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Leighton C, Cooper A, Porter A, Edwards A, Joseph-Williams N. Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review. BJGP Open 2024; 8:BJGPO.2023.0177. [PMID: 37783479 PMCID: PMC11169987 DOI: 10.3399/bjgpo.2023.0177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND There is a focus on increasing asynchronous telemedicine use, which allows medical data to be transmitted, stored, and interpreted later; however, limited evidence of the quality of care it allows in general practice hinders its use. AIM To investigate uses and effectiveness of asynchronous telemedicine in general practice, according to the domains of healthcare quality, and describe how the COVID-19 pandemic changed its use. DESIGN & SETTING Systematic review in general practice. METHOD A systematic search was carried out across four databases using terms related to general practice, asynchronous telemedicine, uses, and effectiveness, and supported by citation searching. This was followed by screening according to pre-defined criteria, data extraction, and critical appraisal. Narrative synthesis was then undertaken guided by the six domains of healthcare quality and exploring differences in use before and following the COVID-19 pandemic. RESULTS Searches yielded 6864 reports; 27 reports from 23 studies were included. Asynchronous telemedicine is used by a range of staff and patients across many countries. Safety and equity are poorly reported but there were no major safety concerns. Evidence from other domains of healthcare quality show effectiveness in making diagnoses, prescribing medications, replacing other consultations, providing timely care, and increased convenience for patients. Efficiency is impacted by negative effects on workflow, through poor implementation and patient non-adherence, limiting usability and requiring new administrative approaches from healthcare staff. Asynchronous telemedicine use increased rapidly from March 2020, following the COVID-19 pandemic outbreak. CONCLUSION Asynchronous telemedicine provides quality care for patients but is limited by reports of increased workload and inefficient workflow compared with face-to-face consultations. Limits of evidence include heterogeneity and small-scale studies. Further research into cost-effectiveness, equity, safety, and sustained implementation will influence future policy and practice.
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Affiliation(s)
| | - Alison Cooper
- Division of Population Medicine Cardiff University, Cardiff, UK
| | | | - Adrian Edwards
- Division of Population Medicine Cardiff University, Cardiff, UK
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Hajebrahimi S, Talebpour A, Kabiri N, Ahmadian N, Soleimanzadeh F, Behbahani Z, Salehi-Pourmehr H. Promoting post discharge telephone follow-up of patients with transurethral resection for bladder cancer: a best practice implementation project. JBI Evid Implement 2023; 21:251-258. [PMID: 37159920 DOI: 10.1097/xeb.0000000000000374] [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: 05/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Telephone follow-up (TFU) is a method that can be recommended for patients with chronic disease, including patients with nonmuscle-invasive bladder cancer (NMIBC) after transurethral resection of the bladder (TURB). This project aimed to improve postdischarge TFU of patients with TURB in a tertiary care system and referral system in Tabriz, Iran. METHODS This evidence implementation project used the JBI evidence implementation framework. Two audit criteria were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to evaluate changes in practice. RESULTS The aggregated data collated from the urology ward demonstrated that all criteria had achieved 0% compliance in the baseline audit round. Strategies such as patient education about TFU, educational pamphlets developed according to the latest validated guidelines, and a mobile app for education material about bladder cancer, diagnosis, management, and follow-up were implemented. The Phase 3 follow-up showed an 88% increase in compliance with staff education about the postdischarge TFU as a component of comprehensive discharge planning and a 22% achievement of timely patient follow-up by telephone. CONCLUSIONS A clinical audit is an effective approach to promoting postdischarge TFU in bladder cancer cases following TURB. TFU for bladder cancer patients who underwent TURB is an optimal goal that is easily achieved through patient, nursing staff, and residents' education using the latest guidelines.
