WhatsApp in hospital? An empirical investigation of individual and organizational determinants to use

Interprofessional actions in responsible discharge: contributions to transition and continuity of care

OBJECTIVE

To analyze the interprofessional team's perception of the actions carried out by means of responsible hospital discharge, and their contribution to improving the transition and continuity of patient care.

METHODS

A qualitative study was carried out in two hospitalization units, in October - November 2020, interviewing health professionals from a teaching hospital in the state of São Paulo. The reports were transcribed and subjected to thematic content analysis.

RESULTS

Twelve professionals participated (doctor, nurse, physiotherapist, nutritionist, speech therapist and social worker) and three thematic categories emerged from the interviews: 1. informational continuity in responsible discharge; 2. interaction between professionals and services for the transition of care; and 3. workload management for better transition and continuity of care.

CONCLUSION

The team recognized interprofessional advances and challenges in responsible discharge related to the informational and relational continuity of patient care and highlighted the (over)workload as an unfavorable aspect in the transition process, generating impacts for patients, professionals and health services.

The role of messaging services in day-to-day practice in pediatric neurosurgery, advantages of a bubble network, and an international survey

INTRODUCTION

Messaging services (MS) are used widely worldwide. The implications of MS usage in daily hospital patient care have not been investigated. In this study, we discuss the extensive usage of MS in our Pediatric Neurosurgical Department, introduce our bubble algorithm, and provide additional input from an international survey.

METHODS

WhatsApp activity in the department of pediatric neurosurgery at Dana Children's Hospital, Tel Aviv, Israel, was analyzed. We designed a graphic representation of the content of the different conversation bubbles and how they interact. We also described a survey evaluating MS use in daily neurosurgical practice was sent to 25 neurosurgeons around the world. Collected data included details on the usage of MS, the type of information being transferred, and the participants' opinion of the potential risks and benefits of these systems. We began collecting messaging data November 2018, before the COVID pandemic era. We continued to collect data over the course of almost 3 years.

RESULTS

We identified a bubble network structure that reflects a logical method of communication between different segments of pediatric neurosurgical care in our institution. Additionally, we analyzed 22 survey responses, received from 14 different countries. The vast majority of centers with "department groups" use messaging services to transfer multimedia files of patient-related data. Nineteen responders believe that MS significantly improve overall patient care.

CONCLUSION

MS has revolutionized and improved the patterns of communication in our department. The great benefits of quick, simple access to information strongly outweigh formality and the potential for medicolegal disadvantages (e.g., HIPAA).

Pilot drug and therapeutic committee programme in Sierra Leone: A descriptive mixed method study

AIMS

Irrational medicine use is a global crisis, but incidences are proportionately higher in low- and middle-income countries such as Sierra Leone. This study explores the structure, functions and challenges of drug and therapeutics committees (DTCs), an intervention towards irrational medicine use recently piloted in Sierra Leone.

METHODS

A 2-phase mixed-method study design was used in this study. Firstly, a cross-sectional survey was conducted on all pharmacists who have worked for at least 1 year in DTC-piloted hospitals, using an online questionnaire to assess DTCs' structure, indicators and challenges. In phase 2, all eligible pharmacists were invited for a semistructured online interview using the WhatsApp messaging application to get deeper insights into the key issues that emerged from the survey; however, only 5 of the 7 consented to participate. MS Excel 2019 and NVivo version 12 were respectively used for data management and analysis.

RESULTS

A total of 6 survey responses and 5 interviews were included in the analysis. Participants are pharmacists from the 7 hospitals in Sierra Leone where DTC was piloted. Most DTCs are comprised of a minimum of 10 members consisting of both medical and hospital administrative staff. The main functions of DTCs are ensuring rational medicines use, monitoring and reporting adverse drug reactions. All 7 hospitals with established pilot DTCs have different subcommittees operating at varying functionality levels, ranging from effective to nonfunctional. The main challenges in DTC functions and maintenance are funding (n = 6), DTC decision implementation (n = 4), and unmotivated members (n = 4). Strategies suggested to improve DTCs at public hospitals and nationwide include resource allocation, monitoring and evaluating DTC functions and its members' capacity building.

CONCLUSION

DTCs present a compelling opportunity towards achieving rational medicines use at the hospital level in Sierra Leone. Nonetheless, the lack of funding and operational resources are significant limitations that must be noted by policymakers before expanding DTC programmes to other hospitals in Sierra Leone.

Telemedicine in Southeast Asia: A Systematic Review

Introduction: Telemedicine is an effective means of delivering health care in Southeast Asian (SEA) countries. This systematic review explored the use of telemedicine systems for delivering health care services in SEA countries during the past 10 years. Methods: Literature searches were conducted in PubMed, Embase, Medline, Global Health, and CENTRAL (Cochrane Central Register of Controlled Trials). The inclusion criteria were as follows: (1) studies published between 2010 and 2021; (2) study settings located in SEA countries; (3) articles published in English; and (4) availability of a full-text version of the article. Information was extracted and evaluated for each study based on quality and risk of bias. Results: Thirty-seven of 6,554 records were eligible for inclusion. Studies included based on percentage were descriptive (29.73%), cost-effective (8.11%), randomized controlled trials (5.41%), and mixed methods (2.7%). Teleophthalmology and teleconsultation were the major reasons for using telemedicine, representing 21.62% of all studies. A hub-and-spoke and store-and-forward models were used. Free messenger applications supported communication modalities in or out of the systems. Discussion: The COVID-19 (coronavirus disease 2019) pandemic increased research studies on telemedicine, with most studies occurring in Singaporean hospitals (49%). Descriptive studies predominated, followed by retrospective and cross-sectional studies. Conclusions: Our findings demonstrated that telemedicine was a powerful tool. It is feasible, safe, effective, and less expensive than traditional methods. However, robust research is needed to fully investigate telemedicine systems in SEA countries.

Translation and validation of the techno-stress questionnaire in Brazil

OBJECTIVE

The aim of this study was to translate the techno-stress questionnaire proposed by Ragu Nathan et al into Brazilian Portuguese and to culturally adapt and validate it. For this, 4 of the 11 original questionnaires' domains were used.

METHODS

The questionnaires' domains translated and adapted were as follows: techno-overload, techno-invasion, techno-complexity, and job satisfaction. Initially, the techno-stress questionnaire was translated into Brazilian Portuguese language according to international standards, followed by cultural adaptations. Validation for feasibility and psychometric properties of translated questionnaire was performed on 138 gynecologists and obstetricians who use message applications to communicate with patients. The physicians were divided into groups according to the weekly messaging application usage time for communication with patients: <2 h (GI, n=89), 2-5 h (GII, n=29), and >5 h (GIII, n=23). The questionnaire was applied to all participants twice on the same day, overseen by two different interviewers, at a 15-min interval. After 15 days, it was readministered. The discriminant validity and reliability were calculated to validate the instrument.

RESULTS

Techno-stress subscales showed statistically significant differences between the groups. The Cronbach's alpha coefficient for the techno-stress questionnaire was >0.80, showing good internal consistency. No differences were observed in the test-retest comparison of the techno-stress questionnaire, and the intraclass correlation coefficient results showed excellent reproducibility (³0.75).

CONCLUSION

The techno-stress questionnaire was adequately translated into Brazilian Portuguese, with good discriminant validity, good internal consistency, and adequate test-retest results.

Message applications in the doctor-patient relationship as a stressor

OBJECTIVE:

The aim of this study was to assess the use of smartphones’ messaging apps as a stressor affecting the well-being of gynecologists who use this tool to communicate with patients.

METHODS:

A cross-sectional study was conducted with gynecologists who use message applications to communicate with patients. Participants answered the WhatsApp Stress Scale, Oldenburg Burnout Inventory, and the techno-stress questionnaire. The population sample consisted of gynecologists and obstetricians selected by convenience.

RESULTS:

Physicians who spent more time using WhatsApp to communicate with patients had higher levels of stress (p=0.010), Burnout (p<0.001), and techno-invasion score (p<0.05).

CONCLUSIONS:

A positive association was found between the high frequency of WhatsApp usage for communication with patients and doctor's Burnout and stress, negatively influencing professional's well-being.

Smartphone technology for communications between clinicians - A scoping review

OBJECTIVES

This scoping review aims to review explore, assess, and map the literature to inform clinical practice regarding communication between clinicians. Specific Apps/channels used were identified and assessed with a focus on data security with key concepts and knowledge gaps identified.

DATA

The Joanna Briggs Institute framework is followed, with search results reported as per the PRISMA ScR for scoping reviews guidelines.

SOURCES

A systematic search strategy encompassing EBSCO and OneSearch databases was conducted - two identical searches, (June and October 2020) limited to English language articles published 2016-2020. A narrative synthesis was used to integrate and report the findings.

STUDY SELECTION

Sixty-six publications were selected. Twelve from EBSCO, thirty-five from OneSearch, nineteen were hand searched. Sixteen of the publications were research studies, nine were literature reviews, twenty-six were editorial, one was a newspaper article and fourteen were grey literature. Instant Messaging (40%, n = 23), image sharing (41%, n = 24), and video conferencing (19%, n = 11) were functions most popular with clinicians. WhatsApp, generic instant messaging, Facebook messenger, ZOOM, and Skype are evidenced as channels for communication between clinicians within the EU. A sizeable proportion of the publications (38%; n = 25) failed to identify or adequately address technical security concerns and requirements around privacy and data protection.

CONCLUSIONS

Clinicians use smartphones /Apps to communicate clinical information with each other. The security and privacy issues arising from their communication of sensitive data is absent or only superficially acknowledged within the literature.

CLINICAL SIGNIFICANCE

Clinician's need clearer guidance on the use of smartphone technology for clinical communications.

WhatsApp and Gynecologist-Patient Interaction: Development and Validation of a Questionnaire to Assess the Stress Perceived by the Doctor

OBJECTIVE

 Construction and validation of the WhatsApp Stress Scale (WASS), a questionnaire designed for physicians that measures how the use of smartphones and related software communication applications affects the quality of life of gynecologists who use this tool to communicate with patients.

METHODS

 The present cross-sectional observational study analyzed 60 gynecologists according to weekly WhatsApp usage time for communication with patients and compared the data with the perception of the doctor on the use of this virtual interaction as a stressor. Physicians were equally divided into three groups: < 2 hours, 2 to 5 hours, and > 5 hours. The authors created a questionnaire in Likert scale format. The study proceeded in three phases: development of the questionnaire items, pretesting, constructing, and validity and reliability testing using factor analysis, Cronbach α coefficient, and paired t-test.

RESULTS

 A 9-item instrument using a 5-point Likert scale was created and administered to the participants in 3 different times: T0, T1 (15 minutes after the end of T0), and T2 (15 days later). All questionnaire items possessed adequate content validity indices and the internal consistency of the instrument was satisfactory (Cronbach α 0.935; 95% confidence interval [CI]: 0.744-0.989; p = 0.0001). No statistically significant differences were observed in the responses between the rounds of testing, indicating good test-retest reliability. A positive association between the high frequency of WhatsApp usage for communication with patients and the stress perceived by the doctor was shown.

CONCLUSION

 The WASS is a valid and reliable instrument for assessing the use of messaging applications to communicate with patients as a stressor perceived by gynecologists.

Conexão SUS: um canal do YouTube como instrumento de formação educacional e fortalecimento do Sistema Único de Saúde

RESUMO Trata-se da análise estatística de alcance e audiência do canal Conexão SUS, através dos dados do YouTube Studio. Foram analisados o alcance do canal e o engajamento do público de 2016 a 2021, avaliando-se o padrão anual de: número de inscritos, visualizações, impressões, compartilhamentos, marcações ‘gostei’, marcações ‘não gostei’ e tempo de exibição em horas. A sazonalidade do número de visualizações do canal foi avaliada através de análise do mapa de calor em cluster do número de visualizações diárias do canal de 2016 a 2021. Ademais, foi avaliado o comportamento dos usuários do canal com base nas interações dos usuários com os assuntos abordados pelos vídeos do canal. Assim, foi observado que o canal conta com 19.625 inscritos, 984.347 visualizações, 36.796 horas assistidas e 4.259.577 impressões. A audiência do canal conta com participação de 73,3% de mulheres, com idade entre 25 e 34 anos, que acessam os conteúdos produzidos preferencialmente por dispositivo móvel. Atenção básica é o conteúdo com maior engajamento e alcance do canal. O canal Conexão SUS se mostrou uma ferramenta propulsora da comunicação sobre o Sistema Único de Saúde (SUS) nas redes sociais.

Análise dos materiais didáticos utilizados por radiologistas e residentes de radiologia brasileiros: mudança de paradigma

Resumo Objetivo: Identificar o perfil de utilização dos recursos didáticos pelos médicos radiologistas e residentes em radiologia e diagnóstico por imagem brasileiros. Materiais e Métodos: Estudo observacional, transversal e descritivo, realizado por meio de questionário eletrônico contendo perguntas referentes ao perfil do médico, formação, local de atuação, perfil de acesso a recursos educacionais e tipos de recursos mais utilizados. Resultados: Responderam ao questionário 265 médicos com idade média de 38,2 anos, sendo a maioria radiologistas formados (170; 64,2%), do sexo masculino (166; 62,6%), trabalhando em instituições privadas (174; 65,7%), sem vínculo acadêmico (167; 63,0%), atuando principalmente nas áreas de ultrassonografia (212; 80,0%) e tomografia computadorizada (206; 77,7%). A carga horária média de estudo semanal foi de 9,6 horas (mediana: 6 horas), sendo maior no grupo dos médicos que estão em formação e nos que atuam em instituições públicas e acadêmicas. Quanto ao recurso para o acesso do material de estudo, observou-se uma tendência pela maior utilização do computador (65,3%). A maioria dos respondentes optou por acessar materiais didáticos sem custo (61,9%), sendo os sites da web, livros e revistas eletrônicas os mais pesquisados. Conclusão: Os radiologistas brasileiros utilizam recursos eletrônicos e digitais como principais materiais didáticos, sendo os sites da web, livros e revistas eletrônicas as fontes mais utilizadas.

WhatsApp Messenger use in oncology: a narrative review on pros and contras of a flexible and practical, non-specific communication tool

The spread of instant messenger systems provides an excellent opportunity and a helpful tool to healthcare professionals. WhatsApp instant messenger use is widely prevalent among health professionals, cancer patients, caregivers and the general population. It is a quick and easy communication tool that may also be used on personal computers and business purposes. WhatsApp instant messenger and other similar tools may be a very useful complement for e-medicine. Instant messaging systems may be helpful, especially in rural areas, in medium- or low-income countries, or to avoid unnecessary travels, improve knowledge and awareness of cancer, monitor home care and support the delivery of home care. The unregulated use of WhatsApp instant messenger requires sound and shared guidelines to assure impeccable professional service. Although a significant number of papers have investigated the roles of social networks in connecting patients to health professionals, there is still a lack of information and scientific data about their uses, benefits and limitations in connecting health providers only for professional communication. The role of instant messenger systems in cancer practice and research needs to be clarified. In this paper, we report a focus on available data, pros and contras of the unregulated use of WhatsApp instant messaging, in the context of e-medicine, as an interprofessional and doctor/patient communication tool in oncology.

WhatsApp-Delivered Intervention for Continued Learning for Nurses in Pakistan During the COVID-19 Pandemic: Results of a Randomized-Controlled Trial

The COVID-19 pandemic has necessitated support for continued learning in frontline practitioners through online digital mediums that are convenient and fast to maintain physical distancing. Nurses are already neglected professionals for support in training for infection control, leadership, and communication in Pakistan and other developing countries. For that reason, we aimed to deliver a WhatsApp-based intervention for continued learning in nurses who are currently working in both private and public sector. A 12-week intervention was delivered to 208 nurses (102 in the control group and 106 in the intervention group) who had been employed in the clinical setting during data collection. The analysis reveals that nurses in the intervention group show significantly better results for learning in “infection prevention and control” and “leadership and communication.” Results of a content analysis based on participant's feedback also confirm that the WhatsApp-based intervention is a valuable tool for education. This study highlights the effectiveness of online-based digital interventions as a convenient training tool for awareness and management of infectious diseases, leadership, and communication during COVID-19 and beyond. Furthermore, this study emphasizes that group interventions with other healthcare practitioners and the role of on-going longer WhatsApp-based interventions can become integral tools to support continued learning and patient safety practices.

‘Where is the ECG machine?’: a quality improvement project using WhatsApp to improve the efficiency in locating shared medical devices in an inpatient unit

Access to medical devices are vital to deliver safe patient care. In the context of constrained resources, however, clinical areas often have insufficient basic equipment, which tend to be shared among multiple clinical teams. This can result in delayed patient management and reduced institutional productivity. In our experience, in 2019, while working at Carseview Centre, an inpatient mental health unit in Dundee (National Health Service Tayside), there was only one functioning ECG machine shared between the five wards.

Using the work WhatsApp chat, we aimed to facilitate better sharing of the one machine. Plan, do, study, act (PDSA) 1 intervention introduced the project protocol, which encouraged doctors to post a photo of the device after use, captioned with its location. PDSA 2 involved printing a physical copy of the memorandum and attaching it to the machine to prompt further compliance. In PDSA 3, concise photo-posting guidelines were established and adherence was encouraged to mitigate concerns for potential confidential-data leaks.

A dynamic outcome measure, the overall effectiveness metric (OEM), was conceived to prospectively monitor the effectiveness of our interventions. An OEM ≥1 indicates engagement and thereby improvement, whereby <1 indicates no change compared with baseline.

The intervention in PDSA 1 was a success with an OEM of 3.5. Although no actual data leaks occurred, a potential for concern was raised by a senior doctor. This limited engagement with the protocol during PDSA 2 and 3, causing the OEM to decline to <1 towards the end of the project. Sixty percent reported that the protocol saved them time in locating the machine.

Individual factors, mainly frustration with the current situation, was a primary driver for the initial engagement among doctors. Although other factors such as senior doctor buy-in, may play a greater role in directing longevity of a technology-based quality improvement solution.

Social Media and Health Care (Part II): Narrative Review of Social Media Use by Patients

Background

People are now connected in a borderless web-based world. The modern public, especially the younger generation, relies heavily on the internet as the main source of health-related information. In health care, patients can use social media for more tailored uses such as telemedicine, finding a provider, and for peer support.

Objective

The aim of this narrative review is to discuss how social media has been used in the health care industry from the perspective of patients and describe the main issues surrounding its use in health care.

Methods

Between March and June 2020, a review of the literature was conducted on PubMed, Google Scholar, and Web of Science for English studies that were published since 2007 and discussed the use of social media in health care. In addition to only English publications that discussed the use of social media by patients, publications pertaining to ethical and legal considerations in the use of social media were included. The studies were then categorized as health information, telemedicine, finding a health care provider, peer support and sharing experiences, and influencing positive health behavior. In addition, two more sections were added to the review: issues pertaining to social media use in health care and ethical considerations.

Results

Initially, 75 studies were included. As the study proceeded, more studies were included, and a total of 91 studies were reviewed, complemented by 1 textbook chapter and 13 web references. Approximately half of the studies were reviews. The first study was published in 2009, and the last was published in 2021, with more than half of the studies published in the last 5 years. The studies were mostly from the United States (n=40), followed by Europe (n=13), and the least from India (n=1). WhatsApp or WeChat was the most investigated social media platform.

Conclusions

Social media can be used by the public and patients to improve their health and knowledge. However, due diligence must be practiced to assess the credibility of the information obtained and its source. Health care providers, patients, and the public need not forget the risks associated with the use of social media. The limitations and shortcomings of the use of social media by patients should be understood.

Surgery remember@: an innovation to reduce surgical cancellations

The use of mobile phones has dramatically increased all over the world. Such revolution in the communication amongst individuals has a great impact in patient care, supporting their self-management and promoting shared responsibility with health services. Given that improved communication facilitates compliance with scheduled procedures and reduces surgical cancellations, the current work aims to develop a communication tool named Surgery Remember@ to mitigate surgical suspensions due to patient absenteeism. The present article is a study of technological production divided into four chapters: literature review; analysis of the hospital administrative profile; software development; and process mapping for software implementation. Taking into account that in the last three years the problem of absenteeism was the main cause of institutional surgical cancellations; the development of Surgery Remember@ endeavours to reduce surgery cancellations, improving efficiency and reducing costs. It is known that sending messages three days before the surgical procedure makes it possible to replace patients in the event of cancellations, optimizing the human and material resources in the operating room. The confirmation of the pre-aesthetic consultation is also positive, for it allows the verification of perioperative assistance improvement. Hence, besides being viable and easy to implement, the software developed allows the addition of other features based on user requirements, proving to be an asset to reduce surgery cancellations.

Utility of WhatsApp in emergency urological practice: An interrater reliability study

INTRODUCTION

The messaging application 'WhatsApp' is used in clinical practice, often for communication between a medical trainee and a consultant. We designed this study to find the interrater reliability of the data transmitted through this application and validating its use in urological practice.

MATERIALS AND METHODS

Clinical details and computerized tomographic (CT) images of 30 patients visiting the urology emergency were posted in a closed WhatsApp group involving three consultants (SKD, APS, and KC). The CT images were posted in the WhatsApp group as Whole Image (WI) and Image of Interest (IOI) format and rated on a scale of 1-5. The consultants formulated a provisional diagnosis and initial management strategy. The interrater reliability of these responses was analyzed in the study.

RESULTS

Mean WI rating ranged from 3.03 ± 0.61 to 3.73 ± 0.64 (Cronbach alfa [α]-0.494, P = 0.006). Mean IOI rating ranged from 3.4 ± 0.56 to 4.13 ± 0.73 (α-0.824, P < 0.0001). For diagnosis, the proportion of observed agreement (P₀) was 83.3% for SKD and APS, 76.6% for SKD and KC, and 73.3% for APS and KC. For management, P₀ was 86.6% for APS and KC, 86.6% for SKD and APS, and 80% for SKD and KC.

CONCLUSIONS

WhatsApp Messenger serves to transmit good quality pictures of CT scan images. A reasonable diagnosis and management strategy can be formulated using this app with fair inter-rater reliability.

Development and psychometric testing of a new measure of the determinants that influence the adoption of WhatsApp in hospitals

Background

Healthcare contexts are witnessing a growing use of applications to support clinical processes and to communicate between peers and with patients. An increasing number of hospital professionals use instant-messaging applications such as WhatsApp in their daily work. Previous research has mainly focused on the advantages and risks of WhatsApp usage in different clinical settings, but limited evidence is available about whether and how individual and organizational determinants can influence the use of WhatsApp in hospitals. Moreover, instruments to explore this phenomenon are lacking. A theoretical four-factor model based on the ‘Technology Acceptance Model’ and the Institutional Theory, guided the development of a new measure of the individual and institutional determinants of WhatsApp usage in hospitals.

Aim

To develop and psychometrically test the questionnaire ‘Digital Innovation Adoption in Hospitals’.

Method

A panel of researchers and clinical experts generated an initial pool of 35 items by identifying and adapting items from existing measures. These items were assessed for content and face validity by fourteen experts. The final 28-item ‘Digital Innovation Adoption in Hospitals’ questionnaire comprising four sections (Perceived risks, Perceived usefulness, Regulative factors and Normative factors) was administered online to nurses and physicians. Construct validity was tested through confirmatory factor analysis.

Results

The sample included 326 hospital nurses and physicians. The theoretical four-factors model was confirmed and the confirmatory factor analysis yielded acceptable fit indexes. The correlations between the factors were significant and ranged from -0.284 to 0.543 (p < .01). Reliability in terms of internal consistency was satisfactory with Cronbach’s alpha coefficient ranging from 0.918–0.973.

Conclusion

This study is the first to provide a validated tool to evaluate the use of WhatsApp in hospitals. The new instrument shows reasonable psychometric properties and is a promising and widely applicable measure of factors that influence the use of WhatsApp in hospitals.

WhatsApp in Clinical Practice-The Challenges of Record Keeping and Storage. A Scoping Review

The use of WhatsApp in health care has increased, especially since the COVID-19 pandemic, but there is a need to safeguard electronic patient information when incorporating it into a medical record, be it electronic or paper based. The aim of this study was to review the literature on how clinicians who use WhatsApp in clinical practice keep medical records of the content of WhatsApp messages and how they store WhatsApp messages and/or attachments. A scoping review of nine databases sought evidence of record keeping or data storage related to use of WhatsApp in clinical practice up to 31 December 2020. Sixteen of 346 papers met study criteria. Most clinicians were aware that they must comply with statutory reporting requirements in keeping medical records of all electronic communications. However, this study showed a general lack of awareness or concern about flaunting existing privacy and security legislation. No clear mechanisms for record keeping or data storage of WhatsApp content were provided. In the absence of clear guidelines, problematic practices and workarounds have been created, increasing legal, regulatory and ethical concerns. There is a need to raise awareness of the problems clinicians face in meeting these obligations and to urgently provide viable guidance.

Integration of mHealth Information and Communication Technologies Into the Clinical Settings of Hospitals in Sub-Saharan Africa: Qualitative Study

Background

There is a rapid uptake of mobile-enabled technologies in lower- and upper-middle–income countries because of its portability, ability to reduce mobility, and facilitation of communication. However, there is limited empirical evidence on the usefulness of mobile health (mHealth) information and communication technologies (ICTs) to address constraints associated with the work activities of health care professionals at points of care in hospital settings.

Objective

This study aims to explore opportunities for integrating mHealth ICTs into the work activities of health care professionals at points of care in clinical settings of hospitals in Sub-Saharan Africa. Thus, the research question is, “How can mHealth ICTs be integrated into the work activities of health care professionals at points of care in hospital settings?”

Methods

A qualitative approach was adopted to understand the work activities and points at which mHealth ICTs could be integrated to support health care professionals. The techniques of inquiry were semistructured interviews and co-design activities. These techniques were used to ensure the participation of frontline end users and determine how mHealth ICTs could be integrated into the point of care in hospital settings. Purposive and snowball sampling techniques were used to select tertiary hospitals and participants for this study from South Africa and Nigeria. A total of 19 participants, including physicians, nurses, and hospital managers, were engaged in the study. Ethical clearance was granted by the University research committee and the respective hospitals. The data collected were sorted and interpreted using thematic analysis and Activity Analysis and Development model.

Results

The findings show that mHealth ICTs are suitable at points where health care professionals consult with patients in the hospital clinics, remote communication is needed, and management of referrals and report writing are required. It was inferred that mHealth ICTs could be negatively disruptive, and some participants perceived the use of mobile devices while engaging with patients as unprofessional. These findings were informed by the outcomes of the interplay between human attributes and technology capabilities during the transformation of the motives of work activity into the intended goal, which is enhanced service delivery.

Conclusions

The opportunities to integrate mHealth ICTs into clinical settings depend on the inefficiencies of interaction moments experienced by health care professionals at points of care during patient consultation, remote communication, referrals, and report writing. Thus, the timeliness of mHealth ICTs to address constraints experienced by health care professionals during work activities should take into consideration the type of work activity and the contextual factors that may result in contradictions in relation to technology features. This study contributes toward the design of mHealth ICTs by industry vendors and its usability evaluation for the work activity outcomes of health care professionals.

Factors influencing the mobile instant messaging application usage behaviours among home healthcare providers

AIMS AND OBJECTIVES

To explore the practice related to mobile instant messaging applications usage among home healthcare providers in Taiwan; and based on the unified theory of acceptance and usage of technology and perceived risk theory to examine the influencing factors.

BACKGROUND

Previous work has indicated the potential for using mobile instant messaging applications in chronic disease, disasters and public health emergencies. However, few studies have conducted to understand how healthcare professionals use them.

DESIGN

A cross-sectional design was used in the study.

METHODS

A wide-ranging empirical investigation was conducted in Taiwan. A total of 102 home agencies participated in this study, and 331 valid data were collected. The ODS guideline was followed.

RESULTS

69% of the participants had used mobile instant messaging applications, with high functionality and interesting value can integrate various messages and contribute to adoption. Performance expectancy, effort expectancy, and social influence were significantly positively correlated with behavioral intention. The perceived risk had a significant negative correlation with performance expectancy and use behavior. Among the relevant influencing factors, different types of organization, job position, and institutional policy were related to significant differences in use behaviors.

CONCLUSIONS

Our research reported on mobile instant messaging applications usage and behavioral intention among home healthcare providers. This study also highlighted the need to establish regulations within the applications and improve safety and security guidelines. Further research may extend the understanding of the organizations' influencing factors.

RELEVANCE TO CLINICAL PRACTICE

This study may help programmers, managers and policymakers improve their strategies for expanding usage of mobile instant messaging applications.

Establishing and operating a 'virtual ward' system to provide care for patients with COVID-19 at home: experience from The Gambia

Health systems in sub-Saharan Africa have remained overstretched from dealing with endemic diseases, which limit their capacity to absorb additional stress from new and emerging infectious diseases. Against this backdrop, the rapidly evolving COVID-19 pandemic presented an additional challenge of insufficient hospital beds and human resource for health needed to deliver hospital-based COVID-19 care. Emerging evidence from high-income countries suggests that a 'virtual ward' (VW) system can provide adequate home-based care for selected patients with COVID-19, thereby reducing the need for admissions and mitigate additional stress on hospital beds. We established a VW at the Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, a biomedical research institution located in The Gambia, a low-income west African country, to care for members of staff and their families infected with COVID-19. In this practice paper, we share our experience focusing on the key components of the system, how it was set up and successfully operated to support patients with COVID-19 in non-hospital settings. We describe the composition of the multidisciplinary team operating the VW, how we developed clinical standard operating procedures, how clinical oversight is provided and the use of teleconsultation and data capture systems to successfully drive the process. We demonstrate that using a VW to provide an additional level of support for patients with COVID-19 at home is feasible in a low-income country in sub-Saharan Africa. We believe that other low-income or resource-constrained settings can adopt and contextualise the processes described in this practice paper to provide additional support for patients with COVID-19 in non-hospital settings.

WhatsApp Tele-Medicine - usage patterns and physicians views on the platform

BACKGROUND

Telemedicine has become an integral part of health care delivery in recent years. One of the leading applications for this use is WhatsApp - a free smartphone application that allows instant messaging with pictures and videos. This study analyzed the emerging role of WhatsApp on reducing the need for referrals to medical specialists and to compare the views of physicians regarding WhatsApp consultations.

METHODS

A cross-sectional study based on an anonymous web-survey was conducted among PCPs and medical specialists working in the Israel Defense Forces Medical-Corps during September and October, 2019.

RESULTS

Of 201 participants, 153 were PCPs and 48 were medical specialists. 86.9 % of PCPs and 86.5 % of specialists used WhatsApp every day in professional settings. Added workload, potential breaching of patient confidentiality and lack of full documentation of consultations were the main concerns among physicians using the application. 60.7 % of PCPs and 95.7 % of specialists stated that these consultations have reduced the need for in-person appointments at least once a week.

CONCLUSIONS

In times of COVID-19 that require social distancing, WhatsApp provides a simple, readily available platform for consultations between healthcare providers, even to the extent of rendering some in-person appointments unnecessary. Healthcare organizations should address the matters troubling healthcare providers, mainly patient confidentiality and lack of documentation in patients' medical records, while providing adequate compensation for those providing the service during and after work hours.

Digital implications for human resource management in surgical departments

Background

Changes in demographics and dynamics of our society are affecting the healthcare system, leading to an intensified “war for talents,” especially for surgical departments. Also with regard to the current COVID-19 pandemic, the present work analyzes the potential of digitalization for human resource management of surgical departments in hospitals.

Methods

PubMed and Google Scholar were searched to identify articles referring to the specific subject of human resource management and its digital support in hospitals and surgical departments in particular.

Results

The main topics include the digital affinity of young physicians and surgeons in terms of staff recruiting, digital support for everyday working life in surgical departments, and the potential of digital approaches for surgical training. These topics are put into the context of company strategies, and their future potential is identified accordingly.

Conclusion

Digital programs, digital structures, and digital tools can today be used by human resources departments to advertise the hospital and to make the recruitment of future candidates increasingly attractive. In addition, by making digital tools available, the employees’ satisfaction can be raised with the potential of a strong employer branding. In times of the COVID-19 pandemic, digital personnel strategies and training formats have to be regarded a contemporary offering.

An apple a day - how the platform economy impacts value creation in the healthcare market

The healthcare industry has been slow to adopt new technologies and practices. However, digital and data-enabled innovations diffuse the market, and the COVID-19 pandemic has recently emphasized the necessity of a fundamental digital transformation. Available research indicates the relevance of digital platforms in this process but has not studied their economic impact to date. In view of this research gap and the social and economic relevance of healthcare, we explore how digital platforms might affect value creation in this market with a particular focus on Google, Apple, Facebook, Amazon, and Microsoft (GAFAM). We rely on value network analyses to examine how GAFAM platforms introduce new value-creating roles and mechanisms in healthcare through their manifold products and services. Hereupon, we examine the GAFAM-impact on healthcare by scrutinizing the facilitators, activities, and effects. Our analyses show how GAFAM platforms multifacetedly untie conventional relationships and transform value creation structures in the healthcare market.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12525-021-00467-2.

Social Media and Health Care, Part I: Literature Review of Social Media Use by Health Care Providers

BACKGROUND

As the world continues to advance technologically, social media (SM) is becoming an essential part of billions of people's lives worldwide and is affecting almost every industry imaginable. As the world is becoming more digitally oriented, the health care industry is increasingly visualizing SM as an important channel for health care promotion, employment, recruiting new patients, marketing for health care providers (HCPs), building a better brand name, etc. HCPs are bound to ethical principles toward their colleagues, patients, and the public in the digital world as much as in the real world.

OBJECTIVE

This review aims to shed light on SM use worldwide and to discuss how it has been used as an essential tool in the health care industry from the perspective of HCPs.

METHODS

A literature review was conducted between March and April 2020 using MEDLINE, PubMed, Google Scholar, and Web of Science for all English-language medical studies that were published since 2007 and discussed SM use in any form for health care. Studies that were not in English, whose full text was not accessible, or that investigated patients' perspectives were excluded from this part, as were reviews pertaining to ethical and legal considerations in SM use.

