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1.
BMC Fam Pract ; 22(1): 146, 2021 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217208

RESUMO

BACKGROUND: Early in the COVID-19 pandemic, general practices were asked to expand triage and to reduce unnecessary face-to-face contact by prioritizing other consultation modes, e.g., online messaging, video, or telephone. The current study explores the potential barriers and facilitators general practitioners experienced to expanding triage systems and their attitudes towards triage during the COVID-19 pandemic. METHOD: A mixed-method study design was used in which a quantitative online survey was conducted along with qualitative interviews to gain a more nuanced appreciation for practitioners' experiences in the United Kingdom. The survey items were informed by the Theoretical Domains Framework so they would capture 14 behavioral factors that may influence whether practitioners use triage systems. Items were responded to using seven-point Likert scales. A median score was calculated for each item. The responses of participants identifying as part-owners and non-owners (i.e., "partner" vs. "non-partner" practitioners) were compared. The semi-structured interviews were conducted remotely and examined using Braun and Clark's thematic analysis. RESULTS: The survey was completed by 204 participants (66% Female). Most participants (83%) reported triaging patients. The items with the highest median scores captured the 'Knowledge,' 'Skills,' 'Social/Professional role and identity,' and 'Beliefs about capabilities' domains. The items with the lowest median scores captured the 'Beliefs about consequences,' 'Goals,' and 'Emotions' domains. For 14 of the 17 items, partner scores were higher than non-partner scores. All the qualitative interview participants relied on a phone triage system. Six broad themes were discovered: patient accessibility, confusions around what triage is, uncertainty and risk, relationships between service providers, job satisfaction, and the potential for total digital triage. Suggestions arose to optimize triage, such as ensuring there is sufficient time to conduct triage accurately and providing practical training to use triage efficiently. CONCLUSIONS: Many general practitioners are engaging with expanded triage systems, though more support is needed to achieve total triage across practices. Non-partner practitioners likely require more support to use the triage systems that practices take up. Additionally, practical support should be made available to help all practitioners manage the new risks and uncertainties they are likely to experience during non-face-to-face consultations.


Assuntos
COVID-19 , Medicina Geral , Clínicos Gerais , Consulta Remota , Triagem , Atitude do Pessoal de Saúde , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/terapia , Competência Clínica , Inglaterra/epidemiologia , Feminino , Medicina Geral/organização & administração , Medicina Geral/normas , Medicina Geral/tendências , Clínicos Gerais/psicologia , Clínicos Gerais/normas , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Masculino , Padrões de Prática Médica/ética , Padrões de Prática Médica/tendências , Consulta Remota/ética , Consulta Remota/métodos , Gestão de Riscos/tendências , SARS-CoV-2 , Triagem/ética , Triagem/métodos , Triagem/organização & administração , Triagem/normas
2.
PLoS One ; 16(7): e0254339, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34260644

RESUMO

In Dec 2020 Brazil became one of the worldwide epicenters of the COVID-19 pandemic with more than 7.2M reported cases. Brazil has a large territory with unequal distribution of healthcare resources including physicians. Resource limitation has been one of the main factors hampering Brazil's response to the COVID-19 crisis. Telemedicine has been an effective approach for COVID-19 management as it allows to reduce the risk of cross-contamination and provides support to remote rural locations. Here we present the analyses of teleconsultations from a countrywide telemedicine service (TelessáudeRS-UFRGS, TRS), that provides physician-to-physician remote support during the COVID-19 pandemic in Brazil. We performed a descriptive analysis of the teleconsultation incoming calls and a text analysis from the call transcripts. Our findings indicate that TRS teleconsultations in Brazil experienced an exponential increment of 802.% during a period of 6 days, after the first death due to COVID-19 was reported. However, the number of teleconsultations cases decreased over time, despite the number of reported COVID-19 cases continuously increasing. The results also showed that physicians in low-income municipalities, based on GDP per capita, are less likely to consult the telemedicine service despite facing higher rates of COVID-19 cases. The text analysis of call transcripts from medical teleconsultations showed that the main concern of physicians were "asymptomatic" patients. We suggest an immediate reinforcement of telehealth services in the regions of lower income as a strategy to support COVID-19 management.


Assuntos
COVID-19/terapia , Consulta Remota/estatística & dados numéricos , Brasil , Disparidades em Assistência à Saúde , Humanos , Médicos , Atenção Primária à Saúde , Consulta Remota/métodos , Saúde da População Rural , Telemedicina/métodos , Telemedicina/estatística & dados numéricos
4.
BMJ Open Qual ; 10(2)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34112657

RESUMO

The COVID-19 pandemic prompted a rapid change in primary care provision. There was a significant shift from face-to-face appointments to remote methods such as electronic consultation (e-consultation). Patients from a primary care provider in London were actively encouraged to use an online consultation platform called 'Dr iQ'. A group of high frequency users of Dr iQ emerged and clinicians were concerned their health needs were not being met through the platform. High frequency attendance in a traditional general practice setting is associated with increased time and healthcare costs.This project evaluated the number of high frequency users (identified as 10 or more consultations a month) of Dr iQ in one busy inner city practice over a 5-month period. We aimed to decrease the subsequent monthly usage frequency of all Dr iQ high frequency users from 10 or more consultations to less than 10 consultations. Our interventions included a semi-structured telephone interview, discussion among the multidisciplinary team, and regular scheduled telephone or face-to-face appointments. Following two Plan-Do-Study-Act cycles, all 12 high frequency users showed a decrease in the number of consultations submitted to Dr iQ to less than 10 consultations a month.This project proposes a method of case managing high frequency users of e-consultation. The majority of high frequency users had unmet health needs and felt a lack of continuity of care on Dr iQ. They often had complex physical and mental health problems. As remote consulting technology continues to develop, more research is required to understand the epidemiology and aetiology of e-consultation high frequency use in order to improve patient outcomes.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Adulto , COVID-19/prevenção & controle , COVID-19/transmissão , Tecnologia Digital/métodos , Feminino , Humanos , Londres , Masculino , Satisfação do Paciente , Relações Médico-Paciente , Atenção Primária à Saúde/métodos , Melhoria de Qualidade , Consulta Remota/métodos
5.
Ann R Coll Surg Engl ; 103(7): 520-523, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192482

RESUMO

INTRODUCTION: In light of the COVID-19 recommendations from the Association of Coloproctology of Great Britain and Ireland, we aimed to study patient and clinician satisfaction with a newly established telephone (TP) colorectal clinic service in lieu of traditional face-to-face (FTF) appointments. Comparative outcomes included patient versus clinician satisfaction; patient versus clinician desire to continue TP clinics postpandemic; and views of Specialty Trainee 3+ (ST3+)/Specialty Associate Specialist (SAS) doctors versus consultants on TP compared with FTF appointments. METHODS: We conducted a prospective service evaluation of patient and clinician satisfaction with colorectal surgery TP clinics between 1 June 2020 and 30 June 2020 in a British District General Hospital. RESULTS: Patients had higher satisfaction than clinicians with TP clinics: 91.5% versus 66.6% reported above-average experience [odds ratio (OR) = 5.35, 95% confidence interval (CI) 1.53 to 18.75, p = 0.01]. Clinicians had lower demand to continue TP clinics post-COVID-19 versus patients, with a trend towards significance (60% versus 82.9%, OR = 0.31, 95% CI 0.10 to 0.97, p = 0.08). ST3+/SAS doctors were more likely than consultants to find TP clinics inferior to FTF consultation for patient assessment (48.3% versus 23.7%, OR = 3.00, 95% CI 1.17 to 7.71, p = 0.03). CONCLUSIONS: While clinicians may be concerned that patient assessment suffers, patient satisfaction with TP clinics is high. There should be a place for TP clinics post-COVID-19 but there must be a robust process for patient selection as well as adequate training for current and future generations of clinicians.


Assuntos
COVID-19/prevenção & controle , Neoplasias Colorretais/diagnóstico , Oncologia/métodos , Consulta Remota/métodos , Telefone , Assistência ao Convalescente/métodos , Assistência ao Convalescente/normas , Assistência ao Convalescente/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/transmissão , Neoplasias Colorretais/terapia , Humanos , Controle de Infecções/normas , Satisfação no Emprego , Oncologia/normas , Oncologia/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Consulta Remota/normas , Consulta Remota/estatística & dados numéricos , Cirurgiões/psicologia , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Reino Unido/epidemiologia
6.
Cutis ; 107(4): E37-E39, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34096860

RESUMO

The COVID-19 pandemic resulted in profound changes to most facets of medical practice. The field of dermatology has adapted by rapidly incorporating teledermatology as a means of evaluating, treating, and staying connected with our patients. Broader dermatology access, convenience to patients, and value to payers are benefits to this rapidly evolving practice model and suggest that teledermatology will be a part of day-to-day practice even as the worst of the pandemic is behind us. This interview provides one recent dermatology resident graduate's experiences incorporating teledermatology into his practice model and provides advice for future residents on preparing to do the same.


Assuntos
COVID-19/prevenção & controle , Consulta Remota/métodos , Dermatopatias/terapia , Telemedicina/métodos , COVID-19/epidemiologia , Dermatologia/normas , Humanos
7.
BMC Fam Pract ; 22(1): 108, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078281

RESUMO

BACKGROUND: Attempts to manage the COVID-19 pandemic have led to radical reorganisations of health care systems worldwide. General practitioners (GPs) provide the vast majority of patient care, and knowledge of their experiences with providing care for regular health issues during a pandemic is scarce. Hence, in a Danish context we explored how GPs experienced reorganising their work in an attempt to uphold sufficient patient care while contributing to minimizing the spread of COVID-19. Further, in relation to this, we examined what guided GPs' choices between telephone, video and face-to-face consultations. METHODS: This study consisted of qualitative interviews with 13 GPs. They were interviewed twice, approximately three months apart in the initial phase of the pandemic, and they took daily notes for 20 days. All interviews were audio recorded, transcribed, and inductively analysed. RESULTS: The GPs re-organised their clinical work profoundly. Most consultations were converted to video or telephone, postponed or cancelled. The use of video first rose, but soon declined, once again replaced by an increased use of face-to-face consultations. When choosing between consultation forms, the GPs took into account the need to minimise the risk of COVID-19, the central guidelines, and their own preference for face-to-face consultations. There were variations over time and between the GPs regarding which health issues were dealt with by using video and/or the telephone. For some health issues, the GPs generally deemed it acceptable to use video or telephone, postpone or cancel appointments for a short term, and in a crisis situation. They experienced relational and technical limitations with video consultation, while diagnostic uncertainty was not regarded as a prominent issue CONCLUSION: This study demonstrates how the GPs experienced telephone and video consultations as being useful in a pandemic situation when face-to-face consultations had to be severely restricted. The GPs did, however, identify several limitations similar to those known in non-pandemic times. The weighing of pros and cons and their willingness to use these alternatives shifted and generally diminished when face-to-face consultations were once again deemed viable. In case of future pandemics, such alternatives seem valuable, at least for a short term.


Assuntos
Atitude do Pessoal de Saúde , COVID-19/prevenção & controle , Medicina Geral/tendências , Padrões de Prática Médica/tendências , Consulta Remota/tendências , COVID-19/epidemiologia , Tomada de Decisão Clínica/métodos , Dinamarca/epidemiologia , Medicina Geral/métodos , Medicina Geral/organização & administração , Humanos , Entrevistas como Assunto , Pandemias , Relações Médico-Paciente , Padrões de Prática Médica/organização & administração , Pesquisa Qualitativa , Consulta Remota/métodos , Consulta Remota/organização & administração , Telefone , Comunicação por Videoconferência
8.
Artigo em Inglês | MEDLINE | ID: mdl-34040680

RESUMO

Background and aim: The current COVID-19 pandemic scenario has driven surgical departments to a transformation.The worldwide spread of the disease has led to a public health quarantine where health care professionals are at high risk of infection. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. This study aims to demonstrate that a combined framework based on telematics and in-person clinical encounter not only ensures medical care but the safety of healthcare professionals and patients. Material and method: Descriptive observational study on the follow-up of patients during the COVID19 Pandemic, combining telephone and traditional. Results: A total of 5031 telephone calls were made, differentiating between medical referrals, specialised primary care visits, and outpatient consultation.They were classified as successful, required an in-person visit, or no successful telephone contact. Furthermore, we divided them into 2 groups: resolved and unresolved.53% of all telematic visits were successful. Conclusions: Telematic medical systems are a feasible option in a orthopedics department and an interesting resource to preserve once the pandemic is resolved. Future lines of research should be opened to improve system success, analyze its cost-effectiveness ratio, and correct any legal conflicts that may exist.


Assuntos
Assistência ao Convalescente/métodos , COVID-19/prevenção & controle , Controle de Infecções/métodos , Ortopedia/métodos , Cuidados Pós-Operatórios/métodos , Consulta Remota/métodos , Telefone , Assistência ao Convalescente/estatística & dados numéricos , COVID-19/epidemiologia , Estudos de Viabilidade , Política de Saúde , Acesso aos Serviços de Saúde , Humanos , Ortopedia/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias , Distanciamento Físico , Cuidados Pós-Operatórios/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Espanha/epidemiologia
9.
Clin Otolaryngol ; 46(4): 689-691, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33872469

RESUMO

Remote communication in ENT has been expanding, spurred by the COVID-19 pandemic. Conferences and teaching have moved online, enabling easier participation and reducing financial and environmental costs. Online multi-disciplinary meetings have recently been instigated in Africa to discuss management of cases in head and neck cancer, or cochlear implantation, expanding access and enhancing patient care. Remote patient consultation has also seen an explosion, but existing literature suggests some caution, particularly because many patients in ENT need an examination to enable definitive diagnosis. Ongoing experience will help us to better understand how remote communication will fit into our future working lives, and also where face-to-face interaction may still be preferable.


Assuntos
COVID-19/epidemiologia , Atenção à Saúde/métodos , Educação Médica/métodos , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Otolaringologia/métodos , Pandemias , Consulta Remota/métodos , Humanos , Aprendizagem , SARS-CoV-2 , África do Sul/epidemiologia
10.
West J Emerg Med ; 22(2): 450-453, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33856338

RESUMO

Poisoning and envenomation are a global health problem for which the mortality burden is shouldered heavily by middle- and low-income countries that often lack poison prevention programs and medical toxicology expertise. Although telehealth or teleconsult services have been used to bridge the expertise gap between countries for multiple specialties, the use of medical toxicology teleconsult services across borders has been limited. We aim to describe the use of a United States-based medical toxicology teleconsult service to support patient care at a hospital in a middle-income country that lacks this expertise. This report outlines the logistics involved in setting up such a service, including the challenges and opportunities that emerged from establishing medical toxicology teleconsult service in a low-resource setting.


Assuntos
Envenenamento , Consulta Remota , Toxicologia , Países em Desenvolvimento , Prova Pericial/métodos , Humanos , Cooperação Internacional , Líbano/epidemiologia , Envenenamento/diagnóstico , Envenenamento/epidemiologia , Envenenamento/terapia , Consulta Remota/métodos , Consulta Remota/organização & administração , Toxicologia/métodos , Toxicologia/organização & administração , Estados Unidos
11.
BMC Pregnancy Childbirth ; 21(1): 328, 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902496

RESUMO

BACKGROUND: Ninety-four percent of all maternal deaths occur in low- and middle-income countries, and the majority are preventable. Access to quality Obstetric ultrasound can identify some complications leading to maternal and neonatal/perinatal mortality or morbidity and may allow timely referral to higher-resource centers. However, there are significant global inequalities in access to imaging and many challenges to deploying ultrasound to rural areas. In this study, we tested a novel, innovative Obstetric telediagnostic ultrasound system in which the imaging acquisitions are obtained by an operator without prior ultrasound experience using simple scan protocols based only on external body landmarks and uploaded using low-bandwidth internet for asynchronous remote interpretation by an off-site specialist. METHODS: This is a single-center pilot study. A nurse and care technician underwent 8 h of training on the telediagnostic system. Subsequently, 126 patients (68 second trimester and 58 third trimester) were recruited at a health center in Lima, Peru and scanned by these ultrasound-naïve operators. The imaging acquisitions were uploaded by the telemedicine platform and interpreted remotely in the United States. Comparison of telediagnostic imaging was made to a concurrently performed standard of care ultrasound obtained and interpreted by an experienced attending radiologist. Cohen's Kappa was used to test agreement between categorical variables. Intraclass correlation and Bland-Altman plots were used to test agreement between continuous variables. RESULTS: Obstetric ultrasound telediagnosis showed excellent agreement with standard of care ultrasound allowing the identification of number of fetuses (100% agreement), fetal presentation (95.8% agreement, κ =0.78 (p < 0.0001)), placental location (85.6% agreement, κ =0.74 (p < 0.0001)), and assessment of normal/abnormal amniotic fluid volume (99.2% agreement) with sensitivity and specificity > 95% for all variables. Intraclass correlation was good or excellent for all fetal biometric measurements (0.81-0.95). The majority (88.5%) of second trimester ultrasound exam biometry measurements produced dating within 14 days of standard of care ultrasound. CONCLUSION: This Obstetric ultrasound telediagnostic system is a promising means to increase access to diagnostic Obstetric ultrasound in low-resource settings. The telediagnostic system demonstrated excellent agreement with standard of care ultrasound. Fetal biometric measurements were acceptable for use in the detection of gross discrepancies in fetal size requiring further follow up.


Assuntos
Assistência Perinatal , Consulta Remota/métodos , Desenvolvimento de Pessoal , Telemedicina/métodos , Ultrassonografia Pré-Natal , Diagnóstico Precoce , Intervenção Médica Precoce/normas , Feminino , Humanos , Obstetrícia/educação , Assistência Perinatal/métodos , Assistência Perinatal/normas , Peru/epidemiologia , Testes Imediatos/organização & administração , Gravidez , Trimestres da Gravidez , Melhoria de Qualidade/organização & administração , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/tendências , Enfermagem Rural/métodos , Desenvolvimento de Pessoal/métodos , Desenvolvimento de Pessoal/organização & administração , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/normas
13.
J R Coll Physicians Edinb ; 51(1): 85-90, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33877145

RESUMO

Telemedicine use has expanded rapidly to cope with increasing demand on services by delivering remote clinical review and monitoring of long-term conditions. Triaging individual patients to determine their suitability for telephone, video or face-to-face consultations is necessary. This is crucial in the context of COVID-19 to ensure doctor-patient safety. Telemedicine was shown to be safe and feasible in managing certain chronic diseases and providing patient education. When reviewing newly referred or long-term patients, different specialty clinics have different requirements for physical examination. Clinicians prefer face-to-face consultations at the initial visit to establish a doctor-patient relationship; telephone or video consultations are reasonable options for long-term patients where physical examination may not be needed. Video consultations, often aided by sophisticated devices and apps or medical assistants, are useful to facilitate remote physical examination. Most patients prefer telemedicine as it saves time and travel cost and provides better access to appointments.


Assuntos
Assistência Ambulatorial , COVID-19 , Doença Crônica/terapia , Exame Físico/métodos , Consulta Remota , Telemedicina , Assistência Ambulatorial/métodos , Assistência Ambulatorial/normas , Assistência Ambulatorial/tendências , COVID-19/epidemiologia , COVID-19/prevenção & controle , Previsões , Humanos , Assistência de Longa Duração/tendências , Relações Médico-Paciente , Consulta Remota/métodos , Consulta Remota/normas , SARS-CoV-2 , Telemedicina/métodos , Telemedicina/normas
14.
Clin Otolaryngol ; 46(4): 699-719, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33754458

RESUMO

AIMS: Remote or tele-consultation has become an emerging modality of consultation in many specialities, including ENT. Advantages include increasing accessibility, potential to reduce costs and, during the COVID-19 pandemic, reduced risk of infection transmission. Here, we systematically collate and synthesise the evidence base on outcomes from remote consultation in adult and paediatric ENT services. METHODS: We performed a review in accordance with PRISMA guidelines. We searched Medline and Embase for relevant articles. Outcomes include specific patient pathway efficiency measures (including number of healthcare visits, lead time, touch time and handoff), patient/clinician satisfaction, cost analysis and safety implications. RESULTS: From 6325 articles screened, 53 met inclusion criteria. Publications included studies on remote consultation for initial, preoperative and follow-up assessment (including postoperative). In most instances, remote consultation reduced costs and time from referral to assessment and was associated with high patient satisfaction. However, a face-to-face follow-up appointment was required in 13%-72% of initial consultations, suggesting that remote consultation is only appropriate in selected cases. CONCLUSION: Remote consultation is appropriate and preferable for ENT consultation in specific conditions and circumstances. Future research should look to better define those conditions and circumstances, and report using recognised quality standards and outcome measures.


Assuntos
COVID-19/epidemiologia , Otolaringologia/métodos , Otorrinolaringopatias/epidemiologia , Pandemias , Consulta Remota/métodos , Telemedicina/métodos , Comorbidade , Humanos , Satisfação do Paciente , SARS-CoV-2
15.
Br J Community Nurs ; 26(3): 110-115, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33719559

RESUMO

The purpose of this article is critical analysis, reflection and discussion in regards to the uses and impacts technology has had in community settings, specifically care homes during the COVID-19 pandemic. This will be investigated and supported with special emphasis on virtual assessment platforms and their use within the care homes settings, furthermore reviewing specific data collected in relation to the usage within community care homes. The article will outline the positive attributes and critically reflect upon the benefits of using audio and video conferencing when assessing patients and the beneficial impacts this has had on patients and the wider health community. While conversely addressing the obstacles and threats faced by clinicians in the use of assessment software.


Assuntos
COVID-19/epidemiologia , Enfermagem em Saúde Comunitária/organização & administração , Pandemias , Consulta Remota/métodos , Custos e Análise de Custo , Humanos , Consulta Remota/economia , SARS-CoV-2 , Telefone , Triagem/métodos
16.
World Neurosurg ; 150: e645-e656, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33757889

RESUMO

BACKGROUND: Global use of telemedicine has increased rapidly during the coronavirus disease 2019 (COVID-19) pandemic to bridge the gap in existing health care services. Intercontinental trends in neurosurgeons' perception and practices of telemedicine have been sparingly reported. METHODS: We conducted an online anonymized and validated survey using a structured questionnaire to gain insight into neurosurgeons' experience with telemedicine across various continents and rated its usefulness on a 5-point Likert scale. RESULTS: We received 286 responses across 5 continents. There was a trend to support a major paradigm shift favoring teleconsultations during the COVID-19 pandemic in respondents from North America (P = 0.06). Signed prescriptions were e-mailed along with video-based teleconsultations preferentially in Europe and North America. In comparison, audio- or text-based teleconsultations along with unsigned prescriptions were prevalent in Asia and Africa (P = 0.0005). Acceptability and perceived usefulness for telemedicine during the pandemic were similar across the globe, regardless of neurosurgeons' experience (mean satisfaction score 3.72 ± 1.09; P = 0.62). A majority of neurosurgeons from Asia and South America complained of difficulties during teleconsultations owing to lack of appropriate infrastructure, internet connectivity/prescription-related issues, and potential risk of litigation (P = 0.0005). Approximately 46% of neurosurgeons, predominantly from Europe and North America, thought that telemedicine could play a vital role in clinical practice even after the COVID-19 pandemic subsides (mean satisfaction score 3.26 ± 1.16; P = 0.007). CONCLUSIONS: Telemedicine in neurosurgery is a viable alternative to physical outpatient services during the COVID-19 pandemic and could potentially play a vital role after the pandemic.


Assuntos
COVID-19 , Neurocirurgia/tendências , Pandemias , Consulta Remota/tendências , Assistência Ambulatorial , Humanos , Internet , Neurocirurgiões , Neurocirurgia/economia , Neurocirurgia/métodos , Prescrições , Consulta Remota/economia , Consulta Remota/métodos , Inquéritos e Questionários , Telemedicina/métodos , Telemedicina/tendências
17.
Aten Primaria ; 53(4): 101983, 2021 04.
Artigo em Espanhol | MEDLINE | ID: mdl-33743202

RESUMO

The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.


Assuntos
Algoritmos , Lista de Checagem , Diabetes Mellitus Tipo 2/terapia , Consulta Remota/métodos , Terapia Combinada , Diabetes Mellitus Tipo 2/diagnóstico , Dietoterapia/métodos , Terapia por Exercício , Humanos , Hipoglicemiantes/uso terapêutico , Adesão à Medicação , Consulta Remota/normas
18.
World Neurosurg ; 148: 251-255, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33770847

RESUMO

The COVID-19 pandemic has impacted neurosurgery in unforeseeable ways. Neurosurgical patient care, research, and education have undergone extraordinary modifications as medicine and mankind have adapted to overcome the challenges posed by this pandemic. Some changes will disappear as the situation slowly recovers to a prepandemic status quo. Others will remain: This pandemic has sparked some long-overdue systemic transformations across all levels of medicine, including in neurosurgery, that will be beneficial in the future. In this paper, we present some of the challenges faced across different levels of neurosurgical clinical care, research, and education, the changes that followed, and how some of these modifications have transformed into opportunities for improvement and growth in the future.


Assuntos
Pesquisa Biomédica/métodos , COVID-19 , Atenção à Saúde/métodos , Neurocirurgia/métodos , Cuidados Críticos , Educação à Distância/métodos , Procedimentos Cirúrgicos Eletivos , Número de Leitos em Hospital , Humanos , Unidades de Terapia Intensiva , Neurocirurgia/educação , Procedimentos Neurocirúrgicos , Salas Cirúrgicas , Inovação Organizacional , Consulta Remota/métodos , SARS-CoV-2 , Telemedicina/métodos
19.
BMJ Open Qual ; 10(1)2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33781992

RESUMO

The COVID-19 is an established threat whose clinical features and epidemiology continues to evolve. In an effort to contain the disease, the National Health Service has adopted a digital first approach in UK general practice resulting in a significant shift away from face-to-face consultations. Consequently, more consultations are being completed without obtaining objective recording of vital signs and face-to-face examination. Some regions have formed hot hubs to facilitate the review of suspected COVID-19 cases and keep their practice site 'clean' including the use of doorstep observations in avoiding the risk of face-to-face examination. To support the safe, effective and efficient remote assessment of suspected and confirmed patients with COVID-19, we established a doorstep assessment service to compliment telephone and video consultations. This allows physiological parameters such as temperature, pulse, blood pressure and oxygen saturation to be obtained to guide further triage. Quality improvement methods were used to integrate and optimise the doorstep assessment and measure the improvements made. The introduction of a doorstep assessment service increased the proportion of assessments for patients with suspected COVID-19 in routine care over weeks. At the same time we were able to dramatically reduce face-to-face assessment over a 6-week period by optimising through a range of measures including the introduction of a digital stethoscope. The majority of patients were managed by their own general practitioner following assessment supporting continuity of care. There were no adverse events during the period of observation; no staff absences related to COVID-19. Quality improvement methods have facilitated the successful integration of doorstep assessments into clinical care.


Assuntos
COVID-19/prevenção & controle , Consulta Remota/métodos , Sinais Vitais , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Melhoria de Qualidade , Reino Unido/epidemiologia
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