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1.
Epidemiol Psychiatr Sci ; 29: e105, 2020 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-32100662

RESUMEN

There is growing interest in digital mental health as well as accumulating evidence of the potential for technology-based tools to augment traditional mental health services and to potentially overcome barriers to access and use of mental health services. Our research group has examined how people with mental illnesses think about and make use of technology in their everyday lives as a means to provide insight into the emerging paradigm of digital mental health. This research has been guided by anthropological approaches that emphasise lived experience and underscore the complexity of psychiatric recovery. In this commentary I describe how an anthropological approach has motivated us to ask how digital technology can be leveraged to promote meaningful recovery for people with mental illnesses and to develop a new approach to the integration of technology-based tools for people with mental illnesses.


Asunto(s)
Servicios Comunitarios de Salud Mental/organización & administración , Trastornos Mentales/rehabilitación , Telemedicina/organización & administración , Humanos , Trastornos Mentales/psicología , Salud Mental
2.
Nurse Pract ; 45(3): 44-49, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32068657

RESUMEN

NP educators are challenged to ensure their students have opportunities to learn how to apply skills within a telehealth context. This article presents an integration of telehealth into clinical learning, depicting the connectedness possible when a healthcare professional and patient are challenged by geographic distance.


Asunto(s)
Educación de Postgrado en Enfermería/organización & administración , Enfermeras Practicantes/educación , Entrenamiento Simulado/organización & administración , Telemedicina/organización & administración , Australia , Humanos , Investigación en Educación de Enfermería
3.
JAMA Netw Open ; 3(1): e1919954, 2020 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-31995214

RESUMEN

Importance: The number of patients presenting to emergency departments (EDs) for psychiatric care continues to increase. Psychiatrists often make a conservative recommendation to admit patients because robust outpatient services for close follow-up are lacking. Objective: To assess whether the availability of a 45-day behavioral health-virtual patient navigation program decreases hospitalization among patients presenting to the ED with a behavioral health crisis or need. Design, Setting, and Participants: This randomized clinical trial enrolled 637 patients who presented to 6 EDs spanning urban and suburban locations within a large integrated health care system in North Carolina from June 12, 2017, through February 14, 2018; patients were followed up for up to 45 days. Eligible patients were aged 18 years or older, with a behavioral health crisis and a completed telepsychiatric ED consultation. The availability of the behavioral health-virtual patient navigation intervention was randomly allocated to specific days (Monday through Friday from 7 am to 7 pm) so that, in a 2-week block, there were 5 intervention days and 5 usual care days; 323 patients presented on days when the program was offered, and 314 presented on usual care days. Data analysis was performed from March 7 through June 13, 2018, using an intention-to-treat approach. Interventions: The behavioral health-virtual patient navigation program included video contact with a patient while in the ED and telephonic outreach 24 to 72 hours after discharge and then at least weekly for up to 45 days. Main Outcomes and Measures: The primary outcome was the conversion of an ED encounter to hospital admission. Secondary outcomes included 45-day follow-up encounters with a self-harm diagnosis and postdischarge acute care use. Results: Among 637 participants, 358 (56.2%) were men, and the mean (SD) age was 39.7 (16.6) years. The conversion rates were 55.1% (178 of 323) in the intervention group vs 63.1% (198 of 314) in the usual care group (odds ratio, 0.74; 95% CI, 0.54-1.02; P = .06). The percentage of patient encounters with follow-up encounters having a self-harm diagnosis was significantly lower in the intervention group compared with the usual care group (36.8% [119 of 323] vs 45.5% [143 of 314]; P = .03). Conclusions and Relevance: Although the primary result did not reach statistical significance, there is a strong signal of potential positive benefit in an area that lacks evidence, suggesting that there should be additional investment and inquiry into virtual behavioral health programs. Trial Registration: ClinicalTrials.gov identifier: NCT03204643.


