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1.
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
2.
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
4.
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
6.
Diabetes Metab Syndr ; 15(5): 102242, 2021.
Article in English | MEDLINE | ID: covidwho-1397297

ABSTRACT

INTRODUCTION: Emergence of COVID-19 pandemic has led to increased use of telemedicine in health care delivery. Telemedicine facilitates long-term clinical care for monitoring and prevention of complications of diabetes mellitus. GUIDELINES: Precise indications for teleconsultation, clinical care services which can be provided, and good clinical practices to be followed during teleconsultation are explained. Guidance on risk assessment and health education for diabetes risk factors, counselling for blood glucose monitoring, treatment compliance, and prevention of complications are described. CONCLUSION: The guidelines will help physicians in adopting teleconsultation for management of diabetes mellitus, facilitate access to diabetes care and improve health outcomes.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 2/therapy , Remote Consultation/standards , Biomedical Research/organization & administration , Biomedical Research/standards , COVID-19/prevention & control , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Communicable Disease Control/standards , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Diabetes Mellitus, Type 2/epidemiology , Expert Testimony , Humans , India/epidemiology , Pandemics , Remote Consultation/methods , Remote Consultation/organization & administration , Telemedicine/organization & administration , Telemedicine/standards
7.
S Afr Fam Pract (2004) ; 63(1): e1-e6, 2021 08 26.
Article in English | MEDLINE | ID: covidwho-1395089

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented international emergency, resulting in a need to adapt the existing healthcare systems, in order to enable ongoing patient care despite the current disruptions. Telemedicine may be a viable option to continue hospital workflow, however there are barriers to its implementation. We set out to establish what barriers might exist and to assess the viability of teleclinics within the province KwaZulu-Natal (KZN), as perceived by doctors. METHODS: This was a quantitative, observational, survey-based study targeted at medical doctors working in both the public as well as the private healthcare sector in University of KwaZulu-Natal (UKZN). RESULTS: One hundred and forty-seven (147) responses were included. The majority (86%) of respondents felt that telemedicine could provide a useful means to continuing hospital workflow, however, only 47% believed that it was a viable option for their unit. The major barrier identified was a feeling that doctors would-be at-increased medico-legal risk. Only 38.4% of doctors were familiar with the Health Professions Council of South Africa (HPCSA) guidelines on telemedicine usage. Other major barriers included: doctors feeling uncomfortable with not seeing a patient in person or not being able to perform a thorough physical examination. Other reasons identified as potential barriers were doctors foreseeing difficulty in accessing patient medical records and the absence of available systems to order investigations without the patient being physically present. CONCLUSION: Telemedicine is currently not widely utilised in KZN; although most doctors were of the opinion that it could be a useful tool in order to continue the workflow during the pandemic. The major barrier identified were issues surrounding medico-legal coverage.


Subject(s)
Attitude of Health Personnel , Medical Staff, Hospital/psychology , Remote Consultation/methods , Telephone , COVID-19/epidemiology , Female , Health Care Surveys , Humans , Liability, Legal , Male , Medical Records , Pandemics , Practice Guidelines as Topic , SARS-CoV-2 , South Africa/epidemiology
9.
Cancer ; 127(22): 4177-4189, 2021 11 15.
Article in English | MEDLINE | ID: covidwho-1363649

