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A review of audiovisual telemedicine utilization and satisfaction assessment during the COVID-19 pandemic. Int J Technol Assess Health Care 2021; 38:e2. [PMID: 34924067 DOI: 10.1017/s026646232100060x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The use of telemedicine has broadened as technology that both restores continuity of care during disruptions in healthcare delivery and routinely provides primary care alone or in combination with in-person care. During the Covid-19 outbreak, the use of telemedicine as a routine care modality further accelerated. METHODS A review of scientific studies that used telemedicine to provide care from December 2019 to December 2020 is presented. From an initial set of 2,191 articles, 36 studies are analyzed. Evidence is organized and evaluated according to the country of study, the clinical specialty, the technology platform used, and satisfaction and utilization outcomes. RESULTS Thirty-one studies reported high patient satisfaction scores. Eight studies reported satisfaction from both providers and patients with no uniformly accepted assessment instrument. Eight studies conducted a descriptive analysis of telemedicine use and patient adoption patterns. Less than one-third of studies were controlled before/after studies. Most studies were conducted in the USA followed by Europe. CONCLUSIONS Reported satisfaction rates are high, consistent with previously documented research, whereas utilization rates increased significantly compared with the prepandemic period. Future work in developing standardized uniform assessment instruments, embedded with each telemedicine system, would increase versatility and agility in the assessment, boosting statistical power and the interpretation of results.
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Shaw SE, Hughes G, Wherton J, Moore L, Rosen R, Papoutsi C, Rushforth A, Morris J, Wood GW, Faulkner S, Greenhalgh T. Achieving Spread, Scale Up and Sustainability of Video Consulting Services During the COVID-19 Pandemic? Findings From a Comparative Case Study of Policy Implementation in England, Wales, Scotland and Northern Ireland. Front Digit Health 2021; 3:754319. [PMID: 34988546 PMCID: PMC8720935 DOI: 10.3389/fdgth.2021.754319] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Requirements for physical distancing as a result of COVID-19 and the need to reduce the risk of infection prompted policy supporting rapid roll out of video consulting across the four nations of the UK-England, Northern Ireland, Scotland and Wales. Drawing on three studies of the accelerated implementation and uptake of video consulting across the four nations, we present a comparative and interpretive policy analysis of the spread and scale-up of video consulting during the pandemic. Data include interviews with 59 national level stakeholders, 55 health and social care staff and 30 patients, 20 national documents, responses to a UK-wide survey of NHS staff and analysis of routine activity data. Sampling ensured variations in geography, clinical context and adoption progress across the combined dataset. Comparative analysis was guided by theory on policy implementation and crisis management. The pandemic provided a "burning platform" prompting UK-wide policy supporting the use of video consulting in health care as a critical means of managing the risk of infection and a standard mode of provision. This policy push facilitated interest in video consulting across the UK. There was, however, marked variation in how this was put into practice across the four nations. Pre-existing infrastructure, policies and incentives for video consulting in Scotland, combined with a collaborative system-level approach, a program dedicated to developing video-based services and resourcing and supporting staff to deliver them enabled widespread buy-in and rapid spread. In England, Wales and Northern Ireland, pre-existing support for digital health (e.g., hardware, incentives) and virtual care, combined with reduced regulation and "light touch" procurement managed to override some (but by no means all) cultural barriers and professional resistance to implementing digital change. In Northern Ireland and Wales, limited infrastructure muted spread. In all three countries, significant effort at system level to develop, review and run video consulting programs enabled a substantial number of providers to change their practice, albeit variably across settings. Across all four nations ongoing uncertainty, potential restructuring and tightening of regulations, along with difficulties inherent in addressing inequalities in digital access, raise questions about the longer-term sustainability of changes to-date.
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Affiliation(s)
- Sara E. Shaw
- 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
| | - Joseph Wherton
- 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
| | - Alex Rushforth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joanne Morris
- Joint Research Management Office, Barts Health NHS Trust, London, United Kingdom
| | - Gary W. Wood
- Independent Research Consultant, Birmingham, United Kingdom
| | - Stuart Faulkner
- 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
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Kierkegaard P, Hicks T, Allen AJ, Yang Y, Hayward G, Glogowska M, Nicholson BD, Buckle P. Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel. Implement Sci Commun 2021; 2:139. [PMID: 34922624 PMCID: PMC8684208 DOI: 10.1186/s43058-021-00242-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians' attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. METHODS We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. RESULTS Several factors underpinned primary care physicians' attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians' willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians' confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians' perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. CONCLUSIONS Improving primary care physicians' knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
- CRUK Convergence Science Center, Institute for Cancer Research & Imperial College London, Roderic Hill Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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Shah SS, Safa A, Johal K, Obika D, Valentine S. A prospective observational real world feasibility study assessing the role of app-based remote patient monitoring in reducing primary care clinician workload during the COVID pandemic. BMC FAMILY PRACTICE 2021; 22:248. [PMID: 34911442 PMCID: PMC8674098 DOI: 10.1186/s12875-021-01594-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/22/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The novel coronavirus disease in 2019 (COVID-19) has placed unprecedented strain on healthcare providers, in particular, primary care services. General practitioners (GP) have to effectively manage patients remotely preserving social distancing. We aim to assess an app-based remote patient monitoring solution in reducing the workload of a clinician and reflect this as time-saved in an economic context. Primary care COVID patients in West London deemed medium risk were recruited into the virtual ward. Patients were monitored for 14 days by telephone or by both the Huma app and telephone. Information on number of phone calls, duration of phone calls and duration of time spent reviewing the app data was recorded. RESULTS The amount of time spent reviewing one patient in the telephone only arm of the study was 490 min, compared with 280 min spent reviewing one patient who was monitored via both the Huma app and telephone. Based on employed clinicians monitoring patients, this equates to a 0.04 reduction of full-time equivalent staffing I.e. for every 100 patients, it would require 4 less personnel to remotely monitor them. There was no difference in mortality or adverse events between the two groups. CONCLUSION App-based remote patient monitoring potentially holds large economic benefit to COVID-19 patients. In wake of further waves or future pandemics, and even in routine care, app-based remote monitoring patients could free up vital resources in terms of clinical team's time, allowing a better reallocation of services.
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Affiliation(s)
| | - Afsana Safa
- GP, NHS Central London (Westminster) CCG, London, UK
| | | | - Dillon Obika
- Clinical and Scientific Team, Huma Therapeutics, London, UK
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155
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Alkureishi MA, Choo ZY, Rahman A, Ho K, Benning-Shorb J, Lenti G, Velázquez Sánchez I, Zhu M, Shah SD, Lee WW. Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions. JMIR Hum Factors 2021; 8:e33364. [PMID: 34705664 PMCID: PMC8675564 DOI: 10.2196/33364] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/14/2021] [Accepted: 10/24/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND As telemedicine utilization increased during the COVID-19 pandemic, divergent usage patterns for video and audio-only telephone visits emerged. Older, low-income, minority, and non-English speaking Medicaid patients are at highest risk of experiencing technology access and digital literacy barriers. This raises concern for disparities in health care access and widening of the "digital divide," the separation of those with technological access and knowledge and those without. While studies demonstrate correlation between racial and socioeconomic demographics and technological access and ability, individual patients' perspectives of the divide and its impacts remain unclear. OBJECTIVE We aimed to interview patients to understand their perspectives on (1) the definition, causes, and impact of the digital divide; (2) whose responsibility it is to address this divide, and (3) potential solutions to mitigate the digital divide. METHODS Between December 2020 and March 2021, we conducted 54 semistructured telephone interviews with adult patients and parents of pediatric patients who had virtual visits (phone, video, or both) between March and September 2020 at the University of Chicago Medical Center (UCMC) primary care clinics. A grounded theory approach was used to analyze interview data. RESULTS Patients were keenly aware of the digital divide and described impacts beyond health care, including employment, education, community and social contexts, and personal economic stability. Patients described that individuals, government, libraries, schools, health care organizations, and even private businesses all shared the responsibility to address the divide. Proposed solutions to address the divide included conducting community technology needs assessments and improving technology access, literacy training, and resource awareness. Recognizing that some individuals will never cross the divide, patients also emphasized continued support of low-tech communication methods and health care delivery to prevent widening of the digital divide. Furthermore, patients viewed technology access and literacy as drivers of the social determinants of health (SDOH), profoundly influencing how SDOH function to worsen or improve health disparities. CONCLUSIONS Patient perspectives provide valuable insight into the digital divide and can inform solutions to mitigate health and resulting societal inequities. Future work is needed to understand the digital needs of disconnected individuals and communities. As clinical care and delivery continue to integrate telehealth, studies are needed to explore whether having a video or audio-only phone visit results in different patient outcomes and utilization. Advocacy efforts to disseminate public and private resources can also expand device and broadband internet access, improve technology literacy, and increase funding to support both high- and low-tech forms of health care delivery for the disconnected.
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Affiliation(s)
| | - Zi-Yi Choo
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Ali Rahman
- University of Chicago, Chicago, IL, United States
| | - Kimberly Ho
- New York University Long Island School of Medicine, Mineola, NY, United States
| | | | - Gena Lenti
- Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | | | - Mengqi Zhu
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Sachin D Shah
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Wei Wei Lee
- Department of Medicine, University of Chicago, Chicago, IL, United States
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156
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COVID-19 pandemic and the great impulse to telemedicine: the basis of the WONCA Europe Statement on Telemedicine at the WHO Europe 70th Regional Meeting September 2020. Prim Health Care Res Dev 2021; 22:e80. [PMID: 34895388 PMCID: PMC8695945 DOI: 10.1017/s1463423621000633] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Telemedicine is the use of telecommunication and information technologies to support the delivery of healthcare at a distance, guaranteeing patients healthcare by facilitating access where barriers exist; the COVID-19 pandemic has attracted worldwide interest in this field. The purpose of this paper is to highlight the main pros and cons of telemedicine, which serve as the basis of the WONCA Europe Statement at the WHO Europe 70th Regional Meeting on 14 September 2020. Pros of telemedicine include virtual healthcare at home, where patients receive support in certain conditions without leaving their houses. During a pandemic, it can be adopted to limit physical human interaction. Unfortunately, it can negatively affect the quality of the doctor–patient relationship, the quality of the physical examination, and the quality of care. Telemedicine requires effective infrastructure and robust investments to be feasible and effective.
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157
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Hendry A, Tucker H. Guest editorial. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-10-2021-082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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158
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Xu B, Ng MSN, So WKW. A review of the prevalence, associated factors and interventions of psychological symptoms among cancer patients in the Chinese Mainland during the COVID-19 pandemic. Ecancermedicalscience 2021; 15:1332. [PMID: 35211201 PMCID: PMC8816509 DOI: 10.3332/ecancer.2021.1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 11/06/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) has placed tremendous pressure on public health systems across the world. Compared with the healthy population, cancer patients are more prone to developing psychological problems, including depression and anxiety, because of worries about cancer recurrence, cancer symptoms, treatment-related discomfort, a lack of social interaction and the impact on their financial well-being. This paper aimed to identify existing evidence on psychological symptoms and their associated factors among cancer patients in the Chinese Mainland during the COVID-19 pandemic, and on interventions to effectively manage these symptoms. Articles related to the prevalence, the risk factors and interventions of psychological symptoms among cancer patients in the Chinese Mainland during COVID-19 published between December 2019 and August 2020 were searched in two English (PubMed and Embase) and two Chinese (CNKI and Wan Fang Data) databases. A total of 180 studies were identified, and 18 studies were included in the review after removing duplicates and screening for relevancy. The results suggest that patients with cancer in the Chinese Mainland have suffered psychological pressure during COVID-19, with a high prevalence of psychological distress, depression and anxiety reported across most of the reviewed studies. Pandemic-related factors such as treatment discontinuation and worry about being infected are associated with these symptoms. Nurses may help to relieve these symptoms by identifying stressors, providing relevant information through mass and social media and referring patients to specialists for psychological support. However, evidence about treatments and interventions for these symptoms is limited, and additional research is warranted to identify effective interventions to promote resilience in this patient population.
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Affiliation(s)
- Binbin Xu
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6/F, Esther Lee Building, The Chinese University of Hong Kong, Hong Kong, China
| | - Marques S N Ng
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6/F, Esther Lee Building, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6/F, Esther Lee Building, The Chinese University of Hong Kong, Hong Kong, China
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159
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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: 11] [Impact Index Per Article: 3.7] [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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160
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Gunner CK, Eisner E, Watson AJM, Duncan JL. Teaching webside manner: development and initial evaluation of a video consultation skills training module for undergraduate medical students. MEDICAL EDUCATION ONLINE 2021; 26:1954492. [PMID: 34313579 PMCID: PMC8317946 DOI: 10.1080/10872981.2021.1954492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/17/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Video consultations are increasingly used to communicate with patients, particularly during the current COVID-19 pandemic. However, training in video consultation skills receives scant attention in the literature. We sought to introduce this important topic to our undergraduate medical school curriculum. OBJECTIVE To increase final year medical students' video consultation skills and knowledge. METHODS We used Plan, Do, Study, Act (PDSA) quality improvement methodology with a pre-post study design to develop a teaching session for 5th year medical students, informed by a literature review and online clinician survey. The 2 hour session comprised an introduction and three practical stations: patient selection and ethics, technology and example videos, and simulation. Subjective pre- and post-session confidence was reported by students across seven domains using 5-point scales (1: not at all confident; 5: extremely confident). Students and facilitators completed post-session feedback forms. RESULTS The 40 students and 3 facilitators who attended, over two separate teaching sessions, provided unanimously positive feedback. All students considered the session relevant. Subjective confidence ratings (n = 34) significantly increased from pre- to post-session (mean increase 1.78, p < 0.001). CONCLUSIONS The inaugural teaching session was well-received and subjective assessment measures showed improvement in taught skills. This pilot has informed a UK-wide multi-centre study with subjective and objective data collection.
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Affiliation(s)
| | - Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK AND Research and Innovation Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Angus JM Watson
- Department of Colorectal Surgery, NHS Highland, Inverness, UK
| | - John L. Duncan
- Highlands Medical Education Centre, University of Aberdeen, Inverness, UK
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161
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Milos Nymberg V, Ellegård LM, Kjellsson G, Wolff M, Borgström Bolmsjö B, Wallman T, Calling S. Trends in remote health care consumption in Sweden: A comparison before and during the first wave of the Covid-19 pandemic. JMIR Hum Factors 2021; 9:e33034. [PMID: 34846304 PMCID: PMC8812677 DOI: 10.2196/33034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/25/2021] [Accepted: 11/28/2021] [Indexed: 01/30/2023] Open
Abstract
Background Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been put against a questionable quality of care as well as risks of increased utilization and costs. The COVID-19 pandemic has contributed to a changed management of patient care to decrease viral spread, with an expected shift in contact types from in-person to remote ones. Objective The main aim of this study was to compare health care consumption and type of contacts (in-person or remote) for RTIs before and during the COVID-19 pandemic. The second aim was to study whether the number of follow-up contacts after an index contact for RTIs changed during the study period, and whether the number of follow-up contacts differed if the index contact was in-person or remote. A third aim was to study whether the pattern of follow-up contacts differed depending on whether the index contact was with a traditional or a private telemedicine provider. Methods The study design was an observational retrospective analysis with a description of all index contacts and follow-up contacts with physicians in primary care and emergency rooms in a Swedish region (Skåne) for RTIs including patients of all ages and comparison for the same periods in 2018, 2019, and 2020. Results Compared with 2018 and 2019, there were fewer index contacts for RTIs per 1000 inhabitants in 2020. By contrast, the number of follow-up contacts, both per 1000 inhabitants and per index contact, was higher in 2020. The composition of both index and follow-up contacts changed as the share of remote contacts, in particular for traditional care providers, increased. Conclusions During the COVID-19 pandemic in 2020, fewer index contacts for RTIs but more follow-up contacts were conducted, compared with 2018-2019. The share of both index and follow-up contacts that were conducted remotely increased. Further studies are needed to study the reasons behind the increase in remote contacts, and if it will last after the pandemic, and more clinical guidelines for remote assessments of RTI are warranted.
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Affiliation(s)
- Veronica Milos Nymberg
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, SE
| | - Lina Maria Ellegård
- Department of eEconomics, Lund University, Lund, SE.,Department of Business Administration, Kristianstad University, Kristianstad, SE
| | - Gustav Kjellsson
- Department of Economics, University of Gothenburg, Gothenburg, SE
| | - Moa Wolff
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, SE
| | - Beata Borgström Bolmsjö
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, SE
| | - Thorne Wallman
- Public Health & Caring Sciences, Family Medicine & Preventive Medicine Section, Uppsala University, Uppsala, SE
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, SE
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162
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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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Parkinson A, Brew-Sam N, Hall Dykgraaf S, Nolan C, Lafferty A, Schmidli R, Brown E, Brown K, Pedley L, Ebbeck H, Pedley E, Wright K, Phillips C, Desborough J. Managing type 1 diabetes during the COVID-19 pandemic is a team effort: a qualitative study of the experiences of young people and their parents. INTEGRATED HEALTHCARE JOURNAL 2021; 3:e000082. [PMID: 38607941 PMCID: PMC8593267 DOI: 10.1136/ihj-2021-000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/26/2021] [Indexed: 11/03/2022] Open
Abstract
Objective To explore the experiences of young people with type 1 diabetes mellitus (T1DM) and their parents in accessing integrated family-centred care in the Australian Capital Territory during the COVID-19 pandemic. Methods and analysis This is a pragmatic, qualitative descriptive study for which we conducted semistructured interviews with 11 young people with T1DM aged 12-16 years and 10 of their parents who attended an outpatient diabetes service in Canberra, Australia. Thematic analysis was conducted in accordance with the methods outlined by Braun and Clarke. Results Three themes were identified: feeling vulnerable, new ways of accessing care and trust in the interdisciplinary diabetes healthcare team. Participants believed having T1DM made them more vulnerable to poor outcomes if they contracted COVID-19, resulting in avoidance of face-to-face care. Telephone consultations offered a convenient and contact-free way to undertake 3-monthly reviews. The greatest difference between telephone and face-to-face consultations was not having access to the whole interdisciplinary diabetes support team at one appointment, physical examination and haemoglobin A1c testing during telehealth consultations. Participants trusted that clinicians would arrange face-to-face meetings if required. Some felt a video option might be better than telephone, reflecting in part the need for more training in communication skills for remote consultations. Conclusion Young people with T1DM and their parents require collaborative care and contact with multiple healthcare professionals to facilitate self-management and glycaemic control. While telephone consultations offered convenient, safe, contact-free access to healthcare professionals during the COVID-19 pandemic, the added value of video consultations and facilitating access to the whole interdisciplinary diabetes support team need to be considered in future clinical implementation of telehealth.
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Affiliation(s)
- Anne Parkinson
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicola Brew-Sam
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sally Hall Dykgraaf
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christopher Nolan
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Antony Lafferty
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Robert Schmidli
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Ellen Brown
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Brown
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lachlan Pedley
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Harry Ebbeck
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Elizabeth Pedley
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kristine Wright
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
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Diaz-Skeete YM, McQuaid D, Akinosun AS, Ekerete I, Carragher N, Carragher L. Analysis of Apps With a Medication List Functionality for Older Adults With Heart Failure Using the Mobile App Rating Scale and the IMS Institute for Healthcare Informatics Functionality Score: Evaluation Study. JMIR Mhealth Uhealth 2021; 9:e30674. [PMID: 34726613 PMCID: PMC8596242 DOI: 10.2196/30674] [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: 05/24/2021] [Revised: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 12/21/2022] Open
Abstract
Background Managing the care of older adults with heart failure (HF) largely centers on medication management. Because of frequent medication or dosing changes, an app that supports these older adults in keeping an up-to-date list of medications could be advantageous. During the COVID-19 pandemic, HF outpatient consultations are taking place virtually or by telephone. An app with the capability to share a patient’s medication list with health care professionals before consultation could support clinical efficiency, for example, by reducing consultation time. However, the influence of apps on maintaining an up-to-date medication history for older adults with HF in Ireland remains largely unexplored. Objective The aims of this review are twofold: to review apps with a medication list functionality and to assess the quality of the apps included in the review using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scale. Methods A systematic search of apps was conducted in June 2019 using the Google Play Store and iTunes App Store. The MARS was used independently by 4 researchers to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality score. Results Google Play and iTunes App store searches identified 483 potential apps (292 from Google Play and 191 from iTunes App stores). A total of 6 apps (3 across both stores) met the inclusion criteria. Of the 6 apps, 4 achieved an acceptable MARS score (3/5). The Medisafe app had the highest overall MARS score (4/5), and the Medication List & Medical Records app had the lowest overall score (2.5/5). On average, the apps had 8 functions based on the IMS functionality criteria (range 5-11). A total of 2 apps achieved the maximum score for number of features (11 features) according to the IMS Institute for Healthcare Informatics functionality score, and 2 scored the lowest (5 features). Peer-reviewed publications were identified for 3 of the apps. Conclusions The quality of current apps with medication list functionality varies according to their technical aspects. Most of the apps reviewed have an acceptable MARS objective quality (ie, the overall quality of an app). However, subjective quality (ie, satisfaction with the apps) was poor. Only 3 apps are based on scientific evidence and have been tested previously. A total of 2 apps featured all the IMS Institute for Healthcare Informatics functionalities, and half did not provide clear instructions on how to enter medication data, did not display vital parameter data in an easy-to-understand format, and did not guide users on how or when to take their medication.
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Affiliation(s)
| | | | | | | | - Natacha Carragher
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.,Alcohol, Drugs and Addictive Behaviours, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Lucia Carragher
- NetwellCASALA Advanced Research Centre, Dundalk Institute of Technology, Dundalk, Ireland
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Scherer J, Osterhoff G, Kaufmann E, Estel K, Neuhaus V, Willy C, Hepp P, Pape HC, Back DA. What is the acceptance of video consultations among orthopedic and trauma outpatients? A multi-center survey in 780 outpatients. Injury 2021; 52:3304-3308. [PMID: 33648741 DOI: 10.1016/j.injury.2021.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/15/2021] [Accepted: 02/12/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of the present study was to assess orthopedic and orthopedic trauma patients' willingness to perform hypothetical remote video consultations, possible advantages as well as concerns. METHODS Between June 2019 and November 2019, a survey amongst consecutive regular orthopedic and orthopedic trauma patients at the outpatient clinics from three European level I trauma centers was conducted via paper-based questionnaires, composed of participants` demographics as well as five open and closed questions. Participation was voluntary and anonymity was granted. RESULTS In total, 780 participants (female 302, 38.7%, male 478, 61.3%) with a mean age of 43.8 years (SD 17.1, range from 14 years to 94 years) were included. The majority of the participants (57,6%) were eager to use a remote consultation. Participants with an age of more than 55 years were significantly less likely to use a remote consultation than their younger counterparts (OR= 0.18, p=0.003. r2=0.141). Among the whole study population, 86.2% stated, that they had a device compatible with an online video consultation. The highest willingness to conduct a video consultation in respect of the participants` occupation was observed in "part-time"-jobs (70.6%), whereas the lowest disposition was seen in retired patients (37.1%) (p= 0.0001). The most stated reason why to conduct a video consultation was "communication of medical findings" (67.8%). The most stated advantage was the "reduction of physical consultations" (66.4%). "No physical examination" was the most frequently stated disadvantage (75.9%). CONCLUSION The majority of orthopedic and orthopedic trauma outpatients would use a video consultation, especially because of commuting and time issues and ideally to communicate medical findings, such as x-ray reports or lab values. Elderly patients appear to be less eager in regard to video consultations. These results may change for even better acceptance in view of a current pandemic situation, as experienced since early 2020. We feel that this assumption may warrant further investigation.
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Affiliation(s)
- Julian Scherer
- Department of Traumatology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - Georg Osterhoff
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Ernest Kaufmann
- Department of Urology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Katharina Estel
- Bundeswehr Hospital Berlin, Clinic of Traumatology and Orthopedics, Berlin, Germany
| | - Valentin Neuhaus
- Department of Traumatology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Christian Willy
- Bundeswehr Hospital Berlin, Clinic of Traumatology and Orthopedics, Berlin, Germany
| | - Pierre Hepp
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Hans-Christoph Pape
- Department of Traumatology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - David A Back
- Bundeswehr Hospital Berlin, Clinic of Traumatology and Orthopedics, Berlin, Germany; Charite University Medicine Berlin, Dieter Scheffner Center for Medical Teaching and Educational Research, Berlin, Germany
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Yadav L, Gill TK, Taylor A, De Young J, Chehade MJ. Identifying Opportunities, and Motivation to Enhance Capabilities, Influencing the Development of a Personalized Digital Health Hub Model of Care for Hip Fractures: Mixed Methods Exploratory Study. J Med Internet Res 2021; 23:e26886. [PMID: 34709183 PMCID: PMC8587193 DOI: 10.2196/26886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 02/06/2023] Open
Abstract
Background Most older people after a hip fracture injury never return to their prefracture status, and some are admitted to residential aged care facilities. Advancement of digital technology has helped in optimizing health care including self-management and telerehabilitation. Objective This study aims to understand the perspectives of older patients with hip fracture and their family members and residential aged caregivers on the feasibility of developing a model of care using a personalized digital health hub. Methods We conducted a mixed methods study in South Australia involving patients aged 50 years and older, their family members, and residential aged caregivers. Quantitative data analysis included basic demographic characteristics, and access to digital devices was analyzed using descriptive statistics. Spearman rank-order correlation was used to examine correlations between the perceived role of a personalized digital health hub in improving health and the likelihood of subsequent use. Findings from qualitative analysis were interpreted using constructs of capability, opportunity, and motivation to help understand the factors influencing the likelihood of potential personalized digital health hub use. Results This study recruited 100 participants—55 patients, 13 family members, and 32 residential aged caregivers. The mean age of the patients was 76.4 (SD 8.4, range 54-88) years, and 60% (33/55) of the patients were female. Approximately 50% (34/68) of the patients and their family members had access to digital devices, despite less than one-third using computers as part of their occupation. Approximately 72% (72/100) of the respondents thought that personalized digital health hub could improve health outcomes in patients. However, a moderate negative correlation existed with increasing age and likelihood of personalized digital health hub use (Spearman ρ=–0.50; P<.001), and the perceived role of the personalized digital health hub in improving health had a strong positive correlation with the likelihood of personalized digital health hub use by self (Spearman ρ=0.71; P<.001) and by society, including friends and family members (Spearman ρ=0.75; P<.001). Most patients (54/55, 98%) believed they had a family member, friend, or caregiver who would be able to help them use a personalized digital health hub. Qualitative analysis explored capability by understanding aspects of existing knowledge, including willingness to advance digital navigation skills. Access could be improved through supporting opportunities, and factors influencing intrinsic motivation were considered crucial for designing a personalized digital health hub–enabled model of care. Conclusions This study emphasized the complex relationship between capabilities, motivation, and opportunities for patients, their family members, and formal caregivers as a patient networked unit. The next stage of research will continue to involve a cocreation approach followed by iterative processes and understand the factors influencing the development and successful integration of complex digital health care interventions in real-world scenarios.
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Affiliation(s)
- Lalit Yadav
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.,Department of Orthopaedics & Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Tiffany K Gill
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Anita Taylor
- Department of Orthopaedics & Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Jennifer De Young
- Department of Orthopaedics & Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Mellick J Chehade
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Department of Orthopaedics & Trauma, Royal Adelaide Hospital, Adelaide, Australia
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Unintended consequences of online consultations: a qualitative study in UK primary care. Br J Gen Pract 2021; 72:e128-e137. [PMID: 34903520 PMCID: PMC8813120 DOI: 10.3399/bjgp.2021.0426] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/08/2021] [Indexed: 01/10/2023] Open
Abstract
Background Health services are increasingly using digital tools to deliver care, and online consultations are being widely adopted in primary care settings. The intended consequences of online consultations are to increase patient access to care and increase the efficiency of care. Aim To identify and understand the unintended consequences of online consultations in primary care. Design and setting Qualitative interview study in eight general practices using online consultation tools in South West and North West England between February 2019 and January 2020. Method Thematic analysis of semi-structured interviews with 19 patients and 18 general practice staff. Results Consequences of online consultations were identified that restricted patient access to care by making it difficult for some patients to communicate effectively with a GP and disadvantaging digitally-excluded patients. This stemmed from patient uncertainty about how their queries were dealt with, and whether practices used online consultations as their preferred method for patients to contact the practice. Consequences were identified that limited increases in practice efficiency by creating additional work, isolation, and dissatisfaction for some staff. Conclusion Unintended consequences often present operational challenges that are foreseeable and partly preventable. However, these challenges must be recognised and solutions resourced sufficiently. Not everyone may benefit and local decisions will need to be made about trade-offs. Process changes tailored to local circumstances are critical to making effective use of online consultation tools. Unintended consequences also present clinical challenges that result from asynchronous communication. Online consultation tools favour simple, well-formulated information exchange that leads to diffuse relationships and a more transactional style of medicine.
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ten Broeke CE, Himmelreich JC, Cals JW, Lucassen WA, Harskamp RE. The Roth score as a triage tool for detecting hypoxaemia in general practice: a diagnostic validation study in patients with possible COVID-19. Prim Health Care Res Dev 2021; 22:e56. [PMID: 34658321 PMCID: PMC8527530 DOI: 10.1017/s1463423621000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/22/2021] [Accepted: 04/20/2021] [Indexed: 01/02/2023] Open
Abstract
AIM To validate the Roth score as a triage tool for detecting hypoxaemia. BACKGROUNDS The virtual assessment of patients has become increasingly important during the corona virus disease (COVID-19) pandemic, but has limitations as to the evaluation of deteriorating respiratory function. This study presents data on the validity of the Roth score as a triage tool for detecting hypoxaemia remotely in potential COVID-19 patients in general practice. METHODS This cross-sectional validation study was conducted in Dutch general practice. Patients aged ≥18 with suspected or confirmed COVID-19 were asked to rapidly count from 1 to 30 in a single breath. The Roth score involves the highest number counted during exhalation (counting number) and the time taken to reach the maximal count (counting time).Outcome measures were (1) the correlation between both Roth score measurements and simultaneous pulse oximetry (SpO2) on room air and (2) discrimination (c-statistic), sensitivity, specificity and predictive values of the Roth score for detecting hypoxaemia (SpO2 < 95%). FINDINGS A total of 33 physicians enrolled 105 patients (52.4% female, mean age of 52.6 ± 20.4 years). A positive correlation was found between counting number and SpO2 (rs = 0.44, P < 0.001), whereas only a weak correlation was found between counting time and SpO2 (rs = 0.15, P = 0.14). Discrimination for hypoxaemia was higher for counting number [c-statistic 0.91 (95% CI: 0.85-0.96)] than for counting time [c-statistic 0.77 (95% CI: 0.62-0.93)]. Optimal diagnostic performance was found at a counting number of 20, with a sensitivity of 93.3% (95% CI: 68.1-99.8) and a specificity of 77.8% (95% CI: 67.8-85.9). A counting time of 7 s showed the best sensitivity of 85.7% (95% CI: 57.2-98.2) and specificity of 81.1% (95% CI: 71.5-88.6). CONCLUSIONS A Roth score, with an optimal counting number cut-off value of 20, maybe of added value for signalling hypoxaemia in general practice. Further external validation is warranted before recommending integration in telephone triage.
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Affiliation(s)
- Charlotte E.M. ten Broeke
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Jelle C.L. Himmelreich
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Jochen W.L. Cals
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - Wim A.M. Lucassen
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Ralf E. Harskamp
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences and Amsterdam Public Health, Amsterdam, the Netherlands
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Pradhan R, Peeters W, Boutong S, Mitchell C, Patel R, Faroug R, Roussot M. Virtual phone clinics in orthopaedics: evaluation of clinical application and sustainability. BMJ Open Qual 2021; 10:bmjoq-2021-001349. [PMID: 34645613 PMCID: PMC8515471 DOI: 10.1136/bmjoq-2021-001349] [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: 01/18/2021] [Accepted: 07/05/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Adoption of virtual clinics has been accelerated by the COVID-19 pandemic and they will continue to form an integral part of healthcare delivery. Our objective was to evaluate virtual clinics in orthopaedic practice and determine how to use them effectively and sustainably. METHODS We surveyed 100 consecutive patients participating in orthopaedic virtual phone clinic (VPC) at an academic hospital to evaluate patient satisfaction against face-to-face (F2F) consultations and obtain suggestions for improving patient experience, and we surveyed 23 clinicians who conducted orthopaedic VPCs in 2020. Data were correlated with clinic outcomes, reason for consultation, diagnosis, patient age and clinician grade. Consultation duration, clinician-associated costs and reimbursement were analysed. Significance was tested using two-tailed Student's t-test and Fisher's exact test. RESULTS Patient satisfaction (out of 5) for VPC was significantly lower than F2F (4.1 vs 4.5, p=0.0003), and a larger proportion of VPC scored <3 compared with F2F (11% vs 2%). Higher VPC scores were associated with appointments for delivering results and where patients felt clinical examination was not needed. Patients suggested introducing video capability, adhering to appointment time and offering the choice of VPC or F2F. Mean clinician satisfaction scores for VPC were 4.3/5 and suggested indications for VPC included: routine surveillance, communication of results, discussing/consenting for surgery and vulnerable patients. Integrating video, providing private rooms and offering patients time intervals for VPC were recommended. Current National Health Service VPC structures uses greater clinician resources and generates lower reimbursement than F2F consultations, resulting in 11.5% reduction in reimbursement. CONCLUSION VPC plays a valuable role when clinical evaluation has been performed or considered not necessary. Offering the choice of VPC or F2F, adding video capability and providing a time interval for VPC may reduce resource use and increase satisfaction. We recommend renegotiating VPC tariffs and cost-neutral modifications of clinic structure.
