Electronic consultation (e-consultation) between primary care and the neurology department: One-year experience in a healthcare area in Andalusia, Spain

Introduction: The COVID-19 pandemic has prompted the implementation of telemedicine programmes to facilitate healthcare. In November 2020 we initiated an e-consultation programme between primary care and the neurology department, with asynchronous response, through a platform integrated into the corporate computer system of the Andalusian Public Health System. We present the results of the first year of operation. Methods: We present a descriptive study of the e-consultations received in 2021 from a health area of approximately 300,000 inhabitants aged ≥ 14 years. The reasons for consultation were pre-established: "primary headache” (PH), "new-onset cognitive impairment” (CI), "complications of dementia” (DEM), and "epilepsy” (EPI). We defined inclusion criteria and the clinical information/tests that had to be provided. General practitioners could choose between e-consultation or face-to-face referral. Results: A total of 1,806 e-consultations were received (approximately 6/1,000 population/year). By reasons for consultation: CI 34.3%, PH 32%, DEM 14.4%, EPI 11.7%, unspecified 7.6%. Responses were sent after an average of 2.25 days and were classified as: "refer for in-person consultation” (47.12%), "resolved” (39.98%), "criteria not met” (12.57%), or "follow-up by e-consultation” (0.33%). As expected, a high proportion of face-to-face referrals were required for CI (73.46%);the main value of the system for these patients was to prioritise appointments and select the most appropriate form of care. For the rest of the reasons for consultation, the proportion of "resolved” e-consultations reached 52.61%. Conclusions: Asynchronous e-consultation between primary care and the neurology department is a useful tool in the indicated conditions, offering a rapid, "one-stop” response to a significant proportion of clinical or therapeutic uncertainties, as well as optimising face-to-face appointments. © 2023

Hospitality and COVID-19: a willingness to choose e-consultation owing to unemployment and home isolation

PurposeCoronavirus disease (COVID-19) was declared as a pandemic since COVID-19's widespread outbreak and the hospitality industry has been the hardest hit due to lockdown. Consequently, hospitality workers are suffering from the negative aspects of mental health. In the event of such a crisis, this study aims to explore the link between unemployment and home isolation to the willingness to choose electronic consultation (e-consultation) by exploiting psychological ill-being and behavioural intention (BI) with marital status as a moderator.Design/methodology/approachA quantitative methodology is applied to primary data collected from 310 workers from the hospitality industry through an online survey.FindingsFindings of this study suggest that the usage of the e-consultation service can be adopted using three levels. There are valid reasons to conclude unemployment and home isolation are linked to higher rates of psychological health behaviours, which can result in stigma, loss of self-worth and increased mortality. The adverse effect is higher for single individuals than for married people.Originality/valueThe study focussed on e-consultation, BI coupled with the Fishbein scale and a classification model for the prediction of willingness to choose e-consultation with the extension of Theory of Planned Behaviour (TPB).

Electronic consultation (e-consultation) between primary care and the neurology department: One-year experience in a healthcare district in Andalusia, Spain

Introduction The COVID-19 pandemic has prompted the implementation of telemedicine programmes to facilitate healthcare. In November 2020 we initiated an e-consultation programme between primary care and the neurology department, with asynchronous response, through a platform integrated into the corporate computer system of the Andalusian Public Health System. We present the results of the first year of operation. Methods We present a descriptive study of the e-consultations received in 2021 from a health area of approximately 300,000 inhabitants aged ≥14 years. The reasons for consultation were pre-established: "primary headache” (PH), "new-onset cognitive impairment” (CI), "complications of dementia” (DEM), and "epilepsy” (EPI). We defined inclusion criteria and the clinical information/tests that had to be provided. General practitioners could choose between e-consultation or face-to-face referral. Results A total of 1806 e-consultations were received (approximately 6/1000 population/year). By reasons for consultation: CI 34.3%, PH 32%, DEM 14.4%, EPI 11.7%, unspecified 7.6%. Responses were sent after an average of 2.25 days and were classified as: "refer for in-person consultation” (47.12%), "resolved” (39.98%), "criteria not met” (12.57%), or "follow-up by e-consultation” (0.33%). As expected, a high proportion of face-to-face referrals were required for CI (73.46%);the main value of the system for these patients was to prioritise appointments and select the most appropriate form of care. For the rest of the reasons for consultation, the proportion of "resolved” e-consultations reached 52.61%. Conclusions Asynchronous e-consultation between primary care and the neurology department is a useful tool in the indicated conditions, offering a rapid, "one-stop” response to a significant proportion of clinical or therapeutic uncertainties, as well as optimising face-to-face appointments. Resumen Introducción La pandemia por Covid-19 ha impulsado la implantación de programas de telemedicina para facilitar la asistencia sanitaria. En noviembre de 2020 iniciamos un programa de e-interconsulta entre Atención Primaria (AP)-Neurología, de respuesta asíncrona, a través de una plataforma integrada en la estación clínica corporativa del Sistema Sanitario Público de Andalucía. Presentamos los resultados de su primer año de funcionamiento. Métodos Estudio descriptivo de las e-interconsultas recibidas durante 2021 desde un área sanitaria de aproximadamente 300.000 habitantes ≥14 años. Se establecieron como motivos de consulta: "Cefalea primaria” (CEF), "Deterioro cognitivo de novo” (DC), "Complicaciones de la demencia” (DEM) y "Epilepsia” (EPI), definiéndose unos criterios preestablecidos y la información clínica/pruebas que se debían aportar. Los médicos/as de familia podían elegir entre e-interconsultar o derivar directamente para cita presencial. Resultados Se recibieron 1.806 e-interconsultas (≈6/1.000 hab./año). Por motivos de consulta: DC 34′3%, CEF 32%, DEM 14′4%, EPI 11′7%, no especificado 7′6%. Las respuestas se demoraron una media de 2′25 días y se clasificaron en: "precisa cita presencial” (47′12%), "alta” (39´98%), "no cumple criterios” (12′57%) o "seguimiento por e-interconsulta” (0′33%). Como era previsible, para el DC una alta proporción precisó cita presencial (73′46%);su mayor utilidad fue priorizar las citas y modalidad de asistencia. Para el resto de motivos, la proporción de "alta” alcanzó el 52′61%. Conclusiones La e-interconsulta asíncrona entre AP-Neurología es una herramienta útil en las condiciones indicadas, permitiendo resolver en un "acto único” y con escasa demora una significativa proporción de dudas clínicas o terapéuticas, así como optimizar las citas presenciales.

Introducing the DigiPart-Index: Mapping and explaining digital political participation on the subnational level in Switzerland

Digital political participation increasingly complements analogue forms of political participation. Elements of the political process such as dialogue, consultation, participation as well as voting have received a further digital boost in the COVID-19 pandemic. Because they reflect the new digital experiences of ever broader sections of the population, using digital means to participate in the political process will play an increasingly important role in the future. The DigiPart-Index (DPI) measures three dimensions of digital political participation for all cantons in Switzerland. The first dimension reflects how political decision-making in democracies is preceded by an opinion-formation phase. It covers tools for e-deliberation, digital political education and e-transparency. The second dimension, co-creation, maps the exchange between government agencies and civil society. The two components, e-consultation and e-demand, are surveyed for this purpose. Thirdly, in addition to public debate and an exchange between the state and society, digital tools can also be used to enable the act of voting. To this end, the foundations must be laid in the form of electronic identification, i.e. an e-ID, so that it can then be used for e-voting and e-collecting, among other things. The values for the DigiPart-Index Switzerland range from 0 to 100 points. Results show that the differences between the cantons are considerable, ranging from a minimum of 6 to a maximum of 55 points. The mean value is 31 points. The ranking tends to be led by cantons with greater financial resources. However, even the cantons at the top range of the index still have room for considerable improvement in all dimensions. © 2022 ACM.

Experiences and Challenges of Emerging Online Health Services Combating COVID-19 in China: Retrospective, Cross-Sectional Study of Internet Hospitals.

BACKGROUND: Internet-based online virtual health services were originally an important way for the Chinese government to resolve unmet medical service needs due to inadequate medical institutions. Its initial development was not well received. Then, the unexpected COVID-19 pandemic produced a tremendous demand for telehealth in a short time, which stimulated the explosive development of internet hospitals. The Second Affiliated Hospital of Zhejiang University (SAHZU) has taken a leading role in the construction of internet hospitals in China. The pandemic triggered the hospital to develop unique research on health service capacity under strict quarantine policies and to predict long-term trends. OBJECTIVE: This study aims to provide policy enlightenment for the construction of internet-based health services to better fight against COVID-19 and to elucidate future directions through an in-depth analysis of 2 years of online health service data gleaned from SAHZU's experiences and lessons learned. METHODS: We collected data from SAHZU Internet Hospital from November 1, 2019, to September 16, 2021. Data from over 900,000 users were analyzed with respect to demographic characteristics, demands placed on departments by user needs, new registrations, and consultation behaviors. Interrupted time series (ITS) analysis was adopted to evaluate the impact of this momentous emergency event and its long-term trends. With theme analysis and a defined 2D model, 3 investigations were conducted synchronously to determine users' authentic demands on online hospitals. RESULTS: The general profile of internet hospital users is young or middle-aged women who live in Zhejiang and surrounding provinces. The ITS model indicated that, after the intervention (the strict quarantine policies) was implemented during the outbreak, the number of internet hospital users significantly increased (ß_2=105.736, P<.001). Further, long-term waves of COVID-19 led to an increasing number of users following the outbreak (ß_3=0.167, P<.001). In theme analysis, we summarized 8 major demands by users of the SAHZU internet hospital during the national shutdown period and afterwards. Online consultations and information services were persistent and universal demands, followed by concerns about medical safety and quality, time, and cost. Users' medical behavior patterns changed from onsite to online as internet hospital demands increased. CONCLUSIONS: The pandemic has spawned the explosive growth of telehealth; as a public tertiary internet hospital, the SAHZU internet hospital is partially and irreversibly integrated into the traditional medical system. As we shared the practical examples of 1 public internet hospital in China, we put forward suggestions about the future direction of telehealth. Vital experience in the construction of internet hospitals was provided in the normalization of COVID-19 prevention and control, which can be demonstrated as a model of internet hospital management practice for other medical institutions.

