Considering the Artifact Ecology when Supporting the Evolution of Practices - Analyzing the Parallel Journeys of Two Teleconsultation Software in a General Hospital

The growing use of teleconsultation, especially since the start of the Covid-19 pandemic, changes physicians' work at the hospital. In this paper, we set out to study how physicians have integrated teleconsultation into their healthcare practices. Moreover, we are interested in how teleconsultation software contributes to developing new medical practices and how the design of teleconsultation software can better support them. Based on 16 months of fieldwork in a general hospital that offers two different teleconsultation software, we have investigated teleconsultation practices through interviews and observations involving ten physicians doing teleconsultation and a telemedicine secretary. Unlike the existing informal remote care by phone, we observe that teleconsultation supports new formal healthcare practices, particularly for patient care management and inter-organizational cooperation. While analyzing the integration of teleconsultation in physicians' practices, we highlight that both pieces of software do not support those practices on equal terms according to their design. We argue that teleconsultation software design can limit the spread of these new healthcare practices and that the artifact ecology of physicians should be considered during the design process.

Tele-Audiology: Current State and Future Directions

The importance of tele-audiology has been heightened by the current COVID-19 pandemic. The present article reviews the current state of tele-audiology practice while presenting its limitations and opportunities. Specifically, this review addresses: (1) barriers to hearing healthcare, (2) tele-audiology services, and (3) tele-audiology key issues, challenges, and future directions. Accumulating evidence suggests that tele-audiology is a viable service delivery model, as remote hearing screening, diagnostic testing, intervention, and rehabilitation can each be completed reliably and effectively. The benefits of tele-audiology include improved access to care, increased follow-up rates, and reduced travel time and costs. Still, significant logistical and technical challenges remain from ensuring a secure and robust internet connection to controlling ambient noise and meeting all state and federal licensure and reimbursement regulations. Future research and development, especially advancements in artificial intelligence, will continue to increase tele-audiology acceptance, expand remote care, and ultimately improve patient satisfaction.

Advantages and Limits of Remote Care and Stress Management Experienced by Mothers of Students with Specific Learning Disabilities During the Covid-19 Period

These instructions give you guidelines for preparing papers. Use this document as a template if you are using Microsoft Word. Otherwise, use this document as an instruction set.. Define all symbols used in the abstract. Do not cite references in the abstract. Do not delete the blank line immediately above the abstract; it sets the footnote at the bottom of this column. Page margins are 1,78 cm top and down; 1,65 cm left and right. Each column width is 8,89 cm and the separation between the columns is 0,51 cm. Abstract-Introduction : The period of confinement due to the COVID-19 pandemic has harmful consequences on the psychological state of parents and their children, especially those with psychological or neurocognitive problems. The care of these children plays a primordial role in their development, particularly during the COVID-19 period. For this reason, our objective is to assess the state of stress among mothers of children with learning disabilities during the COVID-19 period in Morocco, as well as the support of these children. Materials and methods : This is a cross-sectional study that was conducted during the period from April to June 2020. To realise it, we used a investigation form which contains three parts. To evaluate the state of stress in mothers, we used the "PSS10d" scale adapted to the Moroccan context. The target population is composed of mothers of children with learning disabilities who are being monitored by Moroccan Association for Learning Disorders and Difficulties (MALDD) in Casablanca. Results : During the period of confinement, only 13% (n=15) of mothers reported that their children "Dys" had benefited from remote remediation by specialists According to the Odds Ratio calculation, the risk factors influencing the care of "Dys" children during this period of confinement are: lack of cooperation from the child (Odds Ratio= 16.8; IC95%=[3.5-79]). 1]; P-value=0.001), the educational level of mothers (Odds Ratio= 9.4; IC95%=[2.4-35.7]; P-value=0.001), the economic situation (Odds Ratio= 5.1; IC95%=[1.5-17.4]; P-value=0.01) and technical problems (Odds Ratio= 5.1; IC95%=[1.5-17.4]; P-value=0.01). Conclusion : According to our results, we noticed that the psychological state of the mothers is influenced by the remote care of the "Dys" children. For this the responsible authorities in Morocco must support this population.

Healthcare professionals' experience of performing digital care visits - a scoping review

Background: The use of patient initiated digital care visits has been increasing and even more so in the era of the Coronavirus (COVID-19) pandemic. Learning more about healthcare professionals’ experience of using such technology would provide valuable insight and a basis for improvement of digital visits.Aim: This study sought to explore the existing literature on healthcare professionals’ experience of performing digital care visits.Methods: A scoping review was performed following Arksey & O’Malley’s proposed framework and utilizing the Preferred Reporting Items for Systematic reviews and Meta-Analyses – Extension for Scoping Reviews (PRISMA-ScR) checklist. Three large databases – PubMed, Web of Science and IEEE Xplore were searched, and 28 studies were included in the review. The collected data was analyzed using thematic content analysis.Results: Five main themes were identified in the literature: positive experiences/benefits, facilitators, negative experiences/challenges, barriers, and suggestions for improvement. Healthcare professionals mostly reported having overall positive experience with digital visits and saw benefits for themselves and the patients – efficiency, convenience, accessibility, and new perspectives in remote care to name a few. However, opinions were mixed or negative regarding the complexity of decision making, workload and workflow, suitability of this type of care and other challenges. The suggestions for improvement included training and education, improvements within system and tools and support for professionals.Conclusion: Despite overall positive experience and benefits for both professionals and patients, clinicians reported challenges and issues they faced when using digital care visits: physical barriers, technical issues, suitability concerns and others. Digital care visits could not fully replace face-to face visits.