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Affiliation(s)
- Raj Pradhan
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Wouter Peeters
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Orthopaedics, University Hospital Antwerp, Edegem, Belgium
| | - Sara Boutong
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chris Mitchell
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rahul Patel
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rad Faroug
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Roussot
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
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Carr MJ, Wright AK, Leelarathna L, Thabit H, Milne N, Kanumilli N, Ashcroft DM, Rutter MK. Impact of COVID-19 restrictions on diabetes health checks and prescribing for people with type 2 diabetes: a UK-wide cohort study involving 618 161 people in primary care. BMJ Qual Saf 2021; 31:503-514. [PMID: 34642228 PMCID: PMC8520602 DOI: 10.1136/bmjqs-2021-013613] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/25/2021] [Indexed: 12/22/2022]
Abstract
Objective To compare rates of performing National Institute for Health and Care Excellence-recommended health checks and prescribing in people with type 2 diabetes (T2D), before and after the first COVID-19 peak in March 2020, and to assess whether trends varied by age, sex, ethnicity and deprivation. Methods We studied 618 161 people with T2D followed between March and December 2020 from 1744 UK general practices registered with the Clinical Practice Research Datalink. We focused on six health checks: haemoglobin A1c, serum creatinine, cholesterol, urinary albumin excretion, blood pressure and body mass index assessment. Regression models compared observed rates in April 2020 and between March and December 2020 with trend-adjusted expected rates derived from 10-year historical data. Results In April 2020, in English practices, rates of performing health checks were reduced by 76%–88% when compared with 10-year historical trends, with older people from deprived areas experiencing the greatest reductions. Between May and December 2020, the reduced rates recovered gradually but overall remained 28%–47% lower, with similar findings in other UK nations. Extrapolated to the UK population, there were ~7.4 million fewer care processes undertaken March–December 2020. In England, rates for new medication fell during April with reductions varying from 10% (95% CI: 4% to 16%) for antiplatelet agents to 60% (95% CI: 58% to 62%) for antidiabetic medications. Overall, between March and December 2020, the rate of prescribing new diabetes medications fell by 19% (95% CI: 15% to 22%) and new antihypertensive medication prescribing fell by 22% (95% CI: 18% to 26%), but prescribing of new lipid-lowering or antiplatelet therapy was unchanged. Similar trends were observed across the UK, except for a reduction in new lipid-lowering therapy prescribing in the other UK nations (reduction: 16% (95% CI: 10% to 21%)). Extrapolated to the UK population, between March and December 2020, there were ~31 800 fewer people with T2D prescribed a new type of diabetes medication and ~14 600 fewer prescribed a new type of antihypertensive medication. Conclusions Over the coming months, healthcare services will need to manage this backlog of testing and prescribing. We recommend effective communications to ensure patient engagement with diabetes services, monitoring and opportunities for prescribing, and when appropriate use of home monitoring, remote consultations and other innovations in care.
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Affiliation(s)
- Matthew J Carr
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK .,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Alison K Wright
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK.,Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Lalantha Leelarathna
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, The University of Manchester, Manchester, UK.,Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Hood Thabit
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, The University of Manchester, Manchester, UK.,Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicola Milne
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Naresh Kanumilli
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, The University of Manchester, Manchester, UK.,Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, UK
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171
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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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172
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Alami H, Lehoux P, Attieh R, Fortin JP, Fleet R, Niang M, Offredo K, Rouquet R, Ag Ahmed MA, Ly BA. A “Not So Quiet” Revolution: Systemic Benefits and Challenges of Telehealth in the Context of COVID-19 in Quebec (Canada). Front Digit Health 2021. [DOI: 10.3389/fdgth.2021.721898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The COVID-19 pandemic has had a major impact on health and social service systems (HSSS) worldwide. It has put tremendous pressure on these systems, threatening access, continuity, and the quality of patient care and services. In Quebec (Canada), the delivery of care and services has radically changed in a short period of time. During the pandemic, telehealth has been widely deployed and used, notwithstanding the decades-long challenges of integrating this service modality into the Quebec HSSS. Adopting a narrative-integrative approach, this article describes and discusses Quebec's experience with the deployment and utilization of telehealth in the context of COVID-19. Firstly, we introduced the achievements and benefits made with the use of telehealth. Secondly, we discussed the challenges and concerns that were revealed or accentuated by the sanitary crisis, such as: (1) training and information; (2) professional and organizational issues; (3) quality of services and patient satisfaction; (4) cost, remuneration, and funding; (5) technology and infrastructure; (6) the emergence of private telehealth platforms in a public HSSS; (7) digital divide and equity; and (8) legal and regulatory issues. Finally, the article presents recommendations to guide future research, policies and actions for a successful integration of telehealth in the Quebec HSSS as well as in jurisdictions and countries facing comparable challenges.
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173
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Boczar D, Avila FR, Carter RE, Moore PA, Giardi D, Guliyeva G, Bruce CJ, McLeod CJ, Forte AJ. Using Facial Recognition Tools for Health Assessment. Plast Surg Nurs 2021; 41:232-236. [PMID: 34871291 DOI: 10.1097/psn.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The number of applications for facial recognition technology is increasing due to the improvement in image quality, artificial intelligence, and computer processing power that has occurred during the last decades. Algorithms can be used to convert facial anthropometric landmarks into a computer representation, which can be used to help identify nonverbal information about an individual's health status. This article discusses the potential ways a facial recognition tool can perform a health assessment. Because facial attributes may be considered biometric data, clinicians should be informed about the clinical, ethical, and legal issues associated with its use.
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Affiliation(s)
- Daniel Boczar
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Francisco R Avila
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Rickey E Carter
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Pamela A Moore
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Davide Giardi
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Gunel Guliyeva
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Charles J Bruce
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Christopher J McLeod
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Antonio Jorge Forte
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
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174
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Hendry A, Thompson M, Knight P, McCallum E, Taylor A, Rainey H, Strong A. Health and Social Care Reform in Scotland - What Next? Int J Integr Care 2021; 21:7. [PMID: 34754283 PMCID: PMC8555477 DOI: 10.5334/ijic.5633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 08/04/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION This paper analyses the important enablers, barriers and impacts of country-wide implementation of integrated health and social care in Scotland. It offers insights for other systems seeking to advance similar policy and practice. DESCRIPTION Landmark legislation was based on a shared vision and narrative about improving outcomes for people and communities. Implementation has involved coordination of multiple policies and interventions for different life stages, care groups, care settings and local context within a dynamic and complex system. DISCUSSION Relational and citizen led approaches are critical for success, but it takes time to build trusting relationships, influence organisational and professional cultures and cede power. Assessing national impacts is challenging and progress at a national level can seem slower than local experience suggests, due in part to the relative immaturity of national datasets for community interventions. Five years on there are many examples of innovation and positive outcomes despite increasing demographic, workforce, and financial challenges. However, inequalities continue to increase. CONCLUSION Realising the true value from integration will require a stronger focus on place-based prevention and early intervention to achieve a fairer Scotland where everybody thrives. Solidarity, equity, and human rights must guide the next phase of Scotland's story.
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175
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Strumann C, von Meißner WCG, Blickle PG, Held L, Steinhäuser J. Experiences made by family physicians managing patients with SARS-CoV-2 infection during spring 2020 - a cross-sectional analysis. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2021; 165:35-42. [PMID: 34474994 PMCID: PMC8404987 DOI: 10.1016/j.zefq.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In Germany, family physicians care for about 85% of the patients infected with SARS-CoV-2. The geographic distribution of the first wave in 2020 was heterogeneous, and each federal state experienced different percentages of patients that died from COVID-19. Each of the 16 federal states implemented its own regulation about medical care for SARS-CoV-2 infected patients. Against this background, the objective of this analysis was to gather experiences made by primary care physicians managing SARS-CoV-2 infected patients during the first wave in March 2020 and to clinically characterize these patients. METHODS In total, 5,632 physicians were invited to participate in an online questionnaire surveying routine data regarding the general care situation at the physician practice level and the care for patients infected with SARS-CoV-2. Bivariate and multivariate analyses were applied to characterize treatment experiences and to identify patient characteristics predicting the course of disease. RESULTS 132 family physicians from all German federal states (except from Berlin) participated in this analysis (response rate 2.3%) and provided routine care data for 1,085 patients. Information from 373 of these patients were provided in greater detail. On average, each physician treated 8.5 patients infected with SARS-CoV-2. About 15% of the physicians used video consultations to communicate with their infected patients. More than 82% made positive experiences with the exceptional regulation to provide a certificate of incapacity to work by telephone. Half of the physicians faced equipment insufficiencies due to a lack of protective gear, and in 10% of the practices, the staff themselves acquired SARS-CoV-2 infection. Greater numbers of SARS-CoV-2 cases treated in a practice translated into higher odds for members of the practice to get infected (odds ratio (OR) 1.03, 95% CI [1.01;1.06]). Older persons, males and patients in rural areas had higher odds of a severe course of disease. CONCLUSIONS Our results show that a large percentage of primary care physicians additionally managed their COVID-19 patients remotely by telephone or video during the outbreak, while also being at a higher risk for SARS-CoV-2 infection. Further, the increased severity in rural areas underlines the importance of strong primary health care in order to enable hospitals to concentrate on critically ill patients.
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Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus, Lübeck, Germany.
| | | | | | - Linda Held
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus, Lübeck, Germany
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176
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Wahezi SE, Kohan LR, Spektor B, Brancolini S, Emerick T, Fronterhouse JM, Luedi MM, Colon MA, Kitei PM, Anitescu M, Goeders NE, Patil S, Siddaiah H, Cornett EM, Urman RD, Kaye AD. Telemedicine and current clinical practice trends in the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol 2021; 35:307-319. [PMID: 34511221 PMCID: PMC7667401 DOI: 10.1016/j.bpa.2020.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022]
Abstract
Telemedicine is the medical practice of caring for and treating patients remotely. With the spread of the coronavirus disease-2019 (COVID-19) pandemic, telemedicine has become increasingly prevalent. Although telemedicine was already in practice before the 2020 pandemic, the internet, smartphones, computers, and video-conferencing tools have made telemedicine easily accessible and available to almost everyone. However, there are also new challenges that health care providers may not be prepared for, including treating and diagnosing patients without physical contact. Physician adoption also depends upon reimbursement and education to improve the telemedicine visits. We review current trends involving telemedicine, how pandemics such as COVID-19 affect the remote treatment of patients, and key concepts important to healthcare providers who practice telemedicine.
