Providing culturally responsible health care to Pacific Islander communities: The creation of a cultural competency training for healthcare professionals

Cultural competency is the ability to respectfully engage, understand, and communicate through conscientious interaction, enabling effective work and meaningful relationships in cross-cultural situations. Cultural competency recognizes the importance for organizations of participants' diverse social and cultural values, beliefs, and behaviors, and has gained attention because it can bridge health perspectives, understanding, and respect between health professionals and patients. There remains a need for cultural competency in healthcare as disparities persist across the U.S. in racial and ethnic minority groups who experience worse health outcomes and lower healthcare quality than the general public. Therefore, a cultural competency training curriculum was created using various resources to improve interactions between Pacific Islander patients and healthcare professionals. This training helps to reduce racial/ethnic disparities in healthcare by encouraging mutual understanding and improving patient satisfaction, adherence to medical instructions, and overall health outcomes by highlighting patient-centered care as a result of utilizing components of cultural competency. To improve patient experiences in Hawai'i, healthcare professionals need the tools to better interact with patients from different cultures, such as Pacific Islanders. This training provides healthcare professionals with culturally-based content for improving cultural competence techniques for interacting with Pacific Island patients. This training was pilot tested with key stakeholders from community organizations and Cancer Center faculty/staff. Local health clinics, providers, and practices will have the opportunity to participate in this training through a Zoombased electronic training format and be provided with three continuing medical education credits. The initial delivery of the training was intended for in-person sessions;however, a virtual format was adapted due to the COVID-19 pandemic and subsequent social distancing regulations. Healthcare providers are provided pre-training resources, a pre- and post-test, and a course evaluation to determine the validity of training objectives. To date, two Federally Qualified Health Centers have been provided the training, n=60, as well as one Cancer Health Equity Partnerships' Scientific Workshop, n=40. For attendees, the analysis of correct responses from the pretest to post-test showed a significant improvement on 6 of the 12 questions. Respondents also agreed that the training resources aligned with the course objectives. Improved patient interactions from this training can help support better patient outcomes, adherence to medical advice regarding cancer screenings, and many other aspects of improving health equity for Pacific Islanders.

Improving Clinical Decisions Via Remote Blood Sampling

3 An important component for the provision of patient-centric healthcare is the ability to collect blood samples remotely in a manner that delivers samples of a quality comparable to that of current standard phlebotomy collection, enabling routine clinical testing, monitoring disease progression and testing drug concentrations.2-4-г, This blood sampling could be performed at the patient's home, at a nearby pharmacy, or at a local clinic, rather than a centralized facility. Examples of commercially available devices include the Neoteryx Mitra,13 Tasso-M20, SST and Tasso+,14 SeventhSense TAP and TAP II,15 Trajan hemaPEN,16 Labcorp Pixel,17 Capitainer qDBS,1" HemaXis DB10 and DX,19 and Drawbridge OneDraw.20 These devices are capable of collecting from as little as 20 microliters (approximately half a drop) to several hundred microliters of blood and have been widely used to determine clinical parameters,21 drug concentrations,5'22 therapeutic drug monitoring,23 and, more recently, COVID antibody levels.24,25 Some of these devices enable the collection of a fixed volume of blood, collected as dried blood, which can then be shipped and handled at room temperatures-avoiding the need for freezers and dry ice for storing and shipping samples-enabling its adoption even in remote areas with limited infrastructure. Patient-centric blood sampling techniques have been gaining popularity for use in pharmaceutical drug development;however, to date they have not been broadly accessible to the general public.26 This can be partially attributed to the "cliniccentric" healthcare model, where reimbursement is dependent on in-person visits and sample collection. [...]the status quo remains and anyone who needs a blood test is required to go to the doctor's office or clinic. [...]studies have demonstrated that the overall cost to society will be lower, by improving health outcomes and allowing broader access and patient convenience.27 The availability and adoption of patient-centric approaches can provide access and treatment options to clinical trial participants not geographically co-located with the investigative sites and improving access in rural or lesser developed communities, globally, potentially improving the health of the general population.

