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Olive MV, Gastaldi L, Corso M. Digitally-mediated coordination in healthcare: the effects of teleconsultation on doctor-to-doctor relational coordination. BMC Health Serv Res 2024; 24:258. [PMID: 38419009 PMCID: PMC10900703 DOI: 10.1186/s12913-024-10726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Digitalization transforms the way in which interdependent work is coordinated, especially in healthcare settings. This work deepens the effect of teleconsultation use on health professionals' coordination. For this aim, we rely on Relational Coordination Theory (RCT), which explores coordination as an interactive process among group participants within the context of task interdependency. METHODS We collected data through an online survey administered to Italian specialist doctors between March and April 2023. 489 complete answers were gathered. Hypotheses have been tested through Structural Equation Modelling. RESULTS We found that teleconsultation frequency of use has a positive and significant effect on both components of relational coordination, confirming our hypotheses. CONCLUSIONS Theoretically, this research contributes to our understanding of the effect of digitally mediated coordination mechanisms on relational coordination. In practice, we shed light on the organizational implications of telemedicine under a novel perspective, focusing on the role of professional interactions in digitally mediated work and providing useful elements for the organizational design of telemedicine.
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Affiliation(s)
- Mattia Vincenzo Olive
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy.
| | - Luca Gastaldi
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Mariano Corso
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
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Idris H, Nugraheni WP, Rachmawati T, Kusnali A, Yulianti A, Purwatiningsih Y, Nuraini S, Susianti N, Faisal DR, Arifin H, Maharani A. How Is Telehealth Currently Being Utilized to Help in Hypertension Management within Primary Healthcare Settings? A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:90. [PMID: 38248553 PMCID: PMC10815916 DOI: 10.3390/ijerph21010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
Telehealth has improved patient access to healthcare services and has been shown to have a positive impact in various healthcare settings. In any case, little is understood regarding the utilization of telehealth in hypertension management in primary healthcare (PHC) settings. This study aimed to identify and classify information about the types of interventions and types of telehealth technology in hypertension management in primary healthcare. A scoping review based on PRISMA-ScR was used in this study. We searched for articles in four databases: Pubmed, Scopus, Science Direct, and Embase in English. The selected articles were published in 2013-2023. The data were extracted, categorized, and analyzed using thematic analysis. There were 1142 articles identified and 42 articles included in this study. Regarding the proportions of studies showing varying trends in the last ten years, most studies came from the United States (US) (23.8%), were conducted in urban locations (33.3%), and had a quantitative study approach (69%). Telehealth interventions in hypertension management are dominated by telemonitoring followed by teleconsultation. Asynchronous telehealth is becoming the most widely used technology in managing hypertension in primary care settings. Telehealth in primary care hypertension management involves the use of telecommunications technology to monitor and manage blood pressure and provide medical advice and counselling remotely.
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Affiliation(s)
- Haerawati Idris
- Department of Health Administration & Policy, Faculty of Public Health, Sriwijaya University, Indralaya 30662, Indonesia
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Wahyu Pudji Nugraheni
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Tety Rachmawati
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Asep Kusnali
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Anni Yulianti
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Yuni Purwatiningsih
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Syarifah Nuraini
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Novia Susianti
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Debri Rizki Faisal
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Hidayat Arifin
- Department of Basic Nursing Care, Faculty of Nursing, Universitas Airlangga, Surabaya 60286, Indonesia;
| | - Asri Maharani
- Division of Nursing, Midwifery & Social Work, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK;
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Goethals L, Barth N, Martinez L, Lacour N, Tardy M, Bohatier J, Bonnefoy M, Annweiler C, Dupre C, Bongue B, Celarier T. Decreasing hospitalizations through geriatric hotlines: a prospective French multicenter study of people aged 75 and above. BMC Geriatr 2023; 23:783. [PMID: 38017388 PMCID: PMC10685561 DOI: 10.1186/s12877-023-04495-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND The Emergency unit of the hospital (Department) (ED) is the fastest and most common way for most French general practitioners (GPs) to respond to the complexity of managing older adults patients with multiple chronic diseases. In 2013, French regional health authorities proposed to set up telephone hotlines to promote interactions between GP clinics and hospitals. The main objective of our study was to analyze whether the hotlines and solutions proposed by the responding geriatrician reduced the number of hospital admissions, and more specifically the number of emergency room admissions. METHODS We conducted a multicenter observational study from April 2018 to April 2020 at seven French investigative sites. A questionnaire was completed by all hotline physicians after each call. RESULTS The study population consisted of 4,137 individuals who met the inclusion and exclusion criteria. Of the 4,137 phone calls received by the participants, 64.2% (n = 2 657) were requests for advice, and 35.8% (n = 1,480) were requests for emergency hospitalization. Of the 1,480 phone calls for emergency hospitalization, 285 calls resulted in hospital admission in the emergency room (19.3%), and 658 calls in the geriatric short stay (44.5%). Of the 2,657 calls for advice/consultation/delayed hospitalization, 9.7% were also duplicated by emergency hospital admission. CONCLUSION This study revealed the value of hotlines in guiding the care of older adults. The results showed the potential effectiveness of hotlines in preventing unnecessary hospital admissions or in identifying cases requiring hospital admission in the emergency room. Hotlines can help improve the care pathway for older adults and pave the way for future progress. TRIAL REGISTRATION Registered under Clinical Trial Number NCT03959475. This study was approved and peer-reviewed by the Ethics Committee for the Protection of Persons of Sud Est V of Grenoble University Hospital Center (registered under 18-CETA-01 No.ID RCB 2018-A00609-46).
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Affiliation(s)
- Luc Goethals
- SAINBIOSE laboratory, U1059 INSERM - University of Jean Monnet, Saint-Etienne, France.
- Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France.
| | - Nathalie Barth
- SAINBIOSE laboratory, U1059 INSERM - University of Jean Monnet, Saint-Etienne, France
- Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France
- Gerontopole Auvergne-Rhône-Alpes, Saint-Etienne, France
| | - Laure Martinez
- Department of Clinical Gerontology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Noémie Lacour
- Department of Clinical Gerontology, Firminy Hospital, Firminy, France
| | - Magali Tardy
- Department of Clinical Gerontology, Saint-Chamond Hospital, Saint-Chamond, France
| | - Jérôme Bohatier
- Department of Clinical Gerontology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Marc Bonnefoy
- Department of Clinical Gerontology, Lyon Sud University Hospital, Lyon, France
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital of Angers, Angers, France
- UPRES EA 4638, University of Angers, Angers, France
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Caroline Dupre
- SAINBIOSE laboratory, U1059 INSERM - University of Jean Monnet, Saint-Etienne, France
- Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France
| | - Bienvenu Bongue
- SAINBIOSE laboratory, U1059 INSERM - University of Jean Monnet, Saint-Etienne, France
- Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France
- Support and Education Technical Centre of Health Examination Centres (CETAF), Saint-Etienne, France
| | - Thomas Celarier
- Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France
- Gerontopole Auvergne-Rhône-Alpes, Saint-Etienne, France
- Department of Clinical Gerontology, Saint-Etienne University Hospital, Saint-Etienne, France
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Sette AL, François P, Lesprit P, Vitrat V, Rogeaux O, Breugnon E, Baldeyrou M, Mondain V, Issartel B, Kerneis S, Diamantis S, Poitrenaud D, Boussat B, Pavese P. Infectious disease hotlines to provide advice to general practitioners: a prospective study. BMC Health Serv Res 2023; 23:502. [PMID: 37198604 DOI: 10.1186/s12913-023-09515-3] [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: 01/24/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Telephone hotlines in infectious diseases (ID) are part of antimicrobial stewardship programs designed to provide support and expertise in ID and to control antibiotic resistance. The aim of the study was to characterize the activity of the ID hotlines and estimate their usefulness for general practitioners (GPs). METHODS This was a multicenter prospective observational study in different French regions. ID teams involved in antimicrobial stewardship with a hotline for GPs were asked to record their advice from April 2019 to June 2022. In these regions, all GPs were informed of the ID hotline's operating procedures. The main outcome was usage rate of the hotlines by GPs. RESULTS Ten volunteer ID teams collected 4138 requests for advice from 2171 GPs. The proportion of GPs using the hotline varied pronouncedly by region, from 54% in the Isere department, to less than 1% in departments with the lowest usage. These differences were associated with the number of physicians in ID teams and with the age of the hotline. These results highlighted the value of working time as a means of ensuring the permanence of expertise. The main reasons for calling were: a diagnostic question (44%); choice of antibiotic (31%). The ID specialist provided advice on antibiotic therapy (43%) or a proposal for specialized consultation or hospitalization (11%). CONCLUSIONS ID hotlines could help to strengthen cooperation between primary care and hospital medicine. However, the deployment and perpetuation of this activity require reflection concerning its institutional and financial support.
