Problem solving team interventions: Web-based and consultant-based experimental evaluations.

This research was designed to develop, implement, and evaluate an assessment and intervention protocol to increase problem-solving teams' (PSTs) adoption and implementation of evidence-based practices aimed at students with disruptive behavior problems. Participants included 15 PSTs. Adopting single-case design methodology, we examined whether a customized set of assessment and intervention consultant-led intervention procedures could be used to improve the activities, process, and recommendations of PSTs compared to a web-based intervention. We were interested in evaluating two variations of the problem-solving model based on the team initiated problem-solving (TIPS) approach. TIPS includes steps to successful problem solving and solution implementation for student academic and behavioral concerns. Based on visual analysis and statistical randomization tests, we found that a teleconsultation web-based model of PST intervention was not effective in improving the functioning of the PST. In contrast, a customized, consultation-led intervention model with PST facilitators that followed this approach was found to be effective in improving both the foundation and thoroughness of the PST's problem solving. Implications of future PST improvement models for practice and research are discussed.

Quality and Dependability of ChatGPT and DingXiangYuan Forums for Remote Orthopedic Consultations: Comparative Analysis.

BACKGROUND: The widespread use of artificial intelligence, such as ChatGPT (OpenAI), is transforming sectors, including health care, while separate advancements of the internet have enabled platforms such as China's DingXiangYuan to offer remote medical services. OBJECTIVE: This study evaluates ChatGPT-4's responses against those of professional health care providers in telemedicine, assessing artificial intelligence's capability to support the surge in remote medical consultations and its impact on health care delivery. METHODS: We sourced remote orthopedic consultations from "Doctor DingXiang," with responses from its certified physicians as the control and ChatGPT's responses as the experimental group. In all, 3 blindfolded, experienced orthopedic surgeons assessed responses against 7 criteria: "logical reasoning," "internal information," "external information," "guiding function," "therapeutic effect," "medical knowledge popularization education," and "overall satisfaction." We used Fleiss κ to measure agreement among multiple raters. RESULTS: Initially, consultation records for a cumulative count of 8 maladies (equivalent to 800 cases) were gathered. We ultimately included 73 consultation records by May 2023, following primary and rescreening, in which no communication records containing private information, images, or voice messages were transmitted. After statistical scoring, we discovered that ChatGPT's "internal information" score (mean 4.61, SD 0.52 points vs mean 4.66, SD 0.49 points; P=.43) and "therapeutic effect" score (mean 4.43, SD 0.75 points vs mean 4.55, SD 0.62 points; P=.32) were lower than those of the control group, but the differences were not statistically significant. ChatGPT showed better performance with a higher "logical reasoning" score (mean 4.81, SD 0.36 points vs mean 4.75, SD 0.39 points; P=.38), "external information" score (mean 4.06, SD 0.72 points vs mean 3.92, SD 0.77 points; P=.25), and "guiding function" score (mean 4.73, SD 0.51 points vs mean 4.72, SD 0.54 points; P=.96), although the differences were not statistically significant. Meanwhile, the "medical knowledge popularization education" score of ChatGPT was better than that of the control group (mean 4.49, SD 0.67 points vs mean 3.87, SD 1.01 points; P<.001), and the difference was statistically significant. In terms of "overall satisfaction," the difference was not statistically significant between the groups (mean 8.35, SD 1.38 points vs mean 8.37, SD 1.24 points; P=.92). According to how Fleiss κ values were interpreted, 6 of the control group's score points were classified as displaying "fair agreement" (P<.001), and 1 was classified as showing "substantial agreement" (P<.001). In the experimental group, 3 points were classified as indicating "fair agreement," while 4 suggested "moderate agreement" (P<.001). CONCLUSIONS: ChatGPT-4 matches the expertise found in DingXiangYuan forums' paid consultations, excelling particularly in scientific education. It presents a promising alternative for remote health advice. For health care professionals, it could act as an aid in patient education, while patients may use it as a convenient tool for health inquiries.

Teleconsultation dynamic scheduling with a deep reinforcement learning approach.

