The technology acceptance model and beyond: factors influencing physicians' intention to use teleconsultations

Background/Aims: The COVID-19 pandemic accelerated the implementation of telehealth and virtual care services. Clinicians must be comfortable using this technology in order for it to be developed effectively and implemented consistently. This study evaluated the influence of various factors, including those theorised in the technology acceptance model, on physicians' intention to use teleconsultations in their clinical practice in Chennai, India. Methods: A snowball sampling method was used to distribute an online survey to physicians in Chennai, India. The survey measured respondents' intention to use teleconsultations (dependent variable), along seven independent variables relating to this technology (perceived usefulness, perceived ease of use, physicians' attitudes, social influences, facilitating conditions, perceived compatibility with the clinical area and trust). A total of 165 responses were collected. Results were analysed using descriptive and correlational statistics, along with multiple linear regression. Results: All seven independent variables were found to be significantly associated with the dependent variable (P<0.01). Multiple linear regression analysis indicated that the independent variables accounted for 67.8% of the variance in respondents' intention to use teleconsultations. Conclusions: Physicians' intention to use teleconsultations is complex and multi-faceted. Although the factors theorised by the technology acceptance model were significantly associated with intention to use telemedicine, other factors were also found to be important, including social influences, external facilitating factors, perceived compatibility with the clinical area and personal trust in technology.

Social service providers under COVID-19 duress: adaptation, burnout, and resilience

Summary : This article examines the response of social services organizations and their workers to the COVID-19 pandemic in a northeastern U.S. state. Using an exploratory, cross-sectional survey design with a convenience sample (N = 1472), we ask: (1) how did agencies and social service workers manage service disruptions associated with COVID-19;(2) how did social service workers perceive shifts in clients' needs;(3) how did social service workers experience the transition to remote interactions with clients;and (4) how did social service workers cope with COVID-related transitions and demands. Findings : Our findings tell a story of unprecedented crises alongside powerful attempts at adaptation, innovation, and resilience. Faced with extraordinary need among their clients, fears for their own health, and a breakdown of organizational and community functioning and guidance, social workers were able to learn and implement new technologies, adapt to increasing demands, manage new work-life boundaries, and find ways to address gaps in service while experiencing symptoms of burnout. Application : The impact of supervisory and administrative fragmentation and communication breakdowns in the face of crisis put social workers in an untenable position despite surprising abilities to adapt, innovate, and manage their professional lives while under duress. Assuring better supervisory/administrative infrastructure to support workers as they deliver services during crises will help in future crises.

Social Workers Response to Domestic Violence and Abuse during the COVID-19 Pandemic

The rapid global spread of COVID-19 has put increased pressure on health and social service providers, including social workers who continued front line practice throughout the pandemic, engaging with some of the most vulnerable in society often experiencing multiple adversities alongside domestic violence and abuse (DVA). Movement restrictions and stay-at-home orders introduced to slow the spread of the virus, paradoxically leave these families at even greater risk from those within the home. Utilising a survey methodology combining both open- and closed-ended questions, this study captured a picture of social work practice in Ireland with families experiencing DVA during the early waves of the COVID-19 pandemic. Findings highlight both the changes and challenges in work practices and procedures that limit social work assessment and quality contact with families, changes to the help-seeking behaviours from victims/survivors, as well as emerging innovative practice responses with enhanced use of technology. Implications for practice include an increased awareness of the risk and prevalence of DVA accelerated by the pandemic. Conclusions assert that social work assessment and intervention with families experiencing DVA must remain adaptive to the changing COVID-19 context and continue to develop innovative practice approaches.

Administrators and Students on E-Learning: The Benefits and Impacts of Proper Implementation in Nigeria

The quest for better education and knowledge acquisition has triggered the introduction, acceptance and incorporation of e-learning into Nigerian learning. The introduction of the concept of e-learning to Nigerian learning can be dated back to the 1980s, when reputable Nigerians enrolled in several universities in London. In addition, the introduction of e-learning to a premier university in Nigeria, rooted in the college of Ibadan, led to greater interest, causing locals to seek extramural work and other studies at Oxford University. This study examines the impacts that proper educational administration, policy making and implementation, as well as the adoption of e-learning, can have to fix the dilapidated Nigerian educational structure. A quantitative method of data collection was used, through well-structured questionnaires for both administrators and students issued to the four universities sampled in this study. A total of 240 questionnaires were issued to respondents, with 60 each to the different universities and with 30 each for both students and administrators. A total of 180 were retrieved, and descriptive analysis was carried out with SPSS (23). Internal consistency was determined with Cronbach’s alpha, having an internal consistency of 0.78. The findings show that all the administrators were graduates with a minimum of a Bachelor’s degree. It was revealed that 32 (17.8%) of the students possessed smartphones as gadgets for e-learning and that administrators contributed to the enhancement of student performance, hence creating impacts in their examination grades, with a mean of 2.66, being rated ‘Good’ for their performance. Unfavorable government policies and unprofessionalism of administrators in e-learning implementations were the major constraints, with a mean of 4.6. The cost of the procurement of the needed resources (data) for e-learning also impacts e-learning. Internet resources used by the students contributed to huge success in e-learning for 28 (24.6%) and 24 (21.9%) students. Although the constraints limit the effectiveness of e-learning in Nigeria, it also impacts student advancement compared with the face-to-face learning process. The government’s proactive measures will improve e-learning.

Rehabilitations- und Vorsorgeeinrichtungen in der Corona-Krise: Situation und postpandemische Perspektive

Background During the early phase of the Corona pandemic (March to July 2020) rehab clinics were supposed to stop offering rehab treatment in order to be ready for admitting low-care patients from acute hospitals. On the other hand, acute care hospitals postponed elective interventions for the benefit of Corona patients and rehab patients denied treatment due to the fear of becoming infected. As a consequence a loss in revenue turns out while additional costs for infection protection management arose simultaneously. Methodology Aim of the study was to specify the economic risks of rehab facilities caused by the pandemic as well as the increasing medical requirements. Based on a structured questionnaire 97 rehab providers were polled referring to e. g. the „medical treatment situation", the „revenue development", the „cost pressure" and the „effects of supporting activities of the government". Results The revenue of rehab clinics collapsed intermittently up to 70 % compared to the previous year. Simultaneously, additional costs of 349 € per patient and employee per treatment cycle (21 days) accumulated due to decreed infection prevention arrangements. This unplanned cost burden corresponds roughly to 13 % of the revenue per case. The decline of rehab treatments under the pandemic will lead on to an exaggerated demand of medically necessary treatments in future. This congestion of non-performed rehab treatments is prognosed to exceed 20 % to 25 % of the rehab treatments performed in 2019. In 29 % of the facilities the shortage of personal protective equipment was associated with dysfunctional workflows and endangerment of patients suffering an infection. 71 % of the rehab facilities stated not to have benefitted from the procurement initiative of the German Ministry of Health. Discussion The Corona pandemic has reinforced the economic vulnerability of many rehab providers. This, due to additional costs for infection prevention activities, revenue losses owing to reduced occupancy and because of an investment bottleneck accumulated over years. Furthermore, the reimbursement system is complained not to cover the total costs of treatment in an economically sufficient way. Necessary investments in infection protection are a cost-driver but also lead to a factual impairment of treatment capacity. As a consequence, a piling up of medically essential rehab treatment is assumed to happen and will effect an increasing disease burden in the health system. Core Message The risk of insolvency has enhanced for rehab facilities due to the pandemic. Simultaneously, medical requirements have arisen and cost pressure has become more intensive. Because rehabilitation to play a pivotal role in public services the reimbursement system of the rehab sector is urged to be changed. One strong opinion requires to finance the costs of keeping rehab facilities. Indeed, this financing approach should be based on an assessment of the rehab demand. Furthermore, the operating costs are advised to be paid depended on medical quality, physical condition of the patient and the complexity of treatment. Zusammenfassung: Hintergrund Bereits in den ersten 6 Monaten der Pandemie erlitten die Rehabilitations- und Vorsorgeeinrichtungen massive Erlöseinbußen. Dies einerseits durch die Aussetzung von Heilverfahren und Nachsorgeangeboten sowie die Verpflichtung, im Bedarfsfall verlegbare Patienten aus Akutkrankenhäusern zu übernehmen;andererseits führte die Verschiebung elektiver Eingriffe zugunsten der prioritären Behandlung von Covid-19-Patienten in den Akuthäusern sowie die Angst von Reha-Patienten vor einer Infektion zu einem Nachfragerückgang. Demgegenüber entstanden erhebliche Zusatzkosten durch die Organisation infektionssicherer Arbeitsabläufe sowie die Beschaffung von Produkten der persönlichen Schutzausrüstung (PSA) auf einem überhitzten freien Markt. Das Insolvenzrisiko für die Reha-Einrichtungen erhöhte sich. Methoden Ziel der Studie war es, die ökonomischen und ablauforganisatorischen Konsequenzen sowie die Infektionsrisiken für Personal und Patienten einer Unterversorgung mit PSA-Produkten im Bereich der Rehabilitation zu ermitteln sowie die Effektivität staatlicher Eingriffe