Consultation Model Research Articles

The Advisory Board on Cancer, Infertility and Pregnancy: a virtual on-demand multidisciplinary tumour board.

Multidisciplinary consultations are part of standard oncological care. These consultations ensure that patients’ cases are discussed by all involved specialists and that a consensus is reached on the most appropriate treatment course.1 The multidisciplinary consultation model is adequate for most patients with cancer, but teams might have insufficient expertise for people with rare cancers or conditions. Cancer during pregnancy is an example of such a rare condition, for which the traditional single-centre multidisciplinary team might not have the expertise to provide a recommendation.

An exploration of strength-based consultation; The Tree of Change

AimsThis paper presents and evaluates the consultation model Tree of Change (ToC) which offers an alternative approach to traditional problem-solving consultation frameworks for practice in educational psychology. ToC aims to resolve many of the issues associated with the traditional deficit models by enhancing the positive developmental pathways of pupils through augmenting their strengths, as opposed to focusing solely on reducing or eliminating the stated issue of concern (Donovan & Nickerson, 2007; Nickerson & Fishman, 2013; Resiliency Initiatives, 2011).MethodThis study was set within diverse ethnic and socio-economic communities based in north and east London. The researcher used a qualitative case study design. For the purpose of this study, case studies have been defined as a strategy for carrying out an investigation of a particular occurrence within the context of ‘the real world’ (Robson, 2011). The present study fits within Robson’s notion of a ‘set of individual case studies’ because it involves the study of a common set of features (e.g. exploring the implementation of ToC) across eleven consultations: nine Educational Psychologist (EP)and two EP-Teacher-Parent-pupil consultations. In total four EPs participated in the study all of whom were female. Eleven case studies were generated as a result of this: EP A submitting one case study, EP B submitting five cases, EP C submitting three cases and EP D providing two cases. The ethnicity of the EPs were black British, white British and Italian. The ethnicity of the consultees is reported in appendix 3. Consultation meetings were facilitated by EPs using the ToC model, please refer to appendix 1.FindingsEvaluation data revealed the ToC approach generated pupils’ strengths at different levels of ecology which influenced action plans by affecting the choice of strategy and/or target of interventions for young people.LimitationsData purported that information about the ToC should be shared in advance of consultation meetings so that consultees can better prepare and familiarise themselves with the process. Using the ToC virtually reportedly reduced relational connections when compared to engaging in this process face-to-face.ConclusionsThe ToC is a collaborative consultation framework which creates positive developmental pathways for pupils through augmenting their strengths and reducing the emphasis placed on their deficits. The process promotes shared understanding of pupil’s narratives and empowers marginalised voices.

The Analysis of Additional Needs (AANT): Online educational psychology analysis and consultation process

Aim(s)This exploratory research aimed toexplorethe views of education setting staff who have undertaken an Analysis of Additional Needs Screening Tool (AANT) online assessment and consultation with an Educational Psychologist (EP). Initially, education staff complete the online AANT form, comprising a range of solution-oriented questions about the child or young person’s strengths and difficulties. This is followed by a consultation with an EP. Whilst the EP service now utilises video conferencing applications, at the time of this research the consultation was undertaken either face-to-face (F2F) or using the telephone. The research questions centred around the importance of hearing the experiences of education staff as consultees within the AANT process, and how their views might inform further development of the AANT consultation process.Method/RationaleThis exploratory study involved two phases. The first involved three F2F semi-structured interviews with staff who had taken part in both F2F and telephone EP consultation, after having completed the AANT online assessment. This led to phase two which asked specific questions of 46 education staff via a semi-structured telephone conversation with a member of the Local Authority (LA) Psychology & Therapeutic Services (P&TS). The EP Service sits within the P&TS.FindingsThe findings in phase one identified predominant themes relating to the EP Service, how education setting staff engage with and feel about the AANT, the AANT process and AANT outcomes. Broad indicators from this exploratory research are that staff found the AANT process useful and both EP consultation models acceptable and effective. The findings informed further development work in the EP Service.LimitationsThis work was undertaken within one LA and therefore represents a small, but encouraging, geographical sample.ConclusionsAnalysis of the findings helped the LA EP Service to develop the AANT online digital platform which enables effective remote consultation with education setting staff alongside a traditional F2F service delivery model. The level of enthusiastic uptake and positive feedback from educational settings for all ages has exceeded all expectation. The findings extend the evidence base around the use of digital assessment methods and telephone consultation.

