Care Platforms Research Articles

Effect of Digital Care Platforms on Quality of Care for Oncological Patients and Barriers and Facilitators for Their Implementation: Systematic Review.

BackgroundOncological health care services are challenged by the increasing number of cancer survivors, long-term follow-up care, and fragmentation of care. Digital care platforms are potential tools to deliver affordable, patient-centered oncological care. Previous reviews evaluated only one feature of a digital care platform or did not evaluate the effect on enhancement of information, self-efficacy, continuity of care, or patient- and health care provider–reported experiences. Additionally, they have not focused on the barriers and facilitators for implementation of a digital care platform in oncological care.ObjectiveThe aim of this systematic review was to collect the best available evidence of the effect of a digital care platform on quality of care parameters such as enhancement of available information, self-efficacy, continuity of care, and patient- and health care provider–reported experiences. Additionally, barriers and facilitators for implementation of digital care platforms were analyzed.MethodsThe PubMed (Medline), Embase, CINAHL, and Cochrane Library databases were searched for the period from January 2000 to May 2020 for studies assessing the effect of a digital care platform on the predefined outcome parameters in oncological patients and studies describing barriers and facilitators for implementation. Synthesis of the results was performed qualitatively. Barriers and facilitators were categorized according to the framework of Grol and Wensing. The Mixed Methods Appraisal Tool was used for critical appraisal of the studies.ResultsSeventeen studies were included for final analysis, comprising 8 clinical studies on the effectiveness of the digital care platform and 13 studies describing barriers and facilitators. Usage of a digital care platform appeared to enhance the availability of information and self-efficacy. There were no data available on the effect of a digital care platform on the continuity of care. However, based on focus group interviews, digital care platforms could potentially improve continuity of care by optimizing the exchange of patient information across institutes. Patient-reported experiences such as satisfaction with the platform were considerably positive. Most barriers for implementation were identified at the professional level, such as the concern for increased workload and unattended release of medical information to patients. Most facilitators were found at the patient and innovation levels, such as improved patient-doctor communication and patient empowerment. There were few barriers and facilitators mentioned at the economic and political levels.ConclusionsThe use of digital care platforms is associated with better quality of care through enhancement of availability of information and increased self-efficacy for oncological patients. The numerous facilitators identified at the patient level illustrate that patients are positive toward a digital care platform. However, despite these favorable results, robust evidence concerning the effectiveness of digital care platforms, especially from high-quality studies, is still lacking. Future studies should therefore aim to further investigate the effectiveness of digital care platforms, and the barriers and facilitators to their implementation at the economic and political levels.

Do Hospitals Need to Extend Telehealth Services? An Experimental Study of Different Telehealth Modalities during the COVID-19 Pandemic.

The COVID-19 pandemic has changed health care systems and clinical workflows in many countries, including the United States. This public health crisis has accelerated the transformation of health care delivery through the use of telehealth. Due to the coronavirus' severity and pathogenicity, telehealth services are considered the best platforms to meet suddenly increased patient care demands, reduce the transformation of the virus, and protect patients and health care workers. However, many hospitals, clinicians, and patients are not ready to switch to virtual care completely. We designed six experiments to examine how people (as an actual beneficiary of telehealth) evaluate five telehealth encounters versus face-to-face visits. We used an online survey to collect data from 751 individuals (patients) in the United States. Findings demonstrate that significant factors for evaluating five types of telehealth encounters are perceived convenience expected from telehealth encounters, perceived psychological risks associated with telehealth programs, and perceived attentive care services delivered by telehealth platforms. However, significant elements for comparing telehealth services with traditional face-to-face clinic visits are perceived cost-saving, perceived time-saving, perceived hygienic services, perceived technical errors, perceived information completeness, perceived communication barriers, perceived trust in medical care platforms' competency, and perceived privacy concerns. Although the in-person visit was reported as the most preferred care practice, there was no significant difference between people's willingness to use face-to-face visits versus virtual care. Nevertheless, before the widespread rollout of telehealth platforms, health care systems need to determine and address the challenges of implementing virtual care to improve patient engagement in telehealth services. This study also provides practical implications for health care providers to deploy telehealth effectively during the pandemic and postpandemic phases.

