scholarly journals Use and impact of virtual primary care on quality and safety: The public's perspectives during the COVID-19 pandemic

2021 ◽  
pp. 1357633X2110662
Author(s):  
Ana Luisa Neves ◽  
Jackie van Dael ◽  
Niki O’Brien ◽  
Kelsey Flott ◽  
Saira Ghafur ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Characteristics ◽  
Quality And Safety ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Secure Messaging ◽  
Virtual Care ◽  
Care Models ◽  
Remote Care ◽  
Future Work

Introduction With the onset of Coronavirus disease (COVID-19), primary care has swiftly transitioned from face-to-face to virtual care, yet it remains largely unknown how this has impacted the quality and safety of care. We aim to evaluate patient use of virtual primary care models during COVID-19, including change in uptake, perceived impact on the quality and safety of care and willingness of future use. Methodology An online cross-sectional survey was administered to the public across the United Kingdom, Sweden, Italy and Germany. McNemar tests were conducted to test pre- and post-pandemic differences in uptake for each technology. One-way analysis of variance was conducted to examine patient experience ratings and perceived impacts on healthcare quality and safety across demographic characteristics. Results Respondents (n = 6326) reported an increased use of telephone consultations ( + 6.3%, p < .001), patient-initiated services ( + 1.5%, n = 98, p < 0.001), video consultations ( + 1.4%, p < .001), remote triage ( + 1.3, p < 0.001) and secure messaging systems ( + 0.9%, p = .019). Experience rates using virtual care technologies were higher for men (2.4  ±  1.0 vs. 2.3  ±  0.9, p < .001), those with higher literacy (2.8  ±  1.0 vs. 2.3  ±  0.9, p < .001), and participants from Germany (2.5  ±  0.9, p < .001). Healthcare timeliness and efficiency were the dimensions most often reported as being positively impacted by virtual technologies (60.2%, n = 2793 and 55.7%, n = 2,401, respectively), followed by effectiveness (46.5%, n = 1802), safety (45.5%, n = 1822), patient-centredness (45.2%, n = 45.2) and equity (42.9%, n = 1726). Interest in future use was highest for telephone consultations (55.9%), patient-initiated digital services (56.1%), secure messaging systems (43.4%), online triage (35.1%), video consultations (37.0%) and chat consultations (30.1%), although significant variation was observed between countries and patient characteristics. Discussion Future work must examine the drivers and determinants of positive experiences using remote care to co-create a supportive environment that ensures equitable adoption and use. Comparative analysis between countries and health systems offers the opportunity for policymakers to learn from best practices internationally.

Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: An International Cross-sectional Survey Study (Preprint)

2021 ◽  
Author(s):  
Edmond Li ◽  
Rosy Tsopra ◽  
Geronimo Jimenez ◽  
Alice Serafini ◽  
Gustavo Gusso ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Lessons Learned ◽  
Survey Study ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Face To Face ◽  
Remote Care

BACKGROUND With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. OBJECTIVE We explored GPs’ perspectives on the main benefits and challenges of using digital remote care. METHODS GPs across 20 countries completed an online questionnaire between June – September 2020. GPs’ perceptions on main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. RESULTS A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patient’s preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. CONCLUSIONS At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions, and support the long-term development of platforms that are more technologically robust, secure. INTERNATIONAL REGISTERED REPORT RR2-10.2196/30099

Evaluating the impact of COVID-19 on the adoption of virtual care in general practice in 20 countries (inSIGHT): rationale and study protocol (Preprint)

2021 ◽  
Author(s):  
Ana Luísa Neves ◽  
Edmond Li ◽  
Alice Serafini ◽  
Geronimo Larrain Gimenez ◽  
Heidrun Lingner ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Care Delivery ◽  
Quality And Safety ◽  
High Quality ◽  
Virtual Care ◽  
The Future ◽  
Perceived Impact ◽  
Remote Care ◽  
The Impact

BACKGROUND In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. OBJECTIVE This study aims to explore the perspectives of General Practitioners / Family Doctors (GPs/FDs) on a.) use of virtual care during the COVID-19 pandemic; b.) perceived impact on quality and safety of care; c.) essential factors for high-quality and sustainable use of virtual care in the future. METHODS Online cross-sectional questionnaire of GPs/FDs, distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers’ personal contact networks. General Practitioners were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and subgroup analyses will be conducted to explore the relationships between the use of virtual care and perceptions on impact on quality and safety of care, and participants’ characteristics. Qualitative data (free-text responses) will be analysed using framework analysis. RESULTS N/A CONCLUSIONS The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP/FD characteristics, and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design.

scholarly journals Using positive deviance to improve timely access in primary care

2021 ◽  
Vol 10 (4) ◽  
pp. e001228
Author(s):  
MaryBeth DeRocher ◽  
Sam Davie ◽  
Tara Kiran
Keyword(s):  
Primary Care ◽  
Positive Deviance ◽  
Promising Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Secure Messaging ◽  
Care Organisation ◽  
Appointment Schedule ◽  
Timely Access ◽  
Primary Care Organisation

BackgroundImproving timely access in primary care is a continued challenge in many countries. We used positive deviance to try and identify best practices for achieving timely access in our primary care organisation in Toronto, Canada.MethodsSemistructured interviews were used to identify practice strategies used by physicians who successfully maintained a low third next available appointment (TNA) (positive deviants, n=6). We then conducted a cross-sectional survey to understand the prevalence of identified promising practices among all physicians (n=70) in the practice. We used χ2 testing to understand whether uptake of promising practices among survey respondents was different for those with a median TNA of 7 days or less vs a median TNA over 7 days.ResultsWe identified seven promising practice strategies used by positive deviants: adjusting the appointment template based on demand; reviewing the appointment schedule in advance; max-packing of visits; using phone, email and secure messaging; customising care for complex patients; managing planned absences; and involving the interprofessional team. 65 of 70 physicians responded to the survey on promising practices. Uptake of the promising practices was variable among survey respondents. In general, we found no association between uptake of promising practices and median TNA. One exception was that those with a median TNA of 7 or less were more likely to review the schedule in advance to potentially mitigate a visit using phone/email (62% vs 31%, p=0.0159).ConclusionPromising practices used by a small group of physicians (‘positive deviants’) to maintain good access were generally not associated with timely access among a larger sample of physicians in the practice. Our findings highlight the difficulty of untangling physician practice style and its contribution to timely access in primary care.

scholarly journals How Do Virtual Visits Compare? Parent Satisfaction With Pediatric Diabetes Telehealth During the COVID-19 Pandemic

2022 ◽  
Vol 2 ◽  
Author(s):  
Christine A. March ◽  
Radhika Muzumdar ◽  
Ingrid Libman
Keyword(s):  
Parent Satisfaction ◽  
Routine Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Stakeholder Perspectives ◽  
Virtual Care ◽  
Pediatric Diabetes ◽  
The Future ◽  
Care Models ◽  
Virtual Visits

BackgroundIn response to the COVID-19 pandemic, many countries relaxed restrictions on telemedicine, allowing for a robust transition to virtual visits for routine care. In response, centers rapidly instituted and scaled telemedicine for pediatric diabetes care. Despite numerous center reports on their experience, little is known about parent perspectives on the widespread increase of telemedicine for pediatric diabetes appointments.ObjectiveTo assess parent satisfaction with virtual care for pediatric diabetes during the COVID-19 pandemic.MethodsWe conducted an online, cross-sectional survey of parents of youth with diabetes who receive care at a large, academic diabetes center regarding their perspectives on newly introduced virtual appointments. Parents were surveyed at two time points during the pandemic using a validated scale which was adapted for diabetes. We explored demographic and clinical factors which may influence parental satisfaction.ResultsOverall, parents expressed high levels of satisfaction (&gt;90%) with functional aspects of the visit, though only approximately half (56%) felt the visit was as good as an in-person encounter. Nearly three-quarters (74%) would consider using telemedicine again in the future. Prior use of telemedicine significantly influenced parent satisfaction, suggesting that parent preferences may play a role in continued use of telemedicine in the future. There was no difference in responses across the two timepoints, suggesting high satisfaction early in the pandemic which persisted.ConclusionsIf permissive policies for telemedicine continue, diabetes centers could adopt hybrid in-person and virtual care models, while considering various stakeholder perspectives (providers and patients) and equity in access to virtual care.