In this study, the start time of teleconsultations is optimized for the clinical departments of class A tertiary hospitals to improve service quality and efficiency. For this purpose, first, a general teleconsultation scheduling model is formulated. In the formulation, the number of services (NS) is one of the objectives because of demand intermittency and service mobility. Demand intermittency means that demand has zero size in several periods. Service mobility means that specialists move between clinical departments and the National Telemedicine Center of China to provide the service. For problem-solving, the general model is converted into a Markov decision process (MDP) by elaborately defining the state, action, and reward. To solve the MDP, deep reinforcement learning (DRL) is applied to overcome the problem of inaccurate transition probability. To reduce the dimensions of the state-action space, a semi-fixed policy is developed and applied to the deep Q network (DQN) to construct an algorithm of the DQN with a semi-fixed policy (DQN-S). For efficient fitting, an early stop strategy is applied in DQN-S training. To verify the effectiveness of the proposed scheduling model and the model solving method DQN-S, scheduling experiments are carried out based on actual data of teleconsultation demand arrivals and service arrangements. The results show that DQN-S can improve the quality and efficiency of teleconsultations by reducing 9%-41% of the demand average waiting time, 3%-42% of the number of services, and 3%-33% of the total cost of services.

[Implementation of teleconsultation in hospitals in the city of Cordoba during the SARS-CoV-2 pandemic] / Implementación de la teleconsulta en hospitales de Córdoba Capital durante la pandemia de SARS-CoV-2.

Teleconsultation is one of the assets of telemedicine that allows medical professionals to provide diagnostic or therapeutic advice to patients through electronic means. The objective of this study was to estimate the frequency of teleconsultation implementation in hospitals in the city of Cordoba from 2020 to 2022. A descriptive, observational and cross-sectional study was carried out, providing an online survey (Google Forms) to hospital representatives in Córdoba. Descriptive statistics were used. The study was conducted in 30 out of the 50 hospitals in the city, including 17 private (57%) and 13 public institutions (43%). Teleconsultation was provided by a higher percentage of private healthcare facilities (82%) compared to public ones (77%). The results showed that the SARS-CoV-2 pandemic was the main driver behind the implementation of teleconsultation, with 92% of all hospitals having implemented it due to the pandemic while the remaining 8% had already offered this service prior to the pandemic. The most requested services were Internal Medicine and Infectology, and phone calls were the most commonly used tool. Among the hospitals that did not offer teleconsultation, 67% did not plan to do so in the future, while the remaining 33% were making arrangements for its implementation in 2023. Although the pandemic catalyzed the implementation of teleconsultations in most hospitals, there are still some institutions that do not plan to incorporate this modality. This study provides valuable data for improving future medical care strategies in the city of Cordoba.

La teleconsulta es una de las prestaciones de la telemedicina, definida como el conjunto de interacciones médico-paciente cuyo fin es el de proporcionar asesoramiento diagnóstico o terapéutico a través de medios electrónicos. El objetivo principal del presente trabajo es estimar la frecuencia de la implementación de la teleconsulta en hospitales de la ciudad de Córdoba durante el periodo 2020-2022. Se realizó un estudio descriptivo, observacional y transversal, brindando una encuesta online (Google Forms) a directivos de los hospitales de Córdoba Capital. Se utilizaron estadísticos descriptivos. Se pudo entrevistar a 30 representantes de los 50 nosocomios que tenía la ciudad, de los cuales 17 eran privados (57%) y 13 públicos (43%). El 82% de los privados ofrecía teleconsulta versus 77% de los públicos. El 92% del total la implementó por la pandemia de SARS-CoV-2 y el otro 8% la ofrecía previamente. Los servicios más demandados fueron Clínica Médica e Infectología. La llamada telefónica fue la herramienta más utilizada. Sobre los nosocomios que no ofrecieron teleconsulta, 67% no planea hacerlo a futuro, y el resto está realizando gestiones para su aplicación en el 2023. La pandemia de SARS-CoV-2 catalizó la implementación de teleconsultas en la mayoría de los hospitales relevados. A pesar de aumentar la accesibilidad a la consulta, aún hay algunos hospitales que no planean incorporar esta modalidad. Contar con estos datos puede constituir una base para mejorar estrategias futuras de atención médica en la ciudad de Córdoba.

A Systematic Review of Publications on Perceptions and Management of Chronic Medical Conditions Using Telemedicine Remote Consultations by Primary Healthcare Professionals April 2020 to December 2021 During the COVID-19 Pandemic.

