Comparing Virtual to In-Person Delivery of Continuing Medical Education in Dementia Care: Which Is Preferred?

ObjectivesThere is limited understanding of learners’ perceptions of virtual learning during the COVID-19 pandemic, as well as the use of virtual modalities for interprofessional education (IPE) in primary care. Four of 7 in-person annual “Booster Day” IPE sessions for health professionals working in primary care–based memory clinics in Ontario, Canada, were canceled when the pandemic was declared; these sessions were replaced with 2 sessions delivered via live-streamed videoconferencing. This study compares Booster Day session participants’ perceptions of the in-person and virtual sessions and assesses their preferences for in-person or virtual sessions in the future.DesignSurvey methodology.Setting and ParticipantsInterprofessional primary care–based memory clinic team members attending 1 of 5 annual IPE events, 3 delivered in-person immediately prior to the COVID-19 pandemic and 2 subsequently delivered virtually via videoconferencing.MethodsChi-squared test and analysis of variance was used to identify significant differences in reaction, attitude, and preference ratings between delivery modalities.ResultsThere were no significant differences in satisfaction, relevance, knowledge acquisition, and intentions to apply new knowledge between delivery modalities. Although attendance via videoconferencing was perceived as useful, enjoyable, engaging, and as more feasible to attend, it was rated as less enjoyable and perceived as having fewer opportunities for networking than in-person sessions. Most participants preferred in-person sessions.Conclusions and ImplicationsQuality engagement and networking, as afforded by in-person IPE, are highly valued by health professionals attending dementia-related education. IPE on complex health issues of the older people requiring interprofessional perspectives may be best suited to in-person formats.     

Satisfaction with telemedicine for teaching listening and spoken language to children with hearing loss

Auditory-Verbal Therapy (AVT) is an effective early intervention for children with hearing loss. The Hear and Say Centre in Brisbane offers AVT sessions to families soon after diagnosis, and about 20% of the families in Queensland participate via PC-based videoconferencing (Skype). Parent and therapist satisfaction with the telemedicine sessions was examined by questionnaire. All families had been enrolled in the telemedicine AVT programme for at least six months. Their average distance from the Hear and Say Centre was 600 km. Questionnaires were completed by 13 of the 17 parents and all five therapists. Parents and therapists generally expressed high satisfaction in the majority of the sections of the questionnaire, e.g. most rated the audio and video quality as good or excellent. All parents felt comfortable or as comfortable as face-to-face when discussing matters with the therapist online, and were satisfied or as satisfied as face-to-face with their level and their child's level of interaction/rapport with the therapist. All therapists were satisfied or very satisfied with the telemedicine AVT programme. The results demonstrate the potential of telemedicine service delivery for teaching listening and spoken language to children with hearing loss in rural and remote areas of Australia.     

Remote psychotherapy for terminally ill cancer patients

We conducted a feasibility study of remote psychotherapy in 10 terminally ill cancer patients with diagnoses of adjustment disorder or major depression. Subjects received six sessions of individual cognitive therapy with the same therapist. Sessions alternated between face-to-face sessions and remote sessions delivered by analogue videophone. After each therapy session, a brief questionnaire was used to evaluate the subjects' level of satisfaction with the session, sense of connectedness to the therapist and overall progress being made in the therapy. Nine patients completed the study. Of 53 completed therapy sessions, 21 were by videophone and 32 were conducted face to face. Participants reported strong positive perceptions and acceptance after almost all therapy sessions, regardless of service delivery mode. The study suggests that there may be a role for the delivery of psychotherapy using low-bandwidth videophones.     

