ORCID Profile
0000-0001-6913-8663
Current Organisation
Victorian Comprehensive Cancer Centre
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Publisher: Wiley
Date: 09-2015
DOI: 10.1111/IMJ.12793
Abstract: Fast diagnosis and delivery of treatment to patients experiencing acute stroke can reduce subsequent disability. While telemedicine can improve rural community access to specialists and facilitate timely diagnosis and treatment decisions, it is not widely used for stroke in Australia. Identifying the barriers and facilitators to clinician engagement with, and utilisation of, telemedicine consultations could expedite implementation in rural and remote locations. Purposive s ling was used to identify and recruit medical and nursing staff varying in telemedicine experience across one hospital department. Twenty-four in-depth, face-to-face interviews were conducted examining aspects surrounding stroke telemedicine uptake. Inductive qualitative thematic analysis was undertaken, and two further researchers verified coding. The main barriers identified were contrasting opinions about the utility of thrombolysis for treating acute stroke, lack of confidence in the telemedicine system, perceived limited need for specialist advice and concerns about receiving advice from an unfamiliar doctor. Facilitators included assistance with diagnosis and treatment, the need for a user-friendly system and access to specialists for complex cases. Acceptability of telemedicine for acute stroke was multifaceted and closely aligned with regional clinician beliefs about the value of thrombolysis for stroke, highlighting an important area for education. Addressing beliefs about treatment efficacy and other perceived barriers is important for establishing a stroke telemedicine programme.
Publisher: Springer Science and Business Media LLC
Date: 11-01-2018
Publisher: Wiley
Date: 11-09-0027
DOI: 10.1111/JNU.12509
Abstract: Technology-based systems like telemedicine are frequently being implemented into healthcare settings, impacting clinician practices. Little is known about factors influencing acute telemedicine uptake, if factors differ across time, or between nurses and non-nurses. A mixed-methods, pre-post design with implementation of a new acute stroke telemedicine service. A survey based on an extended Technology Acceptance Model (TAM) was administered to clinicians involved in acute stroke care at 16 regional hospitals (2014-2017). Open-ended questions postimplementation (at 6 months) included strengths of the program and areas to improve. Subsequently, a secondary analysis of nurses' semistructured interviews at the first telemedicine site (2010-2011) was completed to provide greater explanatory detail. Surveys were completed by nurses (preimplementation n = 77, postimplementation n = 92) and non-nurses (pre n = 90, post n = 44). Preimplementation, perceived usefulness was the only significant predictor of intending to use telemedicine for nurses, while perceived ease of use and social influence were significant for non-nurses. Postimplementation, perceived usefulness was significant for both groups, as was facilitating conditions for nurses. Specific ex les aligned to TAM categories from our detailed interviews (n = 11 nurses) included perceived usefulness (improved clinical support and patient care), perceived ease of use (technical, clinical aspects), facilitating conditions (setting, education, confidence), and social influence (working relationships). Important factors for acute stroke telemedicine varied between nurses and non-nurses, and changed after implementation. The benefits of telemedicine should be emphasized to nurses. Preimplementation, more non-nurses wanted systems to be easy. Support in clinical, technical, and relationship aspects of telemedicine consultations is required. Nurses are influential in implementing acute telemedicine, which is complex, with clinical and technical aspects entwined. Evidence-based implementation strategies must be tailored over time, and between nurses and non-nurses, to ensure initial uptake and ongoing use.
Publisher: SAGE Publications
Date: 10-2014
DOI: 10.1111/IJS.12325
Abstract: Limited data exist on the long-term needs of community-dwelling stroke survivors. We aimed to describe factors associated with the extent to which needs were met in Australian survivors of stroke. Multifaceted strategies were used to obtain a national s le. Adults 12+ months poststroke and living in the community participated. Needs were assessed over the domains of health, everyday living, work, leisure, social support, and finances. Multivariable negative-binomial and logistic regression were used. Seven hundred sixty-five survivors completed surveys. Most (84%) reported having needs that were not being fully met (median 4 of 20, Q1, Q3: 1, 9). Variations occurred based on age, residential location, time since stroke, and disability level. Multivariable results showed that having fatigue, cognition or emotional problems, decreasing age, and increased disability were associated with increasing numbers of needs not being fully met ( P 0·001). Factors associated with needs not being fully met were as follows: ( 1 ) greater disability (adjusted odds ratio: 3·4, 95% confidence interval: 1·9, 6·0) and fatigue problems (adjusted odds ratio: 2·0, 95% confidence interval: 1·1, 3·4) (health domain) ( 2 ) greater disability (adjusted odds ratio: 7·0, 95% confidence interval: 3·0, 17·0) and being one to two-years poststroke (adjusted odds ratio: 3·4, 95% confidence interval: 1·5, 7·8) (work domain) and ( 3 ) increased disability (adjusted odds ratio: 3·8, 95% confidence interval: 2·2, 6·5) and memory problems (adjusted odds ratio: 2·1, 95% confidence interval: 1·0, 4·2) (leisure domain). The extent to which long-term needs were met was influenced by a variety of factors, particularly age, disability levels, and residential location. Changes need to be made to the way and extent to which survivors are supported following stroke.
