iConnect CKD – virtual medical consulting: A web‐based chronic kidney disease, hypertension and diabetes integrated care program

Katz, Ivor; Pirabhahar, Saiyini; Williamson, Paula; Raghunath, Vishwas; Brennan, Frank; O’Sullivan, Anthony J; Youssef, George; Lane, Cathie; Jacobson, Gary P.; Feldman, Peter; Kelly, John J.

doi:10.1111/nep.13070

Cited by 50 publications

(54 citation statements)

References 16 publications

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“…More than half of the included studies were from 1 of 2 settings: 26 from the Champlain BASE program and 13 from VA settings. 7,[37][38][39][40][41][42][43][44][45][46][47][48] Of the remaining 24 studies, there were 12 from community health centers or large public health care systems, 43,[49][50][51][52][53][54][55][56][57][58][59] 8 from academic medical centers, [60][61][62][63][64][65][66][67] 2 from a nongovernmental humanitarian organization, 68, 69 1 from a not-for-profit integrated health care delivery system, 70 and 1 from a private company providing e-consult services. 71 Most studies were observational in design and lacked a control group.…”

Section: Methodsmentioning

confidence: 99%

“…71 Most studies were observational in design and lacked a control group. One study reported data from a pilot randomized controlled trial; 53 3 studies reported results from cluster randomized controlled trials; 49,56,70 3 studies were pre-post evaluations with a comparison group; 62,66,72 and 1 study employed a retrospective cohort design with a comparison group. 48 Most results were positive.…”

Section: Methodsmentioning

confidence: 99%

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Electronic consultations (E-consults) and their outcomes: a systematic review

Vimalananda

Orlander

Afable

et al. 2019

Journal of the American Medical Informatics Association

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Objective Electronic consultations (e-consults) are clinician-to-clinician communications that may obviate face-to-face specialist visits. E-consult programs have spread within the US and internationally despite limited data on outcomes. We conducted a systematic review of the recent peer-reviewed literature on the effect of e-consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes. Materials and Methods We searched 4 databases for empirical studies published between 1/1/2015 and 2/28/2019 that reported on one or more outcomes of interest. Two investigators reviewed titles and abstracts. One investigator abstracted information from each relevant article, and another confirmed the abstraction. We applied the GRADE criteria for the strength of evidence for each outcome. Results We found only modest empirical evidence for effectiveness of e-consults on important outcomes. Most studies are observational and within a single health care system, and comprehensive assessments are lacking. For those outcomes that have been reported, findings are generally positive, with mixed results for clinician experience. These findings reassure but also raise concern for publication bias. Conclusion Despite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Electronic consultations (E-consults) and their outcomes: a systematic review

Vimalananda

Orlander

Afable

et al. 2019

Journal of the American Medical Informatics Association

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“…exploring issues of usability and acceptability). 45,[99][100][101][102][103][104][105][106][107][108][109][110][111][112][113] Many focus specifically on the clinical use of Skype, 91,[114][115][116][117][118][119][120][121][122][123] either on its own or in combination with other technologies [e.g. WhatsApp (WhatsApp Inc., Mountain View, CA, USA) messaging 124 or FaceTime 125,126 ].…”

Section: Evidence Relating To the Use Of Virtual Consultationsmentioning

confidence: 99%

Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study

Shaw

Wherton

Vijayaraghavan

et al. 2018

Health Serv Deliv Res

148

186

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Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 13/59/26. The contractual start date was in March 2015. The final report began editorial review in July 2017 and was accepted for publication in November 2017. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Depar...

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“…Randomized controlled trials have shown such consultations to be acceptable, safe and effective (and, when measured, to reduce patient-borne costs) in patients deemed clinically eligible in a range of conditions including adult and teenage diabetes [16][17][18], chronic kidney disease [19], chronic obstructive pulmonary disease [20,21], mental health conditions [22,23], chronic pain [24][25][26], support after premature birth [27], support of patients in care homes [28], post-operative follow-up for orthopedics [29][30][31][32], plastic surgery [33] and prostate cancer [34].…”

Section: Introduction Backgroundmentioning

confidence: 99%

Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study (Preprint)

Greenhalgh¹,

Shaw²,

Wherton³

et al. 2018

Preprint

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BACKGROUND There is much interest in virtual consultations using video technology. Randomized controlled trials have shown video consultations to be acceptable, safe, and effective in selected conditions and circumstances. However, this model has rarely been mainstreamed and sustained in real-world settings. OBJECTIVE The study sought to (1) define good practice and inform implementation of video outpatient consultations and (2) generate transferable knowledge about challenges to scaling up and routinizing this service model. METHODS A multilevel, mixed-method study of Skype video consultations (micro level) was embedded in an organizational case study (meso level), taking account of national context and wider influences (macro level). The study followed the introduction of video outpatient consultations in three clinical services (diabetes, diabetes antenatal, and cancer surgery) in a National Health Service trust (covering three hospitals) in London, United Kingdom. Data sources included 36 national-level stakeholders (exploratory and semistructured interviews), longitudinal organizational ethnography (300 hours of observations; 24 staff interviews), 30 videotaped remote consultations, 17 audiotaped face-to-face consultations, and national and local documents. Qualitative data, analyzed using sociotechnical change theories, addressed staff and patient experience and organizational and system drivers. Quantitative data, analyzed via descriptive statistics, included uptake of video consultations by staff and patients and microcategorization of different kinds of talk (using the Roter interaction analysis system). RESULTS When clinical, technical, and practical preconditions were met, video consultations appeared safe and were popular with some patients and staff. Compared with face-to-face consultations for similar conditions, video consultations were very slightly shorter, patients did slightly more talking, and both parties sometimes needed to make explicit things that typically remained implicit in a traditional encounter. Video consultations appeared to work better when the clinician and patient already knew and trusted each other. Some clinicians used Skype adaptively to respond to patient requests for ad hoc encounters in a way that appeared to strengthen supported self-management. The reality of establishing video outpatient services in a busy and financially stretched acute hospital setting proved more complex and time-consuming than originally anticipated. By the end of this study, between 2% and 22% of consultations were being undertaken remotely by participating clinicians. In the remainder, clinicians chose not to participate, or video consultations were considered impractical, technically unachievable, or clinically inadvisable. Technical challenges were typically minor but potentially prohibitive. CONCLUSIONS Video outpatient consultations appear safe, effective, and convenient for patients in situations where participating clinicians judge them clinically appropriate, but such situations are a fraction of the overall clinic workload. As with other technological innovations, some clinicians will adopt readily, whereas others will need incentives and support. There are complex challenges to embedding video consultation services within routine practice in organizations that are hesitant to change, especially in times of austerity.

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iConnect CKD – virtual medical consulting: A web‐based chronic kidney disease, hypertension and diabetes integrated care program

Cited by 50 publications

References 16 publications

Electronic consultations (E-consults) and their outcomes: a systematic review

Electronic consultations (E-consults) and their outcomes: a systematic review

Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study

Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study (Preprint)

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