Email Consultations Research Articles

Yonder: Thank you, Ahmed Rashid, email consultations, ethics rounds, and medical elective fees.

Yonder: Thank you, Ahmed Rashid, email consultations, ethics rounds, and medical elective fees.

Impact of coordination mechanisms based on information and communication technologies on cross-level clinical coordination: A scoping review.

Coordination mechanisms based on information and communication technologies (ICTs) are gaining attention, especially since the pandemic, due to their potential to improve communication between health professionals. However, their impact on cross-level clinical coordination remains unclear. The aim is to synthesize the evidence on the impact of ICT-based coordination mechanisms on clinical coordination between primary care and secondary care (SC) doctors and to identify knowledge gaps. A scoping review was conducted by searching for original articles in six electronic databases and a manual search, with no restrictions regarding time, area, or methodology. Titles and abstracts were screened. Full texts of the selected articles were reviewed and analysed to assess the impact of each mechanism, according to the cross-level clinical coordination conceptual framework. Of the 6555 articles identified, 30 met the inclusion criteria. All had been conducted in high-income countries, most (n = 26) evaluated the impact of a single mechanism - asynchronous electronic consultations via electronic health records (EHR) - and were limited in terms of design and types and dimensions of cross-level clinical coordination analysed. The evaluation of electronic consultations showed positive impacts on the appropriateness of referrals and accessibility to SC, yet the qualitative studies also highlighted potential risks. Studies on other mechanisms were scarce (shared EHR, email consultations) or non-existent (videoconferencing, mobile applications). Evidence of the impact of ICT-based mechanisms on clinical coordination between levels is limited. Rigorous evaluations are needed to inform policies and strategies for improving coordination between healthcare levels, thus contributing to high-quality, efficient healthcare.

My time, your time, our time. Older patients’ and GPs’ time sensibilities around email consultations

ABSTRACT In this study, we discuss how email consultations in general practice operate as a temporal technology, transforming working conditions and power relations between general practitioners (GPs) and patients. We draw on empirical material from Denmark in the form of a set of semi-structured interviews with 53 patients and 15 GPs, including two focus group discussions with 17 GPs. Our theoretical point of departure stems primarily from media theorist Sarah Sharma’s (2014) concept of power-chronography, which describes how power is embedded in temporal relations and everyday life and secondarily from sociologist, Judy Wajcman’s (2015) concept of multiple temporal landscapes. Patients and GPs calibrate their own time and attune their mutual time according to their expectations and ideas about the other party’s time. The patient and the GP can both be viewed as ‘time workers’ and the email consultation as a digital technology fostering the recalibration of one person’s time to that of another, requiring significant labour. The email consultation rearranges the GP-patient boundaries and thereby the power relations. Health institutions ought to consider whose time and labour is being ‘saved’ with digital systems.

Patienters sprogbrug i e-konsultationer med deres praktiserende læge: Hvordan kommunikerer patienter relationel og emotionel information?

In Denmark, the e-mail consultation has been an important part of general practice for more than a decade. This consultation format has several advantages, but general practitioners have been concerned that they cannot, for example, interpret patients’ emotional state through the written medium. In this article, we examine what characterizes those parts of patients’ language use in e-mail consultations that deviate from standard written language. The background is the importance of understanding how digital patients communicate in writing, and what possibilities they have of expressing themselves. Based on 646 e-mail consultations from 38 patients from four Danish general practitioners’ offices, we have analyzed the linguistic devices which deviate from standard written language. Our purpose is to characterize the patients’ use of language, including deviations, alternative sign use, context keywords, and orthographic variation. We argue that patients’ use of these forms makes it possible to communicate relational and emotional information which in a face-to-face meeting would typically be communicated non-verbally. In addition, this language use creates an informal tone with their general practitioner. Our analyses reflect how the e-mail consultation format places new demands on patients, who must be able to express themselves in writing, but who also have to be creative with their keyboard use if they want to express something that is not normally communicated in writing.

Virtual care in the health care system: A concept analysis.

