Publications
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Campbell K, Greenfield G, Li E, et al., 2023, The impact of virtual consultations on the quality of primary care: a systematic review, Journal of Medical Internet Research, Vol: 25, Pages: 1-17, ISSN: 1438-8871
Background: The adoption of virtual consultations, catalysed by the COVID-19 pandemic, has transformed the delivery of primary care services. Due to its rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality.Objective: We evaluated the impact of virtual consultations on the quality of primary care. Methods: Six databases were searched. Studies evaluating the impact of virtual consultations, for any disease, were included. Title and abstract screening, and full-text screening were performed by two pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed.Findings: Thirty studies (5,469,333 participants) were included in the review. Our findings suggest that virtual consultations are equally or more effective than F2F care for the management of conditions including mental illness, excessive smoking, and alcohol consumption. Four studies indicated positive impacts on some aspects of patient-centredness, however, a negative impact was noted on patients’ perceived autonomy support (i.e., the degree to which people perceive others in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care. The evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities between other subgroups depending on contextual factors.Conclusions: Our systematic review has demonstrated that virtual consultations may be equally as effective as F2F care and have a potentially positive impact on the efficiency and timeliness of care However, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centredness
Neves AL, Esteva M, Hoffman R, et al., 2023, Primary care practitioners priorities for improving the timeliness of cancer diagnosis in primary care: a European cluster-based analysis, BMC Health Services Research, ISSN: 1472-6963
Chan SCC, Neves AL, Majeed A, 2023, Electronic health records: don't underestimate the importance of implementation and training., BMJ, Vol: 382, Pages: 1915-1915
Li E, Lounsbury O, Clarke J, et al., 2023, Perceptions of chief clinical information officers on the state of electronic health records systems interoperability in NHS England: a qualitative interview study, BMC Medical Informatics and Decision Making, Vol: 23, Pages: 1-15, ISSN: 1472-6947
BackgroundIn the era of electronic health records (EHR), the ability to share clinical data is a key facilitator of healthcare delivery. Since the introduction of EHRs, this aspect has been extensively studied from the perspective of healthcare providers. Less often explored are the day-to-day challenges surrounding the procurement, deployment, maintenance, and use of interoperable EHR systems, from the perspective of healthcare administrators, such as chief clinical information officers (CCIOs).ObjectiveOur study aims to capture the perceptions of CCIOs on the current state of EHR interoperability in the NHS, its impact on patient safety, the perceived facilitators and barriers to improving EHR interoperability, and what the future of EHR development in the NHS may entail.MethodsSemi-structured interviews were conducted between November 2020 – October 2021. Convenience sampling was employed to recruit NHS England CCIOs. Interviews were digitally recorded and transcribed verbatim. A thematic analysis was performed by two independent researchers to identify emerging themes.ResultsFifteen CCIOs participated in the study. Participants reported that limited EHR interoperability contributed to the inability to easily access and transfer data into a unified source, thus resulting in data fragmentation. The resulting lack of clarity on patients' health status negatively impacts patient safety through suboptimal care coordination, duplication of efforts, and more defensive practice. Facilitators to improving interoperability included the recognition of the need by clinicians, patient expectations, and the inherent centralised nature of the NHS. Barriers included systems usability difficulties, and institutional, data management, and financial-related challenges. Looking ahead, participants acknowledged that realising that vision across the NHS would require a renewed focus on mandating data standards, user-centred design, greater patient involvement, and encouraging i
O'Brien N, Li E, Chaibva C, et al., 2023, SWOT analysis of the use of digital health technologies in primary health care in the Sub-Saharan African Region: a qualitative study, Journal of Medical Internet Research, ISSN: 1438-8871
Background:In many health systems globally, digital health technologies (DHT) have become increasingly commonplace as a means of delivering primary care. COVID-19 has further increased the pace of this trend. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how DHT implementation has been realised in the sub-Saharan Africa (SSA) healthcare environment remains to be further explored.Objective:To capture the multidisciplinary experiences of SSA experts and primary care healthcare providers using DHTs to explore the strengths and weaknesses, as well as opportunities and threats regarding the implementation and use of DHTs in SSA primary care settings.Methods:A combination of qualitative approaches was adopted (i.e., online focus groups and semi-structured interviews), using an online platform. Participants were recruited through AfroPHC and researchers contact networks, using convenience sampling, and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews and focus groups, using the Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. Transcripts were compiled verbatim and systematically reviewed by two independent reviewers using thematic analysis to identify emerging themes. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to ensure the study meets the recommended standards of qualitative data reporting.Results:Strengths of DHT use ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust, to greater collaboration, enabling safer decision-making, and hastening progress towards universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack o
