Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 447
Filtrar
1.
Ann Otol Rhinol Laryngol ; 129(2): 170-174, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31625409

RESUMO

OBJECTIVES: To categorize the primary reasons for electronic consults (eConsults) to otolaryngology from primary care physicians (PCPs). To determine how many patients avoided subsequent in-person otolaryngology office visits. METHODS: This is a retrospective analysis of a pilot study that took place between 2016 and 2017 regarding eConsults to adult otolaryngology placed by primary care physicians at the University of California, San Diego (UCSD) Medical Center. The complaints were categorized as related to the following: ear, nose, throat or neck. Initial recommendations were classified as (1) providing education only (no intervention), (2) suggesting medical therapy provided by the PCP, or (3) suggesting surgical intervention. Univariate statistics and multinomial logistic regression were used to analyze the association of problem type with the need for follow-up in the otolaryngology offices. The data was analyzed for differences in patient age and gender. RESULTS: The study population included 64 patients (average age 54.6 years, 60.9% male). Within this group, 41% of consults were for ear complaints, 15% for nose complaints, 28% had throat-related complaints, and 16% had neck-related complaints. In-person follow-up was not required for 82.8% of the consults. Overall, 76.9% of ear, 100% of nose, 88.9% of throat, and 70.0% of neck complaints did not require in-person visits. CONCLUSIONS: eConsults to otolaryngology were primarily for ear concerns. Of the eConsults, 82.4% did not require in-person follow-up. We therefore conclude that the use of eConsults prevented substantial office visits that would not otherwise be necessary. Efforts should be made to promote the widespread use of eConsults, which may to the more efficient use of resources.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Otolaringologia , Otorrinolaringopatias/terapia , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta , Consulta Remota/estatística & dados numéricos , Centros Médicos Acadêmicos , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos
3.
BMC Health Serv Res ; 19(1): 681, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547824

RESUMO

BACKGROUND: Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform. METHODS: This study aims at exploring the Pediatric Telecardiology Service's evolution, through a comprehensive assessment of the PCS's development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon's framework helped to understand the implementation and scale-up process and the role of policy-making. RESULTS: With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year). PCS presents a dominant "Clan" culture. The Momentum's critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals' engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service. CONCLUSION: The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa. Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.


Assuntos
Cardiologia/métodos , Pediatria/métodos , Consulta Remota/organização & administração , Telemedicina/organização & administração , África , Criança , Comunicação , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Portugal , Consulta Remota/estatística & dados numéricos , Consulta Remota/tendências , Telemedicina/estatística & dados numéricos , Telemedicina/tendências
4.
Cien Saude Colet ; 24(8): 3089-3098, 2019 Aug 05.
Artigo em Português | MEDLINE | ID: mdl-31389555

RESUMO

This study sought to evaluate the frequency and factors associated with non-use of telehealth consultancy by physicians who work in the Family Health Strategy (FHS) in the North of the State of Minas Gerais. It is a cross-sectional study that used a previously-tested self-administered questionnaire. Poisson regression analysis with robust variance was used after bivariate analysis to identify the factors associated with non-use of telehealth consultancy. A total of 385 physicians from 73 municipalities participated in the study. The frequency of non-use of telehealth consultancy by physicians in the FHS was 55.8%. After multiple analysis, the following variables were identified: the lack of availability of computers and Internet access in the Basic Health Units (BHU) for medical professionals (p = 0.001; PR = 1.10; 95% CI: 1.04-1.17), the lack of information about telehealth consultancy (p< 0.001; PR = 1.47; 95% CI: 1.38-1.56) and lack of training in telehealth consultancy (p < 0.001; PR = 1.15; 95% CI: 1.08-1.24). The results support that the informatics infrastructure of the BHU, the dissemination of the service and the training should orient the strategies for implementation, diffusion and improvement of the quality of telehealth consultancy services in primary health care.


Assuntos
Saúde da Família , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Consulta Remota/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Idoso , Brasil , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
5.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 257-260, ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182767

RESUMO

Objetivos: Analizar las características de las teleconsultas y triajes telefónicos pediátricos atendidos por CatSalut Respon y describir su impacto sobre la actitud y la decisión final de los padres-usuarios de acudir o no a urgencias. Método: Estudio observacional transversal. Durante la teleconsulta los pacientes se clasificaron según los niveles del sistema español de triaje. Aquellos que fueron derivados a urgencias se volvieron a clasificar en el hospital, y se compararon los niveles de triaje. Posteriormente, se realizó una llamada de verificación. Se recogieron variables sociodemográficas y clínicas. Resultados: Se analizaron 370 teleconsultas, fundamentalmente no urgentes (n = 300; 81%). Un 20,3% (n = 75) fueron derivadas a urgencias. La fiebre (p = 0,002) y las dudas de medicación (p < 0,001) fueron motivos significativos de teleconsulta no urgente. Casi un 46% de los casos con niveles de gravedad altos en el triaje de la llamada también fueron clasificados con niveles de gravedad altos en el triaje posterior realizado en el servicio de urgencias hospitalario, mostrando una concordancia moderada. Más del 50% de los padres tenían intención de acudir a urgencias antes de la teleconsulta y un 46% cambiaron de actitud tras realizar esta llamada. Conclusiones: Fiebre y dudas de medicación fueron motivos estadísticamente significativos de teleconsulta no urgente. La consulta telefónica produjo un cambio de actitud en casi la mitad de los padres


Objectives: To analyze the characteristics of remote telephone consultations (televisits) and triage of pediatric emergencies attended by the 24-hour emergency service of Catalonia (CatSalut Respon), and to describe the impact of televisits on callers' decisions about whether or not to come to the emergency department and their opinion of the call service. Methods: Observational cross-sectional study. During the call, cases were classified according the Spanish and Andorran triage system. Patients who were sent to the hospital underwent triage again, and the 2 assigned triage levels were compared. The families were later called to check data and ask their opinion of the service. Sociodemographic and clinical data related to the cases were recorded. Results: A total of 370 televisits were made. Most cases (300, 81%) were not emergencies. Seventy-five callers (20.3%) were advised to go to an emergency department. Fever (P = .002) and questions about medication (P < .001) were the problems significantly associated with nonurgent cases. Nearly 46% of the cases classified as serious during telephone triage were also considered serious when the child was brought to the emergency department. The rate of agreement between the 2 triage levels was moderate. Over half the parents stated they had intended to go to the hospital before calling the service; 46% changed their mind based on the call. Conclusions: Fever and questions about medication were significantly associated with televisits for nonurgent cases. Nearly half the parents changed their mind about going to the emergency department after a televisit


Assuntos
Humanos , Criança , Adolescente , Triagem/métodos , Consulta Remota/instrumentação , Medicina de Emergência Pediátrica/métodos , Triagem/estatística & dados numéricos , Consulta Remota/métodos , Consulta Remota/estatística & dados numéricos , Medicina de Emergência Pediátrica/estatística & dados numéricos , Febre/epidemiologia , Estudos Transversais , Consulta Remota/classificação
6.
J Clin Nurs ; 28(21-22): 3966-3976, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31328336

RESUMO

AIMS AND OBJECTIVES: To explore the advantages and disadvantages of using video consultations, as experienced by specialised palliative care healthcare professionals, who are involved in palliative care at home. BACKGROUND: One challenge in the work of specialised palliative care teams is the substantial resources used in terms of time and transport to and from the patient's home. Video consultations may be a solution for real-time specialised palliative home care. DESIGNS: Hermeneutic, postphenomenology. METHODS: An explorative qualitative study utilising data from field notes of an autobiographical diary, participant observations and semi-structured interviews with healthcare professionals. The COREQ guideline was used for reporting the study. See Appendix S1. The data collection took place in patients' homes and at the Department of Oncology, Odense University Hospital, Denmark. RESULTS: Eight participants (n = 8); five community nurses; and three specialised palliative care team members-a head physician, a physiotherapist and a nurse-participated in the study. The healthcare professionals' knowledge was based on n = 82 video consultations with 11 patients. The range of video consultations was 3-18 per patient. The use of tablets in video consultations facilitated direct palliative care and led the community nurses and the specialised palliative care team nurse to co-operate. Potential barriers against using video consultations are the discussions about personal, and private issues regarding the illness, while family members are present. CONCLUSIONS: Video consultations in specialised palliative home care are feasible, and the technology can facilitate multidisciplinary participation and co-operation among healthcare professionals. The continuous use of video consultations over time may increase the quality of specialised palliative home care. RELEVANCE TO CLINICAL PRACTICE: The use of video consultations can provide direct specialised palliative care over distance involving healthcare professionals, patients and their relatives.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida/métodos , Cuidados Paliativos/métodos , Consulta Remota/métodos , Adulto , Atitude do Pessoal de Saúde , Dinamarca , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Consulta Remota/estatística & dados numéricos
7.
Geriatr Psychol Neuropsychiatr Vieil ; 17(3): 261-270, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31293238

RESUMO

The clinical situation and complexity of the medical care of elderly living in nursing homes accounts for a high risk of hospitalization. Geriatric teleconsultations would be one of the solutions proposed to prevent unplanned hospitalizations. Our objective was to evaluate the impact of geriatric teleconsultations on hospitalizations of elderly living in nursing homes. This is a descriptive, retrospective, single-center study of elderly people living in 11 nursing homes in North-West Vendée who received a geriatric teleconsultation and whom the general practitioner would have hospitalized in the absence of teleconsultation. We observed the occurrence of an unscheduled hospitalization within 7 days of the teleconsultation. Thus, 48 patients were included, aged 85.6±6.4. Geriatric teleconsultations prevented hospitalization for 83,3% of cases. The problems related to a psychiatric pathology or a dementia were inversely associated with post-teleconsultation hospitalization (OR=0.077; p=0,01). The geriatric teleconsultation seems to be a tool allowing the reduction of hospitalizations of the elderly living in nursing homes. These results need to be confirmed by other studies.


Assuntos
Hospitalização/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Demência/complicações , Demência/terapia , Feminino , França , Avaliação Geriátrica , Humanos , Masculino , Estudos Retrospectivos
8.
Travel Med Infect Dis ; 30: 73-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31279917

RESUMO

BACKGROUND: Malaria prevention in travellers can be complex and requires consideration of a number of factors. UK healthcare professionals providing pre-travel malaria advice can access specialist support from the National Travel Health Network and Centre (NaTHNaC) telephone advice line. The aim of this study is to characterise queries to the NaTHNaC telephone advice line regarding pre-travel malaria advice. METHOD: Telephone calls received to NaTHNaC's advice line are recorded using an online data capture form. All calls relating to malaria advice during 2016 were selected and data extracted. Analysis was undertaken using Microsoft Excel and STATA. RESULTS: During 2016, 1803 malaria-related calls were received; the majority from general practice and calls were from across the UK. The most common type of pre-travel malaria query was country-specific followed by travellers with special health needs. Many queries related to pregnant and breastfeeding travellers, children under 5 years and travellers over 60 years. CONCLUSIONS: This review presents a large and exceptional dataset and reflects the ambiguity amongst some healthcare professionals regarding malaria advice. We have identified potential knowledge gaps, and as a result will strengthen future guidance, enhance existing malaria maps, and inform the development of future clinical educational activity.


Assuntos
Malária/prevenção & controle , Consulta Remota/estatística & dados numéricos , Telefone , Viagem/estatística & dados numéricos , Humanos , Fatores de Risco , Reino Unido , Vacinação/estatística & dados numéricos
9.
Gen Hosp Psychiatry ; 59: 51-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163299

RESUMO

OBJECTIVE: Given the critical shortage of perinatal psychiatrists, combined with the prevalence of psychiatric conditions in the perinatal period, teleconsultation may help to maximize the efficiency of psychiatrists to reach this population. The Periscope Project (TPP) is a Wisconsin-based program offering real-time provider-to-provider teleconsultation, community resource information, and provider education. This paper describes model adaptations and implementation of TPP and the first 18 months of program data. METHOD: Enrollment and satisfaction data was collected via self-reported online surveys. Encounter data was entered by TPP team members through communication with providers. All data was housed in REDCap. RESULTS: Four hundred eight-five providers enrolled and 268 unique providers accessed services at least once. There were 594 encounters with 85% of encounters resulting in a teleconsultation. Mean call-back time from the psychiatrist was 6.8 min. Over half of utilizing providers practiced in obstetrical settings and 23% practiced in mental health settings. Provider satisfaction with the service was 100%. CONCLUSIONS: Utilization and satisfaction with TPP suggest that perinatal psychiatry access program models can vary in structure and process and experience similar utilization rates. Model adaptations are feasible and demonstrate the teleconsultation service is accepted by providers and may improve the population's health over time.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Complicações na Gravidez/terapia , Desenvolvimento de Programas , Consulta Remota/estatística & dados numéricos , Adulto , Feminino , Humanos , Serviços de Saúde Materna/economia , Serviços de Saúde Mental/economia , Gravidez , Consulta Remota/economia , Wisconsin
10.
Int J Circumpolar Health ; 78(2): 1554174, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31066652

