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Grønning A, Simonsen LM, Lüchau EC, Hvidt EA, Klausen M. My time, your time, our time. Older patients' and GPs' time sensibilities around email consultations. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2024; 33:43-58. [PMID: 38385438 DOI: 10.1080/14461242.2024.2316742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
In this study, we discuss how email consultations in general practice operate as a temporal technology, transforming working conditions and power relations between general practitioners (GPs) and patients. We draw on empirical material from Denmark in the form of a set of semi-structured interviews with 53 patients and 15 GPs, including two focus group discussions with 17 GPs. Our theoretical point of departure stems primarily from media theorist Sarah Sharma's (2014) concept of power-chronography, which describes how power is embedded in temporal relations and everyday life and secondarily from sociologist, Judy Wajcman's (2015) concept of multiple temporal landscapes. Patients and GPs calibrate their own time and attune their mutual time according to their expectations and ideas about the other party's time. The patient and the GP can both be viewed as 'time workers' and the email consultation as a digital technology fostering the recalibration of one person's time to that of another, requiring significant labour. The email consultation rearranges the GP-patient boundaries and thereby the power relations. Health institutions ought to consider whose time and labour is being 'saved' with digital systems.
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Affiliation(s)
- Anette Grønning
- Department of Design, Media and Educational Science, University of Southern Denmark, Odense M, Denmark
| | - Line Maria Simonsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Elle C Lüchau
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Maja Klausen
- Department of Design, Media and Educational Science, University of Southern Denmark, Odense M, Denmark
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Kurek AA, Boone-Sautter KM, Rizor M, Vermeesch K, Ahmed A. Implementation of E-Consults in an Integrated Health System for a Value Population. Popul Health Manag 2023; 26:303-308. [PMID: 37471229 DOI: 10.1089/pop.2023.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
The adoption of e-consults, a form of formal, asynchronous provider-to-provider communication in which specialty medical advice is sought, has been proven to reduce unnecessary specialty consultations, build provider relationships, and reduce fragmentation of care. While the utilization of e-consults is generally a well-accepted alternative method of incorporating specialist expertise into a patient's plan of care and adoption has become common, the implementation of this disruptive care delivery modality can be challenging. This article seeks to describe the process and operational outcomes of e-consult adoption in an integrated health system with a focus on the benefits in the context of value-based care. Implications of e-consult adoption on referral volumes, wait times, and cancellation rates at the service line level are investigated. E-consult adoption and completion metrics, including utilization, completed versus rejected, turn-around times, and projected cost savings, are also discussed.
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Affiliation(s)
- Alexis A Kurek
- Department of Population Health, Corewell Health West, Grand Rapids, Michigan, USA
| | | | - Michelle Rizor
- Department of Population Health, Corewell Health West, Grand Rapids, Michigan, USA
| | - Kristyn Vermeesch
- Department of Population Health, Corewell Health West, Grand Rapids, Michigan, USA
| | - Aiesha Ahmed
- Department of Population Health, Corewell Health West, Grand Rapids, Michigan, USA
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Tuon FF, Amato VS, Zequinao T, Cruz JAW. Emerging computational technologies in human leishmaniasis: where are we? Trans R Soc Trop Med Hyg 2022; 116:981-985. [PMID: 35640661 DOI: 10.1093/trstmh/trac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/25/2022] [Accepted: 04/28/2022] [Indexed: 01/19/2023] Open
Abstract
Human leishmaniasis is a neglected tropical disease (NTD) with high morbidity and is endemic in low- to middle-income countries. Its diagnosis, treatment and epidemiological control methods are outdated and obsolete, which has become a challenge for health practitioners in controlling the disease. Computational methods have proven to be beneficial and have become popular in many fields of medicine, especially in affluent countries. However, they have not been widely used for NTDs. To date, few computational technologies have been employed for leishmaniasis. Although new technologies in leishmaniasis are theorized, they have only been minimally applied and have not been updated, even in other infections. Research and development on NTDs suffers from the inherent difficulties of the demographic regions the diseases afflict. In this narrative review we described the e-tools available in managing leishmaniasis, ranging from drug discovery to treatment.
