1
|
Nyoni T, Evers EC, Pérez M, Jeffe DB, Fritz SA, Colditz GA, Burnham JP. Perceived barriers and facilitators to the adoption of telemedicine infectious diseases consultations in southeastern Missouri hospitals. J Telemed Telecare 2024; 30:1462-1474. [PMID: 36659820 PMCID: PMC10354216 DOI: 10.1177/1357633x221149461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Telemedicine infectious diseases consultations (tele-ID consults) improves access to healthcare for underserved/resource-limited communities. However, factors promoting or hindering implementation of tele-ID consults in low-resource settings are understudied. This study sought to fill this gap by describing perceived barriers and facilitators tele-ID consults at three rural hospitals in southeastern Missouri. METHODS Twelve in-depth, semi-structured interviews were conducted with a purposively sampled group of information-rich hospital stakeholders from three rural, southeastern Missouri hospitals with partial or no on-site availability of ID physicians. Our literature-informed interview guide elicited participants' knowledge and experience with tele-ID consults, perceptions on ID consultation needs, and perceived barriers to and facilitators of tele-ID consults. Interview transcripts were coded using an iterative process of inductive analysis to identify core themes related to barriers and facilitators. RESULTS Perceived barriers to adopting and implementing tele-ID consults included logistical challenges, technology and devices, negative emotional responses, patient-related factors, concerns about reduced quality of care when using telemedicine, lack of acceptance or buy-in from physicians or staff, and legal concerns. Key facilitators included perceived need, perceived benefits to patients and physicians, flexibility and openness to change among staff members and patients, telemedicine champions, prior experiences, and enthusiasm. DISCUSSION Our findings demonstrate that rural hospitals need tele-ID consults and have the capacity to implement tele-ID consults, but operational and technical feasibility challenges remain. Adoption and implementation of tele-ID consults may reduce ID-physician shortage-related service gaps by permitting ID physician's greater geographic reach.
Collapse
Affiliation(s)
- Thabani Nyoni
- Brown School, Washington University in Saint Louis, St. Louis, Missouri, USA
| | - Emily C. Evers
- Brown School, Washington University in Saint Louis, St. Louis, Missouri, USA
| | - Maria Pérez
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Donna B. Jeffe
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie A. Fritz
- Department of Pediatrics, Washington University in St. Louis, Missouri, USA
| | - Graham A. Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason P. Burnham
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
2
|
Osmanlliu E, Burstein B, Tamblyn R, Buckeridge DL. Assessing the potential for virtualizable care in the pediatric emergency department. J Telemed Telecare 2024; 30:1249-1260. [PMID: 36408736 DOI: 10.1177/1357633x221133415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
INTRODUCTION There is increasing interest for patient-to-provider telemedicine in pediatric acute care. The suitability of telemedicine (virtualizability) for visits in this setting has not been formally assessed. We estimated the proportion of in-person pediatric emergency department (PED) visits that were potentially virtualizable, and identified factors associated with virtualizable care. METHODS This was a retrospective analysis of in-person visits at the PED of a Canadian tertiary pediatric hospital (02/2018-12/2019). Three definitions of virtualizable care were developed: (1) a definition based on "resource use" classifying visits as virtualizable if they resulted in a home discharge, no diagnostic testing, and no return visit within 72 h; (2) a "diagnostic definition" based on primary ED diagnosis; and (3) a stringent "combined definition" by which visits were classified as virtualizable if they met both the resource use and diagnostic definitions. Multivariable logistic regression was used to identify factors associated with telemedicine suitability. RESULTS There were 130,535 eligible visits from 80,727 individual patients during the study period. Using the most stringent combined definition of telemedicine suitability, 37.9% (95% confidence interval (CI) 37.6%-38.2%) of in-person visits were virtualizable. Overnight visits (adjusted odds ratio (aOR) 1.16-1.37), non-Canadian citizenship (aOR 1.10-1.18), ethnocultural vulnerability (aOR 1.14-1.22), and a consultation for head trauma (aOR 3.50-4.60) were associated with higher telemedicine suitability across definitions. DISCUSSION There is a high potential for patient-to-provider telemedicine in the PED setting. Local patient and visit-level characteristics must be considered in the design of safe and inclusive telemedicine models for pediatric acute care.
Collapse
Affiliation(s)
- Esli Osmanlliu
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
- Pediatric Emergency Medicine Division, McGill University Health Center, McGill University, Montréal, Canada
- McGill Clinical & Health Informatics (MCHI) Research Group, McGill University, Montréal, Canada
| | - Brett Burstein
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
- Pediatric Emergency Medicine Division, McGill University Health Center, McGill University, Montréal, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
- McGill Clinical & Health Informatics (MCHI) Research Group, McGill University, Montréal, Canada
| | - David L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
- McGill Clinical & Health Informatics (MCHI) Research Group, McGill University, Montréal, Canada
| |
Collapse
|
3
|
Alkhaldi M, Abu Joudeh L, Ahmed YB, Husari KS. Artificial intelligence and telemedicine in epilepsy and EEG: A narrative review. Seizure 2024; 121:204-210. [PMID: 39222613 DOI: 10.1016/j.seizure.2024.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/05/2024] [Accepted: 08/29/2024] [Indexed: 09/04/2024] Open
Abstract
The emergence of telemedicine and artificial intelligence (AI) has set the stage for a possible revolution in the future of medicine and neurology including the diagnosis and management of epilepsy. Telemedicine, with its proven efficacy during the COVID-19 pandemic, offers the advantage of bridging the gap between patients in resource-limited areas and specialized care, where in one study telemedicine reduced the epilepsy treatment gap from 43 % to 9 %. AI innovations promise a transformation in epilepsy care by possibly enhancing the accuracy of electroencephalogram (EEG) interpretation and seizure prediction through machine and deep learning. In one study, abnormal EEG recordings were classified into different categories using a convolutional neural networks (CNN) model showing a specificity of 90 % and an accuracy of 88.3 %. Other models constructed to predict seizures have also achieved a sensitivity of 96.8 % and specificity of 95.5 %. Various machine learning (ML) models highlight the potential AI holds in identifying interictal biomarkers and localizing seizure onset zones aiding in epilepsy treatment decision and outcome prediction. An ML model highlighted in this review localized seizure onset zone with an accuracy reaching 73 % and predicted surgical outcomes with an accuracy reaching 79 % compared to the 43 % accuracy of clinicians. However, limitations and challenges hinder the application of such technologies to reach their full potential in epilepsy care. Limitations include access to compatible devices, integration into clinical workflows, data bias, and availability of sufficient data. Extensive validated research is needed to guide future clinical practice with the implementation of technology-enhanced epilepsy care. This narrative review article will explore the use of AI and telemedicine in EEG and epilepsy care, examining their individual and combined impacts in shaping the future of epilepsy care and discussing the challenges and limitations faced in their usage.
Collapse
Affiliation(s)
- Mohammad Alkhaldi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Layla Abu Joudeh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yaman B Ahmed
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalil S Husari
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
4
|
Wu X, Kuang Y, Guo Y, Wei N, Fan Z, Ling J. Analyzing the barriers and enablers to internet hospital implementation: a qualitative study of a tertiary hospital using TDF and COM-B framework. Front Digit Health 2024; 6:1362395. [PMID: 39175961 PMCID: PMC11340510 DOI: 10.3389/fdgth.2024.1362395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/28/2024] [Indexed: 08/24/2024] Open
Abstract
Background Internet hospitals have become an important way to improve the accessibility of medical services and promote medical equity in China. However, there is still lack of research on the behavior of medical personnel during the process of using Internet medical services, and the elements of behavior that motivate doctors to actively use or resist the use of Internet hospitals are still not fully analyzed. The study applied the Theoretical Domains Framework to examine the factors affecting the engagement of medical personnel in Internet hospitals, with the aim of guiding the design of intervention to enhance Internet hospital participation. Methods This study utilized qualitative analysis. Semi-structured questionnaires based on the Theoretical Domains Framework (TDF) and Capability-Opportunity-Motivation-Behavior (COM-B) model was developed and administered to 40 doctors and nurses at a Grade A tertiary hospital in Guangdong Province. Data was coded and analyzed using qualitative methods including Nvivo software. Results The research displayed 19 barriers and 7 enablers for the implementation of Internet hospitals, all 14 TDF domains impacted participation with motivation cited most frequently. Despite challenges, medical personnel exhibited a generally optimistic stance towards utilization of the Internet hospital. Major barriers include the higher requirement of diagnostic ability, objective difficulties brought by online consultation to the decision-making process, limitation of time and other resources, not ideal technological and institutional environment, lack of self-efficacy and negative expectation of results in online consultation. Key enablers include patient needs and the positive impact of online care on the medical process and patient experience. Discussion This qualitative study identified a range of barriers and enablers to Internet hospital participation according to medical personnel, providing an conceptual framework to guide further research evaluating implementation strategies. Expanded research and targeted interventions design can help optimize participation in this evolving healthcare delivery model.
Collapse
Affiliation(s)
- Xiaolong Wu
- Business School, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yulin Kuang
- Business School, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yonglin Guo
- School of Government, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Ning Wei
- Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Zichun Fan
- Business School, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Jingru Ling
- Business School, Sun Yat-sen University, Shenzhen, Guangdong, China
| |
Collapse
|
5
|
Mandal S, Wiesenfeld BM, Mann DM, Szerencsy AC, Iturrate E, Nov O. Quantifying the impact of telemedicine and patient medical advice request messages on physicians' work-outside-work. NPJ Digit Med 2024; 7:35. [PMID: 38355913 PMCID: PMC10867011 DOI: 10.1038/s41746-024-01001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024] Open
Abstract
The COVID-19 pandemic has boosted digital health utilization, raising concerns about increased physicians' after-hours clinical work ("work-outside-work"). The surge in patients' digital messages and additional time spent on work-outside-work by telemedicine providers underscores the need to evaluate the connection between digital health utilization and physicians' after-hours commitments. We examined the impact on physicians' workload from two types of digital demands - patients' messages requesting medical advice (PMARs) sent to physicians' inbox (inbasket), and telemedicine. Our study included 1716 ambulatory-care physicians in New York City regularly practicing between November 2022 and March 2023. Regression analyses assessed primary and interaction effects of (PMARs) and telemedicine on work-outside-work. The study revealed a significant effect of PMARs on physicians' work-outside-work and that this relationship is moderated by physicians' specialties. Non-primary care physicians or specialists experienced a more pronounced effect than their primary care peers. Analysis of their telemedicine load revealed that primary care physicians received fewer PMARs and spent less time in work-outside-work with more telemedicine. Specialists faced increased PMARs and did more work-outside-work as telemedicine visits increased which could be due to the difference in patient panels. Reducing PMAR volumes and efficient inbasket management strategies needed to reduce physicians' work-outside-work. Policymakers need to be cognizant of potential disruptions in physicians carefully balanced workload caused by the digital health services.
Collapse
Affiliation(s)
- Soumik Mandal
- Dept of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
- Technology Management & Innovation, New York University Tandon School of Engineering, New York, NY, USA.
| | - Batia M Wiesenfeld
- New York University Leonard N Stern School of Business, New York, NY, USA
| | - Devin M Mann
- Dept of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- MCIT Department of Health Informatics, NYU Langone Health, New York, USA
| | - Adam C Szerencsy
- MCIT Department of Health Informatics, NYU Langone Health, New York, USA
| | - Eduardo Iturrate
- Dept of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Oded Nov
- Technology Management & Innovation, New York University Tandon School of Engineering, New York, NY, USA
| |
Collapse
|
6
|
Hu Y, Wang J, Gu Y, Nicholas S, Maitland E, Zhou J. Online medical consultation in China: Demand-side analysis of obese patients' preferences and willingness-to-pay for online obesity consultations. Digit Health 2024; 10:20552076241272525. [PMID: 39119552 PMCID: PMC11307359 DOI: 10.1177/20552076241272525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024] Open
Abstract
Objective With obesity a major health concern and call on healthcare resources in China, we explored the preferences and willingness to pay (WTP) for obesity OMC, including the influencing factors behind WTP and preferences. Method We recruited 400 obese participants to undertake a discrete choice experiment (DCE) and the contingent value method (CVM) survey. We used CVM to measure obese participants' WTP for one-click services (OCS) and used DCE to estimate obesity participants' preferences and WTP for OMC with different attributes. Results Obese participants were willing to pay more than RMB80 on average for OCS, and more than 50% of participants had a WTP over RMB50 and 5% had a WTP over RMB300, reflecting the strong willingness of Chinese obese patients to pay for OMC. Educational background, income, ethnicity, previous OMC experience and accessibility to offline hospitals with different levels impacted WTP. The relative importance score of attributes in descending order was cost, doctors' hospital level, doctors' level, online waiting time, consultation time and consultation form. Obese patients preferred lower cost, doctors from higher-level hospitals, doctors with higher expertise levels, shorter waiting time and consultation duration, and telephone consultation were preferred. 30-min waiting time, 15-min consultation duration and telephone consultation were the most economically efficient set we found. Conclusion To maximize health resources, provincial tertiary and municipal hospitals face different paths to developing obesity OMC platforms. We encouraged young doctors to use OMC. OMC regulators should implement consumer protection policies to optimize OMC pricing and address potential 'unfair' pricing.
Collapse
Affiliation(s)
- Yaolin Hu
- School of Economics, Peking University, Beijing, China
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
- Center for Health Economics and Management, Economics and Management School, Wuhan University, Wuhan, China
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Stephen Nicholas
- Health Services Research and Workforce Innovation Centre, Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
- Australian National Institute of Management and Commerce, Sydney, Australia
| | | | - Jianbo Zhou
- School of Economics, Peking University, Beijing, China
| |
Collapse
|
7
|
Jones E, Cross-Barnet C. Telehealth as a Tool to Transform Pediatric Care: Views from Stakeholders. Telemed J E Health 2023; 29:1843-1852. [PMID: 37252789 DOI: 10.1089/tmj.2022.0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Background and Objectives: The 2020 COVID-19 pandemic generated rapid telehealth expansion. Most prior telehealth studies focus on a single program or health condition, leaving a knowledge gap regarding the most appropriate and effective means of allocating telehealth services and funding. This research seeks to evaluate a wide range of perspectives to inform pediatric telehealth policy and practice. Methods: In 2017, the Center for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation (Innovation Center) issued a Request for Information to inform the Integrated Care for Kids model. Researchers identified 55 of 186 responses that addressed telehealth and analyzed them based on grounded theory principles overlaid with a constructivist approach to contextualize Medicaid policies, respondent characteristics, and implications for specific populations. Results: Respondents noted several health equity issues that telehealth could help to remedy, including timely care access, specialist shortages, transportation and distance barriers, provider-to-provider communication, and patient and family engagement. Implementation barriers reported by commenters included reimbursement restrictions, licensure issues, and costs of initial infrastructure. Respondents raised savings, care integration, accountability, and increased access to care as potential benefits. Discussion and Conclusions: The pandemic demonstrated that the health system can implement telehealth rapidly, although telehealth cannot be used to provide every aspect of pediatric care such as vaccinations. Respondents highlighted the promise of telehealth, which is heightened if telehealth supports health care transformation rather than replicating how in-office care is currently provided. Telehealth also offers the potential to increase health equity for some populations of pediatric patients.
Collapse
Affiliation(s)
- Emily Jones
- Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Baltimore, Maryland, USA
| | - Caitlin Cross-Barnet
- Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Baltimore, Maryland, USA
| |
Collapse
|
8
|
Pelckmans M, Nijmolen P, Bloemen M, Kuijpers E, Meershoek A, Rameckers E. Barriers and Facilitators to the Acceptance of eHealth Interventions by Dutch Pediatric Physical Therapists in Times of the COVID-19 Pandemic: A Mixed-Methods Approach. Pediatr Phys Ther 2023; 35:243-250. [PMID: 36722830 PMCID: PMC10035549 DOI: 10.1097/pep.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic created an urgent need for eHealth as the relevance of infection control and social distancing continues. Evidence describing the acceptability of implementing eHealth into pediatric physical therapy services is limited. PURPOSE To investigate the determinants of eHealth acceptance by Dutch pediatric physical therapists during the COVID-19 pandemic. METHODS A mixed-methods approach was used. It included a quantitative exploratory questionnaire of 154 pediatric physical therapists and qualitative in-depth interviews of 16 pediatric physical therapists. RESULTS The eHealth interventions were beneficial for collaboration between health care professionals and in addition to face-to-face therapy. eHealth interventions were, however, found to be unsuitable especially in the diagnostic phase. Barriers to more extensive application include costs, technical difficulties, and a perceived negative attitude of children. CONCLUSION Pediatric physical therapists used eHealth interventions extensively in times of the COVID-19 pandemic. However, the acceptance of eHealth interventions is dependent on the pediatric physical therapist's perception of usefulness in private practice, rehabilitation setting, or clinical hospital.
Collapse
Affiliation(s)
- Maud Pelckmans
- Maastricht University (Ms Pelckmans), Maastricht, the Netherlands; Dutch Association for Pediatric Physical Therapy (NVFK) (Drs Nijmolen and Bloemen and Ms Kuijpers), Amersfoort, the Netherlands; Research Group Lifestyle and Health (Dr Bloemen), Research Center Healthy Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; Departments of Health Ethics and Society (Dr Meershoek) and Rehabilitation Medicine (Dr Rameckers), Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Rehabilitation Research Centre, Faculty of Rehabilitation Sciences (Dr Rameckers), Hasselt University, Hasselt, Belgium; Centre of Expertise (Dr Rameckers), Adelante Rehabilitation Centre, Valkenburg, the Netherlands
| | - Petra Nijmolen
- Maastricht University (Ms Pelckmans), Maastricht, the Netherlands; Dutch Association for Pediatric Physical Therapy (NVFK) (Drs Nijmolen and Bloemen and Ms Kuijpers), Amersfoort, the Netherlands; Research Group Lifestyle and Health (Dr Bloemen), Research Center Healthy Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; Departments of Health Ethics and Society (Dr Meershoek) and Rehabilitation Medicine (Dr Rameckers), Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Rehabilitation Research Centre, Faculty of Rehabilitation Sciences (Dr Rameckers), Hasselt University, Hasselt, Belgium; Centre of Expertise (Dr Rameckers), Adelante Rehabilitation Centre, Valkenburg, the Netherlands
| | - Manon Bloemen
- Maastricht University (Ms Pelckmans), Maastricht, the Netherlands; Dutch Association for Pediatric Physical Therapy (NVFK) (Drs Nijmolen and Bloemen and Ms Kuijpers), Amersfoort, the Netherlands; Research Group Lifestyle and Health (Dr Bloemen), Research Center Healthy Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; Departments of Health Ethics and Society (Dr Meershoek) and Rehabilitation Medicine (Dr Rameckers), Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Rehabilitation Research Centre, Faculty of Rehabilitation Sciences (Dr Rameckers), Hasselt University, Hasselt, Belgium; Centre of Expertise (Dr Rameckers), Adelante Rehabilitation Centre, Valkenburg, the Netherlands
| | - Eline Kuijpers
- Maastricht University (Ms Pelckmans), Maastricht, the Netherlands; Dutch Association for Pediatric Physical Therapy (NVFK) (Drs Nijmolen and Bloemen and Ms Kuijpers), Amersfoort, the Netherlands; Research Group Lifestyle and Health (Dr Bloemen), Research Center Healthy Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; Departments of Health Ethics and Society (Dr Meershoek) and Rehabilitation Medicine (Dr Rameckers), Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Rehabilitation Research Centre, Faculty of Rehabilitation Sciences (Dr Rameckers), Hasselt University, Hasselt, Belgium; Centre of Expertise (Dr Rameckers), Adelante Rehabilitation Centre, Valkenburg, the Netherlands
| | - Agnes Meershoek
- Maastricht University (Ms Pelckmans), Maastricht, the Netherlands; Dutch Association for Pediatric Physical Therapy (NVFK) (Drs Nijmolen and Bloemen and Ms Kuijpers), Amersfoort, the Netherlands; Research Group Lifestyle and Health (Dr Bloemen), Research Center Healthy Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; Departments of Health Ethics and Society (Dr Meershoek) and Rehabilitation Medicine (Dr Rameckers), Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Rehabilitation Research Centre, Faculty of Rehabilitation Sciences (Dr Rameckers), Hasselt University, Hasselt, Belgium; Centre of Expertise (Dr Rameckers), Adelante Rehabilitation Centre, Valkenburg, the Netherlands
| | - Eugene Rameckers
- Maastricht University (Ms Pelckmans), Maastricht, the Netherlands; Dutch Association for Pediatric Physical Therapy (NVFK) (Drs Nijmolen and Bloemen and Ms Kuijpers), Amersfoort, the Netherlands; Research Group Lifestyle and Health (Dr Bloemen), Research Center Healthy Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; Departments of Health Ethics and Society (Dr Meershoek) and Rehabilitation Medicine (Dr Rameckers), Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Rehabilitation Research Centre, Faculty of Rehabilitation Sciences (Dr Rameckers), Hasselt University, Hasselt, Belgium; Centre of Expertise (Dr Rameckers), Adelante Rehabilitation Centre, Valkenburg, the Netherlands
| |
Collapse
|
9
|
Boggs KM, Glew D, Rahman KN, Gao J, Boyle TP, Samuels-Kalow ME, Sullivan AF, Zachrison KS, Camargo CA. Pediatric Telehealth Use in U.S. Emergency Departments in 2019. Telemed J E Health 2023; 29:551-559. [PMID: 36103263 PMCID: PMC10079250 DOI: 10.1089/tmj.2022.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives: Little is known about the recent usage of pediatric telehealth across all emergency departments (EDs) in the United States. Building upon our prior work, we aimed to characterize the usage of ED pediatric telehealth in the pre-COVID-19 era. Methods: The 2019 National ED Inventory-USA survey characterized all U.S. EDs open in 2019. Among EDs reporting receipt of pediatric telehealth services, we selected a random sample (n = 130) for a second survey on pediatric telehealth usage (2019 ED Pediatric Telehealth Survey). We also recontacted a random sample of EDs that responded to a prior, similar 2017 ED Pediatric Telehealth Survey (n = 107), for a total of 237 EDs in the 2019 ED Pediatric Telehealth Survey sample. Results: Overall, 193 (81%) of the 237 EDs responded to the 2019 Pediatric Telehealth Survey. There were 149 responding EDs that confirmed pediatric telehealth receipt in 2019. Among these, few reported ever having a pediatric emergency medicine (PEM) physician (10%) or pediatrician (9%) available for emergency care. Although 96% of EDs reported availability of pediatric telehealth services 24 h per day, 7 days per week, the majority (60%) reported using services less than once per month and 20% reported using services every 3-4 weeks. EDs most frequently used pediatric telehealth to assist with placement and transfer coordination (91%). Conclusions: Most EDs receiving pediatric telehealth in 2019 had no PEM physician or pediatrician available. Most EDs used pediatric telehealth services infrequently. Understanding barriers to assimilation of telehealth once adopted may be important to enable improved access to pediatric emergency care expertise.
Collapse
Affiliation(s)
- Krislyn M. Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dorsey Glew
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kashfia N. Rahman
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jingya Gao
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tehnaz P. Boyle
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Ashley F. Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kori S. Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Rosenthal JL, Ketchersid A, Horath E, Sanders A, Harper TA, Hoyt-Austin AE, Haynes SC. Using human-centered design to develop a nurse-to-family telehealth intervention for pediatric transfers. Digit Health 2023; 9:20552076231219123. [PMID: 38107976 PMCID: PMC10725135 DOI: 10.1177/20552076231219123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Objective To develop a nurse-to-family telehealth intervention for pediatric inter-facility transfers using the human-centered design approach. Methods We conducted the inspiration and ideation phases of a human-centered design process from July 2022 to December 2022. For the inspiration phase, we conducted a qualitative cross-sectional case study design over 3 months. We used thematic analysis with the framework approach of parent and provider interviews. Five team members individually coded transcripts and then met to discuss memos, update a construct summary sheet, and identify emerging themes. The team adapted themes into "How Might We" statements. For the ideation phase, multidisciplinary stakeholders brainstormed solutions to the "How Might We" statements in a design workshop. Workshop findings informed the design of a nurse-to-family telehealth intervention, which was iteratively revised over 2 months based on stakeholder feedback sessions. Results We conducted interviews with nine parents, 11 nurses, and 13 physicians. Four themes emerged supporting the promise of a nurse-to-family telehealth intervention, the need to effectively communicate the intervention purpose, the value of a user-friendly workflow, and the essentiality of ensuring that diverse populations equitably benefit from the intervention. "How Might We" statements were discussed among 22 total workshop participants. Iterative adaptations were made to the intervention until feedback from workshop participants and 67 other stakeholders supported no further improvements were needed. Conclusion Human-centered design phases facilitated stakeholder engagement in developing a nurse-to-family telehealth intervention. This intervention will be tested in an implementation phase as a feasibility and pilot trial.
Collapse
Affiliation(s)
- Jennifer L Rosenthal
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
- Center for Health and Technology, University of California Davis, Sacramento, CA, USA
| | - Audriana Ketchersid
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - Elva Horath
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - April Sanders
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - Thomas A Harper
- Center for Health and Technology, University of California Davis, Sacramento, CA, USA
| | | | - Sarah C Haynes
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| |
Collapse
|
11
|
Mostafaei A, Sadeghi-Ghyassi F, Kabiri N, Hajebrahimi S. Experiences of patients and providers while using telemedicine in cancer care during COVID-19 pandemic: a systematic review and meta-synthesis of qualitative literature. Support Care Cancer 2022; 30:10483-10494. [PMID: 36322247 PMCID: PMC9628519 DOI: 10.1007/s00520-022-07415-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/17/2022] [Indexed: 11/06/2022]
Abstract
Purpose The objective of this meta-synthesis was to identify, appraise, and synthesize patients and provider’s experiences while using telemedicine in cancer care during the COVID-19 pandemic. Methods The databases Medline, Embase, Cinahl, PsycInfo, Web of Science, and other related databases were searched. Reviewers followed the Joanna Briggs Institute (JBI) meta-aggregation method to identify categories and synthesized findings and to assign a level of confidence to synthesized findings. The listed quotations and the original author interpretations were synthesized using MAXQDA software. Results Nineteen studies were included in the meta-synthesis. Three synthesized findings emerged from 243 primary findings: telemedicine assists but cannot be a substitute for face-to-face appointments in a health care crisis and in the provision of routine care to stable patients with cancer, infrastructural drivers and healthcare provider’s support and attention affect patients’ experiences and feelings about telemedicine, and patients who use telemedicine expect their health care providers to devote enough time and consider emotional needs, the lack of which can develop a negative response. The methodological quality of the studies ranged between 4 and 10, and the overall level of confidence of the synthesized findings was determined to be low and medium. Conclusion The findings from this meta-synthesis gave a new insight to promoting the safe and evidence-based use of telemedicine during the current pandemic and future emergencies. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07415-6.
Collapse
Affiliation(s)
- Ali Mostafaei
- grid.412888.f0000 0001 2174 8913Research Center for Evidence‑Based Medicine: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Sadeghi-Ghyassi
- grid.412888.f0000 0001 2174 8913Research Center for Evidence‑Based Medicine: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Kabiri
- grid.412888.f0000 0001 2174 8913Research Center for Evidence‑Based Medicine: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- grid.412888.f0000 0001 2174 8913Research Center for Evidence‑Based Medicine: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
12
|
Whitehead DC, Jaffe T, Hayden E, Zachrison KS. Qualitative Evaluation of Quality Measurement Within Emergency Clinician–staffed Telehealth Programs. Ann Emerg Med 2022; 80:401-407. [DOI: 10.1016/j.annemergmed.2022.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/05/2022] [Accepted: 05/23/2022] [Indexed: 01/05/2023]
|
13
|
Rosenthal JL, Haynes SC, Bonilla B, Rominger K, Williams J, Sanders A, Orqueza Dizon RA, Grether-Jones KL, Marcin JP, Hamline MY. Enhancing the Implementation of the Virtual Pediatric Trauma Center Using Practical, Robust, Implementation and Sustainability Model: A Mixed-Methods Study. TELEMEDICINE REPORTS 2022; 3:137-148. [PMID: 36185467 PMCID: PMC9518803 DOI: 10.1089/tmr.2022.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This article describes factors related to adoption, implementation, and effectiveness of the Virtual Pediatric Trauma Center intervention, which uses telehealth for trauma specialist consultations for seriously injured children. We aimed at (1) measuring RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation outcomes and (2) identifying PRISM (Practical, Robust, Implementation, and Sustainability Model) contextual factors that influenced the implementation outcomes. METHODS This interim implementation evaluation of our telehealth trial used a convergent mixed-methods design. The quantitative component was a cross-sectional analysis of pediatric trauma encounters using electronic health records. The qualitative component was a thematic analysis of written and verbal feedback from providers and family advisory board meetings. We compared the quantitative and qualitative data by synthesizing them in a joint display table, organized by RE-AIM dimensions. We categorized these key findings into the PRISM domains. RESULTS During the first 10 months of this trial, 246 subjects were randomized, with 177 assigned to standard care and 69 assigned to telehealth. Four referring sites transitioned from standard care into their intervention period. PRISM contextual factors that influenced RE-AIM implementation outcomes included the following findings: Providers struggle to remember, interpret, and navigate intervention workflows; providers have preconceived ideas about the intervention purpose; the intervention mitigates parents' anxieties about the transfer process. DISCUSSION This study revealed implementation challenges that influence the overall success of this telehealth trial. Early identification of these challenges allows our team the opportunity to address them now to optimize the intervention reach, adoption, and implementation. This early action will ultimately enhance the success of our trial and the ability of our intervention to achieve broad impact.
Collapse
Affiliation(s)
- Jennifer L. Rosenthal
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Sarah C. Haynes
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Bethney Bonilla
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | - Katherine Rominger
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Jacob Williams
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - April Sanders
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | | | - Kendra L. Grether-Jones
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA
| | - James P. Marcin
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Michelle Y. Hamline
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| |
Collapse
|
14
|
Zachrison KS, Hayden EM, Boggs KM, Boyle TP, Gao J, Samuels-Kalow ME, Marcin JP, Camargo CA. Emergency Departments' Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study. J Med Internet Res 2022; 24:e33981. [PMID: 35723927 PMCID: PMC9254043 DOI: 10.2196/33981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/25/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telehealth for emergency stroke care delivery (telestroke) has had widespread adoption, enabling many hospitals to obtain stroke center certification. Telehealth for pediatric emergency care has been less widely adopted. OBJECTIVE Our primary objective was to determine whether differences in policy or certification requirements contributed to differential uptake of telestroke versus pediatric telehealth. We hypothesized that differences in financial incentives, based on differences in patient volume, prehospital routing policy, and certification requirements, contributed to differential emergency department (ED) adoption of telestroke versus pediatric telehealth. METHODS We used the 2016 National Emergency Department Inventory-USA to identify EDs that were using telestroke and pediatric telehealth services. We surveyed all EDs using pediatric telehealth services (n=339) and a convenience sample of the 1758 EDs with telestroke services (n=366). The surveys characterized ED staffing, transfer patterns, reasons for adoption, and frequency of use. We used bivariate comparisons to examine differences in reasons for adoption and use between EDs with only telestroke services, only pediatric telehealth services, or both. RESULTS Of the 442 EDs surveyed, 378 (85.5%) indicated use of telestroke, pediatric telehealth, or both. EDs with both services were smaller in bed size, volume, and ED attending coverage than those with only telestroke services or only pediatric telehealth services. EDs with telestroke services reported more frequent use, overall, than EDs with pediatric telehealth services: 14.1% (45/320) of EDs with telestroke services reported weekly use versus 2.9% (8/272) of EDs with pediatric telehealth services (P<.001). In addition, 37 out of 272 (13.6%) EDs with pediatric telehealth services reported no consults in the past year. Across applications, the most frequently selected reason for adoption was "improving level of clinical care." Policy-related reasons (ie, for compliance with outside certification or standards or for improving ED performance on quality metrics) were rarely indicated as the most important, but these reasons were indicated slightly more often for telestroke adoption (12/320, 3.8%) than for pediatric telehealth adoption (1/272, 0.4%; P=.003). CONCLUSIONS In 2016, more US EDs had telestroke services than pediatric telehealth services; among EDs with the technology, consults were more frequently made for stroke than for pediatric patients. The most frequently indicated reason for adoption among all EDs was related to clinical care.
Collapse
Affiliation(s)
- Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Krislyn M Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Tehnaz P Boyle
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States
| | - Jingya Gao
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | | | - James P Marcin
- Department of Pediatrics, University of California Davis School of Medicine, University of California, Sacramento, CA, United States
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| |
Collapse
|
15
|
Lu J, Deng Q, Liu W. Effects of Organizational Atmosphere and Organizational Practice on Knowledge, Attitude, and Practice Toward Diffusion and Utilization of Hepatic Contrast-Enhanced Ultrasound Among Physicians. Front Public Health 2022; 10:778253. [PMID: 35372238 PMCID: PMC8964784 DOI: 10.3389/fpubh.2022.778253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Promoting technology diffusion and utilization is a key measure to address the great disparity in technical capacity within integrated health systems. However, even the effectiveness and appropriateness regarding technology has been widely recognized, its diffusion and utilization are still stagnant. The mechanisms that influence the technology from being recognized to being widely applied in practice remain largely unknown. Purpose Taking hepatic contrast-enhanced ultrasound (CEUS) as an example, this study aimed to investigate the comprehensive influencing mechanism of organizational atmosphere and organizational practice on the knowledge, attitude, and practice toward diffusion and utilization of hepatic CEUS in the medical alliance. Methods Based on the integration of organizational ready for change (ORC) and knowledge-attitude-practice (KAP), a structured questionnaire was developed. A multistage random sampling method was applied to investigate physicians who directly use CEUS working at the liver disease-related departments of sampled health institutions. Structural equation modeling (SEM) was used to verify the proposed hypotheses, and determine the relationship between the factors. Results In total, 292 physicians were included. SEM results demonstrated that knowledge influenced both attitude and practice, while attitude positively predicted practice. Organizational practice and organizational atmosphere associated positively with each other. Organizational atmosphere positively affected the physicians' attitude toward CEUS diffusion and utilization (β = 0.425, p < 0.001), while organizational practice positively affected corresponding knowledge (β = 0.423, p < 0.001) and practice (β = 0.275, p < 0.001). Additionally, there was a partial mediating effect between organizational practice and physicians' CEUS diffusion and utilization behavior. Conclusion By verifying the influencing mechanism of organizational atmosphere and organizational practice on the physicians' KAP of hepatic CEUS diffusion and utilization, this study benefit tailoring strategies for promoting technology diffusion and utilization within medical alliance. It is recommended to develop an organizational atmosphere of advocating technology innovation, establish organizational support mechanism (SM) with multiple concrete supporting countermeasures, and so on.
Collapse
Affiliation(s)
| | | | - Wenbin Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, China
| |
Collapse
|
16
|
Delivering Urgent Care Using Telemedicine: Insights from Experienced Clinicians at Academic Medical Centers. J Gen Intern Med 2022; 37:707-713. [PMID: 34919208 PMCID: PMC8680069 DOI: 10.1007/s11606-020-06395-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/03/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Care delivered using telemedicine has been steadily growing in the USA but represented a small fraction of overall visits before the COVID-19 pandemic as few clinicians had been providing care using telemedicine. Understanding how experienced clinicians have practiced telemedicine can help guide today's exponential adoption of telemedicine. OBJECTIVE The objective of this study was to explore barriers and facilitators to providing effective, high-quality urgent care using telemedicine ("tele-urgent care") from the perspective of clinicians experienced in telemedicine. APPROACH We conducted semi-structured interviews between July 2018 and March 2019 of clinicians who had been providing tele-urgent care services to patients as a part of their routine clinical practice. Themes were identified using content analysis with a constant comparative coding approach. KEY RESULTS Among the 20 clinicians interviewed, the majority were female (90%) and nurse practitioners (65%). We identified four themes related to barriers and facilitators to providing effective, high-quality tele-urgent care. Workplace factors such as a strong information technology (IT) infrastructure, real-time IT support, an electronic health record, and a collegial work environment, often virtual, were necessary standards. Communication and exam techniques from in-person encounters were adapted to tele-urgent care including active listening skills and teaching patients to conduct specific exam maneuvers virtually. The convenience of tele-urgent care should be preserved to support improvements in access to care. Finally, patients and clinicians occasionally had mismatched expectations about what could or would be provided during a tele-urgent care encounter. Managing the added tension that can occur during a telemedicine encounter was important. CONCLUSION As telemedicine becomes an integral part of the care continuum, incorporating and accounting for these key insights when we train and support clinicians will be necessary to provide effective, high-quality care to patients in the future.
Collapse
|
17
|
Kubota T, Kuroda N, Horinouchi T, Ikegaya N, Kitazawa Y, Kodama S, Kuramochi I, Matsubara T, Nagino N, Neshige S, Soga T, Takayama Y, Sone D. Barriers to telemedicine among physicians in epilepsy care during the COVID-19 pandemic: A national-level cross-sectional survey in Japan. Epilepsy Behav 2022; 126:108487. [PMID: 34922326 PMCID: PMC9759923 DOI: 10.1016/j.yebeh.2021.108487] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to investigate the factors affecting the unwillingness of physicians involved in epilepsy care to continue telemedicine during the coronavirus disease 2019 (COVID-19) pandemic in Japan. METHOD This was a national-level cross-sectional survey initiated by Japan Young Epilepsy Section (YES-Japan) which is a national chapter of The Young Epilepsy Section of the International League Against Epilepsy (ILAE-YES). We asked physicians who conducted telemedicine in patients with epilepsy (PWE) during the COVID-19 pandemic at four clinics and 21 hospitals specializing in epilepsy care in Japan from March 1 to April 30, 2021. The following data were collected: (1) participant profile, (2) characteristics of PWE treated by telemedicine, and (3) contents and environmental factors of telemedicine. Statistically significant variables (p < 0.05) in the univariate analysis were analyzed in a multivariate binary logistic regression model to detect the independently associated factors with the unwillingness to continue telemedicine. RESULT Among the 115 respondents (response rate: 64%), 89 were included in the final analysis. Of them, 60 (67.4%) were willing to continue telemedicine, and 29 (32.6%) were unwilling. In the univariate binary logistic regression analysis, age (Odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.10-3.09, p = 0.02), psychiatrist (OR = 5.88, 95% CI 2.15-16.08, p = 0.001), hospital (OR = 0.10, 95% CI 0.01-0.94, p = 0.04), the number of COVID-19 risk factors in the participant (OR = 2.88, 95% CI 1.46-5.69, p = 0.002), the number of COVID-19 risk factors in the cohabitants (OR = 2.52, 95% CI 1.05-6.01, p = 0.04), COVID-19 epidemic area (OR = 4.37, 95% CI 1.18-16.20, p = 0.03), consultation time during telemedicine (OR = 2.51, 95% CI 1.32-4.76, p = 0.005), workload due to telemedicine (OR = 4.17, 95% CI 2.11-8.24, p < 0.001) were statistically significant. In the multivariate binary logistic regression analysis, workload due to telemedicine (OR = 4.93, 95% CI 1.96-12.35) was independently associated with the unwillingness to continue telemedicine. CONCLUSION This national-level cross-sectional survey found that workload due to telemedicine among physicians involved in epilepsy care was independently associated with the unwillingness to continue telemedicine.
Collapse
Affiliation(s)
- Takafumi Kubota
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Neurology, University Hospitals of Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Naoto Kuroda
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan,Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Toru Horinouchi
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Psychiatry and Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Naoki Ikegaya
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan.
| | - Yu Kitazawa
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Neurology and Stroke Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Satoshi Kodama
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Izumi Kuramochi
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Teppei Matsubara
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Naoto Nagino
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Epilepsy Center, TMG Asaka Medical Center, Asaka, Saitama, Japan
| | - Shuichiro Neshige
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan
| | - Temma Soga
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan,Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yutaro Takayama
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Daichi Sone
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| |
Collapse
|
18
|
Alodhayani AA, Hassounah MM, Qadri FR, Abouammoh NA, Ahmed Z, Aldahmash AM. Culture-Specific Observations in a Saudi Arabian Digital Home Health Care Program: Focus Group Discussions With Patients and Their Caregivers. J Med Internet Res 2021; 23:e26002. [PMID: 34889740 PMCID: PMC8701718 DOI: 10.2196/26002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/09/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background There is growing evidence of the need to consider cultural factors in the design and implementation of digital health interventions. However, there is still inadequate knowledge pertaining to the aspects of the Saudi Arabian culture that need to be considered in the design and implementation of digital health programs, especially in the context of home health care services for patients who are chronically and terminally ill. Objective This study aims to explore the specific cultural factors related to patients and their caregivers from the perspective of physicians, nurses, and trainers that have influenced the pilot implementation of Remotely Accessible Healthcare At Home, a connected health program in the Home Health Care department at King Saud University Medical City, Riyadh, Saudi Arabia. Methods A qualitative study design was adopted to conduct a focus group discussion in July 2019 using a semistructured interview guide with 3 female and 4 male participants working as nurses, family physicians, and information technologists. Qualitative data obtained were analyzed using a thematic framework analysis. Results A total of 2 categories emerged from the focus group discussion that influenced the experiences of digital health program intervention: first, culture-related factors including language and communication, cultural views on using cameras during consultation, nonadherence to web-based consultations, and family role and commitment and second, caregiver characteristics in telemedicine that includes their skills and education and electronic literacy. Participants of this study revealed that indirect contact with patients and their family members may work as a barrier to proper communication through the Remotely Accessible Healthcare At Home program. Conclusions We recommend exploring the use of interpreters in digital health, creating awareness among the local population regarding privacy in digital health, and actively involving direct family members with the health care providers.
Collapse
Affiliation(s)
- Abdulaziz A Alodhayani
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Marwah Mazen Hassounah
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fatima R Qadri
- Prince Naif Bin Abdulaziz Health Research Center, King Saud University, Riyadh, Saudi Arabia.,Medical Researches Company, iResearch, Riyadh, Saudi Arabia
| | - Noura A Abouammoh
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zakiuddin Ahmed
- Prince Naif Bin Abdulaziz Health Research Center, King Saud University, Riyadh, Saudi Arabia.,Riphah Institute of Healthcare Improvement & Safety, Riphah International University, Islamabad, Pakistan
| | - Abdullah M Aldahmash
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,College of Medicine, Vision Colleges, Riyadh, Saudi Arabia
| |
Collapse
|
19
|
Finkelstein JB, Tremblay ES, Van Cain M, Farber-Chen A, Schumann C, Brown C, Shah AS, Rhodes ET. Pediatric Clinicians' Use of Telemedicine: Qualitative Interview Study. JMIR Hum Factors 2021; 8:e29941. [PMID: 34860669 PMCID: PMC8686477 DOI: 10.2196/29941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/05/2021] [Accepted: 08/31/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Bedside manner describes how clinicians relate to patients in person. Telemedicine allows clinicians to connect virtually with patients using digital tools. Effective virtual communication or webside manner may require modifications to traditional bedside manner. OBJECTIVE This study aims to understand the experiences of telemedicine providers with patient-to-provider virtual visits and communication with families at a single large-volume children's hospital to inform program development and training for future clinicians. METHODS A total of 2 focus groups of pediatric clinicians (N=11) performing virtual visits before the COVID-19 pandemic, with a range of experiences and specialties, were engaged to discuss experiential, implementation, and practice-related issues. Focus groups were facilitated using a semistructured guide covering general experience, preparedness, rapport strategies, and suggestions. Sessions were digitally recorded, and the corresponding transcripts were reviewed for data analysis. The transcripts were coded based on the identified main themes and subthemes. On the basis of a higher-level analysis of these codes, the study authors generated a final set of key themes to describe the collected data. RESULTS Theme consistency was identified across diverse participants, although individual clinician experiences were influenced by their specialties and practices. A total of 3 key themes emerged regarding the development of best practices, barriers to scalability, and establishing patient rapport. Issues and concerns related to privacy were salient across all themes. Clinicians felt that telemedicine required new skills for patient interaction, and not all were comfortable with their training. CONCLUSIONS Telemedicine provides benefits as well as challenges to health care delivery. In interprofessional focus groups, pediatric clinicians emphasized the importance of considering safety and privacy to promote rapport and webside manner when conducting virtual visits. The inclusion of webside manner instructions within training curricula is crucial as telemedicine becomes an established modality for providing health care.
Collapse
Affiliation(s)
- Julia B Finkelstein
- Department of Urology, Boston Children's Hospital, Boston, MA, United States
| | - Elise S Tremblay
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States
| | - Melissa Van Cain
- Department of Medical Informatics, School of Community Medicine, University of Oklahoma, Tulsa, OK, United States
| | - Aaron Farber-Chen
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Caitlin Schumann
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Christina Brown
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Ankoor S Shah
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States.,Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Erinn T Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States
| |
Collapse
|
20
|
Hayden EM, Davis C, Clark S, Joshi AU, Krupinski EA, Naik N, Ward MJ, Zachrison KS, Olsen E, Chang BP, Burner E, Yadav K, Greenwald PW, Chandra S. Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine. Acad Emerg Med 2021; 28:1452-1474. [PMID: 34245649 PMCID: PMC11150898 DOI: 10.1111/acem.14330] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Telehealth has the potential to significantly change the specialty of emergency medicine (EM) and has rapidly expanded in EM during the COVID pandemic; however, it is unclear how EM should intersect with telehealth. The field lacks a unified research agenda with priorities for scientific questions on telehealth in EM. METHODS Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in EM and telehealth created a research agenda for the topic. The multiyear process used a modified Delphi technique to develop research questions related to telehealth in EM. Research questions were excluded from the final research agenda if they did not meet a threshold of at least 80% of votes indicating "important" or "very important." RESULTS Round 1 of voting included 94 research questions, expanded to 103 questions in round 2 and refined to 36 questions for the final vote. Consensus occurred with a final set of 24 important research questions spanning five breakout group topics. Each breakout group domain was represented in the final set of questions. Examples of the questions include: "Among underserved populations, what are mechanisms by which disparities in emergency care delivery may be exacerbated or ameliorated by telehealth" (health care access) and "In what situations should the quality and safety of telehealth be compared to in-person care and in what situations should it be compared to no care" (quality and safety). CONCLUSION The primary finding from the process was the breadth of gaps in the evidence for telehealth in EM and telehealth in general. Our consensus process identified priority research questions for the use of and evaluation of telehealth in EM to fill the current knowledge gaps. Support should be provided to answer the research questions to guide the evidenced-based development of telehealth in EM.
Collapse
Affiliation(s)
- Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Aditi U Joshi
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Neel Naik
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erica Olsen
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Kabir Yadav
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peter W Greenwald
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shruti Chandra
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
21
|
Leventer-Roberts M, Shimoni N, Feldman B, Bachrach A, Selah T, Wolff L, Waisman Y. Diagnoses and Health Care Utilization for After-Hours Telemedicine Versus Primary Care Visits. Acad Pediatr 2021; 21:1414-1419. [PMID: 34284149 DOI: 10.1016/j.acap.2021.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The use of a nation-wide, pediatricians online (PO) after-hours telemedicine service has been offered in Israel for more than a decade. We sought to compare PO visits with those to the primary care pediatrician (PCP). METHODS This is a retrospective cross-sectional study using Israel's largest health care provider database. We included children aged 0 to 18 years using either PO or PCP between 2015 and 2018. We compared the baseline characteristics, matching by socioeconomic status, chronic illness, and diagnosis, and compared their admission rates, laboratory testing, and medication prescription. RESULTS During this study period there were 262,541 PO visits and a random 10% sample of PCP visits which yielded 1,813,103 visits. Users of PO were more likely to have a higher socioeconomic status (43% vs 28.9%), fever (13.3% vs 4.4%) and less likely to have acute respiratory conditions (8.8% vs 16.7%). Users of PO had higher rates of emergency department admissions (2.9% vs 0.4%), hospital admissions (0.9% vs 0.2%), and lower rates of laboratory testing (3.7% vs 7.4%) and medication prescription (42.0% vs 52.0%) within 24 hours. All differences were statistically significant (P < .005). CONCLUSIONS Our pediatric telemedicine service operating after-hours has been found to be feasible, and widely used, for a myriad of clinical conditions. Significant differences exist between PO and PCP visit characteristics and outcomes. However, it remained unclear whether these differences reflect the difference in the patient population or whether they are the result of the different clinical services. Further research is warranted to clarify this matter.
Collapse
Affiliation(s)
- Maya Leventer-Roberts
- Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai (M Leventer-Roberts), New York, NY; Clalit Research Institute (M Leventer-Roberts, N Shimoni, B Feldman, and A Bachrach), Tel Aviv, Israel.
| | - Nadav Shimoni
- Clalit Research Institute (M Leventer-Roberts, N Shimoni, B Feldman, and A Bachrach), Tel Aviv, Israel
| | - Becca Feldman
- Clalit Research Institute (M Leventer-Roberts, N Shimoni, B Feldman, and A Bachrach), Tel Aviv, Israel
| | - Asaf Bachrach
- Clalit Research Institute (M Leventer-Roberts, N Shimoni, B Feldman, and A Bachrach), Tel Aviv, Israel
| | - Tomer Selah
- Clalit Health Services (T Selah, L Wolff, and Y Waisman), Tel Aviv, Israel
| | - Leor Wolff
- Clalit Health Services (T Selah, L Wolff, and Y Waisman), Tel Aviv, Israel
| | - Yehezkel Waisman
- Clalit Health Services (T Selah, L Wolff, and Y Waisman), Tel Aviv, Israel
| |
Collapse
|
22
|
Thiel B, Iao I, Smid J, de Wit E, Koopman S, Geerts B, Godfried M, Kalkman C. The adoption of a postoperative pain self-report tool, a qualitative study (Preprint). JMIR Hum Factors 2021; 9:e33706. [PMID: 35471472 PMCID: PMC9092239 DOI: 10.2196/33706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background With electronic technologies, patients are provided with tools to easily acquire information and to manage and record their own health status. eHealth interventions are already broadly applied to perioperative care. In a similar way, we aimed to utilize a smartphone application to enable postoperative patients to partially self-manage their postoperative pain. The results of a previously performed proof-of-concept study regarding the application were promising, and nurses as well as patients were optimistic regarding this innovative mobile application. Nevertheless, in reality, it appears that the usage and overall implementation of this application have stagnated since its introduction. Problems with innovation adoption are not novel; various studies have been conducted to explore the reasons for low implementation success of eHealth applications and indicated that adoption is influenced by multiple organizational factors. This study investigated the influence of these organizational factors on the adoption process, aiming to provide more insight in the dos and don’ts for implementing eHealth in the working processes of hospital care. Objective This study aimed to provide insight in how to successfully implement a technological eHealth innovation in a general nonacademic hospital. Methods A qualitative study was conducted to explore organizational factors affecting the innovation adoption process. Data were collected by conducting semistructured one-on-one interviews with 11 stakeholders. The data were analyzed using thematic analysis identifying overarching themes. Results Absorptive capacity, referred to as an organization’s dynamic capability pertaining to knowledge creation and utilization that enhances an organization’s ability to gain and sustain a competitive advantage, was regarded as the most influential factor on the application’s adoption. Accordingly, it appeared that innovation adoption is mainly determined by the capability and willingness to assimilate and transform new information into productive use and the ability to absorb a novel innovation. Absorptive capacity was found to be influenced by the innovation’s benefit and the sense of ownership and responsibility. Organizational readiness and management support were also regarded as essential since absorptive capacity seemed to be mediated by these factors. The size of the hospital influenced eHealth adoption by the amount of resources available and by its organizational structure. Conclusions In conclusion, absorptive capacity is essential for eHealth adoption, and it is mediated by management support and organizational readiness. It is recommended to increase the degree of willingness and ability to adopt an eHealth innovation by enhancing the relevance, engaging stakeholders, and assigning appropriate leaders to offer guidance.
Collapse
Affiliation(s)
- Bram Thiel
- Department of Anesthesiology, OLVG Hospital, Amsterdam, Netherlands
| | - Inez Iao
- Department of Services and Solutions Delivery, Philips Benelux, Amsterdam, Netherlands
| | - Joris Smid
- Department of Cardiology, OLVG Hospital, Amsterdam, Netherlands
| | - Emmy de Wit
- Faculty of Science, Athena Institute, Vu University, Amsterdam, Netherlands
| | - Seppe Koopman
- Department of Anesthesiology, Maasstad Hospital, Rotterdam, Netherlands
| | - Bart Geerts
- Department of Intensive Care, Spaarne Gasthuis Hospital, Haarlem, Netherlands
| | - Marc Godfried
- Department of Anesthesiology, OLVG Hospital, Amsterdam, Netherlands
| | - Cor Kalkman
- Department of Anesthesia and Intensive Care, University Medical Centre Utrecht, Utrecht, Netherlands
| |
Collapse
|
23
|
Liu J, Liu S, Zheng T, Bi Y. Physicians' Perspectives of Telemedicine During the COVID-19 Pandemic in China: Qualitative Survey Study. JMIR Med Inform 2021; 9:e26463. [PMID: 33945493 PMCID: PMC8171288 DOI: 10.2196/26463] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/08/2021] [Accepted: 05/03/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Generalized restriction of movement due to the COVID-19 pandemic, together with unprecedented pressure on the health system, has disrupted routine care for non-COVID-19 patients. Telemedicine should be vigorously promoted to reduce the risk of infections and to offer medical assistance to restricted patients. OBJECTIVE The purpose of this study was to understand physicians' attitudes toward and perspectives of telemedicine during and after the COVID-19 pandemic, in order to provide support for better implementation of telemedicine. METHODS We surveyed all physicians (N=148), from October 17 to 25, 2020, who attended the clinical informatics PhD program at West China Medical School, Sichuan University, China. The physicians came from 57 hospitals in 16 provinces (ie, municipalities) across China, 54 of which are 3A-level hospitals, two are 3B-level hospitals, and one is a 2A-level hospital. RESULTS Among 148 physicians, a survey response rate of 87.2% (129/148) was attained. The average age of the respondents was 35.6 (SD 3.9) years (range 23-48 years) and 67 out of 129 respondents (51.9%) were female. The respondents come from 37 clinical specialties in 55 hospitals located in 14 provinces (ie, municipalities) across Eastern, Central, and Western China. A total of 94.6% (122/129) of respondents' hospitals had adopted a telemedicine system; however, 34.1% (44/129) of the physicians had never used a telemedicine system and only 9.3% (12/129) used one frequently (≥1 time/week). A total of 91.5% (118/129) and 88.4% (114/129) of physicians were willing to use telemedicine during and after the COVID-19 pandemic, respectively. Physicians considered the inability to examine patients in person to be the biggest concern (101/129, 78.3%) and the biggest barrier (76/129, 58.9%) to implementing telemedicine. CONCLUSIONS Telemedicine is not yet universally available for all health care needs and has not been used frequently by physicians in this study. However, the willingness of physicians to use telemedicine was high. Telemedicine still has many problems to overcome.
Collapse
Affiliation(s)
- Jialin Liu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Siru Liu
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Tao Zheng
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Yongdong Bi
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
24
|
Chen Y, Kathirithamby DR, Li J, Candelario-Velazquez C, Bloomfield A, Ambrose AF. Telemedicine in the Coronavirus Disease 2019 Pandemic: A Pediatric Rehabilitation Perspective. Am J Phys Med Rehabil 2021; 100:321-326. [PMID: 33480609 DOI: 10.1097/phm.0000000000001698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
ABSTRACT In the spring of 2020, coronavirus disease 2019 evolved into a worldwide pandemic, forcing traditional face-to-face healthcare to a standstill. Telemedicine was quickly adopted as a major tool for pediatric rehabilitation services. This article describes the national legislative response of the United States to the coronavirus disease 2019 pandemic and the opportunities and challenges of implementing telemedicine in pediatric rehabilitation outpatient settings, consultations, as well as physician and patient education. The feasibility of performing a remote pediatric musculoskeletal and neurological tele-evaluation is also discussed. Although challenges exist, telemedicine has demonstrated its potential and has proven to be a practical system. Future developments in technology and accessibility, in addition to support from government and third-party payers, have the potential to make telemedicine an effective and vital platform in a coordinated healthcare system.
Collapse
Affiliation(s)
- Yuxi Chen
- From the Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | | | | | | | | |
Collapse
|
25
|
Tully L, Case L, Arthurs N, Sorensen J, Marcin JP, O'Malley G. Barriers and Facilitators for Implementing Paediatric Telemedicine: Rapid Review of User Perspectives. Front Pediatr 2021; 9:630365. [PMID: 33816401 PMCID: PMC8010687 DOI: 10.3389/fped.2021.630365] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: COVID-19 has brought to the fore an urgent need for secure information and communication technology (ICT) supported healthcare delivery, as the pertinence of infection control and social distancing continues. Telemedicine for paediatric care warrants special consideration around logistics, consent and assent, child welfare and communication that may differ to adult services. There is no systematic evidence synthesis available that outlines the implementation issues for incorporating telemedicine to paediatric services generally, or how users perceive these issues. Methods: We conducted a rapid mixed-methods evidence synthesis to identify barriers, facilitators, and documented stakeholder experiences of implementing paediatric telemedicine, to inform the pandemic response. A systematic search was undertaken by a research librarian in MEDLINE for relevant studies. All identified records were blind double-screened by two reviewers. Implementation-related data were extracted, and studies quality appraised using the Mixed-Methods Appraisal Tool. Qualitative findings were analysed thematically and then mapped to the Consolidated Framework for Implementation Research. Quantitative findings about barriers and facilitators for implementation were narratively synthesised. Results: We identified 27 eligible studies (19 quantitative; 5 mixed-methods, 3 qualitative). Important challenges highlighted from the perspective of the healthcare providers included issues with ICT proficiency, lack of confidence in the quality/reliability of the technology, connectivity issues, concerns around legal issues, increased administrative burden and/or fear of inability to conduct thorough examinations with reliance on subjective descriptions. Facilitators included clear dissemination of the aims of ICT services, involvement of staff throughout planning and implementation, sufficient training, and cultivation of telemedicine champions. Families often expressed preference for in-person visits but those who had tried tele-consultations, lived far from clinics, or perceived increased convenience with technology considered telemedicine more favourably. Concerns from parents included the responsibility of describing their child's condition in the absence of an in-person examination. Discussion: Healthcare providers and families who have experienced tele-consultations generally report high satisfaction and usability for such services. The use of ICT to facilitate paediatric healthcare consultations is feasible for certain clinical encounters and can work well with appropriate planning and quality facilities in place.
Collapse
Affiliation(s)
- Louise Tully
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Lucinda Case
- W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Niamh Arthurs
- W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James P. Marcin
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Grace O'Malley
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| |
Collapse
|
26
|
Schinasi DA, Atabaki SM, Lo MD, Marcin JP, Macy M. Telehealth in pediatric emergency medicine. Curr Probl Pediatr Adolesc Health Care 2021; 51:100953. [PMID: 33551336 DOI: 10.1016/j.cppeds.2021.100953] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Modern technologies and contemporary clinical practice have set the stage for the integration of telehealth into existing models of healthcare. These models of telehealth care offer novel opportunities for advancing pediatric emergency care. In this manuscript, we introduce applications of telehealth in pediatric emergency medicine (PEM) with the pediatric emergency department (ED) both as originating site and distant site. We present barriers to adoption, implementation, and sustaining PEM telehealth programs, as well as strategies to overcome those. We discuss cost and finances as well as policy considerations and implications. Lastly, we review strategies for evaluation to assess program impact and ensure sustainability.
Collapse
Affiliation(s)
- Dana A Schinasi
- Department of Pediatrics, Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, United States; Telehealth Programs, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 32, Chicago, IL 60611-2605, United States.
| | - Shireen M Atabaki
- Division of Emergency Medicine, Telemedicine Program, Children's National Medical Center, Washington, DC, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Mark D Lo
- Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, United States; Telehealth Center, Seattle Children's Hospital, United States
| | - James P Marcin
- Department of Pediatrics, Division of Critical Care Medicine, University of California Davis School of Medicine, United States
| | - Michelle Macy
- Department of Pediatrics, Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, United States; Telehealth Programs, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 32, Chicago, IL 60611-2605, United States; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, United States
| |
Collapse
|
27
|
Sasangohar F, Bradshaw MR, Carlson MM, Flack JN, Fowler JC, Freeland D, Head J, Marder K, Orme W, Weinstein B, Kolman JM, Kash B, Madan A. Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective. J Med Internet Res 2020; 22:e22523. [PMID: 32936768 PMCID: PMC7546859 DOI: 10.2196/22523] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/04/2020] [Accepted: 09/14/2020] [Indexed: 01/05/2023] Open
Abstract
As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients' home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients' home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.
Collapse
Affiliation(s)
- Farzan Sasangohar
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Major R Bradshaw
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | | | - James N Flack
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - James C Fowler
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Diana Freeland
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - John Head
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Kate Marder
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - William Orme
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Benjamin Weinstein
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Jacob M Kolman
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Bita Kash
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Alok Madan
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| |
Collapse
|
28
|
Rosenthal JL, Sauers-Ford HS, Snyder M, Hamline MY, Benton AS, Joo S, Natale JE, Plant JL. Testing Pediatric Emergency Telemedicine Implementation Strategies Using Quality Improvement Methods. Telemed J E Health 2020; 27:459-463. [PMID: 32580661 DOI: 10.1089/tmj.2020.0067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Despite the recognized benefits of telemedicine use for pediatric emergency consultations, there are barriers to the widespread uptake of this technology. Quality improvement methods can be used to rapidly test implementation strategies. Our objective was to test telemedicine implementation strategies in real-world application using quality improvement methods. Our quality improvement aim was to achieve high rates of telemedicine use for pediatric transfer consultations. Methods: A multidisciplinary multisite improvement team identified that key drivers of increasing telemedicine use included telemedicine resource awareness, streamlined telemedicine workflow, provider buy-in, and data transparency. Interventions focused on telemedicine trainings, disseminating telemedicine uptake data, telemedicine reminders, telemedicine test calls, and preparing for telemedicine use for every transfer consultation. The outcome measure was percentage of pediatric emergency transfer consultations that used telemedicine. The balancing measure was time (minutes) from the initial transfer center call to completion of the consultation. Results: Multiple plan-do-study-act cycles were associated with special cause variation, with an upward shift in mean percentage of telemedicine use from 5% to 22%. Time from initial call to consultation completion remained unchanged. Conclusion: Our study supports the use of quality improvement methods to test telemedicine implementation strategies for pediatric telemedicine emergency consultations.
Collapse
Affiliation(s)
- Jennifer L Rosenthal
- Department of Pediatrics, University of California at Davis, Sacramento, California, USA
| | - Hadley S Sauers-Ford
- Department of Pediatrics, University of California at Davis, Sacramento, California, USA
| | - Moina Snyder
- Department of Pediatrics, Lodi Memorial Hospital, Lodi, California, USA
| | - Michelle Y Hamline
- Department of Pediatrics, University of California at Davis, Sacramento, California, USA
| | - Angela S Benton
- Department of Pediatrics, Lodi Memorial Hospital, Lodi, California, USA
| | - Sharon Joo
- Department of Pediatrics, Mercy Medical Center Redding Hospital, Redding, California, USA
| | - JoAnne E Natale
- Department of Pediatrics, University of California at Davis, Sacramento, California, USA
| | - Jennifer L Plant
- Department of Pediatrics, University of California at Davis, Sacramento, California, USA
| |
Collapse
|
29
|
Jacob C, Sanchez-Vazquez A, Ivory C. Social, Organizational, and Technological Factors Impacting Clinicians' Adoption of Mobile Health Tools: Systematic Literature Review. JMIR Mhealth Uhealth 2020; 8:e15935. [PMID: 32130167 PMCID: PMC7059085 DOI: 10.2196/15935] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/03/2019] [Accepted: 12/31/2019] [Indexed: 01/22/2023] Open
Abstract
Background There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success. Objective The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians’ adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives. Methods A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process. Results The technological factors impacting clinicians’ adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits.
Collapse
Affiliation(s)
- Christine Jacob
- Anglia Ruskin University, Cambridge, United Kingdom.,University of Applied Sciences Northwestern Switzerland, Brugg, Switzerland
| | - Antonio Sanchez-Vazquez
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| |
Collapse
|
30
|
Jacob C, Sanchez-Vazquez A, Ivory C. Social, Organizational, and Technological Factors Impacting Clinicians' Adoption of Mobile Health Tools: Systematic Literature Review. JMIR Mhealth Uhealth 2020. [PMID: 32130167 DOI: 10.2196/preprints.15935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success. OBJECTIVE The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians' adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives. METHODS A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process. RESULTS The technological factors impacting clinicians' adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. CONCLUSIONS The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits.
Collapse
Affiliation(s)
- Christine Jacob
- Anglia Ruskin University, Cambridge, United Kingdom
- University of Applied Sciences Northwestern Switzerland, Brugg, Switzerland
| | - Antonio Sanchez-Vazquez
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| |
Collapse
|
31
|
A Qualitative Analysis of General Emergency Medicine Providers' Perceptions on Pediatric Emergency Telemedicine. Pediatr Emerg Care 2019; 35:856-861. [PMID: 28225376 DOI: 10.1097/pec.0000000000001067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Most children in the United States are evaluated in general emergency departments (ED), which are staffed by practitioners who care for both adults and children and may have limited pediatric resources. The application of telemedicine in pediatrics is growing and has been shown to be effective in outpatient as well as critical care settings. Telemedicine has the potential to address disparities in access to pediatric emergency care. The objective of this study was to explore experiences of general ED providers with telemedicine and their perception about a potential video telemedicine program with pediatric ED providers. METHODS Using qualitative methods, a purposeful sample of general ED providers (attending physicians and physician assistants) in 3 Connecticut hospitals participated in audio-recorded semistructured interviews. In line with grounded theory, 3 researchers independently coded transcripts, collectively refined codes, and created themes. Data collection and analysis continued in an iterative manner, past the point of theoretical saturation. RESULTS Eighteen general ED providers were interviewed. Three themes were identified: (a) familiarity with use in adult stroke patients but limited practical experience with telemedicine; (b) potential uses for pediatric telemedicine (guiding pediatric differential diagnosis and management, visual diagnosis, alleviating provider fears, low-frequency high-stakes events, determining disposition, assessing level of illness, and access to subspecialty consultation); and (c) limitations of telemedicine (infrequent need and implementation barriers). CONCLUSIONS General ED providers identified 7 specific potential uses of pediatric emergency video telemedicine. However, they also identified several limitations of telemedicine in caring for pediatric emergency patients. Further studies after implementation of telemedicine program and comparing provider perceptions with actual practice may be helpful. Furthermore, studies on telemedicine's effect on patient-related outcomes and studies on cost-effectiveness might be necessary before the widespread implementation of a telemedicine program.
Collapse
|
32
|
Mouzoon JL, Lloyd-McLennan A, Marcin JP. Emergency Medicine Physicians' Perceptions of Pediatric Tele-Emergency Services. Telemed J E Health 2019; 26:955-958. [PMID: 31621515 DOI: 10.1089/tmj.2019.0121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: This study evaluated general emergency medicine (GEM) physicians' opinions on the barriers, perceptions, and utility of pediatric tele-emergency services, or the use of telemedicine for critically ill children in the emergency department (ED). Methods: Based on previously published surveys, a 27-item survey was created to assess GEM physicians' perspective on tele-emergency services provided by a regional group of pediatric critical care physicians. The survey was distributed to ED medical directors at 15 hospitals who actively participate in tele-emergency services. Results: Twelve of the 15 medical directors responded to the survey (80%). Results demonstrated that GEM physicians consider the pediatric critical care tele-emergency consultations clinically helpful (92%), particularly for the management of patients with respiratory distress, congenital anomalies, and cardiovascular processes. The most common barriers to using tele-emergency services included limited time (42%), integrating new technology and processes in existing workflows (42%), and the lack of clinical utility (42%), particularly for patients with nonacute and/or routine conditions. Lastly, half of GEM physicians felt that families preferred telemedicine to telephone consultations (50%). Conclusion: GEM physicians support the premise that pediatric tele-emergency services help with the clinical management of critically ill children. However, physicians do not consistently believe that tele-emergency services are always clinically necessary and time constraints continue to be a significant barrier. Selected use on specific clinical conditions and improving the integration in workflow processes would help increase the appropriate use of tele-emergency services in the ED.
Collapse
Affiliation(s)
- Jamie L Mouzoon
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Allison Lloyd-McLennan
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California, USA
| | - James P Marcin
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California, USA
| |
Collapse
|
33
|
Sauers‐Ford HS, Hamline MY, Gosdin MM, Kair LR, Weinberg GM, Marcin JP, Rosenthal JL. Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program. Acad Emerg Med 2019; 26:1022-1033. [PMID: 30974004 DOI: 10.1111/acem.13763] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/04/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric emergency telemedicine consultations have been shown to provide support to community emergency departments treating critically ill pediatric patients. However, despite the recognized value of telemedicine, adoption has been slow. To determine why clinicians frequently do not use telemedicine when it is available for pediatric patients, as well as to learn how to improve telemedicine programs, we conducted a qualitative study using stakeholder interviews. METHODS We conducted a qualitative study using grounded theory methodology, with in-depth interviews of referring and accepting physicians and referring, transport, and transfer center nurses. We analyzed data iteratively and adapted the interview guide based on early interviews. We solicited feedback from the participants on the conceptual model. RESULTS Sixteen interviews were conducted; all respondents had been involved in a telemedicine consultation at least five times, with some having used telemedicine more than 30 times. Analysis resulted in three themes: 1) recognizing and addressing telemedicine biases are central to gaining buy-in; 2) as technology advances, telemedicine processes need to adapt accordingly; and 3) telemedicine increases collaboration among health care providers and patients/families in the patient care process. CONCLUSIONS To improve patient care through increased use of telemedicine for pediatric emergency consultations, processes need to be modified to address provider biases and end-user concerns. Processes should be adapted to allow users to utilize a variety of technologies (including smartphones) and to enable more users, such as nurses, to participate. Finally, telemedicine can be used to improve the patient and family experience by including them in consultations.
Collapse
Affiliation(s)
| | | | - Melissa M. Gosdin
- Center for Healthcare Policy and Research University of California Davis Sacramento CA
| | - Laura R. Kair
- Department of Pediatrics University of California Davis Sacramento CA
| | - Gary M. Weinberg
- Center for Healthcare Policy and Research University of California Davis Sacramento CA
| | - James P. Marcin
- Department of Pediatrics University of California Davis Sacramento CA
| | | |
Collapse
|
34
|
Ames SG, Davis BS, Marin JR, Fink EL, Olson LM, Gausche-Hill M, Kahn JM. Emergency Department Pediatric Readiness and Mortality in Critically Ill Children. Pediatrics 2019; 144:peds.2019-0568. [PMID: 31444254 PMCID: PMC6856787 DOI: 10.1542/peds.2019-0568] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Emergency departments (EDs) vary in their level of readiness to care for pediatric emergencies. We evaluated the effect of ED pediatric readiness on the mortality of critically ill children. METHODS We conducted a retrospective cohort study in Florida, Iowa, Massachusetts, Nebraska, and New York, focusing on patients aged 0 to 18 years with critical illness, defined as requiring intensive care admission or experiencing death during the encounter. We used ED and inpatient administrative data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project linked to hospital-specific data from the 2013 National Pediatric Readiness Project. The relationship between hospital-specific pediatric readiness and encounter mortality in the entire cohort and in condition-specific subgroups was evaluated by using multivariable logistic regression and fractional polynomials. RESULTS We studied 20 483 critically ill children presenting to 426 hospitals. The median weighted pediatric readiness score was 74.8 (interquartile range: 59.3-88.0; range: 29.6-100). Unadjusted in-hospital mortality decreased with increasing readiness score (mortality by lowest to highest readiness quartile: 11.1%, 5.4%, 4.9%, and 3.4%; P < .001 for trend). Adjusting for age, chronic complex conditions, and severity of illness, presentation to a hospital in the highest readiness quartile was associated with decreased odds of in-hospital mortality (adjusted odds ratio compared with the lowest quartile: 0.25; 95% confidence interval: 0.18-0.37; P < .001). Similar results were seen in specific subgroups. CONCLUSIONS Presentation to hospitals with a high pediatric readiness score is associated with decreased mortality. Efforts to increase ED readiness for pediatric emergencies may improve patient outcomes.
Collapse
Affiliation(s)
- Stefanie G. Ames
- Division of Pediatric Critical Care, Departments of
Pediatrics and
| | - Billie S. Davis
- Critical Care Medicine and The Clinical Research,
Investigation, and Systems Modeling of Acute Illness Center, School of Medicine
and
| | | | - Ericka L. Fink
- Departments of Pediatrics,,Critical Care Medicine and The Clinical Research,
Investigation, and Systems Modeling of Acute Illness Center, School of Medicine
and
| | - Lenora M. Olson
- Division of Critical Care and Department of
Pediatrics, National Emergency Medical Services for Children Data Analysis
Resource Center, School of Medicine, The University of Utah, Salt Lake City,
Utah
| | - Marianne Gausche-Hill
- Emergency Medicine and Pediatrics, David Geffen
School of Medicine, University of California, Los Angeles, Los Angeles,
California;,Department of Emergency Medicine,
Harbor–University of California, Los Angeles Medical Center, Torrance,
California; and,Los Angeles County Emergency Medical Services Agency,
Santa Fe Springs, California
| | - Jeremy M. Kahn
- Critical Care Medicine and The Clinical Research,
Investigation, and Systems Modeling of Acute Illness Center, School of Medicine
and,Department of Health Policy and Management, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh,
Pennsylvania
| |
Collapse
|
35
|
Weigel PA, Merchant KA, Wittrock A, Kissee J, Ullrich F, Bell AL, Marcin JP, Ward MM. Paediatric tele-emergency care: A study of two delivery models. J Telemed Telecare 2019; 27:23-31. [PMID: 30966860 DOI: 10.1177/1357633x19839610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Tele-emergency models have been utilized for decades, with growing evidence of their effectiveness. Due to the variety of tele-emergency department (tele-ED) models used in practice, however, it is challenging to build standardized metrics for ongoing evaluation. This study describes two tele-ED programs, one specialized and one general, that provide care to paediatric populations. Through an examination of model structures and patient populations, we gain insight into how evaluative measures should reflect tele-ED model design and purpose. METHODS Qualitative descriptions of the two tele-ED models are presented. We show a retrospective cohort analysis describing paediatric patients' key characteristics, reasons for visit, and disposition status by case/control status. Case/control patient encounter data were collected October 2015 through December 2017, from 15 spoke hospitals within each tele-ED program. RESULTS The two tele-ED models serve distinct paediatric populations, and measures of tele-ED utilization and disposition reflect those differences. In the specialized University of California (UC) Davis Health program, tele-ED was utilized in 36% of paediatric critical care encounters and 78% of those were transferred. In the Avera eCARE program, tele-ED was activated in 1.7% of paediatric encounters and 50.6% of those were transferred. When Avera eCARE paediatric encounters were stratified by severity, measures of tele-ED use and disposition status among high-severity encounters were more similar to UC Davis Health. DISCUSSION This study describes how design choices of tele-ED models have implications for evaluative measures. Measures of tele-ED model success need to reflect model purpose, populations served, and for whom tele-ED service use is appropriate.
Collapse
|
36
|
Ranganathan C, Balaji S. Key Factors Affecting the Adoption of Telemedicine by Ambulatory Clinics: Insights from a Statewide Survey. Telemed J E Health 2019; 26:218-225. [PMID: 30874484 DOI: 10.1089/tmj.2018.0114] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Despite demonstrated benefits and improved demand for telemedicine, adoption rates by U.S. ambulatory clinics remain low. There is a critical need to identify why telemedicine adoption rates remain low among ambulatory providers. Introduction: The aim of this study is to evaluate key predictors of telemedicine adoption by ambulatory clinics and assess salient differences between adopters and nonadopters. Three categories of predictors namely clinic characteristics, health information technology (HIT)-related factor, and organizational variables were examined. Materials and Methods: The study used data from a survey of 1,285 clinics in Minnesota (MN) that was collected by Minnesota Department of Health (MDH) in 2016. Exploratory statistical analyses as well as binary logistic regression analyses were carried out using SPSS software. Results: Fifty-five percent of ambulatory clinics in Minnesota had adopted telemedicine. Real-time consultations were adopted in over 26% clinics, remote patient monitoring in 15% clinics, and store-and-forward consultations in about 7% clinics. Originating site teleconsulting was prevalent in 27% clinics, whereas primary care and specialist services through teleconsulting were adopted by 23% clinics. Logistic regression revealed health system-owned clinics, rural clinics, and primary care ones to exhibit higher levels of telemedicine adoption. Clinics with paperless electronic health record (EHR) systems, health information exchange (HIE)-enablement, and better technological infrastructure had higher odds of telemedicine adoption. Furthermore, clinics that had redesigned their workflows also exhibited higher odds of telemedicine adoption. Clinics that faced high costs of telemedicine equipment, lack of demand had lower adoption levels. Clinics that faced high costs for hosting and staffing were more likely to adopt store-and-forward telemedicine and real-time patient monitoring rather than other high-end telemedicine services. Clinics that reported inadequate coverage or reimbursement were more likely to adopt a restrictive set of telemedicine services. Discussion: Telemedicine is not yet very prevalent among Minnesota ambulatory clinics. Over 45% of the clinics do not offer any telemedicine services. The barriers to adoption vary widely and pertain to HIT as well as organizational factors. Conclusion: With increased demand for telemedicine services, policy changes aimed at improving the reimbursement models, digital infrastructure for telemedicine, HIE capabilities, organizational efforts to move toward paperless EHR systems, and redesigning workflows can facilitate in accelerating telemedicine adoption.
Collapse
Affiliation(s)
- C Ranganathan
- Department of Information & Decision Sciences, University of Illinois at Chicago, Chicago Illinois
| | - S Balaji
- Department of Information Technology and Supply Chain Management, University of Wisconsin-Whitewater, Whitewater, Wisconsin
| |
Collapse
|
37
|
Zachrison KS, Boggs KM, M Hayden E, Espinola JA, Camargo CA. A national survey of telemedicine use by US emergency departments. J Telemed Telecare 2018; 26:278-284. [DOI: 10.1177/1357633x18816112] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Telemedicine has the potential to improve the delivery of emergency medical care: however, the extent of its adoption in United States (US) emergency departments is not known. Our objective was to characterise the prevalence of telemedicine use among all US emergency departments, describe clinical applications for which it is most commonly used, and identify emergency department characteristics associated with its use. Methods As part of the National Emergency Department Inventory-USA survey, we queried all 5375 US emergency departments open in 2016. Multivariable logistic regression analyses identified characteristics associated with emergency department receipt of telemedicine services. Results Overall, 4507 emergency departments (84%) responded to our survey, with 4031 responding to both telemedicine questions (75%). Although 1694 emergency departments (42%) reported no telemedicine in 2016, most did: 1923 (48%) emergency departments received telemedicine services, 149 (4%) emergency departments received telemedicine services and were in hospitals that provided telemedicine, and 265 emergency departments (7%) did not receive telemedicine but were in hospitals that provided telemedicine services. Among emergency departments receiving telemedicine, the most common applications were stroke/neurology (76%), psychiatry (38%), and paediatrics (15%). In multivariable analysis, telemedicine-receiving emergency departments had higher annual total visit volume for adults and lower annual total visit volume by children; were less likely to be academic or freestanding; and varied by region. In multivariable analysis, emergency departments in telemedicine-providing hospitals had higher annual total visit volume for adults and children, were more likely to be academic and were less likely to be freestanding. Conclusion In 2016, telemedicine was used in most US emergency departments (58%), especially for stroke/neurology and psychiatry. Future research is needed to understand the value of telemedicine for different clinical applications, and the barriers to its implementation.
Collapse
|
38
|
The Current State of the Pediatric Emergency Medicine Workforce and Innovations to Improve Pediatric Care. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
39
|
Butler L, Whitfill T, Wong AH, Gawel M, Crispino L, Auerbach M. The Impact of Telemedicine on Teamwork and Workload in Pediatric Resuscitation: A Simulation-Based, Randomized Controlled Study. Telemed J E Health 2018; 25:205-212. [PMID: 29957150 DOI: 10.1089/tmj.2018.0017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Telemedicine provides access to specialty care to critically ill patients from a geographic distance. The effects of using telemedicine on (1) teamwork and communication (TC), (2) task workload during resuscitation, and (3) the processes of critical care have not been well described. OBJECTIVES To evaluate the impact of telemedicine on (1) TC, (2) task workload during a resuscitation, and (3) the processes of critical care during a simulated pediatric resuscitation. METHODS Prospective single-center randomized trial. Teams of two physicians (senior and junior resident) and two standardized confederate nurses were randomized to either telemedicine (telepresent senior physician team leader) or usual care (both physicians in the room) during a simulated infant resuscitation. Simulations were video recorded and assessed for teamwork, workload, and processes of care using the Simulated Team Assessment Tool (STAT), the NASA Task Load Index (NASA-TLX) tool, and time between onset of ventricular fibrillation and defibrillation, respectively. RESULTS Twenty teams participated. There was no difference in teamwork between the groups (mean STAT score 72% vs. 69%; p = 0.383); however, there was a significantly greater workload in the telemedicine group (mean TLX score 56% vs. 48%, p = 0.020). Using linear regression, no difference was found in time-to-defibrillation between groups (p = 0.671), but higher teamwork scores predicted faster time to defibrillation (p = 0.020). CONCLUSIONS In this simulation-based study, a telepresent team leader was associated with increased team workload compared to usual care. However, no differences were noted in teamwork and processes of care metrics.
Collapse
Affiliation(s)
- Lucas Butler
- 1 Department of Emergency Medicine, University of Washington, Seattle, Washington.,2 Department of Pediatrics, Section of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Travis Whitfill
- 2 Department of Pediatrics, Section of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Ambrose H Wong
- 3 Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marcie Gawel
- 4 Department of Community Outreach, Yale-New Haven Hospital, New Haven, Connecticut
| | - Lauren Crispino
- 2 Department of Pediatrics, Section of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Marc Auerbach
- 2 Department of Pediatrics, Section of Emergency Medicine, Yale University, New Haven, Connecticut.,3 Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
40
|
Abstract
Telemedicine, the remote diagnosis and treatment of patients by means of technology, provides an alternative means for patients to gain access to health care services. Telemedicine is a general term that includes the use of various communication technologies, including telephone, email, or videoconferencing. Telemedicine has the potential to reduce inefficiencies in the delivery of healthcare, diminish patient travel and wait times, and increase access to specialists for patients in rural settings. We review the use of telemedicine in the perioperative phase of care for pediatric surgical patients, their caregivers, and surgical providers, including pre-operative assessments, and post-operative follow-up. We also discuss physician billing compliance with remote telemedicine consultation and explore the barriers to adoption among the caregivers of pediatric surgery patients.
Collapse
Affiliation(s)
- Aaron P Lesher
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Sohail R Shah
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
41
|
Driessen J, Chang W, Patel P, Wright RM, Ernst K, Handler SM. Nursing Home Provider Perceptions of Telemedicine for Providing Specialty Consults. Telemed J E Health 2018; 24:510-516. [PMID: 29293071 DOI: 10.1089/tmj.2017.0076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nursing homes (NHs) provide care to a complex patient population and face the ongoing challenge of meeting resident needs for specialty care. A NH telemedicine care model could improve access to remote specialty providers. INTRODUCTION Little is known about provider interest in telemedicine for specialty consults in the NH setting. The goal of this study was to survey a national sample of NH physicians and advanced practice providers to document their views on telemedicine for providing specialty consults in the NH. MATERIALS AND METHODS We surveyed physician and advanced practice providers who attended the 2016 AMDA-The Society for Post-Acute and Long-Term Care Medicine Annual Conference about their likelihood of referral to and perceptions of a telemedicine program for providing specialty consults in the NH. RESULTS We received surveys from 524 of the 1,274 conference attendees for a 41.1% response rate. Respondents expressed confidence in the ability of telemedicine to fill existing service gaps and provide appropriate, timelier care. Providers showed the highest level of interest in telemedicine for dermatology, geriatric psychiatry, and infectious disease. Only 13% of respondents indicated that telemedicine was available for use in one of their facilities. DISCUSSION There appears to be unmet demand for telemedicine in NHs for providing specialty consults to residents. CONCLUSIONS The responses of NH providers suggest support for the concept of telemedicine as a modality of care that can be used to offer specialty consults to NH residents.
Collapse
Affiliation(s)
- Julia Driessen
- 1 Department of Health Policy and Management, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 Department of Biomedical Informatics, School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Woody Chang
- 3 Department of Medicine, University of Pittsburgh Medical Center-Medical Education , Pittsburgh, Pennsylvania
| | - Palak Patel
- 3 Department of Medicine, University of Pittsburgh Medical Center-Medical Education , Pittsburgh, Pennsylvania
| | - Rollin M Wright
- 4 Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Kambria Ernst
- 5 University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Steven M Handler
- 2 Department of Biomedical Informatics, School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,4 Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| |
Collapse
|
42
|
To See or Not to See: Telemedicine's Impact on Triage Outcomes. Pediatr Crit Care Med 2017; 18:1081-1083. [PMID: 29099455 DOI: 10.1097/pcc.0000000000001326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, Bruijnzeel-Koomen CA, de Bruin-Weller MS, van Os-Medendorp H. Barriers and Facilitators to eHealth Use in Daily Practice: Perspectives of Patients and Professionals in Dermatology. J Med Internet Res 2017; 19:e300. [PMID: 28874336 PMCID: PMC5605757 DOI: 10.2196/jmir.7512] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/24/2017] [Accepted: 06/18/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The number of eHealth interventions in the management of chronic diseases such as atopic dermatitis (AD) is growing. Despite promising results, the implementation and use of these interventions is limited. OBJECTIVES This study aimed to assess opinions of the most important stakeholders influencing the implementation and use of eHealth services in daily dermatology practice. METHODS The perspectives of health care professionals and patients towards the implementation and use of eHealth services in daily practice were assessed by using a mixed method design. A cross-sectional survey based on the eHealth implementation toolkit (eHit) was conducted to explore factors influencing the adoption of eHealth interventions offering the possibility of e-consultations, Web-based monitoring, and Web-based self-management training among dermatologists and dermatology nurses. The perspectives of patients with atopic dermatitis (AD) regarding the use of eHealth services were discussed in an online focus group. RESULTS Health care professionals (n=99) and patients (n=9) acknowledged the value of eHealth services and were willing to use these digital tools in daily dermatology practice. Key identified barriers (statements with <50% of the participants scoring totally agree or agree) in the implementation and adoption of eHealth interventions included concerns about the availability (12/99, 12%) and allocation (14/99, 14%) of resources, financial aspects (26/99, 26%), reliability, security, and confidentially of the intervention itself (29/99, 29%), and the lack of education and training (6/99, 6%). CONCLUSIONS Health care professionals and patients acknowledge the benefits arising from the implementation and use of eHealth services in daily dermatology practice. However, some important barriers were identified that might be useful in addressing the implementation strategy in order to enhance the implementation success of eHealth interventions in dermatology.
Collapse
Affiliation(s)
- Lieneke Fm Ariens
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Cynthia Frima
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | - Bernd Wm Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, Netherlands
| | | | | | | |
Collapse
|
44
|
|
45
|
Ly BA, Labonté R, Bourgeault IL, Niang MN. The individual and contextual determinants of the use of telemedicine: A descriptive study of the perceptions of Senegal's physicians and telemedicine projects managers. PLoS One 2017; 12:e0181070. [PMID: 28732028 PMCID: PMC5521789 DOI: 10.1371/journal.pone.0181070] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 06/26/2017] [Indexed: 11/19/2022] Open
Abstract
Telemedicine is considered to be an effective strategy to aid in the recruitment and retention of physicians in underserved areas and, in doing so, improve access to healthcare. Telemedicine's use, however, depends on individual and contextual factors. Using a mixed methods design, we studied these factors in Senegal based on a micro, meso and macro framework. A quantitative questionnaire administered to 165 physicians working in public hospitals and 151 physicians working in district health centres was used to identify individual (micro) factors. This was augmented with qualitative descriptive data involving individual interviews with 30 physicians working in public hospitals, 36 physicians working in district health centres and 10 telemedicine project managers to identify contextual (meso and macro) factors. Physicians were selected using purposeful random sampling; managers through snowball sampling. Quantitative data were analyzed descriptively using SPSS 23 and qualitative data thematically using NVivo 10. At the micro level, we found that 72.1% of the physicians working in public hospitals and 82.1% of the physicians working in district health centres were likely to use telemedicine in their professional activities. At the meso level, we identified several technical, organizational and ethical factors, while at the macro level the study revealed a number of financial, political, legal, socioeconomic and cultural factors. We conclude that better awareness of the interplay between factors can assist health authorities to develop telemedicine in ways that will attract use by physicians, thus improving physicians' recruitment and retention in underserved areas.
Collapse
Affiliation(s)
- Birama Apho Ly
- Population Health Program, University of Ottawa, Ontario, Canada
- Public Health Teaching and Research Department, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ronald Labonté
- Population Health Program, University of Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Ivy Lynn Bourgeault
- Population Health Program, University of Ottawa, Ontario, Canada
- Telfer School of Management, University of Ottawa, Ontario, Canada
| | - Mbayang Ndiaye Niang
- Telemedicine Research and Expertise Interdisciplinary Centre, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal
| |
Collapse
|
46
|
Ray KN, Ashcraft LE, Mehrotra A, Miller E, Kahn JM. Family Perspectives on Telemedicine for Pediatric Subspecialty Care. Telemed J E Health 2017; 23:852-862. [PMID: 28430021 DOI: 10.1089/tmj.2016.0236] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Children often have difficulty accessing subspecialty care, and telemedicine may improve access to subspecialty care, but information is lacking on how best to implement telemedicine programs to maximize acceptance and, ultimately, maximize impact for patients and their families. METHODS AND MATERIALS To understand how subspecialty telemedicine is perceived and to identify design elements with the potential to improve telemedicine uptake and impact, we conducted and analyzed semi-structured interviews with 21 informants, including parents and caregivers of children with subspecialty care needs and adolescent and young adult patients with subspecialty care needs. RESULTS Although informants saw the potential value of using telemedicine to replace in-person subspecialty visits, they were more enthusiastic about using telemedicine to complement rather than replace in-person visits. For example, they described the potential to use telemedicine to facilitate previsit triage encounters to assess whether the patient was being scheduled with the correct subspecialist and with the appropriate level of urgency. They also felt that telemedicine would be useful for communication with subspecialists after scheduled in-person visits for follow-up questions, care coordination, and to discuss changes in health status. Informants felt that it was important for telemedicine programs to have transparent and reliable scheduling, same-day scheduling options, continuity of care with trusted providers, clear guidelines on when to use telemedicine, and preservation of parent choice regarding method of care delivery. CONCLUSIONS Parents and patients articulated preferences regarding pediatric subspecialty telemedicine in this qualitative, hypothesis-generating study. Understanding and responding to patient and caregiver perceptions and preferences will be crucial to ensure that telemedicine drives true innovation in care delivery rather than simply recapitulating prior models of care.
Collapse
Affiliation(s)
- Kristin N Ray
- 1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laura Ellen Ashcraft
- 2 Department of Critical Care Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Ateev Mehrotra
- 3 Department of Health Care Policy and Medicine, Harvard Medical School and RAND Corporation , Boston, Massachusetts
| | - Elizabeth Miller
- 1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeremy M Kahn
- 2 Department of Critical Care Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.,4 Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health , Pittsburgh, Pennsylvania
| |
Collapse
|
47
|
Abstract
OBJECTIVE Although there is growing evidence regarding the utility of telemedicine in providing care for acutely ill children in underserved settings, adoption of pediatric emergency telemedicine remains limited, and little data exist to inform implementation efforts. Among clinician stakeholders, we examined attitudes regarding pediatric emergency telemedicine, including barriers to adoption in rural settings and potential strategies to overcome these barriers. METHODS Using a sequential mixed-methods approach, we first performed semistructured interviews with clinician stakeholders using thematic content analysis to generate a conceptual model for pediatric emergency telemedicine adoption. Based on this model, we then developed and fielded a survey to further examine attitudes regarding barriers to adoption and strategies to improve adoption. RESULTS Factors influencing adoption of pediatric emergency telemedicine were identified and categorized into 3 domains: contextual factors (such as regional geography, hospital culture, and individual experience), perceived usefulness of pediatric emergency telemedicine, and perceived ease of use of pediatric emergency telemedicine. Within the domains of perceived usefulness and perceived ease of use, belief in the relative advantage of telemedicine was the most pronounced difference between telemedicine proponents and nonproponents. Strategies identified to improve adoption of telemedicine included patient-specific education, clinical protocols for use, decreasing response times, and simplifying the technology. CONCLUSIONS More effective adoption of pediatric emergency telemedicine among clinicians will require addressing perceived usefulness and perceived ease of use in the context of local factors. Future studies should examine the impact of specific identified strategies on adoption of pediatric emergency telemedicine and patient outcomes in rural settings.
Collapse
|
48
|
Abstract
OBJECTIVE This study characterized telemedicine utilization among Medicaid enrollees by patients' demographic characteristics, geographic location, enrollment type, eligibility category, and clinical conditions. METHODS This study used 2008-2009 Medicaid claims data from 28 states and the District of Columbia to characterize telemedicine claims (indicated by GT for professional fee claims or Q3014 for facility fees) on the basis of patients' demographic characteristics, geographic location, enrollment type, eligibility category, and clinical condition as indicated by ICD-9 codes. States lacking Medicaid telemedicine reimbursement policies were excluded. Chi-square tests were used to compare telemedicine utilization rates and one-way analysis of variance was used to estimate mean differences in number of telemedicine encounters among subgroups. RESULTS A total of 45,233,602 Medicaid enrollees from the 22 states with telemedicine reimbursement policies were included in the study, and .1% were telemedicine users. Individuals ages 45 to 64 (16.4%), whites (11.3%), males (8.5%), rural residents (26.0%), those with managed care plans (7.9%), and those categorized as aged, blind, and disabled (28.1%) were more likely to receive telemedicine (p<.001). Nearly 95% of telemedicine claims were associated with a behavioral health diagnosis, of which over 50% were for bipolar disorder and attention-deficit disorder or attention-deficit hyperactivity disorder (29.3% and 23.4%, respectively). State-level variation was high, ranging from .0 to 59.91 claims per 10,000 enrollees (Arkansas and Arizona, respectively). CONCLUSIONS Despite the touted potential for telemedicine to improve health care access, actual utilization of telemedicine in Medicaid programs was low. It was predominantly used to treat behavioral health diagnoses. Reimbursement alone is insufficient to support broad utilization for Medicaid enrollees.
Collapse
Affiliation(s)
- Megan Daugherty Douglas
- Ms. Douglas, Mr. Xu, Dr. Mack, and Dr. Rust are with the National Center for Primary Care and Dr. Wrenn is with the Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta (e-mail: ). Ms. Heggs is with the Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta
| | - Junjun Xu
- Ms. Douglas, Mr. Xu, Dr. Mack, and Dr. Rust are with the National Center for Primary Care and Dr. Wrenn is with the Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta (e-mail: ). Ms. Heggs is with the Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta
| | - Akilah Heggs
- Ms. Douglas, Mr. Xu, Dr. Mack, and Dr. Rust are with the National Center for Primary Care and Dr. Wrenn is with the Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta (e-mail: ). Ms. Heggs is with the Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta
| | - Glenda Wrenn
- Ms. Douglas, Mr. Xu, Dr. Mack, and Dr. Rust are with the National Center for Primary Care and Dr. Wrenn is with the Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta (e-mail: ). Ms. Heggs is with the Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta
| | - Dominic H Mack
- Ms. Douglas, Mr. Xu, Dr. Mack, and Dr. Rust are with the National Center for Primary Care and Dr. Wrenn is with the Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta (e-mail: ). Ms. Heggs is with the Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta
| | - George Rust
- Ms. Douglas, Mr. Xu, Dr. Mack, and Dr. Rust are with the National Center for Primary Care and Dr. Wrenn is with the Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta (e-mail: ). Ms. Heggs is with the Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta
| |
Collapse
|
49
|
Abstract
Telemedicine is increasingly becoming an important part of the health care system as it has the potential to help deliver quality medical care to underserved areas. When implemented correctly, it can be a cost-effective way of expanding access to excellent medical care. However, because it is a relatively new and quickly changing field, there are multiple issues and challenges that need to be addressed. This article reviews the current literature on various modalities of telemedicine, evidence for teletrauma, and challenges and barriers related to telemedicine.
Collapse
Affiliation(s)
- Paul T Kim
- Department of General Surgery, University of Cincinnati Medical Center, Cincinnati Children׳s Hospital Medical Center, Cincinnati, Ohio
| | - Richard A Falcone
- Division of Pediatric and Thoracic Surgery, Cincinnati Children׳s Hospital Medical Center, Cincinnati, Ohio.
| |
Collapse
|
50
|
Brophy PD. Overview on the Challenges and Benefits of Using Telehealth Tools in a Pediatric Population. Adv Chronic Kidney Dis 2017; 24:17-21. [PMID: 28224938 DOI: 10.1053/j.ackd.2016.12.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 11/11/2022]
Abstract
Telehealth in Pediatric Medicine presents many of the same benefits and challenges noted in adult-based medicine. In terms of health care delivery, the promise of improving access and reducing costs using telehealth in Pediatrics, particularly chronic care, is high. The ability to address clinician shortages and provide remote guidance for chronic care pathways from pediatric subspecialists to rural-based referring physicians is a developing model that represents a sustainable and cost-effective strategy to improve pediatric care. The adoption and implementation of consistent telehealth programs require a readjustment of current regulatory rules and a national discussion on reimbursement and compliance standards. Presently, state laws generally define the rules, whereby health systems or practices can use telehealth for patient care and education. Long-term telehealth program development depends on the ongoing value and use case provided by pediatric advocates for this emerging health care delivery model.
Collapse
|