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.

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.

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.

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.

The Use of Remote Consultations and Associated Factors in Rheumatology: A Large Retrospective Cohort Study of Follow-Up Consultations Before, During, and After COVID-19.

OBJECTIVE: To investigate the use of remote consultations (RCs) and the influence of consultation, health care provider (HCP), and patient characteristics on the choice for remote or face-to-face consultation. METHODS: A monocenter retrospective cohort study was conducted on follow-up consultations of patients with rheumatic diseases from January 1, 2019 to January 16, 2023, using data from electronic health records. Trends in the proportion of RCs before, during, and after COVID-19 were studied. Cross-classified multilevel logistic regression models were built to account for clustering of consultations (level 1) within both patients and HCPs (level 2). The influence of consultation, patient, and HCP characteristics on the type of consultation was assessed. RESULTS: 157,028 consultations of 30,215 unique patients seen by 64 HCPs were included in the data set. After an initial sharp increase in RC use at the beginning of the COVID-19 pandemic, the proportion of RCs decreased toward a seemingly steady state at around 30%. 90% of the variance in the use of RCs can be attributed to the consultation level, whereas 4% and 6% can be attributed to the patient and HCP level. Longer consultation durations and time since last consultation decreased the odds for a RC, as did higher patient age, shared care, and longer disease duration. Higher travel distance, consultation density, and patient digital access increased the odds for a RC. CONCLUSION: The COVID pandemic resulted in a structural increase in the use of RCs. Although several patient characteristics are associated with the type of consultation, most variance resulted from consultation characteristics compared with patients and HCPs.

Teleconsultation as a Modern Form of Health Care Service in the Case of Poland: Assessment of Its Potential Use from the Perspective of Health Care Providers and Patients.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has facilitated access to health care services through telemedicine in Poland, where it has not been a common approach so far. Therefore, the aim of this study was to evaluate telemedicine as a form of health care provision in the Polish health care system. Methods: An online questionnaire was distributed to 2,318 patients and health care workers. Questions included telemedical services usage, attitude toward telemedical consultations, who should decide about the nature of the consultation, advantages and disadvantages of telemedicine, the possibility of teleconsultations remaining available after the pandemic, and the subjective perception of overuse of remote consultations by doctors. Results: In general, respondents approved of teleconsultations (3.62 on 1-5 scale) but specific clinical situations gained higher and lower scores-among the highest ranking were prescription renewal (4.68), interpretation of examination results (4.15), and treatment continuation/follow-up (3.81). Among least ranking were consulting children 2-6 years old (1.93) and children younger than 2 years old (1.55) as well as consulting acute symptoms (1.47). Health care workers rated their general attitude significantly higher than nonhealth care workers toward telemedicine consults (3.91 vs. 3.34, p < 0.001) and toward 12 out of 13 specific clinical situations and settings (p < 0.001). The only exception was "consulting acute symptoms," which received exactly the same rating within both groups (1.47, p = 0.99). Most respondents agreed that teleconsultations should remain an option for contacting a physician regardless of the epidemic situation. Each group declared that they should be the one to decide about the consultation form. Conclusions: Results of this study could help optimize and facilitate telemedical consultation usage after the COVID-19 pandemic.

Teleconsultation in rheumatology: A literature review and opinion paper.

