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Zhang JJ, Wang EN. Enhancing autism care through remote support: A family-centered approach. World J Psychiatry 2025; 15:102645. [DOI: 10.5498/wjp.v15.i4.102645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 01/16/2025] [Accepted: 02/12/2025] [Indexed: 03/25/2025] Open
Abstract
Autism spectrum disorder (ASD) poses significant challenges for families, with limited access to specialized care being a critical concern. The coronavirus disease 2019 pandemic has accelerated the adoption of remote support, highlighting its potential to enhance family-centered care for children with ASD. In this editorial, we comment on the article by Lu et al, emphasizing the effectiveness of integrating remote support courses with traditional caregiver-mediated interventions. We further explore the benefits of remote support in delivering family-centered care, summarize the essential components of effective family-centered remote support, outline key considerations for implementation, and discuss potential future research directions. We conclude that family-centered remote support has the potential to significantly improve outcomes and quality of life for individuals with ASD and their families.
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Affiliation(s)
- Jun-Jie Zhang
- School of Psychology, Northwest Normal University, Lanzhou 730070, Gansu Province, China
| | - En-Na Wang
- School of Psychology, Northwest Normal University, Lanzhou 730070, Gansu Province, China
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Aldakhil R, Greenfield G, Lammila-Escalera E, Laranjo L, Hayhoe BWJ, Majeed A, Neves AL. The Impact of Virtual Consultations on Quality of Care for Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis. J Diabetes Sci Technol 2025:19322968251316585. [PMID: 39960237 PMCID: PMC11833803 DOI: 10.1177/19322968251316585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2025]
Abstract
BACKGROUND Virtual consultations (VC) have transformed healthcare delivery, offering a convenient and effective way to manage chronic conditions such as Type 2 Diabetes (T2D). This systematic review and meta-analysis evaluated the impact of VC on the quality of care provided to patients with T2D, mapping it across the six domains of the US National Academy of Medicine (NAM) quality-of-care framework (ie, effectiveness, efficiency, patient-centeredness, timeliness, safety, and equity). METHODS A systematic search was conducted in PubMed/MEDLINE, Cochrane, Embase, CINAHL, and Web of Science for the period between January 2010 and December 2024. Eligible studies involved adult T2D patients, evaluated synchronous VCs, and reported outcomes relevant to NAM quality domains. Two independent reviewers performed screening, and studies were assessed using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted for each quality domain, and a meta-analysis of HbA1c levels was performed using random-effects models. RESULTS In total, 15 studies involving 821 014 participants were included. VCs were comparable with face-to-face care in effectiveness, efficiency, patient-centeredness, and timeliness, with improvements in accessibility and patient satisfaction. Mixed results were found for safety due to limitations in physical assessments, and for equity, with older adults and those with lower digital literacy facing more challenges. The meta-analysis showed no significant difference in HbA1c reduction between VCs and face-to-face (standardized mean difference [SMD] = -0.31, 95% confidence interval [CI]: -0.71 to 0.09, P = 0.12). CONCLUSION VCs offer a promising alternative to in-person care, but addressing digital disparities and improving access for older adults are essential for maximizing VC potential.
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Affiliation(s)
- Reham Aldakhil
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Ana Luísa Neves
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Kristiansen E, Atherton H, Austad B, Bergmo TS, Norberg BL, Salisbury C, Zanaboni P. Patients' Use of e-Consultations as an Alternative to Other General Practitioner Services: Cross-Sectional Survey Study. J Med Internet Res 2025; 27:e55158. [PMID: 39778196 PMCID: PMC11754976 DOI: 10.2196/55158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 09/16/2024] [Accepted: 11/28/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND e-Consultations, defined as asynchronous text-based messaging, have transformed how patients interact with their general practitioner (GP). While e-consultations can improve patient access to GP care, concerns about increased workload for GPs are raised. OBJECTIVE This study aimed to address three research questions: (1) For what purpose and with what expectations do patients initiate e-consultations? (2) If e-consultations had not been available, what alternative actions would the patient have taken? and (3) How are the alternative actions associated with patient and e-consultation characteristics? METHODS A cross-sectional study was conducted through a web-based survey on Helsenorge. Helsenorge is the national citizen portal for digital health services in Norway, including e-consultations with the GP. All users who sent e-consultations through Helsenorge were invited to participate between January and February 2023. The survey addressed questions on users' expectations and experience with e-consultations. The association between patient and e-consultation characteristics and alternative actions to e-consultations were analyzed using multinomial logistic regression. RESULTS Overall, 13,011 users answered the survey. The most common reason for initiating an e-consultation was requesting a sick certificate (4940/13,011, 38%). Overall, 68.7% (8802/13,011) of respondents expected an answer within 24 hours, and 17.7% (2310/13,011) anticipated that the GP would ask them to attend a physical examination. If e-consultations had not been available, 45.5% (5917/13,011) of respondents would have booked a GP appointment, and 44.9% (5846/13,011) would have called the front desk. Users who expected a quicker response (odds ratio [OR] 1.64, 95% CI 1.46-1.85) and were less concerned about their health issues (OR 1.29, 95% CI 1.18-1.40) were more likely to call the front desk. Only 2.5% (323/13,011) of respondents would have contacted out-of-hours services. Users with longer travel time to the GP office (OR 6.08, 95% CI 3.46-10.66) and with a new health problem (OR 2.71, 95% CI 2.09-3.51) were more likely to choose this option. In addition, 4.7% (609/13,011) of the users would not have sought help if e-consultations had not been available. Younger patients (OR 2.16, 95% CI 1.38-3.37) and those with a longer travel time to the GP office (OR 2.19, 95% CI 1.27-3.80) or a new health issue (OR 1.74, 95% CI 1.43-2.12) had higher odds for not seeking help. CONCLUSIONS e-Consultations were often the patients' first choice of access route, and users expected a fast response. e-Consultations were mostly perceived as an alternative to GP appointments or calling the front desk. Patients with lower availability to the GP office had higher odds of using e-consultations as an alternative to out-of-hours service or waiting and not seeking GP care. Guidance for patient use should be developed to ensure appropriate and safe use. Further research should assess the effect of e-consultations on health outcomes and efficiency.
