scholarly journals Managing high frequency users of an electronic consultation system in primary care: a quality improvement project

2021 ◽  
Vol 10 (2) ◽  
pp. e001310
Author(s):  
Katherine Leung ◽  
Saffan Qureshi
Keyword(s):  
Primary Care ◽  
High Frequency ◽  
Mental Health Problems ◽  
Rapid Change ◽  
Health Needs ◽  
Significant Shift ◽  
Physical And Mental Health ◽  
Improvement Project ◽  
Face To Face ◽  
Electronic Consultation

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.

School Absence: A Problem for the Pediatrician

PEDIATRICS ◽  
1982 ◽  
Vol 69 (6) ◽  
pp. 739-746
Author(s):  
Michael Weitzman ◽  
Lorraine V. Klerman ◽  
George Lamb ◽  
Jean Menary ◽  
Joel J. Alpert
Keyword(s):  
Teenage Pregnancy ◽  
Mental Health Problems ◽  
Health Problems ◽  
Maladaptive Behavior ◽  
Drop Out ◽  
Health Needs ◽  
Physical And Mental Health ◽  
School Absence ◽  
Large Numbers ◽  
Unmet Health Needs

Children who are frequently or persistently absent from school tend to perform poorly in school and are likely to drop out before graduation from high school. Excessive school absence has significant implications in terms of maladaptive behavior, wasted opportunities, and future unemployment and welfare costs. Epidemiologic information about this problem suggests that physical and mental health problems of students or their families are the sole or contributing cause of this behavior in more than 50% of cases. Excessive school absence may signal such health problems as poor coping with or management of chronic illness, masked depression, teenage pregnancy, substance abuse, inappropriate responses to minor illnesses, or severe family dysfunction. School absence patterns appear to be a readily available, easy-to-use marker of childhood dysfunction which lends itself to screening large numbers of children for unmet health needs. Attention to this area of child behavior as part of routine health care will frequently uncover previously unrecognized health problems in children and their families.

Barriers to Accessing Healthcare: Perspectives from Autistic Adults and Carers

2021 ◽  
pp. 104973232110503
Author(s):  
Shenae Calleja ◽  
Jonathan Kingsley ◽  
Fakir M Amirul Islam ◽  
Rachael McDonald
Keyword(s):  
Mental Health ◽  
Healthcare Access ◽  
Primary Caregivers ◽  
Phenomenological Approach ◽  
Health Needs ◽  
Evidence Based ◽  
Physical And Mental Health ◽  
Face To Face ◽  
Autistic Adults ◽  
Perceived Experiences

Autistic adults have higher health needs compared to most, yet they continue to experience barriers to accessing appropriate healthcare. Presently, no qualitative research exists exploring these barriers which impact overall physical and mental health. We conducted a qualitative analysis in Victoria (Australia) of the perceived experiences of healthcare access for autistic adults ( n = 9) and primary caregivers of autistic adults ( n = 7). Specifically, a three-staged phenomenological approach was applied involving: (i) a communicative checklist, (ii) a health status survey and (iii) face-to-face interviews. Elements such as support, responsibilities and protective factors exhibited by caregivers, may impact healthcare access for autistic adults. Results indicate the need for further research exploring interdependent factors that impact healthcare access by caregivers, so evidence-based interventions can be developed to support caregivers in the future.

scholarly journals P.025 Is this headache normal?: Assessing electronic referrals for headache from primary care physicians

2018 ◽  
Vol 45 (s2) ◽  
pp. S22-S22
Author(s):  
L Panamsky ◽  
A Bradi ◽  
L Sitwell ◽  
C Liddy ◽  
A Afkham ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Unusual Presentation ◽  
Imaging Findings ◽  
Electronic Resources ◽  
Consultation Service ◽  
Face To Face ◽  
Electronic Consultation ◽  
Headache Type ◽  
Clinical Resource

