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Kinley E, Skene I, Steed E, Pinnock H, McClatchey K. Delivery of supported self-management in remote asthma reviews: A systematic rapid realist review. Health Expect 2022; 25:1200-1214. [PMID: 35411670 PMCID: PMC9327809 DOI: 10.1111/hex.13441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background The COVID‐19 pandemic forced health care systems globally to adapt quickly to remote modes of health care delivery, including for routine asthma reviews. A core component of asthma care is supporting self‐management, a guideline‐recommended intervention that reduces the risk of acute attacks, and improves asthma control and quality of life. Objective We aimed to explore context and mechanisms for the outcomes of clinical effectiveness, acceptability and safety of supported self‐management delivery within remote asthma consultations. Design The review followed standard methodology for rapid realist reviews. An External Reference Group (ERG) provided expert advice and guidance throughout the study. We systematically searched four electronic databases and, with ERG advice, selected 18 papers that explored self‐management delivery during routine asthma reviews. Setting, Participants and Intervention Health care professional delivery of supported self‐management for asthma patients during remote (specifically including telephone and video) consultations. Main Outcome Measures Data were extracted using Context‐Mechanism‐Outcome (C‐M‐O) configurations and synthesised into overarching themes using the PRISMS taxonomy of supported self‐management as a framework to structure the findings. Results The review findings identified how support for self‐management delivered remotely was acceptable (often more acceptable than in‐person consultations), and was a safe and effective alternative to face‐to‐face reviews. In addition, remote delivery of supported self‐management was associated with; increased patient convenience, improved access to and attendance at remote reviews, and offered continuity of care. Discussion Remote delivery of supported self‐management for asthma was generally found to be clinically effective, acceptable, and safe with the added advantage of increasing accessibility. Remote reviews could provide the core content of an asthma review, including remote completion of asthma action plans. Conclusion Our findings support the option of remote delivery of routine asthma care for those who have this preference, and offer healthcare professionals guidance on embedding supported self‐management into remote asthma reviews. Patient and Public Contribution Patient and public contribution was provided by a representative of the Asthma UK Centre for Applied Research (AUKCAR) patient and public involvement (PPI) group. The PPI representative reviewed the findings, and feedback and comments were considered. This lead to further interpretations of the data which were included in the final manuscript.
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Affiliation(s)
- Emma Kinley
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Imogen Skene
- Asthma UK Centre for Applied Research, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University London, London, England
| | - Elizabeth Steed
- Asthma UK Centre for Applied Research, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University London, London, England
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Kirstie McClatchey
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
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Walthall H, Schutz S, Snowball J, Vagner R, Fernandez N, Bartram E. Patients' and clinicians' experiences of remote consultation? A narrative synthesis. J Adv Nurs 2022; 78:1954-1967. [PMID: 35362191 PMCID: PMC9321562 DOI: 10.1111/jan.15230] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/09/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
Aims To identify, evaluate and summarize evidence of patient and clinician experiences of being involved in video or telephone consultations as a replacement for in‐person consultations. Design Narrative synthesis. Data sources Medline; EMBASE; EMCARE; CINAHL and BNI. Searching took place from January 2021 to April 2021. Papers included were published between 2013 and 2020. Review Methods Papers were appraised by two independent reviewers for methodological quality. Data extraction was conducted according to the standardized tool from Joanna Briggs Institute. Results Seven qualitative studies were included, from five countries and from the perspective of patients, relatives, administrators, nurses, physiotherapists and physicians. We developed two main themes: Pragmatic Concerns and Therapeutic Concerns. Each theme contained two categories: Pragmatic Concerns: (a) the convenience of non‐face to face consultations; (b) using technology and equipment in a consultation; Therapeutic Concerns (c) building therapeutic relationships; and (d) embracing benefits and addressing challenges. Conclusion This narrative synthesis presents the existing evidence on clinician and patient experience of participating in non‐face to face consultations. Experiences are varied but largely focus on communication and forming relationships, using the technology successfully and the ability for patients to self‐manage with support from clinicians who are not in‐person. More high‐quality studies are required to explore the experiences of patients and clinicians accessing remote consultations as a result of global implementation post‐SARS‐CoV‐2 pandemic to identify any learning and education opportunities. Impact Health care staff can provide high‐quality care through video or telephone appointments as well as face to face appointments. This review has, however, identified that the evidence is limited and weak in this area and recommends there is research further to inform practice and influence future care.
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Affiliation(s)
- Helen Walthall
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Sue Schutz
- Oxford Brookes University and Oxford Biomedical Research Centre, Oxford, UK
| | - Joanne Snowball
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Raluca Vagner
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Nicola Fernandez
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Emilia Bartram
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
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Collins C, Petek D, Diaz E, Muñoz MA. General Practice/Family Medicine Research During the Pandemic: Showing The Links to the EGPRN Research Strategy. EURASIAN JOURNAL OF FAMILY MEDICINE 2022. [DOI: 10.33880/ejfm.2022110101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
General Practice/Family Medicine is at the forefront of the clinical response to the COVID-19 crisis just as it is known to be a critical component of healthcare systems globally.
A large number of COVID-19 related papers have been published and dedicated funding calls were available in many countries and across the European Union. However, General Practice/Family Medicine does not feature as strongly as it should in COVID-19 high impact publications or successful funding applications.
In this paper, we take a look at the findings on which the recommendations of the “European General Practice Research Network (EGPRN) Research Strategy for General Practice in Europe 2021” are based and highlight how these align with the COVID-19 experience of General Practice/Family research.
To elaborate on this, the issues identified and the recommendations of the EGPRN Research Strategy are grouped into three broad areas on which we need to focus – capacity, collaboration, and complexity (3-Cs).
Apparent or presumed deficiencies in these 3-Cs are possibly why the General Practice/Family research impact during COVID-19 does not match its position on the ground in fighting the pandemic and supporting patients. The EGPRN Research Strategy identifies how we might work to position ourselves better in the future and gain the recognition deserved, in terms of publications, research funding, and prominence.
Keywords: general practice, research, pandemics, publications, financing
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Affiliation(s)
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana
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Ewart C, Baharani J, Wilkie M, Thomas N. Patient perspectives and experiences of remote consultations in people receiving kidney care: A scoping review. J Ren Care 2022; 48:143-153. [PMID: 35338610 PMCID: PMC9545432 DOI: 10.1111/jorc.12419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/04/2022] [Accepted: 02/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic resulted in a rapid and sometimes chaotic change in how clinical care was delivered for people living with kidney disease, with increased reliance on digital technologies and the introduction of remote services. OBJECTIVES To conduct a scoping review of studies about patients' experiences and perspectives in receipt of remote consultations for kidney care. DESIGN Using Arksey and O'Malley's framework, three databases were searched on EBSCO (CINAHL, MEDLINE and Psych INFO). The search included studies published in English from August 2010 to August 2021. RESULTS Eight studies met the scoping review criteria (two cross-sectional, two mixed-method and four qualitative). Five themes were identified: overall satisfaction with remote services, benefits to patients (convenience, involvement in care and patient safety), barriers to remote consultations (technical difficulties, digital literacy and loss of interpersonal communication), patient concerns (need for physical examination, privacy and confidentiality) and prerequisites for successful remote care (existing patient-practitioner relationship, stable illness phase and access to technology). CONCLUSION Remote consultations confer multiple advantages to patients; therefore, remote consultations should be offered as an option to patients living with kidney disease beyond the COVID-19 pandemic. However, there are several barriers to remote consultation that need to be addressed and understood before implementing remote care long-term. Future research should examine the impact of remote consultations on people living with kidney disease from under-served groups to identify barriers and ensure their suitability and accessibility to the wider population for a more patient-centred approach to kidney care.
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Affiliation(s)
- Catriona Ewart
- Institute of Health and Social Care, London South Bank University, London, UK
| | | | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Nicola Thomas
- Institute of Health and Social Care, London South Bank University, London, UK
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55
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Russell A, de Wildt G, Grut M, Greenfield S, Clarke J. What can general practice learn from primary care nurses' and healthcare assistants' experiences of the COVID-19 pandemic? A qualitative study. BMJ Open 2022; 12:e055955. [PMID: 35292497 PMCID: PMC8927928 DOI: 10.1136/bmjopen-2021-055955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES UK general practice has radically altered in response to COVID-19. The general practice nursing team has been central to these changes. To help learn from COVID-19 and maintain a sustainable nursing workforce, general practice should reflect on their support needs and perceptions of organisational strategies. This study aimed to explore primary care nurses' and healthcare assistants' experiences and perceptions of general practice, and the changes made to it, during the pandemic. DESIGN Exploratory qualitative study using semistructured interviews. Interview data were analysed using Braun and Clarke's 'codebook' thematic analysis. SETTING General practices in the Midlands, South East and South West England. Interviews were conducted in February and March 2021, as England began to unlock from its third national lockdown. PARTICIPANTS Practice nurses (n=12), healthcare assistants (n=7), advanced nurse practitioners (n=4) and nursing associates (n=1) recruited using convenience and snowball sampling. RESULTS Three themes were identified. Difficult changes describes dramatic changes made to general practice at the onset of the pandemic, creating confusion and anxiety. Dealing with change characterises how negative emotions were intensified by fear of infection, problematic government guidance, personal protective equipment (PPE) shortages and friction with doctors; but could be mitigated through effective practice communication, peer support and individual coping strategies. An opportunity for improvement highlights certain changes (eg, the increased use of telehealth) that participants believed could be adopted long term to improve efficiency. CONCLUSION General practice should learn from the COVID-19 pandemic to nurture the clinical role and resilience of nurses and healthcare assistants in the postpandemic 'new normal'. Robust PPE provision could enable them to undertake their patient-facing duties safely and confidently. Judicious implementation of telehealth could help preserve the practical and caring nature of nursing. Improving channels of communication and interprofessional collaboration could help realise their potential within the primary care team.