O'Brien N, Ayisi-Boateng NK, Lounsbury O, et al., 2023, Digital health in primary health care: Current use and future opportunities in the Sub-Saharan African region, Digital health in primary health care: Current use and future opportunities in the Sub-Saharan African region, Publisher: Imperial College London
Beaney T, Clarke J, Alboksmaty A, et al., 2023, Evaluating the impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in patients with COVID-19 assessed in Emergency Departments in England: a retrospective matched cohort study, Emergency Medicine Journal, Vol: 40, Pages: 460-465, ISSN: 1472-0205
Background:To identify the impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home; CO@h) on health service use and mortality in patients attending Emergency Departments (EDs).Methods:We conducted a retrospective matched cohort study of patients enrolled onto the CO@h pathway from EDs in England. We included all patients with a positive COVID-19 test from 1st October 2020 to 3rd May 2021 who attended ED from three days before to ten days after the date of the test. All patients who were admitted or died on the same or following day to the first ED attendance within the time window were excluded. In the primary analysis, participants enrolled onto CO@h were matched using demographic and clinical criteria to participants who were not enrolled. Five outcome measures were examined within 28 days of first ED attendance: i) death from any cause; ii) any subsequent ED attendance; iii) any emergency hospital admission; iv) critical care admission; and v) length of stay.Results:15,621 participants were included in the primary analysis, of whom 639 were enrolled onto CO@h and 14,982 were controls. Odds of death were 52% lower in those enrolled (95% CI: 7%-75% lower) compared to those not enrolled on CO@h. Odds of any ED attendance or admission were 37% (95% CI: 16-63%) and 59% (95% CI: 16-63%) higher, respectively, in those enrolled. Of those admitted, those enrolled had 53% (95% CI: 7%-76%) lower odds of critical care admission. There was no significant impact on length of stay.Conclusions:These findings indicate that for patients assessed in ED, pulse oximetry remote monitoring may be a clinically effective and safe model for early detection of hypoxia and escalation. However, possible selection biases might limit the generalisability to other populations.
Clarke J, Beaney T, Alboksmaty A, et al., 2023, Factors associated with enrolment into a national COVID-19 pulse oximetry remote monitoring programme in England: a retrospective observational study, The Lancet: Digital Health, Vol: 5, Pages: e194-e205, ISSN: 2589-7500
BACKGROUND: Hypoxaemia is an important predictor of severity in individuals with COVID-19 and can present without symptoms. The COVID Oximetry @home (CO@h) programme was implemented across England in November, 2020, providing pulse oximeters to higher-risk people with COVID-19 to enable early detection of deterioration and the need for escalation of care. We aimed to describe the clinical and demographic characteristics of individuals enrolled onto the programme and to assess whether there were any inequalities in enrolment. METHODS: This retrospective observational study was based on data from a cohort of people resident in England recorded as having a positive COVID-19 test between Oct 1, 2020, and May 3, 2021. The proportion of participants enrolled onto the CO@h programmes in the 7 days before and 28 days after a positive COVID-19 test was calculated for each clinical commissioning group (CCG) in England. Two-level hierarchical multivariable logistic regression with random intercepts for each CCG was run to identify factors predictive of being enrolled onto the CO@h programme. FINDINGS: CO@h programme sites were reported by NHS England as becoming operational between Nov 21 and Dec 31, 2020. 1 227 405 people resident in 72 CCGs had a positive COVID-19 test between the date of programme implementation and May 3, 2021, of whom 19 932 (1·6%) were enrolled onto the CO@h programme. Of those enrolled, 14 441 (72·5%) were aged 50 years or older or were identified as clinically extremely vulnerable (ie, having a high-risk medical condition). Higher odds of enrolment onto the CO@h programme were found in older individuals (adjusted odds ratio 2·21 [95% CI 2·19-2·23], p<0·001, for those aged 50-64 years; 3·48 [3·33-3·63], p<0·001, for those aged 65-79 years; and 2·50 [2·34-2·68], p<0·001, for those aged ≥80 years), in individuals of non-White ethnicity (1·3
Li E, Neves AL, 2023, Virtual primary care use during the COVID-19 pandemic, WHO Health Services Learning Hub (HLH), Publisher: World Health Organization (WHO)
This learning brief draws on findings derived from several publicly available peer-reviewed articles. For further details, please refer to the end of the brief. Prior to the onset of COVID-19, virtual primary care – a broad term describing the use of phone or digital technologies to enable primary care activities – was largely a nascent technology. While slowly increasing in availability over the years, virtual primary care had remained a complementary or alternative means to face-to-face consultations.The COVID-19 pandemic changed all that as it presented health systemsworldwide with a set of unprecedented challenges. Virtual approaches rapidly became the mainstay modality for health care delivery during the early phases of the pandemic, supporting continuity of care, facilitating public health interventions and disease surveillance, and curbing disease transmission in the community. This abrupt and rapid adoption of virtual primary care has had significantimplications on the care received by patients, the health provider’s routineclinical practice, and has pushed health systems towards greater incorporation of virtual primary care as an important means of care delivery, moving on from the pandemic.This briefing aims to summarize the key findings from the experiences of primary care physicians using virtual care tools. Using an online survey, we explored the perspectives of general practitioners working during the COVID-19 pandemic (June-September 2020) across 20 countries, and invited them to share their views on the main barriers and challenges of using virtual care
Teixeira F, Li E, Laranjo L, et al., 2023, Digital maturity and its determinants in General Practice: a cross- sectional study in 20 countries, Frontiers in Public Health, Vol: 10, Pages: 1-10, ISSN: 2296-2565
Background: The extent to which digital technologies are employed to promote the delivery of high-quality healthcare is known as Digital Maturity. Individual and systemic digital maturity are both necessary to ensure a successful, scalable and sustainable digital transformation in healthcare. However, digital maturity in primary care has been scarcely evaluated.Objectives: This study assessed the digital maturity in General Practice (GP) globally and evaluated its association with participants' demographic characteristics, practice characteristics and features of Electronic Health Records (EHRs) use.Methods: GPs across 20 countries completed an online questionnaire between June and September 2020. Demographic data, practice characteristics, and features of EHRs use were collected. Digital maturity was evaluated through a framework based on usage, resources and abilities (divided in this study in its collective and individual components), interoperability, general evaluation methods and impact of digital technologies. Each dimension was rated as 1 or 0. The digital maturity score was calculated as the sum of the six dimensions and ranged between 0 to 6 (maximum digital maturity). Multivariable linear regression was used to model the total score, while multivariable logistic regression was used to model the probability of meeting each dimension of the score.Results: One thousand six hundred GPs (61% female, 68% Europeans) participated. GPs had a median digital maturity of 4 (P25–P75: 3–5). Positive associations with digital maturity were found with: male gender [B = 0.18 (95% CI 0.01; 0.36)], use of EHRs for longer periods [B = 0.45 (95% CI 0.35; 0.54)] and higher frequencies of access to EHRs [B = 0.33 (95% CI 0.17; 0.48)]. Practicing in a rural setting was negatively associated with digital maturity [B = −0.25 (95%CI −0.43; −0.08)]. Usage (90%) was the most acknowledged dimension while interoperability (47%) and use of best practice gen
Fadahunsi KP, Wark PA, Mastellos N, et al., 2022, Assessment of clinical information quality in digital health technologies: an international eDelphi study, Journal of Medical Internet Research, Vol: 24, Pages: 1-10, ISSN: 1438-8871
Background:Digital health technologies (DHTs), such as electronic health records and prescribing systems, are transforming health care delivery around the world. The quality of information in DHTs is key to the quality and safety of care. We developed a novel clinical information quality (CLIQ) framework to assess the quality of clinical information in DHTs.Objective:This study explored clinicians’ perspectives on the relevance, definition, and assessment of information quality dimensions in the CLIQ framework.Methods:We used a systematic and iterative eDelphi approach to engage clinicians who had information governance roles or personal interest in information governance; the clinicians were recruited through purposive and snowball sampling techniques. Data were collected using semistructured online questionnaires until consensus was reached on the information quality dimensions in the CLIQ framework. Responses on the relevance of the dimensions were summarized to inform decisions on retention of the dimensions according to prespecified rules. Thematic analysis of the free-text responses was used to revise definitions and the assessment of dimensions.Results:Thirty-five clinicians from 10 countries participated in the study, which was concluded after the second round. Consensus was reached on all dimensions and categories in the CLIQ framework: informativeness (accuracy, completeness, interpretability, plausibility, provenance, and relevance), availability (accessibility, portability, security, and timeliness), and usability (conformance, consistency, and maintainability). A new dimension, searchability, was introduced in the availability category to account for the ease of finding needed information in the DHTs. Certain dimensions were renamed, and some definitions were rephrased to improve clarity.Conclusions:The CLIQ framework reached a high expert consensus and clarity of language relating to the information quality dimensions. The framework can be used b
Lear R, Freise L, Kybert M, et al., 2022, Perceptions of Quality of Care Among Users of a Web-Based Patient Portal: Cross-sectional Survey Analysis, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 24, ISSN: 1438-8871
