Academic literature on the topic 'Health consultations'
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Journal articles on the topic "Health consultations"
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Atherton, Helen, Anne-Marie Boylan, Abi Eccles, Joanna Fleming, Clare R. Goyder, and Rebecca L. Morris. "Email Consultations Between Patients and Doctors in Primary Care: Content Analysis." Journal of Medical Internet Research 22, no. 11 (November 9, 2020): e18218. http://dx.doi.org/10.2196/18218.
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Background Increasingly, consultations in health care settings are conducted remotely using a range of communication technologies. Email allows for 2-way text-based communication, occurring asynchronously. Studies have explored the content and nature of email consultations to understand the use, structure, and function of email consultations. Most previous content analyses of email consultations in primary care settings have been conducted in North America, and these have shown that concerns and assumptions about how email consultations work have not been realized. There has not been a UK-based content analysis of email consultations. Objective This study aims to explore and delineate the content of consultations conducted via email in English general practice by conducting a content analysis of email consultations between general practitioners (GPs) and patients. Methods We conducted a content analysis of anonymized email consultations between GPs and patients in 2 general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when the emails were sent, the number of emails in an email consultation, and the nature of the content. We used a normative approach to analyze the content of the email consultations to explore the use and function of email consultation. Results We obtained 100 email consultations from 85 patients, which totaled 262 individual emails. Most email users were older than 40 years, and over half of the users were male. The email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. The emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were 3 key themes to the use and function of the email consultations: the role of the GP and email consultation, the transactional nature of an email consultation, and the operationalization of an email consultation. Conclusions Most cases where emails are used to have a consultation with a patient in general practice have a shorter consultation, are clinical in nature, and are resolved quickly. GPs approach email consultations using key elements similar to that of the face-to-face consultation; however, using email consultations has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultations were not a replacement for face-to-face consultations.
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Prathivadi Bhayankaram, N., R. J. Lacey, L. A. Barnett, K. P. Jordan, and K. M. Dunn. "Musculoskeletal consultations from childhood to adulthood: a longitudinal study." Journal of Public Health 42, no. 4 (November 28, 2019): e428-e434. http://dx.doi.org/10.1093/pubmed/fdz141.
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Abstract Background The Global Burden of Disease reports indicate that musculoskeletal conditions are important causes of disability worldwide. Such conditions may originate in childhood, but studies investigating changes longitudinally and from childhood to adulthood are infrequent. Methods Nine birth cohorts of children (starting at ages 7–15 years) were followed. Participants were identified from Consultations in Primary Care Archive, an electronic health record database of 11 English general practices. Musculoskeletal consultation prevalence figures were calculated, and reasons for consultation evaluated. Results Annual musculoskeletal consultation prevalence was similar across cohorts for each age. Prevalence increased from 6 to 16% between ages 7 and 22 and was higher in males until age 15, after which prevalence was higher in females. Pain was the most common reason for consultation. Back pain consultations increased from 1 consultation/1000 7 year olds to 84 consultations/1000 22 year olds. Lower limb pain consultations increased from 21 consultations/1000 7 year olds to 56 consultations/1000 22 year olds. Conclusions This study shows that from childhood, individuals are more likely to seek healthcare for musculoskeletal consultations as they age, but rates are not increasing over time. Changes in consultation rates by age, gender and pain region may inform studies on the development of chronic musculoskeletal pain over the life-course.
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Fan, Xiucong, Danxia Chen, Siwei Bao, Rong Bai, Fang Fang, Xiaohui Dong, Yuyi Zhang, Xiaogang Zhang, Yabin Ma, and Xiaobo Zhai. "Integrating Multidisciplinary Individualized Medication Recommendations Into the Traditional Pharmacists’ Consultation Method: A Retrospective Study Using Propensity Score Matching Analysis." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 59 (January 2022): 004695802210814. http://dx.doi.org/10.1177/00469580221081437.
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Chinese clinical pharmacists consider improving the quantity and quality of consultations to be an important task in providing better pharmaceutical care. To achieve this goal, we developed a clinical pharmacist consultation method using multidisciplinary individualized medication recommendations (MIMRs) and studied the effects of its implementation. A retrospective study of 812 clinical pharmacist-led consultations was conducted. In the pre-intervention group, medication advice was given based on the purpose of the consultation. In the post-intervention group, a consultation method using MIMRs was implemented, in which clinical pharmacists with specialties in anticoagulation, gastroenterology, and nutrition were asked to give individualized medication recommendations. Outcomes, including the effectiveness rate of consultations (ERC) and acceptance rate of consultations (ARC), were compared between the two groups using propensity score matching method. Patterns and numbers of consultations and individualized medication recommendations were also compared. The results showed that the ERC in the post-intervention group compared with the ERC in the pre-intervention group was 83.3% vs 74.0%, respectively (P < .05). Significant difference was also shown between the two groups in ARC (98.4% vs 92.2%, P < .05). The total number of consultations increased, as did the number of general consultations, multidisciplinary/difficult consultations, anti-infection consultations, and non–anti-infection consultations specifically. As a result, we proposed that the implementation of MIMRs can improve the effects of treatment and increase the number of consultations by pharmacists, which is worthy of further promotion to better serve physicians and patients.
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Taylor, Michael J., Dell Horey, Charles Livingstone, Siew-Pang Chan, and Hal Swerissen. "General practitioners and consultation drift: the effects of supply-side changes and reforms on service delivery patterns." Australian Health Review 37, no. 5 (2013): 574. http://dx.doi.org/10.1071/ah12160.
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Objectives To determine what types of supply-side change underpinned the recent decline in longer (Level C and D) consultation provision and to evaluate the impact of the May 2010 reforms in realigning Medicare with long-term health policy objectives. Methods Retrospective analysis of Level C and D consultation provision by general practitioners (GPs) across Australia. Outcome measures were extent (number of consultations per providing GP) and participation (proportion of GPs providing these consultations). Results The proportion of GPs participating in Level C consultation provision is substantial (96%) and constant; however, extent of provision per GP decreased by 21% between 2006 and 2010. Level D participation decreased from 72% during 2006 to a nadir of 62% in 2009, and extent of provision decreased by 26% between 2006 and 2010. Conclusion Two distinct types of change underpinned the overall decline in Level C and D consultation provision. GPs appear to be providing Level C consultations less often, but the overwhelming majority still provide these consultations to some extent. The extent of provision of Level D consultations and the proportion of GPs providing them has decreased; an appreciable number of GPs simply stopped providing Level D consultations. Medicare reforms appear ineffective in realigning Medicare with long-term policy objectives. What is known about the topic? Previous research has demonstrated that GP consultation delivery patterns under Medicare have changed profoundly in recent years, with provision of Level C and D GP consultations having declined substantially. What does this paper add? This research shows that the overall decline in longer consultations is underpinned by distinct supply-side changes: (1) a decrease in average consultation provision per GP (for Levels C and D) and (2) the effective abandonment of Level D consultations by GPs. Medicare reforms do not appear to be entirely effective in addressing these supply changes. What are the implications for practitioners? Despite their centrality to health policy objectives of improved preventive care, chronic disease management and mental healthcare, longer GP consultations are declining in very distinct ways. The ability of the current Medicare model to achieve these health policy objectives appears increasingly questionable.
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Verma, Rhea, Tamar Krishnamurti, and Kristin N. Ray. "Parent Perspectives on Family-Centered Pediatric Electronic Consultations: Qualitative Study." Journal of Medical Internet Research 22, no. 4 (April 9, 2020): e16954. http://dx.doi.org/10.2196/16954.
