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

2019 ◽  
Vol 69 (686) ◽  
pp. e586-e594 ◽  
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.

scholarly journals Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care

2019 ◽  
Vol 69 (686) ◽  
pp. e595-e604 ◽  
Author(s):  
Victoria Hammersley ◽  
Eddie Donaghy ◽  
Richard Parker ◽  
Hannah McNeilly ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Technical Problems ◽  
Face To Face ◽  
Information Giving ◽  
Care Services ◽  
Primary Care Services ◽  
Quasi Experimental ◽  
Primary Care Clinicians

BackgroundGrowing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice.AimTo explore the content, quality, and patient experience of VC, telephone (TC), and FTFCs in general practice.Design and settingComparison of audio-recordings of follow-up consultations in UK primary care.MethodPrimary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet, or computer with camera. Clinicians invited patients requiring a follow-up consultation to choose a VC, TC, or FTFC. Consultations were audio-recorded and analysed for content and quality. Participant experience was explored in post-consultation questionnaires. Case notes were reviewed for NHS resource use.ResultsOf the recordings, 149/163 were suitable for analysis. VC recruits were younger, and more experienced in communicating online. FTFCs were longer than VCs (mean difference +3.7 minutes, 95% confidence interval [CI] = 2.1 to 5.2) or TCs (+4.1 minutes, 95% CI = 2.6 to 5.5). On average, patients raised fewer problems in VCs (mean 1.5, standard deviation [SD] 0.8) compared with FTFCs (mean 2.1, SD 1.1) and demonstrated fewer instances of information giving by clinicians and patients. FTFCs scored higher than VCs and TCs on consultation-quality items.ConclusionVC may be suitable for simple problems not requiring physical examination. VC, in terms of consultation length, content, and quality, appeared similar to TC. Both approaches appeared less ‘information rich’ than FTFC. Technical problems were common and, though patients really liked VC, infrastructure issues would need to be addressed before the technology and approach can be mainstreamed in primary care.

scholarly journals Feasibility, acceptability, and content of video consulting in primary care

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X702941
Author(s):  
Eddie Donaghy ◽  
Vicky Hammersley ◽  
Helen Atherton ◽  
Annemieke Bikker ◽  
Hannah Mcneilly ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Information Exchange ◽  
Mental Health Problems ◽  
Smart Device ◽  
Test Results ◽  
Health It ◽  
Technical Problems ◽  
Face To Face

BackgroundGovernment leaders have called for increased use of video-consulting (VC) in clinical practice. Although provided by the private sector, it is rarely used in NHS primary care. It is unclear how VC differs from telephone (TC) or face-to-face consulting (FTFC), or how useful clinicians and patients find it.AimTo assess the feasibility and acceptability to patients and clinicians of running a VC service in general practice and to explore differences in duration and content compared with FTFC and TC.MethodVC equipment was installed in six GP practices and 13 clinicians were asked to identify patients who required follow-up consultations and who had access to a smart-device or laptop. They were offered the choice of a VC, TC, or FTFC. Consultations were audiorecorded and content analysed using the RIAS system. Patient and clinician views were obtained by questionnaires and interviews.ResultsOne hundred and forty-seven patients were recruited (FTFC = 51, TC = 51, VC = 45). VC users were generally younger. VCs and TCs were shorter (mean VC 5.9, TC 5.6, FTFCs 9.6 minutes), addressed fewer problems (mean VC 1.5, TC 1.7, FTFC 2.0) and had less information exchange than FTFCs. Technical problems were common, but VCs offered significant advantages over TC in terms of non-verbal communication. VC was considered particularly useful to working and housebound people and for those with mental health problems.ConclusionVC has distinct advantages over TC. When integrated into current systems VC will provide an alternative to FTFC. Where formal physical examination is not required (discussing test results, medication changes and mental health) it offers considerable time savings to patients.

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

2019 ◽  
Vol 16 (22) ◽  
pp. 4366 ◽  
Author(s):  
Josep Vidal-Alaball ◽  
Jordi Franch-Parella ◽  
Francesc Lopez Seguí ◽  
Francesc Garcia Cuyàs ◽  
Jacobo Mendioroz Peña
Keyword(s):  
Nitric Oxide ◽  
Primary Care ◽  
Environmental Sustainability ◽  
Atmospheric Pollutants ◽  
Fuel Reduction ◽  
Environmental Footprint ◽  
Time Saving ◽  
Face To Face ◽  
Total Travel Time ◽  
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 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.