Managing diabetes remotely: Evaluation of the uptake and efficacy of the DBm app

Objectives: Insulin optimisation requires review of glucose monitoring;Covid-19 posed challenges to this. We evaluated DBm -a remote monitoring platform utilising a glucometer and smartphone app. Method(s): Evaluation was from January to November 2021. Inclusion criteria was insulin treated diabetes with HbA1c greater than 68mmol/mol. HbA1c, demographics, frequency of CBG uploads and interactions with clinicians were collected. Result(s): 97 patients were offered DBm. 48.5% used the app. There were no statistically significant differences in gender (p = 0.05), age (p = 0.36), type of diabetes (p = 0.13) or deprivation index (p = 0.96) between users and non-users. Patients of white ethnicity were less likely to use the platform (p = 0.01). Amongst users, 70% had a reduction of HbA1c of at least 5mmol/mol over six months, with a mean reduction of 25.6mmol/mol (p = 0.01). There was no difference in age (p = 0.64), gender (p = 0.4), and type of diabetes (p = 0.23) between responders and non-responders. There was also no difference in number of call back requests generated by patients (p = 0.32) or number of CBG uploads (p = 0.899) between responders and non-responders. Conclusion(s): Uptake of the remote monitoring solution was just under 50%, with no evidence of digital exclusion, although the finding that white ethnicity patients were less likely to use the system needs further exploration. Most users had improved glucose control, but there was no association with numbers of tests or call back requests. This study demonstrates that insulin optimisation can effectively be delivered using a remote glucose monitoring system. Future work will explore patient experience and patient satisfaction.

A quantitative framework for health‐care service quality assessment in India

PurposeThe present situation of COVID-19 pandemic has put the health-care systems under tremendous stress and stringent tests for their ability to offer expected quality of health-care services, as it decides the sustainability and growth of health-care service providers. This study aims to deliver a quantitative framework for service quality assessment in the health-care industry by classifying the health-care service quality parameters into four balanced scorecard (BSC) perspectives.Design/methodology/approachTo determine the service quality for the Indian health-care system, decision-making trial and evaluation laboratory and analytical network process are integrated in a fuzzy environment to contemplate the interaction among BSC perspectives and respective performance measures.FindingsThe results indicate "internal processes” perspective assumes the key role within BSC perspectives, while performance measures "nursing staff turnover” and "staff training” play the key roles. The results also signify that "patient satisfaction” is the most vital issue and can be strongly influenced by measures belonging to the "learning and growth” perspective. In "learning and growth” perspective, "staff training” is the most decisive criteria, very highly influencing "patient satisfaction”, highly influencing "profitability,” "change of cost per patient (both in and out patients)” and "outpatient waiting time” while moderately influencing "staff satisfaction,” "bed occupancy” and "nursing staff turnover”. Moreover, "staff training” criteria have a positive influence on "nursing staff turnover.”Originality/valueThe contributions of this study are in two folds in the domain of quantification of service quality for the health-care system. First, it delivers an assessment framework for Indian health-care service quality. Second, it demonstrates an application of the framework for a case situation and validates the proposed framework.

Patient Recruitment Goes High-Tech

Clinical trial patient recruitment is arguably the most difficult aspect of pharmaceutical development, because it involves a variety of factors beyond study sponsors' control. The aggregation of data across 80 hospitals and 20 systems, for the purpose of understanding patients, doing feasibility studies, or engaging in decentralized recruitment, is the trend we're seeing." Nimita Limaye, PhD, is the vice president of research for the life sciences R&D strategy and technology division at the International Data Corporation (IDC), a market research and advisory firm specializing in the technology industry and headquartered in Boston, Mass. Limaye says the rise of social media-based patient recruitment has opened the door for sponsors and investigators to mine real-world data and to give patients a more central focus in research.

Impact of Telehealth on Patient Satisfaction in a Pediatric Surgery Population: Implications for Future Surgical Practice

Introduction: Since COVID-19 spurred transitions from in-person to virtual telehealth visits, Press Ganey scores across adult specialties have shown improved patient satisfaction. The impact of telehealth on the pediatric surgery population, however, has not been characterized. This study aims to evaluate telehealth feasibility in pediatric surgery by examining Press Ganey surveys from the largest pediatric surgery telehealth group in the US. Method(s): Demographics were extracted from medical records of patients evaluated by general pediatric surgeons at a tertiary pediatric center from January to September of 2019 and 2021. Customized Press Ganey results were compared between in-person and telehealth patients. Ratings were categorized as satisfied (good, very good) or not satisfied (very poor, poor, fair). Analysis was performed using two-sample t-test or Fisher's Chi- Squared test. Result(s): In 2019, 7,965 (99.9%) patients were evaluated in-person and 3 by telehealth. In 2021, 8,454 (77%) were evaluated in-person and 2,514 (23%) by telehealth. Telehealth patients were more likely to no-show (11.2% vs 6.1%,p<0.01) and leave without being seen (1.4% vs 0.02%,p<0.01). Spanish speakers attended more in-person visits than telehealth (14% vs 8%,p<0.001). In 2021, telehealth patients reported greater satisfaction with providers and greater likelihood of recommending their provider. Conclusion(s): This study demonstrates improvement in patient satisfaction with telehealth implementation in a large pediatric surgery cohort. However, our data suggest that there may be access to care issues that can be optimized. Lessons from this study may be translated to other surgical disciplines and used to improve access to care and patient satisfaction.

IMPROVING PATIENT SAFETY THROUGH THE ESTABLISHMENT OF A PHARMACIST-LED BLOOD MONITORING CLINIC FOR JAK INHIBITORS IN RHEUMATOLOGY

BackgroundJanus kinase inhibitors drugs (JAKi) are novel small molecule medications known to cause abnormalities such as elevations in hepatic transaminases, decreases in neutrophil and lymphocyte counts and elevations in cholesterol and creatinine kinase. Blood monitoring is recommended and dose adjustments are advised if abnormalities arise. Recent warnings by the EMA and MHRA have highlighted the importance of monitoring these medications.Timely review and management of patients on JAKi drugs is difficult to maintain with increasing workload amongst the rheumatology team. A baseline audit (2020) demonstrated that hospital blood monitoring guidelines for JAKi drugs were not being followed. The rheumatology multidisciplinary team met and utilised Quality Improvement methodology including fish and driver diagrams to address this. This led to the creation of a pharmacist-led JAKi blood monitoring clinic.ObjectivesTo establish a pharmacist-led rheumatology blood monitoring clinic for the JAKi drug class in order to: increase patient safety with increased compliance to blood monitoring, save consultant/nurse time, improve communication with primary care on the frequency of blood testing required, increase patient understanding of the importance of blood monitoring with JAKi drugs, reinforce counselling advice such as risk of infections, shingles and thrombosis and promote medication adherence.MethodsThe clinic was established in March 2021. Patients commencing JAKi drugs are referred to the pharmacist-led clinic by the medical team. The pharmacist contacts the patient by phone following delivery of their medication. The patient is counselled on their new medication and dates for blood checks are agreed. A letter is sent to the patient and their GP providing this information. The patient is booked into virtual telephone appointments and bloods are monitored every month for the first 3 months and every 3 months thereafter. Any change or abnormality in blood results are flagged early in the patient's treatment and if necessary, discussed with the consultant. Adjustments are made to the patient's dose if appropriate.ResultsIn order to evaluate the benefit of the pharmacist clinic a re-audit of compliance with blood monitoring (March 2021- September 2022) was carried out alongside a patient satisfaction postal survey (August 2022).A total of 58 patients were sampled in the re-audit. The re-audit found an increase in compliance in blood monitoring since the introduction of the pharmacist clinic. 98% of patients had their full blood count performed at 3 months compared to 56% in audit 1 and 95% of patients had their lipid profile completed at 3 months compared to 15% in audit 1 (Table 1).A patient satisfaction survey (N=62, response rate 48%) found that 28 (93%) patients either agreed or strongly agreed that they were more aware of the importance of attending for regular blood monitoring when prescribed JAKi therapy as a result of the clinic.The pharmacy team made several significant interventions (self-graded Eadon grade 4 and 5). For example by improving medication adherence, detecting haematological abnormalities that required JAKi dose reduction, identifying patients suffering from infection requiring intervention including shingles and Covid-19.Table 1.Comparison of audit results pre (Audit 1) and post (Audit 2) clinic establishmentAudit 1 (N=48)Audit 2 (N=58)Number of patients with full blood count completed at weeks 4, 8 & 1227 (56%)57 (98%)Number of patients with lipid profile completed at week 127 (15%)55 (95%)Number of patients LFTs completed at weeks 4, 8 & 1226 (54%)54 (93%)ConclusionIntroduction of the pharmacist-led clinic has increased patient safety by ensuring compliance with blood monitoring as per hospital guidelines. The clinic has paved the way for improved communication with primary care teams and has provided patients with extra support during their first months on treatment with their JAKi. It has also expanded the role of the rheumatology pharmacy team and saved nursing and medical time.Acknowled ementsI wish to thank the SHSCT Rheumatology team for all their help, support and guidance with this project.Disclosure of InterestsNone Declared.