Li E, Clarke J, Ashrafian H, et al., 2022, Impact of electronic health record interoperability on safety and quality of care in high-income countries: A systematic review, Journal of Medical Internet Research, Vol: 24, Pages: 1-15, ISSN: 1438-8871
Background: Electronic health records (EHR) and poor systems interoperability are well-known issues in the use of health information technologies worldwide in most high-income countries. Despite the abundance of literature exploring their relationship, its practical implications on patient safety and quality of care remain unclear.Objective: To examine how EHR interoperability affects patient safety, or other dimensions of care quality, in high-income healthcare settings. Methods: A systematic search was conducted using four online medical journal repositories and grey literature sources. Publications included were published in English between 2010-2022, pertaining to EHR use, interoperability, and patient safety or care quality in high-income settings. Screening was completed by three researchers in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Risk of bias assessments was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and the Cochrane Risk of Bias 2 (RoB2) tools. Findings were presented as a narrative synthesis and mapped based on the Institute of Medicine’s framework for healthcare quality.Results: Twelve studies met the inclusion criteria to be included in our review. Findings were categorised into six common outcome measure categories: patient safety events, medication safety, data accuracy and errors, care effectiveness, productivity, and cost-savings. EHR interoperability was found to positively influence medication safety, reduce patient safety events, and lower costs. Improvements to time-savings and clinical workflow are mixed. However, true measures of effect are difficult to determine with certainty due to the heterogeneity in outcome measures used and notable variation in study quality.Conclusion: The benefits of EHR interoperability on the quality and safety of care remain unclear and reflect the extensive heterogeneity in the interventions, designs, and outcome
Espinosa-Gonzalez A, Prociuk D, Fiorentino F, et al., 2022, Remote COVID-19 assessment in primary care (RECAP) risk prediction tool: derivation and real-world validation studies, The Lancet Digital Health, Vol: 4, Pages: e646-e656, ISSN: 2589-7500
BACKGROUND: Accurate assessment of COVID-19 severity in the community is essential for patient care and requires COVID-19-specific risk prediction scores adequately validated in a community setting. Following a qualitative phase to identify signs, symptoms, and risk factors, we aimed to develop and validate two COVID-19-specific risk prediction scores. Remote COVID-19 Assessment in Primary Care-General Practice score (RECAP-GP; without peripheral oxygen saturation [SpO2]) and RECAP-oxygen saturation score (RECAP-O2; with SpO2). METHODS: RECAP was a prospective cohort study that used multivariable logistic regression. Data on signs and symptoms (predictors) of disease were collected from community-based patients with suspected COVID-19 via primary care electronic health records and linked with secondary data on hospital admission (outcome) within 28 days of symptom onset. Data sources for RECAP-GP were Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP-RSC) primary care practices (development set), northwest London primary care practices (validation set), and the NHS COVID-19 Clinical Assessment Service (CCAS; validation set). The data source for RECAP-O2 was the Doctaly Assist platform (development set and validation set in subsequent sample). The two probabilistic risk prediction models were built by backwards elimination using the development sets and validated by application to the validation datasets. Estimated sample size per model, including the development and validation sets was 2880 people. FINDINGS: Data were available from 8311 individuals. Observations, such as SpO2, were mostly missing in the northwest London, RCGP-RSC, and CCAS data; however, SpO2 was available for 1364 (70·0%) of 1948 patients who used Doctaly. In the final predictive models, RECAP-GP (n=1863) included sex (male and female), age (years), degree of breathlessness (three point scale), temperature symptoms (two point scale), and presence of hypert
Li E, Neves AL, 2022, Lessons from remote antenatal care during the COVID-19 pandemic: how can we ensure equitable, safe, and patient-centred care?, BMJ Quality & Safety, ISSN: 2044-5415
Lear R, Freise L, Kybert M, et al., 2022, Patients’ willingness and ability to identify and respond to errors in their personal health records: a mixed methods analysis of cross-sectional survey data, Journal of Medical Internet Research, Vol: 24, ISSN: 1438-8871
