Health Care Provider Satisfaction Research Articles

Satisfaction With Virtual Consultation Services and Associated Factors Among Health Care Providers in Government Health Clinics in Selangor, Malaysia.

In Malaysia, virtual consultation services (VCSs) have been implemented by the Ministry of Health (MOH) since 2019 to complement current healthcare service delivery in government health clinics. Although the services have been proven to benefit patients, little is known about the satisfaction of healthcare providers (HCPs) who run the services. This study utilizes the extended Technology Acceptance Model to evaluate the satisfaction of HCPs with VCS and identify associated factors to further improve these services. In this study, we aimed to determine the proportion of HCPs who were satisfied with the VCS and identify factors contributing to this satisfaction. A cross-sectional study was conducted among 42 government health clinics in Selangor, Malaysia, using an online survey comprising a validated questionnaire of the extended Technology Acceptance Model. A total of 137 HCPs from various categories responded to the online survey. Data were analyzed using descriptive statistics and logistic regression. The majority of the respondents (72.3%) were satisfied with the VCSs, with a mean score of 14.47 ± 3.391. Two factors were found to be significantly associated with HCPs' satisfaction: perceived usefulness (adjusted odds ratio = 9.396; 95% confidence interval = 3.196-27.625) and behavioral intention (adjusted odds ratio = 8.311; 95% confidence interval = 2.494-27.694). Our results indicated a moderately high percentage of HCPs in government health clinics of Selangor who were satisfied with VCS (72.3%). Perceived usefulness and behavioral intention of HCPs were two strong determinants of satisfaction with VCS. Therefore, efforts should be directed towardimproving satisfaction with VCS by addressing these factors to ensure the sustainability of these services to best benefit patients.

A confirmatory factor analysis of a job satisfaction scale for healthcare providers in emergency departments

ABSTRACT Objective Performance of health care providers in a hospital’s emergency department is crucial as they are the first liners in the hospital. This study used a confirmatory factor analysis to verify the validity and reliability of a newly developed multi-dimensional job satisfaction scale for healthcare providers in emergency departments. Method A convenience sampling method used to collect data from emergency departments of Jordan Middle District hospitals. A total of 286 healthcare providers from 11 hospitals participated in the study. The job satisfaction questionnaire was distributed in these hospitals from the beginning of June 2020 until the end of August 2020. Data analysis was performed using AMOS 21 after data entry into SPSS 25. Result A model of four-factor with 16 items yielded adequate goodness-of-fit values with good convergent and discriminant validity after model re-specification. Four confirmed factors in this study were the most common dimensions used in measuring job satisfaction. Namely; physical environment and workplace safety, supervisor support, promotion and compensation, and staff communication and relationship domains. Conclusion The job satisfaction scale was proven to provide a valid measurement model and reliable constructs measuring accurately job satisfaction of healthcare providers in emergency departments and exploring ways to improve their performance.

Practical Experience with the Use of Electronic Headache Diaries and Video Consultations in Migraine Care from a Longitudinal Cohort Study.

Background: Telemedicine offers a promising solution to enhance the delivery and personalization of headache care. Integrating electronic (e-)tools enables the objective monitoring of migraine. Objectives: This study aims to demonstrate the relevance of e-tools for personalized headache care, assess patient and caregiver compliance and satisfaction, and present their use in enhancing care. Methods: Firstly, a systematic review was performed to validate the diagnostic accuracy of e-diaries for diagnosing migraine. Secondly, we collected e-diary data prospectively from diagnosed adult migraine patients at the Leiden Headache Center. Finally, questionnaires were sent to evaluate satisfaction of patients and health care providers with the Leiden e-headache diary and video consultations. Results: In the systematic review, the Leiden Headache Center's e-diary was the only validated tool. Patients (n = 1,009) were followed for a median of 181 days (interquartile range [IQR] 84-240). Compliance was 96.4% (IQR 85.2 - 99.1%), with 10.8% of days missing. Factors positively associated with compliance were older age (p < 0.001), female sex (p < 0.001), higher e-diary grade (p < 0.001), and clinical use (p = 0.04). The e-diary received a median score of 8/10 and was well-liked by patients (n = 535) and providers (n = 23). Video consultations were a good alternative for physical visits according to 76.9% of patients and 84.6% of providers. Conclusion: Validated e-headache diaries and video consultations in telemedicine enhance headache care accessibility, providing convenient care at preferred times and locations.