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Affiliation(s)
- Alice Russell
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Gilles de Wildt
- Institute of Clinical Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Minka Grut
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Joanne Clarke
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
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Torp DC, Sandbæk A, Prætorius T. Technology acceptance of video consultations for Type 2 diabetes care in general practice: a cross-sectional survey of Danish general practitioners (Preprint). J Med Internet Res 2022; 24:e37223. [PMID: 36040765 PMCID: PMC9472039 DOI: 10.2196/37223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Cæsar Torp
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Annelli Sandbæk
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Thim Prætorius
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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Granberg RE, Heyer A, Gehrman PR, Gunter PW, Hoff NA, Guth A, Kayser MS, Kuna S, Frasso R. Patient and provider experiences with CBT-I administered in-person or via telemedicine: A randomized non-inferiority trial. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2038936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Rachel E. Granberg
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Arianna Heyer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philip R. Gehrman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul W. Gunter
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nathan A. Hoff
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amanda Guth
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew S. Kayser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- UNITED KINGDOM
| | - Samuel Kuna
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- UNITED KINGDOM
| | - Rosemary Frasso
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Neher M, Nygårdh A, Broström A, Lundgren J, Johansson P. Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study. J Med Internet Res 2022; 24:e28870. [PMID: 35089139 PMCID: PMC8838545 DOI: 10.2196/28870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 12/20/2022] Open
Abstract
Background Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. Objective The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. Methods This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. Results Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers’ conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. Conclusions Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.
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Affiliation(s)
- Margit Neher
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Annette Nygårdh
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anders Broström
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Patients' and clinicians' perspectives on the primary care consultations for acute respiratory infections during the first wave of the COVID-19 pandemic: an eight-country qualitative study in Europe. BJGP Open 2022; 6:BJGPO.2021.0172. [PMID: 35031559 PMCID: PMC9447319 DOI: 10.3399/bjgpo.2021.0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022] Open
Abstract
Background The impact of the COVID-19 pandemic on patients’ and clinicians’ perceptions of healthcare-seeking behaviour and delivery of care is unclear. The pandemic accelerated the use of remote care, and understanding its benefits and drawbacks may inform its implementation during current and future healthcare emergencies. Aim To explore patients’ and primary care professionals’ (PCPs) experiences of primary care delivery in the first wave of the pandemic. Design & setting Qualitative study using semi-structured interviews in primary care in eight European countries (England, Ireland, Belgium, the Netherlands, Greece, Poland, Sweden, and Germany). Method A total of 146 interviews were conducted with 80 PCPs and 66 patients consulting for respiratory tract infection (RTI) symptoms, in eight European countries. Data were collected between April and July 2020, and analysed using thematic analysis. Results It was found that patients accepted telemedicine when PCPs spent time to understand and address their concerns, but a minority preferred in-person consultations. PCPs felt that remote consultations created emotional distance between themselves and patients, and they reported having to manage diverse COVID-19-related medical and social concerns. Conclusion Remote consultations for RTI symptoms may be acceptable long term if both groups are happy to use this format, but it is important that PCPs take time to address patients’ concerns and provide safety-netting advice.
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Schutz S, Walthall H, Snowball J, Vagner R, Fernandez N, Bartram E, Merriman C. Patient and clinician experiences of remote consultation during the SARS-CoV-2 pandemic: A service evaluation. Digit Health 2022; 8:20552076221115022. [PMID: 35959197 PMCID: PMC9358347 DOI: 10.1177/20552076221115022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives During the SARS-CoV-2 pandemic, clinicians were instructed to move all but
emergency consultations to remote means to reduce the spread of the virus.
The aim of this study was to evaluate patients’ and clinicians’ experiences
of moving to remote means of consultation with their health care
professionals during the SARS-CoV-2 pandemic. Methods The study design was a qualitative service evaluation. Twenty-six clinicians
and forty-eight patients who met the inclusion criteria consented to be
interviewed. Clinician participants were from either medical, nursing, or
allied health professional backgrounds. Patients were recruited from
diabetes, acute care, and haematology and cancer areas. Data analysis was
conducted using a thematic analysis framework. Results Following coding and thematic analysis of the data collected from clinicians,
five themes were identified: personal and professional well-being; providing
a safe and high-quality experience; adapting to a new way of working; making
remote consultations fit for purpose and an awareness of altered dynamics
during consultation. Patient data was coded into 3 themes: remote
consultation adds value; remote consultation brings challenges and concerns
about remote consultation. Conclusions Clinician and patient experiences reported here are reflected in the
literature. The study indicates that remote consultation is not suitable for
all patients and in all contexts. Whilst maintaining the benefits to
patients, remote means of consultation needs organisational support and
preparation. A way forward that maintains the benefits whilst addressing
concerns seems urgent.
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Affiliation(s)
- Sue Schutz
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Helen Walthall
- Nursing and Midwifery Research and Innovation, Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Joanna Snowball
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Raluca Vagner
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Nicola Fernandez
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Emilia Bartram
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Clair Merriman
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
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Jepsen C, Lüchau EC, Assing Hvidt E, Grønning A. Healthcare in the hand: Patients’ use of handheld technology in video consultations with their general practitioner. Digit Health 2022; 8:20552076221104669. [PMID: 35694120 PMCID: PMC9178979 DOI: 10.1177/20552076221104669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/14/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To analyse how the patient's use of handheld technology in video consultations with their general practitioner affects communication and the possibilities for the delivery of quality healthcare. Focusing on the visually communicated aspects of the video consultation, we present three episodes from our recordings of eight video consultations between Danish general practitioners and patients. Methods Using a multimodal social semiotic framework to conduct a micro-level analysis, we present episodes from our data in which the hardware's affordance of mobility gave rise to salient events in the interactions of patients who used handheld devices to carry out their video consultations. Results Patients’ use of technology plays a significant role in the interactions between general practitioner and patient and is thus an important factor to consider in how practice is shaped when using handheld video consultation technology. Conclusions Our findings demonstrate that the mobility of handheld devices (smartphone, tablet) can be used to augment sensing and embodiment and enhance the delivery of healthcare in video consultations. However, mobility may also disrupt the interaction. As a result, possibilities for the delivery of quality healthcare lie quite literally in the patients’ hands.
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Affiliation(s)
- Carole Jepsen
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Elle Christine Lüchau
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Assing Hvidt
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Anette Grønning
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
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Silva CRDV, Lopes RH, de Goes Bay O, Martiniano CS, Fuentealba-Torres M, Arcêncio RA, Lapão LV, Dias S, Uchoa SADC. Digital health opportunities to improve Primary Health Care in the context of COVID-19: A Scoping Review (Preprint). JMIR Hum Factors 2021; 9:e35380. [PMID: 35319466 PMCID: PMC9159467 DOI: 10.2196/35380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/11/2022] [Accepted: 03/21/2022] [Indexed: 01/23/2023] Open
Abstract
Background The COVID-19 pandemic brought social, economic, and health impacts, requiring fast adaptation of health systems. Although information and communication technologies were essential for achieving this objective, the extent to which health systems incorporated this technology is unknown. Objective The aim of this study was to map the use of digital health strategies in primary health care worldwide and their impact on quality of care during the COVID-19 pandemic. Methods We performed a scoping review based on the Joanna Briggs Institute manual and guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. A systematic and comprehensive three-step search was performed in June and July 2021 in multidisciplinary health science databases and the gray literature. Data extraction and eligibility were performed by two authors independently and interpreted using thematic analysis. Results A total of 44 studies were included and six thematic groups were identified: characterization and geographic distribution of studies; nomenclatures of digital strategies adopted; types of information and communication technologies; characteristics of digital strategies in primary health care; impacts on quality of care; and benefits, limitations, and challenges of digital strategies in primary health care. The impacts on organization of quality of care were investigated by the majority of studies, demonstrating the strengthening of (1) continuity of care; (2) economic, social, geographical, time, and cultural accessibility; (3) coordination of care; (4) access; (5) integrality of care; (6) optimization of appointment time; (7) and efficiency. Negative impacts were also observed in the same dimensions, such as reduced access to services and increased inequity and unequal use of services offered, digital exclusion of part of the population, lack of planning for defining the role of professionals, disarticulation of actions with real needs of the population, fragile articulation between remote and face-to-face modalities, and unpreparedness of professionals to meet demands using digital technologies. Conclusions The results showed the positive and negative impacts of remote strategies on quality of care in primary care and the inability to take advantage of the potential of technologies. This may demonstrate differences in the organization of fast and urgent implementation of digital strategies in primary health care worldwide. Primary health care must strengthen its response capacity, expand the use of information and communication technologies, and manage challenges using scientific evidence since digital health is important and must be integrated into public service.
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Affiliation(s)
| | - Rayssa Horácio Lopes
- Department of Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Osvaldo de Goes Bay
- Faculty of Health Sciences, Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | | | | - Ricardo Alexandre Arcêncio
- Department of Maternal Infant Nursing and Public Health, University of São Paulo, Ribeirão Preto, Brazil
| | - Luís Velez Lapão
- Instituto de Higiene e Medicina Tropical, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
- Unidade de Investigação e Desenvolvimento em Engenharia Mecanica e Industrial, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sonia Dias
- Escola Nacional de Saúde Pública, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisboa, Portugal
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Waizinger O, Shpigelman M, Shental R, Yunis B, Shimoni P, Od Cohen Y, Kagan I. Diabetes nurse practitioners in the shadow of the COVID-19 pandemic: Challenges, insights, and suggestions for improvement. J Nurs Scholarsh 2021; 54:453-461. [PMID: 34854227 DOI: 10.1111/jnu.12754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The study examined the role of diabetes nurse practitioners (DiNPs) and their contribution to the quality of care of individuals with diabetes during the COVID-19 pandemic. Specifically, we examined the benefits and barriers of using telemedicine for managing diabetes. DESIGN A descriptive qualitative research using content analysis of interviews. METHODS Participants were invited through the National DiNPs' Forum. Semi-structured interviews were conducted with 24 licensed DiNPs (age range, 37-58 years) who were involved in the clinical care of individuals with diabetes during the COVID-19 pandemic. The interviews were recorded and transcribed, and content analysis was then used for extracting themes and their related categories. FINDINGS Content analysis revealed five themes: (a) Benefits and barriers of remote diabetes treatment; (b) Teamwork and its implications to DiNPs; (c) Technological challenges, resourcefulness, and creativity; (d) Changed perception of DiNP roles; and (e) Cultural diversity and improving communication skills. The benefits of telemedicine included improved control, efficiency, convenience and satisfaction, while the disadvantages of this method included the inability to provide optimal practical guidance on technical aspects of physical assessments and care. Sectors with limited digital literacy and language barriers had difficulties using telemedicine. Teamwork was reported as a facilitator to managing treatment. Telemedicine provided an opportunity for DiNPs to become more efficient and focused and to clearly define their role in the organization. CONCLUSIONS The COVID-19 pandemic has posed new challenges. Along with the need to adapt the therapeutic approach to remote care, DiNPs improved their professional status, acquired new skills, and were satisfied with their personal and professional growth. CLINICAL RELEVANCE Telemedicine should become an integral part of diabetes management to enable access to populations who cannot come to the clinic. Patients should be guided on using telemedicine platforms.
