1
|
Nyoni T, Evers EC, Pérez M, Jeffe DB, Fritz SA, Colditz GA, Burnham JP. Perceived barriers and facilitators to the adoption of telemedicine infectious diseases consultations in southeastern Missouri hospitals. J Telemed Telecare 2024; 30:1462-1474. [PMID: 36659820 PMCID: PMC10354216 DOI: 10.1177/1357633x221149461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Telemedicine infectious diseases consultations (tele-ID consults) improves access to healthcare for underserved/resource-limited communities. However, factors promoting or hindering implementation of tele-ID consults in low-resource settings are understudied. This study sought to fill this gap by describing perceived barriers and facilitators tele-ID consults at three rural hospitals in southeastern Missouri. METHODS Twelve in-depth, semi-structured interviews were conducted with a purposively sampled group of information-rich hospital stakeholders from three rural, southeastern Missouri hospitals with partial or no on-site availability of ID physicians. Our literature-informed interview guide elicited participants' knowledge and experience with tele-ID consults, perceptions on ID consultation needs, and perceived barriers to and facilitators of tele-ID consults. Interview transcripts were coded using an iterative process of inductive analysis to identify core themes related to barriers and facilitators. RESULTS Perceived barriers to adopting and implementing tele-ID consults included logistical challenges, technology and devices, negative emotional responses, patient-related factors, concerns about reduced quality of care when using telemedicine, lack of acceptance or buy-in from physicians or staff, and legal concerns. Key facilitators included perceived need, perceived benefits to patients and physicians, flexibility and openness to change among staff members and patients, telemedicine champions, prior experiences, and enthusiasm. DISCUSSION Our findings demonstrate that rural hospitals need tele-ID consults and have the capacity to implement tele-ID consults, but operational and technical feasibility challenges remain. Adoption and implementation of tele-ID consults may reduce ID-physician shortage-related service gaps by permitting ID physician's greater geographic reach.
Collapse
Affiliation(s)
- Thabani Nyoni
- Brown School, Washington University in Saint Louis, St. Louis, Missouri, USA
| | - Emily C. Evers
- Brown School, Washington University in Saint Louis, St. Louis, Missouri, USA
| | - Maria Pérez
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Donna B. Jeffe
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie A. Fritz
- Department of Pediatrics, Washington University in St. Louis, Missouri, USA
| | - Graham A. Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason P. Burnham
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
2
|
Siciliano B, Ramon S, Gabrielli J, López-López A. [Implementation and use of telemedicine in health care during the outbreak of monkeypox in the health area of Ibiza and Formentera]. Aten Primaria 2024; 56:102742. [PMID: 38432105 PMCID: PMC10915515 DOI: 10.1016/j.aprim.2023.102742] [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: 05/24/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE The objective of this work is to describe how the use of the information and communication technologies has been used in the clinical control, follow-up and treatment of all the patients affected by monkeypox in our health area. DESIGN AND SITE A descriptive, observational and retrospective work has been carried out to show the clinical management of the monkeypox cases assisted in the Health Area of Ibiza and Formentera (ASEF), in the field of the primary care. PARTICIPANTS AND METHODS All patients affected by monkeypox who met the inclusion criteria were included in the study (a total of 79 patients), covering the period from 01/06/22 to 30/11/22. A protocol was designed in order to recruit the patients, extract the samples, monitor the close contacts, notify the cases to the health authorities, clinical assistance and administrative processing of the sick leaves. RESULTS AND CONCLUSIONS The adherence of the patients with the control system was majoritarian. Telemedicine has been a useful tool for the exchange of information during the provision of continuous medical care to patients affected by the outbreak of monkeypox infection, guaranteeing their safety and privacy and allowing the management of an infectious disease that requires isolation, control, and medical monitoring.
Collapse
Affiliation(s)
- Beatriz Siciliano
- Servei d'Atenció Primària, Àrea de Salut d'Eivissa i Formentera, Illes Balears, España
| | - Susana Ramon
- Servei de Microbiologia i Parasitologia, Hospital Can Misses, Eivissa, Illes Balears, España
| | | | - Aránzazu López-López
- Servei de Microbiologia i Parasitologia, Hospital Can Misses, Eivissa, Illes Balears, España.
