Adopt, adapt, or abandon technology-supported person-centred care initiatives: healthcare providers' beliefs matter

Factors influencing adoption and sustained use of rehabilitation technologies: a scoping review and qualitative analysis

PURPOSE

Rehabilitation technology (RT) development has grown, however evidence suggests poor uptake by therapists and patients, with many devices abandoned. Successful implementation encompasses both "adoption," where RT is first utilized, and "sustained use," wherein RT remains in use over time. This scoping review and qualitative analysis aimed to explore the extent and nature of the relevant evidence base and investigate factors that influence adoption and sustained use of RT in clinical practice, from the perspectives of patients and therapists.

METHODS

A systematic search was conducted to identify qualitative and quantitative articles investigating adoption and/or sustained use of RT. Study characteristics were analyzed quantitatively. Factors influencing adoption and sustained use were analyzed using a two-stage thematic analysis. Stage 1 employed an inductive approach, analyzing data related to RT adoption from review papers. Stage 2 employed an abductive approach, where data related to sustained use from primary research and reviews was mapped to Stage 1 themes and new themes were identified.

RESULTS

The review included 42 articles. The majority of articles explored RT adoption. Thematic analysis revealed five themes. Four influenced adoption of RT: (1) "Knowledge" about RT; (2) "Design" of RT; (3) "Circumstances and Characteristics;" and, (4) the "Person-centered" approach. These were confirmed and refined in the sustained use analysis, and a fifth theme, "Healthcare Ecosystem," was identified.

CONCLUSION

These findings highlight factors influencing adoption and sustained use of RT, providing insights for development and implementation of technology in rehabilitation clinical practice. Further research is needed to identify strategies that facilitate sustained use of RT.

Person-centred care in oncological home services: a scoping review of patients' and caregivers' experience and needs

BACKGROUND

Cancer became a chronic disease that could be managed at home. Homecare supported person-centred care, which was guided by the Picker Principles defining key elements for care delivery. The study aimed to explore and appraise the dimensions underlying cancer patients' and caregivers' experience and expectations with Home Cancer Care, adopting a person-centerd care framework.

METHODS

We carried out a scoping review of the literature using three databases, PubMed, Scopus, and WoS for a total of 703 articles. PRISMA guidelines were followed. 57 articles were included in the review. The extracted data were categorized according to the type of care (Palliative, Support, Therapeutic, Recovery after transplant, Rehabilitation), the target population (patients or caregivers), the study design, and the principles related to patients and caregivers' experience, classified through the Picker framework.

RESULTS

The most common type of care in the home setting was palliative care. According to the Picker Principles, most of the studies reported "Emotional support, empathy and respect," followed by "Clear information, communication, and support for self-care," as key consideration for both patients and caregivers. The findings from these studies indicate many positive experiences regarding treatments, services, and interactions with health professionals. Caregivers' needs were most frequently (29%) classified as relational and social. From the patient's perspective, the most common needs fell under the category of "Health System And Information" (43%).

CONCLUSION

We could state that HCCs align with the PCC paradigm; however, careful attention is needed to ensure that the experience of both patients and caregivers remains positive. In our study, a strong need for psychological support does not emerge either for patients or caregivers, unlike previous studies in which psychological needs were among the most frequently cited. Given the growing role of technology in home care, a new category addressing the usefulness and ease of use of technology could be added to the person-centred framework. Recent articles have highlighted the growing use of telemedicine in the home care setting as a support tool for self-care.

What do patients want from a digital device that supports heart failure self-management?

OBJECTIVE

To assess patients' needs and the factors determining their acceptance of an e-Health intervention.

METHODS

Purposive sample of patients with heart failure, attending an outpatient consultation were invited to complete a questionnaire designed to assess their needs and acceptance of an e-Health intervention. Data analysis was performed using Chi-square tests with post-hoc corrections.

RESULTS

Response rate was 61 % (n = 101), with most patients (>70 %) indicating they could see themselves using an e-Health intervention to manage their heart failure. Participants with a healthy lifestyle (i.e., non-smoker and consumed alcohol < once/week) were more likely to have a positive attitude towards technology (p adj.=0.013). Those willing to use an e-Health intervention were convinced of its advantages by other patients with heart failure (p adj.=0.013). Advanced age, education level, employment or marital status did not influence patient attitudes toward health technology.

CONCLUSIONS & PRACTICE IMPLICATIONS

Results indicate patients have a positive attitude towards the use of e-Health interventions to enable their self-management of heart failure. These findings will inform further development and delivery strategies of e-Health interventions.

A Nonrandomized Pilot Study to Investigate the Acceptability and Feasibility of LivR Well: A Multifaceted 28-Day Home-Based Liver Optimization Program for Acute-on-Chronic Liver Failure

Background and Aims

Acute-on-chronic liver failure (ACLF) has a 22%-74% 28-day mortality rate and 30%-40% 30-day readmission rate. We investigated the acceptability and feasibility of a multimodal community intervention for ACLF.

