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Blackground and objective: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area. Methods: Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018. Results: We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018. Conclusions: The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes.
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BACKGROUND AND OBJECTIVE: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are no data corresponding to models between clinicians. An analysis was made of the impact of the COVID-19 pandemic upon the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our healthcare area. METHODS: Patients with at least one e-consultation between 2018 and 2021 were selected. We analyzed the impact of the COVID-19 pandemic upon activity and waiting time for care, hospitalizations and mortality, taking as reference the consultations carried out during 2018. RESULTS: A total of 25,121 patients were analyzed. Logistic regression analysis showed a shorter delay in care and resolution of the e-consultation without the need for face-to-face care to be associated to a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated to poorer health outcomes compared to 2018. CONCLUSIONS: The results of our study show a significant reduction in e-consultation referrals during the first year of the COVID-19 pandemic, with a subsequent recovery in the demand for care, and without the pandemic periods being associated to poorer outcomes. The reduction in time elapsed for resolving the e-consultations and no need for face-to-face visits were associated to improved outcomes.
Subject(s)
COVID-19 , Cardiologists , General Practitioners , Remote Consultation , Humans , COVID-19/epidemiology , Pandemics , Referral and ConsultationABSTRACT
Managing the increasing number of 2-week wait (2WW) suspected skin cancer referrals to specialist National Health Service (NHS) dermatology services is challenging. Currently, once received, these referrals cannot be redirected back to the referrer and data show that around only 6% of these referrals are relevant skin cancers. The use of teledermatology, including dermoscopic images, for pre-2WW triage has therefore been advocated. Current recommendations expect that these images will be taken in a primary care setting by a member of the primary care team as part of a face-to-face interaction. In response to the COVID-19 pandemic, NHS England now recommends that all general practices should be using a total triage model, using telephone or online consultation systems for all patients contacting the practice, to reduce footfall and thereby protect patients and staff. It is speculated that this change in primary care practice will continue for the foreseeable future. The aim of this study was to review the impact of primary care remote consultation activity on 2WW skin cancer referrals. A simple questionnaire was designed to ask patients attending a 2WW appointment of the nature of their interaction in primary care prior to their 2WW referral, including the type of consultation and the responsible healthcare professional. Data were obtained from 347 consecutive patients, and 206 (59 4%) had been seen face to face. Of these, 135 (65 5%) were seen by a doctor and 71 (34 5%) by a nurse. The remaining 141 (40 6%) did not have a face-to-face consultation prior to referral. Of these 86 (61 0) were referred based on either a video consultation with an image from the patient and 55 (39 0%) following a telephone consultation only. These data are important as they show that the increasing emphasis on remote consultations in primary care means that large numbers of patients with suspected skin cancer are being referred without a face-to-face interaction and one in six were referred based on a telephone consultation only. There are two important potential implications of this. Firstly, this is likely to lead to an increase in 2WW referrals and, secondly, proposed models of pre-2WW triage using teledermatology with appropriate images (including dermoscopic) that currently require patients to attend a general practice surgery for appropriate image taking may need to be rethought. Alternative innovative approaches such as the use of community hubs for image taking or rapid-access community-based skin lesion diagnosis clinics ('spot clinics') may need to be considered.
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Introduction: Approximately 16,500 patients develop cancer in Germany in the ages between 18 und 39 years. Many of them experience fnancial and social problems as a consequence of the disease and its treatment. Young patients represent a small proportion of all cancer patients (3%) and their social situation is very heterogenous. Tey face difculties to get helpful counseling and support. Method(s): Young Cancer Portal (www.junges-krebsportal.de) is an internet-based support system for young cancer patients. It has fve sections:.,First Aid" provides hints and experiences how to cope and how to organize oneself in the first time after diagnosis.,Knowledge Base" provides medical, organizational and legal informations on fertility preservation, on the SARS-CoV-2 pandemia, information for students with cancer, young families, how to deal with insurance companies, problems of severely disabled etc. It is built in intensive interaction with young cancer patients from the.,meeting points" of the foundation. The sections.,Online Consultation Hour" and.,Webinars" provide further informations in an easy understandable format. In the section.,Individual Counseling" expert counseling on social and medical topics is offered as chat on a protected sever and in direct contact. As a new feature support from patient peers with special expertise will be realized. These peers are recruited from the editorial teams who were involved in the development of the information pages on the different topics. Result(s): As on march 23rd, 1,098 patients have been registered for.,individual counseling" and 677 consultations have been performed plus by now 100 consultations on reimbursement for fertility preservation. There have been more than 30,000 visits on the Corona pages. Seven patients' editorial teams have been formed. The pages on fnancial and social problems of students and young families are in final editing. Conclusion(s): We present a new way to provide information on medical, fnancial and social problems to support young cancer patients. By involving active patients from the meeting points of the foundation and organizing them in editorial teams the focus of the information pages is sharpened. Based on their work in the editorial teams these patients are enabled and mobilized to support other patients as peers.
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Introduction: As COVID-19 spread across Southeast Asia (SEA) in 2020-2021, healthcare systems in Cambodia, Laos and Myanmar braced as public health officials closed outpatient diabetes clinics and healthcare professionals (HCPS) were redeployed to COVIDtreatment zones. Action4Diabetes (A4D) is a non-profit organization providing free insulin and medical supplies to SEA since 2016. With limited healthcare coverage in Cambodia, Laos, and Myanmar, patients enrolled on A4D's program travel hundreds of miles to diabetes clinics to collect free insulin, blood glucose strips and other medication. Due to COVID-19 lockdowns, insulin often arrived with short expiry dates due to delays in shipments caused by bottlenecks at international logistic hubs, and patients were known to ration insulin due to lack of supply. For disadvantaged people with Type 1 diabetes (T1D) in SEA low-middle-income countries (LMICs), this posed a serious threat due to inaccessible insulin and medical supplies. Objective(s): A4D developed a strategic plan to maintain accessible medical supplies and supported the development of remote econsultations. Method(s): Access to medical supplies and e-consultations. A4D initiated e-consultations and networks of couriers to rural parts of Myanmar, Laos, and Cambodia to deliver medical supplies. In Cambodia, TukTuk drivers who ferried tourists around Angkor Wat were used to deliver insulin to the T1D in farming communities. In Myanmar and Laos, agriculture truck drivers that transported vegetable crops were used to transport medical supplies to remote areas. During COVID-19, A4D used local suppliers for insulin and had to purchase insulin and blood testing strips at a premium rate. Result(s): Conclusion(s): For many disadvantaged people with T1D in SEA, the COVID-19 pandemic reinforced the fragile nature of their T1D management. Through collaborating closely with HCPs on the ground, A4D has developed a more dynamic and resilient logistical system to maintain key life-saving medical supplies.
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Background: Helper is a person with RMD educated to help other patients. Based on the clearly defned authorizations this person helps in advising and information sharing among the ORS members.1 Association of patients with rheumatic diseases of the Republic of Serbia (ORS) operates across the country through the reference centers/branches, but in pandemic the functioning of helper in an regular way was signifcantly impacted. Objectives: In order to continue with the functioning in Association and with Helper during the Covid-19 pandemic, new communication and info-sharing methods has been applied. In this work will be shown how the strategy of communication was shifted from physical to digital, methods used for information sharing and communication tools of the modern world has been used for this purposes. Also, functioning of the branch in Niš and its Helper will be shown through statistical comparison of data prior and during the Covid19. Methods: In the defnition phase of Association's response on the new circumstances, it has been concluded that most of the members are using some of IM platform or e-mail. Based on this fact, out of 247 members of branch in Niš, 168 members have been joined through the most popular IM platform in Serbia-Viber. Through the group the patients has been sharing the information, notifcations and other news important for the patients. Group administrators supported discussions, but also identifed patients who did note use IM platforms and those members were notifed by phone or e-mail. This method of communication was symbiotic with other projects of the Association because we used the same communication channels to increase the awareness of members about the activities of the Association. Results: During 2019, Helper's work took place under normal conditions. At the Niska Banja Institute, Helper used the office where patients with rheumatic diseases used to come. Four lectures by eminent experts in the feld of rheumatology and physiatry were organized, as well as socializing in the form of meetings and feld trips. We marked the World Arthritis Day and the World Osteoporosis Day.2 During 2021, most activities took place online or outdoors, depending on the intensity of the Covid-19 wave. Helper's work took place from home in January and February 2021, and from March to the end of 2021, Helper worked in the office. The lectures that were organized were exclusively online. We have marked the World Arthritis Day with a small number of participants. The event was realized with media support. 