Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory Mixed-Methods-Study (Preprint)

2021 ◽  
Author(s):  
Felix Muehlensiepen ◽  
Johannes Knitza ◽  
Wenke Marquardt ◽  
Susann May ◽  
Martin Krusche ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Quantitative Research ◽  
Information Needs ◽  
Musculoskeletal Diseases ◽  
Mixed Methods Study ◽  
Personal Contact ◽  
Main Concern ◽  
Exact Integration ◽  
Survey Results

BACKGROUND The global burden of rheumatic and musculoskeletal diseases (RMDs) is rising. Professional ressources in rheumatology are scarce. The use of telemedicine could improve access to RMD care. Despite all its promises, telemedicine is still not widely implemented in RMD care. OBJECTIVE To investigate opportunities, barriers, acceptance, and preferences concerning telemedicine among RMD patients and professional stakeholders involved in RMD patient management. METHODS From November 2017 to December 2019 a participatory mixed-methods-study was conducted based on three parts: (1) qualitative expert interviews with RMD patients and professional stakeholders that were used to participatively design (2) a national paper-based patient survey. The survey results were hence discussed in (3) focus groups with patient representatives and rheumatologists. RESULTS Fifteen patients and 26 professional stakeholders participated in the qualitative and further 766 patients took part in the quantitative research. The qualitative interview data reveals opportunities and barriers from the patients' (n=5) and professional stakeholders’(n=23) perspectives: Patients appreciate the potentials of telemedicine to overcome space and time in health care. In contrast, the loss of personal patient-doctor contact is the main concern of patients regarding telemedicine use. Personal contact is equated with physical face-to-face contact, which could be reduced by implementing telemedicine, thus negatively influencing the patient-doctor relationship. Professional stakeholders expect telemedicine to contribute to effective allocation of scarce resources in rheumatology care. This is countered by the absence of physical examinations and organizational challenges as barriers of the use of telemedicine. Both, patients and professional stakeholders describe telemedicine as something broad and complex to define. These qualitative findings align with the survey results: 38% (264/690) of the surveyed patients refuse to try telemedicine, 32% (216/690) are not sure, and 30% (210/690) would like to try telemedicine. ‘No personal contact with the doctor’ (64%, 220/346) was most frequently chosen as a reason against telemedicine, followed by ‘Data security’ (28%, 96/346). Patients prefer to use the telephone (60%, 206/341) over video-consultations (35%, 118/341) as telemedicine use cases. Only 2 (0.3%, 2/714) survey participants indicated that they already had a video consultation with their physician. The focus groups revealed a homogeneous spectrum of opinions with participants confirming the survey results. Patients (n=10) emphasize the high relevance of physical doctor-patient contact. Rheumatologists (n=4) highlight the potential of telemedicine, as a support of existing care structures. However, the exact integration of telemedicine into medical routines remains unclear, especially in view of scarce time resources in rheumatology care. CONCLUSIONS As digital transformation of rheumatology care progresses, the desire for a close patient-doctor relationship persists. Many study participants fear that the use of telemedicine will have negative effects on patient-doctor relationship and therefore oppose the use of telemedicine. We identified further barriers and opportunities, such as information needs, digital infrastructure and equipment requirements, and patient preferences on the composition of digital services, to guide the design and implementation of telemedicine in rheumatology care.

scholarly journals Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study

2021 ◽  
Vol 18 (24) ◽  
pp. 13127
Author(s):  
Felix Muehlensiepen ◽  
Johannes Knitza ◽  
Wenke Marquardt ◽  
Susann May ◽  
Martin Krusche ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Musculoskeletal Diseases ◽  
Patient Survey ◽  
Routine Care ◽  
Mixed Methods Study ◽  
Personal Contact ◽  
Exact Integration ◽  
Scarce Resources ◽  
Organizational Challenges ◽  
Patient Representatives

Despite all its promises, telemedicine is still not widely implemented in the care of rheumatic and musculoskeletal diseases (RMDs). The aim of this study is to investigate opportunities, barriers, acceptance, and preferences concerning telemedicine among RMD patients and professional stakeholders. From November 2017 to December 2019, a participatory, mixed-methods study was conducted, consisting of (1) expert interviews (n = 27) with RMD patients and professional stakeholders, (2) a national paper-based patient survey (n = 766), and (3) focus groups (n = 2) with patient representatives and rheumatologists. The qualitative findings indicate that patients equate personal contact with physical face-to-face contact, which could be reduced by implementing telemedicine, thus negatively influencing the patient–doctor relationship. Correspondingly “no personal contact with the doctor” is the main reason (64%) why 38% of the surveyed patients refuse to try telemedicine. Professional stakeholders expect telemedicine to contribute to the effective allocation of scarce resources in rheumatology care. The main barriers reported by stakeholders were the scarcity of time resources in RMD care, the absence of physical examinations, and organizational challenges associated with the implementation of telemedicine in RMD care. While the exact integration of telemedicine into routine care has yet to be found, the consequences on the patient-physician relationship must be permanently considered.

