scholarly journals Virtual Cancer Care During the COVID-19 Pandemic and Beyond: A Call for Evaluation

JMIR Cancer ◽  
10.2196/24222 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e24222
Author(s):  
Oren Hannun Levine ◽  
Michael McGillion ◽  
Mark Levine
Keyword(s):  
Health Care Providers ◽  
Cancer Care ◽  
Initial Period ◽  
Lessons Learned ◽  
Cancer Center ◽  
Care Providers ◽  
Virtual Care ◽  
Care Intervention ◽  
Increased Risk ◽  
National Quality

The interplay of virtual care and cancer care in the context of the COVID-19 pandemic is unique and unprecedented. Patients with cancer are at increased risk of SARS-CoV-2 infection and have worse outcomes than patients with COVID-19 who do not have cancer. Virtual care has been introduced quickly and extemporaneously in cancer treatment centers worldwide to maintain COVID-19–free zones. The outbreak of COVID-19 in a cancer center could have devastating consequences. The virtual care intervention that was first used in our cancer center, as well as many others, was a landline telephone in an office or clinic that connected a clinician with a patient. There is a lack of virtual care evaluation from the perspectives of patients and oncology health care providers. A number of factors for assessing oncology care delivered through a virtual care intervention have been described, including patient rapport, frailty, delicate conversations, team-based care, resident education, patient safety, technical effectiveness, privacy, operational effectiveness, and resource utilization. These factors are organized according to the National Quality Forum framework for the assessment of telehealth in oncology. This includes the following 4 domains of assessing outcomes: experience, access to care, effectiveness, and financial impact or cost. In terms of virtual care and oncology, the pandemic has opened the door to change. The lessons learned during the initial period of the pandemic have given rise to opportunities for the evolution of long-term virtual care. The opportunity to evaluate and improve virtual care should be seized upon.

scholarly journals Virtual Cancer Care During the COVID-19 Pandemic and Beyond: A Call for Evaluation (Preprint)

2020 ◽  
Author(s):  
Oren Hannun Levine ◽  
Michael McGillion ◽  
Mark Levine
Keyword(s):  
Health Care Providers ◽  
Cancer Care ◽  
Initial Period ◽  
Lessons Learned ◽  
Cancer Center ◽  
Care Providers ◽  
Virtual Care ◽  
Care Intervention ◽  
Increased Risk ◽  
National Quality

UNSTRUCTURED The interplay of virtual care and cancer care in the context of the COVID-19 pandemic is unique and unprecedented. Patients with cancer are at increased risk of SARS-CoV-2 infection and have worse outcomes than patients with COVID-19 who do not have cancer. Virtual care has been introduced quickly and extemporaneously in cancer treatment centers worldwide to maintain COVID-19–free zones. The outbreak of COVID-19 in a cancer center could have devastating consequences. The virtual care intervention that was first used in our cancer center, as well as many others, was a landline telephone in an office or clinic that connected a clinician with a patient. There is a lack of virtual care evaluation from the perspectives of patients and oncology health care providers. A number of factors for assessing oncology care delivered through a virtual care intervention have been described, including patient rapport, frailty, delicate conversations, team-based care, resident education, patient safety, technical effectiveness, privacy, operational effectiveness, and resource utilization. These factors are organized according to the National Quality Forum framework for the assessment of telehealth in oncology. This includes the following 4 domains of assessing outcomes: experience, access to care, effectiveness, and financial impact or cost. In terms of virtual care and oncology, the pandemic has opened the door to change. The lessons learned during the initial period of the pandemic have given rise to opportunities for the evolution of long-term virtual care. The opportunity to evaluate and improve virtual care should be seized upon.

Breaking down barriers: A strategic initiative to collect sexual orientation and gender identity information in the oncology patient population.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 128-128
Author(s):  
Georgina T. Rodgers ◽  
Christa Poole ◽  
MaryKay Moore ◽  
Mikayla Baer ◽  
Christina Ferraro ◽  
...  
Keyword(s):  
Sexual Orientation ◽  
Gender Identity ◽  
Health Care Providers ◽  
Comfort Level ◽  
Cancer Center ◽  
Care Providers ◽  
Target Groups ◽  
Oncology Patient ◽  
Increased Risk ◽  
The Impact

128 Background: The LGBT community is a diverse population that crosses race, ethnicity, socioeconomic status, age, and other factors. It is estimated that 8.8 million Americans are part of the community and the number is likely higher due to under reporting. The population is at increased risk for certain cancers, sexually transmitted infections, and is more likely to use alcohol, tobacco, drugs, and suffer from obesity, and behavioral health issues. LGBT patients face barriers to accessing care due to being under-insured, fear of discrimination and lack of access to culturally competent health care providers. Our cancer center embraced the need to collect sexual orientation/gender identity (SOGI) data as a means to identify and address the comprehensive needs of our patients and set a goal to provide an inclusive, patient-centered environment through education of our teams to build a trusted patient-provider relationship. Methods: We implemented a history section in the EHR to assist with data collection including, preferred name, sexual orientation, gender identity, legal sex, and sex assigned at birth. A project team was developed in 2019 to improve utilization of the existing tool and provide education to increase the comfort level of our caregivers. Our target groups consist of advance practice providers, RN care coordinators, social workers and physicians. Educational sessions occurred through multiple modes and “champions” were identified within target groups to keep the momentum going. Results: There was initial hesitation in utilization due to lack of understanding of the impact on patient care and lack of confidence in communication. Training was modified to include communication techniques and the why collection of SOGI data is important. Conclusions: A monthly report was developed to determine utilization of the SOGI fields and as of May 2020 have increased from 1.5% utilization to 17.5% utilization. A survey has been deployed to education attendees to determine pre and post education comfort levels in addressing the SOGI needs of patients and early data is showing a marked improvement in the comfort level of caregivers.

Prevalence of written advance directives (AD) among cancer care providers at a community-based cancer center

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18563-18563
Author(s):  
B. A. Hammes ◽  
J. A. Lee ◽  
M. A. Mathiason ◽  
M. T. Ertz ◽  
L. L. Sheldon ◽  
...  
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Cancer Care ◽  
Medical Condition ◽  
Cancer Center ◽  
Care Providers ◽  
Community Based ◽  
Life Planning ◽  
End Of Life Planning

18563 Background: Cancer care providers frequently discuss AD with their patients. The providers’ own attitudes toward end-of-life planning likely influence the choices and actions of their patients. We investigated the prevalence of written AD among the care providers at our community-based cancer center. Methods: All cancer center employees who have face-to-face contacts with patients (N=170) were sent an email survey in October 2005. This included medical (physicians, 15), associate (physician assistants and nurse practitioners, 7), and support (nurses, radiation therapists, medical or nurse assistants, and patient liaisons; 148) staffs. We collected data on demographics, work history, and AD. Results: A reply was obtained from 136 (80%) individuals. There were more females (90.2%) and the median age was 43 years (range, 20–63). While 82.8% reported to have discussed their wishes regarding future life-sustaining medical care with those closest to them, only 35.1% had a written AD: medical (58.3%), associate (50%), and support staffs (32.2%). Among those with AD, only 66% had made their own care providers aware of this. The top 5 factors that influenced providers whether to have or not to have AD were: experience at work (36.6%), spouse/domestic partner (25.4%), time to complete written AD (23.9%), family members/friends (21.6%) and children (19.4%). Interestingly, no one considered medical condition or illness as a factor. Increased age was significantly associated with having AD (odds ratio: 1.068; 95% CI:1.029–1.108), while the sex, number of years working with cancer patients, provider role, and marital/living status were not. Among the medical and associate staffs, 55.6% reported routinely discussing AD with their patients. Although all medical/associate staffs rated themselves as knowledgeable about and comfortable with discussing AD, the group who had AD was more apt to rate themselves as very knowledgeable and very comfortable. Conclusions: Only about a third of all cancer care providers and about half of cancer physicians at our institution have a written AD. Despite work experience with a patient population having a high mortality rate, cancer care providers do not adequately communicate end-of-life planning to their own health care providers. No significant financial relationships to disclose.

Improving immunization (imm) rates among oncology patients and health care providers (HCP) through a partnership of continuing medical education (CME) and quality improvement (QI) in an NCI-designated comprehensive cancer center.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 43-43
Author(s):  
Lucille A. Leong ◽  
Mary Mendelsohn ◽  
Ted Bruno ◽  
Jean Kagan ◽  
Crystal J. Saavedra ◽  
...  
Keyword(s):  
Learning Styles ◽  
Health Care Providers ◽  
Medical Staff ◽  
Visual Cues ◽  
Point Of Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Providers ◽  
Self Assessment ◽  
Increased Risk

43 Background: Onc pts are at increased risk of vaccine (vac)-preventable diseases and suffer worse sequelae. Regulatory requirements demand imm of patients and HCP. There is a large practice gap among clinicians in awareness of imm guidelines, of pt imm status, and of the high risk of transmission from HCP to immunocompromised pt. Methods: From May 2012 to June 2013 the City of Hope CME coordinated a team of MDs, QI specialists, infection control, IT, nursing, and pharmacy in a QI CME initiative to increase the imm rates of pt and HCP by education (ed) to clinicians, pt and families. Multiple ed platforms were used (live CME meetings, web-based content, point of care applications, visual cues, clinician longitudinal self-assessment surveys, systems-based support tools, patient handouts) with emphasis on MD-friendly platforms. Results: >350 HCP participated in CME events (59% MDs, 18% RN). Analysis of ed and clinical outcomes is from 4 areas. (1) Change in HCP attitudes through self-assessment surveys shows an increase in clinician knowledge of types and timing of imm, in use of system-based tools (standard orders, vac computerized manager), and in involvement of pts in imm history and ed. (2) There was an increase of doses of influenza vaccines in pts (Sept-March, 2010-11/ 2011-12/ 2012-13: 1129/1480(31% increase)/1838(24% increase). (3) Respiratory viral testing of pts was done to assess number of confirmed infections. (4) Influenza vac rates of hospital workers improved with the largest increase in the medical staff (65 to 76%). Conclusions: This interdisciplinary CME initiative to improve imm rates among onc pts involved ed activities and system-based changes. Improvements were seen in areas of HCP attitude, performance, and acceptance of their own vac. 24% of the medical staff remain unvaccinated, raising both ethical and compliance challenges to reach the 2020 90% goal of Joint Commission. A gap remains in HCP attitudes regarding their own vac which may not be amenable to analytical-based CME. Use of other decision-making/learning styles is necessary for further progress. CA62505 and Pfizer.

scholarly journals Telehealth for Cancer Care in Veterans: Opportunities and Challenges Revealed by COVID

2020 ◽  
pp. OP.20.00520
Author(s):  
Cindy Y. Jiang ◽  
Nadeem T. El-Kouri ◽  
David Elliot ◽  
Jenna Shields ◽  
Megan E. V. Caram ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Cancer Care ◽  
The United States ◽  
Lessons Learned ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Potential Cost ◽  
Tertiary Center

The Veterans Health Administration system is one of the largest integrated health care providers in the United States, delivering medical care to > 9 million veterans. Barriers to delivering efficient health care include geographical limitations as well as long wait times. Telehealth has been used as a solution by many different health care services. However, it has not been as widely used in cancer care. In 2018, the US Department of Veterans Affairs (VA) Pittsburgh Healthcare System expanded the use of telehealth to provide antineoplastic therapies to rural patients by creating a clinical video telehealth clinic of the Virtual Cancer Care Network. This allows oncologists located at the tertiary center to virtually deliver care to remote sites. The recent COVID-19 pandemic forced oncologists across the VA system to adopt telehealth to provide continuity of care. On the basis of our review and personal experience, we have outlined opportunities for telehealth to play a role in every step of the cancer care journey from diagnosis to therapy to surveillance to clinical trials for medical, surgical, and radiation oncology. There are many advantages, such as decreased travel time and potential cost savings; however, there continues to be challenges with veterans having access to devices and the Internet as well as understanding how to use telehealth equipment. The lessons learned from this assessment of the VA telehealth system for cancer care can be adopted and integrated into other health systems. In the future, there needs to be evaluation of how telehealth can be further incorporated into oncology, satisfaction of veterans using telehealth services, overcoming telehealth barriers, and defining metrics of success.