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Affiliation(s)
- Orit Waizinger
- Nursing Care Coordinator in Diabetes, Haifa and Western Galil District, Clalit Health Services, Tel Aviv, Israel
| | - Miriam Shpigelman
- Nursing Care Coordinator in Diabetes, Sharon-Shomron District, Clalit Health Services, Tel Aviv, Israel
| | - Rachel Shental
- Coordinator of Diabetes Care for Adults, Rambam Health Care Campus, Haifa, Israel
| | - Bushra Yunis
- Coordinator of Diabetes Care, Central District, Meuhedet Health Services, Tel Aviv, Israel
| | - Pnina Shimoni
- Nursing Care Coordinator in Diabetes, Sharon-Shomron District, Clalit Health Services, Tel Aviv, Israel
| | | | - Ilya Kagan
- Nursing Department, Ashkelon Academic College, Ashkelon, Israel
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Sandbæk A, Christensen LD, Larsen LL, Primholdt Christensen N, Kofod FG, Guassora AD, Merrild CH, Assing Hvidt E. Guidance for Implementing Video Consultations in Danish General Practice: Rapid Cycle Coproduction Study. JMIR Form Res 2021; 5:e27323. [PMID: 34821560 PMCID: PMC8663649 DOI: 10.2196/27323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/06/2021] [Accepted: 10/05/2021] [Indexed: 12/05/2022] Open
Abstract
Background The COVID-19 pandemic has changed various spheres of health care. General practitioners (GPs) have widely replaced face-to-face consultations with telephone or video consultations (VCs) to reduce the risk of COVID-19 transmission. Using VCs for health service delivery is an entirely new way of practicing for many GPs. However, this transition process has largely been conducted with no formal guidelines, which may have caused implementation barriers. This study presents a rapid cycle coproduction approach for developing a guide to assist VC implementation in general practice. Objective The aim of this paper is to describe the developmental phases of the VC guide to assist general practices in implementing VCs and summarize the evaluation made by general practice users. Methods The development of a guide for VC in general practice was structured as a stepped process based on the coproduction and prototyping processes. We used an iterative framework based on rapid qualitative analyses and interdisciplinary collaborations. Thus, the guide was developed in small, repeated cycles of development, implementation, evaluation, and adaptation, with a continuous exchange between research and practice. The data collection process was structured in 3 main phases. First, we conducted a literature review, recorded observations, and held informal and semistructured interviews. Second, we facilitated coproduction with stakeholders through 4 workshops with GPs, a group interview with patient representatives, and individual revisions by GPs. Third, nationwide testing was conducted in 5 general practice clinics and was followed by an evaluation of the guide through interviews with GPs. Results A rapid cycle coproduction approach was used to explore the needs of general practice in connection with the implementation of VC and to develop useful, relevant, and easily understandable guiding materials. Our findings suggest that a guide for VCs should include advice and recommendations regarding the organization of VCs, the technical setup, the appropriate target groups, patients’ use of VCs, the performance of VCs, and the arrangements for booking a VC. Conclusions The combination of coproduction, prototyping, small iterations, and rapid data analysis is a suitable approach when contextually rich, hands-on guide materials are urgently needed. Moreover, this method could provide an efficient way of developing relevant guide materials for general practice to aid the implementation of new technology beyond the pandemic period.
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Affiliation(s)
- Amanda Sandbæk
- Research Unit for General Practice, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | | | - Nina Primholdt Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Frida Greek Kofod
- The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Massaroni V, Delle Donne V, Ciccarelli N, Ciccullo A, Borghetti A, Faliero D, Visconti E, Tamburrini E, Di Giambenedetto S. Use of telehealth for HIV care in Italy: Are doctors and patients on the same page? A cross-sectional study. Int J Med Inform 2021; 156:104616. [PMID: 34695728 DOI: 10.1016/j.ijmedinf.2021.104616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/29/2021] [Accepted: 10/09/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The COVID-19 pandemic has changed outpatient clinical practice, which has led to the need defining digital healthcare modalities to provide telehealth services. The aim of our study was to explore opinions about HIV management via telehealth in a representative, southern central Italian cohort of individuals with HIV (PLWH) and doctors involved in the treatment process. METHODS We enrolled 80 PLWH who have never used telehealth tools and 60 doctors, who administered an anonymous self-report questionnaire to investigate their opinions about telehealth service use. RESULTS Most of the doctors and patients indicated that they would use telehealth services; however, 88.3% of the doctors and 40% of the PLWH did not want to substitute personal visits with telehealth services. Unlike PLWH, physicians seemed to agree with most of the possible risks of telehealth, such as patients' isolation from the hospital system (71.7%), interaction difficulty (46.7%) and lower quality of patient assessment (63.3%). The doctors focused on the qualitative aspects of telehealth services reducing patients' exposure to stigma (61.7%), improving quality of patient care (41.7%), and improving privacy (58.3%). By contrast, patients focused on the quantitative aspects of telehealth services improving timely access to care (44%), time saving (63%) and improving interaction with doctor (43%). CONCLUSIONS Both PLWH (especially older patients and those with longer experience of disease management) and doctors welcome the use of telehealth services but disagree using it to substitute medical consultation in person focusing on different possible benefits and risks of telehealth depending on the needs expressed. Thus, our results suggest the need to initiate and expand communication about telehealth between doctors and patients.
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Affiliation(s)
- Valentina Massaroni
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy.
| | - Valentina Delle Donne
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy.
| | | | - Arturo Ciccullo
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Alberto Borghetti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Domenico Faliero
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Elena Visconti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Enrica Tamburrini
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy; UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Simona Di Giambenedetto
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy; UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Wherton J, Greenhalgh T, Shaw SE. Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study. J Med Internet Res 2021; 23:e31374. [PMID: 34516389 PMCID: PMC8500351 DOI: 10.2196/31374] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/20/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background Scotland—a country of 5.5 million people—has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. Objective To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland’s video consultation services both before and during the pandemic. Methods Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. Results By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations’ general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. Conclusions The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn.
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Affiliation(s)
- Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Adam S, Zahra SA, Chor CYT, Khare Y, Harky A. COVID-19 pandemic and its impact on service provision: A cardiology prospect. Acta Cardiol 2021; 76:830-837. [PMID: 32646309 DOI: 10.1080/00015385.2020.1787636] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the availability of cardiology services and management of cardiac conditions. Elective surgeries, outpatient appointments and cardiac imaging have been largely cancelled across the world due to the risk of infection transmission and the need for reallocation of resources to deal with the increasing number of COVID-19 patients. The impact on patients with cardiac co-morbidities during these times may be drastic. However, cardiologists and hospitals across the world have implemented measures to ensure on-going monitoring and care of patients remotely. In this review, we discuss the impact of COVID-19 on cardiac services including interventional cardiology services, cardiac imaging and outpatient appointments. In addition, implications for future research and clinical practice are also discussed.
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Affiliation(s)
- Sana Adam
- St George's, University of London, London, UK
| | | | | | - Yuti Khare
- St George's, University of London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Integrative biology, Faculty of Life Sciences, University of Liverpool, Liverpool, UK
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Madden G, Rose T, Crystal L. Using video consultations to support family carers of people living with dementia. Nurs Older People 2021; 34:28-33. [PMID: 34431259 DOI: 10.7748/nop.2021.e1346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/09/2022]
Abstract
Established in 2019, the Lincolnshire Admiral Nurse Service supports family carers of people living with dementia through psychosocial interventions. Before the coronavirus disease 2019 (COVID-19) pandemic, the team provided home visits as standard, but the fact that Lincolnshire is a large rural county affected the team's ability to provide timely support to all the carers who needed it. In 2019-20, a practice development project underpinned by participatory action research was undertaken to trial the use of video consultations with carers. However, carers' uptake of video consultations was low and the project was affected by the COVID-19 pandemic. This article describes the project and discusses the findings of its evaluation. The Admiral Nurse team had mixed experiences and felt that, overall, its support was more effective when delivered face to face. The project provides insights into the challenges and benefits of video consultations for delivering psychosocial interventions to carers of people living with dementia.
