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Nabelsi V, Lévesque-Chouinard A. Successful Electronic Consultation Service Initiative in Quebec, Canada With Primary Care Physicians' and Specialists' Experiences on Acceptance and Use of Technological Innovation: Cross-Sectional Exploratory Study. JMIR Form Res 2024; 8:e52921. [PMID: 38814689 DOI: 10.2196/52921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/10/2024] [Accepted: 04/25/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Electronic consultation (eConsult) is an eHealth service that allows primary care providers (PCPs) to electronically consult specialists regarding their patients' medical issues. Many studies have demonstrated that eConsult services improve timely access to specialist care; prevent unnecessary referrals; improve PCPs', specialists', and patients' satisfaction; and therefore have a large impact on costs. However, no studies have evaluated PCPs' and specialists' acceptance of eConsult services in Quebec, Canada, and worldwide. OBJECTIVE This exploratory study aims to identify factors affecting eConsult service acceptance by PCPs and specialists in urban and rural primary care clinics across 3 regions in the province of Quebec, Canada, by integrating the Unified Theory of Acceptance and Use of Technology and Task-Technology Fit (TTF) models and user satisfaction. This research was designed to broaden and assist in scaling up this effective eHealth service innovation across the province. METHODS A cross-sectional web-based survey was sent to all PCPs (n=263) and specialists (n=62) who used the eConsult Quebec Service between July 2017 and May 2021. We proposed a unified model integrating the Unified Theory of Acceptance and Use of Technology model and TTF model and user satisfaction by endorsing 11 hypotheses. The partial least squares was used to investigate factors influencing the acceptance of the eConsult Quebec Service. RESULTS Of the 325 end users, 136 (41.8%) users responded (PCPs: 101/263, 38.4%; specialists: 35/62, 57%). The results of the analysis with partial least squares method indicate that 9 of our 11 hypotheses are supported. The direct relationships uniting the various constructs of the model highlighted the importance of several key constructs and predominant correlations. The results suggest that satisfaction is the key driver behind the use of the eConsult Quebec Service. Performance expectancy (P<.001) and effort expectancy (P=.03) can have a positive impact on behavioral intention (BI), and BI (P<.001) can impact adoption. TTF has an influence on performance expectancy (P<.001), adoption (P=.02), and satisfaction (P<.001). However, the results show that there is no direct effect between social influence (P=.38) and BI or between facilitating conditions (P=.17) and adoption. CONCLUSIONS This study provides a better understanding of the factors influencing PCPs' and specialists' intention to adopt the eConsult Quebec Service. Furthermore, this study tests a research model and a technology that have never been explored in Quebec until now. On the basis of the results, the service is a good fit to meet the users' need to improve access to specialized medical advice. Therefore, the results of our study have made a valuable contribution to the implementation of the service by policy makers in order to maximize acceptance, use, adoption, and success across the province of Quebec. Moreover, after 4 successful years, the eConsult Quebec pilot project is now the Conseil Numérique digital consultation service.
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Affiliation(s)
- Véronique Nabelsi
- Department of Administrative Sciences, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Annabelle Lévesque-Chouinard
- GMF-U de la Haute-Ville du Centre intégré universitaire de santé et des services sociaux de la Capitale-Nationale, Sainte-Foy, QC, Canada
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Smolinska S, Popescu FD, Izquierdo E, Antolín-Amérigo D, Price OJ, Alvarez-Perea A, Eguíluz Gracia I, Papadopoulos NG, Pfaar O, Fassio F, Hoffmann-Sommergruber K, Dramburg S, Agache I, Jutel M, Brough HA, Fonseca JA, Angier E, Boccabella C, Bonini M, Dunn Galvin A, Gibson PG, Gawlik R, Hannachi F, Kalayci Ö, Klimek L, Knibb R, Matricardi P, Chivato T. Telemedicine with special focus on allergic diseases and asthma-Status 2022: An EAACI position paper. Allergy 2024; 79:777-792. [PMID: 38041429 DOI: 10.1111/all.15964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
Efficacious, effective and efficient communication between healthcare professionals (HCP) and patients is essential to achieve a successful therapeutic alliance. Telemedicine (TM) has been used for decades but during the COVID-19 pandemic its use has become widespread. This position paper aims to describe the terminology and most important forms of TM among HCP and patients and review the existing studies on the uses of TM for asthma and allergy. Besides, the advantages and risks of TM are discussed, concluding that TM application reduces costs and time for both, HCP and patients, but cannot completely replace face-to-face visits for physical examinations and certain tests that are critical in asthma and allergy. From an ethical point of view, it is important to identify those involved in the TM process, ensure confidentiality and use communication channels that fully guarantee the security of the information. Unmet needs and directions for the future regarding implementation, data protection, privacy regulations, methodology and efficacy are described.
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Affiliation(s)
- Sylwia Smolinska
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Florin-Dan Popescu
- Department of Allergology, Nicolae Malaxa Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Elena Izquierdo
- Department of Basic Medical Sciences, Facultad de Medicina, Institute of Applied Molecular Medicine Instituto de Medicina Molecular Aplicada Nemesio Díez (IMMA), Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Madrid, Spain
| | - Darío Antolín-Amérigo
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Oliver J Price
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Alberto Alvarez-Perea
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Ibon Eguíluz Gracia
- Allergy Department, Hospital Regional Universitario de Malaga and Allergy Research Group, Instituto de Investigacion Biomedica de Malaga (IBIMA-Plataforma BIONAND). RICORS "Inflammatory Diseases", Malaga, Spain
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | | | | | - Stephanie Dramburg
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Ioana Agache
- Allergy and Clinical Immunology at Transylvania University, Brasov, Romania
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
- "ALL-MED" Medical Research Institute, Wroclaw, Poland
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Elizabeth Angier
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | | | - Peter G Gibson
- John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Radoslaw Gawlik
- Department of Internal Medicine, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - Farah Hannachi
- Immuno-Allergology Unit, Hospital Centre of Luxembourg, Luxembourg City, Luxembourg
| | - Ömer Kalayci
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Rebecca Knibb
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Paolo Matricardi
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Tomás Chivato
- Department of Clinical Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Madrid, Spain
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Alkhaddo J, Rung JM, Khowaja A, Yin Y, Richards SB, Drury-Gworek C, Afreen S, Rossi C, Manzi S. Treatment approaches and costs associated with diabetes clinical metrics as measured by Healthcare Effectiveness Data and Information Set (HEDIS). BMC Health Serv Res 2024; 24:375. [PMID: 38532406 DOI: 10.1186/s12913-024-10745-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/18/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The clinical outcomes of diabetes can be influenced by primary care providers' (PCP) treatment approaches. This study explores the association between PCP approaches to management and performance measured by established diabetes metrics and related costs. METHODS In phase one, Electronic Medical Records were used to extract diabetes related metrics using Healthcare Effectiveness Data and Information Set (HEDIS), for patients with diabetes who had office visits to 44 PCP practices from April 2019 to March 2020. Using those metrics and scoring system, PCP practices were ranked and then categorized into high- and low-performing groups (top and bottom 25%, n = 11 each), with a total of 19,059 clinic visits by patients with a diagnosis of diabetes. Then extensive analysis was performed to evaluate a correlation between treatment approaches and diabetes outcomes across the top and bottom performing practices. In phase 2, patients with diabetes who were attributed to the aforementioned PCP practices were identified in a local health plan claims data base (a total of 3,221 patients), and the allowed amounts from their claims were used to evaluate differences in total and diabetes-related healthcare costs by providers' performance. RESULTS Comparing 10,834 visits in high-performing practices to 8,235 visits in low-performing practices, referrals to certified diabetes care and education specialists and provider-to-provider electronic consults (e-consults) were higher in high-performing practices (Z = 6.06, p < .0001), while traditional referrals were higher in low-performing practices (Z = -6.94, p < .0001). The patient-to-provider ratio was higher in the low-performing group (M = 235.23) than in the high-performing group (M = 153.26) (Z = -2.82, p = .0048). Claims data analysis included 1,825 and 1,396 patients from high- and low-performing providers, respectively. The patient-to-provider ratio was again higher in the low-performing group (p = .009, V = 0.62). Patients receiving care from lower-performing practices were more likely to have had a diabetes-related hospital observation (5.7% vs. 3.9%, p = .02; V = 0.04) and higher diabetes-related care costs (p = .002; d = - 0.07); these differences by performance status persisted when controlling for differences in patient and physician characteristics. Patients seeing low-performing providers had higher Charlson Comorbidity Index scores (Mdn = 3) than those seeing high-performing providers (Mdn = 2). CONCLUSIONS Referrals to the CDCES and e-Consult were associated with better measured diabetes outcomes, as were certain aspects of cost and types of hospital utilization. Higher patients to providers ratio and patients with more comorbidities were observed in low performing group.
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Affiliation(s)
- Jamil Alkhaddo
- Allegheny Health Network, Division of Endocrinology, Pittsburgh, PA, USA.
| | - Jillian M Rung
- Highmark Health Enterprise Data & Analytics, Pittsburgh, PA, USA
| | - Ameer Khowaja
- Northeast Endocrinology Associates, San Antonio, TX, USA
| | - Yue Yin
- Allegheny-Singer Research Institute, Pittsburgh, PA, USA
| | | | | | - Samina Afreen
- Division of Endocrinology, University of Virginia, Charlottesville, VA, USA
| | - Caitlan Rossi
- Allegheny Health Network Medicine Institute, Pittsburgh, PA, USA
| | - Susan Manzi
- Allegheny Health Network Medicine Institute, Pittsburgh, PA, USA
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Seven NA, Truitt KA, Dierkhising RA, Young NP. Electronic Consultations in a Community Neurology Practice: A Retrospective Study Informing Best Practice. Mayo Clin Proc Innov Qual Outcomes 2024; 8:17-27. [PMID: 38186924 PMCID: PMC10767252 DOI: 10.1016/j.mayocpiqo.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Objective To describe our practice of electronic consultations (e-consults) and assess safety and risk factors for subsequent face-to-face consultations. Patients and Methods A retrospective cohort study of all e-consults completed in a community neurology practice between May 5, 2018, and June 31, 2019, was completed. Clinical and demographic variables were compared between the successful and unsuccessful (defined by presence of subsequent face-to-face consultation) cohorts. Hazard ratios (HR) were calculated using Cox regression model. Kaplan-Meier probability analysis (with 95% CIs) of subsequent face-to-face consultation was performed. Case examples highlighting potential harm were summarized. Results In total, 302 e-consults were reviewed. The most frequent referrals were for headache (n=125, 41.4%), dysesthesia (n=40, 13.2%), and abnormal imaging finding (n=27, 8.9%). The most common e-consult questions were for treatment (57.6%) and diagnostic evaluation (48.0%) recommendations. Moreover, 24.8% (n=75) of e-consults were followed by face-to-face consultations, with primary risk factors including female sex (HR, 1.9), referral for headache (HR, 1.7), and final diagnosis of migraine (HR, 2.0) or long-term migraine (HR, 5.0). Potential harm related to delayed diagnosis/treatment was identified in 6 (2.0%) patients with migraine and 4 (1.3%) without migraine presenting to emergency department. Conclusion Utilization of e-consults may safely improve access to neurologic expertise and prevent the need for some visits, which may have required a face-to-face visit. In patients with chronic migraine, e-consults should be considered short-term and followed by face-to-face consultation as soon as access allows. Neurologists performing e-consults should be able to triage patients to face-to-face consultation, particularly when diagnosis is uncertain or the neurologic examination may help guide appropriate testing.
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Affiliation(s)
| | | | - Ross A. Dierkhising
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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Valverde-López F, Librero-Jiménez M, Fernández-García R, Vezza T, Heredia-Carrasco C, López de Hierro Ruiz M, Galvez J, Jiménez-Rosales R, Redondo-Cerezo E. Impact of an Evidence-Based Prioritization System and Electronic Consultation in Early Diagnosis of Colorectal Cancer. Healthcare (Basel) 2024; 12:194. [PMID: 38255082 PMCID: PMC10815471 DOI: 10.3390/healthcare12020194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Colorectal cancer (CRC) is one of the most common causes of cancer. Timely diagnosis is critical, with even minor delays impacting prognosis. Primary care providers face obstacles in accessing specialist care. This study investigates the impact of implementing an electronic consultation (eConsult) system combined with a specific prioritization system on CRC diagnosis delay and tumor staging. (2) Methods: The study analyzes 245 CRC patients from November 2019 to February 2022, comparing those referred before and after the eConsult system's implementation during the COVID-19 pandemic. Data on referral reasons, pathways, diagnosis delays, and staging were collected. Multivariate analysis aimed to identify independent risk factors for advanced staging at diagnosis. (3) Results: The eConsult system significantly reduced CRC diagnosis delay from 68 to 26 days. The majority of patients referred via eConsult presented with symptoms. Despite expedited diagnoses, no discernible difference in CRC staging emerged between eConsult and traditional referrals. Notably, patients from screening programs or with a positive fecal immunochemical test (FIT) experienced earlier-stage diagnoses. A positive FIT without symptoms and being a never-smoker emerged as protective factors against advanced-stage CRC. (4) Conclusions: This study highlights eConsult's role in reducing CRC diagnosis delay, improving diagnostic efficiency and prioritizing urgent cases, emphasizing FIT effectiveness.
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Affiliation(s)
- Francisco Valverde-López
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Department of Medicine, Universidad de Granada, 18016 Granada, Spain
| | - Marta Librero-Jiménez
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Servicio de Aparato Digestivo, Hospital de Motril, 18600 Granada, Spain
| | - Raúl Fernández-García
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
| | - Teresa Vezza
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
| | - Clara Heredia-Carrasco
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
| | - Mercedes López de Hierro Ruiz
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
| | - Julio Galvez
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Department of Medicine, Universidad de Granada, 18016 Granada, Spain
| | - Rita Jiménez-Rosales
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Department of Medicine, Universidad de Granada, 18016 Granada, Spain
| | - Eduardo Redondo-Cerezo
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Department of Medicine, Universidad de Granada, 18016 Granada, Spain
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Peeters KMM, Reichel LAM, Muris DMJ, Cals JWL. Family Physician-to-Hospital Specialist Electronic Consultation and Access to Hospital Care: A Systematic Review. JAMA Netw Open 2024; 7:e2351623. [PMID: 38214930 PMCID: PMC10787322 DOI: 10.1001/jamanetworkopen.2023.51623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024] Open
Abstract
Importance Globally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)-defined as asynchronous, consultative communication between family physicians and hospital specialists-may offer advantages to face these challenges. Objective To provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals. Evidence Review A systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence. Findings The search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies. Conclusions and Relevance In this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.
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Affiliation(s)
- Ken M. M. Peeters
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Zuyderland Medical Centre, Sittard, the Netherlands
- Omnes Medical Coordinating Centre for Diagnostics and Innovation, Sittard, the Netherlands
| | - Loïs A. M. Reichel
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Dennis M. J. Muris
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Omnes Medical Coordinating Centre for Diagnostics and Innovation, Sittard, the Netherlands
- Public Health Service South Limburg, Heerlen, the Netherlands
| | - Jochen W. L. Cals
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Hodax JK, Crouch JM, Sethness JL, Loren D, Kahn NF, Asante PG, Sequeira GM. Strategies for Providing Gender-Affirming Care for Adolescents in the Primary Care Setting. Pediatr Ann 2023; 52:e442-e449. [PMID: 38049184 DOI: 10.3928/19382359-20231016-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Transgender and gender diverse (TGD) youth have high rates of health disparities and face significant barriers to accessing medical care. Primary care providers (PCPs) are often the first health care providers that TGD youth seek out to discuss gender identity and find support. Thus, it is crucial for PCPs to have an understanding of gender diversity and knowledge to support TGD youth with gender-affirming care. The purpose of this article is to offer strategies PCPs can implement to increase their comfort and capacity in providing care for TGD people. Key steps to support TGD youth in the primary care setting include creating affirming clinical environments, discussing gender identity at routine visits, supporting parents and families, supporting social transition, and providing menstrual suppression for those who desire it. Multidisciplinary gender clinics can partner with PCPs to support adolescents in accessing gender-affirming medical care and to provide additional education and support. [Pediatr Ann. 2023;52(12):e442-e449.].
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Kashyap J, Olanrewaju OA, Mahar K, Israni M, Bai R, Kumar N, Kumari K, Shadmani S, Bashir MA, Elharif M, Varrassi G, Kumar S, Khatri M, Muzammil MA, Sharma R, Ullah F. Neurological Manifestations of Infectious Diseases: Insights From Recent Cases. Cureus 2023; 15:e51256. [PMID: 38288186 PMCID: PMC10823201 DOI: 10.7759/cureus.51256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
This narrative review examines the complex connection between infectious diseases and their neurological effects. It provides a detailed analysis of recent instances and insights derived from various pathogens. As we explore the realm of infectious agents, including viruses, bacteria, parasites, and fungi, a thorough and diverse analysis reveals the intricacies of neurological problems. The review begins by examining viral infections, specifically focusing on how viruses invade the neurological system and its subsequent effects. Significant instances from recent widespread disease outbreaks function as instructive benchmarks, highlighting the progressing comprehension of these ever-changing interconnections. The article examines the complex pathophysiology of neurological problems caused by bacterial infections. It presents current cases that illustrate the various ways these complications might manifest and the difficulties faced in their therapeutic management. Parasitic and fungal infections, which are typically overlooked, are being carefully examined to emphasize their distinct role in causing neurological complications. The mentioned cases highlight the importance of being thoroughly aware of these less-explored areas ranging from protozoan parasites to opportunistic fungal infections. In addition to the immediate effects caused by infectious agents, the review investigates autoimmune responses activated by infections. It provides a detailed examination of specific instances that shed light on the complex relationship between viral triggers and future neurological problems. This text elaborates on the intricacy of autoimmune-related neurological issues, highlighting the necessity for a comprehensive approach to diagnosing and treating them. The narrative next redirects its attention to the diagnostic difficulties that arise when interpreting the neurological symptoms of viral disorders. This article provides a thorough examination of existing diagnostic tools, along with an investigation into new technologies that have the potential to improve our capacity to identify and comprehend complex presentations. This debate connects to the following examination of treatment methods, where current cases that showcase successful interventions are carefully examined to extract valuable insights into good clinical management. The discussion focuses on the public health implications of preventive efforts against infectious infections, including their neurological consequences. The story emphasizes the link between infectious diseases and overall societal health, advocating for a proactive strategy to reduce the impact of neurological complications. The abstract concludes by providing a prospective viewpoint, highlighting areas of research that still need to be addressed, and suggesting potential future avenues. This narrative review seeks to provide a comprehensive resource for physicians, researchers, and public health professionals dealing with the complex field of neurological manifestations in infectious diseases. It combines recent examples, synthesizes current information, and offers a holistic perspective.
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Affiliation(s)
- Jyoti Kashyap
- Medicine, Sri Balaji Action Medical Institute, Delhi, IND
| | - Olusegun A Olanrewaju
- Pure and Applied Biology, Ladoke Akintola University of Technology, Ogbomoso, NGA
- General Medicine, Stavropol State Medical University, Stavropol, RUS
| | - Kinza Mahar
- Medicine, Bahria University Medical and Dental College, Karachi, PAK
| | - Meena Israni
- Medicine, Sir Syed College of Medical Sciences, Karachi, PAK
| | - Reena Bai
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | | | - Komal Kumari
- Medicine, NMC Royal Family Medical Centre, Abu Dhabi, ARE
| | - Sujeet Shadmani
- Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | | | | | | | - Satish Kumar
- Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Mahima Khatri
- Internal Medicine/Cardiology, Dow University of Health Sciences, Karachi, PAK
| | | | - Roshan Sharma
- Medicine, Sanjay Gandhi Memorial Hospital, Delhi, IND
| | - Farhan Ullah
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
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9
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Ramachandran M, Brinton C, Wiljer D, Upshur R, Gray CS. The impact of eHealth on relationships and trust in primary care: a review of reviews. BMC PRIMARY CARE 2023; 24:228. [PMID: 37919688 PMCID: PMC10623772 DOI: 10.1186/s12875-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships. METHODS A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed. RESULTS A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively. CONCLUSIONS Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.
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Affiliation(s)
- Meena Ramachandran
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Christopher Brinton
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - David Wiljer
- Education Technology Innovation, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
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10
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Downes MH, Morgenstern R, Naasan G, Patterson S, Pace A, Agarwal P, Shin S, Abrams R, Mueller B, Young J, Tamler R, Vickrey BG, Kummer BR. Healthcare utilization impacts of an eConsult program for headache at an academic medical center. J Telemed Telecare 2023:1357633X231207908. [PMID: 37901905 DOI: 10.1177/1357633x231207908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Interprofessional consultations ("eConsults") can reduce healthcare utilization. However, the impact of eConsults on healthcare utilization remains poorly characterized among patients with headache. METHODS We performed a retrospective, 1:1 matched cohort study comparing patients evaluated for headache via eConsult request or in-person referral at the Mount Sinai Health System in New York. Groups were matched on clinical and demographic characteristics. Our primary outcome was one or more outpatient headache-related encounters in 6 months following referral date. Secondary outcomes included one or more all-cause outpatient neurology and headache-related emergency department (ED) encounters during the same period. We used univariable and multivariable logistic regression to model associations between independent variables and outcomes. RESULTS We identified 74 patients with headache eConsults who were matched to 74 patients with in-person referrals. Patients in the eConsult group were less likely to achieve the primary outcome (29.7% vs 62.2%, P < 0.0001) or have an all-cause outpatient neurology encounter (33.8% vs 79.7%, P < 0.0001) than patients in the comparison group. Both groups did not significantly differ by headache-related ED encounters. In multivariable analyses, patients in the eConsult group had significantly lower odds of having one or more headache-related or all-cause neurology encounters than patients in the comparison group (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1-0.6; OR 0.1, 95% CI 0.1-0.3, respectively). DISCUSSION In comparison to in-person referrals, eConsult requests for headache were associated with reduced likelihood of outpatient neurology encounters in the short-term but not with differential use of headache-related ED encounters. Larger-scale, prospective studies should validate our findings and assess patient outcomes.
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Affiliation(s)
| | - Rachelle Morgenstern
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Georges Naasan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shanna Patterson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anna Pace
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parul Agarwal
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan Shin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rory Abrams
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bridget Mueller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James Young
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronald Tamler
- Division of Endocrinology, Diabetes, and Bone Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Clinical Informatics, Mount Sinai Health System, New York, NY, USA
| | - Barbara G Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin R Kummer
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Clinical Informatics, Mount Sinai Health System, New York, NY, USA
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Bifulco L, Grzejszczak L, Velez I, Angelocci T, Anderson D. A qualitative investigation of uninsured patient and primary care provider perspectives on specialty care eConsults. BMC Health Serv Res 2023; 23:1133. [PMID: 37864170 PMCID: PMC10589958 DOI: 10.1186/s12913-023-10086-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/28/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Uninsured and underinsured patients face specialty care access disparities that prevent them from obtaining the care they need and negatively impact their health and well-being. We aimed to understand how making specialty care electronic consultations (eConsults) available at a multi-site Federally Qualified Health Center (FQHC) in central Texas affected uninsured patients' care-seeking experiences and impacted their ability to receive the needed care. METHODS We used concepts from Ecological Systems Theory to examine individual, interpersonal, organization-level, social, and health policy environment factors that impacted patients' access to specialty care and the use of eConsults. We conducted thematic analysis of semi-structured, qualitative interviews with patients about seeking specialty care while uninsured and with uninsured patients and FQHC PCPs about their experience using eConsults to obtain specialists' recommendations. RESULTS Patients and PCPs identified out-of-pocket cost, stigma, a paucity of local specialists willing to see uninsured patients, time and difficulty associated with travel and transportation to specialty visits, and health policy limitations as barriers to obtaining specialty care. Benefits of using eConsults for uninsured patients included minimizing/avoiding financial stress, expanding access to care, expanding scope of primary care, and expediting access to specialists. Concerns about the model included patients' limited understanding of eConsults, concern about cost, and worry whether eConsults could appropriately meet their specialty needs. CONCLUSIONS Findings suggest that eConsults delivered in a primary care FQHC addressed uninsured patients' specialty care access concerns. They helped to address financial and geographic barriers, provided time and cost savings to patients, expanded FQHC PCPs' knowledge and care provision options, and allowed patients to receive more care in primary care.
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Affiliation(s)
- Lauren Bifulco
- Weitzman Institute, 19 Grand Street, Middletown, CT, USA
| | | | - Idiana Velez
- Weitzman Institute, 19 Grand Street, Middletown, CT, USA
| | - Tracy Angelocci
- Lone Star Circle of Care, 205 East University, Suite 100, Georgetown, TX, USA
| | - Daren Anderson
- Weitzman Institute, 19 Grand Street, Middletown, CT, USA.
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12
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Sequeira GM, Kahn NF, Ricklefs C, Collin A, Asante PG, Pratt W, Christakis D, Richardson LP. Barriers Pediatric PCP's Identify To Providing Gender-Affirming Care For Adolescents. J Adolesc Health 2023; 73:367-374. [PMID: 37294258 PMCID: PMC10802986 DOI: 10.1016/j.jadohealth.2023.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Both affirming environments and access to gender-affirming medical care have a positive impact on the mental health of transgender and gender diverse (TGD) youth, however, many TGD youth experience barriers in accessing this care. Pediatric primary care providers (PCPs) can play an important role in expanding access to gender-affirming care for TGD youth; however, few currently provide this care. The purpose of this study was to explore pediatric PCPs' perspectives regarding barriers they experience to providing gender-affirming care in the primary care setting. METHODS Pediatric PCPs who had sought out support from the Seattle Children's Gender Clinic were recruited via email to participate in semistructured, one-hour Zoom interviews. All interviews were transcribed and then subsequently analyzed in Dedoose qualitative analysis software using a reflexive thematic analysis framework. RESULTS Provider participants (n = 15) represented a wide range of experiences with respect to years in practice, number of TGD youth seen, and practice location (urban, rural, suburban). PCPs identified both health system and community-level barriers to providing gender-affirming care to TGD youth. Health system-level barriers included: (1) lack of foundational knowledge and skills, (2) limited clinical decision-making support, and (3) health system design limitations. Community-level barriers included (1) community and institutional biases, (2) provider attitudes regarding gender-affirming care provision, and (3) challenges identifying community resources to support TGD youth. DISCUSSION A multitude of health system and community-level barriers must be overcome in the pediatric primary care setting to ensure that TGD youth receive timely, effective, and more equitable gender-affirming care.
