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Miles DT, Goodwin TM, Wilson AW, Doty JF. Workers' Compensation: The Burden on Healthcare Resource Utilization After Foot and Ankle Surgery. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00003. [PMID: 38038489 PMCID: PMC10686597 DOI: 10.5435/jaaosglobal-d-23-00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/01/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The purpose of this study is to investigate the amount of healthcare resources dedicated to patients with WC after common foot or ankle procedures compared with a procedure-matched control group. METHODS A retrospective review was performed of patients with WC and without WC undergoing foot and ankle procedures. Measures of healthcare burden included clinical communications, documents, prescriptions, office visits, and days to return to work and clinic discharge. RESULTS Collectively, 142 patients met the inclusion criteria. Patients with workers' compensation had increased office communication encounters (P < 0.001), processed documents (P < 0.001), medication prescriptions (P < 0.001), number of office visits (P < 0.001), number of days until return to work (P < 0.001), and days until final disposition from clinic (P < 0.001). Patients with workers' compensation were more likely to have postoperative complications (OR 2.1; 95% CI, 1.0 to 4.3; P = 0.04), secondary surgeries (OR 8.2; 95% CI, 2.3 to 29.4; P < 0.001), and new complaints during the perioperative period (OR 1.9; 95% CI, 0.9 to 4.0; P = 0.07) but were less likely to cancel appointments (OR 0.41; 95% CI, 0.19 to 0.86; P = 0.02). DISCUSSION When undergoing common foot and ankle orthopaedic procedures, patients with WC demonstrated increased healthcare utilization of resources. This included more office staff work burden dedicated to patients with WC for longer amounts of time, effectively doubling the effort of a non-WC cohort.
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Affiliation(s)
- Daniel T. Miles
- From the Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | - Tyler M. Goodwin
- From the Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | - Andrew W. Wilson
- From the Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | - Jesse F. Doty
- From the Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
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Bennett RJ, Kelsall-Foreman I, Barr C, Campbell E, Coles T, Paton M, Vitkovic J. Barriers and facilitators to tele-audiology service delivery in Australia during the COVID-19 pandemic: perspectives of hearing healthcare clinicians. Int J Audiol 2023; 62:1145-1154. [PMID: 36194040 DOI: 10.1080/14992027.2022.2128446] [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] [Received: 03/11/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore the utilisation, safety, cost, and patient outcomes of delivering tele-audiology services during the COVID-19 pandemic. DESIGN A national cross-sectional self-report online survey asking participants to reflect on interactions with hearing services between April and October 2020. Data were analysed using descriptive statistics. The COM-B model of behaviour change guided survey creation and the presentation of a subset of the results. STUDY SAMPLE 249 Australia-based hearing healthcare clinicians (age range 23-74 years; 162 female). RESULTS Clinicians reported an increase in the use of tele-audiology services, with key drivers relating to keeping their patients safe and keeping businesses running. Clinicians generally viewed the provision of tele-audiology services as successful and resulting in improved patient outcomes. Overall, clinicians were highly motivated to provide tele-audiology services, and they expressed being confident in their knowledge and understanding of tele-audiology service delivery. Barriers to providing tele-audiology services included concerns about the reliability of the results obtained from remote assessments, as well as concerns around information security and privacy issues. CONCLUSIONS Clinicians' motivations to use tele-audiology services appeared to be driven by their desire to maintain COVID-safe practices during the pandemic and by the COVID-driven increase in availability of funding for tele-audiology services.
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Affiliation(s)
- Rebecca J Bennett
- Brain and Hearing, University of Western Australia, Crawley, Western Australia, Australia
- Ear Science Institute Australia, 1 Salvado Road, Subiaco, Western Australia, Australia
| | - India Kelsall-Foreman
- Brain and Hearing, University of Western Australia, Crawley, Western Australia, Australia
- Ear Science Institute Australia, 1 Salvado Road, Subiaco, Western Australia, Australia
| | - Caitlin Barr
- Soundfair Australia Ltd, Melbourne, Victoria, Australia
| | | | - Tony Coles
- Audiology Australia, Cremorne, Victoria, Australia
| | - Mark Paton
- Australian College of Audiology (ACAud), Spring Hill, Queensland, Australia
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Singh H, Vernon W, Scannell T, Gerwig K. Crossing the Decarbonization Chasm: A Call to Action for Hospital and Health System Leaders to Reduce Their Greenhouse Gas Emissions. NAM Perspect 2023; 2023:202311g. [PMID: 38784639 PMCID: PMC11114593 DOI: 10.31478/202311g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Affiliation(s)
- Hardeep Singh
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine
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Keptner KM, Heath M. The impact of resistance on telemedicine use for people with disabilities. J Telemed Telecare 2023:1357633X231213412. [PMID: 38014763 DOI: 10.1177/1357633x231213412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
People with disabilities face many challenges in accessing healthcare. They may be provided opportunities to utilize new technologies just like non-disabled patients, but their unique challenges might cause them to resist new technology. The purpose of the study is to explore reasons why disabled patients might resist telemedicine. Using thematic analysis, we analyzed open-ended questions from a larger telemedicine survey for people with disabilities in the United States. The analysis identified the following themes: concerns about the patient-provider relationship and trust, worry about security and privacy, telemedicine has its place - but not for every type of visit, and concerns with overutilization and cost. The paper demonstrated that while telemedicine provides convenience to patients in terms of removing barriers such as transportation and cost, patients still value their doctor relationship and certain features of in-person visits. Resistance to telemedicine occurred on both individual and structural levels. This study has implications for institutions serving people with disabilities through remote means.
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Affiliation(s)
- Karen M Keptner
- College of Health, Cleveland State University, Cleveland, OH, USA
| | - Michele Heath
- College of Business, Cleveland State University, Cleveland, OH, USA
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Kelly JT, Law L, De Guzman KR, Hickman IJ, Mayr HL, Campbell KL, Snoswell CL, Erku D. Cost-effectiveness of telehealth-delivered nutrition interventions: a systematic review of randomized controlled trials. Nutr Rev 2023; 81:1599-1611. [PMID: 37016937 PMCID: PMC10639107 DOI: 10.1093/nutrit/nuad032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
CONTEXT Telehealth-delivered nutrition interventions are effective in practice; however, limited evidence exists regarding their cost-effectiveness. OBJECTIVE To evaluate the cost-effectiveness of telehealth-delivered nutrition interventions for improving health outcomes in adults with chronic disease. DATA SOURCES PubMed, CENTRAL, CINAHL, and Embase databases were systematically searched from database inception to November 2021. Included studies were randomized controlled trials delivering a telehealth-delivered diet intervention conducted with adults with a chronic disease and that reported on cost-effectiveness or cost-utility analysis outcomes. DATA EXTRACTION All studies were independently screened and extracted, and quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. DATA ANALYSIS All extracted data were grouped into subcategories according to their telehealth modality and payer perspective, and were analyzed narratively. RESULTS Twelve randomized controlled trials comprising 5 phone-only interventions, 3 mobile health (mHealth), 2 online, and 1 each using a combination of phone-online or phone-mHealth interventions, were included in this review. mHealth interventions were the most cost-effective intervention in all studies. Across all telehealth interventions and cost analyses from health service perspectives, 60% of studies were cost-effective. From a societal perspective, however, 33% of studies reported that the interventions were cost-effective. Of the 10 studies using cost-utility analyses, 3 were cost saving and more effective, making the intervention dominant, 1 study reported no difference in costs or effectiveness, and the remaining 6 studies reported increased cost and effectiveness, meaning payers must decide whether this falls within an acceptable willingness-to-pay threshold for them. Quality of study reporting varied with between 63% to 92%, with an average of 77% of CHEERS items reported. CONCLUSION Telehealth-delivered nutrition interventions in chronic disease populations appear to be cost-effective from a health perspective, and particularly mHealth modalities. These findings support telehealth-delivered nutrition care as a clinically beneficial, cost-effective intervention delivery modality.
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Affiliation(s)
- Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lynette Law
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Keshia R De Guzman
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital; and the School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Hannah L Mayr
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital; and the School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Queensland, Australia
| | - Katrina L Campbell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland; and the Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Erku
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland; and the Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Wicks M, Dennett AM, Peiris CL. Physiotherapist-led, exercise-based telerehabilitation for older adults improves patient and health service outcomes: a systematic review and meta-analysis. Age Ageing 2023; 52:afad207. [PMID: 37979183 PMCID: PMC10657214 DOI: 10.1093/ageing/afad207] [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] [Received: 07/10/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Telerehabilitation can be an appropriate alternative to face-to-face rehabilitation for adults; however, it is uncertain whether it is safe and effective for older adults. OBJECTIVE This review aimed to determine the effect of physiotherapist-led, exercise-based telerehabilitation for older adults on patient outcomes (health-related quality of life, activity limitation, functional impairment) and health service costs. METHODS Randomised or non-randomised controlled trials including community-dwelling older adults (mean age ≥ 65 years) who received exercise-based telerehabilitation led by a physiotherapist were eligible. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PubMed and Cochrane Library were searched from the earliest available date to August 2022. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Data were synthesised with inverse variance, random-effects meta-analyses to determine standardised mean differences and 95% confidence intervals. Certainty of evidence was determined by applying Grading of Recommendations, Assessment, Development and Evaluation criteria. RESULTS Eleven studies (10 randomised) with 1,400 participants (mean age 65-74 years) experiencing musculoskeletal and cardiopulmonary conditions were included. Telerehabilitation was safe, effective and well adhered to. Telerehabilitation was non-inferior to face-to-face physiotherapy in relation to range of movement, strength, 6-min walk distance (6MWD), timed up and go test (TUGT) and quality of life and had lower health-care costs compared with face-to-face physiotherapy. Compared with no intervention, telerehabilitation participants had significantly better range of motion, strength, quality of life, 6MWD and TUGT speed. CONCLUSION Physiotherapist-led, exercise-based telerehabilitation is non-inferior to face-to-face rehabilitation and better than no intervention for older adults with musculoskeletal and cardiopulmonary conditions.
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Affiliation(s)
- Matoula Wicks
- Community Health Program, Eastern Health, Box Hill, VIC 3128, Australia
| | - Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC 3128, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC 3086, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC 3086, Australia
- Allied Health, Royal Melbourne Hospital, Parkville, VIC 3052, Australia
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Ansarian M, Baharlouei Z. Applications and Challenges of Telemedicine: Privacy-Preservation as a Case Study. ARCHIVES OF IRANIAN MEDICINE 2023; 26:654-661. [PMID: 38310426 PMCID: PMC10864944 DOI: 10.34172/aim.2023.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/02/2023] [Indexed: 02/05/2024]
Abstract
Today, technology has an important impact on the development of medical services, especially during the outbreak of COVID-19. Telemedicine, known by terms such as telehealth and digital health, refers to the utilization of technology to provide health care services at a distance that leads to improved monitoring, detecting and treatment of disease, and provision of individual care. It has been considered in various fields such as radiology, cardiology, pulmonology, psychiatry, emergency care and surgery. The most important advantages of using telemedicine are saving time for the doctor and the patient, reducing the cost of multiple visits to the doctor, reducing the spread of contagious diseases and caring for patients who cannot see a doctor, such as the elderly. In this paper, we review the research in the field of applying telemedicine, as well as its advantages and disadvantages. Next, we discuss the challenges in the field of using telemedicine which are privacy preserving, data security, cost of infrastructures, lack of physical examination and responsibility for patients' compensation. One of the most important challenges is privacy preserving of patients' information during transmission and process. We categorize and compare the various methods that have been proposed to protect peoples' privacy.
