Globally there is a shortage in supply of rural health professionals. Tele-health was developed to help reduce distance barriers for health professionals in geographically isolated locations seeking continued medical education (CME). E-health includes all health information and health care delivered electronically. Further, telehealth defines all telecommunication technology used to transfer health information and health care. Tele-health comes in a variety of forms including videoconferencing. The use of videoconferencing to deliver medical education for rural health professionals is expanding area for health education. Videoconferencing provides a flexible method for rural GP registrars to access CME without travel. However, there is limited knowledge surrounding the use and success of telehealth for medical education. Each new telehealth project requires evaluation in order to ensure effectiveness of future programs. This study was based on one General Practice Education Year One (GPEP-1) registrar training program trialling videoconferencing as a method of teaching rurally distant registrars. A qualitative health research thematic analysis was undertaken. All individuals involved in the study were included in this research including; three offsite registrars (who teleconferenced as they lived remotely from the seminars), three onsite registrars (who attended the face to face seminars), and three facilitators. Three focus group interviews were conducted to collect data, one for each respective group. The focus groups accounted for the participant’s individual and collective experience of teleconferencing. Seven main themes emerged from the focus groups including; group culture, facilitation, teleconferenced education, technology, personal priorities, travel, and rural/remote. These themes were further sorted into two groups; reasons for switching to teleconferencing and factors that determine the success or failure of a telehealth CME. The factors that influenced the offsite registrars reasons to switch to teleconferencing included; personal priorities, travel, and rural/ remote. Further, the other four themes determined the success or failure of the teleconferenced training including; group culture, facilitation, teleconferenced education, and technology. All seven themes were relevant for the offsite registrars and onsite registrars, however, for the facilitators only the factors that determined the success of teleconferencing were applicable. Overall, the pilot study there was no difference in the educational experience provided. This study outlined the key factors that are required for effective teleconferenced training including; face to face bonding prior to teleconferencing, a skilled facilitator that provides active facilitation, a well organised structure, good quality technology, and regular checkups with the learners teleconferencing to ensure satisfaction. Additional research is required to replicate this study to compare this teleconferenced training with further teleconferenced training.

Background: Using technology requires nurses to capture, retrieve and organize digital data within virtual environments. Nurses often integrate digital data with other data sources when providing patient care with telehealth technologies and conducting research. Little is understood of how nurses navigate technology and process digital data in professional practice. Purpose: The overall aim of this dissertation was to explore how nurses navigate virtual environments and integrate digital data in professional practice through a grounded theory study of how nurses know the person using telehealth technology. The goals of the dissertation were to: a) Describe how knowing the person occurs with use of telehealth technology; b) Create a theoretical conceptualization of how the nurse comes to know the person in a virtual environment; and, c) Explicate data collection and analytical processes in Charmaz’s constructivist grounded theory. Methods Charmaz’s constructivist grounded theory (ConGT) was used for the research study. Findings: The process of conducting this study yielded two outcomes: 1. A grounded theory and conceptualization for Getting a Picture, which illuminates an integrated and iterative interplay of seven processes and 21 sub-processes that nurses described when forming a mental image of the person being cared for. Twenty-two registered nurses from five telehealth programs in two different provincial health systems participated. Primary data sources included 22 first interviews and 11 second interviews with the participants, and five observational experiences. 2. The approach for conducting ConGT involved operationalizing a series of five steps in the analytic process to visualize and conceptualize Getting a Picture. These steps included Initial Data Collection, Initial Coding, Focused Coding, Theoretical Coding and Theory Building. Conclusion: Visualization played an instrumental role when technology was used for both knowing the person in a virtual environment and operationalizing the methodological processes for this ConGT research study. Three main themes related to this overall finding in this dissertation were: (a) visualization and conceptualization to create a mental image is evident in both clinical and research domains of nursing practice; (b) interoperability of technology can impact visualization; and (c) competencies are required to support mental imaging and use of technology in visualizing a whole and accurate picture.

