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Jessup RL, Awad N, Beauchamp A, Bramston C, Campbell D, Semciw A, Tully N, Fabri AM, Hayes J, Hull S, Clarke AC. Staff and patient experience of the implementation and delivery of a virtual health care home monitoring service for COVID-19 in Melbourne, Australia. BMC Health Serv Res 2022; 22:911. [PMID: 35831887 PMCID: PMC9277602 DOI: 10.1186/s12913-022-08173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Provision of virtual health care (VHC) home monitoring for patients who are experiencing mild to moderate COVID-19 illness is emerging as a central strategy for reducing pressure on acute health systems. Understanding the enablers and challenges in implementation and delivery of these programs is important for future implementation and re-design. The aim of this study was to explore the perspectives of staff involved with the implementation and delivery, and the experience of patients managed by, a VHC monitoring service in Melbourne, Australia during the COVID-19 pandemic. METHODS A descriptive qualitative approach informed by naturalist inquiry was used. Staff interviews were analysed using the Consolidated Framework for Implementation Research (CFIR). Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses as they related to the CFIR. Finally, data from the interviews and patient experience were triangulated to see if patient experience validated data from staff interviews. RESULTS All 15 staff were interviewed, and 271 patients were surveyed (42%). A total of four final overarching themes emerged: service implementation enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths. 19 subthemes aligned with 18 CFIR constructs from staff and patient data. CONCLUSION Rapid implementation was enabled through shared resources, dividing implementation tasks between senior personnel, engaging furloughed healthcare staff in design and delivery, and having a flexible approach that allowed for ongoing improvements. Benefits for patients included early identification of COVID-19 deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges were the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.
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Affiliation(s)
- R L Jessup
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia. .,Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia. .,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, 3086, Australia. .,School of Rural Health, Monash University, Sargeant St, Warragul, 3820, Australia.
| | - N Awad
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia
| | - A Beauchamp
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia.,School of Rural Health, Monash University, Sargeant St, Warragul, 3820, Australia.,Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - C Bramston
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, 3086, Australia
| | - D Campbell
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia.,Faculty of Art, Design and Architecture, Monash University, Clayton, Victoria, Australia
| | - Al Semciw
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, 3086, Australia
| | - N Tully
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia
| | - A M Fabri
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia
| | - J Hayes
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia
| | - S Hull
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia
| | - A C Clarke
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia
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Clarke AC, Hull S, Semciw AI, Jessup RL, Campbell D, Fabri AM, Tully N, Bramston C, Hayes J. Descriptive Analysis of a Telephone Based Community Monitoring Service for COVID-19. J Community Health 2021; 46:1124-1131. [PMID: 33977436 PMCID: PMC8112833 DOI: 10.1007/s10900-021-00996-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 02/08/2023]
Abstract
The coronavirus disease (COVID-19) pandemic has required health services to rapidly respond to the needs of people diagnosed with the virus. Over 80% of people diagnosed with COVID-19 experience a mild illness and there is a need for community management to support these people in their home. In this paper we present, a telephone based COVID-19 community monitoring service developed in an Australian public health network, and we describe the rapid implementation of the service and the demographic and clinical characteristics of those enrolled. A retrospective mixed methods evaluation of the COVID-19 community monitoring service using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Eight hundred and fifty COVID-19 positive patients were enrolled, 54% female, 45% male, mean age 34 years SD 17. Four hundred and nine (48%) patients were born outside Australia. Among the 850 patients, 305 (36%) were classified as having a high risk of serious illness from COVID-19. The most prevalent risk factors were cardiovascular disease (37%), lung disease (30%) and age over 60 years (26%). The most common reported ongoing symptoms were fatigue (55%), breathing issues (26%) and mental health issues such as low mood (19%). There were no deaths in patients that participated in the service. The process of risk stratification undertaken with telephone triage was effective in determining risk of prolonged illness from COVID-19. Telephone monitoring by trained health professionals has a strong potential in the effective management of patients with a mild COVID-19 illness.
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Affiliation(s)
- A C Clarke
- Hospital Without Walls Directorate, Northern Health, 1231 Plenty Road, Bundoora, Melbourne, VIC, 3083, Australia.
| | - S Hull
- Hospital Without Walls Directorate, Northern Health, 1231 Plenty Road, Bundoora, Melbourne, VIC, 3083, Australia
| | - A I Semciw
- Allied Health Research, Northern Health, Melbourne, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - R L Jessup
- Allied Health Research, Northern Health, Melbourne, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,School of Rural Health, Monash University, Warragul, Australia
| | - D Campbell
- Hospital Without Walls Directorate, Northern Health, 1231 Plenty Road, Bundoora, Melbourne, VIC, 3083, Australia
| | - A M Fabri
- Hospital Without Walls Directorate, Northern Health, 1231 Plenty Road, Bundoora, Melbourne, VIC, 3083, Australia
| | - N Tully
- Hospital Without Walls Directorate, Northern Health, 1231 Plenty Road, Bundoora, Melbourne, VIC, 3083, Australia
| | - C Bramston
- Hospital Without Walls Directorate, Northern Health, 1231 Plenty Road, Bundoora, Melbourne, VIC, 3083, Australia
| | - J Hayes
- Hospital Without Walls Directorate, Northern Health, 1231 Plenty Road, Bundoora, Melbourne, VIC, 3083, Australia
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