scholarly journals Assimilation of Medical Appointment Scheduling Systems and Their Impact on the Accessibility of Primary Care: Mixed Methods Study

10.2196/30485 ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. e30485
Author(s):  
Guy Paré ◽  
Louis Raymond ◽  
Alexandre Castonguay ◽  
Antoine Grenier Ouimet ◽  
Marie-Claude Trudel
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Medical Care ◽  
Digital Health ◽  
Appointment Scheduling ◽  
Survey Study ◽  
Equation Modeling ◽  
Valuable Insight ◽  
Health Technologies ◽  
Medical Appointment

Background The COVID-19 pandemic has prompted the adoption of digital health technologies to maximize the accessibility of medical care in primary care settings. Medical appointment scheduling (MAS) systems are among the most essential technologies. Prior studies on MAS systems have taken either a user-oriented perspective, focusing on perceived outcomes such as patient satisfaction, or a technical perspective, focusing on optimizing medical scheduling algorithms. Less attention has been given to the extent to which family medicine practices have assimilated these systems into their daily operations and achieved impacts. Objective This study aimed to fill this gap and provide answers to the following questions: (1) to what extent have primary care practices assimilated MAS systems into their daily operations? (2) what are the impacts of assimilating MAS systems on the accessibility and availability of primary care? and (3) what are the organizational and managerial factors associated with greater assimilation of MAS systems in family medicine clinics? Methods A survey study targeting all family medicine clinics in Quebec, Canada, was conducted. The questionnaire was addressed to the individual responsible for managing medical schedules and appointments at these clinics. Following basic descriptive statistics, component-based structural equation modeling was used to empirically explore the causal paths implied in the conceptual framework. A cluster analysis was also performed to complement the causal analysis. As a final step, 6 experts in MAS systems were interviewed. Qualitative data were then coded and extracted using standard content analysis methods. Results A total of 70 valid questionnaires were collected and analyzed. A large majority of the surveyed clinics had implemented MAS systems, with an average use of 1 or 2 functionalities, mainly “automated appointment confirmation and reminders” and “online appointment confirmation, modification, or cancellation by the patient.” More extensive use of MAS systems appears to contribute to improved availability of medical care in these clinics, notwithstanding the effect of their application of advanced access principles. Also, greater integration of MAS systems into the clinic’s electronic medical record system led to more extensive use. Our study further indicated that smaller clinics were less likely to undertake such integration and therefore showed less availability of medical care for their patients. Finally, our findings indicated that those clinics that showed a greater adoption rate and that used the provincial MAS system tended to be the highest-performing ones in terms of accessibility and availability of care. Conclusions The main contribution of this study lies in the empirical demonstration that greater integration and assimilation of MAS systems in family medicine clinics lead to greater accessibility and availability of care for their patients and the general population. Valuable insight has also been provided on how to identify the clinics that would benefit most from such digital health solutions.

scholarly journals Assimilation of Medical Appointment Scheduling Systems and Their Impact on the Accessibility of Primary Care: Mixed Methods Study (Preprint)

2021 ◽  
Author(s):  
Guy Paré ◽  
Louis Raymond ◽  
Alexandre Castonguay ◽  
Antoine Grenier Ouimet ◽  
Marie-Claude Trudel
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Medical Care ◽  
Digital Health ◽  
Appointment Scheduling ◽  
Survey Study ◽  
Equation Modeling ◽  
Valuable Insight ◽  
Health Technologies ◽  
Medical Appointment

BACKGROUND The COVID-19 pandemic has prompted the adoption of digital health technologies to maximize the accessibility of medical care in primary care settings. Medical appointment scheduling (MAS) systems are among the most essential technologies. Prior studies on MAS systems have taken either a user-oriented perspective, focusing on perceived outcomes such as patient satisfaction, or a technical perspective, focusing on optimizing medical scheduling algorithms. Less attention has been given to the extent to which family medicine practices have assimilated these systems into their daily operations and achieved impacts. OBJECTIVE This study aimed to fill this gap and provide answers to the following questions: (1) to what extent have primary care practices assimilated MAS systems into their daily operations? (2) what are the impacts of assimilating MAS systems on the accessibility and availability of primary care? and (3) what are the organizational and managerial factors associated with greater assimilation of MAS systems in family medicine clinics? METHODS A survey study targeting all family medicine clinics in Quebec, Canada, was conducted. The questionnaire was addressed to the individual responsible for managing medical schedules and appointments at these clinics. Following basic descriptive statistics, component-based structural equation modeling was used to empirically explore the causal paths implied in the conceptual framework. A cluster analysis was also performed to complement the causal analysis. As a final step, 6 experts in MAS systems were interviewed. Qualitative data were then coded and extracted using standard content analysis methods. RESULTS A total of 70 valid questionnaires were collected and analyzed. A large majority of the surveyed clinics had implemented MAS systems, with an average use of 1 or 2 functionalities, mainly “automated appointment confirmation and reminders” and “online appointment confirmation, modification, or cancellation by the patient.” More extensive use of MAS systems appears to contribute to improved availability of medical care in these clinics, notwithstanding the effect of their application of advanced access principles. Also, greater integration of MAS systems into the clinic’s electronic medical record system led to more extensive use. Our study further indicated that smaller clinics were less likely to undertake such integration and therefore showed less availability of medical care for their patients. Finally, our findings indicated that those clinics that showed a greater adoption rate and that used the provincial MAS system tended to be the highest-performing ones in terms of accessibility and availability of care. CONCLUSIONS The main contribution of this study lies in the empirical demonstration that greater integration and assimilation of MAS systems in family medicine clinics lead to greater accessibility and availability of care for their patients and the general population. Valuable insight has also been provided on how to identify the clinics that would benefit most from such digital health solutions.

scholarly journals Revisiting the four core functions (4Cs) of primary care: operational definitions and complexities

2021 ◽  
Vol 22 ◽  
Author(s):  
Geronimo Jimenez ◽  
David Matchar ◽  
Gerald Choon Huat Koh ◽  
Shilpa Tyagi ◽  
Rianne M. J. J. van der Kleij ◽  
...  
Keyword(s):  
Primary Care ◽  
Digital Health ◽  
Descriptive Analysis ◽  
Community Based ◽  
Social Community ◽  
Health Technologies ◽  
Levels Of Care ◽  
Electronic Search ◽  
First Contact ◽  
Community Based Services

Abstract Background: The four primary care (PC) core functions (the ‘4Cs’, ie, first contact, comprehensiveness, coordination and continuity) are essential for good quality primary healthcare and their achievement leads to lower costs, less inequality and better population health. However, their broad definitions have led to variations in their assessment, in the innovations implemented to improve these functions and ultimately in their performance. Objectives: To update and operationalise the 4Cs’ definitions by using a literature review and analysis of enhancement strategies, and to identify innovations that may lead to their enhancement. Methods: Narrative, descriptive analysis of the 4Cs definitions, coming from PC international reports and organisations, to identify measurable features for each of these functions. Additionally, we performed an electronic search and analysis of enhancement strategies to improve these four Cs, to explore how the 4Cs inter-relate. Results: Specific operational elements for first contact include modality of contact, and conditions for which PC should be approached; for comprehensiveness, scope of services and spectrum of population needs; for coordination, links between PC and higher levels of care and social/community-based services, and workforce managing transitions and for continuity, type, level and context of continuity. Several innovations like enrolment, digital health technologies and new or enhanced PC provider’s roles, simultaneously influenced two or more of the 4Cs. Conclusion: Providing clear, well-defined operational elements for these 4Cs to measure their achievement and improve the way they function, and identifying the complex network of interactions among them, should contribute to the field in a way that supports efforts at practice innovation to optimise the processes and outcomes in PC.

Abstract P135: The Role Of Digital Health In The Management Of Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Onoriode Kesiena ◽  
Kofi Seffah ◽  
Navin Kumar ◽  
Eunice Hama
Keyword(s):  
Medication Adherence ◽  
Health Information ◽  
Digital Health ◽  
The Internet ◽  
Chi Square ◽  
Health Technologies ◽  
Medical Appointment ◽  
Use Of Technology ◽  
Use Of The Internet ◽  
Chi Square Analysis

Introduction: Digital health involves the use of technology to delivery health care. It is associated with improved clinical outcomes in various populations. We assessed its role in medication adherence in adults with hypertension. Methods: Data from the 2018 National Health Interview Survey data was used. We analyzed 8,224 respondents with hypertension representing about 69 million United States adults. The independent variables were: Use of the internet to (1) to look up health information (2) to fill a prescription and (3) to schedule a medical appointment and use of an email (4) to communicate with a healthcare provider. The dependent variable was anti-hypertensive medication adherence. Chi-square analysis was used to identify group differences and a logistic regression was used to analyze the association between digital health utilization and anti-hypertensive medication adherence. Results: Of the study population, 7,387/8,224 (89.8%) of the respondents reported adherence to anti-hypertensive medications. Those who were adherent were predominantly > 65 years of age, 4141/7387 (47.8%) and earned > $75,000/yearly, 580/2581 (25.2%). The use of internet to look up health information as compared to those who do not, was associated with 30% reduced odds of medication adherence [OR 0.71, 95% CI 0.59, 0.86, p=<.001]. However, this was insignificant after adjusting for covariates [AOR 0.92, 95% CI 0.89, 1.22, p=0.551]. Using the internet to fill up prescription as compared to those who do not, was associated with 47% odds of medication adherence [OR 1.47, CI 1.14,1.90, p=0.003]. This odd increased further after adjusting for covariates [AOR 1.95, CI 1.37,2.78, p=<.001]. No significant association was found in the relationship between medication adherence and scheduling a medical appointment with the internet or communicating with a provider via email even after adjusting for covariates. Conclusion: Increase adherence to anti-hypertensive medications is associated with online refill of prescriptions. This means that the use of digital health technologies in hypertensive populations can lead to better health outcomes. Future studies should evaluate other aspects of digital health use in hypertensive populations.

scholarly journals Digital Health Tools and Patients With Drug Use Disorders: Qualitative Patient Experience Study of the Electronic Case-Finding and Help Assessment Tool (eCHAT) (Preprint)

2020 ◽  
Author(s):  
Melinda Ada Choy ◽  
Elizabeth Sturgiss ◽  
Felicity Goodyear-Smith ◽  
Gavin JD Smith
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Family Medicine ◽  
Drug Use ◽  
Focus Group ◽  
Assessment Tool ◽  
Digital Health ◽  
Case Finding ◽  
Patient Centered ◽  
Drug Use Disorders

BACKGROUND One of the promises of digital health is to better engage patients and improve care for vulnerable populations. Patients with drug use disorders are a vulnerable population who often do not receive the care they need, both for their drug use disorders as well as their other health care needs. Appropriate primary care for patients with drug use disorders needs to be patient-centered, holistic, highly accessible, and engaging. The electronic Case-finding and Help Assessment Tool (eCHAT) was designed as a patient-centered tool for the identification and measurement of problematic health behaviors and mood states. OBJECTIVE The aim of this study was to explore the patient experience of eCHAT at an Australian family medicine clinic for patients with drug use disorders. METHODS A total of 12 semistructured interviews were conducted with patients, two interviews were conducted with doctors, and one focus group was conducted with patient advocates who were former patients of the clinic where the study took place. The transcripts were analyzed using inductive thematic analysis. RESULTS The key themes identified from the interviews and the focus group were as follows: (1) eCHAT helped reduce stigma related to drug use in the doctor-patient consultation, (2) restricted answer options impacted the ability of patients to tell their stories, (3) patient-related response factors, (4) increased efficiency in the consultation process, and (5) divergence in level of concern around security and privacy. CONCLUSIONS eCHAT has the potential to help vulnerable patients in primary care to engage more with their doctors and reduce experiences of stigma. eCHAT may be a useful digital health intervention in a family medicine clinic for patients with drug use disorders. It has the potential to improve patient engagement and access to health care, which are crucial areas of need in this vulnerable population. However, it is important to clearly communicate the privacy risk of digital health tools and to implement eCHAT such that it will add value to, rather than displace, in-person consultations with the family doctor.

Understanding Decision Making in the Adoption of Digital Health Technology: The Role of Behavioural Economics’ Prospect Theory (Preprint)

2021 ◽  
Author(s):  
Waqas Ullah Khan ◽  
Aviv Shachak ◽  
Emily Seto
Keyword(s):  
Decision Making ◽  
Prospect Theory ◽  
Digital Health ◽  
Health Technology ◽  
Behavioural Economics ◽  
Valuable Insight ◽  
Individual Level ◽  
Health Technologies ◽  
The Individual

UNSTRUCTURED The decision to accept or reject new digital health technologies remains an ongoing discussion. Over the past few decades, interest in understanding the choice to adopt technology has led to the development of numerous theories and models. In 1979, however, psychologists Kahneman and Tversky published their seminal research article that has pioneered the field of behavioural economics. They named their model the “prospect theory” and used it to explain decision making behaviours under conditions of risk and uncertainty as well as to provide an understanding of why individuals may make irrational or inconsistent decisions. Although the prospect theory has been used to explain decision making in economics, law, political science, and clinically at the individual level, its application to understanding choice in the adoption of digital health technology has not been explored. Herein, we discuss how the prospect theory can provide valuable insight on why healthcare patients/clients, technology companies, and policymakers may decide to accept or reject digital health technologies.

scholarly journals Nonadversarially Driven Toxicities

2021 ◽  
pp. 104-124
Author(s):  
Eric D. Perakslis ◽  
Martin Stanley
Keyword(s):  
Life Support ◽  
Digital Health ◽  
Self Care ◽  
Appointment Scheduling ◽  
The Internet ◽  
Medical Conditions ◽  
Medical Appointment ◽  
Medical Terms ◽  
Widespread Availability

The Internet and digital health tools have brought us the convenience of online medical appointment scheduling, quick access to definitions of medical terms, and many other conveniences and capabilities, but these are not without concurrent risks of harm. Widespread availability of self-care tools has the potential for overdiagnosis and overtreatment. Fixation upon potential medical conditions has led to increased cyberchondria; and convenience, when taken to far, can drive risky practices and overdependence on tools that are meant to aid in care but not intended to be reliable life support. In this chapter we examine the five nonadversarially driven toxicities of digital health in order to understand how human frailty, habit, and bias may exacerbate the risks of otherwise harmless and helpful digital health aids.

scholarly journals Digital Health Tools and Patients With Drug Use Disorders: Qualitative Patient Experience Study of the Electronic Case-Finding and Help Assessment Tool (eCHAT)

10.2196/19256 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e19256
Author(s):  
Melinda Ada Choy ◽  
Elizabeth Sturgiss ◽  
Felicity Goodyear-Smith ◽  
Gavin JD Smith
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Family Medicine ◽  
Drug Use ◽  
Focus Group ◽  
Assessment Tool ◽  
Digital Health ◽  
Case Finding ◽  
Patient Centered ◽  
Drug Use Disorders

Background One of the promises of digital health is to better engage patients and improve care for vulnerable populations. Patients with drug use disorders are a vulnerable population who often do not receive the care they need, both for their drug use disorders as well as their other health care needs. Appropriate primary care for patients with drug use disorders needs to be patient-centered, holistic, highly accessible, and engaging. The electronic Case-finding and Help Assessment Tool (eCHAT) was designed as a patient-centered tool for the identification and measurement of problematic health behaviors and mood states. Objective The aim of this study was to explore the patient experience of eCHAT at an Australian family medicine clinic for patients with drug use disorders. Methods A total of 12 semistructured interviews were conducted with patients, two interviews were conducted with doctors, and one focus group was conducted with patient advocates who were former patients of the clinic where the study took place. The transcripts were analyzed using inductive thematic analysis. Results The key themes identified from the interviews and the focus group were as follows: (1) eCHAT helped reduce stigma related to drug use in the doctor-patient consultation, (2) restricted answer options impacted the ability of patients to tell their stories, (3) patient-related response factors, (4) increased efficiency in the consultation process, and (5) divergence in level of concern around security and privacy. Conclusions eCHAT has the potential to help vulnerable patients in primary care to engage more with their doctors and reduce experiences of stigma. eCHAT may be a useful digital health intervention in a family medicine clinic for patients with drug use disorders. It has the potential to improve patient engagement and access to health care, which are crucial areas of need in this vulnerable population. However, it is important to clearly communicate the privacy risk of digital health tools and to implement eCHAT such that it will add value to, rather than displace, in-person consultations with the family doctor.

scholarly journals The role of health technologies in primary care interventions: A systematic review (Preprint)

2020 ◽  
Author(s):  
Geronimo Jimenez ◽  
David Matchar ◽  
Gerald Koh Choon Huat ◽  
MJJ Rianne van der Kleij ◽  
Niels H. Chavannes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Digital Health ◽  
Grey Literature ◽  
Chronically Ill ◽  
Prescribing Practices ◽  
Health Technologies ◽  
Monitoring Technologies ◽  
Multicomponent Interventions

BACKGROUND Several countries around the world have implemented multicomponent interventions to enhance primary care (PC), as a way of strengthening their health systems to cope with an ageing, chronically ill population, and rising costs. Some of these efforts have included technology-based enhancements as one of their features to support the overall intervention, but their details and impact have not been explored. OBJECTIVE To identify the role of digital/health technologies within wider, multi-feature interventions aimed at enhancing PC, and to describe the type of technologies used, aim and stakeholder, and potential impacts. METHODS A systematic review was performed, following Cochrane guidelines. An electronic search, supplemented with manual and grey literature searches, was conducted to identify multicomponent interventions which included at least one technology-based enhancement. After title/abstract and full text screening, selected articles were assessed for quality based on their study design. A descriptive, narrative synthesis was used for analysis and presentation of results. RESULTS Fourteen out of 37 articles (38%) described the inclusion of a technology-based innovation, as part of their multicomponent interventions to enhance PC. The most common identified technologies were the use of electronic health records, data monitoring technologies and online portals with messaging platforms. The most common aim of these technologies was to improve continuity of care and comprehensiveness, which resulted in increased patient satisfaction, increased PC visits compared to specialist visits, and the provision of more health prevention education and improved prescribing practices. Technologies seem also to increase costs and utilization for some parameters, such as increased consultation costs and increased number of drugs prescribed. CONCLUSIONS Technologies and digital health have not played a major role within comprehensive innovation efforts aimed at enhancing PC, reflecting that these technologies have not yet reached maturity or wider acceptance as a means for improving PC. Stronger policy and financial support is needed, as well as the advocacy of key stakeholders, to encourage the introduction of efficient technological innovations, backed by evidence-based research, so that digital technologies can fulfill the promise of supporting a strong, sustainable primary care.

scholarly journals Mental Health Patients’ Expectations about the Non-Medical Care They Receive in Primary Care: A Cross-Sectional Descriptive Study

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 235
Author(s):  
Valle Coronado-Vázquez ◽  
Dolores Museros-Sos ◽  
Bárbara Oliván-Blázquez ◽  
Rosa Magallón-Botaya ◽  
Juan Gómez-Salgado ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Medical Care ◽  
Household Income ◽  
World Health ◽  
Survey Study ◽  
Cross Sectional ◽  
Mental Health Patients ◽  
Health Organization ◽  
Middle Class People

A health system’s responsiveness is the result of patient expectations for the non-medical care they receive. The objective of this study was to assess mental patients’ responsiveness to the health system in primary care, as related to the domains of dignity, autonomy, confidentiality, and communication. Data were collected from 215 people over the age of 18 with mental disorders, using the Multi-Country Survey Study (MCSS) developed by the World Health Organization. Of them, 95% reported a good experience regarding the dignity, confidentiality, communication, and autonomy domains. Regarding responsiveness, patients valued the dignity domain as the most important one (25.1%). Among the patients who experienced poor confidentiality, five out of seven earned less than 900 euros per month (Χ2 = 10.8, p = 0.004). Among those who experienced good autonomy, 85 out of 156 belonged to the working social class (90.4%), and among those who valued it as poor (16.1%), the highest proportion was for middle class people (Χ2 = 13.1, p = 0.028). The two students and 87.5% of retirees experienced this dimension as good, and most patients who valued it as poor were unemployed (43.5%) (Χ2 = 13.0, p = 0.011). Patients with a household income higher than 900 euros more frequently valued responsiveness as good, regarding those domains related to communication, with OR = 3.84, 95% CI = 1.05–14.09, and confidentiality, with OR = 10.48, 95% CI = 1.94–56.59. To conclude, as regards responsiveness in primary care, the dignity domain always obtained the best scores by people with mental disorders. Low economic income is related to a poor assessment of confidentiality. Working class patients, students, and retirees value autonomy as good.

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