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Teo KYC, Eldem B, Joussen A, Koh A, Korobelnik JF, Li X, Loewenstein A, Lövestam-Adrian M, Navarro R, Okada AA, Pearce I, Rodríguez F, Wong D, Wu L, Zur D, Zarranz-Ventura J, Mitchell P, Chaudhary V, Lanzetta P. Treatment regimens for optimising outcomes in patients with neovascular age-related macular degeneration. Eye (Lond) 2024:10.1038/s41433-024-03370-0. [PMID: 39379523 DOI: 10.1038/s41433-024-03370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 09/05/2024] [Accepted: 09/20/2024] [Indexed: 10/10/2024] Open
Abstract
Practice patterns for neovascular age-related macular degeneration (nAMD) have evolved from the landmark registration trials of vascular endothelial growth factor (VEGF) inhibitors. Non-monthly regimens like treat-and-extend (T&E) have become popular due to their effectiveness in clinical practice. T&E regimens attempt to limit the burden of visits and treatments by allowing progressively longer treatment intervals, but in so doing, are potentially associated with the expense of treating quiescent disease. This is acceptable to many patients and their ophthalmologists but can still be problematic in the real-world. Recent studies have further refined the T&E approach by allowing for quicker and longer extension of treatment intervals when less severe disease is detected. With newer drugs offering increased durability, a shift to longer regular intervals may emerge as a new practice pattern for VEGF inhibitor therapy. This review aims to consolidate the current literature on the most effective treatment patterns and update treatment guidelines based on options that are now available. It also summarises new aspects of nAMD management that may help to further refine current practice.
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Affiliation(s)
| | - Bora Eldem
- Department of Ophthalmology, Hacettepe University, School of Medicine, Ankara, Turkey
| | | | - Adrian Koh
- Camden Medical Centre, Singapore, Singapore
| | - Jean-François Korobelnik
- Service d'ophtalmologie, CHU Bordeaux, Bordeaux, France
- University of Bordeaux, INSERM, BPH, UMR1219, F-33000, Bordeaux, France
| | - Xiaoxin Li
- Xiamen Eye Center, Xiamen University, Xiamen, China
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Rafael Navarro
- Retina and Vitreous Department, Institute of Ocular Microsurgery, Barcelona, Spain
| | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ian Pearce
- Royal Liverpool University Hospital, Liverpool, UK
| | - Francisco Rodríguez
- Fundación Oftalmológica Nacional, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - David Wong
- Unity Health Toronto - St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Lihteh Wu
- Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Paul Mitchell
- Department of Ophthalmology, Centre for Vision Research, Westmead Institute for Medical Research, the University of Sydney, Sydney, Australia
| | - Varun Chaudhary
- Hamilton Regional Eye Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
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Hohenschurz-Schmidt D, Cherkin D, Rice ASC, Dworkin RH, Turk DC, McDermott MP, Bair MJ, DeBar LL, Edwards RR, Evans SR, Farrar JT, Kerns RD, Rowbotham MC, Wasan AD, Cowan P, Ferguson M, Freeman R, Gewandter JS, Gilron I, Grol-Prokopczyk H, Iyengar S, Kamp C, Karp BI, Kleykamp BA, Loeser JD, Mackey S, Malamut R, McNicol E, Patel KV, Schmader K, Simon L, Steiner DJ, Veasley C, Vollert J. Methods for pragmatic randomized clinical trials of pain therapies: IMMPACT statement. Pain 2024; 165:2165-2183. [PMID: 38723171 PMCID: PMC11404339 DOI: 10.1097/j.pain.0000000000003249] [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: 08/09/2023] [Accepted: 03/08/2024] [Indexed: 09/18/2024]
Abstract
ABSTRACT Pragmatic, randomized, controlled trials hold the potential to directly inform clinical decision making and health policy regarding the treatment of people experiencing pain. Pragmatic trials are designed to replicate or are embedded within routine clinical care and are increasingly valued to bridge the gap between trial research and clinical practice, especially in multidimensional conditions, such as pain and in nonpharmacological intervention research. To maximize the potential of pragmatic trials in pain research, the careful consideration of each methodological decision is required. Trials aligned with routine practice pose several challenges, such as determining and enrolling appropriate study participants, deciding on the appropriate level of flexibility in treatment delivery, integrating information on concomitant treatments and adherence, and choosing comparator conditions and outcome measures. Ensuring data quality in real-world clinical settings is another challenging goal. Furthermore, current trials in the field would benefit from analysis methods that allow for a differentiated understanding of effects across patient subgroups and improved reporting of methods and context, which is required to assess the generalizability of findings. At the same time, a range of novel methodological approaches provide opportunities for enhanced efficiency and relevance of pragmatic trials to stakeholders and clinical decision making. In this study, best-practice considerations for these and other concerns in pragmatic trials of pain treatments are offered and a number of promising solutions discussed. The basis of these recommendations was an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) meeting organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, United Kingdom
- Research Department, University College of Osteopathy, London, United Kingdom
| | - Dan Cherkin
- Osher Center for Integrative Health, Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Andrew S C Rice
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, United Kingdom
| | - Robert H Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Dennis C Turk
- Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Matthew J Bair
- VA Center for Health Information and Communication, Regenstrief Institute, and Indiana University School of Medicine, Indianapolis, IN, United States
| | - Lynn L DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | | | - Scott R Evans
- Biostatistics Center and the Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Rockville, MD, United States
| | - John T Farrar
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Robert D Kerns
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Michael C Rowbotham
- Department of Anesthesia, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Ajay D Wasan
- Departments of Anesthesiology & Perioperative Medicine, and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, CA, United States
| | - McKenzie Ferguson
- Department of Pharmacy Practice, Southern Illinois University Edwardsville, Edwardsville, IL, United States
| | - Roy Freeman
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Jennifer S Gewandter
- Department of Anesthesiology and Perioperative, University of Rochester, Rochester, NY, United States
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine, Biomedical & Molecular Sciences, Centre for Neuroscience Studies, and School of Policy Studies, Queen's University, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, Buffalo, NY, United States
| | | | - Cornelia Kamp
- Center for Health and Technology (CHeT), Clinical Materials Services Unit (CMSU), University of Rochester Medical Center, Rochester, NY, United States
| | - Barbara I Karp
- National Institutes of Health, Bethesda, MD, United States
| | - Bethea A Kleykamp
- University of Maryland, School of Medicine, Baltimore, MD, United States
| | - John D Loeser
- Departments of Neurological Surgery and Anesthesia and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Sean Mackey
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Neurosciences and Neurology, Palo Alto, CA, United States
| | | | - Ewan McNicol
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, United States
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Kenneth Schmader
- Department of Medicine-Geriatrics, Center for the Study of Aging, Duke University Medical Center, and Geriatrics Research Education and Clinical Center, Durham VA Medical Center, Durham, NC, United States
| | - Lee Simon
- SDG, LLC, Cambridge, MA, United States
| | | | | | - Jan Vollert
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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Hawley-Hague H, Gluchowski A, Lasrado R, Martinez E, Akhtar S, Stanmore E, Tyson S. Exploring the delivery of remote physiotherapy during the COVID-19 pandemic: UK wide service evaluation. Physiother Theory Pract 2024; 40:2241-2255. [PMID: 37610255 DOI: 10.1080/09593985.2023.2247069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION During the Coronavirus (Covid-19) pandemic, physiotherapists changed rapidly to working remotely. Research demonstrates the benefits of remote physiotherapy, but little is known about its implementation in practice. PURPOSE Explore the take-up and delivery of remote physiotherapy during the pandemic in the United Kingdom. METHODS Sequential mixed methods evaluation with physiotherapists leading remote physiotherapy delivery. Two-stage approach included online survey (2020) and semi-structured interviews with documentary/data analysis (2021). RESULTS There were 1620 physiotherapists who completed the survey. The most used devices were telephone (n = 942,71.0%) and the AttendAnywhere platform (n = 511, 38.5%). Remote consultations were frequently used for initial assessment (n = 1105, 83%), screening/triage (n = 882, 67%), or to review, monitor, and progress treatment (n = 982-1004, 74%-76%). Qualitative survey responses reflected respondents' response to COVID-19 and delivery of remote physiotherapy. Twelve remote physiotherapy leads were then purposively sampled across clinical areas. Three main themes emerged from interviews: response to Covid-19, delivery of remote physiotherapy, and future of remote physiotherapy. CONCLUSION Remote physiotherapy was safe, feasible, and acceptable for those who accessed it. There were patients for which it was deemed unsuitable across clinical areas. In practice, it should be combined with in-person consultation based on patients' needs/preferences. Further research should explore post-pandemic maintenance of remote delivery.
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Affiliation(s)
- Helen Hawley-Hague
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Ashley Gluchowski
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Reena Lasrado
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Ellen Martinez
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Shehnaz Akhtar
- Community Podiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma Stanmore
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Sarah Tyson
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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4
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Carter HM, Beard DJ, Leighton P, Moffatt F, Smith BE, Webster KE, Logan P. 'Going through the motions'; a rich account of the complexity of the anterior cruciate ligament reconstruction pathway, a UK qualitative study. BMJ Open 2024; 14:e079468. [PMID: 39289010 PMCID: PMC11409353 DOI: 10.1136/bmjopen-2023-079468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
OBJECTIVES This study aimed to understand the lived experiences of patients on the anterior cruciate ligament reconstruction (ACLR) pathway up to 3 months before, 3 months after and 1 year after surgery. Study objectives were to explore (1) patient experiences of preoperative and postoperative treatment, (2) views of/involvement in prehabilitation and (3) sources and consistency of healthcare advice. DESIGN Semi-structured interviews analysed using reflexive thematic analysis. SETTING Midlands, England. PARTICIPANTS Purposive sample of 18 participants aged 18-45. Three identified as female and 15 as male. Participants' ethnic origin was white (n=14), Indian (n=2), British Asian (n=1) and Pakistani (n=1). 10 participants were awaiting ACLR, six were 3months postsurgery and two were 1 year postsurgery. RESULTS Participants gave a rich account of ACLR pathway experiences discussing negative impacts of the injury, difficulties with navigating the pathway and making decisions about surgery. Interacting with healthcare professionals and managing the variety of resources, advice and opinions were also highlighted as challenges. Participants reflected on their preoperative journey accounting a wide spectrum of expectations and realities of returning to work and physical activity postoperatively. Prehabilitation was perceived to offer an advantage to recovery, mental well-being, injury knowledge, postoperative rehabilitation and supports a faster return to physical activity. Five themes were identified:Injury experience, impact and support.Navigating the treatment pathway.Sense making in the preoperative period.Uncertainty, expectations and reality of the postsurgical period.Balancing resources, advice and opinions. CONCLUSION This study has illuminated patient experiences of the National Health Service (NHS) ACLR pathway, novel to the evidence base.The results highlight the perceived shortcomings in patient support. They also demonstrate the difficulty patients face when navigating the NHS system, communicating with clinicians, making decisions about treatment and managing conflicting sources of healthcare advice. These problems are more prominent than previously recognised in the literature. REGISTRATION ClinicalTrials.gov Identifier: NCT05529511.
