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Hakimjavadi R, Karunananthan S, Levi C, LeBlanc K, Guglani S, Helmer-Smith M, Keely E, Liddy C. Electronic consultation use by advanced practice nurses in older adult care-A descriptive study of service utilization data. Nurs Open 2023; 10:2240-2248. [PMID: 36373892 PMCID: PMC10006590 DOI: 10.1002/nop2.1476] [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: 08/03/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
AIMS AND OBJECTIVES To describe characteristics of service utilization by advanced practice nurses (APNs) employing an electronic consultation (eConsult) service in their care for older adults. BACKGROUND Canada's aging population is projected to place unprecedented demands on the healthcare system. APNs, which include clinical nurse specialists (CNSs) and nurse practitioners (NPs), are nurses with advanced knowledge who can independently provide age-appropriate care. eConsult is a secure web-based platform enabling asynchronous, provider-to-provider communication. APNs can send and receive eConsults to address patient-specific concerns. METHODS This is a retrospective analysis of eConsult utilization and user survey data for cases completed in 2019, reported in line with the STROBE guidelines. Eligible eConsults included those that had APN involvement (as a referrer or responder) and were concerning an older patient (≥65 years). Descriptive statistics were used to analyse service utilization and survey response data. RESULTS Of 430 eligible eConsults, 421 (97.9%) were initiated by NPs and the rest by physicians. 23 (5.3%) were received by a CNS, of which 14 (3.3%) involved an NP-to-CNS exchange. Median specialist response interval was 0.9 days. 53% of eConsults was for dermatology, haematology, cardiology, gastroenterology and endocrinology. 73% of eConsults avoided a face-to-face referral after the consultation. In 90% of eConsults, APNs rated the service as helpful and/or educational. CONCLUSIONS Through eConsult, APNs can collaborate with each other and physicians to access and provide a breadth of advice facilitating timely specialist-informed care for older patients, thus helping to alleviate some of the demands placed on the healthcare system. RELEVANCE TO CLINICAL PRACTICE There is an opportunity for APNs to further adopt eConsult into their clinical practice, and this can, in turn, support the integration of the APN role in the health workforce. PATIENT OR PUBLIC CONTRIBUTION Current APN eConsult users were involved in the study design and interpretation of results.
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Affiliation(s)
- Ramtin Hakimjavadi
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Sathya Karunananthan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.,Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Cheryl Levi
- Emergency Department Outreach Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kimberly LeBlanc
- Nurses Specialized in Wound, Ostomy, and Continence, Ottawa, Ontario, Canada.,Advanced Practice Nurse (Wound, Ostomy, and Continence), KDS Professional Consulting, Ottawa, Ontario, Canada
| | - Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Mary Helmer-Smith
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada.,eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.,eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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2
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Grant R, McMurtry A, Archibald D. Mapping Health Professions Education: Using Complexity Science to Make Sense of Learning Through Electronic Consultations. MEDICAL SCIENCE EDUCATOR 2023; 33:233-242. [PMID: 37008438 PMCID: PMC10060472 DOI: 10.1007/s40670-023-01730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 06/19/2023]
Abstract
Phenomena studied within health professions education are often complex and multifaceted. This article describes a complexity science-informed theoretical framework that was developed for exploring how electronic consultations support learning among primary care providers, as well as within the larger organizations or systems in which they practice. This framework enables researchers to investigate learning occurring simultaneously at multiple levels (including individuals and social groups), without simplistically conflating levels or theories. The various levels of learning and associated theories are illustrated using examples from electronic consultations. This complexity science-inspired framework can be used for studying learning in complex, multilayered systems.
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Affiliation(s)
- Rachel Grant
- Faculty of Education, University of Ottawa, Ottawa, ON Canada
| | - Angus McMurtry
- Faculty of Education, University of Ottawa, Ottawa, ON Canada
| | - Douglas Archibald
- Faculty of Education, University of Ottawa, Ottawa, ON Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
- Bruyère Research Institute, Ottawa, ON Canada
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3
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Carroll JC, Liddy C, Afkham A, Keely E, Goh ES, Graham GE, Permaul JA, Allanson J, Heisey R, Makuwaza T, Manca DP, O'Brien MA, Grunfeld E. Use of eConsult to enhance genetics service delivery in primary care: A multimethod study. Genet Med 2022; 24:2034-2041. [PMID: 35947109 DOI: 10.1016/j.gim.2022.07.003] [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: 03/03/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE Electronic consultation (eConsult) is a freely-available secure online platform connecting primary care providers (PCPs) to geneticists. Our purpose was to determine whether eConsult is effective in improving genetics service delivery in primary care. METHODS PCP questionnaires regarding eConsult's utility, geneticists' tracking form assessments of eConsult type and appropriateness, and geneticists' interviews on implementing eConsult were carried out. RESULTS In 2 regions of Ontario, Canada, from January 2019 to June 2020, there were 305 genetics eConsults. For 169 (55%), PCPs indicated receiving good advice for a new course of action; for 110 (36%), referral was now avoided; and for 261 (86%), eConsult was perceived valuable for patient management. Of the 131 geneticist-completed tracking forms, cancer questions were most common (68, 52%). For 63 (48%), geneticists disagreed/strongly disagreed PCPs should know the answer to the referral question. From the interview data, it was observed that geneticists described eConsult positively and suggested how it might improve access and efficiencies if integrated into genetic service delivery. Dealing with eConsults virtually could reduce waitlists, and suggesting appropriate investigations for PCPs could improve efficiencies. CONCLUSION eConsult offers a potential solution for receiving timely genetics advice and avoiding unnecessary patient referrals, however, greater effect on access and wait times will need systematic integration into PCP and geneticist practice.
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Affiliation(s)
- June C Carroll
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Ontario, Canada.
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ontario, Canada; Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amir Afkham
- Ontario Health East, Ottawa, Ontario, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Endocrinology & Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada
| | - Elaine S Goh
- Laboratory Medicine and Genetics and Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Department of Laboratory Medicine & Pathobiology, University of Toronto, Ontario, Canada
| | - Gail E Graham
- Department of Pediatrics, University of Ottawa, Ontario, Canada; Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Joanne A Permaul
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Judith Allanson
- Department of Pediatrics, University of Ottawa, Ontario, Canada; Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ruth Heisey
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada; Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Tutsirai Makuwaza
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Donna P Manca
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mary Ann O'Brien
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada
| | - Eva Grunfeld
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Yilmaz Y, Papanagnou D, Fornari A, Chan TM. Just-in-Time Continuing Education: Perceived and Unperceived, Pull and Push Taxonomy. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:125-129. [PMID: 34966109 DOI: 10.1097/ceh.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABSTRACT We live in a world where "just-in-time" (JiT) methodologies are increasingly used. Continuing professional development (CPD), including faculty development, has the opportunity to leverage online technologies in a JiT format to further support learner engagement and program sustainability. In this article, the authors propose a model that can serve as a taxonomy for defining and implementing JiT continuing education (JiTCE). The anatomy of JiTCE describes four mechanisms to address CPD needs and delivery procedures: perceived and unperceived, as well as pull and push (PUPP) taxonomy. JiTCE PUPP taxonomy defines four components for designing and developing a program with JiT: on-demand learning, subscription-based learning, performance feedback-driven learning, and data-driven learning. These methods, as backbones, use various online technologies, which offer fundamental support for JiTCE. Delivery systems and technologies are provided as specific examples for JiTCE throughout the article. JiTCE introduces a novel taxonomy to meet continuing education needs and provides an organized approach to design and deploy programming in a sustainable way. Online technologies are evolving everyday and are an indispensable part of both clinical practice and medical education. Pull-push and perceived-unperceived axes can help guide new opportunities for instructional designers and curriculum developers to leverage best practices to align with CPD offerings, which include cutting-edge technologies.
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Affiliation(s)
- Yusuf Yilmaz
- Dr. Yilmaz: Postdoctoral Fellow, McMaster University Education Research, Innovation and Theory (MERIT) Program, Hamilton, Ontario, Canada, Postdoctoral Fellow, McMaster University Office of Continuing Professional Development, Hamilton, Ontario, Canada, and Researcher and Instructor, Department of Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey. Dr. Papanagnou: Professor and Vice Chair of Education, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Associate Provost for Faculty Development, Thomas Jefferson University, Philadelphia, PA. Dr. Fornari: Professor Science Education, Family Medicine, Occupational Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY. Dr. Chan: Associate Professor, Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada, Associate Dean, Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, and Clinician Scientist, McMaster Education Research, Innovation, and Theory (MERIT) Program, Hamilton, Ontario, Canada
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Luconi F, Montoro R, Lalla L, Teferra M. An Innovative Needs Assessment Approach to Develop Relevant Continuing Professional Development for Psychiatrists. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:106-113. [PMID: 34846721 PMCID: PMC8630991 DOI: 10.1007/s40596-021-01564-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/08/2021] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Gaps in psychiatrists' competence can interfere with the delivery of optimal patient care, particularly when these gaps have not been identified. This study aimed to assess the perceived and unperceived continuing professional development needs of psychiatrists practicing in Quebec, Canada. METHODS The authors sent an online cross-sectional survey (2018) to members of the 'Association des médecins psychiatres du Québec' and collected data on unperceived needs via the critical incident method (focused on managing challenging clinical cases/situations). Data were analyzed using descriptive statistics, chi-squared tests, thematic analysis, and triangulation of data. Two coders independently analyzed qualitative data. RESULTS Of 1150 eligible psychiatrists, 187 (16%) completed the survey. Over half were female (58%), caring for adult patients (60%), and practiced in a university hospital (49%). Top perceived and unperceived learning need areas were neurodevelopmental disorders and psychopharmacology. Three hundred forty-three factors influencing the management of reported challenges were classified as case complexity (53%), patient (22%), environment (19%), and lack of knowledge (4%). Consultation with colleagues (49%) was the most frequently accessed resource for approaching challenging cases. During the previous year and across both self-directed and group learning activities, respondents reported engaging more frequently in in-person than online activities. CONCLUSIONS A comprehensive needs assessment integrating perceived and unperceived needs is the cornerstone for planning relevant continuing professional development. The critical incident method is a useful tool to assess psychiatrists' unperceived needs. Critical reflection after solving complex clinical cases might provide an opportunity to optimize psychiatrists' selection of relevant continuing professional development.
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Affiliation(s)
- Francesca Luconi
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Richard Montoro
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Leonora Lalla
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Meron Teferra
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
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Fung C, Shah S, Helmer-Smith M, Levi C, Keely E, Liddy C. Clinical Questions Asked by Long-Term Care Providers Through eConsult: A Retrospective Study. Gerontol Geriatr Med 2021; 7:23337214211032055. [PMID: 34471649 PMCID: PMC8404619 DOI: 10.1177/23337214211032055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 02/02/2023] Open
Abstract
Introduction eConsult allows primary care providers (PCPs) to access timely specialist advice and informs patient care. To understand the use of eConsult in long-term care (LTC) settings, we examined the clinical content and types of questions asked by LTC PCPs. Methods A descriptive, retrospective study of eConsults submitted through the Champlain BASE™ eConsult Service between January 1, 2017, and December 31, 2018, by LTC PCPs was conducted. Cases were classified using validated taxonomies. Descriptive statistics were generated for content and question type classifications, service utilization data, and close-out survey responses. Results 22 LTC PCPs submitted 113 eConsults. They sought advice about drug treatment (58%), diagnosis (44%), and management (38%) in a breadth of clinical areas, often skin-related (39%). Long-term care PCPs frequently asked more than one question type (42%). They received advice within 1 week (91%) and rated eConsult as very helpful and educational. Three case examples are presented. Conclusion This study demonstrates the type of advice LTC PCPs are seeking through eConsult and its usefulness in this setting. Long-term care stakeholders are encouraged to consider implementing eConsult in other regions, as a means to improve access to timely specialist advice, support clinical decision-making, and improve residents’ quality of life.
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Affiliation(s)
- Celeste Fung
- St. Patrick's Home of Ottawa, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada
| | - Soha Shah
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mary Helmer-Smith
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Cheryl Levi
- Emergency Department Outreach Program, The Ottawa Hospital, Ottawa, ON, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, ON, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
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Singh J, Lou A, Green M, Keely E, Greenaway M, Liddy C. Evaluation of an electronic consultation service for transgender care. BMC FAMILY PRACTICE 2021; 22:55. [PMID: 33743596 PMCID: PMC7980551 DOI: 10.1186/s12875-021-01401-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Access to transgender care in Canada is poor. Although primary care providers are ideally positioned to initiate care, many feel uncomfortable providing transgender care. This study aimed to explore the impact of an electronic consultation (eConsult) service between primary care providers and transgender care specialists on access to care and to explore the content of clinical questions that were asked. METHODS This was a retrospective mixed methods analysis of 62 eConsults submitted between January 2017 and December 2018 by primary care providers to specialists in transgender care in a health region in eastern Ontario, Canada. A descriptive analysis was conducted to assess the average response time and the total time spent by the specialist for the eConsults. An inductive and deductive content analysis was carried out to identify common themes of clinical questions being asked to transgender specialists. A post-eConsult survey completed by primary care providers was assessed to gain insight into avoided face-to-face referrals and overall provider satisfaction. RESULTS The median specialist response time was 1.2 days (range: 1 h to 5 days) and the average time spent by specialists per eConsult was 18 min (range: 10 to 40 min). The qualitative analysis identified six major themes: 1) interpretation/management of abnormal bloodwork, 2) change in management due to lack of desired effect/hormone levels not a target, 3) initiation of hormone therapy/initial work up, 4) management of adverse effects of hormone therapy, 5) transition related surgery counseling and post-op complications, and 6) management of patients with comorbidities. Approximately one-third of eConsults resulted in an avoided face-to-face referral and 95% of primary care providers rated the value of their eConsult as a 5 (excellent value) or 4. CONCLUSIONS This study demonstrated that a transgender eConsult service has potential to significantly improve access to care for transgender patients. Given the importance that timely access has on improving mental health and reducing suicide attempts, eConsult has the potential to make a substantial clinical impact on this population. Identified themes of eConsult questions provides insight into potential gaps in knowledge amongst primary care providers that could help inform future continuing education events.
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Affiliation(s)
- Jatinderpreet Singh
- Department of Family Medicine, Queen's University, Kingston, ON, Canada. .,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.
| | | | - Michael Green
- Department of Family Medicine, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
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Plotzker RE, Hauschild BC, Kelley D, Blakley LA, Park IU. Knowing What We Do Not Know: Analysis of an Online Consultation Service to Identify Provider Knowledge Gaps in Sexually Transmitted Disease Care. Sex Transm Dis 2021; 48:e1-e4. [PMID: 32649580 DOI: 10.1097/olq.0000000000001233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The national Sexually Transmitted Diseases (STD) Clinical Consultation Network receives requests regarding complex STD cases. A total of 927 requests from Western states, 2017 to 2019, were analyzed for STD of inquiry and syphilis-specific subtopics. Syphilis requests accounted for most queries, and the number and proportion of syphilis-related requests increased significantly over time.
