A systematic review of the methodologies used to evaluate telemedicine service initiatives in hospital facilities

Background: The adoption of telemedicine into mainstream health services has been slower than expected. Many telemedicine projects tend not to progress beyond the trial phase; there are a large number of pilot or project publications and fewer 'service' publications. This issue has been noted since 1999 and continues to be acknowledged in the literature. While overall telemedicine uptake has been slow, some services have been successful. The reporting and evaluation of these successful services may help to improve future uptake and sustainability. The aim of this literature review was to identify peer reviewed publications of deployed telemedicine services in hospital facilities; and to report, and appraise, the methodology used to evaluate these services

The North Dakota Experience: Achieving High-Performance Health Care Through Rural Innovation and Cooperation

Explores how North Dakota has met the healthcare challenges of rural communities with support for primary care and the idea of a medical home, organization of care through coordination and cooperation networks, and the innovative use of technology

Practice guidelines for videoconference-based telepsychiatry in South Africa

Telepsychiatry, the practice of psychiatry over distance using information and communication technologies is, after teleradiology, the most practiced form of telemedicine in the world. As with any new technology, clinical service, or intervention in medicine, it is prudent to have guidelines for the safe and efficacious use of the technology in clinical practice. Guidelines facilitate best practice and provide both clinicians and patients with a set of standards and procedures that serve to protect their interests. Protection is particularly important when dealing with vulnerable groups.Web of Scienc

N.C. Medicaid Reform: A Bipartisan Path Forward

The North Carolina Medicaid program currently constitutes 32% of the state budget and provides insurance coverage to 18% of the state’s population. At the same time, 13% of North Carolinians remain uninsured, and even among the insured, significant health disparities persist across income, geography, education, and race. The Duke University Bass Connections Medicaid Reform project gathered to consider how North Carolina could use its limited Medicaid dollars more effectively to reduce the incidence of poor health, improve access to healthcare, and reduce budgetary pressures on the state’s taxpayers. This report is submitted to North Carolina’s policymakers and citizens. It assesses the current Medicaid landscape in North Carolina, and it offers recommendations to North Carolina policymakers concerning: (1) the construction of Medicaid Managed Care markets, (2) the potential and dangers of instituting consumer-driven financial incentives in Medicaid benefits, (3) special hotspotting strategies to address the needs and escalating costs of Medicaid\u27s high-utilizers and dual-eligibles, (4) the emerging benefits of pursuing telemedicine and associated reforms to reimbursement, regulation, and Graduate Medical Education programs that could fuel telemedicine solutions to improve access and delivery. The NC Medicaid Reform Advisory Team includes: Deanna Befus, Duke School of Nursing, PhD ‘17Madhulika Vulimiri, Duke Sanford School of Public Policy, MPP ‘18Patrick O’Shea, UNC School of Medicine/Fuqua School of Business, MD/MBA \u2717Shanna Rifkin, Duke Law School, JD ‘17Trey Sinyard, Duke School of Medicine/Fuqua School of Business, MD/MBA \u2717Brandon Yan, Duke Public Policy, BA \u2718Brooke Bekoff, UNC Political Science, BA \u2719Graeme Peterson, Duke Public Policy, BA ‘17Haley Hedrick, Duke Psychology, BS ‘19Jackie Lin, Duke Biology, BS \u2718Kushal Kadakia, Duke Biology and Public Policy, BS ‘19Leah Yao, Duke Psychology, BS ‘19Shivani Shah, Duke Biology and Public Policy, BS ‘18Sonia Hernandez, Duke Economics, BS \u2719Riley Herrmann, Duke Public Policy, BA \u271

Telehealth in primary health care settings within Australia and internationally

Access to appropriate health care services is often limited for people living in rural or remote areas, or for those with restricted mobility. One approach to minimising the inequality in access for those located at a distance from health care services is through telehealth service delivery. This review examined the evidence on telehealth models in Australia and elsewhere, with a specific focus on synchronous, real-time video consultations, where patients and health care providers were present simultaneously

Moving Care to the Community: An International Perspective

Medical treatments that were once provided in hospital are being increasingly administered in the community. Within health systems, there is a renewed focus on delivering general health care in the community, freeing hospitals to provide more complex, specialised and emergency care. As the drive to shift specialised and non-specialised care out of hospital gathers momentum, there is a greater demand for a skilled and competent community nursing workforce to facilitate this shift at a local level. Nurses are essential in the delivery of continuous care as they often serve as an interface between acute and community care, focusing on prevention, self- management and providing support to transition patients smoothly across the health and social care services.Moving care to the community has been a UK-wide health and social care policy priority for more than a decade. However, progress has been slow and in some cases fragmented. In order to address the issue, it is important to first review where this shift has been implemented and which lessons can be learned from international experiences. The RCN is committed to working closely with its equivalent nursing organisations overseas to learn from international best practices and incorporate some of this learning to shape health and social care policy in the UK, and more specifically promote good nursing practice. This report will focus on system-wide or sector specific reforms in Australia, Canada, Sweden, Norway and Denmark as these countries have at one point or another addressed the need todeliver care outside of hospitals, either in patients' homes, GP clinics, community-basedcentres or care home settings