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Affiliation(s)
- Gina M Sequeira
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington.
| | - Nicole F Kahn
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
| | - Colbey Ricklefs
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Arin Collin
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Peter G Asante
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Wanda Pratt
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Dimitri Christakis
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
| | - Laura P Richardson
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
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13
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Conelius J. Developing an Interprofessional e-Consult Checklist for Family Nurse Practitioner Students. Nurs Educ Perspect 2023; 44:188-189. [PMID: 35499948 DOI: 10.1097/01.nep.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
ABSTRACT Family nurse practitioners (FNPs) are filling the provider gaps in primary care. Primary care patients require referrals to different types of specialty providers that are not always readily available. The use of electronic consultations (e-consults) can fill this gap. FNPS may not be aware of e-consults or may feel they are not beneficial in their practice, likely because of a lack of training. This article details the development of an e-consult checklist for graduate FNPs.
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Affiliation(s)
- Jaclyn Conelius
- About the Author Jaclyn Conelius, PhD, FNP-BC, CHSE, FHRS, FNAP, FAAN, is an associate professor and FNP program director, Egan School of Nursing and Health Studies, Fairfield University, Fairfield, Connecticut. Contact her at for more information
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14
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Fernández-Prada M, Cano-García P, Alonso-Penanes P, Zapico-Baragaño MJ, Giménez-Gómez P, Lana A. Preliminary evaluation of an inter-professional e-consultation on vaccines. J Telemed Telecare 2023; 29:111-116. [PMID: 33176541 DOI: 10.1177/1357633x20970077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study was to assess the preliminary effectiveness and acceptability of an inter-professional e-consultation on vaccines. We used a quasi-experimental design to introduce an application in electronic health records that allowed primary health providers to launch e-consults to the hospital vaccines unit. A total of 135 e-consults were received during 10 months. E-consults were more frequently about subjects with chronic diseases (82.2%). Most of the e-consults were global (60.7%), that is, to revise a patient's complete vaccination schedule, whereas 39.3% were specific, that is, to request information regarding a concrete vaccine or serology, with hepatitis vaccines leading the ranking (42.9%). The e-consultation avoided hospital referral in 85.4% of the global e-consults and in 100% of the specific e-consults. Indicators of acceptability were all above nine points (10 points indicated the maximum). The best-rated aspect was the level of recommendation (9.7 ± 0.68 points). In summary, linking primary health-care providers with specialists in vaccines through an e-consultation tool is effective and well-accepted by users.
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Affiliation(s)
- María Fernández-Prada
- Vaccines Unit, Preventive Medicine and Public Health Department, Vital Álvarez-Buylla Hospital, Health Care Service of Asturias, Spain.,Healthcare Research Area, Health Research Institute of Asturias (ISPA), Spain
| | - Paula Cano-García
- Preventive Medicine and Public Health Department, School of Medicine and Health Sciences, University of Oviedo, Spain
| | - Paula Alonso-Penanes
- Preventive Medicine and Public Health Department, School of Medicine and Health Sciences, University of Oviedo, Spain
| | - María J Zapico-Baragaño
- Vaccines Unit, Preventive Medicine and Public Health Department, Vital Álvarez-Buylla Hospital, Health Care Service of Asturias, Spain
| | - Pia Giménez-Gómez
- Health Services Organisation Department, Health Service of the Principality of Asturias, Spain
| | - Alberto Lana
- Healthcare Research Area, Health Research Institute of Asturias (ISPA), Spain.,Preventive Medicine and Public Health Department, School of Medicine and Health Sciences, University of Oviedo, Spain
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15
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Sequeira GM, Kahn NF, Bocek KM, Shafii T, Asante PG, Christakis DA, Pratt W, Richardson LP. Pediatric Primary Care Providers' Perspectives on Telehealth Platforms to Support Care for Transgender and Gender-Diverse Youths: Exploratory Qualitative Study. JMIR Hum Factors 2023; 10:e39118. [PMID: 36719714 PMCID: PMC9929719 DOI: 10.2196/39118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Access to gender-affirming care services for transgender and gender-diverse youths is limited, in part because this care is currently provided primarily by specialists. Telehealth platforms that enable primary care providers (PCPs) to receive education from and consult specialists may help improve the access to such services. However, little is known about PCPs' preferences regarding receiving this support. OBJECTIVE This study aimed to explore pediatric PCPs' perspectives regarding optimal ways to provide telehealth-based support to facilitate gender-affirming care provision in the primary care setting. METHODS PCPs who had previously requested support from the Seattle Children's Gender Clinic were recruited to participate in semistructured, 1-hour web-based interviews. Overall, 3 specialist-to-PCP telehealth modalities (tele-education, electronic consultation, and telephonic consultation) were described, and the participants were invited to share their perspectives on the benefits and drawbacks of each modality, which modality would be the most effective, and the most important characteristics or outcomes of a successful platform. Interviews were transcribed and analyzed using a reflexive thematic analysis framework. RESULTS The interviews were completed with 15 pediatric PCPs. The benefits of the tele-education platform were developing a network with other PCPs to facilitate shared learning, receiving comprehensive didactic and case-based education, having scheduled education sessions, and increasing provider confidence. The drawbacks were requiring a substantial time commitment and not allowing for real-time, patient-specific consultation. The benefits of the electronic consultation platform were convenient and efficient communication, documentation in the electronic health record, the ability to bill for provider time, and sufficient time to synthesize information. The drawbacks of this platform were electronic health record-related difficulties, text-based communication challenges, inability to receive an answer in real time, forced conversations with patients about billing, and limitations for providers who lack baseline knowledge. With respect to telephonic consultation, the benefits were having a dialogue with a specialist, receiving compensation for PCP's time, and helping with high acuity or complex cases. The drawbacks were challenges associated with using the phone for communication, the limited expertise of the responding providers, and the lack of utility for nonemergent issues. Regarding the most effective platform, the responses were mixed, with 27% (4/15) preferring the electronic consultation, 27% (4/15) preferring tele-education, 20% (3/15) preferring telephonic consultation, and the remaining 27% (4/15) suggesting a hybrid of the 3 models. CONCLUSIONS A diverse suite of telehealth-based training and consultation services must be developed to meet the needs of PCPs with different levels of experience and training in gender-affirming care. Beyond the widely used telephonic consultation model, electronic consultation and tele-education may provide important alternative training and consultation opportunities to facilitate greater PCP independence and promote wider access to gender-affirming care.
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Affiliation(s)
- Gina M Sequeira
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Nicole F Kahn
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Kevin M Bocek
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Taraneh Shafii
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Peter G Asante
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Wanda Pratt
- Information School, University of Washington, Seattle, WA, United States
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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16
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Bifulco L, Guidotti O, Velez I, Grzejszczak L, Angelocci T, Okunade L, Anderson D. Impact of eConsults on Clinical Care in Primary Care: A Cross-Sectional Analysis of Primary Care Provider Behavior. J Prim Care Community Health 2023; 14:21501319231202201. [PMID: 37753619 PMCID: PMC10524039 DOI: 10.1177/21501319231202201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION/OBJECTIVES Asynchronous electronic consultations (eConsults) support primary care providers (PCPs) by providing rapid specialist feedback and improve medically underserved patients' access to care. METHODS This cross-sectional study assessed all eConsults requested over a one-year period at a multi-site federally qualified health center in Texas. We analyzed eConsult content and quality and conducted chart reviews for a randomly selected subsample (n = 100) to determine whether PCPs implemented specialists' recommendations within 90 days. Semi-structured interviews with PCPs assessed their ability and willingness to follow recommendations. RESULTS There were 367 eConsults submitted by 25 PCPs across 15 adult medical and surgical specialties. Of the 100 charts reviewed n = 77 (77.0%) contained documentation indicating that the PCP had followed at least 1 of the specialist's recommendations within 90 days. In two-thirds of the cases (n = 66, 66%) the reviewing specialist indicated that a face-to-face referral was not needed. PCPs were most likely to follow recommendations for new medications and least likely to document that they had obtained additional patient history. PCPs noted that they were sometimes unable to follow recommendations when patients could not afford or access treatment or did not return for follow up care, or when they felt that the specialist did not address their specific question. CONCLUSIONS eConsults delivered to medically underserved patients in primary care help PCPs provide timely care for their patients. PCPs utilized a broad range of eConsult specialties and generally implemented eConsult specialists' recommendations within 90 days.
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McMaster T, Mori K, Lee S, Manasa S, Stelmach W, To H. Innovations and Implementation of Telemedicine in Surgical Clinics Beyond COVID-19: A Narrative Review. Telemed J E Health 2023; 29:50-59. [PMID: 35736794 DOI: 10.1089/tmj.2021.0409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction: Telemedicine has emerged as a powerful tool in the delivery of health care to surgical patients and innovations are developing to address challenges in the technology, enhancing consumer-provider encounters while located remotely. Our study aims at collating and commenting on the published evidence for how current challenges in telemedicine for surgical clinics are met by innovations currently in development. We also comment on the implementation and monitoring strategies for telemedicine. Methods: Databases searched included: PubMed, OVID Medline, Embase, Scopus, Web of Science, and review of reference lists. Key words used were "telemedicine"; "telehealth"; "videoconference"; "outpatient"; and "surgical clinic." For inclusion, articles required to be in English, published between 2000 and 2021, were in an outpatient surgical setting, and if they had a focus during the COVID-19 pandemic. Results: Three hundred forty-five articles were identified and screened, so that 73 articles were included in the review. Almost all articles were from Western countries (n = 69), mostly in surgical journals (n = 39) and from a range of sub-specialties, but pre-dominantly orthopedics (n = 12) and general surgery (n = 9). The majority were original comparative studies, with 31 studies directly comparing telemedicine with in-person appointments and 22 articles focused on implementation during COVID-19. Discussion/Conclusion: Advanced telecommunication technology has enabled telemedicine to become an effective and safe form of health care delivery, with high consumer and provider satisfaction. Innovative protocol and technology developments have addressed the limitations of telemedicine. Sophisticated and familiar medical software integrates with electronic medical records to automate and streamline documentation, consent, and billing processes. Surgical clinics are investing in telehealth workflow co-ordination and information technology support to troubleshoot any technical difficulties as well as education for providers and consumers to address technology illiteracy. As health care services continue to transition their systems to an online network, further research is required to understand the ability and assess the feasibility of telemedicine to fully integrate.
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Affiliation(s)
- Thomas McMaster
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Krinal Mori
- Department of Surgery, Northern Health, Epping, Australia
| | - Sharon Lee
- Department of Surgery, Northern Health, Epping, Australia
| | - Siri Manasa
- Department of Surgery, Northern Health, Epping, Australia
| | - Wanda Stelmach
- Department of Surgery, Northern Health, Epping, Australia
| | - Henry To
- Department of Surgery, Northern Health, Epping, Australia.,Department of Surgery, Werribee Mercy Hospital, Werribee, Australia
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18
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Loo JSE, Yow HY, Ten YY, Govindaraju K, Megat Mohd Zubairi MH, Oui HC, Abdul Rahim N. Exploring the rise of telehealth services in Malaysia: A retrospective study. Digit Health 2023; 9:20552076231216275. [PMID: 38025110 PMCID: PMC10664425 DOI: 10.1177/20552076231216275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Background Telehealth services have gained popularity in Malaysia, providing convenient consultations during the COVID-19 pandemic. However, there is limited research on their usage, user demographics and prescribed medications. This study aims to fill that gap by investigating telehealth service utilisation in community pharmacies and identifying trends in common diagnoses and medications prescribed. Methods A retrospective observational study was conducted using a telehealth services database in Malaysian community pharmacies. Consultation records from January 2019 to December 2021 were extracted using a data collection form. The study identified the service usage over time, demographic profiles of users and the most common diagnoses and prescribed medications. Diagnoses were classified using the International Classification of Disease, 10th Revision (ICD-10), and medications were classified using the Anatomical Therapeutic Chemical (ATC) system. Results The study included 835,826 telehealth service records, with 88.8% being assisted consultations with e-prescriptions and 11.2% direct consultations. The user population consisted of primarily Malaysians (96.9%), with a mean age of 50 ± 21 years. Both telehealth services saw an increase in unique users over the 3-year study period. There was a moderate correlation between active COVID-19 cases and monthly user count. Assisted consultations were more widely used than direct consultations. Conclusion This study found an increased usage of telehealth services and its potential to remain as a healthcare system feature in community pharmacies. Further investigation into the impact on medication safety, quality and healthcare delivery is warranted.
