Use and Uptake of eHealth in General Practice: A Cross-Sectional Survey and Focus Group Study Among Health Care Users and General Practitioners

The Motivations of Citizens to Attend an eHealth Course in the Public Library: Qualitative Interview Study

Background

There is worldwide recognition of the potential increase of digital health inequity due to the increased digitalization of health care systems. Digital health skill development may prevent disparities in eHealth access and use. In the Dutch context, the public library has started to facilitate support in digital health skill development by offering public eHealth courses. Understanding the motivations of people to seek support may help to further develop this type of public service.

Objective

This is a qualitative study on the motivations of citizens participating in an eHealth course offered by public libraries. The study aimed to explore why citizens were motivated to seek nonformal support for eHealth use.

Methods

A total of 20 semistructured interviews with participants who participated in an eHealth course were conducted in 7 public libraries across the Netherlands. The interviews were conducted between April and June 2022. Purposive sampling took place in the public library during the eHealth course. The interviews covered participants' motivations, attitudes, and experiences with eHealth use and their motivations to seek help with eHealth use. Interviews were audio-recorded and transcribed. Themes were identified via a comprehensive thematic data analysis.

Results

The participants were 51 to 82 years of age (average 73.5, SD 6.6 y) and 14 (70%) participants were female. Three motivational themes were identified: (1) adapting to an increasingly digital society, (2) sense of urgency facilitated by prior experience in health care, and (3) a need for self-reliance and autonomy. Additionally, participants expressed a general desire for social contact and lifelong learning. A lack of adequate informal support by friends and family for digital skills and positive experiences with formal support from public libraries stimulated the participants to seek formal support for eHealth use.

Conclusions

We show that the participants had a feeling of urgency that sparked their motivation to seek nonformal support in the public library. Motivations to participate in the eHealth course stemmed from the need to adapt to the digital society, being a patient or a caregiver, or the need or wish to be independent from others. Participants of the study were mainly older female adults who had native language abilities, up-to-date digital devices, and time. It is likely that other populations experience similar feelings of urgency but have other support needs. Future research should explore the needs and attitudes of nonusers and other users of digital health toward seeking support in eHealth access and use.

Exploring effective patient feedback methods for eHealth in general practice

BACKGROUND

The use of patient feedback is essential for identifying areas for improvement and tailoring care to the needs of patients, particularly in the context of eHealth, which has increased in adoption due to the pandemic. However, challenges persist in collecting feedback from vulnerable groups, those with severe conditions, or language barriers. Furthermore, concerns exist about the credibility and validity of the feedback received. This study aims to explore various possible forms that general practitioners (GPs) could use to collect patient feedback on eHealth applications in their daily practice.

METHODS

A Participatory Research (PR) was conducted involving an advisory group, patients, GPs and medical receptionists. The advisory group consisting of GPs, a board member, patient representatives and digital care manager affiliated with the primary care organisation 'Regionale Organisatie Huisartsen Amsterdam' (ROHA). The group provided input throughout the research process from the setup, data collection and interpretation to the finalization phase. Semi-structured interviews were conducted with 13 patients, 8 GPs and 2 medical receptionists. Participants were recruited through purposive sampling. Interviews were coded using Thematic Analysis.

RESULTS

Four themes were considered important. First, timing of feedback. Gathering instant feedback immediately after digital interactions was considered important. Secondly, the feedback procedure, whereby feedback should be given through the same communication channel as was used for the doctor-patient contact was valued. Also, participants preferred short and specific surveys, in which they can remain anonymous. Thirdly, for the feedback content some key feedback topics included general experiences, quality of care and technical aspects. The last theme was advertisement. Overall, patients do not want to burden their GP and thus tend to only give feedback if initiated by their GP. GPs themselves pointed out to have limited time for collecting feedback from patients due to their workload.

CONCLUSION

GPs can optimize the feedback collection process by selecting targeted questions and integrating them into existing eHealth applications, thereby investing minimal time from GPs and patients. It is recommended to include automatic selected questions at the end of e-consultations. This integrated approach allows efficient feedback collection without burdening GPs.

Descriptive Norms and eHealth Use Among Older Adults: A Cross-Country Comparative Study

eHealth use enables older adults to access and manage healthcare resources, and benefits their health; however, older adults' uptake of eHealth remains low across societies. Social influences such as descriptive norms may be of critical importance in promoting the elderly's usage of eHealth. Based on the Integrative Model of Behavioral Prediction, this study investigates how descriptive norms relate to eHealth use among the elderly in China and the United States. Analysis of the combined sample (N = 1,070) showed that descriptive norms were positively related to eHealth use. Also, descriptive norms were indirectly associated with eHealth use via injunctive norms, attitudes and self-efficacy. Moderated mediation analysis indicated that these direct and indirect relationships differed across the two countries. This study highlights the important role of descriptive norms in promoting older adults' eHealth use behavior and addresses potential country differences in how the elderly respond to descriptive norms. Several important theoretical and practical implications are also discussed.

Current experience and future potential of facilitating access to digital NHS primary care services in England: the Di-Facto mixed-methods study

Background

Current National Health Service policy in England encourages enhanced digital access in primary care service provision. In this study, we investigate 'digital facilitation' - that range of processes, procedures and personnel which seeks to support National Health Service primary care patients in their uptake and use of online services.

Objectives

Identify, characterise and explore the potential benefits and challenges associated with different models of digital facilitation currently in use in general practice which are aimed at improving patient access to online services in general practice in England. Use the resulting intelligence to design a framework for future evaluations of the effectiveness and cost effectiveness of such interventions. Explore how patients with mental health conditions experience digital facilitation and gauge their need for this support.

Design

Observational mixed-methods study (literature review, surveys, ethnographic observation and interviews); formal synthesis of findings.

Setting

General practice in four regions of England.

Participants

Practice survey: 156 staff. Patient survey: 3051 patients. Mental health survey: 756 patients. General practitioner patient survey: 3 million responders. Ethnographic case-studies: 8 practices; interviews with 36 staff, 33 patients and 10 patients with a mental health condition. Stakeholder interviews: 19 participants.

Intervention

Digital facilitation as undertaken in general practice.

Main outcome measures

Patient and practice staff reported use of, and views of, digital facilitation.

Data sources

Surveys, qualitative research; national General Practitioner Patient Survey (2019-22).

Review methods

Scoping-review methodology applied to academic and grey literature published 2015-20.

Results

While we did find examples of digital facilitation in routine practice, these often involved using passive or reactive modes of support. The context of COVID, and the necessary acceleration (at that time) of the move to a digital-first model of primary care, shaped the way digital facilitation was delivered. There was lack of clarity over where the responsibility for facilitation efforts lay; it was viewed as the responsibility of 'others'. Patients living with mental health conditions had similar needs and experiences regarding digital facilitation to other patients.

Limitations

The context of the COVID pandemic placed limitations on the project. Fewer practices responded to the practice survey than anticipated; reconfiguration of general practices to support COVID measures was a key consideration during non-participant observation with social distancing and other measures still in place during fieldwork.

Conclusions

Digital facilitation, while not a widely recognised concept, is important in supporting the move to a National Health Service with enhanced digital opportunities and enhanced digital access. General practice staff are allocating resources to provide such efforts in general practices in England. The establishment of clear lines of responsibility, the development of digital tools and platforms that work for patients and practice staff, and investment in staff time and training are needed if digital facilitation is to support the intended digital revolution.

Future work

We did not find one single dominant or preferred model of digital facilitation which might reasonably be considered to form the basis of an intervention to be tested. Rather, there is a need to co-develop such an intervention with patients, general practice staff and relevant policy experts. We outline a framework for a future evaluation of such an intervention.

Study registration

This study is registered as ResearchRegistry6523 (www.researchregistry.com/browse-the-registry#home/?view_2_search=Di-Facto&view_2_page=1) and PROSPERO CRD42020189019 (www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019).

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128268) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 32. See the NIHR Funding and Awards website for further award information.

Exploring How Patients Are Supported to Use Online Services in Primary Care in England Through "Digital Facilitation": Survey Study

BACKGROUND

Health service policy in many jurisdictions is driving greater investment into digital primary care services. While some patients and practices may benefit, there are concerns that not all are able or wish to access primary care services online. "Digital facilitation" is the "range of processes, procedures, and personnel seeking to support patients in their uptake and use of online services" and may address such concerns.

OBJECTIVE

As part of a multimethod research program, we undertook surveys of practice staff and patients to gain insight into the support being offered by practices and explore patients' experiences of this support.

METHODS

General practices from 4 regions of England were sent a questionnaire exploring the modes of digital facilitation offered, the personnel involved in its delivery, and views on the motivations and drivers for providing support. Moreover, 12,822 patients registered with 62 general practices (predominantly those providing practice survey responses) were sent a questionnaire exploring their experiences of any support offered by their practice to use online services.

RESULTS

Almost one-third of practices (156/500, 31.2%) responded to the practice survey, with most reporting using passive modes of digital facilitation (eg, display, leaflets, and SMS text messages) and few using active modes (eg, offering tablets or computers or using practice champions). However, 90.9% (130/143) reported providing ad hoc support. Practices agreed that it was the responsibility of both the practice (105/144, 72.9%) and the wider National Health Service (118/143, 82.5%) to support patients in using online services and that providing such support benefited the practice (126/144, 87.5%) and their patients (132/144, 91.7%). Nearly a quarter of the patients (3051/12,822, 23.8%) responded to the patient survey, with few (522/3051, 17.11% or less) reporting awareness of any modes of digital facilitation apart from text messages and emails (1205/3051, 39.5%) and only 13.36% (392/2935) reporting receiving support to use online services. Adjusted logistic regression analyses showed that older patients had a lower likelihood of 4 outcomes: being aware of, or of using, digital facilitation efforts, or being told about or being helped to use online services (all P<.05), particularly with regard to being helped to use online services (adjusted odds ratio for patients aged 85 years versus those aged 55-64 years: 0.08, 95% CI 0.02-0.36). However, ethnic minority participants or those for whom their first language was not English had positive associations with these outcomes.

CONCLUSIONS

General practices recognize that patients would benefit from support to access online services. However, the support provided is often passive or ad hoc, and patients were seldom aware of digital facilitation efforts that their practice provided. There is potential to increase engagement with online primary care services by providing more support for all patients, particularly to provide targeted support for older patients.

Investigating Patient Use and Experience of Online Appointment Booking in Primary Care: Mixed Methods Study

BACKGROUND

Online appointment booking is a commonly used tool in several industries. There is limited evidence about the benefits and challenges of using online appointment booking in health care settings. Potential benefits include convenience and the ability to track appointments, although some groups of patients may find it harder to engage with online appointment booking. We sought to understand how patients in England used and experienced online appointment booking.

OBJECTIVE

This study aims to describe and compare the characteristics of patients in relation to their use of online appointment booking in general practice and investigate patients' views regarding online appointment booking arrangements.

METHODS

This was a mixed methods study set in English general practice comprising a retrospective analysis of the General Practice Patient Survey (GPPS) and semistructured interviews with patients. Data used in the retrospective analysis comprised responses to the 2018 and 2019 GPPS analyzed using mixed-effects logistic regression. Semistructured interviews with purposively sampled patients from 11 general practices in England explored experiences of and views on online appointment booking. Framework analysis was used to allow for comparison with the findings of the retrospective analysis.

RESULTS

The retrospective analysis included 1,327,693 GPPS responders (2018-2019 combined). We conducted 43 interviews with patients with a variety of experiences and awareness of online appointment booking; of these 43 patients, 6 (14%) were from ethnic minority groups. In the retrospective analysis, more patients were aware that online appointment booking was available (581,224/1,288,341, 45.11%) than had experience using it (203,184/1,301,694, 15.61%). There were deprivation gradients for awareness and use and a substantial decline in both awareness and use in patients aged >75 years. For interview participants, age and life stage were factors influencing experiences and perceptions, working patients valued convenience, and older patients preferred to use the telephone. Patients with long-term conditions were more aware of (odds ratio [OR] 1.43, 95% CI 1.41-1.44) and more likely to use (OR 1.65, 95% CI 1.63-1.67) online appointment booking. Interview participants with long-term conditions described online appointment booking as useful for routine nonurgent appointments. Patients in deprived areas were clustered in practices with low awareness and use of online appointment booking among GPPS respondents (OR for use 0.65, 95% CI 0.64-0.67). Other key findings included the influence of the availability of appointments online and differences in the registration process for accessing online booking.

CONCLUSIONS

Whether and how patients engage with online appointment booking is influenced by the practice with which they are registered, whether they live with long-term conditions, and their deprivation status. These factors should be considered in designing and implementing online appointment booking and have implications for patient engagement with the wider range of online services offered in general practice.

How to establish digital health ecosystems from the perspective of health service-organizations: A taxonomy developed based on expert interviews conducted as modified Delphi approach

Objective

Digital health ecosystems may be the next revolution in improving citizens' well-being, health delivery, data management, and health system processes, but solutions have not yet been broadly established. Reasons could be that health service-organizations have misaligned interests or lack capabilities. This study investigates reasons from a multi-health-service-organization perspective, differentiating between payers, insurers, healthcare providers, and innovators, detailing the expected value-adds, preferred participation roles, and required capabilities including a rating assessment.

Methods

Findings are based on a taxonomy development methodology, which combines a literature review with semi-structured qualitative expert interviews, conducted using a modified Delphi approach. Interviews were thematically analysed.

Results

In total, 21 experts across the four health service-organization groups were interviewed. The capability taxonomy includes a total of 16 capabilities, categorized in three themes: 'Health market', 'organizational', and 'technology and informatic'. Providers expect a value-add from strengthening their health process economics through efficiency gains but reveal the largest capability gaps, especially in 'interoperability' and 'platform'. Innovators' 'technology and informatic' capabilities complement well with those of payers for the 'health market'.

Conclusions

We present a health service-organization-specific three-stage approach for establishing digital health ecosystems. Payers and insurers should address their 'technology and informatic' capability gaps, using technical enablers or forming new entities to reduce dependencies from legacy information technology systems. Innovators should clarify their monetization models and create positive awareness for their services, possibly entering the market directly. Providers must address interoperability issues and may require incentives to encourage their participation. Findings suggest governmental policymakers to prioritize three health policy initiatives.

Understanding citizens' attitudes within user-centered digital health ecosystems: A sequential mixed method methodology including a web-survey

Objective

Transitioning from digital health applications to digital health ecosystems, leveraging the advances in technologies and informatics, could be the next revolution in digital health. This includes offering centralized access to various health services and improving citizens' well-being, delivery, clinical processes, and data management. However, a limited understanding of citizens may impede adaptation. Therefore, this study investigates citizens' attitudes within digital health ecosystems, differentiated by their characteristics, to support health service-providers and governmental policymakers in establishing user-centered solutions.

Methods

This study follows a three-step sequential mixed method methodology: (1) a literature review. (2) Qualitative thematic analyses based on semi-structured qualitative interviews. (3) Quantitative analyses based on a web-survey (descriptive statistics, one-way analysis of variances, Tukey-honestly, and Cohen's d tests).

Results

N = 15 citizens were interviewed and n = 1289 responded to the web-survey, to our knowledge the largest survey on this topic. Citizens desire a more convenient management of health services and data (M = 5.2, SD = 1.59). Services with peer-to-peer interactions (M = 3.7, SD = 1.81) and lower involvement of health professionals (M = 3.8, SD = 1.75) are less demanded. Data protection is critical (M = 6.2, SD = 1.23). Public payers are mandated as orchestrators (M = 4.3, SD = 1.99), while private companies receive lower acceptance (M = 3.0, SD = 1.42).

Conclusions

Health service-providers could follow a three-staged approach to establish digital health ecosystems: (1) Increasing the convenience for citizens by enabling online management of health services and data. (2) Extending the citizen-healthcare provider partnership through online interactions. (3) Fostering preventative behaviors and quicker recovery by personalizing health services and interactions. Governmental policymakers should integrate an electronic health record.

Two years of approved digital health applications in Germany - Perspectives and experiences of general practitioners with an affinity for their use

BACKGROUND

Since 2020, physicians in Germany can prescribe approved digital health applications (DHAs) with the costs covered by the health system. There has so far been a lack of studies on attitudes and experiences amongst GPs in using DHAs.

OBJECTIVES

The aim was to elucidate the experiences and observations of GPs that have used DHAs in health care and to examine the conditions necessary for DHAs to gain a foothold in primary care according to the GPs.

METHODS

In 2022, 96 qualitative semi-standardised interviews were conducted with German GPs with experience in prescribing DHAs. The GPs were all organised in digitalisation-oriented physicians' associations. Fifty-four interviews were carried out in person and 42 by phone. The data were analysed according to qualitative content analysis.

RESULTS

Unlike health apps, the interviewees saw DHAs as reliable tools for enhancing the relationship between GPs and their patients. They saw the DHAs they had been prescribing as useful and reported various benefits, including improvements in compliance, mobility, information for patients and weight reduction. The physicians also saw room for further improvement (usability, gamification, training, information sources). Interviewees saw the inclusion of DHAs in evidence-based guidelines as a major step forward.

CONCLUSION

The interviewees rated DHAs favourably regarding healthcare potential and as safer and more reliable than conventional health apps. Many saw benefits to healthcare from using such applications. From the interviewees' point of view, DHAs can be integrated more effectively into patient care.

Development of an electronic medical records project for Al-Razi hospital in Palestine

Background

Electronic medical records (EMR) are considered an important aspect to improve medical services provided to patients. The purpose of this study was to assess the development of an Electronic Medical Records Project for Al-Razi hospital in Palestine.

Design and Methods

The study was mixed method, qualitative and quantitative. The use of a questionnaire for the staff in the Al-Razi hospital and seven administrators' participants were meat as focus group.

Results

Approximately 136 participants in the study. The study findings reported that employees perceived the use of EMRs to have several benefits. The most common benefits include promoting patient safety culture and drug error reduction. In addition, the study findings reported that employees perceived the use of EMRs to have several challenges. The most common challenges include lack of knowledge and skill, insufficient time to use EMR, and limited of computers.

Conclusions

Health informatics brings various benefits to the healthcare system. Some participants believed that the EMR system would improve patient care and it will improve patient satisfaction.

Assessing knowledge, attitude, and readiness to use e-health among doctors in a tertiary health care unit in Bhubaneswar city, Odisha - A cross-sectional survey

BACKGROUND

The term ""e-health"" refers to all technological applications in the delivery of a more affordable, high-speed, and widely accessible mode of health care. It is a definite solution to managing the public's health and well-being during the coronavirus disease (COVID-19) pandemic, and doctors from all fields of expertise are required to be at par with it in terms of knowledge, attitude, and readiness to use it to their advantage under the current circumstances.

MATERIALS AND METHOD

A cross-sectional survey was conducted among the faculty, postgraduates, and interns of the medical and dental schools of a university, which used an expert-validated self-administered questionnaire assessing knowledge, attitude, and readiness to use e-health.

RESULTS

Among the 400 participants, it was observed that the categories of age (P < 0.0001), gender (P = 0.018), designation (P = 0.031), and years of service (P < 0.0001) have significant differences across the groups. It was seen that the mean e-health knowledge (3.55 ± 0.52) and mean attitude (2.42 ± 0.59) to use e-health were more in dentists while participants from the medical field showed higher mean readiness (1.97 ± 0.58) to use e-health in daily practice. It was observed that male professionals had more mean knowledge (3.54 ± 0.60) than female professionals (3.43 ± 0.52) while female participants had more mean e-health readiness (1.96 ± 0.57).