Dementia Caregiver Virtual Support-An Implementation Evaluation of Two Pragmatic Models during COVID-19.

Caregivers of people with Alzheimer’s and related dementias (ADRD) require support. Organizations have pivoted from traditional in-person support groups to virtual care in the face of the COVID-19 pandemic. We describe two model programs and their pragmatic implementation of virtual care platforms for ADRD caregiver support. A mixed methods analysis of quantitative outcomes as well as a thematic analysis from semi-structured interviews of facilitators was performed as part of a pragmatic quality improvement project to enhance delivery of virtual support services for ADRD caregivers. Implementation differed among individual organizations but was well received by facilitators and caregivers. While virtual platforms can present challenges, older adults appreciated the strength of group facilitators and reported enhanced connectedness related to virtual support. Barriers to success include the limitations of virtual programming, including technological issues and distractions from program delivery. Virtual support can extend outreach, addressing access and providing safe care during a pandemic. Implementation differs among organizations; however, some elements of virtual support may be long-lasting.

A Review of Ocular Drug Delivery Platforms and Drugs for Infectious and Noninfectious Uveitis: The Past, Present, and Future.

Uveitis refers to a broad group of inflammatory disorders of the eye that often require medical and surgical management to improve or stabilize vision and prevent vision-threatening pathological changes to the eye. Drug delivery to the eye to combat inflammation and subsequent complications from uveitic conditions is complex as there are multiple barriers to absorption limiting availability of the needed drug in the affected tissues. As such, there has been substantial interest in developing new drugs and drug delivery platforms to help reduce intraocular inflammation and its complications. In this review, we discuss the challenges of drug delivery, novel technologies recently approved for uveitis patient care and promising drug delivery platforms for uveitis and sequelae of ocular inflammation.

Acceptability And Feasibility Of A Tablet Based Supportive Care Platform For Metastatic Breast Cancer Patients

Although metastatic breast cancer (MBC) survival is improving, symptoms associated with the disease process and treatments remain burdensome. Technology enabled supportive care platforms may reduce the challenges some MBC patients experience traveling to cancer centers. PURPOSE: This partial cross-over randomized controlled trial examined the acceptability, feasibility, patient satisfaction, cost, and initial efficacy of a tabled-based supportive care intervention (Nurse AMIE: Addressing Metastatic Individuals Everyday). METHODS: Seventeen female MBC patients (60 ± 11.6y) were randomized to immediate or delayed start for a three month intervention that included daily tablet-based guideline-concordant self-care for pain, distress, fatigue, and sleep, and weekly calls with a patient navigator. The primary outcome was patient acceptability. Secondary outcomes included feasibility, patient satisfaction, cost, and between group change in symptoms (pain, distress, fatigue, and sleep) across time. RM-ANOVAs examined differences in symptoms between immediate and delayed-start over time. Hedges’ d effect sizes [95%CI] quantified the magnitude of differences in change between groups across time for symptoms. RESULTS: We observed a patient acceptance rate of 68%, and feasibility rate of 48%. Patient satisfaction ranged from 83% for walking, to 49% for the psychological interventions. The cost of delivering Nurse AMIE for 3 months was $570.23. No significant group x time interactions were found for all symptoms (all p ≥ 0.16). There were small magnitude, nonsignificant improvements in fatigue (d = 0.24, [-0.70 to 1.17]), pain severity (d = -0.03, [-0.96 to 0.90]), and pain interference (d = -0.08, [-0.85 to 1.01]). Nonsignificant, but potentially clinically meaningful, moderate improvements were found for sleep (d = 0.65, [-0.30 to 1.61]) and distress (d = 0.74, [-0.31 to 1.79]). CONCLUSION: In a setting where the average travel distance to the cancer institute was nearly 50 miles, a tablet-based supportive care platform offering guideline-concordant self-care for pain, fatigue, sleep, and distress was acceptable and feasible for MBC patients. Patient satisfaction scores and initial evaluation of efficacy are promising, and the Nurse AMIE platform warrants further investigation.