| |
Collapse
|
3
|
Swift J, O'Kelly N, Barker C, Woodward A, Ghosh S. A Digital Respiratory Ward in Leicester, Leicestershire, and Rutland, England, for Patients With COVID-19: Economic Evaluation of the Impact on Acute Capacity and Wider National Health Service Resource Use. JMIR Form Res 2024; 8:e47441. [PMID: 38349716 PMCID: PMC10866202 DOI: 10.2196/47441] [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: 03/22/2023] [Revised: 12/04/2023] [Accepted: 12/22/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic stressed global health care systems' acute capacity and caused a diversion of resources from elective care to the treatment of acute respiratory disease. In preparing for a second wave of COVID-19 infections, England's National Health Service (NHS) in Leicester, Leicestershire, and Rutland sought to protect acute capacity in the winter of 2020-2021. Their plans included the introduction of a digital ward where patients were discharged home early and supported remotely by community-based respiratory specialists, who were informed about patient health status by a digital patient monitoring system. OBJECTIVE The objective of the digital ward was to maintain acute capacity through safe, early discharge of patients with COVID-19 respiratory disease. The study objective was to establish what impact this digital ward had on overall NHS resource use. METHODS There were no expected differences in patient outcomes. A cost minimization was performed to demonstrate the impact on the NHS resource use from discharging patients into a digital COVID-19 respiratory ward, compared to acute care length of stay (LOS). This evaluation included all 310 patients enrolled in the service from November 2020 (service commencement) to November 2021. Two primary methods, along with sensitivity analyses, were used to help overcome the uncertainty associated with the estimated comparators for the observational data on COVID-19 respiratory acute LOS, compared with the actual LOS of the 279 (90%) patients who were not discharged on oxygen nor were in critical care. Historic comparative LOS and an ordinary least squares model based on local monthly COVID-19 respiratory median LOS were used as comparators. Actual comparator data were sourced for the 31 (10%) patients who were discharged home and into the digital ward for oxygen weaning. Resource use associated with delivering care in the digital ward was sourced from the digital system and respiratory specialists. RESULTS In the base case, the digital ward delivered estimated health care system savings of 846.5 bed-days and US $504,197 in net financial savings across the 2 key groups of patients-those on oxygen and those not on oxygen at acute discharge (both P<.001). The mean gross and net savings per patient were US $1850 and US $1626 in the base case, respectively, without including any savings associated with a potential reduction in readmissions. The 30-day readmission rate was 2.9%, which was below comparative data. The mean cost of the intervention was US $223.53 per patient, 12.1% of the estimated gross savings. It was not until the costs were increased and the effect reduced simultaneously by 78.4% in the sensitivity analysis that the intervention was no longer cost saving. CONCLUSIONS The digital ward delivered increased capacity and substantial financial savings and did so with a high degree of confidence, at a very low absolute and relative cost.
Collapse
Affiliation(s)
- Jim Swift
- Spirit Health, Leicester, United Kingdom
| | | | | | - Alex Woodward
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Sudip Ghosh
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom
- Department of Allied Health Sciences, De Montford University, Leicester, United Kingdom
| |
Collapse
|
4
|
Sener T, Haenen W, Smits P, Hans GH. Large-scale real-life implementation of technology-enabled care to maximize hospitals' medical surge preparedness during future infectious disease outbreaks and winter seasons: a viewpoint. Front Public Health 2023; 11:1149247. [PMID: 37621607 PMCID: PMC10446840 DOI: 10.3389/fpubh.2023.1149247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Hospitals can be overburdened with large numbers of patients with severe infectious conditions during infectious disease outbreaks. Such outbreaks or epidemics put tremendous pressure on the admission capacity of care facilities in the concerned region, negatively affecting the elective program within these facilities. Such situations have been observed during the recent waves of the coronavirus disease pandemic. Owing to the imminent threat of a "tripledemic" by new variants of the coronavirus disease (such as the new Omicron XBB.1.16 strain), influenza, and respiratory syncytial virus during future winter seasons, healthcare agencies should take decisive steps to safeguard hospitals' surge capacity while continuing to provide optimal and safe care to a potentially large number of patients in their trusted home environment. Preparedness of health systems for infectious diseases will require dynamic interaction between a continuous assessment of region-wide available hospital capacity and programs for intensive home treatment of patients who can spread the disease. In this viewpoint, we describe an innovative, dynamic coupling system between hospital surge capacity and cascading activation of a nationwide system for remote patient monitoring. This approach was developed using the multi-criteria decision analysis methodology, considering previously published real-life experiences on remote patient monitoring.
Collapse
Affiliation(s)
- Talia Sener
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Winne Haenen
- Federal Public Service for Health, Food Chain Safety and Environment, Brussels, Belgium
| | - Patrick Smits
- Cell Crisis Preparedness, Agentschap Zorg en Gezondheid, Brussels, Belgium
| | - Guy H. Hans
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Chief Medical Officer, Antwerp University Hospital (UZA), Edegem, Belgium
| |
Collapse
|
5
|
Monfort-Vinuesa C, Gil-López P, Ramírez-Olivencia G, Chivato-Pérez T, Coca-Benito D, Mata-Forte T. Application of telemedicine in infectious diseases. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:36-39. [PMID: 35810142 DOI: 10.1016/j.eimce.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Infectious pathologies can benefit from the application of Telemedicine (TM). This study provides a description of the infectious pathology treated by the Telemedicine Service of the Hospital Central de la Defensa Gómez Ulla (STM-HCDGU). METHODS Analysis of the e-consultations made by members of the Armed Forces (FA) of Spain displaced to the area of operations (ZO) in the period between 01/1/2015 and 31/12/2018 who developed infectious symptoms. RESULTS 127 infectious diseases were diagnosed, the most frequent being those of respiratory etiology and later malaria. Geographically Africa and embarked contingents were the most significant. It was necessary to evacuate 18 patients to the HCDGU, being the diagnosis of malaria the most frequent reason for evacuation, cause of the only fatal case. CONCLUSIONS infectious diseases benefit from the application of TM, being an important tool for the diagnosis and treatment of these, constituting an opportunity to expand to other displaced or remote populations.
