ABSTRACT
Over the past two decades, different drivers have prompted institutional players to adopt digital innovations in healthcare systems. Telemedicine represents a digital innovation solution to guaranteeing the continuity of care, and patient and personnel safety. However, despite its potential benefits (such as improving care access in rural areas, reduction in hospitalization stay, and saving time for patients and healthcare professionals) and its rapid acceleration in use during the Covid-19 pandemic, the diffusion of telemedicine services remains limited and uneven across Europe. Adopting an explorative approach, this paper analyzes the implementation of telemedicine projects, investigating not only the factors but also the ways in which the analyzed organizations, in order to move from the design to implementation phase, managed the change needed to overcome barriers and to leverage enabling factors. Our research focus is on Southern Italy;a disadvantaged area in comparison to other Italian and European regions. The goal of the paper is to shed light on the characterization of leverages and barriers, as well as the related managerial actions for change implemented in a context whereby the diffusion of telemedicine remains limited. © 2022 Elsevier Ltd
ABSTRACT
Objectives: To investigate the factors influencing the clinical choice to change the current patients' therapies, and the impact of potential support of digital innovation and other knowledge assets, such as INTERCheckWEB information technology and/or guidelines, to optimize the prescription decision-making process in older and frailer patients, in polytherapy. Method(s): A narrative literature review was firstly conducted to define the main clinical and non-clinical factors, impacting on the propensity of the clinicians to change the patients' current therapies. Secondly, an observational study was developed involving 35 clinicians referring to the Internal Medicine wards, of five Italian medium size hospitals. Each clinician completed a questionnaire, aimed at evaluating 15 clinical cases of patients in polypharmacy and suffering from multiple diseases, thus defining if in case of specific information, they would have changed the patient's current therapy, during an Internal Medicine hospitalization. A hierarchical sequential linear regression model was implemented to define the predictors of the clinicians' choice to change the current therapy. Result(s): Inferential analysis demonstrated that younger patient's age (beta=-0.073, p-value=0.048), autonomy (beta=0.303, p-value=0.000) and body-max index (beta=0.505, p-value=0.000), as well as clinician's perception with regard to INTERCheckWEB ease of use (beta=0.298, p-value=0.043) and seniority (beta=0.087, p-value=0.009), number of drugs assumed by the patients (beta=0.541, p-value=0.000) and number of concomitant diseases (beta=0.302, p-value=0.000) are factors influencing a potential change in the current therapy. The above aspects explained the 53.7% of the clinician's choice variance, to modify the prescription, reducing the number of treatments to be administered to the patients. Conclusion(s): The findings provide insight into factors influencing clinical assessment decisions, that could highly be replicable in the COVID-19 era, since hospitalized COVID-19 patients are frequently older with comorbidities and receiving polypharmacy, thus strengthening the need for the clinicians to modify the therapy. Copyright © 2022