The effectiveness of teleconsultations in primary care: systematic review

The association of appointment type in healthcare with patient reported experience measures: a population-based survey study

BACKGROUND

Poor access to healthcare and long waiting times are severe challenges in many countries and therefore countries have increasingly adopted teleconsultations such as video, messaging, and phone calls. Patient-reported experience measures (PREMs) assess the quality of care based on patients' insights covering topics like the quality of communication, patient participation, and adequacy of time allocation of the appointment. The present study examined whether the type of appointment (in-person, by phone call or via digital services), service sector, and encountered health professional were associated with patients' experience of appointment quality in healthcare.

METHODS

The data from the population-based cross-sectional Healthy Finland Survey conducted from September 2022 to February 2023 including 22 665 respondents (53% women) were used. Complex samples logistic regression analyses were used to examine the associations of the independent variables (type of appointment, the service sector and encountered healthcare professional) with PREMs (sufficient time allocation, opportunity to ask questions, active participation, and responsiveness to needs) adjusted for self-rated health, age, sex, and urbanization status.

RESULTS

Those whose appointment was conducted by phone call had greater odds of not agreeing that enough time was allocated (OR = 1.57, 95%CI = 1.36-1.81), opportunity to ask was offered (OR = 1.28, 95%CI = 1.10-1.50), active participation possibilities were given (OR = 1.33, 95%CI = 1.15-1.54-), and their needs were met (OR = 1.39, 95%CI = 1.20-1.60) compared to in-person appointments. Those whose appointment was conducted by digital services had greater odds of not agreeing that enough time was allocated (OR = 1.51, 95%CI = 1.21-1.88) and opportunity to ask was offered (OR = 1.38, 95%CI = 1.07-1.78) compared to in-person appointments. Moreover, respondents had greater odds of disagreeing with PREM statements in health centers and when encountering physicians compared to their counterparts.

CONCLUSIONS

It seems that teleconsultations do not allocate enough time, offer opportunity to ask, give possibility to active participation, and meet patients' needs similarly as in-person appointments. Especially appointments conducted by phone call differed negatively from in-person visits regarding all these aspects. Our findings should be kept in mind when planning and developing teleconsultations. Teleconsultations may be a good option in many cases, but not for all patients or for all situations. Moreover, physicians and health centers should adopt means to improve time allocation, patient participation, and responsiveness to patients' needs.

The Economics of Telehealth: An Overview

Background: Telehealth has long offered promise for improving health care access, but due to restrictive regulations and technology limitations, historic use has been low. Despite telehealth's unprecedented expansion during the COVID-19 pandemic, economic questions remain, raising uncertainty about telehealth's future. Methods: We used an economics lens to conduct a narrative review of the vast medical literature and nascent economic literature on telehealth. We reviewed evidence on demand-side and supply-side forces influencing telehealth adoption and evidence on telehealth's impact on health care use, costs, effectiveness, and equity. Results: Current evidence is sparsely distributed across care types, telehealth modalities (e.g., phone, video, secure messaging), models of telehealth delivery, and pre- and post-pandemic periods. While the literature provides some signals that patients and clinicians are responsive to monetary costs of telehealth, more robust studies are needed, including studies on patient and provider time costs. Telehealth adoption appears to modestly increase outpatient care use, but evidence of its impact on costlier emergency or inpatient care use is needed. There is a lack of studies on monetary costs of telehealth, particularly the impact of telehealth on production costs. Importantly, there is a lack of high-quality studies on the comparative effectiveness of modalities. While there is a growing literature on disparities, studies that address confounders are needed to assess if telehealth can deliver on its promise to improve access for underserved populations. Conclusion: Our review paves the way for a stronger economics literature on telehealth, highlighting areas of future research.

Piloting an In Situ Training Program in Video Consultations in a Gynaecological Outpatient Clinic at a University Hospital: A Qualitative Study of the Healthcare Professionals' Perspectives

Background/Objectives: The successful integration of video consultations in routine hospital care requires further research. This study explores how healthcare professionals experienced and engaged with a pilot training program in video consultations (VCs), focusing on patient-centred communication and technical skills. Methods: A qualitative study was conducted at a gynaecological outpatient clinic in a Danish university hospital. In October 2022, healthcare professionals (n = 8) piloted a training program in VCs with patients suffering from gynaecological disorders, followed by semi-structured interviews. Our data analysis was inductive and inspired by thematic analysis, as proposed by Braun and Clarke. Results: Our analysis resulted in an overall theme, namely feasible, with context-dependent considerations, and followed by four other themes:, namely that (1) pre in situ training presents benefits and challenges, (2) consultation via video can be an advantage to consultations via phone or in-clinic, (3) individual planning and organising is a must, and (4) video consultation calls for new competencies. Conclusions: Our study indicates that a training program focusing on patient-centred communication, technical skills and in situ training with peer feedback is relevant when implementing VCs. Visual contact was an advantage of VC versus phone; however, patient triage was identified as essential when planning VCs. Overall, VCs are feasible in a gynaecological outpatient setting when their implementation is supported by an in situ training program and with ongoing technical support available.

How changes in GPs' ways of working have affected community nurses: a qualitative study

BACKGROUND

A growing literature examines the way two changes in primary care - the shift towards remote working and the diversification of practice teams to incorporate, for instance, physician associates and paramedics - affect patient care within the practice. However, little is known about the effect of these changes on community nurses.

AIM

To explore community nurses' experiences of delivering palliative care in the context of GPs' new ways of working.

DESIGN AND SETTING

Qualitative study using focus groups in the UK.

METHOD

Focus groups were conducted on Zoom with community nurses. Data were analysed thematically using constant comparison.

RESULTS

Community nurses described extending their roles in palliative care. Alongside pride and satisfaction about this, participants raised several areas of concern and dissatisfaction, some of which they associated with changes in GPs' ways of working. Two reasons for dissatisfaction concerned remote working. First, remote communication with colleagues was seen as creating obstacles to nurses' everyday collaboration with GPs, damaging important working relationships. Second, nurses increased their workload by taking the lead in person-centred care where they saw remote provision by GPs as unsatisfactory. Where workforce diversification led to delegating home visits to paramedics or nurse practitioners, community nurses described feeling a lack of the 'GP back-up' that many identified as essential for community palliative care.

CONCLUSION

When considering and evaluating interventions that change the way GPs work, policymakers and commissioners should look not only at consequences that affect primary care teams, but also at the effects across the complex ecosystem within which these teams operate.

Remote Follow-Up After Colorectal Cancer Surgery: A Systematic Review

BACKGROUND

Remote consultations are increasingly being utilized in colorectal cancer follow-up, especially since the COVID-19 pandemic, with benefits continuing beyond the pandemic. It is not clear how remote modalities affect patient satisfaction, quality of life (QoL) and safety of colorectal cancer follow-up.

OBJECTIVES

To investigate the impact of remote follow-up on patient satisfaction, QoL, clinician satisfaction, adherence to investigations, readmission rates, recurrence rates, and mortality rates for colorectal cancer.

METHODS

A systematic review was performed using three electronic databases: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials, along with grey literature. Eligible studies included remote techniques such as telephone, video, or patient-initiated follow-up (PIFU) compared with standard face-to-face follow-up in patients who have undergone colorectal cancer resection. Two independent reviewers screened studies and assessed the risk of bias.

RESULTS

A total of 4417 records were identified with seven studies included. Six studies showed high levels of patient satisfaction in remote follow-up, with two studies showing significantly better satisfaction than standard follow-up. Two studies evaluated QoL, with one showing significantly better QoL in the remote follow-up group than the standard, and the other study showing comparable levels. Safety outcomes were minimally reported, but there were no adverse outcomes. There was at least moderate risk of bias in the four nonrandomized interventions due to confounding from patient selection into intervention groups.

CONCLUSIONS

Remote follow-up in colorectal cancer appears to be comparable to face-to-face follow-up with high levels of patient satisfaction and QoL. While adherence to follow-up investigations was not compromised, the evidence on oncological impact is limited, and further studies on mortality and recurrence rates are required to ensure overall safety.

Strengths, Weaknesses, Opportunities, and Threats (SWOT) of Implementing Teleconsultation: A Systematic Review

Background and Aims

The COVID-19 pandemic has changed the traditional models of providing services in health systems. One of the recommended ways to provide healthcare services in this era is teleconsultation. This study aimed to determine the strengths, weaknesses, opportunities, and threats (SWOTs) of teleconsultation from the general practitioner's point of view and to implement it in the COVID-19 era.

Methods

A systematic review was conducted by searching online databases, including the PubMed, Scopus, and WOS databases, from the beginning to January 1, 2024, without restrictions and using relevant keywords. All studies that mentioned at least one of the areas of strength, weakness, opportunities, or threats related to teleconsultation were included in the study. We used content analysis to combine the results.

Results

Ultimately, 32 studies were included in this review. The most important factors were determined in four domains. Strengths included ease of use of technology, reduction of time and cost, and facilitating documentation. Weaknesses included a lack of physical exams, less direct communication, and internet-related problems. The opportunities included the increasing progress of medical technologies worldwide, continuity of care, and people's interest in the daily use of new technologies. Threats included sociocultural barriers, the need for continuous training, and competing interests.

Conclusion

Examining internal and external factors is important for formulating a plan. Identifying these factors and using them can lead to the formulation of effective and efficient programs in the field of teleconsultation for general practitioners in the era of COVID-19. Without paying attention to these issues, adopting appropriate plans to minimize weaknesses and threats, and effectively using strengths and opportunities to implement telemedicine projects, there is a possibility of failure and waste of time, effort, and credit in the health sector.

Assessing the Utilization of Electronic Consultations in Genetics: Seven-Year Retrospective Study

Background

Patient and health care provider access to genetic subspecialists is challenging owing to limited number of genetics experts across the United States. The University of California San Francisco (UCSF) Genetics electronic consultation (e-Consult) service was implemented along with the usual referral pathway to improve access to timely genetic expertise through robust asynchronous provider-to-provider communication.

objectives

This study examined the impact of the UCSF Genetics e-Consult service on patient access to genetics expertise.

