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3.
Nervenarzt ; 90(12): 1239-1244, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31641794

RESUMO

BACKGROUND: As a result of innovations in the digitalization of healthcare new technologies, such as remote sensoring are gaining in importance for the collection of real-life data in addition to the regular medical examination. This enables a closer view into the daily lives of patients with multiple sclerosis and a more detailed monitoring of disease progression. OBJECTIVE: This article gives a summary of sensor-based measurement technologies in the field of multiple sclerosis RESULTS: A wide variety of sensor-based measurement technologies are already available, which largely focus on gait analysis and mobility. Furthermore, there are many innovative approaches for a sensor-based collation of the multifocal symptoms of multiple sclerosis, for example technologies focus on the area of stress surveillance, the autonomic nervous system, GPS tracking and sleep monitoring. DISCUSSION: Despite the existence of many already available technologies, the aim is now to find a practical way to integrate them into the daily routine of patient monitoring, which includes standardized data collection, evaluation and interpretation. Only at this point a perspective benefit for treating physicians and patients can be achieved.


Assuntos
Esclerose Múltipla , Consulta Remota , Progressão da Doença , Humanos , Esclerose Múltipla/diagnóstico , Consulta Remota/normas , Consulta Remota/tendências
4.
J Stroke Cerebrovasc Dis ; 28(11): 104332, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31439524

RESUMO

INTRODUCTION: Telestroke has increased access to acute management of ischemic stroke in areas that lack stroke care expertise, yet delays persist in evaluation and treatment. We describe variation in time to alert a telestroke physician of suspected acute ischemic stroke patients potentially eligible for acute stroke therapies among community hospitals in our telestroke network, and explore demographic and spoke-related characteristics associated with delays. METHODS: From our telestroke registry, we identified suspected acute ischemic stroke patients who arrived within 6 hours of symptom onset and underwent video consultation at 1 of 17 community hospitals in our hub-and-spoke network. We compared time between patient arrival to telestroke alert (door-to-page-time) and to tissue plasminogen activator (tPA) administration for eligible patients (door-to-needle-time). We identified factors associated with prolonged metrics. RESULTS: Of 1020 cases between 9/2015 and 3/2017, 47% received tPA. Sixty percent had door-to-page-time more than 15 minutes (median 19.5; IQR, 11-34). Door-to-page-time more than 15 minutes was associated with an 8-fold increase in likelihood of door-to-needle-time more than 60 minutes. Patients with severe stroke experienced faster door-to-page-times. Hospitals with more beds had prolonged door-to-page-time. Full time in-house neurology presence, even when not covering emergent consultations, was associated with faster door-to-page-time over telestroke. Seventy-one percent of patients underwent CT brain prior to the telestroke physician alert; this scenario delayed door-to-page and door-to-needle times. CONCLUSIONS: Door-to-page-time varied considerably among spokes. Awaiting CT scan prior to alerting the telestroke consultant of a stroke code delayed metrics. Telestroke physician alert standards are needed, as are educational initiatives on acute ischemic stroke management and workflow.


Assuntos
Benchmarking/normas , Isquemia Encefálica/terapia , Prestação Integrada de Cuidados de Saúde/normas , Equipe de Assistência ao Paciente/normas , Padrões de Prática Médica/normas , Consulta Remota/normas , Acidente Vascular Cerebral/terapia , Terapia Trombolítica/normas , Tempo para o Tratamento/normas , Administração Intravenosa , Idoso , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Ativador de Plasminogênio Tecidual/administração & dosagem , Tomografia Computadorizada por Raios X/normas , Resultado do Tratamento , Comunicação por Videoconferência/normas , Fluxo de Trabalho
7.
J Med Syst ; 43(7): 213, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31154515

