Evaluation of multi-level barriers and facilitators in a large diabetic retinopathy screening program in federally qualified health centers: a qualitative study.

BACKGROUND: Recommended annual diabetic retinopathy (DR) screening for people with diabetes has low rates in the USA, especially in underserved populations. Telemedicine DR screening (TDRS) in primary care clinics could expand access and increase adherence. Despite this potential, studies have observed high variability in TDRS rates among clinics and over time, highlighting the need for implementation supports. Previous studies of determinants of TDRS focus on patients' perspectives, with few studies targeting upstream multi-level barriers and facilitators. Addressing this gap, this qualitative study aimed to identify and evaluate multi-level perceived determinants of TDRS in Federally Qualified Health Centers (FQHCs), to inform the development of targeted implementation strategies. METHODS: We developed a theory-based semi-structured interview tool based on the Consolidated Framework for Implementation Research (CFIR). We conducted 22 key informant interviews with professionals involved in TDRS (administrators, clinicians, staff). The interviews were audio-recorded and transcribed verbatim. Reported barriers and facilitators were organized into emergent themes and classified according to CFIR constructs. Constructs influencing TDRS implementation were rated for each study site and compared across sites by the investigators. RESULTS: Professionals identified 21 main barriers and facilitators under twelve constructs of the five CFIR domains. Several identified themes were novel, whereas others corroborated previous findings in the literature (e.g., lack of time and human resources, presence of a champion). Of the 21 identified themes, 13 were classified under the CFIR's Inner Setting domain, specifically under the constructs Compatibility and Available Resources. Themes under the Outer Setting domain (constructs External Incentives and Cost) were primarily perceived by administrators, whereas themes in other domains were perceived across all professional categories. Two Inner Setting (Leadership Engagement, Goals and Feedback) and two Process (Champion, Engaging) constructs were found to strongly distinguish sites with high versus low TDRS performance. CONCLUSIONS: This study classified barriers and facilitators to TDRS as perceived by administrators, clinicians, and staff in FQHCs, then identified CFIR constructs that distinguished high- and low-performance clinics. Implementation strategies such as academic detailing and collection and communication of program data and successes to leadership; engaging of stakeholders through involvement in implementation planning; and appointment of intervention champions may therefore improve TDRS implementation and sustainment in resource-constrained settings.

Using telepsychology to provide a group parenting program: A preliminary evaluation of effectiveness.

Telepsychology offers the potential to reach rural and underserved children and families with mental health concerns. The current study evaluated the effects of using videoconferencing technology to deliver an evidence-based parenting program, the Group Triple P Positive Parenting Program (Group Triple P; Turner, Markie-Dadds, & Sanders, 2002), with families who had a child experiencing behavioral problems. Using a pre/post design, families (N = 13) from low socioeconomic backgrounds in Kentucky completed the Group Triple P via a videoconferencing delivery format. A benchmarking strategy (Weersing & Hamilton, 2005) indicated that treatment effect sizes for the videoconferencing format were generally comparable to treatment effect sizes for Group Triple P studies conducted in-person. Specifically, child behavior and parenting outcomes were similar across delivery formats. Implications of the study's findings and future directions for telepsychology research and practice with underserved families and children are discussed.

Telehealth for underserved families: an evidence-based parenting program.

Families with a child diagnosed with attention-deficit hyperactivity disorder completed an 8-session parenting program, the Group Triple P Positive Parenting Program, provided by videoconferencing technology. Families reported improved child behavior (effect size of d = -1.23) and decreased parent distress (d = -0.34). Parent training implemented with videoconferencing technology can be an effective way of delivering evidence-based services to families with specialized needs.

Telemedicine: a child psychiatry case report.

The topic addressed is the use of telemedicine involving a rural health care setting and child clinical services provided through an innovative model of telehealth applications. Telehealth technology and services have gained the attention of both scientists and practitioners examining trends and models of health care delivery for underserved populations and in situations where consultation with a team of professionals may benefit service providers in rural communities. Examined is an innovative model of telehealth care delivery through a rural school system in an underserved regional setting. The goals of this model are offered, as are a number of applications within the broad spectrum of services utilizing telehealth. Changing patterns in clinically based health care delivery in a managed care environment are discussed.