Medical Informatics and the Quality of Health: New Approaches to Support Patient Care

2003 ◽  
Vol 42 (02) ◽  
pp. 185-189 ◽  
Author(s):  
R. Haux ◽  
C. Kulikowski ◽  
A. Bohne ◽  
R. Brandner ◽  
B. Brigl ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Informatics ◽  
Health Care Providers ◽  
Medical Knowledge ◽  
Lessons Learned ◽  
Care Providers ◽  
Access To Health Services ◽  
Leading Role ◽  
Future Challenges

Summary Objectives: The Yearbook of Medical Informatics is published annually by the International Medical Informatics Association (IMIA) and contains a selection of excellent papers on medical informatics research which have been recently published (www.yearbook.uni-hd.de). The 2003 Yearbook of Medical Informatics took as its theme the role of medical informatics for the quality of health care. In this paper, we will discuss challenges for health care, and the lessons learned from editing IMIA Yearbook 2003. Results and Conclusions: Modern information processing methodology and information and communication technology have strongly influenced our societies and health care. As a consequence of this, medical informatics as a discipline has taken a leading role in the further development of health care. This involves developing information systems that enhance opportunities for global access to health services and medical knowledge. Informatics methodology and technology will facilitate high quality of care in aging societies, and will decrease the possibilities of health care errors. It will also enable the dissemination of the latest medical and health information on the web to consumers and health care providers alike. The selected papers of the IMIA Yearbook 2003 present clear examples and future challenges, and they highlight how various sub-disciplines of medical informatics can contribute to this.

scholarly journals Are antiretrovirals prescribed according to the recommended prescribed daily doses in the private healthcare sector in South Africa

2011 ◽  
Vol 16 (1) ◽  
Author(s):  
Norah L. Katende-Kyenda ◽  
Martie Lubbe ◽  
Juan H.P. Serfontein ◽  
Ilse Truter
Keyword(s):  
South Africa ◽  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Health Care Sector ◽  
Hiv And Aids ◽  
Healthcare Sector ◽  
Private Health Care ◽  
Care Providers ◽  
Increased Risk

Current antiretroviral treatment (ART) guidelines recommend different combinations that have led to major improvements in the management of HIV and AIDS in the developed and developing world. With the rapid approval of many agents, health care providers may not be able to familiarise themselves with them all. This lack of knowledge leads to increased risk of dose- prescribing errors, especially by non-HIV and AIDS specialists. The purpose of this retrospective non-experimental, quantitative drug utilisation study was to evaluate if antiretrovirals (ARVs) are prescribed according to the recommended prescribed daily doses (PDDs) in a section of the private health care sector in South Africa (SA). Analysed ARV prescriptions (49995, 81096 and 88988) for HIV and AIDS patients were claimed from a national medicine claims database for the period 1 January 2005 through to 31 December 2007. ARV prescriptions prescribed by general practitioners (GPs) with PDDs not according to the recommended ARV dosing increased dramatically, from 12.33% in 2005 to 24.26% in 2007. Those prescribed by specialists (SPs) increased from 15.46% in 2005 to 35.20% in 2006 and decreased to 33.16% in 2007. The highest percentage of ARV prescriptions with PDDs not according to recommended ARV dosing guidelines was identified in ARV regimens with lopinavir−ritonavir at a PDD of 1066.4/264 mg and efavirenz at a PDD of 600 mg prescribed to patients in the age group of Group 3 (19 years > age ≤ 45 years). These regimens were mostly prescribed by GPs rather than SPs. There is a need for more education for all health care professionals and/or providers in the private health care sector in SA on recommended ARV doses, to avoid treatment failures, development of resistance, drug-related adverse effects and drug interactions.OpsommingHuidige riglyne vir behandeling met antiretrovirale middels beveel verskillende kombinasies aan wat tot groot verbetering in die beheer van MIV en VIGS in die ontwikkelde en ontwikkelende wêreld gelei het. Met die vinnige goedkeuring van talle nuwe middels kan dit gebeur dat verskaffers van gesondheidsorg nie kan bybly om hulle hiermee op hoogte te hou nie. Hierdie gebrek aan kennis lei tot ‘n hoër risiko vir foute in die voorgeskrewe dosis en veral deur persone wat nie spesialiste in MIV en VIGS is nie. Die doel van hierdie nie-eksperimentele, retrospektiewe, kwantitatiewe studie van die gebruik van geneesmiddels was om te bepaal of antiretrovirale middels in ‘n deel van die privaat gesondheidsorgsektor in Suid-Afrika (SA) volgens die aanbevole voorgeskrewe daaglikse dosisse (VDD) voorgeskryf word. Voorskrifte van antiretrovirale middels (49995, 81096 en 88988) aan pasiënte met MIV en VIGS wat in die periode van 1 Januarie 2005 tot 31 Desember 2007 van ‘n nasionale medisyne databasis geëis is, is ontleed. Voorskrifte van antiretrovirale middels deur algemene praktisyns (APs) met VDDs wat nie volgens die aanbevole dosisse vir antiretrovirale middels was nie, het dramaties van 12.33% in 2005 tot 24.26% in 2007 toegeneem. Die wat deur spesialiste (SPs) voorgeskryf is, het van 15.46% in 2005 tot 35.20% in 2006 toegeneem en in 2007 tot 33.16% gedaal. Die hoogste persentasie van voorskrifte vir antiretrovirale middels met VDDs wat nie volgens die riglyne was nie, was in die regimens met lopinavir−ritonavir met ‘n VDD van 1066.4/264 mg en efavirens met ‘n VDD van 600 mg wat aan pasiënte in die ouderdomsgroep van ouer as 19 tot en met 45 jaar voorgeskryf is. Hierdie regimens is meer deur APs as deur SPs voorgeskryf. Daar is ‘n behoefte aan nog opleiding van alle gesondheidsprofessies en/of voersieners in die privaat gesondheidsorgsektor in SA oor die aanbevole antiretrovirale middel-dosisse om mislukking van behandeling, ontwikkeling van weerstand, nadelige effekte vanweë geneesmiddels en geneesmiddel interaksies te voorkom.

scholarly journals Uptake and Scalability of a Peritoneal Dialysis Virtual Care Solution: Qualitative Study (Preprint)

2017 ◽  
Author(s):  
Lianne Jeffs ◽  
Trevor Jamieson ◽  
Marianne Saragosa ◽  
Geetha Mukerji ◽  
Arsh K Jain ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Health Care Providers ◽  
Decision Makers ◽  
Care Providers ◽  
Factors Influencing ◽  
Virtual Care ◽  
Key Stakeholders ◽  
Hands On ◽  
Semistructured Interviews ◽  
At Home

BACKGROUND Early research in the area of virtual care solutions with peritoneal dialysis (PD) patients has focused on evaluating the outcomes and impact of these solutions. There has been less attention focused on understanding the factors influencing the uptake, usability, and scalability of virtual care for chronic kidney disease (CKD) patients receiving PD at home. OBJECTIVE In this context, a study was undertaken to (1) assess and understand the factors influencing the uptake of a virtual care solution and (2) provide recommendations for the scalability of a virtual care solution aimed at enhancing CKD patients’ outcomes and experiences. METHODS This study used a qualitative design with semistructured interviews and a thematic analysis approach. A total of 25 stakeholders—6 patients and 3 caregivers, 6 health care providers, 2 vendors, and 8 health system decision makers—participated in this study. RESULTS The following three primary mechanisms emerged to influence the usability of the virtual care solution: (1) receiving hands-on training and ongoing communication from a supportive team, (2) adapting to meet user needs and embedding them into workflow, and (3) being influenced by patient and caregiver characteristics. Further, two overarching recommendations were developed for considerations around scalability: (1) co-design locally, embed into the daily workflow, and deploy over time and (2) share the benefits and build the case. CONCLUSIONS Study findings can be used by key stakeholders in their future efforts to enhance the implementation, uptake, and scalability of virtual care solutions for CKD and managing PD at home.

Sign in / Sign up

Export Citation Format

Share Document