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Affiliation(s)
- Maryam Ansarian
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Baharlouei
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Matti C, Essig S, Föhn Z, Balthasar A. The Role of Wearable Sensors in the Future Primary Healthcare - Preferences of the Adult Swiss Population: A Mixed Methods Approach. J Med Syst 2023; 47:111. [PMID: 37907653 PMCID: PMC10618354 DOI: 10.1007/s10916-023-01998-1] [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: 11/08/2022] [Accepted: 09/28/2023] [Indexed: 11/02/2023]
Abstract
Wearable sensors have the potential to increase continuity of care and reduce healthcare expenditure. The user concerns and preferences regarding wearable sensors are the least addressed topic in related literature. Therefore, this study aimed first, to examine the preferences of the adult Swiss population regarding the use of wearable sensors in primary healthcare. Second, the study aimed to explain and learn more about these preferences and why such wearable sensors would or would not be used. An explanatory sequential design was used to reach the two aims. In the initial quantitative phase preferences of a nationwide survey were analyzed descriptively and a multivariable ordered logistic regression was used to identify key characteristics, that influence the preferences. In the second phase, eight semi-structured interviews were conducted. The cleaned study sample of the survey included 687 participants, 46% of whom gave a positive rating regarding the use of wearable sensors. In contrast, 44% gave a negative rating and 10% were neutral. The interviews showed that sensors should be small, not flashy and be compatible with everyday activities. Individuals without a current health risk or existing chronic disease showed lower preferences for using wearable sensors, particularly because they fear losing control over their own body. In contrast, individuals with increased risk or with an existing chronic disease were more likely to use wearable sensors as they can increase the personal safety and provide real-time health information to physicians. Therefore, an important deciding factor for and against the use of wearable sensors seems to be the perceived personal susceptibility for potential health problems.
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Affiliation(s)
- Corinne Matti
- Department Health Sciences and Medicine, University Lucerne, Lucerne, 6002, Switzerland.
- Institute of Social and Preventive Medicine, University Bern, Mittelstrasse 43, Bern, 3012, Switzerland.
| | - Stefan Essig
- Department Health Sciences and Medicine, University Lucerne, Lucerne, 6002, Switzerland
- Interface Politikstudien Forschung Beratung AG, Seidenhofstrasse 12, Lucerne, 6003, Switzerland
| | - Zora Föhn
- Department Health Sciences and Medicine, University Lucerne, Lucerne, 6002, Switzerland
- Interface Politikstudien Forschung Beratung AG, Seidenhofstrasse 12, Lucerne, 6003, Switzerland
| | - Andreas Balthasar
- Department Health Sciences and Medicine, University Lucerne, Lucerne, 6002, Switzerland
- Interface Politikstudien Forschung Beratung AG, Seidenhofstrasse 12, Lucerne, 6003, Switzerland
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Ward MM, Carter KD, Bhagianadh D, Ullrich F, Merchant KAS, Marcin JP, Law KB, McCord C, Neufeld J, Nelson EL, Shane DM. Comparison of Telehealth and In-Person Behavioral Health Services and Payment in a Large Rural Multisite Usual Care Study. Telemed J E Health 2023; 29:1613-1623. [PMID: 37036816 DOI: 10.1089/tmj.2022.0445] [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: 04/11/2023] Open
Abstract
Background: Telehealth and in-person behavioral health services have previously shown equal effectiveness, but cost studies have largely been limited to travel savings for telehealth cohorts. The purpose of this analysis was to compare telehealth and in-person cohorts, who received behavioral health services in a large multisite study of usual care treatment approaches to examine relative value units (RVUs) and payment. Methods: We used current procedural terminology codes for each encounter to identify RVUs and Medicare payment rates. Mixed linear regression models compared telehealth and in-person cohorts on RVUs, per-encounter payment rates, and total-episode payment rates. Results: We found the behavioral health services provided by telehealth to have modest, but statistically significantly lower RVUs (i.e., less provider work in time spent and case complexity), per-encounter payments, and total episode payments than the in-person cohort. Despite Medicare rates discounting payments for nonphysician providers and the in-person cohort using clinical social workers more frequently, the services provided by the telehealth cohort still had lower payments. Thus, the differences observed are due to the in-person cohort receiving higher payment RVU services than the telehealth cohort, which was more likely to receive briefer therapy sessions and other less expensive services. Conclusions: Behavioral health services provided by telehealth used services with lower RVUs than behavioral health services provided in-person, on average, even after adjusting for patient demographics and diagnosis. Observed differences in Medicare payments resulted from the provider type and services used by the two cohorts; thus, costs and insurance reimbursements may vary for others.
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Affiliation(s)
- Marcia M Ward
- Department of Health Management and Policy and University of Iowa, Iowa City, Iowa, USA
| | - Knute D Carter
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Divya Bhagianadh
- School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
| | - Fred Ullrich
- Department of Health Management and Policy and University of Iowa, Iowa City, Iowa, USA
| | - Kimberly A S Merchant
- Department of Health Management and Policy and University of Iowa, Iowa City, Iowa, USA
| | - James P Marcin
- Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento, California, USA
| | - Kari Beth Law
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia, USA
| | - Carly McCord
- Department of Psychiatry and Behavioral Sciences and Texas A&M University, College Station, Texas, USA
- Department of Educational Psychology, Texas A&M University, College Station, Texas, USA
| | - Jonathan Neufeld
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eve-Lynn Nelson
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dan M Shane
- Department of Health Management and Policy and University of Iowa, Iowa City, Iowa, USA
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Alter N, Arif H, Wright DD, Martinez B, Elkbuli A. Telehealth Utilization in Trauma Care: The Effects on Emergency Department Length of Stay and Associated Outcomes. Am Surg 2023; 89:4826-4834. [PMID: 37132648 DOI: 10.1177/00031348231173944] [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: 05/04/2023]
Abstract
INTRODUCTION Since the onset of the Covid-19 Pandemic, Telehealth utilization has grown rapidly; however, little is known about its efficacy in specific areas of healthcare, including trauma care in the emergency department. We aim to evaluate telehealth utilization in the care of adult trauma patients within United States emergency departments and associated outcomes over the past decade. METHODS PubMed, Google Scholar, EMBASE, ProQuest, and Cochrane were searched for relevant articles published from database conception to Dec 12th, 2022. Our review includes studies that assessed the utilization of telehealth practices within a United States emergency department for the treatment of adult (age ≥ 18) trauma patients. Evaluated outcomes included emergency department length of stay, transfer rates, cost incurred to patients and telehealthimplementing hospitals, patient satisfaction, and rates of left without being seen. RESULTS A total of 11 studies, evaluating 59,319 adult trauma patients, were included in this review. Telehealth practices resulted in comparable or reduced emergency department length of stay for trauma patients admitted to the emergency department. Costs incurred to the patient and rates of leaving without being seen were significantly reduced following telehealth implementation. There was no difference in transfer rates or patient satisfaction for telehealth practices compared to in-person treatment. CONCLUSION Emergency department telehealth utilization significantly reduced trauma patient care-related costs, emergency department length of stay, and rates of leaving without being seen. No significant differences were found in patient transfer rates, patient satisfaction rates, or mortality rates following emergency department telehealth utilization.
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Affiliation(s)
- Noah Alter
- NOVA Southeastern University, Dr Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Hassan Arif
- NOVA Southeastern University, Dr Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - D-Dre Wright
- John A. Burns School of Medicine, Honolulu, HI, USA
| | - Brian Martinez
- NOVA Southeastern University, Dr Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
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Lepre B, Job J, Martin Z, Kerrigan N, Jackson C. The Queensland Virtual Integrated Practice (VIP) partnership program pilot study: an Australian-first model of care to support rural general practice. BMC Health Serv Res 2023; 23:1183. [PMID: 37907917 PMCID: PMC10617120 DOI: 10.1186/s12913-023-10189-0] [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] [Received: 03/31/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND There is a critical lack of medical workforce internationally, and this is particularly notable in rural and remote Australia where strategies to address workforce shortages are urgently required. This pilot study aimed to implement and evaluate a Virtual Integrated Practice (VIP) Program in the Australian rural primary care setting. METHODS The VIP model was developed using co-creation methodology and involves an urban GP joining a rural general practice team to provide ongoing care to patients remotely via secure telehealth. The pilot study was conducted in two western Queensland general practices, commencing in October 2021 with one rural practice and extending to an additional rural practice from November 2022. Evaluation included a retrospective review of service, billing and cost data, and an online survey for patients. Ethical approval was obtained from the University of Queensland Human Research Ethics Committee (Project number: 2021/HE002434). RESULTS There were 1468 services provided through to December 2022, including general consults (n = 1197), therapeutic procedures (n = 68), mental health treatment plans (n = 68) and chronic disease management plans (n = 59). Patients were predominantly female (73.1%) and did not have their appointment at the practice (57.8%). Among 1282 occasions of service, less than 20% of consultations (n = 224) required support from staff (e.g., a nurse), and more than half were repeat patient encounters (53.0%). Survey respondents (n = 45) indicated that they were satisfied (9.3%) or highly satisfied (90.7%) with the care provided, and importantly, 95.5% of respondents reported that the service improved their access to the GP. More than 20% of respondents indicated that they would attend the Emergency Department if virtual care was not available. CONCLUSIONS Data from this pilot study has informed translation to an additional 20 vulnerable rural general practices in three further rural regions in Queensland in 2023 and evaluation is ongoing. This pilot study demonstrates the feasibility and acceptability of an innovative, digitally supported community-focussed, healthcare initiative to arrest the decline in rural general practice workforce, improve patient care access and support rural practice viability.
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Affiliation(s)
- Breanna Lepre
- Centre for Health System Reform and Integration, University of Queensland-Mater Research Institute (UQ/MRI), Royal Brisbane Hospital, Level 8, Health Sciences Building, Herston, QLD, 4029, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4067, Australia
| | - Jennifer Job
- Centre for Health System Reform and Integration, University of Queensland-Mater Research Institute (UQ/MRI), Royal Brisbane Hospital, Level 8, Health Sciences Building, Herston, QLD, 4029, Australia
| | - Zena Martin
- Health Workforce Queensland, Level 4, 348 Edward Street, Brisbane, QLD, 4000, Australia
| | - Natalie Kerrigan
- Western Queensland Primary Health Network, 11 Barkly Hwy, Mount Isa 4825, Miles End QLD, Australia
| | - Claire Jackson
- Centre for Health System Reform and Integration, University of Queensland-Mater Research Institute (UQ/MRI), Royal Brisbane Hospital, Level 8, Health Sciences Building, Herston, QLD, 4029, Australia.
- General Practice Clinical Unit, School of Medicine, University of Queensland, Royal Brisbane Hospital, Level 8, Health Sciences Building, Herston, QLD, 4029, Australia.
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Burstin H, Clark KJ, Duff N, Dopp AL, Bentley E, Wattenberg S, Sandbrink F, Beale RR, Ling SM, Eaton E, Freiling E, Salman A. Integrating Telehealth and Traditional Care in Chronic Pain Management and Substance Use Disorder Treatment: An Action Agenda for Building the Future State of Hybrid Care. NAM Perspect 2023; 2023:202310b. [PMID: 38784634 PMCID: PMC11114598 DOI: 10.31478/202310b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
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Nadkarni A, Garg A, Agrawal R, Sambari S, Mirchandani K, Velleman R, Gupta D, Bhatia U, Fernandes G, D’souza E, Amonkar A, Rane A. Acceptability and feasibility of assisted telepsychiatry in routine healthcare settings in India: a qualitative study. OXFORD OPEN DIGITAL HEALTH 2023; 1:oqad016. [PMID: 38025140 PMCID: PMC10668329 DOI: 10.1093/oodh/oqad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/16/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023]
Abstract
Technology-enabled interventions are often recommended to overcome geographical barriers to access and inequitable distribution of mental healthcare workers. The aim of this study was to examine the acceptability and feasibility of an assisted telepsychiatry model implemented in primary care settings in India. In-depth interviews were conducted with patients who received telepsychiatry consultations. Data were collected about domains such as experience with communicating with psychiatrists over a video call and feasibility of accessing services. Data were analysed using a thematic analysis approach. Patients recognized that technology enabled them to access treatment and appreciated its contribution to the improvement in their mental health condition. They reported that the telepsychiatry experience was comparable to face-to-face consultations. They had a positive experience of facilitation by counsellors and found treatment delivery in primary care non-stigmatizing. While some adapted easily to the technology platform because of increased access to technology in their daily lives, others struggled to communicate over a screen. For some, availability of care closer to their homes was convenient; for others, even the little travel involved posed a financial burden. In some cases, the internet connectivity was poor and interfered with the video calls. Patients believed that scale could be achieved through adoption of this model by the public sector, collaboration with civil society, enhanced demand generation strategies and leveraging platforms beyond health systems. Assisted telepsychiatry integrated in routine healthcare settings has the potential to make scarce specialist mental health services accessible in low resource settings by overcoming geographical and logistical barriers.
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Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Ankur Garg
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Ravindra Agrawal
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Seema Sambari
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Kedar Mirchandani
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Richard Velleman
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
- Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK
| | - Devika Gupta
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Urvita Bhatia
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Godwin Fernandes
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Ethel D’souza
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Akshada Amonkar
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Anil Rane
- Institute of Psychiatry & Human Behaviour , Bambolim, Goa 403108, India
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Javvaji CK, Vagha JD, Meshram RJ, Taksande A. Assessment Scales in Cerebral Palsy: A Comprehensive Review of Tools and Applications. Cureus 2023; 15:e47939. [PMID: 38034189 PMCID: PMC10685081 DOI: 10.7759/cureus.47939] [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: 09/27/2023] [Accepted: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
Cerebral palsy (CP) is a complex neurological condition characterized by motor dysfunction affecting millions worldwide. This comprehensive review delves into the critical role of assessment in managing CP. Beginning with exploring its definition and background, we elucidate the diverse objectives of CP assessment, ranging from diagnosis and goal setting to research and epidemiology. We examine standard assessment scales and tools, discuss the challenges inherent in CP assessment, and highlight emerging trends, including integrating technology, personalized medicine, and neuroimaging. The applications of CP assessment in clinical diagnosis, treatment planning, research, and education are underscored. Recommendations for the future encompass standardization, interdisciplinary collaboration, research priorities, and professional training. In conclusion, we emphasize the importance of assessment as a compass guiding the care of individuals with CP, issuing a call to action for improved assessment practices to shape a brighter future for those affected by this condition.
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Affiliation(s)
- Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayant D Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Yangöz ŞT, Turan Kavradım S, Özer Z. Hotspots and Global Trends of Nursing Research on Telehealth From 2012 to 2021: A Bibliometric Analysis by CiteSpace. Comput Inform Nurs 2023; 41:833-843. [PMID: 37278716 DOI: 10.1097/cin.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Telehealth is commonly used in nursing in recent years; however, there is a lack of information on hotspots and global trends over time. This study aimed to analyze the bibliometric patterns of telehealth research in nursing. This is a descriptive bibliometric study. Data were obtained from Web of Science Core Collection. CiteSpace version 6.1.R6 was used to perform analysis. The co-occurrence and co-citation analyses were conducted. A total of 1365 articles were analyzed. A total of 354 authors and 352 institutions from 68 countries have contributed telehealth research in nursing. The most productive author was Kathryn H. Bowles with six articles. The United States with 688 articles and University of Pennsylvania with 22 articles were the most productive country and institution, respectively. The top 10 keywords on this research area were care , intervention , management , health , technology , quality of life , outcome , mobile application , telemedicine , and experience . In addition, the common themes on keywords were nurse practitioner student perception, hemodialysis patients, and heart failure. The study will help to finding potential collaborators, countries, and institutions for future researchers. In addition, it will guide researchers, practitioners, and scholars in further studies, health policy development, and evidence-based practice on telehealth in nursing.
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Affiliation(s)
- Şefika Tuğba Yangöz
- Author Affiliations: Department of Internal Medicine Nursing, Faculty of Health Sciences, Pamukkale University, Denizli (Dr Yangöz); and Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Antalya (Drs Kavradım and Özer), Turkey
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Snoswell CL, Stringer H, Taylor ML, Caffery LJ, Smith AC. An overview of the effect of telehealth on mortality: A systematic review of meta-analyses. J Telemed Telecare 2023; 29:659-668. [PMID: 34184578 DOI: 10.1177/1357633x211023700] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Telehealth is recognised as a viable way of providing health care over distance, and an effective way to increase access for individuals with transport difficulties or those living in rural and remote areas. While telehealth has many positives for patients, clinicians and the health system, it is important that changes in the delivery of health care (e.g. in-person to telehealth) do not result in inferior or unsafe care. In this review, we collate existing meta-analyses of mortality rates to provide a holistic view of the current evidence regarding telehealth safety. METHODS In November 2020, a search of Pretty Darn Quick Evidence portal was conducted in order to locate systematic reviews published between 2010 and 2019, examining and meta-analysing the effect of telehealth interventions on mortality compared to usual care. RESULTS This review summarises evidence from 24 meta-analyses. Five overarching medical disciplines were represented (cardiovascular, neurology, pulmonary, obstetrics and intensive care). Overall, telehealth did not increase mortality rates. DISCUSSION The evidence from this review can be used by decision makers, in conjunction with other disease-specific and health economic evidences, to support and guide telehealth implementation plans.
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Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- Pharmacy Department, Princess Alexandra Hospital, Australia
| | - Hannah Stringer
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Denmark
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Snoswell CL, Smith AC, Page M, Caffery LJ. Patient preferences for specialist outpatient video consultations: A discrete choice experiment. J Telemed Telecare 2023; 29:707-715. [PMID: 34142895 DOI: 10.1177/1357633x211022898] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Telehealth has been shown to improve access to care, reduce personal expenses and reduce the need for travel. Despite these benefits, patients may be less inclined to seek a telehealth service, if they consider it inferior to an in-person encounter. The aims of this study were to identify patient preferences for attributes of a healthcare service and to quantify the value of these attributes. METHODS We surveyed patients who had taken an outpatient telehealth consult in the previous year using a survey that included a discrete choice experiment. We investigated patient preferences for attributes of healthcare delivery and their willingness to pay for out-of-pocket costs. RESULTS Patients (n = 62) preferred to have a consultation, regardless of type, than no consultation at all. Patients preferred healthcare services with lower out-of-pocket costs, higher levels of perceived benefit and less time away from usual activities (p < 0.008). Most patients preferred specialist care over in-person general practitioner care. Their order of preference to obtain specialist care was a videoconsultation into the patient's local general practitioner practice or hospital (p < 0.003), a videoconsultation into the home, and finally travelling for in-person appointment. Patients were willing to pay out-of-pocket costs for attributes they valued: to be seen by a specialist over videoconference ($129) and to reduce time away from usual activities ($160). CONCLUSION Patients value specialist care, lower out-of-pocket costs and less time away from usual activities. Telehealth is more likely than in-person care to cater to these preferences in many instances.
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Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- Pharmacy Department, Princess Alexandra Hospital, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Denmark
| | - Matthew Page
- Clinical Excellence Queensland, Queensland Health, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
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Nguyen P, Schiaffino MK, Zhang Z, Choi HW, Huh-Yoo J. Toward alert triage: scalable qualitative coding framework for analyzing alert notes from the Telehealth Intervention Program for Seniors (TIPS). JAMIA Open 2023; 6:ooad061. [PMID: 37560155 PMCID: PMC10406700 DOI: 10.1093/jamiaopen/ooad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 08/11/2023] Open
Abstract
Objective Combined with mobile monitoring devices, telehealth generates overwhelming data, which could cause clinician burnout and overlooking critical patient status. Developing novel and efficient ways to correctly triage such data will be critical to a successful telehealth adoption. We aim to develop an automated classification framework of existing nurses' notes for each alert that will serve as a training dataset for a future alert triage system for telehealth programs. Materials and Methods We analyzed and developed a coding framework and a regular expression-based keyword match approach based on the information of 24 931 alert notes from a community-based telehealth program. We evaluated our automated alert triaging model for its scalability on a stratified sampling of 800 alert notes for precision and recall analysis. Results We found 22 717 out of 24 579 alert notes (92%) belonging to at least one of the 17 codes. The evaluation of the automated alert note analysis using the regular expression-based information extraction approach resulted in an average precision of 0.86 (SD = 0.13) and recall 0.90 (SD = 0.13). Discussion The high-performance results show the feasibility and the scalability potential of this approach in community-based, low-income older adult telehealth settings. The resulting coded alert notes can be combined with participants' health monitoring results to generate predictive models and to triage false alerts. The findings build steps toward developing an automated alert triaging model to improve the identification of alert types in remote health monitoring and telehealth systems.
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Affiliation(s)
- Phuong Nguyen
- Department of Computer Science, University of Iowa, Iowa City, Iowa, USA
| | - Melody K Schiaffino
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Zhan Zhang
- Seidenberg School of Computer Science and Information Systems, Pace University, New York, New York, USA
| | - Hyung Wook Choi
- Department of Information Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jina Huh-Yoo
- Department of Information Science, Drexel University, Philadelphia, Pennsylvania, USA
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Snoswell CL, Chelberg G, De Guzman KR, Haydon HH, Thomas EE, Caffery LJ, Smith AC. The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. J Telemed Telecare 2023; 29:669-684. [PMID: 34184580 DOI: 10.1177/1357633x211022907] [Citation(s) in RCA: 127] [Impact Index Per Article: 127.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To promote telehealth implementation and uptake, it is important to assess overall clinical effectiveness to ensure any changes will not adversely affect patient outcomes. The last systematic literature review examining telehealth effectiveness was conducted in 2010. Given the increasing use of telehealth and technological developments in the field, a more contemporary review has been carried out. The aim of this review was to synthesise recent evidence associated with the clinical effectiveness of telehealth services. METHODS A systematic search of 'Pretty Darn Quick'-Evidence portal was carried out in November 2020 for systematic reviews on telehealth, where the primary outcome measure reported was clinical effectiveness. Due to the volume of telehealth articles, only systematic reviews with meta-analyses published between 2010 and 2019 were included in the analysis. RESULTS We found 38 meta-analyses, covering 10 medical disciplines: cardiovascular disease (n = 3), dermatology (n = 1), endocrinology (n = 13), neurology (n = 4), nephrology (n = 2), obstetrics (n = 1), ophthalmology (n = 1), psychiatry and psychology (n = 7), pulmonary (n = 4) and multidisciplinary care (n = 2). The evidence showed that for all disciplines, telehealth across a range of modalities was as effective, if not more, than usual care. DISCUSSION This review demonstrates that telehealth can be equivalent or more clinically effective when compared to usual care. However, the available evidence is very discipline specific, which highlights the need for more clinical effectiveness studies involving telehealth across a wider spectrum of clinical health services. The findings from this review support the view that in the right context, telehealth will not compromise the effectiveness of clinical care when compared with conventional forms of health service delivery.
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Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Georgina Chelberg
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Australia
| | - Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Helen H Haydon
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- University of Southern Denmark, Denmark
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Gambo I, Bueno-Delgado MV, Mooses K, Melero Muñoz FJ, Zviel-Girshin R, Andrushevich A, Mrissa M, Landowska A, Taveter K. Technology adoption review for ageing well: analysis of technical solutions. Front Public Health 2023; 11:1169192. [PMID: 37799155 PMCID: PMC10549926 DOI: 10.3389/fpubh.2023.1169192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/07/2023] [Indexed: 10/07/2023] Open
Abstract
While several technological solutions are available for older adults to improve their wellbeing and quality of life, little is known about the gaps between the needs, provided solutions, and their adoption from a more pragmatic perspective. This paper reports on reviewing existing technological solutions for older adults, which span the work life, life in the community, and wellbeing at home. We analyzed 50 different solutions to uncover both negative and positive features of these solutions from the perspective of the impact of technology adoption on the quality of life of older adults. Our approach harnesses holistic reasoning to determine the most suitable technologies available today and provides suggestions for improvement toward designing and implementing better solutions.
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Affiliation(s)
- Ishaya Gambo
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- Department of Computer Science, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - M. Victoria Bueno-Delgado
- Department of Information and Communication Technologies, Universidad Politécnica de Cartagena, Antiguo Cuartel de Antigones, Cartagena, Spain
| | - Kerli Mooses
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Francisco J. Melero Muñoz
- Department of Information and Communication Technologies, Universidad Politécnica de Cartagena, Antiguo Cuartel de Antigones, Cartagena, Spain
- Technical Research Centre of Furniture and Wood of the Region of Murcia, Yecla, Spain
| | | | - Aliaksei Andrushevich
- HomeLab, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
- Faculty of Applied Mathematics and Computer Science, Belarusian State University, Minsk, Belarus
| | - Michael Mrissa
- InnoRenew CoE, Izola, Slovenia
- Faculty of Mathematics, Natural Sciences and Information Technologies (FAMNIT), University of Primorska, Koper, Slovenia
| | - Agnieszka Landowska
- Department of Software Engineering, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, Gdańsk, Poland
| | - Kuldar Taveter
- Institute of Computer Science, University of Tartu, Tartu, Estonia
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Calvache-Mateo A, Heredia-Ciuró A, Martín-Núñez J, Hernández-Hernández S, Reychler G, López-López L, Valenza MC. Efficacy and Safety of Respiratory Telerehabilitation in Patients with Long COVID-19: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:2519. [PMID: 37761716 PMCID: PMC10530340 DOI: 10.3390/healthcare11182519] [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: 08/02/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this review was to identify, map, and synthesize the extent and nature of research activity on the use of telerehabilitation to support Long COVID-19 rehabilitation and examine the efficacy and safety of respiratory telerehabilitation in patients with Long COVID-19. A systematic review and meta-analysis of randomized controlled trials were performed. We included controlled trials that tested the effect of respiratory telerehabilitation interventions in patients with Long COVID-19 versus no intervention, usual care, placebo, or face-to-face intervention. The data were pooled, and a meta-analysis was completed for quality of life, dyspnea, lung function, anxiety and depression, respiratory muscle strength, functional capacity, and lower limb strength. Finally, 10 studies were included. The meta-analysis results show significant differences in favor of respiratory telerehabilitation in quality of life (p = 0.02), dyspnea (p < 0.00001), respiratory muscle strength (p < 0.001), functional capacity (p < 0.0001), and lower limb strength (p = 0.01) but not in lung function (p = 0.28) and anxiety and depression (p = 0.55). In addition, there were no statistically significant differences in adverse effects (p = 0.06) between the telerehabilitation and comparator groups. The results suggest that these interventions can improve quality of life, reduce dyspnea, and increase respiratory and lower extremity muscle strength as well as functional capacity in patients with Long COVID-19.
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Affiliation(s)
- Andrés Calvache-Mateo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016 Granada, Spain; (A.C.-M.); (A.H.-C.); (J.M.-N.); (S.H.-H.); (M.C.V.)
| | - Alejandro Heredia-Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016 Granada, Spain; (A.C.-M.); (A.H.-C.); (J.M.-N.); (S.H.-H.); (M.C.V.)
| | - Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016 Granada, Spain; (A.C.-M.); (A.H.-C.); (J.M.-N.); (S.H.-H.); (M.C.V.)
| | - Sofía Hernández-Hernández
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016 Granada, Spain; (A.C.-M.); (A.H.-C.); (J.M.-N.); (S.H.-H.); (M.C.V.)
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, 1200 Bruxelles, Belgium;
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, 1200 Bruxelles, Belgium
- Service de Pneumologie, Cliniques Universitaires Saint-Luc, 1200 Bruxelles, Belgium
| | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016 Granada, Spain; (A.C.-M.); (A.H.-C.); (J.M.-N.); (S.H.-H.); (M.C.V.)
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016 Granada, Spain; (A.C.-M.); (A.H.-C.); (J.M.-N.); (S.H.-H.); (M.C.V.)
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McMullen A, Cato G, Situ T, Maruf F, Boyle T, Lumley G, Sivapathasuntharam D. Virtual 'robot' ward rounds: older trauma patients' perceptions of inpatient virtual consultations. Clin Med (Lond) 2023; 23:485-490. [PMID: 37775173 PMCID: PMC10541275 DOI: 10.7861/clinmed.2022-0379] [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: 10/01/2023]
Abstract
Use of telemedicine has increased following the Coronavirus 2019 (COVID-19) pandemic; however, much of the literature is based in outpatient settings. There have also historically been concerns about the efficacy of telemedicine in older patients. This service evaluation implemented virtual consultations into the ward-round setting, using a 'robot' device. Twenty-six older patients undergoing major trauma surgery were surveyed, with all reporting very high satisfaction rates. Ninety percent of patients were 'very happy' or 'happy' with the remote consultations, and 83% found the technology 'easy' or 'very easy' to use. This evaluation is limited by small participant numbers and did not research health outcomes following virtual consultations. To conclude, the use of 'robots' to deliver remote consultations to patients is feasible and welcomed by most patients.
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Atkinson J, Hastie R, Walker S, Lindquist A, Tong S. Telehealth in antenatal care: recent insights and advances. BMC Med 2023; 21:332. [PMID: 37649028 PMCID: PMC10470141 DOI: 10.1186/s12916-023-03042-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND For decades, antenatal care in high-resource settings has involved 12-14 face-to-face visits across pregnancy. The COVID-19 pandemic forced many care providers to rapidly embrace telehealth to reduce face-to-face visits. Here we review recent advances in telehealth used to provide antenatal care. MAIN BODY We conducted a narrative review examining the impact of telehealth on obstetric care. Two broad types of telehealth are used in antenatal care. The first is real-time telehealth, where consultations are done virtually instead of face-to-face. The second is remote monitoring, where in-clinic physical examinations are replaced with at-home alternatives. These can include blood pressure monitoring, fetal heart rate monitoring, and emerging technologies such as tele-ultrasound. Large cohort studies conducted during the pandemic era have shown that telehealth appears not to have increased adverse clinical outcomes for mothers or babies. However, further studies may be required to confidently conclude rare outcomes are unchanged, such as maternal mortality, serious morbidity, or stillbirth. Health economic studies suggest telehealth has the potential to reduce the financial cost of care provision. Telehealth in antenatal care seems to be acceptable to both pregnant women and healthcare providers. CONCLUSION Adoption of telehealth technologies may improve the antenatal care experience for women and reduce healthcare expenditure without adversely impacting health outcomes for the mother or baby. More studies are warranted to confirm telehealth does not alter the risk of rare outcomes such as maternal or neonatal mortality.
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Affiliation(s)
- Jessica Atkinson
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Susan Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Anthea Lindquist
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC, Australia.
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Romaszko-Wojtowicz A, Jaśkiewicz Ł, Jurczak P, Doboszyńska A. Telemedicine in Primary Practice in the Age of the COVID-19 Pandemic-Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1541. [PMID: 37763659 PMCID: PMC10532942 DOI: 10.3390/medicina59091541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: In the era of the COVID-19 pandemic, telemedicine, so far underestimated, has gained in value. Currently, telemedicine is not only a telephone or chat consultation, but also the possibility of the remote recording of signals (such as ECG, saturation, and heart rate) or even remote auscultation of the lungs. The objective of this review article is to present a potential role for, and disseminate knowledge of, telemedicine during the COVID-19 pandemic. Material and Methods: In order to analyze the research material in accordance with PRISMA guidelines, a systematic search of the ScienceDirect, Web of Science, and PubMed databases was conducted. Out of the total number of 363 papers identified, 22 original articles were subjected to analysis. Results: This article presents the possibilities of remote patient registration, which contributes to an improvement in remote diagnostics and diagnoses. Conclusions: Telemedicine is, although not always and not by everyone, an accepted form of providing medical services. It cannot replace direct patient-doctor contact, but it can undoubtedly contribute to accelerating diagnoses and improving their quality at a distance.
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Affiliation(s)
- Anna Romaszko-Wojtowicz
- Department of Pulmonology, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland;
| | - Łukasz Jaśkiewicz
- Department of Human Physiology and Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland;
| | - Paweł Jurczak
- Student Scientific Club of Cardiopulmonology and Rare Diseases of the Respiratory System, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland;
| | - Anna Doboszyńska
- Department of Pulmonology, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland;
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McElligott J, Kruis R, Wells E, Gardella P, Rickett B, Ross J, Warr E, Harvey J. Establishing a Centralized Virtual Visit Support Team: Early Insights. Healthcare (Basel) 2023; 11:2230. [PMID: 37628428 PMCID: PMC10454091 DOI: 10.3390/healthcare11162230] [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: 06/28/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND With the removal of many barriers to direct-to-consumer telehealth during the COVID-19 pandemic, which resulted in a historic surge in the adoption of telehealth into ongoing practice, health systems must now identify the most efficient and effective way to sustain these visits. The Medical University of South Carolina Center for Telehealth developed a Telehealth Centralized Support team as part of a strategy to mature the support infrastructure for the continued large-scale use of outpatient virtual care. The team was deployed as the Center for Telehealth rolled out a new ambulatory telehealth software platform to monitor clinical activity, support patient registration and virtual rooming, and ensure successful visit completion. METHODS A multi-method, program-evaluation approach was used to describe the development and composition of the Telehealth Centralized Support Team in its first 18 months utilizing the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. RESULTS In the first 18 months of the Telehealth Centralized Support team, over 75,000 visits were scheduled, with over 1500 providers serving over 46,000 unique patients. The team was successfully deployed over a large part of the clinical enterprise and has been well received across the health system. It has proven to be a scalable model to support enterprise-level virtual health care delivery. CONCLUSIONS While further research is needed to evaluate the long-term program outcomes, the results of its early implementation suggest great promise for improved telehealth patient and provider satisfaction, the more equitable delivery of virtual services, and more cost-effective means for supporting virtual care.
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Affiliation(s)
- James McElligott
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA
- Center for Telehealth, Medical University of South Carolina, Charleston, SC 29425, USA; (E.W.)
| | - Ryan Kruis
- Center for Telehealth, Medical University of South Carolina, Charleston, SC 29425, USA; (E.W.)
| | - Elana Wells
- Center for Telehealth, Medical University of South Carolina, Charleston, SC 29425, USA; (E.W.)
| | - Peter Gardella
- Center for Telehealth, Medical University of South Carolina, Charleston, SC 29425, USA; (E.W.)
| | - Bryna Rickett
- Center for Telehealth, Medical University of South Carolina, Charleston, SC 29425, USA; (E.W.)
| | - Joy Ross
- Center for Telehealth, Medical University of South Carolina, Charleston, SC 29425, USA; (E.W.)
| | - Emily Warr
- Center for Telehealth, Medical University of South Carolina, Charleston, SC 29425, USA; (E.W.)
| | - Jillian Harvey
- Department of Healthcare Leadership & Management, Medical University of South Carolina, Charleston, SC 29425, USA;
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Pham Q, Wong D, Pfisterer KJ, Aleman D, Bansback N, Cafazzo JA, Casson AJ, Chan B, Dixon W, Kakaroumpas G, Lindner C, Peek N, Potts HW, Ribeiro B, Seto E, Stockton-Powdrell C, Thompson A, van der Veer S. The Complexity of Transferring Remote Monitoring and Virtual Care Technology Between Countries: Lessons From an International Workshop. J Med Internet Res 2023; 25:e46873. [PMID: 37526964 PMCID: PMC10427929 DOI: 10.2196/46873] [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: 03/08/2023] [Revised: 04/25/2023] [Accepted: 05/31/2023] [Indexed: 08/02/2023] Open
Abstract
International deployment of remote monitoring and virtual care (RMVC) technologies would efficiently harness their positive impact on outcomes. Since Canada and the United Kingdom have similar populations, health care systems, and digital health landscapes, transferring digital health innovations between them should be relatively straightforward. Yet examples of successful attempts are scarce. In a workshop, we identified 6 differences that may complicate RMVC transfer between Canada and the United Kingdom and provided recommendations for addressing them. These key differences include (1) minority groups, (2) physical geography, (3) clinical pathways, (4) value propositions, (5) governmental priorities and support for digital innovation, and (6) regulatory pathways. We detail 4 broad recommendations to plan for sustainability, including the need to formally consider how highlighted country-specific recommendations may impact RMVC and contingency planning to overcome challenges; the need to map which pathways are available as an innovator to support cross-country transfer; the need to report on and apply learnings from regulatory barriers and facilitators so that everyone may benefit; and the need to explore existing guidance to successfully transfer digital health solutions while developing further guidance (eg, extending the nonadoption, abandonment, scale-up, spread, sustainability framework for cross-country transfer). Finally, we present an ecosystem readiness checklist. Considering these recommendations will contribute to successful international deployment and an increased positive impact of RMVC technologies. Future directions should consider characterizing additional complexities associated with global transfer.
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Affiliation(s)
- Quynh Pham
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Tefler School of Management, University of Ottawa, Ottawa, ON, Canada
| | - David Wong
- Department of Computer Science, The University of Manchester, Manchester, United Kingdom
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Kaylen J Pfisterer
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Dionne Aleman
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Joseph A Cafazzo
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alexander J Casson
- Department of Electrical and Electronic Engineering, The University of Manchester, Manchester, United Kingdom
- EPSRC Henry Royce Institute, Manchester, United Kingdom
| | - Brian Chan
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - William Dixon
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Gerasimos Kakaroumpas
- Alliance Manchester Business School, The University of Manchester, Manchester, United Kingdom
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Niels Peek
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Henry Ww Potts
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Barbara Ribeiro
- Manchester Institute of Innovation Research, Alliance Manchester Business School, The University of Manchester, Manchester, United Kingdom
| | - Emily Seto
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Charlotte Stockton-Powdrell
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Alexander Thompson
- Manchester Centre for Health Economics, Division of Population Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sabine van der Veer
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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Tak HJ, Cozad M, Horner RD. A National Perspective of Telemedicine Use and Direct Medical Costs: Who Uses It and How Much It Costs. Med Care 2023; 61:495-504. [PMID: 37068023 DOI: 10.1097/mlr.0000000000001856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Telemedicine has the potential to reduce medical costs among health systems. However, there is a limited understanding of the use of telemedicine and its association with direct medical costs. OBJECTIVES Using nationally representative data, we investigated telemedicine use and the associated direct medical costs among respondents overall and stratified by medical provider type and patient insurance status. RESEARCH DESIGN, SUBJECTS, AND MEASURES We used the 2020 Medical Expenditure Panel Survey full-year consolidated file, and outpatient department (OP) and office-based (OB) medical provider event files. Outcomes included total and out-of-pocket costs per visit for OP and OB. The primary independent variable was a binary variable indicating visits made through any telemedicine modality. We used multivariable generalized linear models and 2-part models, adjusting for types of providers and care, patient characteristics, and survey design. RESULTS Among total OP (n = 2938) and OB (n = 20,204) visits, 47.6% and 24.7% of visits, respectively were made through telemedicine. For OP, telemedicine visits were associated with lower total costs (average marginal effect: -$228; 95% confidence interval -$362, -$95) and out-of-pocket costs for all visits and for visits to specialists and to nurse practitioners or physicians assistants. For OB, telemedicine visits were associated with lower total costs, but not with lower out-of-pocket costs, for visits to primary care physicians or nurse practitioners or physician assistants, and for visits by Medicare patients. CONCLUSION Telemedicine was associated with lower direct medical costs. Its potential for cost curbing should be proactively identified and integrated into clinical practice and health policy design.
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Affiliation(s)
- Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE
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Green EH, Aquino PR, Keitz SA. Telemedicine Postpandemic: Where Do We Go From Here? Med Care 2023; 61:491-494. [PMID: 37411002 DOI: 10.1097/mlr.0000000000001892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Eric H Green
- Department of General Internal Medicine, Lahey Hospital & Medical Center
| | - Patrick R Aquino
- Tufts University School of Medicine, Lahey Hospital & Medical Center
| | - Sheri A Keitz
- Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA
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Liu L, Alford-Teaster J, Onega T, Wang F. Refining 2SVCA Method for Measuring Telehealth Accessibility of Primary Care Physicians in Baton Rouge, Louisiana. CITIES (LONDON, ENGLAND) 2023; 138:104364. [PMID: 37274944 PMCID: PMC10237453 DOI: 10.1016/j.cities.2023.104364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Equity in health care delivery is a longstanding concern of public health policy. Telehealth is considered an important way to level the playing field by broadening health services access and improving quality of care and health outcomes. This study refines the recently developed "2-Step Virtual Catchment Area (2SVCA) method" to assess the telehealth accessibility of primary care in the Baton Rouge Metropolitan Statistical Area, Louisiana. The result is compared to that of spatial accessibility via physical visits to care providers based on the popular 2-Step Floating Catchment Area (2SFCA) method. The study shows that both spatial and telehealth accessibilities decline from urban to low-density and then rural areas. Moreover, disproportionally higher percentages of African Americans are in areas with higher spatial accessibility scores; but such an advantage is not realized in telehealth accessibility. In the study area, absence of broadband availability is mainly a rural problem and leads to a lower average telehealth accessibility than physical accessibility in rural areas. On the other side, lack of broadband affordability is a challenge across the rural-urban continuum and is disproportionally associated with high concentrations of disadvantaged population groups such as households under the poverty level and Blacks.
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Affiliation(s)
- Lingbo Liu
- Department of Urban Planning, School of Urban Design, Wuhan University, Wuhan 430072, China
- Center for Geographic Analysis, Harvard University, Cambridge, MA 02138, USA
| | - Jennifer Alford-Teaster
- Norris Cotton Cancer Center, Lebanon, NH 03755, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah; Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
| | - Fahui Wang
- Graduate School and Department of Geography and Anthropology, Louisiana State University, LA 70803, USA
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80
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Mudiyanselage SB, Stevens J, Toscano J, Kotowicz MA, Steinfort CL, Hayles R, Watts JJ. Cost-effectiveness of personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial. PLoS One 2023; 18:e0286533. [PMID: 37319290 PMCID: PMC10270614 DOI: 10.1371/journal.pone.0286533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 05/18/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE The study aims to assess the cost-effectiveness of a personalised telehealth intervention to manage chronic disease in the long run. METHOD The Personalised Health Care (PHC) pilot study was a randomised trial with an economic evaluation alongside over 12 months. From a health service perspective, the primary analysis compared the costs and effectiveness of PHC telehealth monitoring with usual care. An incremental cost-effectiveness ratio was calculated based on costs and health-related quality of life. The PHC intervention was implemented in the Barwon Health region, Geelong, Australia, for patients with a diagnosis of COPD and/or diabetes who had a high likelihood of hospital readmission over 12 months. RESULTS When compared to usual care at 12 months, the PHC intervention cost AUD$714 extra per patient (95%CI -4879; 6308) with a significant improvement of 0.09 in health-related quality of life (95%CI: 0.05; 0.14). The probability of PHC being cost-effective by 12 months was close to 65%, at willingness to pay a threshold of AUD$50,000 per quality-adjusted life year. CONCLUSION Benefits of PHC to patients and the health system at 12 months translated to a gain in quality-adjusted life years with a non-significant cost difference between the intervention and control groups. Given the relatively high set-up costs of the PHC intervention, the program may need to be offered to a larger population to achieve cost-effectiveness. Long-term follow-up is required to assess the real health and economic benefits over time.
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Affiliation(s)
- Shalika Bohingamu Mudiyanselage
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Jo Stevens
- Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
| | - Julian Toscano
- Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
| | - Mark A. Kotowicz
- Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
- Deakin University School of Medicine, Geelong, VIC, Australia
- Melbourne Clinical School-Western Campus, Department of Medicine, The University of Melbourne, St Albans, VIC, Australia
| | - Christopher L. Steinfort
- Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
- Deakin University School of Medicine, Geelong, VIC, Australia
| | - Robyn Hayles
- Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
| | - Jennifer J. Watts
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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81
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Foo CD, Yan JY, Chan ASL, Yap JCH. Identifying Key Themes of Care Coordination for Patients with Chronic Conditions in Singapore: A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11111546. [PMID: 37297686 DOI: 10.3390/healthcare11111546] [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: 04/19/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
A projected rise in patients with complex health needs and a rapidly ageing population will place an increased burden on the healthcare system. Care coordination can bridge potential gaps during care transitions and across the care continuum to facilitate care integration and the delivery of personalised care. Despite having a national strategic vision of improving care integration across different levels of care and community partners, there is no consolidation of evidence specifically on the salient dimensions of care coordination in the Singapore healthcare context. Hence, this scoping review aims to uncover the key themes that facilitate care coordination for patients with chronic conditions in Singapore to be managed in the community while illuminating under-researched areas in care coordination requiring further exploration. The databases searched were PubMed, CINAHL, Scopus, Embase, and Cochrane Library. Results from Google Scholar were also included. Two independent reviewers screened articles in a two-stage screening process based on the Cochrane scoping review guidelines. Recommendation for inclusion was indicated on a three-point scale and rating conflicts were resolved through discussion. Of the 5792 articles identified, 28 were included in the final review. Key cross-cutting themes such as having standards and guidelines for care programmes, forging stronger partnerships across providers, an interoperable information system across care interfaces, strong programme leadership, financial and technical resource availabilities and patient and provider-specific factors emerged. This review also recommends leveraging these themes to align with Singapore's national healthcare vision to contain rising healthcare costs.
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Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Jia Yin Yan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Audrey Swee Ling Chan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Jason C H Yap
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
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Jacob J, Stunden C, Deenadayalan D, Thomas L. Economic Evaluation Comparing Virtual Reality with Child Life Programming for Non-sedated Pediatric Medical Imaging: A Cost-Consequence Analysis. PHARMACOECONOMICS - OPEN 2023; 7:417-429. [PMID: 37041324 PMCID: PMC10089375 DOI: 10.1007/s41669-023-00409-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Effective preparation of children for hospital procedures, including non-sedated medical imaging, is an important clinical issue. This study aimed to assess the costs and consequences (effects) of preparing pediatric patients using two methods of delivering preparation for a scheduled magnetic resonance image (MRI)-virtual reality (VR-MRI) and a certified Child Life Program (CLP). METHODS A cost-consequence analysis (CCA) was performed using a societal perspective in Canada. The CCA catalogs a wide range of costs and consequences of VR-MRI compared with a CLP. The evaluation uses data from a prior randomized clinical trial evaluating VR and a CLP in a simulated trial. The economic evaluation encompassed health-related effects, including anxiety, safety and adverse events, and non-health effects, including preparation time, displaced time from usual activities, workload capacity, patient-specific adaptation, administrative burden, and user-experience metrics. The costs have been categorized into hospital operational costs, travel costs, other patient costs, and societal costs. RESULTS VR-MRI has similar benefits to the CLP in managing anxiety, safety and adverse events, as well as converting patients to non-sedated medical imaging. Preparation time and patient-specific adaptation are in favor of the CLP, while displaced time from usual activities, potential workload capacity, and administrative burden are in favor of VR-MRI. Both programs rank favorably in terms of user experience. The hospital operational costs ranged in Canadian dollars (CAN$) from CAN$32.07 for the CLP to between CAN$107.37 and CAN$129.73 for VR-MRI. Travel costs ranged from CAN$50.58 to CAN$2365.18 depending on travel distance for the CLP, and CAN$0 for VR-MRI. Other patient costs involved caregiver time off, and ranged from CAN$190.69 to CAN$$1144.16 for the CLP and CAN$47.67 for VR-MRI. The total cost for the CLP ranged from CAN$315.16 (CAN$277.91-$426.64) to CAN$3843.41 (CAN$3196.59-$4849.91) per patient depending on travel distance and amount of administrative support required, while VR-MRI preparation ranged from CAN$178.30 (CAN$178.20-$188.76) to CAN$283.85 (CAN$283.71-$298.40) per patient. For every instance where patient travel to visit a Certified Child Life Specialist (CCLS) onsite was replaced with VR-MRI, between CAN$119.01 and CAN$3364.62 total costs could be saved per patient. CONCLUSIONS While it is neither feasible nor appropriate to replace all preparation with VR, using VR to reach children who cannot otherwise visit the CLP onsite could increase access to quality preparation, and using VR in place of the CLP where clinically indicated could reduce the overall costs for patients, the hospital, and society. Our CCA gives decision makers a cost analysis and the relevant effects of each preparation program so they can value the VR and CLP programs more broadly within the potential health and non-health outcomes of pediatric patients scheduled for MRI at their facilities.
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Affiliation(s)
- John Jacob
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, 2D19-4480, Oak Street, Vancouver, BC, V6H 3V4, Canada.
- Digital Lab at BC Children's Hospital, Vancouver, BC, Canada.
- City University of London, London, UK.
| | - Chelsea Stunden
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, 2D19-4480, Oak Street, Vancouver, BC, V6H 3V4, Canada
- Digital Lab at BC Children's Hospital, Vancouver, BC, Canada
| | - Dhayanand Deenadayalan
- Digital Lab at BC Children's Hospital, Vancouver, BC, Canada
- Western University, Ivey School of Business, London, ON, Canada
| | - Luke Thomas
- Digital Lab at BC Children's Hospital, Vancouver, BC, Canada
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Bückmann A, Bernhardt F, Eveslage M, Storck M, Thölking G, Buss H, Domagk D, Juhra C, Lenz P. Telemedical Consultations in Palliative Care: Benefits through Knowledge Exchange and Intercollegiate Collaboration-Findings from the German oVID Project. Cancers (Basel) 2023; 15:cancers15092512. [PMID: 37173978 PMCID: PMC10177576 DOI: 10.3390/cancers15092512] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: As the number of people receiving specialized palliative care (PC) continues to rise, there is a need to ensure the transfer of this expertise from university-based PC departments to primary care hospitals without such in-house access. The present study examines the potential of telemedicine to bridge these gaps. (2) Methods: This is a prospective multi-center feasibility trial. All physicians were appropriately pre-equipped and instructed to conduct telemedical consultations (TCs), which took place within fixed meetings or on-call appointments either related or unrelated to individual patients (allowing TCs also for educational and knowledge exchange purposes). (3) Results: An inquiry for participation was submitted to 11 hospitals, with 5 external hospitals actively cooperating. In the first study section, a total of 57 patient cases were included within 95 patient-related TCs during 80 meetings. Other university disciplines were involved in 21 meetings (26.2%). Therapy adjustments resulted following 25 of 71 affected TCs (35.2%). In 20 cases (21.1%), an on-site consultation at the university hospital was avoided, and in 12 cases (12.6%), a transfer was avoided. Overall, TCs were considered helpful in resolving issues for 97.9% of the cases (n = 93). Yet, technical problems arose in about one-third of all meetings for at least one physician (36.2%; n = 29). Besides, in the second study section, we also conducted 43 meetings between physicians for education and knowledge exchange only. (4) Conclusions: Telemedicine has the potential to transfer university expertise to external hospitals through simple means. It improves collaboration among physicians, may prevent unnecessary transfers or outpatient presentations, and is thus likely to lower costs.
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Affiliation(s)
- Andreas Bückmann
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
| | - Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Muenster, 48149 Muenster, Germany
| | - Gerold Thölking
- Department of Internal Medicine and Nephrology, University Hospital Muenster Marienhospital Steinfurt, 48565 Steinfurt, Germany
| | - Helga Buss
- Department of Geriatrics, EVK Muenster Alexianer Johannisstift GmbH, 48147 Muenster, Germany
| | - Dirk Domagk
- Department of Medicine I: Internal Medicine and Gastroenterology, Josephs-Hospital Warendorf, Academic Teaching Hospital of the University of Muenster, 48231 Warendorf, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Muenster, 48149 Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
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Borg Debono V, Neumark S, Buckley N, Zacharias R, Hapidou E, Anthonypillai J, Faria S, Meyer CL, Carter T, Parker N, Lau B, Abreu E, Duggan S, Bisson E, Pierre J, Visca R, Poulin P. Transition to Virtual Care Services during COVID-19 at Canadian Pain Clinics: Survey and Future Recommendations. Pain Res Manag 2023; 2023:6603625. [PMID: 37051562 PMCID: PMC10085656 DOI: 10.1155/2023/6603625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/01/2023] [Accepted: 03/08/2023] [Indexed: 04/05/2023]
Abstract
Introduction. Due to the COVID-19 pandemic, healthcare centers quickly adapted services into virtual formats. Pain clinics in Canada play a vital role in helping people living with pain, and these clinics remained essential services for patients throughout the pandemic. This study aimed to (1) describe and compare the transition from in-person to virtual pain care services at Canadian pain clinics during the onset of the COVID-19 pandemic and (2) provide postpandemic recommendations for pain care services to optimize the quality of patient care. Materials and Methods. We used a qualitative participatory action study design that included a cross-sectional survey for data collection and descriptive analysis to summarize the findings. Survey responses were collected between January and March of 2021. The survey was administered to the leadership teams of 11 adult pain clinics affiliated with the Chronic Pain Centre of Excellence for Canadian Veterans. Responses were analyzed qualitatively to describe the transition to the virtual pain services at pain clinics. Results. We achieved a 100% response rate from participating clinics. The results focus on describing the transition to the virtual care, current treatment and services, the quality of care, program sustainability, barriers to maintaining virtual services, and future considerations. Conclusions. Participating clinics were capable of transitioning pain care services to the virtual formats and have in-person care when needed with proper safety precautions. The pandemic demonstrated that it is feasible and sustainable for pain clinics to have a hybrid of virtual and in-person care to treat those living with pain. It is recommended that moving forward, there should be a hybrid of both virtual and in-person care for pain clinics. Ministries of Health should continue to develop policies and funding mechanisms that support innovations aimed at holistic healthcare, interdisciplinary teams, and the expansion of clinics’ geographical reach for patient access.
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Affiliation(s)
- Victoria Borg Debono
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Samuel Neumark
- Translational Research Program, Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, 263 McCaul Street, Toronto, Ontario M5T 1W7, Canada
| | - Norman Buckley
- Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Ramesh Zacharias
- Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Eleni Hapidou
- Michael G. DeGroote Pain Clinic, Hamilton Health Science, 1200 Main Street W, Hamilton, Ontario L8N 3Z5, Canada
| | - Jennifer Anthonypillai
- Michael G. DeGroote Pain Clinic, Hamilton Health Science, 1200 Main Street W, Hamilton, Ontario L8N 3Z5, Canada
| | - Susy Faria
- Michael G. DeGroote Pain Clinic, Hamilton Health Science, 1200 Main Street W, Hamilton, Ontario L8N 3Z5, Canada
| | - Carrie-Lynn Meyer
- Michael G. DeGroote Pain Clinic, Hamilton Health Science, 1200 Main Street W, Hamilton, Ontario L8N 3Z5, Canada
| | - Thomas Carter
- CBI Health Clinics, 272 Richmond Street E Suite 100, Toronto, Ontario M5A 1P4, Canada
| | - Nadia Parker
- CBI Health Clinics, 272 Richmond Street E Suite 100, Toronto, Ontario M5A 1P4, Canada
| | - Brenda Lau
- CHANGEpain Clinic, 5655 Cambie Street Lower Level, Vancouver, British Columbia V5Z 3A4, Canada
| | - Emmanuel Abreu
- CHANGEpain Clinic, 5655 Cambie Street Lower Level, Vancouver, British Columbia V5Z 3A4, Canada
| | - Scott Duggan
- Kingston Health Sciences Centre-Hotel Dieu Hospital Site, 166 Brock Street, Kingston, Ontario K7L 5G2, Canada
| | - Etienne Bisson
- Kingston Health Sciences Centre-Hotel Dieu Hospital Site, 166 Brock Street, Kingston, Ontario K7L 5G2, Canada
| | - Josie Pierre
- Operational Stress Injury (OSI) Clinic and Pain Management, Ste-Anne’s Hospital, 305 Boul des Anciens-Combattants Sainte-Anne-de-Bellevue, Montreal, Quebec H9X 1Y9, Canada
| | - Regina Visca
- McGill University Health Centre, Alan Edwards Pain Management Unit Montreal General Hospital, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada
| | - Patricia Poulin
- Department of Anesthesia and Pain Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, Ontario K1N 6N5, Canada
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Gander JC, Goodrich G, McDonald B, McCracken CE, Tavel HM, Davis TL, Weinfield NS, Ritzwoller DP, Roblin DW. Virtual Care and Urinary Tract Infection Management: Comparing Ancillary Service Orders and Patient Order Fulfillments Between Virtual and In-person Encounters During the COVID-19 Pandemic in the United States. Med Care 2023; 61:S21-S29. [PMID: 36893415 PMCID: PMC9994568 DOI: 10.1097/mlr.0000000000001805] [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: 03/11/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, more health care issues were being managed remotely. Urinary tract infections (UTIs) are being managed more often using telehealth although few reports compare the rate of UTI ancillary service orders placed and fulfilled during these visits. OBJECTIVES We aimed to evaluate and compare the rate of ancillary service orders and order fulfillments in incident UTI diagnoses between virtual and in-person encounters. RESEARCH DESIGN The retrospective cohort study involved 3 integrated health care systems: Kaiser Permanente (KP) Colorado, KP Georgia, and KP Mid-Atlantic States. SUBJECTS We included incident UTI encounters from adult primary care data from January 2019 to June 2021. MEASURES Data were categorized as: prepandemic (January 2019-March 2020), COVID-19 Era 1 (April 2020-June 2020), and COVID-19 Era 2 (July 2020-June 2021). UTI-specific ancillary services included medication, laboratory, and imaging. Orders and order fulfillments were dichotomized for analyses. Weighted percentages for orders and fulfillments were calculated using inverse probability treatment weighting from logistic regression and compared between virtual and in-person encounters using χ2 tests. RESULTS We identified 123,907 incident encounters. Virtual encounters increased from 13.4% prepandemic to 39.1% in COVID-19 Era 2. Ancillary service orders from virtual encounters were not placed as often as in-person encounters. However, the weighted percentage for ancillary service order fulfillment across all services remained above 65.3% across sites and eras, with many fulfillment percentages above 90%. CONCLUSIONS Our study reported a high rate of order fulfillment for both virtual and in-person encounters. Health care systems should encourage providers to place ancillary service orders for uncomplicated diagnoses, such as UTI, to provide enhanced access to patient-centered care.
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Affiliation(s)
- Jennifer C. Gander
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
| | - Glenn Goodrich
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Bennet McDonald
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
| | | | - Heather M. Tavel
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Teaniese L. Davis
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
| | - Nancy S. Weinfield
- Kaiser Permanente Mid-Atlantic Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | | | - Douglas W. Roblin
- Kaiser Permanente Mid-Atlantic Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
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86
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Avila FR, Carter RE, McLeod CJ, Bruce CJ, Guliyeva G, Torres-Guzman RA, Maita KC, Ho OA, TerKonda SP, Forte AJ. The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation. Diagnostics (Basel) 2023; 13:diagnostics13061165. [PMID: 36980474 PMCID: PMC10047211 DOI: 10.3390/diagnostics13061165] [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: 12/21/2022] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients' risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation.
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Affiliation(s)
- Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Christopher J McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Charles J Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Gunel Guliyeva
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Olivia A Ho
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Sarvam P TerKonda
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
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87
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Snoswell CL, Haydon HM, Kelly JT, Thomas EE, Caffery LJ, Smith AC. How do consumers prefer their care delivered: In-person, telephone or videoconference? J Telemed Telecare 2023:1357633X231160333. [PMID: 36927220 DOI: 10.1177/1357633x231160333] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
AIM To gain a better understanding of consumer experiences with and preferences for telephone and videoconference consultations (telehealth), and how these compare to traditional in-person consultations. METHODS A national cross-sectional survey was administered to a representative sample of Australian adults who have received a telehealth service within the last year. Consumers were recruited by Qualtrics® through their online sampling service. The sample was representative of the broader Australian population according to gender, age, location (state/territory), and place of residence (urban or remote). Information on demographics (e.g., age, gender, employment status), recent telehealth experience, and preferences for consultation modality was collected. To measure preferences consumers were asked to indicate which modality they would prefer (in-person, telephone, or videoconference) for different scenarios. These included consultations of various time lengths, and for the top ten conditions for which individuals sought a general practitioner. RESULTS A total of 1069 consumers completed the survey. When consumers were asked to describe their most recent telehealth appointment, most were for follow-up appointments (67%) and completed by telephone (77%) rather than by videoconference, and with a general practitioner (75%). In-person consultations at a clinic were the top preference in all clinical scenarios presented, except when needing a prescription or to receive test results. In these cases, a telephone consultation was the preferred modality. Inexperience with videoconference and duration of consultation influenced preference for consultation mode. Consumers preferred to have short consultations of around five minutes done by telehealth (telephone or videoconference), while they preferred in-person for longer consultations (up to 60 minutes). CONCLUSIONS Many Australians have used telehealth in the past year to access healthcare, with telephone being the most common form of communication. Given the option and the experience to date, consumers prefer telephone when consultations related to either prescriptions or test results. Experience with videoconference for consultations increased consumer preferences for using it for future consultations.
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Affiliation(s)
- Centaine L Snoswell
- 430948Faculty of Medicine, Centre for Online Health, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Helen M Haydon
- 430948Faculty of Medicine, Centre for Online Health, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Jaimon T Kelly
- 430948Faculty of Medicine, Centre for Online Health, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Emma E Thomas
- 430948Faculty of Medicine, Centre for Online Health, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Liam J Caffery
- 430948Faculty of Medicine, Centre for Online Health, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- 430948Faculty of Medicine, Centre for Online Health, The University of Queensland, Brisbane, Australia.,Faculty of Medicine, Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia.,Centre for Innovative Medical Technology, 6174University of Southern Denmark, Odense, Denmark
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88
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Shah SR, Munhall CC, Nguyen SA, O'Rourke AK, Miccichi K, Meyer TA. Diagnostic accuracy and management concordance of otorhinolaryngological diseases through telehealth or remote visits: A systematic review & meta-analysis. J Telemed Telecare 2023:1357633X231156207. [PMID: 36916306 DOI: 10.1177/1357633x231156207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION COVID-19 has led to delays in providing healthcare in both emergency and non-emergency settings, especially in surgical subspecialties which rely heavily on referrals and in-person visits. Without an established telehealth infrastructure, many otorhinolaryngological departments experienced decreases in consultations. Telemedicine has attempted to bridge the gap between pre- and post-pandemic periods by creating a safe avenue of communication between otorhinolaryngologists and patients. This review hopes to address the accuracy of telemedicine in patient diagnosis and management. METHODS Searches were conducted since study conception until June 30, 2022, on multiple databases including PubMed, SCOPUS, and CINAHL for this systematic review and meta-analysis. Diagnostic accuracy, management accuracy, kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were meta-analyzed by comparing virtual visits to in-person visits (gold standard). RESULTS Nineteen studies were included in this review. A total of 1518 patients were included across all studies. When comparing virtual visits against in-person visits, accurate diagnosis was made in 86.2% [82.1,89.9, I2 = 73.5%, P < 0.0001] of patients and management accuracy was 91.5% [86.1,95.7, I2 = 81.8%, P < 0.0001] when treating patients. Kappa value determining interrater reliability was 0.8 [0.7,0.9, I2 = 81.8%, P < 0.0001]. CONCLUSION Our data suggest that diagnostic and management concordance is above 80% when comparing diagnosis and management strategies in patients who underwent both telehealth and in-person visits with an otorhinolaryngologist. In uncomplicated patients, telehealth might be a reliable source for diagnosis and management however, in-person consultation is likely still required for pathologies in which physical exam, imaging or procedural elements represent a vital component of the work-up.
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Affiliation(s)
- Sunny R Shah
- Department of Otolaryngology - Head and Neck Surgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Christopher C Munhall
- Department of Otolaryngology - Head and Neck Surgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Ashli K O'Rourke
- Department of Otolaryngology - Head and Neck Surgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Kate Miccichi
- Department of IT Telemedicine, 23410McLeod Health, Florence, SC, USA
| | - Ted A Meyer
- Department of Otolaryngology - Head and Neck Surgery, 2345Medical University of South Carolina, Charleston, SC, USA
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Telehealth Readiness of Healthcare Providers during COVID-19 Pandemic in Saudi Arabia. Healthcare (Basel) 2023; 11:healthcare11060842. [PMID: 36981499 PMCID: PMC10048154 DOI: 10.3390/healthcare11060842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Objective: This study aimed to assess and explore the telehealth readiness of healthcare providers in Saudi Arabia. Methods: This descriptive cross-sectional survey was conducted in a government healthcare facility in Saudi Arabia between August and October 2020. The Telehealth Readiness Assessment (TRA) tool was used. Results: A total of 372 healthcare providers participated in this study. Their mean age was 35.5 years (SD = 10.46). The majority of respondents were female (65.6%), nurses (68.0%), married (60.2%), and non-Saudi nationals (64.2%). The analysis shows that healthcare providers generally had moderate-to-high telehealth readiness. Of the five domains, financial contributions had the lowest rating among nurses and physicians, 63.4% and 66.1%, respectively. Gender (β = 7.64, p = 0.001), years of experience in the organization (β = 11.75, p = 0.001), and years of experience in the profession (β = 10.04, p = 0.023) predicted the telehealth readiness of healthcare providers. Conclusion: The telehealth readiness of healthcare providers in Saudi Arabia showed moderate to high levels. The COVID-19 pandemic poses a catastrophic threat to both patients and healthcare providers. Assessing telehealth readiness should include both patients and healthcare provider factors. A better understanding of the factors of organizational readiness, particularly healthcare providers, could help avoid costly implementation errors.
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90
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Alexander JS, Redfern RE, Duwelius PJ, Berend KR, Lombardi AV, Crawford DA. Use of a Smartphone-Based Care Platform After Primary Partial and Total Knee Arthroplasty: 1-Year Follow-Up of a Prospective Randomized Controlled Trial. J Arthroplasty 2023:S0883-5403(23)00213-9. [PMID: 36889524 DOI: 10.1016/j.arth.2023.02.082] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The rise in demand of knee arthroplasty has led the industry to develop methods to decrease costs of care, such as novel methods of delivering physiotherapy, including smartphone-based exercise educational platforms. The purpose of this study was to determine the noninferiority of one such system after primary knee arthroplasty as compared to traditional in-person physiotherapy. METHODS A prospective, multicenter randomized clinical trial was conducted comparing standard of care rehabilitation to a smartphone-based care platform after primary knee arthroplasty from January 2019 to February 2020. One-year patient outcomes, satisfaction scores, and utilizations of health care resources were analyzed. A total of 401 patients was available for analysis-241 in the control and 160 in the treatment group. RESULTS There were 194 (94.6%) patients in the control group who required 1 or more physiotherapy visits compared to only 97 (60.6%) patients in the treatment group (P < .001). Emergency department visits within 1 year occurred in 13 (5.4%) patients and 2 (1.3%) patients in the control and treatment groups, respectively (P = .03). The change in mean Knee Injury and Osteoarthritis Outcome Score for joint replacement scores at 1 year was similar between both the groups (32.1 ± 1 6.8 versus 30.1 ± 18.1, P = .32). CONCLUSION Implementation of this smartphone/smart watch care platform showed similar outcomes to traditional care models at 1 year postoperative. Traditional physiotherapy and emergency department visits occurred at much lower rates in this cohort, which could alleviate the need for health care dollars spent by reducing postoperative costs and enhancing communication across the health care system.
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91
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Blount E, Davey MG, Joyce WP. Patient reported satisfaction levels with the use of telemedicine for general surgery-A systematic review of randomized control trials. SURGERY IN PRACTICE AND SCIENCE 2023; 12:100152. [PMID: 36570642 PMCID: PMC9769022 DOI: 10.1016/j.sipas.2022.100152] [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: 09/04/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Background As healthcare continues to evolve in the wake of COVID-19 pandemic, surgeons are presented with the opportunity to integrate telemedicine into healthcare in tandem with in-person consultations. We aimed to perform a systematic review of randomized controlled trials to assess patient satisfaction with telemedicine interventions in general surgery. Methods A systematic review was performed in accordance to the PRISMA guidelines. Randomized control trials (RCTs) were included. The risk of bias 2.0 assessment was used to determine potential bias. Results In total, 11 prospective, randomized trials involving 1,598 patients (mean age: 49.1 years) were included. Overall 45.5% (5/11) of the trials compared videoconferencing or telephone follow up to traditional in person follow up. Three studies used smart technologies which include activity tracking devices in combination with a website and mobile application (27.3%). The other 3 interventions involved accelerated discharge on post operative day (POD) 1 with tele videoconferencing on POD 2, Post-operative daily text messages with education videos and video calling capability, and supportive text messages post-operatively. Telemedicine was shown to provide similar levels of patient satisfaction compared to controls in all 11 included RCTs. Conclusion Patient reported satisfaction with the use of telemedicine is similar to standard of care models in general surgery. With several shortcomings confounding the results in support of telemedicine, further experimentation with telemedicine interventions will likely improve patient reported satisfaction with using telemedicine for peroperative surgical care.
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Affiliation(s)
- Eoghan Blount
- Department of Surgery, Galway Clinic, Co. Galway H91 HHT0, Ireland
| | - Matthew G Davey
- Department of Surgery, Galway Clinic, Co. Galway H91 HHT0, Ireland
- Royal College of Surgeons Ireland, 123 St. Stephens Green, Dublin 2, D02 YN77, Ireland
| | - William P Joyce
- Department of Surgery, Galway Clinic, Co. Galway H91 HHT0, Ireland
- Royal College of Surgeons Ireland, 123 St. Stephens Green, Dublin 2, D02 YN77, Ireland
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92
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Brickley B, Burzacott J, Naren T. Enhancing person-centred care and access to primary care for Aboriginal and Torres Strait Islander peoples. AUST HEALTH REV 2023; 47:13-15. [PMID: 36423653 DOI: 10.1071/ah22190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/09/2022] [Indexed: 11/26/2022]
Abstract
The pandemic has amplified the health needs of Aboriginal and Torres Strait Islander peoples and influenced the way primary care services are delivered. The purpose of this critical perspective is to explore the research on person-centred care (PCC) that has been conducted during the pandemic, with a contextual focus on care delivered by general practitioners (GPs) to Aboriginal and Torres Strait Islander communities. The pandemic has shown that primary care needs to be flexible, adaptive and innovative to maintain PCC. During the pandemic, general practice teams maintained their focus on the delivery of PCC and adapted routine services. National health care policy and modifications to the Medicare Benefits Schedule supported the delivery of PCC. Evaluation research has shown that funding extensions made during the pandemic increased patient engagement and the delivery of routine services, which supported primary care clinic sustainability. However, the delivery of PCC by GPs in the clinical setting requires time. Adequately funded, longer primary care consultations are needed to enhance PCC and access to services for Aboriginal and Torres Strait Islander peoples.
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Affiliation(s)
- Bryce Brickley
- Healthy Primary Care, Menzies Health Institute Queensland, G40 Griffith Health Centre, Level 8.86, Gold Coast Campus, Griffith University, Gold Coast, Qld 4222, Australia
| | - Jaydene Burzacott
- Bendigo & District Aboriginal Co-operative, 119 Prouses Road, North Bendigo, Vic. 3550, Australia
| | - Thileepan Naren
- Drug Health Services, Western Health, 3¿7 Eleanor Street, Footscray, Vic. 3011, Australia
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93
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Calleja Z, Job J, Jackson C. Offsite primary care providers using telehealth to support a sustainable workforce in rural and remote general practice: A rapid review of the literature. Aust J Rural Health 2023; 31:5-18. [PMID: 36037328 DOI: 10.1111/ajr.12920] [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: 01/05/2022] [Revised: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Rural and remote general practices face increasing demands for care without the workforce required to meet patient needs. The coronavirus pandemic has created an opportunity to explore sustainable, telehealth-driven solutions to this chronic and complex problem. OBJECTIVE This review examined interventions using offsite primary care providers to deliver ongoing patient care via telehealth to support rural and remote general practices. We aimed to understand the impact of such interventions on the Quadruple Aim (patient experience, provider experience, health care costs, and health outcomes). DESIGN A rapid review of studies published from 2011 and grey literature published from 2016. FINDINGS Six studies met the eligibility criteria. No eligible Australian studies were identified. Most studies investigated ongoing primary care services provided via telehealth by offsite pharmacists. Patients and rural primary care staff reported positive experiences with the interventions. One study demonstrated potential return on investment for rural practices. While one study reported clinically and statistically significant improvements in health outcomes over time, two studies did not observe statistically significant differences in health outcomes between intervention and control cohorts. DISCUSSION The Quadruple Aim should be carefully considered when designing, implementing, and evaluating interventions that involve offsite primary care providers using telehealth to support a sustainable workforce in rural and remote general practice. CONCLUSION Sustainable solutions to workforce shortages in rural and remote general practice are needed urgently. Using offsite primary care providers to deliver telehealth and support practices in these regions is one possible solution that warrants further investigation, particularly in Australia.
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Affiliation(s)
- Zoe Calleja
- Centre for Health System Reform and Integration, Mater Research Institute-University of Queensland (MRI-UQ), Herston, Qld, Australia.,School of Medicine and Dentistry, Griffith University, Brisbane, Qld, Australia
| | - Jennifer Job
- Centre for Health System Reform and Integration, Mater Research Institute-University of Queensland (MRI-UQ), Herston, Qld, Australia
| | - Claire Jackson
- Centre for Health System Reform and Integration, Mater Research Institute-University of Queensland (MRI-UQ), Herston, Qld, Australia
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94
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Doctor for Every Citizen: Telehealth Visits at Dubai Health Authority during COVID-19 Pandemic in Dubai, United Arab Emirates. Healthcare (Basel) 2023; 11:healthcare11030294. [PMID: 36766869 PMCID: PMC9914661 DOI: 10.3390/healthcare11030294] [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: 11/28/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Digital health significantly affects healthcare delivery. Moreover, empirical studies on the utilization of telehealth in Dubai are limited. Accordingly, this study examines the utilization of telehealth services in Dubai Health Authority (DHA) facilities and the factors associated with telehealth appointment completion and turnaround time. METHODS This cross-sectional study examines patients who used telehealth services in DHA from 2020 through 2021 using 241,822 records. A binary logistic regression model was constructed to investigate the association between appointment turnaround time as a dependent variable and patient and visit characteristics as independent variables. RESULTS Of the total scheduled telehealth visits, more than three-quarter (78.55%) were completed. Older patients, non-Emiratis, patients who had their visits in 2020, patients who had video visits, and those who sought family medicine as a specialty had a shorter turnaround time to receive their appointment. CONCLUSIONS This study identifies several characteristics associated with the turnaround time. Moreover, technological improvements focusing on specialties that can readily be addressed through telehealth and further research in this domain will improve service provision and support building an evidence-base in the government sector of the emirate of Dubai.
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Lantheaume S, Doublet L, Mory JE, Durand T, Lebosse W, Heudel PE. A qualitative study of teleconsultation practices among French oncologists in a post-COVID-19 period. Digit Health 2023; 9:20552076231215906. [PMID: 38033511 PMCID: PMC10685777 DOI: 10.1177/20552076231215906] [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: 07/31/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
Background The Covid-19 pandemic has prompted healthcare professionals to adapt and implement new tools to ensure continuity of patient care. Teleconsultation became the only option for some practitioners who had never used it previously and boosted its use for others who already used it. Several studies have reviewed the use of teleconsultation in oncology during the epidemic, but few have addressed its continued use and how practitioners view it in a post-epidemic period. The aim of this survey was to conduct a qualitative exploration of how oncologists use teleconsultation in their daily practice in a post-COVID 19 period. Materials and Methods For this qualitative study, semi-structured interviews were conducted with oncologists in France who utilized teleconsultation in the field of oncology during the COVID-19 period. The interview guide included questions on the interests and limitations of using teleconsultation in oncology, on reluctance to use it among oncologists, and invited participants to formulate proposals for more optimal use. Results Fourteen oncologists participated in the survey. Currently, 12% of the consultations of the surveyed practitioners are conducted via teleconsultation. Seven themes were identified in the analysis of the interviews: (a) The oncologist and teleconsultation; (b) Clinical motivations for using teleconsultation; (c) Comparison between teleconsultation and in-person consultation; (d) Advantages and disadvantages of teleconsultation; (e) Technical modalities of teleconsultation; (f) Role of Covid and confinement in the use of teleconsultation; (h) Epistemic judgments about teleconsultation. Optimal teleconsultation occurs when seamlessly incorporated into patient care, offering reduced patient inconvenience, and providing economic and environmental benefits. Although there's a lack of unified agreement in research literature regarding time efficiency, teleconsultation facilitates more customized patient monitoring and addresses the challenge of "medical deserts" nationally. Considering patient preferences is crucial when contemplating the use of teleconsultation. Predominantly, technical issues stand as the principal barriers to teleconsultation implementation. Conclusion Even after the end of the health crisis, teleconsultation is still used in clinical practice. Recommendations for effective use are suggested.
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Affiliation(s)
- Sophie Lantheaume
- Ramsay Santé Hôpital Privé Drôme Ardèche, 07500 Guilherand-Granges, France
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France
| | - Louis Doublet
- Ramsay Santé Hôpital Privé Drôme Ardèche, 07500 Guilherand-Granges, France
| | - Jean-Eudes Mory
- Ramsay Santé Hôpital Privé Drôme Ardèche, 07500 Guilherand-Granges, France
- Centre de Coordination de Cancérologie Drôme Ardèche, 26000 Valence, France
| | - Thierry Durand
- Direction des systèmes d’information, centre Léon Bérard, 69008 Lyon, France
| | - William Lebosse
- Centre de Coordination de Cancérologie Rhodanien, Centre Léon Bérard, 69008 Lyon, France
| | - Pierre-Etienne Heudel
- Centre de Coordination de Cancérologie Rhodanien, Centre Léon Bérard, 69008 Lyon, France
- Département d’Oncologie Médicale, Centre Léon Bérard, 69008 Lyon, France
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Nguyen A, Zhu CK, O’Brien E. Teledermatology in remote Indigenous populations: Lessons learned and paths to explore, an experience from Canada (Québec) and Australia. Digit Health 2023; 9:20552076231217813. [PMID: 38033523 PMCID: PMC10687935 DOI: 10.1177/20552076231217813] [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: 08/30/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023] Open
Abstract
Objective Recent introduction of a provincially funded and administered teledermatology platform in Quebec presents a major opportunity to improve healthcare delivery to rural Indigenous communities where healthcare is suboptimal. In this study, we assessed approaches, challenges, solutions, and outcomes in implementing teledermatology in rural Indigenous communities of Australia and Canada. Methods A narrative review was performed using journal articles and grey literatures to assess challenges encountered in Canadian and Australian teledermatology programs in rural Indigenous communities. We then conducted a focused search to identify solutions and outcomes to these challenges. We identified four main areas of focus for implementing teledermatology: financial, cultural, legal, and provider competency. Results Main financial concerns included identifying the cost-to-benefit ratio of teledermatology and financial benefits of the store-and-forward system compared to videoconferencing. Delivery of teledermatology through culturally considerate services is crucial to mend the mistrust felt by Indigenous people toward mainstream health services. From a legal standpoint, patient confidentiality and physician liability must be considered. A uniform teledermatology platform and physician competency in both telemedicine and dermatology are needed to ensure standard of care. Conclusion Teledermatology initiatives represent great opportunities to improve healthcare services to rural Indigenous populations.
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Affiliation(s)
- Alex Nguyen
- Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Catherine K Zhu
- Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Elizabeth O’Brien
- Division of Dermatology, McGill University Health Center, Montréal, Quebec, Canada
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97
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Takahashi EA, Schwamm LH, Adeoye OM, Alabi O, Jahangir E, Misra S, Still CH. An Overview of Telehealth in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e558-e568. [PMID: 36373541 DOI: 10.1161/cir.0000000000001107] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telehealth enables the remote delivery of health care through telecommunication technologies and has substantially affected the evolving medical landscape. The COVID-19 pandemic accelerated the utilization of telehealth as health care professionals were forced to limit face-to-face in-person visits. It has been shown that information delivery, diagnosis, disease monitoring, and follow-up care can be conducted remotely, resulting in considerable changes specific to cardiovascular disease management. Despite increasing telehealth utilization, several factors such as technological infrastructure, reimbursement, and limited patient digital literacy can hinder the adoption of remote care. This scientific statement reviews definitions pertinent to telehealth discussions, summarizes the effect of telehealth utilization on cardiovascular and peripheral vascular disease care, and identifies obstacles to the adoption of telehealth that need to be addressed to improve health care accessibility and equity.
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98
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Marks D, Kitcher S, Attrazic E, Hing W, Cottrell M. The Health Economic Impact of Musculoskeletal Physiotherapy Delivered by Telehealth: A Systematic Review. Int J Telerehabil 2022. [DOI: 10.5195/ijt.2022.6524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: While the efficacy of telehealth in musculoskeletal physiotherapy has been supported, its cost effectiveness has not been established. Therefore, the objective of this review was to ascertain the health economic impact of outpatient musculoskeletal physiotherapy delivered by telehealth and describe methodology utilized to date. Methods: Electronic searching of PubMed, CINHAL, PEDro, and Web of Science databases was undertaken alongside handsearching for publications comprising: population: adults with musculoskeletal disorders managed in any type of outpatient ambulatory setting; intervention: physiotherapy delivered by telehealth comparison: traditional in-person physiotherapy; and, outcomes: economic analyses reporting costs and consequences. Appraisal was undertaken with the Downs and Black Questionnaire and the Consolidated Health Economic Evaluation Reporting Standards Checklist. Results: Eleven studies of mixed methodological quality were included. Most were conducted in the public sector, from the economic perspective of the health service funder. Telehealth consistently produced health outcomes akin to in-person care. In all but one, telehealth was less costly, with savings achieved by reducing in-person consultations and travel costs. Conclusion: Telehealth is as effective and cheaper than in-person physiotherapy for musculoskeletal disorders in public hospital outpatients. Further health economic research is needed to clarify the economic impact of telehealth upon non-government providers of musculoskeletal physiotherapy.
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Marks D, Kitcher S, Attrazic E, Hing W, Cottrell M. The Health Economic Impact of Musculoskeletal Physiotherapy Delivered by Telehealth: A Systematic Review. Int J Telerehabil 2022; 14:e6524. [PMID: 38026565 PMCID: PMC10681044 DOI: 10.5195/ijt.2023.6524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Introduction While the efficacy of telehealth in musculoskeletal physiotherapy has been supported, its cost effectiveness has not been established. Therefore, the objective of this review was to ascertain the health economic impact of outpatient musculoskeletal physiotherapy delivered by telehealth and describe methodology utilized to date. Methods Electronic searching of PubMed, CINHAL, PEDro, and Web of Science databases was undertaken alongside handsearching for publications comprising: population: adults with musculoskeletal disorders managed in any type of outpatient ambulatory setting; intervention: physiotherapy delivered by telehealth comparison: traditional in-person physiotherapy; and, outcomes: economic analyses reporting costs and consequences. Appraisal was undertaken with the Downs and Black Questionnaire and the Consolidated Health Economic Evaluation Reporting Standards Checklist. Results Eleven studies of mixed methodological quality were included. Most were conducted in the public sector, from the economic perspective of the health service funder. Telehealth consistently produced health outcomes akin to in-person care. In all but one, telehealth was less costly, with savings achieved by reducing in-person consultations and travel costs. Conclusion Telehealth is as effective and cheaper than in-person physiotherapy for musculoskeletal disorders in public hospital outpatients. Further health economic research is needed to clarify the economic impact of telehealth upon non-government providers of musculoskeletal physiotherapy.
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Affiliation(s)
- Darryn Marks
- Bond University, School of Physiotherapy, Gold Coast, Australia
- Gold Coast University Hospital, Gold Coast, Australia
| | - Sarah Kitcher
- Bond University, School of Physiotherapy, Gold Coast, Australia
| | - Elodie Attrazic
- Bond University, School of Physiotherapy, Gold Coast, Australia
| | - Wayne Hing
- Bond University, School of Physiotherapy, Gold Coast, Australia
| | - Michelle Cottrell
- Physiotherapy Department, Royal Women's and Brisbane Hospital, Australia
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Emonena H, Ojo O. The Efficacy of Tele-Monitoring in Maintaining Glycated Haemoglobin Levels in Patients with Type 2 Diabetes Mellitus: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16722. [PMID: 36554601 PMCID: PMC9779018 DOI: 10.3390/ijerph192416722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND It is well documented that telemedicine offers effective accessibility and consistency which are useful in overcoming the barriers associated with the traditional delivery of chronic disease management. Furthermore, home-based telemonitoring approach for managing chronic disease conditions has been shown to break geographical barriers and facilitate provider-to-patient communication. However, the efficacy of telemedicine in reducing HbA1c is debatable. AIM This systematic review aims to evaluate the effect of telemedicine on glycaemic control in patients with type 2 diabetes. METHOD This systematic review has been conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Searches were primarily conducted using the EBSCOhost database. Other search engines such as Cochrane Library and Google scholar were also used and search of grey literature was performed using google, NHS.uk website, WHO websites, and gov.uk website. Nine articles were included in this review. RESULTS Three themes were identified in this review including diabetes education/telemonitoring technology and glycaemic control, the attitude of participants, and cost effectiveness of tele-medicine. While three studies reported improved glycaemic control with statistically significant improvement in HbA1c compared to the control group, three other studies did not find significant improvement in glycaemic control. In addition, the findings suggest that participants' positive attitude to self-care can lead to an improved HbA1c, and finally, several of the selected studies found that telemonitoring is not cost-effective. CONCLUSION The findings of this review show that telemedicine may be effective in managing blood glucose in patients with type 2 diabetes. However, factors such as educational level of patients, attitude and costs may limit its application in primary care. More studies are required to fully establish the effectiveness of Telemonitoring in managing patients with type 2 diabetes.
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Affiliation(s)
- Hope Emonena
- Woodlands Health Centre, 4, Edwin Hall Place, Hither Green Lane, London SE13 6RN, UK
| | - Omorogieva Ojo
- School of Health Sciences, Avery Hill Campus, University of Greenwich, Avery Hill Road, London SE9 2UG, UK
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