3 Analysis and participation of members in 2019 and 2021 are shown below: • In 2021, 208 vs 260 live contacts in 2019;on average 17 vs 22 contacts per month In 2021, 216 contacts through online meetings;on average 18 per month. IN 2019 no such exercise. In 2021, 2.000 vs 239 contacts in Viber group in 2019;on average 167 vs 20 members In 2019, alternative communication methods were not used. In 2021, 1,023 contacts were made with messages, calls and emails, or 85 per month. Conclusion: Based on the fact mentioned above, 2019 was richer and more ful-flling with lectures, socializing and direct contacts with members, while in 2021 communication was dominated by digital tools and methods (Viber groups, calls, emails) and consultation with doctors via e-consultations and by phone4. The pandemic disabled direct contact with members of the Association and live lectures, but the Association used digitalization as a complement to new ways of working that connected us more than ever before, enabled instant transmission of information and created a basis for support at times when it was necessary the most. With this process in place, we not only fulflled the goal of the Association, but we went a step further-we became the frst contact for patients with RMD.
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Background: The Covid-19 pandemic has changed many aspects of our lives. Perhaps the biggest changes have been in medical services. Institutes specializing in RMD in Serbia were part of the covid system and patients only had access in emergency cases, there was no regular examinations. Objectives: The paper will show how the 'Online Counselling for Arthritis Patients (OCAP)' worked during the pandemic, how many rheumatologists and patients were involved and were patients satisfed with the service provided. Methods: Through the platform 'Lekarinfo' ORS,1 in cooperation with pharmaceutical companies, organized an OCAP. Patients were informed about the possibility of using online consultations with rheumatologists via social networks, viber groups. email. and they were given instructions how to use it, they were advised to send medical documentation before, so the doctor has time to look at it, which gives more time for conversation. Consultations were held by phone or online, depending of patient's wishes and abilities. The time set aside with a rheumatol-ogist was 20 minutes and with a psychologist 30 minutes. One psychologist and 23 rheumatologists were available. The ORS distributed cards to rheumatogists with all necessary data about OCAP to inform their patients. Results: ORS conducted a Survey about OCAP. It was completed by 100 respondents, aged 20 to 75 of whom 75% were women. The 44% of respondents were from Belgrade, but it also included respondents from all over the country. RA have 61% of respondents, but patients with other types of arthritis were also included. 4/5 of patients are non-smokers and half of them are on biological therapy. All but one respondents are ORS's members. The results of Survey are the following: OCAP was used by 27% of respondents and all of them were satisfed except one. Everyone would use it again and would advise others to do so. Online consultation can replace live examination, when the disease is in remission, thinks 62% of respondents. The majority (90%) found it technically easy to use it, but also the majority of respondents felt that there is a space for improvement (70%). One third prefers to have online consultations with their rheumatologist, Half of them understand the importance of telemedicine, 61% think that C-19 pandemic has increased the need for it and 64% think that digital solutions are our perspectives and it should be further developed. Conclusion: It is desirable to continue with this kind of telemedicine. Patients and their families should be encouraged and educated about using digital platforms, aim is to explain them the benefts of telemedicine and that consultations do not necessarily have to be with their rheumatologists. Regardless of the pandemic, digitalization is in every aspect of our life, it is inevitable, but also it is a great advantage that should not be missed. Investments in the development of online platforms, that will facilitate patients access to doctors are an investment in self-control of chronic diseases in extraordinary circumstances, but also in normal conditions when because of the overscheduled doctors, lack of time for employed patients or other reasons, it is not possible for frequent examinations. Telemedicine is an investment not only in physical health but also in mental health of patients, having a doctor 'just a step from you' has calming and positively affects for patients. And without positive attitude it's hard to keep a chronic disease under control.
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Background: The sudden emergence of SARS-CoV-2 onto the world stage has accelerated a major change in the management of patients with chronic rheumatic diseases and has catalyzed the rapid emergence of telemedicine. Objectives: Our aim was to describe which parameters were used by rheumatol-ogists to monitor patients with rheumatoid arthritis (RA) in teleconsultation during the frst wave of the pandemic and identify the most relevant for decision making. Methods: Retrospective monocentric routine care cross-sectional study including RA patients seen in teleconsultation between March and September 2020. Available parameters assessing disease status were collected in teleconsultation files. Clinician intervention was defned by treatment escalation and/or the need for a rapid face-to-face consultation or day hospitalization. Results: 143 RA patients were included (117 females, mean age of 58±16 years, mean disease duration of 14±11 years). The presence or absence of patient self-reported RA fares was mentioned in all medical files, followed by the presence and/or the number of tender joints (76%), the duration of morning stiffness (66%), the number of pain-related nocturnal awakenings (66%) and the CRP value (54%). Patient self-reported RA fares concerned 43/143 patients (30%). The presence of self-reported RA fares was associated with a more detailed evaluation of patient in teleconsultation: The presence (or number) of tender joints and swollen joints were more signifcantly reported in patients who presented a fare (39/43, 91% vs. 70/100, 70%, p=0.008 and 25/43, 58% vs. 23/100, 23%, p<0.001, respectively). Teleconsultation led to a clinician intervention in 22/143 patients (14%), representing 51% of patients with self-reported fares (22/43 patients). Therapeutic escalation was necessary in 13 patients: introduction or dose increase of cor-ticosteroids in 8 patients, introduction or dose increase of methotrexate in 4 patients and introduction of hydroxychloroquine in 1 patient. Face-to-face consultation or day hospitalization were organized for 10 patients. Active disease was confrmed during this next face-to-face visit in 9 patients, with DAS28 ranging from 3.35 to 5.62, leading to therapeutic modifcation. The 133 other patients were seen in face-to-face consultation 6±2 months after the teleconsultation. No DMARD modifcation was recorded during this next face-to-face consultation. The following variables were associated with clinician intervention during the tel-econsultation in univariate analysis: patient self-reported RA fares since the last visit (p<0.001), CRP >10 mg/mL (p=0.012) and a morning stiffness > 30 minutes (p<0.001). Multivariate analysis confrmed RA fares (Odds Ratio, OR: 15.6 95% CI 3.37-68.28) and CRP values >10 mg/L (OR: 3.32, 95% CI % 1.12-13.27) as the variables independently associated with clinician intervention. Conclusion: Our study identifed patient reported RA fares and increased CRP values as 2 red fags in teleconsultation, independently associated with therapeutic modifcation and/or the need for a rapid face-to-face consultation. These indicators may help clinician's decision making in teleconsultation.
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Background: The EPISER study is the frst Spanish epidemiological study that has confrmed the great burden of rheumatic diseases in the general population: they consume a large quantity of health resources (doctor visits, medical products) and imply a high social impact in terms of work absenteeism. Rheumatic diseases represent almost 30% of Primary Care medical consultations in Spain1,2. Electronic consultation could be an alternative response to the increase of this demand, both to make an early diagnosis and derivation and to improve communication with Primary Care physicians3,4. Objectives: To analyze the demand of Primary Care and its resolution through the electronic consultation system of the Rheumatology Department of a tertiary hospital. Methods: Retrospective descriptive study of the data collected in the request and information system (Sistema de Peticiones Electrónicas, SIPE) that supports electronic consultation between primary care physicians of the health area and the Rheumatology Department of a tertiary hospital, between July 2020 and May 2021.The following variables were collected: age, sex, reason for consultation, response time in days and destination (primary care/outpatient follow-up). Descriptive statistics were used to present the results. Results: The last 500 consecutive electronic consultations registered in the system, referring to 496 patients, were