Leaders' support for using online symptom checkers in Finnish primary care : Survey study

Online symptom checkers (SCs) are eHealth solutions that offer healthcare organizations the possibility to empower their patients to independently assess their symptoms. The successful implementation of eHealth solutions, such as SCs, requires a supportive organizational culture and leadership. However, there is limited knowledge about the factors associated with leaders' support for the use of SCs. The aim of the study was to identify the factors associated to primary care leaders' support for SCs in triage and their experiences of the benefits and challenges related to the use of SCs. An online survey was used to collect data from 84 Finnish primary care leaders. The data were analyzed using statistical analysis methods and content analysis. Vision clarity, perceiving efficiency improvements, and considering the service to be beneficial for patients were associated with leaders' support for the service (beta ranging from 0.41 to 0.44, p < 0.001). Leaders' support for the service was also associated with how well the leaders provided information about the service to their subordinates (beta =0.22, p < 0.048). SCs present slightly more challenges than benefits regarding health professionals' work. The developers of SCs should focus more on features that decrease health professionals' workload as well as how the solution can benefit patients.Peer reviewe

Health self-management of older employees: identifying critical peak experiences of a patient portal

Digitalization could provide efficient and cost-effective health and well-being services to the rapidly aging population. However, digital services do not always meet their needs. We investigated the experiences and service needs of older employees by collecting quantitative and qualitative data through a survey (n = 497). The results suggested a negative association between user satisfaction and age during retirement transition. Peak experiences were meaningful, explaining a 26% variation in the overall evaluation of the portal. The negative peak experiences concerned poorly functioning features, and the positive ones the ability to take care of one’s health smoothly and easily. The respondents had high expectations for functionality, efficiency, and ease of use. They wanted more support for self-managing health: controlling weight, sleeping, recovery, and exercising

Johtamisen hyvät käytännöt sähköisten omahoitopalveluiden käyttöönotossa

The ODA (Self-Treatment and Digital Value Services) and Virtuaalisairaala 2.0 projects develop new eHealth services for citizens in Finland. eHealth services change health professionals’ work and professionals often resist change. The successful implementation of eHealth services from planning and piloting to the organizational adoption requires that the changes are systematically incorporated within organizational practices. In this study, we reviewed the existing literature and collected experiences of the ODA and Virtuaalisairaala 2.0 projects to identify good implementation practices and understand their use. First, we collected survey-based data from supervisors and leaders who worked in the 14 health care organizations participating in the ODA project. The supervisors and leaders were asked about their expectations about the implementation of the ODA services. Second, we interviewed four project managers or coordinators about their experiences of implementing services developed in the Virtuaalisairaala 2.0 project. The results suggest that the experiences of the implementing practices supporting successful eHealth service adoption are similar in the Finnish eHealth projects and in international studies. For example, the identified good practices were communicating clear visions and goals for service adoption, leadership support, informing about service implementation and its benefits, and user participation in planning. According the ODA survey results, good implantation practices were not very widely used in Finnish health organizations. The research results give advice for implementing teams, leaders and supervisors how to support systematic implementation leading to successful outcomes. Supervisors have an important role in institutionalization of eHealth services and the identified implementation practices will be used in developing training materials for them.ODA (Omat digiajan hyvinvointipalvelut) ja Virtuaalisairaala 2.0 -hankkeet kehittävät Suomeen uusia kansalaisille suunnattuja sähköisiä omahoitopalveluita. Sähköiset palvelut muuttavat terveysammattilaisten työtä ja aiheuttavat usein myös vastustusta. Uusien palveluiden onnistunut käyttöönotto niiden suunnittelusta ja kokeilusta vakiintuneeseen käyttöön asti vaatii, että muutokset tuodaan organisaatioon suunnitellusti. Tässä tutkimuksessa tunnistettiin käyttöönoton hyviä käytäntöjä tutkimuskirjallisuuden sekä ODA ja Virtuaalisairaala 2.0 -hankkeiden kokemusten perusteella sekä arvioitiin käytäntöjen toteutumista näissä hankkeissa. ODA-hankkeesta kartoitettiin kyselyllä siihen osallistuvien 14 sosiaali- ja terveysalan organisaation esimiesten ja johtajien (n=478) odotuksia Omaolo-palvelukokonaisuuden käyttöönotosta. Virtuaalisairaala 2.0 -hankkeen käyttöönottokokemuksia kerättiin haastattelemalla neljää Terveyskylän eri taloprojektin projektipäällikköä tai -koordinaattoria. Tulosten perusteella kokemukset käyttöönoton onnistumista tukevista käytännöistä ovat hyvin samansuuntaisia suomalaisissa hankkeissa sekä kansainvälisissä tutkimuksissa. Hyviksi käytännöiksi nousivat esimerkiksi selkeän vision ja tavoitteiden kommunikointi, johdon tuki, tehokas tiedottaminen palvelun käyttöönotosta ja sen hyödyistä sekä ammattilaisten ja asiantuntijoiden osallistuminen suunnitteluun. ODA-kyselyn tulosten mukaan käyttöönoton hyvät käytännöt eivät olleet kovin laajassa käytössä suomalaisissa sote-organisaatioissa. Tutkimuksessa tunnistetut hyvät käytännöt antavat vinkkejä käyttöönottotiimeille sekä johtajille ja esimiehille siitä, miten käyttöönoton voi toteuttaa suunnitelmallisemmin ja samalla tukea käyttöönoton onnistumista. Esimiehet ovat tärkeässä roolissa uusien sähköisten palveluiden organisaationlaajuisessa käyttöönotossa ja tunnistettuja käytäntöjä on tarkoitus hyödyntää esimiesten koulutuksen kehittämisessä

Eight-year post-trial follow-up of morbidity and mortality of telephone health coaching

Publisher Copyright: © 2021, The Author(s).Background: Health coaching is a patient-centred approach to supporting self-management for the chronic conditions. However, long-term evidence of effectiveness of health coaching remains scarce. The object of this study was to evaluate the long-term effect of telephone health coaching (THC) on mortality and morbidity among people with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF). Methods: 1535 T2D, CAD and CHF patients with unmet treatment targets were randomly allocated into an intervention group (n = 1034) and control group (n = 501). Intervention group received monthly individual strength-based, autonomy supportive THC sessions (average 30 min) for behavior change with a specially trained nurse for 12 months additional to usual health care. Control group received usual health care services. The primary outcome was a composite of death from cardiovascular causes or non-fatal stroke or non-fatal myocardial infarction (AMI) or unstable angina pectoris (UAP) during a follow-up of 8 years Three other composite endpoints with distinct combinations of fatal and non-fatal cardiovascular events and death from any cause were used as secondary outcomes. Other outcomes followed were the most relevant components of the composite endpoints. Randomized controlled trial (RCT) data was linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year evaluation was conducted using intention-to-treat (ITT) and per-protocol (PP) analysis. Results: The composite primary outcome event rate per 100 person years was lower in the intervention group (3.45) than in control group (3.88) in ITT -analysis, but the difference was not statistically significant (hazard ratio in the intervention group 0.87; 95% CI, 0.71 to 1.07; P = 0.19). In the subgroup (T2D, CAD/CHF) analysis, there were no statistically significant effects. The secondary PP-analysis showed statistically significant benefits for those who participated in the study. Conclusions: No statistically significant effect of health coaching on mortality and morbidity was found in intention to treat analysis. The per protocol results suggest, however, that the intervention may be effective among patients who are willing and able to participate in health coaching. More research is needed to identify patients most likely to benefit from low-intensity health coaching. Trial registration: NCT00552903 (registration date: the 1st of November 2007, updated the 3rd of February 2009).Peer reviewe

Towards digital health equity - a qualitative study of the challenges experienced by vulnerable groups in using digital health services in the COVID-19 era

Background The COVID-19 pandemic has given an unprecedented boost to already increased digital health services, which can place many vulnerable groups at risk of digital exclusion. To improve the likelihood of achieving digital health equity, it is necessary to identify and address the elements that may prevent vulnerable groups from benefiting from digital health services. This study examined the challenges experienced by vulnerable groups in using digital health services during the COVID-19 pandemic. Methods Qualitative descriptive design was utilized. Semi-structured interviews were conducted between October 2020 and May 2021. The participants (N = 74) were older adults, migrants, mental health service users, high users of health services, and the unemployed. Qualitative content analysis with both inductive and deductive approach was used to analyze the data. Challenges related to the use of digital health services were interpreted through digital determinants of health from the Digital Health Equity Framework. Results For most of the participants the access to digital health services was hampered by insufficient digital, and / or local language skills. The lack of support and training, poor health, as well as the lack of strong e-identification or suitable devices also prevented the access. Digital services were not perceived to be applicable for all situations or capable of replacing face-to-face services due to the poor communication in the digital environment. Fears and the lack of trust regarding digital platforms were expressed as well as concerns related to the security of the services. Contact with a health care professional was also considered less personal and more prone to misunderstandings in the digital environment than in face-to-face services. Finally, digital alternatives were not always available as desired by participants, or participants were unaware of existing digital services and their value. Conclusion Several development needs in the implementation of digital health services were identified that could improve equal access to and benefits gained from digital services in the future. While digital health services are increasing, traditional face-to-face services will still need to be offered alongside the digital ones to ensure equal access to services.Peer reviewe

