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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.
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A. Simmons, Tanya, and Helen R. Winefield. "Predictors of Patient Enablement: The Role of Doctors' Helpgiving Style, Patient and Visit Characteristics." Australian Journal of Primary Health 8, no. 3 (2002): 39. http://dx.doi.org/10.1071/py02042.
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Patient enablement is a possible outcome of primary health care consultations and has been employed as a marker of effective helpgiving. We studied predictors of patient enablement, investigating the relative contribution of patient characteristics (gender, age, occupational status, and perceived health status), visit characteristics (length of consultation, duration of physician-patient relationship, and frequency of consultations), and the physician's reported helpgiving style (level of encouragement of patient participation in the consultation). The Helpgiving Practices Scale and Patient Enablement Instrument were completed by 103 patients from eight metropolitan general practices. Patients with better perceived health status and lower occupational status felt more enabled following their consultations. Frequency of consultations employed as a measure of "knowing a doctor well" was also significantly associated with post-consultation enablement. General practitioners' encouragement of patients to participate in their health care then added significantly to the explained variance in patient enablement. Results of this study indicate that the Patient Enablement Instrument is a useful measure of quality of care with scores being less positively skewed than those of frequent employed satisfaction measures.
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Loula, P., E. Rauhala, M. Erkinjuntti, E. Raty, K. Hirvonen, and V. Hakkinen. "Distributed clinical neurophysiology." Journal of Telemedicine and Telecare 3, no. 2 (June 1, 1997): 89–95. http://dx.doi.org/10.1258/1357633971930922.
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We have developed a consultation forum for clinical neurophysiology in Finland. The system connects local digital electroencephalography EEG recording and analysing networks using a high-speed asynchronous transfer mode ATM network. Clinicians can obtain a second opinion using interactive data and video consultations or using data-only consultations. In addition, the system can be used for off-line review of prerecorded data. During a one-month evaluation, 66 EEG recordings were made altogether in Satakunta Central Hospital and consultations were required on 12 occasions. Nine of them were data-only consultations and three were data and video consultations. A data consultation lasted 15-20 min and a data and video consultation 35-45 min. Clinically, there were numerous benefits for the hospitals. The system established a link to a centre of excellence for second opinions or continuing education. It also helped with on-duty arrangements and enabled the construction of national data banks.
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Han, Seung Min, Geva Greenfield, Azeem Majeed, and Benedict Hayhoe. "Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review." Journal of Medical Internet Research 22, no. 11 (November 9, 2020): e23482. http://dx.doi.org/10.2196/23482.
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Background There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. Objective This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. Methods Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). Results In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. Conclusions There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.
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Rungby, Jeanne A., Frans Rømeling, and Peter Borum. "Tonsillectomy: assessment of quality by consultation rate after discharge." Journal of Laryngology & Otology 113, no. 2 (February 1999): 135–39. http://dx.doi.org/10.1017/s0022215100143385.
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AbstractThe aim of this prospective study was to establish a measure of short-term quality of treatment after tonsillectomy/adenotonsillectomy. One hundred and thirty-four questionnaires, returned after 14 days, from 41 children and 93 adults were analysed. Forty-seven per cent had one or more consultations with health-care professionals. Eighty-three consultations by telephone and 33 consultations in person were made. Two recent studies reported higher consultation rates in person to doctors compared to this study. The predominant reason for consulting health-care professionals was pain. Maximum pain scores were significantly higher among those with consultations vs. no consultations (p = 0.0001). Additionally, the intensity as well as the duration of maximal pain increased with the number of contacts per patient (p = 0.0001, p = 0.0045). Sixty-four per cent felt relieved after consultation by telephone and 83 per cent felt relieved after consultation in person. The present study suggests consultation rate as a parameter of quality of treatment and quality of information.
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Huygens, Martine W. J., Ilse C. S. Swinkels, Robert A. Verheij, Roland D. Friele, Onno C. P. van Schayck, and Luc P. de Witte. "Understanding the use of email consultation in primary care using a retrospective observational study with data of Dutch electronic health records." BMJ Open 8, no. 1 (January 2018): e019233. http://dx.doi.org/10.1136/bmjopen-2017-019233.
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ObjectivesIt is unclear why the use of email consultation is not more widespread in Dutch general practice, particularly because, since 2006, its costs can be reimbursed. To encourage further implementation, it is needed to understand the current use of email consultations. This study aims to understand the use of email consultation by different patient groups, compared with other general practice (GP) consultations.SettingFor this retrospective observational study, we used Dutch routine electronic health record data obtained from NIVEL Primary Care Database for the years 2010 and 2014.Participants200 general practices were included in 2010 (734 122 registered patients) and 434 in 2014 (1 630 386 registered patients).Primary outcome measuresThe number and percentage of email consultations and patient characteristics (age, gender, neighbourhood socioeconomic status and diagnoses) of email consultation users were investigated and compared with those who had a telephone or face-to-face consultation. General practice characteristics were also taken into account.Results32.0% of the Dutch general practices had at least one email consultation in 2010, rising to 52.8% in 2014. In 2014, only 0.7% of the GP consultations were by email (the others comprised home visits, telephone and face-to-face consultations). Its use highly varied among general practices. Most email consultations were done for psychological (14.7%); endocrine, metabolic and nutritional (10.9%); and circulatory (10.7%) problems. These diagnosis categories appeared less frequently in telephone and face-to-face consultations. Patients who had an email consultation were older than patients who had a telephone or face-to-face consultation. In contrast, patients with diabetes who had an email consultation were younger.ConclusionEven though email consultation was done in half the general practices in the Netherlands in 2014, the actual use of it is extremely low. Patients who had an email consultation differ from those who had a telephone or face-to-face consultation. In addition, the use of email consultation by patients is dependent on its provision by GPs.
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Žmenja, Marika. "Provision of Health-care Service over the Internet – the Legality of E-consultations in Estonia." Juridica International 26 (November 13, 2017): 47. http://dx.doi.org/10.12697/ji.2017.26.05.
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The number of Web sites providing medical consultations is growing constantly. They offer common information and advice, patient education, and general and individualised consulting. In certain cases wherein Web sites offer consultations, the service is subject to the same legal regulation as conventional health-care provision. The article discusses when consulting via the Internet (i.e., e-consulting) can be considered provision of health-care service and which requirements it has to meet if so. The author concludes that what matters here is not how service providers present their service but whether the essence of e-consultation corresponds to the definition of a health-care service – if it does, e-consultation has to be considered one. Among the obstacles in providing e-consultations is fulfilling the requirement of having consultation premises at the time of applying for the necessary permit. Health-care providers are required to have a physical location where they can provide the services. Also addressed in the article is e-consultation as information-society service. It is concluded that if this is an intermediary service, then – if the design of the service so indicates – legal regulations applicable to health-care service provision do not apply. The author finds that, in general, e-consultations are possible and legitimate in the current legal framework.
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Chetty, Laran. "Client Satisfaction With Virtual Consultations During the COVID-19 Pandemic at an Occupational Health Physical Therapy Clinic." Workplace Health & Safety 70, no. 4 (February 3, 2022): 220–23. http://dx.doi.org/10.1177/21650799211061146.
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Background: The purpose of this project was to determine whether clients were satisfied with their occupational health physical therapy virtual consultations and whether or not they would have preferred a face-to-face consultation instead of a virtual consultation. Methods: Clients were mailed an adapted 10-item Telehealth Satisfaction Scale (TeSS) and asked to complete and return it in a prepaid envelope. Clients who returned the TeSS were then contacted by telephone and asked whether they would have preferred a face-to-face consultation instead of a virtual consultation. Findings: Overall, clients expressed a high degree of satisfaction with their virtual occupational health physical therapy consultation (96.9%). Most clients (82.1%) stated they would have chosen virtual consultations if given the choice. Conclusion/Application to Practice: The cumulative feedback from clients suggested that the benefits of virtual consultations can be sustained post COVID-19 pandemic as clients have accepted and adapted to this new approach within the occupational health physical therapy clinic.
