251
|
Dhahri AA, Iqbal MR, Pardoe H. Agile Application of Video Telemedicine During the COVID-19 Pandemic. Cureus 2020; 12:e11320. [PMID: 33262918 PMCID: PMC7689966 DOI: 10.7759/cureus.11320] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 01/25/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic led to a need to introduce video telemedicine for outpatients as an emergency measure without widespread stakeholder consultation. The patient and clinician experience of video outpatient consultation during the peak of the pandemic was studied for acceptability and to gather recommendations to improve the service during continuing infection control measures. Methods Outpatient video telemedicine was introduced over a 14-day period including the provision of equipment, systems integration and stakeholder communication. Patient and clinician experience were measured between 15 April 2020 and 5 May 2020. Results A total of 43 patients and 79 clinicians provided feedback. Of the patients, 86% were above the age of 30 years, with the largest patient group aged 51-70 years. Patient experience was positive. All (100%) patients found joining the video consultation easy; 93% of them recommended to use it for future consultations. Clinician satisfaction was >90% with sound and video quality. Patients were less satisfied than clinicians in that they had communicated everything they wanted to (86% versus 95%). All (100%) patients thought that the video telemedicine solution met their needs, but 25% of clinicians believed that the patient experience of a video consultation was worse than a face-to-face clinic appointment. The three significant factors identified for introducing video consultations were successful IT, improved patient experience and digital healthcare records. Conclusions In the COVID-19 crisis, video telemedicine played a central role in outpatient consultations with excellent levels of success. With some differences in satisfaction level, clinicians significantly underestimate the level of patient satisfaction with outpatient video consultation.
Collapse
Affiliation(s)
| | | | - Helen Pardoe
- Surgery, Princess Alexandra Hospital NHS Trust, Harlow, GBR
| |
Collapse
|
252
|
Wilkie M. Digital health – The new reality. What does this mean for peritoneal dialysis? Perit Dial Int 2020; 40:525-526. [DOI: 10.1177/0896860820972031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Martin Wilkie
- Sheffield, UK, Editor in Chief of Peritoneal Dialysis International
| |
Collapse
|
253
|
Johnston JL, Hart N. Primary care education in the time of COVID: embodiment, identity and loss. EDUCATION FOR PRIMARY CARE 2020; 32:6-9. [PMID: 33115378 DOI: 10.1080/14739879.2020.1837020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jennifer L Johnston
- Centre for Medical Education, Queen's University Belfast, Belfast, N Ireland
| | - Nigel Hart
- Centre for Medical Education, Queen's University Belfast, Belfast, N Ireland
| |
Collapse
|
254
|
Reardon J, Yuen J, Lim T, Ng R, Gobis B. Provision of Virtual Outpatient Care during the COVID-19 Pandemic and Beyond: Enabling Factors and Experiences from the UBC Pharmacists Clinic. Innov Pharm 2020; 11. [PMID: 34007655 PMCID: PMC8127117 DOI: 10.24926/iip.v11i4.3432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The COVID-19 pandemic has generated an unprecedented level of interest in, and uptake of, technology-enabled virtual health care delivery as clinicians seek ways to safely care for patients with physical distancing. This paper describes the UBC Pharmacists Clinic's technical systems and lessons learned using enabling technology and the provision of virtual patient care by pharmacists. Of 2036 scheduled appointments at the clinic in 2019, only 1.5% of initial appointments were conducted virtually which increased to 64% for follow-up appointments. Survey respondents (n = 18) indicated an overall high satisfaction with the format, quality of care delivery, ease of use and benefits to their overall health. Other reports indicate that the majority of patients would like the option to book appointments electronically, email their healthcare provider, and have telehealth visits, although a small minority (8%) have access to virtual modes of care. The Clinic team is bridging the technology gap to better align virtual service provision with patient preferences. Practical advice and information gained through experience are shared here. As the general population and health care providers become increasingly comfortable with video conferencing as a result of COVID-19, it is anticipated that requests for video appointments will increase, technological barriers will decrease and conditions will enable providers to increase their virtual care capabilities. Lessons learned at the Clinic have application to pharmacists in both out-patient and in-patient care settings.
Collapse
|
255
|
Tenforde AS, Borgstrom H, Polich G, Steere H, Davis IS, Cotton K, O'Donnell M, Silver JK. Outpatient Physical, Occupational, and Speech Therapy Synchronous Telemedicine: A Survey Study of Patient Satisfaction with Virtual Visits During the COVID-19 Pandemic. Am J Phys Med Rehabil 2020; 99:977-981. [PMID: 32804713 PMCID: PMC7526401 DOI: 10.1097/phm.0000000000001571] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The COVID-19 pandemic transformed health care delivery, including rapid expansion of telehealth. Telerehabilitation, defined as therapy provided by physical therapy, occupational therapy, and speech and language pathology, was rapidly adopted with goals to provide access to care and limit contagion. The purpose of this brief report was to describe the feasibility of and satisfaction with telerehabilitation. A total of 205 participants completed online surveys after a telerehabilitation visit. Most commonly, participants were women (53.7%), 35-64 yrs old, and completed physical therapy (53.7%) for established visits of 30-44 mins in duration for primary impairments in sports, lower limb injuries, and pediatric neurology. Overall, high ratings ("excellent" or "very good" responses) were observed for all patient-centered outcome metrics (range, 93.7%-99%) and value in future telehealth visit (86.8%) across telerehabilitation visits. Women participated more frequently and provided higher ratings than male participants did. Other benefits included eliminating travel time, incorporating other health care advocates, and convenience delivering care in familiar environment to pediatric patients. Technology and elements of hands-on aspects of care were observed limitations. Recognizing reduced indirect costs of care that telerehabilitation may provide along with high patient satisfaction are reasons policy makers should adopt these services into future health care delivery models.
Collapse
Affiliation(s)
- Adam S Tenforde
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (AST, HB, GP, HS, ISD, JKS); Spaulding Rehabilitation Hospital, Boston, Massachusetts (AST, HB, GP, HS, ISD, JKS); Brigham and Women's Hospital, Boston, Massachusetts (GP, JKS); Spaulding Outpatient Center Wellesley, Wellesley, Massachusetts (KC); Spaulding Outpatient Center for Children Lexington, Lexington, Massachusetts (MO); and Massachusetts General Hospital, Boston, Massachusetts (JKS)
| | | | | | | | | | | | | | | |
Collapse
|
256
|
Mueller M, Knop M, Niehaves B, Adarkwah CC. Investigating the Acceptance of Video Consultation by Patients in Rural Primary Care: Empirical Comparison of Preusers and Actual Users. JMIR Med Inform 2020; 8:e20813. [PMID: 32969339 PMCID: PMC7644376 DOI: 10.2196/20813] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/31/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The ongoing digitalization in health care is enabling patients to receive treatment via telemedical technologies, such as video consultation (VC), which are increasingly being used by general practitioners. Rural areas in particular exhibit a rapidly aging population, with an increase in associated health issues, whereas the level of attraction for working in those regions is decreasing for young physicians. Integrating telemedical approaches in treating patients can help lessen the professional workload and counteract the trend toward the spatial undersupply in many countries. As a result, an increasing number of patients are being confronted with digital treatment and new forms of care delivery. These novel ways of care engender interactions with patients and their private lives in unprecedented ways, calling for studies that incorporate patient needs, expectations, and behavior into the design and application of telemedical technology within the field of primary care. OBJECTIVE This study aims to unveil and compare the acceptance-promoting factors of patients without (preusers) and with experiences (actual users) in using VC in a primary care setting and to provide implications for the design, theory, and use of VC. METHODS In total, 20 semistructured interviews were conducted with patients in 2 rural primary care practices to identify and analyze patient needs, perceptions, and experiences that facilitate the acceptance of VC technology and adoption behavior. Both preusers and actual users of VC were engaged, allowing for an empirical comparison. For data analysis, a procedure was followed based on open, axial, and selective coding. RESULTS The study delivers factors and respective subdimensions that foster the perceptions of patients toward VC in rural primary care. Factors cover attitudes and expectations toward the use of VC, the patient-physician relationship and its impact on technology assessment and use, patients' rights and obligations that emerge with the introduction of VC in primary care, and the influence of social norms on the use of VC and vice versa. With regard to these factors, the results indicate differences between preusers and actual users of VC, which imply ways of designing and implementing VC concerning the respective user group. Actual users attach higher importance to the perceived benefits of VC and their responsibility to use it appropriately, which might be rooted in the technological intervention they experienced. On the contrary, preusers valued the opinions and expectations of their peers. CONCLUSIONS The way the limitations and potential of VC are perceived varies across patients. When practicing VC in primary care, different aspects should be considered when dealing with preusers, such as maintaining a physical interaction with the physician or incorporating social cues. Once the digital intervention takes place, patients tend to value benefits such as flexibility and effectiveness over potential concerns.
Collapse
Affiliation(s)
- Marius Mueller
- Chair of Information Systems, University of Siegen, Siegen, Germany
| | - Michael Knop
- Chair of Information Systems, University of Siegen, Siegen, Germany
| | - Bjoern Niehaves
- Chair of Information Systems, University of Siegen, Siegen, Germany
| | - Charles Christian Adarkwah
- Department of General Practice and Family Medicine, Philipps-University, Marburg, Germany.,Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
257
|
Completing asthma action plans by screen-sharing in video-consultations: practical insights from a feasibility assessment. NPJ Prim Care Respir Med 2020; 30:48. [PMID: 33087713 PMCID: PMC7578638 DOI: 10.1038/s41533-020-00206-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/25/2020] [Indexed: 11/08/2022] Open
Abstract
Supported self-management is a vital component of routine asthma care. Completion of an agreed personalised asthma action plan is integral to implementation of this care, and traditionally this requires a face-to-face consultation. We aimed to assess the practical feasibility and potential utility of using screen-sharing technologies to complete asthma action plans remotely. Assisted by people with diverse technological ability and using a range of devices, we tested the technological feasibility of completing action plans in remote consultations using two leading video-conference systems. We used a semi-structured topic guide to check functionality and lead feedback discussions. Themes were interpreted using the Model for ASsessment of Telemedicine applications (MAST). Discussions with ten participants (age 20–74 years) revealed that screen-sharing was practical on most devices. Joint editing of an action plan (as was possible with Zoom) was considered to encourage participation and improve communication. Attend Anywhere had less functionality than Zoom, but the NHS badging was reassuring. Most participants appreciated the screen-sharing and considered it enabled a meaningful discussion about their action plan. Online shared completion of action plans is feasible with only a few (potentially remediable) practical problems. These findings suggest this may be a fruitful approach for further study—made more urgent by the imperative to develop remote consultations in the face of a global pandemic.
Collapse
|
258
|
Car J, Koh GCH, Foong PS, Wang CJ. Video consultations in primary and specialist care during the covid-19 pandemic and beyond. BMJ 2020; 371:m3945. [PMID: 33082127 DOI: 10.1136/bmj.m3945] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Pin Sym Foong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - C Jason Wang
- Departments of Pediatrics, Medicine, and Health Research and Policy, Stanford University School of Medicine, Stanford, California
- The New School for Leadership in Health Care, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| |
Collapse
|
259
|
Bressy S, Zingarelli EM. Technological devices in COVID-19 primary care management: the Italian experience. Fam Pract 2020; 37:725-726. [PMID: 32440688 PMCID: PMC7314005 DOI: 10.1093/fampra/cmaa055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Silvia Bressy
- Department of Primary Care, ASLTO5, Via Dante 7, Carmagnola, Italy
| | - Enrico M Zingarelli
- Department of Plastic and Reconstructive Surgery, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| |
Collapse
|
260
|
Development and Operation of a Video Teleconsultation System Using Integrated Medical Equipment Gateway: a National Project for Workers in Underserved Areas. J Med Syst 2020; 44:194. [PMID: 33006060 PMCID: PMC7529321 DOI: 10.1007/s10916-020-01664-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022]
Abstract
Worker health centers and health zones provide occupational healthcare services to workers in underserved areas of industrial health. Health zones cannot counsel workers on occupational disease prevention; worker health center personnel have to provide such services through in-person visits. Video teleconsultation can increase the accessibility of high-quality services to workers who visit health zones and improve professional personnel’s efficiency. This study aimed to develop a system and an infrastructure that could facilitate video teleconsultation services between worker health centers and health zones, and analyze the services’ operation status. A video teleconsultation process based on the role of local and remote institutions was designed. Based on the designed services, a web system supporting teleconsultation and an integrated gateway guaranteeing the interface with medical equipment in the web environment was developed. After analyzing the working environment, an infrastructure consisting of networks, video equipment, medical equipment, and servers necessary for teleconsultation was designed. Statistical results from the developed system and a satisfaction survey conducted by the Korea Occupational Safety and Health Agency were used to analyze the video teleconsultation services’ operation status. A system, gateway, and hardware infrastructure within 21 worker health centers and 21 health zones has been operating this service since January 1, 2018. Over two years, the total number of teleconsultation service users was 4979, and the total number of questionnaire respondents was 1270. The total number of service activities was 6388 and total satisfaction was rated as 4.58 (± 0.59) out of 5. In this study, video teleconsultation services were evaluated as being very satisfactory. In particular, service accessibility and local medical personnel service were rated highly, demonstrating that the developed system and infrastructure were well designed according to the goals of the project.
Collapse
|
261
|
Lam K, Lu AD, Shi Y, Covinsky KE. Assessing Telemedicine Unreadiness Among Older Adults in the United States During the COVID-19 Pandemic. JAMA Intern Med 2020; 180:1389-1391. [PMID: 32744593 PMCID: PMC7400189 DOI: 10.1001/jamainternmed.2020.2671] [Citation(s) in RCA: 381] [Impact Index Per Article: 95.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cross-sectional study uses 2018 data from the National Health and Aging Trends Study to assess the prevalence among older adults in the United States of unreadiness to access video or telephone telemedicine because of disability or inexperience with technology.
Collapse
Affiliation(s)
- Kenneth Lam
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Amy D Lu
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Ying Shi
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Kenneth E Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| |
Collapse
|
262
|
Telehealth tinnitus therapy during the COVID-19 outbreak in the UK: uptake and related factors. Int J Audiol 2020; 60:322-327. [PMID: 33000663 DOI: 10.1080/14992027.2020.1822553] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The Audiology Department at the Royal Surrey County Hospital usually offers face-to-face audiologist-delivered cognitive behavioural therapy (CBT) for tinnitus rehabilitation. During COVID-19 lockdown, patients were offered telehealth CBT via video using a web-based platform. This study evaluated the proportion of patients who took up the offer of telehealth sessions and factors related to this. DESIGN Retrospective service evaluation. STUDY SAMPLE 113 consecutive patients whose care was interrupted by the lockdown. RESULTS 80% of patients accepted telehealth. The main reasons for declining were not having access to a suitable device and the belief that telehealth appointments would not be useful. Compared to having no hearing loss in the better ear, having a mild or moderate hearing loss increased the chance of declining telehealth by factors of 3.5 (p = 0.04) and 14.9 (p = 0.038), respectively. High tinnitus annoyance as measured via the visual analogue scale increased the chance of declining telehealth appointments by a factor of 1.4 (p = 0.019). CONCLUSIONS Although CBT via telehealth was acceptable to most patients, alternatives may be necessary for the 20% who declined. These tended to have worse hearing in their better ear and more annoying tinnitus.
Collapse
|
263
|
Wright RC, Partovi N, Levy RD. Necessity is the mother of invention: Rapid implementation of virtual health care in response to the COVID-19 pandemic in a lung transplant clinic. Clin Transplant 2020; 34:e14062. [PMID: 32954533 PMCID: PMC7536914 DOI: 10.1111/ctr.14062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/29/2020] [Accepted: 08/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Robert C Wright
- Lung Transplant Program, Vancouver General Hospital, Vancouver, BC, Canada.,Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, BC, Canada
| | - Nilufar Partovi
- Lung Transplant Program, Vancouver General Hospital, Vancouver, BC, Canada.,Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, BC, Canada.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,BC Transplant, Vancouver, BC, Canada
| | - Robert D Levy
- Lung Transplant Program, Vancouver General Hospital, Vancouver, BC, Canada.,BC Transplant, Vancouver, BC, Canada.,Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
264
|
Gilbert AW, Jones J, Jaggi A, May CR. Use of virtual consultations in an orthopaedic rehabilitation setting: how do changes in the work of being a patient influence patient preferences? A systematic review and qualitative synthesis. BMJ Open 2020; 10:e036197. [PMID: 32938591 PMCID: PMC7497523 DOI: 10.1136/bmjopen-2019-036197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To systematically review qualitative studies reporting the use of virtual consultations within an orthopaedic rehabilitation setting and to understand how its use changes the work required of patients. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement, we conducted a systematic review of papers to answer the research question 'How do changes in the work of being a patient when using communication technology influence patient preferences?' Electronic databases were searched for studies meeting the inclusion criteria in April 2020. RESULTS The search strategy identified 2057 research articles from the database search. A review of titles and abstracts using the inclusion criteria yielded 21 articles for full-text review. Nine studies were included in the final analysis. Six studies explored real-time video conferencing and three explored telephone consultations. The use of communication technology changes the work required of patients. Such changes will impact on expectations for care, resources required of patients, the environment of receiving care and patient-clinician interactions. This adjustment of the work required of patients who access orthopaedic rehabilitation using communication technology will impact on their experience of receiving care. It is proposed that changes in the work of being a patient will influence preferences for or against the use of communication technology consultations for orthopaedic rehabilitation. CONCLUSION We found that the use of communication technology changes the work of being a patient. The change in work required of patients can be both burdensome (it makes it harder for patients to access their care) and beneficial (it makes it easier for patients to access their care). This change will likely to influence preferences. Keeping the concept of patient work at the heart of pathway redesign is likely to be a key consideration to ensure successful implementation. PROSPERO REGISTRATION NUMBER CRD42018100896.
Collapse
Affiliation(s)
- Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jeremy Jones
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Anju Jaggi
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
265
|
Duncan C, Macleod AD. Video consultations in ordinary and extraordinary times. Pract Neurol 2020; 20:396-403. [DOI: 10.1136/practneurol-2020-002579] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2020] [Indexed: 11/03/2022]
Abstract
Tele-neurology is a neurological consultation at a distance, or not in person, using various technologies to achieve connectivity, including the telephone and the internet. The telephone is ubiquitous and is a standard part of how we manage patients. Video consulting has been used for a long time in some centres, particularly in those where the geography means that patients have to travel long distances. Various technologies can be used, and with the development of various internet-based video-calling platforms, real-time video consulting has become much more accessible. We have provided a tele-neurology service in the North East of Scotland since 2006 using video conferencing with far-end camera control. More recently, we have complemented this using an internet-based platform (NHS Near Me). Here we outline the practicalities of video consulting in ‘ordinary’ times and comment on its use in the ‘extraordinary’ times of the coronavirus pandemic.
Collapse
|
266
|
A brave new world: the new normal for general practice after the COVID-19 pandemic. BJGP Open 2020; 4:bjgpopen20X101103. [PMID: 32487520 PMCID: PMC7465568 DOI: 10.3399/bjgpopen20x101103] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/15/2020] [Indexed: 10/31/2022] Open
|
267
|
Broom A, Kenny K, Page A, Cort N, Lipp ES, Tan AC, Ashley DM, Walsh KM, Khasraw M. The Paradoxical Effects of COVID-19 on Cancer Care: Current Context and Potential Lasting Impacts. Clin Cancer Res 2020; 26:5809-5813. [PMID: 32816894 DOI: 10.1158/1078-0432.ccr-20-2989] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/03/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has fundamentally disrupted the practice of oncology, shifting care onto virtual platforms, rearranging the logistics and economics of running a successful clinical practice and research, and in some contexts, redefining what treatments patients with cancer should and can receive. Since the start of the pandemic in early 2020, there has been considerable emphasis placed on the implications for patients with cancer in terms of their vulnerability to the virus and potential exposure in healthcare settings. But little emphasis has been placed on the significant, and potentially enduring, consequences of COVID-19 for how cancer care is delivered. In this article, we outline the importance of a focus on the effects of COVID-19 for oncology practice during and potentially after the pandemic, focusing on key shifts that are already evident, including: the pivot to online consultations, shifts in access to clinical trial and definitions of "essential care," the changing economics of practice, and the potential legacy effects of rapidly implemented changes in cancer care. COVID-19 is reshaping oncology practice, clinical trials, and delivery of cancer care broadly, and these changes might endure well beyond the short- to mid-term of the active pandemic. Therefore, shifts in practice brought about by the pandemic must be accompanied by improved training and awareness, enhanced infrastructure, and evidence-based support if they are to harness the positives and offset the potential negative consequences of the impacts of COVID-19 on cancer care.
Collapse
Affiliation(s)
- Alex Broom
- The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Kenny
- The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander Page
- The University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Cort
- Duke University Medical Center, Duke University, Durham, North Carolina
| | - Eric S Lipp
- Duke University Medical Center, Duke University, Durham, North Carolina
| | - Aaron C Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - David M Ashley
- Duke University Medical Center, Duke University, Durham, North Carolina
| | - Kyle M Walsh
- Duke University Medical Center, Duke University, Durham, North Carolina
| | - Mustafa Khasraw
- The University of Sydney, Sydney, New South Wales, Australia. .,Duke University Medical Center, Duke University, Durham, North Carolina
| |
Collapse
|
268
|
Modesti PA, Wang J, Damasceno A, Agyemang C, Van Bortel L, Persu A, Zhao D, Jarraya F, Marzotti I, Bamoshmoosh M, Parati G, Schutte AE. Indirect implications of COVID-19 prevention strategies on non-communicable diseases : An Opinion Paper of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk Assessment in Subjects Living in or Emigrating from Low Resource Settings. BMC Med 2020; 18:256. [PMID: 32795303 PMCID: PMC7426897 DOI: 10.1186/s12916-020-01723-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND After its outbreak in China, the novel COronaVIrus Disease 19 is spreading across the globe. It is an emergency the world has never seen before. MAIN TEXT The attention of health systems is mainly focused on COronaVIrus Disease 19 patients and on the risk that intensive care units might be overwhelmed by the serious pulmonary complications. Different countries are also attempting to establish infection prevention and control strategies which proved effective in China where the outbreak was initially reported. We reflect on important lessons to be learnt from different countries. The effects that infection prevention and control strategies, such as social distancing or isolation, can have on the care of millions of patients with non-communicable diseases, who may be indirectly affected, have not been taken into consideration so much. CONCLUSIONS When dealing with COronaVIrus Disease 19, policy makers and healthcare personnel should consider the indirect effects on the treatment of non-communicable diseases.
Collapse
Affiliation(s)
- Pietro A Modesti
- Department of Experimental and Clinical Medicine, School of Medicine, Universita' degli Studi di Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Jiguang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Albertino Damasceno
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health (APH) Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - Luc Van Bortel
- Division of Clinical Pharmacology, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Faical Jarraya
- Université de Sfax, Laboratoire de Recherche LR19ES11 (Ex. UR12ES14), Faculté de Médecine, Avenue M. Boulila, Sfax, 3029, Tunisie
| | - Ilaria Marzotti
- Department of Experimental and Clinical Medicine, School of Medicine, Universita' degli Studi di Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | | | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Department of Cardiology, S. Luca Hospital, IRCCS Istituto Auxologico Medicine and Surgery, Milan, Italy
| | - Aletta E Schutte
- Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa
- School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales and the George Institute for Global Health, Sydney, Australia
| |
Collapse
|
269
|
Liu N, Huang R, Baldacchino T, Sud A, Sud K, Khadra M, Kim J. Telehealth for Noncritical Patients With Chronic Diseases During the COVID-19 Pandemic. J Med Internet Res 2020; 22:e19493. [PMID: 32721925 PMCID: PMC7419134 DOI: 10.2196/19493] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023] Open
Abstract
During the recent coronavirus disease (COVID-19) pandemic, telehealth has received greater attention due to its role in reducing hospital visits from patients with COVID-19 or other conditions, while supporting home isolation in patients with mild symptoms. The needs of patients with chronic diseases tend to be overlooked during the pandemic. With reduced opportunities for routine clinic visits, these patients are adopting various telehealth services such as video consultation and remote monitoring. We advocate for more innovative designs to be considered to enhance patients' feelings of "copresence"-a sense of connection with another interactant via digital technology-with their health care providers during this time. The copresence-enhanced design has been shown to reduce patients' anxiety and increase their confidence in managing their chronic disease condition. It has the potential to reduce the patient's need to reach out to their health care provider during a time when health care resources are being stretched.
Collapse
Affiliation(s)
- Na Liu
- The University of Sydney Business School, Sydney, Australia
| | - Robin Huang
- School of Computer Science, The University of Sydney, NSW, Australia
| | - Tanya Baldacchino
- Telehealth and Technology Centre, Nepean Blue Mountains Local Health District, NSW, Australia
| | - Archana Sud
- Department of Infectious Diseases, Nepean Hospital, NSW, Australia.,Department of Medicine (Infectious Diseases and Immunology), Nepean Clinical School, University of Sydney, NSW, Australia
| | - Kamal Sud
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Department of Renal Medicine, Nepean Hospital, Kingswood, NSW, Australia
| | - Mohamed Khadra
- Strategy and Innovation, Nepean Blue Mountains Local Health District, NSW, Australia
| | - Jinman Kim
- School of Computer Science, The University of Sydney, NSW, Australia.,Telehealth and Technology Centre, Nepean Blue Mountains Local Health District, NSW, Australia
| |
Collapse
|
270
|
Patel T, Wong J. The role of real-time interactive video consultations in dental practice during the recovery and restoration phase of the COVID-19 outbreak. Br Dent J 2020; 229:196-200. [PMID: 32811949 PMCID: PMC7431749 DOI: 10.1038/s41415-020-1918-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID-19 outbreak has caused many challenges for the dental profession and workforce. With the suspension of routine dental services at the end of March 2020, there is a significant number of the general population with acute dental problems. In addition to these, there are patients who had treatment suspended partway through their treatment plans and therefore there is now a backlog of patients awaiting dental care. One challenge that will face the profession moving forward will be facilitating access to these patients and determining which patients should be seen as a priority for necessary dental care. This article looks at the role of real-time interactive video consultations in dental practice during the recovery and restoration phase of the COVID-19 outbreak and how they could facilitate the management of patients waiting to access dental care.
Collapse
Affiliation(s)
- Trishna Patel
- , HEE Leadership Fellow with clinical experience in paediatric dentistry, UK.
| | - Jason Wong
- , Dental local professional network chair NHS England & NHS Improvement Midlands, UK
| |
Collapse
|
271
|
Jazieh AR, Kozlakidis Z. Healthcare Transformation in the Post-Coronavirus Pandemic Era. Front Med (Lausanne) 2020; 7:429. [PMID: 32850915 PMCID: PMC7399067 DOI: 10.3389/fmed.2020.00429] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/03/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Abdul Rahman Jazieh
- Department of Oncology, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Zisis Kozlakidis
- Laboratory Services and Biobanking, International Agency for Research on Cancer, World Health Organization, Lyon, France
| |
Collapse
|
272
|
Kelley LT, Phung M, Stamenova V, Fujioka J, Agarwal P, Onabajo N, Wong I, Nguyen M, Bhatia RS, Bhattacharyya O. Exploring how virtual primary care visits affect patient burden of treatment. Int J Med Inform 2020; 141:104228. [PMID: 32683311 DOI: 10.1016/j.ijmedinf.2020.104228] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 06/20/2020] [Accepted: 06/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is growing emphasis on the role of digital solutions in supporting chronic disease management. This has the potential to increase the burden patients experience in managing their health by offloading care from the health system to patients. This paper explores the effects of virtual visits on patient burden using an explicit framework measuring both the work patients do to care for their health and the challenges they experience that exacerbate burden. METHODS This mixed methods study evaluates a large pilot implementation of virtual visits (video, audio, and asynchronous messaging with providers) in primary care in Ontario, Canada. Participants were recruited using convenience sampling from patients using a virtual visit platform to complete a semi-structured interview or a survey including a free-text response. We conducted 17 interviews and reviewed 427 free text responses related to explore patients' perceived value and burden of these visits. We used qualitative analyses to map patients' feedback on their experience to the framework on patient burden. MAIN FINDINGS Virtual visits appear to reduce the work patients must do to manage their care by 1) improving access, convenience, and time needed for medical appointments, and 2) making it easier to access information and support for chronic disease management. Virtual visits also alleviate patients' perceived burden by improving continuity of care, experience of care, and providing some cost savings. CONCLUSIONS Virtual visits reduced overall patient burden of treatment by decreasing the required patient effort of managing medical appointments and monitoring their health, and by minimizing challenges experienced when accessing care. For regions that want to improve patient experience of care, virtual visits are likely to be of benefit. There is need for further research on the generalizability of the findings herein, particularly for high-needs populations under-represented such as those of low socioeconomic status and those in rural and remote locations.
Collapse
Affiliation(s)
- L T Kelley
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - M Phung
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - V Stamenova
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - J Fujioka
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - P Agarwal
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - N Onabajo
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - I Wong
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - M Nguyen
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada; Department of Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - R S Bhatia
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - O Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
273
|
Stamenova V, Agarwal P, Kelley L, Fujioka J, Nguyen M, Phung M, Wong I, Onabajo N, Bhatia RS, Bhattacharyya O. Uptake and patient and provider communication modality preferences of virtual visits in primary care: a retrospective cohort study in Canada. BMJ Open 2020; 10:e037064. [PMID: 32636284 PMCID: PMC7342856 DOI: 10.1136/bmjopen-2020-037064] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/19/2020] [Accepted: 05/12/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To evaluate the uptake of a platform for virtual visits in primary care, examine patient and physician preferences for virtual communication methods and report on characteristics of visits and patients experience of care. DESIGN A retrospective cohort study. SETTING Primary care practices within five regions in Ontario, Canada after 18 months of access to virtual care services. PARTICIPANTS 326 primary care providers and 14 291 registered patients. INTERVENTIONS Providers used a platform that allowed them to connect with their patients through synchronous (audio/video) and/or asynchronous (secure messaging) communication. MAIN OUTCOME MEASURES User-level data from the platforms including patient demographics, practice characteristics, communication modality used, visit characteristics and patients' satisfaction. RESULTS Among the participants, 44% of registered patients and 60% of registered providers used the platform at least once. Among patient users, 51% completed at least one virtual visit. The majority of virtual visits (94%) involved secure messaging. The most common patient requests were for medication prescriptions (24%) and follow-up from previous appointment (22%). The most common provider request was to follow-up on test results (59%). Providers indicated that 81% of virtual visits required no follow-up for that issue and 99% of patients reported that they would use virtual care services again. CONCLUSIONS While there are a growing number of primary care video visit services, our study found that both patients and providers in rostered practices prefer secure messaging over video. Despite fears that virtual visits would be overused by patients, when patients connected with their own primary care provider, many virtual visits appeared to replace in-person visits, and patients did not overwhelm physicians with requests. This approach may improve access and continuity in primary care.
Collapse
Affiliation(s)
- Vess Stamenova
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Payal Agarwal
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Leah Kelley
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Jamie Fujioka
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Megan Nguyen
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Phung
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Ivy Wong
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Nike Onabajo
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
274
|
Coping with the COVID-19 crisis: an overview of service adaptation and challenges encountered by a rural Psychiatry of Later Life (POLL) team. Ir J Psychol Med 2020; 38:288-292. [PMID: 32611473 PMCID: PMC7399143 DOI: 10.1017/ipm.2020.86] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The COVID-19 pandemic has posed many challenges in maintaining standards of care and treatment for patients while managing the increased anxieties of patients, carers and the public in general. This paper highlights several clinical, administrative, medicolegal and IT implications of COVID-19 on the delivery of mental healthcare to an elderly vulnerable patient cohort due to recommended social distancing measures. Our Psychiatry of Later Life team has adapted to this by restricting face-to-face consultation, while continuing to provide telephone support. We have modified our documentation standard and have improved some aspects of our team working by facilitating flexible working arrangement and relevant training for staff as well as by embracing new technology. Notwithstanding the challenges therefore, this exceptional time has also opened avenues for new and innovative opportunities that can be further explored even when the current crisis eventually passes.