Background: Headache is one of the most frequent complaints in primary care. We reviewed headache questions submitted to an electronic consultation service in Ontario to classify the types of headaches and describe the questions being asked. We also identified reasons why answers were not retrievable within UpToDate, an online clinical resource. Methods: 65 headache eConsults were further divided into 85 questions and categorized by headache type and question theme. Questions were manually searched within UpToDate to determine if they could be answered using this resource. The intent to refer the patient for a face-to-face referral after the eConsult was collected. Results: The top classifications were migraine, unclassified headache, and exertional and/or coital headache. The themes -identified were medication questions (41.7%), investigation questions (33.3%), clinical concerns despite normal neurologic exam and/or imaging (15.5%); and abnormal imaging findings (9.5%). Answers to 40.1% of the questions were not retrievable in UpToDate. The main reason for irretrievability was an unusual presentation. Only 33.8% of eConsults resulted in a face-to-face referral to a specialist. Conclusions: Although electronic resources may be useful in some cases, clinical nuances cannot be accounted for. By providing physicians with rapid access to specialists, eConsult services may obviate the need for formal, face-to-face referrals.

scholarly journals Evaluation of an electronic consultation service for transgender care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jatinderpreet Singh ◽  
Allison Lou ◽  
Michael Green ◽  
Erin Keely ◽  
Mary Greenaway ◽  
...  
Keyword(s):  
Primary Care ◽  
Response Time ◽  
Access To Care ◽  
Hormone Therapy ◽  
Primary Care Providers ◽  
Care Providers ◽  
Face To Face ◽  
Electronic Consultation ◽  
Clinical Questions ◽  
Insight Into

Abstract Background Access to transgender care in Canada is poor. Although primary care providers are ideally positioned to initiate care, many feel uncomfortable providing transgender care. This study aimed to explore the impact of an electronic consultation (eConsult) service between primary care providers and transgender care specialists on access to care and to explore the content of clinical questions that were asked. Methods This was a retrospective mixed methods analysis of 62 eConsults submitted between January 2017 and December 2018 by primary care providers to specialists in transgender care in a health region in eastern Ontario, Canada. A descriptive analysis was conducted to assess the average response time and the total time spent by the specialist for the eConsults. An inductive and deductive content analysis was carried out to identify common themes of clinical questions being asked to transgender specialists. A post-eConsult survey completed by primary care providers was assessed to gain insight into avoided face-to-face referrals and overall provider satisfaction. Results The median specialist response time was 1.2 days (range: 1 h to 5 days) and the average time spent by specialists per eConsult was 18 min (range: 10 to 40 min). The qualitative analysis identified six major themes: 1) interpretation/management of abnormal bloodwork, 2) change in management due to lack of desired effect/hormone levels not a target, 3) initiation of hormone therapy/initial work up, 4) management of adverse effects of hormone therapy, 5) transition related surgery counseling and post-op complications, and 6) management of patients with comorbidities. Approximately one-third of eConsults resulted in an avoided face-to-face referral and 95% of primary care providers rated the value of their eConsult as a 5 (excellent value) or 4. Conclusions This study demonstrated that a transgender eConsult service has potential to significantly improve access to care for transgender patients. Given the importance that timely access has on improving mental health and reducing suicide attempts, eConsult has the potential to make a substantial clinical impact on this population. Identified themes of eConsult questions provides insight into potential gaps in knowledge amongst primary care providers that could help inform future continuing education events.

scholarly journals Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care

2019 ◽  
Vol 69 (686) ◽  
pp. e586-e594 ◽  
Author(s):  
Eddie Donaghy ◽  
Helen Atherton ◽  
Victoria Hammersley ◽  
Hannah McNeilly ◽  
Annemieke Bikker ◽  
...  
Keyword(s):  
Primary Care ◽  
Visual Cues ◽  
Mental Health Problems ◽  
Structured Interviews ◽  
Time Saving ◽  
Technical Problems ◽  
Work Demand ◽  
Face To Face ◽  
Visual Component ◽  
Primary Care Clinicians