Asunto(s)
Terapia Conductista/métodos , Servicio de Urgencia en Hospital , Trastornos Mentales/terapia , Admisión del Paciente/estadística & datos numéricos , Telemedicina/organización & administración , Adulto , Medicina de la Conducta/métodos , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , North Carolina , Automanejo/educación , Resultado del Tratamiento , Adulto Joven
4.
J Stroke Cerebrovasc Dis ; 29(2): 104480, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31780246

RESUMEN

OBJECTIVES: Acute ischemic stroke is one of the leading causes of death. Patient outcomes, such as in-patient mortality, may be impacted by the time of arrival to the hospital. Telestroke networks have been found to be effective and safe at treating acute ischemic strokes. This paper investigated the association between mortality and time of arrival and hospital's participation in a telestroke network. METHODS: Data were collected on ischemic stroke patients who arrived at 15 nonteaching hospitals in Georgia's Paul Coverdell Acute stroke registry from 2009 to 2016. After controlling for patient and hospital characteristics, multivariate logistic regression was conducted to assess whether time of arrival and telestroke participation was associated with in-hospital mortality. Subgroup analysis was conducted based on hospital bed size. RESULTS: Overall, a total of 19,759 admissions for acute ischemic stroke were included in this analysis. The odds of dying in the hospital when arriving during the nighttime are 1.22 times the odds of dying when arriving during the day (95% CI: 1.04-1.45) and the odds of dying at a telestroke hospital are 53% lower than at a nontelestroke hospital (OR .47, 95% CI .31-.71). The associations were more prominent in large hospitals. CONCLUSIONS: Our study found that the hour of arrival for acute ischemic stroke is linked with in-hospital mortality in large hospitals, with patients more likely to die if they arrive during the nighttime hours as compared to the daytime hours. Telestroke participation is linked with lower odds of hospital mortality in all hospitals.


Asunto(s)
Atención Posterior , Isquemia Encefálica/mortalidad , Isquemia Encefálica/terapia , Mortalidad Hospitalaria , Admisión del Paciente , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Telemedicina/organización & administración , Adolescente , Adulto , Anciano , Isquemia Encefálica/diagnóstico , Prestación Integrada de Atención de Salud/organización & administración , Femenino , Georgia/epidemiología , Capacidad de Camas en Hospitales , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/organización & administración , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
5.
Clin Nurse Spec ; 34(1): 17-22, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31789959

RESUMEN

PURPOSE/AIMS: Development and implementation of a predictive analytic scoring system in a system of 21 hospitals required 24-hour surveillance to ensure alerts were responded and acted upon. Identification of gaps in patient care created an opportunity to innovate and develop a team to integrate both workflows. DESCRIPTION OF PROJECT/PROGRAM: A Virtual Nurse team of master's degree-prepared nurses with backgrounds in intensive care and management led by a clinical nurse specialist work remotely from their homes. Each nurse is assigned to either of 2 workflows: Advance Alert Monitor-predictive analytic scores or e-Hospital involving capturing of care gaps. The Virtual Nurse team covers 24 hours a day/7 days a week. OUTCOMES: The program has resulted in 169 lives saved and an observed-to-expected mortality of 0.8. Improvements in standard workflows across the system have enabled Rapid Response Teams to be implemented in each hospital. CONCLUSIONS: The success of the Virtual Nurse team has resulted in developments to spread the program into other Kaiser Permanente regions. The Virtual Nurse team has grown to 40 nurses and will expand as the program spreads.


Asunto(s)
Enfermeras Clínicas , Grupo de Enfermería/organización & administración , Atención al Paciente/normas , Telemedicina/organización & administración , Humanos , Investigación en Evaluación de Enfermería
6.
Mayo Clin Proc ; 94(12): 2510-2523, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31806104

RESUMEN

Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed. PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy. Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians' perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.


Asunto(s)
Servicios de Salud Mental/organización & administración , Telemedicina/organización & administración , Humanos , Videoconferencia
7.
BMC Health Serv Res ; 19(1): 997, 2019 12 26.
Artículo en Inglés | MEDLINE | ID: mdl-31878923

RESUMEN

BACKGROUND: Psychological treatment delivered by telephone is recommended by the National Institute for Health and Care Excellence (NICE) for mild to moderate depression and anxiety, and forms a key part of the Improving Access to Psychological Therapy (IAPT) programme in the UK. Despite evidence of clinical effectiveness, patient engagement is often not maintained and psychological wellbeing practitioners (PWPs) report lacking confidence and training to deliver treatment by telephone. This study aimed to explore the perspectives of professional decision makers (both local and national) on the barriers and facilitators to the implementation of telephone treatment in IAPT. METHODS: Sixteen semi-structured qualitative telephone interviews and one focus group were carried out with decision makers (n = 21) who were involved locally and nationally in policy, practice and research. The interviews and focus group were coded thematically, and then mapped onto the four core constructs of Normalisation Process Theory (NPT). RESULTS: The use of telephone for psychological treatment was universally recognised amongst participants as beneficial for improving patient choice and access to treatment. However, at service level, motives for the implementation of telephone treatments are often misaligned with national objectives. Pressure to meet performance targets has become a key driver for the use of telephone treatment, with promises of increased efficiency and cost savings. These service-focussed objectives challenge the integration of telephone treatments, and PWP acceptance of telephone treatments as non-inferior to face-to-face. Ambivalence among a workforce often lacking the confidence to deliver telephone treatments leads to reluctance among PWPs to 'sell' treatments to a patient population who are not generally expecting treatment in this form. CONCLUSIONS: Perceptions of a need to 'sell' telephone treatment in IAPT persist from top-level decision makers down to frontline practitioners, despite their conflicting motives for the use of telephone. The need for advocacy to highlight the clinical benefit of telephone treatment, along with adequate workforce support and guidance on best practice for implementation is critical to the ongoing success and sustainability of telephone treatment in primary care mental health programmes.


Asunto(s)
Ansiedad/terapia , Actitud del Personal de Salud , Toma de Decisiones en la Organización , Depresión/terapia , Accesibilidad a los Servicios de Salud/organización & administración , Telemedicina/organización & administración , Teléfono , Femenino , Grupos Focales , Humanos , Masculino , Investigación Cualitativa , Medicina Estatal/organización & administración , Reino Unido
8.
BMC Health Serv Res ; 19(1): 984, 2019 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-31864370

RESUMEN

BACKGROUND: Having a tax-funded and supposedly 'National' Health Service (NHS), one might assume that the UK is well-positioned to roll out eHealth innovations at scale. Yet, despite a strong policy push, the English NHS has been limited in the extent to which it has exploited the potential of eHealth. MAIN BODY: This paper considers a range of macro, meso and micro factors influencing eHealth innovation in the English NHS. CONCLUSIONS: While barriers to eHealth innovation exist at all scales, the fragmentation of the NHS is the most significant factor limiting adoption and diffusion. Rather than addressing problems of fragmentation, national policy seems to have intensified the digital divide. As the recently published NHS Long Term Plan places great emphasis on the role of digital transformation in helping health and care professionals communicate better and enabling people to access the care they need quickly and easily, the implications for the digital divide are likely to be significant for effectiveness, efficiency and equity.


Asunto(s)
Difusión de Innovaciones , Medicina Estatal/organización & administración , Telemedicina/organización & administración , Inglaterra , Humanos
9.
Perm J ; 232019.
Artículo en Inglés | MEDLINE | ID: mdl-31702984

RESUMEN

INTRODUCTION: Despite guidelines for prevention of recurrent renal calculi, routine dietary modification and metabolic evaluation are often not performed. OBJECTIVE: To determine feasibility of a multicenter, pharmacist-staffed program to enroll patients at high risk of recurrent kidney stones and provide dietary instruction, metabolic evaluation, and medical therapy via telemedicine. METHODS: A total of 536 consecutive adult patients were referred from 3 Northern California Kaiser Permanente facilities. We determined the proportion of patients who enrolled, received dietary counseling, and completed metabolic evaluation at 12 months. The program was staffed by a clinical pharmacist and supervised by urologists following a protocol based on the American Urological Association guidelines. Patients were contacted entirely via telemedicine. Cystine or struvite kidney stones, renal tubular acidosis, and primary hyperoxaluria were exclusion criteria. RESULTS: Of the 536 patients, 500 agreed to enrollment. Among patients enrolled for 3 months, 99% self-reported compliance with at least 3 of 5 aspects of dietary advice. A complete metabolic evaluation including 24-hour urine collection was performed in 80% of patients by 12 months. A significant improvement in all urinary parameters occurred in 52 patients with calcium stones who repeated 24-hour urine testing. The 12-month dropout rate was 12.4%. CONCLUSION: A telemedicine-administered, pharmacist-staffed, protocol-driven program can provide dietary advice and obtain compliance with metabolic testing for patients at high risk of recurrent kidney stones. Rates of metabolic testing and dropout compare favorably with previously reported rates. This report represents, to our knowledge, the first telemedicine-administered, pharmacist-staffed, kidney stone prevention program published in the literature.


Asunto(s)
Prestación Integrada de Atención de Salud/métodos , Cálculos Renales/prevención & control , Farmacéuticos , Telemedicina/métodos , Adulto , Anciano , Anciano de 80 o más Años , Protocolos Clínicos , Prestación Integrada de Atención de Salud/organización & administración , Dieta , Estudios de Factibilidad , Femenino , Humanos , Cálculos Renales/epidemiología , Masculino , Persona de Mediana Edad , Farmacéuticos/organización & administración , Proyectos Piloto , Telemedicina/organización & administración , Adulto Joven
10.
J Glob Health ; 9(2): 020428, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31673341

RESUMEN

Background: Health Alliance International (HAI) with the Ministry of Health (MoH) of Timor-Leste and Catalpa International implemented a mobile phone-based mHealth program in 2013 known as Liga Inan ("Connecting Mothers"). Liga Inan was designed as a sustainable and scalable effort that would support MoH efforts to improve maternal and newborn health care-seeking and home practices. Key aims were to use mobile phone technology to improve communication between pregnant women and their MoH health providers and to increase optimal maternal health behaviors. MoH health staff registered pregnant women into Liga Inan at their first antenatal care (ANC) visit and followed them through pregnancy, delivery and six months postpartum. A web-based platform sent text messages twice weekly to promote safe pregnancy/delivery and facilitated phone communication between pregnant women and their MoH care providers. Methods: For the program's final evaluation, baseline (2012) and final (2015) surveys interviewed women in one intervention district and one adjacent control district who had given birth in the preceding two years. Primary outcomes were receiving four or more ANC visits, using skilled birth attendants, delivery in health facilities, and timely postnatal care. Results: Multivariate analysis compared endline maternal health behaviors for women in the intervention district compared to baseline and to women in the control district. Controlling for other factors, women in the intervention district had nearly twice the odds of having a skilled birth attendant and a facility delivery, nearly five times the odds of receiving a postpartum care visit within two days of delivery, and over five times the odds of having their newborn's health checked within two days of birth. There was no significant association between Liga Inan exposure and receipt of four or more ANC visits. Conclusions: Liga Inan was associated with substantial increases in MoH health provider-assisted and facility-based births and timely postnatal care in Timor-Leste. These positive results led the MoH to incorporate Liga Inan into the national maternal and child health program. To date the program has expanded to cover all 13 districts in the country, with gradual assumption of management and financial responsibility by the MoH under way.


Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Atención Posnatal/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Telemedicina/organización & administración , Adolescente , Adulto , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Recién Nacido , Persona de Mediana Edad , Embarazo , Evaluación de Programas y Proyectos de Salud , Timor Oriental , Adulto Joven
11.
BMC Health Serv Res ; 19(1): 800, 2019 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-31690287

RESUMEN

BACKGROUND: The growing field of participation in healthcare has the potential to provide a number of benefits for children, patients, healthcare professionals and also the healthcare systems. According to the Convention on the Rights of the Child (UNCRC), children have the right to participate in their own healthcare and make their voice heard. Children's opportunities for understanding their conditions, sharing their views and participating in decisions regarding their care depend on healthcare professionals but also on parents' ability to communicate and include children. E-health solutions can remove barriers to children's communication with healthcare professionals. The aim of this study was to explore parents' perspectives on the outcomes of an e-health solution, Sisom, used by children during healthcare appointments. METHODS: The empirical data is based on interviews with 16 parents. In the present study constructivist, grounded theory was chosen as the method. RESULTS: The theory of enhancing participation, by orientating communication about healthcare towards the voice of the child instead of the parents, summarizes the process of how the outcome of Sisom for children lead to enhanced participation, by making the child the main actor and an agent in his/her own healthcare. The facilitators for achieving participation in Sisom were four interrelated outcomes; engaging, voice-guarding, raising awareness and integrity preserving. In addition to generating increased participation, it emerged that the use of Sisom also initiated a process, which was evident in all four subcategories that facilitated the child in coping with the experience of having an illness. CONCLUSIONS: We conclude, that Sisom orientated communication about healthcare towards the voice of the child instead of the parents as well as including the child in the dialogue with the healthcare professional and thus increasing the child's participation and human rights.


Asunto(s)
Padres/psicología , Pediatría/organización & administración , Telemedicina/organización & administración , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa
12.
Artículo en Inglés | MEDLINE | ID: mdl-31635373

RESUMEN

This study explored the effects of information technology (IT) resources-in conjunction with IT infrastructure and organizational resources-on organizational capabilities and performance. The study further analyzed the mediating effect of organizational capabilities on the relationship between IT resources and organizational performance. A cross-sectional research design was adopted, and questionnaire copies were administered to senior care supervisors of Taiwanese day care centers, care institutions, and hospitals. In total, 328 valid questionnaire responses were obtained. The study results are summarized as follows: (1) A direct effect analysis revealed that IT infrastructure significantly affected service performance and financial performance; organizational resources significantly affected service performance but did not significantly affect financial performance. (2) A mediation model analysis indicated that organizational capabilities exerted a mediating effect on the relationship between IT resources and organizational performance. These results can serve as a reference for medical care organizations in developing strategies for reviewing internal IT resources, integrating internal and external capabilities, creating a competitive advantage, and boosting their performance.


Asunto(s)
Administración de Instituciones de Salud , Recursos en Salud , Administración Hospitalaria , Telemedicina/organización & administración , Estudios Transversales , Eficiencia Organizacional , Humanos , Tecnología de la Información , Encuestas y Cuestionarios , Taiwán
13.
Nurse Pract ; 44(11): 30-35, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31567701

RESUMEN

Consumers of healthcare services are demanding more convenient and accessible options to care. Technologic advancements can support this demand, but telehealth knowledge is lacking. This article will describe the current state of telehealth and examine the role that NPs can play in furthering its adoption.


Asunto(s)
Enfermeras Practicantes , Telemedicina/organización & administración , Humanos , Rol de la Enfermera
14.
BMC Public Health ; 19(1): 1311, 2019 Oct 17.
Artículo en Inglés | MEDLINE | ID: mdl-31623589

RESUMEN

BACKGROUND: The mortality of coronary heart disease can be largely reduced by modifying unhealthy lifestyles. However, the long-term effectiveness of interventions for modifying unhealthy diet and physical inactivity of patients with coronary heart disease remain unsatisfactory worldwide. This study aims to systematically design a set of theory-based and evidence-based, individualized, and intelligent interventions for promoting the adoption and maintenance of a healthy diet and physical activity level in patients with coronary heart disease. METHODS: The interventions will be delivered by a mobile health care system called Individualized, Intelligent and Integrated Cardiovascular Application for Risk Elimination. Three steps of the intervention mapping framework were used to systematically develop the interventions. Step 1: needs assessment, which was carried out by a literature review, in-depth interviews and focus group discussions. Step 2: development of objective matrix for diet and physical activity changes, based on the intersection of objectives and determinants from the Contemplation-Action-Maintenance behavior change model. Step 3: formulation of evidence-based methods and strategies, and practical applications, through a systematic review of existing literature, research team discussions, and consultation with multidisciplinary expert panels. RESULTS: Three needs relevant to content of the intervention, one need relevant to presentation modes of the intervention, and four needs relevant to functional features of the application were identified. The objective matrix includes three performance objectives, and 24 proximal performance objectives. The evidence-based and theory-based interventions include 31 strategies, 61 evidence-based methods, and 393 practical applications. CONCLUSIONS: This article describes the development of theory-based and evidence-based interventions of the mobile health care system for promoting the adoption and maintenance of a healthy diet and physical activity level in a structured format. The results will provide a theoretical and methodological basis to explore the application of intervention mapping in developing effective behavioral mobile health interventions for patients with coronary heart disease. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-INR-16010242. Registered 24 December 2016. http://www.chictr.org.cn/index.aspx.


Asunto(s)
Enfermedad Coronaria/prevención & control , Ejercicio , Promoción de la Salud/organización & administración , Telemedicina/organización & administración , Adulto , Femenino , Promoción de la Salud/métodos , Humanos , Inteligencia , Masculino , Persona de Mediana Edad , Medicina de Precisión , Telemedicina/métodos
15.
BMC Health Serv Res ; 19(1): 681, 2019 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-31547824

RESUMEN

BACKGROUND: Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform. METHODS: This study aims at exploring the Pediatric Telecardiology Service's evolution, through a comprehensive assessment of the PCS's development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon's framework helped to understand the implementation and scale-up process and the role of policy-making. RESULTS: With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year). PCS presents a dominant "Clan" culture. The Momentum's critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals' engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service. CONCLUSION: The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa. Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.


Asunto(s)
Cardiología/métodos , Pediatría/métodos , Consulta Remota/organización & administración , Telemedicina/organización & administración , África , Niño , Comunicación , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Portugal , Consulta Remota/estadística & datos numéricos , Consulta Remota/tendencias , Telemedicina/estadística & datos numéricos , Telemedicina/tendencias
16.
Z Gerontol Geriatr ; 52(6): 529-536, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31492973

RESUMEN

BACKGROUND: The support of relatives living far away in terms of distance caregiving between children and their parents has gained in importance in Europe. At the same time, little is known about these care arrangements based on representative European survey data. OBJECTIVE: This article is concerned with the following questions: which statements are possible in Europe about the prevalence of persons caring for at least one parent from a geographical distance? Which forms of support are provided and which other specific socioeconomic and health-related aspects characterize these care situations? In this respect special attention is paid to differences to relatives who provide help close to their parents who are in need of care. MATERIAL AND METHODS: Data from the Survey of Health, Ageing and Retirement in Europe (SHARE) from the sixth wave of the survey in 2015 were used to perform a descriptive analysis and multivariate logistic regression. RESULTS AND CONCLUSION: The analysis showed that distance caregiving is more than a marginal phenomenon in Europe with a prevalence of 11% for a relatively close terminology (over 100 km distance between locations) and 23% for a broader terminology (over 25 km); however, the various countries are very different in terms of prevalence. The findings also point to some significant differences in terms of resources, care tasks and quality of life compared to caregivers in the same household. In light of these dynamically developing distance caregiving arrangements, this article can provide further discussion, critical reflection, and advancement to the operationalization of informal care.


Asunto(s)
Envejecimiento , Cuidadores , Familia , Jubilación , Telemedicina , Niño , Europa (Continente) , Humanos , Calidad de Vida , Encuestas y Cuestionarios , Telemedicina/organización & administración
18.
J Clin Nurs ; 28(21-22): 3935-3948, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31410925

RESUMEN

AIMS AND OBJECTIVES: To develop an understanding of how Indigenous mothers experience selecting and using health services for their infants can assist nurses in improving their access to care. This understanding may ultimately lead to improved health outcomes for Indigenous infants and their families. BACKGROUND: Access to acute care services is important to minimise morbidity and mortality from urgent health issues; however, Indigenous people describe difficulties accessing care. Indigenous infants are known to use the emergency department frequently, yet little is known about the facilitators and barriers their mothers experience when accessing these services. DESIGN: This study undertook a qualitative, interpretive description design. METHODS: This article adheres to the reporting guidelines of COREQ. Data collection methods included interviews and a discussion group with Indigenous mothers (n = 19). Data analysis was collaborative and incorporated both Indigenous and Western ways of knowing, through the application of Two-Eyed Seeing. RESULTS: A thematic summary resulted in six themes: (a) problematic wait times; (b) the hidden costs of acute care; (c) paediatric care; (d) trusting relationships; (e) racism and discrimination; and (f) holistic care. CONCLUSIONS: The experiences of Indigenous mothers using acute care services for their infants suggest a role for culturally safe and trauma and violence-informed care by health providers in the acute care context. RELEVANCE TO CLINICAL PRACTICE: Nurses can improve access to acute care services for Indigenous mothers and infants through the provision of culturally safe and trauma and violence-informed approaches care, by building rapport with families, providing care that is respectful and nonjudgemental, eliminating fees associated with using acute care services and linking families with cultural resources both in hospital and within the community.


Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Disparidades en Atención de Salud , Indios Norteamericanos/estadística & datos numéricos , Madres/psicología , Adulto , Instituciones de Atención Ambulatoria/organización & administración , Canadá , Servicios Médicos de Urgencia/organización & administración , Femenino , Humanos , Indios Norteamericanos/psicología , Lactante , Investigación Cualitativa , Telemedicina/organización & administración
19.
Int J Health Care Qual Assur ; 32(7): 1072-1080, 2019 Aug 12.
Artículo en Inglés | MEDLINE | ID: mdl-31411096

RESUMEN

PURPOSE: The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources, increasing operational efficiency and considering new processes all have a role in improving delivering these services. The purpose of this paper is to evaluate the safety of a physician associate (PA) delivered virtual outpatient department (VOPD) consultation service that was established in a General and Colorectal Surgery Department at an Irish teaching hospital. DESIGN/METHODOLOGY/APPROACH: A series of low-risk surgical patients were referred by senior surgeons to a PA delivered virtual clinic (VOPD). Medical records belonging to half the included patients were randomly selected for review by two doctors three months following discharge back to primary care to confirm appropriate standards of care and documentation and to audit any recorded adverse incidents or outcomes. FINDINGS: In total, 191 patients had been reviewed by the PA in the VOPD with 159 discharged directly back to primary care. Among the 95 medical records that were reviewed by the NCHDs, there were no recorded adverse incidents after discharge. Medical record keeping was deficient in 1 out of 95 reviewed cases. PRACTICAL IMPLICATIONS: Using a PA delivered VOPD consultation appears to have a role in following up patients who have undergone low-risk procedures irrespective of age or co-morbidity when selected appropriately. This may assist in reducing the demand on outpatient services by reducing unnecessary return visits, thereby increasing the capacity for new referrals. ORIGINALITY/VALUE: While there are reported examples to date of virtual clinics, these relate to services delivered by registered medical practitioners. Here, the authors demonstrate the acceptability of this model of care in an Irish population as delivered by a PA.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Asistentes Médicos/organización & administración , Atención Primaria de Salud/organización & administración , Telemedicina/organización & administración , Adulto , Factores de Edad , Anciano , Colonoscopía/efectos adversos , Colonoscopía/métodos , Comorbilidad , Eficiencia Organizacional , Femenino , Hospitales de Enseñanza , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Factores de Riesgo , Escleroterapia/efectos adversos , Escleroterapia/métodos
20.
Trials ; 20(1): 502, 2019 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-31412937

RESUMEN

BACKGROUND: Globally, eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services; in addition, specialist services are over-utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smartphone-based screening algorithm (Peek Community Screening App). The application (App) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteers (CV) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients or guardians and has a program dashboard for visualising service delivery. We hypothesise that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches. STUDY DESIGN: A single masked, cluster randomised controlled trial design will be used. The unit of randomisation will be the 'community unit', defined as a dispensary or health centre with its catchment population. The community units will be allocated to receive either the intervention (Peek CEH system) or the current care (periodic health centre-based outreach clinics with onward referral for further treatment). In both arms, a triage clinic will be held at the link health facility four weeks from sensitisation, where attendance will be ascertained. During triage, participants will be assessed and treated and, if necessary, referred onwards to Kitale Eye Unit. DISCUSSION: We aim to evaluate a M-health system (Peek CEH) geared towards reducing avoidable blindness through early identification and improved adherence to referral for those with eye problems and reducing demand at secondary care for conditions that can be managed effectively at primary care level. TRIAL REGISTRATION: The Pan African Clinical Trials Registry (PACTR), 201807329096632 . Registered on 8 June 2018.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Agentes Comunitarios de Salud/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Técnicas de Diagnóstico Oftalmológico , Oftalmopatías/terapia , Aplicaciones Móviles , Oftalmología/organización & administración , Telemedicina/organización & administración , Oftalmopatías/diagnóstico , Femenino , Humanos , Kenia , Masculino , Valor Predictivo de las Pruebas , Ensayos Clínicos Controlados Aleatorios como Asunto , Derivación y Consulta/organización & administración , Mensaje de Texto
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