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Affiliation(s)
- Eli Kristiansen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Helen Atherton
- School of Primary Care Population Health and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Bjarne Austad
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Strand Bergmo
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Børge Lønnebakke Norberg
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Chris Salisbury
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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Choong KA. Digital-first primary care: An ambivalent legacy of Covid-19? Med Leg J 2024; 92:201-205. [PMID: 39075861 DOI: 10.1177/00258172241252223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
The vast majority of GP appointments had to move from in-person to remote consultation during the pandemic. Rather than phasing this out now that the threat of the coronavirus has begun to ebb, the UK government has announced that digital-first primary care will continue for the foreseeable future. While remote consultation can be beneficial on several fronts, it can compromise professional identity, therapeutic alliance, patient safety and access to healthcare. A hasty push towards normalising digitally-enabled care may therefore increase the risk of misdiagnoses, medical negligence, unnecessary referrals and health inequity. To enhance the gains and iron out the challenges associated with IT-led triage and consultations, it is important to reflect on the lessons learned from the pandemic.
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Lange E, Danielsson L. Reaching for connection: a qualitative study of communication and interaction in video-based physiotherapy. Physiother Theory Pract 2024; 40:2865-2876. [PMID: 38145499 DOI: 10.1080/09593985.2023.2296574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/17/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Digital technology has become increasingly relevant in physiotherapy, but little is known about communication and interaction in video-based physiotherapy. Therefore, this study aimed to explore the experiences among patients and physiotherapists, of communication and interaction in digital, video-based physiotherapy. METHODS A qualitative interview study with a phenomenological approach was conducted. Participants were purposively recruited from primary health care clinics. Semi-structured, in-depth interviews were conducted with 10 physiotherapists and 6 patients. Interviews were recorded, transcribed, and analyzed using a phenomenological approach. RESULTS The analysis resulted in the overall theme Reaching for connection, which captured the central meaning of the participants' experiences. Four categories emerged from the analysis: 1) Closeness at a distance; 2) Overcoming limited bodily communication; 3) The technology as part of the meeting; and 4) Challenging the physical meeting as a norm. The results suggest that communication and interaction in digital settings differ from physical settings, but there is an ongoing adaptation process to this new paradigm. CONCLUSIONS The results of this study show that video-based physiotherapy, while having several benefits according to both patients and physiotherapists, affects the communication in several ways. Physiotherapists need to acknowledge these limitations and seek strategies to adapt and to compensate for the reduced non-verbal elements and lack of touch. Attention to the physical room and shifting between positions (face/full figure) are suggested practical strategies, but also to practice awareness and embodied communication to improve receptivity in the interaction.
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Affiliation(s)
- Elvira Lange
- Department of General Practice, Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, FoUUI-centrum Göteborg och Södra Bohuslän, Göteborg, Sweden
| | - Louise Danielsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Purisima EM, Arde BO, Nero FD, Locsin RC, Montayre J. Reframing the environment domain of the nursing metaparadigm: Exploring space, place, and technology. BELITUNG NURSING JOURNAL 2024; 10:614-623. [PMID: 39601024 PMCID: PMC11586616 DOI: 10.33546/bnj.3458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/04/2024] [Accepted: 10/27/2024] [Indexed: 11/29/2024] Open
Abstract
Metaparadigms differentiate disciplines in terms of how each discipline develops its knowledge and its scholarship. Four domains comprise the nursing metaparadigm: environment, person, health, and nursing. Of these domains, the environment domain is the least identified. Relating this domain to the broader substantive meaning of the geographical-landscape setting of nursing encounters requires further explanation. Through a discursive process, the article positions "space and place" by referencing the nursing environment. The article aims to clarify and explain the expanding reach of the environment domain, extending its definition while recognizing its range of influence in nursing and healthcare. Distinguishing the nursing environment as a well-established domain of the nursing metaparadigm makes nursing practice more visible, valuable, and relevant. Characterized by its impact on discipline-related knowledge development guiding professional practice, the environment domain assumes an integral "space and place" in human healthcare practice.
