Prescribing Practices at a Residential Treatment Center – from Paper to Plastic (Computers)

Medication prescription procedures were reviewed at psychiatric residential treatment centers (RTC), and a quality improvement project was conducted in order to implement integrated electronic medical records (EMR) and computerized provider order entry (CPOE). To assess the impact of preexisting prescribing practices on RTCs, surveys were sent anonymously to current and past providers of regional and local RTCs. The surveys assessed the impact of the prescribing protocol on workflow, the frequency of medication errors, the impact such errors had on patient care, the overall provider satisfaction, and the discrepancies between electronic and paper charts. Current providers were then re-surveyed after implementing the integrated CPOE system in May 2020, during the COVID-19 pandemic. The first round of provider survey results revealed that the majority of staff (n = 10, 70%) observed frequent medication errors and were largely dissatisfied with the current medication ordering and administration process (n = 10;70%). Incident Response Improvement System (IRIS) reports revealed the most common medication errors were omissions, incorrect dosing, and incorrect medications administered. After the initiation and implementation of the CPOE, staff satisfaction increased with the process (n = 14;50%) noting that medication errors were less frequent than before (n = 14;50%). [ FROM AUTHOR] Copyright of Residential Treatment for Children & Youth is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Satisfaction with telerheumatology care: Patient and clinician perspectives

Use of telerheumatology has increased significantly due to the circumstances surrounding the COVID-19 pandemic. This period of widespread adoption of telerheumatology represents an opportunity to improve access to care in the future by leveraging the newfound experience with and acceptance of telerheumatology achieved during this time. In order to optimize telerheumatology use and efficacy moving forward, the experience of patients and providers with the current state of technology must be considered. In this chapter, we summarize the available evidence describing patient and provider experience with telerheumatology across its lifespan. Patients generally have reported high satisfaction with their telerheumatology visits, citing increased convenience and improved access to care as the primary benefits. Noted barriers included apprehension and nervousness about the process, technologic barriers, and concerns regarding the quality of care. Physicians' opinions were more mixed but overall reported being satisfied with delivering care via telerheumatology. Perceived benefits included shorter waiting times, whereas barriers included impaired communication, inaccurate diagnosis, and possibility for delay in care. Patient and physician attitudes regarding telerheumatology have changed positively in the setting of the COVID-19 pandemic. Future studies should assess whether this positive attitude is temporary or whether it continues in future years. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

Telemedicine During COVID-19 Response: A Welcome Shift for Younger Female Healthcare Workers.

BACKGROUND: Healthcare workers, especially female employees, have historically been at an increased risk for occupational stress. During the early stages of the COVID-19 pandemic, many healthcare workers shifted to a telework model of care and started working from home (WFH). It is unclear how WFH impacted female healthcare employees' job satisfaction and stress levels. OBJECTIVE: To further understand the impact of WFH on job satisfaction and stress among female healthcare employees. DESIGN: An exploratory survey was utilized. Data was evaluated with generalized linear models and logistic regression. Data was collected March to April 2021, between the third and fourth COVID waves in the U.S.A. PARTICIPANTS: All employees (approximately 1050) within the Veterans Affairs Central Western Massachusetts (VACWM) Healthcare System were invited to participate. We received 220 responses with most (78.6%) respondents identifying as female. MAIN MEASURES: A Work-from-Home Satisfaction Scale and the Professional Quality of Life (ProQOL) Compassion Satisfaction and Burnout Scales. KEY RESULTS: A majority of our participants (> 60%) strongly agreed that WFH during COVID-19 increased their work satisfaction and their ability to feel safe and reduced overall stress levels. Female respondents reported that WFH increased their ability to feel safe, reduced overall stress, and did not interfere with work efficiency when compared to male respondents. Overall, reported burnout was low, with only 32.7% of respondents scoring in the moderate category on the PROQOL burnout scale and no respondents scoring in the high burnout category. CONCLUSIONS: Employees at this VA medical center who had the ability to work from home during the COVID-19 pandemic, particularly younger women, reported less stress, less burnout, and more satisfaction, while maintaining work efficiency and team cohesion. Providing permission to WFH may decrease the added burden that female healthcare workers often experience as they strive to overcome gender gaps and inequalities in the workplace.

The Impact of the COVID-19 Pandemic on IBD Care in Alberta: Patient and Provider Perspectives.

