Impact of a Telemedicine Program on the Reduction in the Emission of Atmospheric Pollutants and Journeys by Road

This retrospective study evaluates the effect of a telemedicine program developed in the central Catalan region in lowering the environmental footprint by reducing the emission of atmospheric pollutants, thanks to a reduction in the number of hospital visits involving journeys by road. Between January 2018 and June 2019, a total of 12,322 referrals were made to telemedicine services in the primary care centers, avoiding a total of 9034 face-to-face visits. In total, the distance saved was 192,682 km, with a total travel time saving of 3779 h and a total fuel reduction of 11,754 L with an associated cost of €15,664. This represents an average reduction of 3248.3 g of carbon dioxide, 4.05 g of carbon monoxide, 4.86 g of nitric oxide and 3.2 g of sulphur dioxide. This study confirms that telemedicine reduces the environmental impact of atmospheric pollutants emitted by vehicles by reducing the number of journeys made for face-to-face visits, and thus contributing to environmental sustainability.

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Impact of a Telemedicine Program on the Reduction in the Emission of Atmospheric Pollutants and Journeys by Road

10.20944/preprints201910.0043.v1 ◽

2019 ◽

Author(s):

Josep Vidal-Alaball ◽

Jordi Franch-Parella ◽

Francesc Lopez Segui ◽

Francesc Garcia Cuyàs ◽

Jacobo Mendioroz Peña

Keyword(s):

Nitric Oxide ◽

Environmental Sustainability ◽

Atmospheric Pollutants ◽

Fuel Reduction ◽

Environmental Footprint ◽

Face To Face ◽

Travel Time Savings ◽

Total Travel Time ◽

Time Savings ◽

Hospital Visits

This retrospective study evaluates the effect of a telemedicine program developed in the central Catalan region in lowering the environmental footprint by reducing the emission of atmospheric pollutants thanks to a reduction in the number of hospital visits involving journeys by road. Between January 2018 and June 2019 a total of 12,322 referrals were made to telemedicine services in the primary care centers, avoiding a total of 9,034 face-to-face visits. In total, the distance saved was 192,682 km, with a total travel time savings of 3,779 hours and a total fuel reduction of 11,754 liters with an associated cost of €15,664. This represents an average reduction of 3,248.3 g of carbon dioxide, 4.05 g of carbon monoxide, 4.86 g of nitric oxide and 3.2 g of sulphur dioxide. This study confirms that telemedicine reduces the environmental impact of atmospheric pollutants emitted by vehicles, reducing the number of journeys made for face-to-face visits and can contribute to environmental sustainability.

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Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care

British Journal of General Practice ◽

10.3399/bjgp19x704141 ◽

2019 ◽

Vol 69 (686) ◽

pp. e586-e594 ◽

Cited By ~ 65

Author(s):

Eddie Donaghy ◽

Helen Atherton ◽

Victoria Hammersley ◽

Hannah McNeilly ◽

Annemieke Bikker ◽

...

Keyword(s):

Primary Care ◽

Visual Cues ◽

Mental Health Problems ◽

Structured Interviews ◽

Time Saving ◽

Technical Problems ◽

Work Demand ◽

Face To Face ◽

Visual Component ◽

Primary Care Clinicians

BackgroundPeople increasingly communicate online, using visual communication mediums such as Skype and FaceTime. Growing demands on primary care services mean that new ways of providing patient care are being considered. Video consultation (VC) over the internet is one such mode.AimTo explore patients’ and clinicians’ experiences of VC.Design and settingSemi-structured interviews in UK primary care.MethodPrimary care clinicians were provided with VC equipment. They invited patients requiring a follow-up consultation to an online VC using the Attend Anywhere web-based platform. Participating patients required a smartphone, tablet, or video-enabled computer. Following VCs, semi-structured interviews were conducted with patients (n = 21) and primary care clinicians (n = 13), followed by a thematic analysis.ResultsParticipants reported positive experiences of VC, and stated that VC was particularly helpful for them as working people and people with mobility or mental health problems. VCs were considered superior to telephone consultations in providing visual cues and reassurance, building rapport, and improving communication. Technical problems, however, were common. Clinicians felt, for routine use, VCs must be more reliable and seamlessly integrated with appointment systems, which would require upgrading of current NHS IT systems.ConclusionThe visual component of VCs offers distinct advantages over telephone consultations. When integrated with current systems VCs can provide a time-saving alternative to face-to-face consultations when formal physical examination is not required, especially for people who work. Demand for VC services in primary care is likely to rise, but improved technical infrastructure is required to allow VC to become routine. However, for complex or sensitive problems face-to-face consultations remain preferable.