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Affiliation(s)
- Hayley M Carter
- Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - David J Beard
- Surgical Intervention Trials Unit, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Benjamin E Smith
- Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Phillipa Logan
- School of Medicine, University of Nottingham, Nottingham, UK
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Varese F, Allsopp K, Carter LA, Shields G, Hind D, Davies L, Barrett A, Bhutani G, McGuirk K, Huntley F, Jordan J, Rowlandson A, Sarsam M, Ten Cate H, Walker H, Watson R, Wilkinson J, Willbourn J, French P. The Resilience Hub approach for addressing mental health of health and social care workers during the COVID-19 pandemic: a mixed-methods evaluation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-164. [PMID: 39264827 DOI: 10.3310/hgqr5133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2024]
Abstract
Background Resilience Hubs provide mental health screening, facilitation of access and direct provision of psychosocial support for health and social care keyworkers in England affected by the coronavirus disease 2019 pandemic. Aim To explore implementation of the Hubs, including characteristics of staff using the services, support accessed, costing data and a range of stakeholder perspectives on the barriers and enablers to Hub use and implementation of staff well-being support within the context of the pandemic. Design Mixed-methods evaluation. Setting Four Resilience Hubs. Methods Findings were integrated via mixed-method case studies, including: analyses of Hub mental health screening (N = 1973); follow-up questionnaire data (N = 299) on service use and health status of Hub clients; economic information provided by the Hubs; 63 interviews with Hub staff, wider stakeholders, Hub clients and keyworkers who did not use the Hubs. Results Findings were consistent across Hubs and workstreams. Most Hub clients were NHS staff. Under-represented groups included men, keyworkers from minority ethnic communities, care homes and emergency services staff. Clients reported comorbid mental health needs across multiple domains (anxiety; depression; post-traumatic stress; alcohol use; functioning). Their health status was lower than population norms and relevant pre-pandemic data. Several factors predicted higher needs, but having pre-pandemic emotional well-being concerns was one of the most robust predictors of higher need. Sixty per cent of participants who completed follow-up questionnaires reported receiving mental health support since Hub screening, most of which was directly or indirectly due to Hub support. High levels of satisfaction were reported. As in many services, staffing was the central component of Hub cost. Hubs were predominantly staffed by senior clinicians; this staffing model was consistent with the generally severe difficulties experienced by clients and the need for systemic/team-based working. Costs associated with health and social care use for Hub clients were low, which may be due to barriers to accessing support in general. Enablers to accessing Hubs included: a clear understanding of the Hubs, how to self-refer, and managerial support. Barriers included confusion between Hubs and other support; unhelpful beliefs about job roles, unsupportive managers, negative workplace cultures and difficulties caused by systemic issues. Some keyworkers highlighted a perceived need for further diversity and cultural competency training to improve reach to under-represented communities. Other barriers for these groups included prior negative experiences of services, structural inequalities and stigma. Some wider stakeholders had concerns around growing waiting times for Hub-provided therapy, and insufficient data on Hub usage and outcomes. Feedback was otherwise very positive. Limitations Main limitations included lack of comparative and pre-pandemic/baseline data, small numbers from under-represented groups limiting fine-grained analysis, and participant self-selection. Conclusions Findings highlighted the value of the Hub model of outreach, screening, support navigation and provision of direct support during the coronavirus disease 2019 pandemic, and as a potential model to respond to future crises. The research provided recommendations to improve Hub promotion, equality/diversity/inclusion access issues, management of specialist resources and collection of relevant data on Hub outcomes and activities. Broader recommendations for the primary prevention of mental health difficulties across the health and care system are made, as individual support offers should be an adjunct to, not a replacement for, resolutions to systemic challenges. Research recommendations are made to conduct more robust evaluations of the clinical and cost-effectiveness of the Hubs, using larger data sets and comparative data. Study registration This study is registered as researchregistry6303. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132269) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 29. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Filippo Varese
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, Manchester, UK
| | - Kate Allsopp
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, Manchester, UK
| | - Lesley-Anne Carter
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Gemma Shields
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Daniel Hind
- University of Sheffield, School of Health and Related Research, Sheffield, UK
| | - Linda Davies
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Alan Barrett
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Lancashire, UK
- University of Salford, School of Health and Society, Salford, UK
| | - Gita Bhutani
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Katherine McGuirk
- Greater Manchester Health and Social Care Partnership, Manchester, UK
| | - Fay Huntley
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, Prescot, UK
| | - Joanne Jordan
- Humber and North Yorkshire Resilience Hub, Tees Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Darlington, UK
| | - Aleix Rowlandson
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - May Sarsam
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, Prescot, UK
| | - Hein Ten Cate
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Holly Walker
- Humber and North Yorkshire Resilience Hub, Tees Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Darlington, UK
| | - Ruth Watson
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, Manchester, UK
| | - Jack Wilkinson
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Jenni Willbourn
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Lancashire, UK
| | - Paul French
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
- Pennine Care NHS Foundation Trust, Lancashire, UK
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Kujansivu K, Tolvanen E, Kautto M, Koskela TH. Primary care physicians' experiences of video and online chat consultations: a qualitative descriptive study. Scand J Prim Health Care 2024:1-12. [PMID: 39155525 DOI: 10.1080/02813432.2024.2391406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024] Open
Abstract
OBJECTIVES To explore the perceptions and views of remote consultations and patient care of primary care physicians (PCPs) who work remotely regularly and have experience performing remote consultations. DESIGN A qualitative study using thematic analysis. SETTING Four online focus group interviews with 17 PCPs, working with one private health care provider, with public and private primary care patients. SUBJECTS PCPs who had performed video or online chat consultations with primary care patients for at least 6 months. MAIN OUTCOME MEASUREMENTS PCPs' perceptions and views working remotely in online chat and video consultations. RESULTS Two main themes describing how PCPs perceived remote consultations emerged: 1) remote consultations have an impact on the way physicians work, and 2) remote consultations have an impact on the service system and patients. The subthemes of the first main theme included the physicians' new way of working, impacts on physicians' well-being, and impacts on communication and physician competences. The subthemes for the second main theme were the importance of smoothness of services for the patients, patient suitability, and technical liabilities. CONCLUSION Remote consultations provide PCPs with a new way of working that could improve work-life balance. However, it is important to maintain sufficient clinical competence through versatile work. Digital consultations can make contacting healthcare smoother and easier for patients if the patient selection is performed carefully. Online chat seems suitable for singular contacts and simple issues, but remote consultations could be used to sustain continuity of care.
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Affiliation(s)
- Kaisa Kujansivu
- Department of General Practice, Tampere University, Tampere, Finland
- Pihlajalinna, Tampere, Finland
- The Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Elina Tolvanen
- Department of General Practice, Tampere University, Tampere, Finland
- The Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Mervi Kautto
- Department of General Practice, Tampere University, Tampere, Finland
- Pihlajalinna, Tampere, Finland
| | - Tuomas H Koskela
- Department of General Practice, Tampere University, Tampere, Finland
- The Wellbeing Services County of Pirkanmaa, Tampere, Finland
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7
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Cook D, Pearson J. Musculoskeletal physiotherapists' experiences of using remote consultations during the COVID-19 pandemic: A qualitative study. Musculoskelet Sci Pract 2024; 72:102930. [PMID: 38552401 DOI: 10.1016/j.msksp.2024.102930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND The coronavirus (COVID-19) pandemic resulted in the rapid implementation of remote consultations to maintain musculoskeletal physiotherapy services. However, little is known about UK musculoskeletal physiotherapists' experiences of providing services during the COVID-19 pandemic. OBJECTIVES To explore musculoskeletal physiotherapists' experiences of using remote consultations in one area of England during the COVID-19 pandemic. DESIGN Qualitative study using hermeneutic phenomenology based on the approach of Gadamer. METHODS Semi-structured interviews with twelve musculoskeletal physiotherapists were conducted online using Microsoft Teams. Data were analysed using frameworks based on the philosophical concepts of Gadamer's hermeneutics. FINDINGS Musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic was framed by three concepts: therapeutic relationship, transformational change, and uncertainty. These concepts are underpinned by four main themes capturing their experiences: (1) Disconnection: Difficulties building a rapport and reduced non-verbal communication affected building an effective therapeutic relationship, (2) Necessity: Transformation of services to remote consultations was positive, although technology and connectivity issues had a negative impact, (3) Loss of control: Diagnostic uncertainty, being unprepared, and experience affected physiotherapists' clinical practice, (4) Protection: Peer support and the use of technology facilitated a feeling of protection for physiotherapists. CONCLUSION The findings of this study contribute to a better understanding of musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic. Implications for practice include the need to provide training for all musculoskeletal physiotherapists and undergraduates to enable the effective delivery of remote physiotherapy. Furthermore, digital infrastructure should be optimised to support future delivery of remote musculoskeletal physiotherapy services.
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Affiliation(s)
- Darren Cook
- School of Health and Social Wellbeing, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, United Kingdom.
| | - Jennifer Pearson
- School of Health and Social Wellbeing, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, United Kingdom.
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8
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Subramani Y, Querney J, Singh P, Zhang Y, Fochesato LA, Fatima N, Wood N, Nagappa M. Preoperative Anesthesia Virtual Video Consultations in a Preadmission Clinic: Quality Improvement Study. JMIR Perioper Med 2024; 7:e57541. [PMID: 39052992 PMCID: PMC11310641 DOI: 10.2196/57541] [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: 02/20/2024] [Revised: 06/06/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The preadmission clinic (PAC) is crucial in perioperative care, offering evaluations, education, and patient optimization before surgical procedures. During the COVID-19 pandemic, the PAC adapted by implementing telephone visits due to a lack of infrastructure for video consultations. While the pandemic significantly increased the use of virtual care, including video appointments as an alternative to in-person consultations, our PAC had not used video consultations for preoperative assessments. OBJECTIVE This study aimed to develop, implement, and integrate preoperative video consultations into the PAC workflow. METHODS A prospective quality improvement project was undertaken using the Plan-Do-Study-Act (PDSA) methodology. The project focused on developing, implementing, and integrating virtual video consultations at London Health Sciences Centre and St. Joseph Health Care (London, Ontario, Canada) in the PAC. Data were systematically collected to monitor the number of patients undergoing video consultations, address patient flow concerns, and increase the percentage of video consultations. Communication between the PAC, surgeon offices, and patients was analyzed for continuous improvement. Technological challenges were addressed, and procedures were streamlined to facilitate video calls on appointment days. RESULTS The PAC team, which includes professionals from medicine, anesthesia, nursing, pharmacy, occupational therapy, and physiotherapy, offers preoperative evaluation and education to surgical patients, conducting approximately 8000 consultations annually across 3 hospital locations. Following the initial PDSA cycles, the interventions consistently improved the video consultation utilization rate to 17%, indicating positive progress. With the onset of PDSA cycle 3, there was a notable surge to a 29% utilization rate in the early phase. This upward trend continued, culminating in a 38% utilization rate of virtual video consultations in the later stages of the cycle. This heightened level was consistently maintained throughout 2023, highlighting the sustained success of our interventions. CONCLUSIONS The quality improvement process significantly enhanced the institution's preoperative video consultation workflow. By understanding the complexities within the PAC, strategic interventions were made to integrate video consultations without compromising efficiency, morale, or safety. This project highlights the potential for transformative improvements in health care delivery through the thoughtful integration of virtual care technologies.
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Affiliation(s)
- Yamini Subramani
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, St. Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jill Querney
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, St. Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Priyanka Singh
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, St. Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Yifan Zhang
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, St. Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lee-Anne Fochesato
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, St. Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Nida Fatima
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, St. Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Natasha Wood
- Department of Nursing, London Health Sciences Centre, Western University, London, ON, Canada
| | - Mahesh Nagappa
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, St. Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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9
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Alsaif NS, Alammari DA, Omair A. Examination of Factors Influencing Patient Satisfaction with Virtual Clinic Experience During COVID-19 in MNGHA, Saudi Arabia. Telemed J E Health 2024. [PMID: 38984419 DOI: 10.1089/tmj.2023.0709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Introduction: The COVID-19 pandemic crisis brought great challenges on health care systems around the world, forcing many services to slow or temporarily shut down, including medical services in Saudi Arabia (SA). Health care institutions had to adapt new strategies such as virtual clinics to continue delivering care in light of the situation. Virtual clinics and telemedicine are relatively new and limited literature is available regarding patient's experience in SA. Therefore, the aim of this study is to assess and evaluate the levels of patients' satisfaction with the experience of services provided by virtual clinics at the Ministry of National Guard Health Affairs. Method: A retrospective cross-sectional study based on secondary data collected by the corporate patient experience department at MNGHA. The analysis included all virtual clinics' visits from four MNGHA regions (Central, Eastern, Western, and AlMadinah) between April 19 and May 15, 2020. Findings: The results showed that more than half of our study participants were females (57%) (N = 7,803) and (64%) (N = 8,696) were between the age of 21-64 years. Most of the participants were from the Central region (73%) (N = 10,026). More than half of virtual visits were to hospitals (66%) (N = 9,098). Results from the ordinal regression showed that age, gender, region and, survey method were significantly associated with extreme satisfaction score (4.21-5.0). Males were more likely to be extremely satisfied than females (OR = 1.088), and patients between the ages of 6-20 were extremely satisfied compared with the age group 41-64 (OR = 1.309). Eastern region was more likely to be extremely satisfied than central region (OR = 1.121). Patients surveyed by calls were more likely to be extremely satisfied compared with SMS surveys (OR = 1.808), whereas facility type showed no significance. The overall satisfaction score was 4.1 out of 5. Interpretation: According to our findings, the majority of patients were satisfied with the experiences of virtual clinics at MNGHA. Therefore, we recommend exploring more frequent use of virtual clinics when appropriate beyond the pandemic. Virtual clinics can minimize the risk of disease transmission, save travel time, and is considered a cost-effective alternative to traditional clinics.
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Affiliation(s)
- Nora S Alsaif
- Collage of Public Health and Health Informatics, Riyadh, Saudi Arabia
- Department of Healthcare Systems and Quality Management, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Duaa A Alammari
- Collage of Public Health and Health Informatics, Riyadh, Saudi Arabia
- Department of Healthcare Systems and Quality Management, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs Hospital, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Aamir Omair
- Collage of Public Health and Health Informatics, Riyadh, Saudi Arabia
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10
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Fadaizadeh L, Velayati F, Arab-Zozani M. Satisfaction of Patients and Physicians with Telehealth Services during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Healthc Inform Res 2024; 30:206-223. [PMID: 39160780 PMCID: PMC11333811 DOI: 10.4258/hir.2024.30.3.206] [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: 05/18/2024] [Revised: 07/13/2024] [Accepted: 07/25/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES The rapid spread of coronavirus disease 2019 (COVID-19) posed significant challenges to healthcare systems, prompting the widespread adoption of telehealth to provide medical services while minimizing the risk of virus transmission. This study aimed to assess the satisfaction rates of both patients and physicians with telehealth during the COVID-19 pandemic. METHODS Searches were conducted in the Web of Science, PubMed, and Scopus databases from January 1, 2020, to January 1, 2023. We included studies that utilized telehealth during the COVID-19 pandemic and reported satisfaction data for both patients and physicians. Data extraction was performed using a form designed by the researchers. A meta-analysis was carried out using random-effects models with the OpenMeta-Analyst software. A subgroup analysis was conducted based on the type of telehealth services used: telephone, video, and a combination of both. RESULTS From an initial pool of 1,454 articles, 62 met the inclusion criteria for this study. The most commonly used methods were video and telephone calls. The overall satisfaction rate with telehealth during the COVID-19 pandemic was 81%. Satisfaction rates were higher among patients at 83%, compared to 74% among physicians. Specifically, telephone consultations had a satisfaction rate of 77%, video consultations 86%, and a mix of both methods yielded a 77% satisfaction rate. CONCLUSIONS Overall, satisfaction with telehealth during the COVID-19 pandemic was considered satisfactory, with both patients and physicians reporting high levels of satisfaction. Telehealth has proven to be an effective alternative for delivering healthcare services during pandemics.
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Affiliation(s)
- Lida Fadaizadeh
- Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran,
Iran
| | - Farnia Velayati
- Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran,
Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand,
Iran
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11
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Yoon E, Hur S, Curtis LM, Benavente JY, Wolf MS, Serper M. Patient factors associated with telehealth quality and experience among adults with chronic conditions. JAMIA Open 2024; 7:ooae026. [PMID: 38596698 PMCID: PMC11000823 DOI: 10.1093/jamiaopen/ooae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 02/23/2024] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
Objective To evaluate patient-reported experiences of telehealth and disparities in access, use, and satisfaction with telehealth during the COVID-19 pandemic. Materials and methods We examined data from the fifth wave of the COVID-19 & Chronic Conditions (C3) study conducted between December 2020 and March 2021. Results Of the 718 participants, 342 (47.6%) reported having a telehealth visit within the past 4 months. Participants who had a recent telehealth visit were younger, reported worse overall health and chronic illness burden, and living below poverty level. Among participants who had a telehealth visit, 66.7% reported telephone visits and most participants (57.6%) rated telehealth quality as better-or-equal-to in-person visits. Inadequate health literacy was associated with lower likelihood of reporting telehealth quality and usefulness. In multivariable analyses, lower patient activation (adjusted odds ratio (AOR) 0.19, 95% CI, 0.05-0.59) and limited English proficiency (AOR 0.12, 95% CI, 0.03-0.47) were less likely to report telehealth as being better than in-person visits; lower patient activation (AOR 0.06, 95% CI, 0.003-0.41) and income below poverty level (AOR 0.36, 95% CI, 0.13-0.98) were associated with difficulty remembering telehealth visit information. Discussion Most participants reported usefulness and ease of navigating telehealth. Lower socioeconomic status, limited English proficiency, inadequate health literacy, lower educational attainment, and low patient activation are risks for poorer quality telehealth. Conclusion The COVID pandemic has accelerated the adoption of telehealth, however, disparities in access and self-reported visit quality persist. Since telemedicine is here to stay, we identify vulnerable populations and discuss potential solutions to reduce healthcare disparities in telehealth use.
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Affiliation(s)
- Esther Yoon
- Division of General Internal Medicine & Geriatrics, Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Scott Hur
- Division of General Internal Medicine & Geriatrics, Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Laura M Curtis
- Division of General Internal Medicine & Geriatrics, Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Julia Yoshino Benavente
- Division of General Internal Medicine & Geriatrics, Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Michael S Wolf
- Division of General Internal Medicine & Geriatrics, Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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12
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Kollmann J, Sana S, Magnée T, Boer S, Merkelbach I, Kocken PL, Denktaș S. Patients' and professionals' experiences with remote care during COVID-19: a qualitative study in general practices in low-income neighborhoods. Prim Health Care Res Dev 2024; 25:e32. [PMID: 38826073 PMCID: PMC11362683 DOI: 10.1017/s1463423624000240] [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: 09/01/2023] [Revised: 02/19/2024] [Accepted: 04/03/2024] [Indexed: 06/04/2024] Open
Abstract
AIM To explore how patients and general practice professionals in low-income neighborhoods experienced the increase of remote care during COVID-19. BACKGROUND As the GP (general practitioner) is the first point of contact in Dutch health care, there are concerns about access to remote care for patients from low-income neighborhoods. Now that general practice professionals have returned to the pre-pandemic ways of healthcare delivery, this paper looks back at experiences with remote care during COVID-19. It investigates experiences of both patients and general practice professionals with the approachability and appropriateness of remote care and their satisfaction. METHODS In this qualitative study, 78 patients and 18 GPs, 7 nurse practitioners and 6 mental health professionals were interviewed. Interviews were held on the phone and face-to-face in the native language of the participants. FINDINGS Remote care, especially telephone consultation, was generally well-approachable for patients from low-income neighborhoods. Contrarily, video calling was rarely used. This was partly because patients did not know how to use it. The majority of patients thought remote care was possible for minor ailments but would also still like to see the doctor face-to-face regularly. Patients were generally satisfied with remote care at the time, but this did not necessarily reflect their willingness to continue using it in the future. Moreover, there was lack in consensus among general practice professionals on the appropriateness of remote care for certain physical and mental complaints. Nurse practitioners and mental health professionals had a negative attitude toward remote care. In conclusion, it is important to take the opinions and barriers of patients and care providers into account and to increase patient-centered care elements and care provider satisfaction in remote care. Integrating remote care is not only important in times of crisis but also for future care that is becoming increasingly digitalized.
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Affiliation(s)
- Jelena Kollmann
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Shakib Sana
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Tessa Magnée
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Sarah Boer
- Municipality of Rotterdam, Rotterdam, the Netherlands
| | - Inge Merkelbach
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Paul L. Kocken
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Semiha Denktaș
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
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13
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Del Monte M, Edwards AR, Waldron DB, Aird LD, Airhart CK, Robinson LB, Bright D, Calabrese TM, Diederich S, Fitzpatrick H, Frantz J, Haro TM, Hegland A, Ingstrup K, Jenco M, Kim S, Martin SS, Mazziotti D, Phillips M, Poslosky J, Salmon J, Walsh MC, White ML. Successes and Lessons Learned in Responding to the Needs of Pediatricians, Children, and Families During the COVID-19 Pandemic. Pediatrics 2024; 153:e2024066634. [PMID: 38485704 DOI: 10.1542/peds.2024-066634] [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: 03/14/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 06/02/2024] Open
Abstract
The coronavirus disease 2019 pandemic has presented tremendous challenges to the United States health care system, as well as to individual physicians, communities, and families. Throughout the pandemic, the American Academy of Pediatrics (AAP) has striven to elevate the needs of infants, children, and adolescents, as well as the pediatricians who care for this population. Historically, these communities have often been overlooked and deprioritized in health care systems, and these deficits persisted into the pandemic. To fill this gap, the AAP took on an essential role in leading the national response for pediatrics. This article details the AAP pandemic response and includes the perspectives of multiple AAP leaders involved in the response and details on Academy advocacy with high-level staff and officials at federal agencies and the executive branch. The AAP provided initial guidance to pediatricians that predated the World Health Organization's declaration of a public health emergency. The Academy then developed entirely new approaches to meet the unprecedented needs of its practicing members and families by providing timely, rigorous information endorsed by pediatric experts. When coronavirus disease 2019 vaccines were developed, the AAP strongly advised the inclusion of those younger than 18 years in vaccine trials and advocated for equitable distribution plans. The AAP provided its members with strategies for combating misinformation. The Academy was at the forefront of advocating for the safe return to in-person schooling, recognizing that social isolation was contributing to the growing mental health crisis among youth. In 2021, the AAP, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declared a national emergency in child and adolescent mental health. In addition, the AAP implemented educational and training opportunities for clinicians and developed resources for youth and their families. After the end of the public health emergency, AAP members continue to use innovations and efficiencies developed as part of their pandemic response. The successes of the AAP pandemic response, alongside lessons learned, help define an important model for responding to future pandemics and public health emergencies in ways that support children, families, and the pediatric workforce.
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14
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Seuren LM, Gilbert A, Ramdharry G, Walumbe J, Shaw SE. Video analysis of communication by physiotherapists and patients in video consultations: a qualitative study using conversation analysis. Physiotherapy 2024; 123:30-37. [PMID: 38262264 DOI: 10.1016/j.physio.2023.10.002] [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: 07/10/2022] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To investigate the challenges of doing physical examinations and exercises by video, and the communication strategies used by physiotherapists and patients to overcome them. DESIGN A qualitative study of talk and social actions, examining the verbal and non-verbal communication practices used by patients and physiotherapists. Video consultations between physiotherapists and patients were video recorded using MS Teams, transcribed and analysed in detail using Conversation Analysis. SETTING Video consultations were recorded in three specialist settings (long-term pain, orthopaedics, and neuromuscular rehabilitation) across two NHS hospitals. PARTICIPANTS 15 adult patients (10 female, 5 male; aged 20-77) with a scheduled video consultation. RESULTS Examinations and exercises retain-->were successfully accomplished in all 15 consultations. Two key challenges were identified for physiotherapists and patients when doing video assessments: (1) managing safety and clinical risk, and (2) making exercises and movements visible. Challenges were addressed by through communication practices that were patient-centred and tailored to the video context (e.g., explaining how to frame the body to the camera or adjust the camera to make the body visible). CONCLUSIONS Video is being used by physiotherapists to consult with their patients. This can work well, but tailored communication strategies are critical to help participants overcome the challenges of remote physical examinations and exercises. CONTRIBUTION OF THE PAPER This paper is a first to use video-based analysis to determine the challenges of video consulting for doing remote assessments and exercises in physiotherapy settings. It demonstrates how patients and physiotherapists use communication strategies to raise concerns around safety and visibility and how they overcome these concerns.
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Affiliation(s)
- Lucas M Seuren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom; Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON L5B 1B8, Canada.
| | - Anthony Gilbert
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom
| | - Gita Ramdharry
- University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, United Kingdom
| | - Jackie Walumbe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom; University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, United Kingdom
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom
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15
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Nagy M, Kitsis C, Abdelhameed S, Sidhu GAS, Atherton J, Ashwood N. Virtual Fracture Clinic Patients' Satisfaction Outcomes. Cureus 2024; 16:e60528. [PMID: 38887350 PMCID: PMC11180705 DOI: 10.7759/cureus.60528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/20/2024] Open
Abstract
Background During the COVID-19 pandemic, there was a need to balance optimum treatment service and the safety of patients and hospital staff. The British Orthopaedic Association recommended a virtual fracture clinic to give the right first-time decision and to minimize patient exposure to disease. This study aimed to evaluate the patients' satisfaction outcomes for the service provided through the virtual fracture clinic. Methodology From January to May 2022, all patients seen by the staff in the Emergency Department (ED) at Queens Burton Hospitals were enrolled in a prospective study. An Excel spreadsheet was provided to both ED personnel and the orthopaedic team for accessibility. Patients were continually added to the spreadsheet, and their cases were reviewed by the on-call consultant to devise treatment plans. A satisfaction questionnaire was collected from patients about their virtual clinic experience as a route to provide treatment service. Results The study comprised 150 patients, with an average age of 40 years. Distal radial fractures represented one-third of the cases. Different modalities of management were offered such as a sling, splint, cast, or referral to physiotherapy. Around 75% of cases were satisfied, understood the advice given over the phone, and were not required to attend the actual clinic. The remaining quarter attended the clinic either for further reassessment by an orthopaedic surgeon or for discussion of their injury as they could not get the full message over the phone due to fast calls, hearing struggles, or just listening to messages. Conclusions The virtual fracture clinic is an effective standalone service that gained around 75% satisfaction in patients' outcome questionnaires. It saved the actual fracture clinic slots and hospital resources. It is recommended to be part of the standard daily practice throughout the United Kingdom.
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Affiliation(s)
- Mohamed Nagy
- Trauma and Orthopaedics, Cairo University Hospitals, Kasr Alainy, Cairo, EGY
- Trauma and Orthopaedics, Manchester University Hospitals NHS Foundation Trust, Manchester, GBR
| | - Christos Kitsis
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton, GBR
| | - Samar Abdelhameed
- Radiology, Cairo University Hospitals, Kasr Alainy, Cairo, EGY
- Radiology, Manchester University Hospitals NHS Foundation Trust, Manchester, GBR
| | | | - John Atherton
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton, GBR
| | - Neil Ashwood
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton, GBR
- Research Institute, University of Wolverhampton, Wolverhampton, GBR
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16
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Mussallem A, Panko TL, Contreras JM, Plegue MA, Dannels WA, Roman G, Hauser PC, McKee MM. Making virtual health care accessible to the deaf community: Findings from the telehealth survey. J Telemed Telecare 2024; 30:574-578. [PMID: 35075938 DOI: 10.1177/1357633x221074863] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To reduce COVID-19 exposure risk, virtual visits became widely adopted as a common form of healthcare delivery for the general population. It is unknown how this affected the deaf population, a sociolinguistic minority group that continues to face communication and healthcare barriers. The survey's objective was to describe the deaf participants' experiences with telehealth visits. METHODS A 28-item online survey, available in American Sign Language and English, was developed and disseminated between November 2020 and January 2021. Ninety-nine deaf participants responded. Descriptive statistics were performed to assess the participant's virtual health care use, experiences, and communication approaches. RESULTS Seventy-five percent of respondents used telehealth at least once in the past 12 months (n = 74; age = 37.6 ± 14.5 years). Of those who used telehealth, nearly two-thirds experienced communication challenges (65.3%; n = 49). Half of the participants reported having to connect via a video relay service that employs interpreters who maintain general certification instead of a remote interpreter with specialized health care interpreting certifications for video visits with their health care providers (n = 37) and a third of participants reported needing to use their residual hearing to communicate with their providers (n = 25). CONCLUSION Standard protocols for health care systems and providers are needed to minimize the burden of access on deaf patients and ensure virtual visits are equitable. It is recommended these visits be offered on Health Insurance Portability and Accountability Act-compliant platforms and include multi-way video to allow for the inclusion of remote medical interpreters and/or real-time captionists to ensure effective communication between the provider and the deaf patient occurs.
