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Biomedical subjects

Claudia Pagliari

Publications and source records attributed to Claudia Pagliari.

11 recordsLinked to original sources
PubMed2005

What is eHealth (4): a scoping exercise to map the field.

BACKGROUND: Lack of consensus on the meaning of eHealth has led to uncertainty among academics, policymakers, providers and consumers. This project was commissioned in light of the rising profile of eHealth on the international policy agenda and the emerging UK National Programme for Information Technology (now called Connecting for Health) and related developments in the UK National Health Service. OBJECTIVES: To map the emergence and scope of eHealth as a topic and to identify its place within the wider health informatics field, as part of a larger review of research and expert analysis pertaining to current evidence, best practice and future trends. METHODS: Multiple databases of scientific abstracts were explored in a nonsystematic fashion to assess the presence of eHealth or conceptually related terms within their taxonomies, to identify journals in which articles explicitly referring to eHealth are contained and the topics covered, and to identify published definitions of the concept. The databases were Medline (PubMed), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Science Citation Index (SCI), the Social Science Citation Index (SSCI), the Cochrane Database (including Dare, Central, NHS Economic Evaluation Database [NHS EED], Health Technology Assessment [HTA] database, NHS EED bibliographic) and ISTP (now known as ISI proceedings). We used the search query, "Ehealth OR e-health OR e*health". The timeframe searched was 1997-2003, although some analyses contain data emerging subsequent to this period. This was supplemented by iterative searches of Web-based sources, such as commercial and policy reports, research commissioning programmes and electronic news pages. Definitions extracted from both searches were thematically analyzed and compared in order to assess conceptual heterogeneity. RESULTS: The term eHealth only came into use in the year 2000, but has since become widely prevalent. The scope of the topic was not immediately discernable from that of the wider health informatics field, for which over 320000 publications are listed in Medline alone, and it is not explicitly represented within the existing Medical Subject Headings (MeSH) taxonomy. Applying eHealth as narrative search term to multiple databases yielded 387 relevant articles, distributed across 154 different journals, most commonly related to information technology and telemedicine, but extending to such areas as law. Most eHealth articles are represented on Medline. Definitions of eHealth vary with respect to the functions, stakeholders, contexts and theoretical issues targeted. Most encompass a broad range of medical informatics applications either specified (eg, decision support, consumer health information) or presented in more general terms (eg, to manage, arrange or deliver health care). However the majority emphasize the communicative functions of eHealth and specify the use of networked digital technologies, primarily the Internet, thus differentiating eHealth from the field of medical informatics. While some definitions explicitly target health professionals or patients, most encompass applications for all stakeholder groups. The nature of the scientific and broader literature pertaining to eHealth closely reflects these conceptualizations. CONCLUSIONS: We surmise that the field -- as it stands today -- may be characterized by the global definitions suggested by Eysenbach and Eng.

Delivery of Health Care↗
PubMed2005

Adoption and perception of electronic clinical communications in Scotland.

OBJECTIVES: To determine the uptake of multiple eHealth facilities enabled by the NHS Scotland Electronic Clinical Communications Implementation Programme (ECCI) and to ascertain primary and secondary care users' perceptions. DESIGN: Prospective monthly measurement of 37 indicators of roll-out and adoption. Retrospective questionnaire survey of users. SETTING: Scottish health board regions. Quantitative implementation indicators were gathered in primary and secondary care across all 16 regions. Questionnaire data were obtained from recorded users in five representative regions (112 general practices, 92 secondary care units). OUTCOME MEASURES: Change in uptake levels of ECCI facilities over a 15-month period. Users' perceptions of benefits, facilitators and barriers. RESULTS: All health boards participated in the monthly data set collection. The response rate to the survey was 62% in primary care and 37% in secondary care. Across Scotland as a whole, the process of implementation was gradual. While there were marked gains in the availability of ECCI facilities over the observation period, rates of adoption lagged behind and varied across alternative facilities. Electronic results were widely used, with most laboratories offering them and around half of general practices receiving them. More modest rates of adoption were observed for e-discharge letters, e-referrals, e-clinic letters and clinical e-mail. E-booking was used very little. Among engaged users responding to the survey, electronic access to test results was the most frequently utilised facility and electronic outpatient booking the least. Perceived benefits of ECCI facilities included convenience, ease of use, time-saving and provision of an audit trail. Perceived barriers included the need to duplicate data entry where new systems were not universally implemented, technological difficulties, time, training and resources. CONCLUSIONS: Significant progress was observed in the implementation of ECCI facilities across Scotland. Users reported that these improved communication and were beneficial, but system reliability, incompatibility and duplication of data hindered more widespread uptake. Data were collected at a transitional phase of the programme. Whilst, among users of ECCI facilities, perceptions of the programme and its potential benefits were generally positive, its full impact will not become evident until the new electronic tools are implemented nationally and have been more fully integrated into normal work routines.