Collapse
Affiliation(s)
| | - Pedro Gil-López
- Teniente Coronel Médico, Jefe Servicio de Telemedicina, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Germán Ramírez-Olivencia
- FEA Medicina Interna, UAAN, Sección de Infecciosas, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | | | - David Coca-Benito
- Comandante Médico, Adjunto Servicio de Urgencias, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Tatiana Mata-Forte
- Capitán Médico, Servicio de Medicina Interna, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| |
Collapse
|
6
|
Livorsi DJ, Abdel-Massih R, Crnich CJ, Dodds-Ashley ES, Evans CT, Goedken CC, Echevarria KL, Kelly AA, Spires SS, Veillette JJ, Vento TJ, Jump RLP. An Implementation Roadmap for Establishing Remote Infectious Disease Specialist Support for Consultation and Antibiotic Stewardship in Resource-Limited Settings. Open Forum Infect Dis 2022; 9:ofac588. [PMID: 36544860 PMCID: PMC9757681 DOI: 10.1093/ofid/ofac588] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022] Open
Abstract
Infectious Disease (ID)-trained specialists, defined as ID pharmacists and ID physicians, improve hospital care by providing consultations to patients with complicated infections and by leading programs that monitor and improve antibiotic prescribing. However, many hospitals and nursing homes lack access to ID specialists. Telehealth is an effective tool to deliver ID specialist expertise to resource-limited settings. Telehealth services are most useful when they are adapted to meet the needs and resources of the local setting. In this step-by-step guide, we describe how a tailored telehealth program can be implemented to provide remote ID specialist support for direct patient consultation and to support local antibiotic stewardship activities. We outline 3 major phases of putting a telehealth program into effect: pre-implementation, implementation, and sustainment. To increase the likelihood of success, we recommend actively involving local leadership and other stakeholders in all aspects of developing, implementing, measuring, and refining programmatic activities.
Collapse
Affiliation(s)
- Daniel J Livorsi
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Division of Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Rima Abdel-Massih
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Infectious Disease Connect, Inc, Pittsburgh, Pennsylvania, USA
| | - Christopher J Crnich
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- William S. Middleton VA Hospital, Madison, Wisconsin, USA
| | | | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Medical Center, Hines, Illinois, USA
- Preventive Medicine and Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois, USA
| | - Cassie Cunningham Goedken
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - Kelly L Echevarria
- Department of Veterans Affairs, Antimicrobial Stewardship Task Force, Washington, DC, USA
| | - Allison A Kelly
- Department of Veterans Affairs, Antimicrobial Stewardship Task Force, Washington, DC, USA
- Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - S Shaefer Spires
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - John J Veillette
- Intermountain Healthcare TeleHealth Services, Murray, Utah, USA
- Department of Pharmacy, Intermountain Medical Center, Murray, Utah, USA
| | - Todd J Vento
- Intermountain Healthcare TeleHealth Services, Murray, Utah, USA
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Medical Center, Murray, Utah, USA
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Robin L P Jump
- Geriatric Research Education and Clinical Center (GRECC) at the VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
7
|
Kostovich CT, Etingen B, Wirth M, Patrianakos J, Kartje R, Baharestani M, Weaver FM. Outcomes of Telehealth for Wound Care: A Scoping Review. Adv Skin Wound Care 2022; 35:394-403. [PMID: 35170501 DOI: 10.1097/01.asw.0000821916.26355.fa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To synthesize the literature on delivering wound care via telehealth and compare clinical, healthcare utilization, and cost outcomes when wound care is provided via telehealth (telewound) modalities compared with in-person care. DATA SOURCES An electronic search of PubMed, CINAHL, and Cochrane Clinical Trials databases for articles published from 1999 to 2019 was conducted using the following MeSH search terms: telewound, wound, wound care, remote care, telehealth, telemedicine, eHealth, mobile health, pressure injury, and ulcer. STUDY SELECTION Articles were included if they were a scientific report of a single study; evaluated a telehealth method; identified the type of wound of focus; and provided data on clinical, healthcare utilization, or cost outcomes of telewound care. In total, 26 articles met these criteria. DATA EXTRACTION Data were extracted and grouped into 13 categories, including study design, wound type, telehealth modality, treatment intervention, and outcomes measured, among others. DATA SYNTHESIS Of the 26 studies, 19 reported on clinical outcomes including overall healing and healing time; 17 studies reported on healthcare utilization including hospitalizations and length of stay; and 12 studies reported costs. CONCLUSIONS Evidence regarding the use of telewound care is weak, and findings related to the impact of telewound care on outcomes are inconsistent but indicate that it is not inferior to in-person care. Greater use of telehealth as a result of the COVID-19 pandemic points to further development of navigation and education models of telehealth for wound care. However, additional studies using rigorous research design and leveraging robust sample sizes are needed to demonstrate value.
