Consultation Mode Research Articles

A model of online opinion dissemination based on vector autoregressive model of emotional information entropy

Abstract In the context of the digitalization of big data information, to solve the problems of timeliness and accuracy of traditional online opinion dissemination models. This paper firstly proposes a vector autoregressive model in the research problem of online opinion dissemination model and constructs a vector autoregressive model based on multivariate time series and unit root test. Then the emotional information entropy is determined based on the statistical characteristics of the emotional index, and the evaluation index is mainly composed of the current mainstream online public opinion dissemination modes. Finally, data analysis of online opinion dissemination modes based on the vector autoregressive model is conducted, and the dissemination efficiency of different modes is compared based on the analysis results. The results show that in the microblog dissemination mode, online public opinion’s dissemination efficiency remains in the range of 38.02% to 44.81%, and its average dissemination efficiency is 41.51%. In the online short video dissemination mode: the online public opinion dissemination efficiency remains between 32.15% to 35.74%, and its average dissemination efficiency is 33.97%. In the consultation mode, online public opinion’s dissemination efficiency remains within the range of 22.06% to 28.99%, and its average dissemination efficiency is 25.61%. In terms of the average dissemination efficiency, the microblog dissemination mode performs better than the other two. Through a comprehensive and objective study of online public opinion dissemination modes, this study has a guiding reference value for improving online public opinion dissemination to promote the development of online public opinion dissemination in China.

ThTP1.8 Comparison of clinic outcomes between face-to-face and virtual appointments in patients with gallstone pathology: a single-centre retrospective observational study

Abstract Aims Precautions relating to the COVID-19 pandemic increased the use of virtual telephone and video consultations in the outpatient setting. This study aims to see whether the increased adoption of remote, virtual appointments affected clinic outcomes in patients presenting with gallstone pathology at a district general hospital. Methods Data on mode of consultation and clinic outcome was collected retrospectively for all patients reviewed at our department’s outpatient clinics between 01/04/2019 – 01/07/2019 and 01/04/2022 – 01/07/2022 (n=1243). Only patients with a primary diagnosis of gallstones, choledocholithiasis and cholecystitis were included in this study (n=179). Additional details on demographics and co-morbidities (age, ASA, BMI, previous abdominal surgery, abnormal LFTs) were collected for analysis of confounding factors. Results 60 patients had face-to-face (F2F) appointments and 119 patients had virtual (Virt) appointments (video (VV) n=52, telephone (VT) n=67). Patients who had virtual appointments had a higher rate of discharge (Virt=18.5%, F2F=11.7%) and a lower proportion was offered an operation (Virt=68.1%, F2F=80.0%), although these differences were not statistically significant. When compared to F2F, VT appointments had a significantly higher rate of discharge (26.9%, p-value=0.0540) and a significantly lower proportion were offered operations (58.2%, p-value=0.0144). There were no significant differences in demographics or co-morbidities between the patient groups. Conclusions The use of virtual telephone consultations was associated with significantly lower operation offers and higher rates of discharge when compared to face-to-face appointments. Further continuous auditing across multiple centres is required to uphold the standard of care for patients requiring intervention for gallstone pathology following the widespread introduction of virtual outpatient appointments.

Follow-up arrangements in head and neck cancer clinics during the COVID-19 pandemic: results from two tertiary UK head and neck cancer centres.

The aim of this paper is to report the pattern of follow-up that occurred for a cohort of head and neck cancer (HNC) patients across two large centres in the UK (Aintree and Leeds), as a consequence of the COVID-19 pandemic. Patients had been treated for HNC with curative intent between April 2017 and October 2019 by 14 oral and maxillofacial (OMFS) and ear nose and throat (ENT) oncology surgeons in the Patient Concerns Inventory intervention trial. In October 2020, hospital records were reviewed, and information collected on the timing and mode (face-to-face/telephone/video) of follow-up consultations. In addition, recurrence, second primary tumours and deaths were recorded. At the start of 'lockdown', 212 members of the cohort were known to be alive. During the post-lockdown period (follow-up appointment data comprised 5 months in Aintree and 7 months in Leeds) 7 died and 13 were identified as palliative/recurrence/new primary/metastases ('new event'). In Aintree, the first ENT/OMFS consultations after lockdown were 51 (67%) telephone and 25 (33%) face-to-face appointments. In Leeds, 46 (78%) consultations were by telephone and 13 (22%) were face-to-face. The second ENT/OMFS consultations post lockdown included 11 (44%) telephone and 14 (56%) face-to-face in Aintree, and 21 (75%) telephone and 7 (25%) face-to-face in Leeds. These data suggest that clinicians favoured remote consultations. Variations in practice were observed but reached a point of a 'hybrid follow-up approach' that included both face-to-face and remote consultations. With the emergence of telemedicine, clinicians may consider a follow-up model tailored to risk stratification. The development of the mode of such a consultation model needs further evaluation.

Teleconsultation Perceptions of Medical and Radiation Oncologists in the COVID-19 and Post-COVID-19 Era: A National Survey in the Philippines.

The study reports on the current perception of medical and radiation oncologists regarding teleconsultation in the Philippines. Before the COVID-19 pandemic, the adoption of telemedicine was not widespread. With movement restrictions imposed during the pandemic, physicians were compelled to use telemedicine. It is uncertain whether physicians will still adopt its use in practice in the post-COVID-19 era. This study gives insight into the possible adaptation of this mode of consultation in the future, especially in areas with limited health care resources. We conducted a national survey among medical oncologists and radiation oncologists in the Philippines. A 43-item online survey was developed, validated, and administered to the oncologists. The demographics and data from categorical questions were reported as frequencies and percentages. A total of 142 responses were gathered from 82 medical oncologists and 60 radiation oncologists. There was agreement among participants that, during the pandemic, teleconsultation could be used for the first visit, diagnostic workup request, treatment explanation, follow-up care, and chronic disease management. There was disagreement whether cancer diagnosis disclosure and cancer prognosis revelation could be performed via teleconsultation, and there was agreement that emergency consultation and physical examination would warrant a face-to-face consultation. After the COVID-19 pandemic, 78.7% intend to continue using teleconsultation except for emergency consultations, first visits, physical examination, diagnosis disclosure, and cancer prognosis revelation. Teleconsultation was perceived by oncologists as an acceptable method of providing cancer care during and after the COVID-19 pandemic. Oncologists also intend to use teleconsultation in the post-COVID-19 era in certain aspects of patient care.

Are insect bites responsible for the rise in summer flucloxacillin prescribing in United Kingdom general practices?

Insect bite inflammation may mimic cellulitis and promote unnecessary antibiotic usage, contributing to antimicrobial resistance in primary care. We wondered how general practice clinicians assess and manage insect bites, diagnose cellulitis, and prescribe antibiotics. This is a Quality Improvement study in which 10 general practices in England and Wales investigated patients attending for the first time with insect bites between April and September 2021 to their practices. Mode of consultation, presentation, management plan, and reattendance or referral were noted. Total practice flucloxacillin prescribing was compared to that for insect bites. A combined list size of 161,346 yielded 355 insect bite consultations. Nearly two-thirds were female, ages 3-89 years old, with July as the peak month and a mean weekly incidence of 8 per 100,000. GPs still undertook most consultations; most were phone consultations, with photo support for over half. Over 40% presented between days 1 and 3 and common symptoms were redness, itchness, pain, and heat. Vital sign recording was not common, and only 22% of patients were already taking an antihistamine despite 45% complaining of itch. Antibiotics were prescribed to nearly three-quarters of the patients, mainly orally and mostly as flucloxacillin. Reattendance occurred for 12% and referral to hospital for 2%. Flucloxacillin for insect bites contributed a mean of 5.1% of total practice flucloxacillin prescriptions, with a peak of 10.7% in July. Antibiotics are likely to be overused in our insect bite practice and patients could make more use of antihistamines for itch before consulting.

Consultation Rate and Mode by Deprivation in English General Practice From 2018 to 2022: Population-Based Study

The COVID-19 pandemic has had a significant impact on primary care service delivery with an increased use of remote consultations. With general practice delivering record numbers of appointments and rising concerns around access, funding, and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and modes (ie, face-to-face versus remote). This paper describes trends in consultation rates in general practice in England for key demographics before and during the COVID-19 pandemic. We explore the use of remote and face-to-face consultations with regard to socioeconomic deprivation to understand the possible effect of changes in consultation modes on health inequalities. We did a retrospective analysis of 9,429,919 consultations by general practitioners, nurses, or other health care professionals between March 2018 and February 2022 for patients registered at 397 general practices in England. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national data sets. Negative binomial models were used to predict consultation rates and modes (ie, remote versus face-to-face) by age, sex, and socioeconomic deprivation over time. Overall consultation rates increased by 15% from 4.92 in 2018-2019 to 5.66 in 2021-2022 with some fluctuation during the start of the COVID-19 pandemic. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups, but the extent varies by age. Consultation rates increased with increasing levels of deprivation. Socioeconomic differences in consultation rates, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18, indicating more consultations in the most deprived), effectively narrowing relative differences between deprivation quintiles. This trend remains when stratified by sex, but the difference across deprivation quintiles is smaller for men. The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultation rates compared to the least deprived. The substantial increases in consultation rates observed in this study imply an increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas.

How do consumers prefer their care delivered: In-person, telephone or videoconference?

Aim To gain a better understanding of consumer experiences with and preferences for telephone and videoconference consultations (telehealth), and how these compare to traditional in-person consultations. Methods A national cross-sectional survey was administered to a representative sample of Australian adults who have received a telehealth service within the last year. Consumers were recruited by Qualtrics® through their online sampling service. The sample was representative of the broader Australian population according to gender, age, location (state/territory), and place of residence (urban or remote). Information on demographics (e.g., age, gender, employment status), recent telehealth experience, and preferences for consultation modality was collected. To measure preferences consumers were asked to indicate which modality they would prefer (in-person, telephone, or videoconference) for different scenarios. These included consultations of various time lengths, and for the top ten conditions for which individuals sought a general practitioner. Results A total of 1069 consumers completed the survey. When consumers were asked to describe their most recent telehealth appointment, most were for follow-up appointments (67%) and completed by telephone (77%) rather than by videoconference, and with a general practitioner (75%). In-person consultations at a clinic were the top preference in all clinical scenarios presented, except when needing a prescription or to receive test results. In these cases, a telephone consultation was the preferred modality. Inexperience with videoconference and duration of consultation influenced preference for consultation mode. Consumers preferred to have short consultations of around five minutes done by telehealth (telephone or videoconference), while they preferred in-person for longer consultations (up to 60 minutes). Conclusions Many Australians have used telehealth in the past year to access healthcare, with telephone being the most common form of communication. Given the option and the experience to date, consumers prefer telephone when consultations related to either prescriptions or test results. Experience with videoconference for consultations increased consumer preferences for using it for future consultations.

Experiencing COVID-19, home isolation and primary health care: A mixed-methods study.

Although the vast majority of COVID-19 cases are treated in primary care, patients' experiences during home isolation have been little studied. This study aimed to explore the experiences of patients with acute COVID-19 and to identify challenges after the initial adaptation of the German health system to the pandemic (after first infection wave from February to June 2020). A mixed-method convergent design was used to gain a holistic insight into patients experience. The study consisted of a cross-sectional survey, open survey answers and semi-structured telephone interviews. Descriptive analysis was performed on quantitative survey answers. Between group differences were calculated to explore changes after the first infection wave. Qualitative thematic analysis was conducted on open survey answers and interviews. The results were then compared within a triangulation protocol. A total of 1100 participants from all German states were recruited by 145 general practitioners from August 2020 to April 2021, 42 additionally took part in qualitative interviews. Disease onset varied from February 2020 to April 2021. After the first infection wave, more participants were tested positive during the acute disease (88.8%; 95.2%; P < 0.001). Waiting times for tests (mean 4.5 days, SD 4.1; 2.7days, SD 2.6, P < 0.001) and test results (mean 2.4 days, SD 1.9; 1.8 days, SD 1.3, P < 0.001) decreased. Qualitative results indicated that the availability of repeated testing and antigen tests reduced insecurities, transmission and related guilt. Although personal consultations at general practices increased (6.8%; 15.5%, P < 0.001), telephone consultation remained the main mode of consultation (78.5%) and video remained insignificant (1.9%). The course of disease, the living situation and social surroundings during isolation, access to health care, personal resilience, spirituality and feelings of guilt and worries emerged as themes influencing the illness experience. Challenges were contact management and adequate provision of care during home isolation. A constant contact person within the health system helped against feelings of care deprivation, uncertainty and fear. Our study highlights that home isolation of individuals with COVID-19 requires a holistic approach that considers all aspects of patient care and effective coordination between different care providers.

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...

Scope of Teledentistry during the Trying Times of COVID-19 Pandemic: A Patient Perspective Questionnaire Survey

Introduction: Teledentistry has provided a glimmer of hope for patients who require treatment, but are limited to their homes owing to Coronavirus Disease-2019 (COVID-19) restrictions. Like any other professional careers, dentistry also had to switch to a new normal mode of consultation and teledentistry came to its aid. With the support of advanced technologies dental care was made possible even though face to face interactions were to be refrained due to the curfew restrictions. Aim: To assess the scope of teledentistry from a patient’s perspective. Materials and Methods: The survey was designed as a descriptive cross-sectional study conducted in the Department of Periodontics, Karpaga Vinayaga Institute of Dental Sciences, Chengelpet, Tamil Nadu, on dental patients of Chennai, India, from April 2021 to May 2021 who made use of Telemedicine for dental consultation. The study population included those who sought teledentistry and the study included 100 participants. A computer aided self-administered questionnaire was designed and validated. Practicing dentists were requested to circulate a questionnaire containing 10 questions that assessed scope of teledentistry from patient’s perspective, to their patients at the end of their teleconsultation after obtaining consent. A total of 94 responses were obtained successfully out of 100 participants. Descriptive analysis of the obtained data was done using International Business Machines Statistical Package for the Social Sciences (IBM SPSS) software version 22.0. Results: The mean±Standard Deviation (SD) age of the study participants was 33±2.5 years, there were 51 males and 43 females. A 57.5% (n=54) of individuals made the best use of teledentistry during the lockdown and 59.6% (n=56) of the respondents felt that teledentistry was safe as it prevented the risk of unnecessary exposure and cross-infection. Of all, 79 (84.04%) respondents answered that they support teledentistry in the future. Suggestions were received requesting reduction in consultation fee and to increase consultation timings. Conclusion: Teledentistry proved to be an excellent alternate mode of dental service during the COVID-19 pandemic crisis. Moreover, it helped to bring down the cross-infection and made health services available to people caught up in inaccessible areas thus, making teledentistry a valuable tool that can be used on a day to day basis

A Retrospective Analysis of WhatsApp as a Mode of Teledermatology: A Need of the Present Bringing in a Newer Consultation Mode in Future

Background: Telemedicine is usually considered a provision of health-care services, where distances are a critical factor. WhatsApp is a popular instant messaging app used worldwide, which incorporates encrypted text/voice/video-based communication making it ideal for dermatology consults in the current situation. Objectives: The aim of the study was to do a retrospective analysis of new and follow-up patients seen through teledermatology (TD) using WhatsApp and telemedicine platform as a communication tool during the lockdown due to COVID-19 pandemic. Materials and Methods: Retrospective analysis of new and follow-up patients seen through teledermatology during the lockdown was done. The teleconsultation was provided through WhatsApp and telemedicine platform. Consent was sought, and a detailed history was obtained through messaging and by call. Clinical pictures sent by WhatsApp were analyzed, and a diagnosis was made by correlating the history and image findings. Treatment was individualized for each patient, and a teleprescription was sent as per the guidelines provided by the health-care regulators. Results: This study retrospectively analyzed the usefulness of WhatsApp-based teleconsultations for 60 patients comprising 32 new and 28 follow-up cases during the lockdown. The conditions ranged from various forms of dermatitis, papulosquamous disorders, and autoimmune blistering disorders to cutaneous infections. Conclusion: Diagnosis could be made in all 60 patients. Positive patient perception and prognosis, with decreased financial liabilities were noticed. WhatsApp provides a way to move forward in these uncertain times. Specific guidelines on TD have to be inculcated in routine practice.

Remote consultations in primary care across low-, middle- and high-income countries: Implications for policy and care delivery.

The COVID-19 pandemic mandated a substantial switch in primary health care delivery from an in-person to a mainly remote telephone or video service. As the COVID-19 pandemic approaches its third year, limited progress appears to have been made in terms of policy development around consultation methods for the post-acute phase of the pandemic. In September 2020, the International Primary Care Respiratory Group convened a global panel of primary care clinicians - including family physicians, paediatricians, pharmacists, academics and patients - to consider the policy and health management implications of the move to remote consultations in the primary care setting. The group gave special consideration to how and how far remote consultations should be integrated into routine primary health care delivery. Remote consultations can be a useful alternative to in-person consultations in primary care not only in situations where there is a need for viral infection control but also for the routine delivery of chronic disease management. However, they may not be more time efficient for the clinician, and they can add to the workload and work-related stress for primary care practitioners if they remain the dominant consultation mode. Remote consultations are also less appropriate than in-person consultations for new disease diagnosis, dealing with multiple issues and providing complex care. Ensuring health care professionals have the appropriate skill set to effectively deliver remote consultations, administrative and/or IT support and appropriate reimbursement will be key to achieving optimal integration of remote consultations into routine clinical practice. Addressing digital access and digital literacy issues at a societal level will also be essential to ensure individuals have fair and equitable access to the internet and sufficient security for exchange of personal and health-related data.

Young people talk about primary care and telehealth: A survey of 15- to 25-year olds in the Wellington region of New Zealand.

Young people are known to face challenges when accessing healthcare and generally have low rates of health service utilisation. Use of telehealth might be one way to improve access, but evidence is needed from young people as to how acceptable it is. This online survey of 15- to 25-year olds in the greater Wellington region of New Zealand sought young people's views on telehealth (phone and videocalls) as a means of accessing primary care. The survey included both forced-choice questions and free-text options. We report here on the free-text data from open-ended questions that were qualitatively analysed using template analysis. A total of 346 participants took part between August 6 and September 21, 2021, of whom 60% were female, 12% Māori (indigenous) ethnicity, and 38% had used telehealth methods of consulting previously. Analysis was undertaken of the free-text comments that were provided by 132 participants (38%). Although those contributing comments described both benefits and drawbacks to using telehealth, more drawbacks were cited, with specific examples given to illustrate a range of concerns and potential limitations of telehealth including privacy, communication difficulties and compromised quality of care. Participants thought telehealth could be used successfully in specific situations, for example by people concerned about leaving the house due to anxiety, illness or being immunocompromised and for simple consultations or when the person knows exactly what they need. Respondents expressed a strong desire to be offered the choice between in-person and telehealth consultations. Providing young people with a choice of consultation mode together with clear information about all aspects of a telehealth consultation is important if clinicians want young people to engage with this method of primary care service delivery.

General practice perspective on the use of telehealth during the COVID-19 pandemic in Australia using an Action Research approach: a qualitative study

ObjectivesTelehealth has emerged as a viable and safe mode of care delivery in Australia during the COVID-19 pandemic. However, electronic general practice data reveal differences in uptake and consultation mode,...

Фізкультурно-спортивна реабілітація у системі галузевих соціальних практик

The purpose of the study was to determine the essence and content of physical culture and sports rehabilitation as components of industry social practices. Materials and methods. Systemic approach, methods of analysis and synthesis, documentary method, methods of scientific induction and deduction were used in the study. Results and discussion. The peculiarities of the use of the term "rehabilitation" in the historical context, from the time of the First World War to the present day, are analyzed. Scientists are unanimous in the opinion that rehabilitation is a system of state, socio-economic, medical, professional, pedagogical, professional and other measures aimed at restoring health, the functional state of the human body and its working capacity. It has been studied that rehabilitation is a complex multifaceted concept, which means "restoration" and involves different types of rehabilitation. It has been established that physical culture and sports rehabilitation is a system of measures developed with the use of physical exercises to restore a person's health and is aimed at restoring and compensating with the help of physical culture and sports the functional capabilities of his/her body to improve his/her physical and psychological state. Taking into account the belonging of physical culture and sports rehabilitation to the field of physical culture and sports, which studies the impact of physical culture and sports on health, physical development and physical capabilities of the body, as well as on the recovery of athletes after injuries and illnesses, the application of physical culture and sports will contribute to the significant strengthening and improvement of the effectiveness of the recovery of athletes after injuries and illnesses. Conclusion. Physical culture and sports rehabilitation is an actual object of scientific research. As a postulate of scientific research in the field of physical culture and sports rehabilitation, we accept the statement that rehabilitation is a system of state, socio-economic, medical, professional, pedagogical, professional and other measures aimed at restoring health, the functional state of the human body and its working capacity. In contrast to physical therapy, which is based on the diagnosis and assessment of the functional state of the patient taking into account nosology, and involves the use of physical exercises along with medical and physiotherapeutic measures, physical culture and sports rehabilitation has a predominant focus on restoring and compensating the body's functional capabilities, physical and psychological state of a person with the help of physical education and sports. One of the main methodological provisions of physical culture and sports rehabilitation should be a comprehensive multidisciplinary approach, which involves the formation of the "FSR team" for the recovery of the athlete's condition from specialists in the field of physical culture and sports, and the involvement of specialists from other specialties in a consultative mode

EP-241 Surgical virtual clinic (VC) practice: an audit of practice in the University Hospitals Sussex NHS Trust

Abstract Aims The aim of the study was to assess the appropriateness of surgical virtual clinic practice (VC) in the University of Sussex hospitals. Methods A retrospective assessment of Six consecutive clinics of three consultants, a total of 216 patients, was audited according to guidelines of the Royal College of Surgeons (1). Additionally, feedback forms were obtained from ten Consultants and matched against RCS guidelines. Ethical approval was obtained from the quality improvement department. Results The study cohort mean age was 67 (20–94) years with 1: 1.2 female to male ratio. VC site was 68% from home. The VC attendance rate was 97.5% (2.5% DNA rate) and 93% patients were suitable for VC appointment because 2.8% needed physical examination and remaining percentage was not suitable due to hearing impairment and language barrier. Telephone was the mode of virtual consultation in addition to 100% documentation and 100 conclusion documentations. Four blocks of RCS guidelines compliance based upon the opinion of the consultant surgeon was reported from 65% to 97.5%. Conclusion The attendance of VC clinics was 97.7% with suitability for VC up to 93%. There was a good compliance with RCS guidelines reaching up to 97.5%. However, few areas which needs improvement are obtaining consent (documentation if consent was taken), confirmation of alternative contact details, length and details of VC and reassurance that VC is equivalent to face to face clinic in terms of service provision.

Would you zoom with your doctor? A discrete choice experiment to identify patient preferences for video and in-clinic consultations in German primary care.

The popularity of video consultations in healthcare has accelerated during the COVID-19 pandemic. Despite increased availability and obvious benefits, many patients remain hesitant to use video consultations. This study investigates the relative importance of the consultation mode compared to other attributes in patients' appointment choices in Germany. A discrete choice experiment was conducted to examine the influence of appointment attributes on preferences for video over in-clinic consultations. A total of 350 participants were included in the analysis. The level of continuity of care (46%) and the waiting time until the next available appointment (22%) were shown to have higher relative importance than consultation mode (18%) and other attributes. Participants with fewer data privacy concerns, higher technology proficiency, and more fear of COVID-19 tended to prefer video over in-clinic consultations. The predicted choice probability of a video over a typical in-clinic consultation and opting out increased from <1% to 40% when the video consultation was improved from the worst-case to the best-case scenario. This study provides insight into the effect of the consultation mode on appointment choice at a time when telemedicine gains momentum. The results suggest that participants preferred in-clinic over video consultations. Policymakers and service providers should focus on increasing the level of continuity of care and decreasing the time until the next available appointment to prompt the adoption of video consultations. Although participants preferred to talk to their physician in person over consulting via video per se, the demand for video consultations can be increased significantly by improving the other appointment attributes of video consultations such as the level of continuity of care.

Review of Remote Consultations in Learning Disability During COVID Pandemic

AimsThe aim of this project was to assess the efficacy of remote consultations in patients with Learning Disability (LD). In Aneurin Bevan University Health Board, teleconsultation or “Attend Anywhere” (Video) platforms are the two types of remote consultation that is being offered.MethodsA 9- point Questionnaire was used to assess the efficiency of the consultation. During consultation (Either telephone or attend anywhere), data were collected by the consultants by answering the questionnaire. 23 clinics organised between 04/06/2020 to 23/06/2020 for Service Users' (SU) follow-up.The following key points were covered in the questionnaire: 1.Mode of consultation- telephone or attend anywhere2.Presence of the SU3.Introduction4.Availability of information (patient notes/shared drives) prior to consultation5.Time constraints6.Information not covered due to lack of face-to-face consult7.Technical difficulties8.Expectations from SU9.Feedback from SUResults1.The most common mode of consultation was via telephone (70%), followed by Attend Anywhere (30%)2.The majority of conversations were with SU's family or carers (70%); consultations with SU were only 30%. SU were unable to attend the consultation due to: Communication difficulty (26%), follow-ups provided by carer's/family's feedback (21.7%), SU away due to physical health reasons, or in day care (17.3%).3.Introductions were done and sufficient information regarding the service users were available in all consultations.4.Expectation of SU/carers/family was with regards to medication review (43%).5.52% of remote consultation were disrupted due to technical problems, for instance call drops and line disruptions, microphone issues and SU not being able to use attend anywhere because of its complexity.ConclusionIt was demonstrated that remote consultation could possibly be most effective for medication reviews or regular follow-up appointments.Some of the aspects that were not covered due to the shortcomings of remote consultations were: a.Difficulty in assessing body language and facial expressionsb.Difficulty in assessing the level of function of SUc.Unable to monitor physical health parametersd.Difficulty in picking up non-verbal cues, and assess eye contact to ascertain mood component of presentation.In summary it seems in the early stages of the pandemic, telephone consultation was the predominant form of remote consultation. Further work would be useful to obtain the views of people with LD, their carers and families as to which form of consultation would be their preference and whether remote consultation is acceptable for this patient group.

Attributes for Discrete Choice Experiment on Pharmacy-based Alcohol Brief Intervention Service in Thailand

Purpose: The alcohol brief intervention (ABI) service provided by community pharmacists was not conducted in Thailand. A discrete choice experiment (DCE) is a widely accepted approach to elicit stated preferences in the health economics. This study aims to identify important attributes and levels from both client and community pharmacists' points of view. The step involved in conducting a DCE is to develop the attributes and levels for the model. Attributes relevant to a new community pharmacy-based ABI service were used to determine clients' preferences for receiving this service by a DCE. Methods: The method includes five steps: 1) literature review and researcher observation, 2) raw data collection, 3) attribute selection, 4) attributes and wording confirmation, and 5) researchers' conclusions These steps involved a semi-structured interview given to 20 clients. After conducting the interviews, the data was triangulated to obtain one DCE choice from each client. An iterative constant comparative approach during the data collection and analysis. The selected attribute was derived from a focus group discussion among seven community pharmacists. Results: The five steps resulted in five attributes: modes of consultation, screening methods, a continuation of a conversation, a counseling session, and cost of service. According to the methodological triangulation, eight of ten key informants have opinions congruous with one DCE choice set. Conclusion: The attributes and levels of a Thai community pharmacy-based service for a DCE were derived from both client and community pharmacists' views using five steps. The attributes and levels were suitably used in a subsequent DCE.

Individuals' Perceptions as a Substitute for Guidelines and Evidence: Interview Study Among Clinicians on How They Choose Between In-Person and Remote Consultation.

BackgroundVideo consultation (VC) is increasingly seen as a cost-effective way of providing outpatient care in the face of dwindling resources and growing demand for health care worldwide. Therefore, the sustainable implementation of VC is a phenomenon of interest to medical practitioners, researchers, and citizens alike. Studies are often criticized for not being sufficiently robust because the research settings are mostly small-scale pilot projects and are unable to reflect long-term implementation. The COVID-19 pandemic has compelled clinicians worldwide to conduct remote consultation, creating a favorable context to study large-scale remote consultation implementation.ObjectiveThe aim of this study was to thoroughly investigate how clinicians reason their choice of different consultation modes in the routine of consultation and what the underlying reasons are for their choices. We posited that a deeper understanding of clinicians’ perceptions of remote consultation is essential to deduce whether and how remote consultation will be adopted on a large scale and sustained as a regular service.MethodsA qualitative approach was taken, in which the unit of analysis was clinicians in one of the largest university hospitals in Norway. In total, 29 interviews were conducted and transcribed, which were used as the primary data source. Using the performative model of routine as the theoretical framework, data were analyzed using deductive content analysis.ResultsClinicians have mixed opinions on the merits and demerits of VC and its position between in-person and telephone consultation. Totally, 6 different planning criteria were identified, and individual clinicians used different combinations of these criteria when choosing a mode of consultation. The ideals that clinicians hold for conducting consultation can be divided into three aspects: clinical, interpersonal, and managerial. VC engenders a new ideal and endangers the existing ideals. VC causes minor changes in the tasks the clinicians perform during a consultation; thus, these changes do not play a significant role in their choice of consultation. Clinicians could not identify any changes in the outcome of consultation as a result of incorporating a remote mode of consultation.ConclusionsClinicians feel that there is a lack of scientific evidence on the long-term effect of remote consultation on clinical efficacy and interpersonal and managerial aspects, which are crucial for consultation service. The absence of sufficient scientific evidence and a clear understanding of the merits and demerits of VC and standard practices and shared norms among clinicians regarding the use of video for consultation both create a void in the consultation practice. This void leads clinicians to use their personal judgments and preferences to justify their choices regarding the consultation mode. Thus, diverse opinions emerge, including some paradoxical ones, resulting in an uncertain future for sustainable large-scale implementation, which can reduce the quality of consultation service.