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Kleinschmidt L, Walendzik A, Wasem J, Höfer K, Nauendorf B, Brittner M, Brandenburg P, Aeustergerling A, Schneider U, Wadeck A, Sehlen S, Liersch S, Schwarze K, Schwenke C, Hüer T. Preference-Based Implementation of Video Consultations in Urban and Rural Regions in Outpatient Care in Germany: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e50932. [PMID: 38602749 PMCID: PMC11046389 DOI: 10.2196/50932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/07/2023] [Accepted: 11/29/2023] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Particularly in rural regions, factors such as lower physician density and long travel distances complicate adequate outpatient care. However, urban regions can also be affected by deficits in care, for example, long waiting times. One model of care intending to improve the situation is the implementation of video consultations. The study protocol presents the methodology of the research project titled "Preference-based implementation of the video consultation in urban and rural regions" funded by the German Federal Joint Committee (funding number 01VSF20011). OBJECTIVE This study aims to identify existing barriers to the use of video consultation and the preferences of insured individuals and physicians as well as psychotherapists in order to optimize its design and thus increase acceptance and use of video consultations in urban and rural regions. METHODS Built on a mixed methods approach, this study first assesses the status quo of video consultation use through claims data analysis and carries out a systematic literature review on barriers and promoting factors for the use of video consultations. Based on this preliminary work, focus groups are conducted in order to prepare surveys with insureds as well as physicians and psychotherapists in the second study phase. The central element of the survey is the implementation of discrete choice experiments to elicit relevant preferences of (potential) user groups and service providers. The summarized findings are discussed in a stakeholder workshop and translated into health policy recommendations. RESULTS The methodological approach used in this study is the focus of this paper. The study is still ongoing and will continue until March 2024. The first study phase has already been completed, in which preliminary work has been done on potential applications and hurdles for the use of video consultations. Currently, the survey is being conducted and analyses are being prepared. CONCLUSIONS This study is intended to develop a targeted strategy for health policy makers based on actual preferences and perceived obstacles to the use of video consultations. The results of this study will contribute to further user-oriented development of the implementation of video consultations in German statutory health insurance. Furthermore, the iterative and mixed methods approach used in this study protocol is also suitable for a variety of other research projects. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50932.
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Affiliation(s)
- Lara Kleinschmidt
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Anke Walendzik
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Jürgen Wasem
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Klemens Höfer
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | | | | | - Paul Brandenburg
- Kassenärztliche Vereinigung Schleswig-Holstein, Bad Segeberg, Germany
| | | | | | | | | | | | | | | | - Theresa Hüer
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
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Dryden EM, Anwar C, Conti J, Boudreau JH, Kennedy MA, Hung WW, Nearing KA, Pimentel CB, Moo L. The Development and Use of a New Visual Tool (REVISIT) to Support Participant Recall: Web-Based Interview Study Among Older Adults. JMIR Form Res 2024; 8:e52096. [PMID: 38300691 PMCID: PMC10870211 DOI: 10.2196/52096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Qualitative health services research often relies on semistructured or in-depth interviews to develop a deeper understanding of patient experiences, motivations, and perspectives. The quality of data gathered is contingent upon a patient's recall capacity; yet, studies have shown that recall of medical information is low. Threats to generating rich and detailed interview data may be more prevalent when interviewing older adults. OBJECTIVE We developed and studied the feasibility of using a tool, Remembering Healthcare Encounters Visually and Interactively (REVISIT), which has been created to aid the recall of a specific telemedicine encounter to provide health services research teams with a visual tool, to improve qualitative interviews with older adults. METHODS The REVISIT visual appointment summary was developed to facilitate web-based interviews with our participants as part of an evaluation of a geriatric telemedicine program. Our primary aims were to aid participant recall, maintain focus on the index visit, and establish a shared understanding of the visit between participants and interviewers. The authors' experiences and observations developing REVISIT and using it during videoconference interviews (N=16) were systematically documented and synthesized. We discuss these experiences with REVISIT and suggest considerations for broader implementation and future research to expand upon this preliminary work. RESULTS REVISIT enhanced the interview process by providing a focus and catalyst for discussion and supporting rapport-building with participants. REVISIT appeared to support older patients' and caregivers' recollection of a clinical visit, helping them to share additional details about their experience. REVISIT was difficult to read for some participants, however, and could not be used for phone interviews. CONCLUSIONS REVISIT is a promising tool to enhance the quality of data collected during interviews with older, rural adults and caregivers about a health care encounter. This novel tool may aid recall of health care experiences for those groups for whom it may be more challenging to collect accurate, rich qualitative data (eg, those with cognitive impairment or complex medical care), allowing health services research to include more diverse patient experiences.