Client satisfaction in a feasibility study comparing face-to-face interviews with telepsychiatry

We carried out a pilot study comparing satisfaction levels between psychiatric patients seen face to face (FTF) and those seen via videoconference. Patients who consented were randomly assigned to one of two groups. One group received services in person (FTF from the visiting psychiatrist) while the other was seen using videoconferencing at 128 kbit/s. One psychiatrist provided all the FTF and videoconferencing assessment and follow-up visits. A total of 24 subjects were recruited. Three of the subjects (13%) did not attend their appointments and two subjects in each group were lost to follow-up. Thus there were nine in the FTF group and eight in the videoconferencing group. The two groups were similar in most respects. Patient satisfaction with the services was assessed using the Client Satisfaction Questionnaire (CSQ-8), completed four months after the initial consultation. The mean scores were 25.3 in the FTF group and 21.6 in the videoconferencing group. Although there was a trend in favour of the FTF service, the difference was not significant. Patient satisfaction is only one component of evaluation. The efficacy of telepsychiatry must also be measured relative to that of conventional, FTF care before policy makers can decide how extensively telepsychiatry should be implemented.     

Acceptability and satisfaction using Quick Start with the contraceptive vaginal ring versus an oral contraceptive

BACKGROUND: Many women discontinue their use of hormonal contraception, and even those who continue so may have difficulty using oral contraceptive pills consistently. New delivery systems, including the vaginal ring, may be easier to use, but user acceptability and satisfaction with these new methods may be affected by women's experience with their bodies. MATERIALS AND METHODS: Data for this study were collected as part of a randomized clinical trial on 201 women comparing immediate start of vaginal ring use with immediate start of low-dose oral contraceptive use. We assessed user satisfaction and method continuation 3 months after ring or pill initiation. RESULTS: At 3 months, 174 of 201 subjects (87%) had follow-up interviews. Among the 174 study participants with follow-up data, 61% of ring subjects and 34% of pill subjects were very satisfied with their methods (p=.003). For posttrial contraception, 79% of ring subjects chose to continue with the ring whereas 59% of pill subjects chose to continue with the pill (p<.001). Women who reported greater comfort in touching their genitals, greater frequency of masturbation, more comfort with intercourse and past use of vaginal contraceptives and products were not more likely than others to be satisfied with the ring or to continue using it for birth control. CONCLUSION: Women who were allocated to vaginal ring use, regardless of their baseline characteristics or behavior, were likely to be highly satisfied with the method and to continue its use.     

Nutrition program for the elderly: participants' perception of food quality by type of food service system

A survey of 1028 clients who participated in 21 nutrition sites for the elderly funded by the Suburban Cook County Area Agency on Aging in Chicago, Illinois revealed that participants who received meals prepared on-site were more satisfied with the quality of the meals than participants who received meals that were satellited as hot bulk food or as preplated cook/freeze meals. Participants who judged the meals as fair or poor were more likely than those who rated the food as excellent or good to respond that they would increase their donation if the food were improved. Data from a national survey used as a standard for judging participant satisfaction of food service are presented in this article.     

Determinants of customer satisfaction with the health care system, with the possibility to choose a personal physician and with a family doctor in a transition country

Many Eastern and Central European counties are reforming their health care systems. The aim of this study was to determine customer satisfaction with a reformed health care system, with the possibility of free choice of a family physician and patient satisfaction with the family physician in Slovenia and their major determinants. We used a postal survey of the patients who attended their family physician's offices during the study period. We obtained an 84% response rate. Some 72.9% of the respondents were satisfied with the current organisation of health care services, 95.5% of the respondents were satisfied with the possibility of choosing their own family physician and 58% of participants were very satisfied with the level of care received from their personal family practitioners. It was shown that higher patient satisfaction with the family physician was the most powerful predictor of patients' satisfaction with the health care system. The results show that health care reform in Slovenia has a positive impact on the consumers' perceptions of health care quality, measured in terms of consumer satisfaction with the health care system, the possibility to choose a family physician and the overall satisfaction with the family physician.     

The Rowland Universal Dementia Assessment Scale (RUDAS) as a reliable screening tool for dementia when administered via videoconferencing in elderly post-acute hospital patients

The Rowland Universal Dementia Assessment Scale (RUDAS) is a six-domain screening tool for dementia. We measured the practicality and reliability of administering the RUDAS in a telemedicine setting. Inpatients were recruited from a Geriatric and Rehabilitation Unit. Each patient was administered the RUDAS both face-to-face (FTF) and via videoconferencing (VC). The assessment format (FTF or VC) and the allocation of doctor (Doctor 1 or Doctor 2) to format were randomized. Scores from each assessment format were compared. The outcome of no difference was decided based on a difference in mean of no more than ± one point. Percentage agreement (agreement being ±2 points) was calculated on individual test scores. Forty-two patients (average age 75 years) completed the two assessments. Their mean Mini-Mental State Examination (MMSE) score was 24.7 (range 10-30). The mean RUDAS score for both FTF and VC assessment was 24.9 (difference between the means 0.04), i.e. there was no significant difference. The results suggest that the RUDAS can be reliably administered via VC in post acute patients as an alternative to FTF administration.     

Comparing staff attitudes and patient satisfactions in a home health agency

Patient and staff perceptions of Home Health care delivery were examined in the present study. Opinions from the two groups were surveyed then compared on five perceptual areas. The five areas rated were (a) feelings of ease at home, (b) learning and understanding self-care, (c) trust, (d) quality of care received, and (e) severity of illness. Staff characteristics and patient idiosyncracies were also considered. Overall, patient satisfaction with the Home Health care system was explored. The results indicated a high degree of satisfaction with the amount and appropriateness of Home Health care, confidence about self-care, and feelings of ease at home. All patients returning questionnaires would recommend Home Health services to a friend who may need them. Perhaps more importantly, the provider's opinions exhibited both accordance and discordance with those of the patients surveyed. Accordance was detected in ratings of ease, learning and understanding self-care, trust, and quality of care received at home. Discordance was noted regarding severity-of-illness ratings. As a whole, staff rated the severity of patients' illnesses or injuries as being less severe than did the patients themselves. Independent of primary diagnostic grouping, older patients' illnesses were rated by the staff less severe in nature than those of the younger patients. It was concluded that the Home Health practitioner must guard against legitimizing the illnesses of patients at any age.     

Parent-Based Prevention of Bullying and Cyberbullying During COVID-19 Social Distancing: A Pilot Intervention using the MOST Framework

Parenting skills are important protective factors in the prevention of bullying and cyberbullying, yet few parent-based interventions have been developed and evaluated in this area. This pilot study examined participant responsiveness to and acceptability of an evidence-based parenting curriculum enhanced to address bullying and cyberbullying. Enhancements included intensive role playing, social emotional coaching, and media parenting. The pilot was delivered online via video conferencing during the unique circumstances of the coronavirus disease pandemic 2019 (COVID-19) shelter-at-home orders. Parents (N?=?32; 88% female) participated in weekly online sessions; 30 completed all eight sessions. Using a sequential exploratory mixed method approach, we first conducted quantitative analyses to examine participant responsiveness and qualitative analyses to further explain outcomes and explore participant acceptability. Satisfaction with individual sessions was high. In a few sessions, satisfaction and home practice completion was lower among those with free- and reduced-price lunch eligibility. Qualitative data reinforced and explained quantitative findings. Participants were appreciative of the program and delivery, particularly during the shelter-at-home conditions. They voiced satisfaction with the online format and with home practice assignments. They also made suggestions to strengthen the emphasis on bullying and cyberbullying in the program. Results suggest that the program and enhancements to the program were acceptable to participants, and high rates of satisfaction suggest that video conferencing is a feasible delivery format. Further, parental programming during the stressful context of the COVID-19 pandemic was well received. Although few differences in satisfaction by free- and reduced-priced lunch were observed, technology support for low-income families may be warranted.

