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Bui IT, Youssef RM, Gracey LE. An Investigation of Teledermatology Trends in the State of Texas: A Multicenter, Retrospective Cohort Review of an eConsult Service Line. Telemed J E Health 2024; 30:e1689-e1694. [PMID: 38354287 DOI: 10.1089/tmj.2023.0629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background: An eConsult is a growing teledermatology tool that has the potential to address health disparities. Trends in teledermatology usage are still being defined in the context of the pandemic, postpandemic recovery, and a growing nonphysician primary care provider population. Objective: The aim was to understand teledermatology utilization trends for asynchronous dermatology eConsults in the geographically expansive state of Texas. Methods: This multicenter retrospective study examined the eConsult tool within a large, nonprofit health system, comparing characteristics of 893 eConsult visits with 27,189 in-person dermatology encounters from January 2022 to March 2023. Results: When comparing the demographics of patients seen through eConsult versus traditional in-person visits, eConsults demonstrated a significantly higher prevalence of pediatric (22.5% vs. 7.6%, p < 0.001), Hispanic/Latino (20.5% vs. 10.4%, p < 0.001), African American (12.5% vs. 6.9%, p < 0.001), Asian (4.6% vs. 2.1%, p < 0.001), and American Indian (1.0% vs. 0.5%, p = 0.049) patients compared with in-person visits. eConsult users came from areas with a lower percentage of bachelor's degree holders, reduced average household income, and an increased proportion of Medicaid and Tricare users. Physicians (MD/DO) submitted more eConsult cases than nonphysician providers (NPPs), with comparable diagnostic agreement with teledermatologists and similar recommendation rates for in-person dermatology visits. Conclusions: While the limitation of this study was that it was a descriptive data analysis in a single health care system with limited generalizability, eConsults hold promise to broaden dermatologic access for underserved groups, especially children, individuals from underrepresented backgrounds, and Medicaid and Tricare members. While no significant diagnostic or referral differences were seen for eConsults initiated by primary care physician and NPPs, these changing trends should continue to be examined.
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Affiliation(s)
- Ian T Bui
- Texas A&M School of Medicine, Baylor University Medical Center, Dallas, Texas, USA
| | - Ronnie M Youssef
- Department of Dermatology, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - Lia E Gracey
- Division of Dermatology, Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
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Nabelsi V, Lévesque-Chouinard A. Successful Electronic Consultation Service Initiative in Quebec, Canada With Primary Care Physicians' and Specialists' Experiences on Acceptance and Use of Technological Innovation: Cross-Sectional Exploratory Study. JMIR Form Res 2024; 8:e52921. [PMID: 38814689 PMCID: PMC11176886 DOI: 10.2196/52921] [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: 09/19/2023] [Revised: 04/10/2024] [Accepted: 04/25/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Electronic consultation (eConsult) is an eHealth service that allows primary care providers (PCPs) to electronically consult specialists regarding their patients' medical issues. Many studies have demonstrated that eConsult services improve timely access to specialist care; prevent unnecessary referrals; improve PCPs', specialists', and patients' satisfaction; and therefore have a large impact on costs. However, no studies have evaluated PCPs' and specialists' acceptance of eConsult services in Quebec, Canada, and worldwide. OBJECTIVE This exploratory study aims to identify factors affecting eConsult service acceptance by PCPs and specialists in urban and rural primary care clinics across 3 regions in the province of Quebec, Canada, by integrating the Unified Theory of Acceptance and Use of Technology and Task-Technology Fit (TTF) models and user satisfaction. This research was designed to broaden and assist in scaling up this effective eHealth service innovation across the province. METHODS A cross-sectional web-based survey was sent to all PCPs (n=263) and specialists (n=62) who used the eConsult Quebec Service between July 2017 and May 2021. We proposed a unified model integrating the Unified Theory of Acceptance and Use of Technology model and TTF model and user satisfaction by endorsing 11 hypotheses. The partial least squares was used to investigate factors influencing the acceptance of the eConsult Quebec Service. RESULTS Of the 325 end users, 136 (41.8%) users responded (PCPs: 101/263, 38.4%; specialists: 35/62, 57%). The results of the analysis with partial least squares method indicate that 9 of our 11 hypotheses are supported. The direct relationships uniting the various constructs of the model highlighted the importance of several key constructs and predominant correlations. The results suggest that satisfaction is the key driver behind the use of the eConsult Quebec Service. Performance expectancy (P<.001) and effort expectancy (P=.03) can have a positive impact on behavioral intention (BI), and BI (P<.001) can impact adoption. TTF has an influence on performance expectancy (P<.001), adoption (P=.02), and satisfaction (P<.001). However, the results show that there is no direct effect between social influence (P=.38) and BI or between facilitating conditions (P=.17) and adoption. CONCLUSIONS This study provides a better understanding of the factors influencing PCPs' and specialists' intention to adopt the eConsult Quebec Service. Furthermore, this study tests a research model and a technology that have never been explored in Quebec until now. On the basis of the results, the service is a good fit to meet the users' need to improve access to specialized medical advice. Therefore, the results of our study have made a valuable contribution to the implementation of the service by policy makers in order to maximize acceptance, use, adoption, and success across the province of Quebec. Moreover, after 4 successful years, the eConsult Quebec pilot project is now the Conseil Numérique digital consultation service.
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Affiliation(s)
- Véronique Nabelsi
- Department of Administrative Sciences, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Annabelle Lévesque-Chouinard
- GMF-U de la Haute-Ville du Centre intégré universitaire de santé et des services sociaux de la Capitale-Nationale, Sainte-Foy, QC, Canada
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Aledia AS, Dangodara AA, Amin AA, Amin AN. Implementation of Inpatient Electronic Consultations During the COVID-19 Crisis and Its Sustainability Beyond the Pandemic: Quality Improvement Study. J Med Internet Res 2024; 26:e55623. [PMID: 38754103 PMCID: PMC11140270 DOI: 10.2196/55623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Limiting in-person contact was a key strategy for controlling the spread of the highly infectious novel coronavirus (COVID-19). To protect patients and staff from the risk of infection while providing continued access to necessary health care services, we implemented a new electronic consultation (e-consult) service that allowed referring providers to receive subspecialty consultations for patients who are hospitalized and do not require in-person evaluation by the specialist. OBJECTIVE We aimed to assess the impact of implementing e-consults in the inpatient setting to reduce avoidable face-to-face referrals during the COVID-19 pandemic. METHODS This quality improvement study evaluated all inpatient e-consults ordered from July 2020 to December 2022 at the University of California Irvine Medical Center. The impact of e-consults was assessed by evaluating use (eg, number of e-consults ordered), e-consult response times, and outcome of the e-consult requests (eg, resolved electronically or converted to the in-person evaluation of patient). RESULTS There were 1543 inpatient e-consults ordered across 11 participating specialties. A total of 53.5% (n=826) of requests were addressed electronically, without the need for a formal in-person evaluation of the patient. The median time between ordering an e-consult and a specialist documenting recommendations in an e-consult note was 3.7 (IQR 1.3-8.2) hours across all specialties, contrasted with 7.3 (IQR 3.6-22.0) hours when converted to an in-person consult (P<.001). The monthly volume of e-consult requests increased, coinciding with surges of COVID-19 cases in California. After the peaks of the COVID-19 crisis subsided, the use of inpatient e-consults persisted at a rate well above the precrisis levels. CONCLUSIONS An inpatient e-consult service was successfully implemented, resulting in fewer unnecessary face-to-face consultations and significant reductions in the response times for consults requested on patients who are hospitalized and do not require an in-person evaluation. Thus, e-consults provided timely, efficient delivery of inpatient consultation services for appropriate problems while minimizing the risk of direct transmission of the COVID-19 virus between health care providers and patients. The service also demonstrated its value as a tool for effective inpatient care coordination beyond the peaks of the pandemic leading to the sustainability of service and value.
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Affiliation(s)
- Anna S Aledia
- Department of Medicine & Hospital Medicine, University of California, Irvine, Orange, CA, United States
| | - Amish A Dangodara
- Department of Medicine & Hospital Medicine, University of California, Irvine, Orange, CA, United States
| | - Aanya A Amin
- Department of Medicine & Hospital Medicine, University of California, Irvine, Orange, CA, United States
| | - Alpesh N Amin
- Department of Medicine & Hospital Medicine, University of California, Irvine, Orange, CA, United States
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Brooman-White R, Blakeman T, McNab D, Deaton C. Informing understanding of coordination of care for patients with heart failure with preserved ejection fraction: a secondary qualitative analysis. BMJ Qual Saf 2024; 33:232-245. [PMID: 37802647 DOI: 10.1136/bmjqs-2023-016583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Patients with heart failure with preserved ejection fraction (HFpEF) are a complex and underserved group. They are commonly older patients with multiple comorbidities, who rely on multiple healthcare services. Regional variation in services and resourcing has been highlighted as a problem in heart failure care, with few teams bridging the interface between the community and secondary care. These reports conflict with policy goals to improve coordination of care and dissolve boundaries between specialist services and the community. AIM To explore how care is coordinated for patients with HFpEF, with a focus on the interface between primary care and specialist services in England. METHODS We applied systems thinking methodology to examine the relationship between work-as-imagined and work-as-done for coordination of care for patients with HFpEF. We analysed clinical guidelines in conjunction with a secondary applied thematic analysis of semistructured interviews with healthcare professionals caring for patients with HFpEF including general practitioners, specialist nurses and cardiologists and patients with HFpEF themselves (n=41). Systems Thinking for Everyday Work principles provided a sensitising theoretical framework to facilitate a deeper understanding of how these data illustrate a complex health system and where opportunities for improvement interventions may lie. RESULTS Three themes (working with complexity, information transfer and working relationships) were identified to explain variability between work-as-imagined and work-as-done. Participants raised educational needs, challenging work conditions, issues with information transfer systems and organisational structures poorly aligned with patient needs. CONCLUSIONS There are multiple challenges that affect coordination of care for patients with HFpEF. Findings from this study illuminate the complexity in coordination of care practices and have implications for future interventional work.
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Affiliation(s)
- Rosalie Brooman-White
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Blakeman
- Centre for Primary Care, University of Manchester Faculty of Medical and Human Sciences, Manchester, UK
| | - Duncan McNab
- Medical Directorate, NHS Education for Scotland, Glasgow, UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
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Catapan SDC, Bruckmann G, Nilson LG, Caffery LJ, Kelly JT, Calvo MCM, Boing AF. Increasing primary care capacity and referral efficiency: A case study of a telehealth centre eConsult service in Brazil. J Telemed Telecare 2024:1357633X241235426. [PMID: 38446874 DOI: 10.1177/1357633x241235426] [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: 03/08/2024]
Abstract
INTRODUCTION eConsults are asynchronous digital communications for primary care professionals to seek timely specialist advice. Potential benefits include increased primary healthcare capacity and referral efficiency. Santa Catarina Telehealth Centre in Brazil has offered eConsults for an increasing number of specialties since 2008. This study described the characteristics of this service, including referral efficiency, sustainability, and satisfaction. METHODS Retrospective longitudinal analysis of eConsults activity data from 2015 to 2022 with three domains of the Model for Assessment of Telemedicine Applications used to structure the analysis. RESULTS Characteristics of the application: The total number of eConsults performed in 2015 was 4764, reaching 41,178 in 2022. While 30.3% of eConsults were synchronous in 2015, only asynchronous communication remained from 2021. Clinical effectiveness: eConsults requested to refer patients to specialist care resulting in primary care management remaining above 30% of the total for all specialties from 2019 to 2022, with hematology having the highest percentage (>52%). Organizational aspects: Established workflows with local specialists responding to eConsults (cardiology, endocrinology, hematology and orthopaedics) kept a constant or increasing number of eConsults and maintained the proportion of primary care management from 2019 to 2022, once recovered from COVID-19 and funding restrictions-related reductions. Over 90% of primary care professionals are either satisfied or very satisfied with the eConsult service. CONCLUSION Over 8 years, 223,734 consultations were conducted, with high satisfaction, demonstrating the substantial potential for increased primary care-sensitive conditions management. Hiring local specialists, fostering integrated care, and enabling sustainable workflows are key to eConsults' success.
