Patients' Use of e-Consultations as an Alternative to Other General Practitioner Services: Cross-Sectional Survey Study.

Background: e-Consultations, defined as asynchronous text-based messaging, have transformed how patients interact with their general practitioner (GP). While e-consultations can improve patient access to GP care, concerns about increased workload for GPs are raised.

Objective: This study aimed to address three research questions: (1) For what purpose and with what expectations do patients initiate e-consultations? (2) If e-consultations had not been available, what alternative actions would the patient have taken? and (3) How are the alternative actions associated with patient and e-consultation characteristics?

Methods: A cross-sectional study was conducted through a web-based survey on Helsenorge.

Patients' suggestions for improvements to text-based e-consultations. An online survey of users of the national health portal in Norway.

Background: In recent years, text-based e-consultations have been widely implemented in general practice and are appreciated by patients for their convenience and efficiency. Policymakers aim to enhance patient access to clinical services with the general practitioner (GP) through text-based e-consultations. However, concerns are raised about their efficiency and security.

Patients' experiences with receiving sick leave certificates via remote consultations in Norway during the COVID-19 pandemic: a nationwide online survey.

Objectives: To explore patients' experiences with receiving sick leave certificates via remote consultations during the COVID-19 pandemic and investigate whether there were differences among the types of remote consultation (telephone, video or text).

Design: A nationwide online patient survey consisting of quantitative data supplemented by qualitative opinions conducted in Norway.

Setting: Primary care.

A Trial-Based Cost-Utility Analysis of a Medication Optimization Intervention Versus Standard Care in Older Adults.

Background: Older adults are at greater risk of medication-related harm than younger adults. The Integrated Medication Management model is an interdisciplinary method aiming to optimize medication therapy and improve patient outcomes.

Objective: We aimed to investigate the cost effectiveness of a medication optimization intervention compared to standard care in acutely hospitalized older adults.

Suitability of issuing sickness certifications in remote consultations during the COVID-19 pandemic. A mixed method study of GPs' experiences.

Objective: To explore Norwegian GPs' experiences with and perceived suitability of issuing sickness certifications in remote consultations during the COVID-19 pandemic.

Design: We used a mixed methods research design. An online survey with 301 respondents was combined with qualitative interviews with ten GPs.

Older high-cost patients in Norwegian somatic hospitals: a register-based study of patient characteristics.

Objective: Two-thirds of the economic resources in Norwegian hospitals are used on 10% of the patients. Most of these high-cost patients are older adults, which experience more unplanned hospital admissions, longer hospital stays and higher readmission rates than other patients. This study aims to examine the individual and clinical characteristics of older patients with unplanned admissions to Norwegian somatic hospitals and how these characteristics differ between high-cost and low-cost older patients.

Nationally Shared Medication Lists - Describing Systems in the Nordic Countries.

This paper provides an overview of shared medication lists (SMLs) in four Nordic countries (Denmark, Finland, Norway and Sweden) with a focus on the type of information the list is based on. This is a structured comparison conducted in stages using an expert group, grey papers, unpublished materials, web pages, as well as scientific papers. Denmark and Finland have implemented their solutions for an SML and Norway and Sweden are working on the implementation of their solution.

Internet Use for Obtaining Medicine Information: Cross-sectional Survey.

Background: The internet is increasingly being used as a source of medicine-related information. People want information to facilitate decision-making and self-management, and they tend to prefer the internet for ease of access. However, it is widely acknowledged that the quality of web-based information varies.

Self-reported medication information needs among medication users in a general population aged 40 years and above - the Tromsø study.

Purpose: To determine the prevalence and associated factors of self-reported medication information needs among medication users in a general population aged 40 years and above - The Tromsø Study.

Methods: Cross-sectional study of medication users (n = 10,231) among participants in the Tromsø Study, a descriptive analysis of questionnaire data and multivariable logistic regression (n = 9,194).

Results: Sixteen percent of medication users expressed a need for more information about own medications.

Implementation of a shared medication list in primary care - a controlled pre-post study of medication discrepancies.

Background: Access to medicines information is important when treating patients, yet discrepancies in medication records are common. Many countries are developing shared medication lists across health care providers. These systems can improve information sharing, but little is known about how they affect the need for medication reconciliation.

From Paper to E-Prescribing of Multidose Drug Dispensing: A Qualitative Study of Workflow in a Community Care Setting.

E-prescribing is now widespread and, in some countries, has completely replaced paper prescriptions. In Norway, almost all prescribing is electronic, except for multidose drug dispensing (MDD), which is still sent to the pharmacy by fax or ordinary mail. MDD is an adherence aid used by one-third of all patients receiving home care services.

The Practice Guidelines for Multidose Drug Dispensing Need Revision-An Investigation of Prescription Problems and Interventions.

Multidose drug dispensing (MDD) is an adherence aid used by one-third of patients receiving home care services in Norway. The system can increase patient safety by reducing dispensing errors and increase adherence, however it has also been criticised for unclear routines and distribution of responsibilities. We investigated prescription problems which pharmacists have detected, and the responsibilities they adopt regarding MDD.

Potentially inappropriate prescribing to older patients receiving multidose drug dispensing.

Background: Multidose drug dispensing (MDD) is an adherence aid that provides patients with machine-dispensed medicines in disposable unit bags, usually for a 14 day period. Previous studies have suggested that the quality of prescribing, with time, is lower for MDD users, compared to patients receiving prescriptions dispensed as usual. This study aimed to examine the quality of prescribing to Norwegian elderly home care service patients receiving MDD.

Cost-Effectiveness of Telemedicine in Remote Orthopedic Consultations: Randomized Controlled Trial.

Background: Telemedicine consultations using real-time videoconferencing has the potential to improve access and quality of care, avoid patient travels, and reduce health care costs.

Objective: The aim of this study was to examine the cost-effectiveness of an orthopedic videoconferencing service between the University Hospital of North Norway and a regional medical center in a remote community located 148 km away.

Methods: An economic evaluation based on a randomized controlled trial of 389 patients (559 consultations) referred to the hospital for an orthopedic outpatient consultation was conducted.

Clinical Videoconferencing as eHealth: A Critical-Realist Review and Qualitative Meta-Synthesis.

Background: Earlier work has described videoconferencing technologies, peripheral equipment, organizational models, human relations, purposes, goals and roles as versatile, multifaceted, and those used differently in different clinical practices. Knowledge about benefits and challenges connected to specific characteristics of services are lacking. A 2005 systematic review of published definitions of electronic health (eHealth) identified 51 unique definitions.

Methods to Evaluate the Effects of Internet-Based Digital Health Interventions for Citizens: Systematic Review of Reviews.

Background: Digital health can empower citizens to manage their health and address health care system problems including poor access, uncoordinated care and increasing costs. Digital health interventions are typically complex interventions. Therefore, evaluations present methodological challenges.

Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial.

Rationale: Early detection of chronic obstructive pulmonary disease (COPD) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization.

Objectives: To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities.

Methods: This multicenter, randomized clinical trial recruited 312 patients with Global Initiative for Chronic Obstructive Lung Disease grades II to IV COPD (median age, 71 yr [interquartile range, 66-76 yr]; 49.

How to Measure Costs and Benefits of eHealth Interventions: An Overview of Methods and Frameworks.

Information on the costs and benefits of eHealth interventions is needed, not only to document value for money and to support decision making in the field, but also to form the basis for developing business models and to facilitate payment systems to support large-scale services. In the absence of solid evidence of its effects, key decision makers may doubt the effectiveness, which, in turn, limits investment in, and the long-term integration of, eHealth services. However, it is not realistic to conduct economic evaluations of all eHealth applications and services in all situations, so we need to be able to generalize from those we do conduct.

The effectiveness and cost effectiveness of the PAtient-Centred Team (PACT) model: study protocol of a prospective matched control before-and-after study.

Background: The present study protocol describes the evaluation of a comprehensive integrated care model implemented at two hospital sites at the University Hospital of North Norway (UNN). The PAtient Centred Team (PACT) model includes proactive, patient-centred interdisciplinary teams that aim to improve the continuum and quality of care of frail elderly patients and reduce health care costs. The main objectives of the evaluation are to analyse the effectiveness and cost effectiveness of using patient-centred teams as part of routine service provision for this patient group.

Using QALYs in telehealth evaluations: a systematic review of methodology and transparency.

Background: The quality-adjusted life-year (QALY) is a recognised outcome measure in health economic evaluations. QALY incorporates individual preferences and identifies health gains by combining mortality and morbidity into one single index number. A literature review was conducted to examine and discuss the use of QALYs to measure outcomes in telehealth evaluations.

Low-intensity self-management intervention for persons with type 2 diabetes using a mobile phone-based diabetes diary, with and without health counseling and motivational interviewing: protocol for a randomized controlled trial.

Background: The present study protocol is designed to cover the Norwegian part of the European Union Collaborative Project-REgioNs of Europe WorkINg together for HEALTH (RENEWING HEALTH). Self-management support is an important element of care for persons with type 2 diabetes (T2D) for achieving metabolic control and positive lifestyle changes. Telemedicine (TM) with or without health counseling may become an important technological aid for self-management and may provide a user-centered model of care.

Approaches to economic evaluation in telemedicine.

External validity or generalizability is a major challenge in the economic evaluation of telemedicine. There are two possible ways of increasing generalizability: the first is to use a pragmatic trial design so it better reflects normal patient caseload and everyday practice. The second is to use existing data from the literature and decision modelling to estimate the expected costs and outcomes of different alternatives.

Economic evaluation in telemedicine - still room for improvement.

It has been reported that economic evaluations of telemedicine are less adherent to methodological standards than economic evaluations in other fields. Systematic reviews also show that most studies evaluate benefits in terms of the cost savings, with no assessment of the health benefits for patients. In a recent review of economic evaluations, I found 33 articles that measured both costs and non-resource consequences of using telemedicine in direct patient care.