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Affiliation(s)
| | - Bernardo Oliber Arde
- College of Nursing, University of Northern Philippines, Vigan, Ilocos Sur, Philippines
| | - Francis Don Nero
- College of Nursing, University of Northern Philippines, Vigan, Ilocos Sur, Philippines
| | - Rozzano C. Locsin
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Jed Montayre
- The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
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Glock H, Jakobsson U, Borgström Bolmsjö B, Milos Nymberg V, Wolff M, Calling S. eVisits to primary care and subsequent health care contacts: a register-based study. BMC PRIMARY CARE 2024; 25:297. [PMID: 39135150 PMCID: PMC11318178 DOI: 10.1186/s12875-024-02541-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Evidence concerning health care use related to virtual visits is conflicting. More research has been called for regarding the effectiveness of text-based virtual visits (eVisits). Therefore, we investigated patient characteristics, diagnoses, and subsequent health care contacts after eVisits to primary care. METHODS We conducted a register-based cohort study of eVisits to an all-virtual public primary care unit in Sweden and subsequent health care contacts within 14 days. Data for 2021 were acquired from the regional health care databases. Diagnoses were sorted into relevant diagnostic groups, such as skin diagnoses and respiratory tract diagnoses. Multiple logistic regression was performed with subsequent health care contact as the outcome variable and diagnostic group for the eVisit as the predictor variable. Analyses were adjusted for age, sex, and socioeconomic index. RESULTS There were 5817 eVisits to a nurse and 4267 eVisits to a general practitioner (N = 10 084). Most patients were 20 to 39 years of age (41.8%). Skin diagnoses were most frequent (47.3%), followed by respiratory tract diagnoses (19.9%). Approximately one-fourth (25.8%) of the patients who completed an eVisit with a nurse or a general practitioner had a subsequent face-to-face visit within 14 days, mostly in primary care. Subsequent contacts were more frequent after an eVisit to a nurse than to a general practitioner. After an eVisit to a general practitioner, patients with infections (especially respiratory tract but also urinary tract) and unspecified diagnoses (especially skin-related) were more likely to require further health care contact compared to a group with various other diagnoses. CONCLUSIONS eVisits to an all-virtual primary care unit may be appropriate for uncomplicated medical complaints. Nonetheless, the effectiveness of eVisits in terms of substitution of physical visits, and resource utilization in relation to the more complex care needs of a primary care population, should be further studied.
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Affiliation(s)
- Hanna Glock
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Box 50332, Malmö, 202 13, Sweden.
- University Clinic Primary Care Skåne, Region Skåne, Box 50332, Malmö, 202 13, Sweden.
| | - Ulf Jakobsson
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Box 50332, Malmö, 202 13, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Box 50332, Malmö, 202 13, Sweden
| | - Beata Borgström Bolmsjö
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Box 50332, Malmö, 202 13, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Box 50332, Malmö, 202 13, Sweden
| | - Veronica Milos Nymberg
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Box 50332, Malmö, 202 13, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Box 50332, Malmö, 202 13, Sweden
| | - Moa Wolff
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Box 50332, Malmö, 202 13, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Box 50332, Malmö, 202 13, Sweden
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Box 50332, Malmö, 202 13, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Box 50332, Malmö, 202 13, Sweden
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Traulsen P, Kitschke L, Steinhäuser J. Perceptions Toward Telemedicine of Health Care Staff in Nursing Homes in Northern Germany: Cross-Sectional Study. JMIR Aging 2024; 7:e47072. [PMID: 39113368 PMCID: PMC11322793 DOI: 10.2196/47072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/12/2024] [Accepted: 06/25/2024] [Indexed: 08/16/2024] Open
Abstract
Background Digitalization in the German health care system is progressing slowly, even though it offers opportunities for improvement of care. In nursing homes, most of the staff's work is paper based. Following the pandemic, there has been a decrease in the use of telemedicine applications. To ensure long-term implementation, the views of users, in this case nurses, are of interest. Objective This cross-sectional study was conducted to describe which digital applications are already being used at inpatient care facilities, the attitude of nurses toward telemedicine, and for which areas the use of telemedicine in the facilities is considered appropriate by the participants. Methods All inpatient care facility staff in Schleswig-Holstein were invited to participate in the survey from August 1 to October 31, 2022. The questionnaire consists of 17 determinants that ask about the attitude, use, and possible applications of telemedicine. In addition to a descriptive analysis, the influence of the general attitude toward telemedicine on various determinants was examined using the Fisher exact test for nominal variables and Spearman correlation coefficient for metric variables. Results A total of 425 caregivers participated in the survey. Of these respondents, 10.7% (n=41) currently used video consultations, and 76.1% (n=321) of the respondents were in favor of video consultations being practiced in training. Furthermore, 74.8% (n=312) of the respondents would attend a training on telephone medical consultation. Respondents indicated that video consultations have a small added value compared to asynchronous telemedicine (eg, sending photos). However, video consultations were perceived as somewhat less time-consuming than other communication channels. Video consultations are perceived as most useful for clarifying urgent problems. The respondents estimated that one in five paramedic calls at their facilities could be reduced through telemedicine approaches. It was important to the participants that telemedicine is as simple as possible and that there is a high level of data security. Conclusions Although many caregivers have a positive attitude toward telemedicine and perceive its advantages, communication channels such as video consultation are still used infrequently in care facilities. To promote the use of telemedicine applications, it is important to emphasize their benefits. The presumed saving of paramedic calls thus represents a benefit, and it is crucial to train caregivers in the use of telemedicine to avoid uncertainties in dealing with the newer technologies. It is important to give them enough time and repetitions of the training.