Methods

A retrospective chart review of 622 e-Consult requests was conducted. Data pertinent to e-Consult completion rates, provider response times, consultation content, and adherence to geneticist recommendations were abstracted.

Results

From October 2016 to March 2024, the UCSF Genetics e-Consult service received a total of 622 consultation orders, with yearly volumes increasing from 34 in 2017 to 144 in 2023. A total of 360/622 (57.8%) consultations were completed, of which 197/360 (54.6%) were resolved without requiring a specialty care visit. Of the 262/622 (42.1%) e-Consult orders declined by the geneticist reviewer, 184/262 (70.2%) were scheduled for a synchronous genetics visit due to case complexity precluding an appropriate e-Consult response and 29.8% (78/262) were recommended to be referred to a different and more appropriate specialty. Geneticists responded to 83.9% (522/622) of e-Consults within 3 days, with most spending between 5 and 20 minutes on their e-Consult response. Nearly half of the genetics e-Consult requests (69/144; 47.9%) came from primary care providers and pediatricians. Among the 144 e-Consult requests in 2023, 50.6% (73/144) were about diagnostic queries, 17% (25/144) were on symptom management, and 11% (16/144) were about test interpretation. Provider adherence to geneticists' recommendations was observed in 84% (116/144) of cases.

Conclusions

The UCSF Genetics e-Consult service has demonstrated efficiency in providing timely genetic consultations, with a high rate of provider adherence to recommendations. These findings support the potential of e-Consult frameworks as a viable strategy for enhancing access to genetic health care services.

The impact of COVID-19 pandemic restrictions on general practitioner contacts among patients with common and at-risk diagnoses: a Norwegian registry-based study

BACKGROUND

Disease prevention strategies during the COVID-19 pandemic could potentially disrupt the continuity of care. Aims: (1) describe changes in contacts with general practitioner (GP) before and during the pandemic, (2) compare consultation rates for common and at-risk diagnoses, and (3) examine the impact of COVID-19 restrictions on monthly consultation rates across patient subgroups.

METHODS

Register study with data from the Norwegian Registry for Primary Health Care (NRPHC) for the period 1 April 2018 to 30 March 2021. Changes in consultation rate were the main outcome. Twenty-five diagnoses representing common and at-risk for mortality diagnoses were studied. Interrupted time series analyses were applied.

RESULTS

Face-to-face consultations decreased from 2935 to 2304 per 1000 inhabitants per year from the pre-pandemic period to the first pandemic year, with an increase in e-consultations from 60 to 846 per 1000 inhabitants per year. Consultations for common diagnoses decreased by 25.6%, whereas those for high-risk diagnoses decreased by 10.7%. In the group of common diagnoses, the decrease in average monthly consultation rates was less among the eldest compared to the youngest age group. A similar decrease was found in the group with multiple morbid conditions compared to single or no morbidity.

CONCLUSIONS

The pandemic resulted in fewer face-to-face consultations, but there was a substantial rise in electronic consultations. Consultations for at-risk for mortality diagnoses decreased relatively less than for common diagnoses. Consultation rates for older adults and those with multiple decreased less, suggesting that sicker patients continued to visit their GP during the pandemic.

Barriers and limitations to the development of a telemental health service for workers in Peru- A user-centered approach

INTRODUCTION

Over the past decade, the surge in digital healthcare services has transformed traditional healthcare, requiring multidisciplinary engagement to adapt to the digital realm. The rise of telehealth services, particularly amid COVID-19, has been widely embraced globally, but its implementation in Peru faces unique challenges, including infrastructure issues and economic constraints. Therefore, this research aims to identify the barriers and limitations in developing a telemental health service for screening, evaluation, and timely referral of vulnerable occupational groups.

MATERIALS AND METHODS

A qualitative study was undertaken. We adopted a phenomenological approach, utilizing semi-structured interviews with vulnerable occupational groups and decision-makers. We conducted 23 interviews: 5 providers of telemental health services, 5 teachers users, 5 police officers users and 5 health professionals of telemental health services, and 3 decision-makers involved in telemental health regulation in Peru.; exploring experiences, barriers, and facilitators related to mental telemental health. The interviews were recorded and transcribed verbatim, furthermore, a thematic analysis was done to identify key themes.

RESULTS

The research identified barriers and limitations to developing a telemental health services screening service based on the experiences of workers, some of them were related to user dissatisfaction, emphasizing the need for personalized solutions beyond technical aspects. Scheduling issues call for flexibility and improved communication. Healthcare professionals' varied experiences highlight the necessity for targeted training, while successful telemental health services integration demands addressing resource limitations through a comprehensive approach.

CONCLUSION

The study advocates for a holistic, user-centred paradigm in telemental health services implementation, addressing both technological aspects and human and systemic elements. Multifaceted challenges inherent in telemental health, particularly in Peru, emphasize the need for strategic interventions by stakeholders. The study calls for a policy shift towards enhancing telemental health equity through system-level changes and eliminating structural barriers for marginalized populations.

Towards conversational diagnostic artificial intelligence

At the heart of medicine lies physician-patient dialogue, where skillful history-taking enables effective diagnosis, management and enduring trust1,2. Artificial intelligence (AI) systems capable of diagnostic dialogue could increase accessibility and quality of care. However, approximating clinicians' expertise is an outstanding challenge. Here we introduce AMIE (Articulate Medical Intelligence Explorer), a large language model (LLM)-based AI system optimized for diagnostic dialogue. AMIE uses a self-play-based3 simulated environment with automated feedback for scaling learning across disease conditions, specialties and contexts. We designed a framework for evaluating clinically meaningful axes of performance, including history-taking, diagnostic accuracy, management, communication skills and empathy. We compared AMIE's performance to that of primary care physicians in a randomized, double-blind crossover study of text-based consultations with validated patient-actors similar to objective structured clinical examination4,5. The study included 159 case scenarios from providers in Canada, the United Kingdom and India, 20 primary care physicians compared to AMIE, and evaluations by specialist physicians and patient-actors. AMIE demonstrated greater diagnostic accuracy and superior performance on 30 out of 32 axes according to the specialist physicians and 25 out of 26 axes according to the patient-actors. Our research has several limitations and should be interpreted with caution. Clinicians used synchronous text chat, which permits large-scale LLM-patient interactions, but this is unfamiliar in clinical practice. While further research is required before AMIE could be translated to real-world settings, the results represent a milestone towards conversational diagnostic AI.

Telehealth in primary health care: a study of activities and time spent by professionals

BACKGROUND

(1) Telehealth practices in PHC take place via voice connection. (2) The nursing team carries out the highest volume of telehealth activities in PHC. (3) Consultations accounted for the largest share of time and frequency of telehealth activities in PHC.

to describe the telehealth activities carried out by professionals in Primary Health Care (PHC).

descriptive observational study, using time-motion methodology. The sample consisted of 31 Family Health teams, 14 Oral Health teams and two multidisciplinary teams working in PHC. An adapted workload instrument was used to collect the data. A descriptive analysis of the data was carried out considering the total time, average time and percentage of activities according to professional category and telehealth modality.

632 telehealth activities were observed, representing 2.67% of all activities. The most used modality was voice calls (60.28%). The average nursing consultation time was 4.86 minutes and 6.17 minutes for medical consultations. The greatest number of telehealth activities and time spent in PHC was carried out by the nursing team.

PHC professionals carry out a variety of telehealth activities, predominantly by voice connection, with the nursing team being the most expressive. In addition, the study shows the time dedicated and the distribution of activities, supporting discussions on the planning and sizing of the digital health workforce.

Medical students' and educators' opinions of teleconsultation in practice and undergraduate education: A UK-based mixed-methods study

INTRODUCTION

As information and communication technology continues to shape the healthcare landscape, future medical practitioners need to be equipped with skills and competencies that ensure safe, high-quality, and person-centred healthcare in a digitised healthcare system. This study investigated undergraduate medical students' and medical educators' opinions of teleconsultation practice in general and their opinions of teleconsultation education.

METHODS

This study used a cross-sectional, mixed-methods approach, utilising the additional coverage design to sequence and integrate qualitative and quantitative data. An online questionnaire was sent out to all medical schools in the UK, inviting undergraduate medical students and medical educators to participate. Questionnaire participants were given the opportunity to take part in a qualitative semi-structured interview. Descriptive and correlation analyses and a thematic analysis were conducted.

RESULTS

A total of 248 participants completed the questionnaire and 23 interviews were conducted. Saving time and the reduced risks of transmitting infectious diseases were identified as common advantages of using teleconsultation. However, concerns about confidentiality and accessibility to services were expressed by students and educators. Eight themes were identified from the thematic analysis. The themes relevant to teleconsultation practice were (1) The benefit of teleconsultations, (2) A second-best option, (3) Patient choice, (4) Teleconsultations differ from in-person interactions, and (5) Impact on the healthcare system. The themes relevant to teleconsultation education were (6) Considerations and reflections on required skills, (7) Learning and teaching content, and (8) The future of teleconsultation education.

DISCUSSION

The results of this study have implications for both medical practice and education. Patient confidentiality, safety, respecting patients' preferences, and accessibility are important considerations for implementing teleconsultations in practice. Education should focus on assessing the appropriateness of teleconsultations, offering accessible and equal care, and developing skills for effective communication and clinical reasoning. High-quality teleconsultation education can influence teleconsultation practice.

Examining experiences and system impacts of publicly funded episodic virtual care: protocol for a cross-provincial mixed methods study

INTRODUCTION

Health systems are under pressure as one in five Canadians have no regular place for primary care, with many experiencing substantial travel times and delays in accessing care. In the context of these urgent needs, platforms for virtual care offer immediate access to care in 'walk-in' style format, with limited continuity for ongoing health needs or coordination with other health services. We refer to these services as episodic virtual care (EVC), to distinguish them from virtual services offered in longitudinal primary care. The governments of Nova Scotia (NS) and New Brunswick (NB) both offer publicly funded EVC and offer a unique opportunity for research.The overarching goal of this work is to learn from the implementation of EVC in NS and NB to understand experiences and system impacts, includingWhat are patient perceptions and experiences of EVC and how do these differ by patient characteristics?What are the characteristics of patients who use EVC and of clinicians who deliver it?What are the system impacts of EVC?