RESUMO

The QoE measurement has become a novel theme today. To achieve a quality service and minimize the negative impact that traffic on network can cause, it's very important to manage the devices that intervene in this service. Hence, the QoE evaluation allows obtaining benefits both customers and service providers. The main objective of this paper is to measure QoE of a teleconsultation application in Mental Health named Psiconnect, using an approach based on pentagram model. For the QoE evaluation of Psiconnect application we used the pentagram model based on the measurement of 5 factors (integrality, retainability, availability, usability, and instantaneousness). This model allows to design quantifiable metrics for quality evaluations. Using the model cited the value of QoE for Psiconnect is 1.793 (between 1.6 and 1.8). Comparing with Mean Opinion Scores (MOS) test, some users are dissatisfied with the use of the application although the result is near 1.8, so the most of users are satisfied with the use of teleconsultation service based in Skype in the Psiconnect app. There are different models to measure QoE having into account subjective parameters. This is important an estimation of QoE in a quantitative form. Other models can be used to improve the quality of apps.


Assuntos
Saúde Mental , Aplicativos Móveis , Satisfação do Paciente , Qualidade da Assistência à Saúde , Consulta Remota/métodos , Humanos , Indicadores de Qualidade em Assistência à Saúde , Consulta Remota/instrumentação , Consulta Remota/normas
8.
Br J Gen Pract ; 69(682): e336-e344, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30910874

RESUMO

BACKGROUND: Recent years have seen the introduction of online triage allowing patients to describe their problem via an online form. Subsequently, a GP telephones the patient, conducting a telephone consultation or arranging a face-to-face consultation. AIM: This study aimed to explore patterns-of-use and patients' experiences of using an online triage system. DESIGN AND SETTING: This retrospective study analysed routinely collected data (from all practices using the 'askmyGP' platform for the duration of the study period, 19 May 2017 to 31 July 2017), using both quantitative and qualitative approaches. Data originated from an online triaging platform used by patients in nine general practices across the UK. METHOD: Data from 5447 patients were quantitatively analysed to describe characteristics of users, patterns-of-use, and reasons given by patients for using the platform. Free-text comments left by patients (n = 569) on their experience of use were qualitatively analysed. RESULTS: Highest levels of use were observed in females (65.5%, n = 3570) and those aged 25-34 years. Patterns of use were high between 0800 and 0959, and on Mondays and Tuesdays. Use outside of GP practice opening hours was low. Common reasons for using the platform were for medication-related enquiries, for administrative requests, and to report a specific symptom. Comments left by patients suggested advantages to using the platform, for example, convenience and the written format, but these did not extend to all users. CONCLUSION: Patterns-of-use and patient types were in line with typical contacts to GP practices. Though the age of users was broad, highest levels of use were from younger patients. The perceived advantages to using online triage, such as convenience and ease of use, are often context dependent.


Assuntos
Clínicos Gerais , Preferência do Paciente/estatística & dados numéricos , Padrões de Prática Médica/organização & administração , Atenção Primária à Saúde , Consulta Remota , Triagem , Fatores Etários , Agendamento de Consultas , Humanos , Modelos Organizacionais , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Consulta Remota/métodos , Consulta Remota/normas , Inquéritos e Questionários , Triagem/métodos , Triagem/organização & administração , Reino Unido
9.
BMC Health Serv Res ; 18(1): 650, 2018 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-30134891

RESUMO

BACKGROUND: A teledermatology pilot scheme was first conducted in the town of Manresa (Barcelona) in the summer of 2010. The clinical success of the scheme prompted its expansion to the whole county of Bages in 2011 and to the adjacent county of Berguedà in 2012. In the teledermatology service, primary care physicians take a photograph of the lesion and attach it to the electronic medical records of the patient together with a brief clinical account. In the referral hospital, the consultant dermatologists access the electronic medical records, review the images and suggest a treatment or action plan. Next, the primary care physicians review these recommendations and call the patient to report the results. This whole process is usually completed in less than 5 working days. METHODS: A cost saving analysis comparing teledermatology with dermatology face-to-face visits was performed in the county of Bages measuring the cost difference attributable to visits saved. RESULTS: The estimated added costs of the teledermatology service during 2016 amounted to 61,870 €. For the same period, the estimated costs of traditional outpatient dermatology services were of 113,034 €. This represents savings of 51,164 € per year. After subtraction of societal costs, the savings equal 10,350 € per year. CONCLUSIONS: Using a teledermatology service instead of face-to-face dermatology consultations could save 51,164 € per year (11.4 € per patient visited) in the county of Bages. Societal savings are the most significant.


Assuntos
Redução de Custos/economia , Dermatologia/economia , Médicos de Atenção Primária/economia , Consulta Remota , Análise Custo-Benefício , Dermatologia/organização & administração , Registros Eletrônicos de Saúde , Humanos , Projetos Piloto , Encaminhamento e Consulta , Consulta Remota/economia , Consulta Remota/normas , Espanha
10.
Mil Med ; 183(1-2): e71-e76, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29401334

RESUMO

Background: Access to specialty health care in the Veterans Affairs (VA) system continues to be problematic. Given the potential temporal and fiscal benefits of telehealth, the Madison VA developed a virtual consultation (VC) mechanism to expedite diagnostic and therapeutic interventions for Veterans with incidentally discovered pulmonary nodules. Materials and. Methods: VC, a remote encounter between referring provider and thoracic surgeon for incidentally discovered pulmonary nodules, was implemented at the Madison VA between 2009 and 2011. Time from request to completion of consultation, hospital cost, and travel costs were determined for 157 veterans. These endpoints were then compared with in-person consultations over a concurrent 6-mo period. Results: For the entire study cohort, the mean time to completion of VC was 3.2 d (SD ± 4.4 d). For the 6-mo period of first VC availability, the mean time to VC completion versus in-person consultation was 2.8 d (SD ± 2.8 d) and 20.5 d (SD ± 15.6 d), respectively (p < 0.05). Following initial VC, 84 (53%) veterans were scheduled for virtual follow-up alone; no veteran required an additional office visit before further diagnostic or therapeutic intervention. VA hospital cost was $228 per in-person consultation versus $120 per episode for VC - a 47.4% decrease. The average distance form veteran home to center was 86 miles, with an average travel reimbursement of $112 per in-person consultation, versus no travel cost associated with VC. Conclusions: VC for incidentally discovered pulmonary nodules significantly decreases time to consultation completion, hospital cost, and veteran travel cost. These data suggest that a significant opportunity exists for expansion of telehealth into additional practice settings within the VA system.


Assuntos
Medicina/métodos , Consulta Remota/economia , Consulta Remota/normas , Fatores de Tempo , Veteranos/estatística & dados numéricos , Estudos de Coortes , Humanos , Medicina/estatística & dados numéricos , Consulta Remota/métodos , Estados Unidos , United States Department of Veterans Affairs/organização & administração , United States Department of Veterans Affairs/estatística & dados numéricos
11.
Br J Gen Pract ; 68(666): e1-e8, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29109115

RESUMO

BACKGROUND: The level of demand on primary care continues to increase. Electronic or e-consultations enable patients to consult their GP online and have been promoted as having potential to improve access and efficiency. AIM: To evaluate whether an e-consultation system improves the ability of practice staff to manage workload and access. DESIGN AND SETTING: A qualitative interview study in general practices in the West of England that piloted an e-consultation system for 15 months during 2015 and 2016. METHOD: Practices were purposefully sampled by location and level of e-consultation use. Clinical, administrative, and management staff were recruited at each practice. Interviews were transcribed and analysed thematically. RESULTS: Twenty-three interviews were carried out across six general practices. Routine e-consultations offered benefits for the practice because they could be completed without direct contact between GP and patient. However, most e-consultations resulted in GPs needing to follow up with a telephone or face-to-face appointment because the e-consultation did not contain sufficient information to inform clinical decision making. This was perceived as adding to the workload and providing some patients with an alternative route into the appointment system. Although this was seen as offering some patient benefit, there appeared to be fewer benefits for the practices. CONCLUSION: The experiences of the practices in this study demonstrate that the technology, in its current form, fell short of providing an effective platform for clinicians to consult with patients and did not justify their financial investment in the system. The study also highlights the challenges of remote consultations, which lack the facility for real time interactions.