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Affiliation(s)
| | - Benjamin C Hauschild
- Denver Prevention Training Center, National Network of STD Clinical Prevention Training Centers, National Coordination Center, Denver, CO
| | - Destiny Kelley
- Denver Prevention Training Center, National Network of STD Clinical Prevention Training Centers, National Coordination Center, Denver, CO
| | - Lauren A Blakley
- From the California Prevention Training Center, University of California San Francisco, Bixby Center for Global Reproductive Health, San Francisco, CA
| | - Ina U Park
- From the California Prevention Training Center, University of California San Francisco, Bixby Center for Global Reproductive Health, San Francisco, CA
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Muscat DM, Patel P, Reid S, Hoffmann T, Albarqouni L, Trevena L. Content analysis of clinical questions from Australian general practice which are prioritised for answering: identifying common question types and perceived knowledge gaps. BMJ Evid Based Med 2020; 25:15-21. [PMID: 31235528 PMCID: PMC7029252 DOI: 10.1136/bmjebm-2019-111210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2019] [Indexed: 12/29/2022]
Abstract
Perceived knowledge gaps in general practice are not well documented but must be understood to ensure relevant and timely evidence for busy general practitioners (GPs) which reflects their diverse and changing needs. The aim of this study was to classify the types of questions submitted by Australian GPs to an evidence-based practice information service using established and inductive coding systems. We analysed 126 clinical questions submitted by 53 Australian GPs over a 1.5-year period. Questions were coded using the International Classification of Primary Care (ICPC-2 PLUS) and Ely and colleagues' generic questions taxonomy by two independent coders. Inductive qualitative content analysis was also used to identify perceived knowledge gaps. Treatment (71%), diagnosis (15%) and epidemiology (9%) were the most common categories of questions. Using the ICPC-2 classification, questions were most commonly coded to the endocrine/metabolic and nutritional chapter heading, followed by general and unspecified, digestive and musculoskeletal. Seventy per cent of all questions related to the need to stay up-to-date with the evidence, or be informed about new tests or treatments (including complementary and alternative therapies). These findings suggest that current guideline formats for common clinical problems may not meet the knowledge demands of GPs and there is gap in access to evidence updates on new tests, treatments and complementary and alternative therapies. Better systems for 'pulling' real-time questions from GPs could better inform the 'push' of more relevant and timely evidence for use in the clinical encounter.
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Affiliation(s)
- Danielle Marie Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- ASK-GP Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Pinika Patel
- ASK-GP Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sharon Reid
- ASK-GP Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tammy Hoffmann
- ASK-GP Centre for Research Excellence, Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Loai Albarqouni
- ASK-GP Centre for Research Excellence, Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Lyndal Trevena
- ASK-GP Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Armson H, Perrier L, Roder S, Shommu NS, Wakefield J, Shaw E, Zahorka S, Elmslie T, Lofft M. Assessing Unperceived Learning Needs in Continuing Medical Education for Primary Care Physicians: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:257-267. [PMID: 33284177 DOI: 10.1097/ceh.0000000000000300] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Assessing needs before developing continuing medical education/continuing professional development (CME/CPD) programs is a crucial step in the education process. A previous systematic literature review described a lack of objective evaluation for learning needs assessments in primary care physicians. This scoping review updates the literature on uses of objective evaluations to assess physicians' unperceived learning needs in CME/CPD. Identifying and understanding these approaches can inform the development of educational programs that are relevant to clinical practice and patient care. The study objectives were to (1) scope the literature since the last systematic review published in 1999; (2) conduct a comprehensive search for studies and reports that explore innovative tools and approaches to identify physicians' unperceived learning needs; (3) summarize, compare, and classify the identified approaches; and (4) map any gaps in the literature to identify future areas of research. METHODS A scoping review was used to "map" the literature on current knowledge regarding approaches to unperceived needs assessment using conceptual frameworks for planning and assessing CME/CPD activities. RESULTS Two prominent gaps were identified: (1) performance-based assessment strategies are highly recommended in nonresearch articles yet have low levels of implementation in published studies and (2) analysis of secondary data through patient input or environmental scanning is emphasized in grey literature implementation strategies more so than in peer-reviewed theoretical and research articles. DISCUSSION Future evaluations should continue to incorporate multiple strategies and focus on making unperceived needs assessments actionable by describing strategies for resource management.