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Affiliation(s)
- Anna Luce Sette
- Médecine Générale, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France.
| | - Patrice François
- Service d'épidémiologie et évaluation médicale, Centre Hospitalier Universitaire Grenoble-Alpes, Pavillon Taillefer, La Tronche, 38700, France.
| | - Philippe Lesprit
- Service des maladies infectieuses et tropicales, Centre Hospitalier Universitaire Grenoble-Alpes, Pavillon Taillefer, La Tronche, France
| | - Virginie Vitrat
- Service de maladies infectieuses, Centre Hospitalier d'Annecy, Annecy, France
| | - Olivier Rogeaux
- Service des maladies infectieuses et tropicales, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Emma Breugnon
- Service de maladies infectieuses, Centre Hospitalier Universitaire de Saint-Etienne, Saint- Etienne, France
| | - Marion Baldeyrou
- Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Centre Hospitalo-Universitaire, Rennes, France
| | - Véronique Mondain
- Maladies Infectieuses, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Bertrand Issartel
- Médecine Interne Infectieuse et Tropicale, MiiT médical selarl, Lyon-Villeurbanne, France
| | - Solen Kerneis
- Equipe Mobile d'Infectiologie, APHP, Hôpital Cochin, Paris, F-75014, France
| | - Sylvain Diamantis
- Service de Maladies infectieuses, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Delphine Poitrenaud
- Maladies infectieuses et tropicales, Centre Hospitalier d'Ajaccio, Ajaccio, France
| | - Bastien Boussat
- Laboratoire TIMC-IMAG, Université de Grenoble Alpes, Grenoble, France
| | - Patricia Pavese
- Service des maladies infectieuses et tropicales, Centre Hospitalier Universitaire Grenoble-Alpes, Pavillon Taillefer, La Tronche, France
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Nertinger S, Kirschner RJ, Naceri A, Haddadin S. Acceptance of Remote Assistive Robots with and without Human-in-the-Loop for Healthcare Applications. Int J Soc Robot 2022. [DOI: 10.1007/s12369-022-00931-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractAssistive social robots aim to facilitate outpatient-care including required safety critical measures. Accepting a robot to perform such measures, e.g., operate in close physical interaction for medical examinations, requires human trust towards the robot. Human-in-the-loop (HIL) applications where the robot is teleoperated by a human expert can help the person to accept even risky tasks performed by a robot. Therefore, the assistive humanoid GARMI was designed to enable HIL applications with varying autonomy. In this study, we use GARMI to understand which tasks in the framework of care may be accepted depending on human socio-demographics and user beliefs as well as the level of robot autonomy. Firstly, we seek to understand the general acceptance of GARMI using the Almere questionnaire. Secondly, we ask adults to rate their willingness to use several functionalities of GARMI. Lastly, we investigate the effect of the introduction method of GARMI on user acceptance. We assemble all relevant factors on acceptance to provide direction in the user-centered design process of assistive robots. The results of 166 participants show that alongside others, trust towards the robot and utilitarian variables such as perceived usefulness are the most influencing factors on the acceptance of GARMI and should be considered for the design of robotic semi-autonomous outpatient-services.
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Ji M, Wang S, Peng C, Li J. Two-stage robust telemedicine assignment problem with uncertain service duration and no-show behaviours. COMPUTERS & INDUSTRIAL ENGINEERING 2022; 169:108226. [PMID: 35634093 PMCID: PMC9124295 DOI: 10.1016/j.cie.2022.108226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
The current pandemic of COVID-19 has caused significant strain on medical center resources, which are the main plac healthcare managers to make an effective assignment plan for the patients and telemedical doctors when providing telemedicine services. Motivated by this, we present the first comprehensive study of a two-stage robust telemedicine assignment problem when three different sources of uncertainty are incorporated, including uncertain service duration, no-show behaviours of both patients and telemedical doctors. From an algorithmic viewpoint, we propose an efficient nested column-and-constraint generation (C&CG) solution scheme that decomposes the model into an outer level problem and an inner level problem. Our results show that we can solve the problems of realistic sizes within a reasonable time (e.g., up to 100 patients, 10 telemedical doctors, and 200 scenarios within two hours). On the empirical side, we demonstrate how the hyper-parameters make a balance between cost management and the coverage level of the served patients in the presence of three different sources of uncertainty. Our comparison with a two-stage stochastic programming model implies that our model is not overly conservative and seems to provide a relatively cheaper modeling alternative that requires much less information support when hedging against three different sources of uncertainty under a worst-case situation.
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Affiliation(s)
- Menglei Ji
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
| | - Shanshan Wang
- Department of Decision Sciences, HEC Montréal & GERAD, Montréal H3T 2A7, Canada
| | - Chun Peng
- Department of Decision Sciences, HEC Montréal & GERAD, Montréal H3T 2A7, Canada
| | - Jinlin Li
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
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King I, Heidler P. Teleconsultation Services in Pediatric Primary Care in Austria: Upgrading Clinical Decision Support in Primary Health Care Settings. Telemed J E Health 2022; 28:1470-1478. [PMID: 35357947 DOI: 10.1089/tmj.2021.0452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The general practitioners' increasing comprehensive pediatric health care provision in Austria faces great challenges in ensuring high-quality health care in the future as the shortage of pediatricians continues to grow. Tele-expertise services provide an excellent opportunity to facilitate and strengthen interdisciplinary collaboration and access medical expertise of uncertainties in diagnosis and treatment plans. The purpose of this study was to investigate and evaluate the usability, applicability, and clinical advantages of an Austrian tele-expertise platform for doctors, emphasizing its value to strengthen collaborative efforts to extend and ensure quality care in infant, child, and adolescent health while focusing on diagnostic acceleration, verification, and potential modification of a treatment plan. Materials and Methods: A mixed-method approach included the retrospective evaluation of data provided via Intercom to elicit professional and geographical distribution and analysis of four hypotheses (H1: geographic distribution of initial enquires; H2: pediatric expertise level of the requester; H3: teleconsultations will result in changes in diagnosis and therapeutic decisions; and H4: teleconsultations stimulate cooperation and collaboration between physicians of all specialties). The study was based on survey questionnaires and qualitative semi-structured interviews. Discussion: Benefits were the most apparent in shorter diagnosis times, a potential quality increase in care, and cooperative stimulation. Intended therapy plans were found to be more sensitive to modification. Nevertheless, an overall positive attitude toward the teleconsultation chat became obvious. Moreover, the potential regarding quality improvements in pediatric primary care, shorter diagnosis time, and improved treatment options was found. Conclusions: Outcomes are urging Austrian health authorities to establish political and legal structures for appropriate monetary compensation and broad application of an expert consultation system. The article further highlights the importance of teleconsultations in critical situations, such as pandemic times.
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Affiliation(s)
- Isabel King
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia.,Sunshine Coast Health Institute, Birtinya, Australia
| | - Petra Heidler
- Department for Economy and Health, Danube University Krems, Krems, Austria.,Department of International Trade and Sustainable Economy, IMC University of Applied Sciences Krems, Krems, Austria
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Kang E, Lee H, Hong KJ, Yun J, Lee JY, Hong YC. General public’s perspectives on telemedicine during the COVID-19 pandemic in Korea: an analysis of the nationwide survey. Epidemiol Health 2022; 44:e2022020. [PMID: 35130418 PMCID: PMC9117104 DOI: 10.4178/epih.e2022020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We investigated the awareness, experience, approval, intention to use, and the desired type of telemedicine among Korean general public. METHODS From November to December 2020, we conducted an online self-reported survey on awareness, experience, approval, and intent to use telemedicine services among Korean residents aged 20 years or older. A total of 2,097 participants completed the survey. RESULTS Of the 2,097 participants, 1,558 (74.3%) were aware of, 1,198 (57.1%) approved of, and 1,474 (70.3%) had the intention to use telemedicine. Participants from regions other than the Seoul metropolitan area and Daegu–Gyeongbuk Province (adjusted odds ratio [aOR], 1.29; 95% confidence interval [CI], 1.02 to 1.63), households with a monthly household income of US$6,000 or more (aOR, 1.44; 95% CI, 1.01 to 2.08), participants who had a college/university or associate’s degree (aOR, 1.35. 95% CI, 1.04 to 1.75) or a master’s degree or above (aOR, 1.73; 95% CI, 1.20 to 2.50), and housewives (aOR, 1.30; 95% CI, 1.03 to 1.64) had higher odds of approval. Elderly participants, those with a chronic disease (aOR, 1.26; 95% CI, 1.04 to 1.54), those who had experienced delays of healthcare services (aOR, 1.94; 95% CI, 1.27 to 2.96), and those who had experience with telemedicine (aOR, 4.28; 95% CI, 1.69 to 10.82) were more likely to intend to use telemedicine services. Regarding types of telemedicine, teleconsultation between doctors showed the highest approval rate (73.1%). CONCLUSIONS In the context of the coronavirus disease 2019 pandemic, more than 70% of participants had already used or intended to use telemedicine at some point. Groups with a substantial need for telemedicine were more in favor of telemedicine.
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Affiliation(s)
- EunKyo Kang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Family Medicine, National Cancer Center, Goyang, Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jieun Yun
- Department of Pharmaceutical Engineering, Cheongju University, Cheongju, Korea
| | - Jin Yong Lee
- ublic Healthcare Center, Seoul National University Hospital, Seoul, Korea
- HIRA Research Institute, Health Insurance Review and Assessment Service, Wonju, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Correspondence: Jin Yong Lee Public Healthcare Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea E-mail:
| | - Yun-Chul Hong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Co-correspondence: Yun-Chul Hong Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea E-mail:
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Beheshti L, Kalankesh LR, Doshmangir L, Farahbakhsh M. Telehealth in Primary Health Care: A Scoping Review of the Literature. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2022; 19:1n. [PMID: 35440933 PMCID: PMC9013222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The use of telehealth as a viable mobility to deliver quality services steadily increases in various levels of the health system. Despite the increasing use of telemedicine in secondary and tertiary health care services, there is a long way to go in the use of this technology in public health and primary health care (PHC). This study aimed to explore the features, approaches, and various dimensions of telehealth in PHC. METHODS A scoping review was conducted using the Arksey and O'Malley framework. A search was conducted in three bibliographic databases including PubMed, Web of Sciences, and Scopus and in Google Scholar to collect papers published in November 2018 to 2000. Data were extracted according to a predefined form and check for completeness and accuracy by a second reviewer. RESULTS Through reviewing papers, the authors extracted information on the general characteristics and features of telehealth services, kinds of PHC services delivered via telehealth, hardware and software facilities used for providing health care through telehealth services packages, as well as their benefits, outcomes and obstacles. CONCLUSION Telehealth can be used for different purposes of PHC through deploying a full range of communication channels available to the public. Due to the opportunistic use of existing devices and platforms, telehealth can provide scalable PHC services nationwide and worldwide. However, implementing telehealth in PHC faces challenges from technical, organizational, and human perspectives. Digital equity (in terms of technology access and e-health literacy) is required to expand telehealth services to the populations in underserved areas.
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Oates EV, Lim GHC, Nevins EJ, Kanakala V. Are Surgical Patients Satisfied With Remote Consultations? A Comparison of Remote Versus Conventional Outpatient Clinic Follow-Up for Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Patient Exp 2021; 8:23743735211035916. [PMID: 34377778 PMCID: PMC8326624 DOI: 10.1177/23743735211035916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Access to remote appointments (RA) by telephone or video is increasing as technology advances and becomes more available to patients. This meta-analysis of randomized controlled trials (RCTs) aims to discover whether surgical patients are satisfied with RAs when compared with conventional outpatient clinics (OPC). A literature search of RCTs of surgical patient satisfaction of RAs versus OPC appointments was performed. The PubMed, EMBASE, OVID, Cochrane Library, and Google Scholar databases were searched to include articles from January 2000 to 2020. A random-effects meta-analysis model was used to compare outcomes. All 7 RCTs showed that patients were as satisfied with RAs as OPC appointments (RR = 1.00, [0.98-1.02]; P = .73). Furthermore, both patient cohorts would prefer RAs for future follow-up (RR = 2.29, [1.96-2.97]; P < .00001). One RCT found the cost to institutions was less in the RA group ($19.05 vs $52.76) and another found the patients would save $9.96 on transportation costs. The majority of RCTs suggested cost to patients and or institutions would be less for RA. In conclusion, surgical patients are satisfied with RAs and in fact would prefer them.
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Affiliation(s)
- Emily V Oates
- James Cook University Hospital, England, United Kingdom
| | - Grace H C Lim
- James Cook University Hospital, England, United Kingdom
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11
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Tian PGJ, Harris JR, Seikaly H, Chambers T, Alvarado S, Eurich D. Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan. JMIR Form Res 2021; 5:e17672. [PMID: 33620325 PMCID: PMC7943336 DOI: 10.2196/17672] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/04/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. OBJECTIVE As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. METHODS We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. RESULTS The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. CONCLUSIONS Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use. .
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Affiliation(s)
| | - Jeffrey Richard Harris
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Thane Chambers
- University of Alberta Libraries, University of Alberta, Edmonton, AB, Canada
| | - Sara Alvarado
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Dean Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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12
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Chrapah S, Becevic M, Washington KT, Sheets LR, Wallach E, Chitima R, Malm-Buatsi E. Patient and Provider Satisfaction With Pediatric Urology Telemedicine Clinic. J Patient Exp 2021; 8:2374373520975734. [PMID: 34179351 PMCID: PMC8205389 DOI: 10.1177/2374373520975734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The use of telemedicine continues to grow as more patients are receptive to this innovative way of providing health care. Multiple publications in telemedicine indicated high satisfaction for this service. This study focuses on the use of telemedicine in a pediatric urology clinic and examines 3 research questions: (1) How did patients' parents/guardians feel about their video appointments? (2) What were the experiences of novice telemedicine providers conducting postsurgical appointments via video? and (3) How did novice telemedicine providers' experiences compare to those of expert telemedicine providers?
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Affiliation(s)
- Sandra Chrapah
- University of Missouri, Missouri Telehealth Network, Columbia, MO, USA
| | - Mirna Becevic
- University of Missouri, Missouri Telehealth Network, Columbia, MO, USA.,Department of Dermatology, University of Missouri, Columbia, MO, USA
| | - Karla T Washington
- University of Missouri, Family and Community Medicine, Columbia, MO, USA
| | - Lincoln R Sheets
- University of Missouri, Missouri Telehealth Network, Columbia, MO, USA.,Department of Health Management and Informatics, University of Missouri, Columbia, MO, USA
| | | | - Rebecca Chitima
- University of Missouri, Missouri Telehealth Network, Columbia, MO, USA
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13
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Tian PGJ, Eurich D, Seikaly H, Boisvert D, Montpetit J, Harris J. Telephone consultations with otolaryngology - head and neck surgery reduced emergency visits and specialty consultations in northern Alberta. J Otolaryngol Head Neck Surg 2020; 49:39. [PMID: 32571420 PMCID: PMC7310048 DOI: 10.1186/s40463-020-00439-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 06/12/2020] [Indexed: 11/20/2022] Open
Abstract
Background RAAPID (Referral, Access, Advice, Placement, Information, and Destination) is a 24-h call center in Alberta, Canada, facilitating urgent telephone consultations between physicians and specialists. We evaluated the extent to which RAAPID calls to Otolaryngology-Head and Neck Surgery (OHNS) reduced visits to the emergency department and specialty clinics. Methods This was a cross-sectional study evaluating all telephone consultations to OHNS from physicians in northern Alberta between 2013 and 2014 (T1) (where consultations by residents occurred) and 2015 to 2017 (T2) (where consultations were done by consultants during office hours and residents during after hours). Outcomes of the calls included medical advice, specialty clinic referrals, and emergency department (ED) referrals. Differences in the reduction of ED visits and costs, overall as well as in T1 and T2, were assessed using multivariate logistic regression. Results Overall, 62.3% (1064/1709) of telephone consultations reduced ED visits consisting of advice being provided (n = 884; 83.1%) and referral to specialty clinics (n = 180; 16.9%). The adjusted odds ratio of calls reducing emergency visits in T2 as compared to T1 was 2.47 (95% CI 1.99 to 3.08). The adjusted odds ratio of reducing ED visits during office hours compared to after-hours 2.54 (95% CI 1.77–3.64). The estimated direct costs avoided from ED visits in T1 and T2 were $42,224.22 and $114,393.86, respectively. Conclusion RAAPID telephone consultations to OHNS were effective in reducing ED visits and healthcare costs. This model should be considered in other areas to improve efficiencies within the health system.