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Affiliation(s)
- Eileen M Dryden
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Veterans Health Administration, Bedford, MA, United States
| | - Chitra Anwar
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Veterans Health Administration, Bedford, MA, United States
| | - Jennifer Conti
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Veterans Health Administration, Bedford, MA, United States
| | - Jacqueline H Boudreau
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Veterans Health Administration, Bedford, MA, United States
| | - Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Veterans Health Administration, Bedford, MA, United States
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
| | - William W Hung
- Bronx Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Veterans Health Administration, Bronx, NY, United States
- Icahn School of Medicine, New York, NY, United States
| | - Kathryn A Nearing
- Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Veterans Health Administration, Aurora, CO, United States
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Camilla B Pimentel
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Veterans Health Administration, Bedford, MA, United States
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Veterans Health Administration, Bedford, MA, United States
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Lauren Moo
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Veterans Health Administration, Bedford, MA, United States
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Veterans Health Administration, Bedford, MA, United States
- Harvard Medical School, Boston, MA, United States
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Liao J, Jiang M, Liu J, Zhou X, Zhang Z, Rao Q, Bai L, Hou X. Developing a Quality Evaluation Index System for E-Consultation Doctor-Patient Communication Using the Delphi Method. J Multidiscip Healthc 2023; 16:3493-3506. [PMID: 38024131 PMCID: PMC10658931 DOI: 10.2147/jmdh.s433224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background E-consultation medical services have become popular globally, which offers patients more options, regardless of time or location. However, research indicates a prevalent issue with the communication quality in e-consultations, leading to sub-optimal patient experiences. Objective This study aims to design an evaluation system for e-consultation quality. The developed scale guides operators in improving services and users in assessing their experience. It aids in selecting e-consultation services, saving costs, and assisting doctors in making informed decisions. Methods This study combines existing scales, literature analysis, and expert consultation to form preliminary evaluation indicators. Fourteen experts were invited using stratified purposive sampling. Two rounds of Delphi method were conducted to exclude indicators that did not meet basic conditions. The final evaluation system was determined through expert discussions and revisions. The Analytic Hierarchy Process (AHP) quantified indicator weights. Results Both rounds of the questionnaire saw compelling response rates of 100% (14 out of 14) and 92.86% (13 out of 14), respectively. Meanwhile, the Expert Authority Coefficient (Cr) was recorded at 0.89 and 0.88, respectively, while the Kendall Consistency Coefficient (Kendall W) for all level indicators fluctuated between 0.133 and 0.37 (P<0.05). The ultimate indicator system formulated includes three primary indicators, ten secondary indicators, and thirty-two tertiary indicators. The highest to lowest weighted first-level indicators were 'Joint Decision-Making between Doctors and Patients' (0.6232), 'Patient Responsiveness' (0.2395), and "Interpersonal Relationship between Doctors and Patients" (0.1373). Weights for the second-level and third-level indicators were also determined. Conclusion A scientific scale for e-consultation quality evaluation has been created, which effectively captures the essence of online medical communication and patient experiences. It enriches the theoretical framework for evaluating e-consultation quality, broadens perspectives in Internet medicine, provides practical guidance for network medical service managers and users and the development of the "Internet + medical health" service model.
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Affiliation(s)
- Jing Liao
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Mengyao Jiang
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Jiaxiu Liu
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Xiaoyu Zhou
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Zuyue Zhang
- Chengdu Blood Center, Chengdu, 610041, People’s Republic of China
| | - Qingmao Rao
- Educational Affairs Office, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610065, People’s Republic of China
| | - Li Bai
- Hospital of Zigong Mental Health Central, Zigong, Sichuan, People’s Republic of China
| | - Xiaorong Hou
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
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Mazouri-Karker S, Lüchinger R, Braillard O, Bajwa N, Achab S, Hudelson P, Dominicé Dao M, Junod Perron N. Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians. JMIR Hum Factors 2023; 10:e50740. [PMID: 37934574 PMCID: PMC10664018 DOI: 10.2196/50740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/12/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND While the use of telemedicine (TLM) increased worldwide during the early phases of the COVID-19 pandemic, little is known about the use and acceptance of TLM post the COVID-19 pandemic. OBJECTIVE This study aims to evaluate patients' and physicians' self-reported use, preferences, and acceptability of different types of TLM after the initial phases of the COVID-19 pandemic. METHODS We conducted a cross-sectional survey among patients and physicians in Geneva, Switzerland, between September 2021 and January 2022. Patients in waiting rooms of both private and public medical centers and emergency services were invited to answer a web-based questionnaire. Physicians working in private and public settings were invited by email to answer a similar questionnaire. The questionnaires assessed participants' sociodemographics and digital literacy; self-reported use of TLM; as well as preferences and acceptability of TLM for different clinical situations. RESULTS A total of 567 patients (309/567, 55% women) and 448 physicians (230/448, 51% women and 225/448, 50% in private practice) responded to the questionnaire. Patients (263/567, 46.5%) and physicians (247/448, 55.2%) generally preferred the phone over other TLM formats and considered it to be acceptable for most medical situations. Email (417/567, 73.6% and 308/448, 68.8%) was acceptable for communicating exam results, and medical certificates (327/567, 67.7% and 297/448, 66.2%) and video (302/567, 53.2% and 288/448, 64.3%) was considered acceptable for psychological support by patients and physicians, respectively. Older age was associated with lower acceptability of video for both patients and physicians (odds ratio [OR] 0.03, 95% CI 0.00-0.33 and OR 0.23, 95% CI 0.08-0.66) while previous use of video was positively associated with video acceptability (OR 3.16, 95% CI 1.84-5.43 and OR 3.34, 95% CI 2.91-5.54). Psychiatrists and hospital physicians were more likely to consider video to be acceptable (OR 10.79, 95% CI 3.96-29.30 and OR 3.97, 95% CI 2.23-7.60). CONCLUSIONS Despite the development of video, the acceptability of video remains lower than that of the phone for most health issues or patient requests. There is a need to better define for which patients and in which medical situations video can become safe and efficient.