Collapse
|
275
|
Mobeireek A, Alzamil H. In the coronavirus disease-19 era, is the care of noncoronavirus disease-19 patients being compromised? Ann Thorac Med 2020; 15:103-104. [PMID: 32831929 PMCID: PMC7423208 DOI: 10.4103/atm.atm_176_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Abdullah Mobeireek
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hana Alzamil
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
276
|
Nadarzynski T, Bayley J, Llewellyn C, Kidsley S, Graham CA. Acceptability of artificial intelligence (AI)-enabled chatbots, video consultations and live webchats as online platforms for sexual health advice. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:210-217. [PMID: 31964779 DOI: 10.1136/bmjsrh-2018-200271] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Sexual and reproductive health (SRH) services are undergoing a digital transformation. This study explored the acceptability of three digital services, (i) video consultations via Skype, (ii) live webchats with a health advisor and (iii) artificial intelligence (AI)-enabled chatbots, as potential platforms for SRH advice. METHODS A pencil-and-paper 33-item survey was distributed in three clinics in Hampshire, UK for patients attending SRH services. Logistic regressions were performed to identify the correlates of acceptability. RESULTS In total, 257 patients (57% women, 50% aged <25 years) completed the survey. As the first point of contact, 70% preferred face-to-face consultations, 17% telephone consultation, 10% webchats and 3% video consultations. Most would be willing to use video consultations (58%) and webchat facilities (73%) for ongoing care, but only 40% found AI chatbots acceptable. Younger age (<25 years) (OR 2.43, 95% CI 1.35 to 4.38), White ethnicity (OR 2.87, 95% CI 1.30 to 6.34), past sexually transmitted infection (STI) diagnosis (OR 2.05, 95% CI 1.07 to 3.95), self-reported STI symptoms (OR 0.58, 95% CI 0.34 to 0.97), smartphone ownership (OR 16.0, 95% CI 3.64 to 70.5) and the preference for a SRH smartphone application (OR 1.95, 95% CI 1.13 to 3.35) were associated with video consultations, webchats or chatbots acceptability. CONCLUSIONS Although video consultations and webchat services appear acceptable, there is currently little support for SRH chatbots. The findings demonstrate a preference for human interaction in SRH services. Policymakers and intervention developers need to ensure that digital transformation is not only cost-effective but also acceptable to users, easily accessible and equitable to all populations using SRH services.
Collapse
Affiliation(s)
- Tom Nadarzynski
- Department of Psychology, University of Southampton, Southampton, UK
| | - Jake Bayley
- Sexual Health and HIV, Bart's Healthcare NHS Trust, London, UK
| | - Carrie Llewellyn
- Primary Care & Public Health, Brighton and Sussex Medical School (BSMS), Brighton, UK
| | | | | |
Collapse
|
277
|
Dijkstra HP, Ergen E, Holtzhausen L, Beasley I, Alonso JM, Geertsema L, Geertsema C, Nelis S, Ngai ASH, Stankovic I, Targett S, Andersen TE. Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic. Br J Sports Med 2020; 54:1162-1167. [PMID: 32605933 PMCID: PMC7513251 DOI: 10.1136/bjsports-2020-102650] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2020] [Indexed: 12/12/2022]
Abstract
Background The COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services. Aim The aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template. Results eHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education. Conclusion teleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms—eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide.
Collapse
Affiliation(s)
- H Paul Dijkstra
- Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar .,Department for Continuing Education, University of Oxford, Oxford, UK
| | - Emin Ergen
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Louis Holtzhausen
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,Section Sports Medicine, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Ian Beasley
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,The Royal Ballet, London, UK
| | - Juan Manuel Alonso
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Liesel Geertsema
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Celeste Geertsema
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Sofie Nelis
- Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Aston Seng Huey Ngai
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Ivan Stankovic
- Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Stephen Targett
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Thor Einar Andersen
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| |
Collapse
|
278
|
Cullum RJ, Shaughnessy A, Mayat NY, Brown ME. Identity in lockdown: supporting primary care professional identity development in the COVID-19 generation. EDUCATION FOR PRIMARY CARE 2020; 31:200-204. [PMID: 32589524 DOI: 10.1080/14739879.2020.1779616] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The current COVID-19 pandemic has dramatically impacted undergraduate medical studies. Whilst challenges for knowledge and clinical skills are being actively addressed, wider considerations such as the impact on professional identity development have been mostly neglected thus far. A robust professional identity is linked to professional behaviour and has been shown to reduce burnout and be an important factor for general practice career choice amongst medical students. The Communities of Practice Model is a sociocultural approach that conceptualises the formation of professional identity through student engagement within a community. We argue the current suspension of clinical placements holds the potential to negatively influence such identity acquisition. In this commentary we explore how the Communities of Practice Model may inform professional identity development of medical students within the COVID-19 environment, considering digital communities and volunteering roles within primary care. We further encourage educators and institutions to consider professional identity in future planning to address the challenges posed by the current situation, both in terms of placement loss but also changes in the way primary care is delivered. Such considerations will be essential if we are to avoid problems relating to poor medical student professional identity development in future.
Collapse
Affiliation(s)
| | | | - Nabilah Y Mayat
- Medical Student, Barts and the London School of Medicine and Dentistry , London, UK
| | - Megan El Brown
- Health Professions Education Unit, Hull York Medical School , York, UK
| |
Collapse
|
279
|
|
280
|
Kang E, Lee SY, Jung H, Kim MS, Cho B, Kim YS. Operating Protocols of a Community Treatment Center for Isolation of Patients with Coronavirus Disease, South Korea. Emerg Infect Dis 2020; 26:2329-2337. [PMID: 32568665 PMCID: PMC7510742 DOI: 10.3201/eid2610.201460] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Most persons with confirmed coronavirus disease (COVID-19) have no or mild symptoms. During the COVID-19 pandemic, communities need efficient methods to monitor asymptomatic patients to reduce transmission. We describe the structure and operating protocols of a community treatment center (CTC) run by Seoul National University Hospital (SNUH) in South Korea. SNUH converted an existing facility into a CTC to isolate patients who had confirmed COVID-19 but mild or no symptoms. Patients reported self-measured vital signs and symptoms twice a day by using a smartphone application. Medical staff in a remote monitoring center at SNUH reviewed patient vital signs and provided video consultation to patients twice daily. The CTC required few medical staff to perform medical tests, monitor patients, and respond to emergencies. During March 5–26, 2020, we admitted and treated 113 patients at this center. CTCs could be an alternative to hospital admission for isolating patients and preventing community transmission.