Systematic Literature Review of Performance Measurement Systems in Health Sector of Pakistan

Building The research study is primarily focused on identifying the parameters of Performance Measurement System within the healthcare sectors of Pakistan. The main purpose is to identify the efficacy of different Performance Measurement Systems within Pakistan, and its impacts on performance of physicians. Considering the current performance and situation in healthcare sector of Pakistan, it has been analyzed that the country has come a long way towards progress, however there is still a major lacking of proper standards and guidelines which must be followed in all the healthcare institutions. The problem statement emphasizes over the need of PMS in the healthcare institutions, with the help of which the improvements and efficacy in performance of the healthcare professionals can be determined. The research objective designed for this study is identify the impact of Performance Measurement Systems on the improvisations in current practices, on patient satisfaction and recovery, changes in patterns of mortality rates and budgetary control within the country for healthcare sectors. In order to conduct this research study, the type of research method which has been mainly opted is qualitative analysis involving the write up of a Systematic Literature Review. This review has been designed on the basis of PRISMA method, and proper skimming of research articles have been performed accordingly. 22 articles have been taken for further investigation, published after the year of 2010. The indicators which have been focused on in this study include Patient Satisfaction, Mortality, Survival rates and Cost Allocation to healthcare sectors of the country. Based on the findings of number of research articles, it has been identified that Patient Satisfaction and Cost Allocation have not been improved via Performance Management System. However, during the COVID-19 pandemic, the mortality and survival rates in the public and private sectors of the country were controlled due to constant supervision by governmental agencies and the use of an effective and efficient Performance Measurement method for staff members in the healthcare industry.

Role of telemedicine in anesthesia: Are we ready yet?

Telemedicine is a modality which utilizes technology to provide and support health care across large distances. It has redefined the practices of medicine in many specialties and continues to be a boon for clinicians on many frontiers. Its role in the branch of anesthesia remains largely unexplored but has shown to be beneficial in all the three phases: pre-operative, intra-operative, and post-operative. Now time has come that anesthesiologists across the globe reassess their strategies and utilize the telemedicine facilities in the field of anesthesia.Copyright © 2021 EDP Sciences. All rights reserved.

Analysis of the Professional Aspects of Medical Drugs Industry in the Republic of Serbia in Times of COVID-19 Pandemic

The research subject of this paper is the analysis of the attitudes of employees in pharmaceutical companies towards the business aspects of the pharmaceutical industry during and after the end of the pandemic in the Republic of Serbia. The aim is to examine the differences in the attitudes of employees, as well as to determine which variables predict the situations of endangering the professional reputation of pharmaceutical companies during the COVID-19 pandemic. The research was conducted by means of a survey during 2021 on a sample of 27 innovative and generic pharmaceutical companies. We used the SPSS program for descriptive statistics analysis, chi square test and binary logistic regression models. The findings show that there is a statistically significant difference in the expressed attitudes of employees in innovative and generic pharmaceutical companies in terms of coming to the office during the pandemic;the lack of medicines and medical devices used in the treatment of COVID-19 infections;the patient access to a chosen doctor;the expectations of the employees to continue working from home after the outbreak of the COVID-19 pandemic. The findings of the binary regression models show the slowdown in the supply chain, the access to doctors and working from the home office have not been perceived as creating situations of endangering professional reputations, that is, they contribute to the sustainable economic success. On the other hand, the introduction of digital technologies decreases the occurrence of conditions in which their professional reputation has been threatened.

EVALUATION OF PATIENT SATISFACTION WITH REMOTE SELF-INJECTION TRAINING: A SINGLE-CENTRE PATIENT-REPORTED SURVEY

BackgroundSubcutaneous self-injection of methotrexate (SC MTX) is used for the treatment of several inflammatory diseases. All newly initiated patients should be educated and trained in the proper injection technique by their healthcare provider (HCP), with the first injection performed under medical supervision. This training has typically been conducted during face-to-face consultations, however since the start of the COVID-19 pandemic it has been necessary to conduct training remotely due to the cancellation of clinics.ObjectivesTo understand patient-reported experiences and satisfaction with remote SC MTX self-injection training.MethodsA cross-sectional electronic survey was administered between 11 October 2022 and 30 November 2022 to patients at Southern Health and Social Care Trust who had recently been trained via telephone or video conference [VC] on how to self-inject methotrexate using a pre-filled, auto-injector pen. Patients were aged ≥18 with a range of arthritis types, including rheumatoid, psoriatic, polyarticular juvenile idiopathic and chronic reactive inflammatory arthritis. Remote training was delivered by the patient's nurse as per routine practice (independently of this survey). Patients were sent a patient information pack (PIP) prior to the training consultation. During the training, the nurse discussed the process of injecting with the auto-injector pen before virtually supervising the first injection.The survey consisted of 14 questions;topics included experiences and satisfaction with preparation for the HCP appointment, the training consultation itself and post-training experiences and preferences. The responses were analysed descriptively on an item-by-item basis.ResultsIn total 73 patients completed the survey;77% (n=56/73) were female, and 96% (n=70/73) had no prior experience with a SC MTX auto-injector pen. The training was completed by telephone for 92% (n=67/73) of patients and by VC for 8% (n=6/73). 99% (n=72/73) received a PIP in advance of their training consultation and 92% (n=67/73) received this by post. 67% (n=49/73) of patients strongly agreed and 26% (n=19/73) agreed that they felt prepared for the training after receiving the PIP;78% (n=57/73) of patients strongly agreed and 22% (n=16/73) agreed that it was easy to read and understand, whilst 52% (n=38/73) strongly agreed and 32% (n=23/73) agreed that the PIP was helpful and did not require additional instructions before the appointment. 84% (n=61/73) took 15 minutes or less to complete the training with their HCP. None of the participants felt confused or did not understand the training instructions from their HCP, 78% (n=57/73) strongly agreed and 19% (n=14/73) agreed that the remote training was helpful and made them feel more confident to use the injector pen on their own and 97% (n=71/73) did not need to contact their HCP for more training or advice following their appointment. When asked about the main advantages of remote training, 32% (n=23/73) agreed it was more convenient, 25% (n=18/73) agreed that it was time saving and 30% (n=22/73) agreed that not having to attend the hospital was beneficial. 85% (n=62/73) strongly agreed and 14% (n=10/73) agreed that they were satisfied with the remote training provided and 82% (n=60/73) strongly agreed and 18% (n=13/73) agreed that they would recommend the remote training to another patient.ConclusionThese findings provide new insight into patients' experiences with self-injection training when delivered remotely by their HCP. The patient information pack and training consultation were well received as most patients found it helpful, convenient and time saving.References:NIL.AcknowledgementsThis survey was funded by Nordic Pharma. Medical writing support was provided by Angie Bonsu of Open Health and funded by Nordic Pharma.Disclosure of InterestsShannon McCourt Grant/research support from: Nordic Pharma, Mano Andiappan Employee of: Open Health who were paid by Nordic Pharma to support the work described in the .

Isometric thumb extension exercise as part of a multimodal intervention for de Quervain's syndrome: A randomised feasibility trial

Introduction: de Quervain's syndrome is a painful condition commonly presented to hand therapists. Exercise is utilised as an intervention, but isometric exercise has not been investigated. We aimed to assess the feasibility and safety of isometric thumb extension exercise for de Quervain's syndrome and to explore differences between high-load and low-load isometric exercise. Method(s): This parallel-group randomised clinical feasibility trial included individuals with de Quervain's syndrome. All participants underwent a 2 week washout period where they received an orthosis, education, and range of motion exercises. Eligible participants were then randomised to receive high or low-load isometric thumb extension exercises, performed daily for 4 weeks. Feasibility and safety were assessed by recruitment and drop-out rates, adherence, adverse events, and participant feedback via semi-structured interviews. Secondary outcomes included patient-reported outcomes for pain and function, and blinded assessment of range of motion and strength. Result(s): Twenty-eight participants were randomised. There were no drop-outs after randomisation, and no serious adverse events. Adherence to exercise was 86.7%, with 84% of participants stating they would choose to participate again. There were clinically and statistically significant improvements in pain and function over time (p < 0.001) but not in range of motion or strength. There were no statistically significant between-group differences. Conclusion(s): Isometric thumb extension exercise within a multimodal approach appears a safe and feasible intervention for people with de Quervain's syndrome. A large multi-centre trial would be required to compare high- and low-load isometric exercises. Further research investigating exercise and multimodal interventions in this population is warranted.Copyright © The Author(s) 2023.

