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    • "It has been argued that the most important ingredient to effectively managing chronic illnesses is communication between patients and providers.1 Yet, our current healthcare system is fragmented, delivering episodic face-to-face treatment with negligible communication between encounters, and minimal care coordination over time.2 Given the current level of innovation in e-health technologies and recent legislation to reform the U.S. healthcare system, it seems inevitable that the paradigm of healthcare delivery will evolve rapidly. "
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    ABSTRACT: Many e-health technologies are available to promote virtual patient-provider communication outside the context of face-to-face clinical encounters. Current digital communication modalities include cell phones, smartphones, interactive voice response, text messages, e-mails, clinic-based interactive video, home-based web-cams, mobile smartphone two-way cameras, personal monitoring devices, kiosks, dashboards, personal health records, web-based portals, social networking sites, secure chat rooms, and on-line forums. Improvements in digital access could drastically diminish the geographical, temporal, and cultural access problems faced by many patients. Conversely, a growing digital divide could create greater access disparities for some populations. As the paradigm of healthcare delivery evolves towards greater reliance on non-encounter-based digital communications between patients and their care teams, it is critical that our theoretical conceptualization of access undergoes a concurrent paradigm shift to make it more relevant for the digital age. The traditional conceptualizations and indicators of access are not well adapted to measure access to health services that are delivered digitally outside the context of face-to-face encounters with providers. This paper provides an overview of digital "encounterless" utilization, discusses the weaknesses of traditional conceptual frameworks of access, presents a new access framework, provides recommendations for how to measure access in the new framework, and discusses future directions for research on access.
    Journal of General Internal Medicine 11/2011; 26 Suppl 2(Suppl 2):639-47. DOI:10.1007/s11606-011-1806-6 · 3.42 Impact Factor
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    • "ICTs, including telehealth, have the capacity to improve access at all levels of care for a large range of health conditions, offer patient-centred care at lower costs, increase the efficiency of clinical decision-making, and improve the efficacy of chronic health management [17]. These technologies facilitate knowledge acquisition, transfer, and exchange, which can directly impact on many aspects related to the quality of health professionals' professional lives and their levels of work satisfaction [13,15,18]. "
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    ABSTRACT: In Canada, workforce shortages in the health care sector constrain the ability of the health care system to meet the needs of its population and of its health care professionals. This issue is of particular importance in peripheral regions of Quebec, where significant inequalities in workforce distribution between regions has lead to acute nursing shortages and increased workloads. Information and communication technologies (ICTs) are innovative solutions that can be used to develop strategies to optimise the use of available resources and to design new nursing work practices. However, current knowledge is still limited about the real impact of ICTs on nursing recruitment and retention. Our aim is to better understand how work practice reorganization, supported by ICTs, and particularly by telehealth, may influence professional, educational, and organizational factors relating to Quebec nurses, notably those working in peripheral regions. First, we will conduct a descriptive study on the issue of nursing recruitment. Stratified sampling will be used to select approximately twenty innovative projects relating to the reorganization of work practices based upon ICTs. Semi-structured interviews with key informants will determine professional, educational, and organizational recruitment factors. The results will be used to create a questionnaire which, using a convenience sampling method, will be mailed to 600 third year students and recent graduates of two Quebec university nursing faculties. Descriptive, correlation, and hierarchical regression analyses will be performed to identify factors influencing nursing graduates' intentions to practice in peripheral regions. Secondly, we will conduct five case studies pertaining to the issue of nursing retention. Five ICT projects in semi-urban, rural, and isolated regions have been identified. Qualitative data will be collected through field observation and approximately fifty semi-structured interviews with key stakeholders. Data from both parts of this research project will be jointly analysed using triangulation of researchers, theoretical approaches, methods, and results. Continuous exchanges with decision makers and periodic knowledge transfer activities are planned to facilitate the dissemination and utilization of research results in policies regarding the nursing recruitment and retention.
    BMC Health Services Research 02/2011; 11(1):27. DOI:10.1186/1472-6963-11-27 · 1.71 Impact Factor
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    ABSTRACT: Pain and depression are 2 of the most common and disabling cancer-related symptoms. In the Indiana Cancer Pain and Depression trial, 202 cancer patients with pain and/or depression were randomized to the intervention group and received centralized telecare management augmented by automated symptom monitoring (ASM). Over the 12-month trial, the average patient completed 2 ASM reports and 1 nurse call per month. Satisfaction with both ASM and care management was high regardless of patient characteristics or cancer type. Adherence was also generally good, although several predictors of fewer ASM reports and nurse calls were identified. Only a minority of ASM reports triggered a nurse call, suggesting the efficiency of coupling clinician-delivered telecare management with automated monitoring.
    The Journal of ambulatory care management 04/2011; 34(2):126-39. DOI:10.1097/JAC.0b013e31820ef628
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