Objective: The COVID-19 pandemic necessitated changes in the delivery of ambulatory care for patients with inflammatory bowel disease (IBD), including transitioning many visits to virtual formats and delaying non-urgent assessments. We aimed to evaluate the impact of the COVID-19 pandemic on IBD patient care from health care providers' (HCP) and patients' perspectives. Methods: We administered a 42-question HCP survey and a 44-question patient survey, which evaluated HCP and patient experience and satisfaction with care delivery and delays in access to IBD care during the first wave of the COVID-19 pandemic. Results: Surveys were completed by 19.2% (24/125) HCPs and 25.8% (408/1581) patients. Overall, 82.7% of patients with IBD maintained their care without disruption. The majority of patients were satisfied with a transition to virtual care. All HCPs were willing to use virtual care in the future; however, 60% (14/24) of HCPs reported that virtual care was not equivalent to in-person visits. Patients reported concerns around access to health resources, the uncertainty of IBD-specific care, and fear and stress due to employment uncertainty and safety. Providers also reported concerns about patient safety, patient education, adequate remuneration and challenges with providing care for new patients on virtual platforms. Conclusion: While some delays in health care delivery occurred during the first wave of the pandemic, both patients and HCPs were satisfied with a transition to new models of care delivery. These models may remain in place post-pandemic and allow for flexibility in care delivery that is acceptable to both patients and HCPs.

Teleallergy: Where Have We Been and Where Are We Going?

Telemedicine uptake in allergy/immunology was slow before the coronavirus disease 2019 pandemic, but has accelerated since. This review examines where telemedicine has been in allergy/immunology and where it is headed in the future. Focus is placed on patient, physician, and health care professional satisfaction with telemedicine, capacity to expand access to allergy/immunology care, cost considerations, the regulatory environment, and future applications of telemedicine including adherence monitoring, wearable biosensors, artificial intelligence, and machine learning addressed.

Patient and Clinician Attitudes Toward Telemedicine for Allergy and Immunology.

The use of telemedicine has increased in allergy/immunology, with rapid uptake of its use during the coronavirus disease 2019 pandemic. Existing data indicate an overall positive view of telemedicine by patients, particularly during the coronavirus disease 2019 pandemic. However, patients and clinicians prefer in-person visits for specific types of allergy/immunology encounters, such as those requiring a physical examination or diagnostic testing. The most data for telemedicine exist with asthma, and provide a model for treatment technique, therapeutic monitoring, and education in other allergic and immunologic conditions. Clinician satisfaction is also necessary for telemedicine to be an enduring option for patient/clinician interactions, and this is influenced by a multitude of factors, including technology quality, reimbursement, and maintenance of patient/clinician relationships. Areas of future research should include the need for more outcome data in additional disease states, which will likely help facilitate improved logistical policies around telemedicine that would facilitate its adoption.

Assessing Telehealth Through the Lens of the Provider: Considerations for the Post-COVID-19 Era.

Introduction: Following the coronavirus disease (COVID-19) pandemic restrictions, many health care systems turned to telehealth as an alternative to in-person care. Current literature describes sustained patient satisfaction levels with virtual care throughout the pandemic era. However, provider opinions on the transforming landscape are largely unknown. Objectives: The aim of this study is to better understand provider intentions and limitations to telehealth adoption, along with preferences by various specialties and in various settings. Methods: A mixed-methods study design was used. An attitudinal survey was sent to 2,633 health care providers at a large, quaternary, integrated health system. The survey collected deidentified quantitative and qualitative data on factors influencing provider use, satisfaction, and concerns with telehealth during and after the initial pandemic-era restrictions. Results: Five hundred eighteen providers participated in the survey. Utilization of telehealth was largely motivated by (1) improving patient access (mean 29.3%; range 28-31.6%) and (2) patient interest (mean 23%; range 17.1-28.8%). Barriers included (1) technology limitations (mean 16.1%; range 12.4-23.8%) and (2) reimbursement uncertainties (mean 15.2%; range 4.8-18.8%). Preference for virtual care was reported to be highest in ambulatory settings, including direct-to-patient care and outpatient care. Discussion: Provider preference for telehealth, regardless of specialty or health care setting, revolves around a consumer-centric care delivery model, with increased access to care being a central theme. While provider values are patient oriented, this study found that concerns included connectivity, quality, and patient privacy. Amid changing care standards and regulations, provider preference is supportive of virtual care platforms, both now and postpandemic.

Telehealth multidisciplinary prenatal consultation during the COVID-19 pandemic: enhancing patient care coordination while maintaining high provider satisfaction.

