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Mahalwar G, Kumar A, Kalra A. Virtual Cardiology: Past, Present, Future Directions, and Considerations. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:117-122. [PMID: 37305213 PMCID: PMC10225773 DOI: 10.1007/s12170-023-00719-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/13/2023]
Abstract
Purpose of Review Through this review, we attempt to explore the role of telemedicine and virtual visits in the field of cardiology pre-COVID-19 and during COVID-19 pandemic, their limitations and their future scope for delivery of care. Recent Findings Telemedicine, which rose to prominence during COVID-19 pandemic, helped not only in reducing the burden on the healthcare system during a time of crisis but also in improving patient outcomes. Patients and physicians also favored virtual visits when feasible. Virtual visits were found to have the potential to be continued beyond the pandemic and play a significant role in patient care alongside conventional face-to-face visits. Summary Although tele-cardiology has proven beneficial in terms of patient care, convenience, and access, it comes with its fair share of limitations-both logistical and medical. Whilst there remains a great scope for improvement in the quality of patient care provided through telemedicine, it has shown the potential to become an integral part of medical practice in the future. Supplementary Information The online version contains supplementary material available at 10.1007/s12170-023-00719-0.
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Affiliation(s)
- Gauranga Mahalwar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH USA
| | - Ankur Kalra
- Franciscan Physician Network Cardiology, Franciscan Health, 3900 St. Francis Way, Suite 200 Lafayette, IN 47905 Lafayette, USA
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Nirel R, Levy I, Adar SD, Vakulenko-Lagun B, Peretz A, Golovner M, Dayan U. Concentration-response relationships between hourly particulate matter and ischemic events: A case-crossover analysis of effect modification by season and air-mass origin. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 760:143407. [PMID: 33199016 DOI: 10.1016/j.scitotenv.2020.143407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 05/13/2023]
Abstract
Most studies linking cardiovascular disease with particulate matter (PM) exposures have focused on total mass concentrations, regardless of their origin. However, the origin of an air mass is inherently linked to particle composition and possible toxicity. We examine how the concentration-response relation between hourly PM exposure and ischemic events is modified by air-mass origin and season. Using telemedicine data, we conducted a case-crossover study of 1855 confirmed ischemic cardiac events in Israel (2005-2013). Based on measurements at three fixed-sites in Tel Aviv and Haifa, ambient PM with diameter < 2.5 μm (PM2.5) and 2.5-10 μm (PM10-2.5) concentrations during the hours before event onset were compared with matched control periods using conditional logistic regression that allowed for non-linearity. We also examined effect modification of these associations based on the geographical origin of each air mass by season. Independent of the geographical origin of the air mass, we observed concentration-response curves that were supralinear. For example, the overall odds ratios (ORs) of ischemic events for an increase of 10-μg/m3 in the 2-h average of PM10-2.5 were 1.08 (95% confidence interval (CI): 1.03-1.14) and 1.00 (0.99-1.01) at the median (17.8 μg/m3) and 95th percentile (82.3 μg/m3) values, respectively. Associations were strongest at low levels of PM10-2.5 when air comes from central Europe in the summer (OR: 1.27; 95% CI: 1.06, 1.52). Our study demonstrates that hourly associations between PM2.5 and PM10-2.5 and ischemic cardiac events are supralinear during diverse pollution conditions in a single population that experiences a wide range of exposure levels.
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Affiliation(s)
- Ronit Nirel
- Department of Statistics and Data Science, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Ilan Levy
- Air quality and Climate Change Division, Israel Ministry for Environment Protection, Jerusalem, Israel.
| | - Sara D Adar
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States.
| | - Bella Vakulenko-Lagun
- Department of Statistics and Data Science, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Alon Peretz
- Occupational Medicine Clinic, Rabin Medical Center, Petah Tiqua, Israel.