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Affiliation(s)
- Soraia de Camargo Catapan
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Guilherme Bruckmann
- Public Health Department, Federal University of Santa Catarina, Florianopolis, Brazil
- Telehealth Centre of the Federal University of Santa Catarina, Florianopolis, Brazil
| | - Luana Gabrielle Nilson
- Telehealth Centre of the Federal University of Santa Catarina, Florianopolis, Brazil
- Medicine and Public Health Department, Regional University of Blumenau, Blumenau, Brazil
| | - Liam J Caffery
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Maria Cristina Marino Calvo
- Public Health Department, Federal University of Santa Catarina, Florianopolis, Brazil
- Telehealth Centre of the Federal University of Santa Catarina, Florianopolis, Brazil
| | - Antonio Fernando Boing
- Public Health Department, Federal University of Santa Catarina, Florianopolis, Brazil
- Telehealth Centre of the Federal University of Santa Catarina, Florianopolis, Brazil
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Rabat Restrepo JM, Rebollo Pérez IM, García Luna PP, Pereira Cunill JL, Vílchez López FJ, Gonzalo Marín M, Yestes Doblas C, Martínez Ortega AJ, Martínez-Ramírez MJ, Losada Morell C, Rojas García J, Ortiz Sánchez M, Obando de la Corte J, Macías Colorado Campiña ME. [Consensus on criteria and minimum data set for the referral of candidate patients for home enteral nutrition teleconsultation: TELENUT project]. NUTR HOSP 2024. [PMID: 38258660 DOI: 10.20960/nh.04702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION teleconsultation is a useful healthcare tool in the multidisciplinary management of patients with indications of home enteral nutrition (HEN). The use of different teleconsultation platforms, as it happens in the Andalusian Health System (SAS), results in heterogeneous referral processes between Primary Care and hospital services in the same region. OBJECTIVES to establish a consensus on patient profiles and the minimum data set necessary to guarantee an adequate referral to NED teleconsultation regardless of the existing platform. These agreed aspects in Andalusia can serve as a reference in other regions. METHODS three consecutive steps were followed: a) non-systematic review of the indexed literature on teleconsultation in clinical nutrition in Spain; b) survey to know the implementation and unmet needs of teleconsultation platforms in Andalusian public hospitals; and c) working meetings and consensus of 14 health professionals of Primary Care (n = 4) and endocrinology and hospital clinical nutrition (n = 10). RESULTS three referral forms were agreed in which three patient profiles were defined, with the corresponding minimum set of data necessary to request NED teleconsultation. The Primary Care team should provide this set of data to the clinical nutrition specialist via a teleconsultation platform, implemented in the SAS. CONCLUSIONS three agreed forms between healthcare professionals involved in the referral process serve to standardize the request for teleconsultation of NED between healthcare teams based on patient profiles.
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Affiliation(s)
| | | | - Pedro P García Luna
- Servicio de Endocrinología y Nutrición. Hospital Universitario Virgen del Rocío
| | | | | | | | - Carmen Yestes Doblas
- Servicio de Endocrinología y Nutrición. Hospital Universitario Clínico San Cecilio
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Peeters KMM, Reichel LAM, Muris DMJ, Cals JWL. Family Physician-to-Hospital Specialist Electronic Consultation and Access to Hospital Care: A Systematic Review. JAMA Netw Open 2024; 7:e2351623. [PMID: 38214930 PMCID: PMC10787322 DOI: 10.1001/jamanetworkopen.2023.51623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024] Open
Abstract
Importance Globally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)-defined as asynchronous, consultative communication between family physicians and hospital specialists-may offer advantages to face these challenges. Objective To provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals. Evidence Review A systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence. Findings The search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies. Conclusions and Relevance In this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.
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Affiliation(s)
- Ken M. M. Peeters
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Zuyderland Medical Centre, Sittard, the Netherlands
- Omnes Medical Coordinating Centre for Diagnostics and Innovation, Sittard, the Netherlands
| | - Loïs A. M. Reichel
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Dennis M. J. Muris
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Omnes Medical Coordinating Centre for Diagnostics and Innovation, Sittard, the Netherlands
- Public Health Service South Limburg, Heerlen, the Netherlands
| | - Jochen W. L. Cals
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Dos Santos LF, Carvalho F, Rados DV, de Oliveira EB, Gonçalves MR, Katz N, Umpierre RN, Mendonça CS. Reasons for Provider-to-Provider Synchronous Teleconsultations Between Nurses in Primary Care: A Cross-Sectional Study of TelessaúdeRS-UFRGS Service. Telemed J E Health 2024; 30:77-84. [PMID: 37205851 DOI: 10.1089/tmj.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
Introduction: Nurses have proven to be fundamental for the expansion and consolidation of primary health care (PHC), as well as the development of digital health strategies. We explored the results of a synchronous telephone teleconsultations service between professionals for nurses in Brazil. Methods: This is a cross-sectional study. We retrieved data from teleconsultations registry. All teleconsultations answered by the team of nurses between September 2018 and July 2021 were analyzed regarding the reasons (according to International Classification of Primary Care, 2nd edition-ICPC-2) and decisions of the teleconsultation. Results: There were 9,273 phone teleconsultations registered in the period, requested by 3,125 nurses from all states throughout the country, of which 56.9% called once and 15.9% used the teleconsultations at least 4 times. We found 362 different reasons for solicitations, which were classified according to the ICPC-2 chapters. The most frequent codes were respiratory (25.9%), general and unspecified (21.2%), and skin (21.2%), which corresponded to 68% of the total sample. Most teleconsultations (66.9%) had as outcome the maintenance of the case at PHC. Conclusion: Teleconsultations are widely used and address a broad number of situations. This service may improve the quality of Brazilian PHC and promote the development of clinical reasoning and critical thinking by nurses.
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Affiliation(s)
- Laura Ferraz Dos Santos
- Graduate Program in Epidemiology, TelessaúdeRS-UFRGS, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program Professional Masters Modality Assessment and Production of Technologies for the SUS, Porto Alegre, Brazil
| | - Fabiana Carvalho
- Graduate Program in Epidemiology, TelessaúdeRS-UFRGS, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Dimitris Varvaki Rados
- Graduate Program in Epidemiology, TelessaúdeRS-UFRGS, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Elise Botteselle de Oliveira
- Graduate Program in Epidemiology, TelessaúdeRS-UFRGS, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Rodrigues Gonçalves
- Graduate Program in Epidemiology, TelessaúdeRS-UFRGS, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Natan Katz
- Graduate Program in Epidemiology, TelessaúdeRS-UFRGS, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Roberto Nunes Umpierre
- Graduate Program in Epidemiology, TelessaúdeRS-UFRGS, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Claunara Schilling Mendonça
- Graduate Program Professional Masters Modality Assessment and Production of Technologies for the SUS, Porto Alegre, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Culmer N, Smith TB, Stager C, Wright A, Fickel A, Tan J, Clark C(T, Meyer H, Grimm K. Asynchronous Telemedicine: A Systematic Literature Review. TELEMEDICINE REPORTS 2023; 4:366-386. [PMID: 38143795 PMCID: PMC10739789 DOI: 10.1089/tmr.2023.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/26/2023]
Abstract
Background Asynchronous telemedicine (ATM), which describes telemedical interaction between a patient and provider where neither party communicates simultaneously, is an important telemedicine modality that is seeing increased use. In this article, we summarize the published peer-reviewed literature specifically related to ATM to (1) identify terms or phrases that are used to describe ATM, (2) ascertain how this research has thus far addressed the various aspects of the quadruple aim of medicine, and (3) assess the methodological rigor of research on ATM. We also divided the literature into pre- and post-COVID-19 onset periods to identify potential variations in the literature between these two periods. Methods This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search, utilizing multiple databases and applying inclusion and exclusion criteria, initially produced 2624 abstracts for review. De-duplication and screening ultimately yielded 104 articles for data extraction. Results "Store-and-forward" and variations of "e-visit" were the most frequently used alternative terms for ATM. Care quality was the most frequently addressed aspect of the Quadruple Aim of Medicine-more than double any other category-followed by patient satisfaction. We separated cost of care into two categories: patients' cost of care and providers' cost to provide care. Patient cost of care was the third most addressed aspect of the Quadruple Aim of Medicine followed by provider well-being and provider's cost to provide care. Methodological rigor of the studies was also addressed, with only 2 quantitative studies ranked "Strong," 5 ranked "Moderate," and 97 ranked "Weak." Qualitative studies were generally acceptable but struggled methodologically with accounting for all participants and articulation of results. Conclusions Although "store-and-forward" is somewhat more frequently used in the studies included in this review, variants of "e-visit," are growing in recent usage. Given the relative newness of modality, it is not surprising that quality of care is the most researched aspect of the Quadruple Aim of Medicine in ATM research. We anticipate more balance between these areas as research in this field matures. Primary areas of research need currently relate to practitioners-specifically their costs of providing care and well-being. Finally, future ATM research needs to address research challenges of selection bias and blinding in quantitative studies and improved participant tracking and articulation of both study design and results in qualitative studies.
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Affiliation(s)
- Nathan Culmer
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Todd Brenton Smith
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Catanya Stager
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Andrea Wright
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Jet Tan
- The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Hannah Meyer
- The University of Alabama, Tuscaloosa, Alabama, USA
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Rey Velasco E, Pedersen HS, Laursen DH, Skinner T. A meta-narrative review of coding tools for healthcare interactions and their applicability to written communication. PEC INNOVATION 2023; 3:100211. [PMID: 37711399 PMCID: PMC10498410 DOI: 10.1016/j.pecinn.2023.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023]
Abstract
Background Although healthcare professionals (HCP) undergo communicative skills training, these are sometimes unsatisfactory for patients (empathy, discussion managing). Existing coding tools overlook the interaction and patients' responses. Meanwhile, remote consultations are redefining communication channels. While some researchers adapt those tools to telehealth, few investigate written interactions. Objective To identify and evaluate coding tools for healthcare interactions and examine their suitability for written interactions. Methods We conducted a meta-narrative review in PubMed, PsycINFO, Embase, Web of Science, CINAHL, and Scopus databases up to December 2022 with Communicati* AND Human* AND Linguistic* AND Professional-Patient Relation* as search terms. We extracted data regarding methodology, unit of analysis (UoA), coding categories, reliability, strengths, weaknesses, and inter-rater reliability (IRR). Results We identified 11 mixed-methods tools. Qualitatively, coding dimension was focused (n = 6) or comprehensive (n = 5). Main quantitative methods were descriptive statistics (n = 4) and cross-tabulations (n = 4). Main UoA was utterance (n = 7). Relevant categories were processes (n = 4), content (n = 3), emotional expressions and responses (n = 3), and grammatical format (n = 2). IRR ranged from 0.68 to 0.85 for coding categories. Conclusion Despite similarities, category terminologies were inconsistent, one-sided, and mostly covered conversation topics and behaviours. A tool with emotional and grammar categories could bridge the gap between a speaker's intended meaning and the receiver's interpretation to enhance patient-HCP communication. Furthermore, we need empirical research to determine whether these tools are suitable for written interactions. Innovation This review presents a comprehensive and state-of-the-art overview of healthcare interactions' coding tools and identifies their barriers. Our findings will support communication researchers in selecting appropriate coding tools for evaluating health interactions and enhancing HCP training.
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Affiliation(s)
- Elena Rey Velasco
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
- Liva Healthcare, Danneskiold-Samsøes Allé 41, 1434, Copenhagen K, Denmark
| | - Hanne Sæderup Pedersen
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
| | | | - Timothy Skinner
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
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Avouac J, Marotte H, Balsa A, Chebbah M, Clanche SL, Verhagen LAW, Filková M, Mueller RB, Mongey AB, Taylor PC. Teleconsultation in rheumatology: A literature review and opinion paper. Semin Arthritis Rheum 2023; 63:152271. [PMID: 37813005 DOI: 10.1016/j.semarthrit.2023.152271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/18/2023] [Accepted: 08/27/2023] [Indexed: 10/11/2023]
Abstract
In this article, we review published literature on "telerheumatology", a term describing the use of telemedicine in rheumatology. This field has received considerable recent attention through the development of efficient digital technologies, resulting in a good level of satisfaction among patients and health care professionals. In 2020, the social distancing constraints during the COVID-19 pandemic accelerated more widespread adoption worldwide. Telerheumatology is particularly suited for patients with rheumatoid arthritis who have achieved a sustained therapeutic target of remission or low disease activity. To facilitate remote consultations and meet expectations of rheumatologists and patients, international and national guidelines have recently been proposed and existing tools, such as Patient-Reported Outcomes questionnaires, have had to be digitally adapted. In addition, telerheumatology toolkits are proposed by the Arab League of Associations for Rheumatology (ArLAR), the Association of American Medical College (AAMC), and the American College of Rheumatology (ACR) for all learners, from medical students to practicing clinicians, encouraging the acquisition of telehealth skills and facilitating their integration into their routine clinical practice. The main benefits reported for this mode of health care are greater access to specialty care, flexibility, reduced rates of missed appointments, as well as improved patient engagement and autonomy. Limitations include the absence of physical examination. However, to implement telerheumatology effectively and widely in daily clinical practice, some barriers still need to be addressed. These include training of health care professionals, technological restrictions and reimbursement mechanisms. Despite the advantages of telerheumatology, it is not intended to replace face-to-face visits, but rather as a way to enhance access to care, service delivery and health care support for patients.
