Video Consultations Research Articles

The impact of the COVID-19 pandemic on first-episode psychosis presentations in two early intervention in psychosis services.

To assess the impact of the COVID-19 pandemic on first-episode psychosis (FEP) presentations across two Early Intervention in Psychosis (EIP) services in Ireland, by comparing pre-pandemic and post-pandemic cohorts. A cross-sectional observational design with retrospective medical record review was employed. The study population comprised 187 FEP patients (77 in pre-pandemic and 110 in post-pandemic cohort). Outcomes measured included duration of untreated psychosis (DUP), FEP presentation numbers, referral sources, global assessment of functioning scores, inpatient admissions, substance misuse and service delivery methods. Statistical analyses utilised chi-square tests to assess categorical variables, Mann-Whitney U tests to compare non-normally distributed continuous variables and Kruskal-Wallis tests to examine interactions between categorical and continuous variables. A significant increase in FEP presentations was observed in the post-pandemic cohort (p = 0.003), with an increase in all urban areas and a decrease in the study's only rural area. The difference in DUP between cohorts was not significant. However, significant interaction between gender, cohort and DUP was shown (p = 0.008), with women in the post-pandemic cohort experiencing longer DUP (p = 0.01). A significant rise in telephone (p = 0.05) and video consultations (p = 0.001) offered was observed, in the post-pandemic cohort. A similar number of in-person appointments were attended across both cohorts. This study highlights the impact of the pandemic on FEP presentations, particularly rurally and regarding increased DUP among women. These findings underscore the need for flexible EIP services to respond to public health crises. Despite increased presentations, services adapted, maintaining service continuity through telehealth and modified in-person contact.

Experiences, impacts, and requirements of synchronous video consultations between nurses, allied health professionals, psychological therapists, and adult service-users: A review of the literature.

Telemedicine is increasingly used within healthcare worldwide. More is known about its efficacy in treating different conditions and its application to different contexts than about service-users' and practitioners' experiences or how best to support implementation. To review adult service-users' experiences of synchronous video consultations with nurses, allied health professionals and psychological therapists, find out how consultations impact different groups of service-users and identify requirements for their conduct at individual, organisational, regional, and national levels. CINAHL, Embase, Medline, PsycINFO Scopus were searched for papers published between 01/01/2018 and 19/03/2021. One reviewer independently reviewed citations and a second reviewed those excluded by the first, in a liberal accelerated approach. Quality assessment was undertaken using the Mixed Methods Appraisal Tool and data were synthesised narratively. 65 papers were included. Service-users' experiences of video consultations ranged from feelings of connection to disconnection and ease of access to challenges to access. Many were excluded from video consultation services or research, for example because of lack of access to technology. Individual service-users required clear orientation and ongoing technical support, whereas staff needed support to develop technical and online-relational skills. At organisational levels, technology needed to be made available to users through equipment loan or service models such as hub-and-spoke; services required careful planning and integration within organisational systems; and security needed to be assured. Regional and national requirements related to interorganisational cooperation and developing functionality. To support safe and equitable video consultation provision, we recommend: (1) providers and researchers consider how to maximise participation, for example through inclusive consent processes and eligibility criteria; (2) sharing video consultation user guides and technical support documentation; and (3) continuing professional development for practitioners, focusing on the technical and relational skills that service-users value, such as the ability to convey empathy online.

Assessment of knowledge, perception, and readiness for telepharmacy-assisted pharmaceutical services among young pharmacists in rural Indonesia