bei der Beschaffung von PSA-Produkten zu reflektieren. Durchgeführt wurde im Zeitraum 25. bis 28. Woche 2020 eine Online-Befragung unter 79 Einrichtungen mittels strukturiertem Fragebogen, u. a. spezifiziert nach den Erhebungsbereichen „Versorgungssituation bei PSA-Produkten", „Umgang mit PSA-Versorgungsengpässen", „Ertragssituation", „Zusatzkosten" und „Wirksamkeit staatlicher Hilfsmaßnahmen". In weiteren 18 Einrichtungen wurden Einzelinterviews zur Praxis des Pandemie-Managements vor Ort geführt. Die Erhebung wurde auf orthopädische, kardiologische und neurologische Einrichtungen konzentriert. Ergebnisse Der Umsatz der Einrichtungen ging um zeitweise bis zu 70 % gegenüber dem Vorjahr zurück, gleichzeitig erhöhten sich die Kosten für Infektionsprophylaxe um durchschnittlich 349 € pro Patient und Mitarbeiter pro Behandlungszyklus (21 Tage), was etwa 13 % des Fall-Erlöses bedeutete. Durch den Rückgang bei Patientenbehandlungen während der Pandemie baute sich ein Behandlungsstau auf, der zwischen 20 und 25 % der Reha-Leistungen des Jahres 2019 entspricht und die Krankheitslast im Gesundheitssystem zukünftig erhöhen wird. Der Mangel an Schutzausrüstung führte in 29 % der Einrichtungen zu erschwerten Arbeitsabläufen mit Infektionsgefährdung für Patienten und Mitarbeitende. Von der Beschaffungsinitiative des Bundesministeriums für Gesundheit fühlten sich 71 % der Einrichtungen nicht versorgt. Diskussion Die Corona-Pandemie hat die Anfälligkeit zahlreicher Reha-Einrichtungen für eine wirtschaftliche Schieflage verstärkt. Ursache dafür sind pandemiebedingte Zusatzkosten, Erlösausfälle aufgrund von Belegungsrückgängen und ein Investitionsstau in zahlreichen Einrichtungen. Notwendige Maßnahmen des Infektionsschutzes erhöhen nicht nur die Kostenbelastung, sondern vermindern faktisch die verfügbare Behandlungskapazität. Als Konsequenz ist ein Behandlungsstau zu erwarten, der mit erhöhter Krankheitslast im Gesundheitssystem verbunden sein wird. Kernbotschaft Das Insolvenzrisiko hat sich für Rehabilitations- und Vorsorgeeinrichtungen durch die Corona-Krise erhöht, gleichzeitig sind die Anforderungen an medizinische Qualität und Infektionsschutz ebenso wie die Vorhalte- und Behandlungskosten gestiegen. Eine Reform der Refinanzierung von Reha-Leistungen ist notwendig: Dies betrifft die Finanzierung von Vorhaltekosten von Reha-Einrichtungen als Teil der Daseinsvorsorge. Hier ist allerdings eine versorgungsstrukturelle und institutionenorientierte Bedarfsermittlung vorzuschalten, um Mitnahmeeffekten vorzubeugen. Weiterhin ist die Vergütung der Betriebskosten qualitäts- und aufwandorientiert am Krankheitsbild und am Patientenzustand vorzunehmen.

Access as an enabler and an obstacle to nurses' use of ICT during the COVID-19 pandemic: Results of a national survey

The COVID-19 global pandemic has altered the way people in Aotearoa New Zealand live, work, play, and access healthcare, and this has included an increase in the use of technology. The aim of this exploratory study was to understand Aotearoa New Zealand nurses' use of technology during the COVID-19 lockdown, in particular what information and communication technologies (ICT) was being used and how nurses felt about using ICT in their practice. An anonymous online survey, utilising both open and closed-ended questions, was selected as an appropriate and safe data collection method during the pandemic. Snowball sampling was used with an online survey that was sent out during the level 3 lockdown (from March to May 2020) via social media and existing email networks and so potentially dispersed to nurses throughout Aotearoa New Zealand. In total 220 responses were received. The results were analysed using descriptive statistics, and open-ended qualitative comments were thematically analysed. The key finding was that there were significant access issues related to nurses using ICT in their practice: Access to information technology systems and resources, access to technical support, access to connectivity (particularly for those working from home in rural communities) and access to patients and colleagues. As predicted, this study has identified areas for future exploration but highlights Aotearoa New Zealand nurse's ability and willingness to embrace technology to better meet the needs of their patients.