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Affiliation(s)
- Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifical Catholic University of Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná 80215-901, Brazil
| | - Valdir Sabagga Amato
- Departamento de Doenças Infecciosas e Parasitária da Faculdade de Medicina da Universidade de São Paulo São Paulo, Av. Dr Arnaldo 455, São Paulo 05403-000, Brazil
| | - Tiago Zequinao
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifical Catholic University of Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná 80215-901, Brazil
| | - June Alisson Westarb Cruz
- School of Business, Pontifical Catholic University of Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná 80215-901, Brazil.,Fundação Getúlio Vargas, EAESP, São Paulo, Av. 9 de Julho 2029, São Paulo 013013-902, Brazil
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Stephens J, Greenberg GM. Asynchronous Telehealth. Prim Care 2022; 49:531-541. [DOI: 10.1016/j.pop.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Melian C, Kieser D, Frampton C, C Wyatt M. Teleconsultation in orthopaedic surgery: A systematic review and meta-analysis of patient and physician experiences. J Telemed Telecare 2022; 28:471-480. [PMID: 32873138 DOI: 10.1177/1357633x20950995] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The primary purpose of this review was to evaluate patient and physician preference and satisfaction for teleconsultation in orthopaedic surgery compared to traditional face-to-face consultation. In addition, we evaluated the effects of teleconsultation on patient length of visit, healthcare costs, range of motion (ROM), pain, quality of life (QOL), and ongoing management plans. METHODS A systematic review of MEDLINE, Embase, Web of Science, and Cochrane Library was conducted according to PRISMA guidelines. Randomised control trials and case control studies comparing teleconsultation with traditional, face-to-face consultation in the management of orthopaedic conditions were included. The primary outcome measures were patient and physician preference and satisfaction. Secondary outcomes included patient length of visit, healthcare costs, ROM, pain, QOL, and ongoing management plans. RESULTS A total of 13 articles meeting the eligibility criteria were included for systematic review and 8 for meta-analysis. There was no significant difference in patient satisfaction, length of visit, or time spent with the physician between the telemedicine and in-office control group. The mean difference of patient preference for telemedicine was significantly higher in the telemedicine group compared to the in-office visit group (OR 1.44, 95% CI 1.12-1.87, p = 0.005). DISCUSSION Telemedicine was not inferior to face-to-face office visits in regard to patient and physician preference and satisfaction. Therefore, it would be an effective adjunct to face-to-face office visits, serving as a mechanism of triage and long-term continuity of care.
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Affiliation(s)
| | - David Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, New Zealand
| | - Christopher Frampton
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, New Zealand
| | - Michael C Wyatt
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, New Zealand
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Payne T, Kevric J, Stelmach W, To H. The Use of Electronic Consultations in Outpatient Surgery Clinics: Synthesized Narrative Review. JMIR Perioper Med 2022; 5:e34661. [PMID: 35436223 PMCID: PMC9052035 DOI: 10.2196/34661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/20/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Electronic consultations (eConsults) are an increasingly used form of telemedicine that allows a nonspecialist clinician to seek specialist advice remotely without direct patient-specialist communication. Surgical clinics may see benefits from such forms of communication but face challenges with the need for intervention planning. Objective We aimed to use the Quadruple Aim Framework to integrate published knowledge of surgical outpatient eConsults with regard to efficacy, safety, limitations, and evolving use in the era of COVID-19. Methods We systematically searched for relevant studies across four databases (Ovid MEDLINE, Embase, Scopus, and Web of Science) on November 4, 2021, with the following inclusion criteria: English language, published in the past 10 years, and data on the outcomes of outpatient surgical eConsults. Results A total of 363 studies were screened for eligibility, of which 33 (9.1%) were included. Most of the included studies were from the United States (23/33, 70%) and Canada (7/33, 21%), with a predominant multidisciplinary focus (9/33, 27%). Most were retrospective audits (16/33, 48%), with 15% (5/33) of the studies having a prospective component. Conclusions The surgical eConsult studies indicated a possible benefit for population health, promising safety results, enhanced patient and clinician experience, and cost savings compared with the traditional face-to-face surgical referral pathway. Their use appeared to be more favorable in some surgical subspecialties, and the overall efficacy was similar to that of medical subspecialties. Limited data on their long-term safety and use during the COVID-19 pandemic were identified, and this should be the focus of future research.