The involvement of nurses and midwives in screening and brief interventions for hazardous and harmful use of alcohol and other psychoactive substances

This report provides details of a review of the literature on the involvement of nurses and midwives in screening and brief interventions for hazardous and harmful use of alcohol and other psychoactive substances

The characteristics of dermatology inpatients seen at the quaternary Inkosi Albert Luthuli Central Hospital in Durban, South Africa, over a 5-year period – 2015 - 2020

Background. In recent years, dermatology has been offered as an outpatient service, with decreasing inpatient dermatology admissions. However, dermatology consultation services have remained active, offering care to patients admitted for non-cutaneous indications by other specialties.Objectives. To describe the clinical spectrum and characteristics of inpatient dermatology diseases managed at a quaternary South African (SA) hospital. Methods. We retrospectively reviewed and analysed electronic records of all dermatology inpatients managed by dermatologists from 2015 to 2020 at Inkosi Albert Luthuli Central Hospital (IALCH) in Durban, South Africa. Demographic and clinical data on the International Classification of Diseases (ICD) 10 dermatology diagnosis and admitting specialty were collected and analysed. Results. A total of 4 867 patients were managed by the IALCH dermatology service during the study period. Females accounted for 2 527 (51.9%), while black African, coloured, Indian/Asian, white and unclassified patients constituted 3 146 (64.6%), 106 (2.2%), 1 129 (23.2%), 431 (8.9%) and 55 (1.1%), respectively. The median (interquartile range) age of the study population was 42.0 (28.0 - 58.0) years. Of 867 patients, 183 (3.8%) were dermatology inpatient admissions, whereas the remainder, 4 684 (96.2%), were seen as consults from other specialties. Most (1 010 (20.7%)) of the dermatology consults were received from plastic and reconstructive surgeons, while bacterial infections, decubitus ulcers and lower limb ulcers were the three most common referred diagnoses overall. Conclusion. A broad range of diagnoses is managed through the dermatology inpatient service, particularly as consultations. These services remain essential in the holistic management of patients

Outpatient services and primary care: scoping review, substudies and international comparisons

This study updates a previous scoping review published by the National Institute for Health Research (NIHR) in 2006 (Roland M, McDonald R, Sibbald B.Outpatient Services and Primary Care: A Scoping Review of Research Into Strategies For Improving Outpatient Effectiveness and Efficiency. Southampton: NIHR Trials and Studies Coordinating Centre; 2006) and focuses on strategies to improve the effectiveness and efficiency of outpatient services.Findings from the scoping reviewEvidence from the scoping review suggests that, with appropriate safeguards, training and support, substantial parts of care given in outpatient clinics can be transferred to primary care. This includes additional evidence since our 2006 review which supports general practitioner (GP) follow-up as an alternative to outpatient follow-up appointments, primary medical care of chronic conditions and minor surgery in primary care. Relocating specialists to primary care settings is popular with patients, and increased joint working between specialists and GPs, as suggested in the NHS Five Year Forward View, can be of substantial educational value. However, for these approaches there is very limited information on cost-effectiveness; we do not know whether they increase or reduce overall demand and whether the new models cost more or less than traditional approaches. One promising development is the increasing use of e-mail between GPs and specialists, with some studies suggesting that better communication (including the transmission of results and images) could substantially reduce the need for some referrals.Findings from the substudiesBecause of the limited literature on some areas, we conducted a number of substudies in England. The first was of referral management centres, which have been established to triage and, potentially, divert referrals away from hospitals. These centres encounter practical and administrative challenges and have difficulty getting buy-in from local clinicians. Their effectiveness is uncertain, as is the effect of schemes which provide systematic review of referrals within GP practices. However, the latter appear to have more positive educational value, as shown in our second substudy. We also studied consultants who held contracts with community-based organisations rather than with hospital trusts. Although these posts offer opportunities in terms of breaking down artificial and unhelpful primary–secondary care barriers, they may be constrained by their idiosyncratic nature, a lack of clarity around roles, challenges to professional identity and a lack of opportunities for professional development. Finally, we examined the work done by other countries to reform activity at the primary–secondary care interface. Common approaches included the use of financial mechanisms and incentives, the transfer of work to primary care, the relocation of specialists and the use of guidelines and protocols. With the possible exception of financial incentives, the lack of robust evidence on the effect of these approaches and the contexts in which they were introduced limits the lessons that can be drawn for the English NHS.ConclusionsFor many conditions, high-quality care in the community can be provided and is popular with patients. There is little conclusive evidence on the cost-effectiveness of the provision of more care in the community. In developing new models of care for the NHS, it should not be assumed that community-based care will be cheaper than conventional hospital-based care. Possible reasons care in the community may be more expensive include supply-induced demand and addressing unmet need through new forms of care and through loss of efficiency gained from concentrating services in hospitals. Evidence from this study suggests that further shifts of care into the community can be justified only if (a) high value is given to patient convenience in relation to NHS costs or (b) community care can be provided in a way that reduces overall health-care costs. However, reconfigurations of services are often introduced without adequate evaluation and it is important that new NHS initiatives should collect data to show whether or not they have added value, and improved quality and patient and staff experience. Funding, The NIHR Health Services and Delivery Research programme.The NIHR Health Services and Delivery Research programme