Collapse
|
281
|
Hoffmann M, Wensing M, Peters-Klimm F, Szecsenyi J, Hartmann M, Friederich HC, Haun MW. Perspectives of Psychotherapists and Psychiatrists on Mental Health Care Integration Within Primary Care Via Video Consultations: Qualitative Preimplementation Study. J Med Internet Res 2020; 22:e17569. [PMID: 32554369 PMCID: PMC7333073 DOI: 10.2196/17569] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background Many patients with mental disorders remain untreated. Video-based mental health care demonstrates comparable effectiveness to face-to-face treatments and is a promising mode for delivering specialized care within primary care. Nevertheless, professionals struggle with implementing video consultations in their daily practice. Specifically, little is known about mental health specialists’ acceptance of mental health video consultations in routine practice. The PROVIDE (ImPROving cross-sectoral collaboration between primary and psychosocial care: An implementation study on VIDEo consultations) project aims to improve cross-sectoral collaboration between primary and psychosocial care through implementing video consultations in primary care. To increase the uptake of video consultations, it is crucial to account for necessary prerequisites and to tailor interventions to the needs of the target group prior to implementation. Objective The aim of this study was to explore the acceptance of video consultations embedded in primary care from the perspectives of mental health specialists in Germany. Methods We conducted a qualitative, exploratory, preimplementation study in urban and rural counties. We conducted three semistructured focus groups with 11 mental health specialists. We used qualitative content analysis combining an inductive-deductive approach, applying the Tailored Implementation in Chronic Diseases (TICD) framework to the text material, which comprises individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; social, political, and legal factors; and guideline factors. Results Against the background of long waiting times and a shortage of mental health specialists, especially in rural areas, participants valued video consultations as a potential means to improve access to mental health care. With respect to the TICD framework domains, the participants most often discussed individual health professional factors, followed by patient factors. All participants highlighted the importance of a trusting relationship between the patient and the therapist and doubted whether such a relationship could be established through video consultations (11/11, 100%). However, participants considered mental health specialist video consultations to be particularly suited for patients in rural areas, those with impaired mobility, and those who may otherwise remain untreated (6/11, 55%). Most participants expected video consultations to help the aforementioned patient groups avoid tedious searching for an available therapist and save on travel time and, therefore, improve access to specialized care for patients (7/11, 64%). Moreover, the participants expected video consultations to improve collaboration with the family physician (6/11, 55%). Finally, participants identified organizational aspects, such as reliable scheduling, the duration of the individual consultation (9/11, 82%), and reimbursement conditions (7/11, 67%), as key drivers for the acceptance and adoption of the model. Conclusions While mental health specialists expect video consultations to improve access to specialized care for some patients, they consistently wonder whether such consultations can establish a trusting patient-therapist relationship. When implementing video consultations, these concerns should be addressed by training providers in managing technology-based treatment settings, with extra consideration for fostering the patients’ and therapists’ engagement. Trial Registration German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one
Collapse
Affiliation(s)
- Mariell Hoffmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
282
|
Incorporating Video Visits into Ophthalmology Practice: A Retrospective Analysis and Patient Survey to Assess Initial Experiences and Patient Acceptability at an Academic Eye Center. Ophthalmol Ther 2020; 9:549-562. [PMID: 32535837 PMCID: PMC7293175 DOI: 10.1007/s40123-020-00269-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has led to rapid adoption of teleophthalmology to deliver eyecare remotely. The purpose of our study was to assess the implementation and patient acceptability of video consultation for outpatient ophthalmic care at our institution. METHODS We conducted a retrospective, cross-sectional analysis and patient survey of adult patients who completed a virtual video visit at our institution from 18 March 18 through to 27 April 2020. All video visit encounters were assessed for patient characteristics, diagnoses, management, and follow-up outcomes. Patients were surveyed for their feedback on acceptability and utility of their virtual video consultation. RESULTS A total of 219 patients (mean age 55 years; range 21-89 years) completed 231 video visit encounters at our department over a 6-week period, of whom 118 were women (54%). About half of these encounters were acute visits (102 visits, 47%). The most common diagnosis of these visits was postoperative state (20 visits, 9% of the total), followed by conjunctivitis (16 visits, 7%), and keratitis (14 visits, 6%). The most common management decisions were medication prescription (102 visits, 46%) or reassurance (86 visits, 39%), while 17 video visit patients (8%) were escalated to an urgent, in-person evaluation. Ninety-two patients completed a follow-up survey (42% response rate), of whom 45 (49%) indicated that they might have delayed seeking care during this pandemic in the absence of a virtual video option. Seventy-two (78%) reported that they would consider participating in a video visit as an alternative to an office-based encounter in the future, and the overall video visit experience was rated highly, with a weighted mean Likert scale rating of 4.3 out of 5 (Cronbach's α = 0.88). CONCLUSION Virtual video visits may be used to manage a range of ophthalmic complaints. Patients participating in this survey found such video visits acceptable and timesaving, and the majority would consider using video consultations for future eyecare encounters.
Collapse
|
283
|
Abstract
This article provides an overview of tools which enable remote working in Dentistry. It assesses the availability of tools for use in three areas of remote working in healthcare: video conference calls between professionals, apps for patients to send photographs to clinicians and platforms for telemedicine clinics and highlights the main features of common tools. CPD/Clinical Relevance: Remote working in healthcare has become increasingly popular during the COVID-19 pandemic and an understanding of how this remote working can be utilized in Dentistry, and the associated benefits, is relevant to all clinicians.
Collapse
Affiliation(s)
- Kate Parker
- Orthodontic Senior Specialty Registrar, Eastman Dental Hospital and Croydon University Hospital
| | - Matthew Chia
- Consultant Orthodontist, Clinical Lead in Orthodontics and Restorative Dentistry, Croydon University Hospital, 530 London Road, Thornton Heath CR7 7YE, UK
| |
Collapse
|
284
|
Razai MS, Oakeshott P, Kankam H, Galea S, Stokes-Lampard H. Mitigating the psychological effects of social isolation during the covid-19 pandemic. BMJ 2020; 369:m1904. [PMID: 32439691 DOI: 10.1136/bmj.m1904] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Mohammad S Razai
- Population Health Research Institute, St George University of London, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George University of London, London, UK
| | - Hadyn Kankam
- St George's University Hospital NHS Foundation Trust, London, UK
| | - Sandro Galea
- Boston University School of Public Health, Boston, Massachusetts, USA
| | | |
Collapse
|
285
|
Stommel WJP, van Goor H, Stommel MWJ. The Impact of Video-Mediated Communication on Closed Wound Assessments in Postoperative Consultations: Conversation Analytical Study. J Med Internet Res 2020; 22:e17791. [PMID: 32310816 PMCID: PMC7238083 DOI: 10.2196/17791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Research on the use of video-mediated technology for medical consultations is increasing rapidly. Most research in this area is based on questionnaires and focuses on long-term conditions. The few studies that have focused on physical examinations in video consultations indicated that it poses challenges for the participants. The specific activity of wound assessment through video in postsurgery consultations has not yet been studied. Furthermore, a comparative analysis of face-to-face and video settings on the moment-to-moment organization of such an activity is original. OBJECTIVE The aim of this study was to examine the impact of video technology on the procedure of postsurgery wound assessment and its limits. METHODS We recorded 22 postoperative video consultations and 17 postoperative face-to-face consultations. The primary purpose of the consultation was to inform the patient about the final pathology results of the resected specimen, and the secondary purpose was to check on the patient's recovery, including an assessment of the closed wound. The recordings were transcribed in detail and analyzed using methods of conversation analysis. RESULTS The way that an assessment of the wound is established in video consultations differs from the procedure in face-to-face consultations. In the consultation room, wound assessments overwhelmingly (n=15/17) involve wound showings in the context of surgeons reporting their observations formatted with evidentials ("looks neat") and subsequently assessing what these observations imply or what could be concluded from them. In contrast, wound assessments in video consultations do not tend to involve showing the wound (n=3/22) and, given the technological restrictions, do not involve palpation. Rather, the surgeon invites the patient to assess the wound, which opens up a sequence of patient and physician assessments where diagnostic criteria such as redness or swollenness are made explicit. In contrast to observations in regular consultations, these assessments are characterized by epistemic markers of uncertainty ("I think," "sounds...good") and evidentials are absent. Even in cases of a potential wound problem, the surgeon may rely on questioning the patient rather than requesting a showing. CONCLUSIONS The impact of video technology on postoperative consultations is that a conclusive wound assessment is arrived at in a different way when compared to face-to-face consultations. In video consultations, physicians enquire and patients provide their own observations, which serve as the basis for the assessment. This means that, in video consultations, patients have a fundamentally different role. These talking-based assessments are effective unless, in cases of a potential problem, patient answers seem insufficient and a showing might be beneficial.
Collapse
Affiliation(s)
- Wyke J P Stommel
- Centre for Language Studies, Radboud University, Nijmegen, Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Martijn W J Stommel
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
286
|
Connor MJ, Winkler M, Miah S. COVID-19 pandemic - is virtual urology clinic the answer to keeping the cancer pathway moving? BJU Int 2020; 125:E3-E4. [PMID: 32232915 DOI: 10.1111/bju.15061] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Martin J Connor
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Imperial Prostate, Department of Surgery and Cancer, Charing Cross Hospital, Imperial College London, London, UK
| | - Mathias Winkler
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Imperial Prostate, Department of Surgery and Cancer, Charing Cross Hospital, Imperial College London, London, UK
| | - Saiful Miah
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
287
|
Greenhalgh T, Choon Huat Koh G, Car J. Covid-19: avaliação remota em Atenção Primária à Saúde. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2020. [DOI: 10.5712/rbmfc15(42)2461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
O que você precisa saber? A maioria dos pacientes com Covid-19 podem ser manejados remotamente com aconselhamento de manejo de sintomas e autoisolamento; Apesar da maioria das consultas poderem ser feitas por telefone, a imagem de vídeo fornece pistas adicionais visuais e a presença terapêutica do profissional de saúde para o paciente; Falta de ar é um sintoma preocupante, embora, hoje, não há ferramenta validada para avaliá-la remotamente;Aconselhamento sobre rede de segurança para o paciente é crucial, uma vez que, alguns pacientes deterioram muito a sua condição de saúde em 2 semanas, mais comumente por pneumonia.
