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      Preference-Based Implementation of Video Consultations in Urban and Rural Regions in Outpatient Care in Germany: Protocol for a Mixed Methods Study

      research-article
      , MSc 1 , , , Dr 1 , , Prof Dr 1 , , MA 1 , , MSc 2 , , MA 3 , , MA 4 , , MA 5 , , PD Dr 6 , , MA 6 , , Dr 7 , , Dr 7 , , MA 8 , , Dr PH 9 , , MA 1
      (Reviewer), (Reviewer)
      JMIR Research Protocols
      JMIR Publications
      study protocol, video consultation, preference elicitation, discrete choice experiment, implementation, telemedicine, teleconsultation, e-consultation, outpatient, rural area, remote, preferences, strategy

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          Abstract

          Background

          Particularly in rural regions, factors such as lower physician density and long travel distances complicate adequate outpatient care. However, urban regions can also be affected by deficits in care, for example, long waiting times. One model of care intending to improve the situation is the implementation of video consultations. The study protocol presents the methodology of the research project titled “Preference-based implementation of the video consultation in urban and rural regions” funded by the German Federal Joint Committee (funding number 01VSF20011).

          Objective

          This study aims to identify existing barriers to the use of video consultation and the preferences of insured individuals and physicians as well as psychotherapists in order to optimize its design and thus increase acceptance and use of video consultations in urban and rural regions.

          Methods

          Built on a mixed methods approach, this study first assesses the status quo of video consultation use through claims data analysis and carries out a systematic literature review on barriers and promoting factors for the use of video consultations. Based on this preliminary work, focus groups are conducted in order to prepare surveys with insureds as well as physicians and psychotherapists in the second study phase. The central element of the survey is the implementation of discrete choice experiments to elicit relevant preferences of (potential) user groups and service providers. The summarized findings are discussed in a stakeholder workshop and translated into health policy recommendations.

          Results

          The methodological approach used in this study is the focus of this paper. The study is still ongoing and will continue until March 2024. The first study phase has already been completed, in which preliminary work has been done on potential applications and hurdles for the use of video consultations. Currently, the survey is being conducted and analyses are being prepared.

          Conclusions

          This study is intended to develop a targeted strategy for health policy makers based on actual preferences and perceived obstacles to the use of video consultations. The results of this study will contribute to further user-oriented development of the implementation of video consultations in German statutory health insurance. Furthermore, the iterative and mixed methods approach used in this study protocol is also suitable for a variety of other research projects.

          International Registered Report Identifier (IRRID)

          DERR1-10.2196/50932

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          Most cited references32

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Utilization of the PICO framework to improve searching PubMed for clinical questions

            Background Supporting 21st century health care and the practice of evidence-based medicine (EBM) requires ubiquitous access to clinical information and to knowledge-based resources to answer clinical questions. Many questions go unanswered, however, due to lack of skills in formulating questions, crafting effective search strategies, and accessing databases to identify best levels of evidence. Methods This randomized trial was designed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system. Two of the search interfaces utilized a specific framework called PICO, which was designed to focus clinical questions and to prompt for publication type or type of question asked. The third interface was the standard PubMed interface readily available on the Web. Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US. Thirty-one subjects were randomized to one of the three interfaces, given 3 clinical questions, and asked to search PubMed for a set of relevant articles that would provide an answer for each question. The success of the search results was determined by a precision score, which compared the number of relevant or gold standard articles retrieved in a result set to the total number of articles retrieved in that set. Results Participants using the PICO templates (Protocol A or Protocol B) had higher precision scores for each question than the participants who used Protocol C, the standard PubMed Web interface. (Question 1: A = 35%, B = 28%, C = 20%; Question 2: A = 5%, B = 6%, C = 4%; Question 3: A = 1%, B = 0%, C = 0%) 95% confidence intervals were calculated for the precision for each question using a lower boundary of zero. However, the 95% confidence limits were overlapping, suggesting no statistical difference between the groups. Conclusion Due to the small number of searches for each arm, this pilot study could not demonstrate a statistically significant difference between the search protocols. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results.
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              Constructing experimental designs for discrete-choice experiments: report of the ISPOR Conjoint Analysis Experimental Design Good Research Practices Task Force.

              Stated-preference methods are a class of evaluation techniques for studying the preferences of patients and other stakeholders. While these methods span a variety of techniques, conjoint-analysis methods-and particularly discrete-choice experiments (DCEs)-have become the most frequently applied approach in health care in recent years. Experimental design is an important stage in the development of such methods, but establishing a consensus on standards is hampered by lack of understanding of available techniques and software. This report builds on the previous ISPOR Conjoint Analysis Task Force Report: Conjoint Analysis Applications in Health-A Checklist: A Report of the ISPOR Good Research Practices for Conjoint Analysis Task Force. This report aims to assist researchers specifically in evaluating alternative approaches to experimental design, a difficult and important element of successful DCEs. While this report does not endorse any specific approach, it does provide a guide for choosing an approach that is appropriate for a particular study. In particular, it provides an overview of the role of experimental designs for the successful implementation of the DCE approach in health care studies, and it provides researchers with an introduction to constructing experimental designs on the basis of study objectives and the statistical model researchers have selected for the study. The report outlines the theoretical requirements for designs that identify choice-model preference parameters and summarizes and compares a number of available approaches for constructing experimental designs. The task-force leadership group met via bimonthly teleconferences and in person at ISPOR meetings in the United States and Europe. An international group of experimental-design experts was consulted during this process to discuss existing approaches for experimental design and to review the task force's draft reports. In addition, ISPOR members contributed to developing a consensus report by submitting written comments during the review process and oral comments during two forum presentations at the ISPOR 16th and 17th Annual International Meetings held in Baltimore (2011) and Washington, DC (2012). Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Journal
                JMIR Res Protoc
                JMIR Res Protoc
                ResProt
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                1929-0748
                2024
                11 April 2024
                : 13
                : e50932
                Affiliations
                [1 ] Institute for Health Care Management and Research University of Duisburg-Essen Essen Germany
                [2 ] Kassenärztliche Vereinigung Berlin Berlin Germany
                [3 ] Kassenärztliche Vereinigung Westfalen-Lippe Dortmund Germany
                [4 ] Kassenärztliche Vereinigung Schleswig-Holstein Bad Segeberg Germany
                [5 ] Kassenärztliche Vereinigung Mecklenburg-Vorpommern Schwerin Germany
                [6 ] Techniker Krankenkasse Hamburg Germany
                [7 ] AOK Nordost Potsdam Germany
                [8 ] AOK NordWest Dortmund Germany
                [9 ] SCO:SSiS Minden Germany
                Author notes
                Corresponding Author: Lara Kleinschmidt lara.kleinschmidt@ 123456medman.uni-due.de
                Author information
                https://orcid.org/0009-0003-5917-0995
                https://orcid.org/0000-0001-9687-7525
                https://orcid.org/0000-0001-9653-168X
                https://orcid.org/0009-0009-5028-9184
                https://orcid.org/0009-0000-2380-2522
                https://orcid.org/0009-0005-7829-6387
                https://orcid.org/0009-0005-7613-2493
                https://orcid.org/0009-0005-9655-6138
                https://orcid.org/0000-0001-7079-4721
                https://orcid.org/0009-0002-8204-2038
                https://orcid.org/0009-0005-9240-7047
                https://orcid.org/0000-0002-8613-4434
                https://orcid.org/0000-0003-0321-8673
                https://orcid.org/0000-0002-2501-7410
                https://orcid.org/0009-0008-7628-5707
                Article
                v13i1e50932
                10.2196/50932
                11046389
                38602749
                23770d93-ca4c-44e6-a169-ade9c64cc9ba
                ©Lara Kleinschmidt, Anke Walendzik, Jürgen Wasem, Klemens Höfer, Beatrice Nauendorf, Matthias Brittner, Paul Brandenburg, André Aeustergerling, Udo Schneider, Anja Wadeck, Stephanie Sehlen, Sebastian Liersch, Katharina Schwarze, Carsten Schwenke, Theresa Hüer. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 11.04.2024.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                : 17 July 2023
                : 20 October 2023
                : 7 November 2023
                : 29 November 2023
                Categories
                Protocol
                Protocol

                study protocol,video consultation,preference elicitation,discrete choice experiment,implementation,telemedicine,teleconsultation,e-consultation,outpatient,rural area,remote,preferences,strategy

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