Methods

A single-arm nonrandomized pilot study of consecutive participants with ACLF was conducted in a tertiary health service. Participants received weekly medical and nursing reviews, dietetics, physiotherapy, pharmacy, social work, addiction medicine, and neuropsychiatry, where indicated. A digital platform included remote weight monitoring and online surveys. The primary outcome was acceptability/feasibility. Secondary outcomes included safety, mortality, readmission, liver disease severity, and costs.

Results

Fifty-nine patients were enrolled with median age 51 years (interquartile range (IQR): 45-59); majority alcohol etiology (74%),and median Model for End-Stage Liver Disease Sodium score 16 (IQR: 12-21). LivR Well was acceptable with low attrition (8 of 59), adherence to the program including home visits (mean 8.4 ± 4.2) and consultations (mean 2.4 ± 1.5) per patient. This was supported by positive feedback and themes identified through a qualitative subanalysis. Feasibility was demonstrated by recruitment rate of 4.94 patients/month and 86% completion. Mortality was lower than expected at 3%, 30-day readmission rate was 15%, and median Model for End-Stage Liver Disease Sodium score reduced to 15 (P = .01). Median 6-month costs reduced from $30,454 (IQR: $21,953-$65,657) to $17,657 ($4249-$42,876) (P = .009). The total 6-month health-care cost was $1,868,859 (95% confidence interval 1,081,821-2,655,897) compared to $2,518,227 (95% confidence interval 1,959,610-3,076,844).

Conclusion

LivR Well was acceptable, feasible, and safe with low short-term mortality and readmission rates. Health-care costs were reduced by 26% driven by a 40% reduction in 30-day readmission. Further evaluation includes a randomized controlled trial of LivR Well compared to standard care.

Examining attitudes to uptake and sustainment of technology among care aides in the delivery of care: a scoping review protocol

INTRODUCTION

Care aides are health workers who deliver hands-on care to patients across the healthcare continuum. The use of technology in healthcare delivery is increasing, and evidence regarding how care aides' attitudes may either facilitate or hinder the adoption of healthcare technologies is lacking.The aim of the proposed scoping review is to examine available evidence regarding care aides' attitudes towards the adoption of innovation and factors that may influence the sustainable use of technology in healthcare delivery. Published studies, grey literature and review articles that identify a method for the review, conference abstracts and website publications regarding the attitude, uptake and sustainable use of technology in care delivery by care aides will be included. For abstracts that have resulted in publications, the full publications will be included. The search for evidence commenced in June 2023 and will end in March 2024.

METHODS AND ANALYSIS

The Joanna Briggs Institute (JBI) method will be used to conduct the review. The CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, PROSPERO, Web of Science and JBI Evidence Synthesis databases will be searched using keywords for publications within the last 20 years to examine trends in health technology and attitudes of care aides towards innovation over the last two decades. A search of grey literature and websites will be conducted. The reference list of the retrieved articles will be used to identify additional literature. The search results will be exported into a literature management tool for screening and analysis. Article screening will be performed by two authors and if a third is needed to resolve any differences. Data analysis will be guided by two theoretical frameworks.

ETHICS AND DISSEMINATION

No ethics approval is required. The findings will be disseminated in a peer-reviewed journal and presented in conferences.

REGISTRATION DETAILS

https://doi.org/10.17605/OSF.IO/CZQUP.

Barriers and facilitators influencing implementation of care technology for people with intellectual disabilities: A cross-sectional study among care professionals

BACKGROUND

Implementation issues often hinder reaching the potential of care technology to improve daily lives of people with intellectual disabilities. We investigated barriers to and facilitators of implementing different technology modalities (app/social robot/sensor/domotics) in long-term care.

METHOD

Care professionals (N = 83) from 12 Dutch disability care organisations completed a customised measurement instrument for determinants of innovations (MIDI) questionnaire.

RESULTS

Out of 27 determinants, 20 were identified as facilitators and 16 as barriers. We highlight common barriers: few colleagues who work with the technology; no (awareness of) formal ratification of technology use; no arrangements regarding turnover of staff using the technology; unsettling organisational changes; technological defects and limited IT preconditions.

CONCLUSIONS

The results, which could be combined and compared across study sites, provide insight into which implementation determinants were already well addressed, and where there is ground to gain when implementing care technology in disability care organisations.

Hospital Staff Perspectives on the Drivers and Challenges in Implementing a Virtual Rehabilitation Ward: Qualitative Study

Background

Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood.

Objective

This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff's perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery.

Methods

Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework.

Results

The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families.

Conclusions

In this qualitative study exploring health care staff's experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW.

Impact of Remote Patient Monitoring Systems on Nursing Time, Healthcare Providers, and Patient Satisfaction in General Wards

INTRODUCTION

Remote patient monitoring systems (RPMS) are increasingly integrated into hospital wards to improve patient safety and reduce the workload on healthcare professionals (HCPs). This study evaluates the efficacy of RPMS in general wards, focusing on their impact on nursing efficiency, patient care, HCPs, and patient satisfaction.

