Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 8.057
Filter
Add filters

Year range
1.
Pharmacia ; JOUR(3):891-901, 69.
Article in English | Web of Science | ID: covidwho-2099954

ABSTRACT

Lack of access to the patient medical record (90.6%) was the major barrier for the integration of pharmaceutical care into practice. The majority of participants (93.0%) encouraged creating a website that provides pharmaceutical care. Furthermore, 45.1% would pay for such a service if present. Moreover, the majority (89.8%) agreed that creating a comprehensive database for patients' data will help in decreasing medical errors. Among the four aspects of pharmaceutical care (technical, psychosocial, communication and administrative) that were assessed for students and pharmacist's, general weakness in all aspects was noticed. This study highlights that absence of proper documentation of patient medical information raises the risk of medical problems and is considered the most documented barrier for the integration of pharmaceutical care. This emphasizes the future role of telemedicine and the availability of a specialized website and database repository that stores patient's information to ensure the continuity of care even during pandemics.

2.
Acta Odontol Latinoam ; 35(2): 144-154, 2022 Sep 30.
Article in English | MEDLINE | ID: covidwho-2101108

ABSTRACT

The aim of this study was to analyze oral health actions in four municipalities in Brazil during the COVID-19 pandemic according to a theoretical framework model on oral healthcare management. It was a qualitative study carried out in two stages. A theoretical-empirical model on the significance of oral healthcare management was developed, following the Grounded Theory method. Fourteen dentists and five healthcare managers participated, through open interview. Subsequently, collaborative research was performed, and the model was applied to analyze the documents produced to address the pandemic by each of four municipalities in Santa Catarina State. The model provided a framework for analyzing actions for coping with the pandemic regarding oral health services. Actions were identified in all dimensions of the model: reduction in supply of dental care due to restricted access to elective services; search for biosafety care standards; dissemination of standardized science-based guidelines; attempt to maintain comprehensive dental assistance through re-adaptation of specialized services and collective actions; and relocation of oral health professionals to assist in other sectors. The oral health care management framework can serve as a reference for redesigning oral health actions and services in other municipalities during the COVID-19 pandemic, in a broader perspective.


Analisar as ações de saúde bucal em quatro municípios brasileiros durante a pandemia de COVID-19, segundo um modelo de referencial teórico sobre gestão da atenção à saúde bucal. Estudo qualitativo realizado em dois momentos. Foi desenvolvido um modelo teórico-empírico sobre o significado da gestão do cuidado em saúde bucal, seguindo o método da Teoria Fundamentada nos Dados. Participaram 14 dentistas e cinco gestores de saúde, por meio de entrevista aberta. Posteriormente, no segundo momento, foi realizada uma pesquisa colaborativa, e o modelo foi aplicado para analisar os documentos produzidos em cada município para o enfrentamento local da pandemia, em quatro municípios do Estado de Santa Catarina, sul do Brasil. O modelo forneceu uma estrutura para analisar as ações de enfrentamento da pandemia nos serviços de saúde bucal. Foram identificadas ações em todas as dimensões do modelo: redução da oferta de atendimento odontológico devido à restrição de acesso aos serviços eletivos; a busca por padrões de assistência à biossegurança; disseminação de diretrizes padronizadas e com base científica; a tentativa de manter a assistência odontológica integral por meio da readaptação de serviços especializados e ações coletivas; e realocação de profissionais de saúde bucal para atendimento em outros setores. O referencial de gestão da atenção à saúde bucal pode servir de referência para redesenhar as ações e serviços de saúde bucal em outros municípios em período de pandemia de COVID-19, em uma perspectiva mais ampla.


Subject(s)
COVID-19 , Pandemics , United States , Humans , Brazil/epidemiology , Pandemics/prevention & control , Cities , Grounded Theory , COVID-19/prevention & control
3.
Ann Glob Health ; 88(1): 96, 2022.
Article in English | MEDLINE | ID: covidwho-2100230

ABSTRACT

Background: Education and capacity building in palliative care are greatly needed in Nigeria. Currently, two institutions integrate palliative care into the undergraduate medical curriculum and no post graduate training exists. A team from the University of Lagos in Nigeria and Northwestern University in the US collaborated to design, implement, and evaluate a 12-hour virtual palliative care training program for Nigerian health professionals. Objective: This study investigated the impact of the first session of the training program on healthcare professionals' knowledge, skills, attitudes, and confidence in palliative care. Methods: The Education in Palliative and End-of-Life (EPEC) curriculum and the Kenya Hospices and Palliative Care Association (KEHPCA) curriculum were used as foundations for the program and adapted for the Nigerian context. Delivered online, the training focused on goals of palliative care, whole patient assessment, communication skills, pain management, psychosocial issues, palliative care in COVID, oncology, and HIV. A mixed-methods evaluation based on Kirkpatrick's evaluation framework was used and data were gathered from surveys and focus groups. Findings: Thirty-five health professionals completed the training. The training had a positive impact on knowledge, skills, and attitudes. Confidence in providing end-of-life care increased from 27.3% to 92.9% while confidence in prescribing medication to relieve symptoms at the end of life increased from 42.9% to 92.0%. Performance on multiple-choice knowledge tests increased by 10% (p < 0.01). All participants stated that they would recommend the program to a peer while 96.4% reported the program was relevant to the Nigerian context. Qualitative analysis suggested that the training would help participants provide more holistic care for patients, communicate better, and change how they interacted with families. Topics to be addressed in future training were identified. Conclusions: This virtual training can be an important element in palliative care capacity building in Nigeria and represents a model for global health collaboration.


Subject(s)
COVID-19 , Education, Distance , Humans , Palliative Care , Nigeria , Curriculum , Workforce
4.
BJGP Open ; 6(2)2022 Jun.
Article in English | MEDLINE | ID: covidwho-2099925

ABSTRACT

BACKGROUND: The impact of the COVID-19 pandemic on patients' and clinicians' perceptions of healthcare-seeking behaviour and delivery of care is unclear. The pandemic accelerated the use of remote care, and understanding its benefits and drawbacks may inform its implementation during current and future healthcare emergencies. AIM: To explore patients' and primary care professionals' (PCPs) experiences of primary care delivery in the first wave of the pandemic. DESIGN & SETTING: Qualitative study using semi-structured interviews in primary care in eight European countries (England, Ireland, Belgium, the Netherlands, Greece, Poland, Sweden, and Germany). METHOD: A total of 146 interviews were conducted with 80 PCPs and 66 patients consulting for respiratory tract infection (RTI) symptoms, in eight European countries. Data were collected between April and July 2020, and analysed using thematic analysis. RESULTS: It was found that patients accepted telemedicine when PCPs spent time to understand and address their concerns, but a minority preferred in-person consultations. PCPs felt that remote consultations created emotional distance between themselves and patients, and they reported having to manage diverse COVID-19-related medical and social concerns. CONCLUSION: Remote consultations for RTI symptoms may be acceptable long term if both groups are happy to use this format, but it is important that PCPs take time to address patients' concerns and provide safety-netting advice.

5.
BMC Pulm Med ; 22(1): 156, 2022 Apr 24.
Article in English | MEDLINE | ID: covidwho-1798412

ABSTRACT

BACKGROUND: China launched its new round of health care reform to develop primary care in 2009, establishing 954,390 primary care institutions that employed over 10 million staff by 2019. However, some studies have shown that the prevention and management of respiratory diseases is inadequate in these institutions. METHODS: We conducted a cross-sectional survey of grassroots institutions throughout China between September and December 2020 based on the standardized Prevention and Treatment System and Capacity Building Project of Respiratory Diseases in primary care settings. The operation of the respiratory department in primary health care institutions was evaluated in terms of facilities, drugs, personnel and management of chronic diseases by means of questionnaires. Descriptive analyses were performed to calculate percentages and frequencies of key parameters. RESULTS: A total of 144 primary health care institutions were surveyed, including 51 in the east, 82 in the west, 9 in the central and 2 in the northeast. Approximately 60% of institutions had spirometers and pulse oximeters. The majority had short-acting bronchodilators, theophylline, systemic corticosteroids, antibiotics, and traditional Chinese medicine. More than half had at least one respiratory physician and operator for spirometry. Half of the institutions carried out screening of chronic obstructive pulmonary disease within the jurisdiction. The institutions in the east were superior to those in the west regarding the equipment, common drugs, medical staff, and management of respiratory diseases. CONCLUSIONS: The study reveals that the overall operation of the respiratory department in primary care settings needs to be further strengthened. It is crucial to provide adequate essential equipment, medical professionals, and medicines for proper diagnosis and treatment of chronic respiratory diseases, as well as improving the management of diseases.


