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Fox JL, Doolan TD, Gurney TM, McGrail MR. Short-term medical student placements completed consecutively at a rural general practice positively impact chronic disease management. Rural Remote Health 2023; 23:7611. [PMID: 37069128 DOI: 10.22605/rrh7611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Little is known about how medical school placements in rural areas impact key stakeholders such as patients, host organisations and the wider rural community. With engagement from rural communities crucial to the success of rural medical training, this case study sought to demonstrate the benefit that rural clinical placements can have on rural general practices (systems) and likely impacts on communities (health outcomes). Specifically, we describe how a series of consecutive short-term student placements in a single rural practice were the drivers of a series of clinical audits and interventions resulting in improved management of chronic disease. METHODS Data for this project were obtained from student research reports completed as part of a rural and remote medicine rotation at an Australian medical school. For this series of projects, eight consecutive students were based at the same rural medical centre, with each attending for 6 weeks across a 15-month period, completing a report for a quality improvement activity and evaluating the outcomes. Each project related to chronic kidney disease (CKD), with CKD chosen based on the needs of the medical centre and the higher burden of this disease in rural areas. Each project was developed and delivered in consultation with the practice, taking into account student interest and skills, and related projects completed prior or concurrently. Projects were related to database management (n=2), alignment between CKD management and best-practice guidelines (n=3), patient health literacy (n=3), and a summary and staff perceptions of the preceding quality improvement activities (n=1). RESULTS The combination of student projects led to tangible improvements in CKD management at a rural general practice. All doctors at the medical centre (n=4) reported using the database management tools implemented by the students and felt the interventions were sustainable, long-term solutions for ensuring clinical investigations are not being delayed or missed. Following the various interventions completed by the students, clinician knowledge and implementation of best-practice CKD management increased, and some patients became more aware of their condition and how to manage it. CONCLUSION This case study provides evidence that short-term rural clinical placements for medical students have the potential to greatly improve health care and clinical practice in rural and remote communities, when designed around a consistent topic within a medical practice. Outcomes of the student projects in combination demonstrate that addressing CKD management longitudinally led to improvements in administrative processes, clinical practices, and patient awareness and accountability, despite each student only being at the medical centre for a short period of time. Similar approaches to structuring rural clinical placements and defining community projects for medical students should be considered more broadly.
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Affiliation(s)
- Jordan L Fox
- Rural Clinical School, The University of Queensland, Rockhampton, Qld 4700, Australia
| | | | - Tiana M Gurney
- Regional Training Hubs, Rural Clinical School, The University of Queensland, Toowoomba, Qld 4350, Australia
| | - Matthew R McGrail
- Rural Clinical School, The University of Queensland, Rockhampton, Qld 4700, Australia
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Glynn L, Murphy AW, Scully R, Strasser R, Quinlan D, Cowley J, Hayes P, O'Donnell P, O'Regan A, Tuli S, Santana MADO, Sparrow-Downes VM, Petrazzuoli F, Nowlan S, Collins C, Fogarty F, MacFarlane A, Wynn-Jones J, Chater AB. The Limerick Declaration on Rural Health Care 2022. Rural Remote Health 2023; 23:7905. [PMID: 36631080 DOI: 10.22605/rrh7905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The 19th World Rural Health Conference, hosted in rural Ireland and the University of Limerick, with over 650 participants coming from 40 countries and an additional 1600 engaging online, has carefully considered how best rural communities can be empowered to improve their own health and the health of those around them. The conference also considered the role of national health systems and all stakeholders, in keeping with the commitments made through the Sustainable Development Goals and the enjoyment of the highest attainable standard of health as one of the fundamental rights of every human being. This conference declaration, the Limerick Declaration on Rural Healthcare, is designed to inform rural communities, academics and policymakers about how to achieve the goal of delivering high quality health care in rural and remote areas most effectively, with a particular focus on the Irish healthcare system. Congruent with current evidence and best international practice, the participants of the conference endorsed a series of recommendations for the creation of high quality, sustainable and cost-effective healthcare delivery for rural communities in Ireland and globally. The recommendations focused on four major themes: rural healthcare needs and delivery, rural workforce, advocacy and policy, and research for rural health care. Equal access to health care is a crucial marker of democracy. Hence, we call on all governments, policymakers, academic institutions and communities globally to commit to providing their rural dwellers with equitable access to health care that is properly resourced and fundamentally patient-centred in its design.
