Virtual care to increase military medical centre capacity in the primary health care setting: A prospective self-controlled pilot study of symptoms collection and telemedicine

Accuracy of Dental Symptom Checker Web Application in the Singapore Military Population

PURPOSE

Symptom checkers (SCs) are virtual health aids to assist laypersons in self-assessing dental complaints. This study aimed to investigate the triage performance, clinical efficacy, and user-perceived utility of a prototype dental SC, Toothbuddy, in assessing unscheduled dental complaints in Singapore.

METHODS

A pilot trial was conducted amongst all unscheduled dental attendees to military dental facilities in Singapore from January to May 2023. The accuracy of Toothbuddy to tele-triage dental conditions into 3 categories-routine, urgent, and emergency-was determined. Based on the patient-reported symptoms input, clinical recommendations were provided to users for each category. Thereafter, all dental attendees were clinically assessed to determine the definitive category. Finally, a user questionnaire assessed the application's functionality and utility and the user's satisfaction. Sensitivity and specificity analyses were performed.

RESULTS

During the study, 588 patients with unscheduled dental visits presented. Of these cases, 275 (46.8%) were evaluated to be routine dental conditions for which treatment could be delayed or self-managed, 243 (41.3%) required urgent dental care, and 60 (10.2%) required emergency dental intervention. The accuracy of Toothbuddy in identifying the correct category was 79.6% (468/588). Sensitivity and specificity in categorising routine vs non-routine conditions were 94.5% (95% confidence interval, 92.0%-97.1%) and 74.0% (95% confidence interval, 68.8%-79.2%), respectively. The app was generally well received and rated highly.

CONCLUSIONS

Preliminary data suggest that Toothbuddy can perform accurate dental self-assessment for a suitable range of common dental concerns and this is a promising platform for virtual advice on spontaneous dental issues. Furthermore, dental facilities are typically not sized to handle the large volumes of unplanned dental visits that may occur in the military population. SC apps to self-manage or delay treatment without adversely affecting disease prognosis may preserve the limited bandwidth of dental facilities in providing acute care and managing true dental emergencies expediently.

Military Doctors' and Nurses' Perceptions of Telemedicine and the Factors Affecting Use Intention

Purpose: This study investigated military doctors' and nurses' perceptions of telemedicine and the factors influencing their intention to use it based on the unified theory of acceptance and use of technology. Method: This study adopted a questionnaire-based, cross-sectional descriptive approach. It used a web questionnaire for data collection over a 5-week period, starting in June 2021. Results: A total of 72.6% of participants indicated that telemedicine is required in the military. The intention to use telemedicine was significantly higher among women, younger individuals (<30 years), and military nurses. In addition, factors such as voluntariness of use, performance expectancy, social influence, and facilitating conditions positively affected the intention to use telemedicine. Conclusions: To improve military doctors' and nurses' use and understanding of telemedicine, consensus must be reached regarding its use in military contexts. Discussions that incorporate opposing views should be encouraged as well. Moreover, the voluntariness of use significantly affected respondents' intention to use telemedicine. There is an urgent need, therefore, for in-depth analyses of the various factors associated with voluntariness of use of telemedicine; the resulting insights could be used to encourage military doctors and nurses to adopt telemedicine. Finally, along with promoting the use of smartphones for medical consultation among military personnel, military nurses' role should be extended to include health consultation using smartphones. This could promote the active use of telemedicine in military nursing, which could contribute to health promotion among military personnel.

The Impact of Virtual Consultations on the Quality of Primary Care: Systematic Review

BACKGROUND

The adoption of virtual consultations, catalyzed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality.

OBJECTIVE

This study aims to evaluate the impact of virtual consultations on the quality of primary care.

METHODS

A total of 6 databases were searched. Studies that evaluated the impact of virtual consultations, for any disease, were included. Title and abstract screening and full-text screening were performed by 2 pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed.