| | | | - Uri Dayan
- Department of Geography, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Nirel R, Adar SD, Dayan U, Vakulenko-Lagun B, Golovner M, Levy I, Alon Z, Peretz A. Fine and Coarse Particulate Matter Exposures and Associations with Acute Cardiac Events among Participants in a Telemedicine Service: A Case-Crossover Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:97003. [PMID: 30203992 PMCID: PMC6375393 DOI: 10.1289/ehp2596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Subclinical cardiovascular changes have been associated with ambient particulate matter (PM) exposures within hours. Although the U.S. Environmental Protection Agency continues to look for additional evidence of effects associated with sub-daily PM exposure, this information is still limited because most studies of clinical events have lacked data on the onset time of symptoms to assess rapid increased risk. OBJECTIVE Our objective was to investigate associations between sub-daily exposures to PM and acute cardiac events using telemedicine data. METHODS We conducted a case-crossover study among telemedicine participants [Formula: see text] of age who called a service center for cardiac-related symptoms and were transferred to a hospital in Tel Aviv and Haifa, Israel (2002-2013). Ambient [Formula: see text] and [Formula: see text] measured by monitors located in each city during the hours before the patient called with symptoms were compared with matched control periods. We investigated the sensitivity of these associations to more accurate symptom onset time and greater certainty of diagnosis. RESULTS We captured 12,661 calls from 7,617 subscribers experiencing ischemic (19%), arrhythmic (31%), or nonspecific (49%) cardiac events. PM concentrations were associated with small increases in the odds of cardiac events. For example, odds ratios for any cardiac event in association with a [Formula: see text] increase in 6-h and 24-h average [Formula: see text] were 1.008 [95% confidence interval (CI): 0.998, 1.018] and 1.006 (95% CI: 0.995, 1.018), respectively, and for [Formula: see text] were 1.003 (95% CI: 1.001, 1.006) and 1.003 (95% CI: 1.000, 1.007), respectively. Associations were stronger when using exposures matched to the call time rather than calendar date and for events with higher certainty of the diagnosis. CONCLUSIONS Our analysis of telemedicine data suggests that risks of cardiac events in telemedicine participants [Formula: see text] of age may increase within hours of PM exposures. https://doi.org/10.1289/EHP2596.
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Affiliation(s)
- Ronit Nirel
- 1 Department of Statistics, Hebrew University of Jerusalem , Jerusalem, Israel
| | - Sara D Adar
- 2 Department of Epidemiology, University of Michigan , Ann Arbor, Michigan, USA
| | - Uri Dayan
- 3 Department of Geography, Hebrew University of Jerusalem , Jerusalem, Israel
| | | | | | - Ilan Levy
- 5 Center of Excellence in Exposure Science and Environmental Health, Technion , Haifa, Israel
| | - Zvi Alon
- 1 Department of Statistics, Hebrew University of Jerusalem , Jerusalem, Israel
| | - Alon Peretz
- 6 Occupational Medicine Clinic, Rabin Medical Center , Petah Tiqua, Israel
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Molinari G, Molinari M, Di Biase M, Brunetti ND. Telecardiology and its settings of application: An update. J Telemed Telecare 2017; 24:373-381. [PMID: 28084886 DOI: 10.1177/1357633x16689432] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Among the wide range of medical specialties in which telemedicine has been successfully applied, cardiology can be considered as one of the most important fields of application. Through the transmission of clinical data and the electrocardiogram, telecardiology allows access to a real-time assessment (teleconsultation) without any need to travel for both patient and cardiologist. This review discusses the impact of telecardiology in different clinical settings of application. Pre-hospital telecardiology has proved to be useful either in the clinical management of remote patients with acute coronary syndrome or in supporting the decision-making process of general practitioners. In the setting of in-hospital telecardiology, most of the applications refer to real-time echocardiography transmissions between rural small hospitals and tertiary care centres, particularly for the diagnosis or exclusion of congenital heart disease in newborns. Finally, many trials show that post-hospital telecardiology improves outcomes and reduces re-admissions or outpatient contacts in patients with heart failure, arrhythmias or implantable devices.
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Affiliation(s)
| | | | - Matteo Di Biase
- 2 Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Natale D Brunetti
- 2 Department of Medical and Surgical Sciences, University of Foggia, Italy
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Abstract
Cardiovascular disease is one of the main fields of application for telemedicine, with benefits in almost all areas in the continuum of cardiovascular disease. The greatest impact has been shown in the early diagnosis of cardiovascular disease, in second consultation, between non-cardiologist and cardiologist and between cardiologists, and in follow-up and secondary prevention of cardiovascular disease. At present, the main area of implementation for telemedicine in cardiovascular disease is represented by pre-hospital triage, with telemedicine electrocardiogram in acute myocardial infarction. Significant results have also been achieved in the second opinion consultation of pediatric subjects with congenital cardiovascular disease, home-monitoring and the management of patients affected by chronic heart failure or with an implanted device. However, there is significant room for further improvement in delivering telemedicine assistance even in 'very-remote' populations, such as detainees, patients in developing countries or in underdeveloped areas of developed countries.