Uncertainty about cellulitis and unmet patient information needs: a mixed methods study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697349
Author(s):  
Anna Lalonde ◽  
Emma Teasdale ◽  
Ingrid Muller ◽  
Joanne Chalmers ◽  
Peter Smart ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Information Needs ◽  
Qualitative Data ◽  
Information Provision ◽  
Mixed Methods Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Face To Face ◽  
Patient Information Needs ◽  
History Of

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.

scholarly journals An intervention to decrease burnout and increase retention of early career nurses: a mixed methods study of acceptability and feasibility

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Judy Brook ◽  
Leanne M. Aitken ◽  
Julie-Ann MacLaren ◽  
Debra Salmon
Keyword(s):  
Mixed Methods ◽  
Nursing Students ◽  
Focus Groups ◽  
Academic Staff ◽  
Skills Training ◽  
Early Career ◽  
Mixed Methods Study ◽  
Healthcare Organisation ◽  
Structured Interviews ◽  
Over Time

Abstract Aims To understand the experiences of nursing students and academic staff of an intervention to decrease burnout and increase retention of early career nurses, in order to identify acceptability and feasibility in a single centre. Background Internationally, retention of nurses is a persistent challenge but there is a dearth of knowledge about the perspectives of stakeholders regarding the acceptability and feasibility of interventions to resolve the issue. This study reports an intervention comprising of mindfulness, psychological skills training and cognitive realignment to prepare participants for early careers as nurses. Methods This is an explanatory sequential mixed methods study, conducted by a UK university and healthcare organisation. Participants were final year pre-registration nursing students (n = 74) and academics (n = 7) involved in the implementation of the intervention. Pre and post measures of acceptability were taken using a questionnaire adapted from the Theoretical Framework of Acceptability. Wilcoxon Signed Ranks test was used to assess change in acceptability over time. Qualitative data from semi-structured interviews, focus groups and field notes were thematically analysed, adhering to COREQ guidelines. Data were collected February to December 2019. Results One hundred and five questionnaires, 12 interviews with students and 2 focus groups engaging 7 academic staff were completed. The intervention was perceived as generally acceptable with significant positive increases in acceptability scores over time. Student nurses perceived the intervention equipped them with skills and experience that offered enduring personal benefit. Challenges related to the practice environment and academic assessment pressures. Reported benefits align with known protective factors against burnout and leaving the profession. Conclusion Planning is needed to embed the intervention into curricula and maximise relationships with placement partners. Evaluating acceptability and feasibility offers new knowledge about the value of the intervention for increasing retention and decreasing burnout for early career nurses. Wider implementation is both feasible and recommended by participants.

scholarly journals Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study

2020 ◽  
Vol 8 (15) ◽  
pp. 1-256
Author(s):  
Alicia O’Cathain ◽  
Emma Knowles ◽  
Jaqui Long ◽  
Janice Connell ◽  
Lindsey Bishop-Edwards ◽  
...  
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
General Practitioner ◽  
Health Service ◽  
Health Services ◽  
Focus Groups ◽  
Emergency Departments ◽  
Help Seeking ◽  
Mixed Methods Study ◽  
Coping Capacity

