Use of alternative consultation forms in Danish general practice in the initial phase of the COVID-19 pandemic – a qualitative study

Abstract 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.

Download Full-text

Testing the Mig-HealthCare Algorithm in Greece

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1446 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Riza ◽

P Karnaki ◽

D Zota ◽

A Linos

Keyword(s):

Health Care ◽

Early Stage ◽

Health Care Systems ◽

Health Conditions ◽

Health Issues ◽

Host Countries ◽

Local Hospital ◽

Raising Awareness ◽

Significant Burden ◽

Care Systems

Abstract The Mig-HealthCare Algorithm is a tool, comprising a set of questions developed with the aim to (a) guide the user on how to access all the categories and tools that are available through the Roadmap & Toolbox (b) help the user identify the health issues of importance when providing care to a specific migrant/refugee. At the end of a series of questions, a brief report summarizing the main outcomes is generated. The algorithm was tested in Greece in two mainland reception centres and a local hospital in an area serving migrants/refugees. Results discuss the usefulness of the algorithm for improving the delivery of appropriate health services to migrants/refugees and its importance in raising awareness about the health conditions which are crucial for migrants/refugees and are expected to pose a significant burden on the health care systems of host countries unless dealt with adequately at an early stage.

Download Full-text

The Impact and Implications of The COVID-19 Pandemic on Organ Procurement Outside of an Epicenter

Progress in Transplantation ◽

10.1177/15269248211002808 ◽

2021 ◽

pp. 152692482110028

Author(s):

Janice Jene Hudgins ◽

Allison Jo Boyer ◽

Kristen Danielle Orr ◽

Clint Allen Hostetler ◽

Jeffrey Paul Orlowski ◽

...

Keyword(s):

Health Care ◽

Initial Phase ◽

Organ Procurement ◽

Health Care Systems ◽

Health Data ◽

Organ Procurement Organization ◽

Care Systems ◽

The Impact ◽

Variable Impact ◽

Single Organ

The COVID-19 pandemic has been well-documented to have a variable impact on individual communities and health care systems. We describe the experience of a single organ procurement organization (OPO), located in an area without a large cluster of cases during the initial phase of the COVID-19 pandemic. A review of community health data describing the impact of COVID-19 nationally and in Oklahoma was conducted. Additionally, a retrospective review of available OPO data from March 2019-May 2020 was performed. While the amount of donor referrals received and organs recovered by the OPO remained stable in the initial months of the pandemic, the observed organs transplanted vs. expected organs transplanted (O:E) decreased to the lowest number in the 15-month period and organs transplanted decreased as well. Fewer organs from Oklahoma donors were accepted for transplant despite staff spending more time allocating organs.

Download Full-text

Living Within and Without: Life-Space Mapping to Visualize Need and Resource Access of Rural Dementia Dyads

Innovation in Aging ◽

10.1093/geroni/igaa057.1404 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 434-435

Author(s):

Julia Loup ◽

A Lynn Snow ◽

Michelle Hilgeman

Keyword(s):

Visual Cues ◽

Daily Life ◽

Health Care Systems ◽

Qualitative Interviews ◽

Time Data ◽

Life Space ◽

Resource Access ◽

Space Modeling ◽

Care Systems ◽

Moca Score

Abstract Rural-dwelling veterans with dementia (PWD) and their family caregivers (CG) have unique needs and resource access limitations. Life-Space assessment models suggest older adults’ needs are reflected in their daily-life mobility and routines (Peel et al., 2005). Yet, medical treatment models seldom incorporate non-health related activities (e.g., transportation, groceries, distance to formal and informal support networks). This mixed-methods study proposes an exploratory life-space modeling visualization that integrates qualitative and quantitative daily-life data from rural dwelling dyads in Alabama. Two case studies are selected from a sample of 30 qualitative interviews to demonstrate this innovative analytic approach. One case depicts a married dyad (PWD and spousal CG) (CGage = 74; PWDage = 80, PWD MoCA score = 21) and the second visualization is of a PWD living alone (PWDage = 82, PWD MoCA Score = 20). Daily-life experiences and routines mentioned during interviews were categorized using a rapid analysis template approach and informed by unmet needs theories (Algase et al., 1996). Next, extracted data were placed into mapping visualization software. The maps include visual cues (colors, transportation routes, and icons) to designate met, unmet, and vulnerable needs and resources, allowing visual interaction with the two cases’ dementia caregiving context and qualitative responses. Life-space maps may be useful tools to visualize resource access and assist integrated health care systems in better understanding daily interactions and intervention gaps for difficult to reach populations. Future developments include ecological momentary assessment and Global Positioning System (GPS) data to develop life-space maps using real-time data collection.

Download Full-text

A Cross-Cultural Comparison of Nurses' Ethical Concerns

Nursing Ethics ◽

10.1177/0969733008095385 ◽

2008 ◽

Vol 15 (6) ◽

pp. 745-760 ◽

Cited By ~ 14

Author(s):

Barbro Wadensten ◽

Stig Wenneberg ◽

Marit Silén ◽

Ping Fen Tang ◽

Gerd Ahlström

Keyword(s):

Ethical Dilemmas ◽

Health Care Systems ◽

Empirical Studies ◽

Qualitative Interviews ◽

Work Situation ◽

Work Related ◽

Cross Cultural Comparison ◽

Care Systems ◽

Related Stress ◽

Seriously Ill Patients

The aim of this study was to compare Swedish and Chinese nurses' experiences of ethical dilemmas and workplace distress in order to deepen understanding of the challenges neuroscience nurses encounter in different cultures. Qualitative interviews from two previously performed empirical studies in Sweden and China were the basis of this comparative study. Four common content areas were identified in both studies: ethical dilemmas, workplace distress, quality of nursing and managing distress. The themes formulated within each content area were compared and synthesized into novel constellations by means of aggregated concept analysis. Despite wide differences in the two health care systems, the nurse participants had similar experiences with regard to work stress and a demanding work situation. They were struggling with similar ethical dilemmas, which concerned seriously ill patients and the possibilities of providing good care. This indicates the importance of providing nurses with the tools to influence their own work situation and thereby reducing their work-related stress.

Download Full-text

Introducing teledermoscopy of possible skin cancers in general practice in Southern Denmark

Family Practice ◽

10.1093/fampra/cmaa041 ◽

2020 ◽

Vol 37 (4) ◽

pp. 513-518

Author(s):

Tine Vestergaard ◽

Sumangali C Prasad ◽

Annette Schuster ◽

Rasa Laurinaviciene ◽

Anette Bygum ◽

...

Keyword(s):

General Practice ◽

Diagnostic Accuracy ◽

Health Care Systems ◽

Final Diagnosis ◽

Skin Lesions ◽

University Hospital ◽

Predictive Values ◽

Face To Face ◽

Skin Cancers ◽

Care Systems

Abstract Background The increasing incidence of skin cancers poses a burden to health care systems. General practitioners (GPs) play an important role in triaging these diseases and referring relevant patients to specialists. It is challenging to distinguish benign from malignant skin lesions, and GPs may benefit from diagnostic support from teledermoscopy (TD). Objectives To assess whether the introduction of TD in general practice was feasible and might reduce the number of unnecessary referrals to specialists and to assess the diagnostic accuracy and confidence of participating GPs. Methods Fifty general practices in Southern Denmark participated. Adult patients presenting to their GP with suspected skin cancer could be included. Images including dermoscopy were taken by the GP and sent for evaluation by specialized dermatologists at a university hospital. Patients were simultaneously referred for a face-to-face evaluation at the university hospital. Diagnoses proposed by the GPs and by TD were compared to the final diagnoses obtained by histopathology or, if not available, face-to-face evaluation. Results Five hundred and nineteen patients with 600 suspected skin cancers were included. The final diagnosis was benign in 72.3%. The photo quality was good or fair in 90.5%. GPs reported uncertainty about their diagnoses in 41.5% of cases. The GPs’ positive predictive values for any malignancy and for malignant melanoma were 49.5% and 26.3%, respectively. On evaluation by TD, 31.5% of lesions did not need further in-person assessment. Conclusion Useful images of suspicious skin lesions were obtained from general practice, and GPs could benefit from TD to improve their diagnostic accuracy and confidence.

Download Full-text

Return to Normalcy? Principles on Resuming Surgical Services in the COVID-19 Era

OTO Open ◽

10.1177/2473974x20936658 ◽

2020 ◽

Vol 4 (2) ◽

pp. 2473974X2093665

Author(s):

Taher S. Valika ◽

Kathleen R. Billings

Keyword(s):

Health Care ◽

Patient Care ◽

Health Care Systems ◽

Lessons Learned ◽

Drastic Reduction ◽

The Public ◽

Surgical Services ◽

Outpatient Visits ◽

Care Systems ◽

Full Capacity

The rapidly changing health care climate related to coronavirus disease 2019 (COVID-19) has resulted in numerous changes to health care systems and in practices that protect both the public and the workers who serve in hospitals around the country. As a result, these past few months have seen a drastic reduction in outpatient visits and surgical volumes. With phased reopening and appropriate guidance, health care systems are attempting to return to normal. Our institution has had the unique opportunity to already return operations back to full capacity. The experiences and lessons learned are described, and we provide guiding principles to allow for a safe and effective return to patient care.

Download Full-text

COVID-19 containment policies through time may cost more lives at metapopulation level

10.1101/2020.04.22.20075093 ◽

2020 ◽

Cited By ~ 3

Author(s):

Konstans Wells ◽

Miguel Lurgi

Keyword(s):

Health Care ◽

Decision Making ◽

Health Care Systems ◽

Informed Decision ◽

Mitigation Strategies ◽

Disease Spread ◽

Informed Decision Making ◽

Short Term ◽

Care Systems

AbstractThe rapid and pandemic spread of COVID-19 has led to unprecedented containment policies in response to overloaded health care systems. Disease mitigation strategies require informed decision-making to ensure a balance between the protection of the vulnerable from disease and the maintenance of global economies. We show that temporally restricted containment efforts, that have the potential to flatten epidemic curves, can result in wider disease spread and larger epidemic sizes in metapopulations. Longer-term rewiring of metapopulation networks or the enforcement of feasible long-term measures that decrease disease transmissions appear to be more efficient than temporarily restricted intensive mitigation strategies (e.g. short-term mass quarantine). Our results may inform balanced containment strategies for short-term disease spread mitigation in response to overloaded health care systems and longer-term epidemiological sizes.

Download Full-text

Viewpoint: eHealth solutions for Covid-19 and patientinvolvement (Preprint)

10.2196/preprints.19186 ◽

2020 ◽

Author(s):

Nina Pappot ◽

Gry Assam Taarnhøj ◽

Helle Pappot

Keyword(s):

Patient Involvement ◽

Healthcare Professionals ◽

Health Care Systems ◽

Special Importance ◽

Health Issues ◽

The Public ◽

Systems Perspective ◽

Public Media ◽

Care Systems ◽

User Friendly

UNSTRUCTURED Many eHealth researchers at present hope for telemedicine to solve health issues during the Covid-19 pandemic crisis, and we agree that this is to hope for. However, most eHealth solutions have focus on the health care systems perspective and not necessarily the patients. With set-off in Covid-19 case-stories in the public media, our own experience from being healthcare professionals in this pandemic and experiences from previous research on eHealth and patient involvement in other severe illnesses, we here focus on eHealth solutions for Covid-19 and patientinvolvement, which may be of special importance, when the issue is isolation and quarantine. Going through a group of eHealth providers’ perception of their tool’s functionality according to eHealth solutions for Covid-19, we find that nearly all the solutions have potential for patient involvement, and it is our hypothesis that these solutions may benefit from patient involvement to integrate the healthcare systems needs and the patient’s needs, ensuring an improved outcome. Especially, when it comes to eHealth solutions to overcome isolation and quarantine patientinvolvement may be crucial to secure a successful, user-friendly and meaningful tool. During the Covid-19 pandemic every possible tool avoiding feelings of loneliness, stress and anxiety is needed. We hope, that the Covid-19 pandemic can benefit from existing technologies used with the patient’s perspective to help solve the patients’ needs.

Download Full-text

Clinical Strategies for the Treatment and Management of Patients Prescribed Long-term Opioid Therapy

Pain Medicine ◽

10.1093/pm/pny211 ◽

2018 ◽

Vol 20 (9) ◽

pp. 1737-1744

Author(s):

Jessica J Wyse ◽

Linda Ganzini ◽

Steven K Dobscha ◽

Erin E Krebs ◽

Janet Zamudio ◽

...

Keyword(s):

Chronic Pain ◽

Drug Testing ◽

Health Care Systems ◽

Qualitative Interviews ◽

The United States ◽

Opioid Therapy ◽

Prescribing Practices ◽

Policy And Practice ◽

Care Systems

Abstract Objectives Across diverse health care systems, growing recognition of the harms associated with long-term opioid therapy (LTOT) for chronic pain has catalyzed substantial changes to policy and practice designed to promote safer prescribing and patient care. Although clear goals have been defined, how clinics and providers should most effectively implement these changes has been less well defined, and facilities and providers have had substantial flexibility to innovate. Methods Qualitative interviews were conducted with 24 Department of Veterans Affairs (VA) clinicians across the United States who prescribe LTOT for chronic pain. Interviews probed the practices and initiatives providers utilized to meet opioid safety requirements and address common challenges in caring for patients prescribed LTOT. Results Innovative strategies in the design and organization of clinical practice (urine drug testing, informed consent, limiting transfer requests, specialty patient panel) and resources utilized (engaged pharmacists, non-opioid pain treatments, intra-organizational collaborations) are described. Conclusions We conclude with recommendations designed to improve opioid prescribing practices, both within the VA and in other settings.

Download Full-text