1,721,256 research outputs found
The role of digital communication in patient-clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study
No full textBackground: young people (aged 16–24 years) with long-term health conditions tend to disengage from health services, resulting in poor health outcomes. They are prolific users of digital communications. Innovative UK NHS clinicians use digital communication with these young people. The NHS plans to use digital communication with patients more widely.Objectives: to explore how health-care engagement can be improved using digital clinical communication (DCC); understand effects, impacts, costs and necessary safeguards; and provide critical analysis of its use, monitoring and evaluation.Design: observational mixed-methods case studies; systematic scoping literature reviews; assessment of patient-reported outcome measures (PROMs); public and patient involvement; and consensus development through focus groups.Setting: twenty NHS specialist clinical teams from across England and Wales, providing care for 13 different long-term physical or mental health conditions.Participants: one hundred and sixty-five young people aged 16–24 years living with a long-term health condition; 13 parents; 173 clinical team members; and 16 information governance specialists.Interventions: clinical teams and young people variously used mobile phone calls, text messages, e-mail and voice over internet protocol.Main outcome measures: empirical work – thematic and ethical analysis of qualitative data; annual direct costs; did not attend, accident and emergency attendance and hospital admission rates plus clinic-specific clinical outcomes. Scoping reviews–patient, health professional and service delivery outcomes and technical problems. PROMs: scale validity, relevance and credibility.Data sources: observation, interview, structured survey, routinely collected data, focus groups and peer-reviewed publications.Results: digital communication enables access for young people to the right clinician when it makes a difference for managing their health condition. This is valued as additional to traditional clinic appointments. This access challenges the nature and boundaries of therapeutic relationships, but can improve them, increase patient empowerment and enhance activation. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information and communication failures, but clinicians and young people mitigate these risks. Workload increases and the main cost is staff time. Clinical teams had not evaluated the impact of their intervention and analysis of routinely collected data did not identify any impact. There are no currently used generic outcome measures, but the Patient Activation Measure and the Physicians’ Humanistic Behaviours Questionnaire are promising. Scoping reviews suggest DCC is acceptable to young people, but with no clear evidence of benefit except for mental health.Limitations: qualitative data were mostly from clinician enthusiasts. No interviews were achieved with young people who do not attend clinics. Clinicians struggled to estimate workload. Only eight full sets of routine data were available.Conclusions: timely DCC is perceived as making a difference to health care and health outcomes for young people with long-term conditions, but this is not supported by evidence that measures health outcomes. Such communication is challenging and costly to provide, but valued by young people.Future work: future development should distinguish digital communication replacing traditional clinic appointments and additional timely communication. Evaluation is needed that uses relevant generic outcomes.Study registration: two of the reviews in this study are registered as PROSPERO CRD42016035467 and CRD42016038792.Funding: the National Institute for Health Research Health Services and Delivery Research programme
Digital communication between clinician and patient in General Practice and the impact on marginalised groups: a realist review
No full textBackground: increasingly, the NHS is embracing the use of digital communication technology for communication between clinicians and patients. Policymakers deem digital clinical communication as presenting a solution to the capacity issues currently faced by general practice. There is some concern that these technologies may exacerbate existing inequalities in accessing health care. It is not known what impact they may have on groups who are already marginalised in their ability to access general practice.Aim: to assess the potential impact of the availability of digital clinician?patient communication on marginalised groups? access to general practice in the UK. Design and setting: realist review in general practice. Method: a four-step realist review process was used: to define the scope of the review; to search for and scrutinise evidence; to extract and synthesise evidence; and to develop a narrative, including hypotheses. Results: digital communication has the potential to overcome the following barriers for marginalised groups: practical access issues, previous negative experiences with healthcare service/staff, and stigmatising reactions from staff and other patients. It may reduce patient-related barriers by offering anonymity and offers advantages to patients who require an interpreter. It does not impact on inability to communicate with healthcare professionals or on a lack of candidacy. It is likely to work best in the context of a pre-existing clinician?patient relationship. Conclusion: digital communication technology offers increased opportunities for marginalised groups to access health care. However, it cannot remove all barriers to care for these groups. It is likely that they will remain disadvantaged relative to other population groups after their introduction
Exploring patients' and clinicians' experiences of video consultations in primary care : a systematic scoping review