No sistema brasileiro de saúde, cabe aos Centros de Saúde o papel de órgão provedor de assistência médica primária. Para que esse papel seja cumprido com responsabilidade e eficácia, se mostrou fundamental a condução de programas públicos de atenção primária que envolvam visitas domiciliares aos pacientes. O objetivo desses programas, tais como o Estratégia de Saúde da Família (ESF), também conhecido como Programa de Saúde da Família (PSF), é o de melhorar a qualidade do serviço de saúde prestado à população por meio da aproximação entre equipes de saúde e a comunidade, permitindo, dessa forma, uma migração do paradigma de tratamento de doenças para o de promoção da saúde. No entanto, apesar da importância desses programas para a organização e articulação do sistema de atenção primária, as atividades de atenção domiciliar são normalmente conduzidas com pouco ou nenhum suporte de Tecnologia da Informação (TI). Esta pesquisa de mestrado tem por objetivo mostrar a definição e o desenvolvimento de um sistema móvel que auxilie os profissionais de saúde na coleta de informações dos pacientes que usufruem dos serviços de saúde citados acima. O projeto recebeu o nome de Projeto Borboleta e durante o tempo desta pesquisa várias versões do software foram desenvolvidas. Essas versões geraram protótipos do sistema que foram submetidos a testes em campo e, a partir da avaliação realizada pelos profissionais de saúde, surgiram alterações diversas. / In the Brazilian Health System, the healthcare centers have the role of primary health care providers. To successfully fulfill this responsibility with more dedication and effectiveness, the Brazil- ian government created public primary health programs of homecare where the health professionals visit the patient\'s homes. Those programs, as the Family Health Strategy (also known as Fam- ily Health Program), aim to raise the quality of health services provided by the centers to the neighboring community. This enables a new way of treatment of diseases and health care promo- tion. Nevertheless, those important programs have almost no Information Technology mechanisms helping them to manage the processes involved by the program. This master research objective is to present a definition and development of a mobile system that helps the healthcare providers to collect relevant data on the patient status on the site of the homecare treatment. The project was named as the Borboleta Project and during, the development of this research, several versions were released. Those versions were tested as prototypes on a real situation until a more stable version fitted the health professionals needs. Other objectives of this research were to analyze the solutions adopted by the development team, to describe the difficulties encountered by the team while working on this mobile system, and finally to show which were the feedbacks of the usage of the system on the field, during the test phase.

COVID-19 was declared a pandemic by the World Health Organization on March 11th, 2020. Many states issued stay-at-home orders to prevent the spread of the coronavirus. Any non-essential clinical services were canceled or postponed to decrease in-person visits at clinics, which led to clinics having decreased patient volume. Telehealth was used as a way to continue clinical care to patients in an alternate form. Health departments (HD) provide fundamental services to patients based on a sliding fee scale. Federally Qualified Health Centers (FQHC) provide a wide variety of health care services to underserved communities. Policies on the implementation of telehealth varied between the two systems. The concentration of this study is on the characteristics of telehealth service provision before and during the COVID-19 pandemic and future considerations for clinic service provision. A quantitative analysis was conducted through statewide surveys. The statewide surveys assessed clinic characteristics and contraceptive care service provision among HD family planning clinics and FQHC clinics in two Southeastern states, South Carolina (SC) and Alabama (AL), with similar clinic structures. The survey was conducted from July- November 2020. Survey items included evaluating the impact of COVID-19 on clinical service provision, including services provided prior to (2019) and during (March-June 2020) the pandemic. The response rate was 86.8% (N=112) among HD clinics and 53.8% (N=127) among FQHC clinics. Chi-Squared tests of independence were used to assess differences in service provision among HD and FQHC clinics in SC and AL. Fischer’s Exact test was applied where categorical responses were fewer than five. Among survey respondents, 64.9% (N=72) of HD clinics and 38.9% (N=49) of FQHC clinics indicated no telehealth services were provided prior to the pandemic (p < .0001). Nearly 35% (N=85) of all clinics reported introducing at least one telehealth service during the pandemic. The most prevalent telehealth service provided by HD clinics during the pandemic was prescribing refills of hormonal contraceptive methods at 58.2% (N=64). FQHC clinics’ most prevalent telehealth service provided during the pandemic was primary health care at 89.8% (N=114). Regarding the future of telehealth, 12.4% (N=12) of HD clinics plan to continue all telehealth services offered during March-June 2020, whereas 52.5% (N=62) of FQHC clinics plan to continue all telehealth services offered during March-June 2020 (p < .001). These findings highlight the significance of policy and procedures among the HD clinics in states that have a centralized health department structure. The telehealth services adopted by HD clinics and FQHC clinics varied and further research is needed to understand the barriers to telehealth provision in each state. The importance of reimbursement policy for telehealth services plays a vital role in providing contraceptive services, thus it may be critical to expand billing options and maintain reimbursement of telehealth through Medicaid.

No description available.