METHODS AND ANALYSIS

We will use a cross-sectional survey conducted through an online questionnaire to explore patient perceptions and experiences with EVC. We will also examine how these differ based on the type of care needed, age, gender, residence (urban or rural), immigration and language preference. We will use linked administrative data and quasi-experimental analysis to assess the impacts of EVC on visits to community-based primary care (including in-person walk-in clinics), emergency department visits, prescriptions and referrals for other health services like laboratory testing, imaging and consulting specialist physicians.

ETHICS AND DISSEMINATION

This proposal has been reviewed and received approval from the Nova Scotia Health Research Ethics Board. Findings will identify the impacts and trade-offs in the deployment of EVC, which will inform primary care planning. In addition to traditional academic publications and information provided to primary care patients/the public, this study will inform decision-makers across multiple jurisdictions as they contend with the challenge of meeting patients' immediate care needs for access to primary care, while seeking to improve coordination and integration of systems as a whole.

Primary care physicians' experiences of video and online chat consultations: a qualitative descriptive study

OBJECTIVES

To explore the perceptions and views of remote consultations and patient care of primary care physicians (PCPs) who work remotely regularly and have experience performing remote consultations.

DESIGN

A qualitative study using thematic analysis.

SETTING

Four online focus group interviews with 17 PCPs, working with one private health care provider, with public and private primary care patients.

SUBJECTS

PCPs who had performed video or online chat consultations with primary care patients for at least 6 months.

MAIN OUTCOME MEASUREMENTS

PCPs' perceptions and views working remotely in online chat and video consultations.

RESULTS

Two main themes describing how PCPs perceived remote consultations emerged: 1) remote consultations have an impact on the way physicians work, and 2) remote consultations have an impact on the service system and patients. The subthemes of the first main theme included the physicians' new way of working, impacts on physicians' well-being, and impacts on communication and physician competences. The subthemes for the second main theme were the importance of smoothness of services for the patients, patient suitability, and technical liabilities.

CONCLUSION

Remote consultations provide PCPs with a new way of working that could improve work-life balance. However, it is important to maintain sufficient clinical competence through versatile work. Digital consultations can make contacting healthcare smoother and easier for patients if the patient selection is performed carefully. Online chat seems suitable for singular contacts and simple issues, but remote consultations could be used to sustain continuity of care.

Sore throat or severe threat? The teleconsultation that uncovered neutropenic sepsis

ABSTRACT

This case report describes a telemedicine visit by a patient with fever, sore throat, and odynophagia. The patient had recently started taking propylthiouracil (PTU) for Graves disease. She was referred to the ED, where a complete blood cell count revealed agranulocytosis with a neutrophil count of 200 cells/mm3. PTU was promptly discontinued, and she received treatment with IV piperacillin-tazobactam, resulting in an improvement in her condition. With the rise of telemedicine, clinicians must prioritize thorough history-taking to detect uncommon complications of medications and to ensure patient safety.

Comparison of the Effect of Teleconsultations, Hybrid Visits, and In-Person Visits on Glycemic and Metabolic Parameters Among Individuals With Type 2 Diabetes in India

AIM

We compared biochemical and clinical data of individuals with type 2 diabetes (T2D) who opted for only teleconsultation (ie, no in-person visit at all), hybrid visits (combining home blood tests and in-person consultation), and fully in-person visits (both tests and consultation in person) at a tertiary care diabetes center.

METHODS

In this observational cohort study, we retrieved demographic, anthropometric, and biochemical data of 8197 individuals with T2D who sought diabetes care between 2021 and 2023 (384 participants with only teleconsultations, 721 with hybrid visits, and 7092 with fully in-person visits) from the electronic medical records of a chain of tertiary diabetes care centers across India.

RESULTS

Individuals who opted for teleconsultation had a shorter duration of diabetes compared with those who opted for hybrid or fully in-person visits. Although participants who opted for a teleconsultation had better glycemic and lipid control at baseline, those who underwent hybrid and in-person visits showed greater improvements in fasting plasma glucose, glycated hemoglobin (A1c), and LDL cholesterol (LDL-C) during follow-up. Improvements in overall ABC target achievement (A1c, Blood pressure, and LDL-C) were greater in participants who had in-person visits compared with the other two groups.

CONCLUSION

While teleconsultation is a useful complement to in-person visits, the latter results in better glycemic and lipid control, perhaps due to more effective engagement with the diabetes care team.

Uses of Virtual Care in Primary Care: Scoping Review

BACKGROUND

The COVID-19 pandemic catalyzed an uptake in virtual care. However, the rapid shift left unanswered questions about the impact of virtual care on the quality of primary care and its appropriateness and effectiveness. Moving forward, health care providers require guidance on how best to use virtual care to support high-quality primary care.

OBJECTIVE

This study aims to identify and summarize clinical studies and systematic reviews comparing virtual care and in-person care in primary care, with a focus on how virtual care can support key clinical functions such as triage, medical assessment and treatment, counseling, and rehabilitation in addition to the management of particular conditions.

METHODS

We conducted a scoping review following an established framework. Comprehensive searches were performed across the following databases: Embase, MEDLINE, PsycInfo, Emcare, and Cochrane Database of Systematic Reviews. Other well-known websites were also searched. PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were followed. Articles were selected by considering article type, language, care provided, intervention, mode of care delivery, and sample size.

RESULTS

A total of 13,667 articles were screened, and 219 (1.6%) articles representing 170 studies were included in the review. Of the 170 studies included, 142 (83.5%) were primary studies, and 28 (16.5%) were systematic reviews. The studies were grouped by functions of primary care, including triage (16/170, 9.4%), medical assessment and treatment of particular conditions (63/170, 37.1%), rehabilitation (17/170, 10%), and counseling (74/170, 43.5%). The studies suggested that many primary care functions could appropriately be conducted virtually. Virtual rehabilitation was comparable to in-person care and virtual counseling was found to be equally effective as in-person counseling in several contexts. Some of the studies indicated that many general primary care issues could be resolved virtually without the need for any additional follow-up, but data on diagnostic accuracy were limited. Virtual triage is clinically appropriate and led to fewer in-person visits, but overall impact on efficiency was unclear. Many studies found that virtual care was more convenient for many patients and provided care equivalent to in-person care for a range of conditions. Studies comparing appropriate antibiotic prescription between virtual and in-person care found variable impact by clinical condition. Studies on virtual chronic disease management observed variability in impact on overall disease control and clinical outcomes.

CONCLUSIONS

Virtual care can be safe and appropriate for triage and seems equivalent to in-person care for counseling and some rehabilitation services; however, further studies are needed to determine specific contexts or medical conditions where virtual care is appropriate for diagnosis, management outcomes, and other functions of primary care. Virtual care needs to be adapted to fit a new set of patient and provider workflows to demonstrate positive impacts on experience, outcomes, and costs of care.

Delphi definition of general practice/family medicine specialty for a post-COVID world: in-person and remote care delivery

INTRODUCTION

The evolving landscape of general practice (GP)/family medicine (FM) in the post-COVID-19 era, focussing on integrating telemedicine and remote consultations requires a new definition for this specialty. Hence, a broader consensus-based definition of post-COVID-19 GP/FM is warranted.

METHODS

This study involved a modified electronic Delphi technique involving 27 specialists working in primary care recruited via convenient and snowball sampling. The Delphi survey was conducted online between August 2022 and April 2023, utilizing the Google Forms platform. Descriptive statistics were employed to analyse consensus across Delphi rounds.

RESULTS

Twenty-six international experts participated in the survey. The retention rate through the second and third Delphi rounds was 96.2% (n = 25). The broader consensus definition emphasizes person-centred care, collaborative patient-physician partnerships, and a holistic approach to health, including managing acute and chronic conditions through in-person or remote access based on patient preferences, medical needs, and local health system organization.

CONCLUSION

The study highlights the importance of continuity of care, prevention, and coordination with other healthcare professionals as core values of primary care. It also reflects the role of GP/FM in addressing new challenges post-pandemic, such as healthcare delivery beyond standard face-to-face care (e.g. remote consultations) and an increasingly important role in the prevention of infectious diseases. This underscores the need for ongoing research and patient involvement to continually refine and improve primary healthcare delivery in response to changing healthcare landscapes.

Perspectives on Conducting Behavioral Intervention With Adolescents Using a Virtual Platform-A Thematic Analysis From the Viewpoint of Study Coordinators

BACKGROUND

The COVID-19 pandemic led to widespread adoption of virtual communication platforms. Virtual study visits were implemented in the pilot cluster randomized trial (CRT) stage of Teen Adherence in KidnEy transplant Improving Tracking To Optimize Outcomes (TAKE-IT TOO). The present study aimed to understand study coordinators' perspectives on conducting a behavioral intervention with adolescent kidney transplant recipients using virtual conferencing platforms.

METHODS

Study coordinator participants (N = 6) completed questionnaires and participated in a semi-structured interview that probed comfort with digital technology, issues encountered, and overall perspectives on conducting virtual study visits. Qualitative thematic analysis was used to identify themes and subthemes.

RESULTS

Participants expressed confidence with technology and ability to handle the complexities of the virtual conferencing. Some expressed that virtual study visits led to a change in work habits and higher workload due to increased technology complexity. Qualitative analyses of participant interviews revealed four themes: adaptability, accessibility, logistics (including subthemes scheduling and fluidity), and communication (including subthemes clarity, engagement, and rapport). Convenience for coordinators and the perceived comfort for adolescents were noted advantages for virtual visits. Technical issues, periodic adolescent distractions, and challenges with instructional teaching through virtual conferencing were identified as potential limitations of virtual study visits.

CONCLUSIONS

Overall, virtual study visits were appreciated and endorsed by study coordinators. Researchers should consider the feasibility of completing study-related tasks virtually, including accessibility of visual materials on all type of electronic devices, and ensure adequate training of study personnel when deciding to implement virtual platform in CRTs.

