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1.
Eur J Anaesthesiol ; 38(12): 1284-1292, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1608616

ABSTRACT

BACKGROUND: During the surge in coronavirus disease 2019 (COVID-19) infections in early 2020, many medical organisations began developing strategies for implementing teleconsultation to maintain medical services during lockdown and to limit physical contact. Therefore, we developed a teleconsultation preoperative evaluation platform to replace on-site preoperative meetings. OBJECTIVE: This study assessed the feasibility of a teleconsultation for preoperative evaluation and procedure-associated adverse events. DESIGN: Implementation study. SETTING: A tertiary care university hospital in Germany from April 2020 to October 2020. PATIENTS: One hundred and eleven patients scheduled for elective surgery. INTERVENTION: Patients were assigned to receive teleconsultation for preoperative evaluation and to complete a subsequent survey. MAIN OUTCOME MEASURES: Primary endpoints were medical and technical feasibility, user satisfaction and time savings. RESULTS: For 100 out of 111 patients, telepreoperative consultations allowed for adequate perioperative risk assessment, patient education and also for effective collection of legal signatures. For six patients (5.4%), consultations could not be started because of technical issues, whereas for five patients (4.8%), clearance for surgery could not be granted because of medical reasons. A clear majority of anaesthetists (93.7%) rated the telepreoperative evaluations as equivalent to on-site meetings. The majority of the patients considered teleconsultation for preoperative evaluation as convenient as an on-site meeting (98.2%) and would choose a teleconsultation again (97.9%). Median travel time saved by patients was 60 min (Q1 40, Q3 80). We registered one adverse event: we detected atrial fibrillation in one patient only immediately prior to surgery. CONCLUSION: Telepreoperative evaluations are medically and technically feasible, yielding high satisfaction rates on both sides. However, regarding patient safety, not every patient is equally well suited. Overall, implementation of teleconsultation for preoperative evaluation into clinical routine could help maintain medical care during the COVID-19 pandemic. TRIAL REGISTRATION: NCT04518514, ClinicalTrials.gov.


Subject(s)
COVID-19 , Remote Consultation , Communicable Disease Control , Feasibility Studies , Humans , Pandemics , SARS-CoV-2
2.
BMJ Open ; 11(12): e055823, 2021 12 27.
Article in English | MEDLINE | ID: covidwho-1595269

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has resulted in a shift to remote consultations, but telehealth consultation guidelines are lacking or inconsistent. Therefore, a scoping review was performed to chart the information in the articles exploring telehealth for the UK allied health professionals (AHPs) and compare them with the UK AHP professional bodies' guidelines. DESIGN: Scoping review following Aksey and O' Malley methodological framework. DATA SOURCES: CINHAL and MEDLINE were searched from inception to March 2021 using terms related to 'telehealth', 'guidelines' and 'AHPs'. Additionally, the UK AHP professional bodies were contacted requesting their guidelines. STUDY SELECTION: Articles exploring telehealth for patient consultations, written in English and published in peer-reviewed journal or guidelines available from UK AHP professional bodies/their websites were considered eligible for review. DATA EXTRACTION: One reviewer extracted data concerning three overarching domains: implementation, financial and technological considerations. RESULTS: 2632 articles were identified through database searches with 21 articles eligible for review. Eight guidelines were obtained from the UK AHP professional bodies with a total of 29 included articles/guidelines. Most articles were published in the last two years; there was variety in telehealth terminology, and most were developed for occupational therapists, physiotherapists and speech and language therapists. Information was lacking about the assessment of telehealth use and effectiveness, barriers and limitations, the logistical management, the family's and caregiver's roles and the costs. There was lack of clarity on the AHPs' registration requirements, costs and coverage, and legal aspects. CONCLUSION: This study identified gaps in current guidelines, which showed similarities as well as discrepancies with the guidance for non-AHP healthcare professionals and revealed that the existing guidelines do not adequately support AHPs delivering telehealth consultations. Future research and collaborative work across AHP groups and the world's leading health institutions are suggested to establish common guidelines that will improve AHP telehealth services.