Background:Errors in electronic health records are known to contribute to patient safety incidents, yet systems for checking the accuracy of patient records are almost non-existent. Personal health records, enabling patient access to, and interaction, with the clinical record, offer a valuable opportunity for patients to actively participate in error surveillance.Objective:The aim of this study was to evaluate patients’ willingness and ability to identify and respond to errors in their personal health records.Methods:A cross-sectional survey study was conducted using an online questionnaire. Patient sociodemographic data were collected, including age, gender, ethnicity, educational level, health status, geographical location, motivation to self-manage, and digital health literacy (measured by the eHEALS tool). Patients with experience of using the Care Information Exchange (CIE) portal, who specified both age and gender, were included in these analyses. Patients’ responses to four relevant survey items (closed-ended questions, some with space for free-text comments) were examined to understand their willingness and ability to identify and respond to errors in their personal health records. Multinomial logistic regression was used to identify patient characteristics that predict i) ability to understand information in CIE, and ii) willingness to respond to errors in their records. The Framework Method was used to derive themes from patients’ free-text responses.Results:Of 445 patients, 40.7% (n=181) “definitely” understood CIE information and around half (49.4%, n=220) understood CIE information “to some extent”. Patients with high digital health literacy (eHEALS score ≥30) were more confident in their ability to understand their records compared to patients with low digital health literacy (odds ratio (OR) 7.85, 95% confidence interval (CI) 3.04-20.29, P<.001). Information-related barriers (medical terminology; lack of
Lounsbury O, Roberts L, Kurek N, et al., 2022, The role of digital innovation in improving healthcare quality in extreme adversity: an interpretative phenomenological analysis study, Journal of Global Health Reports, Vol: 6, ISSN: 2399-1623
Background: High quality is a necessary feature of healthcare delivery. These healthcare quality challenges are particularly present in areas of extreme adversity, such as in conflict settings or sustained humanitarian crises. Digital health technologies have recently emerged as an innovation to deliver care around the world in a variety of settings. However, there is little insight into how digital health technologies can be used to improve the quality of care where extreme adversity introduces unique challenges. Objective: This study aimed to identify where digital health technologies may be most impactful in improving the quality of care and evaluate opportunities for accelerated and meaningful digital innovation in adverse settings. Methods: A phenomenological approach (Interpretative Phenomenological Approach [IPA]), using semi-structured interviews, was adopted. Six individuals were interviewed in-person based on their expertise in global health, international care delivery, and application of digital health technologies to improve the quality of care in extreme adversity settings. The interviews were informed by a semi-structured topic guide with open-ended questions. The transcripts were compiled verbatim and were systematically examined by 2 reviewers, using the framework analysis method to extract themes and subthemes. Results: The participants identified several areas in which digital health technologies could be most impactful, which include engagement in care, continuity of care, workforce operations, and data collection. Opportunities for accelerated digital innovation include improving terminology, identity, ownership, and interoperability, identifying priority areas for digital innovation, developing tailored solutions, co-ordination and standardisation, and sustainability and resilience.Conclusions: These results suggest that there are conditions that favour or challenge the application of digital health technologies, even in specific areas in which
Lear R, Freise L, Kybert M, et al., 2022, Patients’ perceptions of the impact of a patient portal on quality of care: a cross-sectional survey analysis (Preprint)
<sec> <title>BACKGROUND</title> <p>Online patient portals enable patients access to, and interaction with, their personal electronic health records. Although there is increasing adoption of patient portals in many healthcare systems, little is known about the impact of patient portals on quality of care.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The aims of this study were i) to evaluate patients’ perceptions of the impact of an online patient portal on the six domains of quality of care and ii) to identify which segments of the population perceive improved overall quality of care and greater satisfaction with care with portal use.</p> </sec> <sec> <title>METHODS</title> <p>A cross-sectional web-based survey study was undertaken to understand patients’ experiences with the Care Information Exchange (CIE) portal. Patient sociodemographic data were collected, including age, sex, ethnicity, educational level, health status, geographical location, motivation to self-manage, and digital health literacy (measured by the eHEALS tool). Patients with experience of using CIE, who specified both age and sex, were included in these analyses. Relevant survey items (closed-ended questions) were mapped to the Institute of Medicine’s six domains of quality of care. Patients’ responses were examined to understand their perceptions of the impact of portal use on overall quality of care, the six domains of care quality, and patient’s satisfaction with care. Multinomial logistic regression analyses were performed to identify patient characteristics associated with i) perceived improvements in overall care quality, and ii) greater satisfaction
Li E, Tsopra R, Jimenez G, et al., 2022, General practitioners’ perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study, PLOS Digital Health, Vol: 1, Pages: 1-23, ISSN: 2767-3170
With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs’ perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June–September 2020. GPs’ perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients’ preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure.