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Affiliation(s)
| | - Dean Eurich
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Hadi Seikaly
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, Canada
| | | | - John Montpetit
- Poison and Drug Information Service and RAAPID, Alberta Health Services, Calgary, Canada
| | - Jeffrey Harris
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, Canada
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14
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Lacasta Tintorer D, Manresa Domínguez JM, Jiménez-Zarco A, Rodríguez-Blanco T, Flayeh Beneyto S, Torán-Monserrat P, Mundet Tuduri X, Saigí-Rubió F. Efficiency as a determinant of loyalty among users of a Community of Clinical Practice: a comparative study between the implementation and consolidation phases. BMC FAMILY PRACTICE 2020; 21:15. [PMID: 31980016 PMCID: PMC6979059 DOI: 10.1186/s12875-020-1081-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/06/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND A community of clinical practice called the Online Communication Tool between Primary and Hospital Care (ECOPIH) was created to enable primary care and specialist care professionals to communicate with each other in order to resolve real clinical cases, thereby improving communication and coordination between care levels. The present work seeks to analyse whether ECOPIH makes it possible to reduce the number of referrals. To that end, the objectives are: (1) To find out the degree of loyalty among ECOPIH users, by comparing the medical professionals' profiles in the tool's implementation phase to those in its consolidation phase. (2) To evaluate the degree of fulfilment of users' expectations, by establishing the determining factors that had an influence on the physicians' intention to use ECOPIH in the implementation phase and observing whether its use had an effective, direct impact on the number of patient referrals that primary care physicians made to specialist care professionals. METHODS Two studies were conducted. Based on a survey of all the physicians in a Primary Care area, Study 1 was a descriptive study in ECOPIH's implementation phase. Study 2 was a randomised intervention study of ECOPIH users in the tool's consolidation phase. The results from both studies were compared. Various bivariate and multivariate statistical techniques (exploratory factor analysis, cluster analysis, logistic regression analysis and ANOVA) were used in both studies, which were conducted on a sample of 111 and 178 physicians, respectively. RESULTS We confirmed the existence of an ECOPIH user profile stable across both phases: under-50-year-old women. Regarding the second objective, there were two particular findings. First, the discriminant factors that had an influence on greater ECOPIH use were habitual Social media website and app use and Perceived usefulness for reducing costs. Second, PC professionals who were ECOPIH members made fewer referrals to SC professionals in Cardiology, Endocrinology and Gastroenterology than older PC professionals who were not ECOPIH members. CONCLUSIONS The use of a community of clinical practice by primary care and specialist care professionals helps to reduce the number of referrals among medical professionals.
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Affiliation(s)
- David Lacasta Tintorer
- Centre d’Atenció Primària Gran Sol, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut. Avinguda del Doctor Bassols, 112 - 130, 08914 Badalona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, CAP El Maresme. Camí del Mig, 36 planta 4ª, 08303 Mataró, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès. Campus de la UAB, Plaça Cívica, s/n, 08193 Bellaterra, Barcelona, Spain
| | - Josep Maria Manresa Domínguez
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, CAP El Maresme. Camí del Mig, 36 planta 4ª, 08303 Mataró, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès. Campus de la UAB, Plaça Cívica, s/n, 08193 Bellaterra, Barcelona, Spain
| | - Ana Jiménez-Zarco
- Faculty of Economics and Business, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Teresa Rodríguez-Blanco
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès. Campus de la UAB, Plaça Cívica, s/n, 08193 Bellaterra, Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
| | - Souhel Flayeh Beneyto
- Centre d’Atenció Primària Gran Sol, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut. Avinguda del Doctor Bassols, 112 - 130, 08914 Badalona, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, CAP El Maresme. Camí del Mig, 36 planta 4ª, 08303 Mataró, Spain
- Departament de Ciències Mèdiques, Universitat de Girona, C/ Emili Grahit, 77, 2n, 17003 Girona, Spain
| | - Xavier Mundet Tuduri
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès. Campus de la UAB, Plaça Cívica, s/n, 08193 Bellaterra, Barcelona, Spain
- Unitat de Suport a la Recerca Barcelona Ciutat, IDIAP Jordi Gol, Carrer Sardenya 375, 08025 Barcelona, Spain
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona. Av. Tibidabo, 39-43, 08035 Barcelona, Spain
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15
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Mold F, Hendy J, Lai YL, de Lusignan S. Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review. JMIR Med Inform 2019; 7:e13042. [PMID: 31793888 PMCID: PMC6918214 DOI: 10.2196/13042] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/11/2019] [Accepted: 08/07/2019] [Indexed: 12/27/2022] Open
Abstract
Background Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. Objective This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. Methods A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. Results This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. Conclusions E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.
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Affiliation(s)
- Freda Mold
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Jane Hendy
- Brunel Business School, Brunel University London, Uxbridge, United Kingdom
| | - Yi-Ling Lai
- Faculty of Business and Law, University of Portsmouth, Portsmouth, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
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16
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Vallasciani S, Abdo B, Rauf Z, Anjum A, Ghulman S, Alghammas H, AlTaweel W. Telehealth for the Assessment of Patients Referred for Pediatric Urological Care: A Preliminary Cost Savings Analysis and Satisfaction Survey. Telemed J E Health 2018; 25:756-761. [PMID: 30359550 DOI: 10.1089/tmj.2018.0159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Almost one-fifth of the population of Saudi Arabia lives in rural areas and may still lack access to specialty healthcare. Because of the growing demand for telehealth services, we initiated the virtual clinic (VC) concept for new referrals to the pediatric urology clinic (PUC), the primary tertiary care unit in Riyadh. Methods: We conducted a retrospective analysis of costs and timing involved with the VC practice for a 1-year period. The cost analysis is based on savings realized by patients as a result of the VC evaluation. A 15-question nonvalidated satisfaction survey was also conducted by an independent observer. Results: Of 105 patients assessed through the VC program, 44 were accepted for surgery and further investigation. The number of trips to the center saved by the virtual encounter were 203, resulting in a savings of 740,950 Saudi Arabian Riyals (SAR) minus the cost of the VC. The cost of conducting most of the investigations at the referring hospital instead of the PUC represented a savings of 639,970 SAR. Thus, the overall cost savings to patient and family and to the PUC was 1,311,570 SAR. An additional benefit was the reduction in the time for treatment from 6.6 to 3.9 months. The overall satisfaction rate was 89%. Conclusions: Although preliminary, our study indicates that telemedicine can achieve a cost savings without compromising the safety or adversely affecting patient management. Further studies should more clearly define the benefits and any limitations, and reveal how the technology could be used most effectively.
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Affiliation(s)
- Santiago Vallasciani
- 1Pediatric Urology Division, Urology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Badawiya Abdo
- 3Department of Health Outreach and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zainab Rauf
- 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abeeda Anjum
- 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Sanaa Ghulman
- 4Department of Nursing Affairs, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hanan Alghammas
- 5Quality Management Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Waleed AlTaweel
- 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,6Urology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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17
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Ippoliti R, Falavigna G, Montani F, Rizzi S. The private healthcare market and the sustainability of an innovative community nurses programme based on social entrepreneurship - CoNSENSo project. BMC Health Serv Res 2018; 18:689. [PMID: 30185186 PMCID: PMC6125879 DOI: 10.1186/s12913-018-3513-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/29/2018] [Indexed: 11/28/2022] Open
Abstract
Background CoNSENSo is a project funded by the European Union, which is aimed at developing an innovative care model based on community nurses to support active ageing in mountain areas. The planned sustainability of this innovative approach relies on social entrepreneurship on the healthcare market, and this work highlights the necessary conditions for the successful implementation of these entrepreneurial initiatives. Methods Considering municipalities in the Piedmont Region and those aged 65 or older as target population, the authors propose several negative binomial regression models to estimate the effectiveness of current private healthcare services in supporting the active aging process. Such effectiveness may represent the ex-ante (positive) reputation of these new social entrepreneurial initiatives on the market. Results According to our results, the private supply of healthcare services can effectively support the aging process. Indeed, given that the other predictor variables in the model are held constant, there are statistically significant negative relations between the number of hip fractures and the private supply of healthcare services by dental practitioners and psychologists (p-value < 0.05), as well as the private supply of opportunities for social interaction by coffee bars (p-value < 0.05). Conclusions The authors expect a favourable environment for the entrepreneurial initiatives of community nurses in mountain areas. Accordingly, policy makers cannot reject the hypothesis that the goals reached by the CoNSENSo project may be maintained for the sake of the future generations, avoiding its collapse as soon as public funding shifts to new programmes.
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Affiliation(s)
| | - Greta Falavigna
- Istituto di ricerca sulla crescita economica sostenibile (IRCrES) - Consiglio Nazionale delle Ricerche (CNR), Moncalieri, Italy
| | | | - Silvia Rizzi
- Direzione Sanità - Regione Piemonte, Torino, Italy
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18
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Vasquez-Cevallos LA, Bobokova J, González-Granda PV, Iniesta JM, Gómez EJ, Hernando ME. Design and Technical Validation of a Telemedicine Service for Rural Healthcare in Ecuador. Telemed J E Health 2018; 24:544-551. [DOI: 10.1089/tmj.2017.0130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Leonel A. Vasquez-Cevallos
- Biomedical Engineering and Telemedicine Group, Biomedical Technology Centre CTB, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
- Department of Health Sciences, Universidad Técnica Particular de Loja (UTPL), Loja, Ecuador
- Research Group in Telecommunications Systems, GISTEL, Universidad Politécnica Salesiana, Guayaquil, Ecuador
| | - Jana Bobokova
- Department of Health Sciences, Universidad Técnica Particular de Loja (UTPL), Loja, Ecuador
- Department of Oncology, Hospital Eugenio Espejo, Quito, Ecuador
| | | | - José M. Iniesta
- Biomedical Engineering and Telemedicine Group, Biomedical Technology Centre CTB, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Enrique J. Gómez
- Biomedical Engineering and Telemedicine Group, Biomedical Technology Centre CTB, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - M. Elena Hernando
- Biomedical Engineering and Telemedicine Group, Biomedical Technology Centre CTB, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
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19
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Lacasta Tintorer D, Manresa Domínguez JM, Pujol-Rivera E, Flayeh Beneyto S, Mundet Tuduri X, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC FAMILY PRACTICE 2018; 19:56. [PMID: 29743030 PMCID: PMC5944103 DOI: 10.1186/s12875-018-0739-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 04/18/2018] [Indexed: 11/10/2022]
Abstract
Background The current reality of primary care (PC) makes it essential to have telemedicine systems available to facilitate communication between care levels. Communities of practice have great potential in terms of care and education, and that is why the Online Communication Tool between Primary and Hospital Care was created. This tool enables PC and non-GP specialist care (SC) professionals to raise clinical cases for consultation and to share information. The objective of this article is to explore healthcare professionals’ views on communities of clinical practice (CoCPs) and the changes that need to be made in an uncontrolled real-life setting after more than two years of use. Methods A descriptive-interpretative qualitative study was conducted on a total of 29 healthcare professionals who were users and non-users of a CoCP using 2 focus groups, 3 triangular groups and 5 individual interviews. There were 18 women, 21 physicians and 8 nurses. Of the interviewees, 21 were PC professionals, 24 were users of a CoCP and 7 held managerial positions. Results For a system of communication between PC and SC to become a tool that is habitually used and very useful, the interviewees considered that it would have to be able to find quick, effective solutions to the queries raised, based on up-to-date information that is directly applicable to daily clinical practice. Contact should be virtual – and probably collaborative – via a platform integrated into their habitual workstations and led by PC professionals. Organisational changes should be implemented to enable users to have more time in their working day to spend on the tool, and professionals should have a proactive attitude in order to make the most if its potential. It is also important to make certain technological changes, basically aimed at improving the tool’s accessibility, by integrating it into habitual clinical workstations. Conclusions The collaborative tool that provides reliable, up-to-date information that is highly transferrable to clinical practice is valued for its effectiveness, efficiency and educational capacity. In order to make the most of its potential in terms of care and education, organisational changes and techniques are required to foster greater use. Electronic supplementary material The online version of this article (10.1186/s12875-018-0739-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David Lacasta Tintorer
- Centre d'Atenció Primària Gran Sol, Gerència d'Àmbit d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Avinguda del Doctor Bassols, 112 - 130, 08914, Badalona, Spain.,Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol. CAP El Maresme, Camí del Mig, 36 planta 4a, 08303, Mataró, Spain.,Universitat Autònoma de Barcelona, Plaça Cívica, s/n, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Josep Maria Manresa Domínguez
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol. CAP El Maresme, Camí del Mig, 36 planta 4a, 08303, Mataró, Spain.,Universitat Autònoma de Barcelona, Plaça Cívica, s/n, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Enriqueta Pujol-Rivera
- Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, àtic, 08007, Barcelona, Spain
| | - Souhel Flayeh Beneyto
- Centre d'Atenció Primària Gran Sol, Gerència d'Àmbit d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Avinguda del Doctor Bassols, 112 - 130, 08914, Badalona, Spain
| | - Xavier Mundet Tuduri
- Universitat Autònoma de Barcelona, Plaça Cívica, s/n, 08193 Bellaterra, Cerdanyola del Vallès, Spain.,Unitat de Suport a la Recerca Barcelona Ciutat, IDIAP Jordi Gol, Carrer Sardenya 375, 08025, Barcelona, Spain
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona. Av. Tibidabo, 39-43, 08035, Barcelona, Spain.
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20
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Paul DL, McDaniel RR. Influences on teleconsultation project utilization rates: the role of dominant logic. BMC Med Inform Decis Mak 2016; 16:155. [PMID: 27931219 PMCID: PMC5146905 DOI: 10.1186/s12911-016-0392-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/22/2016] [Indexed: 01/18/2023] Open
Abstract
Background This research analyzes teleconsultation from both a mechanistic and complex adaptive system (CAS) dominant logic in order to further understand the influence of dominant logic on utilization rates of teleconsultation projects. In both dominant logics, the objective of teleconsultation projects is to increase access to and quality of healthcare delivery in a cost efficient manner. A mechanistic dominant logic perceives teleconsultation as closely resembling the traditional service delivery model, while a CAS dominant logic focuses on the system’s emergent behavior of learning resulting from the relationships and interactions of participating healthcare providers. Methods Qualitative case studies of 17 teleconsultation projects that were part of four health sciences center (HSC) based telemedicine networks was utilized. Data were collected at two points in time approximately 10 years apart. Semi-structured interviews of 85 key informants (clinicians, administrators, and IT professionals) involved in teleconsultation projects were the primary data collection method. Results The findings indicated that the emergent behavior of effective and sustainable teleconsultation projects differed significantly from what was anticipated in a mechanistic dominant logic. Teleconsultation projects whose emergent behavior focused on continuous learning enabled remote site generalists to manage and treat more complex cases and healthcare problems on their own without having to refer to HSC specialists for assistance. In teleconsultation projects that continued to be effectively utilized, participant roles evolved and were expanded. Further, technology requirements for teleconsultation projects whose emergent behavior was learning did not need to be terribly sophisticated. Conclusions When a teleconsultation project is designed with a mechanistic dominant logic, it is less likely to be sustained, whereas a teleconsultation project designed with a CAS dominant logic is more likely to be sustained. Consistent with a CAS dominant logic, teleconsultation projects that continued to be utilized involved participants taking on new roles and continuously learning. This continuous learning enabled remote site generalists to better handle the constantly changing nature of the problems faced. A CAS dominant logic provides a theoretical framework which explains why the teleconsultation literature about the role of technology, which is based on a mechanistic dominate logic, does not have adequate explanatory power. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0392-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David L Paul
- Department of Business Information and Analytics, Daniels College of Business, University of Denver, Denver, CO, USA.
| | - Reuben R McDaniel
- McCombs School of Business, The University of Texas at Austin, Austin, TX, USA
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21
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Zanaboni P, Wootton R. Adoption of routine telemedicine in Norwegian hospitals: progress over 5 years. BMC Health Serv Res 2016; 16:496. [PMID: 27644324 PMCID: PMC5028940 DOI: 10.1186/s12913-016-1743-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 09/13/2016] [Indexed: 11/25/2022] Open
Abstract
Background Although Norway is well known for its early use of telemedicine to provide services for people in rural and remote areas in the Arctic, little is known about the pace of telemedicine adoption in Norway. The aim of the present study was to explore the statewide implementation of telemedicine in Norwegian hospitals over time, and analyse its adoption and level of use. Methods Data on outpatient visits and telemedicine consultations delivered by Norwegian hospitals from 2009 to 2013 were collected from the national health registry. Data were stratified by health region, hospital, year, and clinical specialty. Results All four health regions used telemedicine, i.e. there was 100 % adoption at the regional level. The use of routine telemedicine differed between health regions, and telemedicine appeared to be used mostly in the regions of lower centrality and population density, such as Northern Norway. Only Central Norway seemed to be atypical. Twenty-one out of 28 hospitals reported using telemedicine, i.e. there was 75 % adoption at the hospital level. Neurosurgery and rehabilitation were the clinical specialties where telemedicine was used most frequently. Despite the growing trend and the high adoption, the relative use of telemedicine compared to that of outpatient visits was low. Conclusions Adoption of telemedicine is Norway was high, with all the health regions and most of the hospitals reporting using telemedicine. The use of telemedicine appeared to increase over the 5-year study period. However, the proportion of telemedicine consultations relative to the number of outpatient visits was low. The use of telemedicine in Norway was low in comparison with that reported in large-scale telemedicine networks in other countries. To facilitate future comparisons, data on adoption and utilisation over time should be reported routinely by statewide or network-based telemedicine services.
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, 9038, Tromsø, Norway.
| | - Richard Wootton
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, 9038, Tromsø, Norway.,Faculty of Health Sciences, The Arctic University of Norway, Langnes, P.O. Box 6050, 9037, Tromsø, Norway
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Oliviera DGD, Frias PGD, Vanderlei LCDM, Vidal SA, Novaes MDA, Souza WVD. [Analysis of the implementation of the TeleHealth Program in Pernambuco State, Brazil: a case study]. CAD SAUDE PUBLICA 2016; 31:2379-89. [PMID: 26840817 DOI: 10.1590/0102-311x00125914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 05/04/2015] [Indexed: 11/21/2022] Open
Abstract
The Network of TeleHealth Centers (RedeNutes) is part of the TeleHealth Brazil Program and conducts activities for the Family Health Strategy through the telecare and teleeducation services. The objective of this study was to evaluate the degree of implementation of RedeNutes in six municipalities (counties) in Pernambuco State. This was an evaluation study analyzing implementation in the second component, referring to analysis of the impact of implementation on the observed effects, backed by the multiple case study strategy. The analysis involved the manager, municipal, and global dimensions and their components: planning, development, portal, telecare, and teleeducation. In the Manager dimension, the degree of implementation was considered implemented; in the Municipal and Global dimensions, partially implemented; in the TeleCare component it was not implemented. In conclusion, TeleHealth can help improve comprehensive healthcare for the assisted population, but it requires overcoming problems with adherence to the intervention, especially in TeleCare.
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Paul DL, McDaniel RR. Facilitating telemedicine project sustainability in medically underserved areas: a healthcare provider participant perspective. BMC Health Serv Res 2016; 16:148. [PMID: 27112268 PMCID: PMC4845495 DOI: 10.1186/s12913-016-1401-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/18/2016] [Indexed: 11/18/2022] Open
Abstract
Background Very few telemedicine projects in medically underserved areas have been sustained over time. This research furthers understanding of telemedicine service sustainability by examining teleconsultation projects from the perspective of healthcare providers. Drivers influencing healthcare providers’ continued participation in teleconsultation projects and how projects can be designed to effectively and efficiently address these drivers is examined. Methods Case studies of fourteen teleconsultation projects that were part of two health sciences center (HSC) based telemedicine networks was utilized. Semi-structured interviews of 60 key informants (clinicians, administrators, and IT professionals) involved in teleconsultation projects were the primary data collection method. Results Two key drivers influenced providers’ continued participation. First was severe time constraints. Second was remote site healthcare providers’ (RSHCPs) sense of professional isolation. Two design steps to address these were identified. One involved implementing relatively simple technology and process solutions to make participation convenient. The more critical and difficult design step focused on designing teleconsultation projects for collaborative, active learning. This learning empowered participating RSHCPs by leveraging HSC specialists’ expertise. Conclusions In order to increase sustainability the fundamental purpose of teleconsultation projects needs to be re-conceptualized. Doing so requires HSC specialists and RSHCPs to assume new roles and highlights the importance of trust. By implementing these design steps, healthcare delivery in medically underserved areas can be positively impacted.
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Affiliation(s)
- David L Paul
- Department of Business Information and Analytics, Daniels College of Business, University of Denver, Denver, Colorado, USA.
| | - Reuben R McDaniel
- McCombs School of Business, The University of Texas at Austin, Austin, Texas, USA
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Peeters JM, Krijgsman JW, Brabers AE, Jong JDD, Friele RD. Use and Uptake of eHealth in General Practice: A Cross-Sectional Survey and Focus Group Study Among Health Care Users and General Practitioners. JMIR Med Inform 2016; 4:e11. [PMID: 27052805 PMCID: PMC4838754 DOI: 10.2196/medinform.4515] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/21/2015] [Accepted: 01/21/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Policy makers promote the use of eHealth to widen access to health care services and to improve the quality and safety of care. Nevertheless, the enthusiasm among policy makers for eHealth does not match its uptake and use. eHealth is defined in this study as "health services delivered or enhanced through the Internet and related information and communication technologies." OBJECTIVE The objective of this study was to investigate (1) the current use of eHealth in the Netherlands by general practitioners (GPs) and health care users, (2) the future plans of GPs to provide eHealth and the willingness of health care users to use eHealth services, and (3) the perceived positive effects and barriers from the perspective of GPs and health care users. METHODS A cross-sectional survey of a sample of Dutch GPs and members of the Dutch Health Care Consumer Panel was conducted in April 2014. A pre-structured questionnaire was completed by 171 GPs (12% response) and by 754 health care users (50% response). In addition, two focus groups were conducted in June 2014: one group with GPs (8 participants) and one with health care users (10 participants). RESULTS Three-quarters of Dutch GPs that responded to the questionnaire (67.3%, 115/171) offered patients the possibility of requesting a prescription via the Internet, and half of them offered patients the possibility of asking a question via the Internet (49.1%, 84/171). In general, they did intend to provide future eHealth services. Nonetheless, many of the GPs perceived barriers, especially concerning its innovation (eg, insufficient reliable, secure systems) and the sociopolitical context (eg, lack of financial compensation for the time spent on implementation). By contrast, health care users were generally not aware of existing eHealth services offered by their GPs. Nevertheless, half of them were willing to use eHealth services when offered by their GP. In general, health care users have positive attitudes regarding eHealth. One in five (20.6%, 148/718) health care users perceived barriers to the use of eHealth. These included concerns about the safety of health information obtained via the Internet (66.7%, 96/144) and privacy aspects (55.6%, 80/144). CONCLUSIONS GPs and health care users have generally positive attitudes towards eHealth, which is a prerequisite for the uptake of eHealth. But, general practitioners in particular perceive barriers to using eHealth and consider the implementation of eHealth to be complex. This study shows that there is room for improving awareness of eHealth services in primary care. It will take some time before these issues are resolved and eHealth can be fully adopted.
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Vitacca M, Fumagalli LP, Borghi G, Colombo F, Castelli A, Scalvini S, Masella C. Home-Based Telemanagement in Advanced COPD: Who Uses it Most? Real-Life Study in Lombardy. COPD 2016; 13:491-8. [PMID: 26765586 DOI: 10.3109/15412555.2015.1113243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Current evidence indicates that the benefits of tele-health may not be uniform across all patients. Therefore, to understand what specific variables influence use of home-based telemanagement in COPD, we conducted this retrospective study. A 6-month home-based telemanagement program (HTP) was offered to 1,074 COPD patients over a 4-year period. Multivarible linear regression analysis was used to identify predictors of HTP use/week (phone calls and specialist consultations) among all variables: clinical (body mass index, co-morbidities, HTP prescription not following an exacerbation, long-term oxygen therapy use, COPD severity, hospital readmissions, exacerbations and death), socio-demographic (sex, age, place of abode), smoking history, arterial blood gases (ABG), and specialist/general practitioner (GP) urgent need. Logistic regression was conducted to predict relapses/hospitalizations risk as well as the disease impact (COPD Assessment Test, CAT) at the end of the program. Presence of relapses (p < 0.001), ABGs (p < 0.001) and GP request (p < 0.001) were significantly associated with higher HTP-use. Smoking history (OR 1.542 [IC 95% 1.069-2.217], p = 0.020), specialist (OR 2.895 [2.144-3.910], p < 0.001) and GP consultations (OR 6.575 [4.521-9.561], p < 0.001) were the only independent risk factors for relapse. No predictor of hospitalization was found. High final CAT score was inversely related to oxygen therapy use (p = 0.001) and HTP prescription (p < 0.001), and positively related to presence of co-morbidities (p = 0.001) and baseline CAT (p < 0.001). This HTP in Lombardy shows that relapsers, people requiring several ABGs and urgent GP visits are the patient subgroup most likely to consume telemanagement services (scheduled and unscheduled). We propose a patient 'identikit' to improve prioritization for HTP prescriptions.
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Affiliation(s)
- Michele Vitacca
- a Salvatore Maugeri Foundation , IRCCS Institute of Care and Scientific Research , Lumezzane (Brescia) , Italy
| | - Lia Paola Fumagalli
- b Department of Management, Economics and Industrial Engineering , Politecnico di Milano , Milano , Italy
| | | | - Fausto Colombo
- d Respiratory Unit , Macchi Hospital Foundation , Varese , Italy
| | | | - Simonetta Scalvini
- a Salvatore Maugeri Foundation , IRCCS Institute of Care and Scientific Research , Lumezzane (Brescia) , Italy
| | - Cristina Masella
- b Department of Management, Economics and Industrial Engineering , Politecnico di Milano , Milano , Italy
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Implementation of a novel occupational and environmental medicine specialty teleconsultation service: the VHA experience. J Occup Environ Med 2015; 57:173-7. [PMID: 25654518 DOI: 10.1097/jom.0000000000000330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Occupational and environmental medicine (OEM) physician specialty practices continue to grow in scope and intensity across the Veterans Health Administration. This study characterizes the implementation of a novel, nationwide telemedicine program that provides OEM specialty consultation to providers across the Veterans Health Administration. METHODS We examined provider requests and specialist responses for a 6-month pilot from May to October 2013. Characteristics of consult users, determinants of case complexity, and specific applications of OEM specialty expertise were identified. RESULTS Over a 6-month period, employee occupational health providers consulted the OEM telemedicine pilot a total of 65 times. Employee occupational health providers without formal training repeatedly identified complex cases related to work and disability. CONCLUSIONS The program has created a new system management solution to deliver expert, in-depth consultation and real-time provider education in OEM.
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Lacasta Tintorer D, Flayeh Beneyto S, Manresa JM, Torán-Monserrat P, Jiménez-Zarco A, Torrent-Sellens J, Saigí-Rubió F. Understanding the discriminant factors that influence the adoption and use of clinical communities of practice: the ECOPIH case. BMC Health Serv Res 2015; 15:373. [PMID: 26358037 PMCID: PMC4566431 DOI: 10.1186/s12913-015-1036-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/04/2015] [Indexed: 11/24/2022] Open
Abstract
Background The aim of the study presented in this article is to analyse the discriminant factors that have an influence on the use of communities of practice by primary and specialist healthcare professionals (physicians and nurses) for information sharing. Obtaining evidence from an ex-ante analysis to determine what factors explain healthcare professionals’ clinical community of practice use allows aspects of its use to be identified. Methods A theoretical model based on a modified technology acceptance model was used as the analysis tool, and a discriminant analysis was performed. An ad-hoc questionnaire was designed and sent to a study population of 357 professionals from the Badalona-Sant Adrià de Besòs Primary Care Service in Catalonia, Spain, which includes nine primary care centres and three specialist care centres. The study sample was formed by the 166 healthcare professionals who responded. Results The results revealed three main drivers for engagement in a CoP: First, for the whole sample, perceived usefulness for reducing costs associated with clinical practice was the factor with the greatest discriminant power that distinguished between users and non-users, followed by perceived usefulness for improving clinical practice quality, and lastly habitual social media website and application use. Turning to the two sub-samples of healthcare professions (physicians and nurses, respectively), we saw that the usefulness stemming from community of practice use changed. There were differences in the levels of motivation of healthcare professionals with regards to their engagement with CoP. While perceived usefulness for reducing costs associated with clinical practice was the main factor for the physicians, perceived usefulness of the Web 2.0 platform use for communication for improving clinical practice quality and perceived ease of use were the main factors for the nurses. Conclusions In the context of communities of practice, the perception of usefulness of Web 2.0 platform use for communication is determined by organisational, technological and social factors. Specifically, the position that professionals have within the healthcare structure and particularly the closer healthcare professionals’ activity is to patients and their professional experience of using social networks and ICTs are crucial to explaining the use of such platforms. Public policies promoting Web 2.0 platform use for communication should therefore go beyond the purely technological dimension and consider other professional and social determinants.
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Affiliation(s)
- David Lacasta Tintorer
- Centre d'Atenció Primària la Salut, Institut Català de la Salut, Badalona, Spain. .,Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Santa Coloma de Gramenet, Spain. .,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.
| | | | - Josep Maria Manresa
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Santa Coloma de Gramenet, Spain. .,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Santa Coloma de Gramenet, Spain. .,Departament de Ciències Mèdiques, Universitat de Girona, Girona, Spain.
| | - Ana Jiménez-Zarco
- Economics and Business Studies and Internet Interdisciplinary Institute, Universitat Oberta de Catalunya, Barcelona, Spain.
| | - Joan Torrent-Sellens
- Economics and Business Studies and Internet Interdisciplinary Institute, Universitat Oberta de Catalunya, Barcelona, Spain.
| | - Francesc Saigí-Rubió
- Department of Health Sciences and Internet Interdisciplinary Institute, Universitat Oberta de Catalunya, Barcelona, Spain.
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Kirsh SR, Ho PM, Aron DC. Providing specialty consultant expertise to primary care: an expanding spectrum of modalities. Mayo Clin Proc 2014; 89:1416-26. [PMID: 24889514 DOI: 10.1016/j.mayocp.2014.04.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/11/2014] [Accepted: 04/16/2014] [Indexed: 01/18/2023]
Abstract
In most models of health care delivery, the bulk of services are provided in primary care and there is frequent request for the input of specialty consultants. A critical issue for current and future health care systems is the effective and efficient delivery of specialist expertise for clinicians and patients. Input on a patient's care from specialty consultants usually requires a face-to-face visit between the patient and the consultant. New and complementary models of knowledge sharing have emerged. We describe a framework assessment of a spectrum of knowledge-sharing methods in the context of a patient-centered medical home. This framework is based on our experience in the Veterans Health Administration and a purposive review of the literature. These newer modes of specialty consultation include electronic consultation, secure text messaging, telemedicine of various types, and population preemptive consults. In addition to describing these modes of consultation, our framework points to several important areas in which further research is needed to optimize effectiveness.
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Affiliation(s)
- Susan R Kirsh
- Office of Specialty Care, Veterans Health Administration, Washington, DC; Office of Specialty Care/VA HSR&D QUERI Evaluation Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - P Michael Ho
- Office of Specialty Care/VA HSR&D QUERI Evaluation Center, Eastern Colorado Health Care System Medical Center, Aurora, CO; Department of Medicine, School of Medicine, University of Colorado Denver, Aurora, CO
| | - David C Aron
- Office of Specialty Care/VA HSR&D QUERI Evaluation Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Organizational Behavior, Weatherhead School of Management, Cleveland, OH.
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Improving integrated care: modelling the performance of an online community of practice. Int J Integr Care 2014; 14:e007. [PMID: 24648835 PMCID: PMC3952812 DOI: 10.5334/ijic.1200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/29/2014] [Accepted: 02/02/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION THIS ARTICLE AIMS TO CONFIRM THE FOLLOWING CORE HYPOTHESIS: a Community of Practice's use of a Web 2.0 platform for communication between primary and hospital care leads to improved primary care and fewer hospital referrals. This core hypothesis will be corroborated by testing a further five partial hypotheses that complete the main hypothesis being estimated. METHODS An ad-hoc questionnaire was designed and sent to a sample group of 357 professionals from the Badalona-Sant Adrià de Besòs Primary Care Service in Catalonia, Spain, which includes nine primary care centres and three specialist care centres. The study sample was formed by 159 respondents. The partial least squares methodology was used to estimate the model of the causal relationship and the proposed hypotheses. RESULTS It was found that when healthcare staff used social networks and information and communication technologies professionally, and the more contact hours they have with patients, the more a Web 2.0 platform was likely to be used for communication between primary and hospital care professionals. Such use led to improved primary care and fewer hospital referrals according to the opinions of health professionals on its use. CONCLUSIONS The research suggests that the efficiency of medical practice is explained by the intensity of Web 2.0 platform use for communication between primary and specialist care professionals. Public policies promoting the use of information and communication technologies in communities of practice should go beyond the technological dimension and consider other professional, organisational and social determinants.
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Lacasta Tintorer D, Flayeh Beneyto S, Alzaga Reig X, Mundet Tuduri X, De la Fuente JA, Manresa JM, Torán Monserrat P, Saigí Rubió F. Impact of the implementation of an online network support tool among clinicians of primary health care and specialists: ECOPIH Project. BMC FAMILY PRACTICE 2013; 14:146. [PMID: 24088387 PMCID: PMC3852545 DOI: 10.1186/1471-2296-14-146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/30/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND There has been created an online communication tool with the objective to improve the communication among different levels of care, between Primary Care clinicians and Specialists. This tool is web 2.0 based technology (ECOPIH project). It allows to review clinical cases and to share knowledge. Our study will evaluate its impact in terms of reduction on the number of referrals to three specialties two years after the use of this tool. METHODS/DESIGN Open, multicenter, controlled, non random intervention study over 24 months. Study population includes 131 Primary Care Physicians assigned to nine health centers. The study will compare the clinicians that use the ECOPIH with the ones that do not use the tool. Also, professionals that start to use the tool during the period time of the study will be included.The number of annual referrals during the first and second year will be analyzed and retrospectively compared with the previous year to the implementation of the tool. Moreover, it will be assessed the level of satisfaction of the professionals with the tool and to what extend the tool responds to their needs. DISCUSSION The implementation of ECOPIH in the field of Primary Health Care can decrease the number of referrals from primary care to specialist care.It is expected that the reduction will be more noticeable in the group of professionals that use more intensively the tool. Furthermore, we believe that it can be also observed with the professionals that read the contributions of the others.We anticipate high degree of customer satisfaction as it is a very helpful resource never used before in our environment.