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.

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.

Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study.

BACKGROUND: eConsulta-that is, asynchronous, two-way teleconsultation in primary care-is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system. OBJECTIVE: This study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic. METHODS: A descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them. RESULTS: During the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas. CONCLUSIONS: The COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity.

Perspectives of Health Care Providers in an Integrated Health Care Delivery Network on Inpatient Electronic Consultation (e-Consult) Use During the COVID-19 Pandemic.

A large academic hospital system (Allegheny Health Network) introduced inpatient electronic consultations (e-Consults) during the COVID-19 crisis. Providers were invited to complete an anonymous survey on their perceptions of e-Consults. Descriptive statistics were used to analyze Likert-scale data. Cronbach's alpha was used to assess internal consistency. Ninety-five providers completed the survey. Requesting and consulting providers agreed that e-Consults were easy to use (100% and 96.2%, respectively). Both groups also concurred that e-Consults either decreased or did not significantly impact their workload (81% and 74%, respectively) and that training was appropriate (77.8% and 86.8%, respectively). The advantage and barrier selected most frequently by specialists was "timelier completion of the consult versus in-person" and "inadequate information to complete the consult," respectively. The disadvantage selected most frequently by requesting physicians was "lack of communication between providers." Open-ended comments were categorized into themes. Concerns were raised regarding whether provider-provider communication via this platform offered enough information to make recommendations compared to traditional encounters. The perceived benefits and barriers of e-Consults should be further explored with the goal of improving patient care delivery and provider satisfaction.

The Impact of Signals Transmission on Patients' Choice through E-Consultation Websites: An Econometric Analysis of Secondary Datasets.

(1) Background: The COVID-19 pandemic has dramatically and rapidly changed the overall picture of healthcare in the way how doctors care for their patients. Due to the significant strain on hospitals and medical facilities, the popularity of web-based medical consultation has drawn the focus of researchers during the deadly coronavirus disease (COVID-19) in the United States. Healthcare organizations are now reacting to COVID-19 by rapidly adopting new tools and innovations such as e-consultation platforms, which refer to the delivery of healthcare services digitally or remotely using digital technology to treat patients. However, patients' utilization of different signal transmission mechanisms to seek medical advice through e-consultation websites has not been discussed during the pandemic. This paper examines the impact of different online signals (online reputation and online effort), offline signals (offline reputation) and disease risk on patients' physician selection choice for e-consultation during the COVID-19 crisis. (2) Methods: Drawing on signaling theory, a theoretical model was developed to explore the antecedents of patients' e-consultation choice toward a specific physician. The model was tested using 3-times panel data sets, covering 4231 physicians on Healthgrades and Vitals websites during the pandemic months of January, March and May 2020. (3) Results: The findings suggested that online reputation, online effort and disease risk were positively related to patients' online physician selection. The disease risk has also affected patients' e-consultation choice. A high-risk disease positively moderates the relationship between online reputation and patients' e-consultation choice, which means market signals (online reputation) are more influential than seller signals (offline reputation and online effort). Hence, market signals strengthened the effect in the case of high-risk disease. (4) Conclusions: The findings of this study provide practical suggestions for physicians, platform developers and policymakers in online environments to improve their service quality during the crisis. This article offers a practical guide on using emerging technology to provide virtual care during the pandemic. This study also provides implications for government officials and doctors on the potentials of consolidating virtual care solutions in the near future in order to contribute to the integration of emerging technology into healthcare.

Care of traditional patients in the campaign against COVID-19: casualties of friendly fire.

In response to the COVID-19 pandemic, hospitals have adopted protocols geared to optimize the care of patients with COVID-19, while mitigating risk of exposure to other patients and to health care workers. These modifications can have un-intended consequences and impact the care of non-COVID patients. In the campaign against COVID-19, we must remain vigilant that patients with traditional disease processes also receive thoughtful and coordinated care.