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

SAGE Open ◽  
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.

scholarly journals Provision of services in primary care for type 2 diabetes: a qualitative study with patients, GPs, and nurses in the East of England

2020 ◽  
Vol 70 (698) ◽  
pp. e668-e675
Author(s):  
Hajira Dambha-Miller ◽  
Simon J Griffin ◽  
Ann Louise Kinmonth ◽  
Jenni Burt
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Care Provision ◽  
Structured Interviews ◽  
High Quality ◽  
Face To Face ◽  
Healthcare Experiences ◽  
Provision Of Services ◽  
The Impact

BackgroundThere is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients, their GPs, and nurses.AimTo explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses.Design and settingA qualitative primary care interview study in the East of England.MethodSemi-structured interviews were conducted, between August 2017 and August 2018, with people who have type 2 diabetes along with their respective GPs and nurses. Purposive sampling was used to select for heterogeneity in glycaemic control and previous healthcare experiences. Interviews were audio-recorded and analysed thematically. The consolidated criteria for reporting qualitative research were followed.ResultsThe authors interviewed 24 patients and 15 GPs and nurses, identifying a changing landscape of diabetes provision owing to burgeoning pressures that were presented repeatedly. Patient responders wanted GP-delivered care with continuity. They saw GPs as experts best placed to support them in managing diabetes, but were increasingly receiving nurse-led care. Nurses reported providing most of the in-person care, while GPs remained accountable but increasingly distanced from face-to-face diabetes care provision. A reluctant acknowledgement surfaced among GPs, nurses, and their patients that only minimum care standards could be maintained, with aspirations for high-quality provision unlikely to be met.ConclusionType 2 diabetes is a tracer condition that reflects many aspects of primary care. Efforts to manage pressures have not been perceived favourably by patients and providers, despite some benefits. Reframing expectations of care, by communicating solutions to both patients and providers so that they are understood, managed, and realistic, may be one way forward.

Student paramedics' views on placements in general practice as part of a degree

2019 ◽  
Vol 11 (12) ◽  
pp. 519-525
Author(s):  
Alyesha Proctor
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Care Pathway ◽  
Structured Interviews ◽  
Learning And Development ◽  
Alternative Care ◽  
Face To Face ◽  
The Uk ◽  
University Degree

Background: Frontline paramedics are increasingly attending to non-emergency problems and calls that could be managed by a primary care provider. Alongside this, there is a growing pressure to manage patients at home or use an alternative care pathway and reduce hospital conveyance. Student paramedic training, including both placement and taught elements at university, should therefore reflect this. However, placement opportunities for student paramedics in primary care settings is variable across the UK. Aim: To explore student paramedics' views on incorporating a placement within general practice as part of their degree and its effects on their learning and development as an autonomous paramedic. Method: A small pedagogic study as part of a postgraduate certificate in academic practice for higher education, involving a case study, qualitative approach using face-to-face, semi-structured interviews and thematic analysis, was carried out. Findings: Student paramedics feel that incorporating a placement in general practice as part of their degree will significantly help in their learning and development as autonomous paramedics. Specifically, they feel it: will help them understand the role of the GP and what the GP expects of them; will help them to focus their assessments and improve confidence in decisions not to convey patients; may lead to better knowledge of alternative care pathways; and, finally, may provide an insight into the role of the paramedic in general practice as a future career opportunity. There are a few reservations about whether students would be able to use the skills and knowledge gained in this setting, as they feel they do not have access to the tools or the authority in a frontline ambulance service. Students would prefer to have a placement in a GP surgery in the final year of their university degree. Conclusion: Placement within a GP surgery for student paramedics should be included as part of a paramedic science degree as a priority. This is necessary, particularly given the changing role of the contemporary paramedic who attends to non-emergency problems.

Provider Views of the Feasibility and Utility of Lifestyle Obesity Treatment in Primary Care: Insights from the Think Health! Study

2015 ◽  
Vol 3 (1) ◽  
pp. 77 ◽  
Author(s):  
Etienne Phipps ◽  
Lisa Chacko ◽  
Jennifer Fassbender ◽  
Kelly Allison ◽  
David Sarwer ◽  
...  
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Obesity Treatment ◽  
Weight Loss Program ◽  
Health Study ◽  
Clinical Practices ◽  
Structured Interviews ◽  
Practice Based Research ◽  
Primary Care Clinicians ◽  
Post Hoc

Rationale:   Feasible approaches for providing obesity treatment in primary care settings have been difficult to identify. We assessed the views of primary care clinicians and practice staff about a simplified, lifestyle weight loss program after their participation in a randomized trial designed to evaluate the program within their clinical practices.  Methods: Post-hoc interviews were conducted with 13 clinicians and 12 auxiliary staff at the 5 participating practices in the Think Health! Study of weight management in primary care.  A 13-item survey was used to guide semi-structured interviews about the perceived strengths, weakness, and potential long-term utility of the program. Responses were analyzed using descriptive statistics and qualitative methods. Results:  Providers unanimously endorsed the need for weight loss counseling for their patients.  They supported the need for more frequent visits initially to best engage patients in a weight loss program.  Additional training in counseling skills was desired. Conclusion:  Clinicians participating in a practice- based trial valued having weight loss materials available to share with patients.  Offering patient materials that convey key content and structure for behavior change tasks while allowing provider discretion in how materials are integrated into patient care might be a viable option for testing in future practice-based research. 

scholarly journals Help Seeking and Access to Primary Care for People from “Hard-to-Reach” Groups with Common Mental Health Problems

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
K. Bristow ◽  
S. Edwards ◽  
E. Funnel ◽  
L. Fisher ◽  
L. Gask ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Help Seeking ◽  
Mental Health Problems ◽  
Health Problems ◽  
Structured Interviews ◽  
Care Givers ◽  
Common Mental Health Problems ◽  
Access To Primary Care ◽  
The Uk

Background. In the UK, most people with mental health problems are managed in primary care. However, many individuals in need of help are not able to access care, either because it is not available, or because the individual's interaction with care-givers deters or diverts help-seeking. Aims. To understand the experience of seeking care for distress from the perspective of potential patients from “hard-to-reach” groups. Methods. A qualitative study using semi-structured interviews, analysed using a thematic framework. Results. Access to primary care is problematic in four main areas: how distress is conceptualised by individuals, the decision to seek help, barriers to help-seeking, and navigating and negotiating services. Conclusion. There are complex reasons why people from “hard-to-reach” groups may not conceptualise their distress as a biomedical problem. In addition, there are particular barriers to accessing primary care when distress is recognised by the person and help-seeking is attempted. We suggest how primary care could be more accessible to people from “hard-to-reach” groups including the need to offer a flexible, non-biomedical response to distress.

scholarly journals Primary care nurses' approach to cases of violence against children

2013 ◽  
Vol 21 (spe) ◽  
pp. 172-179 ◽  
Author(s):  
Ailton de Souza Aragão ◽  
Maria das Graças Carvalho Ferriani ◽  
Telma Sanchez Vendruscollo ◽  
Sinara de Lima Souza ◽  
Romeu Gomes
Keyword(s):  
Primary Care ◽  
Family Health ◽  
Structured Interviews ◽  
Face To Face ◽  
Violence Against Children ◽  
The Family ◽  
Primary Care Nurses ◽  
The Face ◽  
The City

In Primary Care, the field of nursing comes face-to-face with the complexity of violence, leading these professionals to constantly re-evaluate their habitus. OBJECTIVE: to analyze how cases of violence against children and adolescents are approached by primary care nurses, identifying limits and possibilities for dealing with these cases. METHOD: a qualitative study, undertaken in 2011, through semi-structured interviews with 8 out of 48 nurses in the Family Health teams in the city of Uberaba in the state of Minas Gerais, the analysis of which followed the interpretation of meanings, based in dialectical hermeneutics. RESULTS: the following stand out: non-identification of violence as a problem for the nurses; denunciations and notifications as a role of the nurses; and the limits found in the face of violence. CONCLUSION: it is determined that the habitus of nursing directed at health promotion and prevention of violence must be restructured, overcoming the biomedical paradigm and involving intersectorial and multidisciplinary actions.

scholarly journals A Validated Questionnaire to Evaluate Primary Care Pediatrician Satisfaction With the Use of Teledermatology

Iproceedings ◽  
10.2196/35438 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e35438
Author(s):  
Juan Carlos Palazón Cabanes ◽  
G Juan Carpena ◽  
L Berbegal García ◽  
T Martínez Miravete ◽  
B Palazón Cabanes ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care Quality ◽  
Care Quality ◽  
Patient Privacy ◽  
Cutaneous Lesions ◽  
Technical Problems ◽  
Face To Face ◽  
Health Area ◽  
Validated Questionnaire ◽  
Time Required

Background Teledermatology (TD) is a branch of telemedicine focused on the evaluation of cutaneous lesions by dermatologists remotely, in order to avoid unnecessary in-person consults that could be otherwise resolved by this method, and to shorten the time required for prompt evaluation of cutaneous diseases. Objective This study aimed to create and validate a questionnaire to evaluate satisfaction with the use of TD among primary care pediatricians (PCPs) and to test the questionnaire in our health area before performing an intervention for the optimization of TD. Methods We first created a questionnaire based on previous publications. Then, an expert consultation was made before drafting the final version of the questionnaire. We tested it twice among pediatricians of different health areas, with a 1-month gap between both evaluations. Internal consistency, reproducibility, and validity of the questionnaire were evaluated. Finally, the validated questionnaire was tested among the PCPs of our health area, to analyze their responses. Results We registered 38 questionnaire responses. In all, 30 (78.9%) PCPs actively used TD several times within a month or a year; none of them used TD daily. Technical and health care quality of TD was mostly considered as good or very good. TD was regarded as similar or even better than face-to-face evaluation for most PCPs, whereas 7.9% (3/38) of PCPs thought TD was worse than conventional consults. Most PCPs considered TD as an effective, self-learning, and trustable tool, and 10.5% (4/38) of them identified that pictures captured by mobile phones were a barrier for its use, as it affects patient privacy. Technical problems, absence of exclusive devices for image taking, and delayed answers are some other barriers for TD that need to be overcome. Nonetheless, all PCPs were satisfied with TD, and all of them reported they would continue or start to use this tool. Conclusions TD has demonstrated to be an efficient tool, as it reduces waiting time and costs for dermatology evaluation, and it increases satisfaction among professionals. With our proposed questionnaire, we validated that quality, usability, efficacy, and satisfaction related to TD in our health area had a positive consideration among PCPs in general, but there still are barriers to overcome. Conflict of Interest None declared.

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