Fig 1
Source publication
Background
Although Norway is well known for its early use of telemedicine to provide services for people in rural and remote areas in the Arctic, little is known about the pace of telemedicine adoption in Norway. The aim of the present study was to explore the statewide implementation of telemedicine in Norwegian hospitals over time, and analyse i...
Context in source publication
Context 1
... who are spread over nearly 400,000 square kilometres, making it one of the most sparsely populated countries in Europe [10]. The responsibility for specialist care lies with the state, administered by four Regional Health Authorities (Northern, Central, Western, and South-Eastern Norway). Each region operates a number of public hospitals (Fig. 1). Municipalities are responsible for primary care. Private specialist health facilities are invited as partners to the system on a contractual basis [11]. Despite having one of the highest densities of physicians in Europe, Norway still struggles to ensure geographical and social equity in access to healthcare ...
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Citations
... Case studies conducted before the pandemic in the United Kingdom and Norway found that introducing virtual care is a complex change that disrupts established clinical processes, practices, culture, and division of work [14][15][16][17][18]. In qualitative interviews, physicians raised concerns about privacy, safety, and litigation risk, as well as potential detriments to the quality of care provided to their patients [14,17,18]. ...
... FPs, most of whom had no or very limited experience delivering care virtually, were required to adopt virtual visits rapidly to support patients and limit the spread of infection in the changing pandemic environment. This transition represented a significant change to workflows and clinical practice [14][15][16][17][18]. It also required a substantial investment of time and money as physicians had to learn about different technologies, regulatory and privacy requirements, vendors, as well as how to adapt their practices to those modalities. ...
Background
Prior to the pandemic, Canada lagged behind other Organisation for Economic Cooperation and Development countries in the uptake of virtual care. The onset of COVID-19, however, resulted in a near-universal shift to virtual primary care to minimise exposure risks. As jurisdictions enter a pandemic recovery phase, the balance between virtual and in-person visits is reverting, though it is unlikely to return to pre-pandemic levels. Our objective was to explore Canadian family physicians’ perspectives on the rapid move to virtual care during the COVID-19 pandemic, to inform both future pandemic planning for primary care and the optimal integration of virtual care into the broader primary care context beyond the pandemic.
Methods
We conducted semi-structured interviews with 68 family physicians from four regions in Canada between October 2020 and June 2021. We used a purposeful, maximum variation sampling approach, continuing recruitment in each region until we reached saturation. Interviews with family physicians explored their roles and experiences during the pandemic, and the facilitators and barriers they encountered in continuing to support their patients through the pandemic. Interviews were audio-recorded, transcribed, and thematically analysed for recurrent themes.
Results
We identified three prominent themes throughout participants’ reflections on implementing virtual care: implementation and evolution of virtual modalities during the pandemic; facilitators and barriers to implementing virtual care; and virtual care in the future. While some family physicians had prior experience conducting remote assessments, most had to implement and adapt to virtual care abruptly as provinces limited in-person visits to essential and urgent care. As the pandemic progressed, initial forays into video-based consultations were frequently replaced by phone-based visits, while physicians also rebalanced the ratio of virtual to in-person visits. Medical record systems with integrated capacity for virtual visits, billing codes, supportive clinic teams, and longitudinal relationships with patients were facilitators in this rapid transition for family physicians, while the absence of these factors often posed barriers.
Conclusion
Despite varied experiences and preferences related to virtual primary care, physicians felt that virtual visits should continue to be available beyond the pandemic but require clearer regulation and guidelines for its appropriate future use.
... Adoption and diffusion of approved technologies is often slow, disrupted, and inequitable [12,13]. For example, videoconferencing for remote consultations and monitoring is not new, but nation-wide attempts to its implementation prior to the COVID-19 pandemic have had limited success [14]. ...
Background
Innovation in healthcare technologies can result in more convenient and effective treatment that is less costly, but a persistent challenge to widespread adoption in health and social care is end user acceptability. The purpose of this study was to capture UK public opinions and attitudes to novel healthcare technologies (NHTs), and to better understand the factors that contribute to acceptance and future use.
Methods
An online survey was distributed to the UK public between April and May 2020. Respondents received brief information about four novel healthcare technologies (NHTs) in development: a laser-based tool for early diagnosis of osteoarthritis, a virtual reality tool to support diabetes self-management, a non-invasive continuous glucose monitor using microwave signals, a mobile app for patient reported monitoring of rheumatoid arthritis. They were queried on their general familiarity and attitudes to technology, and their willingness to accept each NHT in their future care. Responses were analysed using summary statistics and content analysis.
Results
Knowledge about NHTs was diverse, with respondents being more aware about the health applications of mobile apps (66%), followed by laser-based technology (63.8%), microwave signalling (28%), and virtual reality (18.3%). Increasing age and the presence of a self-reported medical condition favoured acceptability for some NHTs, whereas self-reported understanding of how the NHT works resulted in elevated acceptance scores across all NHTs presented. Common contributors to hesitancy were safety and risks from use. Respondents wanted more information and evidence to help inform their decisions, ideally provided verbally by a general practitioner or health professional. Other concerns, such as privacy, were NHT-specific but equally important in decision-making.
Conclusions
Early insight into the knowledge and preconceptions of the public about NHTs in development can assist their design and prospectively mitigate obstacles to acceptance and adoption.
... To date, adult social care related studies have mostly focused on the role of such technologies in telemedicine, and the digital divide COVID-19 has created for the elderly [12,13]. One key concern about digital innovations in health and social care is the abandonment of such technologies even after initial uptake [15,16]. ...
... For example, in Norway twenty-one out of 28 hospitals reported using telemedicine, however relative use of telemedicine compared to that of outpatient visits in qualifying specialties was only about one percent[16]. ...
Background
To support proactive care during the coronavirus pandemic, a digital COVID-19 symptom tracker was deployed in Greater Manchester (UK) care homes. This study aimed to understand what factors were associated with the post-uptake use of the tracker and whether the tracker had any effects in controlling the spread of COVID-19.
Methods
Daily data on COVID-19, tracker uptake and use, and other key indicators such as staffing levels, the number of staff self-isolating, availability of personal protective equipment, bed occupancy levels, and any problems in accepting new residents were analysed for 547 care homes across Greater Manchester for the period April 2020 to April 2021. Differences in tracker use across local authorities, types of care homes, and over time were assessed using correlated effects logistic regressions. Differences in numbers of COVID-19 cases in homes adopting versus not adopting the tracker were compared via event design difference-in-difference estimations.
Results
Homes adopting the tracker used it on 44% of days post-adoption. Use decreased by 88% after one year of uptake (odds ratio 0.12; 95% confidence interval 0.06–0.28). Use was highest in the locality initiating the project (odds ratio 31.73; 95% CI 3.76–268.05). Care homes owned by a chain had lower use (odds ratio 0.30; 95% CI 0.14–0.63 versus single ownership care homes), and use was not associated with COVID-19 or staffing levels. Tracker uptake had no impact on controlling COVID-19 spread. Staff self-isolating and local area COVID-19 cases were positively associated with lagged COVID-19 spread in care homes (relative risks 1.29; 1.2–1.4 and 1.05; 1.0–1.1, respectively).
Conclusions
The use of the COVID-19 symptom tracker in care homes was not maintained except in Locality 1 and did not appear to reduce the COVID-19 spread. COVID-19 cases in care homes were mainly driven by care home local-area COVID-19 cases and infections among the staff members. Digital deterioration trackers should be co-produced with care home staff, and local authorities should provide long-term support in their adoption and use.
... Moreover, a recent study conducted in 2019-2020 on general practice in the UK showed that digital-first access models using online, telephone or video consultations are likely to increase the GP's workload by 25%, 3%, and 31%, respectively [21]. Our review of sources [9,10,11,12,13,14,15,16,17,18] highlighted a number of challenges of remote video/telephone consultations, including slow internet speed, poor audio/video quality, security and privacy concerns and patients preferring face-to-face consultations. ...
The COVID-19 Pandemic has resulted in a forced transition to telemedicine, where history-taking and clinical assessments are performed remotely during video or telephonic consultations. While telemedicine has added to safety and social distancing during the pandemic, the manual and resource-intense pro-cess of telephonic and video consultations has not helped to ease the patient backlog, rather has added to this snowballing issue. This paper describes about YouDiagnose pre-consultation exercise that automates patient triage and clinical assessment using artificial intelligence technologies delivered through either a Smart Questionnaire or Chatbot. A usability evaluation was conducted with participants from the Patient and Public Involvement and Engagement Senate (PIES) of the Innovation Agency (an Academic Health Science Net-work) Qualitative feedback was obtained from the participants on both modalities and quantitative feedback in the form of the System Usability Scale (SUS), comparing the usability of both interaction modalities. The SUS scores were analysed using the Adjective Rating Scale that revealed the Smart Questionnaire had Good Usability compared to OK Usability of the Chatbot. The results shows the user experience and untapped potential of process automation and artificial intelligence in clinical services.
... Un análisis de telemedicina evaluando condiciones reales de trabajo, en distintos niveles de gestión institucional, es el modelo NASSS (sigla en inglés Nonadoption, Abandonment, Scale-up, Spread, and Sustainability) desarrollado por Greenhalgh 22 . Este trabajo recogió y analizó 28 modelos referenciales en la literatura, evaluando la implementación de tecnologías en salud durante 3 años en más de 20 organizaciones, recogiendo datos multinivel: de usuarios (micro), de procesos organizacionales (meso) y de políticas públicas (macro). ...
... Este trabajo recogió y analizó 28 modelos referenciales en la literatura, evaluando la implementación de tecnologías en salud durante 3 años en más de 20 organizaciones, recogiendo datos multinivel: de usuarios (micro), de procesos organizacionales (meso) y de políticas públicas (macro). El modelo NASSS reconoce 7 dimensiones, incluyendo la condición o problemas de salud para la cual se pretende aplicar la telemedicina y la evaluación dirigida de la tele-consulta remota por el profesional médico 23 ; recoge la complejidad socio-técnica de las organizaciones de salud y las condiciones reales de atención de salud; y genera un marco de trabajo accesible para múltiples audiencias, no solo académicas 22,24 . Las dimensiones del este modelo se aprecian en Tabla 1. ...
Introducción: La telemedicina emerge como una alternativa para dar continuidad a las pres¬taciones de salud en el contexto pandémico. Nuestro trabajo analizó las condicionantes de uso y desarrollo de la telemedicina (modalidad de atención remota por especialista) en un contexto territorial de alta dispersión geográfica y ruralidad, y un contexto organizacional de instituciones públicas en redes crónicamente afectadas por las reformas neoliberales del sector.
Material y Métodos: Se utilizó un diseño cualitativo de corte hermenéutico basado en entre¬vistas semiestructuradas con equipos de salud y gestores de una red asistencial pública del sur de Chile.
Resultados: Los resultados muestran que se validan beneficios como el acercamiento de la atención del médico especialista al territorio, el aprendizaje entre profesionales y la continuidad de cuidados entre niveles de atención. Las motivaciones, intereses y resistencias de las personas emergen como los principales condicionantes del uso y desarrollo de la tele¬medicina, con importantes asimetrías de carga de trabajo en los procesos de gestión clínica y de recursos entre niveles de atención.
Discusión: la pandemia habría facilitado la extensión de la telemedicina, mientras que sus beneficios y efectividad dependerían del valor que los equipos le otorguen para apoyar la atención de salud y de su traducción en un aprendizaje colectivo para la institución, antes que el cumplimiento de marcos normativos. Se vuelve prioritario, en este nuevo escenario, explorar las percepciones de los usuarios respecto a la expansión de la telemedicina.
... However developed countries are better to implement telemedicine as compared with low-income nations, 76% of united states of America health institutions full function the system [9]. 75% of Norway's health institutions successfully implement telemedicine system, But in low-income countries only 10%of their health institutions provide health service through telemedicine [8,10]. ...
Introduction
In resource-limited settings incorporating the Telemedicine system into the healthcare system enhances exchanging valid health information for practicing evidence-based medicine for the diagnosis, treatment, and prevention of diseases. Despite its great importance, the adoption of telemedicine in low-income country settings, like Ethiopia, was lagging and increasingly failed. Assessing the readiness of health professionals before the actual adoption of telemedicine is considered the prominent solution to tackle the problem. However, little is known about Health professionals’ telemedicine readiness in this study setting.
Objective
Accordingly, this study aimed to assess health professionals’ readiness and its associated factors to implement a Telemedicine system at private hospitals in North West, Ethiopia.
Materials and methods
An institution-based cross-sectional study was conducted from March 3 to April 7, 2021. A total of 423 health professionals working in private hospitals were selected using a simple random sampling technique. Multi-variable logistic regression was fitted to identify determinant factors of health professional readiness after the other covariates were controlled.
Result
In this study the overall readiness of telemedicine adoption was 65.4% (n = 268) [95% CI:60.1–69.8]. Knowledge (AOR = 2.5;95% CI: [1.4, 4.6]), Attitude (AOR = 3.2;95% CI: [1.6, 6.2]), computer literacy (AOR = 2.2; 95% CI: [1.3, 3.9]), computer training (AOR = 2.1;95% CI: [1.1, 4.1]), Computer skill (AOR = 1.9;95% CI: [1.1, 3.4]), computer access at office (AOR = 2.1;95% CI: [1.1, 3.7]), Internet access at office (AOR = 2.8; 95% CI: [1.6, 5.1]), Own personal computer (AOR = 3.0; 95% CI: [1.5, 5.9]) and work experience (AOR = 3.1; 95% CI: [1.4, 6.7]) were significantly associated with the overall health professionals readiness for the adoption of telemedicine using a cut point of p-value lessthan 0.05.
Conclusion and recommendation
Around two-thirds of the respondents had a good level of overall readiness for the adoption of telemedicine. The finding implied that less effort is required to improve readiness before the implementation of telemedicine. This findings implied that respondents who had good knowledge and a favorable attitude toward telemedicine were more ready for such technology. Capacity building is needed Enhance computer literacy, and computer skills building their confidence to rise ready for such technology. Building their capacity through training, building good internet connection, and availability of computers, where the necessary measures to improve Telemedicine readiness in this setting. Additionally, further studies are recommended to encompass all types of telemedicine readiness such as organizational readiness, technology readiness, societal readiness, and so on. Additionally, exploring the healthcare provider opinion with qualitative study and extending the proposed study to other implementation settings are recommended to be addressed in future works. The study has a positive impact on the successful implementation and use of telemedicine throughout hospitals at countries level by providing pertinent information about health professionals’ preparedness status. Therefore, implementing telemedicine will have a significant contribution to the health system performance improvement in terms of providing quality care, accessibility to health facilities, reduction of costs, and creating a platform for communication between health professionals across different health institutions for providing quality patient care.
... Telemedicine solutions offer opportunities for the healthcare system to continue the care of long-distance patients living with diabetes, for example during infectious disease outbreaks [4,6]. Although Norway as a country adopted telemedicine at an early stage [7], very little is known about the benefits and challenges of using telemedicine solutions for diabetes care in Norway. Therefore, we conducted a scoping review to provide an overview of the evidence as preliminary assessment of the size and scope of available literature in this field. ...
The recent pandemic highlighted telemedicine’s potential for continuity of remote diabetes patients’ care. The study objective was to identify diabetes telemedicine services, benefits, and challenges in Norway. We searched for publications on the topic in PubMed, ScienceDirect, CINAHL, and Nora. Most of the included studies (7/15) focused on telemedicine for type 2 diabetes. Telemedicine benefits include improved self-management and cost and time effectiveness. Challenges include organizational and technical issues. To optimize the health system, telemedicine can be used for highly engaged diabetes patients. Creating clear and practical national and organizational telemedicine guidelines for diabetes management could solve the identified challenges.
... Pre-pandemic adoption of virtual care in Ontario, Canada's most populated province with 14.6 million people, translated into approximately 1.6% of visits in each 2018 and 2019 . Video-dominated pre-pandemic virtual care use, with most representing the provision of rural telemedicine care (Taylor et al., 2021;Zanaboni and Wootton, 2016). The majority of hospital-based specialist care in Ontario was conducted in-person and adoption across specialties was variable (O'Gorman et al., 2016). ...
Purpose
The purpose of this study is to understand virtual care use (e.g. telephone and video visits) during the COVID-19 pandemic across three hospital-based ambulatory clinics (i.e. mental health, renal and respiratory care) and to describe associated patient and provider experiences.
Design/methodology/approach
A mixed-methods convergent study was conducted including quantitative electronic medical records data on virtual care use, electronic surveys assessing domains of experience (e.g. satisfaction, acceptance and technology use) among patient and providers and semi-structured interviews exploring the associated barriers and facilitators of virtual care adoption.
Findings
Virtual care adoption rates and relative modality use (telephone vs video) varied across specialty clinics. Mental health clinics) showed the greatest use of virtual care and greater use of video over telephone, as compared to renal and respiratory care, where telephone was used almost exclusively. Patients and providers reported an overall good satisfaction and acceptance of virtual care (60–72%) across clinics, but commonly observed barriers (technical problems, behavioral adaptations needed and inequity) persisted. Good value propositions, tech support and the presence of early adopters who can support others in workflow re-design and highlight value propositions of virtual care were listed as adoption facilitators.
Originality/value
The study provides a unique opportunity to compare the rate of virtual care adoption before and during the COVID-19 pandemic across distinct specialties that operate within the same organizational and political setting. This study showed that the nature of the condition (e.g. mental health conditions) and the characteristics of the users (e.g. younger patients) may drive models of care with higher rate of video use. Focusing on removing common barriers, like providing tech support and ensuring equitable access to patients, continues to be important even in the context of high virtual care adoption rates during the pandemic.
... More than 76% of healthcare institutions in the USA have a fully functioning telemedicine system (8) . More than 75% in Norway and in developing countries 10% of their health care institutions have successfully implemented a Telemedicine system (7,9) . ...
Introduction: in resource-limited settings incorporating the Telemedicine system into the healthcare system enhances exchanging valid health information for practicing evidence-based medicine for the diagnosis, treatment, and prevention of diseases. The successful implementation of a telemedicine system in health care inquires a study of numerous technical, organizational, infrastructure, and human elements.
Objective: This study aimed to assess health professionals' readiness and its associated factors to implement a Telemedicine system at private hospitals in Amhara Region, Ethiopia 2021.
Method: An institution-based cross-sectional study was conducted among 423 health professionals from March 3 to April 7 2021 at private hospitals in Amhara Region. A self-administered questionnaire was employed to collect the data. The data were analyzed by SPSS version 20 software. Descriptive statistics,bi-variable and multi-variable logistic regression analyses were performed. An adjusted odds ratio (AOR) with 95% CI was used to determine the s association between the independent and the outcome variable.
Result: About Two-third (268;65.4%) of health professionals were ready to Telemedicine system.Knowledge (AOR=2.5;95% CI: [1.4, 4.6]), Attitude (AOR=3.2;95% CI: [(1.6,6.2]), computer literacy (AOR=2.2; 95% CI: [1.3, 3.9]), computer training (AOR=2.1;95% CI: [1.1, 4.1]), Computer skill (AOR=1.9;95% CI:[1.1, 3.4]),computer access at office (AOR = 2.1;95% CI: [1.1,3.7],Internet access at office (AOR=2.8;95%CI: [1.6,5.1]),Own personal computer(AOR=3.0;95% CI: [1.5,5.9])and work experience(AOR=3.1;95%CI: [1.4,6.7]) were significantly associated withTelemedicine readiness .
Conclusion and Recommendation: In general the overall readiness of health professionals for the Telemedicine system is moderate. Inclusive packages of capacity building are fundamental to increasing the level of, knowledge, attitude, and training among health professionals.
... We cannot ignore the growing number of randomized controlled trial studies that show how VC impacts diagnosis-specific clinical efficacy and safety [39,40]. However, there is an increasing discrepancy between experimental trials and the experience of remote consultation as a regular service [12,41,42]. The clinicians in our study wondered about the long-term effects of VC on the quality of care. ...
... Moreover, we identified that it is not only how VC impacts the clinical aspect that needs to be considered but also how it impacts the interpersonal and managerial aspects. Scientific evidence on the long-term effect of VC on all the three aspects is inadequate according to clinicians in our study, and this is consistent with previous studies [41,42]. ...
Background:
Video consultation is increasingly seen as a cost-effective way of providing outpatient care in the face of dwindling resources and the growing demand for healthcare across the globe. Therefore, the sustainable implementation of video consultation is a phenomenon of interest to medical practitioners, researchers, and citizens alike. Studies are often criticized for not being robust enough because the research settings are mostly small-scale pilot projects and unable to reflect on long-term implementation. The COVID-19 pandemic has compelled clinicians across the world to conduct remote consultation, creating a favorable context to study large-scale remote consultation implementation.
Objective:
The aim is to thoroughly investigate how clinicians reason their choice of different consultation modes in the routine of consultation and what the underlying reason(s) are for their choices. We posit that a deeper understanding of clinicians' perceptions of remote consultation is essential to deduce whether and how remote consultation will be adopted on a large scale and sustained as a regular service.
Methods:
A qualitative approach is taken, where the unit of analysis is clinicians in one of the largest university hospitals in Norway. In total, 29 interviews were conducted and transcribed, which have been used as the primary data source. Using the performative model of routine as the theoretical framework, data were analyzed following deductive content analysis.
Results:
Clinicians have mixed opinions on the merits and demerits of video consultation and where it stands between in-person and telephone consultation. Six different planning criteria have been identified, and individual clinicians used a different combination of these criteria when choosing a consultation mode. The ideals clinicians hold for conducting consultation can be divided into three aspects: clinical, interpersonal, and managerial. Video consultation engenders a new ideal and endangers the existing ideal(s). Video consultation causes minor changes in the tasks the clinicians perform in a consultation; thus, these changes do not play a significant role in their choice of consultation. Clinicians cannot identify any changes in the outcome of consultation as a result of incorporating a remote mode of consultation.
Conclusions:
Clinicians feel there is a lack of scientific evidence on the long-term effect of remote consultation on clinical efficacy and on interpersonal and managerial aspects, which are crucial for consultation service. The absence of (1) sufficient scientific evidence and a clear understanding of the merits and demerits of VC and (2) standard practices and shared norms among clinicians regarding the use of video for consultation both create a void in the consultation practice. This void leads clinicians to use their personal judgments and preferences to justify the choices they make for consultation mode. Thus, diverse opinions emerge, including some paradoxical ones resulting in an uncertain future for sustainable large-scale implementation, which can reduce the quality of consultation service.
Clinicaltrial:
