What do Australian dermatologists expect to be paid for store-and-forward teledermoscopy? A preliminary investigation

Introduction: Determining appropriate remuneration for teledermoscopy service is important because inadequate remuneration can be a barrier to practitioner uptake and participation. This study explores dermatologist remuneration expectations for a single lesion store-and-forward teledermoscopy consultation. Methods: Fourteen dermatologists participated in telephone interviews during May–June 2017. Questions regarding remuneration focused on a clinical scenario involving teledermoscopy of a single lesion suspected to be skin cancer. The initial scenario was an existing patient, with a provisional diagnosis of benign neoplasm from the images, to be followed-up with routine skin checks, taking three minutes to review. Participants indicated their remuneration expectation by selecting from an ascending array of pre-determined remuneration ranges. The question was repeated a further four times with one aspect of the scenario changed each time; consultation length, source (patient or general practitioner), required follow-up, and a new rather than existing patient. Participants were also asked how appropriate they thought teledermoscopy was for the scenario, and whether they would choose to undertake the consultation presented. Results: Nine dermatologists selected the AU$61–90 or AU$91–120 remuneration ranges for the initial scenario. When given the opportunity to comment on teledermoscopy service provision in Australia, respondents reflected that it was a valuable, advanced dermatology service, but they would prefer face-to-face consultation with patients where possible to allow for a full body examination. Discussion: Dermatologists expect to be remunerated in the range of AU$61–120 for a single lesion store-and-forward teledermoscopy consultation when face-to-face examination is not possible

Health literacy, dementia knowledge and perceived utility of digital health modalities among future health professionals

Objectives: Studies of dementia knowledge (including dementia risk reduction) in health-care trainees highlight varying levels of understanding across countries and disciplines. This draws attention to the need for a well-trained health workforce with the knowledge to champion and implement such strategies. This study (a) assessed dementia knowledge and health literacy among a sample of Australian health-care students, (b) identified modality preferences of digital health interventions addressing dementia prevention and (c) examined potential relationships among health literacy, dementia knowledge, dementia prevention knowledge and a student's preferences for different digital health modalities. Methods: A cross-sectional survey assessed dementia knowledge and health literacy in 727 health students across 16 Australian universities representing both metropolitan and regional cohorts. The All Aspects of Health Literacy Scale and the Dementia Knowledge Assessment Scale were administered. Questions about the perceived effectiveness of strategies and preferred digital health modalities for dementia prevention/risk reduction were asked. Results: The students had relatively high health literacy scores. However, dementia knowledge and evidence-based dementia prevention knowledge were average. Only 7% claimed knowledge of available dementia-related digital health interventions. Associations among health literacy, dementia knowledge and dementia prevention, with recommendations for different digital modalities, are presented. Conclusions: Health-related degrees need to increase dementia knowledge, health literacy and knowledge of effective dementia-related digital health interventions. It is imperative to equip the future health workforce amid an ageing population with increased dementia rates and where evidence-based digital health interventions will increasingly be a source of support

Consumer preference and willingness-to-pay for direct-to-consumer mobile-teledermoscopy services in Australia

Objective: To investigate consumer preference and willingness to pay for mobile teledermoscopy services in Australia. Methods: Consumers who were taking part in a randomised controlled trial comparing mobile teledermoscopy and skin self-examination were asked to complete a survey which incorporated a discrete choice experiment (DCE) and a contingent valuation question. Responses were used to determine their willingness to pay for mobile teledermoscopy services in Australia and their overall service preferences. Results: The 199 consumers who responded were 71% female and had a mean age of 42 years (range, 18–73). The DCE results showed that consumers prefer a trained medical professional to be involved in their skin cancer screening. Consumers were willing to pay AUD 41 to change from a general practitioner reviewing their lesions in-person to having a dermatologist reviewing the teledermoscopy images. Additionally, they were willing to pay for services that had shorter waiting times, that reduced the time away from their usual activities, and that have higher accuracy and lower likelihood of unnecessary excision of a skin lesion. When asked directly about their willingness to pay for a teledermoscopy service using a contingent valuation question, the majority (73%) of consumers selected the lowest two value brackets of AUD 1–20 or AUD 21–40. Conclusion: Consumers are willing to pay out of pocket to access services with attributes such as a dermatologist review, improved accuracy, and fewer excisions

A meta-analysis of pharmacists and pharmacy technicians’ accuracy checking proficiency

Background: Delegation the accuracy checking task to appropriately trained pharmacy technicians is desirable in all pharmacy settings, however it requires rigorous evidence prior to implementation to ensure safety. The delegation of accuracy checking has a twofold benefit, it frees time for pharmacists to undertake clinical activitiesn and creates an advanced scope role for pharmacy technicians. Institutions also experience economic benefits when tasks can be reallocated to a lower-cost workforce. Objective: To perform a meta-analysis of pharmacist and technician accuracy rates when completing the final accuracy check on a prepared item. Methods: A systematic literature search was conducted to identify articles that reported the accuracy rates for the final check on prepared items. PubMed, EMBASE, CINAHL, Scopus, and Web of Science were used to retrieve articles. No limit was placed on publication year or item type. Once identified, data were extracted regarding study characteristics and accuracy rates. A meta-analysis was conducted using a random effects model. Results: Twelve articles were located which reported that 96.23–99.78% of items were accurately checked by pharmacists, and 98.25–99.95% of items were accurately checked by pharmacy technicians. The meta-analysis calculated the pharmacist accuracy rate for 216402 items to be 99.27% (95% CI: 98.77–99.64) and 99.72% (95% CI: 98.60–99.81) for 563296 items for pharmacy technicians. The difference between the two groups was statistically significance at a level of p < 0.0001. Conclusions: Pharmacy technicians demonstrated a higher level of accuracy, and a lower variation in accuracy rates reported between studies. Improving checking accuracy and pharmacist availability for other clinical tasks is desirable for workforce efficiency and patient safety. These empirical accuracy rates of pharmacy technicians performing accuracy checking could be used by legislative and regulatory bodies to supplement necessary policy changes that improve the safety of the dispensing process

Immersive virtual reality in health care: systematic review of technology and disease states

Background: Immersive virtual reality (IVR) presents new possibilities for application in health care. Health care professionals can now immerse their patients in environments to achieve exposure to a specific scene or experience, evoke targeted emotional responses, inspire, or distract from an experience occurring in reality. Objective: This review aimed to identify patient-focused applications for head-mounted IVR for acute treatment of health conditions and determine the technical specifications of the systems used. Methods: A systematic review was conducted by searching medical and engineering peer-reviewed literature databases in 2018. The databases included PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Association for Computing Machinery, Institute of Electrical and Electronics Engineers, Scopus, and Web of Science. Search terms relating to health and IVR were used. To be included, studies had to investigate the effectiveness of IVR for acute treatment of a specific health condition. IVR was defined as a head-mounted platform that provides virtual and auditory immersion for the participant and includes a minimum of 3 degrees of orientation tracking. Once identified, data were extracted from articles and aggregated in a narrative review format. Results: A total of 58 studies were conducted in 19 countries. The studies reported IVR use for 5 main clinical areas: neurological and development (n=10), pain reduction through distraction (n=20), exposure therapy for phobias (n=9), psychological applications (n=14), and others (n=5). Studies were primarily feasibility studies exploring systems and general user acceptance (n=29) and efficacy studies testing clinical effect (n=28). Conclusions: IVR has a promising future in health care, both in research and commercial realms. As many of the studies examined are still exploring the feasibility of IVR for acute treatment of health conditions, evidence for the effectiveness of IVR is still developing