In this article, we review published literature on "telerheumatology", a term describing the use of telemedicine in rheumatology. This field has received considerable recent attention through the development of efficient digital technologies, resulting in a good level of satisfaction among patients and health care professionals. In 2020, the social distancing constraints during the COVID-19 pandemic accelerated more widespread adoption worldwide. Telerheumatology is particularly suited for patients with rheumatoid arthritis who have achieved a sustained therapeutic target of remission or low disease activity. To facilitate remote consultations and meet expectations of rheumatologists and patients, international and national guidelines have recently been proposed and existing tools, such as Patient-Reported Outcomes questionnaires, have had to be digitally adapted. In addition, telerheumatology toolkits are proposed by the Arab League of Associations for Rheumatology (ArLAR), the Association of American Medical College (AAMC), and the American College of Rheumatology (ACR) for all learners, from medical students to practicing clinicians, encouraging the acquisition of telehealth skills and facilitating their integration into their routine clinical practice. The main benefits reported for this mode of health care are greater access to specialty care, flexibility, reduced rates of missed appointments, as well as improved patient engagement and autonomy. Limitations include the absence of physical examination. However, to implement telerheumatology effectively and widely in daily clinical practice, some barriers still need to be addressed. These include training of health care professionals, technological restrictions and reimbursement mechanisms. Despite the advantages of telerheumatology, it is not intended to replace face-to-face visits, but rather as a way to enhance access to care, service delivery and health care support for patients.

Patient satisfaction, experience and preferences in the implementation of genetics teleconsultations in the North-eastern region of France.

INTRODUCTION: In France, few centres per region offer genetics consultations. Consequently, each centre covers a large area, often requiring patients to take a day off to travel long distances. In certain situations, genetic counselling in particular, a physical exam is not required. In these cases, teleconsultations between medical professional and patients, at the patient's location of choice, are an interesting offer. The COVID-19 pandemic has accelerated the implementation and the use of this type of consultation. With the aim of developing teleconsultation for certain types of referrals, a study of patient satisfaction, experience and preferences has been set up in our region. METHODS: 2307 patients who had a teleconsultation by phone or videoconferencing with professionals from one of five genetic centres in North-eastern France between March and December 2020 were asked by e-mail or by post to answer an online survey. RESULTS: 20% of the patients (n = 465) responded to the survey (80% women, 55% over 40 years old). In 64% of the cases (n = 299), the teleconsultation replaced a physical consultation due to the pandemic. In 56% of cases (n = 217), the consultations were conducted by videoconference. The teleconsultation involved the disclosure of results in 56% of cases (n = 260), a first consultation in 30% of cases (n = 138), and a follow-up consultation in 14% of cases (n = 67). The satisfaction rate was 96% (n = 447), with a rating of "excellent" in 72% of responses (n = 290) and "good" in 24% of responses (n = 157). Only 22% of the patients (n = 103), particularly patients who lived near the hospital or who were older than 70 years, would have preferred a physical consultation. Half of respondents (n = 232) declared that they avoided more than 1.5 h of transport, and 69% (n = 321) avoided taking a work day off. Patients were less often accompanied by a relative than if the consultation had taken place face-to-face (43%; n = 201 vs. 61%; n = 285). There was no change in responses during or after lock-down. CONCLUSION: This collection of feedback and analysis of patients' preferences has validated the long-term implementation of medical genetics teleconsultations in certain circumstances and indications, for patients who prefer this approach.

Introduction of augmented reality to the remote wound care nursing consultation system.

OBJECTIVE: We implemented augmented reality (AR) in remote consultations for enhanced pressure injury (PI) care in homecare nursing and improved the efficiency of on-site technical education for homecare nurses. The study aimed to depict expert techniques using AR technology to improve PI healing time in a male patient. METHOD: We developed and implemented a new system that combines a transparent hand with an image and gives an output as a video image in the existing remote consultation software. The system was used to support remote care of PIs by nurses. RESULTS: We succeeded in superimposing the expert nurse's nonverbal hand gestures onto the patient's wound in real time. The visiting nurse's understanding of the system had improved and there was an improvement in the patient's PI healing. CONCLUSION: These results suggest that remote consultation using AR is effective to observe precise wound care demonstrations of the steps of the PI treatment and provide effective treatment.

[From face-to-face consultation to teleconsultation: Primary health care professionals' experiences in the Basque Country during the pandemic]. / De la consulta presencial a la teleconsulta: experiencias de profesionales de atención primaria del País Vasco durante la pandemia.