RESUMO

The cost of providing health care in northern Canada is higher than the rest of Canada. Telehealth has the potential to reduce health care expenditures. Yet this is still underutilised in Canada and globally. This paper describes the services provided through telehealth in some northern regions of Canada. It provides recommendations on the requirements for setting up real presence telehealth and how utilisation can be enhanced. Telehealth offers potential benefits for health outcomes by increasing access to healthcare, and reducing expenditures.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Serviços de Saúde Rural/organização & administração , População Rural/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Canadá , Humanos , Atenção Primária à Saúde/organização & administração
11.
Complement Med Res ; 26(3): 174-181, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-30965320

RESUMO

Hintergrund: Der Antibiotikaeinsatz bei Nutztieren fördert die Entwicklung antibiotikaresistenter Bakterien. Die Komplementärmedizin könnte einen Beitrag zur Reduktion von Antibiotika leisten, wird bisher jedoch nicht flächendeckend angeboten. Das Beratungsprogramm "Kometian" unter-stützt teilnehmende Landwirte darin, ihre Tiere komplementärmedizinisch zu behandeln. Methoden und Resultate: 128 von 223 teilnehmenden Betrieben nutzten in den ersten 3 Projektjahren die telefonische Beratung von Kometian. Die Mehrheit der Landwirte hielt Milchkühe. Frühestens 1 Woche nach der Kometianberatung wurde eine telefonische Nachfrage beim Tierbesitzer hinsichtlich des Gesundheitszustandes des Tieres durchgeführt. Es konnten so 661 Beratungsfälle recherchiert werden. In 486 Fällen erfolgte keine weitere schulmedizinische Behandlung, in 373 Fällen gab der Landwirt einen Behandlungserfolg an. Von 188 angefragten und seit mindestens einem Jahr an Kometian teilnehmenden Betrieben stellten 46 ihre Behandlungsjournale zur Verfügung. Die betriebliche antibiotische Behandlungsinzidenz sank signifikant (p < 0,001) von 27 vor Beitritt auf 18 Behandlungen pro 100 Tiere im ersten Jahr. Schlussfolgerung: Es scheint, dass Kometian einen Beitrag dazu leisten konnte, den Antibiotikaeinsatz auf Betriebsebene zu reduzieren. BACKGROUND: A regular use of antibiotics in farm animals is assumed to induce antibiotic-resistant bacteria. Complementary and alternative medicine (CAM) may contribute to a reduction of antibiotic use but it is not extensively offered by Swiss veterinarians. The advisory program "Kometian" supports farmers in treating their animals with CAM. METHODS AND RESULTS: 128 out of 223 participating farmers used the telephone consultations of Kometian in the first 3 years of the project. The majority of the farmers kept dairy cattle. No sooner than 1 week after such a consultation, the famer was questioned by phone about the health progress of the animal. Thus, the development of health could be verified in 661 cases (of 714). 486 cases were not treated further by conventional medicine; in 373 cases the farmer reported a positive treatment effect. Of 188 examined farms, which had participated in the advisory program for at least 1 year, 46 made their treatment records available. The incidence of antibiotic treatment decreased significantly (p < 0.001) from 27 before entering the program to 18 treatments per 100 animals in the first year. CONCLUSION: It seems that the advisory program Kometian could contribute to reduce the use of antibiotics on the farm level.


Assuntos
Doenças dos Animais/terapia , Antibacterianos/uso terapêutico , Doenças dos Bovinos/terapia , Terapias Complementares/veterinária , Uso de Medicamentos/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Medicina Veterinária/métodos , Animais , Bovinos , Terapias Complementares/estatística & dados numéricos , Indústria de Laticínios , Seguimentos , Suíça , Medicina Veterinária/estatística & dados numéricos
12.
Rural Remote Health ; 19(1): 4743, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30825873