OBJECTIVE: Comprehensive fetal care centers address congenital anomalies by developing pre- and post-natal care plans in a multidisciplinary format. To reduce exposure during the Coronavirus Infectious Disease-2019 (COVID-19) pandemic, the Centers for Medicare & Medicaid Services (CMS) broadened access to telehealth services. We assessed provider satisfaction with the rapid transition from in-person prenatal visits to multidisciplinary consultations via telehealth as an adaptive response to the pandemic. METHODS: Patients referred to an urban academic fetal care center during the first 6 weeks of the COVID-19 pandemic underwent advanced imaging including fetal MRI, focused ultrasound, and fetal echocardiography. Subsequently, multidisciplinary telehealth consultations occurred with all providers attending virtually. Patients were given the option of attending the multidisciplinary telehealth consultation in a conference room in the hospital or from home. During these meetings, relevant images were reviewed with all participants via screen sharing through a secure video platform. Provider satisfaction with the telehealth paradigm was assessed using an electronic survey. RESULTS: Twenty-two surveys were administered with a response rate of 82%. 89% of providers were highly satisfied with the telehealth format. 72% of providers would prefer the multidisciplinary telehealth format to an in-person visit for future visits after COVID-19 restrictions are lifted. 22% of providers would leave the choice to the patient's family. One provider preferred in-person visits. Some providers noted that virtual conferences limited the ability to draw pictures, show educational materials, and provide emotional support. CONCLUSION: Providers were overwhelmingly supportive of continuing multidisciplinary telehealth conferences for complex prenatal consultations, even after restrictions are lifted, which has led to the continuation of this model for the duration of the pandemic. Providers highlighted the convenience and improved care coordination across specialties. Further studies to examine the patient experience with virtual consultations are warranted.

Provider Satisfaction With Infectious Diseases Telemedicine Consults for Hospitalized Patients During the Coronavirus Disease 2019 (COVID-19) Pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, our institution transitioned infectious diseases (ID) consultations on hospitalized patients to telemedicine. We evaluated satisfaction with telemedicine among referring providers and ID consultants. Respondents were satisfied with telemedicine consults for hospitalized patients, although there were significant differences in perceptions of quality and timeliness between consultants and referring providers.

A Pilot Trial Using Telemedicine in Radiation Oncology: The Future of Health Care Is Virtual.

Background: Social determinants of health directly affect cancer survival. Driven by advances in technology and recent demands due to COVID-19, telemedicine has the ability to improve patient access to care, lower health care costs, and increase workflow efficiency. The role of telemedicine in radiation oncology is not established. Materials and Methods: We conducted an IRB-approved pilot trial using a telehealth platform for the first post-radiation visit in patients with any cancer diagnosis. The primary endpoint was feasibility of using telehealth defined by completion of five telehealth visits per month in a single department. Secondary endpoints included the ability to assess patients appropriately, patient and physician satisfaction. Physicians were surveyed again during the pandemic to determine whether viewpoints changed. Results: Between May 27, 2016 and August 1, 2018, 37 patients were enrolled in the Telehealth in Post-operative Radiation Therapy (TelePORT) trial, with 24 evaluable patients who completed their scheduled telehealth visit. On average, 1.4 patients were accrued per month. All patients were satisfied with their care, had enough time with their physician and 85.7% believed the telehealth communication was excellent. All physicians were able to accurately assess the patient's symptoms via telehealth, whereas 82.3% felt they could accurately assess treatment-related toxicity. Physicians assessing skin toxicity from breast radiation were those who did not feel they were able to assess toxicity. Discussion and Conclusions: Both health care providers and patients have identified telemedicine as a suitable platform for radiation oncology visits. Although there are limitations, telemedicine has significant potential for increasing access of cancer care delivery in radiation oncology.

Comparison of provider satisfaction with specialty pharmacy services in integrated health-system and external practice models: A multisite survey.

PURPOSE: The purpose of this study is to obtain insight into providers' satisfaction with services offered by health-system integrated specialty pharmacies and to determine whether providers' perceptions of services offered under an integrated model differ from perceptions of external specialty pharmacy services. METHODS: A multi-site, cross-sectional, online survey of specialty clinic healthcare providers at 10 academic health systems with integrated specialty pharmacies was conducted. The questionnaire was developed by members of the Vizient Specialty Pharmacy Outcomes and Benchmarking Workgroup and was pretested at 3 pilot sites prior to dissemination. Prescribers of specialty medications within each institution were identified and sent an email invitation to participate in the study that included a link to the anonymous questionnaire. Respondents were asked to rate their agreement with 10 statements regarding quality of services of integrated and external specialty pharmacies on a 5-point scale (1 = strongly disagree, 5 = strongly agree). An analysis to determine differences in providers' overall satisfaction with the integrated and external specialty pharmacy practice models, as well as differences in satisfaction scores for each of the 10 statements, was performed using paired-samples t tests. RESULTS: The mean (SD) score for overall satisfaction with integrated specialty pharmacies was significantly higher than the score for satisfaction with external specialty pharmacies: 4.72 (0.58) vs 2.97 (1.20); 95% confidence interval, 1.64-1.87; P < 0.001. Provider ratings of the integrated specialty pharmacy model were also higher for all 10 items evaluating the quality of services (P < 0.05 for all comparisons). CONCLUSION: The study results confirm that the health-system integrated specialty pharmacy practice model promotes high rates of provider satisfaction with services and perceived benefits.