Telemedicine technologies allow distribution of health-related services and information and can include electronic and telecommunication technologies, remote patient and clinician contact, referral and prescribing, patient education, and monitoring. This systematic review aimed to evaluate publications on the perceptions and management of chronic medical conditions using telehealth remote consultations by primary healthcare professionals between April 2020 and December 2021 during the COVID-19 pandemic. Electronic databases, including Cinhal, PubMed, Science Direct, and ProQuest were searched to extract qualitative studies relevant to the topic. Inclusion criteria were developed based on the Population, Exposure, and Outcomes scoping framework. The target population was healthcare professionals working in primary care settings. Included studies encompassed various types of telemedicine, such as synchronous telemedicine, video conferencing, telephone conversations, and smart devices. Eight studies were included. Synchronous telemedicine was highly effective in ensuring the continuity of care and treatment, providing patients with convenience, improved access to treatment, and earlier disease management. Video conferencing and telephone consultations were the most common methods used. Challenges included concerns about patient privacy, technology literacy, and acceptance. Telemedicine was commended for its ability to provide access to immediate expert medical advice and eliminate the need for long-distance travel, contributing to increased patient compliance. Synchronous telemedicine is a promising solution for managing chronic conditions during and after the COVID-19 pandemic, offering benefits to patients and healthcare professionals. To maximize its potential, concerns regarding patient privacy, confidentiality, and technology literacy need to be addressed. Proper legislation and regulations are required for long-term success of telemedicine, making it a valuable component of healthcare systems.

[Scope and limitations of teleconsultation during the covid-19 pandemic: accounts from primary healthcare professionals in the Autonomous City of Buenos Aires]. / Alcances y limitaciones de la teleconsulta en pandemia de covid-19: relatos de profesionales de la salud del primer nivel de atención de la Ciudad Autónoma de Buenos Aires.

The aim was to explore the scope and limitations of teleconsultation during the pandemic from the perspective of primary care physicians at the Hospital Italiano de Buenos Aires, a private institution located in the Autonomous City of Buenos Aires. A qualitative study was conducted with ten individual semi-structured interviews between January and April 2022. The three major emerging topics were the transition to virtuality, accessibility, and the new care model. Obstacles were related to the massive, forced, and unplanned implementation of teleconsultations. The main benefits included providing care during isolation-distancing and addressing epidemiological doubts. Changes were highlighted in care strategies, consultation frameworks, exchange among colleagues, referral criteria, requests for complementary studies, and in the profiles of those seeking consultations. A misuse of the system by individuals and a trivialization of the consultation moment emerged. The rise of communication and information technologies undoubtedly allowed the continuity of healthcare processes, but it does not replace in-person care, and normative guidelines are needed for its continuity.

El objetivo fue explorar alcances y limitaciones de la teleconsulta en pandemia, desde la perspectiva de médicos y médicas del primer nivel de atención del Hospital Italiano de Buenos Aires, una institución privada ubicada en la Ciudad Autónoma de Buenos Aires. Se realizó un estudio cualitativo con diez entrevistas semiestructuradas individuales entre enero y abril de 2022. Los tres grandes tópicos emergentes fueron la transición a la virtualidad, la accesibilidad y el nuevo modelo de atención. Los obstáculos se relacionaron con la implementación masiva, forzada y no planificada de las teleconsultas. Los principales beneficios fueron brindar atención durante el aislamiento-distanciamiento y evacuar dudas epidemiológicas. Se destacan cambios en estrategias de atención, encuadre de las consultas, intercambio entre colegas, criterios de derivación y de pedido de estudios complementarios, y en los perfiles de consultantes. Surgió un sobreuso del sistema por parte de las personas, y una banalización del momento de la consulta. El auge de las tecnologías de la comunicación e información indudablemente permitió dar continuidad a los procesos asistenciales en salud, pero no reemplaza la presencialidad y se requieren lineamientos normativos para su continuidad.

Digitally-mediated coordination in healthcare: the effects of teleconsultation on doctor-to-doctor relational coordination.

BACKGROUND: Digitalization transforms the way in which interdependent work is coordinated, especially in healthcare settings. This work deepens the effect of teleconsultation use on health professionals' coordination. For this aim, we rely on Relational Coordination Theory (RCT), which explores coordination as an interactive process among group participants within the context of task interdependency. METHODS: We collected data through an online survey administered to Italian specialist doctors between March and April 2023. 489 complete answers were gathered. Hypotheses have been tested through Structural Equation Modelling. RESULTS: We found that teleconsultation frequency of use has a positive and significant effect on both components of relational coordination, confirming our hypotheses. CONCLUSIONS: Theoretically, this research contributes to our understanding of the effect of digitally mediated coordination mechanisms on relational coordination. In practice, we shed light on the organizational implications of telemedicine under a novel perspective, focusing on the role of professional interactions in digitally mediated work and providing useful elements for the organizational design of telemedicine.

Key Factors Influencing the Operationalization and Effectiveness of Telemedicine Services in Henan Province, China: Cross-Sectional Analysis.