METHODS

A comprehensive time-motion study was conducted along with surveys targeting HCPs and patients in M.S. Ramaiah Memorial Hospital, Bangalore, India, which has implemented RPMS in general wards. The study involved observing and comparing nursing activities in RPMS-equipped wards versus control wards without RPMS across various shifts. In addition, feedback on the system's impact on patient safety, overall care quality, and usability was gathered through a survey form.

RESULTS

RPMS decreases the amount of time nurses spend on routine monitoring, communication, and coordination, enabling a 43.11% increase in time available for patient care. More than 89% of HCPs noted improvements in the level of care and overall patient safety. More than 80% of the HCPs also noted improvement in the patient's experience. More than 50% of HCPs find RPMS easy to use and user-friendly. More than 60% of the patients noted an overall improvement in care quality.

CONCLUSION

RPMS has proven to be a valuable asset in hospital wards, enhancing patient monitoring and safety while reducing the workload on staff. In addition, significant time savings on routine tasks and high satisfaction levels from both staff and patients underscore the system's benefits.

Generative AI in healthcare: an implementation science informed translational path on application, integration and governance

BACKGROUND

Artificial intelligence (AI), particularly generative AI, has emerged as a transformative tool in healthcare, with the potential to revolutionize clinical decision-making and improve health outcomes. Generative AI, capable of generating new data such as text and images, holds promise in enhancing patient care, revolutionizing disease diagnosis and expanding treatment options. However, the utility and impact of generative AI in healthcare remain poorly understood, with concerns around ethical and medico-legal implications, integration into healthcare service delivery and workforce utilisation. Also, there is not a clear pathway to implement and integrate generative AI in healthcare delivery.

METHODS

This article aims to provide a comprehensive overview of the use of generative AI in healthcare, focusing on the utility of the technology in healthcare and its translational application highlighting the need for careful planning, execution and management of expectations in adopting generative AI in clinical medicine. Key considerations include factors such as data privacy, security and the irreplaceable role of clinicians' expertise. Frameworks like the technology acceptance model (TAM) and the Non-Adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) model are considered to promote responsible integration. These frameworks allow anticipating and proactively addressing barriers to adoption, facilitating stakeholder participation and responsibly transitioning care systems to harness generative AI's potential.

RESULTS

Generative AI has the potential to transform healthcare through automated systems, enhanced clinical decision-making and democratization of expertise with diagnostic support tools providing timely, personalized suggestions. Generative AI applications across billing, diagnosis, treatment and research can also make healthcare delivery more efficient, equitable and effective. However, integration of generative AI necessitates meticulous change management and risk mitigation strategies. Technological capabilities alone cannot shift complex care ecosystems overnight; rather, structured adoption programs grounded in implementation science are imperative.

CONCLUSIONS

It is strongly argued in this article that generative AI can usher in tremendous healthcare progress, if introduced responsibly. Strategic adoption based on implementation science, incremental deployment and balanced messaging around opportunities versus limitations helps promote safe, ethical generative AI integration. Extensive real-world piloting and iteration aligned to clinical priorities should drive development. With conscientious governance centred on human wellbeing over technological novelty, generative AI can enhance accessibility, affordability and quality of care. As these models continue advancing rapidly, ongoing reassessment and transparent communication around their strengths and weaknesses remain vital to restoring trust, realizing positive potential and, most importantly, improving patient outcomes.

The Perspective of Nurses and Healthcare Providers on the use of Television Videos with People with Moderate to Severe Dementia

BACKGROUND

Nurses and healthcare providers need practical tools to deliver person-centred care in hospitals and long-term care homes. Few non-pharmacological interventions are designed to meet the needs of people with moderate to severe dementia. Dementia-friendly television videos (TV videos) offer a familiar stimulation with the potential for meaningful engagement in the relational space of technology. TV videos refer to moving visuals with audio that can be shown on TV and other devices. They can be used for different purposes for people with dementia, such as stimulating memories and facilitating expressions.

PURPOSE

This study aims to understand the perspectives of nurses and healthcare providers on the potential function and practice considerations of using TV videos for people with moderate to severe dementia.

METHODS

We conducted five focus groups with 23 nurses and healthcare providers in a long-term care home and a geriatric hospital unit. Data were analyzed using reflexive thematic analysis and guided by Kitwood's person-centred care model.

RESULTS

Our analysis identified five themes about the use of TV videos: (1) calm the person with dementia who is in emotional distress, (2) form connections with the person with dementia, (3) bring people with dementia together, (4) facilitate the Person's Activities of Daily Living (ADLs), (5) help the person connect with their past.

CONCLUSION

TV videos should be designed to match the person's cognitive abilities, interests, and cultural and linguistic backgrounds. Our findings supplemented Kitwood's model by identifying the person's cultural and language needs.

