Consultation Time Research Articles

Prospective Drug Utilization Evaluation Analysis in Outpatient Departments with Ear, Nose, and Throat Outpatients: Incorporating Benchmarks and World Health Organization Indicators.

Drug utilization studies are tools for determining the effectiveness of drug use. The aim of the study was to evaluate drug usage patterns in ear, nose, and throat (ENT) outpatient settings by incorporating established benchmarks and World Health Organization (WHO) indicators. A cross-sectional study on drug utilization evaluation (DUE) was conducted on 800 patients from the ENT outpatient department. We gathered data on currently prescribed medications and identified any discrepancies with a thorough analysis. Continuing educational activities such as "dear doctor" letters and personal consultations were used to rectify any irrational prescribing patterns among physicians. The WHO/International Network for Rational Use of Drugs core drug use indicators, specifically prescribing and patient care indicators, and established benchmarks were applied to encourage rational prescribing. The three most common diagnoses were pharyngitis (51.49%), allergic rhinitis (25.11%), and acute suppurative otitis media (21.17%). Montelukast, in combination with levocetirizine (13.77%) and amoxicillin in combination with clavulanic acid (8.81%), was the most frequently prescribed medication. The average number of drugs per prescription was 4.2% (±1.1), with low usage of generic names (33.0%) and suboptimal reliance on the essential drugs list (76.7%). Furthermore, patient care indicators demonstrated room for improvement, particularly concerning consultation times (6 minutes), dispensing times (30 seconds), and drug labeling practices (0% labeled). The DUE improved the prescribing rate of first-line drugs for five diseases and few aspects of prescribing and patient care indicators. There is an overuse of prescribed drugs, a need for more utilization of generic names, and less than optimal use of the essential drugs list. Additionally, shortcomings in patient care were observed, including issues in consultation, drug dispensing times, and labeling. However, DUE effectively improved WHO patient care metrics and the prescription of first-line drugs warranting its implementation.

Sexual outcomes following the surgical treatment of traumatic rupture of the corpora cavernosa.

Penile fracture is a post-traumatic condition affecting the tunica albuginea of the corpora cavernosa when erect. Clinical diagnosis and urgent surgical intervention are crucial to avoid severe functional complications, particularly erectile dysfunction. We aimed to evaluate male sexual function after surgical treatment in patients with penile fracture and to identify predictive factors of postoperative erectile dysfunction. We underwent a hospital-based retrospective study on patients who underwent surgical repair for fractures of the corpora cavernosa between 2012 and 2023. Included in this study were all patients who have a postoperative follow-up of at least 12 months. Patients were clinically evaluated for the presence of erectile dysfunction and the presence of postoperative penile curvature. The patients were asked to answer the structured questionnaire of the International Index of Erectile Function (IIEF-15). We included 87 patients. The mean age was 38 ± 12years. Fourteen patients (16%) developed a fibrous plaque, with a median onset time of 30days postoperatively. Erectile dysfunction was noted in forty-four patients (51%). Active smoking (p < 0.002), the surgical approach (p = 0.02), a consultation time > 7.5h (p = 0.01), a length of the discontinuity of the corpora cavernosa > 2.5cm (p = 0.01) and the use of an erection inhibitor postoperatively (p = 0.021) were independent predictive factors of erectile dysfunction at 1 year postoperatively. Considering the results of our study, we propose rapid and urgent surgical management for penile fractures, and an elective surgical approach may be considered. We emphasize the fundamental role of sexual education, especially for young people, in preventing this sexual accident that could negatively impact their sexual life.

“It Just Galls Me, as a Taxpayer”: Trust Implications of School Closure Decision-Making in Ontario

More than 400 publicly funded schools in Ontario, Canada, permanently closed between 2011 and 2017. This study examines the impact of highly criticized closure decisions on trust, guided by the OECD competence-values framework for citizens’ trust in public institutions. Interviews with key informants reveal factors affecting trust, including timing and format of public consultations, reliability of data informing closure recommendations, silencing of community concerns, timeliness of government coordination, asset management horizons, and system-wide approaches to planning. This study underscores the need for an alternative school-closure decision-making model for Ontario.

