Strategies to Ensure Continuity of Care Using Telemedicine with Older Adults during COVID-19: A Qualitative Study of Physicians in Primary Care and Geriatrics
Ontology highlight
ABSTRACT:
SUBMITTER: Chen K
PROVIDER: S-EPMC9207584 | biostudies-literature | 2022 Jun
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundThe COVID-19 pandemic changed the healthcare system, leading to the rapid evolution and implementation of telemedicine (TM). TM has the potential to improve the quality of primary health care and increase accessibility for the population. However, its use may represent challenges for older people, as they may have distinct needs from the general population due to age-related changes in perceptual, motor, and cognitive capacities. We, thus, aimed to identify potential facilitators and barriers to TM use in primary care for older adults and develop recommendations accordingly.MethodsWe conducted a qualitative study to explore the challenges associated with TM use among older adults and healthcare professionals (HCPs) in primary care practice. Interviews were conducted with 29 older adults, and three focus groups involving HCPs from four McGill family medicine sites were organized. Employing a hybrid codebook thematic analysis, guided by the Consolidated Framework for Implementation Research (CFIR), we identified facilitators and barriers affecting the optimal use of TM by older adults and HCPs. We synthesized the results from semi-structured interviews and focus groups. These findings were then presented during a deliberative dialogue with eight participants, including family physicians, nurses, a social worker, and a government-level TM expert, to validate our results. The purpose was to gather feedback, identify and refine actionable recommendations. Subsequently, we utilized a thematic analysis using the same codebook to synthesize findings from the deliberative dialogue.ResultsParticipants agreed that TM contributed to maintaining the continuity of care and was particularly convenient when there was an existing or established patient-physician relationship or for addressing minor health issues. TM was found to be beneficial for people with limited mobility, reducing their exposure to potentially high-risk environments. However, participants expressed concerns about the lack of visual contact, causing essential details to be overlooked. Additionally, issues related to miscommunication due to language or hearing barriers were identified. HCPs perceived that most older adults did not consider phone consultations a medical act. Participants were open to a hybrid approach, combining in-person consultations and TM, based on their specific health conditions. Building upon these results, we formulated seven key recommendations.ConclusionsBoth older adults and HCPs consider TM a good alternative for accessing healthcare services. To improve the effective use of TM, it's crucial to advocate for a hybrid approach that integrates both in-person and virtual methods. This approach should actively encourage and support individuals in becoming familiar with technological tools.
| S-EPMC11253566 | biostudies-literature
Project description: Not available
| S-EPMC10022479 | biostudies-literature
Project description:BackgroundBurnout is high in primary care physicians and negatively impacts the quality of patient care. While many studies have evaluated burnout, there have been few which investigate those physicians who are satisfied with their careers and life-a phenomenon we term "thriving."ObjectiveTo identify factors contributing to both career and life satisfaction through qualitative interviews.ParticipantsThe subjects were primary care physicians.ApproachQualitative interviews were performed between July 2018 and March 2020. Physicians were identified by snowball sampling and were asked to complete validated instruments to identify job/life satisfaction and lack of burnout. Semi-structured interviews were conducted, focused on aspects of participants' career and life which contributed to their thriving, including work environment, social networks, family life, institutional support, coping strategies, and extracurricular activities. Transcripts were analyzed using thematic content analysis using a grounded theory approach.Main measuresPersonal, professional, and life factors that contributed to achieving career and life satisfaction in primary care physicians and potential solutions for burnout.ResultsThirty-two physicians were interviewed (9.4% family physicians, 9.4% combined internists-pediatricians, 40.6% internists, and 40.6% pediatricians) with a mean age 54.7 years and 23.8 years in practice. No physicians included met the criteria for burnout. All met the criteria for career and life satisfaction. Five themes were identified as critical to thriving: an intrinsic love for the work, a rich social network, a fulfilling doctor-patient relationship, a value-oriented belief system, and agency in the work environment.ConclusionsSeveral factors contribute to professional fulfillment and life satisfaction among primary care physicians, which we propose as a model for physicians thriving. Some factors were intrinsic, such as having value-oriented beliefs and inherent love for medicine, while others were extrinsic, such as having a fulfilling social network. Barriers and opportunities to apply these lessons for the wider physician community are discussed.
