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Grant H, Skamagki G. Clinicians' perspectives on remote patient management: A qualitative exploration of physiotherapists using the DiAL (Direct Access Line) programme. Musculoskelet Sci Pract 2024; 73:103132. [PMID: 39024739 DOI: 10.1016/j.msksp.2024.103132] [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: 01/16/2024] [Revised: 06/06/2024] [Accepted: 06/30/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND In response to the COVID-19 pandemic, face-to-face consultations within healthcare settings were suspended. Remote consultations became crucial for managing musculoskeletal conditions alongside Patient Initiated Follow-ups, leading to the development of the DiAL programme at a large National Health Service Community Trust. Previous research has focused on quantitative data, little is known about staff experiences with this programme. OBJECTIVES To explore the perceptions and opinions of physiotherapy staff using DiAL, in order to highlight the benefits and challenges of this service with identification of areas for future development. DESIGN Qualitative focus groups. METHODS Two virtual focus groups were conducted via Microsoft Teams, involving a purposive sample of physiotherapy staff in the musculoskeletal services known to have used DiAL. Thematic analysis was conducted. RESULTS Ten clinicians participated in the study, generating two main themes: Clinician Autonomy and Institutional Needs. These themes encompassed several subthemes. CONCLUSIONS Clinicians reported higher job satisfaction and improved accessibility for patients, attributing these positive outcomes to the autonomy and flexibility provided by the platform. While the programme met National Health Service targets for Patient Initiated Follow-ups, there was a desire for ongoing improvements and a recognition that previous audits failed to capture all the benefits. DiAL serves as a treatment choice, supporting evidence on the advantages of remote consultations and contributing to the National Health Services' goal of reducing its carbon footprint. There is a collective desire for the platform to continue with future recommendations including expanding its use and exploring additional audit metrics.
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Affiliation(s)
- Heather Grant
- Midland Partnership University NHS Foundation Trust, UK.
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Melman A, Vella SP, Dodd RH, Coombs DM, Richards B, Rogan E, Teng MJ, Maher CG, Ghinea N, Machado GC. Clinicians' Perspective on Implementing Virtual Hospital Care for Low Back Pain: Qualitative Study. JMIR Rehabil Assist Technol 2023; 10:e47227. [PMID: 37988140 DOI: 10.2196/47227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/02/2023] [Accepted: 09/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Alternate "hospital avoidance" models of care are required to manage the increasing demand for acute inpatient beds. There is currently a knowledge gap regarding the perspectives of hospital clinicians on barriers and facilitators to a transition to virtual care for low back pain. We plan to implement a virtual hospital model of care called "Back@Home" and use qualitative interviews with stakeholders to develop and refine the model. OBJECTIVE We aim to explore clinicians' perspectives on a virtual hospital model of care for back pain (Back@Home) and identify barriers to and enablers of successful implementation of this model of care. METHODS We conducted semistructured interviews with 19 purposively sampled clinicians involved in the delivery of acute back pain care at 3 metropolitan hospitals. Interview data were analyzed using the Theoretical Domains Framework. RESULTS A total of 10 Theoretical Domains Framework domains were identified as important in understanding barriers and enablers to implementing virtual hospital care for musculoskeletal back pain. Key barriers to virtual hospital care included patient access to videoconferencing and reliable internet, language barriers, and difficulty building rapport. Barriers to avoiding admission included patient expectations, social isolation, comorbidities, and medicolegal concerns. Conversely, enablers of implementing a virtual hospital model of care included increased health care resource efficiency, clinician familiarity with telehealth, as well as a perceived reduction in overmedicalization and infection risk. CONCLUSIONS The successful implementation of Back@Home relies on key stakeholder buy-in. Addressing barriers to implementation and building on enablers is crucial to clinicians' adoption of this model of care. Based on clinicians' input, the Back@Home model of care will incorporate the loan of internet-enabled devices, health care interpreters, and written resources translated into community languages to facilitate more equitable access to care for marginalized groups.
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Affiliation(s)
- Alla Melman
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Simon P Vella
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Rachael H Dodd
- The Daffodil Centre, Faculty of Medicine and Health, a joint venture between The University of Sydney and Cancer Council New South Wales, Sydney, Australia
| | - Danielle M Coombs
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Bethan Richards
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- Rheumatology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Min Jiat Teng
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- RPA Virtual Hospital, Sydney, Australia
| | - Chris G Maher
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Narcyz Ghinea
- Department of Philosophy, Macquarie University, Sydney, Australia
| | - Gustavo C Machado
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
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Kaloty K, Rudecki J, Craine V, Moyes A, Armstrong R, Baxter M, Hunter J, Mustafa N, Grant G, Vader K, Bosma R. Virtual care exercise interventions in multidisciplinary chronic pain clinics: a qualitative study of perspectives of adults living with chronic pain. Disabil Rehabil 2023; 45:2976-2983. [PMID: 36073755 DOI: 10.1080/09638288.2022.2117864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/04/2022] [Accepted: 08/20/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Chronic pain affects 1 in 4 Canadians and is a leading contributor of disability. Although virtual care has become more prevalent, it is unclear how adults living with chronic pain perceive virtual delivery of exercise interventions within multidisciplinary chronic pain clinics (MCPC). This study explores the perspectives of adults living with chronic pain regarding their perceived barriers and facilitators and recommendations when implementing virtual care exercise interventions within MCPCs. METHODS We conducted an interpretive description qualitative study based on semi-structured interviews with adults (age ≥18 years) living with chronic pain from a MCPC in Toronto, Canada, between March 1 and April 30, 2021. RESULTS We completed fifteen (N = 15) interviews of adults living with chronic pain. We identified eight themes that addressed the study objectives: 1) virtual care supplements in-person care, 2) virtual care improves accessibility, 3) impact of technology on participation, 4) navigating the home environment, 5) impact of pain on participation, 6) impact of supervision and feedback, 7) the need for tailored care, and 8) the need for preparation and additional support. CONCLUSION Our results reveal that adults living with chronic pain view virtual care exercise interventions positively however, the implementation of these interventions must be carefully considered within MCPCs. Specifically, virtual care was considered an excellent adjunct to in-person care but should not replace it completely.Implications for RehabilitationChronic pain is a leading contributor of disability.Exercise interventions are recommended component of comprehensive pain management.Virtual delivery of exercise interventions are becoming more prevalent.Adults living with chronic pain view virtual care exercise interventions positively as they can supplement in-person care and improve access to this type of care.
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Affiliation(s)
- Kiren Kaloty
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Julia Rudecki
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Vanessa Craine
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Alexander Moyes
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Robert Armstrong
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Megan Baxter
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Judith Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Nida Mustafa
- Toronto Academic Pain Medicine Institute (TAPMI), Women's College Hospital, Toronto, Canada
| | - Gillian Grant
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Toronto Academic Pain Medicine Institute (TAPMI), Women's College Hospital, Toronto, Canada
| | - Kyle Vader
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Rachael Bosma
- Toronto Academic Pain Medicine Institute (TAPMI), Women's College Hospital, Toronto, Canada
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Buscemi V, Chicken J, Mahy T, Knight L, Scott W. An updated audit of the patient selection process for pain management programmes in a speciality care service before and during the COVID-19 pandemic. Br J Pain 2023; 17:226-238. [PMID: 37337591 PMCID: PMC9791070 DOI: 10.1177/20494637221147200] [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] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The provision of pain management programmes (PMPs) changed substantially in response to the COVID-19 pandemic with virtual delivery implemented in many services. Little is known about patient selection processes for virtual PMPs and how this might differ from in-person programmes. The aim of this audit was to document the patient selection process for PMPs at a speciality pain service prior to and during the pandemic. METHODS This retrospective audit used data from consecutive patients attending a multidisciplinary assessment to determine the suitability of a PMP. Anonymized data were extracted from assessment letters and hospital records in the months prior to the pandemic (n =168) and during the start of the pandemic once the service began delivering virtual PMPs (n =171). RESULTS For the standard pain management pathway, most patients were offered a PMP option within the service before and during the pandemic, although a greater proportion of patients were offered treatment during the pandemic. For the neuromodulation pathway, most patients were offered a pre-neuromodulation PMP option, and this was similar before and during the pandemic. Psychosocial complexities and unwillingness to engage in a pain management approach that does not principally focus on pain reduction were the most common reasons that patients were not offered a programme. DISCUSSION This audit points to a pattern of more inclusive assessment outcomes within our service over time and particularly during the pandemic. Offering a range of in-person and virtual PMPs can meet a wider range of patient need. Research is needed to understand how to best assess and match patients with the breadth of treatment delivery formats now available.
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Affiliation(s)
- Valentina Buscemi
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Joe Chicken
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Tim Mahy
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Lucie Knight
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Whitney Scott
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
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Gupta L, Najm A, Kabir K, De Cock D. Digital health in musculoskeletal care: where are we heading? BMC Musculoskelet Disord 2023; 24:192. [PMID: 36918856 PMCID: PMC10012296 DOI: 10.1186/s12891-023-06309-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
BMC Musculoskeletal Disorders launched a Collection on digital health to get a sense of where the wind is blowing, and what impact these technologies are and will have on musculoskeletal medicine. This editorial summarizes findings and focuses on some key topics, which are valuable as digital health establishes itself in patient care. Elements discussed are digital tools for the diagnosis, prognosis and evaluation of rheumatic and musculoskeletal diseases, coupled together with advances in methodologies to analyse health records and imaging. Moreover, the acceptability and validity of these digital advances is discussed. In sum, this editorial and the papers presented in this article collection on Digital health in musculoskeletal care will give the interested reader both a glance towards which future we are heading, and which new challenges these advances bring.
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Affiliation(s)
- Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.,City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.,Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Aurélie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Sir Graeme Davies Building Level 4, Glasgow, UK.,NHS Royal Alexandra Hospital, Glasgow, UK
| | - Koroush Kabir
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Diederik De Cock
- Biostatistics and Medical Informatics Research Group, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium.
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Haines KJ, Sawyer A, McKinnon C, Donovan A, Michael C, Cimoli C, Gregory M, Berney S, Berlowitz DJ. Barriers and enablers to telehealth use by physiotherapists during the COVID-19 pandemic. Physiotherapy 2023; 118:12-19. [PMID: 36308980 PMCID: PMC9450484 DOI: 10.1016/j.physio.2022.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/07/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate the perceived barriers and enablers experienced by physiotherapists whilst delivering community and outpatient services during the COVID-19 pandemic. METHODS Qualitative study undertaken at a University-affiliated hospital in Melbourne, Australia. Physiotherapists working in the outpatient setting participated in a semi-structured interview. Interviews were analysed using Framework Analysis, with themes mapped to the Theoretical Domains Framework (TDF). RESULTS From 19 interviews, we identified major themes and mapped these to the TDF domains: 1. The pandemic rapidly closed the knowledge-practice gap; 2. Adaptation of existing skills and integration of new skills were required; 3. Supportive senior leadership helped the transition; 4. Capabilities and confidence improved with time; 5. Environmental factors were crucial to success or failure of telehealth; 6. Access to and delivery of care improved for some; 7. Identification of appropriate patients and future hybrid models of care; 8. Changes in work practices, role certainty and identity; 9. Development of educational resources consolidated knowledge; 10. Socialisation of telehealth and optimism for the future. Within each domain, key barriers and enablers were also identified. CONCLUSIONS The findings of this study suggest that the delivery of community and outpatient physiotherapy via telehealth during the COVID-19 pandemic was an initial challenge. Growing knowledge, confidence and ability to problem solve barriers enabled physiotherapists to move along the continuum of 'fear' to 'triumph' as the pandemic progressed. These results can be used by clinicians, managers, and academics to guide future workforce planning, hospital environmental design, and service delivery. CLINICAL MESSAGE.
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Affiliation(s)
- Kimberley J. Haines
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia,Department of Critical Care, School of Medicine, The University of Melbourne, Victoria, Australia,Corresponding author at: Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Abbey Sawyer
- Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia,Institute for Breathing and Sleep, Victoria, Australia
| | - Clare McKinnon
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Ashleigh Donovan
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Chris Michael
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Chris Cimoli
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Mel Gregory
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Sue Berney
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - David J. Berlowitz
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia,Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
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Benisha RB. An efficient Sheep Flock Optimization-based hybrid deep RaNN for secure and enhanced video transmission quality. Neural Comput Appl 2023. [DOI: 10.1007/s00521-022-08083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Booth G, Zala S, Mitchell C, Zarnegar R, Lucas A, Gilbert AW. The patient acceptability of a remotely delivered pain management programme for people with persistent musculoskeletal pain: A qualitative evaluation. Br J Pain 2022; 16:581-592. [PMID: 36452127 PMCID: PMC9703243 DOI: 10.1177/20494637221106411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Introduction Remotely delivered pain management programmes have been offered in place of in-person programmes by many chronic pain services since the onset of the COVID-19 pandemic. There is a lack of evidence regarding the acceptability of these programmes. In this evaluation, we have explored patients' acceptability of a remotely delivered pain management programme for patients with persistent musculoskeletal pain. Methods Qualitative data were collected using focus groups with participants who had previously attended the remote pain management programme. Data were analysed using abductive analysis. Results Three focus groups were conducted with a total of 13 participants. The programmme was either entirely acceptable, had some acceptable components or was not acceptable to patients. Factors leading to the programme being acceptable include learning to manage pain from home, receiving high quality care from home, enhancing the potential of rehabilitation using technology, enabling attendance on a pain management programme from home, overcoming social distancing requirements of COVID-19 using technology, and virtual peer support. Factors leading to the programme not being acceptable include having an inappropriate home environment for virtual therapy, communication challenges with virtual therapy, technological issues and concerns regarding the quality of care. Conclusions There is a spectrum of acceptability with respect to the remote programme. The factors that influence this are dynamic, individual and situational. Hybrid programmes have the potential to enhance access to pain management programmes and improve patient experience and programme outcomes in the future.
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Affiliation(s)
- Gregory Booth
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
- Population Health Research Institute, St George’s University of London, UK
| | - Sonia Zala
- School of Health and Social Care, London South Bank University, London, UK
| | - Chloe Mitchell
- Department of Clinical Health Psychology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
- Department of Psychology, Staffordshire University, Stoke-on-Trent, UK
| | - Roxaneh Zarnegar
- Pain Clinic, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Andrew Lucas
- Department of Clinical Health Psychology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
- Department of Psychology, City University of London, UK
| | - Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
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Evering RMH, Postel MG, van Os-Medendorp H, Bults M, den Ouden MEM. Intention of healthcare providers to use video-communication in terminal care: a cross-sectional study. BMC Palliat Care 2022; 21:213. [PMID: 36451219 PMCID: PMC9713136 DOI: 10.1186/s12904-022-01100-5] [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: 02/21/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Interdisciplinary collaboration between healthcare providers with regard to consultation, transfer and advice in terminal care is both important and challenging. The use of video communication in terminal care is low while in first-line healthcare it has the potential to improve quality of care, as it allows healthcare providers to assess the clinical situation in real time and determine collectively what care is needed. The aim of the present study is to explore the intention to use video communication by healthcare providers in interprofessional terminal care and predictors herein. METHODS In this cross-sectional study, an online survey was used to explore the intention to use video communication. The survey was sent to first-line healthcare providers involved in terminal care (at home, in hospices and/ or nursing homes) and consisted of 39 questions regarding demographics, experience with video communication and constructs of intention to use (i.e. Outcome expectancy, Effort expectancy, Attitude, Social influence, Facilitating conditions, Anxiety, Self-efficacy and Personal innovativeness) based on the Unified Theory of Acceptance and Use of Technology and Diffusion of Innovation Theory. Descriptive statistics were used to analyze demographics and experiences with video communication. A multiple linear regression analysis was performed to give insight in the intention to use video communication and predictors herein. RESULTS 90 respondents were included in the analysis.65 (72%) respondents had experience with video communication within their profession, although only 15 respondents (17%) used it in terminal care. In general, healthcare providers intended to use video communication in terminal care (Mean (M) = 3.6; Standard Deviation (SD) = .88). The regression model was significant (F = 9.809, p-value<.001) and explained 44% of the variance in intention to use video communication, with 'Outcome expectancy' (beta .420, p < .001) and 'Social influence' (beta .266, p = .004) as significant predictors. CONCLUSIONS Healthcare providers have in general the intention to use video communication in interprofessional terminal care. However, their actual use in terminal care is low. 'Outcome expectancy' and 'Social influence' seem to be important predictors for intention to use video communication. This implicates the importance of informing healthcare providers, and their colleagues and significant others, about the usefulness and efficiency of video communication.
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Affiliation(s)
- Richard M. H. Evering
- grid.5477.10000000120346234Research group Technology, Health & Care, Saxion, University of Applied Sciences, Enschede, Netherlands
| | - Marloes G. Postel
- grid.5477.10000000120346234Research group Technology, Health & Care, Saxion, University of Applied Sciences, Enschede, Netherlands
| | - Harmieke van Os-Medendorp
- grid.5477.10000000120346234Research group Smart Health, Saxion, University of Applied Sciences, School of Health, Deventer/ Enschede, Netherlands
| | - Marloes Bults
- grid.5477.10000000120346234Research group Technology, Health & Care, Saxion, University of Applied Sciences, Enschede, Netherlands
| | - Marjolein E. M. den Ouden
- grid.5477.10000000120346234Research group Technology, Health & Care, Saxion, University of Applied Sciences, Enschede, Netherlands ,Research group Care and Technology, Regional Community College of Twente, Hengelo, Netherlands
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Dummermuth M, Keller F, Smith L. Experiences of people living with long-term neurological conditions and using telerehabilitation during the COVID-19 lockdown in Switzerland: explorative interviews. PHYSIOSCIENCE 2022. [DOI: 10.1055/a-1771-4789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Background Therapy interventions were disrupted by the first lockdown during the COVID-19 pandemic in Switzerland. An instant change to telerehabilitation had to be implemented by physiotherapists.
Aim Exploration of experiences of individuals living with a long-term neurological condition receiving telerehabilitation physiotherapy interventions during the first lockdown.
Method Persons with a long-term neurological condition were recruited from the outpatient clinic of a local hospital in the German-speaking part of Switzerland during February and March 2021. Semi-structured individual interviews with a phenomenological perspective were audio-recorded, transcribed verbatim and analyzed using reflexive thematic analysis.
Results 4 persons, 2 with multiple sclerosis and 2 with stroke (aged 44–75), were interviewed. There were 3 main themes, of which 2 had 3 subthemes: 1) Living with a neurological condition during a pandemic (daily life without and within a pandemic, symptoms, feelings and attitudes influenced by the pandemic); 2) Therapy experiences (therapeutic relationship, remote therapy, therapy experiences after the first lockdown); and 3) Family and social environment. Synchronous interventions such as live video sessions or live online groups were favored when compared to telephone calls or asynchronous digital interventions. However, for participants, it was equally important to explain how the pandemic influenced them in general.
