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Bracken K, Salerno J, Yang L. Physician-Led Synchronous Telemedicine Compared to Face-To-Face Care in Primary Care: A Systematic Review. Eval Health Prof 2024:1632787241273911. [PMID: 39140652 DOI: 10.1177/01632787241273911] [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: 08/15/2024]
Abstract
The COVID-19 crisis rapidly introduced telemedicine as the predominate modality to deliver healthcare however this change has not received attention in primary care settings and the health-related impacts are unknown. The study's objective was to explore the effects of physician-led synchronous telemedicine compared to face-to-face care delivered in the primary care setting on healthcare system use and attributes of primary care as reported in recent studies. We performed a comprehensive literature search in five databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycInfo) and critical appraisal using the Joanna Briggs Institute tools. Of 6,247 studies identified, 157 studies underwent full text review, and 19 studies were included. Most studies were conducted in the U.S. (78.9%) and used video and telephone telemedicine (57.9%). An outcome-based qualitative description and narrative synthesis showed similar or fewer emergency department visits, hospital visits, and prescribing, and fewer diagnostic tests and imaging for telemedicine visits compared to face-to-face care. Our systematic review fills a gap in the literature on telemedicine in primary care settings however our results need to be interpreted cautiously given studies' susceptibility to selection bias, confounding, and limited applicability to other health systems and time periods.
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Affiliation(s)
- Keyna Bracken
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Canada
| | - Jennifer Salerno
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Ling Yang
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Canada
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Hodwitz K, Wigle J, Juando-Prats C, Allan K, Li X, Fallon B, Birken CS, Maguire JL, Parsons JA. Physicians' perspectives on COVID-19 vaccinations for children: a qualitative exploration in Ontario, Canada. BMJ Open 2024; 14:e081694. [PMID: 39025822 PMCID: PMC11288156 DOI: 10.1136/bmjopen-2023-081694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 06/27/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES Parents' decisions to vaccinate their children against COVID-19 are complex and often informed by discussions with primary care physicians. However, little is known about physicians' perspectives on COVID-19 vaccinations for children or their experiences counselling parents in their decision-making. We explored physicians' experiences providing COVID-19 vaccination recommendations to parents and their reflections on the contextual factors that shaped these experiences. DESIGN We conducted an interpretive qualitative study using in-depth interviews. We analyzed the data using reflexive thematic analysis and a socioecological framework. SETTING This study involved primary care practices associated with The Applied Research Group for Kids (TARGet Kids!) primary care research network in the Greater Toronto Area, Ontario, Canada. PARTICIPANTS Participants were 10 primary care physicians, including family physicians, paediatricians and paediatric subspecialists. RESULTS Participants discussed elements at the individual level (their identity, role, and knowledge), the interpersonal level (their relationships with families, responsiveness to parents' concerns, and efforts to build trust) and structural level (contextual factors related to the evolving COVID-19 climate, health system pandemic response, and constraints on care delivery) that influenced their experiences providing recommendations to parents. Our findings illustrated that physicians' interactions with families were shaped by a confluence of their own perspectives, their responses to parents' perspectives, and the evolving landscape of the broader pandemic. CONCLUSIONS Our study underscores the social and relational nature of vaccination decision-making and highlights the multiple influences on primary care physicians' experiences providing COVID-19 vaccination recommendations to parents. Our findings offer suggestions for future COVID-19 vaccination programmes for children. Delivery of new COVID-19 vaccinations for children may be well suited within primary care offices, where trusting relationships are established, but physicians need support in staying knowledgeable about emerging information, communicating available evidence to parents to inform their decision-making and dedicating time for vaccination counselling.
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Affiliation(s)
- Kathryn Hodwitz
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jannah Wigle
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Clara Juando-Prats
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kate Allan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Xuedi Li
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Barbara Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S. Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L. Maguire
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Janet A. Parsons
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Martignoni MM, Arino J, Hurford A. Is SARS-CoV-2 elimination or mitigation best? Regional and disease characteristics determine the recommended strategy. ROYAL SOCIETY OPEN SCIENCE 2024; 11:240186. [PMID: 39100176 PMCID: PMC11295893 DOI: 10.1098/rsos.240186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/01/2024] [Indexed: 08/06/2024]
Abstract
Public health responses to the COVID-19 pandemic varied across the world. Some countries (e.g. mainland China, New Zealand and Taiwan) implemented elimination strategies involving strict travel measures and periods of rigorous non-pharmaceutical interventions (NPIs) in the community, aiming to achieve periods with no disease spread; while others (e.g. many European countries and the USA) implemented mitigation strategies involving less strict NPIs for prolonged periods, aiming to limit community spread. Travel measures and community NPIs have high economic and social costs, and there is a need for guidelines that evaluate the appropriateness of an elimination or mitigation strategy in regional contexts. To guide decisions, we identify key criteria and provide indicators and visualizations to help answer each question. Considerations include determining whether disease elimination is: (1) necessary to ensure healthcare provision; (2) feasible from an epidemiological point of view and (3) cost-effective when considering, in particular, the economic costs of travel measures and treating infections. We discuss our recommendations by considering the regional and economic variability of Canadian provinces and territories, and the epidemiological characteristics of different SARS-CoV-2 variants. While elimination may be a preferable strategy for regions with limited healthcare capacity, low travel volumes, and few ports of entry, mitigation may be more feasible in large urban areas with dense infrastructure, strong economies, and with high connectivity to other regions.
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Affiliation(s)
- Maria M. Martignoni
- Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John’s, Canada
- Department of Ecology, Evolution and Behavior, A. Silberman Institute of Life Sciences, Faculty of Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Julien Arino
- Department of Mathematics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Hurford
- Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John’s, Canada
- Biology Department and Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John’s, Canada
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Bubela T, Flood CM, McGrail K, Straus SE, Mishra S. How Canada's decentralised covid-19 response affected public health data and decision making. BMJ 2023; 382:e075665. [PMID: 37487604 DOI: 10.1136/bmj-2023-075665] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Affiliation(s)
- Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Colleen M Flood
- Faculty of Law, Queen's University, Kingston, Ontario, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - Sharmistha Mishra
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
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Clark J, Straus SE, Houston A, Abbasi K. The world expected more of Canada. BMJ 2023; 382:p1634. [PMID: 37487602 DOI: 10.1136/bmj.p1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Affiliation(s)
| | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adam Houston
- Human Rights Research and Education Centre, University of Ottawa, Ottawa, Canada
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