Why the Individual Provider Approach to Pediatric Palliative Care Consultation Exacerbates Healthcare Disparities: A Moral Argument for Standard Referral Criteria

Pediatric palliative care is specialized medical care for children who live with serious and life-limiting illnesses, with the central goal to improve quality of life for both children and their families. Presently, a majority of pediatric palliative care referrals are based on the traditional consultative model, in which primary providers serve as the gatekeepers to palliative care access. It is well-known that racial and ethnic healthcare disparities exist across the continuum of care, fraught with healthcare providers' biases that impact the care delivered. This includes the referral practices, allocation and utilization of palliative care services, and leaving vulnerable children and families with potentially unmet palliative care needs. We make the moral argument that the establishment of standard referral criteria for pediatric palliative care services is one simple step that must be taken to begin to address and hopefully ameliorate the impact of providers' biases and disparities that exist within pediatric palliative care.

Matching Autism Interventions to Goals With Planned Adaptations Using COMPASS

To understand the process by which evidence-based practices (EBPs) move from identification as effective through research establishing empirically validated effects, to being routinely adopted to bring about meaningful impact, we examined the selection/adaptation process within a well-established consultation model, COMPASS, applying two frameworks—the Evidence-Based Practice in Psychology (EBPP) Framework and the Consolidated Framework for Implementation Research (CFIR). The EBPP Framework proposes the equal importance of the EBP, student/family factors, and school/teacher factors in decision-making. CFIR highlights greater understanding of the iterative decision-making process and elucidates how an EBP moves through selection, adaptation, and use. Descriptive analysis of COMPASS intervention plans revealed that five EBPs were selected on average and specific EBPs were based on goal domain. Social goals used the widest variety of EBPs and demonstrated the greatest number of intercorrelations with other EBPs. Goal attainment outcomes were similar across goal domains.

Abstract 12170: A National Heart Failure Initiative is Associated With Improved Use of Guideline-Directed Medical Therapies

Background: Heart Failure (HF) is projected to impact over 8 million people by 2030. Guideline-Directed Medical Therapy (GDMT) reduces mortality and morbidity, but many eligible patients are not receiving the recommended medications. The 2022 ACC/AHA/HFSA Guideline for the Management of HF highlight the importance of SGLT2i and ARNi, which continue to be underused in eligible HFrEF patients. Methods: IMPLEMENT-HF (I-HF), a national HF quality improvement initiative focusing on early adoption of GDMT, aims to improve use of SGLT2i and ARNi for HFrEF patients. I-HF creates a transformative learning collaborative and resource repository across seven U.S regions to promote education and adherence to GDMT, that includes sharing models of clinical care, targeted training, resource development, and quality improvement consultation. Participation in a learning collaborative allows for sharing of interventions, such as adding SGLT2i on formulary, optimizing EHR tools for GDMT (best practice alerts, disease-specific order sets, dot phrases), provider education, and patient resources to address medication affordability. Sites receive educational materials, including webinars, pocket guideline booklets, and guideline reminder cards to reinforce GDMT. Participating hospitals collect GDMT data in Get With The Guidelines®-Heart Failure (GWTG-HF). ARNi and SGLT2i at discharge was analyzed from baseline (Q1 & Q2 2021 aggregate) through Q1 2022. Results: Data from 62 sites (16,533 HF patient records) showed that use of ARNi at hospital discharge increased from baseline 46% to 58% in Q1 2022, +12%, p value <0.001. SGLT2i use at discharge increased from 8% to 26%, +18%, p value <0.001 (Figure 1). Conclusions: Among centers participating in the I-HF initiative, early findings suggest there has been a rapid increase in use of SGLT2i and ARNi at discharge for HFrEF patients. Further study is needed to assess post-discharge GDMT use, adherence, and clinical outcomes.