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Affiliation(s)
- Jérôme Avouac
- Service de Rhumatologie, Hôpital Cochin, AP-HP Centre - Université Paris Cité, 75014 Paris, France
| | - Hubert Marotte
- SAINBIOSE, INSERM U1059, Université Jean Monnet, Saint-Etienne, France; Service de Rhumatologie, CHU Saint-Etienne,42055 Saint-Etienne, France; CIC 1408, Saint-Etienne, France
| | - Alejandro Balsa
- Rheumatology Unit, University Hospital La Paz, Institute for Health Research-IdiPAZ, Universidad Autonoma de Madrid,28046 Madrid, Spain
| | - Myriam Chebbah
- Public Health Expertise, Département Affaires Médicales, 10 boulevard de Sébastopol, 75004 Paris, France
| | - Solenn Le Clanche
- Public Health Expertise, Département Affaires Médicales, 10 boulevard de Sébastopol, 75004 Paris, France
| | | | - Mária Filková
- Institute of Rheumatology, Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Peter C Taylor
- Norman Collison Professor of Musculoskeletal Sciences at the Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
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12
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Suresh K, Hill PA, Kahn CE, Schnall MD, Rosen MA, Zafar HM, Trerotola SO, Cook TS. Quality Improvement Report: Design and Implementation of a Radiology E-Consult Service. Radiographics 2023; 43:e230139. [PMID: 38032820 DOI: 10.1148/rg.230139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Electronic consultations (e-consults) mediated through an electronic health record system or web-based platform allow synchronous or asynchronous physician-to-physician communication. E-consults have been explored in various clinical specialties, but relatively few instances in the literature describe e-consults to connect health care providers directly with radiologists.The authors outline how a radiology department can implement an e-consult service and review the development of such a service in a large academic health system. They describe the logistics, workflow, turnaround time expectations, stakeholder management, and pilot implementation and highlight challenges and lessons learned.
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Affiliation(s)
- Kalpana Suresh
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Paul A Hill
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Charles E Kahn
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Mitchell D Schnall
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Mark A Rosen
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Hanna M Zafar
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Scott O Trerotola
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Tessa S Cook
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
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13
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Bifulco L, Grzejszczak L, Velez I, Angelocci T, Anderson D. A qualitative investigation of uninsured patient and primary care provider perspectives on specialty care eConsults. BMC Health Serv Res 2023; 23:1133. [PMID: 37864170 PMCID: PMC10589958 DOI: 10.1186/s12913-023-10086-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/28/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Uninsured and underinsured patients face specialty care access disparities that prevent them from obtaining the care they need and negatively impact their health and well-being. We aimed to understand how making specialty care electronic consultations (eConsults) available at a multi-site Federally Qualified Health Center (FQHC) in central Texas affected uninsured patients' care-seeking experiences and impacted their ability to receive the needed care. METHODS We used concepts from Ecological Systems Theory to examine individual, interpersonal, organization-level, social, and health policy environment factors that impacted patients' access to specialty care and the use of eConsults. We conducted thematic analysis of semi-structured, qualitative interviews with patients about seeking specialty care while uninsured and with uninsured patients and FQHC PCPs about their experience using eConsults to obtain specialists' recommendations. RESULTS Patients and PCPs identified out-of-pocket cost, stigma, a paucity of local specialists willing to see uninsured patients, time and difficulty associated with travel and transportation to specialty visits, and health policy limitations as barriers to obtaining specialty care. Benefits of using eConsults for uninsured patients included minimizing/avoiding financial stress, expanding access to care, expanding scope of primary care, and expediting access to specialists. Concerns about the model included patients' limited understanding of eConsults, concern about cost, and worry whether eConsults could appropriately meet their specialty needs. CONCLUSIONS Findings suggest that eConsults delivered in a primary care FQHC addressed uninsured patients' specialty care access concerns. They helped to address financial and geographic barriers, provided time and cost savings to patients, expanded FQHC PCPs' knowledge and care provision options, and allowed patients to receive more care in primary care.
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Affiliation(s)
- Lauren Bifulco
- Weitzman Institute, 19 Grand Street, Middletown, CT, USA
| | | | - Idiana Velez
- Weitzman Institute, 19 Grand Street, Middletown, CT, USA
| | - Tracy Angelocci
- Lone Star Circle of Care, 205 East University, Suite 100, Georgetown, TX, USA
| | - Daren Anderson
- Weitzman Institute, 19 Grand Street, Middletown, CT, USA.
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14
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Petre J, Donald M, Jackson C. Supporting complex care in general practice via an eConsultant model of care: the Australian specialist perspective. Aust J Prim Health 2023; 29:455-462. [PMID: 37183355 DOI: 10.1071/py22243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/11/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Accessing timely specialist physician advice and guidance is of critical importance to both Australian GP specialists (GPs) and their patients. The traditional method of referral, triage and subsequent face-to-face (FTF) consultation is facing challenges from an ever increasing volume of referrals and the needs of underserved populations. In response to such issues, electronic consults (eConsults) have been successfully used internationally to provide GPs with a means of asynchronously accessing specialist physician advice and guidance within 72h. Few studies have addressed the potential impact of eConsults from the view of the non-GP specialist receiving the request, and none specifically related to specialist adult medicine physicians. The aim of this study was to determine the perceptions of current Royal Australasian College of Physicians (RACP) adult medicine Fellows towards establishing an eConsult model of care within their own clinical practice. METHODS Semi-structured interviews were conducted with 14 RACP adult medicine Fellows between December 2019 and February 2020. Purposive and snowball sampling strategies were used to recruit physicians of differing ages and gender from diverse specialties and healthcare settings. The data were subjected to a descriptive thematic analysis. RESULTS We describe five key themes of relevance to study participants: (1) improved access to non-GP specialist care; (2) the business model in relation to remuneration and time; (3) enhanced GP-Physician relationships; (4) impact on physician work-life balance; and (5) the need for a structured model of care. There was broad consensus that a significant number of outpatient referrals to adult medicine physicians would be more appropriately addressed in primary care with support via an asynchronous eConsult arrangement. RACP Fellows agreed this could improve access to timely specialist advice, place downward pressure on outpatient FTF clinic waiting times and reduce unnecessary patient travel. CONCLUSION These findings identify the drivers and barriers to the establishment of an Australian eConsultant model of care from the adult medicine physician's perspective.
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Affiliation(s)
- Joel Petre
- UQ Centre for Health System Reform and Integration, University of Queensland, Brisbane, Qld 4006, Australia
| | - Maria Donald
- UQ Centre for Health System Reform and Integration, University of Queensland, Brisbane, Qld 4006, Australia
| | - Claire Jackson
- UQ Centre for Health System Reform and Integration, University of Queensland, Brisbane, Qld 4006, Australia
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15
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Bradley C, Smith L, Youens K, White BAA, Couchman G. Formalizing the curbside: digitally enhancing access to specialty care. Proc AMIA Symp 2023; 36:716-720. [PMID: 37829223 PMCID: PMC10566420 DOI: 10.1080/08998280.2023.2240364] [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: 03/31/2023] [Accepted: 07/17/2023] [Indexed: 10/14/2023] Open
Abstract
Asynchronous medical care has increased in utilization, patient interest, and industry demand. While E-consults have been discussed extensively in the literature, there are rare examples of a multispecialty implementation within a large health system. Here, we describe our experience in implementing an internal E-consult program for asynchronous, nonurgent communication between ambulatory specialists and primary care providers in our large multispecialty regional health system. To ensure adoption of the program, patient, specialist, and primary care physician concerns were systematically addressed. The program commenced in February 2022 with three high referral rate specialties: cardiology, orthopedics, and dermatology. In the 12 months after implementation, 2243 total E-consults were ordered among 505 ordering providers. Dermatology received the most consultations, and we have expanded to 19 specialties and subspecialties available in the program in the first year. Our E-consult implementation experienced substantial growth in a short time period, demonstrating the viability of E-consult utilization for increasing asynchronous access to ambulatory specialists' expertise in a large healthcare system.
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Affiliation(s)
- Camille Bradley
- Baylor Scott and White Health Family Medicine Lakewood, Dallas, Texas, USA
| | - LaPortia Smith
- Department of Internal Medicine, Baylor Scott and White Medical Center Round Rock, Round Rock, Texas, USA
| | - Kenneth Youens
- Department of Pathology and Laboratory Medicine, Baylor Scott and White Medical Center Temple, Temple, Texas, USA
| | - Bobbie Ann Adair White
- Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Glen Couchman
- Department of Family Medicine, Baylor Scott and White Medical Center Temple, Temple, Texas, USA
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Graever L, Issa AFC, da Fonseca VBP, Melo MM, da Silva GPDC, da Nóbrega ICP, Savassi LCM, Dias MB, Gomes MK, Lapa e Silva JR, Guimarães RM, Seródio RC, Frølich A, Gudbergsen H, Jakobsen JC, Dominguez H. Telemedicine Support for Primary Care Providers versus Usual Care in Patients with Heart Failure: Protocol of a Pragmatic Cluster Randomised Trial within the Brazilian Heart Insufficiency with Telemedicine (BRAHIT) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5933. [PMID: 37297537 PMCID: PMC10253100 DOI: 10.3390/ijerph20115933] [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: 03/16/2023] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
Heart failure is a prevalent condition and a frequent cause of hospital readmissions and poor quality of life. Teleconsultation support from cardiologists to primary care physicians managing patients with heart failure may improve care, but the effect on patient-relevant outcomes is unclear. We aim to evaluate whether collaboration through a novel teleconsultation platform in the Brazilian Heart Insufficiency with Telemedicine (BRAHIT) project, tested on a previous feasibility study, can improve patient-relevant outcomes. We will conduct a parallel-group, two-arm, cluster-randomised superiority trial with a 1:1 allocation ratio, with primary care practices from Rio de Janeiro as clusters. Physicians from the intervention group practices will receive teleconsultation support from a cardiologist to assist patients discharged from hospitals after admission for heart failure. In contrast, physicians from the control group practices will perform usual care. We will include 10 patients per each of the 80 enrolled practices (n = 800). The primary outcome will be a composite of mortality and hospital admissions after six months. Secondary outcomes will be adverse events, symptoms frequency, quality of life, and primary care physicians' compliance with treatment guidelines. We hypothesise that teleconsulting support will improve patient outcomes.
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Affiliation(s)
- Leonardo Graever
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21044-020, Brazil
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Aurora Felice Castro Issa
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Brazil; (A.F.C.I.); (V.B.P.d.F.); (M.M.M.); (I.C.P.d.N.)
| | | | - Marcelo Machado Melo
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Brazil; (A.F.C.I.); (V.B.P.d.F.); (M.M.M.); (I.C.P.d.N.)
| | | | | | | | | | - Maria Kátia Gomes
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21044-020, Brazil
| | - Jose Roberto Lapa e Silva
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21044-020, Brazil
| | | | | | - Anne Frølich
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1353 Copenhagen, Denmark; (A.F.); (H.G.)
| | - Henrik Gudbergsen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1353 Copenhagen, Denmark; (A.F.); (H.G.)