Attitude to Computers↗
PubMed2005

Implementing the National Programme for IT: what can we learn from the Scottish experience?

The National Programme for IT (NPfIT) promises to revolutionize the delivery of health care by enabling seamless and secure electronic exchange of clinical information within the NHS. Challenges to NPfIT highlighted in the media and academic commentary are common to such initiatives worldwide. This paper offers key messages and recommendations derived from a comparable electronic clinical communications programme in Scotland, and elsewhere, as a means to aid the implementation process.

Diffusion of Innovation↗
PubMed2004

Development and evaluation of a concordance training course for medical practitioners.

The authors sought to develop and evaluate a training course on the theory and methods of seeking 'concordance' with patients who are using medications inappropriately. Eight general practitioners were recruited to a four-day interactive course including factual materials, attitudinal challenge, skills development and assessment. Participants enjoyed the course and thought they had learned from it. Knowledge and skills improved significantly and attitudes showed a non-significant shift. The study demonstrated that concordance-related skills can be taught and measured, suggesting that trials to assess the impact of such training on patient outcomes may be feasible and worthwhile.

Clinical Competence↗
PubMed2004

Electronic Clinical Communications Implementation (ECCI) in Scotland: a mixed-methods programme evaluation.

AIMS: The Electronic Clinical Communications Implementation programme aims to facilitate implementation of electronic systems for primary-secondary care communication, focusing on laboratory results reporting, outpatient appointment booking, referral, discharge and clinic correspondence, and clinical e-mail. This independent programme evaluation explored the processes and outcomes of implementation, barriers and facilitators to system adoption, and benefits and drawbacks for professional users. METHODS: The mixed methods approach incorporated document review, surveys, stakeholder interviews, consensus exercises, and monthly recording of quantitative process and outcome variables. RESULTS: Qualitative and survey work highlighted wide variation in the technologies and implementation approaches adopted. A consensus process was used to instigate a national minimum dataset. To date, implementation of laboratory results reporting has demonstrated the greatest success and electronic outpatient booking the least. A mixed-format survey of users in clinical practice revealed a more detailed picture of behaviour and attitudes demonstrating that where systems are available and accepted they are utilized, while product usability, process complexity and user-engagement methods influence uptake. CONCLUSIONS: The evaluation has demonstrated the difficulties faced when attempting to implement a multifaceted technological and behavioural change intervention on a national scale, but has also revealed unexpected benefits, including general improvements in Information Management & Technology capability across the Scottish health service.

Efficiency, Organizational↗
PubMed2004

A survey of GP attitudes to and experiences of email consultations.

Email is an accepted part of modern communication in business and education. The use of email could benefit communication between patients and healthcare professionals. Use of email within health care has been hampered by concerns about privacy, technical barriers, perceived fear of change and increased workload.Sixty-two general practitioners within Dundee in east Scotland responded to a questionnaire and indicated that they regularly used email for communication within their practices and with outside agencies, but rarely with patients. Many perceived a need to provide an email service for clinical enquiries and repeat prescription requests but felt constrained from doing so by a lack of an accepted system and workload concerns.

Attitude of Health Personnel↗
PubMed2004

Email consultations in general practice.

BACKGROUND: Email is an established method of communication in business, leisure and education but not yet health care. AIM: To evaluate an email service enabling communication between patients and their general practice regarding repeat prescriptions, appointment booking and clinical enquiries. DESIGN: Qualitative analysis of interactions and an electronic user survey. SETTING: An urban practice in Dundee, Scotland. PARTICIPANTS: 150 patients aged 24 to 85. METHODS: We set up a practice facility to allow our patients to use email to book appointments, order repeat prescriptions and consult their general practitioner (GP). RESULTS: Patient satisfaction with the service was very high. Patients specifically commended the practice for setting up a facility to allow communication outside standard working hours and for the ease of ordering repeat prescriptions. Patients were pleased to have a means of seeking their doctor's comment or opinion without bothering him or her by making and attending a formal face-to-face consultation. Email dialogue was polite, factual, but less formal than standard letters. Staff did not experience any perceptible rise in workload. CONCLUSIONS: Use of an email consultation facility worked well within an urban practice, was deemed helpful by patients, and resulted in no apparent increase in GP workload. Our results suggest that there may be an unmet need amongst patients for clinical email services, and that such services may have positive outcomes for patients and practices.