collected. Mean age was 59.5±17.7 years;74.2% women. Mean response time was 2 days, median response time 1 day and range 0-45. The reasons for consultation (see Graph 1) were: osteoporosis assessment 55 (11%), treatment adjustment 50 (10%), appointment request 49 (9.8%), loss to follow-up 43 (8.6%), local-regional pathology assessment 39 (7.8%), infltration request 28 (5, 6%), suspected rheumatoid arthritis 19 (3.8%), fare 18 (3.6%), suspected polymyalgia rheumatica or giant cell arteri-tis 16 (3.2%), COVID vaccine consultation 14 (2.8%), Raynaud's phenomenon 13 (2.6%), monoarthritis assessment 12 (2.4%), assessment of polyarthritis 11 (2.2%), adverse effects of treatment 11 (2.2%), suspected spondyloarthritis 11 (2.2%), suspected psoriatic arthritis 8 (1, 6%), generalized pain 7 (1.4%), suspected Sjögren's syndrome 5 (1%), suspected systemic lupus erythematosus 1 (0.2%), suspected other systemic autoimmune diseases 9 (1.8%), others 81 (16.2%). Fifty-seven and four % (287) of the patients required an appointment at the Rheumatology outpatient clinic and in 42.6% of the patients (213) the electronic consultation was successful, so it was not necessary to refer the patient to the hospital. Conclusion: Forty-two and six percent of the queries were resolved thanks to the electronic consultation system in an average of two days, otherwise that patients would have been referred to specialized care. The main reasons for consultation were osteoporosis assessment and clarifcation of doubts about the treatment of patients who were already being followed up by the Rheumatology Department.
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BACKGROUND: Electronic consultations (eConsults) are formal, asynchronous clinical consultations between primary care providers and specialists. With increasing implementation of inpatient eConsult programs, studies have classified the most frequently consulted departments and reported hospitalist satisfaction, with logistic discussion of inpatient eConsults. However, there are no studies analyzing the time to inpatient eConsult response and the prevalence of COVID-19 in eConsult patients. METHODS: A retrospective chart review of inpatient eConsults at a single U.S. tertiary care medical center from 3/26/20 to 10/8/20. We reviewed patient demographics, COVID-19 status, type of consult question, time to response, conversion rate to a face-to-face visit, and recommendation for outpatient specialty follow-up. RESULTS: There were 538 documented eConsults for 417 patients, with an average age of 52.8 years, 59.0% male, 72.9% white. The most frequently eConsulted departments were Physical Medicine and Rehabilitation (25.7%), Hematology Oncology (13.2%), and Cardiology (7.80%). Inpatient eConsults were predominately regarding patient management questions (87.9%), compared to questions about diagnosis (14.3%) and interpretation of labs or imaging (14.9%). eConsults with multiple question types (15.8%) were more frequent than previously observed in studies of outpatient eConsults. The majority of eConsults were answered and resolved by specialists after one note (61.7%);however, 34.9% of eConsults were followed virtually with multiple notes, and 3.35% were converted to face-to-face consults. Outpatient specialty follow-up was recommended in 12.6% of eConsults. Only 92 (17%) eConsults were linked to orders, enabling measurement of the time the note was signed by the consultant attending physician. The median time from eConsult order until the attending note signature was 14.1 hours. 65.2% of these eConsults had a response within 1 day. 68 study patients (16.3%) were hospitalized with COVID-19, comprising 123 (22.9%) inpatient eConsults. 1.63% of COVID-19 eConsults were converted to face-to-face consultations versus 3.86% of non-COVID-19 eConsults. 72 patients (17.3%) had multiple eConsults, with 39 (9.35%) of these patients having eConsults to multiple different specialties. Of these 39 patients, 21 had COVID-19 during their hospitalization, a higher proportion than the nonCOVID-19 cohort, χ2 (1, N = 417) = 28.083, p < 0.001. CONCLUSIONS: Evaluation of our inpatient eConsult program demonstrates that the majority of eConsults were regarding patient management, with few consults requiring conversion to face-to-face encounters. The findings also reveal an association of multiple specialty eConsults for COVID19 patients. Additionally, inpatient eConsults provide an avenue for reducing consultant exposure to COVID-19. Further efforts can focus on improving the workflow in an effort to optimize consultant response times and assessing the conclusion of outpatient specialty follow-up recommendations.
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STATEMENT OF PROBLEM/QUESTION: With Chronic Kidney Disease (CKD) on the rise, Grady Health System (GHS) implemented a novel Electronic-Consultation (E-Consult) Service for outpatient Nephrology and we sought to determine the characteristics and outcomes of these patients to better recognize the utility in our new approach to kidney care. DESCRIPTION OF PROGRAM/INTERVENTION: The Nephrology EConsult service was launched in September 2020 across all primary care clinics at GHS, which is located in downtown Atlanta, GA, and serves a population of mainly Medicare/Medicaid and uninsured patients. With this service, Primary Care Providers (PCPs) submit an E- Consult and a single Nephrologist reviews the chart to communicate closed-loop recommendations via the patient's Electronic Health Record (EHR). If high-complexity factors are discovered (including nephrotic-range proteinuria, acute kidney injury (AKI), or CKD 4/5), the patient is scheduled for an in-person clinic visit with Nephrology. MEASURES OF SUCCESS: We retrospectively analyzed the charts of 200 randomly-selected E-Consults placed 09/2020-12/2021 to determine disease complexity, A1c and albuminuria screening rates, DM2 control, common comorbidities, renoprotective medication use, as well as the percentage of PCPs who completed the consultation recommendations. We identified the number of in-person Nephrology clinic visits that were prevented with this virtual service and compared waitlist times against a traditional referral to outpatient Nephrology. FINDINGS TO DATE: The majority of patients (55%) have low-complexity kidney disease, and nearly half of all E- Consults are managed entirely virtually, avoiding an in-person visit to Nephrology. Fewer E-Consults have high- complexity disease (45%), most of which involve AKI (60%) and/or CKD4 (35%), warranting an in-person Nephrology evaluation, and with this service an in-person visit occurs in 1/3 the time of traditionally-placed referrals. The most common comorbidities are hypertension (80%) and DM2 (51%), and interestingly, the majority of patients with DM2 have relative control of their disease with an A1c <7% (63%). However, the rate of screening A1c differs from albuminuria: most patients have a recent A1c (70%) while less than half of patients have a recent urine albumin. Very few patients are prescribed an SGLT2-inhibitor (5%) and more than a quarter of eligible patients are not on any renoprotective medications. Nearly a quarter of PCPs do not complete the e-consult recommendations, representing an area where EMR automatization may be useful. KEY LESSONS FOR DISSEMINATION: Our Nephrology E-Consult Service improves access to kidney care for all patients, reduces clinic wait times for those with high-complexity disease, and may play an important role during the Covid-19 pandemic by reducing healthcare-associated exposures. By providing a closed-loop method of communication between PCP and Nephrologist, guideline-based recommendations for routine screening and renoprotective strategies can be exchanged for the patient's benefit.
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Since late 2021, we have observed a significant increase in the proportion of children infected with SARS-CoV-2. The course of the disease in children is usually sparsely symptomatic or asymptomatic. However, the predominance of new virus variants makes children more likely to become symptomatically ill and require hospitalisation. This paper aims to update recommendations for managing a child with COVID-19 in out- and inpatient settings. Current options for prevention and antiviral treatment are discussed, noting the limited availability of therapy for children. In most children with COVID-19, the basis for treatment remains symptomatic and supportive therapy and measures to reduce SARS-CoV-2 infection spread.
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Introduction: The COVID-19 pandemic placed a strained NHS under further pressure, resulting in a significant backlog of work. Fundamental change is needed to improve efficiency and allow service re-establishment with a capability to deal with this backlog. Outpatient service structure will be pivotal to the recovery. Within this, intelligent triage plays a key role. Our department has 5 triaging consultants for benign disease GP referrals, interdepartmental referrals, and electronic consultations with 4 departmental Programmed Activities weekly. Patients and Methods: Data from the NHS e-referral system (e-RS) for the 12 months commencing December 2020 was accessed. Data from our E-consultation services was obtained for the same period. Data comprised total referrals, referrals accepted, and referrals managed with advice and guidance without consultation (AAG). E-consultation services were analysed for total volume, and the resulting outpatient consultations. AAG was streamlined using a library of standard guidance for common conditions. Results: From 3380 e-RS referrals, 23.7% were managed with AAG. Some inter-consultant triage variability was observed but appeared unrelated to individual consultant years of experience. Similarly, with E-consultation there was some variability between clinicians in conversion rates to outpatient consultations. Conclusions: Using senior clinicians in intelligent triage ensures appropriate use of outpatient consultations, with 23.7% of e-RS referrals managed with AAG. Whilst argument may be made for administrative staff fulfilling the triage role, we feel algorithmic triaging is suboptimal for patient safety. Appropriate AAG, red flag identification, appropriate timescales for outpatient review, and accurate direction to subspecialty clinics are all enhanced by consultant involvement.
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Purpose: The demand for pediatric gender-affirming care has increased throughout the COVID-19 pandemic, highlighting the need for telehealth-based specialist-to-primary care provider (PCP) consultative support. Accordingly, the purpose of this study was to identify PCPs’ perspectives on receiving training and consultation in pediatric gender-affirming care using three telehealth modalities, with the larger goal of informing the development of future consultative support offerings. Methods: PCPs who had previously reached out to the Seattle Children’s Gender Clinic for a gender care consultation were invited to participate in a semi-structured, one-hour Zoom interview. During the interview, three different telehealth modalities (tele-education, electronic consultation, telephonic consultation) were described and participants were asked to share their perspectives on 1) the benefits and drawbacks of each modality, 2) which modality would be most effective in supporting them in providing gender-affirming care in the primary care setting, and 3) factors that would make a consultation platform successful. Interviews were transcribed and analyzed using an inductive thematic analysis framework by two authors using Dedoose qualitative analysis software. All participants provided informed consent and all study procedures were approved by the Seattle Children’s Institutional Review Board. Results: Interviews were completed with 15 PCPs. For the tele-education platform, PCPs most often identified continuing medical education (67%) and the community or network it creates (47%) as benefits and the commitment required (73%) and scheduling difficulties (40%) as drawbacks. For the electronic consultation model, timeliness of response (67%) and convenience (53%) were cited as benefits and electronic medical record system requirements (60%) and difficulty conveying the message electronically (53%) were considered the main drawbacks. For the telephonic consultation, PCPs identified the ability to have a conversation (80%) and the timeliness of response (60%) as the main benefits and phone-tag (87%) and finding time to make the initial call (40%) as the main drawbacks. Regarding the most effective platform, responses were mixed: 27% endorsed the electronic consultation, 27% the tele-education platform, and 20% the telephonic consultation, with the remaining 27% suggesting a hybrid of the three models. Finally, responses regarding what would make a platform successful were much more varied across participants, with the most common responses including being non-judgmental and supportive (33%) and flexible with the ability to pivot to other platforms as needed (27%). Conclusions: With the increasing demand to provide gender-affirming care in the primary care setting, further training and support is necessary for pediatric PCPs to deliver this time-sensitive care. The results of this study indicate the need for a more flexible suite of gender-focused specialist-to-PCP telehealth-based consultative services to facilitate the provision of pediatric gender-affirming care. Sources of Support: This project was supported by the Seattle Children's Research Institute and AHRQ (K12HS026393-03;PI: Sequeira) and a grant from Pivotal Ventures.
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PURPOSE: COVID-19 has increased the need for innovative virtual care solutions. Electronic consultation (eConsult) services allow primary care practitioners to pose clinical questions to specialists using a secure remote application. We examined eConsult cases submitted to a COVID-19 specialist group in order to assess usage patterns, impact on response times and referrals, and the content of clinical questions being asked. METHODS: This was a mixed-methods analysis of eConsult cases submitted between March and September 2020 in Ontario, Canada to 2 services. We performed a descriptive analysis of the average response time and the total time spent by the specialist for eConsults. Primary care practitioners completed a post-eConsult questionnaire that asked about the outcome of the eConsult. We performed an inductive and deductive content analysis of a subset of cases to identify common themes among the clinical questions asked. RESULTS: A total of 208 primary care practitioners submitted 289 eConsult cases. The median specialist response time was 0.6 days (range = 3 minutes to 15 days); the average time spent by specialists per case was 16 minutes (range = 5 to 59 minutes). In 69 cases (24%), the eConsult enabled avoidance of a face-to-face referral. Content analysis of 51 cases identified 5 major themes: precautions for high-risk and special populations, diagnostic clarification and/or need for COVID-19 testing, guidance on self-isolation and return to work, guidance on personal protective equipment, and management of chronic symptoms. CONCLUSIONS: This study demonstrates the considerable potential of eConsults during a pandemic as our service was quickly implemented across Ontario and resulted in primary care practitioners' rapid and low-barrier access to specialist input.