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark & Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, 2200 Copenhagen, Denmark;
| | - Helena Dominguez
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
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17
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Job J, Nicholson C, Donald M, Jackson C, Byrnes J. An eConsultant versus a hospital-based outpatient consultation for general (internal) medicine: a costing analysis. BMC Health Serv Res 2023; 23:478. [PMID: 37170265 PMCID: PMC10174616 DOI: 10.1186/s12913-023-09436-1] [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: 02/21/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The eConsultant model of care is an outpatient substitution approach which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving primary care physicians remote access to specialist support for patient care within 3 business days. Results from initial trials of the eConsultant model in Australia support international evidence of reduced wait times and improved access to specialist input, avoidance of face-to-face hospital outpatient visits, and better integrated care. This study compared the cost of delivery of an eConsultant episode of care with that of a hospital-based outpatient appointment. METHODS A cost-minimisation analysis, using a decision analytic model, was used to compare the two approaches. eConsultant costs were calculated from specialist reported data (minutes spent preparing the response; the number of patients referred subsequently for a hospital-based outpatient appointment) and administration staff data (time spent recording the occasion-of-service). Outpatient costs were calculated using finance data and information from outpatient clinic managers at the hospital-based outpatient clinic. The primary outcome was incremental cost saving per patient from a hospital system perspective. Uncertainty was explored using one-way sensitivity analyses and characterised with probabilistic sensitivity analysis using 10,000 Monte Carlo simulations. RESULTS The traditional referral pathway cost estimate was $587.20/consult compared to $226.13/consult for an eConsultant episode: an efficiency saving of $361.07 per patient. The incremental difference between eConsultant and traditional care was most sensitive to the cost estimate of an outpatient attendance, the time for a specialist to complete an eConsult, and the probability of a patient requiring a face-to-face hospital-based attendance following an eConsult. However, at the upper bounds of each of these estimates, an eConsult remained the most cost-efficient model. In 96.5% of the Monte Carlo simulations eConsult was found to be more cost efficient than the traditional approach. CONCLUSIONS The eConsultant model of care was associated with a 61.5% efficiency gain, allowing diversion of support to hospital-based outpatient appointments.
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Affiliation(s)
- Jenny Job
- UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia.
| | - Caroline Nicholson
- UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia
| | - Maria Donald
- UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Claire Jackson
- UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia
- General Practice and Primary Care Research, The University of Queensland, Brisbane, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Health Economics School of Medicine and Dentistry, Griffith University, Brisbane, Australia
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18
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Hakimjavadi R, Karunananthan S, Levi C, LeBlanc K, Guglani S, Helmer-Smith M, Keely E, Liddy C. Electronic consultation use by advanced practice nurses in older adult care-A descriptive study of service utilization data. Nurs Open 2023; 10:2240-2248. [PMID: 36373892 PMCID: PMC10006590 DOI: 10.1002/nop2.1476] [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: 08/03/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
AIMS AND OBJECTIVES To describe characteristics of service utilization by advanced practice nurses (APNs) employing an electronic consultation (eConsult) service in their care for older adults. BACKGROUND Canada's aging population is projected to place unprecedented demands on the healthcare system. APNs, which include clinical nurse specialists (CNSs) and nurse practitioners (NPs), are nurses with advanced knowledge who can independently provide age-appropriate care. eConsult is a secure web-based platform enabling asynchronous, provider-to-provider communication. APNs can send and receive eConsults to address patient-specific concerns. METHODS This is a retrospective analysis of eConsult utilization and user survey data for cases completed in 2019, reported in line with the STROBE guidelines. Eligible eConsults included those that had APN involvement (as a referrer or responder) and were concerning an older patient (≥65 years). Descriptive statistics were used to analyse service utilization and survey response data. RESULTS Of 430 eligible eConsults, 421 (97.9%) were initiated by NPs and the rest by physicians. 23 (5.3%) were received by a CNS, of which 14 (3.3%) involved an NP-to-CNS exchange. Median specialist response interval was 0.9 days. 53% of eConsults was for dermatology, haematology, cardiology, gastroenterology and endocrinology. 73% of eConsults avoided a face-to-face referral after the consultation. In 90% of eConsults, APNs rated the service as helpful and/or educational. CONCLUSIONS Through eConsult, APNs can collaborate with each other and physicians to access and provide a breadth of advice facilitating timely specialist-informed care for older patients, thus helping to alleviate some of the demands placed on the healthcare system. RELEVANCE TO CLINICAL PRACTICE There is an opportunity for APNs to further adopt eConsult into their clinical practice, and this can, in turn, support the integration of the APN role in the health workforce. PATIENT OR PUBLIC CONTRIBUTION Current APN eConsult users were involved in the study design and interpretation of results.
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Affiliation(s)
- Ramtin Hakimjavadi
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Sathya Karunananthan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.,Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Cheryl Levi
- Emergency Department Outreach Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kimberly LeBlanc
- Nurses Specialized in Wound, Ostomy, and Continence, Ottawa, Ontario, Canada.,Advanced Practice Nurse (Wound, Ostomy, and Continence), KDS Professional Consulting, Ottawa, Ontario, Canada
| | - Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Mary Helmer-Smith
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada.,eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.,eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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19
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Mazón-Ramos P, Cinza-Sanjurjo S, Garcia-Vega D, Portela-Romero M, Rodríguez-Mañero M, Rey-Aldana D, Morandeira AP, Lage-Fernández R, Gude-Sampedro F, González-Juanatey JR. The impact of inter-clinician electronic consultation in patients diagnosed with atrial fibrillation in primary care. Eur J Clin Invest 2023; 53:e13904. [PMID: 36346678 DOI: 10.1111/eci.13904] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND An early diagnosis and early initiation of oral anticoagulants (OAC) are main determinants for outcomes in patients with atrial fibrillation (AF). Inter-clinician electronic consultations (e-consultations) program for the general practitioner referrals to cardiologist may improve health care access by reducing the elapsed time for cardiology care. OBJECTIVE To evaluate the effect of a reduced elapsed time to care after a inter-clinician e-consultations program implementation (2013-2019) in comparison with previous in-person consultation (2010-2012) in the outpatient health care management in a Cardiology Department. METHODOLOGY We included 10,488 patients with AF from 1 January 2010, to 31 December 2019. Until 2012, all patients attended an in-person consultation (2010-2012). In 2013, we instituted an e-consult program (2013-2019) for all primary care referrals to cardiologists that preceded patient's in-person consultation when considered. The shared electronic patient dossier (EPD) was available between GP and cardiologist, and any change in therapy advice from cardiologist was directly implemented in this EPD. RESULTS During the e-consultation period (2013-2019) were referred 6627 patients by GPs to cardiology versus 3861 during the in-person consultation (2010-2012). The e-consultation implementation was associated with a reduction in the elapsed time to anticoagulation prescription (177.6 ± 8.9 vs. 22.5 ± 8.1 days, p < .001), and an increase of OAC use (61% [95% IC: 19.6%-102.4%], p < .001). The e-consult program implementation was associated with a reduction in the 1-year CV mortality (.48 [95% CI: .30-.75]) and all-cause mortality (.42 [95% CI: .29-.62]). The OAC reduces the stroke mortality (.15 [95% CI: .06-.39]) and CV mortality (.43 [95% CI: .29-.62]) and all-cause mortality (.23 [95% CI: .17-.31]). CONCLUSION A shared EPD-based inter-clinician e-consultation program significantly reduced the elapsed time for cardiology consultation and initiation of OAC. The implementation of this program was associated with a lower risk of stroke and cardiovascular/all-cause mortality.
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Affiliation(s)
- Pilar Mazón-Ramos
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Sergio Cinza-Sanjurjo
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,CS Milladoiro, Área Sanitaria Integrada Santiago de Compostela, Ames, Spain
| | - David Garcia-Vega
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Manuel Portela-Romero
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,CS Concepción Arenal, Área Sanitaria Integrada Santiago de Compostela, Santiago de Compostela, Spain
| | - Moisés Rodríguez-Mañero
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Daniel Rey-Aldana
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,CS A Estrada, Área Sanitaria Integrada Santiago de Compostela, A Estrada, Spain
| | | | - Ricardo Lage-Fernández
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Francisco Gude-Sampedro
- Unidad de Epidemiología Clínica, Complejo Hospitalario Universitario de Santiago de Compostela, IDIS, redIAPP, Madrid, Spain
| | - José R González-Juanatey
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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20
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Beldjerd M, Quarello E, Lafouge A, Giorgi R, Le Corroller Soriano AG. A cost minimization analysis comparing asynchronous tele-expertise with face-to-face consultation for prenatal diagnosis in France. J Telemed Telecare 2023:1357633X231151713. [PMID: 36755393 DOI: 10.1177/1357633x231151713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Timely detection of congenital anomalies using ultrasound improves neonatal care. As specialist sonographers are often geographically dispersed, they are sometimes requested to provide a second opinion via tele-expertise. The present study aimed to evaluate the economic impact of asynchronous tele-expertise in obstetric ultrasound care in private medical practice through a comparison with face-to-face consultations. We conducted a cost minimization analysis using decision tree modeling in order to determine whether asynchronous tele-expertise or face-to-face consultation had the lowest cost, under the assumption of equivalent effectiveness in terms of prenatal diagnosis. Costs were measured from the societal perspective. The data for the base case of our modeling came from a retrospective analysis of the clinical practice of an expert who had been conducting asynchronous tele-expertise for 4 years in France. The study included 260 patients for whom 322 requests for expert opinions were made by physicians/midwives from January 2016 to January 2020. The expected average total cost for tele-expertise for a patient was €74.45 (95% CI: €66.36-€82.54) compared to €195.02 (95% CI: €183.90-€206.14) for the conventional face-to-face strategy. Accordingly, using tele-expertise led to a statistically significant reduction of €120.57 in the average total cost per patient. A sensitivity analysis confirmed the robustness of the model produced. The results of the present study underline the efficiency of tele-expertise and highlight related economic benefits. Accordingly, they could inform public health policy on the dissemination of tele-expertise in the field of obstetric ultrasound care.
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Affiliation(s)
- M'hamed Beldjerd
- Inserm, Aix Marseille Univ, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Edwin Quarello
- Centre Image 2, 6 rue Rocca, Marseille, France
- Service de Gynécologie Obstétrique 26 Bd de Louvain, Hôpital Saint Joseph, Marseille, France
| | - Antoine Lafouge
- Cabinet de gynécologie et obstétrique Hyères, Hyères, France
| | - Roch Giorgi
- Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, ISSPAM, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
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21
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Grant R, McMurtry A, Archibald D. Mapping Health Professions Education: Using Complexity Science to Make Sense of Learning Through Electronic Consultations. MEDICAL SCIENCE EDUCATOR 2023; 33:233-242. [PMID: 37008438 PMCID: PMC10060472 DOI: 10.1007/s40670-023-01730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 06/19/2023]
Abstract
Phenomena studied within health professions education are often complex and multifaceted. This article describes a complexity science-informed theoretical framework that was developed for exploring how electronic consultations support learning among primary care providers, as well as within the larger organizations or systems in which they practice. This framework enables researchers to investigate learning occurring simultaneously at multiple levels (including individuals and social groups), without simplistically conflating levels or theories. The various levels of learning and associated theories are illustrated using examples from electronic consultations. This complexity science-inspired framework can be used for studying learning in complex, multilayered systems.
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Affiliation(s)
- Rachel Grant
- Faculty of Education, University of Ottawa, Ottawa, ON Canada
| | - Angus McMurtry
- Faculty of Education, University of Ottawa, Ottawa, ON Canada
| | - Douglas Archibald
- Faculty of Education, University of Ottawa, Ottawa, ON Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
- Bruyère Research Institute, Ottawa, ON Canada
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22
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Fernández-Prada M, Cano-García P, Alonso-Penanes P, Zapico-Baragaño MJ, Giménez-Gómez P, Lana A. Preliminary evaluation of an inter-professional e-consultation on vaccines. J Telemed Telecare 2023; 29:111-116. [PMID: 33176541 DOI: 10.1177/1357633x20970077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study was to assess the preliminary effectiveness and acceptability of an inter-professional e-consultation on vaccines. We used a quasi-experimental design to introduce an application in electronic health records that allowed primary health providers to launch e-consults to the hospital vaccines unit. A total of 135 e-consults were received during 10 months. E-consults were more frequently about subjects with chronic diseases (82.2%). Most of the e-consults were global (60.7%), that is, to revise a patient's complete vaccination schedule, whereas 39.3% were specific, that is, to request information regarding a concrete vaccine or serology, with hepatitis vaccines leading the ranking (42.9%). The e-consultation avoided hospital referral in 85.4% of the global e-consults and in 100% of the specific e-consults. Indicators of acceptability were all above nine points (10 points indicated the maximum). The best-rated aspect was the level of recommendation (9.7 ± 0.68 points). In summary, linking primary health-care providers with specialists in vaccines through an e-consultation tool is effective and well-accepted by users.