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Affiliation(s)
| | - Tom Rose
- St Barnabas Hospice, Lincolnshire, England
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Greenhalgh T, Rosen R, Shaw SE, Byng R, Faulkner S, Finlay T, Grundy E, Husain L, Hughes G, Leone C, Moore L, Papoutsi C, Pope C, Rybczynska-Bunt S, Rushforth A, Wherton J, Wieringa S, Wood GW. Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics. Front Digit Health 2021; 3:726095. [PMID: 34713199 PMCID: PMC8521880 DOI: 10.3389/fdgth.2021.726095] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022] Open
Abstract
Establishing and running remote consultation services is challenging politically (interest groups may gain or lose), organizationally (remote consulting requires implementation work and new roles and workflows), economically (costs and benefits are unevenly distributed across the system), technically (excellent care needs dependable links and high-quality audio and images), relationally (interpersonal interactions are altered), and clinically (patients are unique, some examinations require contact, and clinicians have deeply-held habits, dispositions and norms). Many of these challenges have an under-examined ethical dimension. In this paper, we present a novel framework, Planning and Evaluating Remote Consultation Services (PERCS), built from a literature review and ongoing research. PERCS has 7 domains-the reason for consulting, the patient, the clinical relationship, the home and family, technologies, staff, the healthcare organization, and the wider system-and considers how these domains interact and evolve over time as a complex system. It focuses attention on the organization's digital maturity and digital inclusion efforts. We have found that both during and beyond the pandemic, policymakers envisaged an efficient, safe and accessible remote consultation service delivered through state-of-the art digital technologies and implemented via rational allocation criteria and quality standards. In contrast, our empirical data reveal that strategic decisions about establishing remote consultation services, allocation decisions for appointment type (phone, video, e-, face-to-face), and clinical decisions when consulting remotely are fraught with contradictions and tensions-for example, between demand management and patient choice-leading to both large- and small-scale ethical dilemmas for managers, support staff, and clinicians. These dilemmas cannot be resolved by standard operating procedures or algorithms. Rather, they must be managed by attending to here-and-now practicalities and emergent narratives, drawing on guiding principles applied with contextual judgement. We complement the PERCS framework with a set of principles for informing its application in practice, including education of professionals and patients.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Richard Byng
- Plymouth Institute of Health and Care Research, University of Plymouth, Plymouth, United Kingdom
| | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah Rybczynska-Bunt
- Plymouth Institute of Health and Care Research, University of Plymouth, Plymouth, United Kingdom
| | - Alexander Rushforth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gary W. Wood
- Independent Research Consultant, Birmingham, United Kingdom
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Clinicians' and patients' experiences of managing heart failure during the COVID-19 pandemic. BJGP Open 2021; 5:BJGPO.2021.0115. [PMID: 34353790 PMCID: PMC9447295 DOI: 10.3399/bjgpo.2021.0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background Severe acute respiratory coronavirus 2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19), resulted in unprecedented societal and healthcare provision change, which has been implemented at pace. Little is known about the indirect impacts of these changes and what the future effects may be. Aim To explore patients’ and clinicians’ experiences of managing heart failure (HF) during the COVID-19 pandemic. Design & setting Qualitative study in three regions of the UK: Cambridgeshire, Greater Manchester, and the West Midlands. Method Semi-structured interviews (n = 30) were conducted with older adults with established HF and healthcare providers from primary and secondary health services involved in their care. Interviews were analysed thematically. Results Compliance with the government guidance ‘Stay at home, protect the NHS, and save lives’ during the COVID-19 pandemic, and perceptions relating to risk from COVID-19 and underlying morbidity, drove ‘being careful’ behaviours and organisational changes. Enacting behavioural change and implementing organisational change resulted in opportunities and challenges for health and healthcare practice. Conclusion Perception of risk led to significant behavioural and organisational change during the pandemic. Some changes described by both patients and clinicians, such as enhanced relationships and self-monitoring, present as opportunities, and consideration should be given as to how to maintain or develop these. Equally, indirect impacts of COVID-19 and the associated lockdown, such as disengagement and withdrawal, and the fallout from reluctance to access health services, should be acknowledged and interventions to address these challenges are needed.
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Het gebruik van videobeelden bij triage op de huisartsenpost. ACTA ACUST UNITED AC 2021; 64:42-44. [PMID: 34376860 PMCID: PMC8336669 DOI: 10.1007/s12445-021-1240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Bij een deel van de patiënten die de huisartsenpost bellen, kunnen triagisten de klacht niet goed beoordelen omdat ze de patiënt niet kunnen zien. Dan wordt er een consult afgesproken, terwijl dat achteraf niet altijd nodig bleek te zijn. Het gebruik van videobeelden kan dit probleem mogelijk oplossen, maar er zijn vragen over de toegevoegde waarde van deze methode. In dit artikel geven we antwoord op vragen als: hoe vaak worden videobeelden ingezet bij triage, wat is daarvoor de indicatie en is het gebruik doelmatig, effectief en veilig?
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Connolly SL, Gifford AL, Miller CJ, Bauer MS, Lehmann LS, Charness ME. Provider Perceptions of Virtual Care During the Coronavirus Disease 2019 Pandemic: A Multispecialty Survey Study. Med Care 2021; 59:646-652. [PMID: 34009880 PMCID: PMC8191369 DOI: 10.1097/mlr.0000000000001562] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic increase in virtual care (VC) across outpatient specialties, but little is known regarding provider acceptance of VC. OBJECTIVE The objective of this study was to assess provider perceptions of the quality, efficiency, and challenges of VC versus in-person care with masks. DESIGN This was a voluntary survey. PARTICIPANTS Mental health (MH), primary care, medical specialty, and surgical specialty providers across the 8 VA New England Healthcare System medical centers. MEASURES Provider ratings of: (1) quality and efficiency of VC (phone and video telehealth) compared with in-person care with masks; (2) challenges of VC; and (3) percentage of patients that providers are comfortable seeing via VC in the future. RESULTS The sample included 998 respondents (49.8% MH, 20.6% primary care, 20.4% medical specialty, 9.1% surgical specialty; 61% response rate). Most providers rated VC as equivalent to or higher in quality and efficiency compared with in-person care with masks. Quality ratings were significantly higher for video versus phone (χ2=61.4, P<0.0001), but efficiency ratings did not differ significantly. Ratings varied across specialties (highest in MH, lowest in SS; all χ2s>24.1, Ps<0.001). Inability to conduct a physical examination and patient technical difficulties were significant challenges. MH providers were comfortable seeing a larger proportion of patients virtually compared with the other specialties (all χ2s>12.2, Ps<0.01). CONCLUSIONS Broad provider support for VC was stratified across specialties, with the highest ratings in MH and lowest ratings in SS. Findings will inform the improvement of VC processes and the planning of health care delivery during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Samantha L. Connolly
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Harvard Medical School
| | - Allen L. Gifford
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Boston University School of Medicine
- Boston University School of Public Health, Boston
| | - Christopher J. Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Harvard Medical School
| | - Mark S. Bauer
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Harvard Medical School
| | - Lisa S. Lehmann
- Harvard Medical School
- VA New England Healthcare System, Bedford
| | - Michael E. Charness
- Harvard Medical School
- Boston University School of Medicine
- VA Boston Healthcare System, Boston, MA
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Due TD, Thorsen T, Andersen JH. Use of alternative consultation forms in Danish general practice in the initial phase of the COVID-19 pandemic - a qualitative study. BMC FAMILY PRACTICE 2021; 22:108. [PMID: 34078281 PMCID: PMC8170055 DOI: 10.1186/s12875-021-01468-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022]
Abstract
Background Attempts to manage the COVID-19 pandemic have led to radical reorganisations of health care systems worldwide. General practitioners (GPs) provide the vast majority of patient care, and knowledge of their experiences with providing care for regular health issues during a pandemic is scarce. Hence, in a Danish context we explored how GPs experienced reorganising their work in an attempt to uphold sufficient patient care while contributing to minimizing the spread of COVID-19. Further, in relation to this, we examined what guided GPs’ choices between telephone, video and face-to-face consultations. Methods This study consisted of qualitative interviews with 13 GPs. They were interviewed twice, approximately three months apart in the initial phase of the pandemic, and they took daily notes for 20 days. All interviews were audio recorded, transcribed, and inductively analysed. Results The GPs re-organised their clinical work profoundly. Most consultations were converted to video or telephone, postponed or cancelled. The use of video first rose, but soon declined, once again replaced by an increased use of face-to-face consultations. When choosing between consultation forms, the GPs took into account the need to minimise the risk of COVID-19, the central guidelines, and their own preference for face-to-face consultations. There were variations over time and between the GPs regarding which health issues were dealt with by using video and/or the telephone. For some health issues, the GPs generally deemed it acceptable to use video or telephone, postpone or cancel appointments for a short term, and in a crisis situation. They experienced relational and technical limitations with video consultation, while diagnostic uncertainty was not regarded as a prominent issue Conclusion This study demonstrates how the GPs experienced telephone and video consultations as being useful in a pandemic situation when face-to-face consultations had to be severely restricted. The GPs did, however, identify several limitations similar to those known in non-pandemic times. The weighing of pros and cons and their willingness to use these alternatives shifted and generally diminished when face-to-face consultations were once again deemed viable. In case of future pandemics, such alternatives seem valuable, at least for a short term.
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Affiliation(s)
- Tina Drud Due
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Thorkil Thorsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Julie Høgsgaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
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Chang JE, Lai AY, Gupta A, Nguyen AM, Berry CA, Shelley DR. Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era. Milbank Q 2021; 99:340-368. [PMID: 34075622 PMCID: PMC8209855 DOI: 10.1111/1468-0009.12509] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Policy Points Telehealth has many potential advantages during an infectious disease outbreak such as the COVID‐19 pandemic, and the COVID‐19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode. Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID‐19 pandemic. Without proactive efforts to address both patient‐ and provider‐related digital barriers associated with socioeconomic status, the wide‐scale implementation of telehealth amid COVID‐19 may reinforce disparities in health access in already marginalized and underserved communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them.
Context The COVID‐19 pandemic has catalyzed fundamental shifts across the US health care delivery system, including a rapid transition to telehealth. Telehealth has many potential advantages, including maintaining critical access to care while keeping both patients and providers safe from unnecessary exposure to the coronavirus. However, not all health care providers and patients are equally ready to take part in this digital revolution, which raises concerns for health equity during and after the COVID‐19 pandemic. Methods The study analyzed data about small primary care practices’ telehealth use and barriers to telehealth use collected from rapid‐response surveys administered by the New York City Department of Health and Mental Hygiene's Bureau of Equitable Health Systems and New York University from mid‐April through mid‐June 2020 as part of the city's efforts to understand how primary care practices were responding to the COVID‐19 pandemic following New York State's stay‐at‐home order on March 22. We focused on small primary care practices because they represent 40% of primary care providers and are disproportionately located in low‐income, minority or immigrant areas that were more severely impacted by COVID‐19. To examine whether telehealth use and barriers differed based on the socioeconomic characteristics of the communities served by these practices, we used the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) to stratify respondents as being in high‐SVI or low‐SVI areas. We then characterized respondents’ telehealth use and barriers to adoption by using means and proportions with 95% confidence intervals. In addition to a primary analysis using pooled data across the five waves of the survey, we performed sensitivity analyses using data from respondents who only took one survey, first wave only, and the last two waves only. Findings While all providers rapidly shifted to telehealth, there were differences based on community characteristics in both the primary mode of telehealth used and the types of barriers experienced by providers. Providers in high‐SVI areas were almost twice as likely as providers in low‐SVI areas to use telephones as their primary telehealth modality (41.7% vs 23.8%; P <.001). The opposite was true for video, which was used as the primary telehealth modality by 18.7% of providers in high‐SVI areas and 33.7% of providers in low‐SVI areas (P <0.001). Providers in high‐SVI areas also faced more patient‐related barriers and fewer provider‐related barriers than those in low‐SVI areas. Conclusions Between April and June 2020, telehealth became a prominent mode of primary care delivery in New York City. However, the transition to telehealth did not unfold in the same manner across communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them.
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Affiliation(s)
- Ji E Chang
- New York University School of Global Public Health
| | | | - Avni Gupta
- New York University School of Global Public Health
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75
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Homeniuk R, Collins C. How COVID-19 has affected general practice consultations and income: general practitioner cross-sectional population survey evidence from Ireland. BMJ Open 2021; 11:e044685. [PMID: 38607944 PMCID: PMC8039245 DOI: 10.1136/bmjopen-2020-044685] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives How general practice is delivered in many countries has drastically changed due to the COVID-19 pandemic. This study aimed to answer the question of how general practice has changed in Ireland in response to COVID-19. Design The Irish College of General Practitioners surveyed its membership before and after the global pandemic hit Ireland using a cross-sectional online survey instrument. Setting This study focuses on primary care, specifically general practice, in Ireland. Participants In February 2020 before the global pandemic, 526 general practices across Ireland submitted responses to the survey; 538 general practices responded to the second survey during the pandemic in June 2020. This covers 32% and 33% of practices in Ireland, respectively. Main outcome measures The type of consultations by general practitioners (GPs) and practice nurses in both surveys is the main outcome measure reported in this paper. Other changes such as the perceived change in attendance by certain patient groups and practice income are also reported. Results Face-to-face consultations significantly (p<0.001) decreased from a median of 26 (IQR 21.3-30) to a median of 8 (IQR 6-13). GP telemedicine consultations increased (p<0.001) from a median of 2.4 (IQR 0-5.3) to a median of 11.3 (IQR 6-19). The majority of practices (80.0%) reported reduced practice profit. Respondents reported a decline in non-COVID-19-related consultations among certain patient cohorts-92.0% for children under 6 years old; 79.5% for patients over 70 years. Conclusions It is likely that the way general practice is delivered will not return to as it was before the COVID-19 pandemic and increased telemedicine can be expected. However, it is necessary to assess the impact of this shift on patient health and to assess healthcare provider and patient experience to ensure continued high-quality care and patient safety.
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Affiliation(s)
- Robyn Homeniuk
- Research Centre, Irish College of General Practitioners, Dublin, Ireland
| | - Claire Collins
- Research Centre, Irish College of General Practitioners, Dublin, Ireland
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Phiri P, Ramakrishnan R, Rathod S, Elliot K, Thayanandan T, Sandle N, Haque N, Chau SWH, Wong OWH, Chan SSM, Wong EKY, Raymont V, Au-Yeung SK, Kingdon D, Delanerolle G. An evaluation of the mental health impact of SARS-CoV-2 on patients, general public and healthcare professionals: A systematic review and meta-analysis. EClinicalMedicine 2021; 34:100806. [PMID: 33842872 PMCID: PMC8022621 DOI: 10.1016/j.eclinm.2021.100806] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The global impact of COVID-19 pandemic continues to affect the lives of billions of people with recurrent waves. Healthcare systems are struggling to manage pre-existing patient care and recurring covid-19 demands. As a result, we evaluated the mental health impact using systematic review and meta-analysis. METHODS A comprehensive search was undertaken from April 2020 to 22nd January 2021 using multiple electronic databases. A systematic review protocol was developed and published on PROSPERO registration; CRD42020181481. A random-effects model was used to compute pooled estimates of anxiety, depression, PTSD, insomnia and suicidal thoughts. FINDINGS Our search yielded 11,295 studies and of those 287 met the inclusion criteria. The meta-analysis of 206 studies revealed minimal differences in prevalence of anxiety, depression, and PTSD among HCPs compared with the public during the pandemic but higher prevalence of suicidal thoughts/ideation or self-harm (11% vs 5.8%) and lower prevalence of wellbeing (28.2% vs 52.6%) among the public compared to HCPs. INTERPRETATION The pandemic has led to a high mental health burden especially amongst HCPs and higher suicidal ideation and lower wellbeing in general public which warrants further investigation and management globally. These findings highlight an emerging critical public health issue that requires urgent solutions.
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Affiliation(s)
- Peter Phiri
- Southern Health NHS Foundation Trust, Research and Development Dept., Clinical Trials Facility, Moorgreen Hospital, Southampton SO30 3JB, UK
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK
| | - Rema Ramakrishnan
- Nuffield Department of Women's and Reproductive Health, University of Oxford, UK
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Research and Development Dept., Clinical Trials Facility, Moorgreen Hospital, Southampton SO30 3JB, UK
| | - Kathryn Elliot
- Southern Health NHS Foundation Trust, Research and Development Dept., Clinical Trials Facility, Moorgreen Hospital, Southampton SO30 3JB, UK
| | - Tony Thayanandan
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford OX3 7JX, UK
| | - Natasha Sandle
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford OX3 7JX, UK
| | - Nyla Haque
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford OX3 7JX, UK
| | - Steven WH Chau
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - Oscar WH Wong
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - Sandra SM Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - Evelyn KY Wong
- Department of Psychiatry, North District Hospital, Hong Kong
| | - Vanessa Raymont
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford OX3 7JX, UK
| | - Sheena K Au-Yeung
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford OX3 7JX, UK
| | - David Kingdon
- University Department of Psychiatry, Academic Centre, College Keep, University of Southampton, UK
| | - Gayathri Delanerolle
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford OX3 7JX, UK
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Varsi C, Stenehjem AE, Børøsund E, Solberg Nes L. Video as an alternative to in-person consultations in outpatient renal transplant recipient follow-up: a qualitative study. BMC Nephrol 2021; 22:105. [PMID: 33752608 PMCID: PMC7983085 DOI: 10.1186/s12882-021-02284-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/28/2021] [Indexed: 01/10/2023] Open
Abstract
Background Renal transplant recipients have to see a nephrologist for regular follow-up for the rest of their lives. To reduce the burden for the patients, video consultation can be an alternative to traditional in-person hospital consultations. The aim of the current study was, from the perspectives of patients and health care providers, to investigate the perceived benefits and challenges of using video consultations in outpatient renal transplant recipient follow-up. Methods Patients (i.e., renal transplant recipients; n = 18) alternated between regular in-person follow-up consultations and video consultations. Patients and health care providers were then invited to participate in semi-structured interviews. The interviews were analyzed using thematic analysis. Results Patients interviewed (n = 15) were median 53 years old (range 37–64) and 53% female. The video consultation solution used in the study turned out to have major technical deficiencies. Despite the technical challenges, however, the majority of the patients reported appreciating being able to alternate between video and in-person hospital consultations. Main benefits reported included not needing to travel to the hospital and thereby saving time, less focus on being chronically ill and potential economic benefits for patients and society. The health care providers (n = 3) also valued the benefits provided by the use of video consultations, but described the reoccurring technical challenges as disruptive. The fact that patients were in a stable phase of their health condition and already had an established, trusting relationship with their nephrologist, acted as facilitators for success. Possible challenges and harms described included concerns related to security, confidentiality and interruptions, as well as the potential need for physical examinations. Conclusions Benefits from using video consultations as an alternative to in-person consultations may outweigh potential technological challenges for patients as well as health care providers. A long-lasting mutually trusting relationship between patient and provider may be an important prerequisite for the experienced benefits of using video consultation. Findings also indicate that starting such care delivery changes in a small-scale, with a few selected patients in a stable phase of their condition, may be an important factor for success. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02284-3.
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Affiliation(s)
- Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway. .,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Aud-Eldrid Stenehjem
- Department of Nephrology, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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78
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[Telemedicine satisfaction of primary care patients during COVID-19 pandemics]. Semergen 2021; 47:248-255. [PMID: 33781673 PMCID: PMC7951945 DOI: 10.1016/j.semerg.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 11/26/2022]
Abstract
Objetivo Evaluar el grado de satisfacción de los pacientes con la telemedicina durante la pandemia de la COVID-19 en la Unidad de Salud Familiar Vitrius. Este trabajo podría obtener información sobre la aceptación de la teleconsulta (TC). Material y métodos Estudio transversal con 253 individuos. Se realizó un cuestionario mediante escala Likert (entre 1-nada satisfecho a 5-totalmente satisfecho) en pacientes con diabetes, hipertensión y en sujetos con otras patologías, entre el primero de abril del 2020 y el primero de mayo de ese mismo año. Se recopilaron datos sociodemográficos, citas previas de telemedicina, niveles de satisfacción con la TC y de aclaración de dudas e interés en un mayor seguimiento de telemedicina. Además, se realizó un análisis comparativo entre los períodos de enero-febrero y abril-mayo de 2020 en relación con la edad, el sexo, la hipertensión arterial (HTA), la diabetes mellitus (DM) y el tipo de contacto (presencial o telemático). Las estadísticas se realizaron con el SPSS® y Excel®. Resultados y discusión Las consultas de seguimiento de diabetes representaron el 34,4% del total. Mayoritariamente hubo un alto nivel de satisfacción e interés en el seguimiento futuro con telemedicina. Sin embargo, los individuos diabéticos y mayores estaban menos interesados en este tipo de seguimiento. Se encontraron diferencias estadísticamente significativas en satisfacción para la edad, sexo y presencia/ausencia de diabetes. El 70,6% de los pacientes sanos prefirió el contacto por correo electrónico al teléfono. Ha sido analizado el número de consultas entre enero-febrero y abril-mayo de 2020 donde se destaca: una reducción significativa del número de consultas presenciales por diabetes (-50,1%) y por hipertensión (-94,1%). Las consultas presenciales por cualquier razón disminuyeron un 72,6% y las no presenciales aumentaron un 61,9%. Existe un sesgo de selección porque la muestra no fue aleatoria. La mayor prevalencia de consultas de diabetes y la falta de ajuste por factores de confusión también pueden afectar los resultados. Conclusiones Este estudio permitió confirmar la importancia de la telemedicina en atención primaria, sobre todo durante la pandemia. En general, los participantes se quedaron satisfechos con la telemedicina y reconocieron su utilidad en el acceso a los cuidados de salud.