Conclusion Individuals interviewed appreciated having received therapy during the lockdown, favoring synchronous interventions. However, there are still many unanswered questions about how best to support these populations, and evidence-based recommendations are needed.
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Affiliation(s)
- Monique Dummermuth
- University of the West of England, Bristol, United Kingdom
- Bürgerspital Solothurn, Solothurn, Switzerland
| | | | - Lindsay Smith
- University of the West of England, Bristol, United Kingdom
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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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Glinkowski WM. Orthopedic Telemedicine Outpatient Practice Diagnoses Set during the First COVID-19 Pandemic Lockdown-Individual Observation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5418. [PMID: 35564814 PMCID: PMC9103315 DOI: 10.3390/ijerph19095418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/10/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023]
Abstract
The COVID-19 pandemic has caused a substantial intensification of the telemedicine transformation process in orthopedics since 2020. In the light of the legal regulations introduced in Poland, from the beginning of the SARS-CoV-2 pandemic, physicians, including orthopedic surgeons, have had the opportunity to conduct specialist teleconsultations. Teleconsultations increase epidemiological safety and significantly reduce the exposure of patients and medical staff to direct transmission of the viral vector and the spread of infections. The study aimed to describe diagnoses and clinical aspects of consecutive orthopedic teleconsultations (TC) during the pandemic lockdown. The diagnoses were set according to the International Classification of Diseases (ICD-10). Hybrid teleconsultations used smartphones and obligatory Electronic Health Record (EHR) with supplemental voice, SMS, MMS, Medical images, documents, and video conferencing if necessary. One hundred ninety-eight consecutive orthopedic teleconsultations were served for 615 women and 683 men (mean age 41.82 years ± 11.47 years). The most frequently diagnosed diseases were non-acute orthopedic disorders "M" (65.3%) and injuries "S" (26.3%). Back pain (M54) was the most frequent diagnosis (25.5%). Although virtual orthopedic consultation cannot replace an entire personal visit to a specialist orthopedic surgeon, in many cases, teleconsultation enables medical staff to continue to participate in providing medical services at a sufficiently high medical level to ensure patient and physician. The unified approach to TC diagnoses using ICD-10 or ICD-11 may improve further research on telemedicine-related orthopedics repeatability. Future research directions should address orthopedic teleconsultations' practical aspects and highlight legal, organizational, and technological issues with their implementations.
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Affiliation(s)
- Wojciech Michał Glinkowski
- Center of Excellence “TeleOrto” for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 00-581 Warsaw, Poland;
- Polish Telemedicine and eHealth Society, 03-728 Warsaw, Poland
- Gabinet Lekarski, 03-728 Warsaw, Poland
- Centrum Medyczne PZU Zdrowie, 02-715 Warsaw, Poland
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13
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Walthall H, Schutz S, Snowball J, Vagner R, Fernandez N, Bartram E. Patients' and clinicians' experiences of remote consultation? A narrative synthesis. J Adv Nurs 2022; 78:1954-1967. [PMID: 35362191 PMCID: PMC9321562 DOI: 10.1111/jan.15230] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/09/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
Aims To identify, evaluate and summarize evidence of patient and clinician experiences of being involved in video or telephone consultations as a replacement for in‐person consultations. Design Narrative synthesis. Data sources Medline; EMBASE; EMCARE; CINAHL and BNI. Searching took place from January 2021 to April 2021. Papers included were published between 2013 and 2020. Review Methods Papers were appraised by two independent reviewers for methodological quality. Data extraction was conducted according to the standardized tool from Joanna Briggs Institute. Results Seven qualitative studies were included, from five countries and from the perspective of patients, relatives, administrators, nurses, physiotherapists and physicians. We developed two main themes: Pragmatic Concerns and Therapeutic Concerns. Each theme contained two categories: Pragmatic Concerns: (a) the convenience of non‐face to face consultations; (b) using technology and equipment in a consultation; Therapeutic Concerns (c) building therapeutic relationships; and (d) embracing benefits and addressing challenges. Conclusion This narrative synthesis presents the existing evidence on clinician and patient experience of participating in non‐face to face consultations. Experiences are varied but largely focus on communication and forming relationships, using the technology successfully and the ability for patients to self‐manage with support from clinicians who are not in‐person. More high‐quality studies are required to explore the experiences of patients and clinicians accessing remote consultations as a result of global implementation post‐SARS‐CoV‐2 pandemic to identify any learning and education opportunities. Impact Health care staff can provide high‐quality care through video or telephone appointments as well as face to face appointments. This review has, however, identified that the evidence is limited and weak in this area and recommends there is research further to inform practice and influence future care.