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Affiliation(s)
- María Fernández-Prada
- Vaccines Unit, Preventive Medicine and Public Health Department, Vital Álvarez-Buylla Hospital, Health Care Service of Asturias, Spain.,Healthcare Research Area, Health Research Institute of Asturias (ISPA), Spain
| | - Paula Cano-García
- Preventive Medicine and Public Health Department, School of Medicine and Health Sciences, University of Oviedo, Spain
| | - Paula Alonso-Penanes
- Preventive Medicine and Public Health Department, School of Medicine and Health Sciences, University of Oviedo, Spain
| | - María J Zapico-Baragaño
- Vaccines Unit, Preventive Medicine and Public Health Department, Vital Álvarez-Buylla Hospital, Health Care Service of Asturias, Spain
| | - Pia Giménez-Gómez
- Health Services Organisation Department, Health Service of the Principality of Asturias, Spain
| | - Alberto Lana
- Healthcare Research Area, Health Research Institute of Asturias (ISPA), Spain.,Preventive Medicine and Public Health Department, School of Medicine and Health Sciences, University of Oviedo, Spain
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23
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Khan N, Gilliar W, Bamrah JS, Dave S. Post-COVID-19: can digital solutions lead to a more equitable global healthcare workforce? BJPsych Int 2023; 20:18-23. [PMID: 36812032 PMCID: PMC9909439 DOI: 10.1192/bji.2022.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
An unintended consequence of the COVID-19 pandemic has been the exponential growth of telemedicine, with automation of healthcare becoming more common. Face-to-face meetings and training events have been replaced relatively seamlessly with online versions, taking clinical or academic expertise to distant parts of the world and making them more accessible and affordable. The wide reach of digital platforms offering remote healthcare offers the opportunity of democratising access to high-quality healthcare, However, certain challenges remain: (a) clinical guidance developed in one geographical area may need adaptation for use in others; (b) regulatory mechanisms from one jurisdiction need to offer patient safety across other jurisdictions; (c) barriers created by disparity in technology infrastructure and the variation in pay for services across different economies, leading to brain drain and an inequitable workforce. The World Health Organization's Global Code of Practice on the International Recruitment of Health Personnel could offer the preliminary framework on which solutions to these challenges could be built.
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Affiliation(s)
- Nagina Khan
- BHSc, PGCert, PhD, Senior Research Associate, College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA.
| | - Wolfgang Gilliar
- DO, FAAPMR, Dean, College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - J. S. Bamrah
- FRCPSYCH, MHSM, FIIOPM, Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Park House, North Manchester General Hospital, UK
| | - Subodh Dave
- FRCPsych, MMed, Consultant Psychiatrist and Deputy Director of Undergraduate Medical Education, Derbyshire Healthcare Foundation Trust, University of Bolton, UK.
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24
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Bifulco L, Guidotti O, Velez I, Grzejszczak L, Angelocci T, Okunade L, Anderson D. Impact of eConsults on Clinical Care in Primary Care: A Cross-Sectional Analysis of Primary Care Provider Behavior. J Prim Care Community Health 2023; 14:21501319231202201. [PMID: 37753619 PMCID: PMC10524039 DOI: 10.1177/21501319231202201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION/OBJECTIVES Asynchronous electronic consultations (eConsults) support primary care providers (PCPs) by providing rapid specialist feedback and improve medically underserved patients' access to care. METHODS This cross-sectional study assessed all eConsults requested over a one-year period at a multi-site federally qualified health center in Texas. We analyzed eConsult content and quality and conducted chart reviews for a randomly selected subsample (n = 100) to determine whether PCPs implemented specialists' recommendations within 90 days. Semi-structured interviews with PCPs assessed their ability and willingness to follow recommendations. RESULTS There were 367 eConsults submitted by 25 PCPs across 15 adult medical and surgical specialties. Of the 100 charts reviewed n = 77 (77.0%) contained documentation indicating that the PCP had followed at least 1 of the specialist's recommendations within 90 days. In two-thirds of the cases (n = 66, 66%) the reviewing specialist indicated that a face-to-face referral was not needed. PCPs were most likely to follow recommendations for new medications and least likely to document that they had obtained additional patient history. PCPs noted that they were sometimes unable to follow recommendations when patients could not afford or access treatment or did not return for follow up care, or when they felt that the specialist did not address their specific question. CONCLUSIONS eConsults delivered to medically underserved patients in primary care help PCPs provide timely care for their patients. PCPs utilized a broad range of eConsult specialties and generally implemented eConsult specialists' recommendations within 90 days.
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25
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Aboelkhir HAB, Elomri A, ElMekkawy TY, Kerbache L, Elakkad MS, Al-Ansari A, Aboumarzouk OM, El Omri A. A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16952. [PMID: 36554837 PMCID: PMC9778793 DOI: 10.3390/ijerph192416952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The referral process is an important research focus because of the potential consequences of delays, especially for patients with serious medical conditions that need immediate care, such as those with metastatic cancer. Thus, a systematic literature review of recent and influential manuscripts is critical to understanding the current methods and future directions in order to improve the referral process. METHODS A hybrid bibliometric-structured review was conducted using both quantitative and qualitative methodologies. Searches were conducted of three databases, Web of Science, Scopus, and PubMed, in addition to the references from the eligible papers. The papers were considered to be eligible if they were relevant English articles or reviews that were published from January 2010 to June 2021. The searches were conducted using three groups of keywords, and bibliometric analysis was performed, followed by content analysis. RESULTS A total of 163 papers that were published in impactful journals between January 2010 and June 2021 were selected. These papers were then reviewed, analyzed, and categorized as follows: descriptive analysis (n = 77), cause and effect (n = 12), interventions (n = 50), and quality management (n = 24). Six future research directions were identified. CONCLUSIONS Minimal attention was given to the study of the primary referral of blood cancer cases versus those with solid cancer types, which is a gap that future studies should address. More research is needed in order to optimize the referral process, specifically for suspected hematological cancer patients.
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Affiliation(s)
| | - Adel Elomri
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Tarek Y. ElMekkawy
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
| | - Laoucine Kerbache
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Mohamed S. Elakkad
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Abdulla Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- College of Medicine, QU-Health, Qatar University, Doha 2713, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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26
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Correale MR, Soever LJ, Rampersaud YR. A Model to Implement Standardized Virtual Care for Low Back Pain Amongst a Large Network of Providers in Urban and Rural Settings. J Prim Care Community Health 2022; 13:21501319221130603. [PMID: 36300425 PMCID: PMC9623358 DOI: 10.1177/21501319221130603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Prior to the COVID-19 pandemic, virtual care (VC) was not routinely offered for
assessment of low back pain (LBP), a highly prevalent, disabling condition.
COVID-19 related healthcare closures resulted in a rapid backlog of patients
referred to a provincial interprofessional LBP program. Without management,
these patients were at high risk of experiencing untoward outcomes. Virtual care
became a logical option. However, many clinicians lacked experience and
confidence with LBP virtual care (LBP-VC); and either were unfamiliar with, or
did not have access to, requisite technology. Multi-stakeholder engagement was
utilized to understand barriers, identify enablers, and ultimately promote VC
for LBP. As a result of the multi-stakeholder engagement, the concept of a
toolkit for LBP-VC, including clinical resources and guidelines, emerged. The
toolkit contains preparatory steps for VC and a standardized approach to virtual
LBP assessment. Key steps in the toolkit have potential applicability to other
musculoskeletal populations.
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Affiliation(s)
- Marcia Rebecca Correale
- University Health Network, Toronto, ON,
Canada,University of Toronto, Toronto, ON,
Canada,Marcia Rebecca Correale, Schroeder
Arthritis Institute, University Health Network, 399 Bathurst Street, Toronto, ON
M5T 2S8, Canada.
| | - Leslie Jayne Soever
- University Health Network, Toronto, ON,
Canada,University of Toronto, Toronto, ON,
Canada
| | - Yoga Raja Rampersaud
- University Health Network, Toronto, ON,
Canada,University of Toronto, Toronto, ON,
Canada,Krembil Research Institute, Toronto,
ON, Canada
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27
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Saigí-Rubió F, Borges do Nascimento IJ, Robles N, Ivanovska K, Katz C, Azzopardi-Muscat N, Novillo Ortiz D. The Current Status of Telemedicine Technology Use Across the World Health Organization European Region: An Overview of Systematic Reviews. J Med Internet Res 2022; 24:e40877. [DOI: 10.2196/40877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Several systematic reviews evaluating the use of telemedicine by clinicians, patients, and health authorities to improve the delivery of care in the 53 member states of the World Health Organization (WHO) European Region have been conducted in recent years. However, a study summarizing the findings of these reviews has not been conducted.
Objective
This overview of systematic reviews aimed to summarize findings regarding the use of telemedicine across the 53 member states and identify the medical fields and levels of care in and at which the effectiveness, feasibility, and applicability of telemedicine have been demonstrated. The barriers to and facilitators of telemedicine use were also evaluated and collated to help with the design and implementation of telemedicine interventions.
Methods
Through a comprehensive systematic evaluation of the published and unpublished literature, we extracted clinical, epidemiological, and technology-related data from each review included in the study. We focused on evaluating the barriers to and facilitators of the use of telemedicine apps across the 53 member states considered. We rated the methodological quality of each of the included reviews based on A Measurement Tool to Assess Systematic Review 2 approach and judged the overall certainty of evidence by using the Grading of Recommendations, Assessment, Development, and Evaluations methodology. The entire process was performed by 2 independent authors.
Results
This overview drew on data from >2239 primary studies, with >20,000 enrolled patients in total, within the WHO European Region. On the basis of data from randomized trials, observational studies, and economic evaluations from several countries, the results show a clear benefit of telemedicine technologies in the screening, diagnosis, management, treatment, and long-term follow-up of a series of chronic diseases. However, we were unable to pool the results into a reliable numeric parameter because of the high heterogeneity of intervention methodologies, scheduling, primary study design discrepancies, settings, and geographical locations. In addition to the clinical outcomes of the interventions, the social and economic outcomes are highlighted.
Conclusions
The application of telemedicine is well established across countries in the WHO European Region; however, some countries could still benefit from the many uses of these digital solutions. Barriers related to users, technology, and infrastructure were the largest. Conversely, the provision of health services using technological devices was found to significantly enhance patients’ clinical outcomes, improve the long-term follow-up of patients by medical professionals, and offer logistical benefits for both patients and health workers.
Trial Registration
PROSPERO (International Prospective Register of Systematic Reviews) CRD42022309375; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309375
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28
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Job J, Nicholson C, Calleja Z, Jackson C, Donald M. Implementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia. BMC Health Serv Res 2022; 22:1278. [PMID: 36280832 PMCID: PMC9589630 DOI: 10.1186/s12913-022-08663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background In response to lengthy wait times for specialist outpatient appointments, electronic consultation (eConsult) services have developed globally, providing asynchronous, secure and timely communication between general practitioner (GP) and specialist. This study aims to track adoption of a Queensland eConsultant service in two Australian Primary Health Networks (Western Queensland and Brisbane South) to understand key barriers and enablers to adoption and inform modification of the implementation strategy. Methods Our theory-informed mixed-methods evaluation assessed implementation between July 2020 and March 2022. Adoption and implementation activities were prospectively recorded in bespoke tracking spreadsheets with implementation activities coded against the Expert Recommendations for Implementing Change (ERIC) strategies. Semi-structured interviews with GPs and stakeholders informed by the Consolidated Framework for Implementation Research (CFIR) were conducted to understand determinants of implementation. Results Of the 40 practices invited to take part in the eConsultant service, 20 (50%) enrolled. Of the 97 GPs who consented, 38 sent at least one Request for Advice (RFA) to the eConsultant with a total of 112 RFA sent. Implementation was predominantly guided by eight strategies. Qualitative interviews were conducted with 11 GPs and 4 stakeholders (12 from rural/remote regions, 11 females and two sole practitioners). Interviewees felt the eConsultant service supported outpatient appointment avoidance and provided efficient, timely access to specialist support for GPs and their patients. Barriers identified to using eConsultant related to digital infrastructure, competing priorities, and keeping the service ‘front of mind’. Key enablers identified were the relative advantage of eConsultant over other options, patient benefits and COVD-19 facilitating the use of digital technology. Conclusions This evaluation highlighted service enablers as well as user priorities for broader implementation. A focus on a well-integrated digital system and availability of a variety of eConsultant specialties are seen as key strategies to embedding the eConsultant option in GP advice processes in Australia. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08663-2.