The Expanding Divide between Videoconferencing and Enterprise-Grade Virtual Care Platforms for Healthcare Systems

COVID19’s silver lining in healthcare technology ushered in a massive adoption of virtual care by health systems, clinicians, and patients. In the post pandemic world, as consumer/patient adoption for digital health access exponential continues to grow—Health systems, Insurers, and clinicians all need re-evaluate strategies create larger budgets, and commitments towards Digital health. The growth and rapid adoption seen during the early months of the pandemic was stimulated by removal of legislative, financial and reimbursement barriers. Healthcare systems must carefully and strategically evaluate secure, purpose built, and strategic technological investment.

Patient and Family Engagement Approaches for Digital Health Initiatives: Protocol for a Case Study.

BackgroundDigital health initiatives such as patient portals, virtual care platforms, and smartphone-based apps are being implemented at a rapid pace in health care organizations worldwide. This is often done to improve access beyond traditional in-person care and enhance care quality. Recent studies have indicated that better outcomes of using these initiatives and technologies may be achieved when patients and their family members are engaged in all aspects of planning, implementation, use, and evaluation. However, little guidance exists for how health care administrators can achieve effective engagement in digital health initiatives specifically.ObjectiveThe objective of this study is to document processes related to planning and implementing patient and family engagement (PFE) in digital health initiatives. This information will be used to develop tangible resources (eg, a field guide) that other organizations can use to implement PFE approaches for digital health initiatives in their organizations.MethodsA previously developed multidimensional conceptual framework for PFE in health and health care contexts will be used to guide this work. To understand the intricacies involved in using PFE approaches in digital health strategies, a case study will be conducted. More specifically, this work will employ an embedded single-case design with PFE in digital health initiatives at a large Canadian mental health and addictions teaching hospital. Multiple digital health projects being undertaken at the study site will be explored to better understand where the PFE is intended to support the design, implementation, and operation of the digital health platform or technology. These projects will form the individual units of analysis. Data collection will involve field notes and artifact collection by a participant observer and interviews with the various digital health project teams. Data analysis will include a content and thematic analysis, triangulation of the findings, and a chronological mapping of data to a PFE process.ResultsFunding for this work was provided by the Canadian Institutes of Health Research (CIHR), via a Health System Impact Fellowship. As of August 2020, digital health projects that will form the case study units have been identified, and the participant observer has started to embed themselves into these projects. Although the development and collection of field notes and artifacts, respectively, have begun, interviews have not been conducted. The study is expected to conclude in September 2021. Once this study is complete, the development of a field guide and resources to support the uptake of PFE strategies in digital health will begin.ConclusionsBy better understanding the processes involved in PFE in digital health projects, guidance can be provided to relevant stakeholders and organizations about how to do this work in an effective manner. It is then anticipated that with the increasing use of PFE approaches, there may be improved uptake, experience, and outcomes associated with using digital health technologies.International Registered Report Identifier (IRRID)PRR1-10.2196/24274

Best practices for virtual care to support youth with chronic pain and their families: a rapid systematic review to inform health care and policy during COVID-19 and beyond.

The COVID-19 pandemic has acutely challenged health systems and catalyzed the need for widescale virtual care and digital solutions across all areas of health, including pediatric chronic pain. The objective of this rapid systematic review was to identify recommendations, guidelines, and/or best practices for using virtual care to support youth with chronic pain and their families (CRD42020184498). MEDLINE, CINAHL, Embase, APA PsychINFO, and Web of Science were searched the week of May 25, 2020, for English language peer-reviewed articles published since 2010 that (1) discussed children and adolescents aged <18 years reporting any type of chronic pain (ie, pain lasting >3 months); (2) focused on any type of virtual care (eg, telephone, telehealth, telemedicine, mHealth, eHealth, online, or digital); and (3) reported on guidelines, best practices, considerations, or recommendations for virtual care. Abstract and full text screening and data extraction were performed in duplicate. Meta-ethnography was used to synthesize concepts across articles. Of 4161 unique records screened, 16 were included addressing diverse virtual care and pediatric chronic pain conditions. Four key themes were identified: (1) opportunities to better leverage virtual care, (2) direct effective implementation of virtual care, (3) selection of virtual care platforms, and (4) gaps in need of further consideration when using virtual care to support youth with chronic pain and their families. No existing guidelines for virtual care for pediatric chronic pain were identified; however, best practices for virtual care were identified and should be used by health professionals, decision makers, and policymakers in implementing virtual care.

