scholarly journals Preference for Telehealth Sustained Over Three Months at an Outpatient Center for Integrative Medicine

2021 ◽  
Vol 10 ◽  
pp. 216495612199736
Author(s):  
Michael T. M. Finn ◽  
Hannah R. Brown ◽  
Emily R. Friedman ◽  
A. Grace Kelly ◽  
Kathryn Hansen
Keyword(s):  
Integrative Medicine ◽  
Discrete Choice ◽  
Mixed Method ◽  
Southeastern United States ◽  
Chronic Medical Conditions ◽  
Administrative Staff ◽  
Outpatient Center ◽  
Rapid Transition ◽  
Chronic Pain Conditions

Background Integrative medicine is a key framework for the treatment of chronic medical conditions, particularly chronic pain conditions. The COVID-19 pandemic prompted rapid implementation of telehealth services. Objective We present outcomes of a complete and rapid transition to telehealth visits at an outpatient integrative medicine center in the Southeastern United States. Method Patients and administrative staff took surveys comparing telehealth to in-person visits within four weeks of our clinic's transition to telehealth and three months later. Beginning four weeks after the clinic’s telehealth conversion in March 2020, patients who had a telehealth visit at the center completed a survey about their telehealth experience and another survey three months later. Results Patient quality judgements significantly favored telehealth at baseline, B = .77 [0.29 – 1.25], SE = .25, t(712) = 3.15, p = .002, and increased at three months, B = .27 [–0.03 – 0.57], SE = .15, t(712) = 1.76, p = .079. Telehealth technology usability and distance from the center predicted patient ratings of telehealth favorability. Providers favored in-person visits more than patients, B = –1.00 [–1.56 – –0.44], SE = .29, t(799) = –3.48, p < .001, though did not favor either in-person or telehealth more than the other. Patient discrete choice between telehealth and in-person visits was split at baseline (in-person: n = 86 [54%]; telehealth: n = 73 [46%]), but favored telehealth at three months (in-person: n = 17 [40%]; telehealth: n = 26 [60%]). Overall, discrete choice favored telehealth at follow-up across providers and patients, OR = 2.69 [.1.18 – 6.14], z = 2.36, p = .018. Major qualitative themes highlight telehealth as acceptable and convenient, with some challenges including technological issues. Some felt a loss of interpersonal connection during telehealth visits, while others felt the opposite. Conclusion We report converging mixed-method data on the successful and sustained implementation of telehealth with associated policy and clinical implications during and beyond the COVID-19 pandemic.

scholarly journals Interactive, Hands-On Training for Hospital Workers Increases Level of Special Pathogen Preparedness

Sci ◽  
2021 ◽  
Vol 3 (2) ◽  
pp. 29
Author(s):  
Syra Madad ◽  
Eleanor Tolf
Keyword(s):  
New York ◽  
New York City ◽  
Mixed Method ◽  
Hospital Workers ◽  
Department Of Health ◽  
Interactive Training ◽  
Hands On ◽  
Before And After ◽  
Question Survey

The purpose of this evaluation was to determine the effect of intensive, interactive training on hospital workers’ preparedness for special pathogen cases by utilizing the Frontline Facility Special Pathogens Training Course created by the Systemwide Special Pathogens Program at New York City Health + Hospitals (NYC H+H). An 8 h course was offered in 2018 and 2019 to healthcare employees throughout the Department of Health and Human Services Region 2, mostly from NYC H+H. Evaluation included multiple-choice pre and post exams, a 26-question survey about level of preparedness before and after the training, and follow-up interviews focused on changes in facility protocols. As a result, 61% of survey respondents indicated that they had never previously attended a hospital-sponsored special pathogen training. After the training, there was a 53.3% report rate of feeling “very prepared,” compared to 14.6% before the training. Additionally, there was an 11% improvement in test scores. Furthermore, 77% of respondents reported that their facility had changed protocols relating to topics of the course after their training date. Survey participants reported general satisfaction with the course, as well as an increased level of preparedness for special pathogen cases. Together, the results of the exams, survey, and interviews suggest that this interactive, mixed-method training increases special pathogen preparedness across different healthcare sectors. With the ongoing threat of special pathogens, the need for continued training and maintaining a state of readiness is paramount in healthcare.

Remote Follow-up of Self-isolating COVID-19 Patients with a Patient Portal: Protocol for a Mixed-method Pilot Study (The Opal-COVID Study) (Preprint)

2021 ◽  
Author(s):  
David Lessard ◽  
Kim Engler ◽  
Yuanchao Ma ◽  
Adriana Rodriguez Cruz ◽  
Serge Vicente ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Mixed Method ◽  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Sociodemographic Characteristics ◽  
Patient Portal ◽  
Implementation Outcomes ◽  
Service Outcomes ◽  
Qualitative Analyses

BACKGROUND Individuals diagnosed with COVID-19 are instructed to self-isolate at home. However, during self-isolation, they may experience anxiety and insufficient care. Some patient portals can allow patients to self-monitor and share their health status with healthcare professionals for remote follow-up, but little data is available on the feasibility of their use. OBJECTIVE This manuscript presents the protocol of the Opal-COVID Study which has four objectives: 1) assess the implementation of using the Opal patient portal for distance monitoring of COVID-19 patients self-isolating at home; 2) identify influences on the intervention’s implementation; and describe 3) service and 4) patient outcomes of this intervention. METHODS This mixed-method pilot study aims to recruit 50 COVID-19 patient participants tested at the McGill University Health Centre (MUHC, Montreal, Canada) for 14 days of remote follow-up. With access to questionnaires through the Opal patient portal smartphone app, configured for this study, patients will complete a daily self-assessment of symptoms, vital signs, and mental health, monitored by a nurse, and receive subsequent teleconsultations, as needed. Study questionnaires will be administered to collect data on sociodemographic characteristics, medical background, implementation outcomes (acceptability, usability, and respondent burden) and patient satisfaction. Coordinator logbook entries will inform on feasibility outcomes, namely, recruitment/retention rates and fidelity, as well as on the frequency and nature of contacts with healthcare professionals via Opal. The statistical analyses for Objectives 1 (implementation outcomes), 3 (service outcomes), and 4 (patient outcomes) will evaluate the effects of time and sociodemographic characteristics on the outcomes. For Objectives 1 (implementation outcomes) and 4 (patient outcomes), the statistical analyses will also examine the attainment of predefined success thresholds. As to the qualitative analyses, for Objective 2 (influences on implementation), semi-structured qualitative interviews will be conducted with four groups of stakeholders (i.e., patient participants, healthcare professionals, technology developers and study administrators) and submitted to content analysis, guided by the Consolidated Framework for Implementation Research to help identify barriers and facilitators of implementation. For Objective 3 (service outcomes), reasons for contacting healthcare professionals through Opal will also be submitted to content analysis. RESULTS Between December 2020 and March 2021, 51 patient-participants were recruited. Qualitative interviews were conducted with 39 involved stakeholders, from April to September 2021. Delays in the study process were experienced due to implemented measures at the MUHC to address COVID-19 but the quantitative and qualitative analyses are currently underway. CONCLUSIONS This protocol is designed to generate multidisciplinary knowledge on the implementation of a patient portal-based COVID-19 care intervention and will lead to a comprehensive understanding of feasibility, stakeholder experience, and influences on implementation that may prove useful for scaling up similar interventions. CLINICALTRIAL ClinicalTrials.gov identifier NCT04978233.

341 Alder Hey Experience of Paediatric Virtual Fracture Clinic During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Stead ◽  
M Ashraf ◽  
S Gandham ◽  
M Khattak ◽  
C Talbot
Keyword(s):  
Patient Contact ◽  
Fracture Clinic ◽  
Social Challenges ◽  
Face To Face ◽  
Elbow Injuries ◽  
Rapid Transition ◽  
Clavicle Fractures ◽  
Alder Hey ◽  
Virtual Fracture Clinic

Abstract Introduction The SARS-CoV2/COVID-19 pandemic represented an unprecedented emergency prompting a drive to minimise non-essential patient contact and the need for a virtual fracture clinic (VFC); an uncommon practice in paediatric units. Management of paediatric fractures requires a greater degree of vigilance to safeguard children. The current climate has created social challenges that theoretically increase the risk of harm and exploitation to children. This study investigates VFC in the management of paediatric fractures to determine the efficiency of such a process and the risk of safeguarding. Method A protocol was devised in affiliation with BSCOS for the immediate management and streamlining of paediatric fractures into VFC. We retrospectively audited 235 VFC consults over a 1-month period. Patient sex was roughly evenly distributed, and age ranged from 9 months to 16 years (mean 8.4 years). Results 42% of patients were recalled for a face-to-face (F2F) review (26% expedited), primarily for clinical assessment, plaster complaints and imaging requirements. 33% were discharged and 15% continued follow-up in VFC. All clavicle fractures were discharged. Forearm, hand, foot and elbow injuries were more likely to be discharged. Lower leg, upper arm and knee presentations more frequently required a F2F review. 2.3% of cases required safeguarding reviews. Conclusions Given the rapid transition to VFC without the use of triage we have determined a number of non-complex fractures safely managed and discharged via VFC. The low percentage of recall due to safeguarding concern highlights this may not be a barrier to the continuation of virtual care outside of the context of a pandemic.

Analisis Pola Penyelewengan Beban Perjalanan Dinas pada Kementerian di Indonesia Tahun 2015-2017

2020 ◽  
Vol 5 (4) ◽  
pp. 255-272
Author(s):  
Dyah Setyaningrum ◽  
Irfan Jeremi
Keyword(s):  
Qualitative Methods ◽  
Mixed Method ◽  
Reporting Process ◽  
Quantitative And Qualitative Methods

This study aims to analyze the pattern of official travel misappropriation, especially related to the pattern of the type of case that usually occurred, the misappropriation causes, and the follow-up process for recommendation given. The research samples are all ministries in Indonesia in the year of 2015-2017. The method used in this study is mixed method, which is a combination of quantitative and qualitative methods. The quantitative method’s purpose is to find the pattern from the type of case in general, then choosing and detailing the type of case with the greatest number of findings. The qualitative method’s purpose is to deepen the information related to the type of case studied. The result of this study shows that the type of case with the greatest findings is granting travel expenses not according to regulations. That case happened because the implementation of the functions and responsibilities of the officers who have a role in the payment and reporting process for official travel are not optimal. The solution to this problem is optimizing officers' roles through the implementation of three lines of defense.

scholarly journals Psychological Inflexibility as a Predictor of Sexual Functioning Among Women with Vulvovaginal Pain: A Prospective Investigation

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3596-3602
Author(s):  
Pernilla Maathz ◽  
Ida K Flink ◽  
Linnea Engman ◽  
Johanna Ekdahl
Keyword(s):  
Sexual Functioning ◽  
Functional Disability ◽  
Preliminary Evidence ◽  
Multiple Regression Model ◽  
Pain Severity ◽  
Psychological Inflexibility ◽  
Chronic Pain Conditions ◽  
Over Time

Abstract Objective Persistent vulvovaginal pain affects many women and often has adverse effects on sexual functioning. Psychological inflexibility related to pain is associated with distress and functional disability across different types of chronic pain conditions, but little is known about the role of psychological inflexibility in vulvovaginal pain. The present study examines psychological inflexibility related to pain as a predictor of sexual functioning over time among women with vulvovaginal pain. Methods Questionnaires including measures of psychological inflexibility, pain severity, and sexual functioning were administered to female university students at two points in time. One hundred thirty women with vulvovaginal pain responded to the questionnaire at baseline and at follow-up after 10 months. A multiple regression model was used to explore psychological inflexibility and pain severity as predictors of sexual functioning at follow-up. Results Higher levels of psychological inflexibility and more severe pain at baseline were associated with poorer sexual functioning 10 months later. In analysis adjusting for baseline levels of sexual functioning, psychological inflexibility was the only significant predictor of sexual functioning at follow-up. Conclusions The findings provide preliminary evidence that psychological inflexibility is associated with sexual adjustment over time among women with vulvovaginal pain and point to the relevance of further examinations of the psychological inflexibility model in the context of vulvovaginal pain.

scholarly journals Long-Term Evaluation of the Use of the Transdermal Contraceptive Patch in Adolescents

2004 ◽  
Vol 4 ◽  
pp. 512-516 ◽  
Author(s):  
Stephanie Logsdon ◽  
Jessica Richards ◽  
Hatim A. Omar
Keyword(s):  
Young Women ◽  
Skin Irritation ◽  
Adolescent Medicine ◽  
Outpatient Center ◽  
Term Evaluation ◽  
Complete Detachment ◽  
Lost To Follow Up ◽  
Contraceptive Patch

The transdermal contraceptive patch, Ortho Evra™, was approved in December 2001 and released on the market in June 2002. In this study, we reviewed clinical data of young women who started the patch between June 2002 and December 2003 in the adolescent medicine clinic at a university-based outpatient center. A total of 62 patients started the patch in that period and two of them were lost to follow-up. Mean age of patients was 17.9 years and mean length of use was 10 cycles. Only 10 patients (16.7%) discontinued use. Reasons for discontinuation were moderate to severe skin irritation (3 patients, 5%), complete detachment (3 patients, 5%), and economic reasons (4 patients, 6.7%). Compliance was excellent overall and the side-effects profile was good. No pregnancies occurred during this period. These results confirmed that the transdermal contraceptive patch is easy to use and an effective method of birth control that may be better tolerated by young women. It also seemed to improve contraceptive compliance in this population.

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