Retrospective Study of the Reasons and Time Involved for Dental Providers' Medical Consults.

Background: Patient-reported medical histories and medical consults are primary approaches to obtaining patients' medical histories in dental settings. While patient-reported medical histories are reported to have inconsistencies, sparse information exists regarding the completeness of medical providers' responses to dental providers' medical consults. This study examined records from a predoctoral dental student clinic to determine the reasons for medical consults; the medical information requested, the completeness of returned responses, and the time taken to receive answers for medical consult requests. Methods: A random sample of 240 medical consult requests for 179 distinct patients were selected from patient encounters between 1 January 2015 and 31 December 2017. Descriptive statistics and summaries were calculated to determine the reasons for the consult, the type of information requested and returned, and the time interval for each consult. Results: The top two reasons for medical consults were to obtain more information (46.1%) and seek medical approval to proceed with treatment (30.3%). Laboratory and diagnostic reports (56.3%), recommendations/medical clearances (39.6%), medication information (38.3%), and current medical conditions (19.2%) were the frequent requests. However, medical providers responded fewer times to dental providers' laboratory and diagnostic report requests (41.3%), recommendations/medical clearances (19.2%), and current medical conditions (13.3%). While 86% of consults were returned in 30 days and 14% were completed after 30 days. Conclusions: The primary reasons for dental providers' medical consults are to obtain patient information and seek recommendations for dental care. Laboratory/diagnostic reports, current medical conditions, medication history, or modifications constituted the frequently requested information. Precautions for dental procedures, antibiotic prophylaxis, and contraindications included reasons to seek medical providers' recommendations. The results also highlight the challenges they experience, such as requiring multiple attempts to contact medical providers, the incompleteness of information shared, and the delays experienced in completing at least 25% of the consults. Practical Implications: The study results call attention to the importance of interdisciplinary care to provide optimum dental care and the necessity to establish systems such as integrated electronic dental record-electronic health record systems and health information exchanges to improve information sharing and communication between dental and medical providers.

How Do Dental Clinicians Obtain Up-To-Date Patient Medical Histories? Modeling Strengths, Drawbacks, and Proposals for Improvements.

Background: Access to up-to-date patient medical history is essential for dental clinicians (DCs) to avoid potential harm to patients and to improve dental treatment outcomes. The predominant approach for dental clinicians (DCs) to gather patients' medical history is through patient-reported medical histories and medical consults. However, studies reported varied concordance and reliability of patient-reported medical conditions and medication histories compared to the patient medical records and this process also places a significant burden on patients. Information technology tools/platforms such as an integrated electronic health record containing an electronic dental record module may address these issues. However, these integrated systems are expensive and technically complex and may not be easily adopted by DCs in solo and small group practice who provide the most dental care. The recent expansion of regional healthcare information exchange (HIE) provides another approach, but to date, studies on connecting DCs with HIE are very limited. Our study objectives were to model different aspects of the current approaches to identify the strengths and weaknesses, and then model the HIE approach that addresses the weaknesses and retain the strengths of current approaches. The models of current approaches identified the people, resources, organizational aspects, workflow, and areas for improvement; while models of the HIE approach identified system requirements, functions, and processes that may be shared with software developers and other stakeholders for future development. Methods: There are three phases in this study. In Phase 1, we retrieved peer-reviewed PubMed indexed manuscripts published between January 2013 and November 2020 and extracted modeling related data from selected manuscripts. In Phase 2, we built models for the current approaches by using the Integrated DEFinition Method 0 function modeling method (IDEF0), the Unified Modeling Language (UML) Use Case Diagram, and Business Process Model and Notation (BPMN) methods. In Phase 3, we created three conceptual models for the HIE approach. Results: From the 47 manuscripts identified, three themes emerged: 1) medical consult process following patient-reported medical history, 2) integrated electronic dental record-electronic health record (EDR-EHR), and 3) HIE. Three models were built for each of the three themes. The use case diagrams described the actions of the dental patients, DCs, medical providers and the use of information systems (EDR-EHR/HIE). The IDEF0 models presented the major functions involved. The BPMN models depicted the detailed steps of the process and showed how the patient's medical history information flowed through different steps. The strengths and weaknesses revealed by the models of the three approaches were also compared. Conclusions: We successfully modeled the DCs' current approaches of accessing patient medical history and designed an HIE approach that addressed the current approaches' weaknesses as well as leveraged their strengths. Organizational management and end-users can use this information to decide the optimum approach to integrate dental and medical care. The illustrated models are comprehensive and can also be adopted by EHR and EDR vendors to develop a connection between dental systems and HIEs.