Collapse
Affiliation(s)
- Carol T Kostovich
- Carol T. Kostovich, PhD, RN, CHSE, is Research Health Scientist, Edward Hines, Jr. VA Hospital, Hines, IL; and Associate Professor, Assistant Dean of Innovative Educational Strategies, Marcella Niehoff School of Nursing, Loyola University, Chicago, IL. At the Hines VA Hospital, Bella Etingen, PhD, is Research Health Scientist, Center of Innovation for Complex Chronic Healthcare; Marissa Wirth, MPH, is Research Health Science Specialist; Jamie Patrianakos, MA, is Research Health Science Specialist; and Rebecca Kartje, MD, MS, is Analyst. Mona Baharestani, PhD, APN, CWON, FACCWS, is Associate Chief, Wound Care & Research, James H. Quillen VAMC, Johnson City (Mountain Home), Johnson City, TN. Frances M. Weaver, PhD, is Research Health Scientist, Hines VA Hospital, and Professor, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL. Acknowledgment: This work was supported by the US Department of Veterans Affairs, Diffusion of Excellence Office, and Office of Research and Development, Health Services Research and Development Service, Quality Enhancement Research Initiative Program (PEC 19-310). Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views, position, or policy of the Department of Veterans Affairs or the US Government. The authors have disclosed no other financial relationships related to this article. Submitted June 8, 2021; accepted in revised form July 23, 2021; published online ahead of print February 14, 2022
| | | | | | | | | | | | | |
Collapse
|
8
|
Infectious diseases and primary care telemedicine in France. Infect Dis Now 2022; 52:236-238. [PMID: 35331975 PMCID: PMC9584825 DOI: 10.1016/j.idnow.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/10/2022] [Indexed: 11/20/2022]
|
9
|
Payvandi L, Parsons C, Bourgeois FC, Hron JD. Inpatient telehealth experience of limited English proficient patients: a cross-sectional survey and semi-structured interview (Preprint). JMIR Form Res 2021; 6:e34354. [PMID: 35438641 PMCID: PMC9066319 DOI: 10.2196/34354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/17/2022] [Accepted: 03/10/2022] [Indexed: 12/20/2022] Open
Abstract
Background Patients with limited English proficiency (LEP) are at a higher risk of poor health outcomes and are less likely to use telehealth than English-speaking patients. To date, there is no formal evaluation of inpatient (IP) telehealth user experience of patients and their families by language preference during visits with their clinicians. Objective This study aims to compare the experiences of English- and Spanish-speaking patients and their families using IP telehealth, as well as to evaluate the experience of Spanish interpreters providing services through IP telehealth. Methods We prospectively administered a survey to English- and Spanish-speaking patients and their families who used IP telehealth from October 1, 2020, to March 31, 2021. We performed semistructured phone interviews of hospital-based Spanish interpreters who provided services through IP telehealth. Results A total of 661 surveys were administered, with completion rates of 18% (112/621) in English and 62% (25/40) in Spanish. On a 10-point scale, the overall satisfaction of Spanish speakers (median 10, IQR 10-10) was higher than that of English speakers (median 9, IQR 8-10; P=.001). Both English- and Spanish-speaking patients used IP telehealth for visits with their primary IP care team, subspecialty consultants, and other clinicians. Hospital tablets were used more often than personal devices, and only English-speaking patients used personal laptops. Patients and their families encountered challenges with log-in, team coordination with multiple users, and equipment availability. Interpreters encountered challenges with audio and video quality, communication, safety, and Wi-Fi access. Conclusions Both English- and Spanish-speaking patients reported high satisfaction using IP telehealth across multiple disciplines despite the workflow challenges identified by interpreters. Significant investment is needed to provide robust infrastructure to support use by all patients, especially the integration of multiple users to provide interpreter services for patients with LEP.
Collapse
Affiliation(s)
- Lily Payvandi
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
| | - Chase Parsons
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Fabienne C Bourgeois
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Jonathan D Hron
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
10
|
Suzuki H, Shealy SC, Throneberry K, Stenehjem E, Livorsi D. Opportunities and challenges in improving antimicrobial use during the era of telehealth expansion: A narrative review. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2021; 1:e26. [PMID: 36168461 PMCID: PMC9495641 DOI: 10.1017/ash.2021.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Abstract
Efforts to improve antimicrobial prescribing are occurring within a changing healthcare landscape, which includes the expanded use of telehealth technology. The wider adoption of telehealth presents both challenges and opportunities for promoting antimicrobial stewardship. Telehealth provides 2 avenues for remote infectious disease (ID) specialists to improve inpatient antimicrobial prescribing: telehealth-supported antimicrobial stewardship and tele-ID consultations. Those 2 activities can work separately or synergistically. Studies on telehealth-supported antimicrobial stewardship have reported a reduction in inpatient antimicrobial prescribing, cost savings related to less antimicrobial use, a decrease in Clostridioides difficile infections, and improved antimicrobial susceptibility patterns for common organisms. Tele-ID consultation is associated with fewer hospital transfers, a shorter length of hospital stay, and decreased mortality. The implementation of these activities can be flexible depending on local needs and available resources, but several barriers may be encountered. Opportunities also exist to improve antimicrobial use in outpatient settings. Telehealth provides a more rapid mechanism for conducting outpatient ID consultations, and increasing use of telehealth for routine and urgent outpatient visits present new challenges for antimicrobial stewardship. In primary care, urgent care, and emergency care settings, unnecessary antimicrobial use for viral acute respiratory tract infections is common during telehealth encounters, as is the case for fact-to-face encounters. For some diagnoses, such as otitis media and pharyngitis, antimicrobials are further overprescribed via telehealth. Evidence is still lacking on the optimal stewardship strategies to improve antimicrobial prescribing during telehealth encounters in ambulatory care, but conventional outpatient stewardship strategies are likely transferable. Further work is warranted to fill this knowledge gap.