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Affiliation(s)
- Thomas Payne
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Surgery, The Northern Hospital, Melbourne, Australia
| | - Jasmina Kevric
- Department of Surgery, The Northern Hospital, Melbourne, Australia
| | - Wanda Stelmach
- Department of Surgery, The Northern Hospital, Melbourne, Australia
| | - Henry To
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Surgery, The Northern Hospital, Melbourne, Australia
- Department of Surgery, Werribee Mercy Hospital, Melbourne, Australia
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Rey-Aldana D, Mazón-Ramos P, Portela-Romero M, Cinza-Sanjurjo S, Alvarez-Alvarez B, Agra-Bermejo R, Rigueiro-Veloso P, Espasandín-Domínguez J, Gude-Sampedro F, González-Juanatey JR. Longer-Term Results of a Universal Electronic Consultation Program at the Cardiology Department of a Galician Healthcare Area. Circ Cardiovasc Qual Outcomes 2022; 15:e008130. [PMID: 35041483 DOI: 10.1161/circoutcomes.121.008130] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Telemedicine models play a key role in organizing the growing demand for care and healthcare accessibility, but there are no described longer-term results in health care. Our objective is to assess the longer-term results (delay time in care, accessibility, and hospital admissions) of an electronic consultation (e-consultation) outpatient care program. METHODS Epidemiological and clinical data were obtained from the 41 258 patients referred by primary care to the cardiology department from January 1, 2010, to December 31, 2019. Until 2012, all patients were attended in an in-person consultation (2010-2012). In 2013, we instituted an e-consultation program (2013-2019) for all primary care referrals to cardiologists that preceded patients' in-person consultations when considered. We used an interrupted time series regression approach to investigate the impact of the e-consultation on (1) delay time (days) in care and (2) hospital admissions. We also analyzed (3) total number and referral rate (population-adjusted referred rate) in both periods (in-person consultation and e-consultation), and (4) the accessibility was measured as number of consultations and variation according to distance from municipality and reference hospital. RESULTS During the e-consultation, the demand increased (7.2±2.4% versus 10.1±4.8% per 1000 inhabitants, P<0.001), and referrals from different areas were equalized. The reduction in delay to consultation during the in-person consultation (-0.96 [95% CI, -0.951 to -0.966], P<0.001) was maintained with e-consultations (-0.064 [95% CI, 0.043-0.085], P<0.001). After the implementation of e-consultation, we observed that the increasing of hospital admission observed in the in-person consultation (incidence rate ratio, 1.011 [95% CI, 1.003-1.018]), was stabilized (incidence rate ratio, 1.000 [95% CI, 0.985-1.015]; P=0.874). CONCLUSIONS Implementing e-consultations in the outpatient management model may improve accessibility of care for patients furthest from the referral hospital. After e-consultations were implemented, the upward trend of hospital admissions observed during the in-person consultation period was stabilized with a slight downward trend.
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Affiliation(s)
- Daniel Rey-Aldana
- CS A Estrada, Área Sanitaria Integrada Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain (D.R.-A.)
| | - Pilar Mazón-Ramos
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela (IDIS), CIBERCV, Spain (P.M.-R., B.A.-A., R.A.-B., P.R.-V, J.R.G.-J.)
| | - Manuel Portela-Romero
- CS Concepción Arenal, Área Sanitaria de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), CIBERCV, Spain (M.P.-R.)
| | - Sergio Cinza-Sanjurjo
- CS Porto do Son, Área Sanitaria Integrada Santiago de Compostela (IDIS), CIBERCV, Spain (S.C.-S.)
| | - Belen Alvarez-Alvarez
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela (IDIS), CIBERCV, Spain (P.M.-R., B.A.-A., R.A.-B., P.R.-V, J.R.G.-J.)