BackgroundPeople increasingly communicate online, using visual communication mediums such as Skype and FaceTime. Growing demands on primary care services mean that new ways of providing patient care are being considered. Video consultation (VC) over the internet is one such mode.AimTo explore patients’ and clinicians’ experiences of VC.Design and settingSemi-structured interviews in UK primary care.MethodPrimary care clinicians were provided with VC equipment. They invited patients requiring a follow-up consultation to an online VC using the Attend Anywhere web-based platform. Participating patients required a smartphone, tablet, or video-enabled computer. Following VCs, semi-structured interviews were conducted with patients (n = 21) and primary care clinicians (n = 13), followed by a thematic analysis.ResultsParticipants reported positive experiences of VC, and stated that VC was particularly helpful for them as working people and people with mobility or mental health problems. VCs were considered superior to telephone consultations in providing visual cues and reassurance, building rapport, and improving communication. Technical problems, however, were common. Clinicians felt, for routine use, VCs must be more reliable and seamlessly integrated with appointment systems, which would require upgrading of current NHS IT systems.ConclusionThe visual component of VCs offers distinct advantages over telephone consultations. When integrated with current systems VCs can provide a time-saving alternative to face-to-face consultations when formal physical examination is not required, especially for people who work. Demand for VC services in primary care is likely to rise, but improved technical infrastructure is required to allow VC to become routine. However, for complex or sensitive problems face-to-face consultations remain preferable.

Mental health of older people: the role of primary care

2011 ◽  
Vol 26 (S2) ◽  
pp. 838-838
Author(s):  
G. Ivbijaro ◽  
F. Torres-González ◽  
H. Parmentier ◽  
M. Gómez-Beneyto
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Problems ◽  
Traditional Approach ◽  
The Elderly ◽  
Integrated System ◽  
Physical And Mental Health ◽  
Family Doctors ◽  
Number Of Children ◽  
Health And Social Care

There are currently over 600 million people aged over 60 and it is predicted that, by 2025, the number will double and, by 2050 there will be over 2 billion people aged 60 and above and the number of over 60's will be greater than the number of children under the age of 15. Co-morbid physical and mental health conditions are associated with an aging population and many of this population will suffer from stroke, hypertension, loneliness, depression, dementia, mobility and sight problems. The traditional approach of caring for people in hospitals is increasingly inappropriate for many of the elderly population and primary care is often the first point of contact for many people seeking access to health and social care. In 2008, the WHO and Wonca (World Organisation of Family Doctors) published a document about the integration of mental health into primary care across spectrum. We will be describing the principles and method of integration of mental health problems in old age into primary care using examples from the Australian and UK setting. Also we will examine the role non-governmental organisations can play in the process of integration. Caring for the elderly is rewarding and possible in the primary care setting. The current situation where many elderly people do not have access to an integrated health care system is unacceptable. Using data and a series of case vignettes we will illustrate that primary care has an important role to play within an integrated system.

scholarly journals Improving the Referral Process, Timeliness, Effectiveness, and Equity of Access to Specialist Medical Services Through Electronic Consultation: Pilot Study (Preprint)

2019 ◽  
Author(s):  
Véronique Nabelsi ◽  
Annabelle Lévesque-Chouinard ◽  
Clare Liddy ◽  
Maxine Dumas Pilon
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Rural Communities ◽  
Social Services ◽  
Primary Care Providers ◽  
Referral Process ◽  
Care Providers ◽  
Face To Face ◽  
Primary Care Clinics ◽  
Electronic Consultation

BACKGROUND Access to specialty care remains a major challenge in the Canadian health care system. Electronic consultation (eConsult) services allow primary care providers to seek specialist advice often without needing the patient to go for a face-to-face consultation. It improves overall access to specialists and the referral process using an electronic care consultation service in urban and rural primary care clinics. This study describes the preliminary results of a pilot study with an eConsult service across 3 regions in the province of Quebec, Canada. OBJECTIVE The main objective of this study was to provide a 1-year snapshot of the implementation of the eConsult Quebec Service in rural and urban primary care clinics to improve access to care and the specialty referral process for primary care providers (PCPs). METHODS We established an eConsult service that covers urban and rural communities in 3 regions of Quebec. We conducted a quantitative analysis of all eConsult cases submitted from July 4, 2017, to December 8, 2018. RESULTS For over a year, 1016 eConsults have been generated during the course of this study. A total of 97 PCPs submitted requests to 22 specialty groups and were answered by 40 different specialists. The most popular specialty was internal medicine (224/1016, 22%). Overall, 63% (640/1016) of completed cases did not require a face-to-face visit. PCPs rated the service as being of high or very high value for themselves in 98% (996/1016) of cases. CONCLUSIONS The preliminary data highlight the success of the implementation of the eConsult Quebec Service across 6 primary care clinics. The eConsult platform proves to be effective, efficient, and well received by both patients and physicians. If used more widely, eConsult could help reducing wait times significantly. Recently, the Ministry of Health and Social Services of Quebec has identified developing a strategic plan to scale eConsults throughout other regions of the province as a top priority.

scholarly journals Reorganisation of primary care for older adults during COVID-19: a cross-sectional database study in the UK

2020 ◽  
Vol 70 (697) ◽  
pp. e540-e547 ◽  
Author(s):  
Mark Joy ◽  
Dylan McGagh ◽  
Nicholas Jones ◽  
Harshana Liyanage ◽  
Julian Sherlock ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Temporal Trends ◽  
Rapid Change ◽  
Home Visits ◽  
Relative Increase ◽  
Cross Sectional ◽  
Sentinel Network ◽  
Database Study ◽  
Face To Face

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has resulted in a rapid change in workload across healthcare systems. Factors related to this adaptation in UK primary care have not yet been examined.AimTo assess the responsiveness and prioritisation of primary care consultation type for older adults during the COVID-19 pandemic.Design and settingA cross-sectional database study examining consultations between 17 February and 10 May 2020 for patients aged ≥65 years, drawn from primary care practices within the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network, UK.MethodThe authors reported the proportion of consultation type across five categories: clinical administration, electronic/video, face-to-face, telephone, and home visits. Temporal trends in telephone and face-to-face consultations were analysed by polypharmacy, frailty status, and socioeconomic group using incidence rate ratios (IRR).ResultsAcross 3 851 304 consultations, the population median age was 75 years (interquartile range [IQR] 70–82); and 46% (n = 82 926) of the cohort (N = 180 420) were male. The rate of telephone and electronic/video consultations more than doubled across the study period (106.0% and 102.8%, respectively). Face-to-face consultations fell by 64.6% and home visits by 62.6%. This predominantly occurred across week 11 (week commencing 9 March 2020), coinciding with national policy change. Polypharmacy and frailty were associated with a relative increase in consultations. The greatest relative increase was among people taking ≥10 medications compared with those taking none (face-to-face IRR 9.90, 95% CI = 9.55 to 10.26; telephone IRR 17.64, 95% CI = 16.89 to 18.41).ConclusionPrimary care has undergone an unprecedented in-pandemic reorganisation while retaining focus on patients with increased complexity.

scholarly journals MO211FORMALIZATION AND DEVELOPMENT OF A NEPHROLOGY ELECTRONIC CONSULTATION (ECONSULT) IN COVID-19 PANDEMIC

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Juan Carlos Herrero Berron ◽  
Carolina Lentisco ◽  
Aniana Oliet ◽  
Andrea Suso ◽  
Irene Onate Alonso ◽  
...  
Keyword(s):  
Primary Care ◽  
Response Time ◽  
Primary Care Providers ◽  
Care Providers ◽  
Median Response ◽  
Face To Face ◽  
Problem Resolution ◽  
Day Range ◽  
Electronic Consultation

Abstract Background and Aims Due to COVID-19 pandemic we must continue attending in our hospital consultations and, at the same time, avoid transfers and visit that involve risks to our patients. For this reason, we implemented new forms of care. Mainly electronic consultation (eConsult) using institutional email as way of contact between Primary Care Providers (PCPs) and nephrologist, trying to decrease in-person visit. Objective To analyze the results of the creation in June 2020 of a Nephrology electronic consultation in our hospital. Method Retrospective observational study of eConsults made to our department, which serves a population of 200.000 people, with total of 9 primary care centers. The study period was June 10, 2020 to December 31, 2020. We have studied the number of eConsults, response time, type of consult made, problem resolution and subsequent follow up. Results Of 141 workdays, in 61 days (43%) there was eConsult, total 80 eConsults, mean 1.3 and median 1 daily (range 1 to 3). All primary care centers used this communication way, as well as 50 PCPs. Median response time for eConsult was 1 day (range 1-4). 55% patient was male, mean age 70.8 years (SD 13.9) (range 16-95 years). 64% it was his first assessment for Nephrology. The most frequent causes of eConsult: increase of creatinine (41.3%), uncontrolled blood pressure (12.5%), sodium and potassium disturbances (11.3%), treatment adjustment (11.3%) and changes in previous appointment (8.8%). After assessment eConsult, to 55% of patients was treatment adjustment, 22.5% were converted to an in-person visit, 11% they didn´t need any action but only 1 patient was referred to the emergency room. 44% patient is subsequent follow up by PCPs, 39% by nephrologist, 15% joint assessment PCP and nephrologist and 2% by other specialists. Only 2 patients (2.5%) made second eConsult. Conclusion The eConsult is an important help to PCPs to solve doubts quickly, avoid unnecessary the travels to hospital the patients, treatment adjustment above all in control of hypertension an ionic disturbance, and guide in handling of chronic kidney disease. The diffusion and empowerment of this type of consultation in a next future may decrease, partly, the usual saturation of face-to-face visit and optimize the patient population being seen by nephrologist.

scholarly journals A Provocation

2021 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
William Locke
Keyword(s):  
Blended Learning ◽  
Current Model ◽  
Rapid Change ◽  
Physical And Mental Health ◽  
Health Food ◽  
Lifelong Learners ◽  
Face To Face ◽  
Hybrid Approaches ◽  
High Participation ◽  
The Face

Most universities across the world have been offering what has come to be called ‘blended learning’ for a number of years now. However, this has largely been supplementing traditional, face to face, classroom teaching with varying degrees of online elements. The pandemic has done us all a favour by highlighting the fact that what universities have been doing with this ‘blended learning’ is no longer sufficient and arguably already passed its sell-by date. The pandemic has accelerated existing trends. But it has also moved us in new directions.   In the medium term, university teachers know they are going to have to teach some students on campus and others remotely, and both alongside each other. Some have called this ‘dual mode’ or ‘dual track’ teaching. However, for many universities, and countries, this approach may not be feasible for any length of time as it is both resource-intensive and time-consuming. More importantly, it fails to recognise the limitations of our current model of educational provision for high participation societies – which privileges students who can access and afford the face-to-face campus experience and short-changes students with poor or restricted access to WiFi, computers or places to study or whose life circumstances require alternative learning modes. So let’s not waste this opportunity to rethink and redesign our online learning platforms, environments and technologies, and improve them, so that they are fit for purpose.   Ultimately, however, the crises caused by the pandemic should encourage us to look beyond new platforms and technologies to the longer term, and rethink what we teach and what students learn, as well as how we teach and how we assess learning. Universities could be preparing students for a longer-term future and to solve some of the urgent global challenges of our time, including climate change and repair, poverty, inequality, poor health, food insecurity and cyber insecurity, to name a few of the most urgent. This should include developing learner’s abilities to manage their lives, careers, work-life balance and physical and mental health and not simply obtain their first graduate job.   By doing so, universities could rediscover the public and collective purposes of higher education, as well as the private and individual benefits it offers. Universities need to not only help students be lifelong learners but open their doors in genuinely flexible ways to respond to the needs of learners of all ages and abilities. So, alongside the new modes of blended learning – or what might be called hybrid approaches to facilitating distributed learning communities – this pandemic-induced crisis is an opportunity for universities to also reconsider what is taught as well as how, the purposes of education in unpredictable times of rapid change and greater risk, and the new opportunities and broader possibilities opened up by this.   There is a world of difference between remote teaching in an emergency and carefully designed and planned hybrid learning for the future.

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