The use of mobile devices is developing in palliative care services, promising enhancements to patient care and service delivery. However, mobile device use is not well documented in the research literature even though it is necessary to understand how its use is developing in the medical field. Therefore, an online survey was developed in English, French and Arabic and distributed across palliative care providers in the 33 out of 54 countries in Africa where palliative care services are present. The survey gathered information about the service provided where a respondent was based, and a framework was presented to respondents documenting the different stages of palliative care delivery (ie, diagnosis, referral, up to bereavement care). For each stage of delivery, participants were asked to outline how they currently use mobile devices and to specify any perceived barriers and benefits to mobile device development at their site, alongside thoughts on priorities for future research development. The results of this survey, and the priorities it indicates, will be presented

Allsop, MJ

Namisango, E

Powell, R

White Rose Research Online

This is a repository copy of Mobile devices in palliative care services: a methodological approach to identifying use and implementation.White Rose Research Online URL for this paper:http://eprints.whiterose.ac.uk/110720/Version: Accepted VersionProceedings Paper:Allsop, MJ orcid.org/0000-0002-7399-0194, Powell, R and Namisango, E (2016) Mobile devices in palliative care services: a methodological approach to identifying use and implementation. In: To be confirmed. 5th International African Palliative Care Conference, 16-19 Aug 2016, Kampala, Uganda. . eprints@whiterose.ac.ukhttps://eprints.whiterose.ac.uk/Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. 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Dr Matthew Allsop University of LeedsResearch Fellow in Applied HealthMobile devices in palliative care services: a methodological approach to identifying use and implementation by service providers in Africa Matthew Allsop, Eve Namisango, Richard Powell Overview• Background & literature review• Details of survey approach • Findings from survey • Conclusions • Recommendations for research and practiceBackground: mHealth – what is it? • mHealth – what is it?• “mHealth or mobile health is medical and public health practicesupported by mobile devices, such as mobile phones, patientmonitoring devices, personal digital assistants (PDAs), andother wireless devices” (World Health Organization, 2011)• Voice and short messaging service (SMS) • General packet radio service (GPRS)• 3G and 4G systems • Global positioning system (GPS)• Bluetooth technologyBackground: mHealth – why? Ericsson Mobility Report, sub-Saharan Africa,  November 2015Background: mHealth in palliative care – why? • Demand for palliative care is high and rapid development of services is urgently needed• Particular attention needed for cancer and NCD agenda • Innovative methods adopted by SSA PC services, such as roadside care delivery• Examples of potential for mHealth include: • Address rural / urban access issues• Extend reach of palliative care services• Improve data accuracy and access• Improve patient careLiterature Review: mHealth use in palliative care servicesLiterature Review: mHealth use in palliative care services• To identify the development and use of mHealth in palliative care services in SSA• Searched 13 databases for research articles discussing mHealth use • Use in Nigeria, Uganda, Kenya and Malawi, mostly patient-to-provider contact reported, supporting palliative treatment, management and coordination • Discussed at mHealth workshop in Kampala, July 2015 Survey approach• Link to an electronic survey was emailed to palliative care providers in 30 sub-Saharan African countries, facilitated by APCA  • Survey designed to gather information on use of mHealth directly from palliative care providers• Survey asked providers to document: • At which stage(s) of the palliative care pathway• How mHealth was occurring Survey content: palliative care pathwaymHealth use: WHO framework for patientsmHealth use: WHO framework for health professionalsCombined WHO and mHealth FrameworkmHealth use: Reported use in literaturemHealth survey: who responded? mHealth survey: which countries responded? mHealth survey: job roles of respondents0 5 10 15 20 25 30 35 40YesNoPatient education and behaviour changemHealth use: findings from patient useCameroon: To take appointments or confirm appointments with patients and to follow up patients or pass urgent information to patientsKenya: Patients contact us via mobile phone if they have questions about medications, appointments or new symptoms, and we advise and respond to their questionsmHealth use: findings from patient use0 5 10 15 20 25 30 35 40 45 50YesNoSensors or point-of-care diagnosticsTogo: communicating about blood tests or additional medical testsmHealth use: findings from patient use0 5 10 15 20 25 30 35 40YesNoPatient data collection and reporting Mauritania: We have both a pain visual analogue scale and a faces scale, on the tablet computer. The patient can either point somewhere on the line or a face on the scale, the clinician then records this by ticking the relevant box. This is still at early stages and is not our routine practiceUganda: During treatment patients are called up to find out if their symptoms are improving on a given medication and the score of their symptom recordedmHealth use: findings from patient use0 5 10 15 20 25 30 35 40YesNoAdd information