98 results on '"digital care"'
Search Results
2. Study on the relationship between technology, data and body isomorphism—The example of smartwatches
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Yuqian Lu, Zihan Zhou, and Xuelian Li
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Smart watch ,Self-tracking ,Technical body ,Digital care ,Information technology ,T58.5-58.64 ,Telecommunication ,TK5101-6720 - Abstract
The Smart Watch has become an important tool for individuals to understand the physical body, construct the technological body and promote the right of self-determination of the body. This study examined the daily self-tracking practices of 25 smartwatch users through participatory observation and semi-structured interviews. On the one hand, the tracking data generated by the smartwatch helps to build the technological body, thus digitizing the body and empowering the individual's body cognition. On the other hand, continuous monitoring results in the body being shaped by technology and data, and people bear the cost of digitization under the power of Technology. This study also noted the care logic of smart watches. When children give their parents smart watches as gifts, a lively and powerful practice of digital care is taking place. The investigation of the self-tracking practice in the use of smart watches is helpful to understand the role of data technology in contemporary life politics from the perspective of human subjectivity.
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- 2024
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3. Telemedicine in Swedish primary health care - a web-based survey exploring patient satisfaction
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Carl Rockler Meurling, Elisabet Adell, Moa Wolff, Susanna Calling, Veronica Milos Nymberg, and Beata Borgström Bolmsjö
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Telemedicine ,Digital care ,Satisfaction ,Primary health care ,Symptom group ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Direct-to-consumer telemedicine (TM), with patients having access to a physician via video or text chat, has gradually been introduced into Swedish primary care during the last two decades. Earlier studies have concluded that patients were generally satisfied with TM and the satisfaction rate was consistently above 80% and comparable with in-person visits. Despite the number of studies looking at user experience, studies assessing what factors influence patient satisfaction are lacking. To further develop digital care, it is important to explore the patients’ opinions of this relatively new phenomenon. The primary aim of this study was to explore patient opinions regarding satisfaction with TM-provided care, based on different age groups, sex, symptoms, and which type of health care professional they were assessed by. Methods The study was a quantitative web survey performed in 2020–2021 in which 688 patients using a TM provider in Southern Sweden responded. The results were analysed using Chi-2 test with the main outputs; satisfaction level and percentage that would use TM for similar symptoms in the future. Results The results from the survey population show that patients that were assessed by a doctor were more likely to intend to use TM in the future and were more satisfied with the visit than patients assessed by a nurse. Our results also show that patients older than 70 years of age were less likely to use TM again compared to the total population. Conclusion This study shows that patient satisfaction with TM varied depending on the patient’s age. The older patients were less satisfied than their younger equivalents. For patient satisfaction to be high, it was also crucial which health care provider the patient had been assessed by. The patients were more satisfied when assessed by a doctor than by a nurse. In addition, the study shows that patient satisfaction with TM was generally comparable to traditional care.
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- 2023
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4. Librarians bridging the digital divide: Experiences from Finland.
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Lehtinen, Emmi, Poutanen, Seppo, and Kovalainen, Anne
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LIBRARIANS , *DIGITAL divide , *PUBLIC libraries , *DIGITAL library resources - Abstract
In various countries, public libraries play a crucial role in supporting citizens' access to public online services. In Finland, libraries provide both traditional library services and digital support to help customers access their personal bank accounts and health records. However, the impact these new support demands on librarians' expertise and work remains understudied. To address this gap, we interviewed 21 librarians, exploring their experiences in providing digital access services. Qualitative thematic analysis of the transcripts revealed four situational dimensions of digital care work, which encompasses ethical and emotional aspects. We also recommend some best practices for digital access services. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Co-Designing Digital Technologies for Improving Clinical Care in People with Parkinson's Disease: What Did We Learn?
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Monje, Mariana H. G., Grosjean, Sylvie, Srp, Martin, Antunes, Laura, Bouça-Machado, Raquel, Cacho, Ricardo, Domínguez, Sergio, Inocentes, John, Lynch, Timothy, Tsakanika, Argyri, Fotiadis, Dimitrios, Rigas, George, Růžička, Evžen, Ferreira, Joaquim, Antonini, Angelo, Malpica, Norberto, Mestre, Tiago, and Sánchez-Ferro, Álvaro
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PARKINSON'S disease , *DIGITAL technology , *CLINICAL medicine , *CARE of people , *INTEGRATIVE medicine - Abstract
The healthcare model is shifting towards integrated care approaches. This new model requires patients to be more closely involved. The iCARE-PD project aims to address this need by developing a technology-enabled, home-based, and community-centered integrated care paradigm. A central part of this project is the codesign process of the model of care, exemplified by the active participation of patients in the design and iterative evaluation of three sensor-based technological solutions. We proposed a codesign methodology used for testing the usability and acceptability of these digital technologies and present initial results for one of them, MooVeo. Our results show the usefulness of this approach in testing the usability and acceptability as well as the opportunity to incorporate patients' feedback into the development. This initiative will hopefully help other groups incorporate a similar codesign approach and develop tools that are well adapted to patients' and care teams' needs. [ABSTRACT FROM AUTHOR]
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- 2023
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6. An evaluation of registered nurses’ experiences of person-centered care and competence after participating in a course in digital competence in care
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Malin Carlsson, Annika Kjällman Alm, and Malin Holmström Rising
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Competence ,Digital care ,Person-centred care ,Qualitative content analysis ,Registered nurses ,Nursing ,RT1-120 - Abstract
Abstract Background Health care’s rapid transition from in-person visits to more digital care meetings has challenged nurses to find new, sustainable ways of using digital technology. Methods The aim was to describe registered nurses’(RN) experiences with person-centred care (PCC) and competence after participating in a course in Digital Competence in Care (DCC). In this study, a qualitative descriptive design was used, and 16 individual interviews were carried out with RNs. Data were analysed using qualitative content analysis. The COREQ checklist was used in this study. Results The results were presented in four categories: being open to change and new ways of working with patients; struggling to handle requirements; developing new ways of working and focusing on patients despite the distance. Conclusions The DCC course helped develop RNs' skills and practice of PCC in digital care meetings. Training in digital care theory increased RNs' competence and facilitated the creation of new knowledge. The RNs' professional role was strengthened by participating in the changing of work routines. Digital care meetings were shown to be distance bridging and complementary to physical care meetings contributing to PCC. The increased availability of health care via digital means has affected the consumption of care and tailored education needs for RNs must be met by nursing education programs. Digital care is accessible, efficient and enables care regardless of geographical conditions, its innovative development needs to be based on science and experience and RNs are key personnel in this process. Trial registration Not applicable.
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- 2022
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7. An evaluation of registered nurses’ experiences of person-centered care and competence after participating in a course in digital competence in care.
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Carlsson, Malin, Alm, Annika Kjällman, and Rising, Malin Holmström
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Background: Health care’s rapid transition from in-person visits to more digital care meetings has challenged nurses to find new, sustainable ways of using digital technology. Methods: The aim was to describe registered nurses’(RN) experiences with person-centred care (PCC) and competence after participating in a course in Digital Competence in Care (DCC). In this study, a qualitative descriptive design was used, and 16 individual interviews were carried out with RNs. Data were analysed using qualitative content analysis. The COREQ checklist was used in this study. Results: The results were presented in four categories: being open to change and new ways of working with patients; struggling to handle requirements; developing new ways of working and focusing on patients despite the distance. Conclusions: The DCC course helped develop RNs' skills and practice of PCC in digital care meetings. Training in digital care theory increased RNs' competence and facilitated the creation of new knowledge. The RNs' professional role was strengthened by participating in the changing of work routines. Digital care meetings were shown to be distance bridging and complementary to physical care meetings contributing to PCC. The increased availability of health care via digital means has affected the consumption of care and tailored education needs for RNs must be met by nursing education programs. Digital care is accessible, efficient and enables care regardless of geographical conditions, its innovative development needs to be based on science and experience and RNs are key personnel in this process. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]
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- 2022
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8. The Ongoing and Collective Character of Digital Care for Older People: Moving Beyond Techno-Determinism in Government Policy.
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Lindberg, Jens, Kvist, Elin, and Lindgren, Simon
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SCHOLARLY method , *DIGITAL technology , *SOCIAL networks , *PUBLIC administration , *GOVERNMENT policy , *POLICY sciences , *ELDER care , *TELEMEDICINE , *OLD age - Abstract
In this article, we contrast policy understandings of digital care with older people's day-to-day digital care. In doing so, we discuss problems relating to deterministic approaches in government policy. Our policy analysis shows that digital care is articulated as an individual practice, and digital technologies as static actors. This bears clear marks of techno-deterministic reasoning. Our ethnographic study demonstrates the ongoing and collective character of older people's digital care. When policy is not aligned with everyday practice, there is a risk of excluding groups of users. We argue that a socio-technical approach in government policy could contribute to achieving important societal goals. [ABSTRACT FROM AUTHOR]
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- 2022
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9. The Impact of COVID-19 on Older Adults' Perceptions of Virtual Care: Qualitative Study.
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Abdallah, Lama, Stolee, Paul, Lopez, Kimberly J., Whate, Alexandra, Boger, Jennifer, and Tong, Catherine
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COVID-19 pandemic ,OLDER people ,TECHNOLOGY & older people ,TELEMEDICINE ,DIGITAL divide - Abstract
Background: In response to the COVID-19 pandemic, older adults worldwide have increasingly received health care virtually, and health care organizations and professional bodies have indicated that virtual care is "here to stay." As older adults are the highest users of the health care system, virtual care implementation can have a significant impact on them and may pose a need for additional support. Objective: This research aims to understand older adults' perspectives and experiences of virtual care during the pandemic. Methods: As part of a larger study on older adults' technology use during the pandemic, we conducted semistructured interviews with 20 diverse older Canadians (mean age 76.9 years, SD 6.5) at 2 points: summer of 2020 and winter/early spring of 2021. Participants were asked about their technology skills, experiences with virtual appointments, and perspectives on this type of care delivery. Interviews were digitally recorded and transcribed. A combination of team-based and framework analyses was used to interpret the data. Results: Participants described their experiences with both in-person and virtual care during the pandemic, including issues with accessing care and long gaps between appointments. Overall, participants were generally satisfied with the virtual care they received during the pandemic. Participants described the benefits of virtual care (eg, increased convenience, efficiency, and safety), the limitations of virtual care (eg, need for physical examination and touch, lack of nonverbal communication, difficulties using technology, and systemic barriers in access), and their perspectives on the future of virtual care. Half of our participants preferred a return to in-person care after the COVID-19 pandemic, while the other half preferred a combination of in-person and virtual services. Many participants who preferred to access in-person services were not opposed to virtual care options, as needed; however, they wanted virtual care as an option alongside in-person care. Participants emphasized a need for training and support to be meaningfully implemented to support both older adults and providers in using virtual care. Conclusions: Overall, our research identified both perceived benefits and perceived limitations of virtual care, and older adult participants emphasized their wish for a hybrid model of virtual care, in which virtual care is viewed as an addendum, not a replacement for in-person care. We recognize the limitations of our sample (small, not representative of all older Canadians, and more likely to use technology); this body of literature would greatly benefit from more research with older adults who do not/cannot use technology to receive care. Findings from this study can be mobilized as part of broader efforts to support older patients and providers engaged in virtual and in-person care, particularly post-COVID-19. [ABSTRACT FROM AUTHOR]
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- 2022
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10. Effects of a Digital Care Pathway for Multiple Sclerosis: Observational Study.
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Vesinurm M, Maunula A, Olli P, Lillrank P, Ijäs P, Torkki P, Mäkitie L, and Laakso SM
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- Humans, Male, Female, Middle Aged, Adult, Patient Satisfaction, Critical Pathways, Case-Control Studies, Finland, Telemedicine, Surveys and Questionnaires, Multiple Sclerosis psychology, Multiple Sclerosis therapy
- Abstract
Background: Helsinki University Hospital has developed a digital care pathway (DCP) for people with multiple sclerosis (MS) to improve the care quality. DCP was designed for especially newly diagnosed patients to support adaptation to a chronic disease., Objective: This study investigated the MS DCP user behavior and its impact on patient education-mediated changes in health care use, patient-perceived impact of MS on psychological and physical functional health, and patient satisfaction., Methods: We collected data from the service launch in March 2020 until the end of 2022 (observation period). The number of users, user logins, and their timing and messages sent were collected. The association of the DCP on health care use was studied in a case-control setting in which patients were allowed to freely select whether they wanted to use the service (DCP group n=63) or not (control group n=112). The number of physical and remote appointments either to a doctor, nurse, or other services were considered in addition to emergency department visits and inpatient days. The follow-up time was 1 year (study period). Furthermore, a subgroup of 36 patients was recruited to fill out surveys on net promoter score (NPS) at 3, 6, and 12 months, and their physical and psychological functional health (Multiple Sclerosis Impact Scale) at 0, 3, 6, and 12 months., Results: During the observation period, a total of 225 patients had the option to use the service, out of whom 79.1% (178/225) logged into the service. On average, a user of the DCP sent 6.8 messages and logged on 7.4 times, with 72.29% (1182/1635) of logins taking place within 1 year of initiating the service. In case-control cohorts, no statistically significant differences between the groups were found for physical doctors' appointments, remote doctors' contacts, physical nurse appointments, remote nurse contacts, emergency department visits, or inpatient days. However, the MS DCP was associated with a 2.05 (SD 0.48) visit increase in other services, within 1 year from diagnosis. In the prospective DCP-cohort, no clinically significant change was observed in the physical functional health between the 0 and 12-month marks, but psychological functional health was improved between 3 and 6 months. Patient satisfaction improved from the NPS index of 21 (favorable) at the 3-month mark to the NPS index of 63 (excellent) at the 12-month mark., Conclusions: The MS DCP has been used by a majority of the people with MS as a complementary service to regular operations, and we find high satisfaction with the service. Psychological health was enhanced during the use of MS DCP. Our results indicate that DCPs hold great promise for managing chronic conditions such as MS. Future studies should explore the potential of DCPs in different health care settings and patient subgroups., (©Märt Vesinurm, Anna Maunula, Päivi Olli, Paul Lillrank, Petra Ijäs, Paulus Torkki, Laura Mäkitie, Sini M Laakso. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 07.08.2024.)
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- 2024
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11. Telemedicine in Swedish primary health care - a web-based survey exploring patient satisfaction
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Rockler Meurling, Carl, Adell, Elisabet, Wolff, Moa, Calling, Susanna, Milos Nymberg, Veronica, and Borgström Bolmsjö, Beata
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- 2023
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12. Providing Holistic Care
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Marsden, Daniel, Cooper, Susan, Heslop, Pauline, editor, and Hebron, Crispin, editor
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- 2020
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13. The cost-effectiveness of digital health interventions: A systematic review of the literature
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Andrea Gentili, Giovanna Failla, Andriy Melnyk, Valeria Puleo, Gian Luca Di Tanna, Walter Ricciardi, and Fidelia Cascini
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digital health ,telemedicine ,mobile health ,electronic health ,telehealth ,digital care ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundDigital health interventions have significant potential to improve safety, efficacy, and quality of care, reducing waste in healthcare costs. Despite these premises, the evidence regarding cost and effectiveness of digital tools in health is scarce and limited.ObjectivesThe aim of this systematic review is to summarize the evidence on the cost-effectiveness of digital health interventions and to assess whether the studies meet the established quality criteria.MethodsWe queried PubMed, Scopus and Web of Science databases for articles in English published from January 1, 2016 to December 31, 2020 that performed economic evaluations of digital health technologies. The methodological rigorousness of studies was assessed with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2009 checklist.ResultsSearch identified 1,476 results, 552 of which were selected for abstract and 35 were included in this review. The studies were heterogeneous by country (mostly conducted in upper and upper-middle income countries), type of eHealth intervention, method of implementation, and reporting perspectives. The qualitative analysis identified the economic and effectiveness evaluation of six different types of interventions: (1) seventeen studies on new video-monitoring service systems; (2) five studies on text messaging interventions; (3) five studies on web platforms and digital health portals; (4) two studies on telephone support; (5) three studies on new mobile phone-based systems and applications; and (6) three studies on digital technologies and innovations.ConclusionFindings on cost-effectiveness of digital interventions showed a growing body of evidence and suggested a generally favorable effect in terms of costs and health outcomes. However, due to the heterogeneity across study methods, the comparison between interventions still remains difficult. Further research based on a standardized approach is needed in order to methodically analyze incremental cost-effectiveness ratios, costs, and health benefits.
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- 2022
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14. Co-Designing Digital Technologies for Improving Clinical Care in People with Parkinson’s Disease: What Did We Learn?
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Mariana H. G. Monje, Sylvie Grosjean, Martin Srp, Laura Antunes, Raquel Bouça-Machado, Ricardo Cacho, Sergio Domínguez, John Inocentes, Timothy Lynch, Argyri Tsakanika, Dimitrios Fotiadis, George Rigas, Evžen Růžička, Joaquim Ferreira, Angelo Antonini, Norberto Malpica, Tiago Mestre, Álvaro Sánchez-Ferro, and iCARE-PD Consortium
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digital technologies ,codesign ,digital care ,Parkinson’s disease ,Chemical technology ,TP1-1185 - Abstract
The healthcare model is shifting towards integrated care approaches. This new model requires patients to be more closely involved. The iCARE-PD project aims to address this need by developing a technology-enabled, home-based, and community-centered integrated care paradigm. A central part of this project is the codesign process of the model of care, exemplified by the active participation of patients in the design and iterative evaluation of three sensor-based technological solutions. We proposed a codesign methodology used for testing the usability and acceptability of these digital technologies and present initial results for one of them, MooVeo. Our results show the usefulness of this approach in testing the usability and acceptability as well as the opportunity to incorporate patients’ feedback into the development. This initiative will hopefully help other groups incorporate a similar codesign approach and develop tools that are well adapted to patients’ and care teams’ needs.
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- 2023
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15. Digital citizenship and social vulnerability.
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Abene, Nico
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CITIZENSHIP , *OLDER people - Abstract
This work analyses the problems related to the digital citizenship of disadvantaged and vulnerable social categories, such as the elderly and the sick, in a context that is already marked by advanced marginalization at different levels. [ABSTRACT FROM AUTHOR]
- Published
- 2022
16. Digital Health: Unlocking Value in a Post-Pandemic World.
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D'Anza, Brian and Pronovost, Peter J.
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DIGITAL technology , *MEDICAL care , *COVID-19 pandemic , *TELEMEDICINE - Abstract
The COVID-19 pandemic has forever changed health care, spurring a revolution in digital health technologies. Across the world, hundreds of thousands of health care systems are considering a central question: how do we connect with our patients? Digital health has been used as a stopgap in many cases to continue the essential functions of health systems. As the post-pandemic world and our "new normal" come into focus, further needs will have to be met with a digital patient interaction, with an eye toward value transformation. One barrier to fully leveraging digital tools is the lack of a framework for classifying the type of digital health care. This can limit our ability to design, deploy, evaluate, and communicate through digital means. This article presents 3 categories of digital health and their relationships to value metrics: (1) telehealth or direct care delivery, (2) digital access tools, and (3) digital monitoring. An evidence-based discussion reveals past successes, current promises, and future challenges in reducing defects in value through digital care. In the coming years, value transformation will become more crucial to the success of health care systems. By using the taxonomy in this article, health systems can better implement digital tools with a value-driven purpose. Defining the role of digital health in the post-pandemic world is needed to assist health systems and practices to build a bridge to value-based care. [ABSTRACT FROM AUTHOR]
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- 2022
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17. Antibiotic Prescribing by Digital Health Care Providers as Compared to Traditional Primary Health Care Providers: Cohort Study Using Register Data.
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Wallman A, Svärdsudd K, Bobits K, and Wallman T
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- Humans, Male, Female, Sweden, Middle Aged, Adult, Aged, Cohort Studies, Practice Patterns, Physicians' statistics & numerical data, Drug Prescriptions statistics & numerical data, Pandemics, Young Adult, Registries, Adolescent, SARS-CoV-2, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Primary Health Care statistics & numerical data, Telemedicine statistics & numerical data, COVID-19
- Abstract
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., (©Andy Wallman, Kurt Svärdsudd, Kent Bobits, Thorne Wallman. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.06.2024.)
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- 2024
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18. Medical Professionals and Medical Apps: Why Oversight Must Come from Within.
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Krieger, William H and Cotton, Brandi P
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Phone or tablet-based healthcare applications, or "medical apps," play an important role in an evolving healthcare system. The effect of medical apps on consumers has been welldocumented; however, little attention has been paid to the impacts that apps have had on medical professionals, people whose best interests like in ensuring that medical apps positively impact patient outcomes. After a brief introduction, introducing the spectrum of problems surrounding medical apps, this paper will move its focus to issues of concern for medical practitioners who prescribe or use medical apps as a part of their approach to medical care. Given the current lack of regulatory oversight of medical apps and noting the potential for improper use of these mHealth technologies, the authors will argue that as qualified, well suited, and interested parties, medical professionals should help to shape this new regulatory and ethical landscape. Additionally, before concluding, the authors will provide concrete examples of ways that medical professionals have put these ideas into practice. [ABSTRACT FROM AUTHOR]
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- 2021
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19. Psykologers upplevelse av den digitala plattformen Stöd och behandling : - En intervjustudie
- Abstract
Sammanfattning: E-hälsa och digitala arbetssätt är ett växande område som fyller en viktig funktion inom hälso-och sjukvården. Digitala arbetssätt som integreras i hälso- och vården kan ge en ökad tillgänglighet till vårdkontakt och innebära möjligheter för en mer individualiserad vård samt kan innebära en mer kostnadseffektiv vård. För att implementera digitala arbetssätt på ett lyckat sätt så behöver personalen anpassa sig till den nya tekniken, en övergång som kräver såväl samarbete som god integrering av de digitala verktyg som införs. Mer kunskap behövs om användarna, till exempel hälso-och sjukvårdspersonalens perspektiv vid integrering av digitala vårdplattformar. Syfte: Att undersöka psykologers upplevelser av den digitala plattformen Stöd och behandling (SOB). Metod: Kvalitativ analys av individuella intervjuer (n=8) som genomfördes över Zoom. Intervjuguiden innefattade tio frågor och intervjuerna varade i mellan 30-50 minuter. Materialet analyserades sedan med kvalitativ innehållsanalys. Samtliga informanter var Legitimerade Psykologer mellan 30-59 år gamla med en medelålder på 40 år. Informanterna rekryterades via ett nätverk för psykologer på Facebook och enbart kvinnor deltog i studien. Resultat: Analysen resulterade i två teman, tre kategorier och flera underkategorier som beskriver psykologers upplevelser av plattformen Stöd och behandling. Det första temat var ”Ökade krav” och det andra ”Potential för ökade möjligheter till jämlik vård”. Flera av informanterna menar att det är svårare för vissa patienter att ta till sig behandling digitalt via Stöd och behandling.Informanterna själva beskriver å ena sidan ökad frihet, effektivitet och flexibilitet, å andra sidan ökade krav, inte minst på egna tekniska färdigheter. Vidare diskuterades plattformens potential att bidra till en mer tillgänglig och jämlik vård. Slutsatser: Informanterna beskriver att det finns fördelar med digital behandling som kan vara gynnsamma för hälso-och sjukvården i framtiden. Men, Introduction: E-health and digital interventions are a growing area that fulfills an important function in health care. Digital interventions that are integrated into routine can provide increased accessibility to healthcare and provide opportunities for more individualized care and can mean more cost-effective care. To implement digital ways of working successfully, staff need to adapt to the new technology, a transition that requires both collaboration and good integration of the digital tools that are introduced. More knowledge is needed about users' perspectives when integrating and using digital healthcare platforms. Purpose: To investigate Psychologists' perceptions of the digital platform Support and treatment. Method: Qualitative analysis of individual interviews (n=8) conducted over Zoom. The interview guide included ten questions and the interviews lasted between 30-50 minutes. The material was then analyzed with qualitative content analysis. All informants were Licensed psychologists with an average age of 40 years (30-59 years old) and only women participated in the study. The informants were recruited through a network for psychologists on Facebook. Results: The analysis resulted in two themes, three categories and several subcategories that describe psychologists' experiences of the platform Support and treatment. The first theme was "Increased demands" and the second "Potential for increased opportunities for equal care". Several of the informants believed that it is more difficult for some patients to access treatment digitally via SOB. The informants themselves described on the one hand increased freedom, efficiency, and flexibility, on the other hand increased demands, not least regarding the staff´s technical skills. Furthermore, the platform's potential to contribute to more accessible and equal care was discussed. Conclusion: The informants describe that there are advantages to digital treatment that can be beneficial for health care in
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- 2023
20. Distriktssköterskors erfarenhet av det digitala vårdmötet i Närhälsan online : En kvalitativ intervjustudie
- Abstract
Bakgrund: Sverige har som mål att år 2025 vara bäst i världen på digital vård. Det senaste decenniet har användandet av vårdapplikationer ökat där både privata och offentliga aktörer erbjuder vård genom dessa. Distriktssköterskan har en viktig roll i att leda och utveckla digitala hjälpmedel inom vården samt att göra patienten delaktig i den digitala utvecklingen vården står inför. Tidigare forskning visar att det finns utmaningar för såväl patienter som vårdpersonal samt en risk för digitalt utanförskap i den digitala utvecklingen av vården. Syfte: Syftet med studien var att beskriva distriktssköterskors och sjuksköterskors erfarenheter av det digitala vårdmötet i Närhälsan online. Metod: I studien användes en kvalitativ innehållsanalys med induktiv ansats. Semistrukturerade intervjuer genomfördes med åtta distriktssköterskor och sjuksköterskor som arbetar på Närhälsan online. Resultat: I resultatet framkom två kategorier, positiva vårdmöten samt arbetet i en digital vårdmiljö. Fyra underkategorier kom fram, tillgänglighet, effektiva besök, hitta rätt i vårdkedjan samt trygg i sin profession. Resultatet visade att digitala vårdbesök ökar tillgängligheten i primärvården och är ett komplement till fysiska vårdbesök. Konklusion: Studien visar att digitala vårdmöten är ett bra komplement till fysiska besök i primärvården. Besöken blir mer effektiva och fler patienter får lättare tillgång till vården., Background: Sweden's goal is to be the best in the world in digital care by 2025. In the last decade, the use of care applications has increased, where both private and public actors offer care through them. The district nurse has an important role in leading and developing digital aids in healthcare as well as making the patient a participant in the digital development healthcare is facing. Previous research shows that there are challenges for both patients and healthcare staff as well as a risk of digital exclusion in the digital development of healthcare. Purpose: The purpose of the study was to describe district nurses' and nurses' experiences of the digital care meeting in Närhälsan online. Method: The study used a qualitative content analysis with an inductive approach. Semi-structured interviews were conducted with eight district nurses and nurses who work at Närhälsan online. Results: Two categories emerged in the results, positive care meetings and work in a digital care environment. Four subcategories emerged, accessibility, efficient visits, finding the right way in the care chain and secure in one's profession. The results showed that digitalcare visits increase accessibility in primary care and are a complement to physical care visits. Conclusion: The study shows that digital care meetings are a good complement to physical visits in primary care. Visits will be more efficient and more patients will have easier access to care.
- Published
- 2023
21. Distriktssköterskors erfarenhet av det digitala vårdmötet i Närhälsan online : En kvalitativ intervjustudie
- Abstract
Bakgrund: Sverige har som mål att år 2025 vara bäst i världen på digital vård. Det senaste decenniet har användandet av vårdapplikationer ökat där både privata och offentliga aktörer erbjuder vård genom dessa. Distriktssköterskan har en viktig roll i att leda och utveckla digitala hjälpmedel inom vården samt att göra patienten delaktig i den digitala utvecklingen vården står inför. Tidigare forskning visar att det finns utmaningar för såväl patienter som vårdpersonal samt en risk för digitalt utanförskap i den digitala utvecklingen av vården. Syfte: Syftet med studien var att beskriva distriktssköterskors och sjuksköterskors erfarenheter av det digitala vårdmötet i Närhälsan online. Metod: I studien användes en kvalitativ innehållsanalys med induktiv ansats. Semistrukturerade intervjuer genomfördes med åtta distriktssköterskor och sjuksköterskor som arbetar på Närhälsan online. Resultat: I resultatet framkom två kategorier, positiva vårdmöten samt arbetet i en digital vårdmiljö. Fyra underkategorier kom fram, tillgänglighet, effektiva besök, hitta rätt i vårdkedjan samt trygg i sin profession. Resultatet visade att digitala vårdbesök ökar tillgängligheten i primärvården och är ett komplement till fysiska vårdbesök. Konklusion: Studien visar att digitala vårdmöten är ett bra komplement till fysiska besök i primärvården. Besöken blir mer effektiva och fler patienter får lättare tillgång till vården., Background: Sweden's goal is to be the best in the world in digital care by 2025. In the last decade, the use of care applications has increased, where both private and public actors offer care through them. The district nurse has an important role in leading and developing digital aids in healthcare as well as making the patient a participant in the digital development healthcare is facing. Previous research shows that there are challenges for both patients and healthcare staff as well as a risk of digital exclusion in the digital development of healthcare. Purpose: The purpose of the study was to describe district nurses' and nurses' experiences of the digital care meeting in Närhälsan online. Method: The study used a qualitative content analysis with an inductive approach. Semi-structured interviews were conducted with eight district nurses and nurses who work at Närhälsan online. Results: Two categories emerged in the results, positive care meetings and work in a digital care environment. Four subcategories emerged, accessibility, efficient visits, finding the right way in the care chain and secure in one's profession. The results showed that digitalcare visits increase accessibility in primary care and are a complement to physical care visits. Conclusion: The study shows that digital care meetings are a good complement to physical visits in primary care. Visits will be more efficient and more patients will have easier access to care.
- Published
- 2023
22. Essays on the effect of health care and the environment on health
- Abstract
This thesis consists of three self-contained papers studying different topics in health economics. The first chapter studies the substitution effect between in-person physician visits and a new type of doctor visits, direct-to-consumer (DCT) telemedicine, where a person can call a doctor directly via an app. To causally assess to which degree DCT consultations substitute for in-person consultations, we exploit exogenous changes in patient fees in a fuzzy difference-in-discontinuities analysis of young adults in Sweden. We estimate a degree of substitution of 45%, implying an increase in the consultation volume. While the characteristics of the additional demand raise concerns related to healthcare equity and efficiency, the results also suggest that the increase in volume is close to cost neutral and there is no evidence of decreased quality of care. The second chapter studies the importance of patient-to-practice continuity of care for patient outcomes. Exploiting plausibly exogenous timing of closures of primary care practices in a Swedish region, I find that patients who experience a practice discontinuity have an immediate 15% decrease in visits to primary care physicians which lasts for at least two years, with some evidence showing this is partially offset by an increase in visits to nurses and other primary care providers. This effect is stronger for patients with no history of chronic diseases and immigrants. I find that a large share of directly affected patients migrate to neighbouring remaining practices which temporarily crowds out previously established incumbent patients. The third chapter in this thesis studies the effect waterborne disease risk on children's health and learning in Tanzania. Using a difference-in-differences approach, we find that when one-tenth of the local area is covered by simulated disease-prone stagnant water, children are 2.8 percentage points likelier to have diarrhoea, corresponding to an almost 11% increase relative to the b
- Published
- 2023
23. The Political Economy of Digital Health Equity: Structural Analysis.
- Author
-
Shaw J and Glover W
- Subjects
- Humans, Psychotherapy, Digital Technology, Ethnicity, Digital Health, Health Promotion
- Abstract
Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race, ethnicity, and socioeconomic status. In this paper, we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism in Western contexts produce and sustain digital health inequities by describing 6 structural challenges to the effort to promote health equity through digital health, as follows: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to the internet and digital devices, (4) underinvestment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose future immediate and long-term directions for work to support meaningful change for digital health equity., (©James Shaw, Wiljeana Glover. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.03.2024.)
- Published
- 2024
- Full Text
- View/download PDF
24. Action Opportunities to Pursue Responsible Digital Care for People With Intellectual Disabilities: Qualitative Study.
- Author
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Siebelink NM, van Dam KN, Lukkien DRM, Boon B, Smits M, and van der Poel A
- Subjects
- Humans, Reproducibility of Results, Social Interaction, Qualitative Research, Intellectual Disability therapy, Robotics
- Abstract
Background: Responsible digital care refers to any intentional systematic effort designed to increase the likelihood of a digital care technology developed through ethical decision-making, being socially responsible and aligned with the values and well-being of those impacted by it., Objective: We aimed to present examples of action opportunities for (1) designing "technology"; (2) shaping the "context" of use; and (3) adjusting the behavior of "users" to guide responsible digital care for people with intellectual disabilities., Methods: Three cases were considered: (1) design of a web application to support the preparation of meals for groups of people with intellectual disabilities, (2) implementation of an app to help people with intellectual disabilities regulate their stress independently, and (3) implementation of a social robot to stimulate interaction and physical activity among people with intellectual disabilities. Overall, 26 stakeholders participated in 3 multistakeholder workshops (case 1: 10/26, 38%; case 2: 10/26, 38%; case 3: 6/26, 23%) based on the "guidance ethics approach." We identified stakeholders' values based on bottom-up exploration of experienced and expected effects of using the technology, and we formulated action opportunities for these values in the specific context of use. Qualitative data were analyzed thematically., Results: Overall, 232 effects, 33 values, and 156 action opportunities were collected. General and case-specific themes were identified. Important stakeholder values included quality of care, autonomy, efficiency, health, enjoyment, reliability, and privacy. Both positive and negative effects could underlie stakeholders' values and influence the development of action opportunities. Action opportunities comprised the following: (1) technology: development of the technology (eg, user experience and customization), technology input (eg, recipes for meals, intervention options for reducing stress, and activities), and technology output (eg, storage and use of data); (2) context: guidelines, training and support, policy or agreements, and adjusting the physical environment in which the technology is used; and (3) users: integrating the technology into daily care practice, by diminishing (eg, "letting go" to increase the autonomy of people with intellectual disabilities), retaining (eg, face-to-face contact), and adding (eg, evaluation moments) certain behaviors of care professionals., Conclusions: This is the first study to provide insight into responsible digital care for people with intellectual disabilities by means of bottom-up exploration of action opportunities to take account of stakeholders' values in designing technology, shaping the context of use, and adjusting the behavior of users. Although part of the findings may be generalized, case-specific insights and a complementary top-down approach (eg, predefined ethical frameworks) are essential. The findings represent a part of an ethical discourse that requires follow-up to meet the dynamism of stakeholders' values and further develop and implement action opportunities to achieve socially desirable, ethically acceptable, and sustainable digital care that improves the lives of people with intellectual disabilities., (©Nienke M Siebelink, Kirstin N van Dam, Dirk R M Lukkien, Brigitte Boon, Merlijn Smits, Agnes van der Poel. Originally published in JMIR Mental Health (https://mental.jmir.org), 28.02.2024.)
- Published
- 2024
- Full Text
- View/download PDF
25. [Digital care beds in long-term care-Support, relief for caregivers or just illusion? An ethnographic explorative study].
- Author
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Ruppert SN and Hasseler M
- Subjects
- Humans, Long-Term Care, Nursing Homes, Caregivers, Illusions
- Abstract
Background: The digitalization of care items, in this case the care bed, is a logical consequence of the general shortage of personnel and resources in professional care and an increase in the number of very old people in need of long-term care. Sensors integrated into the nursing bed, interfaces for data transmission and connection to a monitoring system are generated for moments of support and relief for professional nurses and to increase the nursing outcome. Accompanying nursing research examines the implementation of 97 digital care beds in a long-term care facility for old people., Method: Mixed methods research approach over 24 months RESULTS: The lack or implementation of a consistent care process, unfavorable accompanying circumstances, interdependent contextual factors and an insufficient implementation management have a negative impact on the implementation and integration of the digital care beds into the care routines., Conclusion: For a successful implementation of digital assistance systems (dAS), they have to be considered in the care process besides a reliable technical connection. Furthermore, an implementation management as well as the review and adaptation of all relevant context factors are required., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
26. Methodological Insights on Recruitment and Retention From a Remote Randomized Controlled Trial Examining the Effectiveness of an Alcohol Reduction App: Descriptive Analysis Study.
- Author
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Oldham M, Dinu L, Loebenberg G, Field M, Hickman M, Michie S, Brown J, and Garnett C
- Abstract
Background: Randomized controlled trials (RCTs) with no in-person contact (ie, remote) between researchers and participants offer savings in terms of cost and time but present unique challenges., Objective: The goal of this study is to examine the differences between different forms of remote recruitment (eg, National Health Service [NHS] website, social media, and radio advertising) in the proportion of participants recruited, demographic diversity, follow-up rates, and cost. We also examine the cost per participant of sequential methods of follow-up (emails, phone calls, postal surveys, and postcards). Finally, our experience with broader issues around study advertising and participant deception is discussed., Methods: We conducted a descriptive analysis of 5602 increasing-and-higher-risk drinkers (Alcohol Use Disorders Identification Test score ≥8), taking part in a 2-arm, parallel group, remote RCT with a 1:1 allocation, comparing the intervention (Drink Less app) with usual digital care (NHS alcohol advice web page). Participants were recruited between July 2020 and March 2022 and compensated with gift vouchers of up to £36 (a currency exchange rate of £1=US $1.26988 is applicable) for completing follow-up surveys, with 4 stages of follow-up: email reminders, phone calls, postal survey, and postcard., Results: The three main recruitment methods were advertisements on (1) social media (2483/5602, 44.32%), (2) the NHS website (1961/5602, 35.01%), and (3) radio and newspapers (745/5602, 13.3%), with the remaining methods of recruitment accounting 7.37% (413/5602) of the sample. The overall recruitment cost per participant varied from £0 to £11.01. Costs were greater when recruiting participants who were men (£0-£28.85), from an ethnic minority group (£0-£303.81), and more disadvantaged (£0-£49.12). Targeted approaches were useful for recruiting more men but less useful in achieving diversity in ethnicity and socioeconomic status. Follow-up at 6 months was 79.58% (4458/5602). Of those who responded, 92.4% (4119/4458) responded by email. Each additional stage of follow-up resulted in an additional 2-3 percentage points of the overall sample being followed up, although phone calls, postal surveys, and postcards were more resource intensive than email reminders., Conclusions: For remote RCTs, researchers could benefit from using a range of recruitment methods and cost-targeted approaches to achieve demographic diversity. Automated emails with substantial financial incentives for prompt completion can achieve good follow-up rates, and sequential, offline follow-up options, such as phone calls and postal surveys, can further increase follow-up rates but are comparatively expensive. We also make broader recommendations focused on striking the right balance when designing remote RCTs. Careful planning, ongoing maintenance, and dynamic decision-making are required throughout a trial to balance the competing demands of participation among those eligible, deceptive participation among those who are not eligible, and ensuring no postrandomization bias is introduced by data-checking protocols., (©Melissa Oldham, Larisa Dinu, Gemma Loebenberg, Matt Field, Matthew Hickman, Susan Michie, Jamie Brown, Claire Garnett. Originally published in JMIR Formative Research (https://formative.jmir.org), 05.01.2024.)
- Published
- 2024
- Full Text
- View/download PDF
27. The Ongoing and Collective Character of Digital Care for Older People: Moving Beyond Techno-Determinism in Government Policy
- Author
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Elin Kvist, Jens Lindberg, and Simon Lindgren
- Subjects
Systemvetenskap, informationssystem och informatik med samhällsvetenskaplig inriktning ,techno-determinism ,Health (social science) ,Sociologi ,Computer Networks and Communications ,Information Systems, Social aspects ,General Social Sciences ,socio-technical ,Digital care ,government policy ,older people ,Sociology ,eHealth ,Social Sciences (miscellaneous) - Abstract
In this article, we contrast policy understandings of digital care with older people’s day-to-day digital care. In doing so, we discuss problems relating to deterministic approaches in government policy. Our policy analysis shows that digital care is articulated as an individual practice, and digital technologies as static actors. This bears clear marks of techno-deterministic reasoning. Our ethnographic study demonstrates the ongoing and collective character of older people’s digital care. When policy is not aligned with everyday practice, there is a risk of excluding groups of users. We argue that a socio-technical approach in government policy could contribute to achieving important societal goals.
- Published
- 2022
28. Public Private Partnerships Delivering Smart Health to Combat the Tsunami of Noncommunicable Diseases.
- Author
-
SUBRAMANIAM, Kannan
- Abstract
Key noncommunicable diseases (NCD) such as cardiovascular disease, diabetes, cancer and chronic respiratory disease are responsible for 71% of all deaths worldwide. Many of these deaths are premature and impact low- and middle-income countries (LMIC) the most. The economic realities in LMICs and their greater reliance on development assistance hinder investments in public health to adequately prevent risk factors for NCDs or manage established disease. Public private partnerships (PPP) can deliver smart health solutions to improve the health outcomes of those at risk of NCDs and those who have an illness. These solutions can range from simple digital concepts to complex technology constructs that can utilize artificial intelligence to intervene at many touch points along the patient journey. We present three case studies of smart health deployed through PPP to try improving outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
29. Digital Follow-Up and the Perspective of Patient-Centered Care in Oncology: What's the PROblem?
- Author
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Giordano, Frank A., Welzel, Grit, Siefert, Victor, Jahnke, Lennart, Ganslandt, Thomas, Wenz, Frederik, Grosu, Anca-Ligia, Heinemann, Felix, and Nicolay, Nils H.
- Subjects
- *
CANCER patient medical care , *MEDICAL care , *HEALTH outcome assessment , *PATIENTS , *TELEMEDICINE , *DECISION making in clinical medicine , *PATIENT-centered care - Abstract
There is accumulating evidence from randomized trials suggesting that digital patient-centered care allows a more reliable detection of tumour-related symptoms and adverse events - with a direct impact on overall survival. Consequently, a variety of unsynchronized approaches were kicked off to (electronically) measure patient-reported outcomes (PROs). Despite increasing evidence that PRO data are highly relevant for patient care, the data generated in these initial projects lack standardized processing pathways in order to impact clinical routine; therefore, potential future routine PRO assessments require adequate analysis, storage and processing to allow a robust, reproducible and reliable incorporation into routine clinical decision-making. Here, we discuss relevant challenges of digital follow-up that need to be tackled to render PRO data as relevant to physicians as laboratory or biomarker data. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
30. Low Adoption of Video Consultations in Post-COVID-19 General Practice in Northern Europe:Barriers to Use and Potential Action Points
- Author
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Elisabeth Assing Hvidt, Helen Atherton, Jelle Keuper, Eli Kristiansen, Elle Christine Lüchau, Børge Lønnebakke Norberg, Jost Steinhäuser, Johannes van den Heuvel, and Lilian van Tuyl
- Subjects
general practice ,Physician-Patient Relations ,research ,barriers ,digital care ,clinician ,Northern Europe ,COVID-19 ,Health Informatics ,Telemedicine ,Europe ,practitioner ,action potential ,consultation ,Humans ,barrier ,video consultation ,care ,viewpoint ,implementation ,Pandemics ,adoption ,COVID-19/epidemiology - Abstract
In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post–COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries’ general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism.
- Published
- 2023
31. Co-Designing Digital Technologies for Improving Clinical Care in People with Parkinson’s Disease: What Did We Learn?
- Author
-
Consortium, Mariana Monje, Sylvie Grosjean, Martin Srp, Laura Antunes, Raquel Bouça-Machado, Ricardo Cacho, Sergio Domínguez, John Inocentes, Timothy Lynch, Argyri Tsakanika, Dimitrios Fotiadis, George Rigas, Evžen Růžička, Joaquim Ferreira, Angelo Antonini, Norberto Malpica, Tiago Mestre, Álvaro Sánchez-Ferro, and iCARE-PD
- Subjects
digital technologies ,codesign ,digital care ,Parkinson’s disease - Abstract
The healthcare model is shifting towards integrated care approaches. This new model requires patients to be more closely involved. The iCARE-PD project aims to address this need by developing a technology-enabled, home-based, and community-centered integrated care paradigm. A central part of this project is the codesign process of the model of care, exemplified by the active participation of patients in the design and iterative evaluation of three sensor-based technological solutions. We proposed a codesign methodology used for testing the usability and acceptability of these digital technologies and present initial results for one of them, MooVeo. Our results show the usefulness of this approach in testing the usability and acceptability as well as the opportunity to incorporate patients’ feedback into the development. This initiative will hopefully help other groups incorporate a similar codesign approach and develop tools that are well adapted to patients’ and care teams’ needs.
- Published
- 2023
- Full Text
- View/download PDF
32. Essays on the effect of health care and the environment on health
- Author
-
Mattisson, Linn
- Subjects
Children's learning ,Economics ,Continuity of care ,health care spillovers ,Child Health ,practice closures ,waterborne diseases ,Test scores ,Physician visits ,Sanitation ,Primary care ,Digital care ,Telemedicine - Abstract
This thesis consists of three self-contained papers studying different topics in health economics. The first chapter studies the substitution effect between in-person physician visits and a new type of doctor visits, direct-to-consumer (DCT) telemedicine, where a person can call a doctor directly via an app. To causally assess to which degree DCT consultations substitute for in-person consultations, we exploit exogenous changes in patient fees in a fuzzy difference-in-discontinuities analysis of young adults in Sweden. We estimate a degree of substitution of 45%, implying an increase in the consultation volume. While the characteristics of the additional demand raise concerns related to healthcare equity and efficiency, the results also suggest that the increase in volume is close to cost neutral and there is no evidence of decreased quality of care. The second chapter studies the importance of patient-to-practice continuity of care for patient outcomes. Exploiting plausibly exogenous timing of closures of primary care practices in a Swedish region, I find that patients who experience a practice discontinuity have an immediate 15% decrease in visits to primary care physicians which lasts for at least two years, with some evidence showing this is partially offset by an increase in visits to nurses and other primary care providers. This effect is stronger for patients with no history of chronic diseases and immigrants. I find that a large share of directly affected patients migrate to neighbouring remaining practices which temporarily crowds out previously established incumbent patients. The third chapter in this thesis studies the effect waterborne disease risk on children's health and learning in Tanzania. Using a difference-in-differences approach, we find that when one-tenth of the local area is covered by simulated disease-prone stagnant water, children are 2.8 percentage points likelier to have diarrhoea, corresponding to an almost 11% increase relative to the baseline incidence. We also find that children have 0.07 standard deviations lower test scores. These results mask important heterogeneities: We find that the most vulnerable children are those who live in urban areas with poor sanitation. Hence, policymakers should consider local environmental risk factor of waterborne diseases when implementing sanitation policies
- Published
- 2023
33. District nurses’ experiences of the digital care meeting in Närhälsan online : A qualitative interview study
- Author
-
Bäck, Kristina and Dernsjö, Jenny
- Subjects
primary care ,erfarenhet ,Omvårdnad ,distriktssköterska ,personcentrerad vård ,primärvård ,district nurse ,Nursing ,experiences ,person-centred care ,Digital vård ,Digital care - Abstract
Bakgrund: Sverige har som mål att år 2025 vara bäst i världen på digital vård. Det senaste decenniet har användandet av vårdapplikationer ökat där både privata och offentliga aktörer erbjuder vård genom dessa. Distriktssköterskan har en viktig roll i att leda och utveckla digitala hjälpmedel inom vården samt att göra patienten delaktig i den digitala utvecklingen vården står inför. Tidigare forskning visar att det finns utmaningar för såväl patienter som vårdpersonal samt en risk för digitalt utanförskap i den digitala utvecklingen av vården. Syfte: Syftet med studien var att beskriva distriktssköterskors och sjuksköterskors erfarenheter av det digitala vårdmötet i Närhälsan online. Metod: I studien användes en kvalitativ innehållsanalys med induktiv ansats. Semistrukturerade intervjuer genomfördes med åtta distriktssköterskor och sjuksköterskor som arbetar på Närhälsan online. Resultat: I resultatet framkom två kategorier, positiva vårdmöten samt arbetet i en digital vårdmiljö. Fyra underkategorier kom fram, tillgänglighet, effektiva besök, hitta rätt i vårdkedjan samt trygg i sin profession. Resultatet visade att digitala vårdbesök ökar tillgängligheten i primärvården och är ett komplement till fysiska vårdbesök. Konklusion: Studien visar att digitala vårdmöten är ett bra komplement till fysiska besök i primärvården. Besöken blir mer effektiva och fler patienter får lättare tillgång till vården. Background: Sweden's goal is to be the best in the world in digital care by 2025. In the last decade, the use of care applications has increased, where both private and public actors offer care through them. The district nurse has an important role in leading and developing digital aids in healthcare as well as making the patient a participant in the digital development healthcare is facing. Previous research shows that there are challenges for both patients and healthcare staff as well as a risk of digital exclusion in the digital development of healthcare. Purpose: The purpose of the study was to describe district nurses' and nurses' experiences of the digital care meeting in Närhälsan online. Method: The study used a qualitative content analysis with an inductive approach. Semi-structured interviews were conducted with eight district nurses and nurses who work at Närhälsan online. Results: Two categories emerged in the results, positive care meetings and work in a digital care environment. Four subcategories emerged, accessibility, efficient visits, finding the right way in the care chain and secure in one's profession. The results showed that digitalcare visits increase accessibility in primary care and are a complement to physical care visits. Conclusion: The study shows that digital care meetings are a good complement to physical visits in primary care. Visits will be more efficient and more patients will have easier access to care.
- Published
- 2023
34. Everything changes to stay the same: persistent global health inequalities amidst new therapeutic opportunities and mobilities for Filipino nurses.
- Author
-
Thompson, Maddy
- Subjects
- *
NURSES , *OCCUPATIONAL mobility , *ECONOMIC mobility , *CAREER changes , *WORLD health , *HEALTH equity - Abstract
The global migration of Filipino nurses has received significant attention, yet little is known of these healthcare workers' experiences and mobilities within the Philippines. I explore the experiences and narratives of Filipino nurses living in Manila, some of whom have no desires to migrate. I uncover the often novel forms of therapeuticmobilities undertaken by these nurses, focusing on call centre nursing and entrepreneurship as key alternative career pathways within the realms of 'therapeutics'. Through interrogating the various mobilities undertaken by nurses - physical mobilities and migration, socioeconomic mobilities and occupational mobilities in the form of a career change - it becomes clear that international physical mobility is no longer key. Nevertheless, Filipino nurses continue to provide care in global contexts in novel 'therapeutic' industries and doing so allows them to increase their socioeconomic mobility. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
35. Data Futures
- Author
-
Kitchin, Rob, author
- Published
- 2021
- Full Text
- View/download PDF
36. The ongoing and collective character of digital care for older people : moving beyond techno-determinism in government policy
- Abstract
In this article, we contrast policy understandings of digital care with older people’s day-to-day digital care. In doing so, we discuss problems relating to deterministic approaches in government policy. Our policy analysis shows that digital care is articulated as an individual practice, and digital technologies as static actors. This bears clear marks of techno-deterministic reasoning. Our ethnographic study demonstrates the ongoing and collective character of older people’s digital care. When policy is not aligned with everyday practice, there is a risk of excluding groups of users. We argue that a socio-technical approach in government policy could contribute to achieving important societal goals.
- Published
- 2022
- Full Text
- View/download PDF
37. Design a hybrid patient journey in supportive care
- Abstract
Supportive care, regardless of its diversity or who provides it, aims to enhance and preserve the quality of life and independence and to empower and optimize well-being (Fitch, 2008). We can see that digital health can benefit supportive care by empowering users, providing more accessible support, and encouraging self-management. However, the impact of digital health interventions on existing organizations and systems is not always positive and effective. We could conclude that even with the rapid development of DHIs, physical or traditional interventions cannot be replaced entirely. That is to say, digital health intervention remains a viable option rather than a necessity, its purpose being to be a supplement and complement to the current medical system. (Yildiz & Oksuzoglu, 2020) This project explores how to connect digital and traditional care to create a seamless experience that fully embraces patients in cancer care when and where they need it. However, it is unclear how this hybrid model fits in the context of the supportive care plan. To understand how to build such a hybrid patient journey, we decided to research the types of problems in SCP and think about what role the DHIs could play. To gain a more systematic understanding, we researched three groups of people: patients, health professionals, and medical experts. The result of the research led to a picture of the current patient journey, which helped us identify opportunities for intervention. We believe the DHIs can help alleviate the current pressure on the system and provide patients with timely, adequate and effective supportive care. However, it must be based on providing patients with digital care that fits their situation. Based on this, we designed the future patient journey. It shows how digital care can be combined with traditional care. Also, it includes 1) the opportunities to involve more DHIs in SCP; 2) the concept of the AI support syste, Strategic Product Design
- Published
- 2022
38. The cost-effectiveness of digital health interventions: A systematic review of the literature
- Abstract
Background: Digital health interventions have significant potential to improve safety, efficacy, and quality of care, reducing waste in healthcare costs. Despite these premises, the evidence regarding cost and effectiveness of digital tools in health is scarce and limited. Objectives: The aim of this systematic review is to summarize the evidence on the cost-effectiveness of digital health interventions and to assess whether the studies meet the established quality criteria. Methods: We queried PubMed, Scopus and Web of Science databases for articles in English published from January 1, 2016 to December 31, 2020 that performed economic evaluations of digital health technologies. The methodological rigorousness of studies was assessed with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2009 checklist. Results: Search identified 1,476 results, 552 of which were selected for abstract and 35 were included in this review. The studies were heterogeneous by country (mostly conducted in upper and upper-middle income countries), type of eHealth intervention, method of implementation, and reporting perspectives. The qualitative analysis identified the economic and effectiveness evaluation of six different types of interventions: (1) seventeen studies on new video-monitoring service systems; (2) five studies on text messaging interventions; (3) five studies on web platforms and digital health portals; (4) two studies on telephone support; (5) three studies on new mobile phone-based systems and applications; and (6) three studies on digital technologies and innovations. Conclusion: Findings on cost-effectiveness of digital interventions showed a growing body of evidence and suggested a generally favorable effect in terms of costs and health outcomes. However, due to the heterogeneity across study methods, the comparison between interve
- Published
- 2022
39. The ongoing and collective character of digital care for older people : moving beyond techno-determinism in government policy
- Abstract
In this article, we contrast policy understandings of digital care with older people’s day-to-day digital care. In doing so, we discuss problems relating to deterministic approaches in government policy. Our policy analysis shows that digital care is articulated as an individual practice, and digital technologies as static actors. This bears clear marks of techno-deterministic reasoning. Our ethnographic study demonstrates the ongoing and collective character of older people’s digital care. When policy is not aligned with everyday practice, there is a risk of excluding groups of users. We argue that a socio-technical approach in government policy could contribute to achieving important societal goals.
- Published
- 2022
- Full Text
- View/download PDF
40. The ongoing and collective character of digital care for older people : moving beyond techno-determinism in government policy
- Abstract
In this article, we contrast policy understandings of digital care with older people’s day-to-day digital care. In doing so, we discuss problems relating to deterministic approaches in government policy. Our policy analysis shows that digital care is articulated as an individual practice, and digital technologies as static actors. This bears clear marks of techno-deterministic reasoning. Our ethnographic study demonstrates the ongoing and collective character of older people’s digital care. When policy is not aligned with everyday practice, there is a risk of excluding groups of users. We argue that a socio-technical approach in government policy could contribute to achieving important societal goals.
- Published
- 2022
- Full Text
- View/download PDF
41. The ongoing and collective character of digital care for older people : moving beyond techno-determinism in government policy
- Abstract
In this article, we contrast policy understandings of digital care with older people’s day-to-day digital care. In doing so, we discuss problems relating to deterministic approaches in government policy. Our policy analysis shows that digital care is articulated as an individual practice, and digital technologies as static actors. This bears clear marks of techno-deterministic reasoning. Our ethnographic study demonstrates the ongoing and collective character of older people’s digital care. When policy is not aligned with everyday practice, there is a risk of excluding groups of users. We argue that a socio-technical approach in government policy could contribute to achieving important societal goals.
- Published
- 2022
- Full Text
- View/download PDF
42. The ongoing and collective character of digital care for older people : moving beyond techno-determinism in government policy
- Abstract
In this article, we contrast policy understandings of digital care with older people’s day-to-day digital care. In doing so, we discuss problems relating to deterministic approaches in government policy. Our policy analysis shows that digital care is articulated as an individual practice, and digital technologies as static actors. This bears clear marks of techno-deterministic reasoning. Our ethnographic study demonstrates the ongoing and collective character of older people’s digital care. When policy is not aligned with everyday practice, there is a risk of excluding groups of users. We argue that a socio-technical approach in government policy could contribute to achieving important societal goals.
- Published
- 2022
- Full Text
- View/download PDF
43. Design a hybrid patient journey in supportive care
- Abstract
Supportive care, regardless of its diversity or who provides it, aims to enhance and preserve the quality of life and independence and to empower and optimize well-being (Fitch, 2008). We can see that digital health can benefit supportive care by empowering users, providing more accessible support, and encouraging self-management. However, the impact of digital health interventions on existing organizations and systems is not always positive and effective. We could conclude that even with the rapid development of DHIs, physical or traditional interventions cannot be replaced entirely. That is to say, digital health intervention remains a viable option rather than a necessity, its purpose being to be a supplement and complement to the current medical system. (Yildiz & Oksuzoglu, 2020) This project explores how to connect digital and traditional care to create a seamless experience that fully embraces patients in cancer care when and where they need it. However, it is unclear how this hybrid model fits in the context of the supportive care plan. To understand how to build such a hybrid patient journey, we decided to research the types of problems in SCP and think about what role the DHIs could play. To gain a more systematic understanding, we researched three groups of people: patients, health professionals, and medical experts. The result of the research led to a picture of the current patient journey, which helped us identify opportunities for intervention. We believe the DHIs can help alleviate the current pressure on the system and provide patients with timely, adequate and effective supportive care. However, it must be based on providing patients with digital care that fits their situation. Based on this, we designed the future patient journey. It shows how digital care can be combined with traditional care. Also, it includes 1) the opportunities to involve more DHIs in SCP; 2) the concept of the AI support syste, Strategic Product Design
- Published
- 2022
44. Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial.
- Author
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Pak SS, Janela D, Freitas N, Costa F, Moulder R, Molinos M, Areias AC, Bento V, Cohen SP, Yanamadala V, Souza RB, and Correia FD
- Subjects
- Humans, Shoulder Pain therapy, Shoulder Pain etiology, Quality of Life, Physical Therapy Modalities, Exercise Therapy methods, Joint Instability complications, Shoulder Joint
- Abstract
Background: Chronic shoulder pain (CSP) is a common condition with various etiologies, including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. It is associated with substantial disability and psychological distress, resulting in poor productivity and quality of life. Physical therapy constitutes the mainstay treatment for CSP, but several barriers exist in accessing care. In recent years, telerehabilitation has gained momentum as a potential solution to overcome such barriers. It has shown numerous benefits, including improving access and convenience, promoting patient adherence, and reducing costs. However, to date, no previous randomized controlled trial has compared fully remote digital physical therapy to in-person rehabilitation for nonoperative CSP., Objective: The aim of this study is to compare clinical outcomes between digital physical therapy and conventional in-person physical therapy in patients with CSP., Methods: We conducted a single-center, parallel-group, randomized controlled trial involving 82 patients with CSP referred for outpatient physical therapy. Participants were randomized into digital or conventional physical therapy (8-week interventions). The digital intervention consisted of home exercise, education, and cognitive behavioral therapy (CBT), using a device with movement digitalization for biofeedback and asynchronous physical therapist monitoring through a cloud-based portal. The conventional group received in-person physical therapy, including exercises, manual therapy, education, and CBT. The primary outcome was the change (baseline to 8 weeks) in function and symptoms using the short-form of Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcome measures included self-reported pain, surgery intent, analgesic intake, mental health, engagement, and satisfaction. All questionnaires were delivered electronically., Results: A total of 90 participants were randomized into digital or conventional physical therapy, with 82 receiving the allocated intervention. Both groups experienced significant improvements in function measured by the short-form of the Disabilities of the Arm, Shoulder, and Hand questionnaire, with no differences between groups (-1.8, 95% CI -13.5 to 9.8; P=.75). For secondary outcomes, no differences were observed in surgery intent, analgesic intake, and mental health or worst pain. Higher reductions were observed in average and least pain in the conventional group, which, given the small effect sizes (least pain 0.15 and average pain 0.16), are unlikely to be clinically meaningful. High adherence and satisfaction were observed in both groups, with no adverse events., Conclusions: This study shows that fully remote digital programs can be viable care delivery models for CSP given their scalability and effectiveness, assessed through comparison with high-dosage in-person rehabilitation., Trial Registration: ClinicalTrials.gov (NCT04636528); https://clinicaltrials.gov/study/NCT04636528., (©Sang S Pak, Dora Janela, Nina Freitas, Fabíola Costa, Robert Moulder, Maria Molinos, Anabela C Areias, Virgílio Bento, Steven P Cohen, Vijay Yanamadala, Richard B Souza, Fernando Dias Correia. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 18.08.2023.)
- Published
- 2023
- Full Text
- View/download PDF
45. The Effectiveness of Digital Apps Providing Personalized Exercise Videos: Systematic Review With Meta-Analysis.
- Author
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Davergne T, Meidinger P, Dechartres A, and Gossec L
- Subjects
- Adult, Humans, Exercise Therapy methods, Bias, Quality of Life, Exercise
- Abstract
Background: Among available digital apps, those providing personalized video exercises may be helpful for individuals undergoing functional rehabilitation., Objective: We aimed to assess the effectiveness of apps providing personalized video exercises to support rehabilitation for people with short- and long-term disabling conditions, on functional capacity, confidence in exercise performance, health care consumption, health-related quality of life, adherence, and adverse events., Methods: In this systematic review, we searched MEDLINE, CENTRAL, and Embase databases up to March 2022. All randomized controlled trials evaluating the effect of apps providing personalized video exercises to support rehabilitation for any condition requiring physical rehabilitation were included. Selection, extraction, and risk of bias assessment were performed by 2 independent reviewers. The primary outcome was functional capacity at the end of the intervention. The secondary outcomes included confidence in exercise performance, care consumption, health-related quality of life, adherence, and adverse events. A meta-analysis was performed where possible; the magnitude of the effect was assessed with the standardized mean difference (SMD)., Results: From 1641 identified references, 10 papers (n=1050 participants, 93% adults) were included: 7 papers (n=906 participants) concerned musculoskeletal disorders and 3 (n=144 participants) concerned neurological disorders. Two (n=332 participants) were employee based. The apps were mostly commercial (7/10); the videos were mostly elaborated on by a physiotherapist (8/10). The duration of app use was 3-48 weeks. All included studies had a high overall risk of bias. Low-quality evidence suggested that the use of apps providing personalized video exercises led to a significant small to moderate improvement in physical function (SMD 0.35, 95% CI 0.19-0.51; Phet=.86; I
2 =0%) and confidence in exercise performance (SMD 0.67; 95% CI 0.37-0.96; Phet=.22; I2 =33%). Because of the very low quality of the evidence, the effects on quality of life and exercise adherence were uncertain. Apps did not influence the rate of adverse events., Conclusions: Apps providing personalized video exercises to support exercise performance significantly improved physical function and confidence in exercise performance. However, the level of evidence was low; more robust studies are needed to confirm these results., Trial Registration: PROSPERO CRD42022323670; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323670., (©Thomas Davergne, Philippe Meidinger, Agnès Dechartres, Laure Gossec. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 13.07.2023.)- Published
- 2023
- Full Text
- View/download PDF
46. eHealth Interventions for Dutch Cancer Care: Systematic Review Using the Triple Aim Lens
- Subjects
psychosocial ,Triple Aim ,mobile phone ,systematic review ,quality of care ,digital care ,cancer ,costs ,eHealth ,population health ,intervention - Published
- 2022
47. eHealth Interventions for Dutch Cancer Care: Systematic Review Using the Triple Aim Lens
- Author
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Liza van Deursen, Anke Versluis, Rosalie van der Vaart, Lucille Standaar, Jeroen Struijs, Niels Chavannes, and Jiska J Aardoom
- Subjects
psychosocial ,Cancer Research ,Triple Aim ,mobile phone ,Oncology ,systematic review ,quality of care ,digital care ,cancer ,costs ,eHealth ,population health ,intervention - Abstract
Background Globally, the burden of cancer on population health is growing. Recent trends such as increasing survival rates have resulted in a need to adapt cancer care to ensure a good care experience and manageable expenditures. eHealth is a promising way to increase the quality of cancer care and support patients and survivors. Objective The aim of this systematic review was 2-fold. First, we aimed to provide an overview of eHealth interventions and their characteristics for Dutch patients with and survivors of cancer. Second, we aimed to provide an overview of the empirical evidence regarding the impact of eHealth interventions in cancer care on population health, quality of care, and per capita costs (the Triple Aim domains). Methods The electronic databases Web of Science, PubMed, Cochrane, and Ovid PsycINFO were searched using 3 key search themes: eHealth interventions, cancer care, and the Netherlands. The identified interventions were classified according to predetermined criteria describing the intervention characteristics (eg, type, function, and target population). Their impact was subsequently examined using the Triple Aim framework. Results A total of 38 interventions were identified. Most of these were web portals or web applications functioning to inform and self-manage, and target psychosocial factors or problems. Few interventions have been tailored to age, disease severity, or gender. The results of this study indicate that eHealth interventions could positively affect sleep quality, fatigue, and physical activity of patients with and survivors of cancer. Inconclusive results were found regarding daily functioning and quality of life, psychological complaints, and psychological adjustment to the disease. Conclusions eHealth can improve outcomes in the Triple Aim domains, particularly in the population health and quality of care domains. Cancer-related pain and common symptoms of active treatment were not targeted in the included interventions and should receive more attention. Further research is needed to fully understand the impact of eHealth interventions in cancer care on participation, accessibility, and costs. The latter can be examined in economic evaluations by comparing eHealth interventions with care as usual.
- Published
- 2022
48. Werken op afstand en gebruik van onlinecommunicatie in verpleeghuizen tijdens COVID-19-maatregelen
- Author
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Leontjevas, R., Knippenberg, I.A.H., Bakker, Christian, Koopmans, Raymond, Gerritsen, Debby L., RS-Research Line Methodology & statistics (part of UHC program), and Section Methodology & Statistics
- Subjects
Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1] ,COVID-19 ,Nursing homes ,Geriatrics and Gerontology ,Gerontology ,Digital care ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] - Abstract
De maatregelen in Nederlandse verpleeghuizen tijdens de eerste golf van de COVID-19-pandemie leidden tot zowel een toename als een afname van probleemgedrag bij verpleeghuisbewoners. Medewerkers ondernamen diverse initiatieven om de negatieve effecten te verminderen. Zo werd beeldbellen tussen bewoners en hun naasten gefaciliteerd. Daarnaast werden initiatieven op het gebied van digitale zorg (telehealth) ingezet. Doel van dit onderzoek was het verkennen van ervaringen van verpleeghuisprofessionals met onlinecommunicatie tussen bewoners en naasten, het werken op afstand in het algemeen en de behandeling van probleemgedrag op afstand in het bijzonder.Honderdvijfenzeventig verpleeghuisprofessionals (psychologen, specialisten ouderengeneeskunde, verpleegkundig specialisten, medewerkers- welzijn en -dagbesteding) vulden eind 2020/begin 2021 een onlinevragenlijst in. Uit open en gesloten vragen bleek dat face-to-face-contacten de voorkeur genieten boven onlinecommunicatie. Onlinecommunicatie werd vooral als (zinvolle) aanvulling gezien. Hoewel professionals een deel van hun werk op afstand wilden voortzetten, en dit efficiënt en werkdrukverlagend vonden, vonden ze dat dit hun werkplezier en de kwaliteit van zorg kan verslechteren. Voor werken op afstand in het algemeen en behandelen op afstand in het bijzonder, moet steeds per taak beoordeeld worden wat goed uitvoerbaar is en tot goede zorg leidt. Meer onderzoek naar onlinecommunicatie, werken op afstand en behandelen op afstand in verpleeghuizen, is nodig.
- Published
- 2022
49. The use of mobile health technology in the management of osteoarthritis: A scoping review with scientometric analyses.
- Author
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Kamilu Sulaiman, Surajo, Wong, Arnold Y.L., Liangchi Li, Lillian, Fordjour Antwi-Afari, Maxwell, Ou, Haining, and WH Tsang, Hector
- Published
- 2023
- Full Text
- View/download PDF
50. Effectiveness and Medicoeconomic Evaluation of Home Monitoring of Patients With Mild COVID-19: Covidom Cohort Study.
- Author
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Jaulmes L, Yordanov Y, Descamps A, Durand-Zaleski I, Dinh A, Jourdain P, and Dechartres A
- Subjects
- Humans, Cohort Studies, Hospitalization, Delivery of Health Care, Emergency Service, Hospital, COVID-19
- Abstract
Background: Covidom was a telemonitoring solution for home monitoring of patients with mild to moderate COVID-19, deployed in March 2020 in the Greater Paris area in France to alleviate the burden on the health care system. The Covidom solution included a free mobile application with daily monitoring questionnaires and a regional control center to quickly handle patient alerts, including dispatching emergency medical services when necessary., Objective: This study aimed to provide an overall evaluation of the Covidom solution 18 months after its inception in terms of effectiveness, safety, and cost., Methods: Our primary outcome was to measure effectiveness using the number of handled alerts, response escalation, and patient-reported medical contacts outside of Covidom. Then, we analyzed the safety of Covidom by assessing its ability to detect clinical worsening, defined as hospitalization or death, and the number of patients with clinical worsening without any preceding alert. We evaluated the cost of Covidom and compared the cost of hospitalization for Covidom and non-Covidom patients with mild COVID-19 cases seen in the emergency departments of the largest network of hospitals in the Greater Paris area (Assistance Publique-Hôpitaux de Paris). Finally, we reported on user satisfaction., Results: Of the 60,073 patients monitored by Covidom, the regional control center handled 285,496 alerts and dispatched emergency medical services 518 times. Of the 13,204 respondents who responded to either of the follow-up questionnaires, 65.8% (n=8690) reported having sought medical care outside the Covidom solution during their monitoring period. Of the 947 patients who experienced clinical worsening while adhering to daily monitoring, only 35 (3.7%) did not previously trigger alerts (35 were hospitalized, including 1 who died). The average cost of Covidom was €54 (US $1=€0.8614) per patient, and the cost of hospitalization for COVID-19 worsening was significantly lower in Covidom than in non-Covidom patients with mild COVID-19 cases seen in the emergency departments of Assistance Publique-Hôpitaux de Paris. The patients who responded to the satisfaction questionnaire had a median rating of 9 (out of 10) for the likelihood of recommending Covidom., Conclusions: Covidom may have contributed to alleviating the pressure on the health care system in the initial months of the pandemic, although its impact was lower than anticipated, with a substantial number of patients having consulted outside of Covidom. Covidom seems to be safe for home monitoring of patients with mild to moderate COVID-19., (©Luc Jaulmes, Youri Yordanov, Alexandre Descamps, Isabelle Durand-Zaleski, Aurélien Dinh, Patrick Jourdain, Agnès Dechartres. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 23.06.2023.)
- Published
- 2023
- Full Text
- View/download PDF
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