ABSTRACT

BACKGROUND: Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many institutions during the initial peak of the coronavirus disease 2019 pandemic. Its safety in this population has not been established. METHODS: A 16-week, prospective, multicenter national service evaluation was started on March 23, 2020. Suspected HNC referrals undergoing remote triage in UK secondary care centers were identified and followed up for a minimum of 6 months to record the cancer status. Triage was supported by risk stratification using a validated calculator. RESULTS: Data for 4568 cases were submitted by 41 centers serving a population of approximately 26 million. These represented 14.1% of the predicted maximum referrals for this population outside of pandemic times, and this gave the study a margin of error of 1.34% at 95% confidence. Completed 6-month follow-up data were available for 99.8% with an overall cancer rate of 5.6% (254 of 4557). The rates of triage were as follows: urgent imaging investigation, 25.4% (n = 1156); urgent face-to-face review, 27.8%; (n = 1268); assessment deferral, 30.3% (n = 1382); and discharge, 16.4% (n = 749). The corresponding missed cancers rates were 0.5% (5 of 1048), 0.3% (3 of 1149), 0.9% (12 of 1382), and 0.9% (7 of 747; P = .15). The negative predictive value for a nonurgent triage outcome and no cancer diagnosis was 99.1%. Overall harm was reported in 0.24% (11 of 4557) and was highest for deferred assessments (0.58%; 8 of 1382). CONCLUSIONS: Remote triage, incorporating risk stratification, may facilitate targeted investigations for higher risk patients and prevent unnecessary hospital attendance for lower risk patients. The risk of harm is low and may be reduced further with appropriate safety netting of deferred appointments. LAY SUMMARY: This large national study observed the widespread adoption of telephone assessment (supported by a risk calculator) of patients referred to hospital specialists with suspected head and neck cancer during the initial peak of the coronavirus disease 2019 pandemic. The authors identified 4568 patients from 41 UK centers (serving a population of more than 26 million people) who were followed up for a minimum of 6 months. Late cancers were identified, whether reviewed or investigated urgently (0.4%) or nonurgently (0.9%), but the overall rate of harm was low (0.2%), with the highest rate being seen with deferred appointments (0.6%).


Subject(s)
COVID-19/prevention & control , Head and Neck Neoplasms/diagnosis , Remote Consultation/methods , Triage/methods , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/transmission , Child , Child, Preschool , Communicable Disease Control/standards , Female , Follow-Up Studies , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/therapy , Humans , Infant , Male , Middle Aged , Pandemics/prevention & control , Prospective Studies , Remote Consultation/standards , Risk Assessment/methods , Triage/standards , United Kingdom/epidemiology , Young Adult
10.
PLoS One ; 16(8): e0249872, 2021.
Article in English | MEDLINE | ID: covidwho-1341484

ABSTRACT

This paper analyzes the application of various telemedicine services in Gansu Province, China during the COVID-19 epidemic, and summarizes the experiences with these services. In addition, the satisfaction levels of patients and doctors with the application of telemedicine in COVID-19 were investigated, the deficiencies of telemedicine in Gansu were determined, and recommendations for modification were proposed. Coronavirus Disease 2019 (COVID-19) has broken out in China, and Gansu Province in Northwest of China has not been spared. To date, there are 91 local COVID-19 cases and 42 imported cases. 109 hospitals were selected as designated hospitals during the COVID-19 outbreak, and most of them were secondary hospitals. However, it was unsatisfactory that the ability of medical services is relatively low in most of secondary hospitals and primary hospitals. Therefore, we helped the secondary hospitals cope with COVID-19 by means of remote consultation, long-distance education, telemedicine question and answer (Q&A). Our practical experience shows that telemedicine can be widely used during the COVID-19 epidemic, especially in developing countries and areas with lagging medical standards.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Telemedicine/organization & administration , China/epidemiology , Disease Outbreaks , Education, Distance/organization & administration , Education, Distance/statistics & numerical data , Education, Medical, Continuing/methods , Education, Medical, Continuing/organization & administration , Education, Medical, Continuing/statistics & numerical data , Education, Nursing, Continuing/methods , Education, Nursing, Continuing/organization & administration , Education, Nursing, Continuing/statistics & numerical data , Epidemics , Geography , Health Services Accessibility/organization & administration , Health Services Accessibility/statistics & numerical data , Humans , Physician-Patient Relations , Remote Consultation/instrumentation , Remote Consultation/methods , Remote Consultation/organization & administration , Remote Consultation/statistics & numerical data , SARS-CoV-2/physiology , Software , Telemedicine/instrumentation , Telemedicine/methods
11.
PLoS One ; 16(7): e0254339, 2021.
Article in English | MEDLINE | ID: covidwho-1309961

