Background: Digital technologies (DTs) have profoundly impacted health care delivery globally and are increasingly used in clinical practice. Despite this, there is a scarcity of guidelines for implementing training in digital health competencies (DHC) in…

Asking Questions: Techniques for Semistructured Interviews - Volume 35 Issue 4

Background: Evidence suggests that illness perceptions held by people living with multiple sclerosis (MS) impact affective distress and physical health outcomes. In a #RCT #ClinicalTrial, we developed 2 MS #Online Courses—the standard care course and the…

Semistructured interviews and focus groups with experts in biodiversity finance in Europe identify opportunities and barriers to upscaling private investment in biodiversity, and emphasize that public...

Background: In Quebec, the shortage of nurses during night shifts compromises the safety and quality of resident care, particularly in small residential and long-term care centers (“Centres d’hébergement et de soins de longue durée”; CHSLDs) located in…

Background: In Spain, the prevalence of heart failure is twice the European average, partly due to inadequate #patient management. To address this issue, a standardized care model, the Care Model for #patients with Heart Failure (Modelos Asistenciales de Atención al Paciente con Insuficiencia Cardíaca), was developed. This model emphasizes the importance of sequential visits from hospital discharge until the #patient transitions to chronic care to prevent rehospitalization. The standardized care pathway has been implemented in certain areas of the Andalusia #health Service. However, there is uncertainty about whether the region’s #ehr system, Diraya, can effectively support this model. If not properly integrated, it could lead to data inaccuracies and noncompliance with the standardized care pathway. Objective: This study aimed to explore how to improve Diraya to better support #health care professionals in adhering to the transition standardized care model for #patients with heart failure as they move from hospital care to chronic care. Methods: In total, 16 semistructured interviews were conducted with nurses and physicians from both hospital and primary care settings. Thematic analysis was used to analyze the data and recommendations for improvements that were developed based on the findings. These recommendations were further supported by existing literature and validated through additional interviews. Results: In total, 65 codes, 23 subthemes, and 8 themes were identified. The main themes included optimizing #medical data management for enhanced clinical workflow, agreement on standardization and enhancement of the discharge report, enhancing clinical decision support through updated guidelines and automated tools, optimizing interoperability as a solution for better management of #patients with heart failure, and encouraging communication based on #digital tools and personal connection. In total, 15 improvements were proposed, such as standardizing technology across Andalusia #health Service facilities and offering targeted training programs. These measures aim to enhance interoperability, streamline communication between different #health care settings, and reduce the administrative burden for #health care professionals. Conclusions: Diraya currently does not adequately support the transition standardized care model, placing a significant administrative burden on #health care professionals, often with ethically concerning implications. To ensure effective implementation of the standardized care model, major updates are necessary for Diraya’s clinical information management, system functionality, and organizational structure within the Andalusia #health Service.

Purpose: Intentional communication acts, or purposefully directed vocalizations and gestures, are particularly difficult for infants at elevated ...

Background: Patients with #cardiovascular implantable electronic devices (CIEDs) typically attend in-person CIED clinic visits at least annually, in addition to remote monitoring (RM). Because the CIED data available through in-person CIED clinic visits and RM are nearly identical, the 2023 #heart Rhythm Society expert consensus statement introduced “alert-based RM,” an RM-first approach where patients with CIEDs that are consistently and continuously connected to RM, in the absence of recent alerts and other cardiac comorbidities, could attend in-person CIED clinic visits every 24 months or ultimately only as clinically prompted by actionable events identified on RM. However, there is no published information about patient and clinician perspectives about barriers and facilitators to such an RM-first care model. Objective: To understand patient and clinician perspectives about an RM-first care model for CIED care. Methods: We interviewed 40 rural Veteran patients who were experienced with RM for with CIEDs and 22 CIED clinicians who were experienced in using RM regarding barriers and facilitators to an RM-first care model. We conducted reflexive thematic analysis of interviews. Two authors familiarized themselves with the dataset and generated separate codebooks based on both the interview guides and inductively coded notes. These two authors met and reviewed each other’s codes, sought additional author input, and resolved differences before one author coded the remaining interviews and developed candidate themes. These themes were refined, named, and supported with quotations. Results: Patients expressed interest in an RM-first approach, particularly to reduce the burden of long travel times, sometimes in inclement weather, and to enable clinicians to provide care for other patients. However, many preferred routine in-person visits; reasons included a skepticism of the capabilities of RM, a sense that in-person visits provided superior care, and enjoyment of in-person patient-clinician relationships. Clinicians were interested in RM-first care, especially for stable, RM-adherent patients who were not device-dependent. Clinicians most frequently cited the benefit of reducing patient travel burden as well as optimizing clinic space and time to focus on other care such as reviewing routine RM transmissions, but also noted barriers including lack of in-person assessment, patient-perceived diminution of the patient-clinician relationship, possible loss to follow-up, and technological difficulties. Clinicians felt that an RM-first care model should be evaluated for success based on patient satisfaction and assessment of timely addressing of rhythm issues to prevent adverse outcomes. Most clinicians expected that RM-first care represented the future of CIED care. Conclusions: Both patients and CIED clinicians interviewed who were experienced in using RM were open to an RM-first care model that reduces in-person visits but reported some barriers about solely relying on RM and possible diminution of the patient-clinician relationship. Implementation of new RM recommendations will require attention to these perceptions and prioritization of patient-centered approaches.