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Zöllner JP, Rosenow F, Schubert-Bast S, Roth C, Knake S, Eickhoff C, Scheuble P, Martin J, Bollensen E, Teepker M, Singer O, Schirmer S, Dietz A, Henn KH, Stolz E, Schüttler-Gahin K, Fischer M, Noda A, Mann C, Strzelczyk A. Consultation Requests and Satisfaction with a Telehealth Network for Epilepsy: Longitudinal Analysis of the Epilepsy Network Hessen Evaluation. Telemed J E Health 2024; 30:e2013-e2023. [PMID: 38683593 DOI: 10.1089/tmj.2023.0659] [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: 05/01/2024] Open
Abstract
Background: Telemedicine improves access to specialized medical expertise, as required for paroxysmal disorders. The Epilepsy Network Hessen Evaluation (ENHE) is a pilot cross-sectoral teleconsultation network connecting primary neurologists and pediatricians with epilepsy centers in Hessen, a federal German state. Methods: We prospectively and longitudinally evaluated telehealthcare in the ENHE. Participating physicians rated each consultation for satisfaction and impact on further management. The survey was administered at each consultation and 3 months later. Results: We analyzed 129 consultations involving 114 adult and pediatric patients. Their mean age was 34 years (standard deviation: 26, range: 0.1-91 years), 48% were female, and 34% were children and adolescents. The most common consultation requests were co-evaluation of an electroencephalogram (electroencephalogram [EEG]; 76%) and therapeutic (33%) and differential diagnosis (24%) concerns. Physicians transmitted one paraclinical examination on average (range: 1-4), predominantly EEG (85%), followed by magnetic resonance imaging (17%) and written records (9%). Response rates were 72% for the initial and 67% for the follow-up survey. Across respondents, 99% (n = 92) were satisfied with the ENHE. Overall, 80% of the consultations contributed to the diagnosis, and 90% were considered helpful for treatment, influencing it in 71% of cases. Seizure frequency had decreased more often (96%) than increased (4%) at 3 months. The initial diagnosis was confirmed in 78% of patients. Discussion: In this pilot teleconsultation network for paroxysmal disorders, diagnostic and therapeutic advice was perceived as helpful. Clinical outcomes were largely positive, suggesting tele-epileptology is viable for paroxysmal (seizure) disorders.
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Affiliation(s)
- Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
- Department of Neuropediatrics, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Christian Roth
- Department of Neurology, DRK Kliniken Kassel, Kassel, Germany
- Department of Neurology, Gesundheit Nordhessen-Klinikum Kassel, Kassel, Germany
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | | | - Pascal Scheuble
- Department of Pediatrics, St. Vincenz Krankenhaus, Limburg, Germany
| | | | - Edgar Bollensen
- Neurological Practice, Neurozentrum Eschwege, Eschwege, Germany
| | - Michael Teepker
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Neurological Practice, MVZ Hardtwaldklinik I, Bad Zwesten, Germany
| | | | - Svenja Schirmer
- Neuropediatric Practice, Sozialpädiatrisches Zentrum, Offenbach, Germany
| | - Andreas Dietz
- Department of Neurology, Hochtaunus-Kliniken, Bad Homburg, Germany
| | | | - Erwin Stolz
- Neurological Practice, Frankfurt am Main, Germany
| | | | - Michaela Fischer
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
| | - Anna Noda
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Medical Center for Adults with Disabilities (MZEB), Varisano Klinikum Frankfurt-Höchst, Frankfurt am Main, Germany
| | - Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
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Gandelman-Marton R. Potential feasibility of a remote first visit in the epilepsy clinic. Epilepsy Behav 2023; 146:109358. [PMID: 37499578 DOI: 10.1016/j.yebeh.2023.109358] [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: 04/22/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Since the beginning of coronavirus disease (COVID-19) epidemic in Israel in early 2020, follow-up visits through phone consultations were available only for patients treated in our outpatient epilepsy clinic. OBJECTIVE To assess the potential feasibility of phone consultation instead of in-person first visit in the outpatient epilepsy clinic. METHODS The computerized database and medical records of all the patients who had an in-person first visit in our outpatient epilepsy clinic during a 4-year period (2018-2021) were retrospectively reviewed. Potential feasibility of a remote visit was assessed for all visits and was deemed possible when physical examination or vagal nerve stimulator (VNS) examination or parameter adjustment was not reported in the visit summary. RESULTS The study group included 462 patients who had an in-person first visit in the outpatient epilepsy clinic during the study period. A remote first visit was deemed potentially feasible in 404 (87%) patients. Those in whom a remote first visit was deemed potentially infeasible were older (p = 0.0001), with longer disease duration (p = 0.001) and higher rates of antiseizure medication polytherapy (p = 0.0001), VNS and additional symptoms (p = 0.0001). CONCLUSIONS A remote visit may be potentially feasible for most patients who are scheduled for a first visit in the epilepsy clinic. An in-person visit may remain the preferred option for patients with additional neurological symptoms or a VNS, and may also be considered in older patients and those with longer disease duration or antiseizure medication polytherapy.