Beaney T, Neves AL, Alboksmaty A, et al., 2022, Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England, Nature Communications, Vol: 13, Pages: 1-9, ISSN: 2041-1723
The Covid-19 mortality rate varies between countries and over time but the extent to which this is explained by the underlying risk in those infected is unclear. Using data on all adults in England with a positive Covid-19 test between 1st October 2020 and 30th April 2021 linked to clinical records, we examined trends and risk factors for hospital admission and mortality. Of 2,311,282 people included in the study, 164,046 (7.1%) were admitted and 53,156 (2.3%) died within 28 days of a positive Covid-19 test. We found significant variation in the case hospitalisation and mortality risk over time, which remained after accounting for the underlying risk of those infected. Older age groups, males, those resident in areas of greater socioeconomic deprivation, and those with obesity had higher odds of admission and death. People with severe mental illness and learning disability had the highest odds of admission and death. Our findings highlight both the role of external factors in Covid-19 admission and mortality risk and the need for more proactive care in the most vulnerable groups.
Beaney T, Clarke J, Alboksmaty A, et al., 2022, Population level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with COVID-19 in England: a national analysis using a stepped wedge design, Emergency Medicine Journal, Vol: 39, ISSN: 1472-0205
BackgroundTo identify the population level impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home; CO@h) in England on mortality and health service use.MethodsWe conducted a retrospective cohort study using a stepped wedge pre- and post- implementation design, including all 106 Clinical Commissioning Groups (CCGs) in England implementing a local CO@h programme. All symptomatic people with a positive COVID-19 polymerase chain reaction test result from 1st October 2020 to 3rd May 2021, and who were aged ≥65 years or identified as clinically extremely vulnerable were included. Care home residents were excluded. A pre-intervention period before implementation of the CO@h programme in each CCG was compared to a post-intervention period after implementation. Five outcome measures within 28 days of a positive COVID-19 test: i) death from any cause; ii) any ED attendance; iii) any emergency hospital admission; iv) critical care admission; and v) total length of hospital stay.Results217,650 people were eligible and included in the analysis. Total enrolment onto the programme was low, with enrolment data received for only 5,527 (2.5%) of the eligible population. The period of implementation of the programme was not associated with mortality or length of hospital stay. The period of implementation was associated with increased health service utilisation with a 12% increase in the odds of ED attendance (95% CI: 6%-18%) and emergency hospital admission (95% CI: 5%-20%) and a 24% increase in the odds of critical care admission in those admitted (95% CI: 5%-47%). In a secondary analysis of CO@h sites with at least 10% or 20% of eligible people enrolled, there was no significant association with any outcome measure. ConclusionAt a population level, there was no association with mortality before and after the implementation period of the CO@h programme, and small increases in health service utilisation were observed. However, lower than
Alboksmaty A, Beaney T, Elkin S, et al., 2022, Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19: a systematic review, The Lancet Digital Health, Vol: 4, Pages: e279-e289, ISSN: 2589-7500
The COVID-19 pandemic has led health systems to increase the use of tools for monitoring and triaging patients remotely. This study aims to assess the effectiveness and safety of pulse oximetry in Remote Patient Monitoring (RPM) of COVID-19 patients at home. We conducted a systematic review, searching five databases, Medline, Embase, Global Health, medRxiv, and bioRxiv, from inception to April 15, 2021. We included feasibility studies, clinical trials, observational studies, including preprints. We found 561 studies, of which 13 were included in our synthesis. The final studies were all observational cohorts and involved a total of 2,908 participants. A meta-analysis was not feasible due to the heterogeneity of the outcomes reported in the included studies. Our review confirmed the safety and potential of using pulse oximetry in monitoring COVID-19 patients at home. It can potentially save hospital resources for those who may benefit most from care escalation. However, we could not identify explicit evidence on the impact on health outcomes compared with other monitoring models that have not used pulse oximetry. Based on our findings, we make 11 recommendations and three measures for setting up an RPM system using pulse oximetry.
