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Accessibility, continuity and appropriateness: key elements in assessing integration of perinatal services.

https://arctichealth.org/en/permalink/ahliterature183622
Source
Health Soc Care Community. 2003 Sep;11(5):397-404
Publication Type
Article
Date
Sep-2003
Author
Danielle D'Amour
Lise Goulet
Jean-François Labadie
Liette Bernier
Raynald Pineault
Author Affiliation
Faculté des sciences infirmières and Groupe de recherche interdisciplinaire en santé (GRIS), Université de Montréal, Montreal, Quebec, Canada. Danielle.damour@umontreal.ca
Source
Health Soc Care Community. 2003 Sep;11(5):397-404
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Continuity of Patient Care - statistics & numerical data
Delivery of Health Care, Integrated - statistics & numerical data
Female
Health Care Rationing - statistics & numerical data
Health Services Accessibility - statistics & numerical data
House Calls - statistics & numerical data
Humans
Infant, Newborn
Length of Stay
Patient Education as Topic - standards
Perinatal Care - statistics & numerical data
Postnatal Care - statistics & numerical data
Pregnancy
Quebec
Regional Health Planning - methods
Telemedicine - statistics & numerical data
Abstract
A trend toward the reduction in the length of hospital stays has been widely observed. This increasing shift is particularly evident in perinatal care. A stay of less than 48 hours after delivery has been shown to have no negative effects on the health of either the mother or the baby as long as they receive an adequate follow-up. This implies a close integration between hospital and community health services. The present article addresses the following questions: To what extent are postnatal services accessible to mothers and neonates? Are postnatal services in the community in continuity with those of the hospital? Are the services provided by the appropriate source of care? The authors conducted a telephone survey among 1158 mothers in a large urban area in the province of Quebec, Canada. The results were compared to clinical guidelines widely recognised by professionals. The results show serious discrepancies with these guidelines. The authors found a low accessibility to services: less than half of the mothers received a home visit by a nurse. In terms of continuity of care, less than 10% of the mothers received a follow-up telephone call within the recommended time frame and only 18% benefited from a home visit within the recommended period. Finally, despite guidelines to the contrary, hospitals continue to intervene after discharge. This results in a duplication of services for 44.7% of the new-borns. On the other hand, 40.7% are not seen in the recommended period after hospital discharge at all. These results raise concerns about the integration of services between agencies. Following earlier work, the present authors have grouped explanatory factors under four dimensions: the strategic dimension, particularly leadership; the structural dimension, including the size of the network; the technological dimension, with respect to information transmission system; and the cultural dimension, which concerns the collaboration process and the development of relationships based on trust.
PubMed ID
14498836 View in PubMed
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Development and implementation of IT require focus on user participation, acceptance and workflow.

https://arctichealth.org/en/permalink/ahliterature264081
Source
Stud Health Technol Inform. 2014;201:219-26
Publication Type
Article
Date
2014
Author
Ina Koldkjær Sølling
Per Carøe
Kirsten Siggaard Mathiesen
Source
Stud Health Technol Inform. 2014;201:219-26
Date
2014
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Denmark
Internet
Meaningful Use - statistics & numerical data
Nurses - statistics & numerical data
Online Systems
Patient Acceptance of Health Care - statistics & numerical data
Patient Satisfaction - statistics & numerical data
Telecommunications - utilization
Telemedicine - statistics & numerical data
Workflow
Workload - statistics & numerical data
Abstract
The study "Online Care" follows a municipal project "Online Welfare" where a nurse's presence in the citizen's own home was replaced by online communication. The paper is based on a citizen's perspective and seeks to develop meaningful workflow for the benefit of citizens with medical problems. The study examines five citizens' opinions on whether online communication in a meaningful way supports the citizens in what they associate with a good life. In addition, relatives and the citizen's nurse were interviewed individually concerning the same issues as the citizens. The study has been approved by the Danish System of Ethics in Science and is conducted in collaboration with Aalborg University, Aalborg Municipality and DanAge, (NGO). The municipality's goal of efficiency and financial savings regarding "Online Welfare" was not honored due to insufficient network infrastructure and technical problems. An adoption barrier was that the municipality did not determine the efforts and the goal of the project, who could benefit from participating and the requirements of the professionals and the organization including ethical considerations.It was difficult to find citizens who were willing to participate. Citizens, who were included in the study accepted and adopted the technology however, "Online Welfare" could not replace the care they used to receive. Therefore, the offer was perceived as an "appendix" which tended to meaninglessness by some of the citizens.The nurses' perception of nursing care and their limited IT skills was a barrier to acceptance, adoption and development of technology opportunities in nursing. The citizens' disability, the screen appearance, and the technology setup meant that the citizens perceived poor usability of the equipment. The study showed a change in workflow, as the cooperation between the citizen and the professional developed. New roles occurred for the professionals.The citizens had many ideas concerning the development of the technology and the study recommends that users are involved in the development and implementation of welfare technology and telemedicine. The relatively small sample size of the study shows findings that must be clarified by further research.
PubMed ID
24943547 View in PubMed
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Flight diversions due to onboard medical emergencies on an international commercial airline.

