Interactive telemedicine: effects on professional practice and health care outcomes

Profile and risk factors in farmer injuries: a review based on Haddon matrix and 5 E's risk reduction strategy

Farmers are considered a high-risk group for intentional and unintentional injuries. This review identified significant risk factors for agricultural injuries in farmers and explored injury prevention countermeasures based on the literature. Therefore, CiteSpace software was used to analyze the relevant literature in this field. Additionally, we identified both key risk factors and countermeasures using the Haddon matrix and the 5 E's risk reduction strategies conceptual framework, respectively. The risk factors were identified from four categories (host, agent, physical environment, and social environment) corresponding to three phases (pre-event, event, and post-event). Interventions of 5 E's risk reduction strategies including education, engineering, enforcement, economic, and emergency response have been proven effective in preventing injuries or reducing their severity. Our findings provide a comprehensive foundation and research direction for the study and prevention of injuries among farmers.

Influence of Physical Attractiveness and Gender on Patient Preferences in Digital Doctor Consultations: Experimental Study

BACKGROUND

The rise of digital health services, particularly digital doctor consultations, has created a new paradigm in health care choice. While patients traditionally rely on digital reviews or referrals to select health care providers, the digital context often lacks such information, leading to reliance on visual cues such as profile pictures. Previous research has explored the impact of physical attractiveness in general service settings but is scant in the context of digital health care.

OBJECTIVE

This study aims to fill the research gap by investigating how a health care provider's physical attractiveness influences patient preferences in a digital consultation setting. We also examine the moderating effects of disease severity and the availability of information on health care providers' qualifications. The study uses signal theory and the sexual attribution bias framework to understand these dynamics.

METHODS

Three experimental studies were conducted to examine the influence of health care providers' physical attractiveness and gender on patient preferences in digital consultations. Study 1 (n=282) used a 2×2 between-subjects factorial design, manipulating doctor attractiveness and gender. Study 2 (n=158) focused on women doctors and manipulated disease severity and participant gender. Study 3 (n=150) replicated study 2 but added information about the providers' abilities.

RESULTS

This research found that patients tend to choose attractive doctors of the opposite gender but are less likely to choose attractive doctors of the same gender. In addition, our studies revealed that such an effect is more prominent when the disease severity is high. Furthermore, the influence of gender stereotypes is mitigated in both the high and low disease severity conditions when service providers' qualification information is present.

CONCLUSIONS

This research contributes to the literature on medical information systems research and sheds light on what information should be displayed on digital doctor consultation platforms. To counteract stereotype-based attractiveness biases, health care platforms should consider providing comprehensive qualification information alongside profile pictures.

Needs and Demands for e-Health Symptom Management Interventions in Patients with Post-COVID-19 Condition: A User-Centered Design Approach

Introduction: Post-COVID-19 is an increasing chronic disease for which potential treatment options require further development and examination. A well-established approach to symptom management in post-COVID-19 patients could be e-Health interventions. To enhance the implementation and utilization of e-Health interventions, the needs and demands of patients should be taken into consideration. The aim of this study was to investigate needs and demands of post-COVID-19 patients concerning e-Health symptom management interventions. Methods: A total of 556 patients participated in this cross-sectional online survey study. Recruitment was performed from January 19 to May 24, 2022. Data related to the needs and demands for e-Health interventions were analyzed, along with medical and sociodemographic information. Results: The majority of the patients preferred interventions accessible on smartphones (95.3%). The favored content formats were applications (82.7%), interactive training (69.3%), or audio and video materials (61.1%). Furthermore, the preferred session length was about 10-20 min. The most desired topics included "quality of life," "information about how intensively I may exert myself or do sports," "adjustment to new life situation," and "handling physical changes." Conclusions: This study provides a detailed framework for the content and design of e-Health interventions to support patients managing their post-COVID-19 symptoms. The findings could significantly influence the further development of tailored e-Health interventions to address this pressing global health concern.

Public and Research Interest in Telemedicine From 2017 to 2022: Infodemiology Study of Google Trends Data and Bibliometric Analysis of Scientific Literature

BACKGROUND

Telemedicine offers a multitude of potential advantages, such as enhanced health care accessibility, cost reduction, and improved patient outcomes. The significance of telemedicine has been underscored by the COVID-19 pandemic, as it plays a crucial role in maintaining uninterrupted care while minimizing the risk of viral exposure. However, the adoption and implementation of telemedicine have been relatively sluggish in certain areas. Assessing the level of interest in telemedicine can provide valuable insights into areas that require enhancement.

OBJECTIVE

The aim of this study is to provide a comprehensive analysis of the level of public and research interest in telemedicine from 2017 to 2022 and also consider any potential impact of the COVID-19 pandemic.

METHODS

Google Trends data were retrieved using the search topics "telemedicine" or "e-health" to assess public interest, geographic distribution, and trends through a joinpoint regression analysis. Bibliographic data from Scopus were used to chart publications referencing the terms "telemedicine" or "eHealth" (in the title, abstract, and keywords) in terms of scientific production, key countries, and prominent keywords, as well as collaboration and co-occurrence networks.

RESULTS

Worldwide, telemedicine generated higher mean public interest (relative search volume=26.3%) compared to eHealth (relative search volume=17.6%). Interest in telemedicine remained stable until January 2020, experienced a sudden surge (monthly percent change=95.7%) peaking in April 2020, followed by a decline (monthly percent change=-22.7%) until August 2020, and then returned to stability. A similar trend was noted in the public interest regarding eHealth. Chile, Australia, Canada, and the United States had the greatest public interest in telemedicine. In these countries, moderate to strong correlations were evident between Google Trends and COVID-19 data (ie, new cases, new deaths, and hospitalized patients). Examining 19,539 original medical articles in the Scopus database unveiled a substantial rise in telemedicine-related publications, showing a total increase of 201.5% from 2017 to 2022 and an average annual growth rate of 24.7%. The most significant surge occurred between 2019 and 2020. Notably, the majority of the publications originated from a single country, with 20.8% involving international coauthorships. As the most productive country, the United States led a cluster that included Canada and Australia as well. European, Asian, and Latin American countries made up the remaining 3 clusters. The co-occurrence network categorized prevalent keywords into 2 clusters, the first cluster primarily focused on applying eHealth, mobile health (mHealth), or digital health to noncommunicable or chronic diseases; the second cluster was centered around the application of telemedicine and telehealth within the context of the COVID-19 pandemic.

CONCLUSIONS

Our analysis of search and bibliographic data over time and across regions allows us to gauge the interest in this topic, offer evidence regarding potential applications, and pinpoint areas for additional research and awareness-raising initiatives.

Defining practices suitable for care via teleconsultation in gynaecological and obstetrical care: a French Delphi survey

OBJECTIVE

Delineate the scope of teleconsultation services that can be effectively performed to provide women with comprehensive gynaecological and obstetrical care.

DESIGN

Based on the literature and experts' insights, we identified a list of gynaecological and obstetrical care practices suitable for teleconsultation. A three-round Delphi consensus survey was then conducted online among a panel of French experts. Experts using a 9-point Likert scale assessed the relevance of each teleconsultation practice in four key domains: prevention, gynaecology and antenatal and postnatal care. Consensus was determined by applying a dual-criteria approach: the median score on a 9-point Likert scale and the percentage of votes either below 5 or 5 and higher.

SETTING

The study was conducted at a national level in France and involved multiple healthcare centres and professionals from various geographical locations.

PARTICIPANTS

The panel comprised 22 French experts with 19 healthcare professionals, including 12 midwives, 3 obstetricians-gynaecologists, 4 general practitioners and 3 healthcare system users. Participants were selected to include diverse practice settings encompassing hospital and private practices in both rural and urban areas.

PRIMARY AND SECONDARY OUTCOME MEASURES

The study's primary outcome was the identification of gynaecological and obstetrical care practices suitable for teleconsultation. Secondary outcomes included the level of professional consensus on these practices.

RESULTS

In total, 71 practices were included in the Delphi survey. The practices approved for teleconsultation were distributed as follows: 92% in prevention (n=12/13), 55% in gynaecology (n=18/33), 31% in prenatal care (n=5/16) and 12% in postnatal care (n=1/9). Lastly, 10 practices remained under discussion: 7 in gynaecology, 2 in prenatal care and 1 in postnatal care.

CONCLUSIONS

Our consensus survey highlights both the advantages and limitations of teleconsultations for women's gynaecological and obstetrical care, emphasising the need for careful consideration and tailored implementation.

Relationship Between Clinics Offering Telemedicine and Population Density in Japan: An Ecological Study

Background

The number of clinics offering telemedicine in Japan has been increasing. Regional characteristics such as population density and the number of physicians may be associated with the provision of telemedicine. This study investigated the relationship between clinics offering telemedicine and such regional characteristics for each prefecture in Japan.

Methods

Data were collected from publicly available information that included the percentage of clinics offering telemedicine (real-time synchronous type) among all clinics (in 2022), population density, and the number of physicians for each of Japan's 47 prefectures. An ecological study was carried out to determine the correlation between the percentage of clinics offering telemedicine and regional characteristics for each prefecture, and Pearson correlation analysis and multiple regression analysis adjusted for regional characteristics were performed.