Subject(s)
COVID-19 , Remote Consultation , Telemedicine , Allied Health Personnel , Humans , Pandemics , SARS-CoV-2 , United Kingdom
4.
Br Dent J ; 231(12): 741-746, 2021 12.
Article in English | MEDLINE | ID: covidwho-1577660

ABSTRACT

Collecting information in preparation for a domiciliary visit can identify potential barriers to treatment and allow for appropriate planning and mitigation of treatment risks. The coronavirus (COVID-19) pandemic has changed the way dental professionals can work. Prior identification can eliminate unnecessary visits and so reduce the risk of potential COVID-19 transmission between dental professionals and patients receiving domiciliary dental care. This article will explain two documents: the Domiciliary Patient Information Sheet (DPIS) and Domiciliary Risk Assessment (DRA). Case studies will be used to demonstrate the importance of the DPIS and DRA implementation.


Subject(s)
COVID-19 , Remote Consultation , Dentistry , Humans , Risk Assessment , SARS-CoV-2
6.
J Med Internet Res ; 23(2): e22790, 2021 02 19.
Article in English | MEDLINE | ID: covidwho-1574794

ABSTRACT

BACKGROUND: Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services. OBJECTIVE: We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates. METHODS: The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order. RESULTS: We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts. CONCLUSIONS: App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider.


Subject(s)
COVID-19/psychology , Emergency Shelter/methods , Intimate Partner Violence/psychology , Quality Improvement/standards , Remote Consultation/methods , Telemedicine/methods , Adult , Female , Humans , Male , Pilot Projects , Pregnancy , SARS-CoV-2
7.
Soins Psychiatr ; 42(337): 35-41, 2021.
Article in French | MEDLINE | ID: covidwho-1550083

ABSTRACT

In the context of the Covid-19 pandemic, teleconsultation is an obvious solution in psychiatry to ensure continuity of care and facilitate access. However, the digitisation of ambulatory practices raises a certain number of reservations, in particular concerning the remote management of psychiatric emergencies. These situations, because of the specific aspects they cover, are in fact upsetting texts and recommendations of good practice in terms of teleconsultation. Thus, the questions of eligibility of people suffering from psychiatric disorders, the identification of an immediate self- or hetero-aggressive risk during teleconsultation and the establishment of a measure of psychiatric care without consent at the end of a teleconsultation require specific reflection in order to allow the practitioner to anticipate and manage the situation in the best possible way.


Subject(s)
COVID-19 , Remote Consultation , Emergencies , Humans , Pandemics , SARS-CoV-2
8.
Chiropr Man Therap ; 29(1): 47, 2021 11 25.
Article in English | MEDLINE | ID: covidwho-1538081

ABSTRACT

BACKGROUND: Remote consultations (RCs) enable clinicians to continue to support patients when face-to-face appointments are not possible. Restrictions to face-to-face care during the COVID-19 pandemic has accelerated a pre-existing trend for their adoption. This is true for many health professionals including some chiropractors. Whilst most chiropractors in the UK have used RCs in some form during the pandemic, others have not. This study seeks to understand the views of chiropractors not using RCs and to explore perceived potential barriers. METHODS: A national online survey was completed by 534 registered practicing UK chiropractors on the use of RCs. Respondents had the opportunity of providing open-ended responses concerning lack of engagement in RCs during the COVID-19 pandemic. Textual responses obtained from 137 respondents were coded and analysed using thematic analysis. RESULTS: The use of RCs provided an opportunity for chiropractors to deliver ongoing care during the COVID-19 pandemic. However, many chiropractors expressed concern that RCs misaligned with their strong professional identity of providing 'hands-on' care. Some chiropractors also perceived that patients expected physical interventions during chiropractic care and thus considered a lack of demand when direct contact is not possible. In the absence of a physical examination, some chiropractors had concerns about potential misdiagnosis, and perceived lack of diagnostic information with which to guide treatment. Clinic closures and change in working environment led to practical difficulties of providing remote care for a few chiropractors. CONCLUSIONS: The COVID-19 pandemic may have accelerated changes in the way healthcare is provided with RCs becoming more commonplace in primary healthcare provision. This paper highlights perceived barriers which may lead to reduced utilisation of RCs by chiropractors, some of which appear fundamental to their perceived identity, whilst others are likely amenable to change with training and experience.


Subject(s)
COVID-19 , Chiropractic , Musculoskeletal Manipulations , Remote Consultation , Humans , Pandemics , SARS-CoV-2
9.
Ann Cardiol Angeiol (Paris) ; 70(5): 317-321, 2021 Nov.
Article in French | MEDLINE | ID: covidwho-1525669

ABSTRACT

Telemedicine has been recognized since 2010 as a constitutive element of care, however, it was not until 2016 that the first national experiments were able to be launched with the aim of validating a framework allowing a possible rapid passage in the common right. These experiments, which are due to end in December 2021, have succeeded in involving more than 100,000 patients, mainly suffering from cardiac pathologies. The arrival of COVID-19 has made it possible to measure the usefulness of practices at a distance both from teleconsultation and telemonitoring, with the appearance of organizational and technical innovations that must now be maintained and developed in order to integrate the telemedicine of tomorrow into our actual medicine.