     

An online positive parenting skills programme for paediatric traumatic brain injury: feasibility and parental satisfaction

We examined the feasibility of and parental satisfaction with a training programme for parents with children who had suffered traumatic brain injury (TBI). Families who did not have a home computer and/or webcam were loaned the necessary equipment. Skype was used for videoconferencing. After the initial treatment session in the family's home, the remaining nine sessions were conducted online. Each session had two parts: (1) a self-guided web session with information about a particular skill; (2) a videoconference session with the therapist. Three of the 20 families (15%) dropped out prior to the final 6-month follow-up visit. Of the remaining 17 families, 13 (65% of those enrolled) completed 9-14 sessions. Almost all of the caregivers (87%) said that the Skype sessions were helpful compared to a conventional office visit. Almost all parents were satisfied with the programme and the technology that was used. Parental satisfaction with the programme was not influenced by prior computer ownership or comfort with technology. The programme appears to be feasible for a wide range of parents of children with TBI and provides an alternative to conventional office-based sessions that may not be accessible to all families.     

A Qualitative Examination of California WIC Participants’ and Local Agency Directors’ Experiences during the Coronavirus Disease 2019 Pandemic

BackgroundThe US Department of Agriculture granted waivers to allow flexibility in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) operations during the coronavirus disease 2019 (COVID-19) pandemic; however, research examining the associations between waiver introduction and changes in perceptions, practices, and challenges of WIC participants’ and agency directors’ experiences is limited.ObjectiveThe objective of this study was to assess California WIC participants’ and agency directors’ perceptions and practices of remote WIC services during the COVID-19 pandemic. A secondary aim was to understand other COVID-19 challenges related to maintaining access to healthy foods by WIC participants.DesignA qualitative study that included semistructured interviews was conducted between June 2020 and March 2021.Participants and settingOne hundred eighty-two WIC participants with a child aged 0 to 5 years from three regions of California (Southern, Central, and Northern) and 22 local WIC agency directors across the state were interviewed.Main outcome measuresWIC participants’ and agency directors’ perceptions, practices, and other challenges during COVID-19.Statistical analyses performedInterviews were recorded, transcribed, and analyzed using a grounded theory approach.ResultsParticipants shared that they valued the information received from WIC and were very satisfied with remote WIC services. Participants reported that enrolling in WIC remotely was easier than coming in person. All waivers and changes to WIC operations, namely the physical presence, remote benefit issuance, and separation of duties waivers, and remote work and remote delivery of nutrition education, were largely viewed by WIC agency directors as options that should be continued postpandemic. Further, a majority (63%) of households reported experiencing food insecurity, and half of respondents received food from a food bank or pantry during the pandemic.ConclusionsFindings suggest WIC will attract and retain the most families by offering a hybrid model of services, incorporating both onsite services and remote options to work more efficiently and effectively.     

Training the allied health assistant for the telerehabilitation assessment of dysphagia

We examined the effect of knowledge and task specific training provided to an allied health assistant (AHA), prior to her involvement in facilitating assessments of dysphagia (swallowing disorders) via telerehabilitation. The AHA received four hours of training, which included basic theoretical information regarding dysphagia as well as hands-on training with simulated patients. A written test examining swallowing function and its evaluation was completed pre- and then immediately post-training, and then again after the 15th and 30th of 31 consecutive patient assessments. In addition, after each set of 5 clinical dysphagia assessments completed with patients following the training, two speech pathologists rated the AHA's competence in relation to performing the tasks and activities required of her during the telerehabilitation swallowing assessment. The AHA also self-rated the perceived level of confidence at these times. Before training, the assistant's knowledge of dysphagia theory was at 40%. Following training, all tests were above the 80% level. The AHA's performance was rated as competent on each evaluation post-training. The AHA also expressed overall satisfaction with the initial training provided and reported feeling confident after the initial sessions with patients. Thus for an AHA with previous clinical experience, competence and perceived comfort in providing assistance in the sessions was achieved with only a few hours of task specific training.     

Telehealth service delivery for persons with alcoholism

Videoconferencing at a bandwidth of 384 kbit/s was used in open sessions for subjects with alcohol use disorders (AUD). Study participants received eight sessions of group therapy over a four-week period from an accredited addictions counsellor. Outcome assessment included self-report measures, a qualitative interview and a chart review. Of the 18 subjects who started the study, 14 attended at least four sessions of therapy, completed self-report assessments and the thematic interview. The participants reported high levels of satisfaction with telepsychiatry, found the intervention to be highly credible, had good session attendance and attrition comparable to that expected with conventional same-room treatment. In all, 82% of subjects reported that they would recommend the service to a friend or family member. The results demonstrate the feasibility of using videoconferencing for service delivery to adults with AUD, and encourage the future performance of randomized controlled trials.     

老年失智社区预防项目实施效果满意度评估与分析

摘要:目的　了解项目参与者对服务的利用和满意情况,为完善和改进项目服务提供依据。方法　利用问卷调查法收集资料,EpiData3.0数据录入并建立数据库,SPSS17.0统计分析;采用整群随机抽样方法确定研究对象。结果　项目的总体平均满意度得分为90.09分（92.12%）。其中,归属感满意度得分为95.15分（98.99%）,易及性满意度得分为90.51分（92.93%）,接受性满意度得分为94.24分（100.00%）,舒适性满意度得分为95.15分（100.00%）,安全性满意度得分为93.33分（98.99%）,完善性满意度得分为87.27分（93.90%）,成效性满意度得分为83.31分（80.30%）。性别、年龄、婚姻状况及离退休前从事的职业性质对满意度评分无影响（P＞0.05）,文化程度对满意度评分有影响（P＜0.05）。结论　参与者对项目总体比较满意,在归属感、接受性、舒适性和安全性方面非常满意;在易及性、完善性和成效性方面比较满意,知识率和主观知信行均有改善和提高,但成效性评分相对偏低。提示认知功能的改善需要一个漫长复杂的过程,需要服务者与参与者双方的共同努力,在项目实施中需不断完善服务,并探索提高依从性的方法。     

Treatment perception in adolescent onset anorexia nervosa: retrospective views of patients and parents

OBJECTIVE: To investigate perception of treatment in former patients with anorexia nervosa (AN) and their parents, and to determine whether this was related to outcome and treatment characteristics. Client satisfaction is important for treatment engagement and adherence. METHOD: Forty-six (of 55) girls with adolescent onset AN, 33 mothers and 26 fathers participated in a follow-up study conducted 8.8 (SD 3.3) years after start of treatment. The former patients were assessed using diagnostic interviews. Only nine participants (19%) had an eating disorder (ED) at follow-up. Perception of treatment was assessed by questionnaires. RESULTS: Parents reported having an overall positive perception of treatment. However, reports from former patients were significantly more negative than from the parents. In former patients, the "perception of therapists" total score and the items "therapists' knowledge of ED" and "usefulness of pediatric inpatient treatment" correlated with ED symptoms at follow-up. The perception of therapists' scores of the parents were not associated with the ED outcome of their daughters. More family therapy sessions were associated with the former patients' satisfaction with the therapists, while higher age at admission was associated with their mothers' satisfaction. CONCLUSION: In spite of good ED outcome, former patients were only moderately satisfied with their treatment, whereas parental satisfaction was high.     

Patient satisfaction at health centres in Trinidad and Tobago

The aim of this paper is to identify background characteristics of health centre users in Trinidad and Tobago and their perceptions of the services provided. Multi-staged sampling was used to select 1,500 health centre users throughout the country. Data were obtained using structured interviews conducted on regular clinic days.Results show that there is an overwhelmingly large percentage of unemployed persons (80.4%) and women(75.9%) among the users of health centres. The elderly is well represented, with 25.4 percent of the sample being over 60 years of age. Also, occupational status of family wage earners and educational attainment levels of respondents reflect a disproportionately higher number from lower socio-economic groupings among health centre users. On the other hand, proportions of different ethnic and religious groups among the respondents bear a striking similarity to the general population of Trinidad and Tobago.Respondents appear to be generally satisfied with the services of the health centres. When the categories for‘satisfied’ and ‘very satisfied’ were combined, results show that 73.0% of respondents were satisfied with the comfort of the health centre, 81.7% with the ease and convenience of getting to the health centre and 67.4% with the medical care received at the health centre.According to respondents' opinions, the services in greatest need of improvement are the pharmacy anddoctor services, especially through reducing the long waiting period. When the doctors, nurses and pharmacists were compared with respect to ‘courtesy and consideration’, ‘Skills and Competence’ and ‘advice provided’, results show that the generally high levels of satisfaction are remarkably similar in all three cases.     

