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1. Prevention of delayed referrals through the Champlain BASE eConsult service.

Author

Liddy C, Drosinis P, Fogel A, and Keely E

Subjects
Adolescent, Adult, Aged, Child, Child, Preschool, Cross-Sectional Studies, Female, Health Services Accessibility organization & administration, Humans, Infant, Infant, Newborn, Interprofessional Relations, Male, Middle Aged, Ontario, Referral and Consultation statistics & numerical data, Surveys and Questionnaires, Young Adult, Health Services Accessibility standards, Outcome and Process Assessment, Health Care, Practice Patterns, Physicians' organization & administration, Primary Health Care organization & administration, Referral and Consultation organization & administration
Abstract

Objective: To identify the proportion and evaluate the content of eConsults (electronic consultations) in which the Champlain BASE (Building Access to Specialists through eConsultation) eConsult process prompted a referral to a specialist that was not originally contemplated by the primary care provider (PCP)., Design: Cross-sectional study of all eConsults submitted between April 15, 2011, and January 31, 2015., Setting: Champlain Local Health Integration Network, a large health region in eastern Ontario., Participants: Primary care providers registered to use the Champlain BASE eConsult service., Main Outcome Measures: Answers from a close-out survey-completed by PCPs at the conclusion of each eConsult-stating that specialist referral was not originally contemplated but that the eConsult process had prompted referral. The logs containing the communication exchanged between the PCPs and the specialists were reviewed, and each prompted referral case was categorized by the type of question asked, if pharmaceutical advice was given, if the referral was redirected to a different specialty group, and if the referral was urgent., Results: A total of 188 (3.4%) of 5601 eConsults completed during the study period were cases in which PCPs stated that they had originally not contemplated referring the patient to a specialist but that the Champlain BASE eConsult process had prompted referral. Prompted referrals were most often directed to cardiologists (10.6%), dermatologists (10.6%), infectious disease specialists (9.0%), hematologists (9.0%), and urologists (8.5%). The most common questions were about diagnosis (34.0%), drug treatment (18.0%), and management (15.0%). Pharmaceutical advice was given in 28.0% of prompted referral cases, and in 26.0% of cases, the face-to-face referral was redirected to another specialty group. In 5.0% of cases, the specialist stated the referral was urgent. The median specialist response time was 0.96 days (interquartile range 0.17 to 3.80 days)., Conclusion: By providing PCPs with increased access to specialists, the Champlain BASE eConsult service serves an important role in identifying and preventing the potential detrimental consequences of delayed medical referrals across specialty groups., (Copyright© the College of Family Physicians of Canada.)

Published
2017

2. Interventions and decision-making at the end of life: the effect of establishing the terminal illness situation

Author

Rafael Montoya-Juárez, María Paz García-Caro, E. Hernández-López, César Hueso-Montoro, F. Ojeda-Virto, C. Campos-Calderón, [Campos-Calderón,C] Foundation of Progress and Health, Andalusian Health Service, Granada, Spain. [Montoya-Juárez,R, Hueso-Montoro,C, García-Caro,MP] Nursing Department, University of Granada, Granada, Spain. [Hernández-López,E] General Hospital of the Virgen de las Nieves of Granada, Andalusian Health Service, Granada, Spain. [Ojeda-Virto,F] Hospital Santa Ana, Andalusian Health Service, Motril, Spain., and This work is part of an investigative project financed by the Department of Health of the Board of Andalucía in its 2010 call for papers, titled ‘Variability of Clinical Practice and Conditional Factors in the Implementation of the Processes of Attention at End of Life’.Ref: PI-0670-2010.

Subjects
Palliative care, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Case-Control Studies::Retrospective Studies [Medical Subject Headings], medicine.medical_treatment, España, Psychological intervention, Chemicals and Drugs::Inorganic Chemicals::Elements::Chalcogens::Oxygen [Medical Subject Headings], Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 0302 clinical medicine, Oxygen therapy, Medicine, Analgésicos opioides, Oxígeno, 030212 general & internal medicine, Patient Comfort, Practice Patterns, Physicians', Resuscitation Orders, Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospitals [Medical Subject Headings], Geographicals::Geographic Locations::Europe::Spain [Medical Subject Headings], Medicine(all), Terminal Care, Palliative Care, Do not resuscitate, Symptom management, General Medicine, Prognosis, Hospitals, Humanos, End-of-life care, Teaching/learning strategies, 030220 oncology & carcinogenesis, Peripheral venous catheter, Hospitales, Research Article, medicine.medical_specialty, Clinical Decision-Making, education, M-learning, Prescripciones, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Peripheral Nervous System Agents::Sensory System Agents::Analgesics::Analgesics, Opioid [Medical Subject Headings], Advance Care Planning, Estudios retrospectivos, 03 medical and health sciences, Humans, Terminally Ill, Medical prescription, Órdenes de resucitación, Intensive care medicine, Retrospective Studies, Delivery of care, Hospital care, business.industry, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Emergency Treatment::Resuscitation::Resuscitation Orders [Medical Subject Headings], Andalucía, Retrospective cohort study, Spain, business, Decision making, Physical therapy, Health Care::Health Care Facilities, Manpower, and Services::Health Services::Pharmaceutical Services::Prescriptions [Medical Subject Headings]
Abstract

Background: Mobile learning (m-learning) has becoming very popular in education due to the rapidly advancing technology in our society. The potentials of the mobile applications should be used to enhance the education process. Few mobile applications have been designed to complement the study of physical therapy skills for physiotherapy students. The aim of this study was to investigate whether a mobile application, as a supplement to traditional learning, is useful for physiotherapy students in the acquisition of palpation and ultrasound skills in the shoulder area. Methods: Forty-nine students participated in this single-blinded, randomized controlled study. They were randomly distributed into two groups: experimental, with free access to the mobile application; and control, with access to traditional learning materials on the topic. Objective structured clinical evaluation (OSCE) and multiple-choice questionnaire (MCQ) were used to assess the educational intervention. Then, we also assessed the time taken to get a reliable ultrasound image and to localize a specific shoulder structure by palpation. Results: There was no significant intergroup difference in the acquisition of theoretical knowledge (p = .089). Scores were significantly higher in the experimental group than in the control group for the majority items in the ultrasound assessment; positioning of patient (p < .001), positioning of ultrasound probe (p = 0.007), handling of ultrasound probe (p = .013) and global OSCE (p < .001) and skills in palpation of the shoulder; position of patient (p = .009), direction of palpation contact (p = .021) and global OSCE (p = .034). There were no significant differences in the time required to perform the examination between groups in ultrasound (p = .944) and palpation (p = .393). The results from the post-program survey assessing the global satisfaction with the mobile application were high (8.200 ± .767), on an 11 numeric point rating scale. Conclusion: These results suggest the effectiveness of an m-learning program as a complement to traditional education for developing skills in ultrasound and palpation of the shoulder region in undergraduate physiotherapy students., The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by a grant from the Educational Innovation Unit of the University of Granada, Spain (PID 13–86).

Published
2016