Exploring how the design and provision of digital self-management technology can improve the uptake by older adults with chronic kidney disease, diabetes and dementia: A modified e-Delphi study

Objectives: As development and introduction of digital self-management technologies continues to increase, the gap between those who can benefit, and those who cannot correspondingly widens. This research aimed to explore the use of digital self-management technology by older adults with three highly-prevalent long-term conditions (chronic kidney disease, diabetes and dementia), and build expert consensus across the conditions on changes needed to improve effective usage. Method: This qualitative research involved a modified e-Delphi Study. The Delphi panel was comprised of experts with personal, academic or clinical expertise related to one of the long-term conditions and/or the development and use of digital self-management technology. The e-Delphi involved a round of online semi-structured interviews followed by two rounds of a structured online survey. Results: Fourteen experts participated in the study, with eleven of the fourteen completing all three rounds. Analysis of the interviews (round 1 of the Delphi) led to 7 main themes and 29 sub-themes. These were translated into 26 statements that formed the basis of the online survey questions. In the first administration of the survey (round 2) 19 statements reached consensus. After the second administration a further 6 statements reach consensus. Conclusion: The findings reflect expert consensus on barriers to the use of digital self-management by older adults with 3 different, but inter-related conditions, and identify ways in which the design and provision of such technologies could be improved to facilitate more effective use. It is concluded that both the design and the provision of technologies should consider a combination of individual, condition-specific and age-related requirements. By building a consensus on issues and potential strategies common across the three conditions, we aim to inform future research and practice and facilitate effective self-management by older adults.

Development and optimisation of a mobile app (iMPAKT) for improving person-centred practice in healthcare settings: A multi-methods evaluation study

Objective

To develop and optimise an app (iMPAKT) for improving implementation and measurement of person-centred practice in healthcare settings.

Methods

Two iterative rounds of testing were carried out based on cognitive task analysis and qualitative interview methods. The System Usability Scale (SUS) was also used to evaluate the app. Quantitative data on task completion and SUS scores were evaluated descriptively, with thematic analysis performed on qualitative data. The MoSCoW prioritisation system was used to identify key modifications to improve the app.

Results

Twelve participants took part (eight health professionals and four patient and public involvement representatives). Views on design and structure of the app were positive. The majority of the 16 tasks undertaken during the cognitive task analysis were easy to complete. Mean SUS scores were 73.5/100 (SD: 7.9; range = 60-92.5), suggesting good overall usability. For one section of the app that transcribes patients speaking about their experience of care, a non-intuitive user interface and lack of transcription accuracy were identified as key issues influencing usability and acceptability.

Conclusions

Findings from the evaluation were used to inform iterative modifications to further develop and optimise the iMPAKT App. These included improved navigational flow, and implementation of an updated artificial intelligence (AI) based Speech-To-Text software; allowing for more accurate, real-time transcription. Use of such AI-based software represents an interesting area that requires further evaluation. This is particularly apparent in relation to potential for large-scale collection of data on person-centred measures using the iMPAKT App, and for assessing initiatives designed to improve patient experience.

A Survey of Technology Abandonment in US Nursing Homes

OBJECTIVE

Adoption of health information technology (HIT) in nursing homes (NHs) improves quality of care. Although there is a robust body of research on HIT adoption, the closely related process of technology abandonment is not well understood. As NHs grow more reliant on HIT, problems of technology abandonment, defined as failure to scale up, spread, and sustain HIT need to be studied. Our objective is to describe HIT abandonment and its associations with organizational characteristics among a national sample of US NHs.

DESIGN

Longitudinal, retrospective analysis of data from 2 sources: HIT Maturity Survey and Staging model and public data from the Care Compare database.

SETTING AND PARTICIPANTS

Random sample of NHs (n = 299) representing each US state that completed the HIT maturity survey in 2 consecutive years: year 1 (Y1) was June 2019-August 2020 and year 2 (Y2) was June 2020-August 2021.

METHODS

The primary dependent variable was technology abandonment, operationalized by using total HIT maturity score, HIT maturity stage, and subscale scores within each dimension/domain. Independent variables were NH organizational characteristics including bed size, type of ownership, urbanicity, Centers for Medicare & Medicaid Services Five-Star Overall Rating and Staffing Rating.

RESULTS

Over the 2-year period, HIT abandonment occurred in 28% (n = 85) of NHs compared with 44% (n = 133) that experienced growth in HIT systems. HIT capabilities in resident care were abandoned most frequently. Using multivariable multinomial logistic regression, we found that large NHs (bed size greater than 120) were more likely to experience technology abandonment in administrative activities.

CONCLUSIONS AND IMPLICATIONS

Technology abandonment can increase strain on scarce resources and may impact administrators' ability to oversee clinical operations, especially in large NHs. This study contributes to the limited understanding of technology abandonment and can serve as a building block for others working to ensure limited resources are used effectively to improve care for NH residents.

Addressing complexity when developing an education program for the implementation of a stroke Electronic Medical Record (EMR) enhancement

BACKGROUND

Digital interventions in health services often fail due to an underappreciation of the complexity of the implementation. This study develops an approach to address complexity through an evidenced-based, theory-driven education and implementation program for an Electronic Medical Record (EMR) digital enhancement for acute stroke care.

METHODS

An action research approach was used to design, develop, and execute the education and implementation program over several phases, with iterative changes over time. The study involved collaboration with multiple statewide and local key stakeholders and was conducted across two tertiary teaching hospitals and a regional hospital in Australia.

RESULTS

Insights were gained over five phases. Phase 1 involved a review of evidence that supported blended learning strategies for the education and training of staff end-users. In Phase 2, contextual assessment was conducted via observation of study sites, providing awareness of local context variability and insight into key implementation considerations. The Non-adoption, Abandonment, Scale-Up, Spread and Sustainability (NASSS) framework assisted in Phase 3 to identify and manage the key domains of complexity. Phase 4 involved the design of the program which included group-based training and an e-learning package, endorsed and evaluated by key leaders. Throughout implementation in Phase 5, further barriers were identified, and iterative changes were tailored to each context.

CONCLUSIONS

The NASSS framework, combined with a multi-phased approach employing blended learning techniques, context evaluations, and iterative modifications, can serve as a model for generating theory-driven and evidence-based education strategies that adresss the complexity of the implementation process and context.

Health Care Professionals' Experiences and Views of eHealth in Pediatric Care: Qualitative Interview Study Applying a Theoretical Framework for Implementation

BACKGROUND

The development and evaluation of eHealth interventions in clinical care should be accompanied by a thorough assessment of their implementation. The NASSS (Non-adoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies) framework was designed to facilitate the implementation and scale-up of health technology programs, providing an option for analyzing the progression of these initiatives as they are implemented in real-time. Considering health care provider perspectives within the framework for implementation offers valuable insights into the early identification of barriers and facilitators in the implementation of potentially effective eHealth innovations. Nevertheless, there is a dearth of studies on eHealth interventions that encompass longer time frames and delve into the complexities of scaling up and sustaining such interventions within real-world health care environments.

OBJECTIVE

This study aims to investigate the perspectives and insights of health care professionals (HCPs) regarding the implementation of an eHealth intervention in pediatric health care while applying the NASSS framework to theorize and evaluate the conditions influencing the implementation of eHealth solutions.

METHODS

Semistructured interviews were performed with health care providers, including both staff and management personnel, within a university pediatric hospital (N=10). The data collection process occurred concurrently with a clinical trial focused on developing and assessing an eHealth app for self-management in pediatric care following hospital discharge. Using an abductive approach, the interviews were initially analyzed qualitatively and subsequently mapped onto the 7 domains of the NASSS framework to identify factors influencing implementation, encompassing facilitators, barriers, and varying levels of complexity.

RESULTS

In the realm of pediatric care, the family was identified as the primary unit of care, and patient heterogeneity was a prominent feature. The implementation of eHealth tools, while deemed usable and flexible, was also seen as a delicate balance between safety and adaptability, highlighting challenges related to health care integration. Child participation and secrecy, especially for adolescents, contributed to the complexity of using eHealth. HCPs had high eHealth literacy, and thus challenges concerning adoption were related to work adaptations and the risk of "app overload." The readiness for implementation was experienced as induced through the research study and the pandemic situation. However, to move from research to implementation in clinical practice, organizational challenges identified a need to update the concept of care and ensure activity measurements. In a wider context, HCPs raised concerns related to regulatory requirements for documentation, public procurement, and data safety. Implementation became more complex due to a lack of overview in a large organization.

CONCLUSIONS

Important perspectives for implementation were considerations of regulatory requirements, as well as the need for a shared vision of eHealth and the establishment of eHealth-related work as part of regular health care. Key contextual factors that support reach and impact are communication channels between different levels at the hospital and a need for paths and procedures compatible with legal, technological, and security concerns. Further research should focus on how eHealth interventions are perceived by children, adolescents, their parents, and other stakeholders.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04150120; https://clinicaltrials.gov/ct2/show/NCT04150120.

Emvolio - A battery operated portable refrigerator preserves biochemical and haematological integrity of biological samples in preclinical studies

Background: Emvolio is a non-medical device, indigenously developed portable refrigeration for maintaining the internal temperature 2-8˚C. The Indian Patent Office has granted patent for applications such as preservation and transport of medicines, vaccines, food, beverages, dairy etc. Further, use of Emvolio can be utilized in transport and store biologicals to preserve their biochemical and cellular integrity.  The objective of this study was to evaluate the biochemical and haematological integrity of biological samples such as rat blood, serum and liver. Methods: The steady temperature was maintained inside the Emvolio, and it was compared to that of thermocol and polypropylene boxes aided with frozen gel packs. The blood and liver samples were isolated from Wistar rats and kept in Emvolio, thermocol and polypropylene boxes for 10 hrs, and the temperature was monitored. The blood parameters, namely red blood cells (RBC), white blood cells (WBC), platelets, haematocrit, haemoglobin, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC) and red cell distribution width (RDW), serum parameters like alanine transaminase, alkaline phosphatase, total protein, albumin, creatine kinase, blood urea nitrogen and liver parameters like superoxide dismutase (SOD), glutathione (GSH), catalase were estimated and compared. Results: Emvolio maintained a constant inner temperature range of 2-8˚C, whereas a significant temperature variation was seen in thermocol and polypropylene boxes. There was no significant deviation in the parameters tested when samples were kept in Emvolio for six hours compared to the zero hour readings. In contrast, there was a significant deviation among the parameters for the samples kept in thermocol and polypropylene boxes for six hours compared to zero hour parameters. Conclusions: Emvolio maintained constant temperature and preserved the biological integrity of rat blood, serum and liver. Thus, Emvolio can be efficiently used as a biological sample carrier, especially in preclinical studies.

Beyond Plan-Do-Study-Act cycle - staff perceptions on facilitators and barriers to the implementation of telepresence robots in long-term care

BACKGROUND

Quality improvement (QI) programs with technology implementations have been introduced to long-term care (LTC) to improve residents' quality of life. Plan-Do-Study-Act (PDSA) cycle is commonly adopted in QI projects. There should be an appropriate investment of resources to enhance learning from iterative PDSA cycles. Recently, scholars explored possibilities of implementation science (IS) with QI methods to increase QI projects' generalisability and make them more widely applicable in other healthcare contexts. To date, scant examples demonstrate the complementary use of the two methods in QI projects involving technology implementation. This qualitative study explores staff and leadership teams' perspectives on facilitators and barriers of a QI project to implement telepresence robots in LTC guided by the Consolidated Framework for Implementation Research (CFIR).

METHODS

We employed purposive and snowballing methods to recruit 22 participants from two LTC in British Columbia, Canada: operational and unit leaders and interdisciplinary staff, including nursing staff, care aides, and allied health practitioners. CFIR was used to guide data collection and analysis. Semi-structured interviews and focus groups were conducted through in-person and virtual meetings. Thematic analysis was employed to generate insights into participants' perspectives.

RESULTS

Our analysis identified three themes: (a) The essential needs for family-resident connections, (b) Meaningful engagement builds partnership, and (c) Training and timely support gives confidence. Based on the findings and CFIR guidance, we demonstrate how to plan strategies in upcoming PDSA cycles and offer an easy-to-use tool 'START' to encourage the practical application of evidence-based strategies in technology implementation: Share benefits and failures; Tailor planning with staff partners; Acknowledge staff concerns; Recruit opinion leaders early; and Target residents' needs.

CONCLUSIONS

Our study offers pragmatic insights into the complementary application of CFIR with PDSA methods in QI projects on implementing technologies in LTC. Healthcare leaders should consider evidence-based strategies in implementing innovations beyond PDSA cycles.

Sustainable adoption of noninvasive telemonitoring for chronic heart failure: A qualitative study in the Netherlands

Objective

Noninvasive telemonitoring aims to improve healthcare for patients with chronic heart failure (HF) by reducing hospitalizations and improving patient experiences. Yet, sustainable adoption seems to be limited. Therefore, the goal of our study is to gain insight in the processes that support sustainable adoption of telemonitoring for patients with HF.

Methods

We conducted semi-structured interviews with 25 stakeholders that were involved with the adoption of telemonitoring, such as healthcare professionals, policymakers and healthcare insurers. We analyzed the interviews by using a combination of open-coding and the themes of the Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability framework.

Results

We found that telemonitoring projects have moved beyond initial pilot phases despite a high level of complexity on multiple topics. The patient selection, the business case, the evidence, the aims of telemonitoring, integration of telemonitoring in the care pathway, reimbursement, and future centralization were items that yielded different and sometimes contradictory opinions.

Conclusions

This study showed that the sustainable adoption of telemonitoring for HF is a complex endeavor. Different aims and perspectives play an important role in the patient selection, design, evaluations and envisioned futures of telemonitoring. High conviction among participants of the added value that telemonitoring may support further adoption of telemonitoring. Structural evaluations will be needed to guide cyclical improvement and adapt programs to employ telemonitoring in such a manner that it contributes to collectively supported aims.

Exploring the acceptability and experience of receiving diabetes and pregnancy care via telehealth during the COVID-19 pandemic: a qualitative study

BACKGROUND

The COVID-19 pandemic has significantly impacted the delivery of diabetes in pregnancy care and general maternity care. This study aimed to explore the experiences and acceptability of telehealth use in diabetes in pregnancy care during the COVID-19 pandemic, from the perspectives of pregnant women and their clinicians. The secondary aim was to explore the experiences of pregnant women receiving general maternity care via telehealth during the COVID-19 pandemic.

METHODS

In-depth qualitative semi-structured interviews were undertaken and analysed via thematic inductive approaches. The Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies Framework (NASSS) was applied.

RESULTS

Eigthteen interviews were conducted with culturally and linguistically diverse pregnant women and 4 clinicians (endocrinologists and dietitians). All interviewees were satisfied with telehealth as a positive alternative to face-to-face consultations for diabetes care during the COVID-19 pandemic. Numerous benefits of delivering diabetes care via telehealth were discussed and themes centred around greater access to care, economic benefits and improved safety. Most barriers concerned the adopters (clinicians), yet, feasible and realistic suggestions to overcome barriers were voiced. The scope for technology adaptation and ongoing embedment into routine diabetes care was described. Overall, a hybrid flexible delivery model, predominantly consisting of telephone consultations, with some face-to-face consultations for initial diabetes appointments was recommended for future care. The use of telehealth in replacement of face-to-face appointments for general maternity care was perceived as reducing care quality.

CONCLUSION

In this study, telehealth was viewed as acceptable to women and clinicians for diabetes in pregnancy care, supporting the ongoing delivery of a hybrid service model of telehealth and face-to-face care. These findings provide valuable information to improve diabetes in pregnancy services to meet the needs of women during the COVID-19 pandemic and beyond.

The changing role of patients, and nursing and medical professionals as a result of digitalization of health and heart failure care

AIM

The aim of the study is to discuss the changing role of patients, nurses and doctors in an era of digital health and heart failure care.

BACKGROUND

With a growing demand for heart failure care and a shortage of health care professionals to meet it, digital technologies offer a potential solution to overcoming these challenges.

EVALUATION

In reviewing pertinent research evidence and drawing on our collective clinical and research experiences, including the co-design and development of an autonomous remote system, DoctorME, we offer some reflections and propose some practical suggestions for nurturing truly collaborative heart failure care.

KEY ISSUES

Digital health offers real opportunities to deliver heart failure care, but patients and health care professionals will require digital skills training and appropriate health services technological infrastructure.

CONCLUSIONS

Heart failure care is being transformed by digital technologies, and innovations such as DoctorME have profound implications for patients, nurses and doctors. These include major cultural change and health service transformation.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should create inclusive and supportive working environments where collaborative working and digital technologies in heart failure care are embraced. Nurse managers need to recognize, value and communicate the importance of digital health in heart failure care, ensuring that staff have appropriate digital skills training.

Technology-based support for stroke caregiving: A rapid review of evidence

AIM

This rapid review examines the technology-based interventions for caregivers of stroke proposed in the literature while also identifying the acceptance, effectiveness and satisfaction of the implemented approaches.

BACKGROUND

The increasing burden of supporting stroke survivors has resulted in caregivers searching for innovative solutions, such as technology-based interventions, to provide better care. Hence, its potential to support caregivers throughout the disease trajectory needs to be assessed.

EVALUATION

Five electronic databases were systematically searched for articles related to stroke caregiving technologies based on well-defined inclusion and exclusion criteria.

KEY ISSUE(S)

Fifteen articles met the inclusion criteria that focused on supporting caregivers through functionalities such as education, therapy and support, remote consultations, health assessments and logs and reminders using different devices. The majority of interventions demonstrated positive conclusions for caregiving impact, acceptance, effectiveness and satisfaction.

CONCLUSION

Findings highlight the influences of technology in improving stroke caregiving and the need to include user-centred design principles to create a meaningful, actionable and feasible system for caregivers.

IMPLICATIONS FOR NURSING MANAGEMENT

Technology can educate and support stroke caregivers, thereby minimizing uncertainty and ensuring better care for the survivor.

A home-based, multidisciplinary liver optimisation programme for the first 28 days after an admission for acute-on-chronic liver failure (LivR well): a study protocol for a randomised controlled trial

Background

Acute-on-chronic liver failure (ACLF) represents a rising global healthcare burden, characterised by increasing prevalence among patients with decompensated cirrhosis who have a 28-day transplantation-free mortality of 33.9%. Due to disease complexity and a high prevalence of socio-economic disadvantage, there are deficits in quality of care and adherence to guideline-based treatment in this cohort. Compared to other chronic conditions such as heart failure, those with liver disease have reduced access to integrated ambulatory care services. The LivR Well programme is a multidisciplinary intervention aimed at improving 28-day mortality and reducing 30-day readmission through a home-based, liver optimisation programme implemented in the first 28 days after an admission with either ACLF or hepatic decompensation. Outcomes from our feasibility study suggest that the intervention is safe and acceptable to patients and carers.

Methods

We will recruit adult patients with chronic liver disease from the emergency departments, in-patient admissions, and an ambulatory liver clinic of a multi-site quaternary health service in Melbourne, Australia. A total of 120 patients meeting EF-Clif criteria will be recruited to the ACLF arm, and 320 patients to the hepatic decompensation arm. Participants in each cohort will be randomised to the intervention arm, a 28-day multidisciplinary programme or to standard ambulatory care in a 1:1 ratio. The intervention arm includes access to nursing, pharmacy, physiotherapy, dietetics, social work, and neuropsychiatry clinicians. For the ACLF cohort, the primary outcome is 28-day mortality. For the hepatic decompensation cohort, the primary outcome is 30-day re-admission. Secondary outcomes assess changes in liver disease severity and quality of life. An interim analysis will be performed at 50% recruitment to consider early cessation of the trial if the intervention is superior to the control, as suggested in our feasibility study. A cost-effectiveness analysis will be performed. Patients will be followed up for 12 weeks from randomisation. Three exploratory subgroup analyses will be conducted by (a) source of referral, (b) unplanned hospitalisation, and (c) concurrent COVID-19. The trial has been registered with the Australian New Zealand Clinical Trials Registry.

Discussion

This study implements a multidisciplinary intervention for ACLF patients with proven benefits in other chronic diseases with the addition of novel digital health tools to enable remote patient monitoring during the COVID-19 pandemic. Our feasibility study demonstrates safety and acceptability and suggests clinical improvement in a small sample size. An RCT is required to generate robust outcomes in this frail, high healthcare resource utilisation cohort with high readmission and mortality risk. Interventions such as LivR Well are urgently required but also need to be evaluated to ensure feasibility, replicability, and scalability across different healthcare systems. The implications of this trial include the generalisability of the programme for implementation across regional and urban centres.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001703897. Registered on 13 December 2021.

WHO Trial Registration Data Set. See Appendix 1

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06679-x.

Beyond the Point of No Return: A Discourse Analysis of Healthcare Professionals' Perceptions of Digitally Supported Person-Centred, Integrated, and Proactive Care

Most countries are facing a common challenge: a rise in the number of chronically ill patients and limited medical resources. The combination of digital support and the principles of person-centred, integrated, and proactive care (Digi-PIP care) services constitutes the most ambitious initiative for patients with long-term needs. While there is research on digital support, person-centred, integrated, and proactive care, the combination of these components has been less explored. The data set consisted of 29 qualitative interviews with healthcare professionals involved in four Nordic Digi-PIP care initiatives. Building on prevailing discourses on the modernisation of healthcare, we used discourse analysis to determine how the professionals discussed their perceptions and experiences of the care transformation initiatives. We identified four discourses illustrating that, despite challenges with adoption, the vision of Digi-PIP care was strongly embedded among participants across professions and contexts. In contrast to the discourses on their separate components, the emergent discourses on Digi-PIP care were surprisingly consistent. The new care model was found to be beneficial for patients, healthcare professionals, and society. Digitalisation may vitalise and even catalyse person-centred, integrated, and proactive practices. To the employees involved, Digi-PIP has moved beyond the point of no return; it is the future of modern healthcare.

The evaluation of the role of technology in the pathways to comorbidity care implementation project to improve management of comorbid substance use and mental disorders

In substance use treatment settings, comorbid mental health problems can occur in up to 70% of people. An integrated approach for managing comorbidity, implementing evidence-based intervention in drug and alcohol settings, remains problematic. Technology can help in adopting evidence-based practice to implement effective treatment healthcare pathways. This study sought to examine aspects of tailored portal utilization (barriers and facilitators) by participants taking part in a program aimed at improving the implementation of evidence-based practice for comorbidity management Pathways to Comorbidity Care (PCC).

Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics

Establishing and running remote consultation services is challenging politically (interest groups may gain or lose), organizationally (remote consulting requires implementation work and new roles and workflows), economically (costs and benefits are unevenly distributed across the system), technically (excellent care needs dependable links and high-quality audio and images), relationally (interpersonal interactions are altered), and clinically (patients are unique, some examinations require contact, and clinicians have deeply-held habits, dispositions and norms). Many of these challenges have an under-examined ethical dimension. In this paper, we present a novel framework, Planning and Evaluating Remote Consultation Services (PERCS), built from a literature review and ongoing research. PERCS has 7 domains-the reason for consulting, the patient, the clinical relationship, the home and family, technologies, staff, the healthcare organization, and the wider system-and considers how these domains interact and evolve over time as a complex system. It focuses attention on the organization's digital maturity and digital inclusion efforts. We have found that both during and beyond the pandemic, policymakers envisaged an efficient, safe and accessible remote consultation service delivered through state-of-the art digital technologies and implemented via rational allocation criteria and quality standards. In contrast, our empirical data reveal that strategic decisions about establishing remote consultation services, allocation decisions for appointment type (phone, video, e-, face-to-face), and clinical decisions when consulting remotely are fraught with contradictions and tensions-for example, between demand management and patient choice-leading to both large- and small-scale ethical dilemmas for managers, support staff, and clinicians. These dilemmas cannot be resolved by standard operating procedures or algorithms. Rather, they must be managed by attending to here-and-now practicalities and emergent narratives, drawing on guiding principles applied with contextual judgement. We complement the PERCS framework with a set of principles for informing its application in practice, including education of professionals and patients.