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Affiliation(s)
- Sayed E Wahezi
- Departments of Rehabilitation Medicine, Anesthesiology, and Orthopedic Surgery, Montefiore Medical Center, 1250 Waters Place, Bronx NY 10461, USA.
| | - Lynn R Kohan
- Department of Anesthesiology, University of Virginia, 545 Ray C Hunt Dr. Suite 3168, Charlottesville, VA, 22908, USA.
| | - Boris Spektor
- Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road NE, 5th Floor Tower, T5L38, Atlanta, GA 30322, USA.
| | - Scott Brancolini
- Department of Anesthesiology and Pain Medicine, University of Pittsburgh Medical Center, 200 Delafield Road Medical Arts Building 200, Suite 2070, Pittsburgh, PA 15215, USA.
| | - Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, Division of Chronic Pain, University of Pittsburgh Medical Center, Falk Medical Building - 6th floor, 3601 Fifth Avenue, Pittsburgh, PA 15213, USA.
| | - Jean M Fronterhouse
- Department of Psychiatry, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Markus M Luedi
- Department of Anesthesiology and Pain Therapy, Inselspital, Universitatsspital Bern, Switzerland.
| | - Marc A Colon
- Department of Psychiatry, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Paul M Kitei
- Department of Physical Medicine & Rehabilitation, Rothman Orthopaedic Institute and Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
| | - Magdalena Anitescu
- Department of Anesthesiology and Critical Care, University of Chicago, 5841 S Maryland Ave, MC 4028, Chicago, IL 60637, USA.
| | - Nicholas E Goeders
- Department of Pharmacology, Toxicology & Neuroscience, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Shilpavedi Patil
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Harish Siddaiah
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
| | - Alan D Kaye
- Academic Affairs, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
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177
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Johns G, Burhouse A, Tan J, John O, Khalil S, Williams J, Whistance B, Ogonovsky M, Ahuja A. Remote mental health services: a mixed-methods survey and interview study on the use, value, benefits and challenges of a national video consulting service in NHS Wales, UK. BMJ Open 2021; 11:e053014. [PMID: 34593506 PMCID: PMC8487209 DOI: 10.1136/bmjopen-2021-053014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED Social distancing laws during the first year of the pandemic, and its unprecedented changes to the National Health Service (NHS) forced a large majority of services, especially mental health teams to deliver patient care remotely. For many, this approach was adopted out of necessity, rather than choice, thus presenting a true 'testing ground' for remote healthcare and a robust evaluation on a national and representative level. OBJECTIVE To extract and analyse mental health specific data from a national dataset for 1 year (March 2020-March 2021). DESIGN A mixed-methods study using surveys and interviews. SETTING In NHS mental health services in Wales, UK. PARTICIPANTS With NHS patients and clinicians across child and adolescent, adult and older adult mental health services. OUTCOME MEASURES Mixed methods data captured measures on use, value, benefits and challenges of video consulting (VC). RESULTS A total of 3561 participants provided mental health specific data. These data and its findings demonstrate that remote mental health service delivery, via the method of VC is highly satisfactory, well-accepted and clinically suitable for many patients, and provides a range of benefits to NHS patients and clinicians. Interestingly, clinicians working from 'home' rated VC more positively compared with those at their 'clinical base'. CONCLUSIONS Post 1-year adoption, remote mental health services in Wales UK have demonstrated that VC is possible from both a technical and behavioural standpoint. Moving forward, we suggest clinical leaders and government support to sustain this approach 'by default' as an option for NHS appointments.
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Affiliation(s)
- Gemma Johns
- Department of Informatics, TEC Cymru, Aneurin Bevan University Health Board, Gwent, UK
| | - Anna Burhouse
- Northumbria Healthcare NHS Foundation Trust, Northumbria, UK
| | - Jacinta Tan
- Child & Adolescent Mental Health Services, Aneurin Bevan University Health Board, Ty Bryn, St Cadocs Hospital, Newport, UK
| | - Oliver John
- Royal College of Psychiatrists Wales, Cardiff, UK
| | - Sara Khalil
- Department of Informatics, TEC Cymru, Aneurin Bevan University Health Board, Gwent, UK
| | - Jessica Williams
- Department of Informatics, TEC Cymru, Aneurin Bevan University Health Board, Gwent, UK
| | - Bethan Whistance
- Department of Informatics, TEC Cymru, Aneurin Bevan University Health Board, Gwent, UK
| | - Mike Ogonovsky
- Department of Informatics, TEC Cymru, Aneurin Bevan University Health Board, Gwent, UK
| | - Alka Ahuja
- Department of Informatics, TEC Cymru, Aneurin Bevan University Health Board, Gwent, UK
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178
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Landgren S, Cajander Å. Non-use of Digital Health Consultations Among Swedish Elderly Living in the Countryside. Front Public Health 2021; 9:588583. [PMID: 34568247 PMCID: PMC8460856 DOI: 10.3389/fpubh.2021.588583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Digital health consultations in primary care have the advantage of offering equal healthcare for people residing in the countryside. While it is gaining acceptance among young- and middle-aged people, the elderly are reluctant to use it. The aim of this study was hence to identify reasons for non-use among elderly in the countryside and describe perceived possible challenges and opportunities with digital health consultations. Semi-structured interviews were conducted with 13 persons over 65 years old residing in the Swedish countryside. There was a mistrust for services offered by private companies and their public funding, a lack of knowledge of available services, and a lack of perceived usefulness. Personal interaction and continuity was more important than time or travel conveniences, although these advantages were recognized. To prevent digital exclusion, caregivers need to offer information, encouragement, or tools for the elderly. Digital primary care also needs to offer familiarity, with continuity and personal connections.
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Affiliation(s)
- Sara Landgren
- Department of Informatics and Media, Uppsala University, Uppsala, Sweden
| | - Åsa Cajander
- Department of Informatics and Media, Uppsala University, Uppsala, Sweden.,Department of Information Technology, Uppsala University, Uppsala, Sweden
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179
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Li C, Neugroschl J, Zhu CW, Aloysi A, Schimming CA, Cai D, Grossman H, Martin J, Sewell M, Loizos M, Zeng X, Sano M. Design Considerations for Mobile Health Applications Targeting Older Adults. J Alzheimers Dis 2021; 79:1-8. [PMID: 33216024 DOI: 10.3233/jad-200485] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Mobile technologies are becoming ubiquitous in the world, changing the way we communicate and provide patient care and services. Some of the most compelling benefits of mobile technologies are in the areas of disease prevention, health management, and care delivery. For all the advances that are occurring in mobile health, its full potential for older adults is only starting to emerge. Yet, existing mobile health applications have design flaws that may limit usability by older adults. The aim of this paper is to review barriers and identify knowledge gaps where more research is needed to improve the accessibility of mobile health use in aging populations. The same observations might apply to those who are not elderly, including individuals suffering from severe mental or medical illnesses.
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Affiliation(s)
- Clara Li
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Carolyn W Zhu
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, Bronx, NY, USA
| | - Amy Aloysi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Corbett A Schimming
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, Bronx, NY, USA
| | - Dongming Cai
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, Bronx, NY, USA
| | - Hillel Grossman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, Bronx, NY, USA
| | - Jane Martin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Maria Loizos
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xiaoyi Zeng
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary Sano
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, Bronx, NY, USA
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180
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Philadelphia-Negative Chronic Myeloproliferative Neoplasms during the COVID-19 Pandemic: Challenges and Future Scenarios. Cancers (Basel) 2021; 13:cancers13194750. [PMID: 34638236 PMCID: PMC8507529 DOI: 10.3390/cancers13194750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 12/30/2022] Open
Abstract
An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) started in December 2019 in China and then become pandemic in February 2020. Several publications investigated the possible increased rate of COVID-19 infection in hematological malignancies. Based on the published data, strategies for the management of chronic Philadelphia-negative chronic myeloproliferative neoplasms (MPNs) are provided. The risk of severe COVID-19 seems high in MPN, particularly in patients with essential thrombocythemia, but not negligible in myelofibrosis. MPN patients are at high risk of both thrombotic and hemorrhagic complications and this must be accounted in the case of COVID-19 deciding on a case-by-case basis. There are currently no data to suggest that hydroxyurea or interferon may influence the risk or severity of COVID-19 infection. Conversely, while the immunosuppressive activity of ruxolitinib might pose increased risk of infection, its abrupt discontinuation during COVID-19 syndrome is associated with worse outcome. All MPN patients should receive vaccine against COVID-19; reassuring data are available on efficacy of mRNA vaccines in MPNs.
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181
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Goonasekera C, Gammon N, Found P, Sheikh A, Fleming I, Amoako D, Nanavati N. Enhancing the utility of virtual surgical pre-assessment. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:1032-1038. [PMID: 34605255 DOI: 10.12968/bjon.2021.30.17.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
During the COVID-19 pandemic, virtual pre-assessment was introduced for all elective and semi-urgent surgeries to maintain surgical clinical services in the authors' Trust. This mainly involved telephone pre-assessments, although occasionally video technology was used. This had to be managed and maintained at a distance with little or no training or established method. This article includes experiences of staff involved in a single tertiary centre, an assessment of the pros and cons of virtual pre-assessment and concludes with a set of recommendations to enhance the utility of the service for the future.
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Affiliation(s)
- Chulananda Goonasekera
- Consultant Anaesthetist, Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London
| | - Nicola Gammon
- Neurosurgical Pre-assessment Sister-in-Charge, King's College Hospital NHS Foundation Trust, London
| | - Phil Found
- Consultant Anaesthetist, Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London
| | - Asme Sheikh
- Consultant Anaesthetist, Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London
| | - Ian Fleming
- Consultant Anaesthetist, Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London
| | - Derek Amoako
- Consultant Anaesthetist, Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London
| | - Nilesh Nanavati
- Consultant Anaesthetist, Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London
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182
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Digital healthcare in cystic fibrosis. Learning from the pandemic to innovate future care. J Cyst Fibros 2021; 20 Suppl 3:64-66. [PMID: 34565704 PMCID: PMC8461043 DOI: 10.1016/j.jcf.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/19/2022]
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183
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Commiskey P, Armstrong AW, Coker TR, Dorsey ER, Fortney JC, Gaines KJ, Gibbons BM, Nguyen HQ, Singla DR, Szigethy E, Krupinski EA. A Blueprint for the Conduct of Large, Multisite Trials in Telemedicine. J Med Internet Res 2021; 23:e29511. [PMID: 34542417 PMCID: PMC8491114 DOI: 10.2196/29511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Recent literature supports the efficacy and efficiency of telemedicine in improving various health outcomes despite the wide variability in results. Understanding site-specific issues in the implementation of telemedicine trials for broader replication and generalizability of results is needed. Lessons can be learned from existing trials, and a blueprint can guide researchers to conduct these challenging studies using telemedicine more efficiently and effectively. This viewpoint presents relevant challenges and solutions for conducting multisite telemedicine trials using 7 ongoing and completed studies funded by the Patient-Centered Outcomes Research Institute portfolio of large multisite trials to highlight the challenges in implementing telemedicine trials. Critical issues of ensuring leadership and buy-in, appropriate funding, and diverse and representative trials are identified and described, as well as challenges related to clinical, informatics, regulatory, legal, quality, and billing. The lessons learned from these studies were used to create a blueprint of key aspects to consider for the design and implementation of multisite telemedicine trials.