| S-EPMC8642558 | biostudies-literature
Project description:IntroductionThe Geriatrics 5Ms provide a novel framework for caring for older adults that directly maps to the current Accreditation Council for Graduate Medical Education (ACGME) core competencies in geriatrics for internal and family medicine residents. Using the 5Ms framework of Mobility, Medications, Mind, Multicomplexity, and Matters Most, we conducted a workshop for residents in a primary care clinic to improve care of older adults.MethodsThrough Kern's six-step approach to curriculum development, we used our needs assessment and stakeholder interviews to guide development of a half-day Geriatrics 5Ms workshop for residents in primary care. The workshop was piloted with 33 internal medicine residents and included interactive modules and point-of-care tools for each of the Geriatrics 5Ms centered on a longitudinal primary care patient case.ResultsInitial evaluation of the workshop showed high satisfaction and indicated residents appreciated learning about point-of-care tools for primary care, particularly for cognitive assessment, prognosticating, and deprescribing. Of the learners completing the workshop, 75% reported high self-efficacy ratings (score > 3.5) on the Geriatrics 5Ms domains, compared to only 40% of control learners and 20% of learners completing the preworkshop needs assessment.DiscussionA longitudinal, interactive, case-based workshop using the Geriatrics 5Ms framework improved primary care residents' self-efficacy and knowledge of tools in the care of older adults and geriatric competencies outlined by the ACGME. The workshop offers an innovative and efficient method to teach geriatrics to residents in primary care and prepare them to care for an aging population.
| S-EPMC6489378 | biostudies-literature
Project description:ObjectiveWe aimed to identify the factors that are most important for community-dwelling older individuals (i.e., users) and primary care (PC) providers to enhance PC services.MethodsDiscrete choice experiment surveys were administered to 747 individuals aged ≥ 60 years and 242 PC physicians in Singapore between December 2020 and August 2021. Participants were asked to choose between two hypothetical PC clinics and their current clinic. Latent class models were used to estimate the relative attribute importance (RAI) and to calculate the predicted uptake for enhanced PC services.ResultsBased on the attributes and levels used in this study, the out-of-pocket cost (RAI: 47%) and types of services offered (RAI: 25%) were the most important attributes for users while working hours (RAI: 28%) and patient load (RAI: 25%) were the most important for providers. For out-of-pocket visit costs ranging from Singapore dollars (S)$100 to S$5, users' predicted uptake for enhanced PC services ranged from 46 to 84%. For daily patient loads ranging from 60 to 20 patients, providers' predicted uptake ranged from 64 to 91%, assuming their income remains unchanged.ConclusionsOur study provides timely insights for the development of strategies to support the government's new health care initiative (HealthierSG), which places PC at the center of Singapore's healthcare system. The ability to choose their preferred clinic, low out-of-pocket costs and types of services offered (for users), and reasonable working conditions (for providers) were the key factors for users and providers to participate in enhanced PC services.
| S-EPMC10169155 | biostudies-literature
Project description:Obesity is recognized as a chronic disease and one of the major healthcare challenges facing us today. Weight loss can be achieved via lifestyle, pharmacological and surgical interventions, but weight maintenance remains a lifetime challenge for individuals with obesity. Guidelines for the management of obesity have highlighted the role of primary care providers (PCPs). This review examines the long-term outcomes of clinical trials to identify effective weight maintenance strategies that can be utilized by PCPs. Because of the broad nature of the topic, a structured PubMed search was conducted to identify relevant research articles, peer-reviewed reviews, guidelines and articles published by regulatory bodies. Trials have demonstrated the benefit of sustained weight loss in managing obesity and its comorbidities. Maintaining 5-10% weight loss for ?1 year is known to ameliorate many comorbidities. Weight maintenance with lifestyle modification - although challenging - is possible but requires long-term support to reinforce diet, physical activity and behavioural changes. The addition of pharmacotherapy to lifestyle interventions promotes greater and more sustained weight loss. Clinical evidence and recently approved pharmacotherapy has given PCPs improved strategies to support their patients with maintenance of weight loss. Further studies are needed to assess the translation of these strategies into clinical practice.
| S-EPMC4715703 | biostudies-other
Project description:BackgroundThe growing number of primary care physicians (PCPs) reducing their clinical work hours has raised concerns about meeting the future demand for services and fulfilling the continuity and access mandates for patient-centered care. However, the patient's experience of care with part-time physicians is relatively unknown, and may be mediated by continuity and access to care outcomes.ObjectiveWe aimed to examine the relationships between a physicians' clinical full-time equivalent (FTE), continuity of care, access to care, and patient satisfaction with the physician.DesignWe used a multi-level structural equation estimation, with continuity and access modeled as mediators, for a cross-section in 2010.ParticipantsThe study included family medicine (n = 104) and internal medicine (n = 101) physicians in a multi-specialty group practice, along with their patient satisfaction survey responses (n = 12,688).Main measuresPhysician level FTE, continuity of care received by patients, continuity of care provided by physician, and a Press Ganey patient satisfaction with the physician score, on a 0-100 % scale, were measured. Access to care was measured as days to the third next-available appointment.Key resultsPhysician FTE was directly associated with better continuity of care received (0.172% per FTE, p < 0.001), better continuity of care provided (0.108% per FTE, p < 0.001), and better access to care (-0.033 days per FTE, p < 0.01), but worse patient satisfaction scores (-0.080% per FTE, p = 0.03). The continuity of care provided was a significant mediator (0.016% per FTE, p < 0.01) of the relationship between FTE and patient satisfaction; but overall, reduced clinical work hours were associated with better patient satisfaction (-0.053 % per FTE, p = 0.03).ConclusionsThese results suggest that PCPs who choose to work fewer clinical hours may have worse continuity and access, but they may provide a better patient experience. Physician workforce planning should consider these care attributes when considering the role of part-time PCPs in practice redesign efforts and initiatives to meet the demand for primary care services.
| S-EPMC4351271 | biostudies-literature
Project description:(1) Background: Internal medicine (IM) resident physicians need to be trained to care for older adults and transition them safely across care settings. Objective: The study purpose was to evaluate the efficacy of a curriculum in geriatrics assessment and communication skills for transitions of care (TOCs) to IM resident physicians. (2) Methods: IM residents rotated for 4 weeks on the geriatrics consult service at a large public teaching hospital, where they received didactic lectures and clinical experience in consultation and transitional care. The curriculum was designed to meet consensus guidelines for minimum geriatrics competencies expected of IM residents. Previously validated and published assessment tools were used for geriatrics knowledge and attitudes. Locally developed tools were used to directly observe and rate communication skills, and self-assess geriatrics assessment and health literacy skills. The curriculum was evaluated using a quasi-experimental, nonrandomized, single-group pre- and post-test observational design. Data on 31 subjects were collected over 18 months and analyzed using mixed-effects models. (3) Results: Average knowledge scores improved from 65% to 74% (Δ9%, 95% CI 4-13%, p < 0.001). Communication skills improved by an average of 1.15 points (95% CI 0.66-1.64, p < 0.001) on a 9-point scale. Attitudes did not change significantly. Self-rated confidence in geriatrics assessment and health literacy skills improved modestly. (4) Conclusions: The curriculum is effective in teaching basic geriatrics knowledge and communication skills, and increasing self-confidence in geriatrics assessment skills. In settings where an inpatient geriatrics consult service is feasible, the curriculum may be a model for combining geriatrics and TOC training.
| S-EPMC7720122 | biostudies-literature
Project description:BackgroundGeriatrics training is essential for future primary care providers. The Extension for Community Healthcare Outcomes (ECHO) model improves access to specialty care via case-based videoconferencing, but Project ECHO has not previously been designed to target residents.ObjectiveWe designed Project ECHO-Geriatrics to deliver geriatrics education to primary care trainees using the ECHO model and evaluated self-rated geriatrics competency of trainees from the University of Washington Family Medicine Residency Network programs who participated between January 2016 and March 2017.MethodsWe assessed outcomes of Project ECHO-Geriatrics through anonymous surveys. Participants rated didactics, case discussions, and geriatrics-specific knowledge before and after sessions on a 5-point scale (1, low, to 5, high). Participants were asked whether they planned to do anything differently in their practice and, if yes, to describe this change.ResultsFifteen sessions were held with 204 unique participants from 12 sites, with an average of 28 (range, 13-41) participants per session. From the 9 of 29 (31%) Family Medicine Residency Network programs that enrolled, 63% percent (116 of 184) of eligible residents attended. Sessions were highly rated (89% of responses were 4 or 5). Self-reported geriatrics-specific knowledge increased significantly (before 3.3 [SD = 0.89] versus after 4.0 [SD = 0.60], P < .001). Sixty-five percent (118 of 181) of participants reported plans to change their practice.ConclusionsProject ECHO-Geriatrics is an innovative, feasible way to train the future primary care workforce in geriatrics and grow the capacity to provide high-quality care to older adults.
| S-EPMC6008038 | biostudies-literature
Project description:BackgroundThe postpartum period is redefined as 12 weeks following childbirth. Primary care physicians (PCP) often manage postpartum women in the community after uneventful childbirths. Postpartum care significantly impacts on the maternal and neonatal physical and mental health. However, evidence has revealed unmet needs in postpartum maternal care.AimThe study aimed to explore the experiences of PCPs in managing postpartum mothers.MethodsFour focus group discussions and eleven in-depth interviews with twenty-nine PCPs were conducted in this qualitative research study in urban Singapore. PCPs of both gender and variable postgraduate training background were purposively enrolled. Audited transcripts were independently coded by two investigators. Thematic content analysis was performed using the codes to identify issues in the "clinician", "mother", "postpartum care" and "healthcare system & policy" domains stipulated in "The Generalists' Wheel of Knowledge, Understanding and Inquiry" framework.FindingsPCPs' personal attributes such as gender and knowledge influenced their postpartum care delivery. Prior training, child caring experience and access to resource materials contributed to their information mastery of postpartum care. Their professional relationship with local multi-ethic and multi-lingual Asian mothers was impacted by their mutual communication, language compatibility and understanding of local confinement practices. Consultation time constraint, awareness of community postnatal services and inadequate handover of care from the specialists hindered PCPs in the healthcare system.DiscussionPersonal, maternal and healthcare system barriers currently prevent PCPs from delivering optimal postpartum care.ConclusionInterventions to overcome the barriers to improve postpartum care will likely be multi-faceted across domains discussed.
| S-EPMC8244666 | biostudies-literature