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Praha N, Sriyuktasuth A, Puwarawuttipanit W, Chuengsaman P, Kusakunniran W. Factors Influencing Telehealth Service Use and Health Outcomes in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Cross-Sectional Study. J Med Internet Res 2023; 25:e48623. [PMID: 38051557 PMCID: PMC10731559 DOI: 10.2196/48623] [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: 05/01/2023] [Revised: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Several studies have demonstrated the efficacy and user acceptance of telehealth in managing patients with chronic conditions, including continuous ambulatory peritoneal dialysis (CAPD). However, the rates of telehealth service use in various patient groups have been low and have declined over time, which may affect important health outcomes. Telehealth service use in patients undergoing CAPD has been recognized as a key challenge that needs to be examined further. OBJECTIVE This study aimed to explore the rates of telehealth service use over 4 months, identify factors influencing its use, and examine the relationship between telehealth service use and health outcomes in Thai people undergoing CAPD. METHODS This cross-sectional study, which was a part of a pragmatic randomized controlled trial study, was conducted at a dialysis center in Bangkok, Thailand. The study included patients who were undergoing CAPD. These patients were randomly enrolled in the intervention group to receive telehealth service and additional standard care for 4 months. Data were collected using self-reported questionnaires, including a demographic form, Functional, Communicative, and Critical Health Literacy Scale, Perceived Usefulness Questionnaire, Brief Illness Perception Questionnaire, Patient-Doctor Relationship Questionnaire, and Kidney Disease Quality of Life 36 Questionnaire. Additionally, Google Analytics was used to obtain data on the actual use of the telehealth service. These data were analyzed using descriptive statistics, repeated-measures ANOVA, and regression analyses. RESULTS A total of 159 patients were included in this study. The mean rate of telehealth service use throughout the period of 4 months was 62.06 (SD 49.71) times. The rate of telehealth service use was the highest in the first month (mean 23.48, SD 16.28 times) and the lowest in the third month (mean 11.09, SD 11.48 times). Independent variables explained 27.6% of the sample variances in telehealth service use. Older age (β=.221; P=.002), higher perceived usefulness (β=.414; P<.001), unemployment (β=-.155; P=.03), and positive illness perception (β=-.205; P=.004) were associated with a significantly higher rate of telehealth service use. Regarding the relationship between telehealth service use and health outcomes, higher rates of telehealth service use were linked to better quality of life (β=.241; P=.002) and lower peritonitis (odds ratio 0.980, 95% CI 0.962-0.997; P=.03). CONCLUSIONS This study provides valuable insights into factors impacting telehealth service use, which in turn affect health outcomes in patients undergoing CAPD.
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Affiliation(s)
- Nattaya Praha
- Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | | | | | - Worapan Kusakunniran
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, Thailand
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Durante-Mangoni E, Riccardi A, Guarino M, Cesaro F, Lugarà M, Mascolo S, Morelli L, Natale V, Andreoni M. Emergency department care of ABSSSI with dalbavancin infusion, direct discharge, and outpatient telemedicine follow up: a study protocol. J Chemother 2023; 35:397-403. [PMID: 36264157 DOI: 10.1080/1120009x.2022.2134616] [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: 12/30/2021] [Revised: 08/05/2022] [Accepted: 10/06/2022] [Indexed: 10/24/2022]
Abstract
Novel therapeutic strategies such as the long-acting lipoglycopeptide antibiotics allow for the treatment and discharge of selected emergency department (ED) patients with Acute Bacterial Skin and Skin Structure Infections (ABSSSI), who require intravenous antibiotics and would otherwise be hospitalized. The COVID-19 pandemic highlighted the need to develop strategies that may reduce hospitalization. The telehealth approach has shown success in remote management of cellulitis patients and could aid in the remote follow up of overall ABSSSI patients. This article describes a study protocol for the telemedicine follow up of patients diagnosed with ABSSSI in the ED, requiring intravenous treatment, receiving a single dalbavancin dose, and directly discharged. A telehealth system for remote follow up is evaluated as well as the possible inclusion of point-of-care ultrasound for the appropriate diagnosis of ABSSSI. The study will be conducted in compliance with regulatory requirements; and all collected data will be kept strictly confidential and in accordance with all relevant legislation on the control and protection of personal information. Dissemination of the study protocol may help increasing knowledge and awareness on this topic, with the aim of optimizing patient management, reducing hospitalization and lower the impact on healthcare associated costs.