Health care providers need a better understanding of virtual care to recognise and use it for service delivery. To provide a more comprehensive definition of the concept of virtual care. This study was conducted based on Walker and Avant's concept analysis method. A comprehensive review of the published texts in English from 2012 to 2022 was performed using the PubMed, Web of Science, Scopus, ProQuest, Science Direct, Ovid, CINAHL and Google Scholar databases. The main aspects and attributes of virtual care, including the use of any information and communication technology in various formats such as platforms, telephone calls, messages, email consultation, remote monitoring, secure and two-way digital communication between health care providers and patients, the possibility of providing remote care synchronously or asynchronously, more interaction between patients and caregivers, the possibility of transferring information between patients and health care providers and within the teams themselves, symptom management, sending diagnostic results in the form of video visits, and providing follow-up care, are attributes that distinguish virtual care from telehealth, telemedicine and other methods of providing remote healthcare services. Considering the positive and negative consequences of implementing virtual care, the findings of this study developed a basis for an operational definition of the concept so that providers can understand the meaning of virtual care and consider it when providing virtual care to patients. The findings of this study can be used in many international and national contexts in the health care system and in future studies on interventions to increase the use of virtual care.

Telemedicine in the management of patients with headache: current situation and recommendations of the Spanish Society of Neurology’s Headache Study Group

IntroductionThe COVID-19 pandemic has caused an unexpected boost to telemedicine. We analyse the impact of the pandemic on telemedicine applied in Spanish headache consultations, review the literature, and issue recommendations for the implementation of telemedicine in consultations. MethodThe study comprised 3 phases: 1) review of the MEDLINE database since 1958 (first reported experience with telemedicine); 2) Google Forms survey sent to all members of the Spanish Society of Neurology’s Headache Study Group (GECSEN); and 3) online consensus of GECSEN experts to issue recommendations for the implementation of telemedicine in Spain. ResultsCOVID-19 has increased waiting times for face-to-face consultations, increasing the use of all telemedicine modalities: landline telephone (from 75% before April 2020 to 97% after), mobile telephone (from 9% to 27%), e-mail (from 30% to 36%), and video consultation (from 3% to 21%). Neurologists are aware of the need to expand the availability of video consultations, which are clearly growing, and other e-health and m-health tools. ConclusionsThe GECSEN recommends and encourages all neurologists who assist patients with headaches to implement telemedicine resources, with the optimal objective of offering video consultation to patients under 60-65 years of age and telephone calls to older patients, although each case must be considered on an individual basis. Prior approval and advice must be sought from legal and IT services and the centre’s management. Most patients with stable headache and/or neuralgia are eligible for telemedicine follow-up, after a first consultation that must always be held in person.

Changes in family practice work management in Zagreb due to the COVID-19 pandemic.

Since the COVID-19 pandemic has impacted family medicine practice (FMP) workload, we aimed to determine changes in the structure of work of FMPs in the number and type of consultations, check-ups, administrative, preventive, and other diagnostic-therapeutic procedures (DTPs) during the COVID-19 pandemic (2021 and 2022) compared to 2019. In this cross-sectional study, 172 FMPs from Zagreb (39%) were analysed based on monthly work reports for March and April of 2019, 2021, and 2022. Before being analysed, all noted DTPs were divided into 5 main groups (administration, telephone and e-mail consultations, check-ups, face-to-face consultations, preventive work, and other DTPs). In 2021 the number of check-ups and face-to-face consultations dropped by 36.20%, whereas the total number of telephone and e-mail consultations, patients per day, and DTPs done per day increased by 120.12%, 6.67%, and 13.76%, respectively. The amount of administrative work rose only in 2022 by 17.58% along with other procedures which significantly impacted the share of medical work: 42.84% in 2019, 49.58% in 2021, and 46.79% in 2022. Around two-thirds of FMPs made home visits (3 to 4 visits monthly) and performed electrocardiography (6 to 7 tests monthly) independently of the analysed year. Analysing 39% of FMPs in Zagreb we found a significant workload change during the COVID pandemic, especially in the excessive increase of telephone and e-mail consultations. The already small number of examinations, diagnostic, preventive procedures, and home visits, further decreased with the arrival of the pandemic and did not significantly recover in 2022, as was expected.