BackgroundThe implementation of telepharmacy technology has expanded significantly, particularly during the COVID-19 pandemic, to ensure continuous pharmaceutical care services. This practice is vital in rural and underserved areas where access to healthcare is limited. ObjectiveThis study aims to assess the knowledge, perception, and readiness of young pharmacists in rural Indonesia towards telepharmacy-assisted pharmaceutical services. MethodsA cross-sectional study was conducted from January to July 2023 in rural areas of Java, Sumatra, and Kalimantan, Indonesia. A convenience sampling method was employed with the aim of recruiting 520 registered pharmacists under 35 years of age (23–34 years old). Data were collected using an online questionnaire adapted for the local context and analyzed using SPSS version 26.0. ResultsThe study achieved an 86.67 % response rate. Most participants were female (73.1 %) and aged between 26 and 30 years (53.8 %). Nearly all pharmacists (97.1 %) held a Pharm.D degree. The knowledge assessment showed high awareness of telepharmacy's importance and its role during the COVID-19 pandemic, with 96.15 % recognizing the need for a strong internet connection. Positive perception was noted, with 90.38 % agreeing that telepharmacy enhances medication access in rural areas. However, concerns about increased error rates and workload were highlighted. A substantial proportion of pharmacists expressed readiness for conducting drug counselling via video consultation (44.23 %) and showed a willingness to undergo relevant training (59.62 %). ConclusionYoung pharmacists in rural Indonesia demonstrate a good level of knowledge and generally positive perceptions about telepharmacy, with notable readiness among pharmacists with less than five years of experience. While there is notable willingness to engage in telepharmacy practices and training, addressing concerns about workload and data security through targeted support and training will be crucial for the successful implementation of telepharmacy, potentially enhancing healthcare access in rural areas.

Facilitators and barriers for digital screening and a supportive intervention within antenatal care among danish pregnant women facing intimate partner violence: A qualitative study nested in the STOP study

ObjectiveTo understand barriers and facilitators for participation in digital IPV screening and a digital supportive intervention among pregnant women. MethodsPregnant women attending standard antenatal care in the Region of Southern Denmark were systematically screened for IPV through a digital questionnaire. Those who screened positive were offered 3–6 video consultations with midwives and access to safety planning app. Semi-structured qualitative interviews were conducted with pregnant women who screened positive for IPV and participated in a digital supportive intervention. ResultsTwenty pregnant women were interviewed, and the following facilitators for participation were highlighted: The digital systematic screening approach was acceptable and helped acknowledge IPV exposure as women experienced it as more private and allowed for reflection time compared to risk-based, face-to-face screening. Video counselling was highly acceptable, as the digital approach eased conversations on sensitive topics and the flexibility boosted participation. Trust in the healthcare system, having a trained midwife as a counsellor, and familiarity with the digital tool enhanced participation. Barriers included concerns about disclosing IPV, technological issues, and the need for a private space for counselling. Additionally, women who had experienced digital violence were uncomfortable with the digital nature of the intervention. The safety app was perceived as being inefficient as it did not meet the needs of the women. ConclusionSystematic digital screening and supportive video counselling for IPV within antenatal care is well-received among pregnant women as it offers increased privacy and flexibility and facilitating discussions on sensitive topics. To enhance participation, barriers such as confidentiality concerns, technological challenges, and the need for private counselling spaces must be addressed. Incorporating digital tools into antenatal care can supplement other support services and increase the proportion of pregnant women who receive help.

A new normal in primary care: the rapid normalization of a major eHealth program in public health centers

BackgroundThis study aimed to contribute to a better understanding of the context, mechanisms and outcomes in the implementation process of an eHealth video consultation program in primary care. The study focused on how the program is normalized in the primary care setting. The primary research question for this study is “in what ways is the implementation of video consultation normalized in primary care?”.MethodsThe qualitative design and content analysis of primary data from the transcripts were based on in-depth interviews, complemented with free-text answers to open-ended survey questions and various documents. The study focuses on the large-scale implementation of the public eHealth program Närhälsan Online, which represents more than 100 health centers in Sweden’s largest region of Västra Götaland. Multiagent perspectives on how the program is normalized were drawn from expressed perceptions by professions directly linked to both strategic and functional implementation, as well as administration and clinical operation.ResultsThis study both confirms and enhances the field with a theoretical contribution in six ways to the reviewed previous research, as well as showing practical implications. It also provides multi-agent perspectives on the rapid normalization of the implementation program studied.ConclusionsIn relation to the rapid progression of different initiatives in eHealth, this study contributes to perspectives on specific challenges as expressed by professions directly linked to both strategic and functional implementation as well as administration and clinical operation.

The Added Value of Using Video in Out-of-Hours Primary Care Telephone Triage Among General Practitioners: Cross-Sectional Survey Study.