Assessing the Effect of Telemedicine Implementation on Patient Satisfaction With and Adherence to Gynecologic Appointments

INTRODUCTION: The COVID-19 pandemic led to a rapid increase in telemedicine visits to ensure delivery of essential health services while minimizing infection exposure. While there have been studies related to telemedicine in other specialties, there is a paucity of data assessing the effect of telemedicine visits in gynecology. The purpose of this study is to evaluate whether and how implementation of telemedicine affects patient adherence to and satisfaction with scheduled gynecologic appointments. METHODS: A retrospective review of 1,170 patients who participated in gynecologic telemedicine visits and 5,303 patients who participated in in-person gynecologic visits between March 1, 2020, and December 1, 2021, was performed to evaluate demographic information, chief complaint, and visit attendance. A cross-sectional survey of 1,248 patients who participated in gynecologic telemedicine visits between these dates was also performed to evaluate perceptions of satisfaction, access, quality and safety, and convenience of telemedicine. Institutional review board exempt protocol HP-00099093. RESULTS: The average no-show rate for gynecologic telemedicine visits was 2% compared to 22% for in-person gynecologic visits (P <.001). 33/1,249 patients responded to the survey. Sixty-nine percent (23/33) of survey respondents were satisfied with telemedicine visits. CONCLUSION: This study supports the continued incorporation of telemedicine into standard gynecologic practice to increase patient adherence with visits. Our gynecologic telemedicine no-show rates are significantly lower than patients' overall no-show rates for in-person visits. These outcomes may be associated with patients' satisfaction with telemedicine visits because of their being convenient, time saving, and less disruptive to their day. [ FROM AUTHOR] Copyright of Obstetrics & Gynecology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Telemedicine versus traditional consultations in clinical genetics: comparison of patient satisfaction rates

Background/Objectives: Telemedicine is a service delivery model in which credentialed specialists provide care remotely to clients. Data regarding patient satisfaction with telemedicine consultations in the field of clinical genetics, and specifically paediatric genetics is lacking. We aimed to compare patient satisfaction rates from telemedicine versus traditional, face-to-face genetics consultations during the COVID-19 pandemic. Method(s): A cross-sectional survey, sent to 1672 parents of minors (patients<18years), or adult patients, who received counselling through the Tel-Aviv Souraski Medical Center Genetics Institute between 1/1/2020-1/6/2020. Data were collected through REDCap and converted to Microsoft EXCEL Database Program( v16.0) and STATA(v14.1). Result(s): Full responses were collected from 457 patients (27.3%). Of them, 330 patients (72.2%) had face-to-face consultations, 80 (17.5%) were counselled through telemedicine, and 47 had both (10.3%). Satisfaction or high satisfaction were reported in 82.1% in the face-to-face consultation group, while 6.3% were unsatisfied or unsatisfied at all, compared with 82.5% and 11.2% in the telemedicine group, respectively. Differences were insignificant statistically between the two groups. Data were further stratified according to subspecialties. Of total consults, 58 (12.7%) were in paediatric genetics. None of the patients who received paediatric genetics counselling solely through telemedicine were unsatisfied. Seventy-six percent of all patients who were counselled through telemedicine would want to use telemedicine services in the future, while 18.7% are undecided, and 5% do not. Conclusion(s): Telemedicine consultations in the genetics clinic during the COVID-19 pandemic, and specifically in paediatric genetics, were associated with high satisfaction rates, non-inferior to traditional consultations satisfaction rates.

Building an OPAT service ‘without walls': what did we learn on the way?