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Støme, Linn Nathalie, Tone Vaksvik, Christian Ringnes Wilhelmsen, and Kari Jorunn Kværner. "PP03 Early Assessment Of Video Consultations In Rehabilitation After Hand Injury." International Journal of Technology Assessment in Health Care 38, S1 (December 2022): S39. http://dx.doi.org/10.1017/s0266462322001489.
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IntroductionWith the aim of reducing patient travel and related costs, physiotherapists and occupational therapists at the Oslo University Hospital began offering video consultations to patients with hand and arm injuries in March 2020. A feasibility study was initiated to describe the first year of using video consultations in the rehabilitation of upper extremity injuries in children and adults, and to assess the acceptability of the service from the perspective of hand therapists. The secondary objective of the study was to investigate the economic effects of using video consultation for this patient group.MethodsThe therapists documented the individual consultations in an Excel spreadsheet. Utility and acceptability were analyzed based on the content of each video consultation. The therapists also registered the patient’s municipality in order to calculate costs related to travel, accommodation, and other costs related to in-person consultation. Utility was analyzed using an early economic model based on scenario analysis to compare the costs of video consultations with in-person consultations.ResultsBased on the content analysis from 89 consultations, video consultations were deemed acceptable by the therapists. The total travel distance from patients’ homes to the hospital was 20,190 km, as hand rehabilitation is a national service. The video consultations that replaced the consultations at the hospital were potentially more time efficient, reduced patients’ travel time and absence from home and work, and saved costs for the Oslo University Hospital and society.ConclusionsBased on early decision support provided by this study, adaptions were made to the delivery of video consultations to improve the cost effectiveness of the service. The findings from this study provided an indication of the potential value of the new service, which may be used for benchmarking purposes to ensure that it meets the needs of users, the health service, and society.
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Pecina, Jennifer L., and Frederick North. "A retrospective analysis of medical record use in e-consultations." Journal of Telemedicine and Telecare 23, no. 5 (June 14, 2016): 544–49. http://dx.doi.org/10.1177/1357633x16654607.
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Introduction Under certain circumstances, e-consultations can substitute for a face-to-face consultation. A basic requirement for a successful e-consultation is that the e-consultant has access to important medical history and exam findings along with laboratory and imaging results. Knowing just what information the specialist needs to complete an e-consultation is a major challenge. This paper examines differences between specialties in their need for past information from laboratory, imaging and clinical notes. Methods This is a retrospective study of patients who had an internal e-consultation performed at an academic medical centre. We reviewed a random sample of e-consultations that occurred in the first half of 2013 for the indication for the e-consultation and whether the e-consultant reviewed data in the medical record that was older than one year to perform the e-consultation. Results Out of 3008 total e-consultations we reviewed 360 (12%) randomly selected e-consultations from 12 specialties. Questions on management (35.8%), image results (27.2%) and laboratory results (25%) were the three most common indications for e-consultation. E-consultants reviewed medical records in existence more than one year prior to the e-consultation 146 (40.6%) of the time with e-consultants in the specialties of endocrinology, haematology and rheumatology, reviewing records older than one year more than half the time. Labs (20.3%), office notes (20%) and imaging (17.8%) were the types of medical data older than one year that were reviewed the most frequently overall. Discussion Management questions appear to be the most common reason for e-consultation. E-consultants frequently reviewed historical medical data that is older than one year at the time of the e-consultation, especially in endocrinology, haematology and rheumatology specialties. Practices engaging in e-consultations that require transfer of data may want to include longer time frames of historical information for those specialties.
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Vázquez-Barquero, J. L., G. Wilkinson, P. Williams, J. F. Diez-Manrique, and C. Peña. "Mental health and medical consultation in primary care settings." Psychological Medicine 20, no. 3 (August 1990): 681–94. http://dx.doi.org/10.1017/s0033291700017207.
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SynopsisThis paper examines the effect of psychiatric morbidity, as measured by the GHQ-60, on the probability of being in contact with a primary care physician, and the socio-demographic factors which influenced this effect. We found that the presence of psychiatric morbidity emerged as a major determinant of primary care utilization in both sexes, and about one-sixth of consultations in men and one-fifth of consultations in women could be attributed to it. Logistic modelling was used to investigate the joint effect on general practitioner consultation of psychiatric morbidity and seven socio-demographic variables. Sex, age, and psychiatric morbidity exerted independent, but not interactive, effects on consultation.
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Alhajri, Noora, Mecit Can Emre Simsekler, Buthaina Alfalasi, Mohamed Alhashmi, Majd AlGhatrif, Nahed Balalaa, Maryam Al Ali, et al. "Physicians’ Attitudes Toward Telemedicine Consultations During the COVID-19 Pandemic: Cross-sectional Study." JMIR Medical Informatics 9, no. 6 (June 1, 2021): e29251. http://dx.doi.org/10.2196/29251.
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Background To mitigate the effect of the COVID-19 pandemic, health care systems worldwide have implemented telemedicine technologies to respond to the growing need for health care services during these unprecedented times. In the United Arab Emirates, video and audio consultations have been implemented to deliver health services during the pandemic. Objective This study aimed to evaluate whether differences exist in physicians’ attitudes and perceptions of video and audio consultations when delivering telemedicine services during the COVID-19 pandemic. Methods This survey was conducted on a cohort of 880 physicians from outpatient facilities in Abu Dhabi, which delivered telemedicine services during the COVID-19 pandemic between November and December 2020. In total, 623 physicians responded (response rate=70.8%). The survey included a 5-point Likert scale to measure physician’s attitudes and perceptions of video and audio consultations with reference to the quality of the clinical consultation and the professional productivity. Descriptive statistics were used to describe physicians’ sociodemographic characteristics (age, sex, designation, clinical specialty, duration of practice, and previous experience with telemedicine) and telemedicine modality (video vs audio consultations). Regression models were used to assess the association between telemedicine modality and physicians’ characteristics with the perceived outcomes of the web-based consultation. Results Compared to audio consultations, video consultations were significantly associated with physicians’ confidence toward managing acute consultations (odds ratio [OR] 1.62, 95% CI 1.2-2.21; P=.002) and an increased ability to provide patient education during the web-based consultation (OR 2.21, 95% CI 1.04-4.33; P=.04). There was no significant difference in physicians’ confidence toward managing long-term and follow-up consultations through video or audio consultations (OR 1.35, 95% CI 0.88-2.08; P=.17). Video consultations were less likely to be associated with a reduced overall consultation time (OR 0.69, 95% CI 0.51-0.93; P=.02) and reduced time for patient note-taking compared to face-to-face visits (OR 0.48, 95% CI 0.36-0.65; P<.001). Previous experience with telemedicine was significantly associated with a lower perceived risk of misdiagnosis (OR 0.46, 95% CI 0.3-0.71; P<.001) and an enhanced physician-patient rapport (OR 2.49, 95% CI 1.26-4.9; P=.008). Conclusions These results indicate that video consultations should be adopted frequently in the new remote clinical consultations. Previous experience with telemedicine was associated with a 2-fold confidence in treating acute conditions, less than a half of the perceived risk of misdiagnosis, and an increased ability to provide patients with health education and enhance the physician-patient rapport. Additionally, these results show that audio consultations are equivalent to video consultations in providing remote follow-up care to patients with chronic conditions. These findings may be beneficial to policymakers of e-health programs in low- and middle-income countries, where audio consultations may significantly increase access to geographically remote health services.
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Bauer, Brenton S., Ai Len Nguyen-Phan, Michael K. Ong, Boback Ziaeian, and Kim-Lien Nguyen. "Cardiology electronic consultations: Efficient and safe, but consultant satisfaction is equivocal." Journal of Telemedicine and Telecare 26, no. 6 (February 25, 2019): 341–48. http://dx.doi.org/10.1177/1357633x19828130.
