Gaps to Best Practices for Teleconsultations Performed by General Practitioners: A Descriptive Cross-Sectional Study.

The COVID-19 pandemic led to large increases in telemedicine activity worldwide. This rapid growth, however, may have impacted the quality of care where compliance with guidelines and best practices are concerned. The aim of this study was to describe the recent practices of a telemedicine activity (teleconsultations) and the breaches of best practice guidelines committed by general practitioners (GPs) in the Greater Eastern Region of France. A cross-sectional study was conducted using a 33-item questionnaire and was provided to the Regional Association of Healthcare Professionals, Union Régionale des Professionnels de Santé (URPS) to be shared amongst the GPs. Between April and June 2021, a total of 233 responses were received, showing that (i) by practicing telemedicine in an urban area, (ii) performing a teleconsultation at the patient's initiative, and (iii) carrying out more than five teleconsultations per week were factors associated with a significantly higher level of best practices in telemedicine. All in all, roughly a quarter of GPs (25.3%, n = 59) had a self-declared good telemedicine practice, and the rules of good practice are of heterogeneous application. Despite the benefits of learning on the job for teleconsultation implementation during the COVID-19 lockdowns, there may be a clear need to develop structured and adapted telemedicine training programs for private practice GPs.

Experience of Primary Care Physicians in the Aube Department, France, Regarding the COVID-19 Crisis.

BACKGROUND: General practitioners (GPs) played a decisive role during the COVID-19 epidemic, particularly in the identification and care of patients at home. This study aimed to describe the primary care physicians' perceptions of the COVID-19 crisis and to guide future decisions regarding measures to prolong, abrogate, or improve upon methods for crisis management. METHODS: This is a cross-sectional study based on a 30-item questionnaire aiming to investigate how primary care physicians (GPs) working in the rural Aube Department experienced the COVID-19 crisis. RESULTS: Among the 152 respondents, 60.5% were not satisfied with the level of information from authorities during the crisis. By multivariate analysis, a feeling of having been adequately informed (OR 21.87, 95%CI 4.14-115.53) and a feeling that non-COVID-19-related diseases were adequately managed (OR 6.42, 95%CI 1.07-38.51) were both significantly associated with an overall satisfaction with the management of the crisis. CONCLUSION: This study about rural primary care physicians in Eastern France highlights some of the weaknesses of the French healthcare system in terms of the provision of primary care during the epidemic. A leading cause of dissatisfaction was that the information relayed by the health authorities about the disease and its management largely overlooked the primary care providers, many of whom had to rely on traditional media to obtain information.

Chest CT Characteristics are Strongly Predictive of Mortality in Patients with COVID-19 Pneumonia: A Multicentric Cohort Study.

RATIONALE AND OBJECTIVES: The novel coronavirus (COVID-19) has presented a significant and urgent threat to global health and there has been a need to identify prognostic factors in COVID-19 patients. The aim of this study was to determine whether chest computed tomography (CT) characteristics had any prognostic value in patients with COVID-19. MATERIALS AND METHODS: A retrospective analysis of COVID-19 patients who underwent a chest CT-scan was performed in four medical centers. The prognostic value of chest CT results was assessed using a multivariable survival analysis with the Cox model. The characteristics included in the model were the degree of lung involvement, ground glass opacities, nodular consolidations, linear consolidations, a peripheral topography, a predominantly inferior lung involvement, pleural effusion, and crazy paving. The model was also adjusted on age, sex, and the center in which the patient was hospitalized. The primary endpoint was 30-day in-hospital mortality. A second model used a composite endpoint of admission to an intensive care unit or 30-day in-hospital mortality. RESULTS: A total of 515 patients with available follow-up information were included. Advanced age, a degree of pulmonary involvement ≥50% (Hazard Ratio 2.25 [95% CI: 1.378-3.671], p = 0.001), nodular consolidations and pleural effusions were associated with lower 30-day in-hospital survival rates. An exploratory subgroup analysis showed a 60.6% mortality rate in patients over 75 with ≥50% lung involvement on a CT-scan. CONCLUSION: Chest CT findings such as the percentage of pulmonary involvement ≥50%, pleural effusion and nodular consolidation were strongly associated with 30-day mortality in COVID-19 patients. CT examinations are essential for the assessment of severe COVID-19 patients and their results must be considered when making care management decisions.

