scholarly journals Telehealth-based diagnostic testing in general practice during the COVID-19 pandemic: an observational study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0123
Author(s):  
Rae-Anne Hardie ◽  
Gorkem Sezgin ◽  
Chisato Imai ◽  
Emma Gault ◽  
Precious McGuire ◽  
...  
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Diagnostic Testing ◽  
World Health Organisation ◽  
Estimating Equation ◽  
World Health ◽  
Test Collection ◽  
Face To Face ◽  
Health Technologies

BackgroundSince the World Health Organisation declared COVID-19 a pandemic on 11 March 2020, health technologies have been rapidly scaled up to ensure access to care. A significant innovation has been telehealth in general practice. Now widespread, it remains unknown how this shift to virtual care has impacted on quality-of-care indicators such as pathology testing and diagnosis.AimTo undertake a comparison of telehealth and face-to-face general practice consultations to: identify if there were differences in the proportion of pathology test referrals from 2019-2020; and quantify any change in pathology test collection and follow-up patterns.Design and SettingRetrospective observational study of routinely collected electronic patient data from 807 general practices across New South Wales and Victoria, Australia.MethodMultivariate generalised estimating equation models were used to estimate the proportion of pathology test referrals for: overall, face-to-face, and telehealth consultations. Pathology test follow-up was described through median (and interquartile range (IQR)) time.ResultsPathology test referrals declined during periods of high COVID-19 cases, falling from 10.8% in February 2020 to a low 4.5% during the first peak in April. Overall, pathology test referrals were lower for telehealth than face-to-face. Median time between referral and test collection was 3 days (IQR 1–14) for telehealth and 1 day (IQR 0–7) for face-to-face.ConclusionFor telehealth to become part of routine care, it is crucial that gaps in functionality, including difficulty in test referral processes, be addressed. Quality improvements supporting care practices will ensure clinicians’ workflows are supported and patients receive diagnostic testing.

scholarly journals Improving Risk Assessments by Sanitary Inspection for Small Drinking-Water Supplies—Qualitative Evidence

Resources ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 71 ◽  
Author(s):  
Katherine Pond ◽  
Richard King ◽  
Jo Herschan ◽  
Rosalind Malcolm ◽  
Rory Moses McKeown ◽  
...  
Keyword(s):  
Drinking Water ◽  
Assessment Tool ◽  
World Health Organisation ◽  
Ease Of Use ◽  
World Health ◽  
Remedial Action ◽  
Water Supplies ◽  
Qualitative Evidence ◽  
Operations And Maintenance

Small drinking-water supplies face particular challenges in terms of their management. Being vulnerable to contamination but often not monitored regularly nor well-maintained, small drinking-water supplies may pose consequences for health of users. Sanitary inspection (SI) is a risk assessment tool to identify and manage observable conditions of the water supply technology or circumstances in the catchment area that may favour certain hazardous events and introduce hazards which may become a risk to health. This qualitative research aimed to identify the strengths and weaknesses of the SI tool as published by the World Health Organisation to inform a review and update of the forms and to improve their robustness. The study identified a number of benefits of the approach, such as its simplicity and ease of use. Challenges were also identified, such as potential for inconsistencies in perception of risk between inspectors, in interpreting questions, and lack of follow-up action. The authors recommend a revision of the existing SI forms to address the identified challenges and development of complementary advice on possible remedial action to address identified risk factors and on basic operations and maintenance.

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.

Imaging in low-grade glioma: a guide for neurologists

2017 ◽  
Vol 18 (1) ◽  
pp. 27-34 ◽  
Author(s):  
Jennifer Larsen ◽  
Nigel Hoggard ◽  
Fiona M McKevitt
Keyword(s):  
Surgical Planning ◽  
World Health Organisation ◽  
Low Grade Glioma ◽  
World Health ◽  
Low Grade ◽  
The Central Nervous System ◽  
Contemporary Management

The management of low-grade glioma (LGG) is shifting as evidence has emergedthat refutes the previously commonplace imaging-based ‘watch and wait’ approach, in favour of early aggressive surgical resection. This coupled with the recent 2016 update to the World Health Organisation Classification of Tumours of the Central Nervous System is changing LGG imaging and management. Recently in Practical Neurology the contemporary management of low-grade glioma and the changes to this grading system were discussed in detail. 1 In this complementary article, we discuss the role of imaging in the diagnosis, surgical planning and post-treatment follow-up of LGG. We describe the principles of imaging these tumours and use several cases to highlight some difficult scenarios.

scholarly journals Gestational diabetes with diabetes and prediabetes risks: a large observational study

2018 ◽  
Vol 179 (1) ◽  
pp. 51-58 ◽  
Author(s):  
Yun Shen ◽  
Peng Wang ◽  
Leishen Wang ◽  
Shuang Zhang ◽  
Huikun Liu ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Observational Study ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
World Health ◽  
Oral Glucose ◽  
Adjusted Risk ◽  
Postpartum Diabetes ◽  
Incident Cases

Aims To compare risks of early postpartum diabetes and prediabetes in Chinese women with and without gestational diabetes mellitus (GDM) during pregnancy. Subjects and methods Tianjin GDM observational study included 1263 women with a history of GDM and 705 women without GDM who participated in the urban GDM universal screening survey by using World Health Organization’s criteria. Postpartum diabetes and prediabetes were identified after a standard oral glucose tolerance test. Cox proportional hazards regression was used to assess risks of postpartum diabetes and prediabetes between women with and without GDM. Results During a mean follow-up of 3.53 years postpartum, 90 incident cases of diabetes and 599 incident cases of prediabetes were identified. Multivariable-adjusted hazard ratios among women with prior GDM, compared with those without it, were 76.1 (95% CI: 23.6–246) for diabetes and 25.4 (95% CI: 18.2–35.3) for prediabetes. When the mean follow-up extended to 4.40 years, 121 diabetes and 616 prediabetes cases were identified. Women with prior GDM had a 13.0-fold multivariable-adjusted risk (95% CI: 5.54-30.6) for diabetes and 2.15-fold risk (95% CI: 1.76-2.62) for prediabetes compared with women without GDM. The positive associations between GDM and the risks of postpartum diabetes and prediabetes were significant and persistent when stratified by younger and older than 30 years at delivery and normal weight and overweight participants. Conclusions The present study indicated that women with prior GDM had significantly increased risks for postpartum diabetes and prediabetes, with the highest risk at the first 3–4 years after delivery, compared with those without GDM.

scholarly journals Impact of COVID-19 on Delays in General Practice. A Retrospective Analysis

2021 ◽  
Author(s):  
Henk Schers ◽  
Kees van Boven ◽  
Reinier Akkermans ◽  
Chris van Weel ◽  
Tim olde Hartman ◽  
...  
Keyword(s):  
General Practice ◽  
Help Seeking ◽  
Diagnostic Testing ◽  
Musculoskeletal Symptoms ◽  
Duration Of Symptoms ◽  
Health Symptoms ◽  
Delivery Modes ◽  
Seeking Behavior

Abstract BackgroundFrom the beginning of the COVID-19 pandemic, worries have been exposed about collateral damage to patients’ health through postponed appointments, and delayed diagnostic testing and referrals in general practice.AimTo study delays in presentation and management of health problems in general practice during the first 9 months of the COVID-19 crisis. We aimed at symptoms that were most relevant: COVID-19 related symptoms, cancer-related symptoms, mental health symptoms, and musculoskeletal symptoms. Design and settingRetrospective analysis of routine patient data from a practice based registration network in the Netherlands (population 40.000 patients; 30 GPs).MethodWe compared data from the first nine months of the COVID-19 crisis to the preceding 5 years, and analyzed differences between the periods of time in the duration of symptoms before presentation, and the duration from the first presentation in general practice until diagnostic testing and referrals.ResultsWe found no indications that patients waited longer to contact the FP for newly presented health symptoms; only COVID-19 related symptoms were presented earlier to family practice (p< 0.001). Also, we found no delays in general practice for diagnostic testing or referring to hospital care in 2020.ConclusionsGeneral practice maintained its capability to deliver timely care for newly presented health symptoms during the COVID-19 crisis, despite serious changes in delivery modes: patients have contacted their GPs broadly when it was needed, and do not seem to have postponed their help seeking behavior massively. Follow-up studies are needed to monitor long term consequences also in other health echelons.

The effectiveness of telepsychiatry measured using the Health of the Nation Outcome Scale and the Mental Health Inventory

2003 ◽  
Vol 9 (1) ◽  
pp. 12-16 ◽  
Author(s):  
Craig Kennedy ◽  
Peter Yellowlees
Keyword(s):  
Mental Health ◽  
Health Outcome ◽  
General Practice ◽  
Initial Assessment ◽  
Face To Face ◽  
Significant Difference ◽  
Outcome Scores ◽  
The Face ◽  
One Year

In a telepsychiatry project in rural Queensland, data were collected from 124 patients attending hospital and general practice facilities for mental health-care and then again at follow-up one year later. Thirty-two of the patients were dealt with using telepsychiatry. Two health status scales were used to measure effectiveness: the Health of the Nation Outcome Scale (HoNOS), administered by the practitioners; and the Mental Health Inventory (MHI), which was self-administered by the patients. There was a significant difference between the initial assessment and follow-up groups on most subscales of the HoNOS, but no significant difference between the face-to-face and telepsychiatry groups. Similarly, the MHI results showed a significant difference on all subscales between the initial assessment and follow-up groups, but no significant difference between the face-to-face and telepsychiatry groups. Individuals who used and did not use telepsychiatry all had improved health outcome scores on the HoNOS and MHI during the study period. Telepsychiatry was as effective as face-to-face care.

scholarly journals Understanding the use of email consultation in primary care using a retrospective observational study with data of Dutch electronic health records

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019233 ◽  
Author(s):  
Martine W J Huygens ◽  
Ilse C S Swinkels ◽  
Robert A Verheij ◽  
Roland D Friele ◽  
Onno C P van Schayck ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Observational Study ◽  
Patient Characteristics ◽  
Retrospective Observational Study ◽  
Electronic Health Record Data ◽  
Face To Face ◽  
Patients With Diabetes ◽  
General Practices ◽  
Electronic Health

ObjectivesIt is unclear why the use of email consultation is not more widespread in Dutch general practice, particularly because, since 2006, its costs can be reimbursed. To encourage further implementation, it is needed to understand the current use of email consultations. This study aims to understand the use of email consultation by different patient groups, compared with other general practice (GP) consultations.SettingFor this retrospective observational study, we used Dutch routine electronic health record data obtained from NIVEL Primary Care Database for the years 2010 and 2014.Participants200 general practices were included in 2010 (734 122 registered patients) and 434 in 2014 (1 630 386 registered patients).Primary outcome measuresThe number and percentage of email consultations and patient characteristics (age, gender, neighbourhood socioeconomic status and diagnoses) of email consultation users were investigated and compared with those who had a telephone or face-to-face consultation. General practice characteristics were also taken into account.Results32.0% of the Dutch general practices had at least one email consultation in 2010, rising to 52.8% in 2014. In 2014, only 0.7% of the GP consultations were by email (the others comprised home visits, telephone and face-to-face consultations). Its use highly varied among general practices. Most email consultations were done for psychological (14.7%); endocrine, metabolic and nutritional (10.9%); and circulatory (10.7%) problems. These diagnosis categories appeared less frequently in telephone and face-to-face consultations. Patients who had an email consultation were older than patients who had a telephone or face-to-face consultation. In contrast, patients with diabetes who had an email consultation were younger.ConclusionEven though email consultation was done in half the general practices in the Netherlands in 2014, the actual use of it is extremely low. Patients who had an email consultation differ from those who had a telephone or face-to-face consultation. In addition, the use of email consultation by patients is dependent on its provision by GPs.

Ultrasonographic determination of thyroid volume in infants and children from Aegean region of Turkey and comparison with national and international references

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Edis Çolak ◽  
Behzat Özkan ◽  
Sinan Genç ◽  
Burak Polat
Keyword(s):  
Standard Deviation Score ◽  
Body Height ◽  
Thyroid Volume ◽  
World Health Organisation ◽  
World Health ◽  
Turkish Children ◽  
Aegean Region ◽  
Normal Ranges

Abstract Objectives Accurate diagnosis and follow-up of pediatric patients with thyroid disorders, depends on the availability of appropriate data for normal thyroid volume (TV). The aim of this study was to determine the TV by ultrasonography (US) in subjects from the newborn period up to 18 years of age from the Aegean region of Turkey. Methods We measured the thyroid volumes in 513 children using US and compared them with the children’s age, gender, standard deviation score (SDS) of body height (BH-SDS), body weight (BW-SDS), body mass index (BMI-SDS), and body surface area (BSA-SDS). The 3rd, 50th, and 97th percentiles of the age-dependent distribution of the TV were calculated and compared with national and international references. Results The BH, BW, BMI, and BSA of all the participants were within the normal ranges for Turkish children. The TV was significantly positively correlated with age, gender, BH-SDS, BW-SDS, BMI-SDS, and BSA-SDS in all subjects (r=0.748, r=0.267, r=0.730, r=0.735, r=0.664 and r=0.735, respectively; p<0.0001 for all). The most important predictors for TV were age and BW-SDS, followed by BSA-SDS and BH-SDS. In multivariate regression, age and BW-SDS were the only significant independent predictors for TV. Our results were nearly similar to the corresponding data reported by the World Health Organisation in 2004. Conclusions The present study provides updated values for TV that can serve as a potential tool in differentiating the normal from the abnormal size of the thyroid gland in children aged 0–18 years from the Aegean region of Turkey.

scholarly journals Patient complaints in general practice seen through the lens of professionalism: a retrospective observational study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2020.0168
Author(s):  
Pieter C Barnhoorn ◽  
Geurt TJM Essers ◽  
Vera Nierkens ◽  
Mattijs E Numans ◽  
Walther NKA van Mook ◽  
...  
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Waiting Times ◽  
Retrospective Observational Study ◽  
Exact Nature ◽  
Out Of Hours ◽  
Face To Face ◽  
Patient Complaints ◽  
Rich Diversity ◽  
Open Coding

BackgroundProfessionalism is a key competence for physicians. Patient complaints provide a unique insight into patient expectations regarding professionalism. Research exploring the exact nature of patient complaints in general practice, especially focused on professionalism, is limited.AimTo characterise patient complaints in primary care and to explore in more detail which issues with professionalism exist.Design & settingA retrospective observational study in which all unsolicited patient complaints to a representative out-of-hours general practice (OOH GP) service provider in The Netherlands were analysed over a 10-year period (2009–2019).MethodComplaints were coded for general characteristics and thematically categorised using the CanMEDS Physician Competency Framework (CanMEDS) as sensitising concepts. Complaints categorised as professionalism were subdivided using open coding.ResultsOut of 746 996 patient consultations (telephone, face-to-face, and home visits) 484 (0.065%) resulted in eligible complaint letters. The majority consisted of two or more complaints, resulting in 833 different complaints. Most complaints concerned GPs (80%); a minority (19%) assistants. Thirty-five per cent concerned perceived professionalism lapses of physicians. A rich diversity in the wording of professionalism lapses was found, where 'not being taken seriously' was mentioned most often. Forty-five per cent related to medical expertise, such as missed diagnoses or unsuccessful clinical treatment. Nineteen per cent related to management problems, especially waiting times and access to care. Communication issues were only explicitly mentioned in 1% of the complaints.ConclusionMost unsolicited patient complaints were related to clinical problems. A third, however, concerned professionalism issues. Not being taken seriously was the most frequent mentioned theme within the professionalism category.

scholarly journals One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial (Preprint)

2021 ◽  
Author(s):  
Svein Ivar Bekkelund ◽  
Kai Ivar Müller
Keyword(s):  
General Practice ◽  
Patient Satisfaction ◽  
Chronic Headache ◽  
Remission Rate ◽  
Face To Face ◽  
The Face ◽  
Video Group ◽  
One Year ◽  
Headache Patients

BACKGROUND Chronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management. OBJECTIVE The goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway. METHODS Patients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Tromsø) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ≥15 to &lt;15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up). RESULTS From a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7% (86/120) in the video group and 67.3% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0% (37/86) in the video group and 39.5% (30/76) in the face-to-face group (<i>P</i>=.38). Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face-to-face; <i>P</i>=.25). A total of 30% (11/37) in the video group and 53% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (<i>P</i>=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (<i>P</i>=.19). CONCLUSIONS One-year remission rate from chronic headache was about 40% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice. CLINICALTRIAL ClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177

Sign in / Sign up

Export Citation Format

Share Document