RESULTS

The initial search yielded 83 studies. More studies were included from article references, and a total of 158 studies were reviewed. SM uses were best categorized as health promotion, career development or practice promotion, recruitment, professional networking or destressing, medical education, telemedicine, scientific research, influencing health behavior, and public health care issues.

CONCLUSIONS

Multidimensional health care, including the pairing of health care with SM and other forms of communication, has been shown to be very successful. Striking the right balance between digital and traditional health care is important.

Understanding How to Improve the Use of Clinical Coordination Mechanisms between Primary and Secondary Care Doctors: Clues from Catalonia

Clinical coordination between primary (PC) and secondary care (SC) is a challenge for health systems, and clinical coordination mechanisms (CCM) play an important role in the interface between care levels. It is therefore essential to understand the elements that may hinder their use. This study aims to analyze the level of use of CCM, the difficulties and factors associated with their use, and suggestions for improving clinical coordination. A cross-sectional online survey-based study using the questionnaire COORDENA-CAT was conducted with 3308 PC and SC doctors in the Catalan national health system. Descriptive bivariate analysis and logistic regression models were used. Shared Electronic Medical Records were the most frequently used CCM, especially by PC doctors, and the one that presented most difficulties in use, mostly related to technical problems. Some factors positively associated with frequent use of various CCM were: working full-time in integrated areas, or with local hospitals. Interactional and organizational factors contributed to a greater extent among SC doctors. Suggestions for improving clinical coordination were similar between care levels and related mainly to the improvement of CCM. In an era where management tools are shifting towards technology-based CCM, this study can help to design strategies to improve their effectiveness.

Nurses' Use of Personal Smartphone Technology in the Workplace: Scoping Review

Background

There has been an increase in the technological infrastructures of many health care organizations to support the practice of health care providers. However, many nurses are using their personal digital devices, such as smartphones, while at work for personal and professional purposes. Despite the proliferation of smartphone use in the health care setting, there is limited research on the clinical use of these devices by nurses. It is unclear as to what extent and for what reasons nurses are using their personal smartphones to support their practice.

Objective

This review aimed to understand the current breadth of research on nurses’ personal smartphone use in the workplace and to identify implications for research, practice, and education.

Methods

A scoping review using Arksey and O’Malley’s methodological framework was conducted, and the following databases were used in the literature search: CINAHL, PubMed, ProQuest Dissertations and Theses, Embase, MEDLINE, Nursing and Allied Health Database, Scopus, Web of Science, and Cochrane Reviews. Search terms used were Nurs* AND (personal digital technology OR smartphone OR cellphone OR mobile phone OR cellular phone). Inclusion criteria included research focused on nurses’ use of their own digital technologies, reported in English, and published between January 2010 and January 2020. Exclusion criteria were if the device or app was implemented for research purposes, if it was provided by the organization, if it focused on infection control, and if it was focused on nursing students or nursing education.

Results

A total of 22 out of 2606 articles met the inclusion criteria. Two main themes from the thematic analyses included personal smartphone use for patient care and implications of personal smartphone use. Nurses used their smartphones to locate information about medications, procedures, diagnoses, and laboratory tests. Downloaded apps were used by nurses to locate patient care–related information. Nurses reported improved communication among health team members and used their personal devices to communicate patient information via text messaging, calling, and picture and video functions. Nurses expressed insight into personal smartphone use and challenges related to distraction, information privacy, organizational policies, and patient perception.

Conclusions

Nurses view personal smartphones as an efficient method to gather patient care information and to communicate with the health care team. This review highlights knowledge gaps regarding nurses’ personal device use and information safety, patient care outcomes, and communication practices. This scoping review facilitates critical reflection on patient care practices within the digital context. We infer that nurses’ use of their personal devices to communicate among the health care team may demonstrate a technological “work-around” meant to reconcile health system demands for cost-efficiency with efforts to provide quality patient care. The current breadth of research is focused on acute care, with little research focus in other practices settings. Research initiatives are needed to explore personal device use across the continuum of health care settings.

Digitally-Enabled Remote Care for Cancer Patients: Here to Stay

OBJECTIVE

Digital Technology has become a pervasive, even ubiquitous part of our daily lives, affecting almost every aspect of our lives. Although the uptake of digital technology in health care has lagged behind other sectors, today, digital health is already becoming a cornerstone of developed health systems all over the world. Hence, the question is not whether we should adopt digital technology in health care, but how to do it most effectively. Digitally enabled remote care, or telemedicine has been available for many years but large-scale adoption has been slow. COVID-19 has caused a quantum leap in this area and particularly in the area of chronic disease and cancer care. The objective of this article is to briefly review the literature on the use of digitally enabled remote health care, in general and in cancer care specifically, with a focus on nursing practice, and to define the questions that need to be asked to guide effective implementation.

DATA SOURCES

Review of the literature and the experience of the authors.

CONCLUSION

There is increasing uptake of digitally enabled remote care. A growing body of evidence suggests that care delivered via telemedicine can be both safe and effective, in some cases with better outcomes than conventional face-to-face care. However, tele-oncology has not yet become standard practice. Digital health solutions need to be integrated into the patient pathway and in health care team practices for optimal supportive care in oncology in line with appropriate guidelines. Training education and formative evaluation are required to guide effective implementation. Formulating the right questions to ask is a critical starting point.

IMPLICATIONS FOR NURSING PRACTICE

There is very little debate today about the centrality of the role of the oncology nurse in coordinating care, guiding the patient, and providing ongoing support. Mobile technology provides an opportunity for monitoring and support through a minimally burdensome, maximally accessible approach. Moreover, smartphones and applications allow for repeated evaluation of adherence and symptoms in real time, ideally enhancing care for patients. However, even with the growing acceptance of "nursing telepractice", there are challenges and barriers to overcome to mainstream digital health into oncology nursing practice. Telemedicine services go much further than simply digitizing traditionally analogue health care processes and services, they fundamentally reorganize processes, procedures, and services. Thus, in addition to training and education, nursing tele-oncology demands a service transformation.

Prehospital tele-electrocardiographic triage improves the management of acute coronary syndrome in rural populations: A systematic review and meta-analysis

INTRODUCTION

Acute coronary syndrome (ACS) patients residing in rural areas are predisposed to higher risk of poor outcomes due to substantial delays in disease management, emphasising the importance of emerging telecardiology technologies in delivering emergency services in such settings. This meta-analysis aimed to investigate the impacts of prehospital telecardiology strategies on the clinical outcomes of rural ACS patients.

METHODS

A literature search was performed of articles published up to April 2020 through six databases. Included studies were assessed for bias risk using the ROBINS-I tool, and a random-effects model was utilised to estimate effect sizes. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

RESULTS

Twelve studies with a total of 3989 patients were included in this review. Prehospital telecardiology in the form of tele-electrocardiography (tele-ECG) enabled prompt diagnosis and triage, resulting in a decreased door-to-balloon (DTB) time (mean difference = -25.53 minutes, 95% confidence interval (CI) -36.08 to -14.97 minutes; I² = 98%), as well as lower in-hospital mortality (odds ratio (OR) = 0.57, 95% CI 0.36-0.92) and long-term mortality (OR = 0.52, 95% CI 0.39-0.69) rates, both with negligible heterogeneity (I² = 0%). GRADE assessment yielded very low to moderate certainty of evidence.Conclusion Prehospital tele-ECG appeared to be an effective and worthwhile approach in the management of rural ACS patients, as shown by moderate quality evidence on lower long-term mortality. Given the uncertainties of the evidence quality on DTB time and in-hospital mortality, future studies with a higher quality of evidence are required to confirm our findings.

WhatsApp video call communication between oncological patients and their families during COVID-19 outbreak

BACKGROUND

On March 8^th, 2020 the Italian Government implemented extraordinary measures to limit COVID-19 viral transmission. The aim of the study was to verify if the use of WhatsApp facilitates communication, improves health information, perception of safe and security, reduce emotional stress during the COVID-19 emergency.

METHODS

In this study we identified two period, in the pre-COVID 1-month period (February 9^th - March 8^th, 2020) 34 patients underwent elective surgery for malignancies (21) and benign (13) diseases, respectively. We provided patients' families on a daily basis with clinical information face-to-face in the ward regarding their postoperative course. In the post-COVID 1-month period (March 9^th - April 5^th, 2020), 15 patients with malignancies were treated. In this period, patients and their families given a consent form to let the surgical team to communicate clinical data using WhatsApp. At the end of the study period we collected a satisfaction anonymous questionnaire of both patients and families.

RESULTS

Statistically significant differences were observed in the pre- vs. post- COVID period regarding the number of surgical procedures (P=0.004). In the post-COVID period, the satisfaction questionnaire showed a good reliability (Cronbach's α 0.912) and a high percentage of satisfaction of patients and their families for the adopted communication tool, reassurance, privacy protection and reduction of emotional stress.

CONCLUSIONS

WhatsApp is a safe and fast technology, it offers the opportunity to facilitate clinical communications, reduce stress, improve patient security, obtain clinical and psychological positive implications in patient's care preserving their privacy in the COVID-19 emergency period.

Impact of COVID-19 pandemic on chronic pain management: Looking for the best way to deliver care

Although pain treatment has been described as a fundamental human right, the Coronavirus disease 2019 (COVID-19) pandemic forced healthcare systems worldwide to redistribute healthcare resources toward intensive care units and other COVID-19 dedicated sites. As most chronic pain services were subsequently deemed non-urgent, all outpatient and elective interventional procedures have been reduced or interrupted during the COVID-19 pandemic in order to reduce the risk of viral spread. The shutdown of pain services jointly to the home lockdown imposed by governments has affected chronic pain management worldwide with additional impact on patients' psychological health. Therefore, the aim of this review is to analyze the impact of COVID-19 pandemic on chronic pain treatment and to address what types of strategies can be implemented or supported in order to overcome imposed limitations in delivery of chronic pain patient care.

Effects of a WhatsApp-Delivered Education Intervention to Enhance Breast Cancer Knowledge in Women: Mixed-Methods Study

Background

Breast cancer is the leading cause of cancer-related death in the female population. Health education interventions based on the use of mobile technologies enable the development of health self-care skills and have emerged as alternative strategies for the control of breast cancer. In previous studies, WhatsApp has stood out as a useful tool in health education strategies; however, it has not yet been applied for breast cancer education.

Objective

This study aimed to analyze the potential of WhatsApp as a health education tool used to improve women's knowledge on the risk reduction of breast cancer. It also aimed to understand how women feel sensitized within the WhatsApp group throughout the intervention and how they incorporate information posted to improve knowledge about early detection and risk reduction methods.

Methods

The study involved a pre-post health educational intervention with 35 women (aged 45-69 years) included in a WhatsApp group to share information (audio, video, text, and images) over 3 weeks on the early detection and risk reduction of breast cancer. Data were collected through questionnaires on topics related to risk reduction, as well as qualitative content analysis of group interactions. Effectiveness and feasibility were analyzed through conversations and the comparison of the scores obtained in the questionnaires before and after the intervention.

Results

A total of 293 messages were exchanged (moderator 120 and users 173). The average scores of the participants were 11.21 and 13.68 points before and after the educational intervention, respectively, with sufficient sample evidence that the difference was significant (P<.001). The intervention enabled women to improve their knowledge on all topics addressed, especially “myths and truths,” “incidence,” “clinical manifestations,” and “protective factors.” Some themes emerged from the interactions in the group, including group dynamics, general doubts, personal narratives, religious messages, daily news, and events.

Conclusions

The use of groups for women in WhatsApp for health education purposes seems to be a viable alternative in strategies on breast cancer control, especially as it provides a space for the exchange of experiences and disinhibition. However, the need for a moderator to answer the questions and the constant distractions by members of the group represent important limitations that should be considered when improving this strategy.

WhatsApp guidelines - what guidelines? A literature review

INTRODUCTION

Instant messaging (IM) is pervasive in modern society, including healthcare. WhatsApp, the most cited IM application in healthcare, is used to share sensitive patient information between clinicians. Its use raises legal, regulatory and ethical concerns. Are there guidelines for the clinical use of WhatsApp? Can generic guidelines be developed for the use of IM, for one-to-one and one-to-many healthcare professional communication using WhatsApp as an example?

AIM

We aimed to investigate if there are guidelines for using WhatsApp in clinical practice.

METHOD

Nine electronic databases were searched in January 2019 for articles on WhatsApp in clinical service. Inclusion criteria: paper was in English, reported on WhatsApp use or potential use in clinical practice, addressed legal, regulatory or ethical issues and presented some form of guideline or guidance for WhatsApp use.

RESULTS

In total, 590 unique articles were found and 167 titles and abstracts met the inclusion criteria. Twenty-one articles identified the need for general guidelines. Twelve articles provided some form of guidance for using WhatsApp. Issues addressed were confidentiality, identification and privacy (eight articles), security (seven), record keeping (four) and storage (three). Mandatory national guidelines for the use of IM for patient-sensitive information do not appear to exist, only advisories that counsel against its use.

CONCLUSION

The literature showed clinicians use IM because of its simplicity, timeliness and cost effectiveness. No suitable guidelines exist. Generic guidelines are required for the use of IM for healthcare delivery which can be adapted to local circumstance and messaging service used.

Patients With Cancer and COVID-19: A WhatsApp Messenger-Based Survey of Patients' Queries, Needs, Fears, and Actions Taken

PURPOSE

This descriptive investigation was undertaken at three oncology units to report queries, needs, and fears related to severe acute respiratory syndrome coronavirus 2 (COVID-19) of patients with cancer and to avoid uncontrolled treatment delays or withdrawal, behavioral mistakes, and panic.

PATIENTS AND METHODS

All queries spontaneously delivered through the WhatsApp instant messaging system commonly used by patients to communicate with oncology units were collected and grouped by homology in five categories. Responses to the queries were given according to recommendations by the Italian Association of Medical Oncology through WhatsApp and by subsequent phone calls. Patients were also classified according to the site of the primary tumor, stage of disease, and current treatments. Analysis of the association between these data and queries was carried out.

RESULTS

The social scenario in Italy is a nationwide lockdown except for hospitals, pharmacies, and food supplies. Overall, 446 different patients’ WhatsApp conversations were analyzed between March 1 and March 13 and comprised the following: requirement of visit delay by patients undergoing oral therapies or in follow-up, delays in chemotherapy or immunotherapy administration, queries about possible immunosuppression, and changes in lifestyle or daily activities. Delay requirements were statistically more frequent among patients with prostate or breast cancer compared with those with lung or pancreatic cancer. Actions taken by oncologists are also reported.

CONCLUSION

To our knowledge, the WhatsApp instant messaging system has been occasionally used in other medical settings with controversial results. In our experience, WhatsApp turned out to be adequate to give a rapid answer to most queries from patients with cancer in the COVID-19 pandemic scenario.

Reactions and countermeasures of medical oncologists towards the incoming COVID-19 pandemic: a WhatsApp messenger-based report from the Italian College of Chief Medical Oncologists

Background

This descriptive, unplanned investigation has been undertaken to report reactions, attitudes and countermeasures which have been put in place and implemented by medical oncology units facing the COVID-19 outbreak in Southern Italy.

Materials and methods

Data have been retrospectively obtained from the time-related analysis of conversations via a WhatsApp messenger-based group chat between the medical directors belonging to the Italian College of Medical Oncology Directors. Overall number, intensity and time trend of conversations related to reactions during the 4 weeks of observation related to the crucial events which occurred between 24 February and 28 March, 2020 2020 are included. A sentiment analysis of conversations was also carried out.

Results

We report 956 conversations among 19 medical oncology units related to reactions to the crucial events, such as epidemic spread, Government ordinances and guidelines during the 4 weeks of observation. Data show significant awareness of problems linked to the COVID-19 spread among oncologists and rapid diffusion of countermeasures. Actions taken were correlated time wise to crucial events. A correlation between conversations and the volume of activity of oncology units was found. By analysing the sentiment analysis of raw data, positive emotions were reduced in percentage over the weeks. A significant increase in negative emotions was observed as the outbreak impacted on the healthcare system.

Conclusion

In our experience, the WhatsApp instant-messaging system seems to be a useful tool to share news and reactions between medical oncologists to rapidly implement necessary health measures and answers to most cancer patients' needs and queries in the COVID-19 pandemic scenario.

Patient Uptake, Experience, and Satisfaction Using Web-Based and Face-to-Face Hearing Health Services: Process Evaluation Study

BACKGROUND

Globally, access to hearing health care is a growing concern with 900 million people estimated to suffer from disabling hearing loss by 2050. Hearing loss is one of the most common chronic health conditions, yet access to hearing health care is limited. Incorporating Web-based (voice calling, messaging, or emailing) service delivery into current treatment pathways could improve access and allow for better scalability of services. Current electronic health studies in audiology have focused on technical feasibility, sensitivity, and specificity of diagnostic hearing testing and not on patient satisfaction, experiences, and sustainable models along the entire patient journey.

OBJECTIVE

This study aimed to investigate a hybrid (Web-based and face-to-face) hearing health service in terms of uptake, experience, and satisfaction in adult patients with hearing loss.

METHODS

A nonprofit hearing research clinic using online and face-to-face services was implemented in Durban, South Africa, using online recruitment from the clinic's Facebook page and Google AdWords, which directed persons to an online Web-based hearing screening test. Web-based and face-to-face care pathways included assessment, treatment, and rehabilitation. To evaluate the service, an online survey comprising (1) a validated satisfaction measurement tool (Short Assessment of Patient Satisfaction), (2) a process evaluation of all the 5 steps completed, and (3) personal preferences of communication methods used vs methods preferred was conducted, which was sent to 46 patients who used clinic services.

RESULTS

Of the patients invited, 67% (31/46) completed the survey with mean age 66 years, (SD 16). Almost all patients, 92% (30/31) reported that the online screening test assisted them in seeking hearing health care. Approximately 60% (18/31) of the patients accessed the online hearing screening test from an Android device. Patients stayed in contact with the audiologist mostly through WhatsApp instant messaging (27/31, 87%), and most patients (25/31, 81%) preferred to use this method of communication. The patients continuing with hearing health care were significantly older and had significantly poorer speech recognition abilities compared with the patients who discontinued seeking hearing health care. A statistically significant positive result (P=.007) was found between age and the number of appointments per patient. Around 61% (19/31) of patients previously completed diagnostic testing at other practices, with 95% (18/19) rating the services at the hybrid clinic as better. The net promoter score was 87, indicating that patients were highly likely to recommend the hybrid clinic to friends and family.

CONCLUSIONS

This study applied Web-based and face-to-face components into a hybrid clinic and measured an overall positive experience with high patient satisfaction through a process evaluation. The findings support the potential of a hybrid clinic with synchronous and asynchronous modes of communication to be a scalable hearing health care model, addressing the needs of adults with hearing loss globally.

WhatsApp and other messaging apps in medicine: opportunities and risks

WhatsApp is a popular messaging application frequently used by physicians and healthcare organizations that can improve the continuity of care and facilitate effective health services provision, especially in acute settings. However WhatsApp does not comply with the rules of the European GDPR and the US HIPA Act. So it is inappropriate to share clinical information via WhatsApp.For this reason alternatives to Whatsapp are considered. In particular, the features that must have secure messaging apps to be in compliance with GDPR and HIPAA and to protect patient data will be discussed. The aim is to encourage healthcare organizations and physicians to abandon WhatsApp and to adopt one of the many secure messaging apps now available, some of them at no cost.

As mídias e as plataformas digitais no campo da Educação Permanente em Saúde: debates e propostas

RESUMO Este ensaio buscou debater a relevância das mídias e das plataformas digitais como ferramentas para o desenvolvimento e gestão de ações de Educação Permanente em Saúde. Defende-se que as mídias sociais e as plataformas digitais são uma chave para a gestão da educação e do trabalho em saúde se (e somente se) considerados e respeitados os usos tácitos daquelas já existentes e utilizadas pela comunidade de usuários, gestores e trabalhadores. Inicialmente, discute-se o já estabelecido reconhecimento das tecnologias de informação e comunicação como elemento importante para a educação na saúde, a despeito das dificuldades de sua utilização crítica nos cenários. Em seguida, a partir da perspectiva dos estudos digitais, introduzem-se algumas noções correntes sobre redes sociais, cyber e digital, fenômenos que vão além da adoção de certos dispositivos e tecnologias como mediadores, reconhecendo-os como elemento central de diversos grupos e atividades humanas na cultura contemporânea. Por fim, sugere-se a ampliação da proposta de adoção dessas tecnologias para uma de reconhecimento das plataformas e das mídias digitais e seu uso corrente como ferramentas estratégicas para a gestão da educação e do trabalho na saúde.