ABSTRACT

In Dec 2020 Brazil became one of the worldwide epicenters of the COVID-19 pandemic with more than 7.2M reported cases. Brazil has a large territory with unequal distribution of healthcare resources including physicians. Resource limitation has been one of the main factors hampering Brazil's response to the COVID-19 crisis. Telemedicine has been an effective approach for COVID-19 management as it allows to reduce the risk of cross-contamination and provides support to remote rural locations. Here we present the analyses of teleconsultations from a countrywide telemedicine service (TelessáudeRS-UFRGS, TRS), that provides physician-to-physician remote support during the COVID-19 pandemic in Brazil. We performed a descriptive analysis of the teleconsultation incoming calls and a text analysis from the call transcripts. Our findings indicate that TRS teleconsultations in Brazil experienced an exponential increment of 802.% during a period of 6 days, after the first death due to COVID-19 was reported. However, the number of teleconsultations cases decreased over time, despite the number of reported COVID-19 cases continuously increasing. The results also showed that physicians in low-income municipalities, based on GDP per capita, are less likely to consult the telemedicine service despite facing higher rates of COVID-19 cases. The text analysis of call transcripts from medical teleconsultations showed that the main concern of physicians were "asymptomatic" patients. We suggest an immediate reinforcement of telehealth services in the regions of lower income as a strategy to support COVID-19 management.


Subject(s)
COVID-19/therapy , Remote Consultation/statistics & numerical data , Brazil , Healthcare Disparities , Humans , Physicians , Primary Health Care , Remote Consultation/methods , Rural Health , Telemedicine/methods , Telemedicine/statistics & numerical data
12.
BMC Fam Pract ; 22(1): 146, 2021 07 03.
Article in English | MEDLINE | ID: covidwho-1295439

ABSTRACT

BACKGROUND: Early in the COVID-19 pandemic, general practices were asked to expand triage and to reduce unnecessary face-to-face contact by prioritizing other consultation modes, e.g., online messaging, video, or telephone. The current study explores the potential barriers and facilitators general practitioners experienced to expanding triage systems and their attitudes towards triage during the COVID-19 pandemic. METHOD: A mixed-method study design was used in which a quantitative online survey was conducted along with qualitative interviews to gain a more nuanced appreciation for practitioners' experiences in the United Kingdom. The survey items were informed by the Theoretical Domains Framework so they would capture 14 behavioral factors that may influence whether practitioners use triage systems. Items were responded to using seven-point Likert scales. A median score was calculated for each item. The responses of participants identifying as part-owners and non-owners (i.e., "partner" vs. "non-partner" practitioners) were compared. The semi-structured interviews were conducted remotely and examined using Braun and Clark's thematic analysis. RESULTS: The survey was completed by 204 participants (66% Female). Most participants (83%) reported triaging patients. The items with the highest median scores captured the 'Knowledge,' 'Skills,' 'Social/Professional role and identity,' and 'Beliefs about capabilities' domains. The items with the lowest median scores captured the 'Beliefs about consequences,' 'Goals,' and 'Emotions' domains. For 14 of the 17 items, partner scores were higher than non-partner scores. All the qualitative interview participants relied on a phone triage system. Six broad themes were discovered: patient accessibility, confusions around what triage is, uncertainty and risk, relationships between service providers, job satisfaction, and the potential for total digital triage. Suggestions arose to optimize triage, such as ensuring there is sufficient time to conduct triage accurately and providing practical training to use triage efficiently. CONCLUSIONS: Many general practitioners are engaging with expanded triage systems, though more support is needed to achieve total triage across practices. Non-partner practitioners likely require more support to use the triage systems that practices take up. Additionally, practical support should be made available to help all practitioners manage the new risks and uncertainties they are likely to experience during non-face-to-face consultations.


Subject(s)
COVID-19 , General Practice , General Practitioners , Remote Consultation , Triage , Attitude of Health Personnel , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/therapy , Clinical Competence , England/epidemiology , Female , General Practice/organization & administration , General Practice/standards , General Practice/trends , General Practitioners/psychology , General Practitioners/standards , Health Knowledge, Attitudes, Practice , Humans , Infection Control/methods , Infection Control/standards , Male , Practice Patterns, Physicians'/ethics , Practice Patterns, Physicians'/trends , Remote Consultation/ethics , Remote Consultation/methods , Risk Management/trends , SARS-CoV-2 , Triage/ethics , Triage/methods , Triage/organization & administration , Triage/standards
14.
Ann R Coll Surg Engl ; 103(7): 520-523, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288675