CONCLUSION

In a broad sense, the majority of participants responded positively to using e-health in their everyday practice. While medical doctors have a stronger outlook and preparedness, dentists showed more literacy and a supportive attitude to adopting e-health and telemedicine. Thus, it is necessary to step up comprehensive e-health workshops and training sessions for health care experts.

Patient Portals as Facilitators of Engagement in Patients With Diabetes and Chronic Heart Disease: Scoping Review of Usage and Usability

BACKGROUND

Patient portals have the potential to improve care for chronically ill patients by engaging them in their treatment. These platforms can work, for example, as a standalone self-management intervention or a tethered link to treatment providers in routine care. Many different types of portals are available for different patient groups, providing various features.

OBJECTIVE

This scoping review aims to summarize the current literature on patient portals for patients with diabetes mellitus and chronic heart disease regarding usage behavior and usability.

METHODS

We conducted this review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for scoping reviews. We performed database searches using PubMed, PsycInfo, and CINAHL, as well as additional searches in reviews and reference lists. We restricted our search to 2010. Qualitative and quantitative studies, and studies using both approaches that analyzed usage behavior or usability of patient portals were eligible. We mapped portal features according to broad thematic categories and summarized the results of the included studies separately according to outcome and research design.

RESULTS

After screening, we finally included 85 studies. Most studies were about patients with diabetes, included patients younger than 65 years, and were conducted in the United States. Portal features were categorized into educational/general information, reminder, monitoring, interactivity, personal health information, electronic/personal health record, and communication. Portals mostly provided educational, monitoring, and communication-related features. Studies reported on usage behavior including associated variables, usability dimensions, and suggestions for improvement. Various ways of reporting usage frequency were identified. A noticeable decline in portal usage over time was reported frequently. Age was most frequently studied in association with portal use, followed by gender, education, and eHealth literacy. Younger age and higher education were often associated with higher portal use. In two-thirds of studies reporting on portal usability, the portals were rated as user friendly and comprehensible, although measurement and reporting were heterogeneous. Portals were considered helpful for self-management through positive influences on motivation, health awareness, and behavioral changes. Helpful features for self-management were educational/general information and monitoring. Barriers to portal use were general (eg, aspects of design or general usability), related to specific situations during portal use (eg, login procedure), or not portal specific (eg, user skills and preferences). Frequent themes were aspects of design, usability, and technology. Suggestions for improvement were mainly related to technical issues and need for support.

CONCLUSIONS

The current state of research emphasizes the importance of involving patients in the development and evaluation of patient portals. The consideration of various research designs in a scoping review is helpful for a deeper understanding of usage behavior and usability. Future research should focus on the role of disease burden, and usage behavior and usability among older patients.

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

BACKGROUND

Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products.

OBJECTIVE

In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals.

METHODS

A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis.

RESULTS

We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure.

CONCLUSIONS

The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.

Perceptions of Dutch general practitioners towards eHealth for patients with type-2 diabetes: a qualitative study

BACKGROUND

eHealth provides a viable option to facilitate type-2 diabetes mellitus self-management and adherence. To this end, a web-based computer-tailored eHealth programme, My Diabetes Profile (MDP), was developed and implemented in Dutch diabetes care. To fully utilize the potential of eHealth, the reach of effective programmes like MDP should be maximized. Therefore, it is vital to explore perceptions of general practitioners (GPs) regarding eHealth and factors that influence GPs' decision to adopt eHealth programmes.

OBJECTIVE

To shed light on Dutch GPs' perceptions towards eHealth in general and specifically, the adoption of MDP.

METHODS

Interviews were conducted among a heterogeneous sample of 16 Dutch GPs. The interview guide, based on the Diffusion of Innovations Theory, addressed perceptions about eHealth in general, characteristics of MDP, organizational characteristics, and external influences on adoption. Audio-recordings were transcribed and analysed using deductive coding in NVivo.

RESULTS

Nearly all GPs used some form of eHealth and listed many benefits and few drawbacks about eHealth. Sometimes, GPs were unaware of what eHealth encompassed; programmes resembling MDP were not mentioned. COVID-19 immensely increased eHealth uptake, especially for remote communication. Regarding MDP, the organizational and external influences on adoption were limited, while characteristics of the innovation were deemed more important. GPs expressed benefits of MDP (e.g. uncomplex, user-friendly, tailored) other than attributed to eHealth in general and fewer drawbacks.

CONCLUSION

While GPs' opinions about eHealth and MDP were positive, the concept of MDP was relatively unfamiliar. Future research should focus on targeting GPs' awareness of eHealth possibilities.

The Usability of Homelab, a Digital Self-service at a Dutch General Practice, for Diagnostic Tests: Pilot Study With a Questionnaire

BACKGROUND

eHealth potentially can make health care more accessible and efficient and help reduce the workload in primary health care. Homelab is an eHealth tool implemented in a general practice environment, and it offers relatively simple laboratory diagnostic tests without the referral of the general practitioner. After logging in this eHealth tool, patients select and order a diagnostic test based on their symptoms. The test results are presented online to the general practitioner and the patient.

OBJECTIVE

This study aims to evaluate the use, usability, and user characteristics of Homelab. Further, it aims to evaluate whether Homelab replaces an appointment with the general practitioner.

METHODS

Homelab has been implemented since May 2021 as a pilot in a Dutch general practice. The number of requests and the ordered diagnostic packages are monitored. After using Homelab, patients are invited to complete a short questionnaire. The questionnaire contains demographic questions and assesses usability using the System Usability Scale (10 items). In addition, questions about requesting an appointment with the general practitioner without Homelab are included. All data were anonymous.

RESULTS

The questionnaire was filled by 74 individual patients. The mean age of the patients was 40.33 (SD 12.11) years, and half of them were females (39/74, 53%). The majority of the patients were highly educated (56/74, 76%) and employed (53/74, 72%). Approximately 81% (60/74) of the patients reported that they would use Homelab again in the future and 66% (49/74) reported that they would have gone to the general practitioner if they had not used Homelab. The usability of Homelab was perceived higher by the younger age group (mean 73.96, SD 14.74) than by the older age group (mean 61.59, SD 14.37). In total, 106 test packages were ordered over 1 year, and the most requested diagnostic package was "Am I still healthy? I want to do my annual health checkup." Homelab was used the most during the months of the COVID-19 lockdown.

CONCLUSIONS

The use of Homelab, a digital self-service for ordering diagnostic tests, was monitored in this study, and its usability was perceived as above average. Our findings showed that patients are willing to use Homelab in the future and they would use it most of the time as a replacement for regular consultations. Homelab offers opportunities for more accessible and efficient health care for both the patient and the general practitioner.

The importance of trusting conditions for organizations' readiness to implement mHealth to support healthy lifestyle behaviors: An interview study within Swedish child and school healthcare

Objective

To explore perceptions among nurses, managers, and policymakers regarding organizational readiness to implement mHealth for the promotion of healthy lifestyle behaviors in child and school healthcare.

Methods

Individual semi-structured interviews with nurses (n = 10), managers (n = 10), and policymakers (n = 8) within child and school healthcare in Sweden. Inductive content analysis was used for data analysis.

Results

Data showed that various trust-building aspects in health care organizations may contribute to readiness to implement mHealth. Several aspects were perceived to contribute trusting conditions: (a) how health-related data could be stored and managed; (b) how mHealth aligned with current organizational ways of working; (c) how implementation of mHealth was governed; and (d) camaraderie within a healthcare team to facilitate use of mHealth in practice. Poor capability to manage health-related data, as well as lack of governance of mHealth implementation were described as dealbreakers for readiness to implement mHealth in healthcare organizations.

Conclusions

Healthcare professionals and policymakers perceived that trusting conditions for mHealth implementation within organizations were central for readiness. Specifically, governance of mHealth implementation and the ability to manage health-data produced by mHealth were perceived critical for readiness.

Exploring Adult Patients’ Perceptions and Experiences of Telemedicine Consultations in Primary Care: A Qualitative Systematic Review

The COVID-19 pandemic transformed a gradual uptake of telemedicine, into a sudden worldwide implementation of telemedicine consultations. Primary care is a particular area affected and one where telemedicine consultations are expected to be the future. However, for effective long-term implementation it is vital that patient perceptions and experiences are understood. The aim of this qualitative systematic review was to explore the perceptions and experiences of adults who have used telemedicine consultations in primary care. Studies were identified through a search of four electronic databases (MEDLINE, EMBASE, CINAHL, and CENTRAL) alongside reference list and citation searches. Quality assessment was conducted using the CASP checklist and data was synthesized using a simplified approach to thematic analysis. From 2492 identified records, ten studies met the eligibility criteria all of which were judged as either good or moderate quality. Three themes were identified which were potential benefits, potential barriers, and beneficial prerequisites for telemedicine consultations in primary care. Within these themes, sixteen sub-themes were identified with examples including accessibility and convenience for potential benefits, lack of face-to-face interaction and impersonal consultations for potential barriers, and continuity of care for beneficial prerequisites. Analysing these subthemes, four main recommendations for practice can be made which are to utilise continuity of care, offer both video and telephone consultations, provide adequate support, and that healthcare professionals should demonstrate an explicit understanding of the patient’s health issues. Further research is needed to explore and expand on this topic area and future research should be viewed as a continuous process.

Telemedicine in medical education: An example of a digital preparatory course for the clinical traineeship - a pre-post comparison

Introduction: Telemedicine is a significant component of healthcare in most disciplines, giving great importance to the education of young physicians in this field. However, the topic of telemedicine has not yet been implemented in medical schools' curricula. This paper makes an important contribution to closing this gap by designing, implementing and evaluating a course with telemedical components. Using the example of a clinical traineeship preparation course, we investigated the extent to which integrated telemedical modules can contribute to the subjective confidence of students with regard to knowledge and confidence in performing practical telemedical skills, such as doctor-patient communication, taking medical histories, and applying handover techniques. Project description: The course evaluation was descriptive. Subjective confidence in clinical telemedicine skills was assessed before and after completion of the course using an online questionnaire and calculated in a pre-post design using Wilcoxon's signed-rank test. Results: The course was rated "very good" (31%) and "good" (54.2%) by the vast majority of students. The results of the Wilcoxon test show significant increases in students' feelings of confidence in performing practical telemedicine skills for all items. Discussion: This study shows that telemedicine modules integrated in a digital preparatory course contribute positively to students' subjective confidence in terms of knowledge and confidence in performing practical telemedicine skills. Specifically, this paper illustrates that professional digital doctor-patient communication, digital documentation of a medical history, and handoff techniques can be learned through telemedicine course content. Conclusion: Telemedicine modules increase students' subjective confidence in performing practical telemedicine skills. Practical telemedicine course content can thus reduce uncertainty in the use of telemedicine and prepare future physicians for its use.

Teleconsultation adoption since COVID-19: comparison of barriers and facilitators in primary care settings in Hong Kong and the Netherlands

The COVID-19 pandemic has boosted the adoption of digital health technologies such as teleconsultation. This research aimed to assess and compare barriers and facilitators for teleconsultation uptake for primary care practitioners in Hong Kong and the Netherlands and evaluate the role of their different healthcare funding models in this adoption process within the context of the COVID-19 pandemic.

A qualitative research following a social constructivist paradigm was performed. The study employed a conceptual framework from Lau and colleagues that identifies four levels of factors influencing change in primary care: (1) external contextual factors; (2) organization-related factors; (3) professional factors; and (4) characteristics of the intervention. The four levels were studied through semi-structured, open-ended interviews with primary care physicians. External factors were additionally assessed by means of a literature review.

Hong Kong and the Netherlands showed different penetration rates of teleconsultation. Most stakeholders in both settings shared similar barriers and facilitators in the organizational, professional, and intervention levels. However, external contextual factors (i.e., current teleconsultation legislation, available incentives, and level of public awareness) played an important and differing role in teleconsultation uptake and had a direct effect on the organization, the professionals involved, and the type of technology used. Political and organizational actions are required to develop a comprehensive legal framework for the sustainable development of teleconsultation in both settings.

Personas for Better Targeted eHealth Technologies: User-Centered Design Approach

Background

The full potential of eHealth technologies to support self-management and disease management for patients with chronic diseases is not being reached. A possible explanation for these lacking results is that during the development process, insufficient attention is paid to the needs, wishes, and context of the prospective end users. To overcome such issues, the user-centered design practice of creating personas is widely accepted to ensure the fit between a technology and the target group or end users throughout all phases of development.

Objective

In this study, we integrate several approaches to persona development into the Persona Approach Twente to attain a more holistic and structured approach that aligns with the iterative process of eHealth development.

Methods

In 3 steps, a secondary analysis was carried out on different parts of the data set using the Partitioning Around Medoids clustering method. First, we used health-related electronic patient record data only. Second, we added person-related data that were gathered through interviews and questionnaires. Third, we added log data.

Results

In the first step, 2 clusters were found, with average silhouette widths of 0.12 and 0.27. In the second step, again 2 clusters were found, with average silhouette widths of 0.08 and 0.12. In the third step, 3 clusters were identified, with average silhouette widths of 0.09, 0.12, and 0.04.

Conclusions

The Persona Approach Twente is applicable for mixed types of data and allows alignment of this user-centered design method to the iterative approach of eHealth development. A variety of characteristics can be used that stretches beyond (standardized) medical and demographic measurements. Challenges lie in data quality and fitness for (quantitative) clustering.

Willingness of French General Practitioners to Prescribe mHealth Apps and Devices: Quantitative Study

Background

The field of mobile health (mHealth) is constantly expanding. Integrating mHealth apps and devices in clinical practice is a major and complex challenge. General practitioners (GPs) are an essential link in a patient’s care pathway. As they are patients’ preferred health care intermediaries, GPs play an important role in supporting patients’ transition to mHealth.

Objective

This study aims to identify the factors associated with the willingness of French GPs to prescribe mHealth apps and devices to their patients.

Methods

This study was part of the ApiAppS project whose overall objective was to help remove barriers GPs face when prescribing mHealth apps and devices by developing a custom-built platform to aid them. The study included GPs recruited from the general practice department of several medical faculties in France (Lyon, Nice, and Rouen) and mailing lists of academic GPs, health care professional associations, and social and professional networks. Participants were asked to complete a web-based questionnaire that collected data on various sociodemographic variables, indicators of their involvement in continued education programs and the amount of time they dedicated to promoting healthy behaviors during patient consultations, and indicators characterizing their patient population. Data on their perceptions of mHealth apps and devices were also collected. Finally, the questionnaire included items to measure GPs’ acceptability of prescribing mHealth apps and devices for several health-related dimensions.

Results

Of the 174 GPs, 129 (74.1%) declared their willingness to prescribe mHealth apps and devices to their patients. In multivariate analysis, involvement in continued education programs (odds ratio [OR] 6.17, 95% CI 1.52-28.72), a better patient base command of the French language (OR 1.45, 95% CI 1.13-1.88), GP-perceived benefits of mHealth apps and devices for both patients and their medical practice and GP-perceived drivers for mHealth apps and device implementation in their medical practice (OR 1.04, 95% CI 1.01-1.07), and validation of mHealth apps and devices through randomized clinical trials (OR 1.02, 95% CI 1.00-1.04) were all associated with GPs’ willingness to prescribe mHealth apps and devices. In contrast, older GPs (OR 0.95, 95% CI 0.91-0.98), female GPs (OR 0.26, 95% CI 0.09-0.69), and those who perceived risks for the patient or their medical practice (OR 0.96, 95% CI 0.94-0.99) were less inclined to prescribe mHealth apps and devices.

Conclusions

mHealth apps and devices were generally seen by GPs as useful in general medicine and were, for the most part, favorable to prescribing them. Their full integration in general medicine will be conditioned by the need for conclusive certification, transparency (reliable and precise data concerning mHealth app and device methods of construction and clinical validation), software aids to assist GPs prescribe them, and dedicated training programs.

Actionable absolute risk prediction of atherosclerotic cardiovascular disease based on the UK Biobank

Cardiovascular diseases (CVDs) are the primary cause of all death globally. Timely and accurate identification of people at risk of developing an atherosclerotic CVD and its sequelae is a central pillar of preventive cardiology. One widely used approach is risk prediction models; however, currently available models consider only a limited set of risk factors and outcomes, yield no actionable advice to individuals based on their holistic medical state and lifestyle, are often not interpretable, were built with small cohort sizes or are based on lifestyle data from the 1960s, e.g. the Framingham model. The risk of developing atherosclerotic CVDs is heavily lifestyle dependent, potentially making many occurrences preventable. Providing actionable and accurate risk prediction tools to the public could assist in atherosclerotic CVD prevention. Accordingly, we developed a benchmarking pipeline to find the best set of data preprocessing and algorithms to predict absolute 10-year atherosclerotic CVD risk. Based on the data of 464,547 UK Biobank participants without atherosclerotic CVD at baseline, we used a comprehensive set of 203 consolidated risk factors associated with atherosclerosis and its sequelae (e.g. heart failure). Our two best performing absolute atherosclerotic risk prediction models provided higher performance, (AUROC: 0.7573, 95% CI: 0.755-0.7595) and (AUROC: 0.7544, 95% CI: 0.7522-0.7567), than Framingham (AUROC: 0.680, 95% CI: 0.6775-0.6824) and QRisk3 (AUROC: 0.725, 95% CI: 0.7226-0.7273). Using a subset of 25 risk factors identified with feature selection, our reduced model achieves similar performance (AUROC 0.7415, 95% CI: 0.7392-0.7438) while being less complex. Further, it is interpretable, actionable and highly generalizable. The model could be incorporated into clinical practice and might allow continuous personalized predictions with automated intervention suggestions.

Priorities for family physician and general practitioner recruitment and retention in Singapore: a PRIORITIZE study

Background

A shortage of primary care physicians has been reported in many countries. Primary care systems are diverse and the challenges leading to a decline in workforce are at times context-specific and require tailored solutions. Inviting frontline clinicians to share their insights can help identify optimal strategies for a particular setting. To determine priorities for family physicians’ and general practitioners’ recruitment and retention in Singapore, we invited primary care physicians to rank pertinent strategies using PRIORITIZE, a transparent, systematic priority-setting approach.

Methods

The study advisory board, consisting of representatives of Singapore’s key primary care stakeholders, determined the criteria for prioritising of general practitioners (GPs) and family physicians (FPs) recruitment and retention strategies in Singapore. A comprehensive list of GPs and FPs recruitment and retention strategies was extracted from a recent systematic review of the relevant literature. A questionnaire listing the strategies and the scoring criteria was administered online to doctors practicing in public and private sector in Singapore. Respondents’ scores were combined to create a ranked list of locally most relevant strategies for improving GPs and FPs recruitment and retention.