Patient and Provider Satisfaction With Telemedicine in Otolaryngology.

OBJECTIVE: The objective of this study is to evaluate patient and provider satisfaction with telemedicine encounters across 3 otolaryngology practices. STUDY DESIGN: Cross-sectional survey. SETTING: A military community hospital, an academic military hospital, and a nonmilitary academic center. METHODS: A telephone-based survey of patients undergoing telemedicine encounters for routine otolaryngology appointments was performed between April and July 2020. Patients were asked about their satisfaction, the factors affecting care, and demographic information. A provider survey was emailed to staff otolaryngologists. The survey asked about satisfaction, concerns for reimbursement or liability, encounters best suited for telemedicine, and demographic information. The results were analyzed with descriptive statistics and a multivariable logistic linear regression model to determine odds ratios. RESULTS: A total of 325 patients were surveyed, demonstrating high satisfaction with telemedicine (average score, 4.49 of 5 [best possible answer]). Patients perceived "no negative impact" or "minor negative impact" on the encounter due to the lack of a physical examination or face-to-face interaction (1.86 and 1.95 of 5, respectively). High satisfaction was consistent across groups for distance to travel, age, and reason for referral. A total of 25 providers were surveyed, with an average satisfaction score of 3.44 of 5. Providers reported "slight" to "somewhat" concern about reimbursement (40%) and liability (32%). CONCLUSION: Given patients' and providers' levels of satisfaction, there is likely a role for telemedicine in otolaryngology practice that may benefit patient care independent of the COVID-19 pandemic.

Feasibility and acceptability of virtual academic detailing on opioid prescribing.

INTRODUCTION: Social distancing requirements during COVID-19 pose a challenge to conducting traditional academic detailing, which typically involves in-person peer education visits to improve patient outcomes. The main alternative is to conduct virtual academic detailing delivered through web-based technology, but this approach is fraught with many challenges. This study aimed to examine the feasibility and acceptability of a virtual academic detailing program implemented among health care providers. METHODS: The academic detailing program focused on appropriate opioid prescribing and chronic non-cancer pain management among a sample of providers. An initial in-person visit was followed by a virtual visit up to 8 weeks later. Videoconferencing was used to conduct the virtual visit with telephone as a backup. Feasibility was assessed whether the virtual visits could happen, and acceptability was assessed by provider satisfaction. Validated measures of Provider Satisfaction with Academic Detailing (PSAD) and Detailer Assessment of Visit Effectiveness (DAVE) with a 5-point Likert-type scale were used. Higher scores corresponded to higher satisfaction and greater perceived effectiveness. Non-parametric and parametric statistical tests were used to compare instrument summary scores across visits and between groups. Pairwise analyses across visits only included instrument responses for providers who participated in both visits and completed both surveys in their entirety. RESULTS: There were 127 (90 %) initial in-person visits completed out of 141 visits scheduled, with a survey response rate of 96 %. Out of 120 virtual follow-up visits scheduled, 92 (77 %) were conducted, and 56 surveys (61 %) were collected. There was a high level of satisfaction with the initial and follow up virtual academic detailing visits, though, among providers who participated in both visits and had completed surveys (n = 50), initial visits had slightly higher scores (mean difference = -2.94 [95 % Confidence intervals: -4.38, -1.50], p < 0.001). There was no significant difference in detailer perception across the two visits as seen in the scale summary score (0.05 [-0.56, 0.66], p = 0.86) and two individually reported items related to feasibility (0.07 [-0.29, 0.42], p = 0.72) and conversation (-0.05 [-0.28, 0.17], p = 0.63). Forty-one (44.6 %) virtual visits were conducted using WebEx, where video and screen sharing of visit content was possible, while the remaining 51 (55.4 %) were conducted using a telephone. There was no significant difference in provider satisfaction between WebEx vs. telephone visits (-1.47 [-4.99, 2.05], p = 0.82). Provider satisfaction was also not impacted by any technical difficulties as reported by the detailer (-0.04 [-3.30, 3.38], p = 0.98). CONCLUSION: The results slightly favor in-person visits and suggest that virtual detailing visits need to incorporate strategies that minimize technical difficulties and prevent participants from defaulting to less favorable technology. Future research opportunities include evaluating the effectiveness of a virtual versus in-person delivery of AD program on outcomes such as providers' opioid prescribing behavior.