ASSIGNMENT 3: USING EVIDENCE TO INFORM DECISION Essay Example

ASSIGNMENT 3: USING EVIDENCE TO INFORM DECISION

Assessment 3: Using Evidence to Inform Decision

DEVELOPING A FOCUSED QUESTION AND ACQUIRING RELEVANT EVIDENCE PART 1:

Use the following categories to help define your problem and what you are looking at in simple terms1.

: Patient/Problem, Intervention, Comparison, and Outcome. PICO

healthcare experience and outcomes amongst patients
Patient/Problem:

Telehealth
Intervention:

other approaches to healthcare provision
Comparison:

Improved outcome and experience
Outcome:

Now use these terms from the question above to create your PICO research question so that you have a clear purpose for your search:2.

In a community healthcare, does telehealth/telemedicine as compared to other approaches improve the healthcare experience and outcome amongst patients?

3. What type of clinical question do you think this PICO answers?

Prognosis

The table below will help you to think of the other terms that you might also like to look up when searching for evidence to help you answer your question – this is part of basic planning for a research search.4.

• because sometimes articles from different countries and health systems call things different names – for example, in Australia we sometimes us the term ‘community nurses’, but in the UK they often talk about ‘district nurses’ – if you only searched under ‘district nurse’ you’d miss all the articles which happened to a different term – you would be missing some of the picture!alternative terms We ask you to look up

Population	Intervention	Comparison (not commonly used in actual database search strategy)	(not commonly used in actual database search strategy)
Main search term:What is your population? Adults Patients What other terms might have been used? Alternative search terms: Of age patients Grown patients	Main search term:What is your intervention? Telehealth What other terms might have been used? Alternative search terms: Telemedicine e-health	Main search term:What is your comparison? Other approaches What other terms might have been used? Alternative search terms: Normal methods Traditional approaches	Main search term:What is your outcome? Improved experience What other terms might have been used? Alternative search terms: Improved care provision Quality care

5. Is there a particular group of people that you want to look at? List here any inclusion criteria you might use to refine your search if you have too many papers:

Young adults to older adults (25 and above)
Age Range:Males and females
Gender:

English
Language:2001 to 2017
Publication Dates:

What kind of study do you think would best answer your question? 6.

1. Randomized Controlled Trial (RCT)

Qualitative Study 2. Economic Evaluation3.

Systematic Search Strategy Worksheet

7. Now that you have decided on WHAT you will be searching, you need to put down a plan of HOW you will search for your articles. This helps you and others to see how you got your evidence and how you made sure you got the best evidence to help you decide on your clinical action.

• Using the PICO terms in your table, enter each term in a row (group them together under the PICO categories).

• The next step is to combine similar terms using ‘OR’ .

• The final step is to use ‘AND’ to combine your searches for different PICO elements.

	Key terms:
	Impacts of telehealth
	Improved healthcare
	Community healthcare provision
	Adult patients
	Healthcare experience
	Healthcare outcome
	Telehealth towards improved community healthcare
	Improving healthcare experience
	Improving healthcare provision
	Telehealth amongst adult patients
	District healthcare
	District healthcare OR community healthcare
	Telehealth OR telemedicine OR e-health
	Telehealth and Improved community healthcare outcome amongst adult patients
	Telemedicine and improved district healthcare experience amongst adult OR of age patients

OR = combine alternate terms for the same topic – to get as many potential papers as possible!

AND = combine the groups of topics to get papers which cover ALL the terms!

PART 2: EVIDENCE OF APPLICATION OF SEARCH STRATEGY (PLAN) IN DATABASE SEARCHES

Enter your planned search into two different databases of your choice (such as Medline and CINHAL) using the skills you have learnt in the library session, online library videos, and library workshops.

8. Place the screenshots/screengrabs/digital pictures of your two (2) database searchers here. Please ensure your screenshots provide all steps of your search (see the example in Assessment one templet) and are clear enough to be legible – these must be READABLE!!

Database search 1

Database search 2

9. Select a randomised controlled trial that can help you answer your PICO question and place the abstract here. Please add this as a screenshot, do not retype this yourself. (The abstract must be readable)

10. Choose a qualitative study that is relevant to your PICO from the list of provided articles in Assessment 3 folder and place the abstract here. It is ok if your qualitative study does not exactly match your PICO, but it should be relevant. Please add this as a screenshot, do not retype this yourself. (The abstracts must be readable).

