Remote general practitioner consultations during COVID-19.
Ontology highlight
ABSTRACT:
SUBMITTER: Green MA
PROVIDER: S-EPMC8691847 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Objectives How general practice is delivered in many countries has drastically changed due to the COVID-19 pandemic. This study aimed to answer the question of how general practice has changed in Ireland in response to COVID-19. Design The Irish College of General Practitioners surveyed its membership before and after the global pandemic hit Ireland using a cross-sectional online survey instrument. Setting This study focuses on primary care, specifically general practice, in Ireland. Participants In February 2020 before the global pandemic, 526 general practices across Ireland submitted responses to the survey; 538 general practices responded to the second survey during the pandemic in June 2020. This covers 32% and 33% of practices in Ireland, respectively. Main outcome measures The type of consultations by general practitioners (GPs) and practice nurses in both surveys is the main outcome measure reported in this paper. Other changes such as the perceived change in attendance by certain patient groups and practice income are also reported. Results Face-to-face consultations significantly (p<0.001) decreased from a median of 26 (IQR 21.3–30) to a median of 8 (IQR 6–13). GP telemedicine consultations increased (p<0.001) from a median of 2.4 (IQR 0–5.3) to a median of 11.3 (IQR 6–19). The majority of practices (80.0%) reported reduced practice profit. Respondents reported a decline in non-COVID-19-related consultations among certain patient cohorts—92.0% for children under 6 years old; 79.5% for patients over 70 years. Conclusions It is likely that the way general practice is delivered will not return to as it was before the COVID-19 pandemic and increased telemedicine can be expected. However, it is necessary to assess the impact of this shift on patient health and to assess healthcare provider and patient experience to ensure continued high-quality care and patient safety.
| S-EPMC8039245 | biostudies-literature
Project description:Telemedicine is becoming a standard method of consultation, and the COVID-19 pandemic has increased its need. Telemedicine is suitable for non-communicable diseases (NCDs) in the pediatric population, as these are chronic conditions that affect many children worldwide. The aim of this study was to analyze the bibliometric parameters of publications on the use of telemedicine for the most common NCDs in children before and after the COVID-19 pandemic. Following the electronic search, 585 records were selected. "Metabolic diseases" was the most frequent topic before and after the pandemic, accounting for 34.76% in 2017-2019 and 33.97% in 2020-2022. The average IF of the journals from which records were retrieved was 5.46 ± 4.62 before and 4.58 ± 2.82 after the pandemic, with no significant variation. The number of citations per reference averaged 14.71 ± 17.16 in 2017-2019 (95% CI: 12.07; 17.36) and 5.54 ± 13.71 in 2020-2022 (95% CI: 4.23; 6.86). Asthma, metabolic diseases, and neurodevelopmental disorders were the most explored topics. A relevant finding concerns the increasing number of observational studies after the pandemic, with a reduction of the interventional studies. The latter type of study should be recommended as it can increase the evaluation of new strategies for the management of NCDs.
| S-EPMC9407809 | biostudies-literature
Project description:ObjectiveIn response to the COVID-19 pandemic, there has been a shift globally from face-to-face consultations to remote consultations. In our department, remote consultations have taken in the form of telephone consultations. In this paper, we set out to study a group of Irish psychiatrists' experience of these consultations.MethodsWe identified recurrent themes in the existing literature on doctors' experience of telephone consultations with a view to determining the applicability of these themes to a group of Irish psychiatrists. A questionnaire was developed based on themes in the literature. This was sent to all psychiatrists working in a busy psychiatric service in Dublin.ResultsThe questionnaire response rate was 72% (n = 26/35). Diagnostic challenges, the effect of phone consultation on the therapeutic alliance, challenges associated with the use of technology and ethical concerns were identified as issues. Flexibility in the working day and convenience were identified as possible benefits to telephone consultations.ConclusionsThe group that participated in this research study identified a number of challenges to carrying out successful phone consultations. This study highlights the need at our clinical site for interventions to address the issues identified by staff. The findings also highlight the requirement for larger studies with stronger methodologies to determine the generalisability of our results.
| S-EPMC7283108 | biostudies-literature
Project description:ObjectiveTo ascertain any differences between care from nurse practitioners and that from general practitioners for patients seeking "same day" consultations in primary care.DesignRandomised controlled trial with patients allocated by one of two randomisation schemes (by day or within day).Setting10 general practices in south Wales and south west England.Subjects1368 patients requesting same day consultations.Main outcome measuresPatient satisfaction, resolution of symptoms and concerns, care provided (prescriptions, investigations, referrals, recall, and length of consultation), information provided to patients, and patients' intentions for seeking care in the future.ResultsGenerally patients consulting nurse practitioners were significantly more satisfied with their care, although for adults this difference was not observed in all practices. For children, the mean difference between general and nurse practitioner in percentage satisfaction score was -4.8 (95% confidence interval -6.8 to -2.8), and for adults the differences ranged from -8.8 (-13.6 to -3.9) to 3.8 (-3.3 to 10.8) across the practices. Resolution of symptoms and concerns did not differ between the two groups (odds ratio 1.2 (95% confidence interval 0.8 to 1.8) for symptoms and 1.03 (0.8 to 1.4) for concerns). The number of prescriptions issued, investigations ordered, referrals to secondary care, and reattendances were similar between the two groups. However, patients managed by nurse practitioners reported receiving significantly more information about their illnesses and, in all but one practice, their consultations were significantly longer.ConclusionThis study supports the wider acceptance of the role of nurse practitioners in providing care to patients requesting same day consultations.
| S-EPMC27347 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic imposed an acute, sharp rise in the use of video consultations (VCs) by general practitioners (GPs) in Norway.ObjectiveThis study aims to document GPs' experiences with the large-scale uptake of VCs in the natural experiment context of the pandemic.MethodsA nationwide, cross-sectional online survey was conducted among Norwegian GPs during the pandemic lockdown (April 14-May 3, 2020). Each respondent was asked to evaluate up to 10 VCs. Basic demographic characteristics of the GPs and their practices were collected. The associations between GPs' perceived suitability of the VCs, the nature of the patients' main problems, prior knowledge of the patients (relational continuity), and follow-up of previously presented problems (episodic continuity) were explored using descriptive statistics, diagrams, and chi-square tests.ResultsIn total, 1237 GPs (26% of the target group) responded to the survey. Among these, 1000 GPs offered VCs, and 855 GPs evaluated a total of 3484 VCs. Most GPs who offered VCs (1000/1237; 81%) had no experience with VCs before the pandemic. Overall, 51% (1766/3476) of the evaluated VCs were considered to have similar or even better suitability to assess the main reason for contact, compared to face-to-face consultations. In the presence of relational continuity, VCs were considered equal to or better than face-to-face consultations in 57% (1011/1785) of cases, as opposed to 32% (87/274) when the patient was unknown. The suitability rate for follow-up consultations (episodic continuity) was 61% (1165/1919), compared to 35% (544/1556) for new patient problems. Suitability varied considerably across clinical contact reasons. VCs were found most suitable for anxiety and life stress, depression, and administrative purposes, as well as for longstanding or complex problems that normally require multiple follow-up consultations. The GPs estimate that they will conduct about 20% of their consultations by video in a future, nonpandemic setting.ConclusionsOur study of VCs performed in general practice during the pandemic lockdown indicates a clear future role for VCs in nonpandemic settings. The strong and consistent association between continuity of care and GPs' perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning.
| S-EPMC7872327 | biostudies-literature
Project description:Since the COVID-19 pandemic started, there have been changes in clinical practice to limit transmission, such as switching from face-to-face to remote consultations. We aimed to study the influence of technical factors on remote consultations in our experience during the pandemic. 12 clinicians completed data collection forms after consultations, recording the technology used (video vs phone); technical problems encountered; discharge or subsequent appointment status; and technical aspects of the consultation process using 0-10 numerical rating scales (NRS) (Time Adequate; Relevant History; Physical Exam; Management Plan; and Communication Quality). Data were collated on an MS Access 2016 database and transferred to SPSS version 25 for statistics. Of 285 forms valid for analysis, 48 (16.8%) had video consultations. Of 259 forms with technical problems data recorded, 48 (18.5%) had a technical problem. Video patients were significantly younger (mean 49.3 vs 61.3 years, p < 0.001), had higher scores on Physical Exam scale (mean 4.0 vs 2.6, p < 0.001), but had no significant difference on Management Plan scale (7.3 vs 7.2). Those with technical problems were more common among video consultations (33.3% vs 15.4%, p = 0.005), had lower scores on Time Adequate scale (7.7 vs 8.7, p < 0.001) and Communication Quality scale (7.1 vs 8.4, p < 0.001), but had no significant difference on Management Plan scale (7.3 vs 7.2). The strongest correlation of Management Plan scale was with Communication Quality scale (Rho = 0.64). Of the NRS, a 1-point reduction in scores on Management Plan scale was the strongest predictor of subsequent face-to-face appointment (Odds Ratio 1.88, 95% CI 1.58-2.24), and this remained an independent predictor in multivariate analysis (adjusted OR 1.90, 1.57-2.31). Having a technical problem was inversely associated with the outcome of a subsequent face-to-face appointment (OR 0.17, 0.04-0.74), and this remained significant after adjustment for Management Plan in multivariate analysis (adjusted OR 0.09, 0.12-0.54). Video patients were younger suggesting a preference for video amongst younger patients. Although technical problems were more common with video, having a video consultation or a technical problem had no significant impact on management plan. Scoring lower on the Management Plan scale was the strongest predictor of, and independently associated with, requesting a subsequent face-to-face appointment. The inverse relationship of technical problems with subsequent face-to-face appointment request will need validation in further studies.
| S-EPMC8995407 | biostudies-literature
Project description:PurposePrior research has shown that the majority of those bereaved by suicide express a need for mental health care services. However, there is a lack of knowledge about these individuals' use of primary health care. The objective of our study was to estimate the association between suicide bereavement and general practitioner (GP) consultations for mental health reasons.MethodsA population-wide, register-based cohort study identifying 25,580 individuals bereaved by suicide. Estimations of increases in consultation rate were modeled through individual fixed-effects linear analyses adjusted for age and time-period.ResultsOverall, 35% of those bereaved by suicide had a GP consultation for mental health reasons during the first 1-2 months, and 53% after two years. In the month immediately after bereavement by suicide, there was a large increase in the consultation rate with a GP for mental health reasons. In the months that followed, the consultation rate gradually decreased. One year after bereavement, the consultation rate stabilized at a somewhat higher level than before the death. The increase in consultation rate was evident across all kinship groups, and the increase was greatest for partners and smallest for siblings. Women had more contact with the GP before the suicide and a greater increase in contact than men.ConclusionOur findings suggest that many of those bereaved by suicide seek assistance from primary health care, and that some are in need of prolonged follow-up from the GP. Health governments should be aware of this and seek to strengthen the GPs knowledge of the needs and challenges associated with this patient group. Measures should also be taken to remove barriers to contact the health care system, especially for men and bereaved siblings.
| S-EPMC11343791 | biostudies-literature
Project description:According to the outbreak of the Covid-19 pandemic, medical teleconsultations using various technologies have become an important tool to mediate communication between general practitioners (GP) and the patients in primary health care in many countries. The quality of the GP-patient communication is an essential factor, which improves the results of treatment and patient satisfaction. The objective of this paper is to study patients' satisfaction from teleconsultation in primary care and the impact of teleconsultations on GP-patient communication through the Covid-19 pandemic in Poland. We analyse whether the teleconsultations performed without physical examinations have a positive impact on GP-patient communication. The quality of teleconsultation and GP-patient communication have been measured using a questionnaire regarding the quality of medical care in a remote care conditions. Among 36 items, nine questions have been related to the dimension of GP-patient communication and ten to system experience. Our results suggest that the quality of teleconsultations is not inferior to the quality of consultation during a face-to-face visit. The patients indicated a high level of satisfaction regarding communication with their GP during teleconsultation. We have also identified that the technical quality and the sense of comfort during teleconsultation positively impact the communication quality.
| S-EPMC8284634 | biostudies-literature
Project description:BackgroundVideo consultations have the potential to play a significant role for the future of healthcare by solving some of the imminently arising healthcare challenges, as pointed by the European Commission in Europe and the National Academy of Medicine in the United States of America. This technology can improve quality, efficiency, and enhance access to healthcare.ObjectiveThe aim of this study is to explore and understand individual video consultations acceptance drivers.MethodsAn extended technology acceptance model was created based on the diffusion of innovation theory (DOI), unified theory of acceptance and use of technology (UTAUT), health belief model (HBM), and concerns for information privacy framework (CFIP). 346 valid responses were collected through an online questionnaire, and the partial least squares (PLS) modeling approach was used to test the model.ResultsThe model explained 77.6 % (R2) of the variance on intention to use, and 71.4 % (R2) of the variance in attitude. The predictors of intention to use are attitude (beta = 0.504, p-value<0.001), performance expectancy (beta = 0.196, p-value = 0.002), and COVID-19 (beta = 0.151, p-value<0.001). The predictors of attitude are performance expectancy (beta = 0.643, p-value>0.001), effort expectancy (beta = 0.138, p-value = 0.001), and COVID-19 (beta = 0.170, p-value<0.001).ConclusionsThis research model highlights the importance of creating extended acceptance models to capture the specificities of each technology in healthcare. The model created helps to understand the most important drivers of video consultation acceptance, highlighting the importance of the COVID-19 pandemic and perceived health risks.
| S-EPMC9852263 | biostudies-literature
Project description:BackgroundRemote mental health consultations were swiftly implemented across mental health services during the COVID-19 pandemic. Research has begun to inform future design and delivery of telemental health services. Exploring the in-depth experiences of those involved is important to understand the complex, multi-level factors that influence the implementation of remote mental health consultations. The aim of this study was to explore stakeholder perspectives and experiences of the implementation of remote mental health consultations during the COVID-19 pandemic in Ireland.MethodsA qualitative study was conducted whereby semi-structured, individual interviews were undertaken with mental health providers, service users, and managers (n = 19) to acquire rich information. Interviews were conducted between November 2021 and July 2022. The interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). Data were analysed thematically using a deductive and inductive approach.ResultsSix themes were identified. The advantages of remote mental health consultations were described, including convenience and increased accessibility to care. Providers and managers described varying levels of success with implementation, citing complexity and incompatibility with existing workflows as barriers to adoption. Providers' access to resources, guidance, and training were notable facilitators. Participants perceived remote mental health consultations to be satisfactory but not equivalent to in-person care in terms of quality. Views about the inferior quality of remote consultations stemmed from beliefs about the inhibited therapeutic relationship and a possible reduction in effectiveness compared to in-person care. Whilst a return to in-person services was mostly preferred, participants acknowledged a potential adjunct role for remote consultations in certain circumstances.ConclusionsRemote mental health consultations were welcomed as a means to continue care during the COVID-19 pandemic. Their swift and necessary adoption placed pressure on providers and organisations to adapt quickly, navigating challenges and adjusting to a new way of working. This implementation created changes to workflows and dynamics that disrupted the traditional method of mental health care delivery. Further consideration of the importance of the therapeutic relationship and fostering positive provider beliefs and feelings of competence are needed to ensure satisfactory and effective implementation of remote mental health consultations going forward.
| S-EPMC10262124 | biostudies-literature