in Canada. Factors that could influence ePHR adoption were related to knowledge (confusion with other electronic medical records [EMRs] and lack of awareness), system design (usability and relevance), user capacities and attitudes (patient health literacy, education and interest, support for professionals), environmental factors (government commitment, targeted populations) and legal and ethical issues (information control and custody, confidentiality, privacy and security). CONCLUSION: ePHRs are slowly entering the Canadian healthcare landscape but provinces do not seem well-prepared for the implementation of this type of record. Guidance is needed on critical issues regarding ePHRs, such as ePHR definition, data ownership, access to information and interoperability with other electronic health records (EHRs). Better guidance on these issues would provide a greater awareness of ePHRs and inform stakeholders including clinicians, decision-makers, patients and the public. In turn, it may facilitate their adoption in the country.