BACKGROUND: Telemedicine has demonstrated its potential in alleviating the unbalanced distribution of medical resources across different regions. Henan, a province in China with a population of approximately 100 million, is especially affected by a health care divide. The province has taken a proactive step by establishing a regional collaborative platform for telemedicine services provided by top-tier provincial hospitals. OBJECTIVE: We aim to identify the key factors that influence the current operationalization and effectiveness of telemedicine services in Henan province. The insights gained from this study will serve as valuable references for enhancing the efficient operation of telemedicine platforms in low- and middle-income regions. METHODS: We analyzed service reports from the performance management system of telemedicine services in Henan province throughout 2020. Using descriptive statistics and graphical methods, we examined key influencing factors, such as management competency; device configuration; and hospital capability, capacity, and service efficacy, across hospitals at 2 different tiers. In addition, we used generalized linear models and multiple linear regression models to identify key operational factors that significantly affect the service volume and efficacy of 2 major telemedicine services, namely teleconsultation and tele-education. RESULTS: Among the 89 tier 3 hospitals and 97 tier 2 hospitals connected to the collaborative telemedicine platform, 65 (73%) and 55 (57%), respectively, have established standardized management procedures for telemedicine services. As the primary delivery method for telemedicine services, 90% (80/89) of the tier 3 hospitals and 94% (91/97) of the tier 2 hospitals host videoconferencing consultations through professional hardware terminals rather than generic computers. Teleconsultation is the dominant service type, with an average annual service volume per institution of 173 (IQR 37-372) and 60 (IQR 14-271) teleconsultations for tier 3 and tier 2 hospitals, respectively. Key factors influencing the service volume at each hospital include available funding, management competency, the number of connected upper tiers, and the number of professional staff. After receiving teleconsultations from tier 3 (65/89, 73%) and tier 2 (61/97, 63%) hospitals, patients reported significant improvements in their medical conditions. In addition, we observed that service efficacy is positively influenced by management competency, financial incentives, the number of connected upper or lower tiers, and the involvement of participating medical professionals. CONCLUSIONS: Telemedicine has become increasingly popular in Henan province, with a notable focus on teleconsultation and tele-education services. Despite its popularity, many medical institutions, especially tier 2 hospitals, face challenges related to management competency. In addition to enhancing the effectiveness of existing telemedicine services, health care decision-makers in Henan province and other low- and middle-income regions should consider expanding the service categories, such as including remote emergency care and telesurgery, which have promise in addressing crucial health care needs in these regions.

Family Physician-to-Hospital Specialist Electronic Consultation and Access to Hospital Care: A Systematic Review.

Importance: Globally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)-defined as asynchronous, consultative communication between family physicians and hospital specialists-may offer advantages to face these challenges. Objective: To provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals. Evidence Review: A systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence. Findings: The search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies. Conclusions and Relevance: In this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.

How Is Telehealth Currently Being Utilized to Help in Hypertension Management within Primary Healthcare Settings? A Scoping Review.

Telehealth has improved patient access to healthcare services and has been shown to have a positive impact in various healthcare settings. In any case, little is understood regarding the utilization of telehealth in hypertension management in primary healthcare (PHC) settings. This study aimed to identify and classify information about the types of interventions and types of telehealth technology in hypertension management in primary healthcare. A scoping review based on PRISMA-ScR was used in this study. We searched for articles in four databases: Pubmed, Scopus, Science Direct, and Embase in English. The selected articles were published in 2013-2023. The data were extracted, categorized, and analyzed using thematic analysis. There were 1142 articles identified and 42 articles included in this study. Regarding the proportions of studies showing varying trends in the last ten years, most studies came from the United States (US) (23.8%), were conducted in urban locations (33.3%), and had a quantitative study approach (69%). Telehealth interventions in hypertension management are dominated by telemonitoring followed by teleconsultation. Asynchronous telehealth is becoming the most widely used technology in managing hypertension in primary care settings. Telehealth in primary care hypertension management involves the use of telecommunications technology to monitor and manage blood pressure and provide medical advice and counselling remotely.

Infant and early childhood teleconsultation and training: Program description and feasibility outcomes from a statewide implementation.

To address high rates of mental health and developmental concerns facing young children ages 0-6 in the United States and internationally, providers across professional sectors need Infant and early childhood mental health (IECMH) training and support. The training and teleconsultation program (TTP) is a state-funded program developed in one Mountain West state in the United States to provide free IECMH training and teleconsultation to any provider working with young children. The TTP included access to webinars and individual or group consultation with licensed mental health providers. Webinars focused on increasing awareness and knowledge related to attachment and child development, supporting parents and caregivers, trauma-informed practice, supporting emotional health of staff and providers, and culturally responsive practices with infants, young children, and caregivers. Teleconsultation included case consultation, reflective individual and group supervision, and collaboration supports/referrals. During the 18-month evaluation period, 1568 unique providers engaged in either training or teleconsultation services, an average of 9% growth in new providers each month, with representation from all professional sectors and all state counties. This program demonstrates the feasibility and need for statewide training and teleconsultation programs to help meet the needs of providers who interact with and support young children and caregivers.