Abstract 4126893: Feasibility and Acceptability of a Nurse-Pharmacist Post-Discharge Telehealth Model of Care for Heart Failure Patients

Background: Suboptimal medication management is common in patients with heart failure (HF), particularly during transitions-of-care. To date, there are few studies assessing the feasibility of a nurse-pharmacist post-discharge telehealth service for medication optimisation in patients with HF. We performed a feasibility study to determine service uptake and acceptability, and ability to identify medication-related issues for HF patients as they transition from hospital to home. Methods: HF patients were referred to an existing post-discharge telehealth service and offered medication reconciliation and education in addition to their usual care; a service we termed ‘MedRec’ (MR). Primary outcomes were feasibility, measured through recruitment and successful MR completion, and acceptability, measured by an investigator-developed survey. Secondary outcomes were medication-related issues detected during MR. Results: A total of 100 HF patients were offered a post-discharge MR. Mean age of patients was 68.5 ±14.2 years, and mostly male sex (62%). Pharmacist MRs were requested by 80% of patients. In total 62 MRs (77.5%) were performed; 9 patients declined MR during follow-up and an additional 9 patients were uncontactable. Mean time to MR following nurse referral was 10.98 ±9.74 days. Drug-related toxicity or adverse effect presentation was identified in 25 (40.3%) MR recipients at the time of consultation and subsequently required general practitioner follow-up. Medication compliance issues were detected by the pharmacist in 13 (20.9%) patients; forgotten doses being the most common concern. Undertreated medical conditions, such as symptomatic HF and chronic pain, were identified in 12 (19.3%) MR recipients. Medications prescribed without any apparent indication were found in 8 (12.9%) patients. Drug or disease management information was requested by 35 (56.4%) MR recipients. A total of 35 (56.5%) post-MR surveys were successfully completed. All participants who completed a post-MR survey agreed that a post-discharge telehealth MR was an acceptable form of education provision. Engagement with a pharmacist MR was perceived to ease anxiety associated with understanding medication-related changes and empowered greater medication self-management. Conclusions: A post-discharge nurse-pharmacist telehealth service is a feasible and acceptable model of care. Inclusion of a routine MR post-discharge may be an effective means of maintaining continuity of care for HF patients.

Delivery of Supported Self-Management in Primary Care Asthma Reviews: Insights From the IMP2ART Programme.

Supported self-management (SSM) for asthma reduces the risk of asthma attacks and improves asthma control and quality of life. SSM optimally includes patient-centred communication and behaviour change support, however, the extent to which this occurs in routine primary care is unclear. This project was nested within the IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) programme; a UK-wide trial evaluating an implementation strategy (including healthcare professional (HCP) training on behaviour change strategies and patient-centred care) to improve support for asthma self-management. To provide an understanding of how healthcare professionals deliver SSM in UK clinical practice; through assessing time spent on SSM strategies, how and to what extent patient-centred care and behaviour change discussions are delivered, and to explore whether factors such as mode of review or implementation support influence delivery. We conducted an observational study using video-recordings of 12 HCPs delivering routine face-to-face and telephone asthma reviews (n = 64) in a sample of general practices participating in the IMP2ART trial (implementation n = 4; control n = 6). Analytical methods included: ALFA Toolkit Multi-Channel Video Observation (to code and quantify tasks undertaken); the Patient-Centred Observation Form; and The Behaviour Change Counselling Index (to assess patient-centeredness and behaviour change counselling used by HCPs). HCPs mostly spent time during routine asthma reviews discussing: an individual's asthma condition and management (average of 27.8% of consultation time); collaboratively reviewing and completing a personalised asthma action plan (6.3%) and training for practical self-management activities (5.4%). Areas of patient-centred care delivery and behavioural discussions included: creating and maintaining relationships, discussing asthma action plans and medication reconciliation. Professionals in IMP2ART implementation group practices delivered more SSM strategies. Comparison of face-to-face and remote consultations found no significant differences in HCP delivery of SSM. HCPs in UK primary care spent half the time in both face-to-face and remote asthma reviews delivering components of SSM suggesting that either mode of delivery may be acceptable. Reviews carried out in IMP2ART implementation group practices demonstrated more behaviour change and collaborative SSM strategies compared to those in the control group. Asthma UK Centre for Applied Research (AUKCAR) PPI members were involved throughout, including project conception, providing feedback on participant-facing documents, and discussing implications of study findings.

A review of clinical ethics consultations in a regional healthcare system over a two-year timeframe

BackgroundClinical Ethics Consultations (CECs) are used by healthcare systems to offer healthcare practitioners a structured level of support to approach ethical questions. The objective of this study was to detail the elements of surveyed CECs and offer guidance in the approach to future ethics consultations at a regional healthcare system.MethodsThis cohort study has a qualitative and quantitative retrospective approach, surveying ethics consultations through the dates of 4/27/22 to 4/26/24. A documentary sheet was created, and information was entered via online data-gathering forms. The cases are from a range of specialties within a regional healthcare system servicing Minnesota, Wisconsin, and North Dakota.Results103 CECs were performed within the study period across the regional healthcare system. Consultations were identified through retrospective review of the internal CEC database, and patient information was collected through the medical record. Decision-making was often performed by a substitute decision-maker (N = 54), occurring in 70.1% of cases with known decision makers. CECs were documented in an ethics-specific note in the patient medical record in 37 of 82 (45.1%) documented patient cases. It was common for physicians to mention the ethics consultation in their patient notes, occuring in 51 of 82 (62.2%) of documented patient cases. Age was recorded in 92.0% (N = 91) of unique patient cases; the median age was 62 years. Ethical questions concerning end-of-life care were the most common cause for consultation (N = 35, 34%), and CECs were most commonly requested in general medicine or hospitalist departments (N = 38, 45.2%). Most consultations resulted in resolution at time of initial consultation with the ethics call team.ConclusionsRecommendations for increased frequency and timing of policy review are given based on the results of the data presented. Using interpretation of the CECs in this study, we offer recommendations towards the use and documentation of ethics consultations in the era of open notes, open the door towards areas of future research, and ultimately promote use of CECs for more favorable patient outcomes.

Automated assessment of brain MRIs in multiple sclerosis patients significantly reduces reading time.

Assessment of multiple sclerosis (MS) lesions on magnetic resonance imaging (MRI) is tedious, time-consuming, and error-prone. We evaluate whether assessment of new, expanding, and contrast-enhancing MS lesions can be done more time-efficiently by radiologists with assistance of artificial intelligence (AI). Baseline and three follow-up (FU) MRIs of thirty-five consecutive patients diagnosed with MS were assessed by a radiologist manually, and with assistance of an AI-tool. Results were discussed with a consultant neuroradiologist and time metrics were evaluated. The mean reading time for the resident radiologist was 9.05min (95CI: 6.85-11:25). With AI-assistance, the reading time was reduced by 2.83min (95CI: 3.28-2.41, p < 0.001). The reading decreased steadily from baseline to FU3 for the resident radiologist (9.85min baseline, 9.21 FU1, 8.64 FU2 and 8.44 FU3, p < 0.001). Assistance of AI further remarkably decreased reading times during follow-ups (3.29min FU1, 3.92 FU2, 3.79 FU3, p < 0.001) but not at baseline (0.26min, p = 0.96). The baseline reading time of the resident radiologist was 5.04min (p < 0.001), with each lesion adding 0.14min (p < 0.001). There was a substantial decrease in the baseline reading time from 5.04min to 1.59min (p = 0.23) with AI-assistance. Discussion of the reading results of the resident with the neuroradiology consultant (as usual in clinical routine) was exemplary done for FU-3 MRIs and added another 3min (CI:2.27-3.76) to the reading time without AI-assistance. We found that AI-assisted reading of MRIs of patients with MS may be faster than evaluating these MRIs without AI-assistance.

Design and development of a mobile health intervention for rehabilitation support after knee arthroplasty: TeleRehabilitation after knee ArThroplasty (TReAT) project

BackgroundThe steep increase in knee arthroplasties in lower- and middle-income countries has increased demand for personalised rehabilitation care. Technology-based rehabilitation programs offer potential to replace or augment conventional face-to-face rehabilitation for providing continuum of care. We aimed to systematically develop a theory, evidence-driven, contextualised, and user-centred mobile health platform for people undergoing knee arthroplasty to facilitate monitoring progress during rehabilitation.MethodsWe followed the UK Medical Research Council’s framework and adopted a behaviour design thinking approach, consisting of five steps; (1) conduct multiple literature reviews and cross-sectional surveys to determine the needs and problems experienced during the rehabilitation phase by healthcare professionals and individuals with replaced knees, (2) identify target behaviours along with barriers and facilitators, integrated within the Capability, Opportunity, Motivation-Behaviour (COM-B) framework, (3) identify intervention functions and components, behaviour change techniques, and features for the mobile application, selected after discussions with orthopaedic surgeons, physiotherapists and behavioural experts, (4) develop a prototype application for end-users, and a web-based platform for healthcare professionals, and (5) pilot test the intervention for end-users’ feedback on usability of the application and to identify possible strategies for implementing the intervention package.ResultsUsing the COM-B model, education, training, persuasion, enablement, and modelling were chosen as intervention functions for improving adherence to exercise protocol during early-phase of rehabilitation. The application featured five interlinked components; education, training, goal setting and self-management, communication, and a personalized therapy plan utilising 13 behaviour change techniques. An education booklet, exercise videos, text messaging, video consultation, and a digital tool for measuring range of motion were incorporated into the application. Feedback on the interactive prototype and education material was sought from ten patient volunteers and a physiotherapist. Pilot testing in a convenient sample with broad eligibility criteria (n = 30) indicated importance of digital literacy and dedicated time for remote consultation by healthcare provider within the existing clinical work. Overall, the intervention was well received and valued by the end users.ConclusionThis paper demonstrates the development of a contextualised digital behavioural intervention grounded in behavioural theory and evidence from literature to improve end-user’s engagement with rehabilitation protocols after knee arthroplasty in lower- and middle-income country context.Trial registrationStudy registered prospectively (on 16 February 2023) at Clinical Trials Registry of India (CTRI/2023/02/049792).

Primary care physicians' attitudes, practices, and perceived barriers toward depression screening in older people in the Kingdom of Bahrain.

This study aimed to explore attitudes, practices, and perceived barriers of primary care physicians (PCPs) toward depression screening in older people. This cross-sectional study enrolled PCPs from randomly selected representative primary care centers in Bahrain. A self-administered piloted semi-structured questionnaire was used for data collection. We enrolled 248 PCPs in the study (82.3% females, and the mean age = 40 ± 8.7 years). More than half of the participants (54.4%) had a positive attitude toward depression screening in older people. However, only 10.9% of the participants reported systematically screening for this condition without using specific tools for screening in 45.5%. The most reported barriers toward this service are short consultation time (95%), the presence of multiple co-morbidities in this age group (90%), and the absence of guidelines or appropriate training in around 30%. Positive attitudes were significantly higher among older PCPs (p = 0.039), family physician consultants (p = 0.008), those with more than 10 years of work experience (p = 0.024), and those who participated in related educational activities (p = 0.007). Under-screening practice is associated with perceived short consultation time (p = 0.002), insufficient continuous medical education (CME) activities attendance in older people's mental health (p = 0.048) as well as having a general physician's title (p = 0.049). Only the PCPs' job title, Adjusted Odds Ratio (OR) = 3.513, 95 C.I [1.225-10.074] and attendance of CME activities, OR = 1.278, 95 C.I [1.098 - 3.192] remained significant when controlled for age and experience. More training on older people's mental health and provision of screening and management guidelines are priorities to promote older people's mental health in primary care settings.

Venous disease progression in western Europe (VENPRO): A prospective cohort study.

Objective: A prospective cohort study aimed to determine factors which influence the progression of chronic venous disease (CVD) in an attempt to aid in the early identification of those at patients who are likely to benefit from early intervention.Methods: A prospective cohort study of patients referred to tertiary vascular services with varicose veins over 7years was conducted. The primary outcome measure was the rate of disease progression from time of referral to time of consultation. The secondary outcome measure was to the rate of venous complications during the same time period.Results: 1000 patients from routine varicose vein waiting lists were included in the study. The mean waiting time was 2.96 ± 1.25years. The majority of patients were female (73% versus 27%), and the average age was 57.8 ± 14.7years. One fifth of the cohort developed a complication or showed evidence of disease progression. Logistic regression showed that advancing age and previous episodes of cellulitis are significant risk factors for the development of CVD progression.Conclusions: Varicose veins are more than a cosmetic issue and can be associated with substantial health and economic costs. Continuous identification of risk factors will enable clinicians to implement treatment strategies earlier for at risk patients.

Views of nurses and midwives working in primary healthcare services on intimate partner violence against women.

Background Violence against women is a global public health problem. Primary healthcare services and health workers play an important role in managing this problem. The aim was to identify barriers and facilitators to the identification and management of intimate partner violence (IPV) among women presenting to primary healthcare services from the perspective of nurses/midwives, and to identify the challenges and needs to improve practices. Methods This was a qualitative descriptive study, in which semistructured interviews were conducted with 19 nurses/midwives working in primary healthcare services. The interviews were analysed using a thematic analysis approach through an inductive process. The Consolidated Criteria for Reporting Qualitative Research was used to ensure comprehensive reporting of the protocol for this qualitative study. Results Four main themes were identified: (1) detection of intimate partner violence, (2) nurses'/midwives' current practices, (3) barriers to identification and management, and (4) needs. Conclusions Primary care nurses/midwives in this study perceived that they were not responsible for the detection and management of intimate partner violence, and a majority reported they did not want to take an active role. However, those who were willing to engage in the detection and management of IPV required sufficient time for patient consultations, a reduced workload and a separate room with suitable physical conditions. It is recommended that nurses/midwives be provided with training on IPV detection and management at specific intervals, and studies be conducted to evaluate the outcomes of such training, and initiate the professional decision-making process of nurses/midwives to effectively identify, respond to and support individuals affected by IPV.

Expanding access to addictions care: Implementation of a 24-hour healthcare provider support line in British Columbia, Canada

BackgroundMorbidity and mortality related to substance use have risen to catastrophic levels in North America, and treatment services are often difficult to access. In response, the province of British Columbia (BC), Canada, launched a province-wide addiction medicine support phone line that offers clinicians immediate access to phone consultation with an addictions medicine expert. The service operates 24/7 is accessible to any clinician in the province seeking assistance with an addiction-related question. We describe an evaluation of the reach and perceived impact of the service over its first two years.MethodsThe 24/7 Addiction Medicine Clinician Support Line was evaluated prospectively from June 2020 to April 2022. All provider-to-provider encounters were included. Data was collected from two primary sources: health provider demographic information collected at the time of consultation, and optional clinician surveys conducted after the consultation was complete. Descriptive data are presented as numerical values and percentages.ResultsOver the 22-month evaluation period, 1,279 consultations were requested by 631 distinct care providers across British Columbia. The service averaged 15 calls per week across the province, and 51.5% of calls were made outside of business hours. Physicians made the majority of calls to the service (n = 865, 67.6%), followed by nurse practitioners (n = 162, 12.7%). Among those who completed a follow-up survey (n = 258 calls, 20.2% total calls), 81.8% (n = 211) were “very” or “extremely” satisfied with the consultation. Of these respondents, 65.5% (n = 169) reported that the consultation led to the provision of better care for their patient, with 58.1% (n = 150) initiating a new prescription and 22.1% (n = 57) reporting expedited treatment for their patient. The consultation area of focus was most commonly opioid use (n = 417; 59.6%), followed by polysubstance use (n = 98; 14.0%).ConclusionsThe impact of the 24/7 Addiction Clinician Support Line was widespread, and the service increased accessibility to evidence-based addictions treatment across a range of care settings. Clinicians expressed a high degree of satisfaction with the service. To our knowledge, this province-wide program is the first of its kind in North America, offering a scalable and adaptable model to support access to evidence-based addictions care in under-resourced settings.

Productivity and consultation times in Portuguese primary care: trends and payment model variations

Abstract Background Portugal faces a shortage of primary care workforce resulting in an increase in patients without Family Physician (FP). While expanding the patient list per FP may help, it could also result in excessive workloads, compromising Consultation Times (CT) and quality of care. Furthermore, it is important to study the role of the primary healthcare (PHC) financing model in incentivizing their productivity. This study aims to analyse the productivity and CT in PHC units in Portugal, variation over time, and differences across PHC unit payment models. Methods 6,563 PHC units with different payment models (salary at UCSP, salary and group pay-for-performance at USF-A, and salary, capitation, and individual pay-for-performance at USF-B) from 2015 to 2022 were analysed, including the annual numbers of medical and nursing consultations and full-time equivalents (FTE) of physicians and nurses. Weekly productivity (WP) was calculated using the consultations per FTE physician and nurse. CT were determined by dividing each FTE’s weekly workload by WP. Multivariate analysis explored differences in CT between PHC units, temporal variations, and the influence of the patient population characteristics. Results FTE physicians had a mean WP of 117 consultations (SD 39) lasting 22.4 minutes (SD 7.0). FTE nurses had a mean WP of 56 consultations (SD 18) lasting 41.0 minutes (SD 14.3). Compared to UCSPs, USF-A and USF-B had shorter CT (p &amp;lt; 0.05) by 2.48 to 4.05 minutes for medical consultations and by 5.51 to 8.04 minutes for nursing consultations. CT increased over time, decreased with higher PHC age and favorable socio-demographic context, and increased with higher population density and elderly patients’ proportion (p &amp;lt; 0.05). Conclusions USF-B professionals showed higher productivity and shorter CT, suggesting that financial incentives are effective in enhancing productivity but that gains may be obtained with losses in visit duration. Key messages • Effective workforce management is crucial given the current primary care professionals shortages. • Physicians and nurses in PHC units pay-for-performance exhibit higher productivity and shorter consultation time.

Application of Artificial Intelligence Models to Predict the Onset or Recurrence of Neovascular Age-Related Macular Degeneration

Neovascular age-related macular degeneration (nAMD) is one of the major causes of vision impairment that affect millions of people worldwide. Early detection of nAMD is crucial because, if untreated, it can lead to blindness. Software and algorithms that utilize artificial intelligence (AI) have become valuable tools for early detection, assisting doctors in diagnosing and facilitating differential diagnosis. AI is particularly important for remote or isolated communities, as it allows patients to endure tests and receive rapid initial diagnoses without the necessity of extensive travel and long wait times for medical consultations. Similarly, AI is notable also in big hubs because cutting-edge technologies and networking help and speed processes such as detection, diagnosis, and follow-up times. The automatic detection of retinal changes might be optimized by AI, allowing one to choose the most effective treatment for nAMD. The complex retinal tissue is well-suited for scanning and easily accessible by modern AI-assisted multi-imaging techniques. AI enables us to enhance patient management by effectively evaluating extensive data, facilitating timely diagnosis and long-term prognosis. Novel applications of AI to nAMD have focused on image analysis, specifically for the automated segmentation, extraction, and quantification of imaging-based features included within optical coherence tomography (OCT) pictures. To date, we cannot state that AI could accurately forecast the therapy that would be necessary for a single patient to achieve the best visual outcome. A small number of large datasets with high-quality OCT, lack of data about alternative treatment strategies, and absence of OCT standards are the challenges for the development of AI models for nAMD.

Mixed-methods systematic review of shared decision-making tools for cancer screening

Abstract Shared decision-making (SDM) tools hold promise for guiding informed choices in cancer screening. However, their effectiveness among underserved people, as well as the specific characteristics of these tools preferred by this group and clinicians, remains unclear. This review aimed to synthesize evidence on the effectiveness of SDM tools for cancer screening and explored the preferences of underserved people and clinicians regarding the specific characteristics of the SDM tools. A mixed-method convergent segregated approach was employed, which involved an independent synthesis of quantitative and qualitative data. Articles were systematically selected and screened, resulting in the inclusion and critical appraisal of 55 studies. Results from the meta-analyses showed that SDM tools for cancer screening are effective in reducing decisional conflict for both the general population and the underserved, and in increasing cancer screening knowledge and intention for underserved people only. Subgroup analyses showed minimal heterogeneity for decisional conflict outcomes, measured over a six-month period. Insights from the qualitative findings revealed that underserved people highly preferred SDM tools with relevant information about cancer risk, culturally tailored content, and high accessibility, both during clinical encounters and beyond. Meanwhile, clinicians highly preferred tools that can be easily integrated into medical systems, and can effectively guide SDM, while considering their patients’ values and the limited time for consultation. There is strong evidence on the effectiveness of SDM tools in facilitating informed choice in cancer screening, especially among underserved people. However, evidence on long-term outcomes remains insufficient. Additionally, considering the difference in preferences of key stakeholders in terms of tool characteristics, fostering collaboration with them during the creation of an SDM tool for cancer screening is essential. Key messages • Shared decision-making tools are effective in increasing screening knowledge and intention among underserved people. • Considering the difference in preferences of key stakeholders in terms of tool characteristics, fostering collaboration with them during the creation of an SDM tool for cancer screening is essential.

Proton-pump inhibitor use in older adults: Public vs. Private Prescribing in Portugal

Abstract Background Proton pump inhibitors (PPI) are frequently overprescribed, posing challenges to patients and healthcare systems. In Portugal, the publicly funded National Health Service (NHS) provides universal coverage and reimburses the cost of medications regardless of the prescription origin. If private practices may benefit from longer consultation times allowing better prescription, they do not face any incentive to avoid over-prescription. We aimed to compare outpatient prescription trends, patterns, and costs of PPI among older adults in private and public sectors. Methods Nationwide retrospective ecological study on PPI prescribed for older adults in Portugal 2020-2022. Data on defined daily doses (DDD) and costs were obtained from a national public database by healthcare sector, sex (female/male), and age group (65-74, ≥75). We analysed trends, market share of DDD per 1000 older adults per day (DID), and mean cost per DDD (€/DDD) for all PPI substances. Results We observed a decrease in prescribed PPI from 349.0 DID in 2020 to 341.9 DID in 2022. Omeprazole (reference and cheaper substance) was the most prescribed drug for females and pantoprazole for males in the public sector. Similar pattern was observed among those aged ≥75 in the private sector while for those aged 65-74, esomeprazole was the most prescribed drug. Overall, the private sector prescribed PPI with a 20% higher price (0.126 €/DDD) than the public (0.106 €/DDD), with greater differences among the most expensive substances (rabeprazole +0.032 €/DDD; lansoprazole +0.029 €/DDD; esomeprazole +0.021 €/DDD). Conclusions PPI prescription followed similar trends in both sectors, but private practitioners tend to prescribe more expensive drugs, because their patients can afford them and because there is no incentive for more rational prescription. Since the NHS financially supports drugs prescribed in private practices, financial incentives towards rationale prescription should also fall in this sector. Key messages • Overall, the private sector prescribed PPI with a 20% higher price (0.126 €/DDD) than the public (0.106 €/DDD), with greater differences among the most expensive substances. • Since the National Health Service financially supports drugs prescribed in private practices, financial incentives towards rationale prescription should also fall in this sector.

Integrating an AI-powered symptom assessment application (SAA) in a hospital network in Portugal

Abstract Introduction Patients often struggle to understand medical information and healthcare worker shortage strains health systems. Integrating SAAs that guide patients and provide diagnostic decision support (DDS) to doctors can help. This study evaluates the impact of the SAA ‘Ada’, a class IIa medical device, after its integration into the patient portal of a Portuguese hospital network, CUF, on clinical workflow and patient health. Methods This on-going post-market quality improvement study, started in Nov 2023 and has enrolled 664 participants. Participating doctors complete a baseline survey. Consenting patients conduct symptom assessments and answer survey questions within the app. The patient’s symptom report is shared with their physician, who then completes a post-consultation survey. Results After using Ada, 86% of patients could enter all their symptoms, 79% felt more prepared for their consultation, and 39% felt less health anxiety (N = 664). In the baseline survey, most doctors utilize online resources (96%) in the absence of a symptom checker, followed by discussions with colleagues (65%) for challenging cases (N = 26). In the post-consultation survey, 95% of doctors found Ada’s condition suggestions reasonable, with only 10% disagreeing with its triage classification. Doctors reported time saving and increased consultation efficiency (64%), and 59% felt more confidence in their diagnosis. A majority said that Ada provided them with additional information about patients (77%). Ada also improved consultation efficiency (74%), preparation (78%), patient engagement (82%), and health knowledge (77%; N = 22). Conclusions By providing personalized health information, Ada prepares patients for their consultation, resulting in improved patient engagement and facilitation of clinical conversation. Incorporating a SAA into routine patient care enhances quality of consultation, reduces consultation time, increases efficiency, and provides DDS to doctors. Key messages • Digital health enhances patient engagement, clinical efficiency, and diagnostic decision support for doctors in healthcare settings. • Ada’s personalized health information empowers patients, improves consultations, and reduces health-related anxiety.

The Impact of International Classification of Disease-Triggered Prescription Support on Telemedicine: Observational Analysis of Efficiency and Guideline Adherence.

Integrating decision support systems into telemedicine may optimize consultation efficiency and adherence to clinical guidelines; however, the extent of such effects remains underexplored. This study aims to evaluate the use of ICD (International Classification of Disease)-coded prescription decision support systems (PDSSs) and the effects of these systems on consultation duration and guideline adherence during telemedicine encounters. In this retrospective, single-center, observational study conducted from October 2021 to March 2022, adult patients who sought urgent digital care via direct-to-consumer video consultations were included. Physicians had access to current guidelines and could use an ICD-triggered PDSS (which was introduced in January 2022 after a preliminary test in the preceding month) for 26 guideline-based conditions. This study analyzed the impact of implementing automated prescription systems and compared these systems to manual prescription processes in terms of consultation duration and guideline adherence. This study included 10,485 telemedicine encounters involving 9644 patients, with 12,346 prescriptions issued by 290 physicians. Automated prescriptions were used in 5022 (40.67%) of the consultations following system integration. Before introducing decision support, 4497 (36.42%) prescriptions were issued, which increased to 7849 (63.57%) postimplementation. The physician's average consultation time decreased significantly to 9.5 (SD 5.5) minutes from 11.2 (SD 5.9) minutes after PDSS implementation (P<.001). Of the 12,346 prescriptions, 8683 (70.34%) were aligned with disease-specific international guidelines tailored for telemedicine encounters. Primary medication adherence in accordance with existing guidelines was significantly greater in the decision support group than in the manual group (n=4697, 93.53% vs n=1389, 49.14%; P<.001). Most of the physicians adopted the PDSS, and the results demonstrated the use of the ICD-code system in reducing consultation times and increasing guideline adherence. These systems appear to be valuable for enhancing the efficiency and quality of telemedicine consultations by supporting evidence-based clinical decision-making.

Optimizing Emergency Department Length of Stay and Quality of Care: A Quality Improvement Project.

Background Patients' long length of stay (LOS) in the emergency department (ED) is a common measure of quality of care that could be a cause of increased morbidity and mortality. This quality improvement project (QIP) aimed to identify causes of long LOS and to improve common causes such as long consultation times. Methodology Over two months, three plan, do, study, and act (PDSA) cycles were conducted aiming to identify causes of long ED LOS and improve common causes that extended ED LOS beyond four hours. Additionally, the projectaimed to reduce the time taken from requesting a consultation from another specialty until it was completed and documented to an average of 60 minutes. Main interventions included raising awareness of staff and administration through video presentations, printed posters, direct contact, and optimizing the electronic health records system to audit performance. Results From PDSA cycle 1 through PDSA cycle 3, average consultation times decreased from 91 to 65 minutes. Common organization-related causes of long LOS included pending radiology or laboratory investigations, awaiting inpatient admission, and awaiting consultations from other specialties. Physician-related factors included delay in documentation likely resulting from heavy workload. Pending investigations and admissions were factors that could be amended with better administrative control. Conclusions A multifaceted approach that tackles physician-related and organization-related factors could be a necessity to improve LOS and the quality of care in the ED. Having staff and administration aware of targets and performance along with utilizing the electronic health records system to audit performance and increase efficiency are beneficial in improving the LOS in the ED.

IMPROVING THE EffiCIENCY OF THE NEURO-ONCOLOGY NEW PATIENT CLINIC AT THE ROYAL MARSDEN HOSPITAL

Abstract AIMS Patients seen for the first time in the neuro oncology outpatient unit are typically reviewed by a registrar, then a consultant and a clinical nurse specialist (CNS). This can lead to repetition in history taking and prolonged appointment times. We aimed to improve this by introducing a clerking proforma. METHOD Prospective audit of all new patients seen in clinic over a four month period. The total clinic appointment time was recorded for each patient. A proforma was designed to cover the main domains of presenting symptoms, especially focussing on tumour related symptoms, medications including dexamethasone and antiepileptic use, and ensured the appropriate information was given to the patient about the treatment proposed and driving restrictions. The proforma was introduced in to the clinic after 2 months and results analysed to see if a difference was made in terms of overall patient time in the clinic. Qualitative feedback gathered from the team members involved. RESULTS 10 patients were included prior to the use of the proforma and 9 patients afterwards. Patients presented with a mixture of high and low grade gliomas. Treatment options discussed included chemotherapy, radiotherapy, surveillance and best supportive care. The average time of patient stay in the department prior to the proforma was 107 minutes (range 65 to 165) and after the introduction of the proforma was 91 (range 40 to 110). The proforma was well received by the clinical team, it was felt useful to have a template to structure the new patient consultation, especially for more junior registrars, and the consultants were more confident that the appropriate information had been given. CONCLUSION Within the confines of a small sample size, the introduction of a proforma reduced the average new patient consultation time and standardised the clinical information collected.