Acute Health Care Provision in Rural Long-Term Care Facilities: A Scoping Review of Integrated Care Models

Barriers to and Facilitators of Implementing Overnight Nursing Teleconsultation in Small, Rural Long-Term Care Facilities: Qualitative Interview Study

BACKGROUND

Teleconsultation has expanded rapidly in recent years, especially during the COVID-19 pandemic, and has become standard practice among physicians. The benefits of teleconsultation, namely, improving access to care, ensuring continuity and quality of care, increasing patient satisfaction, and reducing costs and wait times, are well documented. However, its use in nursing practice, especially in long-term care settings, remains underresearched despite its significant transformative potential, particularly in resource-limited and rural settings, where it could address major challenges such as nursing shortages and access to care.

OBJECTIVE

This study aimed to identify barriers to and facilitators of implementing overnight nursing teleconsultation in rural residential and long-term care centers in Quebec, Canada (centres d'hébergement et de soins de longue durée [CHSLDs]), with ≤50 beds.

METHODS

A 6-month pilot project was rolled out sequentially in 3 rural CHSLDs in 2 administrative regions of Quebec between July 2022 and March 2023. A total of 38 semistructured interviews were conducted with managers (n=27, 71%), nursing staff members (n=9, 24%), and resident committee presidents (n=2, 5%) between February 2023 and July 2023.

RESULTS

The study identified several barriers to the implementation of teleconsultation. The main barriers reported included union opposition (managers: 23/27, 85%), network instability (resident committee presidents: 2/2, 100%), limited technology skills (nursing staff members: 7/9, 78%), a perceived increase in workload (nursing staff members: 8/9, 89%; resident committee presidents: 2/2, 100%), and a low volume of teleconsultations (nursing staff members: 8/9, 89%). Despite the barriers, participants also identified key facilitators. These included the care setting (nursing staff members: 9/9, 100%; managers: 21/27, 78%), buy-in from senior management and managers (managers: 27/27, 100%; resident committee presidents: 2/2, 100%), collaboration between the departments (nursing staff members: 9/9, 100%), nursing staff motivation (nursing staff members: 9/9, 100%), and improvements in professional practices (nursing staff members: 8/9, 89%). Finally, the relative benefits of teleconsultation, such as enhanced mutual vision, faster assessment of clinical situations, improved resident care management quality, and greater flexibility and safety, were unanimously recognized (38/38, 100%) as contributing to its acceptability and potential for success.

CONCLUSIONS

This study provides an in-depth understanding of the barriers to and facilitators of implementing overnight nursing teleconsultation in small rural CHSLDs. This constitutes a sound basis for developing tailored strategies aimed at overcoming identified barriers and optimizing facilitators. The results also provide practical guidelines for decision makers, highlighting the need to adapt implementation approaches to the unique context of each facility. Furthermore, this study highlights the importance of further research to broaden our knowledge on the dissemination and scale-up of health care innovations. This includes the development of learning health systems capable of responding in an agile and effective way to the needs of rural and vulnerable populations both in Quebec and elsewhere.

Improving primary healthcare quality in China through training needs analysis

The diagnosis and treatment capability levels of healthcare professionals directly affect the overall quality of medical services. Enhancing these capability levels requires strengthening the professional skill training of healthcare workers, especially those in primary care settings in economically underdeveloped areas. To understand the actual needs for professional skill training among primary healthcare workers, thereby providing data support for targeted training initiatives. An online survey was conducted using convenience sampling and subsequently, snowball sampling from May 10, 2023 to January 31, 2024. The survey included 3811 healthcare workers across China, and 3617 valid questionnaires were recovered. Descriptive analysis was used to compare the professional backgrounds and training needs of healthcare workers at different medical facility levels. Univariate and multivariate logistic regression analyses were employed to explore factors influencing the training of primary healthcare workers. The survey revealed that 70.1% of respondents were female, and 94.2% were from medical facilities below the provincial level, with 43.2% from township-level or lower medical facilities. Significant differences were found in age distribution, work experience, professional titles, educational levels, and training needs among provincial/national, prefectural/county, and township levels (P < 0.05). Busy clinical work schedules were the primary barrier to training participation. Most healthcare workers (78.7%) expected more than four training sessions per year, with the optimal frequency being quarterly. The most anticipated training topics among primary care workers were latest medical guidelines, new technologies/skills, and advanced management concepts, with over 80% interest. Compared with prefectural/county-level facilities, primary care workers at grassroots facilities are more significantly impacted by lower professional titles, lower education levels, weaker medical/technical skills, and insufficient specialized funding (odds ratio > 1, P < 0.001). Training should be tailored to the needs of healthcare workers at different medical facility levels. Particularly for primary care settings, providing special funding support and training in the latest medical guidelines, new technologies/skills, and advanced management concepts are important to improve the composition of titles, education, and professional technicians.

We need a radical change to take place now´-The potential of integrated healthcare for rural long-term care facilities

OBJECTIVES

This study explores healthcare professionals' perceptions in rural German long-term care facilities, focusing on integrated health systems. The aim is to understand experiences, challenges, and preferences.

METHODS

Twenty nurses and paramedics participated in in-depth interviews. Thematic analysis was applied to transcripts, revealing key themes: acute healthcare provision, interdisciplinary collaboration, telemedicine use, and preferences for the future healthcare landscape.

RESULTS

Themes highlighted factors influencing acute care situations and the crucial role of interdisciplinary collaboration. Integrated care was infrequently encountered despite high demand in rural long-term care facilities.

CONCLUSIONS

Though uncommon, integrated healthcare remains crucial in addressing long-term care facility residents' complex needs. Healthcare professionals express a strong demand for integrated care in rural areas, citing potential benefits for resident wellbeing, healthcare effectiveness, and job satisfaction. The findings guide healthcare organizations in developing institutional-level strategies for integrated care integration, emphasizing its importance in rural settings.

Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China

Objectives

China has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China.

Methods

An interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform.

Results

After the intervention of MCs reform, a significant increase was observed in the total number of inpatients (β3 = 174.28, p < 0.05). However, no statistically significant change was observed in the total number of outpatient and emergency visits (β3 = 155.82, p = 0.91). Additionally, the implementation of MCs reform led to an amplification in service volumes provided by county hospitals, with significant increases in the number of outpatient and emergency visits (β3 = 1376.54, p < 0.05) and an upward trend in the number of inpatients (β3 = 98.87, p < 0.01). However, no significant changes were observed under the MCs policy for grassroots medical institutions regarding the number of outpatient and emergency visits (β3 = -1220.72, p = 0.22) and number of inpatients (β3 = 75.42, p = 0.09).

Conclusion

The Sanming MCs reform has achieved some progress in augmenting service volumes. Nevertheless, it has not led to an increase in service volumes at the grassroots medical institutions. There persists an insufficiency in the efficiency of services and a need for further improvement in primary healthcare. To address these concerns, it is imperative for county hospitals to offer targeted assistance that can enhance motivation among grassroots medical institutions. Besides the MCs should explore initiatives, including improved management of medical equipment, allocation of funding, and personnel resources.