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Affiliation(s)
- Jason SE Loo
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
- Medical Advancement for Better Quality of Life Impact Lab, Taylor's University, Subang Jaya, Malaysia
| | - Hui Yin Yow
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yi Yang Ten
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kayatri Govindaraju
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Hui Che Oui
- DOC2US, Heydoc International Sdn Bhd, Malaysia
| | - Nusaibah Abdul Rahim
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
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19
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Ng SM, Kalaitzoglou E, Utari A, van Wijngaard-de Vugt C, Donaldson M, Wolfsdorf JI, Boot AM, Drop S. Ten-Year Experience of a Global and Freely Accessible e-Learning Website for Pediatric Endocrinology and Diabetes. Horm Res Paediatr 2022; 96:366-375. [PMID: 36349753 DOI: 10.1159/000527984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/08/2022] [Indexed: 11/11/2022] Open
Abstract
The European Society for Paediatric Endocrinology (ESPE) interactive website, https://www.espe-elearning.org, was first published online in 2012. We describe the various applications of the content of the e-learning website that has been greatly expanded over the last 10 years. A large module on pediatric diabetes was added with the support of the International Society for Paediatric and Adolescent Diabetes (ISPAD). A separate multilingual module was created that focuses on frontline health care providers in limited resource settings. This module has been well received, particularly in targeted parts of the world. e-Learning may also be an opportunity to expand or tailor educational activities for learners according to their differing learning needs. The e-learning website provides guidelines for those interested in general pediatrics, neonatology, clinical genetics, and pediatric gynecology. We also describe various new applications such as master classes in the format of interactive video lectures and joint and complementary e-learning/e-consultation webinars. Finally, international certification was recently realized as e-learning courses were recognized by the European Accreditation Council for Continuing Medical Education (EACCME). As a result of the social distancing measures introduced to control the COVID-19 pandemic, digital education, whether individual or in a virtual classroom setting, has become even more important since e-learning can connect and engage individuals across geographic boundaries as well as those who live in remote areas. The future of education delivery may include hybrid learning strategies, which include in-person and e-learning platforms. Combined e-learning and e-consultation webinars illustrate how international academic institutions, learned medical specialty societies and networks are uniquely placed to deliver balanced, disease-oriented, and patient-centered e-learning education and at the same time provide expert consultation. Moreover, they are well equipped to maintain professional standards and to offer appropriate accreditation.
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Affiliation(s)
- Sze May Ng
- Department of Paediatric, Southport and Ormskirk NHS Trust, Southport, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Evangelia Kalaitzoglou
- Department of Pediatrics and Barnstable Brown Diabetes Center, University of Kentucky, Lexington, Kentucky, USA
| | - Agustini Utari
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | | | - Malcolm Donaldson
- Honorary Senior Research Fellow, Glasgow University School of Medicine, Glasgow, UK
| | - Joseph I Wolfsdorf
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Annemieke M Boot
- Division Endocrinology, Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stenvert Drop
- Department of Pediatrics, Division Endocrinology, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands
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20
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The Future of Telehealth for Allergic Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2514-2523. [PMID: 36038132 PMCID: PMC9420069 DOI: 10.1016/j.jaip.2022.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
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21
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Gong X, Hou M, Guo R, Feng XL. Investigating the relationship between consultation length and quality of tele-dermatology E-consults in China: a cross-sectional standardized patient study. BMC Health Serv Res 2022; 22:1187. [PMID: 36138410 PMCID: PMC9493166 DOI: 10.1186/s12913-022-08566-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Consultation length, the time a health provider spend with the patient during a consultation, is a crucial aspect of patient-physician interaction. Prior studies that assessed the relationship between consultation length and quality of care were mainly based on offline visits. Research was lacking in E-consults settings, an emerging modality for primary health care. This study aims to examine the association between consultation length and the quality of E-consults services. Methods We defined as standardized patient script to present classic urticaria symptoms in asynchronous E-consults at tertiary public hospitals in Beijing and Hangzhou, China. We appraised consultation length using six indicators, time waiting for first response, time waiting for each response, time for consultation, total times of provider’s responses, total words of provider’s all responses, and average words of provider’s each response. We appraised E-consults services quality using five indicators building on China’s clinical guidelines (adherence to checklist; accurate diagnosis; appropriate prescription; providing lifestyle modification advice; and patient satisfaction). We performed ordinary least squares (OLS) regressions and logistic regressions to investigate the association between each indictor of consultation length and E-consults services quality. Results Providers who responded more quickly were more likely to provide lifestyle modification advice and achieve better patient satisfaction, without compromising process, diagnosis, and prescribing quality; Providers who spent more time with patients were likely to adhere to clinical checklists; Providers with more times and words of responses were significantly more likely to adhere to the clinical checklist, provide an accurate diagnosis, appropriate prescription, and lifestyle modification advice, which achieved better satisfaction rate from the patient as well. Conclusions The times and words that health providers provide in E-consult can serve as a proxy measure for quality of care. It is essential and urgent to establish rules to regulate the consultation length for Direct-to-consumer telemedicine to ensure adequate patient-provider interaction and improve service quality to promote digital health better. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08566-2.
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Affiliation(s)
- Xue Gong
- School of Public Health, Capital Medical University, Beijing, China
| | - Mengchi Hou
- China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Rui Guo
- School of Public Health, Capital Medical University, Beijing, China.
| | - Xing Lin Feng
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
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22
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Asynchronous electronic consultation between primary care and specialized care proved effective for continuum of care for viraemic hepatitis C patients. GASTROENTEROLOGÍA Y HEPATOLOGÍA 2022; 46:266-273. [PMID: 35964811 DOI: 10.1016/j.gastrohep.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION It has been proposed that primary care diagnose and treat hepatitis C virus (HCV) infection. However, a care circuit between primary and specialized care based on electronic consultation (EC) can be just as efficient in the micro-elimination of HCV. It is proposed to study characteristics and predictive factors of continuity of care in a circuit between primary and specialized care. METHODS From February/2018 to December/2019, all EC between primary and specialized care were evaluated and those due to HCV were identified. Variables for regression analysis and to identify predictors of completing the care cascade were recorded. RESULTS From 8098 EC, 138 were performed by 89 (29%) general practitioners over 118 patients (median 50.8 years; 74.6% men) and were related to HCV (1.9%). Ninety-two patients (78%) were diagnosed>6 months ago, and 26.3% met criteria for late presentation. Overall, 105 patients required assessment by the hepatologist, 82% (n=86) presented for the appointment, of which 67.6% (n=71) were viraemic, 98.6% of known. Finally, 61.9% (n=65) started treatment. Late-presenting status was identified as an independent predictor to complete the care cascade (OR 1.93, CI 1.71-1.99, p<0.001). CONCLUSION Communication pathway between Primary and Specialized Care based on EC is effective in avoiding significant losses of viraemic patients. However, the referral rate is very low, high in late-stage diagnoses, heterogeneous, and low in new diagnoses. Therefore, early detection strategies for HCV infection in primary care are urgently needed.
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23
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Medford RJ, Granger M, Pickering M, Lehmann CU, Mayorga C, King H. Implementation of Outpatient Infectious Diseases E-Consults at a Safety Net Healthcare System. Open Forum Infect Dis 2022; 9:ofac341. [PMID: 35903155 PMCID: PMC9315945 DOI: 10.1093/ofid/ofac341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Indexed: 01/24/2023] Open
Abstract
Background Safety net healthcare systems have high patient volumes and significant demands for specialty care including infectious diseases (ID) consultations. Electronic ID consults (E-consults) can lessen this burden by providing an alternative to face-to-face ID referrals and decreasing financial, time, and travel constraints on patients. This system could increase access to ID care for patients in limited-resource settings. Methods We described characteristics of all outpatient ID E-consults at Parkland Health in Dallas, Texas, from March 2018 to February 2021. We used modeling to determine which characteristics influenced conversion of E-consults to clinic visits and integrated these data into a predictive model for face-to-face conversion. Results For 725 E-consults, common E-consult topics included 118 (16%) latent tuberculosis, 116 (16%) syphilis, and 76 (10%) gastrointestinal infections. Nearly two-thirds of E-consults (456 [63%]) were requested by primary care providers. The majority (78%) were resolved without a face-to-face ID visit. Osteomyelitis, nontuberculous mycobacterial, and gastrointestinal questions frequently required face-to-face visits at rates of 65%, 49%, and 32%, respectively. Our logistic regression model predicted the need for a face-to-face visit with 80% accuracy and an area under the receiver operating characteristic curve of 0.72. Conclusions An outpatient ID E-consult program at a safety net healthcare system was an effective tool to provide timely input on common ID topics. E-consults were requested by a range of providers, and most were completed without a face-to-face visit. Predictive modeling identified important characteristics of E-consults and predicted conversion to face-to-face visits with reasonable accuracy.
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Affiliation(s)
- Richard J Medford
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA,Division of Infectious Diseases, Parkland Health and Hospital System, Dallas, Texas, USA,Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madison Granger
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Madison Pickering
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA,Division of Physical Sciences, Department of Computer Science, University of Chicago, Chicago, Illinois, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christian Mayorga
- Division of Digestive and Liver Diseases, Parkland Health and Hospital System, Dallas, Texas, USA,Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Helen King
- Correspondence: Helen King, MD, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9113, USA ()
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24
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Kappel C, Rushton-Marovac M, Leong D, Dent S. Pursuing Connectivity in Cardio-Oncology Care-The Future of Telemedicine and Artificial Intelligence in Providing Equity and Access to Rural Communities. Front Cardiovasc Med 2022; 9:927769. [PMID: 35770225 PMCID: PMC9234696 DOI: 10.3389/fcvm.2022.927769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/24/2022] [Indexed: 01/22/2023] Open
Abstract
The aim of this review is to discuss the current health disparities in rural communities and to explore the potential role of telehealth and artificial intelligence in providing cardio-oncology care to underserviced communities. With advancements in early detection and cancer treatment, survivorship has increased. The interplay between cancer and cardiovascular disease, which are the leading causes of morbidity and mortality in this population, has been increasingly recognized. Worldwide, cardio-oncology clinics (COCs) have emerged to deliver a multidisciplinary approach to the care of patients with cancer to mitigate cardiovascular risks while minimizing interruptions in cancer treatment. Despite the value of COCs, the accessibility gap between urban and rural communities in both oncology and cardio-oncology contributes to health care disparities and may be an underrecognized determinant of health globally. Telehealth and artificial intelligence offer opportunities to provide timely care irrespective of rurality. We therefore explore current developments within this sphere and propose a novel model of care to address the disparity in urban vs. rural cardio-oncology using the experience in Canada, a geographically large country with many rural communities.
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Affiliation(s)
- Coralea Kappel
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Moira Rushton-Marovac
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Darryl Leong
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Susan Dent
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, NC, United States
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25
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Arora A, Fekieta R, Nouri Z, Carder D, Colgan MM, Fuhlbrigge A, Jackson SL, Collins S, Gleason N, Chen J. Trends in Utilization of Electronic Consultations Associated With Patient Payer and Language Among US Academic Medical Centers During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2224628. [PMID: 35904781 PMCID: PMC9338406 DOI: 10.1001/jamanetworkopen.2022.24628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Electronic consultations (eConsultations) are increasingly used to obtain specialist guidance, avoiding unnecessary face-to-face patient visits for certain clinical questions. During the COVID-19 pandemic, when in-person care was limited, eConsultations may have helped clinicians obtain specialist input to guide patient care. OBJECTIVE To understand how the use of eConsultations changed during the COVID-19 pandemic and whether trends in eConsultation utilization differed based on patient's payer and primary language. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted at 6 academic medical centers in the United States, all participating in the Association of American Colleges Coordinating Optimal Referral Experiences program. Participants included adult patients who had an outpatient visit, referral, or eConsultation during the study period. Data were analyzed from June 4, 2019, to July 28, 2020. MAIN OUTCOMES AND MEASURES The primary outcome was the eConsultation proportion of specialty contact, defined as the number of completed eConsultations divided by the sum of the number of completed eConsultations and specialty referrals, expressed as a percentage. eConsultation percentages of specialty contact were further stratified by payer type and language. Payers included commercial, Medicare, Medicaid, self-pay or uninsured, and other. Primary language included English and non-English languages. RESULTS A total of 14 545 completed eConsultations and 189 776 referrals were included. More eConsultations were completed for English-speaking patients (11 363 eConsultations [95.0%]) than non-English-speaking patients (597 eConsultations [5.0%]). Patients with commercial insurance represented the highest number of completed eConsultations (8848 eConsultations [60.8%]) followed by Medicare (3891 eConsultations [26.8%]), Medicaid (930 eConsultations [6.4%]), other insurance (745 eConsultations [5.1%]), and self-pay or no insurance (131 eConsultations [0.9%]). At the start of the pandemic, across all academic medical centers, the percentage of specialty contact conducted via eConsultation significantly increased by 6.21% (95% CI, 4.97%-7.44%; P < .001). When stratified by payer and language, the percentage of specialty contact conducted via eConsultation significantly increased at the beginning of the pandemic for both English-speaking patients (change, 6.09% (95% CI, 4.82% to 7.37%; P < .001) and non-English-speaking patients (change, 8.48% [95% CI, 5.79% to 11.16%]; P < .001) and for all payers, except self-pay and uninsured patients (change, -0.21% [95% CI, [-1.35% to 0.92%]; P = .70). CONCLUSIONS AND RELEVANCE This retrospective cohort study found that eConsultations provided an accessible mechanism for clinicians to receive specialist input when in-person care was limited.
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Affiliation(s)
- Anita Arora
- Yale School of Medicine, New Haven, Connecticut
| | | | - Zakia Nouri
- Association of American Medical Colleges, Washington, District of Columbia
| | - Danielle Carder
- Association of American Medical Colleges, Washington, District of Columbia
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26
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Chua BQY, Chong VWS, Teng TZJ, Chia CTW, Aung MO, Shelat VG. Does technology-enhanced communication improve Helicobacter pylori eradication outcomes?-A meta-analysis. Helicobacter 2022; 27:e12890. [PMID: 35363943 DOI: 10.1111/hel.12890] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Helicobacter pylori (H. pylori) is a highly prevalent organism that can induce an inflammatory state in the upper gastrointestinal tract and lead to complications such as peptic ulcer and gastric cancer. The treatment regime is complicated, and mild-to-moderate adverse effects are common, making patient compliance a key determinant of successful eradication. One attractive strategy is to leverage on technology-enhanced communication (TEC) strategies. However, the current data on the efficacy of TEC modalities in improving H. pylori eradication are limited. This is the first meta-analysis evaluating its effectiveness to the best of our knowledge. Thus, it is essential to evaluate the current body of evidence to learn the impact of TEC initiatives. METHODS A literature search was done on PubMed, World of Science, and Embase. A total of 9 studies variably reported on compliance rate, eradication rate, adverse effect rate, symptom relief, patient satisfaction, treatment cost, patient disease awareness, and follow-up rates. RESULTS This meta-analysis showed that TEC initiatives significantly improve patient compliance (OR 4.52, 95% CI 2.09 - 9.77, p < .01) and eradication rate (OR 1.98, 95% CI 1.34 - 2.93, p < .01) but not adverse effect rate (OR 0.65, 95% CI [0.27 - 1.57], p = .34). Due to the small number of studies and population sample, patient satisfaction, symptom relief, treatment costs, disease awareness, and follow-up rates were assessed qualitatively. CONCLUSION TEC initiatives effectively improve compliance to the H. pylori eradication regime and increase the eradication rate.
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Affiliation(s)
| | | | | | - Christopher Tze Wei Chia
- Lee Kong Chian School of Medicine, NTU Singapore, Singapore, Singapore
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Myint Oo Aung
- Lee Kong Chian School of Medicine, NTU Singapore, Singapore, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishal G Shelat
- Lee Kong Chian School of Medicine, NTU Singapore, Singapore, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Abstract
OBJECTIVE This article summarizes the existing literature on psychiatric electronic consultation (e-consultation or e-consult) to provide guidance on psychiatric e-consult practice and suggest next steps in research on psychiatric e-consults. METHOD A narrative review was conducted using relevant search terms in PubMed and Google Scholar. RESULTS AND DISCUSSION The psychiatric e-consult is a method of asynchronous consultation between primary care providers and psychiatric specialists that is associated with primary care provider satisfaction and promotes access to specialist guidance in mental health care. Major themes in the literature include contextual factors that affect implementation of psychiatric e-consult services, outcomes associated with psychiatric e-consults, and specific practical considerations that may affect psychiatric e-consult technique. CONCLUSIONS Psychiatric e-consults may help address the widespread lack of access to specialty psychiatric care. Further studies are needed to examine clinical outcomes based on psychiatry e-consults.
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28
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Payne T, Kevric J, Stelmach W, To H. The Use of Electronic Consultations in Outpatient Surgery Clinics: Synthesized Narrative Review. JMIR Perioper Med 2022; 5:e34661. [PMID: 35436223 PMCID: PMC9052035 DOI: 10.2196/34661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/20/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Electronic consultations (eConsults) are an increasingly used form of telemedicine that allows a nonspecialist clinician to seek specialist advice remotely without direct patient-specialist communication. Surgical clinics may see benefits from such forms of communication but face challenges with the need for intervention planning. Objective We aimed to use the Quadruple Aim Framework to integrate published knowledge of surgical outpatient eConsults with regard to efficacy, safety, limitations, and evolving use in the era of COVID-19. Methods We systematically searched for relevant studies across four databases (Ovid MEDLINE, Embase, Scopus, and Web of Science) on November 4, 2021, with the following inclusion criteria: English language, published in the past 10 years, and data on the outcomes of outpatient surgical eConsults. Results A total of 363 studies were screened for eligibility, of which 33 (9.1%) were included. Most of the included studies were from the United States (23/33, 70%) and Canada (7/33, 21%), with a predominant multidisciplinary focus (9/33, 27%). Most were retrospective audits (16/33, 48%), with 15% (5/33) of the studies having a prospective component. Conclusions The surgical eConsult studies indicated a possible benefit for population health, promising safety results, enhanced patient and clinician experience, and cost savings compared with the traditional face-to-face surgical referral pathway. Their use appeared to be more favorable in some surgical subspecialties, and the overall efficacy was similar to that of medical subspecialties. Limited data on their long-term safety and use during the COVID-19 pandemic were identified, and this should be the focus of future research.
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Affiliation(s)
- Thomas Payne
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Surgery, The Northern Hospital, Melbourne, Australia
| | - Jasmina Kevric
- Department of Surgery, The Northern Hospital, Melbourne, Australia
| | - Wanda Stelmach
- Department of Surgery, The Northern Hospital, Melbourne, Australia
| | - Henry To
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Surgery, The Northern Hospital, Melbourne, Australia
- Department of Surgery, Werribee Mercy Hospital, Melbourne, Australia
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29
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Malcolm EJ, Brandon Z, Wilson LE, Shoup JP, King HA, Lewinski A, Greiner MA, Malone S, Miller J, Keenan RT, Tarrant TK, Phinney D, Cho A, Bosworth HB, Shah K. eConsults' Impact on Care Access and Wait Times in Rheumatology. J Clin Rheumatol 2022; 28:147-154. [PMID: 35067514 DOI: 10.1097/rhu.0000000000001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE A growing number of health systems have implemented eConsults to improve access to specialty advice, but few studies have described their use in rheumatology or impact on visit wait times. We evaluated the uptake of an eConsult program and its impact on wait times for in-person rheumatology visits. METHODS In this quality improvement project, we analyzed electronic health record data from 4 intervention clinics and 4 comparison clinics, 12 months before and after implementation of an eConsult program. We compared median wait time for rheumatology appointments using a pre-post difference-in-differences analysis and quantile regression, adjusting for patient age, race, sex, clinic pair, and primary insurance payer. We also interviewed 11 primary care providers from the intervention clinics and conducted a rheumatology provider focus group (n = 4) to elucidate experiences with the program. RESULTS Rheumatologists recommended management in primary care or referral to another specialty for 41% of eConsults, reducing initial demand for in-person visits. The median wait times dropped in the intervention and the comparison clinics (42 and 25 days, respectively). Intervention clinic median wait time dropped 17 days more than comparison clinics, and this was nonstatistically significant (p = 0.089). eConsults fit provider care tasks best for triage or initial workup for diagnosis, and less well when tests required interpretation, or when back and forth communication was needed to manage the patient's condition. CONCLUSIONS Implementation of eConsults for rheumatology was associated with reduced wait times for rheumatology appointments and supported primary care providers in the triage and workup for a substantial portion of patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Julie Miller
- From the Duke University School of Medicine, Durham
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30
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Ip W, Prahalad P, Palma J, Chen JH. A Data-Driven Algorithm to Recommend Initial Clinical Workup for Outpatient Specialty Referral: Algorithm Development and Validation Using Electronic Health Record Data and Expert Surveys. JMIR Med Inform 2022; 10:e30104. [PMID: 35238788 PMCID: PMC8931647 DOI: 10.2196/30104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/22/2021] [Accepted: 01/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Millions of people have limited access to specialty care. The problem is exacerbated by ineffective specialty visits due to incomplete prereferral workup, leading to delays in diagnosis and treatment. Existing processes to guide prereferral diagnostic workup are labor-intensive (ie, building a consensus guideline between primary care doctors and specialists) and require the availability of the specialists (ie, electronic consultation). OBJECTIVE Using pediatric endocrinology as an example, we develop a recommender algorithm to anticipate patients' initial workup needs at the time of specialty referral and compare it to a reference benchmark using the most common workup orders. We also evaluate the clinical appropriateness of the algorithm recommendations. METHODS Electronic health record data were extracted from 3424 pediatric patients with new outpatient endocrinology referrals at an academic institution from 2015 to 2020. Using item co-occurrence statistics, we predicted the initial workup orders that would be entered by specialists and assessed the recommender's performance in a holdout data set based on what the specialists actually ordered. We surveyed endocrinologists to assess the clinical appropriateness of the predicted orders and to understand the initial workup process. RESULTS Specialists (n=12) indicated that <50% of new patient referrals arrive with complete initial workup for common referral reasons. The algorithm achieved an area under the receiver operating characteristic curve of 0.95 (95% CI 0.95-0.96). Compared to a reference benchmark using the most common orders, precision and recall improved from 37% to 48% (P<.001) and from 27% to 39% (P<.001) for the top 4 recommendations, respectively. The top 4 recommendations generated for common referral conditions (abnormal thyroid studies, obesity, amenorrhea) were considered clinically appropriate the majority of the time by specialists surveyed and practice guidelines reviewed. CONCLUSIONS An item association-based recommender algorithm can predict appropriate specialists' workup orders with high discriminatory accuracy. This could support future clinical decision support tools to increase effectiveness and access to specialty referrals. Our study demonstrates important first steps toward a data-driven paradigm for outpatient specialty consultation with a tier of automated recommendations that proactively enable initial workup that would otherwise be delayed by awaiting an in-person visit.
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Affiliation(s)
- Wui Ip
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Priya Prahalad
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Jonathan Palma
- Neonatology & Perinatal Medicine, Orlando Health Winnie Palmer Hospital for Women & Babies, Orlando, FL, United States
| | - Jonathan H Chen
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.,Stanford Center for Biomedical Informatics Research, Stanford, CA, United States
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31
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Use of telemedicine for initial outpatient subspecialist consultative visit: A national survey of general pediatricians and pediatric subspecialists. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2022; 10:100600. [PMID: 34875456 PMCID: PMC8881319 DOI: 10.1016/j.hjdsi.2021.100600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Evidence-based strategies are needed to support appropriate use of telemedicine for initial outpatient subspecialty consultative visits. To inform such strategies we performed a survey of general pediatricians and pediatric subspecialists about use of telemedicine for patients newly referred for pediatric subspecialty care. METHODS We developed and fielded an e-mail and postal survey of a national sample of 840 general pediatricians and 840 pediatric subspecialists in May and June 2020. RESULTS Of 266 completed surveys (17% response rate), 204 (76%) thought telemedicine should be offered for some and 29 (11%) thought telemedicine should be offered for all initial subspecialist visits. Most respondents who indicated telemedicine should be offered for some initial consultations believed this decision should be made by subspecialty attendings (176/204, 86%). Respondents prioritized several data elements to inform this decision, including clinical information and family-based contextual information (e.g., barriers to in-person care, interest in telemedicine, potential communication barriers). Factors perceived to reduce appropriateness of telemedicine for subspecialty consultation included need for interpreter services and prior history of frequent no-shows. Responses from generalists and subspecialists rarely differed significantly. CONCLUSIONS Survey results suggest potential opportunities to support the appropriate use of telemedicine for initial outpatient pediatric subspecialty visits through structured transfer of specific clinical and contextual information at the time of referral and through strategies to mitigate perceived communication or engagement barriers. IMPLICATION Pediatric physician beliefs about telemedicine for initial outpatient subspecialty consultative visits may inform future interventions to support appropriate telemedicine use. LEVEL OF EVIDENCE Survey of a national sample of clinicians.