Collapse
Affiliation(s)
- Hiroyuki Suzuki
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Stephanie C. Shealy
- Intermountain Healthcare TeleHealth Services, Murray, Utah
- Department of Pharmacy, Intermountain Medical Center, Murray, Utah
| | - Kyle Throneberry
- Intermountain Healthcare TeleHealth Services, Murray, Utah
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Daniel Livorsi
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| |
Collapse
|
11
|
Monfort-Vinuesa C, Gil-López P, Ramírez-Olivencia G, Chivato-Pérez T, Coca-Benito D, Mata-Forte T. Application of telemedicine in infectious diseases. Enferm Infecc Microbiol Clin 2021; 41:S0213-005X(21)00078-1. [PMID: 33858708 DOI: 10.1016/j.eimc.2021.03.009] [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: 01/23/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Infectious pathologies can benefit from the application of Telemedicine (TM). This study provides a description of the infectious pathology treated by the Telemedicine Service of the Hospital Central de la Defensa Gómez Ulla (STM-HCDGU). METHODS Analysis of the e-consultations made by members of the Armed Forces of Spain displaced to the area of operations in the period between 01/1/2015 and 31/12/2018 who developed symptoms of infectious diseases. RESULTS 127 infectious diseases were diagnosed, the most frequent being those of respiratory etiology and later malaria. Geographically Africa and embarked contingents were the most significant. It was necessary to evacuate 18 patients to the HCDGU, being the diagnosis of malaria the most frequent reason for evacuation, cause of the only fatal case. CONCLUSIONS infectious diseases benefit from the application of TM, being an important tool for the diagnosis and treatment of these, constituting an opportunity to expand to other displaced or remote populations.
Collapse
Affiliation(s)
- Carlos Monfort-Vinuesa
- FEA Medicina Interna, Unidad de Tuberculosis, Hospital La Fuenfría, SERMAS, Cercedilla, Madrid, España.
| | - Pedro Gil-López
- Teniente coronel medico, Servicio de Telemedicina, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - Germán Ramírez-Olivencia
- FEA Medicina Interna, UAAN, Sección de Infecciosas, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | | | - David Coca-Benito
- Comandante médico, Servicio de Urgencias, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - Tatiana Mata-Forte
- Capitán médico, Servicio de Medicina Interna, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| |
Collapse
|
12
|
Pappalardo M, Fanelli U, Chiné V, Neglia C, Gramegna A, Argentiero A, Esposito S. Telemedicine in Pediatric Infectious Diseases. CHILDREN-BASEL 2021; 8:children8040260. [PMID: 33800549 PMCID: PMC8066295 DOI: 10.3390/children8040260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
Telemedicine is the remote practice of medicine through the use of information and communication technologies for the prevention, diagnosis, treatment and management of diseases. In this narrative review, we illustrate how telemedicine technologies are increasingly integrated into pediatric infectious disease programs with the aim of facilitating access to specialist care and reducing costs. There is widespread use of telemedicine for the management of acute and chronic infectious diseases, particularly in countries in which the majority of the population lives in rural areas, far from third-level hospital centers located in large urban centers. Obviously, telemedicine is also used in developed countries, and its importance has been further increased recently given the COVID-19 pandemic. It has many advantages for patients, such as saving time, money and working hours, and reducing cancelled appointments and delays, while there are also many advantages for doctors, allowing collaborations with specialists and continuous updating. Among the disadvantages are the limitation in carrying out an objective examination, which is particularly important for children under 2 years of age, and the need for cutting-edge technology and reliable connectivity. Telemedicine increasingly represents the future and the beginning of a new healthcare system that also will redefine medical care for the treatment of infectious diseases, both acute and chronic. However, the majority of the experience has involved adults, and its validation in pediatric care, as well as its application in real-life practices, are urgently needed.
Collapse
Affiliation(s)
- Marco Pappalardo
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Umberto Fanelli
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Vincenzo Chiné
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Cosimo Neglia
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Andrea Gramegna
- Respiratory Unit and Cystic Fibrosis Adult Center, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
- Correspondence: ; Tel.: +39-0521-704790
| |
Collapse
|
13
|
File TM, Jump RLP, Goff DA. The Role of Antibiotic Stewardship and Telemedicine in the Management of Multidrug-Resistant Infections. Infect Dis Clin North Am 2020; 34:903-920. [PMID: 33131574 DOI: 10.1016/j.idc.2020.05.002] [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: 10/23/2022]
Abstract
This article summarizes the literature describing how antimicrobial stewardship and telemedicine interventions affect antimicrobial resistance. Discussion includes why we need stewardship, how to collaborate with team members, and the evidence of stewardship's and telemedicine's impact on resistance.
