Continuity of care and consultation mode in general practice: a cross-sectional and longitudinal study using patient-level and practice-level data from before and during the COVID-19 pandemic in England

Improvement in quality of life and cognitive function in Post-COVID syndrome after online occupational therapy: Results from a randomized controlled pilot study

BACKGROUND

Post-COVID syndrome (PCS) poses enormous clinical challenges. Occupational therapy (OT) is recommended in PCS, but structural validation of this concept is pending.

METHODS

In an unblinded randomized pilot study (clinical trial # DRKS0026007), feasibility and effects of online OT in PCS were tested. Probands received structured online OT over 12 weeks either via interactive online treatment sessions (interactive group) or prerecorded videos (video group). 50% of probands received no online OT (control group). At week 0, 12, and 24, we analyzed study experience, health-related quality of life, cognitive functions. impairment in performance, and social participation.

RESULTS

N = 158 probands (mean age 38 yrs., 86% female) were included into the analyses. The study experience was described as positive or very positive in 83.3% of probands in the interactive versus 48.1% of probands in the video group (p = 0.001). After 12 weeks, all groups displayed significant improvement in concentration, memory, and performance of daily tasks. After 24 weeks, significant improvement in concentration and memory were observed in control- and video-probands, and social participation had improved after video-OT. However, only probands in the interactive online OT group showed improvement of all measured endpoints including concentration, memory, quality of life, and social participation.

CONCLUSION

We show that online OT is feasible, and that interactive online OT is a promising treatment strategy for affected patients. We present exploratory data on its efficacy and describe variables that can be employed for further investigations in confirmatory trials.

COVID-19 pandemic and risk factor measurement in individuals with cardio-renal-metabolic diseases: A retrospective study in the United Kingdom

BACKGROUND

Comprehensive research about changes in risk factor (RF) management of people with chronic conditions during the COVID-19 pandemic is sparse. We aimed to study the impact of the pandemic on RF assessment in people with type 2 diabetes (T2DM), cardiovascular disease (CVD), and chronic kidney disease (CKD).

METHOD

Using UK Clinical Practice Research Datalink GOLD, we identified adults with T2DM, CVD and CKD who were alive and registered two years before (March 2018 - February 2019; March 2019 - February 2020) and one year during (March 2020 - February 2021) the pandemic. We estimated the proportion of people whose RFs (systolic (SBP) and diastolic (DBP) blood pressure, total cholesterol (TC), body mass index, smoking, and HbA1c) were assessed, mean values, and the proportion of controlled at each period for each cohort, overall and by age, sex, ethnicity, and deprivation. Multivariable logistic regression was used to estimate the association of patient characteristics (age, sex, ethnicity, deprivation, and comorbidity) with the outcome of having all RFs assessed during a given period.

RESULTS

Within the T2DM cohort, 66.4% and 65.2% had assessments of HbA1c in 2018 and 2019, which reduced to 43.4% in 2020. In CVD cohort, 76.9% and 72.6% had their BP measurements (54.5% and 51.3% for TC) in 2018 and 2019 respectively, which declined to 40.6% (30.7% for TC) in 2020. In CKD cohort, BP assessments declined from 77.9% and 72.3% in 2018 and 2019 respectively to 45.0% in 2020. These findings were consistent across patient demographics. In those with T2DM, SBP and DBP increased (+1.65 mmHg and +1.02 mmHg) in 2020. Elderly people were less likely to have all their RFs assessed in 2020 in all three cohorts compared to previous years.

CONCLUSIONS

Among people with major cardiometabolic conditions, there have been substantial reductions in the assessment and control of several key RFs during the pandemic. These patients will need regular monitoring in future for the prevention of complications. Our findings also highlight the need for resilient healthcare systems to ensure continuity of care and mitigate disparities in high-risk populations.

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

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

Rehab-AMD: co-design of an application for visual rehabilitation and monitoring of Age-related Macular Degeneration

BACKGROUND

The increasing demand for remote medical care, driven by digital healthcare advancements and the COVID-19 pandemic, necessitates effective solutions tailored to patients and healthcare practitioners. Co-design, involving collaboration between software developers, patients, and healthcare practitioners, prioritizes end-user needs. Research indicates that integrating patient perspectives enhances user experience and usability. However, its application in healthcare has been limited to small projects. This work focuses on co-designing a technological solution to enhance the monitoring and visual rehabilitation of individuals with Age-Related Macular Degeneration (AMD), a condition that significantly impacts the quality of life in people over 60. Current vision rehabilitation systems lack personalization, motivation, and effective progress monitoring. Involving patients and healthcare practitioners in the design process aims to ensure the final product meets their needs.

METHODS

The project employs iterative and collaborative principles, involving a vision rehabilitation expert and two AMD patients as active users in the application's development and validation. The process begins by establishing requirements for user accounts and rehabilitation exercises. It continues with an initial approach extended through user validation. Co-design is facilitated by specific workshops marking each project iteration, totaling four workshops, along with continuous communication sessions between experts and developers to validate design decisions. Initial requirements gathering and constant feedback from end-users, the visual rehabilitator, and patients are crucial for refining the product effectively.

RESULTS

The workshops produced a prototype featuring a test to monitor changes and progression and 15 visual rehabilitation exercises. Numerous patient and vision rehabilitation-driven software modifications led to a final design that is responsive and adaptive to end-user needs.

CONCLUSIONS

The Rehab-AMD pilot project aims to develop a collaborative and adaptive software solution for AMD rehabilitation by actively involving stakeholders and applying iterative design principles. Co-design in the Rehab-AMD solution proves to be a methodology that identifies usability issues and needs from the initial design stages. This approach ensures that software developers create a final product that is genuinely useful and manageable for people with AMD and the targeted vision rehabilitators.