scholarly journals Electronic Consultation Services Worldwide: Environmental Scan (Preprint)

2018 ◽  
Author(s):  
Justin Joschko ◽  
Erin Keely ◽  
Rachel Grant ◽  
Isabella Moroz ◽  
Matthew Graveline ◽  
...  
Keyword(s):  
Health Care ◽  
Literature Review ◽  
Literature Search ◽  
Primary Care Providers ◽  
Care Providers ◽  
Patient Anxiety ◽  
Specialist Care ◽  
Environmental Scan ◽  
Gray Literature ◽  
Electronic Consultation

BACKGROUND Excessive wait times for specialist care pose a serious concern for many patients, leading to duplication of tests, patient anxiety, and poorer health outcomes. In response to this issue, many health care systems have begun implementing technological innovations designed to improve the referral-consultation process. Among these services is electronic consultation (eConsult), which connects primary care providers and specialists through a secure platform to facilitate discussion of patients’ care. OBJECTIVE This study aims to examine different eConsult services available worldwide and compare the strategies, barriers, and successes of their implementation in different health care contexts. METHODS We conducted an environmental scan comprising 3 stages as follows: literature review; gray literature search; and targeted, semistructured key informant interviews. We searched MEDLINE and EMBASE (literature review) and Google (gray literature search). Upon completing the search, we generated a list of potential interview candidates from among the stakeholders identified. Potential participants included researchers, physicians, and decision makers. The maximum variation sampling was used to ensure sufficient breadth of participant experience. In addition, we conducted semistructured interviews by telephone using an interview guide based on the RE-AIM framework. Analyses of transcripts were conducted using a thematic synthesis approach. RESULTS A total of 53 services emerged from the published and gray literature. Respondents from 10 services participated in telephonic interviews. The following 4 major themes emerged from the analysis: service structure; benefits of eConsult; implementation challenges; and implementation enablers. CONCLUSIONS eConsult services have emerged in a variety of countries and health system contexts worldwide. Despite differences in structure, platform, and delivery of their services, respondents described similar barriers and enablers to the implementation and growth and reported improved access and high levels of satisfaction.

scholarly journals Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan

10.2196/17672 ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. e17672
Author(s):  
Peter George Jaminal Tian ◽  
Jeffrey Richard Harris ◽  
Hadi Seikaly ◽  
Thane Chambers ◽  
Sara Alvarado ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Literature Search ◽  
Primary Care Providers ◽  
Emergency Department Visits ◽  
Care Providers ◽  
Specialist Care ◽  
Telephone Consultation ◽  
Cost Avoidance ◽  
Environmental Scan ◽  
Physician Consultation

Background Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. Objective As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. Methods We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. Results The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. Conclusions Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use. 

scholarly journals Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan (Preprint)

2020 ◽  
Author(s):  
Peter George Jaminal Tian ◽  
Jeffrey Richard Harris ◽  
Hadi Seikaly ◽  
Thane Chambers ◽  
Sara Alvarado ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Literature Search ◽  
Primary Care Providers ◽  
Emergency Department Visits ◽  
Care Providers ◽  
Specialist Care ◽  
Telephone Consultation ◽  
Cost Avoidance ◽  
Environmental Scan ◽  
Physician Consultation

BACKGROUND Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. OBJECTIVE As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. METHODS We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. RESULTS The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. CONCLUSIONS Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use. 

scholarly journals SAT0640-HPR RHEUMATOLOGY CARE OF MIGRANTS FROM SUB-SAHARAN AFRICA; A QUALITATIVE PILOT STUDY OF PATIENTS’ PERSPECTIVES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1279.1-1279
Author(s):  
Z. Rutter-Locher ◽  
J. Galloway ◽  
H. Lempp
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Care ◽  
Health Care Providers ◽  
Unmet Need ◽  
Primary Care Providers ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Specialist Care ◽  
Sub Saharan ◽  
The Uk

Background:Rheumatological diseases are common in Sub-Saharan Africa [1] but specialist healthcare is limited and there are less than 150 rheumatologists currently serving 1 billion people in Sub-Saharan Africa [2]. Rheumatologists practising in the UK NHS are likely to be exposed to migrant patients. There is therefore, an unmet need for health care providers to understand the differences in rheumatology healthcare provision between Sub-Saharan Africa and the UK and the barriers which migrants face in their transition of rheumatology care.Objectives:To gain an understanding of the experiences of patients with rheumatological conditions, about their past healthcare in Sub-Saharan Africa and their transition of care to the UK.Methods:A qualitative study using semi-structured interviews was conducted. Participants were recruited from two rheumatology outpatient clinics in London. Thematic analysis was applied to identify key themes.Results:Seven participants were recruited. Five had rheumatoid arthritis, one had ankylosing spondylitis and one had undifferentiated inflammatory arthritis. Participants described the significant impact their rheumatological conditions had on their physical and emotional wellbeing, including their social and financial implications. Compared to the UK, rheumatology healthcare in Sub-Saharan Africa was characterised by higher costs, limited access to specialists, lack of investigations and treatments, the use of traditional medicines and poor communication by clinicians. Barriers to transition of rheumatology care to the UK were: poor understanding of rheumatological conditions by the public and primary care providers, lack of understanding of NHS entitlements by migrants, fear of data sharing with immigration services and delayed referral to specialist care. Patient, doctor and public education were identified by participants as important ways to improve access to healthcare.Conclusion:This study has described, for the first time, patients’ perspectives of rheumatology health care in Sub-Saharan Africa and the transition of their care to the UK. These initial findings allow healthcare providers in the UK to tailor management for this migrant population and suggests that migrants need more information about their NHS entitlements and specific explanations on what non-clinical data will be shared with immigration services. To increase access to appropriate care, a concerted effort by clinicians and public health authorities is necessary to raise awareness and provide better education to patients and migrant populations about rheumatological conditions.References:[1]G. Mody, “Rheumatology in Africa-challenges and opportunities,” Arthritis Res. Ther., vol. 19, no. 1, p. 49, 2017.[2]M. A. M. Elagib et al., “Sudan and Sweden Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between,” J. Rheumatol. J. Rheumatol. January, vol. 43, no. 10, pp. 1777–1786, 2016.Acknowledgments:We are grateful to the patients involved in this study for their time and involvement.Disclosure of Interests:None declared

scholarly journals eConsults and Learning Between Primary Care Providers and Specialists

2019 ◽  
Vol 51 (7) ◽  
pp. 567-573 ◽  
Author(s):  
Clare Liddy ◽  
Tala Abu-Hijleh ◽  
Justin Joschko ◽  
Douglas Archibald ◽  
Erin Keely
Keyword(s):  
Primary Care ◽  
Qualitative Content Analysis ◽  
Primary Care Providers ◽  
Free Text ◽  
Care Providers ◽  
Specialist Care ◽  
Educational Tools ◽  
Educational Value ◽  
Electronic Consultation ◽  
Poor Access

Background and Objectives: Patients in many countries face poor access to specialist care. Electronic consultation (eConsult) improves access by allowing primary care providers (PCPs) and specialists to communicate electronically. As more countries adopt eConsult services, there has been growing interest in leveraging them as educational tools. Our study aimed to assess PCPs’ perspectives on eConsult’s ability to improve collegiality between providers and serve as an educational tool. Methods: We conducted a qualitative content analysis of free-text comments left by PCPs using the Champlain BASE eConsult service based in Eastern Ontario, Canada. All responses provided between January 1, 2015 and January 31, 2017 that mentioned education or collegiality were included. Results: PCPs completed 16,712 closeout surveys during the study period, of which 3,601 (22%) included free-text comments. Of these, 223 (6%) included references to education or collegiality. Three prominent themes emerged from the data: building provider relationships, teaching incorporated into answer, and prompting further learning. Conclusions: PCPs described eConsult’s ability to foster stronger relationships with specialists, deliver responses that provided teaching in multiple areas of their practice, and support further learning that extended beyond the case at hand and into their overall practice. The Champlain BASE eConsult service has educational value for providers. Further study is underway to explore how questions and replies submitted through eConsult can be used to facilitate reflective learning and promote feedback to providers.

scholarly journals What are the impacts when primary care providers diminish stigma for patients with opioid use disorder in British Columbia?