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Affiliation(s)
- Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A JBI Center of Excellence
- Urology Department, Imam Reza General Hospital, Tabriz University of Medical Sciences
- Clinical Research Development Unit, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Talebpour
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A JBI Center of Excellence
| | - Neda Kabiri
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A JBI Center of Excellence
| | - Niloufar Ahmadian
- Urology Department, Imam Reza General Hospital, Tabriz University of Medical Sciences
- Clinical Research Development Unit, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzin Soleimanzadeh
- Urology Department, Imam Reza General Hospital, Tabriz University of Medical Sciences
- Clinical Research Development Unit, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahereh Behbahani
- Urology Department, Imam Reza General Hospital, Tabriz University of Medical Sciences
- Clinical Research Development Unit, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A JBI Center of Excellence
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Adams MD, Wong J, Gadre A, Greene JS, Milligan D, Paknezhad H, Purdy N, Rager J, Wertz A, Whitenight S, Haugen TW. Impact of Giving Patients Your Personal Phone Number in Otolaryngology-Head & Neck Surgery. Ann Otol Rhinol Laryngol 2023; 132:403-409. [PMID: 35607722 DOI: 10.1177/00034894221096976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Patient-provider communication is a major barrier to care, with some providers giving their personal phone number (PPN) to patients for increased accessibility. We investigated participant utilization of provider's PPN, its effect on participant satisfaction, provider's ability to predict abuse of this practice, and evolving provider perceptions. STUDY DESIGN Prospective, randomized study. SETTING Single institution, tertiary referral center. METHODS During a 2-week period, otolaryngology patients were randomized to either receive their provider's PPN or not. Providers predicted the likelihood of abuse. All calls/texts were documented for 4 weeks. At the study's conclusion, participants were surveyed using Press Ganey metrics. Providers were surveyed before and after to assess their likelihood of providing patients with their PPN and its impact on work demands. RESULTS Of the 507 participants enrolled, 266 were randomized to the phone number group (+PN). Of 44 calls/texts from 24 participants, 8 were considered inappropriate. Ten participants were predicted to abuse the PPN, but only one was accurately identified. Participants in the +PN group had a greater mean composite satisfaction score than the control group (4.8 vs 4.3; Welch's t-test, P < .0011). At the conclusion of the study, providers were more likely to share their PPN (Wilcoxon signed-rank test, P < .0313), and their perceived impact of this practice on workload was lower (Wilcoxon signed-rank test, P < .0469). CONCLUSION This study demonstrates low patient utilization of provider PPNs, and poor provider predictive ability of patient abuse. Receipt of provider's PPN was associated with improved patient satisfaction.
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Affiliation(s)
- Matthew D Adams
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Jeff Wong
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Arun Gadre
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Joseph Scott Greene
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Donna Milligan
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Hassan Paknezhad
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Nicholas Purdy
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Jennifer Rager
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Aileen Wertz
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Season Whitenight
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Thorsen W Haugen
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA
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Clark M, Kennard A, Watson DA. Attitudes, practices, and experiences of medical specialists towards email communication with their patients. Intern Med J 2021; 53:590-598. [PMID: 34779570 DOI: 10.1111/imj.15627] [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: 07/26/2021] [Revised: 10/07/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The medical profession has been slow in embracing email as a means of improving communication with patients. AIM To explore the attitudes, practices, and experiences of senior medical specialists towards email communication with their patients. METHODS A cross-sectional qualitative interview of 30 medical staff specialists employed by Canberra Health Services, administered via one-on-one interviews conducted between June and August 2020 (several months into the COVID-19 pandemic). MAIN OUTCOME MEASURES Comments extracted from the interviews were categorised into five domains: (1) Integration of email use with patients, (2) Issues addressed via email, (3) Benefits of email communication, (4) Concerns and barriers to email communication, and (5) Practice pointers for email use with patients. RESULTS Regular email correspondence with patients was not widespread. The main benefits identified were improved efficiency and flexibility, especially in the context of managing chronic disease and patient follow-up. Participants also identified barriers, including time commitments, privacy and confidentiality, patient expectations, and potential for misuse. Most participants were hesitant to endorse email with patients in their practices, citing concerns over the utility and safety of the medium and lack of established protocols and recommendations for email usage. CONCLUSIONS There is a want and need for comprehensive and accessible professional guidance on email use with patients. Our results indicate opportunities to inform good clinical practice in respect of doctor-patient relationships, clinical workloads, and risk management. There is also a need for formal guidelines on emailing with patients. The COVID-19 pandemic has heightened the need for such guidelines. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Morgan Clark
- Medical School, College of Health and Medicine, The Australian National University
| | - Alice Kennard
- Department of Nephrology, Canberra Health Services, and Medical School, College of Health and Medicine, The Australian National University
| | - D Ashley Watson
- Department of Infectious Diseases, Canberra Health Services, and Medical School, College of Health and Medicine, The Australian National University, Australian Capital Territory, Australia
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Kohler JE, Riggle KM, Fallat ME. It's the message not the medium: Ethics in pediatric surgery communication. Semin Pediatr Surg 2021; 30:151099. [PMID: 34635281 DOI: 10.1016/j.sempedsurg.2021.151099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
New communication technologies and generational differences in communication techniques create ethical challenges for pediatric surgeons. Using two hypothetical cases we explore the ethics of modern communication in pediatric surgery. The first case explores the ethics of text messaging with patients and families and of social media posts, both of which have useful ethical analogues in older communication technologies. The second case explores ways that generational experiential differences in learning can foster misunderstandings between team members at different levels of training and potentially impact important medical care decisions. The ethical rules that govern the delivery of patient care also apply to what we say and how we say it. Effective, ethical and compassionate communication will often be the aspect of therapy most appreciated by the patient and family.
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Affiliation(s)
- Jonathan E Kohler
- Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of California - Davis, University of California - Davis Children's Hospital, Sacramento, CA, United States.
| | - Kevin M Riggle
- Division of Pediatric Surgery, The Hiram J. Polk Jr. Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY, United States
| | - Mary E Fallat
- Division of Pediatric Surgery, The Hiram J. Polk Jr. Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY, United States
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Mselle L, Sirili N, Anaeli A, Massawe S. Understanding barriers to implementing referral procedures in the rural and semi-urban district hospitals in Tanzania: Experiences of healthcare providers working in maternity units. PLoS One 2021; 16:e0255475. [PMID: 34437576 PMCID: PMC8389460 DOI: 10.1371/journal.pone.0255475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 07/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Maternal and perinatal deaths occurring in low and middle income countries could be prevented with timely access to maternal and new-born care. In order to increase access to maternal and child health services, a well-functioning referral system that allows for continuity of care across different tiers of healthcare is required. A reliable healthcare system, with adequate numbers of skilled staff, resources and mechanisms, is critical to ensuring that access to care is available when the need arises. MATERIAL AND METHODS This descriptive, qualitative study design was used to explore barriers to implementing a reliable referral system. Twelve individual qualitative interviews were conducted with health care providers working in rural and semi-urban district hospitals in the Northern, Western, Eastern and Southern zones of Tanzania. Thematic analysis guided analysis of data. RESULTS Three (3) main and interconnected themes were abstracted from the data relating to participants' experiences of referring women with obstetric complications to adequate obstetric care. These were: 1. Adhering to a rigid referral protocol; 2. Completing the referral of women to an adequate health facility and 3. Communicating the condition of the woman with obstetric complications between the referring and receiving facilities. CONCLUSION Because of referral regulations, assistant medical officers were unable to make referral decisions even when they felt that a referral was needed. The lack of availability of hospital transport as well as the lack of a reliable feedback mechanism, prohibited effective referrals of patients. The Ministry of Health should revise the referral protocol to allow all clinicians to provide referrals, including assistant medical officers- who make up the majority of clinical staff in rural health care facilities. A mechanism to ensure effective communication between the referral facility and the tertiary care hospital should be instituted for quality and continuity of care. Furthermore, health care facilities should put aside budget for fuelling the ambulance for effective referrals.
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Affiliation(s)
- Lilian Mselle
- Department of Clinical Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nathanael Sirili
- Department of Development Studies, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Amani Anaeli
- Department of Development Studies, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Siriel Massawe
- Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Evaluation of clustering and topic modeling methods over health-related tweets and emails. Artif Intell Med 2021; 117:102096. [PMID: 34127235 DOI: 10.1016/j.artmed.2021.102096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 03/30/2021] [Accepted: 05/05/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Internet provides different tools for communicating with patients, such as social media (e.g., Twitter) and email platforms. These platforms provided new data sources to shed lights on patient experiences with health care and improve our understanding of patient-provider communication. Several existing topic modeling and document clustering methods have been adapted to analyze these new free-text data automatically. However, both tweets and emails are often composed of short texts; and existing topic modeling and clustering approaches have suboptimal performance on these short texts. Moreover, research over health-related short texts using these methods has become difficult to reproduce and benchmark, partially due to the absence of a detailed comparison of state-of-the-art topic modeling and clustering methods on these short texts. METHODS We trained eight state-of- the-art topic modeling and clustering algorithms on short texts from two health-related datasets (tweets and emails): Latent Semantic Indexing (LSI), Latent Dirichlet Allocation (LDA), LDA with Gibbs Sampling (GibbsLDA), Online LDA, Biterm Model (BTM), Online Twitter LDA, and Gibbs Sampling for Dirichlet Multinomial Mixture (GSDMM), as well as the k-means clustering algorithm with two different feature representations: TF-IDF and Doc2Vec. We used cluster validity indices to evaluate the performance of topic modeling and clustering: two internal indices (i.e. assessing the goodness of a clustering structure without external information) and five external indices (i.e. comparing the results of a cluster analysis to an externally known provided class labels). RESULTS In overall, for number of clusters (k) from 2 to 50, Online Twitter LDA and GSDMM achieved the best performance in terms of internal indices, while LSI and k-means with TF-IDF had the highest external indices. Also, of all tweets (N = 286, 971; HPV represents 94.6% of tweets and lynch syndrome represents 5.4%), for k = 2, most of the methods could respect this initial clustering distribution. However, we found model performance varies with the source of data and hyper-parameters such as the number of topics and the number of iterations used to train the models. We also conducted an error analysis using the Hamming loss metric, for which the poorest value was obtained by GSDMM on both datasets. CONCLUSIONS Researchers hoping to group or classify health related short-text data can expect to select the most suitable topic modeling and clustering methods for their specific research questions. Therefore, we presented a comparison of the most common used topic modeling and clustering algorithms over two health-related, short-text datasets using both internal and external clustering validation indices. Internal indices suggested Online Twitter LDA and GSDMM as the best, while external indices suggested LSI and k-means with TF-IDF as the best. In summary, our work suggested researchers can improve their analysis of model performance by using a variety of metrics, since there is not a single best metric.
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Abstract
Abstract
NEW TECHNOLOGIES HAVE FACILITATED DOCTOR–PATIENT EMAIL CONSULTATIONS (E-CONSULTATIONS). GUIDELINES FOR E-CONSULTATION USE IN DENMARK STATE THAT THEY SHOULD BE USED FOR SIMPLE, CONCRETE AND NON-URGENT QUERIES; HOWEVER, A SMALL-SCALE DANISH STUDY SUGGESTED THAT DOCTORS ENCOUNTER E-CONSULTATIONS THAT DO NOT MATCH THE GUIDELINES. THE PURPOSE OF THIS ARTICLE IS TO EXPLORE WHETHER E-CONSULTATIONS IN DENMARK REFLECT RECOMMENDATIONS THAT THEY SHOULD BE SIMPLE, SHORT, CONCRETE AND WELL DEFINED, AND IF NOT, WHAT FORMS OF COMPLEXITY ARE EVIDENT. WE INDUCTIVELY ANALYSED 1,671 E-CONSULTATIONS FROM 38 PATIENTS AGED 21–91 YEARS COMMUNICATING WITH 28 DOCTORS, 6 NURSES, 1 MEDICAL STUDENT AND 8 SECRETARIES. RESULTS SHOWED BOTH QUANTITATIVE COMPLEXITY IN TERMS OF NUMBER OF INTERACTION TURNS, COMMUNICATIVE PARTICIPANTS, AND QUESTIONS ASKED, AND QUALITATIVE COMPLEXITY RELATING TO PATIENTS’ PSYCHOSOCIAL CONTEXTS AND GPS’ BIOMEDICAL DISEASE PERSPECTIVE. THUS, DESPITE EXISTING GUIDELINES AND THE LEANNESS ASSOCIATED WITH THE EMAIL MEDIUM, MULTIPLE FORMS OF COMPLEXITY WERE EVIDENT. THIS MISMATCH HIGHLIGHTS THE NEED FOR THEORETICAL DEVELOPMENT AS WELL AS THE VALUE OF RE-EXAMINING EXISTING POLICIES AND GUIDELINES REGARDING EXPECTATIONS FOR E-CONSULTATION USE.
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9
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Amran MM, Kopit AB, Kranc HA, Peleg R. The prevalence, reasons and attitudes for the practice of informal medicine. BMC FAMILY PRACTICE 2021; 22:30. [PMID: 33535980 PMCID: PMC7860190 DOI: 10.1186/s12875-020-01362-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Informal medicine, entailing undocumented medical advice, has been described in diverse medical disciplines and geographical regions. We assessed the current prevalence and characteristics of informal medical consulting, the reasons physicians provide it, and their attitudes toward it. METHODS We conducted a survey among family physicians in Israel, a country with a national health insurance system. A questionnaire was emailed to all primary care physicians in the two largest HMOs in southern Israel. Fifteen questions addressed the prevalence, practice and attitudes to informal medical consulting. Ten questions assessed demographics and professional experience. RESULTS Of 143 respondents (mean age 41 years), 55% were women. Ninety-five percent of the respondents reported requesting informal medical consulting from other physicians. Fifty-four percent reported often providing informal consulting to family and friends; and an additional 27% reported doing so under exceptional circumstances. The main reasons given for informal consulting requests were availability and accessibility (81% of respondents), and not financial savings. Only 17.5% stated being in favor of informal consulting for family and friends. Only 11% expressed feeling satisfaction after providing such consultation; 49% expressed discomfort. Sixty-six percent thought a position paper on informal consulting to family and friends is needed. CONCLUSIONS Our survey of primary care physicians shows very frequent informal medical consulting, despite high dissatisfaction with such, and an interest in receiving guidelines on this practice.
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Affiliation(s)
- Menashe Meni Amran
- Maccabi Health Services, Tel Aviv, Israel.
- Ben Gurion University of the Negev, Be'er Sheva, Israel.
| | | | | | - Roni Peleg
- Ben Gurion University of the Negev, Be'er Sheva, Israel
- Clalit Health Services, Tel Aviv, Israel
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10
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Atherton H, Boylan AM, Eccles A, Fleming J, Goyder CR, Morris RL. Email Consultations Between Patients and Doctors in Primary Care: Content Analysis. J Med Internet Res 2020; 22:e18218. [PMID: 33164902 PMCID: PMC7683246 DOI: 10.2196/18218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background Increasingly, consultations in health care settings are conducted remotely using a range of communication technologies. Email allows for 2-way text-based communication, occurring asynchronously. Studies have explored the content and nature of email consultations to understand the use, structure, and function of email consultations. Most previous content analyses of email consultations in primary care settings have been conducted in North America, and these have shown that concerns and assumptions about how email consultations work have not been realized. There has not been a UK-based content analysis of email consultations. Objective This study aims to explore and delineate the content of consultations conducted via email in English general practice by conducting a content analysis of email consultations between general practitioners (GPs) and patients. Methods We conducted a content analysis of anonymized email consultations between GPs and patients in 2 general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when the emails were sent, the number of emails in an email consultation, and the nature of the content. We used a normative approach to analyze the content of the email consultations to explore the use and function of email consultation. Results We obtained 100 email consultations from 85 patients, which totaled 262 individual emails. Most email users were older than 40 years, and over half of the users were male. The email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. The emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were 3 key themes to the use and function of the email consultations: the role of the GP and email consultation, the transactional nature of an email consultation, and the operationalization of an email consultation. Conclusions Most cases where emails are used to have a consultation with a patient in general practice have a shorter consultation, are clinical in nature, and are resolved quickly. GPs approach email consultations using key elements similar to that of the face-to-face consultation; however, using email consultations has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultations were not a replacement for face-to-face consultations.
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Affiliation(s)
- Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Anne-Marie Boylan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Abi Eccles
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Joanna Fleming
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Clare R Goyder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rebecca L Morris
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
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Keir M, Penner M, Dehghani P, Neudorf C, Lim HJ, Bradley TJ, Bree T, Kakadekar A. Barriers to Care in ACHD: A Study of Young Adults in Saskatchewan. CJC Open 2020; 2:439-446. [PMID: 33305202 PMCID: PMC7710945 DOI: 10.1016/j.cjco.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/23/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Adults with congenital heart disease (CHD) are living longer with more complex disease. Maintaining lifelong care prevents morbidity and mortality, but many patients remain lost to follow-up or experience care gaps. We sought to assess barriers to care for patients with adult CHD (ACHD) in Saskatchewan, a Canadian province with no local congenital cardiac surgical support and no clear framework for ACHD care. METHODS We performed a telephone survey of patients with CHD transferred from pediatric to adult cardiology from 2007 to 2014. Our primary outcome was loss to follow-up > 2 years from last recommended cardiology appointment and/or multiple missed cardiology appointments. Secondary outcomes were guideline-based care (specialist training, adherence to appropriate endocarditis prophylaxis, pre-pregnancy counselling for women), presence or absence of previously described barriers to care in ACHD, and health care autonomy using the Krantz Health Opinion Survey. RESULTS We interviewed 32 patients (30% response rate). One-quarter met the primary outcome: lost to follow-up > 2 years from last recommended cardiology appointment and/or self-report of missed cardiology appointments. Only 69% of young adults in Saskatchewan were receiving guideline-based care for their CHD (appropriate level of specialist expertise and frequency of follow-up). Only 72% of patients were adhering to endocarditis prophylaxis recommendations and 61% of women surveyed received counselling regarding pregnancy. Patients indicated a low preference for participating in decision making regarding their care on the Krantz Health Opinion Survey. CONCLUSIONS With our survey, we have created a novel snapshot of CHD care in Saskatchewan and have identified significant deficits.
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Affiliation(s)
- Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Marie Penner
- Division of Pediatric Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Cordell Neudorf
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hyun J. Lim
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Timothy J. Bradley
- Division of Pediatric Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Terry Bree
- Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ashok Kakadekar
- Division of Pediatric Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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De Gagne JC, Yang Y, Rushton S, Koppel PD, Hall K. Email Use Reconsidered in Health Professions Education: Viewpoint. JMIR MEDICAL EDUCATION 2020; 6:e19300. [PMID: 32478659 PMCID: PMC7296417 DOI: 10.2196/19300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 05/06/2023]
Abstract
Email has become a popular means of communication in the past 40 years, with more than 200 billion emails sent each day worldwide. When used appropriately, email can be an effective and useful form of correspondence, although improper practices, such as email incivility, can present challenges. Email is ubiquitous in education and health care, where it is used for student-to-teacher, provider-to-provider, and patient-to-provider communications, but not all students, faculty members, and health professionals are skilled in its use. This paper examines the challenges and opportunities posed by email communication in health professions education and reveals important deficiencies in training, as well as steps that can be taken by health professions educators to address them. Recommendations are offered to help health professions educators develop approaches for teaching email professionalism.