No full textBackground Video consultation (VC) is an emerging consultation mode in general practice. The challenges and benefits of implementing it are not necessarily realised until it is in use, and being experienced by patients and clinicians. To date, there has been no review of the evidence about how patients and clinicians experience VC in general practice. Aim The study aimed to explore both patients' and clinicians' experiences of VCs in primary care. Design & setting A systematic scoping review was carried out of empirical studies. Method All major databases were searched for empirical studies of any design, published from 1 January 2010 to 11 October 2018 in the English language. Studies were included where synchronous VCs occurred between a patient and a clinician in a primary care setting. Outcomes of interest related to experience of use. The quality of included studies were assessed. Findings were analysed using narrative synthesis. Results Seven studies were included in the review. Patients reported being satisfied with VC, describing reduced waiting times and travel costs as a benefit. For patients and clinicians, VC was not deemed appropriate for all presentations and all situations, and a face-to-face consultation was seen as preferable where this was possible. Conclusion The findings of this scoping review show that primary care patients and clinicians report both positive and negative experiences when using VCs, and these experiences are, to a certain extent, context dependent. VC is potentially more convenient for patients, but is not considered superior to a face-to-face consultation. Accounts of experience are useful in the planning and implementation of any VC service
Improving health outcomes for young people with long term conditions: the role of digital communication in current and future patient–clinician communication for NHS providers of specialist clinical services for young people – LYNC study protocol
No full textBackground: young people living with long term
conditions are vulnerable to health service disengagement. This endangers their
long term health. Studies report requests for digital forms of communication –
email, text, social media – with their health care team. Digital clinical
communication is troublesome for the UK NHS.
Aim: in this article we aim to present
the research protocol for evaluating the impacts and outcomes of digital
clinical communications for young people living with long term conditions and
provide critical analysis of their use, monitoring and evaluation by NHS
providers (LYNC study: Long term conditions, Young people, Networked
Communications).
Methods: the research involves: (a) patient
and public involvement activities with 16–24 year olds with and without long
term health conditions; (b) six literature reviews; (c) case studies – the main
empirical part of the study – and (d) synthesis and a consensus meeting. Case
studies use a mixed methods design. Interviews and non-participant observation
of practitioners and patients communicating in up to 20 specialist clinical
settings will be combined with data, aggregated at the case level
(non-identifiable patient data) on a range of clinical outcomes meaningful
within the case and across cases. We will describe the use of digital clinical
communication from the perspective of patients, clinical staff, support staff
and managers, interviewing up to 15 young people and 15 staff per case study.
Outcome data includes emergency admissions, A&E attendance and DNA (did not
attend) rates. Case studies will be analysed to understand impacts of digital
clinical communication on patient health outcomes, health care costs and
consumption, ethics and patient safety.
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Internet videoconferencing for patient-clinician consultations in long-term conditions: a review of reviews and applications in line with guidelines and recommendations
No full textBackground: the use of internet videoconferencing in healthcare settings is widespread, reflecting the normalisation of this mode of communication in society and current healthcare policy. As the use of internet videoconferencing is growing, increasing numbers of reviews of literature are published. Methods: the authors conducted a review of the existing reviews of literature relating to the use of internet videoconferencing for consultations between healthcare professionals and patients with long-term conditions in their own home. The review was followed with an assessment of UK National Institute for Health and Clinical Excellence guidelines for patient care in the context of common long-term illnesses to examine where videoconferencing could be implemented in line with these recommendations. Results: the review of reviews found no formal evidence in favour of or against the use of internet videoconferencing. Patients were satisfied with the use of videoconferencing but there was limited evidence that it led to a change in health outcomes. Evidence of healthcare professional satisfaction when using this mode of communication with patients was limited. The review of guidelines suggested a number of opportunities for adoption and expansion of internet videoconferencing. Implementing videoconferencing in line with current evidence for patient care could offer support and provide information on using a communication channel that suits individual patient needs and circumstances. The evidence base for videoconferencing is growing, but there is still a lack of data relating to cost, ethics and safety. Conclusions: while current evidence base for the internet videoconferencing is equivocal, it is likely to change as more research is undertaken and evidence published. With more videoconferencing services added in more contexts, research needs to explore how internet videoconferencing can be implemented in ways that it is valued by patients and clinicians, and how it can fit within organizational and technical infrastructure of the healthcare services
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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