Barriers and facilitators to family participation in the care of their hospitalized loved ones

This study’s objective was to better understand family members’ experiences in order to identify how healthcare organizations can facilitate their participation in the care of a hospitalized loved one. Eighteen individuals at the bedside of a hospitalized loved one were interviewed individually. Roles at the bedside and factors that facilitated their participation or represented barriers were examined. A qualitative analysis using a mixed inductive/deductive approach was performed. Reassurance and emotional support, as well as sharing information with the healthcare team emerged as main roles. Quality and timeliness of the information received about the patient’s condition, prognosis and changes in medical condition, as well as information on how to participate in their care, were the factors most frequently evoked as facilitating participation. On the other hand, the need to improve communication channels and access to doctors were highlighted. Most family members having no prior knowledge or exposure to healthcare environments reported feeling overwhelmed in this foreign environment. Among the suggestions on how to improve their experience, having a well-identified contact person who liaises with them and who can instruct them on how to participate in care during hospitalization and back at home was frequently suggested. Furthermore, many mentioned that recognizing the experiential knowledge they have of the patient allows for more holistic care and contributes to improve both patient and family experience. Families need to be adequately recognized and supported and have access to information in a timely manner so that their contribution to their loved one’s care is maximized and the burden associated with this stressful experience alleviated

M-health adoption by healthcare professionals : a systematic review

Objective The aim of this systematic review was to synthesize current knowledge of the factors influencing healthcare professional adoption of mobile health (m-health) applications. Methods Covering a period from 2000 to 2014, we conducted a systematic literature search on four electronic databases (PubMed, EMBASE, CINAHL, PsychInfo). We also consulted references from included studies. We included studies if they reported the perceptions of healthcare professionals regarding barriers and facilitators to m-health utilization, if they were published in English, Spanish, or French and if they presented an empirical study design (qualitative, quantitative, or mixed methods). Two authors independently assessed study quality and performed content analysis using a validated extraction grid with pre-established categorization of barriers and facilitators. Results The search strategy led to a total of 4223 potentially relevant papers, of which 33 met the inclusion criteria. Main perceived adoption factors to m-health at the individual, organizational, and contextual levels were the following: perceived usefulness and ease of use, design and technical concerns, cost, time, privacy and security issues, familiarity with the technology, risk-benefit assessment, and interaction with others (colleagues, patients, and management). Conclusion This systematic review provides a set of key elements making it possible to understand the challenges and opportunities for m-health utilization by healthcare providers

Perceived barriers to completing an e-learning program on evidence-based medicine

Purpose The Continuing Professional Development Center of the Faculty of Medicine at Laval University offers an internet-based program on evidence-based medicine (EBM). After one year, only three physicians out of the 40 who willingly paid to register had completed the entire program. This descriptive study aimed to identify physicians' beliefs regarding their completion of this online program. Methods Using theoretical concepts from the Theory of Planned Behaviour, a semi-structured telephone interview guide was developed to assess respondents' attitudes, perceived subjective norms, perceived obstacles and facilitating conditions with respect to completing this internet-based program. Three independent reviewers performed content analysis of the interview transcripts to obtain an appropriate level of reliability. Findings were shared and organised according to theoretical categories of beliefs. Results A total of 35 physicians (88% response rate) were interviewed. Despite perceived advantages to completing the internet-based program, barriers remained, especially those related to physicians' perceptions of time constraints. Lack of personal discipline and unfamiliarity with computers were also perceived as important barriers. Conclusions This study offers a theoretical basis to understand physicians' beliefs towards completing an internet-based continuing medical education (CME) program on EBM. Based upon respondents' insights, several modifications were carried out to enhance the uptake of the program by physicians and, therefore, its implementation

Implementation of an electronic medical record in family practice: a case study

Background Electronic medical records (EMRs) have the potential to foster a safer, more effective and more efficient healthcare system. However, their implementation in primary care practice remains a challenge. Objective This study aims at exploring factors that have influenced the successful implementation of an EMR system in a family medicine group (FMG) in the Province of Qu_bec, Canada. Methods A case study approach was selected to get a deep understanding of the phenomenon in its context. The case was chosen on the basis that it was the first FMG in Qu_bec to implement a full EMR used by all clinicians. Fifteen semi-structured interviews were conducted with key informants. Results Factors that have influenced the success of the EMR implementation were classified under three broad themes: a project leader who combined the roles of clinical, technology and knowledge champion; an organisation that was open to and supportive of change; and an evidence-based implementation strategy tailored to the local context and adoption pace. Conclusions This study underscores the importance of a champion for successful EMR implementation. It proposes a set of roles and characteristics that could be found in a champion as well as other elements for a successful EMR implementation strategy