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Affiliation(s)
- Jennifer Job
- grid.1003.20000 0000 9320 7537UQ-MRI Centre for Health System Reform and Integration, Mater Research Institute, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD 4029 Australia
| | - Caroline Nicholson
- grid.1003.20000 0000 9320 7537UQ-MRI Centre for Health System Reform and Integration, Mater Research Institute, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD 4029 Australia ,Integrated Care and Innovation Translation, Mater Misericordiae Ltd, Brisbane, Australia
| | - Zoe Calleja
- grid.1003.20000 0000 9320 7537UQ-MRI Centre for Health System Reform and Integration, Mater Research Institute, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD 4029 Australia
| | - Claire Jackson
- grid.1003.20000 0000 9320 7537UQ-MRI Centre for Health System Reform and Integration, Mater Research Institute, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD 4029 Australia ,grid.1003.20000 0000 9320 7537Primary Care Faculty of Medicine, The University of Queensland, Brisbane, Australia ,grid.1003.20000 0000 9320 7537General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Maria Donald
- grid.1003.20000 0000 9320 7537UQ-MRI Centre for Health System Reform and Integration, Mater Research Institute, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD 4029 Australia ,grid.1003.20000 0000 9320 7537General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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29
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Virtual Access to Subspecialty Care. Prim Care 2022; 49:557-573. [PMCID: PMC9581700 DOI: 10.1016/j.pop.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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30
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Novick AM, Kwitowski M, Dempsey J, Cooke DL, Dempsey AG. Technology-Based Approaches for Supporting Perinatal Mental Health. Curr Psychiatry Rep 2022; 24:419-429. [PMID: 35870062 PMCID: PMC9307714 DOI: 10.1007/s11920-022-01349-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE OF REVIEW This review explores advances in the utilization of technology to address perinatal mood and anxiety disorders (PMADs). Specifically, we sought to assess the range of technologies available, their application to PMADs, and evidence supporting use. RECENT FINDINGS We identified a variety of technologies with promising capacity for direct intervention, prevention, and augmentation of clinical care for PMADs. These included wearable technology, electronic consultation, virtual and augmented reality, internet-based cognitive behavioral therapy, and predictive analytics using machine learning. Available evidence for these technologies in PMADs was almost uniformly positive. However, evidence for use in PMADs was limited compared to that in general mental health populations. Proper attention to PMADs has been severely limited by issues of accessibility, affordability, and patient acceptance. Increased use of technology has the potential to address all three of these barriers by facilitating modes of communication, data collection, and patient experience.
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Affiliation(s)
- Andrew M Novick
- Department of Psychiatry, University of Colorado School of Medicine, 1890 N Revere Ct, MS F546, Aurora, CO, 80045, USA
| | - Melissa Kwitowski
- Department of Psychiatry, University of Colorado School of Medicine, 1890 N Revere Ct, MS F546, Aurora, CO, 80045, USA
| | - Jack Dempsey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Danielle L Cooke
- Department of Psychiatry, University of Colorado School of Medicine, 1890 N Revere Ct, MS F546, Aurora, CO, 80045, USA
| | - Allison G Dempsey
- Department of Psychiatry, University of Colorado School of Medicine, 1890 N Revere Ct, MS F546, Aurora, CO, 80045, USA.
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31
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Impacto de un Nuevo Programa de Trabajo Social en el Acceso a la Atención Terciaria. Ann Glob Health 2022; 88:45. [PMID: 35854923 PMCID: PMC9249001 DOI: 10.5334/aogh.3886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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Asynchronous Remote Communication as a Tool for Care Management in Primary Care: A Rapid Review of the Literature. Int J Integr Care 2022; 22:7. [PMID: 36043028 PMCID: PMC9374012 DOI: 10.5334/ijic.6489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
Aim: To review the available evidence on asynchronous communication models between primary care professionals and patients in different countries around the world in order to analyse the added value that this model brings to patients and professionals. Design: A rapid literature review was conducted using the World Health Organisation guidance to include a variety of studies on the concept of asynchronous communications between primary care and patients in different countries. Data sources: The search for articles was carried out in PubMed and Google Academics and with the contribution of telemedicine experts from the Catalan Institute of Health. Selection of studies: The review included 271 articles. The inclusion criteria were: publications from 2010 onwards, in English, Spanish or Catalan, focused on asynchronous communications between primary care professionals and patients to improve patient management. After discarding duplicates and applying the exclusion criteria (255 articles), 16 were included for further review. Data extraction: The rapid literature review was conducted by an evaluator; detecting 5 main general themes: reduction of face-to-face visits, available services and most frequent uses, characteristics and perceptions of primary care professionals, characteristics and perceptions of users, and barriers and facilitators for the implementation of asynchronous teleconsultation. Results: A total of sixteen studies were included, including seven quantitative studies, seven qualitative studies and two mixed studies. Conclusions: The high degree of satisfaction of both users and professionals, the outbreak of COVID-19 and the effectiveness and efficiency of asynchronous remote communications are key factors for the implementation and improvement in the management of the different healthcare systems across the world.
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Arora A, Fekieta R, Nouri Z, Carder D, Colgan MM, Fuhlbrigge A, Jackson SL, Collins S, Gleason N, Chen J. Trends in Utilization of Electronic Consultations Associated With Patient Payer and Language Among US Academic Medical Centers During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2224628. [PMID: 35904781 PMCID: PMC9338406 DOI: 10.1001/jamanetworkopen.2022.24628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Electronic consultations (eConsultations) are increasingly used to obtain specialist guidance, avoiding unnecessary face-to-face patient visits for certain clinical questions. During the COVID-19 pandemic, when in-person care was limited, eConsultations may have helped clinicians obtain specialist input to guide patient care. OBJECTIVE To understand how the use of eConsultations changed during the COVID-19 pandemic and whether trends in eConsultation utilization differed based on patient's payer and primary language. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted at 6 academic medical centers in the United States, all participating in the Association of American Colleges Coordinating Optimal Referral Experiences program. Participants included adult patients who had an outpatient visit, referral, or eConsultation during the study period. Data were analyzed from June 4, 2019, to July 28, 2020. MAIN OUTCOMES AND MEASURES The primary outcome was the eConsultation proportion of specialty contact, defined as the number of completed eConsultations divided by the sum of the number of completed eConsultations and specialty referrals, expressed as a percentage. eConsultation percentages of specialty contact were further stratified by payer type and language. Payers included commercial, Medicare, Medicaid, self-pay or uninsured, and other. Primary language included English and non-English languages. RESULTS A total of 14 545 completed eConsultations and 189 776 referrals were included. More eConsultations were completed for English-speaking patients (11 363 eConsultations [95.0%]) than non-English-speaking patients (597 eConsultations [5.0%]). Patients with commercial insurance represented the highest number of completed eConsultations (8848 eConsultations [60.8%]) followed by Medicare (3891 eConsultations [26.8%]), Medicaid (930 eConsultations [6.4%]), other insurance (745 eConsultations [5.1%]), and self-pay or no insurance (131 eConsultations [0.9%]). At the start of the pandemic, across all academic medical centers, the percentage of specialty contact conducted via eConsultation significantly increased by 6.21% (95% CI, 4.97%-7.44%; P < .001). When stratified by payer and language, the percentage of specialty contact conducted via eConsultation significantly increased at the beginning of the pandemic for both English-speaking patients (change, 6.09% (95% CI, 4.82% to 7.37%; P < .001) and non-English-speaking patients (change, 8.48% [95% CI, 5.79% to 11.16%]; P < .001) and for all payers, except self-pay and uninsured patients (change, -0.21% [95% CI, [-1.35% to 0.92%]; P = .70). CONCLUSIONS AND RELEVANCE This retrospective cohort study found that eConsultations provided an accessible mechanism for clinicians to receive specialist input when in-person care was limited.
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Affiliation(s)
- Anita Arora
- Yale School of Medicine, New Haven, Connecticut
| | | | - Zakia Nouri
- Association of American Medical Colleges, Washington, District of Columbia
| | - Danielle Carder
- Association of American Medical Colleges, Washington, District of Columbia
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Santos DS, Batistelli CRS, Lara MMDS, Ferreira EDS, Moreira TR, Cotta RMM. The effectiveness of the use of telehealth programs in the care of individuals with hypertension and, or diabetes mellitus: systematic review and meta-analysis. Diabetol Metab Syndr 2022; 14:76. [PMID: 35643495 PMCID: PMC9148205 DOI: 10.1186/s13098-022-00846-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/06/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diabetes Mellitus and Hypertension are some of the main Chronic Noncommunicable Diseases, representing a big challenge for global health. In this context, Telehealth programs are presented as a tool with exciting potential to complement and support health care. This paper aimed to analyze the effectiveness of the use of Telehealth programs in the care of individuals with Hypertension and/or Diabetes Mellitus. METHODS A systematic review with meta-analysis was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol methodology. The following databases were used: PubMed, EMBASE, SciELO, ScienceDirect and Cochrane Library. Papers were included if they addressed the use of technologies that allow two-way communication at a distance between health professionals and patients affected by Hypertension and/or Diabetes Mellitus, type 1 or type 2. Experimental, cross-sectional, case-control, cohort, and clinical trials were included in the review. RESULTS We included 164 papers in the review and 45 in the meta-analysis final synthesis. The systematic review results showed a prevalence of telemonitoring as the main form of Telehealth. The study showed a reduction in expenses with the use of Telehealth, both for the users and for the health systems providers, followed by greater satisfaction. Our meta-analysis showed that Telehealth is an effective tool in the care of diabetic patients, providing a 0.353% reduction in HbA1c compared to traditional care. No studies on Hypertension that met our eligibility criteria for inclusion in the meta-analysis were found. CONCLUSIONS Telehealth is an effective tool for the care of people with Diabetes Mellitus and/or Hypertension.
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Affiliation(s)
- Daniel Souza Santos
- Department of Medicine and Nursing, Federal University of Viçosa (UFV), Viçosa, MG, 36570-900, Brazil.
| | | | | | - Emily de Souza Ferreira
- Department of Nutrition and Health, Federal University of Viçosa (UFV), Viçosa, MG, 36570-900, Brazil
| | - Tiago Ricardo Moreira
- Department of Medicine and Nursing, Federal University of Viçosa (UFV), Viçosa, MG, 36570-900, Brazil
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Liddy C, Mitchell R, Guglani S, Mihan A, Sethuram C, Miville A, Keely E. The Provincial Spread and Scale of the Ontario eConsult Service: Evaluation of the First 2 Years. Ann Fam Med 2022; 20:262-265. [PMID: 35606133 PMCID: PMC9199054 DOI: 10.1370/afm.2812] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/13/2021] [Accepted: 12/02/2021] [Indexed: 11/09/2022] Open
Abstract
This paper reports on a multimethod cross-sectional study of the Ontario electronic consultation (eConsult) service. Utilization and closeout survey data from July 2018 through June 2020 were analyzed using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Requesting clinicians submitted 60,474 eConsults, and monthly cases increased from 1,487 in July 2018 to 4,179 in June 2020. The median specialist response time was 1 day. An originally contemplated referral was avoided in 51% of cases. Ontario eConsult showed successful uptake across Ontario, demonstrating continued spread and scale, and offering a template for trailblazers looking to implement digital health innovations in their own jurisdictions.
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Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada .,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rhea Mitchell
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.,eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ariana Mihan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Claire Sethuram
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Andrea Miville
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Erin Keely
- eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
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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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Impact of a Novel Social Work Program on Access to Tertiary Care. Ann Glob Health 2022; 88:24. [PMID: 35481980 PMCID: PMC8992777 DOI: 10.5334/aogh.3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: In the movement for global health equity, increased research and funding have not yet addressed a shortage of evidence on effectively implementing context-specific interventions; one unmet need is facilitating access to specialty care within the public health sector in Mexico. Compañeros en Salud has been piloting a novel program, called Right to Healthcare (RTHC), to increase access to specialty care for the rural poor in Chiapas, Mexico. The RTHC program incorporates social work, patient navigation, referrals, direct economic support, and accompaniment for patients. Objectives: This study evaluates the effectiveness of the RTHC program. Primary outcomes analyzed included acceptance of any referral and attendance of any appointment. Secondary outcomes included acceptance of the first referral and rate of appointment attendance for patients with an accepted referral. Methods: Using referral process data for the years 2014 to 2019 from a public tertiary care hospital in Chiapas, 91 RTHC patients were matched using 2:1 optimal pair matching with a control cohort balancing covariates of patient age, sex, specialty referred to, level of referring hospital, and municipality. Findings: RTHC patients were more likely to have had an accepted referral (OR 17.42, 95% CI 3.68 to 414.16) and to have attended an appointment (OR 5.49, 95% CI 2.93 to 11.60) compared to the matched control group. RTHC patients were also more likely to have had their first referral accepted (OR 2.78, 95% CI 1.29 to 6.73). Among patients with an accepted referral, RTHC patients were more likely to have attended an appointment (OR 3.86, 95% CI 1.90 to 8.57). Conclusions: The results demonstrate that the RTHC model is successful in increasing access to specialty care by both increasing referral acceptance and appointment attendance.
