scholarly journals Orthopaedic provider perceptions of virtual care

2021 ◽  
Vol 2 (6) ◽  
pp. 405-410
Author(s):  
Nikhil R. Yedulla ◽  
Zachary A. Montgomery ◽  
Dylan S. Koolmees ◽  
Eric B. Battista ◽  
Charles S. Day
Keyword(s):  
Clinical Experience ◽  
Likert Scale ◽  
Provider Perceptions ◽  
Provider Perspectives ◽  
Virtual Care ◽  
Virtual Visits ◽  
Care Survey ◽  
Research Consortium ◽  
Strongly Agree

Aims The purpose of our study was to determine which groups of orthopaedic providers favour virtual care, and analyze overall orthopaedic provider perceptions of virtual care. We hypothesize that providers with less clinical experience will favour virtual care, and that orthopaedic providers overall will show increased preference for virtual care during the COVID-19 pandemic and decreased preference during non-pandemic circumstances. Methods An orthopaedic research consortium at an academic medical system developed a survey examining provider perspectives regarding orthopaedic virtual care. Survey items were scored on a 1 to 5 Likert scale (1 = “strongly disagree”, 5 = “strongly agree”) and compared using nonparametric Mann-Whitney U test. Results Providers with less experience were more likely to recommend virtual care for follow-up visits (3.61 on the Likert scale (SD 0.95) vs 2.90 (SD 1.23); p = 0.006) and feel that virtual care was essential to patient wellbeing (3.98 (SD 0.95) vs 3.00 (SD 1.16); p < 0.001) during the pandemic. Less experienced providers also viewed virtual visits as providing a similar level of care as in-person visits (2.41 (SD 1.02) vs 1.76 (SD 0.87); p = 0.006) and more time-efficient than in-person visits (3.07 (SD 1.19) vs 2.34 (SD 1.14); p = 0.012) in non-pandemic circumstances. During the pandemic, most providers viewed virtual care as effective in providing essential care (83.6%, n = 51) and wanted to schedule patients for virtual care follow-up (82.2%, n = 50); only 10.9% (n = 8) of providers preferred virtual visits in non-pandemic circumstances. Conclusion Orthopaedic providers with less clinical experience seem to favourably view virtual care both during the pandemic and under non-pandemic circumstances. Providers in general appear to view virtual care positively during the pandemic but are less accommodating towards it in non-pandemic circumstances. Cite this article: Bone Jt Open 2021;2(6):405–410.

scholarly journals Uptake and patient and provider communication modality preferences of virtual visits in primary care: a retrospective cohort study in Canada

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037064 ◽  
Author(s):  
Vess Stamenova ◽  
Payal Agarwal ◽  
Leah Kelley ◽  
Jamie Fujioka ◽  
Megan Nguyen ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Secure Messaging ◽  
Communication Modality ◽  
Care Services ◽  
Virtual Care ◽  
Virtual Visits

ObjectivesTo evaluate the uptake of a platform for virtual visits in primary care, examine patient and physician preferences for virtual communication methods and report on characteristics of visits and patients experience of care.DesignA retrospective cohort study.SettingPrimary care practices within five regions in Ontario, Canada after 18 months of access to virtual care services.Participants326 primary care providers and 14 291 registered patients.InterventionsProviders used a platform that allowed them to connect with their patients through synchronous (audio/video) and/or asynchronous (secure messaging) communication.Main outcome measuresUser-level data from the platforms including patient demographics, practice characteristics, communication modality used, visit characteristics and patients’ satisfaction.ResultsAmong the participants, 44% of registered patients and 60% of registered providers used the platform at least once. Among patient users, 51% completed at least one virtual visit. The majority of virtual visits (94%) involved secure messaging. The most common patient requests were for medication prescriptions (24%) and follow-up from previous appointment (22%). The most common provider request was to follow-up on test results (59%). Providers indicated that 81% of virtual visits required no follow-up for that issue and 99% of patients reported that they would use virtual care services again.ConclusionsWhile there are a growing number of primary care video visit services, our study found that both patients and providers in rostered practices prefer secure messaging over video. Despite fears that virtual visits would be overused by patients, when patients connected with their own primary care provider, many virtual visits appeared to replace in-person visits, and patients did not overwhelm physicians with requests. This approach may improve access and continuity in primary care.

Virtual vs traditional care settings for low-acuity urgent conditions: An economic analysis of cost and utilization using claims data

2019 ◽  
pp. 1357633X1986123
Author(s):  
Tim Lovell ◽  
Jordan Albritton ◽  
Joe Dalto ◽  
Cheryl Ledward ◽  
William Daines
Keyword(s):  
Primary Care ◽  
Emergency Care ◽  
Antibiotic Use ◽  
Cost Of Care ◽  
Urgent Care ◽  
Cross Sectional ◽  
Care Programme ◽  
Virtual Care ◽  
Virtual Visits

Background On-demand, direct-to-consumer video (or virtual) visits represent one of the fastest growing telemedicine services. Due to the absence of an in-person physical examination, some question the effectiveness, efficiency and value of virtual care visits. To address these questions, we conducted a retrospective, cross-sectional review of Intermountain Healthcare’s virtual care programme. Method This study used SelectHealth claims for virtual, urgent, primary and emergency care delivered between 1 April 2016–31 March 2017. We included all claims with primary diagnosis from the nine most common categories for virtual care. A secondary data source included survey data indicating how virtual visits redirect care. Results We matched 1531 virtual visit claims with claims from urgent (4377), primary (4388) and emergency care (2285). There were no differences in follow-up rates between virtual and urgent care and no differences in antibiotic use between virtual and urgent or primary care. Virtual care was significantly lower than all other care settings in utilization of laboratory and imaging services, index visit cost and total costs over 21 days. Conclusions This study affirmed lower cost for virtual care without an associated increase in overall follow-up rates or antibiotic use when compared with urgent or primary care. This suggests that virtual visits are can be used to lower the total cost of care for applicable conditions. The implications are that virtual visits help lower operational costs of providing care, particularly in integrated systems with capitated reimbursement. Under the right circumstances, the increased adoption of virtual care should lead to greater savings.

scholarly journals 41 Innovative solutions to support “Virtual First” pediatric endocrine care

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e30-e30
Author(s):  
Ellen Goldbloom ◽  
Sarah Lawrence
Keyword(s):  
Health Care ◽  
Care Delivery ◽  
Family Needs ◽  
Pediatric Endocrinology ◽  
High Quality ◽  
Virtual Care ◽  
Innovative Solutions ◽  
Virtual Visits ◽  
Endocrinology Clinic

Abstract Primary Subject area Endocrinology and Metabolism Background With the onset of the SARS-CoV-2 pandemic, health care providers everywhere were forced to rapidly shift the way they deliver care. Within our community-based academic organization, there was variability in response to required changes among different clinical areas, with many clinics ramping down their services while they restructured. In our pediatric endocrinology clinic, we had built the infrastructure to support virtual care using a provincial platform as part of a pilot program for our diabetes population in the year preceding the pandemic. This experience set the stage for a swift pivot to virtual care. To ensure ongoing high quality consultation and follow-up services during the pandemic, our clinic required rapid restructuring to successfully and immediately shift completely to a sustainable “virtual first” approach in March 2020. Objectives In the months following the onset of the SARS-CoV-2 pandemic, we sought to quickly develop and implement innovative strategies, using a quality improvement framework, to supplement virtual care and maintain high quality care delivery. Design/Methods As soon as physical distancing measures were implemented in March 2020, our multidisciplinary team held daily 30-minute meetings to troubleshoot, brainstorm, and strategize potential adaptations in care delivery to ensure we continued to meet patient and family needs with primarily virtual care. Barriers and problems were presented and prioritized, solutions proposed, then implemented with support of operation and e-health teams. Attention to educational needs for medical students, residents and fellows helped shape solutions. Results The following innovative solutions were successfully implemented within three months: • a drive thru hemoglobin A1C clinic for patients with diabetes • a streamlined “low touch” Auxology Clinic to supplement virtual visits when body measurement, vital signs or physical exam assessment were required • pre-visit preparation instructions for patients and families • active promotion of patient portal enrolment • re-design of follow-up orders content to allow providers to accurately indicate suitability of virtual care alone or with support measures • a workflow to allow quick conversion from in-person to virtual visits to prevent cancellations related to isolation requirements • an educational framework to ensure level-appropriate exposure to and involvement in patient care for trainees • auto-faxing of medication and supplies • printer mapping and workflow for external lab requisitions • provider/staff scheduling and role re-assignment to facilitate minimal number of on-site staff • support of the team to adopt best practices for virtual visits Conclusion While virtual care delivery existed before the pandemic, it was rarely used outside of pilot projects, or only from necessity, when travel to a health care facility was not possible. Herein we provide an overview of an innovative, primarily virtual, care delivery model to satisfy patient and family needs in a pediatric endocrinology clinic in an academic centre. Many components of our model have (and can be) applied or adapted to support care delivery in other clinical areas. The people, processes, and digital health adaptations required to support a primarily virtual mode of care were critical to its success.

scholarly journals Virtual Care in Rhinology

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Kristine A. Smith ◽  
Andrew Thamboo ◽  
Yvonne Chan ◽  
Christopher J. Chin ◽  
Megan Werger ◽  
...  
Keyword(s):  
Response Rate ◽  
Neck Surgery ◽  
Primary Objective ◽  
Nasal Endoscopy ◽  
History Taking ◽  
Foreseeable Future ◽  
Virtual Care ◽  
Virtual Visits

Abstract Background The SARS-CoV-2 (COVID) pandemic has resulted in an increase in virtual care. While some specialties are well suited to virtual care, Otolaryngology – Head and Neck Surgery could be limited due to reliance on physical examination and nasal endoscopy, including Rhinology. It is likely virtual care will remain integrated for the foreseeable future and it is important to determine the strengths and weaknesses of this treatment modality for rhinology. Methods A survey on virtual care in rhinology was distributed to 61 Canadian rhinologists. The primary objective was to determine how virtual care compared to in-person care in each area of a typical appointment. Other areas focused on platforms used to deliver virtual care and which patients could be appropriately assessed by virtual visits. Results 43 participants responded (response rate 70.5%). The majority of participants use the telephone as their primary platform. History taking and reviewing results (lab work, imaging) were reported to be equivalent in virtual care. Non-urgent follow up and new patients were thought to be the most appropriate for virtual care. The inability to perform exams and nasal endoscopy were reported to be significant limitations. Conclusion It is important to understand the strengths and limitations of virtual care. These results identify the perceived strengths and weaknesses of virtual care in rhinology, and will help rhinologists understand the role of virtual care in their practices. Graphical abstract

Evaluating Virtual Care Experiences for Patients with Covid-19 Chief Complaints: Best-Practices Recommendations (Preprint)

2020 ◽  
Author(s):  
Saif Khairat ◽  
Malvika Pillai ◽  
Barbara Edson ◽  
Robert Gianforcaro
Keyword(s):  
Patient Experience ◽  
Wait Time ◽  
Secondary Outcome ◽  
Major Drawback ◽  
Cross Sectional ◽  
Average Wait Time ◽  
Adherence To Medication ◽  
Virtual Care ◽  
Chief Complaints ◽  
Virtual Visits

BACKGROUND Importance: Positive patient experiences are associated with illness recovery and adherence to medication. The shift toward virtual visits creates a need to understand the opportunities and challenges in providing a patient experience that is at least as positive as in-person visits. OBJECTIVE To evaluate the virtual care experience for patients with Covid-19 as their chief complaints. METHODS We conducted a cross-sectional study of the first cohort of patients with Covid-19 concerns in a virtual clinic. We collected data on all virtual visits between March 20-29, 2020. Outcomes: The main endpoints of this study were patient diagnosis, prescriptions received, referrals, wait time and duration, and satisfaction. The secondary outcome was the reported choice of alternative care options. RESULTS Of the 358 total virtual visits, 42 patients marked “Covid-19 Concern” as their chief complaint. Of those patients, 23 (54.8%) female patients, the average age of patients was 33.9 years, and 41 (97.7%) patients were seeking care for themselves and one (3.3%) visit was for a dependent. For all virtual visits, the average wait time (SD) was 157.2 (181.7) minutes and the average wait time (SD) for Covid-19 Concern visits was 177.4 (186.5) minutes. Covid-19 Concern phone visits had an average wait time (SD) of 180.1 (187.2), compared to 63.4 (34.4) minutes for Covid-19 Concern video visits. Thirteen (65%) patients rated their provider as “Excellent” with similar proportions among phone (64.3%) and video (66.7%). CONCLUSIONS This study evaluated the virtual experiences of patients with Covid-19 concerns. There were different experiences for patients depending on their choice of communication. Long wait times were a major drawback in the patient experience. We have learned from evaluating the experience of our first cohort of Covid-19 Concern patients.

scholarly journals P071 Survey of rheumatology patient satisfaction with telephone consultations during the COVID-19 pandemic

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Mia Rodziewicz ◽  
Terence O'Neill ◽  
Audrey Low
Keyword(s):  
Patient Satisfaction ◽  
Physical Examination ◽  
Management Plan ◽  
Service Development ◽  
Telephone Consultation ◽  
Face To Face ◽  
Communication Difficulties ◽  
Strongly Agree ◽  
The Uk

Abstract Background/Aims  Rheumatology departments were required to switch rapidly from face-to-face (F2F) to remote consultations during the COVID-19 pandemic in the UK. We conducted a patient satisfaction survey on the switch to inform future service development. Methods  All patients [new (NP), follow-up (FU)] were identified between 1st to 5th June 2020. Patients who attended or did not attend (DNA) a pre-booked F2F consultation or cancelled were excluded. Of the remainder, half the patients was surveyed by phone using a standardised questionnaire and the other half was posted the same questionnaire. Both groups were offered the opportunity to complete the survey online. Patients were surveyed on the organisation and content of the consultation, whether they were offered a subsequent F2F appointment and future consultation preference. Results  233 consultations were scheduled during the study period. After 53 exclusions (34 pre-booked F2F, 16 DNA, 3 cancellations), 180 eligible consultations were surveyed (85 via mailshot, 95 by telephone). 75/180 patients (42%) responded within 1 month of the telephone consultation (20 NP, 47 FU, 8 missing). The organisation of the switch was positively perceived (Table). Patients were highly satisfied with 4 of the 5 consultation domains but were undecided whether a physical assessment would have changed the outcome of the consultation (Table). After the initial phone consultation, 7 of 20 NP and 19 of 47 FU were not offered subsequent F2F appointments at the clinicians’ discretion. Of those not offered subsequent F2F appointments, proportionally more NP (3/7, 43%) would have liked one, compared to FU (5/19, 26%). Reasons included communication difficulties and a desire for a definitive diagnosis. 48/75 (64%) would be happy for future routine FU to be conducted by phone “most of the time" or "always”; citing patient convenience and disease stability. Caveats were if physical examination was required or if more serious issues (as perceived by the patient) needed F2F discussion. Conclusion  Patients were generally satisfied with telephone consultations and most were happy to be reviewed again this way. NPs should be offered F2F appointments for first visits to maximise patient satisfaction and time efficiency. P071 Table 1:Median age, yearsFemale; n (%)Follow-up; n (%)All eligible for survey; n = 18056122 (68)133 (74)Sent mailshot; n = 855459 (69)65 (76)Surveyed by phone; n = 955663 (66)68 (72)Responder by mail; n = 166911 (69)13 (82)Responder by phone; n = 525437 (71)34 (65)Responder by e-survey; n = 7495 (71)UnknownOrganisation of the telephone consultation, N = 75Yes, n (%)No, n (%)Missing, n (%)Were you informed beforehand about the phone consultation?63 (84)11 (15)1 (1)Were you called within 1-2 hours of the appointed date and time?66 (88)6 (8)3 (4)Domains of the consultation, N = 75Strongly disagree, n (%)Disagree, n (%)Neutral, n (%)Agree, n (%)Strongly agree, n (%)Missing, n (%)During the call, I felt the clinician understood my problem3 (4)1 (1)1 (1)20 (27)49 (65)1 (1)During the call, I had the opportunity to ask questions regarding my clinical care1 (1)02 (3)16 (21)55 (73)1 (1)A physical examination would have changed the outcome of the consultation16 (21)18 (24)20 (27)11 (15)10 (13)0The clinician answered my questions to my satisfaction2 (3)06 (8)18 (24)49 (65)0At the end of the consultation, the clinician agreed a management plan with me3 (4)2 (3)6 (8)24 (32)39 (52)1 (1)Future consultations, N = 75Never, n (%)Sometimes, n (%)Most of the time, n (%)Always, n (%)Missing, n, (%)In the future, would you be happy for routine FU to be conducted by phone?5 (7)20 (27)16 (21)32 (43)2 (3) Disclosure  M. Rodziewicz: None. T. O'Neill: None. A. Low: None.

Simulation and analysis of the effects of room surface reflectance combinations on a proposed retrofit illumination system of an office

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Subarna Roy ◽  
Sudipta Majumder ◽  
Sourin Bhattacharya ◽  
Imran Hossain Sardar
Keyword(s):  
Likert Scale ◽  
Surface Reflectance ◽  
Survey Questionnaire ◽  
Content Type ◽  
Scale Type ◽  
Illumination System ◽  
Office Space ◽  
Strong Linear Correlation ◽  
Lighting Simulation ◽  
Strongly Agree

Purpose An indoor office space should not only provide adequate illuminance on horizontal planes but also cater to the physiological and psychological requirements of the occupants. This paper aims to describe a lighting simulation-based work conducted in Kolkata, India which modeled an indoor office to investigate the effects of variation in room surface reflectance combinations on user perception, mean room surface exitance (MRSE), average horizontal illuminance and overall uniformity of horizontal illuminance. Design/methodology/approach A fluorescent illumination system–based office space was modeled and retrofitted with tubular LED lamps in DIALux. Simulations were conducted for 16 different room surface reflectance combinations and a five-point Likert scale-type survey questionnaire was formulated to conduct a survey with 32 test subjects to assess the subjective preferability of each resultant light scene. Findings Simulation results demonstrate that the relationship between average horizontal illuminance and MRSE as well as between average horizontal illuminance and overall uniformity of horizontal illuminance, was statistically significant (p < 0.001). In the conducted survey, the resultant light scene arising out of the reflectance combination of wall:ceiling:floor = 60%:90%:20% was the most well-received one with 187 convinced agreements (“agree” and “strongly agree” responses). Originality/value This work found strong linear correlation between average horizontal illuminance and MRSE and between average horizontal illuminance and overall uniformity. A five-point Likert scale-type survey questionnaire with seven questions was formulated and validated with 32 test subjects (Cronbach’s alpha > 0.9295), which showed that the wall:ceiling:floor reflectance combination of 60%:90%:20% was the most favored choice.

Defect characterisations in the Malaysian affordable housing

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
AbdulLateef Olanrewaju ◽  
Yien Yen Tan ◽  
See Ning Soh
Keyword(s):  
Affordable Housing ◽  
Likert Scale ◽  
Housing Development ◽  
Median Income ◽  
Repair Work ◽  
Content Type ◽  
Remedial Actions ◽  
Bad Weather ◽  
Strongly Agree ◽  
Systemic Decision Making

PurposeThe successive Malaysian government aims to provide housing to households earning the median income and below. However, there has been continuous criticism and complaints from the media and literature on the magnitude of the defects in affordable housing. Therefore, this research has investigated the defects in affordable housing for the users’/occupants' perspectives.Design/methodology/approachWith a response rate of 69%, the research developed a questionnaire instrument that included twenty-one defects in buildings based on literature and observation. These were scored on a 5-point Likert scale ranging from very common to least common. Twelve causes of defects measured on a five-point scale were included in the survey. Thirteen additional items that had to do with remedial actions to reduce defects were included. These were scored on a 5-point Likert scale ranging from strongly agree to least agree. The survey forms were administered to all the 152 home occupants in a Program Perumahan Rakyat (PPR) housing estate through hand delivery in a northern state in Malaysia.FindingsThe data revealed that broken doors, damaged roofs, damp walls and broken tiles in rooms were the most common defects in the housing development. It was found that defects in the buildings were caused by poor workmanship, defective materials, poor designs and bad weather. Additionally, to rectify the defects, adequate supervision is required during maintenance, the repairs must be conducted on time and there is a need to have competent maintenance organisations. Through factor analysis, the 21 defects were structured into six factors, the 12 causes were grouped into 5 factors and the 13 remedial actions were grouped into 6 factors.Practical implicationsThe information on the nature, degree and kinds of defects from the users' perspectives will dictate when repair work is to be undertaken and allow future work to be programmed and financed as part of a maintenance rolling programme.Originality/valueThis research focused specifically on “Program Perumahan Rakyat” housing development. Furthermore, none of the previous research on defects conducted attempted to categorise the defects in the buildings. The categorisation is very important for systemic decision-making because there are continuous interactions amongst the defects, causes and remedial actions.

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