Ehdotus sosiaali- ja terveyspalveluiden uudeksi kansalliseksi mittaristoksi

Sote-uudistus edellyttää hyvinvoinnin ja terveyden edistämisen tarpeen arviointia sekä palvelutuotannon kustannusten, tuottavuuden, laadun ja vaikuttavuuden arviointia ja vertailua. Myös monissa muissa maissa on viime aikoina kehitetty mittaristoja palvelujärjestelmän suorituskyvyn arviointiin. Mittaristo laaditaan tavoitteiden toteutumisen seuraamiseksi, joten kehitystyötä on tehty sote-uudistuksen tavoitteiden, ministeriön työryhmissä käytyjen keskustelujen, asiantuntijahaastatteluiden sekä kirjallisuuden ja tilastoanalyysien pohjalta. Mittariston viitekehys mukailee Triple Aim –rakennetta: kustannukset, vaikuttavuus ja laatu (saatavuus, turvallisuus ja asiakaskokemus). Ehdotetussa mittaristossa kustannuksia seurataan kokonaiskustannusten tasolla hyödyntäen Sitran ja STM:n palvelupakettimallia ja erikseen paljon palveluita käyttäville asiakasryhmille. Vaikuttavuutta ehdotetaan mitattavaksi sekä kovilla, tietojärjestelmäpohjaisilla mittareilla, joista ylätason mittariksi ehdotetaan DALY:a (disability-adjusted life years), että asiakkaan itse raportoimilla mittareilla. Tietopohjan keskeisimmät kehittämiskohteet liittyvät 1) asiakkailta kerättävään tietoon: asiakaskokemukseen ja asiakkaan raportoimaan toimintakykyyn ja terveydentilaan, 2) turvallisuuden kokonaisvaltaiseen seurantaan ja 3) sosiaalipalveluiden rakenteisen kirjaamisen kattavuuden parantamiseen. Tietojen on oltava asiakastasolla hyödynnettävissä. Tarvittava tietoprosessi on muissa hankkeissa kehitettävän kansallisen arkkitehtuurisuunnitelman mukainen. Kansallinen mittaristo edellyttää konkreettista, nykyistä selkeämpää tavoiteasetantaa kustannustavoitteen lisäksi myös laadulle ja vaikuttavuudelle. Valmiita mittareita ja indikaattoreita on olemassa runsaasti sekä kansallisesti että kansainvälisesti, mutta tarvitaan selkeät tavoitteet ennen kuin mittarit voidaan valita

The NORDeHEALTH 2022 Patient Survey: Cross-Sectional Study of National Patient Portal Users in Norway, Sweden, Finland, and Estonia

Background: Although many surveys have been conducted on patients accessing their own health records in recent years, there is a limited amount of nationwide cross-country data available on patients’ views and preferences. To address this gap, an international survey of patient users was conducted in the Nordic eHealth project, NORDeHEALTH. Objective: We aimed to investigate the sociodemographic characteristics and experiences of patients who accessed their electronic health records (EHRs) through national patient portals in Norway, Sweden, Finland, and Estonia. Methods: A cross-sectional web-based survey was distributed using the national online health portals. The target participants were patients who accessed the national patient portals at the start of 2022 and who were aged ≥15 years. The survey included a mixture of close-ended and free-text questions about participant sociodemographics, usability experience, experiences with health care and the EHR, reasons for reading health records online, experience with errors, omissions and offense, opinions about security and privacy, and the usefulness of portal functions. In this paper, we summarized the data on participant demographics, past experience with health care, and the patient portal through descriptive statistics. Results: In total, 29,334 users completed the survey, of which 9503 (32.40%) were from Norway, 13,008 (44.35%) from Sweden, 4713 (16.07%) from Finland, and 2104 (7.17%) from Estonia. National samples were comparable according to reported gender, with about two-thirds identifying as women (19,904/29,302, 67.93%). Age distributions were similar across the countries, but Finland had older users while Estonia had younger users. The highest attained education and presence of health care education varied among the national samples. In all 4 countries, patients most commonly rated their health as “fair” (11,279/29,302, 38.48%). In Estonia, participants were more often inclined to rate their health positively, whereas Norway and Sweden had the highest proportion of negative health ratings. Across the whole sample, most patients received some care in the last 2 years (25,318/29,254, 86.55%). Mental health care was more common (6214/29,254, 21.24%) than oncological care (3664/29,254, 12.52%). Overall, most patients had accessed their health record “2 to 9 times” (11,546/29,306, 39.4%), with the most frequent users residing in Sweden, where about one-third of patients accessed it “more than 20 times” (4571/13,008, 35.14%). Conclusions: This is the first large-scale international survey to compare patient users’ sociodemographics and experiences with accessing their EHRs. Although the countries are in close geographic proximity and demonstrate similar advancements in giving their residents online records access, patient users in this survey differed. We will continue to investigate patients’ experiences and opinions about national patient-accessible EHRs through focused analyses of the national and combined data sets from the NORDeHEALTH 2022 Patient Survey