| | - Rosa Agra-Bermejo
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela (IDIS), CIBERCV, Spain (P.M.-R., B.A.-A., R.A.-B., P.R.-V, J.R.G.-J.)
| | - Pedro Rigueiro-Veloso
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela (IDIS), CIBERCV, Spain (P.M.-R., B.A.-A., R.A.-B., P.R.-V, J.R.G.-J.)
| | - Jenifer Espasandín-Domínguez
- Unidad de Epidemiología Clínica, Complejo Hospitalario Universitario de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain (J.E.-D.)
| | - Francisco Gude-Sampedro
- Unidad de Epidemiología Clínica. Complejo Hospitalario Universitario de Santiago de Compostela, IDIS, redIAPP, Spain (F.G.-S.)
| | - José R González-Juanatey
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela (IDIS), CIBERCV, Spain (P.M.-R., B.A.-A., R.A.-B., P.R.-V, J.R.G.-J.)
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8
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Anderson E, Rinne ST, Orlander JD, Cutrona SL, Strymish JL, Vimalananda VG. Electronic consultations and economies of scale: a qualitative study of clinician perspectives on scaling up e-consult delivery. J Am Med Inform Assoc 2021; 28:2165-2175. [PMID: 34338797 DOI: 10.1093/jamia/ocab139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/18/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore Veterans Health Administration clinicians' perspectives on the idea of redesigning electronic consultation (e-consult) delivery in line with a hub-and-spoke (centralized) model. MATERIALS AND METHODS We conducted a qualitative study in VA New England Healthcare System (VISN 1). Semi-structured phone interviews were conducted with 35 primary care providers and 38 specialty care providers, including 13 clinical leaders, at 6 VISN 1 sites varying in size, specialist availability, and e-consult volume. Interviews included exploration of the hub-and-spoke (centralized) e-consult model as a system redesign option. Qualitative content analysis procedures were applied to identify and describe salient categories. RESULTS Participants saw several potential benefits to scaling up e-consult delivery from a decentralized model to a hub-and-spoke model, including expanded access to specialist expertise and increased timeliness of e-consult responses. Concerns included differences in resource availability and management styles between sites, anticipated disruption to working relationships, lack of incentives for central e-consultants, dedicated staff's burnout and fatigue, technological challenges, and lack of motivation for change. DISCUSSION Based on a case study from one of the largest integrated healthcare systems in the United States, our work identifies novel concerns and offers insights for healthcare organizations contemplating a scale-up of their e-consult systems. CONCLUSIONS Scaling up e-consults in line with the hub-and-spoke model may help pave the way for a centralized and efficient approach to care delivery, but the success of this transformation will depend on healthcare systems' ability to evaluate and address barriers to leveraging economies of scale for e-consults.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jay D Orlander
- Medical Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Judith L Strymish
- Medical Service and Section of Infectious Diseases, VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Cambridge, Massachusetts, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA
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Melian C, Frampton C, Wyatt MC, Kieser D. Teleconsultation in the Management of Elective Orthopedic and Spinal Conditions During the COVID-19 Pandemic: Prospective Cohort Study of Patient Experiences. JMIR Form Res 2021; 5:e28140. [PMID: 34048355 PMCID: PMC8208469 DOI: 10.2196/28140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 01/26/2023] Open
Abstract
Background The global adoption of teleconsultation has been expedited as a result of the COVID-19 pandemic. By allowing remote communication, teleconsultation may help limit the spread of the virus while maintaining the crucial patient-provider relationship. Objective The aim of this study is to evaluate the value of teleconsultation compared to in-person visits in the management of elective orthopedic and spinal procedures. Methods This was a prospective observational cohort study of 853 patients receiving orthopedic and spinal care at a private outpatient clinic in New Zealand. Patients were randomly divided into two groups: (1) patients receiving telephone consultation remotely, and (2) patients receiving in-person office consultations at the outpatient clinic. All patients received telephone consultations for 4 weeks during the mandated COVID-19 lockdown, followed by 4 weeks of telephone or in-person consultation. Patient preference, satisfaction, and duration of visit were recorded. Comparisons of patient preference between groups, visit type, sex, and location were performed using chi-square tests; similarly, satisfaction scores and visit durations were compared using a general linear model. Results We report that 91% (353/388) of patients in the telephone group preferred teleconsultation over in-person office visits during the COVID-19 lockdown (P<.001). A combined-group analysis showed that 55.3% (446/807) of all patients preferred teleconsultation compared to 31.2% (252/807) who preferred in-person office visits (P<.001). Patients in the telephone group reported significantly higher satisfaction scores (mean 9.95, SD 0.04, 95% CI 9.87-10.03) compared to patients in the in-person group (mean 9.53, SE 0.04, 95% CI 9.45-9.62; P<.001). Additionally, in-person consultations were significantly longer in duration compared to telephone consultations, with a mean visit time of 6.70 (SE 0.18) minutes, 95% CI 6.32-7.02, compared to 5.10 (SE 0.17) minutes, 95% CI 4.73-5.42 (P<.001). Conclusions Patients who use telephone consultations are more likely to prefer it over traditional, in-person visits in the future. This increased preference, coupled with higher patient satisfaction scores and shorter duration of visits, suggests that teleconsultation has a role in orthopedic surgery, which may even extend beyond the COVID-19 pandemic.
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Affiliation(s)
- Christina Melian
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | | | | | - David Kieser
- Christchurch School of Medicine, Christchurch, New Zealand
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Majersik JJ, Ahmed A, Chen IHA, Shill H, Hanes GP, Pelak VS, Hopp JL, Omuro A, Kluger B, Leslie-Mazwi T. A Shortage of Neurologists - We Must Act Now: A Report From the AAN 2019 Transforming Leaders Program. Neurology 2021; 96:1122-1134. [PMID: 33931527 DOI: 10.1212/wnl.0000000000012111] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/04/2021] [Indexed: 11/15/2022] Open
Abstract
In nearly every US state, a large mismatch exists between the need for neurologists and neurologic services and the availability of neurologists to provide these services. Patients with neurologic disorders are rising in prevalence and require access to high-level care to reduce disability. The current neurology mismatch reduces access to care, worsens patient outcomes, and erodes career satisfaction and quality of life for neurologists as they face increasingly insurmountable demands. As a community, we must address this mismatch in the demand and supply of neurologic care in an aggressive and sustained manner to ensure the future health of our patients and our specialty. The American Academy of Neurology has multiple ongoing initiatives to help reduce and resolve the existing mismatch. With the intent of raising awareness and widening the debate nationally, we present a strategic plan that the Academy could implement to coordinate and expand existing efforts. We characterize the suggested strategies as shaping the demand, enhancing the workforce, and advocating for neurologist value. The proposed framework is based on available data and expert opinion when data were lacking. Prioritization of strategies will vary by geography, practice setting, and local resources. The time to act is now to allow concerted effort and targeted interventions to avert this looming public health crisis.
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Affiliation(s)
- Jennifer J Majersik
- From the Department of Neurology, Division of Vascular Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Medicine (A.A.), Penn State Health, Hershey, PA; Department of Neurology, Division of Neuromuscular Medicine (I-H.A.C.), Medical University of South Carolina, Charleston; Barrow Neurological Institute (H.S.), University of Arizona College of Medicine-Phoenix; Sarasota Memorial Hospital (G.P.H.), FL; Departments of Neurology and Ophthalmology (V.S.P.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.L.H.), University of Maryland School of Medicine, Baltimore; Department of Neurology (A.O.), Yale School of Medicine, New Haven, CT; Departments of Neurology and Medicine (B.K.), University of Rochester Medical Center, NY; and Departments of Neurosurgery and Neurology (T.L.-M.), Massachusetts General Hospital, Boston.
| | - Aiesha Ahmed
- From the Department of Neurology, Division of Vascular Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Medicine (A.A.), Penn State Health, Hershey, PA; Department of Neurology, Division of Neuromuscular Medicine (I-H.A.C.), Medical University of South Carolina, Charleston; Barrow Neurological Institute (H.S.), University of Arizona College of Medicine-Phoenix; Sarasota Memorial Hospital (G.P.H.), FL; Departments of Neurology and Ophthalmology (V.S.P.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.L.H.), University of Maryland School of Medicine, Baltimore; Department of Neurology (A.O.), Yale School of Medicine, New Haven, CT; Departments of Neurology and Medicine (B.K.), University of Rochester Medical Center, NY; and Departments of Neurosurgery and Neurology (T.L.-M.), Massachusetts General Hospital, Boston
| | - I-Hweii A Chen
- From the Department of Neurology, Division of Vascular Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Medicine (A.A.), Penn State Health, Hershey, PA; Department of Neurology, Division of Neuromuscular Medicine (I-H.A.C.), Medical University of South Carolina, Charleston; Barrow Neurological Institute (H.S.), University of Arizona College of Medicine-Phoenix; Sarasota Memorial Hospital (G.P.H.), FL; Departments of Neurology and Ophthalmology (V.S.P.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.L.H.), University of Maryland School of Medicine, Baltimore; Department of Neurology (A.O.), Yale School of Medicine, New Haven, CT; Departments of Neurology and Medicine (B.K.), University of Rochester Medical Center, NY; and Departments of Neurosurgery and Neurology (T.L.-M.), Massachusetts General Hospital, Boston
| | - Holly Shill
- From the Department of Neurology, Division of Vascular Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Medicine (A.A.), Penn State Health, Hershey, PA; Department of Neurology, Division of Neuromuscular Medicine (I-H.A.C.), Medical University of South Carolina, Charleston; Barrow Neurological Institute (H.S.), University of Arizona College of Medicine-Phoenix; Sarasota Memorial Hospital (G.P.H.), FL; Departments of Neurology and Ophthalmology (V.S.P.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.L.H.), University of Maryland School of Medicine, Baltimore; Department of Neurology (A.O.), Yale School of Medicine, New Haven, CT; Departments of Neurology and Medicine (B.K.), University of Rochester Medical Center, NY; and Departments of Neurosurgery and Neurology (T.L.-M.), Massachusetts General Hospital, Boston
| | - Gregory P Hanes
- From the Department of Neurology, Division of Vascular Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Medicine (A.A.), Penn State Health, Hershey, PA; Department of Neurology, Division of Neuromuscular Medicine (I-H.A.C.), Medical University of South Carolina, Charleston; Barrow Neurological Institute (H.S.), University of Arizona College of Medicine-Phoenix; Sarasota Memorial Hospital (G.P.H.), FL; Departments of Neurology and Ophthalmology (V.S.P.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.L.H.), University of Maryland School of Medicine, Baltimore; Department of Neurology (A.O.), Yale School of Medicine, New Haven, CT; Departments of Neurology and Medicine (B.K.), University of Rochester Medical Center, NY; and Departments of Neurosurgery and Neurology (T.L.-M.), Massachusetts General Hospital, Boston
| | - Victoria S Pelak
- From the Department of Neurology, Division of Vascular Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Medicine (A.A.), Penn State Health, Hershey, PA; Department of Neurology, Division of Neuromuscular Medicine (I-H.A.C.), Medical University of South Carolina, Charleston; Barrow Neurological Institute (H.S.), University of Arizona College of Medicine-Phoenix; Sarasota Memorial Hospital (G.P.H.), FL; Departments of Neurology and Ophthalmology (V.S.P.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.L.H.), University of Maryland School of Medicine, Baltimore; Department of Neurology (A.O.), Yale School of Medicine, New Haven, CT; Departments of Neurology and Medicine (B.K.), University of Rochester Medical Center, NY; and Departments of Neurosurgery and Neurology (T.L.-M.), Massachusetts General Hospital, Boston
| | - Jennifer L Hopp
- From the Department of Neurology, Division of Vascular Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Medicine (A.A.), Penn State Health, Hershey, PA; Department of Neurology, Division of Neuromuscular Medicine (I-H.A.C.), Medical University of South Carolina, Charleston; Barrow Neurological Institute (H.S.), University of Arizona College of Medicine-Phoenix; Sarasota Memorial Hospital (G.P.H.), FL; Departments of Neurology and Ophthalmology (V.S.P.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.L.H.), University of Maryland School of Medicine, Baltimore; Department of Neurology (A.O.), Yale School of Medicine, New Haven, CT; Departments of Neurology and Medicine (B.K.), University of Rochester Medical Center, NY; and Departments of Neurosurgery and Neurology (T.L.-M.), Massachusetts General Hospital, Boston
| | - Antonio Omuro
- From the Department of Neurology, Division of Vascular Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Medicine (A.A.), Penn State Health, Hershey, PA; Department of Neurology, Division of Neuromuscular Medicine (I-H.A.C.), Medical University of South Carolina, Charleston; Barrow Neurological Institute (H.S.), University of Arizona College of Medicine-Phoenix; Sarasota Memorial Hospital (G.P.H.), FL; Departments of Neurology and Ophthalmology (V.S.P.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.L.H.), University of Maryland School of Medicine, Baltimore; Department of Neurology (A.O.), Yale School of Medicine, New Haven, CT; Departments of Neurology and Medicine (B.K.), University of Rochester Medical Center, NY; and Departments of Neurosurgery and Neurology (T.L.-M.), Massachusetts General Hospital, Boston
| | - Benzi Kluger
- From the Department of Neurology, Division of Vascular Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Medicine (A.A.), Penn State Health, Hershey, PA; Department of Neurology, Division of Neuromuscular Medicine (I-H.A.C.), Medical University of South Carolina, Charleston; Barrow Neurological Institute (H.S.), University of Arizona College of Medicine-Phoenix; Sarasota Memorial Hospital (G.P.H.), FL; Departments of Neurology and Ophthalmology (V.S.P.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.L.H.), University of Maryland School of Medicine, Baltimore; Department of Neurology (A.O.), Yale School of Medicine, New Haven, CT; Departments of Neurology and Medicine (B.K.), University of Rochester Medical Center, NY; and Departments of Neurosurgery and Neurology (T.L.-M.), Massachusetts General Hospital, Boston
| | - Thabele Leslie-Mazwi
- From the Department of Neurology, Division of Vascular Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Medicine (A.A.), Penn State Health, Hershey, PA; Department of Neurology, Division of Neuromuscular Medicine (I-H.A.C.), Medical University of South Carolina, Charleston; Barrow Neurological Institute (H.S.), University of Arizona College of Medicine-Phoenix; Sarasota Memorial Hospital (G.P.H.), FL; Departments of Neurology and Ophthalmology (V.S.P.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.L.H.), University of Maryland School of Medicine, Baltimore; Department of Neurology (A.O.), Yale School of Medicine, New Haven, CT; Departments of Neurology and Medicine (B.K.), University of Rochester Medical Center, NY; and Departments of Neurosurgery and Neurology (T.L.-M.), Massachusetts General Hospital, Boston
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Lamplot JD, Taylor SA. Good Comes From Evil: COVID-19 and the Advent of Telemedicine in Orthopedics. HSS J 2021; 17:7-13. [PMID: 33967635 PMCID: PMC8077989 DOI: 10.1177/1556331620972046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Joseph D. Lamplot
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Samuel A. Taylor
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
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Hellingman T, Swart MED, Meijerink MR, Schreurs WH, Zonderhuis BM, Kazemier G. Optimization of transmural care by implementation of an online expert panel to assess treatment strategy in patients suffering from colorectal cancer liver metastases: A prospective analysis. J Telemed Telecare 2020; 28:559-567. [PMID: 33019855 DOI: 10.1177/1357633x20957136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Centralization of oncological care results in a growing demand for specialized consultations and referrals. Improved telemedicine solutions are needed to facilitate access to specialist care and select patients eligible for referral. The purpose of this quality improvement initiative was to optimize transmural care for patients suffering from colorectal cancer liver metastases through implementation of an online expert panel. METHODS A digital communication platform was developed to share medical data, including high-quality diagnostic imaging of patients suffering from colorectal cancer liver metastases. Feasibility of local treatment strategies was assessed by a panel of liver specialists to select patients for referral. After implementation, an observational cohort study was conducted to evaluate quality improvement in transmural care using revised Standards for Quality Improvement Reporting Excellence guidelines. RESULTS From September 2016-September 2018, eight hospitals were connected to the platform, covering a population of 3 m. In total, 123 cases were assessed, of which 54 (43.9%) were prevented from needless physical referral. Assessment of treatment strategy by an online expert panel significantly reduced the average lead time during multidisciplinary team meetings from 3.73 min to 2.12 min per patient (p < 0.01). CONCLUSIONS Implementation of an online expert panel is an innovative, accessible and user-friendly way to provide cancer-specific expertise to regional hospitals. E-consultation of such panels may result in more efficient multidisciplinary team meetings and prevent fragile patients from needless referral. Sustainability of these panels however is subject to structural financial compensation, so a cost-effectiveness analysis is warranted.