Telemedicine's Hesitant Reception Among Digital Natives: A Cluster Analysis of Polish Students' Attitudes

Objective: As digital natives appear to be the most suitable target group for technological innovations, we tested this notion by analyzing their attitude toward the implementation of telemedicine in Poland. Methods: An online survey was conducted from April to October 2021, yielding responses from 475 university students on their experience with teleconsultations, which are an essential part of telemedicine. Satisfaction-related questions were used to perform cluster analysis, and subsequently, clusters were compared based on significant differences in responses including sociodemographic and utilization patterns. Open-ended questions were analyzed to further gauge the rationale behind the demonstrated attitude. Results: The responses were polarized. In the cluster analysis, on one side were the "Skeptics" and "Enemies," who shared negative opinions on professionalism and convenience, differing only in their assessment of intangible skills. On the other side were the "Enthusiasts," who were satisfied in all categories; the "Indifferent," who lacked strong opinions; and the "Time-pressed," who, while openly admitting its drawbacks, were highly likely to continue using it due to its time-saving potential. Recurring concerns in open-ended questions focused on unreliable diagnoses and uncooperative administrative personnel. Conclusions: The reception was polarized. The split in answers suggests that administrative problems were limited to some providers, indicating they should be possible to overcome. There is a clear pattern that telemedicine is seen as an incomplete service. However, many would happily continue to use it due to its convenience and time-saving benefits.

Nurses' experiences of text-based digital triage at primary healthcare centres in Sweden: a qualitative interview study

BACKGROUND

Telehealth services are becoming increasingly popular at primary healthcare centres. Some examples include text-based digital triage and health guidance using chats, emails, images and pre-filled forms. Telephone-based communication has until recent years been the predominant means for triage and health guidance, but now includes written communication via computer or smartphone. Hence conditions to perform triage and health guidance have changed, which may affect the quality of nurses' work and patient safety. This motivates an in-depth exploration of the consequences of such changes for nurses working with telehealth. The study aimed to explore nurses' experiences of digital triage and health guidance at primary healthcare centres in Sweden.

METHODS

A qualitative inductive design was chosen for the current study. Four registered nurses and two public health nurses, working at primary healthcare centres in southern Sweden, contributed with information about text-based digital triage and health guidance. Semi-structured interviews were conducted to collect data. Data were analysed using qualitative content analysis.

FINDINGS

One main theme, "Adapting to a new professional toolbox to triage and give health guidance" was constructed based on three categories which describe the altered professional tools. They were: "Using one's senses differently to collect information", "Change of communication mode to convey messages" and "Change of timeframe and the use of time". Six subcategories describe how the new toolbox was experienced by the nurses. They were: "Loss of clinical ear", "Gain of viewing images", "Difficulties in written communication of care and emotions", "Seeing oneself as a writer or talker", "Tardy asynchronous communication" and "Available time".

CONCLUSION

The findings tell of a substantial change in nurses' professional toolbox that demanded other skills than they were used to working with. Due to limitations in communication and communication skills, digital triage alone may lead to an impaired workflow, quality of care, and patient safety as well as maintain the digital divide. However, digital triage may also enhance nurses' work with the addition of attached images, convenient communication for those who are comfortable with writing, and a gain of time for consultation and reflection. The current study contributes insights regarding new competencies that nurses and patients must have or gain to be able to benefit from the possibilities of digitisation of primary healthcare.

Higher Percentage of Virtual Primary Care Associated With Minimal Differences in Achievement of Quality Metrics

OBJECTIVE

To test the impact of virtual care usage on quality metrics used for performance measurement.

BACKGROUND

Virtual care improves access to primary care; however, the quality of care must not be adversely impacted by its use.

METHODS

This is a mixed-design etiologic study using data from patients receiving primary care in a large, regional health system from January 2020 through December 2021. Eligible patients had at least one primary care contact. Eligible physicians had 10 or more patient contacts. The quartile of virtual visits per physician per month is calculated as the percentage of total visits conducted by phone or video (Q1 is the lowest). Six metrics used for value-based reimbursement were chosen for modeling with generalized linear mixed models.

RESULTS

The data included 200,090 patients of 683 physicians in 42 clinics over 24 months. Virtual care usage peaked in April 2020 at 78% and then stabilized at 18%. The blood pressure metric was met in 66% (95% CI: 63%-69%) of physician months in Q1 and 65% (95% CI: 63%-68%) in Q4 ( P = 0.003). The hemoglobin A1c metric was met in 73% (95% CI: 70%-76%) of physician months in Q1 and 72% (95% CI: 69%-75%) in Q4, not a significant difference. Breast cancer screening completion and colon cancer screening completion did not differ across virtual care quartiles. Medicare annual wellness visits were completed in 55% (95% CI: 50%-60%) of Q1 physician months and 54% in each of Q2, Q3, and Q4 ( P < 0.0001).

CONCLUSIONS

Some quality metrics were modestly impacted by high virtual primary care usage; the absolute differences in rates were small. This may provide reassurance to physicians and their health systems that telemedicine use may not adversely impact quality metrics.

"I have never felt so alone and vulnerable" - A qualitative study of bereaved people's experiences of end-of-life cancer care during the Covid-19 pandemic

BACKGROUND

COVID-19 drastically affected healthcare services world-wide. In the UK, many cancer services were overwhelmed as oncology staff were reassigned, and cancer diagnoses and treatments were delayed. The impact of these pressures on end-of-life care for patients with advanced cancer and their relatives is not well understood.

METHODS

Secondary thematic analysis of qualitative survey and interview data, collected from family members and close friends bereaved by cancer, as part of a national COVID-19 bereavement study (Survey N = 156; Interview N = 10).

RESULTS

Four key themes were identified: The impact of COVID-19 on contact with patients towards the end of life; Mixed experiences of support for family members; Variable communication quality from health and social care professionals; Prioritisation of COVID-19 and its impact on patient care. Hospital care was perceived more negatively than community care in almost all areas, while support from cancer charities and district nurses was appreciated the most. Almost all participants felt that COVID-19 was detrimentally prioritised over care for their relative/friend.

CONCLUSIONS

People bereaved by cancer were uniquely affected by pandemic-restrictions and disruptions to services. As services re-build post-pandemic, improvements in palliative care in hospitals, investment into community care, and ensuring compassionate communication with patients and families must be prioritised, alongside preparedness for future pandemics or similar events.

An evaluation of a virtual musculoskeletal podiatry service implemented to address prolonged National Health Service waiting times

BACKGROUND

The COVID-19 pandemic had a substantial impact on healthcare systems globally, particularly in the public sector. To address the challenges posed by the pandemic, musculoskeletal (MSK) healthcare providers had to rapidly adopt virtual platforms for delivering care, representing a major shift in how healthcare was delivered.

OBJECTIVE

This manuscript aims to retrospectively evaluate a virtual MSK podiatry service offered by a private provider under a National Health Service commission, in terms of patient access, waiting times and patient-reported pain. This service was developed and implemented in response to the COVID-19 pandemic and the extended waiting times.

METHODS

A retrospective clinical service evaluation was conducted on MSK podiatry services delivered via telephone or virtual consultations. The evaluation covered a cohort of 574 referred patients over a 19-month period (July 2021 to January 2023). It analysed demographic data, initial and final visual analogue pain scores, pathology categories, orthoses prescriptions and exercise rehabilitation plans.

RESULTS

Data from a total of 492 patients (male = 152 and female = 340) were analysed, with 82 patients excluded for non-attendance. The average waiting time from referral-to-first appointment and referral-to-discharge was 35 and 91 days, respectively. Results showed statistically significant improvement (p < 0.001) in the mean visual analogue scale when patients received orthoses with and without a rehabilitation plan (4.12 ± 2.55 and 3.33 ± 2.88, respectively). Most patients (61.5%) were aged 40-69, with "foot pain" being the main reported pathology category. Patients had an average of two appointments. 56.5% of patients remained virtual throughout their journey and were successfully discharged to self-management. 43.9% were discharged to other face-to face services.

CONCLUSIONS

The study provided evidence that the virtual MSK podiatry service achieved a statistically significant reduction in patient-reported pain for various pathologies with reasonable waiting times. The service delivered favourable outcomes and complemented traditional services at a time with limited access due to the COVID-19 pandemic.

Telemedicine in Acute Trauma Care: A Review of Quantitative Evaluations on the Impact of Remote Consultation

BACKGROUND

There is extensive literature describing the application of telemedicine techniques to trauma care. However, there is a paucity of articles showing quantitative assessment of its safety and efficacy. This structured review examines articles with quantitative assessment of telemedicine's impact in acute trauma care.

METHODS

Medline and CINAHL databases were searched for peer-reviewed articles that quantitatively assess the impact of telemedicine on diagnostic accuracy, clinical decision-making, emergency department length of stay, transfer rates, and mortality in initial trauma management.

RESULTS

Only 9 of the 408 screened articles met the criteria for quantitative assessment. Telemedicine appears to be preferentially used for more severely injured patients. Limited quality evidence supports procedural interventions at remote sites. Telemedicine may help abbreviate pre-transfer length of stay. However, its impact on diagnosis and mortality remains unclear.

CONCLUSIONS

Telemedicine's potential to enhance the quality and efficiency of trauma care, especially for resource-scarce areas, warrants continued quantitative research.

Quality of the digital gp visits and characteristics of the users: retrospective observational study

OBJECTIVES

This study compares the demographics, diagnoses, re-admission rates, sick leaves, and prescribed medications of patients accessing digital general practitioner (GP) visits with those of patients opting for traditional face-to-face appointments in a primary health care setting.

DESIGN

The study adopted a retrospective analysis of patient record data collected in 2019, comparing visits to a digital primary health center with traditional health center visits.

SETTING

Primary health care.

PARTICIPANTS

The data encompassed patients who utilized the digital clinic and those who visited public health centers for primary health care services.

MAIN OUTCOME MEASURES

The study assessed demographics, health diagnoses, prescribed medications, sick leave recommendations, re-admission rates, and differences in costs between digital clinic and face-to-face visits. Secondary outcomes included a comparative analysis of medication categories, resolution rates for health problems, and potential impacts on health care utilization.

RESULTS

Digital clinic users were typically younger, more educated, and predominantly female compared with health centre users. Digital visits were well-suited for uncomplicated infections, while health centre appointments were associated with a higher prevalence of chronic conditions. Medication patterns differed between the two modalities, with digital clinic users receiving generic over-the-counter drugs and antibiotics, whereas health centre visits commonly involved cardiac and antihypertensive medications. Sick leave recommendations were slightly higher in the digital clinic, but the difference was not significant. Approximately 70% of health problems addressed in the digital clinic were successfully resolved, and the cost of digital visits was about 50,3% of face-to-face appointments.