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Rea CJ, Toomey SL, Rosen M, Le T, Shah S. Understanding Caregiver Perspectives on an Electronic Consultation and Referral System. Clin Pediatr (Phila) 2022; 61:270-279. [PMID: 35090366 DOI: 10.1177/00099228221074856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined caregiver impressions of an electronic consultation and referral (ECR) system. Participants included 56 caregivers of primary care patients referred through the ECR system. Semistructured interviews and surveys were conducted between August 2018 and April 2019. Transcripts were coded and themes developed using thematic content analysis. A total of 51% of caregivers stated that they would prefer to see their child's primary care provider (PCP) for a specialty issue if they could receive the same quality of care. All caregivers who received an electronic consult (n = 28) said that they would utilize that process again. Three themes emerged: (1) caregivers expect immediate action prior to or instead of a specialty referral; (2) caregiver preferences for PCP versus specialist are mediated by both child and provider characteristics; (3) caregiver attitudes toward the ECR system are influenced by external considerations and experiences with the system. Results suggest caregivers value enhanced communication and immediate access to specialty input facilitated by the ECR system.
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Affiliation(s)
- Corinna J Rea
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sara L Toomey
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Tiffany Le
- Boston Children's Hospital, Boston, MA, USA
| | - Snehal Shah
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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The New Role of Telehealth in Contemporary Medicine. Curr Cardiol Rep 2022; 24:271-275. [PMID: 35218502 PMCID: PMC8881748 DOI: 10.1007/s11886-022-01640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/25/2022]
Abstract
Purpose of Review Understand the current uses for telehealth as well as future directions as it relates to the COVID-19 pandemic and cardiovascular medicine. Recent Findings Telehealth interventions in various forms have proven to be efficacious in the management of obesity, hypertension, glycemic control in diabetes, hyperlipidemia, medication adherence, and ICU length of stay and mortality. The use and study of such interventions have been greatly expanded during the pandemic partly due to the expanded coverage by payers. However, heterogenous interventions and a relative lack of cost analyses are barriers to more widespread adoption. Summary Telehealth has proven efficacy for modifying risk factors for cardiovascular disease. To date, this has not been shown to translate to a reduction in hard cardiovascular endpoints such as mortality. With ongoing research and expanded funding, the role of telehealth is likely to evolve as the COVID pandemic continues.
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Stevens JP, Landon B. Opportunities to improve the quality of inpatient consultation: one hospital’s investigation but an age old struggle. Isr J Health Policy Res 2022; 11:7. [PMID: 35101143 PMCID: PMC8802474 DOI: 10.1186/s13584-022-00520-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
Inpatient consultation is widely used by hospital physician teams to access specialized expertise and procedures. However, the quality of the resultant consultation varies widely. This commentary describes prior efforts to understand variation in rates of consultation and potential implications across the spectrum of care from underuse to overuse. Improving the quality of consultation requires a full understanding of the aspects of consultation that contribute to quality, including clear requests and communications from the consulting team, but also recognition of organizational and cultural constraints that can impact the availability and quality of consultations provided.
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Anderson KN, Warren N, Duddy M, McKean P, Miller JA. Delivering an advice and guidance service in neurology. Pract Neurol 2022; 22:209-212. [PMID: 35074798 PMCID: PMC9120374 DOI: 10.1136/practneurol-2021-003100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/13/2022]
Abstract
It is increasingly common for secondary care to provide advice to primary care without an outpatient appointment. Even before the increased telemedicine during COVID-19, many hospital services gave advice alone for some referrals, yet there are few published data about patient outcomes. Does advice and guidance alter outpatient numbers or simply mean that patients are seen later? Which neurological conditions can we manage at a distance? Do complaints increase from either primary care or patients? Do clinics become more complex and time consuming? Our department has developed an advice and guidance service embedded within the English electronic referral system since 2017, allowing detailed analysis of the outcome of 6500 patients over 2.5 years. We suggest ways to set up and run a neurology advice and guidance service, looking at the potential benefits and the barriers.
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Affiliation(s)
- Kirstie N Anderson
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK .,Neurology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Naomi Warren
- Neurology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Martin Duddy
- Neurology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Paul McKean
- Information Services, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - James Al Miller
- Neurology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
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Ionescu A, de Jong PGM, Drop SLS, van Kampen SC. A scoping review of the use of e-learning and e-consultation for healthcare workers in low- and middle-income countries and their potential complementarity. J Am Med Inform Assoc 2021; 29:713-722. [PMID: 34966930 PMCID: PMC8922198 DOI: 10.1093/jamia/ocab271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Although the provision of e-learning (EL) training for healthcare workers (HCWs) and provider-to-HCW e-consultation (EC) is considered useful for health outcomes, research on their joint use is limited. This scoping review aimed to create an overview of what is currently known in the literature about the use and implementation of EC and EL by HCWs in LMICs and to answer the question of whether there is evidence of complementarity. MATERIALS AND METHODS Scientific databases were searched and peer-reviewed papers were reviewed systematically according to predefined inclusion/exclusion criteria. Data were extracted including the study focus (EC/EL), year of publication, geographical location, target population, target disease(s) under study, type(s) of study outcomes, and article type. RESULTS A total of 3051 articles were retrieved and screened for eligibility, of which 96 were kept for analysis. Of these, only 3 addressed both EL and EC; 54 studies addressed EL; and 39 addressed EC. Most studies looked at gain in knowledge/skills usability, efficiency, competence, and satisfaction of HCW, or barriers/challenges to implementation. Descriptive studies focused on the application of EL or EC for targeting specific health conditions. Factors contributing to the success of EC or EL networks were institutional anchoring, multiple partnership, and capacity building of local experts. CONCLUSIONS Our review found an important gap in the literature in relation to the complementary role of EL and EC for HCWs in LMICs evidenced by outcome measures. There is an important role for national and international academic institutions, learned medical societies, and networks to support regional experts in providing EL and EC for added value that will help the clinical performance of HCWs and improve health outcomes.
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Affiliation(s)
- Alma Ionescu
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter G M de Jong
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Stenvert L S Drop
- Division of Endocrinology, Department of Pediatrics, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands,Corresponding Author: Stenvert L.S. Drop, MD, PhD, Division of Endocrinology, Department of Pediatrics, Sophia Children’s Hospital, Erasmus MC, Sp2430, PO Box 2060, Rotterdam 3000 CB, The Netherlands;
| | - Sanne C van Kampen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Dosani T, Xiang J, Wang K, Deng Y, Connell NT, Connery D, Levin F, Roy A, Wadia RJ, Wong EY, Rose MG. Impact of Hematology Electronic Consultations on Utilization of Referrals and Patient Outcomes in an Integrated Health Care System. JCO Oncol Pract 2021; 18:e564-e573. [PMID: 34914541 DOI: 10.1200/op.21.00420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Electronic consultations (e-consults) may be a valuable tool in the current era of increased demand for hematologists. Despite the increasing use of e-consults in hematology, their optimal utilization and impact on patient outcomes and workload are largely unknown. METHODS In this retrospective cohort study, we studied the hematology consult experience at Veterans Affairs Connecticut from 2006 to 2018. We included 7,664 hematology consults (3,240 e-consults and 4,424 face-to-face [FTF] consults) requested by 1,089 unique clinicians. RESULTS We found that e-consults were rapidly adopted and used equally among physicians of different degrees of experience. The number of FTF consults did not decrease after the introduction of e-consult services. E-consults were preferentially used for milder laboratory abnormalities that had been less likely to result in a consult before their availability. Referring clinicians used e-consults preferentially for periprocedural management, anemia, leukopenia, and anticoagulation questions. Eighty-three percent of e-consults were resolved without needing an FTF visit in the year after the consult. Consults for pancytopenia, gammopathy, leukocytosis, and for patients with known malignancy were less likely to be resolved by e-consult. Among patients who were diagnosed with a new hematologic malignancy after their consult, having an e-consult before an FTF visit did not adversely affect survival. CONCLUSION In summary, e-consults safely expanded delivery of hematology services in our health care system but increased total consult volume. We report novel data on what types of consults may be best suited to the electronic modality, the impact of e-consults on workload, and their optimal use and implementation.
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Affiliation(s)
- Talib Dosani
- Yale School of Medicine and Yale Cancer Center, New Haven, CT
| | - Jenny Xiang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Kaicheng Wang
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Nathan T Connell
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | - Alicia Roy
- VA Connecticut Healthcare System, West Haven, CT
| | - Roxanne J Wadia
- Yale School of Medicine and Yale Cancer Center, New Haven, CT.,VA Connecticut Healthcare System, West Haven, CT
| | - Ellice Y Wong
- Yale School of Medicine and Yale Cancer Center, New Haven, CT.,VA Connecticut Healthcare System, West Haven, CT
| | - Michal G Rose
- Yale School of Medicine and Yale Cancer Center, New Haven, CT.,VA Connecticut Healthcare System, West Haven, CT
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Yagnik KJ, Saad HA, King HL, Bedimo RJ, Lehmann CU, Medford RJ. Characteristics and Outcomes of Infectious Diseases Electronic COVID-19 Consultations at a Multisite Academic Health System. Cureus 2021; 13:e19203. [PMID: 34877196 PMCID: PMC8642131 DOI: 10.7759/cureus.19203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 12/25/2022] Open
Abstract
Objective The need for clinicians to access Infectious Diseases (ID) consultants for clinical decision-making support increased during the Coronavirus Disease 2019 (COVID-19) pandemic. Traditional ID consultations with face-to-face (FTF) patient assessments are not always possible or practical during a pandemic and involve added exposure risk and personal protective equipment (PPE) use. Electronic consultations (e-consults) may provide an alternative and improve access to ID specialists during the pandemic. Methods We implemented ID e-consult platforms designed to answer clinical questions related to COVID-19 at three academic clinical institutions in Dallas, Texas. We conducted a retrospective review of all COVID-19 ID e-consults between March 16, 2020 and May 15, 2020 evaluating characteristics and outcomes of e-consults among the clinical sites. Results We completed 198 COVID-19 ID e-consults at participating institutions. The most common e-consult indications were for 63 (32%) repeat testing, 61 (31%) initial testing, 65 (33%) treatment options, and 61 (31%) Infection Prevention (IP). Based on the e-consult recommendation, 53 (27%) of patients were initially tested for COVID-19, 45 (23%) were re-tested, 44 (22%) of patients had PPE precautions initiated, and 37 (19%) had PPE precautions removed. The median time to consult completion was four hours and 8 (4%) consults were converted to standard FTF consults. Conclusion E-consult services can provide safe and timely access to ID specialists during the COVID-19 pandemic, minimizing the risk of infection to the patient and health care workers, while preserving PPE and testing supplies.