RESUMO

INTRODUCTION: This study aimed to demonstrate that teleneurology consultations conducted via tablet technology are an efficient and cost-effective means of managing acute neurologic emergencies at community-based hospitals and that utilizing such technology yields high community physician satisfaction. METHOD: During a 39-month period, Vanderbilt University Medical Center in Tennessee USA, provided teleneurology services to 10 community-based hospitals that lacked adequate neurology coverage. Hospitalists at one community-based hospital were not comfortable treating any patient with a neurologic symptom, resulting in 100% of those patients being transferred. This facility now retains more than 60% of neurology patients. For less than US$1200, these hospitals were able to meet the only capital expenditure required to launch this service: the purchase of handheld tablet computers. Real-time teleneurology consultations were conducted via tablet using two-way video conferencing, radiologic image sharing, and medical record documentation. Community physicians were regularly surveyed to assess satisfaction. RESULTS: From February 2014 to May 2017, 3626 teleneurology consultations were conducted. Community physicians, in partnership with neurologists, successfully managed 87% of patients at the community-based hospital. Only 13% of patients required transfer to another facility for a higher level of care. The most common diagnoses included stroke (34%), seizure (11%), and headache/migraine (6%). The average time for the neurologist to answer a request for consultation page and connect with the community physician was 10.6 minutes. Ninety-one percent of community physicians were satisfied or somewhat satisfied with the overall service. CONCLUSION: In the assessment of neurology patients, tablets are a more cost-effective alternative to traditional telehealth technologies. The devices promote efficiency in consultations through ease of use and low transfer rates, and survey results indicate community physician satisfaction.


Assuntos
Pessoal de Saúde/estatística & dados numéricos , Satisfação no Emprego , Neurologia/organização & administração , Consulta Remota/estatística & dados numéricos , Telemedicina/organização & administração , Humanos , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Padrões de Prática Médica
13.
Telemed J E Health ; 25(1): 3-10, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29746210

RESUMO

BACKGROUND: Wait times to access specialist care remain a huge frustration for patients and providers. In Ontario, two electronic consultation (eConsult) services provide prompt, secure access to specialist advice: The Champlain Building Access to Specialists through eConsultation (BASE™) eConsult-managed service, and the Ontario Telemedicine Network (OTN). INTRODUCTION: To gain a broader understanding of specialists' perspectives providing eConsult services, we surveyed all specialists actively participating in either platform. METHODS: A 34-item web questionnaire focused in four key areas (experience with the service, ideas for provincial expansion, recommendations for enhancements to the service, and specialist demographics) was sent to all specialists who had completed at least one eConsult on either service. RESULTS: There was a 66% (114/172) response rate for BASE and a 47% (61/130) response rate for OTN. The most frequent motivations for participating in eConsult were innovative patient care (58% and 69%), opportunity to reduce wait times (45% and 54%), and opportunity to communicate directly with primary care providers (41% and 51%). Most specialists agreed that eConsult is feasible, results in improved communication between providers, and can be integrated into their clinical workflow without difficulty. Fifty-two percent of OTN specialists and 49% of BASE specialists agreed that they were appropriately compensated for answering eConsults. DISCUSSION: Specialists participate in eConsult services to improve communication with primary care, provide innovative care, and reduce wait times. CONCLUSIONS: As eConsult services expand across regions and provinces, the provider perspectives and experiences should be used to evaluate the benefits of eConsult and impact on provider satisfaction.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Medicina/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Especialização/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Reembolso de Seguro de Saúde/estatística & dados numéricos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Motivação , Ontário , Equipe de Assistência ao Paciente , Médicos de Atenção Primária/estatística & dados numéricos , Listas de Espera
14.
Prim Health Care Res Dev ; 20: e5, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29909798

RESUMO

BACKGROUND: In 2014, in the United Kingdom, the government made a commitment to spend £3.6 million on the introduction of Skype video calling consultations in general practice, however the efficacy of such technology has not yet been explored fully.AimThe study aimed to explore the views and attitudes of General Practitioners (GPs) towards video consultation in primary care; specifically, in three broad areas ∙The benefits of video consultations to patients and healthcare professionals.∙Potential problems with video consultation and its implementation.∙The cost-effectiveness of video consultation in this setting. METHOD: A convenience sample of the views of 12 general practitioners across two primary care centres in North London were identified using topic guide based semi-structured interviews. A thematic framework approach was used to analyse the data collected to isolate main and sub-themes.FindingsThree main themes were identified 1.Technology - GPs expressed concerns about the ability of patients to use technology, the availability of technology and the quality of technology available.2.Utility - encompassing GP's ideas about the usefulness of video consultations to patients, practitioners and the doctor-patient relationship. GPs presented mixed views on the extent to which video consultation would be useful.3.Practicality - covering the views of GPs on implementation and effects on workload. GPs unanimously felt that it was not a practical substitute for face-to-face consultation. There were mixed feelings about it being used as an alternative to telephone consultation. CONCLUSION: GPs did see potential benefits to using video consultations but also expressed concerns that need to be addressed if they are to have full confidence in the system. The views of those who are going to use video consultation as a means of increasing patient access are paramount if such tools are to be a core part of primary care.