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Affiliation(s)
- Revital Gandelman-Marton
- Neurology Department, Shamir-Assaf Harofeh Medical Center, Zerifin 70300, Israel; Faculty of Medicine, Tel Aviv University, Israel.
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Sasaki R, Yunoki T, Nakano Y, Fukui Y, Takemoto M, Morihara R, Abe K, Yamashita T. Actual Telemedicine Needs of Japanese Patients with Neurological Disorders in the COVID-19 Pandemic. Intern Med 2023; 62:365-371. [PMID: 36418105 PMCID: PMC9970807 DOI: 10.2169/internalmedicine.9702-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective During the coronavirus disease 2019 (COVID-19) pandemic, many social activities have moved online using applications for digital devices (e.g. computers, smartphones). We investigated the needs of telemedicine and trends in medical status and social care situations of Japanese patients with neurological disorders in order to estimate their affinity for an online telemedicine application. Methods We designed an original questionnaire for the present study that asked participants what problems they had with hospital visits, how the COVID-19 pandemic had affected their lives, and whether or not they would like to receive telemedicine. Patients The present study included volunteer caregivers, participants with Parkinson's disease (PD), epilepsy, stroke, dementia, immune-mediated neurological disease (IMMD), spinocerebellar degeneration (SCD), amyotrophic lateral sclerosis (ALS), headache, myopathy, and other neurological diseases from Okayama University Hospital. Results A total of 29.6% of patients wanted to use telemedicine. Patients with headaches (60.0%) and epilepsy (38.1%) were more likely to want to use telemedicine than patients with PD (17.8%) or stroke (19.0%). Almost 90% of patients had access to a digital device, and there was no association between favoring telemedicine, ownership of a digital device, hospital visiting time, or waiting time at the hospital, although age was associated with motivation to telemedicine use (52.6 vs. 62.2 years old, p<0.001). Conclusion We can contribute to the management of the COVID-19 pandemic and the medical economy by promoting telemedicine, especially for young patients with headaches or epilepsy.
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Affiliation(s)
- Ryo Sasaki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Taijun Yunoki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yumiko Nakano
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yusuke Fukui
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Mami Takemoto
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Ryuta Morihara
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Koji Abe
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Toru Yamashita
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
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Tabaeeian RA, Hajrahimi B, Khoshfetrat A. A systematic review of telemedicine systems use barriers: primary health care providers' perspective. JOURNAL OF SCIENCE AND TECHNOLOGY POLICY MANAGEMENT 2022. [DOI: 10.1108/jstpm-07-2021-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose
The purpose of this review paper was identifying barriers to the use of telemedicine systems in primary health-care individual level among professionals.
Design/methodology/approach
This study used Scopus and PubMed databases for scientific records identification. A systematic review of the literature structured by PRISMA guidelines was conducted on 37 included papers published between 2009 and 2019. A qualitative approach was used to synthesize insights into using telemedicine by primary care professionals.
Findings
Three barriers were identified and classified: system quality, data quality and service quality barriers. System complexity in terms of usability, system unreliability, security and privacy concerns, lack of integration and inflexibility of systems-in-use are related to system quality. Data quality barriers are data inaccuracy, data timeliness issues, data conciseness concerns and lack of data uniqueness. Finally, service reliability concerns, lack of technical support and lack of user training have been categorized as service quality barriers.
Originality/value
This review identified and mapped emerging themes of barriers to the use of telemedicine systems. This paper also through a new conceptualization of telemedicine use from perspectives of the primary care professionals contributes to informatics literature and system usage practices.