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Beizaga-Luna V, Navarrete-Pérez C, Ávila-Toscano JH, Limaymanta CH. Colaboración y estructura intelectual de la producción científica peruana y colombiana en Ciencias Sociales (2011 - 2020). REVISTA ESPANOLA DE DOCUMENTACION CIENTIFICA 2022. [DOI: 10.3989/redc.2022.2.1881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Los estudios latinoamericanos sobre publicaciones en Ciencias Sociales no son abundantes; estas disciplinas merecen mayor atención en países de la región por parte de los sistemas científicos nacionales. Este estudio analiza la producción científica peruana y colombiana en Ciencias Sociales publicada en Web of Science (2011-2020) con el objetivo de determinar indicadores de colaboración y analizar redes de coautoría entre instituciones y países, además de identificar la estructura intelectual mediante cocitación y acoplamiento bibliográfico de autores. Se analizaron 2888 documentos para Perú y 12747 para Colombia, a partir de los cuales se identificó el patrón de colaboraciones en ambos países con tendencia a constituir mayor cantidad de vínculos internacionales que regionales. Pese a la amplia diferencia en el número de documentos, los indicadores de colaboración siguen dinámicas similares en ambos países; también es común el acoplamiento bibliográfico y la cocitación enfocados en autores clásicos de estas disciplinas y en autores institucionales.
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Malcolm EJ, Brandon Z, Wilson LE, Shoup JP, King HA, Lewinski A, Greiner MA, Malone S, Miller J, Keenan RT, Tarrant TK, Phinney D, Cho A, Bosworth HB, Shah K. eConsults' Impact on Care Access and Wait Times in Rheumatology. J Clin Rheumatol 2022; 28:147-154. [PMID: 35067514 DOI: 10.1097/rhu.0000000000001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE A growing number of health systems have implemented eConsults to improve access to specialty advice, but few studies have described their use in rheumatology or impact on visit wait times. We evaluated the uptake of an eConsult program and its impact on wait times for in-person rheumatology visits. METHODS In this quality improvement project, we analyzed electronic health record data from 4 intervention clinics and 4 comparison clinics, 12 months before and after implementation of an eConsult program. We compared median wait time for rheumatology appointments using a pre-post difference-in-differences analysis and quantile regression, adjusting for patient age, race, sex, clinic pair, and primary insurance payer. We also interviewed 11 primary care providers from the intervention clinics and conducted a rheumatology provider focus group (n = 4) to elucidate experiences with the program. RESULTS Rheumatologists recommended management in primary care or referral to another specialty for 41% of eConsults, reducing initial demand for in-person visits. The median wait times dropped in the intervention and the comparison clinics (42 and 25 days, respectively). Intervention clinic median wait time dropped 17 days more than comparison clinics, and this was nonstatistically significant (p = 0.089). eConsults fit provider care tasks best for triage or initial workup for diagnosis, and less well when tests required interpretation, or when back and forth communication was needed to manage the patient's condition. CONCLUSIONS Implementation of eConsults for rheumatology was associated with reduced wait times for rheumatology appointments and supported primary care providers in the triage and workup for a substantial portion of patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Julie Miller
- From the Duke University School of Medicine, Durham
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Hakimjavadi R, Levi C, LeBlanc K, Guglani S, Helmer-Smith M, Joschko J, Karunananthan S, Keely E, Liddy C. Electronic Consultation by Advanced Practice Nurses to Improve Access to Specialist Care for Older Adults. J Gerontol Nurs 2022; 48:33-40. [PMID: 35343843 DOI: 10.3928/00989134-20220307-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Older adults face several challenges when accessing specialist care. Advanced practice nurses (APNs) can perform an important role in primary care for older adults, particularly when bolstered with digital tools. In the current study, we conducted a multiple case study of electronic consultations (eConsults) involving APNs to assess how these practitioners use the service to improve access to care. All eConsults submitted by or to an APN in 2019 on behalf of patients aged ≥65 years were reviewed to identify examples from six settings representative of the range of advanced nursing practices. For each setting, a final case was chosen using an iterative process and stratified by specialty and type of advice. Included cases were assessed using a conceptual framework for health care access. Selected cases illustrate how APNs can be effective users of eConsults in a diversity of health care settings. The framework allowed for an in-depth study of access over the range of interactions that take place among patients, caregivers, providers, and the health care system. [Journal of Gerontological Nursing, 48(4), 33-40.].
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Maria ARJ, Serra H, Heleno B. Teleconsultations and their implications for health care: A qualitative study on patients' and physicians' perceptions. Int J Med Inform 2022; 162:104751. [PMID: 35339887 DOI: 10.1016/j.ijmedinf.2022.104751] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/18/2022] [Accepted: 03/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Digitization in everyday medical practice has gained importance along with the drive to expand teleconsultations arising from the COVID-19 pandemic. Previous qualitative research on teleconsultations has focused on synchronous communication between patients and clinicians. This study aims to explore physicians' and patients' perspectives on the adoption of teleconsultations between primary care and the referral cardiology department. METHODS Participants were recruited for semi-structured interviews between September 2019 and January 2020. The interviews were audio-recorded and pseudonymized. The transcribed interviews were stored, coded, and content analysis was performed in MAXQDA. RESULTS A total of 29 participants were interviewed. Patients and physicians merged in their views on 'process' issues, i.e., those concerning a better prioritization of patients and an improved collaborative practice, albeit with possible technological constraints. Physicians recognized that teleconsultations presented an educational opportunity for managing patients' health problems. Our findings suggest that not all patients would require equally intensive collaborative activities across the health system. The barriers described included difficulties using the system (technical issues) and concerns about workload as a consequence of the disruption of traditional clinical routines. Increasing the range of collaborative strategies available to health care providers may require a broader assessment of the way that care processes are structured between levels of care. Patients revealed strong support for teleconsultation on the grounds of interprofessional collaboration and avoidance of unnecessary hospital visits. CONCLUSIONS The implementation of teleconsultations between levels of care may be facilitated when patients, caregivers and physicians see the added value of this service, that adequate resources are put in place and that there is flexible implementation. This work adds an in-depth understanding of participants' perceptions of this intervention in a case study. Obtaining context-dependent knowledge will help program leaders better understand how to establish telemedicine services as a real-world sustainable option.
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Affiliation(s)
- Ana Rita J Maria
- Regional Health Administration of Lisbon and Tagus Valley Teaching Assistant and PhD Student at Comprehensive Health Research Centre (CHRC), Nova Medical School Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Helena Serra
- Interdisciplinary Centre of Social Sciences (CICS. NOVA), NOVA School of Social Sciences and Humanities Faculdade de Ciências Sociais e Humanas, Universidade NOVA de Lisboa, Portugal
| | - Bruno Heleno
- Comprehensive Health Research Centre (CHRC), Nova Medical School Faculdade de Ciências Médicas, Universidade NOVA de Lisboa General Practitioner, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal
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Use of telemedicine for initial outpatient subspecialist consultative visit: A national survey of general pediatricians and pediatric subspecialists. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2022; 10:100600. [PMID: 34875456 PMCID: PMC8881319 DOI: 10.1016/j.hjdsi.2021.100600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Evidence-based strategies are needed to support appropriate use of telemedicine for initial outpatient subspecialty consultative visits. To inform such strategies we performed a survey of general pediatricians and pediatric subspecialists about use of telemedicine for patients newly referred for pediatric subspecialty care. METHODS We developed and fielded an e-mail and postal survey of a national sample of 840 general pediatricians and 840 pediatric subspecialists in May and June 2020. RESULTS Of 266 completed surveys (17% response rate), 204 (76%) thought telemedicine should be offered for some and 29 (11%) thought telemedicine should be offered for all initial subspecialist visits. Most respondents who indicated telemedicine should be offered for some initial consultations believed this decision should be made by subspecialty attendings (176/204, 86%). Respondents prioritized several data elements to inform this decision, including clinical information and family-based contextual information (e.g., barriers to in-person care, interest in telemedicine, potential communication barriers). Factors perceived to reduce appropriateness of telemedicine for subspecialty consultation included need for interpreter services and prior history of frequent no-shows. Responses from generalists and subspecialists rarely differed significantly. CONCLUSIONS Survey results suggest potential opportunities to support the appropriate use of telemedicine for initial outpatient pediatric subspecialty visits through structured transfer of specific clinical and contextual information at the time of referral and through strategies to mitigate perceived communication or engagement barriers. IMPLICATION Pediatric physician beliefs about telemedicine for initial outpatient subspecialty consultative visits may inform future interventions to support appropriate telemedicine use. LEVEL OF EVIDENCE Survey of a national sample of clinicians.
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Rea CJ, Toomey SL, Rosen M, Le T, Shah S. Understanding Caregiver Perspectives on an Electronic Consultation and Referral System. Clin Pediatr (Phila) 2022; 61:270-279. [PMID: 35090366 DOI: 10.1177/00099228221074856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined caregiver impressions of an electronic consultation and referral (ECR) system. Participants included 56 caregivers of primary care patients referred through the ECR system. Semistructured interviews and surveys were conducted between August 2018 and April 2019. Transcripts were coded and themes developed using thematic content analysis. A total of 51% of caregivers stated that they would prefer to see their child's primary care provider (PCP) for a specialty issue if they could receive the same quality of care. All caregivers who received an electronic consult (n = 28) said that they would utilize that process again. Three themes emerged: (1) caregivers expect immediate action prior to or instead of a specialty referral; (2) caregiver preferences for PCP versus specialist are mediated by both child and provider characteristics; (3) caregiver attitudes toward the ECR system are influenced by external considerations and experiences with the system. Results suggest caregivers value enhanced communication and immediate access to specialty input facilitated by the ECR system.
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Affiliation(s)
- Corinna J Rea
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sara L Toomey
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Tiffany Le
- Boston Children's Hospital, Boston, MA, USA
| | - Snehal Shah
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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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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Berard C, Di Mascio T, Montaleytang M, Couderc AL, Villani P, Honoré S, Daumas A, Correard F. Telemedication Reviews to Optimize Medication Prescription for Older People in Nursing Homes. Telemed J E Health 2021; 28:1225-1232. [PMID: 34958258 DOI: 10.1089/tmj.2021.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Older people living in nursing homes (NH) are at a higher risk of preventable drug-related adverse events because of age-related physiological changes, polypathology, and polypharmacy. NH residents are particularly exposed to potentially inappropriate medications (PIMs). Many strategies have been developed to improve the quality and the safety of drug prescription in NH, including medication reviews (MRs). Methods: In the context of the application of telemedicine, we developed and are currently implementing a novel hospital expert-based MRs through tele-expertise (or "telemedication review," telemedication reviews hereafter [TMR]) in French NH residents. The impact of these TMR on unplanned hospitalizations 3 months after implementation is assessed. TMR consider all available sociodemographic, clinical, biological, and pharmaceutical data pertaining to the patient and are performed in accordance with their health care objectives. Results: The preliminary results for the 39 TMRs performed to date (September 2021) showed that a total of 402 PIMs were detected, and all residents had at least one PIM. We also present the feasibility and the usefulness of this novel TMR for NH, illustrating these preliminary results with two concrete TMR experiences. Among the 39 TMR performed, the average acceptance rate of expert recommendations made to general practitioners (GP) working in NH was ∼33%. Discussion and Conclusions: The success of this novel TMR depends on how the proposed prescription adjustments made by the hospital expert team are subsequently integrated into health care practices. The low acceptance rate by GP highlights the need to actively involve these professionals in the process of developing TMR, with a view to encouraging them to act on proposed adjustments.