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Affiliation(s)
- Pia Traulsen
- Institute for Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Luebeck, Germany
| | - Lisa Kitschke
- Institute for Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Luebeck, Germany
| | - Jost Steinhäuser
- Institute for Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Luebeck, Germany
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Lubomski J, Malchrzak W, Babicki M, Kłoda K, Suwała S, Mastalerz-Migas A. Teleconsultation as a Modern Form of Health Care Service in the Case of Poland: Assessment of Its Potential Use from the Perspective of Health Care Providers and Patients. Telemed J E Health 2024; 30:234-241. [PMID: 37406293 DOI: 10.1089/tmj.2023.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has facilitated access to health care services through telemedicine in Poland, where it has not been a common approach so far. Therefore, the aim of this study was to evaluate telemedicine as a form of health care provision in the Polish health care system. Methods: An online questionnaire was distributed to 2,318 patients and health care workers. Questions included telemedical services usage, attitude toward telemedical consultations, who should decide about the nature of the consultation, advantages and disadvantages of telemedicine, the possibility of teleconsultations remaining available after the pandemic, and the subjective perception of overuse of remote consultations by doctors. Results: In general, respondents approved of teleconsultations (3.62 on 1-5 scale) but specific clinical situations gained higher and lower scores-among the highest ranking were prescription renewal (4.68), interpretation of examination results (4.15), and treatment continuation/follow-up (3.81). Among least ranking were consulting children 2-6 years old (1.93) and children younger than 2 years old (1.55) as well as consulting acute symptoms (1.47). Health care workers rated their general attitude significantly higher than nonhealth care workers toward telemedicine consults (3.91 vs. 3.34, p < 0.001) and toward 12 out of 13 specific clinical situations and settings (p < 0.001). The only exception was "consulting acute symptoms," which received exactly the same rating within both groups (1.47, p = 0.99). Most respondents agreed that teleconsultations should remain an option for contacting a physician regardless of the epidemic situation. Each group declared that they should be the one to decide about the consultation form. Conclusions: Results of this study could help optimize and facilitate telemedical consultation usage after the COVID-19 pandemic.
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Affiliation(s)
- Jan Lubomski
- Ma-na-ma Huisartsgeneeskunde, KU Leuven, Belgium
| | - Wojciech Malchrzak
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Mateusz Babicki
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Szymon Suwała
- Department of Endocrinology and Diabetology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
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Buss VH, Cox S, Moore G, Angus C, Shahab L, Bauld L, Brown J. Alcohol and smoking brief interventions by socioeconomic position: a population-based, cross-sectional study in Great Britain. BJGP Open 2023; 7:BJGPO.2023.0087. [PMID: 37549977 PMCID: PMC11176676 DOI: 10.3399/bjgpo.2023.0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Alcohol and smoking brief interventions (BIs) in general practice have been shown to be effective in lowering alcohol and smoking-related harm. AIM To assess prevalence of self-reported BI receipt among increasing or higher-risk drinkers and past-year smokers in England, Scotland, and Wales, and associations between intervention receipt and socioeconomic position. DESIGN & SETTING Cross-sectional study using data from a monthly population-based survey in England, Scotland, and Wales. METHOD The study comprised 47 799 participants (15 573 increasing or higher-risk drinkers [alcohol use disorders identification test consumption score ≥5] and 7791 past-year smokers) surveyed via telephone in 2020-2022 (during the COVID-19 pandemic). All data were self-reported. Prevalence of self-reported BI receipt was assessed descriptively; associations between receipt and socioeconomic position were analysed using logistic regression. RESULTS Among adults in England, Scotland, and Wales, 32.2% (95% confidence interval [CI] = 31.8 to 32.7) reported increasing or higher-risk drinking and 17.7% (95% CI = 17.3 to 18.1) past-year smoking. Among increasing or higher-risk drinkers, 58.0% (95% CI = 57.1 to 58.9) consulted with a GP in the past year, and of these, 4.1% (95% CI = 3.6 to 4.6) reported receiving BIs. Among past-year smokers, 55.8% (95% CI = 54.5 to 57.1) attended general practice in the past year; of these, 41.0% (95% CI = 39.4 to 42.7) stated receiving BIs. There was a tendency for patients from socioeconomically disadvantaged backgrounds to receive more alcohol (adjusted odds ratio [aOR] 1.38, 95% CI = 1.10 to 1.73) or smoking BIs (aOR 1.11, 95% CI = 0.98 to 1.26), but for the latter the results were statistically non-significant. Results did not differ notably by nation within Great Britain. CONCLUSION BIs in general practice are more common for smoking than for alcohol. A greater proportion of BIs for alcohol were found to be delivered to people who were from socioeconomically disadvantaged backgrounds and who were increasing or higher-risk drinkers.
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Affiliation(s)
- Vera Helen Buss
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Sharon Cox
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Graham Moore
- SPECTRUM Research Consortium, Edinburgh, UK
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Colin Angus
- SPECTRUM Research Consortium, Edinburgh, UK
- Sheffield Alcohol Research Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Linda Bauld
- SPECTRUM Research Consortium, Edinburgh, UK
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
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Collaço N, Campion A, McNicholas R, Darlington AS. COVID-19- Experiences and support needs of children and young people with Hydrocephalus and parents in the United Kingdom. Childs Nerv Syst 2023; 39:3255-3262. [PMID: 37209198 PMCID: PMC10199430 DOI: 10.1007/s00381-023-05980-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/30/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE Little is known about the impact of COVID-19 on children and young people (CYP) with hydrocephalus and their families. This study explored the experiences and support needs of CYP with hydrocephalus and parents who have a child with hydrocephalus during the COVID-19 pandemic. METHODS CYP with hydrocephalus and parents of CYP with hydrocephalus in the United Kingdom completed an online survey with open and closed questions exploring experiences, information, support needs and decision making processes. Qualitative thematic content analysis and descriptive quantitative analyses were undertaken. RESULTS CYP aged 12-32 years (n=25) and parents of CYP aged 0-20 years (n=69) responded. Parents (63.5%) and CYP (40.9%) worried about the virus, and both were vigilant for virus symptoms (86.5% and 57.1%). Parents (71.2%) and CYP (59.1%) worried about their child/feeling more isolated during the virus outbreak. Parents felt concerned about having to take their child to hospital with a suspected shunt problem during the virus outbreak (64.0%). Qualitative findings reported the following themes: (1) Healthcare and treatment provision: delays and challenges to access and availability of care (2) Impact of COVID-19/lockdown on daily lives and routines, and (3) Provision of information and support for parents and CYP with hydrocephalus. CONCLUSION The impact of COVID-19 and national measures to control the spread of the virus- no contact with anyone outside the household significantly impacted the daily lives and routines of CYP with hydrocephalus and parents. Social engagements were missed, families faced challenges to their work life, education and access to health care and support, which subsequently contributed negatively to their mental wellbeing. CYP and parents highlighted a need for clear, timely and targeted information to address their concerns.
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Affiliation(s)
- Nicole Collaço
- School of Health Sciences, Centre for Psychosocial Research in Cancer (CentRIC+), University of Southampton, Southampton, SO17 1BJ, England.
| | - Anna Campion
- Southampton General Hospital, Southampton, England
| | | | - Anne-Sophie Darlington
- School of Health Sciences, Centre for Psychosocial Research in Cancer (CentRIC+), University of Southampton, Southampton, SO17 1BJ, England
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12
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Campbell K, Greenfield G, Li E, O'Brien N, Hayhoe B, Beaney T, Majeed A, Neves AL. The Impact of Virtual Consultations on the Quality of Primary Care: Systematic Review. J Med Internet Res 2023; 25:e48920. [PMID: 37647117 PMCID: PMC10500356 DOI: 10.2196/48920] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The adoption of virtual consultations, catalyzed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality. OBJECTIVE This study aims to evaluate the impact of virtual consultations on the quality of primary care. METHODS A total of 6 databases were searched. Studies that evaluated the impact of virtual consultations, for any disease, were included. Title and abstract screening and full-text screening were performed by 2 pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed. RESULTS In total, 30 studies (5,469,333 participants) were included in this review. Our findings suggest that virtual consultations are equally effective to or more effective than face-to-face care for the management of certain conditions, including mental illness, excessive smoking, and alcohol consumption. Overall, 4 studies indicated positive impacts on some aspects of patient-centeredness; however, a negative impact was noted on patients' perceived autonomy support (ie, the degree to which people perceive those in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care settings. Evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities among other subgroups depending on contextual factors. CONCLUSIONS Our systematic review demonstrated that virtual consultations may be as effective as face-to-face care and have a potentially positive impact on the efficiency and timeliness of care; however, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centeredness, highlighting areas where future research efforts should be devoted. Capitalizing on real-world data, as well as clinical trials, is crucial to ensure that the use of virtual consultations is tailored according to patient needs and is inclusive of the intended end users. Data collection methods that are bespoke to the primary care context and account for patient characteristics are necessary to generate a stronger evidence base to inform future virtual care policies.
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Affiliation(s)
- Kate Campbell
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Edmond Li
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Niki O'Brien
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Ana Luísa Neves
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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13
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Lemanska A, Andrews C, Fisher L, Bacon S, Frampton AE, Mehrkar A, Inglesby P, Davy S, Roberts K, Patalay P, Goldacre B, MacKenna B, Walker AJ. Healthcare in England was affected by the COVID-19 pandemic across the pancreatic cancer pathway: A cohort study using OpenSAFELY-TPP. eLife 2023; 12:e85332. [PMID: 37561116 PMCID: PMC10414967 DOI: 10.7554/elife.85332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 07/14/2023] [Indexed: 08/11/2023] Open
Abstract
Background Healthcare across all sectors, in the UK and globally, was negatively affected by the COVID-19 pandemic. We analysed healthcare services delivered to people with pancreatic cancer from January 2015 to March 2023 to investigate the effect of the COVID-19 pandemic. Methods With the approval of NHS England, and drawing from a nationally representative OpenSAFELY-TPP dataset of 24 million patients (over 40% of the English population), we undertook a cohort study of people diagnosed with pancreatic cancer. We queried electronic healthcare records for information on the provision of healthcare services across the pancreatic cancer pathway. To estimate the effect of the COVID-19 pandemic, we predicted the rates of healthcare services if the pandemic had not happened. We used generalised linear models and the pre-pandemic data from January 2015 to February 2020 to predict rates in March 2020 to March 2023. The 95% confidence intervals of the predicted values were used to estimate the significance of the difference between the predicted and observed rates. Results The rate of pancreatic cancer and diabetes diagnoses in the cohort was not affected by the pandemic. There were 26,840 people diagnosed with pancreatic cancer from January 2015 to March 2023. The mean age at diagnosis was 72 (±11 SD), 48% of people were female, 95% were of White ethnicity, and 40% were diagnosed with diabetes. We found a reduction in surgical resections by 25-28% during the pandemic. In addition, 20%, 10%, and 4% fewer people received body mass index, glycated haemoglobin, and liver function tests, respectively, before they were diagnosed with pancreatic cancer. There was no impact of the pandemic on the number of people making contact with primary care, but the number of contacts increased on average by 1-2 per person amongst those who made contact. Reporting of jaundice decreased by 28%, but recovered within 12 months into the pandemic. Emergency department visits, hospital admissions, and deaths were not affected. Conclusions The pandemic affected healthcare in England across the pancreatic cancer pathway. Positive lessons could be learnt from the services that were resilient and those that recovered quickly. The reductions in healthcare experienced by people with cancer have the potential to lead to worse outcomes. Current efforts should focus on addressing the unmet needs of people with cancer. Funding This work was jointly funded by the Wellcome Trust (222097/Z/20/Z); MRC (MR/V015757/1, MC_PC-20059, MR/W016729/1); NIHR (NIHR135559, COV-LT2-0073), and Health Data Research UK (HDRUK2021.000, 2021.0157). This work was funded by Medical Research Council (MRC) grant reference MR/W021390/1 as part of the postdoctoral fellowship awarded to AL and undertaken at the Bennett Institute, University of Oxford. The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, UK Health Security Agency (UKHSA), or the Department of Health and Social Care. Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
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Affiliation(s)
- Agnieszka Lemanska
- Faculty of Health and Medical Sciences, University of SurreyGuildfordUnited Kingdom
| | - Colm Andrews
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Seb Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Adam E Frampton
- Faculty of Health and Medical Sciences, University of SurreyGuildfordUnited Kingdom
- HPB Surgical Unit, Royal Surrey NHS Foundation TrustGuildfordUnited Kingdom
- Oncology Section, Surrey Cancer Research Institute, Department of Clinical and Experimental Medicine, University of SurreyGuildfordUnited Kingdom
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Peter Inglesby
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Simon Davy
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Keith Roberts
- Institute of Immunology and Immunotherapy, University of BirminghamBirminghamUnited Kingdom
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing and Centre for Longitudinal Studies, University College LondonLondonUnited Kingdom
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Alex J Walker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
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14
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Assing Hvidt E, Atherton H, Keuper J, Kristiansen E, Lüchau EC, Lønnebakke Norberg B, Steinhäuser J, van den Heuvel J, van Tuyl L. Low Adoption of Video Consultations in Post-COVID-19 General Practice in Northern Europe: Barriers to Use and Potential Action Points. J Med Internet Res 2023; 25:e47173. [PMID: 37213196 DOI: 10.2196/47173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023] Open
Abstract
In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post-COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries' general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism.
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Affiliation(s)
- Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical School, Coventry, United Kingdom
| | - Jelle Keuper
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg Universit, Tilburg, Netherlands
| | - Eli Kristiansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Elle Christine Lüchau
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - Lilian van Tuyl
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
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15
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Smart C, Newman C, Hartill L, Bunce S, McCormick J. Workload effects of online consultation implementation from a Job-Characteristics Model perspective: a qualitative study. BJGP Open 2023; 7:BJGPO.2022.0024. [PMID: 36410768 DOI: 10.3399/bjgpo.2022.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/22/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Online consultation (OC) was previously promoted by the NHS to solve primary care workload challenges. Its implementation was sped up during the COVID-19 pandemic. Workload effects are widely debated. Using a job design perspective may enhance understandings of workload effect. AIM To qualitatively interrogate the workload experiences of primary care staff involved in OC implementation, using the Job Characteristics Model (JCM) to enable the following: a clearer understanding of the primary care staff psychological experiences; and recommendations informing the design of digital implementations and continued use. DESIGN & SETTING A qualitative interview study of GP practices using OC within South West England. METHOD Thirteen participants representing seven practices completed JCM-based semi-structured telephone interviews. An abductive theoretically driven thematic analysis was completed. RESULTS Participants experienced different tasks pre- and post-implementation of OC, and adapted differently to them. Differences included the following: contact modality change, some administrative staff felt removed from patient contact; and in perceived autonomy, some GPs valued increased workload control. Variation in workload experience was affected by job role and practice context, and the form of and rationale for implementation. Use of a psychological model (the JCM) allowed clearer consideration of the effects of change, as well as OC on workload. CONCLUSION Psychological theory may be helpful in interpreting workload effects of technology implementation such as OC. Designing change to include consideration of technology effects, psychological experiences, differences across roles, and individual and practice contexts may be important for technology implementation and evaluation of its workload effects.