Results

The min-max and mean levels were, respectively, 3.4-39.2% and 15.6% of clinics offering telemedicine, 66.6-6402.6 and 657.1 people per square kilometer of population density, and 185.2-356.7 and 274.0 physicians per 100,000 people. Geographically, the northeastern regions appeared to show a high percentage of clinics offering telemedicine relative to the southwestern regions. There was a significant negative correlation between the percentage of clinics offering telemedicine and population density (r = -0.31, p < 0.05; β = -0.31, p < 0.05).

Discussion

The negative relationship of the provision of telemedicine in clinics with population density throughout Japan might be a reflection to ensure residents' access to clinics in less populated areas. Although further detailed studies are needed to confirm this, population density might be a useful measure for considering whether to offer telemedicine in clinics in Japan.

Preparedness of diabetic patients for receiving telemedical health care: A cross-sectional study

Introduction

This study evaluates feasibility of telemedicine to deliver diabetic care among different regions of the country.

Materials and Methods

Medical interns affiliated with Rotaract Club of Medicrew (RCM) organized a Free Diabetes Screening Camp called "Diab-at-ease" at multiple sites across the country. Of all beneficiaries of the camp >18 years of age, patients previously diagnosed with diabetes and undiagnosed patients with a random blood sugar level of more than 200 mg/dL were interviewed regarding their knowledge, attitude, and practice regarding diabetes care and preparedness and vigilance to receiving care through telemedicine. Random blood sugar, height, weight, and waist circumference were also documented.

Results

About 51.1% (N = 223) of female patients aged 57.57 ± 13.84 years (>18 years) with body mass index (BMI) =26.11 ± 4.63 were the beneficiaries of the health camps. About 75.3% (n = 168) of them were on oral hypoglycemic agents (OHAs), 15.7% (n = 35) were on insulin preparations, and 59.6% (n = 156) and 88.5% (n = 31) of which were highly compliant with treatment, respectively. About 35% (n = 78) and 43.9% (n = 98) of them were unaware of their frequency of hypoglycemic and hyperglycemic episodes, respectively. About 64.6% (n = 144) of the patients were equipped for receiving teleconsultation. Glucometer was only possessed by 51.6% (115) of which only 46.95% (n = 54) can operate it independently. Only 80 patients (35.9%) were aware of the correct value of blood glucose levels.

Conclusion

While a majority of the population is compliant with treatment and aware about diabetes self-care, they lack adequate knowledge and resource equipment for the same leading to very limited utilization.

Nurse practitioner satisfaction with in-person versus telehealth chronic care delivery

BACKGROUND

The widespread use of telehealth and regulatory changes that enhanced nurse practitioner (NP) practice authority because of the SARS-CoV-2 pandemic offers an opportunity to assess postpandemic NP satisfaction with telehealth care delivery and perceptions of its feasibility compared with in-person visits.

PURPOSE

Outpatient chronic care delivery satisfaction and preference were compared among NPs who provide care to adults through in-person and/or telehealth visits and examined NP demographic and clinical characteristics associated with overall satisfaction by care delivery type.

METHODOLOGY

Data were collected using a cross-sectional, descriptive design through online dissemination of The Care Delivery Satisfaction Survey to a nationally representative sample of 586 NPs.

RESULTS

Compared with NPs using both visit types to deliver care, NPs delivering care in-person only had significantly lower satisfaction scores for interpersonal manner ( p = .0076) and communication ( p = .0108). NPs using telehealth only had significantly higher overall satisfaction and satisfaction subscale scores (all p < .01) compared with NPs using both visit types. Overall, 77% of NPs using both visit types preferred in-person delivery.

CONCLUSIONS/IMPLICATIONS

NPs delivering telehealth care only were more satisfied with chronic care delivery than NPs using both delivery types. NPs using both types were more satisfied with interpersonal manner and communication compared with NPs delivering in-person care only. Most NPs using both types preferred in-person care delivery. Given increased telehealth use, health systems, academic institutions, and insurance companies can use these study findings to inform policy on telehealth resources and infrastructure.

Telemedicine's Impact on Diabetes Care during the COVID-19 Pandemic: A Cohort Study in a Large Integrated Healthcare System

Introduction

To examine if patients exposed to primary care telemedicine (telephone or video) early in the COVID-19 pandemic had higher rates of downstream HbA1c measurement and improved HbA1c levels in the second year of the pandemic.

Research Design and Methods

In a cohort of 242, 848 Kaiser Permanente Northern California patients with diabetes, we examined associations between early-pandemic patient-initiated telemedicine visit and downstream HbA1c monitoring and results during the second year of the pandemic.

Results

Adjusted HbA1c measurement rates were significantly higher among patients with telemedicine exposure in the early-pandemic prior year than those with no visits in the prior year (91.0% testing for patients with video visits, 90.5% for telephone visits, visits, 86.7% for no visits, p < 0.05). Among those with HbA1c measured, the rates of having an HbA1c < 8% in the second year of the COVID-19 pandemic were also statistically significantly higher among patients with telemedicine exposure in the early-pandemic prior year than those with no visits in the prior year (68.5% with HbA1c< 8% for video visits, 67.3% for telephone visits, 66.6% for no visits, p < 0.05).

Conclusions

Access to telephone and video telemedicine throughout the early COVID-19 pandemic was associated with patients' continued engagement in recommended diabetes care. Although our study analyzed telemedicine use during a pandemic, telemedicine visits may continue to support ongoing health care access and positive clinical outcomes.

Telemedical Monitoring of Plantar Temperature in Diabetic Patients at Risk of Foot Ulcers

BACKGROUND

The worldwide prevalence of diabetic foot ulcers (DFUs) among persons with diabetes is estimated at 6.3%, with an annual incidence of 9.1 to 26.1 million persons. The early detection of asymmetrical plantar temperature elevation, followed by reduction of weight-bearing on the affected foot, may be an effective mode of prevention.

METHODS

Patients with diabetes and peripheral neuropathy (DFU risk groups 2/3) were monitored for plantar abnormalities with a telemedical system consisting of sole inserts with temperature sensors and photographic documentation. An open, prospective, randomized controlled trial was performed to determine whether this system prevented DFUs. The intervention and control groups were also trained in ulcer prevention and observed in follow-up at 6-month intervals for 24 months.

RESULTS

283 patients were recruited. In 85 137 observation days, DFUs arose in five patients in the control group (n = 143) and in no patient in the intervention group (n = 140). The primary outcome measure was the hazard ratio, which was calculated to be 0.015 (95% confidence interval [0; 19,717]; p = 0.25) after adjustment for age, sex, severity of neuropathy, and risk class. There were 239 alarms and 75 instructions to reduce weight-bearing on the foot. The subjects carried out the telemedical application on about 70% of the days of observation. Quality of life improved in both groups.

CONCLUSION

The tele-health system used in this trial is practical and enables the early detection of morbidity. Likely explanations for the unexpectedly low ulceration rate in this trial (and, in turn, for the lack of statistical significance) include the availability of a training program and regular follow-up examinations to patients in both arms of the trial, along with lower mobility levels due to the COVID pandemic.

Online Group Consultation on Labor Analgesia for Pregnant Women: Is It Feasible?

INTRODUCTION

Our department of anesthesiology has been conducting weekly, for several years, a group consultation to educate childbearing people about labor analgesia. The emergence of the COVID-19 pandemic forced an adaptation to a virtual consultation format. Since there are no studies about online group consultation on labor analgesia in order to understand its role, an anonymous questionnaire was created and applied. The objective was to evaluate this new consultation format, namely the ease of access, usefulness of the content provided, and its impact on the satisfaction and experience of childbirth.

MATERIALS AND METHODS

An observational prospective study was conducted. A questionnaire was sent by e-mail after childbirth to all childbearing people participating in the online consultation from January 20, 2021, to March 2, 2022. SPSS Statistics version 28.0 (IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp) was used for statistical analysis. Internal consistency was analyzed using Cronbach's alpha.

RESULTS

A total of 563 participants were eligible, and 404 (71.8%) completed questionnaires were analyzed. A few technical problems were reported. The participants considered their privacy respected, and more than 90% were satisfied with the content of the online consultation, the opportunity to pose questions, and the help managing expectations. Considering face-to-face consultation, 89.6% of patients considered the online format an effective alternative, 63.2% believed it could replace the old model, and 96.3% would recommend it.

CONCLUSIONS

Our study demonstrates that online consultation on labor analgesia was a good strategy during the COVID-19 pandemic and has the potential to be used in this format in the future.

Is virtual nutritional counseling efficacious for cancer patients during the COVID-19 pandemic?

This study investigates the outcomes of virtual nutritional counseling (VNC) for oncology patients during the Covid-19 pandemic. Our study evaluated the nutritional status data of cancer patients at the baseline and after VNC. An oncology dietitian evaluated the patients by video calling each patient via WhatsApp and sent an individual nutrition diet plan and recommendations via e-mail. Patient-Generated Subjective Global Assessment (PG-SGA) was used as a screening and evaluation tool to assess nutritional status. A total of 157 patients with a mean age of 55.8 ± 14.7 (r = 19-89) were included in the study. Researchers detected at least one nutrition-related sign in 77.7% of patients. After the VNC and based on the final PG-SGA assessments, 62.2% of the patients whose baseline PG-SGA Score-B improved to Score-A, 12.5% with a baseline PG-SGA Score-C improved to Score-A and 54.2% with a baseline Score-C improved to a Score-B (χ2 = 55,000, P < 0.001). Based on the number of VNCs, the improvement in malnutrition status following two sessions and three or more sessions was found to be 17.6% and 35.7%, respectively (P < 0.001). Our results confirm that VNC can improve the nutritional status of cancer patients. Hence, nutritional counseling should be an integral part of oncological treatment.

Health equity, care access and quality in headache - part 2

BACKGROUND

Headache disorders are a global public health concern affecting diverse populations. This review examines headache service organizations in low-, middle-, and high-income countries. It addresses global challenges in pharmacological headache treatment, with a focus on safety, tolerability, reproductive and child health, and outlines disparities in accessing innovative treatments worldwide.

MAIN BODY

Organized headache services are essential due to the wide prevalence and varying severity of headache disorders. The tiered headache service model is globally recognized, although its implementation varies based on financial and workforce considerations. Headache burden affects well-being, causing disability, economic challenges, and work limitations, irrespective of location or income. All nations still require improved diagnosis and treatment, and the majority of countries face obstacles including limited access, awareness, economic barriers, and inadequate health policies. Provided adequate internet availability, telemedicine could help improve health equity by expanding access to headache care, since it can offer patients access to services without lengthy waiting times or extensive travel and can provide healthcare unavailable in underserved areas due to staff shortages. Numerous health disparities restrict global access to many headache medications, especially impacting individuals historically excluded from randomized controlled trials, such as those with cardiovascular and cerebrovascular conditions, as well as pregnant women. Furthermore, despite advancements in researching migraine treatments for young patients, the options for treatment remain limited. Access to headache treatment relies on factors like medication availability, approval, financial coverage, and healthcare provider expertise. Inadequate public awareness leads to neglect by policymakers and undertreatment by patients and healthcare providers. Global access discrepancies are exacerbated by the introduction of novel disease-specific medications, particularly impacting Asian, African, and Latin American nations excluded from clinical trials. While North America and Europe experience broad availability of migraine treatments, the majority of countries worldwide lack access to these therapies.

CONCLUSIONS

Healthcare disparities, treatment access, and medication availability are concerning issues in headache medicine. Variations in national healthcare systems impact headache management, and costly innovative drugs are widening these gaps. Healthcare practitioners and experts should acknowledge these challenges and work towards minimizing access barriers for equitable global headache care in the future.

Patterns of Telemedicine Use and Glycemic Outcomes of Endocrinology Care for Patients With Type 2 Diabetes

Importance

Telemedicine can increase access to endocrinology care for people with type 2 diabetes (T2D), but patterns of use and outcomes of telemedicine specialty care for adults with T2D beyond initial uptake in 2020 are not known.

Objective

To evaluate patterns of telemedicine use and their association with glycemic control among adults with varying clinical complexity receiving endocrinology care for T2D.

Design, Setting, and Participants

Retrospective cohort study in a single large integrated US health system. Participants were adults who had a telemedicine endocrinology visit for T2D from May to October 2020. Data were analyzed from June 2022 to October 2023.

Exposure

Patients were followed up through May 2022 and assigned to telemedicine-only, in-person, or mixed care (both telemedicine and in-person) cohorts according to visit modality.

Main Outcomes and Measures

Multivariable regression models were used to estimate hemoglobin A1c (HbA1c) change at 12 months within each cohort and the association of factors indicating clinical complexity (insulin regimen and cardiovascular and psychological comorbidities) with HbA1c change across cohorts. Subgroup analysis was performed for patients with baseline HbA1c of 8% or higher.

Results

Of 11 498 potentially eligible patients, 3778 were included in the final cohort (81 Asian participants [2%], 300 Black participants [8%], and 3332 White participants [88%]); 1182 used telemedicine only (mean [SD] age 57.4 [12.9] years; 743 female participants [63%]), 1049 used in-person care (mean [SD] age 63.0 [12.2] years; 577 female participants [55%]), and 1547 used mixed care (mean [SD] age 60.7 [12.5] years; 881 female participants [57%]). Among telemedicine-only patients, there was no significant change in adjusted HbA1c at 12 months (-0.06%; 95% CI, -0.26% to 0.14%; P = .55) while in-person and mixed cohorts had improvements of 0.37% (95% CI, 0.15% to 0.59%; P < .001) and 0.22% (95% CI, 0.07% to 0.38%; P = .004), respectively. Patients with a baseline HbA1c of 8% or higher had a similar pattern of glycemic outcomes. For patients prescribed multiple daily injections vs no insulin, the 12-month estimated change in HbA1c was 0.25% higher (95% CI, 0.02% to 0.47%; P = .03) for telemedicine vs in-person care. Comorbidities were not associated with HbA1c change in any cohort.

Conclusions and Relevance

In this cohort study of adults with T2D receiving endocrinology care, patients using telemedicine alone had inferior glycemic outcomes compared with patients who used in-person or mixed care. Additional strategies may be needed to support adults with T2D who rely on telemedicine alone to access endocrinology care, especially for those with complex treatment or elevated HbA1c.

Oral cancer: Current status and public health perspectives

Despite advances in surgical and oncological treatments, the incidence and five-year survival rates (~50 percent) of oral cancers (OC) have not improved over the last decades and remain a major public health problem. Seventy percent are still diagnosed at a late stage (T3 or T4), with an average delay in diagnosis of two to five months. As the cure and survival of patients are directly related to the development stage of the tumor at the time of diagnosis, the objective of this work was to analyze all the determinants related to oral cancer and to propose new clinical approaches for diagnosis and screening. A proposal for new models of screening, training, and concrete action to improve public awareness of the major global problem of OC is made. The strengths and weaknesses of OC screening studies need to be objectively understood to effectively guide and energize testing in primary care settings, with the prospect of using new and emerging technologies that can help improve the discriminatory accuracy of case detection. Most national organizations have not, to date, recommended population-based mass screening, due to a lack of sufficient scientific evidence of associated mortality reduction. Where health care resources are high, opportunistic individual screening is recommended, although the low diagnostic capacity of front-line clinicians is alarming.

Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies

Type 2 diabetes mellitus (T2DM) and sarcopenia (low skeletal muscle mass and function) share a bidirectional relationship. The prevalence of these diseases increases with age and they share common risk factors. Skeletal muscle fat infiltration, commonly referred to as myosteatosis, may be a major contributor to both T2DM and sarcopenia in older adults via independent effects on insulin resistance and muscle health. Many strategies to manage T2DM result in energy restriction and subsequent weight loss, and this can lead to significant declines in muscle mass in the absence of resistance exercise, which is also a first-line treatment for sarcopenia. In this review, we highlight recent evidence on established treatments and emerging therapies targeting weight loss and muscle mass and function improvements in older adults with, or at risk of, T2DM and/or sarcopenia. This includes dietary, physical activity and exercise interventions, new generation incretin-based agonists and myostatin-based antagonists, and endoscopic bariatric therapies. We also highlight how digital health technologies and health literacy interventions can increase uptake of, and adherence to, established and emerging treatments and therapies in older adults with T2DM and/or sarcopenia.

Direct Discharge from the Critical Care Resuscitation Unit: Results from a Longitudinal Assessment

Background

The critical care resuscitation unit (CCRU) facilitates interhospital transfer (IHT) of critically ill patients for immediate interventions. Due to these patients' acuity, it is uncommon for patients to be directly discharged home from this unit, but it does happen on occasion. Since there is no literature regarding outcomes of patients being discharged from a resuscitation unit, our study investigated these patients' outcome at greater than 12 months after being discharged directly from the CCRU.

Methods

We performed a retrospective cohort study of all adult patients directly discharged from the CCRU between January 01, 2017, and December 31, 2020. The primary outcome was number of ED visits or hospitalizations within 6 months. Secondary outcomes were number of ED visits or hospitalizations within 6, 12, and >12 months from CCRU discharge.

Results

We analyzed 145 patients' records. Mean age was 56 (standard deviation [SD] ± 19), with a majority being male (72%) and Caucasian (58%). The most common discharge destination was home (139 patients, 96% of total subjects) versus hospice (2%) or nursing facilities (2%). Most patients (55%) did not have any hospital revisits within the first 6 months of discharge, while 31% had 1-2 revisits, and 14% had ≥3 revisits. The most common discharge diagnoses were soft tissue infection (16.5%), aortic dissection (14%), and stroke (11%). Factors which were associated with a greater likelihood of any return hospital visit within 6 months receiving mechanical ventilation during CCRU stay (coefficient -2.23, 95% CI 0.01-0.87, P=0.036), while high hemoglobin on CCRU discharge was associated with no ED revisit (coeff. 0.42, 95% CI 1.15-2.06, P=0.004).

Conclusions

Most patients who were discharged from the CCRU did not require any hospital revisits in the first 6 months. Requiring mechanical ventilation and having soft tissue infection were associated with high unplanned hospital revisits following discharge. Further research is needed to validate these findings.

Experience of primary caregivers in utilising an mHealth application for remote dental screening in preschool children

Objectives This study aimed to address the acceptance of mHealth applications for a dental screening app that facilitates patient information entry and captures dental photos remotely to assist in caries diagnosis in preschool children in Australia. Methods All participants were recruited through the ORIGINS Project, a community-based interventional birth cohort study in Western Australia. Forty-two primary caregivers, who were the users of a teledental screening app, were given a questionnaire with 17 questions; these were constructed based on the theme of the Technology Acceptance Model: perceived ease of use (PE), perceived usefulness (PU), behavioural intention to adopt (BI), anxiety (ANX), attitude toward a behaviour (ATB), and self-efficacy (SE). Cronbach's alpha was estimated to determine internal consistency. Path analysis was employed to quantify the relationship between each theme. Results The mean values for most themes indicated high satisfaction with the intervention among caregivers (scores out of 5): PE (4.54 ± 0.55), PU (4.65 ± 0.49), BI (4.40 ± 0.65), ATB (4.23 ± 0.70), SE (4.36 ± 0.64). Results indicated high consistency in response in the PE, PU, ATB, and SE (α  = 0.74-0.84) and moderate consistency was observed in ANX and BI (α = 0.50-0.62). The overall intention of using the dental screening app was significantly related to both PU and ATB (P  Conclusion The perceived usefulness and attitude toward behaviours influenced the overall behavioural intention of the participants to use the telehealth model in dental screening. Recognising these relationships indicates community readiness for implementing the telehealth application in the dental program and enables identification of areas for improving its diffusion.

Online versus in-person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness

Cognitive behavioural therapy (CBT) including exposure and response prevention is the first-line psychological treatment for obsessive compulsive disorder (OCD). Given changes in the clinical landscape, there are increasing efforts to evaluate its effectiveness in online contexts. Mirroring the traditional in-person delivery, few studies have assessed the role of therapist-guided, manual-based CBT for OCD delivered in real-time via videoconferencing methods. The present study sought to fill this gap by comparing in-person and online delivery of group-based CBT for the treatment of OCD. A convenience sample of participants with moderate to severe OCD (n = 144) were recruited from a naturalistic database from two large OCD specialty assessment and treatment centres. Patients received group-based CBT that was provided in-person (pre-COVID-19 pandemic; March 2018 to March 2020) or online via videoconferencing (during the COVID-19 pandemic; March 2020 to April 2021). In both delivery methods, treatment consisted of 2-h weekly sessions led by trained clinicians. Analyses revealed that, regardless of treatment modality, both in-person and online groups demonstrated significant, reliable, and statistically equivalent improvements in OCD symptoms post-treatment. Videoconferenced, clinician-led CBT may be a promising alternative to in-person delivery for those with moderate to severe OCD symptoms.

The Impact of Virtual Consultations on the Quality of Primary Care: Systematic Review

BACKGROUND

The adoption of virtual consultations, catalyzed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality.

OBJECTIVE

This study aims to evaluate the impact of virtual consultations on the quality of primary care.

METHODS

A total of 6 databases were searched. Studies that evaluated the impact of virtual consultations, for any disease, were included. Title and abstract screening and full-text screening were performed by 2 pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed.

RESULTS

In total, 30 studies (5,469,333 participants) were included in this review. Our findings suggest that virtual consultations are equally effective to or more effective than face-to-face care for the management of certain conditions, including mental illness, excessive smoking, and alcohol consumption. Overall, 4 studies indicated positive impacts on some aspects of patient-centeredness; however, a negative impact was noted on patients' perceived autonomy support (ie, the degree to which people perceive those in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care settings. Evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities among other subgroups depending on contextual factors.

CONCLUSIONS

Our systematic review demonstrated that virtual consultations may be as effective as face-to-face care and have a potentially positive impact on the efficiency and timeliness of care; however, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centeredness, highlighting areas where future research efforts should be devoted. Capitalizing on real-world data, as well as clinical trials, is crucial to ensure that the use of virtual consultations is tailored according to patient needs and is inclusive of the intended end users. Data collection methods that are bespoke to the primary care context and account for patient characteristics are necessary to generate a stronger evidence base to inform future virtual care policies.

Refugee Telehealth Utilization for Hypertension Management During the COVID-19 Pandemic

Objectives: The COVID-19 pandemic limited refugees' access to healthcare. Increased use of telehealth could enable continuity of care but also create barriers to chronic disease management. This study explores refugees' experience with telehealth and hypertension management during the pandemic. Methods: We recruited 109 refugee participants diagnosed with hypertension. We conducted semi-structured interviews about their experience with telehealth during the COVID-19 pandemic. Interviews were transcribed, translated, and data was coded using inductive thematic analysis. Results: 86% used telehealth modalities at least once during the pandemic. Interviews highlighted three main themes: (1) Social isolation worsened mental health, affecting their motivation to manage their blood pressure; (2) telehealth alleviated discontinuity of care but posed logistical and cultural challenges; (3) participants relied on public blood pressure monitors that were not available during the pandemic which affected disease management. Conclusion: Refugees faced challenges managing their hypertension during the COVID-19 pandemic. Virtual community building may alleviate their stress and isolation. Telehealth must be adapted to account for language, cultural, and technological barriers. Communities with hypertension should increase access to personal or public blood pressure monitors.

Perception, willingness, and practices of telemedicine in patients with chronic diseases: implication of digital health in patients' perspective at a tertiary care hospital in Ethiopia

Background

Technology-based healthcare services have important implications for the diagnosis, prevention, and treatment of diseases, as well as providing access to high-quality care that both the patient and the healthcare practitioner can benefit from. To access medical information, patients have also searched for methods of technology-based healthcare services like telemedicine (TM). However, little is known regarding the perceptions, willingness, and practices of TM among Ethiopian patients, especially in the study setting.

Objective

This study assessed the perceptions, willingness, and practice of TM among patients with chronic disease at the University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia.

Methods

A cross-sectional study was conducted from June 1 to July 30, 2022, among patients with chronic diseases who were on follow-up at the UoGCSH. Eligible participants were included in the study using a systematic random sampling technique. A structured questionnaire was used and recorded in the Kobo data collection tool. The collected data were managed and analyzed using the Statistical Package for Social Science (SPSS) version 26.

Results

Out of 422 patients approached, 384 (91% response rate) were included in the final analysis. The mean (±SD) age of the participants was 48.07 ± 16.17 years. The overall perceptions mean (±SD) score of the respondents was 3.92 ± 1.06. Generally, near to three-fourths (71.1%) of the participants had a positive perception of TM services, and around two-thirds (63.3%) had a willingness to be involved in the TM service. However, only around one-fourth (24.5%) of the participants were perceived to have a high level of TM practice currently.

Conclusion

The findings suggest that although the level of perception and willingness of TM services among patients with chronic diseases was positive, their level of practice was low. Therefore, creating awareness and suitable conditions to improve their utilization of TM could be important.

Telemedicine and direct to consumer advertising attitudes and the future of telehealth: Women report telemedicine as a comfortable option for accessing birth control

PURPOSE

This paper addresses what variables predict and mediate relationships involving accessing telemedicine in the form of online birth control websites that are often advertised online on social media.

BASIC PROCEDURES

This is a survey study of N = 252 under 60 women (Mage = 24.71); multiple linear regression and mediation analyses were done to examine the influence of IBM variables on behavioral intentions.

MAIN FINDINGS

Women who currently use contraceptives report comfort and likelihood to use telemedicine services if they have positive attitudes about telemedicine and DTC advertising. Comfort with using an online contraceptive prescription service mediated the relationship between contraceptive use and likelihood to use telemedical services and between positive telemedicine attitudes and likelihood.

PRINCIPAL CONCLUSIONS

Women who are positive about telemedicine and DTC ads are comfortable using these resources, and comfort is a salient mediator. Comfort and its antecedents are important predictors and facilitators of telemedicine intentions and behaviors. Using telemedicine can improve the patient experience by offering alternatives to face-to-face visits (i.e., removing barriers to provider-to-patient communication).

The Moral Value of Telemedicine to the Physician-Patient Relationship

Covid-19 heralded a natural experiment with telemedicine. My experience as a clinician was very positive, and learning how to use telemedicine has made me a better doctor. Telemedicine has flipped the medical service paradigm; families do not need to conform their busy lives to the medical office workflow. An appointment can be a virtual house call that takes less time for my patient's family and allows me to learn even more about their home. While there are limitations of telemedicine, there are good ethical reasons for clinicians to support the broader use of telehealth, including equity, efficiency, effectiveness, and respecting preferences. Empirical health-services research that assesses satisfaction, quality, and health outcomes will be necessary to determine the impact of telehealth on a population level to ensure that is used in a way that promotes equity in care.

Telementoring With Project ECHO: A New Era in Diabetes-Related Continuing Education for Primary Care to Address Health Disparities

Project ECHO® is a telementoring workforce development model that targets under-resourced communities lacking access to specialty care. The model builds virtual communities of practice, including specialists and community primary care professionals (PCPs) to combat clinical inertia and health disparities. While the ECHO model has gained global recognition, implementation of the model related to diabetes is lagging compared to other specialty conditions. This review highlights diabetes-endocrine (ENDO)-focused ECHOs using data reported in the ECHO Institute's centralized data repository (iECHO) and the learning collaborative for diabetes ECHOs. It also describes the implementation of diabetes ECHOs and their evaluation. Learner and patient-centered outcomes related to diabetes ECHOs are reviewed. Program implementation and evaluations have demonstrated utility of the ECHO model for diabetes programs to (1) address unmet needs of diabetes care in the primary care setting, (2) improve knowledge and confidence in managing complex diabetes and change provider prescribing habits, (3) improve patient outcomes, and (4) address diabetes quality improvement practices in primary care. More studies with broader collaboration among sites are needed to evaluate the model related to diabetes, especially applied to addressing therapeutic inertia, adoption of diabetes technology, and reducing health disparities.

What is the efficacy and effectiveness of telemedicine intervention for deaf signing populations in comparison to face-to-face interventions? A systematic review

BACKGROUND

Deaf signing populations face inequality in both access to health services and health outcomes. Telemedicine intervention might offer a potential solution to address these inequalities in mental health and health related services, therefore a systematic review was carried out. The review question was: "What is the efficacy and effectiveness of telemedicine intervention for Deaf signing populations in comparison to face-to-face interventions?".

METHODS

The PICO framework was applied to identify the components of the review question for this study. The inclusion criteria were: Deaf signing populations; any intervention that includes the delivery of telemedicine therapy and/or the delivery of assessment (e.g. psychological assessments) using telemedicine; and any evidence for the benefits, efficacy and effectiveness of telemedicine intervention with Deaf people whether in health and/or mental health services. The databases PsycINFO, PubMed, Web of Science, CINAHL, and Medline were searched up to August 2021.

RESULTS

Following the search strategy, and after the duplicates were removed, 247 records were identified. Following screening, 232 were removed as they did not meet the inclusion criteria. The remaining 15 full-text articles were assessed for eligibility. Only two met the criteria to be included in the review (both concerned telemedicine and mental health interventions). However, they did not fully answer the review's research question. Therefore, the evidence gap remains regarding the effectiveness of telemedicine intervention for Deaf people.

CONCLUSIONS

The review has identified a gap in the knowledge on the efficacy and effectiveness of telemedicine intervention for Deaf people when compared with face-to-face interventions.

Health Care Utilization and Death in Patients With Heart Failure During the COVID-19 Pandemic

Objective

To compare the 1-year health care utilization and mortality in persons living with heart failure (HF) before and during the coronavirus disease 2019 (COVID-19) pandemic.

Patients and Methods

Residents of a 9-county area in southeastern Minnesota aged 18 years or older with a HF diagnosis on January 1, 2019; January 1, 2020; and January 1, 2021, were identified and followed up for 1-year for vital status, emergency department (ED) visits, and hospitalizations.

Results

We identified 5631 patients with HF (mean age, 76 years; 53% men) on January 1, 2019, 5996 patients (mean age, 76 years; 52% men) on January 1, 2020, and 6162 patients (mean age, 75 years; 54% men) on January 1, 2021. After adjustment for comorbidities and risk factors, patients with HF in 2020 and patients with HF in 2021 experienced similar risks of mortality compared with those in 2019. After adjustment, patients with HF in 2020 and 2021 were less likely to experience all-cause hospitalizations (2020: rate ratio [RR], 0.88; 95% CI, 0.81-0.95; 2021: RR, 0.90; 95% CI, 0.83-0.97) compared with patients in 2019. Patients with HF in 2020 were also less likely to experience ED visits (RR, 0.85; 95% CI, 0.80-0.92).

Conclusion

In this large population-based study in southeastern Minnesota, we observed an approximately 10% decrease in hospitalizations among patients with HF in 2020 and 2021 and a 15% decrease in ED visits in 2020 compared with those in 2019. Despite the change in health care utilization, we found no difference in the 1-year mortality between patients with HF in 2020 and those in 2021 compared with those in 2019. It is unknown whether any longer-term consequences will be observed.

Mixed methods evaluation of pediatric telehealth equity for patients/families who communicate in languages other than English

Background

Emerging research demonstrates telehealth disparities for patients who communicate in languages other than English. A better understanding of pediatric telehealth use with families who communicate in languages other than English is needed to inform interventions to promote telehealth equity.

Methods

We conducted a mixed methods study of telehealth care in a children's hospital health system using electronic health record data for outpatient video telehealth encounters from April 2020 to July 2021 and qualitative interviews with clinical staff and Spanish-speaking parents of telehealth patients.

Results

The 16-month study period included 102,387 telehealth encounters; 5% of which were encounters in languages other than English. 83% of languages other than English encounters were with patients/families with a preferred healthcare language of Spanish. 11% of providers conducted ≥10 languages other than English telehealth encounters. This subset of providers conducted 71% of all languages other than English encounters. We conducted 25 interviews with clinical staff (n=13) and parents (n=12). Common themes identified across interviews were: (I) technology barriers affect access to and quality of telehealth; (II) clinical staff and parents are uncertain about the future role of telehealth for patients/families who communicate in languages other than English; (III) the well-known impact of language barriers on in-person healthcare access and quality for patients who communicate in languages other than English is also evident in telehealth.

Conclusions

Patients who communicate in languages other than English were underrepresented among telehealth encounters and encounters were concentrated among few providers. Promoting equitable telehealth care requires investment to address technology barriers, increase the readiness of providers and clinics to provide telehealth care in languages other than English, and continued attention to reducing the healthcare impact of language barriers.

A service evaluation to examine the effectiveness of chronic pain management programmes delivered using video conferencing technology compared to in-person

Introduction

The Covid-19 pandemic required rapid substitution of in-person Pain Management Programmes (PMP) delivery with delivery via videoconferencing technologies (VCT). No prior published VCT-PMP effectiveness findings were found, so an evaluation was conducted to explore effectiveness of this method and to compare psychometric outcomes with pre-pandemic, in-person- PMPs, delivered in routine clinical settings.

Methods

Participants were routinely attending PMPs. A consecutive series of six in-person-PMPs (n = 61) immediately prior to the pandemic were compared with the first series of six VCT-PMPs (n = 64) delivered in the same services. A within-subjects comparison of clinical outcomes (pre-post for VCT-PMP and in-person PMP) and a between-subjects comparison of delivery type was conducted (two-way mixed ANOVA). Reliable change indices examined reliable improvements and deteriorations by delivery type.

Results

Both PMP delivery format groups made significant improvements in anxiety, depression, pain self-efficacy, chronic pain acceptance and pain catastrophising. No significant difference was found between VCT-PMP and in-person-PMP on each of the measures. Reliable change indices indicated similar levels of improvement and deterioration with each delivery format with improvements far outweighing deteriorations. Attrition was greater in the VCT format (33%) versus in-person-PMP (18%).

Conclusion

This study indicates that meaningful change as measured by standard psychometric questionnaires can occur in PMPs delivered via VCT and appear broadly equivalent to that achieved through in-person delivery. Physical performance outcomes such as quality and amount of movement were not measured or explored.

Experiences of Using an Electronic Health Tool Among Health Care Professionals Involved in Chronic Obstructive Pulmonary Disease Management: Qualitative Analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases of the 21st century. eHealth tools are seen as a promising way of supporting health care professionals in providing evidence-based COPD care, for example, by reinforcing information and interventions provided to the patients and providing easier access and support to the health care professional themselves. Still, knowledge is scarce on the experience of using eHealth tools from the perspective of the health care professional involved in COPD management.

OBJECTIVE

The study explored the experiences of using an eHealth tool among health care professionals that worked with patients with COPD in their daily clinical practice.

METHODS

This exploratory qualitative study is part of a process evaluation in a parallel group, controlled, pragmatic pilot trial. Semistructured interviews were performed with 10 health care professionals 3 and 12 months after getting access to an eHealth tool, the COPD Web. The COPD Web, developed using cocreation, is an interactive web-based platform that aims to help health care professionals provide health-promoting strategies. Data from the interviews were analyzed using qualitative content analysis with an inductive approach.

RESULTS

The main results reflected health care professionals' experiences in 3 categories: receiving competence support and adjusting practice, improving quality of care, and efforts required for implementation. These categories highlighted that using an eHealth tool such as the COPD Web was experienced to provide knowledge support for health care professionals that led to adaptation and facilitation of working procedures and person-centered care. Taken together, these changes were perceived to improve the quality of care through enhanced patient contact and encouragement of interprofessional collaboration. In addition, health care professionals expressed that patients using the COPD Web were better equipped to tackle their disease and adhered better to provided treatment, increasing their self-management ability. However, structural and external barriers bar the successful implementation of an eHealth tool in daily praxis.

CONCLUSIONS

This study is among the first to explore experiences of using an eHealth tool among health care professionals involved in COPD management. Our novel findings highlight that using an eHealth tool such as the COPD Web may improve the quality of care for patients with COPD (eg, by providing knowledge support for health care professionals and adapting and facilitating working procedures). Our results also indicate that an eHealth tool fosters collaborative interactions between patients and health care professionals, which explains why eHealth is a valuable means of encouraging well-informed and autonomous patients. However, structural and external barriers requiring time, support, and education must be addressed to ensure that an eHealth tool can be successfully implemented in daily praxis.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187.

Accessibility and Utilization of Telehealth Services During the COVID-19 Pandemic Among Medicare Beneficiaries by Diabetes Status

Due to the influence types of telehealth services (i.e., phone and/or video) can have on patient care and outcomes, we sought to examine factors associated with the types of telehealth services offered and used among Medicare beneficiaries. We analyzed the Medicare Current Beneficiary Survey COVID-19 Public Use File (N = 1,403 and N = 2,218 for individuals with and without diabetes, respectively) and performed multinomial logit models to examine factors (e.g., sociodemographics, comorbidities, digital access/knowledge) associated with types of telehealth services offered and used among beneficiaries aged ≥65 years by diabetes status. Medicare beneficiaries seemed to prefer using telehealth via phone than video. Regardless of diabetes status, having not previously participated in video or voice calls or conferencing can be a barrier to telehealth being offered and used via video for beneficiaries. For older adults with diabetes, disparities in accessibility of telehealth via video by income and languages spoken other than English were observed. [Research in Gerontological Nursing, xx(x), xx-xx.].