An evaluation of telephone versus videoconference consults for pre-treatment medication history taking by cancer pharmacists

Introduction The primary aim was to compare the successful completion rates of pre-treatment medication history consults conducted by pharmacists with patients either via an unscheduled telephone consult (current standard care) or a scheduled videoconference consult model. Secondary aims were to examine pharmacist perceptions of the telephone and videoconference consults and explore patient (+/− support person) perceptions of videoconference consults. Method Completion data were collected and compared for the two modalities. In addition, pharmacists commented on any positive/negative factors impacting all consults. For the final 35 participants completing a videoconference consult, patients, support people, and pharmacists involved, completed a survey exploring perceptions and satisfaction. Results A significantly higher completion rate (p < 0.0001) was found for the videoconferencing model, with 94% (76 of 81) completed successfully compared to 72% (76 of 105) of the unscheduled telephone consults. Pharmacists reported multiple factors impacting the success of the telephone consults including scheduling issues and patient factors. Survey responses revealed that 100% of patients/support people and 82% of pharmacists reported satisfaction with videoconference consults. Surveyed participants noted some technical issues, however, the ‘ability to show/view medication containers and/or labels’ and ‘convenience of scheduled time’ were benefits of the videoconference model. Discussion Results indicate that pre-treatment medication history consults should be offered via videoconference to maximise success.

Personalized Intelligent Syndrome Differentiation Guided By TCM Consultation Philosophy.

Traditional Chinese Medicine (TCM) is one of the oldest medical systems in the world, and inquiry is an essential part of TCM diagnosis. The development of artificial intelligence has led to the proposal of several computational TCM diagnostic methods. However, there are few research studies among them, and they have the following flaws: (1) insufficient engagement with the patient, (2) barren TCM consultation philosophy, and (3) inadequate validation of the method. As TCM inquiry knowledge is abstract and there are few relevant datasets, we devise a novel knowledge representation technique. The mapping of symptoms and syndromes is constructed based on the diagnostics of traditional Chinese medicine. As a guide, the inquiry knowledge base is constructed utilizing the "Ten Brief Inquiries," TCM's domain knowledge. Subsequently, a corresponding assessment approach is proposed for an intelligent consultation model for syndrome differentiation. We establish three criteria: the quality of the generated question-answer pairs, the accuracy of model identification, and the average number of questions. Three TCM specialists are asked to undertake a manual evaluation of the model separately. The results reveal that our approach is capable of pretty accurate syndrome differentiation. Furthermore, the model's question and answer pairs for simulated consultations are relevant, accurate, and efficient.

Strengthening Home Visitor Practice Through an Embedded Model of Infant and Early Childhood Mental Health Consultation.

Home visitors face the difficult task of engaging and supporting families who experience economic, social, and mental health challenges. Infant and Early Childhood Mental Health Consultation (IECMHC) is one strategy to improve early childhood professionals' abilities to promote maternal and children's mental health through relationship building and collaboration. To date, most of the evidence showing positive effects of IECMHC comes from evaluations conducted in center-based early childhood programs. Only a few have examined the implementation and outcomes of IECMHC in home visiting programs. Using a longitudinal, matched-comparison group design, a three-year pilot study of a cross-system, embedded model of IECMHC assessed implementation and outcomes for teachers and home visitors. Here, we focus on intervention effects on home visitor-family relationships based on an analysis of 42 recordings of home visits. We used the Home Visit Rating Scales Adapted & Extended to Excellence (HOVRS-A+ v.2.1; Roggman et al., in2010) and created another scale, the IECMHC scale, of items aligned with the expected outcomes of the model. Home visitors in the intervention group scored significantly higher on the HOVRS-A+ home visitor responsiveness to family scale over time than those in the comparison group. Additionally, scores of home visitors in the intervention group increased at a greater rate, on average, on the newly developed IECMHC scale than scores of home visitors in the comparison group. We conclude that the Illinois model of IECMHC successfully improved home visitors' responsiveness to families and improved the quality of home visits. Due to the small sample, we recommend further study of the model in home visiting and further development of the IECMHC scale as part of the HOVRS-A+ .

Telefonische Sprechstunde am Institut und der Poliklinik für Arbeits-, Sozial- und Umweltmedizin der Friedrich-Alexander-Universität Erlangen-Nürnberg

Telephone consultation at the Institute and Outpatient Clinic of Occupational, Social, and Environmental Medicine at the Friedrich-Alexander-University of Erlangen-Nürnberg Objective: With the spread of the COVID-19 pandemic, the goal was to establish telephone consultations at the Institute and Outpatient Clinic of Occupational, Social, and Environmental Medicine at the Friedrich-Alexander-University of Erlangen-Nürnberg. Methods: After initial contact, the patient’s suitability for a telephone consultation is verified and an outpatient appointment can be explicitly requested. Prior to the consultation, written consent and a referral must be submitted; the submission of additional documents is optional. During the telephone appointment, the data are first compared. If there is any indication of a need for biomonitoring, the samples are usually taken by the referring physician and the analysis is performed in our laboratory. Finally, a doctor’s letter is written. Results: Since March 2020, 139 patients out of 253 referrals have been advised by telephone and 30 on an outpatient basis. Of all telephone consultation cases, 53.2 % (n = 74) were female. The mean age of patients advised by phone was 51.3 years, the mean duration of the call was 54.3 minutes, and the mean potential travel distance was 69.7 kilometres. A potential 9,688.8 kilometres of travel were thus avoided due to the availability of phone consultations. Biomonitoring was initiated in 23.7 % of cases, technical information was submitted in 88.5 %, further diagnostics were recommended in 37.4 %. A telephone consultation was deemed useful by physicians in 99.3 % of cases. Conclusion: Our model of a telephone consultation in the areas of occupational and environmental medicine enabled meaningful and effective patient care including both anamnesis and medical advice. Keywords: telephone consultation – consultation in occupational and environmental medicine – telemedicine

Application of the DanOBS questionnaire combined with a patient-centered consultation video for measuring teaching efficacy in a general practice course.

Introduction Diverse ways to measure course effectiveness in medical education exist, but it takes time to have the results. The authors have developed a tool consisting of a questionnaire (DanOBS) combined with a test video consultation. The students watched a consultation video and completed a questionnaire about patient-centered elements before and after the course. This study aimed to assess the utility of a new quick tool for measuring efficacy in teaching the patient-centered consultation model. Method Altogether 201 students from autumn 2019 were included in this study, assigned by the university to three general practice courses and six small study groups. After introducing the patient-centered consultation model on the first day of the course, the students watched a video consultation and completed the DanOBS online on their Mobile Phones. They watched the video and completed the questionnaire again on one of the last days of the course. The number of correct answers in each item was compared before and after the course. Furthermore, effect sizes for each item were calculated. Results The number of students completing the questionnaire before and after the course was 161. The number of correct answers increased after the course. Items where the teaching was a success, as well as items where it needs intensifying, were identified. The DanOBS instrument reflected the effect of strengthening the learning in some elements of the patient-centered mode. Conclusion A tool for measuring efficacy in teaching patient-centered consultation has been implemented and has given valuable information to teachers about where the students need intensified teaching. The tool can measure the effectiveness of various educational interventions.

