Imperial College London

DrPatrickKierkegaard

Faculty of MedicineDepartment of Surgery & Cancer

Research Fellow
 
 
 
//

Contact

 

p.kierkegaard Website

 
 
//

Location

 

Office 513E, CRUK Convergence Science CenterRoderic Hill BuildingSouth Kensington Campus

//

Summary

 

Publications

Publication Type
Year
to

31 results found

Kierkegaard P, Hicks T, Allen AJ, Yang Y, Hayward G, Glogowska M, Nicholson BD, Buckle P, CONDOR Steering Committeeet al., 2021, Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel., Implement Science Communications, Vol: 2, Pages: 1-20, ISSN: 2662-2211

BACKGROUND: The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians' attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. METHODS: We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. RESULTS: Several factors underpinned primary care physicians' attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians' willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians' confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth

Journal article

Micocci M, Buckle P, Hayward G, Allen AJ, Davies K, Kierkegaard P, Spilsbury K, Thompson C, Astle A, Heath R, Sharpe C, Akrill C, Lasserson D, Perera R, Body R, Gordon ALet al., 2021, Point of care testing using rapid automated antigen testing for SARS-COV-2 in care homes - an exploratory safety, usability and diagnostic agreement evaluation, Journal of Patient Safety and Risk Management, Vol: 26, Pages: 243-250, ISSN: 2516-0435

IntroductionSuccessful adoption of POCTs (Point-of-Care tests) for COVID-19 in care homes requires the identification of ideal use cases and a full understanding of the contextual and usability factors that affect test results and minimise biosafety risks. This paper presents a scoping-usability and test performance study of a microfluidic immunofluorescence assay for COVID-19 in care homes.MethodsA mixed-methods evaluation was conducted in four UK care homes to scope usability and to assess the agreement with qRT-PCR. A dry run with luminescent dye was conducted to explore biosafety issues.ResultsThe agreement analysis was conducted on 227 asymptomatic participants (159 staff and 68 residents) and 14 symptomatic participants (5 staff and 9 residents). Asymptomatic specimens showed 50% (95% CI:1.3%−98.7%) positive agreement and 96% (95% CI: 92.5%−98.1%) negative agreement with overall prevalence and bias-adjusted Kappa (PABAK) of 0.911 (95% CI: 0.857−0.965). Symptomatic specimens showed 83.3% (95% CI: 35.9%−99.6%) positive agreement and 100% (95% CI: 63.1%−100%) negative agreement with overall prevalence and bias-adjusted Kappa (PABAK) of 0.857 (95% CI: 0.549−1). The dry run highlighted four main sources of contamination that led to the modification of the standard operating procedures. Simulation post-modification showed no further evidence of contamination.ConclusionCareful consideration of biosafety issues and contextual factors associated with care home are mandatory for safe use the POCT. Whilst POCT may have some utility for ruling out COVID-19, further diagnostic accuracy evaluations are needed to promote effective adoption.

Journal article

Tulloch JSP, Micocci M, Buckle P, Lawrenson K, Kierkegaard P, McLister A, Gordon AL, Garcia-Finana M, Peddie S, Ashton M, Buchan I, Parvulescu Pet al., 2021, Enhanced lateral flow testing strategies in care homes are associated with poor adherence and were insufficient to prevent COVID-19 outbreaks: results from a mixed methods implementation study, Age and Ageing, Vol: 50, Pages: 1868-1875, ISSN: 0002-0729

IntroductionCare homes have been severely affected by the SARS-CoV-2 pandemic. Rapid antigen testing could identify most SARS-CoV-2 infected staff and visitors before they enter homes. We explored implementation of staff and visitor testing protocols using lateral flow devices (LFDs).MethodsAn evaluation of a SARS-CoV-2 LFD-based testing protocol in 11 care homes in Liverpool, UK, including staff and visitor testing, plus a qualitative exploratory study in nine of these homes. The proportion of pilot homes with outbreaks, and outbreak size, were compared to non-pilot homes in Liverpool. Adherence to testing protocols was evaluated. Fifteen staff were interviewed, and transcript data were thematically coded using an iterative analysis to identify and categorize factors influencing testing implementation.ResultsIn total, 1,638 LFD rapid tests were performed on 407 staff. Protocol adherence was poor with 8.6% of staff achieving >75% protocol adherence, and 25.3% achieving ≥50%. Six care homes had outbreaks during the study. Compared to non-pilot care homes, there was no evidence of significant difference in the proportion of homes with outbreaks, or the size of outbreaks. Qualitative data showed difficulty implementing testing strategies due to excessive work burden. Factors influencing adherence related to test integration and procedural factors, socio-economic factors, cognitive overload and the emotional value of testing.ConclusionImplementation of staff and visitor care home LFD testing protocols was poorly adhered to and consequently did not reduce the number or scale of COVID-19 outbreaks. More focus is needed on the contextual and behavioural factors that influence protocol adherence.