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Affiliation(s)
- Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli" and Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Napoli, Italy
| | | | - Mario Guarino
- Unit of Emergency Medicine, Ospedale CTO, A.O.R.N. Ospedali dei Colli, Napoli, Italy
| | - Flavio Cesaro
- Unit of Emergency Medicine, Ospedale CTO, A.O.R.N. Ospedali dei Colli, Napoli, Italy
| | - Marina Lugarà
- Unit of General Medicine, Ospedale del Mare, ASL Napoli 1 Centro, Napoli, Italy
| | - Silvia Mascolo
- Unit of Immunodeficiency and Gender Infectious Diseases, A.O.R.N. Ospedali dei Colli - Ospedale Cotugno, Napoli, Italy
| | - Lucia Morelli
- Unit of Emergency Medicine, Ospedale San Paolo, ASL Napoli 1 Centro, Napoli, Italy
| | - Vincenzo Natale
- Unit of Emergency Medicine, ASP Vibo Valenzia, and SIMEU Calabria, Vibo Valentia, Italy
| | - Massimo Andreoni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Infectious Diseases Unit, University Hospital "Tor Vergata", Roma, Italy
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Zhang A, Spiegel T, Bundy A, Sullivan K, Green G, Chia S, Krishnamurthy R, Press VG. Evaluation of a transitions clinic to bridge emergency department and primary care. J Hosp Med 2023; 18:217-223. [PMID: 36737107 DOI: 10.1002/jhm.13056] [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: 09/14/2022] [Revised: 12/15/2022] [Accepted: 01/01/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Suboptimal transitions from the emergency department (ED) to ambulatory settings contribute to poor clinical outcomes and unnecessary nonurgent ED utilization. Care transition clinics (CTCs) are a potential solution by providing ED follow-up and facilitating the bridge to longer-term primary care. OBJECTIVE The objective was to evaluate the implementation of an ED transitions clinic on 30-day ED revisits and hospital readmissions. DESIGNS Retrospective cross-sectional study. SETTINGS AND PARTICIPANTS This study included adults 18 years and older discharged from the ED and reeferred to the CTC. MAIN OUTCOME AND MEASURES Appointment attendance, follow-up time, and frequencies of care type provided were computed to assess clinic utilization. Rates of 30-day ED revisit and hospital admission were compared between completed and missed appointments using logistic regression. RESULTS Between March 2021 and March 2022, 373 patients were referred to the CTC totaling 405 appointments. Half (53%) of appointments were completed with a median follow-up time of 4 days (IQR = [2, 7]). The most common care types provided were wound care (44%) and clinical problem management (33%), with wound care appointments more likely to be completed compared with clinical appointments (OR = 1.7, CI = [1.1, 2.8], p = .03). Patients who completed their CTC appointment were 50% less likely to return to the ED in 30 days compared with those who did not complete their appointment (OR = 0.51, CI = [0.27, 0.98], p < .05). No effect was seen for CTC appointment completion on hospital readmission. Transition clinics are a viable method to provide timely access to follow-up for patients discharged from the ED and may help reduce excess ED use for ambulatory care needs.
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Affiliation(s)
- Amanda Zhang
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Thomas Spiegel
- Department of Emergency Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Andrea Bundy
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kate Sullivan
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
| | - Geneatra Green
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
| | - Stephanie Chia
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Valerie G Press
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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Espinera AR, Mycyk MB. Clinical pathways linking antibiotics to follow-up care can reduce hospital admissions. Acad Emerg Med 2021; 28:1204-1205. [PMID: 34038013 DOI: 10.1111/acem.14304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Alyssa R. Espinera
- Louisiana State University Health Sciences Center New Orleans Louisiana USA
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Koziatek CA, Rubin A, Lakdawala V, Lee DC, Swartz J, Auld E, Smith SW, Reddy H, Jamin C, Testa P, Femia R, Caspers C. Assessing the Impact of a Rapidly Scaled Virtual Urgent Care in New York City During the COVID-19 Pandemic. J Emerg Med 2020; 59:610-618. [PMID: 32737005 PMCID: PMC7290166 DOI: 10.1016/j.jemermed.2020.06.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The coronavirus disease (COVID)-19 pandemic quickly challenged New York City health care systems. Telemedicine has been suggested to manage acute complaints and divert patients from in-person care. OBJECTIVES The objective of this study was to describe and assess the impact of a rapidly scaled virtual urgent care platform during the COVID-19 pandemic. METHODS This was a retrospective cohort study of all patients who presented to a virtual urgent care platform over 1 month during the COVID-19 pandemic surge. We described scaling our telemedicine urgent care capacity, described patient clinical characteristics, assessed for emergency department (ED) referrals, and analyzed postvisit surveys. RESULTS During the study period, a total of 17,730 patients were seen via virtual urgent care; 454 (2.56%) were referred to an ED. The most frequent diagnoses were COVID-19 related or upper respiratory symptoms. Geospatial analysis indicated a wide catchment area. There were 251 providers onboarded to the platform; at peak, 62 providers supplied 364 h of coverage in 1 day. The average patient satisfaction score was 4.4/5. There were 2668 patients (15.05%) who responded to the postvisit survey; 1236 (49.35%) would have sought care in an ED (11.86%) or in-person urgent care (37.49%). CONCLUSIONS A virtual urgent care platform was scaled to manage a volume of more than 800 patients a day across a large catchment area during the pandemic surge. About half of the patients would otherwise have presented to an ED or urgent care in person. Virtual urgent care is an option for appropriate patients while minimizing in-person visits during the COVID-19 pandemic.
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Affiliation(s)
- Christian A Koziatek
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Ada Rubin
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Viraj Lakdawala
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York; Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Jordan Swartz
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Elizabeth Auld
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Silas W Smith
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York; Institute for Innovations in Medical Education, New York University School of Medicine, New York, New York
| | - Harita Reddy
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Catherine Jamin
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Paul Testa
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Robert Femia
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Christopher Caspers
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
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