Results

We recruited a diverse sample of 50 GPs and FPs practicing in a variety of primary care settings, many with a range of additional professional responsibilities. Around 60 and 66% of respondents thought that there was a problem with recruitment and retention of GPs and FPs in Singapore, respectively. Strategies focusing on promoting primary care by emphasizing the advantages and enhancing the status of the profession as well as training-related strategies, such as sub-specialisation and high-quality rotations were considered priorities for improving recruitment. For retention of GPs and FPs, improving working conditions by increasing GPs’ and FPs’ salary and recognition, as well as varying or reducing time commitment, were seen as the most important strategies. The ranking between physicians working in public and private sector was mostly similar, with nine out of the top ten recruitment and retention strategies being the same.

Conclusion

Primary care physicians’ ranking of recruitment and retention strategies for GPs and FPs in Singapore provide important insight into the challenges and the solutions as seen by the members of the profession themselves. This information can guide future policy and decision making in this area.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01570-1.

Facilitators of and Barriers to Lifestyle Support and eHealth Solutions: Interview Study Among Health Care Professionals Working in Cardiac Care

BACKGROUND

Cardiovascular diseases (CVDs) pose a significant health threat and reduce both people's life expectancy and quality of life. Healthy living is a key component in the effective prevention and treatment of CVD. However, health care professionals (HCPs) experience difficulties in supporting lifestyle changes among their patients. eHealth can provide a solution to these barriers.

OBJECTIVE

This study aims to provide insights into the factors HCPs find important in the support of patients with CVD in the uptake of and adherence to a healthy lifestyle and the perceived facilitators of and barriers to using eHealth to provide lifestyle support to patients with CVD.

METHODS

In-depth interviews were conducted with 16 Dutch HCPs specializing in lifestyle support in cardiac care.

RESULTS

We identified 13 themes, of which the first 12 concerned lifestyle support in general and were related to intervention, patient, or health care. Throughout these themes, the use of eHealth reoccurred as a potential facilitator of or solution to barriers to lifestyle support. Our final theme specifically concerned barriers to the adoption and usability of eHealth.

CONCLUSIONS

HCPs do recognize the potential advantages of eHealth while experiencing barriers to using digital tools. Incorporating their needs and values in the development of lifestyle support programs, especially eHealth, could increase their use and lead to a more widespread adoption of eHealth into health care.

SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation

Background

The implementation of eHealth applications in primary care remains challenging. Enhancing knowledge and awareness of implementation determinants is critical to build evidence-based implementation strategies and optimise uptake and sustainability.

Objectives

We consider how evidence-based implementation strategies can be built to support eHealth implementation.

Discussion

What implementation strategies to consider depends on (potential) barriers and facilitators to eHealth implementation in a given situation. Therefore, we first discuss key barriers and facilitators following the five domains of the Consolidated Framework for Implementation Research (CFIR). Cost is identified as a critical barrier to eHealth implementation. Privacy, security problems, and a lack of recognised standards for eHealth applications also hinder implementation. Engagement of key stakeholders in the implementation process, planning the implementation of the intervention, and the availability of training and support are important facilitators. To support care professionals and researchers, we provide a stepwise approach to develop and apply evidence-based implementation strategies for eHealth in primary care. It includes the following steps: (1) specify the eHealth application, (2) define problem, (3) specify desired implementation behaviour, and (4) choose and (5) evaluate the implementation strategy. To improve the fit of the implementation strategy with the setting, the stepwise approach considers the phase of the implementation process and the specific context.

Conclusion

Applying an approach, as provided here, may help to improve the implementation of eHealth applications in primary care.

SERIES: eHealth in primary care. Part 5: A critical appraisal of five widely used eHealth applications for primary care - opportunities and challenges

Background

Given the pressure on modern healthcare systems, eHealth can offer valuable opportunities. However, understanding the potential and challenges of eHealth in daily practice can be challenging for many general practitioners (GPs) and their staff.

Objectives

To critically appraise five widely used eHealth applications, in relation to safe, evidence-based and high-quality eHealth. Using these applications as examples, we aim to increase understanding of eHealth among GPs and highlight the opportunities and challenges presented by eHealth.

Discussion

eHealth applications can support patients while increasing efficiency for GPs. A three-way division (inform, monitor, track; interaction; data utilisation) characterises many eHealth applications, with an increasing degree of complexity depending on the domain. All applications provide information and some have extra functionalities that promote interaction, while data analysis and artificial intelligence may be applied to support or (fully) automate care processes. Applications in the inform domain are relatively easy to use and implement but their impact on clinical outcomes may be limited. More demanding applications, in terms of privacy and ethical aspects, are found in the data utilisation domain and may potentially have a more significant impact on care processes and patient outcomes. When selecting and implementing eHealth applications, we recommend that GPs remain critical regarding preconditions on safe, evidence-based and high-quality eHealth, particularly in the case of more complex applications in the data utilisation domain.

Online and telephone access to general practice: a cross-sectional patient survey

Background

Improving access to primary health care in the UK has focused on the use of telephone and online access, but little is known about how awareness of and use varies between different patient groups.

Aim

To determine how patients are interacting with telephone and online channels for accessing general practice services and information, and to analyse how this varies according to patient characteristics and health status.

Design & setting

A cross-sectional self-administered survey of adult patients in general practices across the West Midlands, UK.

Method

Descriptive statistics were used to show participants’ awareness of and interaction with online information sources and remote access. Multivariable logistic regression was used to model the relationships between demographic and health characteristics, and awareness and use of online services and alternatives to face-to-face consultations (for example, telephone).

Results

A total of 2789 patients (19.0% response rate) from 43 general practices participated. The study found 60.8% (n = 1651/2715) of participants were aware of online services and 30.3% (n = 811/2674) reported having used one. Daily internet usage and frequently visiting the GP showed the strongest associations with knowledge and use of online services.

Conclusion

The study shows that there is the potential for inequitable awareness and use of telephone and online services in general practice populations. Given that their use has greatly increased owing to the COVID-19 pandemic, future service design will need to ensure equity is taken into account.

The information needs of internet users and their requirements for online health information-A scoping review of qualitative and quantitative studies

OBJECTIVE

This scoping review has been conducted to summarise the information needs of internet users and their requirements for online health information.

METHODS

We searched MEDLINE, Web of Science and Scopus up to July 2019. Qualitative, quantitative and mixed-method studies were included and a thematic synthesis with category formation and exact description of the items was carried out.

RESULTS

118 studies were included. To address all users' needs mentioned in the included studies, we grouped them into nine main categories: authority, comprehension, currency, evidence-based information, exchange with others, independence, purpose, services, user experience. The evaluation showed that website users wanted qualifications of authors to be cited. Users preferred health information that offered interactive elements and resources for relatives, whilst also providing an opportunity for online contact with others. The ease with which information was accessed and the intelligibility of texts were regarded as being very important to users.

CONCLUSION

Given the rapid evolvement and changes of online health information, it is crucial to provide up to date insights and a comprehensive overview of the range of criteria.

PRACTICE IMPLICATIONS

With the results obtained through this scoping review, the creators of online health information could be assisted in providing user-specific resources.

Exploring the Role of the Internet, Care Quality and Communication in Shaping Mental Health: An Analysis of the Health Information National Trends Survey

Determinants of user mental health are diverse, interrelated, and often multifaceted. This study explores how internet use, perceived care quality, patient education, and patient centered communication influence mental health, using structural equation modeling. Findings suggest that increased internet use even for health purposes negatively impacts mental health (= -0:087; = -0:065; P < 0:001). On the other hand, education level, patient centered-communication (PC-Com) and perception of care quality impact mental health positively (= 0:082; = 0:146; = 0:077; P < 0:001; respectively). Moreover, we also explored the changes across various demographics. The influence of patient education on PC-Com was only significant for Hispanic respondents (= -0:160; P < 0:001). Internet use for health purposes influenced P C-Com negatively for White American respondents (= -0:047; P = 0:015). The study reinstated that the internet use, patient centered communication, patient education, and perceived care quality might influence mental health. The society will increasingly seek health information from online sources, so our study provides recommendations to make online health information sources more user friendly and trustworthy, ultimately to minimize negative impact on mental health.

Patient and clinician satisfaction with video consultations in dentistry - part one: patient satisfaction

Introduction Although often used in medicine, video consultations are less commonly used in dentistry. During the COVID-19 pandemic, the orthodontic team at Croydon University Hospital introduced the use of video consultations to provide continued patient care at a time when face-to-face appointments were not possible.Aim To assess patient and clinician satisfaction with the Attend Anywhere video consultations used by the orthodontic team at Croydon University Hospital.Method Two separate satisfaction questionnaires were piloted and developed: one for patients and one for clinicians. All patients scheduled for a video consultation between 15 May 2020 and 15 June 2020 were invited to complete a patient satisfaction questionnaire at the end of their consultation.Results In total, 114 patients attended video consultations in the time period assessed, of which 111 completed a satisfaction questionnaire (97.4% response rate). Fifty-six percent of patients were female with an average age of 16.5 years. Patient satisfaction was highest for the video consultations being easy to use and convenient. Over 90% of patients strongly agreed or agreed with all of the satisfaction statements and in terms of whether they would recommend using video consultations. Approximately one-third of patients preferred the video consultation to a face-to-face appointment and one-third of patients were neutral.Conclusion This study found high levels of patient satisfaction with video consultations in orthodontics. Thoughtful consideration needs to be given to the application of video clinics, going forwards, to ensure that high standards of patient care are maintained.

Patient and clinician satisfaction with video consultations in dentistry - part two: clinician satisfaction

Introduction Video consultations are currently not commonly used in dentistry; therefore, most clinicians lack experience in using this technology and seeing patients in this way. When implementing video clinics, it is important to assess clinician satisfaction as well as patient satisfaction to allow for developments and improvements, and to ensure that the highest levels of care are provided.Aim To assess patient and clinician satisfaction with the Attend Anywhere video consultations used by the orthodontic team at Croydon University Hospital.Method Two separate satisfaction questionnaires were piloted and developed: one for patients and one for clinicians. For all patients scheduled for a video consultation between 15 May 2020 and 15 June 2020 in the orthodontic department, all clinicians were invited to complete a clinician satisfaction questionnaire at the end of the consultation to assess satisfaction with the encounter.Results In total, 114 patients attended video consultations, for which there were 128 clinician completed questionnaires, as some patients were seen by multiple clinicians on multidisciplinary clinics. Over 89% of clinicians strongly agreed or agreed with all of the satisfaction statements, with the highest levels of satisfaction being for ease of use and convenience. Over 95% of clinicians strongly agreed or agreed that they would recommend using video consultations and over 89% preferred using a video consultation, if appropriate, to a face-to-face appointment. Overall, the highest levels of satisfaction were for retainer reviews.Conclusion High levels of clinician satisfaction were found with the telemedicine clinics in orthodontics across a range of different appointment types and encounters. Satisfaction varied according to the type of appointment; therefore, this should be a factor for consideration when planning the most appropriate use of telemedicine clinics going forwards.

Persoonlijke gezondheidscounseling via e-health

Zowel in de huisartsenpraktijk als in de klinische setting krijgt een gezonde leefstijl en trouw medicijngebruik meer aandacht bij chronische patiënten. Naast face-to-face-counseling kan leefstijl- en medicatieadvies ook via e-health plaatsvinden. E-health-interventies zijn effectief én kosten-effectief gebleken. Wanneer onderbouwd met een gedegen theoretisch gedragsmodel, kan e-health een zinvolle en waardevolle aanvulling zijn op face-to-facecounseling.

Toward Integration of mHealth in Primary Care in the Netherlands: A Qualitative Analysis of Stakeholder Perspectives

Background: There is a growing need to structurally change the way chronic illness care is organized as health systems struggle to meet the demand for chronic care. mHealth technologies can alter traditional approaches to health care provision by stimulating self-management of chronically ill patients. The aim of this study was to understand the complex environment related to the introduction of mHealth solutions into primary care for chronic disease management while considering health system functioning and stakeholder views.

Methods: A transdisciplinary approach was used informed by the Interactive Learning and Action (ILA) methodology. Exploratory interviews (n = 5) were held with representatives of stakeholder groups to identify and position key stakeholders. Subsequently, professionals and chronically ill patients were consulted separately to elaborate on the barriers and facilitators in integration, using semi-structured interviews (n = 17) and a focus group (n = 6). Follow-up interviews (n = 5) were conducted to discuss initial findings of the stakeholder analysis.

Results: Most stakeholders, in particular primary care practitioners and patients, seem to have a supporting or mixed attitude toward integration of mHealth. On the other hand, several powerful stakeholders, including primary care information system developers and medical specialists are likely to show resistance or a lack of initiative toward mHealth integration. Main barriers to mHealth integration were a lack of interoperability with existing information systems; difficulties in financing mHealth implementation; and limited readiness in general practices to change. Potential enablers of integration included co-design of mHealth solutions and incentives for pioneers.

Conclusion: Stakeholders acknowledge the benefits of integrating mHealth in primary care. However, important barriers perceived by end-users prevent them to fully adopt and use mHealth. This study shows that the complexity of introducing mHealth into primary care calls for strategies encouraging collaboration between multiple stakeholders to enhance successful implementation.

A narrative synthesis systematic review of digital self-monitoring interventions for middle-aged and older adults

OBJECTIVE

Self-monitoring is crucial to raise awareness for own behaviors and emotions, and thus facilitate self-management. The composition of self-monitoring within interventions, however, varies and guidelines are currently unavailable. This review aimed to provide a comprehensive overview of technology-based self-monitoring interventions that intend to improve health in middle-aged and older adults (>45 years).

METHODS

Five online databases were systematically searched and articles were independently screened. A narrative synthesis of 26 studies with 21 unique interventions was conducted. Primary focus lay on the composition of self-monitoring within interventions, including technology used, health-aspects monitored, and type of feedback provided. Secondly, the usability of/adherence to the self-monitoring treatment, intervention effects, and their sustainability were examined.

FINDINGS

Studies concentrated on middle-aged adults (mean of 51 years). Mobile technologies seem necessary to ensure flexible self-monitoring in everyday life. Social health aspects were rarely monitored. Mechanisms and the sustainability of intervention effect are understudied.

CONCLUSION

Digital self-monitoring technologies hold promise for future trials as they seem suitable to understand and support health-related self-management. Key elements including automatic and personal feedback following the blended care principle were highlighted and may guide study designs. Prospectively, research is especially needed to study sustained self-monitoring to support disease prevention and lasting lifestyle changes.

SERIES: eHealth in primary care. Part 1: Concepts, conditions and challenges

Primary care is challenged to provide high quality, accessible and affordable care for an increasingly ageing, complex, and multimorbid population. To counter these challenges, primary care professionals need to take up new and innovative practices, including eHealth. eHealth applications hold the promise to overcome some difficulties encountered in the care of people with complex medical and social needs in primary care. However, many unanswered questions regarding (cost) effectiveness, integration with healthcare, and acceptability to patients, caregivers, and professionals remain to be elucidated. What conditions need to be met? What challenges need to be overcome? What downsides must be dealt with? This first paper in a series on eHealth in primary care introduces basic concepts and examines opportunities for the uptake of eHealth in primary care. We illustrate that although the potential of eHealth in primary care is high, several conditions need to be met to ensure that safe and high-quality eHealth is developed for and implemented in primary care. eHealth research needs to be optimized; ensuring evidence-based eHealth is available. Blended care, i.e. combining face-to-face care with remote options, personalized to the individual patient should be considered. Stakeholders need to be involved in the development and implementation of eHealth via co-creation processes, and design should be mindful of vulnerable groups and eHealth illiteracy. Furthermore, a global perspective on eHealth should be adopted, and eHealth ethics, patients’ safety and privacy considered.

A Mobile Patient-Reported Outcome Measure App With Talking Touchscreen: Usability Assessment

Background

In the past years, a mobile health (mHealth) app called the Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in The Netherlands. The aim of development was to enable Dutch physical therapy patients to autonomously complete a health-related questionnaire regardless of their level of literacy and digital skills.

Objective

The aim of this study was to evaluate the usability (defined as the effectiveness, efficiency, and satisfaction) of the prototype of the DTTSQ for Dutch physical therapy patients with diverse levels of experience in using mobile technology.

Methods

The qualitative Three-Step Test-Interview method, including both think-aloud and retrospective probing techniques, was used to gain insight into the usability of the DTTSQ. A total of 24 physical therapy patients were included. The interview data were analyzed using a thematic content analysis approach aimed at analyzing the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took the participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating that was used to provide a rough estimate of the need for additional usability efforts.

Results

All participants within this study were very satisfied with the ease of use of the DTTSQ. Overall, 9 participants stated that the usability of the app exceeded their expectations. The group of 4 average-/high-experienced participants encountered only 1 problem in total, whereas the 11 little-experienced participants encountered an average of 2 problems per person and the 9 inexperienced participants an average of 3 problems per person. A total of 13 different kind of problems were found during this study. Of these problems, 4 need to be addressed before the DTTSQ will be released because they have the potential to negatively influence future usage of the tool. The other 9 problems were less likely to influence future usage of the tool substantially.

Conclusions

The usability of the DTTSQ needs to be improved before it can be released. No problems were found with satisfaction or efficiency during the usability test. The effectiveness needs to be improved by (1) making it easier to navigate through screens without the possibility of accidentally skipping one, (2) enabling the possibility to insert an answer by tapping on the text underneath a photograph instead of just touching the photograph itself, and (3) making it easier to correct wrong answers. This study shows the importance of including less skilled participants in a usability study when striving for inclusive design and the importance of measuring not just satisfaction but also efficiency and effectiveness during such studies.

Current practices of health care providers in recommending online resources for chronic pain self-management

Purpose

Online health resources (websites, apps and social media) may be an adjunct to provide self-management support for people with persistent or chronic pain. Endorsement of online health resources by health care providers is crucial for uptake by end-users. The aim of this study was to investigate the current practices of New Zealand (NZ) health care providers in recommending online resources for persistent pain management, and to identify what factors predict health care providers’ recommendations and to explore the common concerns.

Methods

An online survey of NZ health care providers (ie, chiropractors, general practitioners, nurses, occupational therapists, osteopaths, physiotherapists, psychologists, specialist consultants, and social workers) involved in the management of persistent pain was conducted. The recruitment strategy was tailored to each occupation via occupation-specific professional organizations, and by approaching multidisciplinary professional organizations.

Results

Data from 213 health care providers were used in the final analysis. Most of the health care providers were physiotherapists (n=71), followed by chiropractors (n=39) and general practitioners (n=31). Fifty three percent (111/210) of health care providers reported currently recommending online resources. A multivariate logistic regression model showed that specialist interest in treating pain (OR=3.84; 95% CI: 1.66, 8.87; P=0.002), and level of confidence in recommending online resources (OR=1.05; CI: 1.04, 1.07; P<0.001), positively influenced recommending online resources. The majority of the health care providers (65%, 138/213) were concerned about the safety issues related to the risk of patients misinterpreting online information and to the lack of evidence-based information.

Conclusion

Half of the health care providers surveyed reported recommending online resources, which may suggest limited confidence in recommending, or knowledge of, existing online resources for persistent pain management. Ongoing education for health care providers on evidence-based online resources is required to recommend online resources as a self-management support tool for people with persistent pain.

eHealth for people with COPD in the Netherlands: a scoping review

Background: In the Netherlands, almost 600,000 people had chronic obstructive pulmonary disease (COPD) in 2017. This decreases quality of life for many and each year, COPD leads to approximately 6,800 deaths and about one billion health care expenditures. It is expected that eHealth may improve access to care and reduce costs. However, there is no conclusive scientific evidence available of the added value of eHealth in COPD care. We conducted a scoping review into the use of eHealth in Dutch COPD care. The aim of the research was to provide an overview of all eHealth applications used in Dutch COPD care and to assess these applications on a number of relevant criteria. Methods: In order to make an overview of all eHealth applications aimed at COPD patients in the Netherlands, literature was searched in the electronic databases PubMed and Google Scholar. In addition, Dutch health care websites were searched for applications that have been evaluated for effectiveness and reliability. The identified eHealth applications were assessed according to five relevant quality criteria, eg, whether research has been conducted on the effectiveness. Results: Thirteen health care programs and patient platforms in COPD care have been found that use eHealth. In addition, 13 self-care and informative websites and 15 mobile apps were found that are available to citizens and patients. Five of 13 care programs and patient platforms were found to be effective in improving quality of life or reducing hospital admissions in small pilot studies. The effectiveness of these and the other eHealth applications should be established in larger studies in the future. Discussion: More research into the effectiveness of eHealth applications for COPD patients is needed. We recommend to develop a nationwide open source platform where well-evaluated eHealth applications can be showcased for patients and health care providers to improve COPD care.

Utilisation of Electronic Health Records for Public Health in Asia: A Review of Success Factors and Potential Challenges

INTRODUCTION

Electronic health records offer a valuable resource to improve health surveillance and evaluation as well as informing clinical decision making. They have been introduced in many different settings, including low- and middle-income countries, yet little is known of the progress and effectiveness of similar information systems within Asia. This study examines the implementation of EHR systems for use at a population health level in Asia and to identify their current role within public health, key success factors, and potential barriers in implementation.

MATERIAL AND METHODS

A systematic search process was implemented. Five databases were searched with MeSH key terms and Boolean phrases. Articles selected for this review were based on hospital provider electronic records with a component of implementation, utilisation, or evaluation for health systems or at least beyond direct patient care. A proposed analytic framework considered three interactive components: the content, the process, and the context.

RESULTS

Thirty-two articles were included in the review. Evidence suggests that benefits are significant but identifying and addressing potential challenges are critical for success. A comprehensive preparation process is necessary to implement an effective and flexible system.

DISCUSSION

Electronic health records implemented for public health can allow the identification of disease patterns, seasonality, and global trends as well as risks to vulnerable populations. Addressing implementation challenges will facilitate the development and efficacy of public health initiatives in Asia to identify current health needs and mitigate future risks.

The Medical Virtualist: Is Pediatric Patient Care Using Telemedicine, a New Specialty?

Telemedicine (TM) is undergoing unprecedented growth that is being driven by numerous factors, one of which is patient preference. Providers who use this tool to deliver health care tend to be early adoptors of new technology, but do they also represent a nascent specialty of pediatric virtualist? We believe that such practitioners, although exhibiting characteristics common to all early adopters, represent the cutting edge of what will become routine medical care. They tend to engage in less small talk with patients, focus more on efficient problem-solving, and collect less data while achieving patient outcomes and satisfaction that are as good as, or possibly even better than, their colleagues who practice in traditional settings. In doing so, they are leading the way for all providers to deliver care to patients using this new technology. Eventually, we feel that medical encounters using TM will be referred to simply as "patient care." [Pediatr Ann. 2019;48(6):e243-e248.].

Development and Validation of Online Textual Pediatrician-Parent Communication Instrument Based on the SEGUE Framework

The prevalence and feature of online textual pediatrician-parent communication (OPPC) have been recognized, but evidence on OPPC assessment remains insufficient. This study aimed to develop and validate an OPPC instrument to provide measurement and quality characteristics for quality assessment and management. 490 OPPC exchanges of 61 tertiary hospitals from 9 Chinese provinces were obtained from the Spring Rain Doctor website. The SEGUE framework, OPPC feature, and a pilot study were considered to establish the instrument. An empirical study was conducted to validate it and the incidence of OPPC items was also analyzed. As a result, a four-dimensional, 15-item OPPC instrument was developed. The empirical results are as follows. Cronbach's α values of dimensions were 0.80, 0.62, 0.64, and 0.60; the mean interrater reliability was 0.93; the correlation coefficients between items and their corresponding dimensions' scores ranged from 0.51 to 0.89 (P<0.001). The goodness-of-fit indices were acceptable. The overall incidence rate of parent-dominated/cooperative items (46.9%) was higher than that of pediatrician-dominated items (39.6%). Thus, the instrument is acceptable and OPPC quality is characterized by more parent-dominated and cooperative behaviors.

Cardiac Rehabilitees' Technology Experiences Before Remote Rehabilitation: Qualitative Study Using a Grounded Theory Approach

Background

Even though technology is becoming increasingly common in rehabilitation programs, insufficient data are as yet available on rehabilitees’ perceptions and experiences. It is important to understand their abilities when using technology for remote rehabilitation.

Objective

This is a qualitative study on technology experiences of persons affected by cardiovascular disease assessed before remote rehabilitation. The aim of the study was to explore rehabilitees’ experiences and attitudes toward technology before 12 months of remote rehabilitation.

Methods

Qualitative interviews were conducted with 39 rehabilitees in four focus groups. The subjects were aged 34 to 77 years (average age 54.8 years) and 74% (29/39) of them were male. They had been diagnosed with coronary artery disease and were undergoing treatment in a rehabilitation center. The interviews were conducted between September 2015 and November 2016. Data were analyzed using Glaser’s mode of the grounded theory approach.

Results

The result of the study was an “identifying e-usage” experience category, which refers to the rehabilitees’ notions of the use of information and communication technologies (e-usage) in the process of behavior change. The main category comprises four subcategories that define the rehabilitees’ technology experience. These subcategories are “feeling outsider,” “being uninterested,” “reflecting benefit,” and “enthusiastic using.” All rehabilitees expected that technology should be simple, flexible, and easy to use and learn. The results reflecting their technology experience can be used in e-rehabilitation programs. Rehabilitees who feel like outsiders and are not interested in technology need face-to-face communication for the major part of rehabilitation, while rehabilitees who reflect benefit and are enthusiastic about the use of technology need incrementally less face-to-face interaction and feel that Web-based coaching could offer sufficient support for rehabilitation.

Conclusions

The findings show that persons affected by heart disease had different experiences with technology and expectations toward counseling, while all rehabilitees expected technology to be easy to use and their experiences to be smooth and problem-free. The results can be used more widely in different contexts of social and health care for the planning of and training in remote rehabilitation counseling and education.

Trial Registration

ISRCTN Registry ISRCTN61225589; http://www.isrctn.com/ISRCTN61225589 (Archived by WebCite at http://www.webcitation.org/74jmrTXFD)

Mixed feelings: general practitioners' attitudes towards eHealth for stress urinary incontinence - a qualitative study

BACKGROUND

Stress urinary incontinence (SUI) is the most prevalent subtype of urinary incontinence and is a bothering condition in women. Only a minority of those with SUI consult a general practitioner (GP). EHealth with pelvic floor muscle training (PFMT) is effective in reducing incontinence symptoms and might increase access to care. The role of the GP regarding such an eHealth intervention is unknown. The aim of the study is to gain insight into the attitudes towards a PFMT internet-based, eHealth, intervention for SUI.

METHODS

A qualitative study was conducted. Data were collected through semi-structured interviews among purposively sampled GPs. Audio records were fully transcribed, and analysed thematically.

RESULTS

Thirteen GPs were interviewed, nine females and four males. Three themes emerged: appraisal of eHealth as a welcome new tool, mixed feelings about a supportive role, and eHealth is no cure-all. GPs welcomed eHealth for SUI as matching their preferences for PFMT and having advantages for patients. With eHealth as stand-alone therapy GPs were concerned about the lack of feedback, and the loss of motivation to adhere to the intervention. Therefore, GPs considered personal support important. The GP's decision to recommend eHealth was strongly influenced by a woman's motivation and her age. GPs' treatment preferences for elderly are different from those for young women with SUI; both PFMT and eHealth are perceived less suitable for older women.

CONCLUSION

EHealth with PFMT fits into the GPs' routine practice of SUI and adds value to it. Although there is evidence that eHealth as a stand-alone intervention is effective, GPs consider personal support important to supplement the perceived shortcomings. Probably GPs are not aware of, or convinced of the existing evidence. Training should address this issue and should also focus on common misunderstandings about regular care for women with SUI, such as the idea that PFMT is not suitable for the elderly. Improving GPs' knowledge that eHealth can be a stand-alone therapy for SUI facilitates the implementation in daily care.

Effectiveness of web-based personalised e‑Coaching lifestyle interventions

Introduction

Interventions to reduce the impact of modifiable risk factors, such as hypercholesterolaemia, smoking, and overweight, have the potential to significantly decrease the cardiovascular disease burden. The majority of the global population is unaware of their own risk of developing cardiovascular disease. Parallel to the lack of awareness, a rise in obesity and diabetes is observed. e‑Health tools for lifestyle improvement have shown to be effective in changing unhealthy behaviour. In this study we report on the results of three different trials assessing the effectiveness of MyCLIC, an e‑Coaching lifestyle intervention tool.

Methods

From 2008 to 2016 we conducted three trials: 1) HAPPY NL: a prospective cohort study in the Netherlands, 2) HAPPY AZM: a prospective cohort study with employees of Maastricht UMC+ and 3) HAPPY LONDON: a single-centre, randomised controlled trial with asymptomatic individuals who have a high 10-year CVD risk.

Results

HAPPY NL and HAPPY AZM showed that e‑Coaching reduced cardiovascular risk. Both prospective trials showed a 20–25% relative reduction in 10-year cardiovascular disease risk. A lesser effect was seen in the HAPPY LONDON trial. A low frequency of logins suggests a low degree of content engagement in the e‑Coaching group, which could be age related as the mean age of the participants in the HAPPY LONDON study was high.

Conclusion

e-Coaching using MyCLIC is a low cost and effective method to perform lifestyle interventions and has the potential to reduce the 10-year cardiovascular disease risk.

Modeling and Predicting Outcomes of eHealth Usage by European Physicians: Multidimensional Approach from a Survey of 9196 General Practitioners

Background

The literature has noted the need to use more advanced methods and models to evaluate physicians’ outcomes in the shared health care model that electronic health (eHealth) proposes.

Objective

The goal of our study was to design and evaluate a predictive multidimensional model of the outcomes of eHealth usage by European physicians.

Methods

We used 2012-2013 survey data from a sample of 9196 European physicians (general practitioners). We proposed and tested two composite indicators of eHealth usage outcomes (internal practices and practices with patients) through 2-stage structural equation modeling. Logistic regression (odds ratios, ORs) to model the predictors of eHealth usage outcomes indicators were also calculated.

Results

European general practitioners who were female (internal practices OR 1.15, 95% CI 1.10-1.20; practices with patients OR 1.19, 95% CI 1.14-1.24) and younger—aged <35 years (internal practices OR 1.14, 95% CI 1.02-1.26; practices with patients OR 1.32, 95% CI 1.13-1.54) and aged 36-45 years (internal practices OR 1.16, 95% CI 1.06-1.28; practices with patients OR 1.21, 95% CI 1.10-1.33)—had a greater propensity toward favorable eHealth usage outcomes in internal practices and practices with patients. European general practitioners who positively valued information and communication technology (ICT) impact on their personal working processes (internal practices OR 5.30, 95% CI 4.73-5.93; practices with patients OR 4.83, 95% CI 4.32-5.40), teamwork processes (internal practices OR 4.19, 95% CI 3.78-4.65; practices with patients OR 3.38, 95% CI 3.05-3.74), and the doctor-patient relationship (internal practices OR 3.97, 95% CI 3.60-4.37; practices with patients OR 6.02, 95% CI 5.43-6.67) had a high propensity toward favorable effects of eHealth usage on internal practices and practices with patients. More favorable eHealth outcomes were also observed for self-employed European general practitioners (internal practices OR 1.33, 95% CI 1.22-1.45; practices with patients OR 1.10, 95% CI 1.03-1.28). Finally, general practitioners who reported that the number of patients treated in the last 2 years had remained constant (internal practices OR 1.08, 95% CI 1.01-1.17) or increased (practices with patients OR 1.12, 95% CI 1.03-1.22) had a higher propensity toward favorable eHealth usage outcomes.

Conclusions

We provide new evidence of predictors (sociodemographic issues, attitudes toward ICT impacts, and working conditions) that explain favorable eHealth usage outcomes. The results highlight the need to develop more specific policies for eHealth usage to address different realities.

Physiotherapists' experiences with a blended osteoarthritis intervention: a mixed methods study

INTRODUCTION

E-Exercise is an effective 12-week blended intervention consisting of around five face-to-face physiotherapy sessions and a web-based application for patients with hip/knee osteoarthritis. In order to facilitate effective implementation of e-Exercise, this study aims to identify physiotherapists' experiences and determinants related to the usage of e-Exercise. Methods: An explanatory sequential mixed methods design embedded in a randomized controlled trial comparing e-Exercise with usual physiotherapy in patients with hip/knee osteoarthritis. Usage of e-Exercise was based on recruitment rates of 123 physiotherapists allocated to e-Exercise and objective web-based application usage data. Experiences and determinants related to e-Exercise usage were investigated with a questionnaire and clarified with semi-structured interviews. Results: Of the 123 physiotherapists allocated to e-Exercise, 54 recruited more than one eligible patient, of whom 10 physiotherapists continued using e-Exercise after the study period. Physiotherapists had mixed experiences with e-Exercise. Determinants related to intervention usage were appropriateness, added value, time, workload, professional autonomy, environmental factors, and financial consequences. Physiotherapists recommended to improve the ability to tailor e-Exercise to the individual needs of the patient patients' individual needs. Discussion: Determinants related to the usage of e-Exercise provided valuable information for the implementation of e-Exercise on broader scale. Most importantly, the flexibility of e-Exercise needs to be improved. Next, there is a need for education on how to integrate an online program within physiotherapy.

Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health Care

Background

Electronic health (eHealth) solutions are considered to relieve current and future pressure on the sustainability of primary health care systems. However, evidence of the effectiveness of eHealth in daily practice is missing. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary health care and accelerate the implementation of eHealth, a 3-year Living Lab project was set up. In the Living Lab, called eLabEL, patients, health care professionals, small- and medium-sized enterprises (SMEs), and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary health care. Seven primary health care centers, 10 SMEs, and 4 research institutes participated.

Objective

This viewpoint paper aims to show the process of adoption of eHealth in primary care from the perspective of different stakeholders in a qualitative way. We provide a real-world view on how such a process occurs, including successes and failures related to the different perspectives.

Methods

Reflective and process-based notes from all meetings of the project partners, interview data, and data of focus groups were analyzed systematically using four theoretical models to study the adoption of eHealth in primary care.

Results

The results showed that large-scale implementation of eHealth depends on the efforts of and interaction and collaboration among 4 groups of stakeholders: patients, health care professionals, SMEs, and those responsible for health care policy (health care insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. We experienced that patients reported expected benefits regarding the use of eHealth for self-management purposes, and health care professionals stressed the potential benefits of eHealth and were interested in using eHealth to distinguish themselves from other care organizations. In addition, eHealth entrepreneurs valued the collaboration among SMEs as they were not big enough to enter the health care market on their own and valued the collaboration with research institutes. Furthermore, health care insurers and policy makers shared the ambition and need for the development and implementation of an integrated eHealth infrastructure.

Conclusions

For optimal and sustainable use of eHealth, patients should be actively involved, primary health care professionals need to be reinforced in their management, entrepreneurs should work closely with health care professionals and patients, and the government needs to focus on new health care models stimulating innovations. Only when all these parties act together, starting in local communities with a small range of eHealth tools, the potential of eHealth will be enforced.

General Practitioners' Attitudes Toward a Web-Based Mental Health Service for Adolescents: Implications for Service Design and Delivery

Background

Anxiety disorders and depression are prevalent among youth. General practitioners (GPs) are often the first point of professional contact for treating health problems in young people. A Web-based mental health service delivered in partnership with schools may facilitate increased access to psychological care among adolescents. However, for such a model to be implemented successfully, GPs’ views need to be measured.

Objective

This study aimed to examine the needs and attitudes of GPs toward a Web-based mental health service for adolescents, and to identify the factors that may affect the provision of this type of service and likelihood of integration. Findings will inform the content and overall service design.

Methods

GPs were interviewed individually about the proposed Web-based service. Qualitative analysis of transcripts was performed using thematic coding. A short follow-up questionnaire was delivered to assess background characteristics, level of acceptability, and likelihood of integration of the Web-based mental health service.

Results

A total of 13 GPs participated in the interview and 11 completed a follow-up online questionnaire. Findings suggest strong support for the proposed Web-based mental health service. A wide range of factors were found to influence the likelihood of GPs integrating a Web-based service into their clinical practice. Coordinated collaboration with parents, students, school counselors, and other mental health care professionals were considered important by nearly all GPs. Confidence in Web-based care, noncompliance of adolescents and GPs, accessibility, privacy, and confidentiality were identified as potential barriers to adopting the proposed Web-based service.

Conclusions

GPs were open to a proposed Web-based service for the monitoring and management of anxiety and depression in adolescents, provided that a collaborative approach to care is used, the feedback regarding the client is clear, and privacy and security provisions are assured.

Feasibility, acceptability and effectiveness of an online alternative to face-to-face consultation in general practice: a mixed-methods study of webGP in six Devon practices

OBJECTIVES

To evaluate the feasibility, acceptability and effectiveness of webGP as piloted by six general practices.

METHODS

Mixed-methods evaluation, including data extraction from practice databases, general practitioner (GP) completion of case reports, patient questionnaires and staff interviews.

SETTING

General practices in NHS Northern, Eastern and Western Devon Clinical Commissioning Group's area approximately 6 months after implementing webGP (February-July 2016).

PARTICIPANTS

Six practices provided consultations data; 20 GPs completed case reports (regarding 61 e-consults); 81 patients completed questionnaires; 5 GPs and 5 administrators were interviewed.

OUTCOME MEASURES

Attitudes and experiences of practice staff and patients regarding webGP.

RESULTS

WebGP uptake during the evaluation was small, showing no discernible impact on practice workload. The completeness of cross-sectional data on consultation workload varied between practices.GPs judged 41/61 (72%) of webGP requests to require a face-to-face or telephone consultation. Introducing webGP appeared to be associated with shifts in responsibility and workload between practice staff and between practices and patients.81/231 patients completed a postal survey (35.1% response rate). E-Consulters were somewhat younger and more likely to be employed than face-to-face respondents. WebGP appeared broadly acceptable to patients regarding timeliness and quality/experience of care provided. Similar problems were presented by all respondents. Both groups appeared equally familiar with other practice online services; e-consulters were somewhat more likely to have used them.From semistructured staff interviews, it appeared that, while largely acceptable within practice, introducing e-consults had potential for adverse interactions with pre-existing practice systems.

CONCLUSIONS

There is potential to assess the impact of new systems on consultation patterns by extracting routine data from practice databases. Staff and patients noticed subtle changes to responsibilities associated with online options. Greater uptake requires good communication between practice and patients, and organisation of systems to avoid conflicts and misuse. Further research is required to evaluate the full potential of webGP in managing practice workload.