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A qualitative exploration of patients’ experiences, needs and expectations regarding online access to their primary care record

BMJ Open ◽

10.1136/bmjopen-2020-044221 ◽

2021 ◽

Vol 11 (3) ◽

pp. e044221

Author(s):

Brian McMillan ◽

Gail Davidge ◽

Lindsey Brown ◽

Moira Lyons ◽

Helen Atherton ◽

...

Keyword(s):

Primary Care ◽

Focus Groups ◽

Negative Consequences ◽

Face To Face ◽

Primary Care Record ◽

Online Access ◽

Additional Support ◽

The Uk ◽

Records Access ◽

Qualitative Exploration

ObjectivesPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need.DesignFocus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach.SettingFocus groups and interviews were conducted in community settings in the UK.ParticipantsFifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else.ResultsParticipants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated.ConclusionsDiscussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.

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Administrative Work and Job Role Beliefs in Primary Care Physicians: An Analysis of Semi-Structured Interviews

SAGE Open ◽

10.1177/2158244019899092 ◽

2020 ◽

Vol 10 (1) ◽

pp. 215824401989909

Author(s):

Eric Apaydin

Keyword(s):

Primary Care ◽

Los Angeles ◽

Primary Care Physicians ◽

Theory Approach ◽

Structured Interviews ◽

Job Roles ◽

Face To Face ◽

Administrative Work ◽

Job Role ◽

The Relationship

Primary care physicians face increasing amounts of administrative work (e.g., entering notes into electronic health records, managing insurance issues, delivering test results, etc.) outside of face-to-face patient visits. The objective of this study is to qualitatively describe the experience that primary care physicians have with administrative work, with an emphasis on their beliefs about their job role. I conducted semi-structured interviews with 28 family physicians and internists in Chicago, Los Angeles, and Miami and qualitatively analyzed themes from interview transcripts using the grounded theory approach. Two major themes concerning the relationship between primary care physicians and administrative work were discovered: (a) Administrative work was not central to primary care physicians’ job role beliefs, and (b) “below license” work should be delegated to nonphysicians. Job roles should be considered in future efforts to reduce physician administrative work in primary care.

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COVID-19 Pandemic: The Urgent Dental Hub experience from a primary care perspective

Primary Dental Journal ◽

10.1177/20501684211033391 ◽

2021 ◽

Vol 10 (3) ◽

pp. 41-45

Author(s):

Zohaib Khwaja ◽

Awais Ali ◽

Manraj Rai

Keyword(s):

Public Health ◽

Primary Care ◽

Dental Care ◽

Specialist Care ◽

Health Message ◽

Face To Face ◽

General Dental Practitioner ◽

Public Health Message ◽

The Uk

In response to the nationwide lockdown on 23 March 2020 in the UK, urgent dental hubs (UDHs) were established in the community to provide emergency dental care. Consecutive referrals to a primary care UDH were prospectively analysed over a one-month period, from 18 May 2020 to 18 June 2020. Of 400 referrals received, the most common were in relation to pain (87%). In 63% neither a radiograph nor photograph was provided with the referral. Seventy percent of patients were telephone triaged within 24 hours of receipt of referral. Fifty-three percent of referrals were accepted for face-to-face treatment, of which 69% were treated by extraction. Of rejected referrals (n=179; 45%), 79% were due to symptoms having settled or being manageable by the time of triage. A small number of referrals were redirected for specialist care. Referrals that were accepted were more likely to have been prescribed antibiotics and less likely to have been referred by the general dental practitioner (GDP) they regularly saw (p <0.01). Patients that were older and those that identified themselves as not having a regular GDP were less likely to have been referred to an UDH. The quality of referrals was poor and there may be a role for virtual consultations moving forwards. We found pre-referral antimicrobial prescriptions were high and a confused public health message may have been sent.

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Factors affecting general practitioners’ choice of drug therapy: A study in primary healthcare in Iceland

Læknablaðið ◽

10.17992/lbl.2021.11.660 ◽

2021 ◽

Vol 107 (11) ◽

pp. 522-527

Author(s):

Yrsa Ívarsdóttir ◽

◽

Jón Steinar Jónsson ◽

Kristján Linnet ◽

Anna Bryndís Blöndal ◽

...

Keyword(s):

Primary Care ◽

Decision Making ◽

Drug Interaction ◽

Drug Therapy ◽

Primary Care Physicians ◽

New Drugs ◽

Factors Affecting ◽

Face To Face ◽

Software Information ◽

Strongly Agree

Introduction: This study aimed to analyse several factors that influence the decision-making of primary care physicians in Iceland in their choice of drug therapy for their patients. Also, to find which factors can act as a hindrance in making the best choices. Finally, to analyse which elements could be most important in facilitating decisions. Material and methods: A questionnaire was sent by e-mail to physicians working in primary care in Iceland. The questionnaire comprised closed questions, open text boxes, and ranking questions. The data was processed and analysed using Microsoft Excel. Results: The total number of primary care physicians who responded to the questionnaire was 93, a response rate of 40.7% of all the primary care physicians. The results reveal that physicians working in primary care consider clinical guidelines, the Icelandic National Formulary, and personal experience to be the most important factors when choosing a medication. Primary care physicians strongly agree that the lack of drug interaction software connected to medical records is a shortcoming. The most important factors that need improvement to facilitate primary care physicians' decision-making are drug formularies and interaction software. Conclusion: The results suggest some factors that support physicians in primary care in making decisions when choosing drug therapy, such as a drug formulary, drug interaction software, information about patients’ drug therapy, variable length in face-to-face consultations, evidence based information on new drugs, and counselling provided by clinical pharmacists.

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Concordance studies of a web based system in teledermatology.

Colombia Medica ◽

10.25100/cm.v40i3.654 ◽

1969 ◽

Vol 40 (3) ◽

pp. 259-270

Author(s):

Carlos Ruiz ◽

Claudia Gaviria ◽

Miguel Gaitán ◽

Rubén Manrique ◽

Ángela Zuluaga ◽

...

Keyword(s):

Primary Care ◽

Health Information ◽

User Satisfaction ◽

Diagnostic Reliability ◽

Web Based ◽

Face To Face ◽

A Priority ◽

Web Based System ◽

The Web

Introduction: Implementation of teledermatology in primary care offers the possibility of treating patients using specific dermatologic knowledge in far away places with infrequent availability to these services. It is a priority to implement teledermatology services which demonstrate diagnostic reliability and satisfaction among users. Objectives and methods: To measure the diagnostic reliability of an asynchronous teledermatology web based application by means of intraobserver and interobserver concordance during teleconsultation and traditional presential («face to face») consultation. Furthermore, to evaluate user satisfaction regarding the teleconsultation and the web application.Results: A sample of 82 patients with 172 dermatologic diagnoses was obtained, in which an intraobserver concordance between 80.8% and 86.6%, and an interobserver concordance between 77.3% and 79.6% were found. Satisfaction was evaluated to be on an average of 92.5%.Conclusions: The teleconsultation reliability in teledermatology is evidenced to be high, and is susceptible of improvement through the implementation of health information standards and digital dermatologic photography protocols.

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Performance of a new symptom checker in patient triage: Canadian cohort study

PLoS ONE ◽

10.1371/journal.pone.0260696 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260696

Author(s):

Forson Chan ◽

Simon Lai ◽

Marcus Pieterman ◽

Lisa Richardson ◽

Amanda Singh ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Emergency Departments ◽

Prospective Cohort ◽

Simulated Patients ◽

Medical Issues ◽

Care Seek ◽

Hospital Patients ◽

Hospital Visits ◽

Hospital Emergency Departments

Background Computerized algorithms known as symptom checkers aim to help patients decide what to do should they have a new medical concern. However, despite widespread implementation, most studies on symptom checkers have involved simulated patients. Only limited evidence currently exists about symptom checker safety or accuracy when used by real patients. We developed a new prototype symptom checker and assessed its safety and accuracy in a prospective cohort of patients presenting to primary care and emergency departments with new medical concerns. Method A prospective cohort study was done to assess the prototype’s performance. The cohort consisted of adult patients (≥16 years old) who presented to hospital emergency departments and family physician clinics. Primary outcomes were safety and accuracy of triage recommendations to seek hospital care, seek primary care, or manage symptoms at home. Results Data from 281 hospital patients and 300 clinic patients were collected and analyzed. Sensitivity to emergencies was 100% (10/10 encounters). Sensitivity to urgencies was 90% (73/81) and 97% (34/35) for hospital and primary care patients, respectively. The prototype was significantly more accurate than patients at triage (73% versus 58%, p<0.01). Compliance with triage recommendations in this cohort using this iteration of the symptom checker would have reduced hospital visits by 55% but cause potential harm in 2–3% from delay in care. Interpretation The prototype symptom checker was superior to patients in deciding the most appropriate treatment setting for medical issues. This symptom checker could reduce a significant number of unnecessary hospital visits, with accuracy and safety outcomes comparable to existing data on telephone triage.

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Primary care for patients with respiratory tract infection before and early on in the COVID-19 pandemic: an observational study in 16 European countries

BMJ Open ◽

10.1136/bmjopen-2021-049257 ◽

2021 ◽

Vol 11 (7) ◽

pp. e049257

Author(s):

Alike W van der Velden ◽

Eva A Bax ◽

Emily Bongard ◽

Rune Munck Aabenhus ◽

Marilena Anastasaki ◽

...

Keyword(s):

Primary Care ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Laboratory Testing ◽

Diagnostic Testing ◽

European Countries ◽

Fine Tuning ◽

Face To Face ◽

Degree Of Confidence

ObjectiveTo describe primary health care (consultation characteristics and management) for patients contacting their general practitioner (GP) with a respiratory tract infection (RTI) early on in the COVID-19 pandemic in contrasting European countries, with comparison to prepandemic findings.SettingPrimary care in 16 countries (79 practices), when no routine SARS-CoV-2 testing was generally available.Design and participantsBefore (n=4376) and early in the pandemic (n=3301), patients with RTI symptoms were registered in this prospective audit study.Outcome measuresConsultation characteristics (type of contact and use of PPE) and management characteristics (clinical assessments, diagnostic testing, prescribing, advice and referral) were registered. Differences in these characteristics between countries and between pandemic and prepandemic care are described.ResultsCare for patients with RTIs rapidly switched to telephone/video consultations (10% in Armenia, 91% in Denmark), and when consultations were face-to-face, GPs used PPE during 97% (95% CI 96% to 98%) of contacts. Laboratory testing for SARS-CoV-2 in primary care patients with RTIs was rapidly implemented in Denmark (59%) and Germany (31%), while overall testing for C reactive protein decreased. The proportion of patients prescribed antibiotics varied considerably between countries (3% in Belgium, 48% in UK) and was lower during the pandemic compared with the months before, except for Greece, Poland and UK. GPs provided frequent and varied COVID-related advice and more frequently scheduled a follow-up contact (50%, 95% CI 48% to 52%). GPs reported a slightly higher degree of confidence in the likely effectiveness of their management in face-to-face (73% (very) confident, 95% CI 71% to 76%) than in virtual consultations (69%, 95% CI 67% to 71%).ConclusionsDespite between-country variation in consultation characteristics, access to SARS-CoV-2 laboratory testing and medication prescribing, GPs reported a high degree of confidence in managing their patients with RTIs in the emerging pandemic. Insight in the highly variable pandemic responses, as measured in this multicountry audit, can aid in fine-tuning national action and in coordinating a pan-European response during future pandemic threats.

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Teleconsultations between Patients and Healthcare Professionals in Primary Care in Catalonia: the Evaluation of Text Classification Algorithms Using Machine Learning

10.20944/preprints201912.0220.v1 ◽

2019 ◽

Author(s):

Francesc López Seguí ◽

Ricardo Ander Egg Aguilar ◽

Gabriel de Maeztu ◽

Anna García-Altés ◽

Francesc García Cuyàs ◽

...

Keyword(s):

Machine Learning ◽

Primary Care ◽

Text Classification ◽

Learning Strategy ◽

Care Service ◽

Learning Algorithms ◽

Machine Learning Algorithms ◽

Face To Face ◽

Classification Tool ◽

The Impact

Background: the primary care service in Catalonia has operated an asynchronous teleconsulting service between GPs and patients since 2015 (eConsulta), which has generated some 500,000 messages. New developments in big data analysis tools, particularly those involving natural language, can be used to accurately and systematically evaluate the impact of the service. Objective: the study was intended to examine the predictive potential of eConsulta messages through different combinations of vector representation of text and machine learning algorithms and to evaluate their performance. Methodology: 20 machine learning algorithms (based on 5 types of algorithms and 4 text representation techniques)were trained using a sample of 3,559 messages (169,102 words) corresponding to 2,268 teleconsultations (1.57 messages per teleconsultation) in order to predict the three variables of interest (avoiding the need for a face-to-face visit, increased demand and type of use of the teleconsultation). The performance of the various combinations was measured in terms of precision, sensitivity, F-value and the ROC curve. Results: the best-trained algorithms are generally effective, proving themselves to be more robust when approximating the two binary variables "avoiding the need of a face-to-face visit" and "increased demand" (precision = 0.98 and 0.97, respectively) rather than the variable "type of query"(precision = 0.48). Conclusion: to the best of our knowledge, this study is the first to investigate a machine learning strategy for text classification using primary care teleconsultation datasets. The study illustrates the possible capacities of text analysis using artificial intelligence. The development of a robust text classification tool could be feasible by validating it with more data, making it potentially more useful for decision support for health professionals.

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