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van Vugt V, Dijkgraaf S, Elfering I. Het implementeren van enkelzijdig beeldbellen. HUISARTS EN WETENSCHAP 2021:1-7. [PMID: 33716311 PMCID: PMC7938675 DOI: 10.1007/s12445-021-1079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Begin 2020 werd de huisartsenzorg door de COVID-19-pandemie sterk ontregeld. Vanwege het besmettingsrisico werden face-to-face consulten in de huisartsenpraktijk zoveel mogelijk beperkt. Om reguliere zorg te kunnen blijven leveren, zij het op afstand, hebben we daarom in onze huisartsenpraktijk met spoed beeldbellen ingevoerd. In dit artikel beschrijven we het implementatietraject: het protocol, de ervaringen van patiënten en huisartsen en onze aanbevelingen voor de toekomst.
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Affiliation(s)
- Vincent van Vugt
- Huisarts-in-opleiding en postdoctoraal onderzoeker (tevens Amsterdam UMC afdeling Huisartsgeneeskunde en Amsterdam Public Health onderzoeksinstituut), SAG Gezondheidscentrum Haveneiland, Amsterdam, Nederland
| | - Serge Dijkgraaf
- Huisarts, SAG Gezondheidscentrum Haveneiland, Amsterdam, Nederland
| | - Ingrid Elfering
- Huisarts, SAG Gezondheidscentrum Haveneiland, Amsterdam, Nederland
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80
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Singhal A, Cowie MR. Digital Health: Implications for Heart Failure Management. Card Fail Rev 2021; 7:e08. [PMID: 34035953 PMCID: PMC8135017 DOI: 10.15420/cfr.2020.28] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022] Open
Abstract
Digital health encompasses the use of information and communications technology and the use of advanced computing sciences in healthcare. This review covers the application of digital health in heart failure patients, focusing on teleconsultation, remote monitoring and apps and wearables, looking at how these technologies can be used to support care and improve outcomes. Interest in and use of these technologies, particularly teleconsultation, have been accelerated by the coronavirus disease 2019 pandemic. Remote monitoring of heart failure patients, to identify those patients at high risk of hospitalisation and to support clinical stability, has been studied with mixed results. Remote monitoring of pulmonary artery pressure has a consistent effect on reducing hospitalisation rates for patients with moderately severe symptoms and multiparameter monitoring shows promise for the future. Wearable devices and apps are increasingly used by patients for health and lifestyle support. Some wearable technologies have shown promise in AF detection, and others may be useful in supporting self-care and guiding prognosis, but more evidence is required to guide their optimal use. Support for patients and clinicians wishing to use these technologies is important, along with consideration of data validity and privacy and appropriate recording of decision-making.
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Affiliation(s)
| | - Martin R Cowie
- Royal Brompton Hospital London, UK
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London London, UK
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81
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Björndell C, Premberg Å. Physicians' experiences of video consultation with patients at a public virtual primary care clinic: a qualitative interview study. Scand J Prim Health Care 2021; 39:67-76. [PMID: 33650941 PMCID: PMC7971243 DOI: 10.1080/02813432.2021.1882082] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To describe physicians' experiences of video consultation with new patients visiting a publicly owned virtual primary care clinic. DESIGN In this qualitative study, data were collected from semi-structured individual interviews and analysed by systematic text condensation. SETTING A publicly owned virtual primary care clinic in Region Västra Götaland, Sweden. SUBJECTS Ten primary care physicians working at the clinic. RESULTS Connecting with a patient over video could be either straightforward or deficient, depending on communication and the patient's condition. Clinical experience, communication skills, and involving patients throughout the consultation and examination were crucial for assessments over video where patients were guided to perform self-examination. The flexibility of work and the regulated assignment online were positive for the physicians' work situation and wellbeing. Providing video consultation within the same organisation as the patient's regular health centre was considered to facilitate patient care and safety. Video consultation was considered suitable for some diagnoses and for some patients not able to reach a primary healthcare centre, though doubts were expressed about the healthcare and social benefits of this virtual care service. CONCLUSION For the physicians, video consultation induced changes in the basis for assessment of primary care patients. The limitations on informational exchange demanded an extended form of patient involvement founded upon consultation skills, clinical experience and new skills for virtual examination. Combining virtual care with traditional general practice has the potential to reduce the workload for the individual physician and ensure medical competence in virtual primary care. Video consultation experienced suitable in some situations, but easy access to it expressed problematic in terms of medical prioritisation in healthcare.KEY POINTSVideo consultation is suitable for primary care visits for some patients, but physicians' experiences of this are rarely studied. •Clinical experience and consultation skills are important for video assessment of primary care patients which involves physician-guided patient self-examination.•Video consultation facilitates care in some situations and could benefit from the provider being connected to patient's regular health centre.•Virtual care offers a flexible way of working but challenges healthcare prioritisation from the primary care physician's perspective.
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Affiliation(s)
- Cajsa Björndell
- Närhälsan Brämaregården Health Centre, Gothenburg, Sweden
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development Primary Health Care, Research and Development Centre Gothenburg and Södra Bohuslän, Gothenburg, Sweden
| | - Åsa Premberg
- Research and Development Primary Health Care, Research and Development Centre Gothenburg and Södra Bohuslän, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study. Br J Gen Pract 2021; 71:e166-e177. [PMID: 33558332 DOI: 10.3399/bjgp.2020.0948] [Citation(s) in RCA: 243] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/06/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms. AIM To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic. DESIGN AND SETTING Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire. METHOD Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff in four rounds investigated practices' experience of the move to remote consulting, challenges faced, and solutions. A thematic analysis utilised Normalisation Process Theory. RESULTS There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April to July 2020 compared to 2019; GPs and nurses maintained a focus on older patients, shielding patients, and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased. CONCLUSION The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.
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83
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Barkai G, Gadot M, Amir H, Menashe M, Shvimer-Rothschild L, Zimlichman E. Patient and clinician experience with a rapidly implemented large-scale video consultation program during COVID-19. Int J Qual Health Care 2021; 33:6033552. [PMID: 33313891 PMCID: PMC7799005 DOI: 10.1093/intqhc/mzaa165] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/14/2020] [Accepted: 12/14/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has forced health-care providers to find creative ways to allow continuity of care in times of lockdown. Telemedicine enables provision of care when in-person visits are not possible. Sheba Medical Center made a rapid transition of outpatient clinics to video consultations (VC) during the first wave of COVID-19 in Israel. OBJECTIVE Results of a survey of patient and clinician user experience with VC are reported. METHODS Satisfaction surveys were sent by text messages to patients, clinicians who practice VC (users) and clinicians who do not practice VC (non-users). Questions referred to general satisfaction, ease of use, technical issues and medical and communication quality. Questions and scales were based on surveys used regularly in outpatient clinics of Sheba Medical Center. RESULTS More than 1200 clinicians (physicians, psychologists, nurses, social workers, dietitians, speech therapists, genetic consultants and others) provided VC during the study period. Five hundred and forty patients, 162 clinicians who were users and 50 clinicians who were non-users completed the survey. High level of satisfaction was reported by 89.8% of patients and 37.7% of clinician users. Technical problems were experienced by 21% of patients and 80% of clinician users. Almost 70% of patients but only 23.5% of clinicians found the platform very simple to use. Over 90% of patients were very satisfied with clinician's courtesy, expressed a high sense of trust, thought that clinician's explanations and recommendations were clear and estimated that the clinician understood their problems and 86.5% of them would recommend VC to family and friends. Eighty-seven percent of clinician users recognize the benefit of VC for patients during the COVID-19 pandemic but only 68% supported continuation of the service after the pandemic. CONCLUSION Our study reports high levels of patient satisfaction from outpatient clinics VC during the COVID-19 pandemic. Lower levels of clinician satisfaction can mostly be attributed to technical and administrative challenges related to the newly implemented telemedicine platform. Our findings support the continued future use of VC as a means of providing patient-centered care. Future steps need to be taken to continuously improve the clinical and administrative application of telemedicine services.
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Affiliation(s)
- Galia Barkai
- Central Management, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,Sackler Faculty of Health, Tel-Aviv University, Tel-Aviv, Israel
| | - Moran Gadot
- Sackler Faculty of Health, Tel-Aviv University, Tel-Aviv, Israel.,Oncology Center, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Hadar Amir
- Central Management, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,The Graduate School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Menashe
- Human Experience Unit, Central Management, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | | | - Eyal Zimlichman
- Central Management, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,Sackler Faculty of Health, Tel-Aviv University, Tel-Aviv, Israel
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Johnsen TM, Norberg BL, Kristiansen E, Zanaboni P, Austad B, Krogh FH, Getz L. Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners. J Med Internet Res 2021; 23:e26433. [PMID: 33465037 PMCID: PMC7872327 DOI: 10.2196/26433] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic imposed an acute, sharp rise in the use of video consultations (VCs) by general practitioners (GPs) in Norway. Objective This study aims to document GPs’ experiences with the large-scale uptake of VCs in the natural experiment context of the pandemic. Methods A nationwide, cross-sectional online survey was conducted among Norwegian GPs during the pandemic lockdown (April 14-May 3, 2020). Each respondent was asked to evaluate up to 10 VCs. Basic demographic characteristics of the GPs and their practices were collected. The associations between GPs’ perceived suitability of the VCs, the nature of the patients’ main problems, prior knowledge of the patients (relational continuity), and follow-up of previously presented problems (episodic continuity) were explored using descriptive statistics, diagrams, and chi-square tests. Results In total, 1237 GPs (26% of the target group) responded to the survey. Among these, 1000 GPs offered VCs, and 855 GPs evaluated a total of 3484 VCs. Most GPs who offered VCs (1000/1237; 81%) had no experience with VCs before the pandemic. Overall, 51% (1766/3476) of the evaluated VCs were considered to have similar or even better suitability to assess the main reason for contact, compared to face-to-face consultations. In the presence of relational continuity, VCs were considered equal to or better than face-to-face consultations in 57% (1011/1785) of cases, as opposed to 32% (87/274) when the patient was unknown. The suitability rate for follow-up consultations (episodic continuity) was 61% (1165/1919), compared to 35% (544/1556) for new patient problems. Suitability varied considerably across clinical contact reasons. VCs were found most suitable for anxiety and life stress, depression, and administrative purposes, as well as for longstanding or complex problems that normally require multiple follow-up consultations. The GPs estimate that they will conduct about 20% of their consultations by video in a future, nonpandemic setting. Conclusions Our study of VCs performed in general practice during the pandemic lockdown indicates a clear future role for VCs in nonpandemic settings. The strong and consistent association between continuity of care and GPs’ perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning.