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Affiliation(s)
- Ashley Mussallem
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Tiffany L Panko
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Jessica M Contreras
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Wendy A Dannels
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Gretchen Roman
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Peter C Hauser
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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17
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Cockburn L, Baer G, Rhodes J. Level of diagnostic agreement in musculoskeletal shoulder diagnosis between remote and face-to-face consultations: A retrospective service evaluation. Health Sci Rep 2024; 7:e2060. [PMID: 38650721 PMCID: PMC11033340 DOI: 10.1002/hsr2.2060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
Background and Aims To determine the level of diagnostic agreement between remote and face-to-face consultation in assessing shoulder complaints. Methods A retrospective service evaluation with three groups of patient data; those assessed only face-to-face (group 1), remotely then face-to-face (group 2), remotely only (group 3). Patient data were extracted from 6 secondary care shoulder Advanced Physiotherapy Practitioner's (APPs) records, covering six sites. Three-hundred-and-fifty-nine sets of patient data were included in the final evaluation. The main outcome measure was the percentage of agreement between diagnosis at initial and follow-up consultation, when assessed by APPs across the three groups. A Pearson χ 2 test was used to assess the relationship between the method of consultation and the level of diagnostic agreement. Diagnoses were categorized as either the same, similar, or different by an independent APP. Secondary outcome measures investigated whether age or the length of time between appointments had any effect in determining the level of diagnostic concordance. Results There was exact agreement of 77.05% and 85.52% for groups 1 and 3, respectively, compared with 34.93% for patient data in group 2. Similar clinical impressions across both initial and follow-up were seen 16.39% of the time in group 1, 7.24% of the time in group 3, and 36.99% in group 2. Lastly, the percentage of times a diagnosis was changed between initial and review appointments occurred in only 6.56% of group 1 contacts, 7.24% of group 3 contacts, but 28.08% of the time in group 2. Conclusion There was a large mismatch in the diagnosis of musculoskeletal shoulder complaints, when patients are initially assessed remotely and then followed-up in-person. This has implications for the future provision of shoulder assessment in physiotherapy.
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Affiliation(s)
- Louise Cockburn
- Division of Dietetics Nutrition Biological Sciences Physiotherapy Podiatry and RadiographyQueen Margaret UniversityMusselburghUK
| | - Gill Baer
- Division of Dietetics Nutrition Biological Sciences Physiotherapy Podiatry and RadiographyQueen Margaret UniversityMusselburghUK
| | - Jenna Rhodes
- Division of Dietetics Nutrition Biological Sciences Physiotherapy Podiatry and RadiographyQueen Margaret UniversityMusselburghUK
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18
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Rohatinsky N, Russell B, Peña-Sánchez JN, Boklaschuk S, Bhasin S, Fowler S, Guzowski T, Wicks K, Wicks M. Exploring the Experiences of Virtual Inflammatory Bowel Disease Care in Saskatchewan. Can J Nurs Res 2024; 56:95-108. [PMID: 38062657 PMCID: PMC10804685 DOI: 10.1177/08445621231219299] [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] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Individuals with inflammatory bowel disease (IBD) require life-long interactions with the healthcare system. Virtual care (VC) technologies are becoming increasingly utilized for accessing healthcare services. Research related to the use of VC technology for the management of IBD in Canada is limited. This study aimed to examine the VC experiences from the perspectives of individuals with IBD and gastroenterology care providers (GCPs). METHODS A patient-oriented, qualitative descriptive approach was used. Semi-structured interviews were completed with individuals with IBD and GCPs. Data were analyzed using an inductive content analysis approach. RESULTS A total of 25 individuals with IBD and five GCPs were interviewed. Three categories were identified: benefits of virtual IBD care delivery, challenges of virtual IBD care delivery, and optimizing IBD care delivery. Individuals with IBD and GCPs were satisfied with the use of VC technology for appointments. Participants believed VC was convenient and allowed enhanced access to care. However, VC was not considered ideal in some instances, such as during disease flares or first appointments. Thus, a blended use of virtual and in-person appointments was suggested for individualized care. CONCLUSIONS The virtual method of connecting patients and providers is deemed useful for routine appointments and for persons living in rural areas. VC is becoming more common in the IBD care environment. Nurses are in a key position to facilitate and enhance virtual IBD care delivery for the benefit of both individuals living with IBD and providers.
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Affiliation(s)
- Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Sask., Canada
| | - Brooke Russell
- College of Nursing, University of Saskatchewan, Saskatoon, Sask., Canada
| | - Juan Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada
| | | | - Sanchit Bhasin
- Division of Gastroenterology, Department of Medicine, Saskatchewan Health Authority, Regina General Hospital, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, College of Medicine, University of Saskatchewan, Canada
| | - Sharyle Fowler
- Division of Gastroenterology and Hepatology, Department of Medicine, College of Medicine, University of Saskatchewan, Canada
| | - Tomasz Guzowski
- Division of Gastroenterology and Hepatology, Department of Medicine, College of Medicine, University of Saskatchewan, Canada
| | | | - Mike Wicks
- Patient and Family Partner, Saskatchewan, Canada
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Rostron H, Wright JM, Gilbert AW, Dillon B, Pini S, Redmond AC, Livermore P. Adoption of technology enabled care to support the management of children and teenagers in rheumatology services: a protocol for a mixed-methods systematic review. BMJ Open 2024; 14:e082515. [PMID: 38387983 PMCID: PMC10882409 DOI: 10.1136/bmjopen-2023-082515] [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: 11/25/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION COVID-19 catalysed a rapid move to provide care away from the hospital using online communication platforms. Technology enabled care (TEC) continues to be an important driver in progressing future healthcare services. Due to the complex and chronic nature of conditions seen within paediatric rheumatology, TEC may lead to better outcomes. Despite some growth in published literature into the adoption of TEC in paediatric rheumatology, there is limited synthesis. The aim of this review is to provide a comprehensive understanding and evaluation of the adoption of TEC by patients in paediatric rheumatology services, to establish best practices. METHODS AND ANALYSIS This proposed mixed-methods systematic review will be conducted by searching a wide variety of healthcare databases, grey literature resources and associated charities and societies, for articles reported in English language. Data extraction will include population demographics, technology intervention, factors affecting adoption of intervention and consequent study outcomes. A parallel-results convergent synthesis design is planned, with independent syntheses of quantitative and qualitative data, followed by comparison of the findings of each synthesis using a narrative approach. Normalisation process theory will be used to identify, characterise and explain implementation factors. The quality of included articles will be assessed using the Mixed Methods Appraisal Tool for research papers and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for grey literature. Overall confidence in quality and strength of evidence will be assessed using the Confidence in the Evidence from Reviews of Qualitative Research tool. ETHICS AND DISSEMINATION Ethical approval is not required due to the nature of this mixed-methods systematic review. The findings will be disseminated via a peer-reviewed journal, relevant conferences and any other methods (eg, via NHS Trust or NIHR YouTube channels) as advised by paediatric rheumatology patients. PROSPERO REGISTRATION NUMBER CRD42023443058.
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Affiliation(s)
- Heather Rostron
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Children's Research Team, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Simon Pini
- Psychological and Social Medicine, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Polly Livermore
- Infection, Immunity & Inflammation Department, University College London, London, UK
- NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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20
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Bray M, Turner J, Jones S, Miah T, Milberger S. Developing Workforce Skills and Capacity in Telehealth: What LEND Trainees Need to Know. Matern Child Health J 2024; 28:240-245. [PMID: 37889391 DOI: 10.1007/s10995-023-03794-2] [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] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION The COVID-19 pandemic significantly impacted the way health-related services are delivered, rapidly shifting from in-person to telehealth visits. To ensure that future healthcare providers are fully prepared to deliver services to families of youth with neurodevelopmental disabilities (NDD), understanding telehealth's advantages and barriers is vital. To this end, data were gathered to inform the development of a nationally available telehealth curriculum aimed at training future healthcare professionals from the Leadership Education in Neurodevelopmental Disabilities (LEND) network. METHODS Surveys were sent out nationally to current LEND trainees, practicing healthcare professionals, and family members of youth with NDD in November of 2020. Multiple choice and free response questions were completed and analyzed. A total of N = 208 surveys were completed (88 LEND trainees, 94 practicing professionals, 23 family members). RESULTS Most survey respondents reported having positive experiences with telehealth. LEND trainees and current healthcare professionals cited increased access to care and engagement as the top benefit of telehealth. Most family members reported using telehealth services (78%) and felt it was superior to in-person visits in terms of location of visit, scheduling, and meeting transportation needs. Trainees and professionals agreed the top barriers to telehealth for families were lack of broadband access and complexity of implementation and use. LEND trainees agreed telehealth basics should be included in LEND curriculum. DISCUSSION Trainees, professionals, and family members all agreed that knowing the basics of telehealth is essential for effective telehealth service delivery. Emerging healthcare professionals need to understand how those they will be serving engage with technology, their levels of experience in this area, and effective strategies for engaging children and youth with NDD through telehealth. This will bridge the engagement gap many families of children with disabilities face when not meeting in person. Findings from this study contributed to the design of learning materials that currently support LEND trainees across the country in developing these skills.
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Affiliation(s)
- Michael Bray
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA.
| | - Jane Turner
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA
| | - Sean Jones
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA
| | - Tazia Miah
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA
| | - Sharon Milberger
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA
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21
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Keegan D, Heffernan E, Clarke B, Deasy C, O'Donnell C, Crowley P, Hughes A, Murphy AW, Masterson S. Tools and methods for evaluating the change to health service delivery due to pandemics or other similar emergencies: A rapid evidence review. EVALUATION AND PROGRAM PLANNING 2024; 102:102378. [PMID: 37856938 DOI: 10.1016/j.evalprogplan.2023.102378] [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: 10/11/2021] [Revised: 08/21/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
The novel coronavirus, SARS-CoV-2 and its associated disease COVID-19, were declared a pandemic in March 2020. Countries developed rapid response activities within their health services to prevent spread of the virus and protect their populations. Evaluating health service delivery change is vital to assess how adapted practices worked, particularly during times of crisis. This review examined tools and methods that are used to evaluate health service delivery change during pandemics and similar emergencies. Five databases were searched, including PubMed, CENTRAL, Embase, CINAHL, and PsycINFO. The SPIDER tool informed the inclusion criteria for the articles. Articles in English and published from 2002 to 2020 were included. Risk of bias was assessed using the Mixed-Methods Appraisal Tool (MMAT). A narrative synthesis approach was used to analyse the studies. Eleven articles met the inclusion criteria. Many evaluation tools, methods, and frameworks were identified in the literature. Only one established tool was specific to a particular disease outbreak. Others, including rapid-cycle improvement and PDSA cycles were implemented across various disease outbreaks. Novel evaluation strategies were common across the literature and included checklists, QI frameworks, questionnaires, and surveys. Adherence practices, experience with telehealth, patient/healthcare staff safety, and clinical competencies were some areas evaluated by the tools and methods. Several domains, including patient/practitioner safety and patient/practitioner experience with telemedicine were also identified in the studies.
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Affiliation(s)
- Dylan Keegan
- UCD Clinical Research Centre, School of Medicine, University College Dublin, Dublin, Ireland; Discipline of General Practice, Clinical Science Institute, School of Medicine, University of Galway, Galway, Ireland.
| | - Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, University of Galway, Galway, Ireland; National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK; Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, UK.
| | - Bridget Clarke
- National Ambulance Service, Health Service Executive, Dublin, Ireland.
| | - Conor Deasy
- National Ambulance Service, Health Service Executive, Dublin, Ireland; Emergency Department, Cork University Hospital, Cork, Ireland; University College Cork, Cork, County Cork, Ireland.
| | - Cathal O'Donnell
- National Ambulance Service, Health Service Executive, Dublin, Ireland.
| | - Philip Crowley
- National Quality Improvement Team, Health Service Executive, Dublin, Ireland.
| | - Angela Hughes
- National Quality Improvement Team, Health Service Executive, Dublin, Ireland.
| | - Andrew W Murphy
- Discipline of General Practice, Clinical Science Institute, School of Medicine, University of Galway, Galway, Ireland; HRB Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland.
| | - Siobhán Masterson
- Discipline of General Practice, Clinical Science Institute, School of Medicine, University of Galway, Galway, Ireland; National Ambulance Service, Health Service Executive, Dublin, Ireland.