Building reflective capacity and improving well-being of early childhood professionals through an embedded cross-system model of infant early childhood mental health consultation.

Infant and Early Childhood Mental Health Consultation (IECMHC) aims to improve early childhood professionals' abilities to promote children's mental health through relationship building and collaboration. Using a longitudinal, matched-comparison group design, a 3-year pilot study of a cross-system, embedded model of IECMHC assessed teachers and home visitors in intervention and comparison programs in reflective capacity, burnout, and perceptions of children's behavior. A sample of 136 staff (n = 72 intervention group; n = 64 comparison group; 21% Black; 51% White; 28% Latina/Hispanic) participated in surveys over a 21-month implementation period. A subsample of staff (n = 26) participated in interviews that included a narrative measure of reflective capacity; and a smaller subsample of teachers only (n = 21) completed assessments of children. Staff in the intervention group significantly increased reflective capacity after 21 months. For the staff interview subsample, receiving the intervention predicted lower levels of burnout at 12-15 months post-baseline. Among teachers completing child assessments, those with higher reflective capacity rated children's behaviors more positively than teachers with lower reflective capacity. We conclude that this IECMHC model successfully improved reflective capacity in staff. Future research should investigate reflective capacity as a potential mechanism of change for IECMHC.

Development and implementation of a tool for measuring the training effectiveness of the patient-centered consultation model

Background: The patient-centered consultation model comprises four elements: exploring health, illness and disease experiences, understanding the whole person, finding common ground, and enhancing the patient-doctor relationship. This method is taught at the course in general practice at Copenhagen University. The aim of the study was to develop a simple tool consisting of a questionnaire about the patient-centered elements and a test video consultation. The outcome is the change in the students’ ability to identify these elements. Used as a pre-course and post-course test it can inform the teachers which elements of the patient-centered consultation need intensifying in the teaching. Methods: The students from a course in general practice volunteered to participate in all steps of the development. They took part in individual interviews to select items from an already existing questionnaire (DanSCORE). The preliminary questionnaire was tested for face and content validity, pilot-tested and tested for test-retest reliability. All video consultations were transcribed and assessed for patient-centered elements through a conversation analysis. The videos showed medical students seeing real patients. Results: The preliminary version of the questionnaire (called DanOBS) had 23 items. In the subsequent interviews, items were reduced to 17, each with three response options. After a pilot test, the questionnaire was further reduced to 13 items, all strictly relevant to the model and with two response options. The final questionnaire had acceptable test-retest reliability. The number of test consultation videos underwent a reduction from six videos to one. Conclusions: The DanOBS combined with a test video consultation, used as a pre-and post-course test demonstrates for teachers which elements in the patient-centered consultation need to be intensified in the teaching.

Universal electronic consultation program (e-consultation) of a cardiology department: long-term results in mortality

Abstract Background Many health systems have initiated electronic consultation programs, although little is known about their impact on accessibility, safety and satisfaction (1). The implementation of integrated electronic medical record projects between healthcare levels allows all healthcare professionals access to all the clinical information of patients, which is a key factor in optimizing the management of healthcare resources, facilitating the communication between professionals and avoiding medical acts that do not add value, always from the premise of safety and quality for patients (2). In our model, a General Practitioner sends an e-referral to the Cardiology Department (CD). A Cardiologist can either answer without needing the face-to-face consultation, or schedule the patient for a single act consultation. In our health area, from 2009 to 2012, a “single act” cardiology consultation model was implemented, according to which the appointment includes, on the same day, all the complementary tests that might be necessary for the diagnosis. From 2013 until present, an electronic consultation or e-consultation model has been implemented; consisting of a telematic evaluation of the e-consultation by a cardiologist, who can either solve the GP's requests directly or book an appointment for the patient in person, in cases where it is considered necessary (3). Purpose The aim of this study is to assess the clinical impact of the implementation of a model of outpatient care that includes an initial electronic consultation (e-consultation), comparing it with a face-to-face single act model. Methods We selected patients with at least one visit to the Cardiology Department between 2010 and 2019. Using an interrupted time series regression model, we analysed the impact of incorporating the e-consultation into the healthcare model (started in 2013), evaluating: waiting time for care and mortality. Results We analysed 47,377 patients: 61.9% attended by incorporating the e-consultation and 38.1% in the face-to-face consultation model. The delay time for care in the e-consultation model (median [IQR]: 7 days [5–13]) was shorter than in the face-to-face model (median [IQR]: 33 days [14–81]), p&amp;lt;0.001. The regression model for interrupted time series showed that the incorporation of e-consultation contributed a very important decrease in the delay of attention, remaining around 9 days, although with slight oscillations, Figure 1. The patients evaluated via e-consultation had less mortality (2.5% vs 3.9%, p&amp;lt;0.001), Figure 2. Conclusions An outpatient care program that includes an e-consultation has shown to reduce waiting times significantly and is a safe model with a lower rate of mortality over the first year after the consultation. Funding Acknowledgement Type of funding sources: None.