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Affiliation(s)
- Helen Walthall
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Sue Schutz
- Oxford Brookes University and Oxford Biomedical Research Centre, Oxford, UK
| | - Joanne Snowball
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Raluca Vagner
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Nicola Fernandez
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Emilia Bartram
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
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14
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Thompson J, Gabriel L, Yoward S, Dawson P. The advanced practitioners' perspective. Exploring the decision-making process between musculoskeletal advanced practitioners and their patients: An interpretive phenomenological study. Musculoskeletal Care 2022; 20:128-136. [PMID: 33993603 DOI: 10.1002/msc.1562] [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: 04/28/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Advanced practice roles for allied health professionals continue to expand and provide key services within pathways of care for patients with musculoskeletal conditions. Despite the extensive utilisation of these roles and previously reported high patient satisfaction, little is understood about how these practitioners interact with their patients and the factors that influence decision-making conversations. STUDY A qualitative study utilised Interpretive Phenomenological Analysis (IPA) to explore the decision-making process occurring between Advanced Practitioners (APs) and their patients in a musculoskeletal service. AP data were collected through focus groups and analysed using IPA methodology. CONCLUSIONS Advanced practice decision-making is a complex process and APs exhibit a range of styles, from paternalistic to shared decision-making. APs may have a personal preference, but exhibit the ability to flex between styles in consultations. Multiple themes emerged from the data that influenced the decision-making process, including AP staff understanding the importance of patient expectations and the complex factors that influence patient interactions. It is important that clinicians have an awareness of the multiple factors that contribute to the decision-making process.
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Affiliation(s)
| | | | | | - Pamela Dawson
- Northumbria University, Newcastle upon Tyne, UK
- Plymouth Marjon University, Plymouth, UK
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15
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Gilbert AW, Jones J, Stokes M, May CR. Patient, clinician and manager experience of the accelerated implementation of virtual consultations following COVID-19: A qualitative study of preferences in a tertiary orthopaedic rehabilitation setting. Health Expect 2022; 25:775-790. [PMID: 35014124 PMCID: PMC8957728 DOI: 10.1111/hex.13425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 12/01/2022] Open
Abstract
AIM To investigate the experiences of patients, clinicians and managers during the accelerated implementation of virtual consultations (VCs) due to COVID-19. To understand how patient preferences are constructed and organized. METHODS Semi-structured interviews with patients, clinicians and managerial staff at a single specialist orthopaedic centre in the United Kingdom. The interview schedule and coding frame were based on Normalisation Process Theory. Interviews were conducted over the telephone or by video call. Abductive analysis of interview transcripts extended knowledge from previous research to identify, characterize and explain how patient preferences for VC were formed and arranged. RESULTS Fifty-five participants were included (20 patients, 20 clinicians, 15 managers). Key mechanisms that contribute to the formation of patient preferences were identified. These were: (a) context for the consultation (normative expectations, relational expectations, congruence and potential); (b) the available alternatives and the implementation process (coherence, cognitive participation, collective action and reflexive monitoring). Patient preferences are mediated by the clinician and organisational preferences through the influence of the consultation context, available alternatives and the implementation process. CONCLUSIONS This study reports the cumulative analysis of five empirical studies investigating patient preferences for VC before and during the COVID-19 pandemic as VC transitioned from an experimental clinic to a compulsory form of service delivery. This study has identified mechanisms that explain how preferences for VC come about and how these relate to organisational and clinician preferences. Since clinical pathways are shaped by interactions between patient, clinicians and organisational preferences, future service design must strike a balance between patient preferences and the preferences of clinicians and organisations. PATIENT AND PUBLIC CONTRIBUTION The CONNECT Project Patient and Public Involvement (PPI) group provided guidance on the conduct and design of the research. This took place with remote meetings between the lead researcher and the chair of the PPI group during March and April 2020. Patient information documentation and the interview schedule were developed with the PPI group to ensure that these were accessible.
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Affiliation(s)
- Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK.,Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Applied Research Collaboration, North Thames, UK
| | - Jeremy Jones
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Maria Stokes
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Applied Research Collaboration, Wessex, UK
| | - Carl R May
- NIHR Applied Research Collaboration, North Thames, UK.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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16
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Schutz S, Walthall H, Snowball J, Vagner R, Fernandez N, Bartram E, Merriman C. Patient and clinician experiences of remote consultation during the SARS-CoV-2 pandemic: A service evaluation. Digit Health 2022; 8:20552076221115022. [PMID: 35959197 PMCID: PMC9358347 DOI: 10.1177/20552076221115022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives During the SARS-CoV-2 pandemic, clinicians were instructed to move all but
emergency consultations to remote means to reduce the spread of the virus.