to electronic medical recordsMauritania: All health records within the project are electronic, with no hard copies. So it is only used internally within the project. I am not aware of any other electronic health records in the country.Kenya: This helps us to identify treatments clients are on even if the files are missingmHealth use: findings from patient use0 5 10 15 20 25 30 35 40YesNoPatient-to-provider communication Kenya: The patient or relative can call to consult, to inform that they are coming for services, to get clarification. For follow up especially if a patient is very sick to offer support to the family, just to be there but via the phoneKenya: Patients can self-refer to the project by phoning one of the project's mobile phone numbers (kept with the local nurses). Patients and families can use this number to seek advice or request a visit.mHealth use: summary of health professional usemHealth use: summary of health professional use0 5 10 15 20 25 30 35 40YesNoElectronic decision supportKenya: For confirmation of treatment and protocolsKenya: Software installed on the phone to some health professionals for use to inform consultations during the continuum of caremHealth use: summary of health professional use0 5 10 15 20 25 30 35 40YesNoProfessional-to-professional communication Kenya: Everyone on the team has a mobile phone.  We do face-to-face patient reviews as a team every day, but when questions or issues arise otherwise, we communicate by mobile phoneMalawi: Discuss management of case over phone, facilitate referral to another provider and even source medication that patients needmHealth use: summary of health professional use0 5 10 15 20 25 30 35 40YesNoRegistries or vital trackingCôte d'Ivoire: Patient records stored in the databaseKenya: Palliative care unit report deaths of patients to Ministry of HealthKenya: Monthly reportsmHealth use: summary of health professional use0 5 10 15 20 25 30 35 40YesNoWork planning or schedulingCôte d'Ivoire: Call patients to schedule home visits and search for those lost to follow-upKenya: Making appointments for multidisciplinary team visitsmHealth use: summary of health professional use0 5 10 15 20 25 30 35 40YesNoHealth professional training and educationCameroon: to encourage, give information to particular problem, give or repeat directivesMauritania: online learning in the office and downloading of articles for offline educational usemHealth use: summary of health professional use0 5 10 15 20 25 30 35 40YesNoHuman resources managementTogo: This is very important to us because who does what in the chain must be made known to all, if any change in the partner teams must knowmHealth use: summary of health professional use0 5 10 15 20 25 30 35 40YesNoSupply chain managementKenya: using computer system in pharmacy to track amount of stocks remaining when dispensing medications to wards and patientsZimbabwe: When ordering medication mHealth use: summary of health professional use0 5 10 15 20 25 30 35 40 45YesNoFinancial transactions and incentivesGhana: Patient and caregivers are able to settle bills via mobile money payments to palliative care unit accountCôte d'Ivoire: Money transfer by mobile moneymHealth use: Reported use in literaturemHealth use: Reported use in survey mHealth use: priorities and reported barriers • Funding to build capacity (e.g. computers, tablet computers)• Consistency and reach of existing mobile networks • Illiteracy of patients • Resistance if seen to replace human contact• Existing records are paper-based • Using existing mobile phones and technology to improve communication between patients and health professionals• Concept seen as good, with support from many providers• Priorities emerging: communication, information and educationLimitations• Recruitment of respondents based on established contacts with APCA and not representative of each country• Responses not obtained from all countries, but recruitment ongoing • Where countries responded, only obtained an insight into a small proportion of mHealth activities• Crossover in responses found when describing mHealth use, which could indicate a need to refine  some of the definitions of mHealth uses  Conclusions• mHealth is occurring in most palliative care services across the sub-Saharan Africa region  • The most commonly reported uses of mHealth are: • Patient education and behaviour change (47%)• Patient data collection and reporting (47%)• Patient-to-provider communication (49%)• Professional-to-professional contact (57%)*• mHealth is being explored for each health system strengthening approach identified by the WHO• The research literature does not accurately reflect the level of mHealth development Recommendations for research and practice• Systematic evaluation of mHealth approaches can help to understand existing practice by providers• While mHealth use in emerging, development of an evidence base is required to understand how to develop and implement mHealth interventions that are acceptable to patients and health professionals • With diverse mHealth use and development occurring across palliative care services, a platform for sharing approaches and experiences may be beneficial Thank youm.j.allsop@leeds.ac.ukhttps://leeds.onlinesurveys.ac.uk/mhealth

Mobile devices in palliative care services: a methodological approach to identifying use and implementation

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Mobile devices in palliative care services: a methodological approach to identifying use and implementation

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