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Affiliation(s)
| | - Simonetta Scalvini
- b U.O. Cardiologia Riabilitativa , IRCCS Fondazione Salvatore Maugeri , Brescia , Italy
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Ginsberg JP, Pietrabissa G, Manzoni GM, Castelnuovo G. Treating the mind to improve the heart: the summon to cardiac psychology. Front Psychol 2015; 6:1101. [PMID: 26300804 PMCID: PMC4523709 DOI: 10.3389/fpsyg.2015.01101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/17/2015] [Indexed: 12/04/2022] Open
Affiliation(s)
- J P Ginsberg
- Research and Development, Cardiopsychology Research Laboratory, Dorn VA Medical Center Columbia, SC, USA
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS Ospedale San Giuseppe, Verbania, Italy ; Department of Psychology, Catholic University of Milan Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS Ospedale San Giuseppe, Verbania, Italy ; Department of Psychology, Catholic University of Milan Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS Ospedale San Giuseppe, Verbania, Italy ; Department of Psychology, Catholic University of Milan Italy
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Leshem-Rubinow E, Assa EB, Shacham Y, Zatelman A, Oren-Shamir A, Malov N, Golovner M, Roth A. Expediting Time from Symptoms to Medical Contact Utilizing a Telemedicine Call Center. Telemed J E Health 2015; 21:801-7. [PMID: 26431259 DOI: 10.1089/tmj.2014.0227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND No definitive solution has been forthcoming for the often dangerously long interval between symptom onset and seeking medical care in the prehospital setting. We examined the implementation of telemedicine technology and characterization of its utilizers for its efficacy in reducing this possibly life-threatening time lag. MATERIALS AND METHODS A retrospective observational study was performed on the working database of an operational telemedicine facility that included all subscribers. Time-to-contact measurements throughout 2012 were retrieved from its medical files, and data on age, gender, medical history, and main complaint were analyzed. RESULTS Throughout 2012, 22,274 of a total of 46,556 calls (47.8%) were made ≤60 min from symptom onset. It is important that 26.9% of all calls (12,522/46,556) were made in <15 min. Significantly more males (10,794/22,229 [49%]) contacted in ≤60 min compared with females (11,480/24,327 [47%], p<0.03). Subjects <60 years of age (2,889/5,717 [51%]) called earlier than those >60 years (19,386/40,839 [47%], p<0.001). Patients with prior resuscitation and/or myocardial infarction contacted significantly more rapidly than those with other cardiac diseases. Over one-half of patients with cardiac complaints contacted the call center ≤60 min from symptom onset, as did those who suffered physical trauma, but not patients with gastrointestinal symptoms or pain elsewhere. CONCLUSIONS A telemedicine system with rapid accessibility to a professional call center and prompt triage thereafter could be an additional promising strategy for shortening the interval between symptom onset and call for medical assistance. Implementation of a widespread telemedicine infrastructure may bridge the unmet gap between occurrence of symptoms to initiation of medical treatment.
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Affiliation(s)
- Eran Leshem-Rubinow
- 1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Eyal Ben Assa
- 1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Yacov Shacham
- 1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | | | | | - Nomi Malov
- 2 'SHL'-Telemedicine, Israel, Tel Aviv, Israel
| | | | - Arie Roth
- 1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
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Telemedicine for cardiovascular disease continuum: A position paper from the Italian Society of Cardiology Working Group on Telecardiology and Informatics. Int J Cardiol 2015; 184:452-458. [PMID: 25755064 DOI: 10.1016/j.ijcard.2015.02.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/02/2015] [Accepted: 02/21/2015] [Indexed: 11/20/2022]
Abstract
Telemedicine is the provision of health care services, through the use of information and communication technology, in situations where the health care professional and the patient, or 2 health care professionals, are not in the same location. It involves the secure transmission of medical data and information, through text, sound, images, or other forms needed for the prevention, diagnosis, treatment, and follow-up of a patient. First data on implementation of telemedicine for the diagnosis and treatment of acute myocardial infarction date from more than 10 years ago. Telemedicine has a potential broad application to the cardiovascular disease continuum and in many branches of cardiology, at least including heart failure, ischemic heart disease and arrhythmias. Telemedicine might have an important role as part of a strategy for the delivery of effective health care for patients with cardiovascular disease. In this document the Working Group on Telecardiology and Informatics of the Italian Society of Cardiology intends to remark some key-points regarding potential benefit achievable with the implementation of telemedicine support in the continuum of cardiovascular disease.
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Frederix I, Vanhees L, Dendale P, Goetschalckx K. A review of telerehabilitation for cardiac patients. J Telemed Telecare 2014; 21:45-53. [PMID: 25475219 DOI: 10.1177/1357633x14562732] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We conducted a literature review of telerehabilitation interventions on cardiac patients. We searched for studies evaluating some form of telerehabilitation in cardiac patients. A total of 116 publications were screened initially, of which 37 publications were eligible for further review. We assessed study strength, based on the level of evidence and the quality of the intervention. The majority of the articles (70%) represented the highest level of evidence. Most interventions were of good (46%) or fair (51%) quality. Most studies evaluated the efficacy of the telerehabilitation interventions (84%), while 38% reported on feasibility and acceptance. Most studies did not include safety and/or cost-benefit analyses. Most telerehabilitation interventions (90%) employed only one or two core components of cardiac rehabilitation (CR). Of the CR core components, physical activity was most frequently evaluated. Telerehabilitation appears to be a feasible and effective additional and/or alternative form of rehabilitation, compared to conventional in-hospital CR. Evaluations of telerehabilitation programmes taking into account patient safety and health economics are now required.
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Affiliation(s)
- Ines Frederix
- Department of Medicine, Katholieke Universiteit Leuven, Belgium Department of Medicine, Hasselt University, Belgium
| | - Luc Vanhees
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium
| | - Paul Dendale
- Department of Cardiology, Jessa Hospital, Belgium
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Clark RA, Conway A, Poulsen V, Keech W, Tirimacco R, Tideman P. Alternative models of cardiac rehabilitation: a systematic review. Eur J Prev Cardiol 2013; 22:35-74. [PMID: 23943649 DOI: 10.1177/2047487313501093] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The traditional hospital-based model of cardiac rehabilitation faces substantial challenges, such as cost and accessibility. These challenges have led to the development of alternative models of cardiac rehabilitation in recent years. The aim of this study was to identify and critique evidence for the effectiveness of these alternative models. A total of 22 databases were searched to identify quantitative studies or systematic reviews of quantitative studies regarding the effectiveness of alternative models of cardiac rehabilitation. Included studies were appraised using a Critical Appraisal Skills Programme tool and the National Health and Medical Research Council's designations for Level of Evidence. The 83 included articles described interventions in the following broad categories of alternative models of care: multifactorial individualized telehealth, internet based, telehealth focused on exercise, telehealth focused on recovery, community- or home-based, and complementary therapies. Multifactorial individualized telehealth and community- or home-based cardiac rehabilitation are effective alternative models of cardiac rehabilitation, as they have produced similar reductions in cardiovascular disease risk factors compared with hospital-based programmes. While further research is required to address the paucity of data available regarding the effectiveness of alternative models of cardiac rehabilitation in rural, remote, and culturally and linguistically diverse populations, our review indicates there is no need to rely on hospital-based strategies alone to deliver effective cardiac rehabilitation. Local healthcare systems should strive to integrate alternative models of cardiac rehabilitation, such as brief telehealth interventions tailored to individual's risk factor profiles as well as community- or home-based programmes, in order to ensure there are choices available for patients that best fit their needs, risk factor profile, and preferences.