The aim of this study was to evaluate patients’ and clinicians’ experiences
of moving to remote means of consultation with their health care
professionals during the SARS-CoV-2 pandemic. Methods The study design was a qualitative service evaluation. Twenty-six clinicians
and forty-eight patients who met the inclusion criteria consented to be
interviewed. Clinician participants were from either medical, nursing, or
allied health professional backgrounds. Patients were recruited from
diabetes, acute care, and haematology and cancer areas. Data analysis was
conducted using a thematic analysis framework. Results Following coding and thematic analysis of the data collected from clinicians,
five themes were identified: personal and professional well-being; providing
a safe and high-quality experience; adapting to a new way of working; making
remote consultations fit for purpose and an awareness of altered dynamics
during consultation. Patient data was coded into 3 themes: remote
consultation adds value; remote consultation brings challenges and concerns
about remote consultation. Conclusions Clinician and patient experiences reported here are reflected in the
literature. The study indicates that remote consultation is not suitable for
all patients and in all contexts. Whilst maintaining the benefits to
patients, remote means of consultation needs organisational support and
preparation. A way forward that maintains the benefits whilst addressing
concerns seems urgent.
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Affiliation(s)
- Sue Schutz
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Helen Walthall
- Nursing and Midwifery Research and Innovation, Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Joanna Snowball
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Raluca Vagner
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Nicola Fernandez
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Emilia Bartram
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Clair Merriman
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
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17
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Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121314. [PMID: 34946259 PMCID: PMC8705012 DOI: 10.3390/medicina57121314] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 12/11/2022]
Abstract
Background and objective: Telemedicine or telehealth services has been increasingly practiced in the recent years. During the COVID-19 pandemic, telemedicine turned into and indispensable service in order to avoid contagion between healthcare professionals and patients, involving a growing number of medical disciplines. Nevertheless, at present, several ethical and legal issues related to the practice of these services still remain unsolved and need adequate regulation. This narrative review will give a synthesis of the main ethical and legal issues of telemedicine practice during the COVID-19 pandemic. Material and Methods: A literature search was performed on PubMed using MeSH terms: Telemedicine (which includes Mobile Health or Health, Mobile, mHealth, Telehealth, and eHealth), Ethics, Legislation/Jurisprudence, and COVID-19. These terms were combined into a search string to better identify relevant articles published in the English language from March 2019 to September 2021. Results: Overall, 24 out of the initial 85 articles were considered eligible for this review. Legal and ethical issues concerned important aspects such as: informed consent (information about the risks and benefits of remote therapy) and autonomy (87%), patient privacy (78%) and confidentiality (57%), data protection and security (74%), malpractice and professional liability/integrity (70%), equity of access (30%), quality of care (30%), the professional–patient relationship (22%), and the principle of beneficence or being disposed to act for the benefit of others (13%). Conclusions: The ethical and legal issues related to the practice of telehealth or telemedicine services still need standard and specific rules of application in order to guarantee equitable access, quality of care, sustainable costs, professional liability, respect of patient privacy, data protection, and confidentiality. At present, telemedicine services could be only used as complementary or supplementary tools to the traditional healthcare services. Some indications for medical providers are suggested.
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18
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Kumar A, Sinha S, Jameel J, Kumar S. Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review. J Taibah Univ Med Sci 2021; 17:203-213. [PMID: 34690642 PMCID: PMC8521392 DOI: 10.1016/j.jtumed.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/13/2021] [Accepted: 09/03/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives In the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients’ safety, data security, and implementation-related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice. Methods We systematically searched the database of Thomson Reuters Web of Science for telemedicine-related articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and a qualitative review. Results Fifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review. Conclusion Telemedicine can satisfactorily cover a major proportion of patients' visits to outpatient departments, thus limiting hospitals’ physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.
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Affiliation(s)
- Arvind Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Siddhartha Sinha
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Javed Jameel
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sandeep Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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19
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Gilbert AW, Davies L, Doyle J, Patel S, Martin L, Jagpal D, Billany JCT, Bateson J. Leadership reflections a year on from the rapid roll-out of virtual clinics due to COVID-19: a commentary. BMJ LEADER 2021. [DOI: 10.1136/leader-2020-000363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
COVID-19 changed the way we delivered care to our patients at our Hospital. Prior to the pandemic, no patient facing video clinics and only a small number of telephone clinics were held. In this paper, we share our experience of rapidly implementing virtual clinics (VCs) due to COVID-19. This commentary is based on focused discussions between hospital leaders and provides a reflective account and commentary on leadership lessons learnt from our experience of deploying VCs. We outline success factors (being able to capitalise on existing strategy, having time and space to establish VCs, using an agreed improvement framework, empowering a diverse and expert implementation team with a flat hierarchy, using efficient decision pathways, communication and staff willingness to change), technical challenges (patient capability and skills to use technology, patient connectivity and platform capacity) and considerations for the future (sustaining new ways of working, platform selection, integration, business continuity and commissioning considerations, barriers regarding capability and communication, effectiveness and clinical outcomes). Finally, we provide an overview of the leadership lessons from this project and identify key areas of focus for delivering successful change projects in future (the vision, allocation of resources, methodology selection and managing the skills gap).