Journal article

Kierkegaard P, Micocci M, McLister A, Tulloch JSP, Parvulescu P, Gordon AL, Buckle Pet al., 2021, Implementing lateral flow devices in long-term care facilities: experiences from the Liverpool COVID-19 community testing pilot in care homes- a qualitative study, BMC Health Services Research, Vol: 21, ISSN: 1472-6963

INTRODUCTION: Antigen-based lateral flow devices (LFDs) offer the potential of widespread rapid testing. The scientific literature has primarily focused on mathematical modelling of their use and test performance characteristics. For these tests to be implemented successfully, an understanding of the real-world contextual factors that allow them to be integrated into the workplace is vital. To address this gap in knowledge, we aimed to explore staff's experiences of integrating LFDs into routine practice for visitors and staff testing with a view to understand implementation facilitators and barriers. METHODS: Semi-structured interviews and thematic analysis. RESULTS: We identified two main themes and five subthemes. The main themes included: visitor-related testing factors and staff-related testing factors. Subthemes included: restoring a sense of normality, visitor-related testing challenges, staff-related testing challenges, and pre-pilot antecedent factors. CONCLUSION: Our study demonstrates that the real-world implementation of LFDs to test visitors and staff faces significant challenges as a result of several contextual factors negatively affecting the work practice and environment. More comprehensive studies are needed to identify and inform effective implementation strategies to ensure that LFDs can be adopted in an agile way that better supports an already exhausted and morally depleted workforce.

Journal article

Buckle P, Micocci M, Tulloch J, Kierkegaard P, Parvulescu P, Thompson C, Spilsbury K, Allen AJ, Body R, Hayward G, Buchan I, Gordon ALet al., 2021, COVID-19 point-of-care testing in care homes: what are the lessons for policy and practice?, Age and Ageing, Vol: 50, Pages: 1442-1444, ISSN: 0002-0729

COVID-19 has devastated care homes. Point-of-care tests (POCTs), mainly using lateral flow devices (LFDs), have been deployed hurriedly without much consideration of their usability or impact on care workflow. Even after the pandemic, POCTs, particularly multiplex tests, may be an important control against spread of SARS-CoV-2 and other respiratory infections in care homes by enabling identification of cases. They should not, however, replace other infection control measures such as barrier methods and quarantine. Adherence to LFDs as implemented among care home staff is suboptimal. Other tests-such as point-of-care polymerase chain reaction and automated antigen tests-would also need to be accommodated into care home workflows to improve adherence. The up-front costs of POCTs are straightforward but additional costs, including staffing preparation and reporting processes and the impacts of false positive and negative tests on absence rates and infection days, are more complex and as yet unquantified. A detailed appraisal is needed as the future of testing in care homes is considered.

Journal article

Hicks T, Winter A, Green K, Kierkegaard P, Price DA, Body R, Allen AJ, Graziadio Set al., 2021, Care pathway and prioritization of rapid testing for COVID-19 in UK hospitals: a qualitative evaluation, BMC HEALTH SERVICES RESEARCH, Vol: 21

Journal article

Kierkegaard P, Hicks T, Allen AJ, Yang Y, Hayward G, Glogowska M, Nicholson BD, Buckle Pet al., 2021, Strategies To Implement SARS-CoV-2 Point-of-Care Testing Into Primary Care Settings: A Qualitative Secondary Analysis Guided By The Behaviour Change Wheel

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background:</jats:bold> There is little empirical evidence to inform implementation strategies for introducing SARS-CoV-2 point of care (POC) testing into primary care settings. The purpose of this study is to develop a theory-driven understanding of the behavioural determinants underpinning the implementation of SARS-CoV-2 POC testing in primary care. This will allow identification of potential intervention strategies that could encourage successful implementation of testing into routine practice and facilitate face-to-face consultations.<jats:bold>Methods: </jats:bold>We used a secondary qualitative analysis approach to re-analyse data from a qualitative study that involved interviewing 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify barriers/enablers to the implementation of SARS-CoV-2 POC testing and identified behaviour change techniques to inform intervention strategies that targeted the barriers/enablers.<jats:bold>Results: </jats:bold>We identified 10 barriers and enablers to POC implementation under eight Theoretical Domains Framework (TDF): (1) knowledge; (2) behavioural regulation; (3) reinforcement; (4) skills; (5) environmental context and resources; (6) social influence; (7) professional role and identity; and (8) belief about consequences. Linkages with the Behaviour Change Techniques (BCT) taxonomy enabled the identification of intervention strategies to address the social and contextual factors influencing primary care physician’s willingness and capacity to adopt POC testing.<jats:bold>Conclusions:</jats:bold> A theory-informed approach identified barriers to the adoption of POC tests in primary care as well as guiding implementation strategies to address these challenges.</jats:p>

Working paper

Kierkegaard P, Hicks T, Allen AJ, Yang Y, Hayward G, Glogowska M, Nicholson BD, Buckle P, Committee CONDORSet al., 2021, Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: A qualitative secondary analysis guided by the Behaviour Change Wheel

<jats:title>Abstract</jats:title> <jats:p>Background There is little empirical evidence to inform implementation strategies for introducing SARS-CoV-2 point of care (POC) testing into primary care settings. The purpose of this study is to develop a theory-driven understanding of the behavioural determinants underpinning the implementation of SARS-CoV-2 POC testing in primary care. This will allow identification of potential intervention strategies that could encourage successful implementation of testing into routine practice and facilitate face-to-face consultations.Methods We used a secondary qualitative analysis approach to re-analyse data from a qualitative study that involved interviewing 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify barriers/enablers to the implementation of SARS-CoV-2 POC testing and identified behaviour change techniques to inform intervention strategies that targeted the barriers/enablers.Results We identified 10 barriers and enablers to POC implementation under eight Theoretical Domains Framework (TDF): (1) knowledge; (2) behavioural regulation; (3) reinforcement; (4) skills; (5) environmental context and resources; (6) social influence; (7) professional role and identity; and (8) belief about consequences. Linkages with the Behaviour Change Techniques (BCT) taxonomy enabled the identification of intervention strategies to address the social and contextual factors influencing primary care physician’s willingness and capacity to adopt POC testing.Conclusions A theory-informed approach identified barriers to the adoption of POC tests in primary care as well as guiding implementation strategies to address these challenges.</jats:p>

Working paper

Micocci M, gordon A, Allen J, Hicks T, Kierkegaard P, McLister A, Walne S, Hayward G, Buckle Pet al., 2021, COVID-19 testing in English care homes and implications for staff and residents, Age and Ageing, Vol: 50, Pages: 668-672, ISSN: 0002-0729

IntroductionCare home residents are at high risk of dying from COVID-19. Regular testing, producing rapid and reliable results is important in this population because infections spread quickly, and presentations are often atypical or asymptomatic. This study evaluated current testing pathways in care homes to explore the role of point-of-care tests (POCTs).Methods:Ten staff from eight care homes, purposively sampled to reflect care organisational attributes that influence outbreak severity, underwent a semi-structured remote videoconference interview. Transcripts were analysed using process mapping tools and framework analysis focussing on perceptions about, gaps within, and needs arising from, current pathways.Results:Four main steps were identified in testing: infection prevention, preparatory steps, swabbing procedure, and management of residents. Infection prevention was particularly challenging for mobile residents with cognitive impairment. Swabbing and preparatory steps were resource-intensive, requiring additional staff resource. Swabbing required flexibility and staff who were familiar to the resident. Frequent approaches to residents were needed to ensure they would participate at a suitable time. After-test management varied between sites. Several homes reported deviating from government guidance to take more cautious approaches, which they perceived to be more robust. Conclusion:Swab-based testing is organisationally complex and resource-intensive in care homes. It needs to be flexible to meet the needs of residents and provide care homes with rapid information to support care decisions. POCT could help address gaps but the complexity of the setting means that each technology must be evaluated in context before widespread adoption in care homes.

Journal article

Micocci M, Buckle P, Hayward G, Allen AJ, Davies K, Kierkegaard P, Spilsbury K, Thompson C, Astle A, Heath R, Sharpe C, Akrill C, Lasserson D, Perera R, Body R, Gordon ALet al., 2021, Point of Care Testing using rapid automated Antigen Testing for SARS-COV-2 in Care Homes – an exploratory safety, usability and diagnostic agreement evaluation

<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>Successful adoption of POCTs (Point-of-Care tests) for COVID-19 in care homes requires the identification of ideal use cases and a full understanding of contextual and usability factors that affect test results and minimise biosafety risks. This paper presents findings from a scoping-usability and test performance study of a microfluidic immunofluorescence assay for COVID-19 in care homes.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A mixed-methods evaluation was conducted in four UK care homes to scope usability and to assess the agreement with qRT-PCR. A dry run with luminescent dye was carried out to explore biosafety issues.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The agreement analysis was carried out on 227 asymptomatic participants (159 staff and 68 residents) and 14 symptomatic participants (5 staff and 9 residents). Asymptomatic specimens showed 50% (95% CI: 1.3%-98.7%) positive agreement and 96% (95% CI: 92.5%-98.1%) negative agreement with overall prevalence and bias-adjusted Kappa (PABAK) of 0.911 (95% CI: 0.857-0.965). Symptomatic specimens showed 83.3% (95% CI: 35.9%-99.6%) positive agreement and 100% (95% CI: 63.1%-100%) negative agreement with overall prevalence and bias-adjusted Kappa (PABAK) of 0.857 (95% CI: 0.549-1).</jats:p><jats:p>The dry run showed four main sources of contamination that led to the modification of the standard operating procedures. Simulation after modification showed no further evidence of contamination.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Careful consideration of biosafety issues and contextual factors associated with care home are mandatory for safe use the POCT. Whilst POCT may have some utility

Working paper

Kierkegaard P, Hicks T, Yang Y, Lee J, Hayward G, Turner PJ, Allen AJ, Nicholson BDet al., 2021, Primary care and point-of-care testing during a pandemic: Clinician’s perspectives on integrating rapid testing for COVID-19 into the primary care pathway

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Real-world evidence to support the adoption of SARS-CoV-2 point-of-care (POC) tests in primary care is limited. As the first point of contact of the health system for most patients, POC testing can potentially support general practitioners (GPs) quickly identify infectious and non-infectious individuals to rapidly inform patient triaging, clinical management, and safely restore more in-person services.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To explore the potential role of SARS-CoV-2 point-of-care testing in primary care services.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>A qualitative study using an inductive thematic analysis.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>21 general practices located across three regions in England.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Three major themes were identified related to POC test implementation in primary care: (1) Insights into SARS-CoV-2 POC tests; (2) System and organisational factors; and (3) Practice-level service delivery strategies. Thematic subcategories included involvement in rapid testing, knowledge and perception of the current POC testing landscape, capacity for testing, economic concerns, resource necessities, perception of personal risk and safety, responsibility for administering the test, and targeted testing strategies.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>GPs knowledge of POC tests influences their degree of trust, uncertainty, and their perception of risk of POC test use. Concerns around funding, occupational exposure, and workload play a crucial role in GPs

Journal article

Kierkegaard P, McLister A, Buckle P, 2021, Rapid point-of-care testing for COVID-19: quality of supportive information for lateral flow serology assays, BMJ Open, Vol: 11, ISSN: 2044-6055