Impact of the implementation of electronic consultation in outpatient care for patients with cardiovascular disease in a Cardiology Service of a tertiary hospital

Abstract The main objective of health systems is to organize health care in a universal way, by including the population as a whole, cost-effectively, and incorporating care methodologies that allow personalized health care (1). The integrated electronic medical records between levels of care allows non-face care modalities such as electronic consultation. In it, a health professional, most commonly a General Physician, consults with a Hospital doctor through a computer system in which the clinical history is housed, allowing part of the health care to be resolved without displacement of the patients (2). Despite the growing implementation of telematic consultation models and the recommendations to regularly evaluate the quality of care, to ensure patient safety and the best possible diagnosis and treatment practices in telemedicine (3). This aspect acquires a special relevance in the case of patients with an established diagnosis of cardiovascular disease since an e-consultation through the electronic medical record could be less efficient than a face-to-face consultation, in identifying symptoms and clinical signs of alarm and compromise in some cases its clinical evolution. Purpose To evaluate the clinical impact of the introduction of an electronic consultation in the ambulatory care model of a Cardiology Service to patients with an established diagnosis of cardiovascular disease, comparing it with a face-to-face single act consultation model. Methods The epidemiological and clinical data available from the 47,337 patients referred from January 1, 2010 to December 31, 2019, to the Cardiology Service of a health area were recorded, in which all physicians share the same electronic medical record. Patients with cardiovascular disease were considered if they had a history of ischemic heart disease, heart failure, peripheral arterial disease and ischemic cerebrovascular disease. The number of visits to the emergency room, the number of admissions due to cardiovascular causes and mortality were analyzed as events of interest during the first year after attending the Cardiology Service. Results Patients without CVD were resolved more frequently in the e-consultation (24.8% vs 11.3%, p&amp;lt;0.001) and patients with CVD required more follow-up consultations (69.8% vs 40.8%, p&amp;lt;0.001). The analysis of time trends showed that since the implementation of the e-consultation, waiting times were reduced in a similar way in both analysis groups (p&amp;lt;0.001) and, in addition, there was a decrease in emergency services assistance (p&amp;lt;0.001) and in mortality (RR: 0.78 [CI95%: 0.65–0.95], p&amp;lt;0.001), Figure 1; and a stabilization in admissions (RR: 0.95 [CI95%: 0.87–1.04], p&amp;lt;0.001), Figure 2 Conclusions The introduction of an e-consultation in the outpatient management model of referrals for consultation to a cardiology service is effective in reducing waiting time and is safe, since it reduces mortality in patients with cardiovascular disease. Funding Acknowledgement Type of funding sources: None.

