Development of an Interdisciplinary Electronic Consultation Platform in the Netherlands: a mixed methodes observational study. (Preprint)

2021 ◽  
Author(s):  
Sanne Sanavro ◽  
Henk van der Worp ◽  
Danielle Jansen ◽  
Paul Koning ◽  
Marco H Blanker
Keyword(s):  
Observational Study ◽  
Secondary Care ◽  
Knowledge Exchange ◽  
Interdisciplinary Approach ◽  
First Year ◽  
Patient Centered ◽  
Interactive Communication ◽  
Mean Response Time ◽  
Questions And Answers ◽  
To Receive

BACKGROUND Consultation between General Practitioners (GPs) and hospital specialists can be challenging due to mutual unavailability and lack of interactive communication tools. By contrast, team-based case collaboration on a patient-centered network of healthcare professionals could facilitate communication and knowledge transfer. A digital interactive platform was developed to support this new way of collaboration. OBJECTIVE Purpose. To describe the development of the digital consultation platform (PRISMA) to connect general GPs with hospital specialists via the Siilo application and to evaluate the first year of use, including consultations, topic diversity, and number of participating physicians. METHODS Methods. We conducted a mixed-methods observational study, analyzing qualitative and quantitative data for cases posted on the platform between June 2018 and May 2020. Any GP can post questions to an interdisciplinary group of secondary care specialists, with the platform designed to facilitate discussion and knowledge exchange for all users. RESULTS Results. In total, 3674 cases were posted by 424 GPs across 16 specialisms. Most questions and answers concerned diagnosis, non-medical treatment, and medication. Mean response time was 76 minutes (range, 44–252). An average of three users engaged with each case (up to seven specialists). Almost half of the internal medicine cases received responses from at least two specialisms in secondary care, contrasting with about one-fifth for dermatology. Of note, the growth in consultations was steepest for dermatology. CONCLUSIONS Conclusions. Digital consultations offer the possibility for GPs to receive quick responses when seeking advice. The interdisciplinary approach of PRISMA creates opportunities for digital patient-centered networking. CLINICALTRIAL none

scholarly journals Ethnicity and impact on the receipt of cognitive–behavioural therapy in people with psychosis or bipolar disorder: an English cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e034913
Author(s):  
Rohan Michael Morris ◽  
William Sellwood ◽  
Dawn Edge ◽  
Craig Colling ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cohort Study ◽  
Cognitive Behavioural Therapy ◽  
Secondary Care ◽  
Behavioural Therapy ◽  
Single Session ◽  
Black African ◽  
Cognitive Behavioural ◽  
Black Caribbean ◽  
To Receive

Objectives(1) To explore the role of ethnicity in receiving cognitive–behavioural therapy (CBT) for people with psychosis or bipolar disorder while adjusting for differences in risk profiles and symptom severity. (2) To assess whether context of treatment (inpatient vs community) impacts on the relationship between ethnicity and access to CBT.DesignCohort study of case register data from one catchment area (January 2007–July 2017).SettingA large secondary care provider serving an ethnically diverse population in London.ParticipantsData extracted for 30 497 records of people who had diagnoses of bipolar disorder (International Classification of Diseases (ICD) code F30-1) or psychosis (F20–F29 excluding F21). Exclusion criteria were: <15 years old, missing data and not self-defining as belonging to one of the larger ethnic groups. The sample (n=20 010) comprised the following ethnic groups: white British: n=10 393; Black Caribbean: n=5481; Black African: n=2817; Irish: n=570; and ‘South Asian’ people (consisting of Indian, Pakistani and Bangladeshi people): n=749.Outcome assessmentsORs for receipt of CBT (single session or full course) as determined via multivariable logistic regression analyses.ResultsIn models adjusted for risk and severity variables, in comparison with White British people; Black African people were less likely to receive a single session of CBT (OR 0.73, 95% CI 0.66 to 0.82, p<0.001); Black Caribbean people were less likely to receive a minimum of 16-sessions of CBT (OR 0.83, 95% CI 0.71 to 0.98, p=0.03); Black African and Black Caribbean people were significantly less likely to receive CBT while inpatients (respectively, OR 0.76, 95% CI 0.65 to 0.89, p=0.001; OR 0.83, 95% CI 0.73 to 0.94, p=0.003).ConclusionsThis study highlights disparity in receipt of CBT from a large provider of secondary care in London for Black African and Caribbean people and that the context of therapy (inpatient vs community settings) has a relationship with disparity in access to treatment.

Incidence of hypersensitivity reactions in patients on H1-receptor antagonists receiving oxaliplatin-based chemotherapy

2021 ◽  
pp. 107815522110039
Author(s):  
Christine Barrett ◽  
Seon Jo Park ◽  
Lindsay Edmondson ◽  
Dulabh Monga
Keyword(s):  
Observational Study ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Controlled Trials ◽  
Severe Reaction ◽  
Hypersensitivity Reactions ◽  
H1 Receptor ◽  
Receptor Antagonists ◽  
Randomized Controlled ◽  
To Receive

Objective This study determined the incidence of hypersensitivity reactions in patients receiving oxaliplatin-based chemotherapy while on H1-receptor antagonists (H1RAs). Prophylaxis for patients receiving oxaliplatin is not currently recommended. H1RAs are used for the treatment of reactions; however, prophylactic H1RAs have not been well-studied. Methods This retrospective chart review included patients with solid tumor malignancies who received H1RAs while on oxaliplatin-based chemotherapy between August 1, 2016 and October 31, 2019. Results Of fifty-one patients, there were four hypersensitivity reactions (8%), most of which were mild, occurred within 60 minutes of the start of the infusion, and did not result in an interruption in treatment. One severe reaction occurred, which required discontinuation of therapy. Forty-two patients (82%) were able to receive at least 9 cycles of oxaliplatin without a reported reaction. Conclusion In this observational study, the incidence rate of hypersensitivity reactions in patients receiving oxaliplatin while on H1RAs was lower than reported in previous literature. Most reactions were mild, and patients were able to continue oxaliplatin-based therapy. With future, randomized controlled trials, H1RAs may prove to be effective in preventing or delaying the onset of hypersensitivity reactions related to oxaliplatin.

scholarly journals The Patient Teacher in General Practice Training: Perspectives of Residents

2018 ◽  
Vol 6 (4) ◽  
pp. 287-295 ◽  
Author(s):  
Marie José Aires ◽  
Rémi Gagnayre ◽  
Olivia Gross ◽  
Cam-Anh Khau ◽  
Sophie Haghighi ◽  
...  
Keyword(s):  
General Practice ◽  
Medical Training ◽  
Teacher Characteristics ◽  
Teacher Participation ◽  
Patient Specific ◽  
First Year ◽  
Patient Centered ◽  
Agreement Rate ◽  
Specific Content ◽  
General Practice Training

Background: Patient teachers were involved in training general practice residents (GPRs) to strengthen the patient-centered approach. They teach a course on health democracy by themselves and teach in tandem with a physician teacher during reflective practice-based classes (named GEPRIs). We present the GPRs’ representations of patient teacher characteristics and capacities and their perception of how useful patient teachers are to their professional development. Methods: We administered a questionnaire based on a preliminary qualitative study to 124 GPRs. It explored (a) changes in the GPRs’ representations about patient teacher characteristics and capacities with regard to teaching over the first year of the experiment; (b) GPRs’ perception of patient teacher utility to their training and their contribution to developing patient perspective–related competencies. Results: The response rate was 89.5% (111/124). The majority of GPRs agreed with 17 (before) and 21 (after) of the 23 patient teacher characteristics and with 17 (before) and 19 (after) of the 20 capacities. The agreement rate increased, overall, after patient teacher participation. The GPRs found patient teacher useful to their training in 9 of 11 topics (agreement rate 65%-92%). They felt they had developed the 14 patient knowledge–related competencies (agreement rate 62%-93%), and 52% to 75% of the GPRs rated the patient teachers’ contribution to those competencies “high or very high,” depending on the competency. Conclusion: This study demonstrates the specific contribution of patient teachers to university-level medical training in France. The GPRs recognized that patient teachers helped them develop competencies by providing patient-specific content.

scholarly journals Empathy levels among first year Malaysian medical students: an observational study

2014 ◽  
pp. 149 ◽  
Author(s):  
Brett Williams ◽  
Sivalal Sadasivan ◽  
Amudha Kadirvelu ◽  
Alexander Olaussen
Keyword(s):  
Medical Students ◽  
Observational Study ◽  
First Year

scholarly journals The University Medical Centre: A student’s perspective

2021 ◽  
Author(s):  
Gabrielle Hubert ◽  
Cameron Pow ◽  
Sandra Tullio-Pow
Keyword(s):  
Primary Care ◽  
Healthcare Professionals ◽  
Care Physician ◽  
Medical Centre ◽  
First Year ◽  
Patient Centered ◽  
First Year Students ◽  
Centered Care ◽  
The University ◽  
University Setting

Over 515,000 students attended Ontario Universities in 2015/16, including 60,000 international students from abroad (https://ontario universityes.ca/resources/data/numbers). First-year students who are away from home find themselves needing a new primary care physician. While a few researchers have examined student health care within the university setting in regard to mental health (Evans, 1999), sexual health (Habel et al., 2018)., and health promotion (Griebler et al., 2017), there has been little research focused on the first-year student experience in finding primary care. Our study examined communication pathways, wayfinding and misconceptions students have related to the university medical centre. Patient centered care involves a partnership between a healthcare provider and their patient. In this partnership healthcare professionals must consider the patient experience and be more informative, mindful, empathic and collaborative to provide the best possible care (Epstein & Street, 2011).

scholarly journals A study to improve the quality of writing clinic letters to patients attending the outpatient clinic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S211-S211
Author(s):  
Irangani Mudiyanselage ◽  
Madhvi Belgamwar
Keyword(s):  
Outpatient Clinic ◽  
Standards Of Care ◽  
Multidisciplinary Teams ◽  
Patient Centered ◽  
Second Person ◽  
County Mental Health ◽  
Hospital Doctors ◽  
The Uk ◽  
To Receive

AimsIn many countries (including the UK and Australia) it is still common practice for hospital doctors to write letters to patients’ general practitioners (GPs) following outpatient consultations, and for patients to receive copies of these letters. However, experience suggests that hospital doctors who have changed their practice to include writing letters directly to patients have more patient centred consultations and experience smoother handovers with other members of their multidisciplinary teams. (Rayner et al, BMJ 2020)The aim of the study was to obtain patient's views to improve the quality of clinical letters sent to them, hence the level of communication and standards of care.MethodAn anonymous questionnaire was designed and posted to collect information from patients attending one of the South County Mental Health outpatient clinic in Derbyshire. 50 random patients were selected between March to November 2020. Patients were asked to provide suggestions to improve the quality of their clinic letters written directly to them and copies sent to their GPs.ResultOut of 50 patients 48% (n = 24) responded. Majority of patients (92%) expressed their wish to receive their clinic letters written directly to them and 79% preferred to be addressed as a second person in the letters. More than half (54%, N = 13) of them would like to have letter by post. Majority of them (92%, N = 22) wished to have their letter within a week of their consultations.Patients attending clinics felt that the communication could be better improved through writing clearly: a) reflection of what was discussed during the consultation b) updated diagnosis c) a clear follow-up plan d) current level of support e) medication change f) emergency contact numbers g) actions to be carried out by their GP and further referrals should there be any.ConclusionPatients in community prefer to have their clinic letters directly addressing them in second person. It was noted that the letters needed to reflect accurately on what was discussed during the consultation in order to have patient centered consultations. This in turn would improve communication and thus rapport, trust and overall therapeutic relationship.

scholarly journals NHS Hospital ‘Learning from Deaths’ reports: A qualitative and quantitative analysis of the first year of a countrywide patient safety programme

2020 ◽  
Author(s):  
Zoe Brummell ◽  
Cecilia Vindrola-Padros ◽  
Dorit Braun ◽  
S. Ramani Moonesinghe
Keyword(s):  
Patient Safety ◽  
Secondary Care ◽  
Secondary Data ◽  
Patient Safety Culture ◽  
Organisational Learning ◽  
First Year ◽  
Qualitative And Quantitative ◽  
Safety Programme ◽  
National Guidance ◽  
Common Learning

ABSTRACTIntroductionPotentially preventable deaths occur worldwide within healthcare organisations. Organisational learning from incidents is essential to improve quality of care. In England, inconsistencies in how NHS secondary care trusts reviewed, investigated and shared learning from deaths, resulted in the introduction of national guidance on ‘Learning from Deaths’ (LfDs) in 2017. This guidance provides a ‘framework for identifying, reporting, investigating and learning from deaths’. Amendments to NHS Quality Account regulations, legally require NHS trusts in England to report quantitative and qualitative information relating to patient deaths annually. The programme intended trusts would share this learning and take measurable action to prevent future deaths.MethodWe undertook qualitative and quantitative secondary data analysis of all NHS secondary care trust LfDs reports within their 2017/18 Quality Accounts, to review how organisations are using the LfDs programme to learn from and prevent, potentially preventable deaths.ResultsAll statutory elements of LfDs reporting were reported by 98 out of 222 (44%) trusts. The percentage of deaths judged more likely than not due to problems in healthcare was between 0% and 13%. The majority of trusts (89%) reported lessons learnt; the most common learning theme was poor communication. 106 out of 222 trusts (48%) have shared or plan to share the learning within their own organisation. The majority of trusts (86%) reported actions taken and 47% discussed or had a plan for assessment of impact. 37 out of 222 trusts (17%) mentioned involvement of bereaved families.ConclusionsThe wide variation in reporting demonstrates that some trusts have engaged fully with LfDs, while other trusts appear to have disengaged with the programme. This may reveal a disparity in organisational learning and patient safety culture which could result in inequity for bereaved families. Many themes identified from the LfD reports have previously been identified in national and international reports and inquiries. Further work is needed to strengthen the LfDs programme.

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