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Affiliation(s)
- Liam Glynn
- SLÁINTE Research and Education Alliance in General Practice, Primary Healthcare and Public Health, School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; and Health Research Board Primary Care Clinical Trials Network Ireland
| | - Andrew W Murphy
- Department of General Practice, National University of Ireland Galway, Galway, Ireland; and Health Research Board Primary Care Clinical Trials Network Ireland
| | - Robert Scully
- School of Medicine, Medical and Biological Sciences Building, St Andrews KY69TF Fife, Scotland
| | - Roger Strasser
- Rural Health, University of Waikato; Rural Health and Founding Dean Emeritus Northern Ontario School of Medicine (NOSM), Sudbury, ON, Canada
| | - Diarmuid Quinlan
- Woodview Family Doctors, Glanmire, Cork, Ireland; and Irish College of General Practitioners, Dublin, Ireland
| | - Jerry Cowley
- Institute of Rural Health Ltd t/a Rural, Island & Dispensing Doctors of Ireland; and Mulranny Surgery, Mulranny, County Mayo, Ireland
| | - Peter Hayes
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Andrew O'Regan
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | | | - Victoria M Sparrow-Downes
- Department of Family Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Ferdinando Petrazzuoli
- European Rural and Isolated Practitioners Association Scientific Board; Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Shelley Nowlan
- School of Nursing and Midwifery, University of Queensland, St Lucia, Qld, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia; School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Qld, Australia; School of Medicine, Griffith University, Brisbane, Qld, Australia; and Association Queensland Nursing and Midwifery Leaders
| | - Claire Collins
- Irish College of General Practitioners, Dublin, Ireland; and Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Anne MacFarlane
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; and Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Alan Bruce Chater
- Rural WONCA (WONCA Working Party on Rural Practice); and Mayne Academy of Rural and Remote Medicine, Rural and Remote Medicine Clinical Unit, University of Queensland, Herston, Qld, Australia
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Galloway S, Taunton C, Matysek R, Hempenstall A. Seeking to improve access to COVID-19 therapeutics in the remote Torres and Cape communities of Far North Queensland during the first COVID-19 omicron outbreak. Rural Remote Health 2022; 22:7657. [PMID: 36262083 DOI: 10.22605/rrh7657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The first outbreak of the omicron variant of COVID-19 in the Torres and Cape region of Far North Queensland in Australia was declared in late December 2021. A COVID-19 Care at Home program was created to support the health and non-health needs of people with COVID-19 and their families throughout the mandatory isolation periods and included centralising the coordination and delivery of COVID-19 therapeutics. The therapeutics available included one intravenous monoclonal antibody (sotrovimab) and two oral antiviral therapies: nirmatrelvir and ritonavir (Paxlovid®) and molnupiravir (Lagevrio®). This article describes the uptake and delivery of this therapeutics program. METHODS COVID-19 cases were documented in a notification database, screened to determine eligibility for COVID-19 therapies and prioritised based on case age, vaccination status, immunosuppression status and existing comorbidities, in line with Queensland clinical guidelines. Eligible cases were individually contacted by phone to discuss treatment options, and administration of therapies were coordinated in partnership with local primary healthcare centres and hospitals. RESULTS A total of 4744 cases were notified during the outbreak period, of which 217 (4.6%) were deemed eligible for treatment after medical review. Treatment was offered to 148/217 cases (68.2%), with 90/148 cases (60.8%) declining treatment and 53/148 cases (35.8%) receiving therapeutic treatment for COVID-19. Among these 53 cases, 29 received sotrovimab (54.7%), 20 received Paxlovid (37.7%) and four received Lagevrio (7.5%). First Nations people accounted for 48/53 cases (90.6%) who received treatment, and COVID-19 therapeutics were delivered to cases in 16 remote First Nations communities during the outbreak period. CONCLUSION The COVID-19 Care at Home program demonstrated a novel, public health led approach to delivering time-critical medications to individuals across a large, remote and logistically complex region. The application of similar models to outbreaks and chronic conditions of public health importance offers potential to address many health access inequities experienced by remote Australian First Nations communities.
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Affiliation(s)
- Sarah Galloway
- Torres and Cape Hospital and Health Service, 165 Douglas St, Thursday Island, Queensland, Australia
| | - Caroline Taunton
- Torres and Cape Hospital and Health Service, 120 Bunda St, Cairns, Queensland, Australia
| | - Rittia Matysek
- Torres and Cape Hospital and Health Service, 120 Bunda St, Cairns, Queensland, Australia
| | - Allison Hempenstall
- Torres and Cape Hospital and Health Service, 165 Douglas St, Thursday Island, Queensland, Australia
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Terrero Ledesma NE, Nájera A, Reolid-Martínez RE, Escobar-Rabadán F. Internet health information seeking by primary care patients. Rural Remote Health 2022; 22:6585. [PMID: 36192837 DOI: 10.22605/rrh6585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION As patients seek health information more frequently on the internet, the impact on their health status and their relationship with doctors could be a matter of concern. The objective of this study is to know how frequently rural primary care patients seek health information on the internet and the factors associated with it. METHODS This cross-sectional study surveyed 850 patients aged over 15 years who attended two rural health centers in Cuenca (Spain). Consecutive case sampling was done. The participants were invited to answer a survey with sociodemographic and clinical aspects, and questions about possible internet searches for health information. The statistical analysis included the description of the variables and a bivariate analysis, and was completed with a logistic regression analysis. RESULTS Patients' median age was 54 years, interquartile range 39-67 years; 60.9% were female. Of those surveyed, 49.8% (95% confidence interval 46.3-53.2) stated that they used the internet to seek health information. Statistically significant differences were apparent for gender, age, level of education, disease and attendance (p<0.0001). A logistic regression analysis showed an independent relationship with health information seeking on the internet for the variables gender, age, level of education (p<0.0001) and having a chronic disease (p=0.004). CONCLUSION Roughly half the primary care patients in the rural area sought health information on the internet. Females, young people, those with a higher level of education and a chronic disease background did so more frequently.
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Affiliation(s)
| | - Alberto Nájera
- Centre for Biomedical Research, School of Medicine, University of Castilla-La Mancha, Albacete, Spain
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Petrazzuoli F, Gokdemir O, Antonopoulou M, Blahova B, Mrduljaš-Đujić N, Dumitra G, Falanga R, Ferreira M, Gintere S, Hatipoglu S, Jacquet JP, Javorská K, Kareli A, Mohos A, Naimer S, Tkachenko V, Tomacinschii A, Randall-Smith J, Kurpas D. Patient consultations during SARS-CoV-2 pandemic: a mixed-method cross-sectional study in 16 European countries. Rural Remote Health 2022; 22:7196. [PMID: 36260933 DOI: 10.22605/rrh7196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Remote consultations help reduce contact between people and prevent cross-contamination. Little is known about the changes in consultation in European rural primary care during the SARS-CoV-2 (COVID-19) pandemic. The purpose of this mixed-methods cross-sectional study was to find out more about the effects of the pandemic on changes in patient consultations in European rural primary care. METHODS A key informant survey from 16 member countries of the European Rural and Isolated Practitioners Association (EURIPA) was undertaken using a self-developed questionnaire. The steering committee of this project, called EURIPA Covid-19 study, developed a semi-structured questionnaire with 68 questions, 21 of which included free-text comments. Proportions were calculated for dichotomized or categorized data, and means were calculated for continuous data. Multivariate analysis by logistic regression model was used to assess the association of multiple variables. RESULTS A total of 406 questionnaires from primary care providers (PCPs) in 16 European countries were collected; 245 respondents (60.5%) were females, 152 PCPs were rural (37.5%), 124 semi-rural (30.5%). Mean age of the respondents was 45.9 years (standard deviation (SD) 11.30) while mean seniority (length of experience) was 18.2 years (SD 11.6). A total of 381 (93.8%) respondents were medical doctors. Significant differences were found between countries in adopting alternative arrangements to face-to-face consultation: remote teleconsultation is well appreciated by both healthcare professionals and patients, but the most common way of remote consultation remains telephone consultation. A factor significantly inversely associated with the adoption of video consultation was the seniority of the PCP (odds ratio 1.19, 95% confidence interval 1.02-1.40, p=0.03). CONCLUSION Telephone consultation is the most common form of remote consultation. The adoption of video-consultation is inversely related to the seniority of the informants.
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Affiliation(s)
- Ferdinando Petrazzuoli
- European Rural and Isolated Practitioner Association (EURIPA); and Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Ozden Gokdemir
- European Rural and Isolated Practitioner Association (EURIPA); and Faculty of Medicine, Izmir University of Economics, Balçova, Izmir, Turkey
| | - Maria Antonopoulou
- European Rural and Isolated Practitioner Association (EURIPA); and Spili Primary Care Center, Regional Health System of Crete, Spili, Greece
| | - Beata Blahova
- European Rural and Isolated Practitioner Association (EURIPA); and Department of Public Health, Slovak Medical University, Bratislava, Slovakia
| | - Natasa Mrduljaš-Đujić
- European Rural and Isolated Practitioner Association (EURIPA); and Department of Family Medicine, University of Split, School of Medicine, Croatia
| | - Gindrovel Dumitra
- European Rural and Isolated Practitioner Association (EURIPA); Department of Family Medicine, University of Medicine and Pharmacy, Craiova, Romania
| | - Rosario Falanga
- European Rural and Isolated Practitioner Association (EURIPA); and Department of Primary Care, Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Mercedes Ferreira
- European Rural and Isolated Practitioner Association (EURIPA); and Department of Primary Care, Cerdido, Area Sanitaria de Ferrol, Sergas, Spain
| | - Sandra Gintere
- European Rural and Isolated Practitioner Association (EURIPA); and Department of Family Medicine, Medical Faculty, Rīga Stradiņš University, Dzirciema St. 16, Riga, LV-1007, Latvia
| | - Sehnaz Hatipoglu
- European Rural and Isolated Practitioner Association (EURIPA); and Turkish Association of Family Physicians, Primary Care Center, Izmir, Turkey
| | - Jean-Pierre Jacquet
- European Rural and Isolated Practitioner Association (EURIPA); and Collège de la Médecine Générale, France
| | - Kateřina Javorská
- European Rural and Isolated Practitioner Association (EURIPA); and Czech GP Society, Department of Social Medicine, Faculty of Medicine, Charles University, Hradec Králové, Czech Republic
| | - Ana Kareli
- European Rural and Isolated Practitioner Association (EURIPA); and Georgian Family Medicine Association, Tbilisi State Medical University, Tbilisi, Georgia
| | - András Mohos
- European Rural and Isolated Practitioner Association (EURIPA); and Department of Family Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Sody Naimer
- European Rural and Isolated Practitioner Association (EURIPA); and Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, BeerSheva, Israel
| | - Victoria Tkachenko
- European Rural and Isolated Practitioner Association (EURIPA); and Department of Family Medicine, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Angela Tomacinschii
- European Rural and Isolated Practitioner Association (EURIPA); and University Clinic of Primary Medical Assistance, State University of Medicine and Pharmacy, N. Testemițanu”, the Republic of Moldova
| | | | - Donata Kurpas
- European Rural and Isolated Practitioner Association (EURIPA); and Family Medicine Department, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
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Abstract
INTRODUCTION In countries such as New Zealand, where there has been little community spread of COVID-19, psychological distress has been experienced by the population and by health workers. COVID-19 has caused changes in the model of care that is delivered in New Zealand general practice. It is unknown, however, whether the changes wrought by COVID-19 have resulted in different levels of strain between rural and urban general practices. This study aims to explore these differences from the impact of COVID-19. METHODS This study is part of a four-country collaboration (Australia, New Zealand, Canada and the USA) involving repeated cross-sectional surveys of primary care practices in each respective country. Surveys were undertaken at regular intervals throughout 2020 of urban and rural general practices throughout New Zealand. Five core questions were asked at each survey, relating to experiences of strain, capacity for testing, stressors experienced, types of consultations being carried out and numbers of patients seen. Simple descriptive statistics were used to analyse the data. RESULTS A total of 1516 responses were received with 20% from rural practices. A moderate degree of strain was experienced by general practices, although rural practices appeared to experience less strain compared to urban ones. Rural practices had fewer staff absent from work, were less likely to use alternative forms of consultations such as video consultations and telephone consultations, and had possibly lower reductions in patient volumes. These variations might be related to personal characteristics of rural as compared to urban practices or different models of care. CONCLUSION New Zealand rural general practice appeared to have a different response to the COVID-19 pandemic compared to urban general practice, illustrating the significant strengths and resilience of rural practices. While different experiences from COVID-19 might reflect differences in the demographics of the rural and urban general practice workforce, another proposition is that this difference indicates a rural model of care that is more adaptive compared to the urban one. This is consistent with the literature that rural general practice has the capacity to manage conditions in a different way to urban. While other comparable countries have demonstrated a unique rural model of care, less is known about this in New Zealand, adding weight to an argument to further define New Zealand rural general practice.
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Affiliation(s)
- Kyle Eggleton
- Department of General Practice and Primary Health Care, The University of Auckland, Grafton, Auckland 1023, New Zealand
| | - Nam Bui
- Department of General Practice and Primary Health Care, The University of Auckland, Grafton, Auckland 1023, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, The University of Auckland, Grafton, Auckland 1023, New Zealand
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Buck-McFadyen E, Lee-Popham S, White A. Pilot program integrating outpatient opioid treatment within a rural primary care setting. Rural Remote Health 2021; 21:6413. [PMID: 34445877 DOI: 10.22605/rrh6413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
CONTEXT Canada is experiencing an opioid crisis. In rural areas, limited access to specialty addictions services, public transportation, and many of the social determinants of health create a unique set of challenges for people who use substances. ISSUE The Rural Outpatient Opioid Treatment (ROOT) program was created to bring some of the structure of an inpatient treatment program into a rural primary care setting in Ontario, Canada. The program uses a harm reduction approach to provide group recovery work, primary care, peer support, smoking cessation, opioid agonist therapy, screening and treatment for hepatitis C and HIV, and longitudinal follow-up. Sixteen participants have enrolled in three rounds of the ROOT program to date. LESSONS LEARNED A program evaluation shows that opioid use decreased while use of other substances remained high, in particular methamphetamine use, which is increasing more broadly in the local area. Participants described feeling cared for and appreciated the 'seamless' nature of the multidisciplinary program, the peer support provided, and their new and expanded social networks. The rural context created both benefits and challenges for their substance use, recovery, and for community programming. In conclusion, the evaluation of this pilot program demonstrates that it is possible to successfully integrate an outpatient substance-use treatment program into rural primary care.
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Affiliation(s)
- Ellen Buck-McFadyen
- Trent/Fleming School of Nursing, Trent University, Peterborough, Ontario, Canada
| | | | - Ashley White
- Bancroft Family Health Team, Bancroft, Ontario, Canada
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Chua IS, Ransohoff JR, Ehrlich O, Katznelson E, Virk ZM, Demetriou CA, Petrides AK, Orav EJ, Schiff GD, Melanson SEF. Laboratory-Generated Urine Toxicology Interpretations: A Mixed Methods Study. Pain Physician 2021; 24:E191-E201. [PMID: 33740356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Clinicians frequently order urine drug testing (UDT) for patients on chronic opioid therapy (COT), yet often have difficulty interpreting test results accurately. OBJECTIVES To evaluate the implementation and effectiveness of a laboratory-generated urine toxicology interpretation service for clinicians prescribing COT. STUDY DESIGN Type II hybrid-convergent mixed methods design (implementation) and pre-post prospective cohort study with matched controls (effectiveness). SETTING Four ambulatory sites (2 primary care, 1 pain management, 1 palliative care) within 2 US academic medical institutions. METHODS Interpretative reports were generated by the clinical chemistry laboratory and were provided to UDT ordering providers via inbox message in the electronic health record (EHR). The Partners Institutional Review Board approved this study.Participants were primary care, pain management, and palliative care clinicians who ordered liquid chromatography-mass spectrometry UDT for COT patients in clinic. Intervention was a laboratory-generated interpretation service that provided an individualized interpretive report of UDT results based on the patient's prescribed medications and toxicology metabolites for clinicians who received the intervention (n = 8) versus matched controls (n = 18).Implementation results included focus group and survey feedback on the interpretation service's usability and its impact on workflow, clinical decision making, clinician-patient relationships, and interdisciplinary teamwork. Effectiveness outcomes included UDT interpretation concordance between the clinician and laboratory, documentation frequency of UDT results interpretation and communication of results to patients, and clinician prescribing behavior at follow-up. RESULTS Among the 8 intervention clinicians (median age 58 [IQR 16.5] years; 2 women [25%]) on a Likert scale from 1 ("strongly disagree") to 5 ("strongly agree"), 7 clinicians reported at 6 months postintervention that the interpretation service was easy to use (mean 5 [standard deviation {SD}, 0]); improved results comprehension (mean 5 [SD, 0]); and helped them interpret results more accurately (mean 5 [SD, 0]), quickly (mean 4.67 [SD, 0.52]), and confidently (mean 4.83 [SD, 0.41]). Although there were no statistically significant differences in outcomes between cohorts, clinician-laboratory interpretation concordance trended toward improvement (intervention 22/32 [68.8%] to 29/33 [87.9%] vs. control 21/25 [84%] to 23/30 [76.7%], P = 0.07) among cases with documented interpretations. LIMITATIONS This study has a low sample size and was conducted at 2 large academic medical institutions and may not be generalizable to community settings. CONCLUSIONS Interpretations were well received by clinicians but did not significantly improve laboratory-clinician interpretation concordance, interpretation documentation frequency, or opioid-prescribing behavior.
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Affiliation(s)
- Isaac S Chua
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jaime R Ransohoff
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Olga Ehrlich
- Phyllis Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | - Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus; The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Athena K Petrides
- Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Endel J Orav
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Gordon D Schiff
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Stacy E F Melanson
- Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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LeBlanc M, Petrie S, Paskaran S, Carson DB, Peters PA. Patient and provider perspectives on eHealth interventions in Canada and Australia: a scoping review. Rural Remote Health 2020; 20:5754. [PMID: 32949485 DOI: 10.22605/rrh5754] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Despite the promises of universal health care in most developed countries, health inequities remain prevalent within and between rural and remote communities. Remote health technologies are often promoted as solutions to increase health system efficiency, to enhance quality of care, and to decrease gaps in access to care for rural and remote communities. However, there is mixed evidence for these interventions, particularly related to how they are received and perceived by health providers and by patients. Health technologies do not always adequately meet the needs of patients or providers. To examine this, a broad-based scoping review was conducted to provide an overview of patient and provider perspectives of eHealth initiatives in rural communities. The unique objective of this review was to prioritize the voices of patients and providers in discussing the disparities between health interventions and needs of people in rural communities. eHealth initiatives were reviewed for rural communities of Australia and Canada, two countries that have similar geographies and comparable health systems at the local level. METHODS Searches were performed in PubMed, Scopus, and Web of Science with results limited from 2000 to 2018. Keywords included combinations of 'eHealth', 'telehealth', 'telemedicine', 'electronic health', and 'rural/remote'. Individual patient and provider perspectives on health care were identified, followed by qualitative thematic coding based on the type of intervention, the feedback provided, the affected population, geographic location, and category of individual providing their perspective. Quotes from patients and providers are used to illustrate the identified benefits and disadvantages of eHealth technologies. RESULTS Based on reviewed literature, 90.1% of articles reported that eHealth interventions were largely positive. Articles noted decreased travel time (18%), time/cost saving (15.1%), and increased access to services (13.9%) as primary benefits to eHealth. The most prevalent disadvantages of eHealth were technological issues (24.5%), lack of face-to-face contact (18.6%), limited training (10.8%), and resource disparities (10.8%). These results show where existing eHealth interventions could improve and can inform policymakers and providers in designing new interventions. Importantly, benefits to eHealth extend beyond geographic access. Patients reported ancillary benefits to eHealth that include reduced anxiety, disruption on family life, and improved recovery time. Providers reported closer connections to colleagues, improved support for complex care, and greater eLearning opportunity. Barriers to eHealth are recognized by patient and providers alike to be largely systemic, where lack of rural high-speed internet and unreliability of installed technologies were significant. CONCLUSION Regional and national governments are seen as the key players in addressing these technical barriers. This scoping review diverges from many reviews of eHealth with the use of first-person perspectives. It is hoped that this focus will highlight the importance of patient voices in evaluating important healthcare interventions such as eHealth and associated technologies.
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Affiliation(s)
- Michele LeBlanc
- Department of Health Sciences, Carleton University, 1125 Colonel By Dr, Ottawa, ON K1S 5B6, Canada
| | - Samuel Petrie
- Department of Health Sciences, Carleton University, 1125 Colonel By Dr, Ottawa, ON K1S 5B6, Canada
| | - Saambavi Paskaran
- Department of Health Sciences, Carleton University, 1125 Colonel By Dr, Ottawa, ON K1S 5B6, Canada
| | | | - Paul A Peters
- Department of Health Sciences, Carleton University, 1125 Colonel By Dr, Ottawa, ON K1S 5B6, Canada
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Abstract
Cutaneous squamous cell carcinoma (SCC) is the second most common type of cancer in Swedish men and women. The incidence of SCC is increasing rapidly. Primary treatment is complete surgical excision with sufficient margins to avoid recurrence and metastasis. The aim of this retrospective study was to identify the clinicopathological factors associated with incomplete excision of SCCs. Clinicopathological data and surgical outcome was obtained for 691 SCCs excised during a 2-year period (2014 to 2015) in Gothenburg, Sweden. Overall, 81 SCCs (11.7%) were incompletely excised. Incomplete excisions were associated with physician specialty and experience, tumour localization in the head and neck region, larger tumour diameter, and lower grade of tumour differentiation. However, multiple regression analysis revealed that large tumour size and excisions carried out by general practitioners were the only factors that significantly negatively affected rates of incomplete excision. These results should be taken into consideration when excising SCCs, in order to avoid multiple excisions.
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Affiliation(s)
- Helena Svensson
- Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
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