Enhancing Competence in Preventing Childhood Diseases for Preschool Teachers in Vietnam

This study aims to evaluate the current competence of preschool teachers in preventing childhood diseases in Vietnam and provide recommendations for their development in effectively addressing these issues. The research employed consulting methods, including telephone and email consultations, as well as a Google Form questionnaire. The questionnaire utilized a 5-level rating scale (Good, Fair, Average, Weak, Poor). The study involved 25 administrators (Education and Training officers, Kindergarten Principals, and Vice Principals) and 118 preschool teachers from Lao Cai city, Lao Cai province. The research was conducted from April 2021 to November 2021.
 Results of the study revealed several limitations in the current ability of preschool teachers to prevent childhood diseases in the study area. These limitations included inadequate competence among certain members of the Board of Education and management staff, particularly the principals. Furthermore, there was incomplete awareness among some management staff and teachers regarding the significance of fostering skills in preventing contagious diseases among Kindergarten teachers. The training activities related to preventing contagious diseases in children for Kindergarten teachers in Lao Cai city and province were also found to be inadequate. The schools predominantly followed an experiential approach rather than a systematic one. Based on the research findings, the study team proposes recommendations for enhancing the competence of preschool teachers in preventing childhood diseases.

How is mhealth and web-based telemedicine implemented in patient with hypertension? : a narrative scoping review

In this digital era, telemedicine has become one of the cutting-edge approaches that is feasible for hypertension management. Despite the proliferation of trial research, reviews of how telemedicine is practiced are limited. The aim of this study is to review how telehealth is applied in patients with hypertension. A scoping review according to the Joanna Briggs Institute Reviewer Manual's instructions was used with a narrative approach to the type of RCT intervention articles. The search was conducted through electronic databases Scopus, PubMed, and Medline-OVID with the keywords "Telemedicine" and "hypertension". Of 1945 articles, 13 studies met the criteria and were reviewed. Telemedicine interventions including mhealth-based and web-based provide various ways to manage and provide telemonitoring for BP. The utilization of m-health can be through the development of smartphone applications, text messaging, or the use of current social media. Whereas web-based utilization mostly uses email consultations and not many uses paid websites but are integrated with mobile phones. Telemedicine whether mhealth or web-based makes it easier for healthcare professionals to manage and monitor patients' BP, offering a sustainable positive impact in the future.

Perinatal psychiatric practitioner consultation program delivers rapid response to OB/GYN practitioners.

Screening and treatment initiation for perinatal psychiatric conditions is a recommended competency in OB/GYN practitioners, yet perinatal psychiatry is rapidly evolving. Practitioner-to-psychiatrist consultation programs have the potential to improve the management of psychiatric conditions in perinatal women. This study describes utilization of a statewide perinatal psychiatric consultation service by OB/GYN practitioners through examination of the volume, responsivity, content and outcomes of clinical inquiries, and satisfaction. This quality improvement study describes the 460 telephone or e-mail consultations requested by OB/GYN practitioners over 2 years and housed within a REDCap database. Data include the characteristics of consult users, month-over-month and total utilization, the patient's perinatal status, the reason for contact, current symptoms and medications, and the consulting psychiatrist recommendations. Practitioner satisfaction with consultation is also described. After completion of triage, the psychiatrist returned the practitioner's call ≤5min in 59% of consultations. The most common inquiries were for pregnant (64%) women for depressive (51%) or anxiety (46%) symptoms with 47% of inquiries reporting the patient was currently taking a psychiatric medication. Had consultation not been available, referral to mental health (41%) or starting a medication (15%) were most often reported. This perinatal psychiatric consultation service rapidly and effectively met the needs of practitioners practicing in OB/GYN settings across a state having a critical psychiatry shortage and varying urban and rural geography. Future recommendations include the assessment of direct patient outcomes, practitioner skill attainment, and long-term cost savings of this perinatal psychiatric consultation model.

Enhancing an online cognitive behavioural therapy intervention for depression: Harnessing the feedback of sexual and gender minority youth to help improve SPARX.

SPARX is an online cognitive behavioural therapy self-help intervention for adolescent depression provided in serious game format. Since 2014, it has been freely available in Aotearoa New Zealand (NZ) due to funding from the NZ government. In 2020/21, feedback from sexual and gender minority youth (SGMY) was used to refine and update SPARX. Three online focus groups and follow-up email consultations involved 12 SGMY (16 to 25 years old) in NZ. A general inductive approach was used to analyse data. SGMY had specific needs as well as preferences and four themes were identified: attend to our contextual realities; portrayals of sexual and gender minority people in games; envisaged ideals for serious gaming and appraisals of SPARX. SGMY feedback was used to improve SPARX for this unique population, with the updates launched in October 2021. SGMY are underserved in terms of their mental health needs. Refining or tailoring existing interventions proffers a potential way forward in terms of addressing these needs.

Changes in consultation mode during different phases of the COVID-19 pandemic in Croatian family medicine: a cross-sectional study

ObjectivesTo describe the changes in the type, length and reasons for consultations in primary healthcare during the COVID-19 pandemic in Croatia. This study aimed to test a hypothesis regarding the...

Proposal for Assessment and Inventory of the Landscape as Geoheritage

Methods for quantitatively assessing geological heritage have been used in a variety of settings and for different purposes, such as environmental impact assessment, inventory of natural heritage, tourism promotion, and conservation unit management. In this sense, there are adaptations to each study in relation to the methodology and the regional context in which the research is developed, and the final objective. This research proposes a methodology for taking inventory with the goal of analyzing the landscape while adhering to the concepts and parameters that allow for the assessment of geoheritage. In addition to reviewing the literature, the Delphi method was used in 2020 email consultations with 76 experts on geoheritage and landscape. It is expected that, when using the proposed inventory, managers will be able to identify places with better scientific possibilities in the use of landscape in relation to geoheritage, which will be useful when reviewing city planning and management planning of conservation units under the scope of geoconservation.

Contacts in general practice during the COVID-19 pandemic: a register-based study.

The COVID-19 pandemic has altered the provision of health care and expanded telehealth consultations. To study the effect of the COVID-19 pandemic on contact patterns in general practice, and to identify patient groups at risk of losing care. Register-based study of Danish general practice, including daytime and out-of-hours (OOH) services. All individuals residing in Denmark from 1 January 2017 to 31 October 2020 were included. The incidence rate for six contact types in general practice and adjusted incidence rate ratio were calculated by comparing the incidence rate in the pandemic period with the adjusted expected incidence rate based on the incidence rate in the pre-pandemic period. The number of face-to-face in-clinic consultations declined during the lockdown in March 2020. A subsequent increase in the number of clinic consultations was observed, rising to a level above that of the pre-pandemic period; this increase resulted mainly from the introduction of telehealth consultations (that is, video and extended telephone). The number of daytime email consultations increased, whereas the number of daytime home visits decreased. Likewise, the number of OOH telephone consultations increased, whereas the number of OOH home visits and clinic consultations decreased. Consultation rates of patients who are vulnerable, that is, those with low education, old age, and comorbidity, were most adversely affected by the pandemic. The most adverse impact in OOH clinic consultations was seen for children aged 0-9 years. New methods are called for to ensure access to general practice for patients who are vulnerable during a pandemic. The potential of telehealth consultations should be further investigated.

A Study on the Current Situation and Problems of Payment Methods in the International Trade between Korea and China

Purpose This study provides practically useful guidelines for Korean companies by analyzing the status of the payment methods of Korea and China, which is increasingly important in accordance with the recent increase in trade volume, discovering problems, and suggesting solutions. Design/Methodology/Approach This study included a comprehensive review of prior domestic and foreign literature as well as e-mail consultations with experts in the payment field around the world. Findings Findings revealed that as for the payment methods of Korea’s exports in 2021, the remittance method accounted for 70.3%, letter of credit method was 7.6%, collection method was 8.3%, and other methods were 13.8%. The remittance method accounts for 70% of the total export value, followed by the collection method and L/C method. Since there are no official statistics on payment methods in China, it is impossible to grasp the status of China’s recent payment methods. Research implications This paper presented the status and problems of payment methods of Korea and China. Korea needs to revise the statistics of payment methods, and China needs to perform official statistical work on payment methods.

Methodological challenges in researching email consultations as a form of communication in patient-provider interactions

Email is a born-digital form of communication, which can be studied in a number of ways using a variety of methods, as with any other socially and culturally mediated phenomenon. However, despite a great number of studies, the methodologies of the studies have attracted only little attention. In this paper, we wish to extend our knowledge regarding methodological challenges in studying emails. In particular, we will consider the methodological challenges, which any scholar will encounter when email in its digital form is transformed to and preserved as an object of study. Based on a review of existing studies’ archiving strategies as well as our own study on email consultations in a healthcare setting, we will examine and discuss analytical and methodological consequences of different approaches to archiving and data management of emails. We demonstrate that the archived record is shaped by its context of creation. Since collection methods and archiving tools are not neutral, we call for a greater attentiveness to this part of the research process. We conclude by outlining implications for systematic empirical research into emails as a form of communication.

Childhood cancer survivorship care during the COVID-19 pandemic: an international report of practice implications and provider concerns.

PurposeLong-term follow-up (LTFU) care is essential to optimise health outcomes in childhood cancer survivors (CCS). We aimed to assess the impact of the COVID-19 pandemic on LTFU services and providers.MethodsA COVID-19 working group within the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) distributed a questionnaire to LTFU service providers in 37 countries across Europe, Asia, North America, Central/South America, and Australia. The questionnaire assessed how care delivery methods changed during the pandemic and respondents’ level of worry about the pandemic’s impact on LTFU care delivery, their finances, their health, and that of their family and friends.ResultsAmong 226 institutions, providers from 178 (79%) responded. Shortly after the initial outbreak, 42% of LTFU clinics closed. Restrictions during the pandemic resulted in fewer in-person consultations and an increased use of telemedicine, telephone, and email consultations. The use of a risk assessment to prioritise the method of LTFU consultation for individual CCS increased from 12 to 47%. While respondents anticipated in-person consultations to remain the primary method for LTFU service delivery, they expected significantly increased use of telemedicine and telephone consultations after the pandemic. On average, respondents reported highest levels of worry about psychosocial well-being of survivors.ConclusionsThe pandemic necessitated changes in LTFU service delivery, including greater use of virtual LTFU care and risk-stratification to identify CCS that need in-person evaluations.Implications for Cancer Survivors Increased utilisation of virtual LTFU care and risk stratification is likely to persist post-pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11764-021-01120-9.

Health and service needs, priorities and initiatives of primary health networks related to chronic pain.

Chronic pain is a major and growing public health issue. Multidisciplinary tertiary pain services cannot meet patient demand and greater involvement of primary care is needed. The aims of this study were to understand the needs and priorities of Australian primary health networks (PHNs) related to the management and secondary prevention of chronic pain; map current PHN chronic pain initiatives and identify gaps; highlight key enablers to implementation; and highlight solutions identified by PHNs to increase capacity to commission initiatives. Mixed methods were used, including: a review of PHN needs assessments; and consultation with PHN executive-level staff and program managers from 27 out of the 28 PHNs, and the WA Primary Health Alliance (WAPHA - a state alliance between three Western Australian PHNs) via telephone interviews, online surveys, a workshop, a deliberative dialogue and email consultation. Chronic pain was identified as a health and/or service need by approximately half of PHNs. Barriers for PHNs to identifying chronic pain as a need or priority are highlighted. Gaps identified by the mapping included: initiatives related to the secondary prevention of chronic pain (post-surgery or post-injury), digitally enabled consumer and health professional chronic pain initiatives, and chronic pain initiatives for specific populations groups such as Aboriginal and Torres Strait Islander people. Among existing PHN practice, two exemplar evidence-based initiatives suitable for scale-up across PHNs in Australia were identified: multidisciplinary community-based pain programs, and an online health professional capacity-building initiative, Project ECHO (chronic pain). Solutions identified by PHNs to increase capacity to commission initiatives included: co-funding initiatives across different PHN funding streams, collaborative initiatives between PHNs, and co-commissioning with government and non-government partners. Chronic pain has been classified as a disease in itself through the World Health Organization. PHNs recognising chronic pain as a distinct condition in PHN needs analysis and data collection would lead to more dedicated funding. PHNs could do more to improve the secondary prevention and management of chronic pain. A self-identified need for greater collaboration across PHNs and co-commissioning with local and state governments and non-government partners would help to build PHN capacity.

Community-based pain programs commissioned by primary health networks: key findings from an online survey and consultation with program managers.

There is an increasing demand for tertiary pain services, with long waiting times compounded by limited reach to regional and remote areas. Community-based pain programs are a feasible evidence-based model of care to improve access to multidisciplinary care. Australian primary health networks (PHNs) are well placed to commission pain programs to reduce the growing burden of chronic pain. The aim of this study was to support PHN decision-making by: (1) describing current PHN community-based pain programs; (2) assessing their alignment to key elements and implementation enablers of pain programs identified by an expert consensus process; and (3) describing PHN pain program adaptations during the COVID-19 pandemic. PHN program managers of community-based pain programs (n = 9) were invited to participate in an online survey and follow-up email consultation about their pain program. Six PHN program managers (representing South Eastern NSW PHN, Nepean Blue Mountains PHN, North Western Melbourne PHN, Gold Coast PHN, Adelaide PHN and the WA Primary Health Alliance) participated in the study with three PHNs commissioning two different types of pain programs. PHN community-based pain programs are multidisciplinary programs underpinned by a biopsychosocial model of pain, and focus on self-management (e.g. exercise, psychological strategies) and pain education. Most PHN pain programs are group-based programs that target adults with chronic non-cancer pain, provide individual allied health referrals as required and are evaluated as part of the electronic Persistent Pain Outcomes Collaboration. Gaps include pain programs for Aboriginal and Torres Strait Islander people, and people from culturally and linguistically diverse backgrounds, with one notable exception of a PHN pain program for people from culturally and linguistically diverse and refugee backgrounds co-designed with consumers and relevant services. Programs targeting subacute pain to prevent progression to chronic pain are, with one exception, another gap area. PHN pain programs demonstrated a high level of alignment with expert-agreed key elements and implementation enablers. The COVID-19 pandemic precipitated the rapid adaptation of PHN pain programs using available methods for the delivery of digitally enabled care. The findings provide a greater understanding for researchers and PHN decision-makers of the key features of PHN community-based pain programs, their alignment with expert-agreed key elements and implementation enablers, the target-population gaps, and the types of program adaptations during the COVID-19 pandemic. The findings also illustrate the potential for using digitally enabled delivery methods to increase accessibility to pain programs with further research warranted.

Oralizations in e-mail consultations: A study of general practitioners’ use of non-verbal cues in written doctor–patient communication

It is well-known that non-verbal cues are essential in doctor–patient communication. As doctor–patient communication is turning increasingly digital and written, it becomes relevant to explore the role of non-verbal cues in such communication genres. One more recent genre is the doctor–patient e-mail consultation. Research has found that while patients like e-mail consultations, they also miss facial expressions, eye contact, etc. In this study, we explored the different ways in which Danish GPs use non-verbal cues in e-mail consultations. We analysed 633 e-mail consultations written by 22 GPs. We applied the concept oforalization, which includes the use of emoticons and non-standard use of grammar and spatial arrangement. We found that the dominant types of oralizations were non-corrected spelling errors and lack of attention to capitalization. Overall, GPs used a limited number of other non-verbal cues. We discuss how these findings relate to norms of formality and professional context.