https://arctichealth.org/en/permalink/ahliterature139603
Source
Aviat Space Environ Med. 2010 Nov;81(11):1037-40
Publication Type
Article
Date
Nov-2010
Author
Rahim Valani
Marisa Cornacchia
Douglas Kube
Author Affiliation
McMaster University, Department of Medicine and Pediatrics, Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada. valanir@mcmaster.ca
Source
Aviat Space Environ Med. 2010 Nov;81(11):1037-40
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Aerospace Medicine - statistics & numerical data
Canada - epidemiology
Commerce
Emergency Medical Services - statistics & numerical data
Humans
Incidence
Telemedicine - statistics & numerical data
Travel - statistics & numerical data
Abstract
Each year, close to 2 billion passengers travel on commercial airlines. In-flight medical events result in suboptimal care due to a variety of factors. Flight diversions due to medical emergencies carry a significant financial and legal cost. The purpose of this study was to determine the causes of in-flight medical diversions from Air Canada.
This was a review of in-flight medical emergencies from 2004-2008. Both telemedicine and Air Canada databases were crossreferenced to capture all incidents. Presenting complaints were categorized by systems. Descriptive statistics were used to analyze the data.
Over the 5 yr, there were 220 diversions, of which 91 (41.4%) of the decisions were made by pilots or onboard medical personnel. During this period there were 5386 telemedicine contacts with ground support providers, who on average recommended 2.4 diversions per 100 calls. The rate for diversions almost doubled from 2006 to 2007, with a sharp drop in telemedicine contacts during the same period. The four most common categories resulting in diversions were cardiac (58 diversions, 26.4%), neurological (43 diversions, 19.5%), gastrointestinal (GI) (25 diversions, 11.4%), and syncope (22 diversions, 10.0%). Only 6.8% of all diversions were due to cardiac arrest.
Medical conditions most commonly leading to diversions were cardiac, neurological, gastrointestinal, and syncope. Our study showed that a decrease in telemedicine contact during this period was accompanied by an increase in diversions, while increased pre-screening of passengers did not prove effective in decreasing diversion rates.
PubMed ID
21043302 View in PubMed
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Heuristic evaluation of a telehealth system from the Danish TeleCare North Trial.

https://arctichealth.org/en/permalink/ahliterature268346
Source
Int J Med Inform. 2015 May;84(5):319-26
Publication Type
Article
Date
May-2015
Author
Pernille Heyckendorff Lilholt
Morten Hasselstrøm Jensen
Ole K Hejlesen
Source
Int J Med Inform. 2015 May;84(5):319-26
Date
May-2015
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Denmark
Female
Heuristics
Humans
Male
Meaningful Use - statistics & numerical data
Pulmonary Disease, Chronic Obstructive - diagnosis - therapy
Telemedicine - statistics & numerical data
User-Computer Interface
Abstract
The aim was to evaluate the usability of the design of the telehealth system, named Telekit, developed for the Danish TeleCare North Trial, early into the design process in order to assess potential problems and limitations which could hinder its successful implementation.
Five experts, including one who pilot-tested the Telekit system, individually evaluated its usability and its compliance with Jakob Nielsen's ten usability heuristics for interaction design. Usability problems were categorised according to Rolf Molich's severity classification.
The five experts identified a total of 152 problems in the Telekit system, each identifying 22-40 problems. 86 (57%) out of the 152 problems were identified only once. All heuristics were used, but the three most frequently used were: "Match between system and the real world" (32%), "Consistency and standards" (13%) and "Aesthetic and minimalist design" (13%). The most widely used classifications were: "Improvement" (40%) and "Minor problem" (43%).
Heuristic evaluation was an effective method for uncovering and identifying problems with the system. The consistent finding of particular usability problems confirms that the development of a telehealth system should pay particular attention to user aspects. The most serious problem was the inability of the system to inform users of how to perform measurements correctly and to "speak the users' language". The problems found in the heuristic evaluation have led to several significant changes in the telehealth system. We suggest that heuristic evaluation always be followed by user tests to evaluate the design of telehealth systems.
PubMed ID
25666638 View in PubMed
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Internet use, eHealth literacy and attitudes toward computer/internet among people with schizophrenia spectrum disorders: a cross-sectional study in two distant European regions.

https://arctichealth.org/en/permalink/ahliterature291131
Source
BMC Med Inform Decis Mak. 2017 Sep 20; 17(1):136
Publication Type
Journal Article
Date
Sep-20-2017
Author
Christina Athanasopoulou
Maritta Välimäki
Katerina Koutra
Eliisa Löttyniemi
Antonios Bertsias
Maria Basta
Alexandros N Vgontzas
Christos Lionis
Author Affiliation
Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland. christina@knowledgeunicorn.com.
Source
BMC Med Inform Decis Mak. 2017 Sep 20; 17(1):136
Date
Sep-20-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Attitude to Computers
Cross-Sectional Studies
Female
Finland - epidemiology
Greece - epidemiology
Health Literacy - statistics & numerical data
Humans
Internet - statistics & numerical data - utilization
Male
Middle Aged
Schizophrenia - epidemiology
Schizophrenic Psychology
Telemedicine - statistics & numerical data
Young Adult
Abstract
Individuals with schizophrenia spectrum disorders use the Internet for general and health-related purposes. Their ability to find, understand, and apply the health information they acquire online in order to make appropriate health decisions - known as eHealth literacy - has never been investigated. The European agenda strives to limit health inequalities and enhance mental health literacy. Nevertheless, each European member state varies in levels of Internet use and online health information-seeking. This study aimed to examine computer/Internet use for general and health-related purposes, eHealth literacy, and attitudes toward computer/Internet among adults with schizophrenia spectrum disorders from two distant European regions.
Data were collected from mental health services of psychiatric clinics in Finland (FI) and Greece (GR). A total of 229 patients (FI = 128, GR = 101) participated in the questionnaire survey. The data analysis included evaluation of frequencies and group comparisons with multiple linear and logistic regression models.
The majority of Finnish participants were current Internet users (FI = 111, 87%, vs. GR = 33, 33%, P 
Notes
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Cites: Neuropsychiatr Dis Treat. 2013;9:1311-32 PMID 24049446
PubMed ID
28931385 View in PubMed
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Living with Lung Cancer--Patients' Experiences as Input to eHealth Service Design.