RESULTS

In total, 30 studies (5,469,333 participants) were included in this review. Our findings suggest that virtual consultations are equally effective to or more effective than face-to-face care for the management of certain conditions, including mental illness, excessive smoking, and alcohol consumption. Overall, 4 studies indicated positive impacts on some aspects of patient-centeredness; however, a negative impact was noted on patients' perceived autonomy support (ie, the degree to which people perceive those in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care settings. Evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities among other subgroups depending on contextual factors.

CONCLUSIONS

Our systematic review demonstrated that virtual consultations may be as effective as face-to-face care and have a potentially positive impact on the efficiency and timeliness of care; however, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centeredness, highlighting areas where future research efforts should be devoted. Capitalizing on real-world data, as well as clinical trials, is crucial to ensure that the use of virtual consultations is tailored according to patient needs and is inclusive of the intended end users. Data collection methods that are bespoke to the primary care context and account for patient characteristics are necessary to generate a stronger evidence base to inform future virtual care policies.

A Systematic Implementation of Telemedicine in Singapore's COVID-19 Community Recovery Facilities

Introduction: This article describes the experience of the Singapore Armed Forces (SAF) implementing telemedicine consultations for COVID-19-positive patients recovering within community recovery facilities (CRFs) in a semi-inpatient setting. Materials and Methods: The SAF adopted a systematic approach to telemedicine implementation and scaling up, with Phase 1 being the deployment of medical teams operating on-site clinics daily at six CRFs and telemedicine only provided for after-hours medical consultations on an ad hoc basis. Subsequently in Phase 2, most clinical consultations in the CRFs were conducted virtually. Results: Phases 1 and 2 recorded 1,902 and 449 clinical consultations, respectively. The mean number of clinical encounters was 33 per 1,000 occupants per day in Phase 1, and 12 per 1,000 occupants per day in Phase 2 (p < 0.001). Acute respiratory illness (52.3% in Phase 1 and 46.7% in Phase 2) was the most common reason for consultations. With full telemedicine in Phase 2, there was reduction in the mean number of clinical encounters per 1,000 occupants per day (p = 0.001), lower man-hours in personal protective equipment (PPE) (p < 0.001), and rise in escalation of care (p < 0.001) but without adverse events reported. Conclusions: Telemedicine for patients was safe, improved medical manpower efficiency, and reduced man-hours in PPE. The increased escalation of care in Phase 2 due to the lack of physical examination capabilities was to be expected to ensure patients' safety. Overall, it is recommended that for stable and mild medical conditions, telemedicine is a viable, safe, and efficient health care delivery tool in crisis situations similar to COVID-19.

COVID-19 Assessment and Testing in Rural Communities During the Pandemic: A Cross Sectional Analysis

Background

The COVID-19 pandemic exacerbated the need for urgent improvements in access to health care for rural, remote, and underserviced communities. The Renfrew County Virtual Triage and Assessment Centre (VTAC) was designed to provide access to COVID-19 testing and assessment with a family physician. The goal was to protect emergency departments and 911 paramedics while ensuring that nobody was left at home, suffering in silence. Residents were encouraged to call their own family physician for any urgent health needs. If they did not have a family physician or could not access their usual primary care provider, then they could call VTAC. This study reports on the output of a service model offering access to assessment and COVID-19 testing through a blend of virtual and in-person care options by a multidisciplinary team.

Objective

The purpose of this study was to assess the ability of VTAC to provide access to COVID-19 assessment and testing across rural, remote, and underserviced communities.

Methods

We conducted a cross-sectional analysis of the data derived from the cases handled by VTAC between March 27, 2020 (launch day), and September 30, 2020.

Results

Residents from all 19 census subdivisions and municipalities of Renfrew County accessed VTAC. A total of 10,086 family physician assessments were completed (average 64 per day). Of these, 8535 (84.6%) assessments were to unique patient users. Thirty physicians provided care. Using digital equipment setup in the patients’ home, 31 patients were monitored remotely. VTAC community paramedics completed 14,378 COVID-19 tests and 3875 home visits.

Conclusions

Renfrew County’s experience suggests that there is tremendous synergy between family physicians and community paramedics in providing access to COVID-19 assessment and COVID-19 testing. The blended model of virtual and in-person care is well suited to provide improved access to other aspects of health care post pandemic, particularly for patients without a family physician.