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Background Electronic consultations, which use store-and-forward transfer of clinical information between a primary care physician and a specialist, improve access to specialty care. Adoption of electronic consultations is beginning in pediatric health care systems, but little is known about parent perspectives, informational needs, and preferences for interaction with this new model of care. Objective This study aimed to examine parent perspectives about electronic consultations, including perceived benefits and risks, anticipated informational needs, and preferences for parent engagement with electronic consultations. Methods We recruited caregivers of pediatric patients (aged 0-21 years) attending visits at an academic primary care center. Caregivers were eligible if their child had ever been referred for in-person specialty care. Caregivers participated in a semistructured interview about electronic consultations, including general perspectives, desired information, and preferences for parental engagement. Interviews were transcribed and qualitatively analyzed to identify parent perspectives on electronic consultations in general, information parents would like to receive about electronic consultations, and perspectives on opportunities to enhance parent engagement with electronic consultations. Results Interviewees (n=20) anticipated that electronic consultations would reduce the time burden of specialty care on families and that these had the potential to improve the integrity and availability of clinical information, but interviewees also expressed concern about data confidentiality. The most detailed information desired by interviewees about electronic consultations related to data security, including data confidentiality, availability, and integrity. Interviewees expressed concern that electronic consultations could exclude parents from their child’s health care decisions. Interviewees saw value in the potential ability to track the consultation status or to participate in the consultation dialogue, but they were more ambivalent about the idea of read-only access to consultation documentation. Conclusions Parents identified the potential risks and benefits of pediatric electronic consultations, with implications for communication with families about electronic consultations and for incorporation of features to enhance parent engagement.
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Saraswat, Charvi, and Catherine Bright. "Review of Remote Consultations in Learning Disability During COVID Pandemic." BJPsych Open 8, S1 (June 2022): S144—S145. http://dx.doi.org/10.1192/bjo.2022.415.
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AimsThe aim of this project was to assess the efficacy of remote consultations in patients with Learning Disability (LD). In Aneurin Bevan University Health Board, teleconsultation or “Attend Anywhere” (Video) platforms are the two types of remote consultation that is being offered.MethodsA 9- point Questionnaire was used to assess the efficiency of the consultation. During consultation (Either telephone or attend anywhere), data were collected by the consultants by answering the questionnaire. 23 clinics organised between 04/06/2020 to 23/06/2020 for Service Users' (SU) follow-up.The following key points were covered in the questionnaire: 1.Mode of consultation- telephone or attend anywhere2.Presence of the SU3.Introduction4.Availability of information (patient notes/shared drives) prior to consultation5.Time constraints6.Information not covered due to lack of face-to-face consult7.Technical difficulties8.Expectations from SU9.Feedback from SUResults1.The most common mode of consultation was via telephone (70%), followed by Attend Anywhere (30%)2.The majority of conversations were with SU's family or carers (70%); consultations with SU were only 30%. SU were unable to attend the consultation due to: Communication difficulty (26%), follow-ups provided by carer's/family's feedback (21.7%), SU away due to physical health reasons, or in day care (17.3%).3.Introductions were done and sufficient information regarding the service users were available in all consultations.4.Expectation of SU/carers/family was with regards to medication review (43%).5.52% of remote consultation were disrupted due to technical problems, for instance call drops and line disruptions, microphone issues and SU not being able to use attend anywhere because of its complexity.ConclusionIt was demonstrated that remote consultation could possibly be most effective for medication reviews or regular follow-up appointments.Some of the aspects that were not covered due to the shortcomings of remote consultations were: a.Difficulty in assessing body language and facial expressionsb.Difficulty in assessing the level of function of SUc.Unable to monitor physical health parametersd.Difficulty in picking up non-verbal cues, and assess eye contact to ascertain mood component of presentation.In summary it seems in the early stages of the pandemic, telephone consultation was the predominant form of remote consultation. Further work would be useful to obtain the views of people with LD, their carers and families as to which form of consultation would be their preference and whether remote consultation is acceptable for this patient group.
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Martin, Shirley, Deirdre Horgan, Margaret Scanlon, Nazih Eldin, and Anne O’Donnell. "Including the voices of children and young people in health policy development: An Irish perspective." Health Education Journal 77, no. 7 (April 19, 2018): 791–802. http://dx.doi.org/10.1177/0017896918768638.
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Objective: This paper presents findings of a qualitative study which explored children and young people’s understanding of health and the factors that contribute, or act as barriers, to healthy lifestyles. Views were elicited from consultations with children and young people as part of the process for the development of a National Obesity Policy in Ireland. Design: Child participatory methodology was used which prioritised the voice of the child in policy making. Methods: Two consultations were held – one with 48 children between the ages of 8 and 12 and the other with 34 young people aged 13–17 years. The consultations utilised qualitative participatory methodology which prioritised the voices of children and young people in policy making. A diverse range of methodological tools (e.g. ‘lifelines’, ‘body maps’, world café workshops) were used to collect data and optimise levels of participant engagement. Qualitative visual and written data produced during the consultations was then subjected to thematic analysis. Results: Children and young people’s constructions of health and healthy lifestyles are multifaceted. Participants in the consultation appeared well informed as to the general factors which contribute to healthy and unhealthy lifestyles. There were notable differences of emphasis related to age, with the older age group engaging more with issues relating to mental health and peer relationships, while younger children focused more on balanced diet and exercise. Conclusion: Findings from this consultation suggest that children’s constructions of health, and their understandings of the factors that impact health, are complex and often go beyond medical constructions of the meaning of health. The consultation informed the development of the new National Obesity Policy in a number of ways, including specific actions in relation to the development of a whole school healthy lifestyles programme, developing a health and well-being model for early childhood services, and providing clinical services specifically for children.
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Jones, Matthew T., Rameez Arif, and Ashok Rai. "Patient Experiences With Telemedicine in a National Health Service Rheumatology Outpatient Department During Coronavirus Disease-19." Journal of Patient Experience 8 (January 2021): 237437352110349. http://dx.doi.org/10.1177/23743735211034973.
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The coronavirus disease-19 pandemic changed rheumatology practice with remote consultations being increasingly utilized where appropriate. We evaluated patient experiences with telephone consultations and report on patient attitudes toward current health care delivery and perspectives of telemedicine in a UK National Health Service rheumatology outpatient department. We analyzed 297 questionnaires from a postal survey conducted during the summer of 2020 after a telephone follow-up consultation. The mean age of respondents was 67 years and 68% were female. The 161 respondents (54%) reported it was their first telephone consultation and overall, 239 (84%) were satisfied with their health assessment. 60% would be happy to have future routine follow-up telephone consultations. Patients advised to shield shared similar satisfaction to the whole sample. However, with increasing age we identified a higher proportion were dissatisfied with telephone consultations and unlikely to have accessibility to video consultation or preferentially opt for this modality.
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Quiroz, Juan C., Liliana Laranjo, Ahmet Baki Kocaballi, Agustina Briatore, Shlomo Berkovsky, Dana Rezazadegan, and Enrico Coiera. "Identifying relevant information in medical conversations to summarize a clinician-patient encounter." Health Informatics Journal 26, no. 4 (August 29, 2020): 2906–14. http://dx.doi.org/10.1177/1460458220951719.
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To inform the development of automated summarization of clinical conversations, this study sought to estimate the proportion of doctor-patient communication in general practice (GP) consultations used for generating a consultation summary. Two researchers with a medical degree read the transcripts of 44 GP consultations and highlighted the phrases to be used for generating a summary of the consultation. For all consultations, less than 20% of all words in the transcripts were needed for inclusion in the summary. On average, 9.1% of all words in the transcripts, 26.6% of all medical terms, and 27.3% of all speaker turns were highlighted. The results indicate that communication content used for generating a consultation summary makes up a small portion of GP consultations, and automated summarization solutions—such as digital scribes—must focus on identifying the 20% relevant information for automatically generating consultation summaries.
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Hiscock, Harriet, Rachel Pelly, Xinjang Hua, Sue West, Dianne Tucker, Chin-Mae Raymundo, and Kim Dalziel. "Survey of paediatric telehealth benefits from the caregiver perspective." Australian Health Review 46, no. 2 (October 18, 2021): 197–203. http://dx.doi.org/10.1071/ah21036.
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Objective This study determined caregivers’ evaluations of telehealth consultations for their child, preference over in-person consultations and potential cost savings by child condition, family socioeconomic status and location. Methods A survey was conducted of 2436 caregivers attending a telehealth consultation with their child for a broad group of conditions between 3 June and 25 August 2020 at a tertiary paediatric hospital in Melbourne, Australia. Results Most caregivers found telehealth consultations convenient, acceptable, safe and private, and capable of answering their questions and concerns. However, caregivers who spoke a language other than English and patients attending for behavioural and mental health, developmental or other (e.g. allied health) concerns were more likely to prefer in-person consultations over telehealth. Mean (±s.d.) reported cost savings on caregiver time were A$144.98 ± 99.04 per family per consultation, whereas mean (±s.d.) transport cost savings were A$84.90 ± 100.74 per family per consultation. Cost savings were greatest for families living in low and middle socioeconomic areas and regional or rural areas. Conclusions Paediatric telehealth video consultations were largely viewed favourably by caregivers, except for those attending for behavioural and mental health or developmental concerns. What is known about the topic? Adult consumers of telehealth consultations view them as useful, convenient and cost saving, but less is known about caregivers’ evaluations of telehealth consultations and potential cost savings for paediatric patients, and whether these differ by family location, socioeconomic status or child condition. What does this paper add? This is the first Australian paper to report on caregivers’ evaluations across a range of paediatric conditions and locations. Most caregivers found telehealth consultations convenient, safe, acceptable, able to answer their questions and concerns about their child’s health and cost saving. What are the implications for practitioners? Caregivers of children with behavioural, mental health or developmental problems were less likely to prefer telehealth over in-person consultations, so practitioners should consider providing such consultations in person.
Dissertations / Theses on the topic "Health consultations"
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Collins, Sarah Frances. "Communication and strategy in health care consultations." Thesis, University of York, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.431649.
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Andén, Annika. "Outcomes from GPs' Consultations." Doctoral thesis, Linköpings universitet, Allmänmedicin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-18483.
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Background and aims. Patients’ consultations with GPs can deal with a wide range of conditions and problems. Generally, consultation outcomes have been considered in evaluations but outcome has a meaning for elaboration of care beyond the graduating role of quality and other evaluation instruments. Knowledge about outcomes is needed for understanding and development. The aim of this thesis was to investigate outcomes of GPs’ consultations as directly experienced by patients and GPs and to investigate connections between clinical strategies and presumed patient outcomes. Methods. First, concepts describing outcomes from patients’ and GPs’ viewpoints were developed from interviews in groups and individually. Secondly, based on this, questionnaires about the consultation outcomes were formulated. Then, patients and GPs answered questionnaires regarding the same recent consultation. The numbers of the different outcomes were counted and the experiences of outcomes from the same consultations were compared. Finally, another questionnaire including both the GP outcome questions and questions about the clinical situation and decisions made was answered by GPs. Results. Concepts describing consultation outcomes were brought forward. Cure/symptom relief, reassurance, patient understanding and satisfaction were used by both patients and GPs to describe outcome of consultations. Only patients described as outcomes a confirmation of their ideas and a change in self-perception. GPs, but not patients, described the patient outcomes in terms of check-up and coping. Besides this, GPs also described other outcomes that concerned relationship-building, a change of surgery routines and self-evaluation. Selfevaluation was related to a perceived collegial consensus about right and wrong. The concordance between GPs and patients assessing the same consultations was high for satisfaction, intermediate for patient understanding and low for belief in cure/symptom relief. Clinical strategies were linked to outcomes. Immediate problem solving was registered in about half the consultations. When immediate problem solving was registered the patients were supposed to be more reassured, satisfied and coped better than after gradual problem solving. With increasing psychosocial content of the consultation the GPs registered more dissatisfaction both for themselves and their patients. Conclusions. Change in self- perception was a prominent patient outcome. GPs’ self-evaluations ought to have the inherent possibility to serve as a basis for development of general practice. The entire map of the encountered outcome concepts can serve as a basis for further research and development. The mapping of concepts can be of help when prioritising. Knowledge about the total picture of consultation outcomes can help the GP to understand the patients’ worlds better. It can also contribute to a realistic picture of possible consultation outcomes. The GPs seemed to adjust their problem solving (immediate or gradual) to the registered problem and furthermore adjust the immediate problem solving, focusing either on the problem or on the patient as a person.
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O'Keefe, Maree Frances. "Maternal perspectives of child health consultations by medical students." Title page, contents and abstract only, 2002. http://web4.library.adelaide.edu.au/theses/09PH/09pho4121.pdf.
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"June 2002" Errata inside back cover. Bibliography: leaves 244-256. The first aim of this thesis was to determine the relationship between medical student clinical competence and patient-centredness, and maternal satisfaction and subsequent recall of information in child health consultations. The second aim was to test the application of this knowledge in medical student teaching programmes. The study demonstrated the ability of mothers to assess the clinical competence and patient-centredness of medical students in videotaped consultations. Applications in medical student learning were also developed and evaluated.
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Siouta, Eleni. "Communication Patterns in Consultations Between Patients with Atrial Fibrillation and Health Professionals." Licentiate thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-19834.
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Background Patients’ preferences, needs and desires are important when discussing treatment. In consultations between patients with atrial fibrillation (AF) and health professionals, knowledge, understanding and insight about communication patterns are of vital importance for strengthening patient involvement in decision-making about their care and treatment. Aim The general aim of this thesis was to describe communication patterns in consultations between patients with AF and health professionals. Specific aims (1) To describe (i) the topics patients with AF and their nurses and physicians discuss; (ii) the use of discursive space in consultations between these participants; and (iii) the frequencies with which patients and nurses/physicians introduce the identified topics. (2) To describe the types of patient resistance to accepting treatment with warfarin and how cardiologists respond to such resistance. Methods An inductive design was used. In study I, the sample consisted of 23 consultations between patients with AF (13 women and 10 men) and health professionals (5 women and 5 men) who were employed in six different cardiologic outpatient clinics. Content analysis was used to obtain a description of topics discussed. The patterns of dominance for the various topics and participant were explored from the framework of an analysis of dominance (I). In study II, the sample consisted of 11 consultations between patients with AF (7 women and 4 men) and cardiologists (2 women and 3 men). Conversation analysis was used to describe interactions concerning resistance to treatment with warfarin. Findings Study I. Four topics were introduced by both nurses and physicians during the consultations. These were “pathophysiology”, “treatment”, “diagnostic procedures”, and “activity”. In the nurse–patient consultations an additional topic, “routines related to the physician’s responsibilities”, emerged. With respect to the number of words and turns, the distribution of the discourse space was almost equal between nurses and patients, and unequal between physicians and patients. The patients were the dominant initiators of the topic “activity”, which refers to adaptation of activities in daily life in relation to AF. Study II. There were four types of patient resistance to accepting treatment with warfarin. These included “Giving reasons for their resistance”, “Suggesting other treatment options”, “Stating treatment preferences” and “Questioning or challenging the cardiologist’s treatment recommendations”. The cardiologists’ responses to the patients’ resistance included “Repeating the treatment recommendation”, “Negotiation with the patient”, “Providing additional information about the recommended treatment” and “Extending their explanation of the purpose of the treatment”. Conclusions The medical-driven agenda dominated over the patient-driven agenda in consultations between health care professionals and patients with AF. During conversations in consultations with nurses, the patients initiated discussion of living with AF and were more talkative than they were with physicians. An awareness of types of patient resistance to treatment would enable cardiologists to consider patients’ experience-based views about their treatment;
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Dalgarno, Elizabeth Louise. "'Through the looking glass' : primary care consultations, work and health : a qualitative study." Thesis, Keele University, 2018. http://eprints.keele.ac.uk/5580/.