Subject(s)
COVID-19/epidemiology , Pandemics , Telemedicine/organization & administration , COVID-19/therapy , Diabetes Mellitus/therapy , Heart Failure/therapy , Humans , Kidney Failure, Chronic/therapy , Patient Satisfaction , Remote Consultation/methods , Remote Consultation/organization & administration , Respiratory Insufficiency/therapy , Telemedicine/economics , Telemedicine/trends
10.
GMS J Med Educ ; 38(4): Doc81, 2021.
Article in English | MEDLINE | ID: covidwho-1523662

ABSTRACT

Background: Due to the pandemic-related restrictions in classroom teaching at the medical faculties of the LMU Munich and the University of Basel, teaching methods with standardized patients (SPs), were shifted to a digital, web-based format at short notice as of April 2020. We report on our experiences with the WebEncounter program, which was used for the first time in German-speaking countries. The program enables one-to-one encounters between SPs and students. Students receive an invitational email with brief instructions and background information on the case. SPs use case-specific criteria that are compliant with the learning objectives for digital evaluation during the encounter. A feedback session takes place immediately following the encounter. The SPs address the didactically relevant sections and can illustrate them with the corresponding video sequences. Finally, the students receive the links to the video recordings of the encounter and the feedback unit by email. Project description: The aim of this pilot study was to analyze the practicability of the program and its acceptance by students and SPs. In addition, we examined whether the operationalization of the learning objectives in the form of assessment items has an impact on the content and thematic development of courses in the area of doctor-patient communication. Methods: To implement the program, patient cases previously tested in communication seminars in Munich and Basel were rewritten and case-specific evaluation criteria were developed. SPs were trained to use the program, to present their patient figure online and to give feedback. The experience of those involved (faculty, SPs and SP trainers, students) in implementing the program was documented at various levels. The frequency and causes of technical problems were described. Student results on the patient cases and on the feedback items were collected quantitatively and, where possible, supplemented by free-text statements. Results: Data from 218/220 students in Basel and 120/127 students in Munich were collected and evaluated. Students were very satisfied with the patient cases, the encounter with the SPs and their feedback: 3.81±0.42. SPs experienced the training as an increase in their competence and the structured feedback as particularly positive. The training effort per SP was between 2.5 and 4 hours. The results show predominantly normally-distributed, case-specific sum scores of the evaluation criteria. The analysis of the individual assessment items refers to learning objectives that students find difficult to achieve (e.g. explicitly structuring the conversation). Problems in the technical implementation (<10 percent of the encounters) were due mainly to the use of insufficient hardware or internet connection problems. The need to define case-specific evaluation criteria triggered a discussion in the group of study directors about learning objectives and their operationalization. Summary: Web-based encounters can be built into the ongoing communication curriculum with reasonable effort. Training the SPs and heeding the technical requirements are of central importance. Practicing the virtual consultation was evaluated very positively by the students - in particular, the immediate feedback in the protected dialogue was appreciated by all involved.


Subject(s)
COVID-19 , Communication , Physician-Patient Relations , Remote Consultation , Clinical Competence/statistics & numerical data , Feedback , Germany , Humans , Internet , Pilot Projects , Remote Consultation/standards , Switzerland
12.
Neurol India ; 69(5): 1234-1240, 2021.
Article in English | MEDLINE | ID: covidwho-1502576

ABSTRACT

Background: Globally, social distancing has been practiced during the ongoing coronavirus disease 2019 (COVID-19) pandemic to prevent the transmission of the virus. One of the measures to ensure social distancing and restricting the movements has been national lockdown, to break the chain of transmission. Telemedicine is a cost-effective measure to provide medical services to remote underserved areas. Objective: The present study aimed to evaluate the efficacy and acceptability of teleconsultation as an alternative option to in-person consultation in providing continued medical care for neurology patients during the national lockdown period of the COVID-19 pandemic. Materials and Methods: The clinical demographic profile, frequency of different neurological disorders, and treatment details of the patients attending the teleneurology consultation (TNCO) outpatient department (OPD) at Sir Sunderlal Hospital (S.S.H.), Institute of Medical Sciences (I.M.S.), BHU, Varanasi, India, were recorded in a prespecified pro forma. Results: A total of 1,567 patients attended the TNCO OPD over 90 days. The average patient attendance was 35 per day, and 72% were males. Out of these, 77% of patients were from the same district, and the majority of patients (68%) were regularly followed up in-person by the neurology OPD. The most common illness for consultation was epilepsy (19%) followed by low backache and stroke (18% each). The satisfaction rate among the patients with respect to teleservices was high (90%). Conclusion: TNCO seems to be as effective as in-person OPD in the management of neurological disorders. During the lockdown due to the COVID-19 pandemic, avoiding physical visits through TNCO may reduce the spread of the virus. Parallel tele-OPD with routine OPD is a good option in the future.


Subject(s)
COVID-19 , Epilepsy , Neurology , Remote Consultation , Communicable Disease Control , Humans , Male , Pandemics , SARS-CoV-2 , Telephone
13.
PLoS One ; 16(11): e0259398, 2021.
Article in English | MEDLINE | ID: covidwho-1502074

ABSTRACT

The first case of COVID-19 in Nigeria was recorded on February 27, 2020, being an imported case by an Italian expatriate, to the country. Since then, there has been steady increase in the number of cases. However, the number of cases in Nigeria is low in comparison to cases reported by other countries with similar large populations, despite the poor health system prevailing in the country. This has been mainly attributed to the low testing capacity in Nigeria among other factors. Therefore, there is a need for innovative ways to increase the number of persons testing for COVID-19. The aim of the study was to pilot a nasopharyngeal swab self-sample collection model that would help increase COVID-19 testing while ensuring minimal person-to-person contact being experienced at the testing center. 216 participants took part in this study which was carried out at the Nigerian Institute of Medical Research between June and July 2020. Amongst the 216 participants, 174 tested negatives for both self-collected samples and samples collected by Professionals, 30 tested positive for both arms, with discrepancies occurring in 6 samples where the self-collected samples were positive while the ones collected by the professionals were negative. The same occurred in another set of 6 samples with the self-collected samples being negative and the professional-collected sample coming out positive, with a sensitivity of 83.3% and a specificity of 96.7%. The results of the interrater analysis are Kappa = 0.800 (95% CI, 0.690 to 0.910) which implies an outstanding agreement between the two COVID-19 sampling methods. Furthermore, since p< 0.001 Kappa (k) coefficient is statistically different from zero, our findings have shown that self-collected samples can be reliable in the diagnosis of COVID-19.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , COVID-19/prevention & control , Polymerase Chain Reaction/methods , Telemedicine/methods , Adolescent , Adult , Aged , COVID-19 Testing/statistics & numerical data , Diagnostic Tests, Routine , Female , Humans , Male , Middle Aged , Nigeria/epidemiology , Remote Consultation/methods , Reproducibility of Results , SARS-CoV-2 , Sensitivity and Specificity , Specimen Handling/methods , Young Adult
14.
Acta odontol. Colomb. (En linea) ; 11(1): 71-82, 2021. ilus, tab
Article in Spanish | LILACS (Americas) | ID: covidwho-1498038

ABSTRACT

Objetivo: describir las aplicaciones de la teleodontología para la atención de pacientes durante y posterior a la pandemia de la COVID-19. Método: la búsqueda de artículos sobre teleodontología se realizó en las bases de datos PubMed, EMBASE, EBSCO, SCOPUS, ClinicalKey y LILACS, para identificar estudios publicados en inglés, español y portugués; se incluyeron estudios que contenían las palabras claves teleodontología y COVID-19, publicados desde enero a diciembre de 2020 y que estuvieran completos. La calidad de los artículos se evaluó según las directrices PRISMA-P. Resultados: se identificaron 49 artículos y se incluyeron 14 para la evaluación. De estos estudios, dos eran descriptivos (test de diagnóstico), seis eran estudios descriptivos de corte transversal, cinco eran pruebas pilotos; se identificó, además, un estudio de diseño retrospectivo. Se presenta la teleodontología como alternativa para diagnósticos y tratamientos de enfermedades bucales en tiempos de pandemia, mediante uso de dispositivos móviles, teleorientación y fotografías. La mayoría de los estudios presentaron un riesgo de sesgo de moderado a alto. Conclusión: la teleodontología es una herramienta tecnológica remota para apoyar la orientación, educación y tratamiento, que permite consolidar información de manera sincrónica y asincrónica sin la necesidad del contacto directo entre odontólogo y paciente.