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Affiliation(s)
| | - Yesol Yang
- Duke University School of Nursing, Durham, NC, United States
| | - Sharron Rushton
- Duke University School of Nursing, Durham, NC, United States
| | - Paula D Koppel
- Duke University School of Nursing, Durham, NC, United States
| | - Katherine Hall
- West Virginia University School of Nursing, Morgantown, WV, United States
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Godzik CM. Gateless communication: A concept analysis. Nurs Forum 2019; 54:636-641. [PMID: 31515829 DOI: 10.1111/nuf.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The movement toward the use of electronic technologies in everyday life has also impacted healthcare. Patient portals allow patients to send messages to their healthcare team from the comfort of their own homes and even on mobile devices. With responses typically sent within 24 business hours, some patients are looking for more timely feedback to their health questions. This is true in behavioral health, where real-time communication between psychologist-patient is valued. It is not uncommon for psychiatric providers including psychiatrists and nurse practitioners to provide personal cell phone numbers or secure-texting services to their patients. The real-time texting that occurs between patients and providers is emerging as a new way in which information is shared. A literature review in PubMed and CINAHL revealed a plethora of research conducted on information exchanged via the patient portal; however, there appears to be a gap in the information known about direct patient-provider communication that utilizes other types of technology. This concept analysis looks at this type of communication and proposes that a new concept be developed to perform future research studies. "Gateless communication" will be explored using a previous paper eight-step method for conceptualizing this new concept.
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Affiliation(s)
- Cassandra M Godzik
- Graduate School of Nursing, University of Massachusetts at Worcester, Worcester, Massachusetts
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Paslakis G, Fischer-Jacobs J, Pape L, Schiffer M, Gertges R, Tegtbur U, Zimmermann T, Nöhre M, de Zwaan M. Assessment of Use and Preferences Regarding Internet-Based Health Care Delivery: Cross-Sectional Questionnaire Study. J Med Internet Res 2019; 21:e12416. [PMID: 31099338 PMCID: PMC6542248 DOI: 10.2196/12416] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/14/2019] [Accepted: 04/08/2019] [Indexed: 12/30/2022] Open
Abstract
Background There has been an incremental increase in the use of technology in health care delivery. Feasibility, acceptability, and efficacy of interventions based on internet technologies are supported by a growing body of evidence. Objective The aim of this study was to investigate use and preferences in the general adult population in Germany for remote, internet-based interaction (eg, email, videoconferencing, electronic medical records, apps). Methods A nationwide cross-sectional questionnaire survey in adults that was representative in terms of age, sex and educational level was carried out. Results A total of 22.16% (538/2428) of survey participants reported not using the internet for work or private use. The nonuser phenotype can be described as being older, having lower educational and income status, and living in less populated areas. The majority of participants within the cohort of internet users reported that they would not consider using electronic medical records (973/1849, 52.62%), apps (988/1854, 53.29%), or emails to report symptoms (1040/1838, 56.58%); teleconference with one (1185/1852, 63.98%) or more experts (1239/1853, 66.86%); or participate in video psychotherapy (1476/1853, 79.65%) for the purpose of medical consultation or treatment. Older age and lower educational level were the most robust predictors of assumed future denial of use. Conclusions Our results point toward low use and preference rates among the general population for the use of telemedicine. It also seems that those who might benefit from telemedical interventions the most, are, in fact, those who are most hesitating. These low use and preference rates of eHealth should be considered prior to designing and providing future telemedical care, supporting the need for easy-to-use, data secure solutions.
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Affiliation(s)
- Georgios Paslakis
- University Health Network, Toronto General Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Josefine Fischer-Jacobs
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Lars Pape
- Department of Pediatric, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.,Project Kidney Transplantation 360°, Hannover Medical School, Hannover, Germany
| | - Mario Schiffer
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.,Department of Nephrology, University Hospital, Friedrich-Alexander University, Erlangen, Germany
| | - Raoul Gertges
- Project Kidney Transplantation 360°, Hannover Medical School, Hannover, Germany
| | - Uwe Tegtbur
- Project Kidney Transplantation 360°, Hannover Medical School, Hannover, Germany.,Department of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Tanja Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.,Project Kidney Transplantation 360°, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.,Project Kidney Transplantation 360°, Hannover Medical School, Hannover, Germany
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Hirst Y, Lim AWW. Acceptability of text messages for safety netting patients with low-risk cancer symptoms: a qualitative study. Br J Gen Pract 2018; 68:e333-e341. [PMID: 29581127 PMCID: PMC5916080 DOI: 10.3399/bjgp18x695741] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/05/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Safety netting is an important diagnostic strategy for patients presenting to primary care with potential (low-risk) cancer symptoms. Typically, this involves asking patients to return if symptoms persist. However, this relies on patients re-appraising their symptoms and making follow-up appointments, which could contribute to delays in diagnosis. Text messaging is increasingly used in primary care to communicate with patients, and could be used to improve safety netting. AIM To explore the acceptability and feasibility of using text messages to safety net patients presenting with low-risk cancer symptoms in GP primary care (txt-netting). DESIGN AND SETTING Qualitative focus group and interview study with London-based GPs. METHOD Participants were identified using convenience sampling methods. Five focus groups and two interviews were conducted with 22 GPs between August and December 2016. Sessions were audiorecorded, transcribed verbatim, and analysed using thematic analysis. RESULTS GPs were amenable to the concept of using text messages in cancer safety netting, identifying it as an additional tool that could help manage patients and promote symptom awareness. There was wide variation in GP preferences for text message content, and a number of important potential barriers to txt-netting were identified. Concerns were raised about the difficulties of conveying complex safety netting advice within the constraints of a text message, and about confidentiality, widening inequalities, and workload implications. CONCLUSION Text messages were perceived to be an acceptable potential strategy for safety netting patients with low-risk cancer symptoms. Further work is needed to ensure it is cost-effective, user friendly, confidential, and acceptable to patients.
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Affiliation(s)
- Yasemin Hirst
- Research Department of Behavioural Science and Health, University College London, London
| | - Anita Wey Wey Lim
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London
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Rorie DA, Flynn RWV, Mackenzie IS, MacDonald TM, Rogers A. The Treatment In Morning versus Evening (TIME) study: analysis of recruitment, follow-up and retention rates post-recruitment. Trials 2017; 18:557. [PMID: 29169373 PMCID: PMC5701451 DOI: 10.1186/s13063-017-2318-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/15/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The use of information technology (IT) is now the preferred method of capturing and storing clinical research data. The Treatment In Morning versus Evening (TIME) study predominantly uses electronic data capture and IT to compare morning dosing of hypertensive medication against evening dosing. Registration, consent, participant demographics and follow-up data are all captured via the study website. The aim of this article is to assess the success of the TIME methodology compared with similar studies. METHODS To assess the TIME study, published literature on similar clinical trials was reviewed and compared against TIME recruitment, follow-up and email interaction data. RESULTS The TIME website registered 31,695 individuals, 21,116 of whom were randomised. Recruitment cost per randomised participant varied by strategy: £17.40 by GP practice, £3.08 by UK Biobank and £58.82 for GoShare. Twelve-month follow-up retention rates were 96%. A total of 1089 participants have withdrawn from their assigned time of dosing, 2% of whom have declined follow-up by record linkage or further contact. When the TIME data are compared with similar study data, study recruitment is very successful. However, TIME suffers difficulties with participant follow-up and withdrawal rates similar to those of conventional studies. CONCLUSIONS The TIME study has been successful in recruitment. Follow-up, retention rates and withdrawal rates are all acceptable, but ongoing work is required to ensure participants remain engaged with the study. Various recruitment strategies are necessary, and all viable options should be encouraged to maintain participant engagement throughout the life of studies using IT.
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Affiliation(s)
- David A. Rorie
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY UK
- Medicines Monitoring Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY UK
| | - Robert W. V. Flynn
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY UK
| | - Isla S. Mackenzie
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY UK
| | - Thomas M. MacDonald
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY UK
| | - Amy Rogers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY UK
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