Application of e-health among patients visiting community healthcare centers in Shanghai / 中华全科医师杂志

Objective@#To exmine the status and perspectives of e-health among patients in Shanghai community health center.@*Methods@#In November 2014, a semi-open and in-depth qualitative interview was conducted among 40 patients from two community health service centers in Shanghai. According to the results of the interview, a self-made questionnaire was designed and a cross-sectional survey was carried out from March 2015 to May 2015. Eight districts or counties of Shanghai were randomly selected, and one community health service center was randomly selected from each district or county. Total 480 patients who visited the selected center participated in the survey. The main contents of the interviews and questionnaires included: the current status of communication using information and communication technologies (ICT) in patient daily life; the status of the communication with medical personnel by using ICT; the attitudes and perspectives of patients in applying ICT for medical service; and views on e-health development.@*Results@#Among the participants, 25.0%(10/40) of the interviewees and 16.7%(62/371)of the quesitionnaire surveyees had experience of using e-health. Among the questionaired patients, telephone-call was the most common method for communication with doctors (90.3%, 335/371), followed by short message (16.1%, 60/371) and wechat (12.9%, 48/371). Illness consulting is the most common perpurse for communication(64.5%, 40/62), followed by medicine advice(40.3%, 25/62) and sudden physical help(24.2%, 15/62). Among the participants, 56.3%(209/371)of whom thought that e-health should be promoted in the community, 69.4% (145/209) of whom thought that it could save time and effort; among the patients not using or considering unnecessary to use e-health, 87.6% (142/162) of whom thought they lived closer to the hospital and easy to access.@*Conclusion@#At present, less patients have the experience of using e-health, but more than half of them believe that it is necessary to use e-health and it should be promoted in the community healthcare.

Effectiveness of preoperative medical consultations by internal medicine physicians: a systematic review.

OBJECTIVE: Clinics have been established to provide preoperative medical consultations, and enable the anaesthetist and surgeon to deliver the best surgical outcome for patients. However, there is uncertainty regarding the effect of such clinics on surgical, in-hospital and long-term outcomes. A systematic review of the literature was conducted to determine the effectiveness of preoperative medical consultations by internal medicine physicians for patients listed for elective surgery. DESIGN: Systematic searches of MEDLINE, EMBASE, CINAHL, PubMed, Current Contents and the NHS Centre for Reviews and Dissemination were conducted up to 30 April 2017. SETTING: Elective surgery. STUDY SELECTION: Randomised controlled trials and non-randomised comparative studies conducted in adults. OUTCOME MEASURES: Length of hospital stay, perioperative morbidity and mortality, costs and quality of life. RESULTS: The one randomised trial reported that preadmission preoperative assessment was more effective than the option of an inpatient medical assessment in reducing the frequency of unnecessary admissions with significantly fewer surgical cancellations following admission for surgery. A small reduction in length of stay in patients was also observed. The three non-randomised studies reported increased lengths of stay, costs and postoperative complications in patients who received preoperative assessment. The timing and delivery of the preoperative medical consultation in the intervention group differed across the included studies. CONCLUSION: Further research is required to inform the design and implementation of coordinated involvement of physicians and surgeons in the provision of care for high-risk surgical patients. A standardised approach to perioperative decision-making processes should be developed with a clear protocol or guideline for the assessment and management of surgical patients.

Aspectos subjetivos implicados en la demanda de consulta médica frecuente / Subjective aspects implicated in the demand for frequent medical consult

Este artículo contiene los resultados de una investigación realizada con el n de acercarse a la comprensión de los aspectos subjetivos implicados en el pedido de consulta médica de consultantes frecuentes. Se utilizó un diseño cualitativo, la metodología fue el estudio de casos y la técnica de recolección de información fue la entrevista semiestructurada a profundidad. La muestra correspondió a nueve consultantes frecuentes de una institución de salud de Medellín. Los resultados sugieren que existe una búsqueda de alivio y control en la consulta médica por parte de los consultantes frecuentes, motivada por el sufrimiento que manifiestan y padecen. Aspectos como el vínculo con el médico, la demanda del paciente y las representaciones sociales que construyen son determinantes para la percepción de control y alivio de este sufrimiento y el inicio y mantenimiento de la consulta frecuente en salud.

This article contains the results of a study made with the purpose of getting close to the understanding of subjective aspects that underlay the frequent demand of medical appointments, by patients. The research design was qualitative, the methodology was case studies and the information recollection technique was the in depth semi-structured interview. Nine samples were taken from frequent medical consultants of a health institution in Medellin. The results suggest that there is a search for relief and control in the medical appointment made by the frequent consultants, motivated by the suffering they manifest and have. Aspects like the tie with the doctor, patient demand and the social representations constituted are decisive for the perception of control and relief of this suffering and the beginning and maintenance of the frequent medical consultant.