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Affiliation(s)
- Tor Magne Johnsen
- Norwegian Centre for E-health Research, Tromsø, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Børge Lønnebakke Norberg
- Norwegian Centre for E-health Research, Tromsø, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Paolo Zanaboni
- Norwegian Centre for E-health Research, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjarne Austad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frode Helgetun Krogh
- Norwegian Centre for E-health Research, Tromsø, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Linn Getz
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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85
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Lüchau EC, Jepsen C, Grønning A, Hvidt EA. Reciprocal dynamics between patients' choice of place and how they experience video consultations: A qualitative study. Digit Health 2021; 7:20552076211052158. [PMID: 34733540 PMCID: PMC8559177 DOI: 10.1177/20552076211052158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyse the reciprocal dynamics between patients' choice of place and how they experience video consultations (VCs) with the general practitioner. METHODS Qualitative, semi-structured interviews with 27 Danish patients were conducted over a period of 9 months, from February to October 2020. Interviews were analysed using thematic analysis. The analysis was guided by Nelly Oudshoorn's concept of technogeography of care. RESULTS The following three themes were identified in the data: VC-home dynamics: balancing boundaries; VC-workplace dynamics: logistical considerations; and VC-body image dynamics: on-screen exposure. CONCLUSIONS Taking human geography and science and technology studies as our analytical point of departure, we used the concept of technogeography of care and demonstrated how the reciprocal dynamics between patients' choice of place and how they experience VC made boundaries fluid and complex between different contexts and places, such as the home, the workplace and the clinic. These boundaries were negotiated differently by the patients depending on their need for privacy, convenience and support. Additionally, VC reconfigured patients' and general practitioners' roles, increasing patients' responsibility in securing an appropriate health care setting.
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Affiliation(s)
- Elle C. Lüchau
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Carole Jepsen
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Anette Grønning
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
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86
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Cliffe S, Stevenson K. Patient experiences of virtual consultation during COVID 19: A musculoskeletal service evaluation. Musculoskeletal Care 2020; 19:380-383. [PMID: 33370498 DOI: 10.1002/msc.1534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Stephanie Cliffe
- Rheumatology Centre Haywood Hospital, Burslem, Stoke on Trent Staffordshire, UK
| | - Kay Stevenson
- Rheumatology Centre Haywood Hospital, Burslem, Stoke on Trent Staffordshire, UK.,Impact Accelerator Unit, Keele University, Keele Staffordshire, UK
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87
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Mulvihill C, Cooper J, Pavey J, Laake JP. Remote consultations in primary care during the COVID-19 pandemic: student perspectives. Postgrad Med J 2020; 98:e88-e89. [PMID: 33115908 DOI: 10.1136/postgradmedj-2020-139149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Josh Pavey
- Warwick Medical School, University of Warwick, Coventry, UK
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88
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Tenforde AS, Borgstrom H, Polich G, Steere H, Davis IS, Cotton K, O'Donnell M, Silver JK. Outpatient Physical, Occupational, and Speech Therapy Synchronous Telemedicine: A Survey Study of Patient Satisfaction with Virtual Visits During the COVID-19 Pandemic. Am J Phys Med Rehabil 2020; 99:977-981. [PMID: 32804713 PMCID: PMC7526401 DOI: 10.1097/phm.0000000000001571] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The COVID-19 pandemic transformed health care delivery, including rapid expansion of telehealth. Telerehabilitation, defined as therapy provided by physical therapy, occupational therapy, and speech and language pathology, was rapidly adopted with goals to provide access to care and limit contagion. The purpose of this brief report was to describe the feasibility of and satisfaction with telerehabilitation. A total of 205 participants completed online surveys after a telerehabilitation visit. Most commonly, participants were women (53.7%), 35-64 yrs old, and completed physical therapy (53.7%) for established visits of 30-44 mins in duration for primary impairments in sports, lower limb injuries, and pediatric neurology. Overall, high ratings ("excellent" or "very good" responses) were observed for all patient-centered outcome metrics (range, 93.7%-99%) and value in future telehealth visit (86.8%) across telerehabilitation visits. Women participated more frequently and provided higher ratings than male participants did. Other benefits included eliminating travel time, incorporating other health care advocates, and convenience delivering care in familiar environment to pediatric patients. Technology and elements of hands-on aspects of care were observed limitations. Recognizing reduced indirect costs of care that telerehabilitation may provide along with high patient satisfaction are reasons policy makers should adopt these services into future health care delivery models.
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Affiliation(s)
- Adam S Tenforde
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (AST, HB, GP, HS, ISD, JKS); Spaulding Rehabilitation Hospital, Boston, Massachusetts (AST, HB, GP, HS, ISD, JKS); Brigham and Women's Hospital, Boston, Massachusetts (GP, JKS); Spaulding Outpatient Center Wellesley, Wellesley, Massachusetts (KC); Spaulding Outpatient Center for Children Lexington, Lexington, Massachusetts (MO); and Massachusetts General Hospital, Boston, Massachusetts (JKS)
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89
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Srinivasan M, Asch S, Vilendrer S, Thomas SC, Bajra R, Barman L, Edwards LM, Filipowicz H, Giang L, Jee O, Mahoney M, Nelligan I, Phadke AJ, Torres E, Artandi M. Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center. Ann Intern Med 2020; 173:527-535. [PMID: 32628536 PMCID: PMC7370832 DOI: 10.7326/m20-1814] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 pandemic spurred health systems across the world to quickly shift from in-person visits to safer video visits. OBJECTIVE To seek stakeholder perspectives on video visits' acceptability and effect 3 weeks after near-total transition to video visits. DESIGN Semistructured qualitative interviews. SETTING 6 Stanford general primary care and express care clinics at 6 northern California sites, with 81 providers, 123 staff, and 97 614 patient visits in 2019. PARTICIPANTS 53 program participants (overlapping roles as medical providers [n = 20], medical assistants [n = 16], nurses [n = 4], technologists [n = 4], and administrators [n = 13]) were interviewed about video visit transition and challenges. INTERVENTION In 3 weeks, express care and primary care video visits increased from less than 10% to greater than 80% and from less than 10% to greater than 75%, respectively. New video visit providers received video visit training and care quality feedback. New system workflows were created to accommodate the new visit method. MEASUREMENTS 9 faculty, trained in qualitative research methods, conducted 53 stakeholder interviews in 4 days using purposeful (administrators and technologists) and convenience (medical assistant, nurses, and providers) sampling. A rapid qualitative analytic approach for thematic analysis was used. RESULTS The analysis revealed 12 themes, including Pandemic as Catalyst; Joy in Medicine; Safety in Medicine; Slipping Through the Cracks; My Role, Redefined; and The New Normal. Themes were analyzed using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to identify critical issues for continued program utilization. LIMITATIONS Evaluation was done immediately after deployment. Although viewpoints may have evolved later, immediate evaluation allowed for prompt program changes and identified broader issues to address for program sustainability. CONCLUSION After pandemic-related systems transformation at Stanford, critical issues to sustain video visit long-term viability were identified. Specifically, technology ease of use must improve and support multiparty videoconferencing. Providers should be able to care for their patients, regardless of geography. Providers need decision-making support with virtual examination training and home-based patient diagnostics. Finally, ongoing video visit reimbursement should be commensurate with value to the patients' health and well-being. PRIMARY FUNDING SOURCE Stanford Department of Medicine and Stanford Health Care.
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Affiliation(s)
- Malathi Srinivasan
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | - Steven Asch
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | - Stacie Vilendrer
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | - Samuel Crandall Thomas
- Stanford University School of Medicine and Intermountain Delivery Institute, Intermountain Healthcare, Palo Alto, California (S.C.T.)
| | - Rika Bajra
- Stanford University School of Medicine, Portola Valley, California (R.B.)
| | - Linda Barman
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | | | | | - Lena Giang
- Stanford Health Care, Palo Alto, California (H.F., L.G.)
| | - Olivia Jee
- Stanford University School of Medicine, Los Altos, California (L.M.E., O.J.)
| | - Megan Mahoney
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | - Ian Nelligan
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | - Anuradha Jayant Phadke
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | - Elise Torres
- Stanford University School of Medicine, Santa Clara, California (E.T.)
| | - Maja Artandi
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
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90
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[Remote consultation: information for Primary Care physicians]. Semergen 2020; 46:560-565. [PMID: 33239153 PMCID: PMC7524681 DOI: 10.1016/j.semerg.2020.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/17/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022]
Abstract
Con la pandemia actual se ha abierto la posibilidad de usar herramientas tecnológicas, como la teleconsulta o consulta no presencial. En zonas rurales, o incluso en zonas semiurbanas, el acceso a servicios médicos puede verse restringido debido a problemas de transporte; en otros lugares el acceso a las consultas se ve limitado para evitar el contagio del paciente o del personal sanitario. Por estas razones se utilizan soluciones tecnológicas que permitan controlar a los pacientes a distancia, especialmente en el caso de pacientes crónicos, o como una forma de triaje a posibles pacientes con coronavirus. Lamentablemente este tipo de sistemas no se ha utilizado con la misma continuidad que en otros países y muchas veces nuestro personal sanitario desconoce la manera correcta de hacer una teleconsulta (por teléfono o video). Con este documento queremos ayudar a orientar de manera inicial cómo efectuar una teleconsulta en Atención Primaria.