Background There is widespread concern about the pressure on emergency and urgent services in the UK, particularly emergency ambulances, emergency departments and same-day general practitioner appointments. A mismatch between supply and demand has led to interest in what can be termed ‘clinically unnecessary’ use of services. This is defined by the research team in this study as ‘patients attending services with problems that are classified as suitable for treatment by a lower urgency service or self-care’. This is a challenging issue to consider because patients may face difficulties when deciding the best action to take, and different staff may make different judgements about what constitutes a legitimate reason for service use. Objectives To identify the drivers of ‘clinically unnecessary’ use of emergency ambulances, emergency departments and same-day general practitioner appointments from patient and population perspectives. Design This was a sequential mixed-methods study with three components: a realist review; qualitative interviews (n = 48) and focus groups (n = 3) with patients considered ‘clinically unnecessary’ users of these services, focusing on parents of young children, young adults and people in areas of social deprivation; and a population survey (n = 2906) to explore attitudes towards seeking care for unexpected, non-life-threatening health problems and to identify the characteristics of someone with a tendency for ‘clinically unnecessary’ help-seeking. Results From the results of the three study components, we found that multiple, interacting drivers influenced individuals’ decision-making. Drivers could be grouped into symptom related, patient related and health service related. Symptom-related drivers were anxiety or need for reassurance, which were caused by uncertainty about the meaning or seriousness of symptoms; concern about the impact of symptoms on daily activities/functioning; and a need for immediate relief of intolerable symptoms, particularly pain. Patient-related drivers were reduced coping capacity as a result of illness, stress or limited resources; fear of consequences when responsible for another person’s health, particularly a child; and the influence of social networks. Health service-related drivers were perceptions or previous experiences of services, particularly the attractions of emergency departments; a lack of timely access to an appropriate general practitioner appointment; and compliance with health service staff’s advice. Limitations Difficulty recruiting patients who had used the ambulance service to the interviews and focus groups meant that we were not able to add as much as we had anticipated to the limited evidence base regarding this service. Conclusions Patients use emergency ambulances, emergency departments and same-day general practitioner appointments when they may not need the level of clinical care provided by these services for a multitude of inter-related reasons that sometimes differ by population subgroup. Some of these reasons relate to health services, in terms of difficulty accessing general practice leading to use of emergency departments, and to population-learnt behaviour concerning the positive attributes of emergency departments, rather than to patient characteristics. Social circumstances, such as complex and stressful lives, influence help-seeking for all three services. Demand may be ‘clinically unnecessary’ but completely understandable when service accessibility and patients’ social circumstances are considered. Future work There is a need to evaluate interventions, including changing service configuration, strengthening general practice and addressing the stressors that have an impact on people’s coping capacity. Different subgroups may require different interventions. Study registration This study is registered as PROSPERO CRD42017056273. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.

scholarly journals Burnout, resilience, and perception of mindfulness programmes among GP trainees: a mixed-methods study

BJGP Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. bjgpopen20X101058
Author(s):  
Petra Hanson ◽  
Amy Clarke ◽  
Manuel Villarreal ◽  
Majid Khan ◽  
Jeremy Dale
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Help Seeking ◽  
High Stress ◽  
Mixed Methods Study ◽  
Mindfulness Practice ◽  
Negative Effects ◽  
High Prevalence ◽  
High Level ◽  
And Coping

BackgroundTrainee GPs are at risk of developing burnout as a result of high stress levels. Improving resilience may prevent the negative effects of stress on wellbeing, morale, and patient care, thereby supporting recruitment to general practice.AimTo explore experiences of stress and burnout among GP trainees, and their level of interest in undertaking a mindfulness programme.Design & settingA qualitative study was performed with a cohort of GP trainees in Coventry and Warwickshire.MethodThis mixed-methods study utilised a survey with validated measures to investigate the prevalence of burnout, state of wellbeing, and resilience in GP trainees. Focus groups were also used to explore experiences of stress and burnout, and perceptions of mindfulness practice.ResultsIn total, 47 (response rate 39%) trainees completed the survey and 14 participated in focus groups. There was a high prevalence of disengagement (n = 36; 80%) and emotional exhaustion (n = 35; 77%), with 29 (64%) scoring above the cut-off value for both. While 16 (34%) reported already practising mindfulness, 39 (83%) described interest in engaging in mindfulness practice. The focus groups identified a range of issues relating to how trainees recognise stress and burnout, their help-seeking and coping strategies, the perceived barriers to practising self-care, and motivations for participating in mindfulness training.ConclusionThis study confirms the degree of stress and burnout that GP trainees experience, and their desire for greater wellbeing and resilience support. It identified a high level of interest in attending a mindfulness programme, but also barriers to engagement. Results of this research shaped the Mindful Practice Curriculum programme, which was later provided to this cohort of trainees.