https://arctichealth.org/en/permalink/ahliterature278597
Source
Stud Health Technol Inform. 2015;216:391-5
Publication Type
Article
Date
2015
Author
Maria Hägglund
Peter Bolin
Sabine Koch
Source
Stud Health Technol Inform. 2015;216:391-5
Date
2015
Language
English
Publication Type
Article
Keywords
Attitude to Health
Critical Pathways - statistics & numerical data
Electronic Health Records - statistics & numerical data
Focus Groups
Lung Neoplasms - diagnosis - psychology - therapy
Needs Assessment
Patient Participation - statistics & numerical data
Patient Preference - statistics & numerical data
Patient Transfer - statistics & numerical data
Sweden
Telemedicine - statistics & numerical data
Abstract
The objective of the study is to describe the lung cancer care process as experienced by patients, as well as to perform a qualitative analysis of problems they encounter throughout the patient journey. A user-centered design approach was used and data collected through two focus group meetings with patients. We present the results in the form of a patient journey model, descriptions of problems related to the journey as expressed by patients and proposed eHealth services discussed by patients in the focus groups. The results indicate that not only is the patient journey fragmented and different for each patient going through it depending upon their specific type of lung cancer and treatment options, but their experiences are also highly individual and dependent on their personal needs and interpretations of the process. Designing eHealth to improve the patient journey will therefore require flexibility and adaptability to the individual's needs.
PubMed ID
26262078 View in PubMed
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Managers' experience of success criteria and barriers to implementing mobile radiography services in nursing homes in Norway: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature296614
Source
BMC Health Serv Res. 2018 04 25; 18(1):301
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
04-25-2018
Author
Elin Kjelle
Kristin Bakke Lysdahl
Hilde Merete Olerud
Aud Mette Myklebust
Author Affiliation
Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University College of Southeast Norway, Postboks 235, 3603, Kongsberg, Norway. Elin.Kjelle@usn.no.
Source
BMC Health Serv Res. 2018 04 25; 18(1):301
Date
04-25-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Administrative Personnel - psychology
Ambulatory Care - statistics & numerical data
Attitude of Health Personnel
Delivery of Health Care - statistics & numerical data
Diffusion of Innovation
Equipment and Supplies Utilization
Health Policy
Hospitals - statistics & numerical data
Humans
Inventions
Norway
Nursing Homes - statistics & numerical data
Point-of-Care Systems - statistics & numerical data
Qualitative Research
Radiography - statistics & numerical data
Telemedicine - statistics & numerical data
Abstract
In order to meet the future challenges posed by ageing populations, new technology, telemedicine and a more personalized healthcare system are needed. Earlier research has shown mobile radiography services to be highly beneficial for nursing home residents in addition to being cost-effective. Despite the benefits, mobile radiography services are uncommon in Europe and Norway. The purpose of this study was to explore success criteria and barriers in the process of implementing mobile radiography services, from the point of view of the hospital and municipal managers.
Eleven semi-structured interviews were conducted with managers from five hospitals and six municipalities in Norway where mobile radiography services had been implemented. Core issues in the interview guide were barriers and facilitators in the different phases of implementation. The framework method for thematic analysis was used for analysing the data inductively in a research team.
Five main categories were developed through the success criteria and barriers experienced by the participants: national health policy, regional and municipal policy and conditions, inter-organizational implementation projects, experienced outcome, and professional skills and personal characteristics. The categories were allocated into three higher-order classifications: macro, meso and micro levels. The main barriers experienced by the managers were financial, procedural and structural. In particular, the reimbursement system, lack of management across healthcare levels and the lack of compatible information systems acted as barriers. The main facilitators were external funding, enthusiastic individuals in the organizations and good collaboration between hospitals and municipalities.
The managers experienced financial, structural and procedural barriers. The main success criteria in the process were external funding, and the support and engagement from the individuals in the organizations. This commitment was mainly facilitated by the intuitive appeal of mobile radiography. Changes in healthcare management and in the financial system might facilitate services across healthcare levels. In addition, compatible information systems across healthcare levels are needed in order to facilitate the use of new technology and mobile services.
PubMed ID
29699547 View in PubMed
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The Pacific Island Health Care Project (PIHCP): experience with rheumatic heart disease (RHD) from 1998 to 2006.

https://arctichealth.org/en/permalink/ahliterature152392
Source
Hawaii Med J. 2008 Dec;67(12):326-9
Publication Type
Article
Date
Dec-2008
Author
Mazen I Abbas
Donald A Person
Author Affiliation
SHAPE Heathcare Facility, Belguium.
Source
Hawaii Med J. 2008 Dec;67(12):326-9
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Child
Demography
Female
Health Services Research
Humans
Male
Mitral Valve Insufficiency - diagnosis - surgery
Oceania
Remote Consultation - statistics & numerical data
Rheumatic Heart Disease - diagnosis - therapy
Telemedicine - statistics & numerical data
Abstract
Rheumatic heart disease (RHD) continues to be a major health problem in developing countries. The burden of disease in many countries, especially those of Oceania, is very high and is still the leading cause of heart-related deaths. Several factors contribute to the prevalence of RHD in the Pacific Basin including poverty, poor access to care, distance for travel, and limited resources. The Pacific Island Health Care Project (PIHCP) at Tripler Army Medical Center (TAMC) is a unique program which provides indigenous, medically under-served peoples in the United States Associated Pacific Islands (USAPIs) with definitive medical and surgical care. The program has been an important source of patients to enhance Graduate Medical Education (GME) at TAMC. Beginning in 1998, a secure, Web-based, store-and-forward telemedicine network was developed. It was ultimately deployed to 11 sites in the USAPIs. This unique platform has facilitated the selection and definitive care of Pacific Islanders at TAMC. The purpose of this study was to review our experience with RHD in patients referred from the USAPIs utilizing a unique telemedicine system. All patient records that were archived in the PIHCP database were retrospectivelyreviewed for the diagnosis of RHD from 1998 (telemedicine program began) to 2006. Descriptive analysis of the data is displayed in a tabular format. Of the 150 patient consults with RHD in the PIHCP 76 were accepted for care at TAMC and 74 came to Honolulu. Most patients were younger than 40 years of age. Almost all patients evaluated at TAMC had mitral valve involvement, and 81% of patients underwent a surgical procedure to correct the valvular disease. Our experience with RHD and its management illustrates a number of challenges that must be addressed by those who attempt to provide technically advanced care to persons from the developing world. In the case of RHD, patient selection, choice of intervention, and early return of the patient home are critical to the success of any such program. Despite these problems the PIHCP has restored many patients to health and returned them to their island homes as contributing members of society.
PubMed ID
19244704 View in PubMed
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Patient satisfaction with care for urgent health problems: a survey of family practice patients.