Assuntos
Atitude do Pessoal de Saúde , Clínicos Gerais/psicologia , Clínicos Gerais/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Consulta Remota/estatística & dados numéricos , Adulto , Feminino , Humanos , Entrevistas como Assunto , Londres , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pesquisa Qualitativa , Consulta Remota/métodos
15.
Telemed J E Health ; 25(3): 184-198, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29927711

RESUMO

BACKGROUND: Electronic consultation (eConsult) is an asynchronous electronic communication tool allowing primary care providers to obtain a specialist consultant's expert opinion in a timely manner, thereby offering a potential solution to excessive wait times for specialist care, which remain a serious concern in many countries. INTRODUCTION: Our 2014 review of eConsult services demonstrated feasibility and high acceptability among patients and providers. However, gaps remain in knowledge regarding eConsult's impact on system costs and patient outcomes. MATERIALS AND METHODS: Following the PRISMA guidelines, we conducted a systematic review in May 2017 of English and French literature on OVID Medline, EMBASE, ERIC, and CINAHL databases, examining all studies on eConsult services published since our previous review. The Quadruple Aim Framework was used to synthesize outcomes. Articles reporting on the impact of eConsult on access, patient safety and satisfaction, utilization rates, clinical workflow, and continuing medical education were analyzed using a narrative synthesis approach. RESULTS: The initial search yielded 1,021 results, 50 of which were included on abstract and received a quality assessment and full text review. Of these, 43 were included in our final analysis. Results demonstrated the worldwide presence of eConsult services in North America and countries beyond, including Brazil, Australia, Spain, and The Netherlands. The breadth of specialty services offered has greatly expanded beyond dermatology and includes cardiology, nephrology, and hematology among others. Overall impact on access measures, acceptability, cost, and provider satisfaction remain positive. There is limited research on population health outcomes of morbidity and mortality. CONCLUSIONS: The availability of eConsult services has spread both geographically and in terms of specialty services offered. By allowing for a greater population to be served, access to care is being improved; however, long-term impact should continue to be assessed with a focus on patient safety, morbidity, mortality, and cost effectiveness metrics.


Assuntos
Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Qualidade da Assistência à Saúde/economia , Consulta Remota/economia , Telemedicina/economia , Austrália , Brasil , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Países Baixos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Espanha , Telemedicina/estatística & dados numéricos
16.
Popul Health Manag ; 22(2): 153-161, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29969378

RESUMO

Heart failure (HF) is currently among the most prevalent and costly chronic diseases among older adults, who are at increased risk because of other chronic conditions and the aging process. HF has a significant impact on the health care system, patient outcomes, and the unsustainable rising costs of care. The primary objectives were to: (1) determine cost savings differences in medical expenditures between engaged and non-engaged members referred to a HF management program; (2) examine differences in length of stay and time to first post-engagement acute inpatient admission; and (3) examine the impact of using a remote weight monitoring scale on medical expenditures and inpatient admissions. Generalized linear modeling was used to compare key outcomes among individuals who engaged in the program and a propensity-matched cohort of those who were eligible but did not engage. Key outcomes included post-engagement acute inpatient medical service utilization, all-cause per-member-per-month medical expenses, and acute inpatient length of stay. When paired with regular use of a remote weight monitoring scale, engagement in this HF management program appears to be associated with decreased risk for acute inpatient admission and lower all-cause medical expenditures. Participation in a clinically based HF management program may improve health-related and financial outcomes among older individuals. However, further development and evaluation of disease management programs could help to improve their effectiveness and thus patient outcomes.