Para lidiar con las altas tasas de salud mental y preocupaciones sobre el desarrollo a las que se enfrentan los pequeños niños de edad 0-6 en los Estados Unidos e internacionalmente, quienes proveen el servicio dentro de la gama de todos los sectores profesionales necesitan entrenamiento y apoyo en el campo de la salud mental infantil y la temprana niñez (IECMH). El programa de entrenamiento y teleconsulta (TTP) es un programa con fondos estatales desarrollado en un estado del oeste montañoso en los Estados Unidos para ofrecer entrenamiento y teleconsulta gratis en IECMH a cualquier profesional que trabaja con niños pequeños. El TTP incluye acceso a seminarios web y consulta individual o en grupo con profesionales licenciados de la salud mental. Los seminarios web se enfocaron en incrementar la conciencia y el conocimiento relacionado con la afectividad y el desarrollo del niño, apoyar a progenitores y cuidadores, la práctica con atención informada sobre trauma, apoyar la salud emocional del personal y los proveedores, así como las prácticas culturalmente sensibles con los infantes, niños pequeños y quienes les cuidan. La teleconsulta incluyó consulta de casos, supervisión con reflexión tanto individual como de grupo, así como los apoyos/referencias colaborativas. Durante el período de evaluación de 18 meses, 1,568 proveedores con características particulares recibieron los servicios del entrenamiento o de la teleconsulta, un promedio de 9% de aumento de nuevos proveedores cada mes, con representación de todos los sectores profesionales y todos los condados del estado. Este programa demuestra la posibilidad y necesidad de programas de entrenamiento y teleconsulta a través de todo el estado para ayudar a satisfacer las necesidades de los proveedores que interactúan con y apoyan a los niños pequeños y quienes les cuidan.

Pour faire face aux taux élevés d'inquiétudes en matière de santé mentale et de comportement dont sont témoins les jeunes enfants âgés de 0-6 ans aux Etats-Unis et internationalement, les prestataires au travers des secteurs professionnels ont besoin de formation et de soutien en santé mentale du nourrisson et de la petite enfance (IECMH). Le programme de téléconsultation et de formation (TTP en anglais) est un programme financé au niveau de l'état développé dans un état des montagnes rocheuses aux Etats-Unis afin d'offrir une formation et une téléconsultation IECMH gratuite à tout prestataire travaillant avec de jeunes enfants. Le TTP a incorporé un accès à des webinaires et à une consultation individuelle ou de groupe avec des prestataires de santé mentale agréés. Les webinaires ont porté sur l'accroissement de la sensibilisation et des connaissances liées à l'attachement et au développement de l'enfant, au soutien des parents et des personnes prenant soin des enfants, à une pratique consciente des traumas, et au soutien de la santé émotionnelle des employés et des prestataires, et à des pratiques culturellement adaptées avec les nourrissons, les jeunes enfants et les personnes prenant soin d'eux. La téléconsultation a inclus une consultation de cas, une supervision de réflexion individuelle et de groupe, et des soutiens/références de collaboration. Durant la période d'évaluation de 18 mois, 1568 prestataires uniques se sont engagés soit dans une formation ou des services de téléconsultation, avec une moyenne de 9% de croissance chez les nouveaux prestataires chaque mois, avec une représentation de tous les secteurs professionnels et les comtés de l'état. Ce programme démontre la fiabilité et le besoin de programmes de formation et de téléconsultations au niveau de l'état afin d'aider à remplir les besoins des prestataires qui travaillent et soutiennent les jeunes enfants et les personnes prenant soin d'eux.

Prediction of the acceptance of telemedicine among rheumatic patients: a machine learning-powered secondary analysis of German survey data.