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Affiliation(s)
- Tessa Hellingman
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Merijn E de Swart
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | | | - Barbara M Zonderhuis
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
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13
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Castaneda PR, Duffy B, Andraska EA, Stevens J, Reschke K, Osborne N, Henke PK. Outcomes and safety of electronic consult use in vascular surgery. J Vasc Surg 2019; 71:1726-1732. [PMID: 31611112 DOI: 10.1016/j.jvs.2019.08.231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/05/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to determine how electronic consults (eConsults) are used in vascular surgery in a veterans health care setting and whether their use is safe for patients. METHODS A retrospective review was performed of all eConsults completed by the vascular surgery service at the Ann Arbor Veterans Affairs Healthcare System between October 10, 2012 and November 15, 2013. Patients' demographics and comorbidities were collected. eConsult recommendations and patient and provider compliance with recommendations were collected. Data on adverse outcomes up to 1 year after consultation and data on all-cause mortality at 1 year and 5 years were collected. RESULTS Between October 10, 2012 and November 15, 2013, of 350 eConsults completed, 123 (35%) were for peripheral artery disease, 93 (27%) for carotid stenosis, and 57 (16%) for abdominal aortic aneurysm. Unique recommendations were made for 291 consults (83%). Medication recommendations were made in 140 consults (40%). The most commonly recommended medication was cilostazol. Compliance with medication recommendations ranged from 30% to 61%. Noninvasive imaging was recommended in 220 consults (60.3%). Procedures overall were recommended in only six consults (1.7%). Five-year all-cause mortality for categorized diagnoses ranged from 8.3% for nonabdominal aneurysm to 28.1% for abdominal aortic aneurysm. CONCLUSIONS Within the Veterans Affairs vascular surgery service, eConsults provide a safe and effective means of triaging and providing recommendations for patients with vascular disease. eConsults used to augment traditional consultations may provide an important means of reducing clinic congestion for providers and reducing time and cost for patients.
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Affiliation(s)
| | - Blake Duffy
- University of Michigan Medical School, Ann Arbor, Mich
| | - Elizabeth A Andraska
- Heart and Vascular Institute, University of Pittsburgh Medical Centers, Pittsburgh, Pa
| | | | | | - Nicholas Osborne
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Peter K Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.
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Current use of telehealth in urology: a review. World J Urol 2019; 38:2377-2384. [PMID: 31352565 DOI: 10.1007/s00345-019-02882-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Applications of telehealth have been growing in popularity. However, there is little information on how telehealth is being used in Urology. In this review, we examine current applications of telehealth in urological practices as well as barriers to implementation. METHODS A review was conducted of original research within the past 10 years describing telehealth applications in urology. Articles on telehealth as applied to other specialties were reviewed for discussion on real or perceived barriers to implementation. RESULTS Twenty-four articles met the inclusion criteria. The most common application of telehealth was using a video visit to assess or follow-up with patients. The second most commonly described applications of telehealth were telementorship, or the use of telehealth technology to help train providers, and telemedicine used in diagnostics. Studies consistently stated the effectiveness of the telehealth applications and the high level of patient and provider satisfaction. CONCLUSIONS Telehealth is sparingly used in urology. Barriers to implementation include technological literacy, reimbursement uncertainties, and resistance to change in workflow. When used, telehealth technologies are shown to be safe, effective, and satisfactory for patients and providers. Further investigation is necessary to determine the efficacy of telehealth applications.
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