Protocol: Improving Access to Specialist Nephrology Care Among Rural/Remote Dwellers of Alberta: The Role of Electronic Consultation in Improving Care for Patients With Chronic Kidney Disease.
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ABSTRACT:
SUBMITTER: Bello A
PROVIDER: S-EPMC6769217 | biostudies-literature | 2019
REPOSITORIES: biostudies-literature
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Protocol: Improving Access to Specialist Nephrology Care Among Rural/Remote Dwellers of Alberta: The Role of Electronic Consultation in Improving Care for Patients With Chronic Kidney Disease.
Bello Aminu A Zaidi Deenaz D Braam Branko B Courtney Mark M Glassford Jodi J Jindal Kailash K Klarenbach Scott S Kurzawa Julia J Osman Mohammed M Scott-Douglas Nairne N Szigety Sue S Thompson Stephanie S Manns Braden B Hemmelgarn Brenda B Tonelli Marcello M
Canadian journal of kidney health and disease 20190930
<h4>Background</h4>As the burden of chronic kidney disease (CKD) continues to increase, many geographically dispersed Canadians have limited access to specialist nephrology care, which tends to be centralized in major urban areas. As a result, many rural/remote-dwellers in Canada experience poor quality of care and related adverse outcomes. It is imperative to develop alternative care delivery mechanisms to ensure optimal health outcomes for all Canadians.<h4>Objective</h4>To investigate the fea ...[more]
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Project description:ObjectiveTo simulate the impact on population mental health indicators of allowing people to book some Medicare-subsidised sessions with psychologists and other mental health care professionals without a referral (direct access), and of increasing the annual growth rate in specialist mental health care capacity (consultations).DesignSystem dynamics model, calibrated using historical time series data from the Australian Bureau of Statistics, HealthStats NSW, the Australian Institute of Health and Welfare, and the Australian Early Development Census. Parameter values that could not be derived from these sources were estimated by constrained optimisation.SettingNew South Wales, 1 September 2021 - 1 September 2028.Main outcome measuresProjected mental health-related emergency department presentations, hospitalisations following self-harm, and deaths by suicide, both overall and for people aged 15-24 years.ResultsDirect access (for 10-50% of people requiring specialist mental health care) would lead to increases in the numbers of mental health-related emergency department presentations (0.33-1.68% of baseline), hospitalisations with self-harm (0.16-0.77%), and deaths by suicide (0.19-0.90%), as waiting times for consultations would increase, leading to disengagement and consequently to increases in adverse outcomes. Increasing the annual rate of growth of mental health service capacity (two- to fivefold) would reduce the frequency of all three outcomes; combining direct access to a proportion of services with increased growth in capacity achieved substantially greater gains than an increase in service capacity alone. A fivefold increase in the annual service growth rate would increase capacity by 71.6% by the end of 2028, compared with current projections; combined with direct access to 50% of mental health consultations, 26 616 emergency department presentations (3.6%), 1199 hospitalisations following self-harm (1.9%), and 158 deaths by suicide (2.1%) could be averted.ConclusionThe optimal combination of increased service capacity growth (fivefold) and direct access (50% of consultations) would have double the impact over seven years of accelerated capacity growth alone. Our model highlights the risks of implementing individual reforms without knowledge of their overall system effect.
| S-EPMC10952178 | biostudies-literature
Project description:ObjectivesTo evaluate the accessibility of multispecialty advice for primary care providers (PCPs) within correctional facilities, catering to the healthcare needs of individuals in federal custody in Ontario, Canada, through the utilization of electronic consultation (eConsult).DesignRetrospective, cross-sectional, descriptive analysis.SettingeConsults submitted by PCPs within federal correctional facilities through the Ontario eConsult Service between April 1st, 2019, and March 31st, 2023.Participants906 completed eConsults were submitted by 21 PCPs in correctional facilities.ResultsThe top three specialties sent to were cardiology (46%, N = 417), dermatology (14%, N = 128), and endocrinology and metabolism (8%, N = 68). The median specialist response time was 0.9 days. The median time specialists spent responding to each case was 15 minutes. PCPs received advice on a new or additional course of action in 34% of eConsult cases. In-person specialist appointments were avoided in 81% of cases.ConclusionsOntario eConsult provides an ideal venue to improve access to multispecialty advice for people who are incarcerated. This service reduces the need for face-to-face specialist visits, decreases cost-of-care, and avoids unnecessary transportation outside of correctional facilities with potential security issues.