The Use of Telemedicine in Nursing Homes: A Mixed-Method Study to Identify Critical Factors When Connecting with a General Hospital.

Evaluating the use and impact of telemedicine in nursing homes is necessary to promote improvements in the quality of this practice. Even though challenges and opportunities of telemedicine are increasingly becoming well documented for geriatrics (such as improving access to healthcare, patient management, and education while reducing costs), there is still limited knowledge on how to better implement it in an inter-organizational context, especially when considering nursing homes. In this regard, this study aimed first to describe the telemedicine activity of nursing homes when cooperating with a general hospital; and then understand the behavioral differences amongst nursing homes while identifying critical factors when implementing a telemedicine project. We conducted a sequential, explanatory mixed-method study using quantitative then qualitative methods to better understand the results. Three years of teleconsultation data of twenty-six nursing homes (15 rural and 11 urban) conducting teleconsultations with a general hospital (Troyes Hospital, France) were included for the quantitative analysis, and eleven telemedicine project managers for the qualitative analysis. Between April 2018 and April 2021, 590 teleconsultations were conducted: 45% (n = 265) were conducted for general practice, 29% (n = 172) for wound care, 11% (n = 62) for diabetes management, 8% (n = 47) with gerontologist and 6% (n = 38) for dermatology. Rural nursing homes conducted more teleconsultations overall than urban ones (RR: 2.484; 95% CI: 1.083 to 5.518; p = 0.03) and included more teleconsultations for general practice (RR: 16.305; 95% CI: 3.505 to 73.523; p = 0.001). Our qualitative study showed that three critical factors are required for the implementation of a telemedicine project in nursing homes: (1) the motivation to perform teleconsultations (in other words, improving access to care and cooperation between professionals); (2) building a relevant telemedicine medical offer based on patients' and treating physicians' needs; and (3) it's specific organization in terms of time and space. Our study showed different uses of teleconsultations according to the rural or urban localization of nursing homes and that telemedicine projects should be designed to consider this aspect. Triggered by the COVID-19 pandemic, telemedicine projects in nursing homes are increasing, and observing the three critical factors presented above could be necessary to limit the failure of such projects.

Effect of the COVID-19 pandemic lockdown on non-COVID-19 emergency department visits in Eastern France: Reduced risk or avoidance behavior?

OBJECTIVE: To study the impact of COVID-19 pandemic lockdown on avoided emergency department visits and consequent hospitalizations. STUDY DESIGN: An observational retrospective design was used to investigate avoided visits and hospitalizations of an departmental emergency department combined with a clustering approach on multimorbidity patterns. METHODS: A multimorbidity clustering technique was applied on the emergency department diagnostics to segment the population in diseases clusters. Global visits and hospitalizations from an emergency department during the 2020 lockdown were put in perspective with the same period during 2019. Using a comparison with the five previous years, avoided hospitalizations per inhabitants during the lockdown were estimated for each diseases cluster. RESULTS: During the 8 weeks of lockdown, the number of emergency department visits have been reduced by 41.47% and resultant hospitalizations by 28.50% compared to 2019. The retrospective study showed that 14 of 17 diseases clusters had a statistically significant reduction in hospitalizations with a pronounced effect on lower acuity diagnoses and middle-aged patient, leading to 293 avoided hospitalizations per 100,000 inhabitants compared to the 5 previous years and to the 85.8 COVID-19 hospitalizations per 100,000 inhabitants. CONCLUSION: Although specific to a regional context of pandemic containment, the study suggest that COVID-19 lockdown had beneficial effects on the crowding situation of the emergency departments and hospitals with avoidance effects primarily link to reduced risks.