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Affiliation(s)
- Cordet Smart
- Department of Psychology, University of Exeter, Exeter, UK
| | | | | | - Sian Bunce
- Devon Sustainability and Transformation Partnership, Devon, UK
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16
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Williams S, Barnard A, Collis P, Correia de Sousa J, Ghimire S, Habib M, Jelen T, Kanniess F, Mak V, Martins S, Paulino E, Pinnock H, Roman M, Sandelowsky H, Tsiligianni I, van der Steen L, Weber Donatelli F. Remote consultations in primary care across low-, middle- and high-income countries: Implications for policy and care delivery. J Health Serv Res Policy 2022:13558196221140318. [PMID: 36484225 PMCID: PMC10363957 DOI: 10.1177/13558196221140318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic mandated a substantial switch in primary health care delivery from an in-person to a mainly remote telephone or video service. As the COVID-19 pandemic approaches its third year, limited progress appears to have been made in terms of policy development around consultation methods for the post-acute phase of the pandemic. In September 2020, the International Primary Care Respiratory Group convened a global panel of primary care clinicians - including family physicians, paediatricians, pharmacists, academics and patients - to consider the policy and health management implications of the move to remote consultations in the primary care setting. The group gave special consideration to how and how far remote consultations should be integrated into routine primary health care delivery. Remote consultations can be a useful alternative to in-person consultations in primary care not only in situations where there is a need for viral infection control but also for the routine delivery of chronic disease management. However, they may not be more time efficient for the clinician, and they can add to the workload and work-related stress for primary care practitioners if they remain the dominant consultation mode. Remote consultations are also less appropriate than in-person consultations for new disease diagnosis, dealing with multiple issues and providing complex care. Ensuring health care professionals have the appropriate skill set to effectively deliver remote consultations, administrative and/or IT support and appropriate reimbursement will be key to achieving optimal integration of remote consultations into routine clinical practice. Addressing digital access and digital literacy issues at a societal level will also be essential to ensure individuals have fair and equitable access to the internet and sufficient security for exchange of personal and health-related data.
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Affiliation(s)
- Siân Williams
- International Primary Care Respiratory Group, Edinburgh, Scotland, UK
| | - Amanda Barnard
- School of General Practice, Rural and Indigenous Health, 2219The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Phil Collis
- 441760European Lung Foundation, Leamington Spa, UK
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, 56059University of Minho, Braga, Portugal
| | - Suraj Ghimire
- Institute of Medicine, 92959Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Monsur Habib
- 588669Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh
| | - Tessa Jelen
- British Lung Foundation Support Group, Westminster, London, UK
| | - Frank Kanniess
- Practice for Family Medicine and Allergy, Reinfeld, Germany
| | - Vince Mak
- 8946Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Hilary Pinnock
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Hanna Sandelowsky
- Department of Family Medicine and Primary Care, Inst. NVS, 27106Karolinska Institute, Stockholm, Sweden
| | - Ioanna Tsiligianni
- Faculty of Medicine, Department of Social Medicine, University of Crete, Greece
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17
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Selick A, Durbin J, Hamdani Y, Rayner J, Lunsky Y. Accessibility of Virtual Primary Care for Adults With Intellectual and Developmental Disabilities During the COVID-19 Pandemic: Qualitative Study. JMIR Form Res 2022; 6:e38916. [PMID: 35951444 PMCID: PMC9400841 DOI: 10.2196/38916] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has led to an unprecedented increase in the delivery of virtual primary care. Adults with intellectual and developmental disabilities (IDDs) have complex health care needs, and little is known about the value and appropriateness of virtual care for this patient population. Objective The aim of this study was to explore the accessibility of virtual primary care for patients with IDDs during the pandemic. Methods We conducted semistructured interviews with 38 participants in Ontario, Canada between March and November 2021. A maximum variation sampling strategy was used to achieve a diverse sample including 11 adults with IDDs, 13 family caregivers, 5 IDD support staff members, and 9 primary care physicians. An iterative mixed inductive and deductive thematic analysis approach was used to code the data and synthesize higher-level themes. The analysis was informed by the Levesque Patient-Centered Access to Health Care Framework. Results We identified themes related to 4 of 5 access-to-care dimensions that highlighted both the benefits and challenges of virtual care for adults with IDDs. The benefits included saving time spent traveling and waiting; avoiding anxiety and challenging behavior for patients who struggle to attend in-person visits; allowing caregivers who live far away from their loved ones to participate; reducing illness transmission; and allowing health care providers to see patients in their home environments. The challenges included lack of access to necessary technology, lack of comfort or skill using technology, and lack of nonverbal communication; difficulty engaging and establishing rapport; patient exclusion from the health care encounter; and concerns about privacy and confidentiality. An overarching theme was that “one size does not fit all,” and the accessibility of virtual care was dependent on the interaction between the following 5 categories of factors: patient characteristics, patient context, caregiver characteristics, service context, and reason for a particular primary care visit. Though virtual care was not always appropriate, in some cases, it dramatically improved patients’ abilities to access necessary health care. Conclusions This study suggests that a flexible patient-centered system including multiple delivery modalities is needed to ensure all patients have access to primary care. Implementing this system will require improved virtual care platforms, access to technology for patients and caregivers, training for primary care providers, and appropriately aligned primary care funding models.
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Affiliation(s)
- Avra Selick
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Janet Durbin
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yani Hamdani
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Rayner
- Alliance for Healthier Communities, Toronto, ON, Canada
- Centre for Studies in Family Medicine, Western University, London, ON, Canada
| | - Yona Lunsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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18
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Cronin C. Special Collection Editorial: The digital movement in nursing. J Res Nurs 2022; 27:411-420. [PMID: 36131703 PMCID: PMC9483225 DOI: 10.1177/17449871221117437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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19
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Affiliation(s)
- Camille Cronin
- Professor, School of Health and Social Care, University of Essex, UK
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20
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Torp DC, Sandbæk A, Prætorius T. Technology acceptance of video consultations for Type 2 diabetes care in general practice: a cross-sectional survey of Danish general practitioners (Preprint). J Med Internet Res 2022; 24:e37223. [PMID: 36040765 PMCID: PMC9472039 DOI: 10.2196/37223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Cæsar Torp
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Annelli Sandbæk
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Thim Prætorius
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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21
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Nilsson E, Sverker A, Bendtsen P, Eldh AC. A Human, Organization, and Technology Perspective on Patients' Experiences of a Chat-Based and Automated Medical History-Taking Service in Primary Health Care: Interview Study Among Primary Care Patients. J Med Internet Res 2021; 23:e29868. [PMID: 34661544 PMCID: PMC8561406 DOI: 10.2196/29868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/02/2021] [Accepted: 07/27/2021] [Indexed: 01/26/2023] Open
Abstract
Background The use of e-visits in health care is progressing rapidly worldwide. To date, studies on the advantages and disadvantages of e-consultations in the form of chat services for all inquiries in primary care have focused on the perspective of health care professionals (HCPs) rather than those of end users (patients). Objective This study aims to explore patients’ experiences using a chat-based and automated medical history–taking service in regular, tax-based, not-for-profit primary care in Sweden. Methods Overall, 25 individual interviews were conducted with patients in the catchment areas of 5 primary care centers (PCCs) in Sweden that tested a chat-based and automated medical history–taking service for all types of patient inquiries. The semistructured interviews were transcribed verbatim before content analysis using inductive and deductive strategies, the latter including an unconstrained matrix of human, organization, and technology perspectives. Results The service provided an easily managed way for patients to make written contact with HCPs, which was considered beneficial for some patients and issues but less suitable for others (acute or more complex cases). The automated medical history–taking service was perceived as having potential but still derived from what HCPs need to know and how they address and communicate health and health care issues. Technical skills were not considered as necessary for a mobile phone chat as for handling a computer; however, patients still expressed concern for people with less digital literacy. The opportunity to take one’s time and reflect on one’s situation before answering questions from the HCPs was found to reduce stress and prevent errors, and patients speculated that it might be the same for the HCPs on the other end of the system. Patients appreciated the ability to have a conversation from almost anywhere, even from places not suitable for telephone calls. The asynchronicity of the chat service allowed the patients to take more control of the conversation and initiate a chat at any time at their own convenience; however, it could also lead to lengthy conversations where a single issue in the worst cases could take days to close. The opportunity to upload photographs made some visits to the PCC redundant, which would otherwise have been necessary if the ordinary telephone service had been used, saving patients both time and money. Conclusions Patients generally had a positive attitude toward e-visits in primary care and were generally pleased with the prospects of the digital tool tested, somewhat more with the actual chat than with the automated history-taking system preceding the chat. Although patients expect their PCC to offer a range of different means of communication, the human, organization, and technology analysis revealed a need for more extensive (end) user experience design in the further development of the chat service.
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Affiliation(s)
- Evalill Nilsson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Annette Sverker
- Department of Activity and Health and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Medical Specialists in Motala and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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22
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Sahni M, Choudhry J, Mittal A, Bhogal G. Remote Musculoskeletal Consultations: A Survey of General Practitioner Registrars' Level of Confidence, Acceptability, and Management. Cureus 2021; 13:e15084. [PMID: 34150413 PMCID: PMC8209758 DOI: 10.7759/cureus.15084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and objective The coronavirus disease 2019 (COVID-19) pandemic has accelerated the shift towards remote consultations in the medical field, including musculoskeletal (MSK) appointments. General practitioner (GP) registrars are now routinely conducting many MSK consultations remotely; however, very little is known of their level of confidence and satisfaction regarding this new and evolving scenario, or how this may impact patient management of patients. In this study, we aimed to understand GP registrars' level of confidence and satisfaction with respect to remote MSK consultations, and the perceived impact on patient management. Study design This study involved a cross-sectional online survey of GP registrars in the West Midlands, which was conducted in January 2021. Methods The survey asked for ranked responses to questions comparing face-to-face consulting methods with remote consulting, focusing on confidence, satisfaction, onward investigations, and referral activity. Statistical analysis was performed using the R software version 4.0.3. Results The overall survey response was 21.2% (n=312/1,471). Of the respondents, 85.9% of GP registrars had not received any training to prepare them for remote MSK consultations. GP registrars generally felt that they were more confident when treating patients face-to-face compared to remote consultations (p<0.001). This was true for general MSK complaints as well as specific assessments of the hand, shoulder, spine, hip, knee, and ankle; 36.2% of GP registrars were not satisfied and 51.0% thought that their patients were not satisfied with the current quality of remote MSK consultations. Of note, 77.6% of GP registrars said that they were more likely to request additional investigations, and 75.6% stated that they were more likely to refer patients to a specialist after a remote MSK consultation. Conclusion This study highlights the need for further training to better equip primary care doctors for remote MSK consultations. With tailored training, GP registrars could offer more streamlined remote patient care for MSK complaints.
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Affiliation(s)
- Manroy Sahni
- Family Medicine, Royal Wolverhampton NHS Trust, Wolverhampton, GBR
| | - Jamaal Choudhry
- Orthopaedics, Royal Wolverhampton NHS Trust, Wolverhampton, GBR
| | - Ankush Mittal
- Department of Public Health, City of Wolverhampton Council, Wolverhampton, GBR
| | - Gurjit Bhogal
- Physical Medicine and Rehabilitation, Centre for Musculoskeletal Medicine, Royal Orthopaedic Hospital, Birmingham, GBR
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