scholarly journals Improving Access to Rheumatologists: Use and Benefits of an Electronic Consultation Service

2017 ◽  
Vol 45 (1) ◽  
pp. 137-140 ◽  
Author(s):  
Krista Rostom ◽  
C. Douglas Smith ◽  
Clare Liddy ◽  
Amir Afkham ◽  
Erin Keely
Keyword(s):  
Drug Treatment ◽  
Response Time ◽  
Consultation Service ◽  
Median Response ◽  
Or Management ◽  
Face To Face ◽  
Electronic Consultation ◽  
Common Diagnosis ◽  
Clinical Questions ◽  
Improve Access

Objective.To describe the use and benefits of an innovative eConsult service to improve access to rheumatologists.Methods.There were 225 eConsults directed to rheumatology that were categorized by type of question and effect on face-to-face referral rates.Results.The median response time by the rheumatologists was 1.9 days. Clinical questions included drug treatment (34%), diagnosis (26%), or management (14%). Osteoporosis was the most common diagnosis (22%), followed by pain in multiple joints (11%), and polyarthritis (10%). A face-to-face referral was avoided in 38% of cases.Conclusion.There are clinical questions that can be answered quickly by an eConsult, improving access to rheumatologists.

scholarly journals Evaluation of an electronic consultation service for transgender care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jatinderpreet Singh ◽  
Allison Lou ◽  
Michael Green ◽  
Erin Keely ◽  
Mary Greenaway ◽  
...  
Keyword(s):  
Primary Care ◽  
Response Time ◽  
Access To Care ◽  
Hormone Therapy ◽  
Primary Care Providers ◽  
Care Providers ◽  
Face To Face ◽  
Electronic Consultation ◽  
Clinical Questions ◽  
Insight Into

Abstract Background Access to transgender care in Canada is poor. Although primary care providers are ideally positioned to initiate care, many feel uncomfortable providing transgender care. This study aimed to explore the impact of an electronic consultation (eConsult) service between primary care providers and transgender care specialists on access to care and to explore the content of clinical questions that were asked. Methods This was a retrospective mixed methods analysis of 62 eConsults submitted between January 2017 and December 2018 by primary care providers to specialists in transgender care in a health region in eastern Ontario, Canada. A descriptive analysis was conducted to assess the average response time and the total time spent by the specialist for the eConsults. An inductive and deductive content analysis was carried out to identify common themes of clinical questions being asked to transgender specialists. A post-eConsult survey completed by primary care providers was assessed to gain insight into avoided face-to-face referrals and overall provider satisfaction. Results The median specialist response time was 1.2 days (range: 1 h to 5 days) and the average time spent by specialists per eConsult was 18 min (range: 10 to 40 min). The qualitative analysis identified six major themes: 1) interpretation/management of abnormal bloodwork, 2) change in management due to lack of desired effect/hormone levels not a target, 3) initiation of hormone therapy/initial work up, 4) management of adverse effects of hormone therapy, 5) transition related surgery counseling and post-op complications, and 6) management of patients with comorbidities. Approximately one-third of eConsults resulted in an avoided face-to-face referral and 95% of primary care providers rated the value of their eConsult as a 5 (excellent value) or 4. Conclusions This study demonstrated that a transgender eConsult service has potential to significantly improve access to care for transgender patients. Given the importance that timely access has on improving mental health and reducing suicide attempts, eConsult has the potential to make a substantial clinical impact on this population. Identified themes of eConsult questions provides insight into potential gaps in knowledge amongst primary care providers that could help inform future continuing education events.

scholarly journals MO211FORMALIZATION AND DEVELOPMENT OF A NEPHROLOGY ELECTRONIC CONSULTATION (ECONSULT) IN COVID-19 PANDEMIC

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Juan Carlos Herrero Berron ◽  
Carolina Lentisco ◽  
Aniana Oliet ◽  
Andrea Suso ◽  
Irene Onate Alonso ◽  
...  
Keyword(s):  
Primary Care ◽  
Response Time ◽  
Primary Care Providers ◽  
Care Providers ◽  
Median Response ◽  
Face To Face ◽  
Problem Resolution ◽  
Day Range ◽  
Electronic Consultation

Abstract Background and Aims Due to COVID-19 pandemic we must continue attending in our hospital consultations and, at the same time, avoid transfers and visit that involve risks to our patients. For this reason, we implemented new forms of care. Mainly electronic consultation (eConsult) using institutional email as way of contact between Primary Care Providers (PCPs) and nephrologist, trying to decrease in-person visit. Objective To analyze the results of the creation in June 2020 of a Nephrology electronic consultation in our hospital. Method Retrospective observational study of eConsults made to our department, which serves a population of 200.000 people, with total of 9 primary care centers. The study period was June 10, 2020 to December 31, 2020. We have studied the number of eConsults, response time, type of consult made, problem resolution and subsequent follow up. Results Of 141 workdays, in 61 days (43%) there was eConsult, total 80 eConsults, mean 1.3 and median 1 daily (range 1 to 3). All primary care centers used this communication way, as well as 50 PCPs. Median response time for eConsult was 1 day (range 1-4). 55% patient was male, mean age 70.8 years (SD 13.9) (range 16-95 years). 64% it was his first assessment for Nephrology. The most frequent causes of eConsult: increase of creatinine (41.3%), uncontrolled blood pressure (12.5%), sodium and potassium disturbances (11.3%), treatment adjustment (11.3%) and changes in previous appointment (8.8%). After assessment eConsult, to 55% of patients was treatment adjustment, 22.5% were converted to an in-person visit, 11% they didn´t need any action but only 1 patient was referred to the emergency room. 44% patient is subsequent follow up by PCPs, 39% by nephrologist, 15% joint assessment PCP and nephrologist and 2% by other specialists. Only 2 patients (2.5%) made second eConsult. Conclusion The eConsult is an important help to PCPs to solve doubts quickly, avoid unnecessary the travels to hospital the patients, treatment adjustment above all in control of hypertension an ionic disturbance, and guide in handling of chronic kidney disease. The diffusion and empowerment of this type of consultation in a next future may decrease, partly, the usual saturation of face-to-face visit and optimize the patient population being seen by nephrologist.

scholarly journals P.216 Improving access to neurosurgeons through an electronic consultation service

2021 ◽  
Vol 48 (s3) ◽  
pp. S82-S82
Author(s):  
A Wang ◽  
S Guglani ◽  
T McCutcheon ◽  
E Keely ◽  
F Alkherayf
Keyword(s):  
Cross Sectional Study ◽  
Office Visits ◽  
Specialist Care ◽  
Consultation Service ◽  
Cross Sectional ◽  
Median Response ◽  
Face To Face ◽  
Electronic Consultation ◽  
Course Of Action ◽  
Timely Access

Background: Timely access to neurosurgeons for clinical advice is limited depending on region and other social factors. An eConsult service providing access to neurosurgeons in Ontario, Canada may influence primary care provider (PCP) course of action and referral behaviours. Methods: The Champlain BASE (Building Access to Specialist Care via eConsult) service allows PCPs to access specialist care in lieu of traditional face-to-face referrals. We conducted a cross-sectional study of eConsult cases submitted to neurosurgeons by PCPs between Jan 1, 2017 and Dec 31, 2018. Usage data and PCP responses to a mandatory closeout survey were analyzed. Results: A total of 432 eConsults were submitted. Specialist median response time was 2.29 days with 86.8% of responses occurring within 7 days. PCPs received a new or additional course of action in 53% of cases. An unnecessary face-to-face referral was avoided in 57% of all eConsults, and 50% of cases where the PCP initially contemplated requesting a referral. Over 86% of cases were rated at least 4 out of 5 in value for PCPs and their patients. Conclusions: The use of eConsult improves access to neurosurgeons by providing timely, highly-rated practice-changing clinical advice while reducing the need for patients to attend face-to-face office visits.

scholarly journals P.025 Is this headache normal?: Assessing electronic referrals for headache from primary care physicians

2018 ◽  
Vol 45 (s2) ◽  
pp. S22-S22
Author(s):  
L Panamsky ◽  
A Bradi ◽  
L Sitwell ◽  
C Liddy ◽  
A Afkham ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Unusual Presentation ◽  
Imaging Findings ◽  
Electronic Resources ◽  
Consultation Service ◽  
Face To Face ◽  
Electronic Consultation ◽  
Headache Type ◽  
Clinical Resource

Background: Headache is one of the most frequent complaints in primary care. We reviewed headache questions submitted to an electronic consultation service in Ontario to classify the types of headaches and describe the questions being asked. We also identified reasons why answers were not retrievable within UpToDate, an online clinical resource. Methods: 65 headache eConsults were further divided into 85 questions and categorized by headache type and question theme. Questions were manually searched within UpToDate to determine if they could be answered using this resource. The intent to refer the patient for a face-to-face referral after the eConsult was collected. Results: The top classifications were migraine, unclassified headache, and exertional and/or coital headache. The themes -identified were medication questions (41.7%), investigation questions (33.3%), clinical concerns despite normal neurologic exam and/or imaging (15.5%); and abnormal imaging findings (9.5%). Answers to 40.1% of the questions were not retrievable in UpToDate. The main reason for irretrievability was an unusual presentation. Only 33.8% of eConsults resulted in a face-to-face referral to a specialist. Conclusions: Although electronic resources may be useful in some cases, clinical nuances cannot be accounted for. By providing physicians with rapid access to specialists, eConsult services may obviate the need for formal, face-to-face referrals.

scholarly journals An Abstraction of Cyber Inception: Using a Modified Version of Battleship to Study Strategies and Behavior of Deception

2019 ◽  
Vol 63 (1) ◽  
pp. 1326-1330
Author(s):  
Verica Buchanan ◽  
Ashley R. Chinzi ◽  
Nicholas C. Day ◽  
Lidija A. Buchanan ◽  
Rachel Specht ◽  
...  
Keyword(s):  
Response Time ◽  
Cyber Security ◽  
Eye Contact ◽  
Study Strategies ◽  
Point Of View ◽  
Face To Face ◽  
Lower Response ◽  
Behavioral Cues ◽  
Tone Of Voice ◽  
And Behavior

Inception has been proposed as a means to protect our cyber domain. In order to fully take advantage of this strategy we must first understand deception from the human point of view, because it is the human cyber attacker that plans and orchestrates cyberattacks. Moreover, although various deceptive tactics are addressed in the cyber-security literature, it appears they are categorized more from the standpoint of technology than from their behavioral origins. In order to better understand the interplay between attacker and defender, and associated cues of deception, we abstracted the cyber deception task. Participants played a modified version of Battleship either face-to-face or with a divider. Deception was significantly higher in the divider condition. Additionally, participants used patterns of deception analogous to cyber attackers and defenders such as blatant lies, diversion, and honeypots. An array of behavioral cues were also observed when participants lied and included variations in tone of voice, less eye contact, lower response time, and other physical indicators. Implications and future projects are discussed.

The experiences of Australian parents with psychosis: The second Australian national survey of psychosis

2012 ◽  
Vol 46 (9) ◽  
pp. 890-900 ◽  
Author(s):  
Linda Campbell ◽  
Mary-Claire Hanlon ◽  
Abner Weng Cheong Poon ◽  
Stefania Paolini ◽  
Melanie Stone ◽  
...  
Keyword(s):  
National Survey ◽  
Significant Proportion ◽  
Specific Information ◽  
Demographic Information ◽  
Dependent Children ◽  
Face To Face ◽  
Common Diagnosis ◽  
General Functioning ◽  
Independent Functioning ◽  
The Average Range

Objective: Being a parent is an important part of one’s identity and role. Previous research outlines many challenges associated with parenting by people with severe mental illness. However, there is a limited research describing parenting experiences of mothers and fathers who have psychosis. Method: The second Australian national survey of psychosis recruited 1825 people living with symptoms of, or a diagnosis of, psychosis. The survey was conducted through face-to-face interviews and included key clinical and demographic information, as well as parenting specific information. Results: Over half of all women and a quarter of men were parents. Almost a quarter of women but only 5.5% of the men had dependent children (own and/or stepchildren) living at home with them. Of parents with dependent children, the most common diagnosis was schizophrenia (48.2% fathers, 28.9% mothers), and there were high rates of comorbidity with substance abuse/dependence (alcohol: fathers 69.2%, mothers 44.3%; cannabis: fathers 69.22%, mothers 47.8%). A substantial proportion of parents with dependent children experienced challenges including low educational attainment, unemployment, poverty, and social isolation. Although many parents living with dependent children functioned in the average range, a significant proportion was moderately to severely disabled on global independent functioning ratings (fathers 49.1%, mothers 35.7%) and some were identified as having obvious/severe impairments in their ability to care for their child(ren) (fathers 28.3%, mothers 21.3%). Conclusions: Most parents living with psychosis function well. However, a significant proportion has impairments in parenting and general functioning that could have adverse consequences for both the parent and children. This study brings into focus the need for interventions to optimise successful parenting outcomes.

scholarly journals Optimising mHealth helpdesk responsiveness in South Africa: towards automated message triage

2018 ◽  
Vol 3 (Suppl 2) ◽  
pp. e000567 ◽  
Author(s):  
Matthew Engelhard ◽  
Charles Copley ◽  
Jacqui Watson ◽  
Yogan Pillay ◽  
Peter Barron ◽  
...  
Keyword(s):  
South Africa ◽  
Response Time ◽  
Random Sample ◽  
Naive Bayes ◽  
National Level ◽  
Naïve Bayes ◽  
Naive Bayes Classifier ◽  
Bayes Classifier ◽  
Naïve Bayes Classifier ◽  
Median Response

In South Africa, a national-level helpdesk was established in August 2014 as a social accountability mechanism for improving governance, allowing recipients of public sector services to send complaints, compliments and questions directly to a team of National Department of Health (NDoH) staff members via text message. As demand increases, mechanisms to streamline and improve the helpdesk must be explored. This work aims to evaluate the need for and feasibility of automated message triage to improve helpdesk responsiveness to high-priority messages. Drawing from 65 768 messages submitted between October 2016 and July 2017, the quality of helpdesk message handling was evaluated via detailed inspection of (1) a random sample of 481 messages and (2) messages reporting mistreatment of women, as identified using expert-curated keywords. Automated triage was explored by training a naïve Bayes classifier to replicate message labels assigned by NDoH staff. Classifier performance was evaluated on 12 526 messages withheld from the training set. 90 of 481 (18.7%) NDoH responses were scored as suboptimal or incorrect, with median response time of 4.0 hours. 32 reports of facility-based mistreatment and 39 of partner and family violence were identified; NDoH response time and appropriateness for these messages were not superior to the random sample (P>0.05). The naïve Bayes classifier had average accuracy of 85.4%, with ≥98% specificity for infrequently appearing (<50%) labels. These results show that helpdesk handling of mistreatment of women could be improved. Keyword matching and naïve Bayes effectively identified uncommon messages of interest and could support automated triage to improve handling of high-priority messages.

scholarly journals Evaluation of an electronic consultation service in psychiatry for primary care providers

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Douglas Archibald ◽  
Julia Stratton ◽  
Clare Liddy ◽  
Rachel E. Grant ◽  
Douglas Green ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Consultation Service ◽  
Electronic Consultation

scholarly journals PS1 - 188 Rehabilitation Consultation: An Integrated Model for Addressing Rehabilitation Concerns in the Primary Brain Tumor Population

2016 ◽  
Vol 43 (S4) ◽  
pp. S9-S10
Author(s):  
I. Lax ◽  
M. Daniels ◽  
C. Kanter ◽  
W. Mason ◽  
K. Edelstein
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Disease Process ◽  
Primary Brain Tumor ◽  
Rehabilitation Services ◽  
Face To Face ◽  
Primary Brain Tumors ◽  
Common Diagnosis ◽  
Consultation Model ◽  
Oncology Treatment

Individuals with primary brain tumors experience a range of physical, cognitive and psychosocial sequelae which impact their independence, safety and quality of life. These impairments may be addressed through rehabilitation intervention. Despite acknowledgement that timely rehabilitation services over the course of the disease process is of benefit, few outpatient neuro-oncology treatment teams include a rehabilitation professional. Purpose: The aims are: (1) to describe a rehabilitation consultation model of care integrated into outpatient neuro-oncology treatment for individuals with primary brain tumors; and (2) to describe the characteristics of individuals referred for rehabilitation services. Methods: This retrospective descriptive study examined data from 200 individuals that received rehabilitation consultation from January 2015 to March 2016 at Princess Margaret Hospital, Pencer Brain Tumor Centre. Information on patient demographics, referral characteristics, and number of patient care visits was collected. Descriptive statistics were calculated. Preliminary Results: Of all patients, (n=195), the most common diagnosis is glioblastoma, 39% (n=76), and 50% are 50-69 years of age (M=55, SD=15.0). The most common reason for initial referral was decline in physical functioning, strength and balance (41%). In 77% of cases, patients were seen immediately at the time of referral. In total, 540 consultations were completed (face-to-face=230, telephone=310) with 2.78 on average (SD=4.0) per patient. Conclusion: Given the range of symptoms that individuals with primary brain tumors experience coupled with changes in functional status as the disease progresses, integrated and timely rehabilitation consultation is feasible.

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