ABSTRACT

INTRODUCTION: In light of the COVID-19 recommendations from the Association of Coloproctology of Great Britain and Ireland, we aimed to study patient and clinician satisfaction with a newly established telephone (TP) colorectal clinic service in lieu of traditional face-to-face (FTF) appointments. Comparative outcomes included patient versus clinician satisfaction; patient versus clinician desire to continue TP clinics postpandemic; and views of Specialty Trainee 3+ (ST3+)/Specialty Associate Specialist (SAS) doctors versus consultants on TP compared with FTF appointments. METHODS: We conducted a prospective service evaluation of patient and clinician satisfaction with colorectal surgery TP clinics between 1 June 2020 and 30 June 2020 in a British District General Hospital. RESULTS: Patients had higher satisfaction than clinicians with TP clinics: 91.5% versus 66.6% reported above-average experience [odds ratio (OR) = 5.35, 95% confidence interval (CI) 1.53 to 18.75, p = 0.01]. Clinicians had lower demand to continue TP clinics post-COVID-19 versus patients, with a trend towards significance (60% versus 82.9%, OR = 0.31, 95% CI 0.10 to 0.97, p = 0.08). ST3+/SAS doctors were more likely than consultants to find TP clinics inferior to FTF consultation for patient assessment (48.3% versus 23.7%, OR = 3.00, 95% CI 1.17 to 7.71, p = 0.03). CONCLUSIONS: While clinicians may be concerned that patient assessment suffers, patient satisfaction with TP clinics is high. There should be a place for TP clinics post-COVID-19 but there must be a robust process for patient selection as well as adequate training for current and future generations of clinicians.


Subject(s)
COVID-19/prevention & control , Colorectal Neoplasms/diagnosis , Medical Oncology/methods , Remote Consultation/methods , Telephone , Aftercare/methods , Aftercare/standards , Aftercare/statistics & numerical data , COVID-19/epidemiology , COVID-19/transmission , Colorectal Neoplasms/therapy , Humans , Infection Control/standards , Job Satisfaction , Medical Oncology/standards , Medical Oncology/statistics & numerical data , Patient Satisfaction/statistics & numerical data , Prospective Studies , Remote Consultation/standards , Remote Consultation/statistics & numerical data , Surgeons/psychology , Surgeons/statistics & numerical data , Surveys and Questionnaires/statistics & numerical data , United Kingdom/epidemiology
15.
Diabetes Metab Syndr ; 15(4): 102174, 2021.
Article in English | MEDLINE | ID: covidwho-1267653

ABSTRACT

AIMS: To study the feasibility of diabetes education through telemedicine in patients with diabetes mellitus (DM) hospitalized for coronavirus disease 2019 (COVID-19) management. METHODS: This was a prospective study of 100 patients with DM who were admitted in a COVID isolation ward for management of COVID-19. Patients managed with multiple subcutaneous insulin injections were eligible. During teleconsultation, diabetes education including insulin injection technique was given by a diabetes educator via a phone call (audio and video) during hospitalization. They were also re-assessed after 2 weeks of discharge from the hospital via teleconsultation or in-person. RESULTS: Out of 100 patients, 72.0% had prior history of diabetes while 28.0% were newly diagnosed. The median age of our cohort was 56 years and median duration of diabetes was 7.0 years. Telemedicine as a mode of consult for diabetes education was accepted by 96.0% of patients during hospitalization. At 2 weeks' follow-up, 77.0% patients were following insulin instructions correctly and were satisfied with this mode of consultation. CONCLUSION: Diabetes education using telemedicine as a technology is feasible, acceptable, and effective in the management of most patients with DM. Telemedicine appears to be an effective way to replace routine visits in special situations.


Subject(s)
COVID-19/complications , Diabetes Mellitus/drug therapy , Hospitalization/statistics & numerical data , Insulin/administration & dosage , Remote Consultation/methods , SARS-CoV-2/isolation & purification , Adult , Aged , Aged, 80 and over , COVID-19/transmission , COVID-19/virology , Diabetes Mellitus/epidemiology , Diabetes Mellitus/pathology , Diabetes Mellitus/virology , Dose-Response Relationship, Drug , Female , Humans , Hypoglycemic Agents/administration & dosage , India/epidemiology , Male , Middle Aged , Prospective Studies
16.
BMJ Open Qual ; 10(2)2021 06.
Article in English | MEDLINE | ID: covidwho-1266386

ABSTRACT

The COVID-19 pandemic prompted a rapid change in primary care provision. There was a significant shift from face-to-face appointments to remote methods such as electronic consultation (e-consultation). Patients from a primary care provider in London were actively encouraged to use an online consultation platform called 'Dr iQ'. A group of high frequency users of Dr iQ emerged and clinicians were concerned their health needs were not being met through the platform. High frequency attendance in a traditional general practice setting is associated with increased time and healthcare costs.This project evaluated the number of high frequency users (identified as 10 or more consultations a month) of Dr iQ in one busy inner city practice over a 5-month period. We aimed to decrease the subsequent monthly usage frequency of all Dr iQ high frequency users from 10 or more consultations to less than 10 consultations. Our interventions included a semi-structured telephone interview, discussion among the multidisciplinary team, and regular scheduled telephone or face-to-face appointments. Following two Plan-Do-Study-Act cycles, all 12 high frequency users showed a decrease in the number of consultations submitted to Dr iQ to less than 10 consultations a month.This project proposes a method of case managing high frequency users of e-consultation. The majority of high frequency users had unmet health needs and felt a lack of continuity of care on Dr iQ. They often had complex physical and mental health problems. As remote consulting technology continues to develop, more research is required to understand the epidemiology and aetiology of e-consultation high frequency use in order to improve patient outcomes.


Subject(s)
Patient Acceptance of Health Care/statistics & numerical data , Remote Consultation/statistics & numerical data , Adult , COVID-19/prevention & control , COVID-19/transmission , Digital Technology/methods , Female , Humans , London , Male , Patient Satisfaction , Physician-Patient Relations , Primary Health Care/methods , Quality Improvement , Remote Consultation/methods
17.
Kardiol Pol ; 78(7-8): 725-731, 2020 08 25.
Article in English | MEDLINE | ID: covidwho-1264793

ABSTRACT

BACKGROUND: In the midst of the SARS­CoV­2 pandemic, basic healthcare challenges arise as lockdowns and social isolation are implemented to prevent the spread of the virus. In order to overcome these challenges, the Polish National Health Fund has facilitated telemedical consultations. AIMS: The aim of this study was to compare teleconsultations with regular visits at ambulatory clinic of implantable devices and to assess whether teleconsultations would be an adequate replacement during times of limited face­to­face contact. METHODS: Teleconsultations in the clinic were introduced for patients without the possibility of remote control of cardiac implantable electronic devices. Prior to planned visits, physicians phoned patients and interviewed them about their health. Further treatment decisions were made based on the interview and available medical records. RESULTS: Teleconsultations were carried out over 3.5 weeks (March 13 to April 1, 2020). Out of 400 patients who had visits planned at the clinic, 349 were consulted by phone. A total of 299 patients confirmed stable health status, 14 reported some symptoms, and 4 were hospitalized; 2 patients changed their primary clinic and were no longer under our care, 1 was undergoing quarantine, 15 required additional intervention, and 15 had died prior to contact. In general, patients gave positive feedback on their teleconsultations. CONCLUSIONS: Teleconsultations are a much­needed option during the SARS­CoV­2 pandemic. They are an effective way to decrease interpersonal contact and to overcome sudden changes to the ambulatory visit plan, which may otherwise put an overwhelming burden on the clinic.


Subject(s)
Cardiac Resynchronization Therapy Devices/statistics & numerical data , Coronavirus Infections , Defibrillators, Implantable/statistics & numerical data , Monitoring, Ambulatory/methods , Pandemics , Pneumonia, Viral , Remote Consultation/methods , Remote Sensing Technology/methods , COVID-19 , Female , Follow-Up Studies , Humans , Male
18.
BMC Fam Pract ; 22(1): 108, 2021 06 02.
Article in English | MEDLINE | ID: covidwho-1255906

ABSTRACT

BACKGROUND: Attempts to manage the COVID-19 pandemic have led to radical reorganisations of health care systems worldwide. General practitioners (GPs) provide the vast majority of patient care, and knowledge of their experiences with providing care for regular health issues during a pandemic is scarce. Hence, in a Danish context we explored how GPs experienced reorganising their work in an attempt to uphold sufficient patient care while contributing to minimizing the spread of COVID-19. Further, in relation to this, we examined what guided GPs' choices between telephone, video and face-to-face consultations. METHODS: This study consisted of qualitative interviews with 13 GPs. They were interviewed twice, approximately three months apart in the initial phase of the pandemic, and they took daily notes for 20 days. All interviews were audio recorded, transcribed, and inductively analysed. RESULTS: The GPs re-organised their clinical work profoundly. Most consultations were converted to video or telephone, postponed or cancelled. The use of video first rose, but soon declined, once again replaced by an increased use of face-to-face consultations. When choosing between consultation forms, the GPs took into account the need to minimise the risk of COVID-19, the central guidelines, and their own preference for face-to-face consultations. There were variations over time and between the GPs regarding which health issues were dealt with by using video and/or the telephone. For some health issues, the GPs generally deemed it acceptable to use video or telephone, postpone or cancel appointments for a short term, and in a crisis situation. They experienced relational and technical limitations with video consultation, while diagnostic uncertainty was not regarded as a prominent issue CONCLUSION: This study demonstrates how the GPs experienced telephone and video consultations as being useful in a pandemic situation when face-to-face consultations had to be severely restricted. The GPs did, however, identify several limitations similar to those known in non-pandemic times. The weighing of pros and cons and their willingness to use these alternatives shifted and generally diminished when face-to-face consultations were once again deemed viable. In case of future pandemics, such alternatives seem valuable, at least for a short term.


Subject(s)
Attitude of Health Personnel , COVID-19/prevention & control , General Practice/trends , Practice Patterns, Physicians'/trends , Remote Consultation/trends , COVID-19/epidemiology , Clinical Decision-Making/methods , Denmark/epidemiology , General Practice/methods , General Practice/organization & administration , Humans , Interviews as Topic , Pandemics , Physician-Patient Relations , Practice Patterns, Physicians'/organization & administration , Qualitative Research , Remote Consultation/methods , Remote Consultation/organization & administration , Telephone , Videoconferencing
19.
Cutis ; 107(4): E37-E39, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1239181

ABSTRACT

The COVID-19 pandemic resulted in profound changes to most facets of medical practice. The field of dermatology has adapted by rapidly incorporating teledermatology as a means of evaluating, treating, and staying connected with our patients. Broader dermatology access, convenience to patients, and value to payers are benefits to this rapidly evolving practice model and suggest that teledermatology will be a part of day-to-day practice even as the worst of the pandemic is behind us. This interview provides one recent dermatology resident graduate's experiences incorporating teledermatology into his practice model and provides advice for future residents on preparing to do the same.


Subject(s)
COVID-19/prevention & control , Remote Consultation/methods , Skin Diseases/therapy , Telemedicine/methods , COVID-19/epidemiology , Dermatology/standards , Humans
20.
J R Coll Physicians Edinb ; 51(1): 85-90, 2021 03.
Article in English | MEDLINE | ID: covidwho-1194768

ABSTRACT

Telemedicine use has expanded rapidly to cope with increasing demand on services by delivering remote clinical review and monitoring of long-term conditions. Triaging individual patients to determine their suitability for telephone, video or face-to-face consultations is necessary. This is crucial in the context of COVID-19 to ensure doctor-patient safety. Telemedicine was shown to be safe and feasible in managing certain chronic diseases and providing patient education. When reviewing newly referred or long-term patients, different specialty clinics have different requirements for physical examination. Clinicians prefer face-to-face consultations at the initial visit to establish a doctor-patient relationship; telephone or video consultations are reasonable options for long-term patients where physical examination may not be needed. Video consultations, often aided by sophisticated devices and apps or medical assistants, are useful to facilitate remote physical examination. Most patients prefer telemedicine as it saves time and travel cost and provides better access to appointments.


Subject(s)
Ambulatory Care , COVID-19 , Chronic Disease/therapy , Physical Examination/methods , Remote Consultation , Telemedicine , Ambulatory Care/methods , Ambulatory Care/standards , Ambulatory Care/trends , COVID-19/epidemiology , COVID-19/prevention & control , Forecasting , Humans , Long-Term Care/trends , Physician-Patient Relations , Remote Consultation/methods , Remote Consultation/standards , SARS-CoV-2 , Telemedicine/methods , Telemedicine/standards
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