scholarly journals Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review

10.2196/13042 ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. e13042 ◽  
Author(s):  
Freda Mold ◽  
Jane Hendy ◽  
Yi-Ling Lai ◽  
Simon de Lusignan
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Care ◽  
The United States ◽  
Care Staff ◽  
Cochrane Library ◽  
Small Scale ◽  
Care Providers ◽  
Long Term Conditions ◽  
Electronic Consultation

Background Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. Objective This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. Methods A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. Results This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. Conclusions E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.

scholarly journals Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Freda Mold ◽  
Jane Hendy ◽  
Yi-Ling Lai ◽  
Simon de Lusignan
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Care ◽  
The United States ◽  
Care Staff ◽  
Cochrane Library ◽  
Small Scale ◽  
Care Providers ◽  
Long Term Conditions ◽  
Electronic Consultation

BACKGROUND Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. OBJECTIVE This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. METHODS A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. RESULTS This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. CONCLUSIONS E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.

scholarly journals A Systematic Review of the Discrimination Against Sexual and Gender Minority in Health Care Settings

2019 ◽  
Vol 50 (1) ◽  
pp. 44-61 ◽  
Author(s):  
Cemile Hurrem Balik Ayhan ◽  
Hülya Bilgin ◽  
Ozgu Tekin Uluman ◽  
Ozge Sukut ◽  
Sevil Yilmaz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Care Providers ◽  
Care Staff ◽  
Cochrane Library ◽  
Care Providers ◽  
Health Care Settings ◽  
Gender Minority ◽  
Sexual And Gender Minority ◽  
And Gender

The present systematic review aimed to determine discrimination experiences of sexual and gender minority (SGM) individuals and attitudes toward SGM among health care staff in health care settings. Following PRISMA guidelines, the review was conducted in 3 databases (PubMed, Cochrane Library, Science Direct) using keywords of sexual and gender minority, including “gay,” “lesbian,” “bisexual,” “transgender,” “LGB,” “LGBT,” “health care discrimination,” “stigma,” “homophobia,” “transphobia,” and “attitudes of healthcare professionals” from May to September 2016. Predetermined inclusion criteria were selected. Thirty quantitative studies were eligible for inclusion in this review. Discriminative behaviors experienced by SGM individuals were stigma, denial or refusal of health care, and verbal or physical abuse. Knowledge and educational levels, beliefs, and religion of health care providers affected their attitudes toward SGM patients and their homophobia level. These findings revealed that health care providers needed more education about SGM issues, and SGM-friendly policies should be created for improving health care for SGM individuals.

scholarly journals Patient Suffering in Chronic Digestive Diseases: Will Primary Care-Specialist Collaboration With Effective Interactive Communication and Integrative Medicine in the Plan of Care Improve Quality of Life?

2020 ◽  
Vol 7 (6) ◽  
pp. 989-993
Author(s):  
Andrew Thomas ◽  
Annie Thomas
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
The United States ◽  
Care Providers ◽  
Physician Visits ◽  
Digestive Diseases ◽  
Care Specialist

Acute and chronic digestive diseases are causing increased burden to patients and are increasing the United States health care spending. The purpose of this case report was to present how nonconfirmatory and conflicting diagnoses led to increased burden and suffering for a patient thus affecting quality of life. There were many physician visits and multiple tests performed on the patient. However, the primary care physician and specialists could not reach a confirmatory diagnosis. The treatment plans did not offer relief of symptoms, and the patient continues to experience digestive symptoms, enduring this burden for over 2 years. The central theme of this paper is to inform health care providers the importance of utilizing evidence-based primary care specialist collaboration models for better digestive disease outcomes. Consistent with patient’s experience, the authors propose to pilot/adopt the integrative health care approaches that are proven effective for treating digestive diseases.

Is the Far West Mental Health Integration Project Making a Difference? The General Practitioner Perspective

2005 ◽  
Vol 11 (3) ◽  
pp. 32 ◽  
Author(s):  
David Perkins ◽  
David Lyle
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Care Providers ◽  
Care Staff ◽  
Care Providers ◽  
Community Based ◽  
Mental Health Integration ◽  
Integration Project ◽  
The Impact

This paper reports on the evaluation of an Australian Government and NSW State funded Mental Health Integration Project in remote far western NSW. The project was part of the Mental Health Integration Program, developed from the Second National Mental Health Plan. The project implemented a model of community-based mental health services and used innovative financing arrangements to allow the provision of community-based specialist mental health teams to remote communities and to recruit visiting psychiatrists to support the local primary care providers. The evaluation strategy included a survey of general practitioners (GPs) in the Upper Western Sector and Broken Hill, designed to investigate their level and type of contact with psychiatrists and community-based specialist mental health care teams, their perceptions about the impact of the new services, and their interest in further professional development in mental health care.The project has shown that visiting specialists can be deployed in a primary care setting with a focus on meeting the needs of local GPs, primary health care staff and their patients.

scholarly journals Protocol for a Systematic Review of the Effectiveness of Provider-targeted Interventions to Improve Opioid Prescribing in Primary Care

2021 ◽  
Author(s):  
Pallavi Prathivadi ◽  
Natalie Connell ◽  
Louisa Picco ◽  
Karleen F Giannitrapani ◽  
Hong-nei Wong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Primary Care Providers ◽  
Cochrane Library ◽  
Narrative Synthesis ◽  
Care Providers ◽  
Strict Adherence ◽  
Targeted Interventions ◽  
Opioid Prescribing ◽  
Wide Range

Abstract Background: Improving primary care opioid prescribing is a public health priority in many western nations. Governments, policymakers and key stakeholders are intervening on multiple levels to address patient, prescriber and systems factors contributing to opioid over-prescription in primary care. Many opioid prescribing interventions specifically target primary care providers (PCPs); however, the overall effectiveness of these interventions is not known. Identifying effective components of PCP-targeted behaviour change interventions may help inform scalability and translation of prescribing interventions across countries and varying primary healthcare settings. The aim of this systematic review is to assess the effectiveness of provider-targeted interventions to improve opioid prescribing in primary care. This protocol reports the methods of the proposed narrative synthesis review that will be guided by the Theoretical Domains Framework (TDF). Methods: The study will follow Cochrane methods for conducting a narrative synthesis. Reporting is compliant with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocols. The review will conduct searches in PubMed, EMBASE, PsychInfo, CINAHL, and the Cochrane Library databases for studies published in the English language from 2010 onwards. Reference lists of accepted articles will be also screened for additional studies meeting inclusion. Any opioid prescribing behaviour will be measured as an outcome. Intervention components will be mapped to domains of the TDF. No geographic limits will be applied. All stages of screening and data extraction will involve a dual review with gold standard adjudication. The Cochrane Risk of Bias tool will be used to evaluate quality and risk. Discussion: This review is being conducted in strict adherence to Cochrane principles. The protocol was submitted for registration to Prospero prior to publication for transparency and to avoid duplication of research. Formal ethics approval is not required for this research. The findings of this review will inform the delivery and implementation of PCP targeted opioid prescribing interventions. Findings will be disseminated to a wide range of stakeholders involved in quality improvement, prescribing interventions, education and training; professional groups, policymakers, researchers and PCPs.Systematic review registration: Submitted to Prospero 22 December 2020; pending registration

scholarly journals Management of High-Need, High-Cost Patients: A “Best Fit” Framework Synthesis, Realist Review, and Systematic Review

2021 ◽  
Author(s):  
Nancy D. Berkman ◽  
Eva Chang ◽  
Julie Seibert ◽  
Rania Ali ◽  
Deborah Porterfield ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Realist Review ◽  
Healthcare Services ◽  
The United States ◽  
System Level ◽  
Care Providers ◽  
Healthcare Use ◽  
Best Fit ◽  
Best Fit Framework Synthesis

Background. In the United States, patients referred to as high-need, high-cost (HNHC) constitute a very small percentage of the patient population but account for a disproportionally high level of healthcare use and cost. Payers, health systems, and providers would like to improve the quality of care and health outcomes for HNHC patients and reduce their costly use of potentially preventable or modifiable healthcare services, including emergency department (ED) and hospital visits. Methods. We assessed evidence of criteria that identify HNHC patients (best fit framework synthesis); developed program theories on the relationship among contexts, mechanisms, and outcomes of interventions intended to change HNHC patient behaviors (realist review); and assessed the effectiveness of interventions (systematic review). We searched databases, gray literature, and other sources for evidence available from January 1, 2000, to March 4, 2021. We included quantitative and qualitative studies of HNHC patients (high healthcare use or cost) age 18 and over who received intervention services in a variety of settings. Results. We included 110 studies (117 articles). Consistent with our best fit framework, characteristics associated with HNHC include patient chronic clinical conditions, behavioral health factors including depression and substance use disorder, and social risk factors including homelessness and poverty. We also identified prior healthcare use and race as important predictors. We found limited evidence of approaches for distinguishing potentially preventable or modifiable high use from all high use. To understand how and why interventions work, we developed three program theories in our realist review that explain (1) targeting HNHC patients, (2) engaging HNHC patients, and (3) engaging care providers in these interventions. Theories identify the need for individualizing and tailoring services for HNHC patients and the importance of building trusting relationships. For our systematic review, we categorized evidence based on primary setting. We found that ED-, primary care–, and home-based care models result in reduced use of healthcare services (moderate to low strength of evidence [SOE]); ED, ambulatory intensive caring unit, and primary care-based models result in reduced costs (low SOE); and system-level transformation and telephonic/mail models do not result in changes in use or costs (low SOE). Conclusions. Patient characteristics can be used to identify patients who are potentially HNHC. Evidence focusing specifically on potentially preventable or modifiable high use was limited. Based on our program theories, we conclude that individualized and tailored patient engagement and resources to support care providers are critical to the success of interventions. Although we found evidence of intervention effectiveness in relation to cost and use, the studies identified in this review reported little information for determining why individual programs work, for whom, and when.

‘Have you ever traded sex for money or drugs?’ Health care providers’ perspectives on sex trafficking risk assessments in clinics

2021 ◽  
pp. 135581962199747
Author(s):  
Lara Gerassi ◽  
Anna Pederson
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Sex Trafficking ◽  
Health Care Organization ◽  
The United States ◽  
Care Staff ◽  
Risk Assessments ◽  
Care Organization ◽  
Care Providers

Objective The United States’ Institute of Medicine recommends that health care providers be aware of sex trafficking (ST) indicators and conduct risk assessments to identify people at risk. However, the challenges among those who conduct such assessments remain largely understudied. The aim of this study was to understand the perceived barriers to ST risk assessment among health care providers in a large health care organization. Methods This study used a collective case study approach in five sites of a large health care organization that serves high-risk populations in a Midwestern state. Twenty-three in-depth, semi-structured interviews were conducted with health care staff (e.g. medical assistants, nurse practitioners). Two research team members conducted independent deductive coding (e.g. knowledge of ST), and inductive coding to analyse emerging themes (e.g. responses to ST risk or commercial sex disclosures, provider role ambiguity). Results Although staff routinely screened by asking ‘Have you ever traded sex for money or drugs?’, participants primarily described avoiding further discussions of ST with adult patients because they (1) aimed to be non-judgmental, (2) viewed following up as someone else’s job, and/or (3) lacked confidence to address ST concerns themselves, particularly when differentiating sex work from ST. Differences all emerged based on clinical context (e.g. urban location). Conclusions There may be missed opportunities to assess patients for ST risk and use harm-reduction strategies or safety plan to address patients’ needs. Implications for practice, policy, and future research are discussed.

scholarly journals A systematic review of peer mentoring interventions for people with traumatic brain injury

2016 ◽  
Vol 31 (8) ◽  
pp. 1030-1038 ◽  
Author(s):  
Richard PG Morris ◽  
Joanna C Fletcher-Smith ◽  
Kathryn A Radford
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Peer Mentoring ◽  
Grey Literature ◽  
The United States ◽  
Activity Level ◽  
Cochrane Library ◽  
Small Scale ◽  
Author Citations

Objective: This systematic review sought evidence concerning the effectiveness of peer mentoring for people with traumatic brain injury. Data sources: Fourteen electronic databases were searched, including PsycINFO, MEDLINE, CINAHL, EMBASE and the Cochrane Library, from inception to September 21 2016. Ten grey literature databases, PROSPERO, two trials registers, reference lists and author citations were also searched. Review methods: Studies which employed a model of one-to-one peer mentoring between traumatic brain injury survivors were included. Two reviewers independently screened all titles and abstracts before screening full texts of shortlisted studies. A third reviewer resolved disagreements. Two reviewers independently extracted data and assessed studies for quality and risk of bias. Results: The search returned 753 records, including one identified through hand searching. 495 records remained after removal of duplicates and 459 were excluded after screening. Full texts were assessed for the remaining 36 studies and six met the inclusion criteria. All were conducted in the United States between 1996 and 2012 and employed a variety of designs including two randomised controlled trials. A total of 288 people with traumatic brain injury participated in the studies. No significant improvements in social activity level or social network size were found, but significant improvements were shown in areas including behavioural control, mood, coping and quality of life. Conclusion: There is limited evidence for the effectiveness of peer mentoring after traumatic brain injury. The available evidence comes from small-scale studies, of variable quality, without detailed information on the content of sessions or the ‘active ingredient’ of the interventions.

scholarly journals Primary Care Opportunities to Prevent Unintentional Home Injuries: A Focus on Children and Older Adults

2016 ◽  
Vol 12 (2) ◽  
pp. 96-106 ◽  
Author(s):  
Eileen M. McDonald ◽  
Karin Mack ◽  
Wendy C. Shields ◽  
Robin P. Lee ◽  
Andrea C. Gielen
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Injury Prevention ◽  
Health Care Providers ◽  
Public Health Problem ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Clinical Environment ◽  
Home Injuries

Unintentional injuries are a persistent public health problem in the United States. A new health care landscape has the potential to create a clinical environment that fosters greater involvement by health care providers in injury prevention. The aim of this article is to provide evidence supporting the need for engagement by primary care providers in unintentional home injury prevention along with examples of how this could be accomplished. We know a great deal about what population groups are at risk for certain types of injuries. We also know that many injuries can be prevented through policies, programs, and resources that ensure safe environments and promote safe behaviors. For example, the Centers for Disease Control and Prevention’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative comprises clinical decision support tools and educational materials for health care providers. Two effective interventions that have demonstrated a reduction in falls among children are the redesign of baby walkers (engineering) and the mandated use of window guards (enforcement). Primary care clinicians can play a key role in promoting their patient’s safety. Taken collectively, a focused attention on preventing unintentional home injuries by primary care providers can contribute to the reduction of injuries and result in optimal health for all.

scholarly journals Delayed or failure to follow-up abnormal breast cancer screening mammograms in primary care: a systematic review

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jeanette C. Reece ◽  
Eleanor F. G. Neal ◽  
Peter Nguyen ◽  
Jennifer G. McIntosh ◽  
Jon D. Emery
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Primary Care Providers ◽  
The United States ◽  
Cochrane Library ◽  
Care Providers ◽  
Screening Mammograms

Abstract Background Successful breast cancer screening relies on timely follow-up of abnormal mammograms. Delayed or failure to follow-up abnormal mammograms undermines the potential benefits of screening and is associated with poorer outcomes. However, a comprehensive review of inadequate follow-up of abnormal mammograms in primary care has not previously been reported in the literature. This review could identify modifiable factors that influence follow-up, which if addressed, may lead to improved follow-up and patient outcomes. Methods A systematic literature review to determine the extent of inadequate follow-up of abnormal screening mammograms in primary care and identify factors impacting on follow-up was conducted. Relevant studies published between 1 January, 1990 and 29 October, 2020 were identified by searching MEDLINE®, Embase, CINAHL® and Cochrane Library, including reference and citation checking. Joanna Briggs Institute Critical Appraisal Checklists were used to assess the risk of bias of included studies according to study design. Results Eighteen publications reporting on 17 studies met inclusion criteria; 16 quantitative and two qualitative studies. All studies were conducted in the United States, except one study from the Netherlands. Failure to follow-up abnormal screening mammograms within 3 and at 6 months ranged from 7.2–33% and 27.3–71.6%, respectively. Women of ethnic minority and lower education attainment were more likely to have inadequate follow-up. Factors influencing follow-up included physician-patient miscommunication, information overload created by automated alerts, the absence of adequate retrieval systems to access patient’s results and a lack of coordination of patient records. Logistical barriers to follow-up included inconvenient clinic hours and inconsistent primary care providers. Patient navigation and case management with increased patient education and counselling by physicians was demonstrated to improve follow-up. Conclusions Follow-up of abnormal mammograms in primary care is suboptimal. However, interventions addressing amendable factors that negatively impact on follow-up have the potential to improve follow-up, especially for populations of women at risk of inadequate follow-up.

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