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Contini N, Soares SLZB, Falavigna A. Telemedicine for Patients with COVID-19: A Telehealth Experience in the Elderly at a Center in Southern Brazil. TELEMEDICINE REPORTS 2024; 5:205-211. [PMID: 39081456 PMCID: PMC11285998 DOI: 10.1089/tmr.2024.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 08/02/2024]
Abstract
Background Telemedicine has shown benefits in continuous care during the COVID-19 pandemic. This article discusses its practice in elderly patients with COVID-19, considering its limitations and benefits. Methods Patients with COVID-19, aged 60 years or older, were followed up through phone calls three times a week for 10 days at the Telemedicine Section of the Clinical Center of the University of Caxias do Sul (UCS) in the south of Brazil. The outcomes evaluated were referrals to hospital, basic health unit (BHU)/emergency care unit (ECU), and psychology and physiotherapy services; instructions about vaccination, isolation period, tests for COVID-19, taking a specific medication, and measuring oxygen saturation; guidance to family members; and avoiding going to hospitals. Results A total of 64 patients were followed up, the mean age was 69.28 years and 15.62% had at least one comorbidity. Among the patients, 7.81% were instructed about the vaccine, 23.43% about post-diagnostic tests, 25% about medication, 62.5% about isolation, 31.35% received guidance on saturation monitoring and 28.12% received guidance for family members, and 3.12% were referred to the hospital and 7.81% to the BHU/ECU (n = 5/64). Physiotherapy and psychology services were indicated for 4.68% of patients each, hospital visits were avoided in 31.25% and 93.75% recommended telemonitoring. Discussion In this experience, it is suggested that the telehealth service maximizes patient care and the health care effectiveness for patients with COVID-19. Furthermore, the sample studied showed good adherence and suggested the need for more guidance than face-to-face consultation.
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Affiliation(s)
- Natalia Contini
- Physicians graduated from the University of Caxias do Sul (UCS), Caxias do Sul, Brazil
| | | | - Asdrubal Falavigna
- Neurosurgery department at the University of Caxias do Sul, Rio Grande do Sul, Brazil
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Saifullah, Ma Z, Li M, Maqbool MQ, Chen J. Enhancing telehealth services development in Pakistani healthcare sectors through examining various medical service quality characteristics. Front Public Health 2024; 12:1376534. [PMID: 39045155 PMCID: PMC11263101 DOI: 10.3389/fpubh.2024.1376534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/03/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction The telehealth service increased attention both during and after the Covid-19 outbreak. Nevertheless, there is a dearth of research in developing countries, including Pakistan. Hence, the objective of this study was to examine telehealth service quality dimensions to promote the telehealth behavior intention and sustainable growth of telehealth in Pakistan. Methods This study employed a cross-sectional descriptive design. Data were collected from doctors who were delivering telehealth services through a well-designed questionnaire. To examine the hypothesis of the study, we employed the Smart PLS structural equation modeling program, namely version 0.4. Results The study findings indicate that medical service quality, affordability, information quality, waiting time, and safety have a positive impact on the intention to engage in telehealth behavior. Furthermore, the adoption of telehealth behavior has a significant favorable effect on the actual utilization of telehealth services, which in turn has a highly good impact on sustainable development. Conclusion The study determined that telehealth services effectively decrease the amount of time and money spent on travel, while still offering convenient access to healthcare. Furthermore, telehealth has the potential to revolutionize payment methods, infrastructure, and staffing in the healthcare industry. Implementing a well-structured telehealth service model can yield beneficial results for a nation and its regulatory efforts in the modern age of technology.
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Affiliation(s)
- Saifullah
- School of Management, Jiangsu University, Zhenjiang, China
| | - Zhiqiang Ma
- School of Management, Jiangsu University, Zhenjiang, China
| | - Mingxing Li
- School of Management, Jiangsu University, Zhenjiang, China
| | | | - Jing Chen
- Affiliated Hospital of Jiangsu University, Zhenjiang, China
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Alshahrani NS, Hartley A, Howard J, Hajhosseiny R, Khawaja S, Seligman H, Akbari T, Alharbi BA, Bassett P, Al-Lamee R, Francis D, Kaura A, Kelshiker MA, Peters NS, Khamis R. Randomized Trial of Remote Assessment of Patients After an Acute Coronary Syndrome. J Am Coll Cardiol 2024; 83:2250-2259. [PMID: 38588928 DOI: 10.1016/j.jacc.2024.03.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Telemedicine programs can provide remote diagnostic information to aid clinical decisions that could optimize care and reduce unplanned readmissions post-acute coronary syndrome (ACS). OBJECTIVES TELE-ACS (Remote Acute Assessment of Patients With High Cardiovascular Risk Post-Acute Coronary Syndrome) is a randomized controlled trial that aims to compare a telemedicine-based approach vs standard care in patients following ACS. METHODS Patients were suitable for inclusion with at least 1 cardiovascular risk factor and presenting with ACS and were randomized (1:1) before discharge. The primary outcome was time to first readmission at 6 months. Secondary outcomes included emergency department (ED) visits, major adverse cardiovascular events, and patient-reported symptoms. The primary analysis was performed according to intention to treat. RESULTS A total of 337 patients were randomized from January 2022 to April 2023, with a 3.6% drop-out rate. The mean age was 58.1 years. There was a reduced rate of readmission over 6 months (HR: 0.24; 95% CI: 0.13-0.44; P < 0.001) and ED attendance (HR: 0.59; 95% CI: 0.40-0.89) in the telemedicine arm, and fewer unplanned coronary revascularizations (3% in telemedicine arm vs 9% in standard therapy arm). The occurrence of chest pain (9% vs 24%), breathlessness (21% vs 39%), and dizziness (6% vs 18%) at 6 months was lower in the telemedicine group. CONCLUSIONS The TELE-ACS study has shown that a telemedicine-based approach for the management of patients following ACS was associated with a reduction in hospital readmission, ED visits, unplanned coronary revascularization, and patient-reported symptoms. (Telemedicine in High-Risk Cardiovascular Patients Post-ACS [TELE-ACS]; NCT05015634).
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Affiliation(s)
- Nasser S Alshahrani
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; King Khalid University, Abha, Saudi Arabia
| | - Adam Hartley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - James Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Reza Hajhosseiny
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Saud Khawaja
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Henry Seligman
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Tamim Akbari
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Badr A Alharbi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; King Khalid University, Abha, Saudi Arabia
| | - Paul Bassett
- Statsconsultancy Ltd, Amersham, Buckinghamshire, United Kingdom
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Darrel Francis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Amit Kaura
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mihir A Kelshiker
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ramzi Khamis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom.
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Oudbier SJ, Souget-Ruff SP, Chen BSJ, Ziesemer KA, Meij HJ, Smets EMA. Implementation barriers and facilitators of remote monitoring, remote consultation and digital care platforms through the eyes of healthcare professionals: a review of reviews. BMJ Open 2024; 14:e075833. [PMID: 38858155 PMCID: PMC11168143 DOI: 10.1136/bmjopen-2023-075833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/14/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES Digital transformation in healthcare is a necessity considering the steady increase in healthcare costs, the growing ageing population and rising number of people living with chronic diseases. The implementation of digital health technologies in patient care is a potential solution to these issues, however, some challenges remain. In order to navigate such complexities, the perceptions of healthcare professionals (HCPs) must be considered. The objective of this umbrella review is to identify key barriers and facilitators involved in digital health technology implementation, from the perspective of HCPs. DESIGN Systematic umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA SOURCES Embase.com, PubMed and Web of Science Core Collection were searched for existing reviews dated up to 17 June 2022. Search terms included digital health technology, combined with terms related to implementation, and variations in terms encompassing HCP, such as physician, doctor and the medical discipline. ELIGIBILITY CRITERIA Quantitative and qualitative reviews evaluating digital technologies that included patient interaction were considered eligible. Three reviewers independently synthesised and assessed eligible reviews and conducted a critical appraisal. DATA EXTRACTION AND SYNTHESIS Regarding the data collection, two reviewers independently synthesised and interpreted data on barriers and facilitators. RESULTS Thirty-three reviews met the inclusion criteria. Barriers and facilitators were categorised into four levels: (1) the organisation, (2) the HCP, (3) the patient and (4) technical aspects. The main barriers and facilitators identified were (lack of) training (n=22/33), (un)familiarity with technology (n=17/33), (loss of) communication (n=13/33) and security and confidentiality issues (n=17/33). Barriers of key importance included increased workload (n=16/33), the technology undermining aspects of professional identity (n=11/33), HCP uncertainty about patients' aptitude with the technology (n=9/33), and technical issues (n=12/33). CONCLUSIONS The implementation strategy should address the key barriers highlighted by HCPs, for instance, by providing adequate training to familiarise HCPs with the technology, adapting the technology to the patient preferences and addressing technical issues. Barriers on both HCP and patient levels can be overcome by investigating the needs of the end-users. As we shift from traditional face-to-face care models towards new modes of care delivery, further research is needed to better understand the role of digital technology in the HCP-patient relationship.
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Affiliation(s)
- Susan J Oudbier
- Outpatient Division, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Digital Health, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care, Amsterdam, The Netherlands
| | - Sylvie P Souget-Ruff
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Britney S J Chen
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Kirsten A Ziesemer
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hans J Meij
- Outpatient Division, Amsterdam UMC, Amsterdam, The Netherlands
- National University of Singapore Yong Loo Lin School of Medicine, Singapore
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Personalized Medicine, Amsterdam, The Netherlands
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Nees J, Struewe F, Schott S. Medical students' knowledge on cancer predisposition syndromes and attitude toward eHealth. Arch Gynecol Obstet 2024; 309:1535-1541. [PMID: 37934269 PMCID: PMC10894105 DOI: 10.1007/s00404-023-07266-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/10/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Individuals with cancer predisposition syndromes (CPS) inherit elevated cancer risks. Medical supply gaps for people at risk of CPS cause insufficient outreach and miss potential benefits of individualized care strategies. Increased awareness of CPS and progress in the eHealth sector are untapped sources of health care improvement for affected individuals. METHODS AND RESULTS This study addressed German-speaking medical students with an online questionnaire in respect to their knowledge of CPS, their medical education, and perspectives. The study population (n = 404) reported interest in and knowledge of CPS, supported by a satisfactory and sustainable education for their prospective patient care. The next generation of doctors would implement eHealth to improve medical services. Skepticism about digitization was claimed by students. They were especially concerned about deterioration in the physician-patient relationship, data abuse, dependence on technology, and incorrect diagnoses. CONCLUSION Due to increasing diagnosing of CPS and deeper knowledge, this topic is essential for the curriculum in medical schools. In particular, care providers need know-how on identifying patients at risk for a CPS, certain diagnostic and therapeutic steps, surveillance and prophylactic strategies to improve patients' outcomes. Education in medical school as well as implemented eHealth seems to have potential to meet this demand in an upcoming era of personalized medicine. What does this study add to the clinical work. Medical teaching on cancer predisposition syndromes should be expanded to improve knowledge and individualized and personalized healthcare.
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Affiliation(s)
- Juliane Nees
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Farina Struewe
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Sarah Schott
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
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Shahouzaie N, Gholamiyan Arefi M. Telehealth in speech and language therapy during the COVID-19 pandemic: a systematic review. Disabil Rehabil Assist Technol 2024; 19:761-768. [PMID: 36129435 DOI: 10.1080/17483107.2022.2122605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 07/15/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The need for social distancing in order to reduce the prevalence of COVID-19 concomitant with the needs of patients as well as the protection of the patients and service providers which has led to the use of tele health in speech and language therapy. For this reason, we decided to review the studies that focus on tele health in speech and language therapy during the COVID-19 pandemic and the purpose of this study is to investigate the use and satisfaction of tele health in speech and language therapy. MATERIALS AND METHODS We conducted a systematic review of the literature in accordance with the PRISMA statement on google scholar, PubMed, Scopus, Science direct, ProQuest, Web of science, Springer and Cochrane databases between 2020 - 2021. An additional manual search was performed, taking into consideration references of the included papers, through the same eligibility criteria. Two researchers screened the titles and abstracts of articles that met inclusion criteria. The methodological quality of the included papers was evaluated using the Critical Appraisals Skills Program (CASP) checklists. RESULTS The collection of reviewed articles included 83 articles from different countries, subsequently 8 articles (3 clinical trials and 5 experimental) were selected. The data extracted were: participations, objects, methods, tools and results. CONCLUSIONS According to present study, tele health can be used in diagnosis and treatment of speech-language conditions as well as educating speech and language pathology students. Moreover, these findings showed patients and therapists were more inclined to utilise tele health.IMPLICATIONS FOR REHABILITATIONReduced access to in-person rehabilitation care in covid-19 pandemic, along with changes in health care finance and delivery, contributed to an exponential increase in telehealth.Measures of quality and patient satisfaction are unknown in the model of tele rehabilitation.To date, the literature on tele rehabilitation is limited and most commonly describes treatment for an impairment within a specific disease.Beyond infection control, eliminating travel time, incorporating other health care advocates, and convenience delivering care in familiar environments to pediatric patients are all benefits that will be durable outside times of pandemic.For families who live in rural or medically underserved areas and have access to internet and technology, telemedicine is a tool to provide access to medical care. Telemedicine can also increase patient and caregiver satisfaction through reduced travel and clinic wait time and increased potential for appointment time flexibility.Tele rehabilitation medicine provides an opportunity to deliver timely, patient and family-centric rehabilitation care while maintaining physical distancing and reducing potential COVID-19 exposure for our patients, their caregivers and medical providers.Since SLP mostly relies on communication through visual-auditory and perceptual aspects, tele practice could be a proper opportunity to provide care in this field.Given the need for continuous therapy sessions in order to treat speech-language disorders, the application of tele practice may eliminate problems in this area to some extent while preventing the transmission of COVID-19.
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Affiliation(s)
- Nasrin Shahouzaie
- Department of Speech pathology, Rehabilitation faculty, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohadese Gholamiyan Arefi
- Department of Speech pathology, Rehabilitation faculty, Zahedan University of Medical Sciences, Zahedan, Iran
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Chien SY, Wong AMK, Tseng W, Hu HC, Cho HY. Feasibility and Design Factors for Home-Based Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease and Chronic Lung Diseases Based on a People-Object-Environment Framework: Qualitative Interview Study. JMIR Hum Factors 2024; 11:e51150. [PMID: 38452366 PMCID: PMC10958338 DOI: 10.2196/51150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/01/2023] [Accepted: 01/24/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR. OBJECTIVE Through a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease. METHODS One-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties. RESULTS The 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs. CONCLUSIONS The results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design.
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Affiliation(s)
- Shih-Ying Chien
- Department of Industrial Design, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Alice May-Kuen Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Winston Tseng
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, CA, United States
| | - Han-Chung Hu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Respiratory Therapy, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Ying Cho
- Department of Respiratory Therapy, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Cunha AS, Pedro AR, V Cordeiro J. Challenges of Using Telemedicine in Hospital Specialty Consultations during the COVID-19 Pandemic in Portugal According to a Panel of Experts. ACTA MEDICA PORT 2024; 37:198-206. [PMID: 38430471 DOI: 10.20344/amp.19931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/12/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION The COVID-19 pandemic has accelerated the adoption of telemedicine as a means of reducing face-to-face contact and protecting professionals and patients. In Portugal, the number of hospital telemedicine consultations has significantly increased. However, the rapid implementation of telemedicine has also led to disparities in access to these services, resulting in inequalities in healthcare delivery. The aim of this study was to identify the main challenges to accessing hospital medical specialty consultations through telemedicine in Portugal during the COVID-19 pandemic. Additionally, this study aimed to establish a consensus on possible solutions for the challenges which were identified. METHODS This study used the nominal group technique, which involved a panel of 10 experts. The panel generated a total of 71 ideas, which were then categorized into three groups: A) challenges relating to patients, which impact access to hospital-based medical specialty consultations through telemedicine; B) challenges relating to professionals, institutions and health systems, which impact access to hospital medical specialty consultations through telemedicine; C) recommendations to overcome the challenges faced in adopting telemedicine solutions. Each of the ideas was assessed, scored and ranked based on its relevance considering the study objectives. RESULTS This study identified several significant challenges that impacted the adoption of telemedicine in Portugal during the COVID-19 pandemic. The challenges that related to patients (A) that were deemed the most relevant were low digital literacy, lack of information about telemedicine processes, low familiarity with technologies and distrust about the quality of services; the challenges that impacted healthcare professionals, institutions, and health systems (B) and were deemed the most relevant were the lack of integration of telemedicine in the patient's journey, low motivation to adopt telemedicine solutions, poor interoperability between systems, and the absence of the necessary technological equipment. The most relevant recommendations (C) included investing in healthcare institutions, developing clear guidelines for the safety and quality of telemedicine practices, and incorporating telemedicine into the curricula of health professions. CONCLUSION This study identified several challenges that impacted the adoption and implementation of telemedicine services for hospital care in Portugal during the pandemic period. These challenges were related to digital health literacy, technological and operational conditions, and reluctance in technological adoption. To overcome these challenges, training programs for healthcare professionals and patients may be necessary, along with investment in technological infrastructures, interoperability between systems, effective communication strategies and the strengthening of specific regulations.
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Affiliation(s)
- Ana Soraia Cunha
- Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - Ana Rita Pedro
- Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon; Public Health Research Centre. Comprehensive Health Research Center (CHRC). NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - João V Cordeiro
- Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon; Public Health Research Centre. Comprehensive Health Research Center (CHRC). NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon; Interdisciplinary Center of Social Sciences. Universidade NOVA de Lisboa. Lisbon. Portugal
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Gujral K, Scott JY, Dismuke-Greer CE, Jiang H, Wong E, Yoon J. The Clinical Resource Hub Telehealth Program and Use of Primary Care, Emergency, and Inpatient Care During the COVID-19 Pandemic. J Gen Intern Med 2024; 39:118-126. [PMID: 38252242 PMCID: PMC10937884 DOI: 10.1007/s11606-023-08476-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/11/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted delivery of health care services worldwide. We examined the impact of the pandemic on clinics participating in the Veterans Affairs (VA) Clinical Resource Hub (CRH) program, rolled out nationally in October 2019, to improve access to care at under-resourced VA clinics or "spoke" sites through telehealth services delivered by regional "hub" sites. OBJECTIVE To assess whether the CRH program was associated with increased access to primary care, we compared use of primary, emergency, and inpatient care at sites that adopted CRH for primary care (CRH-PC) with sites that did not adopt CRH-PC, pre-post pandemic onset. DESIGN Difference-in-difference and event study analyses, adjusting for site characteristics. STUDY COHORT A total of 1050 sites (254 CRH-PC sites; 796 comparison sites), fiscal years (FY) 2019-2021. INTERVENTION CRH Program for Primary Care. MAIN MEASURES Quarterly number of VA visits per site for primary care (across all and by modality, in-person, video, and phone), emergency care, and inpatient care. RESULTS In adjusted analyses, CRH-PC sites, compared with non-CRH-PC sites, had on average 221 additional primary care visits (a volume increase of 3.4% compared to pre-pandemic). By modality, CRH-PC sites had 643 fewer in-person visits post-pandemic (- 14.4%) but 723 and 128 more phone and video visits (+ 39.9% and + 159.5%), respectively. CRH-PC sites, compared with non-CRH-PC sites, had fewer VA ED visits (- 4.2%) and hospital stays (- 5.1%) in VA medical centers. Examining visits per patient, we found that CRH-PC sites had 48 additional telephone primary care visits per 1000 primary care patients (an increase of 9.8%), compared to non-program sites. CONCLUSIONS VA's pre-pandemic rollout of a new primary care telehealth program intended to improve access facilitated primary care visits during the pandemic, a period fraught with care disruptions, and limited in-person health care delivery, indicating the potential for the program to offer health system resilience.
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Affiliation(s)
- Kritee Gujral
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Jennifer Y Scott
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Clara E Dismuke-Greer
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Hao Jiang
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Emily Wong
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Jean Yoon
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Department of General Internal Medicine, UCSF School of Medicine, San Francisco, CA, USA
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Walley D, McCombe G, Broughan J, O’Shea C, Crowley D, Quinlan D, Wann C, Crowley T, Cullen W. Use of telemedicine in general practice in Europe since the COVID-19 pandemic: A scoping review of patient and practitioner perspectives. PLOS DIGITAL HEALTH 2024; 3:e0000427. [PMID: 38354211 PMCID: PMC10866456 DOI: 10.1371/journal.pdig.0000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 12/06/2023] [Indexed: 02/16/2024]
Abstract
General practice is generally the first point of contact for patients presenting with COVID-19. Since the start of the COVID-19 pandemic general practitioners (GPs) across Europe have had to adopt to using telemedicine consultations in order to minimise the number of social contacts made. GPs had to balance two needs: preventing the spread of COVID-19, while providing their patients with regular care for other health issues. The aim of this study was to conduct a scoping review of the literature examining the use of telemedicine for delivering routine general practice care since the start of the pandemic from the perspectives of patients and practitioners. The six-stage framework developed by Arksey and O'Malley, with recommendations by Levac et al was used to review the existing literature. The study selection process was conducted according to the PRISMA Extension for Scoping Reviews guidelines. Braun and Clarke's' Thematic Analysis' approach was used to interpret data. A total of eighteen studies across nine countries were included in the review. Thirteen studies explored the practitioner perspective of the use of telemedicine in general practice since the COVID-19 pandemic, while five studies looked at the patient perspective. The types of studies included were: qualitative studies, literature reviews, a systematic review, observational studies, quantitative studies, Critical incident technique study, and surveys employing both closed and open styled questions. Key themes identified related to the patient/ practitioner experience and knowledge of using telemedicine, patient/ practitioner levels of satisfaction, GP collaboration, nature of workload, and suitability of consultations for telemedicine. The nature of general practice was radically changed during the COVID-19 pandemic. Certain patient groups and areas of clinical and administrative work were identified as having performed well, if not better, by using telemedicine. Our findings suggest a level of acceptability and satisfaction of telemedicine by GPs and patients during the pandemic; however, further research is warranted in this area.
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Affiliation(s)
- David Walley
- UCD School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Geoff McCombe
- UCD School of Medicine, University College Dublin, Dublin 4, Ireland
| | - John Broughan
- UCD School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Conor O’Shea
- Irish College of General Practitioners, Dublin, Ireland
| | - Des Crowley
- UCD School of Medicine, University College Dublin, Dublin 4, Ireland
- Irish College of General Practitioners, Dublin, Ireland
| | | | | | | | - Walter Cullen
- UCD School of Medicine, University College Dublin, Dublin 4, Ireland
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11
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Dhanani Z, Ferguson JM, Van Campen J, Slightam C, Heyworth L, Zulman DM. Adoption and Sustained Use of Primary Care Video Visits Among Veterans with VA Video-Enabled Tablets. J Med Syst 2024; 48:16. [PMID: 38289373 DOI: 10.1007/s10916-024-02035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
In 2020, the U.S. Department of Veterans Affairs (VA) expanded an initiative to distribute video-enabled tablets to Veterans with limited virtual care access. We examined patient characteristics associated with adoption and sustained use of video-based primary care among Veterans. We conducted a retrospective cohort study of Veterans who received VA-issued tablets between 3/11/2020-9/10/2020. We used generalized linear models to evaluate the sociodemographic and clinical factors associated with video-based primary care adoption (i.e., likelihood of having a primary care video visit) and sustained use (i.e., rate of video care) in the six months after a Veteran received a VA-issued tablet. Of the 36,077 Veterans who received a tablet, 69% had at least one video-based visit within six months, and 24% had a video-based visit in primary care. Veterans with a history of housing instability or a mental health condition, and those meeting VA enrollment criteria for low-income were significantly less likely to adopt video-based primary care. However, among Veterans who had a video visit in primary care (e.g., those with at least one video visit), older Veterans, and Veterans with a mental health condition had more sustained use (higher rate) than younger Veterans or those without a mental health condition. We found no differences in adoption of video-based primary care by rurality, age, race, ethnicity, or low/moderate disability and high disability priority groups compared to Veterans with no special enrollment category. VA's tablet initiative has supported many Veterans with complex needs in accessing primary care by video. While Veterans with certain social and clinical challenges were less likely to have a video visit, those who adopted video telehealth generally had similar or higher rates of sustained use. These patterns suggest opportunities for tailored interventions that focus on needs specific to initial uptake vs. sustained use of video care.
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Affiliation(s)
- Zainub Dhanani
- Department of Health Policy, Stanford University School of Medicine, 290 Campus Dr, Stanford, CA, 94305, USA.
| | - Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - James Van Campen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, Washington, DC, USA
- Department of Medicine, UC San Diego School of Medicine, San Diego, CA, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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12
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Zdziechowski A, Zdziechowska M, Rysz J, Woldańska-Okońska M. The Effectiveness of Preoperative Outpatient and Home Rehabilitation and the Impact on the Results of Hip Arthroplasty: Introductory Report. Healthcare (Basel) 2024; 12:327. [PMID: 38338212 PMCID: PMC10855594 DOI: 10.3390/healthcare12030327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
A total hip replacement is the treatment of choice for end-stage hip osteoarthritis. Rehabilitation performed before surgery (called prehabilitation) is used to improve the results of surgical treatment. However, the results of studies have not unquestionably confirmed the effectiveness of preoperative rehabilitation and its impact on the outcome of surgery. The aim of this study is to assess the effectiveness of preoperative outpatient and home rehabilitation in relation to a control group not subject to these forms of influence. A total of 61 patients qualified for primary hip arthroplasty were randomly assigned to a group with outpatient rehabilitation before surgery, exercises performed at home, or a group without any intervention before surgery. Three weeks after surgery, the patients were re-qualified and underwent three weeks of outpatient rehabilitation in the day rehabilitation department. The patients from all three groups were evaluated in terms of functionality and pain using point scales upon enrolment in the study, on admission to the day rehabilitation department, and after 3 weeks of rehabilitation in the department. A total of 50 subjects completed the study. The study results did not reveal statistically significant differences between preoperative rehabilitation and no intervention. Patients rehabilitated at home gave up self-therapy more often than those undergoing outpatient rehabilitation.
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Affiliation(s)
- Adam Zdziechowski
- Department of Internal Diseases, Rehabilitation and Physical Medicine, Medical University of Łódź, 90-419 Łódź, Poland;
| | - Magdalena Zdziechowska
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Łódź, 90-419 Łódź, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Łódź, 90-419 Łódź, Poland
| | - Marta Woldańska-Okońska
- Department of Internal Diseases, Rehabilitation and Physical Medicine, Medical University of Łódź, 90-419 Łódź, Poland;
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13
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Sawant S, Madathil KC, Molloseau M, Obeid J. Overcoming recruitment hurdles in clinical trials: An investigation of remote consenting modalities and their impact on workload, workflow, and usability. APPLIED ERGONOMICS 2024; 114:104135. [PMID: 37713927 PMCID: PMC10843021 DOI: 10.1016/j.apergo.2023.104135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/01/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
Travel constraints can hinder the recruitment of eligible research participants in clinical trials, causing research timeline extensions, added costs, underpowered results, and early termination. Remote consenting can help solve these issues by allowing researchers and potential participants to connect remotely. This controlled experimental study investigates the effect of remote consenting on workload, workflow, usability, and barriers and facilitators to its implementation. Using a mixed experimental design, simulated consenting sessions were conducted with three different modalities (remote paper consent, eConsent, and teleconsent) with 23 researchers and 93 research participants. Each session involved a single researcher who experienced all three modalities, while three different research participants were assigned to each modality individually. Research participants and researchers completed surveys measuring workload and usability. Remote consenting allows researchers and participants to connect at their preferred location and time, and teleconsenting was found to be the preferred modality by the researchers, primarily due to its ability to exchange visual cues. However, challenges such as training requirements and technology dependence need to be addressed for widespread implementation. Future research should aim to eliminate these barriers and improve remote consenting modalities to facilitate clinical research participation.
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Affiliation(s)
- Sarvesh Sawant
- Department of Industrial Engineering, Clemson University, USA
| | | | - Maria Molloseau
- Department of Industrial Engineering, Clemson University, USA
| | - Jihad Obeid
- Department of Public Health Sciences, Medical University of South Carolina, USA.
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14
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Romero-Ibarguengoitia ME, López-Zamarrón KY, Hernández-Treviño MG, Gutierrez-González D, González-Cantú A, González Peña OI, Garza-Silva A. Development, validation and measurement of patient satisfaction questionnaire in Spanish in drive thru services adapted to hospital pharmacies during COVID-19 pandemic. Saudi Pharm J 2024; 32:101838. [PMID: 38162710 PMCID: PMC10757251 DOI: 10.1016/j.jsps.2023.101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/19/2023] [Indexed: 01/03/2024] Open
Abstract
Background There are no validation studies on patient satisfaction surveys in Spanish that can evaluate a hospital pharmacy drive-thru service. Objective To develop and apply a pharmacy drive-thru satisfaction survey in Spanish during the COVID-19 pandemic with an analysis of the instrument validation. Methods This was a qualitative study for developing, validating, and measuring patient satisfaction who used the drive-thru pharmacy during the COVID-19 pandemic. Content validity was obtained by a two-round Delphi and patient interview for apparent validity. The questionnaire was administered to 110 patients. The researchers made an item reduction by inter-item and item-total correlation analysis, stability validation by a test-retest, a test of reliability by Cronbach's alpha, and extraction of factors by an exploratory factorial analysis. Likewise, confirmatory factor analysis was developed to obtain a structural equation model based on generating an instrument of two sub-models of latent factors (service and place) with ten observed variables (items). Results A questionnaire was developed that relates six observable variables to the latent factor service and four observable variables to the latent factor place which are ten items based on a Likert scale from 1 to 5, obtaining a Cronbach's alpha = 0.901. The mean population satisfaction score was 4.523. The model presented a Root Mean Square Error of Approximation (RMSEA) of 0.026 (0.000-0.098), and standardized beta values greater than 0.2 according to the confirmatory factor analysis. Therefore, the goodness-of-fit of our model is consistent and the instrument of patient satisfaction with the use of drive-thru has been validated. Patient satisfaction had a mean of 4.9 points. Conclusions This study developed and validated a reliable scale that evaluates satisfaction in a hospital pharmacy drive-thru service during COVID-19 pandemic that can be applied in other Spanish speaking countries. A great percentage of the patients that were evaluated had good satisfaction.
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Affiliation(s)
- Maria Elena Romero-Ibarguengoitia
- Research and Education Department, Hospital Clinica Nova, Avenida del Bosque #139 Cuauhtemoc San Nicolás de los Garza, Nuevo León 66450, Mexico
- Universidad de Monterrey, Escuela de medicina, Vicerrectoría de Ciencias de la Salud, Av. Ignacio Morones Prieto 4500-Pte, Zona Valle Poniente, San Pedro Garza García, Nuevo León 66238, Mexico
| | - Katia Yackelyne López-Zamarrón
- Universidad de Monterrey, Escuela de medicina, Vicerrectoría de Ciencias de la Salud, Av. Ignacio Morones Prieto 4500-Pte, Zona Valle Poniente, San Pedro Garza García, Nuevo León 66238, Mexico
| | - Mariana Georgina Hernández-Treviño
- Universidad de Monterrey, Escuela de medicina, Vicerrectoría de Ciencias de la Salud, Av. Ignacio Morones Prieto 4500-Pte, Zona Valle Poniente, San Pedro Garza García, Nuevo León 66238, Mexico
| | - Dalia Gutierrez-González
- Research and Education Department, Hospital Clinica Nova, Avenida del Bosque #139 Cuauhtemoc San Nicolás de los Garza, Nuevo León 66450, Mexico
- Universidad de Monterrey, Escuela de medicina, Vicerrectoría de Ciencias de la Salud, Av. Ignacio Morones Prieto 4500-Pte, Zona Valle Poniente, San Pedro Garza García, Nuevo León 66238, Mexico
| | - Arnulfo González-Cantú
- Research and Education Department, Hospital Clinica Nova, Avenida del Bosque #139 Cuauhtemoc San Nicolás de los Garza, Nuevo León 66450, Mexico
- Universidad de Monterrey, Escuela de medicina, Vicerrectoría de Ciencias de la Salud, Av. Ignacio Morones Prieto 4500-Pte, Zona Valle Poniente, San Pedro Garza García, Nuevo León 66238, Mexico
| | - Omar Israel González Peña
- Research and Education Department, Hospital Clinica Nova, Avenida del Bosque #139 Cuauhtemoc San Nicolás de los Garza, Nuevo León 66450, Mexico
- Evidence-Based Medicine Research Unit, Children’s Hospital of Mexico Federico Gómez, National Institute of Health, Dr. Márquez 162, Col. Doctores, Del. Cuauhtémoc, Mexico City 06720, Mexico
- Universidad Internacional de La Rioja (UNIR), Avenida de la Paz, 137, 26006 Logroño, La Rioja, Spain
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Park JH, Lee MJ, Tsai MH, Shih HJ, Chang J. Rural, Regional, Racial Disparities in Telemedicine Use During the COVID-19 Pandemic Among US Adults: 2021 National Health Interview Survey (NHIS). Patient Prefer Adherence 2023; 17:3477-3487. [PMID: 38143946 PMCID: PMC10749101 DOI: 10.2147/ppa.s439437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The primary objective of this study is to conduct a comparative analysis of telemedicine utilization patterns among adult populations residing in both rural and urban areas and evaluate the probability of telemedicine adoption among adults dwelling in both rural and urban areas amid the backdrop of the COVID-19 pandemic. Methods Our study has attained sample populations (n = 279,260, National Weighted Estimates = 2,391,188,373) through the secondary analysis of the National Health Interview Survey (NHIS) for the year 2021. We examined the relationship between the rural, regional, and racial variables using chi-square tests and binary logistic regression associated with telemedicine use in our multivariable analysis. Results Telemedicine use by population decreased with decreasing urbanization level, from 40.2% among adults living in large central metropolitan to 29.7% among adults living in rural area (p<0.0001). Regarding household income, adults with 400% or more of the federal poverty level (FPL) were significantly more likely to use telemedicine than adults with less than 100% of the FPL. Females were more likely than males to utilize telemedicine. In terms of region, adults living in the West were 1.25 times more likely to use telemedicine than adults living in the Northeast, and minority race/ethnicity groups (eg, Non-Hispanic Black, Hispanic, and other) are less likely to use the telemedicine rather than Non-Hispanic White. Conclusion Health equity is attained when all demographic groups enjoy uniform access to healthcare services, but disparities emerge when there are discernible variations in access to treatment. Considering this study's findings, it becomes evident that the distinctions in poverty rates, median income levels, and healthcare utilization patterns across racial and regional lines may serve as indicators of potential health equity concerns.
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Affiliation(s)
- Jeong-Hui Park
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Min Jee Lee
- Population Science and Policy, School of Medicine, Southern Illinois University, Springfield, IL, USA
| | - Meng-Han Tsai
- Georgia Prevention Institute, Augusta University, Augusta, GA, USA
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Huan-Ju Shih
- Department of Health Administration and Policy, School of Public Health, George Mason University, Fairfax, VA, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA
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Zangiabadi S, Ali-Hassan H. Effect of mode of healthcare delivery on job satisfaction and intention to quit among nurses in Canada during the COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002675. [PMID: 38051737 PMCID: PMC10697541 DOI: 10.1371/journal.pgph.0002675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023]
Abstract
The COVID-19 pandemic resulted in a major shift in the delivery of healthcare services with the adoption of care modalities to address the diverse needs of patients. Besides, nurses, the largest profession in the healthcare sector, were imposed with challenges caused by the pandemic that influenced their intention to leave their profession. The aim of the study was to examine the influence of mode of healthcare delivery on nurses' intention to quit job due to lack of satisfaction during the pandemic in Canada. This cross-sectional study utilized data from the Health Care Workers' Experiences During the Pandemic (SHCWEP) survey, conducted by Statistics Canada, that targeted healthcare workers aged 18 and over who resided in the ten provinces of Canada during the COVID-19 pandemic. The main outcome of the study was nurses' intention to quit within two years due to lack of job satisfaction. The mode of healthcare delivery was categorized into; in-person, online, or blended. Multivariable logistic regression was performed to examine the association between mode of healthcare delivery and intention to quit job after adjusting for sociodemographic, job-, and health-related factors. Analysis for the present study was restricted to 3,430 nurses, weighted to represent 353,980 Canadian nurses. Intention to quit job, within the next two years, due to lack of satisfaction was reported by 16.4% of the nurses. Results showed that when compared to participants who provided in-person healthcare services, those who delivered online or blended healthcare services were at decreased odds of intention to quit their job due to lack of job satisfaction (OR = 0.47, 95% CI: 0.43-0.50 and OR = 0.64, 95% CI: 0.61-0.67, respectively). Findings from this study can inform interventions and policy reforms to address nurses' needs and provide organizational support to enhance their retention and improve patient care during times of crisis.
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Affiliation(s)
- Safoura Zangiabadi
- School of Kinesiology and Health Sciences, Keele campus, York University, Toronto, Canada
| | - Hossam Ali-Hassan
- Department of International Studies, Glendon campus, York University, Toronto, Canada
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17
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Mao L, Mohan G, Normand C. Use of information communication technologies by older people and telemedicine adoption during COVID-19: a longitudinal study. J Am Med Inform Assoc 2023; 30:2012-2020. [PMID: 37572310 PMCID: PMC10654849 DOI: 10.1093/jamia/ocad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/15/2023] [Accepted: 08/11/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVES To investigate how information communication technology (ICT) factors relate to the use of telemedicine by older people in Ireland during the pandemic in 2020. Furthermore, the paper tested whether the supply of primary care, measured by General Practitioner's (GP) accessibility, influenced people's telemedicine options. METHOD Based on 2 waves from The Irish Longitudinal Study on Ageing, a nationally representative sample, multivariate logistic models were applied to examine the association between pre-pandemic use of ICTs and telemedicine usage (GP, pharmacist, hospital doctor), controlling for a series of demographic, health, and socioeconomic characteristics. RESULTS Previously reported having Internet access was a statistically positive predictor for telemedicine usage. The availability of high-speed broadband Internet did not exhibit a statistical association. The association was more prominent among those under 70 years old and non-Dublin urban areas. People with more chronic conditions, poorer mental health, and private health insurance had higher odds of using telemedicine during the period of study. No clear pattern between telemedicine use and differential geographic access to GP was found. DISCUSSION The important role of ICT access and frequent engagement with the Internet in encouraging telemedicine usage among older adults was evidenced. CONCLUSION Internet access was a strong predictor for telemedicine usage. We found no evidence of a substitution or complementary relationship between telemedicine and in-person primary care access.
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Affiliation(s)
- Likun Mao
- Department of Economics, University of Aberdeen, King’s College, Aberdeen AB24 3FX, United Kingdom
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Trinity Central, Dublin D02 R590, Republic of Ireland
| | - Gretta Mohan
- Economic and Social Research Institute, Dublin 2 D02 K138, Republic of Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Republic of Ireland
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Kings College London, London SE5 9PJ, United Kingdom
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Espinoza-Bravo C, Arnal-Gómez A, Martínez-Arnau FM, Núñez-Cortés R, Hernández-Guillén D, Flor-Rufino C, Cortés-Amador S. Effectiveness of Functional or Aerobic Exercise Combined With Breathing Techniques in Telerehabilitation for Patients With Long COVID: A Randomized Controlled Trial. Phys Ther 2023; 103:pzad118. [PMID: 37658773 DOI: 10.1093/ptj/pzad118] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/11/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE The aim of this study was to compare the short-term clinical effects of 2 telerehabilitation programs, functional versus aerobic exercises (AEs), both combined with breathing techniques, regarding the improvement of long coronavirus disease 2019 (COVID-19) symptoms. METHODS A randomized controlled trial was conducted. The participants were assigned randomly to either the functional exercise (FE) group or AE group, both including breathing techniques. The interventions lasted for 8 weeks with 3 sessions per week, and they were conducted through the Fisiotrack mobile phone application. Assessments were performed at baseline and after treatment, including testing fatigue (Fatigue Assessment Scale), dyspnea (London Chest Activity of Daily Living Scale), functional performance (30 Seconds Standing Test), perceived stress (Perceived Stress Scale), anxiety and depression (Hospital Anxiety and Depression Questionnaire), and quality of life (European Quality of Life Scale). The perceived change after treatment (Patient Global Impression of Change Scale), the usability of the application (System Usability Scale), and the adherence to treatment were also examined after treatment. RESULTS In total, 43 participants (FE group, n = 21; AE group, n = 22; mean age = 42.4 [SD = 6.5] years) completed the study. In the intragroup comparison, the FE group showed improved fatigue (-6.7 points; 95% CI = -11.9 to -1.3), functional capacity (2.6 repetitions; 95% CI = 0.3 to 4.9), and perceived stress (-4.9 points; 95% CI = -9.1 to 0.8), while the AE group showed improved perceived stress (-6.2 points; 95% CI = -10.3 to -2.1). No significant differences in the intergroup effect were identified for the studied variables. Significant differences were observed in the Patient Global Impression of Change Scale in favor of the FE group compared to the AE group, and quality of life reached the minimal clinically important difference for both groups. The ease of use of the telerehabilitation tool was rated excellent in both groups. CONCLUSIONS Both telerehabilitation exercise modalities are effective at improving stress symptoms and quality of life in patients with long COVID-19. For improving fatigue and functional performance, FE shows more promising results. IMPACT FE or AE may be recommended depending on patients' symptoms, and both may improve quality of life and stress symptoms in patients with long COVID-19. Telerehabilitation may be an optimal intervention modality for the prescription of physical exercise in patients with long COVID-19.
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Affiliation(s)
- Claudia Espinoza-Bravo
- Day Hospital Unit, Home Hospitalisation Unit, Hospital Clínico la Florida, Santiago, Chile
| | - Anna Arnal-Gómez
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Physiotherapy in Motion Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Francisco Miguel Martínez-Arnau
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Physiotherapy in Motion Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - David Hernández-Guillén
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Department of Physiotherapy, Faculty of Physiotherapy, Group of Physiotherapy in the Aging Process: Social and Health Care Strategies (PT_AGE), Valencia, Spain
| | - Cristina Flor-Rufino
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Sara Cortés-Amador
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Physiotherapy in Motion Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
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Babaei N, Zamanzadeh V, Valizadeh L, Lotfi M, Kousha A, Samad‐Soltani T, Avazeh M. Barriers to the implementation of virtual care programmes for patients with chronic wounds: Qualitative empirical research. Nurs Open 2023; 10:7301-7313. [PMID: 37612895 PMCID: PMC10563415 DOI: 10.1002/nop2.1983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/17/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
AIM To assess the barriers to the implementation of virtual care for patients with chronic wounds from wound therapists' perspective. DESIGN A qualitative study. METHODS The study was conducted in two consecutive phases: (1) literature review, (2) descriptive qualitative study. In the first phase, texts published in English until 2023 were identified using international databases. The entire text of the selected studies was evaluated independently by two reviewers. Data analysis was carried out using textual content analysis. In the second phase of the study, twelve participants from Iranian wound care clinics participated. Data were collected through focus group discussion and analysed using conventional content analysis. Integration of both phases was conducted in the data analysis stage. RESULTS The most important barriers in providing virtual care to patients with chronic wounds were identified into five categories including lack of policymaking in virtual care, ethical challenges in virtual information and communication technology, social, economic and cultural issues, IT users' insufficient knowledge and limitation of virtual care scope of practice. CONCLUSION The findings of the present study identified different barriers in the implementation of virtual care for patients with chronic wounds. In order to successfully develop a virtual care programme, it is necessary to adopt suitable policies regarding information and communication technology, provide the necessary legal frameworks, assign an adequate budget and consider the ethical, cultural, social and social issues. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Identifying barriers to developing a virtual care programme will help manage patients with chronic wounds at home. IMPACT This study accurately identifies barriers to providing virtual care for patients with chronic wounds and helps plan to address these barriers and facilitate the development of a virtual care programme for these patients at home. REPORTING METHOD This research has adhered to the SRQR reporting guideline. NO PATIENT OR PUBLIC CONTRIBUTION The involvement of patients or the public in the design, or conduct, or reporting, or dissemination plans of this research was not suitable.
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Affiliation(s)
- Nasib Babaei
- Department of Medical Surgical Nursing, Faculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Vahid Zamanzadeh
- Department of Medical Surgical Nursing, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Leila Valizadeh
- Department of Pediatric Nursing, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Mojgan Lotfi
- Department of Medical Surgical Nursing, Faculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Ahmad Kousha
- Department of Health Education and Health Promotion, Faculty of HealthTabriz University of Medical SciencesTabrizIran
| | - Taha Samad‐Soltani
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Marziyeh Avazeh
- Department of Pediatric Nursing, Faculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
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20
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Diel S, Doctor E, Reith R, Buck C, Eymann T. Examining supporting and constraining factors of physicians' acceptance of telemedical online consultations: a survey study. BMC Health Serv Res 2023; 23:1128. [PMID: 37858170 PMCID: PMC10588103 DOI: 10.1186/s12913-023-10032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
As healthcare demands exceed outpatient physicians' capacities, telemedicine holds far-reaching potential for both physicians and patients. It is crucial to holistically analyze physicians' acceptance of telemedical applications, such as online consultations. This study seeks to identify supporting and constraining factors that influence outpatient physicians' acceptance of telemedicine.We develop a model based on the unified theory of acceptance and use of technology (UTAUT). To empirically examine our research model, we conducted a survey among German physicians (n = 127) in 2018-2019. We used the partial least squares (PLS) modeling approach to test our model, including a mediation analysis. The results indicate that performance expectancy (β = .397, P < .001), effort expectancy (β = .134, P = .03), and social influence (β = .337, P < .001) strongly impact the intention to conduct online consultations and explain 55% of its variance. Structural conditions regarding data security comprise a key antecedent, associating with performance expectancy (β = .193, P < .001) and effort expectancy (β = .295, P < .001). Regarding potential barriers to usage intentions, we find that IT anxiety predicts performance (β = -.342, P < .001) and effort expectancy (β = -.364, P < .001), while performance expectancy fully mediates (βdirect = .022, P = .71; βindirect = -.138, P < .001) the direct relationship between IT anxiety and the intention to use telemedical applications.This research provides explanations for physicians' behavioral intention to use online consultations, underlining UTAUT's applicability in healthcare contexts. To boost acceptance, social influences, such as personal connections and networking are vital, as colleagues can serve as multipliers to reach convergence on online consultations among peers. To overcome physicians' IT anxiety, training, demonstrations, knowledge sharing, and management incentives are recommended. Furthermore, regulations and standards to build trust in the compliance of online consultations with data protection guidelines need reinforcement from policymakers and hospital management alike.
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Affiliation(s)
- Sören Diel
- Branch Business & Information Systems Engineering of the Fraunhofer FIT and FIM Research Center for Information Management, University of Bayreuth, Wittelsbacherring 10, 95444, Bayreuth, Germany
| | - Eileen Doctor
- Branch Business & Information Systems Engineering of the Fraunhofer FIT and FIM Research Center for Information Management, University of Bayreuth, Wittelsbacherring 10, 95444, Bayreuth, Germany.
| | - Riccardo Reith
- Chair of General Business Management, University of Bayreuth, Universitätsstraße 30, 95447, Bayreuth, Germany
| | - Christoph Buck
- Faculty of Informatics, Augsburg University of Applied Sciences and Branch Business & Information Systems Engineering of the Fraunhofer FIT, Alter Postweg 101, 86159, Augsburg, Germany
- QUT Business School, Centre for Future Enterprise, Queensland University of Technology, 2 George St, Brisbane, QLD-4000, Australia
| | - Torsten Eymann
- Branch Business & Information Systems Engineering of the Fraunhofer FIT and FIM Research Center for Information Management, University of Bayreuth, Wittelsbacherring 10, 95444, Bayreuth, Germany
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21
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Magor D, Berkov E, Siomin D, Karniel E, Lasman N, Waldman LR, Gringauz I, Stern S, Kassif RL, Barkai G, Lewy H, Segal G. Interpretation of Heart and Lungs Sounds Acquired via Remote, Digital Auscultation Reached Fair-to-Substantial Levels of Consensus among Specialist Physicians. Diagnostics (Basel) 2023; 13:3153. [PMID: 37835896 PMCID: PMC10572382 DOI: 10.3390/diagnostics13193153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Technological advancement may bridge gaps between long-practiced medical competencies and modern technologies. Such a domain is the application of digital stethoscopes used for physical examination in telemedicine. This study aimed to validate the level of consensus among physicians regarding the interpretation of remote, digital auscultation of heart and lung sounds. METHODS Seven specialist physicians considered both the technical quality and clinical interpretation of auscultation findings of pre-recorded heart and lung sounds of patients hospitalized in their homes. TytoCareTM system was used as a remote, digital stethoscope. RESULTS In total, 140 sounds (70 heart and 70 lungs) were presented to seven specialists. The level of agreement was measured using Fleiss' Kappa (FK) variable. Agreement relating to heart sounds reached low-to-moderate consensus: the overall technical quality (FK = 0.199), rhythm regularity (FK = 0.328), presence of murmurs (FK = 0.469), appreciation of sounds as remote (FK = 0.011), and an overall diagnosis as normal or pathologic (FK = 0.304). The interpretation of some of the lung sounds reached a higher consensus: the overall technical quality (FK = 0.169), crepitus (FK = 0.514), wheezing (FK = 0.704), bronchial sounds (FK = 0.034), and an overall diagnosis as normal or pathological (FK = 0.386). Most Fleiss' Kappa values were in the range of "fare consensus", while in the domains of diagnosing lung crepitus and wheezing, the values increased to the "substantial" level. CONCLUSIONS Bio signals, as recorded auscultations of the heart and lung sounds serving the process of clinical assessment of remotely situated patients, do not achieve a high enough level of agreement between specialized physicians. These findings should serve as a catalyzer for improving the process of telemedicine-attained bio-signals and their clinical interpretation.
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Affiliation(s)
- Diana Magor
- HIT—Holon Institute of Technology, Holon 5810201, Israel (H.L.)
| | - Evgeny Berkov
- Internal Medicine Department C, Rabin Medical Center, Sharon Campus, Petah Tikva 494149, Israel; (E.B.); (D.S.)
| | - Dmitry Siomin
- Internal Medicine Department C, Rabin Medical Center, Sharon Campus, Petah Tikva 494149, Israel; (E.B.); (D.S.)
| | - Eli Karniel
- Internal Medicine Department B, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Nir Lasman
- Internal Medicine Department I, Chaim Sheba Medical Center, Tel-Hashomer 5265601, Israel;
| | - Liat Radinsky Waldman
- Internal Medicine Department A, Chaim Sheba Medical Center, Tel-Hashomer 5265601, Israel
| | - Irina Gringauz
- Geriatric Department C, Chaim Sheba Medical Center, Rehabilitation Hospital, Tel-Hashomer 5265601, Israel
| | - Shai Stern
- The Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold St, Safed 1311502, Israel
| | - Reut Lerner Kassif
- Department of Pediatric Intensive Care, The Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Tel-Hashomer 5265601, Israel;
| | - Galia Barkai
- Beyond Virtual Hospital, Tele-Medicine Virtual Hospital, Chaim Sheba Medical Center, Tel-Hashomer 5265601, Israel
| | - Hadas Lewy
- HIT—Holon Institute of Technology, Holon 5810201, Israel (H.L.)
| | - Gad Segal
- Beyond Virtual Hospital, Tele-Medicine Virtual Hospital, Chaim Sheba Medical Center, Tel-Hashomer 5265601, Israel
- Education Authority, Chaim Sheba Medical Center, Tel-Hashomer 5265601, Israel
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22
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Painter A, van Dael J, Neves AL, Bachtiger P, O'Brien N, Gardner C, Quint J, Adamson A, Peters N, Darzi A, Ghafur S. Identifying benefits and concerns with using digital health services during COVID-19: Evidence from a hospital-based patient survey. Health Informatics J 2023; 29:14604582231217339. [PMID: 38011503 DOI: 10.1177/14604582231217339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Despite large-scale adoption during COVID-19, patient perceptions on the benefits and potential risks with receiving care through digital technologies have remained largely unexplored. A quantitative content analysis of responses to a questionnaire (N = 6766) conducted at a multi-site acute trust in London (UK), was adopted to identify commonly reported benefits and concerns. Patients reported a range of promising benefits beyond immediate usage during COVID-19, including ease of access; support for disease and care management; improved timeliness of access and treatment; and better prioritisation of healthcare resources. However, in addition to known risks such as data security and inequity in access, our findings also illuminate some less studied concerns, including perceptions of compromised safety; negative impacts on patient-clinician relationships; and difficulties in interpreting health information provided through electronic health records and mHealth apps. Implications for future research and practice are discussed.
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Affiliation(s)
- Annabelle Painter
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Jackie van Dael
- Institute of Global Health Innovation, Imperial College, London, UK
| | - Ana Luisa Neves
- Institute of Global Health Innovation, Imperial College, London, UK
| | | | - Niki O'Brien
- Institute of Global Health Innovation, Imperial College, London, UK
| | - Clarissa Gardner
- Institute of Global Health Innovation, Imperial College, London, UK
| | - Jennifer Quint
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Nicholas Peters
- National Heart and Lung Institute, Imperial College, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College, London, UK
| | - Saira Ghafur
- Institute of Global Health Innovation, Imperial College, London, UK
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23
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Lipton LB, Vuong L, Nichols AA. Virtual simulated patient encounters: Bridging the gap in maternal mental health training for prelicensure nursing students. J Prof Nurs 2023; 48:22-24. [PMID: 37775236 DOI: 10.1016/j.profnurs.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 10/01/2023]
Abstract
Postpartum mood disorders (PPMDs) can result in significant negative impacts for the mother, baby, and family. Nurses can be trained to effectively screen for and educate patients about PPMDs. However, available data suggest that clinical opportunities for practicing these important conversations in real-time can be limited. Focused practice discussing PPMDs with patients may improve a nurse's confidence to conduct screenings and help reduce stigma regarding PPMDs. When in-person clinical learning opportunities are limited, simulated patient encounters can serve as useful and accessible alternatives. Though traditional simulations are often conducted in-person with an actor, they can also be offered to students via a virtual platform. This article describes the creation of two virtual simulated patient encounters (vSPEs) designed to improve prelicensure nursing students' confidence in screening and caring for patients at risk for PPMDs. These vSPEs were implemented during the COVID-19 pandemic to fulfill required labor and birth/postpartum clinical rotation hours. A thorough description of the vSPE design and implementation is provided to encourage nursing and other health professions educators to explore a virtual approach to training students to screen and care for postpartum patients with suspected PPMDs.
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Affiliation(s)
- Lisa B Lipton
- Betty Irene Moore School of Nursing at the University of California, Davis, 4610 X St., Sacramento, CA 95817, United States of America
| | - Linda Vuong
- Betty Irene Moore School of Nursing at the University of California, Davis, 4610 X St., Sacramento, CA 95817, United States of America
| | - Amy A Nichols
- Betty Irene Moore School of Nursing at the University of California, Davis, 4610 X St., Sacramento, CA 95817, United States of America.
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24
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Morreale M, Cohen I, Van Wert M, Beccera A, Miller L, Narrow W, Schweizer B, Straub J, Zandi P, Ruble A. Determinants of experience & satisfaction in telehealth psychiatry during the COVID-19 pandemic for patients & providers. Front Psychiatry 2023; 14:1237249. [PMID: 37720903 PMCID: PMC10502508 DOI: 10.3389/fpsyt.2023.1237249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction The objective of this study was to characterize the experiences and overall satisfaction of patients and providers with the March 2020 transition to telehealth in a psychiatric setting (telepsychiatry). The study also investigated how socio-demographic and clinical characteristics impact an individual's experiences and satisfaction with telepsychiatry. Methods Responses were collected from 604 patients and 154 providers engaged in clinical care at one of three participating Johns Hopkins Medicine outpatient psychiatric clinics between January 2020-March 2021. Survey data were collected by self-report via Qualtrics or telephone follow-up. Results Respondents were predominately female and White. Over 70% of patients and providers were generally satisfied with telepsychiatry. However, providers were more likely to favor in-person care over telepsychiatry for post-pandemic care 48% to 17% respectively, while 35% rated both modalities equivalently. Patients were more evenly divided with 45% preferring telepsychiatry compared to 42% for in-person care, and only 13% rating them equivalently. Among providers, technical difficulties were significantly associated with both less satisfaction and lower preference for telepsychiatry [odds ratio for satisfaction (ORS) = 0.12; odds ratio for preference (ORP) = 0.13]. For patients, factors significantly associated with both lower satisfaction and lower preference for telepsychiatry included technical difficulties (ORS = 0.20; ORP = 0.41), unstable access to the internet (ORS = 0.46; ORP = 0.50), worsening depression (ORS = 0.38; ORP = 0.36), and worsening anxiety (ORS = 0.41; ORP = 0.40). Factors associated with greater satisfaction and higher preference for telepsychiatry among patients included higher education (ORS = 2.13; ORP = 1.96) and a decrease in technical difficulties over time (ORS = 2.86; ORP = 2.35). Discussion Patients and providers were satisfied with telepsychiatry. However, there were greater differences between them in preferences for continuing to use telepsychiatry post-pandemic. These findings highlight factors that influence patient and provider preferences and should be addressed to optimize the use of telepsychiatry in the future.
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Affiliation(s)
- Michael Morreale
- Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Ilana Cohen
- Johns Hopkins Resident Outpatient Continuity Clinic, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Michael Van Wert
- Johns Hopkins Bayview Community Psychiatry Program, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Alexis Beccera
- Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Leslie Miller
- Johns Hopkins Bayview Community Psychiatry Program, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - William Narrow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Community Psychiatry Program, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Barbara Schweizer
- Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Jason Straub
- Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Peter Zandi
- Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Anne Ruble
- Johns Hopkins Resident Outpatient Continuity Clinic, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
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25
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Bar-Lev S. Corona hotels in Israel: Care and abandonment under the auspices of digital medicine. Health (London) 2023; 27:681-700. [PMID: 34949105 DOI: 10.1177/13634593211067904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Following the onset of the COVID-19 pandemic, Israel established a number of 'corona hotels' - hybrid spaces that were neither fully treatment-oriented nor fully incarcerational, in which people known or suspected to be infected with the coronavirus were confined, sometimes for prolonged and indefinite periods. This paper describes the experience of 25 people who were confined in corona recovery and isolation hotels between March and July 2020. The corona hotels exemplify how remote medical technology and digital medicine together enable a new 'technogeography of care', where care and abandonment are inextricably linked. The paper adds to the growing number of critical studies on digital health by showing how the employed technologies impact the concepts of human embodiment, subjectivity and social relations, as well as how the occupants negotiated the meaning of these technologies and resisted their effects.
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Affiliation(s)
- Shirly Bar-Lev
- The Dror (Imri) Center for Health Informatics, Ruppin Academic Center, Israel
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26
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Bernocchi P, Crotti G, Beato E, Bonometti F, Giudici V, Bertolaia P, Perger E, Remuzzi A, Bachetti T, La Rovere MT, Dalla Vecchia LA, Angeli F, Parati G, Borghi G, Vitacca M, Scalvini S. COVID-19 teleassistance and teleconsultation: a matched case-control study (MIRATO project, Lombardy, Italy). Front Cardiovasc Med 2023; 10:1062232. [PMID: 37645519 PMCID: PMC10461473 DOI: 10.3389/fcvm.2023.1062232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Background During the COVID-19 pandemic, telemedicine has been recognised as a powerful modality to shorten the length of hospital stay and to free up beds for the sicker patients. Lombardy, and in particular the areas of Bergamo, Brescia, and Milan, was one of the regions in Europe most hit by the COVID-19 pandemic. The primary aim of the MIRATO project was to compare the incidence of severe events (hospital readmissions and mortality) in the first three months after discharge between COVID-19 patients followed by a Home-Based Teleassistance and Teleconsultation (HBTT group) program and those discharged home without Telemedicine support (non-HBTT group). Methods The study was designed as a matched case-control study. The non-HBTT patients were matched with the HBTT patients for sex, age, presence of COVID-19 pneumonia and number of comorbidities. After discharge, the HBTT group underwent a telecare nursing and specialist teleconsultation program at home for three months, including monitoring of vital signs and symptoms. Further, in this group we analysed clinical data, patients' satisfaction with the program, and quality of life. Results Four hundred twenty-two patients per group were identified for comparison. The median age in both groups was 70 ± 11 years (62% males). One or more comorbidities were present in 86% of the HBTT patients and 89% in the non-HBTT group (p = ns). The total number of severe events was 17 (14 hospitalizations and 3 deaths) in the HBTT group and 40 (26 hospitalizations and 16 deaths) in the non-HBTT group (p = 0.0007). The risk of hospital readmission or death after hospital discharge was significantly lower in HBTT patients (Log-rank Test p = 0.0002). In the HBTT group, during the 3-month follow-up, 5,355 teleassistance contacts (13 ± 4 per patient) were performed. The number of patients with one or more symptoms declined significantly: from 338 (78%) to 183 (45%) (p < 0.00001). Both the physical (ΔPCS12: 5.9 ± 11.4) component and the mental (ΔMCS12: 4.4 ± 12.7) component of SF-12 improved significantly (p < 0.0001). Patient satisfaction with the program was very high in all participants. Conclusions Compared to usual care, an HBTT program can reduce severe events (hospital admissions/mortality) at 3-months from discharge and improve symptoms and quality of life. Clinical trial registration www.ClinicalTrials.gov, NCT04898179.
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Affiliation(s)
- Palmira Bernocchi
- Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Giacomo Crotti
- Epidemiology Unit, Bergamo Health Protection Agency, Bergamo, Italy
| | - Elvira Beato
- Epidemiology Unit, Bergamo Health Protection Agency, Bergamo, Italy
| | - Francesco Bonometti
- Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Vittorio Giudici
- Department of Cardiac Rehabilitation, Bolognini Hospital, Azienda Socio Sanitaria Territoriale Bergamo Est, Bergamo, Italy
| | - Patrizia Bertolaia
- Socio-Health Management Direction, Azienda Socio Sanitaria Territoriale Bergamo Est, Bergamo, Italy
| | - Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Andrea Remuzzi
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Tiziana Bachetti
- Scientific Direction, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Maria Teresa La Rovere
- Cardiac Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Montescano, Pavia, Italy
| | | | - Fabio Angeli
- Department of Medicine and Technological Innovativon (DiMIT), University of Insubria, Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Tradate, Varese, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gabriella Borghi
- Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Michele Vitacca
- Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Simonetta Scalvini
- Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
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Sener T, Haenen W, Smits P, Hans GH. Large-scale real-life implementation of technology-enabled care to maximize hospitals' medical surge preparedness during future infectious disease outbreaks and winter seasons: a viewpoint. Front Public Health 2023; 11:1149247. [PMID: 37621607 PMCID: PMC10446840 DOI: 10.3389/fpubh.2023.1149247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Hospitals can be overburdened with large numbers of patients with severe infectious conditions during infectious disease outbreaks. Such outbreaks or epidemics put tremendous pressure on the admission capacity of care facilities in the concerned region, negatively affecting the elective program within these facilities. Such situations have been observed during the recent waves of the coronavirus disease pandemic. Owing to the imminent threat of a "tripledemic" by new variants of the coronavirus disease (such as the new Omicron XBB.1.16 strain), influenza, and respiratory syncytial virus during future winter seasons, healthcare agencies should take decisive steps to safeguard hospitals' surge capacity while continuing to provide optimal and safe care to a potentially large number of patients in their trusted home environment. Preparedness of health systems for infectious diseases will require dynamic interaction between a continuous assessment of region-wide available hospital capacity and programs for intensive home treatment of patients who can spread the disease. In this viewpoint, we describe an innovative, dynamic coupling system between hospital surge capacity and cascading activation of a nationwide system for remote patient monitoring. This approach was developed using the multi-criteria decision analysis methodology, considering previously published real-life experiences on remote patient monitoring.
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Affiliation(s)
- Talia Sener
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Winne Haenen
- Federal Public Service for Health, Food Chain Safety and Environment, Brussels, Belgium
| | - Patrick Smits
- Cell Crisis Preparedness, Agentschap Zorg en Gezondheid, Brussels, Belgium
| | - Guy H. Hans
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Chief Medical Officer, Antwerp University Hospital (UZA), Edegem, Belgium
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28
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Belachew EA, Getachew D, Netere AK, Gizachew E, Sendekie AK. 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. Front Public Health 2023; 11:1234436. [PMID: 37608985 PMCID: PMC10440689 DOI: 10.3389/fpubh.2023.1234436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
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.
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Affiliation(s)
- Eyayaw Ashete Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Demis Getachew
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adeladlew Kassie Netere
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eshetie Gizachew
- Department of Information System, College of Informatics, University of Gondar, Gondar, Ethiopia
| | - Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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29
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Isakari M, Sanchez A, Conic R, Peretti J, Saito K, Sitapati AM, Millen M, Longhurst C. Benefits and Challenges of Transitioning Occupational Health to an Enterprise Electronic Health Record. J Occup Environ Med 2023; 65:615-620. [PMID: 37043385 PMCID: PMC10332650 DOI: 10.1097/jom.0000000000002864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
OBJECTIVE Occupational health (OH) documentation has traditionally been separate from health system electronic health records (EHRs), but this can create patient safety and care continuity challenges. Herein, we describe outcomes and challenges of such integration including how one health system managed compliance with laws, regulations, and ethical principles concerning digital privacy. METHODS Occupational health integration with the enterprise EHR at the University of California San Diego Health was started in June 2021 and completed in December 2021. RESULTS Integrating with the enterprise EHR allowed for a secure telehealth system, faster visit times, digitization of questionnaires medical clearance forms, and improved reporting capabilities. CONCLUSIONS Integration and interoperability are fundamental building blocks to any OH EHR solution and will allow for evaluation of worker population trends, and targeted interventions to improve worker health status.
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Khashe Y, Tabibzadeh M, Meshkati N. Improving Quality of Care for Patients Receiving Care through Telehealth in the Time of COVID-19 Global Pandemic and Beyond: HCI-based Leading Indicators for Virtual Visits. HUMAN FACTORS IN HEALTHCARE 2023; 4:100050. [PMID: 38620160 PMCID: PMC10290161 DOI: 10.1016/j.hfh.2023.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/22/2023] [Indexed: 04/17/2024]
Abstract
The COVID-19 pandemic expedited the growing rate of reliance on telehealth, as it provided a safer option for patients to seek the care they need and avoid potential negative consequences of being exposed to the COVID-19 virus. The aim of this study is to develop a series of Human-Computer Interaction (HCI)-based leading indicators to proactively analyze and evaluate the user interface in telehealth and virtual visits. Building on Nielsen's usability heuristics and mapping them to the six aspects of quality of care introduced by the Institute of Medicine, we identified the design features that had the highest impact on the quality of care and developed a list of leading indicators for each feature. Further, we developed corresponding checklists for each leading indicator to evaluate the features of the user. Beyond the benefits of telehealth for both patients and healthcare providers during atypical circumstances, the changes prompted by the COVID-19 public health emergency have possibly altered the position of telehealth to the point that communicating through video and audio has become the new normal. Therefore, the importance of designing an interface to facilitate user interaction with the system and consequently with one another is of utmost importance.
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Affiliation(s)
- Yalda Khashe
- Daniel j. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California, United States
| | - Maryam Tabibzadeh
- Manufacturing Systems Engineering & Management Department, California State University, Northridge, California, United States
| | - Najmedin Meshkati
- Department of Civil and Environmental Engineering, University of Southern California, Los Angeles, California, United States
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Alzahrani SA, Khouja JH, GhamdI SA, Alotaybi M, Bargawi A, Alghamdi AA, Fayraq A. Telemedicine Acceptability Among Patients of Primary Health Care Clinics in the Western Region, Saudi Arabia. Cureus 2023; 15:e40857. [PMID: 37489195 PMCID: PMC10363371 DOI: 10.7759/cureus.40857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/26/2023] Open
Abstract
Background Telemedicine has become increasingly important during recent years. Investigating the acceptability of telemedicine among patients is an important first step in adapting and maintaining the use of telemedicine and gaining the advantages of technologies in daily practice. Objective To measure the acceptability of telemedicine among the patients of primary health care centers (PHCC) using the Service User Technology Acceptability Questionnaire (SUTAQ) at King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia. Methods This cross-sectional study utilized a validated questionnaire in phone call interviews with patients of PHCC clinics. All patients who had a telemedicine visit at PHCC within the past month of data collection were eligible for inclusion. The SUTAQ tool was used to measure the acceptability of telemedicine technology. Results Out of 365 people selected for participation, 73.9% responded. The study found that the median age was 40 years old with an interquartile range of 30-52. The majority of participants were female (61.1%) and married (86.7%). The median total SUTAQ score was 4.3, out of a maximum score of 6. The medians for SUTAQ subscales were as follows: the perceived benefits score was 5.4, the privacy and discomfort score was 2.1, the health care personnel concerns score was 3, the satisfaction score was 5.7, and the kit as substitution score was 4.3. Patients who had not previously experienced telemedicine visits showed a higher score in "health care personnel concerns" (P-value=0.009), while first-time patients had a higher score in "kit as substitution" (P-value=0.006). Conclusion This study provided positive evidence that telemedicine is an acceptable service among PHCC patients. However, PHCC providers should prioritize patient education and awareness about telemedicine to improve utilization. Addressing privacy, discomfort, and personnel concerns could increase patient satisfaction. Future studies investigating telemedicine utilization can help in understanding its impact on clinical outcome.
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Affiliation(s)
- Saif A Alzahrani
- Preventive Medicine, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, SAU
- Preventive Medicine, Saudi Board of Preventive Medicine, Jeddah, SAU
| | - Jumana H Khouja
- Preventive Medicine, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, SAU
- Primary Healthcare, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Saad A GhamdI
- Preventive Medicine, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, SAU
- Primary Healthcare, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Moteab Alotaybi
- Preventive Medicine, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, SAU
- Preventive Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Amina Bargawi
- Preventive Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | | | - Amer Fayraq
- Preventive Medicine, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, SAU
- Preventive Medicine, King Abdulaziz Medical City Jeddah, Jeddah, SAU
- Preventive Medicine, Saudi Board of Preventive Medicine, Jeddah, SAU
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Chilunjika SRT, Chilunjika A. Embracing e-health systems in managing the COVID 19 pandemic in Sub-Saharan Africa. SOCIAL SCIENCES & HUMANITIES OPEN 2023; 8:100556. [PMID: 37214273 PMCID: PMC10192599 DOI: 10.1016/j.ssaho.2023.100556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/06/2023] [Accepted: 05/07/2023] [Indexed: 05/24/2023]
Abstract
The COVID-19 pandemic and the policy responses adopted to curtail it have drastically altered how health services are delivered around the globe. To enable the public to continue accessing health care, e-health innovations have become the most viable tool to provide convenient, timely, effective and safe care, while reducing the spread of the virus. This paper utilized data from existing literature to explore the benefits and challenges of implementing e-health technologies in Sub Saharan Africa (SSA) amid this pandemic. Evidence suggests that these technologies have the potential to strengthen public health systems in SSA as they have in First World countries. However, there are a number of challenges that need to be addressed first in order to realize the full promises of e-health on the continent. The paper proposes that African governments should come together and implement similar e-health policies, share software, expertise and other critical ICT infrastructure as it can result in the successful implementation of e-health innovations, while reducing the financial burden associated with their set up.
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Affiliation(s)
- S R T Chilunjika
- School of Public Management, Governance and Public Policy, University of Johannesburg, Auckland Park, Johannesburg, 2006, South Africa
- Department of Governance and Public Management, Midlands State University, Gweru, Zimbabwe
| | - A Chilunjika
- School of Public Management, Governance and Public Policy, University of Johannesburg, Auckland Park, Johannesburg, 2006, South Africa
- Department of Political and Administrative Studies, University of Lesotho, Maseru, Lesotho
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Festl-Wietek T, Erschens R, Griewatz J, Zipfel S, Herrmann-Werner A. How to communicate with patients in written asynchronous online conversations: an intervention study with undergraduate medical students in a cross-over design. Front Med (Lausanne) 2023; 10:1026096. [PMID: 37275354 PMCID: PMC10232748 DOI: 10.3389/fmed.2023.1026096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/25/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction The patient-physician encounter is the core element in the treatment of patients and the diagnosis of disease. In these times of digitalization, patient-physician communication is increasingly taking place online: patients embrace new possibilities offered digitally, and physicians are encouraged to adapt accordingly. Since a huge part of online communication is written, this study aims to investigate how medical students communicate with patients online by focusing on their written competencies and whether an intervention might improve their competencies. Methods This study was performed in an explanatory cross-sectional manner with a cross-over design. Second-year medical students participated. An intervention was developed on how to formulate an appropriate written response to a patient's request and integrated a longitudinal communication class. The intervention consists of education on general set-up (e.g., greetings), syntax, spelling, content and kind of communication (e.g., appreciative attitude). After meeting a patient in a simulated role play medical students received the patient's request via a digital platform. The control group had the same simulated role play and the same task but they received the intervention on communication afterwards. Intervention and control group were statistically compared based on a checklist. Results Twenty-nine medical students took part in the study. The results showed that the medical students had basic competencies in dealing with written communication independent if they received the intervention (CG: M = 3.86 ± 1.23 vs. IG: M = 4.07 ± 1.03; p = 0.625). Similar results were also for the emotional competency ratings (MCG = 3.36 ± 1.08; MIG = 3.67 ± 0.98; p = 0.425).The intervention was able to lead to a more appreciative response toward patient. Discussion Intervention on basic competencies such as simple language and clear presentation might not be needed as an integral part in medical education. However, medical students should learn how to present empathic and authentic behavior in written online communication.
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Affiliation(s)
- Teresa Festl-Wietek
- TIME–Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
| | - Rebecca Erschens
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Jan Griewatz
- TIME–Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
- Deanery of Students’ Affairs, Faculty of Medicine, Eberhard-Karls University of Tuebingen, Tuebingen, Germany
| | - Anne Herrmann-Werner
- TIME–Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
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Lamy ZC, Thomaz EBAF, da Silva-Junior AG, Alexandre GC, Alves MTSSDBE, de Carvalho RHDSBF, de Menezes LO, de Oliveira SS, Moraes M, Magalhães YB, Coimbra TRS, Guzman-Barrera LS. Experiences of women in prenatal, childbirth, and postpartum care during the COVID-19 pandemic in selected cities in Brazil: The resignification of the experience of pregnancy and giving birth. PLoS One 2023; 18:e0284773. [PMID: 37146073 PMCID: PMC10162534 DOI: 10.1371/journal.pone.0284773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 04/06/2023] [Indexed: 05/07/2023] Open
Abstract
The COVID-19 pandemic has impacted public and private health systems around the world, impairing good practices in women's health care. However, little is known about the experiences, knowledge, and feelings of Brazilian women in this period. The objective was to analyze the experiences of women, seen at maternity hospitals accredited by the Brazilian Unified Health System (SUS, acronym in Portuguese), regarding health care during pregnancy, childbirth, and postpartum periods, their interpersonal relationships, and perceptions and feelings about the pandemic. This was a qualitative, exploratory research, carried out in three Brazilian municipalities with women hospitalized in 2020, during pregnancy, childbirth, or postpartum period, with COVID-19 or not. For data collection, semi-structured individual interviews (in person, by telephone, or by digital platform) were conducted, recorded and transcribed. The content analysis of thematic modalities was displayed as per the following axes: i) Knowledge about the disease; ii) Search for health care in prenatal, childbirth, and postpartum periods; iii) Experience of suffering from COVID-19; iv) Income and work; and v) Family dynamics and social support network. A total of 46 women were interviewed in São Luís-MA, Pelotas-RS, and Niterói-RJ. Use of media was important to convey information and fight fake news. The pandemic negatively impacted access to health care in the prenatal, childbirth, and postpartum periods, contributing to worsening of the population's social and economic vulnerabilities. Women experienced diverse manifestations of the disease, and psychic disorders were very frequent. Social isolation during the pandemic disrupted the support network of these women, who found social support strategies in communication technologies. Women-centered care-including qualified listening and mental health support-can reduce the severity of COVID-19 cases in pregnant, parturient, and postpartum women. Sustainable employment and income maintenance policies are essential to mitigate social vulnerabilities and reduce risks for these women.
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Affiliation(s)
- Zeni Carvalho Lamy
- Public Health Department, Universidade Federal do Maranhão, São Luís, MA, Brazil
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Levy BE, Wilt WS, Johnson J, Wallace H, Ballert E, Newcomb M, Cavatassi W, Harris A. Procedure-Based Telehealth Utilization in General Surgery. Am J Med Qual 2023; 38:154-159. [PMID: 37125671 DOI: 10.1097/jmq.0000000000000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The authors hypothesize that standardized telehealth (TH) scheduling processes will improve TH utilization without increasing adverse events. Fifty visits preimplementation and 67 visits postimplementation were audited from June 2021 to January 2022. Both leadership and frontline stakeholders were engaged to identify current workflows and potential interventions targeting outpatient elective procedures. Process mapping outlined current TH scheduling workflows. Outcomes related to TH completion, cost, and TH scheduling were collected after implementation. Preimplementation TH scheduling rate was 32%. The intervention required TH postoperative appointments to be scheduled in clinic at the time of surgery scheduling with TH being the default postsurgical appointment for a standardized list of eligible procedures. Following implementation, 95% of patients undergoing eligible procedures had TH follow-up. This provided improved access to surgical follow-up care, by reducing travel needs to the Veterans Affairs facility. Secondarily, this intervention increased clinic appointment availability and resulted in possible increased revenue for billable visits. Standardizing TH scheduling based on the procedure improves the utilization of TH resulting in improved clinic efficiency and increased revenue, without increasing adverse events.
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Affiliation(s)
- Brittany E Levy
- Department of General Surgery, University of Kentucky, Lexington, KY
| | - Wesley S Wilt
- Department of General Surgery, University of Kentucky, Lexington, KY
| | | | | | - Erik Ballert
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - Melissa Newcomb
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - William Cavatassi
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - Andrew Harris
- Lexington Veteran's Affairs Medical Center, Lexington, KY
- Department of Urology, University of Kentucky, Lexington, KY
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36
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Navarro-Martínez O, Igual-García J, Traver-Salcedo V. Bridging the educational gap in terms of digital competences between healthcare institutions' demands and professionals' needs. BMC Nurs 2023; 22:144. [PMID: 37106389 PMCID: PMC10134655 DOI: 10.1186/s12912-023-01284-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Healthcare professionals with insufficient digital competence can be detrimental to patient safety and increase the incidence of errors. In order to guarantee proper care, healthcare organizations should provide opportunities to learn how to use technology, especially for those professionals who have not received training about this topic during their undergraduate studies. OBJECTIVE This exploratory study aimed to conduct surveys among Spanish healthcare professionals to determine whether their organisations had trained them in the use of healthcare technology and the areas where most emphasis was placed. METHODS 1624 Spanish healthcare professionals responded to an ad hoc online survey 7 questions related to the digital skill training offered by the healthcare organisations they work for. RESULTS Nurses were the most widely represented group, making up 58.29% of the total, followed by physicians namely 26.49%. Only 20% of the nurses surveyed had received some training from their institution related to healthcare technology. According to the participants' responses, physicians received significantly more training in this area than nurses. Training related to database searching for research purposes or computer management followed the same trend. Nurses also received less training than physicians in this area. 32% of physicians and nurses paid for their own training if they did not receive any training from institutions. CONCLUSIONS Nurses receive less training, on topics such as database searching or management, from the healthcare centres and hospitals where they work. Moreover, they also have fewer research and digital skills. Both of these factors may lead to deficits in their care activities, and have adverse effects on patients. Not to mention fewer opportunities for professional progress.
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Affiliation(s)
- O Navarro-Martínez
- Department of Nursing, Catholic University of Valencia, Valencia, Spain.
- Instituto ITACA, Universitat Politècnica de València, Calle Espartero 7, Valencia, Spain.
| | - J Igual-García
- Instituto de Telecomunicaciones y Aplicaciones Multimedia (ITEAM), Departamento de Comunicaciones, Universitat Politècnica de València, Valencia, Spain
| | - V Traver-Salcedo
- Instituto ITACA, Universitat Politècnica de València, Calle Espartero 7, Valencia, Spain
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Dey J, Bhowmik A. Concurring of Neural Machines for Robust Session Key Generation and Validation in Telecare Health System During COVID-19 Pandemic. WIRELESS PERSONAL COMMUNICATIONS 2023; 130:1885-1904. [PMID: 37206633 PMCID: PMC10067522 DOI: 10.1007/s11277-023-10362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 05/21/2023]
Abstract
In this technique, it has been proposed to agree the session keys that have been generated through dual artificial neural networks based on the Telecare Health COVID-19 domain. Electronic health enables secure and protected communication between the patients and physicians, especially during this COVID-19 pandemic. Telecare was the main component which served the remote and non-invasive patients in the crisis period of COVID-19. Neural cryptographic engineering support in terms of data security and privacy is the main theme for Tree Parity Machine (TPM) synchronization in this paper. The session key has been generated on different key lengths and key validation done on the proposed set of robust session keys. A neural TPM network receives a vector designed through same random seed and producing a single output bit. Duo neural TPM networks' intermediate keys would be partially shared between the patient and doctor for the purpose neural synchronization. Higher magnitude of co-existence has been observed at the duo neural networks at the Telecare Health Systems in COVID-19. This proposed technique has been highly protective against several data attacks in the public networks. Partial transmission of the session key disables the intruders to guess the exact pattern, and highly randomized through different tests. The average p-values of different session key lengths of 40 bits, 60 bits, 160 bits, and 256 bits were observed to be 221.9, 259.3, 242, and 262.8 (taken under multiplicative of 1000) respectively.
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Affiliation(s)
- Joydeep Dey
- Department of Computer Science, M.U.C. Women’s College, Burdwan, India
| | - Anirban Bhowmik
- Department of Computer Science, M.U.C. Women’s College, Burdwan, India
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Ali Y, Khan HU. A Survey on harnessing the Applications of Mobile Computing in Healthcare during the COVID-19 Pandemic: Challenges and Solutions. COMPUTER NETWORKS 2023; 224:109605. [PMID: 36776582 PMCID: PMC9894776 DOI: 10.1016/j.comnet.2023.109605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/17/2022] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic ravaged almost every walk of life but it triggered many challenges for the healthcare system, globally. Different cutting-edge technologies such as Internet of things (IoT), machine learning, Virtual Reality (VR), Big data, Blockchain etc. have been adopted to cope with this menace. In this regard, various surveys have been conducted to highlight the importance of these technologies. However, among these technologies, the role of mobile computing is of paramount importance which is not found in the existing literature. Hence, this survey in mainly targeted to highlight the significant role of mobile computing in alleviating the impacts of COVID-19 in healthcare sector. The major applications of mobile computing such as software-based solutions, hardware-based solutions and wireless communication-based support for diagnosis, prevention, self-symptom reporting, contact tracing, social distancing, telemedicine and treatment related to coronavirus are discussed in detailed and comprehensive fashion. A state-of-the-art work is presented to identify the challenges along with possible solutions in adoption of mobile computing with respect to COVID-19 pandemic. Hopefully, this research will help the researchers, policymakers and healthcare professionals to understand the current research gaps and future research directions in this domain. To the best level of our knowledge, this is the first survey of its type to address the COVID-19 pandemic by exploring the holistic contribution of mobile computing technologies in healthcare area.
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Affiliation(s)
- Yasir Ali
- Higher Education Department, Khyber Pakhtunkhwa, Government Degree College Kotha Swabi, KP, Pakistan
- Higher Education Department, Shahzeb Shaheed Government Degree College Razzar, Swabi, KP, Pakistan
| | - Habib Ullah Khan
- Accounting and Information, College of Business and Economics, Qatar University, Doha Qatar
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Little CC, Russell S, Hwang C, Goldberg L, Brown S, Kirke D, Courey M. Applications of Telemedicine in Speech-Language Pathology: Evaluation of Patient Satisfaction. Laryngoscope 2023; 133:895-900. [PMID: 35848893 DOI: 10.1002/lary.30303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The study aimed to evaluate patient satisfaction with speech-language therapy televisits and to identify factors influencing the level of satisfaction. METHODS Participants were recruited from an academic tertiary voice and swallowing center who had completed ≥1 telehealth session of speech-language therapy with a speech-language pathologist between March, 2020 and April, 2021. Patient satisfaction was assessed using the Short Assessment of Patient Satisfaction (SAPS), a validated 7-item survey. Demographic characteristics of participants were collected from a review of patient charts. RESULTS 65/239 patients completed the SAPS survey, representing a response rate of 27%. The average age of study participants was 54.92 ± 16.45 years, with 49.2% identifying as female, 33.9% as male, and 16.9% as trans-female. The mean SAPS score was 22.60 ± 3.89, with 84.62% of patients satisfied or very satisfied with their visit. Patients were most satisfied with provider respect (3.91 ± 0.34) and care received (3.74 ± 0.64), and least satisfied with visit length (2.32 ± 1.38) and explanation of treatment results (2.62 ± 1.72). Patient satisfaction was positively correlated with younger age and an increased number of televisits. Satisfaction did not differ significantly by gender identity, type of therapy received, insurance type, travel distance, or prior in-person therapy. CONCLUSION Clinicians are able to achieve high patient satisfaction with speech-language therapy when delivered by telehealth. Patient satisfaction remained high across diverse patient populations and range of clinical needs. Clinicians should remain cognizant of the unique limitations of older patients when conducting telehealth visits. LAY SUMMARY Clinicians are able to achieve high patient satisfaction with speech-language therapy when delivered via telehealth. Satisfaction remained high regardless of gender identity, type of therapy received, type of insurance, travel distance, or completion of prior in-person therapy. LEVEL OF EVIDENCE 4 Laryngoscope, 133:895-900, 2023.
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Affiliation(s)
- Christine C Little
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Stephen Russell
- Department of Otolaryngology, Naval Medical Center, San Diego, California, U.S.A
| | - Chaewon Hwang
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Leanne Goldberg
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Sarah Brown
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Diana Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Mark Courey
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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Dey J. State-of-the-art session key generation on priority-based adaptive neural machine (PANM) in telemedicine. Neural Comput Appl 2023; 35:9517-9533. [PMID: 37077617 PMCID: PMC10032630 DOI: 10.1007/s00521-022-08169-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/06/2022] [Indexed: 03/24/2023]
Abstract
Telemedicine is one of the safest methods to provide healthcare facilities to the remote patients with the help of digitization. In this paper, state-of-the-art session key has been proposed based on the priority oriented neural machines followed by its validation. State-of-the-art technique can be mentioned as newer scientific method. Soft computing has been extensively used and modified here under the ANN domain. Telemedicine facilitates secure data communication between the patients and the doctors regarding their treatments. The best fitted hidden neuron can contribute only in the formation of the neural output. Minimum correlation was taken into consideration under this study. Hebbian learning rule was applied on both the patient’s neural machine and the doctor’s neural machine. Lesser iterations were needed in the patient’s machine and the doctor’s machine for the synchronization. Thus, the key generation time has been shortened here which were 4.011 ms, 4.324 ms, 5.338 ms, 5.691 ms, and 6.105 ms for 56 bits, 128 bits, 256 bits, 512 bits, and 1024 bits of state-of-the-art session keys, respectively. Statistically, different key sizes of the state-of-the-art session keys were tested and accepted. Derived value-based function had yielded successful outcomes too. Partial validations with different mathematical hardness had been imposed here too. Thus, the proposed technique is suitable for the session key generation and authentication in the telemedicine in order to preserve the patients’ data privacy. This proposed method has been highly protective against numerous data attacks inside the public networks. Partial transmission of the state-of-the-art session key disables the intruders to decode the same bit patterns of the proposed set of keys.
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Affiliation(s)
- Joydeep Dey
- Department of Computer Science, M.U.C. Women’s College, Burdwan, India
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Chiu PC, Su KW, Wang CH, Ruan CW, Shiao ZP, Tsao CH, Huang HH. Development and Testing of the Smart Healthcare Prototype System through COVID-19 Patient Innovation. Healthcare (Basel) 2023; 11:healthcare11060847. [PMID: 36981502 PMCID: PMC10048738 DOI: 10.3390/healthcare11060847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
Since the outbreak of the novel coronavirus disease 2019 (COVID-19), the epidemic has gradually slowed down in various countries and people’s lives have gradually returned to normal. To monitor the spread of the epidemic, studies discussing the design of related healthcare information systems have been increasing recently. However, these studies might not consider the aspect of user-centric design when developing healthcare information systems. This study examined these innovative technology applications and rapidly built prototype systems for smart healthcare through a systematic literature review and a study of patient innovation. The design guidelines for the Smart Healthcare System (SHS) were then compiled through an expert review process. This will provide a reference for future research and similar healthcare information system development.
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Affiliation(s)
- Po-Chih Chiu
- College of Management, National Kaohsiung University of Science and Technology, Kaohsiung 824005, Taiwan
| | - Kuo-Wei Su
- Department of Information Management, National Kaohsiung University of Science and Technology, Kaohsiung 824005, Taiwan
- Correspondence: (K.-W.S.); (C.-H.T.)
| | - Chao-Hung Wang
- Department of Information Management, National Kaohsiung University of Science and Technology, Kaohsiung 824005, Taiwan
| | - Cong-Wen Ruan
- Department of Information Management, National Kaohsiung University of Science and Technology, Kaohsiung 824005, Taiwan
| | - Zong-Peng Shiao
- Department of Information Management, National Kaohsiung University of Science and Technology, Kaohsiung 824005, Taiwan
| | - Chien-Han Tsao
- Department of Otolaryngology, Chung Shan Medical University Hospital and School of Medicine, Taichung 40201, Taiwan
- Correspondence: (K.-W.S.); (C.-H.T.)
| | - Hsin-Hsin Huang
- Department of Otolaryngology, Chung Shan Medical University Hospital and School of Medicine, Taichung 40201, Taiwan
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Patient Satisfaction with Virtual Clinic Encounters: Analysis of Factors that Impact the Press Ganey Survey in the Hand Surgery Population. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
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Nguyen OT, Hanna K, Merlo LJ, Parekh A, Tabriz AA, Hong YR, Feldman SS, Turner K. Early Performance of the Patients Over Paperwork Initiative among Family Medicine Physicians. South Med J 2023; 116:255-263. [PMID: 36863044 PMCID: PMC9991071 DOI: 10.14423/smj.0000000000001526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVES In 2019, the Centers for Medicare & Medicaid Services began implementing the Patients Over Paperwork (POP) initiative in response to clinicians reporting burdensome documentation regulations. To date, no study has evaluated how these policy changes have influenced documentation burden. METHODS Our data came from the electronic health records of an academic health system. Using quantile regression models, we assessed the association between the implementation of POP and clinical documentation word count using data from family medicine physicians in an academic health system from January 2017 to May 2021 inclusive. Studied quantiles included the 10th, 25th, 50th, 75th, and 90th quantiles. We controlled for patient-level (race/ethnicity, primary language, age, comorbidity burden), visit-level (primary payer, level of clinical decision making involved, whether a visit was done through telemedicine, whether a visit was for a new patient), and physician-level (sex) characteristics. RESULTS We found that the POP initiative was associated with lower word counts across all of the quantiles. In addition, we found lower word counts among notes for private payers and telemedicine visits. Conversely, higher word counts were observed in notes that were written by female physicians, notes for new patient visits, and notes involving patients with greater comorbidity burden. CONCLUSIONS Our initial evaluation suggests that documentation burden, as measured by word count, has declined over time, particularly following implementation of the POP in 2019. Additional research is needed to see whether the same occurs when examining other medical specialties, clinician types, and longer evaluation periods.
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Affiliation(s)
- Oliver T. Nguyen
- Department of Community Health & Family Medicine, University of Florida, Gainesville
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Karim Hanna
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa
| | - Lisa J. Merlo
- Department of Psychiatry, University of Florida, Gainesville
| | - Arpan Parekh
- Department of Community Health & Family Medicine, University of Florida, Gainesville
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Department of Oncological Sciences, University of South Florida, Tampa
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville
| | - Sue S. Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Department of Oncological Sciences, University of South Florida, Tampa
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Jaroń K, Jastrzębska A, Mąkosza K, Grajek M, Krupa-Kotara K, Kobza J. Availability of Medical Services and Teleconsultation during COVID-19 Pandemic in the Opinion of Patients of Hematology Clinics-A Cross-Sectional Pilot Study (Silesia, Poland). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4264. [PMID: 36901275 PMCID: PMC10002034 DOI: 10.3390/ijerph20054264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
A new virus, SARS-CoV-2, emerged in December 2019, triggering the COVID-19 pandemic in 2020 due to the rapid spread and severity of cases worldwide. In Poland, the first case of COVID-19 was reported on 4 March 2020. The aim of the prevention efforts was primarily to stop the spread of the infection to prevent overburdening the health care system. Many illnesses were treated by telemedicine, primarily using teleconsultation. Telemedicine has reduced personal contact between doctors and patients and reduced the risk of exposure to disease for patients and medical personnel. The survey aimed to gather patients' opinions on the quality and availability of specialized medical services during the pandemic. Based on the data collected regarding patients' opinions on services provided via telephone systems, a picture was created of patients' opinions on teleconsultation, and attention was drawn to emerging problems. The study included a 200-person group of patients, realizing their appointments at a multispecialty outpatient clinic in Bytom, aged over 18 years, with various levels of education. The study was conducted among patients of Specialized Hospital No. 1 in Bytom. A proprietary survey questionnaire was developed for the study, which was conducted on paper and used face-to-face interaction with patients. Results: 17.5% of women and 17.5% of men rated the availability of services during the pandemic as good. In contrast, among those aged 60 and over, 14.5% of respondents rated the availability of services during the pandemic as poor. In contrast, among those in the labor force, as many as 20% of respondents rated the accessibility of services provided during the pandemic as being well. The same answer was marked by those on a pension (15%). Overwhelmingly, women in the age group of 60 and over showed a reluctance toward teleconsultation. Conclusions: Patients' attitudes toward the use of teleconsultation services during the COVID-19 pandemic varied, primarily due to attitudes toward the new situation, the age of the patient, or the need to adapt to specific solutions not always understood by the public. Telemedicine cannot completely replace inpatient services, especially among the elderly. It is necessary to refine remote visits to convince the public of this type of service. Remote visits should be refined and adapted to the needs of patients in such a way as to remove any barriers and problems arising from this type of service. This system should also be introduced as a target, providing an alternative method of inpatient services even after the pandemic ends.
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Affiliation(s)
- Kamila Jaroń
- Department of Public Health, Department of Public Health Policy, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Piekarska 18, 41-902 Bytom, Poland
| | - Angelika Jastrzębska
- Department of Public Health, Department of Public Health Policy, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Piekarska 18, 41-902 Bytom, Poland
| | - Kamil Mąkosza
- Department of Public Health, Department of Public Health Policy, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Piekarska 18, 41-902 Bytom, Poland
| | - Mateusz Grajek
- Department of Public Health, Department of Public Health Policy, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Piekarska 18, 41-902 Bytom, Poland
| | - Karolina Krupa-Kotara
- Department of Epidemiology, Department of Epidemiology and Biostatistics, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Piekarska 18, 41-902 Bytom, Poland
| | - Joanna Kobza
- Department of Public Health, Department of Public Health Policy, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Piekarska 18, 41-902 Bytom, Poland
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Leonard C, Liu W, Holstein A, Alliance S, Nunnery M, Rohs C, Sloan M, Winchester DE. Informing Use of Telehealth for Managing Chronic Conditions: Mixed-Methods Evaluation of Telehealth Use to Manage Heart Failure During COVID-19. J Am Heart Assoc 2023; 12:e027362. [PMID: 36752228 PMCID: PMC10111499 DOI: 10.1161/jaha.122.027362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Background The COVID-19 pandemic forced Veterans Health Administration facilities to rapidly adopt and deploy telehealth alternatives to provide continuity of care to veterans while minimizing physical contact. The impact of moving to virtual visits on patients with congestive heart failure (HF) is unknown. The goal of this study was to understand how patients with HF and their providers experienced the shift to telehealth for managing a chronic condition, and to inform best practices for continued telehealth use. Methods and Results We identified Veterans Health Administration Medical Centers with high telehealth use before COVID-19 and sites that were forced to adopt telehealth in response to COVID-19, and interviewed cardiology providers and veterans with HF about their experiences using telehealth. Interviews were recorded, transcribed, and analyzed using team-based rapid content analysis. We identified 3 trajectory patterns for cardiology telehealth use before and during COVID-19. They were the low-use class (low to low), high-use class (relatively high to higher), and increased-use class (low to high). The high-use and increased-use classes fit the criteria for sites that had high telehealth use before COVID-19 and sites that rapidly adopted telehealth in response to COVID-19. There were 12 sites in the high-use class and 4 sites in the increased-use class. To match with the number of sites in the increased-use class, we selected the top 4 sites by looking at the months before COVID-19. We identified 3 themes related to telehealth use among patients with HF and cardiology providers: (1) technology was the primary barrier for both patients and providers; (2) infrastructural support was the primary facilitator for providers; and (3) both patients and providers had largely neutral opinions on how telehealth compares to in-person care but described situations in which telehealth is not appropriate. Conclusions Only 12 sites fit the criteria of high telehealth use in cardiology before COVID-19, and 4 fit the criteria of low use that increased in response to COVID-19. Patients and providers at both site types were largely satisfied using telehealth to manage HF. Understanding best practices for managing ambulatory care-sensitive conditions through virtual visits can help the Veterans Health Administration prepare for long-term impacts of COVID-19 on in-person visits, as well as improve access to care for veterans who live remotely or who have difficulty traveling to in-person appointments.
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Affiliation(s)
- Chelsea Leonard
- Denver Seattle Center of Innovation (COIN) Aurora Colorado.,Division of Health Care Policy and Research University of Colorado Medical Campus Aurora Colorado
| | - Wenhui Liu
- Denver Seattle Center of Innovation (COIN) Aurora Colorado
| | - Ariel Holstein
- Denver Seattle Center of Innovation (COIN) Aurora Colorado
| | | | - Mary Nunnery
- Denver Seattle Center of Innovation (COIN) Aurora Colorado
| | - Carly Rohs
- Denver Seattle Center of Innovation (COIN) Aurora Colorado
| | - Marilyn Sloan
- Denver Seattle Center of Innovation (COIN) Aurora Colorado
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46
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Leung T, Chalimourdas A, Timmermans A, Van Rompaey V, Vanderveken OM, Jacquemin L, Schlee W, Marneffe W, Luyten J, Gilles A, Michiels S. Effectiveness of Telerehabilitation Interventions for Self-management of Tinnitus: Systematic Review. J Med Internet Res 2023; 25:e39076. [PMID: 36757768 PMCID: PMC9951082 DOI: 10.2196/39076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 12/16/2022] [Accepted: 12/31/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Tinnitus is a highly prevalent symptom affecting 10%-20% of the adult population. Most patients with tinnitus have chronic tinnitus, which can directly or indirectly disrupt their daily life and negatively affect the health-related quality of life. Therefore, patients with tinnitus are frequently in need of costly and time-consuming treatments. As an answer, telerehabilitation interventions are on a rise to promote self-management in patients with tinnitus and reduce their dependency on in-person care. OBJECTIVE This systematic review aimed to provide an overview of the research concerning the effectiveness of telerehabilitation interventions for self-management of tinnitus. METHODS This systematic review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were eligible for inclusion if study participants were adult patients with complaints of primary subjective tinnitus and the study intervention comprised any possible telerehabilitation form for the self-management of tinnitus complaints. A search for eligible studies was conducted on PubMed, ScienceDirect, Scopus, Web of Science, and Cochrane Library. The Cochrane Risk of Bias 2 tool was used to the assess risk of bias. RESULTS In total, 29 articles were found eligible, and of these, 5 (17%) studied multiple telerehabilitation forms. Internet-based cognitive behavioral treatment with guidance by a psychologist or audiologist was examined in 17 studies (n=1767), internet-based cognitive behavioral treatment without guidance was examined in 4 studies (n=940), self-help manuals were examined in 1 study (n=72), technological self-help devices were examined in 2 studies (n=82), smartphone apps were examined in 8 studies (n=284), and other internet-based interventions were examined in 2 studies (n=130). These rehabilitation categories were proven to be effective in decreasing tinnitus severity and relieving tinnitus distress as measured by tinnitus questionnaires such as Tinnitus Functional Index, Tinnitus Handicap Inventory, or Tinnitus Reactions Questionnaire. However, dropout rates were often high (range 4%-71.4%). All studies reported between some concerns and high concerns of risk of bias, resulting in low to moderate certainty levels. CONCLUSIONS Overall, there is low to moderate quality evidence that telerehabilitation interventions effectively reduce tinnitus severity and distress. These interventions form a possible tool to improve the self-management capacities of the patient and the accessibility of tinnitus care as a replacement or an addition to in-person care. Nevertheless, barriers such as lack of time, engagement, motivation, and openness of the patient causing high dropout should be considered. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021285450; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285450.
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Affiliation(s)
| | - Antonios Chalimourdas
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Annick Timmermans
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Department of translational neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Olivier M Vanderveken
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Department of translational neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Laure Jacquemin
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Department of translational neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Wim Marneffe
- Faculty of Business Economics, Hasselt University, Hasselt, Belgium
| | - Janis Luyten
- Faculty of Business Economics, Hasselt University, Hasselt, Belgium
| | - Annick Gilles
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Department of translational neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Sarah Michiels
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
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Mujtaba M, Kotwani S, Qayyum D, Saghir T, Bhatti KI, Khalid MR, Khanzada MF, Aman S, Shaikh KA, Buraro S, Karim M. Impact of COVID-19 on cardiovascular clinics: Are we ready for telemedicine? SAGE Open Med 2023; 11:20503121231153755. [PMID: 36778198 PMCID: PMC9912032 DOI: 10.1177/20503121231153755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023] Open
Abstract
Objective The need for telemedicine was felt more than ever during the COVID-19 pandemic, which impacted health care worldwide. Therefore, this study aimed to determine the difficulties faced by patients in visiting the cardiac outpatient department during COVID-19, along with assessing the awareness and acceptability of telemedicine. Methods In this cross-sectional study, selected patients presenting to outpatient department of a tertiary care cardiac hospital were interviewed regarding the difficulties faced by patients in visiting the outpatient department during COVID-19 and their awareness and acceptability of telemedicine using a self-designed structured questionnaire. Results Of the 403 patients, 58.3% were male, the mean age was 53.04 ± 11.73 years, and most (77.7%) were urban residents. Ischemic heart disease was present in 69.5%, followed by hypertension (38.7%) and heart failure (29.3%). A total of 26.6% required emergency room visits. Limited appointments (55.6%) was the most common problem faced by patients during COVID-19, followed by financial issues (17.1%), fear of acquiring infection (13.4%), and limited mobility due to lockdown (22.6%). Only 12.2% were aware of telemedicine, 4.5% had previously used it, and 41.2% were willing to opt for telemedicine in the future. No internet access (39.2%) was the key barrier to the usage of telemedicine, followed by a lack of free medicine (39%) and a lack of a smart device (31.5%). Conclusion Limited appointments due to COVID-19 restrictions has made it difficult for patients to visit the clinics, which has led to increased emergency room visits. Telemedicine awareness was found to be limited; however, many patients were willing to adopt it provided their limitations could be overcome.
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Affiliation(s)
- Mustajab Mujtaba
- National Institute of Cardiovascular
Diseases, Karachi, Pakistan,Mustajab Mujtaba, National Institute of
Cardiovascular Diseases, A203, Mehran Square, Clifton block 8, Karachi 75530,
Pakistan.
| | - Sapna Kotwani
- National Institute of Cardiovascular
Diseases, Karachi, Pakistan
| | - Danish Qayyum
- National Institute of Cardiovascular
Diseases, Karachi, Pakistan
| | - Tahir Saghir
- National Institute of Cardiovascular
Diseases, Karachi, Pakistan
| | | | | | | | - Saba Aman
- Dr. Ruth K.M. Pfau Civil Hospital
Karachi, Karachi, Pakistan
| | | | | | - Musa Karim
- National Institute of Cardiovascular
Diseases, Karachi, Pakistan
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Basch C, Ferguson JM, Van Campen J, Slightam C, Jacobs JC, Heyworth L, Zulman D. Overcoming Access Barriers for Veterans: Cohort Study of the Distribution and Use of Veterans Affairs' Video-Enabled Tablets Before and During the COVID-19 Pandemic. J Med Internet Res 2023; 25:e42563. [PMID: 36630650 PMCID: PMC9912147 DOI: 10.2196/42563] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/11/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, as health care services shifted to video- and phone-based modalities for patient and provider safety, the Veterans Affairs (VA) Office of Connected Care widely expanded its video-enabled tablet program to bridge digital divides for veterans with limited video care access. OBJECTIVE This study aimed to characterize veterans who received and used US Department of VA-issued video-enabled tablets before versus during the COVID-19 pandemic. METHODS We compared sociodemographic and clinical characteristics of veterans who received VA-issued tablets during 6-month prepandemic and pandemic periods (ie, from March 11, 2019, to September 10, 2019, and from March 11, 2020, to September 10, 2020). Then, we examined characteristics associated with video visit use for primary and mental health care within 6 months after tablet shipment, stratifying models by timing of tablet receipt. RESULTS There was a nearly 6-fold increase in the number of veterans who received tablets in the pandemic versus prepandemic study periods (n=36,107 vs n=6784, respectively). Compared to the prepandemic period, tablet recipients during the pandemic were more likely to be older (mean age 64 vs 59 years), urban-dwelling (24,504/36,107, 67.9% vs 3766/6784, 55.5%), and have a history of housing instability (8633/36,107, 23.9% vs 1022/6784, 15.1%). Pandemic recipients were more likely to use video care (21,090/36,107, 58.4% vs 2995/6784, 44.2%) and did so more frequently (5.6 vs 2.3 average encounters) within 6 months of tablet receipt. In adjusted models, pandemic and prepandemic video care users were significantly more likely to be younger, stably housed, and have a mental health condition than nonusers. CONCLUSIONS Although the COVID-19 pandemic led to increased distribution of VA-issued tablets to veterans with complex clinical and social needs, tablet recipients who were older or unstably housed remained less likely to have a video visit. The VA's tablet distribution program expanded access to video-enabled devices, but interventions are needed to bridge disparities in video visit use among device recipients.
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Affiliation(s)
| | - Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - James Van Campen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Josephine C Jacobs
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth Services, Veterans Health Administration, Washington, DC, United States.,Department of Medicine, University of California San Diego Health System, San Diego, CA, United States
| | - Donna Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
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Curran VR, Hollett A, Peddle E. Virtual care and COVID-19: A survey study of adoption, satisfaction and continuing education preferences of healthcare providers in Newfoundland and Labrador, Canada. Front Digit Health 2023; 4:970112. [PMID: 36761449 PMCID: PMC9905429 DOI: 10.3389/fdgth.2022.970112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/30/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Virtual care has expanded during COVID-19 and enabled continued access to healthcare services. For many healthcare providers, the adoption of virtual care has been a new experience in the provision of healthcare services. The purpose of this survey study was to explore healthcare providers' experiences with virtual care during COVID-19. Methods A web-based survey-questionnaire was developed by applying Rogers' theory of diffusion of innovation and distributed to healthcare providers (physicians, nurses and allied health professionals) in Newfoundland and Labrador, Canada to explore virtual care experiences, satisfaction and continuing professional development (CPD) needs. Analyses included descriptive statistics and thematic analysis of survey responses. Results Fifty-one percent of respondents (n = 432) indicated they were currently offering virtual care and a majority (68.9%) reported it has improved their work experience. Telephone appointments were preferred over videoconferencing by respondents, with key challenges including the inability to conduct a physical exam, patients' cell phone services being unreliable and patients knowing how to use videoconferencing. Majority of respondents (57.5%) reported quality of care by telephone was lower than in-person, whereas quality of care by videoconferencing was equivalent to in-person. Main benefits of virtual care included increased patient access, ability to work from home, and reduction in no-show appointments. Key supports for adopting virtual care included in-house organizational supports (e.g., technical support staff), local colleague support, and technology training. Important topics for virtual care CPD included complying with regulatory standards/rules, understanding privacy or ethical boundaries, and developing competency and digital professionalism while engaging in virtual care. Discussion Beyond the COVID-19 pandemic, virtual care will have a continuing role in enhancing continuity of care through access that is more convenient. Survey findings reveal a number of opportunities for supporting healthcare providers in use of virtual care, including CPD, guidelines and resources to support adaptation to virtual care provision (e.g., virtual examinations/assessments), as well as patient educational support.
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50
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Hansen MA, Chen R, Hirth J, Langabeer J, Zoorob R. Impact of COVID-19 lockdown on patient-provider electronic communications. J Telemed Telecare 2023:1357633X221146810. [PMID: 36659875 PMCID: PMC9892807 DOI: 10.1177/1357633x221146810] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/30/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND SARS CoV-2 virus (COVID-19) impacted the practice of healthcare in the United States, with technology being used to facilitate access to care and reduce iatrogenic spread. Since then, patient message volume to primary care providers has increased. However, the volume and trend of electronic communications after lockdown remain poorly described in the literature. METHODS All incoming inbox items (telephone calls, refill requests, and electronic messages) sent to providers from patients amongst four primary care clinics were collected. Inbox item rates were calculated as a ratio of items per patient encountered each week. Trends in inbox rates were assessed during 12 months before and after lockdown (March 1st, 2020). Logistic regression was utilized to examine the effects of the lockdown on inbox item rate post-COVID-19 lockdown as compared to the pre-lockdown period. RESULTS Before COVID-19 lockdown, 2.07 new inbox items per encounter were received, which increased to 2.83 items after lockdown. However, only patient-initiated electronic messages increased after lockdown and stabilized at a rate higher than the pre-COVID-19 period (aRR 1.27, p-value < 0.001). In contrast, prescription refill requests and telephone calls quickly spiked, then returned to pre-lockdown levels. CONCLUSION Based on our observations, providers experienced a quick increase in all inbox items. However, only electronic messages had a sustained increase, exacerbating the workload of administrators, staff, and clinical providers. This study directly correlates healthcare technology adoption to a significant disruptive event but also shows additional challenges to the healthcare system that must be considered with these changes.
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Affiliation(s)
- Michael A. Hansen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Health Management and Policy, University of Texas School of Biomedical Informatics, Houston, TX, USA
| | - Rebecca Chen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jacqueline Hirth
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James Langabeer
- Department of Health Management and Policy, University of Texas School of Biomedical Informatics, Houston, TX, USA
| | - Roger Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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