Subject(s)
COVID-19 , Remote Consultation , COVID-19/epidemiology , COVID-19 Testing , Health Services Accessibility , Humans , Ontario , Primary Health Care , Referral and ConsultationABSTRACT
BACKGROUND: Electronic consultations (eConsults) are an increasingly used form of telemedicine that allows a nonspecialist clinician to seek specialist advice remotely without direct patient-specialist communication. Surgical clinics may see benefits from such forms of communication but face challenges with the need for intervention planning. OBJECTIVE: We aimed to use the Quadruple Aim Framework to integrate published knowledge of surgical outpatient eConsults with regard to efficacy, safety, limitations, and evolving use in the era of COVID-19. METHODS: We systematically searched for relevant studies across four databases (Ovid MEDLINE, Embase, Scopus, and Web of Science) on November 4, 2021, with the following inclusion criteria: English language, published in the past 10 years, and data on the outcomes of outpatient surgical eConsults. RESULTS: A total of 363 studies were screened for eligibility, of which 33 (9.1%) were included. Most of the included studies were from the United States (23/33, 70%) and Canada (7/33, 21%), with a predominant multidisciplinary focus (9/33, 27%). Most were retrospective audits (16/33, 48%), with 15% (5/33) of the studies having a prospective component. CONCLUSIONS: The surgical eConsult studies indicated a possible benefit for population health, promising safety results, enhanced patient and clinician experience, and cost savings compared with the traditional face-to-face surgical referral pathway. Their use appeared to be more favorable in some surgical subspecialties, and the overall efficacy was similar to that of medical subspecialties. Limited data on their long-term safety and use during the COVID-19 pandemic were identified, and this should be the focus of future research.
ABSTRACT
The looming dark cloud of the COVID-19 pandemic refuses to leave us alone even after more than a year. Though healthcare workers have given their best and worked round the clock to combat this deadly virus, large scale and immediate relief is hardly anywhere in sight. This zoonotic virus has unleashed untold misery upon people globally especially on the ageing population with comorbidities. Patients suffering from various forms of cancer had to bear the brunt compounded in manners unforeseen. They were faced with a double-edged challenge to their very existence. Taking timely anticancer therapies and observing the required treatment frequency is one of the major challenges for patients battling cancer. This study attempts to evaluate the impact of COVID-19 on patients with cancer. A noteworthy finding was about telemedicine emerging as a boon for cancer patients in the COVID-19 pandemic times. However, there are several obstacles to overcome, such as accurate prescription interpretation, literacy, and connectivity, to name a few.
ABSTRACT
Background: This study aimed to determine how the psychological complaints of geriatric patients with mental disorders were affected by the COVID-19 pandemic and how they continued their treatment during this period. In addition, this work sought to determine the social support resources of these patients and their expectations regarding online consultations. Methods: Telephone interviews were carried out with 776 patients over the age of 65 who had a mental disorder. A sociodemographic data form, the Patient Health Questionnaire-9, the General Anxiety Disorder-7 were employed to evaluate their psychological complaints. Results: A total of 733 patients (94.5%) were unable to go to outpatient visits, although 607 (78.2%) patients used their medications regularly. The most important factor contributing to continue drug treatment was the extension of drug reports by the government. There was an increase in psychiatric complaints in 318 (41.0%) patients. Anxiety (23.7%), insomnia (17.0%), and depression (13.3%) were the most common complaints. 72.7% of the patients wanted to have an online consultation with their psychiatrist. Predictors for depression were increased age and female gender. Predictors for anxiety were disease duration of five years or more and irregular medication intake during the pandemic. Conclusion: The high-risk groups in terms of increasing psychiatric complaints must be identified for psychosocial interventions. During the COVID-19 pandemic, government policies on the health system played an important role in ensuring continued treatment for geriatric psychiatric patients. It is also important to be able to conduct online psychiatric consultations during extraordinary situations.