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To evaluate the role of using outputs from patient-facing online triage tools in clinical decision-making in primary care.
Systematic review.
Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Scopus were searched for literature published between 1 January 2002 and 31 December 2022 and updated for literature published up to end of November 2024.
Studies of any design are included where the study investigates how primary care clinicians make clinical decisions in response to patient concerns reported using online triage tools.
Data were extracted, and quality assessment was conducted using the Mixed Methods Appraisal Tool. Narrative synthesis was used to analyse the findings.
14 studies were included, which were conducted in the UK (n=9), Sweden (n=3) and Spain (n=2). There were no studies that examined clinical decision-making as an outcome. Outcomes relating to the impact on clinical decision-making were grouped into three categories: patient clinical outcomes (n=9), primary care practitioner experience (n=11) and healthcare system outcomes (n=14). Studies reported faster clinical decisions made in response to patient concerns. Other studies reported clinicians offering unnecessary urgent appointments as patients learnt to ‘game’ the system. Clinicians felt confident managing patient requests as they can access additional information (such as a photo attachment). Moreover, clinicians’ time was freed up from appointments with limited clinical value. Contrarily, online triage was perceived as an additional step in the workflow.
Clinicians should be aware that their decision-making processes are likely to differ when using online triage tools. Developers can use the findings to improve the usability of the tools to aid clinical decision-making. Future research should focus on patient-facing online triage tools in general practice and the process of clinical decision-making.
CRD42022373944.
Resumen
La pandemia por COVID-19 fue uno de los acontecimientos más desafiantes a nivel global para la formación en enfermería. Sin embargo, no se encontraron estudios fenomenológicos en Chile que describieran las experiencias y vivencias acontecidas en los estudiantes de enfermería. El objetivo de este estudio fue describir las experiencias de vida de un grupo de estudiantes de enfermería chilenos durante el período de pandemia. Se realizó un estudio fenomenológico descriptivo en siete estudiantes de enfermería basado en los postulados de Heidegger. Se utilizó la técnica de cartografía corporal y narrativas autobiográficas para recolectar la información. En la interpretación de los dibujos se utilizó la propuesta de McCorquodale y DeLuca mientras que los relatos se analizaron mediante la metodología de Codazzi. Producto de la triangulación de los datos se obtuvieron cuatro grandes categorías, a saber: Don COVID, experiencias ominosas en el hogar, problemáticas educativas y Sorge. Los resultados muestran las consecuencias de la rápida digitalización del sistema educativo debido a la crisis sanitaria, provocando inestabilidad en los participantes, exacerbando las emociones, afectando su capacidad de concentración y resolución de problemas académicos. No obstante, se demuestran las capacidades de adaptación y resiliencia que pueden afrontar los estudiantes en situaciones complejas.
Aging populations require adapting healthcare systems for older adult's specific needs. Numerous initiatives to improve older-patient care have emerged, but the field lacks a unified framework. The current study aims to provide a systematic concept analysis of ‘age-friendly healthcare’, examining its characteristics, components and structure.
Rodger's evolutionary concept analysis.
Searches were conducted in ProQuest, CINAHL, PubMed and Scopus databases between November 2022 and October 2023, utilising the PRISMA 2020 reporting checklist.
A literature search using specific terms relevant to age-friendly healthcare retrieved 1407 articles. After screening for duplicates and relevance, 140 articles were examined for eligibility based on inclusion criteria for age-friendly care, language and full-text availability. Following full-text screening, 65 articles were included for data extraction by multiple researchers to synthesise theoretical, methodological and design elements.
Our findings highlight key attributes of age-friendly healthcare: Respect for older adults' autonomy and needs; leadership and organisational knowledge and support; Proactive policies and processes of care; holistic care environments; and communication and follow-up with awareness of challenges and barriers as well as prioritisation of continuity-of-care.
The concept of age-friendly healthcare is still developing, with much research focused on development and implementation rather than evaluation of real-world patient and health-system outcomes. Our analysis of the concept may help unify the field and clarify future research directions through identification of areas requiring further study and enable development of improved practices and policies for implementing age-friendly healthcare in a variety of settings.
This concept analysis did not include any patient or public involvement.
This study utilised the PRISMA reporting checklist.
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