OBJECTIVE: To explore the perceptions of Primary Health Care (PHC) professionals on changes in consultation modalities and their impact on PHC fundamentals during the pandemic. DESIGN: Qualitative exploratory research conducted between October and November, 2021. LOCATION: Four urban and one rural primary health care centers with different socioeconomic profiles in the threeterritories of the Basque Country. PARTICIPANTS: Forty-six professionals from different categories of the PHC team and health centre directors. METHOD: Purposive sampling. Five focus groups and fourin-depth interviews. Thematic analysis with the support of the Atlas.ti programme. Triangulation of results among the research team. RESULTS: Experiences with the development of teleconsultation appear to be directly conditioned by the pandemic context in its different phases and by the PC situation. The professionals identified communication barriers, as well as potentialities of its use that require adequate training and evaluation. Risks of inequity were perceived in the use of teleconsultations that could be affecting the quality of care. Longitudinality was assessed as a facilitating factor and problems of coordination and communication through teleconsultation between care levels were identified. CONCLUSIONS: The replacement of face-to-face consultation by teleconsultation had an impact on fundamental aspects of PHC such as quality, accessibility, equity, coordination and longitudinality. Teleconsultation in PHC should always be evaluated considering the specific circumstances and contexts of its implementation.

Teleconsultation Perceptions of Medical and Radiation Oncologists in the COVID-19 and Post-COVID-19 Era: A National Survey in the Philippines.

PURPOSE: The study reports on the current perception of medical and radiation oncologists regarding teleconsultation in the Philippines. Before the COVID-19 pandemic, the adoption of telemedicine was not widespread. With movement restrictions imposed during the pandemic, physicians were compelled to use telemedicine. It is uncertain whether physicians will still adopt its use in practice in the post-COVID-19 era. This study gives insight into the possible adaptation of this mode of consultation in the future, especially in areas with limited health care resources. MATERIALS AND METHODS: We conducted a national survey among medical oncologists and radiation oncologists in the Philippines. A 43-item online survey was developed, validated, and administered to the oncologists. The demographics and data from categorical questions were reported as frequencies and percentages. RESULTS: A total of 142 responses were gathered from 82 medical oncologists and 60 radiation oncologists. There was agreement among participants that, during the pandemic, teleconsultation could be used for the first visit, diagnostic workup request, treatment explanation, follow-up care, and chronic disease management. There was disagreement whether cancer diagnosis disclosure and cancer prognosis revelation could be performed via teleconsultation, and there was agreement that emergency consultation and physical examination would warrant a face-to-face consultation. After the COVID-19 pandemic, 78.7% intend to continue using teleconsultation except for emergency consultations, first visits, physical examination, diagnosis disclosure, and cancer prognosis revelation. CONCLUSION: Teleconsultation was perceived by oncologists as an acceptable method of providing cancer care during and after the COVID-19 pandemic. Oncologists also intend to use teleconsultation in the post-COVID-19 era in certain aspects of patient care.

Intervención de la telemedicina en pacientes peruanos con insuficiencia cardíaca en tiempos de COVID-19 / Telemedicine Intervention in Peruvian Patients with Heart Failure in Times of COVID-19

Introducción: La insuficiencia cardíaca tiene un gran impacto epidemiológico, no solo por su alta morbilidad y mortalidad, sino también por el alto costo en servicios hospitalarios. Las tasas de hospitalización por reagudizaciones y readmisiones luego del alta se han incrementado los últimos años, lo que constituye en la actualidad un problema de salud pública. Objetivo: Evaluar el efecto de la intervención de la telemedicina en pacientes peruanos con insuficiencia cardíaca en tiempos de COVID-19. Métodos: Se utilizó un diseño cuasi experimental con evaluación antes y después de la intervención en 32 pacientes provenientes de Chimbote (Perú), entre los meses de enero a junio del 2021, que aceptaron participar en el estudio y cumplieron con los criterios de inclusión y exclusión. Se utilizó una ficha de recolección de datos que registró las características clínicas de los pacientes, frecuencia de hospitalización y clase funcional, así como el cuestionario de Kansas City que midió la calidad de vida relacionada a salud. En la intervención, se implementaron actividades de telemedicina que comprendió teleconsulta médica de cardiología, telemonitoreo y teleorientación de enfermería, y teleorientación de nutrición. Resultados: Se redujo la frecuencia de hospitalización de 9,4 por ciento a 0 por ciento en los pacientes categorizados en clase funcional III disminuyó de 28,1 por ciento a 15,6 por ciento, y el score general se mejoró de 65,8 a 69,6 puntos. Conclusiones: La intervención de la telemedicina mejoró los resultados sanitarios de los pacientes peruanos con insuficiencia cardíaca(AU)

Introduction: Heart failure has a great epidemiological impact, not only because of its high morbidity and mortality, but also because of the high cost in hospital services. Hospitalization rates for exacerbations and readmissions after discharge have increased in recent years, which is currently a public health problem. Objective: To evaluate the effect of telemedicine intervention in Peruvian patients with heart failure in COVID-19 times. Methods: A quasi-experimental design was used with evaluation before and after the intervention in 32 patients from Chimbote (Peru), between January and June 2021, who agreed to participate in the study and met the inclusion and exclusion criteria. A data collection form was used to record the clinical characteristics of the patients, frequency of hospitalization and functional class, as well as the Kansas City questionnaire that measured health-related quality of life. Telemedicine activities were implemented in the intervention, including cardiology medical teleconsultation, telemonitoring and nursing tele-guidance, and nutrition tele-guidance. Results: The frequency of hospitalization was reduced from 9.4 to 0 percent, while in patients categorized in functional class III it decreased from 28.1 to 15.6 percent. The overall score was improved from 65.8 to 69.6 points. Conclusions: The telemedicine intervention improved health outcomes in Peruvian patients with heart failure(AU)

Impact of a Pharmacist-Run Electronic Consult Service in a Network of Primary Care Patient-Centered Medical Homes.

BACKGROUND: Electronic consults (eConsults) allow for asynchronous, consultative, provider-to-provider communication. A pharmacy run eConsult service was initiated in a group of primary care clinics composed of 60 attending internal medicine primary care physicians (PCP), 100 internal medicine residents, and 10 pharmacists serving more than 60,000 patients. This study aims to describe (1) the number and types of eConsults placed to pharmacists; (2) the number of eConsults completed, converted to an office visit, or declined by a pharmacist; (3) the number of pharmacist recommendations made and implemented within 30 days of eConsult placement; and (4) PCP perceptions of the eConsult service. DESIGN: A retrospective chart review of all pharmacy eConsults placed between February 25, 2020, and July 6, 2021, was completed to describe eConsult utilization. In addition, an electronic survey was used to assess attending physician perceptions of pharmacy eConsults. RESULTS: A total of 513 eConsults were placed during the study period. The most common type of eConsult placed was "cost savings/formulary med questions" (110, 21.4%). Of the 435 eConsults completed by a pharmacist, 339 (78%) eConsults resulted in specific recommendations for medication therapy and 332 (98%) of these recommendations were implemented by the PCP. A total of 17 PCPs completed the survey assessing the perceived benefits of pharmacy eConsults. The top perceived benefits were improvement in patient outcomes (15, 88%) and ability to save provider time spent on patient care (14, 82%). CONCLUSIONS: eConsults to pharmacists resulted in specific drug therapy recommendations that were routinely implemented by PCPs and perceived as a benefit to both providers and patients.

Validity of patients' online reviews at direct-to-consumer teleconsultation platforms: a protocol for a cross-sectional study using unannounced standardised patients.

INTRODUCTION: As direct-to-consumer teleconsultation (hereafter referred to as 'teleconsultation') has gained popularity, an increasing number of patients have been leaving online reviews of their teleconsultation experiences. These reviews can help guide patients in identifying doctors for teleconsultation. However, few studies have examined the validity of online reviews in assessing the quality of teleconsultation against a gold standard. Therefore, we aim to use unannounced standardised patients (USPs) to validate online reviews in assessing both the technical and patient-centred quality of teleconsultations. We hypothesise that online review results will be more consistent with the patient-centred quality, rather than the technical quality, as assessed by the USPs. METHODS AND ANALYSIS: In this cross-sectional study, USPs representing 11 common primary care conditions will randomly visit 253 physicians via the three largest teleconsultation platforms in China. Each physician will receive a text-based and a voice/video-based USP visit, resulting in a total of 506 USP visits. The USP will complete a quality checklist to assess the proportion of clinical practice guideline-recommended items during teleconsultation. After each visit, the USP will also complete the Patient Perception of Patient-Centeredness Rating. The USP-assessed results will be compared with online review results using the intraclass correlation coefficient (ICC). If ICC >0.4 (p<0.05), we will assume reasonable concordance between the USP-assessed quality and online reviews. Furthermore, we will use correlation analysis, Lin's Coordinated Correlation Coefficient and Kappa as supplementary analyses. ETHICS AND DISSEMINATION: This study has received approval from the Institutional Review Board of Southern Medical University (#Southern Medical Audit (2022) No. 013). Results will be actively disseminated through print and social media, and USP tools will be made available for other researchers. TRIAL REGISTRATION: The study has been registered at the China Clinical Trials Registry (ChiCTR2200062975).

Teleconsultation use and satisfaction among cancerologists during the COVID-19 pandemic in Morocco.

Introduction: health care benefits have undergone major changes during the COVID-19 pandemic. This has led to an explosive growth in teleconsultation services mainly for cancer patients. The purpose of this study was to assess the perception and experience of Moroccan oncologists with the use of teleconsultation during the COVID-19 pandemic. Methods: a 17-question anonymous cross-sectional survey was conducted on Google forms and emailed to all Moroccan oncologists. Statistical analysis was performed using the statistical software Jamovi (version 2.2). Results: out of a total of 500 oncologists who received the questionnaire, 126 responded, with a response rate of 25%. During the pandemic, only 59.5% of oncologists used teleconsultation, with no significant differences among the three groups (radiation oncologists, medical oncologists and cancer surgeons (p=0.294)). Most participants were satisfied with being able to explain medical diagnosis, provide assessment results, and provide treatment recommendations during teleconsultation. Finally, 47.2% of participants were willing to continue conducting teleconsultations after the COVID-19 pandemic, with no significant differences among the three groups. Conclusion: oncology physicians were satisfied with their experiences with teleconsultation and agreed that it is likely to be part of their long-term practice. Future studies are needed to assess patient satisfaction with teleconsultation and to improve patient care through this virtual technology.

[Efficacy of remote consultation between hospital cardiologists and primary care in cardiovascular disease management: the "Cardiologia in linea" project in Trentino, Italy]. / Efficacia del teleconsulto tra la cardiologia ospedaliera e la medicina del territorio nei percorsi di cura delle malattie cardiovascolari: il progetto trentino "Cardiologia in linea".

BACKGROUND: Telemedicine enables patients to receive better care via the simplification of procedures while allowing for a significant reduction of in-office appointments and emergency room visits. The "Cardiologia in linea" project started with the objective of strengthening communications between cardiologists and primary care, particularly with general practitioners. METHODS: Between January 2017 and October 2022, by means of a facilitated telephonic and digital contact between territorial professionals and the cardiologist, the project provided in most cases immediate answers to cardiology queries, which were logged. RESULTS: A total of 2066 telephonic or digital consultations have been recorded, originating from 316 general practitioners in the Trento province (Italy). The mean age of patients was 76.4 years, 53% were male. After consultation, an immediate response was provided in 1989 (96%) of cases. A total of 1112 (54%) cardiology visits were avoided. After the consultation, a cardiologic visit was suggested in 29 cases (1%), and the emergency system was activated in 20 cases (1%). Overall, most questions concerned direct oral anticoagulant prescriptions (537 cases, 31%) and anti-hypertensive treatment (241 cases, 14%). CONCLUSIONS: The "Cardiologia in linea" project demonstrated a low-cost improvement in the patient assistance workflow, in the communication between hospital cardiology and primary care, while reducing the number of emergency room accesses. The project successfully shows the feasibility of a real-time dialogue between the general practitioner and the hospital cardiologist.

Nursing practice and teleconsultations in a pandemic context: A mixed-methods study.

AIM: To explore the use and implementation of teleconsultations by primary care nurses in the context of the COVID-19 pandemic. BACKGROUND: Teleconsultation use increased rapidly during the COVID-19 pandemic. Its implementation has been documented for physicians and specialists, but knowledge is still limited in nursing practice. DESIGN: A sequential mixed-methods study. METHODS: Phase 1: A cross-sectional e-survey with 98 nurses (64 nurse clinicians [NCs] and 34 nurse practitioners [NPs]) was conducted in 2020 in 48 teaching primary care clinics in Quebec (Canada). Phase 2: Semi-structured interviews with four NCs and six NPs were conducted in 2021 in three primary care clinics. This study adheres to STROBE and COREQ guidelines. RESULTS: During the pandemic, telephone was the principal teleconsultation modality used by NPs and NCs compared to other teleconsultation modalities (text messages, email and video). The only variable associated with a higher likelihood of using teleconsultations was type of professional (NCs). Video consultation was almost absent from the modalities used. The majority of participants reported several facilitators to using teleconsultations in their work (e.g. web platforms and work-family balance) and for patients (e.g. rapid access). Some barriers to utilisation were identified (e.g. lack of physical resources) for successful integration of teleconsultations at the organisational, technological and systemic levels. Participants also reported positive (e.g. assessment of cognitive deficiency) and negative (e.g. rural population) impacts of using teleconsultations during a pandemic that made the use of teleconsultations complex. CONCLUSION: This study highlights the potential for nurses to use teleconsultations in primary care practice and suggests concrete solutions to encourage their implementation after the pandemic. RELEVANCE TO CLINICAL PRACTICE: Findings emphasize the need for updated nursing education, easy-to-use technology and the strengthening of policies for the sustainable use of teleconsultations in primary health care. IMPLICATIONS FOR THE PROFESSION: This study could promote the sustainable use of teleconsultations in nursing practice. REPORTING METHOD: The study adhered to relevant EQUATOR guidelines; the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies were used for reporting. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution, as the study focused on the use of teleconsultation among health professionals, specifically primary care nurses.

Remote consultations: review of guiding themes for equitable and effective delivery.

The global coronavirus disease (COVID) -19 pandemic has led to a rapid transformation in the ways in which outpatient care is delivered. The need to minimise the risk of viral infection and transmission through social distancing resulted in the widespread adoption of remote consultations, traditional face-to-face appointments ceasing almost overnight in many specialties. The transition to remote consultations had taken place far faster than anticipated and under crisis conditions. As we work towards the "new normal", remote consultations have become an integral part of outpatient provision in secondary care. Adapting to this change in clinical practice requires a judicious approach to ongoing service development to ensure safe, effective, and equitable care for all patients. Medical societies have provided some initial guidance around effective delivery. In this article we discuss the potential benefits, limitations, types of remote consultations, and factors that require consideration when deciding on patient suitability for remote consultation in a hospital setting. We use cardiology as a specialty exemplar, although many of the principles will be equally applicable to other medical specialties.

Quality comparison of remote anesthetic consultation versus on-site consultation in children with sedation for a magnetic resonance imaging examination-A randomized controlled trial.

BACKGROUND: In the course of the corona pandemic, digital media has increasingly been used in many areas of medical practice to reduce personal contact. As it is of interest whether this can be practiced in the context of anesthesia consultations without loss of quality, we interviewed parents whose children received a cardiac or neuro magnetic resonance imaging (MRI) under sedation. Parents either received an on-site or a remote consultation conducted by an anesthesiologist. Both parents and anesthesiologist were asked to indicate their satisfaction with the respective consultation procedure in a questionnaire. AIM: The aim of this study was to investigate if remote pre-anesthesia consultation, supported by an online video, for parents whose children are receiving MRI examinations under sedation can replace the commonly performed on-site consultation, without decreasing its quality. METHODS: In this randomized trial, a total of 200 patients were included, one half received pre-anesthesia consultation on-site and the other half was given a link to a video and pre-anesthesia consultation was conducted by phone. As a primary analysis, we compared the level of satisfaction for the general procedure, the quality of the pre-anesthesia consultation and the contact to the anesthesiologists (or parents). We further investigated the frequency of complications and the preference for a possible next informed consent. RESULTS: Both groups showed high levels of satisfaction. Some anesthesiologists and parents were less satisfied with the quality of on-site pre-anesthesia consultation than with the remote. In our patient cohort, there was no evidence for higher risk of complications when information was provided by telephone. Further, parents as well as anesthesiologists clearly favored the combined form of telephone information and online video. Overall, 61.2% of parents and 64% of anesthesiologists would choose this form of pre-anesthesia consultation for repeat anesthesia. CONCLUSIONS: We did not observe that combined telephone and video decreased the quality of pre-anesthesia consultation. A remote version seems feasible for simple procedures such as sedation for MRI. Further research on this topic in other areas of anesthesia would be beneficial.

The pandemic, telemedicine, and andrology: what have we learned?

BACKGROUND: Telemedicine gained wide acceptance during the COVID-19 pandemic, as it was deemed critical for patient care when lockdowns were implemented worldwide. While there is evidence to suggest that urology patients were receptive to telemedicine, no systematic review has been done to date on andrology patients and their perception of telemedicine. METHODS: Three electronic databases, PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients "wishing for telemedicine consultation", "preferring telemedicine over in person", "accepting the current telemedicine arrangement", "having needs addressed with teleconsultation", or "willingness to do a teleconsultation". RESULTS: Of the 1128 retrieved abstracts, 56 underwent full-text review and 12 were included in the final analysis, comprising a total cohort of >4021 cases. Video visits were evaluated in 5 studies, telephone encounters were analyzed in 2 studies, and both methods were examined in 1 randomized control study. Three studies showed that andrology and sexual medicine are compatible with telemedicine, with few 30- and 90-day in-person revisit rates. Telemedicine was shown to save an average cost of US$149-$252 per patient, and 8 studies that directly assessed andrology patient perceptions of telemedicine showed that most patients had a "positive perception."Pooled analyses of the positive responses to telemedicine were 68.7% (95% CI, 49.4%-83.1%, P = 0.057), and those of patients who recommended telemedicine were 65.1% (95% CI, 18.4%-93.9%, P = 0.577). While the percentage of patients recommending telemedicine was high among studies using videoconferencing, the percentage dropped in studies using telephone visits only. The difference between recommending video and telephone practices was statistically significant, with 84.6% pooled proportion for recommending video practice compared to 38.9% pooled proportion for recommending telephone practice, P = 0.035. In the telephone-only encounters, up to 27.1% of patients preferred in-person visits, as security and privacy of any mode of telecommunication were of concern. CONCLUSIONS: Most patients have a positive perception of telemedicine, particularly with videoconferencing and less so with telephone visits. These results suggest that telemedicine will likely continue to play a pivotal role in andrology and sexual medicine practices.