“One Degree of Separation”: A Mixed-Methods Evaluation of Canadian Mental Health Care User and Provider Experiences With Remote Care During COVID-19

Objectives The COVID-19 pandemic has contributed to a shift from in-person to remote mental health care. While remote care methods have long existed, their widespread use is unprecedented. There is little research about mental health care user and provider experiences with this transition, and no published studies to date have compared satisfaction between these groups. Methods Canadian mental health care users ( n = 332) and providers ( n = 107) completed an online self-report survey from October 2020 to February 2021 hosted by the Canadian Biomarker Integration Network in Depression. Using a mixed-methods approach, participants were asked about their use of remote care, including satisfaction, barriers to use, helpful and unhelpful factors, and suggestions for improvement. Results Overall, 59% to 63% of health care users and 59% of health care providers were satisfied with remote care. Users reported the greatest satisfaction with the convenience of remote care, while providers were most satisfied with the speed of provision of care; all groups were least satisfied with therapeutic rapport. Health care providers were less satisfied with the user-friendliness of remote care ( P < 0.001) than users, while health care users were less satisfied than providers with continuity of care ( P < 0.001). The use of a video-based platform was associated with remote care satisfaction among health care users ( P < 0.02), and qualitative responses support the importance of visual cues in maintaining therapeutic rapport remotely. The majority of users (55%) and providers (87%) reported a likelihood of using remote care after the pandemic. Conclusions Remote mental health care is generally accepted by both users and providers, and the majority would consider using remote care following the pandemic. Suggestions for improvement include greater use of video, increased attention to body language and eye contact, consistency with in-person care, as well as increased provider training and administrative support.

Use and impact of virtual primary care on quality and safety: The public's perspectives during the COVID-19 pandemic

Introduction With the onset of Coronavirus disease (COVID-19), primary care has swiftly transitioned from face-to-face to virtual care, yet it remains largely unknown how this has impacted the quality and safety of care. We aim to evaluate patient use of virtual primary care models during COVID-19, including change in uptake, perceived impact on the quality and safety of care and willingness of future use. Methodology An online cross-sectional survey was administered to the public across the United Kingdom, Sweden, Italy and Germany. McNemar tests were conducted to test pre- and post-pandemic differences in uptake for each technology. One-way analysis of variance was conducted to examine patient experience ratings and perceived impacts on healthcare quality and safety across demographic characteristics. Results Respondents (n = 6326) reported an increased use of telephone consultations ( + 6.3%, p < .001), patient-initiated services ( + 1.5%, n = 98, p < 0.001), video consultations ( + 1.4%, p < .001), remote triage ( + 1.3, p < 0.001) and secure messaging systems ( + 0.9%, p = .019). Experience rates using virtual care technologies were higher for men (2.4 ± 1.0 vs. 2.3 ± 0.9, p < .001), those with higher literacy (2.8 ± 1.0 vs. 2.3 ± 0.9, p < .001), and participants from Germany (2.5 ± 0.9, p < .001). Healthcare timeliness and efficiency were the dimensions most often reported as being positively impacted by virtual technologies (60.2%, n = 2793 and 55.7%, n = 2,401, respectively), followed by effectiveness (46.5%, n = 1802), safety (45.5%, n = 1822), patient-centredness (45.2%, n = 45.2) and equity (42.9%, n = 1726). Interest in future use was highest for telephone consultations (55.9%), patient-initiated digital services (56.1%), secure messaging systems (43.4%), online triage (35.1%), video consultations (37.0%) and chat consultations (30.1%), although significant variation was observed between countries and patient characteristics. Discussion Future work must examine the drivers and determinants of positive experiences using remote care to co-create a supportive environment that ensures equitable adoption and use. Comparative analysis between countries and health systems offers the opportunity for policymakers to learn from best practices internationally.

TELERA—Asynchronous TELEmedicine for Patients With Rheumatoid Arthritis: Study Protocol for a Prospective, Multi-Center, Randomized Controlled Trial

Innovative strategies are needed to adequately assess and monitor disease activity of patients with rheumatoid arthritis (RA) in times of scarce appointments. The aim of the TELERA study is to evaluate the feasibility and performance of asynchronous telemedicine visits based on patient-generated data and patient's drug history. RA patients use a medical app, ABATON, that captures the results of a self-performed quick CRP-test, joint-count, and electronic patient-reported outcomes in between visits. This is a prospective, multi-center, randomized controlled trial performed in four German university centers. The estimated sample size is 120 patients. The main outcome is the agreement of rheumatologists' treatment decisions based on asynchronous telemedicine patient-generated data with traditional in-person rheumatology clinic-based decisions and with patient suggestions. The TELERA trial will provide evidence regarding the implementation of remote care in rheumatology.Clinical Trial Registration: This clinical trial was registered at German Registry for Clinical Trials (DRKS). http://www.drks.de/DRKS00016350, identifier: DRKS00024928.