Examining the context and helpfulness of family companion contributions to older adults’ primary care visits

ObjectiveOlder adults commonly involve family (broadly defined) in their care. We examined communication behaviors of family companions during older adults’ primary care visits, including whether these behaviors vary with respect to how older adults manage their health, preferences for involving family in medical decision-making, and ratings of companion helpfulness.MethodsAnalysis of audio-taped primary care visits of older patients who were accompanied by a family companion (n = 30 dyads) and linked patient surveys.ResultsFamily companions predominantly facilitated doctor and patient information exchange. More than half of companion communication behaviors were directed at improving doctor understanding of the patient. Companions were more verbally active during visits of patients who delegated the management of their health to others than visits of patients who co-managed or self-managed their health. Companions were rated as more helpful by patients who preferred active involvement of family in medical decision-making.ConclusionFamily companion participation and helpfulness in primary care communication varies by patients’ preferences for involving family in medical decision-making and approach to manage their health.Practice implicationsResearch to examine the effects of clarifying patient and family companion expectations for primary care visits could inform strategies to improve the patient-centeredness of medical communication.     

The Effects on Health Behavior and Health Outcomes of Internet-Based Asynchronous Communication Between Health Providers and Patients With a Chronic Condition: A Systematic Review

Background

In support of professional practice, asynchronous communication between the patient and the provider is implemented separately or in combination with Internet-based self-management interventions. This interaction occurs primarily through electronic messaging or discussion boards. There is little evidence as to whether it is a useful tool for chronically ill patients to support their self-management and increase the effectiveness of interventions.

Objective

The aim of our study was to review the use and usability of patient-provider asynchronous communication for chronically ill patients and the effects of such communication on health behavior, health outcomes, and patient satisfaction.

Methods

A literature search was performed using PubMed and Embase. The quality of the articles was appraised according to the National Institute for Health and Clinical Excellence (NICE) criteria. The use and usability of the asynchronous communication was analyzed by examining the frequency of use and the number of users of the interventions with asynchronous communication, as well as of separate electronic messaging. The effectiveness of asynchronous communication was analyzed by examining effects on health behavior, health outcomes, and patient satisfaction.

Results

Patients’ knowledge concerning their chronic condition increased and they seemed to appreciate being able to communicate asynchronously with their providers. They not only had specific questions but also wanted to communicate about feeling ill. A decrease in visits to the physician was shown in two studies (P=.07, P=.07). Increases in self-management/self-efficacy for patients with back pain, dyspnea, and heart failure were found. Positive health outcomes were shown in 12 studies, where the clinical outcomes for diabetic patients (HbA1c level) and for asthmatic patients (forced expiratory volume [FEV]) improved. Physical symptoms improved in five studies. Five studies generated a variety of positive psychosocial outcomes.

Conclusions

The effect of asynchronous communication is not shown unequivocally in these studies. Patients seem to be interested in using email. Patients are willing to participate and are taking the initiative to discuss health issues with their providers. Additional testing of the effects of asynchronous communication on self-management in chronically ill patients is needed.     

Use of an Electronic Patient Portal Among the Chronically Ill: An Observational Study

BackgroundElectronic patient portals may enhance effective interaction between the patient and the health care provider. To grasp the full potential of patient portals, health care providers need more knowledge on which patient groups prefer electronic services and how patients should be served through this channel.ObjectiveThe objective of this study was to assess how chronically ill patients’ state of health, comorbidities, and previous care are associated with their adoption and use of a patient portal.MethodsA total of 222 chronically ill patients, who were offered access to a patient portal with their health records and secure messaging with care professionals, were included in the study. Differences in the characteristics of non-users, viewers, and interactive users of the patient portal were analyzed before access to the portal. Patients’ age, gender, diagnoses, levels of the relevant physiological measurements, health care contacts, and received physiological measurements were collected from the care provider’s electronic health record. In addition, patient-reported health and patient activation were assessed by a survey.ResultsDespite the broad range of measures used to indicate the patients’ state of health, the portal user groups differed only in their recorded diagnosis for hypertension, which was most common in the non-user group. However, there were significant differences in the amount of care received during the year before access to the portal. The non-user group had more nurse visits and more measurements of relevant physiological outcomes than viewers and interactive users. They also had fewer referrals to specialized care during the year before access to the portal than the two other groups. The viewers and the interactive users differed from each other significantly in the number of nurse calls received, the interactive users having more calls than the viewers. No significant differences in age, gender, or patient activation were detected between the user groups.ConclusionsPrevious care received by the patient is an important predictor for the use of a patient portal. In a group of patients with a similar disease burden, demand for different types of health services and preferences related to the service channel seem to contribute to the choice to use the patient portal. Further research on patient portal functionalities and their potential to meet patient needs by complementing or substituting for traditional health care services is suggested.     