Assuntos
Sistemas de Apoio a Decisões Clínicas/normas , Clínicos Gerais , Atenção Primária à Saúde , Consulta Remota , Carga de Trabalho/estatística & dados numéricos , Agendamento de Consultas , Atitude do Pessoal de Saúde , Sistemas de Apoio a Decisões Clínicas/economia , Eficiência Organizacional , Clínicos Gerais/psicologia , Humanos , Entrevistas como Assunto , Satisfação do Paciente/estatística & dados numéricos , Projetos Piloto , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/tendências , Pesquisa Qualitativa , Consulta Remota/economia , Consulta Remota/normas
12.
J Telemed Telecare ; 24(9): 603-607, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28920525

RESUMO

Introduction Assessment of urothelial bladder cancer during cystoscopy or transurethral resection of bladder tumour has a significant impact on the urologist's decision-making: treatment with simple outpatient fulguration, required depth of resection, and need of immediate post-surgical intravesical therapy. These choices depend heavily on the urologist's ability to accurately assess pre-biopsy tumour stage and grade. The aim of the study was to determine whether evaluation of photographs taken during transurethral resection of bladder tumour can reliably characterize a tumour's stage and grade. Methods Smartphone photographs of 50 urothelial bladder cancer cases were taken at the beginning of transurethral resection of bladder tumour and individually presented to seven senior urologists. All urologists were blinded to the final pathological report and to any other urological evaluation. Each one was asked to rate the tumour as low vs high grade and noninvasive Ta vs noninvasive T1 or muscle invasive. Results were compared with final pathology. Individual appraisal and the majority's opinion were evaluated. Results Urologists have correctly predicted tumour stage and grade in 63.5% of cases (222 of 350, average of 32 out of 50 accurate assessments). The final majority assessment was correct in 40 of 50 cases (80%). Sensitivity and specificity of the final results for the diagnosis of T1 or higher were 80% and 88.6%, respectively. Sensitivity and specificity for Ta low grade were 83.3% and 80%, respectively. Conclusions To the best of our knowledge, this is the first documented attempt to evaluate urologists' ability to assess urothelial bladder cancer stage and grade using endoscopic photographs. Urologists can usually identify stage and grade of urothelial bladder cancer but accuracy increases when multiple senior urologists examine the same photographs and achieve majority consensus. Presenting photographs of urothelial bladder cancer to a team of urologists may lead to an excellent decision regarding type and extent of surgical treatment and substantiate appropriate post-surgical management.


Assuntos
Carcinoma/diagnóstico , Cistoscopia/métodos , Consulta Remota/normas , Neoplasias da Bexiga Urinária/diagnóstico , Urologia/métodos , Idoso , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Sensibilidade e Especificidade , Neoplasias da Bexiga Urinária/cirurgia , Urologia/estatística & dados numéricos
13.
Fam Pract ; 35(1): 93-98, 2018 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-28968806

RESUMO

Background: Excessive wait times for specialist care can have a substantial negative impact on health outcomes. The Champlain BASETM (Building Access to Specialists through eConsultation) eConsult service based in Ottawa, Canada has demonstrated the ability to improve patients' access to specialist care. Objective: We interviewed patients who were treated using eConsult in order to explore their attitudes towards the service and their experiences of receiving care via the service. Methods: We conducted a thematic analysis of patient interviews using a constant comparative approach. Patients whose primary care providers used the eConsult service in their care were contacted by telephone between June 2015 and January 2016 and completed 15-min semi-structured interviews. Results: Of 43 contacted participants, 30 completed interviews (70%). Over half of all respondents (n = 16) reported receiving a follow-up call or appointment within 1 week, and 26 stated that eConsult was useful in their case. Participants unanimously agreed that eConsult was an acceptable way to access specialist care, and 29 stated that they would ask their primary care provider to use eConsult on their behalf in the future. Three themes emerged from the thematic analysis of patient comments: access, acceptability of eConsult and strengthened role of the primary care provider. Conclusions: Patients expressed acceptance for eConsult as a model for improving access to specialist care, had largely positive experiences with it as a model of care delivery, and supported its use in their future care.