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91
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Patel T, Wong J. The role of real-time interactive video consultations in dental practice during the recovery and restoration phase of the COVID-19 outbreak. Br Dent J 2020; 229:196-200. [PMID: 32811949 PMCID: PMC7431749 DOI: 10.1038/s41415-020-1918-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID-19 outbreak has caused many challenges for the dental profession and workforce. With the suspension of routine dental services at the end of March 2020, there is a significant number of the general population with acute dental problems. In addition to these, there are patients who had treatment suspended partway through their treatment plans and therefore there is now a backlog of patients awaiting dental care. One challenge that will face the profession moving forward will be facilitating access to these patients and determining which patients should be seen as a priority for necessary dental care. This article looks at the role of real-time interactive video consultations in dental practice during the recovery and restoration phase of the COVID-19 outbreak and how they could facilitate the management of patients waiting to access dental care.
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Affiliation(s)
- Trishna Patel
- , HEE Leadership Fellow with clinical experience in paediatric dentistry, UK.
| | - Jason Wong
- , Dental local professional network chair NHS England & NHS Improvement Midlands, UK
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92
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Tenforde AS, Iaccarino MA, Borgstrom H, Hefner JE, Silver J, Ahmed M, Babu AN, Blauwet CA, Elson L, Eng C, Kotler D, Homer S, Makovitch S, McInnis KC, Vora A, Borg-Stein J. Telemedicine During COVID-19 for Outpatient Sports and Musculoskeletal Medicine Physicians. PM R 2020; 12:926-932. [PMID: 32424977 PMCID: PMC7276758 DOI: 10.1002/pmrj.12422] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022]
Abstract
Introduction The global pandemic due to SARS‐CoV‐2 has resulted in an expansion of telemedicine. Measures of quality and barriers for rapid use by patients and physicians are not well described. Objective To describe results from a quality improvement initiative during a rapid adoptive phase of telemedicine during the pandemic. Design Patient and physician satisfaction with synchronous audiovisual telemedicine visits was measured during the early adoptive phase (6 April 2020‐17 April 2020) within the division of sports medicine in an academic Physical Medicine and Rehabilitation (PM&R) department. Patients were invited to participate in a quality improvement initiative by completing an online survey at the end of a telemedicine visit. Physicians completed a separate survey. Primary Outcome Measures Patient measures included visit type, duration of encounter, quality, and satisfaction. Physicians reported on experiences performed telemedicine. Results Surveys were completed by 119 patients (293 telemedicine encounters, response rate 40.6%) and 14 physiatrists. Telemedicine was utilized primarily for follow‐up visits (n = 74, 70.6%), and the most common duration was 15 to 29 minutes. Patients rated their telemedicine visit as “excellent” or “very good” across measures (91.6%‐95.0%) including addressing concerns, communication, developing a treatment plan, convenience, and satisfaction. Value of completing a future telemedicine visit was measured at 84.9%. Most reported estimated travel time saved was in excess of 30 minutes. Rate of no‐show was 2.7%. Most physicians (57.1%) had no prior experience with telemedicine visits, and most were comfortable performing these visits after completing 1 to 4 sessions (71%). Nearly all physicians (92.9%) rated their telemedicine experience as very good or excellent. The key barrier identified for telemedicine was technical issues. All physicians reported plans to perform telemedicine visits if reimbursement continues. Conclusions In summary, rapid expansion of telemedicine during the COVID‐19 pandemic was well‐received by a majority of patients and physicians. This suggests feasibility in rapid expansion of telemedicine for other outpatient sports medicine practices.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Mary A Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Haylee Borgstrom
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Jaye E Hefner
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Julie Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Marwa Ahmed
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Ashwin N Babu
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Lauren Elson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Christine Eng
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Dana Kotler
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Scott Homer
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Steven Makovitch
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Kelly C McInnis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Ariana Vora
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Joanne Borg-Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
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93
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Atallah B, El Lababidi R, Jesse W, Noor L, AlMahmeed W. Adapting to the COVID-19 Pandemic at a Quaternary Care Hospital in the Middle East Gulf Region. HEART VIEWS : THE OFFICIAL JOURNAL OF THE GULF HEART ASSOCIATION 2020; 21:133-140. [PMID: 33688399 PMCID: PMC7898996 DOI: 10.4103/heartviews.heartviews_168_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Bassam Atallah
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Department of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Rania El Lababidi
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - William Jesse
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Lubna Noor
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Wael AlMahmeed
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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95
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Gorodeski EZ, Goyal P, Cox ZL, Thibodeau JT, Reay RE, Rasmusson K, Rogers JG, Starling RC. Virtual Visits for Care of Patients with Heart Failure in the Era of COVID-19: A Statement from the Heart Failure Society of America. J Card Fail 2020; 26:448-456. [PMID: 32315732 PMCID: PMC7166039 DOI: 10.1016/j.cardfail.2020.04.008] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022]
Abstract
In response to the COVID-19 pandemic, US federal and state governments have implemented wide-ranging stay-at-home recommendations as a means to reduce spread of infection. As a consequence, many US healthcare systems and practices have curtailed ambulatory clinic visits-pillars of care for patients with heart failure (HF). In this context, synchronous audio/video interactions, also known as virtual visits (VVs), have emerged as an innovative and necessary alternative. This scientific statement outlines the benefits and challenges of VVs, enumerates changes in policy and reimbursement that have increased the feasibility of VVs during the COVID-19 era, describes platforms and models of care for VVs, and provides a vision for the future of VVs.
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Affiliation(s)
- Eiran Z Gorodeski
- Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH.
| | | | - Zachary L Cox
- Lipscomb University College of Pharmacy and Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Kismet Rasmusson
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
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96
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Stommel WJP, van Goor H, Stommel MWJ. The Impact of Video-Mediated Communication on Closed Wound Assessments in Postoperative Consultations: Conversation Analytical Study. J Med Internet Res 2020; 22:e17791. [PMID: 32310816 PMCID: PMC7238083 DOI: 10.2196/17791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Research on the use of video-mediated technology for medical consultations is increasing rapidly. Most research in this area is based on questionnaires and focuses on long-term conditions. The few studies that have focused on physical examinations in video consultations indicated that it poses challenges for the participants. The specific activity of wound assessment through video in postsurgery consultations has not yet been studied. Furthermore, a comparative analysis of face-to-face and video settings on the moment-to-moment organization of such an activity is original. OBJECTIVE The aim of this study was to examine the impact of video technology on the procedure of postsurgery wound assessment and its limits. METHODS We recorded 22 postoperative video consultations and 17 postoperative face-to-face consultations. The primary purpose of the consultation was to inform the patient about the final pathology results of the resected specimen, and the secondary purpose was to check on the patient's recovery, including an assessment of the closed wound. The recordings were transcribed in detail and analyzed using methods of conversation analysis. RESULTS The way that an assessment of the wound is established in video consultations differs from the procedure in face-to-face consultations. In the consultation room, wound assessments overwhelmingly (n=15/17) involve wound showings in the context of surgeons reporting their observations formatted with evidentials ("looks neat") and subsequently assessing what these observations imply or what could be concluded from them. In contrast, wound assessments in video consultations do not tend to involve showing the wound (n=3/22) and, given the technological restrictions, do not involve palpation. Rather, the surgeon invites the patient to assess the wound, which opens up a sequence of patient and physician assessments where diagnostic criteria such as redness or swollenness are made explicit. In contrast to observations in regular consultations, these assessments are characterized by epistemic markers of uncertainty ("I think," "sounds...good") and evidentials are absent. Even in cases of a potential wound problem, the surgeon may rely on questioning the patient rather than requesting a showing. CONCLUSIONS The impact of video technology on postoperative consultations is that a conclusive wound assessment is arrived at in a different way when compared to face-to-face consultations. In video consultations, physicians enquire and patients provide their own observations, which serve as the basis for the assessment. This means that, in video consultations, patients have a fundamentally different role. These talking-based assessments are effective unless, in cases of a potential problem, patient answers seem insufficient and a showing might be beneficial.
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Affiliation(s)
- Wyke J P Stommel
- Centre for Language Studies, Radboud University, Nijmegen, Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Martijn W J Stommel
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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97
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Exploring patients' and clinicians' experiences of video consultations in primary care: a systematic scoping review. BJGP Open 2020; 4:bjgpopen20X101020. [PMID: 32184212 PMCID: PMC7330183 DOI: 10.3399/bjgpopen20x101020] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 12/26/2022] Open
Abstract
Background Video consultation (VC) is an emerging consultation mode in general practice. The challenges and benefits of implementing it are not necessarily realised until it is in use, and being experienced by patients and clinicians. To date, there has been no review of the evidence about how patients and clinicians experience VC in general practice. Aim The study aimed to explore both patients' and clinicians' experiences of VCs in primary care. Design & setting A systematic scoping review was carried out of empirical studies. Method All major databases were searched for empirical studies of any design, published from 1 January 2010 to 11 October 2018 in the English language. Studies were included where synchronous VCs occurred between a patient and a clinician in a primary care setting. Outcomes of interest related to experience of use. The quality of included studies were assessed. Findings were analysed using narrative synthesis. Results Seven studies were included in the review. Patients reported being satisfied with VC, describing reduced waiting times and travel costs as a benefit. For patients and clinicians, VC was not deemed appropriate for all presentations and all situations, and a face-to-face consultation was seen as preferable where this was possible. Conclusion The findings of this scoping review show that primary care patients and clinicians report both positive and negative experiences when using VCs, and these experiences are, to a certain extent, context dependent. VC is potentially more convenient for patients, but is not considered superior to a face-to-face consultation. Accounts of experience are useful in the planning and implementation of any VC service.
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