eConsult Service Research Articles

Characterizing Patients after Opioid Taper in a VA Medical Center

To identify potential areas for intervention and gain insight on current practice in patients who are tapered to zero morphine equivalent daily doses (MEDD) through the Pharmacy Pain E-Consult at a Veterans Healthcare System. This was done by describing the types of follow-up care and resources utilized by patients. This project is a retrospective chart review of Veterans with non-cancer pain on chronic-opioid therapy consulted to the pharmacy e-consult service and tapered to 0 MEDD. Descriptive statistics are collected one year pre-taper and one year post-taper. One year post-taper, approximately one-third of the patients were re-started on opioid therapy. However, average MEDD overall was significantly decreased one year post-taper compared to pre-taper. Average pain scores were not significantly different pre-taper compared to post-taper. Non-opioid medications generally increased post-taper. Follow-up with mental health and pain management clinical pharmacy specialists decreased post-taper. Tapering to zero MEDD did not lead to a significant increase in pain one-year post-taper; however, approximately 33% of patients were re-started on opioids within one year post-taper. Average MEDD scores decreased post-taper as expected but with effects on mental health being largely unknown, we believe that further study in this area will help us better support patients.

Pharmacist eConsult service for primary care medication optimization and safety

BackgroundThere is a critical need in primary care to proactively prevent, identify, and resolve poor medication-related outcomes. However, more than 80% of primary care practices do not have clinical pharmacists as members of expanded care teams. The emergence of eConsult services in primary care settings presents an opportunity for primary care providers (PCPs) to consult with clinical pharmacists as “on-demand” pharmacotherapy specialists. ObjectivesThe objectives were to (1) determine the use of a clinical pharmacist in an existing eConsult network, (2) characterize the use and type of clinical pharmacist eConsults sent by PCPs, and (3) measure the implementation percentage of pharmacist recommendations by PCPs. MethodsThe study was conducted in a federally qualified health center using an existing eConsult platform. A clinical pharmacist was contracted to receive eConsults and was expected to respond within 2 business days. PCPs were introduced to the pharmacist eConsult service through presentations that reviewed the clinical pharmacist’s education/training, suitable pharmacist eConsult topics, and workflow for sending a pharmacist eConsult. ResultsA total of 57 eConsults containing 123 individual questions were answered. Advanced practice nurses (APRNs) sent 3 times the number of eConsults and individual questions per eConsult compared with physicians (P < 0.0001). Most eConsult questions from APRNs related to adverse drug events/drug interactions (44%), drug or dosage changes to reach therapeutic goals (18%), and renal/hepatic dosage adjustments (13%). However, physician eConsult questions were primarily targeted on patient-specific drug or dosage adjustments (62%) and comprehensive medication regimen reviews (17%). A total of 74% of the pharmacist eConsult responses had at least 50% of the recommendations implemented by PCPs. ConclusionThis study revealed the use of a pharmacist eConsult service for medication-related questions in an existing eConsult network for PCPs. As more practices enroll in value-based plans, pharmacist eConsults can improve the quality and safety of prescribing and chronic medication management.

EConsultation perception among health professionals in response to the COVID-19 pandemic in University of Gondar referral hospital, Ethiopia

Abstract: Electronic consultation is a means of communication with clients using different types of electronic devices at distance. However, health professionals’ perception towards the e-consultation is not well addressed. This study aimed to explore health workers’ perception on e-consultation to combat the coronavirus disease 2019 pandemic at the University of Gondar specialized hospital. A qualitative study was undertaken to explore health workers’ perception on e-consultation to tackle COVID-19 pandemic. Eight health-care workers were purposively selected from the University of Gondar specialized hospital. Medical doctors, nurses, medical laboratory professionals and public health officers were selected as key informants for in-depth interview. A thematic analysis was carried out. The analysis was performed with four identified themes, namely e-consultation benefit, technical skill, barriers of e-consultation and facilitators of e-consultation. All the respondents were aware of e-consultation service as a solution in the health-care system to tackle the spread of pandemic. Some had the experience of reminding their clients to take drugs by using their mobile phone. They also expressed their feelings that using e-consultation would have an impact on health professional and client satisfaction by reducing the fear of transmission of the pandemic. Health workers believe that e-consultation solutions can reduce the spread of the pandemic at the point of service delivery. Technical skills, organizational setup and information technology-related factors were major contributing ones. Health professionals’ perception could not be a problem in implementing e-consultation service to tackle the spread of the pandemic.

Clinical Questions Asked by Long-Term Care Providers Through eConsult: A Retrospective Study.

IntroductioneConsult allows primary care providers (PCPs) to access timely specialist advice and informs patient care. To understand the use of eConsult in long-term care (LTC) settings, we examined the clinical content and types of questions asked by LTC PCPs.MethodsA descriptive, retrospective study of eConsults submitted through the Champlain BASE™ eConsult Service between January 1, 2017, and December 31, 2018, by LTC PCPs was conducted. Cases were classified using validated taxonomies. Descriptive statistics were generated for content and question type classifications, service utilization data, and close-out survey responses.Results22 LTC PCPs submitted 113 eConsults. They sought advice about drug treatment (58%), diagnosis (44%), and management (38%) in a breadth of clinical areas, often skin-related (39%). Long-term care PCPs frequently asked more than one question type (42%). They received advice within 1 week (91%) and rated eConsult as very helpful and educational. Three case examples are presented.ConclusionThis study demonstrates the type of advice LTC PCPs are seeking through eConsult and its usefulness in this setting. Long-term care stakeholders are encouraged to consider implementing eConsult in other regions, as a means to improve access to timely specialist advice, support clinical decision-making, and improve residents’ quality of life.

18839 Pediatric dermatology e-consultations: Reduced wait times and face-to-face dermatology visits

Background: Store-and-forward teledermatology provides pediatricians with specialist guidance for managing skin disease. This study evaluates wait times and face-to-face (FTF) dermatology visit avoidance associated with a pediatric dermatology eConsult service at an urban academic medical center.

Virtual Mentoring: Two Adaptive Models for Supporting Early-career Simulation Investigators in the Era of Social Distancing.

Early-career simulation investigators identify limited mentorship as a common barrier to disseminating scholarship and launching a successful academic career in emergency medicine (EM). Conferences often bridge this gap, but the COVID-19 pandemic has forced their indefinite delay. Virtual solutions are needed to capitalize on the breadth of national simulation research experts and grow mentorship in a postpandemic world. We developed two complementary innovations to facilitate scholarship development and minimize COVID-associated career challenges resulting from social distancing requirements. The e-fellows forum (FF) provides a capstone experience for works-in-progress and the e-consultation service (CS) supports simulation research during the earlier project stages of design and development. In conjunction with the Society for Academic Medicine's Simulation Academy, we applied videoconferencing technology for both of these novel, virtual innovations. We analyzed corresponding chat transcripts and detailed field notes for emerging themes. In addition, we collected quantitative data via participant surveys regarding their experiences and impact on their projects. Nine simulation fellows presented at the FF and seven junior simulation investigators participated in the CS sessions. Most preferred the virtual format (56% FF, 66% CS) and found the sessions to be helpful in project advancement (66% FF, 100% CS). COVID-19 affected most projects (89% FF, 67% CS). We identified three themes via qualitative analysis: design concerns and inquiries, validation or support shown by mentors and peers, and professional cohesion. Participants felt that both virtual mentorship innovations advanced their simulation research projects and fostered a sense of professional cohesion within a greater community of practice. These benefits can be powerful at a time where simulation researchers in EM feel disconnected in an era of social distancing. Our future work will include adaptations to a hybrid model with both virtual and in-person modalities as well as creation of more e-mentorship opportunities, thus broadening the early-career simulation research community of practice.

DISSEMINATION, IMPLEMENTATION, AND IMPACT

Research ObjectiveEffective health innovations are rarely scaled‐up—missing countless opportunities to improve health systems. Yet, little evidence exists on strategies to support large scale implementation of proven innovations. eConsult is an asynchronous online platform connecting primary care providers to specialists to discuss patients’ care, that improves access, patient experience, provider satisfaction, and reduces costs. eConsult services have been implemented in 16 countries, most widely in the United States and Canada. In Canada, each province has a single payer health system with universal coverage and efforts to scale‐up eConsult are underway in several provinces, with over 75 000 eConsult cases completed across the country thus far. This provides a unique opportunity to understand the strategies used to support scale‐up of this type of innovation across a range of contexts. Our objective is to present the strategies used to scale‐up eConsult in multiple jurisdictions.Study DesignWe conducted a multiple case study, where the cases were four Canadian provinces at varying stages of scaling‐up eConsult (Ontario, Quebec, Newfoundland and Labrador and Manitoba). Our data sources include document review (e.g., meeting minutes, reports, websites, presentations), meeting observations where provincial scale‐up of eConsult is discussed (n = 26), semi‐structured interviews (n = 25) and focus groups (n = 2). We conducted deductive and inductive thematic analysis using Milat et al.’s scaling‐up conceptual framework (2016) to identify strategies and emerging themes.Population StudiedOur study was conducted with key stakeholders (e.g., patients, family physicians, specialists, policy makers, decision makers) involved in the scaling‐up of eConsult in four Canadian provinces.Principal FindingsWe identified 6 common strategies used to support scaling‐up of eConsult in Canada : (a) Linking eConsult to research has helped develop and improve the innovation (e.g., technological infrastructure), establishing rigorous evidence to support the rationale for scaling‐up provincially, and maintaining eConsult activities during the scaling‐up process through funding and other resources; (b) building on a “coalition of the willing” by engaging partners who believe in the innovation and are willing to support it; (c) having physicians (both primary care and specialists) lead and adapt the innovation to their practice contexts, and relying on physician champions to help spread and scale the innovation; (d) engaging patient partners to strengthen the case to scale‐up eConsult through compelling patient stories and help drive scaling‐up efforts; (e) creating a “buzz” by engaging stakeholders across Canada, getting endorsements from organizations with influence, holding an annual national eConsult policy forum, presenting at various events, and building on other provinces’ experiences and expertise to help catalyze scale‐up efforts; (f) keeping the innovation simple to avoid becoming side‐tracked by peripheral challenges thus facilitating widespread adoption by physicians.ConclusionsThese strategies have been used in a range of contexts across Canada and are perceived by stakeholders as instrumental in scaling‐up efforts to date. The next step of this study is to foster cross‐level and cross‐jurisdictional knowledge exchange between key stakeholders.Implications for Policy or PracticeThis provides a new real‐world understanding of how stakeholders have tackled the challenges of scaling‐up eConsult and may be useful to inform future scaling‐up efforts for eConsult and similar innovations.Primary Funding SourceCanadian Institutes of Health Research.

Developing a pediatric ophthalmology telemedicine program in the COVID-19 crisis

PurposeTo describe our methodology for implementing synchronous telemedicine during the 2019 novel coronavirus (COVID-19) pandemic.MethodsA retrospective review of outpatient records at a single children's hospital from March 21 to April 10, 2020, was carried out to determine the outcome of already-scheduled face-to-face outpatient appointments. The week leading up to the March 21, all appointments in the study period were categorized as follows: (1) requiring an in-person visit, (2) face-to-face visit that could be postponed, and (3) consultation required but could be virtual. Teams of administrators, schedulers, and ophthalmic technicians used defined scripts and standardized emails to communicate results of categorization to patients. Flowcharts were devised to schedule and implement telemedicine visits. Informational videos were made accessible on social media to prepare patients for the telemedicine experience. Simultaneously our children's hospital launched a pediatric on-demand e-consult service, the data analytics of which could be used to determine how many visits were eye related.ResultsA total of 237 virtual ophthalmology consult visits were offered during the study period: 212 were scheduled, and 206 were completed, of which 43 were with new patients and 163 with returning patients. Following the initial virtual visit, another was required on average in 4 weeks by 21 patients; in-person follow-up was required for 170 patients on average 4.6 months after the initial virtual visit. None needed review within 72 hours. The pediatric on-demand service completed 290 visits, of which 25 had eye complaints.ConclusionsWith proper materials, technology, and staffing, a telemedicine strategy based on three patient categories can be rapidly implemented to provide continued patient care during pandemic conditions. In our study cohort, the scheduled clinic e-visits had a low no-show rate (3%), and 8% of the on-demand virtual access for pediatric care was eye related.

Electronic Consultation Systems: Impact on Pediatric Orthopaedic Care

The demand for pediatric orthopaedic surgery consultation has grown rapidly, leading to longer wait times for elective consultation in some regions. Some specialties are addressing this increased demand through electronic consultation services. We wanted to examine the impact of pediatric orthopaedic e-consultations in Canada's Eastern Ontario region. We developed a cross-sectional study of all the cases directed to a pediatric orthopaedic surgery specialist using the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service over a 2-year period and examined their impact on in-person referrals, time of e-consultation and primary care satisfaction as well as types of clinical questions that were asked. Electronic consultations avoided in-person appointments in 68% of the submitted cases. The median response by specialists received by the primary care providers (PCPs) was <20 hours. A total of 69% of consultations involve >1 type of clinical questions, most commonly about basic trauma/fracture care and management recommendations. Ninety-seven percent of the PCPs found the overall value for the care of the patients to be good or excellent. This cross-sectional study demonstrates the effective and timely use of eConsult in pediatric orthopaedic surgery. It also shows a significant reduction in the number of in-person consultations required and demonstrates a high satisfaction rate by PCPs using the service. In addition to the efficacy and time-sensitive care provided to the patients, the study shows that, professionally, 89% of PCPs found this service to be excellent or good. The broader implications of electronic consultation on overall quality of care, population health, and patient satisfaction requires further investigation.

Enabling patient-centred policy for electronic consultations: A qualitative analysis of discussions from a stakeholder meeting

Introduction To support the expansion of a successful regional electronic consultation (eConsult) service, we hosted a full-day national eConsult Policy Think Tank, connecting health-services researchers, clinicians, patients and policymakers to discuss policy considerations related to eConsult. In this paper, we assess the discussion arising from the Think Tank to identify and understand the policy enablers and barriers to the national spread and scale of eConsult services across Canada. Methods We conducted a constant comparative thematic analysis of stakeholder discussions captured during the Think Tank held in Ottawa, Canada, on 5 December 2016. Forty-seven participants attended and debated the following topic areas: (a) delivery of services and standards; (b) payment considerations; and (c) equitable access. The meeting was recorded, and verbatim transcripts were analysed using qualitative approaches. Results We identified four themes affecting spread and scale of eConsult innovation from a policy perspective: (a) patient-centredness; (b) value; (c) regulation; and (d) considerations for spread and scale. Patient-centredness was viewed as a foundational principle upon which policy shifts should be guided. Active participation of patient partners transitioned the discussions and resulting recommendations from provider-centred to patient-centred thinking around the relevant policy issues, explicitly demonstrating the importance of patient involvement in healthcare policy decision making. Discussion eConsult was viewed as a high-value, disruptive innovation with great potential to transform access to specialists in Canada. A patient-centred approach to policy change (and not just healthcare delivery) was identified as a novel yet critical enabler to the scale and spread of eConsult across Canada.

Patients’ use and experiences with e-consultation and other digital health services with their general practitioner in Norway: results from an online survey

ObjectivesTo explore patients’ use and experiences with four digital health services implemented in Norway to enable electronic communication between patients and their general practitioner (GP): (1) electronic booking of appointments;...

The Feasibility of Using Electronic Consultation in Long-Term Care Homes

Patients in long-term care (LTC) homes face barriers to accessing specialist advice. Electronic consultation (eConsult) has the potential to improve access for these patients. We used a multi-method approach to evaluate adoption of the Champlain BASE eConsult service in LTC homes across Eastern Ontario, Canada. We conducted a cross-sectional study of all eConsults submitted by primary care providers (PCPs) working at LTC homes between January 1, 2018 and December 31, 2018. Service use data were collected and descriptive statistics were calculated. We completed a thematic analysis of 4 focus groups with PCPs, senior leadership, and a nurse champion working in LTC homes where eConsult is used. Sixty-four cases were submitted to 23 specialty and subspecialty groups by LTC PCPs, most frequently dermatology (19%), geriatric medicine (11%), and infectious disease (9%). Specialists responded in a median of 0.6 days, and 70% of cases were resolved without the resident needing a face-to-face specialist visit. In 60% of cases, PCPs received advice for a new or additional course of action. Participants described complexities in the LTC context, the value of eConsult in LTC, and considerations for implementation. PCPs with experience using the service described increased access to specialist advice, ease of use, and benefits to themselves, residents, and families. eConsult is feasible in LTC and should continue to be used in this region and beyond to improve equity of access to specialist advice. Resolving the identified limitations in LTC, which hinder access to specialists and adoption of eConsult and similar innovations, should be of high priority to researchers and policy makers.

Telemedicine and eConsults for Hospitalized Patients During COVID-19

Telemedicine and eConsults for Hospitalized Patients During COVID-19

Specialist Participation in e-Consult and e-Referral Services: Best Practices.

Electronic consultations (eConsults) and referrals (eReferrals) are being implemented to improve access to specialist care. As eConsult and eReferral services rely on a roster of engaged specialists for their success, careful attention must be paid to how the term "specialist" is defined, what criteria inform specialists recruitment, and how quality of specialist responses can be monitored and maintained. Key considerations, informed by our personal experiences, review of best practice documents, international frameworks of specialists roles and competencies and a focused small group discussion among providers, health service planners and researchers for each of these important elements is discussed. Individuals participating in services should receive clear expectations around their role and responsibilities and be provided equitable access assuming they meet the necessary requirements. Training and feedback should be provided to ensure timely, quality responses. Paying attention to these key elements will reduce confusion, frustration and disengagement amongst specialists and ensure high quality responses.

MP02-01 IMPLEMENTATION OF A UROLOGY E-CONSULT SERVICE AT A SAFETY NET COUNTY HOSPITAL

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making I (MP02)1 Apr 2020MP02-01 IMPLEMENTATION OF A UROLOGY E-CONSULT SERVICE AT A SAFETY NET COUNTY HOSPITAL Nathan Chertack*, Yair Lotan, Christian Mayorga, and Ryan Mauck Nathan Chertack*Nathan Chertack* More articles by this author , Yair LotanYair Lotan More articles by this author , Christian MayorgaChristian Mayorga More articles by this author , and Ryan MauckRyan Mauck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000816.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the implementation of an e-consult service at a urology clinic in a safety net county hospital. METHODS: An e-consult system was introduced in 2018 at our institution. All e-consults for 2018 were collected and data analyzed. Patient demographics were recorded. Total consults, clinic referrals, cystoscopy referrals, need to reschedule, and need for follow-up were compared. Time from referral to in-person clinic visit was collected. Reason for e-consult and final visit diagnosis were placed into urologic categories and subcategories. RESULTS: In 2018, 472 e-consults were received for 454 patients. The majority were men (62.3%) with a median age of 55 years (IQR 44-63). The majority (52%) were Hispanic. Most patients (69.1%) were scheduled for an in-person clinic visit, with 23.9% of these patients scheduled for a cystoscopy. Median time from referral to in-person clinic visit was 39.5 days (IQR 33-50). One-fourth of patients did not require further follow-up after initial consultation. The majority of e-consults were for hematuria (24%), renal pathologies (20%), and benign prostatic hyperplasia and lower urinary tract symptoms (17%). CONCLUSIONS: Implementation of a urology e-consult service is feasible and decreases need for in-person clinic visits. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e11-e11 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Chertack* More articles by this author Yair Lotan More articles by this author Christian Mayorga More articles by this author Ryan Mauck More articles by this author Expand All Advertisement PDF downloadLoading ...

Response to Tande et al.'s Publication: "Association of a Remotely Offered Infectious Diseases eConsult Service With Improved Clinical Outcomes".

Response to Tande et al.'s Publication: "Association of a Remotely Offered Infectious Diseases eConsult Service With Improved Clinical Outcomes".

Barriers and Facilitators That Influence Telemedicine-Based, Real-Time, Online Consultation at Patients' Homes: Systematic Literature Review.

BackgroundHealth care providers are adopting information and communication technologies (ICTs) to enhance their services. Telemedicine is one of the services that rely heavily on ICTs to enable remote patients to communicate with health care professionals; in this case, the patient communicates with the health care professional for a follow-up or for a consultation about his or her health condition. This communication process is referred to as an e-consultation. In this paper, telemedicine services refer to health care services that use ICTs, which enable patients to share, transfer, and communicate data or information in real time (ie, synchronous) from their home with a care provider—normally a physician—at a clinical site. However, the use of e-consultation services can be positively or negatively influenced by external or internal factors. External factors refer to the environment surrounding the system as well as the system itself, while internal factors refer to user behavior and motivation.ObjectiveThis review aims to investigate the barriers and the facilitators that influence the use of home consultation systems in the health care context. This review also aims to identify the effectiveness of Home Online Health Consultation (HOHC) systems in improving patients’ health as well as their satisfaction with the systems.MethodsWe conducted a systematic literature review to search for articles—empirical studies—about online health consultation in four digital libraries: Scopus, Association for Computing Machinery, PubMed, and Web of Science. The database search yielded 2518 articles; after applying the inclusion and exclusion criteria, the number of included articles for the final review was 45. A qualitative content analysis was performed to identify barriers and facilitators to HOHC systems, their effectiveness, and patients’ satisfaction with them.ResultsThe systematic literature review identified several external and internal facilitators and barriers to HOHC systems that were used in the creation of a HOHC framework. The framework consists of four requirements; the framework also consists of 17 facilitators and eight barriers, which were further categorized as internal and external influencers on HOHC.ConclusionsPatients from different age groups and with different health conditions benefited from remote health services. HOHC via video conferencing was effective in delivering online treatment and was well-accepted by patients, as it simulated in-person, face-to-face consultation. Acceptance by patients increased as a result of online consultation facilitators that promoted effective and convenient remote treatment. However, some patients preferred face-to-face consultation and showed resistance to online consultation. Resistance to online consultation was influenced by some of the identified barriers. Overall, the framework identified the facilitators and barriers that positively and negatively influenced the uptake of HOHC systems, respectively.

Implementation of a Urology E-Consult Service at a Safety Net County Hospital.

We assess the implementation of an e-consult service at a urology clinic in a safety net county hospital. An e-consult system was introduced in 2018 at our institution. All e-consults for January to December 2018 were collected and data analyzed. Patient demographics were recorded. Total consults, clinic referrals, cystoscopy referrals, need to reschedule and need for followup were compared. Time from referral to in-person clinic visit was collected. Reason for e-consult and final visit diagnosis were placed into urological categories and subcategories. In 2018 472 e-consults were received for 454 patients. The majority were men (62.3%) with a median age of 55 years (IQR 44-63). The majority (52%) were Hispanic. Most patients (69.1%) were scheduled for an in-person clinic visit with 23.9% of these patients scheduled for a cystoscopy. Median time from referral to in-person clinic visit was 39.5 days (IQR 33-50). A quarter of the patients did not require further followup after initial in-person consultation. The majority of e-consults were for hematuria (24%), renal pathologies (20%), and benign prostatic hyperplasia and lower urinary tract symptoms (17%). Implementation of a urology e-consult service is feasible and decreases need for in-person clinic visits.

Knowledge, attitude, and perception of Indian population toward coronavirus disease (COVID-19).

Background:Coronavirus disease (COVID-19) has spread very fast worldwide as a pandemic causing unprecedented morbidity and mortality. Most countries in the world have undergone emergency lockdown in an attempt to flatten the curve and reduce the load on healthcare systems.Objective:This study was done to assess the knowledge, attitude, and perception toward the disease among the home-bound Indian population during the lockdown.Methodology:This was a questionnaire-based descriptive cross-sectional study conducted online. Compilation and assessment of the online data in the form of responses were done as for descriptive studies.Results:Among the 320 participants of the study, the awareness about the epidemiological features, including the signs and symptoms of the disease, was very good (more than 99% in some aspects). The attitude toward the measures for prevention of disease at home and outside was also very good (more than 97%) in some aspects, with a scope of improvement in a few others. Only one-third had the knowledge of online (e-consultation) services floated by governments and hospitals for medical advice. Ten percent had the potential to misuse drugs as prophylaxis. Most of the participants perceived that they had no predictable idea about the shape of disease epidemiology in the near future and only hoped for things to get better.Conclusion:This study reflects that aggressive awareness drives have played an important role in the dissemination of knowledge and the development of informed positive attitude toward COVID-19. Few gaps in knowledge and practices related to disease epidemiology, safe practices, mobile app for tracking and the availability of e-resources for medical advice, still remain. These should be addressed more aggressively, to strengthen the efforts to overcome this unprecedented crisis.

Association of a Remotely Offered Infectious Diseases eConsult Service With Improved Clinical Outcomes.

We performed a case–control study to evaluate an electronic, asynchronous infectious diseases consultative service at 2 rural hospitals within our health system. Patients with consultation via this platform (n = 100) had a significantly decreased odds of death at 30 days compared with propensity-matched controls (n = 300; adjusted odds ratio, 0.3; 95% confidence interval, 0.2–0.7; P = .003).