Collapse
|
288
|
Hägi-Pedersen MB, Dessau RB, Norlyk A, Stanchev H, Kronborg H. Comparison of video and in-hospital consultations during early in-home care for premature infants and their families: A randomised trial. J Telemed Telecare 2020; 28:24-36. [PMID: 32228143 PMCID: PMC8721551 DOI: 10.1177/1357633x20913411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction Early in-home care is increasingly being used in Scandinavian countries for clinically stable premature infants. Due to challenges with travel and hospital resources, alternative ways to support parents during early in-home care are being considered. The aim of this study was to test whether the proportion of mothers exclusively breastfeeding, parental confidence and mother–infant interaction increased after early in-home care with premature infants, and to compare the outcomes of in-home care involving the use of video communication and a mobile application with those of in-home care involving in-hospital consultations. Methods This study was conducted in four neonatal wards offering premature infant in-home care in Denmark. Premature infants were randomised using 1:1 block randomisation. During early in-home care, families had planned consultations two to three times a week, during which they received support from nurses: the intervention group had video consultations, while the control group had in-hospital consultations. Results The proportion of exclusively breastfeeding mothers at discharge was 66.7% in the intervention group vs 66% in the control group and decreased to 49.4% vs 55%, respectively, 1 month after discharge. No significant improvements were found in the intervention group compared with the control group. In the intervention group, some video consultations were changed to telephone consultations due to problems with the video function, or to in-hospital consultations due to infants’ requirement for medical services. No significant differences in secondary outcomes were observed. Discussion The study showed similar breastfeeding proportions at discharge. No unfavourable effects of video consultation compared with in-hospital consultation were found, indicating that video consultation could be a viable option and an important supplement during early in-home care. Trial registration ClinicalTrials.gov ID: NCT02581800.
Collapse
Affiliation(s)
- Mai-Britt Hägi-Pedersen
- Department of Paediatrics, Slagelse Hospital, 4200 Slagelse, Denmark.,Department of Public Health, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, 4200 Slagelse, Denmark
| | - Annelise Norlyk
- Department of Public Health, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
| | - Hristo Stanchev
- Department of Paediatrics, Slagelse Hospital, 4200 Slagelse, Denmark
| | - Hanne Kronborg
- Department of Public Health, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
| |
Collapse
|
289
|
Odendaal WA, Anstey Watkins J, Leon N, Goudge J, Griffiths F, Tomlinson M, Daniels K. Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 3:CD011942. [PMID: 32216074 PMCID: PMC7098082 DOI: 10.1002/14651858.cd011942.pub2] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mobile health (mHealth), refers to healthcare practices supported by mobile devices, such as mobile phones and tablets. Within primary care, health workers often use mobile devices to register clients, track their health, and make decisions about care, as well as to communicate with clients and other health workers. An understanding of how health workers relate to, and experience mHealth, can help in its implementation. OBJECTIVES To synthesise qualitative research evidence on health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services, and to develop hypotheses about why some technologies are more effective than others. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, Science Citation Index and Social Sciences Citation Index in January 2018. We searched Global Health in December 2015. We screened the reference lists of included studies and key references and searched seven sources for grey literature (16 February to 5 March 2018). We re-ran the search strategies in February 2020. We screened these records and any studies that we identified as potentially relevant are awaiting classification. SELECTION CRITERIA We included studies that used qualitative data collection and analysis methods. We included studies of mHealth programmes that were part of primary healthcare services. These services could be implemented in public or private primary healthcare facilities, community and workplace, or the homes of clients. We included all categories of health workers, as well as those persons who supported the delivery and management of the mHealth programmes. We excluded participants identified as technical staff who developed and maintained the mHealth technology, without otherwise being involved in the programme delivery. We included studies conducted in any country. DATA COLLECTION AND ANALYSIS We assessed abstracts, titles and full-text papers according to the inclusion criteria. We found 53 studies that met the inclusion criteria and sampled 43 of these for our analysis. For the 43 sampled studies, we extracted information, such as country, health worker category, and the mHealth technology. We used a thematic analysis process. We used GRADE-CERQual to assess our confidence in the findings. MAIN RESULTS Most of the 43 included sample studies were from low- or middle-income countries. In many of the studies, the mobile devices had decision support software loaded onto them, which showed the steps the health workers had to follow when they provided health care. Other uses included in-person and/or text message communication, and recording clients' health information. Almost half of the studies looked at health workers' use of mobile devices for mother, child, and newborn health. We have moderate or high confidence in the following findings. mHealth changed how health workers worked with each other: health workers appreciated being more connected to colleagues, and thought that this improved co-ordination and quality of care. However, some described problems when senior colleagues did not respond or responded in anger. Some preferred face-to-face connection with colleagues. Some believed that mHealth improved their reporting, while others compared it to "big brother watching". mHealth changed how health workers delivered care: health workers appreciated how mHealth let them take on new tasks, work flexibly, and reach clients in difficult-to-reach areas. They appreciated mHealth when it improved feedback, speed and workflow, but not when it was slow or time consuming. Some health workers found decision support software useful; others thought it threatened their clinical skills. Most health workers saw mHealth as better than paper, but some preferred paper. Some health workers saw mHealth as creating more work. mHealth led to new forms of engagement and relationships with clients and communities: health workers felt that communicating with clients by mobile phone improved care and their relationships with clients, but felt that some clients needed face-to-face contact. Health workers were aware of the importance of protecting confidential client information when using mobile devices. Some health workers did not mind being contacted by clients outside working hours, while others wanted boundaries. Health workers described how some community members trusted health workers that used mHealth while others were sceptical. Health workers pointed to problems when clients needed to own their own phones. Health workers' use and perceptions of mHealth could be influenced by factors tied to costs, the health worker, the technology, the health system and society, poor network access, and poor access to electricity: some health workers did not mind covering extra costs. Others complained that phone credit was not delivered on time. Health workers who were accustomed to using mobile phones were sometimes more positive towards mHealth. Others with less experience, were sometimes embarrassed about making mistakes in front of clients or worried about job security. Health workers wanted training, technical support, user-friendly devices, and systems that were integrated into existing electronic health systems. The main challenges health workers experienced were poor network connections, access to electricity, and the cost of recharging phones. Other problems included damaged phones. Factors outside the health system also influenced how health workers experienced mHealth, including language, gender, and poverty issues. Health workers felt that their commitment to clients helped them cope with these challenges. AUTHORS' CONCLUSIONS Our findings propose a nuanced view about mHealth programmes. The complexities of healthcare delivery and human interactions defy simplistic conclusions on how health workers will perceive and experience their use of mHealth. Perceptions reflect the interplay between the technology, contexts, and human attributes. Detailed descriptions of the programme, implementation processes and contexts, alongside effectiveness studies, will help to unravel this interplay to formulate hypotheses regarding the effectiveness of mHealth.
Collapse
Affiliation(s)
- Willem A Odendaal
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Stellenbosch UniversityDepartment of PsychiatryCape TownSouth Africa
| | | | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Brown UniversitySchool of Public HealthProvidenceRhode IslandUSA
| | - Jane Goudge
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Frances Griffiths
- University of WarwickWarwick Medical SchoolCoventryUK
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Mark Tomlinson
- Stellenbosch UniversityInstitute for Life Course Health Research, Department of Global HealthCape TownSouth Africa
- Queens UniversitySchool of Nursing and MidwiferyBelfastUK
| | - Karen Daniels
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- University of Cape TownHealth Policy and Systems Division, School of Public Health and Family MedicineCape TownWestern CapeSouth Africa7925
| | | |
Collapse
|
290
|
Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Gerald Choon Huat Koh
- Saw Swee Hock School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| |
Collapse
|
291
|
Desruisseaux M, Stamenova V, Bhatia RS, Bhattacharyya O. Channel management in virtual care. NPJ Digit Med 2020; 3:44. [PMID: 32219185 PMCID: PMC7096521 DOI: 10.1038/s41746-020-0252-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/28/2020] [Indexed: 11/09/2022] Open
Abstract
Many virtual care initiatives focus heavily on video visits, essentially mimicking face-to-face visits. Meanwhile, clinicians in established settings continue to use the oldest modality, phone calls, and some use the most ubiquitous, asynchronous messaging. The latter, along with live chat and chatbots, could be transformative if workflows were redesigned to incorporate it. With multiple modalities now available for use in virtual care, the central problem is to direct patient-provider interactions to the channels generating the most value. Marketers call this channel management and use sophisticated approaches to implement it. We propose an adaptation of channel management to virtual care and discuss anticipated challenges to its implementation.