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Kuroda N, Kubota T, Horinouchi T, Ikegaya N, Kitazawa Y, Kodama S, Kuramochi I, Matsubara T, Nagino N, Neshige S, Soga T, Takayama Y, Sone D. Impact of COVID-19 pandemic on epilepsy care in Japan: A national-level multicenter retrospective cohort study. Epilepsia Open 2022; 7:431-441. [PMID: 35633311 PMCID: PMC9348370 DOI: 10.1002/epi4.12616] [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: 12/27/2021] [Accepted: 05/25/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The impact of the coronavirus disease 2019 (COVID-19) pandemic on epilepsy care across Japan was investigated by conducting a multicenter retrospective cohort study. METHODS This study included monthly data on the frequency of (1) visits by outpatients with epilepsy, (2) outpatient electroencephalography (EEG) studies, (3) telemedicine for epilepsy, (4) admissions for epilepsy, (5) EEG monitoring, and (6) epilepsy surgery in epilepsy centers and clinics across Japan between January 2019 and December 2020. We defined the primary outcome as epilepsy-center-specific monthly data divided by the 12-month average in 2019 for each facility. We determined whether the COVID-19 pandemic-related factors (such as year [2019 or 2020], COVID-19 cases in each prefecture in the previous month, and the state of emergency) were independently associated with these outcomes. RESULTS In 2020, the frequency of outpatient EEG studies (-10.7%, p<0.001) and cases with telemedicine (+2,608%, p=0.031) were affected. The number of COVID-19 cases was an independent associated factor for epilepsy admission (-3.75*10-3 % per case, p<0.001) and EEG monitoring (-3.81*10-3 % per case, p = 0.004). Further, the state of emergency was an independent factor associated with outpatient with epilepsy (-11.9%, p<0.001), outpatient EEG (-32.3%, p<0.001), telemedicine for epilepsy (+12,915%, p<0.001), epilepsy admissions (-35.3%; p<0.001), EEG monitoring (-24.7%: p<0.001), and epilepsy surgery (-50.3%, p<0.001). SIGNIFICANCE We demonstrated the significant impact that the COVID-19 pandemic had on epilepsy care. These results support those of previous studies and clarify the effect size of each pandemic-related factor on epilepsy care.
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Affiliation(s)
- Naoto Kuroda
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Pediatrics, Wayne State UniversityDetroitMichiganUSA
| | - Takafumi Kubota
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurology, University Hospitals of Cleveland Medical CenterCase Western Reserve UniversityClevelandOhioUSA
| | - Toru Horinouchi
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Psychiatry and NeurologyHokkaido University Graduate School of MedicineSapporoJapan
| | - Naoki Ikegaya
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurosurgery, Graduate School of MedicineYokohama City UniversityYokohamaJapan
| | - Yu Kitazawa
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurology and Stroke MedicineYokohama City University Graduate School of MedicineYokohamaJapan
| | - Satoshi Kodama
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Izumi Kuramochi
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Psychiatry, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Teppei Matsubara
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Naoto Nagino
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Epilepsy Center, TMG Asaka Medical CenterSaitamaJapan
| | - Shuichiro Neshige
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima UniversityGraduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Temma Soga
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of EpileptologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Yutaro Takayama
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurosurgery, National Center HospitalNational Center of Neurology and PsychiatryTokyoJapan
| | - Daichi Sone
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyLondonUK
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Karnehed S, Erlandsson LK, Norell Pejner M. Nurses' perspectives on an electronic medication administration record in home healthcare: Qualitative interview study (Preprint). JMIR Nurs 2021; 5:e35363. [PMID: 35452400 PMCID: PMC9077506 DOI: 10.2196/35363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/21/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background eHealth is considered by policy makers as a prerequisite for meeting the demands of health care from the growing proportion of older people worldwide. The expectation about what the efficiency of eHealth can bring is particularly high in the municipal home health care sector, which is facing pressure regarding resources because of, for example, earlier discharges from hospitals and a growing number of patients receiving medications and treatments at home. Common eHealth services in home health care are electronic medication administration records (eMARs) that aim to communicate delegated tasks between professionals. However, there is an extensive gap in the research on how technology affects and is experienced by home health care professionals. Objective The objective of this paper is to shed light on how home care nurses experience eMARs in a Swedish municipality. Methods This qualitative interview study was conducted among home health care nurses using eMARs to facilitate communication and signing of delegated nursing tasks. The analysis of the interviews was performed using constructivist grounded theory, according to Charmaz. Results Of the 19 day-employed nurses in the municipality where an eMAR was used, 16 (84%) nurses participated in the study. The following two categories were identified from the focus group interviews: nurses become monitors and slip away from the point of care. The nurses experienced that they became monitors of health care through the increased transparency provided by the eMAR and the measurands they also applied, focusing on the quantitative aspects of the delegated nursing tasks rather than the qualitative aspects. The nurses experienced that their monitoring changed the power relations between the professions, reinforcing the nurses’ superior position. The experience of the eMAR was regarded as transitioning the nurses’ professional role—away from the point of care and toward more administration—and further strengthened the way of managing work through delegation to health care assistants. Conclusions Previous analyses of eHealth services in health care showed that implementation is a complex process that changes health care organizations and the work of health care professionals in both intended and unintended ways. This study adds to the literature by examining how users of a specific eHealth service experience its impacts on their daily work. The results indicate that the inscribed functions in an eHealth service may affect the values and priorities where the service is in use. This presents an opportunity for future research and for health care organizations to assess the impacts of specific eHealth services on health care professionals’ work and to further examine the effects of inscribed functions in relation to how they may affect actions and priorities at individual and organizational levels.
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Affiliation(s)
- Sara Karnehed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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