Publisher: SAGE Publications
Date: 22-10-2013
DOI: 10.1111/IJS.12137
Abstract: Urgent treatment of acute stroke in rural Australia is problematic partly because of limited access to medical specialists. Utilization of telemedicine could improve delivery of acute stroke treatments in rural communities. The study aims to demonstrate enhanced clinical decision making for use of thrombolysis within 4·5 h of ischemic stroke symptom onset in a rural setting using a telemedicine specialist support model. A formative program evaluation research design was used. The Victorian Stroke Telemedicine program was developed and will be evaluated over five stages to ensure successful implementation. The phases include: (a) preimplementation phase to establish the Victorian Stroke Telemedicine program including the clinical pathway, data collection tools, and technology processes (b) pilot clinical application phase to test the pathway in up to 10 patients (c) modification phase to refine the program (d) full clinical implementation phase where the program is maintained for one-year and (e) a sustainability phase to assess project outcomes over five-years. Qualitative (clinician interviews) and quantitative data (patient, clinician, costs, and technology processes) are collected in each phase. The primary outcome is to achieve a minimum 10% absolute increase in eligible patients treated with thrombolysis. Secondary outcomes are utilization of the telestroke pathway and improvements in processes of stroke care (e.g., time to brain scan). We will report door to telemedicine consultation time, length of telemedicine consultation, clinical utility and acceptability from the perspective of clinicians, and 90-day patient outcomes. This research will provide evidence for an effective telestroke program for use in regional Australian hospitals.
Publisher: Informa UK Limited
Date: 14-08-2013
DOI: 10.3109/09638288.2012.703755
Abstract: This study was designed to explore the concept of recovery from the perspectives of stroke survivors and informal carers. The aim of this qualitative study was to identify the main factors that are perceived to contribute to recovery after stroke. Data were obtained via focus groups using semistructured questionnaires. One focus group included all participants (n = 14). This was followed by separate focus groups for stroke survivors (n = 8) and informal carers (n = 6). The data from the three focus groups were analysed using thematic analysis, whereby themes and sub-themes were identified and summarised via dual coding. The main theme identified was "in idual recovery expectations". The contributing sub-themes were: "essential elements of recovery", "returning home" and "the environment of rehabilitation". The predominant factors to arise from this study surround the concepts of "returning to normality" for the stroke survivor and the "tension of providing care" for informal carers. This study provides a current description of stroke survivor and carer expectations of recovery. There are erse and ongoing concerns that can be encountered into the chronic phase poststroke. Models of community-based care should adopt targeted interventions that concurrently consider stroke survivor and carer's in idual concepts of recovery. • The concept of recovery can differ for stroke survivors, carers and the health professionals that they encounter. • As it is an in idual phenomenon, many factors comprise the notion of recovery. • Health professionals need to explore stroke survivor and carer's views about their concepts of recovery, as greater awareness and attention may maximise in idual poststroke potential.
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.PEC.2017.01.005
Abstract: Question prompt lists (QPLs) and consultation audio-recordings (CARs) are two communication strategies that can assist cancer patients in understanding and recalling information. We aimed to explore clinician and organisational barriers and facilitators to implementing QPLs and CARs into usual care. Semi-structured interviews with twenty clinicians and senior hospital administrators, recruited from four hospitals. Interviews were recorded, transcribed verbatim and thematic descriptive analysis was utilised. CARs and QPLs are to some degree already being initiated by patients but not embedded in usual care. Systematic use should be driven by patient preference. Successful implementation will depend on minimal burden to clinical environments and feedback about patient use. CARs concerns included: medico-legal issues, ability of the CAR to be shared beyond the consultation, and recording and storage logistics within existing medical record systems. QPLs issues included: applicability of the QPLs, ensuring patients who might benefit from QPL's are able to access them, and limited use when there are other existing communication strategies. While CARs and QPLs are beneficial for patients, there are important in idual, system and medico-legal considerations regarding usual care. Identifying and addressing practical implications of CARs and QPLs prior to clinical implementation is essential.
Publisher: Hindawi Limited
Date: 18-03-2008
DOI: 10.1111/J.1365-2524.2008.00771.X
Abstract: Stroke is a major cause of death and disability in many countries. Early access to the most appropriate medical treatment can improve health outcomes. Despite this, only 30-60% of people who experience a stroke seek medical help within the recommended 3-hour timeframe. This study used open-ended interviews to explore patients' views on factors that influenced their decision to seek help at the time of stroke. Twenty participants were recruited from five centres: three hospitals, a community-based stroke support service and a primary healthcare service focused on providing health care for Maori. A qualitative methodology drawing on Grounded Theory informed data collection and analysis. Four main themes influenced the decision to seek help: making sense of symptoms, maintaining a sense of normality, presence and influence of another person and perception of medical services. Participants appeared to go through a process of recognition, interpretation and negotiation during their decision-making. Each of the four themes seemed to influence this process, either assisting or delaying help-seeking behaviour. The more time spent going through this process (or repeating each step), the longer the delay appeared to be. Our key findings which add to current help-seeking literature, include: (1) people tended to prioritise everyday commitments and responsibilities over their own health (2) at times the presence and influence of another person contributed to delays in seeking help and (3) people had different personal thresholds for when they perceived themselves to be 'sick enough' to seek medical help.
Location: Australia
No related grants have been discovered for Natasha Moloczij.