Telemedicine (TM) has augmented healthcare by enabling remote consultations, diagnosis, treatment, and monitoring of patients, thereby improving healthcare access and patient outcomes. However, successful adoption of TM depends on user acceptance, which is influenced by technical, socioeconomic, and health-related factors. Leveraging machine learning (ML) to accurately predict these adoption factors can greatly contribute to the effective utilization of TM in healthcare. The objective of the study was to compare 12 ML algorithms for predicting willingness to use TM (TM try) among patients with rheumatic and musculoskeletal diseases (RMDs) and identify key contributing features. We conducted a secondary analysis of RMD patient data from a German nationwide cross-sectional survey. Twelve ML algorithms, including logistic regression, random forest, extreme gradient boosting (XGBoost), and neural network (deep learning) were tested on a subset of the dataset, with the inclusion of only RMD patients who answered "yes" or "no" to TM try. Nested cross-validation was used for each model. The best-performing model was selected based on area under the receiver operator characteristic (AUROC). For the best-performing model, a multinomial/multiclass ML approach was undertaken with the consideration of the three following classes: "yes", "no", "do not know/not answered". Both one-vs-one and one-vs-rest strategies were considered. The feature importance was investigated using Shapley additive explanation (SHAP). A total of 438 RMD patients were included, with 26.5% of them willing to try TM, 40.6% not willing, and 32.9% undecided (missing answer or "do not know answer"). This dataset was used to train and test ML models. The mean accuracy of the 12 ML models ranged from 0.69 to 0.83, while the mean AUROC ranged from 0.79 to 0.90. The XGBoost model produced better results compared with the other models, with a sensitivity of 70%, specificity of 91% and positive predictive value of 84%. The most important predictors of TM try were the possibility that TM services were offered by a rheumatologist, prior TM knowledge, age, self-reported health status, Internet access at home and type of RMD diseases. For instance, for the yes vs. no classification, not wishing that TM services were offered by a rheumatologist, self-reporting a bad health status and being aged 60-69 years directed the model toward not wanting to try TM. By contrast, having Internet access at home and wishing that TM services were offered by a rheumatologist directed toward TM try. Our findings have significant implications for primary care, in particular for healthcare professionals aiming to implement TM effectively in their clinical routine. By understanding the key factors influencing patients' acceptance of TM, such as their expressed desire for TM services provided by a rheumatologist, self-reported health status, availability of home Internet access, and age, healthcare professionals can tailor their strategies to maximize the adoption and utilization of TM, ultimately improving healthcare outcomes for RMD patients. Our findings are of high interest for both clinical and medical teaching practice to fit changing health needs caused by the growing number of complex and chronically ill patients.

Using teleconsultation for health aspects of computer-based workers in the new normal situation (post COVID-19) of the world.

BACKGROUND: The use of teleconsultation platforms enabling health professionals to provide advice especially in the new normal post COVID-19 situation has increased in both developing and developed countries. This teleconsultation has also expanded beyond that of post COVID-19 application to other purposes such as in the treatment of musculoskeletal pain. OBJECTIVE: The purpose of this commentary is to focus on presenting a feasible guide related to physical as well as psychological aspects in relation to computer based workers that could be taught to the computer-based workers using teleconsultation platforms. METHODS: A multi-criteria search was performed among available guidelines and approaches related to the physical and psychological aspects used for computer-based workers. RESULTS: A continuation of musculoskeletal pain creates a feedforward loop of pain and distress. Several conventional methods exist to manage musculoskeletal pain, however, the new normal situation following COVID-19 has rendered many of these moot, especially in computer based workers and with the increased reliance on teleconsultation platforms. CONCLUSIONS: During the COVID-19 pandemic, individuals were required to stay home due to varying levels of lockdown protocols and provide their usual services using online platforms both increasing sedentary behaviour in computer based workers and limiting the tools available to health professionals. Following in what is now the worldwide new normal post COVID-19 situation, individuals have adapted and accepted that they receive much of their necessary health advice using teleconsultation platforms as well.

The Viability and Acceptability of a Virtual Wound Care Command Centre in Australia.

The objective of this study was to assess the viability and acceptability of an innovative Virtual Wound Care Command Centre where patients in the community, and their treating clinicians, have access to an expert wound specialist service that comprises a digital wound application (app) for wound analysis, decision-making, remote consultation, and monitoring. Fifty-one patients with chronic (42.6%) wounds were healed, with a median time to healing of 66 (95% CI: 56-88) days. All patients reported high satisfaction with their wound care, 86.4% of patients recommended the Virtual Wound Care Command Centre with 84.1% of patients reporting the app as easy to use. The data revealed that the Virtual Wound Care Command Centre was a viable and acceptable patient-centred expert wound consultation service for chronic wound patients in the community.

What do primary care providers want to know when caring for patients living with frailty? An analysis of eConsult communications between primary care providers and specialists.