Assuntos
Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Atenção Primária à Saúde/normas , Consulta Remota/normas , Adolescente , Adulto , Idoso , Canadá , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Pesquisa Qualitativa , Serviços de Saúde Rural , Adulto Jovem
18.
BMC Health Serv Res ; 17(1): 433, 2017 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-28645288

RESUMO

BACKGROUND: Electronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case). METHODS: Retrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014. Electronic consultation requests were reviewed for the presence/absence of consult domains: symptom acuity/severity, diagnostic evaluation, concurrent medical conditions, and attempted diagnosis. Logic regression was used to examine the association between completeness of consult requests and scheduling an ambulatory clinic visit. Surgical yield was also calculated, as was the percentage of patients requiring unanticipated healthcare visits. RESULTS: In 2014, 1743 electronic consultations were submitted to general surgery. Among the 150 abstracted, the presence of consult domains ranged from 49% to 99%. Consult completeness was not associated with greater likelihood of scheduling an ambulatory visit. Seventy-six percent of consult requests (114/150) were scheduled for a clinic appointment and surgical yield was 46%; without an eConsult system, surgical yield would have been 35% (p=0.07). Among patients not scheduled for a clinic visit (n=36), 4 had related unanticipated emergency department visits. CONCLUSION: Econsult systems can be used to safely optimize the surgical yield of a safety-net general surgery service.


Assuntos
Cirurgia Geral/normas , Encaminhamento e Consulta/normas , Consulta Remota/normas , Adulto , Instituições de Assistência Ambulatorial , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Satisfação do Paciente , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Encaminhamento e Consulta/organização & administração , Estudos Retrospectivos , Especialização
20.
Scand J Trauma Resusc Emerg Med ; 25(1): 52, 2017 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-28506282

RESUMO

BACKGROUND: Telephone consultation and triage are used to limit the workload on emergency departments. Lack of visual cues and clinical tests put telephone consultations to a disadvantage compared to face-to-face consultations increasing the risk of under-triage. Under-triage occurs in telephone triage; however why under-triage happens is not explored yet. The aim of the study was to describe situations of under-triage in context, to assess the quality of under-triaged calls, and to identify communication patterns contributing to under-triage in a regional OOH service in the capital region of Denmark. METHODS: Explanatory simultaneous mixed method with thematic analysis and descriptive statistics was chosen. The study was carried out in an Out-Of-Hours service (OOH) in the Capital Region of Denmark, Copenhagen. Under-triage was defined as Potentially Under-Triaged Calls (PUTC) by specific criteria to an OOH Hotline, and identification by integration of three databases: Medical Hotline database, Emergency number database, including the Ambulance database, and electronic patient records. Distribution of PUTC were carried out using ICD-10 codes to identify diagnosis and main themes identified by qualitative analysis of audio recorded under-triaged calls. Study period was October 15th to November 30th 2014. RESULTS: Three hundred twenty seven PUTC were identified, representing 0.04% of all calls (n = 937.056) to the OOH. Distribution of PUTC according to diagnoses was: digestive (24%), circulatory (19%), respiratory (15%) and all others (42%). Thematic analysis of the voice logs suggested that inadequate communication and non-normative symptom description contributed to under-triage. DISCUSSION: The incidence of potentially under-triage is low (0.04%). However, the over-representation of digestive, circulatory, and respiratory diagnoses might suggest that under-triage is related to inadequate symptom description. We recommend that caller and call-handler collaborate systematically on problem identification and negotiate non-normative symptom description. CONCLUSION: The incidence of under-triage is low (0.04%). However, the over-representation of digestive, circulatory, and respiratory diagnoses might suggest that under-triage is related to inadequate symptom description. We recommend that caller and call-handler collaborate systematically on problem identification and negotiate non-normative symptom description.


Assuntos
Comunicação , Consulta Remota/normas , Avaliação de Sintomas/normas , Triagem/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dinamarca , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Telefone , Triagem/métodos
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