General practitioners’ perceptions of asynchronous telemedicine in a randomized controlled trial of teledermatology.

Background: Telemedicine is viewed as having a key role to play in the Government’s plans to modernise the NHS.1 However, to date there are few studies which have explored the views and acceptability of GPs towards telemedicine in primary care. Aim: To elicit the perceptions of GPs towards teledermatology (TD) before and after it’s introduction into their Practices and to observe whether GP views of TD had changed over the course of the study. Design of study: A postal questionnaire administered as part of a wider randomised controlled trial of telemedicine in dermatology. Setting: A locality group of eight General Practices in Sheffield and a single teaching hospital in Sheffield that provided the local dermatology referral service. Method: A postal questionnaire circulated to all GPs from the eight participating Practices. Results: A 85.7% (36/42) response rate was achieved. Only 21% (n=7; 95% CI: 10-37%) of respondents felt satisfied/very satisfied with TD in their Practice, 47% (n=16) said that they were dissatisfied or very dissatisfied. Thirty one per cent (n=10; 95% CI: 18-49%) said that they felt confident about diagnosis and management of care through TD, with 28% (n=9) reporting that they were unconfident. Only 23% (n=8; 95% CI: 12-39%) of respondents said that they would consider using a telemedicine system in the future, 34% (n=12) said they would probably or definitely not and 43% (n=15) were unsure. There was some evidence that GPs views about TD became more negative over the course of the study. Conclusions: The study reports less favourable GP responses to telemedicine than observed in previous studies, and suggests that the model of telemedicine described in this study paper would not be widely acceptable to GPs

Evaluating diverse electronic consultation programs with a common framework.

BackgroundElectronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion.MethodsUsing a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems' end-users.ResultsOrganizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies.ConclusionA core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs

Nurse Practitioners’ Perceptions of Telehealth Behaviors

Problem: NP’s must be proficient in the behaviors that are required for a successful patient encounter to provide the full benefit of nurse practitioner (NP) telehealth. Consequently, it is imperative for NPs to understand telehealth etiquette behaviors which include the technical and non-technical skills that are necessary for an effective NP-patient patient telehealth encounter (Haney, Kott & Fowler, 2015). Telehealth has been incorporated into healthcare delivery and its use is expanding. In the United States, it is predicted to be used by seven million patients in 2020 (US Department of Health and Human Services, 2018). Appropriate access to health care is a necessity for the advancement of good health. Some common healthcare impediments are lack of available appointments, clinician shortages, inadequate transportation, and rural geographic challenges. Studies in the literature support the benefit of telehealth for reducing issues of inaccessible healthcare. NP telehealth is proven to improve the health care gap that exists when there is reduced health care access. Yet there is limited telehealth behavior education in the NP curriculum (Henry, Ames, & Vozenilek, 2018). A goal of this descriptive research on the NP perceptions of telehealth etiquette was to explore the research topic of nurse practitioners’ perceptions on telehealth etiquette and actual telehealth etiquette behaviors. Methods: This is a qualitative, descriptive study to explore perceptions of NPs on telehealth and the phenomenon of telehealth behaviors. Qualitative data on nine nurse practitioner’s perception of telehealth was collected during individual semi-structured interviews. The 10-question interview spanned approximately 30 minutes and was recorded on zoom web-based software. The recordings from the video-audio interviews were transcribed and thematic analysis used to reach data saturation. Data was categorized using content analysis of themes. Results: All of the study’s NP interview responses were in accord with the theme that telehealth behaviors are unique and are necessary for an effective patient encounter. Responses generated themes to represent etiquette behaviors as a professional skill to be included into nursing education and professional competencies. Themes: 1) Telehealth etiquette specific knowledge base, 2) Telehealth etiquette NP skill competencies, 3) Identification of etiquette behaviors for successful implementation, 4) Evaluation illuminate’s voids where education is needed, 5) Physical assessment can be difficult without touch. Discussion: Data from the study was categorized into five major themes. The themes that developed from the interview corroborated the assertion that telehealth requires specific training to master specific behavior skills in addition to the technical required learning elements. The response data indicated the NPs perception that telehealth practitioners need telehealth training to learn both the technical and human behaviors that are required for telehealth delivery. Applicable NP educational training on telehealth would benefit patients and the nursing profession. Improvements that contribute to the progress of telehealth are also improvements for patient health care access

Seeing the wood for the trees. Carer related research and knowledge: A scoping review

This NIHR-SSCR funded scoping review provides a comprehensive mapping of what is known about carers and caring, and aims to help inform policy, practice and research in relation to carers. The review was undertaken by searching 10 electronic bibliographic databases, supplemented by additional web searches to identify academic research, grey literature and wider knowledge. The analysis adopts a selective thematic approach covering: carer variables - the characteristics of different types of carer and different caring situations; types of care - the nature of needs of the cared for person and the features of the care situation; the impact of caring – resilience and coping, employment and health; and carer support and needs assessment. The final section highlights key messages identified from the review. It found that caring involves all sections and age groups of the population, with people are likely to experience one or more periods of caregiving over their lifetime. The uniqueness of each caring relationship is also highlighted. In relation to types of carers, knowledge about ‘hard to reach’ groups, such as BAME and LGBT carers, remains sparse. Older carers are also relatively invisible in policy and research terms. It found that much of the knowledge about carers identified in the review relates to their characteristics, their lived experience and the nature of their caregiving, with relatively less being known about the effectiveness of interventions to support them. The report concludes by offering suggestions for policy and practice. An appendix provides a bibliography of the 3,434 items identified in review, classified into 17 types of reference

Implementing complex innovations in fluid multi-stakeholder environments: Experiences of 'telecare'

Accepted versio