Subject(s)
Respiration Disorders , China/epidemiology , Chronic Disease , Cross-Sectional Studies , Humans , Primary Health Care , Respiration Disorders/prevention & control
6.
Stud Health Technol Inform ; 299: 279-282, 2022 Nov 03.
Article in English | MEDLINE | ID: covidwho-2099075

ABSTRACT

The effectiveness of the health care system is largely dependent on the knowledge, skills, and motivation of health care workers, which was particularly evident during the COVID-19 pandemic. The systemic planning of human resources is therefore an important condition for ensuring the sustainability and efficiency of the health care system. This article focuses on outlining a basic model of human resource planning in health care and the investigation of related complexities. An in-depth analysis framework based on various materials and evidence is proposed in order to outline the factors that influence human resource planning in health care. In order to achieve greater credibility of the research results, the in-depth analytical process employs an extensive review of the literature and carries out an investigation of numerous sources and materials, in both the national and international contexts. The purpose of the human resource planning initiatives in health care is to calculate the needed number of health care workers in the future, on the basis of past and current data, and based on assumptions about future trends in supply and demand. The research findings reveal that this is a very challenging task, as there are typically many unknowns in future planning, and, in addition, planners often face a lack of reliable data and systemic deficiencies. Moreover, the study indicates that unplanned and delayed solutions concerning the human resource needs in health care can only alleviate problems, but in no way can they replace effective strategic measures and timely structural changes within the health care ecosystem.


Subject(s)
COVID-19 , Pandemics , Humans , Ecosystem , COVID-19/epidemiology , Delivery of Health Care , Workforce
7.
JMIR Res Protoc ; 11(11): e36174, 2022 Nov 16.
Article in English | MEDLINE | ID: covidwho-2098985

ABSTRACT

BACKGROUND: Globally, COVID-19-related psychological distress is seriously eroding health care workers' mental health and well-being, especially in low-income countries like Nigeria. The use of mobile health (mHealth) interventions is now increasingly recognized as an innovative approach that may improve mental health and well-being. This project aims to develop an mHealth psychological intervention (mPsyI) to reduce COVID-19-related psychological distress among health care workers in Nigeria. OBJECTIVE: Our objective is to present a study protocol to determine the level of COVID-19-related psychological distress among health care workers in Nigeria; explore health care workers' experience of COVID-19-related psychological distress; develop and pilot test mPsyI to reduce this distress; and assess the feasibility of this intervention (such as usability, engagement, and satisfaction). METHODS: A mixed (quantitative and qualitative) methods approach is used in which health care workers will be recruited from 2 tertiary health care facilities in southwest Nigeria. The study is divided into 4 phases based on the study objectives. Phase 1 involves a quantitative survey to assess the type and levels of psychosocial distress. Phase 2 collects qualitative data on psychosocial distress among health care workers. Phase 3 involves development of the mHealth-based psychological intervention, and phase 4 is a mixed methods study to assess the feasibility and acceptability of the intervention. RESULTS: This study was funded in November 2020 by the Global Effort on COVID-19 Health Research, and collection of preliminary baseline data started in July 2021. CONCLUSIONS: This is the first study to report the development of an mHealth-based intervention to reduce COVID-19-related psychological distress among health care workers in Nigeria. Using a mixed methods design in this study can potentially facilitate the adaptation of an evidence-based treatment method that is culturally sensitive and cost-effective for the management of COVID-19-related psychological distress among health care workers in Nigeria. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/36174.

8.
Health Promot Pract ; : 15248399221129536, 2022 Oct 28.
Article in English | MEDLINE | ID: covidwho-2098255

ABSTRACT

Recent nationwide racial justice uprisings following ongoing police violence against Black communities juxtaposed with the COVID-19 pandemic have increased the urgency for a reckoning around the ineffectiveness and harm caused by the carceral apparatus. It is well documented that the correctional system was founded upon and continues the legacy of slavery and white supremacy. Research has shown that incarceration directly contributes to many negative health outcomes, including increased risk and spread of hepatitis C virus (HCV) infections, especially among people who inject drugs. This high burden of HCV disproportionately impacts low-income communities of color, who not only report higher rates of substance use due to pervasive discrimination but are also over-incarcerated as a result of structural racism and the War on Drugs. The COVID-19 pandemic further underscores that correctional facilities are fundamentally structured to promote health inequities. Minoritized communities who are overrepresented in corrections continue to be put at increased risk of COVID-19 in overcrowded facilities, are isolated from social support and medical care, and have been ignored in vaccination strategies. In this perspective, we argue that HCV interventions within the carceral apparatus will remain largely ineffective due to the negative health impacts of incarceration. Instead, we propose adopting abolitionist principles for HCV elimination-divesting from the carceral apparatus to prioritize community-based efforts on promoting HCV screening, treatment, and prevention. In doing so, the nation will have not only the capacity to meaningfully eliminate HCV but also the potential to improve overall societal outcomes.

9.
Community Dent Oral Epidemiol ; 2022 Nov 03.
Article in English | MEDLINE | ID: covidwho-2097715

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has tremendously impacted the U.S. healthcare system, but no study has examined the impact of the pandemic on utilization of dental care among U.S. children. Changes in past-year dental versus medical visits and perceived unmet health needs between 2019 and 2020 among U.S. children aged 1-17 years were examined. METHODS: National and state representative, cross-sectional data from the National Survey of Children's Health conducted during June 2019-January 2020 (i.e. pre-pandemic, n = 28 500) and July 2020-January 2021 (i.e. intra-pandemic, n = 41 380) were analysed. Any past-year visit and perceived unmet needs (i.e. delay or inability to receive needed care) were reported by the parent proxy. Weighted prevalence estimates were compared using two-tailed chi-squared tests at p < .05. Poisson regression analyses were used to explore the relationship between having dental and/or medical unmet needs during the pandemic and indicators of poor health and social wellbeing. RESULTS: Between 2019 and 2020, a significantly reduced prevalence of past-year medical (87.2%-81.3%) and dental visits (82.6%-78.2%) among U.S. children aged 1-17 years (all p < .05) were observed. Correspondingly, perceived unmet needs increased by half for dental care (from 2.9% in 2019 to 4.4% in 2020) and almost one-third for medical care (from 3.2% to 4.2% in 2020). Subgroups with the highest prevalence of unmet dental need included those with low socio-economic status, living with their grandparents, uninsured and living with a smoker. CONCLUSIONS: Unmet health needs increased in general but increased more for dental than for medical care among U.S. children aged 1-17 years. Enhanced and sustained efforts will be needed to deliver targeted services towards disadvantaged segments of the population to narrow existing disparities.

10.
J Law Med Ethics ; 49(1): 89-91, 2021.
Article in English | MEDLINE | ID: covidwho-2096544
11.
Journal of Affective Disorders ; JOUR:517-524, 320.
Article in English | Web of Science | ID: covidwho-2095548

ABSTRACT

Background: The first goal of this study was to assess longitudinal changes in burnout among psychotherapists prior to (T1) and during the COVID-19 pandemic (T2). The second objective was to assess the effects of job demands, job resources (including organizational support for evidence-based psychotherapies, or EBPs) and pandemic-related stress (T2 only) on burnout.Method: Psychotherapists providing EBPs for posttraumatic stress disorder in U.S. Department of Veterans Affairs (VA) facilities completed surveys assessing burnout, job resources, and job demands prior to (T1;n = 346) and during (T2;n = 193) the COVID-19 pandemic.Results: Burnout prevalence increased from 40 % at T1 to 56 % at T2 (p < .001). At T1, stronger implementation climate and implementation leadership (p < .001) and provision of only cognitive processing therapy (rather than use of prolonged exposure therapy or both treatments;p < .05) reduced burnout risk. Risk factors for burnout at T2 included T1 burnout, pandemic-related stress, less control over when and how to deliver EBPs, being female, and being a psychologist rather than social worker (p < .02). Implementation leadership did not reduce risk of burnout at T2. Limitations: This study involved staff not directly involved in treating COVID-19, in a healthcare system poised to transition to telehealth delivery. Conclusion: Organizational support for using EBPs reduced burnout risk prior to but not during the pandemic. Pandemic related stress rather than increased work demands contributed to elevated burnout during the pandemic. A comprehensive approach to reducing burnout must address the effects of both work demands and personal stressors.

12.
Popul Health Manag ; 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2097274

ABSTRACT

Oral antivirals for COVID-19 can be game changers in low- and middle-income countries (LMICs). Challenges that may hinder current and future oral antiviral rollouts span use in special populations, drug-drug and herb-drug interactions, adverse events, development of resistance, black markets, and equity in access and prescribing. Future antivirals may address some of these barriers; however, health systems around the world should be equipped to receive and administer COVID-19 oral antivirals. Improvements in manufacturing capacity, community engagement, capacity for testing and linkage to care, and systems for surveillance and safety monitoring could "change the game" for LMICs, irrespective of any specific antiviral drug. Investments in health care infrastructure can promote resilience, not only for COVID-19 but also for future local and global health crises.

13.
J Palliat Med ; 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2097263

ABSTRACT

Objectives: To evaluate the implementation of a triage protocol for palliative care (PC) during the COVID-19 pandemic (PALI-COVID) at a referral center in Brazil. Methods: A retrospective observational study was conducted. Based on the triage protocol, patients were classified into a red group, a yellow group, and a green group (GG). Patients should receive PC as recommended for each group. Results: A total of 1517 patients were included in the analysis. About 11% (n = 162) of patients received PC. About 35% (n = 529) of all patients died. There was a significant difference in the mortality rate between the groups; the GG had the highest mortality rate. Most patients who died (77.1%) did not receive PC. Conclusion: PALI-COVID was effective in identifying patients who had a higher risk of death and needed end-of-life support. Despite the protocol, few patients received PC.

15.
Pain Physician ; 25(6): 427-439, 2022 09.
Article in English | MEDLINE | ID: covidwho-2092757

ABSTRACT

BACKGROUND: COVID-19 quarantine measures have created new challenges in the delivery of medical care, especially in the realm of medical and interventional chronic pain management. This study evaluated the effect of COVID-19 social distancing and quarantine measures on symptoms of pain and anxiety, as well as substance abuse and health care engagement in patients with chronic pain and the role of the clinic's virtual assessment initiatives in managing these patients. METHODS: A 24-question cross-sectional survey was conducted with patients with chronic pain seen at the Montefiore Medical Center Comprehensive Pain Clinic from June 2020 through July 2020. The survey was administered to 552 high-utilizer patients via telephone, evaluating domains such as pain, anxiety, substance use, and health care engagement. The questions were quantitively assessed on a Likert scale or a numerical rating scale. We used descriptive statistics to report our results. RESULTS: Of the 1,023 patients identified as high utilizers of the pain clinic, 552 patients participated in the survey. The median (25th-75th percentile) pain score reported was 7 (5-9) for all responders. Approximately 50% of the patients reported that they were anxious about their pain and somewhat or very concerned that their pain would be uncontrolled during the pandemic. Further, the severity of the pain reported was associated with sleep, appetite, and mood changes. In our cohort, 95% of all patients denied using alcohol, 92% denied using marijuana, and 98% denied using other recreational drugs to manage their pain during the pandemic. In addition, just more than three-fourths (79%) of all patients reported needing to speak with their health care provider during the pandemic. CONCLUSIONS: The survey conducted among high-utilizers demonstrated that patients who remained engaged with their health care team reported minimal concerns regarding chronic pain and associated symptoms during the COVID-19 quarantine period. In addition, the early implementation of virtual consults in the pain clinic may have contributed to mitigating patient concerns. Finally, the study also identified the importance of outreach and patient education on the availability and utilization of telemedicine services. Consequently, it is reasonable to implement virtual assessments and visits alongside other education outreach methods to engage patients with chronic pain who frequently utilize chronic pain health care resources.


Subject(s)
COVID-19 , Chronic Pain , Illicit Drugs , Telemedicine , Chronic Pain/therapy , Cross-Sectional Studies , Humans , Pandemics
16.
Peace building through women's health: Psychoanalytic, sociopsychological, and community perspectives on the Israeli-Palestinian conflict ; CHAP: 221-232,
Article in English | APA PsycInfo | ID: covidwho-2090640

ABSTRACT

The past few years have seen a dramatic worldwide rise in limits on, attacks on, and even killings of health care workers trying to provide health care to injured individuals engaged in conflict. In addition, and most tragically, health care workers are increasingly targeted for even providing preventive services such as vaccinations or, in the case of the COVID-19 pandemic, just because they are health care professionals. This chapter, focusing on one conflict, the Israeli-Palestinian conflict, will review limits placed and attacks on Palestinian health professionals that have occurred since 2000 from two different perspectives. The literature we reference includes third-sector reports, both local and international, United Nations perspectives, and Israeli and Palestinian governmental responses to these limits and attacks on Palestinian health care professionals. In this chapter we detail Israeli limits, including attacks on health care professionals, which, following the Geneva Conventions, should not be occurring. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