Patients'' perceptions of joint teleconsultations: a qualitative evaluation

OBJECTIVE: To determine patient perceptions of joint teleconsultations (JTC), with particular reference to reasons underlying, and factors contributing to, patient satisfaction and dissatisfaction with this mode of health delivery. BACKGROUND: Telemedicine has been welcomed as one way of improving health-care delivery, by improving patient access to secondary care and specialist services hence widening patient choice, particularly for patients outside major conurbations. However, a recent systematic review found currently available data on patient satisfaction with telemedicine to be methodologically flawed. Qualitative evaluations offer the opportunity to elucidate the details of patient satisfaction with this mode of health-care delivery. DESIGN: Qualitative study using semi-structured interviews. SETTING AND PARTICIPANTS: Purposive sample of 28 participants of a major randomized controlled trial (Virtual Outreach study) of JTC conducted in one urban and one rural area in Britain. INTERVENTION: Joint teleconferenced consultations with the patient, patient's general practitioner (GP), and a hospital specialist. The patient and GP were sited in the local practice, while the hospital specialist was in the hospital outpatient department, and the two parties were connected by an ISDN2 link and video-conferencing software. MAIN OUTCOME MEASURES: Patient experiences of JTC, with particular reference to reasons underlying, and factors contributing to, overall satisfaction or dissatisfaction. RESULTS: Two major themes were identified: customer care and doctor-patient interaction. Patients appreciated the customer care aspects of JTC, particularly the enhanced convenience, reduced costs and improved punctuality associated with JTC. However, there were divergent views about the doctor-patient interactions with some patients expressing a sense of alienation arising from the use of technology, and problems with doctor-patient communication. CONCLUSIONS: These data add significantly to the existing literature on patient satisfaction with telemedicine, by elucidating the factors underlying overall satisfaction scores and hence have implications for future service delivery and implementation of telemedicine.     

Cultural relevancy of a diabetes prevention nutrition program for African American women

Diabetes among African American women is a pressing health concern, yet there are few evaluated culturally relevant prevention programs for this population. This article describes a case study of the Eat Well Live Well Nutrition Program, a community-based, culturally specific diabetes prevention nutrition program for African American women. The stages of change theory and principles from community organization guided the development of the program. Health education strategies, including participatory development and program delivery by peer educators, were applied to promote cultural relevance. Results indicated that overall participants (90%) believed the program to be culturally relevant and were very satisfied with the program (82%). Cultural relevancy was significantly associated with greater program satisfaction and changes in dietary patterns when controlling for the number of sessions attended. Conclusions suggest that participatory strategies can be effective in designing culturally specific prevention programs for African American women.     

Patient satisfaction with telemedicine in a prison environment.

Prison inmates were surveyed about their perceptions of the use of videoconferencing in clinical consultations. A 14-item questionnaire was used to assess satisfaction with the patient-physician clinical interaction. Of the 299 inmates surveyed immediately after their teleconsultations, 221 completed questionnaires that were suitable for analysis (74%). Only 9% of patients indicated that they were not satisfied with the teleconsultation. They rated the telemedicine context well above the midpoint of the scale (16) on both an information-exchange and a patient-comfort dimension, with means of 29 and 24, respectively. There was a significant difference (P < 0.01) in the patient-comfort dimension in terms of the location of the prisoners. No significant differences were found in patient satisfaction related to the specialty of the physician. The results suggest that many contextual factors must be considered to understand the communicative implications of patient satisfaction with telemedicine.