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20
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Trisolino G, Toniolo RM, Marengo L, Dibello D, Guida P, Panuccio E, Evangelista A, Stallone S, Sansò ML, Amati C, Costici PF, Boero S, Farsetti P, De Sanctis N, Verdoni F, Memeo A, Gigante C. Resilience Against COVID-19: How Italy Faced the Pandemic in Pediatric Orthopedics and Traumatology. CHILDREN-BASEL 2021; 8:children8070530. [PMID: 34206218 PMCID: PMC8305147 DOI: 10.3390/children8070530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022]
Abstract
Background: We aimed to investigate the variation of medical and surgical activities in pediatric orthopedics in Italy, during the year of the COVID-19 pandemic, in comparison with data from the previous two years. The differences among the first wave, phase 2 and second wave were also analyzed. Methods: We conducted a retrospective multicenter study regarding the clinical and surgical activities in pediatric orthopedics during the pandemic and pre-pandemic period. The hospital databases of seven tertiary referral centers for pediatric orthopedics and traumatology were queried for events regarding pediatric orthopedic patients from 1 March 2018 to 28 February 2021. Surgical procedures were classified according to the “SITOP Priority Panel”. An additional classification in “high-priority” and “low-priority” surgery was also applied. Results: Overall, in 2020, we observed a significant drop in surgical volumes compared to the previous two years. The decrease was different across the different classes of priority, with “high-priority” surgery being less influenced. The decrease in emergency department visits was almost three-fold greater than the decrease in trauma surgery. During the second wave, a lower decline in surgical interventions and a noticeable resumption of “low-priority” surgery and outpatient visits were observed. Conclusion: Our study represents the first nationwide survey quantifying the impact of the COVID-19 pandemic on pediatric orthopedics and traumatology during the first and second wave.
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Affiliation(s)
- Giovanni Trisolino
- Unit of Pediatric Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, IRCCS, 40136 Bologna, Italy;
- Correspondence: ; Tel.: +39-051-636-6484 or +39-340-264-3380
| | - Renato Maria Toniolo
- Department of Orthopaedics and Traumatology, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Lorenza Marengo
- Unit of Pediatric Orthopaedics and Traumatology, Istituto Giannina Gaslini, IRCCS, 16147 Genova, Italy; (L.M.); (S.B.)
| | - Daniela Dibello
- Unit of Pediatric Orthopaedics and Traumatology Giovanni XXIII Children’s Hospital, University of Bari, 70126 Bari, Italy; (D.D.); (C.A.)
| | - Pasquale Guida
- Unit of Pediatric Orthopaedics and Traumatology, Azienda Ospedaliera di Rilievo Nazionale Santobono Pausillipon, 80122 Napoli, Italy; (P.G.); (M.L.S.)
| | - Elena Panuccio
- Department of Paediatric Orthopaedics and Traumatology, Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, 20122 Milano, Italy; (E.P.); (A.M.)
| | - Andrea Evangelista
- Unit of General Affairs, Istituto Ortopedico Rizzoli, IRCCS, 40136 Bologna, Italy;
| | - Stefano Stallone
- Unit of Pediatric Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, IRCCS, 40136 Bologna, Italy;
| | - Maria Lucia Sansò
- Unit of Pediatric Orthopaedics and Traumatology, Azienda Ospedaliera di Rilievo Nazionale Santobono Pausillipon, 80122 Napoli, Italy; (P.G.); (M.L.S.)
| | - Carlo Amati
- Unit of Pediatric Orthopaedics and Traumatology Giovanni XXIII Children’s Hospital, University of Bari, 70126 Bari, Italy; (D.D.); (C.A.)
| | - Pier Francesco Costici
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00050 Rome, Italy;
| | - Silvio Boero
- Unit of Pediatric Orthopaedics and Traumatology, Istituto Giannina Gaslini, IRCCS, 16147 Genova, Italy; (L.M.); (S.B.)
| | - Pasquale Farsetti
- Department of Orthopaedics Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Nando De Sanctis
- Unit of Pediatric Orthopaedics and Traumatology, Campolongo Hospital, 84025 Marina di Eboli, Italy;
| | - Fabio Verdoni
- Unit of Pediatric Orthopaedics and Traumatology, Istituto Galeazzi, IRCCS, 20161 Milan, Italy;
| | - Antonio Memeo
- Department of Paediatric Orthopaedics and Traumatology, Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, 20122 Milano, Italy; (E.P.); (A.M.)
| | - Cosimo Gigante
- Pediatric Orthopaedic Unit, Department of Woman and Child Health, Padua General Hospital, 35121 Padua, Italy;
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