Explore the vast range of titles available.

Social media are dynamic and interactive computer-mediated communication tools that have high penetration rates in the general population in high-income and middle-income countries. However, in medicine and health care, a large number of stakeholders (eg, clinicians, administrators, professional colleges, academic institutions, ministries of health, among others) are unaware of social media's relevance, potential applications in their day-to-day activities, as well as the inherent risks and how these may be attenuated and mitigated. We conducted a narrative review with the aim to present case studies that illustrate how, where, and why social media are being used in the medical and health care sectors. Using a critical-interpretivist framework, we used qualitative methods to synthesize the impact and illustrate, explain, and provide contextual knowledge of the applications and potential implementations of social media in medicine and health care. Both traditional (eg, peer-reviewed) and nontraditional (eg, policies, case studies, and social media content) sources were used, in addition to an environmental scan (using Google and Bing Web searches) of resources. We reviewed, evaluated, and synthesized 76 articles, 44 websites, and 11 policies/reports. Results and case studies are presented according to 10 different categories of social media: (1) blogs (eg, WordPress), (2) microblogs (eg, Twitter), (3) social networking sites (eg, Facebook), (4) professional networking sites (eg, LinkedIn, Sermo), (5) thematic networking sites (eg, 23andMe), (6) wikis (eg, Wikipedia), (7) mashups (eg, HealthMap), (8) collaborative filtering sites (eg, Digg), (9) media sharing sites (eg, YouTube, Slideshare), and others (eg, SecondLife). Four recommendations are provided and explained for stakeholders wishing to engage with social media while attenuating risk: (1) maintain professionalism at all times, (2) be authentic, have fun, and do not be afraid, (3) ask for help, and (4) focus, grab attention, and engage. The role of social media in the medical and health care sectors is far reaching, and many questions in terms of governance, ethics, professionalism, privacy, confidentiality, and information quality remain unanswered. By following the guidelines presented, professionals have a starting point to engage with social media in a safe and ethical manner. Future research will be required to understand the synergies between social media and evidence-based practice, as well as develop institutional policies that benefit patients, clinicians, public health practitioners, and industry alike.

South Asian community members in Canada experience a higher burden of chronic disease than the general population. Digital health innovations provide a significant opportunity to address various health care challenges such as supporting patients in their disease self-management. However, South Asian community members are less likely to use digital tools for their health and face significant barriers in accessing them because of language or cultural factors. The aim of this study is to understand the barriers to and facilitators of digital health tool uptake experienced by South Asian community members residing in Canada. This study used a qualitative community-based participatory action research approach. Residents from Surrey, British Columbia, Canada, who spoke 1 of 4 South Asian languages (Hindi, Punjabi, Urdu, or Tamil) were invited to participate in focus group discussions. A subsample of the participants were invited to use photovoice methods in greater depth to explore the research topics. A total of 197 participants consented to the focus group discussions, with 12 (6.1%) participating in the photovoice phase. The findings revealed several key obstacles (older age, lack of education, and poor digital health literacy) and facilitators (social support from family or community members and positive attitudes toward technology) to using digital health tools. The results support the value of using a community-based participatory action research approach and photovoice methods to engage the South Asian community in Canada to better understand digital health competencies and needs. There were several important implications for policy makers and future research, such as continued engagement of community leaders by health care providers and administrators to learn about attitudes and preferences.

Patients inevitably incur some cost for accessing health care, even in universal systems such as Canada. The COVID-19 pandemic dramatically shifted health care delivery from in-person to telehealth services, also shifting the proportion of costs offset by patients and their families by reducing the need to travel to in-person appointments. This study aimed to develop a method for estimating the costs patients and their families incur and CO emissions attributed to travel needed for emergency department (ED) visits, hospitalizations, and physician appointments. We present a method to evaluate the costs associated with in-person and telehealth care appointments from the perspective of patients, their families, and the environment. We used ED locations, road distances, and duration of appointment to account for costs paid by patients (ie, lost productivity, informal caregiving, and out-of-pocket expenses) attributed to travel to receive medical care. Costs to the environment were evaluated by calculating the amount of CO emitted per medical visit. Using our costs calculated per visit, we apply our method to calculate total patient costs for a simulated population over 1 year. Our method estimates that patients in British Columbia pay up to $300 (2023 CAD, CAD $1=US $0.86) on average to attend an in-person ED visit, depending on where they live; $166 may be attributed to lost productivity, $83 to informal caregiving, and $50 to out-of-pocket expenses. These estimates are higher than most observed cost estimates. In addition, avoiding in-person care diverts up to 13 kg of CO per medical visit, depending on the distance and frequency of travel to appointments. This translates to up to $0.70 in carbon costs per visit, or cumulatively $44,120 per year in British Columbia, conventionally not included in patient cost estimates. We present a novel method for estimating patient-incurred costs and CO emissions from accessing health care and apply it to estimate that every year, patients in British Columbia pay upwards of 30 million dollars to access health care services, primarily for medical travel. Our method adds to the economic evaluation literature by providing a more comprehensive and context-modifiable calculation of patient costs that will allow for more informed decision-making regarding health care services.

British Columbia has over 200 rural, remote, and Indigenous communities that have limited health care resources due to physician isolation, sparsity in clinical resources, the lack of collegial support, and provider burnout. Real-time virtual support (RTVS) peer-to-peer pathways provide support to patients and providers. Amid the COVID-19 pandemic exacerbating existing health care disparities and equitable access to timely care, RTVS presents a portable and additional opportunity to be deployed in a hospital or patient home setting in rural communities. We highlight the story of the Rural Urgent Doctor in-aid (RUDi) pathway within RTVS that successfully supported the Dawson Creek District Hospital (DCDH) emergency department (ED) in 2021. This study aims to describe the rapid implementation process and identify facilitators and barriers to successful implementation. This case study is grounded in the Quadruple Aim and Social Accountability frameworks for health systems learning. The entire study period was approximately 6 months. After 1 week of implementation, we interviewed RUDi physicians, DCDH staff, health authority leadership, and RTVS staff to gather their experiences. Content analysis was used to identify themes that emerged from the interviews. RUDi physicians covered 39 overnight shifts and were the most responsible providers (MRPs) for 245 patients who presented to the DCDH ED. A total of 17 interviews with key informants revealed important themes related to leadership and relationships as facilitators of the coverage's success, the experience of remote physician support, providing a \"safety net,\" finding new ways of interprofessional collaboration, and the need for extensive IT support throughout. Quality improvement findings identified barriers and demonstrated tangible recommendations for how this model of support can be improved in future cases. By acting as the MRP during overnight ED shifts, RUDi prevented the closure of the DCDH ED and the diversion of patients to another rural hospital. Rapid codevelopment and implementation of digital health solutions can be leveraged with existing partnerships and mutual trust between RTVS and rural EDs to ease the pressures of a physician shortage, particularly during COVID-19. By establishing new and modified clinical workflows, RTVS provides a safety net for rural patients and providers challenged by burnout. This case study provides learnings to be implemented to serve future rural, remote, and Indigenous communities in crisis.

Background British Columbia 8–1-1 callers who are advised by a nurse to seek urgent medical care can be referred to virtual physicians (VPs) for supplemental assessment and advice. Prior research indicates callers’ subsequent health service use may diverge from VP advice. We sought to 1) estimate concordance between VP advice and subsequent health service use, and 2) identify factors associated with concordance to understand potential drivers of discordant cases. Methods We linked relevant provincial administrative databases to obtain inpatient, outpatient, and emergency service use by callers. We developed operational definitions of concordance collaboratively with researcher, patient, VP, and management perspectives. We used Kaplan–Meier curves to describe health service use post-VP consultation and Cox regression to estimate the association of caller factors (rurality, demography, attachment to primary care) and call factors (reason, triage level, time of day) with concordance as hazard ratios. Results We analyzed 17,188 calls from November 16, 2020 to April 30, 2021. Callers advised to attend an emergency department (ED) immediately were the most concordant (73%) while concordance was lowest for those advised to seek Family Physician (FP) care either immediately (41%) or within 7 days (47%). Callers unattached to FPs were less likely to schedule an FP visit (hazard ratio = 0.76 [95%CI: 0.68–0.85]). Rural callers were less likely to attend an ED within 48 h when advised to go immediately (0.53 [95%CI:0.46–0.61]) compared to urban callers. Rural callers advised to see an FP, either immediately (1.28 [95%CI:1.01–1.62]) or within 7 days (1.23 [95%CI: 1.11–1.37]), were more likely to do so than urban callers. Interpretation Concordance between VP advice and subsequent caller health service use varies substantially by category of advice and caller rurality. Concordance with advice to “Go to ED” is high overall but to access primary care is below 50%, suggesting potential issues with timely access to FP care. Future research from a patient/caller centered perspective may reveal additional barriers and facilitators to concordance.

Heart failure (HF) is a costly health condition and a major public health problem. It is estimated that 2%-3% of the population in developed countries has HF, and the prevalence increases to 8% among patients aged ≥75 years. Home telemonitoring is a form of noninvasive, remote patient monitoring that aims to improve the care and management of patients with chronic HF. Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring (TEC4Home) is a project that implements and evaluates a comprehensive home monitoring protocol designed to support patients with HF as they transition from the emergency department to home. The aim of this study is to assess the cost of using the home monitoring platform (TEC4Home) relative to usual care for patients with HF. This study is a cost-consequence analysis of the TEC4Home pilot study. The analysis was conducted from a partial societal perspective, including direct and indirect health care costs. The aim is to assess the costs of the home monitoring platform relative to usual care and track costs related to health care utilization during the 90-day postdischarge period. Economic analysis of the TEC4Home pilot study showed a positive trend in cost savings for patients using TEC4Home. From both the health system perspective (Pre TEC4Home cost per patient: CAD $2924 vs post TEC4Home cost per patient: CAD $1293; P=.01) and partial societal perspective (Pre TEC4Home cost per patient: CAD $2411 vs post TEC4Home cost per patient: CAD $1108; P=.01), we observed a statistically significant cost saving per patient. In line with the advantages of conducting an economic analysis alongside a feasibility study, the economic analysis of the TEC4Home pilot study facilitated the piloting of patient questionnaires and informed the methodology for a full clinical trial.

Although the digitization of personal health information (PHI) has been shown to improve patient engagement in the primary care setting, patient perspectives on its impact in the emergency department (ED) are unknown. The primary objective was to characterize the views of ED users in British Columbia, Canada, on the impacts of PHI digitization on ED care. This was a mixed methods study consisting of an online survey followed by key informant interviews with a subset of survey respondents. ED users in British Columbia were asked about their ED experiences and attitudes toward PHI digitization in the ED. A total of 108 participants submitted survey responses between January and April 2020. Most survey respondents were interested in the use of electronic health records (79/105, 75%) and patient portals (91/107, 85%) in the ED and were amenable to sharing their ED PHI with ED staff (up to 90% in emergencies), family physicians (up to 91%), and family caregivers (up to 75%). In addition, 16 survey respondents provided key informant interviews in August 2020. Interviewees expected PHI digitization in the ED to enhance PHI access by health providers, patient-provider relationships, patient self-advocacy, and postdischarge care management, although some voiced concerns about patient privacy risk and limited access to digital technologies (eg, smart devices, internet connection). Many participants thought the COVID-19 pandemic could provide momentum for the digitization of health care. Patients overwhelmingly support PHI digitization in the form of electronic health records and patient portals in the ED. The COVID-19 pandemic may represent a critical moment for the development and implementation of these tools.

BackgroundDiagnostics are increasingly shifting to patients’ home environment, facilitated by new digital technologies. Digital diagnostics (diagnostic services enabled by digital technologies) can be a tool to better respond to the challenges faced by primary care systems while aligning with patients’ and healthcare professionals’ needs. However, it needs to be clarified how to determine the success of these interventions.ObjectivesWe aim to provide practical guidance to facilitate the adequate development and implementation of digital diagnostics.StrategyHere, we propose the quadruple aim (better patient experiences, health outcomes and professional satisfaction at lower costs) as a framework to determine the contribution of digital diagnostics in primary care. Using this framework, we critically analyse the advantages and challenges of digital diagnostics in primary care using scientific literature and relevant casuistry.ResultsTwo use cases address the development process and implementation in the Netherlands: a patient portal for reporting laboratory results and digital diagnostics as part of hybrid care, respectively. The third use case addresses digital diagnostics for sexually transmitted diseases from an international perspective.ConclusionsWe conclude that although evidence is gathering, the often-expected value of digital diagnostics needs adequate scientific evidence. We propose striving for evidence-based ‘responsible digital diagnostics’ (sustainable, ethically acceptable, and socially desirable digital diagnostics). Finally, we provide a set of conditions necessary to achieve it. The analysis and actionable guidance provided can improve the chance of success of digital diagnostics interventions and overall, the positive impact of this rapidly developing field.

Introduction: Relationships are the core of Indigenous Peoples' spiritual and cultural identities, and therapeutic relationships are an integral part of the physical rehabilitation process, directly influencing health outcomes. However, participating in therapeutic relationships can be difficult for First Nations Peoples, particularly in the virtual landscape. There is limited understanding of First Nations Peoples' perspectives on this issue, and this understanding is crucial to developing culturally safe and effective telehealth physiotherapy programs. Therefore, the purpose of this study is to explore the perspectives of First Nations Peoples from British Columbia, Canada, on telehealth physiotherapy, with an emphasis on the virtual therapeutic relationship. Methods: A narrative qualitative study that utilized one-on-one, semistructured interviews was conducted with 19 First Nations adults from remote and rural First Nations communities in north-central British Columbia, Canada. Interviews were recorded, transcribed verbatim, and analyzed using an inductive approach to reflexive thematic analysis. Results: Three themes emerged from data analysis. 'Therapist's attitude and rapport' captures participants' perceptions of what matters the most in how physiotherapists relate to First Nations Peoples and carry out their work. 'Remote nature of virtual care' encompasses the main challenges of virtual care visits, particularly how these were perceived to impact establishing and maintaining solid therapeutic relationships. 'Fostering culturally appropriate and safe telehealth physiotherapy' focuses on what is needed to advance telehealth physiotherapy in a manner that respects and reflects First Nations cultures, equipping all involved parties to provide comprehensive and sensitive services. Our findings advocate a hybrid model that combines in-person and telehealth visits to address communication barriers and the absence of physical interaction. Bridging the digital health literacy gap through training and collaboration with local support staff is crucial (as it is to bridge the possible cultural literary gap of therapists), and the incorporation of cultural elements holds promise for enhancing the engagement and effectiveness of telehealth services in these communities. Conclusion: The pursuit of equitable health care for First Nations communities demands not only increased access but also a thoughtful, culturally safe, trauma-informed, and holistic approach. This approach must be tailored to the unique needs of First Nations Peoples, emphasizing the integration of cultural elements and community support. A hybrid model combining in-person and telehealth visits is recommended to address logistical challenges and enhance the therapeutic relationship, ensuring that care is both effective and respectful of cultural values and practices.