Investigating teleconsultations in primary care pharmacy using human factors

Introduction: Given the drive for transforming primary care using digital solutions such as teleconsultations, there is a need to understand how these technologies are developed and used. The discipline of human factors (HF) is suited to this type of research, however, evidence of applications of HF in primary care are limited. Methods: The Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model was used throughout this thesis. A scoping review identified previous applications of HF approaches and methods to the development of teleconsultations in primary care. A secondary analysis of studies from the review provided an evidence base of factors influencing use of teleconsultations. Interview schedules, informed by the secondary analysis, were then used to understand patient and pharmacists’ perspectives on the use of video consultations (VCs) in Scotland. A scoping review and content analysis of guidance available to pharmacists in Scotland identified commonalities and differences across resources. Results: Twenty HF approaches were identified across 70 studies, with the majority set in general practice and focusing on evaluating use. The secondary analysis identified 36 and 39 factors influencing patients’ and primary care providers’ use of teleconsultations. Fourteen patients and 19 pharmacists participated in interviews, outlining factors influencing their use related to the six components of the SEIPS 2.0Work System. Pharmacists expressed a need for more organisational guidance on using VCs with patients. Analyses of existing guidance identified 94 resources, the majority of which were published by Scottish Government and Technology Enabled Care. Conclusions: To facilitate successful implementation and use of VCs into pharmacy services in Scotland, a systems perspective should be taken to understand the users’needs in each individual context, and to develop guidance which considers each component within the current Work System. Future research should continue to explore applications of HF in primary care, to encourage integration of the discipline in healthcare.Introduction: Given the drive for transforming primary care using digital solutions such as teleconsultations, there is a need to understand how these technologies are developed and used. The discipline of human factors (HF) is suited to this type of research, however, evidence of applications of HF in primary care are limited. Methods: The Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model was used throughout this thesis. A scoping review identified previous applications of HF approaches and methods to the development of teleconsultations in primary care. A secondary analysis of studies from the review provided an evidence base of factors influencing use of teleconsultations. Interview schedules, informed by the secondary analysis, were then used to understand patient and pharmacists’ perspectives on the use of video consultations (VCs) in Scotland. A scoping review and content analysis of guidance available to pharmacists in Scotland identified commonalities and differences across resources. Results: Twenty HF approaches were identified across 70 studies, with the majority set in general practice and focusing on evaluating use. The secondary analysis identified 36 and 39 factors influencing patients’ and primary care providers’ use of teleconsultations. Fourteen patients and 19 pharmacists participated in interviews, outlining factors influencing their use related to the six components of the SEIPS 2.0Work System. Pharmacists expressed a need for more organisational guidance on using VCs with patients. Analyses of existing guidance identified 94 resources, the majority of which were published by Scottish Government and Technology Enabled Care. Conclusions: To facilitate successful implementation and use of VCs into pharmacy services in Scotland, a systems perspective should be taken to understand the users’needs in each individual context, and to develop guidance which considers each component within the current Work System. Future research should continue to explore applications of HF in primary care, to encourage integration of the discipline in healthcare

African American Literature: Books to Stoke Dreams

In addition to market forces, unconsciously damaging trends in many textbooks for teacher education have resulted in classroom trade book collections that represent children who are primarily white and middle class. While all children—whether from Argentina, Afghanistan, or Algeria—deserve to see themselves and their families in books, the focus of this article is on new publications that depict African Americans. Teachers who are committed to learning all they can about multicultural literature and culturally and gender relevant pedagogy become agents of change. Includes significant bibliography of Resources and list of Children’s Literature That Picture Children of African Descent

Evaluating the Performance Benefits of a Smart Radiator Device in Small Spacecraft Missions, for Earth Orbits and Beyond

A Smart Radiator Device (SRD) was developed by MPBC to meet the growing demand for advanced thermal control in smaller spacecraft. The SRDs exhibit a temperature-dependent emissivity profile due to the metal insulator phase transition of the thermochromic material of the coating. This results in a reduction in heat radiated from the spacecraft in low temperatures and consequently, a decrease in the power demand of heaters. We compared the expected performance of the SRD’s to that of a traditional radiator through three simulated missions, with an emphasis on power and payload temperature swings

Application of Systemic Accident Analysis (SAA) Approaches in Telemedicine/Telehealth

This chapter discusses the importance of applying methods based on the systems thinking paradigm in analysing accidents that may occur in a complex healthcare system involving telemedicine/telehealth. Different accident analysis approaches (models and methods) have been utilised to analyse incidents/accidents in different safety-critical domains, including healthcare, to identify weaknesses and to be able to propose safety recommendations. With the advent of systemic accident analysis (SAA) approaches based on the systems thinking paradigm, can they be feasibly and practically applied to incidents resulting from unintended issues relating to telemedicine/telehealth? This chapter discusses three popular SAA approaches, benefits and limitations, including their necessity for improving safety and even security relating to telemedicine processes

Identifying the important outcomes to measure for pharmacy-led, clinical services within primary care : a nominal group technique approach

Background The introduction of clinical pharmacy services is part of a multi-disciplinary approach to reduce pressure on primary care. Ascertaining the impact of clinical pharmacists in general practice is vital to ensure intended benefits are achieved. However, this is complicated by poor quality evidence, multiple interventions, and a lack of agreement regarding outcome measures. Objectives To develop an outcomes framework for clinical pharmacy services delivered in Scottish general practice using a consensus methodology. Methods A modified nominal group technique (NGT) was conducted using Microsoft Teams and Qualtrics. This involved a pre-NGT questionnaire, silent generation of ideas, round robin, discussions, ranking, and a final consensus exercise. A selective sampling strategy recruited experienced pharmacists from Scottish health regions. NGT ranking results were used to signify relative importance of the outcome areas. NGT discussions underwent inductive thematic analysis to explore key areas considered. Result Overall, 13 (median: 24 years of experience) pharmacists participated, representing 11 of 14 Scottish regions. In total, 21 outcome areas, derived from the literature and a pre-NGT questionnaire, were considered during the NGT ranking exercise. Consensus identified five important outcome areas: Patient Experience, Medication Related Adverse Events, Cost-Effectiveness, Medication Optimisation, and Health Related Quality of Life. Thematic analysis highlighted the importance of the outcome framework's target audience, factors influencing the interpretation of outcomes, and the feasibility of the associated outcome measures. Conclusions The five key outcome areas will facilitate evidence-based decisions regarding service delivery. Future work should develop a measurement plan, involving routinely collected sources of outcomes data. The feasibility of collecting outcomes in the real-world context should be considered, identifying measures which are easy to collect within existing data infrastructures. This paper describes a replicable method to gain consensus for a national approach to data collection from a strong theoretical basis using an online methodology

Pharmacist and patient perspectives on the use of video consultations in primary care pharmacy in Scotland

Although over 80% of patients and 94% of healthcare professionals feel video consultations should be offered for healthcare appointments, use in pharmacy has been limited both before and during the COVID-19 pandemic (1, 3). Human Factors is the study of the interactions between humans, the tools and technologies they use and the complex environments in which they work (4). Applying human factors can assist in understanding the influence that each component of a system has on the use of video consultations. The aim of this study was to understand the factors influencing patients' and community and general practice pharmacists' use of video consultations (VCs), using a human factors approach

Pharmacist and patient perspectives on the use of video consultations in primary care pharmacy in Scotland

Although over 80% of patients and 94% of healthcare professionals feel video consultations should be offered for healthcare appointments, use in pharmacy has been limited both before and during the COVID-19 pandemic (1, 3). Human Factors is the study of the interactions between humans, the tools and technologies they use and the complex environments in which they work (4). Applying human factors can assist in understanding the influence that each component of a system has on the use of video consultations. The aim of this study was to understand the factors influencing patients' and community and general practice pharmacists' use of video consultations (VCs), using a human factors approach

Pharmacist and patient perspectives on the use of video consultations in primary care pharmacy in Scotland

Although over 80% of patients and 94% of healthcare professionals feel video consultations should be offered for healthcare appointments, use in pharmacy has been limited both before and during the COVID-19 pandemic (1, 3). Human Factors is the study of the interactions between humans, the tools and technologies they use and the complex environments in which they work (4). Applying human factors can assist in understanding the influence that each component of a system has on the use of video consultations. The aim of this study was to understand the factors influencing patients' and community and general practice pharmacists' use of video consultations (VCs), using a human factors approach

Involving patients and clinicians in the design of wireframes for cancer medicines electronic patient reported outcome measures in clinical care : mixed methods study

Background: Cancer treatment is a key component of health care systems, and the increasing number of cancer medicines is expanding the treatment landscape. However, evidence of the impact on patients has been focused more on chemotherapy toxicity and symptom control and less on the effect of cancer medicines more broadly on patients’ lives. Evolving electronic patient-reported outcome measures (ePROMs) presents the opportunity to secure early engagement of patients and clinicians in shaping the collection of quality-of-life metrics and presenting these data to better support the patient-clinician decision-making process. Objective: The aim of this study was to obtain initial feedback from patients and clinicians on the wireframes of a digital solution (patient app and clinician dashboard) for the collection and use of cancer medicines ePROMs. Methods: We adopted a 2-stage, mixed methods approach. Stage 1 (March to June 2019) consisted of interviews and focus groups with cancer clinicians and patients with cancer to explore the face validity of the wireframes, informed by the technology acceptance model constructs (perceived ease of use, perceived usefulness, and behavioral intention to use). In stage 2 (October 2019 to February 2020), the revised wireframes were assessed through web-based, adapted technology acceptance model questionnaires. Qualitative data (stage 1) underwent a framework analysis, and descriptive statistics were performed on quantitative data (stage 2). Clinicians and patients with cancer were recruited from NHS Greater Glasgow & Clyde, the largest health board in Scotland. Results: A total of 14 clinicians and 19 patients participated in a combination of stage 1 interviews and focus groups. Clinicians and patients indicated that the wireframes of a patient app and clinician dashboard for the collection of cancer medicines ePROMs would be easy to use and could focus discussions, and they would be receptive to using such tools in the future. In stage 1, clinicians raised the potential impact on workload, and both groups identified the need for adequate IT skills to use each technology. Changes to the wireframes were made, and in stage 2, clinicians (n=8) and patients (n=16) indicated it was “quite likely” that the technologies would be easy to use and they would be “quite likely” to use them in the future. Notably, clinicians indicated that they would use the dashboard to enable treatment decisions “with around half” of their patients. Conclusions: This study emphasizes the importance of consulting both patients and clinicians in the design of digital solutions. The wireframes were perceived positively by patients and clinicians who were willing to use such technologies if available in the future as part of routine care. However, challenges were raised, and some differences were identified between participant groups, which warrant further research