How Marketers Conduct Mixed Methods Research

2016 ◽  
pp. 187-196
Author(s):  
Roger Baran
Keyword(s):  
Qualitative Research ◽  
Mixed Methods ◽  
Middle East ◽  
Focus Groups ◽  
Research Methods ◽  
Mixed Methods Research ◽  
Quantitative Research ◽  
Training And Development ◽  
Market Segments ◽  
Quantitative Research Methods

The complimentary nature of qualitative and quantitative research methods are examined with respect to a study assessing the market's view of a training and development institute in the Middle East. The qualitative portion consisted of focus groups conducted with seven distinct market segments served by the institute. The results proved insightful with respect to uncovering and understanding differences of opinion among the seven groups; however, taken alone, the qualitative research would have been very misleading with respect to the institute's standing in the Middle East.

scholarly journals Does Quantitative Research in Child Maltreatment Tell the Whole Story? The Need for Mixed-Methods Approaches to Explore the Effects of Maltreatment in Infancy

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Samuel Glass ◽  
Ruchika Gajwani ◽  
Fiona Turner-Halliday
Keyword(s):  
Mental Health ◽  
Mixed Methods ◽  
Child Maltreatment ◽  
Quantitative Research ◽  
Qualitative Data ◽  
Quantitative Measurement ◽  
Social Care ◽  
Mixed Methods Study ◽  
Semistructured Interviews ◽  
Qualitative Exploration

Background and Aims.Research on child maltreatment has largely overlooked the under-five age group and focuses primarily on quantitative measurement. This mixed-methods study of maltreated children (N=92) entering care (age 6–60 months) combines a quantitative focus on the associations between care journey characteristics and mental health outcomes with a qualitative exploration of maltreatment in four different families.Methods.Care journey data was obtained from social care records; mental health and attachment assessments were carried out following entry to care; qualitative data comprised semistructured interviews with professionals, foster carers, and parents.Results.Significant associations were found between suspected sexual abuse and increased DAI inhibited attachment symptoms (p=0.001) and between reported domestic violence and decreased DAI inhibited (p=0.016) and disinhibited (p=0.004) attachment symptoms. Qualitative results: two themes demonstrate the complexity of assessing maltreatment: (1) overlapping maltreatment factors occur in most cases and (2) maltreatment effects may be particularly challenging to isolate. Conclusions.Qualitative exploration has underscored the complexity of assessing maltreatment, indicating why expected associations were not found in this study and posing questions for the quantitative measurement of maltreatment in general. We therefore suggest a new categorisation of maltreatment and call for the complimentary research lenses of further mixed-methods approaches.

scholarly journals Characterizing business intelligence tasks, use and users in the workplace

2019 ◽  
Vol 8 (3) ◽  
Author(s):  
Tanja Svarre ◽  
Rikke Gaardboe
Keyword(s):  
Mixed Methods ◽  
Business Intelligence ◽  
Mixed Methods Study ◽  
Survey Results

This paper investigates business intelligence (BI) tasks, use and users in aworkplace setting. The study reports on a mixed methods study of users in three different typesof organisations employing BI. 1052 respondents answered a survey and 15 individual and 3group interviews were conducted to elaborate on the survey results. The study finds that themajority of public BI users are employees, and fewer managers and students, that are handlinga variety of tasks. Although they can experience challenges learning and using the BI system,they are still satisfied with it from different perspectives.

scholarly journals Choice? Factors That Influence Women’s Decision Making for Childbirth

2013 ◽  
Vol 22 (3) ◽  
pp. 171-180 ◽  
Author(s):  
Mary Regan ◽  
Katie G. McElroy ◽  
Kristin Moore
Keyword(s):  
Decision Making ◽  
Qualitative Research ◽  
Mixed Methods ◽  
Focus Groups ◽  
Research Method ◽  
Nursing Practice ◽  
Mixed Methods Study ◽  
Consensual Qualitative Research ◽  
Qualitative Research Method ◽  
Types Of Knowledge

This article reports the findings from a mixed-methods study on factors that influence women’s decisions about birth, with the view that women’s decision making about birth can affect the use of cesarean surgery. Data was collected from focus groups and structured postpartum interviews and was analyzed using the Consensual Qualitative Research method. The findings relate specifically to the factors reported as influential in making decisions about birth including how the women categorized, prioritized, and/or favored certain types of knowledge about modes of birth. Four major information categories were identified but only stories about birth and/or attending a birth appeared to have a lasting effect on birth choices. These findings have implications for prenatal and perinatal education and nursing practice.

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