BACKGROUND: Frailty is a complex condition that primary care providers (PCPs) are managing in increasing numbers, yet there is no clear guidance or training for frailty care. OBJECTIVES: The present study examined eConsult questions PCPs asked specialists about patients with frailty, the specialists' responses, and the impact of eConsult on the care of these patients. DESIGN: Cross-sectional observational study. SETTING: ChamplainBASE™ eConsult located in Eastern Ontario, Canada. PARTICIPANTS: Sixty one eConsult cases closed by PCPs in 2019 that use the terms "frail" or "frailty" to describe patients 65 years of age or older. MEASUREMENTS: The Taxonomy of Generic Clinical Questions (TGCQ) was used to classify PCP questions and the International Classification for Primary Care 3 (ICPC-3) was used to classify the clinical content of each eConsult. The impact of eConsult on patient care was measured by PCP responses to a mandatory survey. RESULTS: PCPs most frequently directed their questions to cardiology (n = 7; 11%), gastroenterology (n = 7; 11%), and endocrinology (n = 6; 10%). Specialist answers most often pertained to medications (n = 63, 46%), recommendations for clinical investigation (n = 24, 17%), and diagnoses (n = 22, 16%). Specialist responses resulted in PCPs avoiding referral in 57% (n = 35) of cases whereas referrals were still required in 15% (n = 9) of cases. Specialists responded to eConsults in a median 1.11 days (IQR = 0.3-4.7), and 95% (n = 58) of cases received a response within 7 days. Specialists recorded a median of 15 min to respond (IQR = 10-20), with a median cost of $50.00 CAD (IQR = 33.33 - 66.66) per eConsult. CONCLUSIONS: Through the analysis of questions and responses submitted to eConsult, this study provides novel information on PCP knowledge gaps and approaches to care for patients living with frailty. Furthermore, these analyses provide evidence that eConsult is a feasible and valuable tool for improving care for patients with frailty in primary care settings.

Long-term effects of a prehospital telemedicine system on structural and process quality indicators of an emergency medical service.

The benefits of a telemedical support system for prehospital emergency medical services include high-level emergency medical support at the push of a button: delegation of drug administration, diagnostic assistance, initiation of therapeutic measures, or choice of hospital destination. At various European EMS sites telemedical routine systems are shortly before implementation. The aim of this study was to investigate the long-term effects of implementing a tele-EMS system on the structural and procedural quality indicators and therefore performance of an entire EMS system. This retrospective study included all EMS missions in Aachen city between 2015 and 2021. Regarding structural indicators of the EMS system, we investigated the overall number of emergency missions with tele-EMS and onsite EMS physicians. Furthermore, we analyzed the distribution of tracer diagnosis and process quality with respect to the time spans on the scene, time until teleconsultation, duration of teleconsultation, prehospital engagement time, and number of simultaneous teleconsultations. During the 7-year study period, 229,384 EMS missions were completed. From 2015 to 2021, the total number of EMS missions increased by 8.5%. A tele-EMS physician was consulted on 23,172 (10.1%) missions. The proportion of telemedicine missions increased from 8.6% in 2015 to 12.9% in 2021. Teleconsultations for missions with tracer diagnoses decreased during from 43.7% to 30.7%, and the proportion of non-tracer diagnoses increased from 56.3% to 69.3%. The call duration for teleconsultation decreased from 12.07 min in 2015 to 9.42 min in 2021. For every fourth mission, one or more simultaneous teleconsultations were conducted by the tele-EMS physician on duty. The implementation and routine use of a tele-EMS system increased the availability of onsite EMS physicians and enabled immediate onsite support for paramedics. Parallel teleconsultations, reduction in call duration, and increase in ambulatory onsite treatments over the years demonstrate the increasing experience of paramedics and tele-EMS physicians with the system in place. A prehospital tele-EMS system is important for mitigating the current challenges in the prehospital emergency care sector.

Satisfaction with remote consultations in primary care during COVID-19: a population survey of UK adults.

BACKGROUND: Mode of access to primary care changed during the COVID-19 pandemic; remote consultations became more widespread. With remote consultations likely to continue in UK primary care, it is important to understand people's perceptions of remote consultations and identify potential resulting inequalities. AIM: To assess satisfaction with remote GP consultations in the UK during the COVID-19 pandemic and identify demographic variation in satisfaction levels. DESIGN AND SETTING: A cross-sectional survey from the second phase of a large UK-based study, which was conducted during the COVID-19 pandemic. METHOD: In total, 1426 adults who self-reported having sought help from their doctor in the past 6 months completed an online questionnaire (February to March 2021). Items included satisfaction with remote consultations and demographic variables. Associations were analysed using multivariable regression. RESULTS: A novel six-item scale of satisfaction with remote GP consultations had good psychometric properties. Participants with higher levels of education had significantly greater satisfaction with remote consultations than participants with mid-level qualifications (B = -0.82, 95% confidence interval [CI] = -1.41 to -0.23) or those with low or no qualifications (B = -1.65, 95% CI = -2.29 to -1.02). People living in Wales reported significantly higher satisfaction compared with those living in Scotland (B = -1.94, 95% CI = -3.11 to -0.78), although caution is warranted due to small group numbers. CONCLUSION: These findings can inform the use and adaptation of remote consultations in primary care. Adults with lower educational levels may need additional support to improve their experience and ensure equitable care via remote consultations.