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Affiliation(s)
- Charlotte Berard
- Pharmacy Department, AP-HM, Marseille, France.,Clinical Pharmacy Unit, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
| | - Thomas Di Mascio
- Pharmacy Department, AP-HM, Marseille, France.,Clinical Pharmacy Unit, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
| | - Maeva Montaleytang
- Pharmacy Department, AP-HM, Marseille, France.,Clinical Pharmacy Unit, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
| | - Anne Laure Couderc
- Internal Medicine, Geriatrics and Therapeutics Department, AP-HM, Marseille, France
| | - Patrick Villani
- Internal Medicine, Geriatrics and Therapeutics Department, AP-HM, Marseille, France
| | - Stephane Honoré
- Pharmacy Department, AP-HM, Marseille, France.,Clinical Pharmacy Unit, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
| | - Aurelie Daumas
- Internal Medicine, Geriatrics and Therapeutics Department, AP-HM, Marseille, France
| | - Florian Correard
- Pharmacy Department, AP-HM, Marseille, France.,Clinical Pharmacy Unit, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
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Dosani T, Xiang J, Wang K, Deng Y, Connell NT, Connery D, Levin F, Roy A, Wadia RJ, Wong EY, Rose MG. Impact of Hematology Electronic Consultations on Utilization of Referrals and Patient Outcomes in an Integrated Health Care System. JCO Oncol Pract 2021; 18:e564-e573. [PMID: 34914541 DOI: 10.1200/op.21.00420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Electronic consultations (e-consults) may be a valuable tool in the current era of increased demand for hematologists. Despite the increasing use of e-consults in hematology, their optimal utilization and impact on patient outcomes and workload are largely unknown. METHODS In this retrospective cohort study, we studied the hematology consult experience at Veterans Affairs Connecticut from 2006 to 2018. We included 7,664 hematology consults (3,240 e-consults and 4,424 face-to-face [FTF] consults) requested by 1,089 unique clinicians. RESULTS We found that e-consults were rapidly adopted and used equally among physicians of different degrees of experience. The number of FTF consults did not decrease after the introduction of e-consult services. E-consults were preferentially used for milder laboratory abnormalities that had been less likely to result in a consult before their availability. Referring clinicians used e-consults preferentially for periprocedural management, anemia, leukopenia, and anticoagulation questions. Eighty-three percent of e-consults were resolved without needing an FTF visit in the year after the consult. Consults for pancytopenia, gammopathy, leukocytosis, and for patients with known malignancy were less likely to be resolved by e-consult. Among patients who were diagnosed with a new hematologic malignancy after their consult, having an e-consult before an FTF visit did not adversely affect survival. CONCLUSION In summary, e-consults safely expanded delivery of hematology services in our health care system but increased total consult volume. We report novel data on what types of consults may be best suited to the electronic modality, the impact of e-consults on workload, and their optimal use and implementation.
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Affiliation(s)
- Talib Dosani
- Yale School of Medicine and Yale Cancer Center, New Haven, CT
| | - Jenny Xiang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Kaicheng Wang
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Nathan T Connell
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | - Alicia Roy
- VA Connecticut Healthcare System, West Haven, CT
| | - Roxanne J Wadia
- Yale School of Medicine and Yale Cancer Center, New Haven, CT.,VA Connecticut Healthcare System, West Haven, CT
| | - Ellice Y Wong
- Yale School of Medicine and Yale Cancer Center, New Haven, CT.,VA Connecticut Healthcare System, West Haven, CT
| | - Michal G Rose
- Yale School of Medicine and Yale Cancer Center, New Haven, CT.,VA Connecticut Healthcare System, West Haven, CT
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Sanavro SM, van der Worp H, Jansen D, Koning P, Blanker MH. ‘Evaluation of the First Year(s) of Physicians’ Collaboration on an Interdisciplinary Electronic Consultation Platform in the Netherlands: a mixed-methods observational study. (Preprint). JMIR Hum Factors 2021; 9:e33630. [PMID: 35363155 PMCID: PMC9015779 DOI: 10.2196/33630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/11/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Complexity of health problems and aging of the population create an ongoing burden on the health care system with the general practitioner (GP) being the gatekeeper in primary care. In GPs daily practice, collaboration with specialists and exchange of knowledge from the secondary care play a crucial role in this system. Communication between primary and secondary care has shortcomings for health care workers that want to practice sustainable patient-centered health care. Therefore, a new digital interactive platform was developed: Prisma. Objective This study aims to describe the development of a digital consultation platform (Prisma) to connect GPs with hospital specialists via the Siilo application and to evaluate the first year of use, including consultations, topic diversity, and number of participating physicians. Methods We conducted a mixed methods observational study, analyzing qualitative and quantitative data for cases posted on the platform between June 2018 and May 2020. Any GP can post questions to an interdisciplinary group of secondary care specialists, with the platform designed to facilitate discussion and knowledge exchange for all users. Results In total, 3674 cases were posted by 424 GPs across 16 specialisms. Most questions and answers concerned diagnosis, nonmedical treatment, and medication. Mean response time was 76 minutes (range 44-252). An average of 3 users engaged with each case (up to 7 specialists). Almost half of the internal medicine cases received responses from at least two specialisms in secondary care, contrasting with about one-fifth for dermatology. Of note, the growth in consultations was steepest for dermatology. Conclusions Digital consultations offer the possibility for GPs to receive quick responses when seeking advice. The interdisciplinary approach of Prisma creates opportunities for digital patient-centered networking.
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Affiliation(s)
- Sanne M Sanavro
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, Netherlands
| | - Henk van der Worp
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, Netherlands
| | - Danielle Jansen
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, Netherlands
| | - Paul Koning
- Prisma, Siilo Holding BV, Amsterdam, Netherlands
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, Netherlands
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Rankine J, Yeramosu D, Matheo L, Sequeira GM, Miller E, Ray KN. Optimizing e-Consultations to Adolescent Medicine Specialists: Qualitative Synthesis of Feedback From User-Centered Design. JMIR Hum Factors 2021; 8:e25568. [PMID: 34383665 PMCID: PMC8380586 DOI: 10.2196/25568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/21/2021] [Accepted: 05/24/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND e-Consultations between primary care physicians and specialists are a valuable means of improving access to specialty care. Adolescents and young adults (AYAs) face unique challenges in accessing limited adolescent medicine specialty care resources, which contributes to delayed or forgone care. e-Consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care. However, the optimal application of this model in adolescent medicine requires careful attention to the nuances of AYA care. OBJECTIVE This study aims to qualitatively analyze feedback obtained during the iterative development of an e-consultation system for communication between general pediatricians and adolescent medicine specialists tailored to the specific health care needs of AYAs. METHODS We conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static e-consultation prototype and storyboards and evaluated them with target users (general pediatricians and adolescent medicine specialists). In the second phase, we incorporated feedback to develop a functional prototype within the electronic health record and again evaluated this with general pediatricians and adolescent medicine specialists. In each phase, general pediatricians and adolescent medicine specialists provided think-aloud feedback during the use of the prototypes and semistructured exit interviews, which was qualitatively analyzed to identify perspectives related to the usefulness and usability of the e-consultation system. RESULTS Both general pediatricians (n=12) and adolescent medicine specialists (n=12) perceived the usefulness of e-consultations for AYA patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for AYAs, primarily by improving efficiency (eg, reducing documentation, emphasizing critical information, using autopopulated data fields, and balancing specificity and efficiency through text prompts) and reducing the potential for errors (eg, prompting a review of autopopulated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, whereas documentation of communication and confidentiality expectations were enhanced. CONCLUSIONS Through an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to the care of AYAs. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts that should be considered in the development and use of e-consultations with AYAs.
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Affiliation(s)
- Jacquelin Rankine
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Deepika Yeramosu
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Loreta Matheo
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Gina M Sequeira
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Kristin N Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
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Comparing the content of traditional faxed consultations to eConsults within an academic endocrinology clinic. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2021; 24:100260. [PMID: 34195010 PMCID: PMC8233128 DOI: 10.1016/j.jcte.2021.100260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022]
Abstract
Objective To compare the content of traditional faxed referrals and electronic consultations (eConsults) and determine how many questions sent by traditional referral could be successfully addressed using eConsult. Methods We conducted a cross-sectional, qualitative study of eConsults and faxed referrals sent to a tertiary diabetes and endocrinology clinic in Ottawa, Ontario. A convenience sample of 300 faxed referrals sent between March and July 2017 and 300 eConsults submitted between January and December 2017 were selected and coded using an established taxonomy to determine question type. Two endocrinologists reviewed the faxed referrals to assess whether they could have been addressed using eConsult. Responses to a mandatory closeout survey were reviewed for all eConsults, assessing the case’s outcome, impact on decision to refer, and educational value. Results Most faxed consultations were requests for shared care in diabetes mellitus, whereas most eConsults requested help in diagnostic test interpretation. 25–27% of faxed consults were felt to be potentially amenable to eConsult. Referring provider behaviour was changed in 45.3% of eConsult cases through avoidance of face-to-face consultation. Conclusion eConsult is a promising tool for PCPs to improve access to specialist opinion without necessitating a face-to-face visit.
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50
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Gaye M, Mehrotra A, Byrnes-Enoch H, Chokshi D, Wallach A, Rodriguez L, Barnett ML. Association of eConsult Implementation With Access to Specialist Care in a Large Urban Safety-Net System. JAMA HEALTH FORUM 2021; 2:e210456. [PMID: 35977310 PMCID: PMC8796905 DOI: 10.1001/jamahealthforum.2021.0456] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/17/2021] [Indexed: 12/16/2022] Open
Abstract
Question What was the association of implementation of an eConsult program with access to specialty care in a large safety-net hospital system in the US? Findings In this study, 13% of submitted specialty referral requests were resolved electronically and, among requests requiring an in-person visit, appointment scheduling rates increased and wait times to an appointment decreased following eConsult implementation, while visit rates were unchanged. These improvements were mitigated during a hospital-level electronic health record transition. Meaning Wide-scale implementation of an eConsult program was associated with reduced wait times for patients in an urban safety-net health system with specialty care needs. Importance Accessing specialty care continues to be a persistent problem for patients who use safety-net health systems. To address this access barrier, hospital systems have begun to implement electronic referral systems using eConsults, which allow clinicians to submit referral requests to specialty clinics electronically and enable specialty reviewers to resolve referrals, if appropriate, through electronic dialogue without an in-person visit. Objective Measure the effect of implementing an eConsult program on access to specialty care. Design, Setting, and Participants Using an interrupted time series design with data from 2016 to 2020, this study analyzed 50 260 referral requests submitted during the year before and the year after eConsult implementation at 19 New York City Health + Hospitals (NYC H+H) specialty clinics that spanned 7 NYC H+H hospital facilities and 6 unique specialties. Exposures Referral request was submitted to a specialty clinic in the year following eConsult implementation. Main Outcomes and Measures Main outcomes included the fraction of referral requests resolved without an in-person visit following eConsult implementation; and, among requests triaged to have an in-person visit, the fraction of referrals with a successfully scheduled appointment, mean wait time to a specialty appointment, and the fraction of referral requests with a completed specialty visit. Changes associated with eConsult implementation were estimated using multivariate linear regression adjusting for patient age, gender, and specialty clinic fixed effects. Results Across 19 NYC H+H specialty clinics, 26 731 referral requests were submitted in the year before and 23 529 referrals were submitted in the year after eConsult implementation. Following eConsult implementation, 13% of all requests were resolved electronically. Among requests requiring a follow-up visit, the fraction with an appointment successfully scheduled increased by 15.8%, from 66.5% to 82.3% (P < .001). The mean time to an appointment decreased from 61.0 days pre-eConsult to 54.1 days post-eConsult, an adjusted 8.2-day shorter wait time (or 13.3% reduction) following eConsult adoption (P < .001). The percentage of referrals with a completed follow-up visit with a specialist within 90 days of the request did not change (38.4% vs 37.9%, P = .07). Changes in outcomes were mitigated during months when most clinics underwent an electronic health record transition after implementing eConsult. Conclusions and Relevance In this quality improvement study, implementation of eConsults at a large multi-specialty safety-net system was associated with improvements in appointment scheduling rates and wait times. Despite an additional electronic health record transition, eConsults are a promising health care delivery tool for increasing access to specialty care.
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Affiliation(s)
- Marema Gaye
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Dave Chokshi
- New York City Department of Health and Mental Hygiene, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Andrew Wallach
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
- Office of Ambulatory Care, New York City Health + Hospitals, New York, New York
| | - Laura Rodriguez
- Office of Ambulatory Care, New York City Health + Hospitals, New York, New York
| | - Michael L. Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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