Adult↗
PubMed2003

DARTS 2000 online diabetes management system: formative evaluation in clinical practice.

RATIONALE, AIMS AND OBJECTIVES: Failure to engage in user-informed evaluation of emergent health informatics tools can have negative consequences for future implementation, related both to poor usability or clinical utility and to suboptimal stakeholder buy-in. This paper describes a formative evaluation in primary care of a multifaceted, web-based resource for diabetes management. The primary aims were to assess the usability and utility of the prototype in order to inform system refinements prior to implementation, and to investigate barriers and facilitators to system use so as to aid the development of a tailored implementation plan. METHODS: A mixed-method approach involving survey, remote observation, semi-structured interviews and electronic feedback. CONTEXT: One Scottish local health care cooperative comprising five general practice surgeries and their staff. RESULTS: A survey following temporary exposure to a dummy site revealed high levels of computer familiarity, welcoming attitudes and positive ratings of usability, format and utility. Comments mainly addressed content accuracy, feature suggestions and usability issues. Key barriers and facilitators to use included time and training. Remote observation following access to live clinical data enabled profiling of usage by individual and professional group. In the 3 month observation period administrators were the most frequent users, followed by GPs and nurses, with clinical and data entry screens accessed most often. Semi-structured interviews with key respondents sampled by professional group and usage frequency provided richer qualitative information on barriers and facilitators to use, patterns of system integration into work routines and system usability, content and utility. Content analysis of electronic feedback revealed mainly technical queries and general expressions of satisfaction. CONCLUSIONS: Evaluation informed a number of important and unforeseen improvements to the prototype and helped refine the implementation plan. Engagement in the process of evaluation has led to high levels of stakeholder ownership and widespread implementation.

Attitude to Computers↗
PubMed2003

"Sweet Talk": text messaging support for intensive insulin therapy for young people with diabetes.

Optimal diabetes management involves considerable behavioural modification, while nonadherence contributes significantly to poor glycaemia. Extensive research on psychological interventions aiming to improve glycaemia suggests that current strategies are costly and time-consuming and in our experience do not appeal to young people with Type 1 diabetes. Text messaging has rapidly become a socially popular form of communication. It is personal, highly transportable, and widely used, particularly in the adolescent population. However, text messaging coupled with specific behavioural health strategies has yet to be utilised effectively. We have developed a novel support network ("Sweet Talk"), based on a unique text-messaging system designed to deliver individually targeted messages and general diabetes information. Individualised motivation strategies--based on social cognition theory, the health belief model, and goal setting--form the theoretical basis of the message content. Intensifying insulin therapy and increasing contact with the diabetes team can improve control, but are difficult to provide within existing resources. Our support system offers a means of contact and support between clinic visits and aims to increase adherence with intensive insulin regimens and to improve clinical outcome.

Adult↗
PubMed2002

Impact of group structure and process on multidisciplinary evidence-based guideline development: an observational study.

RATIONALE, AIMS AND OBJECTIVES: This paper presents selected results from a study investigating the impact of small group processes on the development of clinical practice guidelines by multidisciplinary panels. Observations of one panel developing a guideline for primary care over several months are reported here. METHODS: Non-participant observation with content analy-sis of transcripts aided by field notes. RESULTS: Bales's interaction process analysis was used to categorize interactions in terms of their task-oriented or socioemotional qualities. This revealed a well-functioning, task-oriented group characterized by predominantly positive social behaviours. However, a breakdown of dialogue by speaker indicated a marked effect of professional role and status on the level of contribution to group discussions. This, and marked changes in panel composition across meetings, has implications for the multidisciplinarity of decision-making in such groups and hence for the acceptance and implementation of their outputs. CONCLUSIONS: These findings are likely to generalize to other health care settings in view of the growing emphasis on multidisciplinary decision-making and the clear status hierarchies inherent within the medical and allied fields.

Decision Making↗