Synergistic effect of a universal electronic consultation program and oral anticoagulation on outcomes in patients with atrial fibrillation

Abstract Background Recently, the temporal association between episodes of AF and the risk of ischaemic stroke has been assessed, emphasising that the risk is higher in patients who encountered episodes of AF a few days before stroke [1]. In recent years, the use of direct oral anticoagulants (OACs) has increased, which has improved the outcomes of healthcare with important reductions in mortality [2,3]. Despite the growing implementation of telematic consultation models and recommendations to regularly evaluate the quality of care to ensure patient safety, there is scanty evidence to support the quality of healthcare in terms of delays, prognostic impact, and patient and professional satisfaction. We recently published the characteristics of our ambulatory care model for referrals between general practitioners (GPs) and our cardiology department (CD), and the impact on the delay time of care, health care accessibility, and clinical outcomes after the implementation of an e-consultation as a first step in our ambulatory care program [2,4]. Purpose To evaluate the long-term results of our universal e-consultation program in patients with AF, assessing the impact of the temporal trend in OAC and delay of care on clinical outcomes. Methods We included 10488 e-consultations referrals from primary care in patients with diagnoses of AF in this study. We have analysed the outcomes in e-consultation period versus in-person consultation period. We used an interrupted time-series regression on outcomes. To investigate the impact of this program and the use of OAC on the prognosis of AF-related stroke and haemorrhage, the annual incidence of each outcome in both periods was calculated, while deriving the incidence relative risk (iRR) with these incidences. Finally, to individualise the effect of e-consultation and OAC in both outcomes, the analysis was completed using a Spearman correlation between e-consultation or OAC and the incidence of stroke and mortality. Results Following e-consultation, the use of OAC increased (iRR 1.56 (1.13–1.99); p&amp;lt;0.001), Figure 1; hospital admissions due to stroke were lower (iRR: 0.09 [95% CI: 0.02–0.41]) with similar incidences of haemorrhagic complications (iRR: 0.32 [95% CI: 0.04–2.58]), figure 2. The total mortality was lower (iRR 0.36 (95% CI: 0.33–0,39). The independent impact on the risk of stroke mortality after the increase in the OAC rates and e-consultation implementation showed an odds ratio (OR) of 0.270 and 0.403, respectively. Conclusion Thus, a quicker cardiological evaluation of patients with AF and optimised OAC use influence improved clinical outcomes. The healthcare systems need to merge OAC and outpatient ambulatory management that evaluate the patients quickly to reduce the ischaemic strokes. Funding Acknowledgement Type of funding sources: None.

Modifications in self-care, quality of life and therapeutic adherence in patients with rheumatoid arthritis during the SARS-CoV-2 pandemic treated by telehealth

IntroductionRheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation, causing pain and stiffness in the joints. SARS-CoV-2 increases the clinical vulnerability of the population with RA and has led to the implementation and/or development of telemedicine. ObjectiveTo describe changes in level of therapeutic adherence, quality of life and capacity for self-care agency, during the follow-up period of a group of patients linked to a non-face-to-face multidisciplinary consultation model during the SARS-CoV-2 pandemic. MethodologyDescriptive cohort study (July to October 2020). Description of the level of therapeutic adherence (Morisky Green Test), quality of life (EuroQOL-5-Dimensions-3-Level-version) and self-care capacity (ASA-R Scale) in the context of a telehealth model. A univariate and bivariate analysis was performed (Stata Software, Considered p-value <0.05). ResultsOf 71 patients treated under the telehealth model, 85.9% were women, the age range was between 33 and 86 years with a median of 63. The most prevalent comorbidity was arterial hypertension (35.2%). Quality of life did not change during follow-up nor did adherence to treatment, apart from in one item [the patients did not stop taking the medication when they were well (p = 0.029)]. In self-care capacity, there were significant improvements in five dimensions (p < 0.05), without significant differences in the global score. ConclusionPatients with RA evaluated in the context of telehealth in a period of pandemic did not present significant changes in quality of life, adherence to treatment, or capacity for self-care, and remained close to baseline values when they attended a traditional face-to-face assessment.