ContextA collaborative clinical pathway developed between North Bristol NHS Trust (NBT), University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) and Sirona Care and Health under the umbrella of Healthier Together @Home, Bristol North Somerset, and South Gloucestershire Integrated Care System (ICS).Multi-professional team including project management, nursing, pharmacy, infectious disease/microbiology and medical leaders, operational managers, finance, and HR teams collaborated to implement a new system-wide outpatient parental antimicrobial therapy (OPAT) pathway.Issue/ChallengeIssue: System partners had variation in access to OPAT. This was due to the number of staff with appropriate clinical skills (due to turnover and vacancies) available to deliver intravenous (IV) antimicrobials in a person's usual place of care rather than in an acute hospital. System pressures due to capacity not meeting demand, issues with flow and a need to increase elective capacity were significant drivers for change.Challenge: To develop an OPAT pathway with a truly collaborative approach, recognising the different organisations have varying competing services and plans. To develop, through a test and learn approach, an appropriate workforce model and identify additional opportunities to widen the scope of delivery @Home.Assessment of issue and analysis of its causesSystem group formed building on relationships developed through Covid Virtual Ward. Driver diagram completed with clinical and operational leads from the system, developing a shared vision. Clinical audit data alongside pre-existing activity data used to scope demand.Key stakeholders included in the design phase including medical & nursing staff, pharmacy, venous access teams, community nurses, operational managers supporting flow in the hospitals and in the community, project managers, recruitment teams and digital colleagues.Communication plan evolved to support teams understanding of the new pathway and its benefits. Additionally, this supported promotion of the service and helped gain executive support.ImpactBetween November 2021 and June 2022 (8 months) the integrated OPAT model received 160 referrals requiring varied levels of interventions from once-a-day administration or elastomeric 24-hour devices to three times a day delivery. Over 1600 bed days (7 full beds). Representing a value for money saving (if beds were used for elective recovery as proposed) of £345,000.The project had a phased approach starting with step down from hospital. The second phase is development of a step-up model, providing alternatives to hospital admission.InterventionThis project has demonstrated how system leadership can work across organisations through collaboration, joint vision with no one organisation in a lead role. Clinical leads from had a clear remit to develop collaborative working and engage the appropriate stakeholders. Multiple styles of leadership were used by different people within the project group helping inclusivity. Diversity of thinking with a multi-professional group helped the project address issues raised during the testing and learning phase and subsequently. Project management has been key, bringing the right people together with good transformation tools.Leadership was demonstrated by different professionals with a less traditional hierarchical structure. This enabled effective challenge and communication to happen to support progression. The 3 nursing teams co-led development of shared pathways and Standard Operating Procedures, taking time to understand other ways of working, whilst sharing knowledge and supervision. This has been particularly useful when supporting some of the more ‘wicked' problems such as sharing of information, handover, and governance without a shared electronic patient recordInvolvement of stakeholders, such as patients, carers or family members:Patient reported experience (n=48 to date) highlights high levels of satisfaction:Based on the care you, received, how would you rate the service? (Scale 1 â€' 10 high) 9 4 meanHow likely are you to recommend the service? (Scale 1-5 high) 4.6 meanKey MessagesSupportive, Compassionate and collaborative leadership, not competitionPsychological safety harnesses trust and honestyCo-creation of pathways leads to trust, shared knowledge and trainingClinically led meetings support delivery and ensured focus on alignmentDevelopment of a shared governance approach ensures learning from eventsDevelopment of shared communication tools ensured visibility of the serviceMeasurement of improvementPatient satisfaction and increased number of days patients spent at homeStrategy for improvementAn iterative, collaborative process with regular meetings of the core leadership and delivery team to capture lessons learnt, highlighting success and agree actions to resolve challenges.

Improving Healthcare Deserts in Sub-Saharan Africa: A Health Improvement Pilot Study Leveraging a Global, Cloud-Based Telemedicine Platform

Objectives: The objective of this project was to improve healthcare deserts in Sub-Saharan Africa through sustainable knowledge transfer and capacity-building leveraging an advanced cloud-based telemedicine platform. Method(s): In 2022, WTI and its network of partners delivered 2 telehealth devices as part of the effort to create a sustainable platform to address a known health desert in a previously abandoned clinic in the village of Opoji, in the state of Edo, Nigeria. Providers were trained in two cohorts. Global Experts for this project were organized with Providence Health and their Global and Domestic Engagement (GDE) department and trained in telementoring and teleconsulting. Local Specialists were first trained on the platform and then telementored by Global Experts. To better understand the health value outcomes of these interventions, observational research was employed to measure the improvement of patient-to-provider ratios. These ratios were baselined for average patient loads. Result(s): As a result of the pilot, provider-to-patient ratios were improved. Prior to the WTI program, interventions were only available 5% of the time (9 hrs/wk vs 168 hrs/wk), with very basic expertise. After the Opoji Comprehensive Medical Center was reopened and the supporting physicians were scheduled, patients could be seen with a high level of global medical expertise 100% of the time (24 hours per day). Conclusion(s): Telemedicine technology can improve capacity-building in Sub-Saharan Africa with relatively minimal resource allocation in a replicable and scalable manner. Data collection for the pilot did have limitations. The opportunity to collect patient-reported outcomes, including patient satisfaction with telemedicine visits, exists but COVID and other barriers prevented researchers from fully implementing. By mentoring the local specialty hospital staff to deliver care by cloud-based devices, the program has developed an "Africans helping Africans" approach to achieve sustainable capacity building which can be built upon and further researched.Copyright © 2023