Assuntos
Insuficiência Cardíaca , Medicare Part C , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Redução de Custos/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Consulta Remota/métodos , Consulta Remota/estatística & dados numéricos , Estados Unidos/epidemiologia
17.
J Telemed Telecare ; 25(6): 370-377, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29754562

RESUMO

INTRODUCTION: E-consultations (e-consults) were implemented at VA medical centers to improve access to specialty care. Cardiology e-consults are among the most commonly requested, but little is known about how primary care providers (PCPs) use cardiology e-consults to access specialty care. METHODS: This is a retrospective analysis of 750 patients' medical charts with cardiology e-consults requested by medical providers (October 2013-September 2015) in the VA New England Healthcare System. We described the patients and referring provider characteristics, and e-consult questions. We reviewed cardiologists' responses and examined their recommendations. RESULTS: Among the 424 e-consults requested from PCPs, 92.7% were used to request answers to clinical questions, while 7.3% were used for administrative purposes. Among the 393 e-consults with clinical questions, 60 e-consults were regarding preoperative management; these questions most commonly addressed general risk assessment (n = 44), anti-coagulation/anti-platelet management (n = 33), and EKG interpretation (n = 20). Cardiologists provided answers for the majority (89.6%) of clinical questions. Among the e-consults in which cardiologists did not provide answers or clinical guidance (n = 41), the reasons included missing or insufficient clinical information (n = 18), medical complexity (n = 6), and deferment to the patient's non-VA primary cardiologist (n = 7). Cardiologists recommended that the patients be seen as face-to-face consults for 7.9% of e-consults. DISCUSSION: Primary care providers are the most frequent requesters of cardiology e-consults, using them primarily to obtain input on clinical questions. Cardiologists did not provide answers for one in ten, owing principally to insufficient available clinical information. Educating PCPs and standardizing the template for requesting e-consultation may help to reduce the number of unanswered e-consults.


Assuntos
Atenção Primária à Saúde/métodos , Encaminhamento e Consulta/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Cardiologia/organização & administração , Feminino , Pessoal de Saúde , Humanos , Medicina , New England , Estudos Retrospectivos , Veteranos/estatística & dados numéricos
18.
Braz Oral Res ; 32: e128, 2018 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-30569975

RESUMO

This cross-sectional study aimed to evaluate the asynchronous dental teleconsulting of Telehealth Brazil Networks Program in Minas Gerais. Data were collected from secondary databases of the Clinical Hospital of the Universidade Federal de Minas Gerais (CH/UFMG) and Medical School of UFMG (MS/UFMG), from July 2015 to July 2017. The variables analyzed were telehealth center, sex and profession, date and time questions and answers, response time in days, whether the issue was duly addressed, whether the teleconsulting was attended, post status, professional's satisfaction, conduct adopted after teleconsulting, dental specialty area, and type of issues. Sociodemographic data from the Intermediate Geographical Regions (IGR) of Minas Gerais, including the Municipal Human Development Index (MHDI) and Gini Index were also collected. The results were analyzed using SPSS v.22.0. In total, 3,920 teleconsulting were recorded, with increasing demand in the study period. Most were requested by dentists (93.3%) and female professionals (78.6%), during office hours (78.6%), and related to general conducts (72.1%). Almost all were attended (99.7%), with a maximum response time of two days (75.0%). A low feedback on satisfaction and resolution of issues (missing data of 57.2% and 70.2%, respectively) was recorded. Only 5.2% had information on whether patients were referred. The most common inquires were of issues about Pathology/Stomatology specialties (19.0%) and Pharmacology/Anesthesiology (18.8%). The response occurred within the expected time, with prevalent issues in basic dental areas and general conducts. Feedback from professionals must be encouraged to allow a better analysis and improvements of the program.


Assuntos
Assistência Odontológica/métodos , Assistência Odontológica/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Brasil , Estudos Transversais , Odontologia/estatística & dados numéricos , Odontólogos/estatística & dados numéricos , Feminino , Humanos , Masculino , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Estatísticas não Paramétricas , Fatores de Tempo
20.
BMC Health Serv Res ; 18(1): 814, 2018 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-30355346

RESUMO

BACKGROUND: Electronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion. METHODS: Using a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems' end-users. RESULTS: Organizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies. CONCLUSION: A core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs.


Assuntos
Assistência à Saúde/métodos , Consulta Remota/estatística & dados numéricos , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Difusão de Inovações , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , São Francisco , Especialização , Estados Unidos , United States Department of Veterans Affairs
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA