1
|
Aggelidis X, Kritikou M, Makris M, Miligkos M, Papapostolou N, Papadopoulos NG, Xepapadaki P. Tele-Monitoring Applications in Respiratory Allergy. J Clin Med 2024; 13:898. [PMID: 38337592 PMCID: PMC10856055 DOI: 10.3390/jcm13030898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Respiratory allergic diseases affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resources, and shortages of allergy specialists in underserved areas impede effective management. Telemedicine encompasses real-time visits, store-and-forward option triage, and computer-based technologies for establishing efficient doctor-patient communication. Recent advances in digital technology, including designated applications, informative materials, digital examination devices, wearables, digital inhalers, and integrated platforms, facilitate personalized and evidence-based care delivery. The integration of telemonitoring in respiratory allergy care has shown beneficial effects on disease control, adherence, and quality of life. While the COVID-19 pandemic accelerated the adoption of telemedicine, certain concerns regarding technical requirements, platform quality, safety, reimbursement, and regulatory considerations remain unresolved. The integration of artificial intelligence (AI) in telemonitoring applications holds promise for data analysis, pattern recognition, and personalized treatment plans. Striking the balance between AI-enabled insights and human expertise is crucial for optimizing the benefits of telemonitoring. While telemonitoring exhibits potential for enhancing patient care and healthcare delivery, critical considerations have to be addressed in order to ensure the successful integration of telemonitoring into the healthcare landscape.
Collapse
Affiliation(s)
- Xenofon Aggelidis
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Maria Kritikou
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Michael Miligkos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Niki Papapostolou
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| |
Collapse
|
2
|
Esposito S, Rosafio C, Antodaro F, Argentiero A, Bassi M, Becherucci P, Bonsanto F, Cagliero A, Cannata G, Capello F, Cardinale F, Chiriaco T, Consolaro A, Dessì A, Di Mauro G, Fainardi V, Fanos V, Guarino A, Li Calzi G, Lodi E, Maghnie M, Manfredini L, Malorgio E, Minuto N, Modena MG, Montori R, Moscatelli A, Patrone E, Pescio E, Poeta M, Ravelli A, Spelta M, Suppiej A, Vai S, Villa L, Zanini R, Botti R, Gaddi AV. Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF). J Pers Med 2023; 13:jpm13020235. [PMID: 36836469 PMCID: PMC9965862 DOI: 10.3390/jpm13020235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens.
Collapse
Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | | | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | | | | | | | - Giulia Cannata
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Fabio Capello
- UO Territorial Pediatrics, Primary Care Department, AUSL Bologna, 40126 Bologna, Italy
| | - Fabio Cardinale
- UOC of Pediatrics and ED with an Allergy-Pneumological and Immuno-Rheumatological Focus, Giovanni XXIII Pediatric Hospital, University of Bari, 70124 Bari, Italy
| | - Tiziana Chiriaco
- Health Department, ASL Roma 3, 00125 Rome, Italy
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Consolaro
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Angelica Dessì
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | | | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giada Li Calzi
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Lodi
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Manfredini
- Pediatric Pain and Palliative Care Service, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Nicola Minuto
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Maria Grazia Modena
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Rossano Montori
- Community Medicine and Primary Care, AUSL Modena, 41124 Modena, Italy
| | - Andrea Moscatelli
- UOC Anesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Patrone
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Elena Pescio
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Marco Poeta
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maddalena Spelta
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Agnese Suppiej
- Pediatric Clinic, University of Ferrara, 44124 Ferrara, Italy
| | | | - Luca Villa
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | | | - Renato Botti
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Antonio Vittorino Gaddi
- Center for Metabolic Diseases and Atherosclerosis, University of Bologna, 40126 Bologna, Italy
| |
Collapse
|
3
|
Collins-Fairclough A, Barn P, Hirsch-Allen AJ, Rideout K, Shellington EM, Lo W, Lanier T, Johnson J, Butcher A, Cheong SH, Rempel C, Strydom N, Camp PG, Carlsten C. Disparities in self-reported healthcare access for airways disease in British Columbia, Canada, during the COVID-19 pandemic. Insights from a survey co-developed with people living with asthma and chronic obstructive pulmonary disease. Chron Respir Dis 2023; 20:14799731231172518. [PMID: 37171831 PMCID: PMC10184213 DOI: 10.1177/14799731231172518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Patients' perspectives on the impact of the COVID-19 pandemic on their access to asthma and COPD healthcare could inform better, more equitable care delivery. We demonstrate this topic using British Columbia (BC), Canada, where the impact of the pandemic has not been described. We co-designed a cross-sectional survey with patient partners and administered it to a convenience sample of people living with asthma and COPD in BC between September 2020 and March 2021. We aimed to understand how access to healthcare for these conditions was affected during the pandemic. The survey asked respondents to report their characteristics, access to healthcare for asthma and COPD, types of services they found disrupted and telehealth (telephone or video appointment) use during the pandemic. We analysed 433 responses and found that access to healthcare for asthma and COPD was lower during the pandemic than pre-pandemic (p < 0.001). Specialty care services were most frequently reported as disrupted, while primary care, home care and diagnostics were least disrupted. Multivariable logistic regression revealed that access during the pandemic was positively associated with self-assessed financial ability (OR = 22.0, 95% CI: 7.0 - 84.0, p < 0.001, reference is disagreeing with having financial ability) and living in medium-sized urban areas (OR = 2.3, 95% CI: 1.0 - 5.2, p = 0.04, reference is rural areas). These disparities in access should be validated post-pandemic to confirm whether they still persist. They also indicate the continued relevance of exploring approaches for more equitable healthcare.
Collapse
Affiliation(s)
- Aneisha Collins-Fairclough
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Division of Respiratory Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Prabjit Barn
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - A J Hirsch-Allen
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Division of Respiratory Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karen Rideout
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Erin M Shellington
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Division of Respiratory Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Winnie Lo
- Legacy for Airway Health, Community Stakeholder Committee, Vancouver, BC, Canada
| | - Tony Lanier
- Legacy for Airway Health, Community Stakeholder Committee, Vancouver, BC, Canada
| | - Jim Johnson
- Legacy for Airway Health, Community Stakeholder Committee, Vancouver, BC, Canada
| | - Adam Butcher
- Legacy for Airway Health, Community Stakeholder Committee, Vancouver, BC, Canada
| | - Sian-Hoe Cheong
- Legacy for Airway Health, Community Stakeholder Committee, Vancouver, BC, Canada
| | | | - Nardia Strydom
- Department of Family Medicine, Providence Health Care, Vancouver, BC, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Family and Community Medicine, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Pat G Camp
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Centre for Heart and Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Carlsten
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Division of Respiratory Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
4
|
Cerci P, Kendirlinan R, Dalgıç CT. The perspective of allergy and immunology specialists on the innovations of metaverse: A survey study. Allergol Immunopathol (Madr) 2023; 51:186-193. [PMID: 37169577 DOI: 10.15586/aei.v51i3.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/15/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND New technologies have resulted in dramatic shifts in the field of medicine, and it stands to reason that metaverse will also affect the practice of allergy and immunology. This study aimed to determine the attitudes of allergists and raise awareness about metaverse applications in allergy and immunology. METHODS A nationwide survey-based study was conducted in Turkey. First, a 28-item questionnaire was developed and sent to Turkish allergists. After completing the first questionnaire, the participants were asked to watch a 5-min informative video about the metaverse. Lastly, a second survey was conducted to evaluate the changes in the views of the participants. RESULTS A total of 148 allergy doctors in Turkey participated in the survey. After watching a video containing updated information about the metaverse, there was a significant increase in the importance that participants attributed to the use of virtual reality and augmented reality applications in the field of immunology and allergy (P < 0.05). Additionally, there was a significant increase in the percentage of participants who thought that Metaverse applications could be integrated into the existing system and said that this possibility excited them (P < 0.05). There was also a significant increase in the percentage of participants who thought this innovative technology could be helpful in patient examination, student and physician education, allergy testing, and patient education (P < 0.05). CONCLUSIONS Our results demonstrate that providing information to professionals working in the field can positively influence physicians' views on the potential of the metaverse, which is a valuable tool in the field of immunology and allergy.
Collapse
Affiliation(s)
- Pamir Cerci
- Division of Immunology and Allergy, Department of Internal Medicine, Eskisehir City Hospital, Eskisehir, Turkey;
| | - Resat Kendirlinan
- Division of Immunology and Allergy, Department of Chest Diseases, Izmir Atatürk Education and Research Hospital, Izmir, Turkey
| | - Ceyda Tunakan Dalgıç
- Division of Immunology and Allergy, Department of Internal Medicine, Ege University Medical Faculty, Izmir, Turkey
| |
Collapse
|
5
|
Ong KY, Tiew PY, Koh MS. Managing adult asthma during the COVID-19 pandemic: A 2022 review and current recommendations. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022. [DOI: 10.47102/annals-acadmedsg.202285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: This review aims to examine asthma management during the COVID-19 pandemic.
Method: Relevant recommendations and articles were identified by respiratory professional societies and PubMed search using the terms “asthma” and “COVID-19”, and examined for relevance and inclusion in this study.
Results: Recommendations for the management of asthma have remained similar but are now supported by new evidence between the years 2020 and 2022. Patients with well-controlled, mild-to-moderate asthma are unlikely to be at increased risk of acquiring COVID-19 or having worse outcomes from COVID-19. All asthma patients should receive COVID-19 vaccination. Spirometry can be performed with the usual strict infection control procedures unless there is a suspicion of COVID-19. Mask-wearing and other health measures remain important for asthma patients.
Conclusion: While previous recommendations were largely based on expert opinion, the tremendous amount of literature published since the pandemic first emerged 2 years ago has helped guide respiratory professional bodies to update their recommendations. This study provides a timely review of the various recommendations and can be used to guide healthcare professionals in managing asthma patients, as the world prepares for a future with COVID-19 becoming endemic. The long-term consequences of COVID-19 infection in asthma patients and the ripple effects of COVID-19 remain uncertain and deserve ongoing study.
Keywords: Asthma, coronavirus, COVID-19, SARS-CoV-2
Collapse
Affiliation(s)
- Kheng Yong Ong
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Pei Yee Tiew
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| |
Collapse
|
6
|
Gilkey MB, Kong WY, Kennedy KL, Heisler-MacKinnon J, Faugno E, Gwinn B, Wu AC, Loughlin CE, Galbraith AA. Leveraging Telemedicine to Reduce the Financial Burden of Asthma Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2536-2542. [PMID: 35644331 DOI: 10.1016/j.jaip.2022.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
One of the most compelling arguments for telemedicine is its potential to increase health care access by making care more affordable for patients and families, including those affected by asthma. This goal is critically important in the United States, where the high cost of asthma care is associated with nonadherence to preventive care regimens and suboptimal health outcomes. In this clinical commentary review, we draw from the literature and our own research to identify opportunities for and challenges to leveraging telemedicine to reduce the financial burden of asthma care. Our interviews with 42 families affected by asthma during the COVID-19 pandemic suggest that under favorable circumstances, telemedicine can meaningfully reduce costs, including those related to transportation and missed work, while offering high-quality care. However, families also identified ways in which telemedicine can increase costs. For example, some reported reduced access to support services and material resources such as medication samples, which they relied on to manage costs. In this way, our findings underscore the need for careful care coordination and communication in telemedicine. We conclude by discussing the 4Rs, a structured communication approach designed to support cost conversations, increase care coordination, and help families reduce asthma care cost burden.
Collapse
Affiliation(s)
- Melissa B Gilkey
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC.
| | - Wei Yi Kong
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC
| | - Kathryn L Kennedy
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC
| | | | - Elena Faugno
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Barbara Gwinn
- NC Children's Allergy and Asthma Center, UNC Health, Chapel Hill, NC
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Ceila E Loughlin
- NC Children's Allergy and Asthma Center, UNC Health, Chapel Hill, NC; Department of Pediatrics, Division of Pulmonology, University of North Carolina, Chapel Hill, NC
| | - Alison A Galbraith
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| |
Collapse
|
7
|
Eger K, Paroczai D, Bacon A, Schleich F, Sergejeva S, Bourdin A, Vachier I, Zervas E, Katsoulis K, Papapetrou D, Kostikas K, Csoma Z, Heffler E, Canonica GW, Grisle I, Bieksiene K, Palacionyte J, Ten Brinke A, Hashimoto S, Smeenk FWJM, Braunstahl GJ, van der Sar S, Mihălţan F, Nenasheva N, Peredelskaya M, Zvezdin B, Čekerevac I, Hromiš S, Ćupurdija V, Lazic Z, Milenkovic B, Dimic-Janjic S, Yasinska V, Dahlén B, Bossios A, Lazarinis N, Aronsson D, Egesten A, Munir AKM, Ahlbeck L, Janson C, Škrgat S, Edelbaher N, Leuppi J, Jaun F, Rüdiger J, Pavlov N, Gianella P, Fischer R, Charbonnier F, Chaudhuri R, Smith SJ, Doe S, Fawdon M, Masoli M, Heaney L, Haitchi HM, Kurukulaaratchy R, Fulton O, Frankemölle B, Gibson T, Needham K, Howarth P, Djukanovic R, Bel E, Hyland M. The effect of the COVID-19 pandemic on severe asthma care in Europe: will care change for good? ERJ Open Res 2022; 8:00065-2022. [PMID: 35582679 PMCID: PMC8994963 DOI: 10.1183/23120541.00065-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has put pressure on healthcare services, forcing the reorganisation of traditional care pathways. We investigated how physicians taking care of severe asthma patients in Europe reorganised care, and how these changes affected patient satisfaction, asthma control and future care. Methods In this European-wide cross-sectional study, patient surveys were sent to patients with a physician-diagnosis of severe asthma, and physician surveys to severe asthma specialists between November 2020 and May 2021. Results 1101 patients and 268 physicians from 16 European countries contributed to the study. Common physician-reported changes in severe asthma care included use of video/phone consultations (46%), reduced availability of physicians (43%) and change to home-administered biologics (38%). Change to phone/video consultations was reported in 45% of patients, of whom 79% were satisfied or very satisfied with this change. Of 709 patients on biologics, 24% experienced changes in biologic care, of whom 92% were changed to home-administered biologics and of these 62% were satisfied or very satisfied with this change. Only 2% reported worsening asthma symptoms associated with changes in biologic care. Many physicians expect continued implementation of video/phone consultations (41%) and home administration of biologics (52%). Conclusions Change to video/phone consultations and home administration of biologics was common in severe asthma care during the COVID-19 pandemic and was associated with high satisfaction levels in most but not all cases. Many physicians expect these changes to continue in future severe asthma care, though satisfaction levels may change after the pandemic.
Collapse
Affiliation(s)
- Katrien Eger
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Co-first authors
| | - Dora Paroczai
- Csongrad County Hospital and Dept of Pulmonology, University of Szeged, Szeged, Hungary
- Co-first authors
| | - Alison Bacon
- School of Psychology, University of Plymouth, Plymouth, UK
| | | | | | - Arnaud Bourdin
- PhyMedExp, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Isabelle Vachier
- PhyMedExp, CHU Montpellier, University of Montpellier, Montpellier, France
| | | | | | | | | | - Zsuzsanna Csoma
- National Koranyi Institute for Pulmonology, Budapest, Hungary
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital - Rozzano (MI), Italy
- Departmento of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital - Rozzano (MI), Italy
- Departmento of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy
| | | | | | | | | | - Simone Hashimoto
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | - Natalia Nenasheva
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Marina Peredelskaya
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Biljana Zvezdin
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- Medical Faculty Novi Sad, University of Novi Sad, Bucharest, Romania
| | - Ivan Čekerevac
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Dept of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sanja Hromiš
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Vojislav Ćupurdija
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Dept of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Zorica Lazic
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Dept of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Branislava Milenkovic
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade Medical faculty, Belgrade, Serbia
| | - Sanja Dimic-Janjic
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade Medical faculty, Belgrade, Serbia
| | - Valentyna Yasinska
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Barbro Dahlén
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Apostolos Bossios
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Nikolaos Lazarinis
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - David Aronsson
- Respiratory Medicine and Allergology, Dept of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Arne Egesten
- Respiratory Medicine and Allergology, Dept of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Abul Kashem Mohammad Munir
- Respiratory Medicine and Allergology, Dept of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | | | - Christer Janson
- Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sabina Škrgat
- Dept for Pulmonary Diseases, University Medical Centre Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Joerg Leuppi
- Medical Faculty University of Basel and Cantonal Hospital Baselland, Liestal, Switzerland
| | - Fabienne Jaun
- Medical Faculty University of Basel and Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - Nikolay Pavlov
- Dept of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | | | - Simon Doe
- Royal Victoria Infirmary, Newcastle, UK
| | | | | | - Liam Heaney
- Wellcome-Wolfson Centre for Experimental Medicine, Queens University Belfast, Belfast, UK
| | | | | | | | | | | | | | - Peter Howarth
- Global Medical Affairs, Specialty Medicine TA, GSK, Brentford, UK
| | | | - Elisabeth Bel
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
8
|
Furci F, Caminati M, Genovese S, Gangemi S, Senna G. Upsides and downsides of a telecounselling model of integrated asthma management between general practitioners and specialists. Clin Transl Allergy 2022; 12:e12088. [PMID: 35140909 PMCID: PMC8811728 DOI: 10.1002/clt2.12088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Asthma control, one of the most important goals in the management of asthmatic patients, requires good adherence to guidelines and support at a territorial level, in particular on the part of general practitioners (GPs). A territorial hospital alliance can become a strength in asthma management, where control by GPs can also be carried out through a spirometric examination. METHODS The realisation of a telecounselling model management of asthma between GPs and specialists was the aim of this study, to understand how to obtain good asthma control. A specific digital platform, the PneumoApp platform, was used for the insertion of clinical data and flow volume (F-V) curves, performed in asthmatic patients by GPs, and for the subsequent evaluation of these data by specialists. RESULTS GPs have shown to be able to perform a check-up of respiratory function well using a portable spirometer, but the analysis of the collected data showed that GP assessment of the severity level of asthma is incorrect in patients with moderate-severe asthma. CONCLUSIONS The effectiveness of a telecounselling collaboration between hospital and territory in the management of asthma patients can be improved by greater diffusion of the use of Global Initiative for Asthma (GINA) guidelines at a local level.
Collapse
Affiliation(s)
- Fabiana Furci
- Immunology UnitUniversity HospitalVeronaItaly
- Department of Clinical and Experimental MedicineSchool and Operative Unit of Allergy and Clinical Immunology, Policlinico “G. Martino”, University of MessinaMessinaItaly
| | - Marco Caminati
- Department of MedicineUniversity of Verona and Verona University HospitalVeronaItaly
| | - Sara Genovese
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB‐CNR), Messina UnitMessinaItaly
| | - Sebastiano Gangemi
- Department of Clinical and Experimental MedicineSchool and Operative Unit of Allergy and Clinical Immunology, Policlinico “G. Martino”, University of MessinaMessinaItaly
| | - Gianenrico Senna
- Department of MedicineUniversity of Verona and Verona University HospitalVeronaItaly
- Asthma Centre and Allergy UnitUniversity of Verona and Verona University HospitalVeronaItaly
| |
Collapse
|
9
|
Alvarez-Perea A, Dimov V, Popescu FD, Zubeldia JM. The applications of eHealth technologies in the management of asthma and allergic diseases. Clin Transl Allergy 2021; 11:e12061. [PMID: 34504682 PMCID: PMC8420996 DOI: 10.1002/clt2.12061] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 01/14/2023] Open
Abstract
Portable devices, such as smartphones and mobile Internet access have become ubiquitous in the last decades. The term 'eHealth' stands for electronic health. The tools included in the eHealth concept utilize phones, computers and the Internet and related applications to improve the health care industry. Implementation of eHealth technologies has been documented for the management of different chronic diseases, including asthma and allergic conditions. Clinicians and patients have gained opportunity to communicate in new ways, which could be used cost-effectively to improve disease control and quality of life of those affected. Additionally, these innovations bring new opportunities to academic researchers. For example, eHealth has allowed researchers to compile data points that were previously unavailable or difficult to access, and analyse them using novel tools, collectively described as 'big data'. The role of eHealth become more important since early 2020, due to the physical distancing rules and the restrictions on mobility that have been applied worldwide as a response to the coronavirus disease 2019 pandemic. In this review, we summarize the most recent developments in various eHealth platforms and their relevance to the speciality of allergy and immunology, from the point of view of three major stakeholders: clinicians, patients and researchers.
Collapse
Affiliation(s)
- Alberto Alvarez-Perea
- Allergy Service Hospital General Universitario Gregorio Marañón Madrid Spain.,Gregorio Marañón Health Research Institute Madrid Spain
| | - Ves Dimov
- Cleveland Clinic Florida FAU Charles E. Schmidt College of Medicine Weston Florida USA
| | - Florin-Dan Popescu
- Department of Allergology 'Nicolae Malaxa' Clinical Hospital 'Carol Davila' University of Medicine and Pharmacy Bucharest Romania
| | - José Manuel Zubeldia
- Allergy Service Hospital General Universitario Gregorio Marañón Madrid Spain.,Gregorio Marañón Health Research Institute Madrid Spain.,Biomedical Research Network on Rare Diseases (CIBERER)-U761 Madrid Spain
| |
Collapse
|
10
|
Tsao LR, Villanueva SA, Pines DA, Pham MN, Choo EM, Tang MC, Otani IM. Impact of Rapid Transition to Telemedicine-Based Delivery on Allergy/Immunology Care During COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2672-2679.e2. [PMID: 33894393 PMCID: PMC8061180 DOI: 10.1016/j.jaip.2021.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) necessitated wide-scale adoption of telemedicine (TM) and restriction of in-person care. The impacts on allergy/immunology (A/I) care delivery are still being studied. OBJECTIVE To describe the outcomes of rapid transition to TM-based care (video visit followed by in-person visits dedicated to diagnostic and therapeutic procedures when needed) at an academic A/I practice during COVID-19. METHODS Demographic data were compared for patients originally scheduled for in-person visits between March 10, 2020, and April 30, 2020, who completed a video visit instead between March 10, 2020, and June 30, 2020, and those who did not. Appointment completion, diagnoses, and drug allergy and skin testing completion were compared for visits between March 10, 2020, and June 30, 2020, and 1 year prior (March 10, 2019-June 30, 2019). RESULTS Sixty-nine percent (265 of 382) of patients originally scheduled between March 10, 2020, and April 30, 2020, were able to complete video visits. Patients who completed video visits were more likely to be white (52% vs 33%; P < .001), English-speaking (96% vs 89%; P = .01), and privately insured (70% vs 54%; P = .004). With TM-based care compared with in-person care, there were significant decreases in environmental and food skin testing completion rates (91% and 92% in 2019 vs 60% and 64% in 2020, respectively, P < .001). Drug allergy testing completed after internal referral remained low but comparable (51% in 2019 vs 52% in 2020). Transitioning nonprocedural visits to video allowed allergen immunotherapy and biologic injection visits to resume at a volume similar to pre-COVID. No COVID-19 infections resulted from in-clinic exposure. CONCLUSIONS Although transitioning to TM-based care allowed continued A/I care delivery, strategies are needed to achieve higher testing completion rates and ensure video visits do not exacerbate existing health disparities.
Collapse
Affiliation(s)
- Lulu R Tsao
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif.
| | | | - David A Pines
- UCSF Adult Allergy/Immunology Clinic, San Francisco, Calif
| | - Michele N Pham
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif
| | - Eugene M Choo
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif
| | - Monica C Tang
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif
| | - Iris M Otani
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif
| |
Collapse
|
11
|
Shafi KA, Fortson K, Iyer S. Adoption of Telemedicine: A Debrief for the Orthopedic Practitioner. HSS J 2021; 17:99-105. [PMID: 33967651 PMCID: PMC8077978 DOI: 10.1177/1556331620977429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/23/2020] [Indexed: 01/09/2023]
|
12
|
Thomas I, Siew LQC, Rutkowski K. Synchronous Telemedicine in Allergy: Lessons Learned and Transformation of Care During the COVID-19 Pandemic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:170-176.e1. [PMID: 33091636 PMCID: PMC7571459 DOI: 10.1016/j.jaip.2020.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/16/2020] [Accepted: 10/01/2020] [Indexed: 01/28/2023]
Abstract
Background The outbreak of the COVID-19 pandemic facilitated a rapid transition to non–face-to-face models of care across the allergy services. Objective To describe the outcomes of the use of synchronous telemedicine for outpatient consultations in a tertiary adult allergy center. Methods We retrospectively reviewed all non–face-to-face appointments during the second month of the pandemic in the United Kingdom. Results A total of 637 non–face-to-face appointments for unique patients were booked between April 1 and 30, 2020; 91% were new consultations. Most referrals (81.5%) were related to nondrug reactions. The overall “Did Not Attend” rate was 15.7%. A total of 439 patients were assessed for nondrug reactions; 87% were new appointments. Food-related reactions (50.4%), urticaria/angioedema (23.2%), and rhinitis (18.1%) were the most common reasons for new referrals. Two hundred twenty-one (57.7%) of these patients required further allergy testing, primarily for suspected food allergy. More than 42% of the new patients, mainly referred for urticaria/angioedema, were discharged after their remote assessment. Less than 10% of the follow-up patients required additional testing. Ninety-seven new patients were assessed for a suspected drug reaction, predominantly to beta-lactam antibiotics (57.7%). Sixty-nine patients (71%) required further investigations, but a notable 29% did not require further allergy input. The overall experience was very good/good for most patients (85%). Conclusion Telemedicine can transform the current models of allergy care. Screening criteria for selecting suitable new patients are required. A telemedicine-based drug allergy service model can be more time- and cost-effective, and improve patient access to specialist care.
Collapse
Affiliation(s)
- Iason Thomas
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, King's College London, London, United Kingdom.
| | - Leonard Q C Siew
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, King's College London, London, United Kingdom
| | - Krzysztof Rutkowski
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
13
|
Rehman N, Morais-Almeida M, Wu AC. Asthma Across Childhood: Improving Adherence to Asthma Management from Early Childhood to Adolescence. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:1802-1807.e1. [PMID: 32112922 PMCID: PMC7275896 DOI: 10.1016/j.jaip.2020.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/24/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
Asthma affects nearly 6 million US children. Throughout childhood, children undergo a series of biological, developmental, and psychosocial changes. Thus, factors influencing a child's asthma management differ across 3 essential stages-early childhood (0-5 years), school-aged years (5-12 years), and adolescence (12-18 years)-and require varied intervention by parents, school personnel, clinicians, and the children themselves. Because asthma care in children is characterized by fluctuations in severity and coordination among many stakeholders, optimal asthma control is difficult to achieve in this young population. Challenges in childhood asthma management are reflected in the low rates of children's adherence to medication regimes. Although pharmacological and biological factors addressing age in physicians' treatment choices are well outlined, age-specific approaches to patient-provider communication and asthma-related interventions are also important in improving quality of life for patients with pediatric asthma.
Collapse
Affiliation(s)
- Narmeen Rehman
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital, CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Ann Chen Wu
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass.
| |
Collapse
|
14
|
Culmer N, Smith T, Stager C, Wright A, Burgess K, Johns S, Watt M, Desch M. Telemedical Asthma Education and Health Care Outcomes for School-Age Children: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1908-1918. [PMID: 32084596 DOI: 10.1016/j.jaip.2020.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Telemedicine in a school-based setting involving partnerships between a child with asthma and health care provider can provide patients and caregivers with opportunities to better manage chronic conditions, communicate among partners, and collaborate for solutions in convenient locations. OBJECTIVE This systematic review examined outcomes for school-age children with asthma involving asthma-based telemedical education. METHODS Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched 4 databases with terms related to asthma, education, and pediatrics. Included articles involved a school-based setting, children and adolescents, a telemedical mechanism for training, empirical study designs, and peer review. We extracted data regarding (a) participant background, (b) research methods and purpose, and (c) outcomes. RESULTS A total of 408 articles were identified. Five met inclusion criteria. Three studies were randomized and 2 were cohort studies. In addition to clinical and educational outcomes, studies reported on satisfaction, self-management, asthma knowledge gain, and quality of life (QOL). We found support for caregiver/parent QOL and participant self-management behaviors. We also found mixed results for participant QOL. Clinical outcomes showed mixed support regarding airway inflammation improvement, medication use improvement, improvements in symptom burden and symptom-free days, and spirometry improvements. CONCLUSIONS Results of real-time telemedically delivered asthma education to improve QOL, enhance symptom management ability, and reduce symptom burden were positive or nonsignificant. No study indicated negative effects due to telemedicine. Limited results indicate that patient education can, under certain circumstances, positively influence asthma burden. Further validation of intervention methods and tools as well as outcome measurement consistency is recommended.
Collapse
Affiliation(s)
- Nathan Culmer
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala.
| | - Todd Smith
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| | - Catanya Stager
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| | - Andrea Wright
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| | - Karen Burgess
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| | - Samantha Johns
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| | - Mykaela Watt
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| | - Madison Desch
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| |
Collapse
|