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22
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Sassi K, Tardif E, Lasry L, Manenc L, Guerby P, Minville V. Assessing feasibility and satisfaction in third-trimester pre-anaesthetic teleconsultations: A prospective observational study. Indian J Anaesth 2024; 68:183-188. [PMID: 38435660 PMCID: PMC10903770 DOI: 10.4103/ija.ija_721_23] [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: 07/28/2023] [Revised: 11/20/2023] [Accepted: 12/03/2023] [Indexed: 03/05/2024] Open
Abstract
Background and Aims Pregnancy presents risks, particularly for women with pre-existing health problems. Pre-anaesthetic consultations can help anticipate these risks and establish a medical management strategy on the delivery day. While teleconsultations gained popularity during the coronavirus disease 2019 (COVID-19) pandemic, research on pre-anaesthetic teleconsultations during pregnancy is limited. This study aimed to assess patient satisfaction and physician perception of teleconsultations for third-trimester pre-anaesthetic consultations. Methods A prospective observational study included pregnant women who opted for teleconsultations for pre-anaesthetic consultations. Patient satisfaction was assessed using Likert scale questions and the System Use Scale. Anaesthetist satisfaction was evaluated using a Likert scale and by considering changes in anaesthetic techniques and missing clinical data in the pre-anaesthetic assessment. Data analysis utilised SPSS Statistics for Windows, Version 20.0. encompassing descriptive statistics, hypothesis testing and odds ratio calculations. This approach explored the correlation between patient and anaesthetist satisfaction and pertinent risk factors. Results The study enroled 99 patients, with 85% expressing satisfaction and high satisfaction on the Likert scale and 88% finding the teleconsultation acceptable based on the System Use Scale (score ≥ 70). Anaesthetists reported being satisfied with the pre-anaesthetic consultations in 94% of cases. Conclusion This study demonstrates the feasibility and effectiveness of telemedicine consultations in obstetric anaesthesia, showing high patient and anaesthetist satisfaction rates.
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Affiliation(s)
- Kaissar Sassi
- Department of Anaesthesia, Centre Hospitalier Universitaire de Purpan, Toulouse, France
| | - Elsa Tardif
- Department of Anaesthesia, Centre Hospitalier Universitaire de Purpan, Toulouse, France
| | - Louis Lasry
- Department of Anaesthesia, Centre Hospitalier Universitaire de Purpan, Toulouse, France
| | - Lola Manenc
- Department of Anaesthesia, Centre Hospitalier Universitaire de Purpan, Toulouse, France
| | - Paul Guerby
- Department of Anaesthesia, Centre Hospitalier Universitaire de Purpan, Toulouse, France
| | - Vincent Minville
- Department of Anaesthesia, Centre Hospitalier Universitaire de Purpan, Toulouse, France
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Lomer MCE. The low FODMAP diet in clinical practice: where are we and what are the long-term considerations? Proc Nutr Soc 2024; 83:17-27. [PMID: 37415490 DOI: 10.1017/s0029665123003579] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) improves functional bowel symptoms and is a second-line dietary management strategy for the treatment of irritable bowel syndrome (IBS). The diet is complex and involves three stages: restriction, reintroduction and personalisation and clinical effectiveness is achieved with dietitian-led education; however, this is not always available. The aim of this review is to provide an update on the evidence for using the low FODMAP diet, with a focus on the impact of FODMAP restriction and reintroduction considering long-term management of IBS in a clinical setting. Randomised controlled trials have assessed symptom response, quality of life, dietary intake and changes to the gut microbiota during FODMAP restriction. Systematic reviews and meta-analyses consistently report that FODMAP restriction has a better symptom response compared with control diets and a network analysis reports the low FODMAP diet is superior to other dietary treatments for IBS. Research focused on FODMAP reintroduction and personalisation is limited and of lower quality, however common dietary triggers include wheat, onion, garlic, pulses and milk. Dietitian-led delivery of the low FODMAP diet is not always available and alternative education delivery methods, e.g. webinars, apps and leaflets, are available but remove the personalised approach and may be less acceptable to patients and may introduce safety concerns in terms of nutritional adequacy. Predicting response to the low FODMAP diet using symptom severity or a biomarker is of great interest. More evidence on less restrictive approaches and non-dietitian-led education delivery methods are needed.
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Affiliation(s)
- Miranda C E Lomer
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
- Department of Nutritional Sciences, King's College London, Stamford Street, London, UK
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24
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Patsakos EM, Bailey KA, Ditor DS. Exploring the Lived Experiences of Individuals With Spinal Cord Injury During the COVID-19 Pandemic. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241226827. [PMID: 38263725 PMCID: PMC10807388 DOI: 10.1177/00469580241226827] [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: 06/28/2023] [Revised: 12/09/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024]
Abstract
The global spread of severe acute respiratory syndrome coronavirus 2019 (COVID-19) has affected over 100 countries and has led to the tragic loss of life, overwhelmed health care systems and severely impacted the global economy. Specifically, individuals living with spinal cord injury (SCI) are particularly vulnerable during the COVID-19 pandemic as they often face adverse impacts on their health, emotional well-being, community participation, and life expectancy. The objective of this study was to investigate the lived experience of individuals with SCI during the COVID-19 pandemic in Ontario, Canada. An exploratory design with a qualitative descriptive approach was used to address the study objective. Nine semi-structured interviews were conducted with individuals with traumatic and non-traumatic SCI (37-69 years, C3-L5, AIS A-D, and 5-42 years post-injury). Using reflexive thematic analysis, the following themes were created: (1) Caregiver exposure to COVID-19; (2) Staying physically active in quarantine; (3) Living in social isolation; (4) Difficulty obtaining necessary medical supplies; (5) Access to health services and virtual care during COVID-19; and (6) Fighting COVID-19 misinformation. This is one of the first studies to explore the impact of COVID-19 on individuals living with SCI in Ontario. This study contributes to a greater understanding of the challenges faced by individuals living with SCI and provides insight into how to better support and respond to the specific and unique needs of individuals with SCI and their families during a national emergency or pandemic.
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Affiliation(s)
| | | | - David S. Ditor
- Brock University, St. Catharines, ON, Canada
- Brock-Niagara Centre for Health and Well-being, St. Catharines, ON, Canada
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25
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Hasselfeld BW, Links AR, Claus LE, Canino R, Sisson SD, Hughes HK. Provider Perspectives Regarding Ambulatory Telemedicine at a Large Academic Health System During the COVID-19 Pandemic. Telemed J E Health 2023; 29:1696-1704. [PMID: 36940314 DOI: 10.1089/tmj.2022.0483] [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: 03/22/2023] Open
Abstract
Purpose: To understand provider preferences regarding telemedicine across clinical departments and provider demographic groups. Methods: A cross-sectional online survey was distributed to providers at Johns Hopkins Medicine who had completed at least one outpatient telemedicine encounter. The survey included questions about clinical appropriateness and preferred use of telemedicine. Demographic data were obtained from institutional records. Descriptive statistics provided a profile of provider responses. Wilcoxon rank sum tests evaluated departmental and demographic differences. Results: A total of 1,342 of 3,576 providers responded (37.5%). Providers indicated that telemedicine was clinically appropriate for new patients a median of 31.5% of the time (Range: 20% in pediatrics, 80% in psychiatry/behavioral sciences). For existing patients, providers indicated that telemedicine was clinically appropriate a median of 70% of the time (Range: 50% in physical medicine, 90% in psychiatry/behavioral sciences). Providers desired a median of 30% of their schedule template be dedicated to telemedicine (Range: 20% in family medicine, 70% in psychiatry/behavioral sciences). Providers who were female, had fewer than 15 years in practice, or were psychiatrists/psychologists tended to find telemedicine more clinically appropriate (p < 0.05). Conclusions: A majority of providers across clinical departments felt that high-quality care could be delivered through telemedicine, although the amount of care varied widely based on department and patient type. Preferences for future telemedicine similarly showed wide variety across and within departments. These findings indicate that in this early adoption phase of widespread telemedicine integration, there is lack of consensus among providers about the amount of telemedicine appropriate for everyday practice.
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Affiliation(s)
- Brian W Hasselfeld
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Office of Telemedicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Office of Johns Hopkins Physicians, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Anne R Links
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lauren E Claus
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rebecca Canino
- Office of Telemedicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Stephen D Sisson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Office of Johns Hopkins Physicians, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Helen K Hughes
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Office of Telemedicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Antonacci G, Benevento E, Bonavitacola S, Cannavacciuolo L, Foglia E, Fusi G, Garagiola E, Ponsiglione C, Stefanini A. Healthcare professional and manager perceptions on drivers, benefits, and challenges of telemedicine: results from a cross-sectional survey in the Italian NHS. BMC Health Serv Res 2023; 23:1115. [PMID: 37853448 PMCID: PMC10585875 DOI: 10.1186/s12913-023-10100-x] [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: 11/29/2022] [Accepted: 10/01/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service. METHODS An online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis. RESULTS Key factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations' semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can't completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers. CONCLUSIONS Respondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK.
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK.
| | - Elisabetta Benevento
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Pisa, Italy
| | | | | | - Emanuela Foglia
- Healthcare Datascience LAB, LIUC- Carlo Cattaneo University, Castellanza, VA, Italy
| | - Giulia Fusi
- LIUC- Cattaneo University, Castellanza, VA, Italy
| | - Elisabetta Garagiola
- Healthcare Datascience LAB, LIUC- Carlo Cattaneo University, Castellanza, VA, Italy
| | - Cristina Ponsiglione
- Department of Industrial Engineering, University of Naples Federico II, Naples, Italy
| | - Alessandro Stefanini
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Pisa, Italy
- School of Economics and Business, Kaunas University of Technology, Kaunas, Lithuania
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Jiménez-Carrillo M, González-Rábago Y, González Miguel R, Baza Bueno M. [From face-to-face consultation to teleconsultation: Primary health care professionals' experiences in the Basque Country during the pandemic]. Aten Primaria 2023; 55:102702. [PMID: 37437478 PMCID: PMC10345852 DOI: 10.1016/j.aprim.2023.102702] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE To explore the perceptions of Primary Health Care (PHC) professionals on changes in consultation modalities and their impact on PHC fundamentals during the pandemic. DESIGN Qualitative exploratory research conducted between October and November, 2021. LOCATION Four urban and one rural primary health care centers with different socioeconomic profiles in the threeterritories of the Basque Country. PARTICIPANTS Forty-six professionals from different categories of the PHC team and health centre directors. METHOD Purposive sampling. Five focus groups and fourin-depth interviews. Thematic analysis with the support of the Atlas.ti programme. Triangulation of results among the research team. RESULTS Experiences with the development of teleconsultation appear to be directly conditioned by the pandemic context in its different phases and by the PC situation. The professionals identified communication barriers, as well as potentialities of its use that require adequate training and evaluation. Risks of inequity were perceived in the use of teleconsultations that could be affecting the quality of care. Longitudinality was assessed as a facilitating factor and problems of coordination and communication through teleconsultation between care levels were identified. CONCLUSIONS The replacement of face-to-face consultation by teleconsultation had an impact on fundamental aspects of PHC such as quality, accessibility, equity, coordination and longitudinality. Teleconsultation in PHC should always be evaluated considering the specific circumstances and contexts of its implementation.
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Affiliation(s)
- Marta Jiménez-Carrillo
- Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Bizkaia, España; Departamento de Sociología y Trabajo Social, Universidad del País Vasco UPV/EHU, Bizkaia, España; Instituto de Investigación Sanitaria Biocruces Bizkaia, España.
| | - Yolanda González-Rábago
- Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Bizkaia, España; Departamento de Sociología y Trabajo Social, Universidad del País Vasco UPV/EHU, Bizkaia, España
| | - Raquel González Miguel
- OSI Donostialdea, Unidad de Atención Primaria Pasajes San Pedro-Bidebieta, Gipuzkoa, Bizkaia, España
| | - Mikel Baza Bueno
- Instituto de Investigación Sanitaria Biocruces Bizkaia, España; OSI Barrualde-Galdakao, Atención Primaria de Arrigorriaga, Bizkaia, España
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MacKenzie A, Papadopolous E, Lisandrelli G, Abutalib Z, Eannucci EF. Patient satisfaction with telehealth vs in-person hand therapy: A retrospective review of results of an online satisfaction survey. J Hand Ther 2023; 36:974-981. [PMID: 37012122 PMCID: PMC10066728 DOI: 10.1016/j.jht.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 04/03/2023]
Abstract
BACKGROUND The COVID-19 pandemic necessitated a shift from in-person to telehealth visits in many outpatient rehabilitation facilities. PURPOSE To determine whether patients reported similar levels of satisfaction receivingtelehealth hand therapy as when receiving in-person hand therapy. STUDY DESIGN Retrospective review of patient satisfaction surveys. METHODS Satisfaction surveys were reviewed retrospectively among patients who participated in in-person hand therapy between April 21 and October 21, 2019, or after participating in telehealth hand therapy between April 21 and October 21, 2020. Information on gender, age, insurance provider, postoperative status and comments were also collected. Kruskal-Wallis tests were used to compare survey scores between groups. Chi -squared tests were used to compare categorical patient characteristics between groups. RESULTS A total of 288 surveys were included: 121 surveys for in-person evaluations, 53 surveys for in-person follow-up visits, 55 surveys for telehealth evaluations and 59 surveys for telehealth follow-up visits. No significant differences in satisfaction were observed between in-person and telehealth visits of either type or when patients were stratified by age (p = 0.78), gender (p = 0.41), insurance payer group (p = 0.099) or postoperative status (p = 0.19). CONCLUSIONS Similar rates of satisfaction were observed with both in-person visits and telehealth hand therapy visits. Questions that related to registration and scheduling tended to score lower across all groups, while questions related to technology scored lower in the telehealth groups. Future studies are needed to explore the efficacy and viability of a telehealth platform for hand therapy services.
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Carter H, Beard D, Harvey A, Leighton P, Moffatt F, Smith B, Webster K, Logan P. Using normalisation process theory for intervention development, implementation and refinement in musculoskeletal and orthopaedic interventions: a qualitative systematic review. Implement Sci Commun 2023; 4:114. [PMID: 37723546 PMCID: PMC10506319 DOI: 10.1186/s43058-023-00499-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Normalisation process theory (NPT) provides researchers with a set of tools to support the understanding of the implementation, normalisation and sustainment of an intervention in practice. Previous reviews of published research have explored NPT's use in the implementation processes of healthcare interventions. However, its utility in intervention research, specifically in orthopaedic and musculoskeletal interventions, remains unclear. The aim of this review is to explore how NPT (including extended NPT, ENPT) has been used in orthopaedic/musculoskeletal intervention research. METHODS A qualitative systematic review was conducted. Two bibliographic databases (Scopus and Web of Science) and a search engine (Google Scholar) were searched for peer-reviewed journal articles citing key papers outlining the development of NPT, related methods, tools or the web-based toolkit. We included studies of any method, including protocols, and did not exclude based on published language. A data extraction tool was developed, and data were analysed using a framework approach. RESULTS Citation searches, of the 12 key studies, revealed 10,420 citations. Following duplicate removal, title, abstract and full-text screening, 14 papers from 12 studies were included. There were 8 key findings assessed against GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research). Five were of high confidence supporting NPT/ENPT's use in the implementation process for interventions targeting a range of MSK/orthopaedic conditions. NPT/ENPT offers a useful analytical lens to focus attention and consider implementation factors robustly. There is limited evidence for the selection of NPT/ENPT and for the use of the Normalisation Measure Development instrument. Three findings of moderate confidence suggest that coherence is seen as a fundamental initial step in implementation, there is limited evidence that study population limits NPT's utility and the application of ENPT may pose a challenge to researchers. CONCLUSION This review demonstrates NPT's utility in supporting intervention implementation for orthopaedic and musculoskeletal conditions. We have theorised the benefits ENPT offers to intervention development and refinement and recommend future researchers consider its use. We also encourage future researchers to offer clear justification for NPT's use in their methodology. TRIAL REGISTRATION The review protocol is registered with PROSPERO (CRD42022358558).
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Affiliation(s)
- Hayley Carter
- Physiotherapy Outpatients, Level 3, Florence Nightingale Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE1 2QY, UK.
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK.
| | - David Beard
- Surgical Intervention Trials Unit, Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Alison Harvey
- Physiotherapy Outpatients, Level 3, Florence Nightingale Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE1 2QY, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Fiona Moffatt
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Benjamin Smith
- Physiotherapy Outpatients, Level 3, Florence Nightingale Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE1 2QY, UK
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Kate Webster
- Health Sciences 3 Building, La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - Pip Logan
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK
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Simonÿ C, Clausen B, Beck M, Nyberg M, Tang LH, Skou ST, Holm PM. An invigorating journey towards better function and well-being: A qualitative study of knee osteoarthritis patients' experiences with an online exercise and education intervention. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100384. [PMID: 37600484 PMCID: PMC10432237 DOI: 10.1016/j.ocarto.2023.100384] [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: 04/15/2023] [Accepted: 07/06/2023] [Indexed: 08/22/2023] Open
Abstract
Objective To explore what it means for patients with knee osteoarthritis (OA) to engage in online delivered exercise and education. Method We combined participant observations and focus group interviews with knee OA patients who engaged in an 8-week program (12 exercise sessions and 2 education sessions) delivered online. Data underwent a three-level phenomenological-hermeneutic interpretation inspired by Ricoeur's narrative and interpretation theory. Results We performed 17 participant observations during online group-based exercise sessions with twenty individuals with knee OA (12 females), median age 71 years (range: 48 to 81), and five focus group interviews with fifteen of the individuals. The following three themes emerged from the data analysis: 1. Exercise engagement portrays an experience of ownership of the exercise-based treatment, leading to better function and well-being and raising hope for the future 2. A good start but only halfway supported portrays perceived well-guided in performing knee OA exercise, however also some unmet support needs in the online format, and 3. Beneficial peer companionship with online constraints portrays a socially engaging peer forum that, at times, was limited by the online format. Conclusions This phenomenological-hermeneutic study reflects that supervised online exercise and education facilitate identity mobility, potentially increasing self-efficacy to adopt weekly exercise habits in patients with knee OA. However, the program may benefit from enabling a more interactive approach between peer participants and combining the online format with physical group classes. Moreover, further individualization and focus on a gradual approach toward self-management are encouraged.
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Affiliation(s)
- Charlotte Simonÿ
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy,Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark & Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Brian Clausen
- Sano, Denmark & The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark & Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Malene Beck
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy,Naestved-Slagelse-Ringsted Hospitals Slagelse, Denmark & Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mette Nyberg
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy,Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Lars Hermann Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy,Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark & Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren T. Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Naestved-Slagelse-Ringsted Hospitals, Denmark & Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Pætur M. Holm
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Naestved-Slagelse-Ringsted Hospitals, Denmark& Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense Denmark
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Warnock C, Pelton J, Hilton A. Staff experiences of the use of virtual consultations in non-surgical oncology systemic anticancer therapy services. Support Care Cancer 2023; 31:541. [PMID: 37646821 DOI: 10.1007/s00520-023-08005-w] [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: 04/01/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE In response to the COVID-19 pandemic, virtual consultations were introduced rapidly across cancer services. This created a particular set of challenges for systemic anticancer therapy services, where patients have frequent, regular appointments to support decision-making regarding treatment. This study explores the experiences of staff who provide these consultations to understand the implications for patients, staff, and services. METHODS A mixed-methods approach was utilized using electronic surveys containing open text and structured responses and a focus group. The survey was sent to all staff in a regional cancer center who carried out consultations with patients receiving Systemic Anticancer Therapy. Data collection took place between October 2020 and January 2021. Open text responses were analyzed using framework techniques. RESULTS Thirty-three medical, nursing, and pharmacy staff completed the survey, and 21 attended the focus group. Staff experiences were described within a framework of risk, loss, and gain. Virtual consultations had clinical consequences for the accuracy of assessments and communication with patients. Criteria for using virtual or in-person appointments were identified along with organizational systems and processes that influenced effectiveness and safety. Concerns were raised regarding role satisfaction and use of clinical skills. CONCLUSION The study provides new insights into the experiences and concerns of staff associated with virtual appointments. The primary purpose of consultation in systemic anticancer therapy services is to support decision-making regarding treatment, and the study identified obstacles to achieving this alongside possible criteria for determining when in-person or virtual consultations may be appropriate.
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Affiliation(s)
- Clare Warnock
- Researcher in Residence, Cancer Experience, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Witham Road, Sheffield, S10 2SJ, England.
| | - Jeremy Pelton
- Oncology Haematology Business Unit, National Partnership Manager, Bristol Myers Squibb, Buckinghamshire, UK
| | - Anne Hilton
- Deputy Operations Director, Specialised Cancer, Rehabilitation and Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
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Urbonas T, Lakha AS, King E, Pepes S, Ceresa C, Udupa V, Soonawalla Z, Silva MA, Gordon-Weeks A, Reddy S. The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study. Patient Saf Surg 2023; 17:23. [PMID: 37644474 PMCID: PMC10466851 DOI: 10.1186/s13037-023-00368-7] [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: 05/28/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to evaluate the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy. METHODS We conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates, with Clavein-Dindo grade III or greater deemed clinically significant. We performed a subgroup analysis on the cases cancelled on the day of surgery in an attempt to identify key reasons for cancellation following virtual clinic assessment. RESULTS We identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 7% of patients had a cancellation on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal to or greater than Clavien-Dindo grade III) were observed in 1% of patients, and required re-intervention. 30-day readmission rate was 11%. CONCLUSIONS Our series showed that it is safe and feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, its environmental impact, and possible benefits to healthcare economics to support its routine use in general surgery.
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Affiliation(s)
- Tomas Urbonas
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Adil Siraj Lakha
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Emily King
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Sophia Pepes
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Carlo Ceresa
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Venkatesha Udupa
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Zahir Soonawalla
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Michael A Silva
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Alex Gordon-Weeks
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Srikanth Reddy
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
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Allsopp K, Varese F, French P, White H, Chung P, Hassan AA, Wright SA, Young E, Barrett A, Bhutani G, McGuirk K, Huntley F, Sarsam M, Ten Cate H, Watson R, Willbourn J, Hind D. Implementing psychological support for health and social care staff affected by the COVID-19 pandemic: a qualitative exploration of staff well-being hubs ('Resilience Hubs') using normalisation process theory. BMJ Open 2023; 13:e071826. [PMID: 37612138 PMCID: PMC10450134 DOI: 10.1136/bmjopen-2023-071826] [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: 01/12/2023] [Accepted: 06/11/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES Evaluate the implementation of Hubs providing access to psychological support for health and social care keyworkers affected by the COVID-19 pandemic. DESIGN Qualitative interviews informed by normalisation process theory to understand how the Hub model became embedded into normal practice, and factors that disrupted normalisation of this approach. SETTING Three Resilience Hubs in the North of England. PARTICIPANTS Hub staff, keyworkers who accessed Hub support (Hub clients), keyworkers who had not accessed a Hub, and wider stakeholders involved in the provision of staff support within the health and care system (N=63). RESULTS Hubs were generally seen as an effective way of supporting keyworkers, and Hub clients typically described very positive experiences. Flexibility and adaptability to local needs were strongly valued. Keyworkers accessed support when they understood the offer, valuing a confidential service that was separate from their organisation. Confusion about how Hubs differed from other support prevented some from enrolling. Beliefs about job roles, unsupportive managers, negative workplace cultures and systemic issues prevented keyworkers from valuing mental health support. Lack of support from managers discouraged keyworker engagement with Hubs. Black, Asian and minority ethnic keyworkers impacted by racism felt that the Hubs did not always meet their needs. CONCLUSIONS Hubs were seen as a valuable, responsive and distinct part of the health and care system. Findings highlight the importance of improving promotion and accessibility of Hubs, and continuation of confidential Hub support. Policy implications for the wider health and care sector include the central importance of genuine promotion of and value placed on mental health support by health and social care management, and the creation of psychologically safe work environments. Diversity and cultural competency training is needed to better reach under-represented communities. Findings are consistent with the international literature, therefore, likely to have applicability outside of the current context.
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Affiliation(s)
- Kate Allsopp
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Filippo Varese
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Paul French
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Hannah White
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Priscilla Chung
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Alysha A Hassan
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Sally-Anne Wright
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Ellie Young
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Alan Barrett
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
- School of Health Sciences, University of Salford, Salford, UK
| | - Gita Bhutani
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Lancashire, UK
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Katherine McGuirk
- Greater Manchester Health and Social Care Partnership, Manchester, UK
| | - Fay Huntley
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, Liverpool, UK
- Doctorate of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - May Sarsam
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Hein Ten Cate
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Ruth Watson
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jenni Willbourn
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Daniel Hind
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Bourke M, Williams N, Dowdall J, Barry MC. Establishment of a clinical nurse specialist-led, virtual aneurysm surveillance clinic. Vascular 2023; 31:749-757. [PMID: 35337231 DOI: 10.1177/17085381221080001] [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: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic has necessitated significant changes to the manner in which healthcare is delivered. Chief among these has been the need to rapidly adopt virtual, or telephone clinics as a means of reducing unnecessary patient exposure to hospitals and clinical care settings. We were greatly aided in our adoption of virtual clinics by our experience in the establishment and maintenance of a Clinical Nurse Specialist-led, virtual clinic for both abdominal aortic (AAA) and extra-aortic aneurysm (EAA) surveillance within our department since 2016. Patients undergoing surveillance for abdominal aortic aneurysm (AAA) require frequent and lifelong clinical review. Previous studies have shown that post-operative surveillance in particular is critical in prolonging survival in AAA patients and in the early detection of late complications particularly following endovascular repair (EVAR). Poor compliance with EVAR surveillance has been shown to result in worse outcomes. AIM The aim of this study was to evaluate the success of a nurse-led virtual clinic programme in terms of the safe management of patients undergoing AAA surveillance in a nurse-led virtual clinic. RESULTS Over the course of the 4-year period from 2016 to 2019, 1352 patients were enrolled in the virtual aneurysm surveillance clinic. The majority of patients each year were male, ranging from 78.2% in 2016 to 85.2% in 2017. The majority of patients encountered the service owing to pre-operative surveillance of an AAA, with this group comprising at least 65% of the total cohort of patients each year.Over the course of the 4-year period of the virtual clinic there were 1466 patient encounters. Each ambulatory day care centre (ADCC) attendance normally costs the hospital €149. Therefore, a total saving of €218,434 resulted from this initiative alone. No patient presented as an emergency with a ruptured aneurysm during the time period studied. CONCLUSION Patients with AAA can be safely kept under surveillance in a nurse-led virtual clinic. Our experience with this model of care proved to be particularly advantageous during the period of the early COVID-19 pandemic.