Specialist Perspectives on Delivering High-Quality Telemedicine for Diabetes: A Mixed Methods Survey Study

Background

Recent recommendations guiding appropriate use of telemedicine for endocrinology care have largely relied on expert opinion due to limited evidence on factors that increase quality of telemedicine care. In this study, we assessed the perspectives of front-line specialists on factors and strategies perceived to increase quality of diabetes care delivered via telemedicine after more than 2 years of widespread use.

Methods

Adult diabetes specialists in 2 academic health systems who recently used video-based telemedicine to provide diabetes care were invited to participate in an online survey study between March and April 2022. Likert-style questions, followed by related open-ended questions, assessed perspectives on availability of key resources, factors affecting quality, and anticipated benefits from telemedicine for diabetes.

Results

Response rate was 52% (56/111). More than half (54%) of participants reported better overall quality of diabetes care with face-to-face care vs telemedicine. Participants reported clinical data supporting high-quality care, such as home blood glucose readings and vital signs, were often not available with telemedicine. Patient factors, including comorbidities and communication barriers, reduced anticipated benefit from telemedicine, while geographic and mobility barriers increased expected benefit. Providers described multiple health care setting resources that could promote high-quality telemedicine diabetes care, including greater support for sharing patient-generated health data and coordinating multidisciplinary care.

Conclusions

After 2 years of sustained use, diabetes specialists identified telemedicine as an important way to enhance access to care. However, specialists identified additional supports needed to increase appropriate use and delivery of high-quality telemedicine care for patients with complex clinical needs.

A Qualitative Study of the Perspectives of Healthcare Professionals on Features of Digital Health Interventions to Support Physical Activity in Solid Organ Transplant Recipients

Introduction: Digital health interventions may support physical activity among solid organ transplant recipients. These interventions should be designed with users in mind, including healthcare professionals who counsel transplant recipients on physical activity to ensure acceptance and to promote an optimal user experience. The purpose of this study was to explore the perspectives of health care providers on the features of digital health interventions that would be useful in the promotion, implementation, and maintenance of physical activity among solid organ transplant recipients. Methods: This qualitative, cross-sectional study used semistructured interviews that were conducted remotely, via videoconferencing software, with providers who worked with transplant recipients. Interviews were transcribed, and an iterative-inductive, thematic analysis was used to identify common themes. Data were coded using NVivo software. Findings: Thirteen providers participated in this study. Four main themes were identified: (a) physical activity and exercise features (eg, physical activity guidelines, and exercise instructions); (b) credibility; (c) self-management; and (d) user engagement. Potential barriers to using digital health interventions included staffing requirements, professional regulatory issues, cost, perceived low patient motivation to use, and lack of technological literacy or access. Discussion: Digital health interventions were perceived to be a potential adjunct to current physical activity counseling practices, and part of an innovative strategy to address identified barriers to physical activity participation in solid organ transplant recipients.

Translating primary care to telehealth: analysis of in-person consultations on diabetes and cardiovascular disease

BACKGROUND

The COVID-19 pandemic had a considerable impact on primary care, resulting in rapid uptake of telehealth. Patients with chronic conditions, such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), relied heavily on telehealth consultations during this period. It is important to assess whether tasks observed during T2DM or CVD in-person consultations are translatable to telehealth.

AIM

To explore the extent to which in-person GP consultations are translatable to telehealth for patients with T2DM or CVD.

DESIGN & SETTING

This study screened 281 GP consultations conducted in 2017 within the UK general practice setting for consultations pertaining to T2DM or CVD. Seventeen in-person consultations (in deidentified video and transcript) were selected for further analysis.

METHOD

Detailed reporting of tasks, physical artefacts, and physical examinations observed during in-person GP consultations. A new scoring method, applying two key metrics, supporting definitions and examples, was designed to assess translatability of clinical tasks to telehealth.

RESULTS

Across the 17 T2DM or CVD in-person consultations analysed, 23 clinical tasks, 21 physical artefacts, and nine physical examinations were observed. Sixty per cent of tasks analysed were deemed either easily or relatively easily translatable to telehealth. Twenty-six per cent of tasks were rated as 'moderately translatable to telehealth' but may require a patient obtaining their own equipment. Thirteen per cent of tasks were rated as 'potentially translatable to telehealth'. No clinical tasks for these cohorts were rated as untranslatable to telehealth.

CONCLUSION

The majority of tasks observed during T2DM or CVD in-person GP consultations are translatable to telehealth. Further research is warranted to investigate emergent safety concerns from increased uptake of telehealth.

The use and role of telemedicine in maternal fetal medicine around the world: an up-to-date

Purpose

The aim of this narrative review is to sumarize data about the use and role of telemedicine in maternal fetal medicine (MFM).

Methods

We searched pubmed and scopus to find articles about telemedicine in MFM by using the terms telmedicine or telehealth and maternal fetal medicine.

Results

Telehealth has been widely used for several medical specialties. During the coronavirus disease 2019 (COVID-19) pandemic, telehealth has gained investment and further research. Even though telemedicine in MFM has not been frequently applied, from 2020 onwards it has increased in both implementation and acceptance worldwide. The need to screen the patients in overloaded centers in a pandemic scenario required telemedicine in MFM, which has exhibited consistently good results concerning health and budget. The aim of this study was to review the telehealth programs and research focused on MFM around the world. Few studies have been applied to MFM and even fewer in developing and undeveloped countries. The majority of studies were concentrated in the USA and in Europe.

Conclusion

Further research is needed, especially in non-developed countries, to comprehend the potential role of telemedicine in MFM for improving the life quality of the patients, health professionals, and to be cost-efficient.

Digital Disparities in Patient Adoption of Telemedicine

Telemedicine's growth during the COVID-19 pandemic exposed digital and health disparities in U.S. communities. Public health advocates suggest disparities in healthcare access may be mitigated through free or low-cost broadband. However, prior research shows that many factors influence patient adoption of information technologies; therefore, increasing access to broadband alone is insufficient. This paper advances a patient-centered model of telemedicine (TM) adoption supported by qualitative interview data. The model illustrates that patient adoption of TM is driven by a complex sociotechnical system comprised of technology factors, structural factors underlying the provider's provision of TM, and individual patient factors. Findings highlight the importance of the physical place of the TM visit, the need for experienced TM healthcare workers and technology support for patients, the impact of provider-mandated technology on task-technology fit (TTF), and the strength of the patient-provider relationship. These factors affect patient perceptions of TTF and ultimately TM adoption.

Patient experiences of remote care in a pain service during a pandemic

Background

In March 2020, Pain Management Services were obliged to cease face-to-face consultations. This abrupt change, in line with recommendations from the British Pain Society, aimed to protect patients and staff and allowed resource re-allocation. Pain services were obliged to switch to remote consultations using Video Tele-Conferencing Technology (VTC) and Remote Consultations (RC) either through telephone or video calls using a variety of media and software applications. Little is known about the patient experience of remotely delivered pain care especially when alternatives are removed. The aim of this work was to understand the patient experience of this necessary switch regarding pain self-management interventions during the initial stages of the COVID-19 pandemic.

Methods

A mixed-methods evaluation of the patient experience from three pain self-management interventions, taking place in a large community-based pain rehabilitation service along the South Coast of England, was performed. Experience-Based Design (EBD) methods were used to map patient experience at touch points through two interventions that were delivered in a structured format. Semi-structured recorded interviews were transcribed and analysed using thematic analysis for the third.

Findings

Fifty-eight patients took part covering the scope of the service. In general, educational and psychological sessions were well received, with physical rehabilitation components being less easy to convey remotely. Attrition rates were high for the pain management programme. Group pain education worked particularly well in an online format with hope being the predominant emotion experienced. Clear limitations were technical failures and the lack of ability to form relationships in a virtual world.

Conclusions

Remote digitalised interventions were acceptable to most patients. Attention should be paid to access and improving social aspects of delivery when considering such interventions. Physiotherapy may require more face-to-face necessitating a hybrid model and needs further investigation. EBD proved a highly suitable approach.

Health Information Technologies in a Resource-Limited Setting: Knowledge, Attitude, and Practice of Health Professionals

The use of health information technology significantly enhances patient outcomes. As a result, policymakers from developing countries have placed strong emphasis on formulating eHealth policies and initiatives. However, there have not been many successful deployments to show for. The role of individual factors in the successful implementation of these technologies is indispensable. Therefore, this study assesses healthcare professionals' knowledge, attitudes, and practice of health information technology. An institution-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital from November 15 to December 29, 2020. A structured, self-administered questionnaire was used to collect data. Student's t-test was used to learn if there were any significant differences in practice habits between participants with and without previous information technology-related training. In addition, first-order partial correlation was conducted to identify the relationship of knowledge and attitude with practice. A total of 347 health professionals responded to the questionnaire, yielding an 87.2% response rate. Most health professionals are not aware of how to use health information technologies. Notably, practice levels were low and needed prompt action from responsible authorities. Previous training did not work very well to improve the practice levels of health professionals. However, the positive attitude of these professionals encourages policymakers and implementers to engage closely.

Chronic conditions patient's perception of post-COVID-19 pandemic teleconsulting continuation in primary care clinics: a qualitative descriptive study

OBJECTIVES

The COVID-19 pandemic has led to the prioritisation of teleconsultation instead of face-to-face encounters. However, teleconsultation revealed some shortcomings and undesirable effects that may counterbalance benefits. This study aims to explore the perspective of patients with chronic diseases on teleconsultation in primary care. This article also proposes recommendations to provide patient-oriented and appropriate teleconsultations.

DESIGN

We conducted a qualitative descriptive study that explored the patients' perception regarding teleconsultation services and the following themes: access, perceived benefits and disadvantages, interprofessional collaboration, patient-centred approach, specific competencies of professionals, and patient's global needs and preferences.

SETTING

Six primary care clinics in three regions of Quebec.

PARTICIPANTS

39 patients were interviewed by telephone through semistructured qualitative interviews.

RESULTS

Patients want to maintain teleconsultation for the postpandemic period as long as their recommendations are followed: be able to choose to come to the clinic if they wish to, feel that their individual and environmental characteristics are considered, feel involved in the choice of the modality of each consultation, feel that interprofessional collaboration and patient-centred approach are promoted, and to maintain the professionalism, which must not be lessened despite the remote context.

CONCLUSION

Patients mainly expressed high satisfaction with teleconsultation. However, several issues must be addressed. Patients do and should contribute to the implementation of teleconsultation in primary care. They wish to be frequently consulted about their preferred consultation modality, which may change over time. The patient perspective must, therefore, be part of the balanced implementation of optimal teleconsultation that is currently taking place.

Racial Disparities in Patient-Provider Communication During Telehealth Visits Versus Face-to-face Visits Among Asian and Native Hawaiian and Other Pacific Islander Patients With Cancer: Cross-sectional Analysis

BACKGROUND

Telehealth visits increase patients' access to care and are often rated as "just as good" as face-to-face visits by oncology patients. Telehealth visits have become increasingly more common in the care of patients with cancer since the advent of the COVID-19 pandemic. Asians and Pacific Islanders are two of the fastest growing racial groups in the United States, but there are few studies assessing patient satisfaction with telemedicine among these two racial groups.

OBJECTIVE

Our objective was to compare satisfaction with communication during telehealth visits versus face-to-face visits among oncology patients, with a specific focus on Asian patients and Native Hawaiian and other Pacific Islander (NHOPI) patients.

METHODS

We surveyed a racially diverse group of patients who were treated at community cancer centers in Hawaii and had recently experienced a face-to-face visit or telehealth visit. Questions for assessing satisfaction with patient-physician communication were adapted from a previously published study of cancer survivors. Variables that impact communication, including age, sex, household income, education level, and cancer type and stage, were captured. Multivariable logistic models for patient satisfaction were created, with adjustments for sociodemographic factors.

RESULTS

Participants who attended a face-to-face visit reported higher levels of satisfaction in all communication measures than those reported by participants who underwent a telehealth encounter. The univariate analysis revealed lower levels of satisfaction during telehealth visits among Asian participants and NHOPI participants compared to those among White participants for all measures of communication (eg, when asked to what degree "[y]our physician listened carefully to you"). Asian patients and NHOPI patients were significantly less likely than White patients to strongly agree with the statement (P<.004 and P<.007, respectively). Racial differences in satisfaction with communication persisted in the multivariate analysis even after adjusting for sociodemographic factors. There were no significant racial differences in communication during face-to-face visits.

CONCLUSIONS

Asian patients and NHOPI patients were significantly less content with patient-physician communication during telehealth visits when compared to White patients. This difference among racial groups was not seen in face-to-face visits. The observation that telehealth increases racial disparities in health care satisfaction should prompt further exploration.

Telemedicine and health access inequalities during the COVID-19 pandemic

Background

During the COVID-19 pandemic, health systems rapidly introduced in-home telehealth to maintain access to care. Evidence is evolving regarding telehealth's impact on health disparities. Our objective was to evaluate associations between socioeconomic factors and rurality with access to ambulatory care and telehealth use during the COVID-19 pandemic.

Methods

We conducted a retrospective study at an academic medical centre in midwestern United States. We included established and new patients who received care during a one-year COVID-19 period vs pre-COVID-19 baseline cohorts. The primary outcome was the occurrence of in-person or telehealth visits during the pandemic. Multivariable analyses identified factors associated with having a health care provider visit during the COVID-19 vs pre-COVID-19 period, as well as having at least one telehealth visit during the COVID-19 period.

Results

All patient visit types were lower during the COVID-19 vs the pre-COVID-19 period. During the COVID-19 period, 125 855 of 255 742 established patients and 53 973 new patients had at least one health care provider visit, with 41.1% of established and 23.5% of new patients having at least one telehealth visit. Controlling for demographic and clinical characteristics, established patients had 30% lower odds of having any health care provider visit during COVID-19 vs pre-COVID-19 (adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.698-0.71) period. Factors associated with lower odds of having a telehealth visit during COVID-19 period for established patients included older age, self-pay or other insurance vs commercial insurance, Black or Asian vs White race and non-English preferred languages. Female patients, patients with Medicare or Medicaid coverage, and those living in lower income zip codes were more likely to have a telehealth visit. Living in a zip code with higher average internet access was associated with telehealth use but living in a rural zip code was not. Factors affecting telehealth visit during the COVID-19 period for new patients were similar, although new patients living in more rural areas had a higher odds of telehealth use.

Conclusion

Healthcare inequities existed during the COVID-19 pandemic, despite the availability of in-home telehealth. Patient-level solutions targeted at improving digital literacy, interpretive services, as well as increasing access to stable high-speed internet are needed to promote equitable health care access.

Reflexiones sobre la atención primaria del siglo xxi

La atención primaria debe de afrontar los nuevos desafíos del siglo xxi que ya han comenzado con la pandemia de la covid-19. Desafíos que tienen que ver con una nueva realidad sociosanitaria caracterizada por un aumento de la prevalencia de la comorbilidad y fragilidad ligada al envejecimiento y al impacto de los determinantes de la salud; cambios en la población con pacientes más informados y que reclaman participar en las decisiones que afectan a su salud en una sociedad cada vez más digitalizada. En ese contexto la atención primaria debe de resolver nuevos retos como cambiar su funcionamiento con equipos más cohesionados que puedan incorporar nuevos perfiles que aporten valor y donde exista un compromiso con la docencia y la investigación. La gestión de todos estos desafíos requiere que los profesionales que trabajan en atención primaria en el siglo xxi profundicen en sus competencias mirando más allá de las consultas de su centro de salud. Competencias como la selección y el uso del mejor conocimiento, el pensamiento crítico, el uso de la comunicación para acercarse a los valores y las preferencias de los pacientes, la toma de decisiones compartida y la conciencia social.

Para que todos estos cambios se puedan realizar hace falta un impulso institucional con múltiples medidas insistentemente reclamadas por los profesionales. Entre las que están, en primer lugar, una mayor inversión en personal y equipamiento, así como apostar por modelos organizativos avalados por la evidencia destinados a obtener una atención más coordinada e integrada entre la atención primaria, el hospital, la salud mental, la salud pública y los servicios sociales la utilización juiciosa de las soluciones de la e-salud o la incorporación de un área de conocimiento sobre atención primaria en la universidad.

Implementing telemedicine in urogynecology: A feasibility study

INTRODUCTION AND HYPOTHESIS

Telemedicine has been recommended for the management of urogynecological conditions during the coronavirus (COVID 19) pandemic. This study aimed to evaluate the feasibility of telemedicine for urogynecology at a Brazilian public hospital.

METHODS

A descriptive observational study was performed at a urogynecology outpatient clinic. The primary outcome was the desire to continue with telemedicine. Secondary outcomes were appointment resolvability, technical aspects of the appointment, and patient satisfaction. The participants had in-person appointments that were canceled because of the COVID-19 pandemic. We collected data on sociodemographic characteristics and clinical and technical aspects of the appointments. The participants responded to satisfaction questionnaires 7-15 days post-procedure. The categorical variables were evaluated based on absolute and relative frequency. The continuous variables were described as the mean and standard deviation. A chi-square test was performed to determine the association between variables.

RESULTS

In total, 225 patients had appointments canceled due to the COVID-19 pandemic, of which 171 were eligible for the study. Telemedicine appointments were agreed upon by 48% of the participants and 85.5% responded to the satisfaction survey. We found that 57.7% of the participants desired to continue with telemedicine. The appointment resolvability rate was 76.1%, 63.4% of the appointments met the technical criteria, and the satisfaction rate was 93%. The only variable associated with the desire to continue telemedicine was overall patient satisfaction (p=0.02).

CONCLUSIONS

Telemedicine in urogynecology is feasible and can be implemented in the studied population. However, actions are essential to adequately support patient preference and improve the acceptance of telemedicine.

Overcoming adversity: Building a remote interdisciplinary neurorehabilitation service during the COVID-19 pandemic

Background

The COVID-19 pandemic necessitated rapid change in neurorehabilitation delivery at the Defence Medical Rehabilitation Centre (DMRC), with a reduction in inpatient capacity.

Aims and method

An interdisciplinary remote working group developed a novel neurorehabilitation telerehabilitation (TR) model. The plan, do, study, act (PDSA) model was used to develop and monitor activity in the changing pandemic context and to identify clinical outputs, key themes and learning points.

Results

Eight PDSA cycles were performed, including video outpatient clinics, multidisciplinary team meetings, virtual ward rounds and TR for patients at home. Ten patients and 21 staff members provided feedback. Qualitative themes emerged including information technology, consultation environment, access to clinical notes and record keeping, clinical considerations, consent, patient and staff feedback, and feasibility.

Conclusion

COVID-19 accelerated the implementation of TR at DMRC, allowing maintenance of service during lockdown. TR was acceptable to patients but placed a significant burden on staff. Practical suggestions for establishing a TR service are provided alongside challenges and limitations.

Nationwide, large-scale implementation of an online system for remote entry of patient-reported outcomes in rheumatology: characteristics of users and non-users and time to first entry

Aims

In May 2020, a nationwide, web-based system for remote entry of patient-reported outcomes (PROs) in inflammatory rheumatic diseases was launched and implemented in routine care (DANBIO-from-home). After 1.5 years of use, we explored clinical characteristics of patients who did versus did not use the system, and the time to first entry of PROs.

Methods

All patients followed in DANBIO were informed about DANBIO-from-home by electronic invitations or when attending their clinic. Characteristics of patients who did/did not use DANBIO-from-home in the period after implementation were explored by multivariable logistic regression analyses including demographic and clinical variables (gender, age group, diagnosis, disease duration, use of biological disease-modifying agent (bDMARD), Health Assessment Questionnaire (HAQ), Patient Acceptable Symptom Scale (PASS)). Time from launch to first entry was presented as cumulative incidence curves by age group (<40/40–60/61–80/>80 years).

Results

Of 33 776 patients, 68% entered PROs using DANBIO-from-home at least once. Median (IQR) time to first entry was 27 (11–152) days. Factors associated with data entry in multivariate analyses (OR (95% CI)) were: female gender (1.19 (1.12 to 1.27)), bDMARD treatment (1.41 (1.33 to 1.50)), age 40–60 years (1.79 (1.63 to 1.97)), 61–80 years (1.87 (1.70 to 2.07), or age >80 years (0.57 (0.50 to 0.65)) (reference: age <40 years), lower HAQ (0.68 (0.65 to 0.71)) and PASS ‘no’ (1.09 (1.02 to 1.17). Diagnosis was not associated. Time to first entry of PROs was longest in patients <40 years of age (119 (24–184) days) and shortest in the 61–80 years age group (25 (8–139) days).

Conclusion

A nationwide online platform for PRO in rheumatology achieved widespread use. Higher age, male gender, conventional treatment and disability were associated with no use.

Effectiveness and Cost-Effectiveness of Case Management in Advanced Heart Failure Patients Attended in Primary Care: A Systematic Review and Meta-Analysis

AIMS

Nurse-led case management (CM) may improve quality of life (QoL) for advanced heart failure (HF) patients. No systematic review (SR), however, has summarized its effectiveness/cost-effectiveness. We aimed to evaluate the effect of such programs in primary care settings in advanced HF patients. We examined and summarized evidence on QoL, mortality, hospitalization, self-care, and cost-effectiveness.

METHODS AND RESULTS

The MEDLINE, CINAHL, Embase, Clinical Trials, WHO, Registry of International Clinical Trials, and Central Cochrane were searched up to March 2022. The Consensus Health Economic Criteria instrument to assess risk-of-bias in economic evaluations, Cochrane risk-of-bias 2 for clinical trials, and an adaptation of Robins-I for quasi-experimental and cohort studies were employed. Results from nurse-led CM programs did not reduce mortality (RR 0.78, 95% CI 0.53 to 1.15; participants = 1345; studies = 6; I² = 47%). They decreased HF hospitalizations (HR 0.79, 95% CI 0.68 to 0.91; participants = 1989; studies = 8; I² = 0%) and all-cause ones (HR 0.73, 95% CI 0.60 to 0.89; participants = 1012; studies = 5; I² = 36%). QoL improved in medium-term follow-up (SMD 0.18, 95% CI 0.05 to 0.32; participants = 1228; studies = 8; I² = 28%), and self-care was not statistically significant improved (SMD 0.66, 95% CI -0.84 to 2.17; participants = 450; studies = 3; I² = 97%). A wide variety of costs ranging from USD 4975 to EUR 27,538 was observed. The intervention was cost-effective at ≤EUR 60,000/QALY.

CONCLUSIONS

Nurse-led CM reduces all-cause hospital admissions and HF hospitalizations but not all-cause mortality. QoL improved at medium-term follow-up. Such programs could be cost-effective in high-income countries.

Readiness for Telemedical Services in Patients With Cardiovascular Diseases: Cross-sectional Study

BACKGROUND

Telemedicine solutions, especially in the face of epidemiological emergencies such as the COVID-19 pandemic, played an important role in the remote communication between patients and medical providers. However, the implementation of modern technologies should rely on patients' readiness toward new services to enable effective cooperation with the physician. Thus, successful application of patient-centric telehealth services requires an in-depth analysis of users' expectations.

OBJECTIVE

This study aimed to evaluate factors determining readiness for using telehealth solutions among patients with cardiovascular diseases.

METHODS

We conducted a cross-sectional study based on an investigator-designed, validated questionnaire that included 19 items (demographics, health status, medical history, previous health care experience, expected telehealth functionalities, and preferred remote communication methods). Multivariate logistic regression was applied to assess the relationship between readiness and their determinants.

RESULTS

Of the 249 respondents, 83.9% (n=209) consented to the use of telemedicine to contact a cardiologist. The nonacceptance of using telemedicine was 2 times more frequent in rural dwellers (odds ratio [OR] 2.411, 95% CI 1.003-5.796) and patients without access to the internet (OR 2.432, 95% CI 1.022-5.786). In comparison to participants living in rural areas, city dwellers demonstrated a higher willingness to use telemedicine, including following solutions: issuing e-prescriptions (19/31, 61.3% vs 141/177, 79.7%; P=.02); alarming at the deterioration of health (18/31, 58.1% vs 135/177, 76.3%; P=.03); and arranging or canceling medical visits (16/31, 51.6% vs 126/176, 71.6%; P=.03). Contact by mobile phone was preferred by younger patients (OR 2.256, 95% CI 1.058-4.814), whereas older patients and individuals who had no previous difficulties in accessing physicians preferred landline phone communication.

CONCLUSIONS

During a nonpandemic state, 83.9% of patients with cardiovascular diseases declared readiness to use telemedicine solutions.

Feasibility of Self-Performed Lung Ultrasound with Remote Teleguidance for Monitoring at Home COVID-19 Patients

During the COVID-19 pandemic, use of telemedicine with the aim of reducing the rate of viral transmission increased. This proof-of-concept observational study was planned to test the feasibility of a home-based lung ultrasound (LUS) follow-up performed by patients with mild COVID-19 infection on themselves. We enrolled patients presenting to the emergency department with SARS-CoV-2 infection without signs of pneumonia and indication to discharge. Each patient received a brief training on how to perform LUS and a handheld ultrasound probe. Then, patients were contacted on a daily basis, and LUS images were acquired by the patients themselves under “teleguidance” by the investigator. Twenty-one patients were enrolled with a median age of 44 years. All evaluations were of sufficient quality for a follow up. Probability of a better LUS quality was related to higher degree (odds ratio, OR, 1.42, 95% CI 0.5–3.99) and a lower quality to evaluation time (from 0.71, 95% CI 0.55–0.92 for less than 7 min, to 0.52, 95% CI 0.38–0.7, between 7 and 10 min, and to 0.29, 95% CI 0.2–0.43, for evaluations longer than 10 min). No effect related to gender or age was detected. LUS performed by patients and remotely overseen by expert providers seems to be a feasible and reliable telemedicine tool.

Development, implementation and evaluation of high-quality virtual preoperative anaesthetic assessment during COVID-19 and beyond: a quality improvement report

BACKGROUND

Preoperative risk factor identification and optimisation are widely accepted as the gold standard of care for elective surgery and are essential for reducing morbidity and mortality. COVID-19 public health restrictions required a careful balance between ensuring best medical practices and maintaining safety by minimising patient face-to-face attendance in the hospital. Based on the successful implementation of telemedicine (TM) in other medical specialties and its feasibility in the preoperative context, this study aimed to develop, implement and evaluate a high-quality virtual preoperative anaesthetic assessment process.

METHODS

The three-step model for improvement was used. The specific, measurable, actionable, relevant, time aim (step 1) and measures for improvement (step 2) were defined at the onset of the project. The plan-do-study-act tool was used for the structured implementation of improvement interventions (step 3) in three phases. Data relating to virtual and in-person referrals, assessments, did-not-attend (DNA) rate, consultation time, day of surgery delays and cancellations, and service-user and provider experience surveys were recorded prospectively.

RESULTS

A total of 2805 patients were assessed in the preoperative anaesthetic assessment clinic between July 2020 and March 2021. The mean rate of virtual preoperative assessments was 50% (SD ±10) (1390/2805). 0.1% (30/2805) were inappropriately referred on the alternative pathway. The DNA rate was 0.4% (8/1398) and 3% (43/1458) for virtual and in-person pathways, respectively. The mean consultation times for virtual and in-person attendance were 19 (SD ±7) and 31 (SD ±13) min, respectively. There were five same-day surgery cancellations and one delay due to medical reasons. When asked about their experience with the virtual assessment, both service users and providers reported high satisfaction, minimal technical difficulties and shared concerns about limited opportunities for physical examination.

CONCLUSION

This is one of the first implementational studies to comprehensively outline the feasibility of TM in preoperative anaesthetic assessment during COVID-19.