Increasing the Capacity of Primary Care Through Enabling Technology.

Primary care is the foundation of effective and high-quality health care. The role of primary care clinicians has expanded to encompass coordination of care across multiple providers and management of more patients with complex conditions. Enabling technology has the potential to expand the capacity for primary care clinicians to provide integrated, accessible care that channels expertise to the patient and brings specialty consultations into the primary care clinic. Furthermore, technology offers opportunities to engage patients in advancing their health through improved communication and enhanced self-management of chronic conditions. This paper describes enabling technologies in four domains (the body, the home, the community, and the primary care clinic) that can support the critical role primary care clinicians play in the health care system. It also identifies challenges to incorporating these technologies into primary care clinics, care processes, and workflow

Dental Professionals in Non-Dental Settings

This report focuses on nine oral health innovations seeking to increase access to preventive oral health care in nondental settings. Two additional reports in this series describe the remaining programs that provide care in dental settings and care to young children. The nine innovations described here integrate service delivery and workforce models in order to reduce or eliminate socioeconomic, geographic, and cultural barriers to care. Although the programs are diverse in their approaches as well as in the specific characteristics of the communities they serve, a common factor among them is the implementation of multiple strategies to increase the number of children from low-income families who access preventive care, and also to engage families and communities in investing in and prioritizing oral health. For low-income children and their families, the barriers that must be addressed to increase access to preventive oral health care are numerous. For example, even children covered by public insurance programs face a shortage of dentists that accept Medicaid and who specialize in pediatric dentistry. The effects of poverty intersect with other barriers such as living in remote geographic areas and having a community-wide history of poor access to dental care in populations such as recent immigrants. Overcoming these barriers requires creative strategies that address transportation barriers, establish welcoming environments for oral health care, and are linguistically and culturally relevant. Each of these nine programs is based on such strategies, including:-Expanding the dental workforce through training new types of providers or adding new providers to the workforce toincrease reach and community presence;-Implementing new strategies to increase the cost-effectiveness of care so that more oral health care services are available and accessible;-Providing training and technical assistance that increase opportunities for and competence in delivering oral health education and care to children;-Offering oral health care services in existing, familiar community venues such as schools, Head Start programs and senior centers;-Developing creative service delivery models that address transportation and cultural barriers as well as the fear and stigma associated with dental care that may arise in communities with historically poor access.The findings from the EAs of these programs are synthesized to highlight diverse and innovative strategies for overcoming barriers to access. These strategies have potential for rigorous evaluation and could emerge as best practices. If proven effective, these innovative program elements could then be disseminated and replicated to increase access for populations in need of preventive oral health care

Reengineering an Allergy Group Practice in Response to COVID-19: Change Management, Quality Assessment and Financial Considerations

To date, few studies have provided a comprehensive set of requirements for outpatient medical practices to consider when preparing for complex external forces that impact clinic operations. The objective of this qualitative doctoral project is to establish a set of requirements for outpatient medical practices to consider when preparing for pandemic conditions. Using the backdrop of the COVID-19 pandemic, this single case study reviews how an allergy group practice responds to the variables presented during COVID-19 through change management, quality assessment and financial considerations lenses to assist other medical practices in developing pandemic preparedness programming. Findings from this case study are presented within an adapted Lewin change management framework and supported by six domains found to be requisite for an effective outpatient medical practice pandemic response: risk mitigation, operational excellence, talent considerations, clinical excellence, patient engagement and financial vitality. Annual preparedness training and response drills may assist with developing individualized criteria that supports seamless operations during uncontrollable external forces. Medical practice leaders should swiftly develop contingency plans now to better position their medical offices for a robust response during the next pandemic. Utilizing the six domains reviewed in this case study will support an individualized, effective plan to work through issues observed during a group medical practice’s COVID-19 response

“My attitude on telehealth has completely changed.”: Facilitators and Barriers to Implementing Technology for Care Delivery in Community Mental Health Centers

The purpose of this study was to explore facilitators and barriers aiding community mental health centers in implementing technology-assisted care during the COVID-19 pandemic. Six key informants were interviewed and 28 clinicians were surveyed from three community mental health centers. Interviews focused on technology-assisted care implementation efforts and factors that facilitated adoption. Surveys focused on clinician beliefs and experience with technology-assisted care in addition to training needs. Barriers to technology-assisted care implementation included beliefs about the quality of virtual services and a lack of technology access. An increase in service utilization was reported. Technology-assisted care facilitators included reimbursement policy changes and clinic-based factors such as clinician training and supervision efforts. Clinicians reported having the skills necessary to implement technology-assisted care however endorsed a need for training. Implementation of technology-assisted care in community mental health centers was largely successful however support is needed to help clinicians adapt services to client needs

Expanding Rural Elder Care Options: Models That Work

Rural communities and elders need better access to elder care options that enable them to continue to live in the community. Despite a larger proportion of the population over age 65 than urban and suburban America, rural communities lack the services and care coordination systems older adults need to continue living independently in their own communities as they age. In November 2008, the Rural Long Term Care Workgroup convened a national Rural Long Term Care: Access and Options Workshop to identify lessons and strategies for building and sustaining rural community-based elder care services. Finding and building on successful models is an important step towards addressing the challenges faced by rural elders seeking care options in their communities. These options include home, community, and facility-based care supported by care coordination systems that enhance autonomy and quality of life of rural elders. These proceedings of the Workshop are organized around the following topics: The challenges and opportunities for expanding rural elder care options; Five rural elder care models that work; A Rural Elder Care Options Model, a web-based, interactive tool that rural communities can use to customize the options to their specific community; The organizational attributes and strong partnerships needed to build rural community options for elder care; Strategies for increasing access and options for elder care in rural communities; and Steps to move forward in building rural communities that support elder care

Telemental Health Services for Youth in Rural Areas: Meeting Service Gaps and Best Practices

Literature review that explores the benefits of providing telemental health services to youth, with a particular focus on how this delivery format may help close service gaps in rural areas. In addition, this review identifies several common challenges in providing and implementing telemental health services, best practice recommendations for providers and agencies to address these challenges, and strategies state agencies can take to encourage the use and expansion of telemental health services

Perception And Utilization Of Telehealth Services Among Home Health Care Agencies: A National Survey

Eun hae Kim Despite the widely known effectiveness of telehealth services in screening and treating both chronic disease and depression in older adults, their adoption among home health care agencies has been slow. Furthermore, there is a lack of empirical research on telehealth use, barriers, and facilitators of adoption in the home health sector. For these reasons, this study examined home health care staff perceptions and use of telehealth for chronic disease and depression care among older patients. Five hundred and sixteen staff from member home health care agencies of the National Association for Homecare and Hospice (NAHC) completed an online survey. The national survey comprised of 33 questions and was informed by the Unified Theory of Acceptance and Use of Technology Model (Venkatesh et al., 2003) and Bobni’ Innovation Culture paradigm. Twenty staff also participated in a 45-minute qualitative telephone interview. The qualitative interview questions focused on telehealth experience and perceived barriers and facilitators to telehealth adoption. Among HHC agencies that reported using telehealth, telephone (63%) and remote-monitoring devices (56%) were the most utilized telehealth technology. Telehealth services included monitoring of health services (64%), chronic disease management (58%), and patient health education (43%). Telehealth was the least used for depression counseling (15%). Overall, there was a positive perception towards telehealth for patient care. However, telehealth was perceived more positively for chronic disease management (90.7%) than for depression care (53%). A majority (74%) perceived themselves as having the knowledge necessary to use telehealth for chronically ill patients while only 32% did for depressed patients. Results suggest that although there is a positive perception towards telehealth for patient care, there are other factors (e.g., lack of resources and reimbursement, training and buy-in from staff or patients) that affect HHC agencies’ adoption and use of telehealth. Therefore, further education is needed to support telehealth use for depression care. Additionally, there needs to be a reimbursement for telehealth visits by HHC agencies, as well as policies and regulations that ensure the quality of care provided by telehealth services. Future studies may consider comparing existing telehealth programs and identifying policies and regulations that are supportive of such programs

Telehealth in primary health care settings within Australia and internationally

Access to appropriate health care services is often limited for people living in rural or remote areas, or for those with restricted mobility. One approach to minimising the inequality in access for those located at a distance from health care services is through telehealth service delivery. This review examined the evidence on telehealth models in Australia and elsewhere, with a specific focus on synchronous, real-time video consultations, where patients and health care providers were present simultaneously

Digital and Home Healthcare Survey among Nigerians: Assessing Awareness, Preferences, and Willingness to Pay for an Integrated Healthcare Ecosystem to achieve Universal Health Coverage

Introduction: The COVID-19 pandemic highlighted the need for evolving an integrated healthcare ecosystem that will connect patients to digital and home healthcare to achieve universal health coverage. The survey aims to assess perceptions and preferences about digital and home healthcare services and develop an integrated healthcare ecosystem. Methods: A survey of 254 Nigerians was conducted to assess their awareness, preferences, and willingness to pay for digital and home healthcare services using electronic questionnaires, and the data were analysed using SPSS 16.0. Results: Males constituted 70.9%, and 61.4% were aged ≤35 years. Two-third were clients, and a third were healthcare providers. Although about 71% patronized public hospitals, there was poor satisfaction (31.7%) than those attending private hospitals that were more satisfied. The male gender, private hospital utilization, and age of ≤35 years were associated with the satisfaction with OR 1.19 (95% CI 0.69-2.05), OR 1.22 (95% CI 0.73-2.04), and OR 2.41 (95% CI 1.38-4.20) respectively. Thirty minutes was the acceptable delay in receiving care by most respondents.  Only 39.4% were aware of digital health, and 52.8% were aware of home healthcare.  Male gender was associated with DH awareness, while being a healthcare provider was associated with both DH and home healthcare awareness. The respondents' median amount was willing to pay for DH and HH respondents is $1.64 -$6.56 and $3.28 –$6.56, respectively. Conclusion: In response to the survey result, we designed an integrated hospital, digital, and home healthcare project named eDokta, to leapfrog the attainment of universal health coverage in Nigeria

Challenges in Patient Recruitment, Implementation, and Fidelity in a Mobile Telehealth Study

Introduction: Mobile telehealth (MTH) evaluations in diabetes have been conducted, but few report details and issues related to recruitment, implementation (intervention delivery), fidelity, and context. These have important implications on the interpretation of the findings and effectiveness of the intervention. This article reports these data from an MTH study and describes the challenges experienced in running an intervention such as this in an active clinical environment. Materials and Methods: We conducted a mixed-methods MTH study that included a 9-month randomized controlled trial in people with poorly controlled diabetes. Detailed recruitment data were recorded during the study. Data on contacts between MTH participants and the MTH team were collected and used to report on intervention delivery and fidelity. Meeting and field notes, as well as communications between research team members during the study, were used to report on the contextual factors that affected recruitment, implementation, and fidelity. Results: The recruited sample size represented 6% of the total clinic population (n = 1,360) and 10.7% of the number of potentially eligible people at the clinic (n = 802) identified at the beginning of the study. Contextual factors related to patients, healthcare providers, the institution, or the recruitment protocol contributed to influence access to study participants and the number of participants randomized (n = 81). Technical and device-related aspects of the MTH intervention were delivered successfully, but the expected education and clinical feedback by the MTH nurse were not delivered according to the protocol. Although 92.5% of introductory calls were made by the MTH nurses, only 13.3% of expected educational calls were performed. Changes to the MTH nursing staff affected intervention participants differently and contributed to the low fidelity of intervention delivery. Conclusions: The current article presents data on the influence of contextual factors on the conduct of this MTH study and underlines the need for these processes to be assessed and reported adequately in future MTH research