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Affiliation(s)
- Kruti J Yagnik
- Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, USA
| | - Hala A Saad
- Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, USA
| | - Helen L King
- Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, USA
| | - Roger J Bedimo
- Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, USA
| | | | - Richard J Medford
- Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, USA
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Anderson E, Vimalananda VG, Orlander JD, Cutrona SL, Strymish JL, Bokhour BG, Rinne ST. Implications of Electronic Consultations for Clinician Communication and Relationships: A Qualitative Study. Med Care 2021; 59:808-815. [PMID: 34116530 PMCID: PMC8360667 DOI: 10.1097/mlr.0000000000001575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Strong relationships and effective communication between clinicians support care coordination and contribute to care quality. As a new mechanism of clinician communication, electronic consultations (e-consults) may have downstream effects on care provision and coordination. OBJECTIVE The objective of this study was to understand primary care providers' and specialists' perspectives on how e-consults affect communication and relationships between clinicians. RESEARCH DESIGN Qualitative study using thematic analysis of semistructured interviews. SUBJECTS Six of 8 sites in the VISN 1 (Veterans Integrated Service Network) in New England were chosen, based on variation in organization and received e-consult volume. Seventy-three respondents, including 60 clinicians in primary care and 3 high-volume specialties (cardiology, pulmonology, and neurology) and 13 clinical leaders at the site and VISN level, were recruited. MEASURES Participants' perspectives on the role and impact of e-consults on communication and relationships between clinicians. RESULTS Clinicians identified 3 types of e-consults' social affordances: (1) e-consults were praised for allowing specialist advice to be more grounded in patient data and well-documented, but concerns about potential legal liability and increased transparency of communication to patients and others were also noted; (2) e-consults were perceived as an imperfect modality for iterative communication, especially for complex conversations requiring shared deliberation; (3) e-consults were understood as a factor influencing clinician relationships, but clinicians disagreed on whether e-consults promote or undermine relationship building. CONCLUSIONS Clinicians have diverse concerns about the implications of e-consults for communication and relationships. Our findings may inform efforts to expand and improve the use of e-consults in diverse health care settings.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Department of Population and Quantitative Health Sciences, Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester
| | - Varsha G. Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine
| | - Jay D. Orlander
- Medical Service, VA Boston Healthcare System
- Evans Department of Medicine, Boston University School of Medicine
| | - Sarah L. Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Department of Population and Quantitative Health Sciences, Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester
| | - Judith L. Strymish
- Medical Service and Section of Infectious Diseases, VA Boston Healthcare System, Boston
- Harvard Medical School, Cambridge
| | - Barbara G. Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester
| | - Seppo T. Rinne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, MA
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Russell AW, Adkins P, Hayes L, Prior E, McCormack C, DiGregorio J. Electronic consultations (eConsults): a proof of concept trial in Australia. Intern Med J 2021; 52:2150-2156. [PMID: 34432347 DOI: 10.1111/imj.15495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electronic consultations (eConsults) allows general practitioners (GPs) to seek the advice of a specialist via secure asynchronous digital communication. AIMS To report the outcomes of a proof of concept (POC) trial of eConsults for patients with diabetes and endocrine disorders. METHODS A prospective observational study conducted from Nov 2020 to May 2021. eConsults were provided by endocrinologists from the Princess Alexandra Hospital, Brisbane. The requests for advice were from GPs in Brisbane South. An online questionnaire was completed by the GP and endocrinologist after each eConsult. RESULTS Forty eConsults were performed over 7 months. The majority were in relation to type 2 diabetes (30%) or thyroid conditions (30%). All eConsult responses were performed within the target of 72 hours with 92.5% responses provided within 24 hrs. The average time taken for the endocrinologist to perform the eConsult was 14.2 ± 4.4 minutes. The GPs rated the value of eConsults as excellent 97% of the time. The eConsult resulted in a new or additional course of action 68% (19/28) of the time and confirmed a course of action 32% (9/28) of the time. The eConsult avoided the need for referral of the patient for a face-to-face specialist review in 55% of the eConsults. CONCLUSION An eConsult service was able to be delivered by endocrinologists from a tertiary hospital to GPs in Brisbane South. With an appropriate funding model, the broader implementation and adoption of eConsults has the potential to address specialist waiting lists and facilitate models of integrated care. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anthony W Russell
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba, Qld, Australia.,Centre for Health Services Research, University of Queensland, Brisbane, Qld, Australia
| | - Peter Adkins
- Brisbane South Primary Healthcare Network, Eight Mile Plains, Qld, Australia
| | - Lisa Hayes
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - Erin Prior
- Clinical Informatics, Metro South Health, Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - Christine McCormack
- Strategic Partnerships, Metro South Health, Eight Mile Plains, Qld, Australia
| | - John DiGregorio
- Clinical Informatics, Metro South Health, Princess Alexandra Hospital, Woolloongabba, Qld, Australia
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Anderson E, Rinne ST, Orlander JD, Cutrona SL, Strymish JL, Vimalananda VG. Electronic consultations and economies of scale: a qualitative study of clinician perspectives on scaling up e-consult delivery. J Am Med Inform Assoc 2021; 28:2165-2175. [PMID: 34338797 DOI: 10.1093/jamia/ocab139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/18/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore Veterans Health Administration clinicians' perspectives on the idea of redesigning electronic consultation (e-consult) delivery in line with a hub-and-spoke (centralized) model. MATERIALS AND METHODS We conducted a qualitative study in VA New England Healthcare System (VISN 1). Semi-structured phone interviews were conducted with 35 primary care providers and 38 specialty care providers, including 13 clinical leaders, at 6 VISN 1 sites varying in size, specialist availability, and e-consult volume. Interviews included exploration of the hub-and-spoke (centralized) e-consult model as a system redesign option. Qualitative content analysis procedures were applied to identify and describe salient categories. RESULTS Participants saw several potential benefits to scaling up e-consult delivery from a decentralized model to a hub-and-spoke model, including expanded access to specialist expertise and increased timeliness of e-consult responses. Concerns included differences in resource availability and management styles between sites, anticipated disruption to working relationships, lack of incentives for central e-consultants, dedicated staff's burnout and fatigue, technological challenges, and lack of motivation for change. DISCUSSION Based on a case study from one of the largest integrated healthcare systems in the United States, our work identifies novel concerns and offers insights for healthcare organizations contemplating a scale-up of their e-consult systems. CONCLUSIONS Scaling up e-consults in line with the hub-and-spoke model may help pave the way for a centralized and efficient approach to care delivery, but the success of this transformation will depend on healthcare systems' ability to evaluate and address barriers to leveraging economies of scale for e-consults.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jay D Orlander
- Medical Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Judith L Strymish
- Medical Service and Section of Infectious Diseases, VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Cambridge, Massachusetts, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA
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Gaye M, Mehrotra A, Byrnes-Enoch H, Chokshi D, Wallach A, Rodriguez L, Barnett ML. Association of eConsult Implementation With Access to Specialist Care in a Large Urban Safety-Net System. JAMA HEALTH FORUM 2021; 2:e210456. [PMID: 35977310 PMCID: PMC8796905 DOI: 10.1001/jamahealthforum.2021.0456] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/17/2021] [Indexed: 12/16/2022] Open
Abstract
Question What was the association of implementation of an eConsult program with access to specialty care in a large safety-net hospital system in the US? Findings In this study, 13% of submitted specialty referral requests were resolved electronically and, among requests requiring an in-person visit, appointment scheduling rates increased and wait times to an appointment decreased following eConsult implementation, while visit rates were unchanged. These improvements were mitigated during a hospital-level electronic health record transition. Meaning Wide-scale implementation of an eConsult program was associated with reduced wait times for patients in an urban safety-net health system with specialty care needs. Importance Accessing specialty care continues to be a persistent problem for patients who use safety-net health systems. To address this access barrier, hospital systems have begun to implement electronic referral systems using eConsults, which allow clinicians to submit referral requests to specialty clinics electronically and enable specialty reviewers to resolve referrals, if appropriate, through electronic dialogue without an in-person visit. Objective Measure the effect of implementing an eConsult program on access to specialty care. Design, Setting, and Participants Using an interrupted time series design with data from 2016 to 2020, this study analyzed 50 260 referral requests submitted during the year before and the year after eConsult implementation at 19 New York City Health + Hospitals (NYC H+H) specialty clinics that spanned 7 NYC H+H hospital facilities and 6 unique specialties. Exposures Referral request was submitted to a specialty clinic in the year following eConsult implementation. Main Outcomes and Measures Main outcomes included the fraction of referral requests resolved without an in-person visit following eConsult implementation; and, among requests triaged to have an in-person visit, the fraction of referrals with a successfully scheduled appointment, mean wait time to a specialty appointment, and the fraction of referral requests with a completed specialty visit. Changes associated with eConsult implementation were estimated using multivariate linear regression adjusting for patient age, gender, and specialty clinic fixed effects. Results Across 19 NYC H+H specialty clinics, 26 731 referral requests were submitted in the year before and 23 529 referrals were submitted in the year after eConsult implementation. Following eConsult implementation, 13% of all requests were resolved electronically. Among requests requiring a follow-up visit, the fraction with an appointment successfully scheduled increased by 15.8%, from 66.5% to 82.3% (P < .001). The mean time to an appointment decreased from 61.0 days pre-eConsult to 54.1 days post-eConsult, an adjusted 8.2-day shorter wait time (or 13.3% reduction) following eConsult adoption (P < .001). The percentage of referrals with a completed follow-up visit with a specialist within 90 days of the request did not change (38.4% vs 37.9%, P = .07). Changes in outcomes were mitigated during months when most clinics underwent an electronic health record transition after implementing eConsult. Conclusions and Relevance In this quality improvement study, implementation of eConsults at a large multi-specialty safety-net system was associated with improvements in appointment scheduling rates and wait times. Despite an additional electronic health record transition, eConsults are a promising health care delivery tool for increasing access to specialty care.
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Affiliation(s)
- Marema Gaye
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Dave Chokshi
- New York City Department of Health and Mental Hygiene, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Andrew Wallach
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
- Office of Ambulatory Care, New York City Health + Hospitals, New York, New York
| | - Laura Rodriguez
- Office of Ambulatory Care, New York City Health + Hospitals, New York, New York
| | - Michael L. Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Zorron Cheng Tao Pu L, Raval M, Terbah R, Singh G, Rajadurai A, Vaughan R, Efthymiou M, Chandran S. Video consultations during the coronavirus disease 2019 pandemic are associated with high satisfaction for both doctors and patients. JGH OPEN 2021; 5:542-548. [PMID: 34013052 PMCID: PMC8114984 DOI: 10.1002/jgh3.12547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
Abstract
Background and Aim Telehealth has become the standard of care during the COVID-19 outbreak. This study aimed to assess doctor and patient satisfaction of endoscopy-related telehealth clinics with video consultations. Methods A prospective observational study of patients consecutively booked to attend two endoscopy-related telehealth clinics at an ambulatory tertiary care setting was conducted from July to October 2020. Data collected from our previously published study using phone consultations (data collected in April-May 2020) were used as a control arm. The primary outcome (satisfaction) was assessed through the six-question score (6Q_score) as per previous research. Secondary outcomes included failure-to-attend (FTA) rate and perceived necessity of physical examination/in-person follow-up appointment. Results There were 962 endoscopy clinic appointments between July and October, of which 157 were conducted through video. Data on 127 doctor questionnaires and 94 patient questionnaires were analyzed. The median age (years) of patients reviewed via video [57, interquartile range (IQR) 48-66] was lower than those reviewed via phone (65, IQR 55-74, P < 0.01). Patient average 6Q_score was higher with video compared to phone (85.1% vs 78.4%, P = 0.01), as was doctors' 6Q_score (97.5% vs 91.9%, P = 0.02). FTA rates remained similar between the two assessments (6.4% in April/May and 4.4% between July/October, P = 0.12). The requirement for in-person follow-up/physical examination was identified in two video consultations (1.6%). Conclusion Video consultations during the COVID-19 outbreak demonstrated higher patient and doctor satisfaction compared to phone consultations. There was no significant difference in FTA rates and need for in-person follow-up consultations/physical examination between the telehealth two modalities.
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Affiliation(s)
| | - Manjri Raval
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
| | - Ryma Terbah
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
- University of Melbourne, ParkvilleMelbourneVictoriaAustralia
| | - Gurpreet Singh
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
| | - Anton Rajadurai
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
| | - Rhys Vaughan
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
- University of Melbourne, ParkvilleMelbourneVictoriaAustralia
| | - Marios Efthymiou
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
- University of Melbourne, ParkvilleMelbourneVictoriaAustralia
| | - Sujievvan Chandran
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
- University of Melbourne, ParkvilleMelbourneVictoriaAustralia
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44
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Corbetta-Rastelli CM, Morgan TK, Homaifar N, Deangelis L, Autry AM. Experiences in Electronic Consultation (eConsult) Service in Gynecology from a Quaternary Academic Medical Center. J Med Syst 2021; 45:58. [PMID: 33825075 PMCID: PMC8023771 DOI: 10.1007/s10916-021-01732-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/16/2021] [Indexed: 12/02/2022]
Abstract
To evaluate an academic institution’s implementation of a gynecologic electronic consultation (eConsult) service, including the most common queries, turnaround time, need for conversion to in-person visits, and to demonstrate how eConsults can improve access and convenience for patients and providers. This is a descriptive and retrospective electronic chart review. We obtained data from the UCSF eConsult and Smart Referral program manager. The medical system provided institution-wide statistics. Three authors reviewed and categorized gynecologic eConsults for the last fiscal year. The senior author resolved conflicts in coding. The eConsult program manager provided billing information and provider reimbursement. A total of 548 eConsults were submitted to the gynecology service between July 2017 and June 2020 (4.5% of institutional eConsult volume). Ninety-five percent of the eConsults were completed by a senior specialist within our department. Abnormal pap smear management, abnormal uterine bleeding, and contraception questions were the most common queries. Over half (59.3%) of all inquiries were answered on the same day as they were received, with an average of 9% declined. Gynecology was the 10th largest eConsult provider at our institution in 2020. The present investigation describes one large university-based experience with eConsults in gynecology. Results demonstrate that eConsults permit appropriate, efficient triaging of time-sensitive conditions affecting patients especially in the time of the COVID-19 pandemic. eConsult services provide the potential to improve access, interdisciplinary communication, and patient and provider satisfaction.
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Affiliation(s)
- Chiara M Corbetta-Rastelli
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 480 16th Street, 10th Floor, San Francisco, CA, 94158, USA.
| | - Tamandra K Morgan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 480 16th Street, 10th Floor, San Francisco, CA, 94158, USA
| | - Nazaneen Homaifar
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 480 16th Street, 10th Floor, San Francisco, CA, 94158, USA
| | - Lisa Deangelis
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 480 16th Street, 10th Floor, San Francisco, CA, 94158, USA
| | - Amy M Autry
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 480 16th Street, 10th Floor, San Francisco, CA, 94158, USA
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45
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Finucane AM, O'Donnell H, Lugton J, Gibson-Watt T, Swenson C, Pagliari C. Digital health interventions in palliative care: a systematic meta-review. NPJ Digit Med 2021; 4:64. [PMID: 33824407 PMCID: PMC8024379 DOI: 10.1038/s41746-021-00430-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/25/2021] [Indexed: 02/07/2023] Open
Abstract
Digital health interventions (DHIs) have the potential to improve the accessibility and effectiveness of palliative care but heterogeneity amongst existing systematic reviews presents a challenge for evidence synthesis. This meta-review applied a structured search of ten databases from 2006 to 2020, revealing 21 relevant systematic reviews, encompassing 332 publications. Interventions delivered via videoconferencing (17%), electronic healthcare records (16%) and phone (13%) were most frequently described in studies within reviews. DHIs were typically used in palliative care for education (20%), symptom management (15%), decision-making (13%), information provision or management (13%) and communication (9%). Across all reviews, mostly positive impacts were reported on education, information sharing, decision-making, communication and costs. Impacts on quality of life and physical and psychological symptoms were inconclusive. Applying AMSTAR 2 criteria, most reviews were judged as low quality as they lacked a protocol or did not consider risk of bias, so findings need to be interpreted with caution.
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Affiliation(s)
- Anne M Finucane
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK. .,Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK.
| | - Hannah O'Donnell
- The Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Jean Lugton
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
| | - Tilly Gibson-Watt
- Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Claudia Pagliari
- The Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
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46
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Zorron Cheng Tao Pu L, Singh G, Rajadurai A, Terbah R, De Silva R, Vaughan R, Efthymiou M, Chandran S. Benefits of phone consultation for endoscopy-related clinics in the COVID-19 pandemic. J Gastroenterol Hepatol 2021; 36:1064-1080. [PMID: 33037824 PMCID: PMC7675268 DOI: 10.1111/jgh.15292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM During COVID-19 outbreak, restrictions to in-person consultations were introduced with a rise in telehealth. An indirect benefit of telehealth could be better attendance. This study aimed to assess "failure-to-attend" (FTA) rate and satisfaction for two endoscopy-related compulsory telehealth clinics during the COVID-19 outbreak. METHODS Consecutive patients booked for endoscopy-related telehealth clinics at a tertiary hospital were prospectively assessed. In-person clinic control data were assessed retrospectively. Sample size was calculated to detect an anticipated increase in attendance of 8%. Secondary outcomes included FTA differences between clinics and evaluation of patients and doctors satisfaction. Satisfaction was assessed based on six Likert scale questions used in previous telehealth research and asked to both patients and doctors (6Q_score). This study was exempt from IRB review after institutional IRB review. RESULTS There were 691 patients booked for appointments in our endoscopy clinics during the study periods (373 in 2020). FTA rates were lowered by half during the compulsory telehealth clinics (12.6% to 6.4%, P < 0.01). The patient 6Q_score was higher for the advanced endoscopy clinic (84.6% vs 73.8%, P < 0.01), while the doctor 6Q_score was similar between both advanced clinics and post endoscopy clinics (91.1% vs 92.5% respectively, P = 0.80). An in-person follow-up consultation was suggested for 3.5% of the appointments, while the necessity of physical examination was flagged in 5.1%. CONCLUSIONS The use of phone consultations in endoscopy-related clinics during the COVID-19 outbreak has improved FTA rates while demonstrating high satisfaction rates. The need for in-person follow-up consultations and physical examination were low.
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Affiliation(s)
| | - Gurpreet Singh
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia
| | - Anton Rajadurai
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia
| | - Ryma Terbah
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia
| | - Rahil De Silva
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia
| | - Rhys Vaughan
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia,University of MelbourneParkville, MelbourneVictoriaAustralia
| | - Marios Efthymiou
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia,University of MelbourneParkville, MelbourneVictoriaAustralia
| | - Sujievvan Chandran
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia,University of MelbourneParkville, MelbourneVictoriaAustralia
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Milakovic M, Corrado AM, Tadrous M, Nguyen ME, Vuong S, Ivers NM. Effects of a single-entry intake system on access to outpatient visits to specialist physicians and allied health professionals: a systematic review. CMAJ Open 2021; 9:E413-E423. [PMID: 33863800 PMCID: PMC8084550 DOI: 10.9778/cmajo.20200067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Canada lags behind other countries with respect to wait times for specialist physician and allied health professional consultations. We conducted a systematic review to assess the effects of a single-entry model on waiting time, referral volume and the satisfaction of patients and health care providers. METHODS We searched MEDLINE, Embase, Cochrane CENTRAL and CINAHL databases from inception to December 2019. We included studies from countries in the Organisation for Economic Co-operation and Development that reported on the effects of a single-entry model on the time between referral to first assessment by a specialist physician or allied health professional, termed wait time 1 (WT1). Patient volume and the satisfaction of providers and patients were secondary outcomes. We conducted a narrative synthesis using descriptive statistics. RESULTS Of the 4637 citations identified, 17 met the eligibility criteria, and we included 10 of these in the final analysis. All of the included studies reported an absolute reduction in WT1 after implementation of the single-entry model. The average percent reduction in WT1 across specialties was greatest for surgical referrals (57%) and urgent internal medicine referrals (40%). Higher initial WT1 was associated with a greater absolute reduction in WT1 after implementation of the single-entry model (p = 0.002). Patient and provider satisfaction with the single-entry model was high in all studies. The effect estimates from all included studies were at high risk of bias. INTERPRETATION Single-entry models were associated with an absolute reduction in time from referral from primary care to consultation. These models represent a promising option to improve access to a range of health services, but there is a need for rigorous prospective evaluations to inform policy. PROSPERO REGISTRATION CRD42018100395.
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Affiliation(s)
- Milica Milakovic
- Faculty of Medicine (Milakovic), Leslie Dan Faculty of Pharmacy (Tadrous), Department of Family and Community Medicine (Ivers) and Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado) and Women's College Research Institute (Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Faculty of Medicine (Nguyen), Western University, London, Ont.; Faculty of Medicine (Vuong), University of Queensland, Brisbane, Australia
| | - Ann Marie Corrado
- Faculty of Medicine (Milakovic), Leslie Dan Faculty of Pharmacy (Tadrous), Department of Family and Community Medicine (Ivers) and Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado) and Women's College Research Institute (Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Faculty of Medicine (Nguyen), Western University, London, Ont.; Faculty of Medicine (Vuong), University of Queensland, Brisbane, Australia
| | - Mina Tadrous
- Faculty of Medicine (Milakovic), Leslie Dan Faculty of Pharmacy (Tadrous), Department of Family and Community Medicine (Ivers) and Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado) and Women's College Research Institute (Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Faculty of Medicine (Nguyen), Western University, London, Ont.; Faculty of Medicine (Vuong), University of Queensland, Brisbane, Australia
| | - Mary E Nguyen
- Faculty of Medicine (Milakovic), Leslie Dan Faculty of Pharmacy (Tadrous), Department of Family and Community Medicine (Ivers) and Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado) and Women's College Research Institute (Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Faculty of Medicine (Nguyen), Western University, London, Ont.; Faculty of Medicine (Vuong), University of Queensland, Brisbane, Australia
| | - Sandra Vuong
- Faculty of Medicine (Milakovic), Leslie Dan Faculty of Pharmacy (Tadrous), Department of Family and Community Medicine (Ivers) and Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado) and Women's College Research Institute (Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Faculty of Medicine (Nguyen), Western University, London, Ont.; Faculty of Medicine (Vuong), University of Queensland, Brisbane, Australia
| | - Noah M Ivers
- Faculty of Medicine (Milakovic), Leslie Dan Faculty of Pharmacy (Tadrous), Department of Family and Community Medicine (Ivers) and Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado) and Women's College Research Institute (Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Faculty of Medicine (Nguyen), Western University, London, Ont.; Faculty of Medicine (Vuong), University of Queensland, Brisbane, Australia
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Yoon SS, Wong DH, Wormwood JB, Reisman JI, Vimalananda VG. Impact of Electronic Consultation on Timeliness and Guideline Concordance of Workups Leading to Thyroid Nodule Fine-Needle Aspiration Biopsy. Endocr Pract 2021; 27:1011-1016. [PMID: 33766654 DOI: 10.1016/j.eprac.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Electronic consultations (e-consults) are commonly used to obtain endocrinology input on clinical questions without a face-to-face visit, but sparse data exist on the resultant quality of care for specific conditions. We examined workups resulting in a thyroid nodule fine-needle aspiration (FNA) biopsy to investigate whether endocrinology e-consults were more timely and similarly guideline-concordant compared with endocrinology face-to-face visits and whether endocrinology e-consults were more guideline-concordant compared with workups without endocrinology input. METHODS We retrospectively reviewed charts of 302 thyroid FNA biopsies conducted in the Veterans Affairs health system between May 1, 2017, and February 4, 2020 (e-consult, n = 99; face-to-face visit, n = 100; no endocrinology input, n = 103). We used t tests to compare timeliness, χ2 tests to compare the proportion of guideline-concordant workups, and multivariable linear and logistic models to control for demographic factors. RESULTS FNAs preceded by an endocrinology e-consult had more timely workups compared with those preceded by endocrinology face-to-face visits in terms of days elapsed between referral and FNA biopsy (geometric mean 44.7 days vs 61.7 days, P = .01). The difference in the summary measure of guideline concordance across groups was not statistically significant (P =.38). CONCLUSION E-consults were faster than face-to-face consults and similarly guideline-concordant compared with both face-to-face consults and no endocrinology input for workups resulting in FNA. Decisions about the appropriate use of e-consults for thyroid nodules should take into account these data while also considering the potential benefits of direct patient-endocrinologist interaction for complex situations.
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Affiliation(s)
- Samuel S Yoon
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts; Advocate Aurora Health, Division of Endocrinology, Diabetes, and Metabolism, Aurora Wilkinson Medical Clinic, Hartland, Wisconsin.
| | - Denise H Wong
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts; Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, Massachusetts
| | - Jolie B Wormwood
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts; Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | - Joel I Reisman
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts; Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, Massachusetts
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Porto A, Rubin K, Wagner K, Chang W, Macri G, Anderson D. Impact of Pediatric Electronic Consultations in a Federally Qualified Health Center. Telemed J E Health 2021; 27:1379-1384. [PMID: 33719584 DOI: 10.1089/tmj.2020.0394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Access to pediatric specialty care is a challenge, particularly for medically underserved populations. Introduction: One evolving method that has shown promise in helping ameliorate this disparity is electronic consultations (e-consults). Materials and Methods: This retrospective cohort study compared two groups: patients referred to pediatric cardiology, endocrinology, or pulmonology from a Federally-Qualified Health Center 10 months before the implementation of an evidence-based care pathway and those referred in the 10 months after implementation. The care pathway included evidence-based referral guidelines for common pediatric diagnoses and an e-consult process. Data included patient demographics, dates of referral requests, appointment dates, e-consult response dates and times, diagnosis codes, and consultants' recommendations. Results: Twenty-three percent of all referrals made postimplementation were submitted for an e-consult, with 53% preventing an unnecessary face-to-face visit. The most common reason for an e-consult was heart murmur/chest pain for cardiology, short stature for endocrinology, and asthma for pulmonology. Discussion: Providers used e-consults for nearly one-quarter of all consultations postimplementation, resulting in 17% of consultations not needing a face-to-face visit. The use of e-consults combined with evidence-based referral guidelines provided a useful tool to help front line pediatric primary care providers manage complex problems and identify those not needing to see a specialist in person. Conclusions: Evidence-based care pathways combined with e-consults can help improve access to pediatric specialty care by reducing demand for in-person visits and allowing more care to be delivered in primary care.
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Affiliation(s)
| | - Karen Rubin
- UConn School of Medicine, Farmington, Connecticut, USA.,Connecticut Children's Medical Center, Center for Innovation, Hartford, Connecticut, USA
| | | | - Wei Chang
- Weitzman Institute, Middletown, Connecticut, USA
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Bock NW, Wouters H, Lammers AJ, Blanker MH. Online Consultations Between General Practitioners and Psychiatrists in the Netherlands: A Qualitative Study. Front Psychiatry 2021; 12:775738. [PMID: 34803781 PMCID: PMC8600358 DOI: 10.3389/fpsyt.2021.775738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To examine the nature and scope of questions about psychiatric patient cases submitted by general practitioners (GPs) to an established online consultation platform and to determine if they could have been answered by consulting existing clinical guidelines. Methods: All anonymized psychiatric cases submitted by GPs to the online electronic Prisma platform between September 2018 and November 2019 were examined in a mixed-methods study. Descriptive statistics and qualitative thematic analysis were used, followed by axial coding to arrive at overarching themes to characterize cases. Results: Of the 136 included cases, 44.1% concerned female patients and about half concerned patients aged 31-60 years. Common psychiatric disorders were depression, attention deficit hyperactivity disorder, sleeping problems, sexual disorders, and eating disorders. The first response was usually given within 2 h (interquartile range, 0-14.3 h), with 86% answered within 24 h and 95% within 48 h. Qualitative analysis revealed four themes, namely "type of question," "cases in relation to current clinical guidelines," "case complexity" and "the doctor being pressured." Type of question comprised diagnostic, therapeutic, and referral questions. Notably, for 44.1% of questions no current clinical guidelines was present and 46.3% of cases were deemed complex in nature. GPs were willing to share their experiences of coping with being pressured by patients. Conclusion: The findings of this study support the potential for an online electronic consultation platform to facilitate feasible and useful interprofessional consultation between GPs and psychiatrists for a broad range mental illnesses and questions of varying complexity.
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Affiliation(s)
- Nynke W Bock
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, Netherlands
| | - Hans Wouters
- General Practitioners Research Institute, Groningen, Netherlands
| | - Anne J Lammers
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, Netherlands
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, Netherlands
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