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Musculoskeletal conditions are believed to cost UK society approximately £7.4 billion per year, with 30 million working days lost each year due to musculoskeletal conditions. Currently, within the UK, sickness certification can be self-certified for a period of seven days after which time a General Practitioner is required to authorise any further period of absence from work for patients. In April 2010 the Sickness Certificate was replaced with the Fit Note. The existing literature has offered little ‘in-vivo’ insight into the primary care consultation in relation to the management of patient musculoskeletal work-related concerns since the introduction of the Fit Note, and there is a paucity of research exploring the patient experience of these consultations. The research questions in this thesis broadly ask: How are musculoskeletal work-related concerns discussed and managed within the primary care consultation? How do patients experience these consultations? Mixed qualitative methodology is used within this study. Interpretative methods are used to thematically analyse 100 video-recorded consultations and 19 semi-structured interviews to answer these research questions and provide insight into this area. Findings reveal that the management of musculoskeletal work-related concerns within the primary care consultation is sub-optimal. Accessing work-related support for these people is complicated and contingent upon how they come to identify themselves as candidates for work-related support. The theoretical framework of candidacy is offered as a useful device for understanding and conceptualising the patient experience of these consultations. Interactions with healthcare, in combination with sociocultural factors, mediate how people come to understand their candidacy to seek musculoskeletal work-related support. Directions for further research in this area are provided.
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Kumarapeli, Pushpa. "Modelling the computerised clinical consultations : a multi-channel video study." Thesis, Kingston University, 2011. http://eprints.kingston.ac.uk/22364/.
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This study aims to understand the use of a computer during GP consultations and to enable the development of EPR systems which are easier to review, enter data into, use to take action, and is more sensitive to the clinical context. This thesis reports the development of a multi-channel video and data capture toolkit, the ALFA (Activity Log File Aggregation) because existing observation techniques have limitations. None of the existing tools are designed to assess human-computer interaction in the context of the clinical consultation, where the social interaction is the prime focus. The ALFA tool-kit has been used to observe and study 163 live primary care consultations supported by computer systems with four different designs. A detailed analysis of consultation interactions was then performed focusing on doctor-patient communication and the integration of the computer into the consultation workflow. The data collection elements of the ALFA supported recording of consultation activities by providing rating techniques attuned with the characteristics of those interactions. The Log File Aggregation (LFA) component of the ALFA toolkit aggregated those multitudes of data files into a single navigable output that can be studied both quantitatively and qualitatively. A set of Unified Modelling Language (UML) sequence diagrams were then created as they could be used by software engineers to develop better systems. This research proposes a framework with three elements to analyse the computerised clinical consultation; (1) the overview of the context within which the consultation was carried out, (2) time taken to perform key consultation tasks and (3) the process used. Traditional analysis with its emphasis on the technology often misses crucial features of the complex work environments in which the technology is implemented. Direct observation could inform software designers in developing systems that are more readily integrated into clinical workflow. Direct observation of the consultation, using the ALFA toolkit is acceptable to patients; captures the context of the consultation the precise timing and duration of key tasks; and produces an output a software engineer can understand. ALFA offers a range of possibilities for research in the consulting room. The computer should be considered as an active element of the consultation; room layout and consultation models should let the computer in, while software engineers take in the capacity to sustain patient centred social interactions as a core facet of their design agenda.
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Willcox, Adrienne. "Nurse-led pre-travel health consultations : evaluating current practice and developing a new model." Thesis, University of Warwick, 2010. http://wrap.warwick.ac.uk/38542/.
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This study explores the pre-travel consultation between nurses and people who plan to travel abroad from the UK. Travel health services have developed ad hoc in response to rising public demand, and are mainly nurse-led in UK general practice. There is little research evidence to describe or evaluate pre-travel healthcare provision. Using a mainly qualitative bricolage design of six methods, the research traces the ‘journey’ of health recommendations made to travellers. Starting with guidance documents produced by experts, it then tracks the fulfilment of these recommendations through consultations conducted by nurses and captures the ways in which travellers use or discard the recommendations while travelling. It explores the clinical reasoning behind activities in pre-travel consultations, and generates ideas for practice development. The key findings are that pre-travel healthcare is medicine-centric and issues of time, organisation, and the model adopted by nurses affects the quality of consultations. Two styles of consultation were identified: the Kitchen Sink style was comprehensive and verbose; the Medical and Minimal style focused on vaccinations. Travellers recalled or used very little of what was imparted during their consultations, but far from being ‘blank slates’, travellers usually managed their health appropriately and had far more knowledge than nurses recognised. The thesis offers conceptual insights to the pre-travel consultation which relate to patient safety, quality and the legal integrity of practitioners. It offers a prototype model of the pre-travel consultation that takes account of the challenges associated with current practice. The implications for practice relate to education for nurses in consultation management, patient-centredness, proactive versus reactive service provision, and patient education. PRE-TRAVEL - the new model for consultations - contributes a framework for engaging with these issues, subject to post-doctoral testing.
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Campion, Peter David. "On structures in medical interactions : a conversation analytic study of general practice consultations." Thesis, University of Liverpool, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387372.
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This thesis addresses from within the research paradigm of Conversation Analysis (CA) the question "How are interactions between patients and general practitioners organised? ". CA is a relatively recent tradition within the "interpretative paradigm" of sociology, growing out of the ethnomethodology of Garfinkel. The thesis first reviews the relevant literature of CA and medical interactions, and critically discusses the methodology. The empirical analysis used naturally occurring consultations in British general practice, video-recorded in five practices, involving 14 doctors, and about 50 hours of recording, made between 1987 and 1992. Recordings were observed first in an unmotivated way, to note occurrences of interesting interactional phenomena. Objects for further study were copied onto secondary "collection" tapes, which were then examined in depth, and transcribed in detail using conventions developed within CA. The analyses described here are: the use of time in the consultation; the impact of medical records on the interaction; prescribing and associated talk; the phenomenon of "facilitation", how doctors appear to enable patients to talk; patient-initiated questions, and rejection of patients' ideas by doctors; and finally the use of the word "we". The aim was to describe and explore, but not necessarily to explain, although in describing the mechanism of interaction in these areas of activity, empirical evidence is advanced for particular explanations. The phenomenon of patients raising new topics at the end of consultations is described, with its interactional implications: the "by-the-way" phenomenon is explored and documented. Case-notes are seen to contribute to consultations in a complex way, and like talk, are both context-dependent and context-forming. Utterances such as "right", "uhuh", "mmhm" which appear on the face of it to be facilitatory, can be the reverse. The phenomenon of dispreference for disagreements by patients is re-examined, and contexts in which patients do disagree are explored. Doctors' rejections of patients' ideas are described, and implications for teaching about the consultation are drawn. Finally the various ways in which the word "we" is used by doctors are described and critically appraised, in the context of a philosophical understanding of "intersubjectivity". The study adds to the body of transcribed interactions drawn from general practice, and sheds some light on ways in which general practitioners and patients structure their consultations. It has implications for the way medical students learn how to consult, and for how research on the consultation can be conducted. Conversation analysis is shown to be a powerful qualitative analytic methodology, relevant to the study of medical interactions.
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Wyman, Jamie L. "Facilitating Feminist Ethics Consultations: A Legal Solution to Encourage Innovative Ethical Analysis." Thesis, The University of Arizona, 2008. http://hdl.handle.net/10150/193240.
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This thesis aims to make feminist theory an integral part of hospital ethics committee ("HEC") decisionmaking. Specifically, the feminist theories discussed in this thesis prioritize an awareness of social context. The small-scale study conducted for this thesis found that HECs already consider social context to some extent but that they may also be open to more systematic integration. As opposed to courts, HECs provide a space where innovative alternatives (e.g., feminist approaches) to principalist bioethical decisionmaking can be tested. In order to encourage the development of such alternatives, this thesis has proposed a framework for the relationship between courts and HECs so that patients can benefit from the strengths of both entities in ways that have not been possible in the past.
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Andersson, Sven-Olof. "Time and general practice consultations : aspects of length, attendance and quality." Doctoral thesis, Umeå universitet, Allmänmedicin, 1995. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-100583.
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The consultation is the GP’s form of work. How long a consultation should be, and what short/long consultations imply with regard to the satisfaction of patient and doctor has been much debated. The aim of this thesis was to study consultations with regard to content and time consumption in a short term and long term perspective. Three studies were carried out. 1. Consultations with the members of a group of GPs were investigated, where patients and doctors separately assessed different aspects of the consultation, and their ratings were related to the real length of the consultations. The following questions were posed: Was there time enough? Could the patient tell the doctor about her/his problems? Were the problems physical or psychological? 2. Nurses at the primary care health centres were interviewed about their considerations in booking short or long appointments for the patients. 3. Patients who frequently attended one health centre during one year and consumed much time were studied. Quantitative and qualitative methods were used. The results of the first study (Papers I-III) show that the average length of the consultations was 21 minutes; there was considerable variation (ranging from 3 to 60 minutes). (About 600 consultations with 7 male doctors were registered in two batches). The doctors’ mean consultation length also varied widely, from 13-28 minutes. Consultations dealing with psychological problems were longer than those dealing with physical problems. Older patients had longer consultations than younger patients, and female patients had somewhat longer consultations than male patients. The patients were generally more satisfied with the consultations than the doctors were, and there were no clear affinities between long consultations and high satisfaction. Male patients and patients with physical problems mainly received short consultations, whereas patients with ”mixed" problems and older patients received long consultations. The single factors most decisive for the length of a consultation were ‘the doctor factor’, the character of the problem and the age of the patient. "Good” consultations (operational definition) were associated primarily with ‘the doctor factor’, and the real length of the consultations was less important. The interviews with ten experienced primary care nurses (Paper IV) showed that the nurses worked in two perspectives: in the ”immediate” perspective, appointments were booked according to rules which directly impacted the length of the visit, and in the "reflective" perspective, appointments were booked with a view to the quality of the work at the health centre and the long-term time consumption. Other factors of importance were the patient’s age and problem(s), the doctor’s experience and working style, and the current situation at the health centre. Frequent attenders (FAs) at one health centre (Paper V) were compared with a contrast group of matched patients (CPs). The FAs represented 1.7% of the population of the catchment area and made 15% of the visits. The FAs were a heterogeneous group where small boys, women of working age and pensioners of both sexes were overrepresented. The FAs had higher consultation frequency than the CPs during the year of investigation, but few remained FAs for longer periods. The FAs had more problems and more complex problems than the CPs. Complaints regarding the musculo-skeletal organs, and psychosocial problems were common among these patients, often in combination. The present work thus shows that longer consultations do not naturally imply higher patient satisfaction. Other factors than the time factor, in particular ‘the doctor factor’ seem to be more important. ‘The doctor factor’, the characteristics of the patients, the type of problem and the situation at the health centre also have a bearing on consultation length and time consumption in a short-term as well as long-term perspective. The implications of these factors and their relative importance are discussed, but further studies of certain issues, such as ‘the doctor factor’, are necessary.Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 5 uppsatser.
digitalisering@umu
Books on the topic "Health consultations"
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Sackville, Laura. Proceedings of two mental health consultations: Women's Consultation : mental health services, September 27, 1993. [Saskatoon: The Saskatoon District Health Board, 1993.
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Medicine balls: [consultations with the world's greatest TV doctor]. Edinburgh: Black and White Publishing, 2007.
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Fry, Betty-Anne. Results of consultations on women's health and the environment in the Great Lakes Basin. Ottawa, Ont: Health and Welfare Canada, Environmental Health Directorate, Great Lakes Health Effects Program, 1992.
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Lasker, Roz Diane. Survey of visits and consultations. Washington, DC: Physician Payment Review Commission, 1991.
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Hammond, Phil. Medicine balls: Consultations with the world's greatest TV doctor. 2nd ed. Edinburgh: Black & White, 2008.
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Canada, Canada Environment. Consultations on the CEPA New Substances Notification Regulations and New Substances Program: Environment Canada/Health Canada response to the consultation recommendations. [Ottawa]: Environment Canada, 2002.
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Listening to children and young people in healthcare consultations. Oxford: Radcliffe Pub., 2010.
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Maier, Mike. Effectiveness of Oregon OSHA consultations in reducing disabling injuries / by Mike Maier. Salem, Or: Research & Analysis Section, Oregon Dept. of Consumer & Business Services, 1995.
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Commission, New South Wales Law Reform. People with an intellectual disability and the criminal justice system: Consultations. Sydney: The Commission, 1993.
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Bayram, Clare. BEACH: Bettering the evaluation and care of health : male consultations in general practice in Australia 1999-00. Canberra: Australian Institute of Health and Welfare, 2003.
Find full textBook chapters on the topic "Health consultations"
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Sobolev, Boris, Victor Sanchez, and Lisa Kuramoto. "Booking Anesthesiology Consultations." In Health Care Evaluation Using Computer Simulation, 323–33. Boston, MA: Springer US, 2012. http://dx.doi.org/10.1007/978-1-4614-2233-4_17.
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Bigi, Sarah. "Evaluating argumentative moves in medical consultations." In Argumentation and Health, 51–65. Amsterdam: John Benjamins Publishing Company, 2014. http://dx.doi.org/10.1075/bct.64.05big.
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Mills, Deborah J., Lani Ramsey, and Luis Furuya-Kanamori. "Pre- and Post-Travel Medical Consultations." In Tourist Health, Safety and Wellbeing in the New Normal, 47–69. Singapore: Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-16-5415-2_3.
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Calne, Jane, and Lisa Jackson. "Mental health consultations in primary care: managing the ‘heartsink patient’." In Communication Skills in Mental Health Care, 122–31. London: CRC Press, 2022. http://dx.doi.org/10.4324/9781846198304-11.
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Kajombo, Marion Chirwa. "The Sociolinguistic Functions of English and Chichewa in Gynaecological Consultations in a Chichewa Speaking Hospital Setting in Malawi." In Health Communication and Disease in Africa, 207–29. Singapore: Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-16-2546-6_9.
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McBride, Bronwyn, and Trachje Janushev. "Criminalisation, Health, and Labour Rights Among Im/migrant Sex Workers Globally." In Sex Work, Health, and Human Rights, 153–71. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-64171-9_9.
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AbstractThis chapter introduces the structural determinants that shape health and labour rights among im/migrant sex workers globally. It explores issues related to criminalisation, mandatory health testing, precarious immigration status, economic marginalisation, racialisation, racism and discrimination, language barriers, and gender. This chapter examines how these factors shape health access, health outcomes, and labour rights among im/migrant sex workers in diverse contexts. These issues were explored through a review of academic literature, which was complemented by community consultations that elucidate the lived experiences of gender-diverse im/migrant sex workers from Europe and across the globe. Findings illustrate how shifting sex work criminalisation, public health and immigration regulations (e.g. sex worker registration, mandatory HIV/STI testing), and policing practices impact im/migrant sex workers and shape the labour environments in which they work. The chapter subsequently presents recommendations on policy and programmatic approaches to enhance health access and labour rights among im/migrant sex workers. Finally, it concludes by highlighting the ways in which im/migrant sex workers resist social and structural exclusion, stigma, and ‘victim’ stereotypes, highlighting their tenacity and leadership in the fight to advance labour and human rights among im/migrants and sex workers worldwide.
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Yokota, Fumihiko, Manish Biyani, Rafiqul Islam, Ashir Ahmed, Mariko Nishikitani, Kimiyo Kikuchi, Rieko Izukura, Yasunobu Nohara, and Naoki Nakashima. "Co-design, Co-production, and Co-evaluation Processes for a Mobile Health Check-Up Research Project in Jaipur, India: A Case Study of the Portable Health Clinic, 2016–2020." In Decision Science for Future Earth, 93–104. Singapore: Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-15-8632-3_3.
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AbstractThis chapter summarizes the co-design, co-production, and co-evaluation processes of a mobile health check-up research project in Jaipur, India, from March 2016 to June 2020. It is the continuation of our previous paper which was published in November 2018 at Sustainability. The main focus of this chapter is to describe the processes of co-production, co-implementation, and co-evaluation research activities after November 2018. To accomplish this, all documents and materials related to the research processes of co-design, co-production, and co-evaluation were thoroughly reviewed, including minutes from meetings, consultations, workshops, trainings, presentation slides, pictures, and reports. After reviewing the past 4 year’s research process, the road map of a sustainable mobile health check-up project in India was proposed.
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Gerth, Sebastian, and Lars Heim. "Blockchain as an Approach for Secure Data Storage on Digital Consulting Platforms." In Digital Entrepreneurship, 103–20. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-53914-6_6.
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AbstractThis chapter examines the concept of data security in a society increasingly shaped by digital technologies. We show how secure data storage can be optimised regarding digital documentation in the implementation of health-related service offers based on established procedures. Security and privacy of data are therefore particularly important in this subject area since highly sensitive data is stored and processed during health-related online consultations. The advent of blockchain technology provides a valuable opportunity to create trust in digital platforms. After relevant concepts and terms have been clarified, the functionality of the blockchain in general, as well as the different types, will be discussed. From this, options for the use of online consulting are developed and illustrated on the basis of three use cases.
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Gopalakrishnan, Gopi. "Using Technology to Harness Existing Resources for an Emergency: COVID-19 Response." In Health Dimensions of COVID-19 in India and Beyond, 53–64. Singapore: Springer Singapore, 2022. http://dx.doi.org/10.1007/978-981-16-7385-6_3.
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AbstractThe use of technology to respond to the COVID-19 emergency is described. The sudden lockdown imposed by the government with just a four hours’ notice resulted in a paralysis of the healthcare system. World Health Partners (WHP) responded immediately to this crisis. WHP worked in partnership with the state governments of Bihar and Andhra Pradesh. The plan was that the state governments would provide the personnel and WHP would set-up a digitized system for providing health services to the people by using tele-medicine.A quick-to-access dashboard was created to give details in real-time of the number of doctors and assistants who were logged-in, the number of calls received and were attended to, prescriptions issued, and COVID-19 suspects identified. Doctors’ absenteeism proved to be a challenge in Bihar. Consequently, the full potential of the project could not be realized in Bihar. In Andhra Pradesh, however, the project was very successful. Despite receiving less number of calls, more consultations were provided through the tele-medicine project in Andhra Pradesh. The major reason for this success was the high level of political commitment by the state government which led to the availability of trained medical personnel for the project. The entire process of the project was successfully transitioned by WHP to the state government of Andhra Pradesh.
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Minogue, Virginia. "Consultation." In Handbook of Service User Involvement in Mental Health Research, 153–67. Chichester, UK: John Wiley & Sons, Ltd, 2009. http://dx.doi.org/10.1002/9780470743157.ch11.
Full textConference papers on the topic "Health consultations"
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Seuren, L., S. Shaw, C. Pope, and T. Greenhalgh. "2 Conceptualising trust in video consultations." In Negotiating trust: exploring power, belief, truth and knowledge in health and care. Qualitative Health Research Network (QHRN) 2021 conference book of abstracts. British Medical Journal Publishing Group, 2021. http://dx.doi.org/10.1136/bmjopen-2021-qhrn.40.
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Randine, Pietro, John Graham Cooper, Gunnar Hartvigsen, and Eirik Årsand. "Towards a New Model for Chronic Disease Consultations." In 18th Scandinavian Conference on Health Informatics. Linköping University Electronic Press, 2022. http://dx.doi.org/10.3384/ecp187014.
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Persson, Johanna, Sally Wiezell, and Tilda Claeson. "Designing for Including Children in Online Health Care Consultations." In NordiCHI '16: 9th Nordic Conference on Human-Computer Interaction. New York, NY, USA: ACM, 2016. http://dx.doi.org/10.1145/2971485.2996725.
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Penkov, Alexander, Valery Stolyar, Elena Lukianova, Maya Amcheslavskaya, and Ekaterina Shimkevich. "Techniques of establishing efficient doctor-patient interaction at telemedicine consultations." In Innovations in Medical Science and Education. Dela Press Publishing House, 2022. http://dx.doi.org/10.56199/dpcsms.coll5466.
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This article covers a comprehensive study into preparations for and the conduct of telemedicine consultations that would provide for arranging and conducting high-quality remote sessions between a doctor and a patient. The purpose of our study is to detect the factors that have a positive impact on the healthcare services provision level, and to establish a procedure of conducting telemedicine consultations that would allow a clinic to provide medical health quickly, safely and with proper quality and to improve its customer focus. The work is novel in that such studies aimed at defining a telemedicine consultation algorithm have not been carried out in Russia before, therefore, the Department of Medical Informatics and Telemedicine of the Institute of Medicine at the RUDN University decided that it was necessary to hammer out a methodology of medical services provision. As part of the study, we viewed and analyzed pre-recorded telemedicine consultations and put together an expert team consisting of experts in various areas of medicine, as well as of patients. As a result of that work, this article lists and defines common mistakes that lead to conflicts and erode patients’ trust in a clinic, catalogues stages of preparation for a telemedicine consultation making it possible to reduce the number of errors in remote consulting and devises obligatory techniques of remote medical aid.
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Improta, Giovanni, Leandro Donisi, Eduardo Bossone, Ersilia Vallefuoco, Alfonso Maria Ponsiglione, and Francesco Amato. "Discrete Event Simulation to Improve Clinical Consultations in a Rehabilitation Cardiology Unit." In 2022 E-Health and Bioengineering Conference (EHB). IEEE, 2022. http://dx.doi.org/10.1109/ehb55594.2022.9991285.
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Southgate, Genevieve, Arrash Yassaee, Helen Livesey, Matt Harmer, Damian Roland, and Kate Pryde. "453 Technological barriers to video consultations in paediatrics." In Royal College of Paediatrics and Child Health, Abstracts of the RCPCH Conference, Liverpool, 28–30 June 2022. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health, 2022. http://dx.doi.org/10.1136/archdischild-2022-rcpch.172.
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APOSTOL, Vasile. "MANAGEMENT STRATEGIES ON DIGITALIZATION IN THE HEALTH FIELD." In International Management Conference. Editura ASE, 2022. http://dx.doi.org/10.24818/imc/2021/01.16.
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This article presents the analysis of the current state of digitalization in the public health field, more precisely in school medicine in Bucharest, the impact and consequences for the daily activity of medical staff on one hand and to the decisions maker on the other hand and also the steps undertaken to optimize the process by digitalizing the medical assistance in public schools in Bucharest. This analysis was the starting point for an active involvement in the digitization of school medicine practices and implicitly their alignment with European standards. The purpose of this article is to highlight a macro-level management perspective in the digital era. Digital evolution is absolutely necessary and natural in adapting the system to current requirements, the need to have access to important health data at all times being for the benefit of all stakeholders. Another important factor that led to the digitalization of the school medicine network was the crisis generated by the COVID-19 pandemic, which taught us to adapt and move from lost hours for a medical consultation and paper prescriptions to online consultations. Analyzing the imposed situation, we chose to take a major step towards progress, capitalizing on the time of medical staff and patients and the time at management level to properly adapt and implement medium and long term decisions.
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Husemann, Ronaldo, Marcelo Negreiros, Henrique Tomaggi, Aline Lutz Araujo, and Valter Roesler. "Desenvolvimento de uma Ferramenta para Auxílio ao Diagnóstico de Catarata em Telemedicina." In XXV Simpósio Brasileiro de Sistemas Multimídia e Web. Sociedade Brasileira de Computação - SBC, 2019. http://dx.doi.org/10.5753/webmedia_estendido.2019.8154.
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The use of videoconferencing technology for health systems has the potential to increase the number of patients treated while decreasing cost and allowing distributed local consultation facilities close to the target communities, minimizing the need for transportation and minimizing waiting times. One such initiative is the Teleoftalmo-RS videocolaboration program where ophthalmologic consultations are performed. In this paper, the development of an auxiliary tool to help expedite the diagnosis of cataracts in such a system is presented. This work is also part of the ongoing RNP and Microsoft Challenge: Artificial Intelligence R&D.
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Sik-Lanyi, Cecilia. "Virtual reality healthcare system could be a potential future of health consultations." In 2017 IEEE 30th Neumann Colloquium (NC). IEEE, 2017. http://dx.doi.org/10.1109/nc.2017.8263275.
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Nair, Pramod, Ahmed Kamal, Ahmed Aboulnega, and Abrar Ahmed. "1314 Virtual consultations in paediatrics – what have we learnt?" In Royal College of Paediatrics and Child Health, Abstracts of the RCPCH Conference–Online, 15 June 2021–17 June 2021. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health, 2021. http://dx.doi.org/10.1136/archdischild-2021-rcpch.550.
Full textReports on the topic "Health consultations"
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Race Equality Public Action Group, NIHR, Sarah Knowles, Sandra Richards, and Adam Kamenetzky. Report of themes from community consultations on a pilot Race Equality Framework for health and care research organisations. National Institute for Health and Care Research (NIHR), April 2022. http://dx.doi.org/10.3310/nihropenres.1115191.1.
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Race Equality Public Action Group, NIHR, Sarah Knowles, Sandra Richards, and Adam Kamenetzky. Draft themes and selected participant quotes from community consultations on a pilot Race Equality Framework for health and care research organisations. National Institute for Health and Care Research (NIHR), April 2022. http://dx.doi.org/10.3310/nihropenres.1115190.1.
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Peñaloza, Blanca. Does training for healthcare providers in patient-centred care improve patient outcomes? SUPPORT, 2017. http://dx.doi.org/10.30846/1704124.
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Communication problems in healthcare may arise if healthcare providers focus on diseases and their management, rather than people, their lives and their health problems. Training healthcare providers to be more ‘patient centred’ could improve communication in consultations, increase patient satisfaction with care and improve health outcomes.
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Hrynick, Tabitha, and Santiago Ripoll. Key Considerations: Achieving COVID-19 Vaccine and Health Equity in Ealing and North West London. Institute of Development Studies (IDS), November 2021. http://dx.doi.org/10.19088/sshap.2021.041.
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This brief illustrates how COVID-19 vaccine (in)equity has played out on the ground and offers key considerations for how it can be improved in the North West London (NWL) borough of Ealing. We conducted a review of literature and several informal consultations with local actors involved in COVID-19 vaccination efforts in statutory bodies (local authorities and the NHS) and the community in order to build a picture of and contextualise COVID-19 vaccine uptake in Ealing. Key considerations and lessons for achieving greater vaccine and health equity are presented, followed by additional context of interest to responders within statutory authorities and the community. This brief was produced by SSHAP in collaboration with partners in Ealing Council. It was authored by Tabitha Hrynick and Santiago Ripoll and is the responsibility of SSHAP.
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Totten, Annette, Dana M. Womack, Marian S. McDonagh, Cynthia Davis-O’Reilly, Jessica C. Griffin, Ian Blazina, Sara Grusing, and Nancy Elder. Improving Rural Health Through Telehealth-Guided Provider-to-Provider Communication. Agency for Healthcare Research and Quality, December 2022. http://dx.doi.org/10.23970/ahrqepccer254.
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Objectives. To assess the use, effectiveness, and implementation of telehealth-supported provider-to-provider communication and collaboration for the provision of healthcare services to rural populations and to inform a scientific workshop convened by the National Institutes of Health Office of Disease Prevention on October 12–14, 2021. Data sources. We conducted a comprehensive literature search of Ovid MEDLINE®, CINAHL®, Embase®, and Cochrane CENTRAL. We searched for articles published from January 1, 2015, to October 12, 2021, to identify data on use of rural provider-to-provider telehealth (Key Question 1) and the same databases for articles published January 1, 2010, to October 12, 2021, for studies of effectiveness and implementation (Key Questions 2 and 3) and to identify methodological weaknesses in the research (Key Question 4). Additional sources were identified through reference lists, stakeholder suggestions, and responses to a Federal Register notice. Review methods. Our methods followed the Agency for Healthcare Research and Quality Methods Guide (available at https://effectivehealthcare.ahrq.gov/topics/cer-methods-guide/overview) and the PRISMA reporting guidelines. We used predefined criteria and dual review of abstracts and full-text articles to identify research results on (1) regional or national use, (2) effectiveness, (3) barriers and facilitators to implementation, and (4) methodological weakness in studies of provider-to-provider telehealth for rural populations. We assessed the risk of bias of the effectiveness studies using criteria specific to the different study designs and evaluated strength of evidence (SOE) for studies of similar telehealth interventions with similar outcomes. We categorized barriers and facilitators to implementation using the Consolidated Framework for Implementation Research (CFIR) and summarized methodological weaknesses of studies. Results. We included 166 studies reported in 179 publications. Studies on the degree of uptake of provider-to-provider telehealth were limited to specific clinical uses (pharmacy, psychiatry, emergency care, and stroke management) in seven studies using national or regional surveys and claims data. They reported variability across States and regions, but increasing uptake over time. Ninety-seven studies (20 trials and 77 observational studies) evaluated the effectiveness of provider-to-provider telehealth in rural settings, finding that there may be similar rates of transfers and lengths of stay with telehealth for inpatient consultations; similar mortality rates for remote intensive care unit care; similar clinical outcomes and transfer rates for neonates; improvements in medication adherence and treatment response in outpatient care for depression; improvements in some clinical monitoring measures for diabetes with endocrinology or pharmacy outpatient consultations; similar mortality or time to treatment when used to support emergency assessment and management of stroke, heart attack, or chest pain at rural hospitals; and similar rates of appropriate versus inappropriate transfers of critical care and trauma patients with specialist telehealth consultations for rural emergency departments (SOE: low). Studies of telehealth for education and mentoring of rural healthcare providers may result in intended changes in provider behavior and increases in provider knowledge, confidence, and self-efficacy (SOE: low). Patient outcomes were not frequently reported for telehealth provider education, but two studies reported improvement (SOE: low). Evidence for telehealth interventions for other clinical uses and outcomes was insufficient. We identified 67 program evaluations and qualitative studies that identified barriers and facilitators to rural provider-to-provider telehealth. Success was linked to well-functioning technology; sufficient resources, including time, staff, leadership, and equipment; and adequate payment or reimbursement. Some considerations may be unique to implementation of provider-to-provider telehealth in rural areas. These include the need for consultants to better understand the rural context; regional initiatives that pool resources among rural organizations that may not be able to support telehealth individually; and programs that can support care for infrequent as well as frequent clinical situations in rural practices. An assessment of methodological weaknesses found that studies were limited by less rigorous study designs, small sample sizes, and lack of analyses that address risks for bias. A key weakness was that studies did not assess or attempt to adjust for the risk that temporal changes may impact the results in studies that compared outcomes before and after telehealth implementation. Conclusions. While the evidence base is limited, what is available suggests that telehealth supporting provider-to-provider communications and collaboration may be beneficial. Telehealth studies report better patient outcomes in some clinical scenarios (e.g., outpatient care for depression or diabetes, education/mentoring) where telehealth interventions increase access to expertise and high-quality care. In other applications (e.g., inpatient care, emergency care), telehealth results in patient outcomes that are similar to usual care, which may be interpreted as a benefit when the purpose of telehealth is to make equivalent services available locally to rural residents. Most barriers to implementation are common to practice change efforts. Methodological weaknesses stem from weaker study designs, such as before-after studies, and small numbers of participants. The rapid increase in the use of telehealth in response to the Coronavirus disease 2019 (COVID-19) pandemic is likely to produce more data and offer opportunities for more rigorous studies.
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Wain, Harold. Use of Tele-Mental Health in Consultation Liaison Psychiatry. Fort Belvoir, VA: Defense Technical Information Center, November 2001. http://dx.doi.org/10.21236/ada401301.
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Busso, Matías, María P. González, and Carlos Scartascini. On the Demand for Telemedicine: Evidence from the Covid-19 Pandemic. Inter-American Development Bank, April 2021. http://dx.doi.org/10.18235/0003225.
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Telemedicine can expand access to health care at relatively low cost. Historically, however, demand for telemedicine has remained low. Using administrative records and a difference-in-differences methodology, we estimate the change in demand for telemedicine experienced after the onset of the COVID-19 epidemic and the imposition of mobility restrictions. We find a 233 percent increase in the number of telemedicine calls and a 342 percent increase in calls resulting in a medication being prescribed. The effects were mostly driven by older individuals with pre-existing conditions who used the service for internal medicine consultations. The demand for telemedicine remains high even after mobility restrictions were relaxed, which is consistent with telemedicine being an experience good. These results are a proof of concept for policymakers willing to expand access to healthcare using advances in technology.
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Hrynick, Tabitha, and Santiago Ripoll. Evidence Review: Achieving COVID-19 Vaccine Equity in Ealing and North West London. Institute of Development Studies (IDS), November 2021. http://dx.doi.org/10.19088/sshap.2021.040.
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This review sets out key considerations for improving vaccine equity – as well as broader health equity – in the North West London (NWL) borough of Ealing. It foregrounds the political, economic and social dynamics which have perpetuated health inequalities during and prior to COVID-19, and how they have manifested to shape COVID-19 vaccine accessibility and uptake among different social groups. It also highlights how local actors have sought to address these inequalities. By bringing together data and insights from existing social science research and consultations with people involved in local COVID-19 vaccination efforts (in local authorities, the NHS and community groups), we point to ways local authorities and healthcare providers, in collaboration with local people and organisations, can support vaccine equity – and health equity more broadly – now, and into the future. Critical to this are further efforts to integrate sensitivity to context, sustain collaborative working, build trust and meaningfully engage citizens (especially vulnerable groups), and support a robust civil society. The review begins with summary key considerations for operational actors. This review was produced by SSHAP in collaboration with Ealing Council. It was authored by Tabitha Hrynick and Santiago Ripoll, and reviewed by Maddy Gupta-Wright, Ellen Schwartz, and Nikita Simpson. It is the responsibility of SSHAP
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Butler, Nadia, and Soha Karam. Key Considerations for Integrating COVID-19 Vaccination Services: Insights from Iraq and Syria for the MENA Region. SSHAP, September 2022. http://dx.doi.org/10.19088/sshap.2022.034.
Full textAbstract:
With the COVID-19 pandemic well into its third year, governments and response partners are recognising that it no longer makes sense for COVID-19 services, including vaccination, to exist in isolation. There is growing recognition of the potential for integration with other services as the way forward for COVID-19 vaccination. This has recently begun to occur in various countries, but until now, there has been little evidence available as to the success of these initiatives. Service delivery integration occurs where “managerial or operational changes to health systems bring together inputs, delivery, management, and organisation of particular service functions in ways that are contextually appropriate and person-centred with the aim of improving coverage, access, quality, acceptability, effectiveness, and cost-effectiveness” (Haldane et al. 2022) This brief draws on evidence from academic and grey literature and consultations with partners working in the COVID-19 response to review current integration efforts (as of August 2022) and explore potentially effective ways to integrate COVID-19 vaccination into other services in the Middle East and North Africa (MENA) region. Recent guidance on integration from WHO has also been cross-referenced where relevant. Iraq is taken as a detailed case study due to the efforts already made there on integration of COVID-19 and routine immunisation (RI) services. Global integration experiences and a brief discussion of integration efforts in Syria are also included. The brief is part of the Social Science in Humanitarian Action Platform (SSHAP) series on social science considerations relating to COVID-19 vaccines and was written for SSHAP by Nadia Butler supported by Soha Karam (Anthrologica). Verbal consultations and reviews of the draft were provided from response partners in Iraq and other locations within the region (IFRC MENARO, Iraq MoH, UNICEF Iraq, UNICEF MENARO, UNICEF Syria, WHO EMRO). The brief was requested by the UNICEF Middle East and North Africa Regional Office (MENARO) and is the responsibility of SSHAP.
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Hakeem, Luqman, and Riaz Hussain. Key Considerations: Localisation of Polio Vaccination Efforts in the Newly Merged Districts (Tribal Areas) of Pakistan. SSHAP, September 2022. http://dx.doi.org/10.19088/sshap.2022.035.
Full textAbstract:
Poliomyelitis (polio) remains a vital global public health challenge, particularly in countries where eradication efforts are ongoing. For almost three decades, polio programme and frontline workers in Pakistan have suffered human and financial losses due to complex political and bureaucratic management, local resistance to programme efforts, and the context of cross-border insurgency and insecurity.1 Many stakeholders in Pakistan continue to have low confidence in frontline workers and polio vaccination campaigns. In this environment, it is essential that vaccination programmes localise – by taking careful account of the local context, improving local ownership of the programmes, understanding and mitigating the issues at a grassroots level, and tailoring efforts to achieve polio eradication goals. This brief draws on evidence from academic and grey literature, data on polio vaccine uptake, consultations with partners working on polio eradication in Pakistan, and the authors’ own programme implementation experience in the country. The brief reviews the social, cultural, and contextual considerations relevant to increasing polio vaccine uptake amongst vulnerable groups in Pakistan’s tribal areas. It focuses on the current country context, in the aftermath of the 2018 merger of the former Federally Administered Tribal Areas (FATA) into Khyber Pakhtunkhwa province (KPK). This brief is part of a series authored by participants from the SSHAP Fellowship, and was written by Luqman Hakeem and Riaz Hussain from Cohort 2. Contributions were provided by response partners in Pakistan including health communication and delivery staff and local administrative authorities. This brief was reviewed by Muhammad Sufyan (University of Swabi) and Ilyas Sharif (Quaid-e-Azam College of Commerce, University of Peshawar). The brief was supported by Megan Schmidt-Sane and Santiago Ripoll at the Institute of Development Studies and is the responsibility of SSHAP.