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Battista S, Giardulli B, Sieiro Santos C, Aharonov O, Puttaswamy D, Russell AM, Gupta L. Digital Health and Self-Management in Idiopathic Inflammatory Myopathies: A Missed Opportunity? Curr Rheumatol Rep 2024; 26:383-391. [PMID: 39115596 PMCID: PMC11469974 DOI: 10.1007/s11926-024-01157-6] [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] [Accepted: 07/08/2024] [Indexed: 10/12/2024]
Abstract
PURPOSE OF REVIEW This paper explored the potential of digital health in idiopathic inflammatory myopathies (IIMs), with a focus on self-management. Digital self-management technology includes tailored treatment plans, symptom tracking, educational resources, enhanced communication, and support for long-term planning. RECENT FINDINGS After arguing the importance of digital health in IIMs management, from diagnosis until treatment, our literature review revealed a notable gap in research focusing on the efficacy of digital self-management interventions for individuals with IIMs, with no randomised controlled trials or observational studies addressing this topic. Our review further highlighted the significant unmet need for research in self-management interventions for individuals with IIMs. The absence of studies underscores the necessity for collaborative efforts to address this gap and develop personalised, effective strategies for managing IIMs using digital technology. Individuals with IIMs deserve tailored self-management approaches akin to those available for other rheumatic and musculoskeletal diseases.
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Affiliation(s)
- Simone Battista
- School of Health and Society, Centre for Human Movement and Rehabilitation, University of Salford, Salford, Greater Manchester, UK
| | - Benedetto Giardulli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | | | - Or Aharonov
- Department of Psychology, Psychology of Aging Group, University of Vienna, Vienna, Austria
| | - Darshan Puttaswamy
- Seth Gordhandhas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Anne -Marie Russell
- School of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, UK
- School of Health and Care Professions, University of Exeter, Exeter, Devon, UK
- ILD Regional Service, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
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Banerji A, Phadke N, McMahon AE, Cogan AS, Blumenthal KG. Improving care using outpatient electronic consults in patients with chemotherapy hypersensitivity reactions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1368-1371. [PMID: 37951415 DOI: 10.1016/j.jaip.2023.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Neelam Phadke
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Rheumatology and Allergy Clinical Epidemiology Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, Mass
| | - Aubree E McMahon
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Amelia S Cogan
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Rheumatology and Allergy Clinical Epidemiology Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, Mass
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Man JP, Klopotowska J, Asselbergs FW, Handoko ML, Chamuleau SAJ, Schuuring MJ. Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions. Curr Heart Fail Rep 2024; 21:147-161. [PMID: 38363516 PMCID: PMC10924030 DOI: 10.1007/s11897-024-00649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
PURPOSEOF REVIEW Guideline-directed medical therapy (GDMT) underuse is common in heart failure (HF) patients. Digital solutions have the potential to support medical professionals to optimize GDMT prescriptions in a growing HF population. We aimed to review current literature on the effectiveness of digital solutions on optimization of GDMT prescriptions in patients with HF. RECENT FINDINGS We report on the efficacy, characteristics of the study, and population of published digital solutions for GDMT optimization. The following digital solutions are discussed: teleconsultation, telemonitoring, cardiac implantable electronic devices, clinical decision support embedded within electronic health records, and multifaceted interventions. Effect of digital solutions is reported in dedicated studies, retrospective studies, or larger studies with another focus that also commented on GDMT use. Overall, we see more studies on digital solutions that report a significant increase in GDMT use. However, there is a large heterogeneity in study design, outcomes used, and populations studied, which hampers comparison of the different digital solutions. Barriers, facilitators, study designs, and future directions are discussed. There remains a need for well-designed evaluation studies to determine safety and effectiveness of digital solutions for GDMT optimization in patients with HF. Based on this review, measuring and controlling vital signs in telemedicine studies should be encouraged, professionals should be actively alerted about suboptimal GDMT, the researchers should consider employing multifaceted digital solutions to optimize effectiveness, and use study designs that fit the unique sociotechnical aspects of digital solutions. Future directions are expected to include artificial intelligence solutions to handle larger datasets and relieve medical professional's workload.
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Affiliation(s)
- Jelle P Man
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Joanna Klopotowska
- Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Folkert W Asselbergs
- Institute of Health Informatics, University College London, London, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Mark J Schuuring
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Netherlands Heart Institute, Utrecht, The Netherlands.
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Suresh K, Hill PA, Kahn CE, Schnall MD, Rosen MA, Zafar HM, Trerotola SO, Cook TS. Quality Improvement Report: Design and Implementation of a Radiology E-Consult Service. Radiographics 2023; 43:e230139. [PMID: 38032820 DOI: 10.1148/rg.230139] [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: 12/02/2023]
Abstract
Electronic consultations (e-consults) mediated through an electronic health record system or web-based platform allow synchronous or asynchronous physician-to-physician communication. E-consults have been explored in various clinical specialties, but relatively few instances in the literature describe e-consults to connect health care providers directly with radiologists.The authors outline how a radiology department can implement an e-consult service and review the development of such a service in a large academic health system. They describe the logistics, workflow, turnaround time expectations, stakeholder management, and pilot implementation and highlight challenges and lessons learned.
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Affiliation(s)
- Kalpana Suresh
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Paul A Hill
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Charles E Kahn
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Mitchell D Schnall
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Mark A Rosen
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Hanna M Zafar
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Scott O Trerotola
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
| | - Tessa S Cook
- From the Department of Radiology, the Institute for Biomedical Informatics, and the Leonard Davis Institute of Health Economics, The University of Pennsylvania, Penn Medicine, 3400 Spruce St, Philadelphia, PA 19104 (K.S., C.E.K., M.D.S., M.A.R., H.M.Z., S.O.T., T.S.C.); and Valley Health, Winchester, VA (P.A.H.)
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Marco-Ibáñez A, Aguilar-Palacio I, Aibar C. Does virtual consultation between primary and specialised care improve healthcare quality? A scoping review of healthcare quality domains assessment. BMJ Open Qual 2023; 12:e002388. [PMID: 37832971 PMCID: PMC10582872 DOI: 10.1136/bmjoq-2023-002388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Virtual consultation has been proposed as a promising tool to improve the coordination and quality of healthcare between primary and specialised care. However, despite its potential facilitators, the evidence on the usefulness of virtual consultation for improving healthcare quality domains is fragmented and unclear. This scoping review aims to assess the impact of virtual consultation on different healthcare quality domains. MATERIAL AND METHODS We conducted a scoping review with a rigorous search strategy on PubMed, EMBASE and Cochrane Library databases. The inclusion criteria were original articles, reviews, meta-analyses or letters to the editor, published between 1 January 2017 and 24 June 2022, and available in English, Spanish or French. For each of the articles selected, we identified the addressed healthcare quality domains, their facilitators and barriers, areas of improvement and data gaps. We have adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review reporting standards. RESULTS 1284 manuscripts were retrieved. Finally, 235 papers were included in this review, most of which were original, descriptive studies. The most evaluated quality domain was effectiveness (223 articles). Safety and patient-centred care were the least evaluated. Simultaneous assessment of more than one domain was observed in 117 papers, being effectiveness and timeliness the most frequent combination. Our analysis revealed that virtual consultation is in development and underused. This tool has the potential to improve access to specialised care and enhance coordination between professionals. CONCLUSIONS Virtual consultation has the potential to provide effective, efficient, equitable and timely attention. However, its contribution to safety and patient-centered care needs further evaluation. Our review emphasises the need for more rigorous research and standardised quality assessment criteria to obtain robust evidence on the usefulness of virtual consultation for improving healthcare quality domains.
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Affiliation(s)
- Almudena Marco-Ibáñez
- Primary Health Physician, Aragon Health Service, Zaragoza, Spain
- Health Services Research Group (GRISSA), Aragon Health Research Institute, Zaragoza, Spain
| | - Isabel Aguilar-Palacio
- Health Services Research Group (GRISSA), Aragon Health Research Institute, Zaragoza, Spain
- Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
| | - Carlos Aibar
- Health Services Research Group (GRISSA), Aragon Health Research Institute, Zaragoza, Spain
- Preventive Medicine and Public Health, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
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González-Juanatey JR, Cinza Sanjurjo S. Clinician-to-clinician electronic consultation in cardiology is also a digital health technology for cardiovascular care. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:69-70. [PMID: 36974267 PMCID: PMC10039421 DOI: 10.1093/ehjdh/ztad011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- José R González-Juanatey
- Clinical University Hospital of Santiago de Compostela. Choupana s/n, 15706, Santiago de Compostela, A Coruña, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela. Choupana s/n, 15706, Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red - Enfermedades Cardiovasculares (CIBERCV). Av. Monforte de Lemos, 3-5. 28029 Madrid, Spain
| | - Sergio Cinza Sanjurjo
- Instituto de Investigación Sanitaria de Santiago de Compostela. Choupana s/n, 15706, Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red - Enfermedades Cardiovasculares (CIBERCV). Av. Monforte de Lemos, 3-5. 28029 Madrid, Spain
- Centro de Salud de Milladoiro-Ames. Área Sanitaria de Santiago de Compostela, A Coruña, Spain
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Folkerts EK, Pelletier RC, Chung DC, Goldstein SA, Micalizzi DS, Shannon KM, Sweetser DA, Wong EK, Rehm HL, Hull LE. A Pooled Electronic Consultation Program to Improve Access to Genetics Specialists. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.08.23284667. [PMID: 36798390 PMCID: PMC9934799 DOI: 10.1101/2023.02.08.23284667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Innovative service delivery models are needed to increase access to genetics specialists. Electronic consultation (e-Consult) programs can connect clinicians with specialists. At Massachusetts General Hospital, an e-Consult service was created to address genomics-related questions. In its first year, the e-Consult service triaged 153 requests and completed 122 in an average of 3.2 days. Of the 95 e-Consults with actionable recommendations, there was documentation that most ordering clinicians followed through (82%). A variety of providers used the service, although the majority (77%) were generalists. E-Consult models should be considered as one way to increase access to genetics care.
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Affiliation(s)
- Emma K Folkerts
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- The Broad Institute of MIT and Harvard, Cambridge, MA
| | - Renée C Pelletier
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- The Broad Institute of MIT and Harvard, Cambridge, MA
| | - Daniel C Chung
- Division of Gastroenterology, Department of Medicine, Mass General Hospital
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Susan A Goldstein
- Massachussetts General Physicians Organization, Massachusetts General Hospital, Boston, MA
| | - Douglas S Micalizzi
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - David A Sweetser
- Harvard Medical School, Boston, MA
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Eugene K Wong
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Heidi L Rehm
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- The Broad Institute of MIT and Harvard, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Leland E Hull
- Harvard Medical School, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
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Sanavro S, van der Worp H, Jansen D, Stoffelen J, Schers H, Postma M, Koning P, de Boer M, Janus G, Blanker MH. Impact of digital interdisciplinary consultation on secondary care referrals by general practitioners: a protocol for a stepped-wedge cluster randomised controlled trial. BMJ Open 2022; 12:e060222. [PMID: 36456003 PMCID: PMC9716832 DOI: 10.1136/bmjopen-2021-060222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 10/09/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Optimal collaboration between general practice and hospital care is crucial to maintain affordable and sustainable access to healthcare for the entire population. General practitioners (GPs) are the gatekeepers to specialist care and patients will visit hospitals mostly only after referral. However, a substantial part of these referrals may be inappropriate, as communication between GPs and medical specialists can be challenging and referring patients may be the most obvious action for a GP to perform.A new digital platform (Prisma) connects GPs and specialists in interdisciplinary groups and facilitates asynchronous, accessible and fast teleconsultation within the group. No previous research has been done to evaluate the impact of this new platform on the referral rates to the hospital. METHODS AND ANALYSIS A stepped-wedge randomised controlled trial (RCT) will be performed in Zwolle region in the Netherlands to analyse the effect of introduction of the platform on rate of inappropriate referrals to orthopaedic surgery. In four steps, GPs in the region will be given access to the platform. GPs will be part of the control condition until randomisation to the intervention. According to our sample size calculation, we need to include 18 practices with 1008 patients presenting with hip and knee symptoms. Routine care data of hospital registrations will be analysed to calculate the rate of inappropriate referrals (primary outcome). Secondary outcome are costs, primary and secondary care workload, posted cases and user satisfaction. Alongside this quantitative analysis, we will evaluate patient experience, facilitators and barriers for use of the platform. ETHICS AND DISSEMINATION The medical ethics review board of University Medical Center Groningen (UMCG), the Netherlands (METc-number: 2021/288) has confirmed that the Medical Research Involving Human Subjects Act (WMO) does not apply to the process evaluation because the study does not involve randomisation of patients or different medical treatments (letter number: M21.275351). TRIAL REGISTRATION NUMBER NL9704.
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Affiliation(s)
- Sanne Sanavro
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
| | - Henk van der Worp
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
| | - Danielle Jansen
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
| | | | - Henk Schers
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
| | - Maarten Postma
- Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, Groningen, The Netherlands
| | - Paul Koning
- Siilo Holding BV, Amsterdam, The Netherlands
| | - Michiel de Boer
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
- Health Sciences, Section Methodology and Applied Statistics, UMCG, Groningen, The Netherlands
| | - Guus Janus
- Department of Orthopaedic surgery, Isala hospital and Isala movement clinic, Zwolle, The Netherlands
| | - Marco H Blanker
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
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Al Ammary F, Motter JD, Sung HC, Lentine KL, Sharfuddin A, Kumar V, Yadav A, Doshi MD, Virmani S, Concepcion BP, Grace T, Sidoti CN, Yahya Jan M, Muzaale AD, Wolf J. Telemedicine services for living kidney donation: A US survey of multidisciplinary providers. Am J Transplant 2022; 22:2041-2051. [PMID: 35575439 PMCID: PMC9543040 DOI: 10.1111/ajt.17093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/13/2022] [Accepted: 05/08/2022] [Indexed: 01/25/2023]
Abstract
Individuals considering living kidney donation face geographic, financial, and logistical challenges. Telemedicine can facilitate healthcare access/care coordination. Yet difficulties exist in telemedicine implementation and sustainability. We sought to examine centers' practices and providers' attitudes toward telemedicine to improve services for donors. We surveyed multidisciplinary providers from 194 active adult US living donor kidney transplant centers; 293 providers from 128 unique centers responded to the survey (center representation rate = 66.0%), reflecting 83.9% of practice by donor volume and 91.5% of US states/territories. Most centers (70.3%) plan to continue using telemedicine beyond the pandemic for donor evaluation/follow-up. Video was mostly used by nephrologists, surgeons, and psychiatrists/psychologists. Telephone and video were mostly used by social workers, while video or telephone was equally used by coordinators. Half of respondent nephrologists and surgeons were willing to accept a remote completion of physical exam; 68.3% of respondent psychiatrists/psychologists and social workers were willing to accept a remote completion of mental status exam. Providers strongly agreed that telemedicine was convenient for donors and would improve the likelihood of completing donor evaluation. However, providers (65.5%) perceived out-of-state licensing as a key policy/regulatory barrier. These findings help inform practice and underscore the instigation of policies to remove barriers using telemedicine to increase living kidney donation.
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Affiliation(s)
- Fawaz Al Ammary
- Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Hannah C. Sung
- Department of SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Asif Sharfuddin
- Department of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Vineeta Kumar
- Department of MedicineUniversity of AlabamaBirminghamAlabamaUSA
| | - Anju Yadav
- Department of MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Mona D. Doshi
- Department of MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Sarthak Virmani
- Department of MedicineYale UniversityNew HavenConnecticutUSA
| | | | - Terry Grace
- Department of MedicineWake Forest Baptist HealthWinston‐SalemNorth CarolinaUSA
| | | | | | | | - Joshua Wolf
- Piedmont Transplant InstituteAtlantaGeorgiaUSA
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Cook DA, Stephenson CR, Pankratz VS, Wilkinson JM, Maloney S, Prokop LJ, Foo J. Associations Between Physician Continuous Professional Development and Referral Patterns: A Systematic Review and Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:728-737. [PMID: 34985042 DOI: 10.1097/acm.0000000000004575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Both overuse and underuse of clinician referrals can compromise high-value health care. The authors sought to systematically identify and synthesize published research examining associations between physician continuous professional development (CPD) and referral patterns. METHOD The authors searched MEDLINE, Embase, PsycInfo, and the Cochrane Database on April 23, 2020, for comparative studies evaluating CPD for practicing physicians and reporting physician referral outcomes. Two reviewers, working independently, screened all articles for inclusion. Two reviewers reviewed all included articles to extract information, including data on participants, educational interventions, study design, and outcomes (referral rate, intended direction of change, appropriateness of referral). Quantitative results were pooled using meta-analysis. RESULTS Of 3,338 articles screened, 31 were included. These studies enrolled at least 14,458 physicians and reported 381,165 referral events. Among studies comparing CPD with no intervention, 17 studies with intent to increase referrals had a pooled risk ratio of 1.91 (95% confidence interval: 1.50, 2.44; P < .001), and 7 studies with intent to decrease referrals had a pooled risk ratio of 0.68 (95% confidence interval: 0.55, 0.83; P < .001). Five studies did not indicate the intended direction of change. Subgroup analyses revealed similarly favorable effects for specific instructional approaches (including lectures, small groups, Internet-based instruction, and audit/feedback) and for activities of varying duration. Four studies reported head-to-head comparisons of alternate CPD approaches, revealing no clear superiority for any approach. Seven studies adjudicated the appropriateness of referral, and 9 studies counted referrals that were actually completed (versus merely requested). CONCLUSIONS Although between-study differences are large, CPD is associated with statistically significant changes in patient referral rates in the intended direction of impact. There are few head-to-head comparisons of alternate CPD interventions using referrals as outcomes.
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Affiliation(s)
- David A Cook
- D.A. Cook is professor of medicine and medical education, director, Section of Research and Data Analytics, School of Continuous Professional Development, and director of education science, Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine and Science, and consultant, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633
| | - Christopher R Stephenson
- C.R. Stephenson is assistant professor of medicine, Mayo Clinic College of Medicine and Science, associate program director, Mayo-Rochester Internal Medicine Residency Program, and consultant, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0001-8537-392X
| | - V Shane Pankratz
- V.S. Pankratz is professor of internal medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; ORCID: https://orcid.org/0000-0002-3742-040X
| | - John M Wilkinson
- J.M. Wilkinson is associate professor of family medicine, Mayo Clinic College of Medicine and Science, and consultant, Department of Family Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1156-8577
| | - Stephen Maloney
- S. Maloney is professor of health professions education and deputy head of school, Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia; ORCID: https://orcid.org/0000-0003-2612-5162
| | - Larry J Prokop
- L.J. Prokop is a reference librarian, Plummer Library, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-7197-7260
| | - Jonathan Foo
- J. Foo is a lecturer, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia; ORCID: https://orcid.org/0000-0003-4533-8307
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Abu Libdeh A, Flanigan J, Heinan K. Experience with Pediatric Neurology e-Consults from a Specialist Perspective at an Academic Center. J Child Neurol 2022; 37:373-379. [PMID: 35300549 DOI: 10.1177/08830738221077760] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION E-consults improve access to specialty expertise and increase satisfaction for patients and Primary Care Providers (PCPs). Pediatric neurology may be perceived as less amenable to e-consults compared to other specialties. METHODS We performed a retrospective analysis of e-consults performed by pediatric neurologists at the University of Virginia. We reviewed the electronic medical records and analyzed the content of e-consults, recommendations from specialists, and subsequent actions by PCPs. RESULTS Between April 2019 and April 2021, 58 e-consults were performed by pediatric neurologists. Most common indications included spells, headache, and tremor. In 56.9% of cases, the answer was provided without recommending a face-to-face (FTF) visit. For patients seen in clinic, e-consults reduced wait time and facilitated the clinic visit. DISCUSSION E-consults are a suitable option for pediatric neurology, and they help with the workflow. Further education is needed to improve utility of e-consults in pediatric neurology.
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Affiliation(s)
- Amal Abu Libdeh
- Department of Neurology, 2358University of Virginia, Charlottesville, VA, US
| | - Joseph Flanigan
- Department of Neurology, 2358University of Virginia, Charlottesville, VA, US
| | - Kristen Heinan
- Department of Neurology, 2358University of Virginia, Charlottesville, VA, US
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Malcolm EJ, Brandon Z, Wilson LE, Shoup JP, King HA, Lewinski A, Greiner MA, Malone S, Miller J, Keenan RT, Tarrant TK, Phinney D, Cho A, Bosworth HB, Shah K. eConsults' Impact on Care Access and Wait Times in Rheumatology. J Clin Rheumatol 2022; 28:147-154. [PMID: 35067514 DOI: 10.1097/rhu.0000000000001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE A growing number of health systems have implemented eConsults to improve access to specialty advice, but few studies have described their use in rheumatology or impact on visit wait times. We evaluated the uptake of an eConsult program and its impact on wait times for in-person rheumatology visits. METHODS In this quality improvement project, we analyzed electronic health record data from 4 intervention clinics and 4 comparison clinics, 12 months before and after implementation of an eConsult program. We compared median wait time for rheumatology appointments using a pre-post difference-in-differences analysis and quantile regression, adjusting for patient age, race, sex, clinic pair, and primary insurance payer. We also interviewed 11 primary care providers from the intervention clinics and conducted a rheumatology provider focus group (n = 4) to elucidate experiences with the program. RESULTS Rheumatologists recommended management in primary care or referral to another specialty for 41% of eConsults, reducing initial demand for in-person visits. The median wait times dropped in the intervention and the comparison clinics (42 and 25 days, respectively). Intervention clinic median wait time dropped 17 days more than comparison clinics, and this was nonstatistically significant (p = 0.089). eConsults fit provider care tasks best for triage or initial workup for diagnosis, and less well when tests required interpretation, or when back and forth communication was needed to manage the patient's condition. CONCLUSIONS Implementation of eConsults for rheumatology was associated with reduced wait times for rheumatology appointments and supported primary care providers in the triage and workup for a substantial portion of patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Julie Miller
- From the Duke University School of Medicine, Durham
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Prins H, Knijp I, Hermanides G, Blanker M, Rokx C. Online networks facilitating multidisciplinary healthcare: a novel strategy to curb COVID-19. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2021-000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectivesGlobal spread of COVID-19 at an unprecedented speed has heavily strained healthcare systems worldwide, and reliable alternatives to analogue healthcare are urgently needed.MethodsDuring the first COVID-19 wave in the Netherlands, we launched six regional online networks and analysed the activity and content in a qualitative mixed-methods manner.ResultsWe observed continued activity and collaboration on the platform between healthcare professionals at the different levels of care.ConclusionThe networks described here were launched successfully and have the potential to optimise the COVID-19 response.
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Stevens JP, Landon B. Opportunities to improve the quality of inpatient consultation: one hospital’s investigation but an age old struggle. Isr J Health Policy Res 2022; 11:7. [PMID: 35101143 PMCID: PMC8802474 DOI: 10.1186/s13584-022-00520-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
Inpatient consultation is widely used by hospital physician teams to access specialized expertise and procedures. However, the quality of the resultant consultation varies widely. This commentary describes prior efforts to understand variation in rates of consultation and potential implications across the spectrum of care from underuse to overuse. Improving the quality of consultation requires a full understanding of the aspects of consultation that contribute to quality, including clear requests and communications from the consulting team, but also recognition of organizational and cultural constraints that can impact the availability and quality of consultations provided.
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Nicolaus S, Crelier B, Donzé JD, Aubert CE. Definition of patient complexity in adults: A narrative review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221081288. [PMID: 35586038 PMCID: PMC9106317 DOI: 10.1177/26335565221081288] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022]
Abstract
Background Better identification of complex patients could help to improve their care. However, the definition of patient complexity itself is far from obvious. We conducted a narrative review to identify, describe, and synthesize the definitions of patient complexity used in the last 25 years. Methods We searched PubMed for articles published in English between January 1995 and September 2020, defining patient complexity. We extended the search to the references of the included articles. We assessed the domains presented in the definitions, and classified the definitions as based on (1) medical aspects (e.g., number of conditions) or (2) medical and/or non-medical aspects (e.g., socio-economic status). We assessed whether the definition was based on a tool (e.g., index) or conceptual model. Results Among 83 articles, there was marked heterogeneity in the patient complexity definitions. Domains contributing to complexity included health, demographics, behavior, socio-economic factors, healthcare system, medical decision-making, and environment. Patient complexity was defined according to medical aspects in 30 (36.1%) articles, and to medical and/or non-medical aspects in 53 (63.9%) articles. A tool was used in 36 (43.4%) articles, and a conceptual model in seven (8.4%) articles. Conclusion A consensus concerning the definition of patient complexity was lacking. Most definitions incorporated non-medical factors in the definition, underlining the importance of accounting not only for medical but also for non-medical aspects, as well as for their interrelationship.
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Affiliation(s)
- Stefanie Nicolaus
- Department of General Internal Medicine, Biel Hospital, Biel, Switzerland
| | - Baptiste Crelier
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Inselspital, Bern, Switzerland
| | - Jacques D Donzé
- Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
- Division of General Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Carole E Aubert
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Inselspital, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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16
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Phadke NA. Universal Cardiology Electronic Consultations. Circ Cardiovasc Qual Outcomes 2022; 15:e008709. [PMID: 35041485 DOI: 10.1161/circoutcomes.121.008709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Neelam A Phadke
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA. Harvard Medical School, Boston, MA. Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston
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17
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Dosani T, Xiang J, Wang K, Deng Y, Connell NT, Connery D, Levin F, Roy A, Wadia RJ, Wong EY, Rose MG. Impact of Hematology Electronic Consultations on Utilization of Referrals and Patient Outcomes in an Integrated Health Care System. JCO Oncol Pract 2021; 18:e564-e573. [PMID: 34914541 DOI: 10.1200/op.21.00420] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Electronic consultations (e-consults) may be a valuable tool in the current era of increased demand for hematologists. Despite the increasing use of e-consults in hematology, their optimal utilization and impact on patient outcomes and workload are largely unknown. METHODS In this retrospective cohort study, we studied the hematology consult experience at Veterans Affairs Connecticut from 2006 to 2018. We included 7,664 hematology consults (3,240 e-consults and 4,424 face-to-face [FTF] consults) requested by 1,089 unique clinicians. RESULTS We found that e-consults were rapidly adopted and used equally among physicians of different degrees of experience. The number of FTF consults did not decrease after the introduction of e-consult services. E-consults were preferentially used for milder laboratory abnormalities that had been less likely to result in a consult before their availability. Referring clinicians used e-consults preferentially for periprocedural management, anemia, leukopenia, and anticoagulation questions. Eighty-three percent of e-consults were resolved without needing an FTF visit in the year after the consult. Consults for pancytopenia, gammopathy, leukocytosis, and for patients with known malignancy were less likely to be resolved by e-consult. Among patients who were diagnosed with a new hematologic malignancy after their consult, having an e-consult before an FTF visit did not adversely affect survival. CONCLUSION In summary, e-consults safely expanded delivery of hematology services in our health care system but increased total consult volume. We report novel data on what types of consults may be best suited to the electronic modality, the impact of e-consults on workload, and their optimal use and implementation.
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Affiliation(s)
- Talib Dosani
- Yale School of Medicine and Yale Cancer Center, New Haven, CT
| | - Jenny Xiang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Kaicheng Wang
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Nathan T Connell
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | - Alicia Roy
- VA Connecticut Healthcare System, West Haven, CT
| | - Roxanne J Wadia
- Yale School of Medicine and Yale Cancer Center, New Haven, CT.,VA Connecticut Healthcare System, West Haven, CT
| | - Ellice Y Wong
- Yale School of Medicine and Yale Cancer Center, New Haven, CT.,VA Connecticut Healthcare System, West Haven, CT
| | - Michal G Rose
- Yale School of Medicine and Yale Cancer Center, New Haven, CT.,VA Connecticut Healthcare System, West Haven, CT
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Zemanek CE, Martin KB. Clinical Trends Over the First Year of a Psychiatric Electronic Consult Service. J Acad Consult Liaison Psychiatry 2021; 63:244-250. [PMID: 34597854 DOI: 10.1016/j.jaclp.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/05/2021] [Accepted: 09/18/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Electronic consultations (e-consultations) offer rapid, direct, and documented communication through the electronic medical record between primary care physicians (PCPs) and specialists. Psychiatric e-consultations are increasingly being implemented across hospital networks with the recommendation for face-to-face psychiatric evaluation periodically being made by the consulted psychiatrist. It remains to be seen what clinical factors lead the consultant to make this type of recommendation and whether the question asked by the PCP and the diagnosis of the patient has any bearing. OBJECTIVES To determine which psychiatric diagnoses are most commonly electronically consulted on, what types of questions are being asked by primary care providers to electronically consulted psychiatrists, and what questions and which diagnoses result in an electronically consulted psychiatrist to recommend further in-person evaluation. METHODS A retrospective chart review of an e-consultation service was conducted. One hundred sixty-four charts were reviewed. Data were collected on the psychiatric diagnosis, type of question posed by the PCP to the psychiatrist, the number of recommendations for an in-person evaluation made, and the percentages of the diagnoses and questions that were associated with a recommendation for in-person evaluation. RESULTS Two hundred twenty-three diagnoses were consulted on. The most common diagnoses were anxiety disorders (34.5%, N = 77), depressive disorders (32.3%, N = 72), and bipolar disorders (13.5%, N = 30). One hundred eighty-one questions were asked by PCPs. One hundred fifty-one (83.4%) questions regarded pharmacological management. Of the 164 charts, 40 (24.4%) e-consultations resulted in the psychiatrist recommending an in-person evaluation. The in-person evaluation recommendation rates did not change with increasing provider familiarity as the inaugural year went on. Three (7.5%) patients who were recommended for an outpatient psychiatry evaluation were scheduled to be seen by the consulted psychiatrist. Depressive (N = 12) and anxiety disorders (N = 13) were both recommended for in-person follow-up 17% of the time. Bipolar disorder was recommended for follow-up 53% (N = 16) of the time. Of the 181 question types posed by PCPs, 34 (22.5%) pharmacological management questions were recommended for in-person follow-up. CONCLUSIONS Certain diagnoses and question types appear to influence the likelihood that an electronically consulted psychiatrist will recommend a face-to-face evaluation. It also suggests that e-consultation services can be particularly serviceable for certain diagnoses, that is, depression and anxiety, as well as certain question types, that is, pharmacological management. This information can guide PCPs and psychiatrists about which patients are best suited for an e-consultation versus an in-person referral from the outset.
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Affiliation(s)
- Cecilia E Zemanek
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY.
| | - Katherine B Martin
- Department of Psychiatry, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, PA
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Sanavro SM, van der Worp H, Jansen D, Koning P, Blanker MH. ‘Evaluation of the First Year(s) of Physicians’ Collaboration on an Interdisciplinary Electronic Consultation Platform in the Netherlands: a mixed-methods observational study. (Preprint). JMIR Hum Factors 2021; 9:e33630. [PMID: 35363155 PMCID: PMC9015779 DOI: 10.2196/33630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/11/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Complexity of health problems and aging of the population create an ongoing burden on the health care system with the general practitioner (GP) being the gatekeeper in primary care. In GPs daily practice, collaboration with specialists and exchange of knowledge from the secondary care play a crucial role in this system. Communication between primary and secondary care has shortcomings for health care workers that want to practice sustainable patient-centered health care. Therefore, a new digital interactive platform was developed: Prisma. Objective This study aims to describe the development of a digital consultation platform (Prisma) to connect GPs with hospital specialists via the Siilo application and to evaluate the first year of use, including consultations, topic diversity, and number of participating physicians. Methods We conducted a mixed methods observational study, analyzing qualitative and quantitative data for cases posted on the platform between June 2018 and May 2020. Any GP can post questions to an interdisciplinary group of secondary care specialists, with the platform designed to facilitate discussion and knowledge exchange for all users. Results In total, 3674 cases were posted by 424 GPs across 16 specialisms. Most questions and answers concerned diagnosis, nonmedical treatment, and medication. Mean response time was 76 minutes (range 44-252). An average of 3 users engaged with each case (up to 7 specialists). Almost half of the internal medicine cases received responses from at least two specialisms in secondary care, contrasting with about one-fifth for dermatology. Of note, the growth in consultations was steepest for dermatology. Conclusions Digital consultations offer the possibility for GPs to receive quick responses when seeking advice. The interdisciplinary approach of Prisma creates opportunities for digital patient-centered networking.
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Affiliation(s)
- Sanne M Sanavro
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, Netherlands
| | - Henk van der Worp
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, Netherlands
| | - Danielle Jansen
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, Netherlands
| | - Paul Koning
- Prisma, Siilo Holding BV, Amsterdam, Netherlands
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, Netherlands
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Anderson E, Vimalananda VG, Orlander JD, Cutrona SL, Strymish JL, Bokhour BG, Rinne ST. Implications of Electronic Consultations for Clinician Communication and Relationships: A Qualitative Study. Med Care 2021; 59:808-815. [PMID: 34116530 PMCID: PMC8360667 DOI: 10.1097/mlr.0000000000001575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Strong relationships and effective communication between clinicians support care coordination and contribute to care quality. As a new mechanism of clinician communication, electronic consultations (e-consults) may have downstream effects on care provision and coordination. OBJECTIVE The objective of this study was to understand primary care providers' and specialists' perspectives on how e-consults affect communication and relationships between clinicians. RESEARCH DESIGN Qualitative study using thematic analysis of semistructured interviews. SUBJECTS Six of 8 sites in the VISN 1 (Veterans Integrated Service Network) in New England were chosen, based on variation in organization and received e-consult volume. Seventy-three respondents, including 60 clinicians in primary care and 3 high-volume specialties (cardiology, pulmonology, and neurology) and 13 clinical leaders at the site and VISN level, were recruited. MEASURES Participants' perspectives on the role and impact of e-consults on communication and relationships between clinicians. RESULTS Clinicians identified 3 types of e-consults' social affordances: (1) e-consults were praised for allowing specialist advice to be more grounded in patient data and well-documented, but concerns about potential legal liability and increased transparency of communication to patients and others were also noted; (2) e-consults were perceived as an imperfect modality for iterative communication, especially for complex conversations requiring shared deliberation; (3) e-consults were understood as a factor influencing clinician relationships, but clinicians disagreed on whether e-consults promote or undermine relationship building. CONCLUSIONS Clinicians have diverse concerns about the implications of e-consults for communication and relationships. Our findings may inform efforts to expand and improve the use of e-consults in diverse health care settings.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Department of Population and Quantitative Health Sciences, Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester
| | - Varsha G. Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine
| | - Jay D. Orlander
- Medical Service, VA Boston Healthcare System
- Evans Department of Medicine, Boston University School of Medicine
| | - Sarah L. Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Department of Population and Quantitative Health Sciences, Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester
| | - Judith L. Strymish
- Medical Service and Section of Infectious Diseases, VA Boston Healthcare System, Boston
- Harvard Medical School, Cambridge
| | - Barbara G. Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester
| | - Seppo T. Rinne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, MA
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Gholamzadeh M, Abtahi H, Ghazisaeeidi M. Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion. BMC Health Serv Res 2021; 21:458. [PMID: 33985502 PMCID: PMC8116646 DOI: 10.1186/s12913-021-06456-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022] Open
Abstract
Background One of the main elements of patient-centered care is an enhancement of patient preparedness. Thus, pre-visit planning assessment tools was emerged to prepare and involve patients in their treatment process. Objective The main objective of this article was to review the applied tools and techniques for consideration of putting pre-visit planning into practice. Methods Web of Science, Scopus, IEEE, and PubMed databases were searched using keywords from January 2001 to November 2020. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, qualitative analysis was done to suggest an appropriate framework by mapping the main concepts. Results Out of 385 citations were retrieved in initial database searches, 49 studies from ten countries were included. Applied pre-visit techniques can be classified into eight categories. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to before visits. Accordingly, the main approach of included articles was patient preparedness. While 38 studies reported this approach is effective, three studies reported the effectiveness of such tools as moderate, only two articles believed it had a low effect on improving patient-centered care. Conclusion This survey summarized the characteristics of published studies on pre-visit planning in the proposed framework. This approach could enhance the quality of patient care alongside enhancement patient-provider communication. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06456-7.
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Affiliation(s)
- Marsa Gholamzadeh
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeeidi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran.
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Guzik AK, Martin-Schild S, Tadi P, Chapman SN, Al Kasab S, Martini SR, Meyer BC, Demaerschalk BM, Wozniak MA, Southerland AM. Telestroke Across the Continuum of Care: Lessons from the COVID-19 Pandemic. J Stroke Cerebrovasc Dis 2021; 30:105802. [PMID: 33866272 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105802] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 12/22/2022] Open
Abstract
While use of telemedicine to guide emergent treatment of ischemic stroke is well established, the COVID-19 pandemic motivated the rapid expansion of care via telemedicine to provide consistent care while reducing patient and provider exposure and preserving personal protective equipment. Temporary changes in re-imbursement, inclusion of home office and patient home environments, and increased access to telehealth technologies by patients, health care staff and health care facilities were key to provide an environment for creative and consistent high-quality stroke care. The continuum of care via telestroke has broadened to include prehospital, inter-facility and intra-facility hospital-based services, stroke telerehabilitation, and ambulatory telestroke. However, disparities in technology access remain a challenge. Preservation of reimbursement and the reduction of regulatory burden that was initiated during the public health emergency will be necessary to maintain expanded patient access to the full complement of telestroke services. Here we outline many of these initiatives and discuss potential opportunities for optimal use of technology in stroke care through and beyond the pandemic.
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Affiliation(s)
- Amy K Guzik
- Department of Neurology, Wake Forest University, Winston-Salem, NC, USA.
| | - Sheryl Martin-Schild
- Department of Neurology, Touro Infirmary and New Orleans East Hospital, New Orleans, LA, USA
| | - Prasanna Tadi
- Department of Neurology, Creighton University, Omaha, NE, USA
| | - Sherita N Chapman
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Sharyl R Martini
- Department of Neurology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Brett C Meyer
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Bart M Demaerschalk
- Department of Neurology, Center for Connected Care, and Center for Digital Health, Mayo Clinic College of Medicine and Science, Phoenix, AZ, USA
| | - Marcella A Wozniak
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew M Southerland
- Department of Neurology, University of Virginia, Charlottesville, VA, USA; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
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Bock NW, Wouters H, Lammers AJ, Blanker MH. Online Consultations Between General Practitioners and Psychiatrists in the Netherlands: A Qualitative Study. Front Psychiatry 2021; 12:775738. [PMID: 34803781 PMCID: PMC8600358 DOI: 10.3389/fpsyt.2021.775738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To examine the nature and scope of questions about psychiatric patient cases submitted by general practitioners (GPs) to an established online consultation platform and to determine if they could have been answered by consulting existing clinical guidelines. Methods: All anonymized psychiatric cases submitted by GPs to the online electronic Prisma platform between September 2018 and November 2019 were examined in a mixed-methods study. Descriptive statistics and qualitative thematic analysis were used, followed by axial coding to arrive at overarching themes to characterize cases. Results: Of the 136 included cases, 44.1% concerned female patients and about half concerned patients aged 31-60 years. Common psychiatric disorders were depression, attention deficit hyperactivity disorder, sleeping problems, sexual disorders, and eating disorders. The first response was usually given within 2 h (interquartile range, 0-14.3 h), with 86% answered within 24 h and 95% within 48 h. Qualitative analysis revealed four themes, namely "type of question," "cases in relation to current clinical guidelines," "case complexity" and "the doctor being pressured." Type of question comprised diagnostic, therapeutic, and referral questions. Notably, for 44.1% of questions no current clinical guidelines was present and 46.3% of cases were deemed complex in nature. GPs were willing to share their experiences of coping with being pressured by patients. Conclusion: The findings of this study support the potential for an online electronic consultation platform to facilitate feasible and useful interprofessional consultation between GPs and psychiatrists for a broad range mental illnesses and questions of varying complexity.
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Affiliation(s)
- Nynke W Bock
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, Netherlands
| | - Hans Wouters
- General Practitioners Research Institute, Groningen, Netherlands
| | - Anne J Lammers
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, Netherlands
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, Netherlands
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Naveen R, Sundaram TG, Agarwal V, Gupta L. Teleconsultation experience with the idiopathic inflammatory myopathies: a prospective observational cohort study during the COVID-19 pandemic. Rheumatol Int 2020; 41:67-76. [PMID: 33150493 PMCID: PMC7640991 DOI: 10.1007/s00296-020-04737-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/21/2020] [Indexed: 01/26/2023]
Abstract
Teleconsultation has assumed a central role in the management of chronic and disabling rheumatic diseases, such as the idiopathic inflammatory myopathies (IIM), during COVID-19. However, the feasibility, challenges encountered, and outcomes remain largely unexplored. Here, we describe our teleconsultation experience in a prospectively followed cohort of adult and juvenile IIM. 250 IIM enrolled into the MyoCite cohort (2017-ongoing) were offered the option of audio/visual teleconsultation using WhatsApp during the nationwide lockdown. Clinical outcomes (major/minor relapse) and prescription changes were compared between IIM subsets. Socio-demographic and clinico-serological characteristics of those who sought teleconsultation were compared with those who did not. 151 teleconsultations were sought over a 93 day period by 71 (52.2%) of 136 IIM (median age 38 years, F:M 4.5:1). Nearly one-third (38%) consulted on an emergency basis, with voice consultations being the primary medium of communication. Over a quarter (26.8%) reported relapse (15.5% minor, 11.3% major), these being more common in JDM [71.4%, OR 8.9 (1.5-51)] as compared with adult IIM, but similar across various antibody-based IIM subtypes. Patients who relapsed required more consultations [2(2-3) vs 1(1-2), p 0.009]. The demographic and socioeconomic profile of the patients seeking consultation (n = 71) was not different from those who did not (n = 65). Voice-based teleconsultations may be useful to diagnose and manage relapses in IIM during the pandemic. Patient education for meticulous and timely reporting may be improve care, and larger multicentre studies may identify subsets of IIM that require greater care and early tele-triage for effective management of the condition.
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Affiliation(s)
- R Naveen
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - T G Sundaram
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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25
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May JE, Irelan PC, Boedeker K, Cahill E, Fein S, Garcia DA, Hicks LK, Lawson J, Lim MY, Morton CT, Rajasekhar A, Shanbhag S, Zumberg MS, Plovnick RM, Connell NT. Systems-based hematology: highlighting successes and next steps. Blood Adv 2020; 4:4574-4583. [PMID: 32960959 PMCID: PMC7509880 DOI: 10.1182/bloodadvances.2020002947] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/10/2020] [Indexed: 12/21/2022] Open
Abstract
Systems-based hematology is dedicated to improving care delivery for patients with blood disorders. First defined by the American Society of Hematology in 2015, the idea of a systems-based hematologist arose from evolving pressures in the health care system and increasing recognition of opportunities to optimize the quality and cost effectiveness of hematologic care. In this review, we begin with a proposed framework to formalize the discussion of the range of initiatives within systems-based hematology. Classification by 2 criteria, project scope and method of intervention, facilitates comparison between initiatives and supports dialogue for future efforts. Next, we present published examples of successful systems-based initiatives in the field of hematology, including efforts to improve stewardship in the diagnosis and management of complex hematologic disorders (eg, heparin-induced thrombocytopenia and thrombophilias), the development of programs to promote appropriate use of hematologic therapies (eg, blood products, inferior vena cava filters, and anticoagulation), changes in care delivery infrastructure to improve access to hematologic expertise (eg, electronic consultation and disorder-specific care pathways), and others. The range of projects illustrates the broad potential for interventions and highlights different metrics used to quantify improvements in care delivery. We conclude with a discussion about future directions for the field of systems-based hematology, including extension to malignant disorders and the need to define, expand, and support career pathways.
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Affiliation(s)
- Jori E May
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - David A Garcia
- Division of Hematology, University of Washington, Seattle, WA
| | - Lisa K Hicks
- Division of Hematology/Oncology, Department of Medicine, St. Michael's Hospital and University of Toronto, Toronto, ON, Canada
| | | | - Ming Y Lim
- Division of Hematology and Hematological Malignancies, University of Utah, Salt Lake City, UT
| | - Colleen T Morton
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Anita Rajasekhar
- Division of Hematology and Oncology, University of Florida, Gainesville, FL
| | - Satish Shanbhag
- Cancer Specialists of North Florida, Fleming Island, FL; and
| | - Marc S Zumberg
- Division of Hematology and Oncology, University of Florida, Gainesville, FL
| | | | - Nathan T Connell
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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27
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Houchens N, Gupta A. Quality and safety in the literature: September 2020. BMJ Qual Saf 2020; 29:780-784. [DOI: 10.1136/bmjqs-2020-011887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 06/27/2020] [Indexed: 11/04/2022]
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28
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Grattagliano I, Rossi A, Cricelli I, Cricelli C. The changing face of family medicine in the COVID and post-COVID era. Eur J Clin Invest 2020; 50:e13303. [PMID: 32506437 PMCID: PMC7300567 DOI: 10.1111/eci.13303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 12/27/2022]
Abstract
This article describes the prospective changes and the fundamental values of the relationships between family doctors, patients and community according to an ethical-social concept of medicine. New aspects of the organization of the activity and of the roles of family doctors are reported in order to build hypotheses pointing to a modern and efficient management of patients in the coming the post-COVID era.
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Affiliation(s)
- Ignazio Grattagliano
- Italian College of General Practitioners and Primary Care, Florence, Italy.,Family Medicine, English Medical Curriculum, University of Bari, Bari, Italy
| | - Alessandro Rossi
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Iacopo Cricelli
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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29
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Binder AF, Handley NR, Wilde L, Palmisiano N, Lopez AM. Treating Hematologic Malignancies During a Pandemic: Utilizing Telehealth and Digital Technology to Optimize Care. Front Oncol 2020; 10:1183. [PMID: 32676459 PMCID: PMC7333768 DOI: 10.3389/fonc.2020.01183] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022] Open
Abstract
In late January 2020, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) was reported as an outbreak in Wuhan, China. Within 2 months it became a global pandemic. Patients with cancer are at highest risk for both contracting and suffering complications of its resultant disease, Coronavirus 19 (COVID-19). Healthcare systems across the world had to adapt quickly to mitigate this risk, while continuing to provide potentially lifesaving treatment to patients. Bringing care to the home through the use of telehealth, home based chemotherapy, and remote patient monitoring technologies can help minimize risk to the patient and healthcare workers without sacrificing quality of care delivered. These care models provide the right treatment, to the right patient, at the right time, in the right place. Whether these patient-centered models of care will continue to be embraced by key stakeholders after the pandemic remains uncertain.
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Affiliation(s)
- Adam F Binder
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Nathan R Handley
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Lindsay Wilde
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Neil Palmisiano
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Ana Maria Lopez
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
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30
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Mustafa SS, Staicu ML, Yang L, Baumeister T, Vadamalai K, Ramsey A. Inpatient Electronic Consultations (E-consults) in Allergy/Immunology. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2968-2973. [PMID: 32585408 PMCID: PMC7307996 DOI: 10.1016/j.jaip.2020.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/07/2023]
Abstract
Background Electronic consultations (e-consults) are asynchronous clinician-to-clinician exchanges within the electronic health record (EHR). Objective We sought to demonstrate the utility of e-consults in allergy/immunology (A/I) inpatient consultations. Methods Inpatients ≥18 years of age for whom an A/I consultation was requested were eligible for an e-consult. An e-consult was completed if considered appropriate by the A/I physician with recommendations made in the EHR. In-person consultation was performed for inpatients if deemed necessary. Likert scale satisfaction data were collected from requesting providers after the e-consultation. Cost was calculated using time-based billing codes plus the cost of penicillin allergy evaluation, if appropriate. Results Of the 109 inpatient consults, 78 (71.6%) were completed through an e-consult and 31 (28.4%) were completed by an in-person consult. The most common indication for an inpatient consult was evaluation of penicillin allergy in 73 (67%) patients. The most common reason to complete an in-person consult was the need to complete penicillin skin testing in 17 of the 31 (55%) patients. E-consults were completed in less time than in-person consults (15 minutes, interquartile range [IQR]: 10-15 vs 60 minutes, IQR: 45-60, P < .001) and had a shorter turnaround time (1 hour, IQR: 0.5-2 vs 7 hours, IQR: 3-19, P < .001). Management recommendations were followed at a similar rate regardless of type of consult (88% of e-consults vs 96% of in-person consults, P = .162). A total of 97% of requesting providers reported an “excellent” or “good” impression of e-consults. E-consults were less costly than in-person consults. Conclusions E-consults have utility in providing inpatient A/I consultation and may have advantages over in-person evaluation, while adequately maintaining provider satisfaction.
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Affiliation(s)
- S Shahzad Mustafa
- Division of Allergy, Immunology and Rheumatology, Rochester Regional Health, Rochester, NY; Department of Medicine, University of Rochester, Rochester, NY.
| | - Mary L Staicu
- Department of Pharmacy, Rochester General Hospital, Rochester, NY
| | - Luanna Yang
- Division of Allergy, Immunology and Rheumatology, Rochester Regional Health, Rochester, NY
| | - Tyler Baumeister
- Department of Pharmacy, Rochester General Hospital, Rochester, NY
| | | | - Allison Ramsey
- Division of Allergy, Immunology and Rheumatology, Rochester Regional Health, Rochester, NY; Department of Medicine, University of Rochester, Rochester, NY.
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31
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Affiliation(s)
- Varsha G Vimalananda
- Bedford VA Hospital, Bedford, and Boston University School of Medicine, Boston, Massachusetts (V.G.V.)
| | - B Graeme Fincke
- Bedford VA Hospital, Bedford, and Boston University School of Public Health, Boston, Massachusetts (B.G.F.)
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32
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Sylaja PN, Srivastava MVP, Shah S, Bhatia R, Khurana D, Sharma A, Pandian JD, Kalia K, Sarmah D, Nair SS, Yavagal DR, Bhattacharya P. The SARS-CoV-2/COVID-19 pandemic and challenges in stroke care in India. Ann N Y Acad Sci 2020; 1473:3-10. [PMID: 32396683 PMCID: PMC7273096 DOI: 10.1111/nyas.14379] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 11/27/2022]
Abstract
Stroke care in India has evolved rapidly in the last decade with a focus on stroke awareness, prevention, rapid triage, treatment, and rehabilitation. But acute stroke care and poststroke rehabilitation in the country have limitations owing to the economic constraints and poor access to health care. The SARS-CoV-2/COVID-19 pandemic has made stroke care even more challenging. We outline the unfavorable circumstances in stroke care induced by the pandemic; propose mitigating measures; crisis management; and provide a comparative evaluation of stroke care between India and the United States during the pandemic. There is a need for public health systems in both developed and developing countries to improve awareness, implement proper strategies of triage, acute treatment, well-defined rehabilitation plans, telemedicine services, and virtual check-ins.
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Affiliation(s)
- P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudhir Shah
- Department of Neurology, SVPIMSR and NHL Municipal Medical College & Sterling Hospital, Ahmedabad, Gujarat, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Sharma
- Department of Neurology, Zydus Hospital, Ahmedabad, Gujarat, India
| | - Jeyaraj D Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Kiran Kalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Deepaneeta Sarmah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Sruthi S Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Pallab Bhattacharya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
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