Patient Perspectives on Online Health Information and Communication With Doctors: A Qualitative Study of Patients 50 Years Old and Over

Background

As health care systems around the world shift toward models that emphasize self-care management, there is increasing pressure for patients to obtain health information online. It is critical that patients are able to identify potential problems with using the Internet to diagnose and treat a health issue and that they feel comfortable communicating with their doctor about the health information they acquire from the Internet.

Objective

Our aim was to examine patient-identified (1) problems with using the Internet to identify and treat a health issue, (2) barriers to communication with a doctor about online health information seeking, and (3) facilitators of communication with a doctor about patient searches for health information on the Internet.

Methods

For this qualitative exploratory study, semistructured interviews were conducted with a sample of 56 adults age 50 years old and over. General concerns regarding use of the Internet to diagnose and treat a health issue were examined separately for participants based on whether they had ever discussed health information obtained through the Internet with a doctor. Discussions about barriers to and facilitators of communication about patient searches for health information on the Internet with a doctor were analyzed using thematic analysis.

Results

Six higher-level general concerns emerged: (1) limitations in own ability, (2) credibility/limitations of online information, (3) anxiety, (4) time consumption, (5) conflict, and (6) non-physical harm. The most prevalent concern raised by participants who communicated with a doctor about their online health information seeking related to the credibility or limitations in online information. Participants who had never communicated with a doctor about their online health information seeking most commonly reported concerns about non-physical harm. Four barriers to communication emerged: (1) concerns about embarrassment, (2) concerns that the doctor doesn’t want to hear about it, (3) belief that there is no need to bring it up, and (4) forgetting to bring it up. Facilitators of communication included: (1) having a family member present at doctor visits, (2) doctor-initiated inquiries, and (3) encountering an advertisement that suggested talking with a doctor.

Conclusions

Overall, participants displayed awareness of potential problems related to online health information seeking. Findings from this study point to a set of barriers as well as facilitators of communication about online health information seeking between patients and doctors. This study highlights the need for enhanced patient communication skills, eHealth literacy assessments that are accompanied by targeted resources pointing individuals to high-quality credible online health information, and the need to remind patients of the importance of consulting a medical professional when they use online health resources to diagnose and treat a health issue.     

Use and Acceptance of Electronic Communication by Patients With Multiple Sclerosis: A Multicenter Questionnaire Study

Background

The number of multiple sclerosis (MS) information websites, online communities, and Web-based health education programs has been increasing. However, MS patients’ willingness to use new ways of communication, such as websites, mobile phone application, short message service, or email with their physician, remains unknown.

Objectives

We designed a questionnaire to evaluate the a priori use of electronic communication methods by MS patients and to assess their acceptance of such tools for communication with their health care providers.

Methods

We received complete data from 586 MS patients aged between 17 and 73 years. Respondents were surveyed in outpatient clinics across Germany using a novel paper-and-pencil questionnaire. In addition to demographics, the survey items queried frequency of use of, familiarity with, and comfort with using computers, websites, email, and mobile phones.