Patients' experiences with receiving sick leave certificates via remote consultations in Norway during the COVID-19 pandemic: a nationwide online survey.

OBJECTIVES: To explore patients' experiences with receiving sick leave certificates via remote consultations during the COVID-19 pandemic and investigate whether there were differences among the types of remote consultation (telephone, video or text). DESIGN: A nationwide online patient survey consisting of quantitative data supplemented by qualitative opinions conducted in Norway. SETTING: Primary care. PARTICIPANTS: Patients who received a sick leave certificate via remote consultation in the period from 16 November to 15 December 2020. RESULTS: Of the 5429 respondents, 3233 (59.6%) received a sick leave certificate via telephone consultation, 657 (12.1%) via video consultation and 1539 (28.3%) via text-based e-consultation. Most respondents (76.8%) were satisfied. Only 10% of the respondents thought that the doctor would have obtained more information through an office appointment. The majority of the respondents (59.6%) found that they had as much time to explain the problem as at an office appointment. Some patients also thought that it was easier to formulate the problem via a remote consultation (18.2%) and agree with the doctor on the sick leave (10.3%).The users of text-based e-consultations were the most satisfied (79.3%, p<0.001) compared with those using telephone or video consultations. Among users of text-based e-consultations, there was a higher proportion of patients who thought that they had more time to explain the problem compared with an office appointment (p<0.001), it was easier to explain the problem (p<0.001) and agree with the doctor (p<0.001). Most respondents would use the same type of remote consultation if they were to contact the general practitioner (GP) for the same problem, with the highest proportion among the users of video consultations (62.1%, p<0.001). CONCLUSIONS: Patients were satisfied with communicating and receiving sick leave certificates via remote consultations. Future studies should investigate patients' and GPs' use and experiences in a postpandemic setting.

Reasons for Provider-to-Provider Synchronous Teleconsultations Between Nurses in Primary Care: A Cross-Sectional Study of TelessaúdeRS-UFRGS Service.

Introduction: Nurses have proven to be fundamental for the expansion and consolidation of primary health care (PHC), as well as the development of digital health strategies. We explored the results of a synchronous telephone teleconsultations service between professionals for nurses in Brazil. Methods: This is a cross-sectional study. We retrieved data from teleconsultations registry. All teleconsultations answered by the team of nurses between September 2018 and July 2021 were analyzed regarding the reasons (according to International Classification of Primary Care, 2nd edition-ICPC-2) and decisions of the teleconsultation. Results: There were 9,273 phone teleconsultations registered in the period, requested by 3,125 nurses from all states throughout the country, of which 56.9% called once and 15.9% used the teleconsultations at least 4 times. We found 362 different reasons for solicitations, which were classified according to the ICPC-2 chapters. The most frequent codes were respiratory (25.9%), general and unspecified (21.2%), and skin (21.2%), which corresponded to 68% of the total sample. Most teleconsultations (66.9%) had as outcome the maintenance of the case at PHC. Conclusion: Teleconsultations are widely used and address a broad number of situations. This service may improve the quality of Brazilian PHC and promote the development of clinical reasoning and critical thinking by nurses.

Seeing the benefits, but not taking advantage of them: Dog and cat owners' beliefs about veterinary telemedicine.

BACKGROUND: Telemedicine offers benefits to clients and their animals, but potential disadvantages are also being debated. METHODS: Using a questionnaire, we investigated dog and cat owners' (N = 2117) use of and beliefs about telemedicine and whether beliefs impact past and expected future use. RESULTS: Although the majority of owners are aware that telemedicine can lead to the risk of something being missed, they see great potential in remote consultation in terms of usefulness for follow-up appointments or improving access to a specialist. However, only 12% of dog owners and 6% of cat owners have used telemedicine, and around 25% of owners who have never used it would be willing to use it in the future. Owners with a larger number of recent veterinary visits were more likely to have used telemedicine. LIMITATIONS: Although a definition of 'telemedicine' was provided, respondents may have had different perceptions of what this meant. CONCLUSION: Owners of dogs and cats recognise the potential benefits of telemedicine, but there is a mismatch with the actual uptake. This not only raises questions about the current availability of telemedicine but also should increase veterinary professionals' understanding of its potential benefits in veterinary practice.