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Journal of the American Board of Family... 2024This issue highlights changes in medical care delivery since the start of the COVID-19 pandemic and features research to advance the delivery of primary care. Several...
This issue highlights changes in medical care delivery since the start of the COVID-19 pandemic and features research to advance the delivery of primary care. Several articles report on the effectiveness of telehealth, including its use for hospital follow-up, medication abortion, management of diabetes, and as a potential tool for reducing health disparities. Other articles detail innovations in clinical practice, from the use of artificial intelligence and machine learning to a validated simple risk score that can support outpatient triage decisions for patients with COVID-19. Notably one article reports the impact of a voluntary program using scribes in a large health system on physician documentation behaviors and performance. One article addresses the wage gap between early-career female and male family physicians. Several articles report on inappropriate testing for common health problems; are you following recommendations for ordering Pulmonary Function Tests, mt-sDNA for colon cancer screening, and HIV testing?
Topics: Humans; Artificial Intelligence; Family Practice; COVID-19; Telemedicine; Big Data; SARS-CoV-2; Quality Improvement; Primary Health Care; Pandemics
PubMed: 38740469
DOI: 10.3122/jabfm.2024.240050R0 -
The American Journal of Managed Care May 2024Challenges in implementing telemedicine disproportionately affect patients served in safety-net settings. Few studies have elucidated pragmatic, team-based strategies...
OBJECTIVES
Challenges in implementing telemedicine disproportionately affect patients served in safety-net settings. Few studies have elucidated pragmatic, team-based strategies for successful telemedicine implementation in primary care, especially with a safety-net population.
STUDY DESIGN
We conducted in-depth, semistructured qualitative interviews with primary care clinicians and staff in a large urban safety-net health care system on the facilitators, challenges, and impact of implementing team workflows for synchronous telemedicine video and audio-only visits.
METHODS
Interviews were analyzed using modified grounded theory with multistage coding. Common themes were identified and reviewed to describe within-group and between-group variations. We used the Practical, Robust Implementation Sustainability Model framework to organize the final themes with an implementation science lens.
RESULTS
Four themes emerged from 11 interviews: (1) having a dedicated individual preparing patients for video visits is a prerequisite for the successful introduction of video visits to patients with limited digital literacy; (2) health care maintenance during video and audio-only visits benefits from standardized workflows and communication; (3) the increased flexibility and accessibility of telemedicine visits were perceived benefits to patient care, despite barriers for subsets of patients; and (4) telemedicine visits generally have a positive impact on work experience for clinicians and staff due to increased efficiency, despite audio-only visits feeling less engaging.
CONCLUSIONS
Understanding how to strategically use team-based workflows to expand video visit access while ensuring care quality of all telemedicine visits will allow primary care practices to maximize telemedicine's benefits to patients in the safety-net setting.
Topics: Humans; Telemedicine; Primary Health Care; Workflow; Safety-net Providers; Patient Care Team; Qualitative Research; Female; Interviews as Topic; Male; Adult
PubMed: 38820184
DOI: 10.37765/ajmc.2024.89550 -
Family Practice Nov 2023There is a growing interest in the use of digital technologies to foster learning in the health professions, along with the drive to expand teleconsultations arising...
BACKGROUND
There is a growing interest in the use of digital technologies to foster learning in the health professions, along with the drive to expand teleconsultations arising from the COVID-19 pandemic. This study aims to explore whether telemedicine between levels of care can act as continuous medical education (CME) tool for general practitioners (GPs) and hospital consultants at the referral cardiology department.
METHODS
This qualitative study was embedded in an organizational case study of the introduction of a new service model in the Portuguese health system. Semi-structured interviews were audio-recorded and pseudonymized. The transcribed interviews were stored, coded, and content analysis was performed in MAXQDA.
RESULTS
A total of 11 physicians were interviewed. GPs and cardiologists recognized that telemedicine between levels of care could act as a CME tool. Although they departed with different expectations, telemedicine helped them collaborate as a multidisciplinary team, exchanging feedback about clinical decisions, and constructing knowledge collaboratively. Telemedicine also supplemented existing learning meetings. The consequences of technology adoption may be viewed as a result of the actors involved (including the technology itself), characteristics of the context (including the organization), and an interaction between such factors.
CONCLUSION
Teleconsultations can be a learning opportunity for the health professionals involved. Our findings suggest that, in the context of the Portuguese health system, telemedicine as a CME tool helped to build multidisciplinary teams which exchanged feedback and constructed shared knowledge to improve patients' outcomes. It also helped to identify practice-changing contents to be included in face-to-face educational meetings.
Topics: Humans; Education, Medical, Continuing; Pandemics; Telemedicine; Remote Consultation; Learning
PubMed: 37579324
DOI: 10.1093/fampra/cmad085 -
Annual Review of Vision Science Sep 2023This narrative review summarizes the literature on factors related to eye care access and utilization in the United States. Using the Healthy People 2030 framework, this... (Review)
Review
This narrative review summarizes the literature on factors related to eye care access and utilization in the United States. Using the Healthy People 2030 framework, this review investigates social determinants of health associated with general and follow-up engagement, screenings, diagnostic visits, treatment, technology, and teleophthalmology. We provide hypotheses for these documented eye care disparities, featuring qualitative, patient-centered research. Lastly, we provide recommendations in the hopes of appropriately eliminating these disparities and reimagining eye care.
Topics: Humans; Ophthalmology; Telemedicine; Vision Disparity
PubMed: 37254050
DOI: 10.1146/annurev-vision-112122-020934 -
BMC Medical Informatics and Decision... Apr 2024The use of telemedicine technology has significantly increased in recent years, particularly during the Covid-19 pandemic. This study aimed to investigate the use of... (Review)
Review
BACKGROUND
The use of telemedicine technology has significantly increased in recent years, particularly during the Covid-19 pandemic. This study aimed to investigate the use of telemedicine technology for cancer patients during the Covid-19 pandemic.
METHODS
This was a scoping review conducted in 2023. Various databases including PubMed, Web of Science, Scopus, Cochrane Library, Ovid, IEEE Xplore, ProQuest, Embase, and Google Scholar search engine were searched. All quantitative, qualitative, and mixed-method studies published in English between 2020 and 2022 were included. Finally, the needed data were extracted, and the results were synthesized and reported narratively.
RESULTS
A total of 29 articles were included in this review. The results showed that teleconsultation, televisit, and telerehabilitation were common telemedicine services, and video conferencing and telephone were common technologies used in these studies. In most cases, patients and healthcare providers preferred these services compared to the face-to-face consultations due to their convenience and advantages. Furthermore, the findings revealed that in terms of clinical outcomes, telemedicine could effectively reduce anxiety, pain, sleep disorders, and hospital admission rates.
CONCLUSION
The findings provided valuable insights into the various telemedicine technologies, services, users' perspectives, and clinical outcomes in cancer patients during the Covid-19 pandemic. Overall, the positive outcomes and users' satisfaction showed that the use of telemedicine technology can be expanded, particularly in cancer care. Future research needs to investigate both clinical and non-clinical effectiveness of using various telemedicine services and technologies for improving cancer care delivery, which can help to develop more successful strategies for implementing this technology.
Topics: Humans; COVID-19; Pandemics; Telemedicine; Remote Consultation; Anxiety Disorders; Neoplasms
PubMed: 38641567
DOI: 10.1186/s12911-024-02507-1 -
Contact Lens & Anterior Eye : the... Oct 2023COVID-19 spread to numerous countries, overwhelming healthcare systems and economies worldwide. COVID-19 restrictions have prevented patients from attending...
PURPOSE
COVID-19 spread to numerous countries, overwhelming healthcare systems and economies worldwide. COVID-19 restrictions have prevented patients from attending consultations in person and led to the further development of telemedicine to provide health care. The situation also applies to contact lens (CL) practitioners and their patients; telemedicine enables practitioners to provide patients with regular and continuing care. This study aimed to investigate available tools to enable continuing care for rigid gas permeable (RGP) CL wearers who are unable to attend face-to-face consultations.
METHODS
The study consists of three components. Firstly, an approach to enable the assessment of a patient's CL fitting and cornea remotely. Secondly, to find an affordable and reliable method to obtain a patient's visual acuity (VA), and thirdly, to develop a questionnaire to provide practitioners with information to deliver optimal patient care.
RESULTS
The use of a macro lens, smartphone, and auxiliary materials enables high-quality images of the anterior eye and RGP CL to be obtained. Two free and validated smartphone applications (apps) for VA measurements were identified which are available on Android and iOS systems. Two questionnaires were also developed to enable practitioners to obtain additional patient information to facilitate optimal patient care.
CONCLUSION
This study has developed the components of a remote CL consultation to enable patients who cannot attend scheduled appointments to receive care and advice to ensure the safety of their RGP CL wear. The tools involved in this study are low-cost, affordable, and an adjunct, not a substitute, for face-to-face consultations.
Topics: Contact Lenses; COVID-19; Referral and Consultation; Visual Acuity; Telemedicine; Cornea; Humans
PubMed: 37482438
DOI: 10.1016/j.clae.2023.101893 -
JAMA Network Open Sep 2023
Topics: Female; Pregnancy; Humans; Telemedicine; Abortion, Induced
PubMed: 37656461
DOI: 10.1001/jamanetworkopen.2023.31900 -
Journal of Clinical Nursing Sep 2023To evaluate the effectiveness of eHealth interventions to reduce stress and promote mental health in healthcare professionals, and to compare the efficacy of different... (Review)
Review
AIMS
To evaluate the effectiveness of eHealth interventions to reduce stress and promote mental health in healthcare professionals, and to compare the efficacy of different types of programs (guided vs. self-guided; 'third-wave' psychotherapies vs. other types).
BACKGROUND
Healthcare workers present high levels of stress, which constitutes a risk factor for developing mental health problems such as depression and anxiety. eHealth interventions have been designed to reduce these professional's stress considering that the characteristics of this delivery method make it a cost-effective and very appealing alternative because of its fast and easy access.
DESIGN
A systematic review of quantitative studies.
METHODS
A comprehensive database search for quantitative studies was conducted in PubMed, EMBASE and Cochrane (until 1 April 2022). The systematic review was conducted in accordance with the PRISMA and SWiM reporting guidelines. The quality of the studies was assessed using the National Heart, Lung and Blood Institute tools.
RESULTS
The abstracts of 6349 articles were assessed and 60 underwent in-depth review, with 27 fulfilling the inclusion criteria. The interventions were classified according to their format (self-guided vs. guided) and contents ('third-wave' psychotherapies vs. others). Twenty-two interventions emerged, 13 of which produced significant posttreatment reductions in stress levels of health professionals (9 self-guided, 8 'third wave' psychotherapies). Significant effects in improving depressive symptomatology, anxiety, burnout, resilience and mindfulness, amongst others, were also found.
CONCLUSION
The evidence gathered in this review highlights the heterogeneity of the eHealth interventions that have been studied; self-guided and 'third-wave' psychotherapy programs are the most common, often with promising results, although the methodological shortcomings of most studies hinder the extraction of sound conclusions.
PROTOCOL REGISTRATION
PROSPERO CRD42022310199. No Patient or Public Contribution.
Topics: Humans; Health Personnel; Mental Health; Telemedicine; Health Promotion; Mindfulness
PubMed: 36703266
DOI: 10.1111/jocn.16634 -
JAMA Health Forum Oct 2023
Topics: Controlled Substances; Sulfadiazine; Telemedicine
PubMed: 37862032
DOI: 10.1001/jamahealthforum.2023.3251 -
Journal of the American Board of Family... Oct 2023Federally qualified health centers (FQHCs) rapidly adopted and implemented telemedicine during the COVID-19 pandemic. This study analyzes FQHC personnel accounts of care...
BACKGROUND
Federally qualified health centers (FQHCs) rapidly adopted and implemented telemedicine during the COVID-19 pandemic. This study analyzes FQHC personnel accounts of care redesign strategies to support telemedicine implementation in 2020 and 2021, and identifies improvement opportunities.
METHODS
We conducted semistructured, in-depth interviews with clinic personnel (n = 15) at 2 FQHCs in Northern California (December 2020-April 2021) to examine telemedicine adoption and use of audio-video and audio-only/phone telemedicine encounters.
RESULTS
FQHC clinicians and staff reported that telemedicine implementation increased access to care and reduced appointment no-show rates. However, a reported reduced ability to develop and foster interpersonal connections negatively impacted clinician-patient relationships. Care redesign strategies included systems to triage appointment types (in-person versus virtual), work-arounds to screen for and address social and nonmedical needs, and new protocols to navigate privacy needs for first time telemedicine users. In addition, increasing remote monitoring capabilities was deemed an important priority for improving telemedicine use for marginalized populations.
CONCLUSIONS
Telemedicine implementation in FQHCs involved care redesign to optimize virtual interactions and care processes. Guidelines and evidence-based practices are needed to improve telemedicine use in FQHCs, including strategies to support interpersonal connections; approaches to virtually screen for and address social needs; and protocols to further mitigate privacy issues. Future research is needed to identify when telemedicine can optimally supplement in-person care to improve patient outcomes and clinic efficiency, particularly in safety net settings.
Topics: Humans; COVID-19; Pandemics; Telemedicine; Health Personnel; Ambulatory Care Facilities
PubMed: 37648403
DOI: 10.3122/jabfm.2022.220370R2