Lear R, Freise L, Kybert M, et al., 2022, Patients’ Willingness and Ability to Identify and Respond to Errors in Their Personal Health Records: Mixed Methods Analysis of Cross-sectional Survey Data (Preprint)
<sec> <title>BACKGROUND</title> <p>Errors in electronic health records are known to contribute to patient safety incidents; however, systems for checking the accuracy of patient records are almost nonexistent. Personal health records (PHRs) enabling patient access to and interaction with the clinical records offer a valuable opportunity for patients to actively participate in error surveillance.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This study aims to evaluate patients’ willingness and ability to identify and respond to errors in their PHRs.</p> </sec> <sec> <title>METHODS</title> <p>A cross-sectional survey was conducted using a web-based questionnaire. Patient sociodemographic data were collected, including age, sex, ethnicity, educational level, health status, geographical location, motivation to self-manage, and digital health literacy (measured using the eHealth Literacy Scale tool). Patients with experience of using the Care Information Exchange (CIE) portal, who specified both age and sex, were included in these analyses. The patients’ responses to 4 relevant survey items (closed-ended questions, some with space for free-text comments) were examined to understand their willingness and ability to identify and respond to errors in their PHRs. Multinomial logistic regression was used to identify patients’ characteristics that predict the ability to understand information in the CIE and willingness to respond to errors in their records. The framework method was used to derive themes from patients’ free-text responses.</p> </sec> <sec> <titl
van Dael J, Gillespie A, Neves AL, et al., 2022, Patient–clinician communication research for 21st century health care, British Journal of General Practice, Vol: 72, Pages: 52-53, ISSN: 0960-1643
Neves AL, van Dael J, O'Brien N, et al., 2021, Use and impact of virtual primary care on quality and safety: The public's perspectives during the COVID-19 pandemic, Journal of Telemedicine and Telecare, ISSN: 1357-633X
IntroductionWith the onset of Coronavirus disease (COVID-19), primary care has swiftly transitioned from face-to-face to virtual care, yet it remains largely unknown how this has impacted the quality and safety of care. We aim to evaluate patient use of virtual primary care models during COVID-19, including change in uptake, perceived impact on the quality and safety of care and willingness of future use.MethodologyAn online cross-sectional survey was administered to the public across the United Kingdom, Sweden, Italy and Germany. McNemar tests were conducted to test pre- and post-pandemic differences in uptake for each technology. One-way analysis of variance was conducted to examine patient experience ratings and perceived impacts on healthcare quality and safety across demographic characteristics.ResultsRespondents (n = 6326) reported an increased use of telephone consultations ( + 6.3%, p < .001), patient-initiated services ( + 1.5%, n = 98, p < 0.001), video consultations ( + 1.4%, p < .001), remote triage ( + 1.3, p < 0.001) and secure messaging systems ( + 0.9%, p = .019). Experience rates using virtual care technologies were higher for men (2.4 ± 1.0 vs. 2.3 ± 0.9, p < .001), those with higher literacy (2.8 ± 1.0 vs. 2.3 ± 0.9, p < .001), and participants from Germany (2.5 ± 0.9, p < .001). Healthcare timeliness and efficiency were the dimensions most often reported as being positively impacted by virtual technologies (60.2%, n = 2793 and 55.7%, n = 2,401, respectively), followed by effectiveness (46.5%, n =
Costa-Santos C, Neves AL, Correia R, et al., 2021, COVID-19 surveillance data quality issues: a national consecutive case series, BMJ OPEN, Vol: 11, ISSN: 2044-6055
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Neves AL, Smalley K, Freise L, et al., 2021, Sharing electronic health records with patients: Who is using the Care Information Exchange portal? A cross-sectional study, Jornal of Medical Internet Research, Vol: 13, Pages: 1-12, ISSN: 1438-8871
Background: Sharing electronic health records with patients has been shown to improve patient safety and quality of care, and patient portals represent a powerful and convenient tool to enhance patient access to their own healthcare data. However, the success of patient portals will only be possible through sustained adoption by its end-users: the patients. A better understanding of the characteristics of users and non-users is critical to understand which groups remain underserved or excluded from using such tools.Objective: To identify the determinants of usage of the Care Information Exchange (CIE), a shared patient portal program in the United Kingdom.Methods: A cross-sectional study was conducted, using an online questionnaire. Information collected included age, gender, ethnicity, educational level, health status, postcode and digital literacy. Registered individuals were defined as having had an account created in the portal, independent of their actual use of the platform; users were defined as having ever used the portal. Multivariate logistic regression was used to model the probability of being a user. Statistical analysis was performed in R, and Tableau ® was used to create maps of the proportion of CIE users by postcode area.Results: A total of 1,083 subjects replied to the survey (+186% of the estimated minimum target sample). The proportion of users was 61.6% (n=667), and within these, the majority (57.7%, n=385) used the portal at least once a month. To characterise the users and non-users of the system, we performed a sub-analysis of the sample, including only participants that had provided at least information regarding gender and age category. The sub-analysis included 650 individuals (59.8% women, 84.8% over 40 years). The majority of the subjects were white (76.6%, n=498), resident in London (64.7%, n=651), and lived in North West London (55.9%, n=363). Individuals with a higher educational degree (undergraduate/professional or postgraduat
Shaw A, O'Brien N, Flott K, et al., 2021, How to improve patient safety in fragile, conflict-affected, and vulnerable settings: a Delphi study protocol, BMJ Open, Vol: 11, Pages: 1-5, ISSN: 2044-6055
Introduction There is a high burden of adverse events and poor outcomes in fragile, conflict-affected and vulnerable (FCV) settings. To improve outcomes, there is a need to better identify which interventions can improve patient safety in these settings, as well as to develop strategies to optimise their implementation.Objective This study intends to generate a consensus on the most relevant patient safety interventions from experts with experience on FCV settings, including frontline clinicians and managers/administrators, non-governmental organisations, policymakers and researchers.Methods and analysis The study uses an online Delphi research approach (eDelphi). Participants will include experts from a range of backgrounds, including those working in a variety of FCV settings. Participants will be established contacts known to the research team or recruited via snowball sampling, and will be asked to identify and rank the importance of a variety of patient safety interventions. Consensus will be defined as >70% of participants agreeing/strongly agreeing or disagreeing/strongly disagreeing with a statement. Data analysis will be completed in Microsoft Excel and NVivo. The primary outcome of the study will be a list of the most relevant and applicable patient safety interventions for FCV settings.Ethics and dissemination The study has received approval from Imperial College London Ethics Committee (reference number 20IC665). Anonymous results will be made available to the public, academic organisations and policymakers.