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Affiliation(s)
- Heather Armson
- Dr. Armson: Assistant Dean, Continuing Medical Education and Professional Development and Professor, Department of Family Medicine, University of Calgary; Research Director, The Foundation for Medical Practice Education, McMaster University. Dr. Perrier: Research Data Management Librarian, University of Toronto Libraries, University of Toronto. Dr. Roder: Research Program Coordinator, The Foundation for Medical Practice Education, McMaster University. Dr. Shommu: Research Coordinator, Department of Medicine, Cumming School of Medicine, University of Calgary. Dr. Wakefield: Professor Emeritus, Department of Family Medicine, McMaster University; Senior Editor, Module Development, The Foundation for Medical Practice Education, McMaster University. Dr. Shaw: Professor; Associate Chair of Education, Department of Family Medicine; Director, Module Development, The Foundation for Medical Practice Education, McMaster University. Ms. Zahorka: Education Coordinator, The Foundation for Medical Practice Education, McMaster University. Dr. Elmslie: Professor Emeritus, Department of Family Medicine, University of Ottawa; Executive Director, The Foundation for Medical Practice Education, McMaster University. Ms. Lofft: Research Assistant, The Foundation for Medical Practice Education, McMaster University
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11
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Nabelsi V, Lévesque-Chouinard A, Liddy C, Dumas Pilon M. Improving the Referral Process, Timeliness, Effectiveness, and Equity of Access to Specialist Medical Services Through Electronic Consultation: Pilot Study. JMIR Med Inform 2019; 7:e13354. [PMID: 31293239 PMCID: PMC6652123 DOI: 10.2196/13354] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/22/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Access to specialty care remains a major challenge in the Canadian health care system. Electronic consultation (eConsult) services allow primary care providers to seek specialist advice often without needing the patient to go for a face-to-face consultation. It improves overall access to specialists and the referral process using an electronic care consultation service in urban and rural primary care clinics. This study describes the preliminary results of a pilot study with an eConsult service across 3 regions in the province of Quebec, Canada. OBJECTIVE The main objective of this study was to provide a 1-year snapshot of the implementation of the eConsult Quebec Service in rural and urban primary care clinics to improve access to care and the specialty referral process for primary care providers (PCPs). METHODS We established an eConsult service that covers urban and rural communities in 3 regions of Quebec. We conducted a quantitative analysis of all eConsult cases submitted from July 4, 2017, to December 8, 2018. RESULTS For over a year, 1016 eConsults have been generated during the course of this study. A total of 97 PCPs submitted requests to 22 specialty groups and were answered by 40 different specialists. The most popular specialty was internal medicine (224/1016, 22%). Overall, 63% (640/1016) of completed cases did not require a face-to-face visit. PCPs rated the service as being of high or very high value for themselves in 98% (996/1016) of cases. CONCLUSIONS The preliminary data highlight the success of the implementation of the eConsult Quebec Service across 6 primary care clinics. The eConsult platform proves to be effective, efficient, and well received by both patients and physicians. If used more widely, eConsult could help reducing wait times significantly. Recently, the Ministry of Health and Social Services of Quebec has identified developing a strategic plan to scale eConsults throughout other regions of the province as a top priority.
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Affiliation(s)
- Véronique Nabelsi
- Département des Sciences Administratives, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Annabelle Lévesque-Chouinard
- Groupe de Médecine de Famille Universitaires de Gatineau du Centre Intégré de Santé et des Services Sociaux de l'Outaouais, Gatineau, QC, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, ON, Canada.,CT Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Maxine Dumas Pilon
- Department of Family Medicine, McGill University, Montréal, QC, Canada.,Collège Québécois des Médecins de Famille, Montréal, QC, Canada
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