scholarly journals Multidisciplinary work promotes preventive medicine and health education in primary care: a cross-sectional survey

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Ayelet Schor ◽  
Lucia Bergovoy-Yellin ◽  
Daniel Landsberger ◽  
Tania Kolobov ◽  
Orna Baron-Epel
Keyword(s):  
Primary Care ◽  
Health Education ◽  
Preventive Medicine ◽  
Health Professionals ◽  
Health Behaviours ◽  
Occult Blood ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Models ◽  
Influenza Vaccinations

Abstract Background Preventive medicine and health education are among the strategies used in coping with chronic diseases. However, it is yet to be determined what effect do personal and organizational aspects have on its’ implementation in primary care. Methods A cross-sectional survey was conducted in order to assess and compare preventive medicine and health education activities in three types of primary care models: solo working independent physicians, nurse-physician collaborations and teamwork (nurses, dietitians and social workers working alongside a physician). Questionnaires were emailed to 1203 health professionals between September and November 2015, working at Maccabi Healthcare Services, the second largest Israeli healthcare organization. Self-reported rates of health education groups conducted, proactive appointments scheduling and self-empowerment techniques use during routine appointments, were compared among the three models. Independent variables included clinic size as well as health professionals’ occupation, health behaviors and training. A series of multivariate linear regressions were performed in order to identify predictors of preventive medicine and health education implementation. Computerized health records (CHR) validated our self-report data through data regarding patients’ health behaviours and outcomes, including health education group registration, adherence to occult blood tests and influenza vaccinations as well as blood lipid levels. Results Responders included physicians, nurses, dietitians and social workers working at 921 clinics (n = 516, response rate = 31%). Higher rates of proactive appointments scheduling and health education groups were found in the Teamwork and Collaboration models, compared to the Independent Physician Model. Occupation (nurses and dietitians), group facilitation training and personal screening adherence were identified as preventive medicine and health education implementation predictors. Group registration, occult blood tests, healthy population’s well-controlled blood lipids as well as influenza vaccinations among chronically ill patients were all significantly higher in the Teamwork and Collaboration models, compared to the Independent Physician Model. Conclusions The Teamwork and Collaboration models presented higher rates of preventive medicine and health education implementation as well as higher rates of patients’ positive health behaviours documented in these models. This suggests multidisciplinary primary care models may contribute to population’s health by enhancing preventive medicine and health education implementation alongside health professionals’ characteristics.

scholarly journals Prepared and highly committed despite the risk of COVID-19 infection: a cross-sectional survey of primary care physicians’ concerns and coping strategies in Singapore

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jerrald Lau ◽  
David Hsien-Yung Tan ◽  
Gretel Jianlin Wong ◽  
Yii-Jen Lew ◽  
Ying-Xian Chua ◽  
...  
Keyword(s):  
Primary Care ◽  
Coping Strategies ◽  
Stress Management ◽  
Primary Care Physicians ◽  
Well Being ◽  
Pandemic Preparedness ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Accessible Information ◽  
And Coping

Abstract Background Primary care physicians (PCPs) are first points-of-contact between suspected cases and the healthcare system in the current COVID-19 pandemic. This study examines PCPs’ concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak. Methods Two hundred and sixteen PCPs actively practicing in either a public or private clinic were cluster sampled via email invitation from three primary care organizations in Singapore from 6th to 29th March 2020. Participants completed a cross-sectional online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19. Results A total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection (89.9%), and a source of risk (74.7%) and concern (71.5%) to loved ones. PCPs reported acceptance of these risks (91.1%) and the need to care for COVID-19 patients (85.4%). Overall perceived pandemic preparedness was extremely high (75.9 to 89.9%). PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors. Conclusions PCPs continue to serve willingly on the frontlines of this pandemic despite the high perception of risk to themselves and loved ones. Healthcare organizations should continue to support PCPs by managing both their psychosocial (e.g. stress management) and professional (e.g. pandemic preparedness) needs.

Perceived neighborhood food access is associated with consumption of animal-flesh food, fruits and vegetables among mothers and young children in peri-urban Cambodia

2021 ◽  
pp. 1-29
Author(s):  
Minh-Cam Duong ◽  
Hung Nguyen-Viet ◽  
Delia Grace ◽  
Chhay Ty ◽  
Huy Sokchea ◽  
...  
Keyword(s):  
Food Consumption ◽  
Urban Areas ◽  
Food Access ◽  
Fruits And Vegetables ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Phnom Penh ◽  
Consumption Frequency ◽  
Future Work

Abstract Objective: To examine whether mothers’ perceived neighborhood food access is associated with their own and their young children’s consumption of animal-flesh food, fruits and vegetables in peri-urban areas of Cambodia. Design: A cross-sectional survey measured food consumption frequency and perceived neighborhood food access, the latter including six dimensions of food availability, affordability, convenience, quality, safety and desirability. Multivariate logistic regression was used to assess the association between food access and food consumption. Setting: Peri-urban districts of Phnom Penh and Siem Reap, Cambodia Participants: 198 mothers of children between 6 to 24 months old. Results: Over 25% of the mothers and 40% of the children had low consumption (< once a day) of either animal-flesh food or fruits and vegetables. Compared with perceived high food access, perceived low food access was associated with an adjusted 5.6-fold and 4.3-fold greater odds of low animal-flesh food consumption among mothers (95% CI 2.54, 12.46) and children (95% CI 2.20, 8.60) respectively. Similarly, relative to perceived high access, perceived low food access was associated with 7.6-times and 5.1-times higher adjusted odds of low fruits and vegetables consumption among mothers (95% CI 3.22, 18.02) and children (95% CI 2.69, 9.83) respectively. Conclusions: Mothers’ perceived neighborhood food access was an important predictor of their own and their young children’s nutrient-rich food consumption in peri-urban Cambodia. Future work is needed to confirm our findings in other urban settings and examine the role of neighborhood food environment on the consumption of both nutrient-rich and nutrient-poor food.

scholarly journals Responses of physicians to an objective safety and quality knowledge test: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e040779
Author(s):  
Harry B Burke ◽  
Heidi B King
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Cross Sectional Study ◽  
Choice Test ◽  
Quality And Safety ◽  
Cross Sectional ◽  
Percent Correct ◽  
Quality Perceptions ◽  
Clinical Vignettes ◽  
The Usa

ObjectiveFor physicians to practice safe high quality medicine they must have sufficient safety and quality knowledge. Although a great deal is known about the safety and quality perceptions, attitudes and beliefs of physicians, little is known about their safety and quality knowledge. This study tested the objective safety and quality knowledge of practicing US primary care physicians.DesignCross-sectional objective test of safety and quality knowledge.SettingPrimary care physicians practicing in the USA.ParticipantsStudy consisted of 518 US practicing primary care physicians who answered an email invitation. Fifty-four percent were family medicine and 46% were internal medicine physicians.The response rate was 66%.InterventionThe physicians took a 24-question multiple-choice test over the internet.OutcomeThe outcome was the percent correct.ResultsThe average number of correct answers was 11.4 (SD, 2.69), 48% correct. Three common clinical vignettes questions were answered correctly by 45% of the physicians. Five common radiation exposures questions were answered correctly by 40% of the physicians. Seven common healthcare quality and safety questions were answered correctly by 43% of the physicians. Seven Donabedian’s model of structure, process and outcome measure questions were answered correctly by 67% of the physicians. Two Institute of Medicine’s definitions of quality and safety questions were answered correctly by 19.5% of the physicians.ConclusionForty-eight per cent of the physicians’ answers to the objective safety and quality questions were correct. To our knowledge, this is the first assessment of the objective safety and quality knowledge of practicing US primary care physicians.

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