Driving digital transformation of comprehensive primary health services at scale in India: an enterprise architecture framework

In its commitment towards Sustainable Development Goals, India envisages comprehensive primary health services as a key pillar in achieving universal health coverage. Embedded in siloed vertical programmes, their lack of...

Testing the acceptability and feasibility of a tablet-based supportive cancer platform for patients with metastatic breast cancer.

Although metastatic breast cancer (MBC) survival is improving, symptoms remain a significant burden. Returning to a cancer center for symptom management can be challenging. Technology-enabled supportive care platforms are worth exploration. Seventeen patients with MBC were randomized to immediate or delayed start for a 3-month intervention that included daily tablet-based guideline-concordant self-care for pain, distress, fatigue, and sleep disturbance, as well as weekly calls with a patient navigator. The primary outcome was patient acceptability. We also assessed feasibility, patient satisfaction, and cost and compared between group differences for symptoms. RM-ANOVA examined between group differences over time. Hedges' d effect sizes quantified magnitude of differences in change between immediate and delayed start. Sixty-eight percent of patients approached accepted the tablet-based intervention. Patients interacted with the tablet 48% of possible days. Patient satisfaction ranged from 83 for walking to 49% for the psychological interventions. The cost of delivering Nurse AMIE for 3 months was $570.23. Small nonsignificant improvements were found for fatigue (d=0.24). Nonsignificant, but potentially clinically meaningful, moderate reductions were found for sleep (d=0.65) and distress (d=0.74). A tablet-based supportive care platform that offers guideline-concordant self-care for pain, fatigue, sleep, and distress was observed to be highly acceptable and feasible for patients with metastatic breast cancer. Patient satisfaction scores and initial evaluation of efficacy are promising, and the platform warrants further investigation. Technology-based self-care is a promising option to address symptoms in patients with metastatic breast cancer.

Moving beyond 'don't ask, don't tell': Mental health needs of adults with type 1 diabetes in rural and remote regions of British Columbia.

To investigate the mental health needs of adults with type 1 diabetes living in rural and remote regions of Interior, British Columbia (BC) and identify factors associated with accessing support. We also explored perspectives around using peer support and digital health strategies for delivering mental health support. This study recruited 38 adults with type 1 diabetes to complete a self-report survey and participate in focus groups. We conducted six 90-min focus groups that addressed the following: current and past mental health needs, social media use for type 1 diabetes support, peer supporter recruitment and training, and support delivery features for virtual care platforms. Focus groups were recorded, transcribed, quality checked, coded and analysed to develop themes and subthemes. Four core themes emerged: (1) emotional challenges linked to type 1 diabetes management, (2) unique type 1 diabetes-related concerns in rural and remote communities, (3) previous support experiences and future support needs and (4) diabetes-related mental health support interventions involving peer support and digital health strategies. Existing support services are inadequate in meeting the needs of type 1 diabetes adults in Interior BC. Some have turned towards social media as a way to connect with the type 1 diabetes community for support. Though type 1 diabetes adults living in rural and remote settings experience distress associated with the ongoing burdens, frustrations and fears of managing a complex chronic condition, many have not been offered support and do not know how to seek services in the present/future. Peer support and digital health strategies are two potential solutions to address this care gap.

Characterizing the COVID-19 Infodemic on Chinese Social Media: Exploratory Study

BackgroundThe COVID-19 infodemic has been disseminating rapidly on social media and posing a significant threat to people’s health and governance systems.ObjectiveThis study aimed to investigate and analyze posts related to COVID-19 misinformation on major Chinese social media platforms in order to characterize the COVID-19 infodemic.MethodsWe collected posts related to COVID-19 misinformation published on major Chinese social media platforms from January 20 to May 28, 2020, by using PythonToolkit. We used content analysis to identify the quantity and source of prevalent posts and topic modeling to cluster themes related to the COVID-19 infodemic. Furthermore, we explored the quantity, sources, and theme characteristics of the COVID-19 infodemic over time.ResultsThe daily number of social media posts related to the COVID-19 infodemic was positively correlated with the daily number of newly confirmed (r=0.672, P<.01) and newly suspected (r=0.497, P<.01) COVID-19 cases. The COVID-19 infodemic showed a characteristic of gradual progress, which can be divided into 5 stages: incubation, outbreak, stalemate, control, and recovery. The sources of the COVID-19 infodemic can be divided into 5 types: chat platforms (1100/2745, 40.07%), video-sharing platforms (642/2745, 23.39%), news-sharing platforms (607/2745, 22.11%), health care platforms (239/2745, 8.71%), and Q&A platforms (157/2745, 5.72%), which slightly differed at each stage. The themes related to the COVID-19 infodemic were clustered into 8 categories: “conspiracy theories” (648/2745, 23.61%), “government response” (544/2745, 19.82%), “prevention action” (411/2745, 14.97%), “new cases” (365/2745, 13.30%), “transmission routes” (244/2745, 8.89%), “origin and nomenclature” (228/2745, 8.30%), “vaccines and medicines” (154/2745, 5.61%), and “symptoms and detection” (151/2745, 5.50%), which were prominently diverse at different stages. Additionally, the COVID-19 infodemic showed the characteristic of repeated fluctuations.ConclusionsOur study found that the COVID-19 infodemic on Chinese social media was characterized by gradual progress, videoization, and repeated fluctuations. Furthermore, our findings suggest that the COVID-19 infodemic is paralleled to the propagation of the COVID-19 epidemic. We have tracked the COVID-19 infodemic across Chinese social media, providing critical new insights into the characteristics of the infodemic and pointing out opportunities for preventing and controlling the COVID-19 infodemic.

The COVID-19 pandemic as a catalyst for differentiated care models to end the HIV epidemic in the United States: applying lessons from high-burden settings.

The COVID-19 pandemic as a catalyst for differentiated care models to end the HIV epidemic in the United States: applying lessons from high-burden settings.

287 Impact of the COVID-19 pandemic on maternal fetal medicine outpatient health care delivery platforms

The ongoing global COVID-19 pandemic has led to the rapid expansion and deregulation of telemedicine. Our objective was to characterize the incorporation of virtual care platforms into a Maternal Fetal Medicine (MFM) practice in response to this crisis. This retrospective cohort study evaluates all MFM outpatient visits done from 3/1/20-9/13/20 at a large MFM practice in Pennsylvania (PA). In parallel with a PA statewide order to close all non-life sustaining businesses issued 3/19/20 to reduce COVID-19 transmission, we closed 50% of MFM offices for 7 weeks from 3/23/20-5/11/20. Virtual visits (VV, phone and video) were initiated during this time and utilized as clinically appropriate. Ultrasound-only visits were excluded. Data on visit volume, visit type, rendering provider and patient satisfaction were collected. Video visits were done securely via Epic MyChart EMR. 7293 MFM visits occurred during the study period, 37.5% virtually (1165 video, 1571 phone). No VV were done prior to office closures. VV were quickly adopted once introduced, comprising 83% of all visits in the first week (Figure 1). Incorporation of the video platform was more gradual than phone, due to the longer associated learning curve for patients and staff. Proportion of VV declined after offices reopened, but persisted at 18-20% even months after reopening. Because they require less physical resources, the total number of weekly visits were able to be preserved during the period of office closures. Total visits significantly increased after reopening (241±29.7 pre-closure, 236±33.6 closure, 274±25.4 after re-opening, p=0.01). Physicians were less likely than other provider types to perform VV and more likely to use phone (Figure 2). Patient satisfaction scores were stable throughout the study period. Virtual visits are feasible and efficient, and were successfully incorporated into a busy MFM practice during the COVID-19 pandemic. Their ongoing use is likely due to convenience and patient/provider satisfaction, and has the potential to improve access to underserved areas and reduce cost.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