Fiorentino F, Prociuk D, Espinosa Gonzalez AB, et al., 2021, An Early Warning Risk Prediction Tool (RECAP-V1) for Patients Diagnosed With COVID-19: Protocol for a Statistical Analysis Plan, JMIR Research Protocols, Vol: 10, Pages: e30083-e30083
<jats:sec> <jats:title>Background</jats:title> <jats:p>Since the start of the COVID-19 pandemic, efforts have been made to develop early warning risk scores to help clinicians decide which patient is likely to deteriorate and require hospitalization. The RECAP (Remote COVID-19 Assessment in Primary Care) study investigates the predictive risk of hospitalization, deterioration, and death of patients with confirmed COVID-19, based on a set of parameters chosen through a Delphi process performed by clinicians. We aim to use rich data collected remotely through the use of electronic data templates integrated in the electronic health systems of several general practices across the United Kingdom to construct accurate predictive models. The models will be based on preexisting conditions and monitoring data of a patient’s clinical parameters (eg, blood oxygen saturation) to make reliable predictions as to the patient’s risk of hospital admission, deterioration, and death.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>This statistical analysis plan outlines the statistical methods to build the prediction model to be used in the prioritization of patients in the primary care setting. The statistical analysis plan for the RECAP study includes the development and validation of the RECAP-V1 prediction model as a primary outcome. This prediction model will be adapted as a three-category risk score split into red (high risk), amber (medium risk), and green (low risk) for any patient with suspected COVID-19. The model will predict the risk of deterioration and hospitalization.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>After the data have been collected, we will assess the degree of missingness and use a combination
Fiorentino F, Prociuk D, Espinosa Gonzalez AB, et al., 2021, An early warning risk prediction tool (RECAP-V1) for patients diagnosed with COVID-19: the protocol for a statistical analysis plan, JMIR Research Protocols, Vol: 10, ISSN: 1929-0748
Background:Since the start of the Covid-19 pandemic efforts have been made to develop early warning risk scores to help clinicians decide which patient is likely to deteriorate and require hospitalisation. The RECAP (Remote COVID Assessment in Primary Care) study investigates the predictive risk of hospitalisation, deterioration, and death of patients with confirmed COVID-19, based on a set of parameters chosen through a Delphi process done by clinicians. The study aims to use rich data collected remotely through the use of electronic data templates integrated in the electronic health systems of a number of general practices across the UK to construct accurate predictive models that will use pre-existing conditions and monitoring data of a patient’s clinical parameters such as blood oxygen saturation to make reliable predictions as to the patient’s risk of hospital admission, deterioration, and death.Objective:We outline the statistical methods to build the prediction model to be used in the prioritisation of patients in the primary care setting. The statistical analysis plan for the RECAP study includes as primary outcome the development and validation of the RECAP-V1 prediction model. Such prediction model will be adapted as a three-category risk score split into red (high risk), amber (medium risk), and green (low risk) for any patient with suspected covid-19. The model will predict risk of deterioration, hospitalisation, and death.Methods:After the data has been collected, we will assess the degree of missingness and use a combination of traditional data imputation using multiple imputation by chained equations, as well as more novel machine learning approaches to impute the missing data for the final analysis. For predictive model development we will use multiple logistic regressions to construct the model on a training dataset, as well as validating the model on an independent dataset. The model will also be applied for multiple different datasets
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