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Tolu-Akinnawo O, Ezekwueme F, Awoyemi T. Telemedicine in Cardiology: Enhancing Access to Care and Improving Patient Outcomes. Cureus 2024; 16:e62852. [PMID: 38912070 PMCID: PMC11192510 DOI: 10.7759/cureus.62852] [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: 06/21/2024] [Indexed: 06/25/2024] Open
Abstract
Telemedicine has gained significant recognition, particularly since the COVID-19 pandemic. However, its roots date back to its significant role during major epidemic outbreaks such as severe acute respiratory syndrome (SARS), H1N1 and H7N9 influenza, and Middle East respiratory syndrome (MERS), where alternate means of accessing healthcare were adopted to combat the outbreak while limiting the spread of the virus. In Sub-Saharan Africa, telemedicine has supported healthcare delivery, patient and professional health education, disease prevention, and surveillance, starting with its first adoption in Ethiopia in 1980. In the United States, telemedicine has significantly impacted cardiology, particularly at-home monitoring programs, which have proven highly effective for patients with abnormal heart rhythms. Devices such as Holter monitors, blood pressure monitors, and implantable cardioverter-defibrillators have reduced mortality rates and hospital readmissions while improving healthcare efficiency by saving healthcare costs. However, the COVID-19 pandemic accelerated the adoption of telemedicine, as evidenced by a dramatic increase in telemedicine visits at institutions like New York University (NYU) Langone Health during and post-COVID-19 pandemic. In addition, telemedicine has also facilitated cardiac rehabilitation and improved access to specialized cardiology care in rural and underserved areas, reducing disparities in cardiovascular health outcomes. As technology advances, telemedicine is poised to play an increasingly significant role in cardiology and healthcare at large, enhancing patient management, healthcare efficiency, and cost reduction. This review underscores the significance of telemedicine in cardiology, its challenges, and future directions.
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Affiliation(s)
| | - Francis Ezekwueme
- Internal Medicine, University of Pittsburgh Medical Center, Pittsburg, USA
| | - Toluwalase Awoyemi
- Internal Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, GBR
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Cuadros DF, Huang Q, Mathenjwa T, Gareta D, Devi C, Musuka G. Unlocking the potential of telehealth in Africa for HIV: opportunities, challenges, and pathways to equitable healthcare delivery. Front Digit Health 2024; 6:1278223. [PMID: 38500968 PMCID: PMC10944905 DOI: 10.3389/fdgth.2024.1278223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- Diego F. Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, United States
| | - Qian Huang
- Center for Rural Health Research, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Thulile Mathenjwa
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Chayanika Devi
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, United States
| | - Godfrey Musuka
- International Initiative for Impact Evaluation, Harare, Zimbabwe
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Blocker A, Datay MI, Mwangama J, Malila B. Development of a telemedicine virtual clinic system for remote, rural, and underserved areas using user-centered design methods. Digit Health 2024; 10:20552076241256752. [PMID: 38812852 PMCID: PMC11135119 DOI: 10.1177/20552076241256752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/07/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Virtual clinics are an emerging form of telemedicine which can positively impact healthcare accessibility in remote, rural, and underserved areas. However, a virtual clinic system for these contexts must be designed appropriately. The user-centered design method can be employed to develop an appropriate virtual clinic. Methods The development of the virtual clinic used the user-centered design method. First, a situational analysis was conducted to understand the context of public primary healthcare facilities in South Africa. Literature review, observations, and interviews were conducted, which then informed system requirements. A virtual clinic system was then developed and its usability was evaluated with doctors and nurses in a lab setting using healthy participants acting as patients. Doctors and nurses completed system usability scale surveys and provided interview feedback. Results The situational analysis revealed 10 key themes which were translated into a problem statement and 10 system requirements. A virtual clinic system was then developed based on these requirements. 5 doctors and 11 nurses were recruited to complete usability testing with the system. The system received an average of 80.6 scores (good to excellent) out of 100 on the system usability scale. Feedback from participants revealed key areas for improvement of the virtual clinic system, as well as opportunities for further implementation. Conclusion The developed virtual clinic system demonstrated the application of the user-centered design method to telemedicine technologies for remote, rural, and underserved areas. The positive feedback received from the participants demonstrated the importance of the user-centered design method in developing technologies for enhancing service delivery in health systems. Further work will implement this system in real-world clinical settings.
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Affiliation(s)
- Abby Blocker
- Division of Biomedical Engineering, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mohammed Ishaaq Datay
- Department of Electrical Engineering, University of Cape Town, Cape Town, South Africa
| | - Joyce Mwangama
- Directorate of Primary Health Care, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bessie Malila
- Division of Biomedical Engineering, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Marawar R. Seizure Safari: Bridging the Treatment Gap in Rural Tanzania and Shaking Up Epilepsy Care. Epilepsy Curr 2023; 23:238-240. [PMID: 37662456 PMCID: PMC10470108 DOI: 10.1177/15357597231175008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Does the Presence of a Specialist Doctor Reduce the Burden of Disease in People With Epilepsy in Low-Resource Settings? A Comparison of Two Epilepsy Clinics in Rural Tanzania Klein A, Berger TC, Hapfelmeier A, Schaffert M, Matuja W, Schmutzhard E, Winkler AS. Epilepsy Behav. 2023;139:109030. doi:10.1016/j.yebeh.2022.109030 Background: With an estimated lifetime prevalence of epilepsy of 7.6 per 1,000 people, epilepsy represents one of the most common neurological disorders worldwide, with the majority of people with epilepsy (PWE) living in low-income and middle-income countries (LMICs). Adequately treated, up to 70% of PWE will become seizure-free, however, as many as 85% of PWE worldwide, mostly from LMICs, do not receive adequate treatment. Objective: To assess the impact of the presence of a neurologist on the management of PWE in Tanzania. Methods: Two epilepsy clinics in rural Tanzania, one continuously attended by a neurologist, and one mainly attended by nurses with training in epilepsy and supervised intermittently by specialist doctors (neurologists/psychiatrists) were comparatively analyzed by multivariable linear and logistic regression models with regard to the outcome parameters seizure frequency, the occurrence of side effects of antiepileptic medication and days lost after a seizure. Results: The presence of a neurologist significantly reduced the mean number of seizures patients experienced per month by 4.49 seizures (p < 0.01) while leading to an increase in the occurrence of reported side effects (OR: 2.15, p = 0.02). Conclusion: The presence of a neurologist may play a substantial role in reducing the burden of the disease of PWE in LMICs. Hence, specialist training should be encouraged, and relevant context-specific infrastructure established.
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El Tantawi M, Lam WYH, Giraudeau N, Virtanen JI, Matanhire C, Chifamba T, Sabbah W, Gomaa N, Al-Maweri SA, Uribe SE, Mohebbi SZ, Hasmun N, Guan G, Polonowita A, Khan SB, Pisano M, Ellakany P, Baraka MM, Ali AA, Orellana Centeno JE, Pavlic V, Folayan MO. Teledentistry from research to practice: a tale of nineteen countries. FRONTIERS IN ORAL HEALTH 2023; 4:1188557. [PMID: 37397348 PMCID: PMC10311964 DOI: 10.3389/froh.2023.1188557] [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: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Aim The COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries. Methods Data were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe. Results Ten (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national (n = 5), intermediate (provincial) (n = 4) and local (n = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries. Conclusion Despite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry.
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Affiliation(s)
- Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Walter Yu Hang Lam
- Prosthodontics, Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | | | - Jorma I. Virtanen
- Institute of Dentistry, Faculty of Medicine, University of Turku, Turku, Finland
| | - Cleopatra Matanhire
- Department of Oral Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Timothy Chifamba
- Department of Oral Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Wael Sabbah
- Centre for Host Microbiome Interactions, King’s College London, London, United Kingdom
| | - Noha Gomaa
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Sadeq Ali Al-Maweri
- Department of Pre-Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - Sergio E. Uribe
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia
- School of Dentistry, Universidad Austral de Chile, Valdivia, Chile
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Riga, Latvia
| | - Simin Z. Mohebbi
- Research Center for Caries Prevention, Dentistry Research Institute, and Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Noren Hasmun
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Guangzhao Guan
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Ajith Polonowita
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Sadika Begum Khan
- Department of Prosthetic Dentistry, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
| | - Massimo Pisano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Passent Ellakany
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marwa Mohamed Baraka
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | | | | | - Verica Pavlic
- Department of Periodontology and Oral Medicine, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
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Carey N, Abathun E, Maguire R, Wodaje Y, Royce C, Ayers N. Co-design and prototype development of the 'Ayzot App': A mobile phone based remote monitoring system for palliative care. Palliat Med 2023; 37:771-781. [PMID: 37002562 DOI: 10.1177/02692163231162408] [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: 05/30/2023]
Abstract
BACKGROUND Palliative care, a recognised component of care by the World Health Organization is poorly developed in low- and middle-income countries. Mobile phone technology, an effective way to increase access and sustainability of healthcare systems globally, has demonstrated benefits within palliative care service delivery, but is yet to be utilised in Ethiopia. AIM To co-design, develop and evaluate a mobile phone based remote monitoring system for use by palliative care patients in Ethiopia. DESIGN Two-phase co-design approach comprising multiple methods that is stakeholder interviews, focus groups, user-co-creation activities and healthcare worker prioritisation discussions 2019-2020. Phase-1 interviews (n = 40), Phase-2 focus groups (n = 3) and interviews (n = 10). SETTING/PARTICIPANTS Hospice Ethiopia and Yekatit 12 Medical College Hospital: healthcare workers, palliative care patients, family carers & software-developers. RESULTS Co-design activities lead to development of the prototype 'Ayzot' application, which was well received and reported to be easy to use. Patients, and family caregivers saw provision of self-care information and symptom management as a key function of the App and expressed very positive attitudes towards such information being included. Healthcare workers found the App offered service benefits, in terms of time and cost-savings. CONCLUSION This paper provides a detailed example of the development and design of a prototype remote monitoring system using mobile phone technology for palliative care use in Ethiopia. Further development and real-world testing are required, to not only understand how it acts within usual care to deliver anticipated benefits but also to explore its effectiveness and provide cost estimates for wider implementation.
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Affiliation(s)
- Nicola Carey
- Department of Nursing and Midwifery, University of the Highlands and Islands, UK
| | | | - Roma Maguire
- Digital Health and Care and Research, University of Strathclyde, UK
| | | | | | - Nicola Ayers
- Palliative Care Advisor, Ministry of Health, Ethiopia
- School of Nursing, BPP University, Waterloo, London, UK
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Onsongo S, Kamotho C, Rinke de Wit TF, Lowrie K. Experiences on the Utility and Barriers of Telemedicine in Healthcare Delivery in Kenya. Int J Telemed Appl 2023; 2023:1487245. [PMID: 37180825 PMCID: PMC10171985 DOI: 10.1155/2023/1487245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/19/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Telemedicine is the provision of health services over a distance using information communication technology devices. Telemedicine is emerging as a promising component of healthcare care delivery worldwide, accelerated by the COVID-19 pandemic. This study assessed the factors promoting uptake, barriers, and opportunities for telemedicine among doctors in Kenya. Methodology. A semiquantitative, cross-sectional online survey was conducted among doctors in Kenya. During a month, between February and March 2021, 1,200 doctors were approached by email and WhatsApp, of whom 13% responded. Findings. A total of 157 interviewees participated in the study. The general usage of telemedicine was 50%. Seventy-three percent of doctors reported using a mix of in-person care and telemedicine. Fifty percent reported using telemedicine to support physician-to-physician consultations. Telemedicine had limited utility as a standalone clinical service. The inadequate information communication technology infrastructure was the most reported barrier to telemedicine, followed by a cultural resistance to using technology to deliver healthcare services. Other notable barriers were the high cost of initial setup limited skills among patients, limited skills among doctors, inadequate funding to support telemedicine services, weak legislative/policy framework, and lack of dedicated time for telemedicine services. The COVID-19 pandemic increased the uptake of telemedicine in Kenya. Conclusion The most extensive use of telemedicine in Kenya supports physician-to-physician consultations. There is limited single use of telemedicine in providing direct clinical services to patients. However, telemedicine is regularly used in combination with in-person clinical services, allowing for continuity of clinical services beyond the physical hospital infrastructure. With the widespread adoption of digital technologies in Kenya, especially mobile telephone technologies, the growth opportunities for telemedicine services are immense. Numerous mobile applications will improve access capabilities for both service providers and users and bridge the gaps in care.
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Affiliation(s)
- Simon Onsongo
- Aga Khan Hospital, Kisumu, Box 530-40100, Kisumu, Kenya
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Abstract
Africa is ecologically sensitive, with vulnerable communities which are at particular risk of the associations and impacts of climate change. Serious climatic events can result in traumatic stress, developing into chronic psychopathological and psychiatric patterns. Nonetheless, there remains a lack of psychiatric studies on mental disorders associated with climate change within the African context. There is a need in Africa for robust complex adaptive integrated research concerning climate change impacts and associations on and with mental health and healthcare systems, policy and practice, so that relevant interventions may be implemented and strengthened.
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Affiliation(s)
- Monika Dos Santos
- Department of Psychology, University of South Africa, Pretoria, South Africa
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