Requests For Advice Research Articles

Decreasing hospitalizations through geriatric hotlines: a prospective French multicenter study of people aged 75 and above

BackgroundThe Emergency unit of the hospital (Department) (ED) is the fastest and most common way for most French general practitioners (GPs) to respond to the complexity of managing older adults patients with multiple chronic diseases. In 2013, French regional health authorities proposed to set up telephone hotlines to promote interactions between GP clinics and hospitals. The main objective of our study was to analyze whether the hotlines and solutions proposed by the responding geriatrician reduced the number of hospital admissions, and more specifically the number of emergency room admissions.MethodsWe conducted a multicenter observational study from April 2018 to April 2020 at seven French investigative sites. A questionnaire was completed by all hotline physicians after each call.ResultsThe study population consisted of 4,137 individuals who met the inclusion and exclusion criteria. Of the 4,137 phone calls received by the participants, 64.2% (n = 2 657) were requests for advice, and 35.8% (n = 1,480) were requests for emergency hospitalization. Of the 1,480 phone calls for emergency hospitalization, 285 calls resulted in hospital admission in the emergency room (19.3%), and 658 calls in the geriatric short stay (44.5%). Of the 2,657 calls for advice/consultation/delayed hospitalization, 9.7% were also duplicated by emergency hospital admission.ConclusionThis study revealed the value of hotlines in guiding the care of older adults. The results showed the potential effectiveness of hotlines in preventing unnecessary hospital admissions or in identifying cases requiring hospital admission in the emergency room. Hotlines can help improve the care pathway for older adults and pave the way for future progress.Trial registrationRegistered under Clinical Trial Number NCT03959475. This study was approved and peer-reviewed by the Ethics Committee for the Protection of Persons of Sud Est V of Grenoble University Hospital Center (registered under 18-CETA-01 No.ID RCB 2018-A00609-46).

Framing Moroccan Judiciary on tv Dramas: a Public Asset under Constraints

Abstract An efficient, impartial, and independent judiciary is a major demand for Moroccan citizens. In online advocacy, citizens denounce the flawed judiciary, sometimes virally circulating content on its corruption and susceptibility to interference. On tv, non-fiction programs respond to frequent requests for legal advice from audiences. Meanwhile, dramas employ frames that reflect codes on how society should perceive the judiciary and the rule of law. This article assesses the dominant frames of the judiciary on tv dramas. Two programs, Moudāwala and Al-Māḍī Lā Yamūt, are selected based on their relevance and popularity. The qualitative analysis of these programs incorporates character and narrative portrayals into thematic and frame analyses. As the two programs illustrate judicial struggles from within and without, they exemplify portrayals of the legal system that uncover discrepancies between normative practices and ruthless realities. The judiciary’s dominant frames focus on individual solutions and blame citizens for ignoring judicial texts or institutions. Frames reflect how media avoid watchdogging the judiciary and extend, directly or otherwise, hegemony over both the judiciary and the media.

Model-Based Self-Advising for Multi-Agent Learning.

In multiagent learning, one of the main ways to improve learning performance is to ask for advice from another agent. Contemporary advising methods share a common limitation that a teacher agent can only advise a student agent if the teacher has experience with an identical state. However, in highly complex learning scenarios, such as autonomous driving, it is rare for two agents to experience exactly the same state, which makes the advice less of a learning aid and more of a one-time instruction. In these scenarios, with contemporary methods, agents do not really help each other learn, and the main outcome of their back and forth requests for advice is an exorbitant communications' overhead. In human interactions, teachers are often asked for advice on what to do in situations that students are personally unfamiliar with. In these, we generally draw from similar experiences to formulate advice. This inspired us to provide agents with the same ability when asked for advice on an unfamiliar state. Hence, we propose a model-based self-advising method that allows agents to train a model based on states similar to the state in question to inform its response. As a result, the advice given can not only be used to resolve the current dilemma but also many other similar situations that the student may come across in the future via self-advising. Compared with contemporary methods, our method brings a significant improvement in learning performance with much lower communication overheads.

Survey on infectious disease telephone hotlines in primary care: General practitioners’ satisfaction and compliance with advice

ObjectivesInfectious disease (ID) advice is a major part of antimicrobial stewardship programs. The objective of this study was to assess general practitioners’ (GPs)’ opinions and compliance with advice given by ID hotlines. Patients and methodsThis multicenter survey was based on the 7-day assessment of initial advice requested by GPs to a hotline set up by volunteer hospital ID teams to record advice for 3 years. The primary endpoint was the GPs’ satisfaction with the advice given by ID specialists. ResultsTen ID teams participated in the study and recorded 4138 requests for advice, of which 1325 requests included a proposal for antibiotic therapy and justified a follow-up call at seven days. Only 398 follow-up calls (30%) were carried out because many GPs were not reachable.GPs were very satisfied with ID hotlines: 58% considered them indispensable and 38% very useful. The recommendations provided by ID specialists were followed by GPs in more than 80% of cases. The two main motivations for GPs to call the hotline were to get quick advice (86%) and to receive help in managing a patient (76%). ConclusionsThe ID telephone consultations and advice systems for GPs are highly appreciated and are effective in terms of following the recommendations.

Folk conceptualisation of small talk: A view from a Japanese online discussion forum

AbstractThe study explores the perceptions of small talk shared by the users of a Japanese online community, seeking information on their expected speech and behaviour in small talk and factors contributing to positive/negative evaluations of small talk. The study investigates a discussion thread consisting of 73 responses to a contributor's request for advice on improving small talk capabilities from the perspectives of interaction ritual (Goffman 1967), balancing obligations (Ohashi 2008, 2013, 2021) and typology of speech acts (Edmondson & House 1981; House & Kádár 2022b).

Credibility assessment of computational models according to ASME V&V40: Application to the Bologna Biomechanical Computed Tomography solution

Background and objectiveWhen a computational model aims to be adopted beyond research purposes, e.g. to inform a clinical or regulatory decision, trust must be placed in its predictive accuracy. This practically translates into the need to demonstrate its credibility. In fact, prior to its adoption for regulatory purposes, an in silico methodology should be proven credible enough for the scope. This has become especially relevant as, although evidence of the safety and efficacy of new medical products or interventions has been traditionally provided to the regulator experimentally, i.e., in vivo or ex vivo, recently the idea to inform a regulatory decision in silico has made its way in the regulatory scenario. While a harmonised technical standard is currently missing in the EU regulatory system, in 2018 the ASME issued V&V40–2018, where a risk-based framework to assess the credibility of a computational model through the performance of predefined credibility activities is provided. The credibility framework is here applied to Bologna Biomechanical Computed Tomography (BBCT) solution, which predicts the absolute risk of fracture at the femur for a subject. BBCT has recently been the object of a qualification advice request to the European Medicine Agency. MethodsThe full implementation of ASME V&V40–2018 framework on BBCT is shown. Starting from BBCT proposed context of use the whole credibility plan is presented and the credibility activities (Verification, Validation, Applicability) described together with the achieved credibility levels. ResultsBBCT risk is judged medium, and the credibility levels achieved considered acceptable. The uncertainties intrinsically present in the material properties assignment affected BBCT predictions to the highest extent. ConclusionsThis work provides the practical application of the ASME V&V40–2018 risk-based credibility assessment framework, which could be applied to demonstrate model credibility in any field and support future regulatory submissions and foster the adoption of In Silico Trials.

Facebook as an arena for professional cooperation

Digitalization has led to an enormous increase in the teaching and learning materials that teachers have at their disposal. This article aims to shed light on the ways in which teachers make use of a professional online community to help them navigate in today’s complex landscape of educational resources. The article is based on an investigation of the entries and responses during two months in a participant-driven Facebook group for English teachers in Norway. Content analysis was used to identify patterns in the material. While entries covered many issues, the vast majority had to do with the selection and the use of teaching and learning materials. Most entries were requests for help and advice which, in most cases, received considerable response from fellow teachers by way of concrete tips as well as personal insights and experiences. In this way, the group conveys a sense of solidarity, collective responsibility and a low threshold for teachers to ask for help. However, the activity in the group reveals a propensity for “quick-fix” solutions for insecure and time-poor teachers. Thus, the results point to the need for more thorough education related to the choice and the use of educational resources and calls for teacher education and further education initiatives to provide this.

Infectious disease hotlines to provide advice to general practitioners: a prospective study

BackgroundTelephone hotlines in infectious diseases (ID) are part of antimicrobial stewardship programs designed to provide support and expertise in ID and to control antibiotic resistance. The aim of the study was to characterize the activity of the ID hotlines and estimate their usefulness for general practitioners (GPs).MethodsThis was a multicenter prospective observational study in different French regions. ID teams involved in antimicrobial stewardship with a hotline for GPs were asked to record their advice from April 2019 to June 2022. In these regions, all GPs were informed of the ID hotline’s operating procedures. The main outcome was usage rate of the hotlines by GPs.ResultsTen volunteer ID teams collected 4138 requests for advice from 2171 GPs. The proportion of GPs using the hotline varied pronouncedly by region, from 54% in the Isere department, to less than 1% in departments with the lowest usage. These differences were associated with the number of physicians in ID teams and with the age of the hotline. These results highlighted the value of working time as a means of ensuring the permanence of expertise. The main reasons for calling were: a diagnostic question (44%); choice of antibiotic (31%). The ID specialist provided advice on antibiotic therapy (43%) or a proposal for specialized consultation or hospitalization (11%).ConclusionsID hotlines could help to strengthen cooperation between primary care and hospital medicine. However, the deployment and perpetuation of this activity require reflection concerning its institutional and financial support.

In-Basket Reduction: A Multiyear Pragmatic Approach to Lessen the Work Burden of Primary Care Physicians

Summary The in-basket of the primary care physician (PCP) has become unmanageable. A growing volume of messages from system notifications, communications from colleagues, and especially patient medical advice requests has resulted in several hours of such additional indirect care for physicians each day — and is a leading contributor to burnout. Atrius Health embraced this in-basket challenge in 2017, and the authors share their experience here. They determined that they could not effectively create efficiencies in practice for Atrius Health’s PCPs without tackling the in-basket. Atrius had used a team-based model of primary care for decades, but the in-basket processes did not reflect its care model of teamwork; in-basket messages defaulted to the PCP to manage and resolve. Feedback from PCPs, assessments of professional burnout, and measurement of PCP in-basket volume presented a clear need to address this issue. Atrius Health focused on reducing volume but considered performance in quality, safety, and patient experience in all work. The organization launched a multiyear initiative to reduce the burden of what should be a beneficial tool by applying the principles of eliminate, automate, delegate, and collaborate. By 2022, Atrius Health had reduced the in-basket volumes by category as follows: media manager (which refers to a folder in which scanned documents are filed), 98% reduction; carbon copy charts (which refers to notes from other physicians and contains a range of critical new diagnoses, prognoses, or treatment plans along with routine follow-up visits), 35% reduction; ED/hospital admissions/discharge/transfer messages, 100% reduction; prescription renewals, 50% reduction; laboratory results, 30% reduction; and patient medical advice requests, 40% reduction. Through a multipronged approach, the total daily in-basket volume for PCPs was reduced by approximately 25% from 100 messages in 2017 to 75 messages in 2022.

Monitoring the safety of drugs and COVID-19 vaccines by the French Pharmacovigilance Centers during the pandemic: A win-win bet with Health Authorities!

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic virus was a "health crisis" and a significant burden also for the French pharmacovigilance system. It took its toll in 2 phases, the first being in early 2020 when very little was known, and during which the missions of the 31 Regional Pharmacovigilance Centers (RPVCs) from university hospitals were to detect adverse reactions of drugs used in the context of the disease. Whether as a possible aggravating role on COVID-19, or displaying a different safety profile during its course, or to assess safety of curative treatment, this phase preceded that of the arrival of dedicated vaccines. Then the RPVCs' missions were to detect, as early as possible, any new serious adverse effect leading to a potential signal that would modify the benefit/risk ratio of a vaccine and require the implementation of health safety measures. During these two distinct periods, signal detection remained the core business of the RPVCs. Each RPVC had to organize itself to handle an unprecedented surge of declarations and requests for advice, from health care professionals and patients alike. "Leading" RPVCs, who were in charge of monitoring vaccines, had to deal with an extraordinary workload (still going on to this date), to generate in real-time and on a weekly basis, a summary of all the adverse drug reaction (ADR) reports as well as an extended analysis of the different safety signals. The organization put in place at the beginning of the health crisis, adapted to the context of the vaccines, allowed to meet the challenge of real-time pharmacovigilance monitoring, and to identify many safety signals. Efficient "short-circuits exchanges" with the French Regional Pharmacovigilance Centers Network (RPVCN) were paramount to the National Agency for the Safety of Medicines and Health Products (ANSM) to develop an optimal collaborative partnership. The French RPVCN has shown at this occasion both agility and flexibility, swiftly adapting to vaccine- and media-related unrest, and demonstrated its effectiveness in the early detection of safety signals. This crisis also confirmed the superiority of manual/human signal detection over automated ones, as the most effective and powerful tool to date to rapidly detect and validate a new ADR and enable to elaborate rapid risk reduction measures. To maintain the performance of French RPVCN in signal detection and to monitor all drugs as they should, and as expected by our fellow citizens, a new funding model should be considered.

Pharmacovigilance des médicaments et des vaccins contre la COVID-19 durant la pandémie : comment le Réseau français des centres régionaux de pharmacovigilance a relevé le défi ?

The pandemic subsequent to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus resulted, for the French institutional pharmacovigilance, in a "health crisis" in 2 phases: the coronavirus disease 2019-"COVID-19" phase during which the missions of the Regional Pharmacovigilance Centres (RPVC) were to detect a possible impact of drugs on this disease, as whether existed a possible aggravating role of certain drugs, or the safety profile of drugs used for the management of COVID-19 could evolve. The second phase followed the availability of COVID-19 vaccines, during which the RPVCs' missions were to detect as early as possible any new serious adverse effect, source of a potential signal that would modify the benefit/risk ratio of a vaccine and require the implementation of health safety measures. During these two periods, signal detection remained the core business of the RPVCs. The RPVCs had to organize themselves to handle an historical surge of declarations and requests for advice, whereas the RPVCs in charge of monitoring vaccines had to deal with an extraordinary dense activity over a long period of time, in order to produce in real time and on a weekly basis, a summary of all the declarations and an analysis of safety signals. The national organization put in place made it possible to meet the challenge of real-time pharmacovigilance monitoring of 4 vaccines with conditional marketing authorizations. Short-circuit efficient exchanges with the French Regional Pharmacovigilance Centres Network was paramount for the French National Agency for medicines and health products (Agence nationale de sécurité du médicament et des produits de santé) to develop an optimal collaborative partnership. The RPVC network has shown agility and flexibility, has been able to adapt swiftly and demonstrated its effectiveness in the early detection of safety signals. This crisis confirmed the superiority of manual/human signal detection as the most effective and powerful tool to date, to rapidly detect a new adverse drug reaction and enable to elaborate rapid measures of risk reduction. In order to maintain the performance of French RPVCs in signal detection and to monitor all drugs as they should and as expected by our fellow citizens, a new funding model correcting the inadequacy of RPVCs' expertise resources in relation to the volume of reports should be considered.

Dupilumab (Dupixent)


 CADTH recommends that Dupixent be reimbursed by public drug plans for the treatment of patients aged 12 years and older with moderate-to-severe atopic dermatitis (AD) whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable, if certain conditions are met.
 This recommendation supersedes the CADTH Canadian Drug Expert Committee rec­om­men­dation for this drug and indication on April 24, 2020. A Request for Advice was filed in 2022 by public drug programs to address an inquiry regarding the 2020 reimbursement conditions.
 Dupixent should only be covered for patients who previously tried and did not experience improvement with or are unable to use other treatments. These treatments include the highest dose of topically applied drugs combined with phototherapy (where available), and the highest dose of topically applied drugs and at least 1 of the following: methotrexate, cyclosporine, mycophenolate mofetil, or azathioprine.
 Dupixent should only be reimbursed if prescribed by a dermatologist, allergist, clinical immunologist, or pediatrician, and if the cost of Dupixent is reduced.

Clinical and Forensic Aspects of the Management of Child Abuse: The Experience of the Paediatric Emergency Department in Novara, North-West Italy.

Child abuse is an endemic phenomenon that refers to any form of violence aimed at children and adolescents. The Emergency Room is often the entry point to healthcare for the abused child. This is a cross-sectional study including minors, aged 0-18 years, of all genders, who experienced any form of violence examined at the Paediatric Emergency Department of the 'Maggiore della Carità' Hospital in Novara (North-West Italy) between 1 January 2017 to 31 December 2021. Data were extrapolated by looking at the diagnosis at discharge. A comparison of the different variables collected was made between the pre-COVID-19 period and the COVID era. 120 minors presented to the paediatric emergency room seeking help for violence. The average age was 10 years, 55% of the victims were male and 75% of them were Italian. In the pre-COVID period, the number of presentations for abuse was 62, while in the COVID period it was 58 with an increase of peer violence (from 38.71% to 62.07%) and with a statistically significant impact of the pandemic on the phenomenon (p-value < 0.00001). In general, peer violence accounts for 50% of the cases reviewed and resulted in fewer reports to the judicial authority and requests for forensic advice. The SARS-CoV-2-related pandemic has had an impact on total emergency room admissions and the types of abuse perpetrated.

Social Media and Dermatology During the COVID-19 Pandemic: Analyzing User-Submitted Posts Seeking Dermatologic Advice on Reddit.

Reddit, a popular social media website, has numerous forums where users may discuss healthcare-related topics and request diagnostic and treatment advice for dermatologic conditions. We sought to analyze and grade user-submitted requests for dermatologic advice and their top responses on Reddit. User-submitted posts requesting diagnostic advice and their respective responses on two popular Reddit forums, SkinCareAddiction (ScA) and DermatologyQuestions (DQ), were reviewed by three board-certified dermatologists using a grading rubric designed for this study. 300 posts and comments were reviewed. Diagnoses among all graders matched in 52.3% of posts with a mean grader confidence score of 4/5 (95% CI 3.89-4.11). 31% of responder's comments recommended a diagnosis not included by any reviewer.Mean scores for the top comment's accuracy, appropriateness, and potential to be misleading/dangerous were 3.28/5 (95% CI 3.12-3.45), 3.3/5 (95% CI 3.14-3.45), and 2.33/5 (95% CI 2.18-2.48), respectively. Reddit may be informative to patients requesting dermatologic advice. However, responses should be taken with caution as the information provided may be inaccurate or insufficient for treatment recommendations. Dermatologists should be aware of these resources used by patients.

Conditional Funding Recommendations for Drugs in Canada: A Cross-Sectional Analysis.

Before listing by drug plans, new drugs that receive regulatory bodies' approval are assessed by the Health Technology Assessment agencies, including the Canadian Agency for Drugs and Technologies in Health (CADTH). Considering the impact of CADTH recommendations on payers' listing decisions, the growing number of high-cost drugs, and conditional listings, conditional recommendations have increasingly been of interest to the users of CADTH recommendations. This study aims to review the conditional reimbursement recommendations issued by CADTH and explores the reasons for those recommendations. All final drug reimbursement recommendations posted on the CADTH website since 1 January, 2003 were reviewed. Recommendations were included if accepted for review by 1 May, 2021 and completed before 1 January, 2022. The complete records excluding 'requests for advice' were categorized into 'reimburse,' 'do not reimburse,' and 'reimburse with criteria/condition(s)'. The identified variables were extracted and analyzed descriptively. Of the 889 submissions, 785 (88.6%) completed recommendations were consideredrelevant to the study purpose. Of 750 recommendations, excluding 35 (4.5%) 'requests for advice,' 500 (66.6%) were 'reimburse with criteria/condition(s)'. 'Clinical criteria' at 481 (96.2%), 'cost-effectiveness improvement to an acceptable level' at 132 (26.4%), and 'the treatment cost not to exceed the cost of the alternative option(s)' at 118 (23.6%) were the most frequently reported conditions. The most frequent reasons for conditional reimbursement were 'clinical benefit and economic evaluation' at 304 (60.8%). Of conditional recommendations, 468 (93.6%) included more than one reason. CADTH has facilitated patient access to innovative drugs even with limited evidence by conditional recommendations. The clinical criteria are the cornerstone of conditional recommendations. CADTH has developed the assessment process over time.

COVID-19 vaccine allergy advice and guidance: The experience of a UK tertiary referral centre

ObjectiveThe objective was to review COVID-19 vaccine allergy advice and guidance requests received and assess the impact of advice outcome on vaccination outcome. DesignA retrospective analysis of requests for advice and guidance regarding COVID-19 vaccine allergy was completed using an electronic referral system from February 2021 to January 2022. ParticipantsA total of 1265 independent patient requests for advice were received from primary care. Full vaccination information was available on 1210 patients who were included in the analysis. Main outcome measuresWe evaluated the specific outcome of request for advice (written advice versus allergy consultation), rate of vaccination, vaccination combinations, and tolerance of vaccination. ResultsOf the 1210 patients included, 959 (79%) were female. Eight hundred and ninety-six (74%) requests were managed with written advice only and of these 675 (75%) patients went on to be vaccinated. Overall, 891 (74%) of the population were vaccinated with 2 or more doses.Two hundred and nineteen patient consultations were undertaken with 109 (50%) prior to the first vaccination. Forty-nine (45%) consultations prior to vaccination were undertaken due to a label of anaphylaxis to vaccination in the past. Vaccination was recommended for all patients, and 78 (72%) of these received a first dose. Eight of these patients (10%) had symptoms within 1 h of vaccine administration.One hundred and ten (50%) consultations were undertaken for adverse reactions post COVID-19 vaccination, with 84 (76%) concerning immediate symptoms. Thirty patients (27%) who had a consultation had had adrenaline administered post vaccination. One patient had biopsy confirmed Stevens Johnson Syndrome and was referred to Dermatology. All others due for further doses (107 patients) were recommended to have subsequent doses with 49 (45%) offered the same vaccine. Eighty-nine patients had a vaccine administered post adverse reaction and 79 (88%) tolerated the dose.Skin testing and challenge to polyethylene glycol were negative in the 8 patients tested. ConclusionsOver 1000 requests for advice and guidance were received during the review period, managed mainly with written advice. The overwhelming majority of requests for advice and consultations were for females, with equal distribution both pre- and post-COVID-19 vaccine administration. Vaccination was recommended in all but 1 patient (with biopsy confirmed Stevens Johnson Syndrome). Polyethylene glycol allergy was not confirmed in any patient, nor did any patient have confirmed anaphylaxis when the vaccine was administered under our supervision, suggesting that type 1 mediated hypersensitivity is uncommon even in this "high risk" population.

Clinical, methodology, and patient/carer expert advice in pediatric drug development by conect4children.

Many medicines are used "off-label" in children outside the terms of the license. Feasible pediatric clinical trials are a challenge to design. Conect4children (c4c) is an Innovative Medicines Initiative project to set up a pan-European pediatric clinical trial network aiming to facilitate the development of new medicines for children. To optimize pediatric trial development by promoting innovative trial design, c4c set up a European multidisciplinary advice service, including the voice of young patients and families, tailored to industry and academia. A network of experts was established to provide multidisciplinary advice to trial sponsors. Experts were selected to join clinical and innovative methodology expert groups. A patient and public involvement (PPI) database, to include the expert opinion of patients and parents/carers was formed. A stepwise process was developed: (1) sponsors contact c4c, (2) scoping interview takes place, (3) ad hoc advice group formed, (5) advice meeting held, and (6) advice report provided. Feedback on the process was collected. Twenty-four clinical and innovative methodology expert groups (>400 experts) and a PPI database of 135 registrants were established. As of September 30, 2022, 36 advice requests were received, with 25 requests completed. Clinical and methodology experts and PPI representatives participated in several advice requests. Sponsors appreciated the advice quality and the multidisciplinary experts from different countries, including experts not known before. Experts and PPI participants were generally satisfied with the process. The c4c project has shown successful proof of concept for a service that presents a new framework to plan innovative and feasible pediatric trials.

Myasthenia gravis - a retrospective analysis of e-mail inquiries made to a patient organisation and specialized center to uncover unmet needs from patients and caregivers

Background and aimsMyasthenia Gravis requires expert treatment from specialized neurologists. In Germany, this treatment is mainly provided by 18 Integrated Myasthenia Centers (iMZ) accredited by the German Myasthenia Gravis Association (DMG). The DMG is a large and well-organized patient organisation that is regarded as a trusted source for disease-specific information. The aim of this study was to analyse the type of requests that each of these institutions receives in order to identify any potential unmet needs regarding the availability of advice for patients and caregivers. This data can then be used in further research to tailor modern digital communication tools to the specific needs of MG patients.MethodsCounselling requests sent via e-mail to both institutions were extracted for defined examination periods and divided into a period ‘before COVID-19 pandemic’ (01.07.2019–31.12.2019) and ‘during COVID-19 pandemic’ (01.07.2020–31.12.2020). Requests were then analysed using four main categories: medical requests, organisational issues, COVID-19 and social legislation inquiries.ResultsOne thousand seven hundred eleven requests for advice were addressed to DMG and iMZ Charité. Most inquiries directed to the DMG (47%; n = 750) were related to medical issues, most frequently to side effects of medications (n = 325; 20%) and questions about treatment (n = 263; 16%), followed by inquiries regarding organisational issues (26%; n = 412). About half of the inquiries (n = 69; 58%) to the iMZ Charité were related to medical issues and almost one in three inquiries concerned organisational issues (n = 37; 30%). About one in ten inquiries concerned socio-legal matters (iMZ: n = 7; 6% and DMG: n = 177; 11%). During the pandemic, COVID-19 related issues accounted for 8% (n = 6) of inquiries at iMZ, and 16% (n = 253) at DMG.ConclusionsMG sufferers have a high demand for timely advice. In the current setting, they address their requests to both iMZs and the DMG via e-mail. Our findings confirm that the DMG is highly trusted by patients and caregivers and is used to obtain second opinions. A relevant proportion of requests to the iMZ could be answered more effectively through standardized responses or improved process management. The implementation of modern digital solutions, including telemedicine, for communication between patient and specialist should be evaluated in further research.

Who is asking? Requests for antimicrobial prescribing advice received by hospital pharmacists

AbstractDoctors are perceived as the primary decision makers in antimicrobial therapy, but prescribing decisions are influenced by the multidisciplinary team. Antimicrobial stewardship (AMS) programs formalise interprofessional advice‐giving. No studies capture the advice provided by pharmacists. This study aimed to describe the volume and nature of antimicrobial prescribing advice that healthcare professionals seek from hospital pharmacists. A prospective audit of antimicrobial‐related advice requests received by pharmacists (n = 18) at an Australian public hospital was undertaken in July 2020. Antimicrobial advice was sought from 11 pharmacists on 300 occasions. Most requests (80%) were received by the AMS pharmacist. A mean (range) of 30 (17–40) requests per day was recorded and the AMS pharmacist received 24 (16–31) requests daily. Most requests came from the intensive care unit (22.1%), pharmacy (21.4%), and infectious diseases (17.1%). The AMS pharmacist was mostly contacted by consultants and pharmacists, and other pharmacists were contacted by registrars and junior medical officers. Despite COVID‐19 adaptations, face‐to‐face interaction was most common. This audit demonstrates the value of an AMS pharmacist, and indicates the importance of face‐to‐face interactions and the formalisation of pharmacists' role in prescribing decision‐making. Pharmacists provided antimicrobial advice daily to other healthcare professionals. Further research is required to provide insights into the barriers and enablers to effective advice‐giving interactions.

Implementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia

BackgroundIn response to lengthy wait times for specialist outpatient appointments, electronic consultation (eConsult) services have developed globally, providing asynchronous, secure and timely communication between general practitioner (GP) and specialist. This study aims to track adoption of a Queensland eConsultant service in two Australian Primary Health Networks (Western Queensland and Brisbane South) to understand key barriers and enablers to adoption and inform modification of the implementation strategy. MethodsOur theory-informed mixed-methods evaluation assessed implementation between July 2020 and March 2022. Adoption and implementation activities were prospectively recorded in bespoke tracking spreadsheets with implementation activities coded against the Expert Recommendations for Implementing Change (ERIC) strategies. Semi-structured interviews with GPs and stakeholders informed by the Consolidated Framework for Implementation Research (CFIR) were conducted to understand determinants of implementation. ResultsOf the 40 practices invited to take part in the eConsultant service, 20 (50%) enrolled. Of the 97 GPs who consented, 38 sent at least one Request for Advice (RFA) to the eConsultant with a total of 112 RFA sent. Implementation was predominantly guided by eight strategies. Qualitative interviews were conducted with 11 GPs and 4 stakeholders (12 from rural/remote regions, 11 females and two sole practitioners). Interviewees felt the eConsultant service supported outpatient appointment avoidance and provided efficient, timely access to specialist support for GPs and their patients. Barriers identified to using eConsultant related to digital infrastructure, competing priorities, and keeping the service ‘front of mind’. Key enablers identified were the relative advantage of eConsultant over other options, patient benefits and COVD-19 facilitating the use of digital technology.ConclusionsThis evaluation highlighted service enablers as well as user priorities for broader implementation. A focus on a well-integrated digital system and availability of a variety of eConsultant specialties are seen as key strategies to embedding the eConsultant option in GP advice processes in Australia.