Does virtual consultation between primary and specialised care improve healthcare quality? A scoping review of healthcare quality domains assessment

Virtual consultation has been proposed as a promising tool to improve the coordination and quality of healthcare between primary and specialised care. However, despite its potential facilitators, the evidence on the usefulness of virtual consultation for improving healthcare quality domains is fragmented and unclear. This scoping review aims to assess the impact of virtual consultation on different healthcare quality domains.Material and methodsWe conducted a scoping review with a rigorous search strategy on PubMed, EMBASE and Cochrane Library databases. The inclusion criteria were original articles, reviews, meta-analyses or letters to the editor, published between 1 January 2017 and 24 June 2022, and available in English, Spanish or French. For each of the articles selected, we identified the addressed healthcare quality domains, their facilitators and barriers, areas of improvement and data gaps. We have adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review reporting standards.Results1284 manuscripts were retrieved. Finally, 235 papers were included in this review, most of which were original, descriptive studies. The most evaluated quality domain was effectiveness (223 articles). Safety and patient-centred care were the least evaluated. Simultaneous assessment of more than one domain was observed in 117 papers, being effectiveness and timeliness the most frequent combination. Our analysis revealed that virtual consultation is in development and underused. This tool has the potential to improve access to specialised care and enhance coordination between professionals.ConclusionsVirtual consultation has the potential to provide effective, efficient, equitable and timely attention. However, its contribution to safety and patient-centered care needs further evaluation. Our review emphasises the need for more rigorous research and standardised quality assessment criteria to obtain robust evidence on the usefulness of virtual consultation for improving healthcare quality domains

Innovation in diabetic care : from patient-centered care to public policies to reduce the impact of diabetes

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022Introdução A diabetes, nomeadamente a diabetes tipo 2, é uma doença crónica, que necessita de cuidados de saúde em continuidade, de longa duração e muitas vezes multidisciplinares. A diabetes consome vastos recursos de saúde, financeiros e de assistência social, exigindo, em todos os níveis de cuidados de saúde, e às famílias um grande esforço. Sendo uma doença que exige capacitação do paciente, literacia, adesão ao tratamento e promoção de comportamentos saudáveis, é também o paradigma de uma doença onde a relação com os profissionais de saúde e o cuidado centrado no paciente são fatores fundamentais para seu controle. A saúde tem sido palco de muitas inovações, tanto tecnológicas, como também de gestão, prática clínica, farmacológicas, dispositivos vários e uso da informação. Os cuidados na diabetes e outras doenças crónicas estão na linha de frente do desenvolvimento, testagem e implementação destas inovações, o que iremos ilustrar ao longo deste trabalho. Objetivo Identificar e analisar como a inovação nos cuidados prestados aos doentes com diabetes tem vindo a alterar a capacidade de prestar cuidados centrados no doente, e demonstrar abertura a novas iniciativas e ao desenvolvimento de políticas públicas de gestão em saúde, financiamento, tecnologia/informação e sociais com vista providenciar melhores cuidados e reduzir os impactos desta doença. Neste contexto, é nosso objetivo descrever, conceptualizar e sistematizar como a inovação tem evoluído e influenciado os cuidados ao paciente diabético e identificar os respetivos impactos. Métodos Procedeu-se à revisão da literatura usando as bases de dados PubMed, Scopus e Word of Science, pesquisando a associação entre diabetes tipo 2 e inovação. Foram encontrados 254 artigos. A partir da seleção desses trabalhos foi efetuada uma busca manual de artigos a descrever, ilustrar e avaliar as inovações identificadas, num total de 69 artigos.Resultados No âmbito dos cuidados aos doentes com diabetes, foram identificados dezasseis processos de inovação com inegável relevância em quatro áreas – três casos de inovação em gestão, quatro financeiras, seis tecnológicas e três de ação social. Conclusão Constata-se que as diversas categorias de inovação estão interligadas e são complementares, possibilitando oferecer melhores cuidados centrados no paciente, ao mesmo tempo que vislumbram a necessidade de proceder ao “redesenho” dos sistemas e serviços de saúde. Admite-se que, no futuro, a sua adequada integração acarretaria melhores cuidados e permitiria reduzir o impacto da diabetes, podendo vir a ser o modelo a utilizar no manejo de outras doenças crónicas.Background Diabetes, namely type-2 diabetes, is a chronic disease that requires continuous, long-term, and often multidisciplinary medical care. Diabetes consumes a vast amount of health, financial and social care resources, demanding great efforts at all levels of health care and families. As a disease that requires patient training, literacy, adherence to treatment, and the promotion of healthy behaviors, it is also the paradigm of a disease where health professionals’ relationship and patient-centered care are key factors for its control. Health has been the scene of many innovations, both technological, as well as management, clinical practice, medication, a wide variety of devices, and information uses. Diabetic, and of other chronic diseases, is at the forefront of the development, testing, and implementation of these innovations, which we will illustrate throughout this work. Aim Identify and analyze how innovation in care provided to patients with diabetes has been changing the ability to provide patient-centered care, and open-up new initiatives and development of public policies in health, financing, technological/information and social management with the view to provide better care and reduce the impacts of this disease. In this context, we will describe, conceptualize and systematize how innovation has evolved and influenced diabetic patient care and identify the respective impacts. Methods A literature review was carried out using PubMed, Scopus, and Word of Science databases, investigating the association between type 2 diabetes and innovation. Two hundred and fifty-four articles were found. From the research, a manual search of articles aiming to describe, exemplify, and evaluate the innovations in diabetes care, was carried out, resulting in a total of 69 articles.Results Four main areas were identified within the scope of diabetes patients’ care, in which innovation processes are present with undeniable relevance – management, financial, technological, and social action, which will be analyzed on the course of this work. Conclusion It was possible to observe that the different categories of innovation are interconnected and complementary, making it possible to offer better patient-centered care, while at the same time envisioning the need to “redesign” of health systems and services. It is accepted that, in the future, their appropriate integration would lead to better care and reduce the impact of diabetes, as well as potentially become the model that could be used in the management of other chronic diseases

Evaluating diverse electronic consultation programs with a common framework.

BackgroundElectronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion.MethodsUsing a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems' end-users.ResultsOrganizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies.ConclusionA core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs

Masks, Misinformation, and Making Do: Appalachian Health-Care Workers and the COVID-19 Pandemic

The firsthand pandemic experiences of rural health-care providers—who were already burdened when COVID-19 hit—raise questions about the future of public health and health-care delivery. This volume comprises the COVID-19 pandemic experiences of Appalachian health-care workers, including frontline providers, administrators, and educators. The combined narrative reveals how governmental and corporate policies exacerbated the region’s injustices, stymied response efforts, and increased the death toll. Beginning with an overview of the SARS-CoV-2 virus and its impact on the body, the essays in the book’s first section provide background material and contextualize the subsequent explosion of telemedicine, the pandemic’s impact on medical education, and its relationship to systemic racism and related disparities in mental health treatment. First-person narratives from diverse perspectives recount the pandemic’s layered stresses. These visceral, personal experiences of how Appalachian health-care workers responded to the pandemic amid the nation’s deeply polarized political discourse will shape the historical record of this “unprecedented time” and provide a glimpse into the future of rural medicine. Contributors: Lucas Aidukaitis, Clay Anderson, Tammy Bannister, Alli Delp, Lynn Elliott, Monika Holbein, Laura Hungerford, Nikki King, Brittany Landore, Jeffrey J. LeBoeuf, Sojourner Nightingale, Beth O’Connor, Rakesh Patel, Mildred E. Perreault, Melanie B. Richards, Tara Smith, Kathy Osborne Still, Darla Timbo, Kathy Hsu Wibberlyhttps://ohioopen.library.ohio.edu/oupress/1022/thumbnail.jp

Frameshift mutations at the C-terminus of HIST1H1E result in a specific DNA hypomethylation signature

BACKGROUND: We previously associated HIST1H1E mutations causing Rahman syndrome with a specific genome-wide methylation pattern. RESULTS: Methylome analysis from peripheral blood samples of six affected subjects led us to identify a specific hypomethylated profile. This "episignature" was enriched for genes involved in neuronal system development and function. A computational classifier yielded full sensitivity and specificity in detecting subjects with Rahman syndrome. Applying this model to a cohort of undiagnosed probands allowed us to reach diagnosis in one subject. CONCLUSIONS: We demonstrate an epigenetic signature in subjects with Rahman syndrome that can be used to reach molecular diagnosis