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Affiliation(s)
- Patricia Commiskey
- Division of Stroke, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Earl Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - John C Fortney
- Division of Population Health, Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, Department of Veteran's Affairs, Seattle, WA, United States
| | - Kenneth J Gaines
- Division of Stroke, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Brittany M Gibbons
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Huong Q Nguyen
- Division of Health Services Research & Implementation Science, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Daisy R Singla
- Center of Addiction and Mental Health, Toronto, ON, Canada
- Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eva Szigethy
- Center for High Value Health Care, UPMC Insurances Division, Department of Psychiatry, Medicine, and Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth A Krupinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
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184
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Thatcher MD, Thatcher MW, Smith MC, McCarron M, Reed J. Opportunity costs of attending surgical clinic appointments and experiences with telemedicine for follow-up care. SAGE Open Med 2021; 9:20503121211045247. [PMID: 34527246 PMCID: PMC8436310 DOI: 10.1177/20503121211045247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives Telemedicine has been rapidly implemented in orthopedics during the coronavirus (COVID-19) pandemic. The purpose of this study was to quantify opportunity costs for patients attending typical in-person appointments and understand their perceptions of telemedicine for follow-up care. Methods A cross-sectional study was performed by surveying patients who had elective orthopedic surgery and attended at least one in-person and one phone call appointment. The survey assessed opportunity costs associated with in-person appointments, experience with telemedicine, and preferred type of future appointment. Results Of the 49 eligible patients, 41 (83.7%) completed the survey. The median travel distance to the clinic was 108 km, and the time spent in the clinic was 60 min. Participants responded "yes" to various forms of opportunity costs associated with attending in-person appointments, including missed work (46.3%), lost income (34.1%), recreational activities (26.8%), home or yard care (14.6%), socializing with friends or family (12.2%), school (2.4%), and childcare (2.4%). In addition, elements of the telemedicine appointment were rated from 1 (least favorable) to 10 (most favorable), and averages were calculated for ease of use (9.2), convenience (8.4), confidence in the doctor's diagnostic ability (8.2), likelihood of using the service again (6.4), and overall satisfaction (8.2). Preferred future appointment types included having the first visit in-person and subsequent visits via telephone (61.0%), in-person only (36.6%), and unsure (2.4%). Conclusion This study identifies various opportunity costs associated with in-person orthopedic appointments and a favorable view toward telemedicine for follow-up care.
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Affiliation(s)
| | | | - Mckinley C Smith
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Mckinley C Smith, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.
| | - Michelle McCarron
- Research Department, Saskatchewan Health Authority, Regina, SK, Canada
| | - Jeremy Reed
- Department of Orthopedic Surgery, University of Saskatchewan, Saskatoon, SK, Canada
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185
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Yeung T, Merchant J, Chen P, Smart C, Ghafoor H, Woodhouse F, James D, Symons N, Boyce S, Jones O, George B, Lindsey I. The Impact and Restoration of Colorectal Services during the COVID-19 Pandemic: A view from Oxford. SURGICAL PRACTICE 2021; 26:27-33. [PMID: 34899957 PMCID: PMC8652538 DOI: 10.1111/1744-1633.12531] [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: 02/13/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
Aim The coronavirus pandemic has significantly disrupted the way we deliver healthcare worldwide. We have been flexible and creative in order to continue providing elective colorectal cancer operations and to restart services for benign cases during the recovery period of the pandemic. In this paper, we describe the impact of coronavirus on our elective services and how we have implemented new patient pathways to allow us to continue providing patient care. Patients and Methods Data on major colorectal elective resections were prospectively collected in an Enhanced Recovery After Surgery (ERAS) database. Data on the number of proctology cases and telemed appointments were collected from the hospital theatre information management system and electronic patient record system, respectively. Results During the pandemic, there was a complete shift towards cancer cases, with benign services and proctology cases being placed on hold. Hospital length of stay was reduced. We implemented earlier hospital discharge and more intense telephone follow‐up after elective major surgery. This has not resulted in an increase in postoperative complications, nor any increase in readmission to hospital. During the recovery phase, we have introduced a higher proportion of telemed consultations, including one‐stop telemed proctology clinics, resulting in straight to tests or investigations. Conclusion We have created a streamlined multidisciplinary pathway to reinstate our elective colorectal services as soon as possible and to minimise potential harm caused to patients whose treatment have been delayed. We anticipate many of these changes will be permanently incorporated into our clinical practice once the pandemic is over.
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Affiliation(s)
- Trevor Yeung
- Department of Colorectal Surgery Oxford University Hospitals UK.,Nuffield Department of Surgical Sciences University of Oxford UK
| | - Julia Merchant
- Department of Colorectal Surgery Oxford University Hospitals UK
| | - Patrick Chen
- Department of Colorectal Surgery Oxford University Hospitals UK
| | - Corinne Smart
- Department of Colorectal Surgery Oxford University Hospitals UK
| | - Hamira Ghafoor
- Department of Colorectal Surgery Oxford University Hospitals UK
| | - Fran Woodhouse
- Department of Colorectal Surgery Oxford University Hospitals UK
| | - David James
- Department of Colorectal Surgery Oxford University Hospitals UK
| | - Nicholas Symons
- Department of Colorectal Surgery Oxford University Hospitals UK
| | - Stephen Boyce
- Department of Colorectal Surgery Oxford University Hospitals UK
| | - Oliver Jones
- Department of Colorectal Surgery Oxford University Hospitals UK
| | - Bruce George
- Department of Colorectal Surgery Oxford University Hospitals UK
| | - Ian Lindsey
- Department of Colorectal Surgery Oxford University Hospitals UK
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186
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Bell F, Pilbery R, Connell R, Fletcher D, Leatherland T, Cottrell L, Webster P. The acceptability and safety of video triage for ambulance service patients and clinicians during the COVID-19 pandemic. Br Paramed J 2021; 6:49-58. [PMID: 34539255 PMCID: PMC8415205 DOI: 10.29045/14784726.2021.9.6.2.49] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction In response to anticipated challenges with urgent and emergency healthcare delivery during the early part of the COVID-19 pandemic, Yorkshire Ambulance Service NHS Trust introduced video technology to supplement remote triage and 'hear and treat' consultations as a pilot project in the EOC. We conducted a service evaluation with the aim of investigating patient and staff acceptability of video triage, and the safety of the decision-making process. Methods This service evaluation utilised a mixture of routine and bespoke data collection. We sent postal surveys to patients who were recipients of a video triage, and clinicians who were involved in the video triage pilot logged calls they attempted and undertook. Results Between 27 March and 25 August 2020, clinicians documented 1073 triage calls. A successful video triage call was achieved in 641 (59.7%) cases. Clinical staff reported that video triage improved clinical assessment and decision making compared to telephone alone, and found the technology accessible for patients. Patients who received a video triage call and responded to the survey (40/201, 19.9%) were also satisfied with the technology and with the care they received. Callers receiving video triage that ended with a disposition of 'hear and treat' had a lower rate of re-contacting the service within 24 hours compared to callers that received clinical hub telephone triage alone (16/212, 7.5% vs. 2508/14349, 17.5% respectively). Conclusion In this single NHS Ambulance Trust evaluation, the use of video triage for low-acuity calls appeared to be safe, with low rates of re-contact and high levels of patient and clinician satisfaction compared to standard telephone triage. However, video triage is not always appropriate for or acceptable to patients and technical issues were not uncommon.
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Affiliation(s)
- Fiona Bell
- Yorkshire Ambulance Service NHS Trust ORCID: https://orcid.org/0000-0003-4503-1903
| | - Richard Pilbery
- Yorkshire Ambulance Service NHS Trust ORCID: https://orcid.org/0000-0002-5797-9788
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187
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Foroughi M, Gupta R, Ganguly A, Mirza J, Fotros A. Neuropsychiatric Manifestations of COVID-19: A Review. ADVANCES IN PSYCHIATRY AND BEHAVIORAL HEALTH 2021; 1:161-172. [PMID: 38620912 PMCID: PMC8351041 DOI: 10.1016/j.ypsc.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Moein Foroughi
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Rishab Gupta
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Amvrine Ganguly
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Junaid Mirza
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Aryandokht Fotros
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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188
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Mroz G, Papoutsi C, Greenhalgh T. 'From disaster, miracles are wrought': a narrative analysis of UK media depictions of remote GP consulting in the COVID-19 pandemic using Burke's pentad. MEDICAL HUMANITIES 2021; 47:292-301. [PMID: 33782180 PMCID: PMC8008912 DOI: 10.1136/medhum-2020-012111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
During crises (major events characterised by uncertainty, urgency and threat), society must make sense of rapidly unfolding events. This happens mainly through narrativising-depicting a setting, characters and a meaningful sequence of events and actions unfolding over time. In the early months of the pandemic, UK general practice shifted from face-to-face consultations to a remote-by-default model (telephone, video or e-consultation). This shift was initially widely accepted by press and public, but support waned after a politician declared that the change would be permanent. We invoke Burke's dramatistic pentad of act, scene, agent, agency and purpose to theorise findings from a detailed analysis of media coverage of the remote-by-default policy and reactions to it. We consider the 12 weeks from March to June 2020 (first lockdown, when remote-by-default services had just been introduced) and 1 week from late July 2020 (following the ministerial announcement). The initial introduction of remote consulting had strong narrative coherence in which all parts of the pentad were balanced: scene (a deadly virus threatening the country) aligned with act (lockdown, including avoiding face-to-face appointments unless essential), agents (the National Health Service and digital technology as heroic macro-actors), agency (general practitioners 'deployed') and purpose (to control the pandemic). The later period, however, was characterised by a mismatch between scene (a country emerging from lockdown and resuming normal life), act (imposition of the remote model), agent (a politician known for his enthusiasm for technology), agency (top-down directive) and purpose (modernisation). Whereas media narratives in the first period aligned with the genre of heroic adventure (suggesting a worthy battle, bravely fought), those of the second had characteristics of farce (something both comic and grotesque). We conclude that close reading of media narratives may surface potential misalignments between policy decisions and the context in which they must be implemented.
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Affiliation(s)
- Gilly Mroz
- Zoology, University of Oxford, Oxford, UK
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189
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Adams R, Branthwaite H, Chockalingam N. Prevalence of musculoskeletal injury and pain of UK-based podiatrists and the impact of enforced altered working practices. J Foot Ankle Res 2021; 14:53. [PMID: 34470650 PMCID: PMC8409074 DOI: 10.1186/s13047-021-00491-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Occupational musculoskeletal injuries are prevalent in healthcare workers and are reported to be profession-specific. There is, however, a paucity of information around the injuries sustained from working as a podiatrist. This paper looks at the incidence of injury from working as a podiatrist, the aggravating factors to sustain these injuries and whether the changes in workload due to the COVID-19 pandemic altered the incidence. Methods A modified work based musculoskeletal injury questionnaire was distributed in the UK via podiatry led social media platforms. Open and Closed questions explored the demographics of the sample, perceived injury 12 months prior to the COVID-19 pandemic and then 6 months into the lockdown. Pre and post COVID-19 data were analysed for differences and thematic analysis was included to categorise reported experiences. Results 148 podiatrists representing 3 % of HCPC registered practitioners responded to the questionnaire. Employment status altered as a result of the COVID-19 pandemic with a 13 % reduction in those working full time. Environments also changed with domiciliary and telehealth significantly increasing (p > 0.00) and non-clinical roles being extended (p > 0.002). Pain frequency and intensity significantly (p > 0.04) increased as a result of the pandemic with shoulder pain being most frequent before lockdown altering to the neck during the lockdown. Two main themes were identified that were attributed to the causes of pain including physical demands and working in awkward spaces. Conclusions Work-related musculoskeletal pain in podiatrists is common with the shoulder and neck being the most frequently affected. Changes in work practices due to the restrictions enforced from the COVID-19 pandemic increased the frequency and intensity of pain mostly associated with increased domiciliary and telehealth working environments. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00491-7.
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Affiliation(s)
- Robert Adams
- Centre for Biomechanics and Rehabilitation Technologies, Stoke on Trent, Staffordshire University, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Helen Branthwaite
- Centre for Biomechanics and Rehabilitation Technologies, Stoke on Trent, Staffordshire University, Leek Road, ST4 2DF, Stoke-on-Trent, UK.
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Stoke on Trent, Staffordshire University, Leek Road, ST4 2DF, Stoke-on-Trent, UK
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190
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Zaman I, Beevers ZCR, Ahmed R, Lasserson D, Knight T. NEWS2 to assess suspected COVID-19 in the community: a service evaluation of a primary care assessment centre. Fam Pract 2021; 38:i3-i8. [PMID: 34448485 PMCID: PMC8515262 DOI: 10.1093/fampra/cmab016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Primary care has played a central role in the community response to the coronavirus disease-19 (COVID-19) pandemic. The use of the National Early Warning Score 2 (NEWS2) has been advocated as a tool to guide escalation decisions in the community. The performance of this tool applied in this context is unclear. AIM To evaluate the process of escalation of care to the hospital within a primary care assessment centre (PCAC) designed to assess patients with suspected COVID-19 in the community. DESIGN AND SETTING A retrospective service evaluation of all adult patients assessed between 30 March and 22 April 2020 within a COVID-19 primary care assessment centre within Sandwell West Birmingham CCG. METHOD A database of patient demographics, healthcare interactions and physiological observations was constructed. NEWS2 and CRB65 scores were calculated retrospectively. The proportion of patients escalated was within risk groups defined by NHSE guidelines in place during the evaluation period was determined. RESULTS A total of 150 patients were identified. Following assessment 13.3% (n = 20) patients were deemed to require escalation. The proportion of patients escalated with a NEWS2 greater than or equal to 3 was 46.9% (95% CI 30.8-63.6%). The proportion of patients escalated to secondary care using NHSE defined risk thresholds was 0% in the green group, 22% (n = 4) in the amber group, and 81.3% (n = 13) in the red group. CONCLUSION Clinical decisions to escalate care to the hospital did not follow initial guidance written for the COVID-19 outbreak but were demonstrated to be safe.
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Affiliation(s)
- Imran Zaman
- Aston Medical School, Birmingham, UK.,Heath Street Health Centre, Birmingham, UK
| | | | - Ridwan Ahmed
- Aston Pride Community Health Centre, Sandwell and West Birmingham Clinical Commissioning Group, Birmingham, UK
| | - Daniel Lasserson
- University of Warwick, Warwick, UK.,Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Thomas Knight
- Sandwell and West Birmingham NHS Trust, Birmingham, UK
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191
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Magowan D, Burton L, Williams GL, Khurana A. 'Mind if I record this?' Patients making audio-visual recordings of consultations: a survey of surgeons' experiences. Ann R Coll Surg Engl 2021; 104:67-71. [PMID: 34436956 DOI: 10.1308/rcsann.2021.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Audio-visual recordings made by patients of their clinical encounters are increasingly common. This may be done with or without their doctors' knowledge or consent and is considered admissible legal evidence. Many surgeons may feel uncomfortable with being recorded and lack knowledge regarding the legal implications. The aim of this study was to gauge how surgeons react to being recorded, and what specific medico-legal insight they have regarding these matters. METHODS In total, 150 surveys were distributed to surgeons in two hospitals in South Wales by email, Survey Monkey and paper copy between 28 October 2019 and 9 March 2020. The survey was anonymous and recorded level of training, as well as four simple questions regarding how surgeons may react to being recorded and what they felt their legal rights were. RESULTS There were 91 respondents: 28 consultants, 36 registrars and 27 junior surgical trainees. Of the respondents, 56% were uncomfortable with being recorded and 23% would stop a consultation if their patient insisted on recording it. These issues were most marked for junior surgical trainees. Sixty-two per cent of respondents were unaware of their legal rights and 21% believed they were legally able to refuse to continue a consultation. This belief was particularly marked among consultants. CONCLUSION Many surgeons are uncomfortable with being recorded and lack knowledge regarding their medico-legal standing. Education and guidance from the Royal Colleges would help address this issue and avoid misunderstanding when surgeons are faced with these potentially difficult scenarios.
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Affiliation(s)
- D Magowan
- Aneurin Bevan University Health Board, UK
| | - L Burton
- Aneurin Bevan University Health Board, UK
| | | | - A Khurana
- Aneurin Bevan University Health Board, UK
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192
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Plata C, Nellessen M, Roth R, Ecker H, Böttiger BW, Löser J, Wetsch WA. Impact of video quality when evaluating video-assisted cardiopulmonary resuscitation: a randomized, controlled simulation trial. BMC Emerg Med 2021; 21:96. [PMID: 34418968 PMCID: PMC8380108 DOI: 10.1186/s12873-021-00486-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 07/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although not routinely established during cardiopulmonary resuscitation (CPR), video-assisted CPR has been described as beneficial in the communication with emergency medical service (EMS) authorities in out-of-hospital cardiac arrest scenarios. Since the influence of video quality has not been investigated systematically and due to variation of quality of a live-stream video during video-assisted CPR, we investigated the influence of different video quality levels during the evaluation of CPR performance in video sequences. METHODS Seven video sequences of CPR performance were recorded in high quality and artificially reduced to medium and low quality afterwards. Video sequences showed either correct CPR performance or one of six typical errors: too low and too high compression rate, superficial and increased compression depth, wrong hand position and incomplete release. Video sequences were randomly assigned to the different quality levels. During the randomised and double-blinded evaluation process, 46 paramedics and 47 emergency physicians evaluated seven video sequences of CPR performance in different quality levels (high, medium and low resolution). RESULTS Of 650 video sequences, CPR performance was evaluable in 98.2%. CPR performance was correctly evaluated in 71.5% at low quality, in 76.8% at medium quality, and in 77.3% at high quality level, showing no significant differences depending on video quality (p = 0.306). In the subgroup analysis, correct classification of increased compression depth showed significant differences depending on video quality (p = 0.006). Further, there were significant differences in correct CPR classification depending on the presented error (p < 0.001). Allegedly errors, that were not shown in the video sequence, were classified in 28.3%, insignificantly depending on video quality. Correct evaluation did not show significant interprofessional differences (p = 0.468). CONCLUSION Video quality has no significant impact on the evaluation of CPR in a video sequence. Even low video quality leads to an acceptable rate of correct evaluation of CPR performance. There is a significant difference in evaluation of CPR performance depending on the presented error in a video sequence. TRIAL REGISTRATION German Clinical Trial Register (Registration number DRKS00015297 ) Registered on 2018-08-21.
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Affiliation(s)
- Christopher Plata
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Strasse 62, 50937, Cologne, Germany
- Emergency Department, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Martin Nellessen
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Rebecca Roth
- University of Cologne, Faculty of Medicine, and University Hospital of Cologne, Institute of Medical Statistics and Computational Biology, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Hannes Ecker
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Bernd W Böttiger
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Johannes Löser
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Centre of Palliative Medicine, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Wolfgang A Wetsch
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Strasse 62, 50937, Cologne, Germany.
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193
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Freitas BACD, Prado MRMCD, Toledo LV, Fialho WL, Ayres LFA, Almeida SL, Silva TCSE, Brito MP, Siman AG, Oliveira DMD. Analysis of the service telessaúde-COVID in a municipality of Minas Gerais. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210036. [PMID: 34406205 DOI: 10.1590/1980-549720210036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to analyze the sociodemographic and clinical profile of patients treated by the remote care service "Telessaúde-COVID" and the factors associated with positive results for COVID-19. METHODS an exploratory and analytical study, carried out based on the analysis of patient records treated by a remote care service called "Telessaúde-COVID". Characteristics of the patients treated and variables related to the service's functioning were evaluated. A descriptive, inferential analysis was performed by logistic regression. RESULTS 1,854 new patients were evaluated and an estimate of 8,630 visits. Female patients were predominant (60.9%), aged between 20 and 59 years (75.9%). The most frequent signs and symptoms were: headache (41.8%), cough (33.3%) and runny nose (30.0%). Of the total number of patients, 66.4% were reported as suspected case of COVID-19 and 14.5% tested positive for COVID-19. The age of 60 years or more was more common among confirmed cases (26.6%). Most patients (80.4%) did not require face-to-face assistance. Confirmed cases of COVID-19 were associated with the age of the patients (OR 1,020; IC95% 1,007 - 1,032); home contact with a confirmed/suspected case (OR 1,902; IC95% 1,178 - 3,070); presence of nausea/vomiting (OR 2,403; IC95% 1,148 - 5,029) and changes in smell (OR 2,827; IC95% 1,294 - 6,176). CONCLUSION "Telessaúde-COVID" was relevant in the management and notification of cases, avoiding the search for face-to-face consultations without clinical indication. Among the suspected cases, positivity for COVID-19 was associated with aging, history of home contact, gastrointestinal and olfactory symptoms.
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Affiliation(s)
| | | | - Luana Vieira Toledo
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa - Viçosa (MG), Brasil
| | - Wilmara Lopes Fialho
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa - Viçosa (MG), Brasil
| | | | - Sophia Leonel Almeida
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa - Viçosa (MG), Brasil
| | | | - Mirna Peçanha Brito
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa - Viçosa (MG), Brasil
| | - Andréia Guerra Siman
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa - Viçosa (MG), Brasil
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194
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Toniolo S, Scarioni M, Di Lorenzo F, Hort J, Georges J, Tomic S, Nobili F, Frederiksen KS. Dementia and COVID-19, a Bidirectional Liaison: Risk Factors, Biomarkers, and Optimal Health Care. J Alzheimers Dis 2021; 82:883-898. [PMID: 34092646 DOI: 10.3233/jad-210335] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cognitive impairment following SARS-CoV-2 infection is being increasingly recognized as an acute and possibly also long-term sequela of the disease. Direct viral entry as well as systemic mechanisms such as cytokine storm are thought to contribute to neuroinflammation in these patients. Biomarkers of COVID-19-induced cognitive impairment are currently lacking, but there is some limited evidence that SARS-CoV-2 could preferentially target the frontal lobes, as suggested by behavioral and dysexecutive symptoms, fronto-temporal hypoperfusion on MRI, EEG slowing in frontal regions, and frontal hypometabolism on 18F-FDG-PET. Possible confounders include cognitive impairment due to hypoxia and mechanical ventilation and post-traumatic stress disorder. Conversely, patients already suffering from dementia, as well as their caregivers, have been greatly impacted by the disruption of their care caused by COVID-19. Patients with dementia have experienced worsening of cognitive, behavioral, and psychological symptoms, and the rate of COVID-19-related deaths is disproportionately high among cognitively impaired people. Multiple factors, such as difficulties in remembering and executing safeguarding procedures, age, comorbidities, residing in care homes, and poorer access to hospital standard of care play a role in the increased morbidity and mortality. Non-pharmacological interventions and new technologies have shown a potential for the management of patients with dementia, and for the support of their caregivers.