17.
BJGP Open ; 2022 Oct 21.
Article in English | MEDLINE | ID: covidwho-2090414

ABSTRACT

BACKGROUND: Changes in primary care provision during the COVID-19 pandemic could have affected patient experience of primary care both positive and negative. AIM: To assess the experiences of patients of primary care during the COVID-19 pandemic. DESIGN & SETTING: A qualitative study of patients from regions with high and low COVID-19 prevalence in the Netherlands. METHOD: A qualitative study using a phenomenological framework was performed among purposively sampled patients. Individual semi-structured interviews were performed and transcribed. Data were thematically analysed by means of an inductive approach. RESULTS: We interviewed 28 patients (13 men and 15 women, age range 27-91 years). After thematic analysis, two main themes emerged: accessibility and continuity of primary care. Changes considered positive during the pandemic regarding accessibility and continuity of primary care included having a quieter practice, having more time for consultations, and the use of remote care for problems with low complexity. However, patients also experienced decreases in both care accessibility and continuity, such as feeling unwelcome, the GP postponing chronic care, or seeing unfamiliar doctors due to care being segregated. CONCLUSIONS: Despite bringing several benefits, patients indicated that the changes to primary care provision during the COVID-19 pandemic could have threatened care accessibility and continuity, which are core values of primary care. These insights can guide primary care provision not only in this and future pandemics but also when implementing permanent changes to care provision in primary care.

18.
J Med Internet Res ; 24(11): e42431, 2022 Nov 10.
Article in English | MEDLINE | ID: covidwho-2089647

ABSTRACT

BACKGROUND: Until COVID-19, implementation and uptake of video consultations in health care was slow. However, the pandemic created a "burning platform" for scaling up such services. As health care organizations look to expand and maintain the use of video in the "new normal," it is important to understand infrastructural influences and changes that emerged during the pandemic and that may influence sustainability going forward. OBJECTIVE: This study aims to draw lessons from 4 National Health Service (NHS) organizations on how information infrastructures shaped, and were shaped by, the rapid scale-up of video consultations during COVID-19. METHODS: A mixed methods case study of 4 NHS trusts in England was conducted before and during the pandemic. Data comprised 90 interviews with 49 participants (eg, clinicians, managers, administrators, and IT support), ethnographic field notes, and video consultation activity data. We sought examples of infrastructural features and challenges related to the rapid scale-up of video. Analysis was guided by Gkeredakis et al's 3 perspectives on crisis and digital change: as opportunity (for accelerated innovation and removal of barriers to experimentation), disruption (to organizational practices, generating new dependencies and risks), and exposure (of vulnerabilities in both people and infrastructure). RESULTS: Before COVID-19, there was a strong policy push for video consultations as a way of delivering health care efficiently. However, the spread of video was slow, and adopting clinicians described their use as ad hoc rather than business as usual. When the pandemic hit, video was rapidly scaled up. The most rapid increase in use was during the first month of the pandemic (March-April 2020), from an average of 8 video consultations per week to 171 per week at each site. Uptake continued to increase during the pandemic, averaging approximately 800 video consultations per week by March 2021. From an opportunity perspective, participants talked about changes to institutional elements of infrastructure, which had historically restricted the introduction and use of video. This was supported by an "organizing vision" for video, bringing legitimacy and support. Perspectives on disruption centered on changes to social, technical, and material work environments and the emergence of new patterns of action. Retaining positive elements of such change required a judicious balance between managerial (top-down) and emergent (bottom-up) approaches. Perspectives on exposure foregrounded social and technical impediments to video consulting. This highlighted the need to attend to the materiality and dependability of the installed base, as well as the social and cultural context of use. CONCLUSIONS: For sustained adoption at scale, health care organizations need to enable incremental systemic change and flexibility through agile governance and knowledge transfer pathways, support process multiplicity within virtual clinic workflows, attend to the materiality and dependability of the IT infrastructure within and beyond organizational boundaries, and maintain an overall narrative within which the continued use of video can be framed.


Subject(s)
COVID-19 , Telemedicine , Humans , State Medicine , Pandemics , Videoconferencing , Telemedicine/methods
19.
J Med Internet Res ; 24(10): e37436, 2022 10 24.
Article in English | MEDLINE | ID: covidwho-2089629

ABSTRACT

BACKGROUND: Online consultations (OCs) allow patients to contact their care providers on the web. Worldwide, OCs have been rolled out in primary care rapidly owing to policy initiatives and COVID-19. There is a lack of evidence regarding how OC design and implementation influence care quality. OBJECTIVE: We aimed to synthesize research on the impacts of OCs on primary care quality, and how these are influenced by system design and implementation. METHODS: We searched databases from January 2010 to February 2022. We included quantitative and qualitative studies of real-world OC use in primary care. Quantitative data were transformed into qualitative themes. We used thematic synthesis informed by the Institute of Medicine domains of health care quality, and framework analysis informed by the nonadoption, abandonment, scale-up, spread, and sustainability framework. Strength of evidence was judged using the GRADE-CERQual approach. RESULTS: We synthesized 63 studies from 9 countries covering 31 OC systems, 14 (22%) of which used artificial intelligence; 41% (26/63) of studies were published from 2020 onward, and 17% (11/63) were published after the COVID-19 pandemic. There was no quantitative evidence for negative impacts of OCs on patient safety, and qualitative studies suggested varied perceptions of their safety. Some participants believed OCs improved safety, particularly when patients could describe their queries using free text. Staff workload decreased when sufficient resources were allocated to implement OCs and patients used them for simple problems or could describe their queries using free text. Staff workload increased when OCs were not integrated with other software or organizational workflows and patients used them for complex queries. OC systems that required patients to describe their queries using multiple-choice questionnaires increased workload for patients and staff. Health costs decreased when patients used OCs for simple queries and increased when patients used them for complex queries. Patients using OCs were more likely to be female, younger, and native speakers, with higher socioeconomic status. OCs increased primary care access for patients with mental health conditions, verbal communication difficulties, and barriers to attending in-person appointments. Access also increased by providing a timely response to patients' queries. Patient satisfaction increased when using OCs owing to better primary care access, although it decreased when using multiple-choice questionnaire formats. CONCLUSIONS: This is the first theoretically informed synthesis of research on OCs in primary care and includes studies conducted during the COVID-19 pandemic. It contributes new knowledge that, in addition to having positive impacts on care quality such as increased access, OCs also have negative impacts such as increased workload. Negative impacts can be mitigated through appropriate OC system design (eg, free text format), incorporation of advanced technologies (eg, artificial intelligence), and integration into technical infrastructure (eg, software) and organizational workflows (eg, timely responses). TRIAL REGISTRATION: PROSPERO CRD42020191802; https://tinyurl.com/2p84ezjy.


Subject(s)
COVID-19 , United States , Humans , Female , Male , Pandemics , Artificial Intelligence , Referral and Consultation , Quality of Health Care
20.
Inquiry ; 59: 469580221133002, 2022.
Article in English | MEDLINE | ID: covidwho-2089047

ABSTRACT

Gaps between medical needs and health services accessibility are defined as unmet medical needs (UMN). Previous studies assessing UMNs during the coronavirus disease 2019 (COVID-19) pandemic did not account for factors such as the type of medical insurance or chronic disease. Therefore, this study investigated various factors, including medical insurance and chronic diseases, affecting self-reported UMN during the pandemic in Daejeon Metropolitan City, South Korea. This cross-sectional study was conducted using Daejeon Metropolitan City Health Surveys data from 2020. The weighted prevalence of UMN was estimated among participants (n = 1494) aged ≥18 years, while chi-squared and logistic models were used to assess the association between UMN and participant characteristics. The prevalence of UMN was 6.4% (n = 97). Female sex and low education levels were significantly associated with reporting UMN. Medical aid beneficiaries were less likely to report UMN than adults with National Health Programs coverage. Participants with chronic diseases, such as hypertension and arthritis, and those with depression, were more likely to report UMN than adults without these conditions. The findings highlight the need for targeted efforts to decrease UMN in the COVID-19 pandemic, especially for women and individuals with low education levels. The results also indicate that high-risk disease groups should be targeted with additional enabling services to support the management of chronic conditions.


Subject(s)
COVID-19 , Adult , Humans , Female , Adolescent , Cross-Sectional Studies , COVID-19/epidemiology , Pandemics , Chronic Disease , Health Services Accessibility , Health Services Needs and Demand
SELECTION OF CITATIONS
SEARCH DETAIL