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Affiliation(s)
- M Bourke
- Department of Vascular Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - N Williams
- Department of Vascular Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - J Dowdall
- Department of Vascular Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - M C Barry
- Department of Vascular Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
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Ludwick T, Creagh NS, Goller JL, Nightingale CE, Ferdinand AS. The Implementation Experience of COVID-19 Rapid Antigen Testing in a Large-Scale Construction Project in Victoria, Australia. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2023; 3:1-13. [PMID: 37363376 PMCID: PMC10228896 DOI: 10.1007/s43477-023-00085-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 04/29/2023] [Indexed: 06/28/2023]
Abstract
The coronavirus (COVID-19) pandemic has caused major disruptions to industries and workplaces. Rapid Antigen Tests (RATs) for COVID-19, which allow individuals to self-administer tests and receive timely results without laboratory testing, provide the opportunity for surveillance testing of asymptomatic individuals in non-medical settings. However, the literature offers few lessons regarding how to create enabling conditions for effective and sustainable implementation in a workplace setting. Guided by the RE-AIM framework, we assessed factors associated with the adoption, implementation, and maintenance of mandatory RAT in a large-scale construction project in Victoria, Australia. We used a mixed methods approach involving site observation, worker surveys (n = 30), and interviews with 51 site workers and managers to understand the implementation experience. Factors which facilitated adoption included easy, non-invasive testing procedure; sense of workplace safety; and strong backing by management and acceptance by workers that RATs helped limit COVID-19-related lost days of work. Gaps in knowledge and adherence to testing protocols, logistical challenges (test kit supply, observation of test results), and low appetite for long-term, mandatory testing emerged as challenges for effective implementation and sustainability. As RAT becomes normalized in a range of workplace settings, strategies will be required to support the sustainability of implementation, including longer-term acceptability of surveillance testing and adherence to testing protocols. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-023-00085-4.
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Affiliation(s)
- Teralynn Ludwick
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Nicola Stephanie Creagh
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jane L. Goller
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Claire Elizabeth Nightingale
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Angeline Samantha Ferdinand
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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Adepoju OE, Dang P, Valdez MR. Comparing In-Person Only, Telemedicine Only, and Hybrid Health Care Visits Among Older Adults in Safety-Net Clinics. TELEMEDICINE REPORTS 2023; 4:93-99. [PMID: 37283857 PMCID: PMC10240331 DOI: 10.1089/tmr.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 06/08/2023]
Abstract
Introduction Older adults face challenges in seeking health care. This study examined factors associated with in-person only versus telemedicine only versus hybrid health care visits among adults 65+ in safety-net clinics. Methods Data were obtained from a large Texas-based Federally Qualified Health Center (FQHC) network. The dataset included 12,279 appointments for 3914 unique older adults between March and November 2020. The outcome of interest was a 3-level indicator of telemedicine visits: in-person visits only, telemedicine visits only, and hybrid (in person + telemedicine) visits during the study period. We used a multinomial logit model adjusting for patient level characteristics to assess the strength of the relationships. Results Compared to their white counterparts, black and Hispanic older adults were significantly likely to have telemedicine only visits versus in-person only visits (black RRR: 0.59, 95% confidence interval [CI]: 0.41-0.86; Hispanic RRR: 0.46, 95% CI: 0.36-0.60). However, there were no significant racial and ethnic differences in hybrid utilization (black RRR: 0.91, 95% CI: 0.67-1.23; Hispanic RRR: 0.86, 95% CI: 0.70-1.07). Discussion Our findings suggest that hybrid opportunities may bridge racial and ethnic disparities in access to care. Clinics should consider building capacity for both in-person and telemedicine opportunities as complementary strategies.
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Affiliation(s)
- Omolola E. Adepoju
- Department of Health Systems and Population Health Sciences, College of Medicine, University of Houston, Houston, Texas, USA
- Humana Integrated Health Systems Sciences Institute, Houston, Texas, USA
| | - Patrick Dang
- Humana Integrated Health Systems Sciences Institute, Houston, Texas, USA
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Bacon R, Hopkins S, Georgousopoulou E, Nahon I, Hilly C, Millar C, Flynn A, Smillie L, Chapman S, Brown N. While allied health students prefer face-to-face clinical placement, telehealth can support competency development: results from a mixed-methods study. Front Med (Lausanne) 2023; 10:1151980. [PMID: 37256090 PMCID: PMC10226666 DOI: 10.3389/fmed.2023.1151980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/21/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Student clinical placements are a mandatory requirement within most accredited health programs. During the COVID-19 pandemic, many health settings that had traditionally provided placements cancelled their offerings. Telehealth services however, increased and emerged as an alternative placement setting. Aim To compare the learning experiences for allied health students provided by telehealth and face-to-face accredited health placements. Methods Health students, from a university clinic between March to December 2020, delivering both face-to-face and telehealth consultations, were invited to complete a telephone survey with 3 demographic questions; and 10-items comparing their telehealth and face-to-face learning experiences. Pearson's chi-squared/Fisher's exact test was used to examine the association between each item and consultation setting. Qualitative survey data was thematically analysed using a descriptive approach. Results 49 students from 2 universities and 5 disciplines completed the survey. Students rated their face-to-face experiences significantly higher than their telehealth experiences across all items (all p-values <0.01). Across 9 items students reported positive learning experiences in both settings. Students had greater opportunities to work in a multidisciplinary team in a face-to-face setting. Four themes were generated: (1) placements can vary in quality regardless of setting; (2) telehealth can provide valuable learning experiences and support competency development; (3) enablers for telehealth placements and (4) barriers for telehealth placements. Conclusion While telehealth can support student learning and competency development, in this study students preferred face-to-face experiences. To optimise telehealth placements consideration needs to be given to barriers and enablers such as technological issues and university curricula preparation.
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Affiliation(s)
- Rachel Bacon
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Sian Hopkins
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | | | - Irmina Nahon
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Catherine Hilly
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - CaraJane Millar
- College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Allyson Flynn
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Linda Smillie
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Sarah Chapman
- Allied Health Clinical Education Unit, Canberra Health Services, Garran, ACT, Australia
| | - Nicholas Brown
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
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Vasilica C, Wynn M, Davis D, Charnley K, Garwood-Cross L. The digital future of nursing: making sense of taxonomies and key concepts. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:442-446. [PMID: 37173087 DOI: 10.12968/bjon.2023.32.9.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Digital technology is becoming increasingly common in routine nursing practice. The adoption of digital technologies such as video calling, and other digital communication, has been hastened by the recent COVID-19 pandemic. Use of these technologies has the potential to revolutionise nursing practice, leading to potentially more accurate patient assessment, monitoring processes and improved safety in clinical areas. This article outlines key concepts related to the digitalisation of health care and the implications for nursing practice. The aim of this article is to encourage nurses to consider the implications, opportunities and challenges associated with the move towards digitalisation and advances in technology. Specifically, this means understanding key digital developments and innovations associated with healthcare provision and appreciating the implications of digitalisation for the future of nursing practice.
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Affiliation(s)
- Cristina Vasilica
- Reader, Digital Health, School of Health and Society, University of Salford, Salford
| | - Matthew Wynn
- Lecturer, Adult Nursing, School of Health and Society, University of Salford, Salford
| | - Dilla Davis
- Lecturer, Adult Nursing, School of Health and Society, University of Salford, Salford
| | - Kyle Charnley
- Lecturer, Mental Health Nursing, School of Health and Society, University of Salford, Salford
| | - Lisa Garwood-Cross
- Research Fellow, Digital Health, School of Health and Society, University of Salford, Salford
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Brown F, Sanders I, Watkins R, Grey E, Smith P, Springett D, Welsh T, Gillison F. "A disembodied voice over the telephone": a qualitative study of healthcare practitioners' experiences in geriatric medicine. BMC Geriatr 2023; 23:270. [PMID: 37142989 PMCID: PMC10159677 DOI: 10.1186/s12877-023-03909-y] [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: 05/27/2022] [Accepted: 03/20/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES This study explored the experience of delivering care remotely among practitioners in a UK geriatric medicine clinic. METHODS Nine semi-structured interviews were conducted with consultants (n = 5), nurses (n = 2), a speech and language and an occupational therapist, and thematically analysed. RESULTS Four themes developed; Challenges of remote consultations; Perceived advantages of remote consultations; Disruption of involvement of family members; Impact on care staff. Participants felt that rapport and trust had been more feasible to develop remotely than they had anticipated, although this was more challenging for new patients and those with cognitive or sensory impairments. While practitioners identified advantages of remote consultations, including involving relatives, saving time, and reducing anxiety, they also experienced disadvantages such as consultations feeling like a 'production line', missing visual cues and reduced privacy. Some participants felt their professional identity was threatened by the lack of face-to-face contact, linked to feeling that remote consultations are not suitable for frail older adults or those with cognitive deficits. DISCUSSION Staff perceived barriers to remote consultations that went beyond practical concerns, and suggest support for building rapport, involving families, and protecting clinician identity and job satisfaction may be warranted.
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Affiliation(s)
- Frankie Brown
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | | | - Ross Watkins
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Elisabeth Grey
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Paula Smith
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | | | - Tomas Welsh
- Research Institute for the Care of Older People, RICE, Royal United Hospitals Bath NHS Foundation Trust, Bath, BA1 3NG, UK
| | - Fiona Gillison
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
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Islam S, Sanchez AL, McDermott CL, Clapp D, Worley J, Becker-Haimes EM. To Proceed Via Telehealth or Not? Considerations for Pediatric Anxiety and Related Disorders Beyond COVID-19. COGNITIVE AND BEHAVIORAL PRACTICE 2023:S1077-7229(23)00033-0. [PMID: 37363367 PMCID: PMC10028349 DOI: 10.1016/j.cbpra.2023.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/28/2023] [Indexed: 03/23/2023]
Abstract
The COVID-19 pandemic accelerated a widespread shift to telehealth among mental health professionals to prioritize both providers' and clients' safety. Telehealth is likely here to stay; however, there is limited practical guidance for clinicians about how to make decisions regarding who should proceed with care via telehealth versus in-person. There also is virtually no data on the effectiveness of hybrid approaches to care; yet this can be an attractive option with potential clinical benefit. This paper provides practice-informed guidance to support shared clinical decision-making between clinicians and families to decide whether to engage in therapy services in-person or via telehealth. We specifically focus on decision-making guidance relevant for youth with anxiety or related disorders, given the unique implications of telehealth for these youth. Guided by the three-legged stool of evidence-based practice, we discuss how clinicians can use principles of shared decision-making to inform clinical recommendations about treatment modality.
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Affiliation(s)
- Samiha Islam
- University of Pennsylvania and Hall Mercer Community Mental Health, University of Pennsylvania Health System
| | - Amanda L Sanchez
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, George Mason University, and University of Pennsylvania
| | - Cassidy L McDermott
- University of Pennsylvania and Hall Mercer Community Mental Health, University of Pennsylvania Health System
| | - Douglas Clapp
- Hall Mercer Community Mental Health, University of Pennsylvania Health System and LaSalle University
| | - Julie Worley
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, and University of Pennsylvania
| | - Emily M Becker-Haimes
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, and University of Pennsylvania
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Avila FR, Carter RE, McLeod CJ, Bruce CJ, Guliyeva G, Torres-Guzman RA, Maita KC, Ho OA, TerKonda SP, Forte AJ. The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation. Diagnostics (Basel) 2023; 13:diagnostics13061165. [PMID: 36980474 PMCID: PMC10047211 DOI: 10.3390/diagnostics13061165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients' risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation.
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Affiliation(s)
- Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Christopher J McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Charles J Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Gunel Guliyeva
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Olivia A Ho
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Sarvam P TerKonda
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
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[Photo-based examination for diabetic eye pathologies in a German ophthalmological practice without personal doctor-patient contact]. DIE OPHTHALMOLOGIE 2023; 120:301-308. [PMID: 36169715 DOI: 10.1007/s00347-022-01737-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND An increasing number of patients suffering from diabetes require regular ophthalmological check-ups to diagnose and/or treat potential diabetic retinal disease. Some countries have already implemented systematic fundus assessments including artificial intelligence-based programs in order to detect sight-threatening retinopathy. The aim of this study was to improve the detection of diabetic fundus changes in Germany without examination by a doctor and to create an easy access to ophthalmological examinations. MATERIAL AND METHODS In this prospective monocentric study 93 patients in need for a routine check-up for diabetic retinopathy were included. The study participants took up an offer of an examination (visual examination, non-mydriatic camera-based fundus examination) without doctor-patient contact. Patient satisfaction with the organization and examinations was assessed using a questionnaire. RESULTS The mean age was 53.5 years (SD 13.6 years, 49.5% female) and 17 eyes (18.3%) showed a diabetic retinopathy which was detected using a camera-based examination. Within the small sample, no patient had to repeat the examination due to poor image quality. All categories of the questionnaire showed a good to very good satisfaction, indicating a high acceptance of the other examination form that took place at the ophthalmologist's premises. CONCLUSION In our study in an ophthalmological practice a high level of acceptance among the patients interested in the screening for diabetic retinopathy without any direct patient-doctor contact was achieved. Our study shows a very good acceptance and feasibility. Future use of artificial intelligence in clinical practice may help to be able to screen many more patients as in this study imaging quality was very good.
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Elliott J, Fernandes L, Watson M. Maintaining face-to-face appointments in asthma care. J Asthma 2023; 60:421. [PMID: 35315737 DOI: 10.1080/02770903.2022.2056700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Josephine Elliott
- Department of Paediatrics, Imperial College Healthcare NHS Trust, LondonUK
| | | | - Mando Watson
- Department of Paediatrics, Imperial College Healthcare NHS Trust, LondonUK
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Rachagan N, Szabo RA, Rio I, Rees F, Hiscock HM, Hickey M. Video telehealth to manage menopausal symptoms after cancer: a prospective study of clinicians and patient satisfaction. Menopause 2023; 30:143-148. [PMID: 36696638 DOI: 10.1097/gme.0000000000002101] [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: 01/27/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate clinician and patient satisfaction with a novel video conferencing telehealth (VCT) service and barriers to use. METHODS A prospective observational study (2018-2020) of a statewide VCT service using healthdirect was performed. Participants were clinicians and patients from the Menopausal Symptoms After Cancer service. Patients were cancer survivors aged 20 to 70 years referred to the Menopausal Symptoms After Cancer service to manage early menopause/menopausal symptoms or women at high inherited risk of cancer due to pathogenic gene variants, such as BRCA1/2 between September 2018 and May 2020. Data were analyzed descriptively. The main outcome measures for clinicians were clinician satisfaction and ease of use, duration of consultation, patient rapport and standard of care, and future intention to use VCT. Outcome measures for patients were reasons for choosing telehealth, preferred devices, ease of use, perceived benefits and standard of care, and future intention to use VCT. RESULTS Data were available from 109 complete clinician surveys. Overall satisfaction was high (93%), but 32% reported technical difficulties and 42% found VCT distracting. Most reported that standard of care (91%), consultation duration (93%), and patient rapport (73%) were unaffected and 97% would use VCT again for patients not requiring examination. From 35 complete patient surveys, saving travel time and cost were the main reasons for choosing VCT (57%) and for convenience (31%). Most found the platform easy to use (83%) and were comfortable with the technology (83%) without technical difficulties (89%). All found the platform easier and less time consuming than in-person appointments. Most believed that the standard of care received was equivalent to an in-person consultation (94%), were satisfied with the consultation (97%), and would choose VCT again (97%). CONCLUSIONS Clinician and patient satisfaction with VCT was high and clinical standards were maintained. However, technical difficulties and distractions were common for clinicians despite training.
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Affiliation(s)
| | | | - Ines Rio
- Royal Women's Hospital, Melbourne, VIC, Australia
| | - Faith Rees
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Zammit AP, Brown I, Hooper JD, Clark DA, Riddell AD. Malignant polyps in the COVID-19 era: a population-based analysis. ANZ J Surg 2023; 93:932-938. [PMID: 36692251 DOI: 10.1111/ans.18253] [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: 10/01/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Malignant polyps represent the early development of colorectal adenocarcinoma. During 2020, there was widescale rationing of health-care resources in response to the COVID-19 pandemic. In particular there was deferral of some colonoscopy procedures required for timely malignant polyp detection. This study sought to assess how these deferrals affected the diagnosis of malignant polyps. METHODS A population wide analysis was performed of 2079 malignant polyps, diagnosed in Queensland, Australia from 2011 to 2020. A regression analysis, with 95% prediction intervals, was produced to determine whether there was a significant impact on the number of malignant polyps diagnosed in 2020 compared to previous years. Univariate statistical analysis of patient, procedural, and pathological variables was also performed. RESULTS In 2020 there were 211 malignant polyps diagnosed, which was significantly lower than was predicted by the univariate regression analysis (r2 = 0.85, 95% prediction interval: 255.07-323.91, P < 0.001). These malignant polyps were less likely to be diagnosed in a private setting (P < 0.001), and exhibited significantly less depth of submucosal invasion (P = 0.017). There was no significant difference in the management strategy (polypectomy, resection or trans-anal resection) between 2011 and 2019 and 2020. CONCLUSION Because of the significant decrease in the number of malignant polyps, and the natural history of the disease, it is expected that there will be an increase in more advanced colorectal adenocarcinomas presenting in 2021 and beyond. This has implications for healthcare resources, particularly in light of the ongoing strain on health departments as a result of the COVID-19 pandemic.
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Affiliation(s)
- Andrew P Zammit
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ian Brown
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Envoi Specialist Pathologists, Brisbane, Queensland, Australia.,Department of Surgical and Perioperitive Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - John D Hooper
- Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - David A Clark
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Surgical and Perioperitive Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine and Health, University of Sydney and Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia.,Department of Surgery, St Vincent's Private Hospital Northside, Brisbane, Queensland, Australia
| | - Andrew D Riddell
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Surgery, Redcliffe Hospital, Redcliffe, Queensland, Australia
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Makhecha S, Eftychiou L, Tsang V, Vas V, Christiansen N, Crook J, Bentley S. Patient and family perceptions of the provision of medicines as part of virtual outpatient consultations for children during COVID-19 pandemic. BMJ Open Qual 2022; 11:bmjoq-2022-001916. [PMID: 36572442 PMCID: PMC9805823 DOI: 10.1136/bmjoq-2022-001916] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 12/04/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To evaluate (1) views and perceptions of patients/parents/carers and healthcare professionals on the medicines optimisation (MO) process following virtual outpatient clinic (VOC) during the COVID-19 pandemic and (2) the processes introduced at this time, identifying areas for improvements and suggest potential solutions. DESIGN A mixed-methods service evaluation using qualitative and quantitative methods of the MO pathway in children aged 0-18 years following VOC across three specialist children's units.Semi-structured interviews were conducted over the telephone with the participants exploring their experiences and categorised into themes.Process mapping sessions with the multidisciplinary team identified areas for improvement and an ease impact framework developed for potential solutions.Outcome measures included: (1) themes from interviews, (2) patients satisfaction rates, (3) process maps and (4) development of a simplified future process. RESULTS One hundred and twenty-five patients' families were contacted: 71 families consented to participate and their views were categorised into four main themes: (1) patient experience, (2) communication, (3) need for virtual video consultations for patient education by hospital pharmacists and (4) need for electronic processes to send prescriptions to local pharmacies.Median patient satisfaction rate was 96% (range 67%-100%). The convenience of receiving medications directly to patient's homes; access to medicines information helplines and education provided by pharmacists were regarded as valuable. Communication between care providers, development of virtual video consultations by hospital pharmacists and electronic transfer of some prescriptions directly to community pharmacies were identified as areas of improvement. CONCLUSIONS Participants appreciated the pharmacy processes adopted during the pandemic, however, challenges and recommendations for improvement in delivering MO VOC were identified. As digital innovations evolve within the NHS, future research should focus on integrated care and improved communication between care providers with selected medications prescribed directly to community pharmacies using electronic prescription service, with clinical screening and education provided by hospital pharmacists.
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Affiliation(s)
- Sukeshi Makhecha
- Pharmacy, Royal Brompton and Harefield Hospitals, London, UK,Pharmacy, Evelina London Children's Hospital, London, UK
| | | | - Victoria Tsang
- Pharmacy, Royal Brompton and Harefield Hospitals, London, UK,Pharmacy, Evelina London Children's Hospital, London, UK
| | - Venessa Vas
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | | | | | - Siân Bentley
- Pharmacy, Royal Brompton and Harefield Hospitals, London, UK
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Ulloa M, Rothrock B, Ahmad FS, Jacobs M. Invisible clinical labor driving the successful integration of AI in healthcare. FRONTIERS IN COMPUTER SCIENCE 2022. [DOI: 10.3389/fcomp.2022.1045704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Artificial Intelligence and Machine Learning (AI/ML) tools are changing the landscape of healthcare decision-making. Vast amounts of data can lead to efficient triage and diagnosis of patients with the assistance of ML methodologies. However, more research has focused on the technological challenges of developing AI, rather than the system integration. As a result, clinical teams' role in developing and deploying these tools has been overlooked. We look to three case studies from our research to describe the often invisible work that clinical teams do in driving the successful integration of clinical AI tools. Namely, clinical teams support data labeling, identifying algorithmic errors and accounting for workflow exceptions, translating algorithmic output to clinical next steps in care, and developing team awareness of how the tool is used once deployed. We call for detailed and extensive documentation strategies (of clinical labor, workflows, and team structures) to ensure this labor is valued and to promote sharing of sociotechnical implementation strategies.
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Ditwiler RE, Swisher LL, Hardwick DD. Doing things you never imagined: Professional and ethical issues in the U.S. outpatient physical therapy setting during the COVID-19 pandemic. Musculoskelet Sci Pract 2022; 62:102684. [PMID: 36356408 PMCID: PMC9617680 DOI: 10.1016/j.msksp.2022.102684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Despite being the most prevalent physical therapy practice setting in the United States, no literature to date has examined the professional and ethical issues faced by outpatient physical therapists during the COVID-19 pandemic. The purpose of this study was to explore professional and ethical issues experienced by outpatient physical therapists in the United States during the COVID-19 pandemic. DESIGN An explorative semi-structured interview study using reflexive thematic analysis METHODS: Virtual semi-structured interviews explored physical therapists' experiences during COVID-19 in the OP setting. Data was analyzed using reflexive thematic analysis as described by Braun and Clarke. RESULTS Respondents worked predominantly with patients with orthopaedic impairments. Six primary themes and associated subthemes were identified: 1) Disruption of routine professional and personal life. 2) Negative impacts on health and wellbeing (physical, mental, and social). 3) Barriers to relationships, communication, and providing quality care. 4) Telehealth as a safe option to increase access with opportunities and challenges. 5) Discomfort practicing in an environment of misinformation, mistrust, and divisiveness. 6) New & pre-existing ethical issues in the COVID-19 context. CONCLUSIONS Results of this study indicate that physical therapists in the outpatient setting wrestled with critical questions regarding outpatient physical therapy practice during the COVID-19 pandemic: the role of touch in professional identity, challenges to the therapeutic alliance, effect of productivity and fiscal expectations and whether outpatient physical therapy is essential during public emergencies.
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Affiliation(s)
- Rebecca Edgeworth Ditwiler
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, USF Health Morsani College of Medicine, Tampa, FL, USA.
| | - Laura Lee Swisher
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Dustin Dean Hardwick
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, USF Health Morsani College of Medicine, Tampa, FL, USA,School of Physical Therapy, University of the Incarnate Word, San Antonio, TX, USA
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Moayed MS, Khalili R, Ebadi A, Parandeh A. Factors determining the quality of health services provided to COVID-19 patients from the perspective of healthcare providers: Based on the Donabedian model. Front Public Health 2022; 10:967431. [PMID: 36518581 PMCID: PMC9742228 DOI: 10.3389/fpubh.2022.967431] [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: 06/12/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives The present study aims to explain factors determining the quality of health services provided to COVID-19 patients from the perspective of healthcare providers based on the Donabedian model. Method This qualitative study was conducted at a referral hospital on COVID-19 patients in Tehran, in 2020. The data were collected through individual and semi-structured interviews from 20 participants using the purposive sampling method. Besides, data analysis was conducted simultaneously using the directed content analysis method. Results Data analysis results produced 850 primary codes in three predetermined categories of the Donabedian model, including the structure (organizational readiness and continuous training), the process (effective management and leadership, safe care, and comprehensive care measures) and outcomes (professional excellence, quantitative and qualitative improvements in hospital services, and acceptability of healthcare professionals). Conclusion The results of this study can help managers better understand how a public health crisis affects the structure of organizations providing care and treatment, quality of treatment processes in the organization, and the consequences. In addition, this study can be used as a model for optimizing the structures and processes to improve outcomes.
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Affiliation(s)
- Malihe Sadat Moayed
- Trauma Research Center, Nursing Faculty, Baqiyatallah University Medical of Science, Tehran, Iran
| | - Robabe Khalili
- Behavioral Sciences Research Center, Nursing Faculty, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Nursing Faculty, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Akram Parandeh
- Department of Community Health, Medicine, Quran and Hadith Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran,*Correspondence: Akram Parandeh
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K E, L R, G W, F F, S M, C W, DA B. The use of video consultations to support orthopedic patients' treatment at the interface of a clinic and general practitioners. BMC Musculoskelet Disord 2022; 23:968. [PMID: 36348332 PMCID: PMC9640897 DOI: 10.1186/s12891-022-05909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 10/25/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Video consultations have proven to be a powerful support tool for patient–doctor interactions in general, not only during the COVID-19 pandemic. This study analyzed the feasibility and usefulness of orthopedic telemedical consultations (OTCs) for orthopedic patients at the interface of a clinic and general practitioners. Methods The study was carried out at an orthopedic department of a German hospital between April 2020 and October 2020. After written informed consent was obtained, general practitioners (GPs) of a large adjunct health region could present their patients with orthopedic pathologies to specialists at the hospital via OTCs instead of the usual live consultation (LC). The patients, specialists and GPs were evaluated for their OTC experience and attitude (5-point Likert-scale and open questions, 19 to 27 items). Results A total of 89 video consultations took place with 76 patients, 16 GPs and six specialists. The average distance between the GPs/patients and the hospital was 141.9 km. The OTCs were rated as pleasant, and the experience was rated as very satisfying (average Likert-Scale rating, with 5 as strong agreement: specialists = 4.8; GPs = 4.9; patients = 4.7). Following the OTC, a LC was not necessary in 76.4% of cases. Patients with a necessary LC after an OTC showed significantly lower satisfaction with the OTC (p = 0.005). Time savings, the elimination of travel and quick contact with orthopedic consultants were positively highlighted by the participants. A total of 123 recommendations for further treatment were given, such as the initiation of physiotherapy/medication and the use of imaging diagnostics. Different technical and organizational challenges could be identified and addressed. Discussion The vast majority of the participants stated they had a very positive impression. In particular, the potential savings in travel and time as well as straightforward contact with specialists were rated positively. However, limitations in the assessment of initial presentations of complex medical conditions were also highlighted. Further studies on OTCs with a consultative health professional may show other fields of use for this mode of interdisciplinary remote communication. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05909-2.
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