Collapse
Affiliation(s)
- Thomas M File
- Infectious Disease Division, Antimicrobial Stewardship Program, Summa Health, 75 Arch Street Suite 506, Akron, OH 44304, USA; Internal Medicine, Infectious Disease Section, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA.
| | - Robin L P Jump
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA; Geriatric Research, Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, 10701 East Boulevard, 111C(O), Cleveland, OH 44016, USA
| | - Debra A Goff
- Department of Pharmacy, College of Pharmacy, The Ohio State University Wexner Medical Center, 368 Doan Hall, Columbus, OH 43210, USA
| |
Collapse
|
14
|
Hron JD, Parsons CR, Williams LA, Harper MB, Bourgeois FC. Rapid Implementation of an Inpatient Telehealth Program during the COVID-19 Pandemic. Appl Clin Inform 2020; 11:452-459. [PMID: 32610350 DOI: 10.1055/s-0040-1713635] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Relaxation of laws and regulations around privacy and billing during the COVID-19 pandemic provide expanded opportunities to use telehealth to provide patient care at a distance. Many health systems have transitioned to providing outpatient care via telehealth; however, there is an opportunity to utilize telehealth for inpatients to promote physical distancing. OBJECTIVE This article evaluates the use of a rapidly implemented, secure inpatient telehealth program. METHODS We assembled a multidisciplinary team to rapidly design, implement, and iteratively improve an inpatient telehealth quality improvement initiative using an existing videoconferencing system at our academic medical center. We assigned each hospital bed space a unique meeting link and updated the meeting password for each new patient. Patients and families were encouraged to use their own mobile devices to join meetings when possible. RESULTS Within 7 weeks of go-live, we hosted 1,820 inpatient telehealth sessions (13.3 sessions per 100 bedded days). We logged 104,647 minutes of inpatient telehealth time with a median session duration of 22 minutes (range 1-1,961). There were 5,288 participant devices used with a mean of 3 devices per telehealth session (range 2-22). Clinicians found they were able to build rapport and perform a reasonable physical exam. CONCLUSION We successfully implemented and scaled a secure inpatient telehealth program using an existing videoconferencing system in less than 1 week. Our implementation provided an intuitive naming convention for providers and capitalized on the broad availability of smartphones and tablets. Initial comments from clinicians suggest the system was useful; however, further work is needed to streamline initial setup for patients and families as well as care coordination to support clinician communication and workflows. Numerous use cases identified suggest a role for inpatient telehealth will remain after the COVID-19 crisis underscoring the importance of lasting regulatory reform.
Collapse
Affiliation(s)
- Jonathan D Hron
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| | - Chase R Parsons
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| | - Lee Ann Williams
- Patient Care Operations, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Marvin B Harper
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States.,Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Fabienne C Bourgeois
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| |
Collapse
|
15
|
Burnham JP, Fritz SA, Yaeger LH, Colditz GA. Telemedicine Infectious Diseases Consultations and Clinical Outcomes: A Systematic Review. Open Forum Infect Dis 2019; 6:ofz517. [PMID: 31879674 PMCID: PMC6925389 DOI: 10.1093/ofid/ofz517] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022] Open
Abstract
Background Telemedicine use is increasing in many specialties, but its impact on clinical outcomes in infectious diseases has not been systematically reviewed. We reviewed the current evidence for clinical effectiveness of telemedicine infectious diseases consultations, including outcomes of mortality, hospital readmission, antimicrobial use, cost, length of stay, adherence, and patient satisfaction. Methods We queried Ovid MEDLINE 1946-, Embase.com 1947-, Scopus 1823-, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov 1997- through August 5, 2019, for studies looking at clinical outcomes of infectious diseases in the setting of telemedicine use. We did not restrict by language or year of publication. Clinical outcomes searched included 30-day all-cause mortality, 30-day readmissions, patient compliance/adherence, patient satisfaction, cost or cost-effectiveness, length of hospital stay, antimicrobial use, and antimicrobial stewardship. Bias was assessed using standard methodologies. PROSPERO CRD42018105225. Results From a search pool of 1154 studies, only 18 involved telemedicine infectious diseases consultation and our selected clinical outcomes. The outcomes tracked were heterogeneous, precluding meta-analysis, and the majority of studies were of poor quality. Overall, clinical outcomes with telemedicine infectious diseases consultation seem comparable to in-person infectious diseases consultation. Conclusions Although in widespread use, the clinical effectiveness of telemedicine infectious diseases consultations has yet to be sufficiently studied. Further studies, or publication of previously collected and available data, are warranted to verify the cost-effectiveness of this widespread practice. Systematic review registration PROSPERO CRD42018105225.
Collapse
Affiliation(s)
- Jason P Burnham
- Division of Infectious Diseases Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University in St. Louis, Missouri, USA
| | - Lauren H Yaeger
- Bernard Becker Medical Library, Washington University in St. Louis, Missouri, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
16
|
Palacholla RS, Kvedar JC. Telemedicine for infectious disease care-how do we measure the true value? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S178. [PMID: 31656757 DOI: 10.21037/atm.2019.07.81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ramya Sita Palacholla
- Partners HealthCare Pivot Labs, Harvard Medical School, Boston, MA, USA.,Partners Healthcare Connected Health, Harvard Medical School, Boston, MA, USA
| | - Joseph C Kvedar
- Partners HealthCare Pivot Labs, Harvard Medical School, Boston, MA, USA.,Partners Healthcare Connected Health, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
17
|
Tan SJ, Ingram PR, Rothnie AJ, Whitmore TJ, Robinson JO, Hatch JB, Italiano CM, Heath CH. Successful outpatient parenteral antibiotic therapy delivery via telemedicine. J Antimicrob Chemother 2018; 72:2898-2901. [PMID: 29091189 DOI: 10.1093/jac/dkx203] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/25/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives Most outpatient parenteral antimicrobial therapy (OPAT) services use a hospital-based model of care in which patients remain in proximity to large hospitals facilitating clinical review. We aimed to evaluate clinical outcomes and complication rates for patients living in geographically isolated locations managed by telemedicine-supported OPAT. Methods: This was a retrospective cohort study. Results Between 2011 and 2015, we delivered 88 episodes of care involving 83 adult patients resulting in 2261 days of OPAT. The median age was 56 years, 8 of 83 (10%) were indigenous Australian and the median Charlson comorbidity index score was 2 (IQR 1-4). The median distance of patients' residence from our hospital was 288 km (IQR 201-715) and the median duration on the programme was 26 days (IQR 14-34). Bone and joint infections accounted for 75% of infections treated. Favourable clinical outcomes (improvement or cure) were achieved in 87% of patients and the unplanned, OPAT-related readmission rate was 8%. Nineteen percent and 10% of patients had drug-related and line-related adverse effects, respectively. Conclusions Despite a complex case mix, our adverse event and readmission rates are similar to the published literature describing a non-telemedicine model to deliver OPAT. High rates of favourable clinical outcomes and likely cost benefits suggest that telemedicine-supported OPAT is an efficacious and safe substitute for inpatient care in our setting.
Collapse
Affiliation(s)
- Shu J Tan
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Paul R Ingram
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Microbiology (PathWest Laboratory Medicine), Fiona Stanley Hospital Network, Murdoch, Western Australia, Australia
| | - Alison J Rothnie
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Timothy J Whitmore
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - James O Robinson
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Microbiology (PathWest Laboratory Medicine), Fiona Stanley Hospital Network, Murdoch, Western Australia, Australia.,Australian Collaborating Centre for Enterococcus and Staphylococcus species Typing and Research, School of Veterinary and Life Sciences, Murdoch University and School of Biomedical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Jillian B Hatch
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Claire M Italiano
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Christopher H Heath
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Microbiology (PathWest Laboratory Medicine), Fiona Stanley Hospital Network, Murdoch, Western Australia, Australia.,School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
18
|
Murthy R, Rose G, Liddy C, Afkham A, Keely E. eConsultations to Infectious Disease Specialists: Questions Asked and Impact on Primary Care Providers' Behavior. Open Forum Infect Dis 2017; 4:ofx030. [PMID: 28470015 PMCID: PMC5407213 DOI: 10.1093/ofid/ofx030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since 2010, the Champlain BASE (Building Access to Specialist Advice through eConsultation) has allowed primary care providers (PCPs) to submit clinical questions to specialists through a secure web service. The study objectives are to describe questions asked to Infectious Diseases specialists through eConsultation and assess impact on physician behaviors. METHODS eConsults completed through the Champlain BASE service from April 15, 2013 to January 29, 2015 were characterized by the type of question asked and infectious disease content. Usage data and PCP responses to a closeout survey were analyzed to determine eConsult response time, change in referral plans, and change in planned course of action. RESULTS Of the 224 infectious diseases eConsults, the most common question types were as follows: interpretation of a clinical test 18.0% (41), general management 16.5 % (37), and indications/goals of treating a particular condition 16.5% (37). The most frequently consulted infectious diseases were as follows: tuberculosis 14.3% (32), Lyme disease 14.3% (32), and parasitology 12.9% (29). Within 24 hours, 63% of cases responded to the questions, and 82% of cases took under 15 minutes to complete. In 32% of cases, a face-to-face referral was originally planned by the PCP but was no longer needed. In 8% of cases, the PCP referred the patient despite originally not planning to make a referral. In 55% of cases, the PCP either received new information or changed their course of action. CONCLUSIONS An eConsult service provides PCPs with timely access to infectious disease specialists' advice that often results in a change in plans for a face-to-face referral.
Collapse
Affiliation(s)
| | | | - Clare Liddy
- Bruyere Research Institute, Department of Family Medicine, University of Ottawa, Canada; and
| | - Amir Afkham
- BEng, Champlain Local Health Integration Network, Ottawa, Canada
| | | |
Collapse
|
19
|
Horn BP, Barragan GN, Fore C, Bonham CA. A cost comparison of travel models and behavioural telemedicine for rural, Native American populations in New Mexico. J Telemed Telecare 2015; 22:47-55. [PMID: 26026190 DOI: 10.1177/1357633x15587171] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/13/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The purpose of this study was to model the cost of delivering behavioural health services to rural Native American populations using telecommunications and compare these costs with the travel costs associated with providing equivalent care. METHODS Behavioural telehealth costs were modelled using equipment, transmission, administrative and IT costs from an established telecommunications centre. Two types of travel models were estimated: a patient travel model and a physician travel model. These costs were modelled using the New Mexico resource geographic information system program (RGIS) and ArcGIS software and unit costs (e.g. fuel prices, vehicle depreciation, lodging, physician wages, and patient wages) that were obtained from the literature and US government agencies. RESULTS The average per-patient cost of providing behavioural healthcare via telehealth was US$138.34, and the average per-patient travel cost was US$169.76 for physicians and US$333.52 for patients. Sensitivity analysis found these results to be rather robust to changes in imputed parameters and preliminary evidence of economies of scale was found. CONCLUSION Besides the obvious benefits of increased access to healthcare and reduced health disparities, providing behavioural telehealth for rural Native American populations was estimated to be less costly than modelled equivalent care provided by travelling. Additionally, as administrative and coordination costs are a major component of telehealth costs, as programmes grow to serve more patients, the relative costs of these initial infrastructure as well as overall per-patient costs should decrease.
Collapse
Affiliation(s)
- Brady P Horn
- Department of Economics, University of New Mexico, USA Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, USA
| | | | - Chis Fore
- Albuquerque Area Indian Health Service, USA
| | - Caroline A Bonham
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, USA
| |
Collapse
|
20
|
Moore Z, Angel D, Bjerregaard J, O'Connor T, McGuiness W, Kröger K, Rasmussen BSB, Yderstrœde KB. eHealth in Wound Care: from conception to implementation. J Wound Care 2015; 24:S1-S44. [DOI: 10.12968/jowc.2015.24.sup5.s1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Zena Moore
- Professor, Head of School, Previous President of the European Wound Management Association, School of Nursing & Midwifery, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Donna Angel
- Nurse Practitioner, Secretary of the Australian Wound Management Association, Royal Perth Hospital, 197 Wellington Street, Perth WA 6000, Australia
| | - Julie Bjerregaard
- The European Wound Management Association, Nordre Fasanvej 113, Frederiksberg, Denmark
| | - Tom O'Connor
- Deputy Head of School/Director of Academic Affairs, Senior Lecturer, School of Nursing & Midwifery, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - William McGuiness
- Associate Professor, Previous President of the Australian Wound Management Association, Monash Health, 246 Clayton Rd, ClaytonVIC 3168, Australia
| | - Knut Kröger
- Director, Vice President of the Initiative Chronic Wounds e.V., Germany, Department of Angiology, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | | | - Knud Bonnet Yderstrœde
- Associate professor, Consultant Medical Endocrinology and Internal Medicine, Odense University Hospital, Region of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C
| |
Collapse
|
21
|
Parmar P, Mackie D, Varghese S, Cooper C. Use of telemedicine technologies in the management of infectious diseases: a review. Clin Infect Dis 2014; 60:1084-94. [PMID: 25516192 DOI: 10.1093/cid/ciu1143] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Telemedicine technologies are rapidly being integrated into infectious diseases programs with the aim of increasing access to infectious diseases specialty care for isolated populations and reducing costs. We summarize the utility and effectiveness of telemedicine in the evaluation and treatment of infectious diseases patients. The use of telemedicine in the management of acute infectious diseases, chronic hepatitis C, human immunodeficiency virus, and active pulmonary tuberculosis is considered. We recapitulate and evaluate the advantages of telemedicine described in other studies, present challenges to adopting telemedicine, and identify future opportunities for the use of telemedicine within the realm of clinical infectious diseases.
Collapse
Affiliation(s)
| | - David Mackie
- Ottawa Hospital and Regional Viral Hepatitis Telemedicine Program
| | - Sunil Varghese
- Ottawa Hospital and Regional Viral Hepatitis Telemedicine Program
| | - Curtis Cooper
- Faculty of Medicine, University of Ottawa Ottawa Hospital and Regional Viral Hepatitis Telemedicine Program Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ontario, Canada
| |
Collapse
|
22
|
Santos RPD, Deutschendor C, Carvalho OF, Timm R, Sparenberg A. Antimicrobial Stewardship Through Telemedicine in a Community Hospital in Southern Brazil. J Telemed Telecare 2013; 19:1-4. [DOI: 10.1177/1357633x12473901] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We developed an antimicrobial stewardship programme, based on telemedicine, for a remote community hospital in southern Brazil. Expertise in infectious diseases was provided from a 250-bed tertiary hospital for cardiology patients located 575 km away. At the community hospital, antimicrobial prescriptions were completed via a secure web site. A written reply was sent back to the prescriber by email and SMS text message. During a 4-month study period there were 81 prescriptions for 76 patients. Most antimicrobial prescriptions (67%) were for respiratory infections. Ampicillin was prescribed in 44% of cases ( n = 56), gentamicin in 18% of cases ( n = 23) and azithromycin in 18% of cases ( n = 23). Two infectious diseases specialists independently reviewed each antimicrobial prescription. A total of 41 prescriptions (55%) were considered inappropriate. The median time to obtain a second opinion via the web site was 22 min (interquartile range 12–55). Overall compliance with the recommendations of the infectious diseases specialist was 100% (81 out of 81 requests). Telemedicine appears to have a useful potential role in antimicrobial stewardship programmes.
Collapse
Affiliation(s)
- Rodrigo Pires Dos Santos
- Infection Control Committee, Instituto de Cardiologia do Rio Grande do Sul. Porto Alegre, Brazil
- Infection Control Committee, Hospital de Clínicas de Porto Alegre. Porto Alegre, Brazil
| | - Caroline Deutschendor
- Infection Control Committee, Hospital de Clínicas de Porto Alegre. Porto Alegre, Brazil
| | - Otavio Fontoura Carvalho
- Infection Control Committee, Instituto de Cardiologia do Rio Grande do Sul. Porto Alegre, Brazil
| | - Robert Timm
- E-health Centre, Instituto de Cardiologia do Rio Grande do Sul. Porto Alegre, Brazil
| | - Adolfo Sparenberg
- E-health Centre, Instituto de Cardiologia do Rio Grande do Sul. Porto Alegre, Brazil
| |
Collapse
|