Paradox of telemedicine: building or neglecting trust and equity

Yee, Vivian; Bajaj, Simar S.; Stanford, Fatima Cody

doi:10.1016/s2589-7500(22)00100-5

Cited by 37 publications

(16 citation statements)

References 9 publications

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“…What was novel was the use of an app accessed by both pre‐ and within‐hospital clinicians, with information simultaneously shared between different healthcare organisations, hospital departments and professional groups. Considerable advances have been made with wearable devices for digital monitoring, 55 electronic consultations 56 and telemedicine models, 57,58 yet calls continue for research understanding influential factors in successful implementation and sustained use in clinical settings 55,56 . While technical skills are required for implementation (e.g., digital navigators), 59,60 communication remains critical 59 with collaborative skills and interprofessional communication between interdisciplinary clinical team members important for digital health solutions 61–63 .…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the successful implementation of a novel digital health application to streamline multidisciplinary communication across multiple organisations for emergency care

Bagot,

Bladin,

et al. 2023

Evaluation Clinical Practice

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RationaleDelivering optimal patient health care requires interdisciplinary clinician communication. A single communication tool across multiple pre‐hospital and hospital settings, and between hospital departments is a novel solution to current systems. Fit‐for‐purpose, secure smartphone applications allow clinical information to be shared quickly between health providers. Little is known as to what underpins their successful implementation in an emergency care context.AimsTo identify (a) whether implementing a single, digital health communication application across multiple health care organisations and hospital departments is feasible; (b) the barriers and facilitators to implementation; and (c) which factors are associated with clinicians' intentions to use the technology.MethodsWe used a multimethod design, evaluating the implementation of a secure, digital communication application (Pulsara™). The technology was trialled in two Australian regional hospitals and 25 Ambulance Victoria branches (AV). Post‐training, clinicians involved in treating patients with suspected stroke or cardiac events were administered surveys measuring perceived organisational readiness (Organisational Readiness for Implementing Change), clinicians' intentions (Unified Theory of Acceptance and Use of Technology) and internal motivations (Self‐Determination Theory) to use Pulsara™, and the perceived benefits and barriers of use. Quantitative data were descriptively summarised with multivariable associations between factors and intentions to use Pulsara™ examined with linear regression. Qualitative data responses were subjected to directed content analysis (two coders).ResultsParticipants were paramedics (n = 82, median 44 years) or hospital‐based clinicians (n = 90, median 37 years), with organisations perceived to be similarly ready. Regression results (F(11, 136) = 21.28, p = <0.001, Adj R2 = 0.60) indicated Habit, Effort Expectancy, Perceived Organisational Readiness, Performance Expectancy and Organisation membership (AV) as predictors of intending to use Pulsara™. Themes relating to benefits (95% coder agreement) included improved communication, procedural efficiencies and faster patient care. Barriers (92% coder agreement) included network accessibility and remembering passwords. PulsaraTM was initiated 562 times.ConclusionImplementing multiorganisational, digital health communication applications is feasible, and facilitated when organisations are change‐ready for an easy‐to‐use, effective solution. Developing habitual use is key, supported through implementation strategies (e.g., hands‐on training). Benefits should be emphasised (e.g., during education sessions), including streamlining communication and patient flow, and barriers addressed (e.g., identify champions and local technical support) at project commencement.

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Section: Discussionmentioning

confidence: 99%

Factors influencing the successful implementation of a novel digital health application to streamline multidisciplinary communication across multiple organisations for emergency care

Bagot,

Bladin,

et al. 2023

Evaluation Clinical Practice

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“…During this process of workforce expansion, health care systems must also prioritize hiring practices and training efforts that intentionally recruit and retain individuals from historically marginalized populations, as patient-provider cultural concordance has been shown to influence trust, 88 which in turn affects the likelihood of telehealth adoption. 89 In summary, significant policy changes across multiple systems are required to increase access to effective telehealth interventions for populations frequently marginalized. Innovative clinical and research programs have demonstrated the potential for telehealth to reduce inequities in T1D care delivery and outcomes.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Narrowing the Divide: The Role of Telehealth in Type 1 Diabetes Care for Marginalized Communities

Crossen

Wagner

2023

J Diabetes Sci Technol

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Widespread uptake of telehealth in response to the COVID-19 pandemic has highlighted geographic, demographic, and economic disparities in access to virtual care. However, research studies and clinical programs that predate the pandemic demonstrate the potential for telehealth-based interventions to improve access to and outcomes of type 1 diabetes (T1D) care for individuals in geographically or socially marginalized communities. In this expert commentary, we discuss telehealth-based care models that have been successful in improving care for marginalized T1D populations. We also outline the policy changes needed to expand access to such interventions to reduce established disparities in T1D care and promote better health equity among people living with T1D.

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“… 11 Underserved communities have known barriers to video visits, including a lack of reliable internet, concerns about costs, unfamiliarity with telehealth, distrust in health care systems, and low health literacy. 11 , 12 In the United States, 23% of adults still lack access to high-speed service at home; of those who do not use broadband, only 15% have access to a smartphone. 13 Requiring in-office visits for individuals who cannot access face-to-face virtual visits can be a barrier to equitable, quality care.…”

Section: Telehealth Policy and Health Equitymentioning

confidence: 99%

“…Telehealth can improve the opportunity for providing high-quality, equitable care to underserved and underresourced communities when trust and rapport are prioritized and barriers are addressed. 11 , 12 In July 2022, HHS and the US Department of Justice issued guidance on nondiscrimination in telehealth. This guidance explains how various federal laws require accessibility to telehealth for those with disabilities and limited English proficiency.…”

Section: Telehealth Policy and Health Equitymentioning

confidence: 99%