PART 3.1 APPRAISAL OF YOUR RANDOMISED CONTROLLED TRIAL (Please consider the word limit for each question, 13 marks )

Assessing the quality of the available evidence has also been a key focus this semester. Use the CASP tool for RCTs below to appraise the quality of your selected RCT.

Randomised Controlled Trial Appraisal Tool

Section A: Are the results of the trial valid?

Screening Questions

1. Did the trial address a clearly focused issue?

Justify your answer: (Max 50 words)

The trial addressed the idea or concept of telehealth in improving the experience of care provision and patient’s healthcare outcome on the basis of patients and healthcare professionals’ views. In this perspective, basing on the population and outcome of the trial, the focused issue was clearly addressed.

HINT: An issue can be ‘focused’ In terms of

• The population studied

• The intervention given

• The comparator given

• The outcomes considered

2. Was the assignment of patients to treatments randomised? (Max 50 Words)

Justify your answer:

The assignment of treatment was randomised on the qualification of being a heat patient transferred from the hospital to home hospitalisation across randomised sectors. The trial involved heart patients with heart failure and arrhythymia and a phenomenological hermeneutic random approach used to collect data.

HINT: Consider

• How was this carried out?

• Was the allocation sequence concealed from

3. Were all of the patients who entered the trial properly accounted for at its conclusion? (Max 50 words)

Justify your answer:

All the patients who participated in the trial were considered in the conclusion. The data obtained from the eight total participants was considered for the conclusion.

HINT: Consider

• Was the trial stopped early?

• Were patients analysed in the groups to which they were randomised?

Detailed questions

4. Were patients, health workers and study personnel ‘blind’ to treatment? (Max 50 words)

Justify your answer:

The participants were not ‘blind’ for the treatment considering the awareness of use of telehealth to monitor and address the issues of heart condition in patients.

HINT: Think about

• Patients?

• Health workers?

• Study personnel?

5. Were the groups similar at the start of the trial? (Max 50 words)

Justify your answer:

The randomised trial made use of eight male and female participants; however, their number varied. There were only two female heart patients who participated in the trial as compared to six males.

HINT: Look at

• Other factors that might affect the outcome such as age,

• sex, social class

• researchers and patients?

6. Aside from the experimental intervention were the groups treated equally? (Max 50 words)

Justify your answer:

Aside from the experimental intervention, the groups were treated equally; both the male and female participants were interviewed equally on the basis of set criterion of the study. Therefore, it can be argued that the groups were treated equally during the study.

Section B: What are the results?

7. How large was the treatment effect? (Max 150 words)

Justify your answer:

The effect of the treatment can be argued to have been considerably large enough. The trial based the measurement of the outcome in certain themes such as security, freedom, increased awareness of symptoms, being ‘looked after’, and annoyance with the spouse/partners as some of the elements of using telehealth to monitor the health of heart patients at home as viewed by patients and their spouses/partners.

The primary outcome of the trial is clearly specified: the trial found that the patients believe that home hospitalisation facilitates the process of returning to everyday life both physically and mentally. However, the degree of facilitation of recovery as impacted by home hospitalisation was based on the idea that partners were supportive and the telehealth monitoring and administration of healthcare was effective.

HINT: Consider

• What outcomes were measured?

• Is the primary outcome clearly specified?

• What results were found for each outcome?

8. How precise was the estimate of the treatment effect? (Max 100 words)

Justify your answer:

The estimate of treatment or care provision effect can be argued to considerably precise. Considering that results indicated that all the participant heart patients considered and deemed telehealth being positively influential towards quick recovery whilst at home, the confidence level on the test theme is relatively high.

All the participants believed that home hospitalisation was effective for quick recovery in terms of security and freedom, which was considered addressed effectively whilst at home that at the hospital.

HINT: Consider

• What are the confidence limits?

Section C: Will the results help locally?

9. Can the results be applied in your context? (or to the local population?) (Max 100 words)

Justify your answer:

The results of the trial can be applied to the local population. Considering that the theme of the trial was to assess the impacts of telehealth in home hospitalisation as viewed by the patients, the results indicated that patients prefer home hospitalisation, and it is the idea and practice of telehealth that is known to enhance and facilitate patients monitoring and medication administration in home-based care (Heckemann et al. 2017; Fairbrother et a. 2012; Dinesen et al. 2008).

HINT: Consider whether

• Do you think that the patients covered by the trial

• are similar enough to the patients to whom you will

• apply this?, if not how to they differ?

10. Were all clinically important outcomes considered? (Max 50 words)

Justify your answer:

The trial considered the view of the patients about the effects of telehealth technology on them and their spouses/partners, and how the idea impacted the process of recovery. The patients and their spouses/partners were reported to have been identified with the technology, hence accepted.

HINT: Consider

• Is there other information you would like to have seen?

• If not, does this affect the decision?

11. Are the benefits worth the harms and costs? Yes (Max 100 words)

Justify your answer:

The benefits of telehealth to a home-hospitalised patient can be argued to be of importance even if proven to be costly. The trial argued that degree of quick recovery amongst the patients was view of the perceptions that patients felt safe and free whilst at home, which positively impacted their mental and physical readiness to get back into their real life activities.

HINT: Consider: Even if this is not addressed by the review, what do you think?

PART 3.2 APPRAISAL OF YOUR QUALITATIVE ARTICLE (please consider the word limit for each question, 11marks )

Use the CASP Appraisal for Qualitative Research below to decide whether the information presented in your paper is trustworthy and truly reflective of the participant’s voice.

SCREENING QUESTIONS

1. Was there a clear statement of the aims? ☒Yes ☐ Can’t tell☐
No

HINT: Consider

• What was the goal of the research?

• Why it was thought important?

• Its relevance

Your comment: (max 50 words)

The qualitative study had a clear statement of the aims; the research aimed at understanding the views of the professionals and patients on the acceptability and perceived usefulness of tele-monitoring in the management of chronic heart failure in a day-to-day care provision context.

2. Is a qualitative methodology appropriate? ☒Yes ☐ Can’t tell☐
No

HINT: Consider

• If the research seeks to interpret or illuminate the actions and/or subjective experiences of research participants

• Is qualitative research the right methodology for addressing the research goal?

Your comment: (max 50 words)

The research intended to interpret the views of patients and professionals into the ideas that can used to influence decisions concerning the use of tele-monitoring in the care provision. Semi-structured interview with a framework approach is considerably appropriate for the research goal.

DETAILED QUESTIONS

3. Was the research design appropriate to address the aims of the research? ☒Yes ☐ Can’t tell☐
No

HINT: Consider

• If the researcher has justified the research design (e.g. have they discussed how they decided which method to use)?

Your comment: (max 50 words)

The research design is appropriate to address the aims of the research. The design assumed qualitative criterion where post graduate social researchers visited homes of participant and conducted 30 minutes face-to-face interview with each of the participants.

4. Was the recruitment strategy appropriate to the aims of the research? ☒Yes ☐ Can’t tell☐
No

HINT: Consider

• If the researcher has explained how the participants were selected

• If they explained why the participants they selected were the most appropriate to provide access to the type of knowledge sought by the study

• If there are any discussions around recruitment (e.g. why some people chose not to take part)

Your comment: (max 100 words)

The recruitment strategy was appropriate to the aims of the research considering the fact that all participants had all experienced the use of tele-monitoring in care provision. According to the study, the participants comprised of two groups; patients who had been tele-monitored by GP and those that have experienced tele0monitoring by CHF. The patients’ contact details were provided by the hospitals. The study deemed the patients relevant considering their previous experience with the idea; the participants were well aware and experienced with the concept and practice of tele-monitoring of patients.

5. Was the data collected in a way that addressed the research issue? ☒Yes ☐ Can’t tell☐
No

HINT: Consider

• If the setting for data collection was justified

• If it is clear how data were collected (e.g. focus group, semi-structured interview etc.)

• If the researcher has justified the methods chosen

• If the researcher has made the methods explicit (e.g. for interview method, is there an indication of how interviews were conducted, or did they use a topic guide)?

• If methods were modified during the study. If so, has the researcher explained how and why?

• If the form of data is clear (e.g. tape recordings, video material, notes etc)

• If the researcher has discussed saturation of data

Your comment: (Max 100 words)

The data collection approach was justified; the study employed face-to-face interview criterion to obtain fist hand information from the participants who are reported to have experience with the concept and practice of tele-monitoring of patients. Through a 30 minutes interview with each participant, the quality of the data obtained is justified on the basis of similarity of arguments on the basis of experience and perceptions amongst patients and healthcare professionals. Additionally, one of the interviewers was already having ideas of telehealth initiatives; therefore, care was taken to avoid influence that it could have on the quality of information obtained from the interviewees.

6. Has the relationship between researcher and participants
been adequately considered ☒Yes ☐ Can’t tell☐
No

HINT: Consider

• If the researcher critically examined their own role, potential bias and influence during

1. Formulation of the research questions

2. Data collection, including sample recruitment and choice of location

• How the researcher responded to events during the study and whether they considered the implications of any changes in the research design

Your comment: (max 50 words)

The study considered the relationship between the participants and the researchers, and independency was observed. One of the interviewers was reported to already have ideas of telehealth initiatives; therefore, care was taken to avoid influence that it could have on the quality of information obtained from the interviewees.

7. Have ethical issues been taken into consideration? ☒Yes ☐ Can’t tell☐
No

HINT: Consider

• If there are sufficient details of how the research was explained to participants for the reader to assess whether ethical standards were maintained

• If the researcher has discussed issues raised by the study (e.g. issues around informed consent or confidentiality or how they have handled the effects of the study on the participants during and after the study)

• If approval has been sought from the ethics committee

Your comment: (Max 50 words)

The study considered ethical conduct and practice during the process of obtaining the intended information from the participants. For instance, ethical approval was granted by the Lothian Research Ethics Committee and informed consents of the participants were obtained by use of invitation letters.

8. Was the data analysis sufficiently rigorous? ☒Yes ☐ Can’t tell☐
No

HINT: Consider

• If there is an in-depth description of the analysis process

• If thematic analysis is used. If so, is it clear how the categories/themes were derived from the data?

• Whether the researcher explains how the data presented were selected from the original sample to demonstrate the analysis process

• If sufficient data are presented to support the findings

• To what extent contradictory data are taken into account

• Whether the researcher critically examined their own role, potential bias and influence during analysis and selection of data for presentation

Your comment: (max 100 words)

Data analysis can be argued to be sufficiently rigorous considering the in-depth and different themes of consideration, as well thematic analysis used and the ways sufficient data has been provided in support of findings. The analysis of the data followed Framework approach with data management, descriptive accounts, and explanatory accounts as the major stages of the overall analysis. According to the authors, two of the researchers immersed themselves in reading the data from the transcripts and identifying the information based on their relevant themes.

9. Is there a clear statement of findings? ☒Yes ☐ Can’t tell☐
No

HINT: Consider whether

• If the findings are explicit

• If there is adequate discussion of the evidence both for and against the researchers arguments

• If the researcher has discussed the credibility of their findings (e.g. triangulation, respondent validation, more than one analyst)

• If the findings are discussed in relation to the original research question

Your comment: (max 100 words)

The study outlines a clear statement of findings; the application of tele-monitoring and continuity of care amongst patients depends on certain themes. The themes include: information or awareness amongst the patients and professionals; compliance and dependence; changes and challenges perceived, and continuity of care.

10. How valuable is the research? (max 100 words)

HINT: Consider

• If the researcher discusses the contribution the study makes to existing knowledge or understanding e.g. do they consider the findings in relation to current practice or policy?, or relevant research-based literature?

• If they identify new areas where research is necessary

• If the researchers have discussed whether or how the findings can be transferred to other populations or considered other ways the research may be used

Your comment:

The research is considerably valuable to evidence-based care provision practice. It discusses how it contributes to the existing knowledge about the concept of telemedicine or telehealth through the practice of tele-monitoring of patients. According to the article, their findings provide more evidence that the concept and practices of tele-monitoring of patients during care provision is effective; however, low adoption rates due to low awareness levels amongst professionals and patients.

PART 4.1 OVERALL SUMMARY (400 words, 11 marks )

11. Provide an overall summary of what these two papers contribute to answering your research question.

HINT: Consider

• What was your original clinical question?

• What information do you think is useful from these two articles?

• Do you think the information in the articles is unbiased?

• If the information from the articles helpful in answering your overall question?

Based on the original question for this assignment, “In community health provision, does telehealth improve healthcare outcomes?” the question intended to find evidence and demonstrate that telematics practices can positively contribute and enhance health care provision and improve outcome amongst patients. Basing arguments on the two articles, it is evident that telehealth/telemedicine is positively influential to the improved of community health care or local setting.

From the randomised trial; quantitative study; about the impacts of tele-homecare on recovery duration as view amongst patients that have been home-hospitalised, the article provide information that the idea of telemedicine is effective in home-based care. However, the authors report that the effectiveness is based on the perception that freedom and security, amongst other essentials, are provided. Therefore, this information can be used to provide and improve the experience of home-based care amongst patients in local healthcare contexts.