Collapse
Affiliation(s)
| | - Vess Stamenova
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, University of Toronto, Toronto, ON Canada
| | - R. Sacha Bhatia
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, University of Toronto, Toronto, ON Canada
- University Health Network, Toronto, ON Canada
| | - Onil Bhattacharyya
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, University of Toronto, Toronto, ON Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
| |
Collapse
|
292
|
Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joe Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare Morrison
- Technology Enabled Care Programme, Scottish Government, Edinburgh, UK
| |
Collapse
|
293
|
Seuren LM, Wherton J, Greenhalgh T, Cameron D, A'Court C, Shaw SE. Physical Examinations via Video for Patients With Heart Failure: Qualitative Study Using Conversation Analysis. J Med Internet Res 2020; 22:e16694. [PMID: 32130133 PMCID: PMC7059096 DOI: 10.2196/16694] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Video consultations are increasingly seen as a possible replacement for face-to-face consultations. Direct physical examination of the patient is impossible; however, a limited examination may be undertaken via video (eg, using visual signals or asking a patient to press their lower legs and assess fluid retention). Little is currently known about what such video examinations involve. OBJECTIVE This study aimed to explore the opportunities and challenges of remote physical examination of patients with heart failure using video-mediated communication technology. METHODS We conducted a microanalysis of video examinations using conversation analysis (CA), an established approach for studying the details of communication and interaction. In all, seven video consultations (using FaceTime) between patients with heart failure and their community-based specialist nurses were video recorded with consent. We used CA to identify the challenges of remote physical examination over video and the verbal and nonverbal communication strategies used to address them. RESULTS Apart from a general visual overview, remote physical examination in patients with heart failure was restricted to assessing fluid retention (by the patient or relative feeling for leg edema), blood pressure with pulse rate and rhythm (using a self-inflating blood pressure monitor incorporating an irregular heartbeat indicator and put on by the patient or relative), and oxygen saturation (using a finger clip device). In all seven cases, one or more of these examinations were accomplished via video, generating accurate biometric data for assessment by the clinician. However, video examinations proved challenging for all involved. Participants (patients, clinicians, and, sometimes, relatives) needed to collaboratively negotiate three recurrent challenges: (1) adequate design of instructions to guide video examinations (with nurses required to explain tasks using lay language and to check instructions were followed), (2) accommodation of the patient's desire for autonomy (on the part of nurses and relatives) in light of opportunities for involvement in their own physical assessment, and (3) doing the physical examination while simultaneously making it visible to the nurse (with patients and relatives needing adequate technological knowledge to operate a device and make the examination visible to the nurse as well as basic biomedical knowledge to follow nurses' instructions). Nurses remained responsible for making a clinical judgment of the adequacy of the examination and the trustworthiness of the data. In sum, despite significant challenges, selected participants in heart failure consultations managed to successfully complete video examinations. CONCLUSIONS Video examinations are possible in the context of heart failure services. However, they are limited, time consuming, and challenging for all involved. Guidance and training are needed to support rollout of this new service model, along with research to understand if the challenges identified are relevant to different patients and conditions and how they can be successfully negotiated.
Collapse
Affiliation(s)
- Lucas Martinus Seuren
- 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
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Deborah Cameron
- Faculty of Linguistics, University of Oxford, Oxford, United Kingdom
| | - Christine A'Court
- 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
| |
Collapse
|
294
|
Rodgers M, Raine G, Thomas S, Harden M, Eastwood A. Informing NHS policy in ‘digital-first primary care’: a rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07410] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In ‘digital-first primary care’ models of health-care delivery, a patient’s first point of contact with a general practitioner or other health professional is through a digital channel, rather than a face-to-face consultation. Patients are able to access advice and treatment remotely from their home or workplace via a number of different technologies.
Objectives
This rapid responsive evidence synthesis was undertaken to inform NHS England policy in ‘digital-first primary care’. It was conducted in two stages: (1) scoping the published evidence and (2) addressing a refined set of questions produced by NHS England from the evidence retrieved during the scoping stage.
Data sources
Searches were conducted of five electronic databases (MEDLINE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and PROSPERO were searched in July 2018) and relevant research/policy and government websites, as well as the National Institute for Health Research Health Service and Delivery Research programme database of ongoing and completed projects. No date or geographical limitations were applied.
Review methods
After examining the initial scoping material, NHS England provided a list of questions relating to the potential effects of digital modes and models of engagement, and the contracting and integration of these models into primary care. Systematic reviews and evidence syntheses, including evidence on the use of digital (online) modes and models of engagement between patients and primary care, were examined more closely, as was ongoing research and any incidentally identified primary studies focused on the use of digital (online) modes and models of engagement. All records were screened by two reviewers, with disagreements resolved by consensus or consulting a third reviewer.
Results
Evidence suggests that uptake of existing digital modes of engagement is currently low. Patients who use digital alternatives to face-to-face consultations are likely to be younger, female and have higher income and education levels. There is some evidence that online triage tools can divert demand away from primary care, but results vary between interventions and outcome measures. A number of potential barriers exist to using digital alternatives to face-to-face consultations, including inadequate NHS technology and staff concerns about workload and confidentiality. There are currently insufficient empirical data to either substantiate or allay such concerns. Very little evidence exists on outcomes related to quality of care, service delivery, benefits or harms for patients, or on financial costs/cost-effectiveness. No studies examining how to contract and commission alternatives to face-to-face consultations were identified.
Limitations
The quality of the included reviews was variable. Poor reporting of methodology and a lack of adequate study details were common issues. Much of the evidence focused on exploring stakeholder views rather than on objective measurement of potential impacts. The current evidence synthesis is based on a rapid scoping exercise and cannot provide the breadth or depth of insight that might have been achieved with a full systematic review.
Conclusions
Rapid scoping of the literature suggests that there is little high-quality evidence relating to ‘digital-first primary care’ as defined by NHS England. The broader evidence on alternatives to face-to-face consultation addresses certain policy-maker concerns, such as the possible impact of new technologies on workload and workforce, inequalities, local implementation and integration with existing services. However, although this evidence gives an insight into the views and experiences of health professionals in relation to such concerns, quantitative empirical data are lacking.
Funding
The National Institute for Health Research Health Service and Delivery Research programme.
Collapse
Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Gary Raine
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sian Thomas
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
| |
Collapse
|
295
|
Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care. Br J Gen Pract 2019; 69:e595-e604. [PMID: 31262846 PMCID: PMC6607843 DOI: 10.3399/bjgp19x704573] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/05/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Growing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice. AIM To explore the content, quality, and patient experience of VC, telephone (TC), and FTFCs in general practice. DESIGN AND SETTING Comparison of audio-recordings of follow-up consultations in UK primary care. METHOD Primary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet, or computer with camera. Clinicians invited patients requiring a follow-up consultation to choose a VC, TC, or FTFC. Consultations were audio-recorded and analysed for content and quality. Participant experience was explored in post-consultation questionnaires. Case notes were reviewed for NHS resource use. RESULTS Of the recordings, 149/163 were suitable for analysis. VC recruits were younger, and more experienced in communicating online. FTFCs were longer than VCs (mean difference +3.7 minutes, 95% confidence interval [CI] = 2.1 to 5.2) or TCs (+4.1 minutes, 95% CI = 2.6 to 5.5). On average, patients raised fewer problems in VCs (mean 1.5, standard deviation [SD] 0.8) compared with FTFCs (mean 2.1, SD 1.1) and demonstrated fewer instances of information giving by clinicians and patients. FTFCs scored higher than VCs and TCs on consultation-quality items. CONCLUSION VC may be suitable for simple problems not requiring physical examination. VC, in terms of consultation length, content, and quality, appeared similar to TC. Both approaches appeared less 'information rich' than FTFC. Technical problems were common and, though patients really liked VC, infrastructure issues would need to be addressed before the technology and approach can be mainstreamed in primary care.
Collapse
|
296
|
|
297
|
Video consulting study. Br J Gen Pract 2019; 69:380. [PMID: 31345802 DOI: 10.3399/bjgp19x705005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|