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Affiliation(s)
- Sanae Mazouri-Karker
- E-health and Telemedicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Lüchinger
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivia Braillard
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Bajwa
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of General Pediatrics at the Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Sophia Achab
- Treatment Centre ReConnecte, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Clinical and Sociological Research Unit, WHO Collaborating Centre for Training and Research in Mental Health, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Melissa Dominicé Dao
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Noelle Junod Perron
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Medical Directory, Geneva University Hospitals, Geneva, Switzerland
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Peeters K, Giroldi E, Veldhuizen L, Abdelaziz K, Muris D, Cals J. General Practitioner Use of e-Consultation to Consult Hospital Specialists: Interview Study to Obtain Physician's Perceptions About Digital Interprofessional Communication. J Med Internet Res 2023; 25:e40318. [PMID: 36976626 PMCID: PMC10131626 DOI: 10.2196/40318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/11/2022] [Accepted: 12/19/2022] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND In recent years, tasks have shifted from specialized hospital care to primary care, leading to both advantages and challenges for general practitioners (GPs). A frequently mentioned tool to face these challenges is e-consultation, a form of asynchronous digital interprofessional communication between GPs and hospital specialists. OBJECTIVE The objective of this study was to gain insight into GPs' and hospital specialists' views and experiences of e-consultation. METHODS We interviewed 47% (15/32) GPs and 53% (17/32) hospital specialists and performed a thematic analysis. RESULTS We found that both GPs and hospital specialists experience a positive effect on the quality of care and collaboration between GPs and hospital specialists. Positive effects were reported on the accessibility of care, efficiency of care, and relationship between the GP and the patient. Furthermore, communication between GP and hospital specialist became more efficient, and e-consultation offered educational value for the GP. Certain improvements are needed to further optimize e-consultation, regarding applicability, communication, and training purposes. CONCLUSIONS In the future, clinicians and policy makers can use the insights gained from this study to further optimize and implement e-consultation in clinical practice.
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Affiliation(s)
- Ken Peeters
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Zuyderland Medical Centre, Sittard, Netherlands
- Medical Coordination Centre Omnes, Sittard, Netherlands
| | - Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department Educational Development & Research, School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Lotte Veldhuizen
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Kahin Abdelaziz
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Dennis Muris
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Medical Coordination Centre Omnes, Sittard, Netherlands
| | - Jochen Cals
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Kristiansen E, Atherton H, Austad B, Bergmo T, Norberg BL, Zanaboni P. Older patients' experiences of access to and use of e-consultations with the general practitioner in Norway: an interview study. Scand J Prim Health Care 2023; 41:33-42. [PMID: 36592342 PMCID: PMC10088919 DOI: 10.1080/02813432.2022.2161307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To explore older patients' experiences with accessing and using e-consultations to send text-based clinical inquiries to the general practitioner (GP) online. DESIGN Qualitative study based on semi-structured interviews. Results were analysed through a six-phase thematic analysis and interpreted through Levesque's framework of patient-centred access to health care. SETTING General practice in Norway. SUBJECTS Patients aged over 65 years (n = 16) with experience in using e-consultations. RESULTS Respondents considered e-consultations as an integrated part of general practice which helped them achieve better access to health care. We identified four themes describing older patients' access to and use of e-consultations: 1) the importance of digital health literacy to learn about and use the service - and the fear of losing it, 2) the high availability of the service as the main advantage, due to the perceived unavailability of physical GP services, 3) the importance of voluntary use of e-consultations, 4) the importance of a trusting relationship with the GP. IMPLICATIONS Information about e-consultations and guidelines for suitable use are recommended to ensure equal access to all patients, regardless of their digital health literacy. Availability problems and high work burdens for the GPs could affect the patients' choice for using e-consultations. If e-consultations are used for triage purposes, caution should be taken to avoid a shift in workload from the health secretary to the GP.Key points of articleThe extended use of e-consultations with the general practitioner has raised concerns that the service may not be accessible and suitable for older patients.For older users, e-consultations can represent a positive addition to physical consultation forms due to the high availability of the service in a general practice setting characterised by long waiting times.Digital health literacy is essential to learn about and use the service. Information about the service and how to use it should be available to all patients to ensure equal access.A trusting relationship with the GP is described as essential for older patients to perceive the outcome of e-consultations as appropriate and safe.
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Affiliation(s)
- Eli Kristiansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical School, UK
| | - Bjarne Austad
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Bergmo
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Børge Lønnebakke Norberg
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Perez-Rivera ND, Chang G. E-consultation for medications to treat opioid use disorders: a pilot study. J Addict Dis 2022; 40:428-431. [PMID: 35157563 DOI: 10.1080/10550887.2021.2020044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES An electronic consultation to provide expert guidance on medications to treat opioid use disorders [MOUD] was piloted. METHODS Medical record review of the first 100 unique patients receiving consultation with 6-month follow-up. Descriptive statistics, chi-square, and Fisher's exact tests of significance were calculated as appropriate. RESULTS Most consultation requests originated from inpatient psychiatry (66%). Patients (67%) and consultants (33%) preferred buprenorphine/naloxone most often (p < 0.0001). Half of the patients received MOUD prior to discharge. Three quarters of the half who kept their first outpatient appointments received the recommended treatment (p < 0.0001). At 6 months, four patients died and four others overdosed only. Type of MOUD was not associated with either overdose or death, but those who overdosed used cannabis, sedative-hypnotics, or stimulants (all, p < 0 .05). DISCUSSION AND CONCLUSIONS Guidance for MOUD offered via e-consultation may have increased outpatient treatment engagement following inpatient treatment.
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Affiliation(s)
- Natasha D Perez-Rivera
- VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Grace Chang
- VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Ionescu A, de Jong PGM, Drop SLS, van Kampen SC. A scoping review of the use of e-learning and e-consultation for healthcare workers in low- and middle-income countries and their potential complementarity. J Am Med Inform Assoc 2021; 29:713-722. [PMID: 34966930 PMCID: PMC8922198 DOI: 10.1093/jamia/ocab271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Although the provision of e-learning (EL) training for healthcare workers (HCWs) and provider-to-HCW e-consultation (EC) is considered useful for health outcomes, research on their joint use is limited. This scoping review aimed to create an overview of what is currently known in the literature about the use and implementation of EC and EL by HCWs in LMICs and to answer the question of whether there is evidence of complementarity. MATERIALS AND METHODS Scientific databases were searched and peer-reviewed papers were reviewed systematically according to predefined inclusion/exclusion criteria. Data were extracted including the study focus (EC/EL), year of publication, geographical location, target population, target disease(s) under study, type(s) of study outcomes, and article type. RESULTS A total of 3051 articles were retrieved and screened for eligibility, of which 96 were kept for analysis. Of these, only 3 addressed both EL and EC; 54 studies addressed EL; and 39 addressed EC. Most studies looked at gain in knowledge/skills usability, efficiency, competence, and satisfaction of HCW, or barriers/challenges to implementation. Descriptive studies focused on the application of EL or EC for targeting specific health conditions. Factors contributing to the success of EC or EL networks were institutional anchoring, multiple partnership, and capacity building of local experts. CONCLUSIONS Our review found an important gap in the literature in relation to the complementary role of EL and EC for HCWs in LMICs evidenced by outcome measures. There is an important role for national and international academic institutions, learned medical societies, and networks to support regional experts in providing EL and EC for added value that will help the clinical performance of HCWs and improve health outcomes.
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Affiliation(s)
- Alma Ionescu
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter G M de Jong
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Stenvert L S Drop
- Division of Endocrinology, Department of Pediatrics, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands,Corresponding Author: Stenvert L.S. Drop, MD, PhD, Division of Endocrinology, Department of Pediatrics, Sophia Children’s Hospital, Erasmus MC, Sp2430, PO Box 2060, Rotterdam 3000 CB, The Netherlands;
| | - Sanne C van Kampen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Nilsson E, Sverker A, Bendtsen P, Eldh AC. A Human, Organization, and Technology Perspective on Patients' Experiences of a Chat-Based and Automated Medical History-Taking Service in Primary Health Care: Interview Study Among Primary Care Patients. J Med Internet Res 2021; 23:e29868. [PMID: 34661544 PMCID: PMC8561406 DOI: 10.2196/29868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/02/2021] [Accepted: 07/27/2021] [Indexed: 01/26/2023] Open
Abstract
Background The use of e-visits in health care is progressing rapidly worldwide. To date, studies on the advantages and disadvantages of e-consultations in the form of chat services for all inquiries in primary care have focused on the perspective of health care professionals (HCPs) rather than those of end users (patients). Objective This study aims to explore patients’ experiences using a chat-based and automated medical history–taking service in regular, tax-based, not-for-profit primary care in Sweden. Methods Overall, 25 individual interviews were conducted with patients in the catchment areas of 5 primary care centers (PCCs) in Sweden that tested a chat-based and automated medical history–taking service for all types of patient inquiries. The semistructured interviews were transcribed verbatim before content analysis using inductive and deductive strategies, the latter including an unconstrained matrix of human, organization, and technology perspectives. Results The service provided an easily managed way for patients to make written contact with HCPs, which was considered beneficial for some patients and issues but less suitable for others (acute or more complex cases). The automated medical history–taking service was perceived as having potential but still derived from what HCPs need to know and how they address and communicate health and health care issues. Technical skills were not considered as necessary for a mobile phone chat as for handling a computer; however, patients still expressed concern for people with less digital literacy. The opportunity to take one’s time and reflect on one’s situation before answering questions from the HCPs was found to reduce stress and prevent errors, and patients speculated that it might be the same for the HCPs on the other end of the system. Patients appreciated the ability to have a conversation from almost anywhere, even from places not suitable for telephone calls. The asynchronicity of the chat service allowed the patients to take more control of the conversation and initiate a chat at any time at their own convenience; however, it could also lead to lengthy conversations where a single issue in the worst cases could take days to close. The opportunity to upload photographs made some visits to the PCC redundant, which would otherwise have been necessary if the ordinary telephone service had been used, saving patients both time and money. Conclusions Patients generally had a positive attitude toward e-visits in primary care and were generally pleased with the prospects of the digital tool tested, somewhat more with the actual chat than with the automated history-taking system preceding the chat. Although patients expect their PCC to offer a range of different means of communication, the human, organization, and technology analysis revealed a need for more extensive (end) user experience design in the further development of the chat service.
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Affiliation(s)
- Evalill Nilsson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Annette Sverker
- Department of Activity and Health and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Medical Specialists in Motala and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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10
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Solans O, Vidal-Alaball J, Roig Cabo P, Mora N, Coma E, Bonet Simó JM, Hermosilla Pérez E, Saigí-Rubió F, Olmos Domínguez C, Piera-Jiménez J, Abizanda González M, López Seguí F. Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study. J Med Internet Res 2021; 23:e28629. [PMID: 33970867 PMCID: PMC8163495 DOI: 10.2196/28629] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background eConsulta—that is, asynchronous, two-way teleconsultation in primary care—is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system. Objective This study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic. Methods A descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them. Results During the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas. Conclusions The COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity.
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Affiliation(s)
- Oscar Solans
- Health Department, Catalan Ministry of Health, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System, Sistema de Salut de Catalunya, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain.,Faculty of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
| | - Pasqual Roig Cabo
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, Spain
| | - Núria Mora
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Ermengol Coma
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Josep Maria Bonet Simó
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, Spain
| | - Eduardo Hermosilla Pérez
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain.,Jordi Gol i Gurina Primary Health Care Research Institute Foundation, Barcelona, Spain
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Interdisciplinary Research Group on ICTs, Barcelona, Spain
| | | | - Jordi Piera-Jiménez
- Digitalization for the Sustainability of the Healthcare System, Sistema de Salut de Catalunya, Barcelona, Spain.,Servei Català de la Salut, Barcelona, Spain.,Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Mercè Abizanda González
- Health Department, eHealth Unit, Barcelona, Spain.,Pere Virgili Health Park, Primary Care Management Control, Barcelona, Spain
| | - Francesc López Seguí
- Northern Metropolitan Primary Care Directorate, Institut Català de la Salut, Badalona, Spain.,Centre de Recerca en Economia i Salut, Pompeu Fabra University, Barcelona, Spain
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11
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Shah AM, Naqvi RA, Jeong OR. The Impact of Signals Transmission on Patients' Choice through E-Consultation Websites: An Econometric Analysis of Secondary Datasets. Int J Environ Res Public Health 2021; 18:5192. [PMID: 34068291 PMCID: PMC8153351 DOI: 10.3390/ijerph18105192] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/14/2022]
Abstract
(1) Background: The COVID-19 pandemic has dramatically and rapidly changed the overall picture of healthcare in the way how doctors care for their patients. Due to the significant strain on hospitals and medical facilities, the popularity of web-based medical consultation has drawn the focus of researchers during the deadly coronavirus disease (COVID-19) in the United States. Healthcare organizations are now reacting to COVID-19 by rapidly adopting new tools and innovations such as e-consultation platforms, which refer to the delivery of healthcare services digitally or remotely using digital technology to treat patients. However, patients' utilization of different signal transmission mechanisms to seek medical advice through e-consultation websites has not been discussed during the pandemic. This paper examines the impact of different online signals (online reputation and online effort), offline signals (offline reputation) and disease risk on patients' physician selection choice for e-consultation during the COVID-19 crisis. (2) Methods: Drawing on signaling theory, a theoretical model was developed to explore the antecedents of patients' e-consultation choice toward a specific physician. The model was tested using 3-times panel data sets, covering 4231 physicians on Healthgrades and Vitals websites during the pandemic months of January, March and May 2020. (3) Results: The findings suggested that online reputation, online effort and disease risk were positively related to patients' online physician selection. The disease risk has also affected patients' e-consultation choice. A high-risk disease positively moderates the relationship between online reputation and patients' e-consultation choice, which means market signals (online reputation) are more influential than seller signals (offline reputation and online effort). Hence, market signals strengthened the effect in the case of high-risk disease. (4) Conclusions: The findings of this study provide practical suggestions for physicians, platform developers and policymakers in online environments to improve their service quality during the crisis. This article offers a practical guide on using emerging technology to provide virtual care during the pandemic. This study also provides implications for government officials and doctors on the potentials of consolidating virtual care solutions in the near future in order to contribute to the integration of emerging technology into healthcare.
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Affiliation(s)
- Adnan Muhammad Shah
- Department of Information Technology, University of Sialkot, Sialkot 51310, Pakistan
| | - Rizwan Ali Naqvi
- Department of Unmanned Vehicle Engineering, Sejong University, Seoul 05006, Korea;
| | - Ok-Ran Jeong
- School of Computing, Gachon University, Seongnam 13120, Korea
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12
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Bhanot N, Dimitriou G, McAninch L, Rossi C, Thompson D, Manzi S. Perspectives of Health Care Providers in an Integrated Health Care Delivery Network on Inpatient Electronic Consultation (e-Consult) Use During the COVID-19 Pandemic. J Patient Exp 2021; 8:23743735211007696. [PMID: 34179421 PMCID: PMC8205354 DOI: 10.1177/23743735211007696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A large academic hospital system (Allegheny Health Network) introduced inpatient electronic consultations (e-Consults) during the COVID-19 crisis. Providers were invited to complete an anonymous survey on their perceptions of e-Consults. Descriptive statistics were used to analyze Likert-scale data. Cronbach’s alpha was used to assess internal consistency. Ninety-five providers completed the survey. Requesting and consulting providers agreed that e-Consults were easy to use (100% and 96.2%, respectively). Both groups also concurred that e-Consults either decreased or did not significantly impact their workload (81% and 74%, respectively) and that training was appropriate (77.8% and 86.8%, respectively). The advantage and barrier selected most frequently by specialists was “timelier completion of the consult versus in-person” and “inadequate information to complete the consult,” respectively. The disadvantage selected most frequently by requesting physicians was “lack of communication between providers.” Open-ended comments were categorized into themes. Concerns were raised regarding whether provider–provider communication via this platform offered enough information to make recommendations compared to traditional encounters. The perceived benefits and barriers of e-Consults should be further explored with the goal of improving patient care delivery and provider satisfaction.
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Affiliation(s)
- Nitin Bhanot
- Division of Infectious Disease, Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - George Dimitriou
- Department of Internal Medicine, Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Lori McAninch
- Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Caitlan Rossi
- Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Diane Thompson
- Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Susan Manzi
- Medicine and the Autoimmunity Institute, Allegheny Health Network, Pittsburgh, PA, USA
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13
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Qi M, Cui J, Li X, Han Y. Perceived Factors Influencing the Public Intention to Use E-Consultation: Analysis of Web-Based Survey Data. J Med Internet Res 2021; 23:e21834. [PMID: 33470934 PMCID: PMC7857952 DOI: 10.2196/21834] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/24/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background Unbalanced distribution of medical resources is becoming a major challenge, particularly in the selection of doctors. e-Consultation could provide patients with more choices of doctors and break the constraints of time and space. However, the acceptance of e-consultation is still poor and the mechanism of adoption is unclear. Objective The aim of this study was to identify the factors influencing the public intention to use e-consultation and explore the effect path of the factors and behavior intention. Methods The hypotheses of our research model were developed based on the technology acceptance model and perceived risk theory. A web-based survey was conducted by an electronic questionnaire collection platform; this survey that consisted of a 29-item questionnaire with 5-point Likert scales was completed by 934 respondents. Structural equation modeling was used to analyze the data. Item evaluation and reliability, validity, path loading, goodness of fit, and multiple group analysis were used to check the moderation effects. Results The standardized factor loadings of the items were between 0.551 and 0.873. The composite reliability of 9 constructs ranged from 0.706 to 0.840. The average variance extracted ranged from 0.387 to 0.640. The fitness indices showed that the collected data fitted well with the research model. Perceived usefulness was the strongest positive factor effecting behavior intention (β=.399, P<.001). Perceived ease of use had a positive effect on behavior intention but it was not statistically significant (β=.117, P=.07) and it had a positive effect on perceived usefulness (β=.537, P<.001). Perceived risk could be well explained by financial risk (β=.972, P<.001), privacy risk (β=.774, P<.001), social risk (β=.871, P<.001), time risk (β=.894, P<0.001), and psychological risk (β=.774, P<.001). Perceived risk had negative effects on perceived usefulness (β=–.375, P<.001) and behavior intention (β=–.297, P<.001). Personal innovativeness had a positive influence on perceived ease of use (β=.241, P<.001) and a slight effect on behavior intention (β=.124, P=.001). Age (χ258=133.5, P<.001) and usage experience (χ258=82.5, P=.02) had a slight moderation effect on the paths. Conclusions Perceived usefulness and perceived risk have significant effects on public intention to use e-consultation. Therefore, platform and manufacturer must improve the function of e-consultation, which will promote the public intention to use e-consultation fundamentally. In order to control the perceived risk of public, government should play an important role in enforcing management of e-consultation markets and approving corresponding medical insurance policies. Besides, personal innovativeness had an effect on behavior intention. Moreover, the paths of factors had some heterogeneity among people with different characteristics. Therefore, it is necessary to adjust the strategies to fit more groups better.
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Affiliation(s)
- Miaojie Qi
- School of Public Health, Capital Medical University, Beijing, China
| | - Jiyu Cui
- School of Public Health, Capital Medical University, Beijing, China
| | - Xing Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Youli Han
- School of Public Health, Capital Medical University, Beijing, China
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14
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Hellingman T, Swart MED, Meijerink MR, Schreurs WH, Zonderhuis BM, Kazemier G. Optimization of transmural care by implementation of an online expert panel to assess treatment strategy in patients suffering from colorectal cancer liver metastases: A prospective analysis. J Telemed Telecare 2020; 28:559-567. [PMID: 33019855 DOI: 10.1177/1357633x20957136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Centralization of oncological care results in a growing demand for specialized consultations and referrals. Improved telemedicine solutions are needed to facilitate access to specialist care and select patients eligible for referral. The purpose of this quality improvement initiative was to optimize transmural care for patients suffering from colorectal cancer liver metastases through implementation of an online expert panel. METHODS A digital communication platform was developed to share medical data, including high-quality diagnostic imaging of patients suffering from colorectal cancer liver metastases. Feasibility of local treatment strategies was assessed by a panel of liver specialists to select patients for referral. After implementation, an observational cohort study was conducted to evaluate quality improvement in transmural care using revised Standards for Quality Improvement Reporting Excellence guidelines. RESULTS From September 2016-September 2018, eight hospitals were connected to the platform, covering a population of 3 m. In total, 123 cases were assessed, of which 54 (43.9%) were prevented from needless physical referral. Assessment of treatment strategy by an online expert panel significantly reduced the average lead time during multidisciplinary team meetings from 3.73 min to 2.12 min per patient (p < 0.01). CONCLUSIONS Implementation of an online expert panel is an innovative, accessible and user-friendly way to provide cancer-specific expertise to regional hospitals. E-consultation of such panels may result in more efficient multidisciplinary team meetings and prevent fragile patients from needless referral. Sustainability of these panels however is subject to structural financial compensation, so a cost-effectiveness analysis is warranted.
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Affiliation(s)
- Tessa Hellingman
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Merijn E de Swart
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | | | - Barbara M Zonderhuis
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
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15
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Li J, Bao X, Liu X, Ma L. The Impact of Joining a Team on the Initial Trust in Online Physicians. Healthcare (Basel) 2020; 8:E33. [PMID: 32041333 DOI: 10.3390/healthcare8010033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/24/2020] [Accepted: 02/05/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: Trust is a major challenge for the online market and this is especially the case for e-consultation platforms. Research that promotes online physician trust is highly desirable. In this study, we focus on whether joining a team led by a well-known physician will increase physician trust and what team characteristics will affect this trust. Materials and Methods: Brand extension theory is applied to the healthcare context to explain the impact of joining a team on physician trust. Specifically, both team strength and team similarity are hypothesized to have the main effects. In addition, team size is hypothesized to have a moderating effect. A 2 × 2 × 2 experiment was conducted to test the proposed research model. Results: The results indicated that joining a team would significantly increase physician trust (p < 0.001). Both team strength (p < 0.001) and team similarity (p < 0.001) had positive impacts on physician trust. In addition, a larger team size resulted in a reduced positive effect of team strength on physician trust (p < 0.001). Conclusions: Joining a physician team is an effective and low-cost method to address the initial trust problem of unknown online physicians.
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Bello A, Zaidi D, Braam B, Courtney M, Glassford J, Jindal K, Klarenbach S, Kurzawa J, Osman M, Scott-Douglas N, Szigety S, Thompson S, Manns B, Hemmelgarn B, Tonelli M. Protocol: Improving Access to Specialist Nephrology Care Among Rural/Remote Dwellers of Alberta: The Role of Electronic Consultation in Improving Care for Patients With Chronic Kidney Disease. Can J Kidney Health Dis 2019; 6:2054358119878715. [PMID: 31631888 PMCID: PMC6769217 DOI: 10.1177/2054358119878715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/04/2019] [Indexed: 12/30/2022] Open
Abstract
Background: As the burden of chronic kidney disease (CKD) continues to increase, many geographically dispersed Canadians have limited access to specialist nephrology care, which tends to be centralized in major urban areas. As a result, many rural/remote-dwellers in Canada experience poor quality of care and related adverse outcomes. It is imperative to develop alternative care delivery mechanisms to ensure optimal health outcomes for all Canadians. Objective: To investigate the feasibility and effectiveness of electronic consultation (eConsult) as a new model for interactions between specialists and primary care providers (PCPs) to improve access to care for patients with CKD. Design: This is a sequential, mixed methods study that will be conducted in 3 phases. Setting: The study will be conducted across the entire province of Alberta, supported by Alberta Kidney Care (formerly, Northern and Southern Alberta Renal Programs [NARP/SARP]). Patients: Patients suffering from CKD will be included in the study. Measurements: We will assess the barriers and enablers of implementation and adoption of an e-consultation protocol to facilitate access to care for patients with CKD in Alberta with a focus on rural/remote-dwellers with CKD. We will also evaluate the impact of the eConsult system (eg, improved access to specialist care, reduction in care gaps), assess the feasibility of province-wide implementation, and compare eConsult with practice facilitation versus eConsult alone in terms of access to specialist care, quality of care, and related outcomes. Methods: The study will be conducted in 3 phases. In phase 1, we will assess the perceptions of stakeholders (ie, PCPs, nephrologists, patients, policymakers, and other care providers) to improve CKD care delivery, quality, and outcomes in Alberta with focus groups and semistructured interviews. Phase 2 will engage specific family physicians for their input on key factors and logistical issues affecting the feasibility of implementing eConsult for the care of patients with CKD. Phase 3 will provide academic detailing including practice facilitation to clinics in Alberta to assess how eConsult with practice facilitation compares with eConsult alone in terms of access to specialist care, quality of care, and related outcomes. Results: We will assess stakeholder perceptions about potential barriers to and enablers of a new eConsult and decision support system strategy, focusing on elements that are most important for the design of a feasible and implementable intervention. We will develop, pilot test, and assess the impact of the eConsult model in improving access to specialist nephrology care and the feasibility of province-wide implementation. The final phase of the project will address key challenges for optimal care for patients with CKD living in rural, remote, and underserved areas of Alberta, particularly timely referral and disease management as well as the cost-effective benefits of eConsult. Limitations: Lack of high-speed Internet in many rural and remote areas of Alberta may lead to more time spent in completing the eConsult request online versus faxing a referral the traditional way. Allied health care staff (referral coordinators, administrative staff) require training to the eConsult system, and physicians at many remote sites do not have adequate staff to handle eConsult as an added task. Conclusions: Implementation of eConsult can favorably influence referral patterns, access to care, care quality, patient outcomes, and health care costs for people with CKD. Results of this study will inform the optimization of care for rural/remote-dwellers with CKD and will facilitate future partnerships with policymakers and provincial renal programs in Alberta to ensure optimal kidney health for all residents. Trial registration: Not required.
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Affiliation(s)
- Aminu Bello
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Deenaz Zaidi
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Branko Braam
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Mark Courtney
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | | | - Kailash Jindal
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | | | - Julia Kurzawa
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Mohammed Osman
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | | | - Sue Szigety
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | | | - Braden Manns
- Division of Nephrology, University of Calgary, AB, Canada
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17
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Li Y, Yan X, Song X. Provision of Paid Web-Based Medical Consultation in China: Cross-Sectional Analysis of Data From a Medical Consultation Website. J Med Internet Res 2019; 21:e12126. [PMID: 31162129 PMCID: PMC6746088 DOI: 10.2196/12126] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 03/23/2019] [Accepted: 04/26/2019] [Indexed: 01/30/2023] Open
Abstract
Background Web-based medical consultation, which has been adopted by patients in many countries, requires a large number of doctors to provide services. However, no study has provided an overall picture of the doctors who provide online services. Objective This study sought to examine doctors’ participation in medical consultation practice in an online consultation platform. This paper aimed to address the following questions: (1) which doctors provide Web-based consultation services, (2) how many patients do the doctors get online, and (3) what price do they charge. We further explored the development of market segments in various departments and various provinces. Methods This study explored the dataset including all doctors providing consultation services in their spare time on a Chinese Web-based consultation platform. We also brought in statistics for doctors providing offline consultations in China. We made use of Bonferroni multiple comparison procedures and z test to compare doctors in each group. Results There are 88,308 doctors providing Web-based consultation in their spare time on Haodf, accounting for 5.25% (88,308/1,680,062) of all doctors in China as of September 23, 2017. Of these online doctors, 49.9% (44,066/88,308) are high-quality doctors having a title of chief physician or associate chief physician, and 84.8% (74,899/88,308) come from the top, level 3, hospitals. Online doctors had an average workload of 0.38 patients per doctor per day, with an online and offline ratio of 1:14. The average price of online consultation is ¥32.3. The online ratios for the cancer, internal medicine, ophthalmology-otorhinolaryngology, psychiatry, gynecology-obstetrics-pediatrics, dermatology, surgery, and traditional Chinese medicine departments are 16.1% (2,983/18,481), 4.4% (16,231/372,974), 6.3% (8,389/132,725), 9.5% (1,600/16,801), 5.8% (12,955/225,128), 18.0% (3,334/18,481), 10.8% (24,030/223,448), and 3.8% (8,393/22,3448), respectively. Most provinces located in eastern China have more than 4000 doctors online. The online workloads for doctors from most provinces range from 0.3 to 0.4 patients per doctor per day. In most provinces, doctors’ charges range from ¥20 to ¥30. Conclusions Quality doctors are more likely to provide Web-based consultation services, get more patients, and charge higher service fees in an online consultation platform. Policies and promotions could attract more doctors to provide Web-based consultation. The online submarket for the departments of dermatology, psychiatry, and gynecology-obstetrics-pediatrics developed better than other departments such as internal medicine and traditional Chinese medicine. The result could be a reference for policy making to improve the medical system both online and offline. As all the data used for analysis were from a single website, the data might be biased and might not be a representative national sample of China.
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Affiliation(s)
- Yumei Li
- Harbin Institute of Technology, Harbin, China
| | - Xiangbin Yan
- Harbin Institute of Technology, Harbin, China.,University of Science and Technology Beijing, Beijing, China
| | - Xiaolong Song
- School of Management Science and Engineering, Dongbei University of Finance and Economics, Dalian, China
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