Also, the qualitative study provide evidence that tele-monitoring is effective in provision of improved healthcare. Basing their focus on chronic heart patients, the article provide information that patients that require home-based care can be supported using improved monitoring criterion to communicate signs and symptoms to the healthcare professionals who then respond effectively based on the observed issues. This perspective improve evidence-based care provision hence facilitate accuracy of medication administration, hence health outcome (McLean et al. 2013; Fairbrother et al. 2012; Stanhope & Lancaster 2014). Therefore, it can be argued that the information provided by the two articles is relevant to support and improve evidence-practice of homebased care, which is highly preferable in a local health care setting.

The information in the two articles is not biased; they are obtained from participants who have had experience with the technology and healthcare practice approach being tested. The studies have considered different perspectives including the views and perceptions of healthcare provision professionals and patients; hence a common idea has been obtained. Therefore, conclusively, the information that is contained in the two articles is not biased.

Moreover, the rationale of the question focuses on improving the outcome of evidence-based healthcare practice in a local or community setting. Therefore, with the idea and support of tele-monitoring or tele-homecare, the objective of the question is achieved and the bounds maintained to improve the outcome of local healthcare.

PART 4.2 SYNTHESISING THE EVIDENCE (300 words, 5 marks )

Finally, you need to summarise the evidence that relates to your clinical questions in plain language as if you were explaining the rationale for your clinical decision making to a patient within your care.

Local or community health care provision is very essential considering that it is one of the approaches that are used to provide primary care to people. Also, amongst the many patients who live with chronic illnesses, community healthcare is amongst the effective and efficient approaches based in the readiness and reliability (Ricco 2001; Yea-Ing & Lee 2002). However, it relies on the ability of the healthcare system to avail the services close to the patients, which home-based care provision has proved to be effective (Modin & Furhoff 2002). Home-based care is amongst the primary care approaches in a community setting.

In a home-based community healthcare, continuous monitoring and assessment of the patient is highly important, and communication between the patient and the healthcare provider is considered very essential. Therefore, it is imperative that communication be maintained and monitoring of the patients conducted to provide evidence for immediate intervention measures. Therefore, through telehealth/telemedicine, patients become aware of how technology can offer them support of connecting to their healthcare providers at all times. With the idea and practice of tele-monitoring and tele-homecare, patients can continuously check on their conditions based on the symptoms observed upon having adequate awareness supported by the professionals’ knowledge assistance.

Therefore, from the above studies, the evidence shows that telehealth/telemedicine is effective in improving the health outcome among patients under home-based care. It also shows that telehealth/telemedicine is also an efficient and effective approach to provide care and improve the health outcomes amongst patients with chronic illnesses since monitoring of patient health can be done whilst the patient is at home, which Fairbrother et al. (2012) and Dinesen et al. (2008) as demonstrated to be possible with the adoption and utilisation of telehealth/telemedicine.

Reference List

Dinsen, B, Nohr, C, Andersen, SK, Sejersen, H, & Toft, E 2008, ‘Under surveillance, yet looked after: telehomcare as viewed by patients and their spouses/partners’, European Journal of Candiovascular Nursing, Vol. 7, pp. 239-246.

Fairbrother, P, Ure, J, Henley, J, McCloughan, L, Denvir, M, Sheikh, A, & McKinstry, B 2012, ‘Telemonitoring for chronic heart failure: the view of patients and healthcare professionals- a qualitative study’, Journal of Clinical Nursing, Vol. 23, pp. 132-144.

Heckemann, B, Wolf, A, Ali, L, Sonntag, M, & Ekman, I 2017, ‘Discovering untapped relationship potential with patients in telehealth: a qualitative interview study’, DMJ, 6:e009750. DOI: 10.1136

McLean, S, Sheikh, A, Cresswell, K, Nurmatov, U, Mukherjee, M, Hemmi, A, & Pagliari, C 2013, ‘The impact of telehealthcare on the quality and safety of care: a systematic overview’, PLOS Research Article.

Modin, S & Furhoff, AK 2002, ‘Care by general practitioners and district nurses of patients receiving home nursing: a study from suburban Stockholm’, Scandinavian Journal of Primary health Care, Vol. 20, No. 4, pp. 208-212.

Riccio, PA 2001, ‘Quality evaluation of home nursing care: perception of patients, physicians, and nurses’, Journal of Nursing Care Quality, Vol. 15, No. 3, pp. 58-67.

Stanhope, M & Lancaster, J 2014, ‘Foundations of nursing in the community: community-oriented practice (4^th ed.)’, Elsevier.

Yea-Ing, LS & Lee, H 2002, ‘Predictors of nursing home placement and home nursing services utilisation by elderly patients after hospital discharge in Taiwan’, Journal of Advanced Nursing, Vol. 38, No. 4, pp. 398-406.