The impact of telehealth care on escalation to emergency care: A systematic review and meta-analysis.

We compared the impact of accessing healthcare (1) by telehealth (via telephone or video) vs face-to-face; and (2) by telephone vs video telehealth care, on escalation to emergency care. We searched Medline, Embase and Cochrane CENTRAL to 24 July 2023; and conducted a citation analysis on 19 September 2023. We included randomised controlled trials. Risk of bias was assessed using Cochrane Tool 2. We calculated risk ratios for dichotomous outcomes and standardised mean difference for continuous outcomes. Ten trials compared telehealth (five telephone, four video, one both) to face-to-face care. Six were overall low, three some concerns and one high risk of bias. There were no differences between telehealth and face-to-face for visits to the emergency department (RR 1.07, 95% CI 0.89 to 1.29), hospitalisations up to 12 months (RR 0.89, 95% CI 0.56 to 1.41), deaths or other adverse events. Costs of care were similar, as were patient satisfaction scores.Six trials compared telephone to video telehealth: three were overall low, two some concerns, and one high risk of bias. There were no differences between telephone and video for visits to the emergency department (RR 0.67, 95% CI 0.41 to 1.12), hospitalisations (RR 1.04, 95% CI 0.73 to 1.48), deaths, other adverse events, costs, or patient satisfaction. Healthcare provider satisfaction was high. Telehealth care - delivered by telephone or by video - may be an appropriate alternative to face-to-face provision of care, as it does not increase the likelihood of escalation of care to the emergency department for patients in primary care, hospital outpatients, post-discharge patients or residents in aged care.

Practice variation in urine collection methods among pre-toilet trained children with suspected urinary tract infection: a systematic review

BackgroundUrinary tract infections (UTIs) are a common cause of acute illness among infants and young children. There are numerous methods for collecting urine in children who are not toilet trained. This review examined practice variation in the urine collection methods for diagnosing UTI in non-toilet-trained children.MethodsA systematic review was completed by searching MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), PsycInfo (Ovid), CINAHL (EBSCO), and JBI (Ovid) from January 1, 2000 until October 9, 2021 and updated on May 24, 2023. Studies were included if they were conducted in an acute care facility, examined pre-toilet trained children, and compared one urine collection method with another for relevant health care outcomes (such as length of stay in an ED, or re-visits or readmissions to the ED) or provider satisfaction. Two independent reviewers screened the identified articles independently, and those included in the final analysis were assessed for quality and bias using the Newcastle-Ottawa Scale.ResultsOverall, 2535 articles were reviewed and 8 studies with a total of 728 children were included in the final analysis. Seven studies investigated the primary outcome of interest, practice variation in urine collection methods to diagnose a UTI. The seven studies that investigated novel methods of urine collection concluded that there were improved health care outcomes compared to conventional methods. Novel methods include emerging methods that are not captured yet captured in clinical practice guidelines including the use of ultrasound guidance to aid existing techniques. Three studies which investigated healthcare provider satisfaction found preference to novel methods of urine collection.ConclusionsThere is significant practice variation in the urine collection methods within and between countries. Further research is needed to better examine practice variation among clinicians and adherence to national organizations and societies guidelines. PROSPERO registration number CRD42021267754.

The Specialized Donor Care Facility Model Improves Operating Room Efficiency

BackgroundOrgan procurement organizations coordinate organ donation through 2 distinct models of care: the conventional model, in which donors are managed at hospitals where brain death occurs, and the specialized donor care facility (SDCF) model, where brain dead donors are transferred to a freestanding facility. The aim of this study is to compare operating room efficiency for procurements between the SDCF and conventional models of care. MethodsWe performed a prospective analysis of operating room efficiency between thoracic donor procurement operations performed at a SDCF and other organ procurement organizations using the conventional model of care. Key domains of efficiency were chosen based on a literature review and expert panel consensus. Data were collected in real time over a 12-month period via direct observation and personnel interviews. ResultsBetween January 1 and December 31, 2018, data were obtained from 54 procurement operations (n = 17 SDCF; n = 37 conventional). Donors in the 2 groups were similar in baseline characteristics. Procurements at the SDCF were performed with fewer nonsurgeon team members (2 vs 4, P < .001) without any difference in the organ yield. SDCF procurements more closely adhered to planned start times (6 vs 61 minute difference, P < .001), and a trend was observed for SDCF-based procurements to facilitate daytime transplant operations. ConclusionsThe SDCF model of donor care outperforms the conventional model in several important measures of operating room efficiency. These differences are likely to result in cost savings and improved healthcare provider satisfaction in the highly effort- and resource-intensive landscape of organ transplantation.

Evaluating a conceptual framework for quality assessment of medical interpretation

ObjectiveWe aimed to evaluate a proposed conceptual framework for quality assessment of medical interpretation using actual data from clinical settings. MethodsA mixed methods approach was used. Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese physicians, and hospital-provided and ad hoc interpreters were digitally recorded and transcribed. A questionnaire survey examining participants’ satisfaction was conducted; 111 and 13 encounters by hospital-provided and ad hoc interpreters, respectively, were recorded. Segments of consecutively interpreted utterances were coded as “altered,” whereby the interpreter changed the meaning of the source utterance, or “unaltered (accurate).” Frequency and type of alteration were analyzed. The effect of positive interpretation alterations on physician-patient interactions was qualitatively described. ResultsInterpretation accuracy was significantly higher for hospital-provided interpreters, but was not associated with overall patient satisfaction. Overall physician satisfaction was associated with accurate interpretation, clinically negative altered interpretations, and positive voluntary interventions (p < 0.05). Positive alterations promoted patient, physician, and interpreter interactions, which helped to achieve clinical outcomes. ConclusionA new conceptual framework for quality assessment of medical interpretation was developed for clinical settings. Healthcare provider satisfaction can provide a measure of interpretation alterations. Practice implicationsHealthcare providers can effectively use the conceptual framework to improve medical interpretation and collaboration with healthcare interpreters.

The role of patient-centered communication scale in patients’ satisfaction of healthcare providers before and during the COVID-19 pandemic

The role of patient-centered communication scale in patients’ satisfaction of healthcare providers before and during the COVID-19 pandemic

Novel Application of a Dynamic, In-room Survey Platform to Measure Surgical Team Satisfaction.

To elucidate the potential usage of continuous feedback regarding team satisfaction and correlations with operative performance and patient outcomes. Continuous, actionable assessment of teamwork quality in the operating room (OR) is challenging. This work introduces a novel, data-driven approach to prospectively and dynamically assess health care provider satisfaction with teamwork in the OR. Satisfaction with teamwork quality for each case was assessed utilizing a validated prompt displayed on HappyOrNot Terminals placed in all ORs, with separate panels for circulators, scrub nurses, surgeons, and anesthesia providers. Responses were cross-referenced with OR log data, team familiarity indicators, efficiency parameters, and patient safety indicator events through continuous, semiautomated data marts. Deidentified responses were analyzed through logistic regression modeling. Over a 24-week period, 4123 responses from 2107 cases were recorded. The overall response rate per case was 32.5%. Greater scrub nurse specialty experience was strongly associated with satisfaction (odds ratio: 2.15, 95% CI: 1.53-3.03, P < 0.001). Worse satisfaction was associated with longer than expected procedure time (odds ratio: 0.91, 95% CI: 0.82-1.00, P = 0.047), nighttime (0.67, 95% CI: 0.55-0.82, P < 0.001), and add-on cases (0.72, 95% CI: 0.60-0.86, P < 0.001). Higher material costs (22%, 95% CI: 6-37, P = 0.006) were associated with greater team satisfaction. Cases with superior teamwork ratings were associated with a 15% shorter length of hospital stay (95% CI: 4-25, P = 0.006). This study demonstrates the feasibility of a dynamic survey platform to report actionable health care provider satisfaction metrics in real-time. Team satisfaction is associated with modifiable team variables and some key operational outcomes. Leveraging qualitative measurements of teamwork as operational indicators may augment staff engagement and measures of performance.

The influence of working environment on well-being and job satisfaction of healthcare providers in geriatric nursing facilities in Shandong Province in China

The objective of this cross-sectional study was to examine the relationships between working environment, job satisfaction and subjective well-being. Based on the data gathered from 229 employees in the geriatric nursing facilities in Shandong province in China, 68% of elderly caregivers for the elderly, who were examined using the GWB scale, had scores exceeding 73, which indicates positive well-being. Approximately 57 (34.89%) caregivers reported being dissatisfied with their job.Correlation analyses showed that better working environment had positive effects on employees’ well-being and job satisfaction. Multiple linear regression analysis identified several factors that significantly increased the odds of subjective well-being. This included job satisfaction, the number of seniors you care for and the working environment. Specifically, registered nurses working in geriatric nursing facilities had lower levels of subjective well-being compared with other elderly caregivers.

Job Satisfaction Among Healthcare Providers in a Tertiary Care Government Medical College and Hospital in Chhattisgarh.

Background The job satisfaction of healthcare providers is particularly relevant in service management because employees' level of job satisfaction impacts healthcare service users. A positive association is observed between the job satisfaction of healthcare providers and patient satisfaction. This study was conducted to determine the job satisfaction levels and their determinants among healthcare providers (doctors, nurses, and support staff) in a tertiary care hospital. Methodology A cross-sectional study was conducted among 400 healthcare providers of a tertiary care medical college and hospital. The questionnaire method was employed to collect demographic data. Job satisfaction level was assessed using the Job Satisfaction Survey Scale (JSS Scale). Results The mean overall satisfaction score among doctors was 123.05 ± 17.06, for nurses 127.4 ± 14.58, and for the support staff 138.46 ± 22.09. Among all three groups, employees' support staff were found to be more satisfied (40%), followed by doctors (15%) and nurses (6.67%), while the proportion of dissatisfied employees was highest among doctors (20%) than nurses (6.67%) and the support staff (6.67%). Satisfaction was significantly higher among the support staff compared to doctors and nurses. The level of satisfaction was found to be more in the younger staff (38.14%), regular job holders (33.33%), and fresh recruits (37.5%). Overall, satisfaction levels were found to be positively associated with factors such as the type and nature of work (64%) and relationships with co-workers (40%) and supervisors (36%) while more dissatisfied with factors such as interpersonal communication (70%), salary (54%), and promotional opportunities (42%). Conclusion The overall satisfaction among employees was only 20%. Factors such as job security, young age, and work experience were strongly associated with job satisfaction. Employees were more satisfied with the type and nature of work and relationships with co-workers while more dissatisfied with salary, promotional opportunities, and interpersonal communication.

Using Shared Medical Appointments in Your Practice

Shared medical appointments (SMAs) are clinic visits in which a nurse practitioner delivers care to each patient in a group setting, usually in conjunction with other health care professionals. The SMA model is underused, despite growing evidence of its effectiveness in improving patient outcomes, increasing patient and health care provider satisfaction, and increasing productivity and revenue. This report provides practical advice for nurse practitioners interested in using this innovative health care delivery method.

Health System Quality and Performance Indicators for Evaluating Home Care Programming: A Scoping Review

A systematic scoping review of health system Performance and Quality Indicators (PQI) related literature for evaluating publicly funded home care programming was conducted. Through the scoping review we identify PQIs, map these based on quadrants of the Institute for Healthcare Improvement’s (IHI) Quadruple Aim, classify these PQIs under general “areas of focus” categories, and present recommendations for use. We selected all articles that identified, referenced, proposed, and/or described at least 1 PQI to measure home care service programming. Minimum inclusion criteria were a description of 1 or more PQIs designed to evaluate and/or measure home care programming, outcomes of home care clients and/or caregivers, or overall system impacts of home care service provision. The review identified 3,475 citations. A review of the abstracts led to the retrieval of 510 full-text articles for assessment of which 105 articles were selected for detailed review and extraction of identified PQIs. Of the 105 identified articles a total of 829 unique PQIs were gathered. Based on the IHI Quadruple Aim, 661 unique measures were identified as Clinical Outcome, 35 as Healthcare Provider Satisfaction, 99 Patient Experience, and 34 in the Financial/Sustainability quadrants. Many patient outcome specific PQIs exist, followed by patient experience measures. Very few PQIs exist in the financial or healthcare provider experience quadrants. The lack of indicators across all the IHI Quadruple Aim quadrants is an opportunity for further development supporting home care quality oversight.

Inpatient Neurology Huddle Quality Improvement Project (P3-7.006)

<h3>Objective:</h3> To implement a standardized huddle checklist that includes the important patient related issues that need to be addressed daily during inpatient neurology huddle and to assess the level of satisfaction of neurology health care providers about daily huddle flow both before and after implementing the checklist. <h3>Background:</h3> Inpatient interdisciplinary medical team members’ daily huddle is a meeting at which key issues related to patient care and management are discussed among medical team members. Clear communication is important for good patient outcome as well as health care providers satisfaction. Daily huddle improves patient care, safety, and outcomes by facilitating direct communication among all key members involved in patient care. <h3>Design/Methods:</h3> Using Survey monkey, a pre-implementation data was collected to assess the level of satisfaction of the healthcare providers with huddle flow and patient safety. Post-implementation data collected after 9 months of standard checklist implementation. Descriptive analysis was performed for survey results. <h3>Results:</h3> 33 health care providers participated in the pre-implementation survey: 10 (30.3%) nurses, 20 (60.6%) physicians, 2 (6.06 %) case managers, 1 (3.03%) social worker. 32 health care providers participated in the post-implementation survey: 11 (34.38%) nurses, 17 (53.13%) physicians, 2 (6.25%) case managers, 2 (6.25%) social workers. Prior to checklist implementation, 13 (39.39%) of the participants were satisfied with overall huddle flow. After checklist implementation 25 (78.13%) were satisfied with overall huddle flow. Regarding overall patient’s safety as a result of daily huddle, 14 (42.4%) of the participants were satisfied, 5 (15.15%) were dissatisfied and 14 (42.4%) were neither satisfied nor dissatisfied prior to checklist implementation. After checklist implementation, 24 (75 %) were satisfied, 2 (6.25%) were dissatisfied and 6 (18.75%) were neither satisfied nor dissatisfied with the overall patient’s safety because of daily huddle. <h3>Conclusions:</h3> Our data suggest that standardized huddle checklist improves provider’s satisfaction with huddle workflow and patient safety. <b>Disclosure:</b> Dr. Matloub has nothing to disclose. Dr. Carter has nothing to disclose. Dr. Wang has nothing to disclose.

A Pilot of Digital Whiteboards for Improving Patient Satisfaction in the Emergency Department: Nonrandomized Controlled Trial.

Electronic paper (E-paper) screens use electrophoretic ink to provide paper-like low-power displays with advanced networking capabilities that may potentially serve as an alternative to traditional whiteboards and television display screens in hospital settings. E-paper may be leveraged in the emergency department (ED) to facilitate communication. Providing ED patient status updates on E-paper screens could improve patient satisfaction and overall experience and provide more equitable access to their health information. We aimed to pilot a patient-facing digital whiteboard using E-paper to display relevant orienting and clinical information in real time to ED patients. We also sought to assess patients' satisfaction after our intervention and understand our patients' overall perception of the impact of the digital whiteboards on their stay. We deployed a 41-inch E-paper digital whiteboard in 4 rooms in an urban, tertiary care, and academic ED and enrolled 110 patients to understand and evaluate their experience. Participants completed a modified Hospital Consumer Assessment of Health Care Provider and Systems satisfaction questionnaire about their ED stay. We compared responses to a matched control group of patients triaged to ED rooms without digital whiteboards. We designed the digital whiteboard based on iterative feedback from various departmental stakeholders. After establishing IT infrastructure to support the project, we enrolled patients on a convenience basis into a control and an intervention (digital whiteboard) group. Enrollees were given a baseline survey to evaluate their comfort with technology and an exit survey to evaluate their opinions of the digital whiteboard and overall ED satisfaction. Statistical analysis was performed to compare baseline characteristics as well as satisfaction. After the successful prototyping and implementation of 4 digital whiteboards, we screened 471 patients for inclusion. We enrolled 110 patients, and 50 patients in each group (control and intervention) completed the study protocol. Age, gender, and racial and ethnic composition were similar between groups. We saw significant increases in satisfaction on postvisit surveys when patients were asked about communication regarding delays (P=.03) and what to do after discharge (P=.02). We found that patients in the intervention group were more likely to recommend the facility to family and friends (P=.04). Additionally, 96% (48/50) stated that they preferred a room with a digital whiteboard, and 70% (35/50) found the intervention "quite a bit" or "extremely" helpful in understanding their ED stay. Digital whiteboards are a feasible and acceptable method of displaying patient-facing data in the ED. Our pilot suggested that E-paper screens coupled with relevant, real-time clinical data and packaged together as a digital whiteboard may positively impact patient satisfaction and the perception of the facility during ED visits. Further study is needed to fully understand the impact on patient satisfaction and experience. ClinicalTrials.gov NCT04497922; https://clinicaltrials.gov/ct2/show/NCT04497922.

An urgent call for the environmental sustainability of health systems: A 'sextuple aim' to care for patients, costs, providers, population equity and the planet.

Health systems have a duty to protect the health and well-being of individuals and populations. Yet, healthcare contributes about 4.6% of global greenhouse gas emissions. Health systems need to question and improve established practices, assume strong environmental leadership, and aim for ambitious, sometimes radical, actions in favour of the climate. In this paper, we interrogate the suitability and feasibility of integrating the aim of 'environmental sustainability' to form the 'Sextuple Aim.' Environmental sustainability may be in tension with, but also a potential lever to meet the other cardinal aims: (1) quality and experience of patient care; (2) population health; (3) quality of work and satisfaction of healthcare providers; (4) equity and inclusion; and (5) cost reduction. We propose policy and practical avenues to help move towards the Sextuple Aim.

Evaluation of Health Care Providers Satisfaction with the Implementation of a Transitional Pain Service.

Chronic postsurgical pain develops in 10% of patients undergoing surgery. Recently, multidisciplinary, patient-tailored interventions, such as a Transitional Pain Service (TPS) have been developed and implemented to improve perioperative pain management and thereby prevent chronic postsurgical pain. The purpose of this survey was to analyse health care providers satisfaction and learn from their experiences on the implementation of a TPS. In the TRUST study, a randomized controlled trial investigating the effectiveness of a TPS, 176 patients were enrolled. Afterwards, a satisfaction survey was internally developed, which consisted of eight items. Satisfaction was measured using a Likert scale with five response options from never (1 point) to always (5 points). Surveys were sent to all anaesthetists and anaesthesia residents in our department that were faced with the consequences of TPS implementation. In May 2022, 36 caregivers of the Department of Anaesthesiology returned the survey after four rounds of distribution, with a response rate of 82.3%. Thirty staff members (81.0%) strongly felt that patient care had improved with the introduction of a TPS and 33 (86.8%) would like to see the TPS to be continued in the future. Health care provider satisfaction improved after implementation of a TPS in our hospital.

A qualitative assessment of provider satisfaction and experiences with a COVID-19 community mobile health clinic outreach model in underserved Baltimore neighborhoods.

Although previous studies have assessed provider perceptions about telehealth, no prior studies have qualitatively assessed the experiences and satisfaction of health-care providers with a community mobile health clinic model within underserved urban settings. This study draws on the views expressed by community health workers (n = 4), registered nurses (n = 2), Grace Medical Center outreach specialists (n = 2), and physician assistants staffing LifeBridge Health's virtual hospital (n = 3) to understand their satisfaction and experiences with a COVID-19 community mobile health clinic in underserved Baltimore neighborhoods. Thematic analysis of the interviews was used to extract themes and subthemes of our health-care providers' experiences with the community mobile health clinic model. These individuals shared their experiences addressing social determinants of health, the perceived impact of community mobile health clinic, satisfaction with and limitations of the pilot project, as well as future implications for the community mobile health clinic model. Finally, ideas for how the model can fit into the existing healthcare delivery framework are suggested. The context surrounding the COVID-19 pandemic has provided a unique opportunity to critically address healthcare frameworks and models. The LifeBridge community mobile health clinic served as an initiative to truly bridge together community outreach and health access. Among the many themes, health-care providers on the team applauded the model for its potential to bring preventative health care to the patient with the goal of improving patient health outcomes.

Synchronous teleconsultation and monitoring service targeting COVID-19: leveraging insights for post-pandemic healthcare.

Although a great number of teleconsultation services have been developed during COVID-19 pandemic, studies assessing usability and healthcare provider satisfaction are still incipient. To describe the development, implementation and expansion of a synchronous teleconsultation service targeting patients with symptoms of COVID-19 in Brazil, as well as to assess its usability and healthcare professionals' satisfaction. This mixed-methods study was developed in five phases: (i) identification of components, technical and functional requirements and system architecture; (ii) system and user interface development and validation; (iii) pilot testing in the city of Divinópolis; (iv) expansion in the cities of Divinópolis, Teófilo Otoni and Belo Horizonte for Universidade Federal de Minas Gerais faculty and students; (v) usability and satisfaction assessment, using Likert scale and open-ended questions. During pilot development, problems to contact users were solved by introducing standardized text messages (SMS) sent to them to obtain their feedback and keep track of them. Until April, 2022, the expanded system achieved 31,966 patients in 146,158 teleconsultations. Teleconsultations were initiated through chatbot in 27,69% of cases. Teleconsultation efficiency per city was 93.7% in Teófilo Otoni, 92.4% in Divinopolis, and 98.8% in Belo Horizonte (university campus), avoiding in-person assistance for the great majority of patients. 60 healthcare professionals assessed the system's usability as satisfactory, despite a few system instability problems. The system provided updated information about COVID-19 and enabled remote care for thousands of patients, which evidenced the critical role of telemedicine in expanding emergency services capacity during the pandemic. The dynamic nature of the current pandemic required fast planning, implementation, development and updates in the system. Usability and satisfaction assessment was key to identifying areas for improvement. The experience reported here is expected to inform telemedicine strategies to be implemented in a post-pandemic scenario.

Improving diabetes care of community-dwelling underserved older adults.

Diabetes care among rural underserved older adults is negatively affected by social determinants of health (SDOH). Although there is an increased awareness of this problem, evidence-based clinical and community interventions are not widely integrated. This project implemented telemedicine and community health worker (CHW) interventions to improve diabetes management and outcomes. One in five older adults with diabetes mellitus (DM) at a Federally Qualified Health Center in southwest Ohio has uncontrolled disease, largely due to their limited resources and ability to participate in routine clinical management. This quality improvement project used a pre-post intervention design. Participants were adults aged ≥65 years with uncontrolled DM type 1 or 2. The outcomes of interest included A1C values, diabetes self-care activities, diabetes knowledge, and patient and health care provider (HCP) satisfaction levels. The project involved biweekly CHW home visits and diabetes self-management education for 12 weeks. The CHWs, with supervision from a nurse practitioner, conducted SDOH assessments and basic education, and facilitated same-day telemedicine appointments with the HCP to reinforce disease management. The A1C levels and diabetes knowledge of older adults significantly improved after three months. However, there were no statistically significant changes in diabetes self-care activities. The patients and HCPs were highly satisfied with the project interventions. This project delivered patient-centered and equitable diabetes care services that were previously unavailable to underserved older patients, while demonstrably improving outcomes. Future research should evaluate the cost-effectiveness, long-term impact, and sustainability of the project in other primary care settings.