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Multidisciplinary teams, efficient communication, procedure services, and telehealth improve cirrhosis care: A qualitative study.
Serper, Marina; Agha, Aneeza; Garren, Patrik A; Taddei, Tamar H; Kaplan, David E; Groeneveld, Peter W; Werner, Rachel M; Shea, Judy A.
  • Serper M; Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Agha A; Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
  • Garren PA; Leonard David Institute of Health Economics, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Taddei TH; Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, Pennsylvania, USA.
  • Kaplan DE; School of Nursing, NewCourtland Center for Transitions in Health, Department of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Groeneveld PW; Division of Digestive Diseases, Yale University School of Medicine, Department of Medicine, New Haven, Connecticut, USA.
  • Werner RM; VA Connecticut Healthcare System, Department of Medicine, West Haven, Connecticut, USA.
  • Shea JA; Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Hepatol Commun ; 7(6)2023 06 01.
Article in English | MEDLINE | ID: covidwho-2326175
ABSTRACT

BACKGROUND:

Cirrhosis care and outcomes are improved with access to subspecialty gastroenterology and hepatology care. In qualitative interviews, we investigated clinicians' perceptions of factors that optimize or impede cirrhosis care.

METHODS:

We conducted 24 telephone interviews with subspecialty clinicians at 7 Veterans Affairs medical centers with high- and low-complexity services. Purposive sampling stratified Veterans Affairs medical centers on timely post-hospitalization follow-up, a quality measure. We asked open-ended questions about facilitators and barriers of care coordination, access to appointments, procedures, transplantation, management of complications, keeping up to date with medical knowledge, and telehealth use.

RESULTS:

Key themes that facilitated care were structural multidisciplinary teams, clinical dashboards, mechanisms for appointment tracking and reminders, and local or virtual access to transplant and liver cancer specialists through the "specialty care access network extension for community health care outcomes" program. Coordination and efficient communication between transplant and non-transplant specialists and between transplant and primary care facilitated timely care. Same-day access to laboratory, procedural, and clinical services is an indicator of high-quality care. Barriers included lack of on-site procedural services, clinician turnover, patient social needs related to transportation, costs, and patient forgetfulness due to HE. Telehealth enabled lower complexity sites to obtain recommendations for complex patient cases. Barriers to telehealth included lack of credit (eg, VA billing equivalent), inadequate staff, lack of audiovisual technology support, and patient and staff discomfort with technology. Telehealth was optimal for return visits, cases where physical examination was nonessential, and where distance and transportation precluded in-person care. Rapid telehealth uptake during the COVID-19 pandemic was a positive disruptor and facilitated use.

CONCLUSIONS:

We identify multi-level factors related to structure, staffing, technology, and care organization to optimize cirrhosis care delivery.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / COVID-19 Type of study: Cohort study / Prognostic study / Qualitative research Limits: Humans Language: English Year: 2023 Document Type: Article Affiliation country: Hc9.0000000000000157

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / COVID-19 Type of study: Cohort study / Prognostic study / Qualitative research Limits: Humans Language: English Year: 2023 Document Type: Article Affiliation country: Hc9.0000000000000157