Telemedicine, safe medication stewardship, and COVID-19: Digital transformation during a global pandemic

Adherence to Emergency Department Referral Criteria in a Direct-to-Consumer Telemedicine Center

Background: The safety of direct-to-consumer telemedicine (TM) is closely related to red flag detection and correct referrals. The adherence to referral criteria from current guidelines is not well quantified. Objective: To analyze the emergency department (ED) referral rate and adherence to referral guidelines in TM encounters of acutely ill patients calling a center that adopts stewardship protocols. Methods: This is a retrospective observational unicentric study, between March 2020 and March 2022, with patients who spontaneously sought direct-to-consumer urgent virtual medical assistance. A video-based teleconsultation was provided immediately after connection. Physicians managed situations according to their clinical judgment. Current guidelines, containing specific guidance for referral if red flags were identified, were available for consultation. Physicians' semiannual performance feedback was carried out. We analyzed the patterns for referral to immediate face-to-face medical evaluation and the agreement degree with the institutional guidelines. Results: A total of 232,197 patients were available, and 14,051 (6.05%) patients were referred to ED. A total of 8,829 (68.4%) referrals were based in specific guidelines according to the International Classification of Diseases hypothesis, and 8,708 (98.6%) were justified according to guidelines. Diarrhea had the highest guidelines' adherence to referral (97.6%), followed by COVID-19 (90%), headache (84.2%), and conjunctivitis (78.8%). Policies did not support 5,222 (31.6%) referrals, though 5,100 (97.6%) of these were justified according to the doctor's clinical judgment. Conclusion: TM doctors' assessment of acutely ill patients has high rates of adherence to guidelines regarding referral. Stewardship protocol adoption provides high rates of red flag description, even in the referral of nonpolicy diseases.

Investigating the implementation of telehealth and digital technologies during public health crisis: A qualitative review

Public health crises such as the Coronavirus disease 2019 (COVID-19) pandemic across the world overstrained the health care system. Accordingly, telehealth and digital technologies were implemented. Telehealth and digital technologies refer to the provision of health care at a distance using electronic means for diagnosis, evaluation, treatment, monitoring, and education of patients. This approach, while extremely useful, can be challenging for both patients and physicians, mainly as this is a new mode of health care to health practitioners and patients. Intrinsically, when managing the massive disruption to the routine of patient health care workflow, it is important to understand the important factors associated with an accelerated introduction of telehealth and digital technologies for the effective and safe continuation of healthcare during a public health crisis. Accordingly, this current study performed a qualitative review analysis of 40 scientific sources from 2019 to 2022. Findings present health practitioners that implemented telehealth and digital technologies during the public health emergency. Additionally, findings from this study presents a workflow approach for telehealth visit cycle and also discusses the current telehealth and virtual applications being implemented during public health crisis. This study provides implications to support health care managers and policymakers of health centres to be virtually informed regarding digital applications being implemented by patients and health practitioners on how to implement an effective telehealth system during public health crises.

Preventing burnout and substance use disorder among healthcare professionals through breathing exercises, emotion identification, and writing activities

The introduction of the COVID-19 pandemic has placed additional strain on healthcare workers, inducing immense levels of stress and workplace burnout. Health care professionals are acutely susceptible to COVID-19 exposure, ultimately leading to elevated levels of anxiety and mental illness. For example, dental professionals are at high risk due to their close work with the oral cavity. To provide temporary relief to the stress, some may turn toward substance use, especially if that individual has some form of mental illness. To curb the onset of burnout and its byproduct of substance use disorder, it is crucial to be equipped with proper tools and healthy habits that can counteract extreme levels of stress. In this article, a time-effective, 3-step method is introduced, with each activity proven to lessen the symptoms of burnout. When followed, an individual can navigate burnout's symptoms through a healthy mind and body approach. Additionally, resources to find resilience-building and mentorship programs are provided. Common substance use support groups and information regarding group meetings and contact information are listed.