Consultation in out-of-hours practice: a clinical review of Lyme disease

In recent times, telephone triage and virtual consultation have been expedited in the out-of-hours urgent primary care setting. This brings challenges concerning gaining a comprehensive history and building a therapeutic relationship between nurse prescriber and patient. This article presents a clinical review of Lyme disease to explore consultation models and how implementing a hybrid consultation approach may support the practitioner to develop safe prescribing practices and optimise patient expectations. This review of Lyme disease management highlights the sparse, low-quality evidence available, with national guidance indicating antimicrobial treatment for those who present with an erythema migrans rash prior to laboratory testing confirmation. This reinforces the importance of reaching a shared decision with the patient understanding of the perceived risk and benefits of treatment. The factors discussed include Lyme disease prevention and how the practitioner ensures safety netting in the out-of-hours setting.

Modern educational digital competence of future doctors of Poland as a European state

The article examines and analyzes the acquisition of digital competence by students studying in medical education institutions in Poland. In order to fulfill the set goal, the analysis and synthesis of search results in information and reference systems was carried out in order to determine the concepts of research, methods of expert evaluation, testing, questionnaires, observation, modeling, forecasting. The process of implementing information processes in the field of health care in Poland is considered against the background of the use of digital technologies in the countries of the European Union in order to ensure the quality of education and accelerate progress towards the Sustainable Development Goals, which were presented by the United Nations and aimed at achieving a digital future for all. In cooperation with the European Commission in promoting digitalization in education, the Polish government is focused on promoting the development of a highly effective digital education ecosystem and improving digital skills and opportunities for digital transformation to ensure bridging the digital divide in education and strengthening competences. A noticeable change in the development of digital competences of students of medical education institutions in Poland is a greater emphasis on the practical use of both these competences and resources available on the Internet. The development of recommendations of Polish institutions of medical education, specifying the various branches of digital health, terminology, learning objectives, optimal approach to training, duration, evaluation method and structure, was considered. The COVID-19 pandemic has increased the importance of digital health in society. Doctors must be properly prepared to work in a new environment, where a greater share of medical care is provided by digital methods, which involves the use of digital technologies, and determines the priority need for future medical workers to acquire the relevant competencies necessary to work with remote consultation models, eHealth systems, processing of medical data.

Physical Activity Coaching via Telehealth for People With Parkinson Disease: A Cohort Study.

Physical activity (PA) has many known benefits for people with Parkinson disease (PD); however, many people do not meet recommended levels of frequency or intensity. We designed Engage-PD, a PA coaching program delivered via telehealth and grounded in self-determination theory to promote PA uptake and facilitate exercise self-efficacy in people with Parkinson disease. This study aimed to determine the feasibility and preliminary efficacy of Engage-PD, and to explore whether baseline characteristics were associated with outcomes. A single cohort of people with PD (n = 62, Hoehn and Yahr I-III) participated in the 3-month Engage-PD program, which consisted of up to 5 telehealth coaching sessions delivered by physical therapists. Feasibility was evaluated based on recruitment and retention rates, along with participants' feedback. Planned and unplanned PA, exercise self-efficacy (ESE), and individualized goals were assessed pre- and post-intervention. Relationships between baseline characteristics and changes in planned PA and ESE were also evaluated. Recruitment (62%) and retention (85%) rates were high, and the intervention was well accepted and perceived by the participants. From pre- to postintervention, participants increased planned PA (d = 0.33), ESE (d = 1.20), and individualized goal performance (d = 1.63) and satisfaction (d = 1.70). Participants with lower baseline planned PA experienced greater improvements in planned PA, and those with lower baseline ESE experienced greater improvements in ESE. A telehealth PA coaching program for people with PD was feasible and potentially efficacious. Physical therapist-led coaching may be an important component of a consultative model of care starting early in the disease process.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A393).