scholarly journals Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mylaine Breton ◽  
Erin E. Sullivan ◽  
Nadia Deville-Stoetzel ◽  
Danielle McKinstry ◽  
Matthew DePuccio ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Interprofessional Collaboration ◽  
Care Delivery ◽  
Interpersonal Relationship ◽  
Verbal Cues ◽  
Face To Face ◽  
Technological Barriers ◽  
Technological Limitations ◽  
And Training

Abstract Background The COVID-19 pandemic has driven primary healthcare (PHC) providers to use telehealth as an alternative to traditional face-to-face consultations. Providing telehealth that meets the needs of patients in a pandemic has presented many challenges for PHC providers. The aim of this study was to describe the positive and negative implications of using telehealth in one Canadian (Quebec) and one American (Massachusetts) PHC setting during the COVID-19 pandemic as reported by physicians. Methods We conducted 42 individual semi-structured video interviews with physicians in Quebec (N = 20) and Massachusetts (N = 22) in 2020. Topics covered included their practice history, changes brought by the COVID-19 pandemic, and the advantages and challenges of telehealth. An inductive and deductive thematic analysis was carried out to identify implications of delivering care via telehealth. Results Four key themes were identified, each with positive and negative implications: 1) access for patients; 2) efficiency of care delivery; 3) professional impacts; and 4) relational dimensions of care. For patients’ access, positive implications referred to increased availability of services; negative implications involved barriers due to difficulties with access to and use of technologies. Positive implications for efficiency were related to improved follow-up care; negative implications involved difficulties in diagnosing in the absence of direct physical examination and non-verbal cues. For professional impacts, positive implications were related to flexibility (teleworking, more availability for patients) and reimbursement, while negative implications were related to technological limitations experienced by both patients and practitioners. For relational dimensions, positive implications included improved communication, as patients were more at ease at home, and the possibility of gathering information from what could be seen of the patient’s environment; negative implications were related to concerns around maintaining the therapeutic relationship and changes in patients’ engagement and expectations. Conclusion Ensuring that health services provision meets patients’ needs at all times calls for flexibility in care delivery modalities, role shifting to adapt to virtual care, sustained relationships with patients, and interprofessional collaboration. To succeed, these efforts require guidelines and training, as well as careful attention to technological barriers and interpersonal relationship needs.

scholarly journals Telehealth Challenges During COVID-19 As Reported by Primary Healthcare Physicians in Quebec and Massachusetts

2021 ◽  
Author(s):  
Mylaine Breton ◽  
Erin E. Sullivan ◽  
Nadia Deville-Stoetzel ◽  
Danielle McKinstry ◽  
Matthew DePuccio ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Interprofessional Collaboration ◽  
Care Delivery ◽  
Interpersonal Relationship ◽  
Verbal Cues ◽  
Face To Face ◽  
Technological Barriers ◽  
Technological Limitations ◽  
And Training

Abstract Background: The COVID-19 pandemic has driven primary healthcare (PHC) providers to use telehealth as an alternative to traditional face-to-face consultations. Providing telehealth that meets the needs of patients in a pandemic has presented many challenges for PHC providers. The aim of this study was to describe the positive and negative implications of using telehealth in one Canadian (Quebec) and one American (Massachusetts) PHC setting during the COVID-19 pandemic as reported by physicians.Methods: We conducted 42 individual semi-structured video interviews with physicians in Quebec (N = 20) and Massachusetts (N = 22) in 2020. Topics covered included their practice history, changes brought by the COVID-19 pandemic, and the advantages and challenges of telehealth. An inductive and deductive thematic analysis was carried out to identify implications of delivering care via telehealth.Results: Four key themes were identified, each with positive and negative implications: 1) access for patients; 2) efficiency of care delivery; 3) professional impacts; and 4) relational dimensions of care. For patients’ access, positive implications referred to increased availability of services; negative implications involved barriers due to difficulties with access to and use of technologies. Positive implications for efficiency were related to improved follow-up care; negative implications involved difficulties in diagnosing in the absence of direct physical examination and non-verbal cues. For professional impacts, positive implications were related to flexibility (teleworking, more availability for patients) and reimbursement, while negative implications were related to technological limitations experienced by both patients and practitioners. For relational dimensions, positive implications included improved communication, as patients were more at ease at home, and the possibility of gathering information from what could be seen of the patient’s environment; negative implications were related to concerns around maintaining the therapeutic relationship and changes in patients’ engagement and expectations.Conclusion: Ensuring that health services provision meets patients’ needs at all times calls for flexibility in care delivery modalities, role shifting to adapt to virtual care, sustained relationships with patients, and interprofessional collaboration. To succeed, these efforts require guidelines and training, as well as careful attention to technological barriers and interpersonal relationship needs.

scholarly journals VA Video Telehealth and Training Programs During the COVID-19 Response

2021 ◽  
Author(s):  
Rhonda Johnston ◽  
Rita F. Kobb ◽  
Claire Marty ◽  
Padraic McVeigh
Keyword(s):  
Online Survey ◽  
Surgical Care ◽  
Office Visits ◽  
Face To Face ◽  
Patient Interaction ◽  
Telemedicine Consultation ◽  
Physician Patient ◽  
And Training

Study Design: An online survey modeled after the TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) were administered to gauge patient experience with electronic medical record-based telemedicine visits. Results: Participants noted several advantages of telemedicine visits over traditional in-office visits: shorter visits, saving money, and avoiding potential exposure during the pandemic. Thirty-six percent of the patients agreed that the quality of care was hindered by the lack of a physical exam, and 61.7% of the patients agreed that they prefer a face-to-face visit rather than telemedicine consultation. Most patients were satisfied with the care they received via telemedicine (Likert 6.19/7), and 95.8% of the patients would use telemedicine again. Participants self-reported an average saving of $108.70 when using telemedicine. When comparing the telemedicine cohort to the in-office control, the telemedicine patients noted an improved ability to communicate with their physician in 5 out of 8 domains of the MCCS. Conclusion: Surgical preoperative consultation, postoperative follow-up, and routine visits were conducted via telemedicine during the COVID-19 pandemic, representing a new direction for surgical appointments and consultations. This study shows that telehealth provides satisfactory care and increases access to surgical care for patients when external factors prevent the traditional physician–patient interaction. With better-perceived communication via telemedicine appointments, patients may subjectively feel that they can express their symptoms and gather information from the doctor regarding their diagnosis more efficiently.

scholarly journals COVID-19 pandemic and uro-oncology follow-up: A “virtual” multidisciplinary team strategy and patients’ satisfaction assessment

2020 ◽  
Vol 92 (2) ◽  
Author(s):  
Francesca Ambrosini ◽  
Andrea Di Stasio ◽  
Guglielmo Mantica ◽  
Barbara Cavallone ◽  
Armando Serao
Keyword(s):  
Multidisciplinary Team ◽  
Care Delivery ◽  
Post Discharge ◽  
Face To Face ◽  
Patients Satisfaction ◽  
Containment Measures ◽  
Long Term Impact ◽  
Disease Diffusion

COVID-19 pandemic strongly modified the organizations of our clinical practice. Strict containment measures have been adopted to limit the disease diffusion. In particular, hospital face-to-face post discharge and follow up visits have been reduced. Although cancelling or deferring appointments seems to be a pragmatic approach, this solution may have a devasting long-term impact on health medical care and on patients. In this context, telemedicine and remote consultations may have the potential to provide healthcare minimizing virus exposure. In this paper we describe how Multidisciplinary team (MDT) reorganized genitourinary cancer care delivery at our Institute (AO SS Antonio e Biagio e Cesare Arrigo, Alessandria), taking advantage of telematic means. Furthermore, we present our preliminary results regarding patients’ satisfaction.

Action Plans as Active Boundary Objects

2021 ◽  
Vol 31 (4) ◽  
pp. 382-389
Author(s):  
Anne-Marie Tyroll Beck ◽  
Bo Morthorst Rasmussen ◽  
Tina K. Harlev Nielsen
Keyword(s):  
Social Worker ◽  
Interprofessional Collaboration ◽  
Boundary Objects ◽  
Boundary Object ◽  
Action Plans ◽  
Ideal Types ◽  
Face To Face ◽  
The Social ◽  
Service Areas

This article presents how action plans are used as active boundary objects in the meeting between the client, the social worker, and the interprofessional partners within the four core social service areas in Denmark: children and families, handicap, adults at risk, and employment. Empirically, the article is based upon the analysis of 16 action plans and 21 interviews. The theory of boundary objects is applied to illustrate and explore how action plans can create integration across different social and professional domains, or worlds. The degree of integration is illustrated through the theory of interprofessional collaboration, which forms the basis of four ideal types of action plans as boundary objects: the joint plan, the professional one, the administrative one, and the symbolic plan. We find that action plans have a large but often unexploited potential as an active and effective boundary object and only a few functions as joint plans. In order to be an active boundary object, both user and interprofessional involvement are required in making the plans. This requires a highly structured and preferably systematic involvement in face-to-face dialogue meetings led by the social worker as well as frequent follow-up at a distance.

A Qualitative Examination of User Perceptions of User-Driven and App-Controlled Hearing Technologies

2019 ◽  
Vol 28 (4) ◽  
pp. 993-1005 ◽  
Author(s):  
Gitte Keidser ◽  
Nicole Matthews ◽  
Elizabeth Convery
Keyword(s):  
Hearing Aids ◽  
Care Delivery ◽  
Hearing Aid ◽  
New Technology ◽  
Successful Implementation ◽  
Semistructured Interview ◽  
User Perceptions ◽  
Template Analysis ◽  
Training And Support ◽  
And Training

Purpose The aim of this study was to examine how hearing aid candidates perceive user-driven and app-controlled hearing aids and the effect these concepts have on traditional hearing health care delivery. Method Eleven adults (3 women, 8 men), recruited among 60 participants who had completed a research study evaluating an app-controlled, self-fitting hearing aid for 12 weeks, participated in a semistructured interview. Participants were over 55 years of age and had varied experience with hearing aids and smartphones. A template analysis was applied to data. Results Five themes emerged from the interviews: (a) prerequisites to the successful implementation of user-driven and app-controlled technologies, (b) benefits and advantages of user-driven and app-controlled technologies, (c) barriers to the acceptance and use of user-driven and app-controlled technologies, (d) beliefs that age is a significant factor in how well people will adopt new technology, and (e) consequences that flow from the adoption of user-driven and app-controlled technologies. Specifically, suggested benefits of the technology included fostering empowerment and providing cheaper and more discrete options, while challenges included lack of technological self-efficacy among older adults. Training and support were emphasized as necessary for successful adaptation and were suggested to be a focus of audiologic services in the future. Conclusion User perceptions of user-driven and app-controlled hearing technologies challenge the audiologic profession to provide adequate support and training for use of the technology and manufacturers to make the technology more accessible to older people.

Psychopathology 8½ Years Post Parasuicide

Crisis ◽  
1999 ◽  
Vol 20 (3) ◽  
pp. 115-120 ◽  
Author(s):  
Stephen Curran ◽  
Michael Fitzgerald ◽  
Vincent T Greene
Keyword(s):  
Rating Scales ◽  
Psychiatric Morbidity ◽  
Parental Bonding ◽  
Social Maladjustment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Face To Face ◽  
Long Term Follow Up

There are few long-term follow-up studies of parasuicides incorporating face-to-face interviews. To date no study has evaluated the prevalence of psychiatric morbidity at long-term follow-up of parasuicides using diagnostic rating scales, nor has any study examined parental bonding issues in this population. We attempted a prospective follow-up of 85 parasuicide cases an average of 8½ years later. Psychiatric morbidity, social functioning, and recollections of the parenting style of their parents were assessed using the Clinical Interview Schedule, the Social Maladjustment Scale, and the Parental Bonding Instrument, respectively. Thirty-nine persons in total were interviewed, 19 of whom were well and 20 of whom had psychiatric morbidity. Five had died during the follow-up period, 3 by suicide. Migration, refusals, and untraceability were common. Parasuicide was associated with parental overprotection during childhood. Long-term outcome is poor, especially among those who engaged in repeated parasuicides.

Pendayagunaan Sampah Menjadi Produk Kerajinan

2017 ◽  
Vol 17 (1) ◽  
pp. 83
Author(s):  
Nur Fatoni ◽  
Rinaldy Imanuddin ◽  
Ahmad Ridho Darmawan
Keyword(s):  
Waste Management ◽  
Raw Materials ◽  
Economic Value ◽  
Waste Materials ◽  
Waste Collection ◽  
Garbage Disposal ◽  
Waste Separation ◽  
And Training

Waste management is still defined as limited to collection, transportation and garbage disposal. The follow-up of the meaning is the provision of facilities such as garbage bins, garbage trucks and waste collection land. Waste management has not included waste separation. Segregation of waste can minimize the amount of waste that must be discharged to the final place. Segregation of waste can supply recyclable raw materials and handicrafts made from garbage. The manufacture of handicraft products from garbage is still local and requires socialization and training. It is needed to increase the number of craftsmen and garbage absorption on the crafters. Through careful socialization and training, citizens' awareness of waste management becomes advanced by making handicrafts of economic value from waste materials.

Extended Routine Follow-up of Primary Uncomplicated Hip and Knee Arthroplasty is not Necessary

2019 ◽  
Vol 13 (1) ◽  
pp. 266-271
Author(s):  
Georgina Kakra Wartemberg ◽  
Thomas Goff ◽  
Simon Jones ◽  
James Newman
Keyword(s):  
Aseptic Loosening ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Cost Effective ◽  
Face To Face ◽  
Primary Surgery ◽  
Effective System ◽  
Knee Revision Surgery ◽  
Knee Revision

Aims: To create a more effective system to identify patients in need of revision surgery. Background: There are over 160,000 total hip and knee replacements performed per year in England and Wales. Currently, most trusts review patients for up to 10 years or more. When we consider the cost of prolonged reviews, we cannot justify the expenditure within a limited budget. Study Design & Methods: We reviewed all patients' notes that underwent primary hip and knee revision surgery at our institution, noting age, gender, symptoms at presentation, referral source, details of the surgery, reason for revision and follow up history from primary surgery. Results: There were 145 revision arthroplasties (60 THR and 85 TKR) that met our inclusion criteria. Within the hip arthroplasty group, indications for revision included aseptic loosening (37), dislocation (10), and infection (3), periprosthetic fracture, acetabular liner wear and implant failure. All thirty-seven patients with aseptic loosening presented with pain. Twenty-five were referred from general practice with new symptoms. The remaining were clinic follow-ups. The most common reason for knee revision was aseptic loosening (37), followed by infection (21) and then progressive osteoarthritis (8). Most were referred from GP as a new referral or were clinic follow-ups. All patients were symptomatic. Conclusion: All the patients that underwent revision arthroplasty were symptomatic. Rather than yearly follow up, we recommend a cost-effective system. We are implementing a 'non face-to-face' system. Patients would be directly sent a questionnaire and x-ray form. The radiographs and forms will be reviewed by an experienced arthroplasty surgeon. The concerning cases will be seen urgently in a face-to-face clinic.

What Matters to South African Bank Customers? A Case Study of four Main South African Banks

2015 ◽  
Vol 6 (1and2) ◽  
Author(s):  
Kingstone Mutsonziwa
Keyword(s):  
Customer Satisfaction ◽  
South African ◽  
Language Usage ◽  
Face To Face ◽  
Bank Resolution ◽  
African Context ◽  
Key Drivers ◽  
Investment Advice

This paper is a follow-up article based on the first article titled Customers speak for themselves: A case of Customer Satisfaction in the four Main South African Banks. Customer satisfaction within the banking industry is very important in the South African context. Although banks are trying their best to give their customers the best service, it is important to continuously measure customer satisfaction and identify service attributes that contribute to overall customer satisfaction for the banks. The data used in the analysis is based on a quantitative survey of 500 randomly selected customers in Pretoria, Johannesburg, Durban and Cape Town were interviewed using a face to face methodology. The key drivers of overall customer satisfaction based on regression analysis for the different banks were helpfulness and innovativeness (ABSA), helpfulness, innovativeness of the bank, resolution of problems and investment advice (FNB), language usage and friendliness of service consultants (Nedbank), innovativeness of the bank, investment advice and use of language (Standard bank). These attributes were important to the overall customer satisfaction and need to be closely monitored by the management of these banks.

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