27 research outputs found
Teleconsultation service to improve healthcare in rural areas: acceptance, organizational impact and appropriateness
Background: Nowadays, new organisational strategies should be indentified to improve primary
care and its link with secondary care in terms of efficacy and timeliness of interventions thus
preventing unnecessary hospital accesses and costs saving for the health system. The purpose of
this study is to assess the effects of the use of teleconsultation by general practitioners in rural
areas.
Methods: General practitioners were provided with a teleconsultation service from 2006 to 2008
to obtain a second opinion for cardiac, dermatological and diabetic problems. Access, acceptance,
organisational impact, effectiveness and economics data were collected. Clinical and access data
were systematically entered in a database while acceptance and organisational data were evaluated
through ad hoc questionnaires.
Results: There were 957 teleconsultation contacts which resulted in access to health care services
for 812 symptomatic patients living in 30 rural communities. Through the teleconsultation service,
48 general practitioners improved the appropriateness of primary care and the integration with
secondary care. In fact, the level of concordance between intentions and consultations for cardiac
problems was equal to 9%, in 86% of the cases the service entailed a saving of resources and in 5%
of the cases, it improved the timeliness. 95% of the GPs considered the overall quality positively.
For a future routine use of this service, trust in specialists, duration and workload of
teleconsultations and reimbursement should be taken into account.
Conclusions: Managerial and policy implications emerged mainly related to the support to GPs in
the provision of high quality primary care and decision-making processes in promoting similar
services
Psychological morbidity and health related quality of life after injury: multicentre cohort study
Purpose: To demonstrate the impact of psychological morbidity 1 month post-injury on subsequent post-injury quality of life (HRQoL) in a general injury population in the UK to inform development of trauma care and rehabilitation services.
Methods: Multicentre cohort study of 16–70-year-olds admitted to 4 UK hospitals following injury. Psychological morbidity and HRQoL (EQ-5D-3L) were measured at recruitment and 1, 2, 4 and 12 months post-injury. A reduction in EQ-5D compared to retrospectively assessed pre-injury levels of at least 0.074 was taken as the minimal important difference (MID). Multilevel logistic regression explored relationships between psychological morbidity 1 month post-injury and MID in HRQoL over the 12 months after injury.
Results: A total of 668 adults participated. Follow-up rates were 77% (1 month) and 63% (12 months). Substantial reductions in HRQoL were seen; 93% eported a MID at 1 month and 58% at 12 months. Problems with pain, mobility and usual activities were commonly reported at each time point. Depression and anxiety scores month post-injury were independently associated with subsequent MID in HRQoL. The relationship between depression and HRQoL was partly explained by anxiety and to a lesser extent by pain and social functioning. The relationship between anxiety and HRQoL was not explained by factors measured in our study. Conclusions: Hospitalised injuries result in substantial reductions in HRQoL up to 12 months later. Depression and anxiety early in the recovery period are independently associated with lower HRQoL. Identifying and managing these problems, ensuring adequate pain control and facilitating social functioning are key elements in improving HRQoL post-injury
Exercise programme with telephone follow-up for people with hand osteoarthritis – protocol for a randomised controlled trial
Biofeedback for treatment of awake and sleep bruxism in adults: systematic review protocol
Copula Theory as a Generalized Framework for Flow‐Duration Curve Based Streamflow Estimates in Ungaged and Partially Gaged Catchments
Guidelines for the diagnosis and management of syncope (version 2009): the Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)
Guidelines for the diagnosis and management of syncope (version 2009): the Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiolog