Requests For Advice Research Articles

WP2.11 - Improving prescription of discharge medications for day case surgery patients using electronic patient records system (EPIC); a closed loop audit

Abstract Aim It is important to provide patients who have undergone day surgery with appropriate analgesia, antiemetics, and laxatives. Failure to do this can result in a poor patient experience, patient requests for advice, readmission and morbidity. This study audited our adherence to the GIRFT guidelines for day case discharge prescribing. Methods Data was collected retrospectively on the discharge medications for all patients undergoing elective, day case laparoscopic cholecystectomy and inguinal hernia repair at two district general hospitals in our trust over a five-week period. A pre-populated discharge medication order set was then created on the Trust's electronic health records system (EPIC) to improve adherence to the GIRFT guidelines. Discharge medications were observed over a subsequent four-week period. Results Prior to our intervention, adherence to GIRFT guidelines was poor with 25% of patients only received the correct discharge medications. Following introduction of the pre-populated order set, 83% of patients received the correct discharge medications. Conclusions This audit demonstrates that utilizing electronic systems effectively can improve efficiency, ensure patient safety and enhance patient care.

Insights into maternal pertussis vaccination counselling: a qualitative study on perspectives and experiences among midwives and gynaecologists in the Netherlands

BackgroundHealthcare professionals (HCPs) play a significant role in the decision-making process of pregnant women on maternal vaccinations. Whereas a high proportion of HCPs discuss maternal vaccinations with pregnant women, confidence in discussing maternal vaccinations is lacking and HCPs experience inadequate training to discuss maternal vaccinations with pregnant women. Furthermore, different practical barriers might influence the consultation process, such as lack of time. More studies on the barriers, as well as facilitators, to discussing maternal vaccinations is needed and will help us to better understand and support HCPs in discussing maternal vaccinations.MethodsThis qualitative study involved semi-structured interviews with fourteen HCPs working as midwives or gynaecologists in the Netherlands. An integrated theoretical approach was used to inform data collection and analysis. Thematic analysis was conducted using inductive and deductive approaches. This study followed the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.ResultsThe thematic analysis of the data pointed to the following five themes of HCP counselling: the consultation process, attitude, perceived norm, perceived control and improvement ideas. Most HCPs follow a similar approach in maternal pertussis vaccination consultations, beginning by assessing clients’ understanding, providing basic information, and addressing questions. However, consultation timing and prioritization vary among HCPs. Challenges in consultations include client requests for clear advice, with HCPs trained to remain neutral, emphasizing client autonomy in decision-making. Most HCPs acknowledge the importance of their consultations in informing pregnant women about maternal pertussis vaccination.ConclusionsThis study offers a confirmation of the awareness of the pivotal role of HCPs in informing pregnant women about the maternal pertussis vaccination. HCPs stress the importance of neutral counselling, enabling pregnant women to make well-informed decisions independently. Because of upcoming vaccine hesitancy nowadays, HCPs must be equipped with the knowledge and confidence to navigate difficult conversations. Continuous education and training might help to increase HCPs’ confidence in handling difficult consultations. Additionally, making the information materials for pregnant women available in multiple languages and incorporating more visuals to enhance comprehension could support HCPs in reaching a broader group of pregnant women.

Exploring Social Networks: An Analysis of Intra-organizational Networks

This research investigates intra-organizational social networks by employing network science methods, aiming to provide actionable insights for both managers and employees. Using datasets from the Colorado Index of Complex Networks (ICON), this study examines four intra-organizational networks from a consulting firm and a research team, focusing on advice requests and skill awareness. The analysis includes network topology, degree distribution, community detection, correlation between communities and node attributes, maximal clique detection, and multilayer network analysis. The findings reveal that intra-organizational networks are intricate and significantly impact organizational efficiency and individual career development. Key insights include the importance of mid-level employees in network connectivity, the existence of "bad edges" where advice is sought from less competent peers, and the influence of regional and locational factors on communication patterns. The study emphasizes the need to enhance knowledge sharing and inter-region communications. For employees, understanding the structure of these networks can guide them to more effectively leverage their social connections for career advancement. This interdisciplinary effort bridges gaps in the existing literature and showcases the potential of integrating network science methods into social science research.

Expertise and specialization in organizations: a social network analysis

ABSTRACT Organizations rely on their employees’ expertise (i.e. very high domain-specific competence relative to peers) and specialization (i.e. moderate to high competence in tasks for which no direct peers are responsible) to foster innovation and knowledge-sharing processes. While previous research demonstrated the pivotal role of experts and specialists, there remains scant knowledge on their skill profiles and embeddedness in organizational networks. Employing social network analysis (N = 344), we explore the relationships between the reception of advice requests – quantified by in-degree centralities – and self-assessed skills, expertise, and specialization. The results suggest a halo effect, as proficiency in one skill bundle is related to advice requests in other skill bundles. Furthermore, we use an exponential random graph model (ERGM) to provide evidence of similarities in skills, tenure, and leadership responsibility between advice-giver and advice-seeker. Finally, we use optimal matching analyses to compare skill profiles of individuals in our sample with theoretically derived ideal types of skill profiles for experts and specialists. The study underscores the need to further investigate expertise and specialization, emphasizing the importance of distinguishing between diverse knowledge carriers and skill profiles within career development, talent management, and knowledge management.

Evaluation of the impact of neurology electronic consults (e-consults): Experiences of a neurology resident clinic in a safety-net hospital.

Electronic consults (e-consults) are asynchronous, formalized requests by a provider to involve a specialist to assist with decision making. E-consults are an alternative to face-to-face consultation and are a promising strategy to efficiently address certain requests for advice. The objective of this project was to examine the utility and characteristics of electronic consults utilized in a safety-net hospital outpatient neurology clinic. We retrospectively reviewed e-consults to the neurology clinic from1 January 2021 to 31 September 2021. The reasons for requests and any diagnostic or treatment recommendations were collected. The time to completion of the e-consults and the percentage of e-consult referred for an in-person clinic evaluation were determined as outcome measures. Following each e-consult, the consulting provider completed a survey to gather their assessment on the appropriateness of the consult, time spent answering the consult, and if unnecessary testing or clinic visits were avoided. A total of 528 e-consults were completed during the study period. The most frequent e-consult referrals were for headache (22%), stroke/neurovascular (21%), neuropathy/neuritis/disturbance of skin sensation (11%), and seizures/spells (11%). The majority of e-consults (94%) were answered in one business day (defined as occurring within 24 h) with 67% of consults answered the same day (defined as occurring within the same calendar day). The consulting providers reported that more than 90% of e-consults took <15 min to answer, and 84% of e-consult requests were felt to be appropriate. A total 156 (41.4%) patients initially seen as an e-consult were referred for a face-to-face visit within 90 days of the e-consult. E-consults provided expedited input from neurologists, which is vital in health systems that provide care to vulnerable populations. The majority of e-consults were answered within 1 day of referral, offering rapid access to neurological expertise in comparison to wait times currently encountered for face-to-face visits. Accordingly, e-consults have the potential to expedite treatment for patients, empower primary care providers, and reduce demand for in-person consultations, particularly in large health systems caring for vulnerable populations.

Prompt engineering on leveraging large language models in generating response to InBasket messages.

Large Language Models (LLMs) have been proposed as a solution to address high volumes of Patient Medical Advice Requests (PMARs). This study addresses whether LLMs can generate high quality draft responses to PMARs that satisfies both patients and clinicians with prompt engineering. We designed a novel human-involved iterative processes to train and validate prompts to LLM in creating appropriate responses to PMARs. GPT-4 was used to generate response to the messages. We updated the prompts, and evaluated both clinician and patient acceptance of LLM-generated draft responses at each iteration, and tested the optimized prompt on independent validation data sets. The optimized prompt was implemented in the electronic health record production environment and tested by 69 primary care clinicians. After 3 iterations of prompt engineering, physician acceptance of draft suitability increased from 62% to 84% (P <.001) in the validation dataset (N = 200), and 74% of drafts in the test dataset were rated as "helpful." Patients also noted significantly increased favorability of message tone (78%) and overall quality (80%) for the optimized prompt compared to the original prompt in the training dataset, patients were unable to differentiate human and LLM-generated draft PMAR responses for 76% of the messages, in contrast to the earlier preference for human-generated responses. Majority (72%) of clinicians believed it can reduce cognitive load in dealing with InBasket messages. Informed by clinician and patient feedback synergistically, tuning in LLM prompt alone can be effective in creating clinically relevant and useful draft responses to PMARs.

Gender Disparities in Electronic Health Record Usage and Inbasket Burden for Internal Medicine Residents.

Studies have demonstrated patients hold different expectations for female physicians compared to male physicians, including higher expectations for patient-centered communication and addressing socioeconomic or emotional needs. Recent evidence indicates this gender disparity extends to the electronic health record (EHR). Similar studies have not been conducted with resident physicians. This study seeks to characterize differences in EHR workload for female resident physicians compared to male resident physicians. This study evaluated 12months of 156 Mayo Clinic internal medicine residents' inbasket data from July 2020 to June 2021 using Epic's Signal and Physician Efficiency Profile (PEP) data. Excel, BlueSky Statistics, and SAS analytical software were used for analysis. Paired t-tests and analysis of variance were used to compare PEP data by gender and postgraduate year (PGY). "Male" and "female" were used in substitute for "gender" as is precedent in the literature. Mayo Clinic internal medicine residents. Total time spent in EHR per day; time in inbasket and notes per day; time in notes per appointment; number of patient advice requests made through the portal; message turnaround time. Female residents received more patient advice requests per year (p = 0.004) with an average of 86.7 compared to 68, resulting in 34% more patient advice requests per day worked(p < 0.001). Female residents spent more time in inbasket per day (p = 0.002), in notes per day (p < 0.001), and in notes per appointment (p = 0.001). Resident panel comparisons revealed equivocal sizes with significantly more female patients on female (n = 55) vs male (n = 34) resident panels (p < 0.001).There was no difference in message turnaround time, total messages, or number of results received. Female resident physicians experience significantly more patient-initiated messages and EHR workload despite equivalent number of results and panel size. Gender differences in inbasket burden may disproportionally impact the resident educational experience.

Secure app-based secondary healthcare clinical decision support to deployed forces in the UK Defence Medical Services

BackgroundModern instant messaging systems facilitate reach-back medical support for Defence Medical Services (DMS) by connecting deployed clinicians to remote specialists. The mobile app Pando (Forward Clinical, UK) has been used...

“Doing being a good parent” in the pediatric clinic: Parents' knowledge displays in advice requests on infants' everyday care

Parents and pediatricians play pivotal roles in promoting a nurturing environment for children's growth and development, especially during the critical first thousand days of life. Given the challenges involved in infant care and rearing, parents often rely on pediatricians' professional support in a wide range of daily caregiving practices as diverse as complementary feeding, hygiene management, pacifier use, or sleep routines. Nevertheless, little attention has been devoted to the in vivo observation of how parents actually request advice on babies' everyday care, and how pediatricians attend to such requests. By adopting a conversation analysis approach to a corpus of 23 videorecorded Italian pediatric well-child visits, the article explores the different ways through which parents navigate the face-threatening activity of soliciting the pediatrician's advice on infants' everyday care and management. The analysis illustrates that parents overall display (different degrees of) prior knowledge and competence on the topics brought to the pediatrician's attention while, at the same time, acknowledging the pediatrician's expertise and professional role. In this way, I argue that parents display themselves as competent, knowledgeable, caring, and therefore “good parents”. After discussing the results, in the concluding remarks I point to what seems to be a cultural change in parent-healthcare provider interactions.

Somatic disorders in patients followed for a psychiatric disorder at the Ar Razi hospital in Morocco

IntroductionSomatic disorders in patients suffering from psychiatric disorders have become an important issue in the overall care of these patientsComorbidity studies show that 30 to 60% of patients consulted or hospitalized in psychiatry present an associated organic pathologyHowever, the detection of somatic conditions in psychiatric patients remains too late and this exposes them to sometimes lethal somatic complicationsObjectivesTo evaluate the prevalence of somatic disorders in patients followed for a psychiatric disorder at Ar Razi hospital in Salé – Morocco, and to determine the associated factorsMethodsWe carried out a cross-sectional study with 80 patients followed for a psychiatric disorder at Ar Razi hospital in Salé presenting clinical signs in favor of an organic pathology and transferred for specialized advice to the medical-surgical services, in the period from September 1st, 2022 until August 31st, 2023.ResultsMost of our patients were male (65%) with ages ranging from 18 to 65 years. Addictive behaviors were found in more than half of our patients.The most frequent reasons for requests for advice from medical-surgical services was the suspicion of an organic cause of psychiatric symptoms in 25% of cases or the presence of an organic warning sign in 30% of cases.The comorbidity of somatic illness and psychiatric disorder was noted in 35% of cases.Somatic comorbidities were essentially: infections and cardiovascular diseases.Side effects of psychotropic drugs were predominantly neurological in 40 % of casesConclusions Somatic comorbidities in patients hospitalized or in consultation in psychiatric hospitals are very common, often unrecognized, hence the need for early screening in order to improve care.Disclosure of InterestNone Declared

Genomic multidisciplinary teams: A model for navigating genetic mainstreaming and precision medicine.

Recent rapid advances in genomics are revolutionising patient diagnosis and management of genetic conditions. However, this has led to many challenges in service provision, education and upskilling requirements for non-genetics health-care professionals and remuneration for genomic testing. In Australia, Medicare funding with a Paediatric genomic testing item for patients with intellectual disability or syndromic features has attempted to address this latter issue. The Sydney Children's Hospitals Network - Westmead (SCHN-W) Clinical Genetics Department established Paediatric and Neurology genomic multidisciplinary team (MDT) meetings to address the Medicare-specified requirement for discussion with clinical genetics, and increasing genomic testing advice requests. This SCHN-W genomic MDT was evaluated with two implementation science frameworks - the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and GMIR - Genomic Medicine Integrative Research frameworks. Data from June 2020 to July 2022 were synthesised and evaluated, as well as process mapping of the MDT service. A total of 205 patients were discussed in 34 MDT meetings, facilitating 148 genomic tests, of which 73 were Medicare eligible. This was equivalent to 26% of SCHN-W genetics outpatient activity, and 13% of all Medicare-funded paediatric genomic testing in NSW. 39% of patients received a genetic diagnosis. The genomic MDT facilitated increased genomic testing at a tertiary paediatric centre and is an effective model for mainstreaming and facilitating precision medicine. However, significant implementation issues were identified including cost and sustainability, as well as the high level of resourcing that will be required to scale up this approach to other areas of medicine.

Differences in Care Team Response to Patient Portal Messages by Patient Race and Ethnicity

The COVID-19 pandemic was associated with substantial growth in patient portal messaging. Higher message volumes have largely persisted, reflecting a new normal. Prior work has documented lower message use by patients who belong to minoritized racial and ethnic groups, but research has not examined differences in care team response to messages. Both have substantial ramifications on resource allocation and care access under a new care paradigm with portal messaging as a central channel for patient-care team communication. To examine differences in how care teams respond to patient portal messages sent by patients from different racial and ethnic groups. In a cross-sectional design in a large safety-net health system, response outcomes from medical advice message threads sent from January 1, 2021, through November 24, 2021, from Asian, Black, Hispanic, and White patients were compared, controlling for patient and message thread characteristics. Asian, Black, Hispanic, and White patients with 1 or more adult primary care visits at Boston Medical Center in calendar year 2020 were included. Data analysis was conducted from June 23, 2022, through December 21, 2023. Patient race and ethnicity. Rates at which medical advice request messages were responded to by care teams and the types of health care professionals that responded. A total of 39 043 patients were included in the sample: 2006 were Asian, 21 600 were Black, 7185 were Hispanic, and 8252 were White. A total of 22 744 (58.3%) patients were women and mean (SD) age was 50.4 (16.7) years. In 2021, these patients initiated 57 704 medical advice request message threads. When patients who belong to minoritized racial and ethnic groups sent these messages, the likelihood of receiving any care team response was similar, but the types of health care professionals that responded differed. Black patients were 3.95 percentage points (pp) less likely (95% CI, -5.34 to -2.57 pp; P < .001) to receive a response from an attending physician, and 3.01 pp more likely (95% CI, 1.76-4.27 pp; P < .001) to receive a response from a registered nurse, corresponding to a 17.4% lower attending response rate. Similar, but smaller, differences were observed for Asian and Hispanic patients. The findings of this study suggest lower prioritization of patients who belong to minoritized racial and ethnic groups during triaging. Understanding and addressing these disparities will be important for improving care equity and informing health care delivery support algorithms.

Le rôle du service d'infectiologie dans la gestion des anti-infectieux : étude prospective des avis réalisés par le service des maladies infectieuses du CHU Mohammed VI de Marrakech

IntroductionThe aim of this study was to evaluate the role of the infectious diseases department in optimizing the use of antibiotics in the hospital. MethodWe carried out a prospective study of all medical advice performed by the Infectious Diseases Department of the Marrakech University Hospital, over a six-month period. ResultsThe number of medical advices was 153. Surgical departments accounted for 56 % of all requests for advice, compared with 44% for medical departments. The diagnosis of infection was retained in 76% of cases. Infections were nosocomial in 29% of cases and community-acquired in 46%. Among documented infections, multi-resistant bacteria were isolated from 11% of patients, Pseudomonas aeruginosa was the most common microorganisme. Escherichia coli and Klebsiella pneumoniae were the most frequently implicated bacteria in multi-resistant infections. The actions suggested by the referring physician were to start antibiotic therapy in 30% of cases, stop antibiotic therapy in 16% of cases, modify the antibiotic therapy in 23% of cases, and adjust the dose in 11% of cases. The same treatment was maintained in 11% of cases. ConclusionThe study shows that the infectious diseases team's advice allows optimizing or improving the quality of antibiotic prescribing.

‘I Had No Choice’: Adult Neutralisation of Online Sexual Engagement with Children

AbstractThis study explores sexual contact between adults and minors on live internet chat websites like Omegle using the five-point framework of neutralisation to better understand how this behaviour is justified and rationalised by adult participants in such acts. A thematic content analysis was performed based on a sample of 100 requests for advice posted by anonymous users on two open-source platforms from legal professionals. These requests were all from unidentifiable adults. The key themes identified were ‘denial and minimisation of responsibility’, ‘the motivated poster’, ‘awareness of behaviour’, ‘child sexual abuse (CSA)’, and ‘content moderation and censorship’. The results highlight several processes of blame-shifting and neutralisation that are commonly used by adults when describing incidences of sexual contact with minors on Omegle. It enhances our understanding of sexual interactions occurring on live chat platforms, including those that are harmful and illegal, and presents opportunities for proactive intervention and moderation.

Quantifying the impact of telemedicine and patient medical advice request messages on physicians' work-outside-work

The COVID-19 pandemic has boosted digital health utilization, raising concerns about increased physicians’ after-hours clinical work ("work-outside-work”). The surge in patients’ digital messages and additional time spent on work-outside-work by telemedicine providers underscores the need to evaluate the connection between digital health utilization and physicians’ after-hours commitments. We examined the impact on physicians’ workload from two types of digital demands - patients’ messages requesting medical advice (PMARs) sent to physicians’ inbox (inbasket), and telemedicine. Our study included 1716 ambulatory-care physicians in New York City regularly practicing between November 2022 and March 2023. Regression analyses assessed primary and interaction effects of (PMARs) and telemedicine on work-outside-work. The study revealed a significant effect of PMARs on physicians’ work-outside-work and that this relationship is moderated by physicians’ specialties. Non-primary care physicians or specialists experienced a more pronounced effect than their primary care peers. Analysis of their telemedicine load revealed that primary care physicians received fewer PMARs and spent less time in work-outside-work with more telemedicine. Specialists faced increased PMARs and did more work-outside-work as telemedicine visits increased which could be due to the difference in patient panels. Reducing PMAR volumes and efficient inbasket management strategies needed to reduce physicians’ work-outside-work. Policymakers need to be cognizant of potential disruptions in physicians carefully balanced workload caused by the digital health services.

Les forums de discussion dédiés au cancer du sein peuvent-ils être utiles aux soignants ? Analyse des messages initiaux du forum de la Ligue nationale contre le cancer pendant une année

ObjectivesForums are a source of health information and exchange. They can be studied to determine patients’ needs and improve caregivers’ practices. The aim of this study was to identify the needs of breast cancer patients based on messages posted on a discussion forum. MethodsInitial messages posted in 2021 on the Ligue nationale contre le cancer (LNCC) breast cancer forum were analyzed quantitatively. Message content was classified into three categories: testimonial, request for advice or request for medical opinion. The tone of the message (positive, neutral, or negative) was recorded. The temporality of the illness during which the patient expressed herself was defined. Analysis was carried out on the initial messages using the Chi2, Fisher, and Kruskal-Wallis tests, with a significance level of<0.05. ResultsIn 2021, 640 initial messages posted on the LNCC forum dedicated to breast cancer were analyzed. Messages were posted by 312 authors, including 275 patients and 37 family members. Three main types of messages were identified: requests for medical advice (n=339), advice (n=164), and testimonials (n=137). Requests for medical advice elicited fewer responses than testimonials (P<0.001). A need for supportive care was identified in 42.8% of messages, mostly concerning social (17.3%) and psychological (13%) care. ConclusionOur study revealed a need for more information especially regarding the social impact of the disease and the side-effects of treatment. The period of greatest need of information was the diagnostic waiting time. However, patients using discussion forums are not representative of all women with breast cancer and our results should not be generalized to all patients treated for breast cancer.

More Tethered to the EHR: EHR Workload Trends Among Academic Primary Care Physicians, 2019-2023.

The purpose of this study is to evaluate recent trends in primary care physician (PCP) electronic health record (EHR) workload. This longitudinal study observed the EHR use of 141 academic PCPs over 4 years (May 2019 to March 2023). Ambulatory full-time equivalency (aFTE), visit volume, and panel size were evaluated. Electronic health record time and inbox message volume were measured per 8 hours of scheduled clinic appointments. From the pre-COVID-19 pandemic year (May 2019 to February 2020) to the most recent study year (April 2022 to March 2023), the average time PCPs spent in the EHR per 8 hours of scheduled clinic appointments increased (+28.4 minutes, 7.8%), as did time in orders (+23.1 minutes, 58.9%), inbox (+14.0 minutes, 24.4%), chart review (+7.2 minutes, 13.0%), notes (+2.9 minutes, 2.3%), outside scheduled hours on days with scheduled appointments (+6.4 minutes, 8.2%), and on unscheduled days (+13.6 minutes, 19.9%). Primary care physicians received more patient medical advice requests (+5.4 messages, 55.5%) and prescription messages (+2.3, 19.5%) per 8 hours of scheduled clinic appointments, but fewer patient calls (-2.8, -10.5%) and results messages (-0.3, -2.7%). While total time in the EHR continued to increase in the final study year (+7.7 minutes, 2.0%), inbox time decreased slightly from the year prior (-2.2 minutes, -3.0%). Primary care physicians' average aFTE decreased 5.2% from 0.66 to 0.63 over 4 years. Primary care physicians' time in the EHR continues to grow. While PCPs' inbox time may be stabilizing, it is still substantially higher than pre-pandemic levels. It is imperative health systems develop strategies to change the EHR workload trajectory to minimize PCPs' occupational stress and mitigate unnecessary reductions in effective physician workforce resulting from the increased EHR burden.

Implementation of an asynchronous general practitioner‑to‑specialist&amp;nbsp; eConsult service (eConsultant) in Australia

Background: With the rise in demand for specialist care across Australia, patients are experiencing excessive delays for specialist input, linked with subsequent deterioration in health. eConsultant is an outpatient substitution model which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving GPs remote access to specialist support for patient care within 3-business days. This study, the first to track implementation of an eConsultant service in Australia, identifies barriers and enablers to adoption prior to broader implementation. &#x0D; Method: Our prospective mixed-methods observational study included semi-structured interviews with GPs and stakeholders to understand determinants of implementation. GPs send a Request-for-Advice (RFA) to the specialist and advise patients to schedule a timely follow-up appointment to discuss the eConsultant advice. Adoption (program enrolment/usage by GPs &amp; GP practices) was assessed. &#x0D; Results: The study is underway in 12 rural/remote and 10 urban general practices. To date, RFAs have been generated for 178 patients (mean age 59.5yrs, 63% rural, 37% urban). The GPs mean time to response by the eConsultant was 1.7 (SD 2.3) days and patients mean time to specialist input (initial GP to GP follow-up appointment) was 13.0 (SD 2.7) days (well below average waiting times for OPD appointments). Qualitative interviews conducted with 11 GPs and 4 stakeholders highlight the benefits of eConsultant to providing efficient/timely access to specialist support for GPs and their patients. &#x0D; Conclusion: eConsultant is feasible in Australia with benefits to the health system of timely specialist support for patients without the cost of subsidised patient travel, face-to-face visits, and potentially preventable hospital admissions. eConsultant provides GPs with a reliable, auditable record of advice given by specialists, an opportunity for GP practice capacity building and more direct partnership with specialist colleagues. eConsultant offers a streamlined evidence-based option, implementable state-wide, to support patients and primary care providers.

A Content Analysis of Transgender Health and Wellness Themes Shared Through Social Media.

Transgender and gender-diverse (TGD) adolescents experience limited access to gender-affirming care (GAC) and information and use social media platforms for informational and social support. We conducted conventional content analysis of posts on the platform, Tumblr and applied univariate statistics to characterize health and wellness themes represented by this content. Content was predominantly transmasculine-relevant. Posts addressing the trans health care paradigm often co-occurred with content referencing affirmation logs, the physical and emotional impact of affirmation, surgery, and unspecified medical interventions. Gender-affirming hormone therapy was the most prevalent intervention referenced in posts related to non-professional/non-licensed medical care and advice requests. Transgender and gender-diverse youth-serving individuals can use this information to mitigate harm, enhance patient education, and improve the overall well-being of TGD youth. Further research is needed to characterize the effect of content encountered on social media on pediatric patient experiences and on outcomes of GAC.

Understanding suboptimal e-consult requests: lessons from the VA.

Electronic consultations, or e-consults, which are requests for specialist advice without direct patient interaction, are becoming increasingly common across health systems. We sought to identify clinicians' perspectives on the quality of e-consult requests that they send and receive. A qualitative research study at the US Department of Veterans Affairs (VA) New England Healthcare System. We interviewed a total of 73 clinicians, including 38 specialists across 3 specialties (cardiology, neurology, pulmonology) and 35 primary care clinicians (PCCs), between March and June 2019. The interviews were analyzed using thematic analysis. VA specialists and PCCs generally agreed that e-consult requests should be focused and precise, not require lengthy chart review, and include adequate preliminary workup results. At the same time, specialists expressed frustration with what they perceived as suboptimal e-consult requests. Interviewees attributed this gap to 3 factors: limitations of the electronic health record user interface, divergence between PCCs and specialists in the areas of expertise, and organizational pressures on the 2 groups. VA clinicians' perspectives on suboptimal requests contain lessons that are broadly applicable to other health systems that seek to maximize the potential of e-consults to facilitate clinician collaboration and care coordination.