Many countries have introduced video consultations in primary care both inside and outside of office hours. Despite some relational and technical limitations, general practitioners (GPs) have reported the benefits of video use in the daytime as it provides faster and more flexible access to health care. Studies have indicated that video may be specifically valuable in out-of-hours primary care (OOH-PC), but additional information on the added value of video use is needed. This study aimed to investigate triage GPs' perspectives on video use in GP-led telephone triage in OOH-PC by exploring their reasons for choosing video use and its effect on triage outcome, the decision-making process, communication, and invested time. We conducted a cross-sectional questionnaire study among GPs performing telephone triage in the OOH-PC service in the Central Denmark Region from September 5, 2022, until December 21, 2022. The questionnaire was integrated into the electronic patient registration system as a pop-up window appearing after every third video contact. This setup automatically linked background data on the contact, patient, and GP to the questionnaire data. We used descriptive analyses to describe reasons for and effects of video use and GP evaluation, stratified by patient age. A total of 2456 questionnaires were completed. The most frequent reasons for video use were to assess the severity (n=1951, 79.4%), to increase the probability of self-care (n=1279, 52.1%), and to achieve greater certainty in decision-making (n=810, 33%) (multiple answers were possible for reasons of video use). In 61.9% (n=1516) of contacts, the triage GPs anticipated that the contact would have resulted in a different triage outcome if video had not been used. Use of video resulted in a downgrading of severity level in 88.3% (n=1338) of cases. Triage GPs evaluated the use of video as positive in terms of their decision-making process (n=2358, 96%), communication (n=2214, 90.1%), and invested time (n=2391, 97.3%). Triage GPs assessed that the use of video in telephone triage did affect their triage outcome, mostly by downgrading the level of care needed. The participating triage GPs found video in OOH-PC to be of added value, particularly in communication and the decision-making process.

Patients' preferences for virtual outpatient consultations and health care professionals' assessment of suitability for their patients: A single-centre survey.

To explore patients' preferences regarding virtual consultations (via telephone or video) and to explore healthcare professionals' assessment of whether virtual consultations can maintain the same clinical quality as in-person consultations for outpatient care. A cross-sectional survey was conducted among patients with an in-person consultation at the outpatient clinic for internal medicine and among healthcare professionals who treated the patients. The prevalence of preference was determined using descriptive statistics based on cross-tabulated frequencies. Percentages are presented with 95% confidence intervals (95%CI). In total, 218 patients (response rate 67%) completed the questionnaire; 79 patients (36%) preferred a virtual consultation (95%CI: 30%-43%); telephones were the most popular and preferred by 72 patients (33%; 95%CI: 27%-39%) followed by video preferred by 54 patients (25%; 95%CI: 19%-31%). Regarding contextual factors, male gender and previous experiences with telephone or video consultations were statistically significant predictors in favour of virtual consultations. Healthcare professionals estimated that 58 consultations (21%; 95%CI: 17%-26%) could have been conducted virtually with the same professional and clinical quality as the current in-person consultations. Current practice does not fully align with patient preferences for virtual visits in internal medicine outpatient clinics. Patients should be given the choice of virtual consultations whenever they are deemed professionally and clinically possible to enhance patient autonomy and satisfaction, while being mindful of speciality-specific considerations.

Higher interest to continue COVID-19 practice recommendations in non-pandemic times among German GPs with better crisis leadership skills (egePan study)