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Affiliation(s)
- David Lacasta Tintorer
- Centre d’Atenció Primària la Salut. Institut Català de la Salut, Passatge dels Encants s/n, 08914, Badalona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord. IDIAP Jordi Gol, Carrer Major 49-53, 08921, Santa Coloma de Gramenet, Spain
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193, Bellaterra, Cerdanyola del Vallès, Spain
| | - Souhel Flayeh Beneyto
- Centre d’Atenció Primària la Salut. Institut Català de la Salut, Passatge dels Encants s/n, 08914, Badalona, Spain
| | - Xavier Alzaga Reig
- Centre d’Atenció Primària Dr Robert. Institut Català de la Salut, Plaça de la Medicina s/n, 08911, Badalona, Spain
| | - Xavier Mundet Tuduri
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193, Bellaterra, Cerdanyola del Vallès, Spain
- Unitat de Suport a la Recerca Barcelona Ciutat. IDIAP Jordi Gol, Carrer Sardenya 375, 08025, Barcelona, Spain
| | - Josep Anton De la Fuente
- Centre d’Atenció Primària Dr Robert. Institut Català de la Salut, Plaça de la Medicina s/n, 08911, Badalona, Spain
| | - Josep Maria Manresa
- Unitat de Suport a la Recerca Metropolitana Nord. IDIAP Jordi Gol, Carrer Major 49-53, 08921, Santa Coloma de Gramenet, Spain
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193, Bellaterra, Cerdanyola del Vallès, Spain
| | - Pere Torán Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord. IDIAP Jordi Gol, Carrer Major 49-53, 08921, Santa Coloma de Gramenet, Spain
- Departament de Ciències Mèdiques, Universitat de Girona, Carrer Emili Grahit 77, 17071, Girona, Spain
| | - Francesc Saigí Rubió
- Universitat Oberta de Catalunya, Carrer Roc Boronat 117, 08018, Barcelona, Spain
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Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: Impact on professional practice. Int J Med Inform 2013; 82:684-95. [DOI: 10.1016/j.ijmedinf.2013.04.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 04/26/2013] [Accepted: 04/29/2013] [Indexed: 11/27/2022]
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Wade VA, Eliott JA, Hiller JE. A qualitative study of ethical, medico-legal and clinical governance matters in Australian telehealth services. J Telemed Telecare 2012; 18:109-14. [PMID: 22267306 DOI: 10.1258/jtt.2011.110808] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We examined how Australian telehealth service providers perceived and addressed ethical, medico-legal and clinical governance matters arising from service delivery. Thirty-seven telehealth clinicians and managers were interviewed and a qualitative content analysis was conducted. The services covered six Australian jurisdictions and a range of clinical disciplines. There were 11 medical specialities, surgery, mental health, paediatrics, nursing and allied health. Thirty services (83%) used video consulting and 25 (68%) delivered services to rural areas. Telehealth was reported to be beneficial by reducing adverse events, improving health outcomes, offering increased patient choice of service delivery, and improving access to services for rural areas and home care. There were observations of gains or no change in patient-provider rapport compared to face-to-face communication, with some patients reportedly preferring video. Those interviewed reported some problems with privacy and security, and variable informed consent practices. No examples of malpractice were raised, although there was a common misperception that distant providers were not responsible for clinical care. With respect to clinical governance, telehealth was seen as enabling improved quality, integration and implementation of evidence-based care, and to be a major support for the rural health workforce. Although there were potential ethical, medico-legal and governance problems in Australian telehealth services, these had been easily managed in practice.
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Affiliation(s)
- Victoria A Wade
- Discipline of Public Health, University of Adelaide, South Australia.
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Zanaboni P, Lettieri E. Institutionalizing telemedicine applications: the challenge of legitimizing decision-making. J Med Internet Res 2011; 13:e72. [PMID: 21955510 PMCID: PMC3222171 DOI: 10.2196/jmir.1669] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 05/19/2011] [Accepted: 05/18/2011] [Indexed: 12/26/2022] Open
Abstract
During the last decades a variety of telemedicine applications have been trialed worldwide. However, telemedicine is still an example of major potential benefits that have not been fully attained. Health care regulators are still debating why institutionalizing telemedicine applications on a large scale has been so difficult and why health care professionals are often averse or indifferent to telemedicine applications, thus preventing them from becoming part of everyday clinical routines. We believe that the lack of consolidated procedures for supporting decision making by health care regulators is a major weakness. We aim to further the current debate on how to legitimize decision making about the institutionalization of telemedicine applications on a large scale. We discuss (1) three main requirements--rationality, fairness, and efficiency--that should underpin decision making so that the relevant stakeholders perceive them as being legitimate, and (2) the domains and criteria for comparing and assessing telemedicine applications--benefits and sustainability. According to these requirements and criteria, we illustrate a possible reference process for legitimate decision making about which telemedicine applications to implement on a large scale. This process adopts the health care regulators' perspective and is made up of 2 subsequent stages, in which a preliminary proposal and then a full proposal are reviewed.
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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Waldura JF, Neff S, Goldschmidt RH. Teleconsultation for clinicians who provide human immunodeficiency virus care: experience of the national HIV telephone consultation service. Telemed J E Health 2011; 17:472-7. [PMID: 21612517 DOI: 10.1089/tmj.2010.0210] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine the infrastructure, successes, and challenges of a teleconsultation service for human immunodeficiency virus (HIV) clinicians. MATERIALS AND METHODS The HIV Warmline is a telephone consultation service providing free, live HIV/AIDS management advice to U.S. clinicians. We present descriptive data about callers, patients, and consultation topics gathered by electronic query of the HIV Warmline database for 2009. Caller satisfaction survey results for 2009 are also presented. RESULTS The HIV Warmline has provided more than 37,000 consultations since its inception in 1992. The service provides consultations to clinicians from all 50 states, from a variety of professional backgrounds, and with a wide range of HIV experience levels. The majority of call topics concern antiretroviral therapy. Callers are generally pleased with the service, giving a mean Likert scale rating of 4.7 on satisfaction survey questions. CONCLUSION The experience of the HIV Warmline can serve as a model for other programs planning to develop remote consultation systems. HIV teleconsultation has been relatively simple to implement and can be useful for many types of clinicians. HIV teleconsultation should continue to be evaluated as a way to improve HIV care, especially in areas without easy access to HIV expertise.
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Affiliation(s)
- Jessica F Waldura
- Department of Family and Community Medicine, National HIV/AIDS Clinicians' Consultation Center (NCCC), San Francisco General Hospital, University of California, San Francisco, California, USA
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Abstract
PURPOSE The Stollery Children's Hospital serves a very large geographic region of over at least 650,000 km² with patients from outside of Edmonton accounting for approximately 50% of the service population. The aim of this study is to document the experience and opinion of the patient and clinician satisfaction with telehealth encounter for various pediatric surgical consultations and follow-up as a way to bridge the distance gap. METHODS We observe our experience with recent telehealth implementation from 2008 to 2009. Qualitative data were collected through questionnaires aimed at patients and clinicians. RESULTS There were 259 pediatric surgical telehealth encounters, of which 37% were from outside the province. There were 42 antenatal multidisciplinary, 13 chronic pain, 103 general surgery, 2 orthopedic, 63 urology, 33 head and shape nurse practioner clinic, and 3 neurosurgery consults. 83 patient and 12 clinician questionnaires were completed. 97% of patients and 73% of clinicians reported satisfaction with having a telehealth session. 97% of the patients reside more than 200 km from the city and 77% live more than 400 km away. 48% reported a cost saving >$500-$700. CONCLUSION Telehealth for pediatric surgical services is an alternative as an acceptable, effective, and appropriate way to consult and follow-up pediatric patients who live in significantly remote areas with great clinician and patient satisfaction.
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Tung EE, Vickers KS, Lackore K, Cabanela R, Hathaway J, Chaudhry R. Clinical Decision Support Technology to Increase Advance Care Planning in the Primary Care Setting. Am J Hosp Palliat Care 2010; 28:230-5. [DOI: 10.1177/1049909110386045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Physicians are often unable to guide patients through the advance care planning (ACP) process due to cost and time constraints. We conducted a retrospective analysis in the primary care setting targeting older adults without an advance medical directive (AMD). An ACP educational packet was sent to intervention patients before their health maintenance examination (HME). Additionally, their physicians had access to a computerized clinical decision support system on AMD completion at the time of the HME. Control participants’ physicians had access to the computerized decision support system and traditional resources only. All participants who received the packet were sent a follow-up survey. In all, 21.6% of intervention participants completed an AMD, compared with 4.1% of control participants. Combining clinical decision support systems and standardized processes enhances the ACP process.
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Affiliation(s)
- Ericka E. Tung
- Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine,
Rochester, MN, USA,
| | - Kristin S. Vickers
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine,
Rochester, MN, USA
| | - Kandace Lackore
- Healthcare Policy and Research, Mayo Clinic College of Medicine, Rochester, MN,
USA
| | - Rosa Cabanela
- Healthcare Policy and Research, Mayo Clinic College of Medicine, Rochester, MN,
USA
| | - Julie Hathaway
- Department of Patient and Health Education, Mayo Clinic College of Medicine,
Rochester, MN, USA
| | - Rajeev Chaudhry
- Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine,
Rochester, MN, USA
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