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This consensus policy paper reviews the history, use and significance of telehealth in primary care. The emergence of telehealth as a primary strategy to continue to deliver value based, timely primary care during COVID-19 is discussed with recommendations for future applications, payment and preparation of providers to continue to provide quality care of clients in the future using telehealth.

<p> This work is an investigation of user acceptance of a prototype solution utilizing wireless text messaging (or SMS - i.e., short messaging service) to improve people's adherence. Insufficient adherence, also known as medical non-compliance, is a major cause of failure in self-management programs, causing significant losses to all healthcare stakeholders.</p> <p> Innovative mobile healthcare solutions, based on portable devices like cell phones, may address some non-adherence aspects by helping outpatients to follow treatments agreed with their health providers. Although this seems a win-win situation, a verdict on the overall usefulness of such an approach cannot be formulated before exploring outpatient acceptance, as this is a novel technology that targets a new area of implementation. Accordingly, this research investigates key factors that may influence the acceptance of a mobile healthcare solution based on SMS to support improved adherence to healthy behaviour, with special attention to motivation (the 'pro' factors) and perceived risk (the 'con' factors).</p> <p> As a means of investigation, a one-month longitudinal experiment with two groups of subjects (an intervention group and a control group) was utilized. Data were analyzed with quantitative and qualitative techniques: descriptive statistics, partial least squares modelling, and content analysis.</p> <p> Findings show that users are aware of the potential usefulness of such a pioneering application. However, enjoyment is the unique reason for adopting, and perceived financial and psychological risks the main obstacles against adopting, an SMS-based solution for improving adherence to healthy behaviour. Furthermore, a business analysis shows that users are concerned about usefulness features, even when asked about financial aspects.</p> <p> These results, together with encouraging findings about the effectiveness of the application, open the way for medical-led research to investigate if long-term mobile healthcare initiatives customized to patient needs are also beneficial for outpatient adherence and health outcomes.</p> / Thesis / Doctor of Philosophy (PhD)

Bakgrund Utvecklingen av digitala vårdtjänster går snabbt framåt och ses som ett kostnads- och tidseffektivt medel för ökad tillgänglighet. Vård via videomöten erbjuds inom primär-,sluten-, och specialistvård, både av privata och statliga aktörer. Den visuella möjligheten gör att videomöten är den vårdtjänst som mest liknar det fysiska vårdbesöket och används idag kontinuerligt. Vårdgivare som erbjuder vård på distans omfattas av samma lagar och regelverk som övrig hälso- och sjukvård. De är därmed skyldiga att bedriva jämlik vård som utgår från patienten, med hög kvalitet och på ett sätt som tillgodoser patientens behov av trygghet, kontinuitet och säkerhet. Syfte Syftet med studien var att belysa patientens upplevelse av digitala videomöten med hälso- och sjukvården. Metod En icke-systematisk litteraturöversikt utfördes och baserades på 16 vetenskapliga artiklar, av både kvalitativ och kvantitativ ansats. Databaserna Public Medline [PubMed] och Cumulative Index to Nursing and Allied Health Literature [CINAHL] användes för att söka efter de inkluderade artiklarna, med hjälp av sökord i olika kombinationer. Kvalitet granskades med Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Innehåll analyserades med en integrerad analys för att sedan sammanställas i huvud och underkategorier. Resultat Sammanställningen resulterade i huvudkategorierna: Upplevelser av vårdens kvalitet och upplevelser av tillgänglighet. Inom huvudkategorierna framkom en delad bild av patientens tankar om videomöten utifrån individuella preferenser. En stor påverkansfaktor var hur relation och dialog upplevdes samt om trygghet kunde förmedlas genom dessa möten. Upplevelsen påverkades även av tillgänglighet och ökad flexibilitet. En del tyckte att det var en bekväm lösning medan andra hade tekniska svårigheter och upplevde videomöten negativt. Slutsats En sedan tidigare etablerad vårdkontakt med kunskap om sjukdomshistoria upplevdes viktigare än på vilket sätt vårdbesöket utfördes. Resultatet visade även att samverkan, stöd och trygghet kunde främjas via videomöten. Inför operation utgjorde videomöten en möjlighet att samtala direkt med kirurgen och få tydlig information om ingrepp och risker vilket upplevdes lugnande. / Background Digital health services are rapidly developing into a cost and time effective way to increase accessibility for patients. Healthcare by video is offered for primary and specialist care, both by private and public actors. The visual aspect of video conferencing makes it the health care service most resembling that of a physical meeting. Caregivers who offer the service follow the same rules and regulations as all other health care services. They are therefore regulated to offer equal, high-quality healthcare based on individual needs and in a way that meets the patient needs of safety and continuity. Aim The aim of this study was to describe patient experiences and preferences of video appointments in a health care setting. Method A non-systematic literature review was conducted based on 16 scientific articles of both qualitative and quantitative design. The database searches were performed in PublicMedline [PubMed] and Cumulative Index to Nursing and Allied Health Literature [CINAHL], using appropriate keywords. A quality assessment of the 16 articles was made using Sophiahemmet’s quality matrix for scientific classification and quality assurance. The chosen articles were analyzed using an integrated analysis and subsequently grouped into two main categories. Results The compilation resulted in the following main categories: experience of quality of care and experiences of availability. The acceptance of video conferences was based on individual preferences. A major influencing factor was how dialogue and relationships were experienced and whether rapport could be conveyed through these appointments or not. The experience was also influenced by availability and increased flexibility. Some found it a convenient solution, while others had difficulty with the technology and experienced video appointments in a negative way. Conclusions A previously established relationship to health care professionals with knowledge of medical history was considered more important than the way in which the appointment was carried out. Collaboration, rapport, and security could be promoted through video. Before surgery, it provided an opportunity to talk with the surgeon and receive clear information about procedures and risks, which was perceived as reassuring.

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Yes / The COVID-19 national emergency led to a surging demand for telehealth expansion within pediatric occupational therapy. Despite the growing literature on telehealth as a response to COVID-19, few studies explore the use of telehealth for children and young people with autism spectrum disorder (ASD). This pilot study aimed to understand the experiences of occupational therapists adapting to a virtual delivery service model amidst COVID-19 to support youth with ASD. The researchers used a qualitative research design. Semi-structured, video-based interviews were used to collect data. Interviews were analyzed using thematic analysis. This study included 3 UK registered occupational therapists. Four themes emerged from the data: 1. “Telehealth is Reducing Social Anxiety” 2. “Parents End Up Becoming Your Therapy Assistants” 3. “Nothing Will Replace Face to Face for Assessments” 4. “You Definitely Have to Be More Creative.” The themes report that telehealth can reduce social anxiety, increase skill transferability, and improve family involvement. Participants indicated that shorter sessions, movement-based interventions, planning and adapting to home-based resources were strategies that overcame the limitations of virtual therapy. The findings contrast with some previous research that found that telehealth may inhibit engagement and may strain the therapeutic rapport. This study supports existing literature that telehealth can enhance engagement, family involvement and generalization of skills. Findings from this study support the use of telehealth to deliver occupational therapy services for children and young people with ASD, but it is recommended that telehealth should not be a one size fits all service delivery model. Further larger-scale research is needed to confirm the study findings and to explore the family and young person’s perspectives of using telehealth.

Introduction: Telehealth allows behavioral health care and specialty services to be extended to rural residents. Telehealth is an important resource for the Alaskan healthcare system, which is tasked with providing services to culturally diverse populations living in remote areas. Training competent providers to deliver telehealth services is vital for the implementation of successful telehealth programs. Yet, the literature is lacking in the area of provider behavioral telehealth competency training. Methods: This study assessed the impact of a Behavioral Telehealth Ethical Competencies Training program on 16 behavioral health providers' development of behavioral telehealth competency. A total of 14 competencies were developed, which required participants to understand the roles and responsibilities of a behavioral telehealth coordinator working at the distal site as well as the roles and responsibilities of the therapist. Video vignettes evaluating the 14 competencies, self-reported competence surveys and follow-up surveys of progress on telehealth goals were utilized to assess effects of the training. Results: Results indicated participants' behavioral telehealth competencies increased following training. Participants reported positive perceptions regarding their competency, and achieved progress on the majority of behavioral telehealth goals set during the training. Conclusions: This study provides a baseline for developing a best practice model for behavioral telehealth service delivery by identifying specific provider competencies for administering effective behavioral telehealth services. A unique continuing education training model, led by content experts including university professors and Alaska Native Elders, incorporating behavioral telehealth, rural ethics, cultural competency and vicarious trauma training is described. Lastly, this study details the use of an innovative video vignette assessment instrument for evaluating the effectiveness of continuing education training.

Over the past 20 years, with the development and expansion of computer- and internet-based services (e.g., psychoeducational, intervention, and testing programs), the integration of technology with the treatment of mental health disorders has sparked one of the most debated topics in the mental health profession. With no clear end for this debate in sight, many believe that clinicians wish to reach a consensus and adopt a universal stance on computer-based psychological services so that discussion and research can be shifted to make meaningful contributions for the future. Although paramount, many licensed psychologists have yet to state their stance of whether they believe that internet-based therapeutic methods can be helpful; with fewer having declared whether they would be willing to utilize such techniques if given the opportunity. For this reason, the current study aimed to create a multi-focused survey to explore the attitudes of currently licensed and future clinicians (current Ph.D. or Psy.D. doctoral candidates) to explore differences in their acceptance of tele-health therapeutic interventions. An online survey was created to assess such attitudes across various domains of tele-health, as well as assess acceptance or rejection of such modalities. Clinical training directors, faculty, and students from around the United States, as well as members from the APA Division 12 (clinical psychology) were invited to participate. Binary logistic regression, percentages, and descriptive statistics were utilized to examine the data. Data indicated that no significant differences between currently licensed and future psychologists exist in their endorsement of tele-health modalities. However, it was found that cognitive-behavioral-, cognitive-, behavioral-, and systems-oriented psychologists were significantly more endorsing, and willing to utilize tele-health modes of interventions than were dynamic/analytic, or existential-oriented therapists. Data was further analyzed by gender, age, and the interaction of age * orientation. Results of this study will aid in creating a consensus as to the utilization of tele-health practices and help drive research by demonstrating which modalities (e.g., web camera, e-mail, etc.) and orientations should be the focus of research.

Wearable sensor systems composed of small and light sensing nodes have the potential to revolutionise healthcare. While uptake has increased over time in a variety of application areas, it has been slowed by problems such as lack of infrastructure and the functional capabilities of the systems themselves. An important application of wearable sensors is the detection of falls, particularly for elderly or otherwise vulnerable people. However, existing solutions do not provide the detection accuracy required for the technology to gain the trust of medical professionals. This thesis aims to improve the state of the art in automated human fall detection algorithms through the use of a machine learning based algorithm combined with novel data annotation and feature extraction methods. Most wearable fall detection algorithms are based on thresholds set by observational analysis for various fall types. However, such algorithms do not generalise well for unseen datasets. This has thus led to many fall detection systems with claims of high performance but with high rates of False Positive and False Negative when evaluated on unseen datasets. A more appropriate approach, as proposed in this thesis, is a machine learning based algorithm for fall detection. The work in this thesis uses a C4.5 Decision Tree algorithm and computes input features based on three fall stages: pre-impact, impact and post-impact. By computing features based on these three fall stages, the fall detection algorithm can learn patterns unique to falls. In total, thirteen features were selected across the three fall stages out of an original set of twenty-eight features. Further to the identification of fall stages and selection of appropriate features, an annotation technique named micro-annotation is proposed that resolves annotation-related ambiguities in the evaluation of fall detection algorithms. Further analysis on factors that can impact the performance of a machine learning based algorithm were investigated. The analysis defines a design space which serves as a guideline for a machine learning based fall detection algorithm. The factors investigated include sampling frequency, the number of subjects used for training, and sensor location. The optimal values were found to be10Hz, 10 training subjects, and a single sensor mounted on the chest. Protocols for falls and Activities of Daily Living (ADL) were designed such that the developed algorithms are able to cope under a variety of real world activities and events. A total of 50 subjects were recruited to participate in the data gathering exercise. Four common types of falls in the sagittal and coronal planes were simulated by the volunteers; and falls in the sagittal plane were additionally induced by applying a lateral force to blindfolded volunteers. The algorithm was evaluated based on leave one subject out cross validation in order to determine its ability to generalise to unseen subjects. The current state of the art in the literature shows fall detectors with an F-measure below 90%. The commercial Tynetec fall detector provided an F-measure of only 50% when evaluated here. Overall, the fall detection algorithm using the proposed micro-annotation technique and fall stage features provides an F-measure of 93% at 10Hz, exceeding the performance provided by the current state of the art.

Telenursing is a highly specialized area of nursing practice that has evolved in response to the advent of new technologies within the delivery of health care. Telenursing has been defined as “the use of communications and information technology [ICT’s] to deliver health and health care services and information over large and small distances (CRNBC, 2016). Telenurses use health information systems (HIS) in the form of a Clinical Decision Support System (CDSS) to assist callers with their health related concerns on a 24/7 basis. As decision making is an integral part of telenurse practice, particularly because they are using a CDSS while assessing the caller over the phone, it was important to understand the factors that influence the decision making process so as to better support telenurse practice in terms of education as well as other supports. This thesis identified those factors and used Rasmussen’s Decision Ladder as a model in order to provide a framework for telenursing. It was found that there were several factors identified that influenced how telenurses made decisions while using a CDSS. Additionally, the decision ladder was validated as a framework to describe telenurse practice. / Graduate