Objective: to describe the applications of teleodontology for patient care during and after the COVID-19 pandemic. Method: the search for articles on teleodontology was carried out in the PubMed, EMBASE, EBSCO, SCOPUS, ClinicalKey and LILACS databases to identify studies published in English, Spanish and Portuguese; Studies that contained the keywords teleodontology and COVID-19, published from January to December 2020 and that were complete, were included. The quality of the articles was evaluated according to the PRISMA-P guidelines. Results: 49 articles were identified and 14 were included for evaluation. Of these studies, two were descriptive (diagnostic tests), six were descriptive cross-sectional studies, five were pilot tests; In addition, a retrospective design study was identified. Teleodontology is presented as an alternative for diagnosing and treating oral diseases in times of pandemic, through the use of mobile devices, remote orientation and photographs. Most of the studies were at moderate to high risk of bias. Conclusion: teleodontology is the remote tool to support remote guidance, education and treatment through technology, allowing the consolidation of information synchronously and asynchronously without the need for direct contact between dentist and patient


Subject(s)
Humans , Coronavirus Infections , Teledentistry , Telemedicine , Remote Consultation , Diagnosis , Health Promotion
15.
J Plast Reconstr Aesthet Surg ; 74(11): 3178-3185, 2021 11.
Article in English | MEDLINE | ID: covidwho-1491753

ABSTRACT

The novel coronavirus outbreak (COVID-19) in 2019 resulted in the suspension of all elective hospital procedures during the height of the pandemic in the UK. The Clinic in London is one of the first day-case hospitals to resume cosmetic surgery in a post-COVID-19 clinical environment, whilst also employing the use of virtual consultations. Details of the protocol implemented by the Clinic to allow the safe resumption of cosmetic surgery are stated in this paper. The volume of procedures at the Clinic saw a significant increase post-lockdown; reasons as to why this occurred are also explored in this paper. The disruption of cosmetic practice during lockdown can be said to have resulted in a backlog of procedures once lockdown restrictions began to ease. Whilst this may be true, we believe that there are other confounding factors regarding what may have influenced the rise in cosmetic surgery during the pandemic, including the privacy of working from home and the increased exposure to video conferencing software.


Subject(s)
Ambulatory Surgical Procedures , COVID-19 , Pandemics , Reconstructive Surgical Procedures , Ambulatory Surgical Procedures/statistics & numerical data , Cohort Studies , Hospitals , Humans , Infection Control , London/epidemiology , Patient Selection , Reconstructive Surgical Procedures/statistics & numerical data , Remote Consultation , Retrospective Studies
16.
Int J Med Inform ; 157: 104618, 2022 01.
Article in English | MEDLINE | ID: covidwho-1482641

ABSTRACT

BACKGROUND: Healthcare providers have improved consumer access to healthcare services by the adoption of information communication technology and the use of telemedicine. With the current COVID-19 pandemic, consumers are shifting to remote teleconsultation. There are several studies regarding consumers' acceptance and satisfaction with telemedicine among healthcare providers and a few among patients at healthcare facilities. However, studies about patients' motivation toward the use of teleconsultation systems are very few. AIM: The aim of this study was to validate an instrument of a newly developed framework to identify factors that motivate patients to use a teleconsultation system. METHOD: This study used a modified eDelphi method incorporating content validity index and content validity ratio procedures to validate the instrument among fifteen experts from different disciplines. The eDelphi consisted of three rounds to review each item's relevance, clarity, importance and the overall validity of the instrument. RESULT: The result showed a significant level of agreement among experts for individual items' relevance, clarity and importance. For relevance, all items had excellent I-CVI above 0.889, except one item with I-CVI = 0.78, which is still acceptable. For clarity, all items had an excellent I-CVI > 0.889, except one with I-CVI = 0.667. For importance, most items had CVR above the threshold value of 0.778, except 5 items. Also, the result showed moderate to high content validity of the overall instrument (S-CVI/UA = 0.694; S-CVI/Ave = 0.996). DISCUSSION: These findings support the validity and reliability of the developed instrument, which can be used to identify factors that motivated patients to use a teleconsultation system. Future testing of the instrument should be conducted with a larger population that uses a teleconsultation system. CONCLUSION: An instrument was developed to identify factors that motivated consumers to use teleconsultation, using a modified eDelphi method among experts. The eDelphi method consisted of three rounds and the results showed that the instrument is a valid and reliable tool.


Subject(s)
COVID-19 , Remote Consultation , Delphi Technique , Humans , Motivation , Pandemics , Reproducibility of Results , SARS-CoV-2 , Surveys and Questionnaires
17.
J Med Internet Res ; 23(10): e31374, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1477711

ABSTRACT

BACKGROUND: Scotland-a country of 5.5 million people-has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. OBJECTIVE: To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland's video consultation services both before and during the pandemic. METHODS: Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. RESULTS: By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations' general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. CONCLUSIONS: The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn.


Subject(s)
COVID-19 , Remote Consultation , Anthropology, Cultural , Humans , Pandemics , SARS-CoV-2
19.
Torture ; 31(1): 37-52, 2021.
Article in English | MEDLINE | ID: covidwho-1450937

ABSTRACT

INTRODUCTION: Due to the COVID-19 pandemic, Freedom from Torture developed remote telephone assessments to provide interim medico-legal reports, ensuring people could obtain medical evidence to support their asylum claim. METHOD: To audit this new way of working, feedback was collected from the doctors, interpreters, individuals being assessed, and senior medical and legal staff who reviewed the reports. This paper presents findings from the first 20 assessments. RESULTS: Individuals assessed reported that the doctor developed good rapport, but in 35% of assessments reported that there were some experiences they felt unable to disclose. In 70% of assessments, doctors felt that rapport was not as good compared to face-to-face. In the majority of assessments, doctors were unable to gain a full account of the torture or its impact. They reported feeling cautious about pressing for more information on the telephone, mindful of individuals' vulnerability and the difficulty of providing support remotely. Nevertheless, in 85% of assessments doctors felt able to assess the consistency of the account of torture with the psychological findings, in accordance with the Istanbul Protocol (United Nations, 2004). Factors that hindered the assessment included the inability to observe body language, the person's ill health, and confidentiality concerns. CONCLUSION: This research indicates that psychological medico-legal reports can safely be produced by telephone assessment, but are more likely to be incomplete in terms of both full disclosure of torture experiences and psychological assessment. The limitations underline the need for a follow-up face-to-face assessment to expand the psychological assessment as well as undertake a physical assessment.


Subject(s)
COVID-19/epidemiology , Physician-Patient Relations/ethics , Refugees/psychology , Remote Consultation/ethics , Telephone , Torture , Humans , Medical History Taking , Pandemics , Physical Examination , SARS-CoV-2 , United Kingdom/epidemiology
20.
PLoS One ; 16(9): e0257458, 2021.
Article in English | MEDLINE | ID: covidwho-1443839

ABSTRACT

BACKGROUND: The COVID-19 pandemic has sparked a surge in the use of virtual communication tools for delivering clinical services for many non-urgent medical needs allowing telehealth or telemedicine, to become an almost inevitable part of the patient care. However, most of patients with vascular disease may require face-to-face interaction and are at risk of worse outcomes if not managed in timely manner. OBJECTIVE: We aimed to describe the utilization of telemedicine services in the outpatient vascular surgery clinics in a tertiary hospital. METHODS: A retrospective analysis of data on all vascular outpatient encounters during 2019 and 2020 was conducted and compared to reflect the pattern of practice prior to and during the COVID-19 pandemic. RESULTS: The study showed that 61% of the total patient encounters in 2020 were reported through teleconsultation. Females were the majority of patients who sought the virtual vascular care. Consultations for the new cases decreased from 29% to 26% whereas, the follow-up cases increased from 71% to 74% in 2020 (p = 0.001). The number of procedures performed in the vascular outpatient clinics decreased by 46% in 2020 when compared to 2019. This decrease in procedures was more evident in the duration from February 2020 to April 2020 in which the procedures decreased by 97%. The proportion of procedures represented 22.6% of the total encounters in 2019 and 10.5% of the encounters during 2020, (p = 0.001). CONCLUSIONS: Teleconsultation, along with supporting practice guidelines, can be used to maximize the efficiency of care in vascular surgery patients during the pandemic and beyond. Adoption of the 'hybrid care' which combines both virtual and in-person services as an ongoing practice requires evidence obtained through audits and studies on patients and healthcare providers levels. It is essential to establish a clear practice that ensures patient's needs.


Subject(s)
Remote Consultation , Vascular Surgical Procedures , COVID-19/epidemiology , Female , Humans , Male , Outpatients , Qatar/epidemiology , Retrospective Studies , Tertiary Care Centers
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