Results

About 90% of all MS patients used a personal computer (534/586) and the Internet (527/586) at least once a week, 87.0% (510/586) communicated by email, and 85.6% (488/570) communicated by mobile phone. When asked about their comfort with using electronic communication methods for communication with health care providers, 20.5% (120/586) accepted communication by mobile Internet application or short message service via mobile phone, 41.0% (240/586) by websites, 54.3% (318/586) by email service, and 67.8% (397/586) by at least one type of electronic communication. The level of a priori use was the best predictor for the acceptance of electronic communication with health care providers. Patients who reported already searching online for health information (odds ratio 2.4, P < .001) and who had already communicated with a physician through a website (odds ratio 3.3, P = .03) reported higher acceptance for Web-based communication. Patients who already scheduled appointments with their mobile phones (odds ratio 2.1, P = .002) were more likely to accept the use of mobile phone applications or short message service for communicating with their physician.

Conclusions

The majority of MS patients seen at specialist centers already use modern communication technology regularly. New forms of electronic communication appear to have high levels of acceptance for exchanging information about MS between patients and health care providers. Such methods should be integrated into eHealth services such as electronic health records and patient relationship management systems.     

Use of the internet to communicate with health care providers in the United States: estimates from the 2003 and 2005 Health Information National Trends Surveys (HINTS)

Background

Despite substantial evidence that the public wants access to Internet-based communication with health care providers, online patient-provider communication remains relatively uncommon, and few studies have examined sociodemographic and health-related factors associated with the use of online communication with health care providers at a population level.

Objective

The aim of the study was to use nationally representative data to report on the prevalence of and changes in use of online patient-provider communication in 2003 and 2005 and to describe sociodemographic and health-related factors associated with its use.

Methods

Data for this study are from two iterations of the Health Information National Trends Survey (HINTS 2003, HINTS 2005). In both years, respondents were asked whether they had ever used email or the Internet to communicate with a doctor or a doctor’s office. Adult Internet users in 2003 (n = 3982) and 2005 (n = 3244) were included in the present study. Multivariate logistic regression analysis was conducted to identify predictors for electronic communication with health care providers.

Results

In 2003, 7% of Internet users had communicated online with an health care provider; this prevalence significantly increased to 10% in 2005. In multivariate analyses, Internet users with more years of education, who lived in a metro area, who reported poorer health status or who had a personal history of cancer were more likely to have used online patient-provider communication.

Conclusions

Despite wide diffusion of the Internet, online patient-provider communication remains uncommon but is slowly increasing. Policy-level changes are needed to maximize the availability and effectiveness of online patient-provider communication for health care consumers and health care providers. Internet access remains a significant barrier to online patient-provider communication.     

Pediatric Caregiver Attitudes Toward Email Communication: Survey in an Urban Primary Care Setting

Background

Overall usage of email communication between patients and physicians continues to increase, due in part to expanding the adoption of electronic health records and patient portals. Unequal access and acceptance of these technologies has the potential to exacerbate disparities in care. Little is known about the attitudes of pediatric caregivers with regard to their acceptance of email as a means to communicate with their health care providers.

Objective

We conducted a survey to assess pediatric caregiver access to and attitudes toward the use of electronic communication modalities to communicate with health care providers in an urban pediatric primary care clinic.

Methods

Participants were pediatric caregivers recruited from an urban pediatric primary care clinic in Baltimore, Maryland, who completed a 35-item questionnaire in this cross-sectional study.

Results

Of the 229 caregivers who completed the survey (91.2% response rate), 171 (74.6%) reported that they use email to communicate with others. Of the email users, 145 respondents (86.3%) stated that they would like to email doctors, although only 18 (10.7%) actually do so. Among email users, African-American caregivers were much less likely to support the expanded use of email communication with health care providers (adjusted OR 0.34, 95% CI 0.14-0.82) as were those with annual incomes less than US $30,000 (adjusted OR 0.26, 95% CI 0.09-0.74).

Conclusions

Caregivers of children have access to email and many would be interested in communicating with health care providers. However, African-Americans and those in lower socioeconomic groups were much less likely to have positive attitudes toward email.     

Mechanisms of Communicating Health Information Through Facebook: Implications for Consumer Health Information Technology Design

BackgroundConsumer health information technology (IT) solutions are designed to support patient health management and have the ability to facilitate patients’ health information communication with their social networks. However, there is a need for consumer health IT solutions to align with patients’ health management preferences for increased adoption of the technology. It may be possible to gain an understanding of patients’ needs for consumer health IT supporting their health information communication with social networks by explicating how they have adopted and adapted social networking sites, such as Facebook, for this purpose.ObjectiveOur aim was to characterize patients’ use of all communication mechanisms within Facebook for health information communication to provide insight into how consumer health IT solutions may be better designed to meet patients’ communication needs and preferences.MethodsThis study analyzed data about Facebook communication mechanisms use from a larger, three-phase, sequential, mixed-methods study. We report here on the results of the study’s first phase: qualitative interviews (N=25). Participants were over 18, used Facebook, were residents or citizens of the United States, spoke English, and had a diagnosis consistent with type 2 diabetes. Participants were recruited through Facebook groups and pages. Participant interviews were conducted via Skype or telephone between July and September 2014. Data analysis was grounded in qualitative content analysis and the initial coding framework was informed by the findings of a previous study.ResultsParticipants’ rationales for the use or disuse of a particular Facebook mechanism to communicate health information reflected six broad themes: (1) characteristics and circumstances of the person, (2) characteristics and circumstances of the relationship, (3) structure and composition of the social network, (4) content of the information, (5) communication purpose, and (6) attributes of the technology.ConclusionsThe results of this study showed that participants consider multiple factors when choosing a Facebook mechanism for health information communication. Factors included what information they intended to share, what they were trying to accomplish, attributes of technology, and attributes and communication practices of their social networks. There is a need for consumer health IT that allows for a range of choices to suit the intersectionality of participants’ rationales. Technology that better meets patients’ needs may lead to better self-management of health conditions, and therefore, improve overall health outcomes.     

Remote shared decision making through telemedicine: A systematic review of the literature

ObjectivesTo assess the extent to which shared decision making (SDM) can take place in telemedicine (remote SDM).MethodsWe searched Medline, Cochrane, and Scopus from 2010 until August 7th, 2020 for articles on remote SDM in the care of any patient using any technology. We also conducted a search for telemedicine articles citing key reports on SDM outcome measures. Two reviewers independently screened titles and abstracts, reviewed full text eligible studies, and synthesized their content using thematic analysis.ResultsOf the 12 eligible articles, most were European with patients with chronic disease or mental and behavioral health. 8 articles used synchronous remote SDM and 1 used asynchronous remote SDM. Themes related to interactional workability of both telemedicine technologies and SDM emerged, namely access to broadband, digital literacy, and satisfaction with the convenience of remote visits.ConclusionsTelemedicine technologies may foster virtual interactions that support remote SDM, which, in turn, may promote productive patient-clinician interactions and patient-centered care.Practice implicationsDigitally-mediated consultations surged amidst the COVID-19 pandemic. The extent to which SDM frameworks developed for in-person use need any adaptation for remote SDM remains unclear. Investment in innovation, design, implementation, and effectiveness research to advance remote SDM are needed.     

Predictors of eHealth Usage: Insights on The Digital Divide From the Health Information National Trends Survey 2012

Background

Recent eHealth developments have elevated the importance of assessing the extent to which technology has empowered patients and improved health, particularly among the most vulnerable populations. With noted disparities across racial and social groups in chronic health outcomes, such as cancer, obesity, and diabetes, it is essential that researchers examine any differences in the implementation, uptake, and impact of eHealth strategies across groups that bear a disproportionate burden of disease.

Objective

The goal was to examine eHealth use by sociodemographic factors, such as race/ethnicity, socioeconomic status (SES), age, and sex.

Methods

We drew data from National Cancer Institute’s 2012 Health Information National Trends Survey (HINTS) (N=3959) which is publicly available online. We estimated multivariable logistic regression models to assess sociodemographic predictors of eHealth use among adult Internet users (N=2358) across 3 health communication domains (health care, health information–seeking, and user-generated content/sharing).