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Affiliation(s)
- Robyn A Clark
- School of Nursing and Midwifery, Flinders University, Adelaide, Australia
| | - Aaron Conway
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University Technology, Australia
| | | | - Wendy Keech
- National Heart Foundation of Australia, Australia
| | - Rosy Tirimacco
- Integrated Cardiovascular Clinical Network, South Australia
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Fayaz-Bakhsh A, Manesh ZV. Regarding: “Telemedicine for the Reduction of Myocardial Infarction Mortality: A Systematic Review and a Meta-analysis of Published Studies”. Telemed J E Health 2013; 19:646. [DOI: 10.1089/tmj.2012.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ahmad Fayaz-Bakhsh
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Zahra Vahdati Manesh
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
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van den Berg N, Schumann M, Kraft K, Hoffmann W. Telemedicine and telecare for older patients--a systematic review. Maturitas 2012; 73:94-114. [PMID: 22809497 DOI: 10.1016/j.maturitas.2012.06.010] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 06/19/2012] [Accepted: 06/21/2012] [Indexed: 12/21/2022]
Abstract
Telemedicine is increasingly becoming a reality in medical care for the elderly. We performed a systematic literature review on telemedicine healthcare concepts for older patients. We included controlled studies in an ambulant setting that analyzed telemedicine interventions involving patients aged ≥60 years. 1585 articles matched the specified search criteria, thereof, 68 could be included in the review. Applications address an array of mostly frequent diseases, e.g. cardiovascular disease (N=37) or diabetes (N=18). The majority of patients is still living at home and is able to handle the telemedicine devices by themselves. In 59 of 68 articles (87%), the intervention can be categorized as monitoring. The largest proportion of telemedicine interventions consisted of measurements of vital signs combined with personal interaction between healthcare provider and patient (N=24), and concepts with only personal interaction (telephone or videoconferencing, N=14). The studies show predominantly positive results with a clear trend towards better results for "behavioral" endpoints, e.g. adherence to medication or diet, and self-efficacy compared to results for medical outcomes (e.g. blood pressure, or mortality), quality of life, and economic outcomes (e.g. costs or hospitalization). However, in 26 of 68 included studies, patients with characteristic limitations for older patients (e.g. cognitive and visual impairment, communication barriers, hearing problems) were excluded. A considerable number of projects use rather sophisticated technology (e.g. videoconferencing), limiting ready translation into routine care. Future research should focus on how to adapt systems to the individual needs and resources of elderly patients within the specific frameworks of the respective national healthcare systems.
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Affiliation(s)
- Neeltje van den Berg
- University Medicine Greifswald, Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, Greifswald, Germany.
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de Waure C, Cadeddu C, Gualano MR, Ricciardi W. Telemedicine for the Reduction of Myocardial Infarction Mortality: A Systematic Review and a Meta-analysis of Published Studies. Telemed J E Health 2012; 18:323-8. [DOI: 10.1089/tmj.2011.0158] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chiara de Waure
- Institute of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - Chiara Cadeddu
- Institute of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Walter Ricciardi
- Institute of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
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14
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Shacham J, Birati EY, Malov N, Yanay Y, Steinberg DM, Tamari M, Golovner M, Roth A. Telemedicine for diagnosing and managing paroxysmal atrial fibrillation in outpatients. The phone in the pocket. Int J Cardiol 2012; 157:91-5. [DOI: 10.1016/j.ijcard.2010.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 09/30/2010] [Accepted: 12/04/2010] [Indexed: 11/15/2022]
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Haase KR, Loiselle CG. Oncology team members' perceptions of a virtual navigation tool for cancer patients. Int J Med Inform 2012; 81:395-403. [PMID: 22244817 DOI: 10.1016/j.ijmedinf.2011.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 10/12/2011] [Accepted: 11/23/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The Internet has become an important source of health information for patients and health care providers (HCPs) alike. Whereas studies have begun to document the effects of the internet on health behaviors and outcomes, surprisingly few studies have explored HCPs' perceptions of the internet as a key resource accessed by patients. However, as HCPs are seen as pivotal in guiding patients toward these resources, it is timely to study their perceptions. Therefore, the present inquiry explores HCPs' views of a recently developed high quality virtual navigation tool called the Oncology Interactive Navigator™ (OIN). DESIGN Using a qualitative approach, in-depth interviews were conducted with 16 members of a multidisciplinary colorectal oncology team and volunteers at a large Cancer Centre in Montreal, Quebec, Canada. RESULTS Content analysis revealed emerging themes centering on key benefits including: perceptions of a highly accessible, comprehensive high quality repository of cancer information; a means to further enhance HCP-patient communication and trust; and a significant catalyst to patient-family communication and support. Perceived drawbacks included patient (e.g., socio-demographic profile) and system's (e.g., professional roles and time constraints) characteristics that may limit OIN™ full implementation and uptake. CONCLUSIONS The findings underscore the relevance of virtual navigation tools to ensure optimal person-centred care in cancer. Findings also suggest how virtual tools such as the OIN™ can best be used in practice as well as they guide strategies to adopt to optimize implementation of similar innovations in health care.
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Affiliation(s)
- Kristen R Haase
- School of Nursing, Faculty of Medicine, McGill University, Canada
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Shah BR, Adams M, Peterson ED, Powers B, Oddone EZ, Royal K, McCant F, Grambow SC, Lindquist J, Bosworth HB. Secondary prevention risk interventions via telemedicine and tailored patient education (SPRITE): a randomized trial to improve postmyocardial infarction management. Circ Cardiovasc Qual Outcomes 2011; 4:235-42. [PMID: 21406672 DOI: 10.1161/circoutcomes.110.951160] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Secondary prevention by risk factor modification improves patient outcomes, yet it is often not achieved in clinical practice. Reasons for failure stem from challenges of prioritizing risk factor reduction and engaging patients in changing their behaviors. We hypothesize that a novel telemedicine intervention with tailored patient education could improve cardiovascular risk factors. METHODS To evaluate this intervention, we propose enrolling 450 patients with a recent myocardial infarction and hypertension into a 3-arm randomized, controlled trial. The first arm (n=150) will receive home blood pressure (BP) monitors plus a nurse-delivered, telephone-based tailored patient education intervention and will be enrolled into HealthVault, a Microsoft electronic health record platform. The second arm (n=150) will also receive BP monitors plus a tailored patient education intervention and be enrolled in HeartVault. However, the patient education intervention will be delivered by a Web-based program and will cover topics identical to those in the nurse-delivered intervention. Both arms will be compared with a control group receiving standard care (n=150). All participants will have an in-person assessment at baseline and at completion of the study, including standardized measurements of BP, LDL cholesterol, and glycosylated hemoglobin (in diabetic subjects). The study design will allow assessment of a telephone-based, nurse-administered disease management program versus standard care. The main outcome of interest is the reduction in systolic BP in each intervention group compared with the control group at 12 months. Secondary outcomes assessed will include reductions in LDL cholesterol, body weight, and glycosylated hemoglobin, as well as adherence to evidence-based therapies and improvement in health behaviors. CONCLUSION If successful in optimizing BP control, managing other coronary heart disease risk factors, and demonstrating a lower cost, the Web-based disease management tool has the potential to enhance coronary artery disease management, quality of care, and ultimately, patient outcomes. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00901277.
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Affiliation(s)
- Bimal R Shah
- Duke Clinical Research Institute, Duke University, Durham, NC 27705, USA.
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Zaninelli A, Kaufholz C, Schwappach D. Physicians' attitudes toward post-MI aspirin prophylaxis: findings from an online questionnaire in Europe and Latin America. Postgrad Med 2010; 121:44-53. [PMID: 19940416 DOI: 10.3810/pgm.2009.11.2070] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Few surveys have assessed physicians' attitudes toward preventive treatment in post-myocardial infarction (MI) patients, although these patients have a high risk of recurrence. A newly developed online survey, which aimed to determine physicians' attitudes toward aspirin prophylaxis post-MI, was sent to physicians in 18 countries. This report describes findings from 7 European (n = 2842 respondents) and 2 Latin American (n = 149 respondents) countries. Although low-dose aspirin therapy was recommended by most physicians (> 90%), compliance was suboptimal; 29% of patients in Europe and 35% in Latin America were partially or totally noncompliant, and 18% of physicians in Europe and 20% in Latin America had lost contact with their patients. Low-dose aspirin monotherapy or combination therapy, dosage, and physician contact all had a significant effect on compliance (P < 0.00001). Shared decision making by the physician and patient was rated as the most effective measure to improve compliance, which clearly indicates the need for a change in management.
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