https://arctichealth.org/en/permalink/ahliterature161133
Source
Ann Fam Med. 2007 Sep-Oct;5(5):419-24
Publication Type
Article
Author
Michelle Howard
James Goertzen
Brian Hutchison
Janusz Kaczorowski
Kelly Morris
Author Affiliation
Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada. mhoward@mcmaster.ca
Source
Ann Fam Med. 2007 Sep-Oct;5(5):419-24
Language
English
Publication Type
Article
Keywords
Adult
After-Hours Care - statistics & numerical data
Age Distribution
Cross-Sectional Studies
Emergency Medical Services - statistics & numerical data
Emergency Service, Hospital - statistics & numerical data
Family Practice - statistics & numerical data
Female
Health Care Surveys
Health Services Accessibility - statistics & numerical data
Health status
Humans
Male
Ontario
Patient Satisfaction - statistics & numerical data
Telemedicine - statistics & numerical data
Abstract
Patient satisfaction is an important health care outcome. This study compared patients' satisfaction with care received for an urgent health problem from their family physician, at an after-hours clinic in which their physician participated, at a walk-in clinic, at the emergency department, from telephone health advisory services, or from more than 1 of those services.
We mailed a questionnaire to a random sample of patients from 36 family practices in Thunder Bay, Ontario. We elicited satisfaction with care for the most recent urgent health problem in the past 6 months on a 7-point scale (very dissatisfied to very satisfied).
The response rate was 62.3% (5,884 of 9,397). Of the 5,722 eligible patients 1,342 (23.4%) reported an urgent health problem, and data were available for both services used and satisfaction for 1,227 patients. After adjusting for sociodemographic characteristics and self-reported health status, satisfaction with care received for most recent urgent health problem was significantly higher among patients who visited or spoke to their family physician (mean 6.1; 95% confidence interval [CI], 5.8-6.4) compared with all other services (all P
Notes
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PubMed ID
17893383 View in PubMed
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Pre-hospital diagnosis and transfer of patients with acute myocardial infarction--a decade long experience from one of Europe's largest STEMI networks.

https://arctichealth.org/en/permalink/ahliterature108094
Source
J Electrocardiol. 2013 Nov-Dec;46(6):546-52
Publication Type
Article
Author
Peter Clemmensen
Mikkel Malby Schoos
Matias Greve Lindholm
Lars S Rasmussen
Jacob Steinmetz
Rasmus Hesselfeldt
Frants Pedersen
Erik Jørgensen
Lene Holmvang
Maria Sejersten
Author Affiliation
Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark. Electronic address: clemme@rh.dk.
Source
J Electrocardiol. 2013 Nov-Dec;46(6):546-52
Language
English
Publication Type
Article
Keywords
Community Networks - statistics & numerical data
Denmark - epidemiology
Electrocardiography - statistics & numerical data
Emergency Medical Services - statistics & numerical data
Humans
Myocardial Infarction - diagnosis - mortality - therapy
Myocardial Reperfusion - mortality
Patient Transfer - statistics & numerical data
Prevalence
Risk factors
Survival Rate
Telemedicine - statistics & numerical data
Abstract
Early reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) is essential. Although primary percutaneous coronary intervention (pPCI) is the preferred revascularization technique, it often involves longer primary transportation or secondary inter-hospital transfers and thus longer system related delays. The current ESC Guidelines state that PCI should be performed within 120 minutes from first medical contact, and door-to-balloon time should be
PubMed ID
23938107 View in PubMed
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17 records – page 1 of 2.