Objective There is a lack of evidence addressing several important human factors questions pertaining to the quality of supportive information provided by commercial manufacturers that can affect the adoption and use of lateral flow serology assays in practice. We aimed to: (1) identify and assess the quality of information that commercial manufacturers provided for their point-of-care tests (POCTs) and (2) examine the implications of these findings on real-world settings.Design We used a content analysis methodology in two stages to systematically, code and analyse textual data from documents of commercial manufacturers. A deductive approach was applied using a coding guide based on the validated Point-of-Care Key Evidence Tool (POCKET) multidimensional checklist. An inductive approach was used to identify new patterns or themes generated from our textual analysis.Setting Publicly available supportive information documents by commercial manufacturers for lateral flow serology, were identified and gathered from online searches.Participants Supportive information documents retrieved from online searches over 3 months (March 2020 to June 2020).Results A total of 79 POCTs were identified that met the study inclusion criteria. Using the POCKET coding guide, we found that the quality of information varied significantly between the manufacturers and was often lacking in detail. Our inductive approach further examined these topics and found that several statements were vague and that significant variations in the level of details existed between manufacturers.Conclusions This study revealed significant concerns surrounding the supportive information reported by manufacturers for lateral flow serology assays. Information transparency was poor and human factor issues were not properly addressed to mitigate the risk of improper device use, although it should be noted that the results of our study are limited by the data that manufactures were prepared to disclose. Over

Journal article

Kierkegaard P, Owen-Smith J, 2021, Determinants of physician networks: an ethnographic study examining the processes that inform patterns of collaboration and referral decision-making among physicians, BMJ Open, Vol: 11, Pages: 1-14, ISSN: 2044-6055

Objective Most scholarly attention to studying collaborative ties in physician networks has been devoted to quantitatively analysing large, complex datasets. While valuable, such studies can reduce the dynamic and contextual complexities of physician collaborations to numerical values. Qualitative research strategies can contribute to our understanding by addressing the gaps left by more quantitative approaches. This study seeks to contribute to the literature that applies network science approaches to the context of healthcare delivery. We use qualitative, observational and interview, methods to pursue an in-depth, micro-level approach to the deeply social and discursive processes that influence patterns of collaboration and referral decision-making in physician networks.Design Qualitative methodologies that paired ethnographic field observations, semistructured interviews and document analysis were used. An inductive thematic analysis approach was used to analyse, identify and describe patterns in those data.Setting This study took place in a high-volume cardiovascular department at a major academic medical centre (AMC) located in the Midwest region of the USA.Participants Purposive and snowballing sampling were used to recruit study participants for both the observational and face-to-face in-depth interview portions of the study. In total, 25 clinicians and 43 patients participated in this study.Results Two primary thematic categories were identified: (1) circumstances for external engagement; and (2) clinical conditions for engagement. Thematic subcategories included community engagement, scientific engagement, reputational value, experiential information, professional identity, self-awareness of competence, multidisciplinary programmes and situational factors.Conclusion This study adds new contextual knowledge about the mechanisms that characterise referral decision-making processes and how these impact the meaning of physician relationships, organisation of he

Journal article

Hicks T, Winter A, Green K, Kierkegaard P, Price D, Body R, Allen A, Graziadio Set al., 2020, Care Pathway And Prioritization Of Rapid Testing For Covid-19 In UK Hospitals: A Qualitative Evaluation

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Objectives </jats:bold>The second wave of the coronavirus pandemic is now established, occurring at a time of winter pressure on acute care in the NHS. This is likely to be more challenging then the first wave for the diagnosis of COVID-19 because of the similar symptomology with other respiratory conditions highly prevalent in winter. This study sought to understand the care pathways in place in UK NHS hospitals during the first wave (March-July 2020) for identification of patients with COVID-19 and to learn lessons to inform optimal testing strategies within the COVID-19 National Diagnostic Research and Evaluation Platform (CONDOR).<jats:bold>Design, setting &amp; participants </jats:bold>Sixteen hospital-based clinicians from 12 UK NHS Trusts covering 10 different specialties were interviewed following a semi-structured topic guide. Data were coded soon after the interviews and analysed thematically.<jats:bold>Results </jats:bold>We developed a diagrammatic, high-level visualisation of the care pathway describing the main clinical decisions associated with the diagnosis and management of patients with suspected COVID-19. COVID-19 testing influenced infection control considerations more so than treatment decisions. Two main features of service provision influenced the patient management significantly: access to rapid laboratory testing and the number of single occupancy rooms. If time to return of result was greater than 24 hours, patients with a presumptive diagnosis would often be cohorted based on clinical suspicion alone. Undetected COVID-19 during this time could therefore lead to an increased risk of viral transmission.<jats:bold>Conclusions </jats:bold>During the winter months, priority for provision of rapid testing at admission should be given to hospitals with limited access to laboratory services and single room availability.

Journal article

Micocci M, Gordon AL, Allen AJ, Hicks T, Kierkegaard P, McLister A, Walne S, Buckle Pet al., 2020, Understanding COVID-19 testing pathways in English care homes to identify the role of point-of-care testing: an interview-based process mapping study

<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>Care home residents are at high risk of dying from COVID-19. Regular testing producing rapid and reliable results is important in this population because infections spread quickly and presentations are often atypical or asymptomatic. This study evaluated current testing pathways in care homes to explore the role of point-of-care tests (POCTs).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Ten staff from eight care homes, purposively sampled to reflect care organisational attributes that influence outbreak severity, underwent a semi-structured remote videoconference interview. Transcripts were analysed using process mapping tools and framework analysis focussing on perceptions about, gaps within, and needs arising from, current pathways.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Four main steps were identified in testing: infection prevention, preparatory steps, swabbing procedure, and management of residents. Infection prevention was particularly challenging for mobile residents with cognitive impairment. Swabbing and preparatory steps were resource-intensive, requiring additional staff resource. Swabbing required flexibility and staff who were familiar to the resident. Frequent approaches to residents were needed to ensure they would participate at a suitable time. After-test management varied between sites. Several homes reported deviating from government guidance to take more cautious approaches, which they perceived to be more robust.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Swab-based testing is organisationally complex and resource-intensive in care homes. It needs to be flexible to meet the needs of residents and provide care homes with rapid informati

Journal article

Kierkegaard P, Vale MD, Garrison S, Hollenbeck BK, Hollingsworth JM, Owen-Smith Jet al., 2020, Mechanisms of decision-making in preoperative assessment for older adult prostate cancer patients-A qualitative study, JOURNAL OF SURGICAL ONCOLOGY, Vol: 121, Pages: 561-569, ISSN: 0022-4790

Journal article

Essen A, Scandurra I, Gerrits R, Humphrey G, Johansen MA, Kierkegaard P, Koskinen J, Liaw S-T, Odeh S, Ross P, Ancker JSet al., 2018, Patient Access to Electronic Health Records: Differences Across Ten Countries (vol 7, pg 44, 2018), HEALTH POLICY AND TECHNOLOGY, Vol: 7, Pages: 224-224, ISSN: 2211-8837

Journal article

Kierkegaard P, 2015, Mapping Telemedicine Efforts: Surveying Regional Initiatives in Denmark, TELEMEDICINE AND E-HEALTH, Vol: 21, Pages: 427-435, ISSN: 1530-5627

Journal article

Kierkegaard P, 2015, Interoperability after deployment: persistent challenges and regional strategies in Denmark, INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol: 27, Pages: 147-153, ISSN: 1353-4505

Journal article

Kierkegaard P, 2015, Governance structures impact on eHealth, HEALTH POLICY AND TECHNOLOGY, Vol: 4, Pages: 39-46, ISSN: 2211-8837

Journal article

Kierkegaard P, Kaushal R, Vest JR, 2014, Information Retrieval Pathways for Health Information Exchange in Multiple Care Settings, AMERICAN JOURNAL OF MANAGED CARE, Vol: 20, Pages: SP494-SP501, ISSN: 1088-0224

Journal article

Kierkegaard P, Kaushal R, Vest JR, 2014, Applications of health information exchange information to public health practice., AMIA Annu Symp Proc, Vol: 2014, Pages: 795-804

Increased information availability, timeliness, and comprehensiveness through health information exchange (HIE) can support public health practice. The potential benefits to disease monitoring, disaster response, and other public health activities served as an important justification for the US' investments in HIE. After several years of HIE implementation and funding, we sought to determine if any of the anticipated benefits of exchange participation were accruing to state and local public health practitioners participating in five different exchanges. Using qualitative interviews and template analyses, we identified public health efforts and activities that were improved by participation in HIE. HIE supported public health activities consistent with expectations in the literature. However, no single department realized all the potential benefits of HIE identified. These findings suggest ways to improve HIE usage in public health.

Journal article

Kierkegaard P, Kaushal R, Vest JR, 2014, How could health information exchange better meet the needs of care practitioners?, APPLIED CLINICAL INFORMATICS, Vol: 5, Pages: 861-877, ISSN: 1869-0327

Journal article

Kierkegaard P, 2013, eHealth in Denmark: A Case Study, JOURNAL OF MEDICAL SYSTEMS, Vol: 37, ISSN: 0148-5598

Journal article

Kierkegaard P, 2013, E-Prescription across Europe, Health and Technology, Vol: 3, Pages: 205-219, ISSN: 2190-7188

The use of electronic prescription has been designated as an important strategic policy to improve health care in Europe. The aim of the European Union is to have a cross-border electronic healthcare system in Europe which will enable EU citizens to obtain e-Prescriptions anywhere in Europe. Cross border e-Prescription presents a myriad of challenges. This paper examines the issues concerning the EU eHealth interoperability policy, specifically with regards to the cross-border use of e-Prescription. The research involved conducting a review of the most current literature and government reports regarding e-Prescription implementation on a national level in several European countries. The European Union is pushing for more cross border health data exchange. Despite favourable attitudes towards cross border e-Prescriptions, multiple perceived barriers impede its incorporation in clinical practice. There are varying interpretations and implementations of data protection and confidentiality laws in the 27 member states. Infrastructures are not in place to support the system and stakeholders in some jurisdictions are reluctant to embrace e-health due to the high cost and the lack of security of the systems. The study concludes that member states have varying degrees of health care policy, privacy enforcement and laws concerning data protection, telecommunication services and digital signature with regards to e-Prescription. Interoperability of different systems is only a partial solution. Security and enforcement of privacy must also be equally enforced. © 2012 IUPESM and Springer-Verlag Berlin Heidelberg.

Journal article

Kierkegaard S, Kierkegaard P, 2013, Danger to public health: Medical devices, toxicity, virus and fraud, COMPUTER LAW & SECURITY REVIEW, Vol: 29, Pages: 13-27, ISSN: 0267-3649

Journal article

Kierkegaard P, 2012, Medical data breaches: Notification delayed is notification denied, COMPUTER LAW & SECURITY REVIEW, Vol: 28, Pages: 163-183, ISSN: 0267-3649

Journal article

Kierkegaard P, 2011, Electronic health record: Wiring Europe's healthcare, COMPUTER LAW & SECURITY REVIEW, Vol: 27, Pages: 503-515, ISSN: 0267-3649

Journal article

Kierkegaard P, Markopoulos P, 2011, From top to bottom: End user development, motivation, creativity and organisational support, Pages: 307-312, ISSN: 0302-9743

This paper examines the socio-technical and organisational factors that influence the adoption of End User Development (EUD) technology and practices at the workplace. This research focuses on the rehabilitation industry, where a 64-item paper-based survey was completed by 52 therapists working at two rehabilitation clinics in the Netherlands. Results suggest that therapists need to be motivated to act as creators of technological innovations in rehabilitation as this is not part of their current work culture and current rewards for such innovations are perceived as small. Most likely incentives for therapists are (1) time allocated for end user development practices (2) monetary compensation for overtime required for this work (3) and intellectual ownership of the innovation. © 2011 Springer-Verlag.

Conference paper

Kierkegaard P, 2011, Beefing up end user development: Legal protection and regulatory compliance, Pages: 203-217, ISSN: 0302-9743

The integral nature of IT to business processes means that every organization relies on technology to help manage the workflow, encourage innovation and maintain information flows. Agility has come in the form of end -user development, which allows users who do not have background in programming to develop or modify their own applications. Changes exist when users develop their own systems, creating a potential legal minefield. Many of the legal issues relate to copyright infringement and security breach. Aside from the potential liability for intellectual property infringement, end user development raises tort liability issues. Licensing plays a critical role as the tool used to protect rights and distribution condition. Industries have also chosen to restrict the damages which end users can recover through industry end -user licensing agreement, which exempts software publishers from all liability, which are often unacceptable to user. This paper investigates the legal issues surrounding end-user development, in particular copyright issues and whether liability for defects can be excluded through licensing agreement. © 2011 Springer-Verlag.

Conference paper

This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.

Request URL: http://wlsprd.imperial.ac.uk:80/respub/WEB-INF/jsp/search-html.jsp Request URI: /respub/WEB-INF/jsp/search-html.jsp Query String: respub-action=search.html&id=01057666&limit=30&person=true