Comment le MEN s'écrit : autour de trois guides du mal du voyage

Exposer, c'est troubler l'harmoni

La violence politique au village (généalogie et ethnographie d'un conseil municipal)

Cette thèse a pour point de départ les interrogations suscitées par les conflits violents (incendies criminels, menaces...) que les élections municipales d'avril 2001 ont déclenchés à Olignac, petit village des Landes girondines (au sud de Bordeaux). Refusant de réduire ce type d'évènements à un fait divers "clochemerlesque", elle a pour ambition de comprendre pourquoi des élections municipales peuvent repésenter un tel enjeu dans un village d'à peine deux cents habitants. Cette thèse envisage successivement tous les aspects du problème posé par ces incendies à travers, d'abord, une enquête historique sur la région et le village depuis la Révolution française, puis une description ethnographique minutieuse des relations au sein de la population et du conseil municipal après les élections de 2001. Elle soutient l'idée que la compréhension d'un tel évènement ne passe pas par une explication univoque mais suppose que soit patiemment démêlée l'écheveau qu'il constitue et qui le constitue.This dissertation takes as its point of departure the questions raised by the violent conflicts (arson, threats...) which burst during the April 2001 municipal elections in Olignac, tiny village in the "Landes girondines" (south of Bordeaux). This thesis refuses any reduction of such an event to a folklorish incident and aims to understand why municipal elections constitute such a stake in a two-hundred inhabitant village. It successively considers all the aspects of these arsons, starting with a meticulous ethnographical description of the relationships within the village and the municipal council after the 2001 elections .It states that understanding such an incident takes more than a univocal explanation and that all the layers of the event are to be patiently unfolded.PARIS-Médiathèque MQB (751132304) / SudocPARIS-Fondation MSH (751062301) / SudocSudocFranceF

Assessing the cost of electronic health records: a review of cost indicators.

We systematically reviewed PubMed and EBSCO business, looking for cost indicators of electronic health record (EHR) implementations and their associated benefit indicators. We provide a set of the most common cost and benefit (CB) indicators used in the EHR literature, as well as an overall estimate of the CB related to EHR implementation. Overall, CB evaluation of EHR implementation showed a rapid capital-recovering process. On average, the annual benefits were 76.5% of the first-year costs and 308.6% of the annual costs. However, the initial investments were not recovered in a few studied implementations. Distinctions in reporting fixed and variable costs are suggested

Implantation d'un système de conseillers pédagogiques dans un milieu de formation en médecine familiale : une recherche-action

Contexte : En 2005, une équipe d'enseignants en médecine familiale à l'université Laval (Québec) a implanté un système jumelant chaque résident à un conseiller pédagogique pour la durée de la résidence. La fonction de conseiller était celle d'un guide accompagnant un résident dans son parcours de formation au moyen d'une relation interpersonnelle privilégiée et institutionnalisée. But : Décrire l'implantation du système de conseillers pédagogiques dans un milieu de formation en médecine familiale. Méthodes : Une recherche-action s'est déroulée de juin 2005 à juin 2006 avec la participation des conseillers pédagogiques et des résidents. Le recueil des informations s'est fait au moyen de questionnaires écrits individuels, de groupes de discussion et d'observation des réunions pédagogiques régulières des cliniciens enseignants. Les questionnaires et les groupes de discussion ont fait l'objet d'une d'analyse de contenu thématique. Résultats : Au cours de l'année d'implantation, les conseillers pédagogiques ont pu mieux définir et s'approprier leur nouvelle fonction. L'accompagnement continu du résident dans son développement professionnel et les conseils spécifiques en regard de besoins particuliers sont devenus les spécificités de cette fonction. La triangulation des sources d'information et des méthodes de recueil des données a permis d'enrichir les résultats. Globalement, la recherche-action a positivement contribué à l'implantation du changement pédagogique dans ce milieu. Conclusion : La clarification de la fonction de conseiller pédagogique, son appropriation et l'application de moyens concrets permettant de la mettre en pratique sont les principales retombées de cette étude. La recherche-action a permis d'offrir des lieux de réflexion et d'échanges dans l'équipe d'enseignants et entre les enseignants et les résidents en plus d'aider à trouver des solutions aux obstacles rencontrés dans l'implantation du système