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Affiliation(s)
- Sofia Toniolo
- Cognitive Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Marta Scarioni
- Department of Neurology, Amsterdam University Medical Centers, Location VUmc, Alzheimer Center, Amsterdam, The Netherlands.,Department of Pathology, Amsterdam University Medical Centers, Location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Francesco Di Lorenzo
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Brighton, UK.,Non-invasive Brain Stimulation Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Jakub Hort
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | | | - Svetlana Tomic
- Department of Neurology, Osijek University Hospital Center, Osijek, Croatia.,Faculty of Medicine, University Josip Juraj Strossmayer of Osijek, Osijek, Croatia
| | - Flavio Nobili
- Neurology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
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195
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James S, Ashley C, Williams A, Desborough J, Mcinnes S, Calma K, Mursa R, Stephen C, Halcomb EJ. Experiences of Australian primary healthcare nurses in using telehealth during COVID-19: a qualitative study. BMJ Open 2021; 11:e049095. [PMID: 34362804 PMCID: PMC8350972 DOI: 10.1136/bmjopen-2021-049095] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study sought to explore the experiences of Australian primary healthcare (PHC) nurses in the use of telehealth during COVID-19. Telehealth was defined as the use of any telecommunications mode (eg, telephone and videoconferencing) to deliver healthcare. DESIGN AND SETTING Thematic analysis of qualitative interviews undertaken in Australian PHC. PARTICIPANTS Twenty-five PHC nurses who had participated in a national survey about their experiences during COVID-19 were recruited using purposive sampling. METHODS Semistructured telephone interviews were conducted from June to August 2020. Interviews lasted a mean of 38.5 min. They were audio-recorded and transcribed before thematic analysis was undertaken. The consolidated criteria for reporting qualitative research were followed. RESULTS Four overarching themes were identified: preparedness, accessibility of telehealth, care experience and impacts on the PHC nurses' role. Some nurses were experienced in the use of telehealth, while others indicated a lack of preparation and limited appropriate technology to support its use. Telehealth enabled patients to access care but did not support complex clinical assessment. Participants indicated that patient engagement in telehealth was dependent on access and confidence using technology, perceived safety when physically attending the practice and the value they placed on care via telehealth. Many participants expressed frustration about telehealth funding and its impact on facilitating nurses to practise to their full scope. CONCLUSION Telehealth has provided a means to continue PHC service delivery during COVID-19. While there are advantages to adopting this technology, considerations of the challenges and lessons from this experience are important to inform the future implementation of telehealth initiatives.
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Affiliation(s)
- Sharon James
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Christine Ashley
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anna Williams
- School of Nursing and Midwifery, Health Sciences and Physiotherapy, University of Notre Dame, Sydney, New South Wales, Australia
| | - Jane Desborough
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Susan Mcinnes
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kaara Calma
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ruth Mursa
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Catherine Stephen
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elizabeth J Halcomb
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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196
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Tilahun B, Gashu KD, Mekonnen ZA, Endehabtu BF, Angaw DA. Mapping the Role of Digital Health Technologies in Prevention and Control of COVID-19 Pandemic: Review of the Literature. Yearb Med Inform 2021; 30:26-37. [PMID: 34479378 PMCID: PMC8416203 DOI: 10.1055/s-0041-1726505] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Coronavirus Disease (COVID-19) is currently spreading exponentially around the globe. Various digital health technologies are currently being used as weapons in the fight against the pandemic in different ways by countries. The main objective of this review is to explore the role of digital health technologies in the fight against the COVID-19 pandemic and address the gaps in the use of these technologies for tackling the pandemic. METHODS We conducted a scoping review guided by the Joanna Briggs Institute guidelines. The articles were searched using electronic databases including MEDLINE (PubMed), Cochrane Library, and Hinari. In addition, Google and Google scholar were searched. Studies that focused on the application of digital health technologies on COVID-19 prevention and control were included in the review. We characterized the distribution of technological applications based on geographical locations, approaches to apply digital health technologies and main findings. The study findings from the existing literature were presented using thematic content analysis. RESULTS A total of 2,601 potentially relevant studies were generated from the initial search and 22 studies were included in the final review. The review found that telemedicine was used most frequently, followed by electronic health records and other digital technologies such as artificial intelligence, big data, and the internet of things (IoT). Digital health technologies were used in multiple ways in response to the COVID-19 pandemic, including screening and management of patients, methods to minimize exposure, modelling of disease spread, and supporting overworked providers. CONCLUSION Digital health technologies like telehealth, mHealth, electronic medical records, artificial intelligence, the internet of things, and big data/internet were used in different ways for the prevention and control of the COVID-19 pandemic in different settings using multiple approaches. For more effective deployment of digital health tools in times of pandemics, development of a guiding policy and standard on the development, deployment, and use of digital health tools in response to a pandemic is recommended.
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Affiliation(s)
- Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Dessie Gashu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Health System Directorate, Ministry of Health, Ethiopia
| | - Berhanu Fikadie Endehabtu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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197
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Oates EV, Lim GHC, Nevins EJ, Kanakala V. Are Surgical Patients Satisfied With Remote Consultations? A Comparison of Remote Versus Conventional Outpatient Clinic Follow-Up for Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Patient Exp 2021; 8:23743735211035916. [PMID: 34377778 PMCID: PMC8326624 DOI: 10.1177/23743735211035916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Access to remote appointments (RA) by telephone or video is increasing as technology advances and becomes more available to patients. This meta-analysis of randomized controlled trials (RCTs) aims to discover whether surgical patients are satisfied with RAs when compared with conventional outpatient clinics (OPC). A literature search of RCTs of surgical patient satisfaction of RAs versus OPC appointments was performed. The PubMed, EMBASE, OVID, Cochrane Library, and Google Scholar databases were searched to include articles from January 2000 to 2020. A random-effects meta-analysis model was used to compare outcomes. All 7 RCTs showed that patients were as satisfied with RAs as OPC appointments (RR = 1.00, [0.98-1.02]; P = .73). Furthermore, both patient cohorts would prefer RAs for future follow-up (RR = 2.29, [1.96-2.97]; P < .00001). One RCT found the cost to institutions was less in the RA group ($19.05 vs $52.76) and another found the patients would save $9.96 on transportation costs. The majority of RCTs suggested cost to patients and or institutions would be less for RA. In conclusion, surgical patients are satisfied with RAs and in fact would prefer them.
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Affiliation(s)
- Emily V Oates
- James Cook University Hospital, England, United Kingdom
| | - Grace H C Lim
- James Cook University Hospital, England, United Kingdom
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198
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Pillay T, Pillay M. Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2021; 68:e1-e12. [PMID: 34342487 PMCID: PMC8335787 DOI: 10.4102/sajcd.v68i1.832] [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: 03/18/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 11/08/2022] Open
Abstract
Background This study explored the available literature on the phenomenon of clinical reasoning and described its influence on the clinical swallow evaluation. By exploring the relationship between clinical reasoning and the clinical swallow evaluation, it is possible to modernise the approach to dysphagia assessment. Objectives This study aimed to contextualise the available literature on clinical reasoning and the CSE to low-middle income contexts through the use of a scoping review and expert consultation. Method A scoping review was performed based on the PRISMA-ScR framework. The data was analysed using thematic analysis. Articles were considered if they discussed the clinical swallow evaluation and clinical reasoning, and were published in the last 49 years. Results Through rigorous electronic and manual searching, 12 articles were identified. This review made an argument for the value of clinical reasoning within the clinical swallow evaluation. The results of the study revealed three core themes related to the acquisition, variability and positive impact of clinical reasoning in the clinical swallow evaluation. Conclusion The results of this review showed that the clinical swallow evaluation is a complex process with significant levels of variability usually linked to the impact of context. This demonstrates that in order to deliver effective and relevant services, despite challenging conditions, healthcare practitioners must depend on clinical reasoning to make appropriate modifications to the assessment process that considers these salient factors.
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Affiliation(s)
- Thiani Pillay
- Discipline of Speech-Language Pathology, School of Health Sciences, University of KwaZulu-Natal, Durban.
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199
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Rush KL, Seaton C, Li E, Oelke ND, Pesut B. Rural use of health service and telemedicine during COVID-19: The role of access and eHealth literacy. Health Informatics J 2021; 27:14604582211020064. [PMID: 34041936 DOI: 10.1177/14604582211020064] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The COVID-19 pandemic has driven a greater reliance on telemedicine, yet rural access, use, and satisfaction with telemedicine and the role of eHealth literacy are unknown. Using a cross-sectional design, 279 (70.6% female) western rural Canadians completed an online survey. The majority of participants reported access to telemedicine, but nearly 1/5 lacked access to online or virtual mental health services. The majority of participants had used health care services following the declared COVID-19 pandemic in North America, and just under half had used telemedicine. Telemedicine satisfaction scores were higher among participants who had used video (M = 4.18) compared to those who used phone alone (M = 3.79) (p = 0.031). Telemedicine satisfaction and eHealth literacy were correlated (r = 0.26, p = 0.005). Participants did not want telemedicine to replace in-person consultations. Telemedicine practice requires that rural residents have the resources, ability and willingness to engage with remote care.
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Affiliation(s)
| | | | - Eric Li
- University of British Columbia-Okanagan, Canada
| | - Nelly D Oelke
- University of British Columbia-Okanagan, Canada.,Rural Coordination Centre of British Columbia, Canada
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200
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Merolli M, Hinman RS, Lawford BJ, Choo D, Gray K. Digital Health Interventions in Physiotherapy: Development of Client and Health Care Provider Survey Instruments. JMIR Res Protoc 2021; 10:e25177. [PMID: 34319242 PMCID: PMC8367153 DOI: 10.2196/25177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/29/2021] [Accepted: 06/01/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The advancement of digital health has widened the scope of technology use across multiple frontiers of health care services, including personalized therapeutics, mobile health, eHealth record management, and telehealth consultations. The World Health Organization (WHO) responded to this in 2018 by publishing an inaugural broad classification framework of digital health interventions (DHIs) used to address contemporary health system needs. OBJECTIVE This study aims to describe the systematic development of dual survey instruments (clinician and patient) to support data collection, administered in a physiotherapy setting, about perceptions toward DHIs. This is achieved by adapting the WHO framework classification for DHIs for application in real-world research. METHODS Using a qualitative item review approach, WHO DHI descriptors were adapted and refined systematically to be used in a survey form. This approach was designed to align with the processes of delivering and receiving care in clinical practice, using musculoskeletal physiotherapy as a practical case scenario. RESULTS Complementary survey instruments (for health care providers and clients) were developed by adapting descriptor items. These instruments will be used in a larger study exploring the willingness of physiotherapists and patients to use digital technologies in the management of musculoskeletal conditions. CONCLUSIONS This study builds on the WHO-standardized DHI framework. We developed dual novel survey instruments by adapting and refining the functions of DHIs. These may be deployed to explore the perceived usefulness and application of DHIs for different clinical care functions. Researchers may wish to use these survey instruments to examine digital health use systematically in a variety of clinical fields or technology scenarios in a way that is standardized and generalizable.
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Affiliation(s)
- Mark Merolli
- Centre for Digital Transformation of Health, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Health, Exercise, and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise, and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Belinda J Lawford
- Centre for Health, Exercise, and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dawn Choo
- Centre for Digital Transformation of Health, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Audiology and Speech Pathology, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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