COVID-19 and the rise of virtual medicine in spine surgery: a worldwide study

PurposeThe COVID-19 pandemic forced many surgeons to adopt “virtual medicine” practices, defined as telehealth services for patient care and online platforms for continuing medical education. The purpose of this study was to assess spine surgeon reliance on virtual medicine during the pandemic and to discuss the future of virtual medicine in spine surgery.MethodsA comprehensive survey addressing demographic data and virtual medicine practices was distributed to spine surgeons worldwide between March 27, 2020, and April 4, 2020.Results902 spine surgeons representing seven global regions responded. 35.6% of surgeons were identified as “high telehealth users,” conducting more than half of clinic visits virtually. Predictors of high telehealth utilization included working in an academic practice (OR = 1.68, p = 0.0015) and practicing in Europe/North America (OR 3.42, p < 0.0001). 80.1% of all surgeons were interested in online education. Dedicating more than 25% of one’s practice to teaching (OR = 1.89, p = 0.037) predicted increased interest in online education. 26.2% of respondents were identified as “virtual medicine surgeons,” defined as surgeons with both high telehealth usage and increased interest in online education. Living in Europe/North America and practicing in an academic practice increased odds of being a virtual medicine surgeon by 2.28 (p = 0.002) and 1.15 (p = 0.0082), respectively. 93.8% of surgeons reported interest in a centralized platform facilitating surgeon-to-surgeon communication.ConclusionCOVID-19 has changed spine surgery by triggering rapid adoption of virtual medicine practices. The demonstrated global interest in virtual medicine suggests that it may become part of the “new normal” for surgeons in the post-pandemic era.

Casualty Evacuation (CASEVAC) Platform Review and Case Series of US Military Enroute Critical Care Team With Contract Personnel Recovery Services in an Austere Environment.

In a rapidly changing operational environment, in which there has been an emphasis on prolonged field care and limited evacuation platforms, military providers must practice to the full scope of their training to maximize outcomes. In addition to pushing military providers further into combat zones, the Department of Defense has relied on contracted personnel to help treat and evacuate servicemembers. This article is a retrospective review on the interoperability of the expeditionary resuscitative surgical team (ERST) and a contracted personnel recovery (CPR) team in a far-forward austere environment and will discuss actual patient transport case reviews that used multiple evacuation platforms across thousands of miles of terrain. To effectively incorporate CPR personnel into a military transport team model, we recommend including cross-training on equipment and formularies, familiarization with CPR evacuation platforms, and mass casualty (MASCAL) exercises that incorporate the different platforms available.

The goldmine of patient satisfaction-interaction and communication in the context of infectious diseases.

This study aimed to investigate the patient satisfaction level in terms of communication and interaction with the physicians from a Romanian Infectious Disease hospital. The objectives of the study were related to the identification of the general level of satisfaction of the patients, the evaluation of the physicians’ interaction type with their physicians, by using specific behavioral variables, such as respect and attention, as well as to determine the physician-patient communication quality. The data were collected with a self-administered questionnaire and were analyzed using IBM SPSS version 25. The sample comprised 82 patients who were hospitalized in the Department of Infectious Diseases. The quantitative variables were evaluated with the Shapiro-Wilk test and were described by the means and standard deviations, while the qualitative data were described by using the absolute values and percentages. The vast majority of patients were aged between 18–28 years old, were mostly females from urban areas, and 41.5% had university degrees. The outcomes of the study revealed that the general satisfaction of the patients, from a communication perspective, was reflected in the perceived and provided quality of information about the treatment. Although the vast majority of patients highly appreciated the interaction and the communication with their physicians, some individuals felt the need to read more information about their disease, especially from online sources, and they would have preferred their physicians to recommend trustful websites or health care platforms.

Identifying subpopulations of septic patients: A temporal data-driven approach

Sepsis is one of the deadliest diseases in North America and in spite of the vast amount of research on this topic there is still uncertainty in the outcome of sepsis treatments. This study aimed at investigating the informativeness of temporal electronic health records (EHR) in stratifying septic patients and identifying subpopulations of septic patients with similar trajectories and clinical needs. We performed hierarchical clustering and Density-Based Spatial Clustering of Applications with Noise (DBSCAN) analyses using data from septic patients in the MIMIC III intensive care unit database. The t-Distributed Stochastic Neighbor Embedding (t-SNE) method was utilized to map patients to a two-dimensional space. We utilized silhouette index and cluster-wise stability assessment by resampling to investigate the validity of the clusters. The hierarchical clustering with Euclidean metric identified twelve clinically recognizable subgroups that demonstrated different characteristics in spite of sharing common conditions. Our results demonstrated that data-driven approaches can help in customizing care platforms for septic patients by identifying similar clinically relevant groups.

Perceived Impact of an Online Community Care Platform for Dutch Older Adults on Local Participation, Informal Caregiving, and Feelings of Connectedness: Pretest-Posttest Observational Study.

BackgroundIn a changing ageing society wherein older adults are increasingly expected to take care of themselves instead of relying on health care services, online community care platforms can help older adults to meet these expectations. A considerable number of these online community care platforms have been introduced in several European countries based on their potential. However, their actual impact is unclear.ObjectiveThe aim of this study was to investigate the self-reported use, expectations, and perceived impact of a Dutch online community care platform called Grubbenvorst-Online among Dutch older adults. The following 2 questions were studied: (1) What is the self-reported use of Grubbenvorst-Online among older adults? (2) What are their expectations and perceived impact of Grubbenvorst-Online regarding local participation, their social network, mutual informal caregiving, and feelings of connectedness?MethodsAn observational pretest-posttest study was conducted. Participants were recruited via a web-based message on the Grubbenvorst-Online platform and data were collected via postal questionnaires among older users at the start of the study and 4 months later. Data regarding the expectations and the perceived impact of Grubbenvorst-Online were compared and tested.ResultsForty-seven Grubbenvorst-Online users with an average age of 74 years participated in this study. They were healthy, predominantly “internet-skilled,” and they found the internet important for maintaining social contacts. In general, the use of the online community care platform decreased during the 4-month follow-up period. The perceived impact of Grubbenvorst-Online was significantly lower than that expected regarding information provision (P=.003), seeking help from fellow villagers (P<.001), giving help to fellow villagers (P<.001), and consulting care or welfare services (P<.001).ConclusionsThe findings of this study indicate that online community care platforms perhaps do not provide enough “added value” in their current form. We suggest a new direction in which online community care platforms primarily support existing offline initiatives aimed at stimulating local participation, informal caregiving, and feelings of connectedness.

Operationalizing care in a hospital-based respirology clinic during a global pandemic

The novel coronavirus (SARS-CoV-2) pandemic has forced clinicians across Canada to abruptly adapt to a new reality of reduced contact with patients in ambulatory care settings. With minimal lead time, ambulatory clinics in Canada were required to adopt aggressive infection prevention and control measures while facing shortages of personal protective equipment and to enact strategies to urgently reorganize patient care. These adaptations included the conversion of ambulatory clinics to telephone or virtual care platforms. In 2015, the Public Health Agency of Canada (PHAC) published pandemic influenza preparedness guidelines highlighting the importance of pandemic preparedness planning in primary and ambulatory care settings, including clinic continuity planning and provisions for non in-person care. Despite these recommendations, hospital-based ambulatory clinics lacked formal strategic plans to adapt patient care processes during the SARS-CoV-2 outbreak. Thus, in a short time frame, clinics individually adapted their own patient care processes. This creates the potential for gaps in quality of medical care for patients across Canada. In this report, we describe the evolution and operationalization of care planning in our hospital-based respirology clinic, highlight the challenges faced, and make recommendations for respirology clinic adaptations based on available guidance. This process may be used as a foundation to guide future policy, discussion and guidelines for hospital-based respiratory care to ensure optimal preparedness during the next inevitable respiratory viral pandemic or possible worsening of the current pandemic.