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Background Cardiovascular electronic consultation is a new service line in consultative medicine and enables care without in-person office visits. We aimed to evaluate accessibility and time saved as measures of efficiency, determine the safety of cardiology electronic consultations, and assess satisfaction by responding cardiologists. Methods Using a mixed-methods approach and a modified time-driven, activity-based, costing framework, we retrospectively analysed cardiology electronic consultations. A random subset of 500 electronic consultations referred between 2013–2017 were reviewed. Accessibility was determined based upon increased number of patients served without the need for an in-person clinic visit. To assess safety, medical records were reviewed for emergency room visits or hospital admission at six months from the initial electronic consultation date. Responding cardiologist satisfaction was assessed by voluntary completion of an online survey. Results The majority of electronic consultations were related to medication advice, clearance for surgery, evaluation of images, or guidance after abnormal testing. Recommendations included echo (10.8%), stress testing (5.0%), other imaging (4.0%) and other subspecialist referrals (3.8%). Electronic consultations were completed within 0.7±0.5 days of the request, with a time to completion of 5–30 min. Over a six-month follow-up, 13.9% of patients had an in-person visit and 2.2% of patients were hospitalised, but none were directly related to the electronic consultation question. Satisfaction by responding cardiologists was modest. Conclusion In conclusion, within a single-payer system, cardiology electronic consultations represent a convenient and safe alternative for providing consultative cardiovascular care, but further optimization is necessary to minimise electronic consultation fatigue experienced by cardiologists.
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Babaniamansour, Sepideh. "The Quality of Medical Consultations in a Teaching Hospital: A Cross-Sectional Study." Journal of Biomedical Research & Environmental Sciences 2, no. 5 (May 2021): 392–98. http://dx.doi.org/10.37871/jbres1247.
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Background and objectives: Medical consultations became undeniable elements for the quality of health care and training of medical residence. This study aimed to assess the quality of performed consultations. Methods: This retrospective cross-sectional study at Shohadaye Tajrish hospital, affiliated to Shahid Beheshti University of Medical Sciences, in Tehran, Iran between 20th April 2018 and 4th May 2019. The reported items and quality score of medical consultation requests and responses between emergency and non-emergency consultations and between the faculty members and medical residents were assessed by SPSS version 21.0. Results: Among 431 medical consultations, most were non-emergency, requested by residents, and responded to by faculty members. The quality of consultations requested (p < 0.001) or responded (p < 0.001) by faculty members was higher than by medical residents. Higher year residents performed higher quality consultation requests (p = 0.008) and responses (p < 0.001). The quality score of consultation requests (p = 0.51) and responses (p = 0.1) had no significant difference between types of consultation. Conclusion: Underreported items of consultation impressed its quality. Faculty members and higher-year residents performed higher quality consultations.
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Hiscock, Harriet, Rachel Pelly, Xinjang Hua, Sue West, Dianne Tucker, Chin-Mae Raymundo, and Kim Dalziel. "<i>Corrigendum to</i>: Survey of paediatric telehealth benefits from the caregiver perspective." Australian Health Review 46, no. 2 (April 7, 2022): 255. http://dx.doi.org/10.1071/ah21036_co.
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<b>Objective</b>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. <b>Methods</b>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. <b>Results</b>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. <b>Conclusions</b>Paediatric telehealth video consultations were largely viewed favourably by caregivers, except for those attending for behavioural and mental health or developmental concerns. <b>What is known about the topic?</b>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. <b>What does this paper add?</b>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. <b>What are the implications for practitioners?</b>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.
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Leung, Katherine, and Saffan Qureshi. "Managing high frequency users of an electronic consultation system in primary care: a quality improvement project." BMJ Open Quality 10, no. 2 (June 2021): e001310. http://dx.doi.org/10.1136/bmjoq-2020-001310.
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The COVID-19 pandemic prompted a rapid change in primary care provision. There was a significant shift from face-to-face appointments to remote methods such as electronic consultation (e-consultation). Patients from a primary care provider in London were actively encouraged to use an online consultation platform called ‘Dr iQ’. A group of high frequency users of Dr iQ emerged and clinicians were concerned their health needs were not being met through the platform. High frequency attendance in a traditional general practice setting is associated with increased time and healthcare costs.This project evaluated the number of high frequency users (identified as 10 or more consultations a month) of Dr iQ in one busy inner city practice over a 5-month period. We aimed to decrease the subsequent monthly usage frequency of all Dr iQ high frequency users from 10 or more consultations to less than 10 consultations. Our interventions included a semi-structured telephone interview, discussion among the multidisciplinary team, and regular scheduled telephone or face-to-face appointments. Following two Plan–Do-Study–Act cycles, all 12 high frequency users showed a decrease in the number of consultations submitted to Dr iQ to less than 10 consultations a month.This project proposes a method of case managing high frequency users of e-consultation. The majority of high frequency users had unmet health needs and felt a lack of continuity of care on Dr iQ. They often had complex physical and mental health problems. As remote consulting technology continues to develop, more research is required to understand the epidemiology and aetiology of e-consultation high frequency use in order to improve patient outcomes.
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Zhou, Fengli, Zhouhan Wang, Xiaojun Mai, Xiaoyun Liu, Christopher Reid, Sally Sandover, Kouxing Zhang, and Dan Xu. "Online Clinical Consultation as a Utility Tool for Managing Medical Crisis During a Pandemic: Retrospective Analysis on the Characteristics of Online Clinical Consultations During the COVID-19 Pandemic." Journal of Primary Care & Community Health 11 (January 2020): 215013272097551. http://dx.doi.org/10.1177/2150132720975517.
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Coronavirus disease 2019 (COVID-19) is a newly-identified infectious diseases that has rapidly spread throughout the world with rising fatalities with declaration by World Health Organization as the pandemic. Online consultations have been shown to alleviate the pandemic with our study aims to demonstrate whether online consultation can be a solution for acute health crisis. Retrospective analysis of the characteristics of online consultations through two primary care online-consultation platforms during COVID-19 pandemic was performed at the Third Affiliated Hospital of Sun Yat-Sen University, which led the assessment of COVID-19-symptoms patients in Guangzhou. The 3473 online consultations were divided into pre-pandemic and pandemic period groups with Chi-square test as statistical analysis method. The number of online consultations has increased with diagnosis of upper respiratory tract infection, psychological conditions, COVID-19-related investigations and interventions. The increased online consultations met the increased demand of the relevant clinical services and reduced the overwhelming hospital presentations, thus decreasing the potential COVID-19 spread inside the major tertiary hospital and sparing the resources for acute crisis management. The epidemiology and disease characteristics of online consultations during the pandemic have been demonstrated with identification of the enabling factors and potential barriers in improving online healthcare in China with online consultation model being a durable solution for pandemic in future.
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Gonzalez, Francisco, Blanca Cimadevila, Julio Garcia-Comesaña, Susana Cerqueiro, Eladio Andion, Jorge Prado, Jorge Bermudez, and Felix Rubial. "Telephone consultation in primary care." Journal of Health Organization and Management 32, no. 2 (April 9, 2018): 321–37. http://dx.doi.org/10.1108/jhom-08-2017-0201.
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Purpose The purpose of this paper is to describe and analyze a teleconsultation modality based on a simple telephone call, using either landline or mobile phone, made available to more than two million people. Telecommunication systems are an increasingly common feature in modern healthcare. However, making teleconsultations available to the entire population covered by a public health system is a challenging goal. Design/methodology/approach This retrospective longitudinal observational study analyzed how this modality was used at the primary care level in Galicia, a region in the Northwest of Spain, in 2014 and 2015, focusing on demand, gender and age preferences, rural vs urban population and efficiency. Findings Of 28,472,852 consultations requested in this period, 9.0 percent were telephone consultations. Women requested more telephone consultations (9.9 percent of total consultations) than men (7.7 percent of total consultations). The highest demand occurred for the over 85 age group for both men and women. In both years, 2014 and 2015, the number of telephone consultations per inhabitant was higher in urban (0.53 and 0.69) than in rural areas (0.34 and 0.47). In 10.9 percent of cases, the telephone consultations required further face-to-face consultation. Originality/value Conventional voice telephone calls can efficiently replace conventional face-to-face consultations in primary healthcare in roughly 10 percent of cases. Women are more likely than men to use primary care services in both face-to-face and telephone consultation modalities. Public healthcare systems should consider implementing telephone consultations to deliver their services.
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Sumikawa, Yuka, Chikako Honda, Kyoko Yoshioka-Maeda, and Noriko Yamamoto-Mitani. "Characteristics of COVID-19-Related Free Telephone Consultations by Public Health Nurses in Japan: A Retrospective Study." Healthcare 9, no. 8 (August 9, 2021): 1022. http://dx.doi.org/10.3390/healthcare9081022.
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This study aimed to (1) describe the characteristics of community residents who used coronavirus disease 2019 (COVID-19)-related telephone consultation systems by public health nurses (PHNs) and (2) analyze the concerns they had during the first wave of COVID-19 in Japan. Among 1126 telephone consultations, PHNs recorded telephone consultations between 25 March, and 30 April, 2020, in City A, Japan. We analyzed 1017 consultations involving 799 (79%) community residents (resident group) and 218 (21%) organizational representatives (organization group) located in City A. Half of the consultations were made during midmorning, and most of the consultations were regarding COVID-19 symptoms. Among the resident group, visiting a primary care doctor was the most common recommendation by the PHNs; there was no difference in provision of consultation by sex. Health- and welfare-related organizations mainly consulted PHNs about “having COVID-19-related symptoms” and “undergoing PCR testing,” and PHNs’ recommended them to visit a primary care doctor and coordinate PCR testing. The results suggest that public health centers should provide more helpful information on COVID-19 that accurately reflects the concerns of the population.
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Vieira, Gustavo, and Pablo Castanho. "Das consultas terapêuticas à consulta conjunta: contribuições de Winnicott à prática do apoio matricial." Ciência & Saúde Coletiva 27, no. 5 (May 2022): 1929–38. http://dx.doi.org/10.1590/1413-81232022275.08012021.
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Resumo O artigo tem como objetivo revisitar as Consultas Terapêuticas do psicanalista Donald Winnicott, buscando identificar nesta estratégia clínica subsídios para a sustentação técnica e ética do apoio matricial e das consultas conjuntas no Sistema Único de Saúde (SUS). Para tanto, realiza-se uma releitura de textos de Winnicott e comentadores, colocando-os em debate com aspectos do trabalho em saúde mental na atenção básica. A partir da análise detalhada de uma das consultas descritas pelo psicanalista, abordam-se implicações para a prática do apoio matricial, tanto na intervenção junto à equipe, como na escuta do paciente e sua família. Além disso, com base no estudo dos relatos de consultas de Winnicott, apresentam-se contribuições para as consultas conjuntas no SUS, considerando seus eixos assistencial e formativo. Como resultados técnicos e éticos, destacam-se: (a) a prioridade da escuta direta da pessoa sobre quem advém a queixa; (b) a importância de sustentar o “espaço e tempo” que possibilite uma experiência significativa ao paciente; (c) o uso de instrumentos de entrevista à luz do “brincar partilhado”; (d) o paciente como sujeito ativo na construção de seu projeto terapêutico; (e) a importância da equipe local no suporte e “tradução” da experiência do paciente.
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Looi, Jeffrey CL, Stephen Allison, Tarun Bastiampillai, and William Pring. "Private practice metropolitan telepsychiatry in smaller Australian jurisdictions during the COVID-19 pandemic: preliminary analysis of the introduction of new Medicare Benefits Schedule items." Australasian Psychiatry 28, no. 6 (October 5, 2020): 639–43. http://dx.doi.org/10.1177/1039856220960381.
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Objective: To analyse the smaller Australian state/territory service impact of the introduction of new COVID-19 psychiatrist video and telephone telehealth Medicare Benefits Schedule (MBS) items. Method: MBS item service data were extracted for COVID-19 psychiatrist video and telephone telehealth item numbers corresponding to the pre-existing in-person consultations for the Australian Capital Territory (ACT), Northern Territory (NT), South Australia (SA) and Tasmania. Results: The overall rate of consultations (face-to-face and telehealth) increased during March and April 2020, compared to the monthly face-to-face consultation average, excepting Tasmania. Compared to an annual monthly average of in-person consultations for July 2018–June 2019, total telepsychiatry consultations were higher for April than May. For total video and telephone telehealth consultations combined, video consultations were lower in April and higher in May. As a percentage of combined telehealth and in-person consultations, telehealth was greater for April and lower for May compared to the monthly face-to-face consultation average. Conclusions: In the smaller states/territories, the private practice workforce rapidly adopted COVID-19 MBS telehealth items, with the majority of psychiatric consultation shifting to telehealth initially, and then returning to face-to-face. With a second wave of COVID-19 in Australia, telehealth is likely to remain a vital part of the national mental health strategy.
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Böling, Susanna, Johan M. Berlin, Helene Berglund, and Joakim Öhlén. "No ordinary consultation – a qualitative inquiry of hospital palliative care consultation services." Journal of Health Organization and Management 34, no. 6 (August 4, 2020): 621–38. http://dx.doi.org/10.1108/jhom-04-2020-0130.
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PurposeConsidering the great need for palliative care in hospitals, it is essential for hospital staff to have palliative care knowledge. Palliative consultations have been shown to have positive effects on in-hospital care. However, barriers to contact with and uptake of palliative consultation advice are reported, posing a need for further knowledge about the process of palliative consultations. The purpose of this study therefore was to examine how palliative consultations in hospitals are practised, as perceived by consultants and health care professionals on receiving wards.Design/methodology/approachFocus groups with palliative care consultation services, health care personnel from receiving wards and managers of consultation services. Interpretive description and constant comparative method guided the analysis.FindingsVariations were seen in several aspects of practice, including approach to practice and represented professions. The palliative consultants were perceived to contribute by creating space for palliative care, adding palliative knowledge and approach, enhancing cooperation and creating opportunity to ameliorate transition. Based on a perception of carrying valuable perspectives and knowledge, a number of consultation services utilised proactive practices that took the initiative in relation to the receiving wards.Originality/valueA lack of policy and divergent views on how to conceptualise palliative care appeared to be associated with variations in consultation practices, tentative approaches and a bottom-up driven development. This study adds knowledge, implying theoretical transferability as to how palliative care consultations can be practised, which is useful when designing and starting new consultation services.
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Kotwal, Tejas, Kerushan Thomas, Carlos Escudero King, and Avirup Gupta. "Assessement of a structured technological support intervention on uptake of video consultations." BJPsych Open 7, S1 (June 2021): S201—S202. http://dx.doi.org/10.1192/bjo.2021.540.
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AimsThe coronavirus pandemic has led to an increased reliance on remote patient-clinician interactions, mainly the use of telephone and video consultations. Video consultations are key in psychiatric care, as telephone appointments do not sufficiently allow clinicians to accurately ascertain a patient's mental status and perform a risk assessment. The aim of our quality improvement project was to increase the uptake of video consultations within a community mental health team, focusing on substituting telephone consultations for video.MethodWe accessed Electronic Patient Records to retrospectively quantify the method of contact for 130 consultations delivered over a 4-week period. After collecting baseline data, we conducted focused interviews with 10 care providers, identifying the specific clinician and patient barriers to video uptake that informed our intervention design.Our intervention consisted of two 4-week Plan, Do, Study, Act (PDSA) cycles.PDSA 1 involved delivering a focused PowerPoint presentation to the care team, highlighting the benefits of video consultation technology and encouraging clinicians to use it as their primary method of remote communication with patients. Additionally, we conducted qualitative interviews with members of the team to highlight the successes and challenges thus far.PDSA 2 involved creating a video consultation instructional PDF which highlighted how to operate the technological aspects of both Microsoft Teams and WhatsApp Video Call. This included: how to set-up video calls, accept invitations, and overcome common troubleshooting issues.The proportion of remote consultations was quantified retrospectively to compare trends in video consultation uptake from baseline to the conclusion of PDSA 2.ResultOverall, we saw a 15% increase in video consultations with respect to baseline. The greatest change was attributable to PDSA cycle 1, which incurred an 8% increase in video consultation uptake, from 13.85% to 21.9%. PDSA cycle 2 further increased video consultation uptake by 6.97%, from 21.9% to 28.87%. Specifically focusing on remote consultations, the proportion conducted with video rather than telephone increased by 17.3%. Interviewed clinicians reported limited financial access, technological fluency, and issues with patient privacy as the most important barriers to the uptake of video consultations.ConclusionOur project successfully increased the proportion of consultations conducted by video. This was achieved by targeting interventions to address both patient and clinician barriers to video consultation uptake. Moreover, we understand that motivating and mobilising the care team was a key factor. Possible future work includes improving the sustainability of the interventions and assessing their efficacy in other care teams.
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Mathew, Deepa Elizabeth, Vinay Bothra, Shipra Mathur, Cheri Mathews John, Natasha Susan John, Suneela Nayak, and Sanjiv Kumar. "Patient perceptions about virtual clinical consultations during current COVID-19 pandemic: A multi-city survey across India." Indian Journal of Community Health 33, no. 2 (June 30, 2021): 368–72. http://dx.doi.org/10.47203/ijch.2021.v33i02.025.
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Introduction: COVID-19 has prevented many patients from accessing health care through traditional face-to-face clinic visits. Consequently, online consultations have gained popularity. Aim: To explore patient perceptions regarding virtual consultations. Methods: A voluntary online survey using a mix of quantitative and qualitative questions was administered to patients across selected cities in India using a social media platform. Responses were used to explore the characteristics of users, perceived advantages and disadvantages of online consultations and patient satisfaction. Results: There were 679 respondents (M 52.4%: F 47.6%) that had consulted doctors online; 91.8% were from 8 major metro cities. Interestingly, over 80% had never sought online consultation before the COVID-19 pandemic. 46% consultations were via videocalls, 26% through WhatsApp and 21% via telephone calls. The main advantages of online consultations cited by patients included a lower risk of infection (78.8%), reduced waiting time (56.8%) and travel time (58.3%). The main disadvantages included a lack of physical examination (73.4%), a perception that this was not as satisfying as a face-to face consultation (37.9%) and difficulty in communication (24.5%). 78.6% patients rated their online consultations as either good or very good. However, given the choice, almost two-thirds felt they would still prefer face-face consultations. Conclusion: High levels of satisfaction from this survey suggests that teleconsultation has the potential to become a complementary method to access clinical care even after restrictions from the pandemic cease. The disadvantages of online consultations could be mitigated through evolving technologies such as digital stethoscopes and improvement in communication tools.
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Mathew, Deepa Elizabeth, Vinay Bothra, Shipra Mathur, Cheri Mathews John, Natasha Susan John, Suneela Nayak, and Sanjiv Kumar. "Patient perceptions about virtual clinical consultations during current COVID-19 pandemic: A multi-city survey across India." Indian Journal of Community Health 33, no. 2 (June 30, 2021): 368–72. http://dx.doi.org/10.47203/ijch.2021.v33i02.025.
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Introduction: COVID-19 has prevented many patients from accessing health care through traditional face-to-face clinic visits. Consequently, online consultations have gained popularity. Aim: To explore patient perceptions regarding virtual consultations. Methods: A voluntary online survey using a mix of quantitative and qualitative questions was administered to patients across selected cities in India using a social media platform. Responses were used to explore the characteristics of users, perceived advantages and disadvantages of online consultations and patient satisfaction. Results: There were 679 respondents (M 52.4%: F 47.6%) that had consulted doctors online; 91.8% were from 8 major metro cities. Interestingly, over 80% had never sought online consultation before the COVID-19 pandemic. 46% consultations were via videocalls, 26% through WhatsApp and 21% via telephone calls. The main advantages of online consultations cited by patients included a lower risk of infection (78.8%), reduced waiting time (56.8%) and travel time (58.3%). The main disadvantages included a lack of physical examination (73.4%), a perception that this was not as satisfying as a face-to face consultation (37.9%) and difficulty in communication (24.5%). 78.6% patients rated their online consultations as either good or very good. However, given the choice, almost two-thirds felt they would still prefer face-face consultations. Conclusion: High levels of satisfaction from this survey suggests that teleconsultation has the potential to become a complementary method to access clinical care even after restrictions from the pandemic cease. The disadvantages of online consultations could be mitigated through evolving technologies such as digital stethoscopes and improvement in communication tools.
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Corah, Louise, Liz Mossop, Kate Cobb, and Rachel Dean. "Measuring the success of specific health problem consultations in cats and dogs: a systematic review." Veterinary Record 183, no. 1 (March 15, 2018): 22. http://dx.doi.org/10.1136/vr.104759.
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Consultations are complex interactions, are central to achieving optimal outcomes for all stakeholders, yet what constitutes a successful consultation has not been defined. The aim of this systematic review was to describe the scope of the literature available on specific health problem consultations and appraise their identified success measures. Searches of CAB Abstracts and MEDLINE were performed in May 2016 using species and consultation terms. Systematic sorting of the results allowed identification of consultation ‘success factors’ cited in peer-reviewed veterinary literature which were appraised using an appropriate critical appraisal tool (AXIS). Searches returned 11 330 results with a total of 17 publications meeting the inclusion criteria, of which four measured consultation success. Journal of the American Veterinary Medical Association was the most common journal of publication (9 of 17) and the majority of included papers had been published since 2010 (12 of 17). Success factors measured were compliance, client satisfaction and veterinary surgeon satisfaction, and publications primarily used communication analysis tools to measure success. The review highlights the paucity of peer-reviewed literature examining small animal, health problem veterinary consultations. The available evidence is of variable quality and provides weak evidence as to which factors contribute to a successful consultation.
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Spencer, Lisa, Marie-Claire O'Shea, Lauren Ball, Ben Desbrow, and Michael Leveritt. "Attendance, weight and waist circumference outcomes of patients with type 2 diabetes receiving Medicare-subsidised dietetic services." Australian Journal of Primary Health 20, no. 3 (2014): 291. http://dx.doi.org/10.1071/py13021.
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The aim of the present study was to investigate the participation and weight and waist circumference outcomes of patients with type 2 diabetes (T2D) receiving Medicare-subsidised dietetic services. A prospective observational study was conducted between January and September 2011 involving three private practice dietitians who provided services at 11 medical centres in south-east Queensland. All patients with T2D who were referred by their general practitioner (GP) to one of the dietitians as part of their team care arrangements were asked to participate. Participants’ attendance at consultations was recorded for the study duration. The dietitian collected weight and waist circumference measures at each consultation. In all, 129 participants (mean age 58.9 ± 15.7 years; mean body mass index 32.2 ± 5.6 kg m–2) were included in the study. The most frequent number of consultations allocated to a dietitian was two. Small, but significant reductions in bodyweight (1.9 ± 2.9 kg; P ≤ 0.05) and waist circumference (2.0 ± 4.8 cm; P ≤ 0.05) were observed from the initial to final consultation. Participants who attended more than two consultations lost significantly more weight than those who attended two consultations only (3.7 ± 4.2 vs 1.1 ± 1.6 kg, respectively; P ≤ 0.05). Almost one-third of participants (n = 38; 29%) did not complete the allocated number of consultations available through their referral. Modest weight and waist circumference reductions are achievable for patients with T2D receiving Medicare-subsidised dietetic services. The clinical significance of these reductions requires further investigation. Patients who attend more consultations with a dietitian may experience further improvements in weight and waist circumference outcomes. However, many patients do not complete the number of consultations allocated. Further research is required to explore the determinants of attendance at consultations in order to maximise potential improvements in health outcomes for patients receiving Medicare-subsidised dietetic services.
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Băcilă, Ciprian, and Claudia Anghel. "Telepsychiatry in the Romanian Health System During COVID-19 Pandemic." Acta Medica Transilvanica 25, no. 3 (September 1, 2020): 75–77. http://dx.doi.org/10.2478/amtsb-2020-0056.
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AbstractWith the covid-19 pandemic and the related restrictions to reduce the spread of the virus, the interaction between doctor and patient has changed, especially in the outpatients department. Thus, the need for remote consultations also appeared in the Romanian health system, especially in the psychiatric one. Although in other countries psychiatrists were familiar with this form of consultation, for Romanian psychiatrists, who were not trained either in residency or during medical school, it was a great challenge. If until March 2020 the patient’s consultation had to be performed only in the physical presence of a doctor, once the COVID-19 pandemic appeared, the Romanian government and the president, through the legislative acts issued, provided a legal framework for conducting this remote consultations. With the advent of telepsychiatry, discussions arose in the psychiatric community about the advantages and disadvantages of this type of consultation.
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Sumikawa, Yuka, Chikako Honda, Kyoko Yoshioka-Maeda, Riho Iwasaki-Motegi, and Noriko Yamamoto-Mitani. "COVID-19-Related Free Telephone Consultations by Public Health Nurses." Innovation in Aging 4, Supplement_1 (December 1, 2020): 940–41. http://dx.doi.org/10.1093/geroni/igaa057.3444.
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Abstract Public health centers are located in each municipality in Japan and are responsible for infectious disease control including COVID-19. Public health nurses (PHNs) are stationed at the centers and work at the forefront, covering a variety of services from individual consultations to hospital escort for those tested positive. Starting January, PHNs at A city (population approx. 210,000) established a free telephone consultation hotline for COVID-19. This study aims to review the PHNs’ telephone consultations during the first wave of COVID-19. The number of calls were aggregated weekly and their time-trend was examined. The study was approved by the University of Tokyo Ethics Review Board. During the first wave between January and May, there were 3,242 calls, with the highest number of calls (n=491/week) in the second week of April. At this point the regular PHNs were not enough to meet the hightened needs of consultations and PHNs from other departments were temporalily transferred for support. The number of consultation calls fluctuated weekly. The increase of calls seemed to preceed the increase of positive cases by one week. We consider that the call may be an initial action of those who suspected possible infection, and the consultation by the PHN might have led them to proper clinic visits and PCR testing. Telephone consultation is an easy tool to use for general public, especially older persons. Having health professionals respond directly to calls may have had the advantage of providing appropriate guidance for infection control and PCR testing and mental support.
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Bush, Alick, Nigel Beail, Gemma Gray, and Alick Bush. "Department of Health Consultations." FPID Bulletin: The Bulletin of the Faculty for People with Intellectual Disabilities 4, no. 1 (March 2006): 11. http://dx.doi.org/10.53841/bpsfpid.2006.4.1.11.
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Woodbridge, Martin, Anthony Dowell, and Lesley Gray. "'He said he had been out doing the traffic': general practitioner perceptions of sexually transmitted infection and HIV testing strategies for men." Journal of Primary Health Care 7, no. 1 (2015): 50. http://dx.doi.org/10.1071/hc15050.
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INTRODUCTION: Sexual health is an important component of primary care, and optimal sexually transmitted infection (STI) and HIV testing by doctors could help improve sexual health outcomes for men. Currently, little is known about general practitioners' (GPs') assessment of STI and HIV risk, particularly in relation to male patients, and the degree to which current advice can be translated into consistent testing protocols. The aim of the study was to explore STI and HIV testing strategies for men in general practice and opportunities and barriers to more optimal testing. METHODS: This study used a qualitative, multiple-case methodology, incorporating 17 distinct GP cases, drawing on in-depth, semi-structured interviews, and using thematic analysis. FINDINGS: The following themes were identified: sexual health consultations by men in general practice are usually initiated by the patient; GPs appear to have a consistent rationale for their risk assessments in terms of STI testing; the nature of the doctor's interaction with men influences the quality of sexual health services utilisation; optimal sexual health consultations require sufficient time and a recognition of the 'delicacy' of the consultation content for both patient and health practitioner. CONCLUSION: The stratified testing strategies undertaken by GPs appeared appropriate given the risk profiles of their patients. Constraints to optimal sexual health consultations were identified, including inadequate consultation time, male utilisation of GP consultations, and challenges in discussing sexual health topics within the consultation. Prioritising men's sexual health as a topic in CME may be helpful. KEYWORDS: General practitioners; health communication; HIV; men; sexual health; sexually transmitted infections
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Timpka, T., and Elisabeth Arborelius. "The GP’s Dilemmas: A Study of Knowledge Need and Use During Health Care Consultations." Methods of Information in Medicine 29, no. 01 (1990): 23–29. http://dx.doi.org/10.1055/s-0038-1634768.
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AbstractFor use in system development, a method based on both qualitative and quantitative data was employed to study the difficulties – the dilemmas – a general practitioner (GP) faces during daily consultac tions. Video recordings were used for stimulated recall of the consultation. From 46 consultations, 262 dilemmas were identified by the 12 GPs involved. Medical dilemmas were encountered during three out of four consultations. Dilemmas in the communication with the patient occurred during two consultations out of three, while dilemmas in the organizational environment and dilemmas challenging the GP’s personal competence occurred during one consultation out of three, respectively. A phenomenological analysis of the comments showed that few dilemmas were described as problems during “hypothetico-deductive reasoning”. In many cases the GP found it difficult to understand the situation as a whole. Based on these qualitative data, a model of the GP’s management of ill-structured complex dilemmas is discussed and proposed, to be taken into account in the development of decision support systems for outpatient practice.
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Donner-Banzhoff, Norbert, Judith Seidel, Anna Maria Sikeler, Stefan Bösner, Maria Vogelmeier, Anja Westram, Markus Feufel, Wolfgang Gaissmaier, Odette Wegwarth, and Gerd Gigerenzer. "The Phenomenology of the Diagnostic Process." Medical Decision Making 37, no. 1 (July 10, 2016): 27–34. http://dx.doi.org/10.1177/0272989x16653401.
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Background. While dichotomous tasks and related cognitive strategies have been extensively researched in cognitive psychology, little is known about how primary care practitioners (general practitioners [GPs]) approach ill-defined or polychotomous tasks and how valid or useful their strategies are. Objective. To investigate cognitive strategies used by GPs for making a diagnosis. Methods. In a cross-sectional study, we videotaped 282 consultations, irrespective of presenting complaint or final diagnosis. Reflective interviews were performed with GPs after each consultation. Recordings of consultations and GP interviews were transcribed verbatim and analyzed using a coding system that was based on published literature and systematically checked for reliability. Results. In total, 134 consultations included 163 diagnostic episodes. Inductive foraging (i.e., the initial, patient-guided search) could be identified in 91% of consultations. It contributed an average 31% of cues obtained by the GP in 1 consultation. Triggered routines and descriptive questions occurred in 38% and 84% of consultations, respectively. GPs resorted to hypothesis testing, the hallmark of the hypothetico-deductive method, in only 39% of consultations. Limitations. Video recordings and interviews presumably interfered with GPs’ behavior and accounts. GPs might have pursued more hypotheses and collected more information than usual. Conclusions. The testing of specific disease hypotheses seems to play a lesser role than previously thought. Our data from real consultations suggest that GPs organize their search for information in a skillfully adapted way. Inductive foraging, triggered routines, descriptive questions, and hypotheses testing are essential building blocks to make a diagnosis in the generalist setting.
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Naik, Kshipra Vissucanta, Lucy Allen, and Muthukkumaar Gnanavel. "Patient satisfaction with telephone consultations at a community mental health service: a descriptive survey." British Journal of Healthcare Management 28, no. 11 (November 2, 2022): 284–91. http://dx.doi.org/10.12968/bjhc.2021.0115.
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Background/Aims Research has demonstrated that there are several models of teleconsultation, and that these can be effective and acceptable to patients. At the start of the COVID-19 pandemic, there was a sudden shift to phone consultations in community mental health services. This study assessed the impact of this change from the patient perspective and thus determined how this mode of delivery can be optimised going forwards. Method Data were collected using a semi-structured, self-reporting patient satisfaction questionnaire with 17 items, which was sent to 200 patients who had received both an in-person and telephone consultation from a community mental health team in Wales. The themes covered in the questionnaire were communication, interpersonal manner, technical quality, convenience and general satisfaction. A total of 114 respondents rated their agreement with the items on a 5-point Likert scale, and free-text boxes were provided for suggestions and comments. Quantitative data were summarised using descriptive statistics and free-text comments were analysed thematically. Results The majority of the patients gave positive responses, with 70–94% either agreeing or strongly agreeing with the positive statements regarding the communication, interpersonal manner, technical quality and length of consultation that they experienced. Overall, 74% agreed or strongly agreed that they were generally satisfied. However, only 52% believed that telephone consultations were more convenient than in-person hospital appointments, and nearly one-quarter (24%) did not want to continue with telephone consultations in the future. Suggested improvements included the use of video consultations, provision of extra time for consultations and a general increase in the services available. Conclusions Telephone consultations were generally perceived as acceptable, useful and effective, helping patients to access ongoing mental health care. This suggests that telephone consultations could be an effective method of care delivery in the future. However, there is a need for further research and development in the remote delivery of mental health services.
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Lin, Hui-Mei, Chih-Kuang Liu, Yen-Chun Huang, Chieh-Wen Ho, and Mingchih Chen. "Investigating Key Factors Related to the Decision of a Do-Not-Resuscitate Consent." International Journal of Environmental Research and Public Health 19, no. 1 (December 31, 2021): 428. http://dx.doi.org/10.3390/ijerph19010428.
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Background: The decision to sign a do-not-resuscitate (DNR) consent is critical for patients concerned about their end-of-life medical care. Taiwan’s National Health Insurance Administration (NHIA) introduced a family palliative care consultation fee to encourage family palliative care consultations; since its implementation, identifying which families require such consultations has become more important. In this study, the Taiwanese version of the Palliative Care Screening Tool (TW–PCST) was used to determine each patient’s degree of need for a family palliative care consultation. Objective: This study analyzed factors associated with signing DNR consents. The results may inform family palliative care consultations for families in need, thereby achieving a higher DNR consent rate and promoting the effective use of medical resources, including time, labor, and funding. Method: In this retrospective study, logistic regression analysis was conducted to determine which factors affected the DNR decisions of 2144 deceased patients (aged ≥ 20 years), whose records were collected from the Taipei City Hospital health information system from 1 January to 31 December 2018. Results: Among the 1730 patients with a DNR consent, 1298 (75.03%) received family palliative care consultations. The correlation between DNR consent and family palliative care consultations was statistically significant (p < 0.001). Through logistic regression analysis, we determined that participation in family palliative care consultation, TW–PCST score, type of ward, and length of stay were significant variables associated with DNR consent. Conclusions: This study determined that TW–PCST scores can be used as a measurement standard for the early identification of patients requiring family palliative care consultations. Family palliative care consultations provide opportunities for patients’ family members to participate in discussions about end-of-life care and DNR consent and provide patients and their families with accurate medical information regarding the end-of-life care decision-making process. The present results can serve as a reference to increase the proportion of patients willing to sign DNR consents and reduce the provision of ineffective life-prolonging medical treatment.
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Buvik, Astrid, Einar Bugge, Gunnar Knutsen, Arvid Småbrekke, and Tom Wilsgaard. "Patient reported outcomes with remote orthopaedic consultations by telemedicine: A randomised controlled trial." Journal of Telemedicine and Telecare 25, no. 8 (July 4, 2018): 451–59. http://dx.doi.org/10.1177/1357633x18783921.
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Introduction Decentralised services through outreach clinics or modern technology reduce patient travel time and cost to society. Telemedicine consultation through videoconference is one such modality. Here, we compared patient-reported health outcomes and satisfaction between video-assisted remote and standard face-to-face orthopaedic consultations. Methods This randomised controlled trial included two parallel groups: (1) patients receiving video-assisted remote consultation at a regional medical centre (RMC); and (2) patients receiving standard consultation at the orthopaedic outpatient clinic of the University Hospital of North Norway (UNN). This study included patients referred to or scheduled for a consultation at the orthopaedic outpatient clinic. After each consultation, patient satisfaction was determined using patient-completed questionnaires containing questions on patient-reported health (three-level European quality of life five-dimension index (EQ-5D-3L)/European quality of life visual analogue scale (EQ-VAS)) and questions from a validated OutPatient Experiences Questionnaire (OPEQ). Results This study included 389 patients, of which 199 received remote consultation and 190 received standard consultation (total of 559 consultations). In all, 99% RMC-randomised patients and 99% UNN-randomised patients evaluated the consultation as very satisfactory or satisfactory. Moreover, 86% RMC-randomised patients preferred video-assisted consultation as the next consultation. No difference was observed in patient-reported health after 12 months between the two groups. EQ-5D index scores were 0.77 and 0.75 for RMC- and UNN-randomised patients, respectively ( p = 0.42). Discussion We did not observe any difference in patient-reported satisfaction and health (EQ-5D/EQ-VAS) between video-assisted and standard consultations, suggesting that video-assisted remote consultation can be safely offered to some orthopaedic patients. Moreover, a significantly high proportion of patients selected video-assisted remote consultation as their next consultation, thus strengthening the findings of this study. However, economic aspects should be assessed before widely recommending video-assisted consultation.
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Shaw, Sara E., Lucas Martinus Seuren, Joseph Wherton, Deborah Cameron, Christine A'Court, Shanti Vijayaraghavan, Joanne Morris, Satyajit Bhattacharya, and Trisha Greenhalgh. "Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services: Linguistic Ethnographic Study of Video-Mediated Interaction." Journal of Medical Internet Research 22, no. 5 (May 11, 2020): e18378. http://dx.doi.org/10.2196/18378.
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Background Video-mediated clinical consultations offer potential benefits over conventional face-to-face in terms of access, convenience, and sometimes cost. The improved technical quality and dependability of video-mediated consultations has opened up the possibility for more widespread use. However, questions remain regarding clinical quality and safety. Video-mediated consultations are sometimes criticized for being not as good as face-to-face, but there has been little previous in-depth research on their interactional dynamics, and no agreement on what a good video consultation looks like. Objective Using conversation analysis, this study aimed to identify and analyze the communication strategies through which video-mediated consultations are accomplished and to produce recommendations for patients and clinicians to improve the communicative quality of such consultations. Methods We conducted an in-depth analysis of the clinician-patient interaction in a sample of video-mediated consultations and a comparison sample of face-to-face consultations drawn from 4 clinical settings across 2 trusts (1 community and 1 acute care) in the UK National Health Service. The video dataset consisted of 37 recordings of video-mediated consultations (with diabetes, antenatal diabetes, cancer, and heart failure patients), 28 matched audio recordings of face-to-face consultations, and fieldnotes from before and after each consultation. We also conducted 37 interviews with staff and 26 interviews with patients. Using linguistic ethnography (combining analysis of communication with an appreciation of the context in which it takes place), we examined in detail how video interaction was mediated by 2 software platforms (Skype and FaceTime). Results Patients had been selected by their clinician as appropriate for video-mediated consultation. Most consultations in our sample were technically and clinically unproblematic. However, we identified 3 interactional challenges: (1) opening the video consultation, (2) dealing with disruption to conversational flow (eg, technical issues with audio and/or video), and (3) conducting an examination. Operational and technological issues were the exception rather than the norm. In all but 1 case, both clinicians and patients (deliberately or intuitively) used established communication strategies to successfully negotiate these challenges. Remote physical examinations required the patient (and, in some cases, a relative) to simultaneously follow instructions and manipulate technology (eg, camera) to make it possible for the clinician to see and hear adequately. Conclusions A remote video link alters how patients and clinicians interact and may adversely affect the flow of conversation. However, our data suggest that when such problems occur, clinicians and patients can work collaboratively to find ways to overcome them. There is potential for a limited physical examination to be undertaken remotely with some patients and in some conditions, but this appears to need complex interactional work by the patient and/or their relatives. We offer preliminary guidance for patients and clinicians on what is and is not feasible when consulting via a video link. International Registered Report Identifier (IRRID) RR2-10.2196/10913
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Chambers, Georgina M., Sean Randall, Cathrine Mihalopoulos, Nicole Reilly, Elizabeth A. Sullivan, Nicole Highet, Vera A. Morgan, Maxine L. Croft, Mary Lou Chatterton, and Marie-Paule Austin. "Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia." Australian Health Review 42, no. 5 (2018): 514. http://dx.doi.org/10.1071/ah17118.
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Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients’ costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method A retrospective study of MBS utilisation and costs (in 2011–12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results The cost of mental health consultations during the perinatal period was A$17.5 million for women giving birth in 2007, rising to A$29 million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the last decade, with the introduction of numerous policies aimed at prevention, screening and improving access to treatment. Several of these policies have been aimed at perinatal depression, which affects 15% of women giving birth. What does this paper add? This is the first population-based, cost analysis of mental health consultations during the perinatal period (pregnancy to end of the first postnatal year) in Australia. Almost 9% of women giving birth in 2007 had a mental health consultation funded though the MBS, compared with more than 14% in 2010. Over the same period there was a shift from psychiatric consultations to allied health and primary care consultations. In 2010, the total cost (provider fee) of these consultations was A$29 million, equating to an average cost per woman of A$689 and A$133 per service. Despite the changing policy environment, significant disparities exist in access to care according to geographic remoteness. What are the implications for practitioners? Recent policy initiatives have resulted in increasing access to mental health consultations for women around the time of childbirth. However, policies are needed that target women outside of major cities. Furthermore, evidence is needed on whether the increase in access has resulted in improved mental health outcomes for women at this vulnerable time. The cost data provided by this study are unique and will inform future mental health policy development and health economic evaluations.
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Cui, Fangfang, Xianying He, Yunkai Zhai, Minzhao Lyu, Jinming Shi, Dongxu Sun, Shuai Jiang, Chenchen Li, and Jie Zhao. "Application of Telemedicine Services Based on a Regional Telemedicine Platform in China From 2014 to 2020: Longitudinal Trend Analysis." Journal of Medical Internet Research 23, no. 7 (July 12, 2021): e28009. http://dx.doi.org/10.2196/28009.
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Background Telemedicine that combines information technology and health care augments the operational model of traditional medical services and brings new opportunities to the medical field. China promotes telemedicine with great efforts, and its practices in the deployment of telemedicine platforms and delivery of services have become important references for the research and development in this field. Objective Our work described in this paper focuses on a regional telemedicine platform that was built in 2014. We analyzed the system design scheme and remote consultations that were conducted via the system to understand the deployment and service delivery processes of a representative telemedicine platform in China. Methods We collected information on remote consultations conducted from 2015 to 2020 via the regional telemedicine platform that employs a centralized architectural system model. We used graphs and statistical methods to describe the changing trends of service volume of remote consultation, geographical and demographic distribution of patients, and waiting time and duration of consultations. The factors that affect consultation duration and patient referral were analyzed by multivariable linear regression models and binary logistic regression models, respectively. The attitudes toward telemedicine of 225 medical practitioners and 225 patients were collected using the snowball sampling method. Results The regional telemedicine platform covers all levels of medical institutions and hospitals in all 18 cities of Henan Province as well as some interprovince hospitals. From 2015 to 2020, 103,957 remote medical consultations were conducted via the platform with an annual increasing rate of 0.64%. A total of 86.64% (90,069/103,957) of medical institutions (as clients) that applied for remote consultations were tier 1 or 2 and from less-developed regions; 65.65% (68,243/103,945) of patients who applied for remote consultations were aged over 50 years. The numbers of consultations were high for departments focusing in the treatment of chronic diseases such as neurology, respiratory medicine, and oncology. The invited experts were mainly experienced doctors with senior professional titles. Year of consultation, tier of hospital, consultation department, and necessity of patient referral were the main factors affecting the duration of consultations. In surveys, we found that 60.4% (136/225) of medical practitioners and 53.8% (121/225) of patients had high satisfaction and believed that telemedicine is of vital importance for the treatment of illness. Conclusions The development of telemedicine in China shows a growing trend and provides great benefits especially to medical institutions located in less developed regions and senior citizens who have less mobility. Cases of remote consultations are mainly for chronic diseases. At present, the importance and necessity of telemedicine are well recognized by both patients and medical practitioners. However, the waiting time needs to be further reduced to improve the efficiency of remote medical services.
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Kar, Nilamadhab, Lai-Ting Cheung, and Stephen Jiwanmall. "Remote Clinical Assessments and Management During COVID-19: Views of the Patients and Clinicians About the Future Preferences." BJPsych Open 8, S1 (June 2022): S130. http://dx.doi.org/10.1192/bjo.2022.382.
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AimsDuring the COVID-19 pandemic most clinical services changed to remote consultation and management to minimise virus transmission by direct contact. As the social distancing and restrictions have eased with greater control of the pandemic, the nature of consultations is going to change. At this juncture we intended to understand the perception and satisfaction of patients and clinicians on remote consultations and management during COVID-19 and to determine their preference about clinical engagement in the future.MethodsThis was a trust-wide anonymous survey conducted through surveymonkey. It involved both patients and mental healthcare staff (MHS) and explored about the quality and satisfaction in remote consultations, option to patients, and use of remote consultations in future. Clinicians were sent the online link to complete, with a reminder two weeks later. The patients were explained during their appointments about the survey, those who agreed to participate and gave informed consent, their responses to the questions were recorded.ResultsThe sample consisted of 78 patients and 107 MHS representing adult, old age, children and adolescent and intellectual disability subspecialties. Most (92.4%) participants had participated in remote consultations and understood the reason behind it. Around a third (32.7%) of MHS and 46.2% of patients felt strongly satisfied in remote consultations, and together with satisfaction these were 56.1% v 71.8% respectively (p < 0.05). The quality of the remote consultations were considered somewhat (11.2% v 23.1%) or a lot better (8.4% v 15.4%) by MHS and patients respectively (p < 0.05). Majority (82.7%) felt that an option should be given to patients for the type of consultation, face to face or remote. After the pandemic, the preference for psychiatric consultations were primarily face to face (30.3%), primarily remote (8.6%) and a mixture of the two (61.1%); there were no difference between patients and MHS. However while 71.4% doctors, 70.8% other clinicians (occupational therapists and psychologists) and 75.0% of clinical managers opted for mixture of face to face and remote, 26.9% of nurses opted for that. Background subspecialty, age group, ethnicity, experience of remote consultation with GP or hospital doctors, attendance or admission to general or psychiatric hospitals during pandemic, disabilities, or having COVID-19 did not influence the suggestion for the future consultation type.ConclusionFollowing the pandemic, both clinicians and patients express a preference for a mixture of face to face and remote consultations; and an option regarding that should be given to the patients.
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De Guzman, Keshia R., Liam J. Caffery, Anthony C. Smith, and Centaine L. Snoswell. "Specialist consultation activity and costs in Australia: Before and after the introduction of COVID-19 telehealth funding." Journal of Telemedicine and Telecare 27, no. 10 (November 2, 2021): 609–14. http://dx.doi.org/10.1177/1357633x211042433.
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This study describes and analyses the Medicare Benefits Schedule (MBS) activity and cost data for specialist consultations in Australia, as a result of the coronavirus disease 2019 (COVID-19) pandemic. To achieve this, activity and cost data for MBS specialist consultations conducted from March 2019 to February 2021 were analysed month-to-month. MBS data for in-person, videoconference and telephone consultations were compared before and after the introduction of COVID-19 MBS telehealth funding in March 2020. The total number of MBS specialist consultations claimed per month did not differ significantly before and after the onset of COVID-19 ( p = 0.717), demonstrating telehealth substitution of in-person care. After the introduction of COVID-19 telehealth funding, the average number of monthly telehealth consultations increased ( p < 0.0001), representing an average of 19% of monthly consultations. A higher proportion of consultations were provided by telephone when compared to services delivered by video. Patient-end services did not increase after the onset of COVID-19, signifying a divergence from the historical service delivery model. Overall, MBS costs for specialist consultations did not vary significantly after introducing COVID-19 telehealth funding ( p = 0.589). Telehealth consultations dramatically increased during COVID-19 and patients continued to receive specialist care. After the onset of COVID-19, the cost per telehealth specialist consultation was reduced, resulting in increased cost efficiency to the MBS.