CONCLUSION

Digital health care services offer a cost-efficient alternative for specific health problems, appealing to younger, educated individuals, when compared to the users of public health center, and may enable improvement of cost-effectiveness combined with acceptable demand management and patient segmentation practices. The results highlight the potential benefits of digital clinics, particularly for uncomplicated cases, while also emphasizing the importance of suitable referral mechanisms for in-person consultations.

The physician's role in mitigating the climate crisis

Climate change is a growing concern and healthcare is simultaneously being burdened with worsening climate-related health conditions, while significantly contributing to emissions and temperature rises. Studies have documented the effects of emissions on increasing numbers of early deaths, while rising temperatures and altered rainfall patterns lead to a change in vector migratory patterns alongside broader physical and mental health impacts. These changes only exacerbate the current global health inequities. The role of doctors in reducing the burden of the climate emergency can not be understated, including both individual and systemic changes. Preventative medicine can promote an active lifestyle and reduce fossil fuel consumption, while patient education and empowerment on reducing red meat consumption can improve cardiovascular health and reduce emissions. Low carbon solutions can be achieved via smarter prescribing and lean pathways can increase efficiency. It is in everyone's interests for physicians to adjust their practice to improve sustainability.

The Effects of Physical Activity and the Consequences of Physical Inactivity in Adult Patients with Congenital Heart Disease During the COVID-19 Pandemic

BACKGROUND

The ongoing COVID-19 pandemic has infected more than 500 million people worldwide. Several measures have been taken to reduce the spread of the virus and the saturation of intensive care units: among them, a lockdown (LD) was declared in Italy on 9 March 2020. As a result, gyms, public parks, sports fields, outdoor play areas, schools, and multiple commercial activities have been closed. The consequences of physical inactivity can be dramatic in adult patients with congenital heart disease (ACHD), in which the benefit of regular exercise is well known. In this study, we investigated the effects of reduced physical activity during the COVID-19 pandemic on ACHD's exercise capacity.

MATERIALS AND METHODS

Patients who performed exercise or cardiopulmonary exercise tests from October 2019 to February 2020 and one year after lockdown with the same protocol were retrospectively enrolled in our database.

INCLUSION CRITERIA

ACHD patients aged ≥ 18 years old under regular follow-up.

EXCLUSION CRITERIA

significant clinical and/or therapeutic changes between the two tests; significant illness occurred between the two tests, including COVID-19 infection; interruption of one of the tests for reasons other than muscle exhaustion.

RESULTS

Thirty-eight patients (55.6% males) met the inclusion criteria. Before the lockdown, 17 patients (group A) were engaged in regular physical activity (RPA), and 20 patients (group B) had a sedentary lifestyle. After LD, in group A, (a) the weekly amount of physical activity reduced with statistical significance from 115 ± 46 min/week to 91 ± 64 min/week (-21%, p = 0.03); (b) the BMI did not change; (c) the duration of exercise test and VO2 max at cardiopulmonary exercise test showed a significant reduction after the LD. In group B, BMI and exercise parameters did not show any difference.

CONCLUSIONS

The COVID-19 pandemic dramatically changed the habits of ACHD patients, significantly reducing their possibility to exercise. Our data analyzed in this extraordinary situation again demonstrated that physical inactivity in ACHD worsens functional capacity, as highlighted by VO2 max. Regular exercise should be encouraged in ACHD patients to preserve functional capacity.

The Role of Telemedicine in Improving Hypertension Management Outcomes: A Systematic Review

Telehealth has been proven to be effective in a variety of healthcare settings and has enhanced patient utilization of healthcare services. Little is known about the use of telehealth in the treatment of hypertension. This study aimed to categorize and identify data related to various telehealth technologies and intervention types used in the management of hypertension. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to search the literature based on predetermined inclusion and exclusion criteria. These databases contained 1,483 relevant articles, which were screened for duplication using Endnote software. After a careful full-text article evaluation, only 42 of these articles were found to be relevant. The Newcastle-Ottawa Scale was used to assess the risk of bias in each included study. The majority of studies (23.8%) were conducted in urban areas (33.3%), were from the United States, and used a quantitative study approach (69%), according to the proportions of studies displaying different patterns over the past 10 years. Telemonitoring and teleconsultation are the two most used telehealth techniques for managing hypertension. Asynchronous telehealth is quickly becoming the most popular technique for controlling hypertension. In hypertension management, telehealth refers to the use of communication technologies to remotely monitor and regulate blood pressure as well as offer medical advice and counseling.

Effectiveness of text message reminders on paediatric appointment adherence: a systematic review and meta-analysis

Attending health appointments is important for the paediatric population, as it allows for earlier detection of health issues and subsequent necessary treatments. It also ensures timely immunisations while also allowing patients or their parents to raise health concerns. Hence, it is crucial to take steps to ensure that such medical appointments are attended. To evaluate the effectiveness of text message reminders (TMRs) in improving paediatric patients' adherence to their appointments. A systematic review and meta-analysis were conducted. The search spanned across eight online databases from their inception dates to January 2024. The random-effects model was utilised to conduct the meta-analysis, where risk ratio was used as the effect measure. Subgroup analyses were conducted for age, number of TMRs sent, and type of appointments attended. In total, 13 studies were included. Compared to standard care (involving non-text message reminders or no reminders), TMRs were significantly more effective in improving appointment attendance among the paediatric population. Significant subgroup differences were found in the type of appointments attended, where TMRs were more effective for medical appointments compared to vaccination appointments. No differences in adherence to appointments were found across age groups or the number of TMRs sent.   Conclusion: Sending TMRs can be a potentially cost-effective way to improve the attendance rate of paediatric medical appointments, given the ease of implementation and the extensive mobile phone usage globally. Future studies should compare TMRs to other modes of automated reminders such as telephone messages or emails, to identify the most optimal method of delivery.   Trial registration: PROSPERO (CRD42023464893).

Routine measurement of cardiometabolic disease risk factors in primary care in England before, during, and after the COVID-19 pandemic: A population-based cohort study

BACKGROUND

This study estimated to what extent the number of measurements of cardiometabolic risk factors (e.g., blood pressure, cholesterol, glycated haemoglobin) were impacted by the COVID-19 pandemic and whether these have recovered to expected levels.

METHODS AND FINDINGS

A cohort of individuals aged ≥18 years in England with records in the primary care-COVID-19 General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) were identified. Their records of 12 risk factor measurements were extracted between November 2018 and March 2024. Number of measurements per 1,000 individuals were calculated by age group, sex, ethnicity, and area deprivation quintile. The observed number of measurements were compared to a composite expectation band, derived as the union of the 95% confidence intervals of 2 estimates: (1) a projected trend based on data prior to the COVID-19 pandemic; and (2) an assumed stable trend from before pandemic. Point estimates were calculated as the mid-point of the expectation band. A cohort of 49,303,410 individuals aged ≥18 years were included. There was sharp drop in all measurements in March 2020 to February 2022, but overall recovered to the expected levels during March 2022 to February 2023 except for blood pressure, which had prolonged recovery. In March 2023 to March 2024, blood pressure measurements were below expectation by 16% (-19 per 1,000) overall, in people aged 18 to 39 (-23%; -18 per 1,000), 60 to 79 (-17%; -27 per 1,000), and ≥80 (-31%; -57 per 1,000). There was suggestion that recovery in blood pressure measurements was socioeconomically patterned. The second most deprived quintile had the highest deviation (-20%; -23 per 1,000) from expectation compared to least deprived quintile (-13%; -15 per 1,000).

CONCLUSIONS

There was a substantial reduction in routine measurements of cardiometabolic risk factors following the COVID-19 pandemic, with variable recovery. The implications for missed diagnoses, worse prognosis, and health inequality are a concern.

Health Care Usage During the COVID-19 Pandemic and the Adoption of Telemedicine: Retrospective Study of Chronic Disease Cohorts

BACKGROUND

The COVID-19 pandemic accelerated telehealth adoption across disease cohorts of patients. For many patients, routine medical care was no longer an option, and others chose not to visit medical offices in order to minimize COVID-19 exposure. In this study, we take a comprehensive multidisease approach in studying the impact of the COVID-19 pandemic on health care usage and the adoption of telemedicine through the first 12 months of the COVID-19 pandemic.

OBJECTIVE

We studied the impact of the COVID-19 pandemic on in-person health care usage and telehealth adoption across chronic diseases to understand differences in telehealth adoption across disease cohorts and patient demographics (such as the Social Vulnerability Index [SVI]).

METHODS

We conducted a retrospective cohort study of 6 different disease cohorts (anxiety: n=67,578; depression: n=45,570; diabetes: n=81,885; kidney failure: n=29,284; heart failure: n=21,152; and cancer: n=35,460). We used summary statistics to characterize changes in usage and regression analysis to study how patient characteristics relate to in-person health care and telehealth adoption and usage during the first 12 months of the pandemic.

RESULTS

We observed a reduction in in-person health care usage across disease cohorts (ranging from 10% to 24%). For most diseases we study, telehealth appointments offset the reduction in in-person visits. Furthermore, for anxiety and depression, the increase in telehealth usage exceeds the reduction in in-person visits (by up to 5%). We observed that younger patients and men have higher telehealth usage after accounting for other covariates. Patients from higher SVI areas are less likely to use telehealth; however, if they do, they have a higher number of telehealth visits, after accounting for other covariates.

CONCLUSIONS

The COVID-19 pandemic affected health care usage across diseases, and the role of telehealth in replacing in-person visits varies by disease cohort. Understanding these differences can inform current practices and provides opportunities to further guide modalities of in-person and telehealth visits. Critically, further study is needed to understand barriers to telehealth service usage for patients in higher SVI areas. A better understanding of the role of social determinants of health may lead to more support for patients and help individual health care providers improve access to care for patients with chronic conditions.

Remote consultations in primary care: Patient experiences and suggestions for improvement

The use of Remote Consultations (RCs) in primary care expanded rapidly during the Covid-19 pandemic: their ongoing use highlights a need to improve experiences of them. We interviewed 17 adults in the UK, including a sub-sample of five people with a First Language other than English (FLotE). Interpretative Phenomenological Analysis identified five major themes: (1) RCs are convenient, but they require appropriate technology and appropriate conditions of use; (2) even those with good general eHealth literacy and connectivity may struggle with systems that are not user-friendly; (3) greater reliance on verbal communication was experience as limiting empathy, and also made RCs more difficult for people with a FLotE; (4) RCs are considered inappropriate for complex conditions, or those with major psychological components; (5) continuity of care is important, but is often lacking. Overall, interviewees emphasised the need for more user-friendly processes, and greater attention to patients' preferences for consultation type.

Has telemedicine come to fruition? Parents' and pediatricians' perceptions and preferences regarding telemedicine

BACKGROUND

Telemedicine has increasingly become a viable option for patient care and may increase access to care. The aim of our study was to evaluate both parent and pediatrician perceptions, preferences, and acceptability regarding the use of different telemedicine modalities.

METHODS

We conducted a cross-sectional survey of both parents and pediatricians in Geneva, Switzerland in 2021. The questionnaire focused on digital literacy, preferences, acceptability, advantages, and disadvantages regarding telemedicine (phone, email, video, and instant message). Descriptive statistics and comparisons of preferences and perceptions (Pearson Chi2 and logistic regression) were performed.

RESULTS

Two hundred and twenty-two parents and 45 pediatricians participated. After face-to-face consultations, parents and pediatricians preferred the phone for simple medical advice, discussion of parameters, acute or chronic problems, and psychological support. Email was preferred for communication of results and prescription renewal. Main reasons for using telemedicine were avoiding travel and saving time. Disadvantages were lack of physical examination, technical problems, and unsuitability of the reason for consultation.

CONCLUSIONS

Understanding the factors that influence acceptance and satisfaction with telemedicine is vital for its successful implementation. Convenience, quality of care, trust, strong pediatrician-parent relationships, technical reliability, user-friendliness, and privacy considerations play significant roles in shaping parent and pediatrician attitudes toward telemedicine.

IMPACT

The COVID-19 pandemic spurred the expansion of the use of telemedicine in pediatric care. Few studies have addressed parent and pediatrician perceptions and preferences regarding telemedicine. Both parents and pediatricians consider certain telemedicine modalities (phone, email, video, and instant message) pertinent in only specific clinical situations. Advantages of telemedicine outweigh disadvantages with parents and pediatricians appreciating the increased access to care, time savings, and avoiding transport. However, the lack of a physical examination remains a significant disadvantage. Convenience, quality of care, trust, strong pediatrician-parent relationship, technical reliability, user-friendliness, and privacy considerations play significant roles in shaping attitudes towards telemedicine.

Communication during telemedicine consultations in general practice: perspectives from general practitioners and their patients

BACKGROUND

Telemedicine allows delivery of healthcare to occur between parties that are not in the same location. As telemedicine users are not co-present, effective communication methods are crucial to the delivery and reception of information. The aim of this study was to explore perspectives of general practitioners (GPs) and patients on the interactional components of telemedicine consultations.

METHODS

Semi-structured qualitative interviews were held with telemedicine users; 15 GPs and nine patients self-selected from a larger telemedicine study. Participants were asked about their preparation for telemedicine consultations, conducting telemedicine consultations and post-consultation activities. Deidentified transcripts from the interviews were analysed thematically.

RESULTS

GPs and patients discussed factors they used to decide whether a consultation would be best conducted by telemedicine or in-person; the condition to be discussed, the existing doctor-patient relationship and whether physical examination was required. Participants also described how they prepared for their telemedicine consultations, gathering relevant documents, and reading previous notes. Participants described strategies they employed to optimise the telemedicine interaction; improving conversational flow and building rapport, as well as difficulties they experienced when trying to provide and receive care via telemedicine.

CONCLUSIONS

Patient factors including health literacy and familiarity with technology affect the transfer of information shared during telemedicine consultations and consideration of these factors when choosing patients for telemedicine is required. Many GPs and patients have innate communication skills to effectively deliver and receive care through telemedicine. However, they may not be aware of these subconscious techniques to use to optimise telemedicine consultations. Communication training could be delivered to increase conversational flow, build rapport, and establish safety netting.

Changes in reasons for visits to primary care after the start of the COVID-19 pandemic: An international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID)

BACKGROUND

The COVID-19 pandemic has reshaped healthcare delivery worldwide.

OBJECTIVE

To explore potential changes in the reasons for visits and modality of care in primary care settings through the International Consortium of Primary Care Big Data Researchers (INTRePID).

METHODS

We conducted a cross-sectional, retrospective study from 2018-2021. We examined visit volume, modality, and reasons for visits to primary care in Argentina, Australia, Canada, China, Peru, Norway, Singapore, Sweden, and the USA. The analysis involved a comparison between the pre-pandemic and pandemic periods.

RESULTS

There were more than 215 million visits from over 38 million patients during the study period in INTRePID primary care settings. Most INTRePID countries experienced a decline in monthly visit rates during the first year of the pandemic, with rate ratios (RR) and 95% confidence intervals (CI) ranging from RR:0.57 (95%CI:0.49-0.66) to RR:0.90 (95%CI:0.83-0.98), except for in Canada (RR:0.99, 95%CI:0.94-1.05) and Norway (RR:1.00, 95%CI:0.92-1.10), where rates remained stable and in Australia where rates increased (RR:1.19, 95%CI:1.11-1.28). Argentina, China, and Singapore had limited or no adoption of virtual care, whereas the remaining INTRePID countries varied in the extent of virtual care utilization. In Peru, virtual visits accounted for 7.34% (95%CI:7.33%-7.35%) of all interactions in the initial year of the pandemic, dipping to 5.22% (95%CI:5.21%-5.23%) in the subsequent year. However, in Canada 75.30% (95%CI:75.20%-75.40%) of the visits in the first year were virtual, decreasing to 62.77% (95%CI:62.66%-62.88%) in the second year. Diabetes, hypertension and/or hyperlipidemia and general health exams were in the top 10 reasons for visits in 2019 for all countries. Anxiety, depression and/or other mental health related reasons were among the top 10 reasons for virtual visits in all countries that had virtual care.

CONCLUSIONS

The pandemic resulted in changes in reasons for visits to primary care, with virtual care mitigating visit volume disruptions in many countries.

Telemedicine in primary care of older adults: a qualitative study

BACKGROUND

The COVID-19 pandemic changed the healthcare system, leading to the rapid evolution and implementation of telemedicine (TM). TM has the potential to improve the quality of primary health care and increase accessibility for the population. However, its use may represent challenges for older people, as they may have distinct needs from the general population due to age-related changes in perceptual, motor, and cognitive capacities. We, thus, aimed to identify potential facilitators and barriers to TM use in primary care for older adults and develop recommendations accordingly.

METHODS

We conducted a qualitative study to explore the challenges associated with TM use among older adults and healthcare professionals (HCPs) in primary care practice. Interviews were conducted with 29 older adults, and three focus groups involving HCPs from four McGill family medicine sites were organized. Employing a hybrid codebook thematic analysis, guided by the Consolidated Framework for Implementation Research (CFIR), we identified facilitators and barriers affecting the optimal use of TM by older adults and HCPs. We synthesized the results from semi-structured interviews and focus groups. These findings were then presented during a deliberative dialogue with eight participants, including family physicians, nurses, a social worker, and a government-level TM expert, to validate our results. The purpose was to gather feedback, identify and refine actionable recommendations. Subsequently, we utilized a thematic analysis using the same codebook to synthesize findings from the deliberative dialogue.

RESULTS

Participants agreed that TM contributed to maintaining the continuity of care and was particularly convenient when there was an existing or established patient-physician relationship or for addressing minor health issues. TM was found to be beneficial for people with limited mobility, reducing their exposure to potentially high-risk environments. However, participants expressed concerns about the lack of visual contact, causing essential details to be overlooked. Additionally, issues related to miscommunication due to language or hearing barriers were identified. HCPs perceived that most older adults did not consider phone consultations a medical act. Participants were open to a hybrid approach, combining in-person consultations and TM, based on their specific health conditions. Building upon these results, we formulated seven key recommendations.

CONCLUSIONS

Both older adults and HCPs consider TM a good alternative for accessing healthcare services. To improve the effective use of TM, it's crucial to advocate for a hybrid approach that integrates both in-person and virtual methods. This approach should actively encourage and support individuals in becoming familiar with technological tools.

Perception and Acceptance of Telemedicine Use in Health Care Among the General Public in China: Web-Based Cross-Sectional Survey

BACKGROUND

The COVID-19 pandemic is bringing about substantial changes in health care systems, leading to a significant shift toward telemedicine for the delivery of health care services.

OBJECTIVE

This study aims to examine the relationship between perceived usefulness and ease of use of telemedicine services and their association with the behavioral intention to use telemedicine.

METHODS

An anonymous cross-sectional survey was conducted in China. Partial least squares structural equation modeling was used to determine significant predictors of intention to use telemedicine consultation. Types of illnesses that favored seeking telemedicine consultation, as well as the most preferred platform for conducting telemedicine consultations, were also investigated.

RESULTS

In total, 1006 participants completed the survey. A total of 44.3% (n=446) reported being very likely and 49.3% (n=496) reported being likely to seek telemedicine consultation. Overall, the majority of participants expressed strong agreement or agreement regarding the perceived usefulness of telemedicine. Likewise, the majority indicated strong agreement or agreement when it came to their perception of the ease of using telemedicine. In the partial least squares structural equation modeling, perceived usefulness (β=0.322; P<.001) and perceived ease of use (β=0.118; P=.01) were significantly associated with a higher likelihood of seeking telemedicine consultation. A considerable number of participants expressed willingness to use telemedicine services for various medical conditions, particularly respiratory (n=340, 33.8%), skin (n=316, 31.4%), and musculoskeletal issues (n=316, 31.4%) while showing less interest in seeking telemedicine consultations for reproductive health (n=44, 4.4%) and cancer (n=64, 6.4%). The majority preferred video chat (n=443, 44%) and text chat (n=317, 31.5%) as their most preferred platforms for telemedicine consultation, while a smaller proportion preferred telephone (n=193, 19.2%) and email (n=53, 5.3%).

CONCLUSIONS

Telemedicine has the potential to play a larger role in China's health care system. The preferences for certain platforms over others may influence service design and implementation.

Primary Care Models and Depression Outcomes in Rural Adult Populations: A Systematic Review

Rural populations rely on primary care services for depression care due to shortages and maldistributions of specialty mental health care favoring urban areas. Yet, it is unknown which primary care models are effective at reducing depressive symptoms and emergency department (ED) use for depression among rural populations. The purpose of this systematic review is to synthesize the effectiveness of primary care models on depressive symptoms and ED utilization for depression in rural populations. PubMed, PsycINFO, CINAHL, and reference lists of included studies were searched. Eligible articles focused on the impact of primary care models on depressive symptoms or ED utilization for depression among rural populations in the United States. Seventeen studies met the inclusion criteria. Three care models were identified in the studies, including collaborative care (i.e., team-based integrated care that tracks patient populations with a registry; n = 7), tele-psychotherapy (i.e., identification of patients in primary care and referral to virtual psychotherapy; n = 6), or self-management support (i.e., identification of patients in primary care and referral to community support for depression self-management; n = 4). These care models were associated with improved patient-reported depressive symptoms such as Patient-Health Questionnaire reported remission of depression (score < 5). No studies assessed depression ED utilization as an outcome. Collaborative care, tele-psychotherapy, and self-management support may be effective at reducing depressive symptoms, specifically in rural populations and should be implemented at the practice level. Research focused on primary care models and ED utilization for depression among rural populations is needed.

Telehealth Trends and Hypertension Management Among Rural and Medicaid Patients After COVID-19

Objective: Examine the associations between rurality and low income with primary care telehealth utilization and hypertension outcomes across multiple years pre- and post-COVID-19 pandemic onset. Methods: We compiled electronic health record data from the mixed rural/urban Dartmouth Health system in New Hampshire, United States, on patients with pre-existing hypertension or diabetes receiving primary care in the period before (January 2018-February 2020) and after the transition period to telehealth during the COVID-19 Pandemic (October 2020-December 2022). Stratifying by rurality and Medicaid enrollment, we examined changes in synchronous (office and telehealth visits, including audio/video use) and asynchronous (patient portal or telephone message) utilization, and control of mean systolic blood pressure (SBP) <140. Results: Analysis included 46,520 patients, of whom 8.2% were Medicaid enrollees, 42.7% urban residents. Telehealth use rates were 12% for rural versus 6.4% for urban, and 15% for Medicaid versus 8.4% non-Medicaid. The overall postpandemic telehealth visit rate was 0.29 per patient per year. Rural patients had a larger increase in telehealth use (additional 0.21 per year, 95% CI, 0.19-0.23) compared with urban, as did Medicaid (0.32, 95% CI 0.29-0.36) compared with non-Medicaid. Among the 38,437 patients with hypertension, SBP control worsened from 83% to 79% of patients across periods. In multivariable analysis, rurality corresponded to worsened control rates compared with urban (additional 2.4% decrease, 95% CI 2.1-2.8%); Medicaid and telehealth use were not associated with worsened control. Conclusions: Telehealth expansion enabled a higher shift to telehealth for rural and low-income patients without impairing hypertension management.

Facilitators and barriers to implementation of telemedicine in nursing homes: A qualitative systematic review and meta-aggregation

BACKGROUND

Telemedicine is an effective way to provide nursing home residents ease of access to consultations with healthcare professionals. It is safe, effective, and time- and cost-efficient, and can be used when there are movement restrictions, such as during the COVID-19 pandemic. This literature focuses only on healthcare professionals' experiences and perspectives on the use of telemedicine in long-term care facilities.

OBJECTIVES

This review concentrated on telemedicine programs that did not involve remote monitoring. It aimed to comprehensively appraise existing literature examining the facilitators and barriers in implementing telemedicine services in nursing homes.

METHODS

A systematic qualitative review was conducted with content analysis. Database searching was conducted in PubMed, Embase, Cochrane, Scopus, and CINAHL. Hand searching for gray literature and reference lists of included papers was also performed. Qualitative studies or mixed-method studies with a qualitative analysis addressing implementation of telemedicine in any long-term care facilities were included. The Critical Appraisal Skills Programme qualitative checklist was used to assess the quality of the included studies. The data were extracted and cross-checked between two reviewers. A third reviewer was consulted for any disagreements. Meta-aggregation was used to synthesize the results.

RESULTS

Eighty-one findings were extracted, which informed 16 categories and 13 synthesized findings. The synthesized findings were related to the innovation domain, infrastructure, work processes, individuals, and implementation processes.

LINKING EVIDENCE TO ACTION

This review highlighted factors that affect the successful implementation of a telemedicine service in nursing homes. These findings provide evidence to support the future utilization of this service in the nursing home setting. Further research should explore the best approach to address these barriers and facilitators.

Telehealth-Delivered Allied Health Interventions: A Rapid Umbrella Review of Systematic Reviews

Introduction: Telehealth is used by allied health professionals to deliver health care remotely. This umbrella review addressed the following questions: (1) What telehealth interventions have been implemented to deliver allied health care? (2) What are the reported clinical benefits, and challenges of the implementation of telehealth delivered allied health interventions? (3) What are the reported experiences of patients and clinicians? Methods: A rapid umbrella systematic review method was utilized. Following a search of five electronic databases, only systematic reviews reporting on telehealth-delivery allied health interventions published in the past 10 years were included. Reported outcomes included clinical effectiveness, implementation factors, and patient/clinician experiences. Methodological quality was established using the A MeaSurement Tool to Assess systematic Reviews 2. Results: After applying eligibility criteria to 571 studies, 26 studies were included. Findings indicate that telehealth-delivered allied health interventions may obtain similar clinical outcomes as compared with face-to-face appointments. Patients reported less stress and valued the reduced need to travel when telehealth was used. Patient satisfaction with telehealth delivered care was equal to face-to-face care, and no differences were noted in the capacity to build therapeutic alliance when using telehealth. Difficulties with technology use were reported by clinicians and patients. Clinicians were identified as needing increased time management skills. Cautious interpretation of findings is recommended due to the quality rating of low to critical low for the majority of individual reviews. Conclusions: Telehealth-delivered care might obtain similar clinical outcomes to face-to-face care; however, difficulties may arise during broad implementation. It is recommended that health services be strategic to overcome implementation barriers and provide targeted support to enable effective, equitable, and sustained allied health service delivery via telehealth.

'I Do It All Alone': The Burdens and Benefits of Being Diagnosed With, and Treated for, Colorectal Cancer During the Covid-19 Pandemic

INTRODUCTION

The Covid-19 pandemic dramatically altered the way cancer care services were accessed and delivered, including for colorectal cancer (CRC). In the United Kingdom, patients were discouraged from presenting in primary care, many consultations took place remotely, investigative procedures and screening programmes were temporarily suspended, and fewer operations and treatments were delivered. People had to face the practical consequences of having cancer during a pandemic and navigate never before seen pathways, often alone. We examined the experience of being diagnosed and treated for CRC during the pandemic, and the implications of this on people's cancer journeys.

METHODS

Semi-structured interviews were undertaken with people diagnosed with CRC during the Covid-19 pandemic (January 2020-May 2021), in the North East of England. An iterative topic guide was used during interviews, which took place remotely (telephone or Zoom), were audio recorded, pseudo-anonymised and transcribed. Initial transcripts were independently coded by two researchers, and a code 'bank' developed for application across transcripts. Development of themes and overarching analytical constructs was undertaken collaboratively by the research team.

RESULTS

Interviews were conducted with 19 participants, analysed and four key themes identified: (1) The relative threats of Covid-19 and Cancer were not comparable, with cancer seen as posing a far greater risk than Covid-19; (2) Remote consultations were problematic, affecting patients' abilities to build rapport and trust with clinicians, assess nonverbal communication, and feel able to disclose, comprehend and retain information; (3) Stoma follow-up care was seen to be lacking, with long wait times for stoma reversal experienced by some; Finally, (4) Being alone during consultations negatively impacted some peoples' abilities to absorb information, and left them without the support of loved ones at an emotionally vulnerable time. However, some participants preferred being alone at certain points in their pathways, including receiving a diagnosis, and most frequently when receiving in-patient treatment.

CONCLUSION

Being alone brought unexpected benefits, absolving people from undertaking emotions work for others, and instead focus on their recovery, however, remote consultations negatively impacted patients' experiences. This study highlights the complex benefits and burdens of pandemic-located cancer journeys, including how these shifted at different points across cancer pathways.

PATIENT OR PUBLIC CONTRIBUTION

Lorraine Angell, a cancer survivor, has been central to this study from idea conception, contributing to: development of study focus and design; securing funding; production of patient-facing materials; development of interview topic guides; analysis and interpretation of data; and drafting of key findings and manuscripts.

How Informal Carers Support Video Consulting in Physiotherapy, Heart Failure, and Cancer: Qualitative Study Using Linguistic Ethnography

BACKGROUND

Informal carers play an important role in the everyday care of patients and the delivery of health care services. They aid patients in transportation to and from appointments, and they provide assistance during the appointments (eg, answering questions on the patient's behalf). Video consultations are often seen as a way of providing patients with easier access to care. However, few studies have considered how this affects the role of informal carers and how they are needed to make video consultations safe and feasible.

OBJECTIVE

This study aims to identify how informal carers, usually friends or family who provide unpaid assistance, support patients and clinicians during video consultations.

METHODS

We conducted an in-depth analysis of the communication in a sample of video consultations drawn from 7 clinical settings across 4 National Health Service Trusts in the United Kingdom. The data set consisted of 52 video consultation recordings (of patients with diabetes, gestational diabetes, cancer, heart failure, orthopedic problems, long-term pain, and neuromuscular rehabilitation) and interviews with all participants involved in these consultations. Using Linguistic Ethnography, which embeds detailed analysis of verbal and nonverbal communication in the context of the interaction, we examined the interactional, technological, and clinical work carers did to facilitate video consultations and help patients and clinicians overcome challenges of the remote and video-mediated context.

RESULTS

Most patients (40/52, 77%) participated in the video consultation without support from an informal carer. Only 23% (12/52) of the consultations involved an informal carer. In addition to facilitating the clinical interaction (eg, answering questions on behalf of the patient), we identified 3 types of work that informal carers did: facilitating the use of technology; addressing problems when the patient could not hear or understand the clinician; and assisting with physical examinations, acting as the eyes, ears, and hands of the clinician. Carers often stayed in the background, monitoring the consultation to identify situations where they might be needed. In doing so, copresent carers reassured patients and helped them conduct the activities that make up a consultation. However, carers did not necessarily help patients solve all the challenges of a video consultation (eg, aiming the camera while laying hands on the patient during an examination). We compared cases where an informal carer was copresent with cases where the patient was alone, which showed that carers provided an important safety net, particularly for patients who were frail and experienced mobility difficulties.

CONCLUSIONS

Informal carers play a critical role in making video consultations safe and feasible, particularly for patients with limited technological experience or complex needs. Guidance and research on video consulting need to consider the availability and work done by informal carers and how they can be supported in providing patients access to digital health care services.

Measures during the COVID-19 pandemic in public primary health care in Greece: is there still a missing link to universal health coverage?

BACKGROUND

The PRICOV-19 study aimed to assess the organization of primary health care (PHC) during the COVID-19 pandemic in 37 European countries and Israel; and its impact on different dimensions of quality of care. In this paper, we described measures taken by public PHC centers in Greece. Additionally, we explored potential differences between rural and non-rural settings.

METHODS

The study population consisted of the 287 public PHC centers in Greece. A random sample of 100 PHC centers stratified by Health Region was created. The online questionnaire consisted of 53 items, covering six sections: general information on the PHC center, patient flow, infection prevention, information processing, communication to patients, collaboration, and collegiality.

RESULTS

Seventy-eight PHC centers (78%) - 50 rural and 28 non-rural - responded to the survey. Certain measures were reported by few PHC centers. Specifically, the use of online messages about complaints that can be solved without a visit to the PHC center (21% rural; and 31% non-rural PHC centers), the use of video consultations with patients (12% rural; and 7% non-rural PHC centers), and the use of electronic medical records (EMRs) to systematically identify the list of patients with chronic conditions (5% rural; and 10% non-rural PHC centers) were scarcely reported. Very few PHC centers reported measures to support identifying and reaching out to vulnerable population, including patients that may have experienced domestic violence (8% rural; and 7% non-rural PHC centers), or financial problems (26% rural; and 7% non-rural PHC centers). Providing administrative documents to patients through postal mail (12% rural; and 21% non-rural PHC centers), or regular e-mail (11% rural; and 36% non-rural PHC centers), or through a secured server (8% rural; and 18% non-rural PHC centers) was rarely reported. Finally, providing information in multiple languages through a PHC website (12% rural PHC centers only), or an answering machine (6% rural PHC centers only), or leaflets (3% rural PHC centers only; and for leaflets specifically on COVID-19: 6% rural; and 8% non-rural PHC centers) were lacking in most PHC centers.

CONCLUSION

Our study captured measures implemented by few PHC centers suggesting potential priority areas of future improvement.

General practitioner preferences for telehealth consultations in Australia: a pilot survey and discrete choice experiment

AIM

To identify and quantify general practitioner (GP) preferences related to service attributes of clinical consultations, including telehealth consultations, in Australia.

BACKGROUND

GPs have been increasingly using telehealth to deliver patient care since the onset of the 2019 coronavirus disease (COVID-19) pandemic. GP preferences for telehealth service models will play an important role in the uptake and sustainability of telehealth services post-pandemic.

METHODS

An online survey was used to ask GPs general telehealth questions and have them complete a discrete choice experiment (DCE). The DCE elicited GP preferences for various service attributes of telehealth (telephone and videoconference) consultations. The DCE investigated five service attributes, including consultation mode, consultation purpose, consultation length, quality of care and rapport, and patient co-payment. Participants were presented with eight choice sets, each containing three options to choose from. Descriptive statistics was used, and mixed logit models were used to estimate and analyse the DCE data.

FINDINGS

A total of 60 GPs fully completed the survey. Previous telehealth experiences impacted direct preferences towards telehealth consultations across clinical presentations, although in-person modes were generally favoured (in approximately 70% of all scenarios). The DCE results lacked statistical significance which demonstrated undiscernible differences between GP preferences for some service attributes. However, it was found that GPs prefer to provide a consultation with good quality care and rapport (P < 002). GPs would also prefer to provide care to their patients rather than decline a consultation due to consultation mode, length or purpose (P < 0.0001). Based on the findings, GPs value the ability to provide high-quality care and develop rapport during a clinical consultation. This highlights the importance of recognising value-based care for future policy reforms, to ensure continued adoption and sustainability of GP telehealth services in Australia.

Defining practices suitable for care via teleconsultation in gynaecological and obstetrical care: a French Delphi survey

OBJECTIVE

Delineate the scope of teleconsultation services that can be effectively performed to provide women with comprehensive gynaecological and obstetrical care.

DESIGN

Based on the literature and experts' insights, we identified a list of gynaecological and obstetrical care practices suitable for teleconsultation. A three-round Delphi consensus survey was then conducted online among a panel of French experts. Experts using a 9-point Likert scale assessed the relevance of each teleconsultation practice in four key domains: prevention, gynaecology and antenatal and postnatal care. Consensus was determined by applying a dual-criteria approach: the median score on a 9-point Likert scale and the percentage of votes either below 5 or 5 and higher.

SETTING

The study was conducted at a national level in France and involved multiple healthcare centres and professionals from various geographical locations.

PARTICIPANTS

The panel comprised 22 French experts with 19 healthcare professionals, including 12 midwives, 3 obstetricians-gynaecologists, 4 general practitioners and 3 healthcare system users. Participants were selected to include diverse practice settings encompassing hospital and private practices in both rural and urban areas.

PRIMARY AND SECONDARY OUTCOME MEASURES

The study's primary outcome was the identification of gynaecological and obstetrical care practices suitable for teleconsultation. Secondary outcomes included the level of professional consensus on these practices.

RESULTS

In total, 71 practices were included in the Delphi survey. The practices approved for teleconsultation were distributed as follows: 92% in prevention (n=12/13), 55% in gynaecology (n=18/33), 31% in prenatal care (n=5/16) and 12% in postnatal care (n=1/9). Lastly, 10 practices remained under discussion: 7 in gynaecology, 2 in prenatal care and 1 in postnatal care.

CONCLUSIONS

Our consensus survey highlights both the advantages and limitations of teleconsultations for women's gynaecological and obstetrical care, emphasising the need for careful consideration and tailored implementation.

Utilization of Health Care Services and Accessibility Challenges among Adults Aged 50+ before and after Austerity Measures across 27 European Countries: Secular Trends in the SHARE Study from 2004/05 to 2019/20

This study aimed to assess and compare the utilization of preventive and other health services and the cost or availability in different regions of Europe, before and during the economic crisis. The data used in the study were obtained from Wave 8 of the Survey of Health, Ageing and Retirement in Europe (2019/2020) and Wave 1 data (2004/5), with a sample size of 46,106 individuals aged ≥50 across 27 countries, adjusted to represent a population of N = 180,886,962. Composite scores were derived for preventive health services utilization (PHSU), health care services utilization (HCSU), and lack of accessibility/availability in health care services (LAAHCS). Southern countries had lower utilization of preventive services and higher utilization of other health services compared to northern countries, with a significant lack of convergence. Moreover, the utilization of preventive health services decreased, whereas the utilization of secondary care services increased during the austerity period. Southern European countries had a significantly higher prevalence of lack of accessibility. An increase in the frequency of lack of accessibility/availability in health care services was observed from 2004/5 to 2019/20. In conclusion, our findings suggest that health inequalities increase during crisis periods. Therefore, policy interventions could prioritize accessibility and expand health coverage and prevention services.

Primary Technology Enhanced Care Home HbA1c Testing (PTEC HAT) programme: a feasibility pilot study in Singapore

BACKGROUND

Considering time-consuming, cost-related limitations of laboratory-based HbA1c testing and follow-up clinic visits for diabetes management, it is important to explore alternative care models which incorporate point-of-care testing for HbA1c to monitor glycaemic control and related management.

METHODS

Therefore, we adopted an implementation perspective to conduct one group pre- and post-intervention feasibility pilot assessing feasibility, acceptability and satisfaction with conducting home HbA1c test by patients with type 2 diabetes coupled with telemonitoring and teleconsultations (i.e., the Primary Technology Enhanced Care (PTEC) Home HbA1c Testing (HAT) Programme) in Singaporean primary care setting. The secondary objective was to compare the HbA1c, blood pressure and primary care visits at the end or during intervention, vs. 6 months before. Adult patients with type 2 diabetes with HbA1c ≤ 8% without any diabetes complications and having phone compatibility were recruited. Data was collected via patient self-reports and electronic medical records extraction. While summary statistics and paired t-test were computed for quantitative data, open-ended feedback was analysed using content analysis.

RESULTS

A total of 33 participants completed the intervention out of 37 (33/37 = 89%) recruited from 73 eligible (37/73 = 51%). Most were either 51 to 60 years old (46.9%) or more than 60 years (37.5%), with more males (53.1%) and majority Chinese (93.8%). Majority (81.3%) felt that home HbA1c testing was beneficial with most commonly reported benefit of not having a clinic visit. A key finding was the average of diabetes-related visits being significantly lower post-intervention with comparable HbA1c values pre- and post-intervention. The most commonly reported challenge was using Bluetooth to transmit the reading (43.7%), followed by having too many steps to remember (28.1%). While participants reported being overall satisfied with the intervention, only 22% were willing to pay for it.

CONCLUSION

Our findings support home HbA1c testing by patients coupled with telemonitoring and teleconsultations. Following are practical recommendations for the implementation scaling phase: offering PTEC HAT Programme to suitable patients who are self-motivated and have adequate digital literacy, provision of adequate educational and training support, sending reminders and exploring enabling manual submission of HbA1c readings considering Bluetooth-related challenges.