BackgroundThe German College of General Practitioners and Family Physicians (DEGAM) issued a COVID-19 guideline with eleven recommendations to support primary care services during the pandemic. Their use in general practices beyond the pandemic can contribute to pandemic preparedness. This study analysed general practitioners’ (GPs) interest in applying recommended organisational changes in non-pandemic times.MethodsData from the German egePan GP survey (n = 516 GPs) - a multi-level clustered randomised web-based survey - were analysed. GPs’ interest in the future application of the eleven guideline recommendations was calculated. In addition, each recommendation was evaluated by the GPs using a Net-Promoter-Score (NPS range − 100 to 100). A linear regression model identified GP and practice characteristics associated with a higher interest in applying recommendations in non-pandemic times.Results98.5% of the GPs indicated the intention to implement at least one guideline recommendation prospectively: disinfectant dispensers at the entrance (86%), optimised consultation scheduling to reduce waiting times (83%), and glass screens in the reception area (72%), which also received the highest NPS scores. In contrast, lower interest was observed for items such as insurance card readers handled by patients (48%), only selected staff treating infectious patients (44%), and video consultations for patients with infections (26%). A higher interest to implement recommendations in non-pandemic times was associated with a higher crisis leadership score (p < 0.001), using the Corona-Warn-App (p = 0.007), and being a female GP (p = 0.045). In addition, GPs from Western, Northern, and Southern, and those with a higher patient volume per three months, were more interested in future implementation.ConclusionsOverall, GPs demonstrated the readiness to follow the DEGAM COVID-19 guideline outside pandemic periods, establishing them as key contributors to pandemic preparedness in Germany.

A service evaluation of patient and clinician experience of video consultations in a specialist outpatient neurorehabilitation service

IntroductionThere has been a rapid adoption of telerehabilitation services, particularly during the COVID-19 pandemic, with minimal guidance or evaluation of benefit. This survey explores experiences of video consultations in a specialist outpatient neurorehabilitation service. MethodsDigital surveys were designed to evaluate experience of Attend Anywhere. Anyone could answer the survey after attending a video consultation. Setting and participantsPatients and doctors, occupational therapists, physiotherapists and speech and language therapists from a specialist outpatient neurorehabilitation service, between January and November 2020. ResultsA total of 637 surveys were analysed. 74.6% of clinicians and 46.4% of patients indicated that video consultations were effective (X2=158.6, p < 0.001). Physiotherapists indicated that video consultation was not as effective as face to face (30.6%, X2=12.5, p = 0.052). Over 95% of clinicians and patients reported that they would use the video consultation system again X2=5.8, p < 0.016. ConclusionsVideo consultation offers potential for improving access to healthcare for patients with complex neurological conditions.

Understanding the benefits and limitations of mixing virtual and face-to-face consultations to outpatient palliative care services; a mixed-methods study

BackgroundThe Covid-19 pandemic led to a rapid increase in the use of virtual consultations across healthcare. Post-pandemic, this use is expected to continue alongside the resumption of traditional face-to-face clinics. At present, research exploring when to use different consultation formats for palliative care patients is limited.AimTo understand the benefits and limitations of a blended approach to outpatient palliative care services, to provide recommendations for future care.MethodsA mixed-methods study. Component 1: an online survey of UK palliative care physicians. Component 2: a qualitative interview study exploring patients’ and caregivers’ experiences of different consultation formats. Findings from both components were integrated, and recommendations for clinical practice identified.ResultsWe received 48 survey responses and conducted 8 qualitative interviews. Survey respondents reported that face-to-face consultations were appropriate/necessary for physical examinations (n = 48) and first consultations (n = 39). Video consultations were considered appropriate for monitoring stable symptoms (n = 37), and at the patient’s request (n = 42). Patients and caregivers felt face-to-face consultations aided communication. A blended approach increased flexibility and reduced travel burden.ConclusionsA blended outpatient palliative care service was viewed positively by physicians, patients and caregivers. We identified 13 clinical practice recommendations for the use of different consultation formats.

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).

Online video versus face-to-face patient-surgeon consultation: a systematic review.

Online video consultation (OVC) is increasingly used in patient-surgeon pre-surgical and follow-up consultation but a comprehensive review assessing its benefits and downsides as compared to face-to-face (F2F) consultation is currently lacking. This systematic review evaluated the effectiveness of OVC as compared to F2F consultation. A literature search (Ovid/Medline, Embase, and Clarivate Analytics/Web of Science Core Collection) was conducted including studies comparing efficacy, patient and surgeon satisfaction, and information recall between OVC and F2F patient-surgeon consultation (inception-December 4, 2023). Out of 1021 studies, 14 studies with 13,564 patients met the eligibility criteria, consisting of seven RCTs, three prospective, and four retrospective studies. Various types of surgical consultations were evaluated, including new referrals, routine follow-ups, postoperative follow-ups, and mixed consultations (both pre- and postoperative). None of the randomized trials exclusively compared OVC with F2F consultations in the high-demand preoperative setting, or assessed patient information recall. Efficacy outcomes were reported by seven studies. Among these, three RCTs showed that OVC improved efficacy in terms of waiting time (8.2 vs. 20.7 min, P = 0.01) and total appointment time (24 vs 71 min, P = 0.001, and 21.9 vs. 154.8 min, P = 0.001). Patient satisfaction was reported by 10 studies. Regarding patient satisfaction, one "mixed design" study favoured OVC (92% vs. 63%, P = 0.04), while eight studies reported similar outcomes. This systematic review identified some benefits of OVC such as shorter waiting and total appointment times as compared to F2F patient-surgeon consultation, although the true value of OVC remains unknown due to the limited available evidence. Future pragmatic RCTs are needed, which should include the pre-surgical consultation and assess patient information recall.

Behavioural intentions towards use of digital video consultations in primary care: a survey study on physicians’, nurses’ and psychologists’ perceptions in Swedish primary care

ObjectivesThe study aimed to describe the experiences of physicians, nurses and psychologists employed in primary care in using digital video consultations. The second objective was to study the association between...

Trust and confidence in telehealth-delivered services: a nation-wide cross-sectional study

Sustaining telehealth uptake hinges on people’s desire and ability to effectively engage with it. We explored trust and confidence in telehealth delivered by medical and allied health using cross-sectional survey of 1,116 Australians. Descriptive analysis presented factors that would improve trust and confidence in telehealth cross-tabulated with video consultation experience. Inferential statistics compared levels of trust in medical and allied health telehealth with user-related variables. Trust in medical telehealth was higher than in allied health, but practice with video calls, experience with high-quality telehealth, and good internet were associated with greater levels of trust in both groups. Telehealth with a known health professional and no additional costs were top-ranked factors to improve trust and confidence. Participants confident in troubleshooting trusted telehealth more. This first cross-sectional study on trust and confidence in telehealth suggests that digital upskilling and promoting quality video consultations can potentially enhance telehealth adoption.

Telemedical Franconian Obesity Aftercare Therapy (Tele-FANT) Results of a Formative Evaluation

Following rehabilitation, patients are often unable to continue with the behavioral changes they had learned there in the long term. It is therefore important to offer aftercare services to improve self-management. Internet-based and telephone aftercare concepts in particular are low-cost and flexible in application, and offer an opportunity to significantly increase the use of aftercare measures. In, the"Tele-FANT" project, obese patients were supported by an aftercare therapist over a period of 12 months following their inpatient rehabilitation stay by regular telephone or video consultations. A one-group pre-post design was used for the formative evaluation. Participants took part in a written survey at the start of rehabilitation, at the end of rehabilitation and 4, 8 and 12 months after rehabilitation. As a key variable, body weight (external measurement by the family doctor) was also recorded at all measurement times to calculate the percentage weight loss from the start of rehabilitation. Descriptive parameters were calculated at the beginning, as well as mean differences and standardized effect sizes (SES) at the post-measurement time points. A total of 47 obese rehabilitation patients (mean BMI=44.56, SD=7.23) from the Frankenlandklinik Bad Windsheim were recruited to participate in the aftercare program. The complete program up to the 12-month follow-up was completed by 30 participants (drop-out: 36.2%). The remaining participants showed a high level of acceptance for both the structural processes and the content of the aftercare program. A weight loss of at least 10% was achieved by 13 participants (50%) at the 12-month follow-up, a further 4 participants (15.4%) had lost 5 to 10%. The participants were able to reduce their BMI by an average of 4.45 BMI points from 43.69 (SD=7.25) to 39.24 (SD=7.25) since the start of rehabilitation (mean effect size: SES=0.61). In the formative evaluation, the "Tele-FANT" aftercare program shows good feasibility and promising results with regard to the goal of weight reduction/stabilization. However, the high drop-out rate indicates that some of the participants were not satisfied with the program or were unable to achieve the desired outcome. The next step would be to test the effectiveness of the "Tele-FANT" aftercare concept in a randomized control group study.

Video consultations among registered nurses in public sector and associated factors

Abstract Background In digital health services, including services for older people, video consultations can enhance access to care while enabling interaction through audio and visual means. Registered nurses are pivotal in digital care delivery and there is a need for more understanding regarding the use of video consultations in nursing. This study aims to examine factors associated with nurses’ video consultations in the public sector. Methods The Finnish ‘Survey on information systems for registered nurses’ was delivered for registered nurses in March 2023. The respondents were asked whether their work had included video consultations in the past six months. Binary logistic regression was used to examine if career stage and digital skills (basic IT-skills, proficiency in data security, skills in digital working environments) were associated with nurses’ video consultations, adjusted for working unit and location of employment. Results The study included 2,525 public sector nurses (92.7% female, mean age 47.34, SD 10.47). Of them, twelve percent had used video consultations with patients. Most nurses used video consultations in outpatient units (63.3%), whereas they were less used among those working in acute care (3.3%), housing services (3.3%) and home-based services (8.2%). Early-career nurses had lower odds (OR .38, 95% CI .19-.73) of video consultations compared to mid-career nurses. Nurses who had good skills in working in digital environments (OR 2.07, 95% CI 1.26-3.39) had greater odds of video consultations than those with poorer skills. Conclusions The study suggests a limited adoption of video consultations among public sector nurses, particularly among early-career professionals. Increasing targeted support and training, and the availability of tools for various patient service needs in video consultations, are needed. By recognizing the importance of nurses’ digital skills, digital care delivery could be enhanced and potential public health benefits promoted. Key messages • Relatively few registered nurses used video consultations in the public sector. More research is needed to explore if their usage could be increased safely for patients, also in early nursing careers. • Proficiency in digital work environments is imperative for ensuring the quality of care in video consultations. Therefore, collaborative efforts are required to enhance professionals’ digital skills.

STI/HIV care in times of COVID-19 according to Dutch healthcare professionals: A mixed methods study

Abstract Background Surveillance data from the Netherlands show that STI/HIV testing decreased at the start of the COVID-19 pandemic, suggesting barriers in access to STI/HIV care. However, the impact of the pandemic on STI/HIV care may be more complex, and key populations could be differentially affected. The aim of this study was to gain more insight into the impact of COVID-19 on STI/HIV care in the Netherlands from the perspective of STI/HIV care providers. Methods We investigated whether professionals in STI/HIV care experienced changes compared to pre-COVID in access to care, demand and provision of care, shifts online care, and quality of care. An online survey was completed by 192 STI/HIV care professionals. Additionally, semi-structured interviews were held with 23 STI/HIV care professionals. Results According to participants, specific subgroups of priority populations may have had difficulties accessing STI/HIV care during the pandemic especially during lockdowns and at public sexual health services. Professionals were concerned to have lost sight of subpopulations in vulnerable circumstances and that the pandemic may have magnified inequalities in access to STI/HIV care, which may be related to different levels of health and digital literacy required for telephone and video consultations. Furthermore, participants found online care provision was not up to standards and were concerned about follow-up care for patients using private online providers of remote tests. Conclusions Professionals experienced that COVID-19 measures may have compounded existing disparities. To minimize inequalities in access to STI/HIV care during a pandemic, it is recommended to prioritize services for people in vulnerable circumstances such as recent migrants and people with low health or digital literacy. More collaboration between and within sectors may help in better organizing healthcare and prevent overburdening of specific sectors. Key messages • According to STI/HIV care providers, the COVID-19 pandemic differentially impacted different STI/HIV care sectors, but also increased existing inequalities in access to care for vulnerable groups. • Professionals experienced that COVID-19 measures impacted the provision of STI/HIV care, access to care for vulnerable populations, and quality of care.

Engagement of adults with congenital heart disease in research: overcoming barriers relating to social deprivation

Abstract Background In adult congenital heart disease (ACHD), social deprivation is associated with adverse health outcomes, such as increased inpatient admissions and major adverse cardiovascular events (1). Research studies on this topic often rely on patients engaging with surveys, and the characteristics of non-respondents in relation to social deprivation remain unknown. Purpose We assessed the association between social deprivation and response to a research survey in the ACHD population. Methods We included all individuals in the UK who were invited to participate in the APPROACH-IS II study (2), which assessed patient-reported outcomes in ACHD. A validated index of relative deprivation was derived from household postcodes, based on the 2019 Index of Multiple Deprivation (IMD) scores for geographic units in England (3). A lower IMD decile indicates a greater degree of deprivation. We compared patient engagement rates between 2 centres utilising different recruitment approaches: a Southern centre (South) relying on recruitment during mainly telephone or video consultations, and a Northern centre (North) recruiting patients during face-to-face clinic appointment, with the help of an ACHD clinical and research nurse specialist. Results In total, 593 patients were asked to take part in APPROACH-IS II in the UK: 324 patients from the Southern centre and 269 patients from the Northern centre, of whom 130(40.1%) and 209(77.7%) responded, respectively (p&amp;lt;0.0001). In the South, patients approached were homogeneously spread amongst IMD deciles (6.0[4.0-9.0]) and respondents were significantly less deprived (higher IMD decile) than non-respondents (7.0[5.0-9.0] vs 6.0[4.0-8.0], p=0.02). Indeed, the response rate in areas of higher deprivation (IMD decile&amp;lt;=4) was significantly lower than in the least deprived areas (IMD &amp;gt;=8) (31.3% vs 47.0%, p=0.03). In the North, the distribution of deprivation in patients was skewed towards lower IMD deciles, with a significantly higher proportion of patients from areas of higher deprivation (Figure A, 26 vs 99(30.6%) in the South, p&amp;lt;0.0001). There was no difference in IMD decile between respondents and non-respondents in the North (Figure B, 5.0[2.0-7.0] vs 4.0[2.0-7.0], p=0.26). When comparing patients living in the most deprived areas (IMD &amp;lt;=4), there was a large and significant difference in response rate between centres (p&amp;lt;0.0001). Conclusions In our population, deprivation appears to have a significant impact on the likelihood of patients engaging with clinical research. An enhanced approach, involving face-to-face contact and the involvement of a dedicated clinical nurse specialist, can improve recruitment to research studies and abolish the effect of socioeconomic status on patient engagement.Figure 1A and B

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.

Aachen smoking cessation and harm reduction (ASCHR) trial study protocol – scientific evaluation of a psychological-telemedical counseling concept for smoking cessation in patients with vascular diseases

BackgroundSmoking is a major risk factor of cardiovascular diseases, notably peripheral arterial disease (PAD). Despite this link, research on smoking cessation interventions in PAD patients remains scarce and inconclusive regarding the efficacy of such interventions.Therefore, elucidating it is crucial and should address both individuals who smoke that are motivated to quit and individuals who smoke heavily lacking the motivation to quit.Methods/DesignThe Aachen Smoking Cessation and Harm Reduction (ASCHR) trial is a prospective randomized controlled study (RCT) on the benefits of telemedical-psychological support for smoking cessation in patients with PAD, funded by the “Innovation Fund” of the Joint Federal Committee in Germany. This trial aims to scientifically assess the efficacy, feasibility, acceptance, and efficiency of a multi-stage smoking cessation program based on the recommendations of the German guideline for smoking cessation tailored to patients with PAD, compared to a control group receiving no intervention. Central to the program is psychological counseling utilizing motivational interviewing techniques, delivered through telemedicine via video consultations. The primary endpoint of the ASCHR trial is the smoking cessation rate after 8 months of intervention, with a secondary endpoint evaluating sustained abstinence at a further 6 months follow-up. Smoking cessation is defined as a carbon monoxide level in exhaled air of less than 6 ppm. We hypothesize that the group receiving the multi-stage cessation program will yield a cessation rate at least 10 percentage points higher than that of usual care. Anticipating a dropout rate of around 35%, the planned sample size is at least N = 1032 study participants.DiscussionShould the trial demonstrate significant positive outcomes, efforts should be made to integrate the program into routine care in Germany, potentially offering a promising base for future smoking cessation support among PAD patients.