| S-EPMC11614223 | biostudies-literature
Project description:ImportanceGlobally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)-defined as asynchronous, consultative communication between family physicians and hospital specialists-may offer advantages to face these challenges.ObjectiveTo provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals.Evidence reviewA systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence.FindingsThe search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies.Conclusions and relevanceIn this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.
| S-EPMC10787322 | biostudies-literature
Project description:Access to specialist services is limited by wait times and geographic availability. Champlain Building Access to Specialist Advice (BASE) has been implemented in our service region to facilitate access to specialists by primary care providers (PCPs). Through a secure web-based system, PCPs are able to send eConsults instead of requesting a formal in-office consultation.Urology eConsults completed through the Champlain BASE service from March 2013 to January 2015 were analyzed. Each consult was characterized in regard to the type of question asked by the referring physician and the clinical content of the referral. Using the mandatory close-out surveys, we analyzed rates of referral avoidance, physician satisfaction, and overall impact on patient care.Of 190 eConsultations, 70% were completed in less than 10 minutes. The most common clinical questions related to the interpretation of imaging reports (16%) and tests to choose for investigating a condition (15%). The most common diagnoses were hematuria (13%) and renal mass (8%). In 35% of cases, referral to a urologist had originally been contemplated and was avoided. In 8% of cases, a PCP did not believe a consultation was initially needed, but a referral was ultimately initiated after the eConsultation.Our study shows that although certain clinical presentations still require a formal in-person urological consultation, eConsultations can potentially reduce unnecessary clinic visits while identifying patients who may benefit from early urological consultation. Through both these mechanisms, we may improve timely access to urologists.
| S-EPMC5542837 | biostudies-other
Project description:BackgroundWomen in rural and remote northern Alberta access breast cancer screening through a mobile mammogram program (Screen Test). The Enhanced Access to Cervical and Colorectal Cancer Screening (EACS) project was a 2-year pilot that aimed to integrate cervical and colorectal cancer screening with the Screen Test program. This study compares cervical and colorectal cancer screening uptake among women screened through the pilot (Screen Test-EACS) versus Screen Test.MethodsScreen Test-EACS was offered between 2013 and 2015 in selected rural and remote sites, with a focus on hard-to-reach women living in First Nations, Métis and Hutterite communities. Participation in cervical and colorectal cancer screening was analyzed for Screen Test and Screen Test-EACS participants 6 weeks before clients received their mammogram and then again 3 months after.ResultsA total of 8390 and 1312 women participated in Screen Test and Screen Test-EACS, respectively. Screen Test-EACS significantly increased uptake of cervical (10.1% v. 27.5%) and colorectal (10.9% v. 22.5%) cancer screening, increasing the prevalence of women up to date with screening from 52.5% to 62.9% for cervical cancer screening and from 37.3% to 48.7% for colorectal cancer screening.InterpretationScreen Test-EACS increased participation in and the overall prevalence of cervical and colorectal cancer screening among hard-to-reach clients in northern Alberta, probably through removal of barriers to access and increased awareness. Further research should focus on balancing the benefits of increased participation with the costs and potential risks of over-screening.
| S-EPMC5741430 | biostudies-literature
Project description:BackgroundIn 2017, the Canadian Foundation for Healthcare Improvement launched the Connected Medicine collaborative to support the implementation, spread and adaptation of 2 innovative remote consult solutions - the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service and the Rapid Access to Consultative Expertise (RACE) service - across Canada. We evaluated the impact of the programs implemented through the collaborative.MethodsWe conducted a cross-sectional analysis of data from provincial teams that participated in the Connected Medicine collaborative, which took place between June 2017 and December 2018 in 7 provinces across Canada (British Columbia, Alberta, Saskatchewan, Manitoba, Quebec, New Brunswick, Newfoundland and Labrador). Data included utilization data collected automatically by the BASE and RACE services and, where available, responses to surveys completed by primary care providers at the end of each case. We assessed programs on the following outcomes: usage (i.e., number of cases completed, average specialist response time), number of specialties available, impact on primary care provider's decision to refer and impact on emergency department visits. We performed descriptive analyses.ResultsTen provincial teams participated in the collaborative and implemented or adapted either the RACE service (4 teams), the BASE service (5 teams) or a combination of the 2 services (1 team). Average monthly case volume per team ranged from 14.7 to 424.5. All programs offered multispecialty access, with specialists from 5 to 37 specialty groups available. Specialists responded to eConsults within 7 days in 80% (n = 294/368) to 93% (n = 164/176) of cases. Six programs provided survey data on avoidance of referrals, which occurred in 48% (n = 667/1389) to 76% (n = 302/398) of cases. Two programs reported on the avoidance of potential emergency department visits, noting that originally considered referrals were avoided in 28% (n = 138/492) and 74% (n = 127/171) of cases, respectively.InterpretationThe 2 innovative virtual care solutions implemented through the Connected Medicine collaborative received widespread usage and affected primary care providers' decisions to refer patients to specialists. The impact of these models of care in multiple settings shows that they are an effective means to move beyond the pilot stage and achieve spread and scale.
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Project description:ObjectiveTo describe a learning health care system research process designed to increase buprenorphine prescribing for the treatment of opioid use disorder (OUD) in rural primary care settings within U.S. Department of Veterans Affairs (VA) treatment facilities.Data sources and study settingUsing national administrative data from the VA Corporate Data Warehouse, we identified six rural VA health care systems that had improved their rate of buprenorphine prescribing within primary care from 2015 to 2020 (positive deviants). We conducted qualitative interviews with leaders, clinicians, and staff involved in buprenorphine prescribing within primary care from these sites to inform the design of an implementation strategy.Study designQualitative interviews to inform implementation strategy development.Data collection/extraction methodsInterviews were audio-recorded, transcribed verbatim, and coded by a primary coder and secondary reviewer. Analysis utilized a mixed inductive/deductive approach. To develop an implementation strategy, we matched clinical needs identified within interviews with resources and strategies participants had utilized to address these needs in their own sites.Principal findingsInterview participants (n = 30) identified key clinical needs and strategies for implementing buprenorphine in rural, primary care settings. Common suggestions included the need for clinical mentorship or a consult service, buprenorphine training, and educational resources. Building upon interview findings and in partnership with a clinical team, we developed an implementation strategy composed of an engaging case-based training, an audit and feedback process, and educational resources (e.g., Buprenorphine Frequently Asked Questions, Rural Care Model Infographic).ConclusionsWe describe a learning health care system research process that leveraged national administrative data, health care provider interviews, and clinical partnership to develop an implementation strategy to encourage buprenorphine prescribing in rural primary care settings.
| S-EPMC11540581 | biostudies-literature
Project description:BackgroundRural populations in the Gran Chaco region have large prevalence rates of Trypanosoma cruzi infection and very limited access to diagnosis and treatment. We implemented an innovative strategy to bridge these gaps in 13 rural villages of Pampa del Indio held under sustained vector surveillance and control.MethodologyThe non-randomized treatment program included participatory workshops, capacity strengthening of local health personnel, serodiagnosis, qualitative and quantitative PCRs, a 60-day treatment course with benznidazole and follow-up. Parents and healthcare agents were instructed on drug administration and early detection and notification of adverse drug-related reactions (ADR). Healthcare agents monitored medication adherence and ADRs at village level.Principal findingsThe seroprevalence of T. cruzi infection was 24.1% among 395 residents up to 18 years of age examined. Serodiagnostic (70%) and treatment coverage (82%) largely exceeded local historical levels. Sixty-six (85%) of 78 eligible patients completed treatment with 97% medication adherence. ADRs occurred in 32% of patients, but most were mild and manageable. Four patients showing severe or moderate ADRs required treatment withdrawal. T. cruzi DNA was detected by qPCR in 47 (76%) patients before treatment, and persistently occurred in only one patient over 20-180 days posttreatment.Conclusions and significanceOur results demonstrate that diagnosis and treatment of T. cruzi infection in remote, impoverished rural areas can be effectively addressed through strengthened primary healthcare attention and broad social participation with adequate external support. This strategy secured high treatment coverage and adherence; effectively managed ADRs, and provided early evidence of positive therapeutic responses.
| S-EPMC5325580 | biostudies-literature
Project description:IntroductionPlastic surgery is an essential yet underdeveloped field in many African nations, especially in rural areas. The demand for plastic surgery is increasing, but differences in access to respective services between rural and urban domiciles remain ever existent, despite the exponentiation of trauma, burns, and congenital disorders. According to this review, urban areas have access to better facilities and specialized surgeons, while rural areas frequently lack infrastructure, educated healthcare personnel, and medical resources. This review compares the quality and accessibility of plastic surgery services in African rural and urban settings in order to determine the variables influencing said differences in access.MethodsThis literature review was performed using electronic search databases comprising PubMed/MEDLINE, Google Scholar, and Africa Journals online (AJOL). Regional medical journals were also reviewed using keywords and associated Boolean operators pertaining to "plastic surgery", "plastic surgery in rural" and plastic surgery in urban" by selecting studies based on their relevance and content quality. Studies focusing on plastic surgery in Africa were included. A total of 37 articles were analyzed to provide insights into the disparities between rural and urban access to plastic surgery services in Africa. Studies not focusing on plastic surgery were excluded.ResultsThe review highlighted significant disparities in access to plastic surgery services between Africa's rural and urban areas. Rural areas usually lack medical resources, specialized surgeons, infrastructure, while urban areas have access to better facilities and specialized surgeons. Urban regions not only hail more training opportunities for surgeons but also foster further specialized facilities, greater training options, access to modern surgical equipment, sterile facilities and advanced instruments, contributing to clinical and surgical excellence alongside patient satisfaction and outcomes. However, there is a scarcity of qualified plastic surgeons in rural regions, including antiquated technology and a dearth of resources and expertise. Besides, socioeconomic variables that hinder said indifference between rural and urban areas, such as poverty, education, money, and cultural attitudes, precipitated limited access to critical surgical intervention in rural populations.ConclusionFurther research should be done on how plastic surgery services differ in urban and rural areas. Availability of financial expertise and specialists who can provide specialized care in rural settings is recommended. To enhance patient outcomes, the implementation of technological innovation, improved healthcare infrastructure, and effective training initiatives should be implemented in rural Africa. Also, in the field of plastic surgery, emphasizing the use of telemedicine and mobile surgical units may aid universal healthcare for residents in rural domiciles. Significant progress towards ensuring equitable access to high-quality plastic surgery in rural Africa may be achieved through these initiatives.
| S-EPMC11670430 | biostudies-literature
Project description:BackgroundThe goal of the Integrated Access to Cancer Screening (IACS) initiative was to help reduce the disparity in cancer screening participation across Alberta by implementing an integrated mobile service delivery model for breast, cervical, and colorectal cancer screening in rural and remote communities in Northern Alberta, performed by Nurse Practitioners (NPs) that addressed barriers to access. The aim of this study was to evaluate the outcomes and impact the IACS initiative had on the communities and residents of Northern Alberta. This article describes the initiative design, implementation, outcomes, and impact of the initiative.MethodsThe IACS model was implemented in a total of 36 visited communities in Northern Alberta from December 2020 to December 2021. The impact of the IACS initiative was measured using a mixed methods approach. The participation rate, cancer screening overdue status, and connection to a PCP were assessed using quantitative data collected through the existing clinical information system. Patient and provider feedback were collected from opened-ended surveys, and all data was analyzed by the research team. This study evaluated the impact the IACS initiative had on patient cancer screening participation and cancer screening knowledge, addressing known barriers to service delivery in rural and remote Northern Alberta, and to understand how this service might be sustained for future operation.ResultsSix hundred fifty-three people participated in screening offered through the IACS initiative. 99% of Pap screenings offered to patients were accepted, and 98% of FIT kits were accepted from the NPs, with a completion rate of 84%. The clinical data and survey responses from patients and providers indicated support for sustaining the IACS initiative. The IACS model of screening was favoured by most female patients. It also increased screening uptake in the communities we visited in the North Zone of Alberta, where screening rates are low.ConclusionThese findings highlight that the IACS initiative was well-received and brought value to underserved communities in Northern Alberta. The IACS model effectively facilitated screening for those who were overdue or have never been screened before. The reach of the IACS model was broader than anticipated, with those who are attached to a PCP also finding the integrated mobile screening model beneficial, bringing the services closer to home.
| S-EPMC11831772 | biostudies-literature