Results

Among online adults, we saw no evidence of a digital use divide by race/ethnicity. However, there were significant differences in use by SES, particularly for health care and health information–seeking items. Patients with lower levels of education had significantly lower odds of going online to look for a health care provider (high school or less: OR 0.50, 95% CI 0.33-0.76) using email or the Internet to communicate with a doctor (high school or less: OR 0.46, 95% CI 0.29-0.72), tracking their personal health information online (high school or less: OR 0.53, 95% CI 0.32-0.84), using a website to help track diet, weight, and physical activity (high school or less: OR 0.64, 95% CI 0.42-0.98; some college: OR 0.67, 95% CI 0.49-0.93), or downloading health information to a mobile device (some college: OR 0.54, 95% CI 0.33-0.89). Being female was a consistent predictor of eHealth use across health care and user-generated content/sharing domains, whereas age was primarily influential for health information–seeking.

Conclusions

This study illustrates that lower SES, older, and male online US adults were less likely to engage in a number of eHealth activities compared to their counterparts. Future studies should assess issues of health literacy and eHealth literacy and their influence on eHealth engagement across social groups. Clinical care and public health communication efforts attempting to leverage Web 2.0 and 3.0 platforms should acknowledge differential eHealth usage to better address communication inequalities and persistent disparities in health.     

Cultural competence and metaphor in mental healthcare interactions: A linguistic perspective

ObjectivesThe aim of this study is to understand how Spanish-speaking patients conceptualize mental health issues. This study uses a linguistic perspective to focus on how 23 Mexican-origin patients and their doctor talk about mental health during psychiatric interviews conducted in Spanish and how they negotiate cultural barriers.MethodsThis work analyzes when the doctor and his patients reference metaphors (e.g. feeling “empty,” feeling “low”). Metaphors are pervasive in all cultures and languages and reveal important information about people’s attitudes and feelings about a range of conditions and circumstances.ResultsThis work demonstrates the role of metaphor and linguistic analysis in uncovering culturally based constructions of mental health. The results reveal that the doctor and patients reference different sets of metaphors, which, at times, causes miscommunication.ConclusionsPractitioner awareness of how patients use metaphorical expressions in health is crucial for promoting advanced cultural and linguistic competence and ultimately, patient-centered care.Practice implicationsThe main findings have implications for health communication with minority groups such as Spanish-speaking Latinos/as in the United States. Practitioners working with Spanish-speaking patients should be familiar with how Latinos/as conceptualize health and how to avoid or repair confusion caused by cultural barriers.     

How Doctors View and Use Social Media: A National Survey

BackgroundDoctors are uncertain of their ethical and legal obligations when communicating with patients online. Professional guidelines for patient-doctor interaction online have been written with limited quantitative data about doctors’ current usage and attitudes toward the medium. Further research into these trends will help to inform more focused policy and guidelines for doctors communicating with patients online.ObjectiveThe intent of the study was to provide the first national profile of Australian doctors’ attitudes toward and use of online social media.MethodsThe study involved a quantitative, cross-sectional online survey of Australian doctors using a random sample from a large representative database.ResultsOf the 1500 doctors approached, 187 participated (12.47%). Most participants used social media privately, with only one-quarter not using any social media websites at all (48/187, 25.7%). One in five participants (30/155, 19.4%) had received a “friend request” from a patient. There was limited use of online communication in clinical practice: only 30.5% (57/187) had communicated with a patient through email and fewer than half (89/185, 48.1%) could offer their patients electronic forms of information if that were the patients’ preference. Three in five participants (110/181, 60.8%) reported not being uncomfortable about interacting with patients who had accessed personal information about them online, prior to the consultation. Most of the participants (119/181, 65.8%) were hesitant to immerse themselves more fully in social media and online communication due to worries about public access and legal concerns.ConclusionsDoctors have different practices and views regarding whether or how to communicate appropriately with patients on the Internet, despite online and social media becoming an increasingly common feature of clinical practice. Additional training would assist doctors in protecting their personal information online, integrating online communication in patient care, and guidance on the best approach in ethically difficult online situations.     

Effectiveness and impact of networked communication interventions in young people with mental health conditions: a systematic review

Objective

Examine the effectiveness and impacts of the networked communication technologies used by health care professionals for the treatment of adolescents/young adults with mental health disorders.

Methods

Nine electronic databases were searched. Quantitative and qualitative study designs were included, technologies were described and a narrative synthesis of all included studies was undertaken.

Results

20,925 papers were identified from which 12 interventions met the inclusion criteria. Three categories of networked communication were identified: email and/or web-based electronic diary (n = 6); videoconference (n = 5); and virtual reality (n = 1). Three studies reported statistically significant improvements in symptoms post intervention; all involved email communication. Patients were willing to use networked communication in routine care in nine studies.

Conclusions

Networked communication technologies can increase the opportunity for communication between patient and health care professionals. Limited improvements in quality of life and continuity of care for patients were reported. Patients and health care professionals expressed some satisfaction with technologies. Further research exploring concerns over privacy and security is needed.

Practice implications

Networked communication technologies have the potential to be a useful addition to mental health services delivery, however the impact and effectiveness of these technologies is inconclusive.     

Older persons’ expressed worries during nursing care at home: Do health complexity and nature of nursing care in the visit matter?

ObjectiveOlder persons receiving home care express more cues and concerns compared to other clinical contexts. Increased health condition complexity requires a corresponding increase in nursing competence. The aim of this study was to explore how complexity of older persons’ health and nature of the visit influenced their expressed worries.MethodsIn this cross-sectional explorative study, we analysed older persons’ expressed worries (n = 508) identified by the Verona Coding Definitions of Emotional Sequences (VR-CoDES) in 129 audio-recorded home care visits with older persons (≥65 years), collected in 3 city districts and 1 rural area in Norway.ResultsExpressed worries of 45 older persons were included in the analysis: 18 had low health complexity, 5 moderate and 22 high health complexity. The nature of the visit affected the number of expressed worries, health complexity did not. Most of the worries were expressed during basic nursing care visits and/or medication administration.ConclusionFindings suggest that home visit type may influence the older persons’ expressed worries. The complexity of the older persons’ health condition seems to have little impact on the expressed worries.Practice implicationsKnowledge about communication in different complexity of visits is important when planning care for older persons.     

Health Literacy and Control in the Medical Encounter: A Mixed-Methods Analysis

BackgroundPhysician-patient communication can be described according to 4 prototypes of control—paternalism, mutuality, consumerism, or default. Patients with inadequate health literacy skills may be less-active participants in their care and more likely to have paternalistic encounters.MethodsTwo independent coders analyzed 31 transcribed outpatient medical visits between physicians and African American patients with diabetes according to the 4 prototypes of control. Differences in communication and the balance of power by level of patients’ health literacy were analyzed by quantitative and qualitative methods.ResultsFourteen patients (45%) had inadequate health literacy, and most of them (N=8, 57%) had paternalistic encounters. Among patients with marginal or adequate health literacy skills, only 4 (23%) had paternalistic visits (p = .06), and encounters marked by mutuality were most common (N = 9, 53%).ConclusionPatients with inadequate health literacy appear more likely to have paternalistic interactions with their physicians.     

Patients’ perceptions of health system responsiveness in ambulatory care in Germany

Objective

To identify overall levels of health system responsiveness and the associations with social determinants for ambulatory health care in Germany from a user perspective.

Asthma,COPD, and home environments: Interventions with older adults

BackgroundWe describe a multifaceted home environmental intervention project involving low-income older adults with asthma who have a greater risk of asthma-related respiratory impacts because they spend up to 90% of their time in the home where many allergens and respiratory irritants are found. Although sufficient evidence suggests that home interventions are effective in improving health of children with asthma, the Task Force on Community Preventive Services has stated that evidence is insufficient for the effectiveness of home interventions on adults with asthma.ObjectiveTo evaluate the hypothesis that multifaceted home environmental interventions improve the respiratory health and reduce asthma triggers for older adults with asthma.MethodsWe conducted community health worker–led interventions in the homes of 86 low-income older adults (age 62 or older) diagnosed with asthma, residing in public and private subsidized housing in Lowell, Massachusetts, from 2014 to 2017. Health and environmental assessment at baseline and follow-up 1 year later included collecting data on respiratory health, quality of life, medication use, doctor/emergency room/hospital visits, using the St. George Respiratory Questionnaire and Asthma Control Test and evaluation of asthma trigger activities and exposures through questionnaires and home surveys. Interventions included education on asthma and environmental triggers and environmental remediation.ResultsStatistically significant reductions in self-reported environmental asthma triggers and health improvements were found in the following areas: doctor visits, use of antibiotics for chest problems, respiratory symptoms and quality of life indicators, and asthma control (ACT score).ConclusionOur results provide evidence that multifaceted home interventions are effective in improving the environmental quality and respiratory health of an older adult population with asthma.     

An exploration of how positive emotions are expressed by older people and nurse assistants in homecare visits

ObjectiveWe don´t know how positive emotions are being expressed by patients and health care providers in consultations. The aim of this study is to identify positive emotions expressed by older people and nurse assistants to discuss the function of these in the visits.MethodThis paper presents secondary analysis of consultations in the COMHOME project. In this pilot study, six transcribed consultations between nurse assistants and older people in home health care were analysed using a coding system for positive emotions with seven categories capturing both content and emotional intensity of positive affect.ResultsWe found 114 expressions of positive emotions, 63% from nurse assistants and 37% from patients. Patients mostly expressed gratitude, indicating that patients are grateful for being helped. Nurse assistants mostly expressed Praise or Support, indicating that they gave their patients positive affirmation.ConclusionThe praise and support given by nurse assistants to older people in home health care seemed effective in fostering relationships and maintaining patient resilience. Thus, we claim that emotional talk in communication also should include positive emotions.Practice ImplicationTeaching health care providers about the importance of expressions of positive emotions should be integrated in communication skills training.     

Pitfalls in computer housekeeping by doctors and nurses in KwaZulu-Natal: No malicious intent

Introduction

Information and communication technologies are becoming an integral part of medical practice, research and administration and their use will grow as telemedicine and electronic medical record use become part of routine practice. Security in maintaining patient data is important and there is a statuary obligation to do so, but few health professionals have been trained on how to achieve this. There is no information on the use of computers and email by doctors and nurses in South Africa in the workplace and at home, and whether their current computer practices meets legal and ethical requirements. The aims of this study were to determine the use of computers by healthcare practitioners in the workplace and home; the use and approach to data storage, encryption and security of patient data and patient email; and the use of informed consent to transmit data by email.

Methods

A self-administered questionnaire was administered to 400 health care providers from the state and private health care sectors. The questionnaire covered computer use in the workplace and at home, sharing of computers, data encryption and storage, email use, encryption of emails and storage, and the use of informed consent for email communication.

Results

193 doctors and 207 nurses in the private and public sectors completed the questionnaire. Forty (10%) of participants do not use a computer. A third of health professionals were the only users of computers at work or at home. One hundred and ninety-eight respondents (55%) did not know if the data on the computers were encrypted, 132 (36.7%) knew that the data were not encrypted and 30 (8.3%) individuals knew that the data on the computers they were using were encrypted. Few doctors, 58 (16%), received emails from patients, with doctors more likely to receive emails from patients than nurses (p = 0.0025). Thirty-one percent of individuals did not respond to the emails. Emails were saved by 40 (69%) recipients but only 5 (12.5%) doctors encrypted the messages, 19 (47.5%) individuals knowingly did not encrypt and 16 (40.0%) did not know if they encrypted the data. While 20% of health professionals have emailed patient data, but only 41.7% gained consent to do so.

Conclusions

Most health professionals as sampled in South Africa are not compliant with the National Health Act or the Electronic Communications Transactions Act of South Africa or guidelines from regulatory bodies when managing patient data on computers. Many appear ignorant or lack the ability to comply with simple data security procedures.