The effect of remote fitting technology on hearing aid satisfaction

Background: Telemedicine is a method of providing remote healthcare services and consultations to patients using communication technology. Tele-audiology is a sub-branch of telemedicine. It refers to providing audiology services using telehealth strategies. This study aims to compare the satisfaction of patients who come to the hearing aid center and receive device fitting service and patients who have hearing aid fitting using tele-audiology service. For this purpose, hearing aid users were divided into two groups. The study group consisted of 17 participants (10 male, 7 females;mean age 65.17 +/- 13.88) who continued fitting appointments remotely after the first clinic application, while the control group consisted of 23 participants (10 males, 13 females;mean age 62.17 +/- 18.32) who had all hearing aid fittings performed face-to-face in the clinic. The participant's satisfaction was assessed with The International Outcome Inventory for Hearing Aids Turkiye (IOI-HA-TR) questionnaire because it is practical and can be administered over the phone. Result(s): There were no significant differences in hearing aid satisfaction between those who came to the hearing center and filled out the IOI-HA-TR questionnaire personally and those who completed it through the Remote Care application (p < 0.05). In addition, most of the participants stated that using Remote Care solved their problems (35% very good, 24% good) and they were satisfied with the fitting of their hearing aids with this application (35% good, 29% very good). In addition, 13 out of 17 participants stated that they would pay attention to the "remote fitting" feature when purchasing a new hearing aid (76% very good). Moreover, they would like to continue the fitting using the Remote Care application (65% yes). Conclusion(s): Remote fitting technology via smartphone applications can facilitate the lives of hearing aid users and improve their quality of life in cases of risky conditions such as pandemics, various diseases, and physical limitations.Copyright © 2023, The Author(s).

A Systematic Review Identifying Adverse Health Outcomes and Mortality Rates Associated with Telehealth

Background: The literature supporting telehealth management is growing accelerated by the COVID-pandemic. We hypothesize that there are risks of adverse events associated with telehealth interventions. Methods: A review of PubMed (including MEDLINE), Embase, ISI (Web of Science), VHL/GHL, Scopus, Science Direct, and PsycINFO was conducted for all adverse events associated with telehealth from January 1, 1960 to March 1, 2021. This systematic review and meta-analyses were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Of 5,144 citations 78 published studies met criteria for quality evaluation and underwent full text ion including the qualitative synthesis. Of the 78 included studies 8 were included in the quantitative synthesis resulting in 2 meta-analyses. The results of the meta-analysis suggest that monitoring patients using telehealth techniques is associated with 40% lower mortality risks among patients suffering from heart failure, compared to those who received traditional care. The results of the random-effects meta-analysis showed the pooled relative risk of mortality to be 0.60, indicating that patients that underwent telemonitoring had a lower mortality risk compared with the patients that underwent usual care. Among patients with heart implants, patients who received telemonitoring had a 35% lower mortality risk compared to patients receiving traditional care. Conclusions: While RCTs of telehealth interventions demonstrate enhanced patient outcomes in a number of studies and pave the way to evidence-based practice, the heterogeneity of the research questions suggest an important need for more complementary studies with consistent outcome assessments.

Comparison of Patient Perception and Satisfaction of Face-to-Face Versus Telemedicine Encounters in Hand Surgery.

BACKGROUND: The coronavirus disease 2019 (COVID-19) surge has enabled the widespread usage of telemedicine (TM) and presents a unique opportunity to determine the hand surgery patients' perception of care using validated patient satisfaction scores. METHODS: Electronic surveys were distributed to patients aged 18 years and older who underwent a video TM encounter with a single surgeon at an academic medical center during the initial COVID-19 surge (March 23 to October 22, 2020). The study-specific questions were derived from the Press Ganey (PG) Medical Practice TM Survey and compared with institutional PG Outpatient Medical Practice Survey data. Three cohorts were defined: pre-COVID face-to-face, post-COVID TM, and post-COVID face-to-face. RESULTS: Thirty of 65 TM patients (46.2%) responded. No differences in sex, age, or visit type were identified between cohorts. The TM cohort was more likely to live greater than 300 miles from the institution. Median response for all cohorts for the PG care provider and overall experience responses were "very good," and no differences were identified between cohorts. Patient satisfaction with their TM experience was high with median satisfaction scores for arranging and connecting to a TM visit, talking with the provider over a video connection, and having the provider understand the clinical problem were "very good." Patients in the TM cohort reported no difference in preference for face-to-face or TM visits. CONCLUSIONS: Patients are satisfied with TM as a substitute for face-to-face visits suggesting that TM can possibly be used to deliver comparable patient experience for hand surgery encounters.