Autism Spectrum Disorder (autism) is a neurodevelopmental disorder characterized by social skills differences which can interfere with success in developing or maintaining relationships. Social skills training may promote more satisfying change in social interactions for individuals with autism, especially if they already have age-appropriate cognitive and language abilities. Social skills training is a typical approach for addressing social skills needs for many individuals with autism. In some instances, in-person social skills training or groups may not be readily available because of geographical, transportation, or other barriers. Delivering social skills training online is one way to increase access to intervention for individuals without feasible access to in-person social skills groups. However, very little is known about the untapped potential for interactive online social skills groups to provide similar benefits to in-person groups. We conducted a study delivering the same curriculum (UCLA PEERS®) in two modalities -- in person (per the manual) and online (same curriculum, delivered in a live interactive online teleconference environment). Pre- and post-intervention parent report measures were used to assess autism symptoms and social skills were compared across groups. An analysis of variance (ANOVA) was used to identify any significant differences between the two groups. Under analysis, the interaction term indicated no significant differential change over time according to group membership (time by group). This indicates that there were no statistically significant differences between online and in-person groups with the single exception of one subtest score, the detrimental behavior subscale. There were many main effects for time in both groups which indicates positive social improvements over time occurred in both in-person and online groups, primarily with similar trajectories. Our objective is to provide evidence that the outcomes of both modalities were not significantly different. The results indicate that this is generally the case according to our study. It is interesting to note that while students were satisfied with the social validity of either delivery modality, parents were generally more satisfied with the online delivery of social skills.

The personalization of telehealth services to accommodate patient preferences and interaction abilities could significantly improve patient adherence to telehealth treatment plans. Long-term adherence can be as low as 25% among chronic patients for reasons related to ease-of-use and personal preferences, which can be attributed to factors associated with the patient, physicians, and healthcare systems. Poor adherence in the long term can cause increased morbidity, poorer quality of life, a higher risk of mortality, and greater health care utilization. Poor adherence is partly driven by generic telehealth services that are not adapted to individual patients' lived experiences. Recent research calls for the personalization of telehealth services in a manner that addresses long-term adherence. This thesis views the telehealth service context from a multilevel service systems perspective. This perspective enables the articulation of the contextual differences between standardized and personalized services. This thesis proposes a service design method (SerViU: pronounced Serv You) to support a continuous Use - Assess - Personalize process; this design method focuses on the patient personal service encounter level within a telehealth service. SerViU is anchored in the service-dominant logic concept of value-in-use, and it assesses the patient's individualized experiences with the telehealth service and accordingly recommends a suitable personalization. SerViU guides decision-making about telehealth personalization by integrating an existing information communication technology (ICT) service personalization framework that identifies three types of ICT personalization: architectural, relational, and technological. A design science research methodology (DSRM) was used to guide the research activities underlying the development and validation of SerViU. Within this methodology, the SerViU Personalize Tool was selected to demonstrate SerViU's ability to personalize telehealth services by accounting for patient-related, service context-related, and technology-related factors. A multiple case study with embedded units of analysis was conducted at a Canadian hospital to simulate personalization decision-making using the SerViU Personalize Tool. The same participants were then asked to fill out a questionnaire to evaluate the tool's usefulness for decision-making, its relevance to the telehealth context, and whether it contained sufficient information to make personalization decisions. Results show that SerViU was relevant to telehealth contexts, useful for making personalization decisions, and provided sufficient information to make relevant decisions. The collected data were analyzed using cross- and within-case analysis by comparing decisions in different telemonitoring service modes. The comparisons included personalization options, feature selection, scores, rationales, and resource-related information. The results of this research provide a means to operationalize telehealth personalization as proposed in telehealth research. This study provides a method which can guide the transformation of generic telehealth services into personalized services. This research contributes to service design by differentiating between standard and personal service encounter levels, which is paramount for supporting the personalization of ICT-enabled services. This research contributes to the telehealth practice by presenting an ongoing telehealth personalization process that involves patients in decision-making throughout their treatment processes as a means to improving long-term adherence.

The use of telehealth in healthcare has grown in recent years; however, little is known about the effectiveness of this delivery method in the management of Type 2 diabetes mellitus (T2DM). Guided by the chronic care model and telehealth in chronic disease model, the purpose of this systematic literature review was to explore evidence related to lowering hemoglobin A1c levels and managing T2DM using telehealth in the outpatient setting. The practice-focused questions explored telehealth interventions used in T2DM management and their effectiveness. The Joanna Briggs Institute (JBI) method for conducting systematic literature reviews was the process, and data were compiled using the PRISMA evidence-based minimum set for reporting. Eighteen studies met the inclusion criteria for this project. Data were extracted, analyzed, and synthesized using JBI tools for data extraction and critical appraisal. Article appraisals revealed numerous telehealth interventions for management of T2DM including telephone, Internet-based, clinical video, remote monitoring, and smart phones/applications. Overall, telehealth interventions showed statistically significant improvement in the hemoglobin A1c levels of participants compared to traditional outpatient care. Success of the interventions is associated with components of evidenced-based diabetes management such as education, self-management, support, and feedback loop. The implications of this project for positive social change include the integration of telehealth interventions in the outpatient setting to manage T2DM with enhanced access to care, reduction in health disparities, and improved health outcomes for society.

No description available.

No description available.