2020 ◽  
Author(s):  
◽  
Mary MacLellan
Keyword(s):  
Primary Care ◽  
Health Care ◽  
British Columbia ◽  
Literature Review ◽  
Access To Health Care ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Care Providers ◽  
Opioid Use

Stigma is a complex phenomenon with a myriad of detrimental health and social impacts that are not fully studied or understood. Persistent stigma exists towards individuals who have opioid use disorder (OUD) in British Columbia. OUD is a chronic, relapsing, clinical condition that has been identified as one of the most challenging substance use disorders. For those affected, they must also endure the consequences of stigma that promote barriers to health care, health and social inequalities, diminished quality of life as well as increased morbidity and mortality. The current unremitting opioid overdose crisis in British Columbia further emphasizes the importance of eradicating stigma towards individuals who use opioids and/or suffer from OUD, as untreated OUD is fueling this multifaceted public health emergency. For these reasons, an integrative literature review has been conducted to identify how primary care providers in British Columbia can address the intersecting stigmas for individuals suffering OUD. The results are discussed within the context of primary health care in British Columbia. Whittemore and Knafl’s approach to the integrative literature review was utilized in this study to review eleven pertinent articles. The findings suggest that stigma occurs on varying levels for individuals with OUD that serve to reinforce each other and manifest as discrimination, mistrust, social distancing, minimized advocacy, unequal access to health care and suboptimal health care. Further, the findings indicated that the role of primary care providers may be instrumental in eradicating stigma in a timely manner. Recommendations for primary care providers to dismantle the stigma associated with OUD are discussed, and specific strategies for the primary care setting are presented.

754 Insomnia and Depression Symptoms in Primary Care Patients Referred for Mental Health Care

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A294-A294
Author(s):  
Ivan Vargas ◽  
Alexandria Muench ◽  
Mark Seewald ◽  
Cecilia Livesey ◽  
Matthew Press ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Primary Care Providers ◽  
Depression Symptoms ◽  
Care Providers ◽  
Mild Depression ◽  
Significant Depression ◽  
Clinically Significant

Abstract Introduction Past epidemiological research indicates that insomnia and depression are both highly prevalent and tend to co-occur in the general population. The present study further assesses this association by estimating: (1) the concurrence rates of insomnia and depression in outpatients referred by their primary care providers for mental health care; and (2) whether the association between depression and insomnia varies by insomnia subtype (initial, middle, and late). Methods Data were collected from 3,174 patients (mean age=42.7; 74% women; 50% Black) who were referred to the integrated care program for assessment of mental health symptoms (2018–2020). All patients completed an Insomnia Severity Index (ISI) and a Patient Health Questionnaire (PHQ-9) during their evaluations. Total scores for the ISI and PHQ-9 were computed. These scores were used to categorize patients into diagnostic groups for insomnia (no-insomnia [ISI < 8], subthreshold-insomnia [ISI 8–14], and clinically-significant-insomnia [ISI>14]) and depression (no-depression [PHQ-914]). Items 1–3 of the ISI were also used to assess the association between depression and subtypes of insomnia. Results Rates of insomnia were as follows: 34.6% for subthreshold-insomnia, 35.5% for clinically-significant insomnia, and 28.9% for mild-depression and 26.9% for clinically-significant-depression. 92% of patients with clinically significant depression reported at least subthreshold levels of insomnia. While the majority of patients with clinical depression reported having insomnia, the proportion of patients that endorsed these symptoms were comparable across insomnia subtypes (percent by subtype: initial insomnia 63%; middle insomnia 61%; late insomnia 59%). Conclusion According to these data, the proportion of outpatients referred for mental health evaluations that endorse treatable levels of insomnia is very high (approximately 70%). This naturally gives rise to at least two questions: how will such symptomatology be addressed (within primary or specialty care) and what affect might targeted treatment for insomnia have on health were it a focus of treatment in general? Support (if any) Vargas: K23HL141581; Perlis: K24AG055602

Introducing Shared Mental Health Care in Northwestern Ontario: An Analysis of Changing Referral Patterns of Primary Care Providers

2015 ◽  
Vol 34 (2) ◽  
pp. 63-72 ◽  
Author(s):  
Graham Gaylord ◽  
S. Kathleen Bailey ◽  
John M. Haggarty
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
Community Mental Health Services ◽  
Primary Care Providers ◽  
Care Providers ◽  
Referral Patterns

This study describes a shared mental health care (SMHC) model introduced in Northern Ontario and examines how its introduction affected primary care provider (PCP) mental health referral patterns. A chart review examined referrals (N = 4,600) from 5 PCP sites to 5 outpatient community mental health services from January 2001 to December 2005. PCPs with access to SMHC made significantly more mental health referrals (p < 0.001). Two demographically similar PCPs were then compared, one co-located with SMHC. Referrals for depression